100 LECTURE V. 



found in the urine. 1 The general symptoms during coma diabeticum, as 

 Walter 2 showed, have great similarity with those observed during experi- 

 mental acid poisoning. He injected dilute hydrochloric acid into the 

 stomach of rabbits animals which, in contrast to all other animals which 

 have been investigated, are not able to combat acid by the formation of 

 ammonia and dyspnoea soon appeared. The carbonic acid content of 

 the blood was greatly lessened, and the ammonia in the urine considerably 

 increased. By subcutaneous introduction of bicarbonate of soda the 

 symptoms were relieved, and the animal revived. 



The formation of these acetone bodies is not restricted to diabetes. It 

 takes place also under certain conditions in all the different kinds of 

 glucosuria. There is always some disturbance in the metabolism of carbo- 

 hydrates, but there is not necessarily a direct relation between the two 

 symptoms. It must not be forgotten that actually such a deep-seated 

 disturbance of metabolism as exists both in the mild and chronic forms 

 of glucohemia can never exist by itself, i.e., be limited in its effect to one 

 class of substances. Since the metabolism of the organism may be traced 

 back eventually -to the metabolism of its cells, it is easy to see how much 

 the whole metabolism must suffer if one group of its most important 

 nourishing and building materials becomes afflicted. It is readily 

 comprehensible that in the course of time the metabolic disturbance 

 becomes general, and the metabolism of the fats and albumins suffers as 

 well. It is from this point of view that we must regard the patient suffer- 

 ing from a severe type of diabetes, in order to get some idea of the whole 

 scope of the disturbance. It is not alone the loss in energy which goes 

 on during the constant carrying away of large amounts of sugar, and 

 which indeed may be compensated to some extent by other food-stuffs, 

 that governs the whole disease and makes it so serious, but the general 

 derangement of the entire metabolism. The abnormal composition of 

 the blood and of the lymph gives rise to many secondary phenomena, 

 the resistance of the tissues and cells to infection is diminished (the num- 

 erous tissues furnish a favorite nutriment for certain forms of life 

 furunculi, colonies of aspergilli, etc.) and thus one trouble follows another, 

 eventually giving to the disease of diabetes its peculiar characteristics. 



1 Abderhalden: Z. physiol. Chem. 44, 17 (1905). 



2 Arch, exper. Path. Pharm. 7, 148 (1877). 



