414 INTERNAL SECRETIONS OF PANCREAS AND SPLEEN. 



ous system and perhaps of the sympathetic and larger periph- 

 eral nerves may give rise to glycosuria and diahetes is, of 

 course, established," says Flexner. 31 "The number of neu- 

 ropathic conditions in which one or the other of these has 

 been found is now considerable. The one definite condition, 

 the effect of which is constant, is Claude Bernard's piqure, and, 

 as bearing out the physiological relationship existing between 

 certain unknown structures in the floor of the fourth ventricle 

 and the glycogen-store in the liver, may be cited the instances 

 of lesions (hemorrhages, softening, tumors) in man observed 

 in this situation with which glycosuria has been associated. 

 That cerebral and perhaps spinal disturbances other than those 

 in the region of the fourth ventricle may be associated with or 

 followed by diabetes many clinical cases prove. On the other 

 hand, there is no evidence that would show that it is the direct 

 influence of the central nervous system upon the carbohydrate 

 metabolism that produces hyperglycaemia and glycosuria. In- 

 deed, the experiments in which the splanchnics were sectioned 

 after piqure (Claude Bernard and others) without producing 

 glycosuria show the necessity of the interaction of other or- 

 gans." 32 



Eead in the light of all we have said, particularly the 

 allusion to the relationship between the medulla and the 

 suprarenal glands through the splanchnic, these lines, from 

 so competent an observer as Flexner, and which confirm those 

 of Cartier as to the action of section of the splanchnic, seem to 

 us to afford confirmatory evidence based upon the most solid 

 labors of the last half-century and to embody Claude Bernard's 

 own sanction. To analyze their far-reaching meaning would 

 involve the repetition of what has been said in all this volume. 

 Formulated as a deduction, the functional relationship between 

 the floor of the fourth ventricle and glycosuria would be as 

 follows: Puncture of the floor of the fourth ventricle (Claude 

 Bernard) causes glycosuria because the increased Nood-supply in 

 the injured area incident upon the local reparative process corre- 

 spondingly excites the normal structures around this area, which, 



si Flexner: Loc. cit. 



82 All italics are our own. 



