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.

    62/64 (page 60)
    proved, yet it is becoming increasingly probable that the pancreas is diseased in all cases of diabetes mellitus. An increasing bulk of evidence is also accumulating to show that the function of the pancreas which is in abeyance in diabetes is normally performed by certain special groups of cells known as the islands of Langerhans, which are distinct from the ordinary secreting cells of the gland, but which are not improbably formed from the acini. The special lesion of these islands—hyaline degeneration—which has been asso- ciated with diabetes by some writers, is not present in all cases of the disease and may be found (in a less developed •state) in other conditions. 5. The action of the pancreas may be exerted in the direction either of supplying a substance necessary for the assimilation of sugar by the cells of the body or in that of counteracting a poison which in some way causes accumula- tion of sugar in the blood. There is little or no evidence in favour of the former possibility ; in favour of the latter there are the results of experimental intoxication with phloridzin, with suprarenal extract, and with other sub- •stances, and a few inconclusive results obtained by injection of .secretions derived from diabetic patients. 6. We are not yet in a position to state with any certainty what tissue in the body gives rise to the sugar formed in diabetes. The theoretical possibility that sugar may be derived from fat is supported by certain observations which prove that a serious disturbance of the adipose tissue exists in diabetes. Further, if this hypothesis be admissible a certain unity will be introduced into our conception of diabetes, the phenomena of which will be explicable as manifestations of a single process occurring in a single tissue. 7. Lastly, glycosuria as opposed to diabetes may be due to mere excess of sugar poured into the blood from the alimentaxy canal in excess of what the system is capable of assimilating ; or it may be due to causes acting analogously to the diabetic puncture of Claude Bernard and leading to a discharge of sugar by the liver from its ■stores of glycogen. If the views here set forth are correct it follows that in its earliest stage the diabetic process may constitute rather a predisposing cause of glycosuria than the actual cause of the phenomenon, since the breaking down of the tissue-cells into sugar is at first not more than sufficient to saturate the sugar-assimilating powers of the system. At this stage a slight increase of saccharine food will produce glycosuria—an increase which in a normal person would not have this effect. Similarly a slight nervous shock sufficient to cause the liberation of only a comparatively small quantity of glycogen from the liver would also augment the sugar present in the blood above the