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of a carbonated alkali, with the carbonate of ammonia and opium.

A striking feature belonging to Diabetes is the tolerance of opium by persons labouring under the complaint. I have not unfrequently commenced with two and three grains of opium a day, without producing any visible effect. M'Gregor* has placed upon record two cases where he gave opium in very large doses. In one, the quantity was gradually increased, till it reached a drachm in the twenty-four hours. The urine was diminished from 18 lbs. to 2 lbs. and 3 lbs. in quantity. When, however, the opium was discontinued, the thirst increased, and along with it the quantity of urine. In the other case, the administration of opium was continued for nearly three months, and the dose was steadily increased, till it amounted to ninety grains daily. The symptoms of the patient were ameliorated, and the urine was, as in the first case, most materially reduced in quantity. The opium was gradually diminished to a few grains daily; and, after this, the patient failed rapidly, the Diabetic symptoms increased, and a pleuritic attack subsequently produced a fatal termination. In each case, during the administration of the opium, the urine became very highly charged with urea; and, was likewise at one time alkaline from the presence of carbonate of ammonia.

Another feature of peculiarity belonging to the complaint, is the inability that is experienced to render the urine alkaline by the administration of the fixed alkalies and their vegetable salts. Although I have given the carbonate of soda to the extent of four drachms a day; the acetate of potash, half an ounce; the tartrate of potash and soda or Rochelle salt, six drachms, and even an ounce; and the citrate of potash, six drachms; yet, I have never succeeded

*London Med. Gaz.,' May, 1837.

168 ON THE PATHOLOGY AND TREATMENT OF DIABETES.

in rendering the urine alkaline, or in any way approaching this character. It is only in one patient that I have ever seen the urine alkaline in Diabetes. This was in Thair's case (Case IV, Appendix) after his admission into the hospital the second time. He was in a very feeble condition, and his urine was repeatedly, during a period of about three weeks strongly alkaline to test-paper, and threw down a copious deposit of phosphates. The alkalinity, however, was due to the presence of ammonia, and the patient at the time was taking nothing to account for the phenomenon.

I do not consider it necessary to refer to the various remedies that have been proposed, from time to time, upon theoretical grounds for Diabetes as one idea or another has prevailed concerning its nature. The theories themselves have proved, by the progress of knowledge, to be illusory; and, it is not likely, therefore, that what has been founded upon them, could really produce any benefit. I have never seen anything recorded, to give me an atom of faith in anything that has been thus proposed.

The complications that arise during the existence of the Diabetic condition must be treated upon ordinary principles. But, I feel strongly convinced, that a most powerful aid towards attaining the object that is desired, is to be obtained, by adopting the dietetic measures that are known to reduce the intensity of the Diabetic state, at the same time that remedial measures are directed towards the special disorder that exists. The greater the approximation to a healthy state of the fluids that can be produced, the greater will be our chance of success in overcoming whatever secondary disorder may exist for us to treat.

APPENDIX OF CASES.

CASE I.

THE following case contains the results of a close examination of the influence of various articles of food upon the elimination of sugar in Diabetes. The early history of the patient, which I have extracted from the ward report-book, runs thus:

Joseph North, æt. 32, No. 34, Stephen Ward, Guy's Hospital. A light-haired, fresh-complexioned man, who, previous to his present complaint, had scarcely known a day's illness to have happened to him. During the commencement of November, 1860, his disease set in; according to his own account, under the following circumstances: He had been drinking to excess, and was suffering from retention of urine, for the relief of which he procured an ounce of the sweet spirit of nitre, and took it in two doses within the space of five hours. He drank copiously afterwards of linseed tea, and in a few days' time noticed that he began to pass an unusual quantity of urine, which continued increasing in amount, until, within a week, it reached, he said, as much as six to seven quarts during the day, and from three to four during the night. He now suffered from much pain in the loins, and found himself rapidly wasting, with a voracious appetite, an insatiable thirst, and a dry skin.

The patient presented the appearance of being a strong

constitutioned man, although he carried with him the characteristic diabetic aspect. He complained of nothing but what was attributable to his special disorder, and there was no evidence of his lungs or other organs being otherwise than perfectly sound; so that he formed an instance of a pure, uncomplicated case of Diabetes at a middle period of life. He also possessed an amount of intelligence surpassing what is usually met with in persons of his sphere of life, and with readiness and willingness consented to implicitly carry out whatever instructions might be given him. Time showed that he entered enthusiastically into the spirit of the observations that were being conducted. I was dependent upon him, not only for obedience to my instructions and for giving an exact account of all that he partook, but also for attention to the collection of his urine in separate vessels for the several periods into which the twenty-four hours were designedly divided. He was under the surveillance of the attendants and the other patients in the ward, of whom I made inquiries, to see if his statements could be relied upon. From the information I obtained, and from the consistency in the results of my examination of his urine, I have the strongest reason to believe that his share in the inquiry may be taken as performed with as much exactitude as is well possible to have been observed. In every respect, indeed, I regard him as one of the most desirable persons I could have alighted upon for carrying out the investigation that was conducted.

It may be desirable to state that every analysis given in the case was made by myself; but, there are two students to whom my thanks are specially due for their assiduous attention in connection with it. To Mr. Cookson I am indebted for assistance rendered in the ward, and to Mr. Lamb for assistance rendered in the laboratory. Without exception, the analyses were made from day to day, as soon as the twentyfour hours had expired, so as to avoid loss of sugar from decomposition. The determination of the quantity of sugar was effected by the cupro-potassic liquid in the manner I have elsewhere described.

The patient had been an inmate of the hospital for six weeks before he fell under my care. He was admitted under my

colleague, Dr. Gull, December 20th, 1860. I perceive he was then passing from eleven to fourteen pints of urine a day. He had been placed upon full diet, with milk, greens, and four ounces of brandy and two bottles of soda-water daily. His medicine at first consisted of the sesquicarbonate of soda in scruple doses, with the compound tincture of cinchona, out of infusion of hop three times a day, and half a grain of opium also three times a day. This was afterwards changed for the decoction and compound tincture of cinchona, with one grain of opium three times a day. Under this treatment, with the diet already mentioned, he continued until February 1st, when he was transferred to my care, on account of Dr. Gull then taking charge of the clinical wards.

The object I had in view, was to examine as carefully as possible the influence exerted by the common articles of diet over the extent of elimination of sugar-to ascertain, in fact, as closely as I could, the relation existing between the food ingested and the sugar voided by the patient. In order to get the separate effect of his meals, I divided the twenty-four hours into periods of four hours each, and directed him to collect his urine in separate vessels for each. He was always to empty his bladder when the end of the period had arrived, and to be careful that no loss of urine occurred when he had an alvine evacuation. I had thus six specimens of urine for examination every day; and attention was directed to the quantity, specific gravity, extent of saccharine impregnation, and the general properties of each visible to the eye.

A synopsis of all the results obtained will be found arranged in a tabular form further on, with an account of the diet that was from day to day taken. On reference to this table of results, there will be observed a series of columns, the first of which is occupied by the date; next is a column for the several periods into which the day was divided; and in a line with each particular period, in succeeding columns, can be seen the specific gravity of the urine belonging to it, the quantity of urine passed, the number of grains of sugar in the urine per ounce, and the gross amount of sugar for the four hours, which has been, of course, obtained by multiplying the quantity of sugar per ounce with the quantity of urine passed, In the

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