554 DISEASES OF THE INSULAR APPARATUS OF THE PANCREAS 



paralysis had developed. During the next few weeks, the sugar following 

 exclusive meat diet fell to i per cent., but the polyuria had decreased but 

 little. Two months after the trauma traces of sugar were still present, one 

 month later the urine in spite of abundant ingestion of food was entirely 

 free of sugar, but there still existed a diuresis of 4-6 liters, with a specific 

 gravity of 1005. Nothing was noted, unfortunately, as to the further 

 course. The supposition of a hemorrhage in the medulla oblongata, that 

 became still more marked some time after the trauma, is very probable in 

 this case. 



Entirely similar is the case of Plagge. A sixteen-year-old boy suffered 

 a head injury, after which amblyopia and strong glycosuria commenced. 

 The glycosuria disappeared after two or three weeks, while the polyuria 

 remained for two or three months. 



Further I might still mention the case, of Loeb. In the first case (pontile 

 hemorrhage with rupture into the fourth ventricle and with general arterio- 

 sclerosis) sugar and albumin were found in the urine. The urine had been 

 examined previously and found to be free of sugar. In the second case 

 there occurred after an apoplexy (probably small hemorrhage of the pons) 

 sugar and albumin in the urine. 'All manifestations later vanished leaving 

 not a trace behind. Loeb regards the albuminuria as conditioned centrally. 



In addition to the hemorrhages, it is chiefly tumors and abscesses in this 

 region that can lead to glycosuria. The case of Iwan Michael is much cited. 

 In a twenty-five-year-old man there occurred, together with increasing weak- 

 ness and tormenting headache, polyuria, polydipsia, and glycosuria. The 

 amount of urine reached over 6100 cubic centimeters, the elimination of 

 sugar reached to 25 mg. Death in coma followed later. Autopsy showed a 

 cysticercus racemosus of the floor of the fourth ventricle. Steida reports on 

 the contrary a case of cysticercus racemosus of the fourth ventricle which, 

 in spite of changes in the floor of the ventricle, did not call forth glycosuria. 



Of the other changes in the floor of the fourth ventricle associated with 

 glycosuria have been observed tubercle (de Jonge) sclerosis, abscesses and 

 tumors (especially gliomata). The changes may also affect the vicinity of 

 the cerebellum. The first glioma was reported by Nevrat-Perrotton; other 

 cases are described by Reimer, Catola and others. Especially worthy of 

 remark is the case of van Ordt. It concerned an eight-and-one-half-year-old 

 girl in whom no sugar was found at the beginning of the illness. The test 

 for alimentary glycosuria was first positive on the aggravation of the tumor 

 symptoms, then 3^ per cent, of sugar occurred in the urine, then on limita- 

 tion of the carbohydrates in the diet the sugar disappeared, later to reap- 

 pear also on a strict diet to' the extent of % per cent. The autopsy, in addi- 

 tion to showing several miliary tubercles on the floor of the fourth ventricle, 

 revealed a tumor in the territory of the posterior corpora quadrigemina, the 

 pes cerebri, and the tegmentum of the pons, which also involved the floor of 



