I have for a long time insisted upon the fact that during life the liver, being gorged with blood, presents a greater volume and consistency than in the cadaver. The differences concerning the condition of the liver in diabetes are, in a measure, due to this fact. In cer tain subjects attacked with severe dia betes, a brownish color of the skin, and especially that of the face, similar to that witnessed in Addison's disease.
Case of diabite brolizi, of which only 9 certain cases, all by French observers, and 2 doubtful ones have been published. Marie (La Semaine -Med., May 22, '95).
The liver is then atrophied and hard, and there may be ascites. Elanot and Chauffard published two cases of this kind in 1882. Cases were afterward re ported by Letulle, Hanot and Schach mann, Branlt and Galhard, Barth, and others. Upon section, the liver is found hard and distinctly and uniformly sclerotic, and a microscopical examina tion shows the hepatic cells to be in filtrated with yellowish-brown or black granulations, while at certain points there are large black masses. The scle rotic connective tissue shows by its topo graphical distribution the existence of bivenous cirrhosis. In the portal spaces obliterative endarteritis is found, with net-works of biliary pseudocanaliculi, masses of pigments, and vestiges of de stroyed hepatic cells.
The liver is the seat of predilection for deposits of pigment, but it has also been found in the pancreas (llanot and Chauffard); also in slight quantities in the kidney, and even in the heart. Finally, as I have already mentioned above, it occurs in the skin itself.
The quantity of iron chemically de termined in the pigmented organs is variable: Quincke found in a case an enormous quantity of dry matter. The liver was said to contain, in all, 27 grammes. Zaleski justly remarks that this pigmentation is not characteristic of iron.
Urinary System.--Urinary complica tions are very common. First there are those due to previous morbid conditions (gout, for instance), and, in particular, there are those which depend upon the diabetic dyscrasia, and which, as is known, are complex in the case of gravel diabetes.
The renal lesion most common in dia betes has been reported by Armanni and fully described by Strauss.
It affects exclusively the zona limitans, where it invades the straight tubules of Henle, which inay be either large or slender; sometimes, likewise, some of the collecting tubes (Strauss). As to the
localization, there are individual varie ties; in one instance it was found ex clusively in the ascending branch of the loop.
Armanni regarded this lesion as a hyaline metamorphosis. Ehrlich, with the aid of iodized gum, proved that it is really an infiltration of the cells by the glycogenic substance. He regarded it as a constant symptom in diabetes; but this opinion appears to be somewhat ex aggerated. At all events, this lesion proves the facility with which the or ganism synthetically transforms the sugar into glycogen. Ehrlich thought that the sugar so transformed was that contained in the urine. Strauss—basing his opinion npon the fact that the lesion is localized in the zona limitans in the neighborhood of the capillaries inter posed between the uriniferous tubules— is inclined to believe that this sugar comes from the blood of these capilla ries.
[In support of this hypothesis the fact may be advanced that the glycogenic infiltration may take place in other organs besides the kidneys; the brain, for instance (Futterer). Very recently Strauss observed that the glycogenic reaction is sometimes absent, aild that there is only a hyaline substance. R. LEPLNE.] A method for detecting and fixing sugar in the organs just at the place of its excretion. Observations made on the kidneys of rabbits, diabetes having been produced experimentally. The kidney is removed rapidly, and a small portion is placed for fifteen to twenty minutes in a watery solution of phenylhydrazin and glacial acetic acid, previously warmed in a water-bath. It is then washed in water acidified with weak acetic acid, hardened in 10-per-cent. formol solution, frozen, and sections cut. The sections showed the characteristic yellow needles, indicating the presence of sugar, chiefly in the interstitial spaces between the uriniferous tubules. The crystals were much more scanty in the capsules of the glomeruli, while in the lumina of the uriniferotts tubules they were almost absent. The chief ma.sses of crystals were certainly situated in the interstitial vascular and lymph-spaces. Seelig (Archly f. experiment. Path. it. Pharm., B. 37, II. 2, 3).