722 A. S. WAKTHIN 



As the disease progresses further fat metabolism becomes impaired, and 

 diacetic acid appears; still further and protein metabolism, and even 

 that of organic salts becomes involved. Back of the phenomena of meta- 

 bolic disturbances lie the sympathetic and the endocrin organs. The sym- 

 pathetic mobilizes the sugar into the blood by means of the endocrin 

 glands, for the purpose of defense, while the parasympathetic stores it 

 in the tissues as a reserve ; glycosuria may be of organic origin with struc- 

 tural changes in the endocrin glands leading to an overaction of adrenal, 

 thyroid and pituitary, or to an underaction of the pancreas ; or it may be 

 of sympathetic origin, with no evidence of structural changes in any en- 

 docrin gland, but producing a functional overaction of thyroid, adrenal 

 or pituitary or an underaction of the pancreas. It is apparently true that 

 the glycosurias of endocrinal origin are usually recognizable by other 

 evidences of that origin, while ordinary diabetes shows no other signs of 

 endocrinal disease. 



Eppinger and Falta hold that diabetes is not due to the disease of 

 any one endocrin gland but to a loss of balance between them. It has 

 been shown that the balance may be disturbed by disease of any one of 

 them, and experimental proof of such a balance is not wanting. In a 

 dog rendered diabetic by removal of sufficient pancreatic tissue, removal 

 of the adrenals will greatly reduce the glycosuria ; the further removal of 

 the posterior lobe of the pituitary with the pars intermedia, followed by 

 removal of the pancreas does not lead to glycosuria. The balance, which 

 had been disturbed by the first operation, tends to recover as the result 

 of the second. When there is no disease of any one endocrin gland the 

 balance is upset through the sympathetic. Langdon Brown maintains that 

 this must be the case, that it is the sympathetic which simultaneously stim- 

 ulates the glands that lower carbohydrate metabolism and inhibits the one 

 that increases it. Since ordinary diabetes shows no evidence of other en- 

 docrin disease, and since glycosuria of thyroid or pituitary origin shows 

 other symptoms of endocrinal disease, it is possible that the cause of pan- 

 creatic insufficiency is to be found in the sympathetic system. Of the 

 pathology of the sympathetic nervous system we know practically nothing. 

 Further, we know very little of the pathological conditions of the other 

 endocrin organs in diabetes. 



Kraus (1920) found in twelve out of twenty-three cases of diabetes, 

 ten of these of ages varying from 1441 years, the other two older indi- 

 viduals, constant and characteristic changes in the hypophysis, in the form 

 of atrophy of the anterior lobe, changes in number (reduction), size and 

 form of the eosinophile cells, pyknosis, and degeneration of the eosinophile 

 and chief cells. He regards the eosinophile-cell apparatus of the anterior 

 lobe as the bearer of a sugar-regulating function. Increase of the eosino- 

 phile cells leads to hyperfunction and lowers the carbohydrate tolerance, 

 diminution of these raises the tolerance. The diminution of the eosinphile 



