Urine in Chronic Disease of the Pancreas. 373 



each of eight patients, under the care of Mr. Mayo Eobson, were collected 

 and separately examined, but as the methods employed and the results 

 obtained were similar in all it will not be necessary to deal with them 

 individually. The diagnosis of " pancreatitis " in these cases was based upon 

 the clinical symptoms, analyses of the faeces, and the condition of the 

 pancreas found at operation, while in one instance it was confirmed by 

 histological examination of the gland after death. In five the pancreatitis 

 was associated with, and was probably dependent upon, the presence of 

 gall-stones in the common bile duct ; two had had symptoms of " indigestion " 

 for several years, which in one was believed to have originated in an attack 

 of typhoid fever, and in the other had come on insidiously, but was 

 associated with evidence pointing to excessive putrefactive changes in the 

 contents of the intestine and an abnormal intestinal flora. In one there 

 was sub-acute pancreatitis with disseminated fat necrosis, and an impacted 

 gall-stone in the ampulla of Vater ; post-mortem examination in this case 

 showed an abscess in the tail of the pancreas and staining of the walls of the 

 duct of Wirsung, with bile for a distance of about 3 inches from its junction 

 with the common bile duct. Sections of the gland on microscopical 

 examination showed a considerable over-growth of the interlobular connec- 

 tive tissue with some small round-celled inflammatory infiltration and 

 vacuolisation of the acinar cells, which stained feebly. 



The urine from these patients, which had been preserved with chloroform, 

 was filtered to remove suspended matter, and to the 4 litres were added 

 400 c.c. of hydrochloric acid (sp. gr. ri6). The mixture was placed in 

 a flask with a funnel in the mouth to act as a condenser, and the flask 

 heated on a sand-bath until the contents boiled. After being kept gently 

 boiling for 10 minutes the flask was cooled in running water, the urine 

 made up to its original volume with distilled water, and the excess of acid 

 neutralised by slowly adding 1600 grammes of lead carbonate. On the 

 completion of the reaction it was filtered through a moist filter-paper, and 

 the acid filtrate shaken with 1600 grammes of tri-basic lead acetate. The 

 filtrate from this was made alkaline with ammonia, and the resulting 

 precipitate washed with distilled water until the washings no longer acted 

 upon red litmus paper. The precipitate was then suspended in 200 c.c. 

 .of distilled water, made faintly acid with hydrochloric acid, treated with 

 a stream of sulphuretted hydrogen, and the precipitated lead sulphide 

 removed by filtration. The clear filtrate was gently warmed on a water- 

 bath and, when free from sulphuretted hydrogen, was again well shaken 

 with 30 grammes of tri-basic lead acetate, filtered, and the filtrate made 

 alkaline with ammonia. The precipitate that formed, after being washed 



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