Diabetes Mellitus

We mentioned, on page 235, that sugar was found in the urine in rare cases of malaria , either during the paroxysm or shortly after it. This glycosuria is usually very transitory. According to Verneuil, however, it sometimes persists so that malaria may be regarded as a cause of diabetes. Verneuil observed altogether six cases of diabetes, all mild, in the histories of which malaria occurred. Girert claims that he has frequently seen, in Panama, glycosuria follow repeated malarial attacks, and that sometimes officeholders must be sent home on account of it.

In opposition stand Le Roy de Mericourt, Laveran, and Grail. The two first insist that diabetes is no more frequent in malarial regions than in other places, and that, therefore, a causal connection between the two is not likely. Grail examined, in Guiana, the urine of almost 500 malarial cachectics for sugar, and found it in but a few cases, and then only in traces. He could not even find an alimentary glycosuria in cachectics after giving them 100 to 150 gm. of syrup. Taken altogether, it is probable that the occurrence of diabetes with malaria is scarcely more than a coincidence.

Diabetes Insipidus

We have also discussed, on page 234, a postmalarial polyuria. This may be of such a degree and duration as to produce the picture of diabetes insipidus. This persistent polyuria is likewise seen in cachectics (Sydenham).

It must not be forgotten that in some persons quinin has a diuretic effect (Kerner, Schulz). The following case, observed by the author, is a good example of postmalarial diabetes insipidus:

W. J., aged eighteen, draftsman, 'excepting for a pneumonia in infancy, was always healthy. In March, 1893, he had his first attack of intermittent fever with daily paroxysms. From August, 1893, to April, 1894, he suffered six times from the same disease. In May, 1894, he suffered from tertian fever which continued to July 31, when he was admitted to Nothnagel's clinic in Vienna.

August 1, 1894: Robust, well developed man, showing a pale, yellowish brown color. Systolic murmurs over all the orifices of the heart. The spleen extends beyond the border of the ribs about two finger breadths, is firm, and has a rounded margin. The liver extends beyond the border of the ribs, in the parasternal line, about two finger breadths. The urine is light yellow, clear, and contains no abnormal constituents.

July 31: 3 p. m. : Had a violent chill which lasted an hour. This was followed by two hours of a hot stage, and eventually a profuse sweat. The temperature rose, about 5 p. m., to 39.5°; at 12 midnight it was 36.9°.

August 1: Apyretic. Amount of urine, 2000 c.c; sp. gr., 1018.

August 2: Paroxysm like day before yesterday. Urine, 1900 c.c; sp. gr., 1015.

August 3: No paroxysm. Urine, 3400 c.c.; sp. gr., 1010. August 4: 1.5 quinin sulph.; no paroxysm. Urine, 1200 c.c; sp. gr., 1010.

August 5: Quinin as yesterday. No paroxysm. Urine, 2600 c.c; sp. gr., 1600.

August 6: Quinin 1.0. No paroxysm. Urine, 1000 c.c; sp. gr., 1012.

August 7: Quinin 1.0. No paroxysm. Urine, 2400 c.c; sp. gr., 1017.

AugustS: Quinin 1.0. No paroxysm. Urine, 2800 c.c; sp. gr., 1010.

August 9: Quinin, 1.0. No paroxysm. Urine, 4000 c.c; sp. gr., 1010.

August 10: 3 teaspoons of Levico water. No paroxysm. Urine, 3800 c.c; sp.gr., 1006.

August 11: 3 teaspoons of Levico water. No paroxysm. Urine, 2800 c.c; sp.gr., 1010.

August 12: 3 teaspoons of Levico water. No paroxysm. Urine, 900 c.c (?); sp.gr., 1014.

August 13: 3 teaspoons of Levico water. No paroxysm. Urine, 6300 c.c; sp.gr., 1010.

August 14: 3 teaspoons of Levico water. No paroxvsm. Urine, 5300 c.c; sp. gr., 1011.

August 15: 3 teaspoons of Levico water. No paroxysm. Urine, 2800 c.c (?); sp. gr., 1010.

August 16: 3 teaspoons of Levico water. No paroxvsm. Urine, 6200 c.c; sp. gr., 1005.

August 17: 3 teaspoons of Levico water. No paroxvsm. Urine, 4300 c.c; sp. gr., 1010.

August 18: 3 teaspoons of Levico water. No paroxysm. Urine, 6000 c.c; sp. gr., 1010.

August 19: 3 teaspoons of Levico water. No paroxysm. Urine, 4200 c.c; sp. gr., 1006.

August 20: 3 teaspoons of Levico water. No paroxysm. Urine, 3500 c.c; sp. gr., 1009.

Exit.

In this case the polyuria reached a high grade and still continued two weeks after the last fever paroxysm. Whether or not this condition persisted we cannot say. In the future, investigations in this direction would be desirable.