THE OCCURRENCE OF SUGAR IN THE URINE; ITS CLASSIFICATION, ETIOLOGY AND PATHOLOGY
Journal of the American Medical Association
The term diabetes mellitus is usually indiscriminately applied to a disease prominently characterized by an excess of sugar in the blood and by the occurrence of this body in the urine in varying amounts, this condition persisting over a greater or less length of time. The occurrence of sugar in the urine may be primarily divided into the physiologic and the pathologic, the former being again separated into two classes: 1. That condition in which, as ordinarily found in health, the quantity of
... h, the quantity of sugar present in the urine is too small to be detected by the usual clinical, tests as by Fehling's solution, by fermentation, etc. That a certain amount is, however, normally present in health has been repeatedly demonstrated by the more delicate gravimetric method, so that the increased amount of sugar often found in a urine may be simply due to the increased activity of a perfectly physiologic process, which under certain abnormal conditions, may become pathologic. 2. Those cases, much more numerous than usually supposed, the urines of which will be found to contain sugar in such increased amounts as to be appreciable by the common clinical tests. This condition may extend over a considerable period, perhaps many years, the patient in the meanwhile continuing in perfect health and the katabolic processes, to which the term diabetes mellitus is only to be applied, never ensuing. In such a patient the ingestion of carbohydrates does not in the least affect the excretion of sugar. The pathologic division is also to be separated into two main classes, glycosuria and diabetes mellitus proper. Glycosuria, by which is to be understood a temporary increase, as the result of certain abnormal conditions, in the quantity of sugar present in the urine; this sugar disappearing on the removal of the etiologic factors is to be classified as follows: 1. Nervous glycosuria, induced by prolonged and excessive emotions, by great nervous excitement or depression or by brain exhaustion. Thus it may be consequent to overstudy, excessive venery, fright, anxiety or grief. This condition has been well shown by Cohnheim in the lower animals by simply tying them down to a board, the terror and excitement being followed by the presence of sugar in the urine. 2. Febrile, as when sugar tests are obtained during or immediately following many pathologic processes, such as acute fevers or phthisis. 3. Traumatic.-Sugar is observed in urines passed soon after injuries affecting the cranium and its con-tents, such as hemorrhages into the brain substance, fractures of the tables, blows producing unconsciousness, etc. It may continue during inflammatory conditions of the brain or its meninges. Experimentally, it may be shown by the well-known " puncture of the fourth ventricle." Glycosuria also frequently follows any severe traumatism even if it be unassociated with cranial injury. Its occurrence in such a case is probably due to similar influences to those which induce the condition recognized as " shock." 4. Toxic.-Glycosuria may be produced by the action of many chemical and medicinal bodies, as curare or phloridzin, by the administration of anesthetics, etc. It is probably caused by the depressing and paralyzing effect of the drugs upon the peripheral and central nervous system. 5. Dietetic glycosuria is induced in some individuals by excesses of diet, more especially by the inordinate use of carbohydrates but also by the use of alcohol particularly in the form of the dry wines. It is caused in the first instance, by the sudden entrance into the system of more sugar than the organism is able to burn or store up in a given time with the consequent appearance of the unburned portion in the urine. In the second case, the toxic action of the alcohol on the nervous system may be considered as the cause. 6. The glycosuria of lactation immediately precedes the secretion of milk in the puerperal woman. It disappears on the flow becoming established to again appear if the quantity of milk produced is in excess of its consumption. It is, without a doubt, due to a reabsorption of the milk-sugar. Glycosuria, then, is a transient affection depending on the presence of certain exciting conditions, the removal of which is at once followed by a return to the normal. It has no more clinical importance than has a slight variation of temperature except as its presence may temporarily give rise to apprehensions of a true diabetes. Diabetes mellitus proper is a disease depending upon deep-seated nervous processes which can not be traced to any known cause and which are not followed by any constant anatomic changes. It is to be considered purely as a neurosis and may be divided, clinically, under the following heads.