GENUINE DIABETES MELLITUS 543 



Finally I would mention a group of diabetics in whom the conditions 

 of hyperexcitability and hyperirritability of the sympathetic nervous system 

 are still more prominent. These are for the most part diabetics in middle 

 life, who overwork much and who in their occupations are exposed to great 

 excitements and cares; moreover, they may have sustained traumas. Psychic 

 excitements are here an important factor in the influencing of the glycosuria. 

 The blood-pressure is often raised not inappreciably, but in spite of this, 

 traces of albumin are found only transitorily, and here and there is seen an 

 entirely isolated cast. In such cases, adrenalin acted glycosuric in the 

 aglycosuric state; the Lowi's reaction was positive. We may perhaps desig- 

 nate these cases as hypertonic diabetes. 



As example I cite the following case: 



Observation LXIX. G. K., forty-eight years old, conductor; entrance into the first 

 medical clinic on Sept. 6, 1912. In the year 1904 the patient suffered a train injury. 

 In it he was thrown to the floor, and the right thigh was contused. In July, 1910, he fell 

 from a wagon, immediately after which he had the sensation as if something internal had 

 torn. Since this time, always sensitiveness to pressure in this region, and very nervous. 

 In 191 1 unquenchable thirst with decrease of the previous appetite. The skin was dry, the 

 potentia coeundi fell off very much. On entrance there was found 3.7 per cent, sugar and 

 a distinctly positive acetone reaction. The sugar-elimination after the ingestion of 75 gm. 

 of roll and a third of a liter of cream was about 80 gm. dextrose, the excretion of acetone 

 was about 3 gm. On withdrawal of carbohydrates the sugar sank rapidly, the oat-meal 

 treatment that was instituted brought about only traces of sugar, the acetone disappeared. 

 The tolerance rose very quickly, so that after six weeks the patient bore 60 gm. roll, 30 gm. 

 rice, and 60 gm. potato Without excretion of sugar. 



The amount of urine during the sugar-free period was also appreciably increased. 

 Mostly there were values of 2000. At the beginning also values between 3000 and 4000. 

 The specific gravity was raised only in the first day. Then it sank quickly to about 1010, 

 and later showed great variations; it mostly lay low, around or lower than ioio,and tem- 

 porarily would increase to 1020. 



The patient was very excitable, the patellar reflexes were lively, the blood-pressure was 

 high, varying according to measurements by the Riva-Rocci apparatus between 130 and 

 150. Correspondingly the arteries showed increased tension, but there were no signs of 

 arteriosclerosis. The heart dulness was broadened to a slight extent toward the left. In 

 the urine was found on repeated examinations at most minimal traces of albumin. No 

 casts were found in the centrifugated fluid. Lowi's reaction was positive. 



In the aglycosuric condition i mg. of adrenalin was injected many times. Regularly 

 there occurred a not inappreciable elimination of sugar, once to 6 gm., in the hours after 

 the injection. One of these experiments took place at the time that the tolerance of 

 the patient was already essentially increased. Further the diuretic action and especially 

 the action on the heart and vessels was strongly marked. In the experiment mentioned 

 the blood-pressure rose to 180. 



The investigation of the respiratory gas-exchange (Dr. Bernstein) always showed nor- 

 mal COz production, and mostly an increased Oz consumption. The gas-exchange after 

 an adrenalin injection was investigated twice. Both times the oxygen consumption and 

 carbonic-acid production rose strongly, but the respiratory quotient was not influenced. 

 I cite the following experiment as an example: 



