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are 1-arabinose and 1-xylose. After the discovery and the reporting of a case of pentosuria in 1892 by E. Salkowski and Jastrovitz, Blumenthal of Berlin reported two cases in 1895, two in 1900; F. Meyers, one in 1901; Blumenthal, one in 1902; Bial, two in 1902; Bedix, one in 1904; Bial, four in 1904; Klercker, two in 1905; Luzzatte, one in 1904; T. C. Janeway, of New York, two in 1906; Von Jaksch, two cases in 1906; Kaplan, of New York, one case in 1906, and Solomon Cohen, one in 1909. Besides other German and one or two Italian doctors have had cases of pentosuria that have been diagnosed and reported. With such evidence before us we must admit that pentosuria exists and may be in our midst unrecognized.
The general practitioner must no longer be satisfied with his Fehling solution or Haines solution. That reduction of urine by these tests does not necessarily show the presence of grape sugar, for we now know that a variety of sugars are found in the human urine, all of which react to the common tests. The puerperal woman who does not nurse her child may have milk sugar in the urine for months, but this sugar can be differentiated from grape sugar, in that milk sugar does not ferment with yeast, while grape sugar does. We may recognize a less important sugar in levulosuria, characterized by the independence of the ingestion of carbohydrates and recognized by the decided levorotary power developed during the fermentative test. Maltose may also appear occasionally in the urine when the pancreas is diseased, but is hard to detect by the most delicate chemical methods. Of more importance are the pentoses and glycuronic acids. Glycuronic acid may be considered as pentose-carbonic acids. Combined glycuronic acids are formed in the urine after taking drugs as turpentine, morphine, chloral, menthol, antipyrine, etc. These can be diagnosed by the history of the patient having taken one of these drugs. But what about pentosuria? Urine with pentosuria give a distinct but somewhat delayed reaction with Fehling's test, the reduction only taking place upon cooling, and then quite suddenly. The phenylhydrazin test is also positive with pentose, and the Nylander's test. But urine containing
pentose will not ferment with yeast, and such a urine remains optically inactive in the polariscope. To make the diagnosis more certain we have other tests. A urine containing pentose and only such a one gives the orcin test. This is done by decomposing 3cc of urine in 6cc of fuming hydrochloric acid; to this is added a few granules of orcin, and the mixture is then heated to the boiling point. As soon as the mixture begins to boil, a bluish green color appears, which is positive proof of pentose. Urine containing grape sugar or milk sugar does not give this reaction and urine cotnaining glycuronic acid gives the test only upon prolonged boiling, and then the precipitate is never of a greenish blue, but more of a violet color. There is also a phloroglucin test which is not so positive, and consists of 3cc of urine and 3cc of hydrochloric acid of S. G. 1.019, to which a few granules of phloroglucin are added and the mixture heated to boiling point, when a cherry red color develops, which finally turns greenish black. If amyl alcohol is then added, and the mixture shaken, the coloring matter is dissolved, and shows an absorption band between yellow and green in the polariscope. Bial adds a few drops of liq. ferri sesquichlor to the orcin test and produces a beautiful blue color. The orcin test is the most positive, according to F. Blumenthal, and confusion of urine with pentose and other glycuronic acid are not possible, except two glycuronic acids, namely, menthol glycuronic and turpentine glycuronic acid. Both these acids decompose spontaneously, and as free glycuronic acid responds to the orcin test confusion might arise but for the history of having taken either of these drugs or the odor of peppermint in the urine, if due to menthol, or violets if due to turpentine. Therefore, since the introduction of the orcin test there can scarcely be any difficulty in detecting pentose. But if we have a case of pentosuria, what does it indicate? Is not our patient excreting sugar? And what does he care whether he is excreting carbo hydrates put up in 5 atom packages, or whether he is excreting carbo hydrates put up in 6 atom packages? Does this apparent slight chemical difference make any important physiological and pathological
difference? With the present light we have on this subject, let us attempt to answer these questions. Is pentosuria a variety of diabetes mellitus; If so, the combustion of carbo hydrates must be diminished as in the case of diabetes. Then with the withdrawal of starch from the food the pentosuria should disappear or lessen, or by the profuse administration of starch the grape sugar should increase. For outside of the body Ruff has produced pentose from derivities of grape sugar by oxidation with permanganate potassium and hydrogen peroxid, and it is possible that the human organ may carry on this process of oxidation. But when we withdraw carbo hydrates from a person who excretes pentose, it is observed that the pentosuria continues just the same, and when Blumenthal, Bial and others added even 100 grams of grape sugar to their patient's diet, it did not lead to increase of pentosuria. Therefore, it is obvious that pentose in the animal organism is not formed by the oxidation of hexose. In diabetes the power to burn starches or hexose is diminished. This is not true in pentosuria as shown so far, for even 100 grams of grape sugar caused no glycosuria. It follows from this that the patient with pentosuria has no greater tendency to alimentary glycosuria than the healthy. And Blumenthal has, after careful investigation, come to the conclusion that pentosuria is an independent disturbance of metabolism, which is characterized by the fact that in this condition an inactive sugar has been found in nature for the first time, and the law that the animal organism and plants can produce only active varieties of sugar has been proven erroneous. He also proved that pentose is not only the sugar of the vegetable kingdom but also occurs in the animal kingdom in all the animal nucleus.
The varieties of pentosuria are: First, alimentary pentosuria, in which the phenomenon follows the ingestion of food, rich in pentose producing substances as cherries, strawberries, plums, etc. This alimentary pentosuria is distinct from the second variety of chronic pentosuria. True chronic pentosuria is characterized by the fact that independent of food an active arabinose is excreted continuously from 0.3 to I per
cent. Then a third variety, in which the urine contains both pentose and hexose. Up to the present time there have been about forty cases of pentosuria reported in all, and these cases have not shown a special liability to become diabetic. Then, what is the prognosis of pentosuria? It is too early as yet, but it would appear that the prognosis is much more favorable than in a case of mild diabetes, for the pentosuria utilizes fully the starches and other carbohydrates which are administered with the food, and the amount of pentose which he forms and excretes is small, at most from 15 to 20 grams a day. It is possible that the increase in circulating sugar in proof of that, and a person having pentosuria should be looked upon more favorable by life insurance companies than the mildest case of diabetes, for if the case is not diabetes the insurance companies should not classify the pentosuric and diabetic in the same catagory. As yet the insurance companies have not recognized any difference. But important as it is that the pentosuria should be recognized as such by life insurance companies, and not treated as a person having diabetes mellitus, and refused insurance, which would be a gross injustice to him. How much more important it is that pentosuria should be sought for in every case showing reduction tests. With positive orcin test and negative fermatation test the diagnosis is easy. Positive orcin test and positive fermation test denotes pentosuria and glycosuria. But how important it is that the pentosuric be discovered and treated as such. It means to him the removal of diet restrictions that are very exacting and the taking away the fears of a severe chronic disease for one that runs a mild and apparently harmless course. Chemically one atom's difference in its molecular combination physiologically the difference between an essentially mild disease and one that is a profound and dangerous disorder of metabolism associated with grave symptoms.
A TOAST AT THE BANQUET CELBRATING THE FIFTIETH ANNIVERSARY OF THE LUZERNE COUNTY MEDICAL SOCIETY.
BY DR. LEWIS H. TAYLOR, WILKES-BARRE, PA.
READ JANUARY II, 1911.
Mr. President and Fellow Members:
I am overwhelmed with the task that you have set for me in asking me to present a sketch of the Luzerne County Medical Society during the fifty years of its successful existence. To present even the salient points, to touch here and there upon a few of the important things that have happened would require a much longer time than that at my disposal, and would, I fear, tax your patience too greatly for me to hope to retain a good standing as one of your speakers at this banquet. The Luzerne County Medical Society and that for fifty years! I tell you the subject looms up largely, and, I may say, grandly, for we are not ashamed of our heritage.
Twenty-five years ago this month we met in our first annual society banquet at the Wyoming Valley Hotel, at which time that grand old man, Dr. Edward R. Mayer, read a paper on the "Then and Now of Medicine," in which, at its close, he gave a sketch of the founding of this society. After describing a number of the older men of the county of 1861, and especially the one who originated the novel method of hastening delayed labor by incising the scalp of the child with a pair of scissors and inserting the fingers between the scalp and skull for purpose of traction, he goes on to say: "Such were some of the lights of our profession in the early days of this region. Animosities between medical men were rife, and courtesies professional or social were rare. It became necessary to infuse new life into the calling and to resublime the medical caput mortuum. Some few of us who thought we knew more than our elders, put our live heads together, and in the ides of March, A. D. 1861, commenced the organization of the Luzerne