The Goulstonian lectures on some considerations on the nature of diabetes mellitus : delivered before the Royal College of Physicians of London on Marhc 16th, 21st, and 23rd, 1905 / by W. Cecil Bosanquet.

  • Bosanquet, W. Cecil (William Cecil), 1866-1941.
Date:
[1905]
Catalogue details

Licence: In copyright

Credit: The Goulstonian lectures on some considerations on the nature of diabetes mellitus : delivered before the Royal College of Physicians of London on Marhc 16th, 21st, and 23rd, 1905 / by W. Cecil Bosanquet. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

    11/64 (page 9)
    diabetes as a result of ingestion of saccharine food. On the other hand, we know of no other condition in which there is an internal formation of sugar by disintegration of materials e.Kisting in the body. Further, this latter feature is charac- teristic of the developed disease, when all the conditions are presumably best marked. It appears, then, reasonable to regard this internal formation of sugar as the essential characteristic of the disease and to turn our attention specially to this rather than to the alimentary factor. So far as I can judge the reverse procedure has generally been adopted in studying the disease and the result has been to leave what I believe to be the most striking feature of diabetes mellitus unexplained. We have to ask, then. Is it possible to formulate any hypothesis, consistent with what we know of the phenomena of diabetes, which shall explain alimentary diabetes in terms, if I may so express it, of composite diabetes ? Now it may be taken as admitted that the sugar which appears in the urine is merely filtered off from the blood—in other words, that glycosuria presupposes glychjemia. The sugar present in the blood may arise in any one of several ways—from increased ingestion of sugar in the food or from increased formation in the body, or from diminished elimination or assimilation of the amount normally present. In alimentary glycosuria it would seem that the sugar reaches the blood by absorption from the intestine; in composite diabetes it seems that some of it comes from the breaking-down of the tissues. Have we any means of assuring ourselves that in either case only one process is at work ? In the case of the latter condition it seems certain that there is no alimentary element coexisting, since in starva- tion no food is taken. In the former case the same ex- clusion is not possible. It is true that in alimentary glycosuria cutting off the supply of carbohydrate food will stop or diminish the exit of sugar in the urine, but this does not necessarily constitute a proof that such food is the sole source of the sugar. The coexistence of an internal source of sugar formation cannot be excluded. Indeed, Seegen states that dieting in some instances may decrease the sugar which appears in the urine but not that which exists in the blood. Now the amount of sugar present in the blood is the resultant of the forces which respectively pour sugar into it and remove it, and sugar may be removed by assimilation as well as by excretion. It is conceivable that the body may have the power of dealing with a certain quantity of this substance but not with more than a definite amount. If the whole of this amount is formed within the body it is clear that any further quantity entering from the intestine will appear in the urine; while if a large proportion, but not the whole, of the amount is formed within the body then the quantity of sugar which can enter from the intestine without causing glycosuria will be so much less than in a normal person who either forms no internal sugar or only a com-