of the emaciation is marked by the disappearance of the fat from the adipose tissues of the body until every particle of it becomes ultimately absorbed. The rapid absorption of fat, at this period of the disease, is well illustrated by a case recorded by Dr. Prout of an unusually corpulent gentleman, who, before the commencement of an attack of diabetes, weighed 27 stones, but in a short time afterwards was reduced by it to 23 stones, having lost 4 stones at the expense of the fat; and two years afterwards, although he had in a great measure recovered, his weight was further reduced to 21 stones.

2

This loss of fat is a feature of the disease the importance of which, as I shall afterwards point out, has not been sufficiently appreciated by pathologists. Dr. Pavy attributes it to the non-assimilation of starch and sugar; but this explanation, though partly accounting for the phenomenon, is certainly insufficient to give a full explanation of it, inasmuch as it omits one important element which ought to be explained, namely: the non-assimilation of fat when consumed in abundance in the food. It is a well-established physiological fact, that when more

1 Op. cit. p. 30.

2 Researches on the Nature and Treatment of Diabetes, 2nd ed. p. 219.

sugar by the kidneys of diabetics after fasting for several hours. I shall, however, have occasion to show, when considering the sources of sugar in the urine, that a very different explanation can be given of this phenomenon. Besides, the term autophagia, to be strictly appropriate, should be applicable to the whole of the phenomenon instead of only a part of it; as employed by Dr. Jaccoud, however, it could only be applied to the advanced stage of emaciation, supposing the hypothesis on which it is founded to be an established fact.

It is evident that the gradual diminution, and at last the almost complete arrest, of the function of nutrition in the advanced stage of diabetes from the continual saturation of the blood and extra-vascular fluids of the tissues with sugar, and the misappropriation and transformation of so large a proportion of the food into this substance, is of itself a cause amply sufficient to account for the atrophy and emaciation. The muscular and other tissues of the body simply suffer inanition and consequent destructive metamorphosis, and are excreted by the kidneys in the form of urea, which is frequently found in great excess in the urine. I may further add that it is this almost complete arrest of nutrition and resulting destruction of the tissues which ultimately produce

death by exhaustion when the disease runs its full course uninterruptedly.

Besides these constant and characteristic symptoms of diabetes, which, with the superabundance, and saccharine character of the urine, enable us to diagnose the existence of the disease, there are others of minor importance, or less constantly present, which it is necessary to consider before proceeding to the pathology of the affection, under which head it is most convenient to consider the morbid condition of the urine, in consequence of its intimate relation to important pathological questions. The following are the more prominent of the symptoms alluded to:

A spongy bleeding condition of the gums and looseness of the teeth, especially of the incisors, is of frequent occurrence. I have witnessed it in two cases in which it disappeared when the disease was subdued by treatment; in one of these the teeth regained their firmness when the gums became consolidated; in the other, two of them remained loose, and were extracted.

In the early or middle period of the malady the tongue is frequently covered with a thick coating of fur, but in the more advanced stage, with much emaciation, it is generally red and devoid of

F

epithelium, while the mouth is dry and parched, especially in the night-time. A sweet taste in the mouth is a frequent symptom, and the breath of the patient exhales a sweetish sickly odour, which is peculiarly characteristic of the malady, and by which it can frequently be recognised, especially in confirmed cases. In the advanced period the tongue and the lining membrane of the mouth and fauces generally present a dusky red hue, and become covered with apthæ.

There is, generally, constipation of the bowels throughout the course of the disease, and the fœces are dry and hardened. Occasionally, however, the patient suffers from attacks of diarrhoea.

When the disease is far advanced, and the emaciation considerable, the pulse becomes rapid and feeble, and oedema of the lower extremities is frequently developed.

During the course of the disease the power and function of reproduction are suspended, both in the male and female, and as it progresses more and more all the symptoms referable to the nervous system and developed in the early stage, become greatly aggravated in degree: such as the despondency of spirits, the feebleness and vacillation of mind, the dimness of vision, the feeling of chilli

ness, and the anesthesia of the limbs. It is needless to add that, with gradually increasing emaciation, the muscular debility grows more painfully distressing.

Such, then, are the phenomena of a fully developed case of this formidable disease when it runs its course without interruption; it is frequently terminated by suppression of urine, ending in fatal

coma.