AND DIABETES 113 



on fat does not greatly increase the excretion of 

 acetone bodies, especially if the lower fatty acids in 

 butter are washed out with cold water before it is 

 taken. 



When there is severe acidosis, as evidenced by the 

 quantity of diaceticand ,3-oxy butyric acids in the urine, 

 or when there are threatening symptoms such as a 

 little tendency to drowsiness or vomiting, it is neces- 

 sary at all costs to get in carbohydrate at once. The 

 most effectual method of doing so, and one which only 

 very slightly increases the glycosuria, is to adopt 

 von Noorden's oatmeal treatment. He allows nothing 

 for three or four days but seven or eight ounces of 

 oatmeal, given as gruel every two hours, with butter, 

 eggs, and vegetable protein, tea, coffee, wine, or 

 whisky. Then for a day or two he gives nothing 

 but vegetables. 



The effect on the acidosis is usually very marked, 

 the ferric chloride reaction disappearing in a few 

 days. The glycosuria also may improve to a con- 

 siderable extent. It is extraordinary that so much 

 starch as the oatmeal contains should not make the 

 glycosuria worse, but apparently it does not do so. 

 A diet restricted to potatoes may have the same 

 beneficial effect. 



At the same time, of course, alkalies should be 

 administered, either by mouth, rectum, or intra- 

 venously. 



It is well known that diabetic coma may be pre- 

 cipitated by a surgical operation. In some cases 

 matters are so urgent that there is no time for 

 precautions to be taken to avoid this calamity, but 



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