DIABETES MELLITUS.
Dietetic treatment still remains the great resource in the routine of diabetes, drugs being of little avail save for correcting complications. The chief object should be to furnish for the patient a dietary containing the least amount of sugar or starch, or substances easily convertible into sugar. But no two cases of the disease will thrive best upon an exactly similar diet table, and in this lies the secret of treating the affection successfully. By daily estimation of the amount of sugar voided in the urine, and by weighing the patient at short intervals, the diet may be adjusted from time to time, so as to make life comfortable, and in many cases lead to a complete and permanent cure. The amount of sugar ex creted will often convince the physician that some articles can be taken with safety and benefit by one patient which may seriously increase the disease in another; hence each case must be scientifically treated upon its own merits and a routine cut-and-dry dietary is inadmissible.
Roberts's method of daily estimating the amount of sugar excreted can be entrusted to any patient of average intelligence. About 4 oz. of the saccharine urine are put into a 1a oz. bottle, and the bulk of a small walnut of German Yeast is added to it. The bottle is then covered with a nicked cork (which permits the escape of carbonic acid), and set aside on the mantelpiece or other warm place to ferment. Beside it is placed a closed 4 oz. phial filled with the same urine without any yeast. In about 24 hours the fermentation will have ceased, and the scum cleared off or subsided. The fermented urine is then decanted into a urine glass and its specific gravity taken. At the same time the density of the un fermented urine in the companion phial is observed, and the " density lost " ascertained. Fermentation is generally complete in about 18 hours, if the locality be sufficiently warm; and it is desirable to remove the two phials into a cool place two or three hours before the densities are taken.
The difference between the S.G. before and after fermentation will give approximately the number of grains of sugar in each fluid ounce of the urine. Thus, suppose that the unfermented sample by the urino
meter registers S.G. 1040, and that the fermented sample registers S.G. 'ow, the urine for practical purposes may be regarded as containing 3o grs. of sugar per fluid ounce. By multiplying the total number of ounces passed during the twenty-four hours by 3o, the total amount of sugar in grains will lie easily obtained.
It is advisable, before any serious reduction is attempted in the intake of carbohydrates, to examine the urine, testing with perchloride of iron in order to insure that no diacetic acid is present; should this or acetone or hydroxybutyric acid be present the dietetic change should, owing to the danger of coma, be limited to the exclusion of sugar till the acid dis appears. The fall in the pressure of CO,, in the lung alveoli should be determined by Fredericia's tensimeter when acidosis is suspected, where the urinary examination is not conclusive.
The total urine should be collected for 1 or 2 days before dietetic treatment is commenced in order to demonstrate the degree of severity of the affection. Sugar is then prohibited and carbohydrates restricted, and in a few days entirely stopped. If the sugar disappears altogether from the urine, after a week or two of this treatment, a little starchy food may he permitted in gradually increasing quantity till sugar returns in order to test the patient's power of assimilating carbohydrates. These should then be systematically administered in amount short of producing glycosuria. Mild cases require no further treatment, and the disease may entirely pass away under a properly restricted diet.
If, however, the sugar persists in the urine in spite of the absence of all starch and sugar in the food, the case is a severe one, and will tax the resources of the physician to the utmost. The prohibition of both starchy food and sugar must be still enforced, and proteids may also require diminution. Even in this serious type of the disease if the patient con tinues to lose weight and if diacetic acid appears in the urine a small quantity of bread must be allowed.