The endeavor to strike at the root of the disease by treatment of the nervous irritability is often crowned with success. It is true that it is only in rare instances that we see a complete and lasting cure, but in many cases we can obtain a decided improvement as mani fested by the fact that the previously weak and feebly resistant pa tient, who responded to every irritation by an increased glycosuria, now excretes much smaller quantities of sugar under the same diet, and is able to meet the problem of life with a firmer bearing and greater capacity. I may say, indeed, that it is this very therapeutic success obtained by acting upon the general nervous system, that forces upon the physician the conviction that there is really a neurogenous form of diabetes.
b. Diabetes Accompanying Organic Nervous Diseases.—The con ditions present in organic disease of the nervous system are much less favorable than those just considered. We have seen above that it is almost without exception the brain and medulla oblongata that are affected in these cases. We do not refer to the transitory glyco suria following trauma, apoplexy, and the like, which disappears at the end of a few hours or days. It is very improbable that we can ever prevent, by any therapeutic measures at our command, the tran sition of temporary glycosuria into chronic diabetes.
But it seems to be certain also that diabetes mellitus of weeks' or months' duration, which has followed a cerebral injury, concussion of the brain, sunstroke, etc., may often subside spontaneously and coin cidently with the improvement in the nervous affection (F. A. Hoff mann). It would seem to be a thankful task of therapeutics to follow in the path pointed out by nature, but in fact real benefit from active therapeutic measures in organic diseases of the brain is obtained only in those few cases to which surgical procedures are applicable, and in cerebral syphilis. We know of no instance, however, in which a chronic diabetes has been cured as a result of the extirpation of an intracranial lesion, of an operation upon a lumnatoma of the dun" mater, a brain tumor, an abscess, or a hydrocephalus externus or in ternus, or of the mercurial treatment of a gummatous meningitis or encephalitis. The future alone can show whether the path here
pointed out will lead to any practically useful results. Any positive successes in this field would be also of striking significance in respect to the theory of diabetes.
2. Syphilitic Diabetes.---It has been shown above that syphilis may lead to diabetes in either of two ways : (a) Through the in tervention of cerebral disease; this is apparently very rare, and the fact meets us that no case is known in which a cure of diabetes has been obtained indirectly by a previous cure of cerebral syphilis; (b) through the intervention of syphilitic disease of the pancreas.
I have shown that this may possibly play a more important role than has hitherto been attributed to it in the text-books on special pathological anatomy. We cannot ignore the positive assertions of certain writers that they have seen cases of diabetes improved or even cured by mercury and iodine. Schnee records no less than 53 cases of cure and 10 of improvement out of a total of treated by mercury. Seegen also reports some successful cases but says that they are rare. I have known personally of perhaps a dozen cases in which syphilis preceded the occurrence of diabetes ; a cure was obtained in no in stance, marked and lasting improvement in but two, by mixed treat ment with mercury and the iodides; in several instances fatal com plications followed the use of mercury—once gangrene of the foot, twice hmmoptysis and rapid progress of the already incipient tuber culosis of the lungs. It is hardly possible to form a positive judg ment as to the practical value of the antisyphilitic treatment of dia betes. Whoever undertakes it must have the patient under control and see him every day, for diabetics are very prone to suffer from mercurial stomatitis and from a mercurial intestinal catarrh with symptoms resembling dysentery. The best mode of administration of mercury in cases of diabetes is by inunctions carefully made and supplemented by frequent baths.