112 



PANCREAS, 



rates twenty-eight cases in which the disease 

 appeared to be idiopathic, and in eight, which 

 were of long standing, did not extend beyond 

 the pancreas; more frequently, however, it 

 implicates neighbouring parts in some degree, 

 particularly the duodenum, stomach, and py- 

 lorus. It may exist without any increase of 

 size, but more frequently is attended by some 

 enlargement, which may be considerable. Scir- 

 rhus rarely goes on to nlceration, the asso- 

 ciated lesions terminating fatally before that 

 time. It often gives rise to constriction of the 

 bile-duct and deep jaundice, and even com- 

 pression of the aorta : this compression and 

 constriction of the aorta have been known 

 to occasion aneurismal dilatation above the 

 seat of the constriction, as seen by Portal and 

 Salmade. 



Of the twenty-eight cases analysed by Dr. 

 Bigsby, in seventeen the disease had not ar- 

 rived at the stage of softening, although some 

 of them had existed for years ; it was purely 

 scirrhus. In five cases he states the scirrhus 

 had, at the time of death, passed into the soft 

 state called cephaloma by Dr. Carswell, and 

 medullary sarcoma by previous writers. Some 

 parts, however, were as hard as cartilage ; but 

 others had all the pulpy, pale yellow, brain- 

 like character of the second stage of scirrhus. 

 In one case, the pancreas was changed into a 

 sac, with a few shreds of cephaloma here and 

 there on its sides. Lastly, in two cases no 

 vestige of any form of scirrhus remained, the 

 gland being altogether in a state of cancerous 

 ulceration. 



Fungo-hccmatoid disease has been found in 

 the pancreas in three cases by Dr. Aber- 

 crombie, and in single instances by Dr. Bright 

 and others. Dr. Copland found this lesion in 

 the pancreas of a boy fourteen years of age ; 

 several other organs were also affectedby it.* 



e. Calculous concretions in the pancreatic duct 

 and its branches are by no means uncommon, 

 and appear not unfrequently to be the cause 

 of some of those morbid changes that have 

 been already noticed. Sometimes the}' are 

 manifestly in the duct ; at others, though pro- 

 bably primarily so, they appear, from oblite- 

 ration of the duct in which they were lodged, 

 to be in the gland substance. They are usu- 

 ally white, but occasionally black ; they vary 

 much in shape, being sometimes round, and 

 sometimes irregular ; their size ranges from 

 that of a pea to that of a small walnut, and 

 their number from one to twenty ; sometimes 

 they are scattered throughout the gland, 

 sometimes aggregated in a mass. Gendrin 

 mentions that the pancreatic duct is some- 

 times clogged, not with distinct concretions, 

 but with a chalky powder. In respect to 

 chemical composition it seems probable that 

 pancreatic calculi are liable to some varia- 

 tions. Dr. Pemberton-j- mentions having re- 

 ceived one from Dr. Baillie from the human 

 pancreas which consisted entirely of carbonate 

 of lime ; whereas, one from the ox analysed by 

 Dr. Wollaston turned out to be phosphate of 



* Medical Diet. Loc. cit. 

 t On the Viscera, p. C8. 



lime. Portal mentions that in a case in which 

 he met with a dozen of light, round, whitish 

 calculi in the pancreas, he found that when 

 he reduced one or two to coarse powder, 

 and threw this into boiling water, it readily 

 dissolved ; and Fourcroy states, as the result 

 of his examinations, that pancreatic concre- 

 tions are composed of phosphate of lime com- 

 bined with some animal matter, just as is the 

 case with salivary calculi. 



There is one circumstance connected with 

 the morbid anatomy of the pancreas worthy 

 of special note, and with a short reference to 

 this I shall finish this paper ; it is 



The occurrence of fatty stools in connection 

 with pancreatic disease. Attention was first 

 drawn to this subject twenty years ago by 

 the simultaneous publication, in the eigh- 

 teenth volume of the Medico-Chirurgical 

 Transactions, of papers by Drs. Bright and 

 Elliotson and Mr. Lloyd ; but although the 

 subject excited considerable interest at the 

 time, it has since been suffered to lapse, from 

 want apparently of due appreciation of its 

 import ; and it is only recently that it has 

 emerged from its obscurity in consequence of 

 the new interest with which recent physio- 

 logical discoveries have invested it. It is 

 only the most hasty and superficial glance 

 that it will be possible here to give to this 

 most interesting subject : for further details 

 I must refer the reader to the original papers, 

 to others that have since been published, and 

 to an admirable article in the twenty-third 

 number of the British and Foreign Medico- 

 Chirurgical Review. 



The first of these papers first as much 

 in importance as in time was that of Dr. 

 Bright. Not only was he the first to point out 

 the pathological relations of this remarkable 

 phenomenon, but his paper is distinguished 

 by a singular clearness and impartiality, and 

 by a thorough digestion of its carefully ga- 

 thered materials. He thus describes the pe- 

 culiar condition of the evacuations that first 

 excited his attention: " A portion more or 

 less considerable assumes the character of an 

 oily substance resembling fat, which either 

 passes separately from the bowels, or soon 

 divides itself from the general mass, and lies 

 upon the surface, sometimes forming a thick 

 crust, particularly about the edges of the 

 vessel, if the faeces are of a semifluid con- 

 sistence ; sometimes floating like globules of 

 tallow which have melted and become cold ; 

 and sometimes assuming the form of a thin 

 fatty pellicle over the whole, or over the more 

 fluid parts in which the more solid figured 

 faeces are deposited. This oily matter has 

 generally a slight yellow tinge, and a most 

 disgustingly foetid odour." 



After detailing the cases, Dr. Bright insti- 

 tutes the following analysis of them : " In all 

 of these, chronic ailments terminated, soone'- 

 or later, in jaundice ; and in all of them a 

 great peculiarity in the character of the dejec- 

 tions existed. In the result of the examina- 

 tion after death we have likewise some cir- 

 cumstances which coincide in all obstructed 



