PUNCTURE DIABETES. 927 
the condition of the liver which results from such puncture, and which 
tends to cause this transformation of the glycogen into sugar, is clue to 
a disturbance of the hepatic circulation, and especially of the circula- 
tion in the hepatic artery, thus indirectly producing an alteration in the 
normal metabolism of the organ : but this cannot be considered as con- 
clusively proved, and it may be due to a direct interference with the 
action of the nerves to the liver cells. Diabetes does not, however, 
occur on section of the splanchnic nerves alone. 1 But in all probability 
the vasomotor centre is stimulated by the puncture, for other forms of 
stimulation of the vasomotor centre also tend to produce a temporary 
dial letes, such as the prolonged stimulation 2 of most sensory or afferent 
nerves (e .g. the sciatic, the central end of the vagus, 3 and the depressor 4 ), 
which are known so to influence the vasomotor centre as to produce 
constriction or dilatation of the arteries of the body generally. It is 
possible, therefore, that this may be the manner in which the effect is 
produced in the liver, and that the glycsemia is due to the diminution 
of the amount of oxygenated blood passing to the liver through the 
hepatic artery, causing an excitation of the liver cells, and such conse- 
quent alteration in their metabolic activity as ordinarily accompanies 
excitation. 5 Many drugs produce temporary diabetes, e.g. acids, such as 
phosphoric, lactic, and hydrochloric, also strychnine, curari, phosphorus, 
arsenic, carbon monoxide. Some of these may act by affecting the 
circulation, others by producing a dyspnceic condition of the liver cells, 
others again may be direct stimulants to the hepatic cells. 6 
It must be looked upon as a strong argument in favour of the glycogenetic 
theory of Bernard, that we find as a concomitant of the altered (increased?) 
activity of the hepatic cells, both after removal of the liver from the body, 
and after the diabetic puncture, such an increased production of sugar in the 
organ. It is certainly easier to explain the occurrence of puncture diabetes as 
an excess of the normal production of sugar in the liver, than as a phenomenon 
entirely sui generis. 
Action of the pancreas on carbohydrate metabolism. — Until 
recently, it was not known that the pancreas had any more influence 
upon metabolism than other glands of the same type, such as the 
salivary glands. There had, however, been isolated instances recorded 
in which disease of the pancreas was accompanied by a condition of 
diabetes ; but this, for the most part, was ascribed to the implication of 
the sympathetic ganglia, which are in anatomical relationship to the 
pancreas, and no special importance was attached to the pancreas in 
connection with the symptom. 7 It was, however, shown in 1889, by 
1 According to Kaufmann (Compt. rend. Soc. de biol., Paris, 1894, p. 284), puncture 
diabetes is not produced, if the nerves both to the pancreas and liver are cut ; but if one 
set only is severed, it is found to occur. 
2 Even that produced by sections, Kiilz, Arch. f. d. yes. Physiol., Bonn, 1881, Bd. xxiv. 
S. 97. Here also will be found references to previous papers on the subject. 
3 Bernard, ''' Lecons sur le systeme nerveux," Paris, 1858, tome ii. ; Eckhard, Beitr. 
z. Anat. u. Physiol. {Eckhard), Giesen, Bd. viii. 
4 Filehne, Centralbl. f. d. med. Wisscnsch. , Berliu, 1878, No. 18. 
5 Of. Araki, Ztschr. f. physiol. Chem., Strassburg, 1893, Bd. xvii. 
6 References to the literature of some of these substances will be given later ; others will 
be found in Kiilz, loc. cit., supra ; and in Neumeister, " Lehrbuch," Aufl. 2, S. 328. 
7 Since the discovery by v. Mering and Minkowski of the effects of total removal of the 
pancreas, several cases of severe diabetes in man, associated with disease of that gland, 
have been recorded (G. Hoppe-Seyler, Deutsches Arch. f. klin. Med., Leipzig, 1S93, Bd. Hi. 
S. 171 ; Buss, Diss., Gbttingen, 1895). It must not be supposed, however, that this is at 
all common. In most cases of diabetes no affection of the pancreas can be substantiated. 
