cases are never cured by this treatment, which is found to act with diminished energy in proportion as the disease is more advanced at the period of its application, until at last a time arrives when it ceases to exercise any controlling influence whatever. From this fact it follows, that in a considerable number of cases but little or no improvement is effected. Besides it has been shown by Dr. Bardsley' that the life of the patient is sometimes cut short by the sudden accession of inflammatory affections of the abdominal and thoracic viscera when under the influence of a purely animal diet.

I shall now proceed to the consideration of the skim-milk treatment, which I have already introduced into practice through the pages of the 'Lancet' by the contributions already referred to.2 This treatment, I may venture to state, is incomparably superior to that of Rollo in its most approved form, inasmuch as I have found it after numerous trials to yield results far beyond my own expectations, formed at the time when it first occurred to me that it might act beneficially in diabetes.

Cyclopædia of Practical Medicine, vol. i. p. 545. 2 See p. 16.

169

CHAPTER X.

THE SKIM-MILK TREATMENT OF DIABETES.

WHEN the idea first occurred to me to try an exclusive regimen of milk as a remedy for diabetes, I certainly received no encouragement whatever from consulting the writings of the more recent of the acknowledged authorities on the treatment of this disease. On the contrary, I found that they condemned the use of milk with a unanimity highly discouraging, and in itself sufficient to lead to the inference that it must be specially injurious to those suffering from the affection. Thus, Bouchardat1 of Paris, in a contribution to the French Academy of Medicine, has distinctly forbidden the use of milk, although he has recommended sweet cream, and all kinds of cheese; and from the high estimation in which his opinion is held, his condemnation of milk has been adopted in several important works

1 Mémoires de l'Académie nationale de Médecine, tome xvi. Paris, 1852.

on medicine both abroad and in this country. Dr. Pavy, in his work already referred to (p. 263), has given, in a tabular form, an elaborate dietary for diabetics, to enable them to select the suitable or harmless articles of food from those which are prohibited as injurious; and in this table milk is placed at the head of the list of the liquids they are forbidden to drink in consequence of the sugar they contain. Dr. Bence Jones, too, although he does not express himself in equally disparaging terms, in referring to the treatment of diabetes in a recent work, observes that 'milk is more or less injurious according to the stage of the complaint. When animal sugar can be consumed, milk is comparatively harmless.'

It is evident that the strong objection which has prevailed against the use of milk in the treatment of diabetes originated in the fact that it contains from four to six per cent. of milk sugar or lactin, which was supposed to be readily converted into diabetic sugar in the system. It appears that lactin, when taken in a pure, unmixed condition, is transformed into diabetic sugar, and as such is voided by the urine. But this certainly is not the case with lactin

1 Lectures on some of the Appliances of Chemistry and Mechanics to Pathology and Therapeutics, p. 62. London, 1867.

administered as a constituent of milk; for no sooner is milk taken into the stomach than its lactin undergoes fermentation, apparently through the agency of casein as a ferment, and is converted into lactic acid, which is incapable of being changed into glucose, or diabetic sugar. That the lactin of milk undergoes lactic fermentation in the healthy stomach, is a well-known physiological fact;1 and it appeared to me that, in all probability, no abnormal condition exists in the stomach in diabetes to prevent the same process from taking place. This conclusion has been verified by my subsequent experiments with skim-milk in the treatment of the disease. It occurred to me that if milk did produce an injurious effect in diabetes, or if it failed to act beneficially, this might possibly be dependant on the presence of the large quantity of fatty matter, or butter, it contains. From these considerations, and others about to be stated, I resolved to try skimmilk (from which the cream had been carefully removed) as a remedy for the disease.

Skim-milk, as stated in a previous chapter, is (with the exception of a little contained fatty matter) a simple aqueous solution of the salts requisite for

1 Dr. Bence Jones, Lectures on Digestion, Respiration, and Secretion, Med. Times and Gaz., April 19, 1851.

nutrition, and of casein and milk-sugar. It therefore contains an albuminous and a saccharine proximate principle of food—the latter being the analogue of vegetable starch and sugar (entering into the composition of a perfect human food), and destined to undergo the same metamorphic changes, and to serve the same purposes in the process of healthy nutrition. But milk-sugar differs from these vegetable substances in the very important particular, that, being immediately or quickly converted into lactic acid in the stomach, it is incapable of being misappropriated or wasted in the system by the morbid action of diabetes. By the employment of skim-milk, therefore, it struck me that it would be practicable to give to diabetics a saccharine alimentary principle, capable of being assimilated in spite of the disease ; and surely to do this would be to surmount one of the greatest difficulties to be encountered in its treatment.

With regard to the casein of skim-milk, it appeared to me also that, as it is a primitive nutrient albumen formed in the laboratory of nature with the special design of being converted into healthy living tissues, it would be much more likely to effectually resist the mal-assimilating or sugarforming force of the disease than the albumen of