THE INTERNAL SECRETION OF THE PANCREAS 415 



owing to the long time which it takes to heal, the surgical wound 

 in experimental diabetes constitutes a certain danger to life. In 

 the absence of all by-factors, however, the metabolic disturbances 

 lead to death in three, or at most four, weeks after operation. 

 Should the animal live for a longer period, it is safe to assume 

 that extirpation was not complete, and that minute portions of 

 the pancreas were left in situ. 



The autopsy shows that, with the exception of emaciation, 

 there are no noticeable changes in the organs. Fatty degenera- 

 tion is sometimes present in the liver and kidneys, dilatation and 

 hypertrophic changes are observed in the gastro-intestinal canal, 

 and, according to Boccardi, there are changes in the central 

 nervous system. 



Partial Extirpation of the Pancreas. If a portion only of 

 the pancreas is removed, a quarter or one-fifth of any part of the 

 organ being left in situ, glycosuria will not take place. An even 

 larger proportion of the pancreas may be removed and, provided 

 that the remaining portion is sufficiently well nourished and 

 vascularized, the glycosuria will be transient only. Whether the 

 remaining portion is left in situ, or is transplanted externally of 

 the abdominal cavity, is a matter of indifference. The trans- 

 plantation of the processus uncinatus with its vascular peduncle 

 to a position under the abdominal cuticle, prevents glycosuria. 

 Resection of the peduncle did not, in Hedon's experiments, pro- 

 voke glycosuria ; but Lombroso has recently shown that the 

 subsequent ligature of the peduncle produced slight transient 

 glycosuria. In one instance, where the implanted portion of 

 pancreas was efficiently vascularized by a large cuticular artery, 

 the removal of this portion eight days after implantation led to 

 serious diabetes, which terminated fatally. 



Extirpation is sometimes partial as the result of accident, 

 small portions of pancreatic tissue being unintentionally left in 

 situ. Such conditions produce " slight " diabetes, sugar appear- 

 ing in the urine only after administration of the carbohydrates, 

 and disappearing again with a flesh diet. In many instances, 

 this remaining portion undergoes progressive degenerative 

 atrophy, in consequence of which the diabetes passes from the 

 slight into the severe form (Sandmeyer's diabetes). 



METABOLISM IN PANCREATIC DIABETES. 



The derangements of metabolism which follow extirpation 

 of the pancreas are expressed by the glycosuria and the hyper- 

 glycaemia of which it is the immediate outcome ; by the disappear- 

 ance of the glycogen reserve ; by the peculiar behaviour of the 

 organism with regard to the different carbohydrates ; by the 

 increased formation of acetone bodies, due to the absence of the 

 carbohydrates ; by the over-charging of the blood with acids 



