666 DIABETES 



phyxia (carbonic and lactic acid accumulation), and when acids are 

 directly administered; also after the administration of certain drugs 

 whose effects, including lactic and carbonic acid accumulation in the 

 body fluids, closely parallel those of a deficient oxygen supply (phos- 

 phorus, carbon monoxide, chloroform, hydrazine, arsenic, etc.). 

 Certain other drugs, such as curare, strychnia, etc., may interfere 

 with respiratory movements and so cause glycosuria by secondary 

 asphyxia; although other drugs, of which there are many, maj'' op- 

 erate to cause glycosuria in any of the ways by which glycosuria can 

 be produced. ^^ 



(c) The ductless gland extracts which produce glycosuria include 

 those of the adrenal, thyroid and hypophysis. Epinephrine has been 

 discussed in another place, and the reasons are there developed for the 

 belief that the glycosuria it causes is due to a mobilization of sugar 

 from glycogen, which leads to hyperglycemia. Ringer^" showed that 

 when an animal is fully phlorhizinized the subcutaneous injection of 

 epinephrine causes no additional output of sugar nor alteration of the 

 G : N ratio, a fact which has been confirmed by Sansum and Woody- 

 att — thus proving that epinephrine has no power to intensify a diabetes 

 which is already at the point which is called complete. Lusk^^ also 

 showed by respiration experiments the correctness of this interpreta- 

 tion. Eppinger, Falta and Rudinger^^ stated that epinephrine inten- 

 sifies pancreas diabetes, and used this observation in support of their 

 idea that epinephrine, like thyroid extract, exerts in the liver a sugar- 

 mobilizing and sugar-building effect, antagonistic to the action of the 

 pancreas, which, according to the doctrine of the von Noorden school, 

 checks the formation of sugar from glycogen and also from protein 

 and fat. But in their work there has been no adequate proof that be- 

 fore giving the epinephrine the pancreas diabetes was as complete as a 

 pancreas diabetes can be, or that the increased intensity of the dia- 

 betes was any greater than could have been explained bj' a discharge 

 of sugar from glycogen. The power of pituitary extracts to produce 

 glycosuria is likewise ascribable to their effects on glycogen. 



PHLORHIZIN DIABETES" 



Phlorhizin was obtained by alcoholic extraction of the bark and 

 roots of apple, pear, plum and cherry trees by L. de Koninck in 1835. 

 Its glucosidic character was established by Stas, who found that it 



'^ The production of glycosuria by a given drug should not be confused with 

 excretion of paired glycuronic acid compounds, such as occurs after the ad- 

 ministration of many aldehydes, ketones, alcohols and phenols. The reducing 

 power in these cases is not due to glucose but to its oxidation product, 

 COOH— (CH0H)4— COH. 



" Jour. Exper. Med., 1910 (12), 105. 



38 Arch. Int. Med., 1914 (13), 673. 



SB Zeit. f. klin. Med., 1908 (66), 1; 1909 (67), 380. 



*" For a treatise of the whole subject of ])hlc)rhizin glycosuria, with bibliog- 

 raphy, see the monograph by Lusk (Phlorhizin (Uykosurie, Ergcb. der Physiol., 

 1912 (13), 315), free use of which has been made in the following. 



