A form of lichen resembling exan thema has been described in diabetes. In a patient seen by Robinson touching the tumor caused a burning sensation.
Nine cases observed where psoriasis co-existed with gout or diabetes, or both; a causal relation between those affections does undoubtedly exist. Karl Grille (Berliner klin. Woch., vol. miv, No. 52, p. 1134).
Cutaneous disorders observed in dia betes: Generalized xeroderma, which is quite common; eczematous derma tic manifestations occurring in any region of the skin, especiallT prone to attack the flexor surfaces, and more especially the genital, anal, and inguinal regions; furuncular and carbuncular manifesta tions are quite frequent in this condi tion, and are found generally in the nuchal and gluteal regions; erythema tons lesions, some evanescent, others of the graver kind, as erysipelas, are com monly present; gangrene; dermatitis herpetiformis of Duhring; xanthoma diabeticorum; blastomycetic dermatitis. S. Sherwell (Med. News, June 29, 1901).
Loconzotor Apparatus.—The cartilages may present the lesions upon which Krawkow dwells, which are due to a deposit of glycogen.
Frerichs refers to the lightness of the bones. They have been found to be tremely light in some cases. I have stated above that in serious cases the lime in the urine is relatively increased.
Perhaps these anomalies bear less tion to the hyperglyanmia than to the acid dyscrasia of the severe form of dia betes, to which we shall now refer.
Diabetic Coma. — Under this head have been grouped those cases in which the patient falls, in a very short time, into a comatose state, which is nearly always mortal.
Stosch, in 1.828, appears to have' been the first to mention this dangerous com- I plication of diabetes. Twenty years later Pront related 4 cases of diabetes which terminated suddenly in death.
Grisolle, Bence-Jones, Petters, Balt- I hazer, Foster, Kaulich, Howslaip Dick inson, and others have reported similar cases, but the first extensive article on the subject is that of Kussmaul.
Frerichs separates these cases into three categories. We have already studied the first (rapid death by cardiac paresis, see above). In one of the remaining two the
first appearance is not very sudden, there being premonitory signs: increased weakness, gastric disturbances, anorexia; the breath and urine nearly always give off the penetrating odor of acetone, and the urine, after the addition of perchlo ride of iron, usually presents a red color.
Very frequently, as I have already men tioned under SYMPTOMS, there is a de cided difference between the quantity of sugar revealed by Fehling's solution and the smaller quantity registered by the polarimeter. According to my observa tions, the pulse is always accelerated, then cephalalgia sets in, and a peculiar dyspncea, which is not explained by aus cultation of the lungs, and which is char acterized by a great frequency and depth of the respiratory movements. Occa sionally there is cyanosis, with lowering of the temperature, then somnolence, ending in coma and death. The total duration of the symptoms in this variety is from three to five days.
In the third category of such cases the dyspncea does not exist: the patient be comes more or less suddenly excited as though intoxicated, vertigo, delirium, somnolence, and coma. In this variety', which is rather more rare than the pre ceding, the urine presents the same char acteristics.
It is generally admitted that the pathogenic element of diabetic coma is an intoxication, but it has not yet been established with certainty to what sub stance this is due.
Petters—to whom, in 1857, the dis covery of acetone in the urine of one of his patients is due—does not hesitate to attribute these accidents to the presence of this substance. This opinion was all the more readily accepted during a cer tain time, through the fact that the urine in the majority of severe cases of diabetes contains a considerable quan tity of acetone (np to 3 grammes per day —Engel). Experiments, however, have not coincided with this interpretation, for animals support much larger doses without presenting the symptom of dia betic coma.