Diabetes is a very fatal form of disease, recovery being exceedingly rare. Over 50% die of coma, another 25% of phthisis or pneumonia, and the remainder of Bright's disease, cerebral haemorrhage, gangrene, &c. The most favourable cases are those in which the patient is advanced in years, those in which it is associated with obesity or gout, and where the social conditions are favourable. A few cures have been recorded in which the disease supervened after some acute illness. The unfavourable cases are those in which there is a family history of the disease and in which the patient is young. Nevertheless much may be done by appropriate treatment to mitigate the severity of the symptoms and to prolong life.
There are two distinct lines of treatment, that of diet and that of drugs, but each must be modified and determined entirely by the idiosyncrasy of the patient, which varies in this condition between very wide limits. That of diet is of primary importance inasmuch as it has been proved beyond question that certain kinds of food have a powerful influence in aggravating the disease, more particularly those consisting largely of saccharine and starchy matter; and it may be stated generally that the various methods of treatment proposed aim at the elimination as far as possible of these constituents from the diet. Hence it is recommended that such articles as bread, potatoes and all farinaceous foods, turnips, carrots, parsnips and most fruits should be avoided; while animal food and soups, green vegetables, cream, cheese, eggs, butter, and tea and coffee without sugar, may be taken with advantage. As a substitute for ordinary bread, which most persons find it difficult to do without for any length of time, bran bread, gluten bread and almond biscuits. A patient must never pass suddenly from an ordinary to a carbohydrate-free diet. Any such sudden transition is extremely liable to bring on diabetic coma, and the change must be made quite gradually, one form of carbohydrate after another being taken out of the diet, whilst the effect on the quantity of sugar passed is being carefully noted meanwhile. The treatment may be begun by excluding potatoes, sugar and fruit, and only after several days is the bread to be replaced by some diabetic substitute. When the sugar excretion has been reduced to its lowest point, and maintained there for some time, a certain amount of carbohydrate may be cautiously allowed, the consequent effect on the glycosuria being estimated. The best diet can only be worked out experimentally for each individual patient. But in every case, if drowsiness or any symptom suggesting coma supervene, all restrictions must be withdrawn, and carbohydrate freely allowed. The question of alcohol is one which must be largely determined by the previous history of the patient, but a small quantity will help to make up the deficiencies of a diet poor in carbohydrate. Scotch and Irish whisky, and Hollands gin, are usually free from sugar, and some of the light Bordeaux wines contain very little. Fat is beneficial, and can be given as cream, fat of meat and cod-liver oil. Green vegetables are harmless, but the white stalks of cabbages and lettuces and also celery and endive yield sugar. Laevulose can be assimilated up to 1½ ozs. daily without increasing the glycosuria, and hence apples, cooked or raw, are allowable, as the sugar they contain is in this form. The question of milk is somewhat disputed; but it is usual to exclude it from the rigid diet, allowing a certain quantity when the diet is being extended. Thirst is relieved by anything that relieves the polyuria. But hypodermic injections of pilocarpine stimulate the flow of saliva, and thus relieve the dryness of the mouth. Constipation appears to increase the thirst, and must always be carefully guarded against. The best remedies are the aperient mineral waters.
Numerous medicinal substances have been employed in diabetes, but few of them are worthy of mention as possessed of any efficacy. Opium is often found of great service, its administration being followed by marked amelioration in all the symptoms. Morphia and codeia have a similar action. In the severest cases, however, these drugs appear to be of little or no use, and they certainly increase the constipation. Heroin hydrochloride has been tried in their place, but this seems to have more power over slight than over severe cases. Salicylate of sodium and aspirin are both very beneficial, causing a diminution in the sugar excretion without counterbalancing bad effects.
In diabetes insipidus there is constant thirst and an excessive flow of urine, which, however, is not found to contain any abnormal constituent. Its effects upon the system are often similar to those of diabetes mellitus, except that they are much less marked, the disease being in general very slow in its progress. In some cases the health appears to suffer very slightly. It is rarely a direct cause of death, but from its debilitating effects may predispose to serious and fatal complications. It is best treated by tonics and generous diet. Valerian has been found beneficial, the powdered root being given in 5-grain doses.
DIABOLO, a game played with a sort of top in the shape of two cones joined at their apices, which is spun, thrown, and caught by means of a cord strung to two sticks. The idea of the game appears originally to have come from China, where a top (Kouengen), made of two hollow pierced cylinders of metal or wood, joined by a rod—and often of immense size,—was made by rotation to hum with a loud noise, and was used by pedlars to attract customers. From China it was introduced by missionaries to Europe; and a form of the game, known as "the devil on two sticks," appears to have been known in England towards the end of the 18th century, and Lord Macartney is credited with improvements in it. But its principal vogue was in France in 1812, where the top was called "le diable." Amusing old prints exist (see Fry's Magazine, March and December 1907), depicting examples of the popular craze in France at the time. The diable of those days resembled a globular wooden dumb-bell with a short waist, and the sonorous hum when spinning—the bruit du diable—was a pronounced feature. At intervals during the century occasional attempts to revive the game of spinning a top of this sort on a string were made, but it was not till 1906 that the sensation of 1812 began to be repeated. A French engineer, Gustave Phillipart, discovering some old implements of the game, had experimented for some time with new forms of top with a view to bringing it again into popularity; and having devised the double-cone shape, and added a miniature bicycle tire of rubber round the rims of the two ends of the double-cone, with other improvements, he named it "diabolo." The use of celluloid in preference to metal or wood as its material appears to have been due to a suggestion of Mr C. B. Fry, who was consulted by the inventor on the subject. The game of spinning, throwing and catching the diabolo was rapidly elaborated in various directions, both as an exercise of skill in doing tricks, and in "diabolo tennis" and other ways as an athletic pastime. From Paris, Ostend and the chief French seaside resorts, where it became popular in 1906, its vogue spread in 1907 so that in France and England it became the fashionable "rage" among both children and adults.
The mechanics of the diabolo were worked out by Professor C. V. Boys in the Proc. Phys. Soc. (London), Nov. 1907.
DIACONICON, in the Greek Church, the name given to a chamber on the south side of the central apse, where the sacred utensils, vessels, &c., of the church were kept. In the reign of Justin II. (565-574), owing to a change in the liturgy, the diaconicon and protheses were located in apses at the east end of the aisles. Before that time there was only one apse. In the churches in central Syria of slightly earlier date, the diaconicon is rectangular, the side apses at Kalat-Seman having been added at a later date.
DIADOCHI (Gr. διαδἐχεσθαι, to receive from another), i.e. "Successors," the name given to the Macedonian generals who fought for the empire of Alexander after his death in 323 B.C. The name includes Antigonus and his son Demetrius Poliorcetes, Antipater and his son Cassander, Seleucus, Ptolemy, Eumenes and Lysimachus. The kingdoms into which the Macedonian empire was divided under these rulers are known as Hellenistic. The chief were Asia Minor and Syria under the Seleucid Dynasty (q.v.), Egypt under the Ptolemies (q.v.), Macedonia under the successors of Antigonus Gonatas, Pergamum (q.v.) under the Attalid dynasty. Gradually these kingdoms were merged in the Roman empire. (See [Macedonian Empire].)