402 THE LIVER. 



diabetes, where the sugar disappears from the urine when the carbohy- 

 drates are cut off as much as possible from the food, in this class of gly- 

 cosuria. 



A hyperglycaemia which passes into a glycosuria may also be brought 

 about by an excessive or sudden formation of sugar from the glycogen 

 and other substances within the animal body. 



To this group of glycosurias belongs, it seems, the adrenalin glycosuria, 

 in which an increased mobilization of the carbohydrate occurs, espe- 

 cially the liver glycogen. Several circumstances indicate this origin 

 of the sugar. Thus, after adrenalin injection the glycogen disappears 

 from the liver and, according to MiCHAUD, 1 adrenalin is without action 

 in dogs with Eck fistula. The activity of the adrenalin in starving 

 animals whose livers are very poor in glycogen speaks for the possibility 

 that the sugar also may in part have another origin than that from the 

 liver glycogen. 



Adrenalin glycosuria takes, to a certain degree, a central position and 

 as such a glycosuria we consider also several other forms of glycosuria 

 caused by hyperglycaemia. This is for example the case with the gly- 

 cosuria after BERNARD'S sugar puncture or piqfire. That the glycosuria 

 produced after piqure is due to an increased transformation of the gly- 

 cogen, follows from the fact that no glycosuria appears, under the above- 

 mentioned circumstances, when the liver has been previously made free 

 from glycogen by starvation or other means. The close relation of 

 this form of hyperglycaemia and glycosuria to the adrenals follows from 

 the fact that the sugar puncture is without action after the extirpation 

 of the two adrenals. In rats, SCHWARZ found, after such a double extirpa- 

 tion of the adrenals, that the liver was glycogen free and he considers 

 this lack of glycogen as the cause for the inaction of the piqure under 

 these conditions. According to KAHN and STARKENSTEIN 2 the conditions 

 must be different, as they found in rabbits who remained alive a year 

 after the total extirpation of the adrenals, that the liver had a normal 

 amount of glycogen and that the sugar puncture nevertheless was with- 

 out action. Adrenalin caused glycosuria in such animals. 



It is generally admitted that the stimulation which the sugar center 

 in the fourth ventricle exerts, through the sympathetic nerve reaches to 

 the adrenals and causes a secretion of adrenalin, which increases the sugar 

 formation. Certain circumstances, for example, that a glycosuria can be 

 brought about in starving animals > in which the piqure is without action, 

 by adrenalin, make the mechanism of this glycosuria somewhat uncer- 



1 Verhandl. d. deutsch. Kongr. f. inn. Med. Wiesbaden, 1911. 

 2 Schwarz, Pfluger's Arch., 134; Kahn and Starkenstein, ibid., 139; Kahn, ibid., 

 140; Starkenstein, Arch. f. exp. Path. u. Therap., 10. 



