41 6 INTERNAL SECRETION 



(acidosis), with its attendant danger, coma diabeticum ; and by 

 changes in oxidation and general metabolism, as well as by the 

 secondary effects which these produce upon the nutritional con- 

 ditions (polyphagia and emaciation). 



Glycosuria. The characteristic symptom, which appears 

 -earliest after pancreasectomy and is most readily demonstrable, 

 is the presence of grape-sugar (dextrose) in the urine. The 

 amount and the intensity of the glycosuria is subject to immense 

 variation, partly the result of external factors, such as muscular 

 exertion, surrounding temperature, &c., chief among which is 

 the amount and nature of the diet. Assuming these factors to be 

 -equal, however, the condition falls into two distinct types con- 

 nected by transition stages, and these types correspond in all 

 essential particulars to the " slight " and " severe " clinical forms 

 of diabetes. The essential differences which Seegen pointed out 

 between the two clinical conditions are not observed in experi- 

 mental pancreatic diabetes. The differentiation is merely quan- 

 titative and depends upon the degree of pancreatic inadequacy. 



The extirpation of relatively large portions of the pancreas 

 produces slight glycosuria; extirpation of the entire organ is 

 followed by severe glycosuria. If the portions left in situ 

 undergo secondary atrophy, the slight condition may pass into 

 the serious stage (Sandmeyer). Slight diabetes is characterized 

 clinically by the fact that sugar appears in the urine only after 

 a diet containing carbohydrates, and disappears rapidly if the 

 carbohydrates are excluded from the diet. In the severe form, 

 sugar is always present in the urine and, though the quantity 

 is diminished by fasting or by an exclusively meat diet, the 

 sugar never entirely disappears. As Minkowski showed, when 

 the metabolic derangement, after total extirpation of the pancreas, 

 has reached its height, the glycosuria has a certain definite in- 

 tensity, which may be estimated by the proportion between the 

 sugar and the nitrogen in the urine, and which, after fasting 

 or a diet free from carbohydrates, is expressed by the quotient 

 D:N=2.8:i. It has been shown by numerous subsequent ex- 

 periments that Minkowski's quotient of 2.8 varies but slightly in 

 diabetes produced by total extirpation of the pancreas of dogs ; 

 and that within the limits of this quotient, sugar is formed from 

 albumen. As we showed in a previous chapter, the previous or 

 simultaneous ex'tirpation of the thyroid of dogs without pancreas 

 raises the quotient D :N to 3.5, or even higher (Eppinger, Falta 

 and Rudinger). 



Alimentation increases the absolute amount of sugar excreted. 

 Feeding with albumen is followed by a fluctuation of the sugar 

 contents in proportion to the amount of nitrogen present in the 

 urine (Minkowski, Berger, Lehmann, Bendix). The administra- 

 tion of fats does not, as a rule, increase the glycosuria, though 

 Falta, Eppinger and Rudinger observed a transitory, but very 



