Case I.

Benjamin Piggin, Weaver, Mt 40.

Admitted an In-Patient, August 26th, 1799.

Complaints of a troublesome coughs pain in the right side and considerable thirst. Has gradually lost flesh and is so far debilitated as to be unable to follow his employment; pulse 102. Body somewhat costive, appetite not much impaired. Considering this to be a case of incipient Phthisis; digitalis, opiates, a blister, and milk diet, were prescribed.

27th. Cough easier, pain in the side abated, and the pulse reduced to 90.

31st On examining the patient more minutely, on account of his extreme debility, and emaciation, ( which far exceeded what might have been expected to arise from the symptom already enumerated) he then, for the first time, mentioned having noticed a large increase in the quantity, and change in the quality, of his urine. Its peculiar smell first led him to discover, that it had a taste like honey. He had undergone various hardships, and had been addicted to dram drinking; but his health had sustained no material injury until about three months ago when he suffered exceedingly from a harassing journey out of Norfolk, on foot, during wet weather ; and which he considered as the origin of his present malady, Upon examining the urine, it was found to be of a pale straw color, and had a sweet taste, and faintish violet odour. The quantity varied, from six to eight pints, in the twenty-four hours, according to the amount of the liquid he drank. His mouth was clammy, skin hot, and rather dry, and his countenance expressed great anxiety. He could give no account of the exact time when the diabetic symptoms first appeared, but supposed it was about a month since he first noticed the sweetness of his urine.

Having at this period been casually informed, by a medical friend, of the great advantage derived from a strict adherence to animal diet, in the case of diabetes, recorded by Dr. Rollo; I ordered the patient strictly to abstain from bread and vegetables of every kind, and to live solely on broth and animal food. A bolus, composed of five grains of rhubarb, with one grain of opium, was ordered every night, and live grains of asafetida, and ten grains of extract of bark, made into pills, three times a-day.

September 3rd. Pulse 96. thirst and clamminess in the mouth abated makes less urine during the nighty and his sleep is longer and more refreshing.

3rd-6th. Continues to improve in strength and general health makes less urine, which he is confident is not so sweet as usual.

9th. Complaints of spasms in the stomach and bowels with a sense of emptiness and sinking, is much troubled with eructations, and feels great distaste to his animal food, but is persuaded rigidly to persist in its use. Tinct. Ferri mur. ordered along with his other medicines.

11th. The spasms in the stomach not having yet disappeared, three grains of the Extractum cicutce were joined to each dose of the pills. His appetite is become more regular, and his urine neither so sweet, nor so much in quantity.

18th. The spasms in his stomach are much relieved, his strength and looks improved, he has gained flesh considerably within the last week, and the diabetic symptoms have nearly vanished. He says his urine has lost its sweetness; and does not equal the amount of his drink. He can now sleep during the night without a call to make water, and estimates its quantity from three to four pints daily. He was put upon the common diet of the house, and ordered to continue the use of his medicines.

27th. Has gradually improved in his strength and appearance, and is ordered to be discharged cured, at the next weekly board.

Remarks.

This appears to be an instance of diabetes mellitus, under its mildest form. There was neither canine appetite, extreme dryness and harshness of the skin, nor acid taste, and viscid appearance of the saliva, as in the severe, and more strongly marked cases of diabetes. Perhaps the emaciation, and feverish heat, may in part be attributed to the pulmonic affection, which had preceded, and still accompanied the diabetic symptoms. The history of the case must indeed be considered as incomplete, for the urine was not evaporated nor its residuum examined and no regular method was adopted to ascertain the quantity, and relative proportion of the ingesta and egesta; still however, from the colour, taste, and smell of the urine, and its increased quantity, no doubt can be entertained of the nature of the complaint. I have no reason to suspect the patient of either error or falsehood in the description of his symptoms, nor of irregularity in his attention to the sole use of animal diet. It is to this regimen I would attribute the speedy recovery of the patient; but at the same time it must be admitted, that the phenomena of the disease were not so accurately ascertained, nor the practice sufficiently uniform and simple(My knowledge of diabetes at this time, was very limited, and I had not been fortunate enough to meet with Dr. Rollo's interesting publications.), to admit of a positive inference, as to the efficiency of animal diet, in curing this patient. For it may be contended, that such powerful remedies as bark, opium, steel, and cicuta, are adequate singly, but especially if combined, to the removal of a slight diabetic affection. My own subsequent experience, however, and the frequent failure of tonics and antispasmodics, in counteracting this disease, especially when the saccharine impregnation of the urine had existed for any length of time incline me to ascribe the success, in this case,  to the effects of abstinence from vegetable, and the employment of animal diet. No doubt the other remedies proved useful in restoring the tone of the system, and relieving occasional symptoms. The cicuta was evidently beneficial in allaying the spasmodic affection of the stomach and bowels; which, more or less, is to be met with in every instance of genuine diabetes. As I was informed of the patient's intention to return into Norfolk, I obtained a promise from him, that in case of a relapse, he would acquaint me with the fact, and enter into some particulars of his health. I have heard no tidings of him, and therefore am willing to hope, that he has remained free from any diabetic complaint.