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creted by the kidneys, it got into the tissues and viagra alternatives sale set up disturbances. With regard to the pathology of the pancreas in diabetes, Dr. Allen had carefully stated the facts. It was notoriously a knotty question to deter- mine those facts. He admitted that certain pancreases appeared close to the normal, while others showed gross changes. It was not fair, however, to compare the condition of the pancreas from diabetic patients viagra alternatives sale with another pancreas from a patient who came to autopsy. The conditions which led to the death of a diabetic were peculiar. There were not only severe nutritional dis- turbances sublingual viagra online which gave rise to a peculiar blood picture, but there were other conditions which might cause cer- tain organic changes. The work along these lines had been revised and their interpretation of the facts must be extremely guarded. They made a fundamental mis- take in regarding diabetes as one thing, that was, as one disease. Glycosuria in a child did not mean dia- betes in the sense they meant. The child would not sublingual viagra online get the characteristics of this disease unless the diet was bad and the child wasted. He thought he was the first to undertake to learn if keeping the child or young adult sugar free over long periods of time made any particular difference in the termination of that disease. Dr. Allen had stated that the pessimist viagra alternatives sale should not treat this disease, but Dr. Foster thought the pessimist should not treat any disease. Dr. D. D. Van Slyke of New York said that he had undertaken a monumental study of the acetone bodies in diabetes. One question arose with him, "Was acidosis caused by the acetone bodies, only the retained acid, or was it due also to the acidosis form of excretion?" The more acetone bodies in the blood, the more severe the acidosis. The acid formed in the body was neu- tralized by sodium carbonate. The acid doing the damage was retained, but it could be excreted and take sublingual viagra online alkali with it. This damaged the body by causing a double acidosis, the kind that developed the typical diabetic coma. These patients died because of the con- centration of the acetone bodies in the blood and with- out Kussmaul's breathing. It was impossible to viagra alternatives sale say whether death was due to an accumulation of the acetone bodies or not. Dr. Abraham Jacobi of New York asked permission to make one brief remark regarding the frequency of tuberculosis and the frequency of diabetes among the Hebrew race. He said he had looked over the literature carefully and he knew something about the Hebrews. For sixty years he had observed tuberculosis amongst July 7, 19] 7] MEDICAL RECORD. 41 the Hebrews and amongst the poor. It had been re- peatedly stated in the literature that diabetes was fre- quently found amongst the Hebrews; this was not true. It was more frequently found amongst the poor than amongst the rich. It was stated that tuberculosis was very rare amongst the Hebrews; such a viagra alternatives sale false belief should be done away with. Dr. Frederick Madison Allen of sublingual viagra online New York said that they had certain clews which led them to under- take the pathological studies of the human cases which gave them renewed hopes. He believed that the name "renal diabetes" should be changed to "renal gly- cosuria." A distinction should, be made between the actual condition and the main symptoms. Any differ- ence in the course and character could be explained by the thing back of it, such, for instance, as chronic- pancreatitis in old persons. Diabetes was one thing, anatomically, a destruction of the sublingual viagra online islands of Langer- hans. With that conception in view they could do more with the mass of glycosurias familiarly called diabetes. It was impossible to think of any diet being curative of diabetes. There was some specific cause interfering with the growth and development of the normal. It was a fact, too, that persons were killed because of the gloomy prognosis given them; one should tell the parent that the child would live for months and years. The treatment now was improving and the time would certainly come when these patients could be saved; the outlook was very hopeful. Dr. E. P. Joslin of Boston said that 3 per cent, of his patients had tuberculosis with diabetes. With re- gard to the Hebrew race in Boston, a paper was pub- lished not long ago which covered a period of fifteen years, and this writer found that in proportion to the population there was a remarkable increase of this disease amongst the Hebrews compared with the other races in the State. It was best to keep patients viagra alternatives sale on a low diet but yet maintain their weight. Dr. Joslin pre- sented three groups of tables. In the first group ending March, 1916, the patients spent 33 days in the hospital, lost in weight 3.07 kilos, had an average diet of 26 carbohydrates and 54 proteins, and the last week showed calories per kilo .18. In the second group ending July, 1916, the patients spent 23 days in the hospital, lost in weight 2.87 kilos, had an average diet of 43 carbo- hydrates and 60 proteins, and the last week showed calories per kilo, .21. In the third group ending Feb- ruary, 1917, the patients spent 28 days in the hospital, lost in weight 1.6 kilos, had an sublingual viagra online average sublingual viagra online diet of 43 carbohydrates and 60 proteins, and the last week showed sublingual viagra online calories per kilo, .23. In his experience in the treatment of diabetes in children covering over 16 years, Dr. Joslin said he had never viagra alternatives sale seen a case where the physician or the family had given up treatment but what the child was in a worse condition than he would have been if the treatment had been followed viagra alternatives sale straight through to viagra alternatives sale the end. Dr. S. Solis Cohen of Philadelphia said that some 20 years ago he was called upon to deliver a lecture and he went freely over the work in his private prac- tice, in the dispensaries and in the practice of others and he found that amongst the Jews diabetes was very common, both amongst the rich and poor. Whereas tuberculosis was rare amongst the rich Jews, though