PATHOLOGICAL ANATOMY OF DIABETES MELLITUS 557 



surias occurring immediately after, or only a short time after the trauma, 

 and denies the connection between trauma and chronic diabetes, especially 

 when the latter first occurs a long time after [the accident]. I believe 

 that we must consider Kausch right in many points, even if perhaps he goes 

 too far, in the separation of the ephemeral or transitory glycosurias and 

 chronic diabetes. It seems to me appropriate to go a little further into the 

 points [just] previously sketched. I am not regarding the responsibility 

 serving for the law for accidents. Naunyn and v. Noorden mention that one 

 must not be too narrow-minded, as considering the obscurity of the condi- 

 tions, individuals should not suffer harm on account of theoretical considera- 

 tions. The scientific side of the question, however, demands a much stricter 

 criticism. 



Now as regards what concerns the first point, we can ascribe, with con- 

 siderable justification, diabetes after head injury to the injuries of the nervous 

 centers regarding sugar-metabolism, when the elimination of sugar occurs 

 within the first eight to fourteen days and especially when, too, other symptoms 

 are present that indicate an injury to the brain stem and medulla oblongata. 

 I have mentioned in brief several such cases on page 553. As further examples 

 I would cite both cases of Bouchard. In a seventeen-year-old and twenty- 

 one-year-old man respectively there occurred, after fracture of the base of the 

 skull glycosuria to 1.5 per cent, and 1.75 per cent., and albuminuria and cylin- 

 druria. The first case healed entirely, but the second case died after some 

 days. If no brain symptoms are otherwise present, we cannot, however, 

 deny without anything further the connection with the trauma. Very in- 

 teresting is the observation of Honiger that new-born infants whose heads have 

 been strongly squeezed by the artificially induced birth, can show glycosuria 

 for several days, while the long duration of a spontaneous birth never leads 

 in itself to glycosuria. 



If the glycosuria starts in a longer time after the trauma, we can here also 

 not deny the connection with trauma in every case without anything further. 

 It is conceivable that blood effusions that are undergoing absorption in organi- 

 zation, may exercise an irritation in the corresponding centers through shrink- 

 age and the action of traction (Rosenberger) . Of course this would hold only 

 for very few cases. We may regard that of Schaper as such a one. In a duel, 

 a dagger thrust penetrated the orbit and went deep into the cranial cavity. 

 There developed a right-sided paralysis and gradually a high-grade diabetes. 

 Death occurred after three and a half months; it was found that the path of 

 the stab reached to the left border of the medulla oblongata and was filled 

 with pus and coagulated blood. There should finally still be thought of, in 

 such cases of later glycosuria, the spontaneous glycosuria of the traumatic 

 neurosis. We shall consider this latter in the discussion of the connection of 

 psychoses or psychic excitements with glycosuria. The fact whether there 

 is polyuria is important in the solution of the question as to whether the late 



