In relaxing my diet I used great caution and always employed three tests, which I found soon told me of any error of diet which I had committed, and thereby enabled me to retrace my steps. The 1st, which I consider also the most delicate and decided, was increased dryness of mouth, especially during the night, with slightly increased depression of spirits. 2nd. The increased colour of the urine on boiling with liq. potassae, with increased quantity, and increased frequency of micturition. 3rd. Weight.* I weighed myself regularly every month. If I increased in weight, or even remained the same, I was satisfied. If the first and third test were right, I did not regard the increased darkening of the urine when boiled with liq. potassae a reason for giving up a well-considered relaxation of diet, unless it continued for some days. Emboldened by my success I have gradually and cautiously relaxed my diet; always however paying great attention to other means pointed out, especially walking exercise; at this time I was not aware of the benefit derivable from the long-continued use of small doses of iron, and chlorate of potash, which I have now taken regularly for the last 6 months and have been free from, sugar for some time.

* With this we may conjoin the Tannin test, the deposit from which increases, I may say always, with the loss of weight, not having as yet met with a single case in which it has not been so.

My present diet is:

Breakfast

Bacon well done, fish or eggs, brown bread or cakes eaten with plenty of good fresh butter, at times ordinary bread well toasted.

Luncheon

Eggs or soup with maccaroni, or rice, or cold meat, with a table spoonful of brandy or two glasses of claret in a tumbler of water.

Dinner

Soup or fish, meat, green vegetables, potatoes (sparingly), cheese, at times pale ale and a little dry fruit.

I occasionally take two or three glasses of champagne during dinner and never have an appearance of sugar, or any increase in frequency of making water or in the quantity: indeed I always feel the better after taking it. I consider that it is owing to the continued and regular exercise I take that I have been able to relax my diet to this degree; if I take less exercise, which I have occasionally done, I do not feel so well in myself, and feel confident that even now if I were to leave off regular exercise I should soon have to again restrict my diet.

When I am the first to discover the disease in a patient and the symptoms are not severe, and have not existed for a long time, if the diet has consisted of much saccharine and amylaceous food, I commence by cutting off one half of these kinds of food. After four or five days if I find there is an improvement I cut down one half of the remainder. I then wait a few days more, and if there is still improvement I cut off all sugar, potatoes etc. and ordinary bread, giving the patient instead bread made of wheat meal. After a few days I put him on a more stringent diet, giving cakes made after Dr. Camplin's direction or Dr. Pavy's almond bread, meat, and vegetables, such as cabbage, asparagus, lettuce, spinach, etc., which contain no sugar or starchy matter.

This I do,' hoping that the case may be found to belong to the first class mentioned above, viz., that in which the sugar depends on the saccharine and amylaceous food taken.

I have found however that with one exception all the cases that I have seen come under the second class, those in which the sugar is only diminished.

When the least loathing for food occurs I immediately relax the stringency of the diet, knowing from experience what courage is required to persevere in it. In general, if such a diet is attempted to be continued, I find the patient, unknown to his physician, breaks through it, and thus that confidence which should exist between physician and patient is lost, and the re-.sult cannot be otherwise than injurious. Even if the patient should have the courage to continue such a diet I am sure it would be injurious.

Andral relates the following of a woman who, under the full persuasion that she would be cured by a diet strictly animal, took animal food for two months without the slightest deviation; during this time she took nothing but roast and boiled meat, drinking water to which was added a small quantity of brandy. At the end of this time she abandoned the diet which had become insupportable. When she commenced the animal diet, she was passing 27 grammes of sugar, (about 418 grains) in every litre, (34 ounces) when she left it off, the quantity of sugar was 49 grammes (about 759 grains) in the litre. What is important in this case is this, when she relaxed the diet and took meat, eggs, milk, a little ordinary bread, vegetables, and replaced the alcohol by wine and water, the quantity of sugar began to diminish and there were found 30 grammes, then 26 grammes, and then 15 grammes: however, at the end of some days the sugar, though the same diet was continued, began again to increase and after three weeks the quantity was 54 grammes (about 840 grains) per litre. M. Andral mentions the remarkable fact that he has found in all cases where the diet is suddenly changed, whether the starchy element is taken away and replaced by meat or the converse, that the sugar always diminishes, but that after a time if the same diet is continued the sugar again increases.

This I cannot say is according to my experience, but I attribute it to the other means I employ with the diet. When I relax the diet I do so thus: I first substitute brown bread and cakes for Dr. Camplin's cakes, etc., carefully observing the effect as regards the patient's feelings and testing the water as above stated; then I relax a little more, allowing first one thing, then another, until the patient's diet becomes like my own, as mentioned above: if any increase of symptoms occur, which I must say is not often, proceeding in this cautious way, I immediately retrace my steps, cutting off the last food that seems to have been the cause of the increase, and then remaining quiet for a week or two before permitting any further relaxation.

In those cases where the Diabetes has existed a long time and consequently has been under a variety of treatment, I never use the absolutely restricted diet, as I am sure they belong to the second class of cases. I begin by putting them on the wheat meal bread and am guided in other matters of diet by the patient's history, till I gain experience for myself in the case.

Milk I find can be taken for the most part without harm, and when there is a great love for it, which is often the case, I always allow it. Animal sugar is much more easily digested than vegetable; when it produces indigestion, as it sometimes does, a little lime water added to it will often cause it to be borne well. In those cases where great debility exists, two thirds of a tumbler full of milk and one third lime water, with a dessert or table spoonful of brandy taken early in the morning has been of great benefit.

I have only tried in two cases a milk diet as recommended by Dr. Smart of Edinburgh, who asserted that during the time it was taken the sugar disappeared gradually from the urine; the result was not satisfactory.

Dr Scott Donkin has lately advocated the same treatment.*