alimentary principle, such as is supplied by the vegetable substances prohibited in the above list, is essential to the healthy nutrition of the human body, and that the complete withdrawal of such a substance from the food for any length of time is productive of injury to health. Fortunately, milk supplies a principle of this nature, in a form, too, harmless to diabetics, and not prone to reproduce the disease. Consequently by allowing skim-milk to enter largely into the diet of those who have recovered from the affection, we supply a perfect substitute for the prohibited vegetable substances, such as bread, potatoes, and the like, which enter so largely into the composition of ordinary food. The starch and gluten which these substances contain are the analogues, chemically and physiologically, of the lactin and casein of skim-milk.

Under the head of Pathology I have directed attention to certain clinical observations which show conclusively that during the progress of diabetes fatty substances increase the formation of sugar, and aggravate the symptoms of the disease. Convalescents, therefore, should partake sparingly of fatty matter, and limit themselves to the little fat contained in the leaner portion of the meat of superior quality, of which they partake. Pork and bacon

must be avoided, and also butter and cream. I have known these substances productive of considerable injury. Cheese, too, must be avoided.

On account of the quantity of skim-milk consumed, patients seldom require any other fluid. But for drink I have generally been in the habit of allowing a cup of tea or coffee, without sugar, and with or without skim-milk, twice or thrice daily. I have also allowed cocoa, free from fatty matter, especially Cadbury's essence, which is an agreeable and excellent preparation. I have always strenuously opposed the use of alcoholic drinks for the reason already stated.

While patients are under the skim-milk treatment I am in the habit of prescribing out-door exercise when the weather is fine or mild, especially walking, or working lightly in the garden; this they find particularly agreeable, in consequence of the greatly increased, or newly-acquired, strength they generally feel after the sugar has been greatly diminished, and the other symptoms allayed. So great is the improvement in this respect that, as will be shown by the cases recorded further on, patients, after having lived on skim-milk exclusively for several weeks, have been able to walk six or seven miles without fatigue, who were previously

incapacitated from walking more than a quarter of a mile without resting. This sudden restoration of strength has often created astonishment in the minds of relatives and of the patients themselves, who were previously prejudiced against the treatment, on the ground that they believed it impossible for anyone to subsist on what appeared to them to be such exceedingly slender fare.

In cold and damp weather the patient must be confined to the house; both on account of the pernicious influence of chills and because of the small amount of heat-forming material consumed under a skim-milk regimen. For the same reasons thick warm clothing should always be worn in the winter and spring seasons. In summer even flannel should

be worn next to the skin; but the dress should be light though of warm material, on account of the tendency to perspiration imparted by a liquid diet, and the necessity of guarding against sudden vicissitudes of temperature.

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CHAPTER XI.

THE SKIM-MILK TREATMENT OF DIABETES. CASES.

To illustrate the observations made in the preceding chapter, I shall now proceed to give the details of a few cases of diabetes placed under the skim-milk treatment, which, in each instance, was followed out under my own supervision with extreme care. But in doing so I shall avoid selecting any of the milder instances in which the malady existed in its incipient condition, and in which the mere exclusion of starchy and saccharine substances from the food for a period of three or four days is sufficient to remove the sugar entirely from the urine. On the contrary, I shall direct attention to cases in which the disease manifested itself in a much more serious form, and in which the second or more formidable stage presented itself in every phase of development.

The first two cases are fair average examples of what may be expected from the treatment when the disease is uncomplicated, and not too far advanced.

Case II. is specially interesting and instructive, inasmuch as it supplies conclusive evidence of the very great superiority of the skim-milk treatment over an exclusive regimen of ordinary animal food (consisting chiefly of muscular fibre), which has hitherto been the only remedy on which any reliance could be placed.

It is necessary here to direct attention to the fact that during the first two or three weeks of the treatment there is always loss of weight experienced by the patient; this I attribute chiefly to two causes, namely, the great diminution in the quantity of excrement contained in the intestines under a skimmilk diet, and secondly to the gradual withdrawal of the sugar with which the blood and tissue fluids are saturated when the treatment is begun.

CASE I.-Diabetes Mellitus; Removal of the Sugar from the Urine in Fourteen Days; Complete Recovery.

Mr. J. G, aged fifty-eight, a highly respectable merchant, of large, robust, muscular build, and of regular and temperate habits. He has devoted himself very successfully to business pursuits, with all the anxiety attendant thereon.