That the soda penetrates into the system especially if the skin be well brushed whilst in the bath is proved by the experiments of Petit.* I know the absorption of any medicinal substance by the skin has been denied but I think wrongly. Two great powers in promoting absorption are first to scrub the skin well whilst in the bath so as to remove all oily matter. Secondly, that the solution should be very weak, of lower specific gravity than that of the blood, so that endosmosis may take place: the average specific gravity of the blood, according to Nasse, may be fixed at 1055. I may here remark that in rheumatic and gouty cases I have found the alkaline bath not only useful during an attack, but also in warding one off. I have had three patients who were martyrs to rheumatism, and two to gout, and who, since using this bath twice a week, have not had a single attack for years. I need not say that in such cases, if albumen be present in the urine and the reaction is alkaline or nearly so, such a bath should not be used. I find an alkali introduced into the system by the skin does not weaken the digestive organs.

* Des Eaux Minereaux de Vichy.

Fourth point. Warm clothing. Winter and summer the patient should be enveloped in flannel. In winter a flannel binder should also be worn round the abdomen. The patient should not sleep in the flannel worn during the day; but should change it at night for another: when taken off they should be thoroughly exposed to the air.

Thus far for the constitutional treatment: and now we come to medicine. On entering upon the medical treatment of Diabetes we cannot but wonder at the numerous drugs that have been recommended. Much difficulty arises from this. Frank recognised it, when he said "Nullibi plerumque medicina auxilii tam egena est quam ubi majores re-mediorum divitias pro una eademque aegritu-dine possidere gloriantur theorici; in ipso Diabete tam multa tamque contraria inter se auxilia lucidata fuerunt, ut vel ea hac sola rationis medendi inconstantia plurimorum jam nimis manifestetur inertia." In fact there is hardly a medicine in the Pharmacopoeia that has not been used, and what is extraordinary too, used with success. Nothing I think tends to prove more that Diabetes is most frequently a functional, in opposition to an organic, disease; for it seems impossible that if it were the latter such success could take place. In the prescribing of drugs, I take as my basis the two established principles in all true cases of Diabetes; these are too few red corpuscles in the blood, and too little oxygen consumed by the patient. The former is not only proved experimentally, but is seen in the pale face, lips, and inner lining membrane of the mouth, or if the patient should have a florid complexion, (it arises from congested veins, which are often seen much enlarged, and the face of a bluish tint, especially in cold weather,) the lips etc. are usually paler than they ought to be. To remedy this first defect I use some preparation of iron, usually the tincture of the perchloride in small doses, four to five drops for a male, two to three for a female, with one or two drops of tincture of nux vomica, and chlorate of potash, eight to ten grains for a male, five to seven for a female, three times a day. The chlorate of potash I add on the theory that the salt is decomposed in the system, and gives off its oxygen, and thus aids in making up for the diminished absorption of oxygen, and so fulfilling the second indication: whether I am thus right in prescribing these drugs or not, I am sure there is no combination from which I have derived more benefit than this. This prescription I employ when the disease seems to arise from an exaggerated sugar-producing function of the liver. When the Diabetes seems to arise from want of power, and this in the beginning, I order citrate of iron, two grains for a male, and one for a female, with the above mentioned quantity of chlorate of potash, and half a drachm of aromatic spirits of ammonia, three times a day. The great object is to avoid all irritation, and as it were to insinuate the medicine into the system; it must be continued for a long time; I took it for four months, with the steady continuance of the constitutional treatment above mentioned, before I got clear of sugar in the urine.

There is no more suitable way for a patient to take iron than drinking the Tunbridge Wells, water. From the middle of May to the middle of October, in ordinary seasons, the waters may be drunk. This water is perfectly transparent, giving out no air bubbles, its taste is. strongly chalybeate; when taken at the Wells it has an agreeable freshness. Its temperature is always, summer or winter, between 500 and 520 F. The quantity of water yielded by the spring, for there is only one, though there are two basins, one being filled by the overflowing of the other, generally remains the same throughout the year: it is not affected by wet or dry seasons, even during the last summer (1870) the spring yielded its usual quantity of water: about February, when the land-springs break, there is a considerable increase in the quantity, but how much has never been estimated. Its constituents are chloride of sodium, sulphate of soda, lime, protoxide of iron, manganese, silica; also three gases, carbonic acid, oxygen, and nitrogen: it owes its celebrity to the iron which it contains: the quantity is exceedingly small, not above 14 grains in half a pint, yet the water requires to be taken with great caution. During a long practice at Tunbridge Wells I found medical men at a distance, from the small quantity of iron which the water contains, prescribed it in far too large doses, deranged stomach and headache being the result. Whilst taking the water great attention is required to be paid to the digestive organs: the bowels ought on no account to be confined, one free action at least ought to be secured daily, but purging should be sedulously avoided. If the patient be strong enough, the water should be taken in the morning, and at the well; on no account should it be carried away and drunk at home, and this for two reasons, the quantity of carbonic acid gas is small, there being only a surplus of a grain to keep the iron in solution, so that the escape of a very small amount of the gas causes a precipitation of the iron, and the water loses its virtue; the second reason is that the patient should walk after drinking the water, as it promotes digestion. He should be at the wells about 7. 30 or 8 a.m., and begin by taking the smallest glass, two ounces of water, (there are three glasses in use, the smallest two ounces, the next four ounces, the third six ounces;) he should then walk for a quarter of an hour, then take another glass and walk for another quarter of an hour: on reaching home he should rest a little, say half an hour, before taking breakfast. On the third day he should begin afternoon doses, commencing about 3 a.m., taking two of the same glasses with the quarter of an hour walk between, and then walking a quarter of an hour after the second glass. If this quantity produces no indigestion, no feeling of weight at stomach, or headache, he should continue the same quantity for a week; if bad symptoms arise he ought at once to see one of the medical gentlemen of the town, and be guided by him as to his mode of procedure. After a week, if there be nothing to contra-indicate it, another small glass may be added both morning and afternoon, with the quarter of an hour interval of walking. This may be continued as long as the patient remains at the Wells, if no bad symptoms arise: the patient should not leave off taking the waters on his own responsibility. Before beginning to take the water it is well to be three or four days in the place. Before getting up in the morning, a tumbler of milk with a teaspoonful of brandy may be taken, and a little of the bread or cakes mentioned under diet: if it produce acidity or weight at stomach, two tablespoonfuls of lime water may be added. If the patient be not strong enough to take the water in the morning, he should commence about eleven o'clock, or two hours after breakfast, proceeding exactly in the same way as before described. In taking iron I never give it in such doses as to render the stools very black, I consider a slight tinge is enough: when the stools are very black, it shows more iron is being taken than can be assimilated, and it may thus become a source of irritation. The rule for its use is, very small doses diluted largely, rendering the solution of less specific gravity than the blood, so that rapid endosmosis may take place, enabling the iron to be quickly assimilated. The colour of the stools may be regarded as a good test as to the dose to be given; if it produces very black motions the dose must be diminished. I believe the principle of small doses, so as to avoid irritation when the medicine is given for a long time, is too much lost sight of in the treatment of all chronic diseases. If the patient's symptoms indicate much acidity, in addition to the water and baths the following draught may be taken two hours after breakfast, and luncheon, and at bedtime, but as soon as the acid symptoms are removed, this should be given up. I order it at the time mentioned that the acidity after stomachic digestion may be neutralized. With the use of alkaline baths I find it very rare to be obliged to use this mixture long. As soon as the symptoms from acidity are removed, I reduce the bicarbonate of potash one half, and after two days give it up, returning to it if needful. The taking of fatty matter in some form is important. The loss of so much carbon and hydrogen as are contained in the sugar excreted cannot but interfere with the nutrition of the body, consequently the supply of carbon and hydrogen in the shape of fat must be beneficial. As a general rule, therefore, fat ought to be given in large quantities, and in as pleasant a form as possible. Cod liver oil, when it agrees, may be given, if not, as much cream or fresh butter as can be digested. I eat a very large quantity of good fresh butter, and have found great benefit from doing so. All physicians are agreed as to the good to be derived from taking fatty matter: in looking over my notes of cases I find that many of my Diabetic patients have had a dislike to fat, and therefore have eaten but little, agreeing in this respect with many consumptive patients. When the patient is sleepless, or restless, at night, I order pil opii. grain i. or grains ij. at bedtime; except for this purpose, I never employ opium. I tried it on myself in large doses, as I have tried almost every medicine that has been recommended with any authority, but found mischief from it. The urine was reduced from seventy-six ounces to thirty-two ounces: the specific gravity was 1054 instead of 1036; on boiling it with liq. potassae the urine became very dark:

I felt so ill and heartless that I had not resolution to make out the quantity of sugar it contained.

Rec. Potassae Bicarbonatis Эj.

Ammoniae Carbonatis grs. iv. Tr. Calumbae 3j, Tr. Nucis Vomicae my. Aquae ad. ჰiss: