354 THE METABOLISM OF THE CARBOHYDRATES 



extirpation, 1 but immediately reappeared on feeding with flesh, to 

 greatly diminish again just before death, even although flesh was 

 still given (vide table). Minkowski seems to have considered that 

 starvation and flesh feeding are analogous conditions; this, 

 however, does not seem to be the case, sugar being more readily 

 produced from flesh than from tissue proteid. This question 

 requires reinvestigation. 



About the same time as the sugar excretion begins to fall 

 and the emaciation of the animal becomes extreme, /J-oxy- 

 butyric acid, aceto-acetic acid, and acetone may appear in the 

 urine. In cases where, on account of coincident disturbances of 

 nutrition (e.g. gastric ulcer, volvulus of duodenum, &c.), the 

 emaciation proceeds very rapidly, a marked excretion of these 

 substances has been noticed, and there can be little doubt that 

 it is the excessive disintegration of the proteid tissues which 

 furnishes their source. It should be remembered, further, that 

 only a small fraction of the /3-oxy-butyric acid formed in the 

 tissues reappears in the urine, most of it being further oxidised in 

 the organism, as is shown by the fact that 20 grm. sodium butyrate 

 when given to a depancreated dog only reappeared in the urine 

 to the extent of 0'4 grm. This latter fact will explain why in 

 many cases of pancreatic, and other forms of severe diabetes, no 

 /3-oxy-butyric acid is found. 



It will be noted that in our case /3-oxy-butyric acid appeared 

 in the urine only at a late stage in the diabetes. The index 

 of this we have taken as the difference between the percentages of 

 dextrose as estimated by reduction and by rotation of the plane 

 of polarised light. /3-oxy- butyric acid is levo-rotatory, and 

 when present in the urine along with dextrose will diminish the 

 amount of dextro-rotation which this latter should induce. 



We have described the more important features of pancreatic 

 diabetes, and it now remains to discuss what the underlying 

 cause of these may be, and especially of the glycosuria. An 

 examination of the blood reveals a high percentage of sugar 

 sometimes as high as 0*4 per cent. and this, just as in puncture 

 diabetes, is undoubtedly the immediate cause of the glycosuria. 

 If, moreover, the kidneys be removed or the ureters ligatured in 



1 Which, however, was not complete, as revealed by microscopic examination 

 of the duodenum. 



