Pulmonary Apparatus. — The most frequent complication in this direction is pulmonary phthisis. At least one third of the cases of diabetes treated in the hospitals are on account of this. The lesions of diabetic phthisis are al most always those of bacillary tuber culosis. The exceptions met with are cavities following pulmonary gangrene, which, as has been remarked by some clinicians, have not the usual fcetidness. There are also ulcerations due to a fibrous ulcerative pneumonia (Mar chand). Dreschfeld, Fink, and others have reported similar cases. _After phthi sis, pneumonia is a serious complication of diabetes.
Pneumonia is rare in diabetes. In 700 cases of diabetes only 7 cases of pneumonia observed, not counting 1 case of broncho-pneumonia and 5 of influenza pneumonia. In none of these cases did the sugar disappear during the febrile period. The prognosis is always unfavor able. Bussenius (Berliner klin. Woch., No. 14, '96).
Diabetics are so prone to bacterial in vasions because the glucose has a favor able effect on bacterial growth, the sugar lowers the resistance of the tissues, and the diabetic cachexia and the lessened alkalinity of the blood assist. As result of examinations in twenty-nine cases it was found that the most frequent com plication was tuberculosis (41 per cent.).
Honl (Wiener klin. Rund., No. 16, '98).
It may begin like ordinary pneu monia. I have seen several such cases. The temperature does not differ from that usual in pneumonia, and the urine remains, notwithstanding the fever, at its usual ratio. There are also cases of rapid pneumonia, of which I have observed several. In the primary con gestive period death may ensue in a few hours. Pneumonia is principally met with in diabetics presenting intense gly cosuria.
Digestive Apparalus.—The gums are usually red and tumefied. Dental alve olo-periostitis exists, as a rule, when the diabetes dates back several years. The teeth soon become loose in the alveoli and fall out, aiad dental caries frequently exists. In arthritic diabetes pharyngitis is often present, or, at all events, con gestion of the pharynx, with the ex pectoration of sanguineous mucus.
Form of pharyngitis symptomatic of diabetes or albuminuria observed. There is at first a slight difficulty in degluti tion. a sensation of pressure in the throat, and a deposit of mucus which annoys the patient considerably. An examination of the throat shows the pillar of the fences and the posterior portion of the pharynx to be reddened, the mucous membrane red, swelled, and frequently covered by a layer of glairy MUCUS. Garet (Universal Med. Journal,
Dec., '94).
Laryngeal vertigo may also occur, but this symptom belongs rather to the arthritis than to the diabetes.
Diabetic ulceration of the throat noted in five eases. Ulcers have a tendency to increase in depth and extent, and are extremely painful. These ulcerations occurring in diabetics do not present any characteristic appearance or location. W. Freudenthal (Laryngoscope, Feb., 1900).
The stomach is dilated in all cases of polyphagic diabetes. In the latter cases the digestion is apparently accomplished much more readily than one would pose, in view of the enormous quantity of food taken, but this is often only parently the case, as, notwithstanding the absence of symptoms of indigestion, the food is badly digested. The chloric acid is often absent in the gastric juice (Rotenstein, Gans, Honigmann). Sometimes there are lesions of the mu cous tract (interstitial gastritis, atrophy of the glands); in other cases no distinct lesions have been found. Gans and Honigmann claim to have found hy peracidity in certain cases.
The disturbances of the intestinal di gestion are less known, because they are less accessible for investigation.
Among 140 diabetic patients Seegen found the liver enlarged in 28: about 20 per cent. Others have found a greater proportion of enlarged livers.
In GO per cent. of diabetics there is a manifest change in the liver, usually in the right lobe. The density of the organ is increased in one-third and its sensi tiveness in one-fourth of the cases. It is usually increased in size, this increase consisting of elements of induration. Glenard (La Semaine Med., Aug. 3, '90).
In diabetics the function of the liver is unimpaired; cirrhosis and other in tercurrent affections diminish or abolish glycosuria. Dujardin-Beaumetz (Bull. Gen. de Then, Nov. 15, '91).
In ease of diabetes due to influenza liver weighed seven pounds; hyper tropliie cirrhosis with pigmentation throughout hepatic cells, portal spaces, and biliary ducts and vessels. Pancreas large and striated; glands dissociated by fibrous tissue; cells infiltrated with pigment. De Massary (Bull. de la Soc. Anat., July 10, '95).