41 8 INTERNAL SECRETION 



which were totally devoid of pancreas, showed rapid decline both 

 of the temperature and of the N. and D. excretion after an hour 

 in the treadmill, and a few hours later they died. 



Hyperglyccemia. The immediate cause of glycosuria in 

 pancreatic diabetes, as in all the experimental forms, except so- 

 called renal diabetes (phlorizin, renal toxins), is an abnormal 

 increase in the sugar contents of the blood. The renal filter is 

 impermeable to the normal sugar contents of the blood, which 

 are about .1 per cent.; but if the sugar contents of the arterial 

 blood exceed this figure, and especially if the hyperglycaemia is 

 maintained, the kidney is unable to withstand the sugar in the 

 blood and it passes, in consequence, into the urine. A high 

 degree of hyperglycaemia is invariably the result of extirpation 

 of the pancreas ; it is present also in those cases, such as herbi- 

 vorous birds, in which glycosuria is absent (Kausch). The cause 

 of hyperglycaemia lies in a derangement of the regulatory 

 mechanism by which the normal sugar contents of the blood are 

 guaranteed. It is not proposed to enter here into a discussion 

 of the nature of this derangement ; it will be sufficient for the 

 present purpose if we describe the phenomena by which hyper- 

 glycaemia is accompanied. 



A factor of the first importance is supplied by the conditions 

 covering the glycogen contents of the body. Very early after 

 pancreas extirpation the glycogen in the liver is reduced until only 

 traces of it remain. In all cases of severe pancreatic diabetes, 

 the glycogen in the liver is reduced in the first few days to a 

 minimal amount and this does not subsequently disappear. Even 

 after generous feeding with carbohydrates only traces of glycogen 

 are to be found. In the slight form of diabetes, the liver may 

 contain considerable quantities of glycogen. Suppression of the 

 pancreas is also attended by a marked diminution in the amount 

 of glycogen in the muscles, though the muscles do not part with 

 their glycogen as readily as the liver. In face of the disappear- 

 ance of glycogen from the liver, the remarkably high glycogen 

 contents of the leucocytes is very striking (Ehrlich) ; the proba- 

 bility is that these become crammed with superfluous glycogen 

 from the blood. Not all the carbohydrates, however, escape con- 

 version into glycogen. As Minkowski proved, the administration 

 of levulose leads to a storing-up of glycogen in the liver and in 

 the muscles. It has been already pointed out that the administra- 

 tion of levulose does not increase glycosuria; certain later 

 observers (L. Pollak, Neubauer) regard this as the expression 

 of a greater resistency on the part of levulose-glycogen than upon 

 that of glucose-glycogen. As S. Fraenkel justly points out, the 

 administration of any one of the carbohydrates is invariably fol- 

 lowed by the formation of, the same glycogen substance, that, 

 namely, which directs the polarized ray to the right, and which, 

 after hydrolysis, yields dextrose. No one has, up to the present, 



