NON-DIABETIC GLYCOSURIA IN CHILDHOOD
1
1418 L.C.C. LABORATORY SERVICE under one month in 46. per cent., and over six months in only 7 per cent. Combining these figures with the interval between noticing symptoms and application to a hospital, it may be said that in most of these incurable cases the patient was dead in about seven months from the time they first noticed symptoms. Contrary also to the usual view, there is some indica- tion that the duration is shorter in old people. The mean age at death illustrates the low mean age in cancer of the uterus, ovary, lung, and pleura, and the high mean age in cancer of the skin and prostate. Roughly, from one-quarter to a third of patients of cancer of the breast, uterus, and tongue below the age of 60 are untreated, and only from one-quarter to one-third above this age are treated. The absence of treatment in older patients may be due to dis- inclination to face radical measures or to the shorter duration. The report contains much other suggestive information for those concerned with the public I health. ____ L.C.C. LABORATORY SERVICE. FOUR years ago a Southern group laboratory was started at the Park Hospital, Hither Green, which undertook to supply stains, culture media, and other material to various M.A.B. hospitals and institutions. When these were taken over by the L.C.C. the plan was further extended, and arrange- ments have now been made whereby any L.C.C. hospital or institution may obtain culture materials, standardised solutions, or stock vaccines from the laboratory at Hither Green. The group laboratories at Archway (Highgate), Lambeth, and Lewisham Hospitals draw their requirements from the same source, and the amount of material issued will increase as the work now done by outside authorities is taken over by the new L.C.C. laboratories. The Southern group laboratory is now, for example, examining 2500 samples of milk annually for the presence of tubercle bacilli, work previously done at the Lister Institute. The value of such centralisation depends on rapid and efficient transport, and a light motor-van is now being provided to convey specimens for examination from the various hospitals to the group laboratories, returning with stock materials. NON-DIABETIC GLYCOSURIA IN CHILDHOOD. Prof. G. Fanconi/ of Zurich, in reviewing this subject, begins by saying that he diagnoses primary ’, or familial renal glycosuria if he finds glycosuria with a normal fasting blood-sugar and normal blood-sugar curve, if the usual accompanying symptoms of true diabetes are absent, and if there is harmless glycosuria in other members of the family. As an example of secondary, or nephrotic, renal glycosuria he mentions a case where, following a chronic Bacillus coli infection, an infant developed glycosuria with a low level of blood-sugar-as low as 56 mg. per cent. on occasion. His second big group of cases of glycosuria in childhood comprises those associated with diseases of the nervous system. The presence of sugar in the urine in such conditions as tuberculous meningitis and cerebral tumour has long been recognised. Glycosuria was reported by Feer in one of the earliest accounts of pink disease, and in Fanconi’s series of 16 children with this disorder the fasting blood-sugar was frequently higher than the normal average, and the response to dextrose often resembled that seen in genuine diabetes. It is also stated that in chorea glycosuria 1 Jahrb. f. Kinderh., 1931, cxxxiii., 257. is not uncommon. A group of children with a ten- dency to run a temperature for no apparent reason (" constitutional hyperthermic children ") is also included in this " nervous " group, and here also there is a tendency to hyperglyceemia and glycosuria after the administration of dextrose. Third in Fanconi’s classification come endocrine disorders other than those affecting the islets of the pancreas. Here he describes the hypoglycaemia of dystrophia- adiposo-genitalis in contrast to the hyperglycsemia of patients with precocious puberty. Included in this group are also those children with diseases of the thyroid gland. Another interesting group are those with so-called febrile glycosuria, which is probably closely associated with some nervous disturbance. In infants suffering from some forms of toxaemia sugar is often to be found in the urine, according to the Berlin school, and in the clinical syndrome known as alimentary intoxication the fasting blood-sugar is said to be above the average, while in atrophy and dystrophy of infants-using again the German classification-a low blood-sugar is the rule. Prof. Fanconi discusses some of the very difficult points in association with these disturbances of sugar metabolism in infants ; and in another paper 2 Dr. H. Schonfeld records the level of the blood-sugar in normal infants after various periods of starvation. After fasting intervals of 12 to 16 hours the blood sugar falls considerably, he finds, and there is a very low curve after giving dextrose. Evidence is adduced that this " hunger hypoglycaemia " is not due to any increase in insulin activity. Fanconi’s patients were all suffering from various disorders of the alimentary system, and hence his results are not directly comparable with those obtained with normal infants. He describes, in contrast to these, certain cases of " hunger diabetes," where children on diets especially constructed to be poor in carbohydrate (in the treatment of epilepsy) exhibited glycosuria and raised blood-sugar levels closely resembling the biochemical picture found in true diabetes. These cases, taken with several clinical examples of glyco- suria appearing at the height of an attack of aceton- aemic vomiting, raise many difficult points, and there has been much controversy, especially in Germany, about whether insulin should be given in severe attacks of a.cetona3mia,. The finding of raised blood- sugar in the cases described in Fanconi’s paper casts doubt on the action of glucose in this condition. THE CONTROL OF THE PRACTICE OF DISSECTION I PUBLIC interest in the difficulties with which anatomists have had to contend in procuring material for investigation and teaching has been stimulated by recent dramatic representations of the notorious crimes oi Burke and Hare. Those who are concerned to ascertain the bare facts in their proper historical setting, and shorn as far as possible of dramatic colour, will find that in the second edition of his little book 3 on the history of anatomy, Dr. R. H. Hunter has added a considerable section dealing with the Resurrectionists. The book provides a good perspective in its estimate of the struggles of anato- mists in different ages. Dr. Hunter seems to accept a common belief that the Church was purely obstruc- 2 Ibid., p. 331. 3 A Short History of Anatomy. Second edition. By Richard H. Hunter, Ph.D., M.D., M.Ch., Lecturer in Anatomy, Queen’s University, Belfast. London : John Bale, Sons, and Danielsson, Ltd. 1931. Pp. 86. 3s. 6d.
Transcript of NON-DIABETIC GLYCOSURIA IN CHILDHOOD
1418 L.C.C. LABORATORY SERVICE
under one month in 46. per cent., and over six monthsin only 7 per cent. Combining these figures with theinterval between noticing symptoms and applicationto a hospital, it may be said that in most of theseincurable cases the patient was dead in about sevenmonths from the time they first noticed symptoms.Contrary also to the usual view, there is some indica-tion that the duration is shorter in old people. Themean age at death illustrates the low mean age incancer of the uterus, ovary, lung, and pleura, andthe high mean age in cancer of the skin and prostate.Roughly, from one-quarter to a third of patients ofcancer of the breast, uterus, and tongue below theage of 60 are untreated, and only from one-quarterto one-third above this age are treated. The absenceof treatment in older patients may be due to dis-inclination to face radical measures or to the shorterduration. The report contains much other suggestiveinformation for those concerned with the public Ihealth. ____
L.C.C. LABORATORY SERVICE.
FOUR years ago a Southern group laboratory wasstarted at the Park Hospital, Hither Green, whichundertook to supply stains, culture media, andother material to various M.A.B. hospitals andinstitutions. When these were taken over by theL.C.C. the plan was further extended, and arrange-ments have now been made whereby any L.C.C.hospital or institution may obtain culture materials,standardised solutions, or stock vaccines from thelaboratory at Hither Green. The group laboratoriesat Archway (Highgate), Lambeth, and LewishamHospitals draw their requirements from the samesource, and the amount of material issued will increaseas the work now done by outside authorities is takenover by the new L.C.C. laboratories. The Southerngroup laboratory is now, for example, examining2500 samples of milk annually for the presence oftubercle bacilli, work previously done at the ListerInstitute. The value of such centralisation dependson rapid and efficient transport, and a light motor-vanis now being provided to convey specimens forexamination from the various hospitals to the grouplaboratories, returning with stock materials.
NON-DIABETIC GLYCOSURIA IN CHILDHOOD.
Prof. G. Fanconi/ of Zurich, in reviewing thissubject, begins by saying that he diagnoses primary ’,or familial renal glycosuria if he finds glycosuria witha normal fasting blood-sugar and normal blood-sugarcurve, if the usual accompanying symptoms of truediabetes are absent, and if there is harmless glycosuriain other members of the family. As an example ofsecondary, or nephrotic, renal glycosuria he mentionsa case where, following a chronic Bacillus coli infection,an infant developed glycosuria with a low level ofblood-sugar-as low as 56 mg. per cent. on occasion.His second big group of cases of glycosuria in childhoodcomprises those associated with diseases of the nervoussystem. The presence of sugar in the urine in suchconditions as tuberculous meningitis and cerebraltumour has long been recognised. Glycosuria wasreported by Feer in one of the earliest accounts of pinkdisease, and in Fanconi’s series of 16 children withthis disorder the fasting blood-sugar was frequentlyhigher than the normal average, and the responseto dextrose often resembled that seen in genuinediabetes. It is also stated that in chorea glycosuria
1 Jahrb. f. Kinderh., 1931, cxxxiii., 257.
is not uncommon. A group of children with a ten-
dency to run a temperature for no apparent reason(" constitutional hyperthermic children ") is alsoincluded in this " nervous " group, and here alsothere is a tendency to hyperglyceemia and glycosuriaafter the administration of dextrose. Third inFanconi’s classification come endocrine disordersother than those affecting the islets of the pancreas.Here he describes the hypoglycaemia of dystrophia-adiposo-genitalis in contrast to the hyperglycsemiaof patients with precocious puberty. Included inthis group are also those children with diseases ofthe thyroid gland. Another interesting group are
those with so-called febrile glycosuria, which is
probably closely associated with some nervous
disturbance. In infants suffering from some forms oftoxaemia sugar is often to be found in the urine,according to the Berlin school, and in the clinicalsyndrome known as alimentary intoxication the
fasting blood-sugar is said to be above the average,while in atrophy and dystrophy of infants-usingagain the German classification-a low blood-sugaris the rule. Prof. Fanconi discusses some of the verydifficult points in association with these disturbancesof sugar metabolism in infants ; and in another paper 2Dr. H. Schonfeld records the level of the blood-sugarin normal infants after various periods of starvation.After fasting intervals of 12 to 16 hours the blood
sugar falls considerably, he finds, and there is a verylow curve after giving dextrose. Evidence is adducedthat this " hunger hypoglycaemia " is not due to anyincrease in insulin activity. Fanconi’s patientswere all suffering from various disorders of thealimentary system, and hence his results are not
directly comparable with those obtained with normalinfants. He describes, in contrast to these, certaincases of " hunger diabetes," where children on dietsespecially constructed to be poor in carbohydrate(in the treatment of epilepsy) exhibited glycosuriaand raised blood-sugar levels closely resembling thebiochemical picture found in true diabetes. Thesecases, taken with several clinical examples of glyco-suria appearing at the height of an attack of aceton-aemic vomiting, raise many difficult points, and therehas been much controversy, especially in Germany,about whether insulin should be given in severe
attacks of a.cetona3mia,. The finding of raised blood-sugar in the cases described in Fanconi’s paper castsdoubt on the action of glucose in this condition.
THE CONTROL OF THE PRACTICE OF
DISSECTION
I PUBLIC interest in the difficulties with whichanatomists have had to contend in procuring materialfor investigation and teaching has been stimulatedby recent dramatic representations of the notoriouscrimes oi Burke and Hare. Those who are concerned
to ascertain the bare facts in their proper historicalsetting, and shorn as far as possible of dramaticcolour, will find that in the second edition of hislittle book 3 on the history of anatomy, Dr. R. H.Hunter has added a considerable section dealing withthe Resurrectionists. The book provides a goodperspective in its estimate of the struggles of anato-mists in different ages. Dr. Hunter seems to accepta common belief that the Church was purely obstruc-
2 Ibid., p. 331.3 A Short History of Anatomy. Second edition. By Richard
H. Hunter, Ph.D., M.D., M.Ch., Lecturer in Anatomy, Queen’sUniversity, Belfast. London : John Bale, Sons, and Danielsson,Ltd. 1931. Pp. 86. 3s. 6d.
