DIABETES MELLITUS.
Definition.—A malady characterized by non-accidental—that is to say, a per manent or very nearly permanent—gly cosuria.
Symptoms.—With but rare exceptions, the onset of this disease is insidious, and cannot be recognized by the patient. Many cases of diabetes remain entirely unsuspected until the time when some symptom other than the glycosuria at tracts the attention of the patient. This may be either excessive thirst, poly uria, unusual weakness, or even im potence. More rarely, it is a sudden diminution of the acuity of the vision, or perhaps a complication in the form of anthrax or balanitis in men, and pru ritus vulvre in women. The daily quan tity of urine is increased, except in some rare cases, classed under the head of "diabetes decipiens." Initial symptoms of diabetes mellitus in children are apt to be incontinence of urine, nervous irtitability, and great thirst. Strength, flesh, and color may sometimes be retained until nearly the end. A gain of weight and height, even, may occur, without any amelioration of the disease. Townsend (Boston Med. and Surg. Jour., May 11, '99).
Pruritus vulvm is the initial symptom of diabetes in about 20 per cent. of the eases. Premature menopause is rela tively common in diabetics. Danck worth (Centralb. f. Gyniik., No. 23, '99).
In 350 cases 219 complained solely of polydipsia as the first sign of diabetes. Lassitude, neuralgia, insomnia, neuras thenia, and syncope were, in the order named, the principal symptoms. M. E. Dufourt (La Presse 1116d., June 2, 1900).
The urine is pale in color, the reac tion is sometimes unmistakably acid; the specific g,ravity, except in some very rare cases, is very perceptibly increased (1025 to 1045 and even 1050 has been met with). The odor is sweet, owing to the presence of glucose, which may amount to, or even exceed, S per cent. Generally speaking, the quantity as given by Fehling's test is a little more than that registered by the polarimeter. This is due, first, to the fact that the urine contains reducing substances which are not deviated by polarized light, and, second, to the fact that in a number of cases of severe diabetes beta-oxybutyric acid salts are present in the urine, which deviate to the left in such a manner that a portion of the deviation of the glucose to the right is thus masked.
In mild cases of diabetes the true beta-oxybutric acid is not present in the urine; there may, however, be other substances which deviate to the left, especially levulose, which has occasion ally been met with in diabetes, to the exclusion of the glucose (Zimmer, Kiilz, Seegen, Marie).
Other sugars have sometimes been found; for instance, traces of pentose (Salkowski, K.11lz), inosite, etc.
A mixture of dextrosazone and pen tosazone found in the urine of 76 out of SO cases of diabetes. In 64 reaction posi tive, in remaining 12 cases doubtful. KUlz and Vogel (Zeit. f. Biol., B. 32, p. 185, '95).
In 12 cases of diabetes the excretion of calcium salts was considerably in creased in the severe forms of diabetes, while in mild forms the excretion was the same, or only a little in excess of that met with in the urine of healthy persons. This increased lime excretion is due to the greater amount of food and water taken, especially to the increased amount of nitrogenous food. In those cases in which very large quantities of lime salts are excreted (1 to 1/2 grains of calcium oxide) in the twenty-four hours, the destruction of the albumin of the body is playing some part in the production of this condition. E. Ten baum (Zeit. f. Biol., pp. 379-403, '96).
Several important chemical substances are found in diabetic urine. .Next to sugar, those having the greatest signifi cance are acetone, diacetic acid, and oxybutyric acid. E. L. Munson (Jour. Amer. Med. Assoc., May 1 to 22, June 1, '97).
Albuminuria exists in diabetes, in at least one-third of the cases, but in. only a few cases is it symptomatic of Bright's disease.