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Sugar in the Urine - (Diabetes).Symptoms.-The subject of this disease is usually a sufferer from impaired health for some time before the true nature of the diffi culty is ascertained or even suspected. The first symptoms are indigestion, constipation, loss of flesh and strength, thirst and capri cious appetite, sometimes amounting to voracity. After a time the first suspicious symptom makes its appearance ; the patient observes that the acts of urination are more frequent, and that the quantity of urine passed at a time is considerably greater than before. The urine is usually clear and pale, and it emits a sweetish odor. As time elapses the calls to urinate becomes so frequent as to consti tute an annoying symptom ; the patient's rest is seriously disturbed in consequence. In some cases the urine causes a stinging, hot sensation as it passes along the urethra, and soreness of the skin - eczema - is frequently induced around the genitals, especially in women. This complaint is aggravated, perhaps in part caused by the intense itching of the skin-a desire which is in itself a most annoying feature of the disease, especially to females. The quantity of urine is sometimes increased to an enormous extent; instead of three pints, the average amount of a healthy adult, ten, twenty, thirty, and even forty pints may be passed in the twenty-four hours. The urine contains sugar, as can be demonstrated by the proper chemical tests ; not the ordinary table or cane sugar, but a substance which is identical with the sugar of grapes, and is hence termed grape sugar. The quantity of sugar passed in twenty-four hours may vary from half a pound to six or eight pounds. Meanwhile other symptoms quite characteristic of the disease are developed. The skin becomes dry and harsh ; the patient loses flesh and strength; the appetite is usually voracious - a feature which, coupled with the progressive loss of flesh, should alone arouse suspicions as to the nature of the disease. Thirst, too, is a prominent symptom, as can be readily understood when we consider the enormous quantities of water excreted in the twenty-four hours. Digestion usually remains good until the disease is far advanced ; in exceptional cases obstinate vomiting occurs. The teeth are often loosened, and may fall out spontaneously ; the gums are often soft and bleed readily upon pressure. This condition of the mouth is apt to make the breath unpleasant and fetid. In other cases there is a sweetish odor about the breath which is quite characteristic. Sometimes, too, diabetic patients are troubled with a series of boils, which torment the individual for months at a time. In fact, one who is troubled by numerous and frequently recurring boils should submit his urine for examination, since this is occasionally one of the earliest manifestations of the disease. Various dis eases of the skin, and sometimes ulcers of the lower limbs, are accompaniments of the disease. The eyes, too, are the subject of serious difficulties in this dis ease. At times feebleness of vision and even complete blindness may occur without any apparent disease in the eye ; in other cases a whitish opacity of the crystalline lens occurs, so that the pupil looks gray or white instead of black. This condition is known as cataract, and causes partial or complete loss of vision. The ner vous system is also affected, as is shown by dull pains in various parts of the body, especially across the loins, by dizziness and headache, and by an irritable and morose condition of the mind which sometimes culminates in imbecility. In the female the men strual flow gradually diminishes, and finally ceases entirely ; in both sexes the sexual appetite is impaired or lost. The progress of the disease is usually slow and gradual; it has been known to exist for many years before terminating fatally, yet other cases occur in wThich death results after a few months; this fatal result at an early date is commonly due to some other affection which has been implanted upon the diabetic patient. It has been observed that such patients are not only especially prone to certain diseases, especially of the lungs, but also that they mani fest but little power of resistance to disease. A diabetic patient who acquires pneumonia or consumption rapidly succumbs to the disease. Cause.- Up to the present time, we are in ignorance as to what part of the body is at fault in this disease. We are accus tomed to think of it among the diseases of the kidneys, though of course the kidneys are not at fault, since they are merely elimi nating from the blood materials which cannot be used in the system. It seems extremely probable that the root of the disease lies in a fault of the brain, for it is well known that by injuring a certain part of the brain in an animal it is possible to induce a flow of sugary urine. Moreover, it has been repeatedly observed in post mortem examinations of diabetic patients that this particular part of the brain was the subject of disease or injury. As to what should cause this affection, we can as yet only speculate. It has been ascribed to exposure of the body to cold and wet, to the abuse of alcoholic liquors, to sexual excesses, to overwork, and to violent mental emotion. Doubtless these pre dispose to the development of diabetes, as well as to other diseases of the nervous system, yet that they are alone sufficient to cause the disease is not as yet established. Diabetes usually results fatally, yet recoveries do undoubtedly occur. While we are not acquainted with any plan of treatment which can arrest the disease after it has endured for a considerable time, yet much can be done if treatment be begun in the early stage of the disease. Diabetes usually occurs between the ages of 30 and 50 years, and about twice as often in males as in females. With reference to the prospects for life, Dr. Roberts says, in this connection : " The younger the patient, the less hope of ultimate recovery. All the cases under 20 which I have seen have eventu ally succumbed. In persons advanced in years, the appearance and persistence of sugar in the urine is a far less serious affair; it may continue for many years, in oscillating quantity, with fair preservation of health. It is a curious circumstance that diabetes in corpulent persons is very markedly less formidable than in those of spare habit. Saccharine urine, without excess in the quantity of urine, is far less serious than when the urine is abundant. Cases which can be traced to mental anxiety and to injuries, appear to be somewhat more hopeful than those for which no tangible cause can be assigned. " Treatment.-The treatment of diabetes must consist chiefly in such regulations of the diet as shall avoid the introduction into the system of articles containing sugar or starch. It has been shown by long experience that this is the only method which affords even partially satisfactory results. Among medicines nothing has as yet been found which can be relied upon to cure or even to arrest the disease. There are, it is true, several remedies which diminish quite markedly the amount of sugar passed with the urine ; and on this account these remedies have been extolled as efficient agents in controlling the disease. Yet observation shows that although the amount of sugar may be diminished under the use of certain drugs, yet the disease, the steady decline of the patient's health, is not thereby materially retarded. The best standard for estimating the progress of the disease is found to be, not the quantity of sugar present in the urine, but the weight of the patient. So long as the patient's weight steadily decreases the disease is progressing, no matter what be the quantity of sugar passed in the urine. Among the remedies which have found most favor the follow ing prescriptions may be given : Bicarbonate of soda, - - - - 20 grains. Bromide of potassium, - - 15 grains. Water, ------ 1 ounce. To be taken three times a day. If preferred, the powder may be taken dry without the water. Salicylic acid, in doses of five to ten grains, and carbolic acid, in one drop doses taken in water, have also been employed. Among the most frequently used remedies are opium, ergot, and tannin. These may be combined as follows : Opium, ------ 10 grains. Tannic acid, ----- 3 drachms. Tincture of ergot, 6 ounces. Mix, take a teaspoonful four times a day. If this mixture be rejected by the stomach, the opium itself may be administered alone in doses of one-half a grain three times a day, gradually increased to one or two grains at a dose. If no preparation of opium can be well taken, belladonna may be sub stituted. This may be given in the shape of the tincture, fifteen or twenty drops of which may be taken three times a day ; or a pill may be given after the following formula : Extract of belladonna, 8 grains. Extract of nux vomica, - - 6 grains. Extract of ergot, - - - 4 grains. Mix, and make twenty-four pills ; let one be taken before meals. One of the troublesome symptoms which may require treat- rfirient is the thirst. This can sometimes be relieved by the use of lemonade, without sugar, or of citric acid ; or fifteen drops of diluted phosphoric acid may be given in water as often as required. The chief reliance in treatment is, however, upon the regulation of the diet. This regulation includes the exclusion of sugar and articles containing it, as well as the avoidance of starch ; for during digestion starch is converted into sugar and enters the blood as such. The diet may, therefore, include meats of all kinds, excepting liver. Butter, cream, cheese and eggs may be given, but milk should be avoided. Among the vegetables, lettuce, cabbage, celery, onions and spinach may be taken, as they contain but a small amount of starch. Tea and coffee may be taken, though they should be sweet ened not with sugar but with glycerine. If it be necessary to give wines or liquors, those should be preferred which contain the least sugar ; these are claret, sherry and whisky. An important point in the diet of those patients is variety, both in the articles selected and in the mode of their preparation. The stumbling block in prescribing a diet for diabetic patients consists in the want of bread; for no matter how great the variety of other food, the patient has a longing for bread which finally be comes irresistible. To supply this deficiency much ingenuity has been employed, and bread, or rather mixtures which are by courtesy called bread, have been made out of a variety of substances, even out of almonds. That which has secured the most favor among medical men is the bran bread, devised by Dr. Camplin, of London. This gentleman was himself a sufferer from diabetes, and ascribes his recovery for a period of ten or twelve years to the use of certain dietary measures, among them the use of this bread. His recipe is as follows : " Take a quantity of wheat bran, boil it in two successive waters for a quarter of an hour, each time straining it through a sieve ; wash it well with cold water on the sieve until the water runs off per fectly clear. Squeeze the washed bran in a cloth as dry as possible, then spread it thinly on a dish and place it in a slow oven. When it is perfectly dry and crisp it is lit for grinding into fine powder. " The bran thus prepared is ground in the mill for the purpose, and must be sifted through a wire sieve of such fineness as to require the use of a brush to pass it through, and what remains on the sieve must be reground till it is sufficiently soft and fine. " To prepare a cake from it, take of this bran powder three or four ounces, three new-laid eggs, one and a half or two ounces of butter and about half a pint of milk. Mix the eggs with a little of the milk and warm the butter with the remainder of the milk ; stir the whole well together, adding a little nutmeg and ginger or any other spice that may be agreeable. Bake in small pans (patty pans, which must be well buttered) in a rather quick oven for about half an hour. The cakes, when baked, should be a little thicker than a captain's biscuit. " These cakes may be eaten with 'meat or cheese for breakfast, dinner or supper, and require a free allowance of butter ; and the cakes are more pleasant if placed in the oven a few minutes before being placed on the table. " When economy is an object, when a change is required, or if the stomach cannot bear butter, the cakes may be prepared as fol lows : " Take of the prepared bran four ounces, three eggs, about twelve ounces of milk, with a little spice and salt ; to be mixed and put into a basin which has been previously well buttered. Bake it for about an hour ; the loaf may be then cut into convenient slices and toasted when wanted ; or, after slicing, it may be rebaked and kept in the form of rusks. " Nothing has yet been discovered of equal utility to these bran cakes, combining as they do moderate cost with freedom from starch and sufficient pleasantness as an article of food." Various other plans of diet have been proposed, but none of them seem entirely satisfactory. Thus, an exclusively animal diet has been observed in numerous cases with the effect of certainly diminishing rapidly the amount of sugar in the urine, but such a diet cannot be long endured ; and, indeed, it is not reasonable to deprive man of vegetable food. The same remarks apply to another exclu sive diet which has been used apparently with success in several cases by a well-known British physician. This consists exclusively of skint inilky six, eight or ten pints of which may be given in twenty-four hours. If the patient is to be improved by this diet, the improvement will be manifest within a week. Others have sub stituted knmyss for the skim milk in this plan of treating diabetes. One of the most important items in the treatment of this, as in most other diseases of the nervous system, is a complete change in the habits of life, whereby the body may be placed under the best possible conditions for health. Change of scene, including abundant amusement and recreation, have often improved these cases won derfully, even without very rigid attention to the dietary laws above prescribed. An eminent French physician, Trousseau, has found the best results from residence in the country combined with a lib eral diet of fruits and of those vegetables which do not contain much starch. He has even allowed such patients small quantities of bread, and believes that they derive benefit from its use not withstanding the increase in the amount of sugar in the urine. 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