investigate, was, returning from a warm climate at an unfavourable time of the year-the latter end of February, and the early part of March, 1810. The exciting causes in the origin of the epidemic (if I may be allowed to call it so), were exposure to cold and moisture. This complaint (opthalmia) so prevalent, gradually began to disappear as we returned to a warmer latitude, though not entirely, for the space of about four months, notwithstanding prompt means were made use of. I cannot account for its long continuance in the ship, unless it be considered, as many respectable gentlemen have sometimes judged it— "contagious." If so, I should concur with the ingenious Mr Goodlad, that such phenomena (in similar cases of purulency) are modified by the action of the part inflamed."

H. M. Sloop Dotterel, Lisbon, April 4th, 1811.

VII.

Notes on Diabetes Mellitus, as it occurs on Ceylon. By THOMAS CHRISTIE, M. D.

THE

HE enclosed notes on diabetes were written at Columbo in September 1809, a short time previous to my being compelled, from ill health, to leave Ceylon, and were intended for insertion in a work relating to some of the diseases of that island, the publication of which has been deferred.

If you should think them worthy a place in your Journal, you will oblige me by inserting them in the form in which they were originally written, at a time when I had an opportunity of ascer taining the actual state of most of the patients, by personal inspection.

Since my return to Europe, I have been made acquainted with cases of diabetes treated successfully by Dr Watt and others, by venesection, and means apparently opposite to what I have been accustomed to employ, with such striking success, in Ceylon; but as I have had no personal experience of the mode of treatment recommended by Dr Watt, I can only conclude with him that in medicine there are different ways of accomplishing the same end.”

Cheltenham, 25th April, 1811.

Columbo, September 1809. ALTHOUGH I have not the honour of Dr Rolo's acquaintance, I had intended to send him these, and some other cases of diabetes, as a confirmation of his train of reasoning, and of the successful practice he had the merit of introducing in this formerly fatal disease; but as the subject has been casually introduced here, and I have reason to believe that diabetes occurs much more frequently with the inhabitants of this island than in Europe, I think a succinct account of all the cases of diabetes I have met with at Columbo will be acceptable to my readers, and particularly to those gentlemen who may have occasion to practise on Ceylon.

The first case of this disease I treated at Columbo, was in a native of rank, Don Louis de Saram, second maha moo-deliar under this government. He applied to me in the month of June 1804, after having laboured under diabetes for twelve months, and being much reduced in flesh and strength. He had a voracious appetite, with constant thirst; and his urine was in great quantity, yielding a great proportion of saccharine extract. He had also a burning sensation in his stomach; uneasiness in the region of the kidneys; heat in the soles of the feet and palms of the hands; a dry skin; loss of his venereal powers, but no phymosis; his pulse and bowels natural.

He was immediately put upon animal regimen, which I have reason to believe he observed religiously; and ordered hepatized ammonia, lime-water, and pills with digitalis and opium. In a few days his urine was reduced to the natural standard, but lost its saccharine taste and peculiar smell. His other symptoms also more gradually disappeared, and he rapidly recovered his strength and flesh. In three months, having perfectly recovered his health, having increased in weight about 21 t, and being restored to all his functions, he was allowed to eat one meal of rice daily; and no relapse ensuing, he was soon afterwards permitted to return to his usual diet, which consists, in a great degree, of rice, fruit, and fish.

He has since occasionally applied to me in consequence of a slight increase of urine, which is easily removed, by resuming for a few days his animal diet, and taking a few pills, with a small proportion of digitalis and opium, which I have prescribed chiefly as a placebo, for the purpose of inducing him to persevere in his regimen. At the time of writing this note, September 1809, he enjoys excellent health; and although corpulent, very active for a man of his age, which is now fifty-five.

is

My second patient, Don Juan Appoo, aged 49, a Cingalese, and physician by profession, had only had the disease seven months, but was still more reduced than my former patient. On the 12th of January 1805, when he first applied to me, his urine amounted to twelve pints; one pint of which yielded 2 oz. of saccharine extract, of the appearance and consistence of treacle. His emaciation was great, with a dry wrinkled skin, and senseof heat in the stomach, soles, and palms. His appetite various, with constant thirst, parched tongue, and costive bowels. Pulse quick and small. Phymosis, et coitus nullus. Weight 97 b.

He commenced the animal regimen on the 13th, and was ordered half a drachm of kali sulphuratum, and a pint of lime-water daily. In this case the change in the quality of the urine was more gradual, and on the 25th it still yielded a little saccharine extract, when, in addition to the other medicines, he was ordered a grain of opium and digitalis, twice a-day. On the 5th February it only amounted to six pints, having a saline taste and smell, and yielding a little more animal extract than healthy urine. At this time also, all his symptoms had greatly diminished, and his appearance was much improved. On the 15th of March, all his symptoms having left him, and his weight being increased to 127 pounds, he was permitted to eat rice once a-day.

On the 16th of April, when he was desired to leave off medicine, I made the following report :-" My patient has persevered in the use of his pills and lime-water, and only eats of rice once aday, when he consumes about one half measure, equal to one pound of the unboiled grain; at other times he eats animal food, of which he now uses more than two pounds daily. He has had no return of saccharine matter in his urine, which has a saline smell and taste, but yields rather more animal extract than healthy urine. It amounts to two or two and one-half quarts daily, and he thinks it generally increases somewhat every second day, when he bathes. He is now perfectly free from all complaint, has a healthy and robust appearance, and his skin soft, and flesh firm. His weight to-day is 136 pounds; being an increase of ninepounds since the 15th of March, and thirty-nine pounds since the 13th of January, when he commenced the animal regimen. This patient now returned to his usual diet, notwithstanding which his weight was found to have increased to 140 pounds on the 24th of June 1805; and he continued in perfect health till about the 20th of November 1806, when he was seized with febrile symptoms, succeeded by debility, sense of heat in his stomach, thirst, pain in his joints, and increased flow of urine, which on examination was found to contain saccharine matter. On

the 4th of December, he applied to me for these symptoms, when his weight also was found to have decreased to 124 pounds.

"On resuming the animal diet, and the use of the kali sulphuratum, his symptoms almost immediately left him; and in the middle of January 1807, he was again discharged, free from all complaint, his weight having increased to 137 pounds."

At the time of writing this note, he enjoys good health, although he looks more emaciated than in 1807; and says he has occasional increase of urine, when obliged to live very much on vegetable diet, which the state of his circumstances sometimes requires. This man used formerly to practise chiefly amongst small-pox patients, of which he has not seen a case for the last three years, and is in consequence obliged to keep a school as a means of subsistence. It is a remarkable coincidence, which I hope I shall be excused for mentioning, that Don Juan, who in all appearance owes his life to one of the modern improvements in medicine, has lost his usual means of subsistence by a still more important one. It will be anticipated, that I allude to Dr Jenner's great discovery of vaccination, which has been extended to upwards of 120,700 persons on this island, the inhabitants of which, previous to its diffusion, used to suffer dreadful ravages from small pox, which they now only know by name.

*

My third diabetic patient, Cornelius Gomez, aged fifty, applied to me in 1805, but only persevered in the animal regimen for a few days, during which, however, his urine was diminished in quantity, when, getting tired of my prescriptions, he withdrew himself from my care, and went to a distance from Columbo. On inquiry, I learn that he is still living, and that he has occasionally resumed the animal diet with benefit, but being irregular in pursuing any plan, the symptoms of his disease have increased, with extreme emaciation and debility; and his appetite having failed, his native physicians do not expect him to survive long.

A fourth patient, Don Johannes, aged thirty-eight, placed himself under my care on the 12th of May 1805, when I made the following report in my notes: "At present, a thin spare man, but says, that until lately he was robust and lusty, and that he enjoyed good health till within these seven months, when his urine became increased in quantity; and for four months past, he has had an unnatural appetite. He now makes above six quarts of

At the time these observations were written, the small-por had not existed in any part of Ceylon for upwards of eighteen months. In the October following, the contagion was imported by a boat from Quiloa to Jaffnapatnam, but only affected a few individuals there who had not been vaccinated,-24th April 181↓.

urine daily, which yields a considerable quantity of saccharine matter; and he eats about three measures of rice (six pounds of dry grain) in a day, which is three times the quantity he was accustomed to consume when in health. He complains of a sense of heat in his stomach, which is frequently distended with flatus; and also of a sensation of heat and creeping in his palms and soles. He likewise feels some uneasiness in the region of the kidneys. Belly regular; pulse eighty, and soft; tongue appears dry; and he complains of thirst. Skin is however soft; and he perspires as usual, on taking exercise. He says that two of his relations have died of this disease, and that he has taken a great deal of medicine from Cingalese physicians, without benefit.Weight 106 pounds.

He was immediately put on the animal regimen, and ordered a solution of kali sulphuratum, with pills of opium and digitalis; and in three weeks his urine was of the natural appearance and quantity. On the 13th of June his symptoms were nearly all removed, his appearance greatly improved, and his weight somewhat increased. On this day he returned to his usual residence at Bentolle, thirty-six miles distant, with strict injunctions to persevere in his animal regimen and pills.

On the 6th of August he returned to me, complaining of his urine having again increased in quantity, with a saccharine taste; and upon being questioned, he allowed, that soon after he went home, he commenced eating a little rice twice a day.

He was again put on the animal diet, which speedily removed his symptoms, and at the end of the month he returned a second time to Bentolle free from complaint, and increased in weight 13 lib. since he began the treatment. In passing Bentolle in the December following, this patient waited on me, with a present of fruit, when he assured me he continued well; but I have lately heard that he latterly took to dram-drinking, and is since dead. His relations assure me, that the disease which carried him off was dysentery, and that he had no return of sweet urine.

A fifth patient, a Portuguese priest, named Philippe Nera, aged 52, applied to me in July 1805, having been affected with slight symptoms of diabetes mellitus for about a year. As he was a man of information and strong mind, I explained to him my ideas of his case, or rather the reasoning of Dr Rollo, and the beneficial effects we had experienced here from the animal regimen, which he promised to pursue. As his symptoms, however, were slight, he did not confine himself entirely to animal food, but ate an increased proportion of it, from which he experienced great benefit. He was recalled to Goa before his case had VOL. VII. No. 27.

T