Sometimes the pancreas is found of a firmer consistence than natural, without any perceptible alteration in structure. It has been alleged that in these cases it is the secreting structure that is affected, the areolar tissue not being implicated in the induration, which imparts to the gland a more nodular or granular appearance and feeling. But w hether this is so, I cannot say, as I have never submitted an indurated pancreas to microscopical examination. It is said to be not uncommon for induration of this kind to disappear, as happened in a case recorded by Mr. Lawrence, soon after exposure to the air.
Softening has been found to occur chiefly in persons suffering from scrofulous affections. Portal relates that he found the gland remark ably softened without any other change, in two children who died of rneasels. In confluent small-pox and malignant scarlet fever softening of the pancreas has occurred. Dr. Copland states that he has found it softened in cases of malignant remittent fever and scurvy, but only in conjunction with softening of other organs, as the spleen, &c.
b. The number of cases in which post-mortem appearances of acute in flammation of the pancreas have been re corded is certainly very small. When it does occur the appearances are said to be great injection of the whole gland, imparting to it a brown-red colour and an unnatural softness and friability. In a case recorded by Mr. Lawrence, this brown-red colour presented a strong contrast with the pale anwmiated con dition of the other parts. When the inflam mation does not end in resolution, it may give rise to the effusion of plastic lymph on the surfbce, producing a general or partial false capsule, or to the/on/I-a/ion of pus in its sub stance—pancreatic abscess It is also said to end somettmes in gangrene.
In consequence of tile effusion and subse quent organisation of coagulable lymph upon the surface of the pancreas it has occasionally been covered by a false membrane of great consistence. By the extension of the ad hesive inflammation to some of the neigh bouring organs, as the stomach, duodenum, liver, spleen, mesentery, mesocolon, &c., bands are occasionally formed, connecting the pan creas to one or more of these organs, which sometimes acquire so great a degree of hard ness, as to be with difficulty divided with the scalpel.
In suppurative inflammation, whatever may have been its point of commencement, the pus is ultimately infiltrated into the interlobular tissue, and when the process of suppuration is completed, is generally collected into one cavity. In most cases, the inflammation being
but partial, this cavity is of moderate size ; but sometimes the suppuration proceeds to such an extent that the texture of the gland is almost entirely destroyed. In some in stances, this destruction being complete, the purulent matter is contained in a membranous envelope, formed by the cellular tissue which covers the organ. Portal has seen more than two pounds of pus contained in a sac of this description. The character of the purulent matter in such cases seems to be various. According to Gendrin it is commonly inodor ous and creamy ; Portal, on the other hand, states that in complete suppuration of the pancreas, the pus is sometimes of an intoler able smell ; not unfrequently it is combined with a clear yellowish fluid, and with a whitish curdy substance, the most dependent part being occupied with a grey powdery pus. This has been attributed to its admixture with the pancreatic juice.
In the great majority of cases, inflammation appears to extend to the pancreas from neigh bouring organs ; in some cases it becomes adherent to the stomach at a point where the latter is undergoing perforative ulceration, and I have seen a case where this adhesion had a conservative effect and served as a stop gap, whereby, when the ulcer had completely eaten through the coats of the stomach, the escape of its contents into the abdominal cavity was prevented. Portal speaks of ab scess in the pancreas having been frequently observed in disease of the testicles, and men tions one case in particular in which, after the extirpation of a testicle and the ligature of the spermatic cord, a large quantity of pus was found in the ccrd, and a considerable abscess surrounding the pancreas; and he refers to Antoine Petit as adducing different examples of this kind in support of his ob jections to the practice of ligature. M. Ton nelle mentions two cases of puerperal pei tonitis in which pancreatie abcess occurred. In Mr. Lawrence's case the patient died five weeks after delivery. It is to be regretted that in these cases more accurate dissections were not made, particularly with the view of ascertaining the condition of the venous con nexion between the parts primarily affected and the pancreas : it is very possible that the inferior mesenteric vein might have been found in a state of inflammation, and the pancreatic abscess might have been from secondary purulent deposit transmitted to it by branches from the splenic vem after the junction of the inferior mesenteric vein with it.