In diabetes the pancreas is not the only organ involved; for, the causes of diabetes have not concentrated their attack and spent their force upon the pancreas. Diabetes is preceded by and accompanied with impairment and destruction in other and often more important organs. The whole body is more or less affected; diabetes is only one of "several diseases" with which the patient suffers.

There are usually nervous lesions and nervous symptoms, though these are not constant. Hypertrophic enlargement of the heart is common, as is, also, hardening of the arteries. Tuberculosis of the lungs, enlargement and often fatty degeneration of the kidneys, and lobar or bronchopneumonia are common concomitants. There is much other, though often less prominent, pathology in various organs and parts of the body. Indeed, every tissue, even the bones are affected more or less.

Inflammation of the kidneys occurs in at least one half of such cases. Boils and carbuncles, inflammation of the genital organs, sometimes eczema or gangrene, arteriosclerosis, inflammation of the peripheral nerves, sometimes producing striking simulations of locomotor ataxia or paralysis of the legs, shingles, perforating ulcers of the foot, atrophy of the optic nerve (resulting in blindness), loss of sexual power, and coma are the most prominent "complications" of diabetes.

Coma ends in death in a few hours or a few days. Gangrene develops usually in the feet or legs, and occurs largely in elderly patients. It results from the obliteration of an artery by inflammation, the outcome of arteriosclerosis, arterial degeneration, and nutritional perversion.

The patient suffers with several "diseases". Some of these developed prior to the diabetes; some concomitantly with it; and others successive, or even sequent, to it. Not all of the so-called complications of diabetes are sequent to the disordered metabolism resulting from pancreatic failure, but most of them are concomitant and successive developments out of the same causes that produced the diabetes. The firmer our grasp of the principle of continuity the more we must allow to the original causes of the simplest pathology.

If we study any of the other so-called "degenerative diseases of later life" we get very much the same picture. In Bright's disease, for instance, there is the same arteriosclerosis, optic atrophy and blindness, liver impairment, vascular hypertension, cardiac hypertrophy, fatty degeneration of organs and tendency toward pneumonia. In addition there may be dropsy and finally uremia and coma.

In Bright's disease the kidneys are not the only structures involved. In tuberculosis the lung disease is only part of the disease of the body. These same things are true of peptic ulcer, cancer, and other so-called "local pathologies." All so-called organic and chronic "diseases" are merely local developments out of the general systemic derangement.

Just as breeders, breeding for commercial rather than for biological ends, breed for deformity; so in certain pathological states, some parts are forced to develop semi-independently and inordinately, irrespective of the common good of the organism. Acromegaly supplies an excellent example of this. Likewise, the various organic dysfunctions produce their own respective symptom-complexes.

Thus pancreatic dysfunction will produce effects that differ in kind to those produced by thyroid dysfunction, or to those produced by dysfunction of the ovary, or testicle, or the adrenals, or the hypophysis. Impairment of the digestive system gives rise to different affects to those resulting from renal insufficiency, or those due to cardiac failure. This helps to explain why pathology appears so multiform or polymorphous that its essential oneness escapes us.

It will help us if we keep in mind that the various symptom-complexes, arising out of dysfunction of the various glands or other organs, are epiphenomena, or symptoms of an altered constitution, which eventually terminate in the production of various syndromes, but are not the primary or remote cause which furnishes a complete explanation for a given syndrome. Only a recognition of the universal basic cause for all pathology can bring order out of the present pathological chaos.

"Complications" really have three sets of causes; namely (1) the primary causes are those which have been in operation throughout the body for years and, through their persistance, accumulation and extension, are responsible for the general impairment of the body; (2) the secondary causes are the functional failures that result from the breakdown of an important organ, and the resulting greater or lesser impairment of its symbiotic partners; and (3) tertiary causes-are therapeutic procedures which further weaken and destroy the body.

The aggregate of pathological phenomena, from earliest life, to the final ending in diabetes, Bright's disease, cancer, etc., constitute an organic unity, a continuum, and we must learn to view these conditions as evolutional results and to consider together the whole congeries of pathogenic influences and pathological developments. Instead of considering the various "local pathologies," whether they develop together or successively, as "special creations," having no relationship to each other, we must see in them concomitant and successive developments out of the persistence, cumulation, and extension of a common basic cause. The unity of phenomena is a fact, even in pathology, and we could, with profit, abolish the confusing and misleading nomenclature of the schools. As we have dispensed with the alchemy of the ancients, and as we no longer utilize their demonology as serviceable or true, we can afford to dispense with their nosological views.

The universality and uniformity of Natural Law--that continuity of cause and effect which runs unbroken through the warp and woof of the very universe--is beautifully expressed by the poet in the following lines:

"The law which molds a tear And bids it trickle from its source, That law preserves the earth a sphere And guides the planets in their course."

This law assures us that the evolution of pathology must be the same throughout the body. The progressive deterioration of an organ or part goes forward in one continuous "stream," sometimes slowly, sometimes swiftly, but is never broken until its causes are corrected or removed. The process is continuous because its cause is continuous.

The principle of the universality and uniformity of natural law renders it an absolute certainty that the evolution of the humblest symptom must be identical with that which governs the evolution of the most extensive and very worst states of pathology. What is true of the parts is equally true of the whole, and, conversely, what is true of the whole is true of its parts. The essential principles which govern the evolution of the systemic deterioration, viewed in the aggregate, must necessarily be the same as those which may be discerned as controlling the evolution of pathological states of particular organs.