ened marrow; small Great numbers of fatty and cartilaginous; liver and all parts gorged; with bile. Head of pancreas a hard' lump, egg size, firmly glued to duodenum; latter deeply ulcerated. Liver enlarged, olivegreen color, gorged! with bile; gall-bladder distended; intestines ulcerated from pylorus to colon, with fungoid excrescences; pancreas had two fungoid tuber-, cles involving twothirds of its structure. Died tympanitic. Died. Preceded by pain in Recovered. Preceded by a severe Result not given. Pain in the stomach; Recovered completely. 9 Dr. Babbington, F. Globular concretions, Sufferings resembled ir- Suffered many years. 1813. 10 Dr. Babbington. F. Related by Sir 4 Everard Home. 11 Mr. Howship, 1809. 12 Dr. T. Turner. 13 Tulpius, 1683. cutting like wax, cream Ran from her as she ritation of gall-stones. Sallow complexion; Not stated; supposed; F. Soft greasy substance, Violent pain in hepatic Entirely recovered after quantity." F. Solid; size of almonds; Hysteria; enormously Recovery. four to eight daily for distended abdomen; great quantities of fe- F. Like melted butter, Frequently had tertian 16 years after she was 14 Tulpius. F. 70 and emaci-"Death found her little else than a juiceless, dried-up corpse." 1 Fabricius Hildanus paid a visit, Aug. 6, 1612, to Dr. Daniels, the most eminent physician of Louisburg, who was well acquainted with this "pious and virtuous matron," and had seen the fat, which she had preserved many years. mellitus; excruciating At first liquid; became Phthisis and diabetes Death. All the intestines F. Both solid and liquid; 17 Mr. Pearson F. 79 looked yellow, and as though soaked in oil; numerous black points; liver healthy; pancreatic duct crammed with white calculi kidneys sound; lungs tuberculated. Death. No disease of intestines or kidneys; liver large, pale, but healthy; no bile. Gall-stones for some Death. tion. F. Large quantity mixed Not mentioned. M. Thirty pounds vomited 21 Dr. A. A. Gould, M. Transparent oily sub- Constipation, followed stance, hardening in by diarrhea; dis- No sectio cada Cæcum much thicken- Had ordinary vomiting From three to nine Very costive; liver in- a 45 23 Dr. W. L. Wells, M. Resembles lamp oil; Shortness of breath; In a few months he 1852. N. Y. Med. Times, Feb. 1854. 24 M. le Dr. de la Tremblaye, 1852. Quoted by Cl. Bernard in the "Mémoire sur le Pancreas," Chapter Third from "Receuil des travaux de la Société Médicale d'Indre et Loire." cooling to wax consist- 6 The solid feces some- palpitation of heart bought a farm, lived epigastric pain, and on it, and in a few tenderness; pain in weeks the daily disright hypochondrium; charge disappeared. A ejection of food; "fe- year afterwards it had ces deficient in bile reappeared only two or generally;" no loss of three times, slightly. flesh; continues at work. Gradual loss of appetite, feebleness and emaciation; vomiting of food, mucosities, and bile; fourteen months after these symptoms a very copious ptyalism, terminating in death in four months; permanent pain in the epigastrium and umbilical region, increased by pressure and vomiting; obstinate constipation during all the sickness, until eight days before death, when there was copious and continual diarrhoea. Autopsy.-Pancreas of ordinary size; its tissue everywhere diseased, except at two well circumscribed points; it had a deep reddish-brown color; its tissue was much softened under the knife; had the same color as externally, rendering the glandular tissue indistinguishable. One of the healthy parts was about a quarter of the head, the other, the eighth of its left extremity, were of a grayish-white color, and of normal consistence. Liver entirely healthy. Stomach and duodenum presented traces of chronic inflammation, with thickening of their coats. Followed protracted Discharge ceases on REMARKS.-The foregoing summary of cases was compiled partly from the reports of Drs. Bright and Elliottson, contained in Vol. xviii. of the Medico-Chirurgical Transactions, and the rest from the various works in which they originally appeared, or journals to which they were transferred. Dr. Thos. Watson, in his Practice of Medicine, states that he has never seen a case of diarrhoea adiposa, and subsequently can only speak of it as observed by others. From this, together with the very small number of cases discovered by a diligent search, it is believed to be an exceedingly rare circumstance, and that the table contains all that have been publicly reported in English and French writing. Of all who have written upon the subject, no one appears to have succeeded in presenting a theory of the origin and source of the peculiar discharge, entirely unobjectionable, or closed against criticism. Till the time of the appearance of the able work of Cl. Bernard, Mémoire sur le Pancréas, various efforts were made to trace it to diseases of different functions or tissues, but each in turn was abandoned by its author, as further experience developed facts militating against it. Bernard's experiments on dogs appear to show that the digestion of fat is wholly arrested by the withdrawal by the pancreatic secretion. But M. Bernard's proofs of this, though strong, and rendering his theory highly probable, rather fail in the ultima ratio; while in the curious experiments of Brunner, published in 1790, in which a large part, if not the whole of the pancreas, was excised or destroyed in the dog, the health and activity of the animal were maintained, and the functions regularly performed for a considerable time afterwards to an extent which is scarcely consistent with the idea that the digestion of the fat was wholly or nearly suspended. Of the twenty-five cases here collected, fourteen died, and of four the issue is not mentioned by the reporters. Eight are stated to have recovered entirely, or to be so far improved as to experience no inconvenience from the symptom. Among the fourteen fatal cases, eight were found to have diseased pancreas, and four were not examined after death.' Of the cases of the preceding table, Nos. 1, 2, 3, 15, 20, 21, 22, and 24 are cited by M. Cl. Bernard, in his Mémoire in confirmation of his views respecting the role performed by the pancreatic juice in the digestion of the oleaginous portions of the ingesta. In his "conclusions upon these pathological observations," he remarks as follows: "We might cite still a large number of cases in which the presence of fat in the excrements has been noticed, without the condition of the pancreas having been made known by autopsy, either because the patients have been restored to health, or because the attention of the physicians has not been awakened to the possible relation of this symptom to derangement of the pancreas. In the case reported by Tulpius (No. 14), the similar discharge alleged to have issued from the bladder with the urine, is believed to have been an involuntary discharge of the oil from the rectum occurring at the same moment, and for which it was mistaken. A similar correction was ascertained, upon close investigation, to be necessary in other instances. "But it is proper for us to remark that these oily evacuations generally occur only in chronic affections of the pancreas, because in acute disorders of that organ the patients have fever, and eat nothing. Mr. Fearnside has noted several cases of acute disease of the pancreas, giving various other symptoms, but in which he remarks the absence of fatty matters, which he is able to explain up to a certain point by abstinence from food, and the consequent. non-ingestion of fatty substances in the intestine. It is in fact impossible to comprehend the evacuation of fatty matters without their ingestion with the food. In many of the cases we have cited, as well as among the lower animals, it was always readily observed that this fatty excretion was in direct relation to the ingesta. If in certain cases this relation has not been established, it is probable that it does exist, for otherwise it would be necessary to admit. that the fat may be evacuated by the intestine, and be derived. from some other source than the food. It is said, it is true, that cases have been observed of the excretion of fatty matters from strumous tumors of the mesentery, with integrity of the pancreas. But these cases are not sufficiently clear respecting any alteration. of the pancreas, and if they do exist, they will not in any manner invalidate those which we have seen, and have reported." 1 From an examination of the cases in the preceding table, there appear several notable objections to the theories of M. Bernard, that these oily dejections are derived wholly from the ingesta, i. e., directly, and that their existence in the intestines depends upon chronic disorders of the pancreas, while acute derangments of that organ are necessarily free from such results. The first objection is, the enormous quantity reported in some cases to have been discharged, amounting in one instance to thirty pounds in twenty-four hours, though in this case it all came via the stomach. Admitting the truth of this statement (and there appears no reason to doubt it), the theory of Bernard is utterly untenable, that it was derived from the ingesta. Besides this, in In allusion to the cases of Dr. Bright and the matters discharged, it is stated by Dr. Chambers in his work on Digestion and its Derangements, "most of course have been thrown away, but one example” (doubtless the second in the preceding table) "which has been preserved in the Museum of the College of Physicians, turned out, when the museum was put to rights in 1850, not to be fat at all. In fact, microscopic examination showed it to be muscular fibre, a lump of meat washed white in its passages through the bowels of a dyspeptic patient." |