510 DISEASES OF THE INSULAR APPARATUS OF THE PANCREAS 



tionally indeed did the acini seem to have changed their structure. The islands of Lan- 

 gcrlians likewise showed alterations of structure, "perhaps they seem smaller, but their 

 number does not seem to have been diminished." A portion of the island cells showed 

 alterations even already after a few days; in every case the alterations of the islands 

 developed much more slowly than those of the acini. 



Lombroso in his works and in a detailed review has subjected to criticism 

 the experiments just referred to, and has come to the conclusion that the 

 functional independence of the islands of Langerhans has not as yet been 

 demonstrated. In this conclusion Lombroso's own views that to the external 

 secretion of the pancreas must not be ascribed that freedom and independ- 

 ence of the internal secretion that we for a long time tended to ascribe to it, 

 has had a great influence. Before I discuss the question of the independence 

 of the insular apparatus, I must enter first into an account of the disturb- 

 ances of absorption after extirpation of the pancreas or after ligation of its duct. 



Already Abelmann, whom we have to thank for the fundamental absorption experi- 

 ments after extirpation of the pancreas, stated that it is true after total extirpation, the 

 absorption of fat in the intestine almost completely ceases, although fat-splitting may be 

 very good; that, however, the disturbance of absorption never reaches to this extreme 

 grade when a part of the pancreas is left behind, even when its connection with the intes- 

 tine is entirely broken up. Also after ligation of the excretory duct is the disturbance of 

 absorption never intense. It has been attempted to explain this by the statement that in 

 this case the pancreatic juice is in part absorbed, and reaches the intestine by way of the 

 blood-vessels or that the dogs with pancreatic fistula lapped up the secretion that flowed 

 out. (Sinn, Hess, Burckhardt, et al.) 



Besides this it is mentioned that in dogs, there often occur accessory pancreases, and 

 that in such cases therefore the complete cutting-off of the pancreatic juice from the intes- 

 tine is very difficult. Sinn, and Hess found almost regularly in dogs a third excretory duct 

 of the pancreas. According to these authors the ligation of all ducts is especially difficult 

 intra vitam. When it really succeeds, there occurs within some weeks an almost complete 

 necrosis of the pancreatic tissue. In these cases Hess, and Sinn, found no diabetes, in most 

 cases, however, an appreciable temporary disturbance of protein and fat absorption. In 

 some cases indeed the absorption was quite good. Lombroso in his numerous experi- 

 ments has ascertained the following: The absorption of fat in dogs is rather good when the 

 entire number of ducts are ligated, or when after a part of the pancreas has been trans- 

 planted and a fistula from this to the outside has been made, the other part of the pancreas 

 has been extirpated. This also occurred, according to Lombroso, when the re-ingestion of 

 the secretion was entirely prevented. 



In an experiment carried out in Minkowski's laboratory the disturbance of the absorp- 

 tion of fat was indeed not inappreciable (up to 60 per cent.). When later the vascular 

 nervous pedicle of the transplanted part of the pancreas was ligated and cut, a transitory 

 glycosuria occurred, and the fistula secreted further. Only after extirpation of the remain- 

 ing part of the pancreas did the diabetes and the disturbance in fat absorption reach its full 

 height. In a second analogous experiment, glycosuria was present from the first, but the 

 disturbance of absorption in this case was less (38.7 per cent.). Lombroso further showed 

 that bile, saliva, and intestinal juice show no alterations in their enzymatic characteristic, 

 and that therefore an excretion of absorbed pancreatic juice into the intestine was there- 

 fore improbable. This was also confirmed by Zuntz and Mayer. Lombroso concluded 

 from his experiments that the influence of the pancreas on the absorption of fat was also 



