548 DISEASES OF THE INSULAR APPARATUS OF THE PANCREAS 



well preserved or show distinct signs of regeneration; and in many cases 

 they appear entirely normal. KarakaschejJ upholds, as already mentioned 

 previously, the opinion that the islands constitute only reserve material, 

 and under circumstances can form new glandular parenchyma, while 

 Gut maun assumes a new formation of islands from glandular parenchyma. 

 MacCallum describes a case of juvenile diabetes in a child, in which the 

 islands showed a high-grade hypertrophy. Before the appearance of a 

 part of the work directed against the insular theory, Sauerbeck had treated the 

 subject in a "Referat" [collection of references] and in a monograph. He 

 collected one hundred and fifty-seven of diabetes from the literature. The 

 islands found normal in 40 per cent, of which there were twenty-six cases 

 with alterations of the glandular parenchyma. Changes in the islands. 

 were noted in one hundred and seventeen cases. In these the islands were 

 not found at all, or only scars marked their places in seven. In twelve more 

 cases the number of the islands was diminished whereby the glandular par- 

 enchyma was rendered in part atrophic. In ninety-eight cases the islands 

 were altered qualitatively, there occurring hemorrhages, simple atrophy, 

 hyaline or fatty or hydropic degeneration, sclerosis, or acute or chronic in- 

 flammatory alterations. In seventeen of his own cases of diabetes mellitus 

 Sauerbeck found mostly that alterations of the glandular parenchyma ran 

 parallel with those of the islands, and usually that in severe cases of 

 diabetes mellitus distinct alterations of the islands were present. Sauerbeck 

 inclines more to the insular theory; he believes that diabetes cannot originate 

 from the parenchyma, as in cases of severe alterations of the parenchyma 

 the diabetes may remain absent entirely. 



Recent times have brought a series of important studies on this subject. 

 v. Halasz investigated twenty-nine cases of diabetes mellitus. He found 

 90-95 per cent, of the islands normal eight times; six times in 60-90 per cent, 

 of the islands, seven times in 30-40 per cent, of the islands, he found al- 

 terations that consisted in hemorrhages, sclerosis, atrophy, hyaline degen- 

 eration and in atheroma of the blood-vessels. Signs of regeneration were 

 found only twice. Alteration of the parenchyma was found by Halasz chiefly 

 in old diabetics, and the weight of the pancreas was for the most diminished, 

 often distinctly, v. Halasz comes to the conclusion that not every diabetes 

 is a pancreatic diabetes. Heiberg investigated six cases of diabetes mellitus 

 and found the islands either qualitatively altered or the number of them 

 diminished. Heiberg attributes this defect in the islands to their destruction 

 by inflammatory processes, in which residues of the inflammation were not 

 always necessarily present. In one case the islands showed in part the round- 

 cell infiltration described -by M. B. Schmidt, Halasz, and Cecil Russell. 

 There was found in addition in this case islands with necrotic cells, without 

 [round cell] infiltration; Heiberg regards these alterations as the later stage 

 of the inflammatory processes. 



