Two cases of diabetes, in which changes were found in the spinal cord.
In the first case on naked-eye exam ination of the spinal cord, after harden ing in Milller's fluid, degeneration was found in the posterior columns. This was most marked in the cervical and lumbar enlargements. In the lower cervical and dorsal regions the lesion was confined to Go11's columns; above and below it extended laterally into Burdach's columns. The sacral region was unaffected. In the lower dorsal region the right posterior column was distinctly more markedly affected.
In the second case degeneration of the Posterior columns was also found. It was limited to Go11's columns in the upper cervical region. In the lower cervical region it spread to Burdach's columns, and was most extensive in the lower cervical and middle dorsal regions. Below the lumbar enlargement the de generation ceased.
The spinal changes regarded as the result of the action of some toxic sub stance in the blood of diabetic patients. Similar changes have been found in the posterior columns of the spinal cord in pernicious anmmia, leucocythremia, Ad dison's disease, etc. E. Kalmus (Zeit. f. klin. Med., B. 30, H. 5, 6).
Relationship between diabetes mellitus and epilepsy. Cases in which the dia betes is the cause of the epileptic attacks may be divided into two categories, ac cording as the attacks are due to cere bral lesions or to disturbance in the intra-organic exchange consecutive to the glycosuria. Cases belonging to the former group are rare. In the cases of epilepsy due to diabetes the convulsive spasms are determined by toxic products of intra-organic exchange, and take more or less the form of coma. The aceto monk diabetic epilepsy rapidly leads to fatal coma, but when it develops in a chronic and intermittent manner is said to determine epileptic seizures. The cases in which diabetes seems to depend upon epilepsy are divisible into two clinical varieties: those in which the elimination of sugar merely follows the convulsive attack—these have rarely been found; and those in which the glyeosuria is a more or less constant accessory symptom of the epilepsy. The
eases in which diabetes and epilepsy ap pear simultaneously are of two kinds: 1. Epilepsy often alternates with dia betes and mental disorders in neuro pathic families, and it would, therefore, not be a matter of surprise to find the two conditions present in one person of sneh a family. 2. There may be a pre disposing cause of both in the same sub ject.
A ease belonging to this latter class. The patient had an apoplectic stroke resulting from iselnemia of the left hemisphere due to a cardiac lesion. There was aphasia and pollakiuria, but no polydipsia, polyphagia, nor polyuria. Some months later epileptic seizures, with complete loss of consciousness and convulsions in the previously-paralyzed half of the body„ supervened. Ebstein (Sem. MCA., May 22, '96).
Twelve hundred and fifty cases studied in the psychiatric clinic at Leipzig with regard to presence of sugar in the tirine, with positive results in thirty cases. The cases were divided into two groups,: those of chronic diabetes, which was usually associated with chronic brain disease of the type of dementia, and those of transitory glycosuria, usually associated ith acute forms of insanity, partictilarly of a maniacal type. Often the excitement preceded the appearance of sugar in the urine. Four possibilities may be considered: (I) the glyeosuria may be merely an accidental complication of the men tal disturbance; (2) diabetes may be the result of insanity, (3) or it may be the cause, (4) or the two conditions may be the result of some common cause. The second sometimes occurs because ex cessive emotional disthrbances have been known to produce diabetes. R.. Landert heimer (Berliner klin. Woch., May 23, '98).
The pancreas is very frequently found altered in diabetic subjects; sometimes it is simply atrophied, sometimes slightly indurated, and, under the microscope, periglanclular sclerotic lesions have been noticed. There are some rare cases in which the tissue of this organ is almost entirely destroyed in consequence of the presence of calculi.