Hippocrates (460-377 B.C.) made no mention of any condition clearly recognizable as diabetes. A notion concerning the quantity of urine, in a passage translated by Richardson from the third book of the Epidemics,” is like that of Celsus, but the first known recognition of diabetes occurred at about the height of the Roman power.
Aulus Cornelius Celsus (30 B.C.–50 A.D.) wrote as follows:
“When urine, even in excess of the drink, and flowing forth without pain, causes emaciation and danger, if it is thin, exercise and massage are indicated, especially in the sun or before a fire; the bath should be infrequent, nor should one linger long in it; the food should be con stipating, the wine sour and unmixed, in summer cold, in winter luke warm; but everything in smallest possible quantity. The bowels also should be moved by enema, or purged with milk. If the urine is thick, both exercise and massage should be more vigorous; one should stay longer in the bath; the food should be light, the wine likewise. In each disease, all things should be avoided that are accustomed to increase urine.”
In this compressed passage, Celsus gives the first description of diabetes, introduces an error (fluid output greater than intake) destined to endure eighteen centuries, and touches some modern treat ment. It is not known to what extent this knowledge was original with Celsus or handed down by predecessors. At any rate, the recog nition of the disease was so new that it had not yet received a name.
Aulus Cornelius Celsus (c. 25 BC – c. 50 AD) was a Roman encyclopaedist, known for his extant medical work, De Medicina, which is believed to be the only surviving section of a much larger encyclopedia. The De Medicina is a primary source on diet, pharmacy, surgery and related fields, and it is one of the best sources concerning medical knowledge in the Roman world. The lost portions of his encyclopedia likely included volumes on agriculture, law, rhetoric, and military arts. He made contributions to the classification of human skin disorders in dermatology, such as Myrmecia, and his name is often occurring in medical terms about the skin, e.g., kerion celsi and area celsi.
Aretaeus of Cappadocia (30–90 A.D.), living under the emperor Nero, and writing in Ionian Greek, was the second to describe dia betes, and the first known to have called it by the name (6taffaively, to run through; Śwaffhrms, a siphon). In a passage translated by Schnée", Aretaeus outlines some of the principal symptoms, the progressive course, and the fatal prognosis. He anticipates modern conceptions of a failure of assimilation, conversion of tissue into urinary products, and possible origin of some cases in acute infections. He was retro grade in treatment, for he advised a non-irritating diet of milk and carbohydrates, and hiera, nardum, mastix, and theriak (opium?sugar?) as drugs. He is commonly credited with being the first to regard diabetes as a disease of the stomach; but his vague notion of a dis order akin to ascites hardly entitles him to a claim upon this false idea which was productive of so much truth in the period from Rollo to Cantani.
“Diabetes is a strange disease, which fortunately is not very frequent. It con sists in the flesh and bones running together into urine. It is like dropsy in that the the cause of both is moisture and coldness, but in diabetes the moisture escapes through the kidneys and bladder. The patients urinate unceasingly; the urine keeps running like a rivulet. The illness develops very slowly. Its final outcome is death. The emaciation increases very rapidly, so that the existence of the patients is a sad and painful one. The patients are tortured by an unquenchable thirst; they never cease drinking and urinating, and the quantity of the urine ex ceeds that of the liquid imbibed. Neither is there any use in trying to prevent the patient from urinating and from drinking; for if he abstains only a short time from drinking his mouth becomes parched, and he feels as if a consuming fire were raging in his bowels. The patient is tortured in a terrible manner by thirst. If he re tains the urine, the hips, loins, and testicles begin to swell; the swelling subsides as soon as he passes the urine. When the illness begins, the mouth begins to be parched, and the saliva is white and frothy. A sensation of heat and cold extends down into the bladder as the illness progresses; and as it progresses still more there is a consuming heat in the bowels. The integuments of the abdomen become wrinkled, and the whole body wastes away. The secretion of the urine becomes more copious, and the thirst increases more and more. The disease was called diabetes, as though it were a siphon, because it converts the human body into a pipe for the transflux of liquid humors. Now, since the patient goes on drinking and urinating, while only the smallest portion of what he drinks is assimilated by the body, life naturally cannot be preserved very long, for a portion of the flesh also is excreted through the urine. The cause of the disease may be that some malignity has been left in the system by some acute malady, which afterward is developed into this disease. It is possible also that it is caused by a poison con tained in the kidneys or bladder, or by the bite of the thirst-adder or dipsas.”
Total Dietary Regulation
Claudius Galenus makes errors in explaining diabetes which retards progress in knowledge for 1500 years.
Claudius Galenus (born 131 A.D.) saw two patients and introduced two ideas: first, that diabetes is a weakness of the kidneys, which can not hold back water and also are thirsty for fluid; second, that the urine consists of the unchanged drink. Galen's great authority maintained these errors for about 1500 years, and retarded progress in the knowl edge of diabetes.
Total Dietary Regulation in the Treatment of Diabetes
Tchang Tchong-king, the greatest of Chinese physicians, describes diabetes in the year 200.
Chronological order here shifts the narrative to the Far East. According to Iwai, the first oriental description of diabetes was given in the year 200 by Tchang Tchong-king, perhaps the greatest of Chinese physicians. “There is a disease called ‘the disease of thirst,’ in which polyuria is the characteristic symptom. One may drink as much as ten liters per day, which is recovered in the urine.”
Claudius AElianus His Various History
Ancient Spartans would only eat flesh, and their black broth was made of animal blood.
Claudius Aelianus, a Roman author and teacher of rhetoric who lived between c. 175 – c. 235 AD, wrote in his "Various History":
"The cooks at Lacedemon might not dress anything but flesh. He who was skilled in any other kind of cookery was cast out of Sparta. Son of Polybiades, for being grown too fat and heavy through luxury and idleness, they took out of the public Assembly, and threatened to punish him by banishment, unless he altered that blamable and rather Ionic than Laconic course of life: For his shape and habit of body was a shame to Lacedemon and our Laws". - Source
"The dish that was in the highest esteem among the Spartans was called melas zomos, or "black broth" a name which has long excited the curiosity of the learned. What were the precise ingredients of this mess has never been determined with certainty. We remember an old traveler, who, on observing the use of coffee for the first time in the East, conjectured that it was the black broth of the Lacedaemonians! Julius Pollux the preceptor of the Emperor Commodus in his "Onomasticon" says that this famous mess consisted of blood thickened in some particular way. Dr. Lister in his "Notes to Apicius" supposes it was hog's blood; and if so the dish must have had no remote resemblance to the black puddings of our own times. Whatever it was, it could have formed no very alluring dish. We are informed that a citizen of Sybaris having tasted their fare, declared that it was no longer astonishing to him that the Spartans should be so fearless of death in battle, since any one in his senses would much sooner die a thousand deaths than continue to exist on such miserable food. Plutarch relates that a king of Pontus having heard of this celebrated broth purchased a Lacedaemonian cook to make some of it for him. But when he came to taste it he expressed his detestation of the mess in very strong terms on which the cook observed, "Sir, to acquire a relish for this broth it is necessary first to bathe in the Eurotas;" meaning that the hardy habits of the Spartans gave a zest to this fare which it could not otherwise possess. The same writer informs us that the old men were so fond of it that they ranged themselves on one side to eat it leaving the meat to the young people". - Source
Nowadays, it is believed that melas zomos was made of boiled pigs' legs, blood, salt and vinegar. It is thought that the vinegar was used as an emulsifier to keep the blood from clotting during the cooking process.
A Chinese medical work of about the year 600 classifies four supposed groups of cases of diabetes.
The earliest mention of the sweetness of diabetic urine is contained in the Ayur Veda of Susruta, dating from the sixth century. The disease bore the distinctive name of Madhumeha or honey-urine." Thus the most prominent clinical feature, and one of the most widely supported modern hypotheses concerning etiology, received their first mention in India. But Hindu medicine failed to advance beyond this beginning, and exerted no influence on progress elsewhere.
A translation by Chunder Bose is as follows: “Madhumeha is a disease which the rich principally suffer from, and is brought on by their overindulgence in rice, flour, and sugar. The patient feels weak and emaciated, and complains of frequent micturition, thirst, and prostration. Ants flock round his urine. Carbuncles and phthisis are its frequent complications.” For other quotations, see Christie.
A Venetian named Trincavella observes three cases of diabetes and thinks the sweet taste of pee is from the sweet drinks.
Trincavella (1476–1568), a Venetian, observed three cases of dia betes. In one, the etiology was attributed to persecution and grief. In another, the relatives are said to have demonstrated the truth of the Galenic doctrine that diabetic urine is the unchanged drink, by fre quently tasting the urine and finding the taste identical with what the patient had been drinking. Cantani suggests that the drink in this CaSe Was SWeet tea.
About the fifteenth century, diabetes was attributed to wine and high living.
"In 1674, Thomas Willis treated diabetes by recommending a diet high in sugar, in order to replace the sugar being leaked by the kidneys, thereby inadvertently hastening patients’ deaths." via David Haslam
"Thomas Willis pensively sipped from his glass. It was sweet, even a little delicious. In 1674 the Oxford University physician was far from the first doctor to taste urine, but he was the first Western doctor we know of to connect the sweetness of urine to the condition of its owner, a person suffering the effects of diabetes. Willis was baffled by his findings and recorded his experience in Pharmaceutice rationalis: “But why that it is wonderfully sweet like sugar or honey, this difficulty is worthy of explanation.” Sickening Sweet
Arcana Coelestia (Heavenly Arcana)
Emanuel Swedenborg writes religious doctrines that advocate vegetarianism
Eating the flesh of animals, considered in itself, is somewhat profane; for in the most ancient times they never ate the flesh of any beast or bird, but only grain . . .especially bread made of wheat . . . the fruits of trees, vegetables, milks and such things as are made from them, as butter, etc. To kill animals and eat their flesh was to them unlawful, being regarded as something bestial. They only took from them uses and services, as is evident from Genesis 1, 29-30. But in the course of tiume, when mankind became cruel like wild beasts, yea more cruel, then first they began to kill animals and eat their flesh. And because man had acquired such a nature, the killing and eating of animals was permitted and is permitted at the present day. -Heavenly Arcana
Michaels recounts that William Heberden, one of the “most learned physicians of the day,” presented the first properly recorded cases of chest pain to the Royal College of Physicians of London on July 21, 1768. The afflicted “are seized, while they are walking . . . a painful and most disagreeable sensation in the breast, which seems as if it would take their life away if it were to increase or to continue.” These attacks would continue for months, or even years, until the final blow came. Heberden called the condition angina pectoris (severe pain of the breast) (Michaels 2001, 9).
A History of Diabetes Mellitus or How a Disease of the Kidneys Evolved Into a Kidney Disease
Robert Wyatt demonstrates that sugar is in the blood and urine of diabetics.
"The demonstration of sugar in the blood and urine of diabetics by Robert Wyatt in 1774"
Experiments and Observations on the Urine in Diabetes.
Dobson showed that the sweetness of urine is caused by sugar, which he quantified and showed to be subject to alcohol and acetate fermentation, and that its appearance in the urine is preceded and accompanied by a similar sweetness and sugar in the blood, albeit not as much as that detected in the urine.
"Nevertheless, it was the simple observation of Willis that gave the disease its new name “diabetes mellitus,” but it was more than a century later that his argument was substantiated by the demonstration of sugar in the blood and urine of diabetics by Robert Wyatt in 1774 and subsequently by the more thorough studies of Matthew Dobson (1732–1784), who had a fairly good of knowledge of chemistry. In 1776, Dobson showed that the sweetness of urine is caused by sugar, which he quantified and showed to be subject to alcohol and acetate fermentation, and that its appearance in the urine is preceded and accompanied by a similar sweetness and sugar in the blood, albeit not as much as that detected in the urine. Diabetes now came to be viewed as a disorder of nutrition in which sugar accumulates in the blood and is excreted in the urine. This was to launch a whole new approach for the dietary treatment of diabetics and with it a shift to the digestive organs as the site of the disease and more specifically to the absorption of “saccharine matter” in the stomach."
John Rollo by Alexander Marble
Dr Rollo finds a case of Diabetes Mellitus in a weaver in Edinburgh
"In the year 1777 ... I saw a case of the Diabetes Mellitus in a weaver at Edinburgh. He had been at least four months in the Royal Infirmary without having derived any advantage, and was chiedy under the care of the late Dr. Hope, Professor of Botany. When the patient was discharged, a Mr. Johnstone, then a Student of Physic, and myself, detained him a few days, and paid his expenses, in order to bleed him, and obtain some of his urine, so as to ascertain the appearances and spontaneous changes. I well remember that the blood and urine exhibited the appearances discribed by Dr. Dobson; but the papers, and a portion of the saccharine extract which I carried with me abroad, were lost in the hurricane at Barbados in 1789."
John Rollo by Marble
Mr. Cruickshank turns 36 ounces of diabetic urine into honey.
Rollo, with the aid of Cruickshank, carried out laboratory studies with his patients to ascertain the results of treatment and to elucidate the nature of diabetes. The fluid intake, urine output and the body weight were determined. The urine was tasted to indicate the presence of sugar and subjected to experiments before and after evaporation to determine its chemical composition and content of sugar. At the beginning of treatment when Captain Meredith was passing up to twelve quarts of urine in twenty-four hours, the following notes were made:
"Mr. Cruickshank took 36 ounces troy weight of urine voided today, and it yielded by evaporation three ounces and one drachm of saccharine extract, of the appearance of molasses, but thicker, having nearly the consistence of wax, and somewhat tenacious. If, therefore, the whole of the day's urine had been evaporated it would have yielded about 29 ounces troy weight, an astonishing quantity to be formed and seperated form the system. By standing in the air it became moist, and of nearly the consistence, smell and appearance of treacle."
"Treating some of this extract with the nitrous acid, he procured the saccarine or oxalic acid; and with a smaller proportion of the acid it produced a substance, which in resemblance, and smell, could not be distinguished from honey."
Observations on the Diseases Which Appeared in the Army at St. Lucia in 1778 and 1779. To Which Are Prefixed Remarks, Calculated to Assist in Explaining the Treatment of Those Diseases. With an Appendix, Containing a Short Address to Military Gentlemen on the Means of Preserving Health in the West Indies
Dr Rollo, who later recommended a meat diet, writes 20 years earlier while stationed in St Lucia, that the civilized town Carenage with sugar production had far greater disease than the fishing village of Gros Islet and attributes it to a difference in diet.
in the fourth chapter the author describes the situations of the island, in which the men specified in the table were fixed, and endeavours to determine which are the most healthy. For this purpoSe he gives a comparative view of the health of the natives compared with that of the troops.
He observes, that "at Carenage-town the People are:
have annual attacks of fever,
yellow and meagre countenances,
small legs, except when eedematous,
so that they have the appearance of persons worn out by disease.
At Gros Met, we are told:
the inhabitants live longer,
are not fo subject to disease, at least not the same degree or duration,
and that they are fuller in the face,
and more hearty.
At Souffrir the inhabitants have:
and nearly in a state of health with those of Gros Islet,
but this, our author thinks, may be attributed to a better diet rather than situation. "
On the extensive plain to windward of this place very few diseases appear, and they are mostly internments : the countenances here of the women, of the children, and even of the men, have some degree of resemblance to those of the European, the female has the red on her cheek, and the child has all the marks of health.
Carenage, formerly known as Le Carenage, is one of the most popular bays located in west Trinidad. This bay, which is a famous sea bathing and liming area, got its name out of the practice of "careening", or cleaning out the waste materials in sea vessels, which was carried out in the area for centuries.
Initially, Le Carenage was the name given to the river flowing into this bay as well as the valley were the river flowed.
The Carenage valley, possibly because of its extremely fertile soils was essentially an agricultural area where crops sugar-cane, cotton and coffee were grown. In fact, the area contained ten sugar mills, five rum distilleries and a workforce consisting of 607 enslaved Africans and 131 'free' people of colour. Owners of the estates comprised of 19 families (64 whites), including the Dumas, Noel, Dert, Mercie families.
Gros Islet (English: Large Island) is a community near the northern tip of the island country of Saint Lucia, in the Gros Islet Quarter. Originally a quiet fishing village, it has gone on to become one of the more popular tourist destinations in the country.
Who were the Carib? - Possibly a carnivore population.
The Carib Indians were primarily fishing people. They took to sea in their long canoes to catch fish, crabs, and other seafood. Hunters also shot birds and small game. In some Carib communities, farming was an important food source, with cassava, beans, squash, and peppers being grown. Other Carib groups did little farming and acquired peppers and cassava through trade or raiding.
Diabetes It's Medical and Cultural History
Dr Rollo meets Captain Meredith and explains the meat diet to cure diabetes.
"From that period I had not met with a case of Diabetes, although I had observed an extensive range of disease in America, the West Indies, and in England, until 1796." "Captain Meredith, of the Royal Artillery, being an acquaintance. I had seen him very frequently, previous to his going on camp duty in 1794, but then he had no disease; however, he always had impressed me, from his being a large corpulent person, with the idea that he was not unlikely to fall into disease. (Editor: Another instance of Rollo's clinical acuteness.)" "On the 12th of June, 1796, he visited me, and though I was at once struck with the diminution of his size, yet, at the same time, the colour of his face being ruddy, I received no impression, otherwise than of his being in health: a moment's conversation, however, convinced me of the contrary ......
"He complained of great thirst and a keenness of appetite; his skin was hot, dry and parched; and his pulse small and quick. He told me his complaints had been attributed to an old disease, and a liver affection. The thirst, dry skin, and quick pulse, marking a febrile state, depending probably on some local circumstance, and connecting these with the keenness of appetite, Diabetes immediately suggested itself to me. I enquired into the state of his urine, which I found in quantity and colour to be characteristic of the disease; and was at the same time much surprised, that for the two or three months he had been under the care of a Physician and Surgeon, the circumstance of the increased urine had not been known to them. The patient told me, as he drank so much, the quantity of urine had appeared to him a necessary consequence; and of course never having been asked about it, he gave no information. I directed him to keep the urine he next passed, and, on examination, it was found to be sweet; in consequence of which the disease became sufficiently ascertained."
At another point in the case history, Rollo states that Captain Meredith was 34 years of age and was 71 3/4 inches tall. At the time of beginning of the special treatment, the symptoms of diabetes had been present seven months or more and his weight had fallen from 232 to 162 pounds. A view held by some at that time was that diabetes was a primary affection of the kidneys. However, Rollo developed the idea that the disease was "a primary and peculiar affection" of the stomach in which, due to some morbid changes in "the natural powers of digestion and assimilation," sugar or saccharine material was formed in that organ, chiefly from vegetable matter. It was on this basis that he advocated the use of an animal diet together with certain medication designed to quiet the overactive stomach and to diminish the appetite.
Following initial bloodlettings, Rollo's treatment of Captain Meredith was as follows:
"1st. The diet to consist of animal food principally, and to be thus regulated:
Breakfast. One and a half pint of milk and half a pint of lime-water, mixed together; and bread and butter.
Noon. Plain blood-puddings, made of blood and suet only.
Dinner. Game, or old meats, which have been long kept; and as far as the stomach may bear, fat and rancid old meats, as pork. To eat in moderation.
Supper. The same as breakfast."
"2dly. A drachm of kali sulphuratum to be dissolved in four quarts of water which has been boiled, and to be used for daily drink. No other article whatever, either eatable or drinkable, to be allowed, than what has been stated."
"3dly. The skin to be annointed with hog's lard every morning. Flannel to be worn next the skin. The gentlest exercise to be only permitted; but confinement to be preferred."
"4thly. A draught at bed-time of twenty drops of tartarized antimonial wine and twenty-five of tincture of opium; and the quantities to be gradually increased. In reserve, as substances diminishing action, tobacco and foxglove. "
"5thly. An ulceration, about the size of half a crown, to be produced and maintained externally, and immediately opposite to each kidney. And,
"6thly. A pill of equal parts aloes and soap, to keep the bowels regularly open."
A special diabetic diet was undoubtedly one of the foremost therapeutic measures, even before the age of insulin. Even before it was recognized that diabetes was a disorder of carbohydrate metabolism, various kinds of diet had been recommended. A change to a diet decided purely pragmatically, which was nevertheless very effective, did not come until JOHN ROLLO (d. 1809), a Scottish physician, who, in 1797, had achieved good results with a meat diet, made his recommendation (MARBLE; ANDERSON; BECKENDORF). He gave a particularly detailed account The History of Diabetes mellitus 85 of the case of Captain MEREDITH of the Royal Artillery, who became diabetic at the age of 34, and who was very obviously overweight. His diet consisted of a breakfast and supper of milk mixed with lime-water and bread and butter, while his dinner consisted of pudding made of fat and blood and mature, preferably rank pork. In this way he had - without being conscious of it - excluded carbohydrates almost entirely from the diet. The patient of course lost a great deal of weight and felt extremely well.
A second patient was less cooperative and therefore died at the age of 57, 19 months after treatment was begun, mainly - as ROLLO pointed out - because during his last three months he indulged in such things as apple pudding, sugar in his tea, and wine.
The "meat diet" was used well into the 19th century, although gradually it was considered wiser not to cut out all carbohydrates, and patients had a certain amount of carbohydrate added to their diet, even though that caused some glycosuria. This kind of diet was initiated in the middle of the 19th century, mainly by ADOLF NIKOLAUS VON DURING (1820-1882) and RUDOLF EDUARD KULZ (1845-1895). The latter even distinguished between harmful and harmless carbohydrates and found that levulose, inulin, inosit, mannite, and lactose, as well as some root vegetables like celery, comfrey, etc. caused no deterioration of the metabolic condition. But it remains true that many specialists did recommend a carbohydrate-free diet with a lot of meat and fat (DICKINSON; PAVY; SEEGEN; R. SCHUMACHER, STEPP).
Diabetes Its Medical and Cultural History
Captain Meredith is cured of diabetes on Rollo's meat diet. The simplified therapy is thought to be animal food.
Captain Meredith began the above treatment on Oct. 19, 1796. Two days later the quantity of urine passed in twenty-four hours had fallen from seven or eight quarts to six quarts. By November 1 the quantity did not exceed four quarts and on November 4 "he drank only three pints of water, and made only two quarts of urine, which to him and his servants (who had been in the habit of tasting his urine from curiosity) was not sweet." As time went on, the opium at bedtime was discontinued and the rubbing with hog's lard was left off. The latter was found to be a "troublesome and disagreeable" part of the treatment. Rollo decided to simplify therapy to include those features which were considered really essential: animal food, confinement with limitation of activity, and hepatized ammonia. The hepatized ammonia (ammonium sulphide) was used in place of "kali sulphuratum," originally prescribed, with the thought that it might be "a more certain and active medicine than the other on the stomach, in diminishing its action."
Captain Meredith was directed to keep notes regarding his symptoms, diet, medication and progress of his illness. He did this quite faithfully, recording his transgressions as well as his attempts at cooperation. When at times he indulged in apples, bread and beer, Rollo found it necessary "to point out in stronger language the impropriety of such deviations." By December 30 the patient was free from abnormal thirst and polyuria, was regaining some of his lost weight and felt well. Continuation of treatment with a somewhat more liberal allowance of bread in the diet was prescribed.
An account of two cases of the diabetes mellitus
Dr Rollo suggests 2 pounds on only meat, cheese, or eggs for diabetes.
"It was agreed to try the effects of animal food. He is directed to abstain from vegetable food in every shape. To have two eggs for breakfast. Boiled meat and steaks alternately for dinner. Eggs, or cheese for supper. For drink eight pounds of weak beef tea, and two pounds of weak peppermint water. Solid ingested about two pounds. "