March 1, 1798
Robert Nixon's case of diabetes is treated by Dr Jameson who used Rollo's all meat diet to effect a cure: He readily entered into the plan of cure suggested there; which the Patient was desired to adhere to rigidly as far as concerned the regimen; being strictly forbidden to eat any vegetable food.
Cases of the diabetes mellitus: with the results of the trials of certain acids
From Doctor Jameson, Royal Artillery. Tynemouth, 1st March, 1798.
ROBERT NIXON, a Collier, belonging to the works at Benton, about six miles from this place, of a slender make, dark brown hair and complexion, aged 22, and whom I visited on the 29th of December, 1797 informed me, that about two years since, he was induced to work very hard in the damp coal pits, which, he supposes, exceeded his strength and abilities, from an anxious desire to support his aged parents; that he then used to sweat greatly while at work in the mine, and to drink at the same time very freely of cold water, having no opportunity of procuring other liquor. From enquiry, I have reason to believe that he was not addicted either to inebriety or excess in eating, previous to the attack of his present disease : ardent spirits, I was assured, he never tailed ; and no beer or ale-house being nearer his habitation on Benton Moor than two miles, he says he had neither inclination nor opportunity for procuring in the intervals of labour, the common, though perhaps ncceilary indulgence of malt liquor ; and that he feldom tailed it oftener than once a week, and never drank to excess. His food, previous to, and since his indisposition, has been milk, or weak tea, and bread, in the mornings and evenings ; fresh meat for dinner four or five times in the week, with a small proportion of vegetables ; at other times fresh or felted fish, and occasionally pork; the colliers rearing hogs about their huts, in the same manner as is done by the negroes in the West Indies. The bread that the poor people use in this county, is a mixture of about equal parts of second flour and rye meal, of their own baking, and generally unleavened. Since his sickness (at the same time that he has complained of constant thirst) he has also had a keen appetite, but I did not understand that it could at any time be termed voracious. He says he could eat heartily, and more than even himself thought prudent, as his food generally after eating lay heavy on his stomach, and, in his opinion, also increased his thirst ; but he very seldom rejected his food or drink. On the first attack he felt himself languid, and unequal to his customary exercise: had a particular weakness in his knees ; pain in his loins ; unpleasant dry sensation in the mouth and face, with frequent desire for drink; and in describing the progress of his complaint to me, he dwelt much on the excessive dryness of his skin, and entire want of perspiration from the beginnings which he was induced to take particular notice of, from having been remarkably disposed to sweat previous to his illness.
The debility, and other symptoms, obliged him to leave off work about 18 months since, and soon afterwards he put himself under the care of a Surgeon in the neighbourhood ; he also had the advice of a Physician in Newcastle. Previous to his application for medical assistance, he had not attended to the sweetness or increase of his urine, though I have no doubt but that these symptoms existed also from the beginning of his other complaints. The Physician and Surgeon whom he first consulted, pronounced his disease to be Diabetes, and put him under a course of astringents and the customary remedies. These he continued for some time, but with no permanent advantage ; he was therefore induced to discontinue all kinds of medicines for an interval of several months ; during which time his disease became gradually worse, and reduced him to a very feeble and emaciated state.
It was at this period of the disease, and after at least 8 months continuance, that he employed Mr. Burnet, (an ingenious young practitioner of the town of Shields) on the 10th of December, and I have been obliged to take the history of the symptoms and progress, previous to that time, from the patient himself, and his friends; as I have not the pleasure of knowing either of the two gentlemen under whose care he was at first, I have therefore endeavoured to be as accurate as possible in taking the minutes of the case before Mr. Burnet, in hopes they may tend to throw some light on the cause of the disease, or elucidate any circumstances connected with its future progress.
When Mr. Burnet first saw him, he made about 12 quarts of urine in 24 hours, (as measured by his sitter) of a straw colour and sweet taste. His appetite keen, and third exceflive, but the quantity drank during any particular period has not been hitherto ascertained. Bowels inclined to costiveness. Skin dry, and without perforation. He had oedematous swellings of his legs, and was so weak as to be scarcely able to walk across the room. Pulse about 80. Restless at night, with frequent headaches.
He was directed to take on the 10th a grain of opium every night at bed-time ; and as I had had an opportunity previously of conversing with Mr. Burnet on the subject of Diabetes, and giving him a perusal of your publication on that subject, he readily entered into the plan of cure suggested there; which the Patient was desired to adhere to rigidly as far as concerned the regimen ; being strictly forbidden to eat any vegetable food, and to be guided in that respect by the rules you have laid down. He was, however, at the same time ordered an astringent mixture of bark and alum, of which he was to take a spoonful frequently ; and this he continued until I saw him on the 29th. During the interval from the last to the 29th of December, a quart of his urine had been evaporated on each of the following days.
On the 12th, leaving three ounces of a thick . Saccharine extract, in smell and appearance like treacle. On the 20th, two ounces and a half of the same kind. On the 26th, two ounces ditto ; and on the 29th, one ounce and two drachms, evidently mewing a progressive degree of convalescence ; which was also confirmed by a very considerable abatement of all the symptoms; his third in particular had almost left him, and the quantity of urine was diminished to about two quarts in 24 hours. He said he had made 5| quarts the last three days and nights previous to the 29th, as measured by himself. (The extract was weighed by Mr. Burnet.)
On the 29th, when I visited him, though heartedly declared the great advantages of the plan he was pursuing, even in so short a time, he still, however, complained of considerable debility, some pain about his loins, and dryness of skin, with a degree of 26; of restlessness and headache ; but his third and appetite were so moderate, that he found very little self-denial necessary now in abstaining from much food or drink. His mixture had griped him, and occasioned a little sickness at stomach; I therefore advised it to be omitted; and the next day he took 60 grains of the kali sulphuratum, given in 10 grain doses, He was directed to have two small blisters applied to the region of the kidneys. The opium at night to be continued, with an occasional aperient, and to wear a flannel shirt next his skin consistently. The regimen of animal food, &c. to be very rigidly adhered to, and the quantity of liquid taken, as also his urine, carefully measured, and both it and the egeila kept for inspection.
On the 4th January, 1798
On visiting him again, I found the blisters had not been applied, but that he had taken the kali sulphuratum as directed; his skin cool and moist; pulse 79 ; says that he perspires much in the night time, and that his sleep is less disturbed; the flushing of his face, oedematous swelling of his legs, and temporary headache, have almost entirely left him, and he is gaining strength fail. One quart of his urine had been evaporated the day before, and the quantity of extract from it was an ounce. The smell and quantity of his urine little different from natural, and the quantity of the extract much the same as on the 4th. The kali sulphuratum had been omitted ; and though he has taken but very little of any hepatic or narcotic medicines, his progress towards recovery has been very rapid since the plan commenced; and the diminution of the quantity of the residuum lingular in so short a time.
January 16th. Found him not so well as I expected, the plan of cure having been deranged, and retarded confiderably, by the unfortunate circumstance of his brother-in-law (on the 11th) losing his leg, by an accident in a coal-pit; his dependence being entirely upon him, he could not now get proper and regular diet.
Mr. Burnet had also rather prematurely substituted a strong aromatic tincture, which I found him taking, and which might probably, with other circumstances, have tended to disorder his bowels, as he said he had a tendency to diarrhoea for some days past I proposed his taking an emetic and omitting the tinclure; but the emetic was not given him. The evaporation of his urine had also been neglected. He was much better, and the diarrhoea had ceased. The progress towards recovery is by no means so rapid as for some time prior to the 11th, though he appears to gain ground ; his skin moist; appetite and thirst moderate. One quart of his urine, on evaporation, yielded about an ounce of the extract as before.
He was under great depression of spirits, and unhappy from considering himself an incumbrance to his brother-in-law's family. Said he thought himself sufficiently recovered to work for his bread anywhere but in the pits, and would seek employment ; and as I saw this was likely to frustrate the hopes of a complete cure, I proposed taking him into the Artillery Hospital at Tynemouth, where he could have been very well accommodated in a room with the Hospital Steward; and attested him I would maintain him, and I hoped, complete his cure, without any additional expence whatever to himself or friends. The lad himself anxiously wished to embrace the proposol, but it was otherwise opposed; and on my calling again on the 24th February, I was informed, that he had gone to work in the mine again; but after a few days trial, finding his strength inadequate, and the disease gradually returning, he went to Burtley, near Chester Street, about 18 miles from this, where he hoped to meet with easy employment; and I have not had an opportunity of seeing him since.
I think from the great progress towards a cure, considering the time, there is no doubt but had the plan been followed up under more favourable circumstances, it would have terminated successfully. It was my Intention to have been guided entirely by the new theory of this disease, and to adhere strictly to the plan suggested by you ; but I could not get the gentleman who attended him, to abide entirely by it; and as Nixon had little assistance from medicine, the rapid progress at one time towards a cure, is therefore principally to be attributed to regimen, and the advantage of originally a good constitution. Previous to the attack of this disease, he had been a very healthy young man, without scrofula or other complaint, and accustomed always to the plainest and simplest food. The pain in the region of the kidneys ceasing soon after commencing the treatment, renders it probable they were not morbidly affected; and the sympathy or connection between the stomach and skin, in his disease, from the beginning, was remarkable.
Tynemouth 1ft July, 1798.
ON riding past Benton yesterday, I inquired after Nixon, and found he had returned, and been employed in the colliery there as a pitman, about nine days. His strength and appearance were greatly improved. He says, the only remains of his complaint, are some degree of weakness, and lassitude, particularly after working; he also makes rather more urine than when in his former health, which in quality is apparently natural. The edematous swellings of his legs, third, and other bad symptoms, have disappeared. On the whole, I consider him a successful instance of what the regimen suggested by the new theory of the disease can effect, even with little other assistance, when the constitution is originally good, and the habits of the patient not previously vitiated.