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DIABETES 
 
 ITS CAUSE AND PERMANENT CURE 
 
 FROM THE STANDPOINT OF EXPERIENCE AND 
 SCIENTIFIC INVESTIGATION. 
 
 EMIL SCHNEE, M.D. 
 
 'II 
 
 Consulting Physician at Carlsbad, and Physician of the Imperial and Royal 
 Consulate of Austria and Hungary for the Riviera, at Monaco. 
 
 Translated from the German by 
 
 R. L. TAFEL, A.M., Ph.D. 
 
 THE Author. 
 
 ONDON 
 
 6 GOWER STREET 
 
/' V 
 
 
DIABETES 
 
 ITS CAUSE AND PERMANENT CURE 
 
 FROM THE STANDPOINT OF EXPERIENCE AND 
 SCIENTIFIC INVESTIGATION. 
 
 BY 
 
 EMIL SCHNEE, M.D. 
 
 CONSTJLTIKG PhTSICIAK AT CaRLSBAD, AND PHTSICIAK OF THE ISIPEKIAL AND ROYAL 
 CONSTTLATE OF ArSTEIA AND HUNGARY FOE THE ElVIEEA, AT ilONACO. 
 
 Translated from the German by 
 
 R. L. TAFEL, A.M., Ph.D. 
 
 English Edi 
 
 THE Author. 
 
 LONDON 
 
 H. K. LEWIS, 136 GOWER STREET 
 
 1889 
 

 MOTTO 
 Alterius non sit, qui suus esse potest." 
 
 Paracelsus. 
 
 
To His Highness 
 PRINCE 
 
 HERMANN 
 
 OF 
 
 SACHSEN - WEIMAR - EISENACH 
 
 WITH HIS GRACIOUS PERMISSION 
 THIS WORK IS DEDICATED BY 
 
 THE AUTHOR. . 
 
PEEFACE. 
 
 The author of one of the most important scientific 
 treatises on Diabetes, which has hitherto been declared 
 incurable, is Prof. F. T. Frerichs, one of my former 
 teachers. His work (Berlin, 1884), the result of 
 exact, scientific observations, and the fruit of forty 
 years of study, must be regarded as of great 
 authoritative value. Nevertheless, at the close of 
 his work, he feels compelled to acknowledge that, 
 with our present knowledge of diabetes, we are still 
 unable to explain the essential nature of this disease. 
 Baffled, he exclaims : " For a long time perhaps the 
 enigma of this sphinx will yet remain unsolved, and 
 many a human being will yet be carried off by it 
 before we shall find an adequate solution of it." 
 
 I, also, have felt compelled to subscribe to Prof. 
 Frerichs' confession, until the year 1881, when, as I 
 believe, I succeeded in discovering the real cause of 
 diabetes. After continuing, since that time, my 
 observations and experiments, I am at last in a con- 
 dition to lay before the profession the results of the 
 experience I have gained in conquering diabetes. 
 The present work, I trust, will be instrumental in 
 directing into different channels the views that have 
 hitherto prevailed on the nature of this disease ; and 
 it is confidently hoped it will also render this disease 
 
vi Preface. 
 
 more tractable in the hands of the physician than it 
 has been hitherto. 
 
 The present work contains everything of impor- 
 tance that has thus far been written and found out 
 concerning " diabetes," and also concerning " gly- 
 cosuria/' which is frequently confounded with it on 
 account of the sameness of its product of excretion. 
 The essential points, in fact, of the entire literature 
 of both these diseases, from Celsus to Frerichs, and 
 respectively to the present work, will be found fully 
 treated in the following pages ; and on the ground 
 of observation and experience ranging over a period 
 of twenty-five years, it will be demonstrated, I hope, 
 to the satisfaction of everyone that Diabetes, not 
 simply " glycosuria," is curable. 
 
 The method of cure which I follow individualizes 
 every case ; for the success of the method depends 
 upon the time when the disease first manifested 
 itself ; upon its progress ; upon the sex, age, and 
 condition in life of the patient ; further, upon the 
 quality of his habitual food and drink, his power of 
 resistance, the character of his mind and disposition, 
 and upon many other contingent circumstances. 
 
 It is a source of great satisfaction to me to be thus 
 enabled to supply to the student of medicine a safe 
 guide through the labyrinth of this mysterious and 
 perplexing disease ; and to afford to the practical 
 physician, whose mind is taken up by the duties of 
 his profession, a clear insight into the true nature of 
 Diabetes. But especially do I feel happy at being 
 able to minister comfort to those afflicted with this 
 
Preface. vii 
 
 malady ; to instruct them concerning their bodily 
 condition, which has hitherto been regarded as per- 
 fectly hopeless ; and to hold out to those among 
 them who are reasonable and brave the prospect of 
 a lasting cure. 
 
 EMIL SCHNEE. 
 
 Caklsbad, 
 
 September i6. if 
 
TABLE OF CONTENTS. 
 
 I. 
 
 Sugar in the Human Organism. 
 
 Normal quantity of sugar in the blood — Origin of the patho- 
 logical sugar — Claude Bernard's view of the origin of the 
 sugar in the liver — Investigations of the following authors : 
 Pavy, Nasse, Zimmer, Briicke, Weiss, Kiilz, v. Mering, 
 Ebstein — The Author's method of cure i 
 
 II. 
 
 Sugar in the Urine. 
 
 Definition of glycosuria, wherein it differs from diabetes — 
 Transient glycosuria — Pathological glycosuria of pregnant 
 women — Temporary glycosuria after certain diseases, i.e., 
 accidental glycosuria — The opposite character of diabetes 
 mellitus 17 
 
 III. 
 
 How Does Glycosuria Arise ? 
 
 Change in the blood and the circulation — Injuries to certain 
 portions of the nervous system — Disturbances in the diges- 
 tion—Interference with the action of the nerves — Distur- 
 bances in respiration — An excessive use of alcohol causes 
 
X Table of Contents. 
 
 PAGE 
 
 glycosuria— Likewise breathing for some time an atmos- 
 phere charged with oxide of carbon — Inhalations of chloro- 
 form — Experiments on animals — The sugar-puncture — 
 Hyperaemia of the liver — The diabetes of animals is transient 
 glycosuria — Zimmer's idea of the myogenous origin of 
 glycosuria— Glycosuria, after cholera, anthrax, diphtheria, 
 abdominal typhoid fever ; after fever attending suppuration 
 from vaccination ; after meningitis, scarlet-fever, measles, 
 catarrh of the stomach, &c. — Glycosuria arising from a dis- 
 turbance in the action of the nerves, from an obstruction in 
 the respiration and circulation ; from physical and psychical 
 excitement ; from a local, mechanical stimulation of the 
 nerves; from neuralgia, a lesion of the nervus ischiadicus; 
 from stimulations of branches of the nerv. trigeminus; 
 from occipital neuralgia, trauma, concussion of the brain, a 
 luxation of the cervical vertebrce ; from blows on the dorsal 
 vertebrae ; from ear-ache, head-ache, &c. — The secretion of 
 sugar : a symptom — Ebstein's view — The duration of 
 glycosuria 20 
 
 IV. 
 
 The Characteristic Features of Diabetes Mellitus. 
 
 Definition — A lasting secretion of grape-sugar through the 
 kidneys — The distinction between diabetes mellitus and 
 alimentary glycosuria — Inheritance of diabetes mellitus — Its 
 setiological element : lues — Is diabetes contagious ? — The 
 views of Rollo, Bouchardat, Seegen, &c. — The formation of 
 sugar in the Uver, according to Claude Bernard, a normal 
 function of the body ; according to Pavy, a post-mortal 
 process ; according to v. Pettenkofer and v. Voit, the result 
 of a too scanty reception of oxygen — The Author's view — 
 Equilibrium in the change of substance — A cardinal 
 symptom of diabetes : an increase in the decomposition of 
 albumen — Hoffmann's view of diabetes — Neurogenous dia- 
 betes — A definition of diabetes, of universal application — 
 The diabetes of fat persons — Erroneous definitions — Gath- 
 gens' experiments, showing the effect of the diet of diabetic 
 patients on healthy persons — Ebstein's view of hepatic and 
 muscular diabetes 31 
 
Table of Contents. xi 
 
 V. 
 
 Classification of Diabetes Mellitus. 
 
 PAGE 
 
 Ettmiiller's .diabetes verus — The diabetes Aretsei — Diabetes 
 hystericus, artificialis, a vino, arthriticus, febricosns — 
 Cullen's and P. Frank's classifications — Diabetes mellitus 
 and insipidus — Diabetes decipiens —Diabetes inositus — 
 Brain-diabetes, liver and stomach diabetes — Griesinger's 
 transient and chronic diabetes — Redard's ephemeral and 
 severe glycosuria — Senator's neurogenous, gastro-entero- 
 genous, and hepatogenous diabetes — Lecorche's idiopathic 
 diabetes — Seegen's classification — Traube's stages — Hoflf- 
 mann's post-mortem examinations — Zimmer's hepatogenous, 
 muscular, and mixed diabetes — Spuriousness of certain 
 classifications — The Author's protest against the same — 
 Frerichs' classification — Other standpoints — Oxy-butyric 
 acid, the final result of the decomposition of sugar — Ebstein's 
 distinction between alimentary glycosuria and diabetes 
 meUitus — Spurious or light, and genuine or severe diabetes, 
 i.e. , glycosuria and diabetes mellitus 46 
 
 VI. 
 
 The Etiology of Diabetes Mellitus. 
 
 Frerichs' view — Cures of real diabetes effected by the Author 
 — Is trauma a cause of diabetes ? — False inferences with 
 respect to the inheritance of diabetes from diabetes — 
 Seegen's demonstration of 14 per cent, of diabetic patients, 
 by whom that disease was inherited — Similar proofs offered 
 by Schmitz and others — Apoplexy, the result of hereditary 
 lues — Ebstein's declaration with regard to an individual pre- 
 disposition for diabetes by inheritance 5^ 
 
 VII. 
 
 Diagnosis of Diabetes Mellitus. 
 
 The character of the urine — The test by tasting — Spots left 
 on white linen by diabetic urine — Moore's sugar-test — 
 Trommer's test — Bottcher's, Nielander's, and Seegen's 
 sugar-tests — Demonstrations of minimal quantities of sugar 
 — The sugar-tests of Fehling, Worm-Miiller, and Rosenbach 
 
xii Table of Contents. 
 
 PAGE 
 
 — Stiitz's reagent capsules for albumen and sugar — The 
 test of fermentation — The test of polarization — Additional 
 methods for determining sugar — Increased secretion of 
 sugar — Increase of urea by an excessive consumption of 
 meat — Phosphates and sulphates — Creatinine, inosite— Con- 
 cerning sediments — Polyuria — Catarrhal nephritis, coupled 
 with a copious secretion of albumen — Diabetes decipiens — 
 Contingent causes in the production of acute diabetes — ■ 
 Diseases resulting from diabetes — Abnormal thirst and 
 hunger — Pulse and stool — Scanty secretion of saliva — Fungi 
 in the cavity of the mouth — Loosening of the teeth — The 
 tongue and its appearance — Characteristic odour of the 
 breath — Condition of the skin — Sluggishness in the activity 
 of the skin — The Author's method of examining a patient 
 — Outward marks — Fits of ill-humour — Loss of memory — 
 Convulsive movements in the muscles— Sciatica — Decrease 
 in the power of vision — Impotence — Additional symptoms 
 — Rheumatism in the joints and muscles — A wetting of the 
 bed with children — A wasting of babes — Loss in the power 
 of reproduction and assimilation 70 
 
 VIII. 
 
 The Progression, Prognosis, Complications, and Ter- 
 mination OF Diabetes. 
 
 The view of the profession hitherto, with respect to the incura- 
 bility of diabetes — Seegen's experience — Prognosis, dura- 
 tion, and progression of diabetes — Apparent standstill of 
 the disease — Coma diabeticum— Cause of the same — The 
 material gathered from experience by Frerichs — The 
 Author's view of coma diabeticum — Fruitless attempts to 
 prevent the same — The connection of diabetes with diseases 
 of the central nervous system ; with epilepsy, gout, and 
 rheumatism — Curability of these diseases 94 
 
 IX. 
 
 The So-called Cures of Diabetes that have hitherto 
 been made are Illusions. 
 
 Accidental glycosuria is curable— Mistaking glycosuria for 
 diabetes — Did Frerichs cure genuine diabetes ? — Senator's 
 
Table of Contents. xlii 
 
 PAGE 
 
 opinion with regard to the curableness of diabetes — Seegen's 
 opinion on the same subject — The usual termination of the 
 illness — The Author's thesis : Diabetes is curable 103 
 
 X. 
 
 The Occurrence of Diabetes ; Mortality, and the 
 Results of Post-mortem Examinations. 
 The possibility of a climatic influence — At what age is 
 diabetes most frequent ? — Statistics — Frequency of diabetes 
 among the Jews — The results of post-mortem examinations 
 — The pathological changes — Changes produced in the 
 organs 108 
 
 XI. 
 
 Treatment of Diabetes (Therapeutics). 
 
 Progress in the art of healing — Secret of a rational method of 
 healing — A change of substance in agreement with nature 
 — The system of organs engaged in bringing about the 
 change of substance — The processes of transformation 
 through which the material operated upon by the change of 
 substance passes — The procedure of digestion— Import- 
 ance of a proper commingling of the ingredients of the 
 blood, and a normal formation of protoplasm — Inferences 
 drawn for therapeutics — Therapeutical views of Rollo, Prout, 
 V. Tralles, Ebstein — Therapeutics of the Author : mental 
 diet, avoiding mental excitement — Bodily diet : movement, 
 muscular action — The views of Klilz, Nasse, Ebstein, 
 v. Mering, and Oppenheim — Care of the skin — Turkish and 
 Russian baths according to the Author's prescription — No 
 baths in bath-tubs — Drawing deep breath — Pneumatic 
 apparatus — Vocke's experience — Dwelling-rooms — Tem- 
 perature — Massage — Electro-magnetism — Food and assimi- 
 lation — Rollo's diet — The diet of Bouchardat, Dickinson, 
 Pavy, Cantani, Seegen, v. Diiring — Senator's diet — v. 
 Frerichs' regimen — Ebstein's menu. 
 
 Conclusions drawn from all the dietetic instructions of 
 acknowledged authorities and experienced practitioners : — 
 
 Articles of food allowed — Forbidden articles — Bread and its 
 substitutes — Milk — Arguments in favour of, and against, the 
 
xiv Table of Contents. 
 
 PAGE 
 
 use of milk — The Author's dietetic regimen for diabetic 
 patients — Freedom, witli discretion, iu the choice of articles 
 of food — Eating slowly and masticating the food well — 
 Nourishment-cure, in lieu of abstinence-cure — A change in 
 the bodily constitution — Regeneration of the organism — 
 Articles of food and beverages to be avoided — Medicines for 
 combatting diabetes— Specifics — Strengthening remedies — 
 Carlsbad's hot alkaline springs— Paquelin — A summary ... 115 
 
 XII. 
 
 A Few Striking and Significant Accounts of Cases 
 OF Diabetes from the Year 1881. 
 
 The first twelve cases of diabetes cured, from among a great 
 number of cases treated by the Author 164 
 
 XIII. 
 
 Corollaries in Support of the Thesis of the Present 
 Work. 
 The object of the Author in presenting the first twelve cases 
 of cure, from the year 1881 — Proof of the Author's theses : 
 
 1 . Diabetes is the result of a hereditary predisposition ; 
 
 2. Diabetes is curable 181 
 
 XIV. 
 
 ■Contributions to the History and Literature of Diabetes. 
 
 •Celsus' first allusions to diabetes — Aretaeus' views — His thera- 
 peutics— Galenus' deriving diabetes from a diseased state of 
 the kidneys — Paracelsus' idea of an increased formation of 
 salt — Cardano's measurements — Sylvius' derivation of dia- 
 betes from a faulty condition of the blood — Mead's sup- 
 position of an abnormal preparation of bile — Willis discovers 
 sugar in the urine — Later demonstrations of sugar by 
 Dobson, Poole, and Cowley — Howe demonstrates the fer- 
 mentation of diabetic urine — Rollo's animal diet — Nicolas 
 and Gueudeville consider diabetes a disease of the bowels — 
 Ambrosiani proves the existence of sugar in the blood — 
 Bouchardat supposes diabetes to be a disease of the stomach 
 — Mialhe declares the seat of the disease to be in the blood 
 — Artificially produced glycosuria by Claude Bernard — The 
 
Table of Contents. xv 
 
 PAGE 
 
 sugar-puncture — Lehman's experiments — Pavy considers 
 the formation of sugar a post-mortal process — Schiff recom- 
 mends amylaceous food — Claude Bernard's school — His 
 opponents — Voit's and Pettenkofer's idea that diabetes is 
 caused by a too scanty reception of oxygen — Cantani 
 defines diabetes as a disease of the change of substance — 
 Ebstein demonstrates an insufficiency in the production of 
 carbonic acid — Alphabetic etiumeraiion of all authors who 
 have written o?i diabetes. 
 A wish expressed to professional journals, p7vfessio?tal libraries, 
 and medical societies — Necessity of collecting the whole 
 literary material concerning diabetes — Necessity for ex- 
 hausting statistics — Importance of an agreement in the 
 dates concerning the disease — Importance of supplementing 
 the experience of individual practitioners— Observations 
 ought to be made before and after the daily meals 183 
 
DIABETES. 
 
 I. 
 
 SUGAR IN THE HUMAN ORGANISM. 
 
 According to the reliable investigations of C. 
 Schmidt, Bock, Figuier, Bohm, Hoffmann (who 
 experimented on cats, see " Archiv fiir experimen- 
 telle Pathologie,'' 8), sugar occurs constantly, and, 
 indeed, from o"i2 to 0*33 per cent., and, according 
 to Pavy, even to 0*53 per cent, in the blood of every 
 normal, healthy person. Further, in the general 
 nutritive fluid ; in the glandular substance of the 
 liver ; in the interfibrillary, so-called cement, sub- 
 stance of the muscles ; in the cerebro-spinal liquid, 
 etc. The chemical antecedent of this sugar is the 
 so-called glycogen, or glycogene, whichj in a healthy 
 condition of the living human body, is stored up to a 
 considerable amount, from 2*0 to lo'g per cent., in 
 the liver; in a less degree, from o*i to o'\per cent. 
 (as has been observed first by W. Kiihne), in the 
 muscles. Further, in the cartilage, in the white 
 blood-corpuscles, in the stratified epithelia, in new 
 formations, etc. (see also Ziemssen's " Handbuch der 
 speciellen Pathologic und Therapie,'' Leipzig, 1876 ; 
 xiii., 2, p. 187). 
 
 B 
 
2 Diabetes. 
 
 Amylum or starch, by the action of the sahva, is 
 first altered into sugar; the sugar is afterwards 
 changed into alcohol, alcohol into acetic acid, and 
 acetic acid into carbonic acid ; so that carbonic 
 acid must be regarded as the final product of sugar. 
 Whenever the production of carbonic acid is 
 diminished or interfered with, the sugar which is 
 very rapidly and in excess formed in the blood, is no 
 longer subservient to the generation of heat in the 
 body ; for it is no longer burnt up, and ministers no 
 longer to respiration ; but it circulates in the blood 
 as a heterogeneous substance, and is excreted by 
 the kidneys. Such is the case in that condition of 
 the body which, in the following pages, is denomi- 
 nated glycosuria. On account of its great diffusi- 
 bility, the sugar rapidly passes through the capillaries 
 of the blood-vessels, whence there arises a possi- 
 bility of its getting into the liver through the vena 
 portcB. A portion of the sugar is there changed into 
 the above-mentioned glycogen ; that is, into amylum 
 jecoris (hepatine or amyloid substance), a kind of 
 starch, which is soluble in hot water, and which, by 
 being treated with iodine, assumes not a blue, but a 
 brown colour. From the liver the sugar passes into 
 the general circulation, where it combines with the 
 white blood-corpuscles. In the organs themselves 
 this sugar is partly made use of in the formation of 
 glycogen ; but through the action of the serum in 
 the blood this glycogen is partly changed back into 
 sugar. 
 
 Only this latter sugar which has been obtained 
 
Sugar in the Human Organism. 3 
 
 from glycogen can by combustion produce carbonic 
 acid, and is thus able to generate heat. 
 
 The blood-sugar which has been diffused over all 
 the organs is partly changed into glycogen through 
 those processes, bv which the tissues of the body 
 are renovated. The liver, just like the muscles, is a 
 receptacle of the glycogen that has been formed in 
 it out of sugar and plasma. This glycogen, through 
 the action of the blood-serum, is altered again into 
 sugar, in order finally by combustion to produce 
 carbonic acid. 
 
 If the formation of glycogen is interfered with, 
 the sugar from the vena portcB, according to Luch- 
 singer and Frerichs, passes directly into the general 
 circulation without being changed first into glycogen. 
 The blood then becomes flooded with sugar, and 
 there arises glycosuria, or hyperglykceinia. 
 
 For a long time the stomach, and respectively the 
 process of digestion, has been looked upon as the 
 principal source of sugar ; and, indeed, for this 
 reason, that when a person lives on a vegetable diet 
 the stomach changes the starch of the food into 
 sugar (that is, into dextrose, dextrine, lactic acid, 
 laevulose or fruit-sugar), for the use of the circulation 
 of the blood (see Pfliiger's " Archiv,'' etc., for 1877). 
 
 More recently the liver, according to Claude 
 Bernard, has been regarded as the principal source 
 of sugar. The function of the liver, so far as its 
 power of forming sugar is concerned, is, indeed, 
 placed beyond doubt at the present day. 
 
 Claude Bernard found that the venous blood of 
 
4 Diabetes. 
 
 the liver abounded in sugar, and simultaneously with 
 Hensen (1857), although independently of him, he 
 instituted investigations in order to find out whether 
 the sugar is originally contained in the liver itself. 
 For this purpose he removed from a living frog a 
 piece of liver, minced it quickly, and in order to 
 prevent any possible decomposition he put it into 
 boiling water. He then ground up the piece of liver 
 in a mortar, and made a decoction of it with a small 
 quantity of acidulated water. The filtrate of this 
 substance he treated with five or six times the 
 quantity of alcohol, whence resulted a white precipi- 
 tate — a substance akin to starch or amylum, and 
 which, just like starch, possesses the property of 
 being turned into sugar by the action of the diastatic 
 ferments contained in all blood. The above sub- 
 stance Claude Bernard called glycogen. 
 
 Pavy describes glycogen as an "amyloid sub- 
 stance," Tscherinoff as glycophthirium, Cantani as 
 storage sugar. The latter gentleman thinks that the 
 grape-sugar (glucose) formed by the ferment circu- 
 lates through the system in company with this storage 
 sugar. This sugar, which is destitute of ferment, 
 he says, is altogether indifferent and void of action ; 
 wherefore it is not used up, but is excreted at last 
 with the urine. It used to be supposed that the 
 substances entering into the composition of glycogen 
 — that is hydrates of carbon, namely, grape-sugar, 
 cane-sugar, laevulose, inuline, sugar of milk, galactose, 
 etc. — are turned into glycogen directly^ by the recep- 
 tion of water, by division, by synthesis, or any other 
 
Sugar in the Human Organism. 5 
 
 complicated unknown chemical process (see Bunyus' 
 and Schmiedeberg's '* Nachweise"). 
 
 The property of forming glycogen possessed by 
 the liver is inherent in the normal function of the 
 liver-cells. It seems exceedingly plausible that, 
 while departing from these cells, the glycogen is 
 constantly being changed into sugar in the venous 
 blood of the liver. A ferment is required for this 
 purpose, namely, the so-called diastase — a substance 
 generated, e.g., out of the albuminous ingredients 
 (vegetable fi brine) of grains of corn when they 
 germinate. This substance, which belongs to the 
 albuminates, is difficult to isolate. It is soluble in 
 water, and possesses the property of changing starch 
 into dextrine and grape-sugar. 
 
 Claude Bernard already demonstrated how dias- 
 tase — the ferment which is productive of sugar — 
 originates from albuminous bodies, but he did not 
 succeed in isolating it. J. Worhnann only (" Zeit- 
 schrift fiir Physiol. Chemie," 1882, p. 287) was able 
 actually to isolate the diastatic ferments coming 
 from bacteria, by which raw, undissolved, as well as 
 dissolved, starch, and likewise boiled starch, are 
 changed into glucose. 
 
 A pure ferment may be obtained, and thus may be 
 isolated ; or, more precisely, a solution of it may be 
 obtained, by crushing newly germinated barley, stir- 
 ring it up with water, and pressing out the liquid. 
 This liquid is afterwards heated to 75° C. in order to 
 separate the albumen from it. Alcohol throws down 
 from this liquid the diastase in the form of a flaky, 
 
6 Diabetes. 
 
 colourless precipitate, which by and by thickens and 
 dries up into a kind of gum-like mass. It scarcely re- 
 quires to be noted here that the employment of barley 
 in the production of beer is due altogether to the 
 formation of diastase and to its action, as a ferment, 
 upon the starch of the barley. 
 
 According to Claude Bernard, the processes which 
 take place in the liver are to be explained thus : that 
 the substances producing glycogen by the action of 
 a ferment are changed in the cells of the Hver into 
 glycogen, and that, through the reciprocal action of 
 the blood by which these cells are bathed, the 
 glycogen is altered into grape-sugar. 
 
 Pavy assumed a negative position in respect to 
 the new theory of Claude Bernard, so far as the 
 sugar-forming function of the liver is concerned. 
 He maintains that the ferment of the liver-sugar is 
 contained in the blood, and he calls the formation 
 of sugar a post-mortal process. He also supposes 
 that the glycogen of the liver serves a different 
 purpose, and is utilized, perhaps, in the formation of 
 fat. On p. 64 of his " Croonian Lecture," (London, 
 1878), he certainly expresses a different opinion, 
 and thus contradicts his former idea. 
 
 Because most albuminates are altered in the 
 stomach into peptones, peptone also has been re- 
 garded by some as a source of sugar. 
 
 The former Carlsbad physician. Dr. Zimmer^ in 
 contradiction to Claude Bernard and to those who 
 believe that the liver is the sole source of diabetes, 
 agrees with Nasse, who holds that the glycogen of 
 
Sugar in the Human Organism. y 
 
 the liver is also consumed by muscular action (see 
 Pfliiger's " Archiv," etc., xxiv., 41, and " Biologi- 
 sches Centralblatt," 1884, iii., p. 251). For Zimmer 
 is of the opinion that the muscles, too, have a share 
 in the production of diabetes, both as regards the 
 supply of sugar and its decomposition. This view- 
 was set forth already by Brilcke (see " Vorlesungen 
 iiber Physiologie," second edition, Vienna, 1875, p. 
 323), who quotes Sigmund Weiss ^ according to 
 whom the glycogen of the muscles is not subject to 
 any considerable fluctuations, while the glycogen of 
 the liver is used up completely as soon as the food of 
 animals is deprived of its supply of hydrates of 
 carbon. (The literature on the above subject has 
 been collected by Barfurth in the " Archiv fiir 
 Mikroskopische Anatomie," Vol. xxv., p. 397.) 
 
 The muscle, when at rest, stores up glycogen in 
 its tissue in order to change it into sugar when in a 
 state of activity. This sugar in a healthy organism 
 is assimilated totally^ but in a diseased organism 
 only partially. If this process of combustion bv 
 muscular action does not take place, and if the 
 liver is no longer able to store up the glycogen 
 which is constantly being conveyed into it, the con- 
 sequence is that, after the consumption of amylaceous 
 substances, that is, of food containing starch, such 
 as bread, potatoes, etc., the blood is surcharged with 
 sugar, and sugar passes into the urine. 
 
 According to Killz^ sugar is beginning to be 
 excreted by a diabetic patient within half-an-hour to 
 an hour after he has partaken of bread ; within two 
 
8 Diabetes. 
 
 or three hours the excretion of sugar reaches its 
 chmax, and in five to six hours it ceases. Kiilz 
 found that when a patient partakes of bread, sugar 
 is rapidly being formed in the intestinal canal by a 
 ferment which is generated there ; that it speedily 
 reaches the liver, which is unable to retain it, whence 
 it passes into the circulation, so that it is possible 
 for urine free from sugar to become charged with it 
 after the lapse of half-an-hour. According to v. 
 Mering, the sugar in the ductus thoracicus does not 
 come from the liver, but arises from the saccharine 
 contents of the lymph. This, theory, however, does 
 not exclude the idea that the liver is a storehouse of 
 sugar. 
 
 Ebstein, on the one hand, considers it possible 
 that the sugar which has passed from the intestinal 
 canal into the vena portae should be excreted by the 
 urine, and, on the other hand, he inclines to the 
 belief that considering the speedy alteration of the 
 sugar, in consequence of a disturbance in the for- 
 mation of carbonic acid, the excretion of sugar 
 through the urine ought to begin with a diabetic 
 patient already half-an-hour after he has partaken of 
 bread. 
 
 When a diabetic patient was fed with cane-sugar 
 Weiss found 2,369 times more sugar than he did 
 when he was nourished with fibrine and fat, while, 
 on the other hand, the quantity of glycogen in the 
 musculus-pectoralis increased much more by a diet 
 of fibrine (see experiment 3) than it did by a diet of 
 food rich in hydrates of carbon. On the strength of 
 
Sugar in the Human Organism. 9 
 
 this Zimmer supposes that the muscles, by them- 
 selves, produce sugar from albuminates in a large 
 quantity, that they secrete it from the albuminates 
 and store it up in the form of glycogen, while the 
 liver is not able to do this. Zimmer maintains that 
 the muscles from albuminates purvey to the blood 
 six times more sugar than the liver ; wherefore he 
 holds that the source of the severer forms of diabetes 
 is to be sought for in the muscles. 
 
 Meissner, Ritter, Seegen incline to Pavy's view, 
 since they are unable to explain the alteration 
 caused in the amylum of the liver. 
 
 Pavy, Dock, Salomon, Tscherinoff, Luchsinger, 
 Weiss (" Zur Statistik des Glykogens im Thierkor- 
 per," in ** Sitzungsberichte der Wiener Akademie 
 der Wiss.," Bd. 64) were unable to demonstrate the 
 genesis of sugar according to Claude's doctrine, as 
 this had been proved experimentally by Ebstein. 
 My idea has always been that the sugar is the 
 product of a process of alteration which is constantly 
 going on, during life, in the cells of the living 
 body. 
 
 The only thing which the above gentlemen were 
 able to demonstrate was that when a person fasts 
 the amount of sugar is diminished ; but that this 
 amount increases at the same rate in which food is 
 purveyed to the body more copiously, no matter 
 whether it contain hydrates of carbon or albumen. 
 They were able to prove only that the purveyance 
 of sugar to the blood could be increased also 
 from the intestinal canal through the lacteals, or 
 
lo Diabetes. 
 
 through the liver ; further, from the muscles, and, 
 finally, from the milk-glands, by virtue of the sugar 
 of milk which is generated therein, and which from 
 thence passes into the blood. 
 
 In respect to the origin of the sugar in the blood, 
 as well as in respect to its purpose, consumption, 
 and the use it serves, all inquirers — even those who 
 have proceeded according to the strictly scientific 
 method — have dealt merely in guesses and hypothe- 
 ses. By many who have laboured in this direction 
 it was thus supposed that the oxidation, that is, the 
 consumption, does not take place in the blood, but 
 in the tissues ; consequently, that a priori not the 
 alteration of the substance {Stoffumsatz), but the 
 contents of the living cell are influenced by the oxygen 
 (see Wolffberg in " Zeitschrift fiir Biologie," Vol. 
 xii., 2, p. 290). 
 
 Ebstein^s experiments about the origin and con- 
 sumption of sugar (see his work entitled, " Die 
 Zuckerharnruhr " or Diabetes, 1887), on account 
 of the final settlement by his experiments of the 
 pathogeny of Diabetes mellitus, are deserving of 
 the greatest praise. They command the highest 
 theoretical and practical interest of the profession, 
 and when these experiments are verified — which 1 
 believe they are already — they cannot fail to influence 
 largely the therapeutics of the future. By these 
 experiments the process is demonstrated according 
 to which the sugar is formed. They teach us 
 further that sugar is formed in a larger quantity after 
 death than during life ; which fact, however, does 
 
Sugar in the Human Organism. 1 1 
 
 not by any means invalidate the fact of the formation 
 of sugar in the Hver during lifetime. 
 
 The ground of the abnormal formation of sugar in 
 diabetic patients, according to this inquirer, is a 
 relatively insufficient formatio7i of carbonic acid 
 in the tissiies, which subject will be treated at 
 greater length below. 
 
 Ebstein demonstrated ad ociilos the influence 
 exerted by weak acids, especially carbonic acid, 
 upon the sugar-forming ferments which are con- 
 tained chiefly in the tissues, organs, and secretions 
 of certain glands in the animal organism. 
 
 For this purpose he employed the method of v. 
 Wittich, according to which the respective organs 
 or tissues are first minced most minutely ; after- 
 wards they are digested for 24 hours in alcohol ; 
 then they are dried in the air and ground in a 
 mortar. The pulverized mass which is obtained by 
 this means is then sifted through gauze in order to 
 keep back the connective tissue ; and the mass 
 itself is afterwards digested with glycerine, etc. 
 
 In the course of his experiments Ebstein showed 
 that carbonic acid exerts a neutralizing influence on 
 the action of the sugar-forming secretions of the 
 glands, and upon the diastatic ferments which are 
 generated from the organs and tissues of the animal 
 organism. Ebstein' s investigatiofis, consequently, 
 have definitely disclosed the secret ofi that process, 
 according to which sugar is formed in the organism. 
 
 At the outset we have to start with the proposi- 
 tion that the diastatic or sugar-forminp^ ferments 
 
 f^^ Of AMERICA 
 
 IL I B a A 
 
1 2 Diabetes. 
 
 are diffused largely through the entire animal 
 organism. 
 
 By placing minced portions of organs in floating 
 amylum, Lepine proved the presence of diastatic 
 ferments (see " Bericht liber die Verhandlungen der 
 K. Sachsischen Gesellschaft d. Wiss. zu Leipzig," 
 Vol. xxii., 1870, p. 324). This inquirer, by that 
 means, demonstrated the existence of diastatic 
 ferments in the blood, the mucous membrane of the 
 stomach and intestines, the liver, gall, kidneys, the 
 mucous membrane of the bladder, the brain, muscles, 
 etc. Tiegl and P. Ploss in like manner (see 
 " Pfiuger's Archiv," etc., vii.) discovered these 
 ferments in the blood, as well as in all animal 
 organs and tissues, etc. 
 
 Now, inasmuch as the diastatic ferments are most 
 widely diffused in the organs and tissues of the 
 living animal body, and inasmuch as carbonic acid 
 also is produced everywhere in these organs and 
 tissues, according to Ebstein, it may also be taken 
 for granted that "wherever glycogen occurs in the 
 living organism it is under the influence of sugar- 
 forming fermentSj the action of which is regulated 
 by carbonic acid. The production of carbonic acid, 
 however, is at an end when the change of substance 
 {Stoffwechsel) and the circulation of the blood in the 
 liver cease. At the same time also the influence of 
 the carbonic acid upon the protoplasm of the tissue 
 of the liver ceases. The action of the sugar-forming 
 ferment is henceforth no longer regulated by the 
 carbonic acid ; the glycogen of the liver, conse- 
 
Sugar in the Human Organism. 13 
 
 quently, is deprived of the protecting influence of 
 this acid, and there is no longer anything to prevent 
 its being turned into more simply constituted and 
 more easily diffused hydrates of carbon, such as 
 grape-sugar, etc. 
 
 Ehstein proves that wherever there is a sufficient 
 quantity of diastatic ferments, but an insufficient 
 development of carbonic acid, whereby the action 
 of these ferments is checked, the glycogen which 
 exists in the tissues of the organs is more quickly 
 and more abundantly turned into easily diffusible 
 hydrates of carbon, especially into sugar, than is 
 the case in a normally constituted body. 
 
 The forty-two experimental investigations of 
 Ebstein {Of. citat., pp. 20-92), which bear witness 
 of his untiring industry, are full of interest, and not 
 even his opponents will seek to detract from their im- 
 portance. Their object is (i) to explain the influence 
 exerted upon the sugar-forming ferments by diluted 
 acids, especially carbonic acid, and further by a 
 shaking movement compared with a state of rest ; 
 (2) to demonstrate the effect of the above-mentioned 
 acids, and also of a shaking movement upon the secre- 
 tions of the glands wherein are contained diastatic 
 ferments ; and (3) to show how a freshly-made pulp 
 of Hver behaves under the influence of the various 
 above-mentioned contingent circumstances. 
 
 From his experiments Ebstein draws the conclu- 
 sion (pp. 108-1 15) that the carbonic acid checks the 
 action of the diastatic ferments, by which the less 
 diffusible, more composite hydrates of carbon are 
 
14 Diabetes. 
 
 altered into more easily diffusible and more simply 
 constituted hydrates of carbon. He then answers 
 the following cardinal question, namely : What 
 physiological and pathological phenomena of life 
 may be explained by the checking influence which 
 is exerted by the carbonic acid upon the diastatic 
 ferments ? 
 
 The swift alteration of glycogen in a liver taken 
 from a living animal he explains thus : — As soon as 
 the change of substance {Stoffwechsel), as well as 
 the circulation of the blood, cease in the liver, there 
 is an end also to the generation in it of carbonic 
 acid. As soon as the regulating influence of the 
 carbonic acid upon the diastatic ferment of the liver 
 ceases, the glycogen of the liver can be easily 
 altered into sugar. 
 
 Through the influence of the carbonic acid the 
 action of the diastatic ferments is checked and 
 paralyzed. So long as the carbonic acid exerts its 
 regulating, restraining influence, there does not 
 ensue any superabundant, excessive formation of 
 sugar — no over-production. The body is in a state 
 of health. 
 
 V. Wittich quotes Woroschiloff's statement, accord- 
 ing to which glycogen, the chief emporiums of which 
 are situated in the liver and in the muscles, is an 
 invariable constituent of all animal tissues, subject 
 to continual fluctuations, and conditioned or qualified 
 by the energy of the chemical change of substance 
 {Stoffwechsel). 
 
 PfliXger C'Archiv, " ii., 1869, No. 129) and 
 
Sugar in the Human Organism. 15 
 
 Bogdljuhow bear witness to the abundance of car- 
 bonic acid in the liver, whereby the possibility of its 
 action, as pointed out by Ebstein, is confirmed. 
 
 Thus far the practitioner had to content himself 
 with the supposition that sugar, which must be 
 regarded as the product of a chemical alteration 
 more or less independent of the food of the body — ■ 
 ' which product is possibly made use of in the forma- 
 tion of fat by that process of metamorphosis or 
 chemical change which is constantly going on in the 
 cells that are bathed by the current of the animal 
 juices— serves the purposes of life in general, and is 
 utilized in the economy of the human body so long 
 as it does not exist in excess. 
 
 Fortunately the observations made by Senator 
 (see " Handbuch der Allgemeinen Ernahrungssto- 
 rungen," p. 213) need no longer to apply at the 
 present day ; for this author, who judges objectively, 
 says in a general way, " Everyone may suit himself, 
 whether he considers the one or the other hypothesis 
 as more probable." For every thinking physician, 
 since the time that Ebstein made his demonstrations, 
 is bound to admit in the biological processes, and 
 especially in diabetes mellitus, the action of carbonic 
 acid in checking and regulating the ferments — and 
 not the action of those acids, e.g.^ lactic acid, which 
 are generated in the protoplasm of the tissues and 
 organs : for all the acids that might possibly be taken 
 into consideration here are completely neutralized in 
 the tissues, while carbonic acid, on the contrary, 
 is present in a sufficient quantity, both in the form 
 
1 6 Diabetes. 
 
 of a bicarbonate and also in a reabsorbed condition, 
 in order by its presence to exercise an effect. 
 
 My view, based on experience, according to which 
 the aetiological tendency towards diabetes is to be 
 sought for in a luetic {i.e., venereal) constitution by 
 inheritance, acquires a scientific foundation through 
 Ebstein's demonstrations. The pathogenetic con- 
 ception of diabetes henceforth has left the stage of 
 Claude Bernard, and has entered into an altogether 
 new phase. 
 
 It becomes plain, at the same time, why the 
 curative method proposed by myself is able to effect 
 a lasting cure of diabetes, which fact borders on the 
 miraculous ; for my method, for the first time, pur- 
 sues a distinct aim, whereby the protoplasm is 
 renewed or regenerated. 
 
II. 
 
 SUGAR IN THE URINE. 
 
 (The Distinction between Glycosuria and Diabetes.) 
 
 In the urine of a healthy person there is no sugar. 
 The secretion of sugar by the urine, consequently, is 
 not a physiological act. 
 
 Although Briicke, who has been controverted by 
 Wiiederhold, Leconte, and Friedlander, maintains 
 that all normal urine does contain sugar, and although 
 Worm-Muller (in Pfluger's " Archiv," etc., for 1884 
 and 1885) declares that accidental, transitory glyco- 
 suria is caused also in healthy persons after they 
 have partaken in large quantities of various kinds of 
 sugar, there is, nevertheless, no doubt that the secre- 
 tion of sugar by the urine is always a pathological 
 phenomenon, and not a normal process of life. 
 
 As soon as a higher percentage of sugar than 0*3 
 ■per cent, is formed in the blood, the urine at once 
 secretes sugar. A morbid, pathological condition of 
 the body is indicated thereby. This condition may 
 be transitory, as, for instance, (i) in the case of 
 healthy women during the last months of their 
 pregnancy, as in the case communicated by Benne- 
 witz in Hufeland's "Journal" (1865, 61, p. 114), 
 
 c 
 
1 8 Diabetes. 
 
 where a woman from her fourth pregnancy, duruig 
 each successive pregnancy, suffered from glycosuria 
 during the last months (thus regularly for six months), 
 and afterwards recovered ; or (2) during the period 
 when a suckling babe is weaned ; or (3) when the 
 breasts begin to swell at an incipient mastitis, in 
 consequence of the milk retreating into the system, 
 and so forth (see Blot in " Gaz. Hebdom.," 1856, 
 No. 41 ; also Lehmann in his " Lehrbuch der phys. 
 Chemie," i., p. 270 ; Kirsten in " Monatsschr. fiir 
 Geburtsk.," 1857 ; Iwanoff in " Beitrage zur Frage 
 ijber die Glycosurie," etc., Dorpat, 1881 ; Abells in 
 the " Wiener med. Wochenschriften," 1874, who dis- 
 covered sugar in the urine of twenty pregnant and of 
 twenty suckling women ; Hempel in " Archiv fiir 
 Gynakologie," iii,, p. 312). 
 
 The sugar of milk which is formed by the glands 
 of the breast seems here to be absorbed by the 
 blood, to increase its percentage of sugar, and pro- 
 duce glycosuria. 
 
 Sugar also may appear transiently as the symptom 
 of a disease and disappear again. This is an impor- 
 tant distinctive feature, for such is never the case 
 with diabetes. Vogel also (in " Handbuch fiir spez. 
 Pathol, u. Ther.," by Mrchow, Vol. vi.. Section 2), 
 as well as Pavy ("On the Nature and Treatment of 
 Diabetes," London, 1869), declare that sugar some- 
 times appears in the urine apart from all the other 
 symptoms of diabetes mellicus. 
 
 This transient condition I designate as " acci- 
 dental, transient glycosuria or mellituria," should it 
 
Susar in the Uritie. 
 
 "-a 
 
 19 
 
 even not disappear for several months, as in the 
 case of the pregnant woman reported by Bennewitz, 
 or even for years, as in the case of certain fat 
 persons. 
 
 But if the secretion of sugar by the inheritance of 
 a morbid constitution assumes a lasting form — on 
 which subject I shall treat at large below — if, there- 
 fore, this secretion is a symptom of that terrible 
 bodily condition which results in organic destruc- 
 tion, and which no physician thus far has been able 
 to heal, I denominate the constant, "incurable" 
 glycosuria resulting thence Diabetes. 
 
 Glycosuria and diabetes, which in outward appear- 
 ance do not differ much, have thus far very often 
 been confounded, even by the most exact inquirers, 
 but more especially by the physicians residing at 
 Spas and by practical physicians generally ; and 
 not unfrequently they have been under the impres- 
 sion that they had cured diabetes, while in reahty 
 they had only stopped "glycosuria" by removing 
 the causes through which this illness had been called 
 into existence. 
 
III. 
 
 HOW DOES GLYCOSURIA ARISE? 
 
 Accidental glycosuria may arise from a great 
 number of causes — (a) from a change in the blood 
 and in the circulation ; (b) from an injury suffered 
 by certain portions of the nervous system ; (c) from 
 disturbances of the digestion and certain other ill- 
 nesses ; (d) from an obstruction in the action of 
 the nerves, from disturbances of the respiration, etc. 
 
 faj Changes in the blood and in the circulation. — 
 Claude Bernard, Bumm, Sauvage, Willis, etc., have 
 shown that an excessive use of alcohol alone, 
 particularly in the stage of delirium tremens, results 
 in glycosuria ; likewise breathing for several hours 
 an atmosphere charged with oxide of carbon (ac- 
 cording to Bernard) ; further, an inhalation of chloro- 
 form, etc. 
 
 Experiments made on animals have resulted in the 
 formation of sugar after the administration of poisons 
 or poisonous gases ; after poisoning with strychnine ; 
 after injection of nitrate of amyl (see Hoffmann's 
 experiment on dogs in " Archiv fiir Anatomic u. 
 Physiologic," 1872) ; after the introduction of a 
 solution of one per cent, of carbonate, phosphate, or 
 sulphate of sodium administered with gum arabic 
 (see Kuntzel, " Beitrage zur Lehre von der Melli- 
 
How Does Glycosuria Arise P 21 
 
 turie," Berlin, 1872) ; after subcutaneous injec- 
 tions of nitrate of benzole administered to rabbits, 
 and an introduction of the same substance into the 
 mouth of dogs (see Ewald, " Centralblatt f. d. med. 
 Wissensch.," 1875, ^o. 52) ; after methylate of 
 delphinine (Kiilz's and Beschop's experiment) ; after 
 doses of hydrate of chloral administered to dogs (see 
 Teltz, Ritter, Eckhard, etc.) ; after the injection of 
 lactic acid into the stomach of rabbits ; after 
 poisoning dogs with phosphorus ; after the ad- 
 ministration of orthonitro-phenylpropriolic acid 
 (Hoppe-Seyler's experiment) ; after injection of 
 ether and spirits of ammonia into the portal system 
 (Dr. Harley) ; after swallowing curare (Bernard), 
 when, after a lapse of 20 minutes already, sweat, 
 sahva, and sugar were caused ; further, after swal- 
 lowing decomposed prussic acidj concentrated 
 sulphuric acid, and heavy doses of mercury (Sel- 
 kowski's experiment) ; further, after the injection of 
 considerable doses of morphium (Bock and Hoff- 
 mann's ''Experimentalstudieniiber Diabetes," 1874), 
 or of a solution of one per cent, of common salt 
 (see Bock and Hoffmann, " Ueber eine neue 
 Entstehung von Melliturie " in " Arch, fiir Anat. u. 
 Physiologic," 1871) ; again, after an injection of a 
 solution of one per cent, of carbonate, acetate, and 
 succinate of sodium (experiments of Kiilz ; see 
 " Beitrage zur Hydramie und Melliturie " in Eck- 
 hardt's " Beitrage," etc., Vol. vi., 187 1) ; finally, 
 more recently, after phloridzine (Qi H24 Oxo), which 
 exists in the bark of the roots of apple trees 
 
22 Diabetes. 
 
 and cherry trees, had been introduced into the 
 stomach of dogs or rabbits by v. Mering, which re- 
 sulted in the formation of 1 5 per cent, of sugar in 
 the urine. 
 
 (h) Injiiries suffered by certain portions of the 
 nei'vous system. — Sugar has also been formed in 
 animals after portions of their nervous system had 
 been injured ; e.g.^ by puncture, that is, the so- 
 called sugar-puncture (piqure) made by C. Bernard 
 into the fourth ventricle at the extremity of the 
 calamus scriptorius, etc. Sometimes polyuria only 
 arose ; which may be caused also by cutting the 
 two nervi splanchnici, as well as by stimulating the 
 great sympathetic nerve. 
 
 Pavy discovered sugar in the urine after an 
 injury of the vertebral plexus of the great sympathetic 
 nerve, as well as after injuring or removing the 
 cervical ganglion ; Schiff, after destroying the spinal 
 cord in front of, as well as behind, the origin of the 
 bronchial nerves ; Eckhardt found it in dogs in which 
 the hinder lobe of the vermis, in the cerebellum, had 
 been injured. 
 
 Schiff insists in his declaration that he had pointed 
 out the effect of an injury to the nervous centre before 
 Bernard, and he maintains that Bernard's puncture 
 causes a kind of paralytic hyperaemia of the bowels 
 and liver, from which results a stagnation of the 
 blood whereby the ferment which brings about the 
 formation of sugar is developed. A common effect 
 of perhaps the whole of the above experiments is a 
 flooding of the liver with blood. That such an 
 
Hoiv Does Glycosuria Arise f 23 
 
 effect is produced by Pavy's injection of blood is 
 beyond doubt ; that curare and nitrate of arayl react 
 in a similar manner may be likewise assumed with 
 certainty from their well-known physiological effects. 
 The direct mechanical stimulations of the liver, as 
 well as the introduction of stimulating substances 
 into the vena portae or into the intestinal canal, may 
 result, or rather must result, likewise in a hyperaemia 
 of the liver. Whether an injury of the nerves be 
 caused by stimulation or by paralysis, in either case 
 the enlargement of the vessels of the portal system 
 which has been directly observed, after divers 
 nerves had been cut, may be explained. 
 
 With respect to the so-called animal diabetes, 
 experiments made upon animals are very instructive ; 
 still in animals glycosuria only can be caused, NOT 
 diabetes. Their so-called diabetes ceases as soon as 
 the effect of the injections has passed away. 
 
 Kiilz and others have always observed in animals 
 that had been operated upon that, as soon as the 
 forcible interference was stopped, their urine in a 
 short time became normal again. 
 
 Zimmer's idea is that in animals poisoned by 
 arsenic, antimony, or phosphorus, mellituria is 
 caused by an incomplete transformation of the 
 sugar in the muscles, and he opposes the proposition 
 that glycogen in formed in the liver from the sugar 
 contained in the food. His opinion is that the active 
 muscles, along the whole course of the general cir- 
 culation, constitute those organs which are able to 
 bring about a transformation of the sugar of the 
 
24 Diabetes. 
 
 food speedily and in a considerable quantity, and are 
 thus able to destroy it at once. The consumption of 
 hydrates of carbon in the muscles, according to him, 
 is very considerable, for while they are at rest they 
 use up their own supply of glycogen, and, besides, 
 when exerted very much they consume the entire 
 mass of glycogen in the liver. 
 
 According to Zimmer, every kind of glycosuria is 
 caused in the organs of motion. I share his opinion 
 so far as to maintain that by the action of the 
 muscles there is started the chancre of substance 
 {Stoffwechsel) ; and, further, that the muscles burn up 
 the glycogen furnished to them by the current of 
 blood, and that they secrete it through the organs of 
 secretion. Zimmer thinks (see his work on " Mus- 
 keldiabetes,^' p. 17) that a diminished consumption 
 of glycogen in the muscles, together with a too 
 speedy and copious absorption of sugar from the 
 intestinal canal, causes the lighter form of diabetes ; 
 yet this is a mistake, because in that case all healthy 
 persons also would be exposed to this same lighter 
 form of diabetes. Yet on no account can this he 
 demonstrated and established. 
 
 (c) Disturbances of the digestio7i, and certain 
 other illnesses. — Glycosuria arises in cholera, after 
 the secretion of the urine has been suppressed or 
 diminished ; it also regularly follows albuminuria. 
 
 Sugar generally attends anthrax, until the an- 
 thrax is healed. Marchal de Calvi (see '' Medical 
 Times," ii., 1854) supposes erroneously that glyco- 
 suria is the cause of anthrax, when yet the reverse is 
 
How Does Glycosuria ^rise P 25 
 
 everywhere the case, for when the anthrax is healed 
 the accidental glycosuria disappears. The case is 
 quite different when anthrax occurs in *' diabetes,'' 
 which is a connate, constitutional, inherited inclina- 
 tion to glycosuria. Anthrax, then, according to my 
 own numerous observations, is actually a consequence 
 of the severer form of persistent glycosuria. The 
 latter form of glycosuria continues even after the 
 anthrax has been healed, which is one of the proofs 
 of the existence of genuine diabetes. I refer the 
 reader on this subject to Griesinger's observations in 
 his " Studien " (p. 358 et. seq., and p. 413), also to 
 Hertzka's communication in his work entitled " Die 
 Zuckerharnruhr " (p. 102, etc., etc.). 
 
 Frerichs mentions a case where glycosuria was 
 developed into diabetes by diphtheritis. What a 
 host of diabetic patients there would be if every 
 case of diphtheritis were to lead to diabetes ! That 
 glycosuria which is incident upon diphtheritis will 
 certainly lead to diabetes whenever diphtheritis 
 attacks a patient who by inheritance is predisposed 
 to diabetes. Such a case, however, is as rare, or, if 
 you please, it occurs as frequently, as diabetes itself 
 occurs under the same conditions. 
 
 Glycosuria in a transient form, until the disease 
 which it attends has been healed, has also been 
 proved in typhoid fever (see Seiffert's report) ; 
 further, in meningitis cerebro-spinalis (Sherrit) ; in 
 scarlet fever (Zinn's report) ; in measles (Bordier) ; 
 in abdominal dropsy ; m the fever attending suppu- 
 ration after vaccination (Prevost). 
 
26 . Diabetes. 
 
 In malaria, according to Verneuil (" Bull, de 
 TAcadem.," 1881), and according to Bourdel (1882), 
 glycosuria {^glycosiirie palustre) is caused during the 
 fever-stage. It has likewise repeatedly been demon- 
 strated in catarrh of the stomach, especially in 
 gouty subjects ; also in a closure of the vena portae ; 
 in a hardening of the pancreas ; in diseases of the 
 liver, etc. 
 
 (d) Obstruction in the action of the nerves, and 
 disturbances of the respiration. — Glycosuria finally 
 has been caused by a disturbance of the action of 
 the nerves, as well as by disturbances of the respi- 
 ration and circulation, whereby the kidneys become 
 congested, and sugar is transmitted from the blood 
 into the urine. 
 
 As sugar is liable to be formed in the urine by all 
 kinds of physical and psychical excitements, such 
 as anger, wrath, bodily and mental overwork, sexual 
 excesses, etc. (see "Arch. Gener.," 1862, ii., p. 265)^ 
 it is even more especially generated by all local, 
 mechanical stimulations of the nerves ; by neuralgia 
 and injuries of the sciatic nerve ; by stimulations of 
 branches of the nervus trigeminus i^e.g.^ in dental 
 operations) ; further, after neuralgia of the occiput ; 
 after trauma ; after severe concussions of the brain 
 (G. Fischer, in "Arch. Gen.,'' 1862, reports seven- 
 teen cases of injuries of the head accompanied by 
 transient, accidental glycosuria) ; in injuries of the 
 brain ; and, finally, after a sprain of the cervical 
 vertebrae ; likewise after blows inflicted on the dorsal 
 vertebrae. In a few cases, also, glycosuria arose in 
 
Holu Does Glycosuria Arise P 27 
 
 affections of the ear ; from running ears, headache, 
 vertigo, sickness, fainting-fits, etc. 
 
 Since all of the above cases of glycosuria have 
 been caused by forcible interferences with the health 
 of the subject, or arose in cases of illness; and since 
 they have occurred only as symptoms and as the re- 
 sults of such definite interferences and illnesses, there 
 applies to this particular, curable, and — as it may be 
 called — accidental form of glycosuria what has been 
 declared erroneously of " diabetes " in the " Tran- 
 sactions of the Medical Congress" for 1886 (p. 
 177): — "This pathological condition is no illness, 
 but a symptom, just as is the case with fever or 
 icterus. The most diverse aetiological causes are at 
 work in producing it [i.e., glycosuria, as I suggest], 
 and the secretion of sugar is only to be regarded as 
 a symptom," etc. 
 
 Wherever, indeed, there is no hereditary predispo- 
 sition, accidental glycosuria only, not diabetes, will 
 arise from such merely accidental causes. Glycosuria 
 becomes chronic, or, according to the prevailing 
 idea, it becomes " incurable," and thus manifests 
 itself as " diabetes," only in persons who are here- 
 ditarily predisposed for it. 
 
 A.Vulpian (in " Le9ons surl'appareil vasomoteur," 
 Paris, 1875) is decidedly wrong in making the follow- 
 ing general declaration : — " Glycosuria is only a 
 symptom of that malady which is known as diabetes, 
 a malady which physiology has thus far been unable 
 to produce. Glycosuria, in the form in which. we 
 have just determined it, lasts for one, two, and some- 
 
28 Diabetes. 
 
 times for five, six, seven, and even eight days ; after 
 that time has elapsed it disappears, and it is not 
 possible to prolong its duration." 
 
 All those cases of diabetes, therefore, where the 
 patients otherwise feel well, and where, by the use of 
 the Carlsbad waters, or by the help of a rational 
 physician, they are restored to health, I think ought 
 to be classed under " glycosuria," and not under 
 '' diabetes." 
 
 Lasting mellituria, which, according to Seegen 
 ("Diab. MelL," 1878, p. 16), ought never to be 
 made light of, is called "diabetes." 
 
 Gathgens', Pettenkofer's, and Voit's idea is that 
 whenever the sugar contained in the chyle or lymph, 
 in spite of the burning up of albuminates, is not 
 sufficiently destroyed, the secretion of carbonic acid 
 is diminished, and sugar makes its appearance in the 
 urine. 
 
 The experiments of Ebstein confirm this. Hyper- 
 glykaemia, as a consequence, is avoided whenever 
 the carbonic acid which is formed in the tissues of 
 the organism is sufficient to protect against a speedy 
 transformation the glycogen, which, free from nitro- 
 gen, is separated from the albuminates. 
 
 Through this fundamental principle, which Ebstein 
 discovered experimentally (see Op. citat., p. 128 et 
 seq.), this inquirer was brought into the immediate 
 presence of the pathogenesy of glycosuria. He is, 
 therefore, quite justified in declaring that essentially 
 this malady consists in an insufficient formation of 
 carbonic acid in the tissues, the consequence of 
 
How Does Glycosuria Arise P 2,9 
 
 which is that the glycogen stored up in the organism 
 is not protected against the attacks of the diastatic 
 ferment to the same extent as it is in a normally con- 
 stituted organism. The equilibrium between the for- 
 mation and the consumption of sugar in the tissues 
 is thereby disturbed, wherefore the unconsumed 
 sugar, by virtue of its great diffusibility, passes 
 into the current of the juices of the body, the result 
 of which is hyperglykaemia. 
 
 A SUMMING UP. — First of all Ebstein demonstrated 
 experimentally the cause of glycosuria ; that is, of 
 the excessive formation of sugar. He teaches that 
 in a healthy condition of the body the material 
 which is used up in the tissues, and by which the 
 supply of carbonic acid, necessary for regulation, is 
 kept up, is fully replaced by the food. A sufficient 
 amount of substances containing nitrogen (z.e.^ 
 albuminates), and also of substances free from 
 nitrogen (i.e., hydrates of carbon and fats) which 
 are conveyed into the body by the food, is deposited 
 in the organs and tissues in order to replace the 
 consumed material. For a time this stored-up 
 material, during an insufficient supply of food, is 
 able to act as a medium capable of forming in the 
 tissues the carbonic acid necessary for the main- 
 tenance of life. A decrease in weight at last becomes 
 apparent ; in which case only an excessively large 
 amount of fuel is able to furnish the quantity 
 of carbonic acid required for the continuance 
 of life. This carbonic acid is the aofent bv 
 which the diastatic ferments of the organism are 
 
30 Diabetes. 
 
 ■checked in their action. If, therefore, the quantity 
 ■of carbonic acid generated, compared with the avail- 
 able amount of glycogen and diastatic ferment, is 
 too small, its protecting influence will not suffice. 
 A greater amount of glycogen, therefore, than is the 
 case where there is a sufficient quantity of carbonic 
 acid, will then be exposed to the vigorous action of 
 the sugar-forming ferment, and be transformed into 
 sugar. This sugar, which is formed in the tissues 
 from glycogen, becomes diffused easily and quickly 
 throughout the juices of the body — so far as it is not 
 used up, that is, oxidized into carbonic acid in those 
 parts of the body where it was originally formed. In a 
 normal condition of the body there is evidently an 
 equilibrium in the tissues between the formation 
 and the consumption of sugar. The percentage of 
 sugar in the blood in healthy persons is essentially 
 the same at all times ; only occasionally, under well- 
 defined conditions, there is an increase in the per- 
 centage of sugar in the blood of healthy persons. 
 The case is altogether different if the consumption 
 of the sugar in the tissues of the organism is either 
 too limited, or its formation too excessive. 
 
 In either case there arises a hyperglykaemia, the 
 duration of which corresponds exactly with the 
 duration of its cause. Here, therefore, we have a 
 scientific explanation of the origin of accidental 
 glycosuria. 
 
IV. 
 
 THE CHARACTERISTIC FEATURES OF 
 DIABETES MELLITUS. 
 
 As in the case of accidental " glycosuria," so also 
 in the case of " diabetes " under certain well-defined 
 conditions, there exists a continued lasting secretion 
 of grape-sugar through the kidneys, which is mostly 
 combined with disturbances in the entire organism, 
 resulting, without any doubt whatsoever, in the death 
 of the patient. Such a complex of symptoms is- 
 defined by pathology as diabetes ■mellitus. 
 
 There is an essential marked difference between 
 diabetes and simple glycosuria or mellituria. The 
 former is connate, inherited, and presents itself as 
 a chronic disease, which has hitherto been supposed 
 to be incurable. In this disease, as is also the case 
 with curable glycosuria, there is an excessive per- 
 centage of sugar in the blood, from o'22 to 0*44 ^<?r 
 ceitt., and this sugar is not consumed in the system. 
 Glycosuria is transient ; diabetes constitutional. 
 Glycosuria is caused transiently by all those hurtful 
 agencies which have been enumerated in the preced- 
 ing chapter ; but diabetes is never caused in that 
 way — that is, provided a person is not hereditarily 
 predisposed for diabetes. Hereifi lies the great 
 mystery^ never before discovered by anyone, of the 
 
32 Diabetes. 
 
 cause of "diabetes ; '' and here, according to my 
 conviction, hereditary lues on the part of one of the 
 parents, grand-parents, or great-grand-parents of 
 the patient, has to be taken into consideration. 
 A transmission of hies through vaccination also is 
 not excluded. 
 
 The diabetic predisposition begins to show itself 
 when the blood — as is the case also in glycosuria — 
 contains such a percentage of sugar as to be 
 compelled to excrete some portion of it into the 
 urine. 
 
 During many years, and even in ripe old age, a 
 person may be diabetic in a latent state without 
 knowing it. Only when there Is a change wrought 
 in the production of carbonic acid, and when in con- 
 sequence of it there is an excessive formation of 
 sugar — an over-production; only when under such 
 circumstances the percentage of sugar in the blood 
 increases, and nature is no longer able to consume 
 it, latent diabetes becomes active ; and then within 
 a longer or shorter period through accidental causes, 
 but mostly through the coma diabeticuni, death 
 ensues. 
 
 Diabetes, consequently — as already stated — is not 
 a symptom like glycosuria, but it is a well-defined, 
 primary, independent, chronic form of disease, the 
 existence of which is based on a connate, false dis- 
 position, or a wrong composition of the proto- 
 plasm. In its active stage this disease produces 
 deeply- seated, serious, complicated disturbances in 
 the change of substance {Stoffivechsel), and in the 
 
Characteristic Features of Diabetes. 33 
 
 course of time causes a consumption of the physi- 
 cal as well as of the psychical forces. 
 
 A characteristic feature of diabetes is its freedom 
 from fever. Sometimes, even, it pursues its course 
 attended by an abnormally low temperature, while 
 cases of accidental glycosuria are mostly attended 
 by a transient fever. Whenever, therefore, diabetes 
 is accompanied by fever, this fever is caused by a 
 second, adscititious illness, of which the patient 
 suffers at the same time. 
 
 Again, diabetes is not infectious or contagious. 
 The blood of diabetic patients has been inoculated 
 into animals without any injurious effects. 
 
 From Rollo to Bouchardat the cause of diabetes 
 was sought for in gastro-intestinal disturbances — in 
 a faulty digestion, which cause could no longer be 
 upheld as our knowledge of the digestive organs 
 increased. 
 
 Bouchardat, indeed, supposed that the normal 
 gastric juice stops the secretion of sugar, but that a 
 ferment favourable to the formation of sugar arises 
 from, a diseased stomach. McGregor also was of 
 the opinion that a diseased stomach furnishes the 
 aetiological element of the disease, until CI. Bernard 
 pointed out the liver as the organ in which the sugar 
 is formed. 
 
 Basing himself on the effect of certain poisons, 
 after the administration of which, as well as after a 
 division of the great sympathetic nerve, the blood- 
 vessels are enlarged, allowing the blood to pass 
 through without first becoming arterialized, the 
 
 D 
 
Qj. Diabetes. 
 
 vivisector Pavy believed that diabetes was due to a 
 [paralytic] enlargement of the vessels in the liver. 
 
 Seegen traced the cause of diabetes to a morbid 
 transformation of the glycogen of the liver— to an 
 abnormal transformation of substance, which in most 
 cases arises from a disturbance in the province of the 
 nerve-centres. "There is no meUituria," he says, 
 " which is not injurious, even as there is no tubercu- 
 losis which is not dangerous" (p. i8). More than 
 one-third of Seegen's patients also suffered of 
 adiposis. He is of opinion that fatness predisposes 
 to diabetes, and he considered adiposis a precursor 
 of the formation of sugar. 
 
 Dickinson also supposed that diabetes arose from 
 a disturbance in the functions of the liver, which 
 instead of glycogen prepared sugar out of albu- 
 minous food. All changes and disturbances within 
 the nervous system, according to him, cause an 
 abnormal state of the circulation. 
 
 Zimmer searches for the cause of the disease not 
 only in the liver, but also in the muscles, which at 
 first sounds strangely, since an increase of sugar in 
 the blood through the action of the muscles can only 
 be imagined in connection with, and in dependence 
 upon, the liver. 
 
 Claude Bernard maintains that a deeper disturb- 
 ance hes at the bottom of diabetes than at that of 
 glycosuria and glykaemia, the nature of which 
 " deeper disturbance " he thinks will continue to 
 remain unknown to us so long as that complex of 
 physiological processes which we comprise under the 
 
Characteristic Features of Diabetes. 35 
 
 terms " assimilation " and " change of substance " 
 {Stoffwechset) is not made clear to us in all its 
 particulars by physiological investigations. 
 
 CI. Bernard's view called forth an entire school, 
 according to which the formation of sugar is a 
 normal bodily function, which idea is contested by 
 the opposite view of Pavy, Schiff, Ritter, etc., 
 according to whom the above is not the case, but 
 the formation of sugar is explained as a post-mortal 
 process. 
 
 Every inquirer before and after the rise of the 
 above school started a theory of his own. Accord- 
 ing to Lecorche (see " Consideration sur le diabete 
 Sucre," in " Gaz. hebdomad.,'' 1873) the true nature 
 of diabetes consists in a non-assimilation of the 
 proteinous substances, which manifests itself by the 
 enormous daily secretion of urea. 
 
 Vocke supposes that the true nature of diabetes 
 consists in a kind of paralytic infirmity interfering 
 with the formation of glycogen in the liver and 
 the oxidation of the blood-sugar, wherefore our first 
 and essential object should be to increase the activity 
 of the nerves. 
 
 The profession began to be exercised by the fact 
 that in the presence of the wealth of data furnished 
 by the rising sciences of experimental chemistry and 
 experimental physiology, which applied themselves 
 by preference to the investigation of diabetes, no 
 one has as yet been able to solve the riddle of this 
 " sphinx," as Frerichs calls it. 
 
 V. Pettenkofer and v. Voit, in the case of diabetic 
 
^6 Diabetes. 
 
 patients, find a more extensive transformation of 
 substance {^Stoffumsatz) than in healthy persons, 
 coupled with a diminished reception of oxygen. 
 The cause of this greater consumption of material, 
 and of the decrease in the reception of oxygen, they 
 declare, is that the tissues of diabetic patients are 
 ready to decompose, as is proved by the furuncu- 
 losis of which they suffer ; further, by the spon- 
 taneous gangrene of the extremities, the softening of 
 the lungs, the shrinking of the pancreas, the loosen- 
 ing of the teeth and caries of the same, the loss of 
 hair, etc. 
 
 The real cause of all the above symptoms which 
 are exhibited by diabetic patients, namely, the here- 
 ditary transmission of lues, they did not discover. 
 
 In battling with diabetes, the primary thing that 
 has to be attacked is not the formation of sugar, but 
 the faulty composition of the protoplasm, and its 
 inability to produce carbonic acid. 
 
 The postulate, therefore, of my theory, which I 
 have tested practically ever since 1881, is the reno- 
 vation of the entire protoplasm of the body. In this 
 theory I start with the following proposition laid 
 down by v. Pettenkofer and v. Voit : — "An under- 
 standing of that alteration in the normal processes of 
 decomposition, that is,' of that disturbance in the 
 assimilation which is caused by diabetes, can be 
 obtained only by a study of the general processes 
 carried on in the body, such as respiration and 
 decomposition generally, and not by a minute 
 examination of organs torn from their context, that 
 
Characteristic Features of Diabetes. 37 
 
 is, from the series which they form with other organs 
 of the body." 
 
 The method of cure followed by myself is based 
 on a thorough study of those general processes 
 which are constantly carried on in the organism. 
 My aim is an improvement in, and a transforma- 
 tion of, the protoplasm. My entire secret consists 
 in restoring the equiHbrium — the balance in the 
 "change of substance" {in dem Stoffwechsel), 
 which was aimed at by v. Pettenkofer and v. Voit. 
 These gentlemen, indeed, have defined the essential 
 nature of diabetes as consisting in a diminished 
 reception of oxygen and an increased transformation 
 of substance {Stoffumsatz)^ while I consider these 
 physiological conditions as of secondary importance, 
 and attack at once the fundamental cause which 
 resides in the protoplasm. The disturbance in the 
 assimilation of the food, which they, in conjunction 
 with Seegen (see Op. citat., p. 33), have assumed is 
 indeed only a consequence of a wrongly- formed 
 protoplasm, and of an insufficient formation of car- 
 bonic acid. Hence the lowering of the temperature 
 in diabetic patients. 
 
 A cardinal symptom of diabetes which v. Petten- 
 kofer and V. Voit met with in all their investigations 
 is a decomposition or a resolution of the albumen : 
 increased resolution of albumen. 
 
 Ebstein also assumes, from the pathogenetic 
 standpoint, that glycosuria and an increased decom- 
 position of albumen are brought about in the organs 
 and tissues of diabetic persons under a similar con- 
 
3 8 Diabetes. 
 
 dition, namely, under the influence of an insufficient 
 development of carbonic acid. 
 
 Ebstein proves experimentally the insufficient for- 
 mation of carbonic acid ; but he raises difficulties 
 against his theory, which is based on a defective 
 production of carbonic acid, by asserting that a 
 diabetic patient possesses a greater amount of 
 diastatic ferments than a healthy person. The equili- 
 brium in such a case could be re-established only by 
 an increase in the formation of carbonic acid. The 
 normal quantity of carbonic acid required by a 
 healthy person would thus be insufficient in the case 
 of a diabetic person. 
 
 That portion of Ebstein's theory, however, is fully 
 proved where he declares that an excessive forma- 
 tion of sugar ensues whenever the glycogen which is 
 stored up in the tissues, on account of an insufficient 
 formation of carbonic acid, is not protected in a 
 normal manner against the influence of the diastatic 
 ferments (which are likewise in the tissues) ; a 
 lasting disturbance in such a case being caused in the 
 equilibrium between the formation and the con- 
 sumption of sugar, so that that portion of the sugar 
 which is not used up, by virtue of its great diffusi- 
 bility, passes speedily into the circulation of the 
 vital juices. According to this theory the copious 
 transmission of sugar into the urine is due to an 
 insufficient formation of carbonic acid in the tissues. 
 This same theory also requires that a diminished 
 production of carbonic acid, in its character as a 
 symptom of diabetes mellitus, must be regarded as a 
 
Characteristic Features of Diabetes. 39 
 
 primary disturbance, while a decreased reception of 
 oxygen would be only ^.secondary disturbance. By this 
 means light at last is thrown on the lower tempera- 
 ture of the body which prevails with diabetic patients. 
 
 By means of Ebstein's experiments we are able to 
 obtain the only rational explanation of the generation 
 of sugar in an organism where diabetes has been 
 fully developed. Although his experiments do not 
 explain fully and exhaustively the pathogenesy of 
 this disease, they nevertheless became at once of the 
 greatest consequence as soon as it was shown by my 
 experience that those symptoms which he laid down 
 experimentally, are identical with the symptoms of 
 hereditary lues. 
 
 I was somewhat surprised by Hoffmann's definition 
 of diabetes at the Medical Congress held at Wies- 
 baden in 1886, where — certainly in agreement with 
 inquirers of the stamp of Landrieux and Iscovesco 
 (see " Progr^s Medic. " of June 27th, 1885, No. 26), 
 who declared that glycosuria of long standing is 
 " diabetes," while a short transient glycosuria ought 
 to be called an " abortive diabetes " — he said : " If a 
 boundary Hne is to be drawn between glycosuria and 
 diabetes, the decisive criterion can be furnished only 
 by a shorter or longer continuance of the disease." 
 By way of disproval, we need to refer here only to 
 the diabetes of pregnant women, according to 
 Bennewitz's observations, to which reference has 
 been made above. Hoffmann continued : " It is 
 very plain that we still lack some fundamental 
 symptom to aid us in drawing a distinction." 
 
40 Diabetes. 
 
 Such a fundamental symptom is hereditary lues, 
 which, as shall be proved more at large below, 
 serves as an organic basis to diabetes. Wherefore 
 I am justified in giving for the first time the follow- 
 ing definition of diabetes, drawing a sharp distinc- 
 tion between it and glycosuria : Glycosuria must be 
 looked upon by thei^apeutics as something accidental 
 or symptomatic ; but diabetes as something essential, 
 as a state of the human organism, corrupted by 
 inheritance ; as a predisposition, consequently, for a 
 constant, destructi-ve mellituria, combined with an 
 increased decomposition of albumen. 
 
 It is not correct to maintain that alimentary 
 glycosuria, according to circumstances, may become 
 the cause of diabetes ; certainly not of what I under- 
 stand by diabetes. 
 
 Glycosuria, when it lasts long, under unfavourable 
 circumstances may, no doubt, lead to consumption ; 
 in like manner a large accumulation of glycogen, 
 just like diabetes, under peculiar circumstances, may 
 lead to acute intoxication. Nevertheless, glyco- 
 suria is not on that account diabetes ; nor does it 
 become identical with this disease, because certain 
 practitioners define glycosuria as a "neurogenous" 
 form of diabetes. I am acquainted with only one 
 kind of diabetes ; and this one kind of diabetes I 
 treat as a hereditary, connate disease. Only thus 
 unity can be obtained in our conception, and hence 
 unity as a basis to start from. 
 
 I shall direct the attention of my readers here 
 only to one fact, namely, that the diabetes of many 
 
Characteristic Features of Diabetes. 41 
 
 fat persons— according to Pfeiffer they constitute 33 
 per cent, of all cases of diabetes— is frequently a 
 merely accidental glycosuria caused by an excess of 
 sugar, which by the use of the Carlsbad waters can 
 certainly be diminished, nay, even healed. 
 
 The author of a popular treatise on diabetes, 
 which has recently appeared, is not on a par with 
 the present state of medical science, where he 
 maintains that the whole of the sugar originates 
 from the blood ; and where he declares, without any 
 limitation whatever, that all those persons suffer from 
 the sugar disease, or are " diabetic," whose urine 
 has been proved to contain sugar. 
 
 There are diabetic persons who, to the end of 
 their life, use up all the sugar secreted ; so that an 
 excessive accumulation of sugar becomes noticeable 
 only at a certain time of rest, when the action of 
 the muscles ceases, and when the production of 
 carbonic acid becomes deficient ; as, for instance, in 
 cases of illness, such as cholera, small-pox, typhoid 
 fever, scarlet fever, syphilis, gout, a diseased state 
 of the pancreas and Uver, or, again, after catching a 
 cold, or getting wet. Diabetes is never caused by 
 any infectious disease, although wherever there 
 exists a hereditary predisposition for diabetes any 
 disease may become the occasion of the develop- 
 ment of this hereditary malady. If a patient, 
 during the continuance of active diabetes, becomes 
 infected by any acute disease, such as typhoid 
 fever or pneumonia, his condition mostly becomes 
 critical. For the same reason also tuberculosis, 
 
42 Diabetes. 
 
 wounds, etc., mostly cause the death of a diabetic 
 patient. 
 
 Experiments were made with healthy and diabetic 
 persons, where both partook of the same amylaceous 
 food ; thus, Gathgens, for instance, partook of the 
 same nutriment as a diabetic patient (see Gathgens, 
 " Ueber den Stoffwechsel eines Diabetikers," Dorpat, 
 1866; also his report in Kiihne's "Medic. Central- 
 blatt," Berlin, 1887 ; Vol. v., p. 147). Portions of 
 the liver of living persons were removed in order to 
 test its percentage of sugar, and in order to use this 
 percentage afterwards for a comparison ; which pro- 
 cedure, however, was condemned by Ebstein as 
 unbecoming {Op. citat., pp. 150 and 188). Con- 
 clusions also were drawn as to the gradual cessation 
 of the formation of glycogen in the liver ; and as to 
 a direct conveyance of sugar from the bowels through 
 the blood of the vena portaeinto the general circula- 
 tion. But has any inquirer, before Ebstein, ever 
 been able to throw light on the procedures in the 
 protoplasm of the liver-cells, etc. ? According to 
 Luchsinger, the sugar passes into the blood un- 
 changed, as soon as the liver-cells lose their power 
 of action, that is, so far as the formation of glycogen 
 is concerned. 
 
 This idea is favourable to that maintained by Eng- 
 lish physicians, according to whom marasmus is the 
 most frequent cause of diabetes ; for marasmus 
 cannot help diminishing the power of action of the 
 liver-cells. 
 
 In his work on Diabetes, Ebstein enters upon 
 
Characteristic Features of Diabetes. 43 
 
 the standpoint which I announced at Wiesbaden in 
 1886. He starts with the idea that the quantity of 
 carbonic acid formed in the tissues of a diabetic 
 person is too small, compared with the carbon-hold- 
 ing substances there, which require to be oxidized. 
 He regards a diabetic person, most significantly, as 
 an individual who, on account of the defective con- 
 stitution of the protoplasm of his tissues, is unable, 
 out of the same given quantity of carbon-containing 
 fuel, to produce the same amount of carbonic acid 
 as a healthy person. He shows that carbonic 
 acid possesses the property of checking the action 
 of. the diastatic ferments in the tissues and organs, 
 and the ability of regulating the transformation of 
 the glycogen, which is stored up nearly everywhere 
 in the organism. He shows, further, that the 
 carbonic acid is able to change certain albuminates 
 — the globuline — from a liquid into a solid state, and 
 that by an addition of oxygen these same substances 
 are again changed back from the solid into the liquid 
 condition. 
 
 Ebstein starts with the investigations of Voit and 
 Pettenkofer, according to whom a diabetic person 
 decomposes more albumen than a healthy person, 
 and also destroys more fat ; and yet under the same 
 circumstances absorbs less oxygen, and yields less 
 carbonic acid than a healthy person. On the basis 
 of these investigations he sought to prove, by 
 experiments based on an examination of the entire 
 change of substance (^Stoffmnsatz), that the proto- 
 plasm of a diabetic person is unable to form as much 
 
44 Diabetes. 
 
 carbonic acid out of a given amount of carbon-con- 
 taining fuel as the tissue of a healthy person. He 
 looks upon the secretion of sugar in diabetes as the 
 result and the effect of a diseased state of almost 
 the entire protoplasm of most tissues and organs ; 
 since nearly everywhere, where the juices circulate 
 in the living organism, and where the substance of ■ 
 it undergoes change — hence where there is respira- 
 tion, and where carbonic acid is formed in the pro- 
 toplasm — there also diastatic ferments and glycogen 
 are present. 
 
 In view of the great bulk and the extensive volume 
 of the liver and the muscles, Ebstein regards these 
 organs as those parts of the body which are affected 
 most, and are most concerned in the various stages 
 of diabetes ; yet he does not consider the profession 
 justified, at the present state of science, to speak of 
 a special liver-diabetes, or muscle-diabetes. 
 
 After thus disclosing to us, by his theoretical 
 investigations, the cause of the formation of sugar, 
 on the ground of a defective development of carbonic 
 acid, which is surely the real cause of the fatal 
 anomaly in the change of substance witnessed in 
 diabetes, Ebstein only needed to go a little farther, 
 and discover the cause why, in the case of some 
 individuals, at certain times, the development of 
 carbonic acid in the protoplasm is thus interfered 
 with, and why it is not in the case of others. He stood 
 nearer than anyone before him to the head of that 
 source whence alone the answer to these questions 
 could come. According to his theory he was bound 
 
Characteristic Features of Diabetes. 45 
 
 to say : — So long as the formation of carbonic 
 acid is able to regulate or govern the diastatic 
 ferment the predisposition for diabetes remains 
 latent ; but as soon as, through any cause whatsoever, 
 the formation of carbonic acid is interfered with, the 
 fatal predisposition for diabetes is ushered actively 
 into the foreground, by allowing the sugar-forming 
 ferment to display its energy in an excessive manner. 
 Under such circumstances the protoplasm becomes 
 defective ; it loses the power of forming carbonic acid 
 in a normal manner ; sugar is formed, and the patient 
 becomes consigned to death. 
 
 Ebstein, as just mentioned, was very near drawing 
 this inference. The fact that I have succeeded 
 in tracing the fundamental cause of diabetes to a 
 hereditary luetic disposition, lets a flood of light into 
 the chaotic darkness of diabetes. A new epoch 
 in the therapeutics of diabetes has no doubt been 
 inaugurated with this discovery. 
 
V. 
 
 CLASSIFICATION OF DIABETES MELLITUS. 
 
 From a therapeutic point of view it is totally value- 
 less to assume various forms of diabetes ; still, in the 
 interest of science, and in that of the history of 
 literature, it seems worth while to inquire into this 
 subject. 
 
 About 1680, Ettmiiller drew a distinction between 
 diabetes vents, in which liquids pass unchanged 
 through the body and are excreted, and diabetes 
 spurius, in which the solid ingredients of the body 
 become liquefied, wherefore the quantity of the urine 
 exceeds then the quantity of the liquid imbibed. 
 
 Afterwards a diabetes chylosus was spoken of, in 
 which it was supposed that the chyle was secreted 
 in conjunction with the urine ; whence the sweet 
 taste of the latter. 
 
 In the beginning of the last century Sauvage 
 called a particular species of this disease diabetes 
 angliciis, a characteristic feature of which was a 
 sweet, sacchariferous urine. Another distinct species 
 he called diabetes legitimus Aretaei, in which the 
 volume of the excretion was larger than that of the 
 liquid imbibed. 
 
 He distinguished besides the following five forms 
 of this disease : Diabetes hystericus ; diabetes arti- 
 
Classification of Diabetes Mellitus. 47 
 
 ficialisy which ought rather to be called transient 
 glycosuria, since it was caused by tying the vessels 
 of the spleen ; diabetes a vino, caused by high-life, 
 an abuse of spirituous liquors, and by partaking of 
 young, sweet wine; diabetes arthriticus ; diabetes 
 febricosiLS. 
 
 Only towards the end of the last century the per- 
 centage of sugar in the urine was employed as a 
 principle of classification by Cullen and P. Frank, 
 who distinguished between diabetes inellitus or 
 veruSj and false diabetes or diabetes insipidus or 
 spuriiis. The latter species Ewald treated as 
 azoturia^ after Ettmliller's example. 
 
 The disease was called diabetes mellitus when 
 grape-sugar was contained in the urine. But when 
 a large quantity of urine only was passed, without 
 any sugar, they called it diabetes insipidus ; this 
 latter disease, consequently, is identical with 
 polyuria. 
 
 When the urine contained sugar, but its quantity 
 was not in excess of that excreted by a healthy 
 person, Peter Frank denominated that species 
 diabetes decipiens. He described it thus : Urine 
 scanty, but sweet (" Spez. Path. u. Therap.," 
 iibersetzt v. Schernheim, 1840, i., p. 360). This 
 species, as Ch. Bouchard expresses it, is diabetes 
 without polyuria. Briicke does not regard diabetes 
 insipidus as a definite disease ; neither does he 
 regard diabetes inellitus without polyuria as dia- 
 betes. 
 
 When the grape-sugar disappears, and the urine 
 
48 Diabetes. 
 
 instead exhibits inosite, which is incapable of fer- 
 mentation ; when, therefore, there is simply a case 
 of inosituria, while all the remaining symptoms of 
 diabetes continue (as was shown by Vohl in 1858), 
 that condition is called diabetes inositus. In cases 
 where a great deal of water was conveyed into the 
 system Strauss discovered inosite also in the urine 
 of healthy persons. Kiilz is of the opinion that a 
 consumption of upwards of seven pints of any liquid 
 beyond the usual allowance promotes the formation 
 of inosite. A distinction used to be made between 
 brain- diabetes J liver-diabetes, and stomach-diabetes, 
 thus between neurogenous, hepatogenous, and gas- 
 trogenous diabetes. Diabetes was called neuro- 
 genous, or brain-diabetes, when nervous symptoms 
 predominated, such as weakness, ill-humour, itching 
 of the skin, headache, disturbances in the sense of 
 vision ; but it was called liver and stomach-diabetes 
 when combined with adiposis, furunculosis, albu- 
 minuria, gout, irregularities in the digestion. In 
 brain-diabetes a stimulation of the vagus nerve in 
 the brain was assumed ; in the other forms a stimula- 
 tion of the same nerve in the stomach. In the 
 former case diabetes was supposed to be caused by 
 a reflex-excitation of the secretion of sugar ; in the 
 latter case by the digestion of hydrates of carbon. 
 In the former case lean persons, thinkers, persons 
 labouring with their brains were attacked by the 
 disease ; in the latter case fat persons, etc. 
 Griesinger drew a distinction between transient and 
 chronic diabetes. 
 
Classification of Diabetes Mellitus. 49 
 
 Redard (in *' Revue de Chirurg.," 1866) reports a 
 number of cases of "ephemeral" glycosuria, to 
 which he opposes the " severe" illness bearing the 
 same name. 
 
 Senator {Op. citat., p. 216) explains the origin 
 of diabetes in a twofold manner. It is caused 
 by disturbances of the nerve-tracks within the pro- 
 vince of the alimentary canal and the liver, which 
 arise either from any point of these tracks, or else 
 are produced by local causes, by which these organs 
 are affected immediately. In this way are explained 
 the following forms of the disease : A form of 
 diabetes {neurogenous) which originates primarily 
 in the nervous system, and another [gastro-entero- 
 genous and hepatogenous) which originates primarily 
 in the intestinal canal or in the liver. 
 
 The " severe " form of diabetes Lecorche calls the 
 idiopathic. Dickinson uses the same term in order 
 to indicate the condition under which the disease 
 originates in the affected organ itself. Seegert also 
 distinguishes between idiopathic and symptomatic 
 diabetes, and herein lays great stress on the circum- 
 stance whether the secretion of the sugar is only 
 scanty, and whether it occurs only after partaking of 
 a certain kind of food, and thus is merely temporary ; 
 or whether the affection is constant and independent 
 of the food of the patient. Again, Seegen distin- 
 guishes between two other forms of diabetes, accord- 
 ing to the source whence the glycogen is introduced 
 into the system : — ^ 
 
 {a) A form of diabetes, in which only that glyco- 
 
 E 
 
5 o Diabetes. 
 
 gen which has been produced of hydrates of carbon 
 is transformed into sugar. 
 
 {b) Another form, in which the glycogen which 
 has been formed from albuminates by division [Spal- 
 tung) is likewise transformed into sugar. 
 
 In the former species of diabetes sugar is excreted 
 only when hydrates of carbon are introduced into 
 the system ; in the latter species sugar is formed 
 even if a patient lives altogether on a meat-diet. 
 
 Seegen distinguishes further {Op. citat., p. 66) 
 between adipose and slim diabetic patients. The 
 former show sugar in their urine only when they feed 
 on sugar or starch, while the latter produce sugar 
 even if they live exclusively on a meat-diet. 
 
 Traube (see Virchow's " Archiv," etc., iv., 1852, 
 p. 109) regards the above forms as different stages 
 of diabetes. He thinks that in the first stao;e of 
 diabetes, in which the cessation of sugar is caused 
 by an abstinence from hydrates of carbon, the sugar 
 is derived immediately from the food, while in the 
 second stage, in which such is not the case (or only 
 in a limited measure), the sugar is derived imme- 
 diately from that prepared by the liver. Here we 
 have glycosuria and genuine diabetes ! Seegen, it 
 is true, admits that the second form presents itself 
 at once in the severe cases of the disease, without 
 passing first through the milder form, and Pavy 
 declares that the formation of sugar is not a physio- 
 logical process. Hoffmann adopts the neurogenous 
 form, and also that presented by adipose patients, 
 and repudiates a pancreatic form of the disease. 
 
Classification of Diabetes Mellitus. $ i 
 
 He tries to present an image of the neurogenous 
 form of the disease by noting the changes in the 
 medulla oblongata or pons of forty persons who died 
 of diabetes, whose heads were dissected, and to 
 these cases he adds forty other cases in which the 
 active form of the disease had set in soon after an 
 injury to the head. 
 
 Additional classifications were forced on the pro- 
 fession by the experiments of CI. Bernard, who was 
 of the opinion that he had discovered the real cause 
 . of diabetes mellitus in the floor of the fourth ventricle 
 of the brain, although in the animals on which he 
 operated he was able to produce only glycosuria, 
 and not diabetes. Compare Hoist (in the " Petersb. 
 Med. W.," 1880), who arrives at a number of forms 
 presented by diabetes ; and also Pawlinoff (in Vir- 
 chow's "Archiv," etc., 64), who speaks of muscle-dia- 
 betes; likewise Zimmer, who endeavours to make out 
 a hepatogenous, a muscular, and a mixed diabetes. 
 The profession was thus led into error, just as it had 
 been by those observers who in a one-sided way 
 declared diabetes mellitus to be either an affection 
 of the stomach or the bowels, or, again, an affection of 
 the liver ; in which assertion they based themselves 
 on the idea that the liver in a normal condition pro- 
 duces the glycogen which, when a change occurs in 
 the innervation of the liver, or when this organ under- 
 goes organic alterations, is carried as a matter of 
 course into the blood and is excreted thence into 
 the urine. Other new classifications of diabetes 
 which originated with the vivisectors are the follow- 
 
5 2, Diabetes. 
 
 ing : The "manacle-diabetes" {Fess e lungs diab et es ; 
 see Bohm's and Hoffmann's experiments on cats) ; 
 " diabetes by stimulation " {Reisungsdiabetes, 
 which Eckhard caused by stimulating or exciting 
 the vermis of the cerebellum) ; "strychnine-diabetes" 
 (see Schiff's experiments on frogs) ; " curare-dia- 
 betes " (CI. Bernard) ; "oxide of carbon diabetes" 
 (CI. Bernard); "salt-water diabetes" (Bock and 
 Hoffmann), etc. In connection with these experi- 
 ments it may be objected that the animals operated 
 upon were affected with glycosuria, but NOT WITH 
 DIABETES. 
 
 Artificial diabetes {i.e., transient glycosuria), ac- 
 cording to Schiff, may extend over several days, 
 while ordinarily it lasts only a few hours (Kiilz) ; yet 
 this artificial glycosuria is no analogue of human 
 diabetes. Kahler, therefore, says correctly (" Die 
 dauernde Polyurie," etc., Prague, 1886), " A pheno- 
 menon extending over a short time, in matters 
 pathological, is not by any means the correlative of 
 a phenomenon which is permanent, lasting. There 
 is a much greater probability that such transient 
 phenomena are caused by reflex action, or reflex 
 stoppage {Heniinung) ; and this circumstance alone 
 forbids us to assume a definite connection between 
 any injured part in the system and an outward 
 symptom of disease." 
 
 As a leading type of diabetes alternans, CI. 
 Bernard (in " Le9ons de Physiologic," Paris, 1855) 
 points us to that form of diabetes which ensues 
 after attacks of gout or rheumatism. 
 
Classification of Diabetes Mellitus. ^^ 
 
 Since diabetes, as I am endeavouring to prove, is 
 caused by hereditary lues, and since this illness, 
 whenever it becomes active, presupposes a diseased 
 state of the protoplasm of the whole body, from 
 the anatomico-aetiological standpoint I feel bound 
 to protest, with Ebstein {Op. citat.^ p. i8o), against 
 the classification of diabetes into brain-diabetes, 
 Hver-diabetes, pancreatic-diabetes, and muscle-dia- 
 betes. To mention here only one thing : Hoffmann, 
 at the Medical Congress held in Wiesbaden (see 
 *' Verhandlungen," etc., of 1886), among 60 cases 
 which he had collected, found only 10 where he was 
 able to apply the symptomatology of the so-called 
 pancreatic-diabetes. 
 
 Again, the severest affections of the Hver very 
 often take their course without being attended In the 
 least either by glycosuria or diabetes. 
 
 Since the time when Th. Willis reported the case 
 of a woman who, In the morning only, secreted a 
 quantity of urine far In excess of the liquid which 
 she had imbibed, the profession spoke of an mter- 
 mittent diabetes. 
 
 Seegen says [Op. citat., p. 44) : "In a few indi- 
 vidual cases diabetes seems to have arisen as a 
 .consequence of intermittent fever. A definite con- 
 nection can be proved only in one case. In this case 
 there was an intermittent secretion of sup;ar, and 
 according to the observation of the physician In 
 charge, Dr. Lenzberg, who instituted a lengthy and 
 exact examination, sugar showed itself In a moderate 
 quantity only after a paroxysm of fever had been 
 
54 Diaheles. 
 
 passed through, or after it ought to have taken place 
 according to typical laws. The intimate connection 
 between the intermittent fever and the secretion of 
 sugar became more evident by the effect exercised by 
 sulphate of quinine, which had the power of com- 
 pletely stopping the periodically recurring secretion 
 of sugar. This secretion, however, made its appear- 
 ance again as soon as the remedy was discontinued. 
 In another case the patient stated that, after a 
 journey to Holland, he suffered for two years of a 
 periodically recurring intermittent fever. The 
 attacks, he says, always took place during two or 
 three consecutive nights, after which time they 
 stopped again. The patient dates the first symptoms 
 of diabetes from that time ; but only after a lapse 
 of years a serious form of diabetes developed itself. 
 In two cases, before the diabetes showed itself, the 
 patient had suffered of an obstinate attack of inter- 
 mittent fever in the South of Hungary. The follow- 
 ing case is most interesting : — A patient, 58 years 
 old, had suffered much of intermittent fever. The 
 fever stopped ,- but after some time he was troubled 
 by the most violent headache, and, indeed, at exactly 
 the same time when the fever usually had made 
 its appearance. A disproportionate state of weak- 
 ness remained after the attacks ; when the urine 
 was analyzed it was found to contain a considerable 
 quantity of sugar." 
 
 Bourdel (" De la glycosurie ephemere dans les 
 fievres palustres," in "Union Medicale," 1872) 
 frequently observed a secretion of sugar during the 
 
Classification of Diabetes Mellitus. ^^ 
 
 paroxysms of intermittent fever. He says that he 
 discovered sugar in 32 out of 40 cases of highly- 
 developed malarious cachexy. 
 
 Senator {Op. citat., p. 228) pointed out that 
 cases like the above occur mostly in connection 
 with malarious diseases, in which sugar is found 
 periodically in the urine, with or without any typical 
 attack of fever. He continues : " Those typical 
 secretions of sugar, however, which occur in con- 
 nection with intermittent fever, and which, Bourdel 
 says, he has observed, do not present the char- 
 acteristic features of diabetes mellitus, but they are 
 mere instances of transient glycosuria ; wherefore 
 they must not be put into the same category with 
 real diabetes." 
 
 Frerichs draws the following distinctions : — 
 
 I, Mild and severe forms. A form, according to 
 him, is mild or light if the secretion of sugar 
 depends upon the character of the food. He calls 
 it severe if the nature of the food exercises but little 
 influence, and if the urine preserves its saccharine 
 quality even if the patient lives on a pure meat- 
 diet. 
 
 H. Diabetes with polyuria — the most frequent 
 form ; and diabetes without polyuria {Diabetes 
 decipiens). 
 
 in. Diabetes as a consequence of brain-diseases : 
 
 (a) Organic diseases of the brain. 
 
 (b) Disturbances of a mental kind. 
 {c) Mental excitements. 
 
 {d) Injuries to the head. 
 
5 6 Diabetes. 
 
 (e) Reflex forms arising from a stimulation of 
 peripheral nerves (of the vagus nerve, 
 of the trigeminus nerve, and of the 
 sciatic nerve). 
 
 IV. Diabetes in consequence of infectious diseases 
 (cholera, diphtheria, small-pox, typhoid fever, scarlet 
 fever, measles), 
 
 V. Diabetes as the consequence of a chill. 
 
 VI. Diabetes as the consequence of a constitu- 
 tional illness (syphilis, gout, adiposis). 
 
 VII. Diabetes coupled with an affection of the 
 pancreas. 
 
 VIII. Diabetes coupled with a liver-disease. 
 
 IX. Diabetes of children and aged people. 
 
 X. Intermittent diabetes^ where the secretion of 
 sugar frequently ceases ; but where it shows itself 
 anew after a disregard of the rules of diet. 
 
 Bouchardat, Harley, Pavy, Tommasi, Rosenstein, 
 and others, like Frerichs and Seegen, distinguish 
 between mild and severe cases of diabetes. This 
 same classification was accepted by Traube, Bence 
 Jones, Dickinson, and others, but they limited it to 
 two stages of the same disease ; while Hertzka 
 more recently amplified this classification, and pre- 
 sented it thus : («) a severe form, capable of 
 improvement; (o) a severe form, which is abso- 
 lutely unfavourable ; {c) a mild form ; and (</) a 
 still milder form. 
 
 Vocke assumes '' stages " in the disease. The 
 first stage presents the following symptoms : — 
 Fatigue, losing flesh, polyuria, hunger, thirst, dry- 
 ness of the skin, itching of the skin, eruptions, boils, 
 
Classification of Diabetes Mellitus. 57 
 
 inflammation, gangrene, etc. In the second stage, 
 according to him, the patient really begins to look 
 ill and suffering. The symptoms of the first stage 
 become intensified, both as regards the disturbances 
 in the action of the nerves and the assimilation of 
 the food. The weakness increases ; the patient 
 begins to cough ; thirst and polyuria increase. The 
 second stage is quickly run through, and terminates 
 in coma. 
 
 More recently, not acetone and diacetic acid, but 
 oxy-butyric acid (C4 Hg O;^) which, under the effect 
 of polarized light, turns towards the left, has been 
 put down as the final product of the decomposition 
 of sugar, since it has been shown by experiments 
 made on animals that oxy-butyric acid diminishes 
 the alkaline reaction of the blood, and produces 
 coma and paralysis. Vocke calls those cases severe 
 a7id incurable in which all the sugar which has been 
 introduced into the system is found in the urine 
 within the space of an hour. 
 
 Bouchard (" Maladies par ralentissement de la 
 nutrition," Paris, 1855) defines every case of dia- 
 betes, irrespective of the reception of food, as severe 
 or serious where the patient, within 24 hours, 
 secretes more than 50 grammes of sugar ; and he ^^° 
 defines every case as mild ^h.ex& the patient secretes 
 less than 50 grammes of sugar during the 24 hours. 
 
 Ebstein distinguishes an alimentary form of dia- 
 betes, and a protoplasmatic form ; thus he discrimi- 
 nates between the mild, curable glycosuria and 
 genuine diabetes. That glycosuria which mianifests 
 itself sometimes in a healthy person, after he has 
 
5 8 Diabetes. 
 
 partaken of sugar, he calls physiological glycosuria ; 
 but the glycosuria which shows itself in diabetes 
 mellitus he designates as pathological glycosuria. 
 Between alimentary glycosuria and diabetes mellitus 
 he finds a sensible, graduated difference, but not a 
 difference in principle. Herein I have to oppose 
 Ebstein, and, indeed, on grounds belonging to the 
 aetiology and pathogeny of diabetes. 
 
 I recognize only one cause of diabetes, namely, 
 hereditary lues. 
 
 On this ground it is wrong to speak of a " mild," 
 or of a " milder" form of diabetes; for, according 
 to the present mode of treating the disease, the 
 victims of diabetes — whether more slowly or more 
 quickly, it does not matter — are irresistibly, and with- 
 out any hope of being saved, drawn towards the 
 gates of death. There are NO mild., only SERIOUS 
 cases of diabetes. 
 
 Whenever diabetes became active, even at the 
 slightest manifestation of that illness, my teacher 
 Frerichs always became serious, and I never heard 
 him, in ordinary conversation, describe a pronounced 
 form of active diabetes as being " mild." 
 
 There is no need, however, to alter the existing 
 terminology. It suffices to regard the many forms 
 of diabetes as the effects of hereditary lues. If the 
 profession still insists on introducing glycosuria as a 
 form of diabetes, it may be denominated a spurious, 
 " mild " diabetes ; but to diabetes itself, as charac- 
 terized by myself, in all its forms, there appHes only 
 the epithet severe and serious, and it ought to be 
 described as " real, active diabetes." 
 
VI. 
 
 THE yETIOLOGY OF DIABETES 
 MELLITUS. 
 
 Frerichs makes a statement to this effect, that 
 one-tenth of his patients inherited diabetes from 
 diabetic parents. About the remaining nine-tenths 
 he is silent ; but six-tenths, or more, out of these 
 nine-tenths, if I am correct in my computation, were 
 afflicted only with glycosuria. 
 
 In many cases he proved a hereditary transmis- 
 sion from distant, and yet at the same time directly 
 related, members of one family ; for instance, sup- 
 posing an uncle and a nephew to be afflicted by this 
 disease, he inferred from this that the grandfather 
 or grandmother, and eventually the great-grandfather 
 or great-grandmother, were the original sources of 
 diabetes. 
 
 This constitutes the basis, on the strength of 
 .which, after a lengthy examination extending over 
 twenty years, I was led to make the following impor- 
 tant discovery : — 
 
 Diabetes is a hereditary ^ constitutional disease ; 
 and the (Etiological element of this disease is lues 
 contracted liy some ancestor I 
 
 After I had discovered this truth in 1881, and in 
 
6o Diabetes. 
 
 accordance with it had originated a method of cure 
 which combined various curative agencies, and after 
 I had improved this method from year to year, I 
 have at last succeeded in curing radically the most 
 difficult cases of diabetes ; that is, I have suc- 
 ceeded in healing them in such a manner, that my 
 patients, after recovering from their illness, remained 
 thoroughly healthy, and were not compelled to 
 return and undergo a second treatment, except 
 under exceptional circumstances. 
 
 Seventy-one cases of real diabetes were treated 
 by me, partly in Carlsbad and partly in Nice, from 
 1 88 1 to the end of 1884. From among these there 
 were radically cured 
 
 53 PATIENTS, as follows : 
 
 36 men, aged from 21-64 years, 
 
 8 women, ,, ,, 19-32 years, 
 
 5 virgins, „ „ 17-23 years, 
 
 4 children, ,, ,, 9-13 years. 
 
 Ten among the remaining patients were dismissed 
 improved, and they might have recovered by under- 
 going a second treatment, and obeying the dietetic 
 rules which were prescribed ; while eight of them 
 died in the course of that time, on account of the 
 disease having progressed too far ; and thus on 
 account of some new complications having arisen. 
 
 I shall be prepared to report concerning the 
 patients who were .treated by myself during the 
 years 1885, 1886, and 1887, as soon as I shall be in 
 a condition to express a positive opinion as to the 
 
The JEtiology of Diabetes Mellitus, 6i 
 
 lasting character of their cure. Their number is as 
 follows : — 
 
 In the year 1885, 24 cases of real diabetes. 
 ,, ,, ,, 1886, 54 ,, ,, ,, ,, 
 
 )) )) )) ^^^7' 7 " " " " 
 
 Those theories which claim for diabetes a hepato- 
 genous or a myotic (muscular) origin fall to the 
 ground in the face of the fact that all real diabetes 
 is hereditary^ and is caused by a degeneracy of the 
 protoplasm. The same applies to most of what is 
 said, for instance by Frerichs, concerning " the more 
 immediate causes " of diabetes. The more " im- 
 mediate causes " which he enumerates apply only 
 to glycosuria ; and they produce diabetes only 
 where there is a hereditary predisposition for it. 
 
 The marasmus of old age is never a cause of 
 diabetes, as is supposed by Zimmer on the basis 
 of some English statistical tables ; although any 
 latent diabetes becomes developed regularly by the 
 marasmus of old age. 
 
 Frerichs is likewise in error where he supposes 
 that diabetes is caused by a reflex action of the 
 nervus trigeminus and the sciatic nerve. 
 
 At the Medical Congress which was held at 
 Wiesbaden stress was justly laid on the following 
 sentiment : — " If every case of trauma — of a severe 
 bodily injury — of intense fright, of heightened nervous- 
 ness ; and, again, if every sorrow, every misfortune 
 which befalls a family, were productive of diabetes, 
 fully one-half of humanity would be diabetic." 
 
'6i Diabetes. 
 
 Senator observes justly {Op. citat., p. 125) that 
 trauma is only a mediate cause of the disease, since 
 in consequence of it there is developed a more in- 
 tense change of structure, etc., within the province of 
 those nerve-centres which regulate the formation of 
 sugar. The source of these affections, he thinks, is 
 the medulla oblongata or its immediate neighbour- 
 hood ; or, again, if the real cause of the disease is 
 placed at a greater distance, he thinks the area of 
 the fourth ventricle, as may be plainly shown, has 
 some share in its production ; or, again, disturbances 
 in the assimilation of the food or in the circulation 
 may be caused from this area, etc. 
 
 Is not the following case reported by Frerichs {Op. 
 citat., p. 187) a case of glycosuria ? He says that 
 a speculator, after meeting with some severe losses 
 of money, became affected with diabetes, but that 
 after three weeks already he had lost every vestige 
 of sugar ! 
 
 Distinguished medical inquirers have already been 
 on the road leading to my discovery, only they did 
 not go far enough ; they were not prepared to draw 
 the necessary conclusions from their premises ; they 
 did not direct their inquiries to some definite point, 
 and afterwards test their theory by practice. Again, 
 they were one-sided ; they drew [conclusions from 
 diabetes concerning diabetes, from effect concern- 
 ing effect ; and they did not trace diabetes as an 
 effect to hereditary lues as its cause. 
 
 Rondelet already observed diabetes in a father 
 and his daughter ; Morton in a father and a son, and 
 
The Etiology of Diabetes Mellitus. 6^ 
 
 in four brothers and sisters, all of whom were carried 
 off by the disease. 
 
 Isenjiam stated a case where eight children of 
 healthy parents after reaching their eighth year died 
 of diabetes. 
 
 Marsh reports (" Dublin Quarterly Journal of 
 Medicine," 1854, xvii., 17) the case of a family 
 where diabetes was hereditarily transmitted through 
 four generations. 
 
 Langiewicz (Breslau) mentions a diabetic patient, 
 seven of whose nearest blood-relations were epileptic. 
 
 Griesinger treated a patient who had suffered of 
 epilepsy in childhood, and all of whose brothers and 
 sisters were epileptic. 
 
 Similar reports were made by Clai^ke, Eulenhurg^ 
 Westphal, Pavy, Ebstein, and Mullej'. 
 
 Among 140 cases Seegen noted eight cases where 
 both parents were diabetic, but ten cases where the 
 brothers and sisters of the patient were afflicted with 
 diabetes. In one case the father of the patient 
 suffered of diabetes insipidus. In four cases both 
 parents and several of the brothers and sisters had 
 died of diabetes. Seegen treated a young English- 
 man who in the course of time died of diabetes ; 
 his younger sister had died of the same disease, 
 and his father came to Carlsbad in the following 
 year, likewise afflicted with diabetes. In one case 
 Seegen witnessed two sisters dying of diabetes. 
 Unfortunately he did not inquire whether any of the 
 relatives or ancestors of his diabetic patients had 
 been luetic, although he arrived at a conclusion 
 
64 Diabetes. 
 
 which confirms our present position, namely, that a 
 hereditary disposition for diabetes 7?iiist be assumed, 
 even in such cases where either the father or the 
 mother su-fered of an affection of the brain. Seegen 
 treated a brother and sister who suffered of diabetes, 
 both of whom were of a highly nervous temperament, 
 and whose father and grandfather had suddenly died 
 of an apoplectic stroke. In two cases the mothers 
 of patients died insane. In one case the brother of 
 a patient was an idiot, and all her children suffered 
 from brain disease. In another case the father was 
 insane ; the patient himself suffered much from head- 
 ache, and he noticed an early loss of memory. In 
 one case a brother and a sister committed suicide in 
 a fit of melancholia. 
 
 A SUMMING UP. — In 140 cases Seegen proved 20 
 times the hereditary nature of diabetes, and thus in 
 one-seventh of the entire number. If we add to this 
 all those cases where there existed a hereditary cere- 
 bral affection, and if we take into consideration that 
 only in the most recent times the connection between 
 affections of the brain and diabetes has been recog- 
 nized ; further, that only most recently a distinction 
 has been drawn between real diabetes and the so- 
 called milder and more frequent form of this disease, 
 and that most probably many persons have hitherto 
 died of diabetes, the cause of whose death remained 
 unknown, the numbers given above acquire a much 
 greater statistical importance, and bear an imposing 
 testimony in favour of the theory advanced by 
 myself. 
 
The JEtiologi^ of Diabetes Mellitus. 65 
 
 Among 104 cases, from 1868- 18 74, R. Schmitz 
 proved in a most definite manner the hereditary 
 character of diabetes ; for in one case the grand- 
 father had been diabetic, in another case the grand- 
 father and the father, in six cases the father, in six 
 cases the mother, together with the brothers and 
 sisters, in eight cases the brothers and sisters. 
 In these cases, also, he witnessed the manifesta- 
 tion of diabetes in consequence of hurtful agencies 
 (nervous shocks). 
 
 Hertzka infers a connection between the diabetes 
 of a patient 40 years old and the anthrax of which 
 an uncle was suffering. In this connection he ex- 
 presses the same idea which already Blau had uttered 
 (who " was forced " to admit and teach the doctrine 
 of a "diabetic predisposition," see Schmidt's " Jahr- 
 biicher," etc., 1875, p. 205), namely, that it was 
 possible for a predisposition for diabetes to be 
 handed down by inheritance without this disposition 
 becoming active in the immediate progenitor. A 
 case communicated by himself was to prove the fact 
 that the disposition for diabetes is de facto hereditary. 
 In the case of a female patient 24 years old, sugar 
 had been discovered in the urine already in her 
 fifteenth year. Two of her brothers and sisters died 
 of diabetes, another brother perished of phthisis, 
 and the remaining brothers and sisters suffered of 
 catarrh of the lungs, and discharged blood while 
 coughing. 
 
 In quoting this testimony of Hertzka, I am quite 
 pleased to quote also the following question which he 
 
 F 
 
66 Diabetes. 
 
 propounded, and which speaks in favour of my doc- 
 trine : " In the face of such facts, are we not bound 
 to accept that the slumbering germ of the disease 
 was transmitted by inheritance, and are we not 
 compelled thus to assume a predisposition for the 
 disease in the progenitor?" My answer is: most 
 undoubtedly must we assume such a hereditary 
 predisposition. 
 
 Senatoj^ relates that four children of a Polish Jew 
 perished of diabetes in the Polyclinical Institute of 
 the University at Berlin. 
 
 According to the same authority {Op. citat., p. 
 260) a hereditary tendency has also repeatedly been 
 proved in the case of diabetes insipidus. 
 
 Lecorche accepts a hereditary predisposition in the 
 so-called cerebral diabetes. 
 
 Lacombe reports the case of a family where the 
 mother, one daughter, and three sons, as well as the 
 mother's brother and his children, fell a prey to 
 diabetes. 
 
 Other cases where two or more blood-relations 
 suffered from diabetes insipidus are communicated in 
 the "American Journal of Medicine" of 1858, p. 
 
 379- 
 
 Trousseau mentions .the case of a female patient, 
 
 aged 19 years, whose grandfather had suffered from 
 
 diabetes mellitus. 
 
 Charcot (" Maladies des Vieillards," Paris, 1874) 
 
 furnishes the information that persons who descend 
 
 from a gouty family are sometimes affected by 
 
 diabetes mellitus. 
 
The Etiology of Diabetes Mellitus. 67 
 
 Redon shows in 32 cases where children suffered 
 from diabetes that their parents were affected with 
 scrofula, gout, mental diseases, etc. The mother, 
 aunts, and other relatives of a girl 15 years old, who 
 died of diabetes, were all affected by diabetes. 
 
 Reith reports the case of a woman, 24 years old,' 
 whose father and brother suffered from the same 
 disease. 
 
 It was lately pointed out that diabetes occurs with 
 persons of a neuropathic and psychopathic disposi- 
 tion. 
 
 Zim^ner reports 85 cases, out of which nine 
 could be traced to a hereditary predisposition. He 
 also mentions several diseases which he regards as 
 causes of diabetes, but which, on the basis of my 
 inquiries and experience, are competent to produce 
 diabetes only where there is a hereditary predisposi- 
 tion for this disease. He relates the case of a 
 patient, 55 years old, whose father died of apoplexy, 
 while his mother perished from consumption. The 
 latent diabetes of this person became immediately 
 active through trauma — an injury (the fall from a 
 horse). 
 
 What a striking example for our proposition, 
 namely, for the presence of hereditary lues, which 
 is the cause of apoplexy, as well as of diabetes, and 
 which requires a mere outward contingency, in order 
 at once to become developed, and to be stirred into 
 activity ! 
 
 Senator writes {Op. citat., p. 121) : " In a by no 
 means inconsiderable number of cases of diabetes, 
 
68 Diabetes. 
 
 inheritance can be proved to have acted as a predis- 
 posing element. These cases consist partly of such 
 where several brothers and sisters, nay, where all 
 children of certain parents have suffered from this 
 disease ; partly of such where one of the parents, or 
 one of the grand-parents, was diabetic, and trans- 
 mitted this predisposition to his descendants. It 
 seems even that such cases are by no means very 
 rare ; nay, that they occur much more frequently 
 than the profession has been inclined to admit, 
 even to within a comparati'vely shoi^t time. For 
 lately, since more attention has been paid to this 
 matter, reports concerning the hereditary character 
 of diabetes are becoming more and more numerous.'* 
 
 Ebstein, who proves that only a fraction of fat 
 persons become diabetic, is of the opinion that there 
 must exist a particular predisposition for diabetes, 
 so that this disease may be developed in company 
 with adiposis. On p. i68 of his work he puts forth 
 the proposition which I had proved by facts at Wies- 
 baden in 1886, namely, that apart fro?n a definite, 
 morbific predisposition, which is connate, and which 
 very frequently is transmitted by inheritance, no 
 uric gout, and no diabetes mellitus, are developed. 
 Ebstein declares verbally, on p. 180, "All the facts, 
 before ms force us to the belief thdit the development 
 of diabetes requires a definite bodily tendency, an 
 individual predisposition, which in almost all cases 
 fnay be regarded as connate, and not rarely may be 
 considered as the result of inherit ance^ 
 
 This connate predisposition, first characterized 
 
The JEtiology of Diabetes Mellitus. 69 
 
 by myself as hereditary lues, is naturally common 
 to all the organs and all the tissues in which 
 the change of substance {Stoffewechsel) is con- 
 stantly going on. Ebstein thus corroborates my 
 discovery ; although by my discovery it is proved 
 that diabetes descends from hereditary lues, and 
 NOT from diabetes, as is supposed by all those who 
 suspect its hereditary character. 
 
 The above weighty proofs and expressions can 
 scarcely avoid creating some confidence in the truth 
 of my proposition that diabetes is derived by inheri- 
 tance from luetic ancestors ; but any doubts that may 
 still linger in the minds of the profession cannot help 
 being removed by the success which has attended 
 my method of treatment. The additional words of 
 Frerichs and Senator will now be appreciated in 
 their full force : " Cases of diabetes occur also among 
 the more DISTANT relations of persons afflicted with 
 this disease!^ 
 
VII. 
 
 DIAGNOSIS OF DIABETES MELLITUS. 
 
 Patients afflicted with diabetes usually consult 
 their medical adviser only when they are compelled 
 to do so by an increase in their desire to urinate ; 
 when there is a constant dryness in the mouth ; 
 when they experience a general feeling of lassitude 
 and weakness ; when their skin itches ; when they 
 are affected by furunculosis, and when carbuncles 
 are beginning to be formed ; when their sense of 
 vision is debilitated ; when there is a tearing sensa- 
 tion in their limbs, as though caused by rheumatism ; 
 when there are abnormal sensations in the muscles, 
 especially in those of the loins and of the lower 
 extremities ; and especially when there is a striking 
 decrease in weight. 
 
 The first attention of the physician must be 
 directed to the condition of the urine, which is most 
 important for the purposes of diagnosis, since the 
 two cardinal symptoms of diabetes are (i) glycosuria, 
 and (2) an increased decomposition of albuminates. 
 
 Urine of this kind usually has no settlement, and 
 in proportion to the increase of active diabetes it is 
 generally as clear as water ; or it is of a pale colour; 
 or again it exhibits a greenish yellow tint, or one 
 which has a greenish tinge. Ordinarily its reac- 
 
Diagnosis of Diabetes Mellitus. 71 
 
 tion is sour, and its odour is fruity, chloroform- 
 like, aromatic — reminding one of damp hay — and 
 sweetish ; which is due to the presence in it of 
 alcohol and acetone. 
 
 The specific gravity rises from roio to i'o6oj 
 yea, according to Bouchardat, even to i '074. 
 
 Albumen. — Albumen was discovered by Latham 
 and Erasmus Darwin in the urine of diabetic patients 
 at a time when a relaxation of the kidneys was still 
 supposed to be the cause of diabetes. Their results 
 were confirmed by a treatment of the urine with 
 nitric acid, as taught by Haller-Hammerstein ; but 
 of course only in those cases where there was albu- 
 minuria at the same time. 
 
 My experience has taught me that it is not at all 
 essential for the urine in diabetes to contain albumen. 
 In case there is any, it has to be removed, before 
 testing it for sugar. 
 
 The sugar in the urine is grape-sugar (dextrose, 
 glucose). Its presence can be proved by its power 
 of reduction, its property of fermenting, and by its 
 rotating the plane of polarization of a ray of light 
 to the right, which peculiarity justifies the name 
 *' dextrose," as well as that of its preceding stage, 
 ■which is called " dextrine." 
 
 The best known, and most approved methods for 
 establishing the presence of grape-sugar, are the 
 followinsf : — 
 
 I. (i) The test by tasting. — The ancient phy- 
 sicians were obliged to resort to the sense of taste. 
 
 In order to escape this disgusting test, they after- 
 
■72 Diabetes. 
 
 wards tried whether the urine left any spots on white 
 linen ; or whether on cloth there was left a floury 
 dust of the kind which is noticed in vessels where 
 water is evaporated, or as appears sometimes on 
 cabbage or rose-leaves, or on plums, etc. 
 
 A simple method for proving the presence of 
 sugar is by evaporating the urine. If the residue 
 is soluble in water or alcohol the urine contains 
 sugar. 
 
 (2) Moore' s sugar-test by caustic potash. — Pour 
 some urine into a test-tube ; add some liquid caustic 
 potash ; heat the mixture (while constantly shaking 
 it) to the boiling point. The heated portion of the 
 liquid turns brown if there is any sugar present. 
 The darker the colour the greater the quantity of 
 sugar contained in the urine. 
 
 (3) Trommer s sugar-test by a solution of sulphate 
 of copper. — This test is more sensitive than the pre- 
 ceding one. Urine, free from albumen, is made 
 alkaline in a test tube by the addition of one-fourth 
 of its volume of liquid caustic potash or caustic soda. 
 Add in drops a concentrated (1:5) solution of sul- 
 phate of copper. One drop more may be added 
 than is dissolved. On shaking the mixture a frac- 
 tion of the sulphate of copper is turned into a clear, 
 blue liquid, if there is any sugar in the urine. The 
 upper part of the liquid is now heated, almost to the 
 boiling point. A reddish-yellow or brownish-red 
 zone is noticed then even before the boiling point ; 
 this zone soon permeates the whole urine and yields 
 a precipitate of cuprous oxide. N.B. — Before pro- 
 
Diagnosis of Diabetes Mellitus. 73 
 
 ceeding with this, and all other tests, dark urine is 
 made colourless by filtering it through pulverized 
 animal charcoal, or by adding one-ninth part of 
 acetate of lead. The animal charcoal requires to be 
 purified first of all reducing substances by treating 
 it with muriatic acid, and afterwards washing it with 
 water. 
 
 (4) Bouchers test by basic nitrate of suboxide of 
 bismuth. — Saturate the urine with soda ; add a small 
 quantity of the basic nitrate of suboxide of bismuth, 
 and then boil the whole. If any sugar is present the 
 liquid itself, or its precipitate, will turn black. 
 
 (5) The sugar-test of Nielander or Alnien. — Mix 
 two grammes of basic nitrate of bismuth with four 
 grammes of Rochelle salts and 100 grammes of a 
 solution of eight per cent, of caustic soda ; add ten 
 times as much urine, and boil the whole. The mix- 
 ture turns black if sugar is present. 
 
 (6) Seegen^ s sugar-test. — He filters the urine twice 
 or three times through animal charcoal until it is per- 
 fectly colourless. He then washes the coal on the 
 filter with some distilled water. This water he em- 
 ploys for the tests of Trommer or Fehling. Through 
 it, as well as through any equally weak solution of 
 sugar in water, there is produced a beautiful deposit 
 of cuprous oxide along the inner surface of the test- 
 tube. If the urine contains 0*05 per cent, of sugar, 
 the reaction caused by the water used for washing 
 the charcoal is always very characteristic. The 
 second and third waters employed in the washing 
 process cause an equally energetic reaction. 
 
74 Diabetes. 
 
 (7) The sugar-test of Fehling. — The method of 
 Fehling, the so-called method of "titration," is de- 
 scribed in every text-book of chemistry. It consists 
 in an alkaline solution of Rochelle salts, with a cer- 
 tain quantity of sulphate of copper. The solution of 
 Rochelle salts is made in one vessel, that of the sul- 
 phate of copper in another. Pour three-parts of the 
 first solution into one part of the second ; by shaking 
 the mixture you obtain the so-called solution of 
 Fehling. One part of this solution is now heated 
 to the boihng point with one part of the urine. 
 Before the boiling point is reached, a reddish-yellow 
 zone of cuprous oxide is produced ; if only a very 
 small quantity of sugar is contained in the urine, a 
 reddish-yellow precipitate is thrown down after a 
 while. 
 
 (8) The sugar -test of Worm-Muller. — Worm- 
 Miiller, in Christiania, perfected the method of 
 FehHng. In order to determine small quantities of 
 sugar, he titrates the urine with the liquid of 
 Knapp, before and after its being treated with yeast. 
 He takes 2*5 per cent, of a solution of sulphate of 
 copper, and a solution of Rochelle salts — ten parts 
 of double tartrate of sodium and potassium in 100 
 parts of a solution of four per cent, of caustic soda 
 (four parts of liquid caustic soda in 100 parts of 
 water). He now fills the first test-tube with five 
 ccm. of urine ; the second tube with 2'5 ccm. of an 
 alkaline solution of Rochelle salts, and 1*5 ccm. of 
 a solution of sulphate of copper ; whereupon he 
 heats both tubes to the boihng point. Both tubes 
 
Diagnosis of Diabetes Me/litus. 75 
 
 are now allowed to cool down to 70 or 60° C, He 
 then slowly pours the reacting liquid into the urine ; 
 and if much sugar is contained in it, it immediately 
 assumes the colour of cuprous oxide. But if the 
 percentage of sugar is small (under o'l) the colour 
 develops only very gradually, generally in five to ten 
 minutes. 
 
 Sugar, to the amount of 0*25 per cent., can be 
 traced by this test. The precipitate in this latter 
 case does not exhibit a reddish-yellow, but a dirty 
 yellowish-green colour. 
 
 If there is no precipitate, the test is repeated with 
 from 2^ to 4 ccm. of a strengthened solution of sul- 
 phate of copper. 
 
 Worm-Miiller (in Pfluger's " Archiv," etc.. Vol. 
 xxxvi.) proves that healthy persons, after par- 
 taking of large quantities of cane or milk-sugar, 
 secrete through the urine a fraction of this same 
 sugar; but they never pass grape-sugar. He also 
 discovered that healthy persons, different from 
 diabetic persons, after partaking of starch, do not 
 pass any grape-sugar by the urine. In order, there- 
 fore, to prove definitely the existence of diabetes, he 
 gets all who wish their urine to be examined to eat 
 ■food containing starch before their examination. 
 
 (9) The sugar-test of J. Rosenhach. — After satis- 
 fying yourself of the reducing effect of a certain 
 quantity of urine upon a definite quantity of Fehling's 
 solution (add one ccm. of urine to one ccm. of Feh- 
 ling's solution, when an incomplete reduction- below 
 o*5 per cent, still proves the existence of sugar), boil 
 
76 Diabetes. 
 
 a small quantity of urine after adding to it one or 
 two drops of tartaric acid, which prevents the pre- 
 cipitation of phosphates. The boiled urine, after it 
 has cooled off, is distributed into two test-tubes ; in 
 one of the tubes the urine is mixed with a little 
 pressed yeast, after which it is placed near a warm 
 stove. If after a few hours the same quantity of 
 liquid is taken out of each of the tubes, to have it 
 tested by an equal quantity of Fehhng's solution, it 
 will be found that one of the liquids, as before, exerts 
 a positive effect, and thus has a reducing power ; 
 while the second liquid, according to the degree in 
 which the sugar had been decomposed, exerts a 
 negative effect, or, at all events, manifests a much 
 feebler, reducing power. By comparing the two 
 test-tubes, it is easy to discover the difference. An 
 unprofessional examiner even can discover by this 
 method whether a diminution in the reduction of 
 Fehling's solution caused by the urine is due to the 
 presence of sugar or not. The test is not vitiated 
 by the presence of albumen. 
 
 (10) Dr. Ed. Stilts' s reagent capsules.- — The 
 test for sugar and albumen has lately been much 
 facilitated by the introduction of easily portable 
 reagent capsules. With the aid of these gelatinous 
 capsules, which contain the requisite quantity of the 
 most approved reagents, every practitioner can make 
 his tests for sugar or albumen on the spot with the 
 most satisfactory results. Concerning the use of 
 these capsules, which are exported by the firm of 
 " Martln Wallach's Successors," in Cassel, 
 
Diagnosis of Diabetes Mellitus. 'j'j 
 
 Germany^ we read In the circular issued to the pro- 
 fession by Dr. Ed. StUtz, apothecary in Jena, as 
 follows : — 
 
 "I. Reagent-capsules for Albumen. — The idea of 
 providing practitioners with an easily portable re- 
 agent for albumen in the form of gelatine capsules, 
 filled with a mixture which, even at the ordinary 
 temperature, should produce a reaction, we owe to 
 Professor Fiirbringer. The discovery of a suitable 
 reagent was left to the undersigned, who at the 
 same time undertook to carry out the invention in 
 a practical shape. Particulars may be found in 
 Prof. Fiirbringer's essay in the ' Deutsche medicin. 
 Wochenschrift,' No. 27, 1885. 
 
 " The reagent consists of a mixture of chloride of 
 mercury and sodium, with citric acid. The preci- 
 pitate obtained from urine containing albumen is 
 albuminate of mercury. 
 
 " Directions for use. — A capsule, both ends 
 of which are cut off close, is dropped into a test- 
 tube about half-full of urine (any other small vessel 
 of clear glass will answer). More than half a table- 
 spoonful of urine should never be taken. Close the 
 mouth of the tube with the thumb, shake the con- 
 tents thoroughly, then tilt the tube so that the 
 glutinous envelope can sink down to the mouth, 
 where it adheres ; then let the liquid run slowly back 
 into the lower part of the test-tube. When the 
 bubbles caused by the reaction have disappeared an 
 opinion can be formed as to the result. According 
 to Fiirbringer only a pronounced cloudings occurring 
 
yS Diabetes. 
 
 a few minutes after, can be held as proving the pres- 
 ence of albumen. Opalescent traces, even if coming 
 from a slight quantity of albumen, are not worth the 
 practitioner's consideration. 
 
 " Concentrated urines, containing much uric acid, 
 should be diluted with an equal quantity of water 
 before testing. Urate sediment should be warmed, 
 the urine being somewhat diluted with water for this 
 purpose. Entirely fresh alkaline urines, even if 
 clouded by phosphates, require no preparation. 
 
 "II. Reagent-capsules for Sugar. — It was the 
 endeavour of the undersigned to apply Fiirbringer's- 
 idea Ukewise to the sugar-test, and in this connec- 
 tion to extend the test to its quantitative determina- 
 tion. This endeavour was so far successful that he 
 was enabled to prepare the approved reagents (solu- 
 tions of bismuth and copper) in a form which insures 
 their preservation in gelatine envelopes, the com- 
 position of which by repeated trials has been found 
 best for the purpose intended. 
 
 " The copper reagent-capsules are especially 
 designed for cases where the patient is bed-ridden ; 
 the white bismuth capsules for consultations and 
 observation. 
 
 " For determining the quantity of sugar the follow- 
 ing articles are required : Specially prepared cap- 
 sules, filled with an exactly-weighed portion of the 
 salt of copper ; Ukewise a dropping-tube provided 
 with a hollow rubber globe, which, upon light pressure, 
 when held vertically, permits a drop weighing five 
 centigr. to escape ; and also a graduated measuring- 
 
Diagnosis of Diabetes Mellitus. 79 
 
 tube for diluting urines containing much sugar with 
 several volumes of water, since without such a dilu- 
 tion no accurate result can be obtained in such cases. 
 The dropping-glass and measuring-tube should be 
 rinsed before being used with the liquid which is to 
 be tested or diluted. 
 
 " Directions for use. — (^) The white bismuth 
 capsules. — Empty a capsule, as directed for the 
 albumen test, into a test-tube containing about two 
 teaspoonfuls of urine. After removing the envelope 
 with a knife-point heat the liquid over a low flame, 
 letting it boil several minutes. Where a blacken- 
 ing of the liquid or of the precipitate (by the pro- 
 toxide of bismuth) does not occur sugar is not 
 present. 
 
 "Urine containing albumen cannot be tested for 
 sugar with thebismuth reagent. 
 
 " (3) The blue copper reagent-capsules. — Proceed 
 as above, only that the contents of the capsule must 
 be dissolved in 20 — 30 drops of water, not in urine. 
 Heat this solution nearly to the boiling point (if 
 more convenient over the chimney of a kerosene 
 lamp, or by plunging the test-tube into hot water) ; 
 then let five or six small drops of urine fall rapidly 
 into the test-tube, held obliquely so that the urine 
 runs down its inner side. The presence of sugar is 
 indicated if within a minute (during which time a 
 fusion of the strata is to be avoided) there appears 
 between the strata, even with the light shining upon 
 it, a distinct zone of a yellowish red colour, resulting 
 from the formation of cuprous oxide. 
 
8o Diabetes. 
 
 " {c) The quantitative siigai^ reagent. — After shak- 
 ing up well and opening the cover of a capsule pour 
 its contents into a test-tube ; add about 3 cc. of 
 water, heat the liquid to the boiling point, at which 
 point it is to be kept while the urine is added, drop 
 by drop, so long as the blue colour of the reagent 
 remains, which can be observed by holding the test- 
 tube against the light. It must be borne in mind 
 that the precipitation of the cuprous o^fide becomes 
 easier the nearer the point of total precipitation 
 approaches. Therefore, as soon as the particles of 
 the cuprous oxide betray any inclination to sink, the 
 heating process may be suspended until the liquid, 
 which is in the process of clearing, has been examined 
 for a remaining bluish tinge. 
 
 20 drops of o"5°/o urine reduce contents of one capsule. 
 5 )) J) 2 /o ,, ,, ,, )) )) j> 
 
 I drop ,,io% ,, reduces ,, ,, ,, 
 
 " In general terms the percentage of sugar is cal- 
 culated by dividing the number of drops employed 
 by 10. 
 
 " The quantitative reagents are accompanied by a 
 portable glass for the waistcoat pocket ; the qiialita- 
 tive sugar reagents are furnished besides with a 
 sample of pure grape-sugar." 
 
 In another circular Dr. Stiitz gives the follow- 
 ing caution in respect to the qualitative sugar- 
 reagents : — 
 
Diagnosis of Diabetes Mellitus. 8i 
 
 " Darkly coloured, concentrated urines, when 
 treated with bismuth, sometimes yield a reaction, 
 even if there is no sugar contained in them. The 
 precipitate in such a case is of a grey colour. No 
 notice should be taken of such a greyish sediment, 
 for even should it be partly due to a trace of sugar 
 the practitioner will be quite justified in disregarding 
 it, because by other means also it will be impossible 
 for him to prove the presence of such small quan- 
 tities of sugar. If the urine contains o*i per cent. 
 of sugar the precipitate is coloured black ; a larger 
 per cent, of sugar causes at the same time a dark- 
 brown or even a black colour in the liquid overhead. 
 Should this test produce a black colour, and should 
 the copper-test also furnish a corroborating result, 
 the presence of sugar is absolutely certain." 
 
 If a difficulty should be experienced in emptying 
 any of the gelatine-capsules Dr. Stiitz suggests the 
 following expedient : — 
 
 " Rinse a suitable test-tube either with water or 
 urine, and insert the capsule, which has been cut at 
 both ends, into the neck of the tube. After a short 
 time it will adhere there so firmly that after intro- 
 ducing the requisite quantity of urine, by gently 
 rolling the liquid against the capsule, it will empty 
 its contents without any difficulty, and without the 
 gelatinous case getting into the liquid. The case is 
 afterwards removed with a knife." 
 
 \\. The quantitative determination of sugar by 
 the test of fermentation : — 
 
 (a) The long arm of a so-called fermenting tube 
 
 G 
 
82 Diabetes. 
 
 is filled with urine and with a piece of pressed yeast 
 of the size of a pea, which has been well washed. 
 The tube is filled so that no air remains in it. For 
 24 — 48 hours the tube is left in a place, the tempera- 
 ture of which is from 70° to 90° Fahrenheit. Gas is 
 now developed, which gas, if any sugar has been 
 present, is carbonic acid. The open arm is now 
 filled with liquid caustic potash, whereupon the 
 opening is closed and the liquid shaken. If the gas 
 disappears the urine contains sugar, which, through 
 the process of fermentation, has been decomposed 
 into carbonic acid and water. 
 
 This test yields a reliable result, and is not very 
 complicated. 
 
 {b.) The following method is a little different. 
 Filter half a litre (a little less than half a pint) of 
 urine ; determine its specific gravity ; mix with it one 
 per cent, of well-washed brewer's yeast which has 
 been dried in the air ; cover it lightly, and expose it 
 for one or two days to the heat of a stove (from 
 70° — 90° Fahrenheit). Determine again the specific 
 gravity of the urine at the first temperature. Multiply 
 now the difference in number with 219, and divide 
 the product by 1,000, in which case the difference of 
 o'ooi corresponds to a percentage of sugar amount- 
 ing to o'2ig per cent. The yeast which has been 
 precipitated, the transparency of the urine, the dis- 
 appearance of foam, and, again, the fact that the fer- 
 mented urine, when subjected to the copper test, is 
 unable to reduce the sulphate of copper, all this 
 shows that the fermentation has been accomplished. 
 
 f 
 
Diagnosis of Diabetes Mellitus. 83 
 
 In order to test the purity of the yeast repeat the 
 experiment with normal urine or with water. 
 
 III. The test of polarization. — The examination of 
 the urine by means of the polarizing apparatus of 
 Soleil-Ventzke, or by that of Mitscherlich, or, 
 again, by that of Wild, can be executed easily and 
 quickly ; for, if any grape-sugar is present in the 
 urine, the plane of the polarized beam of light is 
 rotated to the right, while fruit-sugar (laevulose), as 
 is well known, rotates it to the left. According to the 
 greater or less amount of rotation caused by the 
 greater or less amount of sugar, the lines of gradua- 
 tion in the apparatus indicate a greater or less per- 
 centage of sugar. The optic test, it is true, does 
 not always tally with the chemical analysis. 
 
 A popular description of the apparatus of polari- 
 zation, inteUigible to all, is furnished by Bernstein. 
 
 Additional methods for determining sugar have 
 been recommended by others, e.g.^ by Pavy, Knapp, 
 Vogel. The latter gentleman draws his inferences 
 as to the percentage of sugar from the lighter or 
 darker colour of the test by caustic potash. Canary- 
 yellow, according to him, corresponds to 2 per cent. 
 of sugar, the colour of dark Jamaica rum to 5 per 
 ■cent., a dark blackish brown colour to 10 per cent., 
 etc. 
 
 The amount of sugar. — The quantity of sugar in 
 the urine, according to the food, mental excitement, 
 movement of the body, etc., differs from one-half to 
 8 per cent. ; according to Segalas and Lehmahn it 
 reaches even 14 per cent., and a still higher per- 
 
.f- 
 
 84 Diabetes. 
 
 centage. Such a high quantity I have never 
 observed myself, and I have to take it for granted, 
 provided there is no cause for doubting the accuracy 
 of the observation. 
 
 The daily amount of sugar by weight may reach 
 500 grammes and beyond, although the average 
 weight is from 200 — 300 grammes. The highest 
 quantity of sugar secreted, as observed by Seegen, 
 amounted to 600 grammes per day. 
 
 In addition to the secretion of sugar, another 
 element of importance in the diagnosis of diabetes 
 is the increased secretion of urine. It increases daily 
 from two to five, yea, to 14 litres (= from i^ to 4|, 
 yea, to i2a pints). Still, there are cases of diabetes 
 in which no considerable increase in the secretion of 
 the urine is noticed. 
 
 Urea, also, owing to the excessive consumption of 
 meat, increases in volume from 100 to 200 per cent., 
 so that 80, and even more, grammes have been 
 formed ^^r day. Gathgens discovered urea and uric 
 acid in still greater quantities during the febricose 
 state of patients. Fiirbringer reports 160 grammes, 
 and Dickinson 142 grammes. 
 
 Phosphates and sulphates increase at the same 
 rate. Other substances also were found to increase 
 in like manner. 
 
 In some cases, for instance, Seegen discovered 
 phosphoric acid to the amount of 6'6 grammes per 
 day. Senator found creatinine, Frerichs inosite. 
 Others demonstrated the presence of salts of 
 ammonia, of diacetic acid, of leucine, acetone, etc. 
 Winogradoff, Stopczanski, and Gathgens, on the 
 
Diagnosis of Diabetes Mellitus. 85 
 
 other hand, noticed a diminution in the secretion of 
 creatine. 
 
 Sediments are mostly found only in the beginning 
 of the active state of diabetes, namely, uric acid and 
 oxalate of lime. The urine of polyuria, which is a 
 later stage of the disease, as said above, is clear. 
 Nevertheless, it becomes turbid when left standing 
 for a considerable time, and the yeast-cells which are 
 then formed yield whitish precipitates. 
 
 A characteristic symptom of diabetic patients, in 
 addition to the polyuria which gradually interferes 
 materially with the process of assimilation, is a 
 catarrhal nephritis, coupled with a copious secretion 
 of albumen. 
 
 The diagnosis of diabetes is more difficult, when 
 its char act eiHstic symptom^ namely^ polyuria^ is 
 wanting ; when, therefore, as the profession calls 
 it, there is a case of diabetes decipiens. 
 
 An interesting property of diabetes, for the pur- 
 poses of diagnosis, is presented by the fact that a 
 latent diabetes very often, by certain contingencies, 
 is instantaneously made active ; for instance, by a 
 kick, a blow, a fall ; further, by mental excitements ; 
 by cares, over-exertion, a reflex action of the nervus 
 vagus or nervus trigeminus in dental or ophthalmic 
 operations ; again, by a reflex action of the sciatic 
 nerve ; by infectious diseases, such as Asiatic 
 cholera, diphtheria, typhoid fever, small-pox, scarlet 
 fever ; by chills, or constitutional diseases, such as 
 syphiHs, gout, adiposis, disease of the pancreas, 
 liver, etc. 
 
 There is no doubt whatever, that in all those 
 
86 Diabetes. 
 
 cases where diabetes becomes manifest under the 
 influence of any of the above contingent causes, the 
 disease has previously been latent in the system. 
 
 Diabetes, consequently, does not arise from 
 marasmus, furunculosis, etc. ; but, on the contrary, 
 diabetes, on account of the faulty assimilation of 
 the food, causes marasmus, furunculosis, diseases of 
 the eyes, ears, and lungs, nephritis, etc. 
 
 Another circumstance that has to be borne in 
 mind in the diagnosis is this, that in active diabetes 
 the character of the food is of comparatively small 
 Import. While, therefore, in accidental glycosuria, 
 by abstaining from certain kinds of food, the per- 
 centage of sugar is diminished, or ceases altogether, 
 in diabetes the urine contains siLgar^ even if the 
 patient lives on meat exclusively. 
 
 A further symptom by which diabetes may be 
 diagnosed, is an abnormal feeling of thirst and 
 hunger. V. Pettenkofer and v. Voit explain the ex- 
 cessive thirst of diabetic patients by the fact that 
 they secrete less carbonic acid and less water than 
 healthy persons. This thirst may be explained thus, 
 that healthy persons burn up more sugar, i.e.^ alter it 
 into carbonic acid and water, which are excreted 
 through the skin and the lungs ; while the diabetic 
 patients pass all their surplus of sugar into the 
 urine. 
 
 Other symptoms that often strike the diagnosing 
 physician in a person suffering from diabetes, are an 
 abnormal greediness, a dryness of the throat and 
 larynx, as has long ago been observed by the 
 
Diagnosis of Diabetes Mellitus. 87 
 
 laryngologist Dr. Ch. Fauvel ; further, an emacia- 
 tion of his whole body, and a diminution in his 
 power of resistance. 
 
 I have noticed several exceptions to this rule in 
 cases where active diabetes nevertheless did exist. 
 
 The pulse of diabetic patients is usually sluggish ; 
 their stool indolent ; although diarrhoea, on the other 
 hand, has also been observed. 
 
 An important symptom is the scanty secretion of 
 saliva. The reaction of the tough saliva is sour ; 
 which may be explained by the growth of a certain 
 fungus {Soorpilz) first mentioned by Friedreich. It 
 grows in the cavity of the mouth, and frequently 
 causes a disease in the gums, by which they redden ; 
 at last the teeth become loosened, and drop out 
 without pain. 
 
 The tongue is often normal, yet frequently also it 
 is thickened, chapped, furrowed, and reddened. The 
 papillae are swollen, sometimes to the size of a pin- 
 head, and even larger, which was pointed out already 
 by Seegen, with whom I agree on the main. He 
 says, "On closer examination it will • be found that 
 the tongue of persons suffering from diabetes is rarely 
 quite normal, and repeatedly I have been induced, 
 by changes that I noticed in the tongue, to examine 
 the urine of patients, which was then found to con- 
 tain sugar. The changes I noticed are as follows : 
 (a) the tongue, almost always, is increased in thick- 
 ness ; it is wider and more bulky. The edges of 
 the tongue exhibit a fine, symmetrical indentation, 
 and appear swollen, (b) After the changes have 
 
88 Diabetes. 
 
 proceeded further, the upper surface of the tongue 
 exhibits a pecuHar design, somewhat similar to the 
 skin of a crocodile. This design originates from a 
 network of fine, superficial fissures, which intertwine 
 in a manifold manner, (c) These fissures some- 
 times penetrate more deeply into the tongue ; some- 
 times they do so to the depth of \"' , and they cross 
 the tongue in all directions. A deep fissure some- 
 times passes through the middle of the tongue, while 
 smaller fissures extend sidewards and transversely. 
 These fissures, however, are by no means bloody, 
 nor are they ulcerated ; but they are sensitive on 
 coming into contact with sour and sharp articles of 
 food. As an illustration of the looks of such a 
 fissured tongue, and also as an illustration of its 
 origin, I may point to a lump of clay which, when it 
 begins to dry up, contracts and is full of cracks, 
 (d) Individual papillae and groups of papillae are 
 very much enlarged ; they protrude in the form of 
 islands, like red spots. I observed some papillae, of 
 the size of moderate pin-heads. In one case the 
 papillae along the edge of the tongue were very 
 much enlarged ; the whole edge was unequal ; it 
 consisted of excrescences and inlets, and the indi- 
 vidual enlarged papillae had the appearance of con- 
 dylomes on top of them, (e) While the normal 
 tongue always makes an impression on the eye as 
 well as on the touching finger, as though it were not 
 always symmetrical ; and again while it rather looks 
 and feels like artists' pencils closely pressed against 
 one another (papillae filiformes), on the tongue of a 
 
Diagnosis of Diabetes Mellitus. 89 
 
 person suffering from diabetes entire portions of this 
 pencil-like structure seem to be wanting. These 
 portions are smooth, shining, bluish-red ; and while 
 the normal tongue is often more or less covered, the 
 above portions are entirely free of any deposit. These 
 spots, which sometimes occupy only a small por- 
 tion, of the size of i ccm., often increase in size, 
 and fill the entire half of the tongue. Such places 
 often have a peculiar smell, like raw meat. In these 
 portions, again, you meet with dense, white, dimly 
 shining places. The histiological significance of 
 these alterations is not yet clear to me. At first it 
 seems as if these portions were deprived of epithe- 
 lium ; yet the above white places seem rather to 
 indicate a luxuriance of epithelium. In some cases, 
 also, there are ulcers of the size of lentils or peas, 
 which are very painful. 
 
 "The changes described under the head of (e) 
 remind one of those syphilitic affections of the 
 tongue which are described under the name of 
 psoriasis linguae and keratosis. Yet in the first 
 place they are not entirelv analogous to them ; 
 and, secondly, I have repeatedly seen them in per- 
 sons where a syphilitic origin could be definitely 
 denied." [?] 
 
 Again, it ought to be mentioned here that the 
 breath of diabetic patients has an aromatic odour, 
 like their urine ; it smells like apples which have 
 been sliced, or like rotten apples, and like damp 
 hay ; or again like fruit in process of fermentation. 
 The cause of this phenomenon seems to be a dimi- 
 
go Diabetes, 
 
 nution in the reception of oxygen, and a decrease in 
 the giving out of carbonic acid. 
 
 The skin of such persons is frequently rough and 
 brittle ; it scales off like bran ; it has folds, and is 
 mostly dry. Usually it feels cool, and exhibits a low 
 degree of warmth ; although patients with good 
 lungs, who have been debilitated very much, some- 
 times are able to give out a considerable quantity of 
 perspiration, which, according to some (Forster, 
 Vogel, Fiirbringer, Griesinger, Hebra), likewise 
 contains sugar; others {e.g., Frerichs, Kiilz in Op. 
 ct'tat., p. 68) found the perspiration free from sugar. 
 
 According to Reich and Liebermeister the skin 
 and lungs of diabetic patients exhale about one- 
 third of the amount of water evaporated by healthy 
 persons. The activity of the skin I sometimes 
 found reduced to zero. 
 
 Since I regard diabetes as predestined in a certain 
 sense, that is, as transmitted by lues from ances- 
 tors, in contradistinction from the physicians of the 
 new as well as of the old school, in my diagnosis, I 
 direct my chief attention to the suppressed activity 
 of the skin. 
 
 Every patient whom I suspect of diabetes I ask 
 to undress, and I first of all endeavour to examine 
 his skin — an element of diagnosis on which hereto- 
 fore no physician has laid much stress. 
 
 Marks of hereditary lues, and therefore of im- 
 portance to me, are the so-called beauty-spots, 
 warts, deposits of pigment, rank growths of epithe- 
 Hum, white spots on the finger-nails, gouty deposits 
 
Diagnosis of Diabetes Mellitus. 91 
 
 in the joints of the fingers and toes, especially in 
 those of the big toe ; further, barky epithelial growths 
 in the feet, etc. 
 
 An unsafe symptom, and yet one which ought 
 still to be taken into consideration, is a vivid itching 
 of the skin. Another suspicious symptom is the 
 formation of fungi, caused by the sugar in the urine, 
 whereby an inflammation is produced in the male 
 genitals ; and with women an insufferable itching 
 (pruritus pudendi) in their genital organs (the large 
 labia of the pudendum), which itching may be over- 
 come by cleanliness. One single drop of sacchari- 
 ferous urine which has dried up at the orifice of the 
 urethra may cause there an itching and burning 
 sensation, with inflammation. In consequence of this 
 there arises sometimes with men balanitis (gonorrhea 
 of the gland), phimosis, paraphimosis, psoriasis in 
 the upper parts of the thigh, on either side of the 
 testicles ; and with women a wearisome eczema 
 (eczeme glycosurique) or prurigo of the labia, etc. 
 (See Winckel's article in the " Zeitschrift fiir 
 praktische Medizin," 1876). 
 
 Often boils and carbuncles seem to form them- 
 selves by preference on the labia of the pudendum ; 
 again, phlegmonous inflammations, gangrene, dis- 
 eases of the lungs. 
 
 A local cure in such cases by well-known remedies 
 is impossible ; for so long as the fundamental cause 
 is not removed, a mere palliative treatment can effect 
 nothing. 
 
 Fits of ill-humour, loss of memory, convulsive 
 
92 Diabetes. 
 
 movements in the muscles, sciatica (according to 
 Berger, in " Breslauer arztliche Zeitschrift," 1883), 
 neuralgias (which Drasche, in " Wien med. Zeit- 
 schrift," 1882, regards as the consequences of a 
 toxical effect of sugar on the peripheral nerves), 
 may eventually raise a suspicion of the existence of 
 diabetes. 
 
 In advanced cases of this disease the power of 
 vision decreases, even as to lead to the formation of 
 cataract, and to the production of other ophthalmic 
 troubles. It also gives rise to mental diseases, 
 sclerosis of the vessels, carcinomas in the pancreas, 
 rectum, breasts, and liver, oedemas of the feet, face, 
 etc. Sexual languor, also, heightened into impo- 
 tence, sometimes serves to indicate the presence of 
 the disease. With women there occur disturbances 
 in the menses. 
 
 So long as there are no inflammatory complica- 
 tions, there is no fever. On the contrary, the tem- 
 perature of the body, as mentioned above, frequently 
 is below the normal warmth, namely, between 34° and 
 36'5°, which observation was already made by Vogel 
 and Dickinson. The pulse at the same time is 
 mostly big and hard, since the arteries are over- 
 filled. 
 
 It is an interestmg feature that in proportion to 
 the progress of the disease, hydrates of carbon, 
 W'ithout being utilized, i.e., without being decom- 
 posed into carbonic acid and hydrogen, appear 
 remarkably soon in the urine in the form of sugar ; 
 and that the albuminates, even in an exclusively 
 
Diagnosis of Diabetes Mellitus. 93 
 
 animal diet, are not able to re-establish the equi- 
 librium in the organism, so that the patient loses in 
 weight. 
 
 The fundamental cause of the illness sometimes 
 also causes at first a general rheumatism of the 
 joints and muscles, etc. 
 
 In children diabetes frequently manifests itself — 
 a thing often overlooked — by a wetting of the bed. 
 Sucking babes that lose flesh ought to have their 
 urine examined. 
 
 A valuable help in the diagnosis is furnished by 
 the fact that the deteriorated organism of a diabetic 
 patient gradually loses the power of reproduction 
 and assimilation, so that, for instance, wounds 
 which ordinarily close in a very short time require a 
 proportionably long time to heal ; they incline 
 towards suppuration, form chronic ulcers, etc. 
 
VIII. 
 
 TPIE PROGRESSION, PROGNOSIS, COM- 
 PLICATIONS, AND TERMINATION OF 
 DIABETES. 
 
 After diabetes has entered upon its active stage, it 
 mostly runs its course without fever, and assumes 
 either an acute or a chronic character. 
 
 Until within the most recent times diabetes has 
 been declared incurable. Seegen {Op. citat., p. 
 125) says that among nearly 400 cases of diabetes 
 in his own practice he has never witnessed a case of 
 perfect cure. He grants, however, that by absti- 
 nence from amylaceous food it is possible for 
 diabetic persons to preserve themselves for years in 
 a state of health, and that the body acquires a 
 tolerance for a certain quantity of sugar, and gradu- 
 ally accommodates itself to the sugar. Senator {Op. 
 citat., pp. 137, 231) speaks of a cure extending over 
 several years as being only a conditional, imperfect 
 cure. The same term he applies to the transition of 
 diabetes mellitus [?] into diabetes insipidus, when 
 followed by a cure. Compare, also, the case which 
 was observed by Plagge (see Virchow's *'Archiv," 
 etc., xiii., p. 93). Vocke, therefore, exclaims {Op. 
 citat.^ p. 84), ''''Real diabetes is equivalent to 
 deathr 
 
'^rhe Progression of Diabetes. 95 
 
 The prognosis, namely, how long it is possible 
 to preserve life after diabetes has become active, 
 depends : {a) upon the tolerance of the system for 
 amylaceous food ; {IS) upon the consistency of the 
 patient in following the dietetic prescriptions ; {c) 
 upon the physical or moral disposition of the 
 patient, since a patient of a cheerful temperament 
 will progress more favourably than a hypochondriac ; 
 {d) upon the age, etc. 
 
 The duration of active diabetes differs very much 
 in the various stages of life. 
 
 In children it mostly leads precipitously to death. 
 In my own practice, up to the year 1881, I often saw 
 diabetes acutus and acutissimus cause death in 
 children, already in the short space of from four to 
 eight weeks. Becquerel even communicates the case 
 of a boy nine years old, who died six days after he 
 had been seized with diabetes. 
 
 Adult persons who, by a rational life, that is, by 
 an appropriate physical and bodily diet, as well as 
 by the use of the Carlsbad waters in Carlsbad 
 itself, know how to regulate the consumption of 
 glycogen and to prevent an over-production of 
 sugar, often enjoy a tolerable degree of health for 
 years after the active form of diabetes has mani- 
 fested itself. Nevertheless, according to my own 
 plentiful experience, they are not able to prolong 
 their sad existence much beyond six years, although 
 in a few individual cases such patients have been 
 kept alive for upwards of seven or eight years. 
 Cases of longer duration I have always considered 
 
g6 Diabetes. 
 
 as examples of simple glycosuria, which I was 
 competent to heal even by the old-fashioned method 
 of treatment before 1881. 
 
 Not unfrequently I have come across communica- 
 tions from even distinguished inquirers, such as 
 Bence Jones, Lebert, Dickinson, by whom we are 
 informed that in mild cases of diabetes the course 
 of the disease has been observed for upwards of 
 20 years. Doubts arise in my mind whether such 
 communications are really not due to a mistake on 
 the part of the inquirers, who have confounded 
 accidental glycosuria with constitutional diabetes. 
 In the course of my large practice, which has ex- 
 tended over many years, I have not become 
 acquainted with a single case of genuine diabetes 
 the duration of which was longer than eight years, 
 although I am acquainted with cases of accidental 
 glycosuria (especially among well-to-do, corpulent 
 persons who lead a rational life) which have lasted 
 for 20 years. 
 
 Sometimes the disease seems to be at a stand- 
 still. The abnormal thirst, the greediness for food, 
 and the increased secretion of urine stop. The loss 
 of flesh and the feeling of lassitude disappear. The 
 physician who allows himself to be deceived calls 
 it a cure, when all at once the enemy reappears, 
 more threatening than ever, and this time he will not 
 allow himself to be driven away again. 
 
 Unless one of the usual complications, such as 
 pulmonary consumption (owing to a defective 
 assimilation of the food), or carbuncle, gangrene, 
 
The Progression of Diabetes. 97 
 
 etc., cause death, it mostly ensues unsuspectedly, 
 instantaneously, without any outward cause ; or, 
 again, it results in consequence of over-exertion, 
 mental excitement, catarrh of the stomach. It 
 occurs then with apoplexy, attended with attacks of 
 paralysis, loss of consciousness, and, indeed, it is 
 caused by a peculiar complex of nervous disturbances 
 and brain symptoms, which are comprised under the 
 general term of " coma diabeticum," the terror of all 
 medical practitioners. 
 
 The cause of death in diabetes is often marasmus, 
 exhaustion of the nervous centres, exhaustion of the 
 heart, which brings about paralysis of the heart; and 
 this on the other hand presupposes a wasting away, 
 and a degeneracy of the muscle of the heart. Coma 
 also ensues in the so-called diabetes insipidus, if the 
 patient does not pass away before by some inter- 
 current disease, or an affection of the brain or spinal 
 marrow. 
 
 Prout, who proved the injurious effect of fatiguing 
 marches on the nerve-life, was the first who made 
 mention of the complex of symptoms in coma 
 diabeticum. Notable physicians, such as Griesinger, 
 Dusch, Hilton-Fagge, Taylor, but especially Kuss- 
 maul, have noted and described similar observations. 
 Frerichs also devotes a considerable portion of his 
 monograph on diabetes to a proof of the fact that 
 most cases of this illness terminate in coma, in 
 sudden death, which is certainly a discouraging sign 
 for practical therapeutists. 
 
 But of what use to the practical physician would 
 
 H 
 
98 Diabetes. 
 
 be this great number of instances showing in what 
 manner death overtakes those who are afflicted with 
 diabetes, if the discovery and the prevention of the 
 cause of this mysterious termination of human hfe 
 were to be regarded as impossible? 
 
 That portion of his material which Frerichs 
 gathered from experience for the purposes of theory 
 and instruction, and which has a bearing upon the 
 subject before us, he divides into three groups. 
 Group I. embraces those persons suffering from 
 diabetes who all at once, perhaps after having made 
 an exertion, are seized with a general weakness, and 
 who pass away in a few^ hours with cold extremities, 
 a small, sinking pulse, loss of consciousness, and 
 somnolence in consequence of paralysis of the heart. 
 Group II. comprises those cases which run their 
 course in from one to five days, and with whom the 
 preliminary stage may be diagnosed thus : General 
 weakness, gastric disturbances, sickness, vomiting, 
 sluggish stools, pharyngitis, phlegmons of limited 
 extent with inclination towards gangrene, bronchitis, 
 pains in the head, chest, and abdomen, a feeling of 
 anxiety, dyspnoea, accelerated breath with or without 
 cyanosis, a weak pulse, a sinking of the temperature, 
 until somnolence and coma intervene. Group III. 
 includes those cases where diabetic patients, without 
 dyspnoea and with no feeling of anxiety, with a 
 moderate tension of the radial arteries, and with 
 their bodily strength in a comparatively good 
 condition, are seized with headache, a feeling of 
 
The Progression of Diabetes. 99 
 
 intoxication, and somnolence, out of which they 
 never awake. Frerichs explains the '' coma diabeti- 
 cum " by an alteration in the nervous centres, 
 brought about by a change in, and a thickening of, 
 the blood owing to an increase in the percentage of 
 sugar ; further, by uraemia, embolisms of fat, 
 acetonaemia, as well as by a disturbance in the 
 secretions. Fetters, Kaulich, Cantani, and others 
 suggest a chloroform-like effect of, and poisoning 
 by, acetone. Griesinger assumes an accelerated 
 formation of lactic acid ; Ebstein supposes uraemia ; 
 Loeb a gradual paralysis of the vagus nerve ; Taylor, 
 Starr and Hamilton suggest embolisms of fat, 
 intoxication by carbonic acid, etc. 
 
 I am of the opinion that in most cases nephritis 
 is caused by the exciting, stimulating substances 
 contained in the blood of diabetic patients ; that in 
 consequence of the inflammation of the kidneys there 
 is a diminution in the excretion of the excrementitious 
 matters of the blood through the urine ; and that in 
 conjunction with the suppression of the activity of the 
 skin, there is produced at last through this cause 
 that blood-poisoning, that uraemia, and, indeed, that 
 self-intoxication which results in the coma diabeti- 
 cum, which manifests itself by a kind of delirium, 
 intoxication, and giddiness. Such is my opinion, 
 although Senator iOp. citat.^ p. 171) thinks that the 
 symptoms of coma do not correspond to an intoxica- 
 tion by uraemia. Again, although he seems rather 
 inclined, in conjunction with Fetters (who, however, 
 
lOO Diabetes. 
 
 was opposed by Frerichs), to regard the presence in 
 the blood of acetone as the cause of those pecuHar 
 symptoms, the experiments made by Prof. Dr. 
 Brieger in Berlin are certainly contradictory to this 
 assumption. Stadelmann (see " Archiv fiir exper. 
 Path. u. Pharm.," xvii., p. 443) suspects an intoxica- 
 tion by an acid, probably by crotonic acid. 
 
 Anyone who adopts my theory of self-poisoning 
 will regard with suspicion all attempts at com- 
 batting the " coma diabeticum." What possible 
 and impossible things have not been recommended 
 and done in order to overcome this coma! One 
 medical practitioner thought the existing dyspnoea 
 ought to be relieved ; another that the action of the 
 heart ought to be stimulated by appropriate 
 remedies ; still another that the secretion of the 
 urine ought to be increased ; while a fourth main- 
 tained that the excrementitious matters that have 
 accumulated in the blood ought to be diminished. 
 It is a great pity that none of these gentlemen have 
 been able to point out the remedy by which the 
 desired result is to be attained. 
 
 Some of them, and among them the great clinical 
 authority, Kussmaul, proposed a physiological solu- 
 tion of common salt, a transfusion of blood, an 
 intravenous injection of a solution of bicarbonate of 
 sodium, saline and stimulant aperients ; again, they 
 advised a return to a mixed diet, lavements, rubbings 
 of the body with lukewarm water, in order to prevent 
 a recurrence of the attack. But have their sugges- 
 
The Progression of Diabetes. loi 
 
 tions and proposals been crowned with success in 
 practice ? 
 
 There is only one means by which coma can be 
 prevented ; and this one means is combatting its 
 efficient cause, namely, hereditary lues. 
 
 Here I wish to point out that already Seegen in 
 his work on Diabetes (p. 65) suspected a hereditary 
 diabetic tendency in cases where either the father or 
 mother have suffered from affections of the brain ; 
 and, further, that Senator, like Seegen before him, 
 assumed a connection of diabetes with diseases of 
 the central nervous system, especially with epilepsy 
 and mental diseases. 
 
 I am able, at this day, to furnish an incontestable 
 proof of this connection ; nay, I am able to declare 
 that there exists a primal consanguinity among all 
 these diseases. 
 
 At all eyents therapeutics are aided but little by 
 inquiries into the character of the anatomical sub- 
 stratum of this disease, the changes caused in the 
 nerves, etc. But the declarations of Formad, 
 Veraguth, Schottelius (see Virchow's ''Archiv," 
 etc., 1882), with regard to the state of the body 
 favourable for the development of diabetes are 
 simply surprising ; for the first regards the disposi- 
 tion of the lymphatic vessels, the second that of the 
 alveolar epithelia, and the last the configuration of 
 the bronchia, as that anatomical element which pre- 
 disposes for diabetes. 
 
 Finally, I wish to extend Cornillaus' idea-^who 
 
102 Diabetes. 
 
 teaches the connection of diabetes with gout mid 
 rheumatistn — so far as to define all these diseases 
 as branches of one and the same root ; and I here- 
 with declare that in all those cases where it has been 
 possible for a morbid condition of the structure of 
 the protoplasm to be reformed and regenerated, such 
 a condition has most assuredly been healed by 
 myself, and will be healed by myself again in the 
 future. 
 
IX. 
 
 THE SO-CALLED CURES OF DIABETES 
 THAT HAVE HITHERTO BEEN MADE 
 ARE ILLUSIONS. 
 
 Between i86i and 1881 I have met in my practice 
 with many (over 200) cases of so-called " neuro- 
 genous diabetes " (glycosuria), and of diabetes of 
 corpulent persons, which cases, according to my 
 present system of classification, are to be classed 
 simply under the head of accidental glycosuria. 
 Such cases also I have frequently encountered after- 
 wards ; and I have cured them. Other practitioners 
 have effected similar cures, without, on that score, 
 being able to declare that they have actually healed 
 genuine diabetes. 
 
 Numberless cases of accidental glycosuria may be 
 stopped almost without the aid of drugs, simply by 
 a combination of an appropriate mental and bodily 
 diet, which shall be explained below. The cure will 
 be speedier if the warm, alkaline waters of Carlsbad, 
 etc., are applied. 
 
 Claude Bernard says (in " Le9ons sur le Diabete," 
 1877, p. 70) : " While diabetes was formerly con- 
 sidered a rare, but always deadly, disease, it is now, 
 in most cases, considered less serious and capable 
 of being healed." 
 
I04 Diabetes. 
 
 But Zimmer justly complains that with all that has 
 been done by Bernard, the therapeutics of diabetes 
 have not been advanced by him in the least, and 
 that the profession is still where it was when RoUo 
 determined upon his empirical treatment of the 
 disease, namely, upon a diet of meat and fat. In 
 making the above declaration Bernard had evidently 
 in his mind only accidental glycosuria. 
 
 Frerichs enumerates some few cases where 
 diabetes has been healed. Such cases, according 
 to his declaration, are cases of diabetes after 
 neuralgia, after paralysis, after apoplexy, after 
 mental excitements, after cholera, after gout, etc. 
 
 It is hard for me to contradict my former teacher ; 
 nevertheless, in accordance with the facts of my 
 experience, I am compelled to believe that he also 
 mistook accidental glycosuria for diabetes. Let us 
 examine his so-called cures : — 
 
 He maintains that in eight weeks Lady v. B., who 
 was 58 years old, after using the Carlsbad waters 
 and by being placed afterwards under the influence 
 of kreosote, was cured of an attack of diabetes 
 brought on by an ophthalmic operation. [Acci- 
 dental glycosuria !] 
 
 Castellan Hanel, 60 years old, who, in conse- 
 quence of an extensive carbuncle in the nech, 
 became diabetic, is said to have been radically cured 
 by the Carlsbad w^aters in eight weeks. [Accidental 
 glycosuria !] 
 
 The corpulent Mr. J. W., 70 years old, is said to 
 have been relieved of all his troubles at Carlsbad, 
 
Illusory Cures of Diabetes. ' 105 
 
 and to have been thoroughly healed of diabetes. 
 [Accidental glycosuria !] 
 
 The apoplectic landed proprietor, Barth, whom / 
 am inclined to i^egard as truly diabetic, was freed 
 from sugar after three years, but he died of an 
 effusion of blood in the brain [arterio-sclerosis. Can 
 this be called a cure ?] 
 
 The Cabinet-minister v. G. was cured after three 
 years ; but he died of an effusion of the blood in the 
 brain [arterio-sclerosis. Was that a cure ?] 
 
 A diabetic professor lost his sugar, but he DIED 
 after a few months of marasmus, by a quickly grow- 
 ing cancerous swelling. [Was that a cure ?] 
 
 Diabetes after cholera was healed. [Accidental 
 glycosuria !] 
 
 Patient No. 8, who suffered from diabetes after 
 mental excitement, did not exhibit any more sugar, 
 but he remained ill of catarrh in the stomach. 
 
 Case No. 9 retained catarrh of the bladder. 
 
 Bookseller Sch. (case No. 10) did not die of 
 coma ; but, after attempts had been made for 20 
 years to cure him, he died of inflammation of the 
 lungs I [Does this prove a cure ?] 
 
 In case No. 1 1 the sugar disappeared after two 
 years, but " cataract was fully developed.''^ 
 
 Lady v. St., from P., who was plethoric and corpu- 
 lent, was healed; but she DIED of nephritis and 
 dropsy, which are regular consequences of diabetes, 
 and which prove the existence of active diabetes. 
 
 In summing up the cases quoted by Frerichs, he 
 has not, in my opinion, cured a single case of true 
 
I o6 Diabetes. 
 
 diabetes. Feeling the insufficiency of his own 
 method of cure, he exclaims, '* Alas ! the termina- 
 tion of diabetes by a cure is very rare indeed ! " 
 
 In the course of his monograph Frerichs states 
 that sometimes diabetes mellitus gives way to 
 another disease, of which the patients die, e.g., 
 nephritis, arterio-sclerosis, diabetes insipidus, etc. 
 But he forgets altogether that these so-called 
 " succedaneous diseases " lie in the very current 
 of diabetes mellitus, and that in the end it matters 
 little what direction the enemy takes, since his 
 victim, without any hope of escape, remains in his 
 clutches for all that. Thus, for instance, a lady, 56 
 years old, dies of marasmus, although, according to 
 his account, diabetes mellitus had already been suc- 
 ceeded by diabetes insipidus. Another patient he 
 dismissed as cured, whose diabetes, I suspect, was 
 simply accidental glycosuria. 
 
 I am inclined to apply to Frerichs and to others 
 who declare that they have cured true diabetes 
 the following language of Senator which he used 
 in respect to Morton: "Morton's statements that 
 he healed completely his three patients makes it 
 doubtful whether they really suffered of diabetes 
 mellitus." 
 
 This opinion of Senator is significant as express- 
 ing his view in respect to the general curability of 
 diabetes, which is also doubted by Seegen, who says 
 {Op. citat., p. 124), " Of the 140 cases of diabetes 
 which I had occasion to observe I have not seen a 
 single case which was completely healed." 
 
Illusory Cures of Diabetes. 107 
 
 Frerichs was often in doubt whether he had before 
 him a case of real diabetes or merely a case of 
 accidental glycosuria. It is possible that where he 
 claims to have effected a cure of diabetes he had in 
 his mind only what I would call glycosuria. The 
 following circumstance seems to prove this, for he 
 closes his monograph with an enumeration of those 
 cases where diabetes resulted in death, and where 
 he uses the words of Senator {Op. citat., p. 230) : — 
 '* The usual t elimination is death ; death by pul- 
 monary consumption (34 times); by marasmus (18 
 times) ; by pneumonia (seven times) ; by nephritis 
 (eight times) ; by paralysis of the brain (twice) ; by 
 effusion of blood (once) ; by softening of the brain 
 (twice) ; by meningitis cerebro-spinalis (three times) ; 
 by formation of carbuncles (seven times) ; by coma 
 (seven times) ; by other complications (nine times ; 
 among which were six cases of carcinoma). 
 
 What a shocking confession of those authorities 
 who have written on diabetes ! 
 
 Let us rejoice that we are able nowadays to pro- 
 claim : Diabetes mellitus is curable ! 
 
X. 
 
 THE OCCURRENCE OF DIABETES ; MOR- 
 TALITY AND THE RESULTS OF POST- 
 MORTEM EXAMINATIONS. 
 
 The possibility was suggested that the occurrence 
 of diabetes in certain places and localities [e.g., in 
 Ceylon) was due to the influences of the climate. 
 There would be a meanine: in such a suofsfestion if 
 it were possible to trace the history of the disease 
 and to observe its development; and if those places 
 could be determined where luetic or venereal 
 diseases, the consequences of which are manifest- 
 ing themselves in the present generation, were once 
 prevalent. 
 
 From i86i-i87ono less than 6,494 persons died 
 in England and Wales of diabetes. It is interesting 
 to note that 1,194 of these cases were reported of 
 persons from 55 to 65 years old, and only 830 cases 
 of persons from 65 to 75 years of age. 
 
 Among 104 diabetic patients Schmitz reports 38 
 cases of persons whose age ranges between 50 and 
 60 years. 
 
 Among 165 diabetic patients Griesinger found 
 that the age of the majority, namely, 91, was 
 between 20 and 40 years. Only two persons among 
 the 165 were seventy years old ; while Schmitz 
 counted four among his 104 cases. 
 
Statistics and Post-mortem Examinations. 109 
 
 Seegen, among whose 140 diabetic patients there 
 were 100 men and 40 women, compiled the following 
 table: — From ist-ioth year=o ; from iith-2oth 
 year=5 ; from 2ist-3oth year=40 ; from 3ist-40th 
 year=2i ; from 4ist-5oth year==33 ; from 5ist-6oth 
 year=43 ; from 6ist-7oth year=i4 ; from 7ist-8oth 
 year=i. 
 
 My own experience and my own notes confirm 
 these communications, and I might multiply them 
 if it were of consequence. According to my notes 
 also active diabetes occurs most frequently in 
 persons between the 35th and 55th year of their 
 life. 
 
 It would be interesting to know what circum- 
 stances conspired in keeping the diabetes of some 
 of the above patients latent until they had reached 
 such a high old age? — provided their medical advisers 
 did not mistake transitory, accidental glycosuria for 
 diabetes — why, therefore, the sugar in their case 
 was used up without being conveyed into the urine ? 
 Or, better still : Why the production of carbonic 
 acid proved sufficient to check the formation of 
 sugar in their case, and to make it normal ? 
 
 If Senator {Op. citat., p. 122) is of the opinion 
 that diabetes frequently begins in early years, and 
 continues into high old age ; in my opinion acci- 
 dental glycosuria only can be meant by him. 
 
 In order to find out the causes of diabetes, 
 Frerichs also subjected no less than 400 cases to 
 a careful examination. In his list there were five 
 diabetic patients between the ist and the loth year ; 
 
no Diabetes. 
 
 29 between the iith and 20th year; and thus in 
 succession in every additional space of ten years, 
 42, 71, loi, 105, 42 and 5 persons; so that 
 according to Frerichs' observations the highest per- 
 centage occurs between the 40th and 60th years of 
 human hfe. Two-thirds of his patients were male, 
 and one-third female patients. 
 
 Among Frerichs' 400 diabetic patients, 102 
 belonged to the Semitic race. Seegen found 36 
 Israelites among 140 diabetic persons ; thus 25 per 
 cent., just like Frerichs. Zimmer noticed 22 per 
 cent, of Israelites ; and Hertzka 50 per cent. — that 
 is, among 86 diabetic patients there were 40 Jews. 
 He believed that this was due to the Jews frequently 
 marrying elderly wives. 
 
 My opinion is, that on the one hand, Jewish 
 patients prefer to be treated by physicians of their 
 own religious persuasion, many of whom practice 
 medicine in the convenient Carlsbad. But another 
 reason why relatively more Jews than Christians 
 (according to Seegen the former constitute 10 per 
 cent, of all the frequenters of Carlsbad) prefer the 
 costly experiment of regaining their health at Carls- 
 bad to a treatment at home or at a hospital, must 
 be sought for in the fact that the Jews are generally 
 better provided with pecuniary means. Moreover, 
 the Jews are usually more anxious about their health, 
 and this anxiety with them has frequently become 
 intensified. The same is the case with ladies, only, 
 from a sense of economy or from attachment to 
 their families, they often prefer to await death at 
 
Statistics and Post-mortem Examinations. 1 1 1 
 
 home rather than to suffer from nostalgia in a distant 
 watering place. 
 
 In order to furnish an anatomical foundation of 
 the disease, some physicians have carefully noted 
 the condition which the bodies of persons who died of 
 diabetes exhibited in post-mortem examinations. 
 
 Seegen carefully examined the records of the post- 
 mortem examinations at the general hospital {Allge- 
 meine Krankenhaus) in Vienna from 1838 to 1870. 
 He found 30 reports of the anatomical condition of 
 such bodies. Not a single case could he find where 
 a change had been undergone by any organ. 
 
 Richardson, on the contrary, mentions a tumour 
 of the size of a bean in the brain of a diabetic 
 patient, caused by brain disease. Seegen also 
 mentions such a tumour of the size of a nut. Some 
 dissectors found an alteration in the pancreas {e.g., 
 Recklinghausen, Fles, Hartsen). Others, again, in 
 several cases, found the kidneys morbidly altered ; 
 also in most cases the lungs. Diseases of the 
 stomach and bowels also have been mentioned ; 
 these diseases were probably the result of a change 
 in the assimilation of the food. 
 
 Frerichs shows in five cases that the local affec- 
 tions of the nervous system have " mostly " been 
 confined to the medulla oblongata, the pons Varolii, 
 and the cerebellum ; and that they " rarely " extended 
 into the hemispheres. In syphilitic affections of the 
 coatings and vessels of the brain the case is the same. 
 Six times he found new growths ; as was shown also 
 by Rosenthal, ReckHnghausen, Hosier, Perotow, 
 
112 Diabetes. 
 
 Lionville, Reimer, Weichselbaum, Dombling, and 
 others. 
 
 The spinal marrow he found altered in one case 
 only. The smaller vessels of the medulla oblongata 
 were much enlarged. 
 
 In half of the cases he found the lungs and the air 
 passages diseased [tuberculosis] ; inflammation of 
 the lungs in these cases had frequently caused death. 
 
 The heart appeared to him mostly small and 
 affected by atrophy ; not unfrequently he found a 
 development of chronic arteritis. 
 
 The stomach sometimes was unaffected, and 
 sometimes it was enlarged. The liver and spleen 
 were mostly normal, only now and then they were 
 abnormal as regards size. 
 
 Twenty-eight times the pancreas was normal ; 1 2 
 times it was abnormally affected by atrophy. The 
 kidneys often appeared normal ; in some special 
 cases he found them small and pale, or large and 
 abounding with blood. Still Frerichs considered 
 himself obliged to assume a glycogenous degene- 
 racy of the small canals of the kidneys, whereby 
 they lost their power of resistance as a constant, 
 anatomical product. [A succedaneous stage of 
 diabetes ?] 
 
 Frerichs enumerates 58 cases of post-mortem 
 examinations which I have studied carefully. Of 
 what great therapeutical value are they ? Alas ! 
 he has been as little able by these cases to demon- 
 strate the organic changes and causes of diabetes as 
 their anatomical foundation. 
 
Statistics and Post-mortem Examinations. 113 
 
 The declaration that a tumour of the size of a 
 hazel-nut in the hinder convolution of the right 
 temporal lobe ; and, again, that a tumour of the 
 size of a pea in the cerebellum actually serve as an 
 anatomical foundation to diabetes, ought to be 
 opposed most strenuously ; for wherever there is no 
 hereditary lues, such tumours will always run their 
 course apart from diabetes, yea, even without any 
 accidental glycosuria. In spite of the most scrupu- 
 lously exact post-mortem examinations of the bodies 
 of persons who died of diabetes, surprisingly few 
 bodies were found in which the changes in the brain, 
 so far as their anatomical localities are concerned, 
 were of such a kind that I would dare to derive from 
 them the cause of diabetes. In by far the greater 
 number of the bodies of persons who died of diabetes, 
 where changes in the brain have been proved, these 
 changes, without doubt, have to be looked upon 
 rather as consequences of diabetes than as the causes 
 of the disease. 
 
 Serious objections also may be raised against 
 other theories raised on the ground of post-mortem 
 examinations. Thus the severest kind of diseases 
 of the lungs have been observed, in which the 
 reception of oxygen was greatly disturbed (dys- 
 pnoea), and yet not even the slightest secretion of 
 sugar in the urine was noticed. 
 
 The derivation of diabetes from diseases of the 
 stomach and liver can be refuted in like manner ; for 
 in the most serious affections of the stomach and 
 liver the urine is often free from sugar. On the 
 
1 1 4 Diabetes. 
 
 other hand, again, in severe cases of diabetes the 
 stomach, as well as the liver, have been found 
 perfectly normal. 
 
 After communicating the sum of his 58 post- 
 7nortem examinations, Frerichs confesses that he 
 is not able to give an account of the processes that 
 take place in the protoplasm of the liver-cells. His 
 learned disciple, G. Salomon, knows as little concern- 
 ing these processes, as other mortals have found out 
 since his time. Ebstein only is on the right track. 
 
 Thus far it has not been possible to prove in a single 
 case that diabetes depends upon any alteration in any 
 particular organ. How many physicians since the 
 time of Celsus have looked for the cause of diabetes 
 among the consequences of this malady ! How 
 many have looked for organical causes, for a visible 
 anatomical substratum, for gross anatomical changes 
 without discovering anything whatever except purely 
 accidental complications or secondary affections, 
 like phthisis, which were consequences of diabetes. 
 Some interest in the subject and patience are 
 required in order to wade through the heaps of barren 
 and prolix dissertations and papers on the subject of 
 diabetes ; and to consider and digest all the unripe, 
 ripe, and over-ripe lucubrations of practical and un- 
 practical physicians, medical candidates, and theoriz- 
 ing medical lecturers on this same subject. Most 
 authors have battled against the devastating waves 
 of this disease at the mouth of the river, and not at 
 the distant fountain-head. 
 
XL 
 
 TREATMENT OF DIABETES (THERAPEU- 
 TICS). 
 
 The steps in advance that have successively been 
 made in the art of heahng have ever exhibited the 
 same kind of progression which we also notice in 
 the advancing course of human nature, as well as in 
 the world of outward phenomena around us. 
 
 The secret of a rational method of healing is the 
 maintenance of the change of substance {Stoff- 
 mechsel) in agreement with nature. The object of 
 this method is, to direct into normal channels the 
 disturbed transformation necessarily undergone by 
 the bodily fluids, and to correct the wrongly consti- 
 tuted protoplasm which has become incompetent to 
 perform its functions, so as to prevent diseases, or 
 to remove them. 
 
 A rational practitioner, therefore, will direct his 
 attention first of all to the entire system of the organs 
 engaged in carrying out the change of substance, 
 namely, {a) to those organs which are receptive of 
 substance, i.e., which prepare the blood, namely, the 
 digestive organs and those which minister to respira- 
 tion ; {b) to those which distribute the substance, 
 namely, the heart and the vessels which are put in 
 charge of the circulation ; {c) to those organs which 
 
1 1 6 Diabetes. 
 
 excrete substance and purge the blood, which organs 
 include the lungs (also mentioned under a), further, 
 the liver, the spleen, the secretive organs of the 
 urinary apparatus, the bowels, and the outer skin. 
 
 The material operated upon by the change of sub- 
 stance {Stoffwechsel) has to pass through sundry 
 processes of transformation before it is rendered fit 
 to serve in the building up, and in the maintenance 
 of, the bodily organism. Through the action of the 
 saHva upon the food which is masticated in the 
 mouth it is first prepared for reception in the 
 stomach. 
 
 The soluble ingredients {e.g., the sugar) are dis- 
 solved, and the insoluble starch is changed into 
 dextrine and grape-sugar. Through the chemically 
 dissolving action of the secretions of the stomach 
 (stomachic mucus and gastric juice, which juice 
 consists chiefly of free muriatic acid and a ferment 
 called pepsine) the food is rendered fit to be pro- 
 perly digested, and the continued transformation of 
 starch into sugar which was commenced by the 
 saliva is accomplished. 
 
 Before the chyme (the pulp of food) passes from 
 the stomach into the intestinal canal it has to pass 
 through the supervision of the pylorus, which, in a 
 normal condition, does not suffer any undigested 
 food to leave the stomach. A new digestion ensues 
 in the intestinal canal. The chyme is there exposed 
 to the action of the intestinal juice, which consists 
 of the bile that enters into the duodenum, and also 
 of the pancreatic juice. The acid reaction of the 
 
Therapeutics of Diabetes. 1 1 7 
 
 chyme is changed thereby into an alkahne one. 
 The starch which has hitherto remained unchanged 
 is altered by the pancreatic juice into sugar, etc., 
 and the undissolved albuminates are altered into 
 peptones. The latter substances, the formation of 
 which was started already in the stomach through the 
 action of pepsine, are easily diffused through animal 
 membranes. 
 
 Additional transformations take place through the 
 action of the intestinal juice, e.g., the transformation 
 of cane-sugar into grape-sugar. The fermentation of 
 butyric acid and of alcohol likewise takes place there. 
 
 The so-called chyle is extracted from the chyme 
 and transferred into the blood by the absorbing 
 lymphatics and by the glands and intestinal villi, 
 which consist of least ducts (about four millions of 
 them). 
 
 All depends upon this chyle and upon the forma- 
 tion of the blood, the quality of which is determined 
 by that of the chyle ; for the blood has to furnish 
 the material for the maintenance of the change of 
 substance and for the building up of the organism, 
 wherefore this chyle may be styled the dissolved, 
 liquid, organism of the human body. 
 
 The excretion of useless material is carried on by 
 various organs. The lungs excrete in great abun- 
 dance altered sugar, namely, carbonic acid and 
 water, while renovating at the same time the venous 
 blood by conveying oxygen to it, and also by impart- 
 ing to it the faculty of assimilation and the possibility 
 of building up the organism, vindicating thereby 
 
1 1 8 Diabetes. 
 
 for the work of respiration the highest mission in the 
 continuance of life. The intestines cast out the 
 useless residuum of the food. The urinary organs 
 dispatch the residuum of the albuminous arid fibrous 
 ingredients out of the body, while the skin excretes 
 the sebaceous and other matters which when con- 
 densed appear in the form of perspiration. 
 
 A glance upon these processes which are carried 
 out in the daily change of substance {Sioffwechsel) 
 shows that all the organs in the body can exist only 
 when the requisite ingredients of the blood are dulv 
 commingled in it, and when there is a normal forma- 
 tion of protoplasm as its natural result. 
 
 Good curative results, therefore, can be obtained 
 by a physician only when in the case of a hereditary, 
 faulty protoplasm he does not undertake any merely 
 sympto7natic cures, but regards the peculiar assi?m- 
 lation of the food by the body as the chief cause of 
 the progression of a disease. A disturbance in the 
 change of substance {Stoffwechsel), as Blumberg 
 and Steinbacher justly observe, is the root of most 
 diseases, and, therefore, a faulty formation of the 
 protoplasm. 
 
 Healing, in the modern sense, means maintaining 
 in a normal condition the change of substance, 
 regulating that change when it is disturbed and 
 directing it again into its proper channels. 
 
 This is the fundamental principle of my thera- 
 peutics in all specific diseases, and particularly m 
 dealing with diabetes. 
 
 Like nature's practitioners (Steinbacher, Priessnitz, 
 
Therapeutics of Diabetes. 119 
 
 Schroth, and others), by exciting in the system new 
 activities, and, indeed, by employing in a rational 
 way all those factors or agencies which are indicated 
 by the pathogeny of a disease, I endeavour to elimi- 
 nate from the human system the elements by which 
 the change of substance is disturbed. 
 
 Although our art of healing, even in the most 
 recent times, has not been able to heal a single case 
 of diabetes, since hereditary or connate defects 
 in the protoplasm cannot be removed by a mere 
 application of medicinal remedies (see Ebstein in 
 Op. citat., p. 193) ; nevertheless, by its sympto- 
 matic, empirical method of treatment it has limited 
 in an essential degree the deadly nature of diabetes, 
 and it has at least mitigated the symptoms of the 
 disease. 
 
 The best results are obtained, and will be obtained 
 in the future, by a proper combination of hygienic, 
 dietetic, and remedial agencies. 
 
 Scientific attempts, based on definite principles, 
 to combat diabetes by dietetic agencies have only 
 been made since the close of the last century. 
 
 J. Rollo in his memorable treatise " On Diabetes 
 Mellitus '' (London, 1797) was the first who recom- 
 mended a dietetic treatment of diabetes as a thera- 
 peutic remedy. His recommendation has gained the 
 approval of the profession even to the present day. 
 
 Rollo prescribed almost exclusively animal food 
 and fats, and especially rancid fats, which he 
 rendered more effective by alkahne and calcareous 
 substances. 
 
1 20 Diabetes. 
 
 Wm. Prout, in his work entitled "On the Nature 
 and Treatment of the Diseases of the Stomach and 
 the Urinary Organs " (translated from the English 
 by Krupp, Leipzig, 1843), likewise recommends fats, 
 because they increase the secretion of saliva, and 
 diminish thirst. Butter he calls the most agreeable 
 form of fat. 
 
 Nourishing food, difficult to digest, such as fish, 
 tripe, the mouth of oxen, etc., was recommended for 
 combatting diabetes by Alexander v. Tralles. 
 
 Many practitioners after him prescribed fats, and 
 justly so ; for they are burnt up into carbonic acid 
 and water, and thus protect the glycogen and the 
 albuminates in the system, and, consequently, 
 diminish the sensation of hunger and thirst in 
 diabetic patients, and counteract autophagy — the 
 process of consuming one's own self. 
 
 Whoever withholds fats from diabetic patients 
 commits a blunder, since patients by eating fat 
 neither become fat themselves, nor is their blood- 
 supply diminished (see Ebstein, Op citat., p. 199). 
 
 An exclusive meat-diet, carried out consistently, 
 may become fatal, as is proved by the so-called 
 Banting-cures. Voit says (in " Physiol, des allg. 
 Stoffwechsels," Leipzig, 1881) that in such a treat- 
 ment the most abundant supply of albuminates does 
 not suffice to preserve the body in a proper albumin- 
 ized condition. 
 
 Following the precedent of Rollo, other physicians, 
 such as Bouchardat, Dickinson, v. During, Cantani, 
 Seegen, Naunyn, Voit, Pavy, Boucheron, Bence 
 
Therapeutics of Diabetes. 121 
 
 Jones, M. Traube, and others, prepared dietetic 
 instructions for diabetic patients. These we shall 
 examine below. 
 
 Ebstein, in giving his noteworthy advice to resort 
 only to dietetic treatment, starts from the position 
 that in a normal condition of the body, under the 
 influence of diastatic ferments, only so much of the 
 glycogen stored up in the body is altered into species 
 of dextrine and sugar as is oxidized completely into 
 carbonic acid and water ; while in diabetic persons 
 the amount of carbonic acid formed in the pro- 
 toplasm no longer suffices to regulate the diastatic 
 ferments, which therefore exert in them a more 
 powerful effect. Glycogen, consequently, being no 
 longer protected is transformed into easily diffusible 
 species of sugar, which quickly pass into the liquid 
 portions of the body, where they produce hyper- 
 glykaemia, and generate what is known as constant 
 glycosuria. 
 
 The defective protoplasm has to be made normal 
 again. Can the medical practitioner effect this ? 
 
 My answer is, Yes, if he aims at altering the 
 disposition of the protoplasm, and at regenerating 
 the protoplasm and the entire blood; if he makes up 
 for the considerable loss of organic substances in a 
 natural manner, and if in addition to the medicinal 
 agencies, wherever they are indicated, he prescribes 
 as a conditio sine qua non, a hygienic treatment, as 
 well as a careful mental and bodily diet. 
 
 In respect to mental diet, Franciscus Place, in his 
 inaugural dissertation, " Concerning the true cause 
 
122 Diabetes, 
 
 of Diabetes" (1784), 'uses the following language 
 which still holds true at the present time, " Frustra 
 remedia exhibentur, nisi adsit placida ilia mentis 
 tranquillitas, animi ilia serenitas, quae non modo 
 remediorum efficaciam auget, sed ipsa remedii prae- 
 stantissimi instar vitia corporis medetur." These 
 words, in an English translation, read as follows, " It 
 is vain to apply medicines, unless a patient possesses 
 that tranquillity of the soul, that serenity of the 
 mind, which not only heighten the effect of the 
 medicines, but which, like the most potent remedy, 
 even heal the infirmities of the body." 
 
 The object of mental diet is to avoid rigorously 
 all physical excitement, all fatiguing mental work, 
 all care and all troubles, since it has been proved 
 that all kinds of mental excitement increase the 
 amount of sugar in the urine. Some propose to 
 conceal from the diabetic patient his condition ; but 
 on psychological grounds I must protest against 
 such a course. 
 
 Under the head of mental diet also comes placing 
 a diabetic patient, if possible, under the influence of 
 a pleasant, home-like, new climate, and among 
 cheerful people, not worried by care. Thus an in- 
 habitant of the North, where often the summer is 
 nothing else than a winter painted green, ought 
 during winter-time to be transferred to the sunny, 
 lively Riviera, which exerts an exhilarating effect on 
 the mind, as well as upon the heart. 
 
 In summer, during the time which is generally 
 devoted to the care of the health, a diabetic patient 
 
Therapeutics of Diabetes. 123 
 
 ought to select as a place of abode a watering- 
 place containing warm, alkaline springs, like Carls- 
 bad. As a central intermediate station between 
 Carlsbad and the Riviera, and vice versa, and also 
 for an after-cure I would recommend the superbly 
 situated Hotel Belle Vue au Lac, in the mild and 
 cheerful Zurich, where there is a prospect that the 
 patient will find all those appliances which are 
 required for the treatment suggested by myself. 
 
 A warm climate is recommended to patients 
 suffering from diabetes also on this ground, that a 
 warm climate, as has already been observed by 
 Dancel (in " De I'infiuence des voyages sur I'homme 
 et sur les malades," .Paris, 1858), stimulates the 
 secretion of the perspiration, and relieves the 
 kidneys. 
 
 Movement. Muscular activity. — The plan of 
 life prescribed for diabetic patients requires first 
 of all regular exercise in open, fresh, good air. 
 While formerly {e.g., by Rollo) the patient was for- 
 bidden to take any exercise at all, on the ground of 
 its being injurious, ever since the time of Trousseau, 
 who prescribed daily exercise and muscular exertion, 
 especially for corpulent persons, muscular activity 
 has been introduced as affording great assistance in 
 the therapeutic treatment of diabetes. As to the 
 rest. Trousseau regards diabetes simply as an indis- 
 position, and not as a disease. Bouchardat also (see 
 " Supplement a I'Annuaire de Therapeutique," etc., 
 Paris, 1846, p. 217), whose diabetic patient while 
 doing rustic work in summer bore amylaceous food 
 
1 24 Diabetes. 
 
 very well, is in favour of regular exercise. The 
 necessary muscular activity for such persons is ob- 
 tained by light work in the garden, by playing at 
 billiards and skittles, by using dumb-bells, fencing, 
 rowing, splitting wood, taking gymnastic exercise, 
 by walking moderately uphill, by hunting, and parr 
 ticularly also by riding on horseback. 
 
 Kiilz made the influence of muscular labour in 
 five persons the subject of careful investigation, and 
 he showed that bodily exertion is indeed able to 
 control the formation of sugar, although he was also 
 obliged to confess that in some individual cases 
 muscular labour had an indifferent effect, nay, acted 
 even injuriously, 
 
 O. Nasse("Berl. Centralblatt," 1884, p. 250) 
 deems it very probable that the muscles destroy the 
 sugar which has made its way into the blood, i.e., 
 that they use it for forming carbonic acid. 
 
 According to Ebstein, the decrease in the forma- 
 tion of sugar during muscular activity, and its 
 increase during a state of rest, is due to ^an in- 
 creased formation of carbonic acid during muscular 
 action, and to a decrease in its formation during a 
 state of muscular rest. 
 
 K. Zimmer, formerly a consulting physician in 
 Carlsbad, is of the opinion that in all cases of 
 hepatogenous diabetes the real cause of the disease 
 is attacked by muscular exertion ; yea, he is con- 
 vinced that cautious, consistent muscular move- 
 ments which are extended to all the large muscular 
 groups, in conjunction with a plentiful meat diet, 
 
Therapeutics of Diabetes. 1 25 
 
 are able to heal many cases of hepatogenous dia- 
 betes, or, at least, that by them the patient is kept 
 for a longer time in a condition in which he is able to 
 act. He further declares that the effect of muscular 
 exertion is more lasting than that of a diet accord- 
 ing to Rollo. 
 
 Cantani endorses these views. 
 
 Those who are opposed to exercise and muscular 
 action in diabetes, object that it is immaterial 
 whether the sugar is secreted through the kidneys, 
 or whether it is burned up during exercise, and 
 during muscular labour, etc. Nevertheless, if you 
 consider that during muscular exertion the rush of 
 blood is led away from the liver, as well as from all 
 abdominal organs, and is directed towards the 
 muscles ; that the sugar therefore is conveyed then 
 into the muscles in order to be utilized there for the 
 production of heat ; if you take into consideration 
 therefore that through exercise there is brought 
 about a consumption of glycogen and a production 
 of carbonic acid and heat ; and, further, that the 
 muscles are strengthened by this means, and that 
 the change of substance and the transformation of 
 substance is promoted thereby, whence there arises 
 an improvement in the whole condition of the body, 
 you must needs hold in high estimation a means of 
 bodily culture whereby the change or alteration in 
 the composition of the body is promoted. 
 
 V. Mering reports, on the basis of observation, 
 that the secretion of sugar was stopped for some 
 time by increased bodily exertion. His patient was 
 
1 26 Diabetes. 
 
 allowed to turn the wheel of a machine by which 
 soda-water siphons were filled, of which work he 
 was very fond. After one hour and a half already 
 he was free from sugar, and, indeed, at a time when 
 he lived altogether on a meat diet. 
 
 This statement, however, is counterbalanced by a 
 case reported by H. Oppenheim, in Pfliiger's 
 *'Archiv," etc., for 1881. He states that a woman 
 was visibly reduced in health by pumping water 
 every day, and that the secretion of sugar was not 
 influenced at all by her exercise. [Who knows, 
 however, what kind of food this poor woman was 
 obliged to live upon, and whether she performed 
 this severe labour willingly or unwillingly .^] 
 
 In every particular case you have to individualise : 
 This fundamental rule must never be lost out of 
 sight, least of all in diabetes. What is easy for 
 persons of a strong constitution, persons of a weak 
 constitution will not be able to bear. What is 
 advisable for young men and the male sex generally, 
 is not necessarily so for old men and the female 
 sex. 
 
 In medicine you must guard against working by 
 rote, and against applying one general rule to all 
 things and all persons. Zimmer's examples also 
 prove this. In 14 cases he demonstrated the great 
 use of muscular exertion, while in his remaining 
 cases he is obliged to confess the reverse, so that 
 he felt bound to advise a CAUTIOUS and SYSTE- 
 MATIC training of muscular activity. 
 
 It is very important to remember this, for with 
 
Therapeutics of Diabetes. 127 
 
 patients whose constitution has run down, you 
 cannot be circumspect and systematic enough. One 
 single exertion may cause their sudden death by 
 coma diabeticum. 
 
 Care of the Skin. — An additional most impor- 
 tant element of bodily diet is an intelligent care 
 of the skin. The skin is cared for by the patient 
 washing his whole body quickly every day with luke- 
 warm water. If the accommodations at home are 
 limited, the patient should undress and stand in a 
 small wooden tub, the bottom of which is covered 
 with warm water, so that the feet are kept warm. In 
 winter the room must be heated. A basin filled with 
 lukewarm water, into which some rectified alcohol 
 or some French brandy has been poured, is placed on 
 a chair close to the tub. With a large sponge the 
 patient now washes himself from top to toe. He 
 then quickly rubs and dries himself with a rough 
 towel, and dresses himself in a woollen or cashmere 
 shirt, and in drawers, stockings, and a suit of clothes 
 of the same material. Linen is prohibited. Woollen 
 garments have been recommended already by Prout 
 in 1843, ^^^ Bouchardat in 1846. 
 
 After the patient has dressed him.self, there comes 
 the important cleansing of the cavity of the mouth 
 and of the teeth. For this purpose it is best to 
 use a solution of chlorate of potassium (this salt 
 dissolves in water in the proportion of ri9) ; one 
 or two spoonfuls of which solution may be put 
 into one pint of water. By using this preparation a 
 diseased state of the gums as well as of the tongue 
 
1 28 Diabetes. 
 
 is avoided. Adding to the above mixture a solution 
 of thymol in alcohol I have also found useful. 
 
 For almost all patients, especially for those who 
 have a dry skin, I prescribe Irish, Roman, Russian, 
 or Turkish baths, as well as a combination of baths 
 according to a special method ; for every one accord- 
 ing to his own individuality ; BUT I NEVER ALLOW 
 ANY ONE TO BATHE IN A BATH TUB. 
 
 The prescribed baths have this effect that they 
 revive and discharge the sebaceous glands and the 
 sweat glands v ''lich deposit their secretion on the 
 surface of the body. This secretion combines there 
 with the dust particles floating in the atmosphere, 
 and condenses into a stratum whereby the respira- 
 tion of the skin is checked. The above baths, there- 
 fore, are of a sanitary as well as of an aesthetic 
 importance for the diabetic patient. 
 
 In patients whose skin had been entirely neglected, 
 and whose nerve-life, in consequence, was very much 
 depressed, I have employed with great advantage — 
 partly also in connection with electricity and gal- 
 vanism — my regenerative method, which is a modi- 
 fication of the method prescribed by Steinbacher, 
 Priessnitz, and Schroth. The nervous system is 
 strengthened by its apphcation ; the sexual potency 
 is revived ; the enfeebled digestive organs are 
 strensfthened, etc. The incitative action of the 
 above-named baths improves not only the state of 
 the skin, but the whole vascular system also is bene- 
 fited thereby. The circulation of the blood becomes 
 more animated, and the change of substance more 
 
Therapeutics of Diabetes. ii(^ 
 
 energetic. By the Russian bath the fluids of the 
 body press more towards the skin, whereby the 
 interior organs are relieved, and a compulsory excre- 
 tion through the skin is brought about. The 
 heightened stimulation of the cutaneous nerves is 
 continued towards the brain and spinal marrow, 
 and by reflex action it operates upon all the organs 
 which are capable of being incited ; as a matter of 
 course, also, it operates upon all the diseased parts. 
 A regulating effect is thus exercised upon the con- 
 ditions whereby the state of the equilibrium of the 
 body is influenced, and by an improvement in the 
 quality of the protoplasm other accidental diseases 
 are prevented. The bath recommended by myself 
 is similar to the Hamam of the Turks, to the warm 
 baths of the Greeks, or also to the baths of the 
 Romans. It is a combination of agreeable influ- 
 ences by which health is promoted. It is an essen- 
 tial means for improving the condition of the body. 
 
 In the Turkish bath I get the patients first of all 
 to transpire in a dry, hot air, the temperature of 
 which towards the close is raised to i6o° Fahrenheit, 
 in order to compel the body to give out an excre- 
 tion. This is followed by a lukewarm douche or 
 shower-bath ; whereupon the body is soaped and 
 shampooed until every vestige of the dead and 
 withered superficial stratum of the epidermis is re- 
 moved, together with every trace of grease, dirt, and 
 dust, and until the sallow, yellow, and withered 
 colour of the skin is succeeded by a healthy, rosy 
 colour. 
 
 K 
 
130 Diabetes. 
 
 From the Turkish bath the patient passes into the 
 Russian vapour-bath, the temperature of which must 
 not exceed 100° Fahrenheit. By breathing its watery 
 vapours the activity of the lungs is stimulated, and 
 the excretion through the skin is promoted. After 
 a shorter stay in this bath the skin is cooled off by a 
 lukewarm, but never by a cold shower. At last the 
 patient is allowed to have a secondary perspiration 
 on a couch, and according to the measure of his 
 strength is allowed to rest for upwards of one 
 hour. After the reaction has set in, w^hich often 
 takes place only after the twelfth bath, the feeling of 
 thirst pecuhar to a diabetic patient begins to cease. 
 About an hour before entering into the bath the 
 patient ought to drink a cup of beef-tea. All feeling 
 of lassitude will then disappear. 
 
 Drawing deep breath. Quality of the air. — 
 Of great importance for a diabetic patient is learn- 
 ing and practising the art of breathing correctly. 
 In order that the lungs may be properly ventilated, 
 it is especially necessary that our ladies who wear 
 ■ corsets should be trained to breathe in a rational 
 manner, for instance, as is prescribed and realized 
 by Dettweiler's method of taking a deep breath. 
 
 The air, in order to be suitable for a diabetic 
 patient, must first of all be free of all substances 
 injurious to the health. A chief requisite is an 
 abundance of ozone. The percentage of ozone in 
 the air can easily be determined by the ozonometer 
 of Lender, which consists of strips of paper painted 
 with a paste of starch containing iodide of potassium. 
 
Therapeutics of Diabetes. 131 
 
 These strips are exposed for some time to the influ- 
 ence of the air, by the action of which, according 
 to the quantity of ozone which is present in it, they 
 are turned more or less blue. The scale of the 
 shades of colour enables you to determine the 
 degree of the intensity of the blue colour. Ozone 
 refreshes the nerves and the blood ; it is subservient 
 to the oxydation of the blood, since the blood cor- 
 puscles possess the property of imbibing ozone as 
 well as common oxygen. 
 
 If diabetes is attended by an insufficient oxydation 
 of the blood-sugar, an increased absorption of oxygen 
 and ozone must be of the greatest importance to 
 those who are suffering from this disease. Unfor- 
 tunately, the experiments which have thus far been 
 made were limited to the inhalation of artificially- 
 prepared oxygen ; and since these experiments, 
 apparently, did not result in much good, they were 
 not followed up. Artificially-prepared oxygen, how- 
 ever, is only a make- shift. A stay in the sunny air 
 of the country is worth much more than all artificial 
 supplies. Such a change of air ought never to be 
 . undervalued, especially not in the case of town- 
 patients, if even, as was shown by Buchheim, only 
 I per cent, of additional oxygen is imbibed by the 
 system. 
 
 What result may be obtained by living in a pure 
 air (of course in combination with a carefully- 
 guarded mode of life, and a most scrupulously 
 observed method of cure) we can see from the 
 example of Dr. Vocke, which is worthy of being 
 
132, Diabetes. 
 
 followed. He relates of himself: "After an ex- 
 hausting medical practice in Berlin, which extended 
 over 25 years, I was attacked by diabetes. At first 
 1 thought that I might conquer the disease by giving 
 up my town-practice and commencing another in a 
 neighbouring village, where I might breathe the 
 country air. Whether the fault lay in the mental 
 excitement which is inseparable from all medical 
 practice, and which is so very injurious to diabetic 
 patients, or whether the morphium injections which 
 I used at the time were at fault ; in short, within two 
 years, on account of increasing feebleness, I was 
 compelled to give up my medical practice altogether. 
 I now removed to my villa in the forest of Fried- 
 richshagen, and transformed its spacious balcony 
 Into a kind of dwelling and sleeping-room by cover- 
 ing it with a marquee of sail-cloth. During the 
 seven summer months, from April i to November i, I 
 lived there during the day and at night ; thus breath- 
 ing the air, rich in ozone, not only for six, but for 
 twenty-four hours daily. In the winter I walked in 
 the woods from four to six hours, and at night I slept 
 with an open window. The same treatment I 
 repeated during the second year ; and, in the third 
 summer, at last I accomplished my cure by staying 
 for six months at the seaside on the Baltic coast. 
 The sugar disappeared already during the first 
 months, and on account of the polyuria which re- 
 mained yet for a very long time I utilized the 
 remainder of the time in confirming this result, for 
 the presence of polyuria made me doubt of the 
 radicalness of my cure." 
 
Therapeutics of Diabetes. 133 
 
 Alas, there are only too many patients who are 
 unable to lead such an idyllic life as Dr. Vocke was 
 able to do ! With the feebler of my patients I 
 employ the pneumatic apparatuses of Geigel, Meyer^ 
 and Waldenburg in order to regulate the gymnastic 
 of their lungs, and to administer it to them in proper 
 doses. I thereby expel the residual air in their lungs, 
 supply oxygen to them, and strengthen their pectoral 
 muscles. 
 
 By a methodic climbing of hills also, according to 
 Oertel's prescription, I teach my patients to take 
 deep breath. For this purpose I find the air-breath- 
 ing-stations {Terrain Kurorte) Carlsbad, Nice, and 
 especially Monaco, of great use. 
 
 Dwelling-rooms. — The sleeping-room of a diabetic 
 patient in winter ought to be towards the south 
 or south-west, in summer, towards the east. It 
 ought always to be furnished with a hygrometer in 
 order, if necessary, to have water evaporated. High 
 situations ought to be selected, and the suite of rooms 
 ought to be thoroughly ventilated. Apparatuses for 
 ventilation are recommended. The air-passage 
 through the stove or lire-side ought never to be 
 blocked up. The windows ought to be left open as 
 long as possible. A window in the room next to 
 that in which the patient sleeps, the door of which 
 should be left open, ought always to remain open in 
 summer, even at night. 
 
 The temperature of the dwelling -rooms in winter 
 ought never to be below 56° Fahrenheit (16° C). 
 
 Considering the temperature of all northern 
 countries during winter, a stay in the Riviera di 
 
1 34 Diabetes. 
 
 t*onente during winter is recommended to the 
 diabetic patient ; but not a stay in Cairo or Alex- 
 andria, where the air is so dry that the hydromania 
 of the patient is only increased. Since the year 
 1882 I have succeeded in curing diabetes radically 
 during winter-time in the Riviera, altogether in the 
 same way as I have been able to do at Carlsbad 
 during summer ; a result which I could scarcely have 
 attained in other places on account of the changes 
 in the temperature and the prevailing cold of winter. 
 Besides, as Fleckles also has mentioned with com- 
 mendation, the warm climate of the Riviera enables a 
 patient to breathe freely and in great abundance an 
 open and pure air, rich in ozone ; for in the middle of 
 winter he is able to sit there for hours in the open 
 air, while Hstening to public exhilarating concerts, 
 or he is able to undertake long walks through forests 
 and fields, in orange and olive groves. Even in 
 January and February he can go about without an 
 overcoat, and is not compelled, after a long walk, 
 to take refuge in the oppressive, hot and smoky 
 rooms of a restaurant. 
 
 Massage. — In many cases, following the example 
 of Reibmayr (see his " Technik der Massage des 
 Unterleibs "), I have declared in favour of his 
 method of rubbing, namely, in favour of massage. 
 Massage constitutes an important factor in my 
 method of treating diabetes. My method, however, 
 differs from the usual practice of massage in this 
 respect — that in rubbing I do not employ a greasy 
 substance, but a preparation of mercury ; ordinarily 
 
Therapeutics of Diabetes. 135 
 
 I prescribe a mild solution of corrosive sublimate 
 in alcohol with an addition of vaseline. I employ the 
 massage daily once, between breakfast and dinner ; 
 only exceptionally I allow a patient to be rubbed 
 before breakfast. 
 
 Heynsius von Hart in Amsterdam already recog- 
 nized the value and use of massage. The influence 
 of a mechanical treatment of living tissues by 
 kneading, pressing, and beating is indeed of great 
 therapeutic value. The conditions under which the 
 change of -substance {Stoffwechsel) is brought about 
 are most favourably influenced by such a treatment. 
 An improvement is effected in the assimilation of 
 the food by the muscles, and the muscular apparatus 
 of the body is rendered more fit to do its work. 
 Again, the circulation of the blood is promoted 
 thereby, and the products of the change of sub- 
 stance are separated and excreted. The volume of 
 the body of a diabetic person is seen to increase 
 visibly under the treatment of massage. 
 
 Finkler in Bonn inquired, in 13 cases, whether 
 the change of substance {Stoffwechsel) in a person 
 afflicted with diabetes underwent any alteration by 
 the mechanical treatment of the .muscles of the 
 body by massage. He found that a considerable 
 influence was exerted thereby upon the secretion of 
 sugar, and the general well-being of the body. The 
 influence upon the secretion of sugar, within 24 
 hours, amounted to an average reduction of 400 to 
 120 grammes ; the muscular energy became invigor- 
 ated ; the weight of the body increased ; the thirst 
 
136 Diabetes. 
 
 decreased ; and the patient began to perspire. Yea, 
 in one case the secretion of sugar ceased for three 
 months. All these results were obtained with a 
 mixed diet, the patients drank water, and no change 
 was made in the use of hydrates of carbon. 
 
 In company with Dr. Brockhaus, of Godesberg, 
 Finkler tried the influence of massage also upon 
 the muscles in cases of paresis, hysteria, etc. 
 
 Electro-magnetic in jliiences. — Zabludowsky noticed 
 remarkable changes in the muscular tone of the body 
 in consequence of electric and magnetic reactions. 
 Likewise Clemens, who after an electric shock of the 
 liver, combined with a faradization of the entire 
 muscular system, saw changes taking place in the 
 formation of sugar. 
 
 I also have repeatedly tried the wholesome in- 
 fluences of electric and magnetic reactions. Under 
 their influence the volume of the muscles and their 
 vigour increased, their sensitive properties were en- 
 hanced, and the physical as well as the psychical 
 well-being of the patients was improved. 
 
 In regard to sexual intercourse^ many practi- 
 tioners when dealing with diabetes forbid what during 
 the progression of the illness need not be forbidden 
 at all, since it ceases of its own accord. 
 
 Although I am of the opinion that in the first 
 stage of the disease, and also afterwards, trans- 
 gressions in this line are followed by serious conse- 
 quences, so that a rational abstinence ought to be 
 recommended ; still my method of nourishment and 
 the principle which underlies my method of cure 
 
Therapeutics of Diabetes. 137 
 
 are able to prevent the injurious consequences of a 
 moderate intercourse. This moderate intercourse 
 I deem admissible in the interest of the building 
 up of the substance of the body, and in that of the 
 regular circulation of the juices. 
 
 Food and nourish7nent. — The fact that the excre- 
 tion of the sugar into the urine ensues but a short 
 time after a patient has partaken of hydrates of 
 carhon, induced the profession many years ago 
 to prohibit them, and to subject the selection of 
 food for a diabetic patient, in every particular case, 
 to the greatest care. 
 
 Unfortunately, not much harmony has prevailed 
 in this respect among the physicians in modern 
 times. 
 
 Although, on the whole, they have assented to 
 RoUo's view, namely, that in order to avoid the 
 formation of sugar all amylaceous substances, as 
 well as all hydrates of carbon, such as grape-sugar, 
 fruit-sugar, cane-sugar, sugar of milk, etc., ought to 
 be forbidden, and albuminous food to be recom- 
 mended ; and that only a few green vegetables, as 
 being less injurious, ought to be allowed ; still in 
 practice the physicians very often follow very diver- 
 gent courses. 
 
 Some demand most rigorously a most copious 
 supply of animal food; while others (Cantani, 
 Fleckles, v. During, Ewald, etc.) advocate a most 
 painful theory of fasting; and, at variance with the 
 former, not only forbid an excess of food, but with 
 the view of reducing the quantity of sugar, sacrifice 
 
138 Diabetes. 
 
 even the proper nourishment of the body. I will 
 only mention here Naunyn, who, in accordance with 
 the principles of Cantani, demands the strictest 
 meat-diet. 
 
 I consider it useful to present here the essential 
 parts of the dietetic instructions of the leading 
 authorities in the field of diabetes, in order to enable 
 the reader to form a judgment as to what is common 
 to all, and what the various authorities have bor- 
 rowed from each other ; likewise, in order that the 
 question may be answered whether any progress can 
 be noticed at all in the matter of diet for the use of 
 diabetic patients. 
 
 Rollds Diet. — He allowed for breakfast : i^ pints 
 of milk mixed with ^ of a pint of hme-water, together 
 with some bread and butter. 
 
 For dinner : Tender meat, sausages prepared of 
 blood and fat. 
 
 For supper : The same. 
 
 Beverage : Water with sulphate of ammonium. 
 
 Bouchardafs Diet. — In the place of milk he 
 orders cream, all kinds of meat, from 150-200 
 grammes of fat per day, and those vegetables 
 which contain only a small quantity of starch, 
 such as spinach, artichokes, cabbage, lettuce, as- 
 paragus, beans ; peaches, strawberries. In the place 
 of ordinary bread he recommends gluten-bread. 
 Men he allows to drink daily from i-i-| pints of 
 claret or Burgundy. He thinks that by the quantity 
 of alcohol contained in the wines he is able to re- 
 place amylaceous food. 
 
Therapeutics of Diabetes, 139. 
 
 Dickinson^ s Diet. — He allows all kinds of meat, 
 including pickled and smoked meats, soups without 
 flour and spices, sauces without sugar ; further, oil, 
 lard, butter, cream, green vegetables, such as cauli- 
 flower, spinach, rape-cole {Kohlrabi), Brussels 
 sprouts, French beans, asparagus, lettuce, radishes, 
 nuts, almonds, as well as the almond-bread pre- 
 scribed by Pavy. 
 
 Beverages allowed : Water, tea, coffee, cocoa, 
 brandy, rum, claret. Burgundy, chablis, hock, and 
 Moselle wines, some good beer [to which exception 
 was made]. 
 
 He forbids : Sugar, honey, bread, milk puddings, 
 carrots, beets, onions, rhubarb, cucumbers, milk, 
 whey, chocolate, champagne, sweet wines, etc. 
 
 Pavys Diet. — He allows all kinds of meat and 
 fish, the liver excepted. Soups not prepared of 
 plants; cheese, eggs, butter, cream. Further, greed 
 vegetables, such as spinach, cucumbers, lettuce, 
 radishes, and celery [which is forbidden by Dickin- 
 son]. He permits blanc mange prepared of cream 
 and the white of eggs. Instead of bread he pre- 
 scribes almond-bread. 
 
 Beverages allowed : Tea, coffee, ■ soda-water [to 
 which exception was taken], wines and spirituous 
 drinks, not sweetened, bitter ale. 
 
 He forbids: Sugar, rice, sago, vermicelli, potatoes, 
 all fruits and puddings. He allows milk in a small 
 quantity. [See the ideas of others on this subject 
 below.] 
 
 Cantani's Diet. — Whether a patient is fat or lean, 
 
140 Diabetes. 
 
 for all meals he only allows the meat and the fat of 
 all vertebrata. Even the viscera, the liver excepted, 
 he permits to be eaten. Meat and fishes he allows 
 cooked in any fashion. Spices, sugar, and flour 
 must not be used in their preparation. He forbids 
 butter [in a most unjustifiable way] on account of 
 the traces of sugar of milk which it contains. [They 
 amount to \ per cent., which amount is surpassed 
 by the hydrates of carbon contained in the meat.] 
 In the place of butter he permits sweet oil. 
 
 Patients whose digestion is weak he advises to 
 eat fats in a pancreatic state, that is, he soaks them 
 for three hours with the fresh pancreas minced of 
 calves, lambs, oxen, or goats, and afterwards has 
 them roasted before the fire. 
 
 As a beverage he prescribes water (in exceptional 
 cases mixed per day with 10-30 grammes of rectified 
 spirits of wine), sometimes a little coffee, tea, etc. 
 He forbids milk, butter, cheese, oranges, peaches, 
 and other fruit, as well as all green vegetables ; 
 further, puddings, sweet drinks, etc. He allows 
 salt to be used in preparing the food, yet sparingly. 
 
 Cantani continues his exclusive diet of fats in 
 mild cases of diabetes during two or three months ; 
 in severe cases from six to nine months. After he 
 has stopped the formation of sugar in mild cases 
 he gradually returns to the former diet. 
 
 Eggs he allows only in exceptional cases. 
 
 Pavy's almond-bread is the only bread which he 
 allows in the place of real bread. 
 
 Seegen' s Diet. — He allows meat and fish in any 
 
Therapeutics of Diabetes. 141 
 
 quantity ; jelly, aspic, eggs, caviar, cream, butter, 
 cheese, bacon. 
 
 Among vegetables he permits : Spinach, lettuce, 
 endive, cucumbers, asparagus, water-cresses, arti- 
 chokes, mushrooms, nuts. 
 
 In moderate quantities he allows : CauHflower, 
 carrots, turnips, savoy, French beans, berries, 
 oranges, almonds. 
 
 He forbids absolutely : Farinaceous food of every 
 kind ; in some special cases bread may be allowed. 
 He also forbids sugar, potatoes, rice, sago, semelina, 
 beans, peas and lentils, green peas, cole-rape, sweet 
 fruits, grapes, etc. 
 
 Beverages, in any quantity, he permits : Water, 
 carbonized waters [to which exception was taken], 
 tea, coffee, clarets, Rhine wines. Moselle wines, 
 Austrian and Hungarian table-wines. In short, all 
 wines which are not sweet and which do not contain 
 an excessive amount of alcohol. 
 
 In moderate quantities he permits : Milk, brandy^ 
 bitter ale ; milk of almonds not sweetened ; lemon- 
 ade not sweetened. 
 
 Beverages forbidden : Champagne, sweet beers, 
 must, cider, liqueurs, fruit-juices, ice-cream and 
 water-ices, cocoa, chocolate, wine prepared of fruits. 
 
 V. During' s Diet. — Diiring's diet differs from 
 other diets by his admitting many hydrates of 
 carbon. For early breakfast he permits : Milk, 
 containing some unsugared coffee, with stale wheat- 
 bread ; alternately rice-soup and porridge without 
 butter. 
 
1 42 Diabetes. 
 
 For second breakfast : Wheat-bread with butter, 
 a boiled egg with a glass of good claret in water ; or 
 alternately a cup of rice-soup, or semelina-soup with 
 or without milk. 
 
 For dinner : Soup of cereals, 250 grammes of 
 meat without fat, together with stewed dried 
 apples, prunes, or cherries. Among vegetables, 
 which are not to be prepared with soup or fat, 
 but simply boiled in salt water, he permits : 
 Carrots, cauliflower, French beans, cabbage, as- 
 paragus. 
 
 For dessert : Fresh fruit, such as apples, cherries, 
 with a glass of claret in water. 
 
 For supper: Rice-soup or semelina-soup without 
 butter ; sometimes milk may be added. 
 Beverage : Ice-water, water, etc. 
 Senator's Diet. — He permits : Meat of mammalia 
 and birds ; further, oysters, mussels, craw-fish, 
 fish. Again, meagre cheese, eggs, salad, cu- 
 cumbers, water-cresses, spinach, asparagus, all 
 kinds of cabbages, scorzonera, radishes, carrots, 
 truffles, butter, bacon, oil, sour or acidulous fruit, 
 etc. 
 
 He forbids : Grapes, cane-sugar, honey, farina- 
 ceous food, such as bread, etc. ; further, potatoes, 
 leguminous plants, rice, maize, semelina, sago, chest- 
 nuts, etc. 
 
 Frerichs' regimen. — He requires an avoidance 
 of amylaceous food ; a shunning of hydrates of 
 carbon. But he allows a small quantity of bread. 
 As a condiment for meat and fish he generally uses 
 
Therapeutics of Diabetes. 14.^ 
 
 green vegetables and other vegetable substances 
 free from starch. Only once Frerichs noticed a 
 favourable result from the use of milk ; more fre- 
 quently he saw bad results. Especially while using 
 the milk cure of Donkin he noticed an increase in 
 the secretion of urine and sugar. He prefers, as a 
 beverage, good, thoroughly fermented beer, which 
 contains but little sugar ,• also claret in moderate 
 quantities, only the sugary Spanish and Hungarian 
 wines he prohibits most strenuously. He permits a 
 moderate use of unadulterated brandy. (See Frerichs, 
 O^. citat., p. 261.) 
 
 Ehstein' s Menu. — (See Ebstein, Op. citat., p. 
 204.) 
 
 Early breakfast : One cup of coffee or black 
 tea, without milk and without sugar. Eat with it 
 from 30 to 50 grammes toasted white bread, or 
 respectively brown bread richly buttered (from 20 to 
 30 grammes of butter). Add to this, if required, 
 the yolk of one Qgg, a little fat ham, or some German 
 sausage {Mettwursf). 
 
 Second breakfast: It is best to do without such a 
 meal ; but, if required, let it constitute a part of the 
 first breakfast ; or else take one cup of broth with 
 the yolk of one Qgg. 
 
 Dinner : Broth with yolk of &gg^ or the marrow of 
 marrow-bones, or with both. The marrow- bone is 
 boiled for half an hour, so that the marrow may be 
 served in a solid form. Some peptone may be added 
 to the broth. Meat : Roasted, boiled, or stewed ; 
 either beef, pork, mutton, veal, fowl, or venison. 
 
144 Diabetes. 
 
 Fat meat is preferred. Gravies are to be prepared 
 with the yolks of eggs or cream in the place of 
 flour. For a change, eat fish cooked with butter. 
 The amount of meat to be eaten at dinner is upwards 
 of 1 80 grammes of meat, apart from the bones, 
 together with one of the vegetables mentioned 
 below, prepared richly with fat. Persons who do 
 not like fat meat will perhaps eat richly-prepared 
 vegetables. Every case should be individualized ! 
 Let the food be well salted and spiced. Some puree 
 of leguminous plants, prepared with fat. Salads 
 dressed with vinegar and oil, or sour cream. After 
 dinner, or in the afternoon, one cup of coffee or of 
 black tea. 
 
 Supper : One cup of tea or bouillon, some roast 
 meat, ham or cheese, or one ^gg, or fish, caviar, 
 from 30-50 grammes of bread with 20-30 grammes 
 of butter. 
 
 Small quantities of apples, pears, etc. {i.e., fruit 
 with kernels) are allowed. 
 
 Among alcoholic liquors Ebstein forbids absolutely 
 the use of beer. He permits about half a bottle of 
 wine. The use of spirits he limits. Milk-cures he 
 condemns on the ground of their being modified 
 abstinence treatments. He tries the patient whether 
 he assimilates milk, in which case he allows moderate 
 doses of good milk, especially of cream. The 
 character of the food which he prescribes depends 
 upon the age and the individuality of the patient. 
 Spare persons he treats to greater quantities of fat 
 than fat persons. 
 
Therapeutics of Diabetes. 145 
 
 Conclusions drawn from all the dietetic instruc- 
 tions of acknowledged authorities and experienced 
 practitio7iers : 
 
 The specialists from whom we have just now 
 quoted agree in recommending the following course 
 of diet : — 
 
 ((^) All kinds of meat, with the exception of the 
 liver, which contains sugar, also all kinds of fowl, all 
 fishes, oysters, likewise butter and other kinds of fat. 
 
 {V) Among vegetables they permit spinach and 
 the Kke, salads, water-cresses, mushrooms, cabbage, 
 green asparagus, nuts, prunes, etc. 
 
 {c) The beverages permitted, it seems, are 
 seltzer-water with brandy, koumiss, genuine hocks 
 when light, cream with raw eggs, coffee without milk, 
 etc. 
 
 Absolutely forbidden articles are : Farinaceous 
 food, potatoes, rice, leguminous plants, sweet sugary 
 wines, etc. 
 
 Konig systematized all articles of food and all 
 beverages in the following work : " Prozentige 
 Zusammensetzung und Nahrgehaltwerth der men- 
 schHchen Nahrungsmittel, etc. Graphisch darge- 
 stellt." Berlin, 1882. 
 
 A similar classification is contained in my pam- 
 phlet : " Hygieine und Diat" (Geneva, Pfeiffer). 
 
 Particular information on the subject is contained 
 in Ebstein's meritorious treatise on the articles of 
 food for man, entitled : " Das diatetische Regimen 
 beim Diabetes mellitus " (a reprint from the 
 " Deutsch-arztl. Vereinsblatt," May, 1883). 
 
146 Diabetes. 
 
 Bread : Since bread contains much starch 
 various substitutes have been proposed in the place 
 of it. 
 
 The gliiten-hread prescribed by Dr. Budde in 
 Copenhagen, as prepared in the bakery of Ras- 
 mussen and Heegard in the same town, is most 
 worthy of recommendation, since it contains only 
 two per cent, of starch. (By washing the flour nearly 
 the whole of the starch is removed, so that only the 
 albuminate of the grain, the gluten, remains.) 
 
 The gluten-bread of Dr. Budde is preferable to 
 the breads of Henry and Bouchardat (who first pro- 
 posed gluten-bread in 1840); further, to the bran- 
 bread of Prout, to the breads introduced at Neuenahr, 
 to the wheat-bread of Dahmens, to the expensive 
 almond-bread of Pavy, as well as to the inuline- 
 bread of Kiilz. The only bread that comes near it in 
 point of excellency is the gluten-bread recommended 
 by Fiirbringer (" Arch, fur Klin. Med.," xxi., 1878, 
 p. 503), which is prepared in the establishment of 
 " Bassermann, Herschel, and Dieffenbacher," in 
 Mannheim, and is free from any farinaceous ad- 
 mixture. In Carlsbad are sold so-called "Diabetes- 
 brodchen" (diabetic biscuits) which sometimes bear 
 the name of a Carlsbad physician. They are cer- 
 tainly to be preferred to the ordinary bread. 
 
 My former teacher, v. Frerichs, and also Fleckles, 
 etc., permit small quantities of bread. In my 
 practice, before 1881, I also permitted small quanti- 
 ties of bread in order to meet the feeling of dis- 
 appointment in patients, and I have always found 
 
Therapeutics of Diabetes. 147 
 
 that the psychical gain richly counter-balanced the 
 bodily harm caused by eating bread. 
 
 Milk : Rollo expressed doubts about the use of 
 milk. Pavy shares this doubt, and a great number 
 of able specialists have rejected milk on the ground 
 of its forming glycogen. Seegen also expressed 
 himself against milk ; he allows it only sparingly 
 because it contains from 4 — 5 per cent, of sugar. 
 Frerichs decided against the use of milk. Ebstein 
 also condemns milk-cures, although he likewise ad- 
 vises careful trials in order to see whether milk 
 agrees with a patient, in which case he allows small 
 portions. My experience also, respecting the use of 
 milk, has been most unsatisfactory, wherefore I only 
 allow cream. 
 
 Nevertheless, there are left a considerable number 
 of physicians who do not unconditionally reject the 
 use of milk, even in the face of authorities like 
 Seegen, Frerichs, Rollo, etc. Th. Wille maintains 
 that he has healed diabetes by a milk-cure consis- 
 tently carried out. The Englishman Donkin, who 
 allows even the use of skimmed milk, makes a similar 
 statement ; he was opposed by Frerichs. Cantani 
 recommends lactic acid as of great service in dia- 
 ' betes. Hoffmann allows milk after a patient by 
 abstaining from hydrates of sugar has lost his sugar, 
 and when he is about to return to his usual diet. 
 [He allows it, consequently, after the "glycosuria" 
 has been healed ? ] Hertzka, who is in favour of 
 a copious consumption of fat, and recommends 
 a meat-diet, allows milk ''when it agrees with a 
 
1 48 Diabetes. 
 
 patient." He does not dread the hydrates of carbon 
 so much, but is rather of the opinion that ner\^ous 
 symptoms, and even the diabetic coma, are connected 
 with, and partly caused by a purely animal diet. 
 Dr. Vocke, who is himself a diabetic subject, de- 
 clares unreservedly that sour milk makes up his 
 supper, both during summer and winter. He whips 
 the sour milk until it becomes liquid and then drinks 
 it out of a cup like sweet milk, for, sa3^s he, " cold 
 liquids are not enjoyed when eaten with a spoon." 
 
 Senator, who permits pieces of ice and milk for 
 quenching the thirst, pronounces against a whole- 
 sale arrangement of a system of diet suitable for all 
 diabetic patients. 
 
 Finkler agrees with him. In five severe cases of 
 diabetes he allowed his patients to partake of bread 
 and potatoes, to drink beer and wine, but, on the 
 other hand, he fed them richly with meat and eggs. 
 Here, however, it must be mentioned that he para- 
 lyzed the influence of the food by the massage, and 
 therefore succeeded in diminishing the secretion of 
 sugar. With one of his patients who used the 
 ordinary diet, the secretion of sugar became reduced 
 in 100 days from 700 to 200 grammes. The quantity 
 of the urine also grew less. The thirst diminished, 
 the perspiration returned, the bodily weight increased, 
 and the general well-being of the patient improved 
 visibly. 
 
 Finkler approaches more nearly than any one else 
 to the standpoint occupied by myself in respect to a 
 rational treatment of diabetes. For he also opposes 
 
Therapeutics of Diabetes. 149 
 
 the draconic severity of the abstinence-cures, 
 although he is ignorant of the premises from which I 
 started in the elaboration of my theory, and also 
 is not aware of the object which I seek to realize. 
 
 Janicke (" Arch, fiir Klin. Med.," Vol. xxx.) and 
 Block {Ibid., Vol. xxv.) declare most emphatically 
 against a one-sided meat-diet, which causes many 
 patients to run down quickly in their health, while 
 an ordinary mixed diet preserves, at least, their 
 former, valuable cheerfulness. 
 
 CI. Bernard also, as well as Boussingault, condemn 
 a diabetic diet which is carried to an extreme ; for 
 they do not consider the doctrine of digestion suffi- 
 ciently advanced to enable us to determine scientifi- 
 cally the influence of food on a diabetic patient. 
 
 Unfortunately, the profession, even down to the 
 most recent period, has aimed only at suppressing 
 the secretion of sugar, without considering that 
 it matters much less whether the sugar is formed 
 than whether the sugar is assimilated and con- 
 sumed in a regular manner ; for only by this means 
 can the protoplasm be regenerated and the over- 
 production of sugar be checked in a lasting manner. 
 
 Hertzka is quite right where he exclaims : " Of 
 what use is it for a diabetic patient if through a 
 course of diet the secretion of sugar is stopped, but 
 if, at the same time, his system has been reduced, 
 and he has altogether run down in health ? Tests 
 of the urine, showing the decrease of sugar, are not 
 decisive, in my opinion. I do not worry myself 
 about the fact whether the urine contains a few 
 
150 Diabetes. 
 
 tenths of sugar more or less. My first question Is 
 always : ' How does the patient feel ? What is the 
 state of his mind ? ' " 
 
 Although Hertzka's question does not contribute 
 anything to the cure, nor to any improvement in the 
 condition of a patient, his standpoint, nevertheless, 
 is correct, and, indeed, so much the more since it is 
 a known fact that the increase of sugar is in exact 
 proportion to the increase of food. In this con- 
 nection I should like to direct the reader to the 
 proofs furnished by Kiilz (in " Arch, fiir experim. 
 Pathol.," etc., 1876, p. 141), whose patient on five 
 successive days was fed with caseine at the following 
 rate: (^), 200 grammes ; (^), 240; (<;), 300; {d), 
 500 ; {e), 240. He secreted sugar in the following 
 proportions : {a), 66 grammes ; C*^), 65*7 ; (c), 96' 7 ; 
 (d), i26'9; (^), 86'6 grammes. 
 
 My own Dietetic Regimen for Diabetic Patients : 
 
 My own ideas concerning an appropriate diet 
 for diabetic patients have undergone a consider- 
 able change since I recognized the real character 
 and cause of diabetes ; for since then I have been 
 led to look upon the so-called injurious effects of 
 certain kinds of food simply as accidental causes, 
 and I have also learned by experience what a great 
 mistake it is when physicians, like Seegen, among 
 all the manifold symptoms by which diabetes is 
 characterized, single out the formation of sugar as 
 the only cause of this malady. Taking all this into 
 consideration, I have been induced to favour freedom 
 
Therapeutics of Diabetes. 151 
 
 in the choice of the articles of food, that is, a free- 
 dom based on the temperate use of food, and which 
 is determined by the individual condition of the 
 patient. The only thing on which I lay stress is 
 eating slowly, and masticating the food well. In 
 the place of an ABSTINENCE-CURE I prescribe a 
 NOURISHMENT-CURE, which results in the proper 
 assimilation of the food ; for my object is to produce 
 
 A CHANGE IN THE BODILY CONSTITUTION AND 
 TO REGENERATE THE ORGANISM. 
 
 For my dietetic regimen I therefore laid down the 
 following rules : Articles of food which have an 
 immediately strengthening and nourishing effect, and 
 which are free from any particular acids, are to be 
 allowed ; further, wines which have a quiescent effect, 
 and do not heat the system — for which purpose I 
 prescribe a claret which contains but little sugar, 
 and light Moselle wines. As to the rest I permit 
 my patients to select easy digestible animal and 
 vegetable articles of food which are free from 
 starch. 
 
 As a preparation for my treatment, that is up to 
 the time when the real treatment begins, I insist 
 upon the diabetic patient, according to his bodily 
 condition, observing the following dietetic rules : 
 (one of the objects to be attained is breaking the 
 habit of a second breakfast, so as not to disturb the 
 process of digestion too often.) 
 
 Breakfast. — 200 grammes of beef-tea, with as 
 many grammes of beef-broth, and 50 grammes of 
 gluten-bread with fresh butter ; or else use the 
 
i^Q. Diabetes. 
 
 chrome-bread introduced several years ago by myself 
 (bichromate of potassium 0*05, distilled water 20*0, 
 mixed with two pounds of dough used for white 
 bread) ; of this bread patients are very fond. Tea 
 or coffee without milk (in the place of milk use 
 cream and eggs), unsweetened with sugar (in the 
 place of sugar use saccharine). 
 
 The above chemical substance prepared, in 1879, 
 by Dr. Fehlberg, of New York, out of the products of 
 coal-tar, which on account of its similarity to sugar 
 is called saccharine^ dissolves easily in alcohol and 
 ether, and also in hot water, tea, coffee. It is 280 
 times sweeter than the common sugar, and possesses 
 the property of leaving the body without being 
 decomposed, and of appearing again in the urine 
 in the form of saccharine. It does not interfere with 
 the digestion, nor does it exert any injurious effect 
 on the organism. Besides, it possesses slight anti- 
 fermentative properties. At present it is offered for 
 sale in easily soluble tablets prepared with carbonate 
 of sodium. 
 
 Dinner. — Oysters, snails, mussels, crawfish, 
 lobster, crabs ; dishes prepared of eggs without any 
 flour ; fish, fried or stewed with butter, served with 
 a sauce made of eggs (caper-sauce or lemon-sauce). 
 Meat of all kinds, which must either be roasted 
 or stewed. Beef-tea and stewed vegetables pre- 
 pared with soup and butter, such as spinach, sorrel, 
 French beans, scorzonera, cauliflower, Brussels 
 sprouts, savoy, and fresh mushrooms. Salads : 
 Watercresses, lettuce, endive, dressed with oil and 
 
Therapeutics of Diabetes. 153 
 
 citric acid, for a change. Radishes, cucumbers 
 pickled in salt-water, but not in vinegar. 
 
 Blanc- mange, prepared of the white of eggs beaten 
 up and flavoured with vanilla, lemon, raspberries, or 
 whortle-berries (bilberries), and sweetened with 
 saccharine. 
 
 For DESSERT, only a few nuts and almonds are 
 allowed, since they dry up the mucous membranes 
 too much. The patient also may eat one apple, 
 not sweet ; also all kinds of cheese. 
 
 When the bowels are constipated the patient may 
 partake of sour milk as a dietetic remedy. 
 
 The SUPPER ought to consist of the very same 
 ingredients as the dinner, only the dishes ought to 
 be fewer in number. 
 
 With most patients I prescribe the exact quantity 
 of food. 
 
 For DRINKING I allow good spring water, not too 
 cold. When the thirst is excessive I administer 
 light, warm tea with a lemon-slice. 
 
 For the meals, or, still better, immediately after 
 the meals, I allow old claret, if it is unadulterated. 
 It is preferable to other wines, since it contains only 
 o'2 per cent, of sugar, and also contains more 
 tannin, and is less acid than wines of the hock 
 kind. 
 
 After ^M^xy meal the patient has to remain passive 
 from 30 to 60 minutes. It is best for him to sit 
 during this period in an easy chair. 
 
 Articles to be avoided : Sugar, and dishes 
 prepared with sugar, also farinaceous dishes, and 
 
154 Diabetes. 
 
 gravies prepared with flour and the like. I also 
 forbid : asparagus, parsnip, all leguminous plants, 
 potatoes, chestnuts, and sweet fruits. 
 
 Absolutely prohibited are all kinds of soda 
 water and sweet beverages. 
 
 Smoking must be reduced in quantity, or is to 
 be abstained from altogether. According to circum- 
 stances I allow from one to two light, good cigars. 
 The orders as to smoking change according to the 
 development of the disease. 
 
 Medicines against Diabetes. 
 
 The application of medicines is determined by the 
 object which it is sought to reahze. Medicines are 
 prescribed differently where the object to be attained 
 is simply to suppress symptoms and their conse- 
 quences, from what is the case — as in my own 
 practice — where the physician attacks the very 
 fundamental cause of a disease. 
 
 A countless number of medicines and remedies 
 (without mentioning bleeding, which was still advo- 
 cated by Prout) have been proposed, and in the 
 course of time have again been abandoned. Rubri- 
 cating and enumerating them results in a total 
 condemnation of the therapeutics of diabetes so far 
 as the application of medicines is concerned, for 
 thus far not a single specific medicinal remedy 
 against diabetes has been discovered. 
 
 Emetics and purgatives have been employed in 
 order to regulate the action of the stomach ; rennet, 
 
Therapeutics of Diabetes. 155 
 
 acids, and alkaline salts In order to replace the diges- 
 tive fluids; oxygen, chlorine, etc., in order to promote 
 the combustion of the sugar ; narcotics in order to 
 react on the nervous system ; alcohol and lactic 
 acid in order to replace the sugar, etc. 
 
 In order to handle more conveniently the vast 
 number of medicines which have been tried, I pro- 
 pose to classify them : {a) into specifics and {b) 
 Into such as are calculated to improve the tone of 
 the system. 
 
 {a) Specifics. 
 
 Among these, narcotics have hitherto occupied 
 the first rank, to which, however, I take exception. 
 
 The chief remedy has been opium^ which was 
 recommended by Rollo, as well as by Jos. Frank, 
 and which was strongly advised by M. Gregor, in 
 1837, on the ground of its diminishing the secretion 
 of the sugar. It was also recommended by Kratsch- 
 mer (" Wiener acad. Sitzungsber.," Vol. Ixv., Vienna, 
 1872) ; further, by Fiirbringer, while the practitioner 
 Dickinson declared that he reaped more harm 
 than good by prescribing opium ! In small doses, 
 opium sometimes reduces the feeling of thirst 
 and hunger, since it diminishes the secretion of the 
 urine, interferes with the excretion of sugar, and 
 causes a patient to put up more readily with the 
 monotony of the diabetic diet ; it also preserves 
 the weight of the body. Frerichs, like myself, 
 pronounced against the derivative use of niorphium 
 which had been successfully employed by others 
 
156 Diabetes. 
 
 {e.g., by Kretschy, " Wiener Med. Zeitschrift," 
 1873, Nos. 3 and 4), and also against the use of 
 codeiuy which Smith and Pavy preferred among the 
 alkaloids of opium, and which they prescribed three 
 times per day in doses from one to four grammes 
 (even as other narcotics have also been prescribed, 
 e.g., belladonna, cannabis, calabar, and ergotine — an 
 ingredient of secale cornutum, together with bromide 
 of potassium, strychnine, quinine, etc.). Frerichs 
 administered opium up to 2*04 ^^r day. But, like 
 Seegen and others, he had to make the unpleasant 
 experience that the body soon gets accustomed to 
 opium, so that in the course of time a diminished 
 influence, or none at all, is obtained from it. 
 
 Besides opium, only a few other specifics exert a 
 decided influence upon the symptoms of diabetes, 
 and either one or the other of these medicines — but 
 only in very definite, individual cases, and solely 
 with the view of counteracting such symptoms, I 
 include in that combination of curative ao;encies 
 which makes up my method of treatment. 
 
 The modern practitioners have applied the anti- 
 zymotic remedy, salicylic acid. Frerichs recommends 
 it as worthy of being tried. Hoffmann finds it effective 
 in " recent cases " [probably in glycosuria], and he 
 orders from five to ten grammes daily. In prolonged 
 cases [hence in active diabetes ?] he finds its effect 
 injurious. 
 
 Salicylate of sodium (from eight to ten grammes 
 per day) was first prescribed by Ebstein, afterwards 
 by Kamen, Fiirbringer, Fetters, Hoffmann, etc. The 
 
Therapeutics of Diabetes. i^y 
 
 latter gentleman maintains that by means of it he 
 cured three-sevenths of all his cases [?]. 
 
 Ebstein maintains that salicylic acid has a decided 
 effect upon diabetes, and Hoffmann is of the opinion 
 that of all the medicines employed against diabetes 
 mellitus, it possesses more than any other the char- 
 acter of a specific. 
 
 In recent cases the sodium preparation of salicylic 
 acid is almost exclusively employed (from five to ten 
 grammes ^er day). Fiirbringer is of the opinion 
 that in the most obstinate form of diabetes, when no 
 medicine seems to be able to act any more, the 
 salicylate of sodium, as well as phenol, by reducing 
 the elimination of nitrogen, are able to bring about a 
 favourable turn. 
 
 Ebstein and J. R. Miiller have first employed suc- 
 cessfully phenol (carbolic acid) in diabetes mellitus. 
 Nevertheless, Ebstein, who at first claimed that 
 opium, phenol, and salicyline were the chief remedies 
 which exert a specific influence upon diabetes, was 
 obliged to acknowledge afterwards that he did not 
 estimate their practical importance very highly, 
 although by means of them you are able to exert an 
 influence upon some of the complications of diabetes, 
 for instance, upon neuralgia. The aim of his thera- 
 peutics is now to increase in the tissues the forma- 
 tion of carbonic acid, which is too scanty in com- 
 parison with the food introduced into the system ; 
 and indeed {a) indirectly through a diet, which will 
 supply the appropriate material for this purpose ; 
 and [h) by stimulating the development of carbonic 
 
158 Diabetes, 
 
 acid in the protoplasm of the tissues and in the 
 organs of the body by intensifying the activity of the 
 muscles. He asks here whether by an increased 
 introduction of carbonic acid (by the drinking of 
 carbonated waters) we are not really able to com- 
 pensate for a relatively insufficient development of 
 that gas in the tissues ? This question, however, 
 does not seem at all indicated, for practical experi- 
 ence in many cases has deemed it necessary to 
 reject the use of carbonated waters. 
 
 Habershon employed carbolic acid as early as 
 1870 ; Ebstein and Jos. Miiller have used it after 
 him. Both found that the sugar disappeared in the 
 same degree in which the introduction of food was 
 reduced. 
 
 Felizet more recently maintains that by an appli- 
 cation of bromide of potassium he has stopped the 
 irritation of the medulla oblongata, which he re- 
 gards as the cause of diabetes. 
 
 Forster combined chloride of iron with bromide 
 of potassium. Clemens declares ('' Allg. mediz. 
 Centr. Blatt.," 1882) that by bromide of arsenic he 
 cured radically severe cases of diabetes [?] 
 
 Laube administered daily \ gramme of arsenic 
 (solut. Fowl. 30 gutt.). Likewise Kiilz and Leh- 
 mann. Lecorche also used it; he showed by his 
 experiments that in the animal on which he operated 
 the glycogen of the liver was diminished in quantity. 
 Kretschy, however, says that he was not successful 
 in the administration of arsenic. 
 
 Frick experimented with secale cornutum; Hunt 
 
Therapeutics of Diabetes. 159 
 
 with ergotine. Other substances that have been 
 employed are as follows : copaiba, benzoic acid, and 
 benzoate of sodium ; tincture of iodine by Seegen, 
 chloral by Eckhard, eucalyptole by Carlatti, potas- 
 sium permanganate by Masoin. 
 
 Cantani considered lactic acid as a substitute for 
 sugar for the purposes of respiration. He adminis- 
 tered from 5 — 10 grammes of acid. lact. purum, and 
 250 — 300 grammes of aromatic water after the meals. 
 By this means he intended to remove the sugar from 
 the urine. I did not notice any beneficial result from 
 their use ; neither could I become convinced of the 
 beneficial result of glycerine which was applied by 
 Schultzen (see " Bed. klin. Wochenschrift," 1872), 
 and more recently by Hoist, Petersburg; other 
 physicians also, e.g.^ Blumenthal, J. Mayer, Kiilz, 
 Ziemssen, Kussmaul, either obtained no effect from 
 it, or a merely negative one. 
 
 Moleschott reports that he successfully used 
 iodoform. 
 
 Yeast also was prescribed by some. Kussmaul 
 obtained a favourable result by injecting diastase 
 into the blood. 
 
 Leyden reports (in '' Berl. klin. Wochenschrift," 
 1877) that /'z7<9^^r^m^ injections exercise a stimulat- 
 ing effect upon the nerves by which the vessels are 
 enlarged ; just as, for instance, the drinking of water 
 heated to 140 — 160° F. produces an increase in the 
 action of the heart and an increase in the tempera- 
 ture (see Glax, '' Mittheil. in Sitz. Ber. d. Akad. d. 
 Wissenschaft." 1877). Cantani, indeed, after the 
 
1 60 Diabetes. 
 
 use of pilocarpine, no longer discovered any sugar 
 in the transpiration of the skin. v. Hoffer also em- 
 ployed sub-cutaneous injections of pilocarpine at 
 intervals of 10 days, thus five injections in 50 days, of 
 a solution of two pei- cent, of the alkaloid. It exerted 
 such an effect on polyuria that the daily amount of 
 urine decreased 5,900 Cc, and the secretion of sugar 
 diminished from 564 to 224 grammes per day. 
 
 I have employed experimentally this last medicine, 
 as well as all those that have been enumerated above ; 
 I prescribed it internally, and as a palliative medicine 
 it has exercised a remarkable effect. 
 
 Finally, I introduced into my combination-method 
 with extraordinary effect both chr ornate of potassium 
 and preparations of mercury, and, indeed, internally, 
 as well as externally in the massage, as these remedies 
 seemed to be indicated by the case in question. 
 
 Internally I employ the corros. sublimate- albumi- 
 nate, prepared according to Bamberger's well-known 
 prescription ; but I never employ it subcutaneously. 
 I also prescribe chrome-water after the carbonic 
 acid has escaped from it, which remedy has been 
 tested in cases of lues by Giinze in Dresden, and 
 the curative effect of which has been confirmed by 
 myself. 
 
 {h) Strengthening Remedies. 
 
 Under the above head the following remedies 
 have acquired some distinction : Preparations of 
 iron, quinine in small doses (Blumenthal adminis- 
 tered daily from 0*4 — 2 gr. of muriate of quinine) ; 
 
Therapeutics of Diabetes. i6i 
 
 cod-liver oil, recommended especially by Buchheim 
 and Senator, and lastly, alkaline salts. 
 
 Alkaline salts. Carlsbad. — Although in 
 some special cases the sodium bicarbonate, which 
 was frequently employed by myself, has proved very 
 effective, the hot alkaline waters of Carlsbad in parti- 
 cular, which were recommended already by Hufeland, 
 have produced most wonderful effects, especially 
 in cases of glycosuria ; while the waters of Mchy, 
 Neuenahr (which Vocke recommends on account of 
 the absence of Glauber-salts), Vals, and other alka- 
 line springs containing carbonic acid, only promote 
 the thirst and the secretion of urine, and increase the 
 dryness in the mouth. During winter Seegen pre- 
 scribed daily one bottle of Celestin or Grande grille 
 of Vich)^ Schmitz sings the praises of Neuenahr 
 as furnishing a specific remedy against diabetes (see 
 " Four cases of diabetes cured '' [?], in " Berl. klin. 
 Wochenschrift," 1873). 
 
 The Carlsbad waters certainly do not exercise any 
 specific effect on genuine diabetes, but their effects 
 upon the conditions of the blood-circulation in the 
 liver, upon the raising of the tone of the whole system, 
 upon the transformation of constitutional states and 
 complications, upon increasing the tolerance for 
 amylaceous substances, etc., are so much the more 
 striking. In thousands and thousands of cases they 
 have caused the sugar to disappear from the urine, 
 and have healed glycosuria. Statistical proofs of the 
 efficiency and significance of the Carlsbad waters 
 have been furnished by Anger, Senator, Seegen, 
 
 M 
 
1 62 Diabetes. 
 
 Griesinger, L. Fleckles, F. Fleckles, Hoppe-Seyler, 
 Emil Pfeiffer (in " Balneol. Studien," Wiesbaden, 
 1880), Hlawacek, Kiilz, Loignard, and others. 
 
 Carlsbad certainly brings relief also to those 
 afflicted with diabetes, if, in addition to the 
 " sprudel," rich in alkalies, there are applied the 
 requisite medicines and a rational method of cure. 
 
 TJie use of tJie Carlsbad waters has thus far not 
 been able to cure diabetes radically ! But it has 
 justly been considered as a matter of importance 
 that Carlsbad is able to stop temporarily the feeling 
 of thirst, the greedy hunger, and polyuria, and further 
 that it increases the tolerance of the system for 
 hydrates of carbon, and has prolonged life for years. 
 
 Senator, Kiilz, Riess, and others prescribed Carls- 
 bad waters for their patients in hospitals, but they 
 did not meet with any success ! Most assuredly 
 they would fail to do so. For those efficient, col- 
 lateral elements by which the action of the waters in 
 Carlsbad itself is supported, namely, a cheerful state 
 of mind, relieved of cares and freed from anxiety — 
 further, muscular action by climbing the forest-clad 
 hills of Carlsbad, with leisurely walks on its sunny 
 heights — cannot be administered in the hospitals at 
 the same time with the waters. 
 
 Since I claim " hereditary lues" as the aetiological 
 element of diabetes, the use of the hot Carlsbad 
 waters, regulated for individual cases, is of especial 
 value as one of the factors in my therapeutical system. 
 
 Paquelin. Where there are complications with 
 albuminuria I have obtained most favourable results 
 
Therapeutics of Diabetes. 163 
 
 by a simultaneous cauterization of the back with this 
 instrument. 
 
 A Summary. After numberless experiments, by 
 combining a hygienic treatment with a careful bodily 
 and mental diet ; by thus utilizing and uniting in one 
 system the various agencies detailed in the present 
 chapter, and by applying the few approved medi- 
 cines, I have succeeded in bringing about a trans- 
 formation of the defective protoplasm, and in effecting 
 a lasting cure of diabetes. 
 
 I am now enabled to prognosticate with certainty : 
 Such a case of genuine diabetes is curable^ while 
 another case, on account of the advanced state of 
 the sclerotic processes, is indeed capable of being 
 ameliorated, but not of being radically cured, because 
 the protoplasm is no longer capable of being recon- 
 structed. 
 
 In bringing the present monograph to a close I 
 shall confine myself to a report of the first twelve 
 cases of diabetes in which I have applied my method 
 of cure, and by which I have demonstrated the 
 curability of diabetes. 
 
 I selected by preference cases which date from 
 the first period when my efforts of curing diabetes 
 became successful, namely, from the year 1881. 
 My object has been to show that the disease which 
 was cured then has not reappeared during the ensuing 
 six, and respectively seven years. I hope at some 
 future time to be able to communicate an account 
 of a great number of additional cures in a strictly 
 scientific treatise on the Therapeutics of Diabetes. 
 
XII. 
 
 A FEW STRIKING AND SIGNIFICANT 
 ACCOUNTS OF CASES OF DIABETES 
 FROM THE YEAR 1881. 
 
 The first twelve cases of diabetes cured from among 
 a great nufnher of cases successfully treated by 
 myself. 
 
 (i) Marie H., 13 years old, from New York, 
 arrived in Carlsbad on May 13, 1 881, in company 
 with her father. The patient was somewhat ema- 
 ciated ; her countenance had an intelligent expres- 
 sion. Her person was not yet developed. 
 
 The skin was very well taken care of, but very dry. 
 The complexion of the face and of the whole body 
 being pale, its lymphatic habit exhibited consider- 
 able deposits of pigment, and in various parts of the 
 body and of the lower extremities epithelial growths 
 of the size of lentils, in groups of ten or twelve, were 
 scattered ; there were also warts of the size of 
 lentils, and even of peas. The hair was of a dark- 
 brown colour and bristly ; the nails of the two great 
 toes were much thickened and out of shape. So- 
 called white lucky spots were on the nails of the 
 hands, the results of disturbances in the assimilation 
 of the food, of the kind very frequently met with in 
 youth and even as late as the thirtieth year. 
 
Accounts of Cases of Diabetes. 165 
 
 The lymphatic glands on both sides of the cervical 
 vertebrae, as well as the inguinal lymphatic glands 
 were swollen ; the former felt as though hardened. 
 Several of the teeth were carious. 
 
 The left side of the surface of the tongue had deep 
 indentations ; while the right side was normal. It 
 was reported that she had been a healthy child, but 
 had a difficulty in teething. From her seventh year 
 she attended school, was diligent in her studies, and 
 had a quick apprehension. 
 
 In January of the present year (1881) she was 
 overtaken by a cold shower, and came home from 
 school wetted through. Soon after, she complained 
 of headache, and especially of pains in the occiput ; 
 she lost her appetite, but in a few days she became 
 ravenously hungry and her thirst increased. 
 
 The physician who was consulted kept the young 
 patient for a few days in bed in order to observe her, 
 and on analyzing her urine he found that while its 
 specific gravity was ro36, it contained 4*2 per cent. 
 of sugar. 
 
 The well-known diet and a corresponding treat- 
 ment were prescribed ; and as her condition was 
 only temporarily relieved during the ensuing weeks, 
 it was resolved to send her to Carlsbad. 
 
 After gathering all the above information I felt 
 compelled to examine the father as well, who com- 
 plained of all kinds of troubles of the digestive 
 organs. I learned from him that he was a captain 
 in the navy ; that while a midshipman, when 18 years 
 of age, and one year before his marriage, 
 
1 66 Diabetes. 
 
 HE WAS LUETIC ; that he was pronounced cured 
 by the doctors, and that only then he resolved to 
 marry. The mother, he said, was perfectly healthy. 
 
 2ist May. — While undergoing the well-known diet, 
 the urine of 24 hours amounted to 2,100 ccm. ; it 
 was nearly of the colour of water ; its specific gravity 
 was I '038 ; and it contained \'6 per cent, of sugar. 
 
 22nd May. — The treatment began, consisting of 
 the drinking of Carlsbad water and the taking of 
 baths, together with the internal remedies men- 
 tioned above, and the massage of the whole body. 
 The thermometer, which was applied between six 
 and seven o'clock in the mornings and evenings, 
 constantly exhibited the following minute fluctua- 
 tions : 36"2 — 36'5 — 36*7° C. 
 
 The intelligent father himself examined the urine 
 daily, most accurately. He was also very expert in 
 the use of the apparatus for polarization. 
 
 On July 28th the patient left Carlsbad with the 
 instruction to continue the prescribed diet and the 
 internal treatment, together with the massage and 
 the baths, until November. From that date I per- 
 mitted her at intervals to return to the ordinary 
 diet, but the Turkish baths, which I had ordered, 
 were to be continued. 
 
 From time to time I received the gratifying news 
 that the sugar had not reappeared and that Miss 
 Marie H. v/as enjoying the best health. 
 
 She married in the month of May of 1886. 
 
 (2) Lady v. S., aged 28 years, of a delicate 
 constitution, daughter of a landed proprietor in 
 
Accounts of Cases of Diabetes. 1 67 
 
 Northern Germany, who had been in the army, and 
 who had died in his 62nd year of diabetes. She 
 reported that in her youth, when she was 16 years 
 of age, she, and also an elder sister, suffered from 
 green sickness. 
 
 When 20 years of age she married, and quickly 
 in succession bare six children. After the birth of 
 the fifth child already, in 1879, she did not feel quite 
 well ; her stomach was frequently out of sorts. In 
 the year 1880, in the third week after the birth of 
 her last healthy child, she was suddenly seized with 
 a ravenous hunger and a violent thirst, coupled with 
 dryness of the mouth. 
 
 Her teeth, which had hitherto been perfectly 
 healthy, became sensitive during mastication, and 
 the two upper incisors came out without pain. 
 
 After she had become emaciated her urine showed 
 7 per cent, of sugar. 
 
 When an examination was made on July 24th, 
 1 88 1, her skin appeared dry; epithelial growths 
 were here and there over the whole body ; there 
 were strongly developed varices on each of the 
 lower thighs, especially on the right side ; all the 
 toe-nails were deformed, without being thickened ; 
 the lungs and heart were healthy ; the right lobe 
 of the liver was enlarged. The quantity of urine 
 passed during 24 hours was from \\ — 9 pints ; its 
 specific gravity was 1*038, and it contained 6*4 per 
 . cent, of sugar. 
 
 The treatment lasted until the end of September, 
 with interruptions during the menses. On September 
 
1 68 Diabetes, 
 
 26th the quantity of the urine was reduced to 1,500 
 ccm., and the sugar had reached zero. 
 
 The hygienic treatment and the diet were continued 
 until December. On Christmas eve she was able 
 to try farinaceous food with milk, after she had been 
 allowed to eat bread and fruit (an apple) since Sep- 
 tember. The urine remained normal. The patierit 
 has remained healthy to the present day ! 
 
 (3) On July 3rd, 1881, General N.^ from Russia, 
 presented himself. He was 59 years of age, of a 
 herculean stature, and had scarcely any hair left on 
 his head. He reported that he had enjoyed good 
 health while a young officer, until in the Caucasus, 
 where he was stationed, he was repeatedly attacked . 
 by intermittent fever. 
 
 After he had been removed from the Caucasus to 
 Odessa, and thence to Warsaw, he recovered his 
 health, but he often complained of headache. When 
 36 years of age he married. He is the father of 
 three children who are all very scrofulous. 
 
 His father frequently suffered of tetter, and 
 he died of tuberculosis when a^i years of age ; as a 
 young man he had been twice treated for venereal 
 disorders. 
 
 The body of the patient, which was somewhat 
 emaciated, exhibited a very dry skin. Epithelial 
 growths in the form of jagged, little warts were on 
 the neck, abdomen, upper thigh ; and on either side 
 of the vertebral column there were dark red spots of 
 the size of pin-heads to the size of a pea ; deposits of 
 pigment were here and there, and the nails of the 
 
Accounts of Cases of Diabetes. 1 69 
 
 big toes were much thickened. On either side of 
 the scrotum there was prurigo, and in the palm of 
 both hands psoriasis. 
 
 Three years previously five healthy teeth had 
 fallen out without pains. The surface of the tongue 
 exhibited deep indentations ; the mouth great dry- 
 ness. 
 
 The patient had always enjoyed a good appetite ; 
 for about the space of a year he had experienced a 
 violent thirst, and on examination a percentage of 
 5*6 of sugar was discovered. The remedies which 
 were applied (bromide of potassium, Vichy-water, 
 opium) had only a temporary effect. 
 
 Lungs and heart healthy, stomach extended, liver 
 and spleen enlarged. Frequent constipation alter- 
 nated with diarrhoea. The percentage of sugar was 
 5"3 ; during 24 hours there were secreted 6\ pints 
 of urine. 
 
 A treatment at Carlsbad for three months, with 
 the aid of the proper medicines, massage, and 
 Russian baths produced a complete cure. The 
 patient is enjoying good health at the present 
 day. 
 
 (4) Anna B., 9 years old, was brought to me by 
 her healthy mother. I was informed that since 
 March, 1881, the child had fallen off very much ; 
 that she was tired, complained always of fatigue, 
 drank much, and constantly craved to eat. All this 
 was attributed to the quick growth of the child, until 
 at last the physician proved the existence of diabetes 
 mellitus. 
 
lyo Diabetes. 
 
 The father had led a very irregular life, and 
 was treated, among other things, for condylomes of 
 the rectum. 
 
 I saw the child for the first time on July i6th. I 
 was struck by the strongly developed head of the 
 very emaciated young patient. 
 
 The prevailing tendency of the body was scrofu- 
 lous, the skin dry and cracked, the complexion 
 dark ; there were very many scars of furunculous 
 ulcers which the child had passed through ; the 
 nails of the hands and feet were deformed and 
 brittle. 
 
 An iritis which the child had gone through had 
 left a synechia in the right eye. The teeth were 
 carious, the gums bulged out, the tongue was 
 normal, and there was an odour of acetone. 
 
 The body was bloated, and there was an accele- 
 rated action of the heart, but the respiration was 
 normal. The temperature indicated 36*4° ; the 
 urine which was passed during 24 hours amounted 
 to 1,800 ccm. ; it was very pale, and its specific 
 gravity was i'040. The percentage of sugar was 5*4. 
 
 After the use of the Carlsbad waters for two 
 months, in conjunction with Russian baths and 
 wet sheet packings, together with the medicines 
 specified above, and massage, as explained in the 
 last chapter, there resulted a complete cure ; the 
 use of the medicines and a dietetic treatment were 
 continued for six months. The patient has remained 
 healthy to the present day. 
 
 (5) Lieutenant R. passed successfully through the 
 
Accounts of Cases oj Diabetes. 1 7 1 
 
 Franco-Germanic war of 1870-1871 ; only he con- 
 tracted a chronic catarrh of the stomach and bowels. 
 
 For several years he suffered of this illness, until 
 at last there was added to it a fistula of the rectum. 
 The fistula was operated upon and healed, where- 
 upon the patient underr^-ent a regular treatment 
 with the view of being freed of his catarrhal affec- 
 tion. 
 
 The medical man who treated him noticed some 
 furunculous ulcers on his back and along his legs, 
 which the patient informed him he had been troubled 
 with for several months. 
 
 The patient, who complained of great thirst, but 
 who had a craving for food only at intervals, was 
 very much emaciated, and in a low state of health. 
 After his urine had been examined it was found that 
 he had 6 per cent, of sugar, when the usual remedies 
 against this illness were employed. He got alter- 
 nately better and worse, until at last he presented 
 himself before me in Carlsbad in the month of August, 
 1881. 
 
 He was then 31 years old ; he was very emaciated, 
 the hair on his head was very scanty, his skin was 
 excessively dry ; there were many epithelial gro-ujths 
 on his body and neck ; his teeth were carious ; his 
 tongue was plowed through by deep fissures, and 
 very dry. His urine during 24 hours amounted to 
 4-^ pints, and contained 6"] per cent, of sugar. 
 
 The parents, brothers, and sisters of the patient 
 were said to be healthy, but his grandfather Jiad 
 suffered of dry tetter^ and had died of consumption. 
 
172 Diabetes. 
 
 The treatment of the patient lasted for four 
 months. During that time he constantly increased in 
 flesh ; he was perfectly healed, and up to the present 
 time he is a railway officer in the Prussian state. 
 
 (6) Nicholas O., 34- years old, from Bavaria, a 
 commercial traveller, middle-sized ; for many years 
 he had complained of troubles in his digestion. He 
 was frequently compelled to interrupt his journeys 
 by bleedings from piles, until at last he resolved to 
 undergo an operation. 
 
 In the year 1880, after undergoing this operation, 
 he had an anthrax on the right shoulder-blade, which 
 healed only very slowly, and reduced him very much. 
 After recovering from it he rejoiced at his good 
 appetite and his desire for much beer, until at last 
 his thirst could no longer be quenched. 
 
 At Strasburg he consulted a medical man with 
 whom he was acquainted. He discovered 9 per 
 cent, of sugar, and sent him to Neuenahr (see the 
 " Literature " below, under the head of " Schmitz ''). 
 He left the watering-place apparently healed, in order 
 to follow his avocation. Business exertions soon re- 
 duced him to his former condition, and he was 
 advised to go to Carlsbad during the same year. 
 
 Mr. N. O. called on me, on August 2, 1881. He 
 had a considerable accumulation of fat, his health 
 had very much run down, and he soon got fatigued 
 in walking. He was the son of a butcher, who had 
 inclined to apoplexy, and had died in his fifty - 
 fourth year. In his youth the father had been 
 treated several times for venereal infections. 
 
Accounts of Cases oj Diabetes. 1 73, 
 
 The complexion and skin of my patient were pale ; 
 he had a large mole on his upper arm. His toes 
 were contracted ; the nails of his big toes were 
 thickened ; the action of his heart was very weak, 
 84 beats of the pulse. 
 
 His teeth, which had been carious even during 
 childhood, showed many chasms. His digestion 
 was sluggish ; the urine which he passed during 
 twenty-four hours amounted to 3,200 ccm., and con- 
 tained ^'6 per cent, of sugar, with traces of albumen. 
 After remaining under my treatment at Carlsbad 
 to the end of September he had by that time lost 
 the sugar and the accumulation of fat, without having 
 diminished very much in weight. At A^ice he re- 
 mained from November to Februar}'. The usual 
 experiments which he underwent in respect to food 
 showed no sugar ; the albumen had disappeared ; 
 the patient felt vigorous, and began to enjoy life 
 again, for the pulsation of the heart also had become 
 more energetic. He has preserved his health to the 
 present day. 
 
 (7) Dr. med. N., from the southern part of 
 Russia, whose father isjas diseased iji his lungs, and 
 whose grandfather on his mother's side had been 
 luetic, enjoyed very good health until his 32nd year. 
 By over-exerting himself in his practice, which was 
 in the country, he contracted an inflammation of the 
 lungs in the spring of 1877. Since that time con- 
 stant catarrhal affections of the bronchia took the 
 place of his former robust state of health. After 
 some time asthmatic affections, with thirst and a 
 
1 74 Diabetes. 
 
 feeling of hunger, manifested themselves ; and these 
 affections became more and more pronounced, until 
 at last the patient began to lose f^esh ; 4 per cent. 
 of sugar were discovered. The remedies known at 
 that time were employed in order to combat the 
 diabetes, but only with a slight effect. 
 
 Prof. Tscherinoff, of Moscow, advised him to go 
 to Carlsbad. Family arrangements forbade the 
 patient, who was very low in his bodily condition, 
 to undertake the journey to Carlsbad before August, 
 1881. 
 
 The skin of the patient was dry, covered with 
 many pigmental spots ; epithelial groiioths were in 
 various places of the body ; the nails of the two 
 big toes were thickened, and embedded much in the 
 flesh. In the year 1878 he lost all his teeth except 
 three of the grinders ; they were perfectly sound, 
 and could be removed without pain and without 
 instruments. 
 
 He complained of being much troubled with piles, 
 without any loss of blood ; and of atony of the 
 bowels, which lasted for entire days. Heart and 
 lungs were normal. 
 
 After a treatment which lasted for six months he 
 recovered his full health ; and at present the former 
 patient enjoys a better state of health thaii he ever 
 did before. 
 
 (8) Herr v. F., 43 years old, landed proprietor 
 from Saxony, had been suffering of diabetes for 
 one and a half years. 
 
 When a young man he had been infected by a 
 
Accounts of Cases of Diabetes. 1 75 
 
 venereal (luetic) disease, and when upwards of 20 
 years old he had painful enlargements of the right 
 tibia, so that three times he was ordered to go to 
 Aix-la-Chapelle. 
 
 His tmcle on his mother's side had died of 
 diabetes. The mother is gouty ; but the father, he 
 said, was a strong, vigorous man, 70 years of age. 
 
 The patient had fallen off in flesh ; he had but 
 little hair on his head ; his skiit was dry with many 
 pigmental spots on the body ; the nails of the feet, 
 especially those of the big toes, were much thickened 
 and painful ; the teeth were remarkably well pre- 
 served ; the tongue was dry, with many fissures ; 
 there were a few plaques ; much thirst, but no 
 abnormal hunger ; the digestion had been disturbed 
 for many years, and he had used the most drastic 
 cathartics. 
 
 The quantity of urine during twenty-four hours 
 was three pints ; its specific gravity 1*042 ; and the 
 percentage of sugar 6' 7. 
 
 A treatment of three months at Carlsbad removed 
 all the ailments of the patient with the exception of 
 some traces of sugar ; and an after-cure of six 
 months restored his health completely. 
 
 (9) Mrs. G., 28 years old, from Russia, had been 
 married for nine years ; she had no children, and led 
 a. life under the happiest circumstances. Three 
 years ago the patient suffered of violent toothache, 
 and had four back-teeth pulled out. From that time 
 she felt very much weakened, so that she could walk 
 only with great difficulty ; and yet to her great 
 
1 76 Diabetes. 
 
 astonishment her appetite and her thirst kept on 
 increasing. 
 
 There was a remarkable increase in the secretion 
 of the urine ; diabetes was diagnosed, with one 
 gallon of urine secreted during twenty-four hours, 
 and 3 per cent, of sugar. 
 
 A treatment of eight months, of which ten weeks 
 were spent in Carlsbad, produced a thorough cure 
 in the mild climate of Nice. Meanwhile she gave 
 birth to a healthy child, and enjoys the very best 
 health. 
 
 Her father died early of consumption. Her grand- 
 father is said to have been treated several times with 
 mercury and iodide of potassium. 
 
 (10) University student, N., 25 years old, a 
 Frenchman, born in Tunis ; the son of wealthy 
 parents, both living. He has two older sisters, both 
 sickly and scrofulous ; and he had also a twin-sister, 
 who died soon after being vaccinated. The patient 
 himself, as a child, was sickly ; he was troubled with 
 all kinds of scrofulous affections, so that the family 
 physician, a doctor of medicine of the famous 
 medical school at Montpellier, advised the young 
 student to undertake a journey around the world. 
 
 The youth overjoyed his family in France by re- 
 turning to them after his journey as a stately young 
 man. He now considered himself sufficiently pre- 
 pared by his studies to be able to follow at once 
 a mercantile pursuit. Various attacks of inter- 
 mittent fever, however, by which he was overtaken 
 in his new home at Bordeaux, induced him to visit 
 
Accounts of Cases of Diabetes. 177 
 
 Nice, where I became acquainted with him. After 
 examining the patient carefully, who had lost much 
 flesh, it appeared that he had 6 per cent, of sugar. 
 The hot, alkaline springs of Carlsbad, as well as an 
 energetic apphcation of my remedies, restored him 
 permanently to a state of healtJi. 
 
 (11) J^oliu L., 41 years old, from Holland, the 
 descendant of an ancient, noble family, introduced 
 himself to me on July 29, 1881, with these words — 
 
 '' For four 3^ears I am suffering from diabetes, yet, 
 different from other diabetic persons, I have not 
 fallen off in flesh, but I have become feeble ; besides, 
 I am no longer young. Aly power of vision has 
 decreased, perhaps in consequence of my having 
 enjoyed prohibited dishes at a wedding last year." 
 
 The patient stated that he had as much as A^per 
 cent, of sugar. His three brothers and sisters died 
 in earliest infancy. His father, upwards of 70 years 
 of age, is still hale, but his mother died in her ^^th 
 year J in consequence of cancer in the breast. 
 
 A considerable accumulation of fat adorns the 
 patient, who weighs 14-^ stone. A scanty supply of 
 hair is on his head, while his back is covered with 
 strongly-developed hair. The nails of his hands, 
 all except the thumb of the left hand, which is almost 
 entirely wanting, are normal ; those of the feet are 
 very thickened and deformed. 
 
 His teeth are preserved all except two ; the tongue 
 exhibits deep indentations. Considerable accumula- 
 tion of fat about the heart ; fatness of the liver. 
 Digestion : great tendency towards diarrhoea. Alter- 
 
 N 
 
1^8 Diabetes. 
 
 nately a feeling of hunger and thirst. Result of the 
 ophthalmoscope — turbidity of the crystaUine lens on 
 each side. 
 
 Quantity of urine per day, 6^ pints ; 4*8 per cent. 
 of sugar ; traces of albumen. Temperature, 35*8 — 
 
 36° c. 
 
 A treatment of six weeks at Carlsbad, and an 
 after-cure in the Riviera of three months, produced 
 a lasting cure. 
 
 (12) Baron F. (the son of a Russian general), who 
 had been luetic in his youth, and had suffered from 
 tetter during his whole life, put himself under my 
 treatment on October 17, 1881. His grandfather 
 had died of consumption. He was educated at the 
 law school in St. Petersburg. When a child he 
 suffered from scrofula, which was proved by several 
 scars (scars of the lymphatic glands) on the neck, 
 but, thanks to the bodily training and the generous 
 treatment he received at the above institution, 
 he developed into a man of a herculean stature. 
 Being intelligent and very talented, after completing 
 his studies he entered into the civil service of his 
 country, already when 2 1 years of age. When 24 
 years old he married, and for 10 years, until he was 
 34 years of age, he felt perfectly well. 
 
 A sense of duty, as well as ambition, Induced 
 him to over-exert himself in his function ; his health 
 broke down, and he passed through a severe attack 
 of typhoid fever; after the lapse of months only he 
 was able to undertake again the responsibilities of 
 his public ofhce. He dragged in the performance 
 
Accounts of Cases of Diabetes. 179 
 
 of his duties. A leave of absence of twelve months 
 restored him to a comparative state of health. He 
 returned to St. Petersburg, and entered anew into 
 the public service. As a special mark of distinction 
 for his past services, and in acknowledgment of his 
 talents, he received the appointment of an assistant- 
 ship to a governor general in the far north, which 
 entailed upon him renewed exertions. When 39 
 years of age he quitted his onerous duties in order 
 to take care of himself, for an indescribable sense of 
 lassitude had come over him. About that time his 
 eldest son was seized with epilepsy, which worked 
 so much upon the feelings of the father that he was 
 seized with another attack of typhoid fever, and 
 regained his consciousness only after a number of 
 weeks. He now began rapidly to fall off in flesh, 
 notwithstanding his good appetite and an ever- 
 increasing thirst. They told him that he was 
 nervous, until at last sugar was discovered in his 
 urine. He was sent to Vichy, and for three years 
 into the Caucasian mountains (Esentuki), and again, 
 a year ago, to Neuenahr, with only a temporary im- 
 provement. 
 
 The patient was tall, had broad shoulders, was 
 very emaciated, had a dry skin, with epithelial 
 growths on his neck of the size of lentils. The nails 
 of the hands were well preserved ; those of the feet, 
 and especially those of the big toes, were thickened 
 and had imbedded themselves into the flesh ; at the 
 slightest touch they were painful. His hair was 
 scanty ; on the body and along the extremities the 
 
1 80 Diabetes. 
 
 hair had developed almost in the form of bristles. 
 His teeth, all except four, had fallen out painlessly j 
 the first tooth had come out as far back as six years 
 ago. The tongue was full of fissures ; the lungs and 
 the heart normal. The liver and spleen were enlarged. 
 The stomach was bloated, the digestion sluggish. 
 For two years he had been impotent. The quantity 
 of urine passed during 24 hours amounted to 4,70^) 
 ccm., with 8*4 per cent, of sugar. After he had 
 been treated according to my method for two months 
 the sugar showed o. When, after an after-cure of 
 two months, without the use of the Carlsbad waters, 
 but with a continuance of the medicines, he returned 
 to the ordinary diet in Russia, the sugar reappeared 
 after 20 days to the amount of 0*3 per cent. 
 
 The patient resumed his diabetic diet, and in the 
 November of 1882 rejoined me at Nice. My 
 treatment, which affects the change of substance 
 an.d the regeneration of the protoplasm, was con- 
 tinued till March. The patient then returned to 
 the ordinary diet, and has remained healthy up to 
 the present time, i.e., to February 28, 1887, conse- 
 quently for nearly six years, during which time he 
 resided at Malta. 
 
 Case 1 2 exhibits lues in a patient whose father, as 
 well as himself, had been born with scrofula, the 
 consequences of hereditary lues. 
 
XIII. 
 
 COROLLARIES IN SUPPORT OF THE 
 THESIS OF THE PRESENT WORK. 
 
 In presenting, from among the great number of 
 cures of diabetes which I have succeeded in effect- 
 ing since 1881, the first twelve cases, I had a distinct 
 object in view. 
 
 For, although I have still numerous interesting 
 cases to communicate, I nevertheless considered it 
 my duty to report, without choice, the first twelve 
 cases where a cure had been effected ; and, indeed, 
 for this reason, that the period from 1881 to 1887, 
 during which my patients have remained healthy, is 
 long enough to answer definitely in an affirmative 
 sense the question whether actually a radical, lasting 
 cure has been effected in those cases ; which, indeed, 
 fro7n a therapeutical point of view, is the chief thing 
 to he considered. 
 
 In a certain sense, also, the above twelve cases 
 are entitled to represent the hundreds of cures which 
 I have been enabled to make since 1881, for they 
 make up the first dozen of those successful cases by 
 which I was encouraged to make renewed exertions, 
 and to institute experiments on an extended scale. 
 They also have imparted to me that encouragement 
 which I needed in order by further treatment and 
 
1 82 Diabetes. 
 
 additional cures to perfect my system of therapeutics 
 in all its parts, so that at last it stands before me as 
 a fixed, accomplished fact. 
 
 It has been proved by experience that in all the 
 above twelve cases a radical cure has been effected. 
 
 The lasting character of these cures was confirmed 
 and attested by annual reports received from each 
 of my former patients. 
 
 The whole of these twelve cases, therefore, fur- 
 nish a final and striking confirmation of my two 
 theses — 
 
 (i) Diabetes is the result of a hereditary predis- 
 position, namely, of hereditary lues. 
 
 (2) Diabetes is curable ! 
 
XIV. 
 
 CONTRIBUTIONS TO THE HISTORY AND 
 LITERATURE OF DIABETES.* 
 
 The Roman physician Aulus Celsus (30 years 
 before Chirist, to 38 years after Christ) is the first 
 who has alluded to diabetes. He may justly be 
 called the Cicero of physicians, and he has handed 
 down to us, in a spirited and elegant style (in his 
 work De artihis of which, since the Florence edition 
 of 1478, at least 60 editions have appeared) the 
 entire medical knowledge and skill of the masters of 
 the earliest medical science even to those of his own 
 time. 
 
 In speaking of diabetes, he alludes especially to 
 the increased secretion of urine, which causes 
 emaciation and endangers life. The respective 
 passage (Celsus de Medic, 1. 8 rec. Daremberg, 
 Lips. MDCCCLIX, lib. iv., c. xxvii., 2) reads ver- 
 bally as follows : — '^ Quum urina super potionum 
 modum etiam sine dolore profluens maciem et peri- 
 culum facit, si tenuis est, opus est exercitatione et 
 frictione, maximeque in sole, vel ad ignem : balneum 
 rarum esse debet, neque longa in eo mora : cibus 
 
 * Also a guide to the publications which are important for 
 obtaining an understanding of the subject of diabetes, and to which 
 reference is made in the present work. 
 
184 Diabetes. 
 
 comprimens : vinum austerum meracum per aestatem 
 frigidum, perhiemem egelidum, sed tantiim, quantum 
 minimum sit. Alvus quoque vel ducenda vel lacte 
 purganda est. Si crassa urina est, vehementior esse 
 debet et exercitatio et frictio : longior in balneo 
 mora : cibis opus est teneris : vino eodem. In 
 utroque morbo vitanda omnia sunt, quae urinam 
 movere consuerunt." In an English translation this 
 passage reads as follows : — ** If the quantity of the 
 urine which is passed is larger than the quantity of 
 the liquids imbibed, even if such takes place without 
 pains, emaciation is caused, and life is endangered. 
 If the urine is thin, motion is required, and friction, 
 chiefily in the heat of the sun or before a fire. A 
 bath should not often be taken, nor ought you to 
 stay in it long. The food should be astringent : the 
 wine rough and unmixed, in summer cold, and in 
 winter a little warmed, but very little ought to be 
 taken of it. The bowels also should be kept open, 
 or purged with milk. If the urine is thick, the motion 
 and the friction should be more energetic ; you ought 
 also to stay longer in the bath. The food must be 
 light, and also the wine. Everything ought to be 
 avoided which is wont to act upon the urinary 
 organs." 
 
 The history proper of diabetes begins, therefore, 
 ■with Celsus, 1,(^00 years ago. 
 
 Aretceus^ a Greek physician of the eclectic school, 
 from Cappadocia (a contemporary of Nero), was the 
 most shining light that adorned the times of the 
 early Roman emperors, and, next to Hippocrates, he 
 
History and Literature of Diabetes. 185 
 
 was renowned in antiquity as the best observer of 
 diseases. He wrote in the Ionic dialect concerning 
 the causes, symptoms, and cure of acute and chronic 
 diseases. He derived the term " diabetes," which 
 was known before his time, from BLa/Salvco (a flowing 
 through of Hquids into the urine), and he considered 
 the stomach as the seat of the disease (see the edition 
 of Kiihn., Vol. xxv., Leipzig, 1828). 
 
 The description which Aretaeus gives of the 
 disease seems so strikingly faithful that we cannot 
 refrain from quoting it here in a free translation : — 
 " Diabetes is a strange disease, which fortunately 
 is not very frequent. It consists in the flesh and 
 bones running together into urine. It is like dropsy 
 in this respect that the cause of both is moisture 
 and coldness ; yet so that in diabetes the moisture 
 escapes through the kidneys and bladder. The 
 patients urinate unceasingly ; the urine keeps 
 running Hke a rivulet. The illness originates very 
 slowly. Its final development is death. The emacia- 
 tion increases very suddenly, so that the existence of 
 the patient is a sad and painful one. The patients 
 are tortured by an unquenchable thirst ; they never 
 cease drinking and urinating, and the quantity of 
 the urine exceeds that of the liquid imbibed. There 
 is no use either in trying to prevent the patient from 
 urinating and from drinking ; for if he abstains only 
 a short time from drinking his mouth becomes 
 parched, and he feels as if a consuming fire were 
 raging in his bowels. The patient is tortured in a 
 terrible manner by thirst. If he retains the urine 
 
i86 Diabetes, 
 
 the hips, loins, and testicles begin to swell ; the 
 swelling subsides as soon as he passes the urine. 
 When the illness begins, the mouth begins to be 
 parched, and the saliva is white and frothy. A 
 sensation of heat and cold extends down into the 
 bladder as the illness progresses ; and as it pro- 
 gresses still more there is a consuming heat in the 
 bowels. The integuments of the abdomen become 
 wrinkled, and the whole body wastes away. The 
 secretion of the urine becomes more copious, and 
 the thirst increases more and more. The illness 
 was called diabetes, as though it were a syphon, 
 because it converts the human body into a pipe 
 for the transflux of Hquid humours. Now, since the 
 patient goes on drinking and urinating, while only 
 the smallest portion of what he drinks is assimilated 
 by the body, Hfe naturally cannot be preserved very 
 long, for a portion of the flesh also is excreted 
 through the urine. The cause of the illness may be 
 that some malignity has been left in the system by 
 some acute malady, which afterwards is developed 
 into this disease. It is possible also that it is caused 
 by a poison contained in the kidneys or bladder, or 
 by the bite of the thirst-adder or dipsas. The bite of 
 this snake causes an almost unquenchable thirst, and 
 in trying to satisfy it the stomach is filled with water. 
 With some who suffer of this disease no urine passes 
 at all, so that they finally burst." 
 
 AretcBus excels Celsus in this respect , that he 
 dwells upon the unquenchable thirst, which is a 
 characteristic feature of the disease. As regards 
 
History and Literature of Diabetes. 187 
 
 the treatment which Aretaeus advises, it is as 
 follows : 
 
 " The disease of diabetes is a kind of dropsy,, 
 only that the water in diabetes runs towards the 
 kidneys and bladder, and is discharged in this way. 
 In treating it your purpose must be to diminish the 
 thirst. For drinking stimulates the desire to urinate, 
 and by the urine many parts of the body which 
 have become liquid are carried off ; wherefore such 
 remedies must be applied as lessen the thirst. The 
 treatment also must have regard to the stomach ; 
 for there lies the cause of diabetes. Let the body 
 be cleansed by the hiera [a sort of antidote against 
 poisons] ; make a poultice of ointment of spikenard, 
 mastix, dates, and quinces. The juice of quinces, 
 together with the oil of spikenard and the oil of 
 roses, is useful for pouring over the body. The 
 pulp of quinces also may be used as a cataplasm; 
 wax and the ointment of spikenards may likewise be 
 mixed with it. The juice of the acacia and of 
 kytinus hypocystis may also be used for this purpose. 
 
 " For a beverage use water in which summer-fruits 
 have been boiled. 
 
 " For food use milk, dishes prepared with milk, 
 starch, pearled barley, soups. Astringent wines, 
 especially very strong ones, are serviceable for 
 strengthening the stomach, and for evaporating and 
 diluting the other fluids of the body. A wine which 
 is astringent, and at the same time cooling, is useful 
 on account of its transforming and cooling pro- 
 perties ; while a sweet wine, just like the blood, 
 
1 88 Diabetes. 
 
 increases the strength, because it generates blood. 
 Of compound remedies, apply that of Vestinus, that 
 of Mithridates, the juice of fruits, as well as all 
 the other remedies, which are also useful in dropsy. 
 The whole diet and mode of living is identical with 
 that which ought also to be applied in dropsy." 
 
 The celebrated physician in ordinary of the young 
 Emperor Commodus, Claudius Galen (born 131 
 A.D.), the most influential medical practitioner of 
 antiquity (in " De loc. affect.," libr. vi., cap. iii.), is 
 of opinion that the cause of diabetes is a diseased 
 state of the kidneys. 
 
 Paracelsus (born in 1493, ^^ Maria Einsiedeln), 
 the reformer of the art of healing, which had been 
 condemned to remain stationary, returned to Hippo- 
 crates' treatment of diseases in conformity with 
 nature. He introduced the chemico-metallic medi- 
 cines ; he was the first author who treated syphilis 
 systematically; and he demanded that "science 
 among the Germans should be German." In his 
 work " De tartaro," lib. ii., he laid down as the cause 
 of diabetes "an increased formation of salt, pro- 
 ducing an irritation of the kidneys." 
 
 The renowned Italian physician and mathematician, 
 Geronimo Cardano (died 1575), who was called the 
 wisest fool, and the most foolish wise man of his age, 
 and whose writings are among the most important 
 literary monuments of the sixteenth century, compiled 
 already a table of the quantity of liquid nourishment 
 received by the body on the one hand and of the 
 urine which was discharged on the other. 
 
History and Literature of Diabetes. 189 
 
 ^yZ-yzW (1478-1555), who most earnestly recom- 
 mended the dissection of dead bodies, maintains (in 
 his '' Opera med.," Amsterdam, 1680, p. 724) that 
 diabetes originates from a faulty co7idition of the 
 blood ; which definition I write upon my own banner 
 to-day where I speak of the defective formation 
 of the protoplasm in persons suffering from diabetes. 
 
 Richard Mead ("Opera med.,'' London, 1744) 
 supposes diabetes to be a disease of the liver, and 
 to arise in consequence of an abnormal preparation 
 of bile, which, however, is pathologically false. To 
 mention only one thing — among the 64 dissections 
 of the bodies of persons who died of diabetes, 
 which are described by Griesinger, an enlargement 
 of the liver could be demonstrated only three times. 
 
 The Englishman Thomas Willis, with the excep- 
 tion of the Indian physicians, was the first who 
 about the year 1674 (see " Pharmaceutica rationalis 
 Oxenofordi ") discovered sugar in the urine by the 
 sweet taste of diabetic urine ; he therefore was the 
 first who diagnosed diabetes inellitus. Henceforth 
 there existed diabetes rnellitiis ; and able experi- 
 menters, such as M. Dohson (1775, who first 
 obtained sugar by evaporating urine), Poolj and 
 especially Th. Cowley and others, demonstrated the 
 existence of sugar {i.e.^ of crumbling, crystalline 
 sugar) beyond any shadow of doubt. 
 
 F. Howe proved the fermentation of diabetic 
 urine. 
 
 The Englishman John Rollo (1797) acquired 
 great merit by his dietetic prescriptions, recom- 
 
190 Diabetes. 
 
 mending animal food. He first recognized the 
 injurious effects of vegetable food on the formation 
 of sugar in the organism, and demanded a meat 
 diet for those afflicted with diabetes. His two 
 works entitled : " On diabetes mellitus," London, 
 1797 ; and his treatise "On diabetes mellitus, with 
 •chemical experiments by W. Cruikshank," Vienna, 
 1 80 1, are still consulted at the present day. 
 
 Henceforth the attention of the profession was 
 directed to the processes which take place during 
 digestion. Many dissertations and articles on this 
 subject appeared in the medical journals, as well as 
 the following treatises : — 
 
 W. P rout J "Inquiry into the nature and the 
 treatment of diabetes, calculus," etc., 2nd edition, 
 London, 1825; and " On the nature and treatment 
 of stomach and renal diseases," London, 1848, 
 with additional editions. 
 
 Venables, " A practical treatise on diabetes," 
 London, 1825. 
 
 Nicolas and Gueudeville supposed diabetes to be 
 a " phthisurie siicree/' caused by a disease of the 
 bowels. 
 
 With the view of obtaining an understanding of 
 the substances which contain and form sugar, 
 and also for the purpose of inquiring into the con- 
 stituents of the blood and urine, chemistry, which 
 Avas then beginning to grow strong and powerful, 
 was drawn upon for help. 
 
 Already, in 1835, the apothecary Amhrosiani 
 proved the existence of sugar in the blood, without, 
 
History and Literature of Diabetes. 191 
 
 on that account, being able to trace the cause of 
 the disease. 
 
 About this time (1835) Boitchardat returned to 
 the standpoint of Aretaeus, and declared that the 
 seat of the disease was in the stomach (see his 
 articles in the " Gaz. med.," of 1835, ^o- ^^ 5 
 further, in the "Rev. med.," 1839, Juin ; in the 
 '' Annuaire de Ther.," 1842, pp. 46, 48; in the 
 '' Clinique europ.," of 1859, p. 58 ; and, finally, in 
 the "Bull, de Ther.," p. 145, where he treats of 
 glycosuria.) 
 
 Mialhe looked for the seat of the disease in the 
 blood : in consideration of the fact that owing to an 
 obstruction in the secretion of the skin the alkaliza- 
 tion of the blood is diminished, and the combustion 
 of the sugar, which is possible only in the presence 
 of free alkalies, is interfered with, he urgently 
 advised the use of alkalies, which is really the only 
 remedy used by the profession up to the present 
 time, either in the form of medicine, or in that of 
 waters drunk at the various alkaline springs. 
 
 The French physician Piorry, between 1840 and 
 1850, ordered his patients to use as much sugar as 
 possible in order to replace the sugar which was 
 lost. 
 
 A new epoch in the history of diabetes was in- 
 augurated by the Frenchman Claude Ber?iardj in 
 so far as by the artificially produced glycosuria 
 through his so-called celebrated sugar-puncture 
 (piqiire), and also through curare, as well as 
 through his experiments upon the liver, with the view 
 
192, Diabetes. 
 
 of throwing light upon the formation of sugar, he 
 created the physiological experiment for the purpose 
 of ferreting out the cause of diabetes — which also is 
 the task I have proposed to myself (see Claude 
 Bernard's " Legons de physiologic experimentale," 
 Paris, 1855, ff. ; further, "' Le9ons sur le Diabete etla 
 Glykogenese animale," Paris, 1877. " Vorlesungen 
 iiber den Diabetes und die thierische Zuckerbil- 
 dung," translated into German by C. Posner, BerHn, 
 1878. Finally, see also C. Bernard's work entitled 
 " New functions of the liver as an organ which forms 
 sugar in man and animals," translated into German 
 by Dr. Schwarzenbach, Wiirzburg, 1853). 
 
 Lehmann entered upon the physiological experi- 
 ment almost at the same time as Bernard (see 
 Lehmann, " Bericht der Gesellschaft der Wissens- 
 chaft. zu Leipzig," 1850). 
 
 Bernard, the originator of experimental diabetes, 
 gave rise to numberless investigations from 1848 
 upwards, which were profitable to the physiology of 
 the production of glycogen, as well as to the patho- 
 logy of diabetes. He is of the opinion that his 
 operations and injections cause a vasomotory irrita- 
 tion, and thereby a hyperaemia of the liver, which 
 results in glycosuria. At all events he considers 
 the glycogen of the liver as a preparatory step for 
 the formation of sugar. Nevertheless, he still left 
 two questions involved in darkness; namely, {a) the 
 origin and use of glycogen ; and {b) the nervous 
 tracks by which the circulation of glycogen is deter- 
 mined. 
 
History and Literature of Diabetes. 193 
 
 The Englishman Pauy is of the opinion that 
 glycogen is subservient to the formation of fat. 
 According to him glycogen is caused by the reception 
 of sugar and starch, which through the agency of a 
 ferment contained in the blood is transformed into 
 sugar. Pavy, a disciple of Bernard, differs from his 
 master in supposing that the formation of sugar is 
 a post-mortal process. 
 
 Schiff—\N\\o still recommended, in 1859, amylaceous 
 food, lest the sugar be formed at the expense of 
 the elements of the body — Tommasi, Naimyn, and 
 others, on the basis of Bernard's investigations 
 instituted the most minute inquiries. The majoritv 
 of the learned favoured now the idea of the origin of 
 diabetes in the liver ; while some inquirers still as- 
 sumed other causes, as, for instance, atrophy, i.e., 
 a fatty degeneration of the pancreas ; namely, Skoda, 
 Oppolzer, and more recently Bdumel, who distin- 
 guishes between a fat, a lean, and a mixed form of 
 the pancreas, and recommends artificial preparations 
 of pancreas for the purpose of curing diabetes. 
 
 Voit and Pettenkofer maintain that diabetes 
 mellitus is caused by a too scanty reception of 
 oxygen. 
 
 Bence Jones, Leiihe, and others share this 
 opinion, but especially Prof. Cantani, of Naples 
 (" Diabetes mellitus," translated into German by 
 Hahn. BerHn, 1880). This latter gentleman 
 regards the sugar in the diabetic blood not as 
 glucose, but as paraglucose ; and he interested 
 himself most actively in the spread of this view. 
 
 o 
 
1 04 Diabetes. 
 
 Cantani says : " Diabetes is a disease of the change 
 of substance {Stoffivechsel). In this disease there 
 is no abnormal production of sugar, either quantita- 
 tively or qualitatively ; but the sugar which has 
 been introduced into the system, or which has been 
 generated there in a normal manner, is not made 
 use of for the purpose of being burned in the manner 
 in which this is done in animal organisms, nor is it 
 employed as a substance capable of undergoing 
 fermentation. It remains as a foreign substance in 
 the body, which is not utilized in the economy of 
 the organism ; for it cannot be made use of in the 
 processes which enter into the change of substance. 
 Wherefore it passes through the system in the form 
 of sugar, without undergoing a final transforma- 
 tion ; and it leaves the system through the urine 
 and the other secretions." 
 
 In animals in which glycosuria was produced 
 artificially it disappears by the injection of bicar- 
 bonate of sodium. This is explained by Cantani in 
 this wise — that the sugar is thereby rendered capable 
 of fermentation, and thus capable of being burned. 
 
 It was reserved for Ehstein to enter into the 
 mystery of the pathogeny of diabetes mellitus, which 
 disease is as interesting for the physiologist as it 
 is for the pathologist. In his treatise on diabetes, 
 which appeared only a short time ago, he has endea- 
 voured, by a remarkable series of experiments, to 
 present a relatively insufficient formation of carbonic 
 acid in the tissues and organs of a person affected 
 by diabetes, as that element which acts the part of 
 
History and Literature of Diabetes. 195 
 
 an instrumental cause in the production of diabetes. 
 By demanding a correction of the defective forma- 
 tion of carbonic acid, he pointed out to the medical 
 practitioners a means by which to cope with dia- 
 betes ; and he directed them to a method of thera- 
 peutics, such as I practised before him, ever since 
 the year 1881. 
 
 Many things worthy of notice are contained in 
 the treatises and articles which have appeared in 
 the present century on the subject of diabetes. 
 Some of these works, as, for instance, those of 
 Seegen, Frerichs, Ebstein, may even be regarded as 
 marking an epoch in the treatment of this disease. 
 The whole of these publications, which at the same 
 time furnish a complete bibliography of diabetes 
 in an alphabetical order, are as follows : — 
 
 Abeles, Wien. med. Jahrb. II. 176 ; also Jbid., 1874. tjber mini- 
 male Mengen Zucker im menschlichen Harn., in C,-B1. d. 
 medic. Wissensch. 1885, No. 26, S. 449. 
 
 Albeztoni, Peter, Die Wirkungen und die Verwandlungen einiger 
 Stoffe in Beziehung zur Pathogenese der Acetonamie und des 
 Diab. Virch. Arch. 18, 1884. 
 
 Aznold, Tiber das Vorkommen " heller" Muskeln beim Menschen, 
 Heidelberg 1886. 
 
 Astaschewsky, Med. Centralbl. 1877, p. 531. 30. 
 
 Balfoux, G. W., On the treatm. of diabetes etc. Edinb. Med. 
 Journ. XV. Febr. 1870. 
 
 Bazfurth, Arch. f. mikr. Anat. Vol. 25. 
 
 Baztels, Mitteil. f. d. Ver. Schleswig-Holst. Arzte. 6. H. 1877. 
 
 Baswitz, Ber. d. chem. Ges. XI. u. XII. 1878 and 1879. 
 
 Bechamp, Compt. rend. T. 60. p. 445. 
 
 Bezengez-Ferand, Compt. rend. Paris 1864. 
 
 Bezgeon, Injection de medicaments gaseux dans le rectum. Paris 
 1887. 
 
1^6 Diabetes. 
 
 Berger, Walt., " Mitteilungen iiber Diabetes." Gathered from the 
 Scandinavian literature in " Schmidt's Jahrbiichern der ges. 
 Med." 1885, No. 207, pp. 135 — 147 and 25c — 258. Berger's 
 " IMitteilungen " contain the following references: i) Dr. V. 
 Budde, on Diabetes mell. u. s. w. Kjobenhavn 1872. (He 
 maintains like myself, that in treating diabetes you must indi- 
 vidualize. He also orders almond-bread, and carries out Kiilz's 
 idea in respect to Icelandic moss.) 2) J. Worm-Miiller iiber 
 Modification des Trommerschen Verfahrens. 
 
 Bezgmann, Lehre von der Kopfverletzung. 1880, Stuttgart. 
 
 Bexnhazdi, W., Pathol, u. Therap. des Diab. mell. Berl. 1881. 
 
 Beztin, E., Recherch. s. la pathogenie d. diabete. L'Union 48. 
 1868. 
 
 Betz, F., Erster Bericht iiber den Diabetes mell. in Wiirttemberg. 
 Wiirtt. Corresp.-Bl. u. s. w. X. III. 4. 1873. 
 
 Bischoff, E., Ein Beitrag zur Pathalog. des Diab. mell. Arztl. In- 
 telligenzbl. 1873. Nr. 23. 
 
 Blau, L., iiber Diab. mell. und insipidus in Schmidt's Jahrb. d. 
 ges. Med. 1875. Bd. 165 and 166. (He concerns himself 
 chiefly with the experimental diabetes of CI. Bernard.) 
 
 Blumenthal, J., Zur Therapie des Diab. mell. Berl. klin. Wochen- 
 schr. X, 13. 1873. 
 
 Bock, C. und F. A. Hoffmann, i) tJber eine neue Entstehungsweise 
 V. Melliturie. Arch. f. Anat., Phys. u. wiss. Med. 1871. 2) 
 Experimentalstudien iiber Diab. Berlin 1874. 
 
 Boese, Zur Diabetesbehandlung. (Deutsch. Arch. f. klin. Med. 16. 
 p. 96). 
 
 Bogolubow, Arbeit des physiolog. Laborat. in Kasan. II. 1872. 
 
 Borg, un caso di diabete mellito etc. II Morgagni XIV, 1872. 
 
 Bouchard, Ch., Maladies par ralentissement de la nutrition, deux. 
 edit. 1885. 
 
 Bouchaxdat, i) Nouv. recherch. sur le diab. Compt. rend. 1841. 
 
 2) Suppl. a I'ann. d. ther. 1846. 
 
 3) De la glycosur. 1875. 
 Bouchezon, Compt. rend, de I'Acad. T. loi. 1885. 
 Bouzneville et Teinturier, Du Coma diabetique. 1875. 
 Boyron, G., Opgrat. du phimosis chez un diab. Gaz. des Hop. 40. 
 
 1869. 
 
History and Literature of Diabetes. 197 
 
 Breusing, Virch. Arch. 107. 1887. 
 
 Btincken, v., Deutsch. med. Wochenschrift 1877, ^O- 39- 
 
 Bxougniaxt, Diabet. gott. 1876. 
 
 Brouardel, P., Etud. crit. des diverses medic, employ, c. le diabete 
 
 Sucre. Par. 1869. 
 Briicke, Sitz.-Ber. d. Wien. Ac. 1871. II. Abt. 63. 
 „ Vorles. iiber Physiolog. I. B. 2. Aufl. 1875. 
 „ Uber Glykosurie bei Wochnerinnen. Wien. mediz. 
 Wochenschrift:. 
 Buchwald, Alf., Uroskopie. Stuttg. 1883. 
 Budde, Die quant. Bestimmung v. Traubenzucker im Harne nach 
 
 Roberts ■\Iethode. Pfliig. Arch. f. d. ges. Phys. des ]\Iensch. 
 
 u. d. Tiere. 
 Burger, F., ]) Untersuch. iiber perspiratio insensibilis bei Diabetes 
 
 mellit. u. insipid. Tiib. 1872. 2) Uber die persp. ins. u. s. w. 
 
 Deutsch. Arch. f. klin. Med. Yl. und XI. p. 323. 1873. 
 Buhl, Tiber diabet. Coma. Ztschr. f. Biol. B. XVI. p. 413. 
 Buxdel, De la glycosurie ephem. d. 1. fievres pall. Union med. 
 
 1872. 
 Burklay, W., On the skim milk treatment of diabetes m. Lancet I, 
 
 21 May, 1873. 
 Canstatt, C, Handb. d. medicin. Klinik v. E. H, Henoch (3. Aufl. 
 
 von " spec. Pathologic u. Therap. v. klin. Standp.,"' 3. vols. 
 
 1854-56). 
 Cantani, A., i) Casi guariti di diab. mell. II ^lorgagni. Febbr. 
 1872. 
 
 2) Klin. Vortrage iiber Diabet. mell. Ubers. v. S. 
 Hahn. Berl. 1877. 
 
 3) Diabetes mellitus. Deutsch von S. Hahn. Berl. 
 
 1880. (French transl. by H. Charvet. Paris 
 1870.) 
 Capland, Diet, of pract. med. I, 507. 
 
 Carey, R. F., Case of diab. mell. Lancet I. 24. June p. 835. 1874. 
 Chambard, E., Du xanthome temporaine des diabetiques etc. 
 Ann. de Dermatol. V, p. 348; s. Schmidt, Jahrb. 1885. 206. 
 p. 254. 
 Charcot, Maladies des vieiOards. Paris 1874. 
 
I gS Diabetes. 
 
 Chanveau, Compt. rend, de I'acad. des sc. Paris 1886. T. 103. 
 
 N. 21. 
 Cohnheim, Virch. Arch. B. 28. 1863. 
 Colin, Diabete Sucre etc. Gaz. hebd. 2. S. X. 30. 1868. 
 da Costa, J. M., Clinical lecture on the treatment of diabetes. 
 Philad. mad. andsurg. Reporter. XXVII.I. 11. March, 
 
 1873. 
 „ Handbuch der medizin. Diagnostik. Berlin 1883. 
 
 Croix, de la, Jalan, Arch. f. exp. Path. VIII, 1880. 
 
 Cxuppi, Zur Theor. des Diab. mell. Inaug.-Dissert. Gottingen 
 
 1879. 
 Cyon und Aladoff, Die Rolle der Nerven bei Erzeugung v. kiinstl. 
 
 Diab. mell. Bull, de I'academ. imp. de St. Peterb. VIII. 
 Dancel, De I'influence des voyages sur I'homme etc. 1858. 
 DeichmiiUer, A., C.-Bl. f. kl. Med. 1882, No. i. p. i. 
 Bemange, E., Art. " Diabet." in the Diet, encycl. des sc. med. by 
 
 Dechambre. Par. 1883. 
 Deverge et Foville, Du traitement du diabete aumoyen de I'arsenic. 
 
 Gaz. d. Par. 22. 1870 und 1871. 
 Dickinson, Howship, i) On certain morbid changes in the nervous 
 system associated with Diabetes. Brit. med. Journ., 
 Febr. 16, 1870. j\Ied. Tim. and Gaz. 1870. March 
 
 9- 
 
 2) Diseases of the kidney. I. Diab. London 1875. 
 
 Bock, F. W., tJber Glykogenbildung in der Leber und ihre Be- 
 ziehung zum Diab. Pfliiger's Arch. V, p. 571. 
 
 Donkin Scott, A., i) On a purely milk diet in the treatm. of diab. 
 melL The Lane. II, 22, 23. Jun. 1869. Lane. I, 18. May 
 1871. I, 2. Jan. 1873 ; 2-"d 1875. "^ol. II. 2) Milk diet in 
 diabetes. jNIed. Times and Gaz. Febr. 1870. 3) Skimmed 
 milk in diabetes. Brit. med. Journ. June 7, 1873. 4) Diab. 
 mell. successfully treated, etc. Idi'd. June 27, 1874. 
 
 IVX'Donnell, Observations on the function of the liver. Dublin, 
 1865. 
 
 Buboue, M., De I'odeur acide etc. Gaz. des hop. loi. 1872. 
 
 During, A. v., Ursache u. Heilung des Diab. mell. 3.Aufl. Han- 
 nover 1880. 
 
History and Literature of Diabetes. 199 
 
 Durand- Fardel, i) Des indications therap. dans le diabete. Gaz. 
 d. Par. 17. 1869. 
 
 2) Note sur la pathogenic du diabete. L'Union 46. 48. 
 1869. Bull, de I'Acad. XXXIV. Avril 15 et 30. Mai 
 15, 1869. 
 
 3) Traite din. et ther. du diab. Paris 1869. 
 
 4) Du regime alimentaire dans le diabete. Paris 1882. 
 Ebstein, W. und J. Miiller, i) Uber die Behandlung der Zucker- 
 
 harnruhr mit Carbolsaure. Berl. klin. Wochenschr. 
 1873. No. 43, X, 49 and 1876. Nr. 24. 
 
 2) Verhandl. der Ges. d. Ntrfrsch. und Aerzte 1874 zu 
 Breslau. p. 103. 
 
 3) Weitere Mitteilungen nebst Bemerk. iiber Anwendung 
 
 der Salicylsaure. Berl. klin. Wochenscrir. 5. 1875. 
 
 4) Bericht d. d. chem. Ges. zu Berlin. Bd. VIII. Berl. 
 1875. 
 
 Ebstein, i) tjber Driisenepithelnecros. beim Diab. u. s. w. Dtsch. 
 Arch. f. klin. Mediz. 28. Bd. 
 
 2) Weiteres iiber Diab. mell. D. Arch. f. klin. Mediz. 
 30. Bd. 
 
 3) Die Fettleibigkeit u. s. w. 7. Aufl. Wiesb. 1887. 
 
 4) Natur u. Behandlung der Gicht. 1882. 
 
 5) Das Regimen bei der Gicht. 1885. 
 
 6) Natur u. Behandlung der Harnsteine. 1884. 
 
 7) Dtsch. Arch. f. klin. Med. 23. 1879. 
 
 8) Das diat. Regimen beim Diab. m. Sep.-Abdr. aus d. 
 dtsch. arztl. Vereinsblatt. Mai 1883. 
 
 9) Die Zukerharnruhr, ihre Theorie und Praxis. Wies- 
 baden 1887. 
 
 Eckaxd, E., i) Die Stell. der Nerv. beim kiinstl. Diab. Beitrage 
 
 zur Anatomie u. Phys. IV. 1867. 
 Eckaxd, E., 2) Uber die zur Zeit feststehenden Thatsachen, welche 
 sich auf die Lehre von Diabet. u. s. w. beziehen. 
 Pest, raed.-chir. Presse IX, 7 — 9. 1873. 
 3) Beitr. Bd. VI. Untersuchungen iiber Hydrurie. 
 Einhoxn, K., Die Gahrungsprobe zum qualit. Nachweise von 
 Zucker im Harn. Arch. f. path. An at. u. Phys. 2. 1885. 
 
2,00 Diabetes. 
 
 Engesser, H., Das Pankreas. Stuttgart 1877. 
 
 Eulenbuzg und Guttman, D. Patliol. d. Sympathikus. Berl. 
 
 1873. 
 Evers, F]., Journ. of physiol. V. p. 342. Febr. 1885. 
 Ewald, i) Centralblatt f. d. med. Wiss. 1873. No. 52. 
 
 2) Berl. kl. Wochenschr. 1875. Nr. 51. 52. 1877, No. 44, 
 p. 651. 
 
 3) Diabet. mell. in Eulenburg, Real-Encykl. d. ges. Heil- 
 kiinde IV. 1880. 
 
 Ewer, Therapie des Diabetes in Osc. Liebreich, Therap. Monats- 
 
 hefte. 
 Falck, C. Ph., i) Zur Kenntnis der Zuckerharnruhr, Dtsch. Klin. 
 1853. 22. ff. 
 
 2) Beitrage zur Lehre von d. einfachen Polyurie. 
 Ibid. 41. 
 Fauconneau-Bufzesne, lettr. s. 1. diabete 1. d. i) Production du 
 Sucre. L'Union 143. 1867. 
 2) Etiologie du diabete. Ibid. 37, 1868. 
 Fleckles, L., i) Zur Balneotherapie gegen Gicht, Melliturie u. s. w. 
 Prag 1861. 
 
 2) Die Geschichte der gangbar. Theorien vom Diab. 
 
 mellit. von Willis 1674 bis auf Pavy. 1864. Dtsch. 
 Klinik 10. 1865. 
 
 3) Tiber Diab. mell. Prag 1865. 
 
 4) Zur Balneotherapie des Diab. mell. mit Riicksicht auf 
 die Saison 1865 in Karlsbad. Berl. kl. Wochenschrift. 
 III. 29. 1866. 
 
 5) Zur Path, und Bain, des Diab. mell. mit bes. Beriick- 
 sichtigung der Wirksamkeit der Karlsbad. Thermen 
 gegen dies. Leid. Dtsch. Klin. 9. 10. 1871. 
 
 Fleckles, Ferdin., Die Dietiitik des Diabetikers, etc. 
 
 Fleury, A. de, Theorie du diabete. Gaz. hebd. 2. Sen IX. 33. 
 
 1872. 
 Folet, Chute des ongles dans le diabet. Gaz. hebd. 2. S. XI. 
 
 1874. 
 Frank, J. P., Spez. Path. u. Therap. Deutsch von J. F. Sobern- 
 
 heim. 3. Ausg. Berl. u. Wien 1840. I. 
 
History and Literature of Diabetes. 201 
 
 Fxezichs, i) Uber den Diabetes, Berlin 1884. 
 
 2) Plotzlicher Tod u. Coma bei Diabetes. Ztschr. f. 
 klin. Med. Bd. VI, p. i. 
 
 3) tJber Verdauung, in Wagner's Handworterb. d. 
 Pliysiol. Ill, I. 
 
 Friedlander, Alfred, Beitrage zur Acetonurie. 1886. 
 Friedreich, N., i) tJber das constante Vorkommen von Pilzen bei 
 
 Diabet. Virch. Arch. 30. B., p. 476. 
 Friedreich, N., 2) Uber Krankheiten des Pankreas in v. Ziemssen's 
 Handbuch der spez. Path. u. Therap. VIII, 2. 2. Aufl. 
 1878. 
 Fiirbringer, P., D. Arch. f. klin. Med. XXI, 1878. p. 469 ff. 
 Gaehtgens, C, i) tJber d. Stoffwechs. e. Diabetikers vergl. m. d. 
 e. Gesunden. Dorp. 1866. Reported by Kiihne in 
 Med. C.-Bl. V. Berl. 1867. p. 147. 
 2) UberKreatinundHarnsaareausscheidung etc. Hoppe- 
 Seylers med. chem. Untersuchg. Berlin 1868. 3. Heft 
 p. 301. 
 Gerhardt, Diab. m. u. Typhoid, Corr.-Bl. d. allg. arztl. Ver. von 
 
 Thiiringen. Ill, 11. 1874. 
 Gigon, C, Note sur I'elimination des liquides par les voies urin, 
 role des reins et de la veine cave ; Glycosurie, theor. nouv. 
 L'Union, 154, f. 1867. De la glycosurie et de la glycoemie. 
 L'Union, 72, 73. 1872. 
 Giovauui,^A. de, Annotationi sul diabete melliio. Riv. klin. XI. 
 
 Nov. 1867. 
 Glax, Sitzungsber. d. k. k. Ak. d. Wiss. III. Jan. 1877. 
 Gmelin, R., Uber die diatet. Behandlung des Diab, mell. Deutsch. 
 
 med. Wochenschr. 1884. X. 
 Goltz, i) Melliturie u. r^Iilchsaureinj. Med. C.-Bl. 1876. No. 45. 
 2) Wirk. d. Milchs. auf den tier. Org. Diss, inaug. Berl. 
 1868. 
 Greenhow, i) Case of diabetes etc. Lancet I, 24. June 1873. 
 
 2) Treatment of diabetes, etc. Brit. med. Journ. June 
 7> 1873. 
 Griesinger, Studien iiber Diabetes. Arch. f. phys. Heilk. 1859, 
 III, I, (" Gesammelte Abhandlungen." 2, Berhn 1872). 
 
202 Diabetes. 
 
 Griitzner, Bresl. iirztl. Ztschr. 1882. No. 17, cf. Pfliiger's Arch. 
 
 Vol. 12. 
 Gueneau de Wlussy, Sur I'odeur special etc. Gaz. hebh. 2. 
 
 S. IX, 29. 1872. (See also on Polyuria Nr. 98. 187 1 
 
 md.). 
 Giinzleir, Uber Diab. mell. Tubingen 1856. 
 Habexshon, Guys Hosp. Rep. 1870, p. 535. 
 Haeser, H., Lehrb. d. Gesch. d. Med. u. d. epid. Krankh. 2. Aufl. 
 
 2. Abd. 1. B. Jena 1867-68. 3. Aufl. i. Bd. Gesch. der Med. 
 
 im Altert. u. Mittelalter. 1875, 
 Harley, G., Diabetes. London 1866. 
 Haxnack, E., i) Zur Pathogenese des Diab. mell. Dorpat 1873. 
 
 2) Deutsch. Arch. f. klin. Med. XIII, 6. 1874. 
 Haxtsen, Noch etwas iiber Diab, mellit. Donders and Berlin's 
 
 Arch. III. 
 Heidenhain, G., Diss, inaug. Konigsberg 1874, see M. C.-Bl. 
 
 Berlin 1875. Bd. XIII. 
 Hein, R., Zur Lehre von D. m. Dtsch. Arch. f. Id. Med. VIII, i. 
 
 1870. 
 Helfxeich, F. C., Zur Pathogenese des D. m. Wiirzb. 1866. 
 Hextex, Ztschr. f. physiol. Chemie. IV. 1880. 
 Kextzka, Die Zuckerharnruhr u. s. w. 1884. 
 Hixsch, Handbuch u. s. w. Erlangen i860. 
 Kixschmann, Jac, Ein Beitrag zur Lehre der diabet. Retinal- 
 
 affecktionen. 18S6. 
 Hofmann und Ultzmann, Anleitung zur Untersuchung des Harns. 
 
 Wien 1878. 
 Holoctschiner, Virchow's Arch. 104. Bd. 1886. 
 Hombuxgex, Mediz. C.-Bl. 1877. 
 Hoppe-Seylex, i) Virchow's Arch. Bd. X, p. 144, XL 1857. 
 
 2) Physiolog. Chemie. 1881. 
 Huizinga, Uber den Nachweis von Traubenzucker im normalen 
 
 Harne. Pfliig. Arch. 10. 11. 1870, 
 Huppext, Tiber die Glycosurie bei Cholera. Arch. f. Heilk. VIII. 
 Jaffe, M. Dr., tjber das Vorkommen zuckerbildender Substanzen in 
 
 den Organen der Diabetiker, in Virchow's Arch. B. 36, p. 20. 
 Jeannexet, L'uree dans le diabete artif. Bern 1872. 
 
History and Literature of Diabetes. 203 
 
 Jones, Bence, Medic. Times and Gaz. 1852. Vol. i. 
 
 ,, On Sugar in the urine. Quarterly journal etc. 1862. 
 
 „ Lectures of chimical diseases, Med. Tim. and Gaz. 1865. 
 Jozdad, Considerations sur un cas de diabete. Paris 1857. 
 Kahler, O., die dauernde Polyurie als cerebrales Herdsymptom. 
 
 Sept.-Abd. aus d. Ztschr. f. Heilk. VII. Prag 1886. 
 Kamen, L., Prag. med. Wchnschr. 1880. No. 17. 
 Kaznocki, V., Patholog-anatom. Untersuchungen von Augen diabe- 
 
 tischer Individuen in Knapp u. Schweigger's Arch. f. Augen- 
 
 heilk. 17. B., 3. Heft. 
 Sisch, H. E , Diat und diatet. Kuren in Real-Encyklop. IV. 1880. 
 Klels und Ittunk, Tageblatt der 43. Vers, dtsch. Naturf. u. Aerzte 
 
 in Innsbruck. 1869 ; and Handbuch der path. Anatomic 1870. 
 
 p. 547 etc. 
 Kobrak, G., Zum Nachweis kleiner Zuckermengen in Harn. Bresl. 
 
 Kohler. 
 Koch, Mitteil. aus dem Kais. Gesundheitsamte. I, 1881. (Compare 
 
 also Koch's Dissert, iiber Diab. mell. Jena 1867). 
 Konig, J., Prozent. Zusammenstellung u. Nahrgehaltwert der men- 
 
 schl. Genussmittel u. s, w. Berlin 1882. 
 Koschlakoff, Analyse des Urins. Petersb. 1887. 
 Kzaske, Diabetes und Sepsis, in Centr.-Bl. f. Chir. 1881, No. 
 
 35- 
 Kratschmer, i) tjber Zucker- und Harnstoffausscheidung beim 
 Diab. mell. unter dem Einflusse von Morphium, 
 kohlensaurem und schwefelsaurem Natron. Wien 
 1872. Wien. akad. Sitzungsber. 65. Bd., 3. Abt., p. 
 265. 
 
 2) Weitere Versuche betr. die Behandl. des. Diab. mell. 
 Wien 1874. 
 
 3) Wien. Med. Wchnschr. 1885, No. 13. 
 Xzaussold, Zur Path. u. Then des Diab. mell. Erlangen 1874. 
 Kzetschy, tJber Diab. mell. Wien. med. Wchnschr. 3. 1873. 
 Kzonser, V. N., iTber Zuckerruhr (d. mell.), u. ihre Heilungen in 
 
 Karlsbad. Wien. Ztschr. 18, i6o. 
 Kiihne, W., Lehrb. der physiol. Chemie. Leipz. 1868. (See 
 also Virch. Arch. XXX. S. 476). 
 
204 Diabetes. 
 
 Kiilz, E., i) Beitrage zur Hydrurie u. jMelliturie. Marburg 1872. 
 
 2) Uber Harnsaureausscheidung in einem Falle von 
 Diab. m. Arch. f. Anat., Physiol, u. wissensch. Med. 
 1872. pp. 293—303. 
 
 3) Studien iiber Diab. mell. u. insip. D. Arch. f. klin. 
 Med. XII., 248. 
 
 4) Beitr. zur Path. u. Therap. des. Diab. Mell. Marburg 
 I. B. 1874 u. 2. B. 1875. (See Sitz.-Ber. d. Marb. 
 Ges. z. Beford. d. Naturw. 1876 Aug.) 
 
 5) Gerhardt's Handb. der. Kinderkrankh. Bd. Ill, 
 1878. 
 
 6) Pfliiger's Arch. 1880. B. XXIV. 
 
 7) Zur Kenntnis d. linksdrehenden Oxybuttersaure. 
 Arch. f. experim. Path. u. Pharm. 1884; compare 
 Vol. VI, 1877. 
 
 8) Tiber eine linksdrehende Saure (Pseudooxybutter- 
 saure) in Zeitschr. f. Biologie, No. 2, 1884. 
 
 9) Zur Prioritatsfrage bez. der Oxybuttersaure im diab. 
 Harn. Ibid. p. 290. 
 
 10) Kann in der schwer. Form des Diab. die Zuckeraus- 
 
 fuhr durch vermehrte Zufuhr von Albuminaten 
 gesleigert werden ? Arch. f. exp. Path. u. Ph. 6, 
 1877, pp. 140 — 142. 
 
 11) Bericht d. dtsch. chem. Gesellsch. XV, Jan. — Juni. 
 Berlin 1882. 
 
 12) Dtsch. Ztsch. f. prct. Med. 1876, No. 23; compare 
 Report in Maly's Jahresber. iiber die Fortschr. der 
 Tierchemie. VI, p. 260. Wiesb. 1877. 
 
 Kiilz, R., Ztschr. f. Biol. Bd. 22. Sep.-Abdr. 
 
 Kuntzel, P., Experim. Beitrage zur Lehre v. d. Melliturie. Berlin 
 
 1872. 
 Kussmaul, Zur Lehre vom Diab. mell. u. s. w. Dtsch. Arch. f. 
 
 klin. Med. XIV, i. 1874. 
 Landzieux und Iscovesco, Progr. medic, 27. Juni 1885, No. 26. 
 Langendozff, O., Untersuchungen iiber die Zuckerbildung in der 
 
 Leber. Arch. f. Ant. und Phys. von Hils, Braun u. Du Bois- 
 
 Reymond. 1886. Phys. Abt. Suppl.-Band. 
 
History and Literature of Diabetes. 205 
 
 langley, J. N. and Eves, F., Journ. of Physiol. Vol. IV, No. i, p. 
 
 18. Compare Fortsch. d. Med. Bd. 4, 1886, p. 666. Report 
 
 by C. Lehmann. 
 I.atham, Lanc. No. 5. Febr. 1881. 
 I.eber und Wiesinger, Uber das Vorkommen von Keratitis, Iritis 
 
 Iridocharioideitis bei Diab. mell. (Arch. f. Ophthalmol. XXXI, 
 
 1885). 
 Leblanc, Gaz. des h6p. 1850, No. 23. 
 lecorche, i) L'amblyapie diabetique. Gaz. hebd. 1861. p. 717. 
 
 2) Consider, theor. et therap. sur le Diab. Sucre. Gaz. 
 hebd. 2. Ser. X. 44- ^J- 1873. 
 
 3) du Diabete sucre etc. Gaz. d. Par. 34. 1873. 
 
 Leo, Hans, Zur Kenntnis der " reduzierenden " Substanzen in dia- 
 
 betischen Harnen, in Virchow's Arch., 10. Folge, 7. B., i 
 
 Heft. 
 Lepine, Ber. iiber die Verb, der k. sachs. Ges. d. W. in Leipzig. 
 
 Math.-phys. Klass. 22. Bd., p. 324. 1870. 
 leube, W., Zur Patholog. u. Ther. des D. mell. Deutsch. Arch. 
 
 f. klin. Med. V. 3. 4. 1869. 
 Leube und Salkowski, Die Lehre vom Harne. 1882. 
 Leudet.E., Du diab. sucre. Clin. med. de I'hotel de Rouen. Paris 
 
 1874. p. 269. 
 Leupoldt, R., Tiber die Harnruhr. Erlangen 1853. 
 Leval-Picquechef, i) " Des Pseudotabes." Lille 1885. HecoUects 
 the tabes-like exhibitions in diabetes, etc. 
 2). These. Paris 1885. 
 Leyronx, Du diabete sucre. Gaz. des Hop. 19. 20. 1870. 
 Lintner, Journ. f. pr. Chemie. 1886. N. F. Bd, 34- p. 370- 
 Lippmann, Die Zuckerarten und ihre Derivate. 1882. 
 Loebisch, Anleitung zur Harnanalyse. Wien 1878. 
 Lozazza, L., Diabete succherino. Bull, delle sc. medich. di 
 
 Bologna. Febr. Marzo 1870. 
 Luchau, Med. Centralbl. 1877. 
 Luchsinger, Experimentelle u. kritisch. Beitrage zur Physiolog. 
 
 und Patholog. des Glykogens. 1875. Zur Glykogenbildung 
 
 in der Leber. Pfliig. Archiv VIII. p. 289. See also Centr. 
 
 Bl. f. d. med. Wiss. 1882. p. 131. 
 
2o6 Diabetes. 
 
 Iiusk, On the origin of diabetes etc. New- York 1870. 
 
 Xuys, Diabete avec lesion du 4rieme ventricule. Gaz. med. i860 
 
 —61. 
 iviaack, v., Zur Tlierapie des D. mell. Arch, des Ver. f. gem. Ar- 
 
 beiten. 1S60. p. 129. 
 Mahe, J., Hop. d^ Brest Compt. rend, de i. cliniq. med. pend. 
 
 1867 — 1869. Arch. med. nav. Oct. — Dec. 1870. 
 Maly, tJber die Trommersche Zuckerreaktion im Harn. Sitzungs- 
 
 Ber. d. k. Akad. d. Wissensch. 63. B. 1871. Jahresbericht 
 
 liber die Fortschr. der Thierchemie. VI, p. 260. Wiesb. 
 
 1877. Chemie der Verdauungssafte u. der Verdauung, in 
 
 Hermann's Handb. der Physiolog. V, 2. 
 Marchal (de Calvi), Comp. rend. 37. 43 ; and Recherches sur les 
 
 accidents diabet. et essai d'une theorie generale du diabete. 
 
 Paris 1864. 
 Mayer, J. Beitrag zur Symptom, u. Ther. des Diab. mell. Berl. 
 
 klin. Wochenschr. 1875. 
 Wlayet, Note sur les fruits sucres etc. L'Union 130. 1873. 
 Meissner, i) Nachrichten v. d. G. A. Univ. in Giessen. 1861. 
 
 No. 15 ; 1862. 10. 
 IVIeissnex, 2) Ztschr. f. rat. ]\Ied. 3. Reihe, B. 16. 1863. 
 
 3) Bericht iiber die Fortschr. d. Anat. u. Phys. i. J. 1867. 
 p. 405. 
 
 4) Ibid. B. 33. 1868. (Beitrage zur Kenntnis des 
 Stoffwechsels). Compare also Schmidt's Jahrb. B. 
 127. 1865. 
 
 Meyer, H., Arch. f. exp. Path. 1882. XVII. 
 
 Meyer, T., Ber. d. D. chem. Ges. B. 17. 1884. 
 
 Minkowski, O., tJber das Vorkommen von Oxybuttersaure im 
 
 Harn bei Diab. mell. Ein Beitrag zurn Coma diab. Arch. f. 
 
 exp. Path. u. Pharm. 1884, 18, and 1885, 19. 
 Miquel, tJber Diabetes mellitus. Arch. f. phys. Heilk. X. 185 1. 
 Mitchell, On the production of Cataract etc. Amer. Jour, of 
 
 med. sc. i860. 
 Moleschott, Die Physiologic der Nahrungsmittel. 1869. 
 Montegazza Paolo, Zur Physiol, u. Therapie des Diab. mell. Gaz. 
 
 Lomb. I. 1854. See Schmidt's Jahrb. B. 85, p. 302. 
 
History and Literature of Diabetes. 207 
 
 MCosler, F., Neuropathische Entstehung der einfachen Harnruhr. 
 Compare also tjber Beschaff. d. Parotidensekrets bei D. m. 
 Arch. f. Heilk. 1864 and Berl. klin. Wochenschr. 1866. Also 
 "Kleinhirnlasion." D. Arch. f. klin. Med. XV. tJber 
 Harnanalyse etc. Virch. Arch. 43. 
 Miiller-Warneck, Berl. klin. Wochenschr. 1877, No. 8. 
 Miinch, Diab. mellitus, Chron. Leberleiden. ^^losk. med. Ztg. 37. 
 
 1869. 
 Munk, J., 1) Verh. d. Phys. Ges. z. Berlin. Sitzg. vom. 24. Nov. 
 1870 ; see INIaly's Jahresbericht iiber die Fortschr. d. 
 Tierchemie. 6. p. 271. 1S77. 
 2) Zur quant. Bestimmung des Zuckers u. der sog. re- 
 duzierenden Substanzen ini Harn mittelst Fehling- 
 scher Losung. Arch. f. path. Anat. u. Phys. p. 63. 
 1886. 
 DfXurray, Glycosuria by the pressure of a clot etc. Lancet, i860. 
 Nasse, O., i) Pfliig. Arch. B. 15. 1877. 
 
 2) Zur Anat. und Phys. der quer gestr. IMuskelsubst. 
 Leipz. 1882. 
 
 3) Biol. Centralbl. II, 1882— S3. Ill, 1884. IV, 1885. 
 
 4) Beitrage zur Physiologic der contractilen Substanz. 
 Arch. f. d. ges. Phys. II. Compare also De mat. 
 amyl. in sanguin. Halle 1866. 
 
 Naunynund Riess, tTber die Harnsaureausscheidung. Reichert's u. 
 du Boys-Reymond's Arch. 1868, pp. 413, 414. 1869, 3. 381. 
 
 Naunyn, Beitrage zur Lehre vom Diab. mell. in Arch. f. sxp. 
 Path, und Pharm. 1874, 1875. 
 
 Neubauex und Vogel, Anl. zur Analysis des Harns. 1872. 
 
 ITicol, Case of diabetes etc. Brit. med. Journ. July. 1871. 
 
 Pavy, Philos. Transactions, i860. On the alleged sugar form- 
 ing function of the liver. Lond. 1861. The influence of 
 diet on the liver. Med. Tmi. June 1865. Researches on the 
 nature and treatment of diabetes. Lond. 1863. Second edit. 
 London, 1869 (rewritten almost entirely). Diabetes treated 
 with carbonate of ammonia etc. Brit. med. Journ. June 26, 
 1869. On the effect of Opium u. s. w. Guy's hosp. Re- 
 ports. 1870. XV, p. 420. Skim, milk treatm. in diabetes.- 
 
2o8 Diabetes. 
 
 Lancet. I, 24. June 1873 and 29. August 1874. British med. 
 
 journ. No. 758. 1875. Lancet. 1874, I, No. i — 5. Dtsch. 
 
 med. Wochenschr. No. 28. 1876. The Croonian lectures 
 
 on certains points connected with diabetes. London 1878. 
 Fellegrino, Caso di diabete melHto etc. Riv. cHn. 2, S. IL 1872, 
 Feltz, Die Analyse des Harns. Giessen 1874. 
 Peters, tJber natron salicyl. beim Diab. m. Inaug.-Diss. 1880. 
 Pettenkofer, M. v. und C. v. Voit, r) Ueber das Wesen der 
 
 Zuckerharnruhr. S. Sitzgs.-Ber. der k. bayr. Akad. d. Wiss. 
 
 in Miinchen. 1865, 2. B., p. 224. 2) Ueber den Stoffver- 
 
 brauch bei der Zuckerharnruhr. Ztschr. f. Biol. IIL, IV. 
 
 Heft, p. 380. 1867. 
 Pettexs, Untersuchungen iiber die Honigharnruhr. Prag. Viertel- 
 
 jahrsschr. Bd. 55. 1857. 
 Pfeiflfer, Balneolog. Studien iiber Wiesbaden, 1883, 
 Pink, H., Zur Lehre vom Diab. mell. u. s. w. Konigsb. 1874. 
 
 Reviewed in Med. C.-Bl. Berl. 1875. B. XIII, p. 43- 
 Plosz, Pfliiger's Arch. VII, 1873. 
 Popoff, L., Vergl. Untersuchungen iiber die Wirkungen einiger 
 
 Arzneistoffe bei der Zuckerharnruhr. Berl. klin. Wochenschr. 
 
 IX, 28. 1872. 
 Popper, M., Das Verhaltnis des D. zum Pankreasleiden u. Fett- 
 
 sucht. Ostr. Ztschr. f. prakt Heilk. XIV, 11. 1868. 
 Preyer, Spez. Phys. des Embryo. 1885. 
 
 Primavera, G., II diabete m. etc. II Morgagni, Ottobre 1872. 
 Prout, W., Ueber das Wes. und die Behandlung der Krankh. des 
 
 Magens u. d. Harnorgane. Translated from the English by 
 
 Krupp. Leipz. 1843. 
 Quincke, Ueber Coma diabetic. Berl. klin. Wochschr. 1880, i ; 
 
 compare Ibid. 1876, Nos. 37 and 38. 
 Recklinghausen, F. v., Drei Falle von Diab. mellit. Virch. Arch. 
 
 B. 30, p. 360. 
 Redon, Du diabete etc. Progr. medic. V. B. 1877, p. 356. 
 Reick, F. Th., De Diabete mellito quaestiones. Grygh. 1859. 
 Reinke, Lehrb. d. allgem. Botanik. 1880. See Pfiiig. Arch. 23. 
 Renzi, E. de, Sulla glycosuria. La nuov. Ligur. med. XVI, Luglio 
 
 1871. 
 
History and Literature of Diabetes. 209 
 
 Reyhex, H., Ein Beitr. zur Pathol, u. Ther. des Diabet. m. Diss. 
 
 Dorp. 1885. 
 Richaxdson, B. W., i) On Diabetes. Med. Tim. and Gaz. 1866. 
 
 2) On diabetic phthisis and its treatment. Med. Tim. and 
 
 Gaz. March 2. 1867. 3) Remarks on D. especially with 
 
 reference to treatment. Lond. 1871. 
 Richet, Arch, de physiol. 1882. 2. sem. 
 Rittex, Ueber d. Amylum u. s. w. Ztschr. f. rat. Med. 2. 3. R. 24. 
 
 1865. 
 Roberts, W., i) On the estimation of sugar in diabetic urine etc. 
 
 Manchester 1861. 2) Case of diabetes etc. Brit. med. Journ, 
 
 Jan. 27, 1872. 
 Robin, Art. " Musculaire" in Dechambre's Diet. enc. des sc. med. 
 
 1876. 
 Ruif, J., Die Zuckerkrankheit u. s. w. Lauppsche Buchhandlung, 
 
 Tiibingen. Die Diabetes-Kur in Karlsbad. 1888. 
 Rupstein, Ueber das Auftreten des Acetous beim Diabetes mell. 
 
 Centralbl. f. d. med. Wiss. 1874. 
 Ryba u. Plumext, Prag. med. Wochenschr. 1877, Nos. 19, 20, 21. 
 Saikowsky, Du diabete. Journ. de Brux. XVII, p. 141, 142. 
 
 1866. 
 Salingex, Beitrag zur Diagnose des Diab. mell. Dtsch. KUn, 34. 35. 
 
 1871. 
 Salomon, G., Ueber Glykogenbildung in der Leber. Centr.-Bl. f. d. 
 
 med. Wiss. 1874, p. 179. 
 Salomon, M., Gesch. der Glycosurie v. Hippokrates bis zum Anf. 
 
 des 19. Jahrh. Leipzig 1871. 
 Schaetzke, Berl. klin. Wochenschr. 1879, No. 22. ■ 
 Schapex, Ein Fall von Diab. m., entstanden durch Trauma. Inaug.- 
 
 Diss. Gottingen 1873. 
 Schaxlau, Die Zuckerharnrahr. Berl. 1846. 
 Schiff, J. M., Untersuchungen liber die Zuckerbildung in der Leber 
 
 und den Einfl. d. Nervensyst. auf die Erzeugung d. Diabetes. 
 
 Wiirzburg 1859. 
 Schiff, M., Nouv. recherch. sur la glycog6nie anim. Journ. de I'Anat. 
 
 et d. 1. Phys. Ill, 4. Juill. et Aout 1866. 
 Schiffex, Diab. mell. bei Schrotbrot in Betz' Mem. Bd. 28. 1883. 
 
 P 
 
2 1 o Diabetes. 
 
 Schirmer, Iritis bei Diabetes in Zehender. Klin. Monatsblt. 35. 
 
 Jahrg. April. 
 Schleich, G., Aus d. med. Klin, in Tubingen. Erfahrungen iiber 
 
 diiit. Behandlung bei D. m. Wiirtt. Corr.-Bl. XLIV, 34. 
 
 1874. 
 
 Schmidt, Jahrbuch der ges. Med. 1885. 206— 256.contains the ac- 
 counts of diseases by which to show the relation which diabetes 
 holds to xanthoma. 
 
 Schmiedebexg, Grundriss der Arzneimittellehre. 1883. 
 
 Schmitz, i) Zwei Falle v. D. m. Brl. kl. Wochenschr. V, 32. 1869. 
 2) Ueber Bad Neuenahr. 7(5'/^. IX, 12. 13. 1872. 3) 4 Falle 
 von geheiltem Diab. mell. u. kurz. Bemerkungen iiber die Ent- 
 stehung dess. Ibid. X, 18. 19. 1873. 4) Zur Aetiologie 
 des Diabetes mell. Ibid. XI, 44. 1874. 
 
 Schopffer, E., Beitrage zur Kenntnis der Glykogenbildung in der 
 Leber. Arch. f. exp. Path. I. 1873. 
 
 Schxoder, W., Diat und Wegweiser fiir Zuckerkranke mit bes. 
 Beriicks. des Saccharin. Berlin. Steinitz. 1887. 
 
 Schtschezbakoff, Ueber Glykogen. Ber. d. dtsch. chem. Ges. in 
 Berlin. 1870. pag. 200. 
 
 Schultzen, C., Beitrage zur Patholog. und Therap. des. Diab. mell. 
 Brl. klin. Wochenschr. IX, 35. 1872. 
 
 Seegen, J., i) Phys. chem. Unters. iiber den Einfluss des Karlsb. 
 Wassers auf einige Formen d. Stoffwchs. Wien. med. Wochen- 
 schr. i860. 2) Beobachtungen iiber Diab. m. Ibid. 1866. 
 No. 34. 3) Die diatet. Behandl. des D. Ibid. XX. 1870. 
 16. 17. 4) Aphorismen iiber D. m. Ibid. 18. 5) Der Diabet. 
 mell., auf Grundl. zahlr. Beobachtungen dargestellt. Leipzig 
 
 1870, 2. Aufl. Berlin. 1875. (a classical work!). 6) Ge- 
 niigen die bis jetzt angewendeten Methoden, um kleine Mengen 
 Zucker mit Bestimmtheit im Harn nachzuweisen ? Wien. 
 
 1 87 1. 7) Beitrage zur Kasuistik der Melliturie in the Arch. f. 
 path. Anat. u. s. w. B. 21, 30 u. 36 (he enumerates 89 cases). 
 8) Ein Fall von Lavulose im diab. Harn. (Med. Centr.-Bl. 
 1884. 43, p. 753). 9) Die physiol. Grundlage fiir die 
 Theorie des Diabetes. Ztschr. f. Klin. Med. 1884. 10) 
 Seegen und Kratschmer. Pfiiig. Arch. B. XIV, p. 593. 
 
History and Literature of Diabetes. 1 1 1 
 
 Senator, i) Ueber Diabetes bei Kindern. Brl. kl. Wochenschr. 
 
 1872. No. IX. 48. 2) Diab. mell. und insipidus, in Handb. d. 
 
 spez. Path. u. Therap. von Dr. H. v. Ziemssen. Bd. XIII. 2. 
 
 Halfte. 1876. 2. Aufi. XIV, i. 1879. See Unters. iiber 
 
 d. fieberh. Prozess. 1873. 
 Senff, L., Ueber den Diab. nach der Kohlenoxydatmung. Leipz, 
 
 1871. 
 Skezzit, M., Brit. med. Journ. Dec. 5, 1885. 
 Stadelmann, E., i) Ueber die im Ham v. Diabetikern vorkom- 
 
 menden patholog. Sauren. [Ztsciar. f. Biol. 21. N. F. 3. 1885). 
 
 2) Ueber die Ursachen der path. Ammoniakausscheidung 
 
 beim Diab. mell. und das Coma diab., in the Arch. f. exp. 
 
 Path, und Pharm. 1883. 17. p. 419. 
 St. Cyr, A case of diabetes mellitus in a dog. Journ. de med. 
 
 vet. 1870. 
 Stokvis, Beitrage zur Kenntnis der Zuckerbildung in der Leber. 
 
 185.6. See Wiener mediz. Wochenschr. 1857. Stockvis, B. 
 
 J., Prof., Amsterdam. A Report in respect to the Patholog. 
 
 u. Therap. of Diab. mell. in the " Verhandlungen des 5. 
 
 Kongresses fiir innere Medizin," II. Wiesb. 1886. 
 Thompsou, H., Case of diabetes etc. Transact, of the clin. soc. of 
 
 London, IV, 1871. 
 Thiersteinez und Uhle, Ueber die Harnstoffausscheidung im. Diab. 
 
 mell. in Arch. f. Heilk. 1858. 
 Thorne, F., The treat, of diabetes etc. Lane. I., 8. 1870. 
 Tiegel, Ueber eine Fermententwicklg. des Blutes. Centr. f. d. 
 
 med. W. 
 Tzaube, M., Ueber die Gesetze der Zuckerausscheidung. Virch. 
 
 Arch. Bd. IV. p. 109. 1852. 
 Tschezinoff, Zur Lehre vom Diab. m. Dtsch. Klinik 14. 15. 17. 18. 
 1867, and Virch. Arch. 47. 1869; s,lso Sitzungsber. d. k. Ak. 
 - Wien. B. 5 1 (iiber die Abhangigkeit des Glykogengehaltes der 
 
 Leber etc.). 
 Tumas, Petersb. med. Wochenschr. 1881. No. 18. 
 Ullenspezgez, J. B., D. gegenwart. path, therap. Standpunkt. v. 
 Diab. m., im Umrisse dargestellt. Blatt. f. Heilwissench. 13. 14. 
 1870. 
 
212 
 
 Diabetes. 
 
 Vixchow-Hirsch, Jahresberichte. 
 
 Vocke, Die Zuckerkrankheit. Berlin und Neuwied. 1887. 
 
 Vogel, Diab. mell. Hdh. d. spez. Path. u. Therap., redig. v. Virchow. 
 
 Voigt, C. v., i) Physiol, d. allgem. Stoffwechs. u. der Ern. Leipz. 
 
 1 88 1. Ueber d. Urs. der Fettablag. im Tierkorper. Miinchen. 
 
 1883. 
 Vulpian, A., Leyons sur I'appareil vasomoteur. T. II. 1875. 
 Vulpian und Philippeaux, Gaz. Hebd. 1861. 
 Wallach, D. J., Diab. mell. in fiinfwochentl. Verlaufe. Virch. Arch. 
 
 B. 36, p. 297. 
 Walter, Arch. f. exp. Path. VII. 1877. 
 Weiss, i) Zur Stat, des Glykogens im Tierkorper. Sitzungsber. 
 
 d. Wien. Ak. d. Wiss. Bd. LXIV. 2) Ueber die Quelle des 
 
 Leberglykogens. Sitzungsber. etc. LXVII. 3. 
 Wittich, Ueber das Leberferment. Pfliig. Arch. VII. 
 Wolpe, H. Arch. f. exp. Pathol. 21. 1886. 
 Worm-Miiller. Pfliig. Arch. Bd. 34. 1884. Bd. 35. 1885. 
 Woxtmann, J., Ztsch. f. phys. Chemie. Bd. VI. 1882. 
 Zalesky, Stan., Zur Patholog. d. Zucherharnruhr u. zur Eisenfrage. 
 
 Arch. f. Path. X, Folg. 4. 1884. 
 Zimmer, K., i) Ein Beitrag zur Lehre vom Diab. mell. Dtsch. 
 
 Klin. 14. 15. 17. 18. 1867. 2) Under the same title, Karlsbad, 
 
 Feller. 3) Der D. m., sein Wes. u. seine Behandl. i. Heft. 
 
 Leipz. 1871. 4) Die nachste Urs. desD. mell. Dtsch. Klin. 5. 
 1871. 5) Die Muskeln, eine Quelle des Zuckers im Diabet. 
 
 Ibid. 7. 1873. 6) D. Musk., e. Quelle, Muskelarbeit ein. 
 Heilmittel bei Diabetes. Karlsbad, Feller. t88g. 
 Zuntz, Beitrag zur Physiolog. des Diabetes. He thinks that the 
 
 formation of acid is favoured in a blood which is saturated 
 
 with carbonate of sodium. 
 
History and Literature of Diabetes. 1 1 3 
 
 A WISH EXPRESSED TO PROFESSIONAL 
 
 JOURNALS, PROFESSIONAL LIBRARIES, 
 
 AND MEDICAL SOCIETIES. 
 
 In glancing over the mass of literary material which 
 has accumulated on the subject of diabetes, and 
 which I have endeavoured to master, and especially 
 in surveying the by no means inconsiderable number 
 of special accounts of cases of diabetes, it seems at 
 first as if a great deal had been done already in this 
 department. Still, admitting all this, a great outlay 
 of time is entailed upon an inquirer, and it is ex- 
 tremely difficult for him to obtain all the existing 
 material and to make a proper use of it. For the 
 material itself is difficult of access, and the observa- 
 tions are not always made according to the same 
 plan. The summing-up, also, is not always done in 
 the same way. 
 
 It seems to me, therefore, that it would be a most 
 grateful task, and one fraught with good results, if 
 the medical societies and editors of medical journals 
 would agree among themselves as to a definite plan 
 according to which reports and accounts of the 
 above disease are to be made ; further, as to some 
 definite place to which such communications might 
 be sent, and where the specialist might find them 
 and work them up, in order afterwards to publish the 
 result of his labours in some journal, where it would 
 become accessible to all interested in this special 
 subject. 
 
2 1 4 Diabetes. 
 
 In this way it would be possible to obtain a statis- 
 tical ensemble of all cases of diabetes ; as regards 
 the course they have taken, and as regards their final 
 result. Everyone would then be able to have access 
 to the whole modern literature on this important sub- 
 ject ; he would be able to examine it and make use 
 of it. Every year, also, a general report ought to be 
 made, which would enable anyone to survey the 
 ever-increasing literature on this subject, and which 
 literature might be found and consulted in some 
 given library. 
 
 Griesinger, in his statistical table, mentions the 
 time when the disease first showed itself ; Dickinson 
 notes the time of death ; while others report only 
 the time during which the patient was treated by 
 them. 
 
 Some physicians report only those cases which 
 have occurred at watering-places ; and hence they 
 have almost nothing to say about children. Others 
 relate only hospital cases, etc. 
 
 It would be very desirable if authors would make 
 their daily observations at one and the same hour. 
 Thus Otto reckons the day from lo o'clock to lo ; 
 Lambe, from 6 to 6 ; Krausold, from 7 to 7. For 
 forming a judgment also it would be valuable to make 
 observations before, and after, the meals. 
 
 At some future occasion I intend to give an 
 account of those literary communications and ob- 
 servations that I have received already, and of any 
 that I may receive in the future ; and I shall also 
 express myself as to the best form in which such 
 
History and Literature of Diabetes. 215 
 
 communications ought to be made. Very gladly I 
 shall examine and take notice of any wishes ex- 
 pressed and any communications sent to me by any 
 of my medical colleagues. They will kindly address 
 me during the summer-months at Carlsbad, Villa 
 Schnee, and during the winter-months at Monte 
 Carlo, Hotel Beau Rivage. 
 
 THE END. 
 
April, 1889. 
 
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 ANESTHETICS THEIR USES AND ADMINISTRA- 
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Catalogue of Works Published by H. K. Lewis. 
 
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 ON INTRA-THOEACIG CANCER. 8vo, 4s. 6d. 
 
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 ON FEVERS: THEIR HISTORY, ETIOLOGY, DIAG- 
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 THE MECHANISM OF THE CIRCULATION OF THE 
 
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Catalogue of Works Published by H. E. Lewis. 
 
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 MODERN SURGERY ; its Progress and Tendencies. Be- 
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 MODEL DIAGRAM OF THE ORGANS IN THE 
 
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 HENEAGE GIBBES, m.d. 
 
 Lecturer on Physiology and on Normal and Morbid Histology in the Medical School of 
 
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 REMARKS ON ARMY SURGEONS AND THEIR 
 
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Catalogue of Works Published by H. K. Lewis. 
 
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 TOOTH EXTRACTION : a Manual on the proper mode 
 
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 JOHN W. S. GOULEY, M.D. 
 
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 DISEASES OP MAN : Data of their Nomenclature, Clas- 
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 A PRACTICAL TREATISE ON THE DISEASES, IN- 
 
 > JURIES, AND MALFORMATIONS OF THE URINARY 
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 SAMUEL W. GROSS, a.m., m.d. 
 
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 ALLAN McLANE HAMILTON, m.d. 
 
 THE MODERN TREATMENT OP HEADACHES. 
 
 Square i6mo, 2s. 6d. ijust Published. 
 
10 Catalogue of Works Published by H. K. Leicis. 
 
 WILLIAM A. HAMMOND, m.d. 
 Professor of Mental and Nervous Diseases in the Medical Department of the University o^ 
 
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 A TREATISE OIV THE DISEASES OF THE NERVOUS 
 
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 HI. 
 
 SPIRITUALISM AND ALLIED CAUSES AND CON- 
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 ALEXANDER HARVEY, m.a., m.d. 
 
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 I. 
 
 FIRST LINES OF THERAPEUTICS; as based on the 
 
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 Disease ; and on the Modes and the Processes of Dying, as resulting 
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 ON THE FCETUS IN UTERO AS INOCULATING THE 
 
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 ALEXANDER HARVEY, m.d. 
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 ALEXANDER DYCE DAVIDSON, m.d., f.r.s. edin. 
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 SYLLABUS OF MATERIA MEDICA FOR THE USE 
 
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 to University College Hospital, &c. 
 
 OUTLINES OF PICTORIAL DIAGNOSIS OF DIS- 
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Catalogue of Works Published by H. K. Lewis. 11 
 
 C. HIGGENS, F.R.c.s. 
 
 Ophtkaimic Surgeon to Guy's Hospital; Leeturer on Ophthalmology at Gay's Hospital 
 
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 l/LANTJAL OF OPHTHALMIC PHACTICE. 
 
 Crov.-n Svo, illustratioas. 6s. [Xow ready. 
 
 [Lewis's Practical Series.] 
 
 BERKELEY HILL, m.b. loxd., f.r.c.s. 
 
 Professor cf C'tinical Sarsery in Ur.ivirii:-.- Collide; SutscCt. to Vni'.£TS:iy Coll-ege 
 H:sp::s: a'lJ :: :■:£ Lj:S Hcsf::i:. 
 
 THE ESSENTIALS OE BANDAGING. Witli directions 
 
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 on Surgical Landmarks. Sixth Edition, rcNTsed and enlarged, Illustrated 
 by 144 Wood Engra\'ings, crown Svo, 5s. 
 
 BERKELEY HILL, m.b. loxd., f.r.c.s. 
 Professor of Clinical Sutfs:-. ■■: L"'.::;?;;:;. C:.li^c: Sur^i:!-. to University College 
 
 AND 
 
 ARTHUR COOPER, l.r.c.p., m.r.c.s. 
 
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 I. 
 
 SYPHILIS AND LOCAL CONTAGIOUS DISORDERS. 
 
 Seccr.d edition, entirely re-v.Titten, royal Sto, iSs. 
 
 II. 
 
 THE STUDENT'S MANUAL OP VENEREAL DIS- 
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 C. R. ILLINGWORTH. m.d. ed.. m.r.c.s. 
 
 THE ABORTIVE TREATMENT OP SPECIFIC PE- 
 
 BRILE DISORDERS BY THE BIXIODIDE OF MERCURY. 
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 SIR W. JENNER, Bart., m.d. 
 
 Physician in Ordinary to H.il. the Qus-e?:, snd to HJiJI. the Prince oj Wales. 
 
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 C. M. JESSOP, M.R.c.p. 
 
 Associate of Kir.g's CclUci, Lcr..icr. ; Brigade Surgeon H.M. British Forces. 
 
 ASIATIC CHOLERA, being a Report on an Outbreak 
 
 of Epidemic Cholera in 1876 at a Camp near Murree in India. With 
 map, demy Svo, 2s. fid. 
 
12 Catalogue of Works Published by H. K. Leiou. 
 
 GEORGE LINDSAY JOHNSON, m.a., m.b., b.c. cantab. 
 
 Clinical Assistant, late House Surgeon and Chloroformist, Royal Westminster Ophthalmit 
 
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 A NEW METHOD OF TREATING CHRONIC GLAU- 
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 NORMAN KERR, m.d., f.l.s. 
 
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 INEBRIETY: its Etiology, Pathology, Treatment, and 
 
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 RUSTOMJEE NASERWANJEE KHORY, m.d. brux. 
 
 Member of the Royal College of Physicians. 
 
 THE PRINCIPLES AND PRACTICE OF MEDICINE 
 
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 A TREATISE ON ORAL DEFORMITIES AS A 
 
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 J. WIGKHAM LEGG, f.r.c.p. 
 
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 I. 
 
 ON THE BILE, JAUNDICE, AND BILIOUS DISEASE 
 
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 II. 
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 III. 
 A TREATISE ON H-S3MOPHILIA, SOMETIMES 
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 ARTHUR H. N. LEWERS, m.d. lond., m.r.c.p. lond. 
 
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 A PRACTICAL TEXTBOOK OF THE DISEASES OF 
 
 WOMEN. With Illustrations, crown 8vo, 8s. 6d. [Now ready. 
 
 [Lewis's Pbactical Series.] 
 
Catalogue of Works Published by H. K. Lewis. 13 
 
 LEWISES PRACTICAL SERIES. 
 
 Under this title Mr. Lewis is publishing a Series of Monographs, em- 
 bracing the various branches of ^vledicine and Surgery. 
 
 The volumes are written by well-known Hospital Physicians and Sur- 
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 MANUAL OF OPHTHALMIC PRACTICE. 
 
 By C. HIGGEXS, F.R.C.S., Ophthalmic Surgeon to Guy's Hospital; Lecturer 
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 8vo, 6s. [Now ready. 
 
 A PRACTICAL TEXTBOOK OF THE DISEASES OF WOMEN. 
 
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 crown 8vo, Ss. 6d. [Ready. 
 
 AN/ESTHETICS THEIR USES AND ADMINISTRATION. 
 
 By DUDLEY W. BUXTON, M.D., B S., M.R.C.P., Administrator of 
 Anesthetics in University College Hospital and the Hospital for Women, Soho 
 Square. Crown Svo, 4s. [Ready. 
 
 TREATMENT OF DISEASE IN CHILDREN: INCLUDING THE OUT- 
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 ON FEVERS: THEIR HISTORY, ETIOLOGY, DIAGNOSIS, PROGNOSIS, 
 
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 HANDBOOK OF DISEASES OF THE EAR FOR THE USE OF STUDENTS 
 
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 BODILY DEFORMITIES AND THEIR TREATMENT: A HANDBOOK OF 
 
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 cr. Svo, 8s. fid. 
 
 Further volumes will be announced in due course. 
 
14 Catalogue of Works Published by H. K. Lewis. 
 
 DR. GEORGE LEWIN. 
 
 Professor at the Fr. With. University, and Surgeon-in-Chief of the Syphilitic Wards and 
 Skin Disease Wards of the Charite Hospital, Berlin. 
 
 THE TREATMENT OF SYPHILIS WITH SUBCUTA- 
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 LEWIS'S POCKET CASE BOOK FOR PRACTITIONERS 
 
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 T. R. LEWIS, M.B., F.R.S. ELECT, ETC. 
 Late Fellow of the Calcutta University, Surgeon-Major Army Medical Staff, &c. 
 
 PHYSIOLOGICAL AND PATHOLOGICAL RESEAR- 
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 J. S. LOMBARD, m.d. 
 Formerly Assistant Professor of Physiology in Harvard College. 
 
 I. 
 
 EXPERIMENTAL RESEARCHES ON THE REGIONAL 
 
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 II. 
 
 ON THE NORMAL TEMPERATURE OF THE HEAD. 
 8vo, 5s. 
 
 WILLIAM THOMPSON LUSK, a.m., m.d. 
 
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 THE SCIENCE AND ART OF MIDWIFERY. 
 
 Third Edition, with numerous Illustrations, 8vo, iSs. 
 
Catalogue of Works Published by H. K. Lewis. 15 
 
 RAW^DON MACNAMARA. 
 
 Professor of Materia Medica, Royal College of Surgeons, Ireland ; Senior Surgeon to the 
 Westmoreland (Lock) Government Hospital ; Surgeon to the Meath Hospital, etc. 
 
 AW INTRODUCTION" TO THE STUDY OP THE 
 
 BRITISH PHARMACOPCEIA. Demy samo, is. 6d. [yust published. 
 
 JOHN MACPHERSON, m.d. 
 
 Inspector-General of Hospitals H.M. Bengal Army [Retired). 
 Author of" Cholera tn its Home," &c. 
 
 ANNALS OP CHOLERA PROM THE EARLIEST 
 
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 BATH, CONTREXEVILLE, AND THE LIME SUL- 
 
 PHATED WATERS. Crown 8vo, 2S. 6d. 
 
 DR. V. MAGNAN. 
 
 Physician to St. Ann Asylum, Paris; Laureate of the Institute. 
 
 ON ALCOHOLISM, the Various Porms of Alcoholic 
 
 Delirium and their Treatment. Translated by W. S. Greenfield, 
 M.D., M.R.C.P. 8vo, 7s. 6d. 
 
 A. COWLEY MALLEY, b.a., m.b., b.ch. t.c.d. 
 
 PHOTO-MICROGRAPHY; including a description of 
 
 the Wet Collodion and Gelatino-Bromide Processes, together with the 
 best methods of Mounting and Preparing Microscopic Objects for Photo- 
 Micrography. Second Edition, with Photographs and Illustrations, 
 crown 8vo, 7s. 6d. 
 
 PATRICK MANSON, m.d., cm. 
 
 Amoy, China. 
 
 THE PILARIA SANGUINIS HOMINIS ; AND CER- 
 
 TAIN NEW FORMS OF PARASITIC DISEASE IN INDIA, 
 CHINA, AND WARM COUNTRIES. Illustrated with Plates and 
 Charts. 8vo, los. 6d. 
 
16 Catalogue of Works Published hy M. K. Lewis. 
 
 PROFESSOR MARTIN. 
 
 MARTIN'S ATLAS OP OBSTETRICS AND GrYTSMCO- 
 
 LOGY. Edited by A. Martin, Docent in the University of Berlin. 
 Translated and edited with additions by Fancourt Barnes, M.D., 
 M.R.C P., Physician to the Chelsea Hospital for Women ; Obstetric 
 Physician to the Great Northern Hospital ; and to the Royal 
 Maternity Charity of London, &c. Medium 4to, Morocco half bound, 
 31S. 6d. nett. 
 
 ^VILLIAM MARTINDALE, f.c.s. 
 
 Late Examiner of the Pharmaceutical Society, andlate Teacher of Pharmacy and Demon- 
 strator of Materia Medica at University College. 
 
 AND 
 
 W. WYNN WESTCOTT, m.b. lond. 
 
 Deputy Coroner for Central Middlesex. 
 
 THE EXTRA PHARMACOPCEIA with the additions in- 
 troduced into the British Pharmacopoeia, 1885, with Medical References, 
 and a Therapeutic Index of Diseases and Symptoms. Fifth Edition, 
 revised with numerous additions, limp roan, med. 24mo,*7S. 6d. 
 
 V/ILLIAM MARTINDALE, f.c.s. 
 
 Late Examiner of the Pharmaceutical Society, &c. 
 
 COCA, COCAINE, AND ITS SALTS : theil- History, 
 
 Medical and Economic Uses, and Medicinal Preparations. Fcap. 8vo, 2s. 
 
 MATERIA MEDICA LABELS. 
 
 Adapted for Public and Private Collections. Compiled from the British 
 Pharmacopoeia of 1885. The Labels are arranged in Two Divisions : — 
 Division I. — Comprises, with few exceptions, Substances of Organ- 
 ized Structure, obtained from the Vegetable and Animal King- 
 doms. 
 
 IHvision II. — Comprises Chemical Materia Medica, including Alco- 
 hols, Alkaloids, Sugars, and Neutral Bodies. 
 On plain paper, los. 6d. nett. On gummed paper, 12s. 6d. 7iett. 
 
 *j;* Specimens of the Labels, of which there are over 450, will be sent on application. 
 
 S. E. MAUNSELL, l.r.c.s.i. 
 
 Surgeon-Major, Medical Staff. 
 
 NOTES OF MEDICAL EXPERIENCES IN INDIA 
 
 PRINCIPALLY WITH REFERENCE TO DISEASES OF THE 
 EYE. With Map, post 8vo, 3s. 6d. 
 
Catalogue of Works Published by H. K. Lewis. 17 
 
 J. F. MEIGS, M.D. 
 
 Consulting Physician to the Children's Hospital, Philadelphia: 
 
 AND 
 
 W. PEPPER, M.D. 
 
 Lecturer on Clinical Medicine iji the University of Pennsylvania. 
 
 A PRACTICAL TREATISE ON THE DISEASES OF 
 
 CHILDREN. Seventh Edition, revised and enlarged, roy. 8vo, 28s. 
 
 Wra. JULIUS MICKLE, m.d., f.r.c.p. lond. 
 
 Medical Superintendent, Grove Hall Asylum, London, &c. 
 
 GENERAL PARALYSIS OP THE INSANE. 
 
 Second Edition, enlarged and rewritten, 8vo, 14s. 
 
 ON INSANITY IN RELATION TO CARDIAC AND 
 
 AORTIC DISEASE AND PHTHISIS. Crown 8vo, 3s. 6d. 
 
 KENNETH W. MILLICAN, b.a. cantab., m.r.c.s. 
 
 THE EVOLUTION OP MORBID GERMS: A Contribu- 
 tion to Transcendental Pathology. Cr. 8vo, 3s. 5d. 
 
 ANGEL MONEY, m.d., m.r.c.p. 
 
 Assistant Physician to University College Hospital, and to the Hospital for 
 Children, Great Ormond Street, &c. 
 
 THE STUDENT'S TEXTBOOK OP THE PRACTICE 
 
 OF MEDICINE. Fcap. Svo, 6s. 5d. \_yjist Published. 
 
 TREATMENT OP DISEASE IN CHILDREN : IN- 
 CLUDING THE OUTLINES OF DIAGNOSIS AND THE 
 CHIEF PATHOLOGICAL DIFFERENCES BETWEEN CHILD- 
 REN AND ADULTS. Crown Svo, los. 6d. 
 
 [Lewis's Practical Series.] 
 
 E. A. MORSHEAD, m.r.c.s., l.r.c.p. 
 
 Assistant to the Professor of Medicine in University College, London. 
 
 TABLES OP THE PHYSIOLOGICAL ACTION OP 
 
 DRUGS. Fcap. Svo, is. 
 
18 Catalogue of Works Published by H. K. Lewis. 
 
 A. STANFORD MORTON, m.b., f.r.c.s. eng. 
 Surgeon to the Royal South London Ophthalmic Hospital. 
 
 REFRACTION OF THE EYE : Its Diagnosis, and the 
 
 Correction of its Errors. Third Edition, with Illustrations, small 8vo. 
 3S. 
 
 C. W. MANSELL MOULLIN, m.a., m.d. oxon., f.r.c.s. eng. 
 
 Assistant Surgeon and Senior Demonstrator of Anatomy at the London Hospital; formerly 
 
 Radclijfe Travelling Fellow and Fellow of Pembroke College, Oxford. 
 
 SPRAINS; THEIR CONSEQUENCES AND TREAT- 
 MENT. Crown 8vo, 5s. INow ready. 
 
 PAUL F. MUNDE, m.d. 
 
 Professor of Gynecology at the New York Polyclinic ; President of the New York Obstetrical 
 Society and Vice-President of the British Gynecological Society, &c. 
 
 THE MANAGEMENT OF PREGNANCY, PARTURI- 
 TION, AND THE PUERPERAL STATE, NORMAL AND 
 ABNORMAL. Square Svo, 3s. 6d. Ijfust Published. 
 
 WILLIAM MURRELL, m.d., f.r.c.p. 
 
 Lecturer on Materia Medica and Therapeutics at Westminster Hospital; Examiner in 
 Materia Medica to the Royal College of Physicians of London, etc. 
 
 MASSOTHERAPEUTICS, OR MASSAGE AS A MODE 
 
 OF TREATMENT. Fourth edition, with Illustrations, crown Svo, 
 4s. 6d. [y^ust published. 
 
 II. 
 
 WHAT TO DO IN CASES OP POISONING. 
 
 Sixth edition, royal 32mo. [In the press. 
 
 in. 
 
 NITRO-GLYCERINE AS A REMEDY FOR ANGINA 
 
 PECTORIS. Crown Svo, 3s. &d. 
 
 DR. FELIX von NIEMEYER. 
 
 Late Professor of Pathology and Therapeutics ; Director of the Medical Clinic of the 
 University of Tubingen. 
 
 TEXT-BOOK OF PRACTICAL MEDICINE, WITH 
 
 PARTICULAR REFERENCE TO PHYSIOLOGY AND PATHO- 
 LOGICAL ANATOMY. Translated from the Eighth German Edi- 
 tion by special permission of the Author, by George H. Humphrey, 
 M.D., and Charles E. Hackley, M.D. Revised edition, 2 vols, 
 large Svo, 36s. 
 
Catalogue of Works Published by H. K. Lewis. 19 
 
 GEORGE OLIVER, m.d., f.r.c.p. 
 
 THE HARROGATE WATERS : Data Chemical and Therapeu- 
 tical, with notes on the Climate of Harrogate. Addressed to the 
 Medical Profession. Crown 8vo, with Map of the Wells, 3s. 6d. 
 
 ON BEDSIDE URINE TESTING : a Clinical Guide to the 
 
 Observation of Urine in the course of Work. Third Edition, revised 
 and enlarged, fcap. 8vo, 3s. 6d. 
 
 SAMUEL OSBORN, f.r.c.s. 
 
 Assistant-Surgeon to the Hospital for Women ; Surgeon Royal Naval Artillery Volunteers 
 
 I. 
 
 AMBULANCE LECTURES : FIRST AID. With Illus- 
 trations, fcap. 8vo, IS. 6d. 
 
 II. 
 AMBULANCE LECTURES: NURSING. With Illustrations, 
 fcap. 8vo, IS. 6d. 
 
 ROBERT W. PARKER. 
 
 Surgeon to the East London Hospital for Children, and to the Grosvenor Hospital for 
 Women and Children. 
 
 TRACHEOTOMY IN LARYNGEAL DIPHTHERIA, 
 
 AFTER TREATMENT AND COMPLICATIONS. Second Edition. 
 With Illustrations, 8vo, 5s. 
 
 CONGENITAL CLUB-FOOT; ITS NATURE AND 
 
 TREATMENT. With special reference to the subcutaneous division 
 of Tarsal Ligaments. 8vo, 7s. 6d. 
 
 JOHN S. PARRY, m.d. 
 
 Obstetrician to the Philadelphia Hospital, Vice-President of the Obstetrical and Patholegi- 
 cal Societies of Philadelphia, &c. 
 
 EXTRA-UTERINE PREGNANCY ; Its Causes, Species, 
 
 Pathological Anatomy, Clinical History, Diagnosis, Prognosis and 
 Treatment. Svo, 8s. 
 
20 Catalogue of Works Published by H. K. Lewis. 
 
 E. RANDOLPH PEASLEE, m.d., ll.d. 
 
 Late Professor of Gynecology in the Medical Department of Dartmouth College ; President 
 
 of the'New York Academy of Medicine, &c., &c. 
 
 OVARIAN TUMOURS : Their Pathology, Diagnosis, and 
 
 Treatment, especially by Ovariotomy. Illustrations, roy. 8vo, i6s. 
 
 G. V. POORE, M.D., F.R.C.P. 
 Profenor of Medical Jurisprudence, University College; Assistant Physician to, and Physi- 
 cian in charge of the Throat Department of. University College Hospital. 
 
 LECTURES ON THE PHYSICAL EXAMINATION OP 
 
 THE MOUTH AND THROAT. With an Appendix of Cases. 8vo, 
 36. 6d. 
 
 R. DOUGLAS POWELL, m.d., f.r.c.p., m.r.c.s. 
 
 Physician Extraordinary to H.M. the Queen ; Physician to the Middlesex Hospital anil 
 Physician to the Hospital for Consumption and Diseases of the Chest at Brompton. 
 
 DISEASES OP THE LUNGS AND PLEURA, INCLUD- 
 ING CONSUMPTION. Third edition, entirely rewritten and en- 
 larged. With coloured plates and wood engravings, 8vo, i6s. 
 
 URBAN PRITCHARD, m.d. edin., f.r.c.s. eng. 
 
 Professor of Aural Surgery at King's College, London; Aural Surgeon to King's College 
 
 Hospital ; Senior Surgeon to the Royal Ear Hospital. 
 
 HANDBOOK- OP DISEASES OP THE EAR POR THE 
 
 USE OF STUDENTS AND PRACTITIONERS. With Illustra- 
 tions, crown 8vo, 4s. 6d. 
 
 [Lewis's Practical Series.] 
 
 CHARLES W. PURDY, m.d. (queen's univ.) 
 Professor of Genitu- Urinary and Renal Diseases in the Chicago Polyclinic, &c., &c. 
 
 BRIGHT'S DISEASE AND THE ALLIED APFECTIONS 
 
 OF THE KIDNEYS. With Illustrations, large 8vo, 8s. 6d. 
 
 CHARLES HENRY RALFE, m.a., m.d. cantab., f.r.c.p. lond. 
 
 Assistant Physician to the London Hospital; Examiner in Medicine to the University of 
 Durham, etc., etc. 
 
 A PRACTICAL TREATISE ON DISEASES OP THE 
 
 KIDNEYS AND URINARY DERANGEMENTS. With Illustra- 
 tions, crown 8vo, los. 6d. 
 
 [Lewis's Practical Series.] 
 
Catalogue of Works Published by H. K. Lewis. 21 
 
 AMBROSE L. RANNEY, a.m., m.d. 
 
 Professor of the Anatomy and Physiology of the Nervous System in the New York Post- 
 
 Graduate Medical School and Hospital ; Professor of Nervous and Mental Diseases 
 
 in the Medical Department of the University of Vermont. 
 
 THE APPLIED ANATOMY OP THE NERVOUS SYS- 
 TEM. Being a Study of this portion of the Human Body from a 
 stand-point of its general interest and practical utility in Diagnosis, 
 designed for use as a text-book and a work of reference. Second edit., 
 238 Illustrations, large 8vo, 21s. [yust published. 
 
 H. A. REEVES, f.r.c.s. edin. 
 
 Senior Assistant Surgeon and Teacher of Practical Surgery at the London Hospital; 
 
 Surgeon to the Royal Orthopedic Hospital. 
 
 BODILY DEFORMITIES AND THEIR TREATMENT: 
 
 A HANDBOOK OF PRACTICAL ORTHOPEDICS. With 
 numerous Illustrations, crown 8vo, 8s. 6d. 
 
 [Lewis's Practical Series]. 
 
 RALPH RICHARDSON, m.a., m,d. 
 
 Fellow of the College of Physicians, Edinburgh. 
 
 ON THE NATURE OP LIFE: An Introductory Chap- 
 ter to Pathology. Second edition, revised and enlarged. Fcap. 4to, 
 los. 6d. 
 
 ^^. RICHARDSON, m.a., m.d., m.r.c.p. 
 
 REMARKS ON DIABETES, ESPECIALLY IN REFER- 
 ENCE TO TREATMENT. Demy 8vo, 4s. 6d. 
 
 SAMUEL, RIDEAL, d.sc. (lond.), f.i.c, f.c.s., f.g.s. 
 
 Fellow of University College, London. 
 
 PRACTICAL ORGANIC CHEMISTRY; The Detection 
 
 and Properties of some of the more important Organic Compounds. 
 i2mo, 2S. 6d. [yw^^ published. 
 
 E. A. RIDSDALE. 
 
 Associate of the Royal School of Mines. 
 
 COSMIC EVOLUTION ; being Speculations on the Origin 
 
 of our Environment. Fcap. 8vo, 3s. [Just published. 
 
22 Catalogue of Woj-ks Published by H. K. Lewis. 
 
 SYDNEY RINGER, m.d., f.r.s. 
 
 Professor of the Principles and Practice of Medicine in University College; Physician to 
 and Professor of Clinical Medicine tn, University College Hospital. 
 
 A HANDBOOK OF THERAPEUTICS. Twelfth Edition, 
 
 thoroughly revised, 8vo, 15s. {^^ust published: 
 
 ON THE TEMPERATURE OP THE BODY AS 
 
 A MEANS OF DIAGNOSIS AND PROGNOSIS IN PHTHISIS. 
 Second edition, small 8vo, 2s. 6d. 
 
 FREDERICK T. ROBERTS, m.d., b.sc, f.r.c.p. 
 
 Examiner in Medicine at the University of London; Professor of Therapeutics and of 
 Clinical Medicine in University College; Physician to University College Hos- 
 pital ; Physician to Brompton Consumption Hospital, &c. 
 
 A HANDBOOK OP THE THEORY AND PRACTICE 
 
 OF MEDICINE. Seventh edition, with Illustrations, in one volume, 
 large 8vo, 21s. L^'"^ published. 
 
 *»* Copies may also be had bound in two volumes cloth for is. 6d. extra. 
 
 THE OFFICINAL MATERIA MEDICA. 
 
 Second edition, entirely rewritten in accordance with the latest British 
 Pharmacopoeia, fcap. 8vo, 7s. 6d. 
 
 R. LAWTON ROBERTS, m.d., m.r.c.s. 
 
 Honorary Life Member of, and Lecturer and Examiner to, the St. John Ambulance 
 Association. 
 
 ILLUSTRATED LECTURES ON AMBULANCE WORK. 
 
 Third edition copiously Illustrated, crown 8vo, 2S. 6d. [Now ready. 
 
 D. B. St. JOHN ROOSA, m.a., m.d. 
 
 Professor of Diseases of the Eye and Ear in the University of the City of New York ; Surgeon 
 to the Manhattan Eye and Ear Hospital. 
 
 A PRACTICAL TREATISE ON THE DISEASES OP 
 
 THE EAR, including the Anatomy of the Organ. Sixth edition. 
 Illustrated by wood engravings and chromo-lithographs, large 8vo, 25s. 
 
Catalogue of Works Published by H. K. Lewis. 23 
 
 ROBSON ROOSE, m.d. 
 
 Fellow of the Royal College of Physicians in Edinburgh. 
 
 GOUT, ATfD ITS RELATIONS TO DISEASES OF 
 
 THE LIVER AND KIDNEYS. Sixth Edition, crown 8vo. 
 
 [Ih the press. 
 II. 
 NERVE PROSTRATION AND OTHER FUNCTIONAL 
 
 DISORDERS OF DAILY LIFE. Crown 8vo, los. 6d. 
 
 [jfust published. 
 
 J, BURDON SANDERSON, m.d., ll.d., f.r.s. 
 Jodrell Professor of Physiology in University College, London. 
 
 UNIVERSITY COLLEGE COURSE OP PRACTICAL 
 
 EXERCISES IN PHYSIOLOGY. With the co-operation of F. J. M. 
 Page, B.Sc, F.C.S. ; W. North, B.A., F.C.S., and Aug. Waller, M.D. 
 Demy 8vo, 3s. 6d. 
 
 W. H. O. SANKEY, m.d. lond., f.r.c.p. 
 Late Lecturer on Mental Diseases, University College, London, etc. 
 
 LECTURES ON MENTAL DISEASE. Second Edition, with 
 coloured plates, Svo, 12s. 6d. 
 
 JOHN SAVORY. 
 
 Member of the Society of Apothecaries, London. 
 
 A COMPENDIUM OP DOMESTIC MEDICINE AND 
 
 COMPANION TO THE xMEDICINE CHEST : Intended as a 
 source of easy reference for Clergymen, Master Mariners, and Tra- 
 vellers ; and for Families resident at a distance from professional assist- 
 ance. Tenth Edition, sm. Svo, 5s. 
 
 EMIL SCHNEE, m.d. 
 
 Consulting Physician at Carlsbad. 
 
 DIABETES, ITS CAUSES AND PERMANENT CURE ; 
 
 from the standpoint of experience and scientific investigation. Trans- 
 lated from the German by R. L. Tafel, A.M., Ph.D. Demy Svo, 6s. 
 
 \^ytist published. 
 
24 Catalogue of Works Published by H. K. Leivis. 
 
 DR. B. S. SCHULTZE. 
 
 Professor of Gynecology; Director of the Lying-in Hospital, and of the Gynecological 
 
 Clinic at Jena. , 
 
 THE PATHOLOGY AND TREATMENT OP DIS- 
 PLACEMENTS OF THE UTERUS. Translated by J. J. Macan, 
 M.A., M.R.C.S. and edited by A. V. Macan, M.B., M.Ch., Master of 
 the Rotunda Lying-in Hospital, Dublin. With 120 Illustrations, medium 
 8vo, I2S. 6d. [Now ready. 
 
 JOHN V. SHOEMAKER, a.m., m.d. 
 
 Professor of Skin Diseases in the Mcdico-Chirtirgical College and Hospital of Philadelphia ; 
 Physician to the Philadelphia Hospital for Diseases of the Skin. 
 
 A PRACTICAL TREATISE ON DISEASES OP THE 
 
 SKIN. Coloured Plates and other Illustrations, large 8vo, 24s. 
 
 WM. JAPP SINCLAIR, m.a., m.d. 
 
 Honorary Physician to the Manchester Southern Hospital for Women and Children, and 
 Manchester Maternity Hospital, 
 
 ON GONORRHOBAL INPECTION IN WOMEN. 
 
 Post 8vo, 4s. \^jfust published. 
 
 A. J. C. SKENE, M.D. 
 
 Professor of Gynecology in the Long Island College Hospital, Brooklyn, New York. 
 
 TREATISE ON THE DISEASES OP WOMEN, POR 
 
 THE USE OF STUDENTS AND PRACTITIONERS. Nine 
 coloured plates and 251 engravings, large 8vo, 28s. 
 
 ALDER SMITH, m.b. lond., f.r.c.s. 
 
 Resident Medical Officer, Christ's Hospital, London. 
 
 RINGWORM : Its Diagnosis and Treatment. 
 
 Third Edition, enlarged, with Illustrations, fcap. 8vo, 5s. 6d. 
 
 J. LE\VIS SMITH, M.D. 
 
 Physician to the New York Infants' Hospital; Clinical Lecturer on Diseases of Children 
 in Bellevue Hospital Medical College. 
 
 A TREATISE ON THE DISEASES OP INPANCY 
 
 AND CHILDHOOD. Fifth Edition, with Illustrations, large 8vo, 21s. 
 
Catalogue of Works Published by H. K. Lewis. 25 
 
 FRANCIS W. SMITH, m.b., b.s. 
 
 THE SALINE WATERS OP LEAMINGTON. Second Edit., 
 with Illustrations, crown 8vo, is. nett. 
 
 JOHN KENT SPENDER, m.d. lond. 
 
 Physician to the Royal Mineral Water Hospital, Bath. 
 
 THE EARLY SYMPTOMS AND THE EARLY TREAT- 
 MENT OF OSTEO-ARTHRITIS, commonly called Rheumatoid 
 Arthritis, with special reference to the Bath Thermal Waters. Sm. 8vo. 
 2s. 6d. \_Just published. 
 
 JAMES STARTIN, m.b., m.r.c.s. 
 Surgeon and Joint Lecturer to St. John's Hospital for Diseases of the Skin. 
 
 LECTURES ON THE PARASITIC DISEASES OP 
 
 THE SKIN. VEGETOID AND ANIMAL. With Illustrations, 
 crown 8vo, 2S. 6d. 
 
 W. R. H. STEWART, f.r.c.s., l.r.c.p. edin. 
 
 Aural Surgeon to the Great Northern Central Hospital; Surgeon to the London Throat 
 
 Hospital, &c. 
 
 EPITOME OP DISEASES AND INJURIES OP THE 
 
 EAR, with a Chapter on Naso-Pharyngeal Diseases causing Deafness. 
 Demy 32mo, 2s. 6d. {Just published. 
 
 LEWIS A. STIMSON, b.a., m.d. 
 
 Surgeon to the Presbyterian and Bellevue Hospitals ; Professor of Clinical Surgery in the 
 Medical Faculty of the University of the City of New York, &c. 
 
 A MANUAL OP OPERATIVE SURGERY. 
 
 Second Edition, with three hundred and forty-two Illustrations, post 
 8vo, los. 6d. 
 
 ADOLF STRUMPELL. 
 
 Director of the Medical Clinic in the University of Erlangen. 
 
 TEXT-BOOK OP MEDICINE POR STUDENTS 
 
 AND PRACTITIONERS. Translated from the latest German edition 
 by Dr. H. F. Vickery and Dr. P. C. Knapp, with Editorial Notes by 
 Dr. F. C. Shattuck, Visiting Physician to the Massachusetts General 
 Hospital, etc. Complete in one large vol., imp. 8vo, with iii Illustra- 
 tions, 28s. 
 
26 Catalogue of Works Published by H. K. Lewis. 
 
 JUKES DE STYRAP, m.k.q.c.p., etc. 
 
 Physician-Extraordinary, late Physician in Ordinary, to the Salop Infirmary ; Consulting 
 Physician to the South Salop and Montgomeryshire Infirmaries, etc. 
 
 THE MEDICO-CHIRTJRGICAL TARIFFS PREPARED 
 
 FOR THE LATE SHROPSHIRE ETHICAL BRANCH OF THE 
 BRITISH MEDICAL ASSOCIATION. Fourth Edition, fcap. 4to, 
 revised and enlarged, 2S. nctt. 
 
 C. W. SUCKLING, M.D.LOND., m.r.c.p. 
 
 Professor of Materia Medica and Therapeutics at the Queen's College, Physician to the 
 
 Queen's Hospital, Birmingham, etc. 
 
 ON THE DIAGNOSIS OF DISEASES OF THE 
 
 BRAIN, SPINAL CORD, AND NERVES. With Illustrations, 
 crown Svo, 8s. 6d. 
 
 JOHN BLAND SUTTON, f.r.c.s. 
 
 Lecturer on Comparative Anatomy, Senior Demonstrator of Anatomy, and Assistant Surgeon 
 
 to the Middlesex Hospital ; Erasmus Wilson Lecturer, Royal College of 
 
 Surgeons, England. 
 
 LIGAMENTS : THEIR NATURE AND MORPHOLOGY. 
 
 With numerous Illustrations, post 8vo, 4s. 6d. 
 
 HENRY R. SW^ANZY, a.m., m.b., f.r.c.s.i. 
 
 Examiner in Ophthalmic Surgery in the Royal University of Ireland, and to the Conjoint 
 
 Board of the King and Queen's College of Physicians and Royal College of 
 
 Surgeons, Ireland ; Surgeon to the National Eye and Ear 
 
 Infirmary, Dublin, etc. 
 
 A HANDBOOK OF THE DISEASES OF THE EYE AND 
 
 THEIR TREATMENT. Second Edition, Illustrated with wood- 
 engravings, colour tests, etc., small Svo, los. 6d. Ijfust published. 
 
 EUGENE S. TALBOT, m.d., d.d.s. 
 
 Professor of Dental Surgery in the Woman's Medical College ; Lecturer on Dental 
 Pathology and Surgery in Rush Medical College, Chicago. 
 
 IRREGULARITIES OF THE TEETH AND THEIR 
 
 TREATMENT. With 152 Illustrations, royal Svo, los. 6d. 
 
 JOHN DAVIES THOMAS, m.d. lond., f.r.c.s. eng. 
 
 Physician to the Adelaide Hospital, S. Australia, 
 I. 
 
 HYDATID DISEASE, WITH SPECIAL REFERENCE 
 
 TO ITS PREVALENCE IN AUSTRALIA. Demy Svo, los. 6d. 
 
 II. 
 HYDATID DISEASE OF THE LUNGS. Demy Svo, 2s. 
 
Catalogue of Works Published by H. K. Lewis. 27 
 
 HUGH OWEN THOMAS, m.r.c.s. 
 
 DISEASES OP THE HIP, KNEE, AND ANKLE 
 
 JOINTS, with their Deformities, treated by a new and efBcient method. 
 Third Edition, 8vo, 25s. 
 
 CONTEIBUTIONS TO SURGERY AND MEDICINE :— 
 
 Part i. — Intestinal Obstruction ; with an Appendix on the Action of 
 Remedies. los. 
 
 , 2. — The Principles of the Treatment of Joint Disease, Inflamma- 
 tion, Anchylosis, Reduction of Joint Deformity, Bone Set- 
 ting. 5s. 
 
 )• 3' — Fractures, Dislocations, Diseases and Deformities of the 
 Bones of the Trunk and Upper Extremities. los. 
 
 ,1 4. — The Collegian of i665 and the Collegians of 1885 ; or what is 
 recognised treatment ? Second Edition, is. 
 
 ,1 5. — On Fractures of the Lower Jaw. is. 
 
 ,. 6.— The Principles of the Treatment of Fractures and Disloca- 
 tions, los. 
 
 „ 8. — The Inhibition of Nerves by Drugs. Proof that Inhibitory 
 Nerve-Fibres do not exist, is. 
 
 (Parts 7, 9 and 10 are in preparation). 
 
 J. ASHBURTON THOMPSON, m.r.c.s. 
 
 Late Surgeon at King's Cross to the Great Northern Railway Company. 
 
 FREE PHOSPHORUS IN MEDICINE WITH SPE- 
 CIAL REFERENCE TO ITS USE IN NEURALGIA. A contribution 
 to Materia Medica and Therapeutics. An account of the History, Phar- 
 maceutical Preparations, Dose, Internal Administration, and Therapeu- 
 tic uses of Phosphorus ; with a Complete Bibliography of this subject, 
 referring to nearly 200 works upon it. Demy 8vo, 7s. 6d. 
 
 J. C. THOROWGOOD, m.d. 
 
 Assistant Physician to the City of London Hospital for Diseases of the Chest. 
 
 THE CLIMATIC TREATMENT OP CONSUMPTION 
 
 AND CHRONIC LUNG DISEASES. Third Edition, post 8vo, 3s 5d. 
 
28 Catalogue of Works Published by H. K. Lewis. 
 
 FREDERICK TREVES, f.r.c.s. 
 
 HunUrian Professor at the Royal College of Surgeons of England ; Surgeon to and Lecturer 
 
 on Anatomy at the London Hospital. 
 
 THE ANATOMY OP THE INTESTINAL CANAL AND 
 
 PERITONEUM IN MAN. Hunterian Lectures, 1885. 4to, 2S. 6d. 
 
 D. HACK TUKE, m.d., ll.d. 
 Fellow of the Royal College of Physicians, London. 
 
 THE INSANE IN THE UNITED STATES AND 
 
 CANADA. Demy Svo, 7s. 6d. 
 
 LAURENCE TURNBULL, m.d., ph.g. 
 
 Aural Surgeon to Jefferson Medical College Hospital, &c., &c. 
 
 ARTIFICIAL ANESTHESIA : A Manual of Anaesthetic 
 
 Agents, and their Employment in the Treatment of Disease. Second 
 Edition, with Illustrations, crown Svo, 6s. 
 
 DR. R. ULTZMANN. 
 
 ON STERILITY AND IMPOTENCE IN MAN. Translated 
 from the German with notes and additions by Arthur Cooper, L.R.C.P., 
 M.R.C.S., Surgeon to the Westminster General Dispensary. With Illus- 
 trations, fcap. Svo, 25. 6d. 
 
 W. H. VAN BUREN, m.d., ll.d. 
 
 Professor of Surgery in the Bellevue Hospital Medical College. 
 
 DISEASES OP THE RECTUM : And the Sxirgery of 
 
 the Lower Bowel. Second Edition, with Illustrations, Svo, 14s. 
 
 RUDOLPH VIRCHOW, m.d. 
 
 Professor iM the University, and Member of the Academy of Sciences of Berlin, &c., &c. 
 
 INFECTION - DISEASES IN THE ARMY, Chiefly 
 
 Wound Fever, Typhoid, Dysentery, and Diphtheria. Translated from 
 the German by John James, M.B., F.R.C.S. Fcap. Svo, is. 6d. 
 
Catalogue of Works PuhUshed by H. K. Lewis. 29 
 
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 Professor of Clinical Medicine in the University of Dorpat, Russia. 
 
 A PRACTICAL TREATISE ON THE DISEASES OF 
 
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30 Catalogue of Works Published by H. K. Lewis. 
 
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 [yust published. 
 
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Catalogue of Works Published by H. K. Lewis, 31 
 
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32 Catalogue of Works Published by H. K. Lewis. 
 
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