AND DIABETES 173 



necessary when a patient is being fed only by the 

 rectum. 



The old-fashioned treatment of rheumatic fever, 

 by combining alkahes with the salicylates, will 

 prevent acidosis from the use of the latter. 



The Prevention of Diabetic Coma. — In the treat- 

 ment of a severe case of diabetes the physician is 

 on the horns of a dilemma. To relieve the ordinary 

 sjanptoms of diabetes, which are due to the excess of 

 sugar, and to enable the patient to make the best 

 possible use of what little internal secretion of the 

 pancreas he has left, the indications are to reduce or 

 exclude the carbohydrates from the food, replacing 

 them by fats and proteins. To prevent the formation 

 of the abnonnal acids from fat in the absence of 

 available sugar, the indications are to reduce the fats 

 and to supply carbohydrates. The one has to be 

 weighed against the other. 



The general treatment of diabetes is not dis- 

 cussed here. The writer has neither the space nor the 

 special experience which would be necessary. We 

 shall confine ourselves to the physiological problem 

 of averting diabetic coma. 



Let it be an axiom that no case of diabetes is 

 suddenly to be put on a carboh3'drate-free diet on 

 first acquaintance. Particularly would this be dan- 

 gerous if he already had diacetic and /3-oxybutyric 

 acids in the urine. If they are absent, that is, if there 

 is no red colour on bringing the urine into contact with 

 ferric chloride, a strict diet will be safe and valuable. 



It would be going too far to say that severe Hmita- 

 tion of the carbohydrates is never indicated when 



