Feb. 6 with a diet of

On Feb. 7 the protein was raised to 80 grams and 0.2% of sugar appeared in the urine. The protein was then reduced to 60 grams and he remained sugar-free on this diet and was discharged so.

In this case, after starvation, a moderate amount of acetone appeared and continued. No symptoms of acidosis. The ammonia ran from 0.3 to 1.0 grams per day.

Case 7. A young man of 25, diabetic for eight months, entered Jan. 20, 1915, with 6.6% (112 grams) of sugar and strongly positive tests for acetone and diacetic acid. After a period of two starvation days he was sugar-free and actually gained three pounds in the process of starvation (probably due to water retention).

His diet was then raised as follows:—

At entrance his ammonia was 1.7 grams per day; after the starvation days it ran from 0.9 grams to 0.3 grams per day. The acetone was a little stronger than at entrance; the diacetic absent except on three days.

On Feb. 5 he was still sugar-free having been so since his starvation days two weeks previously, and weighed 127 pounds, a gain of seven pounds since entrance. At no time did he receive over 2150 calories.

This was a very satisfactory case; no doubt the carbohydrate could have been raised to 50 or 60 grams, but he was doing so well that we felt it unwise to go any further.

Diabetes in children is likely to be a good deal more severe than it is in adults. Still, in the few cases that have been treated with the starvation treatment at the Children's Hospital, the results have been very satisfactory, as far as rendering the patient sugar-free is concerned. Most diabetic children, however, are thin and frail, and they have no extra weight to lose, so it does not seem so desirable to bring about any very great loss of weight, which is quite an essential part of the treatment for most adults. The few children that have been treated have borne starvation remarkably well. It is too early, and we have seen too few children treated by this method, to say what influence it may have on the course of the disease, but it can certainly be said that it is very efficacious in rendering them sugar-free.

Case 8. M. M., female, 12 years, entered the Children's Hospital April 1, 1915. She had probably had diabetes for about 6 months, and had been on a general diet at home. (See charts on pp. 31-36.)

On the ordinary diet of the ward she showed 8.7% sugar, no acetone or diacetic acid. Weight, 52-1/4 pounds,—a very thin, frail girl. She was starved two days, taking about 1-1/2 oz. of whiskey in black coffee each day.

The first day of starvation the sugar dropped to 2.3%, and a slight trace of acetone appeared in the urine. The second day of starvation she was sugar-free, with a moderate acetone reaction. No soda bicarbonate was given. She lost 2 pounds during starvation. After she became sugar-free, her diets were as follows:

From this her diet was raised gradually until on April 16 she took the following:

This calculated to,

The next day the bread was cut down to one slice, and her sugar disappeared. On April 20 she was taking 4 tablespoonfuls of oatmeal and one slice of bread with her meat and vegetables, and was sugar-free. This diet contained:

On April 21, on the same diet, she excreted 1.1% sugar. The next day her oatmeal was cut to 2 tablespoons, giving her about 10 grams less carbohydrate. No glycosuria. She was discharged April 24, sugar-free on

There had never been any diacetic acid in her urine, and only a trace of acetone. She lost about 2 pounds during starvation, but gained part of it back again, so that at the discharge she weighed just a pound less than when she entered the hospital. She has been reporting to the Out-patient Department every two weeks, and has never had any sugar, acetone or diacetic acid in the urine, and appears to be in splendid condition. She is taking just about the same diet as when she left the hospital.

A rather mild case, which responded readily to treatment. The question is, can