"Diabetes is generally a chronic disorder, creeping on at first insidiously, and spreading itself, under judicious management, over many years. Yet it is sometimes fairly entitled to be called an acute disease; for it occasionally breaks out suddenly, is attended with much febrile disturbance, and runs a short course, uncontrolled by any treatment. It often becomes associated in its progress, with pulmonary disease, especially with tubercular phthisis. Sometimes the disease terminates in incurable dropsy; and some times the patient is cut off suddenly, either by apoplexy, or by some peculiar disorder of the stomach. Itching of the skin is often present; and cataract is another not uncommon accompaniment -of Diabetes.

"Dr. Garrod has found gangrene to be of frequent occurrence in diabetic persons. There can be no doubt that their vital power is always greatly lowered by the disease. They are apt to sink rapidly under any sudden mental shock, under bodily injuries, under surgical operations, and even under any unusual fatigue and anxiety.

"We know but little about the outward causes of Diabetes. It is not a very common disorder: and in those who become afflicted with it, there probably has existed a predisposition to it. Dr. Prout remarks that the complaint runs occasionally in families, and is inherited. I had under my observation for some time, three children, two brothers and their sister, all affected with Diabetes. The mother, a maternal uncle, and a sister of a friend of mine, all died of this malady. The daughter of another friend, himself the grandson of an eminent physician, died of Diabetes. He became a widower, married again, and at length incurred and fell himself a victim to the disease; and one of his daughters from the second marriage, is at present diabetic. The same author mentions among the predisposing causes, long-continued intemperance, and especially the immoderate use of spirits, severe evacuations, excessive labour joined with a poor acid diet. Distress and anxiety of mind are held also, and justly I think, to be among the predisposing causes. It sometimes seems to be produced at once, by the operation of some exciting cause, such as exposure of the body to cold; or the drinking of large draughts of cold fluid while the drinker was hot and perspiring. Sir James Bardsley states that, in twelve instances of the disease which had fallen under his own notice, the patients attributed their ailment to one or other of these two causes.

"Diabetes is a malady which justly alarms those who are subject to it. But though too often a fatal malady, it is not necessarily so: and the older I grow, the less despondence do I feel upon first ascertaining that a patient is voiding saccharine urine. Whether it be that the disease is really more common, and at the same time milder and more tractable than it formerly was, or whether (what seems more likely) it is more carefully looked for nowadays, and more easily recognized, certain it is that I both see, and hear of in the practice of others, many more instances of Diabetes than I did some years ago. Of the well-marked cases, a few, not many, have recovered perfectly, and so far as I know permanently, even to the return of the urine to its natural specific gravity. Others have gone on, by slow or by rapid steps, to a fatal termination. In not a few, the main symptom of the complaint, I mean a considerable impregnation of the urine with sugar, has continued for months and years, without material deterioration of the general health, until the patient has been cut off by some other illness.

"No age is exempt from liability to the disorder. In 1860, I saw, in consultation with Dr. Garrod, the youngest diabetic patient that I have myself met with; a boy between three and four years old. His disease ran its fatal course in about five months. The younger the patient is, the worse, according to my experience, is the prognosis. Generally the older the patient, the less anxiety need be felt about the issue of the disease."

It is necessary to be careful not to mistake a temporary lull in the disease for a cure. Some of the medicines taken may check the flow of urine, but until the sugar ceases to be produced the patient is not out of danger. The smallest disturbing cause, exposure to cold, an intemperate meal, unusual exertion and fatigue, sudden or strong mental emotion, may bring back all the symptoms in their former severity. If these and similar hurtful agencies can be averted, life may sometimes be prolonged, in much comfort, for many years.

Dr. Pavy records a case in which an intense degree of Diabetes followed a violent blow upon the head. The sufferer was a cadet at Sandhurst, about 20 years of age. Bernard mentions a quarry-man who became diabetic after a fall upon his head. The sugar disappeared from his urine as recovery from the injury to the head took place.

About the beginning of the present century, Dr. Rollo discovered and taught that a diet composed exclusively of animal matters had a signal effect in reducing the quantity and diminishing the sweetness of diabetic urine. And the reason of this is obvious. Animal food furnishes but scantily the materials for the formation of sugar. The saccharine alimentary principles are chiefly derived from the vegetable kingdom. If then, we exclude aliments of this kind, and confine the patient to animal food alone, we thus cut off the principal supply of the sugar; and without actually curing the disorder suspend its worst effects. But most people have a great objection to living on animal food alone.

If care be taken to exclude all articles of food that contain saccharine matter, or that are readily convertible into saccharine matter, the condition of the patient amends at once. His thirst abates, his appetite becomes more natural, the state of his tongue and his skin improves, and his strength and weight increase. In one example, recorded by Dr. Garrod, the daily amount of urine was reduced within a few days, by regimen alone, from 354 to 100 fluid ounces, and the daily quantity of sugar voided with it from 26 ounces, to rather less than four.