Case V.

Thomas Whitehead, age 50.

Admitted an In-Patient April 22d, 1805.

Complains of a preternatural flow of sweet tasted urine, (which on some occasions has amounted to twelve pints in twenty-four hours ) of thirst, and dryness in the mouth, and great pains extending over the loins and pubes. The appetite is irregular and sometimes craving. He has served nine years as a soldier in the East Indies, where he was much exposed to all the hardships incidental to the climate. Since his discharge from the army, he has acted for some years as a watchman in Manchester, and during this employment, he indulged freely in the use of spirits, and often suffered from cold, wet, and fatigue.

About four months since he was first attacked with the pain in his loins, unusual thirst, heat, and a slight increase in the quantity of urine. The pains were not stationary, but would suddenly leave him for the space of a week, and then return upon the least fatigue, or increased exertion, with an augmentation in the quantity of his urine.

He was never fond of vegetables, and since his illness has confined himself to a milk diet:

pulse 86

April 23d, 1805

He was ordered to live on cold beef and mutton, and occasionally fat pork. For common beverage, one drachm and a half of nitric acid to three pints of water ; two blisters were applied to the region of the kidneys, and an opiate with rhubarb, at bedtime.

April 24th,

Drink three pints, solid ingesta one pound. Urine four pints : one pint of the urine when evaporated, left a residuum weighing four drachms and five grains, which exhibited aii urinary smell and taste, but its consistence was tenacious, and unlike that obtained from healthy urine. Has passed a more comfortable night; his thirst, and inclination to make water being much abated.

April 25th.

Solids Liquids Urine

14oz. 2 pints 3.5 pints

His bowels are open, and thirst moderate. He complains of great faintness in the morning;

pain in the loins and pubes relieved; his urine is still sweet to the taste.

Solids Liquids Urine

9oz. 3 pints 3 pints

April 27th.

Solids Liquids Urine

1 lb   3 pints 3 pints

Says his acid mixture rather gripes him, but is ordered to continue its use.

April 28th, Solids Liquids Urine

15oz. 3 pints. Less than 3 pints

Thirst almost gone.

29th. Solids Liquids Urine

1 lb 3 pints 2.5 pints

The urine now appears of a natural colour, and possesses nearly its usual smell and taste. The patient feels much disinclination to his animal food, and complains of loss of appetite and general debility. He was allowed two ounces of toasted oat-cake daily.

30th. Solids Liquids Urine

19oz. 3 pints 3.5 pints

( Bread two ounces, animal food seventeen) The urine has acquired a sweet taste, and the patient's thirst has rather increased; but he feels stronger, and looks more cheerful.

May 1st. — June 10th,

During this interval, a very favorable alteration has taken place ; the allowance of bread has been gradually increased to six ounces daily, without any unfavourable change in the qualities of the urine, which on the 3d, amounted only to two pints, while the drink was nearly three pints, and the solids one pound. The colour of the urine is quite natural, and it has lost nearly all its saccharine taste and smell.

On evaporation, one pint yielded four drachms, and twelve grains, of a dry, friable, and urinous residuum ; differing little in bulk or appearance, from that which is commonly the product of the same quantity of healthy urine.

The liquid egesta has been, on the average, considerably inferior in quantity, to the ingesta. On some days, the former exceeded the latter, more than one third.

The patient's stomach was not able to digest some broccoli, that was allowed for dinner : it occasioned acidity and griping, and was therefore discontinued.

May 10th – 18th

On the 13th his bread was increased to seven ounces, and a pint of milk allowed for supper; in consequence of which alteration, he passed a restless night; and his urine exceeded more than one-third the liquids he had drank for the last twenty-four hours. On the 13th, he complained of slight febrile symptoms, with nausea, and a sour taste in the mouth.

He was ordered an emetic, and a gentle purgative; on the 18th, the febrile symptoms had totally vanished, and believing himself to be nearly cured, he was urgent to be made an out-patient; at the same time, promising a faithful adherence to the plan of diet, and mode of keeping the register ; which he had so strictly followed, while in the Infirmary. He was discharged accordingly.

May 24th.

The patient was re-admitted into the house, as he experienced a return of his complaint. His urine had augmented in quantity, and become sweet to the taste; his pains in the loins and pubes were troublesome; and his flesh and strength both diminished. His circumstances had not permitted him to adhere steadily to his late plan of diet, and he had also returned to his occupation in a cotton-mill.

To these causes, the relapse of his disorder may be attributed. He was again put upon animal diet, without milk or vegetables; and the acid mixture, and beef tea. were ordered for common drink; an opiate at night, and the blisters on the loins, were also renewed.

July 3rd

By persisting in this plan, the diabetic symptoms have been again subdued. The solid ingesta amounted to eighteen ounces, and the liquid to four pints ; urine to three pints and a half, which had lost all its sweetness, and was of a natural appearance; still the patient remained feeble, and did not gain flesh ; he was therefore ordered the bark with alum, and occasionally, when griped, a carminative mixture with opium; and likewise toasted bread to be added to his diet.

June 6th,

The patient has taken four ounces of toasted bread each day ; not only with impunity, but evident advantage to his appetite and strength.

The liquid ingesta and egesta, have been nearly balanced, and never exceeded three pints each in twenty-four hours.

In order to confirm the cure, and restore the patient to general health, he was continued under a similar treatment, with the addition of a more liberal use of vegetable food, and a small portion of wine, until the 20th ; when be was discharged, not only free from every diabetic symptom, but quite restored to his wonted health and vigor.

Remarks. 

This case is important, not only on account of its successful termination, but also from the entire dependence to be placed on the facts, as stated in the reports of the register. It is an evil which has often been lamented, that the negligence of nurses, and the gross ignorance, and irregular habits of the generality of patients, belonging to public Hospitals ; render it difficult, if not almost impossible, for the practitioner to be assured, that his orders are implicitly obeyed, whenever they enjoin great restraints and privations on the part of the sick.

But in the present instance, no suspicion could be attached to the patient, for his conduct was uniformly regular, and he sustained, with credit, the most minute and scrupulous inspection. Finding him to be a very intelligent man, capable of keeping a Journal, and duly impressed with the necessity of a strict adherence to his plan of written instructions, I was induced to furnish him with accurate weights and scales, and proper vessels, that he might keep an exact register of both the liquid and solid ingesta and the liquid egesta. This was strictly complied with, and the register was submitted to my daily inspection, and to the more frequent superintendance of Mr. Heartley, House-Apothecary, and Mr. Le Sassier, Physician's Pupil. Most, if not all of the characteristic symptoms of diabetes mellitus, were to be discovered in this case. The sweetness of the urine was first noticed by the patient, who was led to taste it from its peculiar odour. The emaciation was certainly much greater than might have been expected, from the short duration of the complaint, and the comparatively moderate discharge of urine. Yet the increased bulk of the urinary residuum, and its altered consistence, sufficiently prove, that much animal extractive matter was carried off by the kidneys; but it does not appear, from its sensible qualities, that the extract contained any portion of saccharine matter, although it is very probable, that the predominant flavor of the urinous salts might prevent its detection.

In other instances (one of which will be noticed hereafter) where the urine was sweet to the taste, and yet the residuum devoid of that quality; oxalic acid was obtained by treating the latter in the usual way with nitric, acid.

The efficacy of animal food, in subduing the diabetic symptoms in this case, is placed beyond all controversy. Its effects were rapid, manifest, and decisive. For, when the patient could not confine himself to this part of the plan, although he steadily persisted in all the rest, a relapse speedily ensued.

He likewise found great and evident relief from the application of perpetual blisters to the loins ; and the nitric acid proved useful in abating thirst and heat.

It is, worthy of observation, that in this case, as well as in some of the others, there seemed to be a certain period, at which it was necessary to join vegetable with animal food. For when the more urgent and characteristic symptoms were subdued, but at the same time the strength and bulk rather diminished than increased, and the appetite also feeble and fastidious ; it was then found necessary to administer with caution, a small proportion of vegetable food. The salutary effects of this addition were soon visible in the patient's improved appetite, and increase of flesh, strength, and spirits. Moreover, whenever a return to vegetable diet was suffered, not only with impunity but advantage ; it formed the surest criterion of the restoration of the assimilating powers of the system, and consequently of the removal of the disease.

I have the satisfaction to add, that I have since frequently conversed with this patient, and found him free from any return of his complaint; and that he is now (September 9th,1806. ) in the enjoyment of better health than he has experienced for many years past.