Three hundred and thirty-two cases of diabetes mellitus in which the knee-jerk was tested. The knee-jerk was lost in 49 per cent. of the cases of slight diabetes and but 24 per cent. of the severe CELSCS. In 11 cases there was neuritis on both sides, no cause but diabetes being pres ent, except possibly alcohol in 2 cases. Three manifestations of nervous disturb ance were caused by increase of sugar in the blood: (1) cramps, or an acute irri tation of nerves; (2) neuritis, or acute inflannnation of thc nerves; (3) a slow degeneration. or nutritive change, in the nerves, seeming to have a preference for the (Tura] nerve, and thus causing loss of knee-jerk. Grube (Lancet, July 22, '99).
The other neurotic symptoms are pain and, more rarely, paralysis. It has been known for a long time that the neuralgia of diabetes is very painful and difficult to cure. Worms has noted that it is very often symmetrical, and states that the pain increases and decreases with the hyperglyetemia, which is certainly in constant. Ziemssen was the first to refer this neuralgia to a neuritis. There are also shooting pains that somewhat semble those of ataxia, and which may, in some cases, suggest the question as to whether there is not actual tabes: a very difficult problem to decide.
The relation existing between tabes and diabetes may vary in character; diabetes being present, certain symptoms of tabes may occur (pseudotabes dia betique) ; or during the course of tabes sugar may appear in the urine (tabes with glycosuria). There is, besides, re lation between true tabes and true dia betes, through the fact that these dis eases occur in various persons of the same family, in consequence of an hered itary nervous taint, both appearing at times in the same subject. Blocq (Revue Neurol., Apr. 30, '94).
Vergely reported a case in which there were pains resembling those of angina pectoris.
The paralyses of diabetes present themselves as follows: 1. Limited and incomplete paralysis; this is, by far, the most prevalent form, as has been stated by Bernard and Fere in 1884. 2. Mon oplegia. 3. Hemiplegia. 4. Para plegia. The various forms of diabetic paralysis are sometimes associated, or are combined, with some unusual ena; for instance, facial hemiplegia pre ceded by facial neuralgia and a falling of the upper eyelid (Chareot, quoted by Bernard and Fere), or paresis of the ex tensors of the left,thigh, impeded speech, and deviation of the mouth to the left (Charcot, ibid.), etc. The progress of
these paralyses is also somewhat pecul iar: they are sometimes migratory and transitory. Some of them are undoubt edly of central origin, but the majority are of peripheral origin, a neuritis form ing their anatomical substratum. The peripheral variety is not exempt from this rule, as is proved by the existence, in diabetic paraplegia, of the symptom complex which Charcot has given the name of steppage, which is characterized by the lowering of the forward part of the foot in walking. This we know is due to the paralysis of the extensors of the foot, and it occurs in peripheral neuritis, but not in myelitis.
Cramps are another motor disturbance met with in diabetic subjects. These occur principally in the lower extremi ties, and at night they give rise to in somnia, which, according to Bernard and Fere, appears to be, in diabetic sub jects, the first symptom of disturbance of the cerebral circulation, and may sometimes prove to be the forerunner of serious symptoms.
Frequency of cramps in the calves in diabetics. Disease frequently beg,ins in form of an obstinate gastric catarrh; ex amination of urine for sugar in all pa tients suffering from rebellious catarrh of stomach, recurring in spite of all treat ment. desirable. Jacobson (Brooklyn Med. Jour., Nov., '94).
[Convulsions are rare. Some time ago I reported a ca.se in which they, as well as aphasia and herniplegia, depended upon microscopical cortical lesions. R.
The complication of aphasia may occur in either pronounced or latent cases of diabetes, and may be associated with ob stinate neuralgia, disturbance of vision, headache, or impairment of hearing. The aphasia may occur at any period in the course of the disease, and may last from a. few hours to a month or more.
The prognosis is always good. The con dition can be siid to resemble very closely the various forms of toxic aphasia that attend uneinia, pneumonia, gout, and tobacco-poisoning. Corneille (Gaz. Hebd. de Med. et de Chir., Jan. 20, '08).
Perforating ulcer sometimes compli cates diabetes. Folet and Auche have observed the falling off of the nails. In IF°let's case they fell without giving rise to pain or inflammation.