THE PERITONEUM. 401 



THE PANCREAS. 



Atrophy of the pancreas is not infrequently found in connec- 

 tion with diabetes mellitus. 



Inflammation of the pancreas is a rare condition. Citrhosis 

 is generally secondary to an inflammatory process in some 

 adjacent tissue ; occasionally it is seemingly due to alcohol 

 and syphilis. 



Carcinoma is the most important tumor found in the pan- 

 creas. It is generally situated at the head of the gland, though 

 the whole organ may be in\ 7 olved. 



THE PERITONEUM. 



Inflammation of the peritoneum, or peritonitis, but rarely 

 occurs as a primary affection, as compared to the frequency of 

 this condition in the other large serous sacs, the pleural and 

 pericardial ; nearly always it is secondary. It may be acute 

 or chronic ; circumscribed or diffuse. So-called idiopathic cases 

 occur at times in which there is no demonstrable cause. In a 

 great majority of instances bacteria play a most important 

 part in exciting the inflammatory process. They may gain 

 direct access to the peritoneum from the blood in septicaemia, 

 pyaemia, and other infectious diseases. Much more frequently, 

 however, there is a local septic inflammation of some organ 

 which the peritoneum covers as of the uterus and its appen- 

 dages, and of the appendix vermiformis. The bacillus coli 

 communis has frequently been found in cases associated with 

 affections of the intestinal tract. Micro organisms met with 

 in other instances are the streptococcus and staphylococcus 

 pyogenes, diplococcus pneumonia?, and gonococcus. 



When the infection takes place gradually and the organisms 

 are in small numbers, the inflammatory process may be local- 

 ized as in connection with appendicitis and affections of the 

 pelvic viscera. The entire peritoneum may subsequently 

 become involved, as the result of extension of the inflamma- 

 tion ; in other cases it is immediately involved by the intro- 

 duction of a large amount of infective material as 

 perforation of the stomach, or intestine, 

 abscess into the peritoneal cavity. 



26 Hist. 



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