A MECHANICAL ENQUIRY INTO THE NATURE, CAUSES, SEAT, AND CURE OF THE
DIABETES.
With an Explication of the most Remarkable Symptoms.
Igitur hi, qui rationalem Medicinam profitentur, haec necessaria esse proponunt: Abditarum & morbos continentium causarum notitiam, deinde Evidentium, post haec etiam Naturalium actionum, novissime partium interiorum.
Rationalem quidem puto medicinam esse debere: instrui vero ab evidentibus.
A. Corn. Cels. in praefat. lib. 1.
OXFORD,
Printed at the THEATRE for
James Fletcher
in the
Turl;
and Sold by
M. Cooper
in
Pater-Noster-Row, London, Ben. Hickey
in
Bristol,
and
J. Leake
at
Bath.
1745.
AN ENQUIRY INTO THE NATURE AND SEAT OF THE
DIABETES.
SCARCE any disorder has afforded greater matter of speculation, especially of late Years, than the
Diabetes;
yet the true
Rationale
of it is not so accurately understood, as to render a farther enquiry into its nature and causes, in order, if possible, to search out the reasons of the several Symptoms of it, useless or unnecessary. Amongst the Antients is was seldom heard of.
Aretaeus
speaks of it, as something miraculous,
,
Miraculum quoddam:
And
Galen
confesses, that in the course of his Practise he only saw two Patients labouring under this complaint. The
uncommoness
of it might be owing to a different manner of Living, but the disorder was probably the same. For the description, which they give of it, in the most essential points agrees with that of the Moderns; it is true indeed, that most of them speak of liquor passing through the kidney not in the least chang'd, and make no mention of the sweetness of the Urine: But these are mistakes, which the colour of the Urine for want of accuracy, and observation, might be the cause of their falling into; for, as Dr.
Willis
observes, it always appears crude, and watry as of those labouring with the
Pica,
or with the Dropsy. Their Methods also of cure, which were rationally founded, and in most respects similar to the present practise, are a farther confirmation of this opinion.
Galen
made use of the following Medicines, as he himself testifies, to the great relief of his Patient.
Bol. Armen. Gum. Tragac. — Arab. — Mastich. Spodium. Sem. Endiv. — Portulac.
&c. and they seem to be well adapted to the removal of this disease, so far as they are known to strengthen weakn'd Solids, to sheath acrimonious humours, to incrassate too much attenuated blood, to abate hectick fevers, and to cool the body. But this will be farther consider'd in its proper place. It may not be improper, before we enter upon the enquiry, briefly to point out the opinions, which the Ancients and some of the Moderns entertain'd of this disease.
De curat. Diabet. Lib. 2. c. 2.
Aretaeus
suppos'd it to be a species of a Dropsy,
, and that it was owing to an Universal debility of body. For as in a Dropsy the solid parts of the body are dissolv'd into water, so in a
Diabetes
they are melted down into
. De morb. diut. Lib. 2. c. 2.
Urine. But supposing such a waste of the body, and such a dissolution of the Solids, how comes it to pass, that they are dissolv'd into Urine? May not the humours arising from such a suppos'd decay, and wasting of the body tend to any other Viscus, as well as to the kidney? And seeing it is well known, that all fluids naturally tend to the weakest parts, is it not by far more reasonable to suppose, that they should be lodg'd either in the
Abdomen,
or
membrana cellulosa,
(being those parts of the body, which give the least resistance,) and form dropsical swellings, than be evacuated by Urine? Such an Universal consumption then of the body does not seem to be the primary cause of this disease, but may be, and is the consequence of it.
.
—
. De loc. affect. lib. sect. p. 4.
Galen,
and his followers,
.
Alexander Trallianus
p. 150. to the same purpose speak
Oribasius, Paulus Aegineta
and
Aetius.
differ'd from this opinion and thought it owing to an imbecillity in the kidneys; and so far indeed they seem to have judg'd right: But then their manner of accounting for such a copious discharge of Urine was very whimsical; for they suppos'd, that the humours contain'd in the several parts of the body were brought to the kidneys by an attractive power in them, and that the humours so attracted quickly forc'd their exit out of the body. This account of it then shews rather a fertility of imagination, than solidity of reasoning. For the possibility of such an attraction is surely as difficult to be conceiv'd, as the cause of attraction itself.
Et quandoque facit Diabetem potus aquae frigidae, aut obsessio vehemens frigoris in totum penetrantis, aut propter vehementiam attractivae propter virtutem calidam — quare renes attrahunt ab hepate.
P. 684.
Avicenna
speaks of it much to the same purpose, and no wonder; seeing that the
Arabian
Physicians borrow'd their Systems of Physick from the
Greek. Aurelianus
's chapter upon this disease is lost: and
Tom. prim. p. 234.
Celsus
only lays down some general methods of cure to be observ'd,
cum Ʋ rina super potionum modum mingitur.
A
Diabetes,
says
Tom. prim. p. 376.
Etmuller,
is either genuine, or spurious. The former is a voiding of liquors by Urine without undergoing any alteration in the body: The latter is a voiding of a much larger quantity of Urine than of liquids receiv'd into the body: The cause of the former, he thinks, is owing to a laxity and openness of the passages, which lead directly from the first passages to the kidnies. But these, he confesses, are not yet known, and no wonder; because it is evident from the nicest observations made in Anatomy, that there are no such passages leading directly to the kidnies, as he imagines, and therefore that no liquor can possibly arrive to the kidnies, but by first entring into the blood. To account for the latter, he supposes, a sharp acrimony in the blood, which resolves, attenuates, and melts down the blood, and even the muscular flesh itself into serum, which being thus melted down, stimulate the kidnies, and force their passage. But this account of it is so very strange and unphilosophical, that it will not admit of a serious consideration.
Exercit. de Diabete
p. 65.
Lister
is singular in his opinion, and thinks that the chief seat of this disorder is in the Stomach, and small Intestines:
At primaria hujus morbi sedes est Stomachus, & Intestina tenuia:
But if these parts of the body were principally affected, a
Lientery,
or a
Diarrhaea
rather than a
Diabetes,
would surely be produc'd.
Dr.
Willis,
that great Physician of his time, observes, that Rhenish Wine, Cyder, and acid liquors being drank provoke a more plentiful
Diuresis
or evacuation by Urine: The cause of this evacuation he attributes to a fusion or melting of the blood into serosities by such acid liquors; so that the Crasis or mixtion of the blood being dissolv'd, the watry parts cannot be contain'd by the more thick, but sliding from their embraces, and being imbu'd with saline particles, do run through the most open passages of the Reins, and so cause a
Diabetes.
And he gives us an Instance of one, who by using Rhenish Wine for his ordinary drink twenty days together, contracted an incurable
Diabetes,
of which he dy'd within a month. But the
Diabetes
in this case, and when brought on by an immoderate drinking of such thin acid liquors does not seem to be owing to such a dissolution of the blood, as the Doctor intimates, but to the natural disposition of such liquors to pass off by Urine. The Secerning Vessels of the kidney then must necessarily be overloaded by the great quantity of fluids, which they admit, and of course greatly relax'd, and hence a
Diabetes
will ensue, as will be shewn more particularly in its due place. For let the blood be in ever so dissolute and broken a state, this Distemper will not be produc'd, unless there is a relaxation of the kidney in conjunction with it, but rather a dropsy, and for reasons that have been already insisted upon. An immoderate drinking then of acid liquors, and thin wines, by their quick and suddain passage through the kidneys will bring on a debility of these organical parts, widen their Secretory ducts, and in this manner produce a
Diabetes;
and such an excess of them seems to be the most frequent cause of it.
The account which
Animal Secretion
p. 70.
Dr.
James Keil
gives of this disease comes next to be consider'd.
He asserts
"that the most evident cause of this disease is an habitual drinking of strong liquors; and that the more spirituous they are, the sooner and more violently they bring it. By such an habitual drinking of strong liquors it comes to pass in process of time, that the Serum, or thin part of the blood, contains a large proportion of a spirituous Fluid, or that part of the Serum, which should be water, is for the greatest part Spirit. Now the Salts of the Urine or blood will not dissolve in a vinous spirit, that is, the particules of which the salts consist, are more strongly attracted by one another, than they are by such a fluid, as by experiment appears; and therefore the Quantity of Salts in the blood will be daily increas'd, and circulating through the Capillary Vessels must irritate the fine fibres, and cause little pains and twitchings all over the body, which, he says, are the preceding Symptoms of this disorder. But when the Serum is full of these salts, the distance between them and the Globules of the blood will be less, and consequently they will attract the Globules of the blood more strongly than the Globules attract one another; And the Globules or red part of the blood will be dissolv'd and diffus'd through the Serum of the blood. And this again is confirm'd by experiments, for nothing does render the red part of the blood so fluid, and keeps it more from coagulating when drawn into a cup, than Urinous Salts and Spirits. When the red part of the blood is thus dissolv'd, and united to its Serum, it will with the Serum be carried off through the Glands of the kidneys, and being united to their Salts, will alter their Figures, and properties, as Litharge and Coral do the Salts of Vinegar, giving them a sweet taste."
In this account of the
Diabetes
there seems to be more ingenuity, than truth. That Spirituous liquors when drank to excess may be productive of this disorder, will be shewn in the sequel of this dissertation; but that an habitual drinking of them is the most evident cause of it, is evidently not true. But granting such a dissolution of the red part of the blood, as the Dr. imagines, which may be possible, but does by no means seem probable, there is no reason assign'd, why it should with its Serum be carried off through the Glands of the kidney. The objections which have been already made, occur here.
Proceed we now to the opinion of the celebrated
In the new Edit. of his book on poisons p. 32.
Dr.
Mead,
which demands our attention as well for its singularity, as for the eminent Character of its Author.
"The
Diabetes,
he says, is not as Physicians have commonly judg'd, a distemper of the
Kidneys,
but of the
Liver,
proceeding likewise from a vitiated mixture of the bile. It most frequently happens to those, who without due exercise indulge themselves in drinking vinous liquors, and then quench their thirst arising from these, by too great a quantity of such as are cooling.
By such ill-timed heating, and cooling of the humours of the body, the natural proportion of Salt in the bile, by which its oily part is incorporated with the water, is not sufficient, now the water over-abounds, to preserve the mixture: So that a great portion of this, together with some of the thinnest of the oil will be discharg'd by the kidneys; and the Urinary Ducts will be greatly enlarg'd by a constant aflux that way. By which means the thicker oily particles are left in a degree of coagulation in the smaller tubes of the Liver, and are there form'd into a hard fatty substance.
The dissection of those, who have died of the
Diabetes,
proves this to be so: For I have always found a
steatomatous
collection in their Liver, in appearance not unlike to what is often discharg'd by stools in a confirm'd jaundice, but of a harder consistence."
In the first place let it be here observ'd, that the texture of the
v. Boerhaave
's
acad. Lect. V. 3. p. 110.
kidney is so very close and compact, that in its natural state, before it has suffer'd any kind of violence, it will not admit any oily substance whatever, unless it be highly attenuated, and thoroughly incorporated in a proper vehicle. A Preternatural dilatation of the kidney must be
prior
to its admittance of any fluid, that is more gross than the Urine. It does not then seem probable, that even this thinnest oil in such circumstances, when the mixture is destroy'd, can be admitted to pass through the kidney. Beside, such a disposition of the liver, as is here suppos'd, and such a vitiated mixture of the bile must necessarily be attended with a high
jaundice,
but as the
Diabetes
often appears without the least icterical Symptom, it seems necessarily to follow, that the liver is not the Seat of the
Diabetes.
The ingenious Dr.
Randolph
in his treatise upon the Medicinal Virtues of the
Bristol
Water, after having made some just observations upon these accounts of it last mention'd, gives us his opinion of it, and is inclin'd to think the kidnies the Seat of this disorder, tho' he owns, that the great alteration made in the Urine seems very much to favour the opinion of a fault in the fluids; for if the kidnies, says he, were only in fault, why should Diabetical Urine differ so much from that which is natural, not only in
Quantity,
but in
Quality
also? But the reason of this alteration will evidently appear by prosecuting the enquiry farther, than seems to have been consistent with his design; and in order to proceed more methodically;
I shall first describe a
Diabetes
by pointing out the several Symptoms of it.
2dly, shew how a relaxation of the
Secretory
Ducts of the kidnies with a broken state of the blood, which may be
prior
to such a relaxation, must necessarily be the cause of such Symptoms, and when not, will be the consequence of it.
A Person then is known to labour under a
Diabetes
by the following Symptoms, to wit; a copious and frequent discharge of pale-colour'd Urine; the taste of which is sweet; the Quantity evacuated exceeds in proportion the Quantity of liquors taken in; it is found to acquire a ropy consistence by being expos'd for some time to the air; as a consequence of this discharge, a hectick fever, loss of flesh, great thirst, a sense of weakness about the Loyns; and if
constitutional,
or too far advanc'd by a neglect of proper remedies, the Person so affected in reality dies of a consumption. These are then the most remarkable Symptoms of a
Diabetes,
and the known consequences of it.
I am in the next place to shew how a relaxation of the
Secretory
Ducts of the kidnies with a dissolute broken blood must necessarily be productive of these Symptoms. But here it will be proper first to point out the causes, by which such a relaxation may be brought on.
And here let it be remark'd, that whenever a Gland is in a state of relaxation it will not duly perform its respective office.
It is well known, that whatever stretches out an animal fibre beyond its due degree of distension, and keeps it for some time so distended, will weaken the contractive spring of that fibre.
Now the Glands may be relax'd, or their contractive spring weakn'd, by several different means; as first, by being prest upon with too great a quantity of fluids, and this may happen either from a stoppage of perspiration, or from a defect of Secretion in one Gland, which may be occasion'd by some obstruction form'd in the
Secretory
Ducts of that Gland, and is known to encrease the Secretion in another; because such an obstruction will in effect be the same as an actual increase of the fluids; a consequence of which will be encreas'd Secretions. It may also happen from the Critical discharges of acute fevers lodging their malignity on these parts; and from excesses of every kind falling on these parts; and here it may be observ'd, that such excesses will chiefly affect those parts, which are by constitution the weakest, and the disorder produc'd will correspond with the nature and office of that organical part, which is affected.
The Glands may also be relax'd, and the crasis of the blood broke by
Mercurial Salivations,
by a long continu'd use of powerful
Deobstruent
Medicines, and the kidnies in particulr by an improper use of such as are stil'd
Diuretick.
An habitual drinking of Spirituous liquors will also bring on the same ill effects, and may in some circumstances be the cause of a
Diabetes.
But to explain the reason of this. —
It appears from several
Dr. Hale's Haemas. p. 124.
experiments, that all strong liquors not only contract the small arteries, but also coagulate the fluids, which are contain'd in them. A consequence of these effects will be a stoppage of the
Secretions,
and if often produc'd, a relaxation of the fibres of the Stomach, and Intestines; hence will arise a failure of digestion, and of course of nutrition. When these necessary offices fail, the solids will soon become weak, and languid, and the blood poor and watry. The body then being brought to this deplorable state by such an abuse of them; if we suppose the prevailing weakness to be in the kidnies, which may happen to be the case either accidentally or constitutionally, it is easy to conceive, that a
Diabetes
will come on.
Opiates
are known to act in the same manner, and therefore will produce like effects.
As the kidnies then may be relax'd by any preternatural pressure, so it is easy to apprehend, how a long suppression of Urine, (be the cause of that suppression what it will,) should be productive of this disorder. Dr.
Lib. 2. obs. 3.
Harris
gives us an instance of such a cause of it in a case, that fell under his own observation. After having prescrib'd several Medicines very unsuccessfully for his Patient, whose case was a total Suppression of Urine for five whole days; the following
Cataplasm
was order'd to be applied to the Umbilical Region of the Sick Person,
℞
Sapon. Nigr.
ʒ vj
Croc. Opt.
ʒ ss
Sal. Succini
gr. xv. F.
Cataplasma.
The day following all the Urinary springs appear'd in a manner burst; and a
Diluvium
of sweet Urine came on, but was however soon stopt by the Assistance of
Rhubarb
chiefly: This Medicine was judg'd by reason of the warmth of it to be the best, that cou'd be adapted to the age of his Patient, who was seventy seven years old; and by reason of the astringency of it, to the nature of the disease; there being no reason to think, why it might not be of equal efficacy in a
Renal
flux, as well as an
Intestinal
one; seeing that the difference of the parts affected constituted the difference of the disorder; in which observation there seems to be a great deal of truth.
But to proceed — As a stone in the kidney by its great pressure or irritation will bring on a relaxation of its fibres, so it may be the cause of this distemper.
Bonet. pract. anat. Tom. 2. lib. 3. sect. 26. obs. 5.
Bonetus
gives us such an instance of it in one, who dying of a
Diabetes,
was dissected, and a stone found in the left kidney.
Ren sinister lapide obsessus est angulos habente obtusos — Lingua squallida, & horridula, aestus, & sitis, meiebat plus justo, urina plane aquea, sensim extabuit, Diabete interiit.
The bites of some kind of animals, particularly the
A kind of serpent found in Libya
Dipsas,
have been known to occasion this disorder. The venemous juice of which Animal, I presume, taken into the blood, and receiv'd by the kidney, will bring on a
mortification
of it, that is, a
resolution
or relaxation of its several component parts; and then it is easy to conceive, that a
Diabetes
will ensue: Tho' I am more inclin'd to think it brought on by the drinking a large quantity of cooling acid liquors in order to appease the intolerable thirst consequent on the bite of this
Reptile.
Hypochondriacal
complaints have sometimes been the Forerunners of this disease. The reason of this may easily be accounted for; because as such disorders generally proceed from a weakness of the Solids, so by supposing the predominant weakness to be in the kidnies, this disorder will necessarily be produc'd.
A
Sphacelated
tumour in the bladder, or whatever causes a relaxation of its
Sphincter,
will be attended with plentiful discharges of Urine. Hence some have imagin'd this distemper to be an
affection
of the
Multis ementitus Diabetes: causam ad affectionem renum referebant: Mortuis contracta plane vesica reperta est cum gangraena & tumore
in capacitate ipsius vesicae.
Bonet. obs. 4. in. loc. prius cit.
bladder, but very erroneously. For it is reasonable to think, that the flux of Urine in all such cases will be involuntary; which constitutes no part of this disorder, and therefore does not properly come under the denomination of a
Diabetes.
The kidnies and their Secretory Ducts being relax'd (be the cause of that relaxation what it will) a general debility of body will come on. Such is the close dependance that the several organical parts of the humane body bear to each other, that if any one be in a diseased state the others will be affected by it. Every part of this complicated Machine must regularly discharge its respective office in order to preserve the harmony or health of the whole. In such a state of the body then as this, there can neither be a due combination of the several parts of the blood, nor a proper assimilation of the
Ingesta.
The consequences of which will be just now consider'd.
Having then enumerated the several causes by which the kidneys may be relax'd, and the crasis of the blood broke; we proceed to shew how such a state of the body must necessarily bring on a
Diabetes.
And here I shall beg leave to mention one disorder, which seems to be in most respects
analogous
to this, and that is, a lacteal
Diabetes.
The learned and judicious Dr.
Boerhaave's Acad. Lect. V. 3. p. 143.
Boerhaave
gives us an instance of such a disease.
"There was, he says, a certain Woman who dwelt at the City of
Dort,
who bore and suckled Children for twelve years successively; but at length she fell into a lacteal
Diabetes,
in which all the nourishment that was taken ran through her Breasts without any suction, under the appearance of milk, insomuch that if she drank a pint of ale there was almost the like quantity of milk evacuated from her Breasts."
This instance then beautifully illustrates, and strongly confirms the Theory laid down.
But to proceed — The first Symptom, that I shall take notice of, by which a Person is known to labour under a
Diabetes
is the copious and frequent discharge of pale colour'd Urine. That this is an effect necessarily arising from such a state of the body will evidently appear from a little consideration. The
Secretory
Ducts of the kidnies being in this relax'd morbid state, they will readily admit those humours, which in a natural state by reason of the compactness of their texture, they would by no means give admittance to; and consequently the discharge must be proportionably great. The little stay the Secreted humours make in the body will be the cause of their undergoing but a little change as to their colour and rancidity: Seeing that the colour and rancid smell of the Urine, when evacuated in a healthy state of the body, are owing most probably to its long retention in it; for by such a retention its oily parts become putrid, and will of course put on a different complexion.
Diabetical
Urine then is somewhat of a Chylous nature, and as all the
nutritious
juices are of a tenacious viscid disposition, so they readily coagulate, when expos'd to the Atmosphere; and to this seems to be owing the reason of its ropy consistence.
That the quantity evacuated should exceed in proportion the quantity of liquors taken in, appears from what has been already observ'd; for in this weakn'd state of the kidnies, and broken condition of the blood, a great portion of those juices, which should be retain'd in the body for its nourishment, will be admitted to pass through the kidnies, and of course be thrown out of it, as tho' excrementitious; to which may be added the actual increase of fluids arising from a general waste of the Solids, which the kidnies being now enlarg'd will greedily receive. No wonder then, that the quantity evacuated should exceed in proportion the quantity of liquors taken in. A necessary consequence of such a discharge, (and because in such circumstances the important office of Nutrition is in a manner suspended,) will be loss of flesh, and a great waste of the body, which is always observable, when this disorder is far advanc'd, and the Patient almost brought by it to a period of his days; and it frequently happens in this last stage of it that even solid pieces of flesh are brought away with the Urine.
The sense of weakness about the Loyns must be owing partly to this relaxation of the kidnies, and partly to the evacuation made; for in all drains whatever those parts of the body sustain the greatest loss of fluids, which are nearest to that part, from which the drain is made, and will consequently be sensible of a proportionably greater weakness. The same complaint is made in other fluxes, in a
gonorrhaea
by Men, and the
fluor albus
by Women; and the reason of it in both cases is the same.
The Symptom that comes next to be accounted for is the sweetness of the Urine.
As a different configuration of the particles of the same body is well known to impress on the nervous
Papillae
of the Tongue different sensations; We conclude, and I think, very reasonably, that the difference of the tastes of bodies is owing to some different texture of their particles; but, as I apprehend, it is no very easy matter to determine
absolutely
what particular disposition or combination of the several parts, of which all bodies are known to consist, is necessary to make a body either
sweet
or
bitter;
so till this can be ascertain'd, we must be contented with this general account of the sweetness of diabetical Urine; that it is owing to some different texture of its several heterogeneous parts.
Animal substances when putrefied give a faetid taste, and the reason of this is ascrib'd not only to their natural disposition to give such a taste; but also to some different modification of their parts acquir'd in the Process of Putrefaction.
Chemistry
teaches us, that all bodies are compos'd of the same Elements,
Fire, Air, Water, Earth, Salt,
and
Oil;
and therefore the variety of their colour, smell, taste, and the like, must be owing primarily to some different disposition of these Elements. We learn indeed from observation, that the nearer the parts of any body approach to a sphaerical disposition; the more mild and soft is the taste of that body; and that the farther they recede from such a disposition, the more acrid, and rough is the sensation, that such bodies excite in us.
That the tastes of bodies do depend upon a different combination of their particles is a truth not to be disputed.
Mercury
in its sphaerical figure is both innocent, and tastless, but when sublim'd, it loses its sphaericity, and becomes acrid, corrosive, and poisonous.
An intire mass of
See Mr. Boyle's Mechanical production of tastes.
Silver
is insipid, but by being dissolv'd in
aqua fortis,
and shooting into Chrystalls, it becomes bitter;
Lead
another tastless body dissolv'd in the same Menstruum makes the
solution
sweet.
A mixture of Spirit of Nitre, and rectified Spirit of Wine, the former highly corrosive, the latter very pungent, composes a body of an agreeable taste.
It appears then from experiments, that a different disposition of the particles of bodies is the cause of that variety of tastes, which is observable in bodies, and that it will also excite tastes in those bodies, which before were insipid.
We have hitherto accounted for the sweetness of diabetical Urine, upon no other principles, than the original and primary cause of the difference of the tastes of natural bodies in general; and into this indeed must all other accounts of it be at last resolv'd: For could we know the various mixtures the Urine may possibly undergoe in this state of the body; yet we should still be at a loss to give a reason for the alterations arising from such mixtures.
But to be more particular — It is known from observation, that the
Ingesta
of what kind soever, after they have been prepar'd and elaborated fine enough by the digestive organs to enter the
Lacteals,
are
v. Boerhaave's Acad. Lect. V. 2. p. 48.
sweet to the taste. The milk, which the Infant sucks from the Breasts of the Mother, is sweet; and even the blood itself is
relatively
sweet. It has been already observ'd that a long retention of the humours in the body is the sole cause of the rancidity of them; and it has been also shewn that in a
Diabetes,
part of those juices, which should be retain'd in the body for its nutrition, is thrown out of it, as tho' excrementitious; so that the Urine in this disease is somewhat of a Chylous nature, and as the salt of Chyle or milk is sweet, so the taste of the Urine must also be sweet; seeing that it has not been long enough circulating in the Vessels to acquire any degree either of rankness or Acrimony. This Chylous nature then of the Urine with a different combination of its several parts will easily account for its remarkable sweetness.
That a
Diabetes
should be attended with a hectick fever will appear evident from a consideration of the known causes of it. But it would be foreign to my purpose to run through all the causes, by which this kind of fever is produc'd, and to shew how necessarily a cachectical body must produce a Hectick. A very common cause of it however is an acrimony in the blood, whether it be of the
acid
or
alkaline
kind, which by irritating and fretting the Solids will accelerate the circulation of the blood, in the accelerated course of which is fixt the Idea of a sever. The same irritation will happen from an
absorption of Pus
in case of an inward Ulcer. But whether or no there is such an
absorption of Pus
is at present a disputed point: Tho', I think, there is all the reason, that can be desir'd, to resolve it in the affirmative; and chiefly because of that true
purulent
matter, with which the
faeces
in ulcerated cases are sometimes known to be tinctur'd, even when there has been no Ulcer in these parts, and theresore could not possibly have been evacuated by
stool;
had it not been first absorb'd into the blood. That there are Vessels in the humane body capable of such
absorption
is granted by every one; That
Pestilential
and other noxious
efluvia
are absorb'd by them, and communicated to the blood, is often verified by fatal experience; That the drops of blood, which gush out from the rupture of a small artery, are also absorb'd into the mass of blood, every day's experience proves. As it is clear then beyond all possible doubt, that there is such an absorption of fluids into the blood, I can see no reason, why the
Pus,
which is discharg'd from an Ulcer, may not also be absorb'd.
That a great loss of blood will also bring on a Hectick, whether occasion'd by
Haemorrhoidal,
or
Dysenterical
fluxes, too plentiful
Phlebotomy,
or the like, appears from observation, and is confirm'd by experiment.
The accurate and ingenious
Haemas. v. 2. Exper. 2. p. 12.
Dr.
Hales
observ'd, that the pulse of a horse, upon which he was going to make an experiment,
"beat forty strokes in a minute, before he was disturb'd or tied down. But when the Glass tube was fixt to the left Crural Artery, it beat fixty five in a minute. And as the horse grew fainter by the loss of blood, the pulse was more and more accelerated, so as to beat an hundred times or more in a minute: Whence we see, that the pulse is weak and quick, when the heart is supplied with little blood; which is the case in the hectick fevers."
But to explain the reason of the hectick, when brought on by any great evacuation more fully.
It is well known, that the Velocity, with which all fluids move through all known Vessels, is reciprocal to the resistance, which they meet with in their passage through such Vessels. Now this resistance among other causes of it will be increas'd or diminish'd in proportion to the Quantity of fluids contain'd in these Vessels; for the greater the Quantity of fluids is contain'd for instance in those Conical Vessels the arteries; the greater degree of force will be requir'd in the blood thrown out of the Heart to drive forward that already in the arteries; and there will also be in such circumstances a greater degree of friction; the Quantity of blood then being diminish'd, these resistances, which are known to retard its progressive motion, will be proportionably remov'd; and the motion of the blood then will now be more free, it will consequently be more quick; and as a quick circulation will cause a quick pulse; and as the pulse is denominated to be either strong or weak in proportion to the greater or less distension of the artery, which depends upon the Quantity or density of the blood; so we may easily collect the reasons from these known facts both of the weakness and quickness of the pulse in Hectick Fevers; and
how
Preternatural fluxes of any kind are necessarily productive of a Hectick. From a diminution of the fluids, or from a relaxation, or dilatation of the Glands, (in which circumstances the Quantity of blood may be suppos'd to be diminish'd,) Dr.
Cheyne
in his
new Theory
of Fevers, has very ingeniously, and fully demonstrated all the
Phaenomena
of Hectick Fevers. Thus then we come to a reason of the Hectick in a
Diabetes;
(viz.) the relaxation of the kidney, and the great evacuation made from it.
The great thirst, which is the last Symptom, that remains to be insisted upon, is owing partly to this inward fever, and partly to the great drain; for in such a case the
fauces
will become dry and rough; the dryness and roughness of which will excite in us that uneasy sensation, which we call, Thirst.
I have now gone through what I intended to insist upon, and hope, that the observations made, tho' rudely digested, will serve to throw some light into the nature of this disorder, and into the reasons of the several
Phaenomena
of it. The Symptoms indeed seem to flow necessarily from the causes assign'd, which is an argument in their favour.
But as the cure of a disease is of far greater concern to mankind, than the
Rationale
of it; tho' this should be first known to the skilful Physician, that he may the more effectually proceed to the removal of it; it may not be improper briefly to point out the Indications of cure, which arise from the account given of it. But I shall content myself by observing in general, that Medicines of a mild, Balsamick, compacting nature, seem to claim the first place: As they will be well adapted to agglutinate the fluids, and will moderately strengthen the weakn'd part. It is however often found necessary to make use of Medicines of a more astringent nature. If the weakness or relaxation of the kidney arises from an acrimony in the blood, that acrimony is first to be corrected by proper rememies. The greatest regard should be had in the cure of this, as well as all other Chronical diseases to a proper
Diet,
which in this case should undoubtedly be that of the
incrassating
kind. A good
Regimen
of the Non-Naturals has been known to eradicate the most stubborn distempers, when Medicines of great efficacy have fail'd: Nor is this at all strange; for seeing that most Chronical disorders are owing to some bad disposition of the blood, and the blood is made from what is taken into the body by way of food; a proper Regimen in such cases must surely be the best, as well as the most natural
Alterative.
That the
Bristol
Water is of remarkable service in this disorder, Experience abundantly testifies. But the reason of its operation does not seem to be clearly understood; neither shall I take upon me to give any account of it; seeing that this is to be learnt only from knowing its Ingredients; and these are to be found out only by Chemical experiments, which are best made on the spot: And the late accurate
Enquirer
into its Medicinal Virtues intends to insist upon this point in the remaining part of his work. But as it is well known to cool the body, to thicken broken fluids, and to strengthen in some degree; so it seems to be well calculated to answer all the Intentions of
Cure
in this disorder.
I shall only offer one word more in order to prevent any objection, that may possibly be rais'd to this manner of enquiring into the nature of the diseases of the humane body.
And here let it be remember'd, that the first improvement, which the Science of Medicine receiv'd, was made by Reasoning upon Mathematical Principles. This then pav'd the way for those great discoveries, which have lately been made in the nature of the
Animal Oeconomy
by the assistance of Mechanical observations.
"
Dr. Mead's preface to his book on Poisons.
Nor could malice itself (as Dr.
Mead
expresses himself on the like occasion) deny this, were not ignorance in confederacy with it, which will secure any one from being benefitted by the most useful Demonstration."
And that this is not only the most likely, but is without all possible doubt, the only certain method of improving Physical Knowledge, is evident from the structure of the humane body. For it appears by Anatomy to consist of Solids and Fluids, both which are subject to the known Laws of
Matter
and
Motion,
and therefore the various disorders, to which this wonderful Fabric is hourly liable, can no way be more rationally accounted for, than by Mechanical Reasonings, and the application of these Laws to such alterations, as are observable in it.
This method then of enquiring into the nature of the diseases of the humane body, when it can be made use of, is the only certain one; I say, when it can be made use of; for there are some disorders of so complicated a nature, others again of so peculiar a one, that they are not capable of being consider'd in this advantageous Light; or of being reduc'd to any known Principles, whereon to found our enquiry. All that can possibly be done in such unhappy cases is to be effected by a careful observation of the Symptoms produc'd, by a diligent attention to the efforts, which Nature endeavours to make for her own relief, and by assisting her in the struggle by a due application of proper Remedies.
"It is past doubt with me, says
In his account of the Non-Naturals p. 168.
Dr.
Wainewright,
whatever some Physicians say against
Theory,
which they don't understand, that 'tis not only useful, but a necessary Qualification of a good Physician. For one that understands the structure of a Humane Body, the nature of the Solids and Fluids, the manner how animal actions are perform'd, the Nature of
Secretion,
the effect of either encreasng or lessening any evacuation, the known Laws of Motion as apply'd to
Mechanicks,
and
Hydrostaticks,
with the application of them to the alterations made in Humane Bodies, is
Caeteris paribus
better qualified for a Physician, than one who is ignorant of these things."
FINIS.