v INTERNAL KEST1TUTIVE SECEETIONS 319 



diabetes, which is only seen when the organ is completely removed. 

 On the other hand (see p. 99), the whole of the solar plexus can 

 be excised without producing permanent diabetes, transitory glyco- 

 suria with acetonuria only being manifested. 



According to Lepine and his pupils, pancreatic diabetes depends 

 on the absence from the blood of a glycolytic ferment of pancreatic 

 origin, which normally oxidises the circulating sugar (see Vol. I. 

 p. 127). According to 0. Cohnheim, again, this ferment of 

 pancreatic origin acts normally not only on the blood, but also 

 on the various tissues of the body. Pniiger contests both these 

 opinions. As against Lepine he points out that researches in vitro 

 show too small a decrease in the sugar content of the blood 

 (4 to 6 per cent) in one hour, to explain the combustion of the 

 carbohydrates. This objection does not, however, meet Cohii- 

 heiin's position. If we take into consideration the combustion not 

 only of the blood-sugar but that of all the sugar contained in the 

 body, the combustion of 6 per cent in one hour would, under 

 normal conditions, account for the total combustion of sugar in the 

 course of the day. Further research is needed to clear up this 

 important question. 



Montuori asserted the importance of the liver in the genesis of 

 pancreatic diabetes (1895). He found by ingenious experiments 

 that when pancreatic extract was added by various means to 

 excised liver, less sugar was found after some time than in other 

 portions of the same liver not submitted to similar treatment. 

 According to him this depends, not on the glycolytic action of a 

 specific enzyme, as assumed by Lepine and Syrnpson for the pan- 

 creas, but on an inhibitory action on hepatic glycogenesis by the 

 pancreas, as was also held by Kaufmann. But in addition to certain 

 theoretical objections, which might be made against the view of 

 Montuori, his experimental results are contradicted by numerous 

 experiments of Pariset (1904-5). 



Marcuse found a proof of the importance of the liver to 

 pancreatic diabetes, in the fact that while diabetes always appears 

 in the depancreatised frog (as shown by Aldehoff) it does not occur 

 in frogs deprived of both pancreas and liver. Montuori experi- 

 mented to see if the same result could be obtained in dogs also. 

 Instead of excising the pancreas he tied all its veins, and instead 

 of excising the liver he tied the portal vein and hepatic artery 

 simultaneously ; instead of examining the sugar content of the 

 urine after these successive operations, he estimated the sugar 

 content of the carotid blood. Half an hour after ligation of the 

 pancreatic veins he found a marked augmentation of the percent- 

 age of sugar in the blood ; about an hour after ligation of the 

 portal and the hepatic artery he found a diminution in the sugar 

 of the blood, which sometimes fell below normal. Moutuori 

 correctly interpreted these results as showing that when the 



