health and comfort. I have seen this result obtained when the patient seemed moribund; the case of J. W., recorded at p. 230, is an illustration of this effect.

Of course these conclusions do not apply to cases which are complicated with pulmonary phthisis or any other serious or necessarily fatal affection, although, in such hopeless instances even, the most extraordinary and rapid subjugation of the more distressing symptoms is generally witnessed.

The most important and valuable property of the skim-milk treatment, and that which gives it a preeminent superiority over the meat regimen, is the fact, which I shall prove by illustrative cases, that it will remove the sugar from the urine and cure the disease when the latter method has completely failed to accomplish this result after a protracted trial. In short it will cure the disease in the second stage when the urine continues to be strongly saccharine notwithstanding the complete exclusion of starch and sugar from the ordinary animal food of the patient. This fact proves most conclusively the very great superiority of the casein of milk over the albumen of muscular fibre in resisting the malassimilating operation of diabetes. I may further add that it is this peculiarity of casein which, combined with the fermentable property of lactin,

confers on skim-milk such a powerfully curative influence over the disease.

I have already, at page 41, laid down precise rules for the application of this treatment, and shall only here repeat what I have already stated most emphatically, that if these rules are not scrupulously observed success is not to be expected, more especially if any other kind of food is permitted until some time has elapsed after the complete removal of the sugar from the urine, which will be effected within six or seven weeks at the latest, or not at all, the average period in the more successful cases being about fifteen or sixteen days.

In about three weeks or a month after the disappearance of the sugar I give, in addition to the skim-milk previously taken, from two to four pints of skim-milk made into curd by the essence of rennet, and at two or three separate meals. This forms, as I have stated, a middle course in the treatment, and when it has been continued a length of time, suitable to the exigencies of the particular case under care, lean meat and green vegetables are allowed, also in addition, at one meal and in moderate quantity. In some instances the meat is tried without the vegetables for a week or so, and if no evil effect is produced the latter are added to the

meal. Gradually the patient is allowed eggs, fish, game, poultry, potted head, cow-heel, and a variety of dishes made from lean meats, so that two solid meals in the day are taken in addition to the skimmilk, which is then either reduced in quantity, or the curd is partly or wholly withdrawn, according to the inclination of the patient.

Such are the principles on which the treatment is to be conducted, but no two cases can be treated equally alike; differences must be made in individual cases, and changes in the same case, from time to time, which cannot be anticipated by rules, however carefully devised. I may add that however simple the skim-milk treatment may appear on paper, it is not so in practice; I have never known any success attained unless the patient is kept closely under observation and the condition of the urine carefully ascertained from day to day. A wholesome check is thus maintained against any infringement of rules, and in favourable eases the progress towards recovery is pointed out, and great encouragement thus given to continued perseverance. Besides, any little inconveniences of casual occurrence are at once remedied, and any uneasiness they may create in the mind of the patient allayed.

It is necessary here to state that general medicinal

treatment is not excluded, but that I have been in the habit of giving such remedies as appeared to me to be required in consequence of the peculiar conditions connected with individual cases. But,

at the same time, I have in several very successful instances considered it unnecessary to prescribe any medicines whatever. In most cases the skim-milk treatment gives rise to constipation, which is best remedied by an occasional dose of castor oil. If diarrhoea should ensue, which is rarely the case, a little of essence of rennet in water after each meal of skim-milk is generally sufficient to allay it; but if necessary, some such astringent as acetate of lead and opium may be given.

After complete recovery from diabetes, a strict regimen, excluding vegetable substances containing starch and sugar, must be adhered to for a lengthened period, the exact limit of which it is impossible to determine, in consequence of the strong tendency which these substances have to excite a return of the disease. Indeed, it would appear that with a considerable proportion of those who have been affected with diabetes an idiosyncrasy remains, rendering them incapable of assimilating starch and vegetable sugar. With such persons, therefore, a cure is purely conditional: they may

continue perfectly free from the disease, and in the enjoyment of health, so long as they strictly refrain from partaking of all kinds of food containing these substances; but if, on the other hand, they persist in breaking through this rule, sugar, in all probability, will reappear in the urine, and the disease will gradually become re-established. So frequently does this occur that I firmly believe the disease always originates in the malassimilation of starch and sugar, especially the former, which appears to be the fuel requisite to kindle up the morbid action.

It follows that convalescents must refrain from taking the following vegetable substances:-

Bread of all kinds; flour in any form; macaroni; vermicelli; rice; sago; tapioca; arrowroot ; peas, or peameal; beans, or beanmeal; French beans; turnips; carrots; parsnips; artichokes ; cauliflower; the white central portion of cabbage; celery; seakale; every kind of fruit, in any form ; pastry of every description.

The following vegetable substances are permissible:

Lettuce; greens; spinach; the green leaves of young cabbage; Brussels sprouts; mustard and cress; watercress.

Experience has clearly shown that a saccharine