CHAPTER XXI 

 EFFECTS ON THE PANCREAS AND SALIVARY GLANDS 



I. THE PANCREAS 



The marked effects of inanition upon the pancreas are of importance in 

 relation to the general disturbance of the digestive system in various conditions 

 of malnutrition. The possible metamorphosis of the pancreatic acini into 

 islets of Langerhans during starvation is of especial interest in connection with 

 the treatment of diabetes mellitus. After a brief summary, the effects of inani- 

 tion upon the pancreas will be considered under (.4) total inanition and (B) 

 partial inanition. 



Summary of the Effects on the Pancreas 



The pancreas during total inanition (or on water only) typically undergoes a 

 marked atrophy. In adult man, the loss in weight usually appears roughly 

 proportional to that of the whole body; but in atrophic infants the degree of 

 atrophy is more variable, usually less than that of the whole body, and often 

 showing an apparent increase in weight (sometimes due to syphilitic infection). 

 In adult animals during inanition, the pancreatic atrophy is extreme, being as a 

 rule relatively greater than that of the entire body. This applies to the ad- 

 vanced stages, however; the pancreatic loss in the early stages of inanition 

 being relatively slight (guinea pig). In the young animals, the pancreas (like 

 the other viscera) appears in general more resistant to loss in weight. 



The gross atrophy of the pancreas during inanition is shown microscopically 

 to be due chiefly to atrophy of the secretory acini. The gland cells undergo 

 marked shrinkage. In the earlier stages of fasting the zymogenic granules 

 increase at the expense of the outer (basal) zone (with uncertain changes in the 

 mitochondria), but in later stages of inanition the gland cells become less 

 granular and more homogeneous in appearance, and may undergo characteristic 

 degenerative changes. The loss in the cytoplasm is much greater than that in 

 the more resistant nucleus, following the general rule. 



Lewaschew and Statkewitsch noted that the degenerating acini may fuse 

 into syncytial masses, "which may resemble the pancreatic islets in appearance. 

 On account of the importance of the islets as endocrine organs, much interest 

 has been taken in the question as to the possible metamorphosis of the exocrine 

 acini into endocrine islets and vice versa, which has been claimed especially 

 during inanition (and refeeding.) Laguesse has been the foremost proponent 

 of this theory, supported by Dale, Vincent and Thompson, Fischer and Retterer. 

 On the other hand, this doctrine has been vigorously opposed by Jarotzky, 

 Rennie, Bensley, and Giannelli (with his coworkers Bergamini andLampronti). 



345 



