170 THE BLOOD IN DIABETES MELLITUS. [BOOK I. 



Whatever may be the part played by the acetone-like body 

 in the production of the phenomena of diabetic coma, we may safely 

 assert that when a diabetic exhales large quantities of that body, 

 the prognosis is peculiarly grave, the probability of a rapid fatal 

 termination being considerable. It is to be noted that the symptoms 

 of diabetic coma may set in and afterwards subside a statement 

 which the Author bases upon a case observed and recorded by 

 Quincke 1 , and upon a second case observed by his friend Dr Grahame 

 Steell in the Manchester Royal Infirmary. 



Lipaemic -^ ^ as been stated (p. 59) that in a perfectly physio- 



condition of logical condition, the serum of blood often presents a 

 the Blood in milky appearance which is due to the suspension of 

 Diabetes. fatty matters. Some of the older writers noticed that 



the blood in diabetes is specially characterized by this lactescent 

 appearance ; the observations of Dr Babbington on this matter being 

 very precise 8 . The fact was, however, lost sight of for a long time, 

 or explained on the theory that diabetics consume large quantities of 

 food, and that as a result, their blood presents the appearance which 

 is usual whilst a full meal is being digested 3 . Recently investigated 

 cases* have directed attention afresh to this lipaemic condition of the 

 blood. It was observed by Dr Balthazar Foster 5 that the blood in 

 certain fatal cases of diabetes presented a milky appearance, and he 

 averred that this was similar to the appearance produced on adding 

 acetone to blood, ether having no solvent action on the fat-like matter. 

 Professor Sanders and Dr Hamilton, in cases which they observed, 

 noticed that the blood had a pink colour, and that there separated 

 from it milk- or cream-like serum ; they however quite correctly 

 remarked that the milk-like appearance " proved to be due to oil, both 

 by microscopic examination, and by the removal of the milky appear- 

 ance by the action of ether, as well as by staining with perosmic acid. 

 Nothing identical with this can be produced by adding acetone to blood." 

 The interest attached to this lipaemic condition of the blood 

 depends upon the fact that Sanders and Hamilton discovered, in one 

 case where death had resulted from diabetic coma and where the 

 blood was intensely lipaemic, fat emboli in the vessels of the lungs and 

 kidney, the appearances being exactly similar to those observed in 

 cases of fat embolism from fractured bone. The resemblance of the 

 symptoms which were observed by Czerny in a case of fat embolism 

 due to this cause to those of diabetic dyspnoea and coma led Sanders 

 and Hamilton to advance the theory that " the peculiar terminal 

 dyspnoea and coma of diabetes are due to lipaemia and fat embolism, 

 rather than to acetonaemia." 



1 Quincke, "Ueber Coma diabeticum." Berliner Minische Wochenschrift, 1880, No.l. 



2 See Article "Blood" by Babbington in Todd's Cyclopaedia of Anatomy and 

 Physiology, Vol. i. p. 422. 



3 Pavy, Researches on the Nature and Treatment, of Diabetes, London, 1862, p. 1 



4 Sanders and Hamilton, "Lipaemia and Fat Embolism in the fatal Dyspnoea 

 Coma of Diabetes." Edinburgh Medical Journal, July 1879, p. 47. 



5 Foster, "Diabetic coma. Acetonaemia." British Me d. Journal, 1878, Vol. i. p. 78. 



