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184 not one either to small-pox, measles, scarlet fever, or "fever." These four deaths were equal to an annual rate of 0’ 5 per 1000, the death-rates from the same diseases last week being 1’2 in London and 1 - 3 in Edinburgh. The fatal cases both of diarrhoea and whooping-cough showed a decline from the numbers in recent weeks. The 197 deaths from all causes in Dublin last week included 41 of infants under one year of age and 58 of persons aged upwards of 60 years; these numbers differed but slightly from those in the previous week. Eight inquest cases and five deaths from violence were registered, and 78, or 39’7 per cent., of the deaths occurred in public institu- tions. The causes of eight, or4’l 1 per cent., of the deaths in Dublin last week were not certified ; the proportion of these uncertified causes of death last week did not exceed 0 - 2 per cent. in London but were equal to 7 2 per cent in Edinburgh. - VITAL STATISTICS OF LONDON DURING DECEMBER, 1907. IN the accompanying table will be found summarised complete statistics relating to sickness and mortality in the Oity of London and in each of the metropolitan boroughs. With regard to the notified cases of infectious diseases it appears that the number of persons reported to be suffering from one or other of the nine diseases specified in the table was equal to an annual rate of 9’1 1 per 1000 of the population, estimated at 4,758,218 persons in the middle of last year ; in the three preceding months the rates were 11 0, 13’ 6, and 11’ 4 per 1000 respectively. The lowest rates last month were recorded in Paddington, the City of Westminster, St. Marylebone, St. Pancras, Holborn, and Finsbury ; and the highest rates in Hackney, Bethnal Green, Stepney, Poplar, Wandsworth, Deptford, and Woolwich. The notified cases of scarlet fever showed a marked decline from the unusually high numbers recorded in recent months ; this disease was proportionally most prevalent in Hackney, .Shoreditch, Bethnal Green, Stepney, Poplar, Bermondsey, Deptford, and Woolwich. The Metropolitan Asylums hospitals contained 4956 scarlet fever cases at the end of last month, against 4293, 5395, and 5600 at the end of the three preceding months ; the weekly admissions averaged 458, against 654, 778, and 621 in the three preceding months. The prevalence of diphtheria showed a considerable decrease from that reported in the previous month ; among the several metropolitan boroughs diphtheria was proportion- ally most prevalent in Fulham, Hackney, 8tepney, Wandsworth, Greenwich, Lewisham, and Woolwich. There were 1168 diphtheria patients under treatment in the Metropolitan Asylums hospitals at the end of last month, against 964, 1252, and 1277 at the end of the three preceding months ; the weekly admissions averaged 155, against 160, 199, and 179 in the three preceding months. Enteric fever was rather less prevalent in December than in the two preceding months; the greatest proportional prevalence of this disease was recorded in Fulham, St. Pancras, Bethnal Green, Poplar, Camberwell, Deptford, and Lewisham. The number of enteric fever patients under treatment in the Metro- politan Asylums hospitals, which had been 99, 123, and 128 at the end of the three preceding months, haa declined again to 119 at the end of last month; the weekly admissions averaged 18, against 21, 20, and 18 in the three preceding months. Erysipelas was proportionally most prevalent in St. Marylebone, the City of London, Shoreditch, Stepney, Poplar, and Deptford. The 17 cases of puerperal fever notified during the month included three belonging to Wandsworth, two to Islington, two to Stepney, and one to each of ten other boroughs. Seven cases of cerebro- spinal meningitis were notified, of which two belonged to Southwark, and one each to Islington, Finsbury, Poplar, Lambeth, and Camberwell. The mortality statistics in the table relate to the deaths of persons actually belonging to the various boroughs, the deaths occurring in institutions having been distributed among the several boroughs in which the deceased persons had previously resided. During the four weeks ending Dec. 28th the deaths of 5532 persons belonging to London were registered, equal to an annual rate of 15 - 2 per 1000 ; in the three preceding months the rates were 12 ’0, 13’ 5, and 14’ 5 per 1000 respectively. The death-rates last month ranged from 8 - 6 in Hampstead, 10’0 in Stoke Newington, 12 - 5 in Lewisham, 12’ 7 in Fulham, and 12’ 8 in Holborn, to 18-0 0 in the City of London, 18-9 in Finsbury, 19 1 in Poplar, 19 ’5 in Chelsea, and 20-1 in Shoreditch. The 5532 deaths from all causes included 354 which were referred to the principal infectious diseases; of these, 101 resulted from measles, 66 from scarlet fever, 61 from diphtheria, 69 from whooping-cough, 12 from enteric fever, and 45 from diarrhoea. No death from any of these diseases was recorded last month in Hampstead; among the other metropolitan boroughs they caused the lowest death-rates in Hammersmith, the City of Westminster, Stoke Newington, Holborn, Camber well, and Lewisham ; and the highest rates in Chelsea, St. Pancras, Hackney, Shore- ditch, Stepney, Poplar, and Battersea. The 101 deaths from measles were 69 below the corrected average number in the corresponding periods of the five preceding years ; tnis disease was proportionally most fatal last month in Chelsea, St. Pancras, Islington, Shoreditch, Stepney, and Battersea. The 66 fatal cases of scarlet fever were 25 in excess of the corrected average ; among the various metro- politan boroughs this disease showed the greatest pro- portional mortality in Fulham, St. Pancras, Stepney, Poplar, Wandsworth, and Woolwich. The 61 deaths from diph- theria were 11 fewer than the average number in the corresponding periods of the five preceding years; the highest death-rates from this disease were recorded in Islington, Hackney, Stepney, Poplar, Battersea, and Greenwich. The 69 fatal cases of whooping-cough were 42 below the corrected average number; this disease was proportionally most fatal in Chelsea, St. Marylebone, Stepney, Poplar, Wandsworth, Greenwich, and Wool- wich. Only 12 deaths from "fever" were recorded last month, against an average of 33 in the corresponding periods of the five preceding years ; of these 12 deaths two belonged to Hackney, two to Shoreditch, and one to each of eight other boroughs. The 45 fatal cases of diarrhoea were 23 fewer than the corrected average number; this disease showed the highest proportional fatality in Kensington, Fulham, Hackney, Stepney, and Bermondsey. In conclusion, it may be stated that the aggregate mortality in London last month from the principal infectious diseases was 30 per cent. below the average. Infant mortality, measured by the proportion of deaths among children under one year of age to registered births was equal to 134 per 1000. The lowest rates of infant mortality were recorded in St. Marylebone, Hampstead, Holborn, Bermondsey, Wandswortb, and Greenwich ; and the highest rates in Islington, Finsbury, the City of London, Shore- ditch, Bethnal Green, Poplar, and Southwark. THE SERVICES. ROYAL NAVY MEDICAL SERVICE. IN accordance with the provisions of Her late Majesty’s Order in Council of April lst, 1881, Fleet-Surgeon George Despard Twigg has been placed on the Retired List, at his own request, with permission to assume the rank of Deputy Inspector-General of Hospitals and Fleets (dated Jan. 6th, 1908). The following appointments are notified :-Staff-Surgeons : H. J. C hater, to the Corrnorant, additional for Ascension Hospital ; P. H. M. Star to the .Forte; and W. R. Center to the Vivid, additional, to be lent to the Skirmisher. ROYAL ARMY MEDICAL CORPS. Lieutenant William H. Gillatt is seconded for service with the Egyptian Army (dated Dec. 27th, 1907). Major H. E. Staddon, from Mauritius, has been appointed for duty at the Carragh. Brevet Colonel R. D. Hodson has joined the London District for duty. Colonel D. Wardrop has been appointed Commandant and Director of Studies, Royal Army Medical Corps, vice Lieutenant-Colonel H. E. R. James. VOLUNTEER CORPS. Royal Garrison Artillery (YoZunteers) : lst Fifeshire : Surgeon-Major R. B. Graham to be Surgeon-Lieutenant- Colonel (dated Dec. 17th, 1907). Rifle.. 15th Middlesex (The Customs and the Docks) Volunteer Rifle Corps : William Cameron Macaulay to be Surgeon-Lieutenant (dated Dec. 13th, 1907). ROYAL ARMY MEDICAL CORPS (VOLUNTEERS). Northern Command: Leeds Companies : Major de B. Birch to be Lieutenant-Colonel (dated Dec. 18th, 1907). Scottish Command: Aberdeen Companies: Major J. S.
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Page 1: THE SERVICES

184

not one either to small-pox, measles, scarlet fever, or

"fever." These four deaths were equal to an annual rateof 0’ 5 per 1000, the death-rates from the same diseases lastweek being 1’2 in London and 1 - 3 in Edinburgh. Thefatal cases both of diarrhoea and whooping-cough showed adecline from the numbers in recent weeks. The 197deaths from all causes in Dublin last week included41 of infants under one year of age and 58 of personsaged upwards of 60 years; these numbers differed but

slightly from those in the previous week. Eight inquestcases and five deaths from violence were registered, and 78,or 39’7 per cent., of the deaths occurred in public institu-tions. The causes of eight, or4’l 1 per cent., of the deathsin Dublin last week were not certified ; the proportion ofthese uncertified causes of death last week did not exceed0 - 2 per cent. in London but were equal to 7 2 per centin Edinburgh.

-

VITAL STATISTICS OF LONDON DURING DECEMBER, 1907.IN the accompanying table will be found summarised

complete statistics relating to sickness and mortality in theOity of London and in each of the metropolitan boroughs.With regard to the notified cases of infectious diseases itappears that the number of persons reported to be sufferingfrom one or other of the nine diseases specified in thetable was equal to an annual rate of 9’1 1 per 1000 ofthe population, estimated at 4,758,218 persons in themiddle of last year ; in the three preceding months the rateswere 11 0, 13’ 6, and 11’ 4 per 1000 respectively. The lowestrates last month were recorded in Paddington, the City ofWestminster, St. Marylebone, St. Pancras, Holborn, andFinsbury ; and the highest rates in Hackney, Bethnal Green,Stepney, Poplar, Wandsworth, Deptford, and Woolwich.The notified cases of scarlet fever showed a marked declinefrom the unusually high numbers recorded in recent months ;this disease was proportionally most prevalent in Hackney,.Shoreditch, Bethnal Green, Stepney, Poplar, Bermondsey,Deptford, and Woolwich. The Metropolitan Asylumshospitals contained 4956 scarlet fever cases at the end oflast month, against 4293, 5395, and 5600 at the end of thethree preceding months ; the weekly admissions averaged458, against 654, 778, and 621 in the three precedingmonths. The prevalence of diphtheria showed a considerabledecrease from that reported in the previous month ; amongthe several metropolitan boroughs diphtheria was proportion-ally most prevalent in Fulham, Hackney, 8tepney,Wandsworth, Greenwich, Lewisham, and Woolwich. Therewere 1168 diphtheria patients under treatment in the

Metropolitan Asylums hospitals at the end of last month,against 964, 1252, and 1277 at the end of the three

preceding months ; the weekly admissions averaged 155,against 160, 199, and 179 in the three precedingmonths. Enteric fever was rather less prevalent inDecember than in the two preceding months; the

greatest proportional prevalence of this disease was

recorded in Fulham, St. Pancras, Bethnal Green,Poplar, Camberwell, Deptford, and Lewisham. The numberof enteric fever patients under treatment in the Metro-

politan Asylums hospitals, which had been 99, 123, and 128at the end of the three preceding months, haa declined againto 119 at the end of last month; the weekly admissionsaveraged 18, against 21, 20, and 18 in the three precedingmonths. Erysipelas was proportionally most prevalent inSt. Marylebone, the City of London, Shoreditch, Stepney,Poplar, and Deptford. The 17 cases of puerperal fevernotified during the month included three belonging toWandsworth, two to Islington, two to Stepney, and oneto each of ten other boroughs. Seven cases of cerebro-

spinal meningitis were notified, of which two belonged toSouthwark, and one each to Islington, Finsbury, Poplar,Lambeth, and Camberwell.The mortality statistics in the table relate to the deaths

of persons actually belonging to the various boroughs, thedeaths occurring in institutions having been distributedamong the several boroughs in which the deceased personshad previously resided. During the four weeks endingDec. 28th the deaths of 5532 persons belonging to Londonwere registered, equal to an annual rate of 15 - 2 per 1000 ;in the three preceding months the rates were 12 ’0, 13’ 5,and 14’ 5 per 1000 respectively. The death-rates last monthranged from 8 - 6 in Hampstead, 10’0 in Stoke Newington,12 - 5 in Lewisham, 12’ 7 in Fulham, and 12’ 8 in Holborn,to 18-0 0 in the City of London, 18-9 in Finsbury, 19 1 inPoplar, 19 ’5 in Chelsea, and 20-1 in Shoreditch. The

5532 deaths from all causes included 354 which werereferred to the principal infectious diseases; of these,101 resulted from measles, 66 from scarlet fever, 61 fromdiphtheria, 69 from whooping-cough, 12 from enteric fever,and 45 from diarrhoea. No death from any of thesediseases was recorded last month in Hampstead; amongthe other metropolitan boroughs they caused the lowestdeath-rates in Hammersmith, the City of Westminster,Stoke Newington, Holborn, Camber well, and Lewisham ; andthe highest rates in Chelsea, St. Pancras, Hackney, Shore-ditch, Stepney, Poplar, and Battersea. The 101 deaths frommeasles were 69 below the corrected average number inthe corresponding periods of the five preceding years ;tnis disease was proportionally most fatal last month in

Chelsea, St. Pancras, Islington, Shoreditch, Stepney, andBattersea. The 66 fatal cases of scarlet fever were 25 inexcess of the corrected average ; among the various metro-politan boroughs this disease showed the greatest pro-portional mortality in Fulham, St. Pancras, Stepney, Poplar,Wandsworth, and Woolwich. The 61 deaths from diph-theria were 11 fewer than the average number in the

corresponding periods of the five preceding years; the

highest death-rates from this disease were recorded inIslington, Hackney, Stepney, Poplar, Battersea, andGreenwich. The 69 fatal cases of whooping-coughwere 42 below the corrected average number; this diseasewas proportionally most fatal in Chelsea, St. Marylebone,Stepney, Poplar, Wandsworth, Greenwich, and Wool-wich. Only 12 deaths from "fever" were recorded lastmonth, against an average of 33 in the corresponding periodsof the five preceding years ; of these 12 deaths two belongedto Hackney, two to Shoreditch, and one to each of eightother boroughs. The 45 fatal cases of diarrhoea were23 fewer than the corrected average number; this diseaseshowed the highest proportional fatality in Kensington,Fulham, Hackney, Stepney, and Bermondsey. In conclusion,it may be stated that the aggregate mortality in Londonlast month from the principal infectious diseases was 30per cent. below the average.

Infant mortality, measured by the proportion of deaths

among children under one year of age to registered births wasequal to 134 per 1000. The lowest rates of infant mortalitywere recorded in St. Marylebone, Hampstead, Holborn,Bermondsey, Wandswortb, and Greenwich ; and the highestrates in Islington, Finsbury, the City of London, Shore-ditch, Bethnal Green, Poplar, and Southwark.

THE SERVICES.

ROYAL NAVY MEDICAL SERVICE.IN accordance with the provisions of Her late Majesty’s

Order in Council of April lst, 1881, Fleet-Surgeon GeorgeDespard Twigg has been placed on the Retired List, at hisown request, with permission to assume the rank of DeputyInspector-General of Hospitals and Fleets (dated Jan. 6th,1908).The following appointments are notified :-Staff-Surgeons :

H. J. C hater, to the Corrnorant, additional for AscensionHospital ; P. H. M. Star to the .Forte; and W. R. Center tothe Vivid, additional, to be lent to the Skirmisher.

ROYAL ARMY MEDICAL CORPS.

Lieutenant William H. Gillatt is seconded for service withthe Egyptian Army (dated Dec. 27th, 1907).Major H. E. Staddon, from Mauritius, has been appointed

for duty at the Carragh. Brevet Colonel R. D. Hodson hasjoined the London District for duty. Colonel D. Wardrophas been appointed Commandant and Director of Studies,Royal Army Medical Corps, vice Lieutenant-Colonel H. E. R.James.

VOLUNTEER CORPS.

Royal Garrison Artillery (YoZunteers) : lst Fifeshire :Surgeon-Major R. B. Graham to be Surgeon-Lieutenant-Colonel (dated Dec. 17th, 1907). Rifle.. 15th Middlesex(The Customs and the Docks) Volunteer Rifle Corps :William Cameron Macaulay to be Surgeon-Lieutenant (datedDec. 13th, 1907).

ROYAL ARMY MEDICAL CORPS (VOLUNTEERS).Northern Command: Leeds Companies : Major de B.

Birch to be Lieutenant-Colonel (dated Dec. 18th, 1907).Scottish Command: Aberdeen Companies: Major J. S.

Page 2: THE SERVICES

185

Riddell, M.V.O., to be Lieutenant-Colonel (dated Dec. 18th, 1

1907). Western Command : Manchester Companies : Surgeon- 1Captain Wilfred Moritz Steinthal, from the 3rd Volunteer c

Battalion, The Lancashire Fusiliers, to be Captain (dated iDec. 5th. 1907). William Robert Douglas to be Lieutenant J

(dated Dec. 12th, 1907). The Cheshire Bearer Company 4 <Major G. W. Sidebotham to be Lieutenant-Colonel (dated i

Dec. 4th, 1907). Eastern Command : Maidstone Companies : iArthur Thomas Falwasser to be Lieutenant (dated Dec. 7th, 41907). ,

THE HEALTH OF THE NAVY.The statistical report of the health of the Royal Navy for 1

the year 1906, which has been issued as a blue book, opens Iwith the satisfactory assurance that the returns for otforce for the year 1906 show a continuous irr,,provethe general health of the fleet as compared with that -:vious years. The total force, corrected for time, in t runder notice was 108,190, and the total number of cases ofdisease and injury entered on the sick list was 77,842, which isin the ratio of 719 - 49 per 1000, being a decrease of 119 3 per1000 as compared with the average ratio of the last nine

years. The average number of men sick daily was 3144’ 77.giving a ratio of 29 ’ 06 per 1000, and showing a decreaseof 6’ 00 in comparison with the last nine years’ average.The total number of days’ sickness on board and in hospitalwas 1,147,843, which represents an average loss of service of10 ’ 6 days for each person, which is a decrease of 2’ 19in comparison with the average for the last nine years.The total number of persons invalided was 2436, which is inthe ratio of 22’ 51 per 1000, and shows a decrease of 5’ 73per 1000 in comparison with the average of the last nineyears. Of the above total 1721 persons were finally invalidedfrom the service (78 of these refused surgical operations),giving a ratio of 15’ 9 per 1000 for the whole force, or 70’ 65per cent. of the number invalided, thus showing an increaseof 0-42 per 1000 when contrasted with 1905. Includingmarines invalided from headquarters, the total number in-valided out of the service was 1901. Of the 2436 invalided,2268, giving a ratio of 20’ 96 per 1000. were invalided fordisease, and 168, giving a ratio of 1-55, for injury. Thetotal number of deaths was 399, giving a ratio of 3-68per 1000, which shows a decrease of 1’46 per 1000as compared with the average ratio of the last nine years.Of this number 269, a ratio of 2’48 per 1000, were fromdisease, and 130, a ratio of 1’2 per 1000, from injury.Under the heading of general diseases 184 cases of entericfever are recorded, with 24 invalidings and 32 deaths. Thecase ratio per 1000 of strength shows a decrease of 0 ’73, theinvaliding of 0’ 17, and the death of 0’ 17, as compared withthe last nine years’ ratios. These figures, the report states,must on the whole be considered satisfactory. The returnsfor the Home Station showed 59 cases; for the MediterraneanStation, 29 ; North America and West Indies and ParticularService Squadron, 26; Atlantic Fleet, 25; Channel Fleets,15; China Station, 13 ; Irregular List, 10 ; Cape of GoodHope Station, 5; and East Indies Station, 2 cases. Themean force for the Home Station was 45 930 ; for theMediterranean Station, 12,130 ; for the North America andWest Indies and Particular Service Squadron, 3690 ;for the Atlantic Fleet, 11,720; for the Channel Fleet,19,600 ; for the China Station, 5000 ; for the IrregularList, 3650; for the Cape of Good Hope Station, 1440; andfor the East Indies Station, 1780. It will be seen, there-fore, that the morbidity with regard to enteric fever differsconsiderably among the different fleets, squadrons, andstations. It would, of course, not be difficult to suggestreasons for these variations, seeing that the conditions ofclimate, local control of the men, and other things must playan important part with regard to the incidence of thedisease. This, no doubt, will explain the difference in

morbidity between the home stations and the Channel Fleet,where the percentages of cases work out at something

. like 0’13 and 0’08 respectively. Still, it is not satis-factory that the figures in the one case should be morethan half as much again as those in the other. Withregard to Mediterranean fever the returns show 216 caseswith 134 invalidings and five deaths. These figures showa decline on the average ratios for the past nine years.The Mediterranean station gave 145 cases, the Home station53, the Channel Fleet five, the China station four, NorthAmerica with Particular Service Squadron and Irregular Listthree each, and the Atlantic Fleet, the East India station,and Australia station one case each, but it seems almostcertain that all the cases owed their primary origin to the

Mediterranean area. Under the heading of tubercle 290 caseswith 216 invalidings and 39 deaths are recorded. Both as

compared with last year and the last nine years the case andinvaliding ratios show a satisfactory decrease. The deathratio is identical with that of last year but shows a decreaseon the nine years’ ratio. For the first time in these

reports the cases of tuberculous disease have been classi-fied. The total number of recorded cases of venerealdiseases is 13,193. There were 279 invalidings and sixdeaths. The total number of days’ loss of service fromvenereal disease was 316 631, while the average dailynumber ineffective from these diseases was 867’ 46. Thisenormous amount of sickness, says the report, shows verylittle sign of any diminution as years go on. A slightfluctuation is noticed year by year but the case ratio for theyear under notice is practically identical with the average

ra8> of the last nine years. Nearly all other diseases showa6 (eady decrease ; these remain in stat’/(, quo. Australiashows the highest case ratio. An appendix to the reportcontains a paper by Staff Surgeon H. C. Whiteside, R.N.,on the work done in the laboratory at the Royal NavalHospital, Malta, during the year 1906 ; a paper by FleetSurgeon J. L. Bnrington, R.N., on Traumatic Aneurysm ofthe Right Common Femoral, Ligature of the External IliacArtery, Recovery; and a paper by Staff Surgeon OswaldRees, R N., on Caisson Disease.

MEDICAL SERVICE IN THE TERRITORIAL FORCEA meeting of members of the medical profession was held

at University College, Bristol, on Jan. 10th to meet ColonelRussell, Deputy Assistant-Director-General from the WarOffice, who in an interesting address explained the organisa-tion of the medical service of the Territorial Force. It was

proposed that Bristol should furnish one of the three infantryfield ambulances which are required for the group of countiesin which Bristol is situated, and also that the city shouldprovide a general hospital. A motion pledging the meet-ing to support the scheme was carried unanimously and itwas further determined that the Faculty of Medicine ofUniversity College, Bristol, should be the committee to selectthe names of physicians and surgeons to be recommended tothe Army Council to serve on the constitution of the proposedgeneral hospital.

THE NAVAL MEDICAL SUPPLEMENTAL FUND.At the quarterly meeting of the directors of the Naval

Medical Supplemental Fund, held on Jan. 14th., Sir J. N.Dick, K.C.B., in the chair, the sum of .665 was distributedamong the several applicants.

Correspondence.

ANOMALOUS REACTIONS GIVEN BYFEHLING’S SOLUTION IN TEST-

ING URINE FOR SUGAR.

"Audi alteram partem."

1’0 the Editor of THE LANCET.

SiR,-In Dr. H. MacLean’s excellent paper on the abovesubject he attributes the yellow precipitate given by manysaccharine urines to the fine state of division in which thered cuprous oxide is precipitated owing to the presence ofkreatinin. There can be little doubt that the colour-changeis due to kreatinin; this was demonstrated in 1900 byNeumayer. Dr. MacLean’s explanation, however, is debatable.Whilst admitting that the precipitate is in a fine state ofdivision, not the utmost comminution will change the red ofcuprous oxide to yellow. Roscoe and Schorlemmer directlycontradict the conjecture in Vol. II., p. 330, of their treatiseon Chemistry, where they state when describing cuprousoxide that " the more finely it is divided and the finer reddoes its colour become." A trifling experiment will showthat something more than the state of division is concerned.It is founded on the fact that cuprous oxide (CIJ20) does notoxidise on exposure to air when in the dry state ; cuproushydroxide (4 C"20 + H20) does oxidise to cupric hydroxideon exposure in the dry state. If a little solution of glucosein water is added to boiling Fehling’s solution cuprousoxide is thrown down as a red precipitate. If a littlediabetic urine which contains an average amount of


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