92 DIABETES MELLITUS 



(that is, of many cases of it). We now recognize that it is oxybutyric acid 

 which produces true dyspneic coma ; that is, an acid coma, i. e., a coma which 

 is an expression of an oyer-acid condition of the blood, and this hyperacidity 

 is due to the presence of a large amount of oxybutyric acid (100 grams or 

 more), which is formed and which enters the blood within twenty-four hours. 

 This fact, and also the danger that by a too rapid withdrawal of carbohydrates 

 one may cause acidosis, as well as coma, renders it necessary for the physician 

 to be familiar with this process. 



V. PRACTICAL THERAPY 



Every therapeutic measure is to be used, but after the dietetic treatment mineral 

 waters alone are of much service. Prophylaxis; obesity and diabetes mellitus. From 

 the point of view of dietetic treatment, three forms of diabetes are to be distinguished: 

 the medium severe, the mild, and the severe. The medium severe cases, their diagnosis 

 and their importance in practice. The aim of treatment in cases of each form. For the 

 proper dietetic treatment of every case a quantitative and qualitative estimate of the 

 entire dietary is necessary. Preliminaries of treatment : Quantitative regulation without 

 limitation; its result. Further steps toward the abolition of glycosuria and improve- 

 ment of tolerance, maximal reduction of albuminous food and the twenty-four-hour fast. 

 Diet lists for the diabetic; there are no foods absolutely permissible. Carbohydrate 

 nutrition: Bread, cereals, vegetables, fruits; calculation of their relative advantages 

 and dangers. Meat, fish, and eggs. Fatty foods. Sausage, cheese, bacon, butter, oil, 

 cream. Drinks : Milk, wine, beer, whiskey, tea, coffee. Artificial foods. Hospital treat- 

 ment. Dispensary treatment and " bath-cures." Disturbances and dangers arising during 

 the treatment of diabetes. 



I wish to speak first and chiefly of the dietetic treatment of diabetes, but 

 of course every other therapeutic measure is to be welcomed and utilized. It 

 should not be forgotten that since almost any disturbance of a diabetic's gen- 

 eral health tends to aggravate the underlying disease, common sense teaches us 

 to treat as carefully as we can any minor ailment from which the patient 

 may suffer from time to time. If he is syphilitic, carefully planned specific 

 treatment should be used, as also quinin. in malaria, digitalis in circulatory 

 disturbances, and appropriate treatment for nervous affections. By such treat- 

 ment we may succeed in improving but, unfortunately, very rarely in curing 

 the diabetes — that is to say, the glycosuria and the other symptoms which 

 may be dependent on it. 



It is just as evident that the treatment of diabetes must always be a 

 treatment of the entire organism, i. e., that the mode of life of the patient 

 must be properly arranged in all respects. Prom this standpoint, there are 

 two factors to be considered — mental and emotional rest, and sufficient 

 muscular exercise; I say sufficieni muscular exercise, but no more, for too 

 much readily increases the glycosuria. 



The main point, however, the alpha and omega in the care of the diabetic, 

 is the dietetic treatment; besides this, mineral water cures (Carlsbad, Neue- 

 nahr, Vichy) also play a role, but not drugs. There is scarcely a physician 

 familiar with diabetes who will resort to drugs to diminish the glycosuria. It 

 is true there are many remedies which bring this about, and among them 

 some which produce this effect without diminishing the demand for food or 



