HUMAN DIABETES 535 



sugar in the blood seems to exercise a deleterious effect upon the 

 tissues of the body, which is especially seen in the failure of 

 repair in wounds. Slight injuries often lead to extensive tissue 

 necrosis and gangrene. That this tendency to tissue disintegra- 

 tion and necrosis depends upon the hyperglycemia seems prob- 

 able, because measures that are taken to reduce the amount of 

 sugar in the blood exercise a favorable influence upon the tissue 

 changes ; however, we cannot be sure that unknown toxic mate- 

 rials are not also being reduced pari passu with the sugar. 

 Furthermore, the amount of necrosis, gangrene, etc., of diabetes 

 does not seem to bear a direct relation to the intensity of the 

 hyperglycemia. However, there is no doubt that measures 

 taken to keep down the amount of sugar in the blood and urine 

 give diabetic patients the greatest freedom from complications 

 and the longest duration of life, whether or not the sugar itself 

 is the cause of their symptoms and sufferings. 



v. Kossa has shown that all varieties of sugar are toxic, caus- 

 ing symptoms in many respects similar to those of diabetes 

 when injected subcutaneously in doses of 1 per cent, (cane-sugar) 

 of the body weight. Smaller doses, long continued, cause ex- 

 treme emaciation with much loss of nitrogen and the develop- 

 ment of nephritis. Albertoni observed increased heart action 

 following injections of sugar, and Harley found that glucose 

 injections caused the appearance of acetone bodies in the 

 blood. 1 Scott 2 has claimed that glucose injections cause an 

 increased elimination of nitrogen in forms other than urea, due 

 to abnormal metabolism ; this observation could not be cor- 

 roborated by Underbill and Closson. 3 



Possibly increased osmotic pressure of the blood, because of 

 the excess of sugar, plays an important role in the tissue 

 changes ; but this factor seems not to have been investigated, 

 except for Pusey's experiments, 4 which suggest the importance 

 of osmotic pressure in the production of cataract, which is such 

 a common result of diabetes. 



Sweet 5 has found that removal of the pancreas causes (in 

 dogs) complete loss of bactericidal power, probably because of 

 loss of bactericidal complement. The hemolytic power for foreign 

 corpuscles is also greatly reduced through this loss of com- 

 plement. It is quite possible that some similar impairment of 

 bactericidal power explains the tendency to infection in diabetes. 



1 See Pfliiger, Pfluger's Arch., 1903 (96), 376. 



2 Jour, of PhysioL, 1902 (28), 107. 



3 Jour. Biol. Chem., 1906 (2), 117. 

 *Arch. of Ophthalmology, 1904 (33), 128. 

 5 Jour. Med. Kesearch, 1903 (10), 255. 



