December 20, 1863
Dr Harley's second patient showed the similar type of diabetes of excess and was placed "on animal diet and gluten bread; no other treatment, After taking conia and cannabis indica during fourteen days; animal diet and gluten bread, as before." She experimented with more bread and potatoes but reduced them after her urine sugar was found to be as bad as it was 9 months before.
Diabetes : its various forms and different treatments
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The next case is that of a lady who also suffers from diabetes by excess. Before coining to me she had been under a gentleman connected with one of the City Hospitals, who treated her according to what has been hitherto considered the orthodox principles of restricted diet, upon which treatment she had thriven so well that when she walked into my consulting-room I never dreamt that she came to talk about herself, but imagined she came about the health of another patient with whom she had been to see me a short time previously. She looked, in fact, the very picture of health ; being plump, hale, and rosy. Like many patients in her position of life, she thoroughly understood the nature of her disease, and criticised the opinions of our first authorities on the subject in a manner which somewhat surprised me — especially when she finished by saying she had come to put herself under my care, not for the purpose of being dieted, but for the purpose of being able to live without being dieted. She was tired, she said, of gluten bread, etc., and wanted to live like other people. She had brains enough to see that dieting kept down the sugar, not by cujing the disease, but merely by stopping the supply, and that as soon as she gave up the restricted diet, back came all the disagreeable symptoms. On analysing the urine I found she was in as good a condition as restricted diet could make her; the quantity of urine passed was moderate, of a specific gravity of 1030, and the amount of sugar comparatively trifling, — 310 grains.
Diagnosing the case to be one of diabetes by excess, I honestly told her that although her case was one of the most favourable as far as longevity was concerned, it was one of the least satisfactory kind to put on ordinary diet. At the same time adding, that the treatment must, in the first place, be entirely experimental, it being impossible to say what remedy would most successfully allow her to dispense with dieting. The case so closely resembled the preceding in its general characters, that I ventured on the same line of treatment, and, as will be seen by the subjoined table, with a favourable result. The sugar gradually diminished, until at length, after seven months' treatment, the saccharine matter had entirely disappeared from the urine. Being too sanguine as to the result, in an unlucky moment I consented to the patient's throwing aside the restricted diet, and whether this was done too suddenly or not I cannot say, but certain it is, that before a month was over, the urine con- tained as much, and even more sugar than when iirst I took the case in hand. One very remarkable peculiarity of this case is the very Large amount of urea passed by the patient. A large quantity of urea is common to all diabetic cases, and especially to those on animal diet. Regarding the cause of the high percentage of urea in diabetes, the Rev. S. Ilaughton (a) remarks that it comes from the excessive decomposition of protein substance which takes place in this disease, quite independent of the amount of bodily work done. In a series of observations on two cases in XJniversity College Hospital, Ringer(b) arrived at the following conclusions : — 1st. That after the influence of food on the urine has entirely disappeared, a constant ratio is maintained between the sugar and urea. 2nd. That after a purely non-amylaceous and non-saccharine meal both the sugar and urea are increased, but that during this increase the same ratio between them is observed. This ratio being 1 of urea to 2-2 of sugar. 3rd. That under both these circumstances the sugar could only be derived from the nitrogeneous elements of the body, and, therefore, that some such ratio might, on a priori grounds, have been expected.