DR. PAVY AND DIABETES 45 



Pavy's Views too Limited but his Teaching still 



Suggestive 



In dealing with Pavy's teaching I have found it necessary 

 to point out that in some fundamentals it is incompatible, not 

 only with the views of the majority (which would be a small 

 matter) but also, as I believe, with physiological probabilities. 

 But I shall have given a wrong impression, however, if it be con- 

 cluded that Pavy held views devoid of basis or that what was 

 special in his teaching is now without significance. There remains 

 indeed much that should yet stimulate experimental research ; 

 it may even be said that quite the most recent experiments have 

 given results which, in a sense, support his special views. 



The primary arrest of the sugar which leaves the intestine is 

 a process that is still not quite clear to us. Physiologists in placing 

 the seat of arrest wholly in the liver are faced with the re- 

 markable experimental fact that the establishment, in the dog, 

 of Eck's fistula, a proceeding which permits the blood flowing 

 from the intestine to enter the general circulation without 

 passing through the liver, is not followed by glycosuria, even 

 when the animal is digesting starch in abundance. One can- 

 not but feel, even if it be impossible to accept Pavy's theory 

 of local assimilation by the intestinal leucocytes, that such facts 

 warrant a further inquiry into the functions of the gut in 

 carbohydrate metabolism. As regards the form in which sugar 

 is carried by the blood, it seems clear that the greater portion 

 of it, if in any combination at all, is so loosely held as to be 

 liberated when the blood proteins are coagulated. The latest 

 observations agree, however, with those of Pavy, in showing 

 that some more complex carbohydrate also exists and there 

 is little doubt that the further study of this question, which he 

 was planning at the time of his death, would have been of 

 great value. We certainly do not yet possess full information 

 either as to the transport of carbohydrate or as to the signifi- 

 cance of that part which circulates in what Pavy called the 

 " amylose " form. 



Pavy, when looking for those errors which lead to diabetes, 

 sought them, as we have seen, almost exclusively on the 

 assimilation or constructive side of metabolism. His views 

 were, we may say, too limited in this respect ; but quite recent 

 research seems to show that, during the last decade, too little 



