Frederick M. Allen

DIABETIC RENAL COMPLICATIONS

To the Editor:— Diabetic renal complications of the intercapillary glomerulosclerosis (Wilson-Kimmelstiel) type are commonly seen at a stage where neither control of sugar or salt, drugs, or other known treatments avail to stop the progression to fatal uremia. The markedly increasing mortality and the generally gloomy prognosis were my reasons for the report of a single case ( Arch. Pediat. 72 :250 [Aug.] 1955). In 1922, when the patient was 6 years old, his severe diabetes was controlled in the Physiatric Institute, first with undernutrition and later with insulin. Later he managed his own treatment with symptomatic success, so that he grew up normally and never missed a day from work. For some 15 years back, there were occasional observations of slight albuminuria, hypertension, and tachycardia. After the symptoms increased, he was hospitalized in November, 1954, and returned to me because of an imminently fatal prognosis. He had uremic malaise, vomiting,

LOW BODY TEMPERATURE

ABSTRACT To the Editor:— Among the admirable data compiled by Laufman (J. A. M. A. [Nov. 24] 1951) in the emergency admission of a patient with unprecedentedly low body temperature, the metabolic rate of —7.8 appears impossible. Theory alone will rule out an energy exchange within normal limits at a hypothermia of 68 F (20 C), but supporting facts are as follows: 1. The demonstrated low metabolism of hibernation and of clinical and experimental hypothermia after the excitement stage. 2. The preservation of refrigerated bloodless extremities for 54 or 96 hours, and still longer survival of various grafts. 3. The record of 3 to 5 shallow respirations per minute, comparable to the observations in animals, could not have provided enough oxygen for life with normal metabolism. 4. Even if enough oxygen were inspired, the 12 to 20 feeble heartbeats per minute could not distribute it adequately. 5. Even if the oxygen

SALT-FREE DIET

To the Editor:— The rapidly widening use of the salt-free diet for hypertension will doubtless bring further accurate reports of results, like the recent one of Kert and associates (The Journal, June 24, p. 721). The following comments are based on an experience of several thousand cases during thirty years: Refractory cases are apt to be more numerous among clinic than private patients, and some adverse reports have been based on such material. It should be noted that cases for diet treatment are taken indiscriminately, without exclusion on account of severity or complications. Statistics of surgical treatment are based on carefully screened cases. Most of those selected and many of those rejected by surgeons will respond to correct diet. The decisive test is not initial benefit (which might be ascribed to hospitalization, psychic or other influences) or apparent failure over several weeks or months. If patients like those