656 DIABETES 



ency of tli()U<ziit would ])o to look i'of ihc cause of such phenomena 

 in a disturbed hepatic function. 



It is interesting to note that of the above-mentioned five cases of 

 pure levulosuria, two showed a lessened tolerance for glucose, and one 

 symptoms of dis])itnitarism, one developed during the puerperium, 

 and one had an endocarditis ; i.e., four out of five had evidence of 

 derangements of the endocrinous glands. The literature has been 

 reviewed and a case reported by Strouse and Friedman. ^- 



Mixed Levulosuria, or the occurrence of levulose along with glucose 

 in severe cases of diabetes, is said by some to be a common event. In 

 view of the great frequency of combined liver and pancreatic changes 

 found at autopsy in diabetic cases, and in view also of the freciuent 

 occurrence in diabetes of signs which point to disturbances of other 

 glands with internal secretion besides the pancreas, this would har- 

 monize well with the view just given. 



Spontaneous or Idiopathic Levulosuria, having a character similar 

 to chronic pentosuria, and running a steady course uninfiueneed by 

 diet, has been reported in one case by Rosin. In this instance the 

 tolerance for glucose was also diminished. 



POLYSACCHARIDES 



Closely related to these meliturias are the forms in which the poly- 

 saccharides,- — lactose, maltose and saccharose, — are the sugars con- 

 cerned. 



Lactosuria: — "When 2 to 3 grams of lactose per kilogram of body 

 weight are given in pure form by mouth to a healthy adult dog or 

 man — alimentary lactosuria generally occurs. Another form of lacto- 

 suria is that seen in lactating women. In these cases the lactose gains 

 access to the general circulation from milk stasis in the breast. Yet 

 another form, the lactosuria in chihlren, having gastro-intestinal dis- 

 eases, has its origin in the lactose of the milk or artificial food. In 

 these cases lactosuria may develop after the ingestion of lactose, in 

 quantity and form ^^ incapable of causing it in a healthy child. The 

 tolerance for lactose is most strikingly decreased in so-called "intoxi- 

 cation" (Finkelstein) in which lactos\iria may follow ingestion of 

 0.4-0.5 g. per kilo of body weight. (Grosz places the assimilation limit 

 for healthy sucklings at 8.6 g. per kilo.) This might be explained in 

 two or more ways. The lactase in the bowel might be deficient and 

 permit unhydrolyzed sugar of milk to accunudate in abnormal con- 

 centration in the lower bowel, and then be absorbed unsplit ; or, as 

 seems more probable, the bowel wall — because of ulcers or simjile in- 

 flammatory changes — might become abnormally permeable. The in- 

 1ra\'euous tolerance limit for lactose approaches zero. During pro- 



32 Arcli. Till. :\rorl., 1012 (0). f)!). 



^^ Pun- iHnicous sohitions (if siitrio- dilVcr in tlio rato of absorption from those 

 ill wliicli till- siijrar is iiicor])(ira(('(l in hctcrojrcncous mixtures. 



