PANCREAS DIABETES AND DIABETES MELITUS 665 



PANCREAS DIABETES AND DIABETES MELITUS 



Historical. — In 1788 Cowley reported atrophy and stone of the 

 pancreas in a case of diabetes. The coincidence of diabetic symp- 

 toms and lesions of tlie pancreas was furtlier studied by Bright, 

 Lloyd and Elliotson (1833). It was Bouchardat " who first defi- 

 nitely formulated 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 devel- 

 opment 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 gh'cosnria 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 )8-hydroxybutyric acids. In fact, the metabolic changes 

 secondary to this operation closely parallel those found in the humai? 

 disease, with certain difit'erences 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 proven in- 

 capable 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 



43 "De la Glvcosurie, etc.," II edit., Paris, 1883. Cited from Nauiivn. 



44 Arch, fiir exp. Path. u. Pharm., 1889 (26), 371; 185)3 (31). 85. 

 45Aldehoff, G. Zcit. f. Biol., 1891-2 (28), 293: Velich, Wien. Med. Zeitung., 



1895 (40), 502: :^rarcuse W.. Zeit. f. klin. Med., 1894 (26), 22.5. 



46 Capparelli, Biol. Zentralbl., 1893 (13), 495. 



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

 of this book. 



