168 ACIDOSIS, ACETONEMIA, 



past few months have taught us to be cautious in 

 coming to the conclusion that the problems of 

 diabetes are solved. A year or two ago Starling and 

 Knowlton advanced what appeared to be most 

 interesting evidence, that after removal of the 

 pancreas the surviving beating heart of a dog is 

 unable to make use of dextrose perfused through it, 

 but that if pancreatic extract is added, the power to 

 utiKze sugar is restored. This of course exactly 

 fitted the theory. But now Starling finds that the 

 supposed results were due to experimental error, 

 and that the diabetic heart is well able to use up 

 sugar. 



Various authorities have tried to go further with 

 the explanation of human diabetes, and have stated 

 that the internal secretion is derived from the clusters 

 of cells called islets of Langerhans, whereas the 

 digestive juices are derived from the acini ; it has 

 further been stated that in diabetes sometimes the 

 islets are destroyed whilst the rest of the pancreas is 

 normal. Ligature of the pancreatic duct causes 

 atrophy of the secreting cells of the alveoli, but not 

 the islets, and is not followed by glycosuria. Some 

 observations by Dale, supposed to tell against the 

 theory, are not confirmed. It is true that in some 

 cases of human diabetes the islets appear to be 

 normal. Perhaps we must look to some alteration 

 in the internal secretions of the ductless glands for 

 an explanation of these cases. 



Again, such wide currency has been given to an 

 experiment of Cohnheim's, that it is necessary to 

 state and refute it. He taught that muscle extract 



