264 HUMAN DIABETES 



hans is to be looked upon as the anatomical basis of diabetes, 

 and that as a matter of fact the severity of the case stands 

 in direct relation with the degree of involvement of the 

 islands. Weichselbaum differentiates a hydropic degenera- 

 tion of these structures, a peri- and an intra-insular sclerosis 

 and a hyaline degeneration, the last characterized by swell- 

 ing of the connective tissue about the vessels of the islands 

 into a homogenous mass. The negative findings of other 

 authors in this line may be satisfactorily explained by the 

 fact that these changes may very readily be overlooked, if 

 particularly attentive examination be not made and if im- 

 perfect preservation of the material has obtained. 52 



As far as the cause of the pancreatic disease is con- 

 cerned many authors are disposed to believe that a relation- 

 ship with previous acute infectious diseases, although cli- 

 nically this can only rarely be proved, is more important than 

 the influence of arteriosclerosis, alcoholism, syphilis, intes- 

 tinal infections, etc. 53 That infectious diseases, even those 

 of frankly mild type as influenza or angina, may make exist- 

 ing diabetes permanently worse and that transient glycosu- 

 rias often occur in the course of febrile affections has been 

 long known. Doubtless, too, from the studies of Weichsel- 

 baum, arteriosclerosis plays an important role in many 

 forms of diabetes. 



The liver has frequently been examined for anatomical 

 changes in diabetes ; but there can be little mistake in believ- 

 ing that in the great bulk of cases in which diabetes has 

 appeared as a sequel of hepatic disturbances, as cirrhosis 

 or cholelithiasis, secondary lesions of the pancreas are the 

 real point in fault. Thus we may appeal to the frequent 

 connective tissue hyperplasia in the pancreas in connection 

 with cirrhosis of the liver (chronic pancreatitis of Hanse- 



52 A. Weichselbaum, Wiener klin. Wochenschr., 24, 153; Sitzungsber. d. 

 Wiener Akad., 119, III, 73, 1910; consult therein, and also in U. Lombroso, 

 Ergebn. d. Physiol., 9, 1-89, 1910, the Literature. 



53 Cf . F. Hirschfeld, Deutsche med. Wochenschr., 1909, 137. 



