DIABETES. To the Editor of the
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Indian Medical Gazette.
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Sir,?The case published by Dr. Macpliail in your January number is no doubt very interesting and unique as a specific gravity of 1*000 in urine with sugar is indeed one the like of which I do not find recorded in any literature on tiio subject, but a specific gravity of 1*010 as was observed on the first day by Dr. Macpliail is by no means rare. In Quain's Dictionary of Medicine, Dr. Alexander Silver says: "5Its (sugar's) piesence in such proportion causes an increased specific gravity, though this is not invariably the case, inasmuch as it may vary from 1*008 to 1*060 or 1*070." Saundby, in his Bradshaw Lecture, said : " A low specific gravity is no proof of the absence of sufrar, nor is a high specific gravity any proof of its pi esence." Tyson in his Guide to the Examination of Urine, says: " In one instance which came under my observation a specific gravity of 1*010 in a specimen of albuminous urine was attended by the evident presence of sugar (easily shown by all the tests) proving that it is not safe to infer from a low specific gravity alone the absence of sugar." s From a survey of 160 reports of chemical analyses of urines of diabetic patients in India received by me, I find one instance of 1 "009 specific gravity with 2*5 per cent, of sugar. Large quantity of albumen was detected also. Did Dr. Macpliail also test for albumen or note the temperature of the urine, for it is apparent that if tlio specific gravity was taken while the urine was warm, the reading was low in about the proportion of one degree of the urinometer for every seven degrees Fahrenheit above the temperature for which the instrument was graduated ? My explanation of the low specific gravity observed on the second day is that it was a precursor of uraemia. Whenever in a case of diabetes the specific gravity rapidly falls, look at that symptom with suspicion. I am not going to discuss the subject of treatment of diabetes, for it will land me in very uncertain ground, but 1 wish to make a few remarks on the treatment in which Dr. Macpliail seems to have some faith, though he admits that the patients returned to say that it temporarily cured them, but that the symptoms recurred. Jambul was originally recommended by Banatwalla whose experiences were confirmed by Quanjer of Batavia. Kingsbury and Mahomed published favourable results in isolated instances (Practitioner, December 1888). Levvaschen (Berlin Klin-Woch, February 23rd, 1891); and Dujardin-Beaumetz [Bull, de Therap., March 23rd, 1891), considered that in combination with strict diet it was useful in mild cases, but produced no effect in severe cases. Hildebrandt has shown that it possesses the power of hindering the diastatic action of plant diastase, and also the sugar forming ferments of blood serum, saliva and pancreatic extract. A few cases showing favourable results have been recorded, as for instance, in the British Medical Journal, March 19tli, 1897. A careful analysis of a large number of cases in India in which it was tried under most favourable conditions (fresh seeds) shows that it has no claim to be considered a cure for diabetes. No doubt in a few instances the quantity of urine and sugar decreased after its use, but the improvement was temporary, and the disease reasserted itself soon after. Given a case of ordinary diabetes in India, one would be tempted to try the fresh seeds of jambul for a few days with strict dietary, but if no appreciable effect on the urine and general symptoms occurred within a short time, the trial should be given up. The pathology of diabetes is so obscure at the present moment that its therapeutics must necessarily be unsatisfactory ; but I have every hope that physiological chemistry will at no distant date throw much useful light on the causation of the disease, and then its treatment will be more rational and les? empirical. Kashmir.
A.
MITRA.
"
Indian Medical Gazette.
"
Sir,?The case published by Dr. Macpliail in your January number is no doubt very interesting and unique as a specific gravity of 1*000 in urine with sugar is indeed one the like of which I do not find recorded in any literature on tiio subject, but a specific gravity of 1*010 as was observed on the first day by Dr. Macpliail is by no means rare. In Quain's Dictionary of Medicine, Dr. Alexander Silver says: "5Its (sugar's) piesence in such proportion causes an increased specific gravity, though this is not invariably the case, inasmuch as it may vary from 1*008 to 1*060 or 1*070." Saundby, in his Bradshaw Lecture, said : " A low specific gravity is no proof of the absence of sufrar, nor is a high specific gravity any proof of its pi esence." Tyson in his Guide to the Examination of Urine, says: " In one instance which came under my observation a specific gravity of 1*010 in a specimen of albuminous urine was attended by the evident presence of sugar (easily shown by all the tests) proving that it is not safe to infer from a low specific gravity alone the absence of sugar." s From a survey of 160 reports of chemical analyses of urines of diabetic patients in India received by me, I find one instance of 1 "009 specific gravity with 2*5 per cent, of sugar. Large quantity of albumen was detected also. Did Dr. Macpliail also test for albumen or note the temperature of the urine, for it is apparent that if tlio specific gravity was taken while the urine was warm, the reading was low in about the proportion of one degree of the urinometer for every seven degrees Fahrenheit above the temperature for which the instrument was graduated ? My explanation of the low specific gravity observed on the second day is that it was a precursor of uraemia. Whenever in a case of diabetes the specific gravity rapidly falls, look at that symptom with suspicion. I am not going to discuss the subject of treatment of diabetes, for it will land me in very uncertain ground, but 1 wish to make a few remarks on the treatment in which Dr. Macpliail seems to have some faith, though he admits that the patients returned to say that it temporarily cured them, but that the symptoms recurred. Jambul was originally recommended by Banatwalla whose experiences were confirmed by Quanjer of Batavia. Kingsbury and Mahomed published favourable results in isolated instances (Practitioner, December 1888). Levvaschen (Berlin Klin-Woch, February 23rd, 1891); and Dujardin-Beaumetz [Bull, de Therap., March 23rd, 1891), considered that in combination with strict diet it was useful in mild cases, but produced no effect in severe cases. Hildebrandt has shown that it possesses the power of hindering the diastatic action of plant diastase, and also the sugar forming ferments of blood serum, saliva and pancreatic extract. A few cases showing favourable results have been recorded, as for instance, in the British Medical Journal, March 19tli, 1897. A careful analysis of a large number of cases in India in which it was tried under most favourable conditions (fresh seeds) shows that it has no claim to be considered a cure for diabetes. No doubt in a few instances the quantity of urine and sugar decreased after its use, but the improvement was temporary, and the disease reasserted itself soon after. Given a case of ordinary diabetes in India, one would be tempted to try the fresh seeds of jambul for a few days with strict dietary, but if no appreciable effect on the urine and general symptoms occurred within a short time, the trial should be given up. The pathology of diabetes is so obscure at the present moment that its therapeutics must necessarily be unsatisfactory ; but I have every hope that physiological chemistry will at no distant date throw much useful light on the causation of the disease, and then its treatment will be more rational and les? empirical. Kashmir.
A.
MITRA.
