The Goulstonian lectures on some considerations on the nature of diabetes mellitus : delivered before the Royal College of Physicians of London on Marhc 16th, 21st, and 23rd, 1905 / by W. Cecil Bosanquet.

  • William Cecil Bosanquet
Date:
[1905]
Catalogue details

Licence: In copyright

Credit: The Goulstonian lectures on some considerations on the nature of diabetes mellitus : delivered before the Royal College of Physicians of London on Marhc 16th, 21st, and 23rd, 1905 / by W. Cecil Bosanquet. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    paratively small amount. I venture to think that this possibility is at least worth considering as involving less difficulty in the explanation of the conversion of a case of ali- mentary glycosuria into one of composite diabetes than is involved in the supposition of the onset of a new pathological process. In favour of an internal formation of sugar in diabetes may be quoted the observations of Kolisch that in Taad cases a carbohydrate diet may cause no increase in the amount of sugar present in the urine, which may vary from day to day quite independently of the food taken. If such a conception were admissible a certain amount of clearness would be gained for a definition of diabetes which would consist in an increased internal formation of sugar. In mild cases this would merely diminish the amount of sugar which could be absorbed from the alimentary canal without appear- ing in the urine ; as the case grew graver and more internal secretion was formed, so the patient’s tolerance for carbo- hydrate food would diminish ; and finally, the amount of internal sugar would be so great as to appear in the urine even in the absence of any alimentary sxipply. It is not necessary to suppose that the amount of sugar which can be dealt with by the tissues without appearing in the urine is the same in all persons. Thus von Noorden found that of two healthy men one was capable of assimi- lating 150 grammes of glucose administered to him, while the other exhibited slight glycosuria when thus treated. Probably if enough sugar were given at once everyone would excrete some of it in the urine. Those who cannot deal with so much as average persons are the alimentary glycosurics ; but there is no reason why they should develop into diabetics apart from an increased internal sugar formation, and as a fact they do not all so develop. The power of assimilating sugar varies even in the same person in different circum- stances, as a man who is working hard will eliminate less sugar in his urine, as the resvilt of an overdose of this sub- stance, than one who is at rest (Breul). Authors appear to differ as to whether carbohydrate food, other than sugar itself, can produce alimentary glycosuria in healthy persons. Theoretical considerations would appear to be on the side of Naunyn and others who affirm this possibility, since it is fairly established that a certain proportion of starchy food is converted into sugar in the alimentary canal (Ellenberger and Hoffmeister). In pathological conditions, such as fevers and alcoholism, it has been actually pro'S’ed by Strauss that glycosuria may result from the ingestion of starchy food. Causatiok. Leaving for the present the question of the essential nature of diabetes, we may turn our attention to the causa- tion of the disease. With regard to the causes which determine the onset of diabetes nothing new seems to have
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