The Type and Distribution of Pathology in Pulmonary Tuberculosis Associated with Diabetes Mellitus *

The association of diabetes mellitus and tuberculosis has been recognized for many years. John Rollo"3, in his book on diabetes published in 1798, gave the dinical and post-mortem records of a case of diabetes complicated by pulmonary tuberculosis with cavity formation. The credit for the first report of a large number of diabetic cases with special reference to tuberculosis of the lungs belongs to Griesinger'0 (1859), who recorded 250 cases. Bourchardat6, in 1875, found pulmonary tuberculosis present in 19 autopsies on diabetics. Windle"9, in 1883, reported the autopsies of 333 diabetic patients, with mention of pulmonary conditions. From this time on the subject has received considerable attention from many standpoints. Some of the most interesting discussions concerning the topic have centered around the type and distribution of the pulmonary pathology. Dreschfeld8 (1884-85) spoke of an acute, tuberculous bronchopneumonia occurring in diabetes mellitus, running a more rapid course than ordinary phthisis and being characterized by an early and very extensive formation of cavities. Babcock2 and Noltemius'2 likewise supported this view. West"8 (1902), in a report of 50 autopsies performed on diabetics, recorded 21 cases of pulmonary tuberculosis. Of these, 17 showed an acute caseous type of pathology characterized by rapid extension with cavity formation and little tendency to fibrosis. Montgomery11, in an excellent summary of the literature up to 1912, reviewed the records of 355 autopsies on diabetic cases, 138 of which showed pulmonary tuberculosis. He conduded that the tuberculosis associated with diabetes is "more likely to take the form of a very rapid and extensive, usually caseous, tuberculosis, with early cavity formation and with no tendency to cicatrization." Fitz and Murphy' (1924), in a review of 37 autopsies, 19 per cent of which showed pulmonary