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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$crt*atitis was either primary or secondary. 'I'lie fornn^r apix'ared to have a tendency to hemorrhage in the pancreas or in its vicinity, in which case a termination in gangrene and ichorous jx*ri[)ancreati- tis might occur. If the juait* {Kincreatitis l>ecame snpjmnitive. multifde, minute abscesses were to found, which tended to lx*come (smtijicnt and to produce a resulting jieritnnitis. 'The .Secondary variety (d acute [lan<•n^•ltitis wjts either the granular degeuci-jition fmuul in infective diseiuse.s, or the einnunscriU'd *• mct»static ” al>- seess. 'I'he jKtssihilitv of a meta.statie janereatiti.s in the course of a parotitis was not to l>e al)soluttdy denied, esp'eially in viidue of the e:ise re{M)rted hy Schm:u-k]>h‘ffer.“ As there is a douhf of the existence of a jvtn- creatiti.s in this ca.se, it may lx* .safely stilted that there is no rcn.son for iulmitting the existence of a metastatic pam-n'atiti.s .secondary to intlammation of the ]«irotid gland. It is evidetit ** that an acute parotitis may arise <lnring the ootirsi* of a jrancreatic intlainmation. This .single instanw (d‘ assiK'iation is prt*smu:ihly analogous to the rs'cnr- rence <d' jsirotid intiammalion in .septic eonditions of various origin. Sinee Friedreich's anatomical recognition of :m a<-ute |>anereatitis was based u|x»n the consideration of four eases, lie admitted his .symptomatoh'gy of this aflection to lx- neither precise nor eomjilete. Furthermore, he seems^* to include under the heail of pancreatic hemorrhage tho.se ca.s»-s where, this lesion is assix iated with nei rosi.s and gan- grene. and others where hemorrhage into the jian- ereas aj>|x‘ars to 1m* the .sole cau.si* rd’ siulden death. Klebs** hail already recogni/.ed the existence of a snppni-ative ixM-i[)anereatitis. and .stated, pii^snmahly from hi.s own observation, that, in most in.stanee.s, this prcK-eeded from lymph-gland.s. These were <*ither tlie .seat <d‘ metastatic iihsc«*.s.ses or were primarily di.s(*ased hy tnuimatie ageiu*ies or injuri- '• p. 1. I.vm, *° lip. at., 273. •• Op. cif., tr>n.$