The Abdomen 



209 



these two sections effect a junction and become adherent to the 

 duodenum, the outcome of which is the common duct. This 

 fact has some bearing on the surgery of the organ, as will be pre- 

 sently seen. 



Vaughan Harley describes the organ in the adult animal as 

 follows: It consists of two portions, the vertical and horizontal 

 or subgastric. One extremity of the vertical portion lies in the 

 mesentery away from the intestine, the other in close connection 

 with the duodenum, where it joins the horizontal portion to form 

 as it were the head of the gland, opposite the junction of the 

 stomach with the duodenum. The blood-supply is from the pancre- 

 atico-duodenal vessels. The horizontal portion is longer. It runs 

 from the point of union to the two parts below and somewhat 

 behind the stomach as far as the spleen, then turns downwards 

 and ends in'a mesentery of its own on the level of about the middle 

 of the left kidney. In this portion the splenic vessels run, and in 

 extirpating it, it is necessary to separate them from the gland 

 substance. 



In the light of considerable experimental surgery that has been 

 performed on the pancreas, physiologists concede that the gland 

 normally not only excretes into the alimentary canal but yields up 

 some substance to the blood, and that there is a constant breaking 

 down of sugar in the blood. If glucose be added to aseptic blood 

 it is used up in twenty-four hours. 



As long ago as 1682 Brunner wrote that total ablation of the 

 gland was impracticable. More recently, the researches of von 

 Mering and Minkowski have shown that complete extirpation is 

 always followed by diabetes mellitus in severe form. Sugar was 

 found in the urine in some cases four hours after operation. Bern- 

 ard, Klebs and Munk, Finkler, Martinotti, Heyden, Vaughan 

 Harley, Senn, Hedon, and Mouret made some observations, finding 

 that complete suppression of the pancreatic function was incom- 

 patible with the animal's existence. 



Senn showed that complete division of the organ through 

 its middle portion leaving the excretory duct intact was not danger- 

 ous, provided hemorrhage, both arterial and venous, was controlled. 

 The detached portion never regained its physiologic importance, 

 and the parenchyma was removed by absorption without any ill- 

 efFects being noticed in the animals. Removal of the entire organ 



15 



