PATHOLOGICAL ANATOMY OF DIABETES MELLITUS 553 



I shall first select from the observations at hand those which seem to me 

 the most important, and describe them more exactly. 



Glycosuria occurs not infrequently in brain-hemorrhages and encephalo- 

 malacias. This was first described by Leudet. They may be associated with 

 acute hemorrhages as well as the chronic encephalomalacias. A case of the 

 latter sort is described by Naunyn in which the diabetes gradually developed 

 during a slowly progressing encephalomalacia. For the most part there 

 exists in addition to the glycosuria, polyuria, and also even albuminuria. 

 Cases of the first kind are communicated by Dutrait, Frerichs, and others. 

 The seat of the hemorrhage or softening in such cases associated with 

 glycosuria is mostly the pons or its vicinity. Especially interesting is the 

 case of Reinhold. In a sixty-three and one-half-year-old woman with 

 melancholia, ten days before death there developed a marked edema of the 

 feet and strong glycosuria. Section showed a hemorrhage on the floor of 

 the fourth ventricle (serial sections), slight hydrocephalus, and a strong 

 hyperemia of the liver. It should not remain unmentioned that glycosuria 

 is sometimes observed in the parts of the brain that lie further off, and that 

 cases occur in which there is no glycosuria in spite of hemorrhages in the 

 neighborhood of the pons. Such a case is reported by Lemcke. In this 

 case there was an enormous lowering of the body temperature to 23C. 

 There was found neither glycosuria nor albuminuria. Section showed a 

 fresh focus of hemorrhage beneath the floor of the fourth ventricle. 



It is an interesting fact that H. Strauss in tests for alimentary glycosuria 

 in cases with fresh apoplectic attack, several times found them positive im- 

 mediately after the attacks but they were negative later. In this category 

 belong too the cases of brain hemorrhage after trauma to the head. The 

 first case was described, by Claude Bernard (Physiol. experim., Tom. i, 

 1855). Glycosuria disappears at the same time as does the wound. 



Here also belongs the case of Drummond. A seventy-six-year-old man 

 suffered a blow on the head. Since that time increasing weakness, thirst, 

 and glycosuria. Autopsy showed besides an extreme dilatation of the 

 lateral ventricle and the aqueduct of Sylvius, a small blood effusion in the 

 fourth ventricle. 



I mention further the case of Kammitz. A seventeen-year-old girl, pre- 

 viously well, caught her head in a cutting machine. Loss of consciousness, 

 later vomiting, and copious bleeding from the nose, and downflow of blood 

 along the posterior wall of the pharynx pointed with certainty to fracture 

 of the base of the skull. The temperature at first was 35C. After two days 

 an abducens paralysis became evident. A week after the trauma there de- 

 veloped increased thirst, polyuria, and glycosuria (about i per cent, sugar). 

 The sugar-contents gradually rose to 2.3 per cent. There now existed excess- 

 ive polyuria. About three weeks after the trauma the somnolent condition 

 had disappeared, the diplopia still existed, and a unilateral hypoglossus 



