Theory of ravy—that in diabetes there is weakening of intestinal epithe lium and of liver, which in the normal state prevents entrance into economy of too great quantity of sugar—does not explain most eases. Paton (Edinburgh :Med. Jour., Dee., '94).
Extirpation of liver prevents ablation of pancreas to cause diabetes in the dog. Mareuse (Zeit. f. klin. Med., B. 26, p. 225, '94).
A patient, aged 4S years, who, in 1SS7, suffered an attack of jaundice lasting six or eight weeks. The following year sugar was discovered in his urine, to the extent of 1 to 2 per cent. Dur ing an annually-repeated "Carlsbad cure" the sugar disappeared from his urine, but after 1S92 it was continually pres ent. In 1S93 icterus reappeared, and there developed ascites, cederna of the legs, dyspncea, and wasting,. The liver and spleen were much enlarged. Ascitie fluid was withdrawn four times in all. After the last puncture the fluid did again collect. The amount of fluid in gested was at first greater than that eliminated, but eight weeks after the last puncture this relation was reversed. With the excessive excretion of urine the ascites and cedema disappeared. The pa tient increased in weight and gained strength, the jaundice disappeared, and the liver decreased in size. The patient remained for a long time in good health, then albumin appeared in the urine and cedema of the feet. During the per sistence of the ascites the sugar disap peared from the urine, to return again as soon as the ascites was gone. After two and a half years of good health the patient died. The necropsy revealed einlosis of the liver with some con traction; tubercles in lung, pleura, and peritonemn; diabetic kidney, and atro phy of the pancreas. Pusinelli (Ber liner klin. \Web., No. 33, '96).
Bronzed diabetes is the result, and not the cause, of the accompanying hepatic cirrhosis, which is thought to he due to augmented function of the liver-cells. Gilbert, Castaigne, and Lereboullet (Gaz. Hebdom. M5d. et de Chin, May 17, 1900).
Pathogenesis.—It would appear, from what has already been stated, that the causes of diabetes are multiple; it is evi dent that nervous diabetes differs from pancreatic diabetes. In obese diabetic
subjects there is usually- no appreciable lesion of the pancreas, and certainly no primary lesion. On the other hand, there are no nervous elements in these cases. This is, again, a different type of diabetes, and it would be easy to multiply the number. As for the im mediate cause of diabetes, it is generally complex, consisting most frequently in an increased production of sugar and a diminution of glyeolysis. In the light of our present knowledge it would be difficult to say much more upon this point if one wishes to refrain from mere hypotheses.
The pancreas is always the cause of glycosuria. Case of diabetes mellitus in an infant of six months, ascribed to the reflex effect of teething upon tbe pan creas. Calcium lactophosphate, by as sisting the evolution of the teeth, cured the glyeosuria. Baumel (Archives de 1116d. des Enfants, -Mar., 1901).
Autopsy of a diabetic negress aged 54 years. The pancreas weighed SO grammes, was soft and of a gray-yellow color. Almost every island of Langer hans showed microscopically a homo geneous material that stained with eosin. This substance at times lay in the midst of groups of cells, but was usually in contact with the walls of the capillaries penetrating the island, or next the peripheral fibrous tissue, and was therefore usually between the re maining cells and the capillary walls. The cells of the island were in large part replaced, so that between the hyaline particles only an occasional compressed fusiform or irregular nucleus could be seen. The hyaline metamorphosis was strictly limited to the islands of Langer hans, the glandular aeini remaining in tact. In this pancreas, therefore, a le sion of obscure etiology had destroyed the islands of Langerhans, while those of the secreting acini, as well as those of other organs, were unaffected. The association of diabetes mellitus affords convincing proof that the islands of Langerhans are intimately connected with the glycogenic metabolism. E. L. Opie (Jour. Exper. Med., Mar. 25, 1901).