DISTURBANCES OF CARBOHYDRATE METABOLISM 301 



orders, though the diagnostic value of the test has not been generally 

 accepted (Rowntree, Hurwitz and Bloomfield). The reaction is fre- 

 quently positive in other conditions such as acute infectious diseases 

 (typhoid, pneumonia, etc.), in pregnancy and, of course, in disorders of 

 the endocrin glands. (Franke, Friedman and Strouse, Keller.) In many 

 of these cases there is no other sign of hepatic insufficiency. Nevertheless, 

 it is claimed that the alimentary fructosuria. itself demonstrates the exist- 

 ence of such, which is regarded as being either too slight to be manifested 

 in any other manner or else to affect only this particular function of the 

 liver. But this is merely begging the question. It would appear to be 

 more accurate to say simply that the capacity* of the organism to utilize 

 ingested fructose has been diminished, leaving the location of the metab- 

 .olic fault to further investigation. It may be that the liver itself is 

 perfectly normal, but is unable to function properly in this regard because 

 some hormone derived from the thyroid, pituitary or other gland is pres- 

 ent in excessive, or deficient, amount, just as a machine will not work 

 effectively if supplied with too much, or too little, or the wrong kind of, 

 lubricant. 



Lactosuria and Galactosuria 



Pathognomonic Factors. Occurrence. For many years it has been 

 known that in the late stages of pregnancy, while nursing and, more 

 especially, upon the weaning of their children, women excrete varying 

 amounts of lactose in the urine. The concentration is only rarely more 

 than 0.5 per cent. The origin of the sugar is obvious. Ziilzer(a) ob- 

 served that women had a lower tolerance for ingested lactose during the 

 period from two to eight days after delivery than normal or pregnant 

 women had. They also reacted to a glucose tolerance test by the excretion 

 of lactose. He offered the teleological explanation that the diminished 

 tolerance of the organism of the mother for lactose was designed for the 

 protection of the offspring. It is more probable that the lowered lactose 

 tolerance is due to the fact that the organism is already, so to speak, 

 saturated with lactose and that the effect of glucose is due merely to an 

 increased formation of lactose, according to the laws of mass action. 



Of quite different significance is the appearance of lactose in the 

 urine of sucklings. Although the excretion of a sugar had been reported 

 as early as 1869, its nature was not known until 1892, when Grosz showed 

 that it was either lactose or galactose, that it was of alimentary origin, 

 and was found only in cases of gastro-intestinal disease. Langstein and 

 Steinitz completed the demonstration that it was almost always lactose, 

 though there might also be some galactose. They also found it only in 

 children with gastro-intestinal disorders. They showed that the condition 

 was not due to the absence of lactose from the intestine, for they were 



