On reaching home I continued the same diet, eating the gluten bread as at Vichy, and drinking four glasses of claret during the day. I resumed practice, but refused all night work; at the end of a month I found general symptoms as follows: no thirst, perspiring freely, appetite very fair, quantity of urine in twenty-four hours 60 oz. being disturbed about three times during the night, specific gravity 1035 very acid, amount of sugar, 713 grains. During the summer, autumn and winter I kept very well, the urine, in all respects, remaining about the same.

I may say of my friend, whom I have frequently seen, and who has been taking by my direction, twice a week, a bath with soda, as described above, that the diabetic symptoms are quite in abeyance and though sugar is still in the urine (1870) it has never exceeded 300 grains in the 24 hours, the specific gravity ranges between 1025 and 1035, the quantity about 60 ounces in the 24 hours.

I went to Vichy for the second time in May, 1866, and stayed 21 days, pursuing the same treatment as before. The result was the same with regard to the diminution both in the quantity of urine passed and in the sugar it contained; urine was now 58 oz. in twenty-four hours, sugar 50 grains. I was much thinner and considerably depressed in spirits and had lost muscular power.

I have been minute in describing my case, because I am sure I was wrong in drinking so much water and taking a bath every day; as no symptoms of acidity were present after my visit to Vichy and as my muscular power was not very great, daily baths were not needed; one once or at the most twice a week would have been sufficient.

I have sent several patients to Vichy and have prescribed the thermal treatment carefully, attending particularly to this, and using the water and baths accordingly. When the urine is alkaline or nearly so, and the perspiration, which I may say always follows the bath, is not very acid, a bath every other day is enough and less water should be drunk; the great object is to avoid depressed spirits or weakness from the treatment.

I relate another case, shewing that in a very advanced stage of the disease, the water and baths may be used with advantage, if great care be taken. Last year, a lady, suffering from Diabetes went by my direction to Vichy; she had had sugar in her urine for about 20 years, but until the last year the general symptoms had not been very severe; she was 64 years of age: the average amount of urine passed in twenty-four hours was 60 oz. specific gravity 1029, sugar about 11 grains in the ounce; she perspired freely; she complained of a dry mouth; her appetite was moderate; she was suffering from cataract; she complained much of acidity, and was very subject to diarrhoea, she remained at Vichy three weeks; I ordered a bath three time a week, to drink 4 oz. in two doses from the Grande Grille in the morning with a walk for half an hour between the doses, and the same quantity taken in like manner, from Celestin in the afternoon. She took ordinary bread, on account of the tendency to diarrhoea, green vegetables and vin ordinaire. She returned improved. The urine reduced to about 46 oz. specific gravity 1035, quantity of sugar in twenty-four hours 200 grains, thirst and acidity gone.

I have seen three patients who not only did not benefit from going to Vichy but actually returned worse; they were all young, that is to say, under 32 years of age. There was a history of consumption in each case; in two commencing consolidation of the apex of left lung, thus countenancing the opinion of Dr. Durand Fardel a physician at Vichy, that the least predisposition to pulmonary phthisis is a contra-indica-tioii to the use of Vichy waters.

I say nothing about the waters of Carlsbad, as I have not been there, but as they combine purgative qualities with alkaline, their action is easily comprehended, they will of course be contra-indicated when there is a tendency to diarrhoea, or when there is great exhaustion: greater care will be required in their use than in those of Vichy.

Professor Seeger* says they overcome the most troublesome symptoms of Diabetes, such as the dryness of the mouth, the excessive thirst, and the frequency of micturition. In 100 cases he observed, there were only 10 or 12 in which these effects were not produced. In the others the sugar disappeared from the urine.

Dr. Crozant, who practises at Pougues a town situated on the great road between Paris and Lyons, about 9 miles from Nevers, speaks highly of the waters there. They contain carbonate of magnesia, lime, and iron, and are very gaseous, having about 325.9 cubic inches of carbonic acid gas in the imperial gallon. He considers that they regulate the function of the liver. He has treated many cases of Diabetes, and with remarkable success. It appears from him that the waters are most useful when there is evidence of congestion of the liver. I have not been to Pougues, nor have I seen a patient who has been there.

In Diabetes there is usually much acidity from derangement of the digestive organs; the urine also is very acid.

* Arch. Gen. de Medecin, 6th series, 1867, vol. ix, p. 295.

Alkalies, either in the form of natural waters as Vichy, or medicine, or baths, should be given, so as to neutralize the acidity, and by doing so it is remarkable how in all cases the quantity of water as well as sugar is diminished; but unless other treatment is adopted so as to give tone to the system, the benefit is only temporary. It is admitted by many, if not by all physicians at Vichy, that tonics should be taken with the waters, and with this I fully concur. Dr. Durand Fardel draws the following conclusion from 122 cases treated by him at Vichy. First. That cures are exceptional. Second. That relapses are frequent, but in general not severe, and in a good number of cases an arrest of the disease takes place, in which the patient maintains a state of health very comfortable and compatible with the exigencies of life, if not pursuing very fatiguing occupations; he adds undoubtedly the course of the disease has not always been satisfactory; and further that the thermic treatment with careful dieting and tonic medicines is the most efficacious.