CHANGES IN THE LUNGS - COMPLICATIONS OF DIABETES.
1. Tuberculosis."—Pulmonary tuberculosis plays a most important role among the complications of diabetes. It is not too much to say that at least one-fourth of all diabetic subjects among us in Germany contract pulmonary tuberculosis, and once they have contracted it, speedily succumb. Yet the distribution of the disease among differ ent eases of diabetes is very unequal. When diabetes attacks you th ful subjects it is the rule that they become tuberculous, unless coma or some accidental intercurrent disease carries them off earlier. Older persons, especially the corpulent or gouty subjects, are in much less danger of this complication. According to Lancereaux, as has already been remarked (cf. p. 71), sufferers from pancreatic diabetes show a special tendency to tuberculosis.
It is a fact of common observation that tuberculosis attacks suf ferers from diabetes among the poorer classes much more frequently than it does those in better circumstances. The former are naturally more exposed to infection by reason of their unfavorable hygienic surroundings and through their stay in hospitals which are always crowded with tuberculous patients. Because of this fact, physicians who have to treat chiefly well-to-do patients at watering-places (Seegen at Carlsbad, Durand-Fardel at Vichy) have sometimes come to the incorrect conclusion that tuberculosis is a rare complication of diabetes.
Tuberculosis may occur at any time in the course of the disease. Even the mildest forms of diabetes appear to increase the natural predisposition in man to tuberculosis. It may be asserted, indeed, that tuberculosis is an even more frequent complication of diabetes than appears from the statistics, for in many cases of pulmonary phthisis the urine is not examined for sugar and thus the diabetes escapes detection.
In addition to the rapidity of its course, pulmonary tuberculosis complicating diabetes presents other peculiarities. Remoptysis is, according to Leyden and Seegen, and also in my own experience, of very rare occurrence. Several authors have remarked that tubercle bacilli are found in small number or not at all ill the sputum. I can recall a case occurring in my own practice of a patient whose lungs were very extensively diseased and whose sputum consisted of the usual tenacious, purulent masses seen in advanced cases of pulmonary plithisis, and yet I had to examine a number of specimens before I was able to discover a few sparsely scattered bacilli. At the autopsy the lungs were found to be very widely destroyed by the tuberculous process, and vast numbers of bacilli were found in the cheesy foci and the parts surrounding them. Seemingly there is present in the sputum of diabetics, under certain circumstances not yet understood, some substance which rapidly destroys the bacilli—a remarkable contrast to the diabetic tissues which offer so favorable a soil for the development of tubercle bacilli ! 2. Go/if/rem(' o/' the Lroifi•.—Pulmonary gangrene occasionally fol lows fibrinous pneumonia, bronclio-imeumonia, injuries to the chest, and even sometimes bronchitis, in cases of diabetes. In other oases the gangrene appears to occur spontaneously. In general it may be regarded as a rare complication, although more frequent in diabetes than in other diseases characterized by loss of strength and cachexia. It furnishes another evidence of the poor resisting powers of the tissues in diabetes.