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402 THE LIVER.
diabetes, where the sugar disappears from the urine when the carbohy-
drates are cut off as much as possible from the food, in this class of gly-
cosuria.
A hyperglycemia which passes into a glycosuria may also be brought
about by an excessive or sudden formation of sugar from the glycogen
and other substances within the animal body.
To this group of glycosurias belongs, it seems, the adrenalin glycosuria,
in which an increased mobilization of the carbohydrate occurs, espe-
cially the liver glycogen. Several circumstances indicate this origin
of the sugar. Thus, after adrenalin injection the glycogen disappears
from the liver and, according to Michaud,1
adrenalin is without action
in dogs with Eck fistula. The activity of the adrenalin in starving
animals whose livers are very poor in glycogen speaks for the possibility
that the sugar also may in part have another origin than that from the
liver glycogen.
Adrenalin glycosuria takes, to a certain degree, a central position and
as such a glycosuria we consider also several other forms of gl}’cosuria
caused by hyperglycemia. This is for example the case with the gly-
cosuria after Bernard’s sugar puncture or piqUre. That the glycosuria,
produced after piqure is due to an increased transformation of the gly-
cogen, follows from the fact that no glycosuria appears, under the above-
mentioned circumstances, when the liver has been previously made free
from glycogen by starvation or other means. The close relation of
this form of hyperglycemia and glycosuria to the adrenals follows from
the fact that the sugar puncture is without action after the extirpation
of the two adrenals. In rats, Schwarz found, after such a double extirpa-
tion of the adrenals, that the liver was glycogen free and he considers
this lack of glycogen as the cause for the inaction of the piqure under
these conditions. According to Kahn and Starkenstein 2
the conditions
must be different, as they found in rabbits who remained alive a year
after the total extirpation of the adrenals, that the liver had a normal
amount of glycogen and that the sugar puncture nevertheless was with-
out action. Adrenalin caused glycosuria in such animals.
It is generally admitted that the stimulation which the sugar center
in the fourth ventricle exerts, through the sympathetic nerve reaches to
the adrenals and causes a secretion of adrenalin, which increases the sugar
formation. Certain circumstances, for example, that a glycosuria can be
brought about in starving animals, in which the piqure is without action,
by adrenalin, make the mechanism of this glycosuria somewhat uncer-
1 Verhandl. d. deutsch. Kongr. f. inn. Med. Wiesbaden, 1911.
* Schwarz, Pfliiger’s Arch., 134; Kahn and Starkenstein, ibid., 139; Kahn, ibid. T
140; Starkenstein, Arch. f. exp. Path. u. Therap., 10.
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