DIABETES AFTER EXTIRPATION OF THE PANCREAS 507 



It is generally recognized that in the present state of our knowledge, the as- 

 sumption of an internal secretion of the pancreas is not to be avoided. 

 Opinions of former authors, that the irritation or injuries to the sympathetic 

 nerve plexuses in the course of the severe operations determined the glyco- 

 suria, are contradicted by the transplantation experiments of Minkowski 

 and Hedon. If the part of the pancreas lying in the mesentery of the duo- 

 denum is transplanted with its vascular peduncle, under the skin, and later 

 the rest of the pancreas removed, diabetes does not occur. A minimal 

 [operative] attack then suffices to remove the transplanted piece and to call 

 forth a diabetes in its fullest intensity. That the presence of pancreatic 

 juice in the intestine is not necessary for the normal course of the carbohy- 

 drate metabolism is readily seen in the fact that administration of pancreatin 

 essentially improves the absorptive disturbances, but rather increases the 

 intensity of the excretion of sugar. 



The experiments detailed lead us to assume, as already mentioned, an 

 inner secretion of the pancreas. We have not as yet succeeded, however, in 

 isolating the internal secretion and defining it chemically. We are not even 

 certain as to the path of the giving off of the same. Biedl showed in his 

 interesting experiments on dogs that after leading off the lymph of the tho- 

 racic duct to the exterior, glycosuria can occur. Biedl concluded from that 

 that the inner secretion of the pancreas is carried off by the lymph. Later 

 Biedl and Ojjer stated that adrenalin glycosuria can be prevented by the simul- 

 taneous injection of duct lymph. If the internal secretion of the pancreas 

 were carried off by the lymph we would expect that on the administration of 

 the lymph of normal dogs to pancreasless dogs the intensity of the metabolic 

 disturbances would be essentially reduced, or that the excretion of sugar 

 would completely disappear, at least for some time. In numerous investiga- 

 tions as to this point we could not find these things. In large dogs that were 

 fed abundantly with carbohydrates, the lymph from the thoracic duct was 

 collected for some hours, and this lymph administered to pancreasless dogs 

 either subcutaneously or by the drop-by-drop method into an exposed vein, 

 without producing an essential influence on the quotient of dextrose to nitro- 

 gen (D : N) , although the experiments were conducted for hours only. When 

 Biedl more recently 'states that he succeeded in similar experiments in de- 

 pressing the D : N ratio from 1.8 per cent, to 1.5-1.2 per cent., it seems to me 

 that the difference is much too small to decide as to this important question. 

 Recently an attempt has been made by Tuckett to explain the glycosuria oc- 

 curring in dogs with a lymph fistula, by the operative injury to the sympa- 

 thetic nerve in the neck and also by the narcosis. This explanation, it seems 

 to me, in consideration of the high percentage of sugar found by Biedl, does 

 not appear satisfactory. If the internal secretion of pancreas is not carried 

 off by the lymphatics I leave this question open there remains its trans- 

 ference by the pancreatic veins. 



