PATHOLOGY. 345 
excretion always accompanies the diabetic habit, and cof- 
tivenefs is perhaps the mod common of thefe 5 for, in 
fome inftances, the bowels have been fo remarkably tor¬ 
pid, that even the moft powerful medicines, in large 
dcfes, produced but a trifling effeft. Watt remarks that 
inflammation and fwelling are very common about the 
external orifice of the urethra in diabetes. 
This difeafe is often attended with fome pulmonic dif¬ 
order; Dr. Bardfley fays invariably, but this does not 
accord with general experience. It is to be remarked, 
however, that diabetes feldom terminates in death until 
a fecondary caufe of the fatal event has arifen in the lungs. 
Under a long continuance of the difeafe, the patient be¬ 
comes much emaciated, the feet cedematous; great debi¬ 
lity arifes, and an obfcure fever, with all the appearances 
of hectic, prevail. In point of number, the pulfe is very 
much diverfified : in moft cafes, it is quicker than natu¬ 
ral, but fometimes it is below the common ftandard. In 
fome cafes vilion becomes very indiftindft, and the pa¬ 
tient is troubled with vertigo. 
In fome inftances, the quantity of urine is much greater 
than that of the ingefta. , Cafes are recorded, in which 
from twenty-five to thirty pints were difcharged in the 
fpace of a natural day, for many fucceflive weeks, and 
even months; and in which the whole ingefta, as was 
faid, did not amount to half the weight of the urine; and 
even the folid matter which this fluid contains often 
reaches an aftonifhing proportion. The furplus of the 
excrement over the increment in this cafe is explained 
by the want of cutaneous fecretion, (the fkin being 
generally dry and harlh,) and an extraordinary imbibi¬ 
tion of water in the lungs. DifieCtions of diabetes have 
fhown the kidneys, in fome inftances, in a loofe flabby 
ftate, much enlarged in fize, and of a pale alh-colour 5 in 
others, on the contrary, they have been found turgid and 
red, and containing in their infundibula, a quantity of 
pus, though without any fign of ulceration. At the 
fame time that thefe appearances have been obferved in 
the interior, the fuperficial veins on their furface were 
found to be much fuller of blood than ufual. In many 
cafes, the whole of the mefentery has been difcovered to 
be much difeafed, and its glands remarkably enlarged ; 
fome of them being very large and of an irregular Jex- 
ture ; others fofter, and of an uniform fpherical Ihape. 
Many of the laCteals have likewife been found confidera- 
bly enlarged. The liver, pancreas, fpleen, and ftomach, 
are in general in a natural ftate ; when they are not fo, 
the occurrence is to be confidered as accidental. The 
bladder is now and then found to contain a quantity of 
muddy urine ; in fome cafes its coats are much thickened, 
and its fize lefs than natural. 
The hypothefes which have been framed to account 
for diabetes refolve themfelves into thefe. The firft, 
for which we are indebted to the fanciful genius of Dar¬ 
win, fuppofes a retrograde motion of the abforbents; an 
idea of which the abfurdity has been pointed out in a 
previous divifion of this work, p. 43. Secondly, that of 
Cullen and Rollo, which fuppofes difeafe of the aifimila- 
ting agents, and eflentially confifts in the fuppofition that 
blood is difeafed in diabetes, and that the kidneys are only 
deranged in their affion in confequence of-the morbid 
ftate of the blood fupplied to them. The third hypothe- 
fis fuppofes that difeafed adtion exifts in the fecernents of 
the kidneys, and that confequently the faccharine matter is 
derivable from healthy blood. 
The fecond hypothefis refts moreover on the ftrong fadl, 
- that, if fugar be introduced into the veins of an animal, 
efpecially if that animal be weak, fugar is firft found in 
the blood, and fecondly in the urine. But, though this 
fliows the poflibility of diabetes arifing from faccharine 
blood, it does not prove that this is the invariable caufe 
of that difeafe and in fadl fugar is not found in the 
blood in diabetic patients in general. The advocates of 
the dodtrine of the cachedtic origin of the difeafe get 
over this objedtion by aflerting, that the elements of fugar 
exiftin the blood. Now this means nothing; for, accor¬ 
ding to this reafoning, the elements of hydrophobic and 
fyphilitic virus exift in the blood ; for the fupplies out 
of which thefe morbid matters are formed are drawn from 
the blood by the fecernents, however incognizable the 
original fluid may be when it has undergone the adlion 
of thefe latter veflels. 
The connection between diabetes and dyfpepfia appears 
to us very evident; but we cannot fee that this proves 
any thing in favour of the opinion that the blood is dif¬ 
eafed in diabetes, when we have fo many inftances of dif- 
eafes of the fecernent fyftem arifing frorngaftric diforder. 
And, moreover, the general diforder of the nervous fyf¬ 
tem and of the Ikin which has been obferved to precede 
diabetes in fo many inftances fufficiently accounts for the 
production of the difeafe without our having recourfe to 
more far-fetched modes of explanation. 
As there is much of uncertainty in our fpeculations 
concerning the nature of diabetes, it is impoflible to at¬ 
tempt any philofophical view of the modus operandi of 
thofe medicines which have been found ufeful in its 
treatment. Our practice in this difeafe mull therefore be 
ftriCtly empirical. In the firft place, bleeding has been 
tried in many cafes of diabetes, and with much fuccefs 
Practical writers aflert.that this evacuation is particu¬ 
larly called for when the difcharge of urine is profufe as 
well as faccharine; but it feetns to have been of much 
ufe in cafes which did not prefent this fymptom in an 
eminent degree. The blood, when abftraCted, appears 
of a darker hue than ordinary, and the craflamentum 
large and eafily broken. After a few bleedings, however, 
the craflamentum acquires firmnefs, and begins to exhi¬ 
bit the buft’y coat. By fome authors it is laid that this 
plan of depletion has completely cured the difeafe under 
confideration ; but more extended experience has not al¬ 
together affirmed this to be the truth ; though it is 
almoft univerfally agreed that bleeding does rpaterially 
diminilh the quantity, if it does not alter the quality, of 
diabetic urine. Animal diet has alfo been very generally 
reforted to, and with occalional fuccefs. It has been 
chiefly recommended on the fuppofition, that, as fugar 
w'as the principal conftituent of chyle prepared from ve¬ 
getables, therefore the adoption of diet of a different 
kind muft effectually cure the difeafe by fubtraCting it: 
but, as we have before fhown that fugar does not ac¬ 
tually exift, we fliould rather incline to fuppofe that ani¬ 
mal diet has cured diabetes rather by its falutary influ¬ 
ence on certain gaftric derangements arifing from excefs 
of vegetable food, than from any fpecific change it in¬ 
duces in the blood ; and hence, that cafes of diabetes 
might arife, in which animal food, by oppreffing the di- 
geftive organs, would do harm. In no cafe fliould we 
expeCt much from diet alone, unlefs thofe important af- 
fiftants to its healthy ufe, viz. pure air and regular exer- 
cife were alfo attended to. In all cafes the moft clofe 
attention muft be paid to the alvine fecretions and their 
regular excretion enforced by appropriate medicines, when 
not fpontaneous; for, whether the difeafe be of cacheCtic 
origin, whether it arifes from inflammation or from 
mucous irritation of the urinary veflels, the belt effeCts 
will naturally be expeCted from medicines which have 
the triple advantage over all others, that they reduce in¬ 
flammation, calm nervous irritation, and eliminate mor¬ 
bid matters from the blood. As in the difeafes of the fe¬ 
cernents in general, fo in thofe of the kidneys in particu¬ 
lar, we often find that, though the caufe of the difeafe be 
effectually removed, the habitual morbid aCtions of the 
veflels remain. In diabetes efpecially, we often find that, 
when the general plethora and the dyfpeptic diforder are 
in a great meafure removed, the urinary difeafe remains 
protraCted and harrafling. In thefe cafes, a fpecific or 
peculiarftimulus may be made to exert an influence on the 
fecernents fufficiently powerful to induce their healthy 
aCtion. Thus we have found much benefit, in a very 
fevere cafe of diabetes, from the exhibition of full dofes 
of 
