Type 1 Diabetes

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.

From Mr. Shirreff, Deptford. February 23d, 1798.

A YOUNG LADY, who has lately completed her 12th year, of a thin habit of body, tall of her age, of a docile disposition, and who has a regular flow of spirits, subject, however, to sick headaches, and accustomed to eat much fruit, sweetmeats and pickles, has become affected with Diabetes.The months of June, July, August, and September, 1797 were passed in Devonshire, near the sea-coast, where she bathed in the sea, and used exercise on horseback. She returned to this neighbourhood early in October with apparently an improved constitution. About the latter end of November she had an attack of angina; the left tonsil became enlarged, as well as the submaxillary and other glands of the same side. The angina went off; but such a state of glands remained as indicated a scrofulous constitution. After the indisposition, she did not recover her usual appearance of health; the wings of the nostrils became enlarged, the upper lip tumified, and the infide of the left nostril red, and excoriated; she had alfo flight herpetic eruptions. Early in the month of January her spirits became deprefled, her disposition indolent, and equally indifferent to study and amusement. She complained of headache and flight cholics; she became thinner though her appetite remained unimpaired. About the middle of February she had an intense thirst, and frequent calls to void urine. These were attributed to an improper habit; and she was retrained from the former, as the latter was supposed to be the consequence. The restraint, however, was impracticable.

At this time I was made acquainted with the circumstances. I desired the urine to be preserved; and on examination, it was evidently characteristic of the Diabetes Mellitus. I sent a portion of it, with an account of the case, to Dr. Rollo (it furnished the purest saccharina extract he had met with, and which granulated by keeping). I directed a diet, consisting chiefly of animal substances; an opiate combined with an antimonial at bed-time; the extremities to be anointed with a liniment of hog's-lard and camphor.

February 24rd. Her thirst was great; her appetite was keen; she had frequent headaches; a costive habit of body; a bitter taste in her mouth, with frequent nausea; her nights were good, but when obliged to get up to void her urine, which was frequent, her skin was cool; no rigors, or local affection in the kidneys; the abdomen was not enlarged, but there was an evident hardness above the pubis, embracing the region of the bladder; her skin, however, put on an appearance which requires a little more attention. Upon her arrival from the seacoast, I have observed she was much improved in her looks, as well as in general health, which was nowhere more conspicuous than in the appearance of the surface of the skin. Being subject to herpetic eruptions, I was accustomed to remark the lingular dryness upon the surface, and particular feel, which seemed inconsistent with health; but after her arrival from sea-bathing; these irregularities had disappeared, and the skin of her arms and neck had a natural look; but now appearances were worse than before, and such as struck me forcibly: the skin was dry, harsh, void of elasticity, shrunk, of a leaden hue, and seemed to adhere to the muscles; one would have supposed that there was no cellular membrane, being not only void of fat, but the motion of the skin was also trifling; in a word it seemed to be what is called hide bound. An emetic was directed in the evening, and the body was to be rubbed with the liniment, to which had been added a solution of the sulphuret of potash. 

February 25th.

The urine is of a deeper colour, and less sweet; an abstinence from liquids was recommended, so far as it was practicable. With my patient I called on Dr. Rollo; we agreed on the plan of treatment, which was to consist of an entire use of the animal diet; as drink, a dilute solution of the sulfurated potash in water, and two grains of the extract of hemlock, with one grain of the antimonial powder at bed-time. February 26th.

Yesterday she ate voraciously at dinner; was put into the warm bath in the evening, and the skin afterwards anointed with a preparation of hog's lard and pure ammonia. She had a good night, and without any occasion to void urine. This morning the urine is high coloured, and saltish to the taste; indeed it might be considered as natural urine.

February 27th. 

I was informed that the urine voided yesterday at one o'clock was free from sweetness, and perfectly insipid; some time after it appeared natural; but two hours after dinner was sweet, and in the evening again apparently natural. She was directed castor oil, being costive : the bath and injunction to be continued, and likewise the diet.

February 28th.

Has had a good night; the urine this morning is evidently urinous, though of a pale colour; her thirst diminishes, and her appetite is less keen; the skin feels softer. Yesterday she ate bread at breakfast, which I was informed of immediately afterwards in paying my morning visit. I was determined not to lose this opportunity of watching through the day any changes in the urine. That which was voided until dinner time, was sensibly sweet. I evaporated three pints of it, and it yielded of a saccharine extract a quantity amounting to 8 ounces 3 drachms. Her dinner was entirely animal food, and what (he passed afterwards deposited a lateritious sediment, and in colour, smell, and taste, differed very little from natural urine.

March 1st. 

She had a good night; the thirst diminished; urine more natural in appearance. She continues the regimen, See. and is ordered to try small doses of the powder of ipecacuanha.

March 3d. The urine differs little, either apparently in quality or quantity, from what is natural. Allowed her boiled milk and bread for breakfast this morning. At 1 o'clock this forenoon, the urine not sweet. She is to be indulged with a biscuit at dinner, and another at tea in the afternoon. The urine was examined at bed-time, and it was found very sweet. 

March 4th. The urine voided in the night was insipid, this morning saltish. Visited Dr. Rollo with my patient. Continuance of the animal food recommended, and occasionally a trial to be made with a small quantity of bread.

March 6th. Urine very sweet; complains of thirst and headaches. I suspected she had been deviating, which was acknowledged; she promises a more ready adherence. 

March 9th. She is able to take three biscuits in the 24 hours, without the production of sweet urine; but if this quantity is exceeded, the saccharine matter is perceptible. Therefore the assimilating powers are now able to convert a certain proportion of bread with animal food into proper chyle, which is capable of being applied to the purposes of nutrition.

March 10th. The appearance of the skin is much altered for the better. Medicines and diet to be continued. The weight of the body was this day found to be 64 pounds.

March 15th.

Nothing particular has occurred these five days past. She has been cautiously increasing and diminishing the quantity of biscuit, according to the effects produced; the number of biscuits has not exceeded three or four, and the fourth generally produces sweet urine.

March 23rd. From the 15th to this day nothing material has happened. The urine voided in the interval of her meals is insipid, and is falter and more urinous the farther distant from the meal. On the night of the 22d the body was covered with a general moisture. 

March 24th. This morning the weight of the body was found to have increased, since the 10th, five pounds and upwards.

March 28th This day I have augmented the quantity of biscuit, The patient's health now improves daily.

March 29th. The additional quantity of biscuit has reproduced the sweet urine, though in a less degree. The number of biscuits to be diminished.

April 9th. During the holidays there has been a great deviation from the plan. On Good Friday she ate sweetened bread; on the Sunday following, sweet cakes and sweetmeats. These were repeated yesterday, with sugar to her tea. In the evening she voided 7 ounces of urine, highly saturated with sugar. The above irregularities were carefully concealed; but thirst, headache, and sweet urine, betrayed the deviation. Being alarmed at such a relapse, she promises more steadiness in future,

April 12th. The urine natural. She takes the biscuit.

May 4th. The whole plan now consists in regulating the quantity of bread; when a large proportion is used, sweet urine is still reproduced, and of the saccharine matter she is sensible, by the peculiar feel of uneasiness about the meatus urinarius. The skin is very soft, and appears different from what it did at the commencement of the disease, and for a long time afterwards; her appetite is good, but not particularly keen; she is not troubled with third; her sleep is undisturbed; no headache, nor any local pains about the kidneys—the tension of the region of the bladder is removed; her spirits are good; her strength returns, and she practices her juvenile studies with alacrity; the disposition, however to the disease is not yet removed.

May 6th. After having returned to the diet she has been accustomed to, before her illness, fweet urine was again reproduced, and which I apprehended before its examination, from the change in the appearance of the skin, of the neck, and arms.

May 16th. Since the 6th, her diet has been very strictly attended to, and the injunctions particularly so; the urine is not sweet.

May 31st. Since the 16th, our patient has been progressively increasing the quantity of biscuits and farinaceous substances; she can with impunity this day confume six biscuits, and the whole produce is disposed of by the assimilating powers. The urine is natural, but on Tuesday the same quantity of bread produced six ounces of water, highly saturated with sugar. The bulk of the body is increased; she is active and capable of using exercise without fatigue. I still persevere in the use of frictions, and anointing the body; the cold bath is recommended, and will be used, for the first time, on Monday next. She has been for some time using bitter and chalybeate medicines.

June 3d. The patient ate some green peas without producing sweet urine. The skin looked florid, the muscles strongly marked, and fuch a general appearance of health as had not before been observed for many months. The bread was this day diminished, lest the usual quantity added to the peas might be more than could be disposed of.

June 4th. Evaporated some of the urine; less animal substance in it than what has hitherto been observed. No sweetness in her urine, which in flavour and colour does not differ from what is natural.

June 6th. Quantity of bread considerably increased without any inconvenience occurring. Medicines, frictions, and injunctions continued; moderate exercise is recommended and used. Formidable as the Diabetes Mellitus has been hitherto found, it can now be moulded to the wish of the practitioner. To remove the disposition to the disease may be difficult, but an important advantage is gained, as we now can cure the unpleasant and most distressing symptoms, and bring the disease into a mild state, which may ultimately be eradicated by regimen and medicines. What may be the extent of time before my patient can get free from the disposition, it may be impossible to ascertain; I have no doubt, however, of its accomplishment, though it may remain until after those changes in the system have taken place, which are brought about at the age of puberty. While the case continues under my charge, every attention shall be followed, and the event shall be communicated to you. 

In the management of this curious disease many reflections on its nature have arifen, but as, these have led me to adopt your opinions generally on the subject, I shall for the present reserve them. In the meantime it gives me some satisfaction to have contributed my share, so far as one case extends, towards elucidating some points in the history and progress of the disease, especially in the changes the urine undergoes at different times after eating, and according to the substances eaten.

From Doctor Pearson, Physiclan to St. George s Hospital, Lecturer on the Practice of Physic and Chemistry, &c. London.

CASE III. 

July, 1798. 

A Gentleman, aged about 56 years, who had lived rather in a fedentarv manner, was troubled for five succeffive winters with a cough, attended by a copious spitting. In the Summer he was almost free from these ailments. During the two last of these winters symptoms appeared, which, it was apprehended were those produced by pulmonary tubercles and vomicae. In the early part of the Summer succeeding the fifth Winter, namely, in May 1797, when the patient was considered as labouring under the chronic kind of pulmonary phthisis, besides taking the usual medicines in such disorders, he began to breathe hydrocarbonate gas; which was administered to him by Dr. Thornton. Soon after the use of this medicine, he experienced a very decisive amendment of his pulmonary disorder ; and continued almost entirely free from cough, spitting, and difficulty of breathing the whole of the Summer ; nor did these complaints return in October following, as they had constantly done for several preceding years. In October last it was observed that, notwithstanding the amendment of the disorder of the chest, a gradual wasting of the flesh had taken place ; so that instead of being, as in health, muscular, and rather corpulent, his body was become thin, and his limbs were emaciated. The appetite continued to be as great, and was frequently greater than in health. The pulse at the wrifl was most commonly about 80 in a minute, and never exceeded that number. The tongue had a healthy appearance, and there was pretty constant thirst. The patient had sweat profusely for the whole preceding year. 

I now learnt that he had been accustomed, for five or six years past, to drink to the amount of from five to eight pints of liquids, such as tea, capillaire, fmall beer, wine, water, coffee, &c. in the space of every twenty-four hours. A proportional quantity of urine was discharged ; that is, as much urine, or thereabouts, as he had taken of drink. As will be expected, the nightrest was difturbed by riling to pass urine. The quantity of urine being at first attended to without reckoning the quantity of drink ; and being perceived by the attendants to be sometimes sweet to the taste, the patient was pronounced to labour under the Diabetes. 

The urine also having been tasted by a person of unquestionable accuracy, it was discovered to be saccharine. A parcel which I examined was not decisively sweet, but I was struck with a smell which I had never perceived on any former occafton, namely, that of stale beer. Half a pint of this urine, on evaporation, yielded 400 grains of extract-like matter, which contained no sugar perceivable by the taste. Another parcel of the same urine, on standing ten days in a warm room, in a three pint bottle, which was half full, and closed with a glass stopper, became covered with a white scum, and a deposit took place of seemingly the same fort of matter ; but the urine itself, which was quite clear, smelled strongly of vinegar, and tasted sourish. On distillation, this sour urine afforded three-fourths of an ounce of liquid acetous acid, of nearly the strength of weak distilled vinegar. It may be useful to notice that the patient had lived principally on animal food for several months, and had drunk a pint of wine daily, instead of a larger quantity, as was his custom before his illness. During my attendance occasionally for three months, the urine generally had the beer smell, and on standing became sour. Two or three different times it had however, undoubtedly, the saccharine taste. Some parcels of this patient's urine, which had a fleshy and beerish smell, happening to stand in a closed vessel, in a warm room, from November, 1797, to May following, not one of them had the usual smell of urine of persons in health, nor of putrid urine ; but either smelled sourish, or musty ; and they deposited less, and were covered with white scum. The urine of the patient, however, sometimes smelt like ordinary urine ; but on keeping it did not grow ascetic, nor acquire an animal odour ; nor did it ferment, and became four. It was also found that this last mentioned sort of urine retained the usual acescency of urine of healthy persons, as betrayed by the test of turnsole, even after keeping in a warm room fix months.

The patient was directed to live four days entirely on vegetable food. The urine during this time proved fo irritating to the urethra and glans penis, as to inflame them, and a little of it was even paffed involuntarily. It was observed that the urine excreted during the ufe of this kind of food, contained none of the uric oxide, which is the usual basis of urinary concretions. According to my observation the urine voided, when the food was entirely animal matter, was equally acescent, and fermentable into vinegar, as when it was entirely vegetable matter.

The quantity of urine, in October and November last, never exceeded, according to eflimation, the quantity of drink ; and the quantity of urine seemed to vary proportionally, or nearly so, as the quantity of liquor varied. Except for some slight incidental colds, the patient was quite free from pulmonic complaints the whole of the last Winter, as well as during the prefent Summer. The thirst has abated a little ; the appetite for food has been of late about the fame as it was in health, instead of being greater than formerly. The pulse at the wrift has varied between 70 and 80 in a minute. The wasting of the flesh has scarce continued to go on of late, and the strength has decreased very little for several months past. The urine, however, does not appear to have diminished in quantity; nor to have been altered in its properties, in proportion to the general amendment. The amount of this excretion has been for fome months, at least, five to six pints in the face of twenty-four hours. It flill commonly has a beerifh fmell, and on Handing in a warm room does not ordinarily fmell urinous, and putrefy like common urine, but becomes acefcent, and deposits lees, and throws up fcum as malt liquor does, on growing four. There is no room to suppofe that the quantity of urine exceeds the quantity of drink.

The patient has continued to live almost entirely on animal food, even breakfasting usually on what is called beef-tea, in place of the vegetable matter commonly taken at this meal. When vegetable substances were occasionally taken as food, the urine was increased in quantity, but no effects were otherwise experienced different from those during the ufe of animal food. It was thought advisable to continue, however, the animal food, as it agreed very well with the patient, and as the urine was less in quantity than when vegetable food was taken.

Remarks.

Saccharine matter is not the immediate cause of Diabetes, but the effect of this disease ; and if animal food is beneficial, and vegetable food is detrimental, it cannot, I think, be shown, that it is because the former does not afford sugar and the latter does. In support of your theory, that the Diabetes is not seated in the kidneys, it may be asserted that the kidneys do not appear to be secretory organs, or organs which compound matters of a different kind from those which enter into them from the blood ; for excepting, perhaps, the secreted mucus from the urinary passages, there is nothing in urine that does not exist in the same state of composition in the blood itself.

It has been attested by persons whose abatements cannot be doubted, that the blood has, in some instances of Diabetes, tasted sweet, and that it had other properties denoting sugar. A single positive evidence of this sort ought not to rejected by any number of negative ones. But, in short, blood and urine to most persons taste is commonly somewhat sweet ; and therefore, it seems not improbable, that there is in general, sugar both in the blood and urine of all animals at certain times. It is not doubted that the sweetness of chyle, and of milk, is from sugar. It seems also that the digestive and assimilating organs of animals compound sugar from merely animal, as well as vegetable aliment ; as appears on examining the chyle and milk of animals which live entirely on animal food ; namely, either those which are purposely fed or which are naturally carnivorous. It does not seem that the fluids of animals which feed on saccharine matters, contain more sugar than those which feed on animal substances. Vegetables manured with merely animal matter contain as much sugar in their fluids as when manured with vegetable matter, or probably with sugar itself. But fugar can also be compounded by fermentation, without the aid of live powers, from dead animal matter and tasteless farina. These facts, it may be proper to notice, seem to justify the observation above made, that, on a theoretical ground, we might conclude that animal food was not likely to be either more beneficial, or less hurtful, than vegetable. In this place it will be proper to point out that fermentation is a more delicate criterion of the preference of sugar in urine than the taste ; for the urine of the above patient did not taste sweet, but it fermented into acetous acid.

5. If the Diabetes be essentially an organic disease of the kidneys, one might expect to see air-ways such a diseased state on dissection ; which, however, could not be perceived in Laurie's cafe above related. There are also deflections published by various persons, in a few of which only was any disease {etn in the kidneys ; nor are there, in general, any complaints of the loins, urinary passages, hips, &c. in diabetic cases. Wherefore if organic affection takes place, it should be considered as an accidental attendant, or consequence ; and in this light mould be regarded the diseased state of the liver, spleen, lungs, &c. observed in some instances. At the most, such organic disease can only be confidered as productive of one species of Diabetes, in which, on examination, it is probable the urine will be found to be very different from that in the other species of this disease. The state of the mesentery should be more accurately attended to on diffection of diabetic patients. In Laurie's cafe above described, it was observed to be diseased, but I was not prepared at that time for examination of this part with a view to any theory. The urine ought also to be examined after the death of the patient, as well as while alive. In fome cafes, as the appetite fails the urine diminishes in quantity, and loses its sweetness a short time before death. The theory that Diabetes is a diseased state of the assimilatory organs, accounts for fome of its molt characteristic symptoms ; namely, for the urine containing fugar and other nutritious matters, the walling of the flesh, frequent discharges of urine, thirst, hunger, weakness of the organs of voluntary action, &c* but it does not account for the quantity of urine much exceeding the quantity of drink.

Glasgow, July 6th, 1798. 

If your book be not printed off, perhaps you may think it necessary to mention the following circumstances, in addition to the cafes which I lately fent you. Mr. Baird, Physician's Clerk in the Infirmary, infpecled the Patient, and sent me the following account, which I have transcribed. " Isabel Harvey (the married patient) having nearly recovered her usual strength, and being completely cured of Diabetes, was dismissed from the Infirmary by Dr. Freer on the 13th of June. She continued well till the 21st, when her belly became costive, and she was seized with fever, attended with acute pain and tension over all the belly. (She went home, four or five miles from Glasgow ; no person was called, consequently nothing was attempted for her relief.) 

On the morning of the 22d, the disorder increased ; in the forenoon she became delirious, and in the evening she lay quiet for about two hours when she expired.  On opening the body, 36 hours after death, the following appearances were observed. " All the thoracic viscera were perfectly found in the abdomen, the small intestines appeared loaded with red vessels, as did several parts of the Colon also, particularly about two inches above the Caecum, where several spots of a black colour, and easily torn, were interspersed among the red. The whole colon was much distended with air, the lower part, from the sigmoid flexure to the neighbourhood of the anus, being plugged up with hard faeces. " The kidneys were enlarged, uncommonly soft, and pale. " The liver, spleen, pancreas, and mesenteric glands, were found." The widow whom I mentioned, Hill continues in the Infirmary ; and concerning her Mr. Baird fent me the following report, which I give in his words. " For the last eight weeks her appetite and third: have been nearly natural; and though, along with animal food, fhe has had 1 lb. of sweet milk and a roll daily, her urine has retained the natural taste and smell, and has rarely exceeded 4 lb. daily. A few weeks ago, several phlegmons rose on her hands, and remained very painful for ten days, during which time she had little appetite, and became languid and listless. These phlegmons are now whole ; her skin is soft ; her appetite and third are natural ; she recovers strength daily, and abating occasional pains through the belly, her feelings are perfectly comfortable." These cases show the great danger of inflammation after the cure of Diabetes by animal food; a danger which increases in proportion to the preceding debility of the Patient, and against which it is necessary to be particularly on our guard.

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.