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GLYCOSURIAS. 401
•circulating in the blood, perhaps from a protein with loosely combined
•carbohydrate groups.
Grube from experiments upon the surviving tortoise liver has made the
suggestion that it is not the kidneys which are first attacked by the phlorhizin
action in phlorhizin glycosuria but the liver. Important experimental evidence
against this view has been raised by Schondorff and Suckrow. 1
Another form of glycosuria which according to certain investigators
is to be connected with a changed permeability of the kidneys (Under-
hill and Closson) is the glycosuria first observed by Bock and Hoff-
mann after the intravascular injection of large quantities of a 1-per
cent salt solution, which is also of great interest because, as shown by
Martin Fischer,2
it can be again arrested by an injection of a salt solu-
tion containing CaCUj. There are investigators who attempt to connect
this glycosuria with the adrenals and a hyperglycemia.
With the exception of these two forms of glycosuria, the phlorhizin
diabetes and the salt-glycosuria, and also the glycosuria produced by
certain kidney poisons, all other forms of glycosuria or diabetes, as far
as known at present, depend on a hyperglycemia.
A hyperglycemia may be caused in various ways. It may be caused,
for example, by the introduction of more sugar than the body can destroy.
The ability of the animal body to assimilate the different varieties
of sugar has naturally a limit. If too much sugar is introduced into the
intestinal tract at one time, so that the so-called assimilation limit
(see Chapter VIII, on absorption) is overreached, then the excess of
absorbed sugar passes into the urine. This form of glycosuria is called
alimentary glycosuria,3
and is caused by the passage of more sugar into
the blood than the liver and other organs can destroy.
As the liver cannot transform into glycogen all the sugar which comes
to it in these, to a certain extent physiological, alimentary glycosurias,
it is possible that a glycosuria may also be produced under pathological
conditions, even by a moderate amount of carbohydrate (100 grams
glucose), which a healthy person could overcome. This is true, among
other cases, in various affections of the cerebral system and in certain
chronic poisonings. Certain observers include the lighter forms of
1
Grube, Pfltiger’s Arch., 128; Schondorff and Suckrow, ibid., 138. See also the
opposed view of Underhill, Journ. of biol. Chem., 13.
2
Bock and Hoffmann, Arch. f. (Anat. u.) Physiol., 1871; M. Fischer, University
of California publications Physiol., 1903 and 1904, and Pfliiger’s Arch., 106 and 109;
Underhill and Closson, Amer. Journ. of Physiol., 15, and Journ. of Biol. Chem., 4.
3
In regard to alimentary glycosuria see Moritz, Arch. f. klin. Med., 46, which also
contains the earlier literature; B. Rosenberg, Ueber das Vorkommen der alimentaren
Glykosurie, etc. (Inaug.-Dissert. Berlin, 1897); van Oondt, Munch, med. Wochen-
schr., 1898; v. Noorden, Die Zuckerkrankheit, 3. Aufl., 1901.
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