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This hindrance to the experiments Avas soon obviated by the implantation of a small piece of pancreatic tissue, preferably from the tail of the pancreas, in the abdominal wall, either before or during pancreatectomy. This small graft sufficed to preserve the resisting power against infec-
tion, and, it may incidentally be mentioned, at the same time prevented the desired outcome of the experiments the production of an experimental glycosuria. As soon as the animal recovered from its serious operation, it was an easy matter to remove the graft (an insignificant opera-
tion, in which danger from sepsis was negligible), with the result that an experimental diabetes was quickly established. This seems to afford evidence of a relation between the internal ecretion of the pancreas and the power to overcome bacterial invasion. The Relation of Infective Processes to Pancreatic Disorder. There are other ways in which mc may give emphasis to this fact. One of the most frequent complications of diabetes, especiall}^ diabetes of pancreatic origin, is tuberculosis, a fact that has impressed not a few clinicians. Montgomery,^ in a recent paper, gives the results of his study of 117 cases of diabetes, from which he concludes that resistance to the tubercle bacillus is lowered in diabetes, and that a large number of diabetics
develop eventually a very acute, extensive, and rapidly fatal form of pulmonary tuberculosis. This investigator notes that when diabetes and tuberculosis occur together, diabetes is usually the primary disease. The frequency with which diabetics suffer from concomitant infections is well known. Small pimples often rapidly become serious boils, and these in turn sometimes assume
the characteristics of carbuncles, and spread with amazing rapidity. Small infections that are considered trivial, or even negligible, may become quite serious in the diabetic, while the frequency of diabetic gangrene is well known. The Opsonic Index in Diabetes. While the author is not convinced that the exact estimation of the opsonic index is possible under ordinary circumstances, there is no doubt that there is an index of opsonic capacity even though we may not be able to estimate it accurately. Comparative estimations are better than none at all, and
the work of King^ is of interest in that it shows that the phagocytic capacity is often reduced in diabetes. This writer makes the following statement: " The first examination of ten diabetics to compare the phagocjrtic activity of leucocjrtes, on a twelve hours' growth of Saccharomyces
cerevisice, showed their indices to be 0-61, 0-64, 0-68, 0-69, 0-73, 0-805, 0-81, 0-87, and 0-99. We found, therefore, in each of these patients a lowering of the resistance, varying to 0*56 of normal. The one with the index 0-64 had one leg amputated for diabetic gangrene four years ago.
The one with the index 0-87 had been taking trypsogen tablets for two months, and said he was much better than he had been
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In his study of the blood-findings in diabetes mellitus, Caro'^ invariably found a reduction of haemoglobin and a decrease in the number of red cells. Leucocytosis was not present. In twenty- two cases out of twenty-eight there was a lymphocytosis which in fifteen cases was as high as
40 to 70 per cent. These patients invariably suffered from gangrene, tuberculosis, etc. From this it must be concluded that either the toxicity of the blood in diabetes is the direct cause of the lowered resistance, or that the absence of a certain hormone has a specific influence upon the resistance, in both incidents the trouble being hormonic in origin iij the former case indirectly, while in the latter directly. These facts seem to establish conclusively that when the internal secretion of the pancreas has been lost, or diminished, either experimentally or from pancreatic
disease, there is always a noticeable reduction in the power of the individual or animal to destroy bacteria. The Action of Pancreas Preparations on Gangrene, etc. Emphasis of an encouraging nature is lent to these statements by the fact that pancreatic preparations have a marked influence upon infections. A very severe case of diabetic gangrene was recently reported by Attix and
Rommel,^ in which the extensive osseous destruction was illustrated by radiographs. The clinical record is of especial interest, as the medical treatment consisted solely of a pancreatic preparation [try opsogen), to which was added ^ grain of codeine three times a day. Here follows a brief abstract of two cases reported : "Mrs. L., aged sixty-five, had injured a corn on the
great toe. It would not heal. The urine, on analysis, showed 4 per cent, of sugar. Under treatment the sugar rapidly disappeared ; but the condition of the toe extended, typical gangrene developed, and eventually the distal half