AN ENQUIRY INTO THE NATURE AND SEAT OF THE DIABETES.

SCARCE any diſorder has afforded greater matter of ſpeculation, eſpecial⯑ly 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 unneceſſa⯑ry. Amongſt the Antients is was ſeldom heard of. Aretaeus ſpeaks of it, as ſomething mi⯑raculous, [...], Miraculum quoddam: And Galen confeſſes, that in the courſe of his Practiſe he only ſaw two Pa⯑tients [2]labouring under this complaint. The uncommoneſs of it might be owing to a diffe⯑rent 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 ſweet⯑neſs 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 ob⯑ſerves, 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 te⯑ſtifies, 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 remo⯑val of this diſeaſe, ſo far as they are known to ſtrengthen weakn'd Solids, to ſheath a⯑crimonious humours, to incraſſate too much attenuated blood, to abate hectick fevers, [3]and to cool the body. But this will be far⯑ther 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.

^a 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 diſ⯑ſolv'd into water, ſo in a Diabetes they are melted down into ^b 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 ſee⯑ing 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 mem⯑brana celluloſa, (being thoſe parts of the bo⯑dy, [4]which give the leaſt reſiſtance,) and form dropſical ſwellings, than be evacuated by U⯑rine? Such an Univerſal conſumption then of the body does not ſeem to be the pri⯑mary cauſe of this diſeaſe, but may be, and is the conſequence of it.

^a Galen, and his followers, ^b differ'd from this opinion and thought it owing to an imbecil⯑lity in the kidneys; and ſo far indeed they ſeem to have judg'd right: But then their manner of accounting for ſuch a copious diſ⯑charge 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 imagina⯑tion, [5]than ſolidity of reaſoning. For the poſ⯑ſibility of ſuch an attraction is ſurely as dif⯑ficult to be conceiv'd, as the cauſe of attra⯑ction itſelf. ^a 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. Aurelia⯑nus's chapter upon this diſeaſe is loſt: and ^b Celſus only lays down ſome general methods of cure to be obſerv'd, cum Ʋrina ſuper po⯑tionum modum mingitur.

A Diabetes, ſays ^c Etmuller, is either genuine, or ſpurious. The former is a voiding of li⯑quors by Urine without undergoing any al⯑teration 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 di⯑rectly from the firſt paſſages to the kidnies. But theſe, he confeſſes, are not yet known, and no wonder; becauſe it is evident from [6]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 kid⯑nies, but by firſt entring into the blood. To account for the latter, he ſuppoſes, a ſharp acrimony in the blood, which reſolves, atte⯑nuates, and melts down the blood, and even the muſcular fleſh itſelf into ſerum, which be⯑ing 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.

^a 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 pro⯑duc'd.

Dr. Willis, that great Phyſician of his time, obſerves, that Rheniſh Wine, Cyder, and a⯑cid liquors being drank provoke a more plen⯑tiful Diureſis or evacuation by Urine: The cauſe of this evacuation he attributes to a fuſion [7]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 im⯑bu'd with ſaline particles, do run through the moſt open paſſages of the Reins, and ſo cauſe a Diabetes. And he gives us an In⯑ſtance 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 im⯑moderate drinking of ſuch thin acid liquors does not ſeem to be owing to ſuch a diſſolu⯑tion 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 over⯑loaded 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 bro⯑ken a ſtate, this Diſtemper will not be pro⯑duc'd, unleſs there is a relaxation of the kid⯑ney in conjunction with it, but rather a drop⯑ſy, and for reaſons that have been already [8]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 man⯑ner produce a Diabetes; and ſuch an exceſs of them ſeems to be the moſt frequent cauſe of it.

The account which ^a 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 [9]appears; and therefore the Quantity of Salts in the blood will be daily increas'd, and cir⯑culating 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 coa⯑gulating when drawn into a cup, than U⯑rinous 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 Co⯑ral 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 Spi⯑rituous [10]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 grant⯑ing ſuch a diſſolution of the red part of the blood, as the Dr. imagines, which may be poſ⯑ſible, 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 ce⯑lebrated ^a Dr. Mead, which demands our at⯑tention as well for its ſingularity, as for the eminent Character of its Author. ‘"The Dia⯑betes, he ſays, is not as Phyſicians have com⯑monly judg'd, a diſtemper of the Kidneys, but of the Liver, proceeding likewiſe from a vitiated mixture of the bile. It moſt fre⯑quently happens to thoſe, who without due exerciſe indulge themſelves in drinking vi⯑nous liquors, and then quench their thirſt ariſing from theſe, by too great a quantity of ſuch as are cooling.’

In the firſt place let it be here obſerv'd, that the texture of the ^a 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 thorough⯑ly incorporated in a proper vehicle. A Pre⯑ternatural [12]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 de⯑ſtroy'd, can be admitted to paſs through the kidney. Beſide, ſuch a diſpoſition of the li⯑ver, as is here ſuppos'd, and ſuch a vitiated mixture of the bile muſt neceſſarily be attend⯑ed with a high jaundice, but as the Diabetes often appears without the leaſt icterical Sym⯑ptom, 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 Wa⯑ter, 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 Dia⯑betical Urine differ ſo much from that which is natural, not only in Quantity, but in Qua⯑lity alſo? But the reaſon of this alteration will evidently appear by proſecuting the en⯑quiry farther, than ſeems to have been con⯑ſiſtent [13]with his deſign; and in order to pro⯑ceed more methodically;

I ſhall firſt deſcribe a Diabetes by pointing out the ſeveral Symptoms of it.

2dly, ſhew how a relaxation of the Secre⯑tory 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-co⯑lour'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 ad⯑vanc'd by a neglect of proper remedies, the Perſon ſo affected in reality dies of a conſum⯑ption. Theſe are then the moſt remarkable Symptoms of a Diabetes, and the known con⯑ſequences of it.

I am in the next place to ſhew how a re⯑laxation of the Secretory Ducts of the kid⯑nies [14]with a diſſolute broken blood muſt neceſſa⯑rily 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 di⯑ſtended, will weaken the contractive ſpring of that fibre.

Now the Glands may be relax'd, or their contractive ſpring weakn'd, by ſeveral diffe⯑rent means; as firſt, by being preſt upon with too great a quantity of fluids, and this may happen either from a ſtoppage of perſpira⯑tion, or from a defect of Secretion in one Gland, which may be occaſion'd by ſome ob⯑ſtruction form'd in the Secretory Ducts of that Gland, and is known to encreaſe the Secre⯑tion 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 [15]parts; and here it may be obſerv'd, that ſuch exceſſes will chiefly affect thoſe parts, which are by conſtitution the weakeſt, and the diſ⯑order produc'd will correſpond with the na⯑ture and office of that organical part, which is affected.

The Glands may alſo be relax'd, and the cra⯑ſis of the blood broke by Mercurial Salivations, by a long continu'd uſe of powerful Deobſtru⯑ent Medicines, and the kidnies in particulr by an improper uſe of ſuch as are ſtil'd Diu⯑retick.

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 ^a experiments, that all ſtrong liquors not only contract the ſmall ar⯑teries, 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 fi⯑bres of the Stomach, and Inteſtines; hence will ariſe a failure of digeſtion, and of courſe of nutrition. When theſe neceſſary offices [16]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 ſup⯑poſe 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 ef⯑fects.

As the kidnies then may be relax'd by any preternatural preſſure, ſo it is eaſy to appre⯑hend, how a long ſuppreſſion of Urine, (be the cauſe of that ſuppreſſion what it will,) ſhould be productive of this diſorder. Dr. ^a Harris gives us an inſtance of ſuch a cauſe of it in a caſe, that fell under his own ob⯑ſervation. After having preſcrib'd ſeveral Me⯑dicines 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. ʒvj Croc. Opt. ʒſs Sal. Succini gr. xv. F. Cataplaſma. The day following all [17]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 Rhu⯑barb 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 Pa⯑tient, who was ſeventy ſeven years old; and by reaſon of the aſtringency of it, to the na⯑ture of the diſeaſe; there being no reaſon to think, why it might not be of equal effi⯑cacy in a Renal flux, as well as an Inteſtinal one; ſeeing that the difference of the parts affected conſtituted the difference of the diſ⯑order; in which obſervation there ſeems to be a great deal of truth.

But to proceed — As a ſtone in the kid⯑ney by its great preſſure or irritation will bring on a relaxation of its fibres, ſo it may be the cauſe of this diſtemper.

^a 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 obtu⯑ſos — Lingua ſquallida, & horridula, aeſtus, & ſitis, meiebat plus juſto, urina plane aquea, ſen⯑ſim extabuit, Diabete interiit.

The bites of ſome kind of animals, parti⯑cularly the ^a Dipſas, have been known to oc⯑caſion 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 rela⯑xation 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 quan⯑tity of cooling acid liquors in order to ap⯑peaſe 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 ſuppo⯑ſing the predominant weakneſs to be in the kidnies, this diſorder will neceſſarily be pro⯑duc'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 diſ⯑temper [19]to be an affection of the ^a 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 pro⯑perly come under the denomination of a Dia⯑betes.

The kidnies and their Secretory Ducts be⯑ing 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 bo⯑dy 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 com⯑bination of the ſeveral parts of the blood, nor a proper aſſimilation of the Ingeſta. The conſequences of which will be juſt now con⯑ſider'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 re⯑ſpects analogous to this, and that is, a lacteal Diabetes. The learned and judicious Dr. ^a Boerhaave gives us an inſtance of ſuch a diſ⯑eaſe. ‘"There was, he ſays, a certain Wo⯑man who dwelt at the City of Dort, who bore and ſuckled Children for twelve years ſucceſſively; but at length ſhe fell into a la⯑cteal Diabetes, in which all the nouriſhment that was taken ran through her Breaſts with⯑out 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 co⯑pious and frequent diſcharge of pale colour'd [21]Urine. That this is an effect neceſſarily ari⯑ſing from ſuch a ſtate of the body will evi⯑dently 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 pro⯑portionably great. The little ſtay the Se⯑creted 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 bo⯑dy, are owing moſt probably to its long re⯑tention 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 vi⯑ſcid diſpoſition, ſo they readily coagulate, when expos'd to the Atmoſphere; and to this ſeems to be owing the reaſon of its ropy conſi⯑ſtence.

That the quantity evacuated ſhould exceed in proportion the quantity of liquors taken in, appears from what has been already ob⯑ſerv'd; [22]for in this weakn'd ſtate of the kid⯑nies, 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' excre⯑mentitious; to which may be added the a⯑ctual increaſe of fluids ariſing from a general waſte of the Solids, which the kidnies being now enlarg'd will greedily receive. No won⯑der 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 man⯑ner ſuſpended,) will be loſs of fleſh, and a great waſte of the body, which is always ob⯑ſervable, 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 [23]is made, and will conſequently be ſenſible of a proportionably greater weakneſs. The ſame complaint is made in other fluxes, in a go⯑norrhaea by Men, and the fluor albus by Wo⯑men; and the reaſon of it in both caſes is the ſame.

The Symptom that comes next to be ac⯑counted for is the ſweetneſs of the Urine.

As a different configuration of the parti⯑cles of the ſame body is well known to im⯑preſs 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 tex⯑ture 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 ac⯑count 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 mo⯑dification [24]of their parts acquir'd in the Pro⯑ceſs of Putrefaction. Chemiſtry teaches us, that all bodies are compos'd of the ſame E⯑lements, Fire, Air, Water, Earth, Salt, and Oil; and therefore the variety of their co⯑lour, ſmell, taſte, and the like, muſt be ow⯑ing primarily to ſome different diſpoſition of theſe Elements. We learn indeed from ob⯑ſervation, that the nearer the parts of any body approach to a ſphaerical diſpoſition; the more mild and ſoft is the taſte of that bo⯑dy; 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 in⯑nocent, and taſtleſs, but when ſublim'd, it loſes its ſphaericity, and becomes acrid, cor⯑roſive, and poiſonous.

An intire maſs of ^a Silver is inſipid, but by being diſſolv'd in aqua fortis, and ſhooting into Chryſtalls, it becomes bitter; Lead ano⯑ther [25]taſtleſs body diſſolv'd in the ſame Men⯑ſtruum 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 ex⯑cite taſtes in thoſe bodies, which before were inſipid.

We have hitherto accounted for the ſweet⯑neſs of diabetical Urine, upon no other prin⯑ciples, than the original and primary cauſe of the difference of the taſtes of natural bodies in general; and into this indeed muſt all o⯑ther accounts of it be at laſt reſolv'd: For could we know the various mixtures the U⯑rine 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 [26]organs to enter the Lacteals, are ^a 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 re⯑tention 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 na⯑ture, 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 cir⯑culating in the Veſſels to acquire any degree either of rankneſs or Acrimony. This Chy⯑lous nature then of the Urine with a diffe⯑rent combination of its ſeveral parts will ea⯑ſily account for its remarkable ſweetneſs.

That a Diabetes ſhould be attended with a hectick fever will appear evident from a con⯑ſideration 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 ca⯑chectical [27]body muſt produce a Hectick. A very common cauſe of it however is an acri⯑mony in the blood, whether it be of the acid or alkaline kind, which by irritating and fret⯑ting 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 whe⯑ther 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 ſome⯑times known to be tinctur'd, even when there has been no Ulcer in theſe parts, and there⯑ſore could not poſſibly have been evacuated by ſtool; had it not been firſt abſorb'd into the blood. That there are Veſſels in the hu⯑mane body capable of ſuch abſorption is grant⯑ed by every one; That Peſtilential and other noxious efluvia are abſorb'd by them, and com⯑municated 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 [28]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 ab⯑ſorb'd.

That a great loſs of blood will alſo bring on a Hectick, whether occaſion'd by Haemor⯑rhoidal, or Dyſenterical fluxes, too plentiful Phlebotomy, or the like, appears from obſer⯑vation, and is confirm'd by experiment.

The accurate and ingenious ^a 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 di⯑ſturb'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 mi⯑nute: Whence we ſee, that the pulſe is weak and quick, when the heart is ſupplied with little blood; which is the caſe in the he⯑ctick 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 Veſ⯑ſels, is reciprocal to the reſiſtance, which they meet with in their paſſage through ſuch Veſ⯑ſels. Now this reſiſtance among other cauſes of it will be increas'd or diminiſh'd in pro⯑portion to the Quantity of fluids contain'd in theſe Veſſels; for the greater the Quantity of fluids is contain'd for inſtance in thoſe Co⯑nical Veſſels the arteries; the greater degree of force will be requir'd in the blood thrown out of the Heart to drive forward that alrea⯑dy in the arteries; and there will alſo be in ſuch circumſtances a greater degree of fri⯑ction; the Quantity of blood then being di⯑miniſh'd, theſe reſiſtances, which are known to retard its progreſſive motion, will be propor⯑tionably remov'd; and the motion of the blood then will now be more free, it will conſequent⯑ly be more quick; and as a quick circulation will cauſe a quick pulſe; and as the pulſe is de⯑nominated to be either ſtrong or weak in proportion to the greater or leſs diſtenſion of the artery, which depends upon the Quanti⯑ty 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 Preternatu⯑ral [30]fluxes of any kind are neceſſarily produ⯑ctive 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 Dia⯑betes; (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 un⯑eaſy ſenſation, which we call, Thirſt.

I have now gone through what I intended to inſiſt upon, and hope, that the obſerva⯑tions 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 great⯑er concern to mankind, than the Rationale of [31]it; tho' this ſhould be firſt known to the skil⯑ful Phyſician, that he may the more effectual⯑ly proceed to the removal of it; it may not be improper briefly to point out the Indica⯑tions 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 moderate⯑ly ſtrengthen the weakn'd part. It is how⯑ever 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 acrimo⯑ny is firſt to be corrected by proper reme⯑mies. The greateſt regard ſhould be had in the cure of this, as well as all other Chroni⯑cal diſeaſes to a proper Diet, which in this caſe ſhould undoubtedly be that of the incraſ⯑ſating kind. A good Regimen of the Non-Na⯑turals 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 in⯑to the body by way of food; a proper Regi⯑men [32]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 abundant⯑ly teſtifies. But the reaſon of its operation does not ſeem to be clearly underſtood; nei⯑ther 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 experi⯑ments, 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 Me⯑dicine 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 [33]Oeconomy by the aſſiſtance of Mechanical ob⯑ſervations. ‘"^a Nor could malice itſelf (as Dr. Mead expreſſes himſelf on the like occaſion) deny this, were not ignorance in confedera⯑cy with it, which will ſecure any one from being benefitted by the moſt uſeful Demon⯑ſtration."’ 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 Mo⯑tion, 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 ap⯑plication of theſe Laws to ſuch alterations, as are obſervable in it.

This method then of enquiring into the na⯑ture 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 ad⯑vantageous [34]Light; or of being reduc'd to any known Principles, whereon to found our en⯑quiry. 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 Na⯑ture 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 ^a Dr. Waine⯑wright, whatever ſome Phyſicians ſay againſt Theory, which they don't underſtand, that 'tis not only uſeful, but a neceſſary Qualifica⯑tion of a good Phyſician. For one that un⯑derſtands the ſtructure of a Humane Body, the nature of the Solids and Fluids, the man⯑ner how animal actions are perform'd, the Nature of Secretion, the effect of either en⯑creaſng or leſſening any evacuation, the known Laws of Motion as apply'd to Mecha⯑nicks, and Hydroſtaticks, with the applica⯑tion of them to the alterations made in Humane Bodies, is Caeteris paribus better qua⯑lified for a Phyſician, than one who is igno⯑rant of theſe things."’