THE PANCREAS AS AN EKDOCRIN GLAND 721 



the pancreas has little if any margin of safety ; but it is large with refer- 

 ence to diabetes. The point at which experimental diabetes begins is sharp 

 and definite. An animal may be brought so close to the verge of diabetes 

 that it is brought on by the removal of as little as 0.1 gm. of additional 

 tissue; at this point a new histologic phenomenon, the hydropic degen- 

 eration of the islets shows itself. Active diabetes must first be present 

 in order for the hydropic change to occur. Its significance in human 

 diabetes is that the islands present in the pancreas are stimulated to meet 

 a demand beyond their capacity. 



Allen's position represents the extreme pancreas-theory of diabetes. 

 To him diabetes is nothing but an overstrain or exhaustion of the en- 

 docrinal function of the islands of Langerhans. What pathologic factors 

 lie back of, or are correlated with this functional overstrain he cannot 

 say, and he has added nothing to our knowledge concerning the nature 

 of this function. He discards, as being nothing less than a superstition, 

 any theory of pluriendocrinopathies as concerned in the formal genesis 

 of diabetes. His conception of the pathology of diabetes, as far as formal 

 pathogenesis is concerned, begins only with the morphologic changes 

 interpreted as indicating an overstrain or exhaustion, with the end-changes 

 rather than the essential formal causes of this overstrain. After all, 

 what Allen really says is that diabetes is a disease that shows itself through 

 the pancreas rather than that it is a disease of the pancreas itself. 



Newburgh and Marsh (1921), in opposition to Allen, have shown that 

 with a high fat diet in diabetes glycosuria may be avoided, the blood-sugar 

 lowered and acidosis be prevented. Woodyatt (1921) likewise regards 

 diabetes as a limitation of the body's power to utilize glucose and that the 

 rational treatment is to bring the quantity of glucose entering the metab- 

 olism from all sources below the quantity that can be utilized without 

 abnormal waste, and to adjust the supply of fatty acids in relationship to 

 the quantity of glucose to limits compatible with freedom from ketoiiuria. 



The more recent writers in Europe, those of the last year, take a 

 much broader view of the essential pathology of diabetes. W. Langdon 

 Brown (1920) holds that diabetes is a sign of exaggerated metabolism, 

 evoked through the sympathetic and the associated endocrin glands, which 

 first shows itself in relation to the most abundant food material, but 

 as it advances expresses itself in relation to all. He regards it as a 

 mistake to look upon the disease merely as a disturbance of carbohydrate 

 metabolism. The carbohydrates represent, however, about 70 per cent 

 of an ordinary diet, and are the most easily mobilized of all tke foodstuffs. 

 When metabolism is but slightly impaired, it will be most likely to show 

 itself in relation to carbohydrates. In one stage the ability to use sugar 

 may be impaired, but the power of converting it into fat may remain. 

 Hence glycosuria may be associated with obesity ; or, as expressed by von 

 Noorden, some cases of obesity are to be looked upon as latent glycosuria. 



