674 DIABETES 



two animals so joined by operative means that permanent inter- 

 mingling of their blood occurs) performed pancreatectomy in one of 

 the animals without producing diabetes in either; from which it might 

 seem that the internal secretion was carried by the blood. In harmony 

 with these results were the investigations of Knowlton and Starling,^'* 

 who found that an isolated beating heart taken from a depancreatized 

 animal (cat) was capable of removing less sugar from the blood used 

 as a perfusion medium than are hearts of normal animals, but these 

 latter experiments have not been confirmed and are subject to criticism. 

 In most of the transfusion experiments reported the standardization 

 of the metabolism prior to giving the fresh blood has not been such 

 as to make the results certain. Carlson and Drennan found that 

 pancreatectomy in a pregnant animal near term might fail to cause 

 diabetes, but that diabetes developed at once following delivery. This 

 could be explained on the basis that an internal secretion passed from 

 fetus to mother, or that sugar failing of utilization in the mother was 

 utilized by the fetuses. Kramer and Murlin failed to note any increase 

 of the respiratory quotient in depancreatized dogs following blood 

 transfusion, and Sansum and Woodyatt saw no improvement following 

 transfusion in a human case." Recently Kleiner^^" has reported a di- 

 minution of the total blood sugar in dogs following infusion of pan- 

 creas emulsion, and this work revives the interest in a problem of great 

 importance. 



Symptoms.^ — ^In the absence of extracts which contain the active 

 principle in measurable quantity, the attention must be turned to a 

 more detailed study of the effects which follow its lack. Now it is 

 well known that in diabetes melitus there are all grades of severity. 

 What follows has reference only to the severest cases — those which may 

 be called "complete diabetes." In the severest cases of diabetes, gly- 

 cosuria persists even when the individual subsists on a fat-protein 

 diet, and after the glycogen in the body has been reduced to a mere trace. 

 When this stage has been reached, and provided no carbohydrate food 

 is eaten, it is found that the total glucose in the urine bears from day 

 to day a constant ratio to the total nitrogen in the urine as already 

 described for phlorhizin diabetes. This "G : N ratio" is not always 

 the same. In depancreatized dogs nourished solely on fat and pro- 

 tein, it is often found, as Minkowski first recognized, at 2.8 : 1, and 

 in human diabetes the same value for G : N is sometimes seen. But, 

 as in phlorhizinized dogs, higher ratios may occur in the human disease. 



If to such a case of diabetes as this we give b}-- mouth 40 grams of 

 glucose there may appear in the urine close to 40 grams of extra sugar. 

 Plainly such extra sugar has escaped utilization of any kind. It can- 

 not have been oxidized or converted into fat, since these processes are 



" Jour, of Physiol., 1913 (45), 146. 



''^ Jour. Amor. Med. Assoc, 1914 (02), 99(5 for lit. references. 



""Jour. Biol. Cheiii., 1919 (40), 153. 



