TREATMENT OF COMPLICATIONS. - DIABETES 1. General Rules.—The complications are in general to be treated according to the indications which they themselves offer; this is especially true as regards surgical intervention. Still it is to be re membered that many complications resulting from the poor nutritive conditions are most successfully met by the hygienic and dietetic treatment of the glycosuria. I have dwelt upon this fact repeatedly in previous chapters. In general, therefore, the complications call for no change in the rules laid clown in the preceding sections, except in so far as they demand a more careful and strict carrying out of the same. The frequent occurrence of complications, dependent for their origin upon the primary disease, will lead us according to circum stances to institute, even in the mild forms of glycosuria, the general line of treatment suitable for the medium or severe forms. A more strict therapy is called for especially in those cases in which obstinate furunculosis, which does not yield to the most painful cleanliness and the most careful local treatment, badly healing wounds, disturbances of vision, neuralgia and inflammation of the peripheral nerves, a ten dency to gangrene, etc., are present.
The success attending these measures often puts in the shade all the results obtained by drugs, electricity, massage, and the like. While we follow the general dietary rules—restriction of carbohy drates and increase in the quantity of fat, proteicls, and alcohol—in combating the complications, we do so partly on purely empirical grounds. The improvement in the nutritive conditions certainly con tributes to the success of these measures, and perhaps also the reduc tion of hyperglycaemia may have something to do with it; but this is purely hypothetical.
The treatment of many complications has been already briefly but sufficiently considered. In some places I subjoined the therapeutic remarks to the description of the diseases themselves. See especially the sections on complicating affections of the skin and mouth. A
few points require particular mention.
2. Gastro-intestinal Catarrh.—This is a very grave occurrence and one that is full of danger to every sufferer from diabetes (see page 105). To arrest its progress as speedily as possible it is advisable to prescribe a fast for a day or two at the very beginning, a measure which experience has shown to be productive of the best therapeutic results in this form of disease. But as diabetics, who are at the same time emaciated, have very weak powers of resistance and are exposed to the danger of exhaustion through fasting, we must resort at the same time to very energetic stimulation—red wine, which contains tannin, in doses of 1+, to 2+ pints a day, diluted with boiled water to control the thirst, gives the best results in these cases. A cautious use of opium may also be made. The opposite mode of treatment with purgative doses of calomel, given with a view to intestinal dis infection, is less certain in its results, very weakening, and should be instituted only in the case of robust individuals. In debilitated patients it rather provokes what it is our object to prevent, namely, collapse and coma.
3. Operative far as possible operations should be avoided, for wounds heal badly and readily become a starting-point for widespreading gangrene. I would especially emphasize the ap plication of this rule in the treatment of boils in diabetic patients. A Nestor of German surgery said recently that he regarded it as an especially difficult task to restrain impetuous surgeons from the opera tive treatment of boils. If the knife had better be laid aside in the treatment of boils in general, it certainly should be when they occur in the course of diabetes. Furuncles disappear rapidly as a rule upon the institution of a suitable diet, combined with the local ap plication of compresses wet with a mild antiseptic (boracic acid) solu tion. Of course this warning should not prevent our resort to the knife in the case of deeper-seated inflammations, such as carbuncles and phlegmons following boils.