Practically, so far as sugar and starchy substances are concerned, there are three types of Diabetes. In the first, by the total suppression of these substances, all sugar disappears from the urine, and this state of things generally continues so long as the diet is restricted. In the second, the sugar is only diminished and this diminution is often temporary. In the third no effect is produced. I should consider the first therefore as the commencement of the disease and of a mild character. Dr. Camplin's case seems to me to have been of this class. I have seen only one case of this kind; the general symptoms were not severe, and the quantity of sugar was not great: after a week on restricted diet, that is to say, meat, eggs, Camplin's flour, milk, toasted brown bread, butter, and iron, the symptoms were greatly improved, and in a month the patient's urine was free from sugar; all thirst was gone and the cure appeared complete. The patient lived four years after, during which time I had an opportunity of seeing him twice; the last time, a year before he died, his urine was free from sugar and he had no symptoms of Diabetes; he died of gastric fever.

In the second type, the sugar found in the urine is evidently furnished either from the azo-tized substances taken as food or from the patient's tissues. M. Griesinger* made the following experiment in a case where no benefit resulted, as far as the sugar in the urine was concerned, from the withdrawal of all starch and sugar as food: he fed the patient for four days upon an exclusively nitrogenized diet, giving sufficient fluid to appease the thirst. The relation between the weight of food taken and the sugar eliminated was 4320 grammes and 542.32 grammes; by subtracting from the weight of the food taken 70 per cent, for water enclosed in it, the patient took 1296 grammes of extract of meat; the weight of sugar eliminated was a little more than two-fifths of the weight of solid material. According to Schmidt, fresh meat contains a mean of 22 per cent of anhydrous albuminates, consequently the patient received in the 4320 grammes of meat about 950 grammes of anhydrous albuminates; the weight of the sugar was about three-fifths of the aliment: on varying the quantity of animal food taken, it was found that the quantity of sugar was precisely three-fifths of the anhydrous albuminates. Reflecting on the result of these experiments, I have considered it injurious to put patients on an absolute meat diet for a long time, and so force them to make the sugar entirely from the nitrogenized aliment.

* Studien uber Diabeten. Archiv. fur Physiolog. Heil-kunde, 1859.

My experience is decidedly in favour of a restriction of diet, but very gradually and cautiously carried out. The majority of patients in my practice have been, as stated before, great sugar and starch eaters, being exceedingly fond, and vast consumers, of bread, potatoes, sugar, and fruit. To cut off these articles of diet suddenly, as is often done, I consider injurious; in preparing for a prize fight, where there is present no known disease in the individual training, how slowly and cautiously the restricted diet is proceeded with; we ought surely to proceed at least as cautiously and carefully when we have a defective constitution to deal with. I was a great lover and eater of bread, potatoes, and sweets of every description, and, comparatively speaking, a very small meat eater, taking animal food as a rule only once a day, at dinner, and a small mutton chop satisfied me. On the discovery of my disease, my opinion being that Diabetes was dependent on an exaggeration of the sugar-forming function of the liver, I left off immediately all saccharine and starchy food, adopting a diet as free as possible from these, the only vegetables I allowed myself were spinach, lettuce, asparagus, and cabbage; I took puddings made of Dr. Camplin's flour and the cakes, as purchased of Mr. Blatchley, 362, Oxford Street, London; these I ate with plenty of butter. I combined with this diet the soda bath, walking much, having recognised the advantages of this before reading M. Bouchardat's work, and wearing very warm clothing. Under this treatment I soon began to improve, how much was owing to the diet it is of course impossible to say. It was after my return from Vichy the second time that I determined to relax my diet cautiously, as I found my loathing to the restricted diet became very great: I looked forward to my meals with horror, the very look of cabbage and green food was detestable, my appetite almost failed me; necessity, as it were, compelled me to alter my diet. I then, for the first time, began to use common wheat meal made into bread and cakes; no yeast was used, but it was raised by a powder consisting of tartaric acid one part and carbonate of soda two parts, and this renders the bread alkaline; occasionally also I partook of white bread, having it toasted and eaten cold with plenty of butter: I then added potatoes to my diet, but not eating largely of them. To my astonishment I found myself not only no worse from such a diet, but on the contrary I was becoming gradually stronger; I thoroughly enjoyed my food, and looked forward with pleasure to my meals, and though I still had sugar in the urine, yet it was in somewhat diminished quantity, I had no symptoms which are considered as characteristic of Diabetes; I was generally disturbed only once at night, my thirst was gone, I perspired freely, and instead of losing weight and power, was gradually increasing in both. Quantity of urine, 72 to 79 ounces; sp. gr. 1036 to 1040; in fact the kidneys were able to excrete all the sugar formed, so that there was no accumulation of it in the system. I had Glycosuria but no Diabetes, and it was in my own case that I first began to have a glimmering of the distinction between these two diseases.