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
Catalogue details

Licence: Public Domain Mark

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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    ■■I’he epigastric- ]i:iiii was severe*, ami on pressm-e leetween the navel and the c'nsil'orm c'artilage a deep-seated transverse tumor txmM lx* felt. 'I'he pancrea.s was four times the nonnal size, and was a<lherent to the st^muu-h l»y some tirni adhesion-s. The neighlmring jH*ritoneum showed s}x)t.s of soft and tirm exudation. The greute.st ineremse in size was in the hea«l, whieh ext«‘nded «lt*eply into tlie right lumlxar region. It was bl.-u‘kish-hn>wn, jmlta- eeous, gnunous, and eoiitiutied distinet hlcKnl-elots. In the more consistent jnu-tion.s there* was no trac^e of natuial gland-tis.suf. The lioely was tirm and close in texture, of a dark-red txdor mottled with black lines and jaunts, and U*eame j»aler towards the lij). The probability of this lx*ing a ease* of malignant diseiise with hemorrhage* is very strong, esjcecially a.s the a]>m*arances do not eorresjxmd with those to 1m* stated later a.s found in hemorrhagic jmnereatitis. Kigal *• rejKnta the case of a man. mt. lifty-two, previously in jx-rfect he.alth, who suffered f<*r seven days from internnttent fever, daily, with short remissions. The alxlomen and legs then U'came swollen, ami some juiin won complained of at the right of the tiavel, where w;is a sen.sitive, indurated sj)ot. flaundice then cM-curred, also ])rogressive weaknes.s and ej>istJixis. Finally f<*ver wa.s noticed, and death t.ook jdace alxnit .seven weeks from the l>eginning of hi.s sickness. The jKim-reji-s was large, the he-ad Ixdng twice the normal size, 'i'he latter was brown, Ixith on in.sjx*ction and se^-tion. On microscopic examination there wa.s mlvanced fatty degeneration, and numerou.s crystals of margarine were seen There wju? also fatty degeneration of the right kidney and an enlargecl and friable sjileen. The liver was normal in size and consistency, the bile-ducts and gall-bhwlder wei-e dilated. rhis case is excluded from the .series which is to follow, from the inability to determine the nature of the changes in the hea<l of the jiancrea.s. At the same time it Ls iulmitted that certain charac- teristics are j)resent**d which render it not unlikely n (iBx. de* Hop.. ISfiO. xiii. .'-*oa.