DEP/DUA/1/33/02 (Transcript version)

William Dods

(1783-1784)

---

Wm Dods. Novr 15

With regards to name of this pat disease no doubt in pron it an examp. of Diabetes.

The Diarrhoea urinosa or Prof. urinae of the ancients.

From these appelat. need hardly observe that great charact of the affect immod. disch of urine.

And accord. by this mark alone all the nosol. writers have def. it.

When consider that disch in this case now to extent only of lb VI in 24 hours may be doubtful how far disease still exists.

For unquest some with whom even in state of health, partic in winter season urine to that quantity

But in [judging] of disease, in pres. advanced state this circum alone must not influ determ

Must take into acct condit in which has been during former progr of affect.

Must attend to other sympt. with which patient then was & still is affected.

And must also pay due regard to state of urine in other respects as well as to quantity.

Disease when patient first applied at Dispens. near four months standing

And although now to quantity only of six pounds yet during great part of course at 20 in day.

By this disch there was soon inducd general wasting of the habit, languor, loss of strength, & some degree of hectic fever as indic by quick & feeble pulse.

And these sympts. constit at least danger part of diabetes, still contin. in some degree

With dimin of quantity of urine others indeed have in great meas. ceased.

Thus both appetite & thirst once excess. have now nearly returned to natural stand.

But from state of both partic of former have strong charact of the affec

In most inst of Diab. which have occurd in my pract. uncomm. appet for food one of most stricking sympt.

In this affect patients neithr satisf nor, as would app. from grad wasting of habit prop nourishd by double or even triple quant of alim formerly suffic.

Probab. as nutrit matter carried off & disch almost as soon as [assimil] into chyle.

That this the cure prob. from anoth very common mark of disease, sweet taste & smell of urine.

From this review then app. that all the charact sympt of this affect either have taken place or are still pres with this pat.

As of last kind may mention that remarkab. circum. pecul sweet taste of urine.

For although accord to accts of patient now much dimin, yet still manif pres to no inconsid degree.

This we may obs. is a sympt not only charact. disease in general but with almost every nosol. fixing a partic species of it.

Thus Mr Sauv. in his syst. gives diabetes with sweet urine the title Diab. Anglic.

Concl. that was a more freq. affect in Engl. than other countries as accurately described by Dr Mead & some other English writers.

Dr Cullen again to this species has given name of Diab Mellitus.

A circum to which has been led from resemb. which this diabet. [urine] has, to other urine in which some prop of honey dissolvd.

But were we to suppose honey either cause, which might be inferrd from name, or in any other way [conc] in affect, opin would be very erron.

This name therfore I am inclind to think is except.

And other Diabetes Anglic when consider that disease by no means pecul. to Engl. is no less so.

Pathol. writers partic Dr Gaub. in treating of urine have pointed out three diff kinds

Urina potus, Urina chyle & Urina sanguinis

There can be no doubt that diabet urine affords strongest example of second of these the urina chyle.

And as little that its pecul qualit. arise from its cont. the constit of chyle, partic sweetness from Sugar of chyle

Better therefore disting from other dropsies by title of Diab. chylosus than any other term.

Into pathol. of this disease, which still involvd in great obs. cannot pretend to enter.

May only remark that the exper. made by Dr Dobson, since repeatd by others, leave no room to doubt, that urine of such pat. cont. real sachar matter.

And as this can be only sachar. part of chyle, before convers. into salin of blood, has been question how thus suddenly thrown off.

Some suppose that happens from diseased state in alim canal or imperf. assimul.

Others again attrib to fault in kidney.

But in both cases has been imag. that [reaches] urinar organs only, through channel of circul. syst.

On this subj. however a diff suppos. thrown out, by late ingen Mr Darwin.

Endeav to render it probab, from variety of phaenom, that matter disch, may without intervent of circul. syst. be immed carried from alim canal to bladder.

This he supposes effected by retrog motion taking place in some of the Lymphat.

To this opin though supported with much ingen. must own cannot be a convert.

But here would be out of place either to enter into consid of proof, or obj that may be urged against it.

And without farther [remarks] on pathol of affect, may obs, that whatever morbid condit may be, disease a very obstin one.

If were to form a conject as to event of pres case, from those I have before treated, should without hesitat give it as my opin. that endeav to serve this patient of no avail.

But when consider hist of case several circum appar. very fav.

And indeed more so than any inst of this affect, which have had form occas. to treat

For although of several months standing, yet this may be consid as but incip state of Diab.

For in many cases has subsisted even for years before prod of any such inconv. as to lead patient to apply for assist.

When that however the case may naturally be supposed more obstin disease than when only of few weeks.

Cause also to which disease of pres patient attrib anoth fav circ.

Accord to his own acct, arose as immed conseq of hard lab.

By this, profuse sweat induced, during which drank large quant of cold water.

That from sudden impress of cold, acting on a body [remd] pecul irrit by heat, very powerful effects [should] be prod, is by no means surpr.

And accord, from condit of habit on which acts, prod very various nay oppos. affect.

That among others should sometimes give rise to uncommon determin to kidney, may readily be supposed.

Hence then whether conject of patient realy well founded or not, must at least admit that is a cause adequate to effect.

And prob of conject not a little confirmd, from accid of this nature being enum by every accur observ. among accid causes induc. the affect.

If however has proceeded from this cause, reason to presume that no perman. local affect has taken place in kidney.

Hence then at least better chanc of recov.

But to these two circum, still a third to be added more fav. than either

That is change for better which has lately taken place in disease of patient.

Independ of any remedy quantity of urine spont. dimin from 20 to 10 lb

And since treatm begun still farther dimin so that no reduced lb VI

With this remark change has in other respects also come [nearer] to natural state.

And in partic sweet taste indic immed disch of chyle much less consid.

Accordingly not wonderful that attended also with dimin of immod appetite.

Hence then reason to inferr that here even spontan. tendency to recov.

And that from being promoted by aid of med, cure may in no long time be accompl.

On these grounds notwith obstin nature of disease must own that have some hopes.

At same time must also remark that in former inst have seen very consid remissions which were followed by more severe attacks than ever.

Hence from pres relief cannot be confid as to future state.

While at the same time weak & very exhaust. condit of pat. against him.

And also not a little so that is a poor lab. exposed to cold, fatigue, & all vicissit of weather.

To all this must also add, that doubtful how far he will either give regul. attend, or be disposed faithfully to employ med we direct.

For while resides at distance in the country seems to have some dispos to prescribe for himself.

As far however as does attend us & will follow direct given, may afford opport for diff trials in way of [Pract].

In this disease Pathology so far obscure, that diffic to say on what princip rational cure can be cond.

But from suppos gener. entert. that arises from want of due tone in secret vessels of kidney, conj with morbid irritab. there, such med have in general been recomm, as will encr. former & dimin latter.

With one of these intent, recourse has been had to diff astring, & pecul stim, while with the other sedatives have been empl.

But if benef sometimes from these, as far as my obs. goes, still more from dimin of determin of fluids to kidney & from prev. occur of [superf] water in general mass of fluids.

On the former latter ground benef. from moderating thirst by other means than by large quantit of diluents.

And on former from support [equab.] circulat & even encreased determ to surface by warm cloath but still more by warm temperat.

And hence perhaps more real benef. in this disease by change from cold to warm clim, than by any other means.

Did circum of patient therfore admit of it, would have no hesistat in recomm it to him, to exchange this country for more southern Sun at least for winter season.

But as this impract. must conten ourselves with enjoin it to him, to avoid cold as far as can, and to defend against it by prop. cloathing.

While at same time may have recourse to diff remed with other [intention]

Since began treatment of this case, have you will observe had recourse to repeated Emet.

From operat of these it is well known that by sickness induced as well as severe action, powerful [deter] is given to surface.

May suppose them serviceable therfore as dimin determ to kidney.

But [here] must observe, that have had recourse to this mode of cure, more on footing of exper, than from any reasoning.

Not however, I must acknowl. from any exper of my own, for in this disease have not before empl. them.

But from having received inform I can depend upon of a case of Diab. cured by occurr of an obstin spont vomiting.

From that fact, although a solitary one, I own have long wishd to have opport. of giving Emet, in this disease a fair trial.

Have accord ordered to this patin five success. Emet, since he came under care.

And may at least venture to say, without any bad effect.

Nay since he began employm app. from which might inferr, that attended with good conseq.

For urine now dimin from extent of twenty pounds in day, to six.

All this change however we cannot with any justice ascribe to the Emet.

For before use, even of first was consid dimin.

And indeed whole of dimin may have arisen from spont. change which had then begun to take place in the disease

But whether reduct to pres low quantity to be attrib to nature or to art, cannot yet be consid as complete cure.

For still retains manif sweet taste.

At one time indeed, during course of last week, this qualit had entirely disapp.

And urine both became scanty & at same time acquired high colour

This we are told, the conseq of excessive spontan looseness.

And probab. more from alim matters being disch, before chyle formd, than from any change, in morbid affect before existing.

While at same time fluids also taken in as well as solids immed hurried off by stool.

And accord on Diarrh ceasing [disease] returned to same state as before.

But although no ground for posit. attrib much to Emet. yet appear suffic fav, to excite desire of persist in use.

Is therfore my intent, if patient will comply with it, to persist in use for some time longer.

And to avoid, what he may think app of inactiv, shall prob. conj. emet with some artic, to be taken daily with view of engaging attent.

For this purpose, have thought of ordering him a combin of Rhub. & Magnes.

From which, while will not interrup pres plan of cure, may expect some good effect, as keeping belly gently open, & at same time strength tone of alim canal.

Besides this if app. progr to recov. shall prob. also prescribe vomit less frequently

If under course of Emet cure should here be accompl. will I own be disp. to look upon it as matter important fact.

And not perhaps of very great conseq. whether we can give a satisf explan of mode of action or not.

But besides what already suggested of influence as give determ to surface other suppos also may be entert.

And must own that for my own part will be disp. to consider this pract. as in some degree fav Mr. Darwins theory of disease already ment.

For At least as probab not impossib that oper. as counteract retrogr. motion of [Lym.] if such take place as in any other way.

But before hazard any conject as to method in which good effects to be expl. first necess to determ with certainty that has such effects.

Should Emet in this case prove unsuccess. or be deserted without prop trial, anoth mode of cure which I wish to employ in this disease.

Remed to which I allude Electric

If disease depends on atonia at kidney in any degree approach to Paralysis, may I think be mean of removing it

But for this mode of cure our patients resid in the country is very unfav.

Shall prob. therfore rather have recourse to trial of Tinct of [Canith] or Serum alum.

Former, although has faild in inst in which have before used it may succeed in pres. which of sligh nature.

And although far from looking on latter as [effic] remedy Dr Dover [repres.] may yet allev if cannot cure disease