Locally, powdered cane-sugar has been used in dry form as an application to ulcers and infected wounds. It seems to promote osmosis, to dissolve fibrin and to favor local nutrition, and it does not form crusts. Zweifel, Sudeck, and others have employed a 50 per cent. solution in amounts of one ounce (30 c.c.) in the vagina for leucorrhea. As a postoperative measure to lessen shock, vomiting, thirst and gas pains, and furnish food, Barbee recommends a 1 1/2 per cent. solution by rectum by the continuous drip at 30 to 40 drops per minute. Goulston and others consider cane-sugar a valuable cardiac nutrient even when taken by mouth. Finding it non-irritant and readily absorbed, Magnus and others have employed a 10 per cent. solution by hypodermoclysis as a nutrient, and claim that it is utilized as well as glucose.

Milk-sugar has no uses except as a diluent in pharmacy and as a food. It is of interest that in Coleman's high calorie typhoid diet as much as 1 1/2 pounds (715 gm.) a day has been given by mouth and completely utilized.

Glucose, dextro-glucose or dextrose, is the natural sugar of the blood. A 5.4 per cent. solution is isotonic with the blood. Henriques and Anderson maintained goats in good nutrition for 3 weeks by a continuous flow through a permanent canula into the jugular vein, of a solution of glucose, sodium acetate, inorganic salts, and meat digested to the amino-acid stage. Leo states that starving rabbits given 15 grains (1 gm.) of glucose daily by the subcutaneous or intravenous route survived 5 days longer than the controls. Woodyat, Sansum and Wilder, by a most careful series of experiments, found that glucose in 10 to 50 per cent. solution can be introduced directly into the veins at rates corresponding closely to 0.85 gm. of glucose per kilogram of body weight per hour, without producing glycosuria or diuresis. This would be 63 gm. per hour for a man of 70 kilograms resting quietly in bed, and at this rate would furnish 6048 calories per day. They call particular attention to the fact that sugar tolerance.must be measured by the rate of administration, i. e., the amount per hour. When given more rapidly than at the rate established glycosuria and diuresis result. For example, a 10-kilogram dog given 5.4 gm. per hour passed the amazing amount of 2800 c.c. of urine in 8 hours. They recommend intravenous glucose as among the best of diuretics, the dilute solutions serving to flush the system, and the concentrated solutions to abstract water from the tissues. They warn that if large quantities of water are given with the glucose, there is a liability to mechanical failure of the heart, while on the other hand too much of a concentrated solution will over-dehydrate even to the extent of producing death.

Burton-Opitz showed that the viscosity of the blood was increased by concentrated solutions and was readjusted by osmotic interchange between the blood and tissues, and Fischer, because of its power to dehydrate colloids, classes sugar with the saline diuretics.

The amount of sugar that can be given by mouth or rectum and disposed of is much below the amount that can be given by vein. It is impossible to produce glycosuria by the rectal injection of glucose, and Hopkins found that while glucose by mouth produced a hyperglycemia in half an hour, 20 gm. sub-cutaneously took 4 1/2 hours and 100 gm. by rectum 4 hours to increase the blood-sugar. Macleod has pointed out that neutral glucose solutions intravenously produce an acidosis, there being twice as much lactic acid in the blood as normal and an increase in the hydrogen ion content. This would suggest the propriety of giving alkali with the intravenous solutions.

Therapeutics

1. As food in rebellious vomiting (postoperative, in pregnancy or gastric disease, etc.), malnutrition, and cardiac decompensation glucose may be employed by continuous intravenous infusion in 10 to 50 per cent. solution in amounts representing 50 gm. per hour. For convenience a larger amount (300 c.c.) may be given slowly two or three times a day, the resulting glycosuria causing a loss of only a few grams of glucose at most. 2. During or following operation it may be employed as a prophylactic against shock intravenously or in 4 to 6 per cent. solution by hypodermoclysis or the continuous drop proctoclysis. 3. As a diuretic, dilute solutions are used intravenously or by proctoclysis in anuria and uremia, acidosis, diabetic coma (Joslin), and other toxemias; and concentrated solutions in cardiac or nephritic edema. Turretini reports the overcoming of anuria in four cases, two of them mercurial poisoning.