420 



INTERNAL SECRETION 



of the tissues; the amount of the fixed alkalis, calcium, and 

 magnesia, present in the urine becomes increased (D. Gerhardt 

 and W. Schlesinger) ; while the alkalescence, of the blood and 

 tissues in very much diminished; and, as a result of the alkaline 

 reduction, coma supervenes. 



This theory of the origin of diabetic coma rests upon a sound 

 clinical and experimental basis, and to-day is very generally 

 accepted. The failure of the alkaline therapy, which was founded 

 on this theory, led v. Noorden to conclude that diabetic auto-intoxi- 

 cation is attributable, not only to the over-production of acids in 

 general, but also to the specific toxic action of isolated inter- 

 mediary products (oxybutyric acid and aceto-acetic acid). 



Acetonuria is a constant symptom in dogs without pancreas ; 

 its presence is the more remarkable from the fact that acetone 

 bodies are not normally present in the urine of these animals, 

 while it is extremely difficult to obtain ketonuria experimentally. 

 The clinical picture presented by diabetic coma is by no means 

 rare in dogs which have lost their pancreas and, in many instances, 

 it is a terminal feature. 



The general metabolism undergoes a fundamental change 

 after the extirpation of the pancreas. The accumulation of sugar 

 in the blood was formerly regarded as due to imperfect oxidation 

 of the carbohydrates and a lowering of the processes of oxidation 

 in general. Falta, Grote, and Staehelin (1907) showed, however, 

 that in dogs with pancreatic diabetes, the processes of oxidation 

 are enormously increased, for the metabolism of albumin of such 

 animals when in the fasting stage may attain to three times the 

 normal. The decomposition of fat is also very much increased. 

 These findings suggest a toxogenic decomposition of albumin. 



According to Eppinger, Falta, and Rudinger, the increased 

 oxidation which follows removal of the pancreas is due to the 

 fact that, owing to suppression .oiH:he inhibitory influence nor- 

 mally exercised by that organ, the activity of the thyroid in 

 promoting metabolism is allowed to proceed unchecked. 



It is certain that, owing to the increased metabolism, there 

 is a reduction in the amount of the albumin, and that this gives 

 rise to emaciation. The emaciation is further accounted for by 

 the permanent caloric deficiency, due to the defective metabolism 

 of the carbohydrates. The increased demand for, and consump- 

 tion of, food (polyphagia) does not entirely counteract the 

 deficiency in the caloric, and does not prevent the rapid emaciation 

 of the body. Dogs which have lost their pancreas become 

 extremely- emaciated within quite a few weeks, and usually perish 

 of inanition. 



THEORY OF PANCREATIC DIABETES. 



Since it was first discovered that diabetes follows extirpation 

 of the pancreas, this condition has formed the subject of searching 



