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November 1, 1796
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I send you an extract of the case of Walker, with Dr. Hope's permission, and you may do with it whatever you please. The effects of the animal diet on the quantity and quality of the urine are perfectly evident, though the case could not be carried to an absolute termination, from the impatience and instability of the patient
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Abstract of a Case of Diabetes Mellitus, in the Royal Infirmary, at Edinburgh.
John Rollo
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4th May, 1797- I SEND you an extract of the case of Walker, with Dr. Hope's permission, and you may do with it whatever you please. The effects of the animal diet on the quantity and quality of the urine are perfectly evident, though the case could not be carried to an absolute termination, from the impatience and instability of the patient. In Hospitals, where patients three three or four times in the day every person about them eating vegetables, a trial of an entire diet of animal food can hardly be expected.
James Walker, a field-labourer, was admitted by Dr. Hope into the Clinical Ward, with a confirmed Diabetes, on the 1st November, 1796.
"His appetite is voracious, and his thirst so urgent, as to make him defire from ten to fixteen quarts in twenty-four hours. His urine is praeternaturally copious, and he has a frequent inclination to pass it. It is limpid, of a light green colour, and having a slightest sweet taste. He is much emaciated ; and his feet and ankles swell towards evening. Pulse 96. Skin parched and rough. Body costive.
He recollects, on a frosty morning in December 1795, having slept fome hours in an open cart, On the May following the above symptoms appeared, and have increased ever since. He has feveral times been the object of medical treatment; but without permanent relief.
2d. Milk daily, and as much drink as he chooses.
3d. Urine 22 pounds, Ingefta 20 pounds.. AtL 153
4d. Urine 13 pounds. Ingefta 17 pounds. The urine becomes turbid on the addition of lime water; when evaporated it affords an extract like molasses, which is sweet to the taste. This matter mixed with lime, exhales the odour of ammonia.
From this day to the 29th December, he remained nearly in the same state, the quantity of urine fluctuating between 12 and 18 pounds in 24 hours. During this interval he took some ferrum vitriolatum in the form of pills; ufed the cold shower bath, and took occassionally fome emetics and laxatives ; —the stomach being at times deranged, and the coflivenefs very obflinate. Under this treatment he feemed to get a little stronger, but without any important change in the general symptoms of the disease. It was agreed to try the effects of animal food, as lately given with success by Dr. Rollo at Woolwich, an account of which was tranfmitted by Dr. Woollcombe to Mr. Marcet.
December 29th, Dr. Hope gave the following report. Ingesta 17 pounds; urine 13 pounds. Five pounds of this urine have afforded 5ounces of a thick saccharine extract. He has had for a month, an unpleasant sense of burning heat in the soles of his feet during the night. He is directed to abstain from vegetable food in every shape. To have two eggs for breakfast. Boiled meat and fleaks alternately for dinner. Eggs, or cheefe for fopper. For drink eight pounds of weak beef tea, and two pounds of weak peppermint water.
30th December. Solid ingested about two pounds ; drink ten pounds ; urine nine pounds. Let him have two pounds of flesh meat for dinner; half a pound of cheese for supper; and three eggs for breakfast—drink as before, Ingefta (drink, and food) ten pounds ; urine five pounds, which exhales an unusually strong urinous smell. Had a partial sweat over the trunk and head in the night. Mouth moist; no sourness. of stomach.
January 1st, 1797- Solid ingesta as usual ; drink nine pounds ; urine eight pounds, more limpid than yeflerday, and has a sharp acid odour. The breath has the fame smell . The colour of the urine, however, is not changed, on addition of syrup of violets. There is slight headache and sickness. The tongue appears much cleaner than usual. Has had a stool. Contin. diaeta animalis.
January 2d. Solid ingefta the fame; drink eight pounds; urine fix pounds. No flcknefs or hcadach ; tongue clear; the burning heat of the feet as before. One Joofe ftool. Contin.
3d. Drink 10 pounds; urine 7 1 pounds, of a deeper yellow than formerly; tongue natural. Contin.
4th. Drink ten pounds; urine feven pounds. Contin.
5th. Drink nine pounds ; urine 6{ pounds, more yellow, with a peculiar (not urinous) odour. Contin.
6th. No report, as laft night he went out, returned to the ward drunk, fo that his urine could not be meafured.
7th. Drink 7 pounds ; urine 6 pounds, having the same peculiar smell,
8th. Drink 7 pounds; urine 6 pounds; body coftive. Contin. diaeta animalis. Sum: ftatim pil. rhoei. comp. ^ l'et iterum eras mane.
9th. 156 Qtfa Drink iix pounds ; urine four pounds ; a copious ftool this morning; ftrength not changed fince he began the animal food. Contin. et habeat aq. menth. piper, lbiv pro potu. minuatur quantitas decocti carnis ad lbiv.
10th. Solid food as formerly ; drink feven pounds ; urine five pounds ; no flool. Sum : flatim pil. rhcei. comp. B 1.
llth. Drink fix pounds ; urine four pounds ; three llools this morning. Contin. diaeta animalis,
12th. Drink fix pounds ; urine four pounds ; two ftools—he thinks his ftrength is fomewhat impaired within thefe two or three days. Adeat eras mane balneum frigidum. Drink feven pounds ; urine five pounds ; bore, the bath well. Contin, 1 4th. Drink eight pounds; urine fix pounds. Contin*
1 5th. Drink eight pounds ; urine fix pounds.
l6tk Solid food as before; drink eight pounds; urine fix pounds, of a light ftraw colour, and with the peculiar fmell it has had for fome time. The urine of the 14th being evaporated, afforded matter of confiderable confiftence, with a ftrong faline, but fcarcely perceptible fweetifh tafte.
17th. Drink eight pounds ; urine fix pounds ; thinks he is weaker.
18th. Drink eight pounds; urine 5| pounds. Contin, IQth and 10th. Drink each day eight pounds ; urine fix pounds. Contin. 1\Ji January. Drink feven pounds ; urine five pounds. He has left the Infirmary to-day, by his own defire, to return to the country."
4th May. Dr. Hope told me a few days ago, that he had just then. received a letter from Walker, who says that since he left the Infirmary he has become weaker; and there is some expectation of his returning foon to the Hospital to resume his treatment. But it is doubtful whether when he was in the Clinical Ward he observed strictly the diet preferred. At least he was accustomed to go about freely; and the nurse told me repeatedly, that she suspected he did not entirely abstain from indulgencies of eating and drinking out of the house.