BOILED VEGETABLES FOR THE USE OF DIABETICS.

1192

BOILED VEGETABLES FOR THE USE OF DIABETICS.

TABLE L-Thrice-boiled

Vegetables.

A, Total "carbohydrate " per cent. B, Reducing sugar per cent.

BY P. J. CAMMIDGE, M.D. LOND

PURELY starchy foods are not, as a rule, well borne by diabetics, and they are consequently replaced to a large extent in the modern diabetic diet by vegetables. When the carbohydrate tolerance of the patient is low many vegetables cannot be taken without glycosuria resulting, and the range of the diet therefore becomes very restricted. It was pointed out by Von Noorden that boiling vegetables in water removes some of the carbohydrate, so that a much larger bulk of a boiled than of a raw vegetable can usually be taken by a diabetic without harm.1 He showed that raw spinach containing about 2’97 per cent. of carbohydrate will when cooked in water yield only about 0’85 per cent., also that 100 g. of ripe peaches containing 9’5 g. of carbohydrate contain only 1’8 g. after boiling and changing the water. Carrying the idea further, Allen has suggested2 that thrice-boiled I, vegetables might be even more useful, especially in ’, instances where ordinary boiled vegetables are not well tolerated, for he states that by boiling through three waters and throwing away the water nearly all the starch can be removed. It is claimed that vegetables prepared in this way are taken gladly by most severe cases of diabetes and without glycosuria. Very little experimental work appears to have been done on the composition of the material resulting from the treatment of vegetables with It has been three changes of boiling water. generally assumed that any vegetable of low carbohydrate value is rendered practically carbohydrate-free, while vegetables of high carbohydrate content, and particularly root vegetables, should not be used. With a view to throwing some light on the question and discovering which are the best vegetables to employ for the purpose, a number of experiments were carried out in my laboratory. Sixteen varieties of commonly used vegetables were investigated. The root vegetables were cut into slices about an eighth of an inch thick and then into strips about half an inch wide, the others were cut into convenient lengths about half an inch long. They were soaked in cold water overnight, then put into a large excess of fresh cold water, brought to the boil, and boiled for a quarter of an hour. This water was drained off and they were again boiled for a quarter of an hour in a fresh supply. A further boiling in fresh water for a quarter of an hour completed the process. After each boiling a sample was taken for analysis. The reducing sugar was estimated by the process I have described,3 and the " total carbohydrate " was determined by the same procedure after hydrolysis with a mineral acid. The figures obtained are summarised in Table I. It will be seen that the number of boilings required to secure a carbohydrate-free residue varies considerably and is not directly related to the amount of carbohydrate originally present; moreover, that comparatively a small proportion of the vegetables investigated were entirely freed by three boilings. Celery, rhubarb, and spinach were free from carbohydrate after the second boiling, sliced turnip and sliced carrot still retained some starch, but were free after the third change; all the other vegetables retained more or less carbohydrate even after three boilings. It is noteworthy that cabbage, which contained only 3’3 per cent. of carbohydrate originally and is generally regarded as a safe vegetable for diabetics, especially 2

1 Die Zuckerkrankheit, 1912, p. 306. Boston Med. and Surg. Journ., 1915, clxxii., p. 241. 3

THE

LANCET, 1917, i.,

p.

613; 1919, i., p. 939.

the thrice-boiled condition, retained 0’5 per cent. 3Lfter the third boiling, whereas a sample of carrot, containing 8’5 per cent. of carbohydrate in the first nstance, was free from starch and sugar after three boilings. Again, beetroot, with 12 per cent. of carbolydrate when purchased, did not contain more after three boilings than cabbage similarly treated. Thus showing that some root vegetables can be made quite as harmless as the green vegetables usually prescribed. n

From these experiments it is clear that three boilings are not sufficient to render all vegetables carbohydrate free, and that the amount of carbohydrate originally present is no guide in selecting those best suited for the preparation of a starch and sugar-free product such as may sometimes prove useful instead of actual fasting for children or severe

cases

of diabetes.

It would

seem

.,

that

celery, rhubarb, spinach, sliced turnip, and sliced carrot can probably be relied upon and are the best to use for the purpose. It should be noted that swedes cannot be employed in place of white turnips, for although they contain nearly the same percentage of total carbohydrate they part with it much more slowly and may contain one per cent. after three boilings, about half of which is reducing sugar. Even when thrice-boiled vegetables are not quite free from carbohydrate the percentage is so much reduced that from 4 to 30 times as much of the thrice-boiled as of the once-boiled material will contain the same amount of carbohydrate. The use of the former, therefore, permits of a much greater bulk of food being taken. As reducing sugar is removed much more rapidly than the " total carbohydrate," and some of the reduction given by the latter is probably due to pectins and indigestible bodies of a similar nature in some instances, the proportion which can be safely allowed is often larger than these figures would

suggest.

Repeated boiling considerably impairs the flavour and appearance of. vegetables, and although their lack of taste can be masked to some extent by serving them with condiments, clear broth, bovril, lemco, and in some instances by sweetening with saccharin, they are not very attractive to most patients. Experiments by Ruth. A. Wardall’ suggest that a more tempting and equally carbohydrate-free product may be prepared from some by 4 Journ. Amer. Med. Assoc., Dec. 1st, 1917, p. 1859.

1193 It appeared to me that aspiration might have repeated extraction at a temperature considerably below the boiling point of water. The vegetables ggreatly delayed the fatal termination in both cases, are finely shredded, covered with an excess of water aand possibly have saved the life of one. at 60° C. (140° F.) and allowed to soak. At intervals A man, aged 42, admitted with extensive ulceration

of 10 to 15 minutes the water is drained off and oof incised sacro-iliac abscess, remained under our obserfresh water at 60° C. added. When this process isvation till death three months later. Another case, died five months after incision from repeated at regular intervals the time required to 1Ssimilarly admitted, Three girls, aged free certain vegetables from available carbohydrate lardaceous disease and cachexia. r and died 16, 16, 12, ten, and five respectively eight, in Table II. was found to be as shown r months after admission with incised lumbar abscess of For comparison the number of extractions spinal origin. In these cases extensive ulceration and boiling water required to produce the same resultslardaceous disease terminated with cachexia. In a boy are given in Table III. aged 9 a spontaneously opened neglected lumbar abscess, in spite of aspiration, did not arrest the original lesion, TABLE III. TABLE II. ‘ and death followed a year after admission. Recently a Extraction at 100&ogr; C. Extraction at 60° C.

with

1 hr. Parsnip ...1" Carrot..... 1½ hrs.

Beet

......

Egg plant...

2

"

Pineapple ... 3 ,, Little affected. Cabbage ...

A. 2 6 Parsnip Carrot ...6...... Egg plant... 7 Beet ...... ...

......

......

B. Trace. 0-4

......

0 0

Pineapple.. 9 ...... — Trace. Cabbage... 8 ......

case

These

are only of a preliminary but the effectiveness of the extraction at 60° C. in the case of beetroot and carrots, for instance, and the better appearance and flavour secured than when boiling water is employed suggest that an agreeable extension of the often limited range of vegetables open to severe cases of diabetes may be obtained by this method of preparation. The extracted vegetables can be preserved for future use by desiccation in a current of air from an electric fan for 3z hours. Stored in a dry place they keep indefinitely, and may be prepared for use when required Ly soaking in water and reheating.

experiments

incised multiple abscesses of six years’ duration by me in a dying condition, terminating fatally

was seen

soon

after.

In more

treated by aspiration the result has been satisfactory in a shorter period, as the following

cases

illustrate. 1. Cases of Spinal Abscess. A cleaner, aged 43, with dorsal abscess, was aspirated

cases

A, Highest number of extracts showing carbohydrate. B, Carbohydrate in residue per cent.

character,

of

,

with arrest in three months. Eighteen months later recurrence in the same site, arrested after six aspirations in two and a half months, and his prognosis now is very good. In an ex-soldier (21) a lumbar abscess was aspirated 20 times during four months with improvement of paraplegia. In a female (20) a right suprascapular abscess was cured with four aspirations in three weeks without recurrence for over 18 months. Against these may be recorded cure in two cases admitted with incised lumbar and dorsal abscess resulting in sinus after 22 months and 7 months respectively.

eight times

2.

Hip joint Abscess.

In a girl aged 16 abscess of lateral thigh arrested after six weeks with four aspirations. Gluteal abscess in two ex-soldiers, aged 29 and 32 respectively, with 10 and Nottingham-place, W. 12 aspirations, was arrested after two months and four months. In a soldier admitted with incised gluteal abscess and sinus curewas effected only after 13 A CLINICAL STUDY OF THE months. A boy (17) with a similar incised abscess was TREATMENT OF TUBERCULOUS ABSCESS cured after seven months, whilst a re-formation was arrested by two aspirations in two weeks. No recurBY ASPIRATION. rence has taken place in any of the cases for over a year. Two girls, aged 15 and 16, admitted with incised BY Z. P. FERNANDEZ, B.A., M.B., CH.B. LEEDS, abscess about Scarpa’s area are still in an unsatisLEEDS CITY ASSISTANT TUBERCULOSIS OFFICER; LATE RESIDENT, LEEDS CITY SANATORIUM. factory condition after one and a half and three and a In one of these reaccumulahalf years respectively. GIVEN early diagnosis, treatment by aspiration tion near the original site was arrested after 12 will frequently arrest the course of a tuberculous aspirations in three and a half months.

and effect a complete cure. Delay in and treatment incision not by diagnosis infrequently end in disaster. The following cases are taken from the wards of the Leeds City Hospital Sanatorium during my tenure of office for over two and a half years. French authorities quoted by Gauvainmaintain that 50 per cent. of patients with spinal abscesses treated by incision end in sinus formation, and that 70 per cent. of cases of sinus formation in spinal disease die. Returning to our own cases, two interesting postmortem examinations made by me are worth

abscess

recording. One case was that of a patient who had been in a moribund condition and who succumbed almost at At the post-mortem it was found that he had once. suffered from what appeared to be a primary laryngeal tuberculosis-admittedly a very rare condition. A cervical abscess had made its way down along the planes of tissue in the neck, and pus had appeared in the axilla. Tubercle bacilli were found in the pus. The second case, one of spinal caries, had been admitted in an exhausted condition, and an abscess had been found dorsally. At the autopsy simple bronchopneumonia was found. 1

THE LANCET, August 10th, 1912, p. 356.

of Abdominal Origin, Implicated. (4) abscess in lumbar

3. Abscess

no

Joint

In a child area subsided with three aspirations in two weeks. In a boy (16) arrested tuberculous ascites was followed by abscess in the thigh. This was aspirated six times and cured in six weeks. On resuming work he received a knock with re-formation. The site of the puncture was probed by a doctor, and the condition has not improved for over a year, with a resulting sinus and discharge. A right groin formation in a tuberculous ex-soldier was cured with 12 aspirations in two months. In another four aspirations in three weeks arrested a similar condition. In a tuberculous girl (16), admitted very ill, a swelling in the epigastric area was successfully aspirated four times with recovery in 71 days. Macdonald in THE LANCET, Feb. 17th, 1912, recorded a similar case successfully incised, and considered it on the authority of Savariand as a primary infection. In our case there was a previous infection of the lung. In a girl (15) tuberculous ascites was arrested by tapping. Later an umbilical abscess formed and arrested in six weeks with four aspirations. Though a sinus resulted later her condition remarkably improved soon after. Male (20) admitted with incised left ’groin abscess, developed one in the right which, with four aspirations, was arrested in two months, and a right lumbar one with three aspirations arrested in two weeks. The