A treatise on the principles and practice of medicine : designed for the use of practitioners and students of medicine / by Austin Flint.
- Austin Flint I
- Date:
- 1884
Licence: Public Domain Mark
Credit: A treatise on the principles and practice of medicine : designed for the use of practitioners and students of medicine / by Austin Flint. Source: Wellcome Collection.
Provider: This material has been provided by the University of Massachusetts Medical School, Lamar Soutter Library, through the Medical Heritage Library. The original may be consulted at the Lamar Soutter Library at the University of Massachusetts Medical School.
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![animals in which the portal vein was closed. On the other hand, it has been shown that puncture of the fourth ventricle does not cause glycosuria if the animal has been poisoned with arsenic or phosphorus, substances which induce fatty metamorphosis of the liA^er. The theory of Hujipert is perhaps the best presentation of the view that diabetes mellitus depends upon diminished oxidation of the sugar. The researches of Pettenkofer and Voit regarding the nutritive changes in a diabetic patient, led them to advocate this theory. According to these investigators, diabetes mellitus is due to a general disturbance of nutrition, in consequence of which the albuminous constituents of tlie body (the organic albumen) undergo abnormally rapid metamorphosis. Proof of this they find in the amount of urea excreted, which exceeds that produced from the ingesta. Hence diabetic individuals rapidly emaciate. Sugar, like urea, they consider to be a normal product of the decomposition of albuminous substances. In health this sugar is rapidly oxidized. In diabetes less oxygen is absorbed than normal, notwithstanding the increased amount of oxidizable substances in the blood. This diminution in the absorption of oxygen is attributed to destruction of red blood-corpuscles, or to their abnormal constitution in conse- quence of their partici])ation in the general mal-nutrition of the body. Inas- much as the sugar produced in increased amount by metamorphosis of albumen, does not find the proper quantity of oxygen for its combustion, it accumulates in the blood and causes abnormal glycohtemia. The observations of Quincke* are not in harmony with Pettenkofer and Voit's explanation of the diminished absorption of oxygen. Quincke found not only no reduction in the amount of haemoglobin in the blood in diabetes, but in one case even an actual increase. The diminished oxidation of the sugar in diabetes has been attributed also to a reduction of the alkalinity of the blood. Dickinson,^ believes that diabetes mellitus is always the result of changes in the central nervous system. The most important of these changes he con- siders to be dilatation of the arteries and of the perivascular spaces and minute hemorrhages with disintegration of nerve-elements. Changes similar to those described by Dickinson, however, have been found in other diseases, and are not constant in diabetes. While it is true, as has been mentioned, that, in certain cases of diabetes mellitus, marked changes have been found in the brain, especially in the pons and medulla oblongata, there is not sufficient evidence for believing that all cases of diabetes are of nervous origin. It can serve no useful purpose to describe other theories Avhich have been proposed, or to attempt to criticize further those which have been cited. They all rest upon too uncertain a foundation. Until we have more positive knowl- edge as to the source of sugar in the healthy organism, and as to its metamor- phoses, we cannot hope for any satisfactory explanation of the abnormal accumulation of sugar in the blood and in the urine in diabetes mellitus. The transient appearance of a small quantity of sugar in the urine in various diseases, has no more pathological importance than the occasional appearance of a trace of albumen. Acetonsemia. The presence of a substance called acetone in the blood in certain diseases has been supposed to be the cause of grave symptoms. This substance, which is a derivative of acetic acid, is recognized in the breath and in the urine by a peculiar odor resembling that of chloroform. Its presence has been demon- ' Quincke, Vlrchow's Archiv, Bd. 54, p. 542. * Dickinson, Med. Times and Gaz., March 9, 1870 ; and Treatise on Diabetes, 1875.](https://iiif.wellcomecollection.org/image/b21198135_0085.jp2/full/800%2C/0/default.jpg)
