THE VARIOUS FORMS OF DIABETES 81 



terminate in recovery. As a result of trauma of the brain we note cases of 

 diabetes that are severe, even very severe; then there are cases which run a 

 milder course similar to those of Schmitz and Zinn mentioned above; finally, 

 there are cases after cerebral injuries, in which transitory glycosuria, without 

 any further consequences, occurs and lasts but a few days. What right have we 

 to deny that these transitory glycosurias represent the mildest forms of dia- 

 betes mellitus ? The same lessons which are taught us by the study of diabetes 

 after cerebral injury in the human subject are paralleled as regards pancreatic 

 diabetes by experiments upon animals; extirpation of the pancreas produces 

 the most severe forms of chronic diabetes; transitory lesions of the organ 

 produce mild ephemeral glycosuria. 



In my opinion we must admit that diabetes may occur as an acute affec- 

 tion, and this conclusion has some practical importance; spontaneous, true, 

 acute diabetes is certainly very rare, but transitory, spontaneous (?) gly- 

 cosuria may be explained in this manner : 



Although the course of the disease is for the most part chronic, the con- 

 ditions are not accurately designated if we call diabetes " a chronic disease " ; 

 in the majority of cases there is an innate hereditary predisposition, a weak- 

 ness of sugar metabolism, which, sooner or later, in combination with other 

 causes, or even without such, may lead to insufficiency of sugar metabolism 

 and thus give rise to the disease. 



According to this, three forms of the disease may be differentiated: 



1. Diabetes mellitus of young individuals (those between thirty and forty 

 years of age) ("pure diabetes"). 



In this form the hereditary weakness of sugar metabolism, without the 

 association of any special disease of an organ, progresses to insufficiency. 

 This occurs at an early period of life, owing to a particular severity of the 

 pathologic predisposition, and, in keeping with this, the cases are for the most 

 part serious. 



2. Diabetes of the aged, the usual mild diabetes of old persons ; the saying 

 that " the age of an individual depends upon the condition of his arteries " 

 is also true in these cases; usually, arteriosclerosis is the underlying condi- 

 tion and with this all factors are operative which favor its development; lux- 

 urious living and, above all, the use of alcohol. 



It is readily seen that the least severely predisposed cases are the ones in 

 which this form of diabetes is most likely to appear; perhaps this accounts 

 for its relatively mild course. 



3. Organic diabetes; this refers to eases in which disease of a particular 

 organ is the immediate cause of the affection. As examples, there may be 

 mentioned: (a) among the diseases of the liver, cirrhosis and, rarely, chronic 

 cholelithiasis; (b) among diseases of the nervous system, apoplexy, chrome 

 encephalomalacia, cerebral syphilis, dementia paralytica, tabes dorsalis, cere- 

 bral trauma of all kinds, the various functional neuroses, particularly the trau- 

 matic ones, and paralysis agitans; (c) diseases of the thyreoid gland (Graves' 

 disease), and (d) diseases of the pancreas. 



Experimental evidence would seem to show that the pancreas takes the 

 first position among the organs which cause diabetes, since by extirpation or 

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