Diabetes Mellitus Glucosura Diabetes, or GIu-cohaemia (Gr. taBaivelv, to pass through), a disease characterized by an excessive secretion of saccharine urine. Though disease marked by diuresis and attended with wasting of the body was frequently spoken of by earlier authors, Willis (1(559) was the first who noted the distinctive character of the complaint, the presence of sugar in that fluid. Since his time diabetes, which is not very rare, has been frequently made a subject of study, yet still much obscurity envelops its causes, its essential character, and its treatment. The invasion of diabetes is commonly insidious. The attention of the patient is perhaps first attracted by the quantity of urine he passes and by the frequent calls to void it, or he notices that while his appetite is greatly increased he is growing weaker and thinner. The urine is not only greatly increased in quantity, but somewhat changed in appearance; it is paler, transparent when first passed, and assumes on standing an opalescent tint like the whey of milk or a solution of honey in water. It has no odor, or a somewhat aromatic one, compared by some to that of new-made hay, by Dr. Watson to that of a room in which apples have been kept.

If kept for a few days at a moderately elevated temperature, instead of acquiring an ammoniacal odor, like ordinary urine, it has a sharp, vinous smell, and will be found to be acid rather than alkaline. The urine has commonly a decidedly sweet taste; drops of it upon the patient's linen or clothes stiffen them like starch, and sometimes leave on evaporation a powdery efflorescence. The specific gravity of the urine is greatly augmented; instead of being on the average about 1.024, as is commonly the case, it ranges from 1.025 to 1.050; M. Bouchard at reports it even as high as 1.074. Two or three simple tests are Sufficient to render the presence of sugar certain. In Trommer's test, a drop or two of solution of sulphate of copper is added to a little of the urine in a test tube; a solution of caustic potash is now added in excess, and the mixture gently boiled over a spirit lamp for a few minutes; if sugar is present, a precipitate of a reddish or yellowish brown color (suboxide of copper) will be thrown down, otherwise the precipitate will be black (common oxide). In Moore's test, a little of the urine is mixed in a test tube with about half its volume of liquor potassae, and the mixture boiled five minutes; if sugar be present, the fluid will acquire a brown hue, otherwise it remains unchanged.

A third test is founded on the fact that diabetic urine rapidly undergoes fermentation when mixed with a little yeast and kept in a warm place. The sugar to which diabetic urine owes its peculiar properties exists in the form of glucose or grape sugar. This is present in all proportions, from a mere trace to 30, 50, and even 134 parts in 1,000. The quantity of solid matter thus drained from the system is very great; Watson estimates it on the average at 1 1/4 lb. a day, but it sometimes amounts to many times this quantity; and it is this drain of solid matter, together with the large amount of urine passed, which gives rise to the constant thirst and enormous appetite. Early in the disease the symptoms are not well marked; when the complaint is established, and the large excretion of urine begins to attract attention, the patient complains that despite his excessive appetite he grows thinner and weaker; the mouth is pasty, the skin dry and hard, the bowels constipated. The digestive functions, at first normal, become deranged; the patient is troubled with heartburn, with a feeling of weight and pain in the epigastrium, and sometimes with vomiting.

The strength declines, he becomes emaciated, the generative functions are impaired or lost; vision often becomes dim, the gums are spongy, there is tenderness and swelling about the orifice of the urethra, the memory and intellect fail, and the temper becomes irritable. In the course of the disease pulmonary consumption is very apt to supervene and carry off the patient. Toward the last diarrhoea, fetid breath, effusion into the great cavities, and oedema of the extremities precede death. Diabetes is essentially a chronic disease, lasting often many years; it is also obstinate and intractable, although most of the cases seem benefited by treatment, and sometimes it appears to be completely cured. - In the beginning of the present century Dr. Rollo found that the amount of urine in diabetic patients as well as its sweetness was very much diminished by confining them to an animal diet. When the ready conversion of starch into grape sugar became known, this was assumed to be the origin of the sugar, and the benefit derived from an exclusively animal diet was thus explained.

But few patients have the resolution to restrict themselves for any length of time to such a diet, and even when' persevered in it is found to be merely palliative. 0. Bernard has ascertained that sugar is a normal production of the liver in all classes of animals, carnivorous as well as herbivorous; that it takes place in the liver of the foetus as well as in that of the adult; that irritating the origin of the pneumogastric nerves in the fourth ventricle increases the secretion of sugar, producing an artificial diabetes. In a state of health the normal secretion of sugar poured into the circulation by the hepatic veins is rapidly decomposed and excreted by the lungs; when the amount is increased by disease, the excess passes off by the kidneys. Under the influence of diastase, sugar is likewise formed from the starch of the food in the process of digestion, as a necessary preliminary to its absorption. When diabetic patients are placed upon an animal diet, this source of supply is cut off, and the amount of sugar in the urine is diminished, but it is still present, since the liver keeps up a supply.

M. Mialhe, believing that sugar in the course of the circulation is decomposed under the influence of the alkalinity of the blood, and that in diabetes the blood is deficient in alkalinity either positively or relatively to the amount of sugar contained in it, recommends the use of bicarbonate of soda in large doses. He recommends half a drachm to be taken three times a day, morning, noon, and night; this is gradually increased until from 180 to 270 grains are taken in the course of the day. In addition, the patient is directed to take Vichy water with his meals, and is recommended to drink two or three pints of lime water daily. He is allowed the ordinary variety in his diet, but the quantity farinaceous food is reduced one half, or at least one third. Flannel is ordered to be worn next the skin; the vapor bath is administered two or three times a week. By these means Mialhe reports a number of cases to have been cured. Dr. A. Clark (New York "Medical and Surgical Journal," January,1859) reports several cases of diabetes either cured or greatly benefited by the use of bicarbonate of soda and of blisters to the nape of the neck. He administered the soda in doses of 11 grains, to be taken as frequently as could be borne until the urine was rendered alkaline or the stomach was nauseated.

Besides the alkaline treatment, the means principally relied on have been, restricting the quantity of farinaceous matter in the patient's diet as far as possible, indulging him in watery vegetables (spinach, turnips, cabbage, etc.) rather than in bread or potatoes, and the use of opium. This last remedy allays the nervous irritability of the patient, and diminishes the thirst and the urinary secretion. - Diabetes insipidus is a disease characterized like the above by the daily discharge of an unnatural quantity of urine; but in this case it is of less specific gravity than natural, and contains no sugar. It consists in fact of the discharge of an excessive quantity of water by the kidneys, the natural ingredients of the urine being simply diluted by the increased volume of the fluid. The daily quantity of urine discharged in this disease may amount to several gallons, while its specific gravity is as low as 1.005. It is accompanied by a corresponding thirst, the patient drinking water enough to supply that discharged by the kidneys.

Diabetes insipidus often lasts a long time without serious injury to the health.