GENERAL DISORDERS OF NUTRITION. 



Bernard has shown that the liver produces glycogenous substances 

 and sugar, the hypothesis that diabetes depends upon a disease of the 

 liver has gained ground, although the theory is not supported either 

 by pathological or clinical observation. Claude Bernard himself 

 thinks that the diabetes induced experimentally in animals, by the 

 " diabetic puncture" depends upon the nervous derangement of the 

 liver to which the operation gives rise. As a consequence of abnormal 

 innervation, not only is the production of glycogenous matter aug- 

 mented, but its conversion into sugar is also hastened. He believes, 

 too, that in the human subject, diabetes mellitus likewise is due to an 

 over-activity of the nerves which stimulate the function of the liver, 

 and considers it probable that, " if it were in our power to galvanize 

 the sympathetic nerve," this would be the best possible mode of treat- 

 ing diabetes symptomatically ; the function of this nerve being weak- 

 ened by the undue activity of its antagonists. The possibility cannot 

 be denied that more glycogenous matter is formed in the liver of a 

 diabetic person than in that of a healthy one ; but it is neither proved 

 nor even probable that this anomaly constitutes the only or even the 

 essential lesion of the disease. It is not to be supposed that the pound 

 of sugar which some patients discharge in the course of every twenty- 

 four hours is only a small portion of the sugar which they produce 

 daily, and that a larger portion undergoes that transformation in the 

 blood which, normally as we know, is undergone by very large quan- 

 tities of sugar, while a smaller portion of it remains, as it were, super- 

 fluous, and passes away in the urine. In conclusion, I will present 

 another very specious hypothesis, which really accounts better than 

 any other for the origin of diabetes. According to Tscherinoff, the 

 liver-sugar is not made from the glycogen, but, on the contrary, the 

 glycogen is formed from the sugar which arrives in the liver. Hence, 

 instead of glycogen (sugar-former), it should be called glycophthin- 

 ium, or sugar-consumer. If the liver loses its capacity to convert the 

 sugar into glycophthinium, the sugar remains in the blood, and thus 

 causes diabetes. 



Regarding the etiology of diabetes, our knowledge is equally 

 vague, for although we learn from the history of many cases that the 

 disease has arisen sooner or later after the exposure of the patient to 

 certain noxious influences, yet these influences are so general in their 

 character, and act so often upon the system without being followed 

 by diabetes, that it becomes questionable whether the disease be at- 

 tributable to their action at all. 



Griesinger, after collecting a large number of foreign and domestic 

 cases, has come to the following conclusion : Diabetes occurs much 

 more frequently in males than in females, the proportion being about 



