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Disease of the Pancrease

diabetes, pancreas, clinical, reported, pancreatic, time and anatomical

DISEASE OF THE PANCREASE.

Since the wonderful discoveries of von Mering and Minkowski particular attention has very naturally been directed, in the study of diabetes, to the pancreas. But it would be belittling the services of earlier investigators not to mention the fact that the importance of pancreatic disease in the etiology of diabetes was signalized a hundred years ago by Cawley, and since his time by many other writers for example, Bouchardat, Fried reich, Bamberger, Frerichs, Senator, and Seegen). Still, these obser vations were little more than reports of cases, and an opinion as to • the causal relation present was never clearly formulated until Lan cereaux, in 1877, on the strength of numerous clinical and anatomical observations, described a special form of diabetes under the name of diabete pattereatique ou diabete maigre. This form was said to be characterized by a sudden onset, unusual malignancy of course, rap idly progressive emaciation, rapid loss of strength, and a special ten dency to pulmonary tuberculosis as a complication. Lancereaux's cases, which were reported at length by Lapierre in his These de Paris, had excited a good deal of well-deserved notice among clinicians, but were on the point of being forgotten again when the discovery of experimentally induced pancreatic diabetes revived a recollection of them and bore striking witness to the clinical acumen of Lancereaux. Since then the number of cases reported of diabetes associated with diseases of the pancreas has assumed considerable proportions. An explanation of the mode of origin of diabetes in disease of the pan creas cannot be again entered upon here, as it has alreacb- been treated of at length elsewhere (pp. 54, 58, 70).

In the light of our present knowledge based upon the facts of ex perimental pathology and clinical experience, the existence of pan creatic diabetes can no longer be doubted. although it may still be questionable whether the clinical picture drawn by Lancereaux is cor rect in all its details. It will be the task of clinical medicine to com plete this picture and to correct its defects. We may then hope to gain such an insight into this condition as to be able to diagnose uitam the disease of the pancreas which holds an etiological re lation to diabetes, or in other cases to exclude it. A noteworthy

beginning has already been made in this direction; but in the mean while we cannot ignore the fact that many obstacles are still to be overcome before we establish satisfactorily the doctrine of pancreatic diabetes in man. In the first place, there are numerous cases on record in which extensive lesions of the pancreas have been found post mortem, although during life there was no glycosuria (see the monograph of I. Seitz on Necrosis of the Pancreas). Then there are also very many cases of diabetes reported in which the most care ful examination of the pancreas has failed to bring to light the exis tence of any lesions in this organ. Some authors go so far in these cases as to inculpate the pancreas in spite of the absence of any ana tomical lesion, alleging in support of their view the indubitable fact that an organ may be functionally diseased although all our known methods of research are unable to detect any anatomical basis there for. This assumption is based upon the attempt to explain all cases of diabetes from one uniform standpoint, viz., that an alteration of the pancreas must always either be the primary cause of diabetes or else it must act as the necessary connecting link between some re mote cause and the outbreak of the disease (see above, in the section on Neurogenous Diabetes).

This argument manifestly goes too far. It cannot, indeed, be positively disproved, but neither can it be established as correct; yet men take it into regions of utter darkness where the door is flung wide open to the most boundless and inconsequential speculations. If, at this early period, we attempt to bring every case of diabetes into relations with the pancreas, we run the risk of impeding the healthy development of our knowledge concerning the disease, just as it was at one time restricted by a one-sided view of the action of the liver in the causation of diabetes. It is still necessary, bearing well in mind what has already been accomplished, to collect and criti cally sift a great many more clinical and pathological facts before we can arrive at any certainty.