546 DISEASES OF THE INSULAR APPARATUS OF THE PANCREAS 



(increased sugar-production). This increase of the catabolism must there- 

 fore be regarded as endogenous; it leads, if the lack cannot longer be made 

 up through ingestion of food, to a melting down of albuminous and fatty 

 substance. We can therefore very well speak of an increased exchange in 

 severe diabetics, whether this is due to the devaluation of the food adminis- 

 tered in excess, or to a melting down of the body substance. This increased 

 transformation is expressed in the experiments on respiration only by increased 

 oxygen requirements not by increased carbonic acid production or heat production. 



These two disturbances show a certain independence of each other; in 

 the initial stages of diabetes the disturbance in anabolism tends to come to 

 the front, as the predominance of the alimentary factor would indicate. 

 There do, however, exist cases in which the catabolic factor predominates 

 already at the commencement (neurogenic diabetes). In the later stages 

 both factors are present at the same time, although they are not always just 

 as strong as each other. 



If we review once more the alterations of metabolism that characterize 

 the diabetes after extirpation of the pancreas, and compare these with those 

 of genuine human diabetes, it is not hard to recognize a distinct difference ; 

 to both are common the anabolic as well as the catabolic disturbances. They 

 differ from each other, however, in the behavior of the protein exchange and 

 the heat production. In the dog with pancreatic diabetes the decomposition 

 of protein and the heat-production are much increased; in genuine diabetes 

 these are not essentially altered. Before we discuss this fundamental dif- 

 ference, I must first tell about the results of pathologico-anatomical research 

 in genuine diabetes. 



Pathological Anatomy of Diabetes Mellitus 



Bouchardat first in 1845 expressed the opinion that diabetes came about 

 through a disease of the pancreas, at all events Bouchardat was forced to the 

 assumption that under circumstances only a functional disturbance may 

 exist, as in many cases of diabetes mellitus he found the pancreas normal. 



After Bouchardat, Lapirre, Frerchs, Cantani, Seegan, and Lanceraux 

 drew attention to the pancreas in autopsies on diabetics, and found that 

 in addition to cases with the most varied alterations of the pancreas there 

 were also cases of diabete maigre in which the pancreas was apparently 

 normal. In 1891 Lemoine and Launois described the sclerosis of the blood 

 and lymph vessels in diabetes. In 1893 Laguesse first expressed the view 

 that in diabetes the islands oiLangerhans were diseased. In 1894 v. Hanse- 

 mann described a specific atrophy of the glandular parenchyma in diabetes 

 mellitus, associated with proliferation of the connective tissue about the 

 acini, which, on account of the similarity to granular atrophy of the kidney 

 he designated granular atrophy of the pancreas. In a later work v. Hanse- 



