GROSS ANATOMICAL DISTURBANCES 519 



genital failure of development especially of the insular apparatus (see genuine 

 diabetes). 



An acute attack of the function of the entire pancreas may be -observed 

 under circumstances in apoplexy of the pancreas or in acute hemorrhagic 

 pancreatitis. The first occurs chiefly in old corpulent drunkards with ad- 

 vanced arteriosclerosis. In association with suddenly onsetting abdominal 

 pains there occurs distention of the abdomen in the epigastrium, retention of 

 feces, vomiting, and finally, with distinctly pronounced manifestations of 

 ileus, death in the course of a few hours or days. Section shows enormous 

 blood effusions in the pancreas, and eventually into the abdominal cavity, as 

 the consequence of hemorrhage from the pancreatic vessels. The course of 

 the disease is for the most part so fulminant, that glycosuria mostly does 

 not occur even on complete destruction of the pancreas. 



Acute hemorrhagic pancreatitis usually sets in with acute gastric dis- 

 turbances after indefinite prodromal symptoms that have lasted for some 

 time; to the gastric disturbances are rapidly added distention of the epigas- 

 trium, violent pressure pains in the pancreatic region and high fever; either 

 death follows rapidly under the manifestations of acute ileus and perforation 

 peritonitis, or the case comes to remissions; then usually the disease lasts a 

 longer time. Symptoms, that depend on falling away of function of the 

 pancreas are not rarely observed. In a case that proceeded rather acutely, 

 I found 12 per cent, of sugar in the urine. In this case the reduction of the 

 copper sulphate took place even in the cold. An interesting case with a 

 chronic course is described by Albu. In a twenty-nine-year-old woman who 

 had formerly 'of ten suffered with violent pains in the gastric region there 

 gradually developed in association with rise in temperature a resistance in 

 the epigastrium, fat-stools, and glycosuria. After a transitory improvement, 

 the manifestations grew worse again, and a piece of necrotic pancreas tissue 

 was removed on operation. A second operation was necessary on account of 

 suppuration of the gall-bladder, after which the febrile process ceased, the 

 fat-stools and the glycosuria disappeared; after some time there was a 

 recurrence of the fat-stools, and of the sugar up to 5 per cent. 



Acute hemorrhagic pancreatitis was first described by Balser. Later the 

 clinical picture was accurately described chiefly by Korte. According to 

 the recent experimental investigations it is to be assumed that there first 

 occurs necrosis of the pancreatic tissue through infection from the intestine 

 or through the pancreatic duct (Korte, Opie) on account of nutritive disturb- 

 ances, and then this goes on to fat necrosis through the action of the pancre- 

 atic juice. The fat necrosis probably travels further by way of the lymph 

 channels, and then the pancreatic secretion gets into the circulation and 

 acts toxic (Gulecke and v. Bergmami). Disturbances in sugar metabolism 

 are lo be expected, only if the process involves the greater part of the gland 

 and is not too fulminant. 



