July 19, 1873
Cantani describes one of his most serious patients and thinks the rigorous meat-only diet cure would need to be done for 6 months to truly allow a mixed diet thereafter. Observations 71, 72, and the last one 73.
Diabetes Mellitus and its dietetic treatment.
OBSERVATION LXXI. - Mr. Cesare de S., 54 years old, owner in Catanzaro. Suffering from ardor in the mouth and from polyuria since 1871, took a treatment which was prescribed to him by Professor Villanova, and which consisted in the menu of Bouchardat, with iron and strychnine, and later of l 'Lactic acid; the morbid symptoms diminished following this long-followed treatment; on July 19, 1873, he still offered 30 gr. of sugar per liter of urine, the polyuria was 4 to 5 liters per day and the specific weight 1036. This patient affirmed to have always singularly abused mealy and fruits, but was not reached by diabetes until after the grief he had suffered. caused the death of his wife. He affirms, moreover, with all possible precision, that he did not begin to feel better, to gain in strength and in plumpness, until after having begun the use of lactic acid: he assures us that , with him, the absolute meat diet rather diminished general strength. After he had been subjected to my rigorous cure (in July 1873), the urine quickly got rid of the sugar, and on April 15, 1874, long after the patient had returned to the use of bread and pasta (albeit with a moderation very different from the abuse of the past), the urine had the specific gravity of 1.023, and the sugar was absolutely lacking in it, as Professor Primavera found; their quantity was perfectly normal. I had further excellent news from this patient later.
OBSERVATION LXXII. - Mr. Guiseppe Ti ..., 46 years old, notary in S. Elia Pianise (province of Molise), client of Doctor Colaviti, consulted me in May 1872; he had recent diabetes, weighing 50 to 60 g. of sugar per liter, and a polyuria of 3 to 4 liters per day. Subjected to my rigorous cure, after four days the urine was free of sugar; he returned, after having strictly followed the meat diet for two months, to a moderately mixed diet, and remained perfectly cured. - In this case, the diabetes had developed without any cause known to the patient, except experienced grief before having diabetes. But he experienced severe colds, and severe grief about two years after being cured of diabetes, and as, as a result, he experienced pain in his lower back and increasing general weakness, with swelling. legs and strong attacks of dyspnea especially during the night, he was afraid of a return of diabetes, and had his urine examined by Professor Primavera on September 18, 1874. The urine was found to be perfectly free from sugar, it weighed 1014, and were loaded with albumin (10 gr. per liter). From this it follows that a man cured of diabetes does not take it again, even after serious grief, provided that he does not abuse hydrocarbons again, even if, by other morbid causes, he has acquired , at that time, another disease. The following case cannot so far be given for a definitive cure; but in any case it deserves to be cited after the cured cases, because a cure (at least transitory) has been obtained in very difficult circumstances, and because, if the patient were prudent and wise, one could even to regard as assured a lasting cure.
OBSERVATION LXXIII. · Mr. Odoardo G., from Bologna, 22 years old, studying veterinary medicine. He says he suffered from polyarthritis for six months, during his teenage years, and after that he felt a stronger heartbeat. He had measles, smallpox, and intermittent fever. He abused Venus, tobacco and wine. He was very fond of starchy foods, and particularly sweets; of these especially he greatly abused. In September 1873, during the course of a slow disease of which he does not know how to specify the point of departure, he noticed that he was urinating enormously, that he experienced an extraordinary thirst and a great appetite, while he was 'significantly weakened and slimmed down. The analysis then showed the presence in the urine of a large amount of sugar. But already, a year and a half before, he was having fun, he himself said more to play than to calm his thirst, to drink 14 or 15 large glasses of gaseous sugar water; So it seems that the thirst was already increased. It should be noted, however, that four months before realizing his current illness, in about May, he fell while climbing a staircase and violently hit his occipital region: to believe that the disease had started slowly much earlier, especially since the patient, in the month of September, when we noticed the presence of sugar in great proportion in the urine, was already notably weakened and emaciated. On October 3, 1873, he entered one of the most important clinics in Italy. Put on the rigorous diet of the meat diet, the sugar completely disappeared after six days; but after various attempts to return to the ordinary diet, and especially several deviations from his diet, the sugar no longer completely disappeared. He left this clinic for good on January 9: returning to his old habits, he noticed an aggravation in all the symptoms, thirst, general weakness, manly impotence, weight loss. The maximum urine output in 24 hours during his stay in this clinic was, according to him, six liters. Having come to Naples, he was received at our clinic on January 19, 1874, exhibiting extraordinary weight loss, general weakness, virile impotence. In the somewhat asymmetrical thorax, there was a slight difference in the pitch of the sound on percussion, and in the prolongation of the expiratory sound. On the heart, a little enlarged, a very slight pericardial murmur: the spleen is enlarged, the liver is not accessible to touch. No other symptoms, no pain in the chest or the rest of the body, no cough, no feeling of worry; but hunger, thirst, and a lot of sugar in the urine. On January 20, he emitted 3 liters, 460 of urine which contained 100 g. of sugar per liter, i.e. 340 gr. per day; the next day he made 5 liters, 760 with 570 gr. of sugar in 24 hours. On January 23, he was put into treatment. From the first day, the urine was 1440 cc in quantity, with 60 gr. of sugar per liter, or 86 gr., 4 per day. The following days the quantity of urine remained normal, on average from 1 to 2 liters, with a high specific weight, between 1030 and 1034, while the quantity of sugar oscillated between 30 and 35 per thousand, between 40 and 70 gr. per 24 hours. On February 4, the first absolute fast of 24 hours was ordered, during which the sugar disappeared entirely: but it reappeared at a dose of 30 gr. per liter, as soon as the patient ate, even meat only. So they reduced her ration, and gave her a soft drink made with bicarbonate of soda of lactic acid, and 1/2 gr. Of potassium carbonate, in water: after this treatment with a reduction of half in the quantity of meat), the sugar fell on February 12 and 13 to the proportion from 1 to 2 gr. per liter. Some thoughtlessness committed from time to time brought it back to 20 per 1000. As the ration increased, the sugar returned to 30 gr. per liter, but a new fast on February 23 made it disappear again completely: the return to the ordinary ration of meat again made traces of sugar reappear, which increased day by day up to 5, 10 and 15 gr .; note that the highest figure was reached only when the patient smoked in secret; when he did not smoke, the sugar decreased, and stood between 4 and 5 gr. per 1000. These small quantities disappeared definitively on March 19, after the administration of pure potassium carbonate dissolved in water, for four days, at a dose of 4 gr. in 24 hours. Since then, the sugar remained absent, the quantity of urine was normal, and their specific weight oscillated between 1026 and 1014. Note that this patient, on entering the Clinic, weighed naked (with his shirt and underpants, and he was is always weighed with the same clothes):
January 19, 1874 ....... kil. 49,500 he first continued to lose weight and weighed, - January 21. the 24th the 29th February 2 ... the 4 kil. 48,900 48,600 48,300 48,000 47,500 ”after which it began to resume on February 7th. the 11 the 12 the 13 kil. 48,200 48,600 48,800 49,200 to decrease and descend on February 15 to ........ kil. 48,500 and return on February 20 to ..... . kil. 48,700 and go back down following diarrhea on February 22 to .... kil. 47,200 The weight rose quickly, so much so that it reached on February 23 ... 27 kilos. 47,800 48,800 and remained such for some time, with insignificant oscillations, after a purgation, it descended on March 8 to ...... kil. 47,500 oscillations which are largely understood by the fact that the intestine is more or less full. After the complete disappearance of sugar, the weight of the body gradually increased: we found >>> >> >> on March 19th. April 24 28 April 11. the 13th the 17th the 19th the 27th May 1st. the 5 the 6 the 22 kil. 48,200 48,700 49,300 49,600 49,800 50,100 50,700 51,000 51,700 51,900 52,700 53,100 >>) »» So that since February 22, the day of minimum weight, he had gained in three months of treatment, 5 kil. 900 gr. The temperature always oscillated between 36 and 37 ° C., the pulsations which initially were between 50 and 60, were maintained later between 64 and 72, sometimes going up to 80: the breaths were always between 20 and 24 Minute.
On May 20, this patient, who as a student had, since April, obtained permission to go out every day, suddenly presented sugar in the urine, 8 gr. per liter and per day. Although the patient affirmed that he had not eaten outside of the clinic, I learned that for several days he had been taking rum, which in Naples always contains a lot of sugar: we are willing to believe that he hadn't eaten anything else. In addition, he was struck with a stone in the chest in the street, and so violent that he was thrown to the ground unconscious, felt pains in the right subclavicular region, a region which had been directly struck: he also had a little fever with sonorous groans with small bubbles.
On May 21, the sugar had reached 10 gr. per liter, from the 22nd it dropped to 4g., on the 23rd and 24th it was maintained at 3g. to disappear on the 25th and remain absent until the 30th, the day when the patient escaped our supervision For more than 15 days this patient, according to his own confession, made when I presented him to my audience to take leave, was eating fresh beans (!), cherries, other fruits, and drank wine. Despite this the glycosuria had ceased. She had not yet reappeared at the end of July, the patient assured me in a letter, although for 12 days he had eaten not only green vegetables, but also milk, cheese and fruits (among which the sweeter ones, like pears, plums, etc.) and half-flour, beans , fresh peas, and eat them up to two kilograms per day (!). The circumscribed pneumonia had somewhat reduced the patient's weight: from 53kil, 1, maximum weight on May 22, it had gradually dropped to 51kil, 4, on May 28, to rise to 53kil, 2, on June 23.
In a patient as advanced as this one, I would not have allowed the return to the mixed diet, or even to the Bouchardat menu, before at least six months of rigorous treatment, after the disappearance of the sugar. - If I report this observation among the cases of cure and the last, I must make this reservation that I am in doubt about it: the cure is not final: it is too short a time since he returned to the use of milk and fruit, etc., and then he abuses them again. In any case, this patient has demonstrated that even very advanced diabetes can be cured when the cure is carried out with all its rigor (1). (1) As I correct the proofs, I receive a final note about this patient. In the second half of August, after further abuse of fruit and wine, this patient again noticed sugar in his urine, and by an approximate calculation evaluated it at 5 or 10 grams per liter. He suspended the use of fruit for a single day, and the sugar disappeared.
At the beginning of October, I received a letter from the father who told me: "For a month the sugar had reappeared following a new abuse of fruit and even bread: we knew afterwards that he had also abused liquors and pills containing vomit nut: he took eight in a single day, whereas he should only take two or three. This gave him a sharp intestinal inflammation, from which he died on September 28 ”. So he died of intestinal inflammation! (Author's note.)