Emotional Glycosuria
The discovery that during strong emotion adrenal secretion is increased, and the fact that injection of adrenin gives rise to glycosuria, suggested that glycosuria might be called forth by emotional excitement, and then that even without the painful element of Böhm and Hoffmann’s experiments, sugar might be found in the urine. The testing of this possibility was undertaken by A. T. Shohl, W. S. Wright and myself in 1911.
Our first procedure was a repetition of Böhm and Hoffmann’s experiments, freed from the factor of pain. The animals (cats) were bound to a comfortable holder, which left the head unfastened. This holder I had used hundreds of times in X-ray studies of digestion, with many different animals, without causing any signs of even so much as uneasiness. Just as in observations on the movements of the alimentary canal, however, so here, the animals reacted differently to the experience of being confined. Young males usually became quite frantic, and with eyes wide, pupils dilated, pulse accelerated, hairs of the tail more or less erect, they struggled, snarling and growling, to free themselves. Females, on the contrary, especially if elderly, were as a rule much more calm, and resignedly accepted the novel situation.
According to differences in reaction the animals were left in the holder for periods varying in length from thirty minutes to five hours. In order to insure prompt urination, considerable quantities of water were given by stomach tube at the beginning of the experiment and in some cases again later. Arrangements were made for draining the urine promptly, when the animal was on the holder or when afterwards in a metal metabolism cage, into a glass receiver containing a few drops of chloroform to prevent fermentation. The diet in all cases consisted of customary raw meat and milk. In every instance the urine was proved free from sugar before the animal was excited.
In our series of observations twelve cats were used, and in every one a well-marked glycosuria was developed. The shortest periods of confinement to the holder which were effective were thirty and forty minutes; the longest we employed, five hours. The average time required to bring about a glycosuria was less than an hour and a half; the average in seven of the twelve cases was less than forty minutes. In all cases no sugar was found in the urine passed on the day after the excitement.
The promptness with which the glycosuria developed was directly related to the emotional state of the animal. Sugar was found early in animals which early showed signs of being frightened or in a rage, and much later in animals which took the experience more calmly.
As cooling may result in increased sugar in the blood, and consequent glycosuria, the rectal temperature was observed from time to time, and it was found to vary so slightly that in these experiments it was a wholly negligible factor. In one cat the rectal temperature fell to 36° C. while the animal was bound and placed in a cold room (about 2° C.) for fifty minutes, but no sugar appeared in the urine.
Further evidence that the appearance of sugar in the urine may arise purely from emotional excitement was obtained from three cats which gave negative results when bound in the holder for varying periods up to four hours. It was noteworthy that these animals remained calm and passive in their confinement. When, however, they were placed, separately, in a small wire cage, and were barked at by an energetic little dog, that jumped at them and made signs of attack, the cats became much excited, they showed their teeth, humped their backs, and growled defiance. This sham fight was permitted to continue for a half hour in each of the three cases. In each case the animal, which after four hours of bondage had exhibited no glycosuria, now had sugar in the urine. Pain, cooling, and bondage were not factors in these experiments. The animal was either frightened or enraged by the barking dog, and that excitement was attended by glycosuria.
The sugar excreted in the twenty-four hours which included the period of excitement was determined by the Bertrand method.[14] It ranged from 0.024 gram to 1.93 grams, or from 0.008 gram to 0.62 gram per kilo body weight, for the twenty-four hours’ quantity.
The presence of sugar in the urine may be used as an indication of increased sugar in the blood, for unless injury has been done to the cells of the kidneys, they do not permit sugar to escape until the percentage in the blood has risen to a considerable degree. Thus, though testing the urine reveals the instances of a high content of blood sugar, it does not show the fine variations that appear when the blood itself is examined. Recently Scott[15] has concluded a thorough investigation of the variations of blood sugar in cats, and has found that merely incidental conditions, producing even mild excitement, as indicated by crying or otherwise, result in a noticeable rise in the amount. Indeed, so sensitive is the sugar-liberating mechanism that all the early determinations of the “normal” content of sugar in blood which has been drawn from an artery or vein in the absence of anesthesia, are of very doubtful value. Certainly when care is taken to obtain blood suddenly from a tranquil animal, the percentage (0.069, Scott; 0.088, Pavy) is much less than when the blood is drawn without anesthesia (0.15, Böhm and Hoffmann), or after light narcosis (0.282, Rona and Takahashi[16]).
Our observations on cats have since been found valid for rabbits. Rolly and Oppermann, Jacobsen, and Hirsch and Reinbach[17] have recently recorded that the mere handling of a rabbit preparatory to operating on it will increase the percentage of blood sugar (in some cases from 0.10 to 0.23 and 0.27 per cent). Dogs are said to be much less likely to be disturbed by the nature of their surroundings than are rabbits and cats. Nevertheless, pain and excitement are such fundamental experiences in animals that without much doubt the same mechanism is operative in all when these experiences occur. Probably, just as the digestion of dogs is disturbed by strong emotion, the blood sugar likewise is increased, for sympathetic impulses occasion both changes.[*] Gib has given an account of a bitch that became much agitated when shut up, and after such enforced seclusion, but never otherwise, she excreted small quantities of sugar in the urine.[18]
[*] Since the foregoing sentences were written Hirsch and Reinbach have reported (Zeitschrift für physiologische Chemie, 1914, xci, p. 292) a “psychic hyperglycemia” in dogs, that resulted from fastening the animals to a table. The blood sugar rose in one instance from 0.11 to 0.14 per cent, and in another from 0.09 to 0.16 per cent.
The results noted in these lower animals have been confirmed in human beings. One of my former students, W. G. Smillie, found that four of nine medical students, all normally without sugar in their urine, had glycosuria after a hard examination, and only one of the nine had glycosuria after an easier examination. The tests, which were positive with Fehling’s solution, Nylander’s reagent, and also with phenyl-hydrazine, were made on the first urine passed after the examination. Furthermore, C. H. Fiske and I examined the urine of twenty-five members of the Harvard University football squad immediately after the final and most exciting contest of the season of 1913, and found sugar in twelve cases. Five of these positive cases were among substitutes not called upon to enter the game. The only excited spectator of the Harvard victory whose urine was examined also had a marked glycosuria, which on the following day had disappeared.
Other tests made on students before and after important scholastic examinations have been published by Folin, Denis and Smillie.[19] Of thirty-four second-year medical students tested, one had sugar before the examination as well as afterwards. Of the remaining thirty-three, six, or 18 per cent, had small but unmistakable traces of sugar in the urine passed directly following the ordeal. A similar study was made on second-year students at a women’s college. Of thirty-six students who had no sugar in the urine on the day before, six, or 17 per cent, eliminated sugar with the urine passed immediately after the examination.
From the foregoing results it is reasonable to conclude that just as in the cat, dog, and rabbit, so also in man, emotional excitement produces temporary increase of blood sugar.