THEORY OF DIABETES 669 



soinewliat stronger alkali t'oiiceiitratioii. '"■ The diabetit' body tlK-re- 

 fore behaves as tliouj^h it were weakened witli respect to the alkali eou- 

 ceiitratioiis which it cau bring to bear on sugars. 



As far back as 1871, Sehultzen suggested that the error in diabetes 

 might be found in the disability of the body to dissociate the glucose 

 juolecule into two 3-carbon substances.-" i^aunigarten "'^ also supported 

 the idea of a "fermentative splitting" which precedes oxidation, be- 

 cause he found a greater percentage utilization of certain substances 

 closely allied to glucose (such as gluconic acid, saccharic acid, mucic 

 acid, etc.), than of glucose itself; whereas gluconic acid and glucose, 

 for example, differ only in that the sugar has an aldehyde group where 

 the acid has carboxyl. Similar general ideas have been expressed 

 from time to time by others. The present writer has urged in place 

 of the vaguer terms, the adoption of chemical "dissociation" in the 

 sense which is rapidh' finding favor in the field of pure organic chem- 

 istry, notably for the explanation of the behavior of aldehydes, ketones 

 and alcohols.'^'-' There can be no doubt that the dissociation of glucose 

 in the body is a normal occurrence. This is directly and conclusively 

 shown whenever muscles make lactic acid (C.jHqO.J out of glucose 

 (CgHijOo), since in this process no chemical phenomenon is involved 

 save cleavage of the hexose and intramolecular rearrangement. The 

 polymerization of sugar into glycogen might be similarly interpreted. 

 Direct proof of a failure of glucose dissociation in diabetes has not yet 

 been brought, although its absence would explain all the metabolic 

 phenomena more directly and simply than any other single physi- 

 ologic error which has been hypothecated. It is, moreover, a tangible 

 chemical conception, whereas to say that the body loses its power to 

 oxidize sugar or to "fix" it as glycogen is merely to name effects in 

 phj^siologic terms. (Cf. Naunyn's diszoamylie). 



It might be assumed that all sugars upon entering certain phases of 

 the cells (phases especially well represented in liver cells), meet con- 

 ditions which are equivalent to those met in a weakly alkaline solution, 

 favoring reciprocal transformations, and, as A. P. Mathews points 

 out, polymerization; but not conditions conducive to the deeper de- 

 structive reactions. That is, especially in the liver, there may be the 

 equivalent of dilute alkali for all sugars. Glucose, being the least 

 dissociable, represents the form into which all other sugars tend to 

 accumulate. But in the normal body a special glucolytic enzyme 

 Calkali carrier or intensifier?) destroys glucose selectively. All other 

 sugars must become glucose before destruction. In diabetes the 

 enzyme necessary for the deep dissociation of glucose is lacking or in- 



50 See Woodyatt, Jour. Biol. Chom., 1015 (20), 129. 



57 Zeit. f. oxp. Path. u. Pliarm.. 1005 (2) . 53. 



58 Glyceric aldehyde and glycerol, according to Sehultzen. 



59 Cf. Xef, loc. cit., and Stieglitz, Qualitative Chemical Analysis. New York, 1912, 

 I, pp. 289-292. 



