It usually begins insidiously. It is most frequently recognized by the progressive increase of thirst and of urinary secretion. About the same time the mouth becomes dry, and there are often noticed on the sides of the tongue two streaks of whitish saliva. Before this the patient has sometimes been troubled with dyspeptic symptoms, weight and oppression at the pit of the stomach, acid eructations, disagreeable taste in the mouth, pains in the head, unusual restlessness, pains in the limbs, troublesome dreams, etc. Frequently then, as Dr. Bence Jones has remarked, the disease is arrested for a time, taking a slower, but progressive, course: at times there are seasons of remission - this has been during summer. A true periodicity has been observed; this tendency shewing itself usually in the spring. But this generally terminates by becoming confirmed Diabetes. After a time the symptoms become more permanent and intense; the thirst, and often the appetite, increases; the amount of urine increases; the saliva becomes more viscid; there is no perspiration; the strength diminishes; emaciation progresses; the voice becomes feeble; the power of producing heat diminishes, also the generative function; there is general restlessness; the sleep is much disturbed; vague pains are felt in the head, back, and limbs; there is a feeling of great depression. Often at this time eruptions on the skin and boils manifest themselves. This state of things may go on even for years: then the symptoms become greatly intensified: the thirst becomes excessive; the tongue, dry, red, and often covered with a black fur in the morning; the breath has a sweetish and often a foetid odour. The digestion becomes more and more troublesome, accompanied with much flatulence, often a perfect disgust for food, vomiting may occur. The tendency to constipation, which before existed, now gives place to diarrhoea. The quantity of urine may diminish much, though the sugar in it remains considerable, or quite at the last may disappear. The skin ceases to act, and at this time carbuncles or even gangrene may be developed. Albumen also may be found in the urine, and the deposit from adding tannin, or a solution of zinc is very great, even when no change takes place by heat and nitric acid. The senses as well as the intellectual powers, now become dull; the prostration is extreme; the ankles and feet become œdematous; the pulse gradually becomes weaker, and life is slowly extinguished, if there does not occur a complication, which is frequently met with, and carries off the patient more rapidly: the physician leaving the patient in a state not indicating immediate danger; in a short time after death occurs.

Such is the course of the disease when it goes on to a fatal termination; but, happily, in the greater number of cases, the symptoms are ameliorated, and by proper treatment the disease is often cured.

When the disease terminates favourably, the symptoms gradually diminish, the quantity of urine secreted lessens, it recovers its proper colour and smell, acquires its normal specific gravity, and finally the sugar disappears.

The course of Diabetes is greatly modified by the constitution of the individual. The symptoms vary in the order of their development and appearance. For example, the patient may remain for a long time in good condition, and the function of digestion may be well performed. The sugar sometimes disappears during the course of an eruption, diar-rhœa, or an accession of fever. M. Guerand,

Physician to the Hotel-Dieu, knew a Professor of Physiology in whom the disease alternated with gout; the Diabetes was cured by a diet of meat, coffee, etc.; he then put himself on a diet of meat and vegetables to cure the gout. The course of Diabetes is, at times, very rapid; - at times, very slow. It has, therefore, been divided into Acute and Chronic. The former is very rare. Some authors have spoken of its being fatal in a few days, but the probability in such cases is that it had escaped notice and that complications had promptly arisen. Dobson, however, gives a case where death occurred at the end of five weeks, and Frank one in which the whole course until a fatal termination was only seventy days. Generally the disease lasts for years. Its duration will vary according to the causes which produce it; this is shown to be so in cases depending upon cerebral disease or injuries; in the first the symptoms increase or diminish according as the disease increases or diminishes, in the second it depends upon the severity of the lesion. In these cases the symptoms are strictly subordinate to the causes which give them birth. Diabetes, which depends upon inherent causes or is constitutional, is generally slow in its progress, sometimes lasting 6, 8, or 10 years before proving fatal. The most frequent complication is pulmonary consumption. Dr. Bardsley seemed to regard it as inevitable, so does Dr. Copland, but this is found not to be the case. Other grave complications in the chest are common enough, - such as congestion of the lungs, exudation into the pleura and pericardium, pneumonia. Cerebral congestion often carries off the patient with extreme rapidity. Boils, ulcerations of the legs, and carbuncles are met with; the last is especially dangerous, being frequently followed by erysipelas, which quickly causes death by exhaustion.