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
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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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    restl(\ssness, perhajis fve(juont fainting. The j)ain bore no detinitf! relation to the vomiting or other symptoms, and was not inereased in projKjrtion to external i)re.ssure. The vomiting was forcible, more or le.ss greenish material lH*ing expelled. The ab- domen was moderately tens(‘, th<>re was slight fever, and the appetiU' was Imt little disturbed and might be inereased. 'Fhere was a moist tongue, thirst, and constipation. The elleet of Clilssfm’s treatment of the subject may be seen nearly thirty years later in the statement by Wardwell that the j)rominent symptoms of acute pamu-eatitis ar<>, deep-seated, (lull, epigastric pain, distention, sickness, and vomiting of a clear, greenish, viscid fluid; thirst, faintness, moist tongue, constipation, and slight pyrexia. Tlie first step towards an ess(*ntial modification of these views was made by Kleb.s, in 1870.*® He preferred to say nothing about inflammation of the j)ancrea.s, but described the various lesions which have Ix^en found in and around this gland, Avith- out attemjding to show their |wssible relations to each other. He availed himself of the cases i)ul>- lished by Portal, Hooper, Loschner, Haller and Klob, and of one in his own experience, to ius.sociate pancreatic hemorrhage with severe symptoms and to recognize the ])ossibility of a hemorrhagic inflam- mation of the pancreas, alrejuly admittful by Rok- itansky,*® as a very rare occurnnuie. Klebs further recognized that this hemorrhagic inflammation might possibly re.sult in a imrulent ])erij»ancreatitis Avitli ]>artial seqm'stratiou of the gland. Friedreich,** however, undertook to present a comj)lete pi(*ture of acute jiancreatitis more in jiccordance with the anatomical treatment of Klebs than with that of Cliissen. He availed himself of the cases used by Klebs; in addition, of one reported by Oppolzer, and of another under his own observation. He suggested that .mute pan- '4 Keynold’a Sv»t. of Med., 1871, Hi. 414. •5 Handli. d. path. Aniitoinio, 1870. i. 2, 503. •6 I,ehrb. d. path. Anat., 3te AutL, 1801, lii. SOU, 242.