kept on ordinary diet, to determine the severity of his diabetes. Then
he is starved, and no food allowed save whiskey and black coffee. The
whiskey is given in the coffee: 1 ounce of whiskey every two hours,
from 7 A.M. until 7 P.M. This furnishes roughly about 800 calories.
The whiskey is not an essential part of the treatment; it merely
furnishes a few calories and keeps the patient more comfortable while
he is being starved. If it is not desired to give whiskey, bouillon or
any clear soup may be given instead. The water intake need not be
restricted. Soda bicarbonate may be given, two drachms every three
hours, if there is much evidence of acidosis, as indicated by strong
acetone and diacetic acid reactions in the urine, or a strong acetone
odor to the breath. In most cases, however, this is not at all
necessary, and there is no danger of producing coma by the starvation.
This is indeed the most important point that Dr. Allen has brought out
in his treatment. At first it was thought best to keep patients in bed
during the fast, but it is undoubtedly true that most patients do
better and become sugar-free more quickly if they are up and around,
taking a moderate amount of exercise for at least a part of the day.
Starvation is continued until the urine shows no sugar. (The daily
weight and daily urine examinations are, of course, recorded.) The
disappearance of the sugar is rapid: if there has been 5 or 6 per
cent., after the first starvation day it goes down to perhaps 2 per
cent., and the next day the patient may be entirely sugar-free or
perhaps have .2 or .3 per cent. of sugar. Occasionally it may take
longer; the longest we have starved any patient is four days, but we
know of obstinate cases that have been starved for as long as ten or
eleven days without bad results. The patients tolerate starvation
remarkably well; in no cases have we seen any ill effects from it.
There may be a slight loss of weight, perhaps three or four pounds,
but this is of no moment, and indeed, Allen says that a moderate loss
of weight in most diabetics is to be desired. A moderately obese
patient, weighing say 180 pounds, may continue to excrete a small
amount of sugar for a considerable period if he holds this weight,
even if he is taking very little carbohydrate; whereas, if his weight
can be reduced to 170 or 160, he can be kept sugar-free, with ease, on
the same diet. _This is very important: reduce the weight of a fat
diabetic, and