566 



DISEASES OF THE INSULAR APPARATUS OF THE PANCREAS 



ffland 



this glycosuria is of thyrogenic origin or whether the hypophysis enters 

 not in some other manner directly into the regulatory mechanism of the 

 carbohydrate metabolism, I shall not touch upon. 



i). Noorden has portrayed the influence of the ductless glands upon the 

 regulation of the carbohydrate metabolism in the following scheme. I have 

 modified it in that I have added to it two connecting lines -one between 

 the chromaffin tissue and the tissue at the periphery (chiefly the muscular 

 system) and one between pancreas and tissue. This lends expression to the 

 opinion that pancreas and chromaffin tissue directly regulate the assimila- 

 tion and dissimilation of carbohydrates. Let me call attention to the 

 fact that, the line of connection between thyroid gland and pancreas is 

 meant to express only the fact that increased thyroid activity disturbs the 

 equilibrium to the disadvantage of the pancreas. Whether this happens 



Thyroid- through the influencing of the activity 

 of the insular apparatus or through in- 

 fluencing the ultimate organs affected 

 is still uncertain. 



"The line of dashes represents nerve 

 paths; the solid lines represent blood paths. 

 The arrows show the direction of the ex- 

 citation; the signs + or behind them 

 mean whether the stimulus transmitted by 

 the respective path increases or diminishes 

 the specific activity of the organ in ques- 

 tion," whether it acts assimilatorily or 

 dissimilatorily. 



Differential Diagnosis. A sharp 

 separation of the ephemeral or transi- 

 tory glycosurias from true diabetes is not practical. There are fleeting tran- 

 sitions between these forms. We would naturally not regard every individual 

 who has one time eliminated grape-sugar in his urine as a diabetic; otherwise 

 if investigations as to alimentary glycosuria (100 gm. grape-sugar) carried out 

 at great intervals result always negatively, we could with justification speak 

 of the cure of the diabetes. 



We would think in general of a pancreatogenic diabetes when the alimen- 

 tary factor comes strongly in the foreground; especially if pancreatogenic 

 resorptive disturbances are present; further in all those conditions, which 

 according to experience favor infection of the pancreas; hence in cholelithia- 

 sis, pancreatic stones, also in lues, cirrhosis of liver, and arteriosclerosis, 

 etc. Hirschfeld regards also the behavior of diuresis as a differential diag- 

 nostic factor. It is not unlikely that in true pancreatic diabetes there is 

 at the beginning no polyuria. 



In glycosurias that occur during the course of infectious diseases, there 

 is indeed much that speaks for the involvement of the pancreas in the infec- 



Chromaffin 

 tissue 



Pancreas 



