Art. V.—A Case of Saccharine Diabetes, vSfi Tabular Observations of its 
Pathology, and the Results of Treatment. By Charles Frick, M. D., 
Baltimore. 
The following case of saccharine diabetes has been iipder my care, in the 
Maryland Penitentiary, for the past ten months. From t\e particular advan- 
tages for medical observation to be obtained in an institution of this character, 
inasmuch as the amount of exercise, diet, and labour is neh>(ly equal from 
day to day, I have had better opportunities for obtaining comparative results, 
and am enabled to state more facts, in relation to this case, than 
could be ascertained elsewhere. And although I have not been able'to deduce 
any explanation of the pathology of this disease which is much in adfynce of 
the theories which at present prevail, yet I feel assured that I am on 
the one side, to substantiate beyond doubt many of the facts recorded by 
previous observers, and on the other to settle definitely one or two disputed 
points. I should moreover state, at the commencement, that the quantity of 1852.] 
Frick, Case of Saccharine Diabetes. 
65 
ingesta and egesta, as recorded in the tables, I am satisfied, is strictly correct, 
and whenever I had reason to suspect the least inaccuracy the observation 
was thrown aside as worthless. 
Nicholas Matthews, mulatto, aet. 37 years, height six feet three inches, 
weight 180 lhs., entered the prison March 23,1851, under a sentence of nine 
years. He is not fleshy, but strong and healthy in appearance. Previous to 
his confinement, he lived in the country, near the village of Ellieott’s Mills. 
The soil is of granitic formation, and he worked most of his life in the open 
air as a stonecutter. His health, for the last nine years, has been so good 
that, during that time, he has not lost a day from sickness, and was enabled 
to do as full a task as any one working at the same occupation. Nine years 
ago he was treated for a pleurisy on the right side, which confined him to the 
house for two weeks, and he has, at this time, slight dulness on percussion 
on that side, from old false membranes. He has always been well fed and 
clothed, and has been a temperate man, for the last nine years having not 
once tasted ardent spirits. His diet consisted of vegetables, meat, and bread, 
and neither his appetite nor thirst could be considered inordinate. The meat 
was almost always salt, and the bread contained no yeast, he having ascer- 
tained that ordinary fermented bread was apt to occasion pain in his bowels. 
He says that his father had something like diabetes at the age of forty ; but 
it passed off in a few years, and he is now alive at the age of eighty-four. 
None of his relatives died of phthisis. One brother, aged fifty-eight, is at 
present an inmate of the prison, sound and well in every respect, and another 
he lost from pneumonia. He had never noticed anything wrong about his 
urine, and is confident that he never passed any unusual amount before his 
confinement. About a year since, he remarked, for the first time, that he had 
occasion to rise once at night to empty his bladder. This has continued ever 
since. After the attack of pleurisy, he had attracted attention among his 
fellow-workmen from the fact of his excessive perspiration. Since his resi- 
dence in the prison, his skin has been dry except in hot weather. For some 
years he has been subject to pain across the loins, and occasional cramps in 
the solei muscles. But these he attributes to an inguinal hernia which was 
produced about that time. The day of his entrance he was placed in the 
spinning-shop, where he continued for five weeks at work, when my attention 
was attracted to him. He had lost twelve pounds in weight, complained of 
great weakness in his knees, and inordinate appetite and thirst. This latter, 
he stated, had been so great that in the dormitory, where he could procure no 
water, he had drunk his own urine, which he described as being sweet to the taste. 
On testing it, I found it distinctly saccharine. He was then removed to the 
hospital for more accurate observation, and for three weeks was subjected to 
different kinds of diet without remedial treatment; every article of food eaten, 
and the exact quantity of urine discharged, being ascertained throughout the 
whole period. I ascertained that his lungs and heart were perfectly sound. 
There was no pain in his head, neck, or along the spinal cord, with or without 
pressure. The liver and spleen are of natural size, and all the abdominal 
organs, as far as I can discover, are in a normal condition. His health now 
is about as good as at entrance. At different periods of his confinement, I 
have examined the following fluids of his body for sugar. The test most 
commonly used was the addition of liquor potassae and sulphate of copper, 
known as Trommer’s. I also used Moore’s test, the Barreswil liquid, yeast, 
and nitrate of silver. Of these, Barreswil’s liquid gives the most satisfac- 66 
Frick, Case of Saccharine Diabetes. 
[July; 
tory results, provided the quantity added before heating be equal at least to 
one-third or one-fourth the quantity of urine.* 
The urine was examined repeatedly, and always contained sugar, the amount 
holding a definite relation to the specific gravity. 
The sweat was examined several times. Half a drachm collected by a 
spoon from his skin always gave the characteristic reaction. 
An infusion made by pouring boiling water on the feces, filtering, and then 
boiling with animal charcoal to decolorize, always contained sugar. The 
largest quantity was obtained from the stools passed during an attack of 
cholera morbus. 
On treating the contents of his stomach in the same way, whether ejected 
by cholera morbus or by an emetic, the characteristic reaction was always made 
evident. This was most marked in the matters thrown up a few hours after 
a meal, and was present when the diet consisted of meat and eggs alone. I 
think we may account for it in this case, by its presence in the mucus and 
gastric juice ejected at the same time. 
While labouring under catarrh, the mucous expectoration from his bronchial 
tubes, on being diluted with water, gave the characteristic reaction. 
This was also the case with the saliva, in every instance that I examined 
it. Bernard states that true saliva in this disease contains no sugar; but, as I 
was unable to separate the secretion obtained from the parotid and sublingual 
glands, and the buccal mucous membrane, I cannot assert that he is mistaken. 
Blood was taken from him, in two instances, by cups. At both times it 
contained sugar, and gave the characteristic reaction in a more marked degree 
than any of the fluids examined. Its detection was very simple. About half 
a drachm of serum was diluted with half an ounce of water. This was heated 
to coagulate the albumen, filtered, and the test applied to the filtered fluid. Or, 
an ounce of blood was dried, pulverized, and alcohol poured on it. This was 
filtered and evaporated at a gentle heat; then dissolved in water. Only a 
few drops of this solution were necessary to indicate the presence of sugar. 
From an abscess of the hand half a drachm of pus was collected. This was 
diluted, boiled, and filtered. The usual test gave the characteristic reaction.j* 
It is thus shown that all the secretions of his body which were available for 
examination indicated most decidedly the presence of sugar, and this without 
any relation to the diet, although the reaction was most marked when sugar 
or starch was used as food. 
* The composition of theBarreswil fluid, for which I am indebted to Dr. Donaldson, 
is as follows :— 
R. Crystallized carbonate of soda gj, i 
Caustic potash gij, £)ij; 
Bitartrate of potash gj, ij; 
Sulphate of copper gj; 
Distilled water Oj. 
M. To be boiled, and then filtered. 
•}■ I am aware that the reduction of the oxide of copper may be produced by other 
organic substances besides sugar, and that from the presence of albumen false inferences 
may be drawn. Such, I am satisfied, is not the case in the present instance. 1852.] 
Frick, Case of Saccharine Diabetes. 
67 
Date. 
Hour of day. 
Urine passed in 
ounces in 24 hours. 
Fluid drank, in 
ounces. 
Specific gravity 
of urine. 
Quantity of sugar 
passed from kid- 
neys, in ounces. 
Quantity of sugar 
contained in food, 
in ounces. 
Water drank, 
in ounces. 
Tea drank, 
in ounces. 
Pood eaten. 
Stools. 
Perspiration. 
Remarks. 
So 
be 
H 
Meat, in 
ounces. 
Bread, 
fermented, 
in ounces. 
Bread, 
unfermented, 
in ounces. 
Dry farina, 
in ounces. 
Sugar, 
in ounces. 
May 
8 
11 
481 
1.033 
16522 
66 
9 
11 
240 
259 
1.013 
2566 
1440 
197 
60 
6 
16 
None 
Moderate 
66 
10 
11 
204 
214 
1 013 
2083 
1440 
154 
60 
8 
16 
1 
Profuse 
Weighs, to-day, 16S lbs. 
(6 
11 
11 
150 
166 
1.026 
3430 
3744 
106 
60 
6 
16 
6 
None 
Profuse 
jjij of sweat collected; con- 
tains sugar. 
ec 
12 
11 
159 
175 
1.033 
5026 
3744 
115 
60 
2 
16 
6 
None 
Profuse 
<( 
13 
11 
165 
176 
1.030 
4547 
3744 
116 
60 
5 
20 
6 
None 
Considerable 
Mucus from bronchial tubes 
contains sugar. 
66 
14 
11 
143 
156 
1.006 
208 
None 
156 
6 
16 
i 
3 loose 
Considerable 
66 
15 
11 
75 
84 
1.021 
992 
None 
84 
6 
16 
3 
None 
Scanty 
ec 
16 
1 1 
52 
98 
1.034 
1263 
1400 
39 
59 
6 
24 
4 
3 
None 
Weighs, to-day, 16S lbs. 
66 
17 
11 
86 
165 
1.029 
1964 
1370 
107 
58 
10 
3 
None 
Yesterday’s stools contain 
sugar in abundance. 
66 
18 
11 
63 
125 
1.024 
925 
None 
125 
6 
24 
2 
None 
66 
19 
11 
39 
104 
1.024 
325 
None 
104 
6 
32 
2 
Moderate 
Detected sugar in sweat to-day. 
66 
20 
11 
84 
93 
1.031 
2088 
None 
93 
6 
32 
None 
None 
66 
21 
11 
133 
150 
1.030 
3539 
1440 
90 
60 
6 
16 
1 
Moderate 
Weighs, to-day, 162 lbs. 
66 
22 
11 
344 
390 
1.037 
12S00 
27820 
230 
160 
44 
None 
None 
Sugar produced nausea, but no 
vomiting. 
66 
23 
11 
264 
293 
1.034 
9065 
15840 
113 
ISO 
30 
None 
None 
66 
24 
11 
251 
273 
1.036 
8888 
14400 
153 
120 
30 
None 
None 
66 
25 
11 
169 
180 
1.036 
5732 
17856 
60 
120 
39 
1 
None 
66 
26 
11 
228 
260 
1.034 
7830 
17856 
140 
120 
16 
39 
2 
None 
Weighs, to-day, 163| lbs. 
66 
27 
11 
321 
351 
1.030 
8461 
17856 
231 
120 
16 
39 
1 
None 
Jan. 
21, 1852 
11 
234 
1.033 
7306 
18432 
None 
48 
3 loose 
None 
22 
11 
252 
1.030 
7162 
18432 
None 
48 
1 loose 
None 
Table Exhibiting the Influence of Diet. 68 
Frick, Case of Saccharine Diabetes. 
[July, 
An examination of the preceding table allows us to make the following 
deductions:— 
In the first place, that the quantity of urine is in itself no measure of the 
extent of the disease, it being regulated by the quantity of fluid drank, the 
perspiration, the number of fecal evacuations, &c. That in no instance was 
the quantity of urine passed greater than the amount of fluid drank, although 
a writer in the October number of the Archives Gentrales de Paris, assuming 
that the contrary was always the case, has endeavoured to prove that in dia- 
betes a portion of the water in the renal secretion is produced by the union 
of hydrogen and oxygen within the body. On comparing the two columns 
of fluid drank and fluid passed, which I have placed side by side for better 
comparison, it will be seen that the relation between the two is very exact, 
and becomes more or less disturbed in proportion to the number of stools and 
the profuseness of the perspiration. 
The quantity of sugar, although in a great measure dependent upon, is not 
always in proportion to, the amount of urine passed. A certain quantity of 
sugar is to be eliminated by the kidneys, and a proportionate amount of water 
is necessary for its solution. This waut is intimated to the sensorium which 
seeks to supply it, just as a farther supply of material for carrying on the 
functions of the animal body is intimated by the sensation of hunger. And 
I ascertained, in the case of the patient under consideration, that when he 
was made to drink more or less fluid than he desired, the quantity of sugar 
remained the same, the specific gravity of the urine only undergoing altera- 
tion. For this reason he was allowed to drink an unlimited quantity of water, 
so that he rarely complained of thirst. In calculating the amount of sugar in 
his urine and food, I do not pretend to have been perfectly accurate; but, as 
my object was to obtain facts which would enable me to institute comparative 
results, I feel assured the mode of proceeding has been sufficiently exact. The 
quantity of urine, and the specific gravity at each period of voiding it, were 
accurately determined, and the amount of solids calculated by the ordinary 
table. I had previously ascertained from analysis that the usual healthy in- 
gredients were all present in about their normal quantity, and as these vary, in 
a healthy individual, from 600 to 700 grains in twenty-four hours, I assumed 
them to be 650 grains, which amount was deducted from the whole solids, 
and the remainder considered as sugar. The quantity of this substance in 
the food was ascertained by taking the analysis of the different articles of diet, 
as laid down by different authorities, and estimating the quantity of sugar, 
and of substances capable of forming it, in each separately. 
On comparing these two results, it will be seen that, although on five days 
no sugar or those substances capable of forming it were taken as food, yet, 
nevertheless, an average of 707 grains was passed each day from the kidneys; 
thus establishing the fact, previously stated by Bernard, that the source of 
the sugar is due to some cause beyond the non-conversion of the saccharine 
and amylaceous elements of food. Taking this fact into consideration, it is 
shown that the additional proportion of these substances, as diet, influences 
directly the quantity of sugar excreted. And whether the food consists of 
sugar alone, or a combination of sugar and starch, the result is nearly the 
same. Thus taking into consideration the quantity contained in the fecal 
discharges, on forty-four ounces of pure sugar the same proportionate amount 
was excreted as on thirty ounces of leavened, or thirty-nine ounces of un- 
leavened bread. 
I have arranged the following table to show the aggregate and average 1852.] 
Frick, Case of Saccharine Diabetes. 
amounts of sugar and urine passed between the different hours of the day, for 
fifteen days, at various intervals:— 
69 
Hour of day. 
Aggregate 
quantity 
of sugar, 
in grains. 
Average 
quantity 
of sugar for 
each day. 
Aggregate 
quantity 
of urine, 
in ounces. 
Average 
quantity of 
urine for each 
day. 
7 to 8 P.M. 
4329 
288 
145 
10 
8 to 9 
5356 • 
357 
186 
12 
9 to 10 
5434 
362 
194 
13 
10 to 11 
7019 
468 
229 
15 
11 to 12 
1008 
67 
48 
3 
12 to 1 
6119 
408 
175 
12 
1 to 2 
1590 
106 
60 
4 
2 to 3 
3477 
232 
110 
7 
3 to 4 
3924 
262 
122 
8 
4 to 5 
2468 
164 
68 
4 
5 to 6 
3426 
228 
104 
7 
6 to 7 
2438 
163 
74 
5 
Breakfast. 
7 to 8 A. M. 
1836 
122 
54 
4 
8 to 9 
1754 
117 
55 
4 
9 to 10 
2548 
169 
82 
6 
10 to 11 
6924 
462 
209 
14 
11 to 12 
4312 
287 
133 
9 
Dinner at 12. 
12 to 1 
5047 
336 
154 
10 
1 to 2 
6597 
439 
197 
13 
2 to 3 
6459 
436 
219 
15 
3 to 4 
8636 
576 
301 
20 
4 to 5 
9622 
630 
338 
25 
5 to 6 
9154 
610 
298 
19 
6 to 7 
6545 
436 
214 
14 
Supper. 
7741 
253 
It will be seen, on reference to the preceding table, that during the seven 
hours occurring between twelve and seven o’olock, or those immediately after 
the ingestion of the principal meal, and under various modes of treatment, 
the average quantity of sugar passed is 3459 grains, or very nearly one-half 
of the whole amount. And, moreover, that the same is true in regard to the 
quantity of urine, 116 ounces having been voided in the same interval of 
time. Another interesting fact is also here exhibited. After each meal, 
both the quantity of sugar and of urine commences and goes on to increase 
in regular progression up to the fourth hour, when it again decreases in nearly 
the same proportion. This table is made up of one hundred and forty-four 
separate observations, and the average specific gravity of the urine for the 
whole number is 1.0305. 
A quantitative analysis of the amount of urea was made on three separate 
occasions. The mode of proceeding was to evaporate the urine over a water- 
bath to about one-fourth its bulk. From thirty to forty ounces were used for 
this purpose, and the urea was obtained in the form of a nitrate or an oxalate. 
It amounted to 90.56 grs., 102 grs., and 121.6 grs., respectively. We will 
not undertake to say that all the urea contained in the specimen examined was 
thus obtained, and shall, therefore, draw no conclusions from its deficiency. 70 
Frick, Case of Saccharine Diabetes. 
[July> 
Table showing the comparative Effects of Treatment for 9 months continuously 
Date. 
Quantity of 
urine in 24 hours 
in ounces. 
Quantity of sugar 
in urine in 24 
hours, in grains. 
Quantity of sugar 
in food in 24 
hours, in grains. 
Medicine taken during 
the day and the week 
previous. 
Stools on the day 
of examination. 
Weight on 
the day of 
examination. 
Remarks. 
June 1 
313 
11657 
19200 
None 
165 X 
“ 8 
401 
11380 
19200 
Cod-liver oil, 93 per week 
170 
“ 16 
358 
9000 
19200 
Cod-liver oil, 7.3 per week 
2 
16046 
Diarrhoea last week 
“ 22 
440 
14900 
19200jCod-liver oil, 203 per week 
4 
170 % 
July 12 
342 
9950 
19200 
Cod-liver oil, 105 per week; 
2 
173 
Gained 746 10s. on 563 
aqua ammonia, 5 drops 3 
cod-liver oil in 42 
times daily 
days. 
“ 20 
278 
7134 
20000 
l-20th gr. of strychnine, 3 
Pus from hand con- 
times daily 
tains sugar. 
“ 25 
130 
3830 
19800 
Strychnine, the same 
2 
170% 
Slight diarrhoea stools 
contain sugar. 
“ 28 
78 
2000 
18200 
l-15th gr. of strychnine, 3 
4 loose 
170 >6 
In hospital for diar- 
times daily; 9s cod-liver 
rhoea. 
oil per week 
Aug. 18 
150 
3550 
22000 
Strychnine and cod-liver oil, 
2 
170 46 
Has taken in 20 days 
the same 
323 of cod-liver oil. 
“ 22 
184 
5520 
21500 
Strychnine l-20th gr. 3 times 
daily 
Sept. 7 
200 
4070 
21950 
Strychnine l-10th gr. 3 times 
166 
daily 
“ 15 
90 
2500 
20080 
Strychnine l-7th gr. 3 times 
Medicine has produced 
daily 
stiffness of neck, and 
increase of venereal 
desire. 
“ 21 
63 
867 
21500 
Strychnine l-6th gr. 3 times 
3 
Only 303 were passed 
daily 
in first 18 hours. 
“ 29 
247 
8000 
18100 
None 
2 
162 
Oct. 5 
177 
4964 
24400 
Strychnine l-12th gr. 3 times 
2 
157>6 
daily 
“ 12 
187 
4630 
23200 
Strychnine l-7th gr. 3 times 
1G1>6 
daily; cod-liver oil 103 per 
week 
“ 19 
116 
2688 
24200 
Strychnine l-6th gr. 3 times 
165 
Has gained 746 lbs. on 
daily ; oil, the same 
203 cod-liver oil in 2 
weeks. 
“ 22 
40 
1000 
No 
None 
4 loose 
Sools equal 1 gallon ; 
food 
contains sugar. 
“ 24 
39 
689 
920 
None 
3 loose 
162 
“ 25 
43 
1017 
4520 
Strychnine l-6th gr. 3 times 
1 
daily 
Nov. 2 
90 
2467 
26300 
Strychnine, the same 
166 
“ 9 
103 
2037 
36000 
Mur. tine, ferri 10 drops, 3 
3 loose 
times daily 
“ 10 
223 
5264 
36000 
Mur. tine, ferri 20 drops, 3 
2 loose 
164 46 
times daily 
“ 21 
267 
6927 
36000 
Iod. potass. 3 grs. 3 times 
5 loose 
16046 
Detected iodine in 
daily 
urine. 
“ 30 
486 
13728 
30000 
Creosote 1 drop ; naphtha 10 
1 
Medicine produces 
drops, 3 times daily 
great discomfort. 
Dec. 7 
442 
12336 
19100 
Cod-liver oil, 83 per week 
3 
167 
“ 14 
572 
15192 
21000 
Cod-liver oil, 63 per week 
1 
167 
“ 21 
515 
15784 
21000 
Cod-liver oil, 63 per week 
2 
168 
“ 28 
648 
16708 
21200 
Cod-liver oil, 113 per week 
3 
169 46 
Jan. 3 
612 
18972 
22000 
Whiskey, 33 daily 
1 
172 
Has taken 403 of cod- 
liver oil in 30 days, 
and gained 1146 lbs. 
“ 8 
648 
19438 
21000 
Whiskey, 33 daily 
1 
170 
“ 13 
206 
4836 
21000 
Strychnine l-9th gr. 3 times 
3 
170 
daily 
“ 20 
172 
2364 
22000 
Strychnine l-6th gr. 3 times 
2 
16946 
daily 
« 29 
522 
16704 
23300 
None 
O 
168 
Feb. 15 
520 
19030 
23300 
Calomel 1 gr.; opium 14 gr. 
4 
171 
Taking this for 2 
once daily 
weeks; rises4 times 
each night. 
“ 22 
420 
11950 
24200 
Ergot 3 grs. 3 times daily 
4 
180^ 
Says he is getting 
well; rises but once 
at night. 
March 1 
703 
20440 
20000 
Ergot 3grs.; iod. ferri 2 grs.; 
3 
171 
strychnine l-10th gr., 3 
times daily 
“ 4 
322 
13860 
25500 
None 
2 
172 1852.] 
Frick, Case of Saccharine Diabetes. 
71 
Inasmuch as it is only of late years that we can conclude with certainty that 
the cases reported as diabetes were in reality that disease, we must take with 
considerable reservation the many accounts of their successful treatment. In 
the second case here reported, the patient believes himself cured, and looks to 
be in perfect health; but he is still passing from four to five ounces of sugar 
from his kidneys daily. And it is certain that, latterly, the journals less 
frequently contain reports of cases of this disease treated successfully. Of 
the ten or twelve that have fallen under my observation, most of them 
through the kindness of my friends, not one, so far as I know, has ever re- 
covered. 
We will now examine, in detail, the effects of treatment in this case. 
Each medicine was continued for at least one week, and the urine examined 
at the end of that period. It is impossible to make any exact comparison of 
these various modes, unless we could ascertain the amount of sugar passed 
in the stools and from the skin, as well as from the kidneys. And an exami- 
nation of the preceding table will convince any one that an estimation of the 
increase or diminution of sugar in the urine is valueless unless, at the same 
time, allowance be made for the quantity passed in the fecal evacuations. The 
amount contained in the sweat we are forced to omit; but, as the condition of 
the skin remained nearly the same during the time the patient was under 
treatment, particularly for the last four months, we can the more readily 
afford to throw this element out of consideration. We endeavoured to ascer- 
tain accurately the amount of sugar contained in the stools, but with little 
success. There were, however, periods when he was kept, as nearly as possi- 
ble, from day to day, under the same conditions, both as regards diet, exercise, 
and medicine; and we then remarked that, when the stools were about the 
same in number and quantity, the amount of sugar contained in the urine 
varied very little, but was increased or diminished in proportion to the fecal 
evacuations. From this fact, and one or two rough analyses of the fecal 
matters, we estimated the average amount of sugar in each stool to be about 
1800 grains, and we shall assume this quantity in considering the effects of 
the different remedies. Whether this 1300 grains be too large or too small, 
the proportionate amounts remain nearly the same, and we subjoin below a 
comparative table of the different quantities of sugar passed from the kidneys 
and bowels together, while under the influence of the above remedies. 
Grains. 
Strychnine | gr. 3369 
“ r gr. 3565 
“ T'5 gr. 6250 
“ T'j gr. 6425 
“ in gr. 6360 
Mur. tine, ferri 10 drops 6900 
“ 20 “ 8264 
Aqua ammonia 5 “ 12550 
Iod. potass. 3 gr. 14270 
Grains. 
Without medicine 14520 
Creosote and naphtha 15028 
Cod-liver oil, 6§ per week 15058 
“ per week 10108 
Pulv. ergot . 17150 
Cod-liver oil, per week 20160 
Whiskey . . 20504 
Calomel and opium 24230 
Ergot, strychnine and iron 24340 
Strychnine.—The amount passed without medicine is obtained from the 72 
Frick, Case of Saccharine Diabetes. 
[July, 
average of eleven analyses. We see, therefore, that the influence of strych- 
nine exerts by far the greatest control over the quantity of sugar passed in 
the urine and feces. The patient was kept under its influence for various 
periods, amounting in all to four months. It is here shown that, under doses 
of one-twentieth of a grain, the amount is diminished to less than one-half, 
and under one-sixth of a grain to less than one-fourth. For three successive 
days he was kept upon a meat diet, and one-sixth of a grain of strychnine 
administered three times daily. The quantity of sugar, on the third day, was 
diminished to 132 grains. This was on the 30th of October, and was the 
smallest quantity we ever found in this patient’s urine. 
Mur. Tine. Ferri.—This remedy, in doses of ten drops, diminished the 
sugar one-half; but on increasing the dose to twenty drops, a notable increase 
manifested itself, though still showing the beneficial effects of the medicine. 
Aqua Ammonia.—The diminution here amounted to one-seventh. Larger 
doses were tried, but they produced so much uneasiness that they had to be 
discontinued. 
Iodide of Potass.—The effect of this remedy over the excretion of sugar 
was little or none. It produced pain in the bowels and diarrhoea. 
Creosote and Naphtha.—These also produced great inconvenience, and their 
effect was to increase slightly the quantity of sugar. 
Cod-liver Oil.—In whatever doses this medicine was administered, its effect 
was to increase the amount of sugar. When six ounces per week were taken, 
the difference was slight; but when increased to twenty, one-third more sugar 
was passed. One fact, however, is worthy of notice. The patient, under 
this remedy, always gained weight, and, with the exception of the period when 
ergot was administered, only at that time. In forty-four days, on four pounds 
of oil, he gained nineteen pounds. 
Pulv. Ergot.—The patient, under the influence of this remedy, gained in 
one week nine and a half pounds, but the amount of sugar increased one- 
sixth. 
Whiskey.—This increased greatly the quantity of urine, as might be sup- 
posed, and also the sugar, which amounted to one-third more than when he 
was taking no medicine. 
Calomel and Opium.—This was continued for two weeks, till the patient 
was brought decidedly under the influence of the mercury. The calls to 
urinate became more frequent, and the amount of sugar became nearly 
doubled. 
Ergot, Strychnine, and Iod. Ferri.—Under this combination, the excretion 
of sugar was about the same as the preceding. He complained greatly of 
the mixture, and it will be seen that the largest quantity of urine was passed 
by him at this time, amounting to forty-four pints. 
In concluding these remarks on the subject of treatment, we have seen that 
those remedies which act directly upon the nervous system exert by far the 
greatest power in lessening the amount of sugar in the secretions. And con- 1852.] 
Frick, Case of Saccharine Diabetes. 
73 
sidering that the formation of this substance in the body was a natural process, 
and that our aim should be, not to prevent its formation, but to rouse up and 
strengthen the vital functions, in the course of whose normal action it is de- 
stroyed and eliminated from the system, we prescribed strychnine, and the 
result, in some measure, has justified our anticipations. It is needless to re- 
strict the patient to an animal diet, for, although the prominent symptoms ame- 
liorate under this treatment, the patient is not in reality better, and, in a 
majority of cases, the discomfort produced by the deprivation of saccharine 
and amylaceous food is not counterbalanced by the diminished thirst and the 
less frequent calls for micturition. 
Case II.—January 10, 1852. , a lawyer by occupation, and 
37 years of age; short, stout, and having every appearance of being in robust 
health; applied for treatment on account of suppuration in the internal and 
external ear. He had lived freely for many years, drinking, principally, whis- 
key, hut was never sick in his life, except a slight attack, three years since, of 
what was called rheumatism, seated in his ankle and wrist. He has been 
discharging purulent matter from his ear for two weeks, which discharge had 
been preceded by intense pain and total deafness of that side. Leeches and 
antiphlogistic treatment generally were ordered. On the 19th of January 
he complained of some pain in the right instep, hut there were no external 
evidences of disease. On the 20th, we found that the discharge from his ear 
had suddenly ceased, and that he heard a watch tick distinctly, at a distance 
of two feet, when the day previous he could only hear it when placed directly 
in contact with his ear. The pain in the instep had increased, and there were 
swelling and redness along the course of the tendons. On the 22d, gout in 
both feet was well declared. On the 24th, in both wrists, and the joints of 
both forefingers, so that he cannot walk or use his hands in the least. His 
intellect is somewhat disturbed at night, and he is sleepless, hut there is no 
tremulousness. Ordered whiskey, Tarrant’s aperient, and colchicum, the 
latter in doses of ten drops only. His urine, which previous to the attack 
had been high coloured and free from albumen, was, at this time, pale 
and copious, and contained albumen in considerable quantity, but no sugar. 
On the 25th, disease the same, urine 1.035, albumen less in amount, no 
sugar. On the 26th, less albumen, but some evidences of sugar; for, 
when the albumen was coagulated and filtered from the urine, the residue 
gave a slight canary tint on heating it with Barreswil’s liquid. On the 28th, 
disease subsiding, but urine contains sugar decidedly, as well as albumen, and, 
on standing for a few hours, throws down a copious deposit of uric acid sand. 
This is the first time this has been the case. On the 29th the albumen had 
disappeared entirely, and has not again made its appearance, but the sugar 
remained. The urine was of a greenish tinge, oily consistency, and strong 
saccharine odour, with a specific gravity of 1.036. 
Feb. 1. The swelling of the joints is subsiding, and he is walking about. 
Urine the same, sp. gr. 1.041, passes 150 ounces in twenty-four hours, con- 
taining nearly eleven ounces of sugar. 
4th. Passing ten ounces of sugar daily from his kidneys. Ordered strych- 
nine and mur. tine, ferri. 
13th. Urine contains seven ounces of sugar. 
Urine contains four ounces of sugar; medicine continued. 
29th. Urine contains five ounces of sugar. 74 
Frick, Case of Saccharine Diabetes. 
[July, 
Remarks.—I have reported the preceding case for many points of interest 
that it possesses. In the first place, it illustrates the early history of the disease. 
The association, at the commencement, with albumen, is probably accidental. 
The man’s health was good tili attacked by suppurative inflammation of the ear. 
The remedies for that affection prostrated his nervous system, and induced an 
attack of gout which he might otherwise have escaped. The albumen made 
its appearance in the urine from simple congestion and effusion from the kidneys, 
produced by their efforts to eliminate irritating materials. And these depress- 
ing causes united induced the presence of sugar in the urine in a patient, no 
doubt, already predisposed to diabetes. We believe this is the first case re- 
ported in which gout and diabetes have co-existed, and it is certainly an unusual 
event to observe uric acid crystals spontaneously deposited in saccharine urine. 
Pathology of the Disease.—It is only of late years that any insight has been 
obtained in regard to the morbid processes that take place in diabetes, and it 
is needless in these remarks to go into any review of the untenable grounds 
that were assumed to prove its location to be in the kidneys. Bouchardat, 
following up Iloilo’s suggestion of there being an abnormal principle in the 
gastric juice no't found in the healthy state which acts upon the starch of the 
food and converts it into sugar, made a considerable advance, but he did not 
embrace the whole matter. Both McG-regor and himself, as well as other 
observers, ascertained that the matters vomited by diabetic patients contained 
sugar, whereas in healthy digestion no such result ensued; and they deduced, 
therefore, that the first step in the morbid chain started from the stomach. Had 
they examined all the available secretions of the same patient, they would have 
discovered that sugar was present in them all, for it is now well ascertained 
that in these cases it exists already formed in the gastric juice. For we ascer- 
tained, in the case here reported, that the presence of sugar may be very readily 
manifested in the matters vomited, when the previous meals consist of eggs 
and meat alone. Mialhe’s theory, that diabetes is dependent on a neutral 
or acid state of the blood, needs only for refutation the fact that in every case 
of the disease where this fluid has been examined the reaction has been of its 
normal alkalinity, as we found it to be in the blood of the patient under con- 
sideration. 
In regard to Professor Graham's experiments in University College Hospital, 
he is evidently wrong when he states that “ the quantity of saccharine matter 
in the urine never exceeds the starch and sugar in the food.” On referring 
to the first table in this article, it will be seen that from May the 15th to the 
21st, a period of seven days, 2770 grains of sugar, or those substances capable 
of forming it, were taken as food, and then on the 16th and 17th only; and 
yet, 5765 grains, or more than double the quantity, were passed by the kidneys 
alone. This fact proves, what Bernard has already asserted, that sugar is 
eliminated by the kidneys even when none is taken into the stomach. And 
although Bouchardat and others are correct in stating that saccharine and 1852.] 
Frick, Case of Saccharine Diabetes. 
75 
amylaceous food influence the amount of sugar in the urinary secretion, yet 
the fact stated above and supported by Bernard’s previous experiments points 
to another, and in all probability a more important source for its production. 
In the July number of the American Journal, Dr. Donaldson, of Baltimore, 
has given in detail Bernard’s experiments, proving the existence of sugar in 
the normal liver; and has detailed his series of experiments on animals, proving 
that this substance may be produced at will in the urine. We will examine 
further on the light that these facts throw upon the disease under con- 
sideration. 
There can be no doubt that a portion of the sugar found in the various fluids 
and secretions of the body of a diabetic patient owes its origin to the amyla- 
ceous and saccharine elements of the food. We know that in healthy diges- 
tion, the atom of starch which subserves merely the purposes of respiration, 
and can by no process be converted into any of the animal tissues, during its 
elimination from the body goes through the following changes: starch, dex- 
trine, sugar, vegetable acid, and carbonic acid. But from some stoppage in 
these changes the series is arrested at the sugar, which in this form is elimi- 
nated by the different excretory organs. What this arrest is, and where it is 
located, it is impossible in the present state of our knowledge to say, inasmuch 
as the only information we possess is the fact that when starch is taken into 
the stomach it is eliminated as carbonic acid and water; and we assume these 
intermediate stages to occur from knowing the changes that the same atom of 
starch would undergo out of the body. 
We have long known, from the researches of Dr. Bensch, that the milk 
of carnivorous animals, fed exclusively on flesh, contained sugar of milk; and 
the announcement of the fact that the livers of the same animals kept on an 
animal diet, as well as those of the human subject living on ordinary food, also 
evidenced the presence of sugar, was not calculated to excite very great sur- 
prise. The fact, however, being now well established, we can no longer consider 
as tenable the idea so long inculcated, that animals had no power to create 
any organic principle found in their bodies, for it is here proved that sugar 
may be formed from nitrogenized materials. Bernard having ascertained that 
this substance existed normally in the right auricle of animals, traced it down 
through the ascending cava and the hepatic veins to the liver, beyond which 
point he was unable to discover it. Now knowing the fact that, if a small 
quantity of sugar be added to some freshly drawn blood and exposed to the 
action of the air, the sugar disappears, we can readily understand how this 
substance, thus proved to exist in the healthy animal economy, can be con- 
sumed in the lungs, so that no trace of it is perceptible in the urine. Bernard 
furthermore ascertained that this sugar, like other secretions, was dependent 
upon the integrity of the nervous system, and that, by irritating the different 
nervous centres, which he ascertained generally produced an increased quantity, 
he occasionally found it completely suspended. This may explain why it is 76 
Frick, Case of Saccharine Diabetes. 
[July 
that the urine of diabetic patients frequently loses its saccharine character a 
short time before death. 
It has been heretofore stated that the blood of the portal vein contains much 
more fat than the hepatic, the proportion being as 3.2 to 1.9; and as a very 
close relation between the elements of sugar and cholalic acid, the principal 
organic ingredient of bile, with glycerine and fatty acid, which together con- 
stitute hit, can be readily shown to exist, it would seem very probable, as M. 
Schmidt, a German physiologist, suggests, that this extra amount of fat going 
to the liver, may be transformed into sugar, and thus account for the presence 
of this substance in that organ. Thus:— 
Fat acid + 14 oxygen = Cholalic acid + 8 water. 
C48H4703 + 14 oxygen = C4sH39Og + 8 HO. 
2 eq. Glycerine + 4 oxygen = Sugar -f 2 water. 
C13H14O10 + 4 oxygen = CuHuOM + 2 TIO. 
This would be very satisfactory; but, unfortunately in some respects for the 
theory, Bernard ascertained that this apparent excess of fat in the portal vein 
was due to regurgitation from the liver, where it is in reality formed; and 
that, if the portal vein be tied immediately on cutting through the abdominal 
parietes, instead of the fat being in excess, it will be found in less quantity 
than in the hepatic veins. 
But that a certain relation does exist between these two substances, and 
possibly after the mode above stated, there can be no doubt; and the singular 
fact has been also stated by Bernard that, when the medulla oblongata is 
punctured, the amount of' fat diminishes just in proportion as the sugar in- 
creases. In addition to this, M. Guillot states that, in diseases where there 
exists an interruption of the normal pulmonary circulation, such as is pro- 
duced in phthisis and pneumonia, there is a quantity of fat found in the lungs 
which does not exist in other diseases. This will probably explain the cause 
of the fatty liver so common in phthisis; for were this circulation not perma- 
nently embarrassed, the fat would be deposited in the cellular tissue, or con- 
sumed in the lungs; but as it is, these organs not ridding themselves of it, 
it first saturates them, and the remainder, as it is secreted, remains in the liver. 
Hence the emaciation, which is wholly due to the want of fatty matter in the 
cellular tissue, which occurs in phthisis. On the other hand, the lungs, in 
diabetes, contain little or no fat, but large quantities of sugar; and although 
emaciation is one of the most prominent symptoms of this disease, yet the 
cause is different from that which produces it in phthisis. In the latter case, 
it is from the accumulation of fat in the lungs and liver; while in diabetes it 
is from the fat undergoing excessive oxidation, and being thus changed into 
sugar. 
If, then, the facts just stated have any bearing, we are principally to explain 
the pathology of diabetes as being dependent on some derangement of the 
changes that ordinarily take place between the fat and sugar secreted in the 1852.] 
Erick, Case of Saccharine Diabetes. 
77 
liver. To assert what this derangement is, would lead us too far into the 
mazes of barren speculation. 
That the sugar produced by the liver should be consumed by the lungs, 
explains the connection between this disease and some pulmonary affections 
which are so often found to co-exist. Not that the one disease produces the 
other, but, when more than the usual amount of sugar is secreted daily by the 
liver, any accidental disease of the lungs, by interfering with their aerating 
power, prevents a certain amount of sugar from being consumed, and which 
must therefore be eliminated from the system without undergoing any change. 
That innumerable cases of diseases of the lungs occur without any connection 
with diabetes, and, moreover, that diabetes frequently takes place without any 
pulmonary complication, as in the two cases here reported, proves, without 
doubt, that deficient respiration, although occasionally acting as an exciting 
cause, bears, in reality, a very small part in occasioning saccharine urine; 
and that the presence of sugar in the secretions is not due to the fact of its 
being secreted in a normal amount by the liver, and remaining unconsumed 
in the lungs, but to its being formed originally in excess. Taking this view 
of the case, we should expect that the temperature of the body would not be 
diminished below that of a healthy man living on a diet excluding starch and 
sugar. And, in reality, such is the case in the present instance. The tem- 
perature of a man in full health, and that of one labouring under dysentery, 
were taken at the same time, by way of comparison. In the healthy man, 
the thermometer in the axilla stood at 98°, in the dysenteric patient 96°, 
while in the one labouring under diabetes it was 99°. 
A statement made by M. Regnoso, to the effect that he has found sugar in 
the urine of various persons labouring under acute and chronic affections which 
disappeared after convalescence, has been published in most of the journals 
within the past few months. I can only say, in reply, that of the many hun- 
dred cases in which I have examined the urine with a view of detecting sugar, 
I never found it in a single instance that was not, either at the time, or proved 
subsequently to be, a case of diabetes. Having control of a hospital averaging 
from ten to twelve patients, I examined, for the space of three mouths, the 
urine of each patient, during his sickness, with this very view, and in no in- 
stance did I ever detect sugar. 
In conclusion, then, to express in a few words the whole of our knowledge 
of the pathology of this disease, we say that in a state of health sugar is 
formed in the liver; that this sugar may be secreted when only azotized food 
is used; that in all probability it is formed from the fat which is also produced 
in this organ; and that it is then conveyed by the blood, together with any 
sugar that may have been taken in as food, to the lungs, and there eliminated1 
in the form of carbonic acid and water. That in diabetes, from some cause 
at present unknown to us, an unusual amount of this substance is formed by 
the liver, more than the lungs can dispose of, the surplus passing off by the 
different excretory and secretory organs; and that although an amylaceous or 
No. XLYII.—July, 1852. [J^y> 
78 
Morland, Extracts from Soc. for Med. Improvement. 
saccharine diet increases the quantity, yet abstinence from these articles of 
food will not prevent it from making its appearance in the urine and other 
excretions. 
For many of the ideas herein stated we are indebted to M. Bernard, and 
we cannot but think that science is under great obligations to him for the 
satisfactory proofs he has given of the functions of the liver, so long a terra 
incognita to pathologists. Indeed, its importance as an organ of sanguifica- 
tion as well as depuration ought readily to be admitted, when we consider its 
large size in proportion to the rest of the body, and the complexity of its 
anatomical structure. 
Baltimore, March 7, 1852.