708 A. S. WARTHIN 



sclerosis of the pancreas without diabetes he also found marked changes 

 in the islands. In a case of "nervous" diabetes he found a fatty degenera- 

 tion of the islands; in 1904 in a case of traumatic diabetes he found a 

 portion of the pancreas with altered islands, while other portions showed 

 a new-formation of apparently normal but very large islands (vicarious 

 hypertrophy). In 1907 he reported seventeen cases of primary pancreatic 

 carcinoma without diabetes, and explained the absence of the latter as due 

 to the preserved condition of the islands. In all of the reports of these find- 

 ings he upheld the island theory. Ilansemann (1901) attacked Opie's 

 findings, finding a hyaline change of the islands in only six cases out of 

 thirty-two of diabetes. He regarded it as a secondary change. In the 

 majority of his own cases he found a granular atrophy or polysarcia which 

 he also considered secondary. He opposed strongly the association of the 

 islands with the internal function of the pancreas. 



Weichselbaum and Stangl (1901) examined the pancreas in thirty-two 

 cases of diabetes, and found in the majority of them, not the granular 

 atrophy of Hansemann, but a simple atrophy of the islands with pale- 

 staining cytoplasm, often deeply-staining contracted nuclei and an in- 

 creased fat content. The pale-staining of the epithelium of the islets has 

 led others to interpret this as a ''hydropic degeneration," although the 

 writers themselves did not use this term. In some of the tubules they 

 found pink-staining cells (centroacinar) which they thought might repre- 

 sent the hyaline change described by Opie. Opie's description of this as 

 a hyaline degeneration of epithelial cells evidently threw them off the 

 track, as they also describe islands resembling obliterated glomeruli in the 

 kidney, undoubtedly the hyaline fibrosis of the islands recognized to-day as 

 the most common change in the diabetic pancreas. 



In five cases of diabetes Herzog found similar changes in the pancreas. 

 The islands were diminished in size and number and surrounded by thick 

 capsules. Hyaline degeneration, as described by Opie, occurred here 

 and there in one case. In another case serial sections showed no trace of 

 islands. In general the acinous tissue showed no marked changes, oc- 

 casionally it was replaced by fat or connective tissue. Herxheimer found 

 interacinar sclerosis in the pancreas in fourteen of twenty diabetics; six 

 of these showed no changes in the islands, while in the other eight cases 

 the islands were more or less altered. Two eases showed fatty infiltra- 

 tion and sclerosis of the entire gland; tlie remaining four showed no 

 changes in either islands or acini. In what he took to be a large island 

 he saw an excretory duct ; also marked proliferation of the collecting ducts 

 and transition forms from these to the island tissue. Basing his belief 

 largely upon the statistics of Truhart (1904) that in only thirty-one cases 

 out of five hundred and seventy-four diabetics was a hyaline degeneration 

 of the islands found, Herxheimer denied the view expressed by Opie that 

 this degeneration is the cause of diabetes. Schmidt found no changes in 



