G84 BURRILL B. CROHN 



The specific gland therapy, as remarkable as it appears, seems limited 

 by the fact that the improvement car be maintained only while the gland 

 or its extract is being administered. 



The Phenomenon of Acute Toxic Necrosis of the 

 Pancreas "Fat Necrosis." 



The pancreas suffers occasionally from a disease characterized by an 

 acute inflammatory, often hemorrhagic degeneration and necrosis, a form 

 of toxic disintegration which is quite peculiar unto itself. As we regard 

 it to-day, it is essentially a nonbacterial disease, one in which an activation 

 of the proenzymes of the gland leads to its own destruction with the 

 origination of an acute severe intoxication that leads to death in the ma- 

 jority of cases. 



One of the quite characteristic features of the disease is the appearance 

 in the parapancreatic and peripancreatic and subperitoneal tissues of areas 

 of fat necrosis. In the course of the last few years our conception of the 

 mechanism of the production of this severe degeneration has undergone 

 much change as the result of encompassing and thorough experimental 

 and chemical research ; a review of this literature is essential to the under- 

 standing of our present day conception. 



Balser in 1882 first described the small opaque white areas in the 

 parapancreatic tissues and interacinous tissues of the gland. He dis- 

 covered these spots in careful routine examination of post mortem ma- 

 terial ; his microscopic examination showed them to consist of necrotic fat 

 cells. They were found in five out of twenty-five bodies examined. Oc- 

 casionally these focal areas were found in more distant areas, thus forming 

 disseminated fat necrosis. Chiari, who confirmed the observation of Bal- 

 scr, drew attention to the fact that their occurrence was associated in five 

 cases with severe disease of the pancreas. 



The essential nature of the process was first explained by Langerhans 

 who demonstrated that the areas were composed of necrotic fat tissue, 

 consisting of fatty acid crystals and glycerin ; in long standing cases cal- 

 cium soaps had been laid down. The soluble glycerin had been absorbed 

 and the fatty acid crystals filled the necrotic fat cell. 



Many chemical confirmations followed in the succeeding years; the 

 necrotic areas were observed over a more extensive region, namely in the 

 subperitoneal and subcutaneous tissues, in the subpericardial and even by 

 Von Hansemann in two cases in the subendocardial tissues. 



The earliest interpretation put upon their presence by Balser, Langer- 

 hans, Ponfick, Dieckhoff and others regarded the areas as essential fat 

 necrosis ; the disease of the pancreas, when present, they regarded as sec- 

 ondary and sequential. Fitz(a) and later Korte laid the foundation of our 



