Alkaline waters perceptibly diminish the sugar in the urine. Their use should consequently not be restricted, unless the patient be very much debilitated. Vichy water, taken at the springs, is particularly recommended for fatty dia betics.
Carlsbad water also appears to be use ful.
For diabetic patients who are already somewhat cachectic, Bourboule water, which contains considerable arsenic, is preferable.
If the kidneys are inactive, Contrexe ville should be recommended.
Independently of the use of mineral waters, it is better not to neglect baths.
Hydrotherapy may be advised for dia betic patients who are still young ancl, as a rule, lotions of cold salt water in mer, and warm baths followed by friction in winter. At Aix warm douches and massage are resorted to. Generally speak ing, massage is always useful for patients whose weak condition does not allow of prolonged muscular exercise. Active movements, if they do not fatigue the patient, are preferable to the passive movements. Warm climates have a fa vorable influence; when the patients are not greatly debilitated, mountain-air has also been recommended.
Physicians are sometimes consulted as to the advisability of allowing the use of saccharin in diabetes, to replace the taste of sugar.
I have not seen any bad effects follow ing the use of saccharin when employed in small doses. An equal quantity of bicarbonate of soda should be added.
In diabetic coma the following intrav enous injection should be used:— 13, Chloride of sodium, 1 drachm.
Bicarbonate of sodium, 2 1/2 drachms.
Distilled water, 1 quart.
A strict milk diet should be instituted at once, and the elimination of poisons should be assisted by the administration of saline purgatives. Should the heart be feeble or irregular, full doses of digi talis and ergotine are to be given.
Results of observation on treatment of diabetic coma by subcutaneous or in travenous injections of bicarbonate and chloride of sodium. 1. Alkaline injec tions have given incontestable results in diabetic coma. 2. These injections are best intravenous, the subcutaneous method being too slow. 3. If possible, intervention should precede coma, as Le pine points out. When the patient
shows progressive aggravation, a. feeble pulse, lowered Urine, SiOW respiration, with increasing dyspnwa, nausea, and vomiting, an intravenous alkaline infu sion of from :300 to 375 grains of bicar bonate of sodium with 112 '/, grains of chloride of sodium to 1000 parts of water is indicated. 11,1. A. Berson (Jour. des Sci. Med. de Lille, Aug. 6, '98).
Nineteen cases of diabetic coma treated by saline injections, mostly published in Germany and England, collected; of these only one, a case of Lepine's, re covered from the coma; but few or none appeared to have received such copious injections. Roget and Balvay (Lyon Med., Jan. 8 and 15, '99).
If there is any reason to fear coma, an energetic use of alkalies should be prescribed. In these circumstances an hypodermic injection of strychnine must be given, and 1/, ounce of soda bi carbonate should be administered as an enema in hot water, and repeated every hour until improvement takes place. Saundby (Practitioner, July, 1900).
Good results follow the prophylactic administration of sodium bicarbonate: 15 to 30 grains daily. In the fully de veloped diabetic coma it has proved a failure. The use of calcium carbonate has been productive of good results. H. Stern (Jour. Amer. Med. Assoc., Dec. 8, 1900).
DIGITALIS.—Digitalis is indigenous to Great Britain, Ireland, and many parts of Europe, where it grows wild on gravelly or sandy soils in young planta tions, at hedge-sides, and in hill-past ures. It has been introduced into America, but is more grown as an orna ment to gardens and in hot-houses than for commercial purposes, and, moreover, it is claimed that it is not so active medicinally as that obtained abroad. Digitalis purpurea is the official plant, though some pharmacopccias take cog nizance of other forms, notably D. Am bigua, Murr., which was extensively ex ploited by Paschkis a few years ago; and all seem to possess much the same gen eral activity, though purple digitalis alone has been at all carefully studied.