OTHER DISEASES - DIABETES MELLITUS.
1. Infectious Diseases.—It has often been sought to establish some connection between diabetes and other diseases, and indeed there is hardly a disease which has not at some time or other been looked upon as the exciting cause of this affection. In most of these cases the causal relation between the two diseases is very doubtful, furnish ing an instance of the confusion of post hoc and proper hoc. I can not refrain from relating a characteristic example of this kind. I was called to see a patient with diabetes who told me that his trouble was the result of a severe attack of influenza. While under treatment for the influenza his urine was examined for albumin and sugar; the former was present in small amount, the latter was absent. After the influ enza had subsided the quantity of urine excreted became greatly in creased, and another examination showed the presence of sugar. Since that time the glycosuria had persisted. Soon after this I re ceived for examination the statement of a life insurance examiner con cerning this patient. The man had applied for insurance prior to the attack of influenza, and an examination of the urine made at that time showed that it contained sugar. In this case, as so often hap pens, the intercurrence of an infectious febrile disease temporarily interrupted the glycosuria. The patient's statement was made in perfectly good faith, for he had not been informed of the discovery of sugar in his urine before the attack of influenza. A similar ex planation may well be imagined for many cases in which diabetes is said to have followed an attack of acute infectious disease. We may assume that not infrequently the disease was present prior to the attack, but that the symptoms were so slight as to pass unobserved, no mention of them being made to the family physician. But after an intercurrent attack of some infectious disease the patient feels weak and convalescence is slow, the urine is examined and a diagnosis of diabetes is established.
But it cannot be denied that acute infectious diseases may actually cause diabetes. Observations made during the past few years, which
have taught us to recognize a certain form of diabetes as an organic disease (pancreatic diabetes), have made this relationship more ex plicable. We so often observe organic affections (involving the heart, kidneys, liver, nerves, etc.) occurring as sequeke of acute infectious diseases, that we may also regard a secondary affection of the pan creas as altogether possible and even probable. There is a wide field here for more exact observations.
Equally uncertain are the reports alleged of the occurrence of dia betes after severe hemorrhages, frequent child-bearing, extensive eczema and other skin eruptions. We have reports for the most part of isolated cases only, the value of which as a basis for generalization concerning any disease is very slight.
Worthy of more especial consideration as etiological factors are obesity, gout, nervous diseases, diseases of the pancreas, and syphilis.
2. diabetes and obesity are frequently associated is an old-established fact. It almost always happens that the obesity comes on first and exists for a number of years before sugar appears in the urine. It is usually, therefore, not until after the fortieth year that the sugar first begins to be excreted. The diabetes associated with obesity is commonly of a benign nature, and a slight glycosuria may exist for years or even decades without affecting the patient's powers to any appreciable degree. It may even disappear com pletely, for instance after the institution of a suitable diabetic regi men, but returns again if the patient grows lax in his observance of the prescribed mode of living.
Much more unfavorable are those cases in which both obesity and diabetes are developed in early life. Under such conditions one may see an herculean frame, both fat and strong in muscle, admired for its powerful proportions, waste away and become reduced to a mere skeleton in a few months.