Three lectures on the pathology and treatment of diabetes mellitus viewed by the light of present-day knowledge / by F.W. Pavy.

  • Pavy, F. W. (Frederick William), 1829-1911.
Date:
1908
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Licence: In copyright

Credit: Three lectures on the pathology and treatment of diabetes mellitus viewed by the light of present-day knowledge / by F.W. Pavy. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    it is necessary, as I have previously said, to have a right comprehension of the manner in which carbohydrate becomes physiologically disposed of within the system. Unless we stand upon soimd ground here, we cannot rationally cope, in the practice of medicine, with the erroneous state existing in diabetes. All are agreed that one destination of carbohydrate is in ■the production of fat. This, however, does not fall within the subject matter before us and therefore does not call for consideration to be here given to it. The point to be dealt with is the mechanism associated with the passage of carbo- hydrate from its seat of absorption in the walls of the alimentary canal to that of utilisation in the tissues. Local absorption by the walls of the alimentary canal and utilisation in the tissues obviously imply that THE CIRCULATORY SYSTEM HAS TO BE TRAVERSED. In what way does this occur 1 The chai'acter of the respi- ratory quotient suffices to show that carbohydrate is used up as such in the tissues to which it must, therefore, of neces- sity be transported from the seat of absorption. It next follows that, in the mode of transport that takes place, there must be nothing to stand in conflict with the maintenance of what is observed, in respect to other conditions, to constitute the normal state. The point plainly put is,—Does the carbo- hydrate pass through the circulation in the form of free •sugar, or does it, on absorption, become immediately placed in combination with other matter, and, in this locked-up state, become transported to the seat of utilisation ? Let us examine the question that has been here put forward and see how the two propositions stand in the presence of the evidence that is respectively adducible in connexion with them. First, let attention be given to the view that the cai-bo- hydrate of our food is conveyed in the form of free sugar through the circulation to the tissues. This view is com- prised in the glycogenic doctrine, which also includes the production of sugar by the liver for furnishing a supply of -sugar to the blood when the supply of carbohydrate from the food is in default. When the doctrine in question was first propounded, the liver was regarded, unlike the other organs of the body, as being loaded with sugar, and the blood issuing from it as containing sugar to a conspicuous extent