110 



PANCREAS. 



junction of the inferior mesenteric vein 

 with it. 



The contents of a pancreatic abscess may 

 be discharged in various directions. Some- 

 times they escape into the cavity of the ab- 

 domen; sometimes they pass into the stomach, 

 and sometimes into the duplicature of the 

 mesocolon, where they may be retained as in a 

 sac, or, having perforated one of its lamina?, 

 nny be effused into the general cavity of the 

 abdomen. It is supposed also that the pus 

 of a pancreatic abscess may find its way info 

 the intestinal canal, and be discharged by stool 

 without any obvious communication being 

 established between them. Thus, in a case 

 communicated by Dr. Haygarth to Dr. Per- 

 cival, in which, on dissection after death, the 

 pancreas was found to contain a considerable 

 abscess, blood and, at length, fetid pus had 

 been discharged by stool during life. 



According to Dr. Pemberton*, ulceration 

 is a very frequent result of inflammation of 

 the pancreas ; and from the small degree of 

 sensibility with which the organ is endowed, 

 the destruction may go a great way without 

 pain or any symptom previously existing 

 which could lead to a suspicion that inflam- 

 mation was going on. 



Portal alleges that gangrene of the pancreas 

 is a frequent consequence of its inflammation, 

 and that he has met with it in several in- 

 stances. In one case, which he particularly 

 specifies, the pancreas was found, on examina- 

 tion, to be of a violet purple colour, softened, 

 and allowing a blackish fetid humour to exude 

 from its external surface. " In short," he 

 says, " it was gangrenous almost throughout 

 its whole extent." Gendrin quotes what he 

 conceives to have been a case of gangrene of 

 the pancreas, occurring after chronic inflam- 

 mation, and suggests it as probable that in 

 this, as in other tissues, acute inflamma- 

 tion passes readily and completely into the 

 state of sphacelus, only in cases in which 

 the organ has been weakened by previous 

 disease. 



c. Hcemorrhage. I have only met with two 

 cases of haemorrhage in the pancreas : one 

 recorded by Mr. Fearnside, in which the right 

 extremity was occupied by a large coagulum ; 

 the other related by Storck, in which the 

 pancreas was so large and heavy that it ex- 

 ceeded thirteen pounds in weight. On cutting 

 into this mass, it was found to consist inertly 

 of a sac filled with blood, partly grumous, 

 partly coagulated, and beginning, it is stated, 

 to become organised. 



d. Structural changes. 1. Non-malignant; 

 cartilaginous transformation. Many cases are 

 on record in which the pancreas had been 

 found cartilaginous ; it is generally enlarged, 

 nodular on the surface, and very hard. In the 

 majority of cases, one or more neighbouring 

 organs have been found similarly affected ; 

 but in some rare cases the pancreas has been 

 the exclusive seat of the cartilaginous de- 

 generation. In persons affected with it 



* On Diseases of the Viscera, p. G3. et seq. 



nausea, vomiting, thirst, pain in the epi- 

 gastrium, &c., had existed, and it was pro- 

 bably the remote consequence of chronic 

 inflammation. 



Steatomatous concretions. Portal states 

 that the pancreas is sometimes found full of 

 steatomatous concretions, hard or softened, 

 white like suet, or yellowish like honey. 

 Sometimes the pancreas is enlarged by this 

 matter throughout its whole substance, some- 

 times it exists only in particular parts. Those 

 who have died of scrofula, and in whom the 

 glands of the neck, axillae, groins, or me- 

 sentery were obstructed, had likewise the pan- 

 creas equally affected. He mentions a par- 

 ticular case in which the mesenteric glands 

 were full of steatomatous concretions, and 

 in which the pancreas, besides being enor- 

 mously enlarged and full of similar concre- 

 tions, was covered by one of the consistence 

 of suet and more than five or six lines in 

 thickness. In this case the surrounding cel- 

 lular texture, the mesocolon, and the parietes 

 of the stomach, were cartilaginous and thick- 

 ened, in consequence, he supposes, of the 

 pressure of the tumour. He states, however, 

 that the pancreas has been found affected 

 when no marks of scrofula were observable 

 in any other part of the body. Meckel state* 

 that he has seen the organ changed to an 

 almost tophaceous mass. 



The steatomatous concretion of Portal 

 seems to be identical with the tubercle of the 

 present day ; and accordingly, both in the 

 human subject and in the lower animals, tu- 

 bercles of the pancreas have been occasionally 

 met with, particularly in cases in which the 

 lungs had undergone a similar degeneration. 

 M. Lombard states that of one hundred cases 

 of tuberculous disease in children which he 

 examined, he found, in five, tubercles exist- 

 ing in the pancreas.* 



Cyslic tumours ; hydatids. These are of 

 rare occurrence. M. Becourt has described a 

 preparation in the Museum of the Medical 

 School at Strasburg, of a cyst of very large 

 size in the body of the viscus. Dr. Gross 

 has given the following description of one, in 

 a communication to the Medical Society of 

 Boston.f On opening the body, a voluminous 

 fluctuating tumour of oval form was found 

 situated beneath the right lobe of the liver, 

 with which it had contracted intimate ad- 

 hesions. It was placed between the intestines 

 and the posterior abdominal wall, passed a 

 little to the left of the vertebral column, and 

 had in front of it the curvature of the duo- 

 denum. It contained from 10 to 14- ounces 

 of a sero-sanguinolent fluid without clot, 

 slightly viscid, and without any appearance 

 of fatty matter. There was not a trace in 

 its walls of any of the normal tissue of the 

 pancreas, although it was evidently formed 

 by that organ. It contained some very small 

 calculi, resembling those ordinarily met with in 

 the ramifications of the pancreatic duct, and 

 two of these, from three to four lines in dia- 



* Library of Medicine, vol. iv. 



f Arcliiv. Gen. do Mc'cl. iv. serie, t. 218. 



