(From to pass of, or through).
Diarrhea urinosa; dipsas; diuresis; hydro/is ad matu-lam; profiuvium urine. An excessive discharge of crude urine, exceeding the quantity drunk. Boerhaave, in his Institutes, says, it is a frequent copious discharge of lacteous urine, in conjunction with an extraordinary tenuity of the fluids.
Dr. Cullen places this genus of disease in the class neuroses, and order spasmi: which he defines a chronic flow of urine, made in immoderate quantities, and of a preternatural quality. He notices two species, 1st. Diabetes mellitus, when the urine hath the colour, odour, and taste of honey. 2d. Diabetes insipidus, when limpid only. Dr. Home defines it to be an extraordinary increase of the urine as to its quantity, and that of a sweetish' taste, attended with perpetual thirst, and a dry skin, which for the most part is also scaly.
Youth is scarcely ever attacked with this disorder: its most frequent subjects are those in the decline of life, often those who have drunk liberally of wine in their earlier years, and who are also employed in the more violent kinds of business.
The flow of insipid urine is owing sometimes to a nervous irritation, and from this cause it appears to be occasionally a symptom of hysteria. It has been owing to relaxation of the kidneys from drinking mineral waters in excess, occasionally to unnatural indulgences, and, as has been said, to too great tenuity of the fluids: generally speaking, when permanent, it is a symptom of debility; when temporary, it is nervous. The insipidity of the urine is not always owing to a deficiency of its solid contents, but to their diluted state, from the large proportion of the menstruum. Vet in some fevers, apparently of the nervous kind, with affections of the head, we have perceived the salts almost wholly retained.
The other species is that which has lately attracted the greatest attention, the diabetes mellitus. In this disease the urine is not only copious in quantity, but wholly different in its quality, since it contains no animal matter, and yields, on evaporation, a considerable quantity of sugar. To constitute this disease, it is not necessary that the urine should be in an unusual quantity; since we find an instance where, in an anomalous consumption, the urine contained three ounces of sugar in a pint, without being uncommonly copious.
In general, in the diabetes mellitus, the skin is dry, parched, and often scaly. The appetite not greatly impaired; but the patient is weak and emaciated, with a low quick pulse. It has been said, that, on the stop-page of the discharge, anasarca has come on; but, in twenty cases we have seen, no such termination has occurred. It is, however, by no means a common complaint. The thirst is excessive.
In speaking of aliment, we have mentioned sugar as highly alimentary: the chyle and milk have been considered as abounding in sugar; so that, with some authors, the conclusion was easy, that the discharge was milky, with others that it was chylous. Modern chemistry, in ascertaining carbone to be the principle of vegetable substances, and azote of animal, has led with more reason to the conclusion, that the saccharine discharge was an imperfectly animalised fluid; and this idea is supported by the disease occurring in exhausted constitutions, while its chief remedies are tonics and stomachics. When we reflect on various symptoms of disease, Ave shall find that saccharine discharges are not uncommon. The depots laiteux of puerperal women are of this kind: in hectics Ave find the sputum occasionally sweet; we have found the saliva of a honied sweetness. Hippocrates has remarked, that the sweet smell and taste of the cerumen are a fatal symptom; and the colliquative sweats of hectic patients are occasionally found to impart the smell of acetous acid, after being confined in napkins. From these facts, our conclusion, that the caeliaca passio may be a deposition of the same kind, will not appear very unreasonable.
Dr. Gottlieb Richter, professor of medicine at Gottin-gen, thinks, according to his experience, that a diabetes is occasioned by a stimulus which acts upon the kidneys. When the particular irritation cannot be discovered nor removed, to counteract its action upon the kidneys by antispasmodics and sedatives, is the proper remedy. In proof of which he refers to Whytt and Mcormic, who saw it originate from gouty matter, and Sydenham from healing an old ulcer. Steller, who cured a patient with bark and opium; Dobson, by warm baths; Mcormic, by Dover's powder; Brisbane, by almond emulsion; support, in his opinion, the same doctrine. Dr. Richter says also, that tincture of cantharides and bark have been variously used with advantage against diabetes; and supposes, that the first acted by carrying off irritation, as in the chin cough; the second by allaying irritation, as in agues. But notwithstanding these, he depends chiefly upon his own experience, and gives some cures in support of his opinion: one case, which succeeded a bilious fever, wherein the pulse was small, tense, irritated, and quick, attended with an uneasy sensation and fulness in the region of the stomach; all the complaints growing worse towards evening, was cured by a vomit, by which a very great quantity of bilious matter was evacuated. A second, wherein some scorbutic symptoms appeared, was conquered by wort. A third and fourth, for which no precise cause could be discovered, yielded to tartar emetic and valerian in the first case; in the second, to ipecacuanha, which occasioned vomiting; and as often as the patient vomited, the disease disappeared for twenty-four hours: but besides these medicines above mentioned, he strongly recommends camphor in emulsion. See Medical and Surgical Observations, Edinburgh, 1794.
This author seems, however, evidently to confound the two species of diabetes; and after having mentioned his arguments and facts, Ave may safely conclude that they do not apply to the diabetes mellitus.
We know nothing of the process of animalisation, but that it is connected with the production or union of azote. The mode in which it is effected Ave cannot in this place ascertain; and all that the refinement of modern practice has suggested, with the assistance of the improved state of chemistry, is the exhibition of azotic substances with an animal diet.
The following remarks, which we transcribe from the 4 A 2 last edition, are apparently directed to the increased . flow of limpid urine.
"The diet should be the some as in an hectic fever, viz. animal substances, such as broth made of beef, shell fish, milk often, and in small quantities; jellies, barley water, in which the root of comfrey is boiled, and lime water, may be the common drink.
"Moderate exercise on horseback, and dry friction of the whole body, assist in promoting perspiration; and which, when excited, peculiarly tends to divert the discharge through the kidneys.
"When unquenched lime is mixed with the serum of blood, it generates those salts that are necessary to the true urinary discharge; and if lime water is drunk as freely as the thirst requires it, its efficacy exceeds that of Bristol water in the cure of a diabetes, notwithstanding the latter is esteemed as a specific: but, in order to this advantage from lime water, it must be drunk while the heat continues, which it possesses from the lime being quenched in the water.
"At proper intervals, during the use of lime water, as above directed, the acidum vitrioli dilutum; cort. Peruv. limatura ferri; and whatever can improve the crasis of the blood, may also be administered.
"A flannel shirt may be worn, to solicit a discharge through the skin. The tincture of cantharides is said by Dr. Morton to be a specific in this complaint. Others prefer the serum aluminosum, made as strong as the stomach will bear it, and direct half a pint to be taken night and morning. With others, the vitr. caerul. gr. ss. given twice a day, dissolved in any agreeable liquor, is most depended on. When the means first proposed are unsuccessful, recourse may be had to these, or such other means as experience may suggest. Rhubarb is found to be of singular advantage; and from the success which follows on the use of antispasmodics, joined with other means, a spasm in the ducts, through which some other excretions are conveyed, rather than an irritation in the kidneys, may be a principal cause of this malady."
From these confident assertions the disease may be supposed tractable, and easily yielding. Each species is, however, peculiarly obstinate, and we fear both resist the best concerted plans. The hepatised ammonia (see Chemistry) has failed in our hands; and the best, most successful, remedies have appeared to be bark, with Dover's powder, and a diet highly alkalescent and animalised. Yet, in general, every attempt has alleviated the disease only; for how can we expect to cure what is, perhaps, a symptom only of a broken constitution ?
See Aretaeus, Lommius, Boerhaave, Lister, London Medical Observations and Inquiries, vol. iii. p. 274, etc. vol. v. p. 298. Cullen's First Lines, vol. iv. Sydenham.