Croonian Lectures ON POINTS CONNECTED WITH DIABETES

1878 The Lancet  
LECTUREpl.—PART III. IMPRESSED with the importance of being able to express ia precise and reliable terms the amount of sugar corresponding with what in my original experiments I de-scribed as a trace in relation to the blood and the liver, I have given my attention to the application of the topper test gravimetrically instead of volumetrically. It is now a common practice with chemists in sugar determinations to employ the former method of procedure in preference to the latter. Greater
more » ... er. Greater precision and certainty belong to a result obtained by the balance than to one derived from watching the gradual disappearance of colour, and mentally .deciding when the required point is just, and only just, obtained, as in the ordinary volumetric process. Moreover, in the case of minute quantities of sugar, as when the blood and the liver in a state belonging to life are dealt with, the suboxide is thrown down in so finely divided a form as to remain diffused through the liquid, and obscure the determination. Indeed, under these circumstances, the difficulty is such as to deprive the estimation of the desired authority as an exact expression of quantity. Hence the reason that actual quantitative results have not hitherto figured more frequently in the discussion of the physiological relations of sugar. In adopting a gravimetric process, the copper may be weighed in different states. The suboxide may be collected and weighed as such, or converted into the oxide and the weighing of this undertaken. From the difficulty, however, that exists in obtaining the metallic oxide in a pure and uniform state, some want of precision belongs to the results thus derived. Looking for something more susceptible of delicate exactness, the plan suggested itself of dissolving the precipitated suboxide and throwing the copper down in the metallic form by galvanic action.,upon a platinum surface, in the same manner as is now extensively done in the assaying of copper ores. Several difficulties at first presented themselves in the execution of this process, and at one time I almost thought it would have to be given up; but one by one they have been overcome, and now I feel that, with the requisite care in manipulation, it supplies a means of furnishing reliable information. The close agreement noticeable in the results yielded by counterpart analyses gives strong testimony in favour of the process being susceptible of great precision. The object to be attained is to determine the amount of 'copper which corresponds with the reducing 'effect of the sugar existing in the product analysed. We must first prepare a suitable liquid for the application of the copper test solution. The precipitated suboxide has then to be collected in a separate form; it is next dissolved, and the copper thrown down by galvanic action upon 'a cylinder of platinum foil. The final part of the operation consists in ascertaining the weight of the copper thus _thrown down. Such are the principal features of the process, but I consider it requisite to furnish an account of the manner in which the several steps of it are carried out. I am anxious not unnecessarily to enter into detail. I feel, however, that these considerations, occupying the fundamental position they do in relation to the physiological conclusions upon which our views concerning the nature of diabetes are based, should not be cursorily passed over. Unless you are satisfied that the chemical method of procedure is entitled to credit, 1 I could not expect you to accept the conclusions derived therefrom. : , Let us suppose, then, that we have a specimen of blood to submit to examination for the quantitative determination of sugar, the following is the manner in which, according to the plan proposed, the operation is conducted. Forty grammes of sulphate of soda in small crystals are weighed out in a beaker of about 200 cc. capacity. About 30 cc. of the blood intended for analysis are then poured upon the crystals, and the beaker and its contents again carefully weighed. In this way the precise weight of the blood taken is ascertained. The blood and crystals are well stirred together with a glass rod, and about 30 cc. of a hot concentrated solution of sulphate of soda added. The beaker is placed over a flame guarded with wire gauze, and the contents heated until a thoroughly-formed coagulum is seen to be suspended in a clear colourless liquid, to attain which actual boiling for a short time is required. The liquid has now to be separated from the coagulum, and the latter washed, to remove all the sugar. This is done by first pouring off the liquid through a piece of muslin resting in a funnel into another beaker of rather larger capacity. Some of the hot concentrated solution of sulphate of soda is then poured on the coagulum, well stirred up with it, and the whole thrown on the piece of muslin. By squeezing, the liquid is expressed, and to secure that no sugar is left behind, the coagulum is returned to the beaker, and the process of washing and squeezing repeated. The liquid thus obtained may be fairly regarded as containing all the sugar that existed in the blood. From the coarse kind of filtration and squeezing employed, it is slightly turbid, and requires to be thoroughly boiled to prepare it for filtration through ordinary filter-paper. A perfectly clear liquid runs through, and to complete this part of the operation the beaker that has been used and the filter-paper are washed with some of the concentrated solution of sulphate of soda before referred to. The next step is boiling with the copper test solution. The liquid is again placed over a flame, and brought to a. state of ebullition. A sufficient quantity of the copper solution to leave some in excess is now poured in, and, from the time of recommencement of boiling, brisk ebullition is allowed to continue for a period of one minute. This suffices for all the sugar to be oxidised, and, accordingly, for all the action upon the copper solution to be completed. There is no risk during this time of spontaneous change occurring in the copper solution; but observation has shown that, should the boiling be continued for a lengthened period (by which I mean ten minutes or a quarter of an hour), the copper solution undergoes alteration, and no longer possesses the power of resisting spontaneous reduction. As regards the amount of copper solution to be used, although 10 cc. of the test as ordinarily made are found to suffice for 20 cc. of the blood of animals in a natural state, yet it is well to employ from 20 to 30 cc. to secure that it is thoroughly in excess. Where, from any circumstance, larger quantities of sugar exist in the blood, more in proportion of the test must, of course, be used. The precipitated suboxide of copper has now to be separated from the excess of copper solution. Experience shows that filtration through filter-paper cannot be resorted to for the purpose. In the first place, the pores of the paper tend to become blocked up and filtration to be stopped ; and in the next-and this is a fatal objection-the paper absorbs and so tenaciously holds some of the copper solution that it cannot be effectually washed out. A plug of asbestos in a filter-funnel may be used instead; but asbestos varies considerably, and it is not always easy to procure it in a state to answer well for free, and at the same time perfect, filtration. A material, however, which has somewhat recently
doi:10.1016/s0140-6736(02)43643-4 fatcat:spfv33a6vbg5nfcl3glgs3ezhi