Mary Middleton, Mt 30. Unmarried.

Admitted an In-Patient, March 15th, 1800:

Complains of a great flow of urine, especially during the night, which is of a pale colour, and has a smell, (according- to her own expression ) '"resembling sweet flowers". Thirst unquenchable^ with a dry hot skin, and at times, she feels intolerable heat in her stomach, and bowels.

The quantity of urine, from four to five quarts each twenty-four hours, and she believes it exceeds the amount of her drink.

Pulse 96 : appetite irregular, but never keen ; she has long laboured under dyspeptic complaints, with a disposition to hysteria.

It is about four months since she first noticed the violent thirst, and increased urinary discharge. Her occupation is weaving, and that in a damp cellar. Has suffered much from cold, hard fare, and distress of mind, the urine (examined by myself) is of a pale straw-colour, devoid of any urinous smell, has rather a grateful odour, and a faintish sweet taste, which the patient, upon tasting, compared to weak and new small beer. She complains, that at times, the discharge is nearly involuntary.

One pint of urine yielded on evaporation only 5iifs. of a dark-coloured extract, totally devoid of sweetness, but not strongly impregnated with urinary salts; the smell, at least, was only slightly urinous.

The quantity of water discharged the first twenty-four hours after her admission, amounted to eight pints, and a half; and the drink to six pints. An accurate register was ordered to be kept of the quantity of liquid ingesta and egesta, and the patient to be put upon a strict diet of animal food, with broths ; and to take opium with rhubarb, at bed time ; and the bark, with bitters, and vitriolic acid, three times in the day; when very low and faint, she was to be indulged with a little spirit and water ; and her bowels to be kept open with rhubarb and magnesia.

March 15th 1800

During this interval, the liquid ingesta and egesta have nearly balanced each other, and are both reduced in quantity; the average not exceeding six pints in the twenty-four hours, there is little change in the colour, taste, or smell of the urine. The patient's strength and spirits seem to be recruiting. As it was found, however, nearly impossible to restrain her from the use of tea, with bread (which she had contrived to procure by stealth) a sort of compromise was entered into, by which she was permitted to take it once a day; provided she would, in every other respect, confine herself to animal diet.

March 22-30th 1800

The symptoms have remained nearly stationary, except, that the quantity of urine, in some days, amounted to eight or nine pints, while on others, it did not exceed five pints and a half.

30th.. The patient complains of sickness, and indigestion her strength continues to increase slowly; and her general appearance is far from healthy. The medicines and regimen were repeated, an emetic was occasionally interposed to obviate indigestion, and a gentle purgative to remove costiveness.

30th of March–16th of April.

She has been gradually gaining ground, until within these few days, when the thirst and discharge of urine were both augmented; still the excess has always been on the side of the liquid ingesta : the register gives the following report.

April 13th. Drinks 9 pints, Urine 8 pints

April 14th. Drinks 9.5 pints, Urine 8 pints.

April 15th. Drinks 9 pints, Urine 8 pints.

April 16th. Drinks 10 pints, Urine 8 pints.

The bark, and other medicines, are ordered to be discontinued, and the hepatis ammonia (prepared according to Mr. Cruickshank's directions) to the amount of five drops three times a-day, and a bolus composed of alum, tinct. of cantharides, and opium, substituted in their place.

April 16th. — May 10th. During this period, the register points out only a very inconsiderable variation from the former report, with respect to the quantities of urine and drink: the qualities of the former, however, have been gradually approaching to a more natural state. The patient's strength, looks, and general health, have also improved. Medicines and diet to be continued.

May 10th, — June 5th. It appears from the register, that an extraordinary variation in the quantities of the liquid ingesta and egesta, had taken place, during this interval ; on some days, the urine and drink have each reached to only three pints and a half, while on others, they have amounted to seven pints ; and once so high as ten pints.

In order to promote a determination to the skin ( which was still harsh and dry ) she was ordered a warm bath, three nights a week. The first twenty-four hours from the patient's use of the bath (which produced a copious perspiration ) the urinary discharge was diminished from six to four pints and a half; but subsequent trials of this remedy, did not produce the same effects, and therefore it was discontinued. The hepatised ammonia having created nausea, and heaviness, it was laid aside; and the bark, with bitters and klum, in the form of whey, resumed. She was allowed bread and milk, with potatoes to her meat at dinner, and a little porter. This alteration in the diet, did not occasion any change in the quantity or quality of the urine, which amounted to six pints in twenty-four hours; but neither the colour nor odour, were completely urinous.

June 5-20th With the exception of making too large a quantity of urine, she may be now pronounced convalescent,' she is able to lie in bed without being disturbed more than once in the nighty her appetite is firm and regular, her spirits more cheerful, and her whole appearance, denotes a speedy return to a condition of health, equal to what she has generally enjoyed. Being herself persuaded of her entire recovery, she was very solicitous to be discharged. It was thought desirable however, for her to remain a week or two longer, for fear of a relapse; but all opposition proving vain, she was discharged cured on the 25th.

Remarks.

It is liable to doubt, whether this is to be considered an instance of the true diabetes mellitus. - The saccharine impregnation of the urine was certainly slight, and no signs of it were discovered in the residuum after evaporation ; which, in quantity, was inferior to what is usually obtained from this liquid, even in a healthy subject. One very important symptom indeed of well marked diabetes mellitus, was altogether wanting, viz. the voracious or canine appetite. In hysteria, and dyspepsia, to which complaints the patient was liable, great irregularity is observable, both in quantity, and quality of the urine ; but the changes are both sudden; and of short duration. The increased flow, and altered appearance of the urine, in hysteria, frequently disappear after the fit, and recur upon any fresh accession; and in dyspepsia, the least irregularity in diet will modify the urinary secretion in a surprising manner; but in the above case, the increased flow, and altered properties of the urine were permanent, and had existed with little or no taxation for months.

The defect in the assimilating powers does not appear indeed, to have been far advanced, as little or no sugar was apparent in the urinary residuum ; nor had there been a rapid wasting of the patient's flesh and strength. The powers of digestion seem therefore to have been more in fault, than the deficiency of the animalizing principle. That the animal diet greatly contributed to her restoration, can scarcely be doubted ; but in what degree, it is not an easy matter to ascertain. In the interval, from April 16th, to May the 10th, during the trial of the hepatised ammonia, the most evident, and material change, in the diabetic properties of the urine, and general improvement of the patient's health, were to be observed. The practice was certainly too complex to afford decisive evidence of the efficacy of this medicine, in subduing the saccharine properties of the urine. Its effects however in creating nausea, and injuring the appetite, prevented such & steady perseverance in its use, as might have led to a more decidedly beneficial result. This person has been removed from the neighborhood of Manchester, and I have been unable to learn any particulars of her subsequent state of health.