PATHOLOGICAL ANATOMY OF DIABETES MELLITUS 549 



In a later publication in which Heiberg reports on investigations of the 

 pancreases of two diabetic children, he again mentions that the number of 

 the islands must be considered as well as their quality. Saltykow examined 

 twenty-one cases with pathologically altered pancreas without diabetes; 

 of these four cases show insignificant alterations in the islands, which were 

 otherwise well preserved. In many cases, especially in sclerosis and diffuse 

 carcinomatous infiltration of the pancreas, the islands were indeed very well 

 preserved. In nine cases of diabetes Saltykow found always alterations in 

 the islands. Among 'these was a case of isolated hyaline degeneration of 

 the insular apparatus with diabetes, as it had already been described by 

 Opie, Wright and Joslin, and others. 



A far-reaching confirmation of Opie's findings was contributed by Russel 

 L. Cecil; he found among ninety cases of diabetes alterations of the pancreas 

 in seven, and among these regularly alterations of the islands, such as 

 sclerosis, hyaline degeneration, leucocytic infiltration. In seventy-six cases 

 were found fibrosis, in twenty-seven hyaline degeneration, etc. In twelve 

 cases the alterations affected the islands exclusively; and among the cases 

 without qualitative alteration of the pancreas was found striking smallness 

 of the organs, or decreased number of islands. 



The question has been studied the most thoroughly by Weichselbaum. 

 Weichselbaum had previously reported with Stangl thirty-three cases of 

 diabetes mellitus in which striking alterations in the islands, but not essen- 

 tial changes in the parenchyma had been found. The latest communication 

 of Weichselbaum is based on the whole on one hundred and eighty-three 

 cases of diabetes mellitus. The number of control experiments and pan- 

 creases of nondiabetics is still greater. Microscopically the pancreases of 

 diabetics often showed distinct atrophy and decrease in size, and fatty 

 degeneration; often they were entirely normal. Microscopically constant 

 alterations in the islands were found. In addition to diminution in the 

 number of islands and decrease of their extent (Neumann), Weichselbaum 

 described a hydropic degeneration of the island cells; in this the protoplasm 

 of the cells loses its structure, becomes transparent, shows characteristic 

 granular inclusions and eventually are decreased in size (transition into 

 atrophy). This hydropic degeneration was found in 53 per cent, of the 

 cases and indeed almost exclusively in younger individuals. In 43 per cent, 

 of the cases, mostly in persons over fifty years of age, Weichselbaum found 

 sclerosis of the islands, proliferation of the connective tissue in and about 

 the islands, and mostly interlobar and intralobar proliferation. There was 

 found also sclerosis of the arteries. In 28 per cent, of the cases there was 

 found hyaline degeneration of the island cells together with the sclerosis 

 above mentioned. Manifestations of regeneration of the islands were 

 found chiefly in the head of the pancreas, and indeed in young individuals. 

 Hypertrophy of the islands were found only in some cases of insular sclerosis. 



