The question has been much discussed whether the sugar in Diabetes entirely arises from the aliment, and though it has been decided that it does not altogether come from this source, yet much importance must be attached to food. M. Contour was struck with the great number of diabetic cases that owe their origin to an insufficient reparative diet or an almost exclusively vegetable one. Most of the patients I have seen were great eaters of bread and potatoes.

Drinks, such as beer, cider, perry, etc, have been considered as a cause of Diabetes and this because the disease is more common in England and Holland where the beverages are much used. Majendie mentions, in his Dictionary of Medicine and Practical Surgery, that a man who had eaten nothing but potatoes for 15 days was seized with Diabetes. It has been considered that the abuse of condiments, especially of pepper, which are exciting in their nature contributes to this disease. M. Bernard made the following experiment on two dogs: he injected water into the stomach of one, into the stomach of the other he injected Ether; he then killed them; he found but little sugar in the hepatic veins of the first, whilst in the second there was a large proportion. Here the direct effect of a stimulant on the liver is seen. According to M. Bouchardat the greater number of cases are met with in those leading a sedentary life. In France he finds notaries having the sad privilege of being the most subject to this disease. He considers the sugar in these cases to arise from their studious habits, from their want of exercise and from having only time to take one copious meal, or at the most two meals during the 24 hours, swallowing their food quickly without properly masticating it; also being usually rich, they live well. The curates in great cities are also liable to Diabetes, they generally have only one, an abundant repast in the day, and the hours passed in the performance of their duties at the confessional are hours of almost absolute rest.

* Valleix Guide de Median Practicien, second edition, vol. iii. p. 555 - 6.

Medical men are placed next; this disease is met with in the more fortunate members of the profession who live well and take but little exercise. It occurs also to the general practitioner who has a large practice: to save time he is obliged to drive, and being over-fatigued sleeps in his carriage; takes but few meals and eats quickly. M. Bouchardat adds that it is to be met with in all social positions in which there is found great ease of circumstances united with great mental exertion and a sedentary life. He further adds, he is sure he is not wrong in saying that in 20 men between 40 and 60, taken either from the legislative assembly, or from the learned bodies, or from those holding the highest positions in commerce, finance, or even the army, one would be found whose urine contained sugar.

Diabetes is frequently seen in those who have led a very active life, and then suddenly given themselves up to ease and tranquility. An unhealthy moist situation has been considered a cause.

A gentleman, a lawyer in a large way of business, consulted me at Tunbridge Wells: he came from rather a damp locality; he had been gradually losing flesh: he was considerably emaciated; he had little thirst, a bad appetite, and complained of great physical as well as mental exhaustion: he slept badly: his bowels were loose: urine, specific gravity 1040., amount 74 ounces in 24 hours, and contained a considerable amount of sugar. I ordered a grain of opium and the same of sulphate of quinine at bedtime; without further treatment, except going out in the open air and walking as much as he could without fatigue, he improved immediately. In 10 days, the urine was clear of sugar, specific gravity 1022, amount 46 ounces: in 3 weeks he left very much improved having gained several pounds in weight.

The next year he returned with all the old symptoms, and sugar in the urine. In about 14 days it disappeared under the opium and quinine treatment with walking. This time he took the Tunbridge waters with great advantage. He left again in 3 weeks completely free from sugar and comparatively speaking well, having again increased in weight. The next year he returned with all the same symptoms. Though the inactive life he led might have had something to do with the Diabetes, according to M. Bouchardat, yet I cannot but think that in this case locality had to do with the Glycosuria, for the symptoms hardly amounted to Diabetes; each time the patient rapidly recovered more quickly than the treatment warranted.

All causes of debility must be ranged among predisposing causes: the disease often develops itself as a consequence of too great mental exertion, excessive evacuations, venereal excess, or too prolonged lactation; also it arises from repeated haemorrhages, anaemia, or the puerperal state: here the Diabetes must be regarded as a secondary affection and symptomatic of others.