512 DISEASES OF THE INSULAR APPARATUS OF THE PANCREAS 



and the insular apparatus. For this independence speak the known trans- 

 plantation experiments of Minkowski, Gley, Thiroloix and Hedon. When we 

 pass these in review from the standpoints above mentioned, we see that the 

 production of pancreatic juice, therefore the function of the glandular 

 parenchyma, is quite independent of the disturbance in carbohydrate me- 

 tabolism. The glandular parenchyma of the transplanted piece may atrophy, 

 the secretion from the fistula may stop flowing, and yet the diabetes remain 

 absent. Only after extirpation of the sclerotic piece (with the retained 

 islands) does the diabetes set in. On the other hand, there is known the ex- 

 periments of Thiroloix in which diabetes set in after the transplantation, in 

 which case therefore the islands probably suffered harm, while the secretion 

 continued to flow from the fistula. 



I do not subscribe to the critical remarks of Lombroso directed against the 

 remaining refractory of the insular apparatus after duct ligation. It seems 

 to be intelligible that the chronic inflammatory processes that occur after 

 ligation of the duct, may under certain circumstances damage also the insular 

 apparatus and on account of this lead transitorily to glycosuria. There is 

 no longer doubt as to the fact, now communicated from all sides, that also a 

 long time after the ligation of the duct the entire glandular apparatus becomes 

 sclerotic, the insular apparatus remains entirely or largely retained, and that 

 on this account disturbances in carbohydrate metabolism remain absent. 

 The experiments on pigeons that Lombroso quotes as support of his position 

 are not convincing. In these experiments although the insular apparatus 

 was apparently markedly damaged, the glycosuria remained absent. As 

 Biedl has already pointed out, however, in many species of birds, the total 

 extirpation of the pancreas does not lead to glycosuria, but only to hypergly- 

 cemia. The experiments on transplantation of the pancreas and the institu- 

 tion of a pancreatic fistula seem to me to be especially poorly adapted for the 

 decision of this question. If the healing follows by primary intention the 

 carbohydrate metabolism and also the insular apparatus do not alter. If, 

 however, infection occurs and on account of this infection sclerosis of the 

 pancreas sets in, naturally the insular apparatus can also be damaged, and 

 often it would be very hard to estimate in such an altered pancreas the 

 functional integrity of the tissue constituents still present. I have carried 

 on some experiments that in spite of the unfavorable relations seem to me to 

 point to the functional independence of the two apparati. 



Zuntz and Mayer found in their pretty experiments that the ligation of 

 the excretory duct led in the dog first to a more or less well-expressed loss of 

 body weight. Mostly the dogs rapidly regain their body weight and then 

 live from then on like normal dogs. In other cases, however, the body weight 

 falls still further, the emaciation terminating in death. Now Zuntz and 

 Mayer found an almost complete disappearance of the glandular acini in 

 these dogs, while in the dogs that recovered the disappearance of the glandu- 



