To carry into effect regular and sustained daily exercise requires great moral courage and energy, the langour and feeling of weakness are so great; but if the exercise be only carried out patiently and perseveringly the task will become not only more and more easy, but soon no longer a task but positively a pleasure.

I repeat, it must never be carried so far as to produce over-fatigue; we must ever remember there is a state of things in Diabetes that makes it difficult for the patient to recover from extra-fatigue, or from anything whatever that lowers his vital powers; we must be careful never to take too much out of a patient. And here I must caution a diabetic patient against taking long railway journeys. Whilst practising at Tunbridge Wells I saw two sudden deaths in diabetic patients after long journeys. One patient about two hours after his arrival from a journey of 200 miles was seized with vomiting. I saw him immediately, he was then in a half comatose state, pulse almost gone. Nothing stopped the vomiting, the patient became more and more comatose and died the same evening. The other patient, after a journey of 100 miles was also seized with vomiting, he became comatose and died within 24 hours of his arrival at Tunbridge Wells. Dr. Bence Jones cautions against long journeys and I am sure most wisely.

The recent observations of Fick and Wisli-cenius, on the result of a certain amount of work performed by themselves, point to the conelusion that muscular effort on a non-nitrogenous diet does not increase the quantity of urea excreted from the body; moreover they conclude that the oxidation of the quantity of albuminoid substance or plastic nitrogenous material which would correspond with the urea and other nitrogenous compounds then excreted, does not yield sufficient potential energy to perform the work accomplished. They ascended the Faulhorn, a mountain of the Bernese Ober-land; they found that the ratio of work performed to the power derivable from the consumption of albuminoid substances in the body was as 3 to 1: they conclude therefore, since it is impossible for the oxidised albumen to be the sole and exclusive source of the power manifested in the work of the body, towards which it can contribute so little, that the oxidation of non-nitrogenous substances must yield at least the larger proportion of the force required, not only for the production of heat, but also of mechanical motion: finally they show that the resemblance of the living animal to a steam engine is more close than is usually admitted; the muscle is an apparatus for burning its appropriate fuel, the hydrocarbons and carbo-hydrates in the same manner as an engine burns its proper fuel, coal or coke: in action the muscle does not specially oxidise itself any more than the engine is burnt, but whilst in action both muscle and engine undergo wear.

The general conclusions of Fick and Wisli-cenius are strengthened by the subsequent researches of Dr. Frankland, who proves that in man non-nitrogenous substances must be the chief source of the energy which is transformed into muscular work, and that the muscle is an apparatus in which this energy is evolved at the expense of the hydro-carbonaceous fuel, or a machine for converting potential energy into mechanical force, and that it does not undergo much more waste when in action than when in comparative rest; though he admits that nitrogenous matter may be also employed for this purpose, as is illustrated by the work performed by men and animals fed on flesh diet exclusively, but it must be remembered that ordinary flesh contains much fatty matter. Lie-big says carnivorous animals are always in motion, so necessary is it in order to decom-pose the muscles and the fat contained in them.* Here therefore we have explained physiologically, what we have learned practically - the advantages of exercise.

* Marshall's Physiology, vol. ii. p. 568 - 571.

Again, Dr. Parkes, in a paper read before the Royal Society of London, January 23rd, 1867, shewed that under every kind of food, whether azotised or non-azotised, muscular exertion was always accompanied by a diminution in the quantity of azotised substances eliminated by the kidneys. Also Winogradoff Bettrage* shewed this diminution, and that thus muscular activity depended on the hydrocarbons taken as food: he shewed likewise that in poisoning with curare, animals pass sugar in the urine, that in this form of poisoning two things are connected, paralysis of motion and the appearance of sugar in the urine; he therefore concludes that the muscles in motion destroy a notable quantity of sugar contained in the organism.

According to him also the lowering of the temperature is the result of this absence of combustion, here, agreeing with M. Bouchar-dat, and proving physiologically the advantage of exercise in Diabetes, not only by destroying sugar in the system, but also by allowing the patient to take bread without mischief, a boon which can only be sufficiently valued by one who has suffered from Diabetes. Exercise, as mentioned above, is to be short of fatigue, and for this reason, when a person is wearied less carbonic acid is exhaled: when taking exercise short of fatigue more carbonic acid is given off, and so more oxidisation of non-nitrogenous materials, such as sugar and fat, takes place. When walking, it is good, I am sure, to take occasionally deep inspirations so as to fill the lungs well, as Dr. E. Smith recommends. In early stages of Diabetes walking exercise is better than riding. Among the causes of Diabetes a sedentary life is particularly mentioned by writers.

* Lehre von Diabetes Mellitus. Virchow Archiv. Bd. 27.

P. 553

The third point in constitutional treatment to which I attach very great importance is the warm bath. Sir Henry Marsh in his Clinical Lectures edited by Dr. H. Hughes, speaks favourably of their use. With me they seemed the turning-point of the disease. My skin was harsh, dry and unperspiring. I took one every other day at a temperature of 960 F., putting a tablespoonful of common washing soda into the water. I remained in the bath 15 minutes, brushing my skin well all the time so as to remove the oily matter which exists on the skin, and thus to render absorption more easy; being then very weak, I took it at 11.30 a.m., about two hours after breakfast. After three baths, the skin began to perspire slightly, and I shall never forget the relief I had to the dryness of the mouth and thirst. There seems to be that harmony of action, at least in Diabetes, between the cutaneous surface and mucous membrane of the mouth, that when the one acts the other does so also: from that time I have never felt thirst, though before the skin began to act I used to drink three or four tumblers of water, or milk and lime-water during the night. The frequency with which the baths ought to be taken greatly depends upon the strength of the patient: no weakness should be permitted to arise from their use. At the beginning a bath should be taken daily, or at least every other day: when the skin acts, once, or at most twice, a week is sufficient: of course in the intervening days the skin should be well washed, plenty of soap being used. If the patient can bear it the bath should be taken in the morning in summer, but in the forenoon in winter; whilst in the bath the skin should be exposed as much as possible to the sun's rays, for I am sure that light is most useful in promoting the action of the skin; we know its effects on plants. If the patient suffer from acidity, heartburn, sour eructations, or if the saliva when first secreted be acid as shown by litmus paper, the soda bath may be taken every day or every other day according to its effects and the strength of the patient.