801 



DIABETES. 



DIAL. 



02 



the kidneys may be the effects of the disease, and not the causes of it. 

 Next to the kidneys, the organs most commonly found in a state of 

 disease are the mesenteric glands, which are enlarged and hardened. 

 The absorbent glands in general are occasionally enlarged, softened, 

 and more Tascular than natural ; the thoracic duct is sometimes 

 dilated, and the lungs are constantly found studded with tubercles in 

 all their stages of disease. Though the functions of the stomach, 

 intestines, and liver are so often disordered during life, yet it is com- 

 paratively rare that any kind or degree of organic change is discover- 

 able in these organs after death. 



The true and invariable antecedents of diabetes, or its 'proper ex- 

 citing causes, are still involved in obscurity. It has been observed to 

 come on after exposure to several morbid agents, as the long-continued 

 application of cold and moisture, especially after the body had been 

 previously over-heated, implying a sudden check to the perspiration, 

 and a corresponding determination of blood from the skin to the in- 

 ternal organs ; exhaustion arising from excessive evacuations, or ex- 

 cessive fatigue, bodily or mental ; in short, whatever greatly and 

 suddenly depresses the powers of life : but such causes are applied in 

 all their intensity to the human body many thousands of times for 

 one in which they produce a case of diabetes. 



Although morbid anatomy throws so little light on the nature of this 

 disease, the recent discovery of sugar in the blood affords grounds for 

 supposing that the real seat of this disease is in the blood, or the 

 organs concerned in the production of the constituents of the blood, 

 rather than in the kidneys. Sugar is not, however, found in all blood, 

 but was first found in the hepatic vein, and was found to be absent in 

 the portal vein. This discovery was followed by researches on the 

 function of the liver, more particularly by M. Bernhard, of Paris, who 

 was the first to announce the fact that the liver had the power of con- 

 verting the constituents of the blood in the portal vein into sugar. 

 The sugar found in the liver more closely resembles in its properties, 

 glucose or grape-sugar, than cane-sugar. It is this sugar apparently 

 that increases in the blood during the disease called diabetes, and this 

 is confirmed by the fact that there is a close resemblance between 

 diabetic- and liver-sugar. 



AB in the diagnosis of diabetes it becomes a matter of importance to 

 detect the presence of sugar in the urine in the earliest stages, much 

 importance has been attached to the means of discovering small 

 quantities of sugar in the urine. The tests used are numerous, but it 

 may be sufficient to mention here those which are most conveniently 

 applied. 



The first we may mention is a colour test, and is known as Moore's 

 test. It consists of adding the liquor ptitatia to the suspected urine 

 in a test-glass and then exposing to the heat of a spirit-lamp; if 

 sugar is present, the urine becomes changed into a bright claret 

 colour. Of course the intensity of the colour will depend on the 

 quantity of the sugar. Dr. Garrod has proposed a modification of 

 this test in his glucometer, which by supplying a standard solution 

 enables the experimenter to judge of the quantity of sugar present by 

 the quantity of liquor potassx required to produce the standard colour. 



Another test more frequently used U that of Trommer. This 

 depends on the facility with which diabetic sugar is decomposed in 

 contact with an oxide of copper. A solution of sulphate of copper is 

 added in a test-tube to the urine, sufficient to colour it blue. Liquor 

 potassa? is then added, which throws down a hydrated oxide of copper. 

 On exposure to heat the sugar is decomposed, and the oxide of copper 

 is reduced to the state of a suboxide, which is known by its rel 

 colour. This test is equally efficient for grape-sugar and liver-sugar, 

 but the above changes go on very slowly in cane-sugar. 



Crystals of sugar may be detected in the urine after evaporation, 

 under the microscope, and the process of fermentation may be esta- 

 blished by the addition of yeast. These are other tests, but not so 

 much to be depended on as the preceding. 



Various theories have been proposed to account for the sugar in 

 the urine, and a treatment has been recommended in accordance 

 with such theories. Dr. Prout attributed the disease to a deranged 

 state of the digestive organs, in which he believed the food was 

 converted into sugar in the stomach and intestines, and thence carried 

 into the blood. 



Dr. Bence Jones has explained the occurrence of the sugar, on the 

 ground that in health the natural changes of certain portions of the 

 food are from starch to dextrine, from dextrine to sugar, and from 

 sugar to carbonic acid. But in diabetes the last stage of change is 

 arrested, and the sugar not being converted into carbonic acid is 

 carried off from the blood by the kidneys. 



M. Bernhard, as the result of his researches on the sugar-forming 

 properties of the liver, regards diabetes either as the result of a too 

 active performance of the function of sugar-forming in the liver, or as 

 pnxluced by a deficient decomposition of the sugar naturally thrown 

 into the blood. 



The treatment suggested by these theories is not inconsistent with 

 the mode of treatment employed by the older practitioners of medicine. 

 It -yas early suggested that those kinds of food which contained sub- 

 stances that were easily converted into sugar, and sugar itself should 

 be withheld, and many patients were found to improve greatly, and 

 even to get well, by withholding substances containing starch and 

 sugar from their diet. In some cases this plan has been pushed to the 



extent of giving the patient nothing but animal food. This, however, 

 is so repugnant to the natural taste of the patient that most prac- 

 titioners have allowed a limited quantity of bread, or prescribed a 

 kind of bread in which the gluten is in much larger quantities than 

 usual. Such bread has been manufactured for the use of diabetic 

 patients. It cannot be said, however, that such bread is necessary to 

 the cure of diabetic patients, as many have improved on a diet in 

 which animal matter has constituted a principal part of the diet, com- 

 bining this with a small proportion of the farinaceous vegetables. 



The most curious point in the history of thia disease is, that cases 

 have been recently published by Dr. Budd, of Bristol, and others, 

 in which they have administered large quantities of sugar to diabetic 

 patients with decided advantage to the patient. Although there can 

 be no doubt of the improvement thus recorded, abundance of cases 

 exist which show that the free administration of amylaceous and sac- 

 charine foods has been attended with an increase of the diabetic 

 symptoms, and that relapses have been frequent after improvement on 

 an animal diet, by the partaking of fruits and farinaceous foods. 



These facts lead to the conclusion that diet alone will not cure 

 diabetes. Nor are there any special remedies that will effect a cure. 

 But the treatment should be directed to the restoration of that state 

 of the system in which only the normal quantity of sugar is allowed 

 to remain in the blood. Under these circumstances the digestive 

 system, the liver, and the blood, should, if possible, be restored to 

 their natural condition. This may be done by the administration of 

 purgatives where needed, by giving tonics such as iron and quinine, 

 which restore the tone of the system, and especially in the administra- 

 tion of medicines which act on the nervous system. There is reason 

 to believe that deranged conditions of the nervous system alone will 

 cause the appearance of sugar in the urine quite short of ordinary 

 diabetic symptoms, and there is abundant evidence to show that opium, 

 camphor, kreasote, and remedies of this class will frequently control 

 the quantity of sugar in the urine. 



An important element in the treatment of these cases is abundant 

 exposure to fresh air. Horse exercise, or walking where it can be 

 borne, should be recommended. This should be done on the principle 

 of securing the greatest possible amount of oxidation for the con- 

 stituents of the blood, as there can be no doubt that one element of 

 the disease consists in deficient change in the blood. 



The state of the skin also demands attention. Warm bathing and 

 the vapour-bath have proved beneficial, and daily ablution of the 

 whole body in warm and cold water, according to circumstances, 

 should be prescribed. Warm flannel clothing should also be worn 

 next the skin. 



DIABETIC SUGAR. [GRAPE SUGAK.] 



DIACAUSTIC CURVE. [CAUSTICS.] 



DIAGONAL, a line drawn from corner to corner ; any line drawn 

 from point to point of a figure, which is not part of its boundary, pro- 

 vided the two extreme points be in the intersection of boundary lines. 

 A figure of n sides has 4 n (n 3) diagonals. 



DIAGONAL SCALE. Equidistant parallel lines cut all lines drawn 

 across them into equal parts. Consequently, a set of equidistant paral- 

 lels laid down upon a ruler, with oblique lines of various lengths 

 drawn across them, give, with the compasses, the means of immediately 

 taking off various proportions of those lines. But the common diagonal 

 scale is as follows, and facilitates the laying down of the hundredths of 



i fl 



units in a scale of equal parts. A description of its use will imme- 

 diately suggest the principle of it to any one slightly acquainted with 

 geometry. A B is the unit of the scale (usually a quarter of an inch) : 

 the diagonal scale professes to determine the hundredth part of this, or 

 the four-hundredth of an inch, and may perhaps, with care, be depended 

 on within the two-hundredth of an inch. By taking off various lines, 

 and writing their numerical designations opposite, we may show the 

 use and meaning of the construction. 



a6 = l-00 ae=l-21 JA = l-22 m 2 = 1-96 



DIAGRAM, a mathematical figure of any kind. 



DIAL, an instrument for determining the hour of the day from the 

 shadow of a point or line upon a graduated surface. The shadow may 

 be that formed by the light of the sun or moon, and be either direct or 

 reflected. The dial, when the sun is used, is called a sun-dial ; and 



