PANCREAS DIABETES. 383 



others have shown that in severe cases of diabetes, in the starving con- 

 dition, the low quotient is not raised after partaking of dextrose, as in 

 healthy individuals, but that it is raised after feeding levulose, which is 

 also of value to diabetics (WEINTRAUD and LAVES). The poverty of the 

 oigans and tissues of diabetics in glycogen indicates that it is perhaps 

 not a diminished combustion of the dextrose which is essential, but 

 more likely an inability of the body to transform the dextrose into 

 glycogen or to utilize it at all. 



The relation of the pancreas to diabetic glycosuria is of the greatest 

 importance for its proper understanding. 



The investigations of MINKOWSKI, v. MERING, DOMINICIS, and later 

 of many other investigators, 1 show that a true diabetes of a severe 

 kind is caused by the total or almost total extirpation of the pancreas 

 of many animals, especially dogs. As in man in severe forms of diabetes, 

 so also in dogs with pancreatic diabetes, an abundant elimination of 

 sugar takes place even on the complete exclusion of carbohydrates from 

 the food. 



Artificial pancreas diabetes may indeed also in other respects present 

 the same picture as diabetes in man but there exist important differences 

 between these two. 2 It is generally accepted that in pancreas diabetes 

 a diminished consumption exists, i.e., diminished utilization, which 

 does not exclude an increased sugar formation. There are also certain 

 investigators who explain this form of diabetes as not entirely due to a 

 diminished combustion of sugar, but to a pathological increase in the 

 sugar formation. 



Many important observations show that a close relation exists 

 between the liver and pancreas diabetes. PFLUGER has also especially 

 shown that in diabetes produced by SANDMEYER'S method (partial extirpa- 

 tion with subsequent destruction of the remains of the gland in the abdom- 

 inal cavity, when the animal remains alive for a longer time than after 

 total extirpation) the liver does not lose weight, although the total weight 

 of the animal diminishes greatly, while in starvation without diabetes 

 the liver loses weight more than the other parts of the body. PFLUGER 

 concludes from this that the liver in diabetes works actively, and is the 

 most important seat of production of diabetic sugar. 



1 See Minkowski, Untersuchungen liber Diabetes mellitus nach Exstirpation des 

 Pankreas (Leipzig, 1893); v. Noorden, Die Zuckerkrankheit (Berlin, 1901), which 

 contains a very complete index of the literature. In regard to diabetes see also Cl. 

 Bernard, Legons sur le diabete (Paris); Seegen, Die Zuckerbildung im Thierkorper 

 (Berlin, 1890), and Pfluger, Des Glykogen, 2. Aufl., 1905, and especially v. Noorden's 

 Hamb. d. Pathol. des Stoffwechsels, 2. Aufl., 1907, Bd. 2, Chapter I. 



2 See Falta " Ueber den Eiweissumsatz beim Diabetes mellitus." Berl. klin. Woch- 

 enschr., 1908, and Zeitschr. f. klin. Med., 66. 



