DR. PAVY AND DIABETES 29 



Bernard, who, of course, had no reasons in his day to consider 

 such possibilities. It is by no means surprising that an in- 

 vestigator's views should be modified with the process of time 

 but it is striking to find that Pavy, in spite of his modified 

 attitude towards the facts, held to the end, as his latest writings 

 show, that the glycogenic doctrine is " mischievous." If in any 

 sense it be so, it is clearly not because it is in essence wrong 

 but because, as originally formulated and as generally under- 

 stood, it allots to the liver too large a share in the initial stages 

 of the metabolism of carbohydrates. When the matter is 

 narrowed down to this quantitative issue, Pavy's views are 

 seen to be special and, maybe (even if we cannot admit the 

 lymphocyte theory), are also right. 



The Utilisation of Sugar in the Body 



I have so far dealt with one aspect alone of the metabolism 

 of carbohydrades and have only discussed the fate of carbo- 

 hydrate of the body before its utilisation, as a source of energy 

 or otherwise, has begun. Of the processes associated with utilisa- 

 tion nothing has been said. When the views of Pavy are under 

 discussion, the attention is inevitably directed more particularly 

 to these earlier stages of metabolism, because he was himself 

 almost entirely preoccupied with them. He was concerned 

 to explain the nature of diabetes and he held that the ab- 

 normality producing that disease was to be sought among the 

 anabolic or assimilative stages of metabolism. In the diabetic 

 organism, he held, catabolic and oxidative processes may be 

 wholly normal. To him the question of right or wrong in the 

 metabolism of carbohydrates was in its broadest aspects a simple 

 one : the normal body converts its carbohydrates into complexes 

 immediately it receives them and sugar never circulates as such. 

 In the errant organism the initial synthetic assimilative functions 

 fail, sugar circulates as such and passes the kidney and this cir- 

 cumstance constitutes the essence of the diabetic condition. The 

 general view is more comphehensive. The error, it is held, may 

 also be on the other side of metabolism ; the body may be 

 diabetic because it fails to grip its sugar at the locus of utilisa- 

 tion. In any case, we have to consider that other region of 

 metabolism. 



In 1889 von Mering and Minkowski presented a gift to 



