she grow and develop on a diet which will keep her sugar-free?

Case 9. M. D., female, age 3-1/2 years, entered April 7, 1915, with a history of having progressively lost weight for a month past, and of having had a tremendous thirst and polyuria. Had been on a general diet at home. At entrance the child was in semi-coma, with very strong sugar, diacetic acid and acetone reactions in the urine. For the first 12 hours she was put on a milk diet, with soda bicarbonate gr. xxx every two hours, and the next day was starved, with whiskey 1 drachm every 2 hours, and soda bicarbonate, both by mouth and rectum. She died after one day of starvation. This is hardly a fair test case of the starvation treatment, as the child was already in coma and almost moribund when she entered the hospital. When a diabetic, old or young, goes into coma, he rarely comes out of it, no matter what the treatment is.

Case 10. H. S., male, 6 years, entered April 29, 1915. Duration of his diabetes uncertain; not discovered until day of entrance. An emaciated, frail looking boy. He would eat very little at first, and on ward diet, containing 31 grams of protein, 73 grams of carbohydrate, and 20 grams of fat, he excreted 5.7% of sugar, with a moderate amount of acetone, and a very slight trace of diacetic acid.

May 2 he was starved, taking 1-1/2 ounces of whiskey. One day of starvation was enough to make him sugar-free. His diet was gradually raised, until on May 7 he was taking 32 grams protein, 33 grams carbohydrate, and 75 grams fat, and was sugar-free, with absent diacetic acid and acetone. May 9 his carbohydrate intake was raised to 45 grams and he excreted .40% sugar. May 10 it was cut to 40 grams, and he excreted 2.2% sugar.

May 11 it was cut to 20 grams, and he became sugar-free and remained so until June 8, when he was discharged, taking the following diet:

For the first few days after entrance he showed a moderate amount of acetone and a slight amount of diacetic acid in the urine; for the rest of his stay in the hospital these were absent. His weight at entrance was 31-1/2 pounds; he lost no weight during starvation, and weighed 32-1/2 pounds on discharge.

He was kept on approximately the same diet, and was followed in the Out-patient Department, and on two occasions only did his urine contain a small trace of sugar and of acetone (July 31 and Oct. 16, 1915). Nov. 9 his mother brought him in, saying he had lost his appetite, which had previously been good. The appearance of the boy was not greatly different than it had been all along, but his mother was advised to have him enter the wards immediately, so that he could be watched carefully for a few days. She refused to leave him, but said she would bring him in to stay the next day. She took him home, and he suddenly went into coma and died that night. This was a most unfortunate ending to what seemed to be a very satisfactory case. The boy's mother was an extremely careful and intelligent woman, and it is certain that all directions as to diet were carried out faithfully.

He had never shown any evidence of a severe acidosis, but he must have developed one very suddenly.

Case 11. V. D., 11 years, female, was admitted to the Children's Hospital Nov. 3, 1915. She had had diabetes for at least a year. On house diet, containing about 90 grams of carbohydrate, she excreted 6.9% of sugar, with moderate acetone and diacetic acid reactions in the urine.

Starting Nov. 5, she was starved 3 days. The first day of starvation the sugar dropped to 3.5%, the second day to 1.1%, and the third day she was sugar-free with a little more acetone in the urine than had been present before, but not quite so much diacetic acid. From then her diet was raised as follows:

Nov. 13 two tablespoonfuls of oatmeal were added to her diet, making the carbohydrate intake about 30 grams. This day she showed .6% sugar. She was starved for half a day and became sugar-free again.

On Nov. 16 she was taking protein 40, carbohydrate 20, fat 90, calories 1080, and had no glycosuria.

Nov. 17 her diet was protein 43, carbohydrate 25, fat 140, calories 1538, and on this diet she showed .5% sugar. The carbohydrate was cut to 15 grams, and kept at this level for 3 days, but she still continued to excrete a trace of sugar, and so on Nov. 21 she was starved again, immediately becoming sugar-free. From this her diet was raised, until on discharge, Nov. 30, she was taking: protein 48, carbohydrate 15, fat 110, calories 1280, and was sugar-free, having been so for 9 days.

At entrance she weighed 56 pounds, at discharge 54, and lost 4 pounds during starvation, part of which she gained back again. On the diet which she was taking at discharge, she was just about holding her weight. She never excreted much acetone or diacetic acid, and when she was discharged there was merely the faintest traces of these in the urine.

It is not well to raise the diet quite so rapidly as was done in this case, but for special reasons she had to leave the hospital as soon as possible, and so her diets were pushed up a little faster than would ordinarily be the case.

Below is a graphic chart, such as we use in recording our cases. It has been split up into several pieces here on account of its size:

Case 8.