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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$T]ie table of seventeen cases (page Nl) ineljides the instances of associated }>anereatic hemorrhage ami inflammation which present common features of syiujitoms and anatomical changes. Of these cases tiiree liave (K-mirred within the vicinity of Jioston; two of these are now, for the first time, re|sjrted, and the gr«jss and muTo.sco]jic sj)ecimens fnan the latter are submitted to your inspection. I am indebted to Di^s. I’inkham and Whitney for their notes of C:ise XXVllI. 'Phe patient was a maj), forty years of age, by cx'cupution a <-atei‘er. He was liable to attm-ks of acute indige.stion. and, for a year or more In-foi-e his death had suffered from general malaise and debility. His disr-omfoi-t w^as attrilmted to indigestion. His last illnes.s was of six days* thiration and was char:w‘terized by epi- gfistric pain, vomiting, ami by great cardia<.' weak- ness. Heath occurre«l from lieart-failure after the pain and vomiting had ceased. There was a large {juantity ofalslnminal fat, and the jH>st-iuortem examinatioti wa.s negative, with the exception ot the a|»j>earau<*e« descrils’d l)clow. The pancrejjs was very large, weighing, with some ad- iierent fat, four hundred ami ten grammes. 'J'he cut surface showed throughont dark-ml streaks and patches l)ctwecn the lobules ami sejiarating them to a slight degree. On microscopic examination there wa.s no evident alteration of the glamlaadls. A considerable quantity of free bhKxU'orpuscles wa.s found in the intralobular ti.ssue. The fat-tissue w.as evervwben* filled with small, opa<}ue-wbite s^Kjt.s, often with a welUletined. dark iKuder. 'I'lieir diameb'r varied from u few millimeters to .several centimeters. They were pres<-nt within the ]>an- creatic fat-ti.ssue .and in that outside tlie organ. Microscopvi! examination showed that the fat-tissue was changed to a finely granular mas.s in which wcp> numerous, very fine, iveitmlar cystals. In the vicinity of the patches of necrotic fat-tissue w'ere found colonies of micriM?(K-(*i. bor the pur{)ose.s of this jkijkt a more extended,$