382 THE LIVER. 



depends, according to BANG l and collaborators, upon an increased 

 decomposition of the glycogen of the muscles and not of the liver. 



A hyperglycsemia and glycosuria may also be caused by a decreased 

 ability of the animal to consume or to utilize the sugar or to trans- 

 form it into glycogen. In this case the sugar must accumulate in the 

 blood, and the formation of severe cases of diabetes mellitus is now 

 generally explained by this process. 



The inability of diabetics to destroy or consume the sugar does not 

 seem to be connected with any decrease in the oxidative energy of the 

 cells. The oxidative processes are not generally diminished in diabetes 

 (ScHULTZEN, NENCKI and SIEBER), and this has recently been sub- 

 stantiated by BAUMGARTEN. 2 This latter investigator made experiments 

 with several bodies which on account of their aldehyde nature were 

 closely related to sugar or were cleavage or oxidation products of it, 

 namely, glucuronic acid, d-gluconic acid, d-saccharic acid, glucosamine, 

 mucic acid, and others, and he found that diabetics destroyed or burnt 

 these bodies to the same extent as healthy individuals. Besides this 

 it must be remarked that the two varieties of sugar, dextrose and levulose, 

 which are oxidized with the same readiness, act differently in diabetics. 

 According to KULZ and other investigators levulose is, contrary to 

 dextrose, utilized to a great extent in the organism, and may, according 

 to MiNKOWSKi, 3 even cause a deposit of glycogen in the liver in animals 

 with pancreas diabetes (see below). The combustion of protein and fat 

 takes place as in healthy subjects, and the fat is completely burned 

 into carbon dioxide and water. In this diabetes the ability of the cells 

 to utilize the dextrose suffers diminution, and the explanation of this 

 has been sought in the fact that the dextrose is not previously split before 

 combustion. 



The variation in the respiratory quotient, i.e., the relation -~, seems 



to show an insufficiency of the dextrose combustion in the tissues in 

 diabetes. As will be thoroughly explained in a following chapter, this 

 quotient is greater the more carbohydrates are burnt in the body, and 

 it is correspondingly smaller when protein and fat are chiefly burnt. 

 The investigations of LEO, HANRIOT, WEINTRAUD and LAVES, 4 and 



1 Bang, Ljungdahl and Bohm, Hofmeister's Beitrage, 10. 



2 Schultzen, Berl. klin. Wochenschr., 1872; Nencki and Sieber, Journ. f. prakt. 

 Chem. (N. F.), 26, 35; Baumgarten, " Ein Beitrag zur Zenntniss des Diabetes mel- 

 litus," Habilitationschrift, also Zeitschr. f. exp. Path. u. Therap., 2, 1905. 



3 Kiilz, Beitrage zur Path. u. Therap. des Diabetes mellitus (Marburg, 1874), 1; 

 Weintraud and Laves, Zeitschr. f. physiol. Chem., 19; Haycraft, ibid.', Minkowski, 

 Arch. f. exp. Path. u. Phann., 31. 



4 See. v Noorden, Die Zuckerkrankheit, 3. Aufl., 1901. 



