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REPORT ON URINARY AND RENAL
By PROF. SAUNDBY, M.D., M.Sc., LL.D., F.R.C.P.
DR. LEO SCHWARZ. "Untersuchungen Ueber Diabetes.”
1. On the Relation of Acetone to Fat.-Formerly acetone was regarded as being due to the destruction of albumen, but later researches have attributed it to the breaking up of fat, and Grube showed that certain articles of fatty food caused more acetonuria than others; butter being one of the worst in this respect, while bacon fat was the best. The author finds that in healthy, well-nourished men the addition of fat to the diet causes only a very slight increase of acetone excretion, and even then occurs only exceptionally and after the ingestion of very large quantities of fat. It is possible that in some conditions, such as hunger, phosphorous poisoning, narcosis, carcinoma, and other diseases, acetonuria may be due to the breaking up of the body fat; yet all wasting diseases are not associated with acetonuria. In severe diabetes acetonuria may result from fat taken as food, but it is probable that it also results from the breaking up of the body fat when carbohydrates are withheld; the intestinal canal does not seem to be of special significance for the origin of acetone bodies. The total excretion of acetone by the urine and breath does not undergo important variations with constant diet. The proportion of beta-oxybutyric acid to the total excretion of acetone bodies is in certain cases very great, and may reach as much as 70 or more per cent. The higher members of the normal fatty acid series, palmitic and stearic acids, increase the excretion of acetone bodies less than butyric
and valerianic and caproic acids, while still less is the influence of the members of the oily series, oleic and erucic acids (C22, H42, O2.) These relations of the fatty acids are explained by the observations that butter causes a greater increase of acetone bodies than the fats formed from the higher fatty acids such as pork, beef fat, etc. No close quantitative dependence of acetone bodies upon the quantity of fat ingested can be determined. Oils appear chiefly to act through the volatile fatty acid which they contain. It is desirable therefore in the dietetic treatment of diabetes to forbid unlimited fat, and in accordance with the amount of acetone excretion to regulate the quantity of fat which each patient may be permitted to take.
2. The Action of Gluconic Acid.-Further observations have verified the statement that the excretion of acetone is diminished by the administration of gluconic acid.
3. Observations on Caramel.-Actual experiments show that caramel, which is formed by prolonged heating of sugar, may be administered to diabetics without increasing the glycosuria or diminishing acetone excretion.
4. The Effect of a Fasting Day.-In the treatment of diabetes it has been recommended by several authorities to order a fasting day from time to time, and the author's experiments show that such a day causes a great diminution in the amount of acetone, as well as in the quantity of sugar, and that it may usefully precede a change to a diet in which the carbohydrates are greatly restricted.
5. On the Changes of Acetone Bodies introduced into the Diabetic Organism.—Beta-oxybutyric acid is more incompletely destroyed by healthy persons abstaining from carbohydrates or by severe cases of diabetes than by fully nourished persons, while acetone undergoes little change either in diabetics or in normal individuals. Acetone, therefore, is not an intermediate product of physiological tissuechange, whereas for beta-oxybutyric acid this possibility cannot be excluded.
6. On Lipamia in Diabetes.-The amount of fat in the blood appears to be somewhat higher in severe cases of diabetes than in non-diabetic persons. Lipæmia occurs in severe diabetes on a fat-free diet and apart from coma, and may exist for a long time without giving rise to symptoms. Its presence appears to be connected with the excretion of large quantities of acetone bodies. The absorption of large quantities of fat causes, as a rule, alimentary lipæmia in severe cases of diabetes. The blood can be lipæmic without containing an abnormal quantity of fat, so that it is probable that diabetic blood is deficient in lipolytic power.
7. On Lævulose.-Lævulose has been shown to be present in a relatively large number of diabetic urines. In two cases this was dependent upon the use of carbohydrates, but in others no such relation was observed. It does not appear to be always more easily assimilable than grape sugar, as has been hitherto believed. In a non-diabetic patient spontaneous lævulosuria has been observed without being accompanied by glycosuria.
Note. The author frequently refers to the Seliwanoff's reaction as a test for lævulose. It is given in Cohn's “Tests and Re-agents" as follows:-"An aqueous solution of resorcin and fructose (lævulose) becomes red on being heated with HCl., and furnishes a precipitate which dissolves in alcohol with a red colour. Cane sugar, invert sugar, and
mellitose behave similarly.
F. W. PAVY and B. L. SIAU. "The Influence of Ablation of the Liver on the Sugar Contents of the Blood." The Journal of Physiology. Vol. XXIX. Nos. 4 and 5, June 15, 1903.
The much-quoted statement of Bock and Hoffmann, that on shutting off the liver from the circulation the sugar quickly falls and disappears altogether within three-quarters of an hour, stands at variance with later observation.
The authors' results agree with those of recent observers in showing that even after the lapse of some hours the lowest point reached by the sugar is about 0.5 per cent. They also
show a great irregularity in the amount of fall in different experiments and much variation in the rate of fall at different periods of an experiment.
The quantity of sugar lost, looked at as a source of energy, is too insignificant to have from this point of view any physiological import.
F. W. PAVY, T. G. BRODIE, and B. L. SIAU. “On the Mechanism of Phloridzin Glycosuria." The Journal of Physiology. Vol. XXIX. No. 6, June 16, 1903.
1. In confirmation of Zuntz, injection of phloridzin into the renal artery of one kidney produces glycosuria from that kidney prior to and to a greater extent than from the other.
2. Perfusion of a surviving kidney with blood containing phloridzin produces a diuresis, accompanied with the presence in the urine of a notable amount of sugar, which is not to be accounted for by the disappearance of sugar that occurs from the blood.
3. Intravenous injection of phloridzin produces glycosuria after ablation of the abdominal viscera (necessarily the kidneys excepted), and the elimination of sugar persists after the blood sugar has fallen to the lowest level that is noticed to
4. The sugar excreted under these circumstances may far exceed that existing in the circulating blood.
5. The fall in blood sugar observable after simple ablation of the viscera undergoes no variation with the supplemented administration of phloridzin, notwithstanding the associated glycosuria.
6. The hitherto proposed theories of phloridzin action fail to meet the requirements of the conditions existing.
7. Under the view propounded by the authors, the glycosuric effect of phloridzin is attributable to a specific action exerted upon the cells of the renal tubules by which they acquire the power of producing sugar. They consider that under the influence of the presence of phloridzin these cells exert a katabolising action upon something reaching them from the blood, resulting in the liberation of dextrose in a manner comparable to that by which lactose is set free by the cells of the mammary gland.
A. LORAND. "The Influence of Nervous Shock in Diabetes."
St. Petersburg Med. Woch. No. 22, p. 223.
The influence of violent emotion in causing glycosuria is well known, and it is only suspected that fright may aggravate diabetes when already established. A barrister came to Carlsbad with 0.3 per cent. of sugar in his urine. Next day, when he heard that he had lost half his fortune, it was 5 per cent. A case of mild diabetes of many years' duration fractured his clavicle; acetone and diacetic acid appeared, and fatal coma rapidly supervened. The wife of a barrister, aged 35, narrowly escaped collision with an electric tram-car; she was frightened, and felt tired and weary when she got home. Five days later thirst and polyuria appeared, and 7 per cent. of sugar was found in the urine. She died comatose within a year of the occurrence. A girl aged 16, while returning from school after dark, was pursued by a man; she escaped, and arrived home breathless and terrified. Next day she complained of weakness and dryness in the throat. She became emaciated and weak, and six months after the fright the urine was found to contain sugar; in spite of treatment she died comatose a few months later.
LANCEREAUX. "Pancreatic Diabetes: Its Lesions and Nature." Bulletin de l'Académie de Médecine, 28th June, 1904.
In this communication Prof. Lancereaux maintains that pancreatic diabetes is synonymous with wasting diabetes, and has special features about which there can be no mistake. These features he gives as, the sudden onset, the great thirst and hunger, the large quantity of urine, the great excess of sugar, and the rapid loss of flesh and strength, but while these symptoms are constant the naked eye changes in the pancreas may vary from fibroid atrophy to fatty change, or to little that can be recognised. It is, however, on microscopical examination that the essential alteration can be seen in the Islands of Langerhans. He claims for Dr. Laguesse priority for the suggestion as early as 1893, that these structures were the source of the internal secretion of the gland, and their