364 INTERNAL SECRETIONS OF PANCREAS AND SPLEEN. 



Osier 2 states that Frerichs recognized three groups of 

 cases; two of these are of special interest to us: (a) Those 

 in which after exertion the patients were suddenly attacked 

 with weakness, syncope, somnolence, and gradually deepen- 

 ing unconsciousness, death occurring in a few hours, (b) 

 Cases with preliminary gastric disturbance, such as nausea 

 and vomiting, or some local affection, as pharyngitis, phleg- 

 mon, or a pulmonary complication. In such cases the attack 

 begins with headache, delirium, great distress, and dyspnoea, 

 affecting both inspiration and expiration: a condition called 

 by Kussmaul air-hunger. Cyanosis may or may not be present. 

 If it is, the pulse becomes rapid and weak and the patient 

 gradually sinks into coma, the attack lasting from one to five 

 days. The need of a copious supply of carbohydrates ob- 

 viously points to increased oxidation. Indeed, complete ab- 

 sence of glycogen in the liver and muscles has been noted. 

 The voracious appetite and rapid wasting further sustain this 

 and simultaneously, therefore, the presence of suprarenal 

 overactivity. The italicized words in the list of terminal 

 symptoms, on the other hand, as prominently point to the 

 gradually deepening suprarenal insufficiency. 



Alluding to the effects of acids in the production of 

 glycosuria, Cartier refers to the experiments of Pavy 3 with 

 phosphoric acid. An increase of sugar was noted in twenty 

 minutes; fifteen minutes later a large quantity was present. 

 In another strong, but fasting, dog the sugar was markedly 

 reduced by a smaller dose. HaBmorrhagic infiltration of the 

 gastric and intestinal tissues and haBmaturia were also noted. 

 These are all familiar landmarks of suprarenal origin. Strik- 

 ing, in this connection, are the observations of Stadelmann, 4 

 who found that the production of C0 2 decreased in the rabbit 

 during acid intoxications as it does in diabetic coma. In a 

 foot-note Cartier says: "Voit and Pettenkofer and Gaethgens 

 have peremptorily shown, by means of most precise experi- 

 ments, that (1) the oxygen absorbed by a diabetic is much less 

 than by a normal man, and that it decreases progressively until 



2 Osier: "Practice of Medicine," third edition. 



8 Pavy: Guy's Hospital Reports, vol. of 1861. 



4 Stadelmann: Deutsche med. Wochenschrift, Nov. 4, 1890. 



