924 Diabetes Mellitus. 



changed into glj'eogen, but passes into the general circulation. While 

 in cases of diabetes mellitus lesions in the liver only were repeatedly 

 observed by several authors in human as well as in veterinary practice 

 (Frohner, Heiss, Storch, Penberthy, Eber, Fettick and others), this 

 does not justify the assumption that in these cases the diabetes had 

 actually been caused by the hepatic disease. Aside from the changes 

 in the liver there may be slight alterations in the pancreas (Herzog), 

 and on the other hand the liver disease may be a consequence of the 

 diabetes. Especially the fatty liver which is frequently mentioned by 

 veterinarians and considered by some as the cause of dial)etes, is very 

 probably due, as is fatty infiltration in general, to the deposit of fat 

 from other parts of the body, without interfering Avith the functioning 

 of the liver cells. The diabetes produced in dogs by extirpation of 

 the pancreas is almost invariably followed by fatty degeneration of 

 the liver (Naunyn). 



Eecently the experiments of v. Mering and Minkowski have afforded 

 the proof that a severe diabetes follows the complete extirpation of 

 the pancreas, while it does not develop if at least one-fifth of the gland 

 is left or has been transplanted successfully under the skin before the 

 removal of the gland. If the entire gland has not ])een excised, only 

 a slight diabetes develops, and especially after a generous ingestion of 

 carbohydrates a glycosuria becomes noticeable but disappears again on 

 insufficient diet. 



These experiments were followed by a long series of control in- 

 vestigations and were responsible for a great many contributions to 

 literature putting the theory of diabetes in an entirely new light. The 

 occurrence of the disease in affections of the pancreas (pancreas- 

 diabetes) was indeed shown to take place by older observers (Frerichs, 

 Windle, Hansemann), but the theory of pancreatic diabetes received 

 a greater vogue only since more attention was paid to the behavior 

 of the islands of Langerhans in the pancreas, to whose influence upon 

 the carbohydrate metabolism Ebner had already called attention. Many 

 authors (Ssobelow, Opie, Weichselbaum & Stangel, Schmidt, Herzog, 

 Sauerbeck, Halasz) found alterations (simple atrophy, sclerosis, colloidal 

 degeneration, disease of the vessel-walls) in the islands of Langerhans, 

 even in those cases in which the secreting glandular tissue was entirely 

 intact. The participation of the pancreas in the causation of diabetes 

 mellitus in domestic animals is proved by cases of Lienaux, Sendrall 

 & Cuille and of Bohl, in which a considerable atrophy of the gland 

 was the only pathological finding. Eber also found atrophy in one 

 case. Fettick observed carcinomatous degeneration of the gland in 

 a case of general carcinomatosis, while Bohl noted diffuse parenchyma- 

 tous degeneration in a dog, Preller chronic inflammation in the pancreas 

 of a horse. On the other hand diabetes failed to develop in a case 

 of atrophy of the pancreas in a dog observed by Miiller. It is to 

 be expected that diabetes mellitus will be brought more fre(iuently into 

 relation to pancreatic disease when this gland receives greater attention 

 by veterinary authors. In man changes in the islands of Langerhans 

 can not infrequently be determined simply by microscopical examina- 

 tion. 



The views still differ as to whether pancreatic diabetes represents solely the 

 consequence of some disease of the islands of Langerhans, or whether it may 

 develop, on the contrary, through any diffuse alteration of the pancreas. 



On the basis of his experiments, E. Pfliiger has recently assumed that the anti- 

 diabetic action of the pancreas, which regulates the cleavage of sugar, is influ- 



