All History

From Doctor Storer, Nottingham. October 18 1797

THAT the cure of the Diabetes Mellitus had hitherto been a desideratum in Medicine, the candid declaration of Dr. Cullen will leave no room to doubt; and though I have reason to think that there exists in certain families a morbid disposition, occasionally showing itself in profuse and sweet urine, thirst, eagerness of appetite, and feverishness, which is relieved by medicine, disappears of itself for a time, and recurs upon any irregularity, much as happens in dyspepsia, yet I think a distinction ought to be made between this milder and more chronic species of the disease and the true Diabetes Mellitus, with rapid emaciation, as described by yourself and others. Respecting the latter, (of which seven distinct cases have fallen under my care) I must say with Dr. Currie, that after the disease was completely formed, I have never seen it cured by the former methods of practice. 

The first notice I had of the new method, was from your notes of Captain Meredith's case, transmitted to me by Dr. Aldrich, (the Gentleman of 77, see page 180,) with a request to have my sentiments respecting the propriety of his pursuing a similar plan. I have reason to think that the Doctor's disease had existed a considerable time, before it was detected in September 1796, when he first complained to me of oedematous legs, great thirst and dryness in the mouth, without any corresponding degree of fever, increasing debility and frequent irritation to urine, the quantity and properties of which had not been observed, the Doctor having strongly adopted the idea, that it was more the infirmities incident to advanced life, than any positive disease under which he laboured. Having declined to recommend anything till the state of the urinary discharge was ascertained, I soon received a note to say, that the colour, taste, smell, consistence and saccharine residuum, after evaporation, all proved the urine to be truly diabetic. In consequence of this information, the Doctor was advised to give up all visits, and pass the winter entirely within his house, to abstain from vegetables, sweet and home made wines, to which he had been, particularly partial, and all redundance of sugar, of which he was fond, and to pursue the plan of medicine stated in his letter to you. Under this treatment six months elapsed before your method was known to us, during which the Doctor was in some respects relieved; the progress of the Diabetes appeared to be arrested, but all its characteristic symptoms still remained. The sequel of the case, from the end of March till the 18th of May, (the date of the report transmitted to you) is better related by the Doctor himself, than I am able to do; to this report I have only to subjoin that on the 17th of June following, 

He found himself able to pass two days here (20 miles from home) on a visit. The swelling of the ankles was no more than what is customary at his age; he appeared as well as he had been for several years; and though his urine had a flight sweetness, it was neither too abundant nor otherwife defective. This state of health continued, although he had in a great measure resumed an ordinary diet (abstinence from vegetables and saccharine matters excepted) till the 14th or 15th of July, when he was seized with a cholera, at a gentleman's house in the neighbourhood; and though the bowel affection ceased, so as to admit of his being removed home, yet on the 18th I found this truly excellent and learned man in a dying state, without any other symptoms than those of debility and dyspncea; his urine was natural. The Doctor himself has stated that he would not consent to enter upon your plan of regimen in the Uriel manner that I would have recommended it to be pursued, at least for some weeks. He entirely rejected any hepatised ammonia, or any nauseating medicine. It was as a substitute for these that I proposed the soda water of Schweppe, having come to the knowledge of a diabetic case in Lancashire; which was understood to have been much relieved by that preparation; and I entirely concur in the Doctor's own opinion, that while it was a solace to his thirst, he derived other advantages from it. In fine, the benefit he experienced from the whole of the plan, much exceeded his expectation and mine; and I do not think, at his age, the cure could have been more complete. 

It is with much concern I remark, that in patients under the influence of Diabetes, there is such an invincible desire for variety in aliment, and often such an aversion to animal substances, that the new method of treatment most often fail for want of a fair trial. I have at this time a man of about 50 under my care, who has laboured under this disease for two years, and who has had all along a disgust to the taste, smell, and often fight of animal food. Six months ago, I strongly recommended to him your plan of regimen; he tried it partially, I believe, without much evident effect and soon abandoned it. Taking advantage of the rapid increase of his diforder lately, and the near prospect of dissolution, if nothing essential was done, I have again enforced it with all my powers of language. The consequence has been, a fresh trial of two days, which he declares himself unable to support, and now he appears to resign himself to his fate.

R. Redfearn M.D. of Lynn Regis, Norfolk

"I therefore immediately suggested to him the propriety, and the absolute necessity, of abstaining ridigly from all fermented liquors and vegetables, with everything else that could impart oxygen to the system by the primae viae; and at the same time ordered that his diet should consist principally of fat beef, pork, and such ailments as were of a gross or unctuous quality, and most likely to produce hydrogen in the greatest abundance. After this patient had persevered in the above medicines and regiment during a fortnight only, he found his thirst by no means so excessive. The quantity of his urine was considerably diminished, and became also of a quality more urinous, and less sweet. His amendment continued to be progressive, without feeling any interruption, either from natural or adventitious causes; and he was completely free from every symtom of the disease in less than three months after the medicines were first administered. He never once deviated from the regimen prescribed. My patient has now continued perfectly well for more than eight months, and to my enquires, very lately, he declared, that he never enjoyed a better state of health, than he does at the moment."

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 Jameson, Royal Artillery. Tynemouth, 1st March, 1798. 

ROBERT NIXON, a Collier, belonging to the works at Benton, about six miles from this place, of a slender make, dark brown hair and complexion, aged 22, and whom I visited on the 29th of December, 1797 informed me, that about two years since, he was induced to work very hard in the damp coal pits, which, he supposes, exceeded his strength and abilities, from an anxious desire to support his aged parents; that he then used to sweat greatly while at work in the mine, and to drink at the same time very freely of cold water, having no opportunity of procuring other liquor. From enquiry, I have reason to believe that he was not addicted either to inebriety or excess in eating, previous to the attack of his present disease : ardent spirits, I was assured, he never tailed ; and no beer or ale-house being nearer his habitation on Benton Moor than two miles, he says he had neither inclination nor opportunity for procuring in the intervals of labour, the common, though perhaps ncceilary indulgence of malt liquor ; and that he feldom tailed it oftener than once a week, and never drank to excess. His food, previous to, and since his indisposition, has been milk, or weak tea, and bread, in the mornings and evenings ; fresh meat for dinner four or five times in the week, with a small proportion of vegetables ; at other times fresh or felted fish, and occasionally pork; the colliers rearing hogs about their huts, in the same manner as is done by the negroes in the West Indies. The bread that the poor people use in this county, is a mixture of about equal parts of second flour and rye meal, of their own baking, and generally unleavened. Since his sickness (at the same time that he has complained of constant thirst) he has also had a keen appetite, but I did not understand that it could at any time be termed voracious. He says he could eat heartily, and more than even himself thought prudent, as his food generally after eating lay heavy on his stomach, and, in his opinion, also increased his thirst ; but he very seldom rejected his food or drink. On the first attack he felt himself languid, and unequal to his customary exercise: had a particular weakness in his knees ; pain in his loins ; unpleasant dry sensation in the mouth and face, with frequent desire for drink; and in describing the progress of his complaint to me, he dwelt much on the excessive dryness of his skin, and entire want of perspiration from the beginnings which he was induced to take particular notice of, from having been remarkably disposed to sweat previous to his illness. 

The debility, and other symptoms, obliged him to leave off work about 18 months since, and soon afterwards he put himself under the care of a Surgeon in the neighbourhood ; he also had the advice of a Physician in Newcastle. Previous to his application for medical assistance, he had not attended to the sweetness or increase of his urine, though I have no doubt but that these symptoms existed also from the beginning of his other complaints. The Physician and Surgeon whom he first consulted, pronounced his disease to be Diabetes, and put him under a course of astringents and the customary remedies. These he continued for some time, but with no permanent advantage ; he was therefore induced to discontinue all kinds of medicines for an interval of several months ; during which time his disease became gradually worse, and reduced him to a very feeble and emaciated state. 

It was at this period of the disease, and after at least 8 months continuance, that he employed Mr. Burnet, (an ingenious young practitioner of the town of Shields) on the 10th of December, and I have been obliged to take the history of the symptoms and progress, previous to that time, from the patient himself, and his friends; as I have not the pleasure of knowing either of the two gentlemen under whose care he was at first, I have therefore endeavoured to be as accurate as possible in taking the minutes of the case before Mr. Burnet, in hopes they may tend to throw some light on the cause of the disease, or elucidate any circumstances connected with its future progress. 

When Mr. Burnet first saw him, he made about 12 quarts of urine in 24 hours, (as measured by his sitter) of a straw colour and sweet taste. His appetite keen, and third exceflive, but the quantity drank during any particular period has not been hitherto ascertained. Bowels inclined to costiveness. Skin dry, and without perforation. He had oedematous swellings of his legs, and was so weak as to be scarcely able to walk across the room. Pulse about 80. Restless at night, with frequent headaches. 

He was directed to take on the 10th a grain of opium every night at bed-time ; and as I had had an opportunity previously of conversing with Mr. Burnet on the subject of Diabetes, and giving him a perusal of your publication on that subject, he readily entered into the plan of cure suggested there; which the Patient was desired to adhere to rigidly as far as concerned the regimen ; being strictly forbidden to eat any vegetable food, and to be guided in that respect by the rules you have laid down. He was, however, at the same time ordered an astringent mixture of bark and alum, of which he was to take a spoonful frequently ; and this he continued until I saw him on the 29th. During the interval from the last to the 29th of December, a quart of his urine had been evaporated on each of the following days. 

On the 12th, leaving three ounces of a thick . Saccharine extract, in smell and appearance like treacle. On the 20th, two ounces and a half of the same kind. On the 26th, two ounces ditto ; and on the 29th, one ounce and two drachms, evidently mewing a progressive degree of convalescence ; which was also confirmed by a very considerable abatement of all the symptoms; his third in particular had almost left him, and the quantity of urine was diminished to about two quarts in 24 hours. He said he had made 5| quarts the last three days and nights previous to the 29th, as measured by himself. (The extract was weighed by Mr. Burnet.) 

On the 29th, when I visited him, though heartedly declared the great advantages of the plan he was pursuing, even in so short a time, he still, however, complained of considerable debility, some pain about his loins, and dryness of skin, with a degree of 26; of restlessness and headache ; but his third and appetite were so moderate, that he found very little self-denial necessary now in abstaining from much food or drink. His mixture had griped him, and occasioned a little sickness at stomach; I therefore advised it to be omitted; and the next day he took 60 grains of the kali sulphuratum, given in 10 grain doses, He was directed to have two small blisters applied to the region of the kidneys. The opium at night to be continued, with an occasional aperient, and to wear a flannel shirt next his skin consistently. The regimen of animal food, &c. to be very rigidly adhered to, and the quantity of liquid taken, as also his urine, carefully measured, and both it and the egeila kept for inspection. 

On the 4th January, 1798 

On visiting him again, I found the blisters had not been applied, but that he had taken the kali sulphuratum as directed; his skin cool and moist; pulse 79 ; says that he perspires much in the night time, and that his sleep is less disturbed; the flushing of his face, oedematous swelling of his legs, and temporary headache, have almost entirely left him, and he is gaining strength fail. One quart of his urine had been evaporated the day before, and the quantity of extract from it was an ounce. The smell and quantity of his urine little different from natural, and the quantity of the extract much the same as on the 4th. The kali sulphuratum had been omitted ; and though he has taken but very little of any hepatic or narcotic medicines, his progress towards recovery has been very rapid since the plan commenced; and the diminution of the quantity of the residuum lingular in so short a time.

January 16th. Found him not so well as I expected, the plan of cure having been deranged, and retarded confiderably, by the unfortunate circumstance of his brother-in-law (on the 11th) losing his leg, by an accident in a coal-pit; his dependence being entirely upon him, he could not now get proper and regular diet. 

Mr. Burnet had also rather prematurely substituted a strong aromatic tincture, which I found him taking, and which might probably, with other circumstances, have tended to disorder his bowels, as he said he had a tendency to diarrhoea for some days past I proposed his taking an emetic and omitting the tinclure; but the emetic was not given him. The evaporation of his urine had also been neglected. He was much better, and the diarrhoea had ceased. The progress towards recovery is by no means so rapid as for some time prior to the 11th, though he appears to gain ground ; his skin moist; appetite and thirst moderate. One quart of his urine, on evaporation, yielded about an ounce of the extract as before. 

He was under great depression of spirits, and unhappy from considering himself an incumbrance to his brother-in-law's family. Said he thought himself sufficiently recovered to work for his bread anywhere but in the pits, and would seek employment ; and as I saw this was likely to frustrate the hopes of a complete cure, I proposed taking him into the Artillery Hospital at Tynemouth, where he could have been very well accommodated in a room with the Hospital Steward; and attested him I would maintain him, and I hoped, complete his cure, without any additional expence whatever to himself or friends. The lad himself anxiously wished to embrace the proposol, but it was otherwise opposed; and on my calling again on the 24th February, I was informed, that he had gone to work in the mine again; but after a few days trial, finding his strength inadequate, and the disease gradually returning, he went to Burtley, near Chester Street, about 18 miles from this, where he hoped to meet with easy employment; and I have not had an opportunity of seeing him since. 

I think from the great progress towards a cure, considering the time, there is no doubt but had the plan been followed up under more favourable circumstances, it would have terminated successfully. It was my Intention to have been guided entirely by the new theory of this disease, and to adhere strictly to the plan suggested by you ; but I could not get the gentleman who attended him, to abide entirely by it; and as Nixon had little assistance from medicine, the rapid progress at one time towards a cure, is therefore principally to be attributed to regimen, and the advantage of originally a good constitution. Previous to the attack of this disease, he had been a very healthy young man, without scrofula or other complaint, and accustomed always to the plainest and simplest food. The pain in the region of the kidneys ceasing soon after commencing the treatment, renders it probable they were not morbidly affected; and the sympathy or connection between the stomach and skin, in his disease, from the beginning, was remarkable.

Tynemouth 1ft July, 1798. 

ON riding past Benton yesterday, I inquired after Nixon, and found he had returned, and been employed in the colliery there as a pitman, about nine days. His strength and appearance were greatly improved. He says, the only remains of his complaint, are some degree of weakness, and lassitude, particularly after working; he also makes rather more urine than when in his former health, which in quality is apparently natural. The edematous swellings of his legs, third, and other bad symptoms, have disappeared. On the whole, I consider him a successful instance of what the regimen suggested by the new theory of the disease can effect, even with little other assistance, when the constitution is originally good, and the habits of the patient not previously vitiated.

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.

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.