DR. PAVY AND DIABETES 41 



the detailed steps in the transformation of amino-acids into 

 sugar. 



Sugar, then, can be excreted in diabetes in large quantity, 

 when carbohydrate, as such, is completely absent from the diet 

 and even when there is no longer a store of glycogen in any of 

 the tissues. I find it very difficult to appraise exactly the attitude 

 of Pavy's mind towards these facts, which can scarcely be 

 reconciled with his view that purely assimilative errors so 

 predominate in the picture of diabetes. The patient, it is true, 

 in a great number of cases of the clincial disease, ceases, or 

 nearly ceases, to excrete sugar, when carbohydrate is, as far as 

 possible, removed from his diet, a method of treatment closely 

 associated with Pavy's name. In such cases it is easy to believe 

 that the error is solely on the side of assimilation. But Pavy 

 was from the first, of course, familiar with the severer forms of 

 the disease in which sugar continues to appear whatever the 

 dietary. Until the quantitative work of recent years had been 

 done there was no definite proof that, even in these cases, 

 the sugar arises directly from protein and Pavy seems to have 

 been slow to admit that there was any but an assimilative error 

 even in the severest cases. Eventually he writes of a " faulty 

 tissue-breakdown " ; but seems, in some way, to reconcile the 

 facts with his fundamental view, by assuming that the circulation 

 of unassimilated sugar, which alone is present in the earlier 

 stages of the disease, is the actual cause of the disordered kata- 

 bolism of protein which may be established later. 1 When, in a 

 discussion concerning normal phenomena, he deals with the proof 

 that protein can yield sugar in the body in so large a quantity, 

 he merely uses it to support the view that sugar is incorporated 

 into protein during intestinal assimilation. 2 



A noteworthy circumstance characteristic of the diabetic 

 condition is that, though the tissues are bathed with a solution 

 of sugar stronger than that to which they are accustomed (for 

 in all forms of diabetes save that due to phloridzin, which is 

 dealt with later on, there is excess of sugar in the blood), there 

 is no inhibition of sugar-producing processes. One would 

 suppose, from considerations of chemical equilibrium, that these 

 processes would be automatically slowed. On purely teleo- 

 logical grounds and looking at the matter from the side of 



1 Carbohydrate Metabolism and Diabetes, pp. 114, 115 (1906). 

 8 Ibid. pp. 50-51. 



