igoS DISEASES OF THE LIVER AND PANCREAS 



3. Subacute pancreatitis. 



4. Chronic pancreatitis. 



(1) Syphilitic in the foetus. 



(2) In the adult. 



{a) Chronic interlobular pancreatitis. 



(b) Chronic interacinar pancreatitis. 



(c) Chronic interlobular and interacinar pancreatitis 



combined. 



It should be remembered that the subtertian parasite is one of 

 the causes of hcemorrhagic pancreatitis. In addition we have seen 

 cancer of the pancreas producing a blocking of the duct of Wirsung, 

 and leading to a ranula which contained many pancreatic calculi. 

 We have once seen an ascaris in the duct of Wirsung associated 

 with a hypersemic condition of the gland. 



After this brief general statement, we must consider congestion 

 of the liver, abscess of the liver, opisthorchiosis, and clonorchiosis. 



TROPICAL LIVER. 



Synonyms. — Congestion of the liver, Hypersemia of the liver, 

 Indian liver. 



Definition. — Congestion of the liver is a hypersemia brought 

 about by many conditions, especially gastro-intestinal disorders. 



Remarks. — There can be no doubt that the European is apt to 

 eat and drink more than is good for him on his first arrival in the 

 tropics, and that this is bound to lead to an increase of blood in 

 the liver, which physiological condition may easily become a con- 

 gestion, with later blood stasis and diminution of the functional 

 activity of the organ. 



Climatology. — Congestion of the liver is a cosmopolitan com- 

 plaint, but is much more commonly met with in the tropics than 

 in the Temperate Zone. 



etiology — Congestion of the liver is brought about by indiscre- 

 tion in diet, such as too much, too rich, or too highly spiced foods, 

 by alcoholic excess, and by chills. 



Pathology. — Post mortem the liver is found to be swollen, dark 

 red in colour, and drips with blood when cut into. The cells are 

 often laden with fat, and, in addition to the changes in the liver, 

 there will be added the pathological changes which have caused 

 the congestion, and which are generally to be found in the alimen- 

 tary canal, as well as those which have caused the death of the 

 patient. 



Symptomatology.- — The illness begins with frontal headache, 

 malaise and loss of appetite, with nausea or sickness, and a bitter 

 taste in the mouth on awakening in the morning. The tongue is 

 coated, and there are the usual signs of dyspepsia, associated with 

 constipation and the passage of pale-coloured motions. The liver 

 is enlarged and tender, and usually there is a sense of weight in the 

 right hypochondrium, and pain below the right scapula or in the 



