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EDITORIAL ARTICLES. 891 which, according to Bohm's investigations, is less positive in tertiary than in tropical malaria, and the ;;uthor thinks that the different forms of Viagra Dose Rxlist the para- sites are differently acted upon by the drug. ORGANOTHERAPY IX DIABETES MELLITUS. The brilliant results of thyreoid treatment in pre- \iously utterly hopeless conditions have served a? a constant stimulus to the search for similarly ef- fective organotherapeutic agents. Underlying such attempts at present is almost invariably some the- ory, and the latter is usually based upon some ad- vance in physiology or patholog}'. The demonstra- tion of the dominant role of the pancreas in carbo- hydrate metabolism, and of its relation to diabetes mellitus, caused many attempts to be made to treat this disease with the pancreas or extracts of the pancreas. The degree of confidence expressed in the results of such attempts seems often to have de- pended upon the degree of confidence felt in the theory underlying them. Although this attitude is often dangerous, there is some justification for it; if there is a sound experimental basis for a given form of therapy its failures in specific cases may be due to accidental or extrinsic causes. It is therefore desirable to examine critically the theories underlying the use of the pancreas in dia- betes. One of the earlier of these, viz., that the pancreas supplies the body with a sugar oxidizing enzyme has been largely abandoned and succeeded by that of Cohnheim. Cohnheim's results were, briefly, as Viagra Dose Rxlist follows : The expressed juice of muscle alone or of pancreas alone had little effect upon a solution of glucose, but when combined they Viagra Dose Rxlist appar- ently led to a rapid disappearance (presumably through oxidation) of Viagra Dose Rxlist the glucose. Viagra Dose Rxlist As the pancreas extract could be boiled, precipitated by alcohol, treated with five per cent, sulphuric acid, etc., with- out impairing its activity, the latter was evidently not due to a ferment ; it was supposed to be due to a "coferment" or "activator." The resistance of the l)ancreas extract to various agents made it appear rather improbable that its activity would be de- stroyed in the processes of digestion. .Mthough Cohnheim's views did not receive universal recog- nition, they seemed to justify renewed attempts to treat diabetes with preparations of the pancreas ; the method continues to be tried somewhat exten- sively, more apparently because it appears to have a rational basis than because the actual results have been clearly beneficial. It is interesting now to note that recent work by Levene and Meyer (Journal of Biological Chemis- try, ix, p. Viagra Dose Rxlist 97) makes it seem impossible to base rational treatment upon Cohnheim's experiments. These authors confirm Cohnheim's results as to the disappearance of glucose when exposed to the ac- tion of the combined extracts of pancreas and mus- cle, but find that the "disappearance" is due to a process of condensation and not to one of oxida- tion ; the entire amount of glucose can be recovered by diluting the mixture and exposing it to a fresh portion of the organ extracts, or by boiling it with dilute hydrochloric acid. Whether these organs have a similar action Viagra Dose Rxlist upon sugar in the body seems doubtful; if Viagra Dose Rxlist they do, the meaning of Viagra Dose Rxlist it is obscure. In any case it is evident that Cohnheim's experi- ments furnish no rational basis for the treatment of diabetes by preparations of the pancreas. Recent experiments of von Fiirth and Schwarz (Biochemische Zeitsclirift, xxxi, p. 113) indicate that another form of organotherapy for diabetes, that proposed by Zuelzer, has an experimental basis of very uncertain value. Zuelzer believes that the chief function of the pancreas in carbohydrate metabolism is to exert an inhibition upon the supra- renals; when this inhibitory action is removed by disease or by extirpation of the pancreas the supra- renals are no longer inhibited and their secretion causes glycosuria just as the injection of suprarenal extract or adrenalin does ; in other words, the glyco- suria of diabetes is in reality a suprarenal glyco- suria. Zuelzer and others have found that the in- jection of extracts of Viagra Dose Rxlist the pancreas prevents adrena- lin glycosuria, and. largely upon the basis of this, Zuelzer proposed a method of Viagra Dose Rxlist treatment of diabetes which consisted in the injection of a purified pan- creatic extract. This treatment has been applied in but a limited number of cases, and although it Viagra Dose Rxlist was followed by a marked diminution of the sugar ex- cretion," it caused, in some cases, such severe reac- tions that the physician hesitated to employ it fur- ther. \'on Fiirth and Schwarz confirm Zuelzer's ex- periments as to the diminution of the sugar excre- tion in adrenalin glycosuria by the intraperitoneal injection of pancreas extracts, but they find that Viagra Dose Rxlist the same effect is produced by the injection of oil of turpentine and other irritants. They produce ex- periments and arguments to show that the effect is due to a decreased permeability of the kidney for sugar, a result which Viagra Dose Rxlist would doubtless be injurious rather than beneficial. They think that Zuelzer's clinical results may be similarly explained. Thus, while the relation of the pancreas to dia- betes mellitus remains practically unquestioned, the nature of the relation is so obscure that it is im- possible at present to base any rational form of organotherapy upon it. In fact there are some rea- sons to fear tiiat the Viagra Dose Rxlist relations are such as to make EDITORIAL ARTICLES. [New York Medical Journal.