Type 1 Diabetes

From Dr. Cleghorn, Lecturer in Chemistry, and one of the Physicians to the Infirmary at Glasgow. Glasgow May l9 1797. 

SOME months ago I was honoured with your excellent pamphlet on Diabetes. At that moment I had two diabetic patients in the Royal Infirmary of this place, and I began instantly to treat them on your plan. They are both cured ; and I have delayed so long to thank you for your politeness, in the hope that I might be able to inform you of this new success. 

CASE L John M'Lean, a Porter, age 38, December 9th, 1796. 

Four months ago had a fever, after which while yet weak, he began to work hard. Soon afterwards he observed his urine more abundant than usual, amounting daily to 24 pounds, or more. 

Though his appetite be voracious, he becomes leaner from clay to day, and is so weak that he cannot walk a few steps without panting. His mouth is parched, tongue red, thirst extreme, belly collive. Pulse 84. 

A few days ago he had a slight cough, with pain in the right breast ; but these complaints have abated. The feelings about the stomach when he thinks himfelf hungry, differ from those he formerly had; they are more uneasy, and the uneasiness is less removed by taking food. He is often troubled with flatulence ; and complains constantly of weakness or pain in the back and loins. Has used no medicines. On examining the urine it was found limpid and very sweet. A pound of it yielded by evaporation more than an ounce of a thick brown extract, like treacle in appearance and taste. 

December 10th. He was ordered an ounce of castor oil, and the same quantity of compound tincture of fenna. His loins were directed to be rubbed every evening and morning with anodyne balfam. Equal parts of kino and ruft of iron, formed into pills rcki pills of five grains, with extract of chamomile^ were to be given, two for a dofe thrice a day. His drink and urine were ordered to be meafured daily, and the following reports, abridged from the Infirmary Regifler, fhew the refult. 

11th and 12th. One stool ; urine 28 pounds ; has drank about 14 pounds, besides the usual allowance of beer and broth. 

13th. Urine 27 pounds ; drink 8 pounds ; has had double allowance of food. Belly natural. To take 8 pills daily. 

14th. Feels himfelf a little eafier and stronger. To drink a pint of alum whey daily at different times. To have the oil and tincture of fennawhen coftive. In this courfe he persevered till the 17th of January, 1797. The quantity of his urine diminifhed daily. On the 16th December it amounted only to 20 pounds ; next day to 1 8 ; next to 1 5 ; next to 13; but on the 20th it rose to 16 pounds, without any cause that could be pointed out, unlefs the increafe proceeded from coftivenefs. Next day it fell again to 13; on the 24th it rofe to 1 5 : after which it varied from 13 to 7 J pounds. This was the quantity voided on the 17th January. It never fell below 71; most commonly it was between 8 and 10 pounds. Meantime the patient confidered himfelf as cured. He slept comfortably, sometimes not rising during the nighty never oftener than once. The feelings about his stomach were more agreeable ; his countenance looked less ghastly, and he felt his strength returning apace. On examining his urine, however, I had the mortification to find it nearly as sweet as ever. I confidered the cure therefore as very incomplete, and I expected that the urine would soon begin to increase, as it had uniformly done in every cafe that I have hitherto feen, and I have feen a confiderable number. 

While under this painful apprehension I received Dr. Rollo's pamphlet, which seemed to me to contain a more distinct theory, and a more reasonable practice, than I had ever met with before. As I could not immediately procure the hepatifed ammonia, I ordered him to use for drink four pounds of water, containing a drachm of lixiva fulphurata. The alum whey to be continued. 

Jan 20 Urine 8 pounds, sweet. Has used vegetables and milk freely. Took 3 pounds of the ammoniated water. The necessity of abstaining from vegetables was explained, and enforced, and he was ordered to continue the water. 

February 10th. This morning took 15 drops at once, with no other effect than a sense of heat in the stomach. Urine 6 pounds, less natural in tafte and smell. Finding himself strong enough, he asked leave to go home, (to the fuburbs of Glafgos) to manage some business which required his prefence. He promised to abstain from vegetables, to take his drops, and to return if he became worse. I have seen him several times at work, and this day, being the 10th of May, I received from his own mouth the following account. 

In 24 hours his urine is about 5 pounds. He taftes it very often, and it has never been fweet, but after getting little animal food for days together (which has happened more than once) it has fometimes been of a four fmell. Formerly he could carry on a wheelbarrow three hundred weight ; at present he carries one hundred weight, and he can walk as well as ever. Two days ago he went express to Paisley, received an answer to the letter he carried, and returned to Glasgow in three hours and a half (about 14§ miles). 

Occafionally he has taken 60 drops a day of the hepatifed ammonia, which he likes, because it gives him an agreeable feeling of warmth, and never produces any inconvenience. For two weeks, however, he has had none, since which his urine has not increas›ed in quantity, has not been sweet, and when evaporated lately by himself, and by a neighbour of his, whose curiosity he has excited, it yielded no sugar. The residuum could not be diftinguished from that of an equal quantity of healthful urine, evaporated at the same time with great care and sagacity. The only kind of animal food that he can procure in sufficient quantity is blood, which he mixes with fat and a little meal. Even this homely fare he finds it difficult at prefent to procure regularly. He was always lean, and is now rather more so than before his fever ; but though he works very hard, he thinks himself stronger, and more fleshy, than when he left the Infirmary. He sleeps well; is regular in his belly, and free from every complaint, except occasional pains about the muscles of his breast and arms, anting obviously from the intense colds to which he has been very much exposed, as he plies near the river from morning to night. He is the father of several children, but since he has been seized with Diabetes—Coitus nullus. Erigitum nunquam : ne quidem femel rigefcit. About a month before he left the Infirmary, the other patient gave the same account of himfelf.

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 Dr. Gerard, Liverpool 

The following case is that mentioned in Dr. Curriers letter to us, and we communicate it with the greatest pleasure to the public as being drawn up with the utmost accuracy, and containing details of procedure of the utmost importance towards perseeling our views of the nature and treatment of the disease, as well as of confirming them.

THE CASE. 

John Clarke, aged 38, was received into the Liverpool Infirmary, under Diabetes, on the 9th February, 1797.

 He was a soldier in Lord Darlington's Light Horse when they were reduced in February, 1796. 

At that time he was in good health ; thinks he might then have weighed about 140 pounds in his clothes; he is 5 feet 7.5 inches in height; has dark hair and grey eyes. He always enjoyed good health, but was subject to pyrosis, and accustomed to perspire much. Happening to reside near the seacoast, he has from a boy been used to bathe frequently during the summer months, not for any indisposition, but merely for gratification ; sometimes he went into the water twice the fame day, and staid in it 10 or 15 minutes; being always of a coflive habit, he also drank of the water occasionally. He discontinued the practice of bathing, however, while the weather still continued warm, as early, he thinks, as the beginning of August; his habitual perspiration leflened afterwards by degrees, and he continued in good health till about the end of November, 1796, when the perspiration entirely ceased, and the cuticle became unnaturally dry, harm, and rough, and is now to all appearance dead, and incapable either of perspiration or absorption, or any kind of transmission. About this time some headache also came on, and the bowels became in general more costive, though he was sometimes troubled with a lax for a few days. 

With the preceding symptoms he was afflicted with a most distressing thirst, which was not to be satisfied. His appetite was increased, and yet he loft flem daily, and grew weaker very felt, particularly in the thighs and small of the back, attended with pain in the region of the kidneys. He also observed, that he made much more urine than usual, and that the quantity increased from day to day. It should be remarked, that having no other means of getting here, he was under the necessity of walking from five, to eight miles each day, for three successive days, before he reached Liverpool ; but this was a whole day's work, and a great fatigue to him. Considering this to be a cafe, that from all former experience might almost be deemed incurable, I wished to consult my Colleagues, Dr. Brandreth and Dr. Currie ; therefore I only ordered him a dose of castor oil, to remove, the costive state of the body. Those gentlemen saw him with me on the 1 1th February. At this time Dr. Currie had just received a publication from Dr. Rollo, Surgeon General to the Royal Artillery, at Woolwich, of a case of Diabetes that he had treated with success ; he had not read it ; but he understood that much was attributed to animal diet. On this authority our patient was ordered to live chiefly on flesh and milk; he was also directed to use the warm bath, and with a view of ascertaining whether the generally received opinion that absorption takes place in this disease be true, he was defined to be weighed naked, both before he went into it, and upon coming out (Dr. Currie having observcd in a case of a different nature, that no absorption took place in the warm bath) ; the pulse to be counted; and the heat of the body ascertained by placing a thermometer under the tongue, and to note the whole down.

February 12th. He went into the bath for the first time, when the pulse was, before bathing, 

75, after it, 85. 

Heat of the body 91, —-—— 95. 

Weight of the body 112lb. 4oz. -- 112lb. 6oz.

February 15th. During the same time he took two pounds and a half of animal food, and twelve pounds of liquids, including milk, beer, and water. The directions for his living on animal food having been misunderstood, he has hitherto had only one meal of flesh daily, and with it a portion of potatoes and bread.

February 20th. Having read Dr. Rollo's publication, he was ordered this day to live entirely on animal food and broth, without either bread, beer, or any vegetable matter, and to persist in that plan without taking any medicine whatever; for as diet appeared to have had a principal share of the success experienced in Dr. Rollo's cafe, we wished to try whether that plan only was capable of effecting a cure.

Feb 24th. He took two pounds of beef, and 6 pounds of broth.

Feb 25th. The dead cuticle is peeling off, and he is obviously improving in every respect, and gaining weight. He continues the diet of animal food, with the daily allowance of a pound of beer.

March 2nd. Urine 6 pounds 5 ounces. The animal food,: with the beer, has been persisted in. I have hitherto thought the griping and looseness were accidental, but as they continue, they may perhaps be owing to the great change made in his diet ; on that idea, therefore, I have allowed him half a pound of bread daily, and have ordered him 30 drops of laudanum at bed-time. He feels himfelf considerably stronger, and can lit up much longer at a time. He has no extraordinary thirst ; the urine has neither sediment nor smell.

The griping and looseness do not abate by the admixture of vegetable matter, on which idea only the bread, as it may be remembered, was allowed. He loses weight daily. This reverse of the success we experienced in the beginning, would prompt me strongly to have recourse to the fulphurated kali, or hepatifed ammonia ; but the circumstance of his having gained so much advantage, and so rapidly, while he lived on animal food entirely, and the wish to try what that diet alone would effect (which should be remembered was the plan we set out upon), determines me to return to it again, especially as it may enable us to decide whether it is alone equal to the cure. I therefore ordered both the bread and beer to be discontinued ; and to rely on the laudanum, absorbents, to correct the diarrhoea. He was allowed milk in place of the beer.

March 14th. He is rather more thirsty ; his appetite is not so good, being satiated with animal food ; he was allowed an onion to his meal.

March 19th. Being desirous of gratifying my patient with any change of diet that could be indulged in without impeding the cure, I ordered him to have a meal of fish, two or three times a week, meaning at the same time to ascertain whether that deviation from the plan of animal diet might be allowed with impunity.

March 20th. He disliked the fish, and said it was not so satisfying to his appetite as the meat; he thinks his thirst and appetite are more craving. He had a very good night, with some perspiration over the whole body; griping quite left him ; and flatulency greatly relieved.

March 26th. He has bad a restless night, and vomited frequently till 3 o'clock in the morning ; his spirits are better, and he thinks himself stronger. He had a pudding made of milk, suet, and eggs, for his dinner, which he was fond of.

March 28th. The diet, with the pudding of milk, eggs, and suet, were given as directed.

March 31st. He continues better, and feels a more comfortable warmth than he has been accustomed to do lately. His pulse has been from 85 to 90 for a week past. He is so tired with broth, that he has refused to take any for some time, and owing to his fondness for the eggs and milk, either baked or boiled with suet, he has eaten too little meat lately. I therefore ordered that he should at leail eat one pound daily.

April 6th. It becomes very irksome to keep him to animal food, even with a very large allowance of milk; and I learn that he takes the suet off the milk when it cools. He feels himfelf better today. He continues the animal food with milk, eggs &c.

April 19th. The diet is continued.

April 25th. Finding that he has upon the whole been losing weight since the 17th, I questioned him very closely about his getting other food than what was allowed him, but he denied it, and shewed much impatience about staying longer with us, saying that he thought himself well and strong again, and that he would rather go, as he was watched like a thief. Though I do not confider him to be so well as he thinks he is, yet as the quantity of his urine is so much reduced, and its former nature so entirely reversed, I have, notwithstanding his having lost weight, allowed him four ounces of flour in his pudding, and two ounces of bread with his meat ; for fear he would run away, and leave us uncertain of the event.

May 6th. I have at length discovered, through the information of another patient in the fame ward, that Clarke adhered rigidly to the regimen prefcribed him, only for about 14 days at the first. In the course of the disease we have often had reasonto suspect that he was deviating from our plan, and three or four times the necessity of a fine attention on his part was particularly infilled on. After these cautions he attended to his regimen strictly for a day or two, but again relaxed, through the almost irresistible propensity to more or less of vegetable diet, which seems to be one of the characteristic symptoms of this disease. With thefe exceptions, it appears that he has generally partaken with the other patients in the common mixed diet of the house, and that he has drank water when thirsty, if he had no milk. I cannot learn that he ever gave any part of the flesh meat to the other patients. It is extremely vexatious to have been so much deceived, yet I don't think it lessens the inference, that animal diet has been the means of effecting the very great alteration in the quantity and quality of his urine ; for though he has eaten more promiscuoufly than was supposed, he has at all times taken a large proportion of animal matter, and a marked effect: has at different periods of the disease followed the more entire use of it, particularly in the beginning, when his apprehension made him adhere rigidly to the plan. The discovery, though vexatious, has perhaps made this a better case, in as much as it shows that an absolute exclusion of vegetable matter is not necessary, at least not for so long a time ; and also as it proves that he is nearer being cured than he was thought to be, by the characteristic symptoms of the disease not having been reproduced by the superior quantity of vegetable matter he has eaten to what he was supposed to have done. Whether his appetite is so strong as to constitute it a remnant of the disease I know not ; but from the impossibility of retraining him, and for the purpose of ascertaining whether the care was complete, he is ordered to have the diet of the house only.

April 7th. His. diet now consists of milk, meat, potatoes, and bread.

April 25th. He was discharged from the Infirmary to all appearance cured of the disease; which, to his own thinking, has long been the case ; and to the opinion of his being even cured I have no hesitation in subscribing.

From Mr. Houston, Brewer Street, London. 

L........... , aged about 30, fair complexion, light hair, and naturally of an extremely irritable constitution, in the month of February, 1793, received a violent shock by the death of one of her parents. On this melancholy occasion her grief was so very poignant, and at times so frantic, that serious apprehensions were entertained of a total derangement of intellect, and in this state she continued several weeks.

(several pages discussing the deterioration of her health leading to diabetes)

On their quitting the Wells, they, on their way home, stopped at Bath; and as her parent received benefit from the use of the waters of that place, they remained there eight weeks ; but before the expiration of the first fortnight, she found her stomach again disordered with heat and acidity, which in a short time increased to a height almost intolerable; the fauces were so sore, that it was a pain to swallow anything; and her tongue was equally so, being covered with a emit, or hardened slough on the top, and blisters round the edge. Her thirst was insatiable; to quench which, she ate a great quantity of fruit, and drank profusely of Seltzer Seltzer water and hock, but to no purpose.

Her skin was so parched, that the pores did not seem to emit the least moisture. To remedy this evil, some doses ofJames's powders were given, but to no effect ; towards the close of her time at Bath, she drank the waters for about a fortnight, they were supposed, however, to do more harm than good ; and growing daily worse there, she set out for London, where she arrived the 4th December, 1796. She immediately sent for her apothecary, who was greatly shocked ; as to all outward appearance, she seemed to be in the last stage of a consumption. Her pulse was exceedingly quick, but so feeble, that he could scarcely feel it, and so tremulous, that he could not with any certainty count or distinguish the strokes. For two days, he gave her every six hours a draught with kali ppt. magnef. alb. aa ^i, taken with half an ounce of lemon juice in the state of effervescence ; they agreed with her, and, as (he thought, cooled her; (he had no cough, but for some time back had loft her appetite, the stomach rejecting almost all solids; and when it did receive any, they generally laid heavy on it, or disagreed ; as some nourishment, however, was necessary, she was advised to eat eggs raw, or done very soft ; as also oysters and other shell-fish, as having a tendency to correct acidity. On the 3d day after her arrival in town (Dec. 6th) an eminent physician was sent for, who ordered a blister to be applied to her breast ; magnef. alb. qr. xv. in a draught every eight hours. These she took till the 15th, when she was ordered a draught with myrrh pulv. gr. xij. ferr. vitriol gr. iij. kali ppt. gr. viij. three times a day. This course she continued, with some trifling variations, but little interruption, till about the 19th February, 1797. By this time those medicines had the effect: of greatly recovering her appetite, and she had been allowed to eat such light animal food as she fancied ; but from this indulgence, of which she availed herself, with the return of her night's rest, which by this time she began to enjoy, she derived no other advantage than a small acquisition of strength ; for there was not the least appearance of bodily nurture, or any abatement of heat and acidity. 

The physician having compared the tardy, if any progress in amendment, with the quantity of food she was able to take, (for her appetite was greater than before her illness) began to discover symptoms of diabetes, and therefore gave orders to measure the quantity of fluids drank, and the quantity of urine she made and finding the latter exceed the former, he had some of it evaporated, and found it to contain a considerable portion of saccharine matter ; upon which she was advised to eat less vegetables and more animal food.

On the 18th, a gentle opening draught was given, though she usually took magnefia when any thing of the kind was necessary. On the 20th March, Dr. R. was consulted with her former physician ; and as he is already so well acquainted with all that has since been done, or happened, it is unnecessary for the writer of this to carry it any further.

Continuation by the Author.

On the 20th March, 1797, I visited the patient, with her physician and apothecary; she complained of a burning sensation at her stomach, which she faid was intolerable, with the sense of a sharp and hot acid rising into her throat ; her teeth were on edge, tongue red, and gums full ; she had little thirst, and was occasionally sensible of a moisture on the palms of her hands, and on other parts of her body ; her appetite was keen, and she never felt satisfied, but said that this degree of appetite had only been lately remarkable ; and she complained much of a burning sensation in her stomach, and of great acidity ; she was extremely emaciated, feeble, and inactive ; her skin dry, and rather warm ; pulse about 88 ; her urine of a pale colour, but to the taste scarcely sweet ; the quantity could not be distinctly ascertained ; it did not seem, however, to have been so increased as to engage any particular notice ; a little of the urine was evaporated; the residuum resembled treacle, but was salty to the taste, and the extractive matter did not seem much to exceed the quantity in healthy urine. On the whole, the adoption of light animal food, with less vegetable matter, and the medicines, had mitigated the disease. The physician who attended had a copy of the notes of Captain Meredith's case the preceding January, and he now very readily agreed to the animal diet entirely.

On the 14th April I saw the patient, with the physician and apothecary ; her looks had more the appearance of returning health ; she moved about with more agility and strength, though she complained of not gaining flesh ; her appetite is now good ; the tongue is clean, but not so florid ; she has no thirst ; the urine does not exceed a quart, a small portion of which being evaporated, the residuum was quite saline, and urinous in smell, but it was not evaporated so much as to determine the tenacity. The burning sensation in her stomach is diminished, and there is less acidity ; however, another emetic is prescribed, and the matter thrown up is to be examined, in order to ascertain whether it possesses acid properties. The patient informed me to-day, that for several years she has indulged in fruit, pickles, and sweetmeats.

April 25th. The emetic ordered on the 14th brought up very acid matter, which was found by the apothecary to effervesce with an alkali ; the urine deposits a reddish sediment ; she has less uneasiness at the fiomach, has more strength, and a more natural appetite ; her skin is moister.

May 10th. Very little change. Asafoetida is added to the pills, with calcined soda, and the quantity of the hepatized ammonia increased. From the delicacy of circumstances, an accurate enquiry cannot be made ; deviation of diet may happen ; in this cafe, we can only hope for a certain compliance with regimen, and a certain information with regard to appearances, and ultimately a recovery with tardy and irregular advances ; it merits much attention however, even with the view of discovering points of importance in the treatment, under the most unfavourable progress.

June 8th. Very sensible of an increase of strength, and that health is returning, the urine continues in a natural state, at least there is no saccharine matter. The heat of the stomach is much diminished ; the appetite feels natural ; no thirst or hectic symptoms ; she has discontinued our medicines, and only takes Schweppe's acidulous soda water, which she likes, and says it has been of much service in relieving the uneasiness of her stomach. To be allowed about four ounces of bread in the day.

June 16th. Since the use of the bread, the disease has been reproduced ; the urine is clear, and of a sensibly sweetish taste ; 18 ounces yielded a saccharine residuum of 1 ounce and 5 drachms ; her skin is again hot and dry ; the pulse quicker, thirst: intenfe, appetite keen, tongue florid and red ; alfo the heat of the stomach extremely unpleasant. She promises to return to the entire use of animal food ; her antimonial opiate to be taken at night; Schweppe's water for drink ; and a blister to be applied to the region of the stomach.

lid. The urine, in smell and taste urinous, having become so in twenty-four hours after leaving off the bread; her appetite is not so keen ; the tongue is not more florid than common, and the uneasy hot fenfation of the stomach is much less, though occasionally troublesome ; the thirst is gone ; the blister relieved the stomach ; the regimen, with Schweppe's water, to be continued.

July 14th. In a state of apparent recovery ; me occasionally takes a biscuit or two, but perseveres in the diet generally, and Schweppe's soda water. Next week she goes to Bristol, where she is to observe the fame conduct, being fully sensible of the influence of a change of diet, and equally so, that everything depends on her own steadiness. No accurate account could be obtained with regard to the quantity of urine ; in general terms it was said that it corresponded with the quantity of drink.

February 5th, 1798. Returned a few days ago from Bristol and Bath ; at the latter place she bathed in the warm bath, and was relieved, by its being followed by a moist skin. The Bristol water was very grateful to her stomach, and generally superfeded the use of Schweppe's soda water. She appears much in the same state as when I saw her in July ; the disposition to the disease still remains, and the feels better or worse according to her diet ; she eats daily some biscuit, and has done fo generally all the time the has been away ; the acidity of her stomach still continues a distressing symptom ; the urine yields a saccharine extract. 

March 6th. Since the first, has been strictly on animal diet ; the several symptoms are removed, and she appears altogether better than I have yet seen her.

March 21st. Continues better, perseveres in the diet. On the l7th she ate a sweet cake which was soon vomited in a sour state.

April 2nd. She assures me no change in the diet has yet been made ; she begins to loath food, but believes it is only animal food, as she feels a strong desire for vegetables ; and alleges that, even under the animal food, she has had the acid state of her stomach, especially at times when her mind has been uneasy ; tongue less red, indeed it is rather pallid ; the urine smells strongly, and has a greasy scum ; on evaporation, it yielded a saline and bitterish tailed residuum, without tenacity ; and when treated with nitrous acid, furnished scales. She was allowed a small quantity of broccoli, spinach, or salad, without sauce.

April 16th. In all respects better, and for these eight days has been eating broccoli and salad occasionally, without any reproduction of the disease.

April 18th. A portion of urine was examined, which was found clear, but of a urinous taste and smell ; its residuum, however, yielded oxalic acid when treated with the nitrous acid.

May 5 th. It was ascertained that she had eaten some biscuit between the l6th and 24th April.] Her skin is moist ; pulse 72, and regular; her appetite less keen, and she feels more uneasiness after eating, or rather has a sense of indigestion ; tongue clear, but not florid; she has gained flesh. She promises to leave off bread, and to take only cauliflower and spinach. The salad does not agree with her; she assures me, and so does her maid, that the other day, after eating more vegetables than usual, the urine smelt and tasted sour immediately after it was voided.

May 10th. Is again to visit Bath and Bristol ; she promises an adherence to the plan, though she acknowledges that her resolution is often likely to fail her; she will, however, be as steady as she can, being perfectly persuaded she has no other prospect of recovery but by so doing. She has again been sensible of the acid smell and taste in the urine, after vegetables. I examined her urine today, but it did not smell or taste of anything, except the urinous flavour and impression.

This Case, though not as yet completely terminated, appears to me of so much importance, that I have inserted it in its present progress. There can be little doubt, that the adherence which has been bestowed on the animal diet since the 20th March, 1797, has not only prolonged life, but given strong hopes of the re-establishment of as great a degree of health, as can possibly be expected, under a long continued stomach complaint. The exact period when Diabetes Mellitus was actually formed cannot be determined : it was probably when the keenness of the appetite took place, but when that happened cannot be accurately ascertained. She had been long subject to stomach complaints, and the keenness of the appetite is only noticed in the account about the lft March, 1797 whereas the cardialgia is mentioned as long before as May, 1796 ; and before these periods the health was much impaired. These complaints had been partly brought on by the circumstances so well related by Mr. Houfton, and partly by the frequent use of fruit, pickles, &c. The animal diet, though not unremittingly perilled in, yet by a more steady use of it in March and the beginning of April, the disease was so far overcome, that the urine became as near as possible to the standard of health. It is to be regretted that a further perseverance did not at that time follow ; however, the progress shows, that certain vegetables, such as broccoli, spinach, salad, &c. may be eaten at a proper time of the treatment, without reproducing the disease, while bread could not be eaten with impunity. This fact we consider of much advantage, as it enables us to guard against the effects of a long continued use of animal diet, and at the same time gratify, in some measure, our longing patient ; we say in some measure, because even these vegetables do not long check the ardent desire for bread ; indeed, the stomach appears very whimsical, for when it obtains its desires, other things are soon solicited. The circumstance of the urine having become acid after the use of more than the usual quantity of vegetables, is a curious fact, but as it merely rests on the testimony of taste and smell, we do not hold it, in this case, as satisfactorily ascertained; it deserves, however, to be kept in view.

Some Remarks on these Communications. 

The only circumstances leading to fix on the predisposing causes of the Diabetes Mellitus are contained, 

• 1ft. In Doctor Falconer's letter, where a case of the disease is related, as having apparently been produced by excessive indulgence in spruce beer, to reduce corpulency. 

• 2d. In Doctor Cleghorn's first cafe, where the patient had worked hard while under convalescence from fever. 

• 3d. In the cafe of the Gentleman of 77 years of age, who had been addicted to the use of large quantities of sugar.

• 4th. In Doctor Gerard's case, the patient had been subject to pyrosis, and liable to much perspiration previous to the diabetic attack

With respect to the treatment of the disease Doctor Duncan found, in one case, fat meats serviceable. 

Doctor Falconer recommends the mephitic alkaline water; and from the advantage the Gentleman of 77 derived from Schweppe's soda water, it may be of service. There is no doubt it will relieve the acescency of the stomach. We would prefer the soda water, as we think it may act less on the kidneys than that made with the vegetable alkali. 

Doctor Beddoes mentions a cafe where the Bristol water cured the disease. 

Doctor Currie has feen several cases of the disease ; but never saw a case of it with sweet urine cured. 

The Case of Walker shews the effects of the animal food. It was begun on the 29th December, when the daily quantity of clear sweet urine amounted to 13 pounds; on the 31 ft day, being two days only, the quantity of the urine was reduced to 5 pounds, and it had acquired a strong urinous smell. The two Cases, treated at Glasgow, by Doctor Cleghorn, shew also the good effects of the animal food, and of the influence of commotions in the bowels on the quantity of the urine.

The Case of the Gentleman of 77, likewise shews the efficacy of animal food ; but the most striking case is that of Clark, as related by Doctor Gerard. This important case points out, 

First. That in this disease there is no absorption of fluids by the skin. 

Secondly, That animal food may alone, if duly persevered in, cure the disease; and such perseverance may probably be of a very limited duration.