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C. W. W. Elkin, M.D.
JAMA. 1934;102(26):2182. doi:10.1001/jama.1934.62750260005009e.
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This case of diabetes mellitus is reported because of the unusual location of the complicating gangrene and infection.

Mrs. S. L., aged 42, a married Jewish woman, seen in October 1931, gave a history of having had diabetes mellitus for six years, without any dietary or insulin treatment. After a short period of supervision of treatment, the patient went through a pelvic operation quite satisfactorily in November 1931, but refused to follow dietary instructions or take insulin. She was not seen again until Nov. 28, 1933, when she was found in a stuporous condition with "air hunger" and "acetone breath." Over the lower part of each labium majus was a large gangrenous area, from one of which (the right) was draining considerable pus. In addition there was a gangrenous area over each ischial region, with considerable sloughing of tissue on the right side. Between the labial and ischial areas involved


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