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alteration the cause of pancretic diabetes. He recalls the observations of Dieckoff, Isobelow, and Opie, and says that on an analysis of 167 observations the alterations in the Islands of Langerhans were found in 130 cases, and although he admits that the relation between wasting diabetes and the changes in these structures has not been absolutely made out, he thinks that it will be proved in time, and he contributes four cases as confirmatory evidence. These four cases were those of well-marked wasting diabetes, and in all the lesion of the Islands of Langerhans was well-marked.

A. E. FINNEY. "The Relations of the Islands of Langerhans to Diabetes Mellitus." Medical Chronicle, 1903.

Finney concludes (1) that diabetes may occur in the absence of demonstrable lesion in the Islands of Langerhans; (2) diabetes may occur unaccompanied by lesions of the Islands, but not of sufficient extent to accord with the results of extirpation of the pancreas, which showed that if a small part of the gland remain the occurrence of diabetes is prevented. It is, however, possible that Islands which presented no anatomical change may have become functionally inactive; (3) diminution in the number of Islands may occur in various proportions, even to total disappearance; (4) lesions of the Islands may occur in the absence of diabetes, but not to any great extent; (5) diabetes may be associated with apparently primary lesions of the Islands in which these have undergone hyaline transformation.

Note. This hyaline transformation of the Islands of Langerhans was described and figured by me in the Bradshaw Lecture, delivered before the Royal College of Physicians, on August 18th, 1890.-R.S.

SIR THOMAS R. FRASER. “Lipæmia in Diabetes Mellitus." Scottish Medical and Surgical Journal, Sept., 1903.

Fraser reports a case of lipæmia, and gives drawings of the blood, fundus oculi, and of sections of the lung and kidneys. He suggests that the fat is really formed from sugar in the blood, under the influence of the organic acids present.

The case died comatose, and at the post mortem examination no special change was noticed in the Islands of Langerhans, though the pancreas is described as being small, soft and flabby.

KRAUS. "On the Transformation of Albumen into Sugar in Diabetes." La Semaine Medicale, 1904, p. 8.

At a meeting of the Berlin Medical Society, Kraus observed that it was generally admitted that in severe cases of diabetes sugar is manufactured at the expense of albumen; yet given the extraordinary appetite of diabetics and the difficulty of dieting them, it may be asked whether the patients do not secretly take starchy or saccharine food, which may explain the amount of glycogen? In order to clear up this point he made experiments upon kittens rendered diabetic by the administration of phlorizin, and had been able to determine that the reserves of glycogen could not furnish all the sugar which they eliminated, so that the possibility of the production of sugar at the expense of the tissues may be admitted.

H. L. VAN LINDEN, VAN DEN HEUVELL, and N. M. FACEE SCHAEFFER. "Diurnal Glycosuria." Nederl. Tijdschr.

voor Geneesk, 15th August, 1903.

The case recorded appears to be unique. A man of 26 passed urine containing 0.7 per cent. of sugar, but this was only present in the night urine, even although the whole of the carbohydrates were eaten at the evening meal. The quantity of urine was not great, about 40 ozs., but the sp.gr. was very high (1045), due to the presence of phosphates. The patient presented no other symptoms of diabetes, but his history showed a marked neuropathic heredity.

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GEORGE PARKER, M.A., M.D. Case of Bronzed Diabetes." Brit. Med. Journal, 1903. Vol. II., p. 1052.

The case recorded was that of a male, aged 65, a fitter, who came to the Bristol General Hospital for treatment of a varicose ulcer. There had been recent loss of flesh, thirst,

dyspepsia, and frequent micturition. The urine contained 5 per cent. of sugar; weight, 10st. 13lbs.; heart and lungs normal. He was treated by dieting, uranium nitrate, and later with opium. When admitted three months later he had lost 13lbs. The skin was dusky on the face, neck, legs, and around the site of the old ulcer; lips and mucous membranes were greyish; tongue much furred and dry; physical signs in chest and abdomen normal; no œdema; liver and spleen not palpable; pulse feeble and low, but arteries thickened; urine averaged 50 ozs. daily, with 5.7 per cent. of sugar. Five weeks after admission he died of coma. At the post mortem examination there was much pigmentation of the skin; the conjunctivæ were jaundiced, and the body was considerably wasted. The abdomen contained 6 or 8 ozs. of dark yellow fluid, but showed no traces of recent peritonitis; the parietal peritoneum was pigmented in places; the surface of the liver was rough and nodular. The liver weighed 53 ozs., and was obviously cirrhosed; the gall bladder was enlarged, and contained two aggregations of gall stones. The spleen weighed 71⁄2 ozs., was purplish grey in colour, and studded with white. patches of fibrosis; its consistency was firmer than normal. The pancreas weighed 2 ozs., was small and firm; it was fibrosed at the thick end; also pigmented, being almost of a bluish black near the duodenum. There were a few varicose veins in the œsophagus. The lungs were congested and œdematous; the heart showed slight atheroma of the aorta, a recent vegetation on the posterior cusp of the mitral valve, and some slight thickening of both valves on the left side. Under the microscope the liver showed extensive monolobular cirrhosis, with pigment granules scattered about in the fibrous tissues and among the cells; these granules gave a marked iron re-action. The pancreas also showed similar masses of pigment and fibrosis with pigmentation. The suprarenal capsules were normal except for a deposit of iron pigment in the cortex. The account of the case is followed by a brief analysis of the various contributions which have been made to this disease since it was originally described by Hanot in 1882. Parker adopts the suggestion of Croftan that sugar is

normally broken up by trypsin at the same time as the hæmoglobin is converted into bile acids and bile pigments. In disease of the pancreas trypsin is deficient, and while sugar is not destroyed, hæmoglobin is not transformed normally, but is changed into hæmochromagin. Where the liver is normal the pigment is removed, and only the symptoms of diabetes result, but where the liver is cirrhosed the pigment accumulates and gives rise to the symptoms of bronzed diabetes.

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JAMES M.
BEATTIE. Hæmochromatosis with Diabetes
Mellitus." The Journal of Pathology and Bacteriology,
August, 1903.

The author described the case of a man, aged 39, whose illness began in November, 1899, when sugar was found in his urine. He had previously been very healthy. He was admitted to the Edinburgh Royal Infirmary about three years later, but the dates are not given. At that time there was bronzing of the skin all over, but most marked on the face and on the inner side of the right hand. He had been twice in a Glasgow hospital on account of the glycosuria, but no bronzing of the skin had been noticed. On admission he was passing 310 grammes of sugar; on the second day he became comatose and remained so until death, which occurred on the twelfth day after admission. These somewhat meagre clinical details are supplemented by a very full account of the post mortem examination. The liver, which weighed 92 ozs., was of a light chocolate colour with a granular surface; the kidneys were enlarged; the pancreas was large, of a deep chocolate colour, and extremely firm; the adrenals showed iron pigmentation of the cells lying just below the capsule. Microscopical examination showed the liver to be the seat of monolobular cirrhosis with pigmentation, the pigment consisting of two forms, (1) hæmofuscin, (2) hæmosiderin. The first form was generally found in the connective tissue, and did not give the iron reaction, while the pigment in the cells was. of the second kind and gave this reaction very definitely.

There was marked fibrosis of the pancreas; the pigment was very abundant and of both kinds; the Islands of Langerhans had mostly disappeared, but where seen the cells were quite free from pigment. There was pigmentation of the kidneys and of the lymphatic glands, but none in the gastro-intestinal tract. In his conclusions Dr. Beattie advances the opinion that the disease is a distinct entity, and that diabetes is only associated with it as a late manifestation, although the history of his case points in the exactly opposite direction. He attributes the degeneration of the cells of the liver, pancreas, and other organs, and the increase of fibrous tissue to a toxic agent derived from the intestine by way of the portal circulation. He thinks the pigment is due partly to the inability of the degenerated cells to perform their metabolic processes properly, and partly to "transporation from the liver and pancreas," whatever that may mean. He finally admits that the cirrhosis may in part be due to irritation caused by the pigment. He does not seem to be aware of Croftan's writings and speculations upon this subject.

O. KOERNER. "Researches and Observations respecting the Influence of Operations upon the Course and Termination of Diabetes." Mitteil. aus den Grenzgebieten der Med. u. Chir., XII., 5. La Semaine Medicale, 1904, p. 86.

Although operations in diabetes are not without their special risks, yet the old dread of such interference has been modified by modern experience. No general rule can be laid down. Of the operation of trephining the mastoid for acute suppuration of the middle ear, Koerner has collected 38 cases. Of these, five died from causes quite independent of diabetes. Of the other 33, 29 were cured and four died. He divides the cases according to the type of diabetes present. Thirteen had slight diabetes in which the sugar disappeared after a few days of strict diet; of these all were cured. In five cases the disease was moderate; that is to say, it required some weeks of diet to remove the sugar, and in these also the result was uniformly good. In nine the disease was severe, with ferricchloride reaction present, and diet remained without much

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