ms may become swollen. Constipation is the rule. The skin
is dry and harsh and sweating rarely occurs. The temperature is under
normal. In spite of the enormous amount of food eaten a patient may become
rapidly emaciated. Patients past middle life may have the disease for
years without much disturbance of the health; on the other hand I have
seen them die after that age. Progress is more rapid the younger the
person. Death usually occurs from coma of diabetes. This is most common in
young patients.

[CONSTITUTIONAL DISEASES 329]

1. There is a sudden onset after exertion of weakness, feeble pulse,
stupor, coma, death in a few hours.

2. Sudden headache, coma, death in a few hours.

3. After nausea, vomiting or a lung complication, there are headache,
delirium, abdominal pain, rapid labored breathing, sweetish odor of the
breath, stupor, rapid feeble pulse, coma and death within a few days.

Recovery.--Instances of cure in true diabetes are rare.

Treatment. Preventive.--The use of starchy and sugary articles of diet
should be restricted in families with a marked disposition to this
disease. Sources of worry should be avoided and he should lead an even
quiet life, if possible, in an equable climate. Flannel and silk should be
worn next to the skin, and the greatest care should be taken to promote
its action. A lukewarm and, if tolerably robust, a cold bath should be
taken every day. An occasional Turkish bath is useful.

Diet.--Let the patients eat food of easy digestion, such as veal, mutton
and the like, and abstain from all sorts of fruit and garden stuff. In
Johns Hopkins' Hospital these patients are kept for three or four days on
the ordinary ward diet, which contains a moderate amount of
carbo-hydrates, in order to ascertain the amount of sugar excretions. For
two days more the starches are gradually cut off. They are then placed on
the following standard non-carbohydrate diet.

Breakfast: 7:30, six ounces of tea or coffee; four ounces of beefsteak,
mutton chops without bone, or boiled ham; one or two eggs.

Lunch: 12:30, six ounces of cold roast beef; two ounces celery, fresh
cucumbers or tomatoes with vinegar, olives, pepper and salt to taste, five
drams of whisky with thirteen ounces of water, two ounces of coffee
without milk or sugar.

Dinner: 6:00 P. M., six ounces of clear bouillon; seven and a half ounces
of roast beef; one and one-half drams of butter; two ounces of green salad
with two and a ha