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400 THE LIVER.
sugar in the blood rises above this average, sugar passes into the urine,
sometimes even with slight rise and in other cases with stronger rise.
The kidneys have the property to a certain extent of preventing the
passage of blood-sugar into the urine; and it follows from this that an
elimination of sugar in the urine may be caused partly by a reduction
or suppression of this above-mentioned activity, and partly also by an
abnormal increase of the quantity of sugar in the blood.
The first seems, according to v. Mering and Minkowski, and others
to be the case in phlorhizin diabetes, v. Mering found that a strong
glycosuria appears in man and animals on the administration of the
glucoside phlorhizin. The sugar eliminated is not derived from the
glucoside alone. It is formed in the animal body, and in fact from the
carbohydrates, or as generally admitted on prolonged starvation, from
the protein substances of the body (Lusk). The quantity of sugar in
the blood is not increased, but rather diminished, in phlorhizin diabetes
(Minkowski), which does not indicate increase in the sugar production
but rather an increased excretion of the sugar by the kidneys. The
fact that after extirpation of the kidney in phlorhizin diabetes no rise
in the blood-sugar is observed, and that after the injection of phlorhizin
in the renal artery of one side the urine secreted by this kidney contains
sugar sooner and more abundantly than the urine from the other kidney
(Ztjntz), tends to favor this view. The experiments especially performed
by Pavt, Brodie, and Siau upon blood containing phlorhizin and sur-
viving kidneys also indicate the same, namely, that the phlorhizin acts
upon the kidneys and the researches of Erlandsen also lead to the same
conclusion. He found that on combining the phlorhizin action with
bleeding that the glycosuria was increased while after bleeding alone
without phlorhizin poisoning the hyperglycemia was absent. While
v. Mering and others believe in an increased permeability of the kidneys
for sugar, produced by the phlorhizin Lepine * is of the view that the
phlorhizin causes a formation of glucose from the virtual sugar in the
kidneys. Pavy is, on the contrary, of the opinion that the kidneys,
under the influence of the phlorhizin, split off sugar from a substance
1
In regard to the literature on phlorhizin diabetes see v. Mering, Zeitschr. f. klin.
Med., 14 and 16; Minkowski, Arch. f. exp. Path. u. Pharm., 31; Moritz and Prausnitz,
Zeitschr. f. Biologie, 27 and 29; Kiilz and Wright, ibid., 27, 181; Cremer and Rioter,
ihvL, 28 and 29; Contejean, Compt. rend, de soc. biol., 48; Lusk, Zeitschr. f. Biologie,
36 and 42; Levene, Journal of Physiol., 17; Pavy, ibid., 20, and with Brodie and Siau,
29; Arteaga, Amer. Journ. of Physiol., 6; O. Loewi, Arch. f. exp. Path. u. Pharm., 47;
X. Zuntz, Arch. f. (Anat. u.) Physiol., 189.5; Stiles and Lusk, Amer. Journ. of Physiol.,
10: Lusk, ibid., 22; Cremer, Ergebnisse der Physiol., 1, Abt. 1; Erlandsen, Bioch.
Zeitschr., 23 and 24; I.epine, Compt. rend. soc. biol., 68; Lusk, Ergebnisse der Physiol.,
Bd. 12, 315-392, and the monographs upon diabetes.
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