Sugar

Sugar was offered to many of the grown people, who disliked it very much, and, to our surprise, the young children were equally averse to it. Towards midnight all our men, except the watch on deck, turned in to their beds, and the fatigued and hungry Eskimaux returned to their boats to take their supper, which consisted of lumps of raw flesh and blubber of seals, birds, entrails, &c.; licking their fingers with great zest, and with knives or fingers scraping the blood and grease which ran down their chins into their mouths. I walked quietly round to look at the different groupes, and in one of the women's boats I observed a young girl, whom we had generally allowed to be the belle of the party, busily employed in tearing a slice from the belly of a seal, and biting it into small pieces for distribution to those around her. I also remarked that the two sexes took their meal apart, the men on the ice, the women sitting in their boats. At midnight they all left us, so exhausted by their day's exertions, that they were quite unable either to scream or laugh . The men paddled slowly away, and the women rowed off with half their party asleep. A few went only to a piece of floating ice astern, where they lay down for the night, while the others made their way to the shore, which was about eight miles distant.

Though Bouchardat (1806-1886) read his first memoir to the Academy of Sciences in 1838, and the final edition of his book appeared in 1875, he came into prominence through important contributions in the decade 1840 to 1850. Like Rollo and all other founders of the dietetic treatment, he considered diabetes a disease of digestion. According to his theory, normal gastric juice has no action upon starch, which is digested in the intestine; but in diabetes, an abnormal ferment digests starch in the stomach, and glycosuria, polyuria, and other symptoms result. He claimed to demonstrate the presence of diastase in the vomitus of diabetics and its absence in that of normal persons. Hypertrophy of the stomach and atrophy of the pancreas in diabetic necropsies were also held to support his theory; and he was thus the first to suggest an influence of the pancreas in the causation of diabetes, and the originator of the attempt to produce it by pancreatectomy in dogs. For sugar determination in urine, he used fermentation, the polariscope, and the Frommherz copper reagent. By the fermentation method he showed the presence of sugar in diabetic blood, but found none in normal blood. At how low an ebb was the Rollo treatment at this time is shown by the pleading and arguments of Bouchardat. He begs all friends of truth to hear him; whatever be the original cause of glycosuria, diabetics, who otherwise all die, are actually saved when his dietetic treatment is used. 

Bouchardat in the clinical field ranks with Claude Bernard in the experimental field. He is easily the most brilliant clinician in the history of diabetes. He resurrected and transformed the Rollo treatment, and almost all the modern details in diabetic therapy date back to Bouchardat. He was first to insist on the need of individualizing the treatment for each patient. He disapproved the rancid character of the fats in the Rollo diet, but followed an intelligent principle of substituting fat and alcohol for carbohydrate in the diet. He forbade milk because of its carbohydrate content. He urged that patients eat as little as possible, and masticate carefully; also (1841) he inaugurated the use of occasional fast-days to control glycosuria. Subsequently he noted the disappearance of glycosuria in some of his patients during the privations of the siege of Paris. 

Though the introduction of green vegetables is credited by Prout to Dr. B. H. Babington, the honor of thus successfully breaking the monotony of the Rollo diet, properly belongs to Bouchardat. He recommended them as furnishing little sugar, a little protein and fat, but especially potassium, organic acids, and various salts. He also devised the practice of boiling vegetables and throwing away the water, to reduce the quantity of starch when necessary. As a similar trick he "torrefied" (i.e., charred and caramelized) bread to improve its assimilation; possibly this is the origin of the widespread medical superstition that diabetics may have toast when other bread must be forbidden. He invented gluten bread; this started the idea of bread substitutes, from which sprang the bran bread of Prout and Camplin, Pavy's almond bread, Seegen's aleuronat bread, and the numerous later products. 

Bouchardat also first introduced the intelligent use of exercise in the treatment of diabetes, and reported the first clinical experiments proving its value. He showed that carbohydrate tolerance is raised by outdoor exercise; and to a patient requesting bread, he replied: "You shall earn your bread by the sweat of your brow." 

There is a modern sound to his complaints of the difficulties of having treatment efficiently carried out in hospitals, of the lack of adequate variety of suitable foods, of deception by patients, and of how, even when improved in hospital, they break diet and relapse after returning home. He advocated daily testing of the urine, to keep track of the tolerance and to guard against a return of sugar without the patient's knowledge. 

He followed Mialhe in giving alkalies, viz. sodium bicarbonate up to 12 to IS gm. per day, also chalk, magnesia, citrates, tartrates, soaps, etc., also ammonium and potassium salts; he found them often beneficial to the patients but not curative of the glycosuria. He told a patient: "You have no organic disease; there is merely a functional weakness of certain parts of your apparatus of nutrition. Restore physiological harmony and you will attain perfect health." 

He used glycerol for sweetening purposes, and introduced both levulose and inulin as forms of carbohydrate assimilable by diabetics, for reasons which well illustrate his intellectual keenness. On giving cane sugar to diabetics, he had found only glucose excreted. Was the levulose utilized or changed into glucose? Levulose proved under certain conditions to be more easily destroyed in vitro than glucose. Accordingly he gave levulose and inulin to diabetics, and found no sugar in the urine. Therefore he recommended levulose for sweetening purposes, and inulin-rich vegetables for the diabetic diet.

Main Works:

• Manuel de matière médicale de thérapeutique et de pharmacie, (1838, fifth edition 1873) – Materia medica manual of therapeutics and pharmacy.

• Eléments de matière médicale et de pharmacie (Paris 1839) – Elements of materia medica and pharmacy.

• Nouveau formulaire magistral, etc. (1840, 19th edition 1874).

• De la glycosurie ou Diabète sucré son traitement hygiénique, Paris, (1875, second edition 1883) – On glycosuria or diabetes mellitus and its hygienic treatment.

• Traité d'hygiène publique et privée basée sur l'etiology, 1881 – Treatise on public and private hygiene, based on etiology.[2]

"The circumstances which diminish obesity, and a tendency to the formation of fat , would seem a priori to be opposed to the cancerous tendency."

“… [I]t seems to me a prudent step to diminish all those dietetic substances easily converted into fat , including not only oily matters themselves, but starch and sugar.”  --John Hughes Bennett, On Cancerous and Cancroid Growths, 1849

The causes of obesity are numerous. It is often hereditary or constitutional, the inclination being derived from either parent. This tendency is seen not only in individuals but in nations: e.g., the Dutch are as stout, as the Americans are proverbially thin. Over-feeding will induce fat, and so will the habit of taking too much fluid. The obese are not always great eaters: but they invariably drink a great deal, even though it be only water. Farinaceous and vegetable foods are fattening, and saccharine matters are especially so. The instance of the slaves in Italy, who got fat during the grape and fig season, has been quoted by Galen. In sugar-growing countries the negroes and cattle employed on the plantations grow remarkably stout while the cane is being gathered and the sugar extracted. During this harvest the saccharine juices are freely consumed; but when the season is over, the superabundant adipose tissue is gradually lost. And then amongst other causes we must reckon insufficient exercise, long continued pros perity and ease of mind, indulgence in too much sleep, and an absence of the sexual appetite. Eunuchs are generally described as being flabby and fat; whilst amongst the lower animals, fattening is readily produced after the removal of the testicles or ovaries. The way in which the same fact can be made to tell in favour of two opposing theories is curiously illustrated by two writers on this subject. Thus, Wadd cites the butchers as examples of corpulence, alleging that their excellent condition is due to animal food. He speaks particularly of the advantages of the “butcher's steak; " and does not believe that these men and their wives owe their good looks to “the effluvia of the meat."* Dancel also speaks of the frequency with which the members of the same class become obese; but he says it is because the butchers eat meat and plenty of vegetables, while their wives generally prefer vegetables to animal food. He has no faith in the opinion that their embonpoint has some connection with the atmosphere of nutritive animal odours in which they live. 

Fats are obtained abundantly from both the animal and vegetable kingdoms. Their predominating elements are carbon and hydrogen. They never contain nitrogen, except as an accidental ingredient. They are made up of three closely allied bodies; viz., stearin (from otéap = suet ], margarin ( from its lustrous appearance, pápyapov = a pearl ], and olein [ oleum = oil ] which is Huid. When fatty matters are heated with the hydrated alkalies, they undergo saponification, during which process a viscid sweet fluid glycerine ( dukùç = sweet ] -is yielded. Now several physiological studies lead to the conclusion that oils and fats may not only be formed in the system from food which contains it ready prepared, but also from the chemical transformation of starch or sugar. Many experiments have been performed on geese, ducks, and pigs, which have proved that these animals accumulate much more fat than could be accounted for by that present in the food. M. Flourens had the bears at the Jardin des Plantes fed exclusively on bread, and they became excessively fat. Magendie, in making experiments on the forage of horses, found that these animals constantly returned more fat in their excrements than their food contained. And several authors have shown that bees form wax, which strictly belongs to the group of fats, when fed exclusively on purified sugar. If with foods of this nature the animals be subjected to a warm atmosphere and allowed but little room for movement, the adipose tissue rapidly gets increased. At Strasburg, the place of all others most noted for its pâtés de foie gras, the geese are fatted by shutting them up in coops within a room heated to a very high temperature, and stuffing them constantly with food. Here all the conditions for insuring obesity are resorted to --- viz. external heat, obscurity, inactivity, and the cramming of the animals with nourishment.

Mummery could not find cavities in the skulls of early Englishmen.