PATHOLOGICAL ANATOMY OF DIABETES MELLITUS 555 



the fourth ventricle. According to the judgment of van Ordt, this could have 

 been present only in the course of the last weeks. The pancreas was found 

 to be normal. According to van Ordfs statistics, glycosuria has been found 

 up to the present in 



Cerebral tumors i time 



Cerebellar tumors i time 



Basal ganglionic .tumors. 



Thalamic tumors 3 times 



Tumors of the corpora quadrigemina 3 times 



Dorsal pontile tumors 5 times 



Basal pontile tumors 



Tumors of the floor of the fourth ventricle 18 times 



If we take only those cases in which the floor of the fourth ventricle was 

 destroyed to a greater or less extent, we find that 70 per cent, of all these 

 cases are associated with glycosuria. Tests for alimentary glycosuria were 

 found positive five times in eleven cases of tumors of the interior of the skull, 

 three times in sixteen cases of other diseases of the brain (among them one 

 case of lues) . . It should be mentioned that abscesses of the cerebellum 

 very commonly lead to increase of temperature and glycosuria (Hammond). 



I believe that among the cases detailed as well as among numerous 

 analogous cases there are those which fulfill all the requisitions of a diabetes 

 conditioned nervously. It is true, as Naunyn says, that he has seen many 

 cases of apoplexy with glycosuria but that he could not exclude in these the 

 possibility that a slight diabetes did not exist beforehand. It must further 

 be said that exact examinations of the pancreas especially with reference to 

 the insular apparatus are scarcely at hand. We can, however, only with 

 difficulty conceive how in individuals with previously perfectly normal sugar- 

 metabolism, and especially in the youthful cases, so high grade a damage 

 to the pancreas can develop so suddenly. The parallelism in the develop- 

 ment of the glycosuria and the brain symptoms points much the more to 

 the fact that alterations in the nervous system have a decisive significance. 

 According to the experimental experience up to the present only the assump- 

 tion of an irritation of the nervous centers and paths as cause of the "nervous" 

 glycosuria is possible. It is therefore intelligible that pathological [altera- 

 tions in the neighborhood of the floor of the ventricle or the sub thai amic 

 region do not always necessarily lead to glycosuria. Irritation would 

 the sooner follow if tumors or apoplexies gradually encroach upon the 

 corresponding centers; rapid destruction of these centers on account of hemor- 

 rhage or softening would much rather lead to symptoms that are the opposite 

 of irritative symptoms. The case of Lemcke with considerable hypothermia 

 may be perhaps explained in the above way. I should like to point out 

 one point further, namely, the strong hyperemia of the liver in Reinhold's 

 case, which is seen regularly too after the piqure. 



