There is little definitely known about the relation of diet to pancreatic diseases, but recent advances in the pathology and treatment of pancreatic diseases clearly indicate the practical importance of this subject. It is known that there is one severe form of diabetes commonly associated with pathological changes in the pancreas, which is consequently spoken of as pancreatic diabetes. These cases run an unfavourable course, and are accompanied by much emaciation. In recent years Mayo Robson has added largely to our knowledge of the different forms of subacute and chronic inflammation of the gland; he has drawn attention to the comparative frequency of pancreatic disease, and to the clinical methods by which it may be recognised. One of these methods must be here alluded to, as in the writer's experience it is of distinct value in connection with dietetic treatment. The pancreatic reaction in the urine, a test devised by Cammidge for the recognition of inflammatory disease of the pancreas is here alluded to. The crystals are believed to be of the nature of a pentose. The writer has made an extensive investigation into the value of this test, based on the examination of the urine of some hundreds of cases of all kinds, medical and surgical, under different dietetic conditions, and the results have shown that while this test has no special value in the diagnosis of pancreatitis, as was at first supposed, it is of great value as an indication of the toleration limit of the body for carbohydrate foods. His observations on this test, since confirmed by many other observers, have shown that a positive reaction occurs in a very much larger number of "control" cases than was originally described by the author of the test, and that a positive reaction is in no way to be regarded as pathognomonic of pancrcatitis, but simply as an indication of derangement of the function of the gland. Further, no clinical significance attaches to the presence of mere traces of a positive reaction as revealed by the presence of only a few crystals on microscopic examination, but much significance attaches to the presence of a marked positive reaction. As the pancreas is the organ most largely concerned in the metabolism of carbohydrates, we are probably justified in concluding that in the clinical conditions which give a pronounced pancreatic reaction in the urine, special attention should be directed to the restriction of the carbohydrates in the food, and practical experience amply confirms this. This view is in conformity with the experience of Mayo Robson, to the effect that not a few of the cases which can now be diagnosed with fair accuracy as subacute or chronic pancreatic disease ultimately develop true diabetes. The treatment of these conditions, whether due to functional or organic disease of the pancreas, is comparatively simple. The difficulty lies in their recognition, which is essential for their successful treatment. The following points will be found helpful in treatment: -

(a) Certain cases of "indigestion," with its varied manifestations, are accompanied by, and in the writer's opinion dependent upon, functional pancreatic disease, which is revealed by the presence of a pronounced pancreatic reaction in the urine. When these cases are appropriately dieted, recovery quickly takes place.

(b) Some cases characterised by neuritic-like pains, commonly regarded as of a rheumatic or gouty nature, are in reality dependent on defects in the pancreas, which can only be remedied by proper feeding. Defective circulation in the feet and hands, with coldness of extremities and liability to chilblains, are present in these patients. These cases are comparable, in minor degree, to the forms of neuritis which are met with in true diabetes.

(c) In cases of muscular and nervous asthenia, the primary fault is occasionally to be found in the pancreas. The author has seen cases of neurasthenia of very long standing, which had long resisted the ordinary treatment, recovering rapidly when the existence of this relationship was recognised, and the treatment directed accordingly.

General Principles Of Treatment

The two essential points in the dietetic treatment are to restrict the carbohydrates, and especially the sugars. Give a simple instead of a rich and varied dietary. The diet should be a mild, anti-diabetic one. Sugar, jams, and sweets of all kind should be reduced, or for a time cut off entirely. In many cases this alone suffices to get rid of the patient's symptoms. In others the starchy foods have also to be reduced; potatoes, suet puddings, starchy puddings, such as sago, arrowroot, etc., and perhaps breadstuffs, must be reduced, and their place taken by a more protein dietary. Custards and curds may take the place of the largely carbohydrate puddings. It is also advisable to exercise caution in the amount of fat taken in the forms of butter, cream, and the like. Spices, condiments, and extra articles of food in general should be avoided, as their presence increases the liability to the milder degree of duodenal catarrh which is so often present in these cases, and is the exciting cause of the pancreatic derangement. The addition of Extract of malt or Taka-diastase is sometimes of value in aiding starch digestion. The dietary on p. 347 will be found suitable for the average case.