724 A. S. WARTHIN 



islets alone are greatly reduced in number. These cases are, however, the 

 exceptional ones, and the writer has seen them only in young diabetics 

 with a family history of diabetes. The great majority of cases of dia- 

 betes (in his experience all adult cases and a few young adults) present a 

 chronic pancreatitis. Allen says it is present in every case, as a rule, with 

 no exceptions yet demonstrated. The writer is convinced that the facts 

 do not support this too dogmatic statement. In two cases of familial dia- 

 betes in young persons no trace of inflammation or sequela? of inflamma- 

 tion could be found in the pancreas; the islets were entirely absent; the 

 acini were hypertrophic but no regenerative formations resembling acini 

 were found. As other writers have noted the same finding, a rule of 

 "no diabetes without pancreatitis" is not justified by the pathologic facts. 

 In twenty-four cases of diabetes studied by the writer a chronic pan- 

 creatitis was present in twenty-one of the cases ; in two of the twenty-one 

 cases the pancreatitis was associated with cholelithiasis and pancreatic 

 lithiasis with chronic inflammation of the ducts. ISTo evidences of syph- 

 ilitic infection were found in the pancreas or in any other organ of these 

 two cases. In the remaining nineteen cases histologic changes of syphilis 

 were found in the heart, aorta, adrenals, testes, nervous system, as well 

 as in the pancreas. Three only of the cases had a clinical history of 

 syphilis, two of these were congenital infections, one was acquired, with 

 a strongly positive Wassermann. In the remaining sixteen cases no 

 clinical history of syphilis had been obtained. In two of these cases 

 spirochetes were found in the myocardial and pancreatic infiltrations and 

 in three others in the myocardium. The pancreatic lesion was the same 

 in all of the nineteen cases, and was identical with the syphilitic lesions 

 of the myocardium, aorta and other parts of the body. The writer is 

 convinced that the pancreatitis is of syphilitic origin. 



In 1016, with Miss Wilson, he reported six of the cases included in the 

 total given above, calling attention to the important fact that syphilis is an 

 etiologic factor in pancreatitis, and that if pancreatitis is a cause of dia- 

 betes, then syphilis must be reckoned with as a factor in the etiology of 

 diabetes. This report attracted much attention, some opposition, but 

 a surprisingly large amount of confirmation from clinicians as to the 

 coincidence of syphilis and diabetes. In his "Harvey Lecture" for 1918 

 the writer presented a study of the pathologic conditions found in the 

 bodies of 300 cases showing histologic evidences of syphilis. In every 

 one of these cases inflammatory lesions of the syphilitic type, plasma 

 cell and lymphocyte infiltrations were found in the pancreas, the changes 

 varying from small scattered areas of fibrosis and infiltration to more 

 diffuse processes involving large portions of the gland. (See Figs. 1-6.) 

 The tail and body portions are especially involved in the syphilitic inflam- 

 mations ; while in the duct inflammations the head and body show the chief 

 changes. In all of the more severe cases the islets show more or less 



