A relative cure (urine free from sugar on a diet containing 200 grammes of car bohydrate a day) is to be anticipated if at the onset of the disease SO to 85 per cent. of the carbohydrate consumed is completely burned up in the body. F. Hirschfeld (Berliner klin. Woch., June 1S and 25, 1900).
The progress of a not essentially grave case varies considerably according to the treatment to which it is subjected. It will bc much more benign if the patient is intelligent and docile, for there are few chronic diseases in which proper care and attention are as beneficial as in dia betes.
riming the period from 1889 to 1899, inclusive. the total number of deaths from diabetes in New York City IN'f1S 1867. H. Stein (Jour. Amer. Med. Assoc., Jan. 26, 1901).
Treatment.—In my opinion, the treat ment of diabetes should not be a atic one. The first thing to be done, and this is a precept to be applied in the treatment of any disease, is to mak-e a careful study of the patient—to indi vidualize him, as it were—to watch at tentively the effects of the treatment, and to have no hesitation in modifying the same according to the results. The diet is more important than the medicinal treatment. As in all diabetics the power of assimulating sugar is more or less diminished, it is important to limit the ingestion of hydrocarbon food. The rule is to forbid it as far as possible, and to advise a diet of meat, fish, eggs, green vegetables, particularly those which con tain but little starch, also salad, cheese, nuts, etc.
Too great a quantity of meat should be avoided.
In healthy persons submitted to diet from which carbohydrates are absolutely excluded, quantity of acetone increases progressively for seven or eight days, then becomes stationary at from 1/3 to V, grain. Diabetes complicated by ace tonuria is rather rapid in its evolution and terminates in death from twelve to twenty months in eases in which there is no gangrene. Treatment: hyperali mentation (carbohydrates in small quan tities, albuminoids in not too great abundance, fat, and alcohol); rest. Hirschfeld (Zeit. f. klin. Med., B. 2S, H. 1, 2. '95).
Some patients will not thrive on any diabetic treatment. Old people often
emaciate if carbohydrates are dropped. In the diabetes of young people carbo hydrates must be withheld as much as possible. Under proteid diet young patients live longer. Patients generally improve on milk. Jacobi (Boston 1Med. and Surg. Jour., Sept. 9, '97).
The exclusion of carbohydrates can never be complete and many patients do better on a, diet not too rigid. The pa, tient should be put on a rigid proteid diet to sec what can be accomplished. Then one article after another contain ing more or less starch or sugar may be added. watching the urine, and finally the diet may be made as liberal as the individual ease will permit. Tyson (Boston .1ed. and Surg. Jour., Sept. 9, '97).
It is of g,reat importance to prescribe definite quantities, and to test the effect of the diet by weekly body-weighing, urine-measurement, and sugar-estima tion. Carbohydrates should be excluded fIS rigidly as possible without damage to the nutrition and general condition of the patient, the case being very carefully watched. Robert Saundby (l3oston Med. and Slug. Jour., Sept. 9, '97).
A diabetic should be placed under no different conditions. of diet than are granted to the healthy person. Con elusions:— l. Sugar is always present in the blood.
2. The absence of carbohydrates from the diet does not cause a disappearance of the blood-sugar.
3. The systemic and ingested albumin is capable of furnishing sugar by its decomposition.
4. An increased decomposition of albumin due to the enforcement of a purely-nitrogenous diet means an in creased metabolism and consequent loss of body-weight.
5. The administration of carbohy drates retards metabolism.
6. The diabetic has an especial pre disposition toward increased metabolism.
7. The diabetic has not lost the power of oxidizing sugar.
S. The abnormal metabolism ,of albu min results in the production of toxic bodies.
9. The depressed nervous condition of the diabetic is especially favorable for the action of these bodies.
10. The production of toxic bodies is prevented or retarded by the administra tion of carbohydrates.