Diabetes Its Medical and Cultural History

"From that period I had not met with a case of Diabetes, although I had observed an extensive range of disease in America, the West Indies, and in England, until 1796." "Captain Meredith, of the Royal Artillery, being an acquaintance. I had seen him very frequently, previous to his going on camp duty in 1794, but then he had no disease; however, he always had impressed me, from his being a large corpulent person, with the idea that he was not unlikely to fall into disease. (Editor: Another instance of Rollo's clinical acuteness.)" "On the 12th of June, 1796, he visited me, and though I was at once struck with the diminution of his size, yet, at the same time, the colour of his face being ruddy, I received no impression, otherwise than of his being in health: a moment's conversation, however, convinced me of the contrary ...... 

"He complained of great thirst and a keenness of appetite; his skin was hot, dry and parched; and his pulse small and quick. He told me his complaints had been attributed to an old disease, and a liver affection. The thirst, dry skin, and quick pulse, marking a febrile state, depending probably on some local circumstance, and connecting these with the keenness of appetite, Diabetes immediately suggested itself to me. I enquired into the state of his urine, which I found in quantity and colour to be characteristic of the disease; and was at the same time much surprised, that for the two or three months he had been under the care of a Physician and Surgeon, the circumstance of the increased urine had not been known to them. The patient told me, as he drank so much, the quantity of urine had appeared to him a necessary consequence; and of course never having been asked about it, he gave no information. I directed him to keep the urine he next passed, and, on examination, it was found to be sweet; in consequence of which the disease became sufficiently ascertained." 

At another point in the case history, Rollo states that Captain Meredith was 34 years of age and was 71 3/4 inches tall. At the time of beginning of the special treatment, the symptoms of diabetes had been present seven months or more and his weight had fallen from 232 to 162 pounds. A view held by some at that time was that diabetes was a primary affection of the kidneys. However, Rollo developed the idea that the disease was "a primary and peculiar affection" of the stomach in which, due to some morbid changes in "the natural powers of digestion and assimilation," sugar or saccharine material was formed in that organ, chiefly from vegetable matter. It was on this basis that he advocated the use of an animal diet together with certain medication designed to quiet the overactive stomach and to diminish the appetite. 

Following initial bloodlettings, Rollo's treatment of Captain Meredith was as follows: 

"1st. The diet to consist of animal food principally, and to be thus regulated: 

Breakfast. One and a half pint of milk and half a pint of lime-water, mixed together; and bread and butter. 

Noon. Plain blood-puddings, made of blood and suet only. 

Dinner. Game, or old meats, which have been long kept; and as far as the stomach may bear, fat and rancid old meats, as pork. To eat in moderation. 

Supper. The same as breakfast." 

"2dly. A drachm of kali sulphuratum to be dissolved in four quarts of water which has been boiled, and to be used for daily drink. No other article whatever, either eatable or drinkable, to be allowed, than what has been stated." 

"3dly. The skin to be annointed with hog's lard every morning. Flannel to be worn next the skin. The gentlest exercise to be only permitted; but confinement to be preferred." 

"4thly. A draught at bed-time of twenty drops of tartarized antimonial wine and twenty-five of tincture of opium; and the quantities to be gradually increased. In reserve, as substances diminishing action, tobacco and foxglove. " 

"5thly. An ulceration, about the size of half a crown, to be produced and maintained externally, and immediately opposite to each kidney. And, 

"6thly. A pill of equal parts aloes and soap, to keep the bowels regularly open."

Therapy 

A special diabetic diet was undoubtedly one of the foremost therapeutic measures, even before the age of insulin. Even before it was recognized that diabetes was a disorder of carbohydrate metabolism, various kinds of diet had been recommended. A change to a diet decided purely pragmatically, which was nevertheless very effective, did not come until JOHN ROLLO (d. 1809), a Scottish physician, who, in 1797, had achieved good results with a meat diet, made his recommendation (MARBLE; ANDERSON; BECKENDORF). He gave a particularly detailed account  The History of Diabetes mellitus 85 of the case of Captain MEREDITH of the Royal Artillery, who became diabetic at the age of 34, and who was very obviously overweight. His diet consisted of a breakfast and supper of milk mixed with lime-water and bread and butter, while his dinner consisted of pudding made of fat and blood and mature, preferably rank pork. In this way he had - without being conscious of it - excluded carbohydrates almost entirely from the diet. The patient of course lost a great deal of weight and felt extremely well. 

A second patient was less cooperative and therefore died at the age of 57, 19 months after treatment was begun, mainly - as ROLLO pointed out - because during his last three months he indulged in such things as apple pudding, sugar in his tea, and wine. 

The "meat diet" was used well into the 19th century, although gradually it was considered wiser not to cut out all carbohydrates, and patients had a certain amount of carbohydrate added to their diet, even though that caused some glycosuria. This kind of diet was initiated in the middle of the 19th century, mainly by ADOLF NIKOLAUS VON DURING (1820-1882) and RUDOLF EDUARD KULZ (1845-1895). The latter even distinguished between harmful and harmless carbohydrates and found that levulose, inulin, inosit, mannite, and lactose, as well as some root vegetables like celery, comfrey, etc. caused no deterioration of the metabolic condition. But it remains true that many specialists did recommend a carbohydrate-free diet with a lot of meat and fat (DICKINSON; PAVY; SEEGEN; R. SCHUMACHER, STEPP).