William Osler

Diet. — Our injunctions to-day aro thoso of Sydenham : " Let the patient est food of easy digestion, eiich aa voal, mutton, and the like, and abstain from all sorts of fruit and garden stuff." The carbohydrates in tho food should be reduced to a minimum. Under a strict hydrocarbonaceous and nitrogenous regimen all casc«are benefited and some arc cured. The most minute and specific instructions should be given in each case, and the dietary arranged with scrupulous care^

 It is of the first importance to give the patient variety in the food, otherwise the loathing of certain essential articles becomes intolerable, and too oft«u tho patient gives up in diegiiet or despair. It is wcl), perhaps, not to attempt the absolute exclusion of the carbohydrates, but to allow a small proportion of ordinary bread, or, belter still, as containing less starch, potatoes. It is beat gradually to cnforoe a rigid system, cutting oH one article after another. Tho following is a list of articles which diabetic patients may take :

1.  Liquids; Soups — ox-tail, turtle, bouillon, and other clear soops 

2. Lemonade, coffee, tea, chocolate, and cocoa; these to be taken without sugar, but they may bo sweetened with saccharin. 

3. Potash or soda water, and the Apoltinatis, or the Saratoga Vichy, and milk in moderation, may be used. 

4. Of animal food : 

• Fish of all sorts, salt and fresh, 

• butcher's meat (with the exception of liver), 

• poultry, 

• and game. 

• Eggs, 

• butter, 

• buttermilk,

•  curds,

•  and cream cheese. 

• Of bread : gluten and bran bread, and almond and coconut biscuits. 

• Of vegetables: Lettuce, tomatoes, spinach, chiccory, sorrel, radishes, water-cress, mustard and cress, cucumbers, celery, and endives. Pickles of various sorts. 

5. Fruits : Lemons, oranges, and currants. Nuts are, as a rule, allowable 

Among prohibited articles are the following : 

1. Thick soups, liver, crabs, lobsters, and oysters; though, if the livers are cut out, oysters may be used. 

2. Ordinary bread of all sorts (in quantity): rye, wheaten, brown, or white. 

3. All farinaceous preparations, such as hominy, rice, tapioca, semolina, arrowroot, sago, and vermicelli. 

4. Of vegetables : Potatoes, turnips, parsnips, sqimslies, vegetable marrow of all hinds, beets, corn, artichokes, and asparagus. 

5. Of liquids: Beer, sparkling wine of all sorts, and the sweet aerated drinks. 

The chief difficulty in arranging the daily menu of a diabetic patient is the bread, and for it various substitutes have been advised — ^bran bread, gluten bread, and almond biscuits. Most of these are unpalatable, and the patients weary of them rapidly. Too many of them are gross frauds, and contain a very much greater proportion of starch than represented. A friend, a distinguished physician, who has, unfortunately, had to make trial of a great many of them, writes : 'That made from almond flour is usually so heavy and indigestible that it can only be used to a limited extent. Gluten flour obtained in Paris or London contains about 15 per cent of the ordinary amount of starch and can be well used. The gluten flour obtained in this country has from 35 to 45 per cent of starch, and can be used successfully in mild but not in severe forms of diabetes." ' Unless a satisfactory and palatable gluten bread can be obtained, it is better to allow the patient a few ounces of ordinary bread daily. The " Soya " bread is not any better than that made from the best gluten flour. As a substitute for sugar, saccharin is very useful, and is perfectly harm- less. Glycerin may also be used for this purpose. It is well to begin the treatment by cutting off article after article until the sugar disappears from the urine. Within a month or two the patient may gradually be allowed a more liberal regimen. An exclusively milk diet, either skimmed milk, buttermilk, or koumyss, has been recommended by Donkin and others. Certain cases seem to improve on it, but it is not, on the whole, to be recommended.

"We are often consulted by persons in whose family obesity prevails to give rules for the prevention of the condition in children or in women approaching the climacteric. In the case of children very much may be done by regulating the diet, reducing the starches and fats in the food, not allowing the children to eat sweets, and encouraging systematic exercises. In the case of women who tend to grow stout after child-bearing or at the climeratic, in addition to systematic exercises, they should be told to avoid taking too much food, and particularly reduce the starches and sugars. There are a number of methods or systems in vogue at present. In the celebrated one of Banting, the carbohydrates and fats were excluded and the amount of fat was greatly reduced.”