560 DISEASES OF THE INSULAR APPARATUS OF THE PANCREAS 



is conceivable. It seems to me that the possibility that a scar formation 

 exercising irritation on the centers regulating sugar metabolism cannot 

 entirely be ruled out, as I have already signified. But at all events severe 

 diabetes of year-long duration, that is progressive and eventually ends in a 

 coma, cannot be explained by it. If the diabetes after the trauma is chronic, 

 it is indeed very probable that a predisposition [Anlage] for diabetes has 

 existed beforehand. 



Although we, in the previously detailed cases of organic alterations of the 

 brain, must regard it as extremely unlikely that an acute alteration of the 

 pancreas should exist at the same time, this (factor) cannot be excluded in 

 those cases of brain syphilis which are also designated "nervous." The 

 cases are so interesting that I would like to discuss them. In 1860, Lendet 

 first described such a case. It was that of a thirty-two-year-old woman, who 

 four years previously had progressed as f-ar as the development of a "saddle 

 nose." In her there developed rather suddenly polyuria and polydipsia, un- 

 consciousness, paralysis of the eye-muscles, left-sided anesthesia, etc. In the 

 urine was abundance of sugar. On the institution of a potassium iodide treat- 

 ment the diabetes insipidus and glycosuria disappeared, and also the brain 

 symptoms ameliorated. Later, with a more recent aggravation of the brain 

 symptoms, polyuria occurred again, but not sugar. Autopsy showed that 

 the choroid plexus was adherent to the left border of the calamus scriptorius, 

 and the brain substance of this was "eroded." In the book by French 

 are reported three cases of lues with brain symptoms and in part associated 

 with very severe diabetes, in which diabetes disappeared under antiluetic 

 treatment, or, as in one case, improved considerably. Very instructive 

 cases are reported by Dub and Lemonier. I would like to mention more in 

 detail the case of Hemptenmacher. In a forty-two-year-old woman who had 

 been infected with syphilis thirteen years previous there developed, at the 

 same time with a polydipsia and pollakisuria, a left-sided hemiplegia with 

 severe headache. In the urine was found 3.6 per cent, of sugar. Under the 

 inunction treatment and potassium iodide the glycosuria gradually disap- 

 peared without the retention of an antidiabetic regime. Also the brain 

 symptoms gradually ameliorated, and later complete cure was obtained. 



In this and in other cases there without doubt exists a causal connection 

 between lues and diabetes. The occurrence of diabetes simultaneously 

 with tertiary luetic symptoms, the cure of diabetes by antiluetic treatment 

 without alteration of the diet alone allows of no other conclusion. On the 

 other hand the interpretation of the condition as nervous diabetes is entirely 

 uncertain, as a simultaneous alteration of the pancreas is not to be excluded. 

 It is true that never was the occurrence of absorptive disturbances mentioned, 

 but the fact cannot be excluded that the insular apparatus may alone have 

 been damaged in its function; the case of Manchot, moreover, that ran along 

 without brain symptoms showed likewise no absorptive disturbances. 



