720 A. S. WARTHLN 



metabolism 'and mobilization of those bodies, all of these organs being 

 mutually interdependent. The pancreas through its internal secretion 

 may be regarded as holding the central position, and preserving the bal- 

 ance. 



Allen regards the polyglandular theory of diabetes as a pure specula- 

 tion, and holds that there is no proof that disturbed action of other 

 organs can produce either functional or structural abnormalities in 

 the pancreas and thus serve as a primary cause of diabetes. He holds 

 tenaciously to the view that there is no diabetes without pancreatic dis- 

 ease, and that the essential specific pathologic lesion of diabetes is the 

 vacuolar or "hydropic degeneration" of the cells of the islets originally 

 described by Weichselbaum. He regards this change as an exhaustion 

 phenomenon due to functional overstrain of an endocrin organ. It is, 

 therefore, in the writer's opinion, an end result of the diabetes, and not a 

 primary pathological change; and its presence cannot be taken as proof 

 that the islands were primarily the seat of alterations that gave rise to 

 diabetes. Allen says : "In human patients, the islands present are appar- 

 ently stimulated to meet a demand beyond their capacity. Presumably 

 the cells respond with an actual or attempted increase of secretory activity 

 for a larger or shorter time while appearing morphologically normal." 

 The primary cause of diabetes may then be sought elsewhere than in the 

 pancreas, if Allen's interpretation is true, in the sympathetic nervous sys- 

 tem, for instance. 



Theories of Diabetes 



Allen's latest statement (1921) of his view of pancreatic diabetes may 

 be given briefly, as follows : The islets of Langerhans are concerned, not 

 merely in the combustion of sugar or storage of glycogen, but also in the 

 maintenance of general tissues or reserves. In some manner an increase in 

 supply of fat or formation of adipose tissue imposes a burden on the island 

 function, and the reduction of any kind of food or of the body weight re- 

 duces the demand upon this function. This would indicate that the island 

 hormone has both a catabolic and an anabolic role. As the diabetic defi- 

 ciency is so much more prominent with regard to the carbohydrates, it is 

 possible that the island function is directly related to this alone, and that 

 other foods are concerned through their influence upon the carbohydrate 

 metabolism, although this is not yet settled. Whether this relationship is 

 direct or indirect, the status of the pancreatic hormone in general metab- 

 olism and of the disturbances of the general metabolism in diabetes is suffi- 

 ciently important that treatment must be directed to it. The islands may 

 be damaged by functional overstrain and saved by limiting the dietary 

 burden. ~No recognizable lesions are produced in the pancreas by fasting. 

 Experiments show that, as far as strictly normal metabolism is concerned, 



