DIABETES AFTER EXTIRPATION OF THE PANCREAS 513 



lar parenchyma proceeds much more slowly. Zuntz and Mayer conclude 

 from this that in addition to the production of the pancreatic juice and, of the 

 still hypothetical hormone regulating carbohydrate metabolism the pancreas 

 has still another function, by which it becomes concerned with general me- 

 tabolism. Cannot fat necroses, that are known to be difficult to avoid in the 

 operation on the pancreas, have played a part in the sudden death of the dogs? 



I should like to summarize the results of the experimental investigation 

 up to the present in the following propositions. There is probably produced 

 from the insular apparatus of the pancreas a hormone that is given principally 

 to the venous blood and carried to the liver. When this hormone is absent, 

 marked excretion of sugar and disturbance of glycogenesis occurs. Further, 

 there occurs elimination of ketone bodies. The decomposition of protein 

 and the excretion of salts, and again the production of calories is highly 

 increased, and finally there occurs an increased excitability of the sympa- 

 thetic nerves. 



According to my view, there speaks for a disturbance of glycogenesis, in 

 addition to the marked poverty in glycogen, especially the fact that we have 

 in partial extirpation of the pancreas (Sandmeyer's diabetes) the occurrence 

 of a glycosuria only on alimentary overfeeding. In the severest forms, 

 at the height of the metabolic disturbance the glycogen formation in the 

 liver seems markedly reduced. For this speaks the observation, as already 

 Minkowski found, that the administration of dextrose raises the sugar- 

 elimination to about the amount administered, and also the demonstration 

 furnished by Grote, S(aehelin and myself, that administration of sugar does not 

 'increase the respiratory quotient. That glycogen formation is not entirely 

 in abeyance is spoken for, among other circumstances, by the fact that we 

 may still obtain it on the administration of levulose. 



In my opinion there speaks for an overproduction of sugar the fact that 

 also in fasting, when the alimentary influences are entirely ruled out, sugar 

 production proceeds in the liver with the intensity that it does. 



Finally there remains for discussion the question as to whether the over- 

 production in the liver is alone the cause of the sugar elimination, or whether 

 also the combustion of sugar in pancreatic diabetes is diminished or increased. 

 An attempt has been made to reach nearer the solution of this question by 

 investigating whether muscular work will reduce the elimination of sugar. 

 The basic investigations of Seo have shown that after incomplete extirpation 

 of the pancreas sugar elimination as well as the quotient D:N diminishes 

 under the influence of muscular work. After complete extirpation of the 

 pancreas no such diminution occurs. If a shorter period be investigated, 

 there rather occurs an increase in the quotient. If in such an animal the 

 elimination of sugar at a later stage has started to fall, there occurs as a result 

 of muscular work an increase in the quotient even above that regarded as 

 the maximal boundary. From this Seo concludes that the increase in the 



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