Case of diabetes in an infant 4 to 5 months old. The urine contained large quantities of sugar. Polyu ria, poly phagia, autophagia, and boils were pres ent. At autopsy there was found acute broucho-pneumonia with pulmonary cedema, a.cute intestinal catarrh, cedema of the dura, and a serous effusion in the third ventricle. .N. A. Orlow (Vratch, Mar. 3, 1901).
Organs of Special Sense.—Cataract is the most common symptom; it nearly always develops in both eyes; if not simultaneously, at least after a short interval. It is characteristic of this form of cataract to be relatively soft. Retinitis is next in order, with white exudations along the vessels and in the perimacular region.
Many causes may lead to ocular le sions in this disease. Among them are (1) diminution of water; (2) diminu tion of resistance of the vessels, due to general weakening of nutrition; (3) the existence of a toxic substance in the blood, produced by abnormal processes; (4) various complications. Mauthner (Inter. klin. Blind., No. 25, '93).
From a study of 25 cases in which lesions of various character were found in association with diabetes, three groups are distinguished: (1) a characteristic inflammation of the central region of the retina, with small, bright areas, and frequently, also, small hxmorrhages; (2) retinal lifemorrhages, with the conse quent inflammatory and degenerative changes; (3) rarer varieties of retinitis and degeneration, the relation of which to the constitutional disease remains to be demonstrated. Hirschberg (Deut.
med. Woch., Dec. 1S, 25, .90).
This form is nearly always accom panied by slight hmorrhages. True optic neuritis is much more rare.
The retinitis of diabetes distinguished from that of Bright's disease as follows: 1. The patches are irregula.rly distrib uted around the centre of the retina, not specially near the macula, and are met with on the nasal as well as on the temporal side of the disk. 2. The patches are never arranged in a fan shape. 3. They are never associated with papillitis or diffuse retinitis. 4. The htemonliages are, as a rule, punctiform, and not striated. 5. themorrhages into the vitre ous are conunon. Saundby (Birming ham Med. Rev., Jan., Feb., '93).
Out of 140 diabetics, 34 were found who were the subjects of retrobulbar neuritis, which could not be attributed to abuse of alcohol or tobacco. Schmidt Rimpler (Annal. d'Oculist., Sept., '96).
Unusual case of neuroretinitis where the changes were very characteristic of albuminuric retinitis, with two excep tions, namely: the star-shaped figure that is commonly seen at the macula in alburainuric retinitis was found below and to the nasal side of the disk, and the papilla was swelled more than is usually found in the albuminuric form. The round, white patches, the numerous small and flame-shaped hmmorrhages, and the cedema were found. Lens and vitreous were clear. Vision equaled The man complained only of decreasing vision.
The urine was repeatedly examined, but showed no trace of albumin or sugar. It was abnormally abundant, very rich in phosphates, and of normal specific gravity. At first he passed seventy-nine ounces daily. Hansell (Phila. Poly clinic, Jan. 30, '97).
This condition would explain the ex istence of the central scotoma sometimes met with in diabetes.
Case of diabetic neuritis with central scotorna. At autopsy zone of degenera tion in optic nerve. Fraser and Bruce (Edinburgh Med. Jour., May, '95).
Besides the ocular lesions mentioned, Panas, and, after him, Hirschberg, have insisted upon visual disturbances caused bv a defect of accommodation.
Out of 7176 eye-patients, 113, or 1 '/, per cent., were diabetics. After ten years' existence this disease regularly causes alterations of the eye-structures, particularly of the lens and retina. In a third of the cases diabetes was found associated with some of the following significant changes: (1) uncomplicated paralysis of accommodation in middle life; (2) late myopia occurring between 40 and GO years, without changes in the lens; (3) retinitis; and (4) quickly de veloped cataract in young persons in poor health. Hirschberg (Deut. tued. 'Woch., Mar. 26, '91).
A diminution in the amplitude of ac commodation seen in five diabetic sub jects is dependent upon a general mus cular weakness affecting more particu larly the internal rectus muscles Mauth ner (La France Med. et Paris Med., Dec., '93).