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Figure 1.1 The title page of Dr Bennewitz's thesis De diabete mellito, graviditatis symptomate,28 with translation into English.

He was convinced that:

The disease appeared along with pregnancy, and at the very same time ...; when pregnancy appeared, it appeared; while pregnancy lasted, it lasted; it terminated soon after the pregnancy.

He showed a degree of humility when he remarked that his patient must be something of a rare bird.

The case history commences on 13 November 1823, when Frederica Pape, aged 22, was admitted at 7 months in her fifth pregnancy to the Berlin Infirmary. The first three pregnancies appear to have been unremarkable, but in the fourth in 1822 she had an onset of thirst and polyuria which had resolved spontaneously after delivery. These symptoms returned at an unspecified time in her fifth pregnancy: she had a really unquenchable thirst - she consumed more than six Berlin measures of beer or spring water, although the quantity of urine greatly exceeded the amount of liquid consumed, and the urine itself smelt like stale beer. Her voice was weak, skin dry, face cold and she complained of a dragging pain in her back.

Treatment was more a matter of belief than of understanding, but apart from having withdrawn 360 mL of venous blood all at once (the equivalent of thirty-six 10 mL routine blood tests today) and taking a high-protein diet, probably deficient in vitamins, she must have benefitted from the rest and care. The measurement of 2 oz of sugar in 16 lb (224 oz) of urine, which is equivalent to about 1% glycosuria, was Bennewitz's only biochemical evidence of diabetes mellitus. From about 32 to

36 weeks the patient had a recurrent sore throat and increased abdominal distension such that twins were suspected. When examined on 28 December 1823 the cervix was dilating and the fetal head already partially descended. On 29 December she had an obstructed labor, and the child died intrapartum, probably due to delay in the second stage. Bennewitz remarks that the baby was of such robust and healthy character whom you would have thought Hercules had begotten.

The infant weighed 12 lb, a fact witnessed carefully. Postpartum, in spite of continued dieting, sweating and purging, and the application of eight leeches, the patient's strength improved daily, and sugar disappeared from her urine. 'With nature to preserve and treat her, we dismissed our patient cured' (Figure 1.2).

Unfortunately, there is no record of the woman's subsequent health, perhaps because Dr Bennewitz presented his thesis within 6 months and having been successful in obtaining his doctorate, dropped out of academic medicine. This pregnancy would certainly qualify as 'carbohydrate intolerance of varying severity with onset or first recognition during pregnancy,' which was the definition agreed for gestational diabetes at the first workshop-conference in Chicago in 1980.

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