Remarks on Diabetes and Gout in their Relationship to Liver Disease, with Hints Regarding their Scientific Treatment
Authors: G. Harley
Journal: BMJ (1893)

As the presence of sugar in urine is not in itself a disease, but simply a sign which may arise from a multiplicity of morbid conditions, I think I am justified in making the five following nosological divisions of the subject:- 1. Hepatic diabetes-including the gouty variety.2. Cerebral diabetes-including allcases of saccharine urine arising from nerve derangements.3. Pancreatic diabetes-the most deadly form of the disease.4. Hereditary diabetes-a form by no means uncommon and one, too, where both brothers and sisters may labour under the disease without either their maternal or paternal parent having been affected by diabetes; though more distant members of the family may have suffered from it.5. Food diabetes-including all forms of saccharin urine arising from the ingestion of unwholesome substances.The presence of sugar in urine is due to a disordered animal chemistry, diabetes being, like gout, a chemical form of disease.As far as I am aware, however, there are but two ways in which the faulty bodily chemistry causes sugar to appear in the urine, and it was this belief that led me, no less than a quarter of a century ago, to divide all cases of dia- betes clinically, as well as scientifically, into two great and distinct classes.To the one I gave the name of diabetes from excessive sugar formation; to the other that of diabetes from diminished saccharine consumption-malassimilation.Patients belonging to the first class are in general well nourished, and are so amenable to treatment that they may be kept alive and in comparative comfort for a quarter of a century and more; those belonging to the diminished consumption group are in general so little influenced by either medicines or diet that the vast majority of them succumb to the exhausting effects of the disease within a few weeks after its commencement.These views were published in 1865 in a course of "Lectures on Urinary Derangements " in the Medical Times and Gazette; and again in 1866 in a book entitled Diabetes its Various Forms and Different Treatments.Be- sides which the entire lectures were translated into French by M. Hahn, and published in Paris in 1875 by Delahaye under the title of De I' Urine et de 8e8 Alt&rations Pathologiques.Notwithstanding which, in 1880, M. Lancereaux published an article in L' Union Mddicale entitled "D Diabite gras et Dia- b6te maigre," thereby, not only adopting my two divisions, but merely parodying my words, without so much as alluding to my name in connection with the subject.However, this is of the less importance, seeing that he has failed to perceive that, not only is his nomenclature descriptively incorrect, but, at the same time, it labours under the disadvantage of not furnishing even so much as the remotest clue to the pathology of the two classes of cases it is supposed to signal- ise.Consequently it is both clinically and scientifically objectionable.W,rere I asked to give types of tlhe two classes of the disease I would give hepatic diabetes as an example of that arising from excessive sugar formation, and pancreatic diabetes as that resulting from diminished consumption-malassimilation.It is with the former class alone I shall at present deal.CASES ILLUSTRATIVE OF HEPATIC DIABETES.CASE I.-The patient was 50 years of age, and being a member of the Semitic race, like most others of the well-to-do Lamong his cg- Fm Tez BRITINN 1097 L LDICkL JOURNAL religionists,I accustomed to indulge in rich foods, work hard mentally, and at the same time take very little muscular exercise.2After listening to his history and examining him thoroughly, from finding his liver not