Fatty degeneration. — I have frequently met with fatty degeneration of the pancreas, and all the instances in which I have detected it have been cases of diabetes. After finding it in four successive cases of this disease, I fancied that I had hit upon its cause and the secret of its true pathology. Although it seemed rather a " lucus a non lucendo " argument to at tribute an undue formation of sugar to the de rangement of a sugar-forming organ-, yet in a class of bodies so full of instances of isomerism as the starch and sugar series, it appeared to me possible that an itnperfect or depraved pancreatic secretion might give rise to the tbrmation of an imperfect glucose incapable of those after changes by which it is worked out of the circulation. The meeting, how ever, with other cases of diabetes in which the pancreas was not fatty, and, still more, the perusal of NI. Bernard's observations with re gard to the part that the liver plays in the formation of sug,ar, and the disease of diabetes, dispelled my theory, and compelled rne to re gard the fatty state of the pancreas as the consequence, and not the cause, of the di:Tased condition, undergoing this degeneration in common with other organs ; for I never found fat in the pancreas without findina it in enor mous quantity in the liver and kidney. I may here remark, that I have not been able to confirm Dr. Johnson's observation*, that in diabetes, when the kidney cells contain a large quantity of oil, the hepatic cells contain an unusually small amount, and have a " starved " appearance ; for I have invariably found the accumulation of fat in the liver and kidney cells, in cases of diabetes, in direct, and not in inverse, propottion.
The microscopical appearances of fatty pan creas are of two kinds,depending, I think, upon the length of time the degeneration has existed, and the amount of fat (fig. 75.). In one, the amount of fat is small, the globules very minute, confined to distinct epithelium cells, and giving them, from the increased opacity it imparts to them, a rnore definite individuality (A. a.); in such a case, if a follicle is ruptured the epithelium escapes, each cell containing its own minute fat globules (A. B ), and the amount of free fat, if any, is very small. In the other case, the appearance of individual epithelium cells in the follicle is altogether lost, the fat globules are larger and mot e nu merous, and the rest of the contents indis tinctly granular. (B. a.) Sonietimes the oil globules completely fill the follicle ; when in such a case pressure is applied, and the follicle contents forced out, no distinct epithelial cells are seen floating about, but all that is not fatty is amorphous and broken down. (B, b.) 2. Scirrhus and These appear to be among the commonest af fections of the pancreas. The disease gene rally affects, or commences in, a part only of the organ ; and appears to be primarly pan creatic, for in some cases the pancreas alone has been found affected. Dr. Bigsby enunie rates twenty-eight cases in which the disease appeared to be idiopathic, and in eight, which were of long standing, did not extend beyond the pancreas; more frequently, however, it implicates neighbouring parts in some degree, particularly the duodenum, stomach, and py lorus. It may exist without any increase of
size, but more frequently is attended by some enlargement, which may be considerable. Scir rhus rarely goes on to ulceration, the asso ciated lesions terminating fatally before that time. It often gives rise to constriction of the bile-duct and deep jaundice, and even com pression of the aorta : this compression and constriction of the aorta have been known to occasion aneurismal dilatation above the seat of the constriction, as seen by Portal and Salmade.
Of the twenty-eight cases analysed by Dr. Bigsby, in seventeen the disease had not ar rived at the stage of softening, although some of them had existed for years ; it was purely scirrhus. In five cases he states the scirrhus had, at the time of death, passed into the soft state called cephalonza by Dr. Carswell, and nzedullary sarcoma by previous writers. Some parts, however, were as hard as cartilage ; but others had all the pulpy, pale yellow, brain like character of the second stage of scirrhus. In one case, the pancreas was changed into a sac, with a few shreds of cephaloma here and there on its sides. Lastly, in tvvo cases no vestige of any form of scirrhus reinained, the gland being altogether in a state of cancerous ulceration.
Fungo-heenzatoid disease has been found in the pancreas in three cases by Dr. Aber crombie, and in single instances by Dr. Bright and others. Dr. Copland found this lesion in the pancreas of a boy fourteen years of age ; several other organs were also affectedby it.* e. Calculous concretions in the pancreatic duct and its branches are by no means uncotnmon, and appear not unfrequently to be the cause of some of those morbid changes that have been already noticed. Sometimes they are manifestly in the duct ; at others, though pro bably primarily so, they appear, from oblite ration of the duct in which they were lodged, to be in the gland substance. They are usu ally white, but occasionally black ; they vary much in shape, being sometimes round, and sometimes irregular ; their size ranges from that of a pea to that of a small walnut, and their number from one to twenty ; sometimes they are scattered throughout the gland, sometimes aggregated in a mass. Gendrin mentions that the pancreatic duct is some times clogged, not with distinct concretions, but with a chalky powder. In respect to chemical composition it seems probable that pancreatic calculi are liable to some varia tions. Dr. Pembertont mentions having re ceived one from Dr. Baillie from the human pancreas which consisted entirely of carbonate of ; whereas, one from the ox analysed by Dr. Wollaston turned out to be phosphate of lime. Portal mentions that in a case in which he met with a dozen of light, round, whitish calculi in the pancreas, he found that when he reduced one or two to coarse powder, and threw this into boiling water, it readily dissolved ; and Fourcroy states, as the result of his examinations, that pancreatic concre tions are composed of phosphate of lime coat bitted with smne animal !natter, just as is the case with salivary calculi.