928 Diabetes Mellitus. 



Sometimes the respiratory organs become affected second- 

 arily with symptoms of laryngeal or bronchial catarrh, to which 

 may later on be added pneumonia or even gangrene of the lungs. 

 Krxiger noted a sweetish odor of the exhaled air. In the ter- 

 minal stage there appear symptoms of cardiac debility. In 

 dogs an enlargement of the liver may be detected. Darras 

 observed in a diabetic dog necrosis of the tip of the tail, Kriiger 

 saw in a horse furunculosis, but Preller found phlegmosis in 

 the subcutis, which however healed completely in contrast to 

 human experience. 



Other organic diseases which may have a causal connection 

 with diabetes are discovered only rarely during the lifetime of 

 the animals. In this respect the case of Preller's is of interest, 

 in which it was possible to diagnose the disease of the pancreas 

 by means of the Cammidge test while the animal was alive. 



In the further course of the disease the debility increases 

 more and more ; finally apathy and stupor appear ; the amount 

 of sugar gradually diminishes and sometimes the sugar dis- 

 appears entirely. There is diarrhea, and, after complete ex- 

 haustion of the patient, death occurs with symptoms of con- 

 vulsions or during coma. 



By coma diabeticum or intoxieatio diabetica is meant in human 

 medicine a peculiar pathologic condition which develops toward the 

 end of diabetes mellitus and is usually followed immediately by death. 

 The respiratory movements suddenly become very deep, labored and 

 hastened; at the same time or a little later the patient becomes un- 

 conscious, or symptoms of collapse appear, or great restlessness develops, 

 followed immediately by death with symptoms of heart failure. In 

 other cases the patients are tormented by headache, their motions are 

 staggering and the end supervenes, the patients being in a stupor. 

 The exhaled air then smells strongly of azetone. This condition is 

 usually referred to the accumulation of organic acids (oxybutyric acid, 

 azetoacetic acid) in the blood. Frohner, Eichhorn, Lienaux have each 

 observed a similar condition in a dog, and the authors themselves met 

 with it in a horse. 



Course. Diabetes mellitus always takes a chronic course. 

 In the cases hitherto observed its duration varied between 1 

 and 12 months. It must however not be forgotten that the 

 disease was always recognized only in a far advanced stage. 

 According to experiences in human medicine the disease may 

 persist for years, although in young animals its duration ap- 

 pears to be short. 



Diagnosis, If the urine permanently contains considerable 

 amounts of grape sugar the diagnosis of diabetes mellitus ap- 

 pears to be perfectly certain. The disease has otherwise no 

 characteristic symptoms and can therefore be recognized with 

 certainty only by means of regular urinalyses. Nevertheless 

 there are a number of symptoms which should cause the affec- 

 tion to be suspected and . should suggest a chemical analysis 

 of the urine; such are particularly the increasing emaciation, 



