AND DIABETES 111 



two or three pints. Sodium carbonate may be given 

 in doses of 4 drachms to the pint, again using two to 

 three pints. It should be the object of the treatment 

 to make the urine alkaline. 



In milder cases, of course, it will be possible to. 

 give remedies by the mouth. The addition of enough 

 starch or sugar to bring the daily supply of carbo- 

 hydrate up to 150 grammes (5 ounces) will effectually 

 banish the pernicious acids from the urine. Alkalies 

 are best given in the form of sodium citrate, 30 grains 

 or more three times a day, until the urine is alkaline. 



It is important to bear in mind the danger of this 

 auto-intoxication, that is, poisoning by the products 

 of the patient's own internal processes, in all the 

 numerous conditions in which insufficient food may 

 be absorbed, so that serious or fatal symptoms may 

 be warded off. Diarrhoea, wasting, or vomiting, 

 from whatever cause, should lead to an examination 

 of the urine for diacetic acid, and the same is specially 

 necessary when a patient is being fed only by the 

 rectum. 



The old-fashioned treatment of rheumatic fever, 

 by combining alkalies 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 

 symptoms 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 



