OBSERVATION XXI. - Mr. Antonio G., notary of Ajello del Sabato (Avellino), had suffered for two years from a dry mouth, and for a year from a sharp thirst, with polyuria, increase of the appetite, impotence and perspiration: for three months, very remarkable loss of weight, with general weakness. He is a man with a flaccid temperament, with an adipose tendency, he has already had ten attacks of gout; for the past two years he has been rid of it: he particularly abused floury foods. Recognized as diabetic by Doctor De Capraris of Atripalda on September 12, 1870, he presented himself to me on September 15 with a polyuria of 5 to 6 liters, the specific weight being 1032, and 72 gr. of sugar per liter. Submitted to the cure, and seen again on November 24, 1870, he was doing perfectly well, had gained in strength and in nutrition and presented urine of the weight of 1022, entirely free of sugar. He resumed with impunity the moderate use of flour; I have long lost sight of him. 

OBSERVATION XXII. Canon Vito M., 59 years old, of S. Agata dei Goti, archpriest of T., abused during all his life mealy and fruit; he had been diabetic for eight months, with 8-10 liters of urine per day, severe weight loss, and beginning to darken his eyesight. He came to see me in March 1872. After twenty days of treatment, he no longer presented any sugar: he continued the treatment for a few months, then returned to mixed food. - Even today (September 1874), he is doing perfectly well, eats everything, and as a precaution has adopted the following diet: three days a week, he eats absolutely nothing but meat. 

OBSERVATION XXIII .-- Canon Francesco F., aged 61, episcopal vicar of Malta, ate meat very rarely, ate almost exclusively flour and sweet fruits, and also abused sugar, to the point of almost constantly having a piece of it in your mouth. Since a long time suffering, weakened, emaciated, recognized diabetic for seven months, he came to see me on August 3, 1872, with notable polyuria (3 to 4 liters per day): the urine, with a specific weight of 1032, contained 60 gr. of sugar per liter: subjected to the cure, the urine, after eight days, was free of sugar, and their weight fell to 1018. It gradually returned to the use of starches, without any unfortunate result, and until the last news he continued to enjoy the best health. I had another report about him in June 1874, from his brother who had come to Naples for an illness; I have learned with pleasure that he is doing very well, eats everything, but mealy foods with wise moderation. 

OBSERVATION XXIV. Mr. C. Pietro B., 44 years old, from Malta, a large consumer of flour, of fruit and sugar, for he ate, even at night, candied fruit and candy. Recognized as diabetic for two years, he presented himself to me on July 14, 1872, with 100 gr. of sugar per liter; the specific gravity of his urine was 1041: he had, moreover, a weakness of sight, attributed by Professors Castorani and Del Monte, whom he had consulted successively, to hyperemia of the optic papilla. Submitted to my cure, the urine was free of sugar from July 22, its specific weight reduced to 1025; he then thought he could use milk, but was quickly punished by the reappearance of sugar in the urine at a dose of 6 gr. per liter, with an increase to 1028 of their specific weight: the milk removed, and the rigorous treatment instituted again, the analysis of the urine carried out on August 3, by Professor Primavera, demonstrated that the sugar had disappeared, and that the specific weight had returned to 1025 (weight still high and due to the abundance of urea and urates); this condition persisted for a long time, then the patient was lost to follow-up. 

OBSERVATION XXV. - M. Domenico 2., lawyer, from Oppido (Calabria), 56 years old, of fat constitution, presented himself to me on May 14, 1871. He has never had only intermittent fevers, and has always eaten a lot of starchy foods. Having come to live in a very humid country, he began to experience a torment in his feet and in his hands, and then tautness and contractions in his whole person which his doctors altered to rheumatism. At the same time, he suffered from polyuria which made him fill two or three vases a day. The demonstration that the sugar had disappeared, and that the specific weight had returned to 1025 (weight still high and due to the abundance of urea and urates); this condition persisted for a long time, then the patient was lost to follow-up. May 16 his urine showed 100 gr. of sugar per liter: submitted to the treatment, on May 19 the sugar was hardly appreciable: this patient having experienced a little diarrhea and some visceral pains, one had to order opium and gum at that time. He later resumed the cure, and was completely cured of the diabetes, as the news received at the beginning of 1874 confirms to me. 

OBSERVATION XXVI. Mr. Francesco P., from Corato (Bari), owner, aged 44, rarely ate meat, and always in very small quantities: he ate almost exclusively starches, fruits and above all made a very - great abuse of sweets. Sick for three years, with no known cause: impotence, thirst, polyuria up to about 4 liters per day, and, for several months, weakened eyesight; he came to me on July 29, 1872; his urine analyzed by Professor Primavera contained 45 gr. of sugar per liter, and presented a specific weight of 1033. Subjected to the treatment on July 31, the urine was, from August 8, of the specific weight of 1014, and completely deprived of sugar. These urine were therefore very poor in urates. After three months of very rigorous treatment, the patient had two months of a mixed diet, but ate mainly meat: the urine was maintained normal. From December 23, 1872, the patient ate everything, like a healthy man, and yet the urine, examined on January 12 and June 7, 1873 by Professor Primavera, was found completely free of sugar: thus the patient could consider himself cured of diabetes, by this ordeal of eight months of mixed diet followed with impunity: this does not prevent that, fearing his old and pronounced penchant for sweets, I urged him to never return to this fatal habit, which could give him the diabetes a second time, as she had done a first (1). .. (1) I learn, when I am correcting the proofs, that a diabetic from Corato, seen by nioi and by Professor PRIMAVERA, and who, for a year, had been perfectly well, had fallen ill again of diabetes, following a new abuse of flour and sweets, and that, as he had not wanted to immediately return to a rigorous cure, he was reduced to the saddest state. It may be Francesco P., but it could also be M. Mat., From Corato, whom I also treated, but that I did not see again, so that I did not know anything positive about it. (Author's note.)

OBSERVATION XXVII. - M. le Baron D'A., Of Naples, aged 50, a great consumer of flour and frozen candies, suffered, without appreciable cause, for two and a half years, from polyuria, general weakness and incapacity ; for a year the thirst, especially after meals, had been so extraordinary that, to quench it, he usually took three or four ice creams (rich in sugar, as we know), after which he was even more thirsty than before. On July 3, 1872 he had his urine examined by Professor Primavera, and they found 40 gr. of sugar per liter: the specific weight was 1025. Submitted to the cure, his urine presented on July 26, the specific weight of 1017, and was absolutely free of sugar: he has continued to do very well since then. though he returned to ordinary food. In the fall of 1873, as a result of an excessive absorption of flour and frozen candies, the sugar reappeared in the urine, but taken in time, and treated for only a month, health returned, the urine remained free of sugar until March 1874: I have no further information. 

OBSERVATION XXVIII. - Mr. Diego della R., diabetic for two years, who absolutely never ate meat, and who, however subjected to my rigorous treatment, got used to it so well that he digested it perfectly, even without lactic acid. His urine had, on July 18, 1872, for specific weight 1040, and containing 100 gr. of sugar per liter: on August 15, they were starved of sugar, and their specific gravity was 1014. He continued to do well, until to the last news received: but it is already some time ago. 

OBSERVATION XXIX. - Baron Francesco TS, of Nicastro, client of Doctor Staglianò: interesting case especially by the intermittences of his diabetes. This patient was doing well when he put himself on the absolute meat diet, and even when he took only moderate quantities of starchy substances. But when he used it extensively for a few consecutive days, he became melituric again, and suffered from drought, thirst and polyuria. His nutrition, however, was still quite good. He did my treatment, not however with all its rigor, on the advice of Doctor Stagliano, and recovered to the point of doing well for a whole year, eating everything. Finally, however, there was a relapse, and this time more serious, October 15, of sugar per liter. The patient subjected to the cure, the sugar disappeared very quickly, reappeared sometimes for a very short time, as I have since learned, and disappeared again, all this as regulated by the diet. - According to later news received in January 1873, his urine was free of sugar, but he suffered from intermittent fevers with hemoptysis; this last accident was, according to his doctor, dependent on the malarial infection. In September 1874, I knew he was fine. 

OBSERVATION XXX. - Mr. Antonio Tirabelli, from Villarica, owner, aged 35, client of Dr. Domenico Majone, abused flour and sweets, had intermittent fevers, and was exposed to colds: no other cause of diabetes can be found in him. For some time, he suffered from polyuria with thirst, without great hunger, and without impotence. For two months, we had observed, in the urine, the presence of sugar, which, on January 5, 1872, reached 80 gr. per liter. The patient submitted to my treatment, and after only three days the urine was free of sugar. He continued the cure for two months, very rigorous for 25 days, but allowing himself three times the use of chicory: later on he softened it even more. The urine, reexamined on January 31, specifically weighed 1019 and did not contain any sugar: it remained that way, as I was convinced by doing my own qualitative analysis of the urine. The patient was well for more than a year, and looked at himself as completely healed, having gained much in nutrition, strength and good looks. The last information received in 1874, by Doctor Majone, is as follows: the patient felt so well that, relying too much on his recovery, he began to eat sugar in great excess, and especially sugar sweet dishes: he noticed at the same time that, each time he made a similar deviation in diet, thirst and polyuria reappeared: sugar was even observed in the urine. If he resumed the rigorous treatment for a single day, the urine became free of sugar again. But he too often repeated these abuses of sweets, for he very much disliked submitting to this suggestion, and, in a fit of mistrust, he decided that he would run the chance, without following any further treatment: so noticeable, impotence, aphonia and general weakness. This last recurrence lasted four months, during which he continued to abuse sugary foods in this way, to eat them every day for 3 or 4 francs ..... and he made all these deviations, because, having become edematous until groin from weakness of the heart, and also a little from excessive fatigue of the kidneys which caused a slight nephritis with albuminuria, he persuaded himself that he would die fatally from dropsy, even though he would be cured of diabetes. 

Finally, at the insistence of his friends, he resumed the treatment, but not rigorously enough: after two weeks, the sugar, which was very abundant on board, had come down to 30 g. per liter, the edema decreased, the strength returned a little, while the thirst and the quantity of urine were normal, and that manly power had reappeared. On March 9, 1874, he underwent the rigorous treatment which I had prescribed for him again, and after a few days the edema had disappeared entirely. The urine examined on April 27, 1874, by Professor Primavera, was completely free of sugar, but contained a small, though quite evident amount of albumin. However, a serious gastric catarrh had developed with complete inappetence; the alvine evacuations were abundant and discolored, according to his attending physician, which made me suspect that the atrophy of the pancreas and the liver were too advanced, as well as the defect of assimilation and absorption of intestines, resulting in thinning and discoloration of feces. 

In the hope, however, that he was not a primary degeneration of the pancreas and the liver, but an incomplete atrophy of these organs, which could still be remedied, (if it was consecutive to the diabetic exhaustion, which could be oppose an improvement in nutrition), I advised adding to lactic acid and pepsin, already ordered by the attending physician, pancreatic fats; and behold, immediately after their use, the patient began to digest better, the stools improved and nutrition was restored. Dr Majone then wrote to me: “Under the influence of this treatment, the patient has always gotten better and better. After five days, the voice became natural, the forces gradually improved, the pulse became stronger and more frequent, the moral state improved, thirst completely extinguished, because he never drinks outside of meals; appetite has become normal, with desire for various foods, and with this peculiarity remarkable, an instinctive tendency towards broths and towards pancreatic fats, all things he hated at first; the stools are regular in quantity, and even in their necks, although they are not absolutely normal. The urine examined by Professor Primavera on May 18, 1874, had a specific gravity of 1018, and, although it was free from sugar, contained some traces of albumin, with a normal proportion of urea and urates. - This patient is still doing well now, September, 1874. This case is still very important, by its apparent form of intermittent diabetes; the intermittences were related to food. After being cured of diabetes, the patient continued to be well, although making use of a mixed diet, provided that it was not too rich in sugary materials, and his urine remained normal: with each excess of sweetness, the urine became sweet and abundant. The organism could therefore overcome and burn a mediocre quantity of hydrocarbons, but it could not overcome the excess of these, and when it had been, for some time, encumbered with these hydrocarbon elements, it lost tolerance towards them, - and intermittent diabetes reverted to the state of continuous diabetes. This case shows again that one can cure diabetes, by following the treatment long enough and rigorously, and that one can continue it again when one is well; but that we must no longer fall back into the excess of hydrocarbons, and especially sweets; it also shows that, even a very slight case of diabetes may change and become very serious, to the point of threatening life in the near future.