e. Travel.—In such an eminently chronic affection as diabetes the patients are naturally very dependent upon their family and the members of their own household. They often chafe under the neces sity, and so much the more energetically the more wretched are their circumstances. It is often indeed a matter of the greatest difficulty to treat a diabetic patient properly in his own home. When the pecuniary conditions are unfavorable the question is chiefly one of diet, and this makes at least a temporary change desirable and de mands that the patient should enter a hospital. Here they improve greatly under suitable care and diet; but it should be remembered that they ought to be placed in a sunny, well-ventilated ward and kept as far as possible from contact with those suffering from pul monary tuberculosis. Unfortunately what is gained in hospital is soon lost again at home, in all moderately severe cases. As with the phthisical so with the diabetic; we have to admit that his treatment in the wretched conditions under which he lives is a thankless and desperate task. His prospects of improvement, or at least of re maining for a long period in a tolerable state, are, under otherwise identical bodily conditions, in proportion to the size of his purse. Poor patients, as a rule, wander from the house to the hospital and from the hospital back to the house, until, after a not very long period, they succumb to exhaustion, coma, or some intercurrent disease.
When the patient's circumstances permit of a free choice, the physician must often energetically oppose his desire to travel about, to go from cure to cure, from spa to spa, to try new places. Other wise the patient will become a restless, whimsical "crank," a nuisance to all about him. But the medical adviser may profitably recom mend a sensible, well-planned change of residence; for example, it is advisable for a diabetic with marked glycosuria to take up his abode permanently in some mild climate.
The patient should be urged to continue his usual occupation as long as possible, although his duties must often be lightened. Once a year, if possible twice, a tolerably long rest from work should be taken, and during this period, according to circumstances, he should undergo a dietetic treatment with abstinence from carbohydrates (see below), take a simple pleasure trip, or visit some health resort. If neither a strict dietetic regimen nor a course of mineral waters is decided upon, the patient should not at any rate visit any of the large cities. A stay in the country, in the hills, or at some mild sea side resort is under all circumstances to be preferred. The more the
patient avoids enclosed places and the more the climatic conditions permit of reclining, sitting, and walking about in the open air, the greater will be the benefits of the trip.
There are still many points to be taken into consideration. Trav elling about from place to place is to be avoided; a long stay in one locality under the same external conditions is far preferable. In the choice of this locality regard must be had to the fact that the proper nourishment of the patient demands a variety and good quality of food, and quarters where the table is not good are to be avoided. Where no special indications exist by reason of complicating diseases, the choice of a place suitable for the diabetic is a large one. He should always keep away from clamp and cold localities, especially from the seashore where the climate is raw, and from forest resorts where there is little sunlight and much moisture; but a warm and sheltered sea-coast is admirably suited to the requirements of all suf ferers from diabetes. Even long sea-voyages at a proper time of the year may be readily permitted.
Young and middle-aged patients will derive much benefit from a stay in the mountains. A visit of three or four weeks' duration in some sunny Alpine resort at an elevation of 1,000 to 1,500 metres (3,000 to 5,000 feet) is often of very great service, especially for those who are at the same time neurasthenic and ancemic, but in general for still fairly robust individuals with a mild form of glycosuria. For the elderly and those whose strength is failing, for patients with glycosuria of considerable or great intensity, and for those with a tendency to gout, more moderate altitudes, under 1,000 metres, should be selected; especially is this advisable when signs of arterial disease or cardiac weakness are present. The only danger of a stay in the mountains is that the patient is tempted to walk too much and to over tax his strength; he should therefore still be kept under medical con trol. In many cases a stay in the mountains may be taken advantage of to institute a milk-cure--not that milk should be taken to the ex clusion of everything else, but that a certain portion of the nutritive necessities should be met by this fluid (see below). This mode of nourishment is well suited to all patients with the milder forms of diabetes, especially young and very old persons. Even when the glycosuria is moderately severe, the milk cure may advantageously be prescribed for a time, for example after a strict fat-and-flesh diet has been maintained for a certain period.