PRACTICAL THERAPY 101 



sidered ! No liqueurs ! These, and often the so-called " bitters," contain enor- 

 mous quantities of sugar. 



CofEee and tea may be looked upon as harmless for the diabetic. Cocoa 

 contains (without admixture) 15 per cent, of starch, and must be estimated 

 accordingly. 



If it is desirable to increase the menu still further, manufacturing chem- 

 ists have placed many preparations on the market for the diabetic. The physi- 

 cian should assist the diabetic to make his life as comfortable as possible, 

 yet the medical adviser must never allow the reins to be taken out of his 

 hands ; unfortunately, this often occurs. 



Which diabetics are to be treated at a hospital (of course, one well appointed 

 with reference to diabetic treatment), which may be treated at home, and 

 which should be sent to Carlsbad, Vichy, Neuenahr, etc.? 



The very mild cases, in which only sugar, potatoes and beer must be 

 restricted in order to make the urine free from sugar, do not need hospital 

 treatment, though it is advisable for them to undergo each year, or at least 

 from time to time, a course of treatment at any one of the previously men- 

 tioned bath cures. Frequently these cases occur in elderly persons, in whom 

 a cure of this sort is indicated on account of complicating arteriosclerosis, 

 disease of the liver, or gout. 



It is often wise in such cases, after sugar has been discovered, to send 

 them at once to Carlsbad; they return free from sugar, and with a greater 

 docility and willingness to carry out "further dietetic treatment. 



If the case is severe, so that it is necessary to reduce to a minimum the 

 allowance of bread in order to free the urine from sugar, the question whether 

 the patient should be treated at home or in a hospital must be settled by the 

 individual circumstances. If the patient is sensible, reliable, and in easy 

 circumstances, treatment at home should be tried, but we must not be too 

 optimistic as to results; as soon as signs of unreliability on the patient's part 

 are detected, hospital treatment should be urged. If, under treatment at 

 home, the sugar has been considerably reduced (to about 20-30 grams a day), 

 we may send the patient to Carlsbad, whence he often returns sugar-free, and 

 he may then more easily than before be kept aglycosuric ; but this applies only 

 to the mild cases. 



Every diabetic whose case is not very mild, or who is not reliable or well- 

 to-do, as well as every moderately severe and every severe ease (that is, every 

 patient from whose diet carbohydrates must be largely or wholly eliminated, 

 if only for a time), must, to begin with, have hospital treatment. In a hos- 

 pital we find out how much can be attained, and we determine the diet on 

 which the patient will become sugar-free, or will have, at least, only a gly- 

 cosuria of definite and known intensity. After this he must remain under 

 supervision, and if the glycosuria again shows a progressive tendency he should 

 return to the hospital. Poor patients with severe diabetes need hospital treat- 

 ment at least every year, of six or eight weeks' duration the first year, and 

 reduced, if necessary, to four weeks the next year. 



In the author's experience, " bath cures " rarely benefit these patients, and 

 often do harm. 



