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Causes of diabetes

Statistics show that the death-rate from diabetes mellitus in England and Wales is steadily increasing.

Taking the records for the last 20 years, we find that, in 1887, there were registered 1,750 deaths from diabetes mellitus; in 1906, 3,242.

Occupation and Social Position. The reports of the Registrar-General show that the mortality from diabetes mellitus varies considerably in different occupations. It is highest amongst innkeepers and publicans. Amongst barristers and solicitors it is "three times the average, and higher than in any other occupation in the list, except innkeepers." Amongst medical men the mortality is also high. The mortality amongst chemists and druggists is high, but is less than amongst medical men. In occupations, in which there is a great mental worry, mental strain, or excitement, there appears to be an increased risk of diabetes developing. Hence the risk of diabetes developing is worthy of a thought in the case of medical men who have a very large practice, which causes much mental strain, especially if little exercise can be taken, if the amount of food eaten should be large, and if there should be a family history of the disease. Prof. V. Noorden points out that 8 per cent of his male cases were medical men. He considers that wealth and culture increases the risk of the disease ten times. Wörms has pointed out that, in Paris, 10 per cent of the men, who do much mental work and take little exercise, are glycosuric.

I am inclined to think that the mayors and aldermen of our large towns, as well as lawyers and medical men, are particularly liable to suffer from the disease. I have also met with a number of cases of diabetes in so-called "working men" (men whose occupation is chiefly hand work), in which the symptoms were first noticed directly after a period of very heavy work. These patients, mechanics and other workmen, had for many weeks or months, worked for several hours in the evening in addition to their ordinary heavy day's work (i.e. had worked "overtime") or had been engaged in night work. Great physical and mental strain had been caused by the work for some months, and then diabetes had developed.

Diabetes affecting both Man and Wife. Attention has been often drawn to the fact that, in rare instances, when a man has become diabetic, his wife has developed the disease later; or the wife had become diabetic first and the husband later.

Amongst 250 private cases of diabetes, seen in consulting practice, I have met with five instances, i.e., 2 per cent, in which man and wife had both suffered from the disease. In three instances, the husband was affected first, in two the wife first. It appears probable that, in many of the instances, when a wife has become diabetic after the husband, the anxiety and mental and physical strain, caused to the wife by nursing the diabetic husband, have been very important factors in the production of the disease in the former; or, when the wife has suffered first, the mental worry and anxiety, caused to the husband have, predisposed to the disease in the latter. In other cases the diabetic man and wife have both been subjected to the same severe mental strain and worry, or both have taken excess of alcohol, or excess of sweet food.

Diet. It is certain that, in many countries where the diet consists chiefly of starchy food diabetes is very rare, and therefore many observers do not regard diet as a factor of importance in the causation. But it appears worthy of further careful consideration, whether the prolonged consumption of large quantities of foods and beverages, containing much sugar, has not a distinct influence in causing diabetes.

It has been shown, that in great beer drinkers alimentary glycosuria can often be produced more readily (i.e. with a smaller quantity of glucose) than in healthy persons. A history of very great alcoholic excess is sometimes obtained from diabetic patients. It appears probable that, as a result of alcoholism, the sugar-destroying function of the system is weakened, and alimentary glycosuria occurs; that later the sugar-destroying function is lost, and permanent diabetes follows.

The fact that the mortality from diabetes in England is greatest amongst innkeepers and publicans is in favour of this relationship. Strümpell states that, in his opinion, it is no accidental coincidence, that diabetes occurs so frequently amongst brewers and innkeepers in Bavaria. I have met with many cases, in which very great excess of alcoholic beverages, especially beer and sweet wines, or of non-alcoholic sweet beverages, has appeared to have played a part in the causation of the disease. From what we know of alimentary glycosuria, I think it must be allowed that this excess very probably acted as an exciting cause of the disease, or at least hastened its development. There was a history of great excess in alcoholic beverages in 6 per cent of my private cases, and in 17 per cent of hospital cases. A sedentary life predisposes to diabetes especially when an excess of food is taken.

By RT Williamson, M.D., F.RCP. Assistant Physician, Manchester Royal Infirmary

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