MILD AND SEVERE FORMS OF DIABETES 83 



it has been proven in more than 30 per cent, of my cases, and becomes more 

 frequent the more closely I investigate. This hereditary predisposition is 

 true of all three varieties, and can be demonstrated in a like number of cases 

 of the organic form, in diabetes of the aged, and in " pure diabetes." The 

 hereditary factor in diabetes is related to the neuropathic taint and to the pre- 

 disposition to gout and obesity. In many families gout or some variety of 

 neurosis or psychosis occurs alternately with diabetes, and if, in such diabetic 

 families, one of the members is conspicuously fat, this is very suspicious of 

 diabetes. These are, incidentally, the eases for which the improperly used 

 term " diabetes of the obese " should be reserved, the eases, namely, in which 

 obesity points to diabetes. 



It is often said that as the cases of diabetes are quite difEerent, and as these 

 etiologic differences correspond with differences in the course and the symp- 

 tomatology, diabetes should no longer be looked upon as a single disease. We 

 should no longer speak of " diabetes mellitus" but of " various forms " of 

 diabetes mellitus. But in answer to this we must again emphasize in all 

 forms of diabetes the hereditary predisposition. This is the common bond 

 which holds these various forms together; it is operative in each of the 

 varieties which are to be differentiated etiologically. In every type of the 

 disease, in nervous diabetes, as well as in liver diabetes, in diabetes after 

 infections, in diabetes of the aged, and in " pure " diabetes, 30 per cent, (or 

 more) are hereditary cases. 



Further, we do not know at present whether the pathogenesis of glycosuria, 

 i. e., the disturbance in metabolism which causes it in the difEerent cases, is 

 as multiform as the etiology; on the contrary, the glycosuria which occurs in 

 all the various types of diabetes mellitus (so far as this point has been inves- 

 tigated) is hyperglycemic in origin, i. e., the condition is due to an increase 

 in the amount of sugar in the blood. This is only true, however, of diabetes 

 mellitus as it occurs in man ; we can produce in animals and in man an experi- 

 mental glycosuria which is not hyperglycemic, i. e., the form due to phloridzin. 

 In animals even the most marked phloridzin glycosuria produces no note- 

 worthy increase of sugar in the blood. 



We cannot, therefore, see any sufficient reason for speaking of " various 

 forms" of diabetes, but we do distinguish a mild and a severe form of the 

 disease. This distinction will be observed throughout the following descrip- 

 tion of the symptomatology and it will also be seen that we have taken full 

 account of the differences in etiology between different groups of diabetic cases. 



III. MILD AND SEVERE FORMS OF DIABETES; COURSE, 

 SYMPTOMATOLOGY AND COMPLICATIONS 



Mild and severe forms of diabetes mellitus. The importance of complicating organic 

 disease in- the symptomatology of the mild cases. Differentiation of the various symp- 

 toms according to whether they are due to the organic disease or to diabetes mellitus. 

 Hyperglycemia as a cause of the latter. The albuminuria of the diabetic. 



In practice we cannot avoid differentiating between mild and severe cases, 

 or the mild and severe forms of diabetes mellitus. It is true that this is only 



