ADDITIONS TO THE REVISED EDITION OF 1880. 



is not known just how sugar is made from the food ; it normally 

 exists in the blood in such slight quantity that it does not transude 

 into the urine ; in the blood of diabetic patients Cantani found it 

 as high as 8 parts in 1,000. 



Artificial mellituria may be induced by dividing the inferior cer- 

 vical ganglia, or by irritating the floor of the fourth cerebral ven- 

 tricle (which at the same time induces polyuria) ; division of the 

 splanchnics has no effect. Schiff induced diabetes by destruction 

 of the spinal medulla before and behind the origin of the brachial 

 nerves, etc. Artificial diabetes may also be induced by injections 

 of curare, solutions of common salts, some of the salts of soda, 

 nitrite of amyl, morphine, etc. ; this effect is prevented by previous 

 division of the splanchnics. 



Diabetes is a disease of the vasomotor nerve-system ; on au- 

 topsy the liver is found normal, but there are frequently changes 

 in the brain (tumors, etc.). Possibly the sugar formed during 

 digestion of amylaceous substances, being taken up by the lymphat- 

 ics and portal vessels, enters the blood directly. Cantani regards 

 sugar in the blood as necessary to life, and thinks it is one source 

 of strength ; it appears as grape-sugar, and is broken up by some 

 ferment ; if the organs furnishing this ferment (the pancreas ?) be 

 diseased, the sugar appears in the urine. In the first stages of 

 diabetes, by withdrawing amylaceous food, the collection of sugar 

 in the blood and its excretion by the urine may be prevented, and 

 by continuing this treatment for some time the disease may perhaps 

 be entirely cured ; even later in the disease, the excretion of sugar 

 may be arrested, but it is doubtful if the disease can be cured. 

 Although the above theories are not universally accepted, the treat- 

 ment advocated is probably the most successful of the many that 

 have been tried. 



Possibly diabetes may depend on a variety of causes, having as 

 a common result the non-consumption of sugar and its excretion by 

 the urine. Senator divides it into neurogenous, gastro-enteroge- 

 nous, and hepatogenous forms. The first would include the cases 

 caused by injuries, tumors, etc., affecting the nervous system ; the 

 second, the Cantani cases ; and the third class, cases- where, as a 

 result of hyperajmia of the liver, hepatic sugar passes more rapidly 

 into the blood. There would seem to be either two forms of dia- 

 betes, or else two stages of the same disease, in one of which exclu- 

 sion of amylaceous substances from the diet prevents the appearance 

 of sugar in the urine. 



Diabetic urine often has a peculiar odor, which is ascribed to 

 aceton. BoUcher tests for sugar by adding to urine in a test-tube 



