(See DIABETES MELLITUS for pancre atic glycosuria.) It is also seen consequent to poisoning by various poisons: morphine, prussic acid, mineral acids, nitrite of amyl, car bonic oxide, chloralamid, nitrobenzol, secale cornutum, etc.
[V. Mering (Congr. f. iunere 'SO) and Minkowski (Berl. Min. Woch., '92) demonstrated that it is possible by in jection or ingestion of phloridzin, a glueo side contained in the root-bark of apple trees, to provoke a marked glycosuria in animals or in man. F. LEvisoN.] When the pancreas is completely ex tirpated glycosuria results, though, if even a small portion of the pancreas remains in the abdominal cavity, this result does not appear. Hedon (Archives de Physiol., Normale et Path., p. 788, '94).
[By extirpation of the pancreas of dogs, Minkowski (Arch. f. cxper. Path. u. Pharin., '93) was able to produce not only glycosuria, but all the symptoms of diabetes mellitus. F. LEvIsolx.] Case of glycosuria for which no ade quate cause could be found, but which was evidently associated with consider able gastrointestinal disturbance. At the autopsy it was found that the pan creas had been almost entirely destroyed by a large suppurating cyst. M. Mac intosh (Lancet, Oct. 24, '96).
Case in which glycosuria was caused by atropine. Experimental confirmation of this fact obtained by administering to rabbits appreciable quantities of atro pine, which resulted in a production of glycosuria. It made no difference whether sugar was included in the food or not. F. Raphael (Deutsche med. Woch., No. 23, '99).
The habitual or excessive use of to bacco will not only aggravate an exist ing glycosuria, but it will, though less frequently, set up this condition. To bacco influences the output of glucose in cases of glycosuria in three ways: First, by protracting the duration of transitory glycosuria and by imparting to alimentary mellituria a certain de gree of chronicity; secondly, by increas ing the quantity of dextrose in the twenty-four hours' urine, in the transi tory as well as the chronic forms of glycosuria; thirdly, by transforming the moderate degrees of chronic gly cosuria into the graver forms. Nico tine is not the causative factor in to bacco glycosuria. The substance in to bacco-smoke regarded as of greatest importance is the carbon monoxide due to the imperfect combustion. This view
seems to find credence in the fact that glycosuria is only found in smokers of cigars, and not in those who use pipes. Heinrich Stern (Med. Record, Apr. 27, 1901).
GOITRE.—Lat., Data., throat.
Definition. — The terms "goitre," "bronchocele," and "struma" include all those conditions in which there is a per sistent enlargement of the whole or a portion of the thyroid gland.
Such enlargement, most often benign, may, however, be also brought about by malignant growth within the organ, and, in that case, one speaks of malignant goitre; but it may be laid down that, in all the conditions included under this term, there is some hypertrophy or over development of one or other of the tis sues of which the gland is composed. Thus, in a goitre, we may distinguish: 1. A general hyperplasia of the gland, all the tissues having undergone over growth.
2. We may find the follicles showing marked hypertrophy, with or without distension of their lumina with colloid material (parenchymatous and colloid goitre).
3. We may have to deal more espe cially with overgrowth of the interstitial substance (fibrous goitre).
4. Or, again, we may have to deal more especially with great distension of the vessels, more frequently of the veins, though some rare cases are recorded of ancurismal dilatation of the arteries (vas cular goitre).
Such changes may either involve the whole of one or both lobes, or be confined to isolated portions of the gland. In the former case we have to deal more espe cially with the vascular and hyperplastic forms. In the latter the change most often begins with the parenchyma and the goitre develops in a nodular form. But both in the hyperplastic as in the nodular parenchymatous goitre the shape and appearance may be profoundly influ enced by cysts. These cysts may attain considerable size and may be single or multiple.
Varieties.—Wolfler, who has written the fullest work upon the pathological anatomy of goitre, gives anatomical divi sions which, however, are too elaborate for practical purposes. For the clinician this classification may be greatly simpli fied.
[Wiilfler's classification is as follows:—