Before we take up the subject of feeding in this disease, let us for a moment discuss the supposed nature and causes of the trouble. It is a disorder of nutrition from many supposed causes as yet not thoroughly understood. The urine passed is excessive in quantity, and the presence of glucose in it to a greater or lesser extent marks the disease. In some cases the nervous system appears to be at fault, in others the liver, in others the pancreas, in others the kidneys, and in others the fault may be in several or all of these parts. As an object lesson to the fault being in the nervous system, take the engine-drivers on our great railroads. Among these men diabetes is said to be more common than in many other conditions of life. Think of the wear and tear of these men, running trains scheduled at fifty miles an hour. Every moment nearly, there is a signal to watch, every moment a danger to avert. No wonder now and again their nervous system yields to the strenuous life. Possibly the constant vibration these men are subjected to has a tendency to stimulate the action of the kidneys by increasing the blood-pressure. This increased action of the kidneys is very noticeable from the same cause, increase of the blood-pressure by vibration, in those travelling on the modern high-power steamships and the naphtha-boats of the present day.

To-day, more and more attention is being called to the pancreas and the suprarenal bodies in looking for a cause for this disease. It is to be hoped much good may come from this and that we may yet get a specific treatment for some forms of diabetes mellitus, as we have to-day in treating certain diseases by thyroid extract and such substances. Physiological chemistry must come in here, and along its lines possibly diabetes mellitus will be largely treated.

We will have to study each individual case as to its pancreatic ability particularly. The individual must get sugar from his food or from his own nitrogenous tissues. He has grown thin, he has parted from his water, and has lived away his fats, and is now living on his muscles, - a dangerous condition, for oxybutyric acid and its derivatives are formed and he may die speedily of coma. We will see more concerning this later when speaking of diet and the removal of all carbohydrates from the diet.

We have probably been following false gods in treating this disease, and possibly the majority of physicians are still following false gods. It will not do always to cut out all starches and sugars. You must study the case and get the individual toleration of carbohydrates. You cannot cut out all carbohydrates, for no one, I am satisfied, can resist them absolutely when starch hunger and sugar hunger strike. The danger is, the patient is indiscreet, and takes too much, and often does himself great injury. If the pancreas oxidizes sugar in the economy we must keep up the habit to some extent by giving very guardedly some starch and some sugar, to keep the pancreas in good temper as it were. The great difficulty in each case is to find out exactly how much starch and how much sugar can be allowed, so as to get neither too much nor too little. In order to get proper foods for the diabetic there are in the market many preparations of so-called gluten flours and other flours more or less free from starch.

Before going further into these let us go into the matter of what a gluten flour should be to be digestible and fit for food. The New Hampshire State Board of Health has established a standard for gluten flour. It must contain at least 30 per cent. of proteids, calculated by multiplying the nitrogen content by the factor 6.25, and to contain not over 48 per cent. of starch. The gluten flour of the market contains usually from 10 to 15 per cent. of proteids and from 60 to 70 per cent. of carbohydrates. With 40 per cent. of protein there is enough starch to feed the yeast and make a spongy loaf that is palatable. You cannot get a gluten flour free from starch probably. If you could, you could not raise it with yeast. It would not be palatable; you could not digest it. After baking, the bread from a 40 per cent. proteid flour would have little starch left, and this small amount should be oxidized by a person with even law vitality, such as diabetics usually have. Wheat flours of the markets contain from 70 to 80 per cent. of starch. Many of the so-called gluten flours are frauds as to the starch they contain. From what we have said we want a gluten flour to contain from 30 to 40 per cent. of proteid, and not over 48 per cent. of starch. By proper manipulation we can get a bread from this the diabetic can eat and digest with the least harm possible to himself. Remember, you cannot starve him all the time as to starch. Often it will be well to allow a slice or two of thin, well-buttered toast or a baked white potato, rather than allow him to live on his own tissues. When buying gluten flour for the diabetic, get it as near the New Hampshire standard as possible.

Bran biscuits may be eaten now and again for a change. Take one-quarter pound of wheat bran, three fresh eggs, one and one-half ounces of butter, and one-half pint of milk. Mix the eggs with a little of the milk, melt the butter in the remainder of the milk, and beat up the whole well. Bake in a quick oven in cakes one-quarter inch thick and eat them swimming in butter or olive oil. These cakes go far to keep the bowels loose where constipation is so common among diabetics.

The diabetic in good condition, as diabetics go, usually has an enormous appetite for food and drink. Great thirst is not a good sign: his tissues are oxidizing too rapidly. He should be cautioned not to give way too much to his appetite. Regular and systematic massage of the muscles, calisthenics, and such, will often do good and check the ravenous desire for food and drink, so these will also do good in those cases of annoying itching of the skin.

The Van Abbots of London have a fairly good line of diabetic foods. The Pure Gluten Food Company of New York City also furnish a breakfast food and crackers within the bounds, also a gluten flour.