EXPERIMENTAL NERVOUS DIABETES 517 



already been dealt with in the chapter on the suprarenals. We might sup- 

 pose an activation of the diastatic ferment in the liver. Hofmeister reports 

 recently that after the puncture, the glycogen for the most part is no longer 

 found in the liver-cells, but in the efferent lymph and blood-vessels. Zulzer 

 first propounded the view that adrenalin and the pancreatic hormone have an 

 antagonistic action. > The poisonous action of adrenalin would be neutralized 

 by the pancreas hormone in the liver, v. Noorden expressed the view that 

 both pancreas and chromaffin tissue influence the diastatic process in a con- 

 trary manner the pancreas inhibits, the chromaffin tissue accelerates it. 

 v. Furth and Schwarz have taken justified exception to the experiment of 

 Zulzer. A certain opposition in the action of the pancreatic hormone and of 

 adrenalin is, however, unmistakable. The former works assimilatorily, govern- 

 ing the building up of glycogen, and the latter is dissimilatory, occasioning 

 melting down of glycogen and decomposition in sugar. At all events we shall 

 see later that the alimentary factor governed by the pancreas and the 

 nervous factpr working by way of the chromaffin tissue may be highly inde- 

 pendent of each other! 



According to later investigations of Bernstein and myself, I might assume 

 that as in the liver so also in the muscular system the same regulating powers 

 that govern assimilation and dissimilation are opposed to each other. In a 

 large series of experiments we saw the respiratory quotient rise in human be- 

 ings after the injection of adrenalin (previously Roth and Fuchs had already 

 reported on two experiments on patients with Addison's disease). The rise 

 in the respiratory quotient may be so appreciable that from it we may infer 

 a combustion-of an additional 30-40 gm. of sugar in the course of from half 

 to three-quarters of an hour. As after injection of adrenalin there occurs 

 also an impoverishment of the muscles in glycogen; I would consider most 

 likely that under the influence of adrenalin the glycogen is everywhere mobil- 

 ized and burnt 1 in a precipitate manner, whereby a greater part of the sugar 

 is furnished precipitately to the blood from the liver, producing hyper- 

 glycemia and glycosuria. Now it is very noteworthy that in severe cases of 

 diabetes mellitus, that had been made sugar-free, we saw after injection of 

 adrenalin considerable glycosuria, but no rise in the respiratory quotient. 

 Hence there is absent in the severe diabetic the power to take into combustion 

 precipitately mobilized sugar; of course the possibility should be considered 

 that the sugar mobilized on account of adrenalin in the severe diabetic ema- 



1 Such an increased combustion of carbohydrate seems moreover to be able to occur isolated 

 in the muscles. I refer to the experiments with "pituitrinum glandulare" already quoted in 

 the chapter on the hypophysis, in which there occurred a rise in the respiratory quotient, while 

 all other actions were quite opposed to those of adrenalin (lessening of the volume of the liver, 

 sinking of blood-pressure, no rise in blood sugar, but more often slight reduction, and finally 

 reduction in the total caloric exchange). Also in two experiments on severe diabetics was there 

 a rise in the respiratory quotients, while the reduction of the total gas exchange, showed with 

 certainty that the agent was active. 



