108 



PANCREAS. 



The whole subject is singularly full of contra- 

 dictions and discrepancies, and it must be con- 

 fessed is also singularly full of sources of 

 fallacy. If Bernard's description of two kinds 

 of pancreatic fluid, normal and morbid, be 

 correct, it may go a great way to explain 

 why those who, like Frerichs, have experi- 

 mented with a watery fluid, poor in albumen, 

 have failed to verify his results, and there- 

 fore it will vitiate their objections. It is 

 almost impossible to help seeing something 

 like a national bias in the adoption of one or 

 the other set of opinions ; for while Lehmann 

 follows Frerichs and Schmidt and Bidder, the 

 French physiologists as implicitly adopt the 

 views of Bernard, and confirm his results. 

 Even the action on starch, though a function 

 of the secretion, can hardly be said to be the 

 function; for the relative size of the gland 

 is greater in carnivorous than in herbivorous 

 animals (the weight being ^^th of that of the 

 whole body in dogs and cats, and only ^^th 

 in that of rabbits*), and further, as Bidder 

 and Schmidt have shown, the greater part of 

 the amylaceous food of the sheep is con- 

 verted into sugar before it enters the duo- 

 denum. With such patent facts as these, 

 and with objections to Bernard's views so 

 many and so grave, I feel disposed to adopt 

 the words of the learned translator of Leh- 

 mann, and say, that " we may fairly conclude 

 that the principal uses of this secretion are 

 still unknown." 



V. MORBID ANATOMY. 



The interest that attaches to the deranged 

 anatomy of the pancreas is the interest of ob- 

 scurity the interest of diagnosis; I may add, 

 too, the interest of situation ; in fact, it is from 

 the situation of the organ that the importance 

 and obscurity of its pathological relations at 

 once result. Close to the stomach, duodenum, 

 liver, spleen, kidney, aorta, cava, mesenteric 

 glands, and coeliac axis, it finds itself in im- 

 mediate relation with the great vascular, nerv- 

 ous, 'digestive and absorbent centres of the 

 abdomen, and may either affect them second- 

 arily, be affected by them, or furnish a source 

 of fallacy and doubt as to whether it be it, or 

 they, or both that are implicated : and while it 

 is thus placed at the most important point in 

 the whole range of medical anatomy, its situ- 

 ation almost completely precludes it from the 

 advantages of physical diagnosis. 



The pancreas enjoys an immunity from 



* It is a singular thing that the very reverse of 

 this fact, the assertion, namely, that the pancreas was 

 'larger in herbivora than carnivora, was advanced by 

 Valentin in support of his views of the metamorphic 

 action of the pancreatic fluid on starch. I had myself 

 made some extensive tables of the absolute and re- 

 lative size of the pancreas in carnivorous and 

 herbivorous animals, and carnivorous and grani- 

 vorous birds, those of a mixed diet, and in reptiles, 

 also in young and old of the same species, but they 

 are unfortunately lost ; all I can say from recollec- 

 tion is, that in conformity with the statement in 

 the text, I found the gland largest in carnivora, 

 smallest in vegetable feeders, and intermediate in 

 those of a mixed diet; its relative size was also 

 inversely as the age, though apparently in no re- 

 gular ratio. 



disease greater than most organs, but I be- 

 lieve this immunity is in part real and in part 

 only apparent ; for it cannot be doubted that 

 one reason why the records of its morbid ana- 

 tomy are so scanty, is that in so large a num- 

 ber of post-mortems, no examination of the 

 organ is made at all. It is the last to be got 

 at, and the cause of death having been as- 

 certained, its examination is looked upon as 

 supererogatory ; besides, it is often obscured 

 and mutilated in the removal of other organs, 

 and its careful dissection from its situation, 

 which is necessary to examine it satisfactorily, 

 is troublesome and not very easy. 



Its simplest morbid conditions, and most 

 common, are those of 



a. Quantitatively perverted nutrition hy- 

 pertrophy and atrophy, induration and soften- 

 ing; and the commonest of all is, 



Hypertrophy. It is difficult to say pre- 

 cisely at what point hypertrophy of the pan- 

 creas commences, because the limits within 

 which the size of the gland may normally vary 

 are so extensive that a considerable excess 

 of volume is evidently quite consistent with 

 anatomical and functional health. Generally, 

 the hypertrophy is not pure, but is associated 

 with some induration ; and in the majority of 

 cases both the induration and hypertrophy 

 appear to result from chronic inflammation, 

 giving rise to some increase in the proper 

 gland structure, but more to an effusion of 

 lymph between the lobes and lobules by the 

 partial organisation of which a great increase 

 in the amount of the interlobular tissue is pro- 

 duced. This gives rise to an appearance of 

 intersection by opaque membranous septa, 

 giving the gland a scirrhoid character; and 

 hence, by some this morbid alteration has been 

 considered as the first step towards scirrhous 

 degeneration, and by others as actual scirrhus. 

 Whenever the colour of an enlarged pancreas 

 is deeper and redder than natural it may be 

 inferred that the hypertrophy is due to this 

 chronic inflammatory action. Sometimes the 

 enlargement is slight, sometimes it is very 

 great. Dr. Fearnside* mentions a case in 

 which the gland was four times its natural 

 size, and could be felt as a large tumour 

 during life, although the- emaciation was not 

 extreme. The results of the hypertrophy are 

 very various ; sometimes it gives rise to 

 jaundice by pressure upon the galUducts ; 

 to dilatation of the stomach, dyspepsia, &c., 

 by pressure on the duodenum and pylorus ; 

 to occlusion, even, of its own ducts f, and to 

 many disturbances, functional and organic, oi 

 neighbouring parts, produced by its altered 

 volume and relations. 



Atrophy of the pancreas, mere diminution of 

 volume unaccompanied by any other change, 

 is sometimes idiopathic, but much more fre- 

 quently caused by neighbouring disease, as 

 for example, the pressure of some tumour. 

 Morgagni found the pancreas atrophied from 

 the pressure of a tumour in the liver. Dr. 

 Hall found the same condition caused by a 

 * Medical Gazette, vol. xlvi. 

 t Copland's Med. Diet, art. Pancreas. 



