Ftuidional Disorders of the Liver. 419 



In ordinar}' cases of reflex glycosuria it may be assumed that 

 the existence of irritation at the peripheral ends of the vagus 

 and of some other nerves, leads to an apparent gl3'cogenic influ- 

 ence passing through these to the brain, and of the distribution 

 of the efferent impulse through the upper portion of the spinal 

 cord, as far as the fourth dorsal vertebra in the rabbit (Cyon, 

 Aladoff, Schiff), and through the sympathetic nerve to the liver. 

 This ma}' account for the appearance of the disorder as a sequel 

 of disease in any part to which the vagus in particular is dis- 

 tributed, and notably in the lungs. A number of poisons 

 (malarial, alcoholic, ether, carbon monoxide, amyl nitrate, 

 curare, or the nitro-propionic acid, methyl delphinin, morphia, 

 chloral h3'drate, arsenic, quinia, ammonia, chloroform, phosphoric 

 acid, and phlorizin ) produce glycosuria. 



The intravenous injection of dilute saline solutions, or frequent 

 blood letting materially increases the sugar, probably by causing 

 solution of the red globules. Phlorizin is the most potent of all 

 these agents. Whether given hypodermically or by the stomach 

 it causes in three hours a marked production of glucose which 

 continues to be eliminated for a period of thirty-six hours. The 

 urine may become charged with glucose to the extent of from 6 

 to 13 percent., and without au}^ rise in the body temperature. 

 This artificial glycosuria may be kept up indefinitely by the con- 

 tinued administration of phlorizin, and even in the fasting animal, 

 or one on an exclusively albuminous diet, as well as in those on 

 an aliment rich in saccharine or hydro-carbonaceous matter. In 

 the frog it produces diabetes even after the extirpation of the 

 liver showing that it stimulates other sources of sugar production 

 beside the hepatic or that it inhibits the transformation of sugar 

 derived from the alimentary canal and other sources. 



Another suggestive source of mellituria is disease of the lungs, 

 or any condition which interferes with the due aeration of the 

 blood and oxidation of the alimentar}' or hepatic sugar. But it 

 cannot be assumed that the role is altogether or mainly chemical. 

 The thoracic organs being supplied by branches of the vagus and 

 sympathetic nerves there is the obvious suggestion of a reflex 

 action through the diabetic centers in the brain. The frequent 

 complication of diabetis with lung diseases (inflammatory, tuber- 

 cular, syphilitic, and otherwise) is abundantly proved, whether it 



