THE PANCREATIC JUICE. 145 



observed that as a result of such interference the resorption of fats 

 is seriously impeded, so that practically all that has been ingested 

 reappears in the feces. In the case of the albumins, it is similarly 

 found that but 44 per cent, is absorbed, and of the ingested starches 

 from 20 to 40 per cent, is eliminated as such. Analogous results 

 are obtained in the human being where atrophy of the pancreas is 

 at times observed. As a consequence, rapid emaciation occurs, and, as 

 has been stated, death ultimately results. It appears, however, that 

 the fatal issue in these cases is not exclusively referable to impaired 

 nutrition as a result of defective absorption. It is, indeed, possible 

 to counteract this effect by administering a sufficient amount of raw 

 pancreas together with the food, whereby the resorption of both fats 

 and albumins is greatly improved. Death, however, takes place never- 

 theless. It is thus apparent that besides its digestive function the 

 pancreas must play an additional and important role iti the metab- 

 olism of the animal body. We find, as a matter of fact, that fol- 

 lowing the extirpation of the pancreas in dogs a severe form of dia- 

 betes rapidly develops, and is accompanied by the appearance of 

 acetone, diacetic acid, and at times of /?-oxybutyric acid in the urine. 

 That this is not due to suspension of the pancreatic digestion can be 

 proved in various ways. If the animal thus receives an adequate 

 amount of raw pancreas together with its food, the absorption of 

 albumins and fats is, as just stated, greatly increased, while the 

 diabetes persists. It has been further noted that ligation of the 

 secretory duct does not lead to the appearance of sugar in the urine, 

 and that the diabetes continues after extirpation even when no food 

 is consumed for several days. The conclusion hence suggests itself 

 that the pancreas, like the thyroid, the adrenal body, and other 

 glands, probably furnishes an internal secretion also, which in some 

 manner controls the metabolism of glucose within the animal body. 

 Arthaud and Butte, it is true, claim that diabetes does not follow 

 ligation of the pancreatic veins ; but it can readily be imagined that 

 in such cases, and perhaps even under normal conditions, the internal 

 secretion of the gland is removed through the lymph-channels. It 

 has been shown, moreover, that diabetes does not occur after extir- 

 pation of the pancreas if a piece of the gland has been previously 

 transplanted under the skin. 



Of the nature of the substance which is thus secreted by the 

 pancreas, and in the presence of which the carbohydrate metabolism 

 continues in a normal manner, our knowledge has been greatly 

 extended through the researches of Cohnheim and Hirsch, who 

 could demonstrate that the pancreas furnishes a substance, possibly 

 of the nature of a kinase, which renders possible the glucolysis in 

 both muscle-tissue and the liver. In its absence this does not occur 

 and diabetes is the necessary consequence. This substance, however, 

 is probably not furnished by the pancreatic cells proper, but by the 

 cells of the islands of Langerhans. At this place we shall deal 

 only with the pancreatic secretion proper. 

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