PATHOLOGICAL ANATOMY OF DIABETES MELLITUS 559 



bility of an injury of the solar ganglion. To me the possibility seems in any 

 case to be thought of that on account of the great swelling formed by the 

 injured vertebra there followed an irritation of the sympathetic paths in 

 their course from the sugar center to the suprarenals. By this means can 

 be explained even the polyuria. Scheuplein also refers to a case of Braun. 

 In a twelve-year-old boy there existed a spondylitis of the twelfth thoracic 

 and first lumbar vertebrae with an acute-angled kyphosis. When the boy 

 was placed in a horizontal position, symptoms of collapse, with polyuria 

 and glycosuria, developed. Comfortable lying on roll pillows brought about 

 a cessation of all manifestations. Also I must not leave unmentioned the 

 case of Schwenkendick. A man sustained a tread of a foot in the vicinity of 

 the navel. After some hours great thirst and polyuria started. Two days 

 afterward there occurred stormy manifestations, marked pallor of the face, 

 coldness of the extremities, distention of the abdomen, frequent vomiting. 

 The urine was at first free of albumin and sugar, after two days more there 

 was found 4.75 per cent, of sugar and abundant acetone. Later the patient 

 evacuated black stools that contained blood, and death soon followed under 

 manifestations of coma. The author thinks of apoplexy of the pancreas 

 or necrosis of the pancreas as an affection of the splanchnic nerves. 



It is possible that in the setting free of this glycosuria, pain plays a con- 

 siderable role. For instance, it has been known for a long time that in severe 

 neuralgias there exists inclination to alimentary glycosuria. Frerichs reports 

 such a case; in a forty-eight-year-old man there occurred, after a cataract 

 operation, at the same time as severe neuralgic pains of the right half of the 

 face, sugar in the urine up to 2% per cent. As the pains ameliorated, the 

 sugar disappeared and ten years later the man was still sugar-free. It is also 

 known that cases of sciatica, especially those with frequent attacks, frequently 

 show alimentary glycosuria. H. Strauss found [urines tested for alimentary 

 glycosuria] in three cases positive, and then when the painful attacks were 

 over, negative in the same patients. Much cited is also the case of Frerichs, 

 concerning a shot injury of the sciatic nerve with severe attacks of pain, 

 during which sugar always appeared in the urine. As the suffering amelio- 

 rated the sugar disappeared entirely. It might be possible that in such cases 

 the irritation passes away along the sympathetic nervous system through 

 irradiation. We do not know certainly as yet as to whether longer con- 

 tinuing glycosuria may originate through involvement of the splanchnics 

 or the great ganglia of the sympathetic as the result of chronic inflammatory 

 processes impaction in hard tissue, hemorrhages, etc. In the cases of long 

 continuing glycosurias of high grade known up to the present time, and 

 previously detailed, the associated involvement of the pancreas or the centers 

 in the brain stem through the violent concussion cannot be excluded entirely. 



I now turn, finally, to the third question, whether in the wake of a trauma 

 a chronic or eventually a later recurring diabetes on a nervous foundation, 



