NOUMBER 25 DIABETES MELLITUS-WALLACE 2107
stated that there is no dinrinution in the total energy future will undoubtedly show a more definite classifi-
production of the diabetic as compared with the normal cation into groups or types than is at present possible.
man. The diabetic obtains his calorific energy from fat Numerous attempts have been and are still being
instead of fromn carbohydrates, and if fat is not given made to discover a specific for diabetes. Naturally tlhis
him in sufficient quantity to maintain his requirement work centers in the preparation of glandular extracets,
he uses his own body fat. and although so far no success has been attained, some
T'ettenkofer and Voit in early experiments on a dia- of the work may be briefly mentioned.
betic foudil no change in thie metabolism from the In 1907 Rennie and Fraser' prepared an extract of
normal. Rlublier, usiIIg a phlorhizinized dog, found that the islands of Langerhans of the pancreas of a certain
thie heat production was increlased by 7 per cent. when genus of fish, the Teleosts. In these pancreas there is a
glycosuria was induced. The protein metabolism was chief island, large enough to be seen macroscopically.
increase(l more tlhan threefold, and he attributed the rise Five diabetic patients were treated with the extract and
in energy prodluction to tle increased protein destruction some improvement seemed to follow. The results have
(specific dynamic aetion of protein). Falta,4 working not been confirmed nor have additional cases been since
wvithi Benedict in Boston, could find no evidence of an reported by these anthors. In the following year a
increased metabolism in diabetes mellitus. Du Bois and paper by Zuelzer2 appeared in which were reported six
Veeder5 report a comparison between the metabolism of cases treated with pancreas extract. The extract was
a normal man and two mein suffering from diabetes. made from dog's pancreas removed during the height
One case, which lw-as of the most severe type of diabetes, of digestion. It was injected intravenously and the
showed an increase in metabolism of 5 per cent. above glycosuria diminished perceptibly during the two or
the normal. Finallr, a preliminary report by F. G. three succeeding days. A decrease in the acetonuria
Benedict and E. P. Joslin of work on the metabolism of was also observed. As a result of the injection fever
thirteen patients representing various types of diabetes, usually occurred. The figures given by Zuelzer are not
declares that the heat producltion of the diabetic may be very convincing, however, and unfortunately the treat-
15 per cent. above thie normal. Zuntz attributes this rise ment in the hands of others has been disappointing.
in metabolism to increased renal activity. Another line of treatment which attracted some
One must take to heart these lessons. The physician attention was introduced bv Moore and Abram3 in
can be sure tlhat hle is treating his patient properly only 1906. These investigators failed to find prosecretin in
when he knows that he is giving him at least the thirty- the duodenum of diabetics, and on this basis and the
five calories per kilogram requlired normally, and these assumption that secretin might increase the internal
nmust be contained in matesials which the patient can secretion of the pancreas, employed an acid extract of
oxidize. Protein will not give more than 10 or 15 per thIe duodenal mucous membrane (secretin) in the treat-
cent. of this requirement of energy. To give fat in suf- mnent of a few eases of diabetes. Good results were
ficient quantity requires all the arts of cook;ery. Here, reccorded. Their conclusions were shortly afterwards
as always, when the appetite is no longer a proper guide attacked by Bainbridge4 who found that prosecretin was
the physician's knowledge of tihe patient's requirensent is usually present in diabetics and that the administration
the only possible resource. Wlhen instinct fails science of secretin failed to produce any effect on glycosuria.
must be invoked. Bainbridge's work has been confirmed by Foster and
others in this country.
In 1908 Minkowski5 again reported the effects of
RECENT ADVANCES IN THE TREATMENT grafting pancreatic tissue in dogs. The graft, if it
OF DIABETES MELLITUS * secures a sufficient blood-supply, grows and functions
OF »IAETS EITSto such an extent that the animal's own pancreas ean
GEORGE B. WALLACE, M.D. hbe completely removed without the occurrence of dia-
NEW YORK betes. Here would seem to be a great therapeutic pos-
.u sp. sibility. But in animal experiments the transplanta-
In spite of all the experimental and clinical work on tion must be made before diabetes has been induced
tion muet ho made before diabetes bas been indnced,
diabetes which has been done isi the past years, a spe- otherwise healing will not take place.
cific or etiologic treatment has not been attained. A The interesting work of Cohnheim9 may be men-
striking advance has been made in dietetic treatment, tioned here. Cohnheim found that the glycolysis occur-
however, and, with the clearer and more detailed knowl- ring when an extract of muscle was added to sugar was
edge of the metabolic derangement present, gained in increased if the further addition of an extract of pan-
the past few years, the general principles of dietetic creas be made. The extract of pancreas, he assumes,
therapy have undergone considerable modification and contains a substance of the nature of a hormone. The
have been placed on a firmer foundation. Much yet objection to his work, on the ground of bacterial con-
remains unknown or obscure, but in no disease of metab- tamination, seems to have been successfully met, and
olism can truly scientific dietetic treatment be more Hall,7 repeating his work, has obtained rather striking
successfully carried out than in diabetes. It has been results. No attempt has been made by these investi-
made clear, lhowever, that no routine line of treatment, gators to apply their w'ork to therapeutics, although it
however sound it may be in principle, can be applied might appear to warrant such application.
to all cases and that the treatment of one individual case
rsmay differ quite markedly frosl that of another. The 1. Rennie and Fraser: Biochem. Journ., 1907, ii, 7.
*·~~~~~~~~~~~ ~~~~2. Zuelzer: Ztschr. f. exper. Path. s. Therap., 1908, v, 306.
3. Moore and Abram: Biochem. Journ., 1906, i, 28.
4. Falta: Wien. klin. Wchnschr., 1909, xxii, No. 16. 4. Bailnbridge: Biochem. Jour., 1908, iii, 82.
5. DuBois, E. F., and Veeder, B. æ.: Arch. Int. Med., 1910, v, 37. 5. Minkowski: Arch. f. exper. Path. u. Pharmakol. (Schmiede-
E Read in the joint meeting of the Section on Pharmacology and berg Festschr.), 1908, p. 395.
Therapeutics and the Section on Pathiology and Physiology of the 6. Cohnheim: Ztschr. f. physiol. Chem., 1903, xxxix, 336; xlii,
Arimerian MeIdical Asso:iations, at the Sixty-First Annual Session, at 4ol.
tSt. Louis, Juue, 1S10. 7 }Is!l: Am. Joar. Physiol., 1907, xviii, 283.