Difference of opinion exists as to the quantity of fluid a Diabetic patient may take - how far such an one should drink to abate the thirst that prevails. Some consider it well to limit the fluid that should be taken, in fact that the patient should suffer inconvenience from thirst. I dare not adopt this plan, but have generally allowed the patient to allay his thirst so as to suffer as little as possible from it; but in doing so I order ice or iced water, the latter to be drunk slowly, and to be kept, and moved about in the mouth for some time before being swallowed. All gulping down of fluids should be avoided; by this manner of acting it is extraordinary what relief is obtained. With regard to the stimulating drink that should be allowed, I permit brandy, dry sherries, such as amontillado, and claret. I generally order the wines to be diluted, even the claret.

Drinking the waters of Vichy has been much recommended in the cure of Diabetes. The following is my experience: I was at Vichy two successive years and have had two friends (Diabetics) there. The good results derived from the thermal baths are manifest at the time; the benefit however, was not permanent. It is difficult to say how much depends on the use of the baths and drinking the water, as there are so many other beneficial causes in operation, such as change of climate, of scenery, alteration in living etc., the walking exercise that is enforced; that all these have something to do with the improvement that takes place at Vichy is rendered more probable from the fact, that whatever may be the place to which a diabetic patient may go there is generally an improvement in health at first. In all the diabetic patients who came to Tunbridge Wells an improvement was observed before treatment had been adopted, except in the two cases before mentioned, who died after a long railway journey.

There are many springs at Vichy, but the characters of them are very much alike. Carbonate of soda is the chief constituent, then in smaller quantities carbonate of lime and magnesia, and in still smaller quantities, chloride and sulphate of soda, oxide of iron, iodine and bromine; there is a small quantity of nitrogen and a considerable quantity of carbonic acid gas so as to render the water sparkling; this is most marked in the Celestin spring. The temperature varies; the following is that of the chief springs as taken by M. Petit in May, 1846.

The Grande Grille 32°C or 89.6°F PuitsChomel 40°C „ 104°F

Grand Puits Carre 45°C „ 113°F

Hopital 32°C „ 89.6°F

Lucas 28°C „ 82.4°F

Celestin 15°C „ 59°F

The Celestin is the coldest and most pleasant to drink.

I was at Vichy in 1865 and 1866. The first time I went in May, here I joined a friend who was also suffering from Diabetes. I had now been ill for four years; my symptoms were little or no thirst, a perspiring skin, pulse weak, averaging about 90, stomach much deranged, with great acidity, sour eructations and burning pains: the saliva acid, even when first secreted. I was very weak especially in my legs, the quantity of urine in 24 hours 79 oz., specific gravity 1040, strongly acid; after fermentation, specific gravity 1024, showing a loss of 16 degrees, and indicating 1264 grains of sugar in the 24 hours; this was the average amount of sugar passed during the week before I went to Vichy. I was on the following diet: meat, green vegetables, cakes made from Dr. Camplin's flour (I had not relaxed my diet then), a table-spoonful of brandy in a tumbler of water with half a bottle of Vichy water at luncheon and dinner, tea and milk; the fluid taken in the twenty-four hours, about four quarts. I had an opportunity of examining my friend's urine before going to Vichy; its specific gravity was 1031, quantity in twenty-four hours 100 oz., after fermentation specific gravity was 1019, the loss being 12 degrees, showing 1200 grains of sugar in twenty-four hours: the symptoms were considerable thirst, dry skin, great weakness and little power to walk, appetite deficient. We both consulted Dr. Willemain at Vichy, who continued the same diet, with Bouchardat's gluten bread; we were to drink of the Grande Grille water 2 oz. at 7.30 a.m. then walk for half an hour; then 2 oz. at 8 and another walk for half an hour; then 2 oz. at 8.30 and walk for 40 minutes; then take a bath at a temperature of 95°F remaining in it for 20 minutes. At 3 p.m. we were again to take 2 oz. of water, walk for half an hour and then take 2 oz. of water. This was continued for 10 days. The effect of the treatment was remarkable. The quantity of sugar in my urine was greatly diminished (it was determined in both cases by M. Jaurand, an excellent and obliging chemist); it was only 315 grains in twenty-four hours, urine slightly alkaline, amount 60 oz.; the quantity of sugar passed by my friend was 400 grains in twentyfour hours, specific gravity 1019, urine slightly acid, amount 66 oz.; the appetite was much improved and the skin was moist.

For the next twenty-one days the same diet, baths, etc., were continued, except that we drank in the afternoon the water from "Celestin" at 3 and 3.30. At the end of this time the following were the conditions of the patients: I had become thinner, having lost 14 lbs. in weight, no thirst, perspiring freely, pulse 74 stronger, quantity of urine in twenty-four hours 66 oz. specific gravity 1015 slightly acid, sugar 63 grains only in twenty-four hours, spirits depressed, much more feeble, appetite not voracious, but thoroughly enjoyed food. My friend was also thinner, appetite not good, perspiring freely, very acid. Urine in twenty-four hours 69 oz., specific gravity 1012 slightly alkaline; sugar in twenty-four hours 80 grains. I had taken no medicine; my friend took sp. ammoniae aromaticae, tr. aurantiae aa 3ssj twice a day. My friend and I then left Vichy.