



718 A. S. WARTHIlSr 



glycemia. The absence of glycogen in the tissues accounts for the asso- 

 ciated pathologic changes of diabetes, such as fatty degeneration and 

 acetonuria. 



From all of the mass of experimental work sketched briefly above, it 

 can be seen that as far as our knowledge of the nature of the internal 

 secretion of the pancreas is concerned we have only conflicting hypotheses ; 

 and in this respect we are not much better off than Minkowski was in 1892 

 after confirming so brilliantly his experimental work on pancreatic dia- 

 betes and announcing his conclusion that the pancreas possesses an un- 

 known internal secretion necessary to the intermediary metabolism, and 

 that failure of this function leads to the production of diabetes. We come 

 back to that original thesis as the cornerstone of our whole conception of 

 the pancreas as an endocrin organ. That loss of the pancreatic func- 

 tion through the removal of the gland or through extensive alterations 

 of its structure, of the islands especially, leads to diabetes we know with 

 absolute certainty, but as to the character and mechanism of this func- 

 tion we have only a number of hypotheses to offer in explanation, some 

 of which are wholly contradictory. We have acquired a certain num- 

 ber of apparent facts that, as yet, we can not correlate or interpret. The 

 case stands thus: All of the evidence up to the present time indicates 

 that the pancreas is an endocrin gland in so far as its islets are concerned. 

 These produce an internal secretion containing an inhibitory agent (hor- 

 mone or enzyme) which affects carbohydrate metabolism. 



Relation of Pancreas with Other Endocrin Organs 



Disturbances of the carbohydrate metabolism are caused in various 

 other ways than by extirpation or disease of the pancreas. Hyperglycemia 

 and glycosuria may be produced by Bernard's sugar-puncture of the 

 medulla oblongata, by stimulation of the splanchnics, administration of 

 thyroid extract, injection of adrenalin, or may be associated with disease 

 of the hypophysis, thyroid, parathyroids and adrenals. 



Lorand demonstrated the fact that extirpation of the thyroid tends 

 to prevent or suppress the development of glycO'Suria in depancreatized 

 animals. Ziilzer saw glycosuria disappear after the ablation of 

 the two adrenals. He found also that adrenalin glycosuria is 

 prevented by pancreatic extract and even pancreatic juice. Frouin 

 found that pancreatic diabetes in a dog diminished after the re- 

 moval of one adrenal and two-thirds of the other. Sweet and Ellis 

 found that complete removal of the glandular portion of the pan- 

 creas caused marked changes in the spleen and thyroid. Mann and Drips 

 regarded the changes found in the pancreas after the removal of the 

 adrenals to be only those due to changes in blood-pressure. They found 



