1909.] Urine in Chronic Disease of the Pancreas. 379 



no reaction after the operation, and in Dog II the reaction which had been 

 obtained on four occasions during the preceding three weeks disappeared 

 after removal of the pancreas. 



It may be objected that the modification of the procedure made necessary 

 by the presence of the fermentable sugar interfered with the reliability test, 

 but that this is not the case has been shown by the results obtained on 

 examining the urines from several patients suffering from glycosuria 

 associated with disease of the pancreas by the same method. One in 

 particular demonstrated this very clearly, and also showed how an exceed-' 

 ingly well-marked reaction may diminish in intensity as destruction of the 

 pancreas progresses, and finally disappears when advanced glycosuria has been 

 established. The patient was first seen in December, 1906 ; there was then 

 an abdominal tumour which was suspected to be pancreatic, but an exami- 

 nation of the urine gave no " pancreatic " reaction, and there was also at that 

 time no sugar. An exploratory examination was performed by Mr. Mayo 

 Robson, and a growth was found in the first part of the duodenum, but quite 

 free from the pancreas. On January 18, a second specimen of urine was 

 examined and found to be free from sugar, but it gave a well-marked 

 " pancreatic " reaction, suggesting that the pancreas was then involved in 

 the disease. At the request of the patient's friends the abdomen was 

 re-opened a few days later and it was then found that the growth had 

 invaded the pancreas as had been suspected. In the early part of May, 1906, 

 examination of the urine showed 5 - 25 per cent, of sugar and a modified 

 " pancreatic " reaction gave many fine crystals soluble in 33-per-cent. 

 sulphuric acid in 5 to 10 seconds. A month later the sugar had increased 

 to 7 per cent., and a much less marked " pancreatic " reaction was obtained. 

 In July the urine contained 7"25 per cent, of sugar and the "pancreatic" 

 reaction gave only a few crystals. In August, 7"5 per cent, of sugar was 

 present, and no crystals were found on carrying out the modified " pancreatic " 

 test. In October the urine contained 9*5 per cent, of sugar and the 

 " pancreatic " reaction was negative. The patient died on November 5. 



The indications afforded by the experimental, pathological, and clinical 

 evidence so far obtained all point to the so-called " pancreatic " reaction in 

 the urine being due to active degenerative changes in the pancreas, and, so 

 far as 1 have been able to determine, to these alone. The fact that the sugar 

 giving rise to the reaction is apparently a pentose suggests that it is probably 

 contained in a derivative of the pancreas nucleo-protein which passes into the 

 blood as a result of the degeneration of the gland cells. In view of the 

 constant presence of a pentose in the nuclei of the cells of other organs and 

 tissues it might be thought that if this were true, degeneration in these 



