Yeast in Diabetes.—Dr. Wood stated that he had a case of diabetes
now under treatment in the Pennsylvania Hospital, which, in the re-
sults thus far obtained, was not without interest in a therapeutic point
of view. lie would first present a brief sketch of the case, drawn up
by his young friend, Dr. B. A. F. Penrose, one of the resident physi-
cians of the hospital, and would then offer a few remarks.
“ Mary Ann Cain, born in Ireland, a domestic, aged thirty, was
admitted into the hospital, November 16, 1852, for palpitation of the
heart. Upon examination, the heart was found acting with unusual
energy and quickness; but the sounds were normal Her general
condition was one of extreme emaciation,, her weight eighty-three
pounds, the pulse frequent but not strong, the tongue red and smooth.
She stated that she suffered much from constant thirst, and had a per-
petual desire to eat. Attention was directed to the urine ; and it was
found that she was passing from 18 to 20 pints daily, of a specific gra-
vity varying from 1036 to 1040. On the addition of yeast it fer-
mented briskly. Boiled, after the addition of solution of sulphate of
copper and solution of caustic potash, it yielded a reddish-brown pre-
cipitate ; boiled with solution of potassa alone, it acquired a dark-brown
or bistre tint. The case was clearly one of saccharine diabetes.
« Two days after admission, she was placed upon an animal diet,
with non-farinaceous vegetables, and one small biscuit three times a
day. Cod-liver oil was also directed, and a teaspoonful of yeast, three
times daily, immediately before meals.
“ 22d. The quantity of urine now passed in 24 hours was ten pints,
and the specific gravity 1022. The thirst and appetite were much di-
minished. The same treatment continued.
il 31th. The patient complained of total loss of appetite, and could
not take her cod-liver oil. The tongue was extremely red and inclined
to dryness, and there was pain on pressure in the epigastrium. The
quantity and sp. gr. of the urine were as at last date. The cod-liver
oil and animal diet were suspended, and she was placed upon farinaceous
drinks with milk. A pill composed of one grain of blue-mass and a
quarter of a grain of opium, was directed four times a day, and the
yeast was continued.
“ 30</i. The patient felt much better, her tongue was moister and less
red, and the gastric symptoms were much ameliorated. Not finding
milk to agree with her, she lived chiefly on oatmeal gruel, with a
soft-boiled egg ocaasionally. The quantity of urine had now been
reduced to seven pints in twenty-four hours, and its specific gravity
to 1020.
“31stf. The patient continues as yesterday, the urine having
amounted, in the last period of twenty-four hours, to only six pints;
the specific gravity not examined.”
Much light, Dr. Wood observed, had recently been thrown upon the
pathology of diabetes. The disease is now admitted to be characterized
by sugar in the blood, the kidneys being only secondarily affected. The
experiments of McGregor proved that sugar exists in great excess in
the stomach of diabetic patients after eating, and it may readily be sup-
posed to pass thence into the circulation. Bernard has shown that the
liver, in its normal action, produces sugar out of the portal blood, and
that this sugar passes through the vena cava, right side of the heart,
and pulmonary arteries, into the lungs, where, in a healthy state, it is
wholly consumed. Excess in the sugar-producing action of the liver,
or deficiency in the sugar-consuming action of the lungs, may be fol-
lowed by the entrance of saccharine matter into the general circulation,
and thus give rise to diabetes. The same physiologist proved that, by
irritating a certain point of the medulla oblongata, the liver was made
to generate a great excess of sugar, which, escaping decomposition
in the lungs, entered the arterial circulation, and passed out with the
urine.
We thus perceive that there may be various sources of the saccha-
rine impregnation of the blood. In the first place, it may arise from
some defect in the gastric digestion, in consequence of which farinaceous
and other nutritive substances are converted into glucose or grape-
sugar, which remains unchanged; or, secondly, from hypertrophy or
other diseases of the liver causing an over-activity of the sugar-
producing function; or, thirdly, from diseases of the lungs, im-
pairing their power of consuming the sugar; or, fourthly, from irri-
tation of the nervous centre in the medulla oblongata which appears to
control the action of the liver in relation to this product; or, lastly,
from two or more of these sources combined.
Now, in the case before us, no organic affection of the liver or of
the lungs could be detected, and there was no reason to suspect the
medulla oblongata; but the smooth, reddened state of the tongue, and
the epigastric tenderness, seemed to point directly to the stomach as the
seat of the disease.
In the number of the Edinburg Monthly Journal of Medical Science,
for October last, it it is stated that Dr. Gray, of Glasgow, had been in-
duced to make trial of rennet in a case of diabetes, in the hope that,
as this body converts sugar out of the body into lactic acid, it might be
found to produce a similar change within the stomach, and the lactic
acid thus generated might be eliminated from the system, or rather de-
composed by the respiratory process. A teaspoonful of rennet was
given three times a day. In eight days, the specific gravity of the
urine was reduced to 1025, with but a trace of sugar; in twenty-five
days, the quantity was four pints, and the density 1022.5, and no sugar
could be detected. At the end of six weeks, the urine remained free
from sugar, and the patient had so far improved in health and strength
as to return to his work.
It occurred to me, observed Dr. Wood, from the results of this case,
that yeast might prove equally beneficial, by causing a decomposition
of the sugar in the stomach such as it is well known to occasion out of
the body, resulting in the production of acetic acid. Being under the
impression that in the case now reported to the College, the primary
disease probably resided in the stomach, and that the diabetic sugar was
generated there, I determined to try the effects of this remedy. The
patient had been two days in the house before she was placed under
treatment, and during this period no change had taken place in the
quantity or character of the urine. It will have been noticed that
quickly after the commencement of treatment, a very great change
took place in both these respects; the quantity of urine being reduced,
in the course of four days, from twenty pints to ten daily, and the spe-
cific gravity from 1036 or 1040 to 1022. But the almost exclusive use
of animal food may be supposed to have contributed to this result. In
consequence of the gastric inflammation, it was necessary to suspend
this diet, and to allow the patient to use farinaceous food, the yeast
bein" continued. So far from any increase of urine in consequence of
this change of diet, its quantity was still further reduced, so that, upon
the last day upon which it was examined, it did not exceed six pints,
while the specific gravity was as low as 1020, the quantity having been
reduced from twenty pint3 to about double that of health, and the
density from 1040 to that of normal urine. There can be no doubt
whatever that the sugar has been very greatly diminished; and there
is no cause apparent to which the result can be ascribed except the use
of yeast.
What may be the further progress of the case, cannot, of course, be
foreseen. Even should we succeed in preventing altogether the elimina-
tion of sugar with the urine, it does not follow that the case will end
in recovery. The remedy is addressed only to one of the effects; a
very important effect, it must be admitted, and itself capable of pro-
ducing great mischief, but still by no means the whole disease. Never-
theless, if, by the steady use of a remedy so little disagreeable as yeast,
we can prevent the abnormal production of sugar, and the exhausting
effects on the system of the excessive secretion of urine occasioned by
it, we shall have gained one great point. We shall at least gain time
for accurately investigating the source of the evil, and applying such
remedies as may offer a reasonable hope of permanent benefit.
Dr. Wood observed, finally, that he should probably take occasion, at
a future meeting of the College, to report the further progress of the
case ; and should have been in less haste at present, had he not thought
that the remedial measure had some claims to notice, and been desirous
that it should, as quickly as possible, receive an ample trial, so that its
merits might be conclusively tested.— Trans. College of Physicians,
Ph iladelphia.