Acute pancreatitis : a consideration of pancreatic hemorrhage, hemorrhagic, suppurative, and gangrenous pancreatitis, and of disseminated fat-necrosis : the Middleton-Goldsmith lecture for 1889 / by Reginald H. Fitz.

Reginald Heber Fitz

Date:: 1889

Credit: Acute pancreatitis : a consideration of pancreatic hemorrhage, hemorrhagic, suppurative, and gangrenous pancreatitis, and of disseminated fat-necrosis : the Middleton-Goldsmith lecture for 1889 / by Reginald H. Fitz. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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$IIEMOKRHA<iK' I'AXCKKATITIS. In cotisideriiig the relation of hemorrhage to atrute pancreatitis, it is im)«)i-tant to agree upon what shall lx* un(lerst<KHl hy tlie latter term. It has alrearly l>een shown that the vii*ws iulvanced hy ritissen atul his {>redeeesso!-s give no aid in this matter. Klolw is non-committal on account of the paucity of evidence, and Kriedivich elalHUiited his systematic de.scription of acute, primary }«ncrea- titia frf>m the consideration of hnir cases. In the one jxiucresus were mnltijde ahs<’cs.s.-s; in another a bhxxly exudation, and infiltrated 1i1<hm1 in the vicin- ity; in a third were si«its <d finely granular, yellow exudation with interlobular hemorrluige; while, the fourth jKincrea.s w.'is g;ingn*non.s. The material whicli has Iwcn accumulating .since the publication of Friedreich's article, in 1875, is ali-e;uly so considerable ami varie<l as to make (xxs- sible a nuuv complete de.scription of the .subjwt. The iwjute innainmatiou of a gland, from the anatomical j>oint of view, <lemands the presiun’c of degenerative (dianges in the parenchyniatou.s c.ell«, or an exudiition in the interstitial ti.s.sue, or lx>th these f:U‘toi-s. Tin* first, the parenchymatous intlammation or gninular di'gtunuation of the jKincrciis. .such as twcurs in infective disea.se.s, or as the result of min- enil jMUsoning, is of no imme<liat4* concern. It is the interstitial variety which, with or with- out a.ssociated parenchymatous changes, mav lx* regaolerl as the genuine, :u-ute jmncmititis; aiid it is in the interstitial ti.ssue of the {(anciv.'us that the intlammatorv exudation is to l>e .sought. lUit this tissue i.s both librous and fatty, one or the other variety predominating in dift'ment imlividuahs, and, jierhaps, at (liffenuit iH-ricKls in life. These tissues lx‘ur a continuous relation to the ]»eritoneum, and to the suhiM>ritoneal and retropanereatie fat-tis.sue. It is, therefon', most probable that an inflammatory process of this fat-ti.s.sue might arise within the pancreas, orls^ continued to the panci'eas from some more remote place of origin. Thus a primary and a secondary, acub*. intej-stitial pam reatitis might$