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results are not so specific as those that follow thyroid medication in hypothyroidism for several reasons : First, not in every case of diabetes is the pancreatic factor present or prominent.* Second, very few preparations of pancreas are made with the object of specifically
supplying as much as possible of the islet substance. Third, it is no easy matter to supply the lacking hormone, for it is normally supplied continuously to the blood, and we have no means of knowing how much is elaborated, or, in disease, how much is lacking in each case. Fourth,
the antagonism of the chromaffin hormone must be considered, for the diabetes may be due not simply to a deficiency of the pancreatic internal secretion, but to an exaggeration of that of the adrenals or a combination of both. Fifth, evidently several other factors are concerned, and hence the hormone treatment of diabetes alone cannot be instituted with hopes of success. The exciting cause of the disturbed hormone balance is not to be neglected, and if it cannot definitely be found (and rarely can this be done, much less can it be controlled), all one can expect to accomplish in this direction is to favour the restoration of the hormone balance as much as possible. This is best accomplished by (1) The regulation of obvious elements of disturbance,
such as indigestion, anaemia, worry, etc. ; (2) the regulation of the dietary, so that a minimum of the deficient hormone will be required; (3) the sedation of adrenal overactivity, if present; and (4) the exhibition of preparations containing a maximum of the Langerhansian hormone in doses graded to fit the condition present. Clinical Experiences with Pancreas Preparations. As an
adjunct remedy in pancreatic diabetes, this method is * By referring to Chapter XI. it will be found that there are undoubtedly ases of diabetes in which the hepatic hypofunction overshadows any possible pancreatic deficiency.
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of encouraging utility. Frequently glycosuria is reduced to a minimum or disappears entirely, and after response to this treatment a wider dietetic range is made possible. Therapeutic trials of feeding pancreas have been carried out by several writers. Combe found it of good service in many cases, although it did not suffice completely to cause the disappearance of glycosuria, save only in a few cases. He called special attention to the improvement in the nutrition and general condition which was also brought about. Cowles relates an interesting case in which the in-
gestion of from one to three raw calves' pancreases daily reduced the daily amount of urine from 7-10 to 2-3 quarts, the specific gravity from 1040-1045 to 1028-1030, and the sugar, although the urine was never entirely sugar-free. The weight was materially increased, during one fortnight 16 pounds being gained. Circumstances caused the patient to stop treatment, and some time later he died from sepsis. The pancreas was found to be a mere fibrous cord. Cowles suggests that the numerous failures with this treatment are due to the administration of too
little pancreatic substance, as " few people would be able to eat, even if they could get, the amount of uncooked pancreas taken by my patient Zuelzer has reported good results from his preparation, and believes that it is possible to cause sugar, acetone, and diacetic acid to disappear from the urine of diabetic patients by the injection of a specially prepared pancreatic extract. In six cases, between six and sixty-five years of age, treated with subcutaneous injections of
extracts of pancreas obtained from living animals at the height of digestion, he reports that the results were uniform and constant, the glucose, acetone, and diacetic acid being always diminished, and usually entirely absent from