•. i :.■! + Mm'^z: $GG"^ G v. i> ■:>:■ m> :- y - f*l>G ■ ' G J fc**8 "> r;'". r"v'. - •.■". 'v l ** # A? • .■•'••':•■ "■ UNITED STATES OF AMERICA WASHINGTON, D. C, GPO 16—67244-1 7896 AN ESSAY DISEASE COMMONLY CALLED DIABETES. BY WILLIAM WASHINGTON, OF ALEXANDRIA, VIRGINIA, HONORARY MEMBER OF THE PHILADELPHIA MEDICAL AND CHEMICAL SOCIKTI**. Multum egerunt qui ante n»s fuerunt, fed non peregerunt j multum adhuc reftat operae, multumq; reftabit, neque ulli nato poll mille fecula pnecidetur, occafio aliquid adhuc adjtciendi. Seneca. PRINTED FOR THE AUTHOR BY JAMES H U M>St*ifi Tfi[$ 'V. *-• &ZZ^J' 1S02. AN INAUGURAL DISSERTATION ros THE DEGREE DOCTOR OF MEDICINE, SUBMITTED TO THE EXAMINATION OP THE REV'D. JOHN EWING, S. T. P. PROVOST, THE TRUSTEES, AND MEDICAL FACULTY, or THE UNIVERSITY OF PENNSYLVANIA; ON THE 27th DAY OF MAY, l8oj. Hot>3Ts> Td Doctor JAMES CRAIK, OF ALEXANDRIA, VIRGINIA, THIS DISSERTATION IS DEDICATED, IN TESTIMONY OF THE RESPECT AND GRATITUDE SO JUSTLY DUE FROM HIS SINCERE AND AFFECTIONATE FORMER PUPIL THE AUTHOR. TO BENJAMIN RUSH, M. D. PROFESSOR OF THE INSTITUTES, PRACTICE, AND OF CLINICAL MEDICINE, IN THE UNIVERSITY OF PENNSYLVANIA, THIS ESSAY IS ALSO INSCRIBED, AS AN ASSURANCE OF MY HIGH ESTEEM FOR HIS VIRTUES AND TALENTS, ALSO AS A TRIBUTE OF GRATITUDE, FOR THE MANY MARKS OF POLITENESS CONFERRED ON HIS MUCH OBLIGED FRIEND THE AUTHOR. TO ATTACK AN ERROR IS THE COMMON RIGHT OF EVERY MAN, IN MEDICINE IT BECOMES A DUTY, AND HE WHO IS CONSECRATED TO THE PRESERVATION OF HIS FELLOW CITIZENS, OUGHT NOT TO FEAR TO RAISE HIMSELF ABOVE PREJUDICES OF WHICH HE KNOWS THE DANGER, PARTICULARLY WHEN HE CAN SUBSTITUTE AN USEFUL TRUTH. BLAIR. AN INAUGURAL DISSERTATION. J.N contemplating the variety of forms under which morbid action makes its appearance in the human body, and the confequences and effects which refult from its determination to particular parts, I am induced to believe, that its attack upon no part ought to claim more of our attention than the one which will confli- tute the fubjecl: of the following Eflay. Although it cannot now be faid to be a difeafe which occurs often, yet its appearance has become far more frequent than formerly. This, perhaps, has been with fufficient rea- fon afcribed, by Dr. Home, to the more fre- quent and fafhionable ufe of fpirituous liquors at the prefent time, than amongft the antients; [ ^ ] 10 which was in a great meafure unknown to them, and is now acknowledged to be one of its molt common exciting caufes. It was fo unufual a complaint at the time of Galen, that only two cafes were noticed by him, and he even goes fo far as to fay, that it was confider- ed almoft a miracle. The difeafe to which I allude, has hitherto been defcribed by mofr medical authors under the appellation of Di- abetes, from the Greek word Diabaino, to pafs off or through. This term, although by no means conveying an accurate idea of the difeafe, I mall adopt, more for the fake of con- forming to cuflom, than from a perfuafion of its propriety. Dr. Cullen, in his Nofology, has placed it in his clafs Neurofes, and order Spafmi, from a belief in its connection with nervous and fpafmodic difeafes; but the im- propriety of this mud be evident, as the fymp- toms which induced him to clafs it among thefe are not uniform, but anomalous or acci- dental circumftances. The following is the definition which he has given of it; Urinceplerumquepreternatu- II rails copla tmmodica profufio Chronica, of which he enumerates two fpecies; viz. Diabetes Mel- htus, and Diabetes injipidus; but as I am well convinced, that no real benefit can be derived from this divifion, I mall include them both under one head, believing them, as I hope to prove hereafter, to be always the effect of one caufe j and owing folely to a morbid or irregu- lar action in the whole fanguiferous fyftem, accompanied with a local determination to the kidneys. There is fcarcely any difeafe which has been looked upon in a more incurable light, or as being one more fatal in its termination. This was particularly obferved by the illuftrious Cul- len, who, when treating of it, exprefsly fays, " that out of twenty patients under his care ff not one of them recovered." This circum- ftance, as well as many others, induced me to make it the fubject of my Diifertation, as I hope to deliver a Theory of it, which will lead to a more fuccefsful mode of treatment than it has heretofore met with, and reduce it as much under the power of medicine as any 12 other difeafe. Before I proceed, it may be thought neceffary that I mould firft declare, from whom this Theory was derived. In doing this, I feel a pleafure in acknow- ledging, that it was taught by the Profeifor of the Inftitutes of Medicine in this Univerfity, who, in his Pathological Lectures informs his pupils, that he had long wifhed for a fatisfac- tory Theory of its production, and had thought much on the fubject; but was at laft forced to refort to the unity of difeafe for its explana- tion, and fince adoption, it has been fupport- ed by the fuccefs attending the practice found- ed upon it. Perfons of every age and fex ap- pear to be fubject to it, but it moft frequently attacks thofe who are in an advanced ftage of life. In purfuing this fubject, I fhall, jirjl, give a general account of the fymptoms with which it is accompanied ; fecondly, the differ- ent kinds of urine fecreted; thirdly, the caufes which ufually bring it on; and, lajily, the proximate caufe, under which head I fhall confider fome of the moft plaufible opinions which have been advanced to explain it. J3 HISTORY of the SYMPTOMS. THE Symptoms which ufually point out the exiftence of Diabetes, are a frequent difcharge of an uncommonly large quantity of pale and colourlefs urine; much greater than the quantity of liquids taken in; exceffive thirft, which is often fo uncommon as that feveral gallons of drink are required, and taken in, in the courfe of a day; pain in the region of the kidneys, with a retraction of one or both tefli- cles, accompanied with a pain extending along the thigh; coftivenefs; a voracious appetite has been faid by fome authors, to be a con- front attendant in this difeafe, from its com- mencement, others again take no notice of it; pains in different parts of the body, and par- ticularly in the head, are not unfrequent; a white and furred tongue; flufhed countenance; inflammation and fwelling of the gums, putting on that appearance which they affume when under the influence of mercury, with a frequent H fpitting of thin watery faliva; a hot and dry fkin; a feeling harfh to the touch; excoriati- on and fwelling of the prepuce of the penis, and a difcharge of blood along with the urine often happens; ftrictures in the urethra like- wife fometimes occur. Thefe, together with a full, quick and tenfe pulfe, are among the moft prominent fymptoms with which it is accompanied. In the courfe of the difeafe, however, the patient, in confequence of the exceflive difcharge, becomes emaciated, and ex- tremely feeble; the feet and legs become cede- matous; and when it proves fatal, thefe fymp- toms are obferved to become more violent. The quality of the urine voided is not al- ways alike. Many cafes are related, where no perceptible difference from that of its natural ftate could be difcovered; but in a majority of inftances it is poffeffed of a fweet tafte, which has been compared to a mixture of honey and water. This has been faid to be uniformly the cafe, and to be a certain characteriftic of the difeafe; but very improperly, for we have many cafes recorded, where it could not be *5 perceived at any period of the complaint; and others, where it difappeared in its courfe fe- veral times, although the quantity of urine difcharged was not at all diminifhed, nor could the exiftence of the difeafe be doubted. Dr. Cullen relates a cafe in which it was perfectly inlipid. The quantity voided varies in differ- ent patients; in moft cafes where adults have the difeafe, from ten to twelve pints is gene- rally made in a day, but we have authority for afferting that it often much exceeds that quan- tity. Cardanus gives an account of one who difcharged thirty-fix pints every day for feveral months. It appears to be increafed in propor- tion to the increafed violence of the foregoing fymptoms. By evaporation a faccharine ex- tract has been obtained; from two pounds of Captain Meredith's urine were afforded two ounces of this matter, which diftilled with nitrous, was converted into the oxalic acid. In the experiments of Dr. Dobfon we obferve, that when it was preferved in an open veffel, it paffed through the vinous, acetous and putre- factive fermentations, from which we are con- vinced of the prefence of faccharine matter. i6 REMOTE CAUSES. WITHOUT entering into a difquifition on the manner in which the remote caufes act in producing Diabetes, I fhall content myfelf with the bare enumeration of them. They appear to be nearly the fame which generally excite other febrile difeafes. The following are the moft common; to wit, the intempe- rate ufe of fpirituous liquors; acid drinks; large quantities of water; excefs in eating; alternate heat and cold; great fatigue from much bodi- ly exercife; the too frequent ufe of diuretic medicines. Dr. Willis mentions a cafe which was brought on by Rhenifh wine, which ended fatally in twenty days. Dr. Cullen was of o- pinion, that it was frequently excited by cal- culi in the kidneys, from its attacking perfons fubject to calcuculous complaints. The heal- ing of an old ulcer has produced it. This was obferved by Dr. Sydenham, who alfo fays, that it often fucceeded intermitting fevers. It l7 is often connected with gout. Medicines act- ing as fedatives, and the debilitating paflioiis of the mind. PROXIMATE CAUSE. HAVING briefly ftated the fymptoms of this difeafe, and the caufes by which it is ufu- ally brought on, I fhall now take up the con- fideration of fome of the opinions which have been advanced by different authors to explain it. Many of them may with truth be faid to be as vifionary and hypothetical, as the opi- nion of Paracelfus refpecting the compofition of the human body, which he imagined to be Salt, Sulphur, and Mercury. To notice them all would be unneceffary; as many of them are, in confequence of the prefent im- proved ftate of medicine, entirely exploded, and it would neceffarily extend this Effay far [ 3 ] i8 beyond its intended limits. I fhall therefore only confider fuch as have attracted moft at- tention, and have been moft accredited. In the firft place, that advanced by the ingeni- ous Darwin, who has afcribed its phenome- na to a retrograde motion in a certain fet of lymphatics, which, he endeavours to prove, form a communication between the ftomach and bladder, is the moft prominent and wor- thy of notice. He accounts for it in the fol- lowing manner, by firft affuming it as a fact, that the great quantity of urine made after drinking largely of water, or fpirituous liquors, is owing to the urinary branch of abforbents, which anaftomofe with the lacteals of the in- teftines, inverting their motions, and by that means conveying it directly to the bladder, which, if repeated often, at length gains an habit of doing it, and the chyle, by that means, is carried directly to the bladder, without en- tering the circulation. This explanation, al- though it has the ufual ingenuity of the author attached to it, does not, in my opinion, coin- cide with the fymptoms of the difeafe, and before we can admit it, the exiftence of thefe *9 lymphatics fhould be proved to a demonftra- tion, and their power of taking on a retro- grade motion, fhould be eftablifhed by facts and experiments. In fupport of this, the Doc- tor has brought forward the experiments of Mr. Charles Darwin and Doctor Kratzenteen, which he confiders the very pillars of its fup- port. The circumftance of thefe being doubt- ed by fome, and even faid to be proved erro- neous by later experiments, was fufBcient to excite a* fufpicion in my mind. I accordingly determined to repeat them exactly in the fame manner that they are related. This was done, not becaufe I pretend to doubt the veracity of the perfons by whom they were made, but from a conviction of the fallacy, or rather uncer- tainty of experiment in many things, and well knowing, how liable we are to be deceived. Of this liability to error every candid perfon muft be fenfible. Scepticifm and incredulity in medicine ought therefore to be admitted and rather admired than reproached. The duty we owe our fellow-citizens renders this abfo- lutely neceffary. The refult of thefe experi- ments as performed by myfelf, I fhall novv 20 give in full, from which the reader may draw his own conclufions. The firft was conduct- ed in the following manner: After having made a tolerable hearty dinner on roaft beef and potatoes together with afparagus, I prepared a fufHciency of punch for the purpofe of the ex- periment, of which I drank until I began to feel intoxicated; I then diffolved three drachms of nitre in about half a pint of the punch, all of which I drank at repeated draughts: In the courfe of three hours I voided nearly three pints of pale colourlefs urine, into which I immer- fed feveral fheets of filtering paper. It was then put into the fhade to dry, and after it had become fo, one or two of them were burnt, but fhewed no evidences of the prefence of nitre. Some gentlemen prefent obferved, that they thought they heard fomething like detonation, but this they were afterwards convinced, was nothing more than that which always accom- panies the combuftion of paper, which had been previoufly wetted and afterwards dried: However, to be certain on this point, we burnt at the fame time, paper which had been dipped in urine made before the commencement of the 21 experiment, and, there was no kind of difference in the refult. In this opinion the gentlemen prefent coincided. Not being difpofed however, to make up my mind from a Angle experiment, I refolved to try it again, and my friend Mr. Hartjhorne was fo obliging, as to be the fubject of its repetition. We conducted it in every refpect like the former, except, that he drank wine inftead of punch. It operated much foon- er on him than it did on myfelf, and he dif- charged a larger quantity of urine in a fhorter time. We treated it in the fame way as we did the former; but there appeared no cir- cumftance whatever which could induce us to think,, that it contained any nitre. A portion of it was afterwards evaporated by Mr. Hartf- horne, and he informed me, he could not de- tect any in it. Finding from thefe experi- ments, that the opinion of a direct communi- cation between the ftomach and bladder was extremely improbable, I determined to repeat the one related by Doctor Kratzenteen in the Philofophical Tranfactions of London, from which Dr. Darwin s Theory has been fuppo- fed to derive additional fupport; this was the 22 ' tyeing up of the ureters of a dog, which dog continued to difcharge urine notwithftanding. With the afliftance of my friend Dr. Jacobs, I tied up the ureters of a bitch, at about half after ten o'clock in the morning, and preffed out what urine was in the bladder; water was then given her, of which me drank plentifully, but eat nothing of any confequence. I watch- ed her attentively for eight hours, and during that time fhe did not void one drop. It being then very late in the evening, and inconvenient to attend to her, it ftruck me, that if a liga- ture was put on the urethra, I fhould afcertain it to a certainty in the morning, by examining the bladder; but finding it inconvenient to get at the urethra, I tied up the mouth of the va- gina, and left her until the next day; when I found her in appearance as well as fhe was when I left her. I then killed her, and upon examining the bladder, it was found quite empty and contracted; the ureters were, well fecured, and diftended to nearly double their natural fize; the vagina and uterus were alfo examined, but they contained no urine. On cutting into the kidneys a quantity iffued out, and they appeared in fome degree inflamed. * *3 From thefe experiments I think we may be warranted in afferting, that the notion of a direct communication from the ftomach to the bladder, is erroneous, and that it has nothing but the high authority from which it comes to recommend it; confequently, the explana- tion of Diabetes, cannot be accounted for up- on this principle. But even admitting it, we fhall find ourfelves as much at a lofs as ever. Howvfhall we account for many of its fymp- toms? Why fhould the kidneys be in every inftance affected ? That they are is undeniable; for one of the moft prominent fymptoms with which it is attended, is a conftant pain in the region where they are fituated. Pain is not the only proof we have of their being difeafed; it is fufficiently evinced by the diflection of perfons who have died of the complaint. The kidneys of the patient diffected by Dr. Home, were found preternaturally enlarged; and ma- ny other cafes are recorded, which I fhall re- late in a fubfequent part of this Effay. The analogy alfo between many of its fymptoms, and thofe which accompany other difeafes of the kidneys, adds additional fupport to the opi- 24 nion of their being affected in Diabetes. Do not authors defcribe a retraction of one or both tefticles, and a pain extending along the thigh, as accompanying calculous affections of the kidneys? They do;...and we have the fame mentioned as attending Diabetes. They oc- curred in one of Dr. Rollo's patients. Its af- fecting thofe perfons fubject to the gout, which often attacks the kidneys, and frequently fuc- ceeding a fit of Nephritis, would at leaft render it probable, if there was no other cir- cumftance in proof of it. Mead mentions a cafe which fjcceeded a fit of Nephritis in a Mr. Bullichius, the chief magiftrate of Copen- hagen, who was fubject for many years to a pe- riodical Diabetes, which returned every month after a fevere nephritic fit, at or near a full moon, when he made twenty-four pounds of urine, although he had not drank a pint. It is alfo admitted by Doctor Cullen, to be fome- times connected with calculous complaints, and calculi have actually been found in the kidneys of thofe who have died of this complaint.* * Sepalchret. Anat. Boneti. 25 A more concluiive proof, however, of the in- fufHciency of the explanation of this difeafe, upon the principle of a communication from the ftomach to the bladder, may be drawn from the following circumftance; viz. the difcovery of faccharine matter in the kidneys: In proof of this we have the authority of Dr. Home and Dr. Munroe, who were both indu- ced to think fo, from a four odour being emit- ted from the kidneys of the patient before quoted, Which muft have been the confequence of its being in a ftate of acetous fermentation: This was alfo noticed by Vanfweten. He al- fo obferves, that particular pains were taken to fee if any lymphatics could be difcover- ed about the neck of the bladder, but there were none to be found. I might now go on to enumerate a number of other facts in oppo- fition to the Doctor's opinion, which fuppofes, that the abforbents poffefs the power of taking on a retrograde action, even admitting thofe of the bladder anaftomofed with thofe of the in- teftines and ftomach, but as this part of the fubject was very handfomely combated, and I [4] 26 think fuccefsfully refuted by Dr. Bibb, in his inaugural difiertation, publifhed laft year,* I fhall pafs over it unnoticed. I will, however, mention an experiment made by Dr. Jacobs, fome time in the courfe of the laft winter. This was, an attempt to inject the lacteals of the inteftines of a young woman with mer- cury who died fuddenly, and in whom they appeared very evident: In every attempt to force it in a contrary direction to their natural courfe, the refiftance given by the valves was fo great, that the lymphatics were ruptured. My friend, Mr. Grimes, alfo informs me, that he found it impoffible to force the chyle in the lacteals of a dog in a direction contrary to its natural courfe. Prefuming, therefore, that thefe experi- ments and facts are fufficient to refute Doctor Darwin's opinion of this difeafe, I fhall pro- ceed to the confideration of the opinion of Doctors Cullen and Dobfon, which fuppofes it to depend upon a defective ftate of the aflimi- * Vide Dr. Bibb's Inaugural Difiertation on the Modus Operandi of medicines. 27 latory powers, or thofe powers employed in converting alimentary matters into the proper animal fluids. The principal reafons that in- duced them to take up this opinion were drawn from the following circumftances; firft, the difficulty of fuppofing, that the fecretory veffels of the kidneys could take on fuch an action as to fecrete urine poffeffed of faccharine proper- ties ; fecondly, the difeafed ftate of the ftomach which fometimes accompanies it; and laftly, a fweet tafte in the ferum of the blood. With refpect to the firft, we can fee no difficulty in accounting for it. It is well known, that by fome myfterious law in the animal ceconomy, morbid action fometimes terminates in effufion, or fecretion of one fubftance, and fometimes another. Morbid action in the liver is often followed by the fecretion of green, black, and acrid bile; in the bowels, thin, watery, and in- odorous ftools; in the falivary glands, thin, watery faliva; in the joints, chalk ftones or calcarious matter; in bones, boney matter; and in foft parts, pus, which often differs in its properties. The gonorhceal difcharge, from being flopped frequently, produces a fimilar fe- cretion from the glands about the eyes, and the 2.8 menftrual fecretion has been performed by the ftomach, nofe, and breafts. From thefe cir- cumftances we may with equal propriety infer, that a gland may not only fecrete a fluid, when labouring under difeafe, different from which it does in health, but it may alfo take on the fecretion of another gland, and therefore, why may we not fuppofe, that the kidneys are pof- feffed of the fame power of having its fecreti- ons fo altered, as to produce a fluid of a fac- charine nature ? To fuppofe that chyle could enter the blood-veffels without being proper- ly prepared, and circulated through the whole fanguiferous fyftem, would be unphilofophi- cal, and incompatible with the laws of the animal ceconomy. If death is produced by the injection of a few drachms of fimple wa- ter, or pus, into the blood-veffels, is it reafon- able to fuppofe, that fuch a large quantity of faccharine matter as is generally fecreted by the kidneys, could exift in them without being followed by the fame fatal confequences ? no; certainly not. The knowledge we now pof- fefs of the abforbent fyftem renders it pretty certain, that they do not take up any thing but what is properly aflimilated. But even 29 admitting, that the chyle entered the blood-vef- fels without being properly afiimilated, would it not be robbing the kidneys of one of the moft effential prerogatives belonging to all glands, to fuppofe, that a fluid could pafs through them without being altered in its properties ? The ferum of the blood and urine fecreted, both in health and difeafe, are by no means a- like, whereas, if the veffels of kidneys were intended for no other purpofe than that of a fimple ftrainer, both of them ought to be of the fame nature. The urine of a patient af- flicted with Diabetes does not coagulate when expofed to heat, but the ferum of the blood does, which I think proves, that it has under- gone fome change in pafling through the kid- neys. As to the ferum of the blood being found fweet by Dr. Dobfon, I am difpofed to think, he mult have been deceived by fome cir- cumftance or other; probably the fenfe of tafte (the fallacy of which none of us can be igno- rant of) was the caufe, from its not being found fo by later obfervations. Dr. Home •\ys, that the blood of both his patients was not fweet, although as much as two ounces of ficcharine matter wsre obtained from thirty-fix 30 of urine voided by one of them; is it therefore reafonable to fuppofe, that fo large a quantity could have exifted formally in the blood, and not be difcovered by the tafte ? however, with- out perfifting on this point, I fhall proceed, to deliver the Theory of this difeafe which I have adopted, as it can be no objection to it, even admitting the chyle was carried into the circulation, without being properly prepared. This, according to Doctor Ru/Jj, confifts in a morbid or irregular action in the whole fanguiferous fyftem, or in other words, it is a ftate of fever accompanied with a local deter- mination to the kidneys. This is evinced by its being attended with all thofe fymptoms which are ufually the confequence of other febrile ftates of the fyftem; viz. pain, increaf- ed action in the pulfe, thirft, increafe of heat, and a flufhed countenance. Thefe are all in- feparable from it, and it muft be acknowled- ged that they are the effects of febrile action. Dr. RuJJj defcribes the pulfe as being full, tenfe, and quick, in thofe patients which he attended; and Dr. Richter, as being fmall, tenfe, irritated, and quick. P. D's. pulfe, 31 Dr. Dobforis patient, was, at irregular inter- vals, up to one hundred and fifteen, and one hundred and twenty ftrokes in a minute. In one of Dr. Rollos patients it was at times one hundred and four in a minute. We judge it to be a ftate of fever, likewife, from the ap- pearance of the blood, which, is generally fizy, and with an inflammatory cruft on the top;* Doctor Home alfo defcribes the fame appear- ance, and Doctors Rollo and Dob/on furnifh two others in proof of it. I infer, alfo, that it is the effect of febrile action from the caufes which produce it, being the fame which pro- duce other ftates of fever; viz. intemperance in eating and drinking; viciffitudes of the wea- ther ; and many more which it would be un- neceffary again to mention; and likewife, from its attacking thofe conftitutions moft liable to fever. This opinion is alfo confirmed by dif- fedtion. The kidneys of the patient before related difcovered every mark of exceflive acti- on; they were preternaturally enlarged, anc. much fofter in their texture than ufual. Mr. Cruikfiank alfo obferved the fame; he found ' Rufl's M. L. J>~ the minute cryptas which fecrete the urine par- ticularly fo. The difeafed ftate of the kidneys is alfo farther confirmed by the following quo- tation from a letter, written by Dr. Bailey to Doctor Rollo. Thefe are his words, " I have " examined not only the ftate of the kidneys, " but of the ftomach; the inteftines, the " glands of the mefentery, the liver, fpleen, " and pancreas, and I do not hefitate to men- {e tion to you, generally, that I was induced " to believe from the morbid appearances in " the kidneys, that the principal feat of the " difeafe was in them." The exceftive dif- charges of fweat and faliva, and the fecretion of urine being increafed in proportion to the increafed violence of its fymptoms, affords ad- ditional proof of it, I infer it alfo, from its being frequently attended with dropfical fymp- toms, which are nineteen times in twenty the effect of fever. This opinion does not reft upon thefe facts alone. The fuccefs attending the practice founded upon it, alfo adds additi- onal confirmation of it, proofs of which I fhall adduce, when treating of the method of cure. 33 METHOD OF CURE. FROM the view we have taken of the proximate caufe of this difeafe; the indications of cure muft be evident. As we have faid that it confifts in an excefs, or rather a morbid action in the whole fanguiferous fyftem, with a local determination to the kidneys; the firft ftep to be taken fhould be to attempt its removal, which may be done by any of the feveral modes of depletion; in the firft place, blood-letting, which fhould be regulated, by the degree of action in the pulfe, and other fymptoms : Then emetics fhould be exhibited;...thefe may be either Tart. Emetic, Ipecacuanha, or Turpeth Mineral, which laft I fhould prefer, as two advantages would probably be derived from it; firft, its action on the ftomach as an emetic, and fecondly, that of producing a falivation, which often follows its ufe when given fimply [si 34 for the purpofe of evacuating the contents of the ftomach. After the febrile fymptoms are in fome degree fubdued, mercury fhould be gi- ven fo as to excite a falivation. Dr. Rujh in- forms his pupils, that by thefe remedies two patients have been cured, and a third was con- fiderably relieved by them, and although he is now fubject to returns of it, he always finds himfelf much benefitted by the abstraction of a few ounces of blood; as a farther teftimony of the propriety of blood-letting we have the authority of Burferius. Capt. M. a patient of Doctor Rand's, was alfo very much relieved by the abftraction of a few ounces, which were taken with a view to afcertain whether the blood was fweet; probably, had it been repeat- ed, he would have recovered much fooner than he did. Mr. Scott, in a letter to Sir Jofeph Banks, fays, he has feen but two cafes of Di- abetes, both of which were cured by mercury; one of them afterwards relapfed, but was again cured by the nitric acid, which produced a ftate of the mouth fimilar to that produced by mercury. A friend of mine likewife informs me, that his preceptor cured a little girl, eight 35 years old, of this difeafe, by means of faliva- tion. Thefe remedies have been ufed with e- qual fuccefs in the Alms-houfe, and at the Qif- penfary, as I am informed, by gentlemen now reliding at both thofe places. Medicines ex- citing perfpiration have been ufed with consi- derable advantage; for this purpofe Dovers powder may be ufed in the ufual way; one cafe is mentioned in the Med. Com. as ha- ving been removed by it. Fifh Oil anointed on the fkin is faid to be ufed with advantage in Scotland; it is ufed with a view of prevent- ing abforption from the furface of the body, but I am inclined to think, that it does not produce its effects in this way, for from the ex- periments of Dr. Roffeau, we are led to believe, tha^i|pforption from the furface never happens. Dff%K&thinks it has a kind of fedative pow- er. The Sac. Sat. was highly recommended by Etmuller, and from its power over the pulfe, I fhould fuppofe it a valuable medicine in this difeafe. For taking off the determination to the kidneys, iffues or fetons may be made on the lumbar region. After the febrile fymptoms are removed, tonics fhould be exhibited; for 3° this purpofe, allum whey has been ufed with moft benefit. With this I fhall clofe this im- perfect EiTay; it now remains for me, to return my moft fincere thanks to each of the Profeffors of this Univerfity, for their politenefs, and the valuable information received from them. r I X I S. MeX. H \st. wz 3L70 W3l