THE PANCREAS 49 



the skin, constipation, loss of sexual power, are among the 

 most prominent symptoms. The diagnosis, when these symp- 

 toms are present, is based upon the finding of sugar in the urine. 

 The percentage varies from 3 to 5 per cent, or over. In the 

 acute cases the course is rapid and the disease is almost inevit- 

 ably fatal. In the chronic cases the condition is not so serious 

 and the patients may live for many years. Among the 

 complications the commonest is pulmonary tuberculosis, the 

 most serious diabetic coma. The presence of ft oxybutyric 

 acid or diacetic acid in the urine is relied upon as a sign of 

 approaching coma. The commonest form is the dyspnosic. 

 The condition may be introduced by lassitude, headache, 

 etc., followed by restlessness. Speech becomes incoherent, 

 and the patient lapses into coma. 



Although physicians have been warned repeatedly against 

 confusing glycosuria with diabetes, a clear distinction between 

 the two is by no means generally made. The " poly glandular " 

 theories of the. Viennese school take no account of the dis- 

 tinction between, for example, adrenin intoxication and true 

 diabetes. 



The work of Mehring and Minkowski referred to above led 

 to a great deal of investigation and to much controversy. Many 

 authors stated that diabetes did not always occur when the 

 pancreas was removed. But this was supposed by the sup- 

 porters of Minkowski to be due to incomplete removal. Pan- 

 creatic feeding seemed useless in diabetes and it was not always 

 possible to find any lesion of the pancreas in cases of diabetes. 

 Considerable stress was laid, moreover, upon the differences 

 between diabetes in the human subject and the condition 

 induced in animals by extirpation of the pancreas. But more 

 recently it has been found that diabetes may be induced 

 artificially in a dog if a sufficient portion of the pancreas be 

 removed, leaving the remainder with its normal blood supply 

 and its normal connection with the duct. In such cases the 

 progress of the disease is hastened by carbohydrate feeding. 

 Changes in the islets have been described in such cases. 



The chief differences which are alleged to exist between 

 clinical and experimental diabetes are as follows. The dextrose 

 nitrogen ratio is said to be 3' 65 in severe human diabetes, 

 while in the dog after extirpation of the pancreas it is not more 

 than 2' 8. The increase of total metabolism in the depan- 



