Etiology.—1. Diseases of the blood-vessels—atheroma, fatty degeneration, alteration of the vessel-walls from alcoholism, syphilis, etc.—are to be regarded as the most frequent cause.

2. Fatty degeneration of the gland-cells and excessive fatty infiltration of the pancreas.

3. Fat necrosis.

4. Hemorrhage in pancreatic cysts.

5. Hemorrhages from the disintegration of neoplasms.

6. Hemorrhage from embolism of the pancreatic artery.

7. Trauma.

Pathology.—"The pancreas is dark-red or violet; the meshes of the interstitial tissue are filled with fresh or altered blood; the acini dull gray, usually diffused with blood-pigment. The hemorrhagic masses extend also into the vicinity of the gland, and especially into the retroperitoneal connective tissue. Moreover the whole gland appears softened and friable." (Klebs.)

"The pancreas, as a rule, is enlarged, and only exceptionally is of normal size." (Draper.)

"The hemorrhage may affect the whole organ, or only part of it. In the most severe cases the tissue is completely disintegrated, a gangrenous, dark-red, discolored pulp displacing the pancreas." (Priner.)

Symptoms.—The disease may come on suddenly, while the patient is in apparently good health, by a sudden seizure of colicky pain in the upper part of the abdomen or lower left breast. The pain soon becomes excruciating, and is attended by nausea and vomiting, which soon becomes obstinate, but without affording any relief.

The pulse is small, rapid, and feeble, the surface cold, which becomes clammy as the patient grows worse. There is a painful and extremely anxious countenance; the patient is restless, followed by great prostration, syncope, and death, which usually takes place in from thirty minutes to twenty-four hours.

Diagnosis.—When a patient, who has previously enjoyed good health, is suddenly seized with intense pain in the epigastric region, attended by uncontrollable vomiting and rapid collapse, we may suspect hemorrhage of the pancreas.

Prognosis.—This is almost always unfavorable.

Treatment.—Stimulants, such as the hypodermic injection of strychnia, camphor and ether, or a pint or two of warm salt solution, will bring about a reaction if it is at all possible. To relieve pain, morphia should be given hypodermically.

The Eclectic Practice of Medicine, 1907, was written by Rolla L. Thomas, M. S., M. D.