PATHOLOGICAL ANATOMY OF DIABETES MELLITUS 547 



mann reported on investigations in thirty-four cases of diabetes mellitus. 

 In the majority of these this granular atrophy was found, in six cases was 

 found hyaline degeneration of numerous islands, to which, however v. Hanse- 

 mann attributed no great significance. Dieckhojj examined the islands espe- 

 cially and among seven cases found three times diminution in the number of 

 islands, once disappearance of the islands, once the insular tissue qualita- 

 tively altered, and twice no alterations. He also found that the glandular 

 parenchyma for the most .part showed changes. In 1898 Schlesinger first 

 reported that he found in cases of pancreatic disease without diabetes that 

 the islands were remarkably well preserved. In several interesting studies, 

 Opie advocated the opinion that the disease of the islands of Langerhans 

 was the cause of the diabetes. 



Opie distinguished two types of chronic inflammation of the pancreas; 

 an interlobar pancreatitis (twenty-one cases) brought about by occlusion 

 of the excretory duct by pancreatic stone or gall-stone, or by compression 

 of the duct by tumors, or as the result of an acute inflammation of the 

 pancreas on account of infection of it from the intestine, or by generalized 

 tuberculosis, or as an accompaniment of atrophic cirrhosis of the liver. Here 

 the islands are only a little altered, and indeed only altered if the cirrhosis is 

 of a very high degree. On the contrary we find in interacinous pancreatitis 

 the islands markedly affected and on marked changes in these also, for the most 

 part, diabetes. Opie describes among the cases here observed also one of 

 generalized hyaline degeneration of the islands of Langerhans. Ssobolew, into 

 a consideration -of wfrose experimental studies I have already entered, de- 

 scribed alterations of the pancreas without diabetes in which the glandular 

 parenchyma was in part highly altered, while the islands seemed to be very 

 much more resistant. In primary or metastatic carcinoma of the pancreas 

 the islands are often retained in the midst of the tumor tissue; only in one 

 case of primary tuberculosis of the pancreas were traces of sugar present, 

 there being present in this case also an extensive dense formation. In 

 sixteen cases of diabetes he found, on the contrary, mostly disappearance 

 of the islands or diminution of their numbers, or signs of degeneration. He 

 comes to the conclusion that in diabetes, the islands seem to be the least resist- 

 ant. As enemies of the insular theory appeared Gutmann, Karakaschejf , 

 Herxheimer, and others. Herxheimer found in a majority of these cases v. 

 Hansemann's granular atrophy, and in addition in five cases found changes 

 with the strong predominance of the regenerative new formation of excretory 

 ducts, and he designates this form cirrhosis of the pancreas on account of its 

 similarity to cirrhosis of the liver. He did not regard as significant the 

 changes he found in the islands. Also Schmidt maintains a sceptical atti- 

 tude. These authors show that in diabetes mellitus also the glandular paren- 

 chyma may be very much diseased, and that the islands throughout do not 

 have to be the only part diseased; in many cases the islands are remarkably 



