Page:The American Cyclopædia (1879) Volume VI.djvu/75

DIABETES to the constant thirst and enormous appetite. Early in the disease the symptoms are not well marked; when the complaint is established, and the large excretion of urine begins to at- tract attention, the patient complains that de- spite his excessive appetite he grows thinner and weaker; the mouth is pasty, the skin dry and hard, the bowels constipated. The digestive functions, at first normal, become deranged ; the patient is troubled with heart- burn, with a feeling of weight and pain in the epigastrium, and sometimes with vomiting. The strength declines, he becomes emaciated, the generative functions are impaired or lost ; vision often becomes dim, the gums are spongy, there is tenderness and swelling about the orifice of the urethra, the memory and intellect fail, and the temper becomes irritable. In the course of the disease pulmonary consumption is very apt to supervene and carry off the patient. Toward the last diarrhoea, fetid breath, effusion into the great cavities, and oedema of the ex- tremities precede death. Diabetes is essentially a chronic disease, lasting often many years ; it is also obstinate and intractable, although most of the cases seem benefited by treatment, and sometimes it appears to be completely cured. In the beginning of the present century Dr. Rollo found that the amount of urine in diabetic patients as well as its sweetness was* very much diminished by confining them to an animal diet. "When the ready conversion of starch into grape sugar became known, this was assumed to be the origin of the sugar, and the benefit derived from an exclusively animal diet was thus explained. But few patients have the resolution to restrict themselves for any length of time to such a diet, and even when persevered in it is found to be merely palliative. C. Bernard has ascertained that sugar is a normal production of the liver in all classes of animals, carnivorous as well as her- bivorous ; that it takes place in the liver of the foetus as well as in that of the adult ; that ir- ritating the origin of the pneumogastric nerves in the fourth ventricle increases the secretion of sugar, producing an artificial diabetes. In a state of health the normal secretion ,of sugar poured into the circulation by the hepatic 1 veins is rapidly decomposed and excreted by the lungs ; when the amount is increased by disease, the excess passes off by the kidneys. Under the influence of diastase, sugar is like- wise formed from the starch of the food in the process of digestion, as a necessary preliminary to its absorption. When diabetic patients are placed upon an animal diet, this source of sup- ply is cut off, and the amount of sugar in the urine is diminished, but it is still present, since the^liver keeps up a supply. M. Mialhe, be- lieving that sugar in the course of the circula- tion is decomposed under the influence of the alkalinity of the blood, and that in diabetes the blood is deficient in alkalinity either posi- tively or relatively to the amount of sugar con- tained in it, recommends the use of bicarbon- DIAGORAS OF MELOS 67 ate of soda in large doses.. He recommends half a drachm to be taken three times a day, morning, noon, and night ; this is gradually in- creased until from 180 to 270 grains are taken in the course of the day. In addition, the pa- tient is directed to take Vichy water with his meals, and is recommended to drink two or three pints of lime water daily. He is allowed the ordinary variety in his diet, but the quan- tity of farinaceous food is reduced one half, or at least one third. Flannel is ordered to be worn next the skin; the vapor bath is ad- ministered two or three times a week. By these means Mialhe reports a number of cases to have been cured. Dr. A. Clark (New York "Medical and Surgical Journal," January,1859) reports several cases of diabetes either cured or greatly benefited by the use of bicarbonate of soda and of blisters to the nape of the neck. He administered the soda in doses of 11 grains, to be taken as frequently as could be borne until the urine was rendered alkaline or the stomach was nauseated. Besides the alkaline treatment, the means principally relied on have been, restricting the quantity of farinaceous matter in the patient's diet as far as possible, indulging him in watery vegetables (spinach, turnips, cabbage, &c.) rather than in bread or potatoes, and the use of opium. This last remedy allays the nervous irritability of the patient, and diminishes the thirst and the urinary secretion. Diabetes insipidus is a disease characterized like the above by the daily discharge of an unnatural quantity of urine ; but in this case it is of less specific gravity than natural, and contains no sugar. It consists in fact of the discharge of an ex- cessive quantity of water by the kidneys, the natural ingredients of the urine being simply diluted by the increased volume of the fluid. The daily quantity of urine discharged in this disease may amount to several gallons, while its specific gravity is as low as 1-005. It is accompanied by a corresponding thirst, the pa- tient drinking water enough to supply that dis- charged by the kidneys. Diabetes insipidus often lasts a long time without serious injury to the health. DIAGORAS OF MELOS, surnamed the Atheist, a Greek philosopher, lived in the time of Soc- rates and Aristophanes, but neither the date of his birth nor that of his death is known. He must have removed from his native island to Athens before the performance of the " Clouds " of Aristophanes (423 B. C.), for he is alluded to in that piece as one well known to the Athenians. He was a disciple of Demo- critus of Abdera. He ridiculed the popular religion, and attacked especially the Eleusinian mysteries. He was accused of impiety (411), but the real grievance was his politics. Fear- ing the result of a trial, he made his escape from the city. He was condemned to death by the court, and a price set upon his head ; yet he lived for a time at Pallene, and finally died at peace in Corinth. His works are all lost.