500 DISEASES OF THE INSULAR APPARATUS OF THE PANCREAS 



was the observation of Ssobolew and of Schulze, that after ligation of the 

 excretory duct of the pancreas, the acinous tissue gradually undergoes atro- 

 phy while the islands remain intact. Also the observations of the patho- 

 logical anatomists show that the islands are much more refractory toward 

 the action of various noxious agents than is the acinous tissue. This furnishes 

 the explanation of the numerous cases of severe disease of the pancreas without 

 glycosuria; on the other hand statements that in diabetes mellitus chiefly the 

 islands diseased were constantly increasing, a direction that was first inau- 

 gurated by Opie and quite particularly upheld by Weichselbaum. Up to the 

 present the insular theory has not, however, won general recognition, as it is 

 found on the pathological anatomical side that there are constantly occurring 

 cases in which in spite of an existing diabetes the insular tissue remains intact 

 and even in certain cases, is especially well developed. This finding has led 

 many authors to the view that both tissue elements of the pancreas, acinous 

 and insular apparatus, produce the hormone. In recent years the problem 

 of the internal secretion of the pancreas has experienced further complication; 

 the view has been expressed that the significant influence that the pancreas 

 exercises over digestion in the intestine depends not alone on the enzymatic 

 properties of the intestinal juice but in part on the internal-secretory activity 

 of the pancreas (Lombroso). Both tissue elements of the pancreas, according 

 to this, are involved in both the external as well as the internal-secretory 

 activities. This teaching has obviously caused much confusion. 



Another aspect of the problem is the question how the pancreas takes 

 part in the carbohydrate metabolism. Claude Bernard assumed that in dia- 

 betes there was increased sugar production. Minowski first expressed the 

 opinion that on the absence of the pancreatic hormone the consumption of 

 the sugar molecule in the body suffers -harm. Naunyn inclines more to the 

 view of a disturbance in glycogenesis (dyszoamylie). Luthje first furnished 

 the certain demonstration that in addition to the carbohydrates also the 

 protein is to be considered as a sugar builder. The increase in the sugar 

 production has been more discussed again since the investigation of O. Lbwi; 

 Eppinger, Falta, and Rudinger assume in experimental pancreatic diabetes 

 both reduction in the sugar consumption (removal of the specific internal 

 secretion) as well as increase in the mobilization of sugar (consecutive 

 increase of function of the chromaffin tissue), a view that / promulgated for 

 human diabetes. On the ground of the investigations of Forges and Salomon, 

 i). Noorden brought the increased sugar production again into the foreground, 

 while lately Starling and Knouthon have advocated the exclusive disturbance 

 of sugar combustion. 



As to what finally is the significance of the pancreas for the pathogenesis 

 of human diabetes views diverge greatly. The discovery of sugar puncture 

 by Claude Bernard led to the viewing of each case of diabetes as neurogenic. 

 After the discovery of experimental pancreatic diabetes, attention was drawn 



