PANCREAS. 



109 



scirrhotis tumour in the mesentery. M. 

 Guerin observed this lesion produced by a 

 similar cause. M. Berjaud by aneurism of 

 the aorta ; and M. Mondiere by scirrhotis 

 pylorus. In some cases it seems to be pro- 

 duced by arrest of its function, as when 

 scirrhous disease of the pylorus has put a stop 

 to the passage of food into the duodenum. 

 Dr. Wolf mentions a case in which the atrophy 

 seems to have been produced by the ossifica- 

 tion of the pancreatic arteries and obstruction 

 of the duct. I do not know if there are any 

 symptoms by which idiopathic atrophy de- 

 clares itself during life, and in those cases in 

 which it is secondary, the symptoms are those 

 of the primary disease and not those of the 

 pancreatic affection. The degree of wasting 

 is sometimes very great ; Cruveilhier met with 

 a case in which it did not exceed an ounce in 

 weight. 



Induration. Sometimes the pancreas is 

 found of a firmer consistence than natural, 

 without any perceptible alteration in structure. 

 It has been alleged that in these cases it is 

 the secreting structure that is affected, the 

 areolar tissue not being implicated in the 

 induration, which imparts to the gland a more 

 nodular or granular appearance and feeling. 

 But whether this is so, I cannot say, as I have 

 never .submitted an indurated pancreas to 

 microscopical examination. It is said to be 

 not uncommon for induration of this kind to 

 disappear, as happened in a case recorded by 

 Mr. Lawrence, soon after exposure to the 

 air. 



Softening has been found to occur chiefly in 

 persons suffering from scrofulous affections. 

 Portal relates that he found the gland remark- 

 ably softened without any other change, in two 

 children who died of measels. In confluent 

 small pox and malignant scarlet fever softening 

 of the pancreas has occurred. Dr. Copland 

 states that he has found it softened in cases 

 of malignant remittent fever and scurvy, but 

 only in conjunction with softening of other 

 organs, as the spleen, &c. 



b. Inflammation. The number of cases in 

 which post-mortem appearances of acute in- 

 flammation of the pancreas have been re- 

 corded is certainly very small. When it does 

 occur the appearances are said to be great 

 injection of the whole gland, imparting to it 

 a brown-red colour and an unnatural softness 

 and friability. In a case recorded by Mr. 

 Lawrence, this brown-red colour presented a 

 strong contrast with the pale anaemiated con- 

 dition of the other parts. When the inflam- 

 mation does not end in resolution, it may give 

 rise to the effusion of plastic lymph on the 

 surface, producing a general or partial false 

 capsule, or to the formation of pus in its sub- 

 stance pancreatic abscess. It is also said to 

 end sometimes in gangrene. 



In consequence of the effusion and subse- 

 quent organisation of coagnlable lymph upon 

 the surface of the pancreas it has occasionally 

 been covered by a false membrane of great 

 consistence. By the extension of the ad- 

 hesive inflammation to some of the neigh- 



bouring organs, as the stomach, duodenum, 

 liver, spleen, mesentery, mesocolon, &c., bands 

 are occasionally formed, connecting the pan- 

 creas to one or more of these organs, which 

 sometimes acquire so great a degree of hard- 

 ness, as to be with difficulty divided with the 

 scalpel. 



In suppurative inflammation, whatever may 

 have been its point of commencement, the 

 pus is ultimately infiltrated into the interlobular 

 tissue, and when the process of suppuration 

 is completed, is generally collected into one 

 cavity. In most cases, the inflammation being 

 but partial, this cavity is of moderate size ; 

 but sometimes the suppuration proceeds to 

 such an extent that the texture of the gland 

 is almost entirely destroyed. In some in- 

 stances, this destruction being complete, the 

 purulent matter is contained in a membranous 

 envelope, formed by the cellular tissue which 

 covers the organ. Portal has seen more than 

 two pounds of pus contained in a sac of this 

 description. The character of the purulent 

 matter in such cases seems to be various. 

 According to Gendrin it is commonly inodor- 

 ous and creamy ; Portal, on the other hand, 

 states that in complete suppuration of the 

 pancreas, the pus is sometimes of an intoler- 

 able smell ; not unfrequently it is combined 

 with a clear yellowish fluid, and with a 

 whitish curdy substance, the most dependent 

 part being occupied with a grey powdery pus. 

 This has been attributed to its admixture with 

 the pancreatic juice. 



In the great majority of cases, inflammation 

 appears to extend to the pancreas from neigh- 

 bouring organs ; in some cases it becomes 

 adherent to the stomach at a point where the 

 latter is undergoing perforative nlceration, 

 and I have seen a case where this adhesion 

 had a conservative effect and served as a stop- 

 gap, whereby, when the ulcer had completely 

 eaten through the coats of the stomach, the 

 escape of its contents into the abdominal 

 cavity was prevented. Portal speaks of ab- 

 scess in the pancreas having been frequently 

 observed in disease of the testicles, and men- 

 tions one case in particular in which, after 

 the extirpation of a testicle and the ligature 

 of the spermatic cord, a large quantity of 

 pus was found in the cord, and a considerable 

 abscess surrounding the pancreas; and he 

 refers to Antoine Petit as adducing different 

 examples of this kind in support of his ob- 

 jections to the practice of ligature. M. Ton- 

 nelle mentions two cases of puerperal peri- 

 tonitis in which pancreatic abscess occurred. 

 In Mr. Lawrence's case the patient died five 

 weeks after delivery. It is to be regretted 

 that in these cases more accurate dissections 

 were not made, particularly with the view of 

 ascertaining the condition of the venous con- 

 nexion between the parts primarily affected 

 and the pancreas : it is very possible that the 

 inferior mesenteric vein might have been 

 found in a state of inflammation, and the 

 pancreatic abscess might have been from 

 secondary purulent deposit transmitted to it 

 by branches from the splenic vein after the 



