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is a great tolerance to carbohydrates in subsecretion of the posterior lobe of the pituitary.

An ordinary simple test of the carbohydrate function is made by giving 100 grams of glucose, in solution, shortly after a light breakfast; or it may be given with the breakfast coffee. The urine should be examined in three, six, and nine hours, and if sugar is found, there is a lowered tolerance for carbohydrates. At the present time there is no satisfactory method of administering the hormones of the islands of Langerhans, and all preparations of pancreas and pancreatic tissue that have been offered have proved unsatisfactory in the treatment of diabetes. At the present time there is no use for pancreas or pancreatic preparations except as a digestant. When pancreas is given to patients as sweetbreads it should be recognized that large amounts of nucleins are offered the patient, which may be inadvisable.

SECRETIN

The importance of the hydrochloric acid of the gastric juice not only as an aid to stomach digestion but as a germicide must be recognized. Another important activity is its ability or its function, when it passes into the intestine, to cause the excretion into the intestine (formed from a substance contained in the epithelial cells termed prosecretin) of an important substance named secretin. Secretin increases the flow of bile and of the pancreatic secretion, but it is soon destroyed in the intestine by the enzymes of digestion.

Secretin has also been proved to be an active stimulant to peristalsis, and this has suggested its use in constipation, but it probably is of no value when given by the mouth, and it should not be given hypodermatically or intravenously. When injected subcutaneously it increases the number of both red and white corpuscles in the blood by stimulating the bone marrow. The normal activity of this substance may be the cause of digestive leucocytosis.

Secretin may be obtained from the mucous membrane of the duodenum and jejunum of a fasting mammal by mascerating this mucous membrane with a weak hydrochloric acid solution, but its therapeutic use is purely experimental.

SPLEEN

Function. The spleen does not produce a vital secretion. This organ can be removed both from animals and man and death not occur. It easily becomes swollen, congested, or hypertrophied in certain diseases, typically in diseases of the blood. It may be that all of the diseases in which it is enlarged are due to infection, and the hypertrophy and increased activity is due to the need for greater purification of the blood and for the production of more phagocytic leucocytes. The function of the spleen seems to be to produce leucocytes and lymphocytes, and to destroy or at least retain broken-down erythrocytes and leucocytes; hence it improves the blood. It has also, associated with the liver and bone marrow, something to do with the production of hemoglobin. As the spleen has rhythmic contractions and dilations it may aid the portal circulation. Under certain conditions of the bone marrow the spleen may produce red corpuscles as it is supposed to do in embryonic life. In type the spleen is a lymph gland.

The advisability of splenectomy should always be considered in serious destruction of red corpuscles, in hemolytic jaundice, and it should, sometimes, be considered in pernicious anemia and in spleno-medullary leukemia. It is obvious that if a certain amount of splenic tissue is required to destroy normally a certain number of red cells a day that twice that amount of normal splenic tissue would destroy twice as many red cells a day.

Splenic extracts have been suggested in many conditions, but there is no good scientific or therapeutic excuse for administering preparations of the spleen. A so-called hormone has been prepared from spleen which has peristaltic activities, but for such activity it must be administered hypodermatically, and it may produce very undesirable effects, hence such use at the present time is not justifiable.

LIVER

Extracts of the liver, when given experimentally, lower the blood-pressure, and preparations containing the bile salts always lower blood-pressure and may increase the activity of the

bowels, but they are more or less depressant, and neither bile nor bile salts should be long administered. Theoretically, when for any reason the bile is absent from the intestines, preparations of bile might be of advantage, but if the diet is properly arranged (namely, foods are given that do not require bile for their digestion, i.e., eliminating fats) other laxatives are safer than to long administer bile. Also the bile salts should not be long given for any possible action they may have in stimulating the liver or in preventing deposits in the gallbladder.

When liver is given as a food it should be recognized that it contains a large amount of nuclein, and therefore will increase the production of uric acid.

KIDNEYS

There is still a difference of opinion as to whether there is, or is not, an internal secretion of the kidneys. It is a clinical fact that if the kidneys are healthy, entire absence of the excretion of urine may go on for several days, even four or five, without uremia occurring. On the other hand, if the kidneys are diseased, as soon as the urine is diminished in amount, and certainly when the excretion ceases, uremia is immediately in evidence.

Not to discuss here just what causes uremic convulsions, whether they are due to irritations of the brain from ammonium salts or to acidosis, clinically, many times, the administration of fresh, raw kidneys, or of watery extracts made from raw kidneys, has prevented for a time uremic convulsions. On the other hand, dried preparations of kidneys, or extracts made and dried of the glandular tissue of the kidney, have not been of great clinical value, except that at times they increase the nitrogen output.

PAROTID GLANDS

It is doubtful if these salivary glands furnish an internal secretion, except that it is exceedingly interesting that when they are inflamed in mumps, metastasis readily occurs to the testicles in the male, and to the ovaries in the female. Why there is this peculiar relationship has not been satisfactorily explained.

When the parotid gland is disturbed, it furnishes a very toxic secretion, and even in mumps it may cause a very high temperature and a very slow pulse, and the patient may die of sudden heart failure. When the parotid gland or glands become inflamed in serious infections, as typhoid fever, the prognosis is bad. Therefore these glands are something more than pure salivary glands.

On account of the relation of these glands to the gonads, extracts from the parotids have been used in certain forms of dysmenorrhea, and in certain conditions of ovarian disturbances, and it has been stated that menorrhagia has been stopped by such treatment. However, at the present time, there seems to be no good therapeutic excuse for using this glandular substance. Parotid extracts may be obtained prepared from the parotid glands of the ox, each 2-grain tablet representing 10 grains of the fresh gland.

BRAIN

Brain extracts have been repeatedly used experimentally, in various cerebral intoxications and in epilepsy, as well as in different kinds of insanities and in neurasthenic conditions, and extracts have also been administered hypodermatically. There seems to be no clinical excuse for such medication.

Brain extracts, however, have been found to be of value in promoting coagulation of the blood; therefore in hemorrhagic conditions, as hemophilia, preparations of brain substance have been both applied locally and injected. This substance contains a fibrin ferment which will cause coagulation. Even if there is plenty of calcium in the blood, the blood will not coagulate unless a prothrombin in the blood will cause the production of thrombin. The best physiology now seems to consider that the blood does not coagulate in the vessels on account of its prothrombin being in combination with an antithrombin. When there is a rupture of a blood-vessel and blood flows into other tissues or externally, the prothrombin is liberated and combines with the calcium salts, thrombin is formed and coagulation is the result.

In bleeders it is the object to present thromboplastic substance which seems to be similar to a lipoid of the brain. Con

sequently, preparations from the brain termed brain lipoid and kephalin are offered for such use. Other preparations of brain extracts are offered under various names as thromboplastins. Some of these preparations are made from brain and spinal cord substances. A preparation termed Coagulin is prepared from blood platelets. The method of using these various sterilized substances is described on each package. Externally, the dry powder may be applied, or aseptic solutions may be made and injected.

NUCLEIN

This substance does not properly belong to the Part devoted to Organotherapy, as it is generally prepared from substances that do not belong to the body.

Nuclein given by the mouth or hypodermatically may cause a leucocytosis. Though once thought to be a stimulant to the phagocytes in infection, it has not been proved to be of value as an agent for that effect. However, preparations containing large amounts of nuclein have been lauded in all acute infections, given internally and hypodermatically, and used locally on ulcers and injured tissues that do not readily heal. So many preparations offer nuclein to the patient, as foods rich in nuclein, testicular extracts, thymus gland, and yeast, that preparations of pure nuclein seem unnecessary. They lower the blood-pressure, somewhat increase the uric acid output, and do not have the therapeutic value that yeast has, in fact, much of the nuclein offered is probably produced from yeast.

Yeast, both brewers' and compressed yeast, is more or less of a gastrointestinal antiseptic, increases the movements of the bowels, cleans a coated tongue, stimulates the production of white corpuscles, and often seems to aid in combating various streptococcic and staphylococcic infections. Hence, it is a valuable treatment for septicemia, and for boils and carbuncles. Locally, yeast solutions have been used as vaginal douches, and as washes for ulcers and external infected areas.

Dried brewers' yeast, as well as fresh yeast, contains a vitamine that is a stimulant to nutrition, and it also may stimulate the appetite.

The dose of the dried yeast is 1 to 2 Gm. three times a day,

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