FREQUENCY AND CAUSES OF THE COMPLICATIONS - COMPLICATIONS OF DIABETES.
Diabetes is a disease that shows an extraordinary tendency to complications; almost every organ of the sufferer from this disease may become the seat of some pathological process. The distur bances met with differ for the most part but little or not at all from those encountered in previously healthy individuals or in persons who have been suffering from some other disease. Certain of the pathological processes, however, receive a special impress under the influence of the diabetes, so that, partly from certain special char acteristics, partly from their course, and partly from the peculiar grouping together of the organic diseases, it may be possible to ar rive at a diagnosis of diabetes mellitus as the primary disease even before the examination for sugar in the urine has given the final proof of its existence.
There has been much discussion as to the causes of the manifold organic affections occurring early or late in the course of diabetes. The complications have at times the character of an inflammation, at times that of simple disturbance of nutrition, of necrosis, or of de generation. Some writers inculpate chiefly the bad general nutritive condition which reduces the powers of resistance of every portion of the body and favors the action of new injurious influences not con nected immediately with diabetes. Among such influences are to be reckoned traumatism and over-strain as well as infections.
Other authors believe that the high percentage of sugar in the circulating fluids exerts a direct injurious influence upon the organs, whether by withdrawing water from the tissues or by impregnating them with a concentrated saccharine solution; tile sugar acts as a poison to the tissues. I may mention as a representative of this doctrine Naunyn, who gives the following list of symptoms and dis eases as caused by the high percentage of sugar in the fluids : Neu ralgia, neuralgic pains, angina cordis, asthma, pruritus, eczema, im potence, inflammations with a tendency to gangrene, scorbutus, boils, carbuncles, cataract, morbid hunger and thirst. The high percen tage of sugar in the fluids is regarded as injurious from another point of view also. Grape sugar, as is well known, favors the growth of a vast number of micro-organisms ; the tendency of the diabetic to cer tain infectious diseases, especially tuberculosis, might therefore be due to the presence of a very favorable saccharine soil in the diabe tic organism. Leo has approached this question experimentally by
testing the resistance of healthy animals and of those made diabetic artificially to various pathogenic bacteria ; he arrived, however, at no definite results. Unfortunately he used phloridzin to produce diabetes in his animals, overlooking the fact that there is no sur charge of the fluids with sugar in phloridzin diabetes (cf. p. 50).
A third view as to the etiology of the complications of diabetes is that, in addition to the undoubted evil results of the lowered nutri tive conditions, there are certain toxic substances present which are prejudicial to the integrity of the organs. Their action is alleged especially in cases of degeneration and of functional disturbances. We do not know of any such poisons, it is true; but we can readily conceive that certain intermediary products may be formed during the morbid metabolism of the cells in diabetes which are poisonous and which find vulnerable spots in one or another organ. Such an explanation is more especially probable in respect to the nervous system, the great susceptibility of which to the action of mere traces of poison is made clear to us by the teachings of toxicology and pharmacology as well as by a study of the infectious diseases. I may instance the paralysis following diphtheria.
We are not yet so far advanced as to be able to discover the causes for all the complications of diabetes. Probably they are manifold. Practically the physician will do best who keeps always in mind the fact that every diabetic has less power of resistance against noxious influences than the healthy individual. It seems to me also to be of practical worth not to lay too great stress upon the presence of sugar in the blood as the injurious factor. Whoever regards this as the prime factor will too readily come to believe that he has done all that is necessary when he has prescribed a diet designed to effect the cure or improvement of the glycosuria, and that the great and pressing danger of complications is thereby removed. Such a belief on the part of the physician is distinctly false and prejudicial to the patient.
We now pass to a consideration of the individual complications of diabetes. In this section it will be sufficient in many places, in order to avoid needless repetition, to refer tire reader to what has been discussed above.