166 ACIDOSIS, ACETONEMIA, 



follows. After complete removal, but not after 

 removal of four-fifths, sugar will continue to appear 

 in the urine even when all carl)ohydrates are excluded 

 from the food, being derived in this case from the 

 breaking down of food and body protein. 



In ordinary human diabetes, the pancreas is found 

 at autopsy to present some abnormality in such a 

 large proportion of cases that the smaller group in 

 which nothing is found amiss may safely be attributed 

 to functional deficiency apart from organic disease. 

 To quote an analogy, mental defect is so often 

 associated with gross changes in the brain that we 

 think we are justified in assuming that there must be 

 some functional derangement of that organ, even when 

 in cases of insanity it appears to be quite normal. 



In what way may destruction of the pancreas 

 conceivably produce diabetes ? 



The present-day teaching is that the pancreas 

 supplies to the blood some internal secretion, some 

 chemical substance, which is carried to the muscles 

 and other tissues to enable them to make use of the 

 sugar brought them by the blood. The tissues are 

 positively in need of sugar. It is probably an essential 

 source of muscular energy. A beating mammalian 

 heart, through which a solution of sahnes containing 

 sugar is repeatedly passed, will use up that sugar. 

 It is a principal source of heat. It is probably a 

 necessity for nearly all the functions of the proto- 

 plasm of the tissues. The blood always contains 

 sugar (about O'l per cent) to supply this need ; the 

 whole process of glycogen-storing in the liver is 

 designed to keep the percentage at a constant level 



