DEP/DUA/1/36/06 (Transcript version)

William Robertson

(1784-1785)

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Wm Robertson. Novr

With regard to disease of this patient very little room for doubt.

Is distinct marked both by [quant] & other sensib qualit of urine.

And when consider extent to which disch as well as pecul sweet taste can have no doubt in pron. it a case of diabetes.

But besides this patient affected also with every othr sympt comm attend the disease.

Such for example as uncomm keen appetite, excessive thirst, bound belly, dry skin &e.

But above all affected with great loss of strength & of flesh.

Circum which may readily suppose must be unavoid conseq. of excess. disch.

In short almost no sympt in case which does not freq occurr in this disease.

While again none of more comm sympt of disease which are not here present.

Among others have to remark degree that sweetness of urine, of late by med writers partic observed in this affect.

Prob. however only from being but of late attended to.

Can I think be little doubt that existed in ancient as well as mod time

And only not described from being overlooked & not attended to.

This sympt indeed some have consid as marking a partic species of the disease.

And accordingly even in system of Dr Cullen, disease divided into Diabetes Mellitus & Insipidus

For this division however, as far as my own observat goes, am inclind to think, that no foundat in nature.

And indeed Dr Cullen though has adopted it speaks of it with great doubt.

Certain that even in same case patient degree of sweet taste very much varied.

And that very generally encreased in proport to quant of disch. & to disch taking place soon after full meal.

A sympt therfore thus subj to such varities, ill suited from being charact of species.

And probab. only not obs. from want of accur attent, from period of observat. from propert of urine at time, or such like circum.

Can only say that in all cases which I have had occas to treat never entirely wanting.

Though in diff cases & at diff times much varied in degree.

This sweetness of urine by [expls] of Dr Dobson, publ. in Lond. Med obs, incontest demonst, to arise from sach matter in the urine.

And indeed his obs. now fully confirmd by those of Dr Black, & othr chem who have taken [trouble] of analys. & evap such urine.

As little doubt that this sachar. matter is same with what gives sweet taste to chyle.

And indeed diabet urine more properly than any other entit to appel of Urina chyli.

And from this immed disch of chyle from syst. whatever may be cause inducing it, most [stricking] sym of disease, partic wasting of habit, & loss of strength, unquest to be expl.

Respect Pathol of this disease [illegible] many disputes

But very few as to Prognosis.

In almost every inst proves if not fatal at least [illegible] disease

Would not indeed affirm that in no cases has recov. taken place.

But in my own pract. must ackn that have never been so success as eithr to accompl cure or to meet with spont. recov.

In this case therefore expect I own by no means sanguine.

And if after all trials that can make shall be oblig to dismiss pat. in no better situat than when came under care, shall not be disapp.

At same time in case before us circum by no means unfav.

Quantity of urine indeed encr. to very consid degree.

And what very common concom of that has remark sweet taste.

While as necess conseq of these two very consid loss of strengh has ensued.

But hitherto no alarm sympt at least such for examp. as hectic fever, have hitherto taken place.

Besides this, disease compar. speak at least but of short durat.

And although skin parchd, yet not to that remark degree, which prob. gives great diffic in cure.

These therefore circum, at least somewhat fav.

And give at least some ground to hope, that although may not be able to accompl. cure, shall at least yet have opport of trying remed most extolld.

And on recomm. of emmin pract. a variety of pract. to which recourse may be had.

Of prin indeed on which these operate can by no means speak with confid.

For concern pathol of the diseas many debates.

And still a matter of much contro whether prin morb. affect, in alim canal or in kidney.

Whether disease princip depends on fault in assimul of alim, or in secret of urine.

For my own part however, inclind to adopt latter opin.

And to considr prin morbid affect as being vitiated secret. often depend even on organ affect of Kidney.

And hence I appreh it is, that so freq resists every remed we can empl.

Great obj therefore is to remove this diseased state, & to restore secret by kidney to natural stand.

And this chiefly to be brought about by restor due tone & remov. morbid sensib.

For accompl. these ends however, must endeav, as much as possib, to remove circum augm these affect.

Must therefore be aim to dimin determ to kidney, & to prev occurr of superf water in blood.

On these grounds, except what done with view of obv. partic sympt, am inclind to think that operat of remed which have been repres at least as success in this disease, may be explaind.

At same time must acknowl. that in treatm of formr cases have often had recourse to remed rathr on Empyr. [footing] than any other

Or at least on ground of exper of those who have repres them as success.

This a good deal the case, with respect to first pract. to which will obs. had here recourse.

The use viz of repeated emetics.

Emetics indeed by some repres as having consid influ in encreas. quant of urine.

This however, when does take place, am inclind to consider only, as conseq in second way.

And to proceed from quantity of water introd to prom operat of emet, but not afterwards disch by vomiting.

Accordingly is by no means a steady or const. effect of empl.

Much more unif emet. prod determ to surface

And by this, flow to kidney, is very gener. in prop. dimin.

In so much that disch. by perspi & urine often obs. to altern with & compen each other.

A circum partic remarkd both on change of season & of clim.

During summer, & in warm weather while perspirat encr. urine dimin.

And in oppos. clim & seasons, is in contrary situat.

This so much case, even with morbid affect of urine, that inst of Diabetes induced by transit from cold to warm clim, & of cure by oppos. change.

Hence then as giving determin from kidney to surface, some ground I think, to expect benef from Emet.

But was not I own upon this footing that had first recourse to use in pres. disease.

Was led to employm on what reckon better found than any [spec] reasoning, [usupp] to pract.

Was informd by a very accur. & observ pract, of a natural cure of diabetes which had falln under his observ. in conseq of spont. vomit.

From this, consider repeated Emet as well meriting future trial.

Accord, had recourse to use with a patient, whom had occas to treat, at Col. Cas. during course of last summer.

These however, as well as sever other remed, were not prod of any matter benefite.

But This want of success however in a case where othr pract had faild, I consid as by no means a suffic reason for declin farther trials.

And pres case seemd fit opport for having again recourse to them.

But in this inst have not been more success. than former.

And after empl. of four diff. emet. without any matter benef to patient, reckond it improp. to push pres. trial farthr.

Have now therfore you will obser had here recourse to anoth remed. viz Tinct of Cantharides.

For introd of this artic, in cure of Diab., we are indebted to Dr Brisb. of London.

In a vol. of select cases, which he pub. some years ago, will find sever. related, of Diabet. patient, with whom success. empl.

To judge of it a priori, sever circum which might seem to occurr as obj to its employm.

Has always, from its action on urin passag, been esteemed in some respects hazard.

And in doubt that in many inst prod of very consid inconv.

But besides this hitherto chiefly employd as means of encr. not of dimin disch of urine.

For my own part, disp. to think that affects in gener. partic strangur. affections which prod, princip the conseq of action on neck of bladder.

But that also does act on kidney, cannot I think be matter of doubt.

And even by affect of stimul, from which on some occas encr. disch, may in others, where morbidty encreased have affect of dimin.

Partic where that morbid encrease arises from an atonic or paralyt state.

But theoret obs, either for or again use, not to be put in competit with well attested facts.

And from observat of Dr Brisb., may consid it, as at least well entit, to future trials.

Cannot however say, that in my pract. use has been attended with equal success.

Have tried it, with sev diabet pat. & with some have pushd it to very great extent, without deriv from it any benef.

These, however, by no means suff numer, to give ground for concl. that will never succeed.

Hence with view to farther trial, have had recourse to it with pres. pat.

Have begun however, you will obs, by directing use in small quant only.

A circum which with a med, the influ of which on hum syst very various, reckon in every case necess.

For with some, as app. from the affects of blisters, even very small quant. suff. to prod very viol strang affections.

If however from trial now made, find that born without inconv. shall not only persist in use, but grad direct an encr. of quant.

For to extent to which now empl. cannot expect from it much influ, as tend to counteract the affect.

But by encr. dose, & persist in use, mean to give full & fair trial.

And if successful, shall at least have done more, by means if it, than have ever yet been able to do in any other inst of Diabet.

Shall not however be much disapp. if after fullest trial find it prod of no benefite.

In that case, is my intent to try another pract, of which have of late heard, very fav. acct.

The use viz of Doves powder cont for some length of time.

Had lately a case commun to me by Dr McCormick of Antrim, & which will soon be pub, in Med Comm. in which was empl. with success.

And am informd by same Gentl. that has since treated another, with simil good affects.

Operat, as far as prod of such good affects prob. to be expl. not from disch under form of sweat, but from determin which gives to surface.

And in this mannr opport at least may be afforded, for vessels of Kidney to recover tone.

If this also unsuccess, or if gives merely allev of affect. shall prob. endeav. still farther to strength vess. by use of tonics & astring.

Partic by Peruv. Bark & Alum which, at least, among most powerf.

If these also fail of success, still another pract which have an intent of trying use viz of Electric.

Partic by drawing electr. sparks from region of kidney.

To this suggest. led, from idea, that excess disch. may arise from aton approach even to Paralysis.

If indeed, other pract fail, must own, that from this can have but little hopes of cure.

At same time, is a trial which may be made without any hazard

And in an affect such obstin, trials of new remed not only allow but even [prefer].

In this way indeed, other suggest might be thrown out.

But what already hinted at, perh. more than shall have opp. of putting in pract.

And not improb. that plans may be interrupted from being obliged to have recourse to pract, for obv. partic sympt.

These however must very much depend on sympt, which occur.

Shall only obs, that if necess to obv. costiv, will with this view, have recourse to Ol. Ricini or to olive oil with mixt of Tinct of Jallap.

To this led from hopes that oleag. matter may also tend to allay [this]

At least in one case, obs. in this way, a very remark affect from fat meat.

A circum which has led me to consid oleagin purgat. as being here [suppr] to others