THE PANCREAS AS AN ENDOCRIN GLAND 709 



either islands or acinous tissues in eight out of twenty-three diabetics. 

 In fifteen other cases only two showed severe changes in both islands and 

 acinous tissue. Of fourteen cases Gutmann found the pancreas perfectly 

 normal in two. In other cases the acini or the whole pancreas was atrophic ; 

 in some of these the islands were few and showed thickened capsules, 

 while in others they were numerous, hyperplastic and appeared to be con- 

 nected with the acini in some places. Gentes, Fischer and Lepine saw 

 cases with island changes. 



Sauerbeck examined the pancreas of seventeen cases of diabetes and 

 of sixty-four non-diabetics. These he included in an analysis of 176 

 cases of diabetes in which the pancreas had been examined. Fifteen 

 showed no changes in islets or acini; thirty-two showed marked changes 

 and twenty-five slight of both tissues. In nineteen cases the changes were 

 more marked in the acini, in fifteen cases in the islands ; in twenty-seven 

 cases changes were found only in the acini, in six cases only in the islands. 

 In the pancreas of non-diabetics precisely similar changes occurred in some 

 cases, acini and islands might be either both markedly changed or entirely 

 normal, or one or the other might be normal while the other showed lesions. 

 In spite of this pathologic-anatomic evidence Sauerbeck favored the island 

 theory on other grounds. 



In the pancreas of fifteen cases of diabetes examined by Halasz changes 

 were found in both islands and acini. In eleven cases Karakascheff found 

 more or less degeneration of the acinous parenchyma with preservation of 

 the islets. By means of serial sections he was convinced that the islands 

 proliferate and form acini. Through embryologic studies he also came 

 to the conclusion that the islands were not definite organ-entities, but only 

 early stages in the development of the acini. Gutmann and Herxheimer 

 on the grounds of pathological investigations concluded that islands 

 were developed from acini ; on the other hand Schmidt, Lazarus, Reitman 

 and others affirmed that the acini arose from proliferating collecting ducts. 



Pathologic studies of the pancreas from cases of human diabetes were 

 made also by Thoinot and Delamare, Lazarus, Dubs, Curtis and Gelle, 

 Kausch, Miller, Lancereaux, Hoppe-Seyler, Carnot and Amet, Peiide, 

 Diamare, Visentini, MacCallum, Cecil, Koch, Saltykow, Fahr, Major, 

 Heiberg, Gautier and Saloz, Winternitz, Labbe, Laignel-Lavastine and 

 Vitry, Dubreuil and Anderodias, and Allen. 



Diabetes has been many times observed in animals, but few studies of 

 the pancreas in such cases have been made. Preller found interacinous 

 pancreatitis with extensive degeneration of islands in a diabetic horse. 

 Krumbhaar found in a diabetic dog marked hydropic degeneration and 

 exhaustion of both Alpha and Beta cells with fibrosis of some of the 

 islands. 



The results obtained by these many pathological studies are widely 

 divergent. The islands may bei normal, they may be absent, atrophic, 



