Cases of the Diabetes Mellitus: With the Results of the Trials of Certain Acids, and Other Substances, in the Cure of the Lues Venerea

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.

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.

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. 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 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.

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.

SECT. II. - Cases and Communications

the first Edition of the Work. From Doctor Marcet. London, January 12, 1798

MY friend and countryman Doctor de la Rive, having informed me that Walker had been readmitted into the Infirmary at Edinburgh, and placed under the care of Doctor Gregory, I requested him to send me an account of the further progress and treatment of the case, which I now have the pleasure to transmit to you. 

Continuation of the Case of Walker. 

June 12th, 1797. 

He had continued perfectly well till within this fortnight, though his urine, which amounted to 5.5 lb. when he left the Hospital, increased gradually to 16 lb. His thirst is at present urgent; his tongue is dry, as well as his skin, which is also hot; says that he sweats frequently ; pulse 108. He complains of a burning pain in the palms of his hands and soles of his feet; of confiderable weakness) and occasional sourness in his stomach, with pain and flatulence. His fleep is disturbed ; his ankles often swell at night. 

June 14th. In the last 24 hours he has passed 17 lb. of urine, which is of the common diabetic appearance. Su.aj. pulv. alum. comp. jfs. 4. in die; libat aquae calcis 2 lb. in die. Full diet, with meat for dinner. 

June 17th. Urine l6 lb. The dose of the compound powder of alum to be increafed to a drachm. 

June 19th. Urine 14 lb. and rather more limpid. The alum powder to be omitted, the lime water continued, and an entire diet of animal food to be adopted, confining of the following articles ; three eggs for breakfaft, four ounces of cheese for fupper, two pounds of meat for dinner, with three pounds of beef-tea in the day. 

June 21st. Urine 8 lb, ftill pale, though less so than before.

June 29th. Urine 5 lb. yellower than it has yet been and of a more natural smell.

July 7th. Urine 5 lb. To be allowed 4 ounces of bread daily, in addition to his diet. 

July 9th. Urine 5.5 lb. He has drank two cups of tea with sugar

July 11th. Urine 5.5 lb.; a portion of yesterday's was evaporated, and the residuum evidently contained saccharine matter.

July l6th. The bread to be omitted, and the animal diet strictly adhered to.

July 27th. Urine 5 lb. Within these few days his strength has been recruited. He is to be discharged. This Patient was detected in following his habits of irregularity and intemperance; indeed he could not be depended upon.

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 Storer, Nottingham. October 18 1797

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

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

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

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

From Mr. Shirreff, Deptford. February 23d, 1798.

A YOUNG LADY, who has lately completed her 12th year, of a thin habit of body, tall of her age, of a docile disposition, and who has a regular flow of spirits, subject, however, to sick headaches, and accustomed to eat much fruit, sweetmeats and pickles, has become affected with Diabetes.The months of June, July, August, and September, 1797 were passed in Devonshire, near the sea-coast, where she bathed in the sea, and used exercise on horseback. She returned to this neighbourhood early in October with apparently an improved constitution. About the latter end of November she had an attack of angina; the left tonsil became enlarged, as well as the submaxillary and other glands of the same side. The angina went off; but such a state of glands remained as indicated a scrofulous constitution. After the indisposition, she did not recover her usual appearance of health; the wings of the nostrils became enlarged, the upper lip tumified, and the infide of the left nostril red, and excoriated; she had alfo flight herpetic eruptions. Early in the month of January her spirits became deprefled, her disposition indolent, and equally indifferent to study and amusement. She complained of headache and flight cholics; she became thinner though her appetite remained unimpaired. About the middle of February she had an intense thirst, and frequent calls to void urine. These were attributed to an improper habit; and she was retrained from the former, as the latter was supposed to be the consequence. The restraint, however, was impracticable.

At this time I was made acquainted with the circumstances. I desired the urine to be preserved; and on examination, it was evidently characteristic of the Diabetes Mellitus. I sent a portion of it, with an account of the case, to Dr. Rollo (it furnished the purest saccharina extract he had met with, and which granulated by keeping). I directed a diet, consisting chiefly of animal substances; an opiate combined with an antimonial at bed-time; the extremities to be anointed with a liniment of hog's-lard and camphor.

February 24rd. Her thirst was great; her appetite was keen; she had frequent headaches; a costive habit of body; a bitter taste in her mouth, with frequent nausea; her nights were good, but when obliged to get up to void her urine, which was frequent, her skin was cool; no rigors, or local affection in the kidneys; the abdomen was not enlarged, but there was an evident hardness above the pubis, embracing the region of the bladder; her skin, however, put on an appearance which requires a little more attention. Upon her arrival from the seacoast, I have observed she was much improved in her looks, as well as in general health, which was nowhere more conspicuous than in the appearance of the surface of the skin. Being subject to herpetic eruptions, I was accustomed to remark the lingular dryness upon the surface, and particular feel, which seemed inconsistent with health; but after her arrival from sea-bathing; these irregularities had disappeared, and the skin of her arms and neck had a natural look; but now appearances were worse than before, and such as struck me forcibly: the skin was dry, harsh, void of elasticity, shrunk, of a leaden hue, and seemed to adhere to the muscles; one would have supposed that there was no cellular membrane, being not only void of fat, but the motion of the skin was also trifling; in a word it seemed to be what is called hide bound. An emetic was directed in the evening, and the body was to be rubbed with the liniment, to which had been added a solution of the sulphuret of potash. 

February 25th.

The urine is of a deeper colour, and less sweet; an abstinence from liquids was recommended, so far as it was practicable. With my patient I called on Dr. Rollo; we agreed on the plan of treatment, which was to consist of an entire use of the animal diet; as drink, a dilute solution of the sulfurated potash in water, and two grains of the extract of hemlock, with one grain of the antimonial powder at bed-time. February 26th.

Yesterday she ate voraciously at dinner; was put into the warm bath in the evening, and the skin afterwards anointed with a preparation of hog's lard and pure ammonia. She had a good night, and without any occasion to void urine. This morning the urine is high coloured, and saltish to the taste; indeed it might be considered as natural urine.

February 27th. 

I was informed that the urine voided yesterday at one o'clock was free from sweetness, and perfectly insipid; some time after it appeared natural; but two hours after dinner was sweet, and in the evening again apparently natural. She was directed castor oil, being costive : the bath and injunction to be continued, and likewise the diet.

February 28th.

Has had a good night; the urine this morning is evidently urinous, though of a pale colour; her thirst diminishes, and her appetite is less keen; the skin feels softer. Yesterday she ate bread at breakfast, which I was informed of immediately afterwards in paying my morning visit. I was determined not to lose this opportunity of watching through the day any changes in the urine. That which was voided until dinner time, was sensibly sweet. I evaporated three pints of it, and it yielded of a saccharine extract a quantity amounting to 8 ounces 3 drachms. Her dinner was entirely animal food, and what (he passed afterwards deposited a lateritious sediment, and in colour, smell, and taste, differed very little from natural urine.

March 1st. 

She had a good night; the thirst diminished; urine more natural in appearance. She continues the regimen, See. and is ordered to try small doses of the powder of ipecacuanha.

March 3d. The urine differs little, either apparently in quality or quantity, from what is natural. Allowed her boiled milk and bread for breakfast this morning. At 1 o'clock this forenoon, the urine not sweet. She is to be indulged with a biscuit at dinner, and another at tea in the afternoon. The urine was examined at bed-time, and it was found very sweet. 

March 4th. The urine voided in the night was insipid, this morning saltish. Visited Dr. Rollo with my patient. Continuance of the animal food recommended, and occasionally a trial to be made with a small quantity of bread.

March 6th. Urine very sweet; complains of thirst and headaches. I suspected she had been deviating, which was acknowledged; she promises a more ready adherence. 

March 9th. She is able to take three biscuits in the 24 hours, without the production of sweet urine; but if this quantity is exceeded, the saccharine matter is perceptible. Therefore the assimilating powers are now able to convert a certain proportion of bread with animal food into proper chyle, which is capable of being applied to the purposes of nutrition.

March 10th. The appearance of the skin is much altered for the better. Medicines and diet to be continued. The weight of the body was this day found to be 64 pounds.

March 15th.

Nothing particular has occurred these five days past. She has been cautiously increasing and diminishing the quantity of biscuit, according to the effects produced; the number of biscuits has not exceeded three or four, and the fourth generally produces sweet urine.

March 23rd. From the 15th to this day nothing material has happened. The urine voided in the interval of her meals is insipid, and is falter and more urinous the farther distant from the meal. On the night of the 22d the body was covered with a general moisture. 

March 24th. This morning the weight of the body was found to have increased, since the 10th, five pounds and upwards.

March 28th This day I have augmented the quantity of biscuit, The patient's health now improves daily.

March 29th. The additional quantity of biscuit has reproduced the sweet urine, though in a less degree. The number of biscuits to be diminished.

April 9th. During the holidays there has been a great deviation from the plan. On Good Friday she ate sweetened bread; on the Sunday following, sweet cakes and sweetmeats. These were repeated yesterday, with sugar to her tea. In the evening she voided 7 ounces of urine, highly saturated with sugar. The above irregularities were carefully concealed; but thirst, headache, and sweet urine, betrayed the deviation. Being alarmed at such a relapse, she promises more steadiness in future,

April 12th. The urine natural. She takes the biscuit.

May 4th. The whole plan now consists in regulating the quantity of bread; when a large proportion is used, sweet urine is still reproduced, and of the saccharine matter she is sensible, by the peculiar feel of uneasiness about the meatus urinarius. The skin is very soft, and appears different from what it did at the commencement of the disease, and for a long time afterwards; her appetite is good, but not particularly keen; she is not troubled with third; her sleep is undisturbed; no headache, nor any local pains about the kidneys—the tension of the region of the bladder is removed; her spirits are good; her strength returns, and she practices her juvenile studies with alacrity; the disposition, however to the disease is not yet removed.

May 6th. After having returned to the diet she has been accustomed to, before her illness, fweet urine was again reproduced, and which I apprehended before its examination, from the change in the appearance of the skin, of the neck, and arms.

May 16th. Since the 6th, her diet has been very strictly attended to, and the injunctions particularly so; the urine is not sweet.

May 31st. Since the 16th, our patient has been progressively increasing the quantity of biscuits and farinaceous substances; she can with impunity this day confume six biscuits, and the whole produce is disposed of by the assimilating powers. The urine is natural, but on Tuesday the same quantity of bread produced six ounces of water, highly saturated with sugar. The bulk of the body is increased; she is active and capable of using exercise without fatigue. I still persevere in the use of frictions, and anointing the body; the cold bath is recommended, and will be used, for the first time, on Monday next. She has been for some time using bitter and chalybeate medicines.

June 3d. The patient ate some green peas without producing sweet urine. The skin looked florid, the muscles strongly marked, and fuch a general appearance of health as had not before been observed for many months. The bread was this day diminished, lest the usual quantity added to the peas might be more than could be disposed of.

June 4th. Evaporated some of the urine; less animal substance in it than what has hitherto been observed. No sweetness in her urine, which in flavour and colour does not differ from what is natural.

June 6th. Quantity of bread considerably increased without any inconvenience occurring. Medicines, frictions, and injunctions continued; moderate exercise is recommended and used. Formidable as the Diabetes Mellitus has been hitherto found, it can now be moulded to the wish of the practitioner. To remove the disposition to the disease may be difficult, but an important advantage is gained, as we now can cure the unpleasant and most distressing symptoms, and bring the disease into a mild state, which may ultimately be eradicated by regimen and medicines. What may be the extent of time before my patient can get free from the disposition, it may be impossible to ascertain; I have no doubt, however, of its accomplishment, though it may remain until after those changes in the system have taken place, which are brought about at the age of puberty. While the case continues under my charge, every attention shall be followed, and the event shall be communicated to you. 

In the management of this curious disease many reflections on its nature have arifen, but as, these have led me to adopt your opinions generally on the subject, I shall for the present reserve them. In the meantime it gives me some satisfaction to have contributed my share, so far as one case extends, towards elucidating some points in the history and progress of the disease, especially in the changes the urine undergoes at different times after eating, and according to the substances eaten.

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

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

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

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

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

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

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

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

On the 4th January, 1798 

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

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

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

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

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

Tynemouth 1ft July, 1798. 

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