THE PANCREAS AS AN EKDOCRIN GLAND 701 



tions extending over thirty years, this writer came to a final conclusion 

 that the cause of diabetes was to be found in an excessive sugar-forming 

 diet and the formation in the stomach of an abnormal diastatic ferment. 

 The suspicion of any causal relation between diabetes and pancreatic dis- 

 ease went no further during this period than the assumption of some 

 change in the composition of the pancreatic juice which either acted ab- 

 noTmally upon the sugar-producing foods in the . intestine, or after the 

 absorption of this abnormal juice caused a disturbance in the carbohydrate 

 metabolism in the body tissues (enterogenous diabetes). Opposed to these 

 views was that of Klebs who explained the coincidence of pancreatic dis- 

 ease and diabetes as dependent upon lesions involving the coeliac plexus. 



The status of the pancreas, as regards its part in sugar metabolism 

 and in the causation of diabetes, in the year 1876, is summed up in Sen- 

 ator's article in the von Ziemssen Handbook, Vol. XVI, as follows: "The 

 behavior of the pancreas (in diabetes) is in the highest degree remarkable. 

 This organ, which under other circumstances is in general so rarely the 

 seat of morbid changes, at least of the grosser sort, is found diseased with 

 surprising frequency, in particular either simply atrophied or, in addi- 

 tion, degenerated. Sometimes the degeneration consists merely in pri- 

 mary fatty destruction of the gland-cells, and sometimes it is induced by 

 cancer, by the formation of calculi, and by obstruction of the efferent 

 ducts, with cystic dilatation of the body of the gland. In certain cases th 

 wasting of the gland has reached the highest degree, so that scarcely 

 discernible remnant of the secreting parenchyma was to be found. The 

 frequency of these affections was not noted until somewhat recently, in 

 consequence of Bouchardat's contributions." Senator then proceeds to a 

 brief survey of the reported cases of coincident morbid pancreatic changes 

 and diabetes, and then concludes: "It cannot be, then, that there is but 

 an accidental coincidence; but a deeper connection must exist, and Klebs's 

 view seems best founded, that the coexistence of diabetes mellitus and dis- 

 eases of the pancreas depends upon lesions of the coeliac plexus. Either 

 the disease (cancer, formation of calculus, and inflammation of the sur- 

 rounding tissue) starts from the pancreas, encroaches upon the plexus, and 

 gives rise to diabetes by destroying its ganglia, or else the coeliac plexus is 

 first affected and in consequence thereof circulatory changes arise in the ter- 

 ritory supplied by the coeliac artery, which lead to degeneration and 

 atrophy of the pancreas." 



During the next year, however, Lancereaux reported two cases of dia- 

 betes associated with severe lesions of the pancreas, fatty atrophy, in one 

 case, and atrophy with calculi and dilatation of the duct in the other. Hie 

 believed that a causal relation existed between severe lesions of the pan- 

 creas and severe forms of diabetes characterized by rapid course with 

 emaciation, etc. He explained the relationship as the result of the dis- 

 turbance in the intestinal secretion of the gland. Lapierre, tBaumler, and 



