364 GENERAL DISEASES. 



vulnerable to slight injuries or infections; gangrene, for example, is 

 liable to occur either with or without marked injury in cases of diabetes. ' 



The Brain may appear to be entirely normal; it may be congested; 

 there may be an increase of serum ; the convolutions may be shrunken ; 

 there may be meningitis-^ there may be dilatation of the blood-vessels, 

 small extravasations of blood around the vessels, enlargement of the peri- 

 vascular spaces, and alterations in the perivascular sheaths and nerve tis- 

 sue bounding the cavities ; there may be tumors at the base of the brain. 



The Spinal Cord may present dilatation of the blood-vessels ; dilatation 

 of the central canal ; changes in the gray matter of the anterior cornua. 

 Marks of multiple neuritis and lesions of the sympathetic ganglia may 

 be present. 



The Lungs. There may be the lesions of pleurisy, bronchitis, broncho- 

 pneumonia, lobar pneumonia, gangrene, tuberculosis. 



The Heart may be small or hypertrophied ; there may be chronic 

 endocarditis. 



The Stomach and Intestines. The stomach may be dilated, its walls 

 may be thickened, there may be haemorrhagic erosions of _the, mucous 

 membrane. Tu the intestines there may be tuberculous ulcers or enteritis. 



The Liver may be~~~cirrhotic oxJJatty , or glycogenic infiltration may_ 

 occur. 



The Kidneys may be enlarged ; they may be the seat of albuminous 

 degeneration or diffuse nephritis ; there may be glycogeuic infiltration 

 of the epithelium of Henle's loops. 



The Blood. In a few cases fat has been found in the blood, and fat 

 emboli in the vessels of the lungs. 



The Pancreas. In a considerable proportion of cases the examination 

 of the pancreas reveals somejesimj, usually atrophy of the parenchyma, 

 often with increase of the interstitial tissue. Hyaline degeneration and 

 interstitial inflammation involving the islands of Laugerhaus are appar- 

 ently of much significance. 2 Fatty degeneration, tumors, and cysts have 

 been found. Extirpation of the pancreas in man or dogs may lead to 

 diabetes. While diabetes may occur without demonstrable lesions of the 

 pancreas, it is fair to assume that functional lesions of grave importance 

 may nevertheless be present. 



Diabetes mellitus may be associated with hsemachromatosis and cirrho- 

 sis of the liver so-called "bronzed diabetes." 3 



Under the influence of the doctrine of internal secretions it is now 

 commonly assumed that the pancreas in addition to its intestinal secre- 

 tion furnishes other substances to the body which are essential in the 

 metabolic changes to which the carbohydrates and proteids must be sub- 

 jected in securing normal nutrition. Interference with this internal se- 

 cretion of the pancreas is thus assumed to be accountable for the faulty 

 metabolism. 4 



1 For bibliography of diabetic gangrene consult Davis, Jour. Am. Med. Assn., July 

 16th, 1898. 



3 For the relationship of diabetes to lesions of the pancreas and particularly to lesions 

 of the islands of Langerhans, see Opie, "Disease of the Pancreas," 1903. 



3 See Opie, loc. cit., p. 281. 



4 Other forms of glycosuria are known which are to be otherwise accounted for. 



