96 LECTURE V. 



The assumption that in some way or other the muscles have lost the 

 power of preparing sugar for consumption does not explain the cause of 

 diabetes, for the real beginning of the chain of disturbances which con- 

 stantly brings into play new effects is not, it is certain, to be attributed 

 originally to a faulty combustion of sugar; in fact, the combustion of 

 sugar is not entirely lost in the organism of diabetics. We come back 

 here, as in the case of most disturbances in metabolism, to the individual 

 cells themselves and their dependence upon the nervous system. Even 

 if we attribute the breaking down and formation of glucose entirely to 

 the action of ferments, we fail even then to get around the responsibility of 

 the cells, for it is they which form the ferment, and the production of the 

 latter seems in many cases to be dependent upon nervous influences. 

 Now if, furthermore, we add to this the fact that many ferments are 

 known which are secreted by the cells in an inactive condition, and are 

 only activated by means of a second ferment produced by other cells 

 often those of another organ then it becomes easy for us to understand 

 how disturbances may originate at countless places in the whole mechanism. 

 These all together may accomplish the final effect, namely, a glucohemia 

 in consequence of the non-consumption of a part at least of the glucose, 

 whether on account of a disturbance in the nervous system, or the fact that 

 the activating agent (perhaps furnished by the pancreas) is lacking, or 

 whether it may be because the muscular cells themselves are diseased. 

 In discussing these possibilities, it must be brought forward once again 

 that in glucohemia we have merely a symptom, a consequence and not a 

 cause, which without question, by means of the resulting changes in the 

 composition of the tissue and of the blood, may effect all sorts of secondary 

 disturbances, and which again, by a continuous circulus vitiosus, tends to 

 diminish the life energy of the body cells and aggravate more and more 

 the nature of the disease. In investigating the causes of pathological 

 phenomena, the endeavor must be more and more to study the purely 

 functional disturbances on the basis of biological experiments, for doubt- 

 less such may be present without there being any indication of mor- 

 phological changes discernible by present methods of investigation. 



We have learned to consider glucosuria as an essential symptom of all 

 forms of diabetes. It can attain quite remarkable proportions: in a 

 single day as much as a kilogram (2.2 pounds) of sugar may be eliminated. 

 Besides glucose we occasionally meet with an elimination of other kinds 

 of sugar; for example, fructose and certain pentoses. Furthermore, in 

 the urine of diabetics, often higher molecular sugars, such as maltose and 

 dextrin-like compounds, have been detected without our being able to 

 draw any conclusions from the occurrence of these products of an evidently 

 incomplete combustion, as to the nature of the disturbance in the metab- 

 olism of carbohydrates. In severe cases of diabetes the urine has a 



