52 THE SALIVA IN DISEASE. [BOOK II. 



SECT. 5. CHANGES WHICH THE SALIVA UNDERGOES IN DISEASE. 

 SALIVARY CONCRETIONS. 



From the difficulties and inconvenience which attend the collec- 

 tion of large quantities of saliva but little knowledge is possessed of 

 the changes which it undergoes in disease. Our information is 

 limited almost entirely to that which relates to the passage of 

 abnormal ingredients into the secretion. 



saliva in In diabetes, the saliva, which was formerly supposed 



diabetes. j. Q con tain sugar, is said to be free from sugar, but to 



contain lactic acid, and to have, in consequence, an acid reaction. 



The Author has examined the saliva collected in two cases of 

 diabetes, after the subcutaneous injection of pilocarpin. The first was 

 that of a diabetic passing large quantities of highly saccharine urine, 

 and charged with the acetone-like body which gives a red colour 

 with ferric chloride ; this patient succumbed to an attack of diabetic 

 coma a few days after the examination of the saliva. The saliva had 

 a very marked alkaline reaction. It contained no trace of sugar. It 

 contained a trace of sulphocyanates. 



In a second case of diabetes, in a woman, the saliva had likewise 

 a very marked alkaline reaction. It contained no trace of sugar. 



These two observations are in contradiction to the usual statement 

 that the saliva of diabetics is acid. 



saliva in The colouring matters of the bile and the bile salts 



are generally stated not to occur 1 in the saliva of per- 

 sons with jaundice. According to Fenwick, however, their presence 

 may be detected in certain cases 2 . 



saliva in In diseases of the kidney the amount of albumin in 



the saliva may be much increased, as has been noticed 



by Vulpian 3 , who examined the saliva of such patients 



after administering pilocarpin. When in such cases the excretion of 



urea by the kidneys diminishes, this constituent is found in saliva in 



much larger quantities than normal 4 . 



^ 



Salivary Concretions. 



Salivary concretions occur in the acini and in the ducts of the 

 salivary glands, as well as in the buccal glands. Often they are of 



1 See v. Jaksch, Clinical Diagnosis. Translated by Dr James Cagney, London 

 1890, see p. 57. 



2 Fenwick, 'Lecture on the presence of bile in the Saliva.' Lancet, 1877, Vol. n. 

 303. 



Fenwick, The Saliva as a Test for Functional Disorders of the Liver- London 

 1887, see p. 11. 



3 Vulpian, 'Augmentation des matieres albuminoides dans la salive des albumi- 

 nuriques.' Comptes Rendus, Vol. LXXXVIII. p. 1165. 



4 Bitter, abstracted in Maly's Jahresbericht, Vol. i. p. 166. 



