2104 Journal of Applied Microscopy 



3. Ascending infection of the unobstructed duct of Wursung may follow an 

 acute lesion of the duodenum or of the bile passages, and may cause chronic 

 inflammation. In cases which have given a history of long, persistent vomiting, 

 chronic diffuse pancreatitis may be found at autopsy, and is probably the result 

 of an ascending infection of the gland. 



4. General or local tuberculosis is occasionally accompanied by chronic 

 diffuse pancreatitis, affecting chiefly the interstitial tissue of the gland. 



5. Chronic interstitial pancreatitis is not infrequently dependent upon the 

 same etiological factors, notably alcohol, which produce cirrhosis of the liver, 

 and in about one-fourth of the cases the two lesions are associated. 



6. Following duct obstruction and ascending infection the lesion affects 

 principally the interlobular tissue, only secondarily invading the lobular tissue 

 and sparing the islands of Langerhans. Diabetes results only when the lesion 

 is far advanced. 



7. Accompanying the so-called atrophic or Laennec's cirrhosis of the liver, 

 the pancreas is at times the seat of a diffuse chronic inflammation characterized 

 by diffuse proliferation of the interacinar tissue, which invades the islands of 

 Langerhans. A similar lesion accompanies hyaline degeneration of the islands 

 of Langerhans, and the condition known as haemochromatosis. 



8. Interacinar pancreatitis is usually accompanied by diabetes mellitus. 

 When diabetes is absent, the lesion is of such slight intensity that the islands of 

 Langerhans are little implicated. w. r. s. 



Steele. A case of Chronic Interstitial Pan- Thirty-five cases of diabetes have been 

 creatitis, with Involvement of the Islands of . j u- i u j *. 4-^„^. -^ 



Langerhans in a Diabetic. Am. J. Med. reported which showed at autopsy an 

 wSc. 124: 71-76,1902. atrophy of the pancreas which in- 



volved the islands of Langerhans. These cases are divided into four groups, 

 viz.: 1. Those where the atrophy is confined to, or greater in the islands. 2. 

 Those where hyaline degeneration of the islands exists. 3. Those where chronic 

 interstitial pancreatitis is found with secondary and late involvement of the 

 islands. 4. Those where necrotic destruction of the organ results, involving 

 the islands. 



Steele's case belongs to the third group. The pancreas at the autopsy pre- 

 sented evidences of the increase in fibrous tissue. The sclerosis was interlobular 

 as well as interacinar in type. In some places the connective tissue had caused 

 the entire destruction of the pancreatic cells by pressure atrophy, and had taken 

 their places by the formation of broad bands of fibrous tissue in which were 

 embedded the islands of Langerhans and remnants of the much degenerated 

 acini. The parenchyma cells showed degenerative properties. The islands 

 were diminished in size and number, and in places the cells seemed considerably 

 compressed and somewhat degenerated. Occasionally an invasion of these 

 islands by connective tissue was made out, which seemed to follow the capillaries. 

 No hyaline changes were observed. w. r. s. 



