Beverages Forbidden

As a rule, patients always do better without alcohol, and strong spirits should be absolutely interdicted as well as sweet and sparkling wines of every kind, all wines with "bouquet," especially Madeira, port, sweet sherry, Sauternes, and champagnes. No punch or liqueurs, cider, beer, ginger or sweet ales. Soda water with sirup is prohibited. No chocolate, unless especially prepared without sugar.

Beverages Allowed

If it becomes necessary to give alcohol as a tonic or stimulant, an acid claret or Burgundy, hock, or still Moselle may be prescribed diluted with mineral water; or a little much-diluted brandy, whisky, or unsweetened gin may be allowed. Weak brandy sometimes allays thirst better than water. Dry sherry, Cha-blis, and Burton bitter ale are prescribed occasionally, and the California Riesling or Zinfandel may be used. Bass's ale may be allowed because the sugar which it originally contained has been entirely converted into alcohol and carbonic acid (Flint).

Tea, alone or with lemon. Coffee, and infusion of cocoa nibs, sweetened with a quarter of a grain of saccharin, are allowed. Chocolate may be manufactured especially without sugar. Buttermilk may sometimes be given. Sour lemon or orange juice in Vichy with a pinch of sodium bicarbonate makes an agreeable and cooling draught. Saccharin may be added. In Germany acorn coffee is sometimes used.

As an adjunct to the dietetic treatment, the alkaline mineral waters are extremely serviceable, especially those from natural wells. The baths and waters of Carlsbad and Neuenahr, Ems in Germany, and Vichy and Contrexeville in France have achieved a considerable reputation for the cure of diabetes, and after making all due allowance for the improvement consequent upon proper regimen, dietetic regulation, and systematic habits of life which are enforced at these spas, there seems to be special benefit derived from the waters themselves. Other waters which may be drunk are Apollinaris, Johannis, Saratoga Vichy, plain soda or potash water, Seltzer, the alkaline calcic Waukesha, or the different lithia waters.

Special Diabetic Diets

Skimmed Milk

An exclusive diet of skimmed milk was first tried by Scott Donkin. At first a gill should be given every two or three hours, or from six to eight pints daily, to be increased up to twelve pints. The small amount of milk sugar contained in it is said to do no harm. Some authors advise the milk diet as a last resort, others recommend trying it at once. Senator says that the sugar of milk does not increase the glycosuria, and undoubtedly some patients are much more tolerant than others of the sugar of milk.

Tyson says it is harder than any other starchy food to convert into glucose in the system. He recommends giving eight ounces of skimmed milk every two hours between 7 A. m. and 7 p. m., or more if necessary. If preferred, the curds and whey may be separately taken.

After six weeks a gradual return to a mixed nitrogenous diet may be permitted. But few patients, however, can be found to accustom themselves to this diet or to endure it for more than two or three days. Koumiss has been successfully substituted for the skimmed milk. In it the milk sugar is already converted into alcohol.

Buttermilk is sometimes given, and like koumiss it allays the thirst to some extent. The milk sugar has been converted into lactic acid.

By many writers, as Dujardin-Beaumetz and Flint, milk in any form is prohibited, while others recommend its use in moderation while a rigid diet of proteid and fat must be adhered to.