124 PHYSIOLOGY. 



diabetes, as has been shown by Lusk. The proportion is 3.5 to 1. 

 In phloridzin diabetes, just as in pancreatic diabetes, the tissue pro- 

 teid is the source of the sugar, and these two forms of diabetes are 

 identical as regards their cause. In phloridzin diabetes, the organism 

 has not lost the power of oxidizing glucose, as in pancreatic diabetes 

 or in diabetes mellitus. Phloridzin diabetes is not hyperglycgemia. 

 Pavy and Brodie have shown that the sugar is formed in the kidney 

 itself, out of serum-proteid in the blood. Phloridzin confers a 

 secretory power on the renal cells. Beta-oxybutyric acid also appears 

 in the urine after prolonged administration of phloridzin. 



To epitomize: Diabetes appears (1) after the use of certain 

 agents, adrenalin, iodothyrin, and particularly phloridzin; (2) after 

 inhalation of chloroform and amyl nitrite; (3) after puncture of 'the 

 medulla oblongata; (4) by section of the spinal cord above the exit 

 of the hepatic nerves, probably by a paralysis of the vasoconstrictors 

 of the liver; (5) by irritation of the central ends of the vagus and 

 depressor; (6) by extirpation of the pancreas. 



The majority of cases of true diabetes terminate fatally. Death 

 is due to exhaustion and blood-poisoning, producing, just previous 

 to the end, a condition of complete coma called acetonsemia. 



Beta-oxybutyric acid is the chief acid in diabetic coma. It is 

 believed to be produced by the excessive metabolism of proteid. 

 Whenever a patient passes more than five grains of oxybutyric acid 

 daily then the danger of acid intoxication must be watched. As to 

 the estimation of the beta-oxybutyric acid, it can be made by ascer- 

 taining the amount of ammonia excreted, as it gives a rough index 

 of the excretion of the acid. Thus, a daily output of ammonia of 

 two grams corresponds to about six grams of the acid. 



The supply of ammonia which can be used to neutralize acids 

 is derived from the metabolism of cells and from the decomposition 

 chiefly of meat used as food. In the beta-oxybutyric acid intoxica- 

 fion, this ammonia, instead of forming urea, goes to neutralize the 

 acid, and is excreted in the urine as an ammonium salt. 



The treatment of this diabetic coma is by sodium bicarbonate, 

 by intravenous injection and by mouth. 



CONJUGATED SULPHATES. 



The aromatic products which are formed in the intestine such as 

 indol, skatol, phenol, and cresol are eliminated by the kidneys in the 

 form of sulphates. The aromatic bodies are absorbed by the portal 

 vein and in the liver unite with suphuric acid produced by the oxida- 

 tion of the sulphur of the proteids. 



