ADDENDUM . 569 



on the integrity of the insular apparatus of the pancreas. Evidence is brought 

 forward that at least one form of diabetes insipidus is associated with cir- 

 culatory disturbances of the pancreas (how is this diabetes insipidus to be 

 correlated with the polyuria approaching a diabetes insipidus that occurs in 

 certain hypophysial affections?), but that is not associated, as is diabetes 

 mellitus, with any evidence of insular involvement. 



It is probable that the good results of oats on diabetes are due to the fact 

 that rest is provided for 'the pancreas. According to Allen: by reason of 

 freedom from harmful stimuli from the intestine, also perhaps by reason of a 

 diminished labor of external secretion, and possibly by reason of a mild 

 beneficial stimulation in a positive sense, the pancreas is able to perform 

 its function of internal secretion more efficiently, and the diabetic condi- 

 tion is correspondingly benefited. This explanation agrees with facts in the 

 literature. 



On the strength of his experiments, Allen has recently advocated and 

 practised with good results a method of treatment, which consists in absti- 

 nence from food and drink, doses of alcohol (not absolutely essential), and 

 the administration of sodium bicarbonate. This regime is continued for 

 twenty-four to forty-eight hours after the absolute disappearance of sugar 

 from the urine (which occurs in from one to eight days), when it is replaced 

 with 10-40 gm. of carbohydrates in the form of steamed green vegetables 

 (gradually increased), together with fats and proteins (which are also in- 

 creased gradually). As soon as sugar reappears in the urine, another fast 

 day is instituted. Stengel, Jonas and Austin while advocating Allen's treat- 

 ment for severe .cases of diabetes showing high ketonuria, have had good 

 results in the milder cases, those in which Allen's treatment is perhaps too 

 severe, by placing the patient on a carbohydrate-free diet, then adding green 

 vegetables to this diet, and later allowing carbohydrates, below the limits of 

 tolerance. The days of the carbohydrate-free diet are to be spent in bed, 

 at rest. 



A recent study of the hypophysis in diabetes mellitus by Fry has shown 

 that it exhibits definite histological changes. It contains adenomatous 

 masses of eosinophile cells, and there is colloid invasion of the anterior lobe, 

 together with area of cellular degeneration in this part of the gland. 



REFERENCES 



Allen (F. M.). Studies concerning glycosuria and diabetes. Boston, 1913, N. M. 

 Leonard. 



Allen (F. M.). Studies concerning diabetes. Jr. Am. M. Ass., Vol. LXIII, No. 

 n, Sept. 12, 1914, p. 939-943- 



Stengel (A.), Jonas (L.), and Austin (J. //.). The treatment of diabetes mellitus 

 with special reference to Allen's method. Pennsylvania Medical Journal. Vol. XIX. 

 No. 4, Jan. 1916, p. 283287. 



Fry (H. J.B.). The pituitary gland in diabetes mellitus and disorders of the glands of 

 internal secretion. The Quarterly Journal of Medicine, Vol. VIII, No. 32, July, 1915, 

 pp. 277-299. 



