as one
of the earlier cases when the diet was raised too quickly after
starvation.) After one more starvation day and two vegetable days he
stayed sugar-free while the diet was raised slowly to 30 grams of
carbohydrate and 45 grams of protein, calories about 2000. Discharged
sugar-free on this diet.

Weight at entrance, 109 pounds.
Weight at discharge, 110 pounds.

* * * * *

Case 3. A man of 35, a severe diabetic, entered Dec. 28, 1914. He had
been in the hospital the previous July for a month and could never be
made sugar-free with the old method of treatment. At entrance he was
putting out 2.5% of sugar (135 grams) per day with strongly positive
acetone and diacetic acid tests. Two starvation days made him
sugar-free, but we made the mistake of not using twice boiled
vegetables for his vegetable day after starvation. So on this day he
got about 30 grams of carbohydrates, and for a few days he showed from
0.2% to 1% of sugar. Another starvation day was given him and he
became sugar-free. This time his vegetables were closely restricted
and he was given only enough twice-boiled vegetables to provide about
15 grams of carbohydrates. After this the diet was raised very slowly.
He remained sugar-free for three weeks and was discharged so on,

Carbohydrate, 20 grams.
Protein, 40 grams.
Fat, 200 grams.
At no time did he receive more than 2200 calories.
Weight at entrance, 139 pounds.
Weight at discharge, 138 pounds.

* * * * *

These three cases were the first ones we tried, and in each one of
them we made the mistake of raising the diet too quickly--either
allowing too many vegetables on the vegetable day, or raising the
protein too quickly afterwards. With the later cases, after we had
more experience, there was no more trouble.

* * * * *

Case 4. A Greek (male) of 48, diabetic for two months, entered Jan.
14, 1915, with 3.8% (65 grams) of sugar and moderate acetone reaction.
There was no diacetic reaction present at entrance. After one
starvation day he became sugar-free, but was kept on starvation one
day longer and then started on vegetables in the usual way. After the
third day a moderate amount of diacetic acid appeared in the urine and
continued. The ammonia rose from 0.7 grams per day to 2.6 grams per
day, and then varied from 0.3 to 1.5 grams per day. No symptoms of
acidosis.

Jan. 18.
C