672 DIABETES 



mulated the belief that pancreatic disease was the cause of diabetes 

 melitus, but his views were uncongenial to the clinicians of his time 

 and it remained for von Mering and Minkowski" (1889) to prove 

 that complete pancreatectomy leads invariably to the development of a 

 severe diabetes. This applies not only to dogs but to cats, rabbits, 

 pigs (Minkowski), tortoises,"*^ frogs;*^ eels,"*^ and other animals. 



Effects of Pancreas Extirpation. — The glycosuria begins soon after 

 the operation and increases in intensity. It persists in spite of a 

 non-carbohydrate diet long after the glycogen reservoirs in the liver 

 and muscles have become greatly impoverished (to 0.1-0.2 per cent, 

 in the liver), but like the human disease, it usually ceases during a 

 fast or may disappear just before death. *^ The glycosuria may be 

 accompanied by an excretion of the acetone bodies, — acetone, aceto- 

 acetic and j3-hydroxybutyric acids. In fact, the metabolic changes 

 secondary to this operation closely parallel those found in the human 

 disease, with certain differences which perhaps are ascribable to species 

 or to the fact that in the experimental diabetes digestion is altered by 

 absence of the pancreatic juice, etc. Although Minkowski's work was 

 assailed from many quarters, the following points have become firmly 

 established by frequent repetition. (1) Complete removal of the 

 pancreas causes a true diabetes (as above); (2) Ligation or oblitera- 

 tion of the duct (or ducts) of Wirsung, no matter how scrupulously 

 carried out, has no such effect; (3) If about one-fifth of the pancreas 

 with its arterial supply be separated from the rest of the gland, this 

 fifth may be implanted extraperitoneally at a distance from the origi- 

 nal site. No diabetes results from this operation, or at most only a 

 transient glycosuria. Now if the main body of the pancreas be fully 

 extirpated with ducts, nerves and bloodvessels, still only a transient 

 glycosuria or none at all develops. At this stage all possible damage to 

 nerves and external secretion has been inflicted and proved incapable 

 of causing diabetes. (4) In the course of weeks the graft atrophies 

 (Sandmeyer's experiment), and then a persistent glycosuria supervenes; 

 or the encapsulated fragment which has been placed in an accessible 

 place under the skin may be extirpated, in which case within a few 

 hours a severe diabetes ensues. (5) There is no other organ in the 

 body extirpation of which has any similar effect, nor (except for phlor- 

 hizinization), is there any known means of experimentally producing 

 a true diabetes without injury to the pancreas. (6) No toxic sub- 

 stance derived from the body of diabetic individuals, man or animal, 

 has been found which is capable of causing diabetes in a second animal. 

 These facts lead to the conclusion {reached by Minkowski) that pancreatic 



** Arch, flir cxp. Path. u. Pharni., 1889 (2G), 371; 1803 (31), 85. 



"AldchofT, G. Zeit. f. Biol., 1891-2 (28), 293; Velich, Wien. Med. Zeitung. 

 1895 (40), 502; Marcuse W., Zeit. f. klin. Mod., 1894 (2G), 225. 



■"« CapparcUi, Biol. Zcntralbl., 1893 (13), 495. 



*' This statement, based on experimental work, appears in the 2d (1914) edition 

 of this book. 



