^4- DISEASES OF THE INSULAR APPARATUS OF THE PANCREAS 



through the appearance of the stools. Up to the present I have not seen 

 similar statements in the literature. Purgative measures are of service 

 in such cases only when they are given in rather large doses, and then defe- 

 cation is rather painful. Such patients prefer enemas to purgatives. 

 The spastic nature of this obstipation is demonstrated too by the prompt 

 action of a subcutaneous injection of atropine (i mg.). On what ground 

 there occurs the development of such a spastic obstipation is difficult to say ; 

 it can hardly be due to the lack of bread in the diet, as these cases on account 

 of considerable ketonuria could not long have been kept on a carbohydrate- 

 free diet, and the diet was in addition always very rich in cellulose (vegetables) . 



I would further mention here an observation which I have likewise not 

 been able to find in the literature. We found in all severe cases of diabetes 

 in which the examination was made, a relative or absolute increase in the 

 mononuclear cells in the blood. As the total count of the leucocytes was 

 always normal, there always existed, then, a relative and absolute diminution 

 in the number of neutrophilic cells. It is possible that chemotactic influences 

 lie at the basis of this. If we regard -this as in connection with the spastic 

 obstipation, we could consider it as the expression of a high tonus of the 

 autonomous nerves. 



I would not leave the description of the manifestations of the vegetative 

 nervous system without mentioning a finding that probably belongs here. 

 In investigations carried out together with Newburgh and Nobel, we found on 

 the administration of thyroidin to nondiabetic individuals a reduction of 

 the fall of blood-pressure from heart to periphery. Investigations on the 

 blood-pressure in the brachial artery with Riva-Rocci's apparatus showed no 

 change, while the investigation at the finger with Gartner's instrument showed 

 in many cases a distinct fall of the blood-pressure. In the diabetics we found r 

 however, after the use of thyroidin a distinct, and in many cases, an appreci- 

 able increase in blood-pressure with both methods; this increase often out- 

 lasted the thyroidin medication for days. We could also observe this in 

 cases in the aglycosuric condition. It is very well likely that this increase 

 of blood-pressure is brought about through an enormously increased activity 

 of the chromafrin tissue. If this is so, it must be assumed that in diabetes 

 there exists an enormously increased excitability of this organ or of the nervous 

 centers regulating its activity. 



Also the erethism of the vessels of the skin speaks for an increased ex- 

 citability of the vegetative nerves. The red face of the diabetic; lending as 

 it does such a characteristic appearance to the advanced case, is well known. 

 Also there mostly exists distinct dermographism. On exposure the skin 

 often reddens to far over the trunk. It is known that the skin of the severe 

 diabetic is often very dry on account of the severe draining of the dry body of 

 its water, yet there do not rarely occur sweats, even in cases that show no 

 manifestations of a complicating tuberculosis of the lungs. 



