RELATION OF GLYCOSURIA TO THE CONDITION OF THE DIGESTIVE ORGANS.
In diabetes the paradox has been observed that the glycosuria the phenomenon upon which we depend especially to measure the gravity of the disease—diminishes immediately upon the intercur rence of gastro-intestinal disturbances. This is, however, only an apparent paradox, and its explanation is simple. In the first place, all gastro-intestinal disturbances of whatever nature are associated with loss of appetite, and with the cutting off of nutritive material the most productive source of the urine sugar begins to flow less freely. In other cases the same result follows, notwithstanding an undiminished ingestion of food, because the power of absorption is restricted. Ordinarily the absorption of nutrient material from the intestine, in cases of diabetes, proceeds most satisfactorily," so that the feces contain scarcely any more nitrogenous substances, fat and carbohydrates, than in health. But with the onset of diarrhoea the conditions are changed, absorption is checked, and this acts in the same way as a diminished ingestion of food.
But this does not exhaust the list of causes that go to lessen glycosuria in acute digestive disorders, for of ten this decrease is more pronounced than could be accounted for by a reduced ingestion and absorption of nutrient material. Experience has taught us to regard such an excessive diminution of the glycosuria as a sig»um omiois, for it is a symptom which may accompany or herald the dreaded diabetic coma. Of this we shall speak later.
Besides acute gastro-intestinal disturbances chronic affections of the digestive organs may also exercise an important and permanent influence upon the excretion of sugar in the urine. Although the process of absorption, as it goes on in the great majority of sufferers from diabetes, leaves little to be desired, there are still exceptions to this rule. In some of these cases the stools are of enormous size, of
a thick pulpy consistence, dirty dark-gray in color, and greasy in appearance. Microscopical examination shows the presence of large fat globules, crystals of soap and fatty acids, and numerous muscular fibres. The results of chemical analysis accord with this microscopi cal picture. Hirschfeld, who has made a special study of these cases, recovered on an average 35.2 per cent. ash, 31.8 per cent. nitrogenous substances, and 34.8 per cent. fat, which had been taken in by the mouth, in the feces ; the normal figures are from 6 to 7 per cent.
All our experience hitherto indicates that, in these cases, we have to do with pancreatic diabetes, and that the changes in the pancreas must be of such a kind that not only the "internal secretion," which regulates sugar consumption (cf. p. 53), but also the discharge of the pancreatic juice into the intestine, is seriously interfered with. The facts gleaned from experiments upon animals speak with special force in support of this view, for identical anomalies of absorption are seen after extirpation of the pancreas in dogs (3.1inkowski, Ahelmann, My experience has been that the glyco suria in these cases (which, it may be remarked, are very rare) is subject to greater and more sudden oscillations in intensity than it is in other forms of diabetes, notwithstanding an unchanged dietary. I have repeatedly examined the feces with a view of determining the cause of these sudden and pronounced oscillations, and have found that the condition of absorption is subject to corresponding change, being now better and now worse. The external appearance of the patient betrays none of these changes.