March 19, 1797
A nameless physician takes Rollo's advice to use the meat diet and cuts out all vegetable foods and sugar. He changes the rancid fats and putrescent flesh regiment to one of "fresh mutton, animal gluten, mucilage."
Cases of the diabetes mellitus : with the results of the trials of certain acids
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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.
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.
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.