340 GENERAL DISORDERS OF NUTRITION. 



and nutritivt condition; nevertheless, the attempt has been made tc 

 ascribe diabetic impotence to the drying up of the sperm for want of 

 water, and to a saccharine condition of the semen, supposed to deprive 

 it of its power of inducing nervous excitement. 



Finally, we have to mention a series of phenomena, which, al- 

 though less constant than those heretofore described, still often accom- 

 pany them and serve to complete the picture of the disease. Caries 

 of the teeth is a symptom which sets in early in the majority of cases. 

 Folk explains this phenomenon by supposing that the teeth are ex- 

 posed to the action of a free acid, formed by decomposition of saccha- 

 rine secretion within the mouth. Then, again, phymosis and excoria- 

 tions of the prepuce and glans in men, and of the parts about the 

 meatus urinarius in women, are very distressing occurrences, due prob- 

 ably to wetting of these parts with saccharine urine. Finally, there 

 is often a great tendency to inflammation, ending in necrosis and mor- 

 tification, exhibited in the very frequent occurrence of furuncles, car- 

 buncles, lobular pneumonia, and pulmonary abscesses and gangrene. 



Consumption of the lungs develops as a terminal symptom in many 

 diabetic persons. According to Griesinger, nearly one-half of all pa- 

 tients die in this way. Now and then albuminuria is associated with 

 mellituria, thereby augmenting the exhaustion and accelerating the 

 demise of the sufferer. It is not improbable that the parenchymatous 

 nephritis, upon which the albuminuria depends, is a consequence of the 

 constant irritation of the kidney by the presence of sugar in the urine, 

 thus forming a sort of analogue with diabetic balanitis. 



The course of diabetes is always chronic, lasting for months and 

 years. In but a very small number of the cases reported, the disease 

 has been acute, terminating fatally within a few weeks, or even sooner. 

 We have scarcely any trustworthy observations of the incipient stages 

 of the malady. Nearly all patients only come under treatment at a 

 period when the profuse urination, tormenting thirst, insatiable hun- 

 ger, and steadily advancing emaciation, have awakened the suspicion 

 of the existence of serious disease ; and they are scarcely ever able 

 accurately to state when the present symptoms first arose, or by what 

 others they had been preceded. Even in the few examples in which 

 the malady has developed quickly, an augmented hunger, thirst, and 

 an unnatural diuresis, were the first manifestations which attracted the 

 attention of the patients and their friends. 



Diabetes usually lasts from one to three years. More than sixty 

 per cent, of the cases collected by Griesinger terminated fatally 

 within that period. It must, however, be recollected that statistics 

 usually refer to cases treated in hospital, while the majority of those 

 treated in private practice are never published. There is no doubt 



