568 DISEASES OF THE INSULAR APPARATUS OF THE PANCREAS 



cosuria at least as much as possible, and counteract the overloading with acids 

 by alkali therapy. 



Much indeed speaks for the fact that in the nervous form too vigorous 

 dietetic measures act unfavorably, although v. Noorden points out that in 

 such cases a weakness of the insular apparatus may always be supposed, which 

 tends to come to the fore in the further course, and therefore that a complete 

 disregard for prophylactic dietary prescriptions may be disastrous for the 

 patients. In the pure thyrogenic form the treatment of the hyperthyrosis 

 occupies the foreground, in the pursual of which, however, vigilance in a 

 dietetic respect is not excluded. The treatment of diabetes in acromegaly 

 should coincide with that of genuine diabetes. 



Addendum 



Allen, in his book on "Glycosuria and Diabetes," draws an essential 

 distinction between these two conditions, pointing out that in nondiabetic 

 animals the limits of tolerance are apparent, not real, and that in these ani- 

 mals there is no real limit to the power of utilization of the sugar except death. 

 Also that in the various forms of glycosuria dextrose always produces a 

 limitation of the amount of urine, never a diuresis as in diabetes. He divides 

 diabetes by pancreatic operation into a diabetes gravis and a diabetes levis, 

 according to whether dextrose is or is not excreted on meat diet, and each 

 of these into a permanent and a transient form. Permanent diabetes gravis 

 and transient diabetes levis are absolute terms; but transient diabetes gravis 

 and permanent diabetes levis are relative, the two conditions passing into 

 each other. These various types depend on the condition of the pancreatic 

 remnant. The ways that diabetes could be produced when the pancreas 

 remnant is of more than ordinary size are by an irritative nervous lesion, such 

 as the Bernard puncture, and by circulatory disturbances in the pancreas. 

 The fact that the nervous system can influence the pancreatic hormone, as is 

 practically also Falta's conclusion, seems to the editor to speak in favor 

 of Crile's contention that diabetes may be conditioned centrally, the nerve 

 cells showing chromatolytic changes. At all events the intermediation of 

 the islands of Langerhans of the pancreas remain unquestioned, this bringing 

 about a deficiency of what Allen terms "pancreatic amboceptor." Accord- 

 ing to Allen's experiments there occurs in diabetes not a change in the hepatic 

 cells that cause them no longer to fix dextrose, but a change in the physical 

 state of dextrose itself. Instead of combining with a colloidal "pancreatic 

 amboceptor" to be in a condition to be utilized, it maintains its ordinary 

 crystalloidal properties, thus causing diuresis. Whether there is any dis- 

 tinction between pancreatic hormone and the pancreatic amboceptor does 

 not seem very clear in a cursory review of Allen's voluminous work. Allen 

 seems to call the substance an amboceptor because it acts as an intermediary 

 body between the dextrose and various body cells. It has in common with 

 hormones, at all events, the fact that it is an internal secretion, dependent 



