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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$rather in the region of the gall-l)l!uhler than in that of the j)ancreas. Acute, intestinal obstruction is most likely to give rise to doubt. It is to be eliminated by deter- mining, through injection, the patency and capacity of the large intestine, by the rarity, in the ei)igas- trium, of an obstructed small intestine, by the immediate jjresence of localized tenderness, and by the usual absence of conspieaious, general tympany or limited distention of intestinal coils. TKKAT.MENT. It is evident that all treatment, at the outset, can be nothing but palliative. With the formation of pus in the omental cavity comes the opportunity for the surgeon. The possibility of the successful removal of the gangrenous pancreas is suggested by the healthy condition of a patient seventeen years after he ha<l discharged this organ from his bowels. An unexiiectedly early verification of the above conclusions has occurred Avithin the week follow- ing the delivery of this lecture. The case Avas that of a well-knoAvn gentleman of Hoston, and presented, so lully, the symptoms above mentioned, that, Avhen (jailed as consultant, I wUvS able to mak(j^i diagnosis of acute pancreatitis, which Avas eventually substantiated. The folloAving is a“ brief summary of the essen- tial features of this case, Avhich Avill, hereafter, be more fidly reporttjd. The patient was suddenly seized, February 19th, Avhile ajiparently in his usual good health, with a severe ])ain and tenderness a short distanc.e above and to the left of the navel. ThisAvas followecl by A'omiting and a certain degree of prostration. Ihe lulministration of nearly a grain of morphia gave re- lief. 1 saAV him in the evening, and during the s\d)se- quent tAvo days of his life, lie died on the third day. The loc.alizecl pain Avas more, or less constant, Avith occasional severe twinges, and Avas also to be elicited by intercostal pressure in the splenic region.$