The importance of prophylactic measures directed toward improving the hygiene and circulation of the feet is clear and has been recognized for years. It can¬ not be emphasized too much, however, that the chief prophylactic measure is the rigid control of the diabetes even in those suffering from its mildest form.The importance of the choice of an anesthetic is well known. On all of these patients we have used spinal anesthesia or one of the gases, either nitrous oxid and oxygen or ethylene. Local anesthesia should not be used in the cases in which there is arteriosclerosis because of the danger of decreasing the already poor blood supply. SUMMARY 1. Not all lesions of the extremities associated with diabetes mellitus are gangrene. 2. A recognition of the type of lesions gives a more accurate prognosis and rational treatment. 3. These lesions occur in untreated diabetic patients with mild types of the disease, and their occurrence gives reason for the rigid control of all cases of mild diabetes.4. The use of insulin aids treatment of the types with infections by preventing coma and abolishing glycosuria. 5. The prognosis is still grave in the group in which there are both impaired circulation and infection. ABSTRACT OF DISCUSSIONDr. E. P. Joslin, Boston : What impressed me was the fact that Dr, Coller struck at the vital point in these cases, namely, the avoidance of procrastination. One cannot operate on these patients too soon. An infection, if it is that type we are dealing with, makes any diabetes worse,

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tis the urine would have become more albuminous and the sediment shown a larger number of casts. Theoretically this is the rule and practically it is often so but not necessarily. I have seen several cases which were exceptions. Weakness, dyspnea» vertigo, headache, and vomiting with accentuated aortic second and a urine such as we have described were sufficient to make a diagnosis of chronic disease of the kidney. The toxemia manifested itself in two ways in her case,