John Rollo

The second case which Dr Rollo has here very minutely detailed, but into the particulars of which we cannot propose to enter, is that of a general officer in the 57th year of his age, with whom the urinary discharge amounted to ten or twelve pints in/the twenty-four hours; and, while the urine had a very sweet taste, he was at the same time subjected to the other common symptoms of diabetes. After his disease had been of at least three years Handing, and after recourse had been had to the assistance of several eminent physicians, without benefit, he came under Dr Rollo's care, in the beginning of January 1797. 

Nearly the same plan of treatment, particularly with respect to the diet of animal food, was here directed, as in the case of Captain Meredith. In a very short time, a remarkable change for the better was produced. His thirst was diminished, and his urine rarely exceeded two, three, or at the most, four pints, in twenty-four hours, being at the same time of the natural sensible quantities. In this way he continued to the end of February, gradually recovering flesh and strength. He now resolved on returning to his residence at Portsmouth. He had very great impatience under refraction. But on parting from Dr Rollo, he was told, that, for preventing the return of his disease, everything depended on himself; and he acknowledged the truth of the observation. He bore his journey very well, and arrived at Portsmouth on the 27th of February. But having eaten something improper on the road the day before, he was attacked with a bowel-complaint. On the 6th of March he had a return of his bowel-complaint, from eating beet-root. On the 9th he had the sanction of a physician to eat what he pleased, and to drink wine. The disease was soon reproduced, for his urine became sweet, and was increased in quantity, with a return of thirst and feverishness. Yet this case, Dr Rollo justly observes, adds strength to the conclusions derived from the former case. From these two cases Dr Rollo draws some general inferences. He concludes, 

1. That the diabetes mellitus is a disease of the stomach, proceeding from some morbid changes in the natural powers of digestion and allimulation. 

2. That the kidneys and other parts of the system, as the head and skin, are affected Secondarily, and generally by sympathy, as Well as by a peculiar Stimulus. 

3. That the stomach-affection consists in an increased action and secretion, with vitiation of the gastric fluid, and, probably, on too afiive a state of the ladteal absorbents. 

4. That the cure of the disease is accomplished by regimen, and medicines preventing the formation of sugar, and diminishing the increased action of the stomach. 

5. That confinement, an entire abstinence from every species of vegetable matter, a diet solely of animal food, with emetics, hepatifed ammonia, and narcotics, comprehend the principal means to be employed. 

6. That the success of the treatment in a feat measure establishes the five preceding inferences. 

7. That the saccharine matter of the disease is formed in the stomach, and chiefly from vegetable matter, as has been shown by the immediate effects produced by the abstinence from vegetable matter, and the life animal food solely. 

8. That acescency is predominant in diabetic stomachs, which continues even sometime after the entire abstinence from vegetable matter, and after the formation of sugar; and that while such acescency remains, the disposition to the disease may be supposed to continue. 

9. That the saccharine matter may be removed in three days, and, by avoiding vegetable matter, will not again be reproduced ; but we are not yet able to state accurately, when the disease, and the disposition to it, can be finally removed. 

10. That there are two circumstances to be considered in this disease, which we may separate in the progress of the treatment. As it has been shown, that though the formation of sugar was prevented,yet the increased action of the stomach remained, and maintained the defect of assimilation, which prevented nutrition. Hence two objects occur in the cure ; for it is not yet determined, whether the preventing the formation of sugar, by an entire abstinence from vegetable matter, and the use of animal food, with fats, if properly persevered in, might not ultimately comprehend the other, namely, the removal of the morbid action of the stomach. 

11.  That the lungs and skin have no connection with the production of the disease. 

12. That the quantity of urine is probably in proportion to the quantity of fluids taken in, and has but little dependence on absorption of fluids, from the surface of either skin or lungs. 

13. That though the disease has been shown to consist in an increased morbid action of the stomach, and probably too great a secretion, with vitiation of the gastric fluid ; yet the peculiar specific condition of either, as forming the disease, is acknowledged to lie in obscurity, and must remain so till the physiology of healthful digestion be properly explained and established. 

14. That the first case had only been of about seven or eight months duration when the treatment commenced ; but the Second case had been upwards of three years continuance. The age of the one thirty-four; of the other, fifty-seven ; circumstances which constituted material differences, though they seemed not to create corresponding difficulties in the treatment, so far as the direct removal of the complaint was concerned. They may however retard, in the one instance, the entire restoration of health. 

15. That, in both cases, deviations occurred in the management, and were respecttively followed by reproductions of the disease, and, though disadvantageous to the patients, have confirmed our views of its nature and treatment. 

16. And, lastly, That from both cases we may warrant this general conclusion, that the diabetes mellitus is so far understood as to be successfully cured. 

To these histories and observations, Dr Rollo has subjoined some remarks respecting the diabetes mellitus, which have been communicated to him by different correspondents, since the dispersion of his notes on the case of Captain Meredith. With regard to the causes of the disease, he observes, that from Dr Falconer's letter it appears, that one case was produced by excessive indulgence diligence in spruce-beer; that in one patient of Dr Cleghorn's, the disease seemed to have arisen from hard work when recovering from a fever, and in another from his being much addicted to the use of large quantities of sugar; and that the patient Whose case is related by Dr Gerard, had been subject to pyrosis, and an excessive discharge under the form of perspiration, previous to the attack of diabetes. With regard to the nature of the disease, Dr Rollo observes, that the appearances found by Dr Baillie, on direction, an account of which will probably soon be published, may have been sequelae of the disease. Mr Abernethy, he remarks, found the serum of the blood in diabetes to be turbid ; and observed, that sugar taken into the stomach increased the saccharine matter in the urine. With regard to the treatment, Dr Rollo informs us, that in one case of diabetes mellitus, Dr Duncan found fat meats serviceable; that Dr Falconer recommends mephitic alkaline water; that Dr Beddoes Mentions a case where Bristol water cured the disease ; but that Dr Currie, who has seen several cases of the disease, never saw one of these cured in which the urine was sweet.

The case of James Walker, treated in the Royal Infirmary of Edinburgh, by Dr Hope, shows, according to Dr Rollo, the good effects of animal food. The treatment in this manner was begun on the 29th of December, when the daily quantity of clear urine of a sweet taste amounted to thirteen pounds. On the 31ft of the month, two days only after the commencement of this treatment, the quantity of urine was reduced to five pounds, and it had acquired a strong urinous smell. The two cases treated at Glasgow, by Dr Cleghorn, show also the good effects of a diet consisting entirely of animal food ; and prove also the influence of commotion in the bowels on the quantity of urine. But the most striking case, Dr Rollo observes, is that related by Dr Gerard of Liverpool, from which it appears, that in diabetes there is no absorption of fluids by the skin, and that animal food alone, if duly persevered in, may cure the disease, though such perseverance be only of a very limited duration. Dr Rollo concludes his remarks on diabetes, by observing, that hepatifed ammonia appeared to him to be a very powerful medicine. But it must, he tells us, be prepared according to Mr Cruickfhanks's method. The ammonia must be pure, and completely saturated with the hepatic gas. To produce its narcotic effects, full and sudden doses of it must be given ; but these require judgement, and an acquaintance with the exhibition of the medicine. It should not be mixed up in-draughts, or in any other form, as it is readily decomposed; but it should be dropt from the P^ial, at the time of using it, into a proper Vehicle, and taken immediately. Distilled water is, he thinks, the best vehicle.

The Diabetes Mellitus, though sometimes terminating in recovery, is yet well known to be a disease which has in general refilled every remedy hitherto recommended for its removal. Every attempt, therefore, to improve the practice in that affection, may justly be considered as deserving particular attention. The ingenious author of the work now before us, recommends a mode of treatment, which, in some instances, has been decidedly productive of remarkable benefit. It may justly, therefore, be considered as well meriting a fair trial in future cafes. 

The first cafe here related, is that of Captain Meredith, of the Royal Artillery. When he came under Dr Rollo's care, on the 16th of October 1796, he voided about twelve quarts of urine in twenty-four hours. This urine, seven quart-bottles of which he had preserved, having been voided during the course of the night, was of a light straw colour, had no urinous smell, but emitted somewhat of a violent flavour, and was very sweet to the taste. He was affected with 1 excessive thirst, and had drank, during the day, feven or eight quarts. His tongue was somewhat whitish, but moist: there was a cleanness in his mouth, and he spat a white frothy saliva, of a sweetish taste. His appetite for food was variable, sometimes unusually keen, particularly at uncommon times, as during the night. His face was fulfilled, his skin dry, but not unusually warm, and his pulse did not exceed eighty-four strokes in the minute. He was frequently sick, and threw up a viscid matter, of a bitterish taste, but with some sweetness. After eating, he complained of a pain of his stomach, which in general continued about half an hour. He complained of a constant pain in the region of the kidneys, extending forwards, but more particularly in the right, in which there seemed to be a greater fullness and tenderness to the touch. There was likewife a retraction of the testicle, with a weakness, sense of coldness, and at night an (Edematous swelling of the leg on the same side. He also complained of a pain and tenderness of the great toe. He felt also a lingular fluttering fenfation in his belly, extending from the fituation of the kidneys. He was regular in his bowels, though sometimes inclined to costiveness. His stools were of a greenish colour, and had no unpleasant smell. The prepuce of the penis did not retract. It had a whitish appearance, with excoriation and soreness, but was not swelled. His gums were reddish, and had the appearance as if affected by mercury. The teeth felt to him loose. There was a fullness about the eyes, with a turbid yellowish cast, and, he had slight occasional headaches. He had not been particularly restricted in diet, which consisted of animal food and vegetables; and he drank from a pint to a bottle of port wine daily. His other drink was toast-water. He used exercise, both in the way of riding and walking; but he could not walk above two miles without much fatigue. At this time thirty-six ounces, Troy weight, of his urine, analyzed by Mr Cruickshank, yielded by evaporation three ounces and one dram of saccharine extract, of the appearance of molasses, but thicker. According to this proportion, his whole urine for a day, would have yielded twentynine ounces Troy weight; an astonishing quantity to be separated daily from the system. Treating some of this extract with the nitrous acid, Mr Cruickshank procured the saccharine or oxalic acid. With a smaller proportion of the acid, it produced a substance which, in appearance, taste, and smell, could not be distinguished from honey. Two portions of blood, about four ounces each, were taken from his arm. These in appearance exactly resembles what is described by Dr Dobson, excepting that the serum did not impart a sensibly sweet taste. The crassamentum of the first cup had a slight buffy coat ; the craffamentum of the fecond had more. The buffy coat in both was of a bluish colour, similar to "what mercury sometimes produces. A portion of blood from a healthy person, drawn on the same day, was placed in the same room, and in the same circumstances with one of the portions of diabetic blood. In two days the diabetic blood assumed a caseous appearance on the surface, and the whole mass became dry and resinous, without having undergone any apparent putrefactive process. At the end of sixteen days, it remained in the same state; whereas the healthy blood exhibited evident marks of great putrefaction in four days ; and it became necessary to throw it away on the seventh.

When this patient came under Dr Rollo's care, his disease had been of seven months standing. During that time he had taken some remedies, under the direction of an eminent physician at Yarmouth, the principal of which were Peruvian bark and alum. He had fallen away very considerably in flesh and fat; for, in October 1794, when in apparent health, he weighed sixteen stones and eight pounds; and in November 1796, he weighed only eleven stones and eight pounds, showing a loss by the disease of no less than five stones in weight. For six months preceding the attack of the diabetes, he was often sick, and vomited at least two or three times a-week ; and he frequently brought up from the stomach, during these vomitings, different things which he had eaten several days before. These seemed to be unaltered, and the taste was very generally four. He always ate heartily, and drank freely, but not intemperately. He was fond of high-seafoned and fat dishes. He had been subjected to two regular attacks of gout, and had at other times two severe fits of cholic. He had been twice married, and had two children. He was, in the thirty-fourth year of his age, five feet eleven inches high, of a fair complexion, with light-brown hair, and dark-blue eyes. From an attentive consideration of all the circumstances of this case, what appeared to Dr Rollo to be the principal objects of treatment, were, to destroy the saccharine process going on in the stomach, to promote a healthy assimilation, to prevent the supposed increase of absorption from the surface, to diminish the increased action, and to change the imagined derangement of the kidneys. With these intentions the following plan of treatment was resolved upon.

1. His diet to confift principally of animal food; for breakfast, a pint and a half of milk mixed with half a pint of lime water, bread and butter; at noon, plain pudding, made of blood and fuet only; at dinner, game, and old meats which have been long kept, and, as far as the stomach may bear, fat and rancid old meats, as pork, taking care always to eat in moderation; for supper, the same as breakfast.

2. For drink, he was allowed daily four quarts of water which had been boiled, and in which was dissolved a dram of the kali sulphuratum. He was strictly forbid to use any other article, excepting these, either in the way of meat or drink.

3. His skin to be anointed with hogs lard every morning. Flannel to be worn next the skin, and the gentle exercise only to permitted, but confinement to be preferred.

4. A draught to be taken at bed-time, confifting of twenty-five drops of tartarised antimonial wine, and twenty-five of tincture of opium and the quantities to be gradually increased.

5. An ulceration, about the size of half a crown, was directed to be produced, and maintained externally, immediately opposite to each kidney. And, lastly, his bowels were to be kept regularly open, by a pill of equal parts of aloes and soap.

This treatment was begun on the 19th of October, and, so soon as the 21ft, some changes occurred. He made, in twenty four hours, only six quarts of urine, and drank only three quarts of the sulphurated alkaline water. The urine was not so pale, had a cloud in it, and was more urinous in smell. 

On the 1ft of November the urine did not exceed four quarts, while it was of a higher colour, and more urinous smell. His skin was moist and he perspired freely; his stools were large, and very offensive, and he was in every respect much easier, though he complained of much pain from the ulcerated parts of the loins. Imagining that the quantity of alkaline salt, which he took daily in the kali sulphuratum, might have some improper effect on the kidneys, it was resolved to try hepatifed ammonia, on the suggestion of Mr Cruickshank, who was of opinion, that it might prove a more certain and active medicine in diminishing the action of the stomach, as well as the action of the system m general. He was therefore directed to take five drops of it, in each half-pint tumbler full of water, which he used as drink. The ill day he took thirty-five drops at different times, which in the evening, produced sickness and vomiting, with giddiness and drowsiness. He was therefore diredled to leave off the hepatifed ammonia for one day, and then to begin with two drops to each tumbler full of water. On the fourth, he drank only two pints of water, and made only two quarts of urine, which was not sweet, and deposited a red sandy, or lateritious sediment. 

On the 5th of November, the opiate at bedtime was discontinued ; and on the 8th the rubbing with the hogs lard was left off. Between the 4th and 14th of November, in consequence of some irregularities on the part of the patient, particularly drinking beer and tea, the disease was to a flight degree reproduced. 

On the 14th, therefore, an entire abstinence from vegetable matter was directed; nothing was allowed approaching nearer to it than milk; and even this was directed to be left off, and strong beef-tea substituted, should the disease not disappear. This soon produced a favourable change, his urine became again of a much Higher colour, and its smell and taste quite urinous. He afterwards continued for some time with tolerable regularity on the course already mentioned, and by the 18th of December his disease seemed to be in a great measure overcome; he was therefore desired to eat half a pound of bread as a daily allowance, and to take exercise more freely. 

On the 30th of December, Dr Rollo found that since the 18th he had continued free from the disease. He was now in high spirits, and rapidly gaining flesh. His urine did not exceed two pints in the twenty-four hours. It was often under that quantity, and perfectly urinous. He now weighed thirteen stones and one pound; so that he had gained about alone and a half lince the end of November; which furnished a convincing proof, not only of the removal of the disease, but also of the disposition to it. 

After this period, Captain Meredith might be considered as continuing free from complaints. He took exercise freely, both in the way of walking and riding. He ate a sufficient proportion of bread, potatoes, and other vegetables, without any inconvenience- His appetite was good and natural, and his bowels regularly open. His urine continued perfectly natural, and, in general," did not exceed a quart in twenty-four hours. Of this urine, which was of the ordinary taste and smell, nine ounces were evaporated, -and yielded of a brown and pungently saline bitterish-tasted matter, without tenacity, three drams and twenty grains, a product excessively different from the saccharine extract resembling molasses, which his urine yielded in October. The product now obtained was very nearly the fame, both in quantity and quality, as Dr Rollo obtained from his own urine, which, he had every reason to believe, was in the healthy state. About the middle of March, Captain Meredith continuing in a state of health, was ordered on active service; to which he very readily assented, being satisfied that his health now enabled him to execute the duties of his station.

EXCLUSIVE of the cases of the Diabetes Mellitus, which have been published in this Work, we have heard of several others, particularly of one in Guy's Hospital, but we remain unacquainted with all the circumstances. Doctor Odier, of Geneva, mentions a cafe in the Bibliotheque Britannique, vol. vii. p. 321, and vol. viii. -p. 168. Doctor Wilmot, at Hawkehurft, in Kent, has also had a case under his charge ; and Doctor Yeats, at Bedford, informs us of a patient he has successfully treated by the animal food; but as he intends to communicate an account of it, we defer any detail. Doctor Beddoes has very lately mentioned to us four cases of the disease, one of which has been cured by the diet alone. He observes, “that in one case, he endeavoured to please the palate by recommending occasionally articles of food, as nearly resembling dishes made of the farinacea as possible. Tripe, fried in a certain way resembles pancake. Buttered eggs offered an agreeable variety. He also advised a method of trying to reduce dried fish and flesh into a kind of flour. These culinary considerations are extremely important; and he has no doubt a diet might be contrived under which patients would feel little privation." We have likewise received indistinct accounts of four cases of the disease in London and its neighbourhood. There is, besides, one which Doctor Marcet has visited. In order, therefore, to show the necessity of attending to this peculiar disease, which has been hitherto deemed uniformly fatal, we shall recapitulate the number of cases we have either seen or heard of since the dispersion of the notes of Captain Meredith's cafe in January 1797-

• Captain Meredith's Cafe — Page 17:    1

• General Officer's do. — Page 63:           1

• Cafes in Chap. II. Sect. I. — Page 142: 10 and upwards

• Cases in Chap. II. Sect. II. Page 237:     23

• this Appendix:                                                 13

• Total:                                                                    48 and upwards

Along with this number may be examined the account of cases given in the third Chapter, p. 356, being those described previous to that of Captain Meredith. From the whole it will appear, that the disease occurs more frequently than has been generally supposed; and of course, its discussion claims the attention of the medical enquirer. It also is entitled to it in another point of view, as tending to illustrate many other complaints depending on a morbid affection of the stomach, and constituting the most troublesome of our chronic diseases.

W. Rhubarb was given, by Doctor Wittman, to a patient for four days; a portion of blood was then taken from the arm, and the serum was, as well as the urine, evidently tinged with its yellow

colour, staining linen.

(Rhubard is high in oxalates)

SECT. III

Of the appropriate Treatment of the Diabetes Mellitus.

THE principles of the treatment, as established by our cases of the disease, by the view we have given of the proximate cause, and we may further add, by the general success, consist;

1. In the prevention of the formation or evolution of the saccharine matter in the stomach.

2. In the removal of the morbidly increased action of the stomach and in its restoration to a healthful condition. 

Whatever may be the cause of the formation of the saccharine matter, it is necessary to prevent it, as on its general stimulus in the system, and particularly on the kidneys, very general affections are maintained. Besides, the means employed to prevent such formation may tend to the removal of the morbid action of the stomach and lacteal absorbents, and the increased and altered state of the gastric fluid, on which its production probably depends. Animal food, and confinement, with an entire abstinence from every kind of vegetable matter, afford the general means ; but which may be facilitated by the daily use of alkalines, calcareous and testaceous substances. The quantity of animal food should be restricted, and given in as small quantities as possible to satisfy the stomach : see page 54. 

When the urine points out the absence of the saccharine matter, and at the same time its quantity continues more than natural, containing likewise more of the extractive matter in a viscid, or tenacious form, while the appetite remains keen, it may be presumed that the increased morbid action of the stomach is not removed. It becomes then necessary to exhibit the hepatifed ammonia, with an opiate and antimonial at night, and to continue them until the morbid condition of the stomach is removed; the marks of which are, a scarcity and high coloured state of the urine, with turbidness, furnishing on evaporation an offensively smelling and saltish tasted residuum, without tenacity, accompanied with a want of appetite and loathing of food. At this time the tongue and gums will be found to have lost their florid colour, and to have become pallid. 

When such a state occurs, exercise is to be enjoined, a gradual return to the use of bread, and those vegetables and drinks which are the least likely to furnish saccharine matter, or to become acid in the stomach, with the occasional use of bitters, &c. Should this period of the disease be overlooked, and the confinement and animal food rigidly persevered in, scurvy, or something akin to it, might be produced. That such might be the termination of Diabetes, the appearances which arose, more especially in Captain Meredith's case, render extremely probable. The gripings, and offensive stools; the oiliness on the surface, and the high colour of the urine; the foetid breath and saltish taste; the great latitude and heaviness, with indifference to either eating, drinking, or moving; were strong marks of a state approaching to scurvy.

When the disease has continued long, it may leave local effects, which may prevent the entire restoration of health ; the most ample form of which might be supposed to consist in mere dilatation, or enlarged capacity of vessels, as those of the kidneys; or in a habit acquired by long continued action. Our first case shows, that these, when the disease has not been of very long duration, may be soon removed. They may, however, prove one of the circumstances retarding recovery in such a length of disease as that of our second case ; but even in this, the kidneys very early partook of apparently their ordinary action. Dissection has shown some morbid condition or derangement of the mesenteric or lacteal absorbent glands, and some altered appearance of the kidneys. There may also arise some derangement of stomach structure, of pancreas, spleen, liver, and possibly of lungs. Such sequelae would probably be sooner and more certainly formed in scrofulous habits. Whenever they occur, recovery must be retarded, if not finally prevented. They, however, will not interfere with the actual removal of the diabetic disease. We suspected some affection of the mesenteric glands, and of the stomach, in our second case; but we are warranted in alleging, that want of steadiness in the patient solely prevented the complete removal of the complaint. The nature of its sequelae, or whether they will remain, so as to maintain a state of chronic disease depending on them for its cause, requires still to be determined. Of this determination we must now continue entirely ignorant, as the patient from unsteadiness died, and was not examined after death. 

These are the general means of treatment, and they will be found adequate to the most common circumstances of the disease. We think it, however, necessary to particularise certain cases and states of the complaint. The former, are those of short, or long continuance, acute or chronic in degree; the latter comprehend the progress and fleps of recovery. It is necessary to attend to these distinctions, as they must direct the remedies and regimen to be employed. 

When the disease has been of short duration, an entire use of the animal diet may be immediately pursued, with an abstraction of all vegetable food and fermented drink which may have been formerly taken. In this state of the disease it may be acute arid then the diet should be spare; blood-letting and blistering may be necessary, with the use of opening and diaphoretic medicines. But when the disease has been of long continuance, especially in persons advanced in years, and whose habits have been luxurious in point of living, it may be proper to regulate the plan of cure by gradually adopting the animal diet: see the case of the Gentleman of 77 Page 179 and Dr. Stoker's continuation, page 253. 

On the removal of the general symptoms, and the return of the urine to a natural condition, which may be ascertained by a comparative examination with the healthy standard of it, as described by Mr. Cruickshank, vegetable substances may be cautiously tried. In the selection of which, the preference should be given to those least likely to furnish sugar, or excite disturbance in the stomach. The urine should now be very frequently examined, and on any appearance of a return of the diabetic state of it, the animal diet must be again strictly renewed. In this way the diet must be varied, until we are certain not only of the removal of the disease, but of the disposition to it. In the prosecution of the plan much steadiness and perseverance are required. We have to lament, that our mode of cure is so contrary to the inclinations of the sick. Though perfectly aware of the efficacy of the regimen, and the impropriety of deviations, yet they commonly trespass, concealing what they feel as a transgression on themselves. They express a regret, that a medicine could not be discovered, however nauseous, or distasteful, which would superfede the necessity of any restriction in diet. 

The vegetable substances we have hitherto found the safest, in the change from the animal diet, are, broccoli, spinach, cauliflower, cabbage, and lettuce. These do not seem to furnish sugar when prudently used in the diabetic stomach, after a proper adoption of the animal diet ; but under certain circumstances they have been supposed to produce an acid urine : see the Cases of Mess. Houston and Thomas. When these vegetables have been safely taken, a return to a very small quantity of bread has reproduced the saccharine matter in the urine, and the general symptoms of distress, as thirst, &c. It becomes, therefore, a principal object in the treatment, to vary the articles of diet, so as to gratify the earned desire of the patient, without bringing on a return of the complaint.

Page 345

Some Remarks on These Communications.

THESE communications are of great importance in the further elucidation of the history, nature, and treatment of the Diabetes Mellitus; and they will probably supersede any more cases in detail. A concise account, however, of such as are attended with new circumstances, and which have terminated, either successfully or fatally, with diffections, must still be required. The continuation of Walker's case, as described by Doctor de la Rive, shows the same unsteadiness, and inefficacy of any other means than the animal diet, and likewise that his patient, by more perseverance, might have obtained a perfect cure.

Doctor Gerard's first case points out a corresponding effect in the female as in the male, by the irritating stimulus of the saccharine matter in the extremity of the urethra ; it also exhibits the effect of vomiting in diminishing the quantity of the urine ; and alludes to some advantage having been obtained from the carbonate of ammonia. 

The second case marks a dropsy previous to the diabetic accession; also the same affection of the urethra as the other; and the patient having more resolution in complying with the means of cure, was likely to obtain a restoration of health. Both show the propensity to deviate from a rigid observance of the animal diet, and the conviction that it is efficacious when strictly pursued. 

Doctor Cleghorn's continuation of the cases of Roger and Maclean, afford additional satisfaction, but more particularly that of the latter. This man died evidently under the effects of a lung disease, during which the Diabetes had not returned. From the appearance of the lungs on dissection, it was supposed that they had been affected previously to the diabetic attack; or, at least, that they were dissused to inflammation, on getting cold, while in the infirmary with the disease. Dissection, while it exhibited no morbid derangement of the kidneys, neither did it of other parts. It is said, the kidneys, though found, were more flaccid than usual, and that the bowels were very pale.

He gives also a concise account of four other cases of the Diabetes Mellitus, treated in the Glasgow Infirmary. The first-of whom was a man who caught cold under mercury, to which the patient described his disease: he got completely well by the animal diet. The insensibility of his stomach to emetic medicines is attributed to an original peculiarity of constitution, which had no connection with the Diabetes. 

The remaining three patients were women, one of whom had the disease while giving suck, which obliged her to wean her child. Had this patient been admitted during her nurfing, it might have been ascertained whether the milk contained more than the usual proportion of saccharine matter. The other two cases show only the efficacy of the animal food. There is a fifth mentioned as being under the treatment, with equal hopes of success. 

The Doctor takes notice of a singular disease among horses, which had some general resemblance to the Diabetes in the human subject:. The urine of one of them was hastily examined, and it was found sour. 

In his letter of the first of July, he gives an account of an acute disease, which attacked one of the diabetic patients, after her dismissal from the infirmary, terminating fatally. The dissection showed inflammation of the bowels ; it also exhibited the kidneys as being enlarged, uncommonly soft, and pale. From this case, and that of Maclean the Doctor supposes, that animal food, when so rigidly persevered in, strongly disposes to inflammatory affections.

(explained at end by Dr. Rollo)

Doctor Storer had met with seven distinct cases of the disease, and he avers with Doctor Currie, that after it had been completely formed, he had never seen it cured by the former methods of practice. He gives a satisfactory account of Doctor Aldrich's case, the Gentleman of 77 years of age ; which shows the effects of our plan of treatment in a very favourable and impartial point of view. He joins in the common regret, that the great desire for variety of aliment, forms a strong bar to the successful application of a diet confining entirely of animal food. He describes a case where Bulimia preceded as well as accompanied the diabetic disease. The account of a mild or chronic species of it, as prevailing in families is important. In this form it is said to be occasionally suspended, and the patient may live to a tolerable age. It does not seem, so far as the Doctor's observation has gone, to depend on any constitutional disposition ; neither does he determine whether this constitutes a difference in the nature, or merely in the degree of the disease. https://www.carniway.nyc/history/animal-food-may-alone-cure-the-disease

https://www.carniway.nyc/history/doctor-aldridge-uses-carnivore-to-cure-diabetes

Doctor Jameson's case of Nixon exhibits a distinct history of the disease, which had been of eighteen months standing. The animal food reduced the saccharine and extractive matter from three ounces, which had been obtained from a quart of the urine to one ounce and two drachma in the short space of 19 days. On the whole, it furnishes an instance of the efficacy of our plan of cure.

Mr. Shirreff's attentive observation has rendered his diabetic case interesting. The subject of it is of an earlier age than that in which the disease commonly appears ; a stomach affection evidently preceded it, during which she eat freely of fruits and sweetmeats. It would seem, that the urine undergoes manifest changes, at different hours after eating, which is more remarkable, according to the substances eaten. In this case, after partaking of vegetable matter, it was found clear, and sweet ; the next portion higher coloured, and insipid ; and when the interval was long, as in the night, the urine was more natural. This is an important fact: in support of the opinion, that the saccharine matter is evolved during the process of digestion.

Mr. Houston's patient shows also, a long continued stomach affection, previous to the detection of the Diabetes, during which she likewise indulged in the liberal use of fruit : but in this case the mind was particularly concerned, being under the influence of the depressing passions. The circumstance of the acid urine is singularly curious ; but it remains to be further ascertained.

Doctor Cleghorn, it may be remembered has mentioned that he found the urine sour, in the case of the horse disease.

Dr. Pearson's three cases, with the ingenious remarks accompanying them, are valuable. The first, shows the same infeasibility to emetics, as in one of the cases related by Doctor Cleghorn. The direction exhibited no morbid appearance, or even any change of the kidneys, or any other part, except in the myfentery and bladder, which were found thickened. The urine contained in the latter was not sweet. This case is peculiarly important to us, from the detection having shown no change whatever, in the natural appearance of the kidneys; a fact strongly supporting our doctrines. The second gives a very distinct account of the disease, which was treated in the best manner, by the remedies usually employed at that time; but without relief. The third contains facts and arguments, in opposition to the theory of the disease, as depending on a primary affection of the kidneys, which must have their weight. The opinion, with regard to the effects of animal and vegetable food, in the formation of saccharine matter, differs from that we entertain. It is an incontrovertible fact, that animal food solely used, deprives the urine of every portion of saccharine matter, so completely, as not to be discoverable by any chemical process, nor by fermentation. See Doctor Gerard's case, page 215.

The experiments of Mr. Cruikshank not only show the difference between what may be termed animal and vegetable sugar; but that the sugar in diabetic urine is very probably the entire product of vegetable substances. There are also some other points in which we cannot perfectly agree ; but these will appear from our general account of the disease.

Doctor Marshal's case is valuable. The appearances on dissection show the state of the kidneys, which has been frequently met with in this disease : but the peculiar condition of the stomach and blood have not been hitherto found, at least not described. The stomach exhibited marks of disease ; and as the villous coat was of a red colour, an increased action of its vessels having happened was apparent. The peculiar smell of the blood, pointed out a great deviation from the natural state ; but it is to be regretted that it had not been more particularly examined. The circumstance of the unmixed chyle is singular. The whole, we apprehend, justifies this conclusion that more morbid changes in the organic powers of assimilation, than of any others in the body, were manifested ; of course, we deem it a fact strongly in favour of our doctrines of the disease.

Doctor Willan's case exhibits a very successful adoption of the animal food, without the use of any other remedy. The disease had been probably of twelve months duration, and was attended with nearly its worst symptoms. In eight days the urine was reduced from 12 to 2.125 pints in the 24 hours ; and in 14 days more, it was probably deprived of the unnatural proportion of extractive, as well as saccharine matter. In five weeks, the recovery seemed to be far advanced. If the same steadiness of conduct, in adhering to the dietetic treatment, continues, there is every reason to expect a perfect restoration of health ; and it will furnish an additional fact, in support of our opinions of the nature and treatment of the disease. 

Mr. Thomas's case, from the minuteness, accuracy, and result of the direction, throws considerable light on the nature of the Diabetes Mellitus, and affords another remarkable fact in favour of our ideas on the subject. The apparent natural condition of the abdominal viscera, demonstrated that the disease did not depend on the derangement of the structure of any organ. The morbid changes which may have been found in other dissections, must have arisen from the long continued morbid action upon particular parts, forwarded, probably, in some instances, by a favourable pre-disposition, especially that connected with scrofula. The circumstance of three brothers having the disease, thews some pre-disposition, which may be hereditary. The effects of various vegetable substances on the urine will improve the practice. The observation that the urine had been voided in an acid date, corresponds with what has been mentioned in Mr. Houston's case, and by Doctor Cleghorn. This, with several other cases, shows the pre-disposition in diabetic patients to inflammatory diseases. The failure of tonic and astringent remedies, with the effects of vegetable food, and the successful administration of opposite means, confirm the opinion that this peculiar disease is accompanied with a state of constitution very different from that in scurvy. In this case, the patient had an attack of pleurisy, in the month of March preceding that of July, which proved fatal. As active diseases of this nature have been found to suspend the Diabetes Mellitus, the intervening circumstances which occurred in it, between the two attacks of the pleurisy, might somewhat have depended on the sequel of the first, as it was the opinion of Mr. Thomas, part of the diseased appearance of the right lung, with the effusion in the chest, was the effect of that attack.

From Mr. Leigh Thomas, Surgeon, Leicester Square, London.

History

 I HAVE this morning (August 28, 1797) met with a confirmed cafe of Diabetes Mellitus ; and, as I consider it a favourable one for a trial of the ingenious mode of treatment you have pointed out for the cure of this disease, I shall be happy either to give it up to your entire management, or co-operate in any plan that may be suggested between us. The subject is a very industrious man, aged 38, by trade a watchmaker, much confined to business, and anxiously labouring for the support of a numerous family.

He is much emaciated, and loses strength and weight daily. He showed me a letter from a brother of his, living in Kent, who also complains of pain in the back, and great debility, with an occasional discharge of sweet urine, especially after any fatigue of body, or distress of mind. It appears that three brothers of this family laboured under the disease, but it could not be traced to either of the parents.

Treatment.

Doctor Rollo having seen the patient, and favoured me with directions how to proceed, he very readily agreed to adhere to any rules laid down for his recovery.

Sept. 2, 1797, he commenced eating animal food, and took six or eight drops of hepatifed ammonia thrice a day, with castor oil occasionally; his common beverage was water and beef tea. After pursuing this plan for days, the urine had entirely lost the sweet taste, and was greatly reduced in quantity ; by the 18th he had lost the pain in the stomach, and the appetite became more moderate. 

The quantity of urine was now reduced to one pint and a half; he felt very weak ; had a violent longing for vegetable food, particularly bread. I could not resist his solicitations, especially as I had a faint hope that the disease was conquered ; I therefore allowed him a small French roll, with a glass of port wine. The urine made that night was highly impregnated with saccharine matter, and increased to the quantity of five pints. The following day, he again indulged a second time with bread and also porter, and so continued to deviate till the beginning of November, sometimes taking three pints of porter daily. In this interval, I ordered him the cinchona and sulphuric acid. His strength was improved, yet he lost weight. The gnawing pain at the stomach had returned, and also the itching and excoriation of the prepuce, the urine very sweet, and had increased to ten pints. The disease being reproduced, and its effects so considerably increased, the patient promised to be more resolute in future. 

Nov. 20th, the animal food was again returned, and, I believe, faithfully adhered to until the middle of February ; the hepatifed ammonia was laid aside ; and milk was torbid, as I had strong reason to believe that it frequently produced sweet urine in the former trial. His strength, at the end of this period, was greatly reduced; the gums spongy, with frequent bleedings, a foetid breath, and a rigidity of the muscles of the lower extremities. The urine had decreased to three pints, not at all sweet, was of a brown colour, and loaded with putrescent mucilage ; in taste exceedingly salt, and much more pungent than urine in a natural state. The appetite was so completely destroyed, that the sight of animal food excited nausea, but, at the same time, there was a longing delire for vegetables and beer. His weight during this time varied something. In November he weighed more than nine stone ; in January, eight and a half; before the end of the course, he regained nine stone. 

The excoriation of the prepuce had gone off, but the natural propensities never returned ; the skin became moist, the clamminess of the fauces had disappeared. A great number of boils came out in different parts, which were exceedingly painful ; some few advanced to suppuration, but never afforded true pus. Every diabetic symptom having left him, and his present state being so very distressing, induced me to allow him a small proportion of vegetable food. As we had experienced the ill effects of bread in the former trial, I directed him to eat sparingly of potatoes, and drink weak brandy and water; he drank, also the alum whey. In two days after this, the sweet urine reappeared, and all the other symptoms soon returned. He never after this adhered to any regular plan, only taking vegetable food very sparingly.

About the middle of March, he had a severe attack of pleurisy, which required two bleedings, and other evacuations, to remove it. In April he passed some time in the country, twenty miles from town, where he constantly eat vegetables, and drank large quantities of mild ale; during this time, the urine was sweet only at times. Under these circumstances, he gained four pounds weight in nine days. After his return to town, his strength daily decreased ; the boils frequently appearing, obliged him to lie almost constantly in bed. During the latter part of this period, the urine was very frequently perfectly sour, and that immediately upon passing off, so as to leave no doubt of its being so in the bladder ; the taste and smell very similar to sour whey, but perfectly transparent ; at this time, it was always small in quantity. In the beginning of July, he had another attack of pleurisy, which terminated his sufferings on the morning of the l6th. (He died)

As I have merely given a summary account of the progress of the case, I shall, in like manner, relate the effects of certain vegetables upon the disease, and which came under my own observation, Bread certainly holds the first rank in exciting the formation of saccharine matter ; nor did this appear to depend upon the fermentation it had undergone, as the sea-biscuit, or a teaspoonful of flour in melted Butter, universally produced the same effect ; potatoes flood next ; onions, leeks, radishes, and turnips, also produced much sugar. Preparation by boiling, or otherwise, did not seem to increase or diminish their effects. Spinach, carrots, peas, broccoli, and cauliflower, had each less effect than the former, particularly the two last; parsnips were eaten with impunity. The urine never tasted sweet after taking them ; at first, the urine had a sourish taste and smell, which I attributed to them, but since, it has been perfectly sour, without being able to account for it. Every kind of fruit invariably produced sweet urine, without being able to ascertain any variation in their effects. Of Liquids, porter appeared the most hurtful ; no difference could be observed with regard to the effect of any of the spirituous liquors, wines, or cider; mild ale he considered as having no effect in producing the disease, but of this I can say nothing of my own knowledge, as he only drank it in the country. He was bled five times in the course of the treatment, purposely to examine the blood; in one instance only had the serum a turbid wheyich appearance ; the slightest taste could not at any time discover anything of a saccharine quality. Upon allowing the blood to evaporate in the open air, no putrefaction took place, it became a solid brittle mafs, of a mining appearance when broken. Dissection Twenty-four hours after death, under the directions of Mr. Cruikshank I proceeded to make a careful examination of the viscera.

From Doctor Willan, London.

August 6th, 1798. 

A Gentleman about 25 years of age, tall and thin, has been engaged in a fatiguing, though sedentary occupation, but always conducted himself with sobriety and regularity. For more than a year past he had found his health and strength gradually declining ; he became pale, emaciated, and skeletal; his hands and feet were unusually dry and hot; he had sometimes a trifling cough, and was affected with a great shortness of breathing, on going up stairs, or any ascent. 

The case being deemed consumptive, he had been recommended to confine himself to a vegetable diet, and to spend as much time as possible in the country. This plan, however, was not attended with any tangible benefit: on the contrary, the wasting and general debility seemed to be daily increasing under it. 

I did not see this young Gentleman till the middle of May last. In addition to the symptoms above mentioned, he then complained of a clamminess in the mouth, a parched tongue, and an unquenchable thirst. His pulse was from 76 to 86, weak, and unequal. He was in general very costive. From these circumstances, I was induced to examine the state of the urinary secretion, before anything was administered to him medicinally.

The result of the first trial was as follows. He took in 24 hours 11 pints of fluid, consisting of milk, or milk and water, with two slices of toasted bread, and within the same time made 12 pints of urine, a portion of which was evaporated by Mr. Moore, of Apothecaries Hall; the result will be subjoined. The urine was of the highest straw colour, had a faint disagreeable smell, and was sweetish to the taste. His breath had, at this time, an unpleasant acidulous smell, nearly the same as that produced by the effluvia of decaying apples. He observed to me, that for several days past he had felt a pain in the head, and a stiffness, or drawing in of the eyes, with imperfect vision, the letters appearing double whenever he attempted to read or write. 

A total change of diet seemed the only means of preserving this worthy young man from almost immediate dissolution. He commenced the plan without hesitation, abstaining wholly from bread, or other vegetable substances, and from all fermented liquors. For breakfast he took milk, with yolk of egg; for dinner, occasionally fish, but, in general, beef or mutton which had been long kept, sometimes a little ham; for supper, a poached egg, or calve's foot jelly, prepared without wine or acid. 

On the eighth clay of this course, a second examination was made of the state of the urine, which amounted only to 2 pints in 24 hours, 3 pints of milk, or tnxlk and water, having been drank within the same time. The urine was more high coloured than before, but had not wholly lost its faint smell. A third trial of the same kind was made on the 10th of June. He drank 3 pints of fluid, and made exactly the same quantity of water. It must, however, be remarked, that the day was extremely chilly, and that he did not ride out, nor take any exercise through the whole of it. 

On the 12th of June, he informed me that his thirst was nearly removed, but that he felt a soreness of the stomach, and great oppression of it after eating, with sickness. These symptoms continued the three following days, which he spent in the country, and then ceased. From that time his stomach became reconciled to animal diet; his appetite and strength increased; he eat with a proper relish, and was not troubled with thirst. 

On the 18th of June he drank 3 pints of liquid, and discharged only 2.75 pints of urine, which had the usual smell and colour. He stated that he had begun to perspire at night, which had not been the case for some time before; alfo, that he felt his hands and feet more moist and comfortable. The complaint of his head and eyes was likewise removed.

June 20th his pulse was more firm; and he found himself recovering strength, so that he could walk a mile or two without fatigue. He eat heartily, slept well, and seldom drank between meals.

On the 12d June some family concerns obliged him to set off for Yorkshire. He went, however, with the resolution of adhering to the plan of diet which had already so much relieved him, without the use of any medicine, excepting a little castor oil, as an occasional laxative. On Saturday Iast, August 4th, in a letter, he informed me, that he bore the journey very well ; but that fome fatigue, and agitation of mind since, had much depressed, and enfeebled him. From this state, however, he recovered in two or three weeks; and he is now able to take considerable exercise either by walking or on horseback. He hopes to be in town soon, and thinks himself qualified to undertake business with as much activity as usual.

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.

From Mr. Houston, Brewer Street, London. 

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

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

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

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

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

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

Continuation by the Author.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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