PANCREAS. 



Ill 



meter and rough on their surface, completely 

 obliterated the opening of the pancreatic canal 

 into the duodenum ; they were composed of 

 carbonate of lime. The rest of the pancreas 

 that is to say its left extremity was about 

 two inches long and very hard : the pancreatic 

 canal of this portion of the gland opened into 

 the cavity of the cyst. This circumstance, and 

 the fact that that portion of the duct leading 

 from the cyst to the duodenum was blocked 

 up by the calculi, make it exceedingly probable 

 that the cyst was primarily nothing but a 

 dilatation of the duct in consequence of this 

 obstruction. It is possible that this may be 

 the origin of most of these cysts, and much 

 to be regretted that the fluid contained in 

 them has not been submitted to a rigorous 

 examination, with the view of ascertaining 

 whether it has any analogy to the secretion, 

 or admixture with it. Two cases of reten- 

 tion of the pancreatic fluid recorded by Cru- 

 veilhier, confirm the probability of this sup- 

 position. " The dilated canal resembled a 

 transparent cyst ; the contained fluid was 

 extremely viscid and clear, but of a whitish 

 hue like a solution of gum arabic ; it had 

 a slightly saline taste ; the collateral ducts 

 were extremely dilated. There were some 

 white patches, resembling plaster, in the centre 

 of many of the lobules. This substance was 

 more abundant in some of the lobules, and, 

 when removed, presented the appearance of 

 small lumps of plaster or chalk." These creta- 

 ceous lumps might have been of the nature of 

 pancreatic calculus, which we have already 

 seen associated with a cyst involving the duct, 

 or the earthy remains of old tubercle. 



Fatty degeneration. I have frequently met 

 with fatty degeneration of the pancreas, and all 

 the instances in which I have detected it have 

 been cases of diabetes. After finding it in 

 four successive cases of this disease, I fancied 

 that I had hit upon its cause and the secret of 

 its true pathology. Although it seemed rather 

 a " lucus a non lucendo " argument to at- 

 tribute an undue formation of sugar to the de- 

 rangement of a sugar-forming organ, yet in a 

 class of bodies so full of instances of isomerism 

 as the starch and sugar series, it appeared to 

 me possible that an imperfect or depraved 

 pancreatic secretion might give rise to the 

 formation of an imperfect glucose incapable 

 of those after changes by which it is worked 

 out of the circulation. The meeting, how- 

 ever, with other cases of diabetes in which the 

 pancreas was not fatty, and, still more, the 

 perusal of M. Bernard's observations with re- 

 gard to the part that the liver plays in the 

 formation of sugar, and the disease of diabetes, 

 dispelled my theory, and compelled me to re- 

 gard the fatty state of the pancreas as the 

 consequence, and not the cause, of the diseased 

 condition, undergoing this degeneration in 

 comra-jn with other organs ; for I never found 

 fat in the pancreas without finding it in enor- 

 mous quantity in the liver and kidney. I may 

 here remark, that I have not been able to 

 confirm Dr. Johnson's observation*, that in 

 * Diseases of the Kidney, p. 395. 



diabetes, when the kidncy^ cells contain a 

 large quantity of oil, the hepatic cells contain 

 an unusually small amount, and have a 

 " starved " appearance ; for I have invariably 

 found the accumulation of fat in the liver and 

 kidney cells, in cases of diabetes, in direct, and 

 not in inverse, proportion. 



The microscopical appearances of fatty pan- 

 creas are of two kinds, depending, I think, upon 

 the length of time the degeneration has existed, 

 and the amount of fat (jftg. 75.). In one, the 

 amount of fat is small, the globults very 

 minute, confined to distinct epithelium cells, 



Fig. 75. 



Fatty Degeneration of the pancreas. 



A. The process here is but slightly advanced, the 

 oil-globules small, and the epithelium distinct, par- 

 ticularly where some cells have escaped, as at b ; at 

 a, too, within the follicles, they are visible. 



B, another specimen, in which the fat was more 

 abundant, and the destruction of the tissue com- 

 plete. 



and giving them, from the increased opacity it 

 imparts to them, a mot e definite individuality 

 (A. a.) ; in such a case, if a follicle is ruptured 

 the epithelium escapes, each cell containing 

 its own minute fat globules (A. B ), and the 

 amount of free fat, if any, is very small. In 

 the other case, the appearance of individual 

 epithelium cells in the follicle is altogether 

 lost, the fat globules are larger and n;oie nu- 

 merous, and the rest of the contents indis- 

 tinctly granular. (B. a.) Sometimes the oil 

 globules completely fill the follicle ; when in 

 such a case pressure is applied, and the follicle 

 contents forced out, no distinct epithelial cells 

 are seen floating about, but all that is not fatty 

 is amorphous and broken down. (B, b.) 



2. Malignant. Scirrhus and carcinoma. 

 These appear to be among the commonest af- 

 fections of the pancreas. The disease gene- 

 rally affects, or commences in, a part only of 

 the organ ; and appears to be primarly pan- 

 creatic, for in some cases the pancreas alone 

 has been found affected. Dr. Bisby enunie- 



