700 A. S. WARTHIN 



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so lost. Tinkler, in 1886, was likewise unable to produce diabetes by 

 removal of the pancreas. Senn, in 1888, made some attempts to remove 

 the pancreas in dogs and cats, but made no examination of the urine. 

 Martinotti, as late as 1888, stated that the experimental removal of the 

 entire pancreas in dogs caused no disturbance either of digestion or of their 

 general condition. His results were generally accepted at that time. In 

 1889, Lustig noted a transitory glycosuria and acetonuria after removal 

 of the coeliac plexus. 



Early Clinical Observations on Coincidence of Pancreatic Disease and 

 Diabetes. During this same period, however, various clinicians were mak- 

 ing observations that inclined them to believe that there was some relation 

 between disease of the pancreas and diabetes. As early as 1788 Cowley 

 had observed the association of diabetes with pancreatic calculi and atrophy 

 of the glandular portion of the organ. This is the oldest known case in 

 which the association between diabetes and pancreatic disease was noted. 

 The patient was a robust man of thirty-three years of age, who suffered 

 from diabetes for six months before- death. The autopsy showed many 

 calculi in the pancreatic ducts; the glandular portion was scirrhous. 

 Bright, in 1833, observed a case of diabetes in which there was a tumor 

 in the head of the pancreas obstructing the ducts and causing a fatty 

 atrophy. The case described by Chopart in 1855 is undoubtedly Cowley's 

 case. Griesinger found the pancreas atrophic in one of five autopsies on 

 diabetics. He believed it to have no significance whatever. Fles and 

 Hartsen each described a case of diabetes mellitus with atrophy of the 

 pancreas. Harley saw a case of diabetes in which there was an abscess 

 in the head of the pancreas obstructing and dilating the duct of Wirsung. 

 Von Recklinghausen noted calculi in the pancreatic ducts with dilatation 

 of these and atrophy of the glandular tissue in two cases of diabetes. In 

 a third case he noted fatty atrophy of the pancreas. According to Seegen, 

 the pancreas in thirteen out of thirty diabetics examined at autopsy in 

 Vienna was found to be very small, soft and anemic. Frerichs, in 1866, 

 found the pancreas in a case of diabetes showing cystic dilatation of its 

 ducts which were filled with products of secretion. In five cases out 

 of nine coming to autopsy he saw atrophy or fatty degeneration of the 

 pancreas. Popper, in 1868, called attention to the relationship of obesity 

 to disease of the pancreas. Other clinicians and pathologists (Lloyd, El- 

 liotson, Bouchardat, Munk and Klebs, Cantani, Seegen, Sylver, Harnack, 

 Kiilz, Schaper and others) during the middle decades of the ^ast century 

 observed cases of diabetes in which pancreatic changes in the form of 

 calculi in the ducts, atrophy of the gland, and fatty atrophy were noted 

 at autopsy. The coincidence of pancreatic disease and diabetes seems, 

 however, to have made little impression upon any of them except Bou- 

 chardat, who is usually quoted as having, in 1845-6, been the first to have 

 definitely connected pancreatic disease with diabetes; but, after observa- 



