Theory apart, it may be asserted that acetonuria and diaceturia appear whenever for any reason a diabetic is unable to take as much nourishment as his needs demand. They are important as an ad monition to attend carefully to the regulation of the diet, for any low ering of the nutritive conditions may hasten the occurrence of coma or in some other way lead to a fatal termination. The excretion of oxybutyric acid is of the gravest prognostic import unless it ceases again in a few clays, for it renders the speedy onset of coma very prol fable.
G. J/ii,er(// Cons/it/rents of the 11).ide. —Chloride of sodium and sul phuric and phosphoric acids are found usually in the urine of diabe tics in greater quantities than in that of healthy persons. That is readily explained by the greater quantity of food ingested by diabetics. As regards sulphuric and phosphoric acids especially, the great con sumption of flesh meats, and also, when present, the pathological de composition of proteids, are significant. The daily excretion of five or six grams of each of these two acids is not uncommon. In gen eral the parallelism between them and the urea is maintained. Ac cording to the investigations of van Ackeren, of Chicago, diabetics often excrete such large quantities of phosphoric acid and lime, as compared with the proportions of these substances contained in the food, that we have to assume a waste of some tissue of which they form an important constituent; such tissue can only be the osseous.
6. certain rare case of diabetes air is voided with the urine, passing out from the urethra with a peculiar bub bling noise. This pueumaturia has been observed in both men and women. It may of course be caused by the entrance of atmospheric air or of intestinal gases into the bladder, when any lesion (ulcera tion, etc.) of these parts has led to the formation of a fistula. Such
cases differ in no way from similar ones occurring iu non-diabetic individuals.
The peculiar form of pueumaturia which has been observed espec ially in diabetes arises from a formation of gas in the bladder it self in consequence of decomposition or fermentation processes in the urine. The subject of the fermentation is the sugar, the excit ants of the fermentation are micro-organisms which in some way, through the passage of a catheter or the occurrence of cystitis, have obtained entrance into the bladder. In the reported cases the micro organisms were not always the same, among those noted being the bacillus of butyric acid fermentation, the bacterium soli commune, the yeast fungus, and other sorts. The gaseous products of the fer mentation are carbon dioxide (COO, hydrogen (II,), and methane (CH,) ; other products of the fermentation of carbohydrates found in urine of this sort are butyric acid and lactic acid. Besides the micro-organisms which seize upon the carbohydrates, other microbes which act upon the albuminoids may occasionally gain entrance to the bladder and, when albumin is present, give rise to the formation of sulphuretted hydrogen gas (Slid. This form of pueumaturia (hydrothionuria) may of course occur in other individuals as well as in diabetics.
The pueumaturia of diabetes is always a very troublesome com plication and one difficult of remedy. Almost inevitably cystitis develops if this have not already existed and contributed to the production of the pueumaturia. Persistent local treatment, con sisting in repeated washing out of the bladder with antiseptic solu tions, is often necessary in order to restore the bladder to an aseptic condition.