274 KOLLIN T. WOODYATT 



pancreas was further studied by Bright, Lloyd and Elliotson (1833). 

 Bouchardat(a) at first definitely formulated the belief that pancreatic dis- 

 ease was the cause of diabetes mellitus. Von Mering and Minkowski 

 (1889) proved that complete pancreatectomy leads invariably to the devel- 

 opment of a severe diabetes. 



This applies not only to dogs but to cats, rabbits, pigs (Minkowski) 

 tortoises, frogs, eels and other animals. 



The glycosuria begins soon after the operation and increases in in- 

 tensity. "It persists in spite of a non-carbohydrate diet long after the 

 glyccgen reservoirs in the liver and muscles have become greatly impover- 

 ished (to 0.1-0.2 per cent in the liver), but like the human disease, it 

 usually ceases during a fast or may disappear just before death." 



The glycosuria may be accompanied by an excretion of the acetone 

 bodies, acetone, acetoacetic and (3-hydroxybutyric acids. In fact, the 

 metabolic changes secondary to this operation closely parallel those found 

 in the human disease, with certain differences which perhaps are ascribable 

 to species or to the fact that in the experimental diabetes digestion is al- 

 tered by absence of the pancreatic juice, etc. The following points have 

 become firmly established by frequent repetition. (1) Complete removal 

 of the pancreas causes a true diabetes (as above). (2) Ligation or obliter- 

 ation of the duct (or ducts) of Wirsung, no matter how scrupulously car- 

 ried out, has no such effect. (3 ) If about 1/16 to 1/10 of the pancreas 

 (Minkowski) with its arterial supply be separated from the rest of the 

 gland, this portion may be implanted extraperitoneally at a distance from 

 the original site. No diabetes results from this operation, or at most 

 only a transient glycosuria. Now if the main body of the pancreas be 

 fully extirpated with ducts, nerves and blood-vessels, still only a transient 

 glycosuria or none at all develops. At this stage all possible damage to 

 nerves and external secretion would seem to have been inflicted and proved 

 incapable of causing diabetes. (4) In the course of weeks the rest 

 atrophies (Sandmeyer's experiment), and then a persistent glycosuria 

 supervenes; or the encapsulated fragment may be extirpated, in which 

 case within a few hours a severe diabetes ensues. (5) There is no other 

 organ in the body extirpation of which has any similar effect, nor (except 

 for phlorhizinization) is there any known means of experimentally pro- 

 ducing a true diabetes without injury to the pancreas. (6) No toxic sub- 

 stance derived from the body of diabetic individuals, man or animal, has 

 been found which is capable of causing diabetes in a second animal. 

 These facts lead to the conclusion (reached by Minkowski} that pancre- 

 atic tissue provides something separate from the pancreatic juice (in- 

 ternal secretion of the pancreas), the lack of which is responsible for the 

 symptoms of diabetes. 



3 The last statement, confirmed by personal observation, appears in a chapter on 

 Diabetes by Woodyatt in Wells' "Chemical Pathology," 2d Ed., 1914. 



