This section is from the book "Materia Medica And Therapeutics Inorganic Substances", by Charles D. F. Phillips. Also available from Amazon: Materia medica and therapeutics.
Pettenkofer and Vogt determined that diabetics absorbed less oxygen than healthy persons, and that hence we might hope, by introducing more into their system, to obviate some conditions of their malady.
Bouchardat, and also Demarquay, have recorded cases relieved by this treatment, but no extensive trial of it has been made. Peroxide of hydrogen has been given internally with the same object - of oxygenation- and with some partial success.
I have tried oxygen-inhalation in several cases of diabetes in which prostration, dyspnoea, and tendency to cyanosis were prominent symptoms -one case was at the very unusual age of seventeen months, another at thirteen years, and three others at adult age. The gas certainly relieved for a time the symptoms mentioned, although it did not in any instance reduce the sugar in the urine.
Cases of this disorder treated successfully by peroxide of hydrogen have been recorded (British Medical Journal and Lancet, 1868), and much good was at one time expected from it as an oxidizing agent; but Dr. B. W. Richardson, who introduced the remedy and used it in more than two hundred cases, came to the conclusion that, although it could reduce the specific gravity of the urine, it at the same time increased its quantity, and had no really good effect (Medical Times, ii., 1868). Dr. Pavy tried it in a few cases without any result ("On Diabetes," p. 268).
Phosphoric acid often relieves the thirst of this malady, and has been recommended by Latham, Paris, Watson, and other practical physicians; on the other hand, the experiments of Pavy (already quoted) indicate that much of it would be injurious, and Griesinger not only states that it does not lessen the excretion of sugar, but in one case supposes it actually to have caused the malady.
Against this, we might set a case recorded by Thornley, in which the thirst was relieved and the patient apparently cured (Medical Press, May 20, 1868); but, without being in a position to dogmatize on the matter, I may say that I have known the acid on several occasions to relieve symp-toms and diminish the amount of sugar in the urine.
In diabetes insipidus, or "polyuria," when there is an excessive flow of limpid but non-saccharine urine, alum deserves further trial, though the malady is anomalous and often is uncontrolled by any remedies. In true diabetes a partial and temporary benefit has been derived by some patients for whom I have prescribed it.
Like most other medicines, arsenic has been tried in this malady, and it has received commendation. Dr. B. W. Foster says that he has seen it act well in improving nutrition and lessening thirst, but not in diminishing the excretion of sugar; hence, he considers it acts mainly by saving the waste of albuminous tissues ("Clinical Medicine," p. 208). Dr. Bartholow finds it beneficial in thin subjects with defective assimilating power, but not in the "stout subjects" who suffer from boils and carbuncles. I have frequently prescribed it in both stout and thin subjects, with good results, but as a rule it only acts as a palliative, checking the sudden emaciation and prostration and relieving the excessive thirst and dryness of mouth. In several cases it lessened for a considerable time the quantity of urine, and in some instances appeared to diminish the sugar; it certainly in nearly all cases improved digestion.
Carbonated iron waters are much esteemed as adjuvants in the management of diabetes; and Dr. Mackey informs me that the bromide of iron, or rather a combination of bromide of potassium and citrate of iron, has given better results than any other medicine in his experience. Of course, the diet and •hygiene must be regulated, and when we can more accurately distinguish the varieties of the malady we may find that certain medicines are more appropriate to some forms than to others, but meanwhile I believe the bromide of iron is available in any ordinary chronic case: I have frequently seen the general health improve, and the amount of sugar grow less under its use.
In this malady, magnesia has been found useful by Hufe-land, Willis, and others. It can only be considered as a palliative of some symptoms.
The use of alkalies in this malady was at one time largely adopted, in the hope that their property of assisting oxidation would be of direct service, but this hope has been in the main disappointed. The permanganate especially was recommended by Sampson (Lancet, i., 1853), and also by Ramskill (Medical Times, ii., 1867), but has not proved reliable (Bence Jones, Basham, and others): it seems, however, to have the power of relieving the intense thirst of the malady. The compound alkaline waters of Vichy, Carlsbad, etc., really ameliorate many cases (v. vol. i., p. 161). The nitrate, chlorate, and tartrate are also serviceable in polydipsia, and are given dissolved in water or lemonade: the citrate in effervescence may give much temporary relief.
Speaking not of the temporary and accidental passage of sugar into the urine, but of the more permanent malady, diabetes, we find that small doses of bicarbonate or of chloride of sodium often lessen the amount of sugar passed (Clarke of New York, and others). The citrate, 1/2 to 1 dr., used, instead of common salt, with the food, is said "to cure saccharine urine" (Ranking, ii., 1866), and alkaline waters have been largely used in the treatment of this condition. At Vichy and similar springs it is found that stout diabetics derive advantage from the waters, when thin and pale patients do not. Transitory cases, such as have arisen from temporary nerve-causes, from carbuncle, etc., often do well at Vichy, and even old-standing cases have been relieved, but those with marked lesion of the pulmonary or digestive organs are not suitable for this treatment.
Ebstein reports favorably of Carlsbad and other alkaline waters, especially for mild cases (Medical Times, i., 1875). According to the theory of Mialhe, they should help to oxidize - burn up - sugar in the system, but their use cannot be based on this hypothesis. Poggiale fed dogs with non-nitrogenous food - starch and sugar - to which he added enough soda to render alkaline the urine, but their blood contained as much glucose as that of dogs fed without any soda; also he injected glucose into the blood of rabbits, and again injected it mixed with soda, in each case finding sugar in the urine, while under tartaric acid the sugar disappeared (Bulletin de l' Academie, 1866, cf. p. 294). Bouchardat, on the other hand, points out that alkalies may act dangerously in increasing both fluidity of the blood, and tendency to apoplexy or pulmonary congestion, and Rabuteau cites several cases that died soon after commencing Vichy treatment. He suggests that whatever benefit is derived from soda salts is really due to the chloride, and according to Nasse and others this salt is deficient in the blood of diabetic patients. Martin Solon (Bulletin Generale, 1842-43), Constant (These, 1844), and Bouchardat have reported some clinical illustrations of the good effects of salt given as medicine to such subjects.