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Practical Hormone Therapy of bacteria escaping from the duodenum, and consequent squeezing of the islands of Langerhans. As soon as the pancreatitis is relieved, the pressure is reduced, and
the islands are enabled to resume their functions, and the glycosuria shortly disappears.
Tiberti has shown that an artificially induced hyperplasia of connective tissue in the pancreas ultimately destroys the islands of Langerhans, and so glycosuria results; and Lissauer found in twenty-four subjects with gin liver that the pancreas showed more or less similar changes. His findings confirm those of Weichsel baum in twenty-seven similar cases. The importance of
this " gin pancreas " is evident when one remembers the comparative frequency of the development of diabetes mellitus in persons addicted to liquor. A report by S. A. Scott of Oxford University is of particular interest. He tells of a case of cancer of the pancreas with no previous glycosuria or symptoms of pancreatic internal secretory loss. At autopsy it was seen that the growth had effectively obliterated the ducts and destroyed the glandular part of the organ,
with the result that only the islands of Langerhans survived. Opie,2^ in his book, describes and illustrates a specimen in a less advanced state than Scott's. Dock's Summary of the Relation of the Pancreas to Diabetes Mellitus. In the Section of Medicine of the Seventeenth International Congress of Medicine, Dock makes the following summary of the foregoing facts: " Now that the relation of the pancreas to diabetes has been carried far towards a conclusion, it is worth while remembering how long it has taken us to reach this stage. Bouchardat very early claimed a place for the pancreas in the pathology of diabetes. Lancereaux and his pupil,
Lapierre, tried to show the relation more than thirty
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years ago, but sought it in the external secretion. Von Mering and Minkowski looked for it in the internal secretions a decade later; Hansemann soon after insisted on a specific anatomical alteration. In 1895 Schafer made the pregnant suggestion that the islands of Langerhans
are at fault, and in a few years this was confirmed on a large scale by the work of Opie, Weichselbaum, Salty koff, Hirschfeld, Russell, Heiberg, and many others. There is no question now as to the existence of the insular lesions in most cases of diabetes. ... It hardly seems
necessary here to discuss the meaning of cases of pancreatic disease without diabetes, and of diabetes without pan- creatic disease at least, disease we can recognize anatomically with our present methods." The Antagonism oi the Adrenals and Pancreas. Attention has already been drawn to the supreme importance of the hormone balance in carbohydrate metabolism (see
Chapter III.), and further elucidation of the part that the internal secretory organs play in the regulation of carbohydrate metabolism may be found by studying von Noorden's diagram and descriptive text, which appears on pp. 33 and 34. A number of experiments have shown that the Langer-hansian hormone antagonizes the power of the chromaffin hormone to " mobilize " sugar, or, in von Noorden's words, " the pancreas acts as a brake upon the sugar factory." Zuelzer" was among the first to discover the fact that adrenaline glycosuria could be suppressed by injections of an albumose-free pancreatic extract. Frugoni then confirmed this by showing that pancreas extract had the power of destroying adrenaline in vitro. Ghedini^^ (and later other investigators) have shown that a fatal dose of adrenaline, when mixed with pancreas extract, does not