80 DIABETES MELLITUS 



the puerperal state, we must know that this has nothing to do with diabetes. 

 As an example of true glycosuria appearing spontaneously in man, yet not 

 the expression of diabetes, I can only mention the form occurring in cholera 

 asiatica and cholera nostras. 



All other forms (unless proofs are present to the contrary) should be 

 looked upon as diabetic ; but we need to know what is meant by diabetes, i. e., 

 the disease of this name as it occurs in the human subject. 



II. THE VARIOUS FORMS OF DIABETES; 

 DIABETIC PREDISPOSITION 



Acute Diabetes, the Acute Form Terminating Fatally and the Acute Form Resulting 

 in Recovery — Transitory, Nervous (Cerebral Trauma), and Pancreatic Glycosuria 

 Representing the Shortest Course of Acute Diabetes Mellitus Terminating in Recovery. 

 Chronic Diabetes Mellitus as an Expression of an Hereditary Predisposition. Its 

 Three Varieties: (a) The Pure Form, (b) Diabetes of the Aged, and (c) Organic 

 Diabetes Mellitus. Etiology of Diabetes Mellitus and the Possibility of its Cure in 

 the Light of Hereditary Predisposition — the Heredity of Diabetes Mellitus. One Form 

 or Several Forms of Diabetes? 



Diabetes is generally considered a chronic affection, but it may take an 

 acute course and be either rapidly fatal or readily curable. 



Well studied cases with an acutely fatal course have been reported; for 

 instance, Wallach reports the case of a chemist who was accustomed to make 

 weekly examinations of his own urine. The urine was always free from sugar 

 until suddenly a severe glycosuria appeared, and within five weeks the man 

 died in diabetic coma. 



The question of acute cases that terminate in recovery is less simple. 



Schmitz reports the case of a four-year-old child of a diabetic mother. 

 The anxious mother had the urine of the child examined frequently, and it 

 was always free from sugar up to November 22, 1871. On ISTovember 26th, 

 the child was attacked by a gastric fever, and on the 27th the sugar contained 

 in the urine amounted to 5.8 per cent. The child was put upon strict diet, 

 and on the 13th of December the urine was again free from sugar. Although 

 the patient gradually returned to the usual saccharine and amylaceous diet 

 the urine remained normal for twenty years. Whether it is correct to say 

 that the diabetes had already been cured upon the 13th of December is at 

 least very questionable, for at that time, and for a long period afterward, the 

 child lived upon a very strict diet, which later was even moje restricted, so 

 that very little was expected from its carbohydrate metabolism. On Decem- 

 ber 13th, the recovery was probably only relative. 



Zinn observed a child attacked by diabetes mellitus after scarlatina; the 

 patient, after ten weeks, even upon " mixed diet " showed no sugar in the 

 urme; unfortunately the observations in regard to the recovery were only 

 continued for a few months. 



Similar conditions may be observed in all cases of true diabetes in which 

 recovery takes place. 



Diabetes after cerebral injuries also occurs as an acute disease which may 



