558 DISEASES OF THE INSULAR APPARATUS OF THE PANCREAS 



glycosuria is associated in any way with the trauma. In many cases of 

 head injury the glycosuria starts in simultaneously with pronounced polyuria. 

 Usually both develop at the same time. If the glycosuria later disappears, 

 the polyuria often lasts for many months, in other cases the polyuria develops 

 first, and the glycosuria accompanies it only after weeks or even months. 

 The central origin of such polyuria is very probable. On it is based the hy- 

 pothesis of a central origin of the glycosuria. In any case the similarity 

 with the sugar and polyuria puncture is worthy of notice. 



The second question concerns itself with whether glycosurias after 

 trauma that does not affect the head, but other parts of the body, can be 

 referred to the trauma and can be regarded as nervous glycosurias. Kausch 

 himself has furnished noteworthy contributions to this subject. He described 

 twelve cases of fractures of the pelvis, thigh, leg, patella, or toes, that showed 

 ephemeral glycosuria. This glycosuria continued for at most ten days and 

 under circumstances, on the ingestion of grape-sugar, would be increased to 

 30 gm. It is worthy of remark that these cases later did not show any alimen- 

 tary glycosurias and therefore presented an entirely normal carbohydrate 

 metabolism. Before Kausch, Haedke has already pointed out that after 

 traumata of different kinds alimentary glycosurias would be obtained in a 

 large percentage. The connection of such transitory glycosurias with trauma, 

 in cases that are not narcotized, is doubtless. Experimental pathology (gly- 

 cosuria after injury to the sciatic, etc.) gives us an idea as to the kind of con- 

 nection. Very much severer is the significance in a series of cases, of which I 

 shall quote the following cases of Scheuplein more exactly. 



A young soldier who was not hereditarily predisposed to diabetes fell 

 about 12 meters from a third-story window. He fell on his buttocks. 

 There was found a luxation of the first lumbar vertebra, without there being 

 symptoms that pointed to an injury of the spinal cord. Reposition was suc- 

 cessful; complete cure resulted, so that later the patient could again ride and 

 carry on severe bodily labor as menial servant [in the army]. Fourteen days 

 after the fall it occurred that the urine was much thinned and pale, and that 

 the feeling of thirst was distinctly increased. The urine contained sugar. 

 Ten days later the sugar-content of the urine was very great, and the amount 

 of urine reached about 13 liters. The patient was placed on a meat diet. 

 After fourteen days the sugar had disappeared, but the polyuria remained 

 for a while longer. Two years after the trauma the patient was entirely 

 free of sugar, although his diet consisted chiefly of cereals. The body weight, 

 that at the time of the sugar elimination had sunk very low, raised again so 

 that in short the patient could be regarded as cured in every respect. The 

 significance of this case is indeed not easy [to determine]. We could perhaps 

 think of an apoplexy of the pancreas, but against this speaks the simultaneous 

 diabetes insipidus. Against a hemorrhage in the medulla oblongata speaks 

 the absence of any other brain symptoms. Scheuplein discussed the possi- 



