INTERNAL SECRETIONS 363 



also on succeeding days. In most cases on the first day there are found only 

 traces, up to one per cent; on the following day from four to six per cent; 

 and only on the third day does the sugar elimination reach its maximum of 

 eight to ten per cent and over. If now food be not given, the quantity of sugar 

 in the urine begins gradually to fall off; but it does not disappear altogether 

 after seven days of fasting. With a plentiful supply of food the sugar in the 

 urine ma}'" amount to ten or twelve per cent, and the daily quantity of sugar 

 eliminated by a dog of 15 kilos on a pure meat diet may reach 102 g., and 

 on addition of carbohydrates may reach a still higher value. 



From these observations it is clear that the pancreas is extremely im- 

 portant for the normal decomposition of the carbohydrates of the body. But 

 it is conceivable that the effects described are due to some accidental lesion 

 attending the operation. This is opposed by the following experimental facts. 

 If a relatively small piece of the gland be left in the abdominal cavity, diabetes 

 does not occur, notwithstanding that the operative procedure is the same. 

 Further, if in the operation a piece of the gland be grafted under the abdom- 

 inal skin in such a way that it remains in vascular connection with the 

 abdominal cavity, and after it has become healed in, the rest of the gland 

 left in the normal position be removed, the animal does not become diabetic, 

 nor does diabetes result from section of the vascular stalk to the subcutaneous 

 graft. But sugar appears in the urine immediately and in large quantities, 

 and the sugar content in the blood rises considerably, as soon as the subcu- 

 taneous graft is removed, although the operation for its removal is quite an 

 insignificant one. We must conclude that neither the operative lesions nor 

 the absence of the pancreatic secretion from the intestine can be the cause 

 of the sugar elimination. The pancreas therefore exercises a specific influ- 

 ence on the transformation of sugar in the body. 



The pancreas may be made to waste away by gradual injection of fat or of 

 acids into the duct of Wirsung. When this is done in the dog, in many cases 

 no sugar appears in the urine (Hedon, Rosenberg). To explain these remark- 

 able facts, we are almost compelled to assume that some other organ has taken 

 over the function of the pancreas in the metabolism of sugar, and that this can 

 only happen in case the function of the pancreas is abolished very gradually. 

 The most natural explanation, namely that portions of the pancreas remain 

 intact, is excluded by the express statements to the contrary of the authors 

 themselves who report these experiments. 



How are the phenomena which follow extirpation of the pancreas to be 

 explained? Even under normal circumstances with a very large amount of 

 sugar in the food, a part of it passes out in the urine (alimentary glyco- 

 suria). Different kinds of sugar behave differently in this respect. Levulose 

 is almost all burned, while cane sugar, grape sugar and especially milk sugar 

 pass over in relatively large quantities into the urine. After extirpation of 

 the pancreas, much larger quantities of sugar than usual are found circulating 

 in the blood ; it is evident, therefore, that sugar must also appear in the urine. 



The different carbohydrates fed to an animal whose pancreas has been 

 removed behave very differently. On feeding grape sugar the entire quantity 

 fed appears in the urine. Maltose is transformed into dextrose and as such is 



