These ingredients are to be cooked together. I find that patients generally prefer to take their oatmeal and eggs separately. With the former I permit cream to be eaten. The oatmeal regimen should be continued for three or four days consecutively and then should be interrupted for one or two days by a diet containing about 30 grams of meat and various green vegetables which contain no starch or almost none. Then the oatmeal regimen should be repeated and for two weeks or more the green vegetable and oatmeal diets should be alternated. In this way surprising reductions in the amount of sugar in the urine, even its disappearance has been effected. However, the regimen is so monotonous that it cannot be maintained much longer than two weeks at a time but it can be returned to from time to time.

A diet of a limited amount of protein, fat, and rice has also been found beneficial.

Potatoes as they contain a large percentage of water can be eaten in larger amounts than bread, and therefore are often more satisfying in the chronic mild cases for which some carbohydrates are permissible.

The following vegetables may be eaten by diabetics: cress, cabbage, lettuce, sprouts, endives, broccoli, spinach, chicory, cucumber, mushrooms, artichokes, green French beans,1 sauerkraut, cauliflower, dandelion, sorrel, asparagus, onions, leeks, tomatoes.

The following table shows the relative percentage of the important constituents of the commonest vegetables:

1 Kleen says that string-beans contain several per cent, of sugar and starch when the seeds are developed; they should be eaten when green. Sauer-kraut, when well fermented contains only a trace of sugar. Celery contains 10 per cent, of sugar, and must be forbidden when diabetics are on a strict diet; some clinicans permit it at other times.

2 When green the percentage of carbohydrate is much less.

Roots and tubers, such as potatoes, carrots, and turnips, as well as beans, peas, and Lima beans, must be forbidden to diabetics, because of the large amount of carbohydrates that they contain. When the diet is relaxed, or the case is a mild one, a potato is often permitted. It is always craved when long forbidden, and is undoubtedly much less harmful than the same weight of bread.

The following table showing the composition of fruits is the best guide to their selection for diabetics:

1 Inulin, levulose, and gum compose the carbohydrates in Jerusalem artichokes. They are therefore an appropriate food in diabetes.

The first half of these contain a percentage of carbohydrate which makes it permissible to allow a prescribed amount of them to a mild case of diabetes. Ebstein recommends peaches and apricots. All fruits should be forbidden to those who are on a strict diet. Dried fruit, preserved fruits, and most dishes flavored with or garnished with fruit must at all times be forbidden. A measured quantity of nuts (except chestnuts) may be allowed in mild cases.

Diabetic patients may be permitted to drink water as freely as they desire. Tea and coffee may also be allowed, providing no sugar is used in them and but little cream. Cocoa and chocolate contain not only a considerable amount of carbohydrate, but, as usually marketed, an additional percentage of sugar. The frequent or constant use of alcoholic beverages is likewise undesirable, for they irritate both the liver and the kidneys, which are unusually active in diabetics. Brandy and whiskey contain no sugar, and several wines, such as Swiss wine, Rhine wine, Burgundy, Bordeaux, and Austrian (red), contain but little. Wines should not be used to flavor foods unless in the smallest quantities. Lemonade can be made with saccharin, and is unobjectionable.

Several of the European spas are famous as resorts for diabetics. The best known of them are Carlsbad, Neuenahr, and Vichy. It is doubtful if the waters in themselves influence diabetes. They may affect favorably concomitant digestive disorders and toxemia. That a short sojourn at these spas is of advantage, is too well known to require a new demonstration. Benefit, however, is derived from a change of life, from an outdoor life, from exercise, and from a regulated diet; all of which are incidental to residence at such a place.

Kleen, of Carlsbad, most frankly and justly says: "As for glycosuria, Carlsbad and Vichy water, and, doubtless, also Neuenahr water, in the moderate and rational amounts recommended at present, which scarcely ever go beyond a liter a day, have no appreciable influence, or at least one that is extremely slight and uncertain."

Mental depression and excitement are very harmful for those who have diabetes. Whenever possible, patients should be freed from business care, family troubles, or a life of excitement. During the last few years of wide-spread financial embarrassment I have frequently been able to trace the effect of sorrow and anxiety in the increasing physical troubles of my diabetic patients. Sexual excess should also be avoided.

The skin should be kept active by baths and friction, and the patient carefully protected by woolen or silken underwear from sudden changes of temperature. Regular exercise and, if possible, outdoor exercise should be taken to insure deep breathing, good oxygenation of the blood, and vigorous metabolism.

When a patient belonging to the first or second groups of diabetics first comes under treatment I give him usually the following directions: Eat and drink only the articles named below. Those in italics are especially recommended. Drink water as desired, tea and coffee with cream, vichy, or appolinaris. Bouillon, beef-tea, chicken-broth. Breads, wheat (stale), graham. Potatoes (boiled, baked), cabbage, (boiled, raw), sauer kraut cauliflower, beans (string or wax), tomatoes (raw or stewed), vegetable marrow, spinach, lettuce, asparagus, cucumbers, onions, radishes, celery, (raw or boiled). Gooseberries, currants, grapefruits, oranges. Cheese (fresh dairy, edam, cream), butter, olive oil. Eggs (soft-cooked, boiled, poached or fried). Meat, beef (steak, roast), lamb (chop, roast), mutton, sweetbreads, chicken, pigeon, turkey, quail, partridge, ham (cold boiled), bacon (hard fried). Fish, codfish, whitefish, perch, trout, shad, oysters, clams, lobsters, crabs, shrimp, salmon, mackerel, sardines, caviar. Mushrooms. Eat slowly, small portions and only at mealtimes. Do not eat sugar or food sweetened with it. Use saccharine if you desire to sweeten anything. Do not eat more than one thin slice of bread at each meal or if you prefer substitute one medium sized baked or boiled potato for the bread.