Attention to the general, symptoms of Diabetes is of the greatest importance; and although the presence of sugar in the urine is a symptom essentially characteristic of the disease, yet it is always accompanied with well marked general symptoms. These bear a relation, within certain limits, not to the quantity of sugar excreted by the kidneys, but rather to the quantity retained, mixing itself with, and poisoning, the various organs and tissues of the body; I say within certain limits, because if the quantity of sugar be very large, it must be derived in part from the decomposition of the tissues of the body, and then the symptoms of debility and loss of weight will bear a relation to this excessive drain upon the system, and will accordingly be well pronounced. The first symptoms that attract the notice of patients are thirst, increased secretion of urine, and frequency of micturition.

Thirst

This is usually great, almost unquenchable. I shall never forget the misery I endured. It is increased generally after taking food; it is greatest in the evening and at night, and it is astonishing how much fluid is often drunk during the night. In my own case three or four tumblers were consumed, though only sufficient was taken at a time to moisten the mouth, and kept long before swallowing it. Anxiety augments it greatly. This is the least exceptional of all the symptoms; I have only met with one case in which it was absent, the other symptoms were strongly marked, the urine having a specific gravity of 1042, amount about 72 ounces in 24 hours, and containing about 10 grains of sugar in the ounce. M. Bouchardat endeavoured to establish a certain relation between the quantity of starch taken as food, and the thirst, viz. as 1 to 7; but this relation was found very different by M. Jordao in his experiments, being as 1 to 18. The mouth is generally very dry, with often a sweetish taste. The tongue varies, at times natural in colour, at other times dirty, covered with a thick yellowish fur. The saliva is generally scanty, viscid, and acid, in one case, however, and that not a severe one, I found it alkaline.

The urine is very abundant, it has a relation to the fluid taken; the greatest quantity is secreted during the night and towards morning. The amount passed in the twenty-four hours is sometimes considerable. "It has exceeded in more than one instance 70 lbs. In the case of Smith, detailed in the Writer's hospital Facts and Observations, 36 pints were voided in twenty-four hours, and in that of Johnson 32 pints. The amount is generally less than the liquid ingesta, but it has been found in one or two cases that the amount of urine considerably exceeded the whole amount both of the solid and liquid ingesta. This fact has been satisfactorily established by Dr. Bardsley, who has shewn that the excess of the former cannot be accounted for solely on the supposition of its being derived from a general wasting and diminution of the solids of the body; for in two or three instances, during the period in which the amount of urine passed almost daily exceeded the quantity of fluid contained in the liquids and solids taken, the patient had gained many pounds in weight. The author receives the fact without framing any hypothesis to explain it, though he states that the researches of modern physiologists, particularly those of Klapp and Dangerfield, render it extremely probable that this superabundant quantity of fluid is absorbed by the lungs from the moisture of the atmosphere." (Art: Diabetes, Cyclopaedia of Practical Medicine, vol. I.) I paid particular attention to this point in my own case, but I always found the fluid taken exceeded the quantity of urine made. The average amount of fluid taken daily for a week, was from 100 to no ounces, the quantity of urine from 90 to 95 oz.

When I perspired the quantity of fluid drunk was about the same, but the quantity of urine was reduced to 63 - 68 oz.* Micturition is painless, but the desire is generally imperative. This with me was most marked. The colour of the urine seems to depend upon the quantity of sugar it contains; when but little, it is scarcely at all changed, but on the contrary, when the amount of sugar is large, the colour is much diminished: as a rule all urine containing much sugar is pale, and of a less marked colour. The colour varies at different hours of the day, having some relation to digestion. The specific gravity depends upon the quantity of sugar and urea it contains; in those who eat largely of animal food the specific gravity is raised considerably, I believe from an excess of urea; in those who eat sparingly the specific gravity is more in accordance with the sugar contained. The specific gravity of healthy urine may be said to range between 1018 and 1025, being higher in summer than in winter, on account of the increased perspiration; in diabetes it ranges between 1025 and 1056, the latter is the highest I have seen; its usual range is between 1025 and 1042. The odour is very peculiar. Sir Thomas Watson describes it as "more like the faint smell of certain apples or rather of an apple-chamber;" often the smell is like honey or whey. According to M. Rayer, the odour mawkish at the moment of emission becomes alcoholic if left to itself, and undergoes fermentation: if exposed to the air for twenty-four or forty-eight hours it has a well pronounced ammoniacal smell: the odour varies at different times of the day, and is also affected by the treatment employed. The taste is generally sweet, sometimes insipid, and has been found even acid. When allowed to stand the urine becomes peppered over its surface with small scales resembling white wax, or as if small portions of melted wax candle had been dropped on the surface; these specks gradually coalesce into a whitish leathery-looking substance of considerable thickness and toughness, adhering to the sides of the glass; this has been called the diabetic ferment; when well washed and preserved in water it gives no indication of change, but if a solution of sugar be added immediately there is evidence of fermentation. On examining this substance by the microscope it will be found to consist of jointed confervoid growths and ovoid vesicles, isolated or united in little chains.* Chemically, the characteristic, indeed the pathognomonic sign of Diabetes, as far as this secretion is concerned, is the presence of sugar; the amount varies greatly. Bouchardat has found it as much as one seventh of the weight of urine, at other times one thirtieth, or even less. The amount of sugar varies from various causes; the quantity of starchy or saccharine aliment has great influence on its amount. Acute Bronchitis, Pneumonia, febrile attacks, or the application of numerous blisters diminishes it much, or may even cause it to disappear for a time.

* I may state that the quantity of urine made varied considerably, depending upon the amount of perspiration.