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Syphilis

diabetes, view and syphilitic

SYPHILIS. A few words must be said concerning the relation of syphilis to diabetes. It cannot be denied that evidences of syphilis have been found, either during life or post mortem, in very many cases of diabetes, a fact that, in view of the wide dissemination of syphilis, need excite no wonder. Isolated cases of diabetes have very often in times past been referred to syphilis for their exciting cause. They were cases in which disease of the cerebral arteries and of the brain itself had been caused by the action of the syphilitic poison, and if it be admitted that diabetes may be produced by in fluences emanating from the central nervous system it follows as a consequence that diabetes may stand in immediate causal relation to syphilis. This assumption has an important therapeutic aspect in view of the fact that neurogenous diabetes is most frequently curable and disappears coincidently with the subsidence of the cerebral affection.

Furthermore, it is certainly of importance, in this connection, to examine into diseases of the pancreas of syphilitic origin. Among all the changes of the pancreas leading to the production of diabetes simple atrophy and sclerosis (overgrowth of the connective tissue at the expense of the parenchyma) seem to be the most frequent. It

has not yet been decided how far these diseases may be caused by syphilis, either directly or as a result of an intervening endarteritis. The determination of this question is also of importance in a thera peutic sense.

On the other hand it is going decidedly too far to assert flatly, as some authors do, that diabetes is a syphilitic disease. This theory is advocated by Schnee in his monograph on Diabetes. He holds that all cases of diabetes are referable to an hereditary predisposi tion, indeed that they are all associated with hereditary syphilis. Such a view must be absolutely rejected, for it is altogether insuffi cient and is opposed by the results of a careful analysis of all the anamnestic points in numerous, I might say most, cases of diabetes. More than that, it may be reinembered that diabetes was a disease recognized by Greek and Roman physicians, while syphilis is sup posed to have been communicated to Europeans by the Indians, after the discovery of America, as if in revenge for their discovery and annihilation (C. Binz").