On Intermitting Diabetes, and on the Diabetes of Old dlge. By II.
B. Jones, F.R.S., Physician to St. George’s Hospital.—The author’s
object in this communication was to point out some phenomena connect-
ed with diabetes, which he had not found mentioned by other writers.
Preliminary to the record of the cases, the author offered some observa-
tions on the incorrect results obtained by calculating the amount of su-
gar present in the urine from the specific gravity. If diabetic urines
were solutions of nothing but sugar in distilled water, the tables by Dr.
Henry, and the amount of sugar calculated from the specific gravity,
would give all the information required; but a multitude of other sub-
stances were present besides sugar, each of which was variable, and each
of which might cause the specific gravity to vary, whilst the quantity of
sugar might remain constant. To be accurate, therefore, the amount of
sugar should always be determined by direct experiment, and never cal-
culated from the specific gravity. Results were given, exhibiting the
specific gravity, the amount of sugar calculated from solid apparatus,
and the absolute amount of sugar obtained by direct analysis. On the
subject of intermitting diabetes, the author observed that there could be
little doubt that our knowledge of the nature of this disorder might be
extended by means of accurate determination of the varieties in the amount
of sugar in the urine passed at different periods of the day, and under
different circumstances. His object in relation to this form of the
disease was to record some cases in which, either from the medical treat-
ment, or the regimen, or the natural course of the complaint, the varia-
tion in the amount of sugar was not from much to little, but from highly
saccharine urine to total absence of sugar. The state of the urine a few
hours after the sugar had disappeared, and an hour or two before it re-
appeared, was most especially worthy of attention, inasmuch as it might
lead to a truer knowledge of the state of the system which preceded the
commencement of diabetes. In intermitting diabetes the disease might
be seen beginning and ending, and the explanation of the state of the
urine which preceded the appearance of the sugar and followed its dis-
appearance, must be included in the true theory of diabetes. Moreover,
a better knowledge of the antecedent phenomena might enable us toward
off the disease, if not to treat it with more success. The records of seven
cases of the intermitting form of the disease were given, and very minute
particulars in several, illustrated the amount of sugar present in the
urine at stated intervals in the twenty-four hours, as well as the influ-
ence of particular forms of diet on the proportion of sugar excreted. In
these cases the state of the urine just after the sugar had disappeared
was worthy of attention. A remarkable excess of urea was constantly
found before and after the sugar disappeared; and although this might
be attributed to the animal diet, yet the occurrence of free uric acid and
oxalate of lime in the urine, pointed most clearly to a state of indiges-
tion which was every day to be found without any sugar appearing in the
urine. The author offered the following theoretical contrast between
ordinary and saccharine indigestion: Ordinary indigestion showed itself
in a want of action on the sugar and starch taken as food, in consequence
of which excessive acidity was produced—that is, the changes in the non-
nitrogenous food were imperfect. Imperfect changes also occurred in
the nitrogenous food; this was made evident by an excess of urates and
urea in the urine, and perhaps also by the formation of oxalate of lime. In
diabetic indigestion the effect might be traced also on the two great
classes of food. At first from the non-nitrogenous food sugar was formed
instead of acid. Ultimately, if not simultaneously, sometimes the arrest
of healthy changes extended to the albuminous food, and, instead of an
excess of urates and urea, other products were formed, one of which was
sugar. It was possible that some of these products might be found in
the urine. Possibly benzoic acid, which is present in some cases of dia-
betes, in variable quantities, might be one of the new products. Whether
this theory were true or not, it was of practical importance to remark
the tendency to acidity in these cases of intermitting diabetes. In such
cases, animal diet alone, or with alkalies, might stop the formation of
sugar. It followed also, that, when oxalate of lime, uric acid, and ex-
cess of urea, were found in the urine, it was probable that the diabetes
might be temporarily, if not permanently, removed. The occurrence or
absence of these substances in the urine might lead to the recognition of
the stage of the disease, and they might thus guide us in our prognosis
and treatment. The second part of the communication related to the
frequency of diabetes in old age. Reference is made to a paper, by M.
Dechambre, on this subject, who concluded, from observations made on
the urine of old people at the Salpetriere, that sugar was habitually pre-
sent in the urine of old people. The author gave the particulars of nine
cases of diabetes in elderly people, and thought that the occurrence of
this affection at the latter periods of life pointed also to the theory of dia-
betes as an indigestion resulting from an arrest of healthy changes in
the food. The cases mentioned in this communication were, in the
opinion of the author, opposed to the view of diabetes depending upon
an affection of the nerves, or of the liver; and his daily observation led
him rather to the view taken by Dr. Prout, that diabetes was an indiges-
tion, and that it first affected the non-nitrogenous, and afterwards the
nitrogenous, constituents of our food. As regarded treatment, whatever
was beneficial for excessive acidity, was found equally serviceable in dia-
betes. Alkalies were used in all the cases with benefit. Small meals,
free from sugar and acid, and the substances that could give rise to sugar
and acids, constituted the best diet. He found, also, that vegetable
acids with alkalies were occasionally useful. In a foot-note, the author
mentioned some experiments he had not yet published, determining the
quantity of sugar in several kinds of beer and wine. Porter contained
from 27 to 57 grains of sugar in each ounce of liquid; ale from 43 to 50
grains; beer 25 to 40 grains; port-wine 8.5 to 11 grains; sherry 2 to
4.7 grains; claret none. The absence of all sugar, and the presence of
a little alcohol, caused claret to taste highly acid, while the quantity ab-
solutely present was not more, sometimes less, than in other wines which
have no acid taste, as, for example, most port wine.—Medical Times
and Gazette.