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The Hepatogenous Forms of Glycosuria

glycogen, liver, experiments, stimulus, animals and results

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Long before any serious study of transitory alimentary glycosuria, in healthy individuals was undertaken, attention was directed to the question whether certain diseases might not depress the assimilation limits for sugar. The following points enter into consideration here : We know that healthy individuals do not acquire glycosuria after the ingestion of carbohydrates for the reason that the glycogen reser voirs are sufficient to dispose of all the sugar. How is it, then, when these natural carbohydrate storage-places become changed through disease, as in functional and organic disturbances of the liver, of the muscles, or of the nervous system which exercises a controlling in fluence upon the latter? Are the organs still in condition to fix the glycogen and to prevent a flooding of the blood with carbohydrates? 1. Erperiniental Forms (Following Puncture of the Floor of Fourth Ventricle, Nerve Injuries, Poisoning, etc.).—In order to reach a just appreciation of the results of clinical investigations, it is neces sary to recall the facts which have been brought to light through ex perimental researches. All these experiments have originated in the celebrated piqdre of Claude Bernard. This ingenious investigator demonstrated the fact that a glycosuria of several hours' duration could be produced in animals by a puncture at the extremity of the calamus scriptorius in the fourth ventricle. After this temporary gly cosuria had passed away the liver was found to contain no glycogen.

No glycosuria follows the puncture if the liver has been previously deprived of all or most of its glycogen. This abstraction of glycogen is effected by an enforced fast of considerable duration, chasing the animal about, inducing a pyretic condition, ligation of the ductus choledochus, or other means.

The interpretation of the experiments, to which there has been scarcely any serious objection, is that from the irritated spot in the central nervous system a centrifugal stimulus is transmitted to the liver, and this stimulus causes the organ to discharge its store of gly cogen. It is believed by many that the primary stimulus is trans

mitted through the vasomotor nerves; others prefer to regard it as a direct action of the nervous irritation upon the hepatic cells. This is a point of secondary importance, however interesting theoretically. The main fact is the sudden discharge of glycogen from the liver. The carbohydrate leaves the cells under the form of grape sugar; hyper glycmmia results, and from this arises the glycosuria. We can now understand why the pipire produces no results in animals whose organism is poor in glycogen, and also why the glycosuria, when it occurs, is of short duration, only as long, namely, as the supply, whether abundant or scanty, of glycogen contained in the liver holds out, and until the excess of sugar thrown out into the blood is eliminated or consumed.

After Claude Bernard's experiments investigation was zealously turned in this direction, and in the course of time many other influ ences have been discovered which are effective in the production of temporary glycosuria. Among these the following may be men tioned: destruction of the superior and inferior sympathetic ganglia in the neck, of the first thoracic ganglion, of the abdominal ganglia, and of other sympathetic nerves; painful stimulation of the periphE ral nerves; psychic disturbances; lesions of various portions of the cerebrum, mid-braiu, and cerebellum. It seems to be possible, in deed, to produce glycosuria by a sudden, strong, paralyzing or excit ing injury of any part of the nervous system. Nevertheless no abso lute dependence can be placed upon the results of experiments either in man or in animals. Glycosuria is obtained in certain experiments on animals and is observed after certain acute traumata in man (for example, after apoplexy), while in other cases, in conditions appar ently exactly similar, this result does not follow. A stimulus applied to the place designated by Claude Bernard is alone to be absolutely relied upon to produce the expected result.

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