Type 2 Diabetes

The other three patients were women, of whom one is married, aged 24, fair and delicate. Her disease began eight months ago, while she was giving suck, and she was very soon compelled to wean her child. She was admitted on the 8th of March, extremely weak and emaciated; her urine, which was very sweet, amounting daily to 15 lb, at least. 

Together with animal food, laxatives, and emetics, she got hepatised ammonia; and for many weeks she has been so well that she is about to be dismissed cured.

The other Patient is a widow aged 29, of a sallow complexion. About four years ago, after delivery, she was dreadfully pained about the umbelicus, where a large tumour arose and suppurated. Matter flowed from it for six months, during which time she was reduced to extreme weakness ; but the wound having closed, she recovered tolerable health, and enjoyed it till two years ago, when Diabetes attacked her. She was admitted on the 19th of April, was treated in every respect like the last, and like her, is to be dismissed cured this week.

The third is an unmarried girl, aged 22. She was admitted June 5th, when her urine daily exceeded 14 lib. and was so sweet, that 1 lb. yielded 3i. 3vi. of thick sweet extract. Without the hepatifed ammonia, in six days her urine has sunk to 6 lb. and has become bitter. Every other symptom has abated in equal proportion; so that in this case also a complete cure may be confidently expected.

From Doctor Gerard. Liverpool, 15 th May, 1798. IN compliance with your request, I shall give you a short account of two cafes of Diabetes Mellitus, which have fallen under my care at our Infirmary since that of Clarke, who, by the way, I must tell you, has never been heard of since he was discharged. They were both females. Mary Jackson, aged 57, was very much reduced indeed, when she was admitted in July last..

She had had 13 children ; the last 7 years of age. The disease commenced about July 1796, but was not attended with any particular circumstance, except an uncommon itching about the meatus urinarius, which returned at intervals, and was always attended with an increased flow of urine. She remarked, that upon the occurrence of a spontaneous vomiting, which continued several days, her water was reduced in quantity one half, but when the vomiting fubfided, the quantity became as great as before. 

She was put upon the animal diet, and in the course of eight or ten days was better, to her feeling, though the urine was little altered; her appetite and thirst were more moderate, her spirits and complexion improved and the skin, which had been very harm and dry, had yielded to moderate perforation, and was become much softer.

 She frequently took an opiate, and occasionally an emetic; and upon the disease proving obstinate, I ordered her five drops of hepatifed ammonia three times a day; the dose was gradually increased to 20 drops, which was repeated five times in the 24 hours, without producing any lasting amendment. Not meeting with the same success in this case as I had experienced in Clarke's, I determined to give her the carbonated ammonia in very full doses, which I was led to make trial of, both from the late discovery of its component parts, and also from the consideration of its being of copiously afforded by healthy urine, and animal matter in general, and therefore corresponding with the plan of animal diet. I also found a further inducement to persevere in this plan, upon hearing that Dr. Currie, of Chester, had succeeded in a case where he had made use of it. It was continued from August to December, and for a great part of the time, to the quantity of giv daily, one half in the form of pills, and the other in solution, saturated with carbonic acid air. It failed, however, in this instance, for she died on the 13th of December; but it must be remarked, that she was continually deviating from the plan, in eating different vegetable matters, and particularly sweets; but this did not come to my knowledge till it was too late; the fact, however, was proved beyond a doubt. The want of success in this instance, cannot, therefore, with any propriety, be attributed to the insufficiency of the plan.

My other Patient, Elizabeth Francis, aged 36, is a married woman. She miscarried near 12 years ago, but never had a live child. Eighteen months after that, she became dropfical, and had 17 quarts of water drawn off by the operation of paracentesis. She recovered of this, and enjoyed tolerable good health for near five years ; but she has been complaining these four years past, and became diabetic about June 1797.

 She was admitted into the Infirmary on the 28th of September following, at which time Mary Jackfon was using the carbonated ammonia, and apparently with advantage. Francis was therefore ordered to take it in the same manner, and to pursue the animal diet; I believe she did so rigidly, and with so good an effect, that on the 12th of November she was discharged at her own request, in consequence of feeling herself better than she had been for four years before, and indeed, to her own thinking, well; her strength being much improved, her thirst and appetite very moderate, and her water reduced to four, and sometimes to three pints in the- 24 hours, and free from sweetness, though for a week before she left us, she had been allowed two ounces of bread per day, and for the week preceding that, one ounce per day. On her going home, however, she increased it to a penny loaf per day, and at the same time took less animal food, owing to her inability to procure it ; the consequence was, that in a few weeks she became somewhat weaker, her urine increased a little, and she was frightened. She was therefore re-admitted on the 1 3th of February, and put again upon the animal diet, which she adhered to strictly till the 29th of March, when she was discharged again, to all appearance cured of the disease, though not restored to the strength and vigour of full health. 

She still keeps to the plan of eating animal food, and avoiding all vegetable matter, but lives a good deal upon milk; and when I called upon her yesterday, she said she had certainly gained strength lately. I then learned, for the first time, that she had also been affected two different times with an itching about the meatus urinarius, which was exceedingly troublesome to her; the water was increased in quantity each time, and was hot and acrimonious ; but she has had no return of it since she left the Infirmary. 

I shall now conclude this account with remarking, that the effects of the animal diet have been so obvious in all the three cases under my care, notwithstanding two of them occasionally deviated very largely, that I perfectly agree with you, in suspecting a deviation from the plan, wherever they are wanting, though the patient should strenuously deny it; for I have experienced the same propensity to deviate, and the same reluctance to acknowledge it, that you have done; and so averse are the other patients to betray the secret, that I believe the truth will seldom be obtained in an Hospital, while the patient remains there.

From Dr Cleghorn

I am just now treating a Gentleman in private practice with equal success. 

I examined John Rogers, (p. 168) today, and found that he had lived very irregularly. He keeps the tap in our prison, where he is much exposed to temptation; and his urine has from time to time become sweet, generally in proportion to his deviation from your rules; he is, however, much stronger, and has continued to be able to attend to his business.

John M'Lean, (p. 158) died last year, in the beginning of August. A month before he had been confined to bed by a violent pain darting from his breast-to-his back, accompanied with difficult breathing, and very severe cough. Having repeatedly recovered from similar attacks without medical aid, he waited till the 10th day, though I had requested him to let me know whenever he began to complain. On the 10th day of his disease I found him extremely hot and oppressed; his breathing hot and laborious, constrained by dreadful pains through the chest, and frequently interrupted by a most severe cough; by which, after violent straining, he brought up a quantity of pus or blood. His pulse was quick, and feeble, but sharp. His features were ghastly and expressive of great agony. His present were so different from his former feelings, that he gave up all hope of recovery, and in despair, not only refused to go again to the Infirmary, but was unwilling to try any remedies. Some of the ordinary ones, however, were used, to no purpose; and in the fifth week of his disease, after voiding a quantity of blood by stool, he expired. In the thorax were numerous adhesions, especjally on the lower part of the sternum, from which the lungs could scarcely be separated, and the separated surfaces were covered with a gelatinous mass; there were familiar adhesions in the posterior part of the right cavity, nearly opposite, in which direction, chiefly, the pain had darted; and also over a great part of the left cavity. Around the adhesions the structure of the lungs was much altered. There were many ulcers, some nearly empty, others full of pus and several parts apparently ruptured, were surrounded with masses of grumous blood. The bowels were very pale, but there was no hardness in any mesenteric gland. The kidneys appeared sound, only more flaccid than usual. That the pneumonia which destroyed this Patient was not connected with Diabetes, is abundantly certain, but it may perhaps be thought, that the animal food necessary for curing the one, tended to produce the other. This is true, though I imagine the great fatigue, and the frequent alternations of heat and cold to which he was exposed, might have produced pneumonia under any regimen. Indeed, it seems probable that he had partial adhesions in the chest before he came to the Infirmary, because every slight causes excited cough and pain in the breast; but the last attack was most violent from the beginning, and the time when evacuations might have checked its progress was unfortunately allowed to go by. I had the curiosity to taste his urine twice or thrice, but it was not sweet. 

From some friends, to whom I have sent or recommended your work, (which is now known over all the west of Scotland). I have learned other instances of success; but, as I do not know the particulars, I think it unnecessary to mention them. Last winter we had a complaint among horses, called by our Sarriers Jaw-pish marked by a great flow of clear urine, emaciation and weakness-— lately I obtained a portion of the urine of a horse labouring under this disease, and found it four; but I had not lesfure to examine it farther.

From Doctor Cleghorn. Glasgow, June 12, 1798. 

TOGETHER with the conclusion of John M'Lean's Case, I have sent a short account of four other Patients, cured according to your plan in our Infirmary. As they were chiefly under the care of my learned Colleague, Dr. Freer, (for I attended them only during a few weeks in his absence) I requested him to write out their cases; but after considering them, he found them so exactly like those already published, that he thought a full detail of the symptoms or practice would lead to unprofitable repetitions. With his concurrence I have extracted the following particulars from the Infirmary Registers. 

One of the Patients was a Weaver, age. 35, of a dark complexion and stout make. The disease had continued 18 months, and arose, as he thought, from cold, to which he was exposed while under salivation from mercury. When admitted on the 9th of February, 1798, his urine, which was very sweet, amounted to 20 lb. daily; when dismissed, in the beginning of May, it varied from 4 to 5 lb. and had no sweetness. 

This Patient got no hepatifed ammonia. He was restricted to animal food, using water, lime water, or alum whey, for drink; he got occasionally laxatives, emetics, and pills containing extract of bark and steel. While he got eggs for supper, his appetite and thirst began to increase, for which reason they were omitted; but the chief peculiarity of his case consisted in the trifling effect of emetics upon him. Ten grains of tartarifed antimony excited no sickness, nor vomiting or purging ; seven grains of vitrified copper with the same quantity of ipecacuan, were equally ineffectual, as was also vitrioiated zinc given to the extent first of 30, afterwards of 35 grains. 

I do not ascribe this insensibility of the stomach to Diabetes, because I never met with it in other cases ; it certainly arose from a constitutional peculiarity as the Patient told me it had always been very difficult to make him vomit. In other respects his progress was quite similar to that already often described. His skin, formerly arid, became soft and moist; in proportion to the abatement of his appetite and thirst, he gained flesh and strength; and his urine, acquiring daily more and more of the natural appearance, during the last month of his fray in the Infirmary, most frequently amounted to 4, but never exceeded 5 lb. Nothing has been heard of this Patient since he left Glasgow, from which, as he lives in the neighbourhood, we conclude that he continues well, because he promised either to return or to write, if he should relapse.