PRACTICAL THERAPY 93 



the actual intake of nourishment. But — they act only in those cases in which 

 the dietetic treatment alone would suffice, and in which they are, therefore, 

 superfluous. During the administration of drugs (if we do use them) the 

 dietetic treatment should never be forgotten, else the case will fail to do well 

 in the long run. For a few weeks, perhaps, here and there, by the adminis- 

 tration of opium, occasionally also by the use of antipyrin and other nervines, 

 the glycosuria may be limited or even removed. Then the action of these drugs 

 ceases and glycosuria returns to its former height, sometimes even exceeding 

 it. It appears, as I have already indicated, that the tolerance of the diabetic 

 is not improved by a drug diminution of glycosuria; and even in an aghj- 

 cosuric condition, in case this is brought aiout by drugs, the patient's toler- 

 ance does not improve as it does under diet. 



That we shall ever find a specific remedy for diabetes, must be regarded 

 as quite unlikely, especially by those who, like myself, look upon the disease 

 as an expression of hereditary weakness of metabolism; at present we cer- 

 tainly do not possess such a remedy. 



We shall now proceed to the discussion of the dietetic treatment in detail. 



This method of treatment has its place not only in the care of confirmed, 

 true diabetes mellitus, but also in prophylaxis. 



In families in whom this disease is hereditary there should be great mod- 

 eration in the use of carbohydrates in any form, i. e., limitation of the sugar 

 metabolism should be made an unalterable law. But there should also be 

 moderation in eating and drinking in general. There can be no doubt that 

 habitual hypernutrition favors the outbreak of diabetes if the predisposition 

 to it exists. The cases of diabetes mellitus complicating obesity (even in 

 full-blooded individuals with arteriosclerosis) are almost all to be included in 

 this category. Alcoholism, at least that form that goes hand in hand with 

 over-nutrition, also plays a part in the etiology of diabetes. 



In individuals with a hereditary predisposition and marked obesity due to 

 over-nutrition, diabetes should always be watched for, and an occasional exam- 

 ination be made of the urine voided four hours after a breakfast in which at 

 least 100 grams of bread and about 30 grams of sugar have been consumed; 

 or, for greater certainty, a test for glycosuria alimentaria e saccharo should 

 be made, and the case should then be judged with the necessary reserve. 



In confirmed diabetes, dietetic therapy has for its object the elimination 

 of glycosuria if possible. This occurs very readily in some cases, in others it 

 is difficult, and in some it may be impossible; even when it may be accom- 

 plished, although with difficulty, there are, unfortunately, many cases in which 

 the results scarcely compensate the physician and patient for the required 

 trouble. 



The amount of energy that should be put into the treatment varies in 

 different cases, and much labor will be saved the physician and the patient 

 if this fact is recognized from the onset; on this account it is convenient to 

 divide diabetics into three groups, a method which I proposed ten years ago. 



1. The moderately severe cases. 



2. The mild cases. 



3. The severe or very severe cases. 



