The alkaline bath, prepared as directed under the heading of baths, is, as I have before said, the most effectual remedy, but when there are no symptoms of acidity it must be used with caution, though it will always be borne once, if not twice, a week: no debility must be produced either by baths or alkaline medicines.

After my return from Vichy the second time I recommenced practice: the sugar again increased, but not to any very great amount, the general symptoms, however, as thirst, dryness of skin, did not return. During the next three years I had much anxiety and had to work very hard in my practice, yet by taking 2 or 3 courses of Tunbridge Wells water during the year and regular exercise I kept myself wonderfully well; occasionally when I had unusual anxiety there was a return of the dryness of mouth, etc, slight increase in the quantity of urine as well as of the sugar in it. Towards the end of 1868 as sugar still continued, about 4 grains to the ounce, quantity of urine about 50 ounces, increased by anxiety to 7 grains in the ounce and 60 or 70 ounces of urine, I determined to retire for a year or two from active practice and endeavour, if possible, to get entirely free from sugar. For 3 months, I took no medicine, living on wheat meal bread, meat, vegetables, and drinking claret: I remained stationary as far as sugar was concerned. I then tried inhalation of oxygen, twice a day for two months, but derived no benefit. I next tried the peroxide of hydrogen, as recommended by Dr. B. Richardson, for 3 months, but was no better. I then determined to take tincture of perchloride of iron, and chlorate of potash; to continue to walk regularly and persistently every day; to wash all my body daily with lukewarm water, using plenty of soap, and exposing my body as much as possible to the sun; to take a soda bath twice a week, and to clothe in flannel. After 3 months I was free from sugar, and have been so ever since.

In two other cases in which the same treatment has been carried out the patients are much improved; the symptoms in both were very severe, dry skin, parched mouth, great feebleness, increased quantity of urine; in the one ninety ounces in twenty-four hours, specific gravity 1042, sugar 2840 grains a day: in the other, urine 76 ounces, sp. gr. 1040, sugar 1292 grains. The first used a soda bath every other day, as there was considerable acidity of stomach and rather severe dyspeptic symptoms, took half a bottle of soda water with half a bottle of Vichy water at luncheon, and the same amount at dinner. The second, as there were no symptoms of acidity and was also very weak, took a bath once a week, and Vichy water with an equal quantity of soda water and a tablespoonful of brandy twice a day. Both were allowed four glasses of claret during the day. The improvement in both is remarkable, though they have been under treatment but a short time; the one two months, the other six weeks. The skin is perspiring, all dryness of mouth is gone, both are much stronger and walk better, one about 1½ miles a day without fatigue, the other a mile. The urine of the first, sixty-five ounces, specific gravity 1028, sugar two grains in the ounce; of the second, sixty-two ounces, specific gravity 1024, sugar twelve grains in the Ounce. I have no doubt that by continuing this treatment both will get well.

The treatment must be strictly carried out in detail: for instance, without walking I am sure the relaxation of diet recommended by me could not be adopted without mischief, and so the walking exercise allows more variety of food, and often even, when circumstances demand it, permits farinaceous aliment to be taken without detriment.

I believe that Diabetes in most cases is a functional disease, and that therefore it is curable: that cases will occur that will prove fatal under any treatment cannot be doubted, when we consider that the general symptoms of Diabetes, as well as sugar in the urine are associated with, if not dependent upon, such diseases as those described by Dr. Dickinson* of Cambridge.

In conclusion; the symptoms and effects of Diabetes point it out as being a very complex disease, the cause of which may often escape us; the presence of sugar in the urine constituting, not the morbid state, but only a symptom. It requires therefore great patience and perseverance in the treatment, and the principles of treatment must be modified according to each individual case; and how can it be otherwise when we consider what we have to deal with, how age, sex, temperament, and previous habit modify the effects of regimen and medicine, and how these are further modified by other forces that come into operation?

* Transactions of the Medical and Chirurgical Society. Vol. liii.

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