556 DISEASES OF THE INSULAR APPARATUS OF THE PANCREAS 



The cases of diabetes after trauma here need a more exact analysis. We 

 have to consider the following points: 



1. Whether the diabetes began immediately or at least a short time after 

 the trauma, or after an interval of several months or years. 



2. Whether the trauma affected the head and whether other brain symp- 

 toms existed in addition to the glycosuria, or whether other parts of the 

 body were affected by the trauma. 



3. Whether the diabetes healed again, or whether it existed further or 

 relapsed; in short, whether a chronic diabetes developed. 



Concerning the frequency of these different factors several statistics are 

 at hand. Jodry (cited by Lepine} collected one hundred and forty-five cases 

 of diabetes after trauma. The trauma affected the head in seventy-two 

 cases 50 per cent. ; the vertebral column in twenty-seven cases 20 per cent.; 

 the abdomen in twelve cases 8 per cent.; the seat of the trauma was not 

 defined in 1.7 per cent. 



In a third of the cases, the diabetes became manifest during the first 

 days after the trauma. 



Lepine analyzed twenty-nine well observed cases from the literature and 

 added five cases of his own. The symptoms of diabetes appeared in the 

 first three days ten times; in the first week five times; in the first three 

 months twelve times; later seven times. 



Asher found among one hundred and twenty-nine cases of diabetes after 

 trauma fifty-four cases of injuries of the head; sixty-two cases of injuries 

 of other parts of the body; nine cases after injuries of an undefined kind. 



Higgins and Ogden among two hundred and twelve cases of head-injury, 

 found sugar in 9.3 per cent. If only the severest cases were considered, the 

 percentage rose to 23.4 per cent. 



Among eighty-four cases of simple wound of the scalp, sugar was found 

 in 5.95 per cent. 



Among forty-three cases of wounds of the scalp that laid bare [freilegten] 

 the bone, in 9.3 per cent. 



Among forty cases of concussion of the brain with loss of consciousness, 

 but without fracture, in 2.5 per cent. 



Among twenty-four cases with fracture of the vault of the skull, in 20.8 

 per cent. 



Among twenty-one cases with fracture of the base of the skull in 23.8 per 

 cent. 



The question as to the connection between trauma and diabetes has been 

 discussed in a lively manner. Ebstein and later Kausch collected the cases of 

 traumatic diabetes from tHe literature. While Ebstein inclines to the view 

 that also cases of chronic diabetes, eventually diabetes first occurring a long 

 time after the trauma may be ascribed to the trauma, Kausch is very 

 sceptical. He would hold as valid only the ephemeral or transitory glyco- 



