DIABETES AFTER EXTIRPATION OF THE PANCREAS 505 



of levulose a part of the same may be deposited as glycogen, in which case, as 

 Eppinger and / observed, also the fattening of the liver is halted. A part 

 of the levulose is excreted as levulose, another part as glucose. The ques- 

 tion as to whether the increase in elimination of sugar conditioned by the 

 administration of protein, depends on the direct formation of sugar from 

 protein was discussed very energetically, especially through the numerous 

 objections of Pftuger, until Luthje ascertained that after abundant adminis- 

 tration of casein the total amount of the excreted sugar far exceeds the pos- 

 sible amount of stored glycogen. The administration of fat does not increase 

 the excretion of sugar, yet it is to be considered that as a result of the absence 

 .of pancreatic juice, fat is very poorly absorbed. On the simultaneous ad- 

 ministration of pancreatin we have seen, however, in individual experiments 

 appreciable, although only transitory increase in the D:N quotient (to 7). 



In addition to the glycosuria there exists polyuria and ketonuria. The 

 occurrence of the latter is combated by many authors, although the experi- 

 ments of Embden and Lattes let it be expected that in the pancreas-diabetic 

 dog there exists a predisposition to ketonuria. If the blood of normal cattle 

 was allowed to flow through the liver of a pancreasless dog, there was found 

 as great an amount of diacetic acid as the liver of normal animals lets be 

 produced only on the addition of the strongest acetone formers. Allard 

 saw in addition to this, in pancreasless dogs, the occurrence of a not inap- 

 preciable amount of diacetic acid and betaoxybutyric acid, especially when 

 pieces of pancreas were placed under the skin of the abdomen and only later 

 extirpated; when therefore the development of the diabetic disturbance of 

 metabolism was retarded. In such animals ketonuria then develops rather 

 rapidly and eventually leads to coma. 



Also the protein metabolism in pancreatic diabetes shows definite dis- 

 turbances. Already Minkowski had shown that after removal of the pan- 

 creas there occurs an increase of the protein decomposition. In collaboration 

 with Grote and Staehelin, I showed that this increase is constant and its 

 intensity conformable to law. The hunger protein exchange after complete 

 extirpation attains to three or three and a half times the hunger protein ex- 

 change before the extirpation. Mohr found less values; however, Eppinger, 

 Rudinger, and /, in the later investigations confirmed our former statements. 



Also the excretion of salt is appreciably increased, according to the in- 

 vestigations of Whitney and myself. 



Finally the respiratory metabolism is essentially increased, according 

 to the investigations of Grote, Staehelin and me, and of Mohr. Our investiga- 

 tions were carried out in Jaquet's respiratory apparatus. Already the ap- 

 preciable increase of the protein destruction would lead one to expect an 

 increase of the caloric production, on account of the specific dynamic energy 

 of protein. According to our investigations, however, the increase of the 

 exchange (about 42 per cent, in the experiments not complicated with fever) 



