DIABETES AFTER EXTIRPATION OF THE PANCREAS 51 1 



conditioned through an internal secretion. Fleckseder has instituted analogous experi- 

 ments. He observed that the using up of fat and albumin is somewhat diminished in 

 the fistula animals, whether the secretion is let flow free from the fistula, or is let stagnate, 

 whether it is re-ingested or not. Very interesting is an experiment of Fleckseder' 's in which 

 gradually, through increasing sclerosis of the piece of pancreas left behind, a diabetes 

 developed to full height, the secretion from the fistula stopped, but the absorption of fat 

 was, however, better than before. 



Lombroso in his review has, as before mentioned, doubted the significance 

 of the ligation experiments for the functional independence of the pancreas. 

 He uses the just mentioned disturbances of absorption in a like sense, and 

 comes to the conclusion that islands as well as gland parenchyma take part 

 in the production of the external secretion of the pancreas, and that this is of 

 importance for the carbohydrate metabolism as well as for fat absorption. 



The amalgamation of both questions seem to be rather unhappy. From 

 the experiments just cited it seems that the two disturbances do not run a 

 parallel course throughout. Thus we found, for instance, in one of Lombroso' s 

 experiments relatively, good absorption in spite of existing glycosuria, and in 

 an experiment of Fleckseder's right good absorption in spite of a fully de- 

 veloped diabetes. On the other hand we find in an experiment of Lombroso's 

 a not inappreciable disturbance of absorption in spite of absence of a dis- 

 turbance in carbohydrate metabolism. So much is therefore certain that, if 

 an internal secretion of the pancreas actually essentially influences the absorption 

 of fat, it is not identical with the pancreatic hormone regulating carbohydrate 

 metabolism. As we shall see later, the same is true of the observations on 

 human diabetes. 



In men the relations are on the whole much clearer than in the dog. Here 

 we find cases with severe lethal diabetes and high-grade isolated disease of 

 the insular apparatus; in spite of this, in these cases the characteristic, not-to- 

 be-overlooked, fat stools are absent. On the other hand, when the pancreatic 

 juice is completely cut off, fat stools occur, as we shall see later, which im- 

 prove considerably on the administration of pancreatin. Characteristic of 

 these pancreas stools in men is the deficiency of the splitting of neutral fat, 

 whereas in the dog, according to the statements of all investigators the split- 

 ting of fats is not essentially disturbed even after the total extirpation of the 

 pancreas. 



In reviewing the information at hand up to the present time, we find, 

 according to my opinion that we can thus far say with certainty, only that 

 the absorptive activity of the intestinal mucosa is somehow influenced by 

 the pancreas even when the pancreas is entirely separated from the intestine, 

 that, however, this influence is independent within wide limits of that of the 

 carbohydrate metabolism through the pancreatic hormone. At all events, I do 

 not regard it as proper that these not at all negligible relations should be used 

 as a basis against the teaching of the functional independence of the glandular 



