Meatritionist

OBSERVATION IX. - Mr. Leopoldo Lam ... of fat constitution, 60 years old, owner in Naples; constant abuse of mealy crops. Patient for more than two years, cataract for a month, eliminating 6 liters of urine, containing 730 gr. of sugar, and of the specific weight of 1037, with some traces of albumin, according to the analysis of Primavera of December 9, 1870. Subjected to the rigorous treatment, meat diet and lactic acid, he experienced from the first twenty-four hours , an extraordinary improvement: after three days, the polyuria and glycosuria had disappeared. On January 4, the patient noticed an improvement in his eyesight: he resumed eating bread and even sweets, without relapse. On January 18, 1871, the urine weight was 1011: the healing was maintained complete. The patient remained in good health for a few months, then died from acute intercurrent lobar pneumonia.

Bouchardat and the evolution of the diabetes diet 

Towards the end of the 1850’s, Pierre Adolphe Piorry (1794-1879), Professor of Internal Medicine in Paris, recommended that diabetics consume large amounts of sugar. However, one of his colleagues, a diabetic, was unfortunate enough to follow his advice and died as a consequence. Nevertheless, at the beginning of the 20th century, a considerable number of physicians still believed in the need to increase the consumption of sugar as a means of treating this disease. Even the most seemingly knowledgeable specialists tended to urge their diabetic patients to gain weight. 

In 1910, the American physician Frederick Madison Allen (1879-1964) developed his famous “Allen starvation treatment”. Considered the best therapy for diabetics before the introduction of insulin, it comprised severely restricted calorie intake (1000 calories per day) and was rich in fat and protein accompanied by 10g of carbohydrate daily.6 

An important first step in the right direction was made when physicians began to adopt a position contrary to that of overeating, realizing that the surplus of food absorbed by diabetics required an extra effort of the organism, this aggravating their condition. Noting that carbohydrates appeared on the whole to be particularly harmful, they additionally recognized that, since the absorptive capacity of the diabetic organism is severely compromised, a diet poor in carbohydrates would likely be appropriate.7 

Bouchardat refuted the disastrous method of Piorry, establishing his own diet specifically adapted to the needs of his diabetic patients. He experimented with periodic fasting, having noted that, during the 4-month siege of Paris in the 1870 Franco-Prussian war, those patients of his who suffered from starvation presented diminished glucose in their urine. He had also observed that exercise seemed to increase the tolerance of diabetics to carbohydrate. “You should earn your bread through the sweat of your brow”, declared Bouchardat to one of his patients who had asked him to increase his food ration.8  Moreover, Bouchardat sought to demonstrate the merits of his principles via their practical clinical application. He was the first to put his patients on a specific diet, thus inaugurating the clinical knowledge of diabetes and its dietary treatment. 

His clinical mind and common sense impelled him to stress the importance the importance of the diabetes diet since he wrote: “...it is difficult to refrain, and to continue thus, when man so much hungers after bread. Despite the most careful monitoring, despite the assurances of these unfortunates, it is true that this food will become fatal for them, since nothing averts them from it. A little later, tired of this treatment that does not end and exhausted, more morally than physically, the diabetics resume their starchy meals; the accidents reappear.....and death arrives”.8  Bouchardat’s work on diabetes, begun in 1830, continued for half a century. All his articles on this disease are summarized in his book De la glycosurie ou diabète sucré; son traitement hygiénique, published in 1875 in Paris and considered as the best approach to dietary treatment of diabetes. 

Although a supporter of Rollo’s gastric theory concerning diabetes, Bouchardat would modify it, adding the hypothesis of the presence in the gastric juice of a “diastase”, an enzyme that promotes the transformation of amide into glucose. Normally carried out in the intestine, this chemical reaction was thought to occur in the stomach under certain pathological conditions; the gastric mucosa would allow a more rapid passage of sugar in the blood, hence the hyperglycemia and glycosuria.8  This constituted an approach similar to that of the German physician Wilhelm Griesinger (1817-1868). 

In his first treatise on diabetes (1830), Bouchardat proposed the presence of a “diastase” in the stomach of diabetic patients. Later, he carried out numerous experiments to study in depth the digestion of starches in both physiological and pathological conditions. The results of these investigations were recorded in various publications dealing with “la fermentation glucosique”, presented at the Academy on January 13, 1845, “la digestion des aliments sucrés et féculents” and “les fonctions du pancréas”, presented to the Academy of Sciences on January 20, 1845.3 

The following question occurred to him: “Does there exist in the gastric juice a specific substance that plays an important role in the disease?” Italian and German medical authors of the same period who had written on diabetes reported the existence of the diastase in normal gastric juice. However, though Bouchardat experimented on the action of normal gastric juice on intact starch, on jelly starch and on bread, he could never discern the least specific debilitating action. He thus concludes: “To my mind, the existence in the gastric juice of a substance that transforms the starch into glucose in the stomach of diabetics concerns a “pathological” fact and not a “physiological” one, and it is none other than the diastase”. This was Bouchardat’s theory, inspired by that of Rollo. He summarized his ideas saying, “... abundant glycogenic food, production of an overly energetic diastatic ferment, excess of glucose in the blood: these are the main conditions defining diabetes mellitus pathogenesis”8  (Figure 2). 

Bouchardat, promoter of the first diet for diabetes in the contemporary age 

Despite some unresolved questions and the unsoundness of his “diastase” theory, the fact remains that Bouchardat was the first physician to formulate a dietary treatment and should therefore be viewed as the originator in the present age of a diet tailored to diabetes. He recommended the substitute of carbohydrate fats and advocated alcohol which, according to him, was a valuable source for diabetics of considerable amounts of calories. He was opposed to milk consumption because of its richness in lactose, while he recommended green vegetables and gluten bread. He also demonstrated the importance for diabetics of a moderate degree of undernutrition combined with physical exercise.9 

In his book, De la glycosurie ou diabète sucré, Bouchardat devotes seventeen pages to enumerating both forbidden and permitted foods. He begins by offering general advice on the alimentation of diabetics such as the following: “Eat moderately and slowly, chewing the food thoroughly; the amount of urine in 24 hours needs to be over one liter and a half; drink the least possible; two meals a day are advised: one at 10 o’clock, the other at 6 o’clock; avoid resting, and especially sleeping, after meals; a good walk out of doors is recommended; sleep only four to five hours after the last meal; refrain from smoking”.8 

In the list of forbidden foods he includes starches and sugars and anything which contains “all fruits” and “jams of all kinds”. Also prohibited are bread, regardless of the cereal, carrots, turnips, rape and other farinaceous roots, or sweet onions, radishes, beans, peas, lentils, beans and chestnuts. This list additionally incorporates honey, milk, beer, cider, wines sparkling or sweetened, carbonated water, soft drinks and other beverages, especially when they are sweet, and also sorrel soup. All these foods are prohibited because they are not used by the body and, moreover, will produce sugar in the urine.9 The list of permitted foods is very long, including gluten bread and many others. Providing more specific advice about meals, he writes: “...you can add egg yolks and cream in the last soups and in chocolate”. Concerning meat, he said: “...all the meats and deli meats, smoked or salted, are acceptable; they can be served dry in slices or with olive oil and herbs on them”. Concerning pastry entries: “...all these dishes should be prepared with gluten flour instead of regular flour”. Regarding wines: “...during the 24-hour day, a liter of wine suffices for a man and 0.5 liter for a woman”. He advocates old wine (white or red) and adds: “...wine is very useful to animate the body’s forces, but when these are diminished by the design of the regime and moderate exercise, it is appropriate to eliminate them from the diet”.8 

In general, the recommended foods were meat (beef, lamb, veal), fish fried or with sauce, cheese, eggs, cream. Preference was given to animal and vegetable fats, in order to replace banned carbohydrates, and alcohols. He suggests that “you can add to coffee and tea infusions either a dash of rum or brandy, kirsch, pure glycerin or a dollop coffee instead of sugar cream”.8  Bouchardat believed that the diabetic’s sugar in the urine was “grape sugar” (glucose). To detect glycosuria, he used the fermentation test, the polariscope and solutions of copper.

OBSERVATION XXXI. The priest Francesco Antonio San Ger- mano, parish priest of Carrano, aged 54, ate almost exclusively on flour. On January 17, 1871, he had 75 gr. Of sugar per liter of urine (plus 10 gr. Of albumin), and on April 5, 51 gr., Of sugar (and 5 gr. Of albumin); submitted to my treatment and received at the clinic, his urine became free of sugar, and remained so, even with a mixed diet, until the last news I received. 

OBSERVATION XXXII. Canon Francesco G. de Serra S. Bruno (Catanzaro), 65 years old, great lover of amacés, came on July 12, 1872, with 50 gr. of sugar per liter of urine, with the specific gravity of 1023: let, after a few days of treatment, they weighed 1015 and the sugar had disappeared. The patient continued to be well, even with a mixed diet, but for some time I have not heard from him. 

OBSERVATION XXXIII. - Lawyer Michelangelo T., 37 years old, from Trani, lover of flour, diabetic for an undetermined time; on January 17, 1872, his morning urine contained 60 gr. of sugar per liter, and those he had emitted in the evening (the same number of hours after the meal) 160 gr. per liter; after three days of treatment, his urine was free of sugar; I saw the patient again on June 9, 1872, the urine was examined again, and found absolutely normal, although for several months the patient had returned to mixed food. 

OBSERVATION XXXIV. Mrs C. 22 year old from S., daughter of a man who died of diabetes. She herself cannot yet be considered diabetic in the truest sense of the word, but whenever she eats a lot of candy she becomes thirsty with polyuria, and at this time her urine contains sugar. It is an intermittent diabetes, which threatens to transform into continuous diabetes, if this lady, warned of the danger did not know how to limit herself much in the use of flour, and did not especially renounce the abuse of sweets. In short, it is a beginning diabetes, it is the beginnings of diabetes, which do not require a rigorous cure, but only a rational diet, not free from flour, but from any excess of bread, pasta, fruit and sweets, a mixed food and sufficiently rich in nitrogen. 

OBSERVATION XXXV. - Mr. Vincenzo d'A., Owner, aged 38, from Trigiano (Bari), ill for three years not general and also mental weakness, impotence, thirst, moderate hunger; he lost weight considerably, so as to lose 12 kilograms in about two years. He did eat a little meat, but mostly bread and pasta. Following a consultation in 1869 with a distinguished professor from Naples, he took arsenic, and later strychnine, but to no avail. In October 1870, Doctor Nicola Scarpelli, of Trigiano, subjected him to my curative method, which he did not follow rigorously, however, because he continued to eat a little bread. His condition improved a lot, but as he did not heal completely, he came to me on May 2, 1871, with 16 gr. only sugar per liter of urine, in order to heal itself completely. After only twenty-four hours of rigorous treatment, the urine was free of sugar. I lost sight of this patient too quickly to be sure that the treatment was continued, and to know the final result. 

OBSERVATION XXXVI. Mr. Giuseppe 1., 45 years old, from Castellamare di Stabia, a great starch lover, recognized as diabetic for about a year, and treated as such for eight months by other Neapolitan doctors and professors, presented himself to Professor Primavera on November 19, 1870, after having followed a diet in which meat dominated for several months: he still had 75 gr. of sugar per liter of urine, and this had the specific gravity of 1032. Professor Primavera recommended that he strictly follow the treatment I instituted, but the patient, always taking certain liberties, we never succeeded in having the urine free from sugar. On March 16, 1871, his urine still weighed 1032, and still contained 75 gr. of sugar per liter. At this moment the cure was applied with all its rigor, and after only fifteen days, the urine was completely deprived of sugar; but the patient, relying too much on this result, returned almost immediately to the use of bread, pasta and sweetened coffee, and resumed the dryness of the mouth, thirst, polyuria: on May 17, his urine contained still 40 gr. of sugar per liter, and their specific weight was 1030. The treatment resumed rigorously, on June 2, the urine weighed only 1020, and the sugar was again entirely absent. I do not know whether the patient has had enough perseverance later on to continue the treatment for a sufficient time to be sure of not having a relapse. 

OBSERVATION XXXVII. Mr. Nicola dell 'E., aged 51, judge, from Castellana de Bari, lover of starchy foods, has suffered for three years from thirst, hunger and polyuria, and also from torpor of the limbs, great general weakness and impotence. The presence of sugar in the urine was noted in March 1871, when he began to cough, to have amblyopia; already he had grown extraordinarily thin. The urine examined at this time contained 48 gr. of sugar per liter, and presented the specific gravity of 1028. A distinguished doctor ordered my rigorous diet, more quina and arsenic: the patient was better anyway, and the sugar disappeared from the urine; however digestion was hurting. It was then that the patient came to see me. The addition to the absolute meat diet, 5 gr. of lactic acid per day, made digestion easy, and possible the continuation of the cure. All symptoms improved rapidly, thirst and urine returned to normal, and within days, manly potency returned. On June 16, 1871, the urine was again examined in Naples: it was entirely free of sugar. I learned again in July 1874 that M. dell 'E. was in perfect health. 

OBSERVATION XXXVIII. - Madame Cristina P., aged 33, from Salerno, a great friend of sweets, presented on September 14, 1870, for analysis by Professor Primavera, urine with a specific weight of 1038, with 140 gr. of sugar per liter, and diabetic symptoms, especially high polyuria, with thirst and weight loss. She was subjected to the treatment, I do not know for how long. A year ago a doctor assured me that she was doing very well. 

OBSERVATION XXXIX. - Doctor Sch., Of Basilicata, aged 40, became diabetic, after having abused flour and sweets, a little also coffee, and after prolonged grief: after noticing the disease in him , he submitted to my treatment: after only four days, the urine was completely free of sugar, and remained such until January 1874, when I heard from one of his parents, a distinguished professor at the Polytechnic School of Naples. 

OBSERVATION XL. - The lawyer Domenico B., from Conversano, aged 50, amylivore par excellence, and diabetic for three years, with notable worsening of symptoms for eight months, presented, on April 26, 1872, urine with a specific weight of 1030, and containing 35 gr. of sugar plus half a gram of albumin per liter. The patient undergoing rigorous treatment, his urine was examined again on May 3: it was absolutely free from sugar; the same on May 15 and 30. Since then I have heard of the complete recovery of this patient, although he had long since returned to mixed food.

OBSERVATION IV. - Mr. Salvatore Musdace, 57 years old, from Naples, trumpet of the National Guard. Powerless and losing weight for three years, polyuria of 5 to 6 liters per day, with no known cause, apart from the almost exclusively starchy diet, he entered the Clinic on February 26, 1871; it emitted 3 liters of urine, specific weight 1042; 372 gr. of sugar per day. 

After twelve days of rigorous treatment, complete absence of sugar, daily quantity 1,200 cc, specific weight 1022 which fell on May 14 to 1017. This slow decrease in specific weight after the disappearance of sugar is interesting, because it indicates a major combustion of albuminates. We noted here the rapid decrease in sugar, and the persistence of small quantities, after a few days of treatment; this is so in advanced cases: it is only in mild, beginning cases that the sugar immediately disappears completely. This patient is still interesting because of his temperature, which has remained low, 350.7 C., 36 ', rarely 360.5, as long as he has sugar, and 12 to 14 breaths; as soon as the strength returned, the temperature rose to 37 ° and respiration to 16-18. 

The recovery of this patient persisted when he resumed the ordinary diet: when he left the clinic, after four months of stay, he weighed 5kil, 6, more than when he entered; When he got home, he was obliged to resume a diet almost exclusively composed of starch and grass. Eighteen months later, he had an abscess of the perineum, which healed after operation, and soon after, hunger, weakness and polyuria returning, he spontaneously began to eat meat: then he returned to the Clinic on the 9th. February 1873, presenting 107 gr. of sugar for 1530 cc of urine. After two days of mixed diet, he had 255 gr. of sugar on 2410 cc of urine within twenty-four hours. After only six days of rigorous diet, the sugar disappeared and never came back. On May 13 the patient went out very well cured.

OBSERVATION VII. Baron Archpriest Girolamo M. di G., from Andiano (Lecce), 52, was sent to me by Doctor Stasi from Spongano, after Doctor Voccoli would have submitted for some time to my cure. Two of his sisters had died of phthisis; himself was thin, prone to intermittent fevers and digestive troubles, which hunting had cured him. At 32, he entered the seminary; soon after was resumed by his acid dyspepsia and coughing up blood; he ate vegetables and fruits, eating meat only exceptionally. When I saw him, he had been suffering from thirst with polyuria for a year; since the same time, he ate and digested well. Voccoli had noticed the presence of sugar, and ordered my treatment; under its influence the health of the patient improved very quickly; the thirst and the polyuria disappeared: the sugar diminished very rapidly. But the bowel pains returned and the sugar increased with each new attack, oscillating between 30 and 40 gr. per liter. Dr Voccoli noted that the glycosuria disappeared left, or nearly four hours after dinner, only to reappear very abundantly three hours before dinner the next day. The gastro-intestinal catarrh treated and improved, the anti-diabetic cure succeeded very well: but the sugar reappeared as soon as the patient ate bread. Through all these tests, the general condition was better: the patient, 61 kilog. and a half, had arrived at 63 kilog. in three months. It was there when I saw it, in April 1871. I did nothing but dismiss the last vestiges of flour that the patient had kept in his diet, and after several months of treatment, he could return to use with impunity, moderate bread. This very intelligent patient still checks the state of his urine daily.