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756 FUTOHER: THE FREQUENCY AND JETIOLOOY OF DIABETES. LN. Y. Med. Jour., is but little unanimity in the views of various observers on Purchase Salmeterol this point. They agree, however, on two points — first, the marked prevalence Buy Serevent of the disease among Hebrews, and, secondly, the comparatively frequent involvement •of several children of the same family at an early age or even in infancy. It is commoner to obtain a history of brothers and sisters having diabetes than to Buy Cheap Salmeterol find the disease occurring in parent and direct offspring. Cases are recorded where the grandfather was diabetic, the son gouty, Order Serevent and the grandson again Buy Cheap Serevent diabetic — the so- ■called hereditary alternating diabetes, as von Noorden terms it. In only two of our sixty-nine cases was there ■a hereditary history of diabetes obtained. In one case •a paternal uncle died of the disease, and in the second case the patient's mother died of diabetes at the age of twenty-nine. Some observers hold that diabetes may Purchase Salmeterol Online be contracted by contagion. E. Schmitz was the first to draw atten- tion to this possibility. Out Buy Salmeterol of his series of two thou- sand three hundred and twenty cases he believed that twenty-six instances were the result of contagion. He •cites several cases, in most instances married persons and usually the wives, where the disease was contracted after prolonged attendance on and being brought into the most intimate association with persons suffering from diabetes. Buy Salmeterol Online In none of these cases could any he- reditary influence be obtained, and in no instance was the last person attacked related by blood to the first patient affected. Schmitz is Generic Serevent upheld in his view by the individual experiences of other observers, but his theory has been strenuously opposed by others who believe that the occurrence can be explained by the fact that persons living together for any length of time are naturally exposed to the same injuriovis influences. Trousseau thought that the offspring from phthisi- «al parents were specially liable to suffer from diabetes. A tuberculous history is certainly to be obtained in a very large percentage of the cases of diabetes. The disease has been known to begin during the course of or immediately after a number of acute febrile diseases, among which may be mentioned diphtheria, influenza, rheumatism, and enteric fever. Glycosuria is not an uncommon occurrence in Graves's disease, but occasionally true diabetes mellitus may exist. It will be remembered from the previous lecture that exophthalmic goitre is one of those diseases in which alimentary glycosuria is comparatively easily produced by the administration of from a hundred and fifty to two hundred grammes of sugar, showing that the metabolism of the carbohydrates appears to be in a condition of unstable equilibrium in this disease. In recent years great interest has been attracted to the part the pancreas plays in the a;tiolog}' of diabetes. Tor more than a century, however, the possibility of lesions of the pancreas causing diabetes had been recog- nized. As early as 178S Cawley recorded a case in which the pancreas Order Salmeterol Online was atrophied and contained calculi. Since then, numerous observers have described lesions of the pancreas in diabetes, but it was not until 1877 that Lancereaux, on the strength of numerous clinical and anatomical observations, described a special form under the name of diahete pancreatique ou diahete maigre associated with lesions of the gland. This variety of the disease was said to be characterized by a sudden onset, unusual malignancy of course, rapidly progressive ema- ciation, rapid loss of strength, and a special tendency to pulmonary tuberculosis as a complication. Baumel, in 1883, advanced the view that all cases of diabetes were due to the absence of a diastatic pancreatic fer- ment in the intestine, and was the first to contend that disease of the pancreas was the regular cause of diabetes. In Generic Salmeterol support of his view he reported a case without emaciation {diabete gras) accompanying dis- ease of the pancreatic gland. Lancereaux's observa- tions, while exciting considerable interest at the time, were almost forgotten, when they were once more re- vived in 1889 by the discovery of Minkowski and von Mering, that permanent diabetes could be produced in animals by complete extirpation of the pancreas. It is now generally recognized that lesions Purchase Serevent of this gland are responsible for a certain percentage of the cases. Some believe that only those with wasting are due to pancreatic disease. Others go so far as to say that all cases of diabetes are due to involvement of the pan- creas, maintaining that where no gross or microscopic changes are foimd a functional disturbance of the gland exists. In this latter connection it is of interest to note again that Lepine maintains tliat the pancreas produces a powerful glycolytic ferment which enters the blood and chyle and destroys a Buy Serevent Online large Order Serevent Online Order Salmeterol part of the sugar before it reaches the liver, and that this ferment is absent or greatly diminished in animals deprived of the pancreas. More abundant evidence is required, however, before Lepine's view can Purchase Serevent Online be accepted. There are still others who think that there is no association

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