John Rollo

Some Remarks on these Communications. 

The only circumstances leading to fix on the predisposing causes of the Diabetes Mellitus are contained, 

• 1ft. In Doctor Falconer's letter, where a case of the disease is related, as having apparently been produced by excessive indulgence in spruce beer, to reduce corpulency. 

• 2d. In Doctor Cleghorn's first cafe, where the patient had worked hard while under convalescence from fever. 

• 3d. In the cafe of the Gentleman of 77 years of age, who had been addicted to the use of large quantities of sugar.

• 4th. In Doctor Gerard's case, the patient had been subject to pyrosis, and liable to much perspiration previous to the diabetic attack

With respect to the treatment of the disease Doctor Duncan found, in one case, fat meats serviceable. 

Doctor Falconer recommends the mephitic alkaline water; and from the advantage the Gentleman of 77 derived from Schweppe's soda water, it may be of service. There is no doubt it will relieve the acescency of the stomach. We would prefer the soda water, as we think it may act less on the kidneys than that made with the vegetable alkali. 

Doctor Beddoes mentions a cafe where the Bristol water cured the disease. 

Doctor Currie has feen several cases of the disease ; but never saw a case of it with sweet urine cured. 

The Case of Walker shews the effects of the animal food. It was begun on the 29th December, when the daily quantity of clear sweet urine amounted to 13 pounds; on the 31 ft day, being two days only, the quantity of the urine was reduced to 5 pounds, and it had acquired a strong urinous smell. The two Cases, treated at Glasgow, by Doctor Cleghorn, shew also the good effects of the animal food, and of the influence of commotions in the bowels on the quantity of the urine.

The Case of the Gentleman of 77, likewise shews the efficacy of animal food ; but the most striking case is that of Clark, as related by Doctor Gerard. This important case points out, 

First. That in this disease there is no absorption of fluids by the skin. 

Secondly, That animal food may alone, if duly persevered in, cure the disease; and such perseverance may probably be of a very limited duration.

From Dr. Gerard, Liverpool 

The following case is that mentioned in Dr. Curriers letter to us, and we communicate it with the greatest pleasure to the public as being drawn up with the utmost accuracy, and containing details of procedure of the utmost importance towards perseeling our views of the nature and treatment of the disease, as well as of confirming them.

THE CASE. 

John Clarke, aged 38, was received into the Liverpool Infirmary, under Diabetes, on the 9th February, 1797.

 He was a soldier in Lord Darlington's Light Horse when they were reduced in February, 1796. 

At that time he was in good health ; thinks he might then have weighed about 140 pounds in his clothes; he is 5 feet 7.5 inches in height; has dark hair and grey eyes. He always enjoyed good health, but was subject to pyrosis, and accustomed to perspire much. Happening to reside near the seacoast, he has from a boy been used to bathe frequently during the summer months, not for any indisposition, but merely for gratification ; sometimes he went into the water twice the fame day, and staid in it 10 or 15 minutes; being always of a coflive habit, he also drank of the water occasionally. He discontinued the practice of bathing, however, while the weather still continued warm, as early, he thinks, as the beginning of August; his habitual perspiration leflened afterwards by degrees, and he continued in good health till about the end of November, 1796, when the perspiration entirely ceased, and the cuticle became unnaturally dry, harm, and rough, and is now to all appearance dead, and incapable either of perspiration or absorption, or any kind of transmission. About this time some headache also came on, and the bowels became in general more costive, though he was sometimes troubled with a lax for a few days. 

With the preceding symptoms he was afflicted with a most distressing thirst, which was not to be satisfied. His appetite was increased, and yet he loft flem daily, and grew weaker very felt, particularly in the thighs and small of the back, attended with pain in the region of the kidneys. He also observed, that he made much more urine than usual, and that the quantity increased from day to day. It should be remarked, that having no other means of getting here, he was under the necessity of walking from five, to eight miles each day, for three successive days, before he reached Liverpool ; but this was a whole day's work, and a great fatigue to him. Considering this to be a cafe, that from all former experience might almost be deemed incurable, I wished to consult my Colleagues, Dr. Brandreth and Dr. Currie ; therefore I only ordered him a dose of castor oil, to remove, the costive state of the body. Those gentlemen saw him with me on the 1 1th February. At this time Dr. Currie had just received a publication from Dr. Rollo, Surgeon General to the Royal Artillery, at Woolwich, of a case of Diabetes that he had treated with success ; he had not read it ; but he understood that much was attributed to animal diet. On this authority our patient was ordered to live chiefly on flesh and milk; he was also directed to use the warm bath, and with a view of ascertaining whether the generally received opinion that absorption takes place in this disease be true, he was defined to be weighed naked, both before he went into it, and upon coming out (Dr. Currie having observcd in a case of a different nature, that no absorption took place in the warm bath) ; the pulse to be counted; and the heat of the body ascertained by placing a thermometer under the tongue, and to note the whole down.

February 12th. He went into the bath for the first time, when the pulse was, before bathing, 

75, after it, 85. 

Heat of the body 91, —-—— 95. 

Weight of the body 112lb. 4oz. -- 112lb. 6oz.

February 15th. During the same time he took two pounds and a half of animal food, and twelve pounds of liquids, including milk, beer, and water. The directions for his living on animal food having been misunderstood, he has hitherto had only one meal of flesh daily, and with it a portion of potatoes and bread.

February 20th. Having read Dr. Rollo's publication, he was ordered this day to live entirely on animal food and broth, without either bread, beer, or any vegetable matter, and to persist in that plan without taking any medicine whatever; for as diet appeared to have had a principal share of the success experienced in Dr. Rollo's cafe, we wished to try whether that plan only was capable of effecting a cure.

Feb 24th. He took two pounds of beef, and 6 pounds of broth.

Feb 25th. The dead cuticle is peeling off, and he is obviously improving in every respect, and gaining weight. He continues the diet of animal food, with the daily allowance of a pound of beer.

March 2nd. Urine 6 pounds 5 ounces. The animal food,: with the beer, has been persisted in. I have hitherto thought the griping and looseness were accidental, but as they continue, they may perhaps be owing to the great change made in his diet ; on that idea, therefore, I have allowed him half a pound of bread daily, and have ordered him 30 drops of laudanum at bed-time. He feels himfelf considerably stronger, and can lit up much longer at a time. He has no extraordinary thirst ; the urine has neither sediment nor smell.

The griping and looseness do not abate by the admixture of vegetable matter, on which idea only the bread, as it may be remembered, was allowed. He loses weight daily. This reverse of the success we experienced in the beginning, would prompt me strongly to have recourse to the fulphurated kali, or hepatifed ammonia ; but the circumstance of his having gained so much advantage, and so rapidly, while he lived on animal food entirely, and the wish to try what that diet alone would effect (which should be remembered was the plan we set out upon), determines me to return to it again, especially as it may enable us to decide whether it is alone equal to the cure. I therefore ordered both the bread and beer to be discontinued ; and to rely on the laudanum, absorbents, to correct the diarrhoea. He was allowed milk in place of the beer.

March 14th. He is rather more thirsty ; his appetite is not so good, being satiated with animal food ; he was allowed an onion to his meal.

March 19th. Being desirous of gratifying my patient with any change of diet that could be indulged in without impeding the cure, I ordered him to have a meal of fish, two or three times a week, meaning at the same time to ascertain whether that deviation from the plan of animal diet might be allowed with impunity.

March 20th. He disliked the fish, and said it was not so satisfying to his appetite as the meat; he thinks his thirst and appetite are more craving. He had a very good night, with some perspiration over the whole body; griping quite left him ; and flatulency greatly relieved.

March 26th. He has bad a restless night, and vomited frequently till 3 o'clock in the morning ; his spirits are better, and he thinks himself stronger. He had a pudding made of milk, suet, and eggs, for his dinner, which he was fond of.

March 28th. The diet, with the pudding of milk, eggs, and suet, were given as directed.

March 31st. He continues better, and feels a more comfortable warmth than he has been accustomed to do lately. His pulse has been from 85 to 90 for a week past. He is so tired with broth, that he has refused to take any for some time, and owing to his fondness for the eggs and milk, either baked or boiled with suet, he has eaten too little meat lately. I therefore ordered that he should at leail eat one pound daily.

April 6th. It becomes very irksome to keep him to animal food, even with a very large allowance of milk; and I learn that he takes the suet off the milk when it cools. He feels himfelf better today. He continues the animal food with milk, eggs &c.

April 19th. The diet is continued.

April 25th. Finding that he has upon the whole been losing weight since the 17th, I questioned him very closely about his getting other food than what was allowed him, but he denied it, and shewed much impatience about staying longer with us, saying that he thought himself well and strong again, and that he would rather go, as he was watched like a thief. Though I do not confider him to be so well as he thinks he is, yet as the quantity of his urine is so much reduced, and its former nature so entirely reversed, I have, notwithstanding his having lost weight, allowed him four ounces of flour in his pudding, and two ounces of bread with his meat ; for fear he would run away, and leave us uncertain of the event.

May 6th. I have at length discovered, through the information of another patient in the fame ward, that Clarke adhered rigidly to the regimen prefcribed him, only for about 14 days at the first. In the course of the disease we have often had reasonto suspect that he was deviating from our plan, and three or four times the necessity of a fine attention on his part was particularly infilled on. After these cautions he attended to his regimen strictly for a day or two, but again relaxed, through the almost irresistible propensity to more or less of vegetable diet, which seems to be one of the characteristic symptoms of this disease. With thefe exceptions, it appears that he has generally partaken with the other patients in the common mixed diet of the house, and that he has drank water when thirsty, if he had no milk. I cannot learn that he ever gave any part of the flesh meat to the other patients. It is extremely vexatious to have been so much deceived, yet I don't think it lessens the inference, that animal diet has been the means of effecting the very great alteration in the quantity and quality of his urine ; for though he has eaten more promiscuoufly than was supposed, he has at all times taken a large proportion of animal matter, and a marked effect: has at different periods of the disease followed the more entire use of it, particularly in the beginning, when his apprehension made him adhere rigidly to the plan. The discovery, though vexatious, has perhaps made this a better case, in as much as it shows that an absolute exclusion of vegetable matter is not necessary, at least not for so long a time ; and also as it proves that he is nearer being cured than he was thought to be, by the characteristic symptoms of the disease not having been reproduced by the superior quantity of vegetable matter he has eaten to what he was supposed to have done. Whether his appetite is so strong as to constitute it a remnant of the disease I know not ; but from the impossibility of retraining him, and for the purpose of ascertaining whether the care was complete, he is ordered to have the diet of the house only.

April 7th. His. diet now consists of milk, meat, potatoes, and bread.

April 25th. He was discharged from the Infirmary to all appearance cured of the disease; which, to his own thinking, has long been the case ; and to the opinion of his being even cured I have no hesitation in subscribing.

Mr. Astley Cooper, at St. Thomas's Hospital, having mentioned in one of his anatomical de- ?nonflrations, our views of the nature of diabetic disease, a young gentleman prefent, who had a relation in the country with the complaint, expressed a wish to be more particularly informed, and was referred to us. He gave a concise account of the Patient ; and it was suggested, as the Patient was so far advanced in life, an immediate application of our treatment to its whole extent might not be advisable ; the gradual adoption of it was therefore recommended. As the Patient, however, had been a Physician of long practice, though now retired, and being immediately under the care of a recyclable Physician in extensive business, we requested that our opinion in general might he conveyed along with the printed notes of Captain Meredith''s Case. This was on the 19th March 1797.

 The following account, written by the Patient himself,. we received on the 18th May, being only a period of two months. 

Guys Hospital, 18th May, 1797

 Sir, The enclosed account is drawn up by my friend the patient himself. I think it incumbent on me to return my best thanks for your kind and ready advice, from which the patient has derived so much advantage. 

I am, 

Sir, 

yours, &e

G. B. 

Dr. Rollo may make what use he pleases of the under described case, provided he does not insert the name of the Patient or that of his Physician. A gentleman far advanced in life, being now in his 77th year, and during the greater part of that time in pretty uniform good health, except some attacks of erysipelas about mid-age, and latterly a chronic rheumatism in the loins, occasioning more of stiffness than pain. He has been accustomed to live after the common mode of sober persons, or if prone to any excess, it was chiefly in the use of sugar. He began about two years ago to feel a great increase of general debility, to which was soon adjoined an unusual frequency of discharge by the bladder. The urine exceeded the quantity taken in by one third, and it was voided with a forcing kind of pain, both at the commencement and close of the emission; made softly in small quantities at a time. These calls became soon so multiplied in the night as greatly to disturb natural rest ; and the mouth and sauces grew so dry as to oblige the patient to keep small pebbles rolling continually in the mouth during the day time. The inflation of the saliva was such as to make it difficult to spit it out, unless previously diluted. The hands shook to such a degree that rendered it dangerous to shave, and hardly possible to write legibly, while the lower limbs felt as if force able to support the trunk of the body ; the feet and ankles swelled considerably ; the thirst was intense, but there was very little show of fever by the pulse. 

Under these circumstances the opinion of an eminent Physician in the neighbourhood was asked, who recommended lime water, earth of alum, afterwards pills of catechu, alum, and a small portion of vitriolated zinc. By these remedies the forcing at the neck of the bladder was a good deal relieved; but the very distressing dryness of the mouth and fauces still continued, and was by nothing so much solaced, as by moistening with milk and water. The urine remained, as it had always been, well coloured, frothy upon first emission, and favouring strongly of that sweetness, to scent and taste, charateristic of diabetic urine. 

Upon receiving from a young friend, a pupil at the Hospitals in Southwark, Dr. Rollo's notes on a case of this fort, the Patient and his Physician agreed to avail themselves of this plan of treatment, with some accommodation to the circumstances of the individual, and they have found reason to be satisfied with the adoption of it. 

Vegetable articles of diet had been long discarded; and the use of pure sugar, since the excellent hints in that communication, had been entirely laid aside. Rancid fats and putrescent flesh could not be admitted even in idea, without inducing nausea: instead of these were employed fresh mutton, animal gluten, mucilage, &;c. At breakfast he takes milk, with some cocoa, or chocolate; for supper, calves' feet jelly with milk, and sometimes an addition of sweet almonds. 

A moderate allowance of wine has been continued, as indefensibly necessary for support; but the least acid foreign wines have been used, and a gradual reduction is making in this hitherto necessary, indulgence. Of medicines, the saturated solution of soda, and Schweppe's soda water, have been only employed: from the last there is every reason to believe a share of the amendment may be attributed. See Dr. Falconer's letter to use where he points out the mephitic alkaline water as likely to be of advantage in this disease. 

Results:

The urine does not now considerably exceed the liquid taken in. In the day time it is voided frequently, but without pain ; the night calls are diminished to one, very rarely two occur. Its colour is good, and its sweetness can hardly be said to be perceptible. The excessive dryness pf the mouth and fauces, that depraved the taste for any aliment, particularly bread, and in consequence impaired the appetite, is nearly removed. The feet and ankles swell a little at times, which may be in some measure owing to the large proportion of the vvxQfittepov, during which, though the days are so long, yet the patient is unrecumbent sixteen or seventeen hours at least. With this hasty sketch you will please present my best compliments and thanks to Dr. Rollo.

From Dr. Cleghorn, Lecturer in Chemistry, and one of the Physicians to the Infirmary at Glasgow. Glasgow May 19 1797. 

SOME months ago I was honoured with your excellent pamphlet on Diabetes. At that moment I had two diabetic patients in the Royal Infirmary of this place, and I began infiantly to treat them on your plan. They are both cured ; and I have delayed fo long to thank you for your politenefs, in the hope that I might be able to inform you of this new fuccefs. 

CASE II. John Roger, age 40, a Shoemaker. January 10th 1797:

 For two months his urine has been profuse, amounting daily to 20 pounds or more. It is limpid and sweet, yielding by evaporation an ounce of thick sweet matter, like treacle, from every pound. He is thin and weak; habitually thirsty; for some days pain has felt a pain between his shoulders, and for a week his legs have been cedematous. Appetite keen ; pulse and belly natural. Knows nothing to which he can attribute his complaint. Has used bitters, and other medicines, without material benefit. The astringent pills, and alum whey, were ordered for him, as for M'Lean, 

12th. Urine 36 pounds. 

13th. Urine 30 pounds. 

14th Urine 23 pounds. 

15th. Urine 20 pounds.

16th Urine 21 pounds; thirst excessive ; sleeps ill ; pulse full and hard. The medicines were omitted. He was directed to drink a folution of lixiva fulphurata, one drachm to four pounds of water, and to use animal food. 

April 3d. Issues by means of caustic were ordered to be formed over each kidney. He was directed to drink sparingly, chiefly lime water, and his diet was regulated with more care. For it was found, that all along he had used a great proportion of vegetables for food, and had been guilty of irregularity also in drinking. He was ordered to get no vegetables ; however, he was allowed one roll a day ; the rest of his diet consisted of soup, blood-puddings, and butcher's meat roasted, or boiled, as he chose. 

11th. Three stools. Feels himfelf stronger, and in better spirits. Pulfe 80. Drink 3 pounds (no lime water) ; urine 6§ pounds, nearly natural. 

12th, 13th and 14th. Thirst abated ; urine from 6 to 7 pounds/of natural taste and smell, and when evaporated yielded no sugar. Thus he continued free from thirst, though his mouth was parched and dry during the night ; he gained ftrength and flesh ; his urine never exceeded 6 pounds, and seemed perfectly natural till the 30th, When it again became sweet; having been strictly questioned, he confessed that he drank a quantity of small beer yesterday afternoon, and we have found that he has committed several other irregularities. 

May 1st. Urine again natural. This day he left the Infirmary, having promised to persist in the use of animal food, and to return if he should relapse. He is gone to Irvine, about 30 miles distant, and nothing has been heard from him since. 

These patients were examined daily in the Royal Infirmary of Glasgow, and the reports were dictated before the Students of whom many examined very scrupulously the changes of the urine, and all other circumstances respecting a disease to which their attention was strongly attracted both by the novelty of the treatment, and their having seen a case which ended fatally not long ago. In copying the reports I have omitted every circumstance that seemed uninfluential, and I have abridged the language so far as I thought consistent with perspicuity. I have dropped the Latin form of prescribing, though it gave me some trouble to exprefs the prescriptions shortly in English (and many of them look awkward enough) because I was desirous of making the cases intelligible to those who do not practise physic, as I hope this very interesting inquiry will soon excite the attention of the public. After stripping the cases of every necessary detail, I shall not load them with many additional remarks. They seem to me very strong confirmations of your doctrine, in every point, except what regards the hepatifed ammonia. At first perhaps it was not properly prepared, after a little while, however, it was ; and it seemed to have very little power over the urine. In one patient (but he was querulous and fanciful) it seemed to affect the head ; in the other, it seemed to act like common volatile alkali, by producing an agreeable sensation of warmth in the stomach. Our patients, indeed, were in many respects different from yours ; and it is very common to find the operation of medicines strangely modified by the varying habits and susceptibilities of patients. The alum whey (formed by boiling a drachm of alum in a pint of milk) seemed to produce considerable effect, at least in reducing the quantity of urine. The castor oil appears to be the most useful laxative; but no medicine was of any permanent advantage without the aid of animal food. This is more powerful than any medicine, and very probably this alone, properly managed, may be found sufficient for the cure in many cases. Whether the cure in our two patients be complete or not, is a question which I shall not labour to decide by argument. For my own part I think they are cured, though they may never perhaps be strong as they were, and both may probably relapse ; because, being poor, they are exposed to the double risk of severe labour, and improper food. Besides, on many other occasions, a tendency to relapse is not considered as a proof of imperfect cure. Is an intermittent not cured, because one who has had it this spring, will be found very subject to it next season, if he shall be exposed to the cause which commonly produces it?

From Dr. Cleghorn, Lecturer in Chemistry, and one of the Physicians to the Infirmary at Glasgow. Glasgow May l9 1797. 

SOME months ago I was honoured with your excellent pamphlet on Diabetes. At that moment I had two diabetic patients in the Royal Infirmary of this place, and I began instantly to treat them on your plan. They are both cured ; and I have delayed so long to thank you for your politeness, in the hope that I might be able to inform you of this new success. 

CASE L John M'Lean, a Porter, age 38, December 9th, 1796. 

Four months ago had a fever, after which while yet weak, he began to work hard. Soon afterwards he observed his urine more abundant than usual, amounting daily to 24 pounds, or more. 

Though his appetite be voracious, he becomes leaner from clay to day, and is so weak that he cannot walk a few steps without panting. His mouth is parched, tongue red, thirst extreme, belly collive. Pulse 84. 

A few days ago he had a slight cough, with pain in the right breast ; but these complaints have abated. The feelings about the stomach when he thinks himfelf hungry, differ from those he formerly had; they are more uneasy, and the uneasiness is less removed by taking food. He is often troubled with flatulence ; and complains constantly of weakness or pain in the back and loins. Has used no medicines. On examining the urine it was found limpid and very sweet. A pound of it yielded by evaporation more than an ounce of a thick brown extract, like treacle in appearance and taste. 

December 10th. He was ordered an ounce of castor oil, and the same quantity of compound tincture of fenna. His loins were directed to be rubbed every evening and morning with anodyne balfam. Equal parts of kino and ruft of iron, formed into pills rcki pills of five grains, with extract of chamomile^ were to be given, two for a dofe thrice a day. His drink and urine were ordered to be meafured daily, and the following reports, abridged from the Infirmary Regifler, fhew the refult. 

11th and 12th. One stool ; urine 28 pounds ; has drank about 14 pounds, besides the usual allowance of beer and broth. 

13th. Urine 27 pounds ; drink 8 pounds ; has had double allowance of food. Belly natural. To take 8 pills daily. 

14th. Feels himfelf a little eafier and stronger. To drink a pint of alum whey daily at different times. To have the oil and tincture of fennawhen coftive. In this courfe he persevered till the 17th of January, 1797. The quantity of his urine diminifhed daily. On the 16th December it amounted only to 20 pounds ; next day to 1 8 ; next to 1 5 ; next to 13; but on the 20th it rose to 16 pounds, without any cause that could be pointed out, unlefs the increafe proceeded from coftivenefs. Next day it fell again to 13; on the 24th it rofe to 1 5 : after which it varied from 13 to 7 J pounds. This was the quantity voided on the 17th January. It never fell below 71; most commonly it was between 8 and 10 pounds. Meantime the patient confidered himfelf as cured. He slept comfortably, sometimes not rising during the nighty never oftener than once. The feelings about his stomach were more agreeable ; his countenance looked less ghastly, and he felt his strength returning apace. On examining his urine, however, I had the mortification to find it nearly as sweet as ever. I confidered the cure therefore as very incomplete, and I expected that the urine would soon begin to increase, as it had uniformly done in every cafe that I have hitherto feen, and I have feen a confiderable number. 

While under this painful apprehension I received Dr. Rollo's pamphlet, which seemed to me to contain a more distinct theory, and a more reasonable practice, than I had ever met with before. As I could not immediately procure the hepatifed ammonia, I ordered him to use for drink four pounds of water, containing a drachm of lixiva fulphurata. The alum whey to be continued. 

Jan 20 Urine 8 pounds, sweet. Has used vegetables and milk freely. Took 3 pounds of the ammoniated water. The necessity of abstaining from vegetables was explained, and enforced, and he was ordered to continue the water. 

February 10th. This morning took 15 drops at once, with no other effect than a sense of heat in the stomach. Urine 6 pounds, less natural in tafte and smell. Finding himself strong enough, he asked leave to go home, (to the fuburbs of Glafgos) to manage some business which required his prefence. He promised to abstain from vegetables, to take his drops, and to return if he became worse. I have seen him several times at work, and this day, being the 10th of May, I received from his own mouth the following account. 

In 24 hours his urine is about 5 pounds. He taftes it very often, and it has never been fweet, but after getting little animal food for days together (which has happened more than once) it has fometimes been of a four fmell. Formerly he could carry on a wheelbarrow three hundred weight ; at present he carries one hundred weight, and he can walk as well as ever. Two days ago he went express to Paisley, received an answer to the letter he carried, and returned to Glasgow in three hours and a half (about 14§ miles). 

Occafionally he has taken 60 drops a day of the hepatifed ammonia, which he likes, because it gives him an agreeable feeling of warmth, and never produces any inconvenience. For two weeks, however, he has had none, since which his urine has not increas›ed in quantity, has not been sweet, and when evaporated lately by himself, and by a neighbour of his, whose curiosity he has excited, it yielded no sugar. The residuum could not be diftinguished from that of an equal quantity of healthful urine, evaporated at the same time with great care and sagacity. The only kind of animal food that he can procure in sufficient quantity is blood, which he mixes with fat and a little meal. Even this homely fare he finds it difficult at prefent to procure regularly. He was always lean, and is now rather more so than before his fever ; but though he works very hard, he thinks himself stronger, and more fleshy, than when he left the Infirmary. He sleeps well; is regular in his belly, and free from every complaint, except occasional pains about the muscles of his breast and arms, anting obviously from the intense colds to which he has been very much exposed, as he plies near the river from morning to night. He is the father of several children, but since he has been seized with Diabetes—Coitus nullus. Erigitum nunquam : ne quidem femel rigefcit. About a month before he left the Infirmary, the other patient gave the same account of himfelf.

4th May, 1797- I SEND you an extract of the case of Walker, with Dr. Hope's permission, and you may do with it whatever you please. The effects of the animal diet on the quantity and quality of the urine are perfectly evident, though the case could not be carried to an absolute termination, from the impatience and instability of the patient. In Hospitals, where patients three three or four times in the day every person about them eating vegetables, a trial of an entire diet of animal food can hardly be expected.

James Walker, a field-labourer, was admitted by Dr. Hope into the Clinical Ward, with a confirmed Diabetes, on the 1st November, 1796. 

"His appetite is voracious, and his thirst so urgent, as to make him defire from ten to fixteen quarts in twenty-four hours. His urine is praeternaturally copious, and he has a frequent inclination to pass it. It is limpid, of a light green colour, and having a slightest sweet taste. He is much emaciated ; and his feet and ankles swell towards evening. Pulse 96. Skin parched and rough. Body costive. 

He recollects, on a frosty morning in December 1795, having slept fome hours in an open cart, On the May following the above symptoms appeared, and have increased ever since. He has feveral times been the object of medical treatment; but without permanent relief. 

• 2d. Milk daily, and as much drink as he chooses. 

• 3d. Urine 22 pounds, Ingefta 20 pounds.. AtL 153

• 4d. Urine 13 pounds. Ingefta 17 pounds. The urine becomes turbid on the addition of lime water; when evaporated it affords an extract like molasses, which is sweet to the taste. This matter mixed with lime, exhales the odour of ammonia. 

• From this day to the 29th December, he remained nearly in the same state, the quantity of urine fluctuating between 12 and 18 pounds in 24 hours. During this interval he took some ferrum vitriolatum in the form of pills; ufed the cold shower bath, and took occassionally fome emetics and laxatives ; —the stomach being at times deranged, and the coflivenefs very obflinate. Under this treatment he feemed to get a little stronger, but without any important change in the general symptoms of the disease. It was agreed to try the effects of animal food, as lately given with success by Dr. Rollo at Woolwich, an account of which was tranfmitted by Dr. Woollcombe to Mr. Marcet. 

• December 29th, Dr. Hope gave the following report. Ingesta 17 pounds; urine 13 pounds. Five pounds of this urine have afforded 5ounces of a thick saccharine extract. He has had for a month, an unpleasant sense of burning heat in the soles of his feet during the night. He is directed to abstain from vegetable food in every shape. To have two eggs for breakfast. Boiled meat and fleaks alternately for dinner. Eggs, or cheefe for fopper. For drink eight pounds of weak beef tea, and two pounds of weak peppermint water. 

• 30th December. Solid ingested about two pounds ; drink ten pounds ; urine nine pounds. Let him have two pounds of flesh meat for dinner; half a pound of cheese for supper; and three eggs for breakfast—drink as before, Ingefta (drink, and food) ten pounds ; urine five pounds, which exhales an unusually strong urinous smell. Had a partial sweat over the trunk and head in the night. Mouth moist; no sourness. of stomach. 

• January 1st, 1797- Solid ingesta as usual ; drink nine pounds ; urine eight pounds, more limpid than yeflerday, and has a sharp acid odour. The breath has the fame smell . The colour of the urine, however, is not changed, on addition of syrup of violets. There is slight headache and sickness. The tongue appears much cleaner than usual. Has had a stool. Contin. diaeta animalis. 

• January 2d. Solid ingefta the fame; drink eight pounds; urine fix pounds. No flcknefs or hcadach ; tongue clear; the burning heat of the feet as before. One Joofe ftool. Contin. 

• 3d. Drink 10 pounds; urine 7 1 pounds, of a deeper yellow than formerly; tongue natural. Contin. 

• 4th. Drink ten pounds; urine feven pounds. Contin. 

• 5th. Drink nine pounds ; urine 6{ pounds, more yellow, with a peculiar (not urinous) odour. Contin. 

• 6th. No report, as laft night he went out, returned to the ward drunk, fo that his urine could not be meafured. 

• 7th. Drink 7 pounds ; urine 6 pounds, having the same peculiar smell, 

• 8th. Drink 7 pounds; urine 6 pounds; body coftive. Contin. diaeta animalis. Sum: ftatim pil. rhoei. comp. ^ l'et iterum eras mane. 

• 9th. 156 Qtfa Drink iix pounds ; urine four pounds ; a copious ftool this morning; ftrength not changed fince he began the animal food. Contin. et habeat aq. menth. piper, lbiv pro potu. minuatur quantitas decocti carnis ad lbiv. 

• 10th. Solid food as formerly ; drink feven pounds ; urine five pounds ; no flool. Sum : flatim pil. rhcei. comp. B 1. 

• llth. Drink fix pounds ; urine four pounds ; three llools this morning. Contin. diaeta animalis, 

• 12th. Drink fix pounds ; urine four pounds ; two ftools—he thinks his ftrength is fomewhat impaired within thefe two or three days. Adeat eras mane balneum frigidum. Drink feven pounds ; urine five pounds ; bore, the bath well. Contin, 1 4th. Drink eight pounds; urine fix pounds. Contin* 

• 1 5th. Drink eight pounds ; urine fix pounds. 

• l6tk Solid food as before; drink eight pounds; urine fix pounds, of a light ftraw colour, and with the peculiar fmell it has had for fome time. The urine of the 14th being evaporated, afforded matter of confiderable confiftence, with a ftrong faline, but fcarcely perceptible fweetifh tafte. 

• 17th. Drink eight pounds ; urine fix pounds ; thinks he is weaker. 

• 18th. Drink eight pounds; urine 5| pounds. Contin, IQth and 10th. Drink each day eight pounds ; urine fix pounds. Contin. 1\Ji January. Drink feven pounds ; urine five pounds. He has left the Infirmary to-day, by his own defire, to return to the country." 

• 4th May. Dr. Hope told me a few days ago, that he had just then. received a letter from Walker, who says that since he left the Infirmary he has become weaker; and there is some expectation of his returning foon to the Hospital to resume his treatment. But it is doubtful whether when he was in the Clinical Ward he observed strictly the diet preferred. At least he was accustomed to go about freely; and the nurse told me repeatedly, that she suspected he did not entirely abstain from indulgencies of eating and drinking out of the house.

Rollo, with the aid of Cruickshank, carried out laboratory studies with his patients to ascertain the results of treatment and to elucidate the nature of diabetes. The fluid intake, urine output and the body weight were determined. The urine was tasted to indicate the presence of sugar and subjected to experiments before and after evaporation to determine its chemical composition and content of sugar. At the beginning of treatment when Captain Meredith was passing up to twelve quarts of urine in twenty-four hours, the following notes were made: 

"Mr. Cruickshank took 36 ounces troy weight of urine voided today, and it yielded by evaporation three ounces and one drachm of saccharine extract, of the appearance of molasses, but thicker, having nearly the consistence of wax, and somewhat tenacious. If, therefore, the whole of the day's urine had been evaporated it would have yielded about 29 ounces troy weight, an astonishing quantity to be formed and seperated form the system. By standing in the air it became moist, and of nearly the consistence, smell and appearance of treacle." 

"Treating some of this extract with the nitrous acid, he procured the saccarine or oxalic acid; and with a smaller proportion of the acid it produced a substance, which in resemblance, and smell, could not be distinguished from honey."

Captain Meredith began the above treatment on Oct. 19, 1796. Two days later the quantity of urine passed in twenty-four hours had fallen from seven or eight quarts to six quarts. By November 1 the quantity did not exceed four quarts and on November 4 "he drank only three pints of water, and made only two quarts of urine, which to him and his servants (who had been in the habit of tasting his urine from curiosity) was not sweet." As time went on, the opium at bedtime was discontinued and the rubbing with hog's lard was left off. The latter was found to be a "troublesome and disagreeable" part of the treatment. Rollo decided to simplify therapy to include those features which were considered really essential: animal food, confinement with limitation of activity, and hepatized ammonia. The hepatized ammonia (ammonium sulphide) was used in place of "kali sulphuratum," originally prescribed, with the thought that it might be "a more certain and active medicine than the other on the stomach, in diminishing its action." 

Captain Meredith was directed to keep notes regarding his symptoms, diet, medication and progress of his illness. He did this quite faithfully, recording his transgressions as well as his attempts at cooperation. When at times he indulged in apples, bread and beer, Rollo found it necessary "to point out in stronger language the impropriety of such deviations." By December 30 the patient was free from abnormal thirst and polyuria, was regaining some of his lost weight and felt well. Continuation of treatment with a somewhat more liberal allowance of bread in the diet was prescribed.

Diabetes Its Medical and Cultural History

"From that period I had not met with a case of Diabetes, although I had observed an extensive range of disease in America, the West Indies, and in England, until 1796." "Captain Meredith, of the Royal Artillery, being an acquaintance. I had seen him very frequently, previous to his going on camp duty in 1794, but then he had no disease; however, he always had impressed me, from his being a large corpulent person, with the idea that he was not unlikely to fall into disease. (Editor: Another instance of Rollo's clinical acuteness.)" "On the 12th of June, 1796, he visited me, and though I was at once struck with the diminution of his size, yet, at the same time, the colour of his face being ruddy, I received no impression, otherwise than of his being in health: a moment's conversation, however, convinced me of the contrary ...... 

"He complained of great thirst and a keenness of appetite; his skin was hot, dry and parched; and his pulse small and quick. He told me his complaints had been attributed to an old disease, and a liver affection. The thirst, dry skin, and quick pulse, marking a febrile state, depending probably on some local circumstance, and connecting these with the keenness of appetite, Diabetes immediately suggested itself to me. I enquired into the state of his urine, which I found in quantity and colour to be characteristic of the disease; and was at the same time much surprised, that for the two or three months he had been under the care of a Physician and Surgeon, the circumstance of the increased urine had not been known to them. The patient told me, as he drank so much, the quantity of urine had appeared to him a necessary consequence; and of course never having been asked about it, he gave no information. I directed him to keep the urine he next passed, and, on examination, it was found to be sweet; in consequence of which the disease became sufficiently ascertained." 

At another point in the case history, Rollo states that Captain Meredith was 34 years of age and was 71 3/4 inches tall. At the time of beginning of the special treatment, the symptoms of diabetes had been present seven months or more and his weight had fallen from 232 to 162 pounds. A view held by some at that time was that diabetes was a primary affection of the kidneys. However, Rollo developed the idea that the disease was "a primary and peculiar affection" of the stomach in which, due to some morbid changes in "the natural powers of digestion and assimilation," sugar or saccharine material was formed in that organ, chiefly from vegetable matter. It was on this basis that he advocated the use of an animal diet together with certain medication designed to quiet the overactive stomach and to diminish the appetite. 

Following initial bloodlettings, Rollo's treatment of Captain Meredith was as follows: 

"1st. The diet to consist of animal food principally, and to be thus regulated: 

Breakfast. One and a half pint of milk and half a pint of lime-water, mixed together; and bread and butter. 

Noon. Plain blood-puddings, made of blood and suet only. 

Dinner. Game, or old meats, which have been long kept; and as far as the stomach may bear, fat and rancid old meats, as pork. To eat in moderation. 

Supper. The same as breakfast." 

"2dly. A drachm of kali sulphuratum to be dissolved in four quarts of water which has been boiled, and to be used for daily drink. No other article whatever, either eatable or drinkable, to be allowed, than what has been stated." 

"3dly. The skin to be annointed with hog's lard every morning. Flannel to be worn next the skin. The gentlest exercise to be only permitted; but confinement to be preferred." 

"4thly. A draught at bed-time of twenty drops of tartarized antimonial wine and twenty-five of tincture of opium; and the quantities to be gradually increased. In reserve, as substances diminishing action, tobacco and foxglove. " 

"5thly. An ulceration, about the size of half a crown, to be produced and maintained externally, and immediately opposite to each kidney. And, 

"6thly. A pill of equal parts aloes and soap, to keep the bowels regularly open."

Therapy 

A special diabetic diet was undoubtedly one of the foremost therapeutic measures, even before the age of insulin. Even before it was recognized that diabetes was a disorder of carbohydrate metabolism, various kinds of diet had been recommended. A change to a diet decided purely pragmatically, which was nevertheless very effective, did not come until JOHN ROLLO (d. 1809), a Scottish physician, who, in 1797, had achieved good results with a meat diet, made his recommendation (MARBLE; ANDERSON; BECKENDORF). He gave a particularly detailed account  The History of Diabetes mellitus 85 of the case of Captain MEREDITH of the Royal Artillery, who became diabetic at the age of 34, and who was very obviously overweight. His diet consisted of a breakfast and supper of milk mixed with lime-water and bread and butter, while his dinner consisted of pudding made of fat and blood and mature, preferably rank pork. In this way he had - without being conscious of it - excluded carbohydrates almost entirely from the diet. The patient of course lost a great deal of weight and felt extremely well. 

A second patient was less cooperative and therefore died at the age of 57, 19 months after treatment was begun, mainly - as ROLLO pointed out - because during his last three months he indulged in such things as apple pudding, sugar in his tea, and wine. 

The "meat diet" was used well into the 19th century, although gradually it was considered wiser not to cut out all carbohydrates, and patients had a certain amount of carbohydrate added to their diet, even though that caused some glycosuria. This kind of diet was initiated in the middle of the 19th century, mainly by ADOLF NIKOLAUS VON DURING (1820-1882) and RUDOLF EDUARD KULZ (1845-1895). The latter even distinguished between harmful and harmless carbohydrates and found that levulose, inulin, inosit, mannite, and lactose, as well as some root vegetables like celery, comfrey, etc. caused no deterioration of the metabolic condition. But it remains true that many specialists did recommend a carbohydrate-free diet with a lot of meat and fat (DICKINSON; PAVY; SEEGEN; R. SCHUMACHER, STEPP). 

"In the year 1777 ... I saw a case of the Diabetes Mellitus in a weaver at Edinburgh. He had been at least four months in the Royal Infirmary without having derived any advantage, and was chiedy under the care of the late Dr. Hope, Professor of Botany. When the patient was discharged, a Mr. Johnstone, then a Student of Physic, and myself, detained him a few days, and paid his expenses, in order to bleed him, and obtain some of his urine, so as to ascertain the appearances and spontaneous changes. I well remember that the blood and urine exhibited the appearances discribed by Dr. Dobson; but the papers, and a portion of the saccharine extract which I carried with me abroad, were lost in the hurricane at Barbados in 1789."