GENERAL HYGIENIC MEASURES - DIABETES.
I have been forced to anticipate in other places much that would properly come under this heading, and would refer the reader for a fuller presentation of the subject especially to the sections on the etiological treatment of neurogenous diabetes and on the employment of the drink-cure. What has been there said will be touched upon here very briefly merely for the sake of completeness, most of our time being given to other topics.
a. Psychic sufferer from diabetes is as a rule a pessimist ; he takes pleasure in brooding over his fate, doubts of the future and thereby loses his enjoyment of the present, and only too often, even while still in possession of his bodily strength, loses all pleasure in his work as well as his energy of will. It is of the great est importance to an 'improvement in this condition, and the success of our efforts here will be more gratefully recognized by the patient and his friends than will our reduction of the amount of sugar excreted in the urine. Our aim is to restore the self-reliance of the patient. Most diabetics know that they are incurable, and they will scarcely believe the physician when, in any special instance, lie opens up the prospect of complete recovery. Before all we must over come the patient's belief that, because he is incurable, he is therefore advancing with rapid steps to the grave, and the further belief that every fractional increase of sugar in the urine is hastening this pro gress. It is a bad sign when a patient begins hypochondriacally to make his spirits and subjective feelings dependent upon the results of the last urinary analysis by the physician or chemist, instead of taking his own strength as a measure of his actual condition.
No general rules can be laid down by which the mental depression and discouragement of the patient can be overcome. Comforting words, procurement of sleep, resumption of occupation or change of the same, iu other cases rest, change of surroundings, travel, drink-, bath-, or cold-water-cures, and the like, above all the clear and un mistakable success, demonstrated by the scales, of a suitable diet, these and many more are the factors contributing to the solution of our problem. It is here of the greatest importance to make a correct choice of measures, after a rapid grasp of the patient's individuality, being guided more by the personal bodily and especially mental needs of the patient than by any therapeutic formula.
In contrast to the over-anxious are the too optimistic patients. These are encountered especially among the rich and idle classes in large cities. A scanty excretion of sugar (0.5 to 1.5 per cent. in the
total amount of urine for the twenty-four hours) is hardly regarded as a sign of genuine diabetes, but is said to be only the natural and usual result of a hard winter campaign of rich dinners ; banker X or neighbor Y had sugar in the urine for a long time and it did him no harm; the harm that the winter has caused will be repaired all right by a course of the waters at Carlsbad in the summer. One often hears remarks of that kind. The physician must actively combat such an optimism, which borders closely on frivolity, for much good may be accom plished in these cases by the institution of a well-ordered and simple mode of life, and much harm may result from neglect of suitable measures.
b. Huscular Exercise.—Credit is due to Zimmer for having forcibly demonstrated the advantage of muscular exercise in diabetes. Among those who have since thoroughly studied the subject may be men tioned particularly von tiering, and Fiukler. It has been shown that the glycosuria is in many cases diminished as a result of muscular work, but in other cases the opposite effect is produced. It is evident that the amount of muscular labor must be care fully adapted to the patient's capacity. The sufferer from dia betes should never be over-tired, a warning that is based upon many experiences ; for example Frerichs calls special attention to the fre quent occurrence of fatal cardiac weakness and of diabetic coma after exhausting labor. In cases in which the patient's muscles are still in condition to increase their carbohydrate consumption during work, and are not forced to seize upon the albumin molecule, their exercise short of fatigue can only be of advantage. It is the best protection against loss of bodily strength and of mental energy, and when the sugar-consuming powers are not too far depressed such moderate ex ercise may well conserve and strengthen them. Indeed, we often see not only an increased tolerance of carbohydrates during the perform ance of carefully increasing muscular exercises, but may even note a more favorable condition weeks and months later. It is difficult, it is true, to determine exactly how much of the good results observed is due to the muscular exercise and how much should be a)..:;ributed to the other factors coming at the same time into play (drink- and bath-cures, fresh air, a suitable diet, etc.). A part of the benefit must, however, be laid to the account of the muscular exercise, leav ing easily aside the undoubted improvement which this brings about in the circulation, intestinal peristalsis, and self-reliance of the patient.