Treatment by Drugs.—Though no substance has yet been discovered which exercises a specific action upon diabetes, many drugs are at the physician's disposal which exert some influence over the glycosuric process.
Opium and its alkaloids are the most reliable of these. Crude opium can be tolerated in very large doses. The extract, in doses of I gr. three times a day, may be started with, and the dose need not generally be pushed beyond 3 or 4 grs. Morphine and Heroin may be employed in proportionately smaller doses. Codeine is less likely to cause disturbance from its narcotic action, being weaker than morphine; the good which opiates unquestionably accomplish in diabetes is altogether independent of their anodyne properties. Codeine may simply be regarded as weak morphine. Fraser found that the therapeutic value of i gr. morphine daily in diabetes exceeded that of 15 grs. codeine. The dose of codeine may commence with !, gr., increased to 2 or 3 grs., three or four times a day. It will be found not to interfere with diges tion, and is always well borne. Under its influence the amount of sugar generally markedly falls in a few days.
Where the codeine treatment with strict diet fails, any of the following drugs may be tried. The list might be much further lengthened out, as nearly every known drug has been experimented with in the manage ment of this serious ailment.
Antipyrine is next in value to opium and its alkaloids, and some observers state that it possesses more influence over the diabetic process than these agents. It must be given in full doses—i.e., 5 to so grs. 4 or 5 times a day, to be suspended as soon as any albuminuria appears.
Aspirin, Salol, Salicylates, Phenacetin, Antifebrin, Exalgine, and the other members of the same class, appear to have a similar but less certain effect. Belladonna or Atropine in full doses has been highly praised.
Carlsbad Waters drunk freely at Carlsbad, in conjunction with strict dietetic treatment, till the urine becomes alkaline, with or without the opium or morphine treatment, have given satisfactory and lasting benefits in many cases, but the bread substitutes procurable at Carlsbad are very unsatisfactory as a rule.
Vichy, Neuenahr, Fels, Contrexeville, and Vats are favourite resorts for treatment; and it is insisted by those at the spas that the drinking of the waters at their source is much more efficacious than undergoing the treatment at home.
Alkalies have been much used, and the good effect of the Vichy, Vals and Carlsbad waters is doubtless owing to their presence. The alkaline carbonates and ammonia phosphate, the citrates of soda and potash and free ammonia, or its carbonate or acetate, have been pushed, but appar ently with very little influence upon the amount of sugar.
Saccharin and Glycerin are only of use as substitutes for sugar. Large quantities are liable to upset the stomach, and by leaving a permanent sweet taste in the mouth may destroy the appetite.
Uranium Nitrate, Strontium, Ozonic Ether, Permanganate of Potas sium and Peroxide of Hydrogen have failed signally in the hands of most physicians. Bromides, Cocaine, Arsenic, Picric Acid, Calcium Sulphide, Lactic Acid, large doses of Quinine, Ergot, Benzosol, Camphor, Magnesium Salts, Lithia Salts, Creosote and Jambul have been reported to have effected cures, but in other hands have almost always proved useless.
Papain, Pepsin and Rennet have been used and found wanting, and the same may be said of the plan of giving large doses of Yeast.
The existence of pancreatic diabetes has directed attention to the use of Pancreatic Extracts, and occasionally good results have been reported. Trypsin should always have a trial; it must be given in Keratin coated capsules or pills in order that it may pass unaltered through the stomach. Amylopsin, Pancreatin, and other preparations of the gland may he given in a similar manner. Secretin prepared from the duodenal mucosa is being tried with the view of stimulating the action of the pancreas, but the reports are unsatisfactory.
Massage and Electricity, Cod-Liver Oil, Iron, and Laxatives of the Castor Oil or Cascara type, are generally useful in combating symptoms or complications arising during the disease.