520 DISEASES OF THE INSULAR APPARATUS OF THE PANCREAS 



It is very probable the chronic inflammatory processes of the pancreas 

 occur more frequently from infection through the pancreatic duct than we 

 had previously supposed. Hirschfeld described three cases in which at the 

 end of an influenza or of febrile angina there occurred either swelling of the 

 liver and gastric distress, or colicky pains and glycosuria of 2 to 6 per cent. 

 After lasting one to five months the pains disappeared. Sometimes chronic 

 pancreatitis occurs in cholelithiasis, although here the insular apparatus 

 is affected only rarely. Mayo Robson found only four cases of diabetes 

 (0.2 per cent, of 0.4 per cent, sugar) among sixty-five cases with stones in 

 the ductus choledochus and with hard enlarged pancreas. In three cases 

 the sugar vanished after the operation. Later one case passed into severe 

 diabetes. 



Before I enter more intimately into chronic pancreatitis and pancreatic 

 cirrhosis, I would mention a special form of "it, namely, the luetic. The heredi- 

 tary syphilitic form is apparently chiefly interstitial, and avoids the insular 

 apparatus, on which account it almost always pursues its course without 

 glycosuria. The syphilitic pancreatitis of adults is either gummatous 

 (Hernheimer, Hirschfeld} , or interstitial. The latter form, if it progresses, may 

 also temporarily damage the insular apparatus and thus lead to glycosuria. 

 Chrelitzer, Ehrmann, Albu et al., report such cases. In the case of Chrelitzer, a 

 relapse of lues occurred ten years after the primary affection. Simultaneously 

 with the exanthema occurred abdominal pains radiating toward the back, 

 vomiting, meteorism, jaundice, swelling of the liver and rise of temperature. 

 A hard tumor was palpable deep between the navel and the xiphoid process. 

 In the urine was found 2.2 per cent, of sugar. Cure occurred spontaneously. 

 In Ehrmann's case an extremely severe diabetes (8 per cent, of sugar, acetone) 

 developed at the time of the outbreak of a syphilitic exanthema. The 

 inunction cure was interrupted and an antidiabetic regimen introduced. All 

 symptoms disappeared within eight days. Albu's case was very chronic. 

 In a forty-four-year old man (primary affection fourteen years previous) 

 there developed gastric disturbances, emaciation, jaundice, and enlargement 

 of the liver; after a longer time, fat stools and glycosuria (0.9 per cent.); 

 also a tumor was palpable deeply. Under enemas of potassium iodide, and 

 pancreatin, improvement occurred; and after several months tumor and 

 glycosuria disappeared and the case was cured. In general, lues does not 

 play a great role in the etiology of diabetes, v. Noorden found syphilis in 

 the history of 1.2 per cent, in male individuals under twenty years of age, 

 7.1 per cent, in males over twenty, and 2.3 per cent, of female diabetics of 

 all ages. 



Chronic indurative pancreatitis is a very common disease. It may proceed 

 from the vessels (arteriosclerosis, endarteritis obliterans) or from the excre- 

 tory ducts. It may be diffuse or circumscribed. In gall-stone affections 

 there may sometimes occur isolated sclerosis of the head of the pancreas 



