juice, constituting at the moment of mixture
a white liquid with an alkaline reaction, had,
five or six hours afterwards, acquired a re-
action distinctly acid. In examining what
had taken place, it was easy to show, by the
ordinary means, that the fatty matter had
been decomposed into glycerine and a fatty
acid. In the test-tube in which the butter
had been subjected to the action of the pan-
creatic fluid, the butyric acid was easily
recognised, even at a distance, by its charac-
teristic odour. Bernard then goes on to prove,
by the method of elimination, the unicity and
propriety of this property of the pancreatic
secretion, by showing that no other fluid in
the body bile, saliva, gastric juice, serum,
the cephalorachidian fluid is capable of ex-
citing it : all these fluids mixed with the
various fatty matters failed in producing an
analogous effect in any degree.
This instantaneous emulsion, however, of
neutral fatty matters, and their separation
into glycerine and a fatty acid, is only effected
by normal pancreatic juice ; that is to say, a
pancreatic juice, alkaline, viscid, and coagu-
lating in a mass by heat or the strong acids.
If, on the other hand, the oil is mixed with
a morbid or altered specimen of the secretion
that is, watery, without viscosity, and not
coagulating by heat, its action on the fatty
matters is nil, and a speedy separation takes
place between the inert pa'ncreatic fluid and
the unmodified fatty matter.
Taking as a postulate the admitted fact,
that it is the white, opaque, milky chyle alone
that contains fatty matter, Bernard then pro-
ceeds to show by experiments on the living
animal, that fatty matter thus modified alone
finds its way into the lacteals, is alone ab-
sorbable, and that it is the pancreatic juice
only that is capable of effecting this change.
In all dogs killed in mid-digestion of fatty
aliments, the fat was merely fluidified by the
heat of the stomach, retained all its charac-
ters, and, on the application of cold, congealed
on the surface of the gastric juice like the
fat on broth. In the intestine, on the con-
trary, below the openings of the pancreatic
duct, the fat could not be distinguished by
these characters, but formed a pultaceous,
creamy, emulsive material ; and the lacteals
were gorged with a white, homogeneous,
milky chyle. But when the pancreatic ducts
were tied, the fat remained unaltered in the
intestine, and the lacteals contained nothing
but a limpid chyle free from all fatty material,
which had ceased to be absorbed in con-
sequence of the abstraction of the pancreatic
secretion.
Furthermore, in the rabbit (in which, by
an arrangement altogether exceptional, the
pancreatic duct opens into the intestine at a
distance of 10 or 12 inches from the pylorus),
another proof of the same fact may be ob-
tained without any ligature or mutilation.
If a rabbit be crammed with lard, and the
intestines examined in mid- digestion, the fat
contained in the small intestine above the
opening of the duct will be found unchanged,
while that immediately below and downward
has undergone the emulsifying process. The
lacteals, also, above that point are filled with
a limpid chyle, while those arising immediately
below are conspicuous for their milky, opaque
contents. It is impossible, as Bernard says,
to find, in the whole range of experimental
physiology, a more elegant and simple method
of proof.
The tardiness of physiologists in the dis-
covery of this function may be explained,
Bernard thinks, by their minds being pre-
occupied with the false notion that the pan-
creatic secretion was analogous to the saliva ;
and the assignation of this function to the
bile by Sir Benjamin Brodie, he accounts for
thus. Brodie performed his experiments on
cats, and found that, after ligature of the cho-
ledoch duct, the lacteals contained no fat, and
that the chyle was limpid and transparent.
Shortly after, Magendie, with the view of
verifying these experiments, repeated them
on dogs, but found that the absorption of the
fat and the whiteness of the chyle were in no
way interfered with by the ligature of the
gall-duct. Now in cats the pancreatic duct
joins the choledoch before it enters the intes-
tine ; so that it is conceivable that Sir Benj.
Brodie, having only in view the action of the
bile, and attaching no importance to the pan-
creatic canal, had tied the one with the other :
and thus the absence of fatty matter in the
chyle may be explained. But in dogs the
choledoch is completely separate from the two
pancreatic ducts, so that after its ligature the
flow of the pancreatic juice remains perfectly
free, the fat continues to be emulsified, and
the chyle to possess its characteristic white-
ness. These experiments, therefore, are en-
tirely in accord, and the difference of their
results is strictly assignable to the different
disposition of the ducts in the animals on
which they were respectively performed.
Some little time ago, while engaged with
Dr. Todd in some investigations upon this
subject, I tied the gall-duct in some score of
dogs, and invariably found that its ligature in
no way interfered with the absorption of the
fat and the perfect elaboration of the chyle.
As long as the supply of the pancreatic secre-
tion was not interfered with, the emulsifying
of the fat was complete, and its absorption
entire. I also repeated Bernard's experi-
ments on rabbits, and obtained results in
perfect accord with his views. I injected
melted lard into the stomach, then gave them
a meal of green food, and killed them in three
or four hours. The point of im mergence
of the pancreatic duct was most distinctly
that of the commencement of the opacity of
the chyle : the lacteals above were filled with
a fluid clear and limpid.
PANCREAS.
107
But these views, so neat and complete in
themselves, and so nicely put forth by Ber-
nard, have of late been vigorously assailed by
the German school, and their fidelity and
conclusiveness altogether impugned. Frerichs,
and Bidder and Schmidt, have, by a repetition
of Bernard's experiments, as well as by many
ingenious and well-devised ones of their own,
failed to verify any of his results, but have been
led by them to conclusions with which they are
altogether discrepant. These experimenters
state that they carefully followed all Bernard's
directions they tied the pancreatic duct,
and, having previously kept the animals on
short food from twelve to twenty-four hours
so that there might be no remains of the se-
cretion in the intestine, fed them with fatty
aliment, and killed them in from four to eight
hours. They always found the lacteals
"most beautifully injected, and the recep-
taculum chyli distended with milky chyle."
Frerichs found on tying the small intes-
tine some distance below the opening of
the pancreatic and bile ducts in cats and
puppies, and injecting into the bowel below the
ligature olive oil and milk, that after two or
three hours the lacteals were filled with white
chyle. He, however, believes that he has
found the extreme comminution of fat, and
hence in some measure its resorption, pro-
moted by the bile and pancreatic juice; for
when in cats that had long fasted, he cut
through the small intestine near the middle,
injected olive oil into both halves, and tied
the two cut extremities, he found the lacteals
springing from the upper part of the intestine
always far more injected than those proceed-
ing from the lower, which he attributes to the
bile and pancreatic juice having access to the
fat in the upper portion.
With regard to the permanence of the
emulsion produced by the mixture of pan-
creatic juice and fat out of the body, Fre-
richs and Bernard are quite at issue; for
while Bernard states, that on being examined
fifteen or eighteen hours afterwards, it was
found to be perfectly maintained, Frerichs
affirms that the particles of oil soon separate
again on the surface.
There certainly are some circumstances
which detract from the conclusiveness of Ber-
nard' s experiments : one is, that the chyle
contains far less fatty acids than the ordinary
neutral fats ; another, that other animal
fluids, as soon as they begin to putrefy, cause
a similar decomposition of the neutral fats j
another, that Bernard's experiments merely
had reference to the production of this change
out of the body. This last deficiency has been
filled up by Lenz.* He fed healthy cats with
fresh butter, or, if necessary, injected it into
their stomachs, an.l killed them in from six
to fourteen hours afterwards. Although all
the lacteals and the thoracic duct were dis-
tended with milky chyle, no trace of butyric
acid could be detected in the stomach and
intestinal canal, or in the thoracic duct, the
* De Adi pis Concoctione et Absorptione. Inaug.
Diss. Dorp. Liv. 18oO.
portal vein, or gall-bladder. By further ex-
peri nental investigation, he found that the
metamorphic action was hindered by the acid
gastric juice in proportion to the amount of
free acid present, that a similar action might
be artificially induced by other acids, as di-
luted lactic, tartaric, and acetic acid, and that
it might be overcome by neutralising the free
acid by bile, or by an alkali. Hence he con-
cluded, that it is only in exceptional cases that
the pancreatic fluid* decomposes the neutral
fats into acids and bases in the living body.
The argument derived from the experiment
on rabbits has been thus explained away by Bid-
der and Schmidt. They say that if the rabbit is
killed two hours after the fat has been given
it the lacteals given off between the pylorus
and the mouth of the pancreatic duct^ are fully
distended with white chyle very rich in fat ;
if not till four hours after the injection, the
lacteals situated about three or four inches
above the mouth of the duct are still filled ;
if at six hours, those only below the duct con-
tain white chyle ; and if not till eight or ten
hours after, the first lacteals well injected with
milky chyle are found to be situated ten or
twelve inches below the duct. Hence it must
have been by always killing the animals six or
eight hours after feeding them with fat, that
Bernard was able apparently to maintain his
view. The facts of the case, say they, were
simply these. The chyle had already passed on-
wards from the lymphatics proceeding from the
first portion of the duodenum, and there was no
more fat to be absorbed in that portion of the
intestine when Bernard began the investiga-
tion. I cannot admit the correctness of this
explanation given by Schmidt and Bidder,
because some of the rabbits on which I re-
peated Bernard's experiments and verified his
results were killed within four, or even three
hours after the injection of the lard.
It was formally maintained by MM. Ber-
nard and Barreswill, that the pancreatic juice
when acidified had an equally solvent power
on the precipitated protein compounds with
the gastric juice, and that its acidity or alka-
linity alone determined whether it should act
on albuminous or amylaceous matters. This
opinion has also been refuted by Frerichs.
Lastly, this physiologist ascribes to the pan-
creatic fluid a peculiar power of hastening the
conversion of the bile into insoluble products,
and so favouring its more perfect elimination.
This view has been completely overthrown by
the experiments of Bidder and Schmidt, who
have shown, first, that the greater part of the
bile is not thrown off with the faeces, as
Frerichs believes ; and, secondly, that the
lime, to which Frerichs especially ascribes
this power, only exists in very subordinate
quantity in the pancreatic fluid.*
In taking a review of all that has been done
with regard to the functions of the pancreatic
secretion, we must admit that the only one
that has been established beyond dispute is its
sugar-making action on amylaceous matters.
* British and Foreign Med. Chir. Review. On the
" Chemistry of Digestion," by Dr. Day.
108
PANCREAS.
The whole subject is singularly full of contra-
dictions and discrepancies, and it must be con-
fessed is also singularly full of sources of
fallacy. If Bernard's description of two kinds
of pancreatic fluid, normal and morbid, be
correct, it may go a great way to explain
why those who, like Frerichs, have experi-
mented with a watery fluid, poor in albumen,
have failed to verify his results, and there-
fore it will vitiate their objections. It is
almost impossible to help seeing something
like a national bias in the adoption of one or
the other set of opinions ; for while Lehmann
follows Frerichs and Schmidt and Bidder, the
French physiologists as implicitly adopt the
views of Bernard, and confirm his results.
Even the action on starch, though a function
of the secretion, can hardly be said to be the
function; for the relative size of the gland
is greater in carnivorous than in herbivorous
animals (the weight being ^^th of that of the
whole body in dogs and cats, and only ^^th
in that of rabbits*), and further, as Bidder
and Schmidt have shown, the greater part of
the amylaceous food of the sheep is con-
verted into sugar before it enters the duo-
denum. With such patent facts as these,
and with objections to Bernard's views so
many and so grave, I feel disposed to adopt
the words of the learned translator of Leh-
mann, and say, that " we may fairly conclude
that the principal uses of this secretion are
still unknown."
V. MORBID ANATOMY.
The interest that attaches to the deranged
anatomy of the pancreas is the interest of ob-
scurity the interest of diagnosis; I may add,
too, the interest of situation ; in fact, it is from
the situation of the organ that the importance
and obscurity of its pathological relations at
once result. Close to the stomach, duodenum,
liver, spleen, kidney, aorta, cava, mesenteric
glands, and coeliac axis, it finds itself in im-
mediate relation with the great vascular, nerv-
ous, 'digestive and absorbent centres of the
abdomen, and may either affect them second-
arily, be affected by them, or furnish a source
of fallacy and doubt as to whether it be it, or
they, or both that are implicated : and while it
is thus placed at the most important point in
the whole range of medical anatomy, its situ-
ation almost completely precludes it from the
advantages of physical diagnosis.
The pancreas enjoys an immunity from
* It is a singular thing that the very reverse of
this fact, the assertion, namely, that the pancreas was
'larger in herbivora than carnivora, was advanced by
Valentin in support of his views of the metamorphic
action of the pancreatic fluid on starch. I had myself
made some extensive tables of the absolute and re-
lative size of the pancreas in carnivorous and
herbivorous animals, and carnivorous and grani-
vorous birds, those of a mixed diet, and in reptiles,
also in young and old of the same species, but they
are unfortunately lost ; all I can say from recollec-
tion is, that in conformity with the statement in
the text, I found the gland largest in carnivora,
smallest in vegetable feeders, and intermediate in
those of a mixed diet; its relative size was also
inversely as the age, though apparently in no re-
gular ratio.
disease greater than most organs, but I be-
lieve this immunity is in part real and in part
only apparent ; for it cannot be doubted that
one reason why the records of its morbid ana-
tomy are so scanty, is that in so large a num-
ber of post-mortems, no examination of the
organ is made at all. It is the last to be got
at, and the cause of death having been as-
certained, its examination is looked upon as
supererogatory ; besides, it is often obscured
and mutilated in the removal of other organs,
and its careful dissection from its situation,
which is necessary to examine it satisfactorily,
is troublesome and not very easy.
Its simplest morbid conditions, and most
common, are those of
a. Quantitatively perverted nutrition hy-
pertrophy and atrophy, induration and soften-
ing; and the commonest of all is,
Hypertrophy. It is difficult to say pre-
cisely at what point hypertrophy of the pan-
creas commences, because the limits within
which the size of the gland may normally vary
are so extensive that a considerable excess
of volume is evidently quite consistent with
anatomical and functional health. Generally,
the hypertrophy is not pure, but is associated
with some induration ; and in the majority of
cases both the induration and hypertrophy
appear to result from chronic inflammation,
giving rise to some increase in the proper
gland structure, but more to an effusion of
lymph between the lobes and lobules by the
partial organisation of which a great increase
in the amount of the interlobular tissue is pro-
duced. This gives rise to an appearance of
intersection by opaque membranous septa,
giving the gland a scirrhoid character; and
hence, by some this morbid alteration has been
considered as the first step towards scirrhous
degeneration, and by others as actual scirrhus.
Whenever the colour of an enlarged pancreas
is deeper and redder than natural it may be
inferred that the hypertrophy is due to this
chronic inflammatory action. Sometimes the
enlargement is slight, sometimes it is very
great. Dr. Fearnside* mentions a case in
which the gland was four times its natural
size, and could be felt as a large tumour
during life, although the- emaciation was not
extreme. The results of the hypertrophy are
very various ; sometimes it gives rise to
jaundice by pressure upon the galUducts ;
to dilatation of the stomach, dyspepsia, &c.,
by pressure on the duodenum and pylorus ;
to occlusion, even, of its own ducts f, and to
many disturbances, functional and organic, oi
neighbouring parts, produced by its altered
volume and relations.
Atrophy of the pancreas, mere diminution of
volume unaccompanied by any other change,
is sometimes idiopathic, but much more fre-
quently caused by neighbouring disease, as
for example, the pressure of some tumour.
Morgagni found the pancreas atrophied from
the pressure of a tumour in the liver. Dr.
Hall found the same condition caused by a
* Medical Gazette, vol. xlvi.
t Copland's Med. Diet, art. Pancreas.
PANCREAS.
109
scirrhous tumour in the mesentery. M.
Guerin observed this lesion produced by a
similar cause. M. Berjaud by aneurism of
the aorta ; and M. Mondiere by scirrhous
pylorus. In some cases it seems to be pro-
duced by arrest of its function, as when
scirrhous disease of the pylorus has put a stop
to the passage of food into the duodenum.
Dr. Wolf mentions a case in which the atrophy
seems to have been produced by the ossifica-
tion of the pancreatic arteries and obstruction
of the duct. I do not know if there are any
symptoms by which idiopathic atrophy de-
clares itself during life, and in those cases in
which it is secondary, the symptoms are those
of the primary disease and not those of the
pancreatic affection. The degree of wasting
is sometimes very great ; Cruveilhier met with
a case in which it did not exceed an ounce in
weight.
Induration. Sometimes the pancreas is
found of a firmer consistence than natural,
without any perceptible alteration in structure.
It lias 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 whether 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 measels. 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. Inflammation. 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 anaemiated 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
surface, producing a general or partial false
capsule, or to the formation of pus in its sub-
stance pancreatic abscess. It is also said to
end sometimes in gangrene.
In consequence of the 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 cord, 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 peri-
tonitis in which pancreatic abscess 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 vein after the
110
PANCREAS.
junction of the inferior mesenteric vein
with it.
The contents of a pancreatic abscess may
be discharged in various directions. Some-
times they escape into the cavity of the ab-
domen; sometimes they pass into the stomach,
and sometimes into the duplicature of the