DIABETES MELLITUS. 839 



sharged from his kidneys, just as another one thirsts who sweats pro- 

 fusely, or who suffers a great evaporation from his skin from fever, or 

 ake a cholera patient who is discharging water through the capillaries 

 of his intestines. A second factor consists in the desiccation of all the 

 tissues as a result of intense endosmotic action from the parenchyma 

 into the vessels. Sugar may be employed as well as salt for the pur- 

 pose of drying meat in order to preserve it. It is by no means rare foi 

 a patient to drink from ten to fifteen quarts of water during the day. 

 The thirst is most intense an hour or two after meals, that is, while 

 the formation of sugar is most active and the production of urine the 

 most copious. 



This immense waste of water through the kidneys likewise accounts 

 for the complete arrest of perspiration, and for the decrease in the in- 

 sensible evaporation from the skin, which have been observed at my 

 clinic. The antagonism between the secretions of the skin and kid- 

 neys is as well shown in the dryness of the surface of diabetic people 

 as in the reduction of diuresis, which usually accompanies profuse per- 

 spiration. Griesinger reports an interesting case, in which sugar was 

 present in the urine and sweat alternately, and in which, whenever the 

 sweat became strongly saccharine, the percentage of sugar in the urine 

 sank one-half. In the aforementioned researches of Liebermeister and 

 Reich, it was found that a diabetic patient scarcely perspired a third 

 of the quantity given off by a healthy person. Finally, according to 

 the experiments of IKunde and ITohnhom, who, by artificial abstraction 

 of water from frogs and mammalia, have induced opacity of the crys- 

 talline lenses of these animals, it seems not improbable that the cataract 

 which often accompanies diabetes is a consequence of the excessive 

 loss of water, although indeed the ophthalmologists have raised many 

 objections to this explanation. 



An insatiable hunger is a symptom of diabetes, quite as constant 

 as is the unquenchable thirst. It is almost incredible how much food 

 such a patient will consume during a day, often quite regardless of its 

 quality. This voracious hunger, as well as the steadily increasing and 

 finally extreme emaciation, manifestly are due to the fact that a large 

 part of the food eaten is of no profit to the system, because, instead 

 of being devoted to the repair of used-up constituents of the body, it 

 is immediately excreted. Moreover, the consumption of the nitro- 

 genous components of the body is considerably increased in diabetes, 

 as is shown by the augmentation in the quantity of urea produced. 

 Of course there can be no elevation of the bodily temperature, a large 

 part of the heat-producing material passing off from the blood unused. 



The impotence, which is nearly always observed in this disease, is 

 probably dependent upon a general decline in the patient's strength 

 103 



