Carbotoxicity

The harm of eating carbohydrates.

Carbotoxicity

Recent History

January 1, 1267

The Popes and Science

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A Friar Bacon is punished (for writing too much) "He was ordered to be confined to his cell in the monastery and to be fed on bread and water for a considerable period"

Unfortunately, difficulties occurred within Friar Bacon's own order. It is not quite clear now just how these came about. The Franciscans of the rigid observance of those early times took vows of the severest poverty. There had been some relaxation of the rule, however, and certain abuses crept in. The consequence was the re-assertion after a time of the original rule of absolute poverty in all its stringency. It was Friar Bacon himself who had chosen this mode of life and had taken the vows of poverty. Paper was a very dear commodity, if indeed it was invented early enough in the century for him to have used it. Vellum was even more expensive. Just what material Bacon employed for his writings is not now known. Whatever it was, it seems to have cost much money, and because of his violation of his vow of poverty Roger Bacon fell under the ban of his order. He was ordered to be confined to his cell in the monastery and to be fed on bread and water for a considerable period. It must not be forgotten that this was within a century after the foundation of the Franciscans, and to an ardent son of St. Francis the living on bread and water would not be a very difficult thing at this time, since his ordinary diet would, at least during certain portions of the year, be scarcely better than this. There is no account of how Roger Bacon took his punishment. He might easily have left his order. There were many others at that time who did. He wished to remain as a faithful son of St. Francis, and seems to have accepted his punishment with the idea that his example would influence others of the order to submit to the enforcement of the regulation with regard to poverty, which superiors now thought so important, if the original spirit of St. Francis was to be regained.

January 1, 1793

Observations on the Nature and Cure of Calculus, Sea Scurvy, Consumption, Catarrh, and Fever

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Corpulence seems here to have been the harbinger of the scurvy. The only one he ever saw affected with the scurvy was a young man remarkably corpulent. From the whole of his observations it appears clearly that obesity predisposed his patients to scurvy.

Among the Africans, of whose sufferings on board the slave ship Dr. Trotter has given so particular and affecting an history, corpulence seems to have been , as it were, the first stage of scurvy. “When a negro was becoming rapidly fat,'” says he, “it was no difficult matter to determine how soon he would be seized with the scurvy; so that corpulence seems here to have been the harbinger of the scurvy. Writers have been particular in noticing that this disease seldom or never produces emaciation. Dr. Trotter, upon whose information we may place full reliance , tells us, that having purposely inquired among his medical acquaintances in the navy, he did not find one who considered the wasting of the flesh or absorption of fat as a symptom congenial to scurvy . He immediately subjoins some observations of his own, that clearly indicate a connection between the scurvy and obesity (p. 98 , 99.). "In a corpulent state of the body,” he says, “the most hideous features of the disease are expressed; such are the bloated looks and countenance, & c. In a mess of midshipmen, who lived altogether on the ship’s fare, the only one he ever saw affected with the scurvy was a young man remarkably corpulent. From the whole of his observations it appears clearly that obesity predisposed his patients to scurvy, or rather was to them what cachexia is to dropsy.

February 9, 1797

John Rollo

Cases of the diabetes mellitus : with the results of the trials of certain acids

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At this time Dr. Currie had just received a publication from Dr. Rollo, Surgeon General to the Royal Artillery, at Woolwich, of a case of Diabetes that he had treated with success; he had not read it; but he understood that much was attributed to animal diet. On this authority our patient, John Clarke, was ordered to live chiefly on flesh and milk.

From Dr. Gerard, Liverpool 


The following case is that mentioned in Dr. Curriers letter to us, and we communicate it with the greatest pleasure to the public as being drawn up with the utmost accuracy, and containing details of procedure of the utmost importance towards perseeling our views of the nature and treatment of the disease, as well as of confirming them.


THE CASE. 


John Clarke, aged 38, was received into the Liverpool Infirmary, under Diabetes, on the 9th February, 1797.


 He was a soldier in Lord Darlington's Light Horse when they were reduced in February, 1796. 

At that time he was in good health ; thinks he might then have weighed about 140 pounds in his clothes; he is 5 feet 7.5 inches in height; has dark hair and grey eyes. He always enjoyed good health, but was subject to pyrosis, and accustomed to perspire much. Happening to reside near the seacoast, he has from a boy been used to bathe frequently during the summer months, not for any indisposition, but merely for gratification ; sometimes he went into the water twice the fame day, and staid in it 10 or 15 minutes; being always of a coflive habit, he also drank of the water occasionally. He discontinued the practice of bathing, however, while the weather still continued warm, as early, he thinks, as the beginning of August; his habitual perspiration leflened afterwards by degrees, and he continued in good health till about the end of November, 1796, when the perspiration entirely ceased, and the cuticle became unnaturally dry, harm, and rough, and is now to all appearance dead, and incapable either of perspiration or absorption, or any kind of transmission. About this time some headache also came on, and the bowels became in general more costive, though he was sometimes troubled with a lax for a few days. 


With the preceding symptoms he was afflicted with a most distressing thirst, which was not to be satisfied. His appetite was increased, and yet he loft flem daily, and grew weaker very felt, particularly in the thighs and small of the back, attended with pain in the region of the kidneys. He also observed, that he made much more urine than usual, and that the quantity increased from day to day. It should be remarked, that having no other means of getting here, he was under the necessity of walking from five, to eight miles each day, for three successive days, before he reached Liverpool ; but this was a whole day's work, and a great fatigue to him. Considering this to be a cafe, that from all former experience might almost be deemed incurable, I wished to consult my Colleagues, Dr. Brandreth and Dr. Currie ; therefore I only ordered him a dose of castor oil, to remove, the costive state of the body. Those gentlemen saw him with me on the 1 1th February. At this time Dr. Currie had just received a publication from Dr. Rollo, Surgeon General to the Royal Artillery, at Woolwich, of a case of Diabetes that he had treated with success ; he had not read it ; but he understood that much was attributed to animal diet. On this authority our patient was ordered to live chiefly on flesh and milk; he was also directed to use the warm bath, and with a view of ascertaining whether the generally received opinion that absorption takes place in this disease be true, he was defined to be weighed naked, both before he went into it, and upon coming out (Dr. Currie having observcd in a case of a different nature, that no absorption took place in the warm bath) ; the pulse to be counted; and the heat of the body ascertained by placing a thermometer under the tongue, and to note the whole down.


February 12th. He went into the bath for the first time, when the pulse was, before bathing, 

75, after it, 85. 

Heat of the body 91, —-—— 95. 

Weight of the body 112lb. 4oz. -- 112lb. 6oz.


February 15th. During the same time he took two pounds and a half of animal food, and twelve pounds of liquids, including milk, beer, and water. The directions for his living on animal food having been misunderstood, he has hitherto had only one meal of flesh daily, and with it a portion of potatoes and bread.


February 20th. Having read Dr. Rollo's publication, he was ordered this day to live entirely on animal food and broth, without either bread, beer, or any vegetable matter, and to persist in that plan without taking any medicine whatever; for as diet appeared to have had a principal share of the success experienced in Dr. Rollo's cafe, we wished to try whether that plan only was capable of effecting a cure.


Feb 24th. He took two pounds of beef, and 6 pounds of broth.


Feb 25th. The dead cuticle is peeling off, and he is obviously improving in every respect, and gaining weight. He continues the diet of animal food, with the daily allowance of a pound of beer.


March 2nd. Urine 6 pounds 5 ounces. The animal food,: with the beer, has been persisted in. I have hitherto thought the griping and looseness were accidental, but as they continue, they may perhaps be owing to the great change made in his diet ; on that idea, therefore, I have allowed him half a pound of bread daily, and have ordered him 30 drops of laudanum at bed-time. He feels himfelf considerably stronger, and can lit up much longer at a time. He has no extraordinary thirst ; the urine has neither sediment nor smell.


The griping and looseness do not abate by the admixture of vegetable matter, on which idea only the bread, as it may be remembered, was allowed. He loses weight daily. This reverse of the success we experienced in the beginning, would prompt me strongly to have recourse to the fulphurated kali, or hepatifed ammonia ; but the circumstance of his having gained so much advantage, and so rapidly, while he lived on animal food entirely, and the wish to try what that diet alone would effect (which should be remembered was the plan we set out upon), determines me to return to it again, especially as it may enable us to decide whether it is alone equal to the cure. I therefore ordered both the bread and beer to be discontinued ; and to rely on the laudanum, absorbents, to correct the diarrhoea. He was allowed milk in place of the beer.


March 14th. He is rather more thirsty ; his appetite is not so good, being satiated with animal food ; he was allowed an onion to his meal.


March 19th. Being desirous of gratifying my patient with any change of diet that could be indulged in without impeding the cure, I ordered him to have a meal of fish, two or three times a week, meaning at the same time to ascertain whether that deviation from the plan of animal diet might be allowed with impunity.


March 20th. He disliked the fish, and said it was not so satisfying to his appetite as the meat; he thinks his thirst and appetite are more craving. He had a very good night, with some perspiration over the whole body; griping quite left him ; and flatulency greatly relieved.


March 26th. He has bad a restless night, and vomited frequently till 3 o'clock in the morning ; his spirits are better, and he thinks himself stronger. He had a pudding made of milk, suet, and eggs, for his dinner, which he was fond of.


March 28th. The diet, with the pudding of milk, eggs, and suet, were given as directed.


March 31st. He continues better, and feels a more comfortable warmth than he has been accustomed to do lately. His pulse has been from 85 to 90 for a week past. He is so tired with broth, that he has refused to take any for some time, and owing to his fondness for the eggs and milk, either baked or boiled with suet, he has eaten too little meat lately. I therefore ordered that he should at leail eat one pound daily.


April 6th. It becomes very irksome to keep him to animal food, even with a very large allowance of milk; and I learn that he takes the suet off the milk when it cools. He feels himfelf better today. He continues the animal food with milk, eggs &c.


April 19th. The diet is continued.


April 25th. Finding that he has upon the whole been losing weight since the 17th, I questioned him very closely about his getting other food than what was allowed him, but he denied it, and shewed much impatience about staying longer with us, saying that he thought himself well and strong again, and that he would rather go, as he was watched like a thief. Though I do not confider him to be so well as he thinks he is, yet as the quantity of his urine is so much reduced, and its former nature so entirely reversed, I have, notwithstanding his having lost weight, allowed him four ounces of flour in his pudding, and two ounces of bread with his meat ; for fear he would run away, and leave us uncertain of the event.


May 6th. I have at length discovered, through the information of another patient in the fame ward, that Clarke adhered rigidly to the regimen prefcribed him, only for about 14 days at the first. In the course of the disease we have often had reasonto suspect that he was deviating from our plan, and three or four times the necessity of a fine attention on his part was particularly infilled on. After these cautions he attended to his regimen strictly for a day or two, but again relaxed, through the almost irresistible propensity to more or less of vegetable diet, which seems to be one of the characteristic symptoms of this disease. With thefe exceptions, it appears that he has generally partaken with the other patients in the common mixed diet of the house, and that he has drank water when thirsty, if he had no milk. I cannot learn that he ever gave any part of the flesh meat to the other patients. It is extremely vexatious to have been so much deceived, yet I don't think it lessens the inference, that animal diet has been the means of effecting the very great alteration in the quantity and quality of his urine ; for though he has eaten more promiscuoufly than was supposed, he has at all times taken a large proportion of animal matter, and a marked effect: has at different periods of the disease followed the more entire use of it, particularly in the beginning, when his apprehension made him adhere rigidly to the plan. The discovery, though vexatious, has perhaps made this a better case, in as much as it shows that an absolute exclusion of vegetable matter is not necessary, at least not for so long a time ; and also as it proves that he is nearer being cured than he was thought to be, by the characteristic symptoms of the disease not having been reproduced by the superior quantity of vegetable matter he has eaten to what he was supposed to have done. Whether his appetite is so strong as to constitute it a remnant of the disease I know not ; but from the impossibility of retraining him, and for the purpose of ascertaining whether the care was complete, he is ordered to have the diet of the house only.


April 7th. His. diet now consists of milk, meat, potatoes, and bread.


April 25th. He was discharged from the Infirmary to all appearance cured of the disease; which, to his own thinking, has long been the case ; and to the opinion of his being even cured I have no hesitation in subscribing.

March 20, 1797

John Rollo

Cases of the diabetes mellitus : with the results of the trials of certain acids

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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."

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.

May 15, 1798

John Rollo

Cases of the diabetes mellitus : with the results of the trials of certain acids

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She was put upon the animal diet, and in the course of eight or ten days was better, to her feeling. However, several months later she died Dec 13th because "she was continually deviating from the plan, in eating different vegetable matters, and particularly sweets"

From Doctor Gerard. Liverpool, 15 th May, 1798. IN compliance with your request, I shall give you a short account of two cafes of Diabetes Mellitus, which have fallen under my care at our Infirmary since that of Clarke, who, by the way, I must tell you, has never been heard of since he was discharged. They were both females. Mary Jackson, aged 57, was very much reduced indeed, when she was admitted in July last..

She had had 13 children ; the last 7 years of age. The disease commenced about July 1796, but was not attended with any particular circumstance, except an uncommon itching about the meatus urinarius, which returned at intervals, and was always attended with an increased flow of urine. She remarked, that upon the occurrence of a spontaneous vomiting, which continued several days, her water was reduced in quantity one half, but when the vomiting fubfided, the quantity became as great as before. 


She was put upon the animal diet, and in the course of eight or ten days was better, to her feeling, though the urine was little altered; her appetite and thirst were more moderate, her spirits and complexion improved and the skin, which had been very harm and dry, had yielded to moderate perforation, and was become much softer.


 She frequently took an opiate, and occasionally an emetic; and upon the disease proving obstinate, I ordered her five drops of hepatifed ammonia three times a day; the dose was gradually increased to 20 drops, which was repeated five times in the 24 hours, without producing any lasting amendment. Not meeting with the same success in this case as I had experienced in Clarke's, I determined to give her the carbonated ammonia in very full doses, which I was led to make trial of, both from the late discovery of its component parts, and also from the consideration of its being of copiously afforded by healthy urine, and animal matter in general, and therefore corresponding with the plan of animal diet. I also found a further inducement to persevere in this plan, upon hearing that Dr. Currie, of Chester, had succeeded in a case where he had made use of it. It was continued from August to December, and for a great part of the time, to the quantity of giv daily, one half in the form of pills, and the other in solution, saturated with carbonic acid air. It failed, however, in this instance, for she died on the 13th of December; but it must be remarked, that she was continually deviating from the plan, in eating different vegetable matters, and particularly sweets; but this did not come to my knowledge till it was too late; the fact, however, was proved beyond a doubt. The want of success in this instance, cannot, therefore, with any propriety, be attributed to the insufficiency of the plan.

Ancient History

8000

B.C.E.

Evolutionary and Population Genomics of the Cavity Causing Bacteria Streptococcus mutans

S. Mutans, the bacteria involved in creating cavities likely evolved and expanded with the population growth 10,000 years ago as humans started relying more on starches and sugars.

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Streptococcus mutans is widely recognized as one of the key etiological agents of human dental caries. Despite its role in this important disease, our present knowledge of gene content variability across the species and its relationship to adaptation is minimal. Estimates of its demographic history are not available. In this study, we generated genome sequences of 57 S. mutans isolates, as well as representative strains of the most closely related species to S. mutans (S. ratti, S. macaccae, and S. criceti), to identify the overall structure and potential adaptive features of the dispensable and core components of the genome. We also performed population genetic analyses on the core genome of the species aimed at understanding the demographic history, and impact of selection shaping its genetic variation. The maximum gene content divergence among strains was approximately 23%, with the majority of strains diverging by 5–15%. The core genome consisted of 1,490 genes and the pan-genome approximately 3,296. Maximum likelihood analysis of the synonymous site frequency spectrum (SFS) suggested that the S. mutans population started expanding exponentially approximately 10,000 years ago (95% confidence interval [CI]: 3,268–14,344 years ago), coincidental with the onset of human agriculture. Analysis of the replacement SFS indicated that a majority of these substitutions are under strong negative selection, and the remainder evolved neutrally. A set of 14 genes was identified as being under positive selection, most of which were involved in either sugar metabolism or acid tolerance. Analysis of the core genome suggested that among 73 genes present in all isolates of S. mutans but absent in other species of the mutans taxonomic group, the majority can be associated with metabolic processes that could have contributed to the successful adaptation of S. mutans to its new niche, the human mouth, and with the dietary changes that accompanied the origin of agriculture.


Undoubtedly, one of the major challenges that S. mutans had to overcome as the carbohydrate content of the human diet increased was surviving at low pH. Although S. mutans does not constitute a significant proportion of the oral flora colonizing healthy dentition, it can become numerically significant when there is repeated and sustained acidification of the biofilms associated with excess dietary carbohydrates or impaired salivary function (Burne 1998).

Luxor, Luxor Governorate, Egypt

2475

B.C.E.

The Earliest Record of Sudden Death Possibly Due to Atherosclerotic Coronary Occlusion
WALTER L. BRUETSCH

The sudden death of an Egyptian noble man is portrayed in the relief of a tomb from the Sixth Dynasty (2625-2475 B.C.). Since there is indisputable evidence from the dissections of Egyptian mummies that atherosclerosis was prevalent in ancient Egypt, it was conjectured that the sudden death might have been due to atherosclerotic occlusion of the coronary arteries.

It may be presumptuous to assume that an Egyptian relief sculpture from the tomb of a noble of the Sixth Dynasty (2625-2475 B.C.) may suggest sudden death possibly due

to coronary atherosclerosis and occlusion. Much of the daily life of the ancient Egyptians has been disclosed to us through well-preserved tomb reliefs. In the same tomb that contains the scene of the dying noble, there is the more widely known relief "Netting Wildfowl in the Marshes." The latter sculpture reveals some of the devices used four thousand years ago for catching waterbirds alive. It gives a minute account of this occupation, which in ancient Egypt was both a sport and a means of livelihood for the professional hunter.

The relief (fig. 1), entitled "Sudden Death," by the Egyptologist von Bissing2 represents a nobleman collapsing in the presence of his servants. The revelant part of the explanatory text, as given by von Bissing, follows (translation by the author):


The interpretation of the details of the theme is left to the observer. We must attempt to comprehend the intentions of the ancient artist who sculptured this unusual scene. In the upper half (to the right) are two men with the customary brief apron, short hair covering the ears, busying themselves with a third man, who obviously has collapsed. One of them, bending over him, has grasped with both hands the left arm of the fallen man; the other servant, bent in his left knee, tries to uphold him by elevating the head and neck, using the knee as a support. Alas, all is in vain. The movement of the left hand of this figure, beat- ing against the forehead, seems to express the despair; and also in the tightly shut lips one can possibly recognize a distressed expression. The body of the fallen noble is limp. . . . Despite great restraint in the interpretation, the impression which the artist tried to convey is quite obvious. The grief and despair are also expressed by the figures to the left. The first has put his left hand to his forehead. (This gesture represents the Egyptian way of expressing sorrow.) At the same time he grasps with the other arm his companion who covers his face with both hands. The third, more impulsively, unites both hands over his head. ... The lord of the tomb, Sesi, whom we can identify here, has suddenly collapsed, causing consternation among his household.

In the section below (to the left) is shown the wife who, struck by terror, has fainted and sunk totheflor. Two women attendants are seen giving her first aid. To the right, one observes the wife, holding on to two distressed servants, leaving the scene. . . .

von Bissing mentions that the artist of the relief must have been a keen observer of real life. This ancient Egyptian scene is not unlike the tragedy that one encounters in present days, when someone drops dead of a "heart attack." The physician of today has almost no other choice than to certify the cause of such a death as due to coronary occlusion or thrombosis, unless the patient was known tohave been aflictedwith rheumatic heart disease or with any of the other more rare conditions which may result in sudden death.


Atherosclerosis among the Ancient Egyptians 


The most frequent disease of the coronary arteries, causing sudden death, is atherosclerosis. What evidence is available that atherosclerosis was prevalent in ancient Egypt?

The first occasion to study his condition in peoples of ancient civilizations presented itself when the mummified body of Menephtah (approx.1280-1211B.C.), the reported "Pharaoh of the Hebrew Exodus" from Egypt was found. King Menephtah had severe atherosclerosis. The mummy was unwrapped by the archaeologist Dr. G. Elliot Smith, who sent a piece of the Pharaoh's aorta to Dr. S. G. Shattock of London (1908). Dr. Shattock was able to prepare satisfactory microscopic sections which revealed advanced aortic atherosclerosis with extensive depositions of calcium phosphate.

This marked the beginning of the important study of arteriosclerosis in Egyptian mummies by Sir Mare Armand Ruffer, of the Cairo Medical School(1910-11). His material included mummies ranging over a period of about 2,000 years (1580 B.C. - 525 A.D.).

The technic of embalming in the days of ancient Egypt consisted of the removal of all the viscera and of most of the muscles, destroying much of the arterial system. Often, however, a part or at times the whole aorta or one of the large peripheral arteries was left behind. The peroneal artery, owing to its deep situation, frequently escaped the em- balmer'sknife. Otherarteries,suchasthe femorals, brachials, and common carotids, had persisted.

In some mummies examined by Ruffer the abdominal aorta was calcified in its entirety, the extreme calcification extending into the iliae arteries. Calcified plaques were also found in some of the larger branches of the aorta. The common carotid arteries frequently revealed patches of atheroma, but the most marked atheroselerotic alterations were in the arteries of the lower extremities. The common iliae arteries were not infrequently studded with calcareous plaques and in some instances the femoral arteries were converted into rigid tubes. In other mummies, however, the same arteries were near normal.


What is known as Mdnekeberg's medial calcification was also observed in some of the mummified bodies. In a histologic section of a peronieal artery, the muscular coat had been changed almost wholly by calcification. In one of Ruffer's photographic plates, a part of a calcified ulnar artery is shown. The muscular fibers had been completely replaced by calcification.


In the aorta, as in present days, the atherosclerotic process had a predilection for the points of origin of the intercostal and other arteries. The characteristics and the localization of the arterial lesions observed in Egyptian mummies leaves litle doubt that atherosclerosis in ancient times was of the same nature and degree as seen in today's postmortem examinations.


As to the prevalence of the disease, Ruffer ventured to say that the Egyptians of ancient times suffered as much as modern man from arterial lesions, identical with those found in our times. Ruffer was well qualified to make this statement having performed many autopsies on modern Egyptians, Moslems, and other people of the Middle East. In going over his material and examining the accompanying photographic plates of arteries, one can have litle doubt that what Ruffer had observed in Egyptian mummies represented arteriosclerosis as it is known today.


Although the embalming left no opportunity to examine the coronary arteries inl mummified bodies, the condition of the aorta is a good index of the decree of atheroselerosis present elsewhere. In individuals with extensive atheroselerosis of the aorta, there is almost always a considerable degree of atherosclerosis in the coronary arteries. If Ruffer's statement is correct that the Egyptians of 3,000 years ago were afflicted with arteriosclerosis as much as we are nowadays, coronary occlusion must have been common among the elderly population of the pre-Christian civilizations.


Furthermore, gangrene of the lower extremities in the aged has been recognized since the earliest records of disease. Gangrene of the extremities for centuries did not undergo critical investigation until Cruveilhier (1791- 1873) showed that it was caused by atherosclerotic arteries, associated at times with a terminal thrombus.


SUMMARY

The record of a sudden death occurring in an Egyptian noble of the Sixth Dynasty (2625-2475 B.C.) is presented. Because of the prevalence of arteriosclerosis in ancient Egyptian mummies there is presumptive evidence that this incident might represent sudden death due to atheroselerotic occlusion of the coronary arteries.

Cairo, Cairo Governorate, Egypt

1580

B.C.E.

ON ARTERIAL LESIONS FOUND IN EGYPTIAN MUMMIES

Arteries of Egyptian mummies from 1580 B.C.E. to 525 A.D. have extensive calcification of the arteries, the same nature as we see today, and unlikely to be due to a very heavy meat diet, which was always a luxury in ancient Egypt. Instead, the diet was mostly a course vegetarian one.

DISCUSSION OF RESULTS.

Nature of the lesions. There can be no doubt respecting the calcification of the arteries, and that it is of exactly of the game nature as we see at the present day, namely, calcification following on atheroma.

The small patches seen in the arteries are atheromatous, and though the vessels have without doubt been altered by the three thousand years or so which have elapsed since death, nevertheless the lesions are still recognisable by their position and microscopical structure.

The earliest signs of the disease are always seen in or close below the fenestrated membrane,-that is, just in the position where early lesions are seen at the present time. The disease is characteiised by a marked degeneration of the muscular coat and of the endothelium. These diseased patches, discrete at first, fuse together later, and finally form comparatively large areas of degenerated tissue, which may reach the surface and open out into the lumen of the tube. I need not point out how completely this description agrees with that of the same disease as seen at the present time.

I have already mentioned the absence of leucocytes and cellular infiltration, and need not therefore return to it here.

In my opinion, therefore, the old Egyptians suffered as much as we do now from arterial lesions identical with those found in the present time. Moreover, when we consider that few of the arteries examined were quite healthy, it would appear that such lesions were as frequent three thousand years ago as they are to-day.


I do not think we can accuse a very heavy meat diet. Meat is and always has been something of a luxury in Egypt, and although on the tables of offerings of old Egyptians haunches of beef, geese, and ducks are prominent, the vegetable offerings are always present in greater number. The diet then as now was mostly a vegetable one, and often very coarse, as is shown by the worn appearance of the crown of the teeth.


Nevertheless I cannot exclude a high meat diet as a cause with certainty, as the mummies examined were mostly those of priests and priestesses of Deir el-Bahari, who, owing to their high position, undoubtedly lived well. I must add, however, that I have seen advanced arterial disease in young modern Egyptians who ate meat very occasionally. In fact, my experience in Egypt and in the East has not strengthened the theory that meat-eating is a cause of arterial disease.

Finally, strenuous muscular exercise can also be excluded as a cause, aa there is no evidence that ancient Egyptians were greatly addicted to athletic sport, although we know that they liked watching professional acrobats and dancers. I n the ca6e of the priests of Deir el-Bahari, it is very improbable, indeed, that they were in the habit of doing very hard manual work or of taking much muscular exercise.

I cannot therefore at present give any reason why arterial disease should have been so prevalent in ancient Egypt. I think, however, that it is interesting to find that it was common, and that three thousand years ago it represented the same anatomical characters as it does now.


FIG. 1.-Pelvic and arteries of thigh completely calcified (XVIlIth-XXth Dynasty).
Fro. 2.-Completely dcifiedprofundaarteryaftersoakinginglycerine(XXIstDynasty). FIQ. 8.-Partly calcified aorta
(XXVIIth Dynasty).
Fro. 4.-Calcified patches in aorta (XXVIIth Dynasty).
Fio. 5.-Calcified atheromatous ulcer of subclavian artery (XVIIIth-XXth Dynasty). Fro. &-Patch of atheroma
i n anterior tibia1 artery (glycerine). The centre of the patch

is calcified (XXIst Dynasty).
FIG. 7.-Atheroma of brachial artery (glycerin) (XXIst Dynasty).
Fro. &-Unopened ulnar artery, atheromatous patch shining through (glycehne) (XXIst Dynasty). 31

FIG. 9.-Section through almost completely calcified posterior peroneal artery (low power). Van Gieson staining. a,al, n2, Remnants of endothelium and

fenestrated membrane. b, Calcified patches.

Many more are seen.
Same stain. (Leitz, Oc. 1, x &.)

FIG. 10.-Section


FIG. 11.-Section m(Leitz, Oc. 1, x *.)

a,Remains of endothelium.
b, Fenestrated membrane.
c, Muscular coat.
d,f,Membrane coat undergoing degenerntion.
e, Completely degenerated remnants of muscular coat.

atheroniatous patch of n h a r artery. Same stain. (Leitz, (Reference letters the same as in Fig. 11.)


FIG. 12.-Section Oc. 1, x fa.)

through calcified patch of ulnar artery. a,d, Calcified patches.
b, Partially calcified m wular coat. c, Annular muscular fibre.

 through atheromatous patch of anterior tibia1 artery. Same stain through
FIG. 13.-Section at edge of atheromatous patch. Hreniatoxylin stain (Leitz, Oc. 1, XTh.1 a,Leucocytes (1). The atheromatous part on the left stains intensely dark with hamatoxylin.

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