522 DISKASKS OF THE INSULAR APPARATUS OF THE PANCREAS 



possible the diagnosis of occlusion of the duct of Wirsung by a pancreatic 

 stone. The impaction of a pancreatic stone can also take place without pains. 

 This was the case in a patient observed by Gigon and me. Also here there 

 recurred from one day to another all the acute absorptive disturbances 

 characteristic of impaction of a pancreatic stone, without, however, the exist- 

 ence of colic. At autopsy there was found in addition to numerous small 

 stones in the pancreas a stone the size of a cherry stone which fully occluded 

 the place of opening of the pancreatic duct into the ampulla of Vater. 



The high-grade indurative pancreatitis that so frequently complicates 

 stone of the pancreas, especially on the occlusion of the chief excretory duct 

 by a stone, makes intelligible the fact that lithiasis of the pancreas is so fre- 

 quently associated with disturbances of the sugar metabolism. Oser reports 

 that among seventy cases, diabetes or at least temporary glycosuria was 

 observed in twenty-four, that is, in more than 34 per cent, of the cases. 

 Lazarus indeed found it in 45 per cent. Albu mentions an interesting case. 

 The test for alimentary glycosuria had previously resulted negative. There 

 existed a tumor in the region of the. pancreas which distinctly enlarged during 

 a severe attack of colic. On test for alimentary glycosuria, 2.9 per cent, of 

 sugar was found in the urine. In the' case of mine previously mentioned a 

 slight diabetes existed before the colic. The patient could easily be made 

 sugar-free by a strict diet. After the colic and the occurrence of the fat 

 stools, the diabetic metabolic disturbances became essentially worse; after 

 about eight days the voluminous stools disappeared; after another two weeks 

 the stools were entirely normal, even after heavy overloading with fat; 

 simultaneously with this there was also observed a retrogression of the dia- 

 betic metabolic disturbances, so that the patient again became temporarily 

 sugar-free. Apparently as a sequel of severe inflammatory processes in the 

 ducts, the islands of Langerhans do not, in occlusion of the duct of Wirsung 

 by stone, behave so refractory as in animal experimentation after ligation 

 of the excretory ducts. It is also of importance for the occurrence of dis- 

 turbances in sugar metabolism, whether the second pancreatic duct is ob- 

 literated or is likewise closed by a stone, or whether numerous intrapancreatic 

 passages are rendered impassable; as the intensity and the extensiveness of 

 the sclerotic processes are in part dependent on these factors. 



These circumstances are also important for the occurrence of disturbances 

 of absorption. It is without other considerations to be expected that these 

 only become manifest in a pronounced manner when the flow of pancreatic 

 juice into the intestine either fs fully interrupted, or at least almost completely 

 ceases. I would like to enter here upon the question as to the relationship 

 that exists between the disturbances of absorption that occur on cessation 

 of the pancreatic juice in man, and the internal secretion of the pancreas. 

 At the beginning, when the animal experiments of Abelmann were regarded 

 as indicative, the question seems to have become entirely cleared. We 



