TIG A. S. WAKTHIN 



J 



hypertrophic, fibrous, sclerotic, hyaline, or show various degenerative 

 changes of their epithelium, such as rarefaction, vacuolar or hydropic 

 degeneration, fatty change, pyknosis, etc., or they may present a round cell 

 infiltration. The comparisons of the pancreatic changes in diabetes 

 with those found in the pancreas of non-diabetic cases show noth- 

 ing specific for the former. Opie's hyaline change, once regarded 

 by some writers as a specific change is only a fibrosis, a cicatrix, 

 that is, an end result, and, of course, does not represent the primary lesion. 

 Allen lays great stress upon the so-called "hydropic degeneration" as 

 the essential primary lesion. There is, however, no positive proof that 

 it is not a secondary one. Heiberg insists that the island changes are 

 not qualitative, but are quantitative. Careful numerical estimates must be 

 made of the number of the islets. The only absolute criterion is a defi- 

 ciency of islets. Pathologically there are, according to Heiberg, two 

 varieties of pancreatic diabetes, one in which the injury is confined to 

 the islets, and another form in which both islets and glandular paren- 

 chyma are involved. These forms cannot be correlated with the clinical 

 varieties. In the rapidly progressive cases, especially in the young, the 

 changes are wholly confined to the islets. They may apparently be en- 

 tirely absent. 



In a diabetic of fifteen years of age, with rapid course, Gautier found 

 no changes in pancreas or liver. The islets were normal. In some cases 

 with a history of family incidence, no islets have been found after the 

 most careful search. Ribbert, in 1915, holds that the islands in the cases 

 of inherited diabetes are always few in number, w T hile in the other 

 forms regressive or inflammatory processes are predominant. It may 

 well be that there is a congenital agenesia or aplasia of the islets, and 

 such a malformation or developmental disturbance may explain the 

 occurrence of congenital cases of diabetes. No doubt, there exist in- 

 dividuals whose tolerance to nutritive sugar is slight, and who throughout 

 their entire lives are in danger of being thrown into a chronic disturbance 

 of sugar tolerance through any one of countless slight injuries not harm- 

 ful to the average individual; in other w r ords, such individuals possess a 

 sugar idiosyncrasy. 



Winternitz has reported a case of diabetes extending over eighteen 

 years, in which hyaline islets were present, with a new-formation of islets 

 occurring more rapidly than their degeneration. He concludes that the 

 pancreas is only one link in the chain controlling carbohydrate metab- 

 olism. Diabetes may occur when the pancreas is perfectly normal, as 

 a result of lesions of the central nervous system or a disturbance in cer- 

 tain endocrinal glands. When the pancreas is involved the essential lesion 

 is in the islands. Very recently Dubreuil and Anderodias have reported 

 a most interesting observation in the case of a new-born child of a diabetic 

 mother in which the islets were found markedly hypertrophic, 20 to 30 



