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Etiological Treatment - Complications of Diabetes

nervous, baths, time, cold, remedies, irritability, diabetics and patient

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Are we ever able to institute an etiological treatment of diabetes? Can we remove the cause and therewith the disease itself? Let us see.

1. Xeurogenotts Diabetes.— (a) Diabetes Accompanying Functional Nervous Disorders.—If severe mental overwork or psychic disturb ance accompanied by marked neurasthenic symptoms have preceded the occurrence of diabetes and appear to have caused it, we shall doubtless be following a most rational therapeutic course if we devote special attention to the treatment of the morbid condition of the nervous system. In such cases, in addition to the dietetic measures and even indeed before their institution, we should endeavor to strengthen the nervous resisting powers of the individual. Before all else we should seek to obtain for the patient relief from confining and exacting professional labors, avoidance of everything that causes worry, and the removal of domestic cares which constitute in them selves constantly renewed causes of uneasiness. Unfortunately our efforts in this direction are often confined to pious wishes. In many cases a long journey in pleasant regions with freedom from business cares suffices to restore the equilibrium of the psychic func tions, to raise the spirits, and to banish insomnia. In general a stay in warm dry regions is to be preferred. Sub-alpine summer re sorts are excellent for the hot months. Diabetics as a rule do not bear damp cold or raw sea air well, for it increases their nervous irritability and causes great discomfort to those of them who are sensitive to external cold.

In other cases, or perhaps supplementary to the procedures al re,ady mentioned, hydrotherapentic measures are useful. The most advantageous of these for nervous diabetics are prolonged warm baths (tub baths, indifferent natural thermal waters, mud baths), or, still better, baths in which carbonic acid gas is set free. On the other hand, strong salt baths and especially bathing in the open sea are particu larly to be avoided, since they rather fatigue and exhaust than in vigorate sufferers from diabetes. Caution must be had also in the use of cold frictions and cold douches ; there are certain diabetics to whom these are most serviceable, but others who do not react even after rubbing for half an hour or an hour; they lose their appetite, suffer from sleeplessness, and become very nervous.

As regards the dietetic regulations, which are of undoubted service in other patients of nervous constitution, we are in a delicate position.

We have to do usually with spare individuals in whom an improve ment in the nutritive conditions is urgently indicated. The attain ment of this object is, however, made difficult by the necessity of withholding as far as possible all carbohydrates from the fattening diet. In general we must be guided in our choice of a diet by the intensity of the glycosuria, a subject which will be treated of in a subsequent section. Here, however, we may remark that the more prominent is the neurasthenic state of the patient the less able are we to dispense with the carbohydrates. It is allowable to diminish or even to withhold entirely the carbohydrates temporarily, but never for more than a few weeks at a time.

Concerning drugs there is not much to be said in this place, except perhaps that the skilful use of medicinal remedies gives better prom ise in the nervous than in other forms of diabetes. The more prom inently nervous irritability stands out and the more probable it is that this is the fundamental cause of the diabetes (and also when the nervous disturbance has first declared itself during the course of the diabetes), the stronger is the indication for narcotic remedies. The favorable results which have for many years been claimed for opium administered with a free hand, and more lately for one of its alkaloids, codeine, are to be referred especially to cases of this sort. The remedy quiets the irritability of the central nervous system and exerts in this way slowly and gradually a curative effect. The theory that opiates increase the sugar-destroying power of the tissues seems to me to be wholly unfounded. In any case the opiates are suitable only for temporary use, and they should never be prescribed for longer than a few weeks at a time. Other nervines, such as anti pyrin, phenacetiu, etc., may be advantageously substituted for them from time to time, but even these remedies are more injurious than helpful if given for long periods. The bromides, on the other hand, can be unhesitatingly recommended, for they can be given continu ously for months without harm to the patient, and when administered in suitable cases are of undoubted benefit. One should not, however, look for the impossible, and it should be remembered that the bromides are not a specific remedy for diabetes, but merely a aid in combating abnormal nervous irritability. For a further con sideration of these and other medicinal remedies, see below.

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