564 DISEASES OF THE INSULAR APPARATUS OF THE PANCREAS 



this condition of hyperexcitability seems to occur primarily and that it in- 

 creases the disturbance in metabolism in a manner that is hardly possible 

 through failure of the insular apparatus alone, while it accompanies the pure 

 pancreogenic type only secondarily and perhaps in a less intense form. That 

 also in the nervous type an increased adrenalin-contents of the blood could 

 not up to the present be demonstrated, seems to me to signify nothing against 

 this assumption; on the one hand, the biological methods up to the present 

 have been insufficient for the demonstration of adrenalin in the serum (I refer 

 to the work of O'Connor, Priestly, Fleming, Kahn and myself] and on the other 

 hand we can conceive that on insufficient contraregulation also minimal sur- 

 plus production of adrenalin already produces a significant effect on sugar 

 metabolism. 



As to the cause of such an abnormal excitation in the nervous system we 

 know as yet nothing. We have, however, met with similar conceptions in the 

 diseases of the other ductless glands. I refer to Basedow's disease where 

 especially in the peracute cases, the increase of function of the thyroid gland is 

 ascribed by many authors to a central excitation; and indeed they regard 

 many symptoms as coordinate with hyper thyroidism, and conditioned cen- 

 trally. We could designate the entire disease picture as hyperthyrosis, and 

 the important syndrome conditioned by the hyperfunction of the thyroid 

 gland we could designate hyperthyroidism. According to this hypothesis we 

 could regard these hyperfunctional conditions of the ductless glands as neu- 

 roses. So far as this theory of diabetes is concerned, we are unmistakably 

 approaching again the view first propounded by the genial investigator of 

 diabetes, Claude Bernard, although in a considerably modified form. 



If we now on the basis of the developed view, finally turn to the question 

 as to why the diabetes of dogs without their pancreas deviates in some essen- 

 tial points from that of the genuine human diabetic it seems to be that as yet a 

 satisfactory explanation has not been possible. The principal difference lies 

 in the fact that in the dog without a pancreas the catabolic factor of the car- 

 bohydrate metabolism is less strong, that of the fat and protein metabolism 

 more strong, while in genuine human diabetes the first is more strongly de- 

 veloped, and the latter factors fail almost entirely. Perhaps there may after 

 all be elicited some grounds for the explanation of this considerable difference. 

 On the one hand it might not be impossible that in the carnivorous dog the 

 significance of the inner secretion of the pancreas is not quite the same for the 

 metabolism as in the omnivorous human being. 



We must then assume that in the dog the pancreatic hormone exercises 

 also a direct inhibiting influence on the splitting up of protein and fat. A 

 certain decision of this question if exact observations of sudden and complete 

 absence of pancreas [function] in man were at hand, which up to the present 

 has not been the case. 



On the other hand the following idea might very well be elicited from what 



