Ketogenic Diet

The Diabetes Mellitus, though sometimes terminating in recovery, is yet well known to be a disease which has in general refilled every remedy hitherto recommended for its removal. Every attempt, therefore, to improve the practice in that affection, may justly be considered as deserving particular attention. The ingenious author of the work now before us, recommends a mode of treatment, which, in some instances, has been decidedly productive of remarkable benefit. It may justly, therefore, be considered as well meriting a fair trial in future cafes. 

The first cafe here related, is that of Captain Meredith, of the Royal Artillery. When he came under Dr Rollo's care, on the 16th of October 1796, he voided about twelve quarts of urine in twenty-four hours. This urine, seven quart-bottles of which he had preserved, having been voided during the course of the night, was of a light straw colour, had no urinous smell, but emitted somewhat of a violent flavour, and was very sweet to the taste. He was affected with 1 excessive thirst, and had drank, during the day, feven or eight quarts. His tongue was somewhat whitish, but moist: there was a cleanness in his mouth, and he spat a white frothy saliva, of a sweetish taste. His appetite for food was variable, sometimes unusually keen, particularly at uncommon times, as during the night. His face was fulfilled, his skin dry, but not unusually warm, and his pulse did not exceed eighty-four strokes in the minute. He was frequently sick, and threw up a viscid matter, of a bitterish taste, but with some sweetness. After eating, he complained of a pain of his stomach, which in general continued about half an hour. He complained of a constant pain in the region of the kidneys, extending forwards, but more particularly in the right, in which there seemed to be a greater fullness and tenderness to the touch. There was likewife a retraction of the testicle, with a weakness, sense of coldness, and at night an (Edematous swelling of the leg on the same side. He also complained of a pain and tenderness of the great toe. He felt also a lingular fluttering fenfation in his belly, extending from the fituation of the kidneys. He was regular in his bowels, though sometimes inclined to costiveness. His stools were of a greenish colour, and had no unpleasant smell. The prepuce of the penis did not retract. It had a whitish appearance, with excoriation and soreness, but was not swelled. His gums were reddish, and had the appearance as if affected by mercury. The teeth felt to him loose. There was a fullness about the eyes, with a turbid yellowish cast, and, he had slight occasional headaches. He had not been particularly restricted in diet, which consisted of animal food and vegetables; and he drank from a pint to a bottle of port wine daily. His other drink was toast-water. He used exercise, both in the way of riding and walking; but he could not walk above two miles without much fatigue. At this time thirty-six ounces, Troy weight, of his urine, analyzed by Mr Cruickshank, yielded by evaporation three ounces and one dram of saccharine extract, of the appearance of molasses, but thicker. According to this proportion, his whole urine for a day, would have yielded twentynine ounces Troy weight; an astonishing quantity to be separated daily from the system. Treating some of this extract with the nitrous acid, Mr Cruickshank procured the saccharine or oxalic acid. With a smaller proportion of the acid, it produced a substance which, in appearance, taste, and smell, could not be distinguished from honey. Two portions of blood, about four ounces each, were taken from his arm. These in appearance exactly resembles what is described by Dr Dobson, excepting that the serum did not impart a sensibly sweet taste. The crassamentum of the first cup had a slight buffy coat ; the craffamentum of the fecond had more. The buffy coat in both was of a bluish colour, similar to "what mercury sometimes produces. A portion of blood from a healthy person, drawn on the same day, was placed in the same room, and in the same circumstances with one of the portions of diabetic blood. In two days the diabetic blood assumed a caseous appearance on the surface, and the whole mass became dry and resinous, without having undergone any apparent putrefactive process. At the end of sixteen days, it remained in the same state; whereas the healthy blood exhibited evident marks of great putrefaction in four days ; and it became necessary to throw it away on the seventh.

When this patient came under Dr Rollo's care, his disease had been of seven months standing. During that time he had taken some remedies, under the direction of an eminent physician at Yarmouth, the principal of which were Peruvian bark and alum. He had fallen away very considerably in flesh and fat; for, in October 1794, when in apparent health, he weighed sixteen stones and eight pounds; and in November 1796, he weighed only eleven stones and eight pounds, showing a loss by the disease of no less than five stones in weight. For six months preceding the attack of the diabetes, he was often sick, and vomited at least two or three times a-week ; and he frequently brought up from the stomach, during these vomitings, different things which he had eaten several days before. These seemed to be unaltered, and the taste was very generally four. He always ate heartily, and drank freely, but not intemperately. He was fond of high-seafoned and fat dishes. He had been subjected to two regular attacks of gout, and had at other times two severe fits of cholic. He had been twice married, and had two children. He was, in the thirty-fourth year of his age, five feet eleven inches high, of a fair complexion, with light-brown hair, and dark-blue eyes. From an attentive consideration of all the circumstances of this case, what appeared to Dr Rollo to be the principal objects of treatment, were, to destroy the saccharine process going on in the stomach, to promote a healthy assimilation, to prevent the supposed increase of absorption from the surface, to diminish the increased action, and to change the imagined derangement of the kidneys. With these intentions the following plan of treatment was resolved upon.

1. His diet to confift principally of animal food; for breakfast, a pint and a half of milk mixed with half a pint of lime water, bread and butter; at noon, plain pudding, made of blood and fuet only; at dinner, game, and old meats which have been long kept, and, as far as the stomach may bear, fat and rancid old meats, as pork, taking care always to eat in moderation; for supper, the same as breakfast.

2. For drink, he was allowed daily four quarts of water which had been boiled, and in which was dissolved a dram of the kali sulphuratum. He was strictly forbid to use any other article, excepting these, either in the way of meat or drink.

3. His skin to be anointed with hogs lard every morning. Flannel to be worn next the skin, and the gentle exercise only to permitted, but confinement to be preferred.

4. A draught to be taken at bed-time, confifting of twenty-five drops of tartarised antimonial wine, and twenty-five of tincture of opium and the quantities to be gradually increased.

5. An ulceration, about the size of half a crown, was directed to be produced, and maintained externally, immediately opposite to each kidney. And, lastly, his bowels were to be kept regularly open, by a pill of equal parts of aloes and soap.

This treatment was begun on the 19th of October, and, so soon as the 21ft, some changes occurred. He made, in twenty four hours, only six quarts of urine, and drank only three quarts of the sulphurated alkaline water. The urine was not so pale, had a cloud in it, and was more urinous in smell. 

On the 1ft of November the urine did not exceed four quarts, while it was of a higher colour, and more urinous smell. His skin was moist and he perspired freely; his stools were large, and very offensive, and he was in every respect much easier, though he complained of much pain from the ulcerated parts of the loins. Imagining that the quantity of alkaline salt, which he took daily in the kali sulphuratum, might have some improper effect on the kidneys, it was resolved to try hepatifed ammonia, on the suggestion of Mr Cruickshank, who was of opinion, that it might prove a more certain and active medicine in diminishing the action of the stomach, as well as the action of the system m general. He was therefore directed to take five drops of it, in each half-pint tumbler full of water, which he used as drink. The ill day he took thirty-five drops at different times, which in the evening, produced sickness and vomiting, with giddiness and drowsiness. He was therefore diredled to leave off the hepatifed ammonia for one day, and then to begin with two drops to each tumbler full of water. On the fourth, he drank only two pints of water, and made only two quarts of urine, which was not sweet, and deposited a red sandy, or lateritious sediment. 

On the 5th of November, the opiate at bedtime was discontinued ; and on the 8th the rubbing with the hogs lard was left off. Between the 4th and 14th of November, in consequence of some irregularities on the part of the patient, particularly drinking beer and tea, the disease was to a flight degree reproduced. 

On the 14th, therefore, an entire abstinence from vegetable matter was directed; nothing was allowed approaching nearer to it than milk; and even this was directed to be left off, and strong beef-tea substituted, should the disease not disappear. This soon produced a favourable change, his urine became again of a much Higher colour, and its smell and taste quite urinous. He afterwards continued for some time with tolerable regularity on the course already mentioned, and by the 18th of December his disease seemed to be in a great measure overcome; he was therefore desired to eat half a pound of bread as a daily allowance, and to take exercise more freely. 

On the 30th of December, Dr Rollo found that since the 18th he had continued free from the disease. He was now in high spirits, and rapidly gaining flesh. His urine did not exceed two pints in the twenty-four hours. It was often under that quantity, and perfectly urinous. He now weighed thirteen stones and one pound; so that he had gained about alone and a half lince the end of November; which furnished a convincing proof, not only of the removal of the disease, but also of the disposition to it. 

After this period, Captain Meredith might be considered as continuing free from complaints. He took exercise freely, both in the way of walking and riding. He ate a sufficient proportion of bread, potatoes, and other vegetables, without any inconvenience- His appetite was good and natural, and his bowels regularly open. His urine continued perfectly natural, and, in general," did not exceed a quart in twenty-four hours. Of this urine, which was of the ordinary taste and smell, nine ounces were evaporated, -and yielded of a brown and pungently saline bitterish-tasted matter, without tenacity, three drams and twenty grains, a product excessively different from the saccharine extract resembling molasses, which his urine yielded in October. The product now obtained was very nearly the fame, both in quantity and quality, as Dr Rollo obtained from his own urine, which, he had every reason to believe, was in the healthy state. About the middle of March, Captain Meredith continuing in a state of health, was ordered on active service; to which he very readily assented, being satisfied that his health now enabled him to execute the duties of his station.

"It was agreed to try the effects of animal food. He is directed to abstain from vegetable food in every shape. To have two eggs for breakfast. Boiled meat and steaks alternately for dinner. Eggs, or cheese for supper. For drink eight pounds of weak beef tea, and two pounds of weak peppermint water. Solid ingested about two pounds. "

The second case which Dr Rollo has here very minutely detailed, but into the particulars of which we cannot propose to enter, is that of a general officer in the 57th year of his age, with whom the urinary discharge amounted to ten or twelve pints in/the twenty-four hours; and, while the urine had a very sweet taste, he was at the same time subjected to the other common symptoms of diabetes. After his disease had been of at least three years Handing, and after recourse had been had to the assistance of several eminent physicians, without benefit, he came under Dr Rollo's care, in the beginning of January 1797. 

Nearly the same plan of treatment, particularly with respect to the diet of animal food, was here directed, as in the case of Captain Meredith. In a very short time, a remarkable change for the better was produced. His thirst was diminished, and his urine rarely exceeded two, three, or at the most, four pints, in twenty-four hours, being at the same time of the natural sensible quantities. In this way he continued to the end of February, gradually recovering flesh and strength. He now resolved on returning to his residence at Portsmouth. He had very great impatience under refraction. But on parting from Dr Rollo, he was told, that, for preventing the return of his disease, everything depended on himself; and he acknowledged the truth of the observation. He bore his journey very well, and arrived at Portsmouth on the 27th of February. But having eaten something improper on the road the day before, he was attacked with a bowel-complaint. On the 6th of March he had a return of his bowel-complaint, from eating beet-root. On the 9th he had the sanction of a physician to eat what he pleased, and to drink wine. The disease was soon reproduced, for his urine became sweet, and was increased in quantity, with a return of thirst and feverishness. Yet this case, Dr Rollo justly observes, adds strength to the conclusions derived from the former case. From these two cases Dr Rollo draws some general inferences. He concludes, 

1. That the diabetes mellitus is a disease of the stomach, proceeding from some morbid changes in the natural powers of digestion and allimulation. 

2. That the kidneys and other parts of the system, as the head and skin, are affected Secondarily, and generally by sympathy, as Well as by a peculiar Stimulus. 

3. That the stomach-affection consists in an increased action and secretion, with vitiation of the gastric fluid, and, probably, on too afiive a state of the ladteal absorbents. 

4. That the cure of the disease is accomplished by regimen, and medicines preventing the formation of sugar, and diminishing the increased action of the stomach. 

5. That confinement, an entire abstinence from every species of vegetable matter, a diet solely of animal food, with emetics, hepatifed ammonia, and narcotics, comprehend the principal means to be employed. 

6. That the success of the treatment in a feat measure establishes the five preceding inferences. 

7. That the saccharine matter of the disease is formed in the stomach, and chiefly from vegetable matter, as has been shown by the immediate effects produced by the abstinence from vegetable matter, and the life animal food solely. 

8. That acescency is predominant in diabetic stomachs, which continues even sometime after the entire abstinence from vegetable matter, and after the formation of sugar; and that while such acescency remains, the disposition to the disease may be supposed to continue. 

9. That the saccharine matter may be removed in three days, and, by avoiding vegetable matter, will not again be reproduced ; but we are not yet able to state accurately, when the disease, and the disposition to it, can be finally removed. 

10. That there are two circumstances to be considered in this disease, which we may separate in the progress of the treatment. As it has been shown, that though the formation of sugar was prevented,yet the increased action of the stomach remained, and maintained the defect of assimilation, which prevented nutrition. Hence two objects occur in the cure ; for it is not yet determined, whether the preventing the formation of sugar, by an entire abstinence from vegetable matter, and the use of animal food, with fats, if properly persevered in, might not ultimately comprehend the other, namely, the removal of the morbid action of the stomach. 

11.  That the lungs and skin have no connection with the production of the disease. 

12. That the quantity of urine is probably in proportion to the quantity of fluids taken in, and has but little dependence on absorption of fluids, from the surface of either skin or lungs. 

13. That though the disease has been shown to consist in an increased morbid action of the stomach, and probably too great a secretion, with vitiation of the gastric fluid ; yet the peculiar specific condition of either, as forming the disease, is acknowledged to lie in obscurity, and must remain so till the physiology of healthful digestion be properly explained and established. 

14. That the first case had only been of about seven or eight months duration when the treatment commenced ; but the Second case had been upwards of three years continuance. The age of the one thirty-four; of the other, fifty-seven ; circumstances which constituted material differences, though they seemed not to create corresponding difficulties in the treatment, so far as the direct removal of the complaint was concerned. They may however retard, in the one instance, the entire restoration of health. 

15. That, in both cases, deviations occurred in the management, and were respecttively followed by reproductions of the disease, and, though disadvantageous to the patients, have confirmed our views of its nature and treatment. 

16. And, lastly, That from both cases we may warrant this general conclusion, that the diabetes mellitus is so far understood as to be successfully cured. 

To these histories and observations, Dr Rollo has subjoined some remarks respecting the diabetes mellitus, which have been communicated to him by different correspondents, since the dispersion of his notes on the case of Captain Meredith. With regard to the causes of the disease, he observes, that from Dr Falconer's letter it appears, that one case was produced by excessive indulgence diligence in spruce-beer; that in one patient of Dr Cleghorn's, the disease seemed to have arisen from hard work when recovering from a fever, and in another from his being much addicted to the use of large quantities of sugar; and that the patient Whose case is related by Dr Gerard, had been subject to pyrosis, and an excessive discharge under the form of perspiration, previous to the attack of diabetes. With regard to the nature of the disease, Dr Rollo observes, that the appearances found by Dr Baillie, on direction, an account of which will probably soon be published, may have been sequelae of the disease. Mr Abernethy, he remarks, found the serum of the blood in diabetes to be turbid ; and observed, that sugar taken into the stomach increased the saccharine matter in the urine. With regard to the treatment, Dr Rollo informs us, that in one case of diabetes mellitus, Dr Duncan found fat meats serviceable; that Dr Falconer recommends mephitic alkaline water; that Dr Beddoes Mentions a case where Bristol water cured the disease ; but that Dr Currie, who has seen several cases of the disease, never saw one of these cured in which the urine was sweet.

The case of James Walker, treated in the Royal Infirmary of Edinburgh, by Dr Hope, shows, according to Dr Rollo, the good effects of animal food. The treatment in this manner was begun on the 29th of December, when the daily quantity of clear urine of a sweet taste amounted to thirteen pounds. On the 31ft of the month, two days only after the commencement of this treatment, the quantity of urine was reduced to five pounds, and it had acquired a strong urinous smell. The two cases treated at Glasgow, by Dr Cleghorn, show also the good effects of a diet consisting entirely of animal food ; and prove also the influence of commotion in the bowels on the quantity of urine. But the most striking case, Dr Rollo observes, is that related by Dr Gerard of Liverpool, from which it appears, that in diabetes there is no absorption of fluids by the skin, and that animal food alone, if duly persevered in, may cure the disease, though such perseverance be only of a very limited duration. Dr Rollo concludes his remarks on diabetes, by observing, that hepatifed ammonia appeared to him to be a very powerful medicine. But it must, he tells us, be prepared according to Mr Cruickfhanks's method. The ammonia must be pure, and completely saturated with the hepatic gas. To produce its narcotic effects, full and sudden doses of it must be given ; but these require judgement, and an acquaintance with the exhibition of the medicine. It should not be mixed up in-draughts, or in any other form, as it is readily decomposed; but it should be dropt from the P^ial, at the time of using it, into a proper Vehicle, and taken immediately. Distilled water is, he thinks, the best vehicle.

From Mr. Leigh Thomas, Surgeon, Leicester Square, London.

History

 I HAVE this morning (August 28, 1797) met with a confirmed cafe of Diabetes Mellitus ; and, as I consider it a favourable one for a trial of the ingenious mode of treatment you have pointed out for the cure of this disease, I shall be happy either to give it up to your entire management, or co-operate in any plan that may be suggested between us. The subject is a very industrious man, aged 38, by trade a watchmaker, much confined to business, and anxiously labouring for the support of a numerous family.

He is much emaciated, and loses strength and weight daily. He showed me a letter from a brother of his, living in Kent, who also complains of pain in the back, and great debility, with an occasional discharge of sweet urine, especially after any fatigue of body, or distress of mind. It appears that three brothers of this family laboured under the disease, but it could not be traced to either of the parents.

Treatment.

Doctor Rollo having seen the patient, and favoured me with directions how to proceed, he very readily agreed to adhere to any rules laid down for his recovery.

Sept. 2, 1797, he commenced eating animal food, and took six or eight drops of hepatifed ammonia thrice a day, with castor oil occasionally; his common beverage was water and beef tea. After pursuing this plan for days, the urine had entirely lost the sweet taste, and was greatly reduced in quantity ; by the 18th he had lost the pain in the stomach, and the appetite became more moderate. 

The quantity of urine was now reduced to one pint and a half; he felt very weak ; had a violent longing for vegetable food, particularly bread. I could not resist his solicitations, especially as I had a faint hope that the disease was conquered ; I therefore allowed him a small French roll, with a glass of port wine. The urine made that night was highly impregnated with saccharine matter, and increased to the quantity of five pints. The following day, he again indulged a second time with bread and also porter, and so continued to deviate till the beginning of November, sometimes taking three pints of porter daily. In this interval, I ordered him the cinchona and sulphuric acid. His strength was improved, yet he lost weight. The gnawing pain at the stomach had returned, and also the itching and excoriation of the prepuce, the urine very sweet, and had increased to ten pints. The disease being reproduced, and its effects so considerably increased, the patient promised to be more resolute in future. 

Nov. 20th, the animal food was again returned, and, I believe, faithfully adhered to until the middle of February ; the hepatifed ammonia was laid aside ; and milk was torbid, as I had strong reason to believe that it frequently produced sweet urine in the former trial. His strength, at the end of this period, was greatly reduced; the gums spongy, with frequent bleedings, a foetid breath, and a rigidity of the muscles of the lower extremities. The urine had decreased to three pints, not at all sweet, was of a brown colour, and loaded with putrescent mucilage ; in taste exceedingly salt, and much more pungent than urine in a natural state. The appetite was so completely destroyed, that the sight of animal food excited nausea, but, at the same time, there was a longing delire for vegetables and beer. His weight during this time varied something. In November he weighed more than nine stone ; in January, eight and a half; before the end of the course, he regained nine stone. 

The excoriation of the prepuce had gone off, but the natural propensities never returned ; the skin became moist, the clamminess of the fauces had disappeared. A great number of boils came out in different parts, which were exceedingly painful ; some few advanced to suppuration, but never afforded true pus. Every diabetic symptom having left him, and his present state being so very distressing, induced me to allow him a small proportion of vegetable food. As we had experienced the ill effects of bread in the former trial, I directed him to eat sparingly of potatoes, and drink weak brandy and water; he drank, also the alum whey. In two days after this, the sweet urine reappeared, and all the other symptoms soon returned. He never after this adhered to any regular plan, only taking vegetable food very sparingly.

About the middle of March, he had a severe attack of pleurisy, which required two bleedings, and other evacuations, to remove it. In April he passed some time in the country, twenty miles from town, where he constantly eat vegetables, and drank large quantities of mild ale; during this time, the urine was sweet only at times. Under these circumstances, he gained four pounds weight in nine days. After his return to town, his strength daily decreased ; the boils frequently appearing, obliged him to lie almost constantly in bed. During the latter part of this period, the urine was very frequently perfectly sour, and that immediately upon passing off, so as to leave no doubt of its being so in the bladder ; the taste and smell very similar to sour whey, but perfectly transparent ; at this time, it was always small in quantity. In the beginning of July, he had another attack of pleurisy, which terminated his sufferings on the morning of the l6th. (He died)

As I have merely given a summary account of the progress of the case, I shall, in like manner, relate the effects of certain vegetables upon the disease, and which came under my own observation, Bread certainly holds the first rank in exciting the formation of saccharine matter ; nor did this appear to depend upon the fermentation it had undergone, as the sea-biscuit, or a teaspoonful of flour in melted Butter, universally produced the same effect ; potatoes flood next ; onions, leeks, radishes, and turnips, also produced much sugar. Preparation by boiling, or otherwise, did not seem to increase or diminish their effects. Spinach, carrots, peas, broccoli, and cauliflower, had each less effect than the former, particularly the two last; parsnips were eaten with impunity. The urine never tasted sweet after taking them ; at first, the urine had a sourish taste and smell, which I attributed to them, but since, it has been perfectly sour, without being able to account for it. Every kind of fruit invariably produced sweet urine, without being able to ascertain any variation in their effects. Of Liquids, porter appeared the most hurtful ; no difference could be observed with regard to the effect of any of the spirituous liquors, wines, or cider; mild ale he considered as having no effect in producing the disease, but of this I can say nothing of my own knowledge, as he only drank it in the country. He was bled five times in the course of the treatment, purposely to examine the blood; in one instance only had the serum a turbid wheyich appearance ; the slightest taste could not at any time discover anything of a saccharine quality. Upon allowing the blood to evaporate in the open air, no putrefaction took place, it became a solid brittle mafs, of a mining appearance when broken. Dissection Twenty-four hours after death, under the directions of Mr. Cruikshank I proceeded to make a careful examination of the viscera.

Page 345

Some Remarks on These Communications.

THESE communications are of great importance in the further elucidation of the history, nature, and treatment of the Diabetes Mellitus; and they will probably supersede any more cases in detail. A concise account, however, of such as are attended with new circumstances, and which have terminated, either successfully or fatally, with diffections, must still be required. The continuation of Walker's case, as described by Doctor de la Rive, shows the same unsteadiness, and inefficacy of any other means than the animal diet, and likewise that his patient, by more perseverance, might have obtained a perfect cure.

Doctor Gerard's first case points out a corresponding effect in the female as in the male, by the irritating stimulus of the saccharine matter in the extremity of the urethra ; it also exhibits the effect of vomiting in diminishing the quantity of the urine ; and alludes to some advantage having been obtained from the carbonate of ammonia. 

The second case marks a dropsy previous to the diabetic accession; also the same affection of the urethra as the other; and the patient having more resolution in complying with the means of cure, was likely to obtain a restoration of health. Both show the propensity to deviate from a rigid observance of the animal diet, and the conviction that it is efficacious when strictly pursued. 

Doctor Cleghorn's continuation of the cases of Roger and Maclean, afford additional satisfaction, but more particularly that of the latter. This man died evidently under the effects of a lung disease, during which the Diabetes had not returned. From the appearance of the lungs on dissection, it was supposed that they had been affected previously to the diabetic attack; or, at least, that they were dissused to inflammation, on getting cold, while in the infirmary with the disease. Dissection, while it exhibited no morbid derangement of the kidneys, neither did it of other parts. It is said, the kidneys, though found, were more flaccid than usual, and that the bowels were very pale.

He gives also a concise account of four other cases of the Diabetes Mellitus, treated in the Glasgow Infirmary. The first-of whom was a man who caught cold under mercury, to which the patient described his disease: he got completely well by the animal diet. The insensibility of his stomach to emetic medicines is attributed to an original peculiarity of constitution, which had no connection with the Diabetes. 

The remaining three patients were women, one of whom had the disease while giving suck, which obliged her to wean her child. Had this patient been admitted during her nurfing, it might have been ascertained whether the milk contained more than the usual proportion of saccharine matter. The other two cases show only the efficacy of the animal food. There is a fifth mentioned as being under the treatment, with equal hopes of success. 

The Doctor takes notice of a singular disease among horses, which had some general resemblance to the Diabetes in the human subject:. The urine of one of them was hastily examined, and it was found sour. 

In his letter of the first of July, he gives an account of an acute disease, which attacked one of the diabetic patients, after her dismissal from the infirmary, terminating fatally. The dissection showed inflammation of the bowels ; it also exhibited the kidneys as being enlarged, uncommonly soft, and pale. From this case, and that of Maclean the Doctor supposes, that animal food, when so rigidly persevered in, strongly disposes to inflammatory affections.

(explained at end by Dr. Rollo)

Doctor Storer had met with seven distinct cases of the disease, and he avers with Doctor Currie, that after it had been completely formed, he had never seen it cured by the former methods of practice. He gives a satisfactory account of Doctor Aldrich's case, the Gentleman of 77 years of age ; which shows the effects of our plan of treatment in a very favourable and impartial point of view. He joins in the common regret, that the great desire for variety of aliment, forms a strong bar to the successful application of a diet confining entirely of animal food. He describes a case where Bulimia preceded as well as accompanied the diabetic disease. The account of a mild or chronic species of it, as prevailing in families is important. In this form it is said to be occasionally suspended, and the patient may live to a tolerable age. It does not seem, so far as the Doctor's observation has gone, to depend on any constitutional disposition ; neither does he determine whether this constitutes a difference in the nature, or merely in the degree of the disease. https://www.carniway.nyc/history/animal-food-may-alone-cure-the-disease

https://www.carniway.nyc/history/doctor-aldridge-uses-carnivore-to-cure-diabetes

Doctor Jameson's case of Nixon exhibits a distinct history of the disease, which had been of eighteen months standing. The animal food reduced the saccharine and extractive matter from three ounces, which had been obtained from a quart of the urine to one ounce and two drachma in the short space of 19 days. On the whole, it furnishes an instance of the efficacy of our plan of cure.

Mr. Shirreff's attentive observation has rendered his diabetic case interesting. The subject of it is of an earlier age than that in which the disease commonly appears ; a stomach affection evidently preceded it, during which she eat freely of fruits and sweetmeats. It would seem, that the urine undergoes manifest changes, at different hours after eating, which is more remarkable, according to the substances eaten. In this case, after partaking of vegetable matter, it was found clear, and sweet ; the next portion higher coloured, and insipid ; and when the interval was long, as in the night, the urine was more natural. This is an important fact: in support of the opinion, that the saccharine matter is evolved during the process of digestion.

Mr. Houston's patient shows also, a long continued stomach affection, previous to the detection of the Diabetes, during which she likewise indulged in the liberal use of fruit : but in this case the mind was particularly concerned, being under the influence of the depressing passions. The circumstance of the acid urine is singularly curious ; but it remains to be further ascertained.

Doctor Cleghorn, it may be remembered has mentioned that he found the urine sour, in the case of the horse disease.

Dr. Pearson's three cases, with the ingenious remarks accompanying them, are valuable. The first, shows the same infeasibility to emetics, as in one of the cases related by Doctor Cleghorn. The direction exhibited no morbid appearance, or even any change of the kidneys, or any other part, except in the myfentery and bladder, which were found thickened. The urine contained in the latter was not sweet. This case is peculiarly important to us, from the detection having shown no change whatever, in the natural appearance of the kidneys; a fact strongly supporting our doctrines. The second gives a very distinct account of the disease, which was treated in the best manner, by the remedies usually employed at that time; but without relief. The third contains facts and arguments, in opposition to the theory of the disease, as depending on a primary affection of the kidneys, which must have their weight. The opinion, with regard to the effects of animal and vegetable food, in the formation of saccharine matter, differs from that we entertain. It is an incontrovertible fact, that animal food solely used, deprives the urine of every portion of saccharine matter, so completely, as not to be discoverable by any chemical process, nor by fermentation. See Doctor Gerard's case, page 215.

The experiments of Mr. Cruikshank not only show the difference between what may be termed animal and vegetable sugar; but that the sugar in diabetic urine is very probably the entire product of vegetable substances. There are also some other points in which we cannot perfectly agree ; but these will appear from our general account of the disease.

Doctor Marshal's case is valuable. The appearances on dissection show the state of the kidneys, which has been frequently met with in this disease : but the peculiar condition of the stomach and blood have not been hitherto found, at least not described. The stomach exhibited marks of disease ; and as the villous coat was of a red colour, an increased action of its vessels having happened was apparent. The peculiar smell of the blood, pointed out a great deviation from the natural state ; but it is to be regretted that it had not been more particularly examined. The circumstance of the unmixed chyle is singular. The whole, we apprehend, justifies this conclusion that more morbid changes in the organic powers of assimilation, than of any others in the body, were manifested ; of course, we deem it a fact strongly in favour of our doctrines of the disease.

Doctor Willan's case exhibits a very successful adoption of the animal food, without the use of any other remedy. The disease had been probably of twelve months duration, and was attended with nearly its worst symptoms. In eight days the urine was reduced from 12 to 2.125 pints in the 24 hours ; and in 14 days more, it was probably deprived of the unnatural proportion of extractive, as well as saccharine matter. In five weeks, the recovery seemed to be far advanced. If the same steadiness of conduct, in adhering to the dietetic treatment, continues, there is every reason to expect a perfect restoration of health ; and it will furnish an additional fact, in support of our opinions of the nature and treatment of the disease. 

Mr. Thomas's case, from the minuteness, accuracy, and result of the direction, throws considerable light on the nature of the Diabetes Mellitus, and affords another remarkable fact in favour of our ideas on the subject. The apparent natural condition of the abdominal viscera, demonstrated that the disease did not depend on the derangement of the structure of any organ. The morbid changes which may have been found in other dissections, must have arisen from the long continued morbid action upon particular parts, forwarded, probably, in some instances, by a favourable pre-disposition, especially that connected with scrofula. The circumstance of three brothers having the disease, thews some pre-disposition, which may be hereditary. The effects of various vegetable substances on the urine will improve the practice. The observation that the urine had been voided in an acid date, corresponds with what has been mentioned in Mr. Houston's case, and by Doctor Cleghorn. This, with several other cases, shows the pre-disposition in diabetic patients to inflammatory diseases. The failure of tonic and astringent remedies, with the effects of vegetable food, and the successful administration of opposite means, confirm the opinion that this peculiar disease is accompanied with a state of constitution very different from that in scurvy. In this case, the patient had an attack of pleurisy, in the month of March preceding that of July, which proved fatal. As active diseases of this nature have been found to suspend the Diabetes Mellitus, the intervening circumstances which occurred in it, between the two attacks of the pleurisy, might somewhat have depended on the sequel of the first, as it was the opinion of Mr. Thomas, part of the diseased appearance of the right lung, with the effusion in the chest, was the effect of that attack.