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years that more attention has been given to the pan- creas in this connection. The total extirpation of the pancreas in clogs has caused diabetes. This is not due to a lesion of the surrounding part, but to the in- terruption of the function of the pancreas. The pro- portion of cases of diabetes associated with pancreatic lesions is at least fifty per cent. The lesions of the pancreas vary in their character. Hansemann says that one lesion which is invariably associated with diabetes is viagra online information granulation atrophy of the pancreas. It has its analogy in granular nephritis. There is an increase of the connective tissue, a thickening of the walls of the vessels, and a diminution of the glandular substance. There is no other lesion which destroys the function of the pancreas that will cause it. Calculus of the duct and new viagra online information growths may cause conditions almost similar. These facts may not be so reliable when we consider that the pancreas is examined at the post-mortem in every case of dia- betes, but is rarely looked at in viagra online information other diseases. He holds that all cases of diabetes are due to changes in the pancreas. There is no characteristic lesion of the liver; indeed, it is often not affected at all. Some lay great stress on the dilatation of the blood-vessels of the liver. This viagra advertising usa is not demonstrable and not im- portant. In some cases the liver cells are changed and there is a glycogenic metamorphosis of the nu- cleus of the cells. He does not believe that the sym- pathetic nervous system has anything to do with the cause of the disease. There is some change in the blood. Glycogen has been seen inside the leucocytes. Diabetics are specially predisposed to complications, especially to infection from pyogenic organisms, boils, carbuncles, etc. Senator says that lobar viagra advertising usa pneumonia is a rare complication; Osier says it is very common. Klemperer says that it is not common, probably be- cause the organism of pneumonia does not grow well in the presence of sugar: but Welch says on the con- trary that the presence of sugar favors its growth. In these cases colon bacillus is found. Dr. John S. Fulton then spoke ol tin- etiology of this disease. When the food supply of carbohydra is excessive the glycogen reservoir is overtaxed. If the ingestion of sugar goes beyond the physiological line, glycosuria appears for a short time. Heredity, age. sex, social condition, geographical position, race. contagion, temperament, viagra advertising usa and certain diseases are all predisposing and determining causes of diabetes. Varieties of Clinical History of Diabetes Dr. William Osler then spoke of the " Varieties and Clinical History of Diabetes." Three questions are asked by the physician : First, Has the patient actu- ally sugar in his urine? viagra advertising usa He referred to viagra online information a case of al- kaptonuria. viagra online information A viagra advertising usa man was rejected for life insurance because he was supposed to viagra advertising usa have glycosuria. Further investigation of this case in 1887 showed the absence of sugar and the presence of a substance called alkap- ton. Dr. Osier had a case last year which was sup- posed to be diabetes. Fehling's and other tests showed the presence of sugar, but the fermentation test and the polariscope showed that no sugar was present. This man also had alkaptonuria, viagra advertising usa and, strange to say, was a brother of the first man referred to. Second, Is it true diabetes or is it a transient glycosuria caused by an excess of starchy food, nervous trouble, or is it a toxic form of glycosuria? Third, Given a patient with dia- betes, is it a mild or a severe case? In a mild case, all' we have to do is to cut off the carbohydrates for three days and put the patient on an ordinary meat diet, and the sugar will disappear in from one to three days.. Most cases we see are in men between forty-five and fifty years old. The disease viagra advertising usa can be controlled by diet. He gave instances in which an excess of starchy food, increased the amount of sugar very markedly, but on a strictly nitrogenous diet the sugar was kept within bounds and the man could follow his business. A case in which the carbohydrates are excluded for three- days and sugar still remains is a grave case. The dis- ease runs a rapid course in children. Adults can' stand it much longer, and in exceptional cases they have been known to live for many years with the dis- ease. Dr. H. Friedenwald then spoke of the "Ocular Manifestations of Diabetes.'"' Diabetic affections of the eye are due either to general debility, to disturb- ances of nutrition, or to the production of the toxic substance in the blood. Visual viagra online information disturbances are gen- eral enfeeblement depending upon weakness of the ex- ternal ocular muscle and still more of the muscles of accommodation. The affections probably due to viagra online information nu- tritive disturbances are cataract, retinitis, and hemor- rhages within the eyeball. Diabetic cataract is not so frequent as is generally supposed. Disease of the eye viagra online information may also be caused by a poisonous product circulating in the blood. Dr. T. C. Gilchrist then spoke of " Cutaneous Affections in Diabetes.'* In diabetes the skin is per- haps more affected than any other organ of the body. The most characteristic cutaneous lesions are found in the genital regions. There are also viagra advertising usa functional affec- tions and trophic changes. The commonest diabetic manifestations on the general surface of the skin are boils and carbuncles. Boils occur early and carbun- cles late in the disease. Gangrene is also a serious- complication of viagra advertising usa diabetes. Prophylaxis and Treatment of Diabetes. Dr. I. E. Atkinson then spoke of the " Prophylaxis and. Treatment of Diabetes." From the variety of its path- ology we would seem to have no way of treating it etio- logically. Measures for prevention can only be taken in a few cases. In hereditary cases, in obese and gor- mandizing persons, and in those who have recovered from one attack, we can take measures to prevent its- recurrence. The medicinal treatment is entirely un- satisfactory. Arsenic occasionally benefits. The lat- est remedy recommended by West, of England, in the British Medical Journal, is twenty grains of uranium nitrate three times a day. One drug which should be spoken of is opium. It has very little influence over the disease, but it checks the glycosuria and polyuria. Codeine and morphine are the best forms in which to give opium. The habitual use of opium in this disease is not desirable. It should be given intermittently- The suggested treatment with pancreatic extract is of