DIABETES MELLITUS This belief is not entirely correct as a great number of cases of diabetes in childhood have been reported in the last ten years, due not to its increased frequency but to its better recognition. Most statistics show that from .5 to 1 per cent. of all cases of diabetes occur in the first ten years of life but my own records embracing 2000 patients give 2.5 per cent. for the first decade. The second half of this period is more affected than the first, although the earliest infancy is not entirely exempt from this disease. Many cases at this early age are probably undetected; indeed many a child whose death certificate has stated gastro-intestinal catarrh, atrophy, asthenia, may in truth have died from diabetes.
It is therefore not superfluous to advise that the examination of the urine even in the earliest childhood be not neglected. Whoever regularly examines the urine of young children, will often be astounded by the positive result of the test for sugar and will be alarmed if he is not cognizant of certain peculiarities in childhood. Small quantities of milk sugar may appear in the urine of breast.- and bottle-fed babies and espe cially when milk-sugar is added to the bottle milk in order to overcome constipation or to improve the nutrition. This alimentary lactosuria is naturally of no importance. Milk-sugar may be identified by the yel lowish red or brownish precipitate in Rubner's copper test instead of the cherry red color due to grape-sugar. The fermentation test is nega tive when the urine has been previously sterilized by heat. The best method of determination is to inoculate the urine with a pure culture of saccharomyces apiculatus: if grape-sugar is present there is marked fermentation, which is absent with milk-sugar.
Young children show a much greater tendency to transitory ulycos aria than do adults. In severe diphtheria and especially in pneumonia with high fever the ingestion of moderate quantities of carbohydrates may induce a glycosuria, a resulting condition which occurs also in adults much oftener than the text books indicate. This is also transitory and to be attributed to functional changes in the pancreas due to the intoxication. I have seen this tendency to glycosuria continue several days longer than the original disease and in one case for two weeks.
On account of the relative frequency of this undeniable transitory glycosuria in children, the diagnosis of diabetes should not. be made on
the first finding of sugar. R. Schmitz also emphasized this in his well known work.
The general etiology, the pathogenesis and metabolic changes which have aroused interest in the scientific investigations of diabetes must be sought for in treatises which consider the disease in adults and also in certain special works upon the subject. Nothing of sufficient importance could be said in a few words and this is not the proper place for a lengthy consideration of the subject.. Only the characteristic con ditions will be mentioned.
in childhood attacks boys and girls with appar ently equal frequency. Some statistics indicate a slight preponderance of the female sex while among adults almost twice as many men as women are affected. Heredity seems to me to be much less marked than in adults, although there are instances where it plays an important part. I have recorded the medical history of a family in which there was a mild case of diabetes in the first generation, three female members of the second generation developed the disease at middle life and two children of the third generation died from severe and rapid types of the disease.
It is a very common experience that cases of diabetes among children do not occur isolated in a family. Several members are usually affected, not at the same time but one after the other when they reach a definite age. This was true in more than one third of the fifty cases of diabetes in childhood treated by me. If the family history is closely investigated it is often found that the parents are blood-relatives or that in a previous generation the marriage of relatives occurred. This confirms the opinion based on other grounds that diabetes in children as well as in many of the cases in adult life must be regarded as an en dogenous degenerative disease. The well-recognized frequency of dia betes in the Jewish race probably depends upon the insufficient admix ture of different strains of blood. The Jewish race certainly shows a marked tendency to diabetes in childhood but not to my mind in the same degree as among the adults. Besides hereditary influences, trauma (concussion of the brain) is often mentioned as a cause of diabetes in children,—whether correctly seems to me certainly more doubtful than in adults.