Carnivore Diet

SECT. III

Of the appropriate Treatment of the Diabetes Mellitus.

THE principles of the treatment, as established by our cases of the disease, by the view we have given of the proximate cause, and we may further add, by the general success, consist;

1. In the prevention of the formation or evolution of the saccharine matter in the stomach.

2. In the removal of the morbidly increased action of the stomach and in its restoration to a healthful condition. 

Whatever may be the cause of the formation of the saccharine matter, it is necessary to prevent it, as on its general stimulus in the system, and particularly on the kidneys, very general affections are maintained. Besides, the means employed to prevent such formation may tend to the removal of the morbid action of the stomach and lacteal absorbents, and the increased and altered state of the gastric fluid, on which its production probably depends. Animal food, and confinement, with an entire abstinence from every kind of vegetable matter, afford the general means ; but which may be facilitated by the daily use of alkalines, calcareous and testaceous substances. The quantity of animal food should be restricted, and given in as small quantities as possible to satisfy the stomach : see page 54. 

When the urine points out the absence of the saccharine matter, and at the same time its quantity continues more than natural, containing likewise more of the extractive matter in a viscid, or tenacious form, while the appetite remains keen, it may be presumed that the increased morbid action of the stomach is not removed. It becomes then necessary to exhibit the hepatifed ammonia, with an opiate and antimonial at night, and to continue them until the morbid condition of the stomach is removed; the marks of which are, a scarcity and high coloured state of the urine, with turbidness, furnishing on evaporation an offensively smelling and saltish tasted residuum, without tenacity, accompanied with a want of appetite and loathing of food. At this time the tongue and gums will be found to have lost their florid colour, and to have become pallid. 

When such a state occurs, exercise is to be enjoined, a gradual return to the use of bread, and those vegetables and drinks which are the least likely to furnish saccharine matter, or to become acid in the stomach, with the occasional use of bitters, &c. Should this period of the disease be overlooked, and the confinement and animal food rigidly persevered in, scurvy, or something akin to it, might be produced. That such might be the termination of Diabetes, the appearances which arose, more especially in Captain Meredith's case, render extremely probable. The gripings, and offensive stools; the oiliness on the surface, and the high colour of the urine; the foetid breath and saltish taste; the great latitude and heaviness, with indifference to either eating, drinking, or moving; were strong marks of a state approaching to scurvy.

When the disease has continued long, it may leave local effects, which may prevent the entire restoration of health ; the most ample form of which might be supposed to consist in mere dilatation, or enlarged capacity of vessels, as those of the kidneys; or in a habit acquired by long continued action. Our first case shows, that these, when the disease has not been of very long duration, may be soon removed. They may, however, prove one of the circumstances retarding recovery in such a length of disease as that of our second case ; but even in this, the kidneys very early partook of apparently their ordinary action. Dissection has shown some morbid condition or derangement of the mesenteric or lacteal absorbent glands, and some altered appearance of the kidneys. There may also arise some derangement of stomach structure, of pancreas, spleen, liver, and possibly of lungs. Such sequelae would probably be sooner and more certainly formed in scrofulous habits. Whenever they occur, recovery must be retarded, if not finally prevented. They, however, will not interfere with the actual removal of the diabetic disease. We suspected some affection of the mesenteric glands, and of the stomach, in our second case; but we are warranted in alleging, that want of steadiness in the patient solely prevented the complete removal of the complaint. The nature of its sequelae, or whether they will remain, so as to maintain a state of chronic disease depending on them for its cause, requires still to be determined. Of this determination we must now continue entirely ignorant, as the patient from unsteadiness died, and was not examined after death. 

These are the general means of treatment, and they will be found adequate to the most common circumstances of the disease. We think it, however, necessary to particularise certain cases and states of the complaint. The former, are those of short, or long continuance, acute or chronic in degree; the latter comprehend the progress and fleps of recovery. It is necessary to attend to these distinctions, as they must direct the remedies and regimen to be employed. 

When the disease has been of short duration, an entire use of the animal diet may be immediately pursued, with an abstraction of all vegetable food and fermented drink which may have been formerly taken. In this state of the disease it may be acute arid then the diet should be spare; blood-letting and blistering may be necessary, with the use of opening and diaphoretic medicines. But when the disease has been of long continuance, especially in persons advanced in years, and whose habits have been luxurious in point of living, it may be proper to regulate the plan of cure by gradually adopting the animal diet: see the case of the Gentleman of 77 Page 179 and Dr. Stoker's continuation, page 253. 

On the removal of the general symptoms, and the return of the urine to a natural condition, which may be ascertained by a comparative examination with the healthy standard of it, as described by Mr. Cruickshank, vegetable substances may be cautiously tried. In the selection of which, the preference should be given to those least likely to furnish sugar, or excite disturbance in the stomach. The urine should now be very frequently examined, and on any appearance of a return of the diabetic state of it, the animal diet must be again strictly renewed. In this way the diet must be varied, until we are certain not only of the removal of the disease, but of the disposition to it. In the prosecution of the plan much steadiness and perseverance are required. We have to lament, that our mode of cure is so contrary to the inclinations of the sick. Though perfectly aware of the efficacy of the regimen, and the impropriety of deviations, yet they commonly trespass, concealing what they feel as a transgression on themselves. They express a regret, that a medicine could not be discovered, however nauseous, or distasteful, which would superfede the necessity of any restriction in diet. 

The vegetable substances we have hitherto found the safest, in the change from the animal diet, are, broccoli, spinach, cauliflower, cabbage, and lettuce. These do not seem to furnish sugar when prudently used in the diabetic stomach, after a proper adoption of the animal diet ; but under certain circumstances they have been supposed to produce an acid urine : see the Cases of Mess. Houston and Thomas. When these vegetables have been safely taken, a return to a very small quantity of bread has reproduced the saccharine matter in the urine, and the general symptoms of distress, as thirst, &c. It becomes, therefore, a principal object in the treatment, to vary the articles of diet, so as to gratify the earned desire of the patient, without bringing on a return of the complaint.

EXCLUSIVE of the cases of the Diabetes Mellitus, which have been published in this Work, we have heard of several others, particularly of one in Guy's Hospital, but we remain unacquainted with all the circumstances. Doctor Odier, of Geneva, mentions a cafe in the Bibliotheque Britannique, vol. vii. p. 321, and vol. viii. -p. 168. Doctor Wilmot, at Hawkehurft, in Kent, has also had a case under his charge ; and Doctor Yeats, at Bedford, informs us of a patient he has successfully treated by the animal food; but as he intends to communicate an account of it, we defer any detail. Doctor Beddoes has very lately mentioned to us four cases of the disease, one of which has been cured by the diet alone. He observes, “that in one case, he endeavoured to please the palate by recommending occasionally articles of food, as nearly resembling dishes made of the farinacea as possible. Tripe, fried in a certain way resembles pancake. Buttered eggs offered an agreeable variety. He also advised a method of trying to reduce dried fish and flesh into a kind of flour. These culinary considerations are extremely important; and he has no doubt a diet might be contrived under which patients would feel little privation." We have likewise received indistinct accounts of four cases of the disease in London and its neighbourhood. There is, besides, one which Doctor Marcet has visited. In order, therefore, to show the necessity of attending to this peculiar disease, which has been hitherto deemed uniformly fatal, we shall recapitulate the number of cases we have either seen or heard of since the dispersion of the notes of Captain Meredith's cafe in January 1797-

• Captain Meredith's Cafe — Page 17:    1

• General Officer's do. — Page 63:           1

• Cafes in Chap. II. Sect. I. — Page 142: 10 and upwards

• Cases in Chap. II. Sect. II. Page 237:     23

• this Appendix:                                                 13

• Total:                                                                    48 and upwards

Along with this number may be examined the account of cases given in the third Chapter, p. 356, being those described previous to that of Captain Meredith. From the whole it will appear, that the disease occurs more frequently than has been generally supposed; and of course, its discussion claims the attention of the medical enquirer. It also is entitled to it in another point of view, as tending to illustrate many other complaints depending on a morbid affection of the stomach, and constituting the most troublesome of our chronic diseases.

Case I.

Benjamin Piggin, Weaver, Mt 40.

Admitted an In-Patient, August 26th, 1799.

Complaints of a troublesome coughs pain in the right side and considerable thirst. Has gradually lost flesh and is so far debilitated as to be unable to follow his employment; pulse 102. Body somewhat costive, appetite not much impaired. Considering this to be a case of incipient Phthisis; digitalis, opiates, a blister, and milk diet, were prescribed.

27th. Cough easier, pain in the side abated, and the pulse reduced to 90.

31st On examining the patient more minutely, on account of his extreme debility, and emaciation, ( which far exceeded what might have been expected to arise from the symptom already enumerated) he then, for the first time, mentioned having noticed a large increase in the quantity, and change in the quality, of his urine. Its peculiar smell first led him to discover, that it had a taste like honey. He had undergone various hardships, and had been addicted to dram drinking; but his health had sustained no material injury until about three months ago when he suffered exceedingly from a harassing journey out of Norfolk, on foot, during wet weather ; and which he considered as the origin of his present malady, Upon examining the urine, it was found to be of a pale straw color, and had a sweet taste, and faintish violet odour. The quantity varied, from six to eight pints, in the twenty-four hours, according to the amount of the liquid he drank. His mouth was clammy, skin hot, and rather dry, and his countenance expressed great anxiety. He could give no account of the exact time when the diabetic symptoms first appeared, but supposed it was about a month since he first noticed the sweetness of his urine.

Having at this period been casually informed, by a medical friend, of the great advantage derived from a strict adherence to animal diet, in the case of diabetes, recorded by Dr. Rollo; I ordered the patient strictly to abstain from bread and vegetables of every kind, and to live solely on broth and animal food. A bolus, composed of five grains of rhubarb, with one grain of opium, was ordered every night, and live grains of asafetida, and ten grains of extract of bark, made into pills, three times a-day.

September 3rd. Pulse 96. thirst and clamminess in the mouth abated makes less urine during the nighty and his sleep is longer and more refreshing.

3rd-6th. Continues to improve in strength and general health makes less urine, which he is confident is not so sweet as usual.

9th. Complaints of spasms in the stomach and bowels with a sense of emptiness and sinking, is much troubled with eructations, and feels great distaste to his animal food, but is persuaded rigidly to persist in its use. Tinct. Ferri mur. ordered along with his other medicines.

11th. The spasms in the stomach not having yet disappeared, three grains of the Extractum cicutce were joined to each dose of the pills. His appetite is become more regular, and his urine neither so sweet, nor so much in quantity.

18th. The spasms in his stomach are much relieved, his strength and looks improved, he has gained flesh considerably within the last week, and the diabetic symptoms have nearly vanished. He says his urine has lost its sweetness; and does not equal the amount of his drink. He can now sleep during the night without a call to make water, and estimates its quantity from three to four pints daily. He was put upon the common diet of the house, and ordered to continue the use of his medicines.

27th. Has gradually improved in his strength and appearance, and is ordered to be discharged cured, at the next weekly board.

Remarks.

This appears to be an instance of diabetes mellitus, under its mildest form. There was neither canine appetite, extreme dryness and harshness of the skin, nor acid taste, and viscid appearance of the saliva, as in the severe, and more strongly marked cases of diabetes. Perhaps the emaciation, and feverish heat, may in part be attributed to the pulmonic affection, which had preceded, and still accompanied the diabetic symptoms. The history of the case must indeed be considered as incomplete, for the urine was not evaporated nor its residuum examined and no regular method was adopted to ascertain the quantity, and relative proportion of the ingesta and egesta; still however, from the colour, taste, and smell of the urine, and its increased quantity, no doubt can be entertained of the nature of the complaint. I have no reason to suspect the patient of either error or falsehood in the description of his symptoms, nor of irregularity in his attention to the sole use of animal diet. It is to this regimen I would attribute the speedy recovery of the patient; but at the same time it must be admitted, that the phenomena of the disease were not so accurately ascertained, nor the practice sufficiently uniform and simple(My knowledge of diabetes at this time, was very limited, and I had not been fortunate enough to meet with Dr. Rollo's interesting publications.), to admit of a positive inference, as to the efficiency of animal diet, in curing this patient. For it may be contended, that such powerful remedies as bark, opium, steel, and cicuta, are adequate singly, but especially if combined, to the removal of a slight diabetic affection. My own subsequent experience, however, and the frequent failure of tonics and antispasmodics, in counteracting this disease, especially when the saccharine impregnation of the urine had existed for any length of time incline me to ascribe the success, in this case,  to the effects of abstinence from vegetable, and the employment of animal diet. No doubt the other remedies proved useful in restoring the tone of the system, and relieving occasional symptoms. The cicuta was evidently beneficial in allaying the spasmodic affection of the stomach and bowels; which, more or less, is to be met with in every instance of genuine diabetes. As I was informed of the patient's intention to return into Norfolk, I obtained a promise from him, that in case of a relapse, he would acquaint me with the fact, and enter into some particulars of his health. I have heard no tidings of him, and therefore am willing to hope, that he has remained free from any diabetic complaint.

Ancient Buffalo Hunt

It’s a Great Day to Hunt Buffalo

Runs-With-Fire and Small Bear stood warming themselves over the cooking fire alternately rubbing their hands together and then rubbing their chest and arms.  It was cold outside, but not as cold as it had been just a few days ago.  Neither spoke as they watched the smoke figures dance in the tipi and then escape through the hole in the center of the lodge.  The two, friends since their youth, and now the best hunters of their people had spent the early morning scouting for sign of a return of the great herds.  By instinct they knew that as the days grew longer it would soon be time to jump the Buffalo. Small Bear and Runs-With-Fire now talked trying to decide who in their tribe they should take to help them lead the big spring hunt.  A large hunt in the spring and another one in the fall kept the people alive, and choosing the right people could decide weather the tribe lives or dies.  This spring hunt would be the most important in their lifetime as the starving time (winter) had come early and many in the tribe were ill or weak from lack of food. Several days had passed and Runs-With-Fire and Small Bear knew it was time. The two stood stoically at the Tipi opening, enjoying the warm morning sun, and greeting the five hunter-warriors they had selected be hunt leaders.  Each of the five were chosen because they had proved themselves and each had a special skill, like White Weasel, selected for his cunning and stealth and Wind-At-Night selected because of his superior vision and hearing.  Although it was an honor to be chosen each knew it was a time for great seriousness and careful planning.  All of this made the selection of the sixteen-year-old Smiling Dog a mystery to the others because he seemed to be always joking and laughing but they would admit that he could throw his hunting spear farther and more accurately than any one else in the tribe.

This was a time long before the whites had come to the west and a time when the British still ruled America.  This was a time when the natives of western America ranged free without horses, living season-to-season and year-to-year.  This was a time when these seven men, none more than thirty yeas of age held the lives of their four hundred fellow tribe members in their hands.  This was a time when life was hard, life was easy, life was sure and life was unsure.  This was a time when the American Indian reigned supreme in his part of the world, the American West.

After three hours of smoking, offering prayers, burning the sweet grass and much planning for the upcoming hunt the council of seven was ready.  Each of the seven picked two or three warriors to help with their part of the hunt, the rest of the tribe would wait nearby until they could hear the awful chunking sound as the buffalo hit the canyon bottom.  When the sound came they would hurry to the area and begin the tedious skinning and butchering of the dozens of animals.  The hunt plan was simple, the same as the ancients had used, run the buffalo off the cliff, kill the cripples, and collect the meat.  The council could only hope that the kill would be that easy.

As the buffalo ranged ever closer to the jump sight the council and their helpers worked feverishly to repair the rock wall that would help turn the shaggy beasts into the cliff and into a six months supply of food for the tribe.  No member of the tribe could remember the original building of the wall; it was so long ago that none of their stories or songs told of it.  The tribal elders simply said it was built before “the sun brought light and warmth to the people”.

The jump sight had not been used in many years because the people always let the wind and rain and the seasons scrub the area clean of all scent and color related to a kill.  Now the time was right and the buffalo were close.  This night all of the tribe would sing and dance the buffalo dance around the fire tomorrow would be a good day!

A dreary gray March morning arrived but it didn’t dampen the spirit of the council because today was the day, Buffalo jump day. Theircamp was nearly an hour’s walk from the jump sight and the warriors left well before the first sight of light in the sky.  They walked by instinct in complete silence until Wind-at-Night stopped them with a barely audible shee, shee.  Wind-At-Night could smell the great heard as it had moved closer to their camp and farther from the jump sight.  Runs-With-Fire and Small Bear looked at each other and smiled, the buffalo were not where they had expected but it still would be a good day because they had prayed and danced around the fire last night and the buffalo were waiting.

In a matter of a few short minutes White Weasel let out the low cry of a morning dove telling the others that he and his three helpers were in place, just behind the herd.  They were crawling now within a few feet draped in wolf skins with the buffalo completely ignored them.  When the spear from Smiling Dog landed almost silently beside them Gray Antelope and Old Tree lit their torches and the torches of the four warriors with them from the hot coals they carried in a hollow buffalo leg bone.  The buffalo started to snort and move away startled as much by the men as by the fire.  But it was too late.  White Weasel and his followers were on their feet wildly swinging the wolf hides in the air and screaming pushing the herd forward.  The prairie was being lit on fire beside the hairy beasts and the buffalo were now starting to move away from the fire and away from the wild wolf men but the rock wall blocked the other side.  Panicking the buffalo stampeded over the cliff to what they thought was freedom and in some strange way it was.

The old people sang as they skinned and butchered the pile of buffalo flesh, assuring themselves health, wealth and shelter for many moons.  It was a great day!

Good Night.

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.