Type 1 Diabetes

German medical student Paul Langerhans discovers the islet cells of the pancreas but is unable to explain their function. The find is dubbed the ‘islets of Langerhans.

Bouchardat and the evolution of the diabetes diet 

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

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

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

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

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

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

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

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

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

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

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

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

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

Lactic ACID IN DIABETES.—Dr. George William Balfour, in a paper read before the Medico-Chirurgical Society of Edin- burgh (L£dinburgh Medical Fournal, December, 1871), calls attention to some observations of Professor Cantani, of Naples, on the use of lactic acid in diabetes, and reports seven cases of this disease in which he has employed it. Prof. Cantani believes that in diabetes the question is not so much one of increased production as of defective combustion of sugar; and this defective combustion, he thinks, depends upon the production of a morbid form of glucose, which he terms para-glucose. This is incapable of being transformed into lactic acid, and therefore cannot be burned, but is passed unchanged in the urine. The consequence is that the heat of the body must be maintained at first by the combustion of the albuminates and fats, and later in the disease by that of the patient’s own tissues. He, in common with many modern pathologists, recognizes the liver as the organ mainly at fault in diabetes ; and his treatment is partly directed towards giving it as complete a rest as possible by depriving it of its pabulum, which is accomplished by subjecting the patient to a rigorous meat- diet, thus reducing to a minimum the introduction into the system of sugar-producing substances, and partly towards ar- resting the waste and ultimate complete degradation of the body, by supplying a combustible agent in a quantity sufficient for the wants of the body, so that the fats may continue to be stored, and the body thus gradually brought back to its normal standard; and he hopes that this restoration of the healthy standard of the constitution, coupled with the prolonged functional rest to the organ affected, may suffice to prevent any relapse into its morbid condition, even after a return to the ordinary dietetic conditions of modern civilized life.

The combustible agent which Cantani has selected is lactic acid; and this he administers in doses of from 70 to 150 grains daily, diluted in from eight to ten fluidounces of water. An exclusive meat-diet is insisted upon; for drink he allows water, either plain or with a little of the purest alcohol ; coffee, tea, and wine being prohibited.

His results have been somewhat surprising. In recent cases the cure is stated to be almost certain, and speedy; and even where an exclusive meat-diet is not persisted in, life is apparently prolonged, and many of the unfavorable results of diabetes are prevented, though the melituria is not arrested. The success which has been claimed for the treatment in which skim-milk is the exclusive article of diet is readily understood when we reflect that milk contains from three to six per cent. of lactin, which, under the influence of the caseous matter, becomes transformed into lactic acid.

Nineteenth century diets for diabetes were just as varied as those of the twentieth century. The Italian physician Cantani, who had a large and lucrative private practice, enforced starvation by locking his patients in their rooms and feeding them on lean meat, fat and dilute alcohol [5].

Cantani treated his diabetic patients by eliminating carbohydrates and prescribing an exclusive meat diet.[3] He believed that stopping glycosuria was the major method of controlling diabetes.[4] He allowed his patients as many calories as they could tolerate without glycosuria. Later he limited daily food intake to about one pound of cooked meat. If glucosuria persisted, he fasted his patients.[5] The exclusive meat diet would continue for several months but if urine was not free of sugar it would extend to six or nine months.[3] To control glycosuria, Cantani would enforce his diet restrictions. He would often lock his patients in a room, so they adhered to the strict diet.[6] He performed microscopic studies on the organs from thousands of cases and observed that atrophy and fatty changes were more frequently found in the pancreas of diabetic patients than of non-diabetics.[7][8]

https://en.wikipedia.org/wiki/Arnaldo_Cantani

Professor Arnoldo Cantani, one of the most brilliant and distinguished of Italian physicians, died on May 1st, aged fifty-seven. His death was caused by Bright's disease, a malady concerning which he had written much. He was at the time of his death Professor of Clinical Medicine in the University of Naples. While at Naples he wrote monographs upon the “ Diseases of Metabolism,” “ Progressive Atrophy of the Skin," “ Lathyrismus," “ Enteroklysma,” “ Different Morbid Aspects of Individual Infective Disease,” to say nothing of a vast number of occasional monographs and notes on his favorite themes of fever, inflammation, and infection. “ The predominant note in Cantani’s character," writes a Neapolitan correspondent of The Lancet, “ was serenity. No one possessed a calmer, more perfectly balanced judgment; no one was further removed from all that savors of flattery or assentation. He had in a rare degree what professional men call the ‘ clinical eye ’ —a possession all the more remarkable in that he did not lay himself out so much for consultant practice as for investigation in the pathological laboratory. The honors, of which he had more than his share, came to him unsought, and he never was heard or seen to set store by them. Called in 1889 to the Senate of the kingdom, his health, never robust, kept him from taking part in its deliberations, except in rare crises in the State. Outside his professional sphere, and that was an extensive one, he had but one predilection—he was passionately fond of music.”

ARNALDO CANTANI, M.D., Professor of Clinical Medicine in the University of Naples. WE regret to announce the death of Professor Arnaldo Cantani, one of the foremost physicians and teachers of Italy, which took place on April 29th. He had been disabled by illness for about two years, but the end came somewhat unexpectedly on the twenty-fifth anniversary of his induction into the chair in which he won distinction as one of the most influential reformers of medical teaching in Italy. Cantani was born at Hainsbach in Bohemia in 1837, but his father was a Neapolitan. In 1855 he entered on the study of medicine in the University of Prague, where he took his degree in 1860. Immediately afterwards he was chosen by Professor Jaksch to be his principal assistant, and for some years he was Privat-docent, taking the professor's place in the lecture room on several occasions with much acceptance. While at Prague he translated Niemeyer's work, Special Pathology and Therapeutics, into Italian. There also he became acquainted with bsalvatore Tommasi, who was destined to take an equally prominent part in the medical renascence of Italy In 1864 the Italian Government offered Cantani the Chair of Materia Medica and Toxicology in the University of Pavia. In 1867 he won by competition the appointment of Physician and head of the Medical Clinic at the Ospedale Maggiorept Milan. Finally, in 1868, the Italian Government invited him to fill the Chair of Clinical Medicine in the University of Naples, which he continued to occupy till his death. So attached was he to the country which had readopted him, that he declined an offer of one of the chairs of clinical medicine in the University of Vienna, which was made to him on the death of Bamberger. 

Cantani's influence as a teacher made itself felt chiefly In the infusion of the modern scientific spirit into Italian medicine, which even thirty years ago was still largely under the sway of " systems," in which facts were' made to fit the Procrustean bed of theory. Cantani laboured by precept and example to rehabilitate the accurate observation and careful collection of facts which had in the sixteenth and seventeenth centuries been the distinctive features of the Italian schools. 

Cantani contributed largely to medical literature on cholera, typhoid fever, rabies, and diabetes. His most important work was his Trattato di Aateria Medica e Farmacologia; his last publication was a work entitled Pro Sylvis, which was a plea for the preservation of forests from the hygienic not less than the aesthetic point of view. 

His funeral was attended by the whole medical faculty of Naples, by representatives of the Senate and Chamber of Deputies, by the Minister of Education, and by the administrative and executive authorities of the province of Naples, and an immense concourse of the general public. Funeral orations were delivered by Professor de Amicis, President of the Medical Faculty, by Professors Gallozzi, De Renzi, and others.

https://babel.hathitrust.org/cgi/ssd?id=uc1.31378008338645;page=ssd;view=plaintext;seq=28;num=14

"According to Vierordt, humans must necessarily absorb 120 grams per day. of albumin, 90 gram. of fat, 330 gram. of hydrated carbides, 2.635 gram. of water and 32 gram. mineral salts. These numbers would be an average. We can take them as such, and take them as a starting point in our studies or our experiences. Let us now study the toll of carnivores, and notice that meat does not is not only albumin, that it contains a quantity of combustible substances: gelatin, fats, muscle sugar, lactic acid. To feed a dog exclusively with meat, it is necessary to give him 40 to 50 grams each day. per kilogram. of its weight: below it will lose weight, above it it will increase in weight. Sees has found that under these conditions a dog absorbs more oxygen than with a mixed diet, and from the therapeutic point of view this is very important: this increase is due to albumin, not to fats nor with gelatins. Digested and assimilated albumin is not used in a single form: according to the uses to which it is to be employed, it will be transformed in various ways; it will take two main forms, which Voit has thus designated: tissue albumin (Organeiweiss), and circulating albumin or provisional albumin (Circulirendes Eiweiss, Vorrathseiweiss), or else blastema or plasma. On this point, Sees is agreement with Bischoff, J. Ranke and Weigelin, and also with our own research. "Tissue albumin" which we prefer to call organized albumin, constitutes the solid parts of tissues, membranes and cell nuclei, it is not as easily attacked by oxygen as "circulating albumin" which I call fluid albumin and which constitutes the amorphous liquid content of tissues. The more meat is eaten, and the more it accumulates in the body of circulating fluid albumin, the more oxygen it absorbs to burn this excess albumin, and produce urea or acid. uric. When a dog is fed on meat and fat, this last substance is an excellent fuel, which spares a lot of albuminates, by burning itself in their place, and taking their oxygen from them, which makes them less combustible. From this results this fact, that such a diet increases the weight of the body, the mass of the flesh, and sometimes also the fatty deposits. In the balance sheet of omnivores, it is about saving as much albuminates, supplying the organic oxidation process with another fuel that is even more economical than fats. By giving the dog meat and hydrocarbons, one could theoretically expect a greater saving of albuminates, since hydrocarbons are more combustible and more oxygenated than fats. In fact, this is what takes place: albuminates are spared, as well as fats, the accumulation of which is thus favored; if the hydrocarbons are introduced in excess, they very markedly decrease, according to Voit, the organic consumption. According to Pettenkofer and Voit, two parts of hydrocarbons are equivalent for the carnivore to one part of fat. Bread alone would not be enough to feed carnivores, or even man; to introduce a normal quantity of nitrogen, it would be necessary to absorb too much starch, which would not be tolerated for long. According to Ranke, collagens do not only spare albuminates, but also fats and even hydrocarbons circulating in the plasma stream: however this excellent fuel would provide little heat. The inorganic substances contained in our food are also of very great importance for nutrition and material exchange; the main ones are: sodium chloride, salts of soda, potash, lime, magnesia, phosphoric acid, water. All these inorganic bodies accelerate the endo- and exosmotic current, the plasma current, and increase the oxidation of circulating albumin. The salts of potash, and especially the phosphate of potash, promote, according to Kemmerich, the production of muscular tissue; according to Ranke, these potassium salts decrease the resistance to cells, would allow an easier passage of the plasma current, and would also promote the organization of albumin or albumin formation of tissue. The excess po- cup would become harmful by the too great depression of the vegetative activity. Water is essential as a liquid menstrual for all processes of diffusion or transformation, oxidation or decomposition, introduction or export. But the excess water in the tissues indicates a sluggish life, a slow and lazy renewal. The balance of herbivores is not essentially different from that of carnivores. The materials used are different, but the results are much the same. Herbivores introduce much more fuel, which promotes fatty deposits; it also seems that they digest at least part of the cellulose, which no carnivore does, including humans. By giving the herbivore nitrogenous food, we do not increase its musculature, but only its reserve of fat. Man is omnivorous, he eats everything: he offers considerable resistance, lives longer than most animals, thanks to his varied and restorative diet, but above all thanks to the influence of his system. nervous system so developed, on vegetative activity and the renewal of its tissues. Meat is certainly his primary food, for hunting, fishing and herding herds preceded agriculture; bread came in later. But the flesh, which man digests very well, remains his best food; it makes him stronger, more energetic, more resistant than is the man living exclusively on vegetables and fruits. And it is with peoples as with individuals: herbivorous peoples degenerate, carnivores progress, in this meaning we could say that the cuisine of peoples is part of their national history. The material renewal varies in intensity according to the various ages. The child oxidizes more, but produces more than he consumes: it is the most plastic age. Likewise, but to a lesser degree in the young man. In middle age, balance is established. In the elderly, despite less consumption, production was no longer sufficient to cover the deficit; regressive metamorphosis wins; it is the organism's first step towards returning to the inorganic state. Let us also note organic individuality as the cause of a variable renewal, too rapid in some, too slow in others. Assuming the correct proportions of the foods introduced, we can distinguish four ways of being of material renewal: 1 ° Regular and balanced renewal; 2 ° excessive consumption; 3 ° self-consumption or autophagy; 4 ° lack of water. In the first case, physiologists admit that all the albuminates introduced replace an equal quantity of organic substances; the more we introduce, the more tissues to renew will be consumed; all the decomposition products found in the urine and other excretions would therefore come from the tissues burned and consumed, and not from the albuminates introduced by the diet. In excessive consumption, there would be an excess introduction of albuminates, only a part of which would serve to renew the tissues, while the other would be burned directly in the blood. The body would not gain weight, since the amount of albuminates intended to increase body mass would be used as fuel. For me, I believe that even in humans well;

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The fats introduced into the organism are burnt there, and give as the last residues water and carbonic acid. The hydrated carbides are starch and scre, and since starch always turns into sugar, all hydrocarbons should be considered sugar. By oxidation they are transformed into lactic acid, and give as last residues water and carbonic acid, as do fats

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To this order of abnormalities belong according to us: diabetes mellitus, oxaluria, gout, uric and calcareous gravel, adipose polysarchaia. (6) Renewal anomalies with consecutive systemopathy by abnormal elaboration of nutrient materials absorbed into the blood, among which we note: Rickets, Osteomalacia, (c) Renewal anomalies with consecutive systemopathy, for example excess or insufficiency in the absorption of certain food substances, which would be scurvy, hydremia and hydrorgania. 2 ° Renewal abnormalities with systemopathy by constitutional defect, which primarily resides in the tissues themselves, irregularly developed, and, for that, endowed with abnormal reactions or little resistance: the main ones are: Nervous erethism, Scrofulosis, Hemophilia, Chlorosis. 3 ° Anomalies of material renewal with systemopathy, having the character of reaction to agents hostile to organic life, which have penetrated into the tissues or into the circulating blood: these harmful agents come either from the economy itself , or from the outside world, and disturb the renewal of the chemical and morphological cular. Here we find: Fever, Primary phlogosis in general, and in particular acute or chronic rheumatism, certain generalized eczemas, certain fleeting erythemas, urticaria, etc., Virulent infection (contagious diseases and mias - matics), Chemical poisoning (acetonemia, cholemia, ammoniaemia, blood dissolution), Chemical poisoning (lead poisoning, arsenicism, hydrargyrosis, etc., ergotism, lathyria, etc.). In diseases where the whole organism changes its type of vegetation, of chemical direction, the organism transforms food substances to a certain point, without leading them to complete decomposition, thus interrupting the series of normal transformations. Its processes of biological chemistry are no longer sufficient for their task, and the imperfect products of their elaboration remain useless or harmful: these products, by accumulating, all become in the long run very harmful. Examples include diabetes, gout, polysarchaia, oxaluria. The diseases of this group can affect the entire economy more or less seriously, preferably without affecting any organ. Other times the abnormal or retained products almost exclusively affect certain organs or certain tissues, which should have eliminated them in another form, as happens with kidney stones, including oxaluria. At other times the whole organism is affected, but certain organs feel it especially and in a very special way,

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By systemopathies I mean those diseases of renewal, those anomalies of organic chemism, in which the disturbance of the processes of chemical transformation affects the nutrition of the whole organism less than that of a specific type. of tissue, of a physiological and histological system of our tissues. Given an alteration of the blood crase, it is easily understood that certain tissues suffer from it more than others, and that this influence extends to all the tissues having between them a certain affinity of nutritional needs, and belonging to the same histological system. A chemical substance whose presence or preponderance in the blood will alter the nutrition of a bone, can and must interfere with the nutrition of other bones: from then on all other bones will be disposed to become diseased, if an occasional cause occurs. Likewise, a substance capable of making the serous membranes of the joints sick can act on the pericardium, endocardium, pleura and other serous membranes. This is the case in rickets, osteomalacia, scurvy, hydremia, hemophilia, scrofulosis, nervous erythema. Finally, in the diseases which have a character of reaction to the harmful agents which have penetrated into the blood, we find above all affected a physiological system: the skin and the mucous membranes in eruptive fevers, the hemocytopoetic and lymphatic glandules in the ileo - typhus, muscles and nerves in lead poisoning, muscles in lymphadenism, etc. In phlogoses which present several foci, It is understood that there is not a single disease without secondary alteration in the composition of the blood, and without at least a local disturbance of molecular renewal. This disorder can spread secondarily to the entire economy. In the course of these lessons, we will mainly deal with the diseases that have been studied in our studies from the point of view of molecular renewal. The most completely treated will be diabetes mellitus. We will speak of others, as much as is possible in the present state of our knowledge, from the pathologico-etiological and therapeutic point of view.

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The Portuguese Amato Lusitano says he cured two diabetics by a very nourishing diet and the use of purgatives. Maybe' Were there cases beginning treated by the diet especially meat. Another Portuguese, Zacuto Lusitano, cures two cases with donkey milk: this is very interesting if we think of the undoubted advantages that we have obtained from the use. lactic acid, and the cure by the milk diet proposed today in England by Donkin. The Italian Cardano had the opportunity to study diabetes on himself, probably it was diabetes insipidus. He also describes a case observed in a young girl, and the first he weighed the urine: according to her calculation, this young girl absorbed only 7 pounds of solid food or drink each day, and gave 36 pounds of urine.

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Sydenham came up with an idea, which is like the prelude to current ideas. According to him diabetes is an assimilation disease, in the sense that the chyle is not fully digested in the blood, and should therefore be eliminated by the kidneys as a foreign body. For treatment he strongly recommended a rich diet in meat, and narcotics, especially theriac.

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Morton regarded diabetes as a kind of phthisis, and attributed the mild flavor of the urine to the flow of the sweet chyle to the kidneys. In etiology, he cites the influence of heredity, kinship, race. He encountered diabetes in the father and son, and another time in a small child who had lost three brothers to diabetes. 

Mead maintains that diabetes is a disease of the liver: he wants to prove it by autopsies which all showed him steatomatosis of the liver. He explains the sweet taste of urine by the separation of salt from bile. 

Dobson demonstrated that diabetic urine can produce alcohol and vinegar by fermentation: he succeeded in preparing very clearly sugar by evaporating the urine: he also discovered the sweet flavor of the serum of the blood of diabetics, and thus demonstrated that sugar exists in the blood of these patients and is not formed in the kidneys.  According to him, it is a defect of assimilation of the chyle which causes the glycosuria: the sugar of the chyle accumulating unaltered in the blood, would come out by the urine. This shows that Dobson already admitted the passage of sugar from food into the blood; he also admitted an abnormal fermentation, and believed that the acidic breath of diabetics was due to the acid fermentation of the sugar contained in saliva. 

Cullen said the diabetes was neuropathy, a spastic disease. However, he recognized the vice of assimilation of chyle. He denounced the ineffectiveness of all remedies. 

Home recognized that by weighing not only the drinks introduced, but also the more or less liquid foods, the quantity of urine does not exceed the quantity of liquids absorbed; he also noticed that the quantity of urine emitted is greater at certain times. Home made quantitative analyzes, and weighed the sugar obtained; he had in one patient an ounce of sugar for a pound of urine, in another an ounce and a half. He confirmed the fermentation capacity of urine with the addition of yeast, and thus showed that it lost its sweet flavor to take on that of small beer. As for the theory, he accepted Dobson's: he treated his patients with a diet consisting mainly of meat.

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Here we close our second period by noting that several of the authors cited lived after the publication of Rollo's works, works intended to prepare for the era of experimental studies. The third period, therapeutic period, is again inaugurated by an Englishman, John Rollo, who at the end of the last century published the story of two cases of diabetes. Rollo was the first to emit, on the pathogenesis of diabetes, a theory which, modified on various points, became widely later; many authors attribute their authorship to Bouchardat. According to this theory, diabetes is a disease of the stomach with overactivity, with exaggerated secretion of abnormal gastric juice, which converts all starchy substances into sugar; this sugar absorbed in the blood would come out with the urine. Note, however, that Rollo did not know that starch normally turns into sugar. This is why he advises to treat diabetes with an especially animal diet, and with drugs that slow down the activity of the stomach: vines and fats only at dinner and at supper: at breakfast one and a half liters of milk, with buttered bread. As drugs, ammonium sulphide, opium and emetics. This treatment, as we can see, somewhat resembled the Bouchardat or Seegen regime. In the hands of Rollo and his contemporaries, he gave mediocre results, which the author attributes to the inaccuracy of patients in following their diet: he notes that they have frequent indigestion, disgust for meat, gastroenteric catarrhs, and he attributes all this to the meat diet: it seems to us that one could, with all appearance, attribute to the drugs indicated above ammonium sulphide, ipecac, stibiae tartar, etc. My patients tolerate a much more rigorous diet and that for several months; they digest very well and eat perfectly. 

After Rollo we have Bouchardat who adopted the same theories, however modifying them so as to adapt them: 1 ° to the discovery made by Tiedemann and Gmelin, that starch is normally transformed into sugar in the intestine, by action of saliva, pancreatic and enteric juice, 2 ° to this fact, demonstrated by Magendie, that this sugar is normally absorbed in the blood. Bouchardat, also admitting that the cause of diabetes is stomach disease, says that starch is transformed into sugar so quickly that too much of it enters the blood in a given time, and the blood, overloaded with sugar, lets part of it escape through the urine. This is Rollo's theory and the same overactivity of the stomach: it is still the same therapy. Bouchardat menus have become famous: meat, cabbages, peaches, lemons, gluten bread, which should only contain nitrogenous substances, and which, in fact, contains far too much starch. It cannot be denied that, of all the treatments offered so far, that of Bouchardat, which basically is that of Rollo, minus ammonium sulphide and emetics, has had the best fortune and deserved it. The goal was not completely achieved, because the regime is not severe enough, but it is very close to the truth: none of the authors and practitioners who came after Bouchardat could neglect the use of his culinary menu. 

Prout also believed that diabetes is a form of dyspepsia: but he saw it as a defect in stomach activity, a difficulty in assimilating sugary foods. 

Gregor, from London, argued that diabetes resides in the stomach. 

Griesinger expressed the opinion that diabetes depends on rather qualitative disturbances in the digestive functions of the stomach, because the disease often begins with noticeable disturbances in digestion. According to him, the great thirst of the diabetic who eats starches, his less thirst when he eats meat, cannot be explained, with the hepatic theories of diabetes, but rather by gastric digestion disorders, by the rapid transformation of starch into sugar, and rapid absorption of sugar into the blood. In addition, the alteration of the digestive ferment of the stomach is a proven fact; the stomach juice of a diabetic on an empty stomach, obtained by vomiting, would contain a ferment which rapidly transforms starch into sugar, which normal gastric sugar would not. Griesinger regrets that this difference has not been sufficiently taken into account; he also admits as possible that, in the stomach and intestines, the albuminates ingested provide sugar in diabetics.

ON THE TREATMENT OF DIABETES. A CLINICAL LECTURE DY PROFESSOR DOJARDIN-BEAUMETZ, Member of the Academy of Medicine Physician to the Hôspital St. Antoine, Paris, France 

GENTLEMEN, 

The dietetic treatment of diabetes deserves the first place. Ever since John Rollo at the end of the last century first called attention to the influence of foods in the production of glycosuria, all authorties have felt the obligation to regulate rigorously the diet of diabetic patients. At their head is Bouchardat; after him I will mention especially Seegen, a German writer, and Cantani, an Italian, and what I have now to offer respecting the hygienic regime of this affection will be based on a careful study of the contributions of these three men. The hygienic treatment is founded on the endeavor, far as possible, to exclude from the food all substances capable of forming glucose. This glucose may be derived from sugar in the ingesta, or from starch which has undergone conversion in the alimentary canal. These glycogenous principles, then, should bo suppressed. All this, however, though simple in theory, is difficult in practice.