The diminished CO,: is the result, not the cause, of the diabetic condition; there is less CO, because there is less combustion of glycogen. Arnold Cantani (Deut. med. Wocli., Nos. 12 to 14, '89).
The diminished elimination of CO2, which is characteristic of diabetes, is the cause of the large sugar production, be cause in health the a,ction of the dias tatic ferment upon glycogen is held in check by CO2. Ebstein (Annual, '90).
When a diabetic subject has been made to absorb a large proportion of starchy matter or sugar, the difference in the respiratory exchange between the diabetic and the healthy subject becomes particularly evident. The healthy per son, soon after this ingestion, exhales a large amount of carbonic acid; in the diabetic there are no very noticeable modifications. This important fact, added to many others, proves that the diabetic is incapable of utilizing the carbohydrates as effectively as a healthy subject.
Views based upon experience with 1004 eases. In diabetes mellitus we have a non-combustion of carbohydrates, whether introduced from without or pro duced within the organism. The fact that the ingestion of sugar is always followed by its appearance in the urine at a very short interval disposes of all theories which make diabetes the result of increased sugar-production in the tissues. Diabetes consists, in the first place, in the non-combustion of sonie part of the carbohydrates, the excess of non-assimilated sugar appearing in the urine. As the disease progresses, a smaller and smaller amount is burned, until none is oxidized. Arnold Cantani (Deut. med. Woeh., Nos. 12 to 14, '89).
Nearly all cases of diabetes show fluct uations in the twenty-four hours. Gen erally diabetics cannot assimilate the car bohydrates which are taken for break fast on an empty stomach, but they may assimilate these substances if taken for luncheon or dinner. There is prognostic value in the fluctuations which occur in the elimination of sugar; if these are regular, they indicate a mild case; if they are not marked and are irregular, the case is relatively severe. F. Fred erick Crouse, Jr. (Albany Med. Annals,
Aug., '99) .
—I shall successively take up (1) those of the nervous system, (2) those of the vascu lar system, (3) those of the respiratory tract, (4) the digestive apparatus, (5) the urinary tract, and (6) the skin and the locomotor apparatus, ending with a summary statement concerning the dia betic coma.
Nervous System.—The most common ' secondary nervous lesions of diabetes are certain peripheral neuroses, especially those which cause the abolition of the knee-jerk.
Eighty-nine out of 210 diabetics, or a little more than 43 per cent., presented either a total loss or a notable depression of the tendon-reflex. NiviC-re (Jour. de 1116d. et de Chir. Prat., June, "S9).
The condition of the knee-jerk tested in 154 cases of diabetes mellitus. As only 1 examination was Made in 56 of the cases, they are exclnded from con sideration. Of the 128 remaining cases, the knee-jerk was normal in 113 and increased in 2. In the latter cases the patients were suffering from a severe form of diabetes. In 4 cases of severe diabetes the knee-jerk was absent or greatly diminished. The phenomenon was absent in 9 slight cases. Excluding 3 of these,—because 2 of the patients were tabetic and the third was too obese to admit of satisfactory examina tion,—there were only 10 patients (7.6 per cent.) in whom the knee-jerk was abolished or much reduced. Grube (Bull. de la, Soc. Anat., Nov. 15, '93).
Analysis of 50 eases of diabetes with relation to the knee-jerks. They were both absent in 50 per cent., both pres ent in 3S per cent., and feeble or one absent in 12 per cent. In patients under 25 years the knee-jerks were absent in 80 per cent.; under 30 years, absent in 75 per cent.; over 30 years, absent in 46 per cent. R. T. Williamson (Med. Chronicle, No. 2, '93).
The loss of the knee-jerk is due to a neuritis., which also underlies the neu ralgias and various peripheral nervous Phenomena. This neuritis is to be met with very much more frequently in the lower extremities than in the upper; it is generally bilateral, but may be one sided. .A.tiche (Lancet, Aug. 8, '91).