Abstract
The following case, which we have recently had under observation, is of clinical and scientific interest because of the evidence it presents of the coexistence of diabetes mellitus and splenohepatomegaly, Goucher.
The history, in brief, is as follows: Patient, male, single; age 28; civil engineer. Family history negative. Patient had no important antecedent illnesses. Physical examination revealed no associated disease of any organs. Blood was practically normal in the beginning, but showed numerical increase in large lymphocytes and decrease in small lymphocytes as the disease advanced. Polynuclear leucocytes showed no suggestive changes.
Patient died in diabetic coma about two and one half years after illness began. There was nothing unusual in the general course of the disease. It progressed in spite of all efforts to combat it. One thing deserves noting, namely, that fat was metabolized poorly, the acidosis increasing whenever the fat in the diet was increased to offset the loss in body weight.
Post-mortem Examination.—The body was embalmed with a fluid containing about 8 per cent. of formalin one hour after death, and the tissues were fixed in formalin, Zenker's fluid and osmic acid twelve hours later.
There was some enlargement of the spleen, its size being 13 × 10.5 × 6 cm. and the weight 338 gm. The enlargement was only slight, therefore. Other organs appeared normal. Microscopically, the kidneys and adrenals were normal. The pancreas showed no general structural change except slight atrophy of the acinal tissue. The islets were normal, though there was some tendency towards hypertrophy. The capillary walls were somewhat thickened. There was no hyaline change in the islet epithelium. The spleen was extensively invaded by large round and oval cells of the endothelial type of Goucher.
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