January 10, 1866
Dr Harley summarizes his views: "The two great types of diabetes, that due to excessive formation, the other to diminished assimilation of saccharine matter, require, of course, as far as animal dieting is concerned, opposite modes of treatment ; for while in the former class of cases it is a most important —I might almost say an essential — adjunct to the other treatment, in the latter it is either detrimental, or, at best, of no use at all."
Diabetes : its various forms and different treatments
The two great types of diabetes, that due to excessive formation, the other to diminished assimilation of saccharine matter, require, of course, as far as animal dieting is concerned, opposite modes of treatment ; for while in the former class of cases it is a most important — I might almost say an essential — adjunct to the other treatment, in the latter it is either detrimental, or, at best, of no use at all.
Even in the most favourable cases for restricted diet, we must never allow ourselves to be deluded into the idea that, because we are mitigating the symptoms, and reducing the amount of sugar in the urine, we are necessarily curing the disease, or we shall frequently be doomed to sad disappointment. In keeping a patient on restricted diet, we are merely with-holding from him the straw and mortar out of which the bricks are made — not removing the makers — so that, as soon as the straw and mortar is refurnished to them, they will again be found at work as actively as ever. It is true that it occasionally happens during the withdrawal of the straw and mortar the makers disappear; but this, unfortunately, is by no means invariably or even frequently the case; it is rather, indeed, the exception than therule. We must therefore rely on other means for the removal of the makers. Of these other means I shall presently speak.
Meanwhile, let me explain that by the term restricted diet we mean not only the avoidance of all sugars, and substances containing saccharine matter, but also of all kinds of food convertible during the process of digestion into sugar. The foods convertible into sugar in the digestive canal are those containing starch (not gums), such as arrowroot, tapioca, sago, flours of all the different kinds of cereals (wheat, barley, oats, peas, beans, etc.), potatoes, carrots, beetroot, parsnips, turnips, and other edible roots.
Green vegetables, on the other hand, such as spinach, cabbage, turnip tops, Brussels sprouts, and lettuce need not be forbidden, as they contain too small an amount of starch to do much injury.
As for animal foods, on the other hand, every imaginable kind of fish, fllesh, and fowl may be indulged in, so that even on the most restricted diet the patient has still a large margin for selection — beef, mutton, pork, venison, poultry, game, and wild fowl, oysters, lobster, crabs, prawns, salmon, cod, turbot, etc., Iceland and Irish moss, calf's foot or gelatine jellies, butter sauces, and salad oils.
The only true hardship, in fact, the patient suffers is the deprivation of ordinary bread, and that appears to be a more severe one than most people imagine. I have known patients in whom the craving became at last almost intolerable, as if nature were crying out for some indispensable element of food. In order to mitigate this hardship, a great number of plans of depriving bread of the forbidden element, starch, have been suggested, and many of them have been in a great measure successful. Thus, we have bran, gluten, almond, and glycerine breads and biscuits constantly kept in stock by many of our London bakers, (a) After a time patients get very tired of these substitutes, so it is as well to know that we may occasionally indulge them with well done toast, or very crisp pulled bread, the extra heat having destroyed a considerable portion of the starch normally contained in the article.
As regards drinks, all such as contain saccharine matter are to be avoided ; such, for example, as sweet sparkling wines, whether they be champagnes, moselles, or hocks. An embargo is also to be put on all liqueurs and fruity wines, such as young port, RoussUlon, etc. ; sweet ales, stout, and porter are also to be shimned. If the patient is to be indulged in wines at all, let him have dry Lisbon, old Madeira, Manzanilla, or Amontillado sherries, Chablis, Niersteiner, or old Sauteme ; sound clarets may also be indulged in. "When stimilants are deemed requisite, brandy, whisky, rum, or Hollands may be used ; but these ought always to be employed with caution for the reasons previously given, when speaking of the artificial production of diabetes by means of stimulants introduced into the portal circulation. All that has now been said regarding regimen has of course only had reference to that form of diabetes arising from excessive formation. There are no restrictions either as regards food or drink requisite in cases springing from defective assimilation. On the contrary, the duty of the Practitioner is to select for his patient not only that which is most nourishing, but also that most easy of assimilation. He will often find, too, that such cases not only tolerate but even demand the free use of stimulants, in order to support the flagging vital energies, and enable the weakened organs to perform their work. I think if I were asked what is the best remedy for diabetes, I might venture to answer, in the language of Opie, when the student inquired what he mixed his colours with, "Brains, Sir." For to say that any one remedy or particular line of treatment is suitable to all cases of diabetes would be simply charlatanism of the worst sort.