GROSS ANATOMICAL DISTURBANCES 521 



(Riedel). Chronic indurative pancreatitis often occurs simultaneously with 

 atrophic cirrhosis of the liver, especially in alcoholics. Weintraud, Bence, 

 and others have described such cases, in which as a result of high-grade de- 

 ficiency of pancreatic function there occurred pronounced disturbances of 

 fat absorption. In Btnce's case severe diabetes existed. The section showed 

 a marked disappearance of the pancreas and sclerosis; the islands of Langer- 

 Jians were entirely destroyed, and only remnants of the acinous tissue were 

 present. In very severe alcoholism there exists simultaneously sclerosis of 

 the liver and pancreas (and suprarenals) , sometimes associated with the 

 deposition of iron-containing pigment in the liver, pancreas, skin, etc. (cir- 

 rhose bronzee or diabete bronzee). Atrophy of the pancreas with sclerosis 

 is a common finding in diabetes mellitus. When it occurs the insular appa- 

 ratus is mostly rather severely damaged. We shall come back later to the 

 consideration of v. Hansemann's granular atrophy of the pancreas and the 

 interacinous sclerosis of Opie, and the sclerosis periacinous of Lepine, and 

 Lemoine and Launois. In severe damaging of the glandular parenchyma, 

 there may in such cases occur disturbances of absorption. In the case of 

 Keuthe, that had previously been described by Glassner and Siegel, there 

 existed a moderate disturbance of the fat absorption (the fat in the diet was 

 slight only) and several times transitory glycosuria (of 0.3 per cent, to 0.7 per 

 cent.). The autopsy showed marked atrophy of the pancreas, the duct of 

 Wirsung was not to be found, the islands of Langerhans were in part retained 

 or were hypertrophied. Sometimes the marked sclerosis of the pancreas is 

 the result of a lithiasis pancreatitis. Lithiasis of the pancreas may occur 

 isolated; but not rarely it is combined with cholelithiasis. In certain cases 

 kidney stones were also found. In this event, we may speak of a general 

 stone diathesis, that not rarely is familial. The pancreas stones are whitish, 

 brittle, crumbly, unlike gall-stones they contain no pigment, but on the con- 

 trary are rich in lime-salts, so that under circumstances they can be demon- 

 strated by the X-rays. Probably they usually originate (as do gall-stones) 

 after a chronic catarrh has established in the duct system of the pancreas. 

 Often the larger and smaller pancreatic passages are plugged up with stones. 

 In other cases there are found one or more larger stones, which pass with 

 severe colic, and may temporarily or permanently block up the larger ducts 

 of the pancreas, or even the principal excretory duct. Behind the place where 

 the stone lodges there often occurs a dilatation of the passage in question and 

 an indurative pancreatitis, which at the beginning affects the islands but little, 

 but no longer duration damages them severely. The pancreatic colics that 

 Minnich first intimately described commence with severe girdle-like pains 

 radiating to the back and even to the shoulder. In a case that I saw, the 

 girdle-like pains associated with symmetrical hyperesthetic zones over 

 the iliac crests led me to think of a spinal affection, until on the next day the 

 occurrence of very voluminous stools with creatorrhea and steatorrhea made 



