Some Perils Confronting State Care of the Insane
1915; Massachusetts Medical Society; Volume: 172; Issue: 7 Linguagem: Inglês
10.1056/nejm191502181720703
ISSN2331-4710
Autores Resumobe beneficial if the general medical profession comes to realize that the interests of the patient require the stopping of both glycosuria and ketonuria, and that it is possible to stop these things within a very few days.Taking up the patient's side of the matter, it can be said that no one has yet refused to take the treatment.The treatment is rigorous, es- pecially in severe cases, but every patient has re- ported increased comfort, and has preferred to endure the low diet rather than to return to what he suffered before beginning treatment.Gastro- intestinal troubles are absent.The patients have shown none of the carbohydrate hunger which is supposed to belong to diabetes.When asked what they would like to have added to the diet, they have said bacon more often than bread.In view of the opportunity to choose patients, the question arises as to what sort should be selected.The choice might be limited to intelligent, well- to-do, careful persons, and thus au attempt made to show what can be clone under ideal conditions.This might be called an unfair test, since most physicians and hospitals cannot thus select their patients.Therefore up to the present, patients have been selected solely on the basis of sever- ity, without regard to character, intelligence, or surroundings.Also, it could be arranged to keep all these patients by themselves.But since some hospitals cannot do this, most of our pa- tients are now kept in wards along with cardiac and other cases, where they might steal food if they tried hard enough, and where they can see trays of bread and desserts going to other pa- tients.These are conditions which they must face when they leave the hospital, and they might as well be accustomed to them.There has been practically no trouble on this account.By taking patients who are poor, ignorant, care- less, and lacking in self-control, it is made cer- tain that our statistics will suffer.Some of these patients will promptly relapse, and others will drop out of sight and never be heard from again.These conditions must all be faced, in order to learn what can be done with the ordinary run of patients.The ultimate results will fall easily into two groups.When the patients follow in- structions carefully, we shall learn what happens under good conditions.If they go downhill un- der these conditions, the scientific factor will be at fault; this will be the test of it.But when the patients fail to obey instructions and pro- ceed to eat bread and potatoes, this will have nothing to do with the theory of the subject, and will represent merely a failure of the human factor.It will be of interest to know whether our method can help this factor.Most patients of all Classes desire to live, and desire to be free from the symptoms that trouble them.Our severe cases have nearly all been told elsewhere that they must die, and even the milder ones gener- ally have a wholesome fear of the word diabetes.
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