CARBOHYDRATES. 91 



it in 1815; while Bouchardat l and Peligot 2 succeeded in identifying it as 

 dextrose, or grape-sugar, in 1838. 



The cause of this disease has for a long time been attributed to a marked 

 glucohemia. This naturally does not account for the whole nature of the 

 disease, but is only one of many symptoms. It may be caused in a number 

 of different ways; and, according to all we know at present regarding 

 diabetes, there is no longer any doubt that diabetes does not represent 

 a single disease, but rather that the glucohemia, or rather the resulting 

 glucosuria, is merely a symptom most readily recognized, and is produced 

 by the most varied pathological conditions. For this reason it would be 

 out of the question to attempt to find a common cause of glucohemia. 

 The disturbance in the metabolism of the carbohydrates varies in different 

 cases. 



We distinguish between a light and severe form of diabetes. In some 

 cases sugar is eliminated in the urine only after the patient has partaken 

 of starch or of glucose. In such cases there is no noticeable glucosuria 

 if the diet is restricted to meat and fats. These mild forms show all 

 stages of alimentary glucosuria, and make it seem probable that the limit 

 of an assimilation for carbohydrates has 'been considerably diminished. 

 In many cases sugar is found in the urine only when carbohydrates are 

 eaten on an empty stomach. Often muscular work suffices to arrest the 

 sugar elimination. In other cases, the glucosuria lasts only while the 

 absorption of sugar continues in the intestine. The cause of this kind of 

 diabetes is generally attributed to a weakening of the liver function. The 

 latter is obviously not able to work over the sugar quickly enough into 

 glycogen. It permits too much sugar to get into the circulation. Thus 

 a glucohemia results, which after a time is compensated by the elimination 

 of sugar by the kidneys, only to appear again from the same cause as before. 

 Against this assumption the objection has been raised that the liver may 

 suffer most severe changes, without the appearance of sugar in the urine. 

 This is, however, not a serious objection, for we know that the liver has 

 quite a number of different functions, of which each is to a certain extent 

 independent of the others, so that one function by itself may be disturbed. 

 It does not follow that every disease of the liver will attack that part of 

 the cells which participates in the regulation of carbohydrate metabolism. 

 A general weakening of the activity of the liver cells can cause diabetes; 

 thus it is met with in persons of undermined constitution. Possibly the 

 fact established by Hofmeister 3 that dogs, after all forms of nourishment 

 had been withheld for a considerable time, eliminated sugar in the urine, 



1 Compt. rend. 6, 337 (1838). 



* Ibid. 7, 106 (1838). 



3 Arch. exp. Path Pharmak. 26, 355 (1890). 



