GENUINE DIABETES MELLITUS 541 



vascular system in diabetes could not be shown. On the contrary, among the 

 cases investigated were a number in which enormous adrenalin-diuresis 

 supervened. Among the numerous non-diabetes cases on whom we tested 

 the diuretic action of adrenalin, we never saw an action so intense. It is 

 especially worthy of remark that among the diabetics who resisted so in- 

 tensely, were also cases in an aglycosuric condition. Therefore in many a 

 diabetic the vessels of the kidneys are in an abnormally irritable state, [a fact] 

 which was not known before. I might take advantage of this opportunity to 

 add some remarks concerning the diuresis in diabetes mellitus. Ordinarily we 

 find a parallelism between the intensity of the elimination of sugar and the 

 amount of the urine. It has been known for a long time that there are ex- 

 ceptions to this rule. There are cases in which a long period of increased 

 diuresis precedes the occurrence of diuresis (v. Noorden}. There are further 

 cases in which, as v. Noorden likewise emphasizes, the polyuria outlasts the 

 glycosuria for a long period. Then there are cases in which, in spite of high 

 percentage of .sugar, the amount of urine is very slight. Naunyn reports, for 

 example, a case in which about 8-9 per cent, of sugar was excreted, with 2 

 liters of urine. In another case there was just as much sugar, and a specific 

 gravity of 1040, with urine amounting to only 1200-1400 c.c. We designate 

 these cases diabetes decipiens. On the other hand there are cases with con- 

 siderable polyuria with relatively little elimination of sugar, especially if 

 the diabetes came as a result of head injury. Naunyn reports, indeed, a case 

 of pure uncomplicated diabetes who constantly, with a diuresis of 5-6 liters 

 eliminated only 1.2^2 per cent, of sugar. Hence the elimination of sugar 

 is certainly not the only cause of the increased diuresis, and perhaps not 

 the principal cause. According to the experiments previously mentioned the 

 increased diuresis has its foundation in an especial sensitiveness of the 

 kidney vessels to an irritant circulating in the blood. We can summarize 

 the observation set forth in the statement that in many cases of diabetes 

 mellitus a heightened excitability of certain organs innervated by the sympathetic 

 (dilator papilla, liver, kidney, etc.), may eventually also exist in the aglycosuric 

 condition. 



The excitability of the autonomous nerves in diabetes mellitus is not 

 diminished throughout. We have even in numerous experiments in the 

 advanced stage of diabetes found strikingly intense actions of pilocarpine 

 on the secretion of sweat and saliva. Also the miotic action of pilocarpine 

 is very distinctly pronounced. That the diabetic glycosuria is not diminished 

 by pilocarpine, is here mentioned because the fact again illustrates the in- 

 dependence of the nervous and alimentary factors. In advanced cases there 

 are found many kinds of manifestations that perhaps may even point to a 

 heightened irritability in many territories of the autonomous nervous 

 system. We observed in almost all very severe cases high-grade obstipation, 

 whose spastic nature was shown on the palpation of the sigmoid flexure and 



