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JAMA. 1888;XI(25):886-893. doi:10.1001/jama.1888.02400760022006.
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In the discussion which followed this paper Dr. Tyson said: "In regard to the infrequency of diabetes among the poor no better proof could be given than in the fact that in the Philadelphia Hospital in which more than a thousand patients are present at one time, it will often be impossible for weeks to get a case for lecture." Dr. Morton also stated: "An inquiry recently made of the superintendents of our State hospitals for the insane shows that although more than twenty thousand patients belonging to the indigent class have been under the care of the present medical officers of these hospitals, there has not, it seems, been a single case of diabetic gangrene in the institutions at Harrisburg, Dixmont, Danville, Norristown, or Warren." Dr. James Darrach said: "Dr. Hunt has mentioned that diabetes is a disease of the well-to-do, and referred to the rarity of the disease in hospital patients and among the poor. This would appear to be corroborated by the statement of Dr. Jordas, who states that in an aggregate of 22,735 admissions into, I think, four hospitals in Lisbon, there was not one case of diabetes; and of 5,700 deaths in 1862, four only were from this cause."


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