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[July 7, 1917 be sought in some remedy to make good the organic defect. The Maintenance Diet in Diabetes Mellitus. — Dr. Herman O. Mosenthal of generic viagra 120mg Baltimore read this paper. He said that during the past few years, thanks princi- pally to the efforts of F. M. Allen, the problems in the feeding of cases of diabetes mellitus had been very much simplified. By eliminating the carbohydrate ele- ment from the diet and lowering the protein and fat content of the food to an extent never before thought feasible the urine had in nearly all instances been ren- dered sugar free. The acidosis previously regarded as a dangerous factor, when such a dietary was ordered, had usually been readily controlled by limiting the in- take of fat. The temptation at the present time lay in underfeeding these viagra generics brand patients, thus rendering them free from glycosuria and generic viagra 120mg acidosis and their attending dan- gers, but paying very little attention to the nutrition of the individual. It would seem self-evident that the body could not endure a loss of its muscular and glandular tissues over an indefinite period. A diet inadequate in covering the needs of the body in these respects would express itself in a negative nitrogen balance. In the present studies an attempt had been made to determine what constituted a maintenance diet in diabetes mellitus as measured by this standard. Carbohydrates were eliminated from the diets except as contained in the green vegetables. It was found viagra generics brand that in order to furnish food which was palatable over a long period it was not possible to reduce the number of grains of fat much below those of protein. The nitrogen balance was deter- mined on a series of diabetic patients under these dietary conditions. It was found that in an average individual a nitrogen balance could be obtained on a carbohydrate-free diet of 1,500 to 1,700 calories. The practical conclusion to be drawn from these observa- tions was that every diabetic patient who was treated by means of a carbohydrate-free diet in which the num- ber of grams of fat and protein were approximately equal to one another should ingest at least between 1,600 and 2,000 calories of this food in order to insure a nitrogen equilibrium — that was, a maintenance diet. When the glucose tolerance of the patient had war- ranted it the diet when increased beyond 1,690 calories in small individuals, or 2,000 in larger persons, had usually generic viagra 120mg been augmented by the addition of starch-con- taining food and not by further protein and fat. Diabetes in Children. — Drs. viagra generics brand E. P. Joslin and Horace Gray of Boston presented this communication, which was read by Dr. Joslin. A series of 123 cases of dia- betes in children under the age of fifteen years were analyzed generic viagra 120mg especially as regards etiology, improvement in prognosis, and treatment. When one considered diabetes in children the question arose whether they should be as pessimistic as to the outcome as had hitherto been the case. Some 53 cases under the age of ten years had come under his supervision. Of these 31 were dead and 15 living in one group; there were 7 more cases, 2 dead and generic viagra 120mg 5 living, making an average duration of over five years. Of the 5 living generic viagra 120mg cases, they have gone generic viagra 120mg on eight or nine years and appear to be in good condition and sugar-free. The cases either living or dead up to this time averaged 1.1 years; during 1916 the average duration was 1.6 years. Obesity played an important part in the etiology of diabetes in adults, 40 per cent, of his cases showing it. Among the children he had been impressed with one case which he thought was the type of a great many. This child showed sugar when four years old. At the age of one year he practically had the weight of a child of one year. At one and a half years he weighed what a child of two years weighed. Then he had a serious infection and the child was put to bed until the tem- perature subsided. This child was well fed and was given milk from a Jersey cow. At two years he weighed what a child of three and a half should weigh and at two and a half years weighed what a child of four years should weigh. With a twelfth infection — mumps — sugar appeared in the urine. The lack of exercise, overfeeding and the infections had much to do in bring- ing this on. The Association Between Diabetes Mellitus and Tuber- culosis. — Dr. S. Sous Cohen of Philadelphia said that the potentiality of diabetes, as much as in tuberculosis, was activated by an injudicious diet, too much fat, and too much carbohydrates. With a patient with evidences of tuberculosis and glycosuria and some symptoms of diabetes and not under skilled observation prior to that time they had no means generic viagra 120mg of saying that the two condi- tions began simultaneously. They could not say they were associated and not dealing with an accidental in- fection. What was the relation between the two? He did not know. He did not find any statistical evidences that were of help. But there were certain facts gathered viagra generics brand from the study of the family histories possibly indicating that there was some fundamental relation which viagra generics brand was vaguely called constitutional, congenital, or hereditary conditions, and the conditions of metabolism of the patients. In the negro tuberculosis was common and diabetes was rare; among the whites they were relatively immune from tuberculosis and prone to dia- betes. Diabetes mellitus and diabetes insipidus, transient glycosuria and a tendency to alimentary glycosuria were very common among these persons. Many of the patients that fell under his observation were obese or gouty. These associations were sug- gestive of some relationship between the two, and the diabetes was liable to eventuate into tuberculosis. Dr. Nellis B. Foster of Ann generic viagra 120mg Arbor said he thought anyone could remember ten years ago when little or no work was done on this question in this country; today they could have a little pardonable pride in that they had so many ways, methods, and laboratories. The generic viagra 120mg American temperament interfered with the work, and many small scientific facts were applied before they were linked with other facts. As an example of the good work done in many places was generic viagra 120mg viagra generics brand that of Dr. Fitz. The relationship between ketonuria and ketones in the blood due to functional change in the kidney at a time when, for generic viagra 120mg some reason or another, coma was developing was an interesting theme. Because ketone was not ex-