OH. xxxiii.] DIABETES. 5 1 1 



temporary glycosuria, but the most interesting and powerful 

 of these is phloridzin. The diabetes produced is very intense. 

 Phloridziu is a glucoside, but the sugar passed in the urine is too 

 great to be accounted for by the small amount of sugar derivable 

 from the drug. Besides that, phloretin, a derivative of phloridzin, 

 free from sugar, produces the same results. 



Phloridzin produces diabetes in starved animals, or in those in 

 which any carbohydrate store must have been got rid of by the 

 previous administration of the same drug. Phloridzin-diabetes is 

 therefore analogous to those intense forms of diabetes in man in 

 which the sugar must be derived from protoplasmic metabolism. 



Acetonaemia. Death in diabetic patients is usually preceded 

 by deep coma, or unconsciousness. Some poison must be pro- 

 duced that acts soporifically upon the brain. The breath and 

 urine of these patients smell strongly of acetone ; hence the 

 term acetoncemia. This apple-like smell should always suggest 

 the possible onset of coma and death, but it is exceedingly 

 doubtful whether acetone (which can certainly be detected in the 

 urine) is the true poison ; ethyl-diacetic acid, which accompanies, 

 and is the source of the acetone, was regarded by some as the 

 actual poison, but these substances, when introduced into the 

 circulation artificially, do not cause serious symptoms. The 

 actual poison is a matter of doubt ; the idea most in vogue at 

 present is that it is amido-hydroxybutyric acid, which is dis- 

 coverable in the blood and urine of the patients who die from 

 so-called acetoiuemia. 



The Nerves of the Liver. 



Claude Bernard observed that an increase of sugar in the blood 

 is brought about by stimulation of the central and peripheral 

 ends of the divided vagus, and that on the section of both vagi 

 sugar disappears from the blood, and glycogen from the liver and 

 tissues generally. These results have been confirmed in recent 

 experiments, and it has been in addition found that stimulation 

 of the ceeliac plexus also leads to a loss of glycogen in the liver, 

 with a corresponding production of glucose that passes into the 

 blood. The disappearance of glycogen from the liver cells after 

 the stimulation of these nerves can also be seen histologically 

 (Cavazzani). These results are due to a direct influence of the 

 nerves on the liver cells, for they are obtained while the circula- 

 tion is intact, or when it is stopped by a ligature of the aorta 

 and portal vein (Morat and Dufourt). 



Vato-motar nerves. The vaso-constrictor fibres for the portal 



