A practical treatise on medical diagnosis for students and physicians / by John H. Musser.

  • Musser, John Herr, 1856-1912.
Date:
1904
Catalogue details

Licence: Public Domain Mark

Credit: A practical treatise on medical diagnosis for students and physicians / by John H. Musser. Source: Wellcome Collection.

Provider: This material has been provided by the Francis A. Countway Library of Medicine, through the Medical Heritage Library. The original may be consulted at the Francis A. Countway Library of Medicine, Harvard Medical School.

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    be found that the two bear a definite ratio. The thirst is greater immediately after meals, although the patient does not necessarily have indigestion. 4. Hunger. Excess of appetite, boulimia or polyphagia, also occurs in diabetes. The amount of food that is taken is sometimes enormous, and the ravenous manner in which it is devoured is revolting. 5. Loss of sexual power. The five symptoms just mentioned, with increased frequency of mictu- rition, are the common symptoms of diabetes mellitus. They may develop gradually. In rare instances the onset is sudden. The occurrence of these symptoms should lead at once to an examination of the renal secretion. Three special characteristics of the urine are observed : (a) The quan- tity is increased, so that from 6 to 10 pints, or even as much as 30 to 40 pints are passed in twenty-four hours. (6) The specific gravity ranges from 1025 to 1045, and may even be higher, (c) The presence of sugar. The sugar is detected by the ordinary tests. (See Examination of Urine.) In addition the urine is usually of a pale color, of a sweetish odor and acid reaction. In addition to thirst and increased appetite, some gastro-iutestinal symptoms may be of diagnostic importance. Of these, first, the appear- ance of the tongue is characteristic. It is dry, red, and glazed. The dryness is increased because of the scanty flow of saliva. The gums are swollen and spongy, and marginal gingivitis and stomatitis are often present. There are no marked dyspeptic symptoms. Constipation is of common occurrence. In diabetes the other secretions of the body are diminished. Perspiration does not occur excepting in inflammatory com- plications. The skin is harsh and dry. As the disease progresses, the heart's action becomes weak and the pulse frequent with higher tension. The temperature of the body is usually below normal. Diabetes may occur at any age, but is most frequent in adult life. In young adults the symptoms are more pronounced, and the duration shorter. In patients past middle life the disease may continue for a number of years without marked interference with the health and nutri- tion. While the symptoms just mentioned should lead to an examination of the urine, diabetes mellitus may not be indicated by any of the usual objective or subjective symptoms. It may happen that none of these symptoms is sufficiently marked, and that only by routine examination of the urine, or by the occurrence of affections known to be associated with sugar in the urine, is the disease discovered. Complications. Of the complications which should lead to the sus- picion of sugar in the urine the following are the most important: 1. Cutaneous Complications. Boils and carbuncles should always lead to an examination of the urine. Pruritus and chronic eczema may have diabetes in the background. Gangrene of the extremities, chiefly of the feet and legs, and gangrene in other situations, are of common occurrence in the course of diabetes. 2. Lung Complications. Tuberculosis of both the chronic and the acute