Meats

I know of no meats that should not be used, except livers. Do not eat the livers of any animal, fish, or reptile.

Soups

Soups are all right to eat if made free from starch or sugar. As a rule, milk soups are allowable.

Vegetables

You may eat, plainly cooked, most of the winter and spring greens, dandelion, cabbage, horseradish, cauliflower, spinach, celery (and plenty of it), okra, lettuce, endives, pickels, kale, cucumbers, cranberries (sweetened with saccharin), and string beans, fresh or canned. Brussels sprouts are very good, and so is kohl rabi. The Soja beans have little starch. Dried, they are oily and unpleasant, unfortunately for bean-eaters. They make fair soup. I hope we may get a good green vegetable from them to eat green that will contain very little starch. Asparagus is a good vegetable and may be eaten all the year round, fresh or canned. Onions are in the doubtful list, especially the sweet Bermuda onions. Eat tomatoes, mushrooms, vegetable salads, and olives. Eat all monstarchy and non-saccharine vegetables.

Bread And Cakes

What shall we do for bread and cakes? The average person, sick or well, must have a little cake and quite a deal of bread. Use the best you can get of the gluten flours before spoken of. From these you can get your pancakes, your griddle cakes, your breakfast foods, your bread, and your pastry. In these matters tax your ingenuity, and be sparing in eating all of them. Be very careful in buying bread, cakes, and such ready made. Many of them contain too much starch and sugar. The Pure Gluten Food Company of New York City make a gluten macaroni which is quite low in starch and is the only one I have ever found much lower than ordinary wheat flour.

Condiments

Red pepper comes first. Then come black pepper, salt, and vinegar. Horseradish is preferable to mustard as purchased. Radishes are a good condiment.

Drinks Allowable

Persons may wonder why the diabetic may drink milk, which we have allowed in the diet a few pages back. In 1000 parts of fresh cows' milk we get water, 873; butter, 30; casein, 48.20; sugar of milk, 43.90; calcium phosphate, 2.31; iron phosphate, .7; potassium chloride, 1.44; sodium chloride, .24; magnesium phosphate, .42; compound of sodium and casein, .42. Milk is a complete food and will support life. There is little fecal residue, and it is often necessary to add lime water, or some alkali, to prevent coagula in the stomach when a patient is living on it alone. The scum of boiled or heated milk is from the albuminoids of the milk, and skimming this off renders the milk of course weak as a nitrogenous food. There are about one and a quarter ounces of fat in a quart of average whole milk.

Casein is the source of albumin in milk, and very much resembles animal albumin. The fat of milk, the cream, is olein, palmitin, butyrin, caproin, and caprin. It owes its peculiar odor to the latter. Butyrin is a compound ether, butyric acid, and glyceryl. Exposure to the air renders butter rancid by decomposing the butyrate of glyceryl and setting butyric acid free.

The sugar is the important matter in the milk for the diabetic to consider. It is a crystallized sugar obtained from the whey by evaporation. Whole milk contains about 5 per cent. of sugar of milk. In whole average milk Atwater and Woods give the carbohydrates as only 2.3, and in average skim milk as 2.2. Of course these come chiefly from the milk sugar.

I believe milk to be a most important article of diet in diabetes mellitus. It is rich in nitrogen and fat. These come from the globules chiefly. The corpuscles are fat, surrounded with a delicate albuminoid coating. The fat here makes the butter, the corpuscle being broken by churning and letting it out. Senator thinks the milk sugar in milk does not increase the glycosuria, as a rule, although some are more tolerant than others of the carbo hydrates. Tyson thinks it more difficult to pass into grape sugar than any other of the carbohydrates. These are matters of clinical experience only, and my own experience conforms to these conclusions. The time comes in any case of diabetes when it is proper and even necessary, as before said, to rest your patient from mixed diet, to rest him from the carbohydrates, even if he tolerates them to a certain extent. Here you have, with which to accomplish this, a resort to whole milk, to skim milk, and to predigested, peptonized, or pancre-atized milk, koumiss, and buttermilk. In koumiss the milk sugar has been converted into alcohol and is not there to vex you. In buttermilk it has been converted into lactic acid. These two articles are in every way a very great help in the diabetic regimen, and should be standbys in every case. They are grateful, refreshing, and in every way acceptable. There may be persons who have a very low tolerance of carbohydrates and cannot take even milk. Your physician must decide here.

You will find diabetics unfortunate like other people, at some time likely to go on drinking bouts. After a bout they are often quite pious and quite repentant and docile; they are sick, indeed. Their digestion is gone, their stomach is irritable. In these cases milk and its derivatives is the remedy to commence with to bring them back to the normal state.

So much for milk. What else shall the diabetic drink? There are waters, good spring waters, and especially the alkaline waters to be purchased in the markets. The vichys, foreign and domestic, are among the best. Coffee and tea, sweetened with saccharin, are allowable, chocolate and cocoa are doubtful. The plain soda water of the shops without sugar is healthful and agreeable. As to wines, sour clarets are the best, and next to these the Rhine wines. Those made in our own country are best, unless we pay large prices. Drink no sweet wines, like champagne, sherry, port, mala-gas, or Madeiras. For spirits, good whiskey with as little caramel as possible is best. A little good brandy may not be amiss, and the same with gin. Do not drink the rums. Drink no malt liquors, not even those long bottled, where the sugar is supposed to have gone to alcohol from age. A high ball of scotch and soda is a proper drink if one must drink.

Gout and diabetes at the same time in one individual. Here is a predicament and a dilemma surely, as far as the dietetic treatment is concerned, for they conflict on all sides. For the gout we must cut down the nitrogen and live much on carbohydrates. For the diabetic condition we must pursue the opposite course. Surely we are between Scylla and Charybdis. Anyhow, there is a marked correlation between the two diseases. I have had cases of this kind, and have watched them carefully and got on quite well with them. As the diabetic condition progressed the gouty condition in a great measure yielded and the sufferer did fairly well. The cases of this kind I have had usually had high carbohydrate toleration, this probably due to the opposite condition of the nitrogen balance.