A 30 year old woman: "several years she has indulged in fruit, pickles, and sweetmeats." She met Dr Rollo and was put upon his all-meat diet, but when she introduced carbohydrates, the diabetes came back. "Since the use of the bread, the disease has been reproduced. Since the first, has been strictly on animal diet; the several symptoms are removed, and she appears altogether better than I have yet seen her."
March 20, 1797
Cases of the diabetes mellitus : with the results of the trials of certain acids
From Mr. Houston, Brewer Street, London.
L........... , aged about 30, fair complexion, light hair, and naturally of an extremely irritable constitution, in the month of February, 1793, received a violent shock by the death of one of her parents. On this melancholy occasion her grief was so very poignant, and at times so frantic, that serious apprehensions were entertained of a total derangement of intellect, and in this state she continued several weeks.
(several pages discussing the deterioration of her health leading to diabetes)
On their quitting the Wells, they, on their way home, stopped at Bath; and as her parent received benefit from the use of the waters of that place, they remained there eight weeks ; but before the expiration of the first fortnight, she found her stomach again disordered with heat and acidity, which in a short time increased to a height almost intolerable; the fauces were so sore, that it was a pain to swallow anything; and her tongue was equally so, being covered with a emit, or hardened slough on the top, and blisters round the edge. Her thirst was insatiable; to quench which, she ate a great quantity of fruit, and drank profusely of Seltzer Seltzer water and hock, but to no purpose.
Her skin was so parched, that the pores did not seem to emit the least moisture. To remedy this evil, some doses ofJames's powders were given, but to no effect ; towards the close of her time at Bath, she drank the waters for about a fortnight, they were supposed, however, to do more harm than good ; and growing daily worse there, she set out for London, where she arrived the 4th December, 1796. She immediately sent for her apothecary, who was greatly shocked ; as to all outward appearance, she seemed to be in the last stage of a consumption. Her pulse was exceedingly quick, but so feeble, that he could scarcely feel it, and so tremulous, that he could not with any certainty count or distinguish the strokes. For two days, he gave her every six hours a draught with kali ppt. magnef. alb. aa ^i, taken with half an ounce of lemon juice in the state of effervescence ; they agreed with her, and, as (he thought, cooled her; (he had no cough, but for some time back had loft her appetite, the stomach rejecting almost all solids; and when it did receive any, they generally laid heavy on it, or disagreed ; as some nourishment, however, was necessary, she was advised to eat eggs raw, or done very soft ; as also oysters and other shell-fish, as having a tendency to correct acidity. On the 3d day after her arrival in town (Dec. 6th) an eminent physician was sent for, who ordered a blister to be applied to her breast ; magnef. alb. qr. xv. in a draught every eight hours. These she took till the 15th, when she was ordered a draught with myrrh pulv. gr. xij. ferr. vitriol gr. iij. kali ppt. gr. viij. three times a day. This course she continued, with some trifling variations, but little interruption, till about the 19th February, 1797. By this time those medicines had the effect: of greatly recovering her appetite, and she had been allowed to eat such light animal food as she fancied ; but from this indulgence, of which she availed herself, with the return of her night's rest, which by this time she began to enjoy, she derived no other advantage than a small acquisition of strength ; for there was not the least appearance of bodily nurture, or any abatement of heat and acidity.
The physician having compared the tardy, if any progress in amendment, with the quantity of food she was able to take, (for her appetite was greater than before her illness) began to discover symptoms of diabetes, and therefore gave orders to measure the quantity of fluids drank, and the quantity of urine she made and finding the latter exceed the former, he had some of it evaporated, and found it to contain a considerable portion of saccharine matter ; upon which she was advised to eat less vegetables and more animal food.
On the 18th, a gentle opening draught was given, though she usually took magnefia when any thing of the kind was necessary. On the 20th March, Dr. R. was consulted with her former physician ; and as he is already so well acquainted with all that has since been done, or happened, it is unnecessary for the writer of this to carry it any further.
Continuation by the Author.
On the 20th March, 1797, I visited the patient, with her physician and apothecary; she complained of a burning sensation at her stomach, which she faid was intolerable, with the sense of a sharp and hot acid rising into her throat ; her teeth were on edge, tongue red, and gums full ; she had little thirst, and was occasionally sensible of a moisture on the palms of her hands, and on other parts of her body ; her appetite was keen, and she never felt satisfied, but said that this degree of appetite had only been lately remarkable ; and she complained much of a burning sensation in her stomach, and of great acidity ; she was extremely emaciated, feeble, and inactive ; her skin dry, and rather warm ; pulse about 88 ; her urine of a pale colour, but to the taste scarcely sweet ; the quantity could not be distinctly ascertained ; it did not seem, however, to have been so increased as to engage any particular notice ; a little of the urine was evaporated; the residuum resembled treacle, but was salty to the taste, and the extractive matter did not seem much to exceed the quantity in healthy urine. On the whole, the adoption of light animal food, with less vegetable matter, and the medicines, had mitigated the disease. The physician who attended had a copy of the notes of Captain Meredith's case the preceding January, and he now very readily agreed to the animal diet entirely.
On the 14th April I saw the patient, with the physician and apothecary ; her looks had more the appearance of returning health ; she moved about with more agility and strength, though she complained of not gaining flesh ; her appetite is now good ; the tongue is clean, but not so florid ; she has no thirst ; the urine does not exceed a quart, a small portion of which being evaporated, the residuum was quite saline, and urinous in smell, but it was not evaporated so much as to determine the tenacity. The burning sensation in her stomach is diminished, and there is less acidity ; however, another emetic is prescribed, and the matter thrown up is to be examined, in order to ascertain whether it possesses acid properties. The patient informed me to-day, that for several years she has indulged in fruit, pickles, and sweetmeats.
April 25th. The emetic ordered on the 14th brought up very acid matter, which was found by the apothecary to effervesce with an alkali ; the urine deposits a reddish sediment ; she has less uneasiness at the fiomach, has more strength, and a more natural appetite ; her skin is moister.
May 10th. Very little change. Asafoetida is added to the pills, with calcined soda, and the quantity of the hepatized ammonia increased. From the delicacy of circumstances, an accurate enquiry cannot be made ; deviation of diet may happen ; in this cafe, we can only hope for a certain compliance with regimen, and a certain information with regard to appearances, and ultimately a recovery with tardy and irregular advances ; it merits much attention however, even with the view of discovering points of importance in the treatment, under the most unfavourable progress.
June 8th. Very sensible of an increase of strength, and that health is returning, the urine continues in a natural state, at least there is no saccharine matter. The heat of the stomach is much diminished ; the appetite feels natural ; no thirst or hectic symptoms ; she has discontinued our medicines, and only takes Schweppe's acidulous soda water, which she likes, and says it has been of much service in relieving the uneasiness of her stomach. To be allowed about four ounces of bread in the day.
June 16th. Since the use of the bread, the disease has been reproduced ; the urine is clear, and of a sensibly sweetish taste ; 18 ounces yielded a saccharine residuum of 1 ounce and 5 drachms ; her skin is again hot and dry ; the pulse quicker, thirst: intenfe, appetite keen, tongue florid and red ; alfo the heat of the stomach extremely unpleasant. She promises to return to the entire use of animal food ; her antimonial opiate to be taken at night; Schweppe's water for drink ; and a blister to be applied to the region of the stomach.
lid. The urine, in smell and taste urinous, having become so in twenty-four hours after leaving off the bread; her appetite is not so keen ; the tongue is not more florid than common, and the uneasy hot fenfation of the stomach is much less, though occasionally troublesome ; the thirst is gone ; the blister relieved the stomach ; the regimen, with Schweppe's water, to be continued.
July 14th. In a state of apparent recovery ; me occasionally takes a biscuit or two, but perseveres in the diet generally, and Schweppe's soda water. Next week she goes to Bristol, where she is to observe the fame conduct, being fully sensible of the influence of a change of diet, and equally so, that everything depends on her own steadiness. No accurate account could be obtained with regard to the quantity of urine ; in general terms it was said that it corresponded with the quantity of drink.
February 5th, 1798. Returned a few days ago from Bristol and Bath ; at the latter place she bathed in the warm bath, and was relieved, by its being followed by a moist skin. The Bristol water was very grateful to her stomach, and generally superfeded the use of Schweppe's soda water. She appears much in the same state as when I saw her in July ; the disposition to the disease still remains, and the feels better or worse according to her diet ; she eats daily some biscuit, and has done fo generally all the time the has been away ; the acidity of her stomach still continues a distressing symptom ; the urine yields a saccharine extract.
March 6th. Since the first, has been strictly on animal diet ; the several symptoms are removed, and she appears altogether better than I have yet seen her.
March 21st. Continues better, perseveres in the diet. On the l7th she ate a sweet cake which was soon vomited in a sour state.
April 2nd. She assures me no change in the diet has yet been made ; she begins to loath food, but believes it is only animal food, as she feels a strong desire for vegetables ; and alleges that, even under the animal food, she has had the acid state of her stomach, especially at times when her mind has been uneasy ; tongue less red, indeed it is rather pallid ; the urine smells strongly, and has a greasy scum ; on evaporation, it yielded a saline and bitterish tailed residuum, without tenacity ; and when treated with nitrous acid, furnished scales. She was allowed a small quantity of broccoli, spinach, or salad, without sauce.
April 16th. In all respects better, and for these eight days has been eating broccoli and salad occasionally, without any reproduction of the disease.
April 18th. A portion of urine was examined, which was found clear, but of a urinous taste and smell ; its residuum, however, yielded oxalic acid when treated with the nitrous acid.
May 5 th. It was ascertained that she had eaten some biscuit between the l6th and 24th April.] Her skin is moist ; pulse 72, and regular; her appetite less keen, and she feels more uneasiness after eating, or rather has a sense of indigestion ; tongue clear, but not florid; she has gained flesh. She promises to leave off bread, and to take only cauliflower and spinach. The salad does not agree with her; she assures me, and so does her maid, that the other day, after eating more vegetables than usual, the urine smelt and tasted sour immediately after it was voided.
May 10th. Is again to visit Bath and Bristol ; she promises an adherence to the plan, though she acknowledges that her resolution is often likely to fail her; she will, however, be as steady as she can, being perfectly persuaded she has no other prospect of recovery but by so doing. She has again been sensible of the acid smell and taste in the urine, after vegetables. I examined her urine today, but it did not smell or taste of anything, except the urinous flavour and impression.
This Case, though not as yet completely terminated, appears to me of so much importance, that I have inserted it in its present progress. There can be little doubt, that the adherence which has been bestowed on the animal diet since the 20th March, 1797, has not only prolonged life, but given strong hopes of the re-establishment of as great a degree of health, as can possibly be expected, under a long continued stomach complaint. The exact period when Diabetes Mellitus was actually formed cannot be determined : it was probably when the keenness of the appetite took place, but when that happened cannot be accurately ascertained. She had been long subject to stomach complaints, and the keenness of the appetite is only noticed in the account about the lft March, 1797 whereas the cardialgia is mentioned as long before as May, 1796 ; and before these periods the health was much impaired. These complaints had been partly brought on by the circumstances so well related by Mr. Houfton, and partly by the frequent use of fruit, pickles, &c. The animal diet, though not unremittingly perilled in, yet by a more steady use of it in March and the beginning of April, the disease was so far overcome, that the urine became as near as possible to the standard of health. It is to be regretted that a further perseverance did not at that time follow ; however, the progress shows, that certain vegetables, such as broccoli, spinach, salad, &c. may be eaten at a proper time of the treatment, without reproducing the disease, while bread could not be eaten with impunity. This fact we consider of much advantage, as it enables us to guard against the effects of a long continued use of animal diet, and at the same time gratify, in some measure, our longing patient ; we say in some measure, because even these vegetables do not long check the ardent desire for bread ; indeed, the stomach appears very whimsical, for when it obtains its desires, other things are soon solicited. The circumstance of the urine having become acid after the use of more than the usual quantity of vegetables, is a curious fact, but as it merely rests on the testimony of taste and smell, we do not hold it, in this case, as satisfactorily ascertained; it deserves, however, to be kept in view.