DISEASES OF THE IXSTLAR APPARATUS OF THE PANCREAS 



While therefore the insular apparatus regularly showed alterations, high- 

 grade degeneration of the glandular parenchyma was found only in closure 

 of the pancreatic duct or in carcinoma of the pancreas. In the control 

 investigations on the pancreases of non-diabetic individuals these changes 

 were almost always absent, but on the contrary there existed high-grade 

 atrophy of the glandular parenchyma, whereby the weight of the pancreas 

 was very much diminished; in chronic tuberculosis even to 20 gm. Weich- 

 selbaum mentions that in diabetes mellitus the relation between regeneration 

 and destruction of the islands must be considered; and not only the structure 

 but also the number of islands. 



On the basis of his investigations Weichselbaum distinguished from the 

 pathologico-anatomical standpoint three forms of human diabetes; first a 

 youthful form, the proper diabete maigre, in which is found the hydropic 

 degeneration of the islands; this is hereditary and would seem to depend 

 on congenital weakness or on failure of formation of the insular apparatus. 

 Then he distinguished the form dependent on chronic interstitial pancreatitis, 

 that occurs in the later years of life and is commonly associated with lipoma- 

 tosis of the pancreas and general adiposis (diabete gras). This form is hence 

 lipogenous or depends on a chronic catarrh of the excretory ducts and chronic 

 alcoholism and is often complicated with cirrhosis of the liver. Finally 

 the third form, which, depending on the hyaline degeneration of the islands, 

 occurs in the later years of life, apparently is a subvariety of the second 

 form, and is usually associated with sclerosis of the arteries. 



I have reproduced rather in detail the numerous labors as to the patho- 

 logical anatomy of the pancreas in "genuine diabetes," and have purposely 

 confined myself strictly to the words of the various authors, because it seemed 

 to me that an intimate penetration into the development of the question 

 makes its solution essentially easier. On reviewing once again the entire 

 material detailed, we see that with increasing exactness the microscopical 

 investigation and also the findings of the pathologico-anatomical alterations 

 in the islands have become essentially commoner, so that the later authors 

 almost all belong to the adherents of the insular theory. It is further per- 

 fectly clear that pathologico-anatomical alterations found in so-called genuine 

 diabetes mellitus are not of a uniform nature, a conception that is upheld 

 in the larger and more thorough of the works cited. A large group possesses 

 well-defined characteristics, although the names given to it by different 

 authors are different. It is the form of interacinous pancreatitis occurring 

 in later life, that v. Hansemann calls granular atrophy of the pancreas, Opie, 

 interacinous sclerosis, Lepine, and Lemoine and Launois, sclerose periacineuse, 

 and which Weichselbaum regards as dependent on interstitial pancreatitis. 

 The causes of it are probably very different. In part they are sclerotic 

 changes similar to those of cirrhosis of the liver, often occurring in common 

 with hepatic cirrhosis and like it dependent on alcoholism. Commonly 





