Authors have spoken of an insipid sugar, but Bouchardat has shown that this sugar is only a mixture of ordinary starch, lactate of soda, chloride of sodium, and extractive matter; when this sugar exists, according to the same author, it is to be considered as a good sign showing that the disease is on the decline.

* Some idea of the severity of the disease may be formed from the time required by this covering to spread itself over the surface; if soon the quantity of sugar is large, if more slowly formed the quantity of sugar is small.

The presence of sugar is not the only change in the chemistry of the urine. In those cases where the appetite is very great and much animal food is taken, the quantity of urea may rise from 496 grains (32 grammes),* about the normal quantity, to 1457 grains (94 grammes.) Creatinine is also increased from 45 grammes or 7 grains, the normal daily excretion, to 8.4 grammes or 128 grains. The Chlorides shew an increase from 170 grains (11 grammes) a day to 558 grains (36 grammes). In cases where great emaciation is taking place I have found a large deposit from adding a solution of Tannin 5 now it is well known, "whatever the peculiarity of the albuminoid body may be, whether Albumen, Syntonin, Casein, Gluten, Legumen, that it is transformed in the stomach into an almost identical albuminoid; moreover this albuminoid, or as it has been called, peptone, possesses properties which distinguish it from other albuminoids, it is no longer coagulable by heat or by nitric acid, though still coagulable by Tannin, metallic salts, and strong alcohol."* In some cases I have met with there seems to be not only a want of power to assimilate sugar, but also peptones, hence the rapid emaciation. In all urine there is a deposit on adding Tannin, but when the health is good this is small. This is what we should almost expect, for we find, as Dr. Playfair says, that in the shape of cellulose, starch globules, and muscular fibre, one twelfth of the Nitrogen in the food passes away by the bowels; so I believe in all cases, even in the most healthy subject, some peptone passes away by the kidneys, but in severe cases of Diabetes, where the patient rapidly emaciates, large quantities are discovered in the urine.† This multiplicity of materials eliminated by the kidney seems to prove that in Diabetes the modifications in nutrition are very complex, and that non-assimilation of sugar is not the only evil to be feared.

* Taking the gramme at 15.5 grains.

With increased thirst, increased quantity and change in the urine, there is generally a very dry skin: the skin is dry and harsh even in the warmest weather; this is not, however, a constant symptom even when the quantity of sugar contained in the urine is great. In my own case though the skin was very dry at first, after a short time I perspired freely, the least exertion causing the perspiration to pour down my face; yet the quantity of sugar in an ounce of urine was eight grains, amount of urine in twenty-four hours sixty-eight ounces. The perspiration was remarkable for its acidity, reddening litmus paper almost as deeply as a mineral acid. Sugar has been discovered in the perspiration by McGregor, Auteureith, Semola and others: the latter author reckoned the quantity of sugar excreted by the skin daily equal to twenty milligrammes; the maximum quantity was in the night and morning; the food whether exclusively azotised or starchy made no difference. When the disease is far advanced the skin often becomes rough and scaly; in some cases an eruption of Lichen, Psoriasis, or Impetigo occurs. Sometimes the skin loses its sensibility, hairs may be pulled out without the patient feeling. When the fatal termination approaches profuse perspiration often occurs.

* Marshall's Physiology.

† I have lately been making experiments on this point, and its relation to sugar and urea, at the College of Chemistry, Great Marlborough-st, and shall publish an account of the results obtained as soon as a sufficient number of cases has been collected.

The bowels are generally confined, the faeces are dry, hard and scybalous, and passed with difficulty: at times they contain fatty matter; is there disease of Pancreas then? The colour is generally that of health: sometimes, especially towards the end, diarrhoea alternates with constipation, becoming gradually more and more continuous so as quickly to exhaust the patient: sometimes the bowels refuse to act and death may result from this. Respiration' is often more feeble and frequent than in health. M. Jordao found the maximum about eighteen per minute. The effect of Diabetes on respiration has been minutely studied by Voit and Pettenkofer: in confirmed Diabetes the quantity of oxygen absorbed is much less than in health, less carbonic acid is also exhaled. The relation is the following, in twenty-four hours.

Further it is known that in a healthy man by increasing animal food the absorption of oxygen is also increased; in Diabetes this is not the case; the same authors give the following results.

Thus the diabetic has in his blood, so to speak, more combustible matter; as a rule he eats more than a healthy man, he absorbs less oxygen, burns less. The quantity of vapour given off by respiration is also less than in health.

In Diabetes there is often a cough, dry at first, accompanied with short breathing, afterwards expectoration occurs: in the expectoration Bernard and others discovered sugar. Pneumonia or Tubercular disease is often met with; according to Dr. Pavy there is a breaking down of the lung tissue, the result of simple chronic inflammation, and the formation of cavities without being preceded by, or accompanied with, any strumous or tubercular deposits: this state of things is rare at the beginning of the disease, for generally at this period the respiratory murmur is distinct, and percussion indicates nothing wrong: sometimes true Pulmonary Consumption shows itself and rapidly leads to death.

Accompanying Diabetes, and especially when the disease is severe, there is feebleness of limbs; the patient soon becomes fatigued; power diminishes: the muscles become flabby, the patient falling into a state of general atony followed often by quick exhaustion. The voice often becomes weak as the disease advances; the sight enfeebled: amaurosis and cataract are apt to occur. The intellectual faculties are generally clear, though there is listless-ness and a sad depressed look. Vague pains are often complained of in the back and loins; at times the feet swell. Sleep is much disturbed by dreams, the mind in some cases seems hardly ever to be at rest. The generative function lessens in power; a time comes when all desire fails; so a return of the desire is a good sign: insupportable itching of the vulva in women at times occurs, at other times erythema of the parts; when such a state of things is met with, an examination for sugar ought always to be made.

In some cases it is remarkable how long the patient will preserve his embonpoint: but uniformly towards the termination of the disease the emaciation becomes extreme. Dr. Fonseca of Pernambuco, South America, found boils and carbuncles so frequent as to be regarded as a symptom characteristic of Diabetes. That they are owing to the sugar in the blood is rendered probable from the following case in the practice of M. Lorain. Two confectioners, in order to economize their money, were accustomed to eat as much sugar as they could; after fifteen or eighteen days of this food they were both seized with an eruption of boils, and were considerably emaciated; no sugar was found in the urine.

Jaccoud, Clinique Medicale, 1867, says, certain facts observed by Romberg, Girard, Becquerel, and Griesinger have shown the existence of Diabetes in individuals employed in the fabrication of sugar. It appears that the daily consumption of an excess of sugar greatly modifies nutrition. Aliment exclusively saccharine has produced symptoms similar to starvation. Magendie relates the following. An English physician, Dr. Stark, in order to appreciate the nutritive properties of sugar, lived on it entirely for a month, he was then obliged to give up this food: he had become very feeble, his legs were swollen, his face presented livid red spots: he died shortly after. Carbuncles occur sometimes on the nape of the neck, and are very fatal, erysipelas setting in, followed by exhaustion, and death.

The pulse at the beginning is generally normal in frequency and strength but becomes weaker and quicker as the disease advances. In a state of health the serum of the blood, habitually clear, becomes opaline some hours after food, if the food be of a fatty character.

Drs. Rollo, Dobson, and McGregor considered this the natural state in Diabetes; this is proved to be incorrect. Sugar has been found in the blood but never in very large quantities; Dr. Becker found that Glycosuria resulted if the sugar in the blood exceeded 5 decigrammes in 100 grammes. M. Bouchardat endeavoured to procure crystallized sugar from the blood, but did not succeed.

Patients often suffer from cold feet, especially at night. As regards temperature M. Donne and Jordao have found it vary under the axilla from 350 C. (950 F.) to 360 C. (96.8° F.). I have examined the temperature in several cases and in all, unless near the termination, have found it natural, that is to say about 98°F. varying a few tenths more or less. Finally, whenever a patient presents thirst, parched and dry mouth, and dry skin, with an increase in the quantity of urine and more frequent micturition, and still further if added to these we have loss of flesh and muscular power, an examination of the urine for sugar should be made.