THE CONSTITUENTS OF THE BILE. 315 



Pfluger expresses himself as follows as to the development of diabetes mellitus: 

 The sugar formed by the liver in excessive amount, in consequence of abnormalyl 

 increased nervous excitation, stimulates the pancreas for it is possible that this 

 gland takes part in the synthetic production of fat from sugar or the fat-forming 

 organs to the production of an increased amount of fat, so that often fat-formation 

 takes place at the beginning of the disease. As soon as the fat-producing organs, 

 exhausted and paralyzed from over-activity, are no longer capable of disposing of 

 the sugar wholly or in part (which may also be the result of excessive ingestion 

 of sugar) , this is excreted by the kidneys, because even the healthy body cannot 

 assimilate the greater portion of the sugar as such, but only after it has been 

 transformed into fats or into soaps. The living body strives to make good the 

 resulting great loss in nutritive material by the assimilation of larger amounts of 

 albumin and fat. Naturally a variety of diabetes is conceivable without hepatic 

 disease as the result of paralysis of the pancreas, or of the fat -producing organs. 

 Lepine's discovery of a glycolytic ferment yielded to the blood by the pancreas, 

 which decomposes the sugar in the blood in some as yet unknown manner, and 

 which is absent or diminished in cases of diabetes, would readily accord with the 

 foregoing hypothesis. 



In the presence of pancreatic diabetes, puncture of the floor of the fourth 

 ventricle increases the excretion of sugar; likewise, remarkably, the addition of 

 raw pancreas to the food. 



(c) Phloridzin, a glucosid from the bark of the roots of cherry-trees and apple- 

 trees, after ingestion causes the sugar normally present in the blood to pass rapidly 

 over into the urine, so that the latter contains a larger and the former a smaller 

 amount of sugar. 



(d) According to Biedl, diabetes occurs after ligation of the thoracic duct in 

 the dog. 



The enormous need of food and drink, together with the signs of consumption 

 of the bodily tissues, is characteristic of diabetic patients. Not rarely, in severe 

 cases, collapse-like coma is observed, which has been designated also diabetic coma, 

 and during the existence of which the breath often smells of acetone, which can 

 also be demonstrated in the urine. Diabetic patients living on an exclusive meat- 

 diet exhibit diacetic acid in the urine, in addition to acetone. Neither acetone 

 nor its antecedent, diacetic acid (which can be recognized by the reddening of the 

 urine when dilute ferric chlorid is added drop by drop) , after the administration 

 of which the urine contains much acetone, is, as direct feeding-experiments show, 

 the cause of this coma; which is perhaps the result of excessive acid-production 

 in the body, therefore an acid intoxication. To neutralize the acid, increased 

 elimination of ammonia takes place from the body. The urinary tubules often ex- 

 hibit signs of coagulation-necrosis, which can be recognized by a bright and swollen 

 appearance of the necrotic cells of the tubules, v. Frerichs found, further, glyco- 

 genic degeneration in Henle's loops, in the liver, the heart, the leukocytes and 

 the lungs. The urine of diabetic patients is discussed on p. 501. 



THE CONSTITUENTS OF THE BILE. 



The bile is a transparent fluid varying from yellowish brown to dark 

 green in color, of a sweetish, bitter taste, feeble musk-like odor, and 

 feebly acid or neutral reaction. The specific gravity of human bile from 

 the gall-bladder is between 1026 and 1032, while that collected from 

 a fistula varies from 1010 to ion. The constituents of the bile are as 

 follows : 



Mucus and in addition a considerable amount of mucoid nucleo- 

 albumin, which together make the bile ropy, are products of the mucous 

 glands and the goblet-cells of the mucous membrane of the bile-ducts. 

 They are precipitated by alcohol, or dilute hydrochloric acid or dilute 

 acetic acid. They cause rapid putrefaction of the bile. 



The two biliary acids : glycocholic acid and taurochplic acid, the 

 called conjugate acids, combined with sodium (and with potassium in 

 traces) to form sodium glycocholate and taurocholate, have a bitter 

 taste and are dextrorotatory. In human bile, as in that of cattle, 



