THE PANCREAS. 



1067 



the stone by manipulation through the wall of the duct, or it must be crushed from without by 

 carefully padded forceps. After all obstruction has been removed a drainage-tube is to be 

 inserted and the external wound closed around it, the stitches being passed through the parietal 

 peritoneum and also through the peritoneum covering the gall-bladder around the incision, so as 

 to bring these two surfaces into apposition. The fistulous opening generally closes in the course 

 of a few weeks, 



THE PANCREAS. 



Dissection. The pancreas may be exposed for dissection in three different ways : 1. By 

 raising the liver, drawing down the stomach, and tearing through the gastro-hepatic omentum 

 and the ascending layer of the transverse meso-colon. 2. By raising the stomach, the arch of 

 the colon, and great omentum, and then dividing the inferior layer of the transverse meso-colon 

 and raising the ascending layer of the transverse meso-colon. 3. By dividing the two layers of 

 peritoneum which descend from the great curvature of the stomach to form the great omentum, 

 turning the stomach upward, and then cutting through the ascending layer of the transverse 

 meso-colon (see Figs. 606 and 616). 



The pancreas (xav-xpsaz, all flesh) or the abdominal salivary gland, is a com- 

 pound racemose gland, similar in structure to the salivary glands, though softer 

 and less compact. It is long and lies transversely across the posterior wall of the 

 abdomen and when hardened in situ is prismatic, with three surfaces. But 

 usually, when removed from the body, it appears flattened, with only two surfaces 

 and two borders. It lies deep in the epigastrium at the level of the second lumbar 

 vertebra ; behind the stomach ; between the duodenum on the right and the spleen 

 on the left, so that for clinical and surgical purposes it is scarcely approachable. 

 In shape, Meckel compared it to a sort of hammer ; Verneuil, to a cross placed 

 on its side, the short vertical arm representing the head. Winslow compared it 

 to a dog's tongue. Its right extremity being broad is termed the head ; then fol- 

 lows a constriction made by the two terminal parts of the duodenal loop called 

 the neck, which connects head and body. The body is the free portion passing to 

 the left, and finally it abuts against the spleen as the tail (Figs. 634 and 679). 



yon-perito- 

 ncal surface 



,-Lefl suprarenal 



capsule 

 Left kidney 



Splenic vessels 



Transverse 

 mesocolon 

 'Left kidney 

 'Descending colon 



"Jejunum 



"Superior mesenteric 

 vessels 



~3fesentery 

 FIG. 679. Pancreas and adjoining viscera from before. His' model. (F. E.) 



In color the pancreas is grayish-white in the intervals of digestion, turning to 

 a rosy hue during secretion. 



Its volume presents many variations. In general it is bigger in man than in 

 woman. It is usually 15-16 cm. long (six inches) ; its width is not one-fourth or 

 one-fifth of its length ; its thickness is 15-18 mm. (one-half to one inch). Length, 

 23 cm. ; width. 4.5 cm. ; thickness, 2.8 cm. (Luschka). Its volume is 54-90 c.c. 

 Its weight is about 70 gm. in the male and 60 in the female, two and one-fourth to 

 three and a half ounces. A maximum weight is 105 gm. 



The head of the pancreas is called disc-shaped, or, since it is elongated both 

 above and below, hammer-shaped. It is flattened from before backward, and con- 

 forms to the whole concavity of the duodenum made up of its four parts, and not vice 



