Pancreatic Calculi.

Concretions in the pancreatic duct occur so rarely that they attract but little interest to the clinician. Out of fifteen hundred autopsies at the Johns Hopkins Hospital, only two cases were found.

They consist principally of carbonate of lime, are grayish-white in color, round in form, and vary in size from that of a small bird-shot to that of a bean. They may be round and smooth, or rough, with prickly spines.

A catarrhal condition of the pancreatic duct, with retained secretion, is the only recognized factor in producing their formation. There is dilatation of the duct, and at times cystic formations, and, in still rarer cases, the formation of abscesses, as the result of the concretions. They may perforate into the stomach, colon, or duodenum.

Atrophy of the pancreas usually follows their presence, and cancer is often associated with them.

There are no characteristic symptoms to suggest their presence, and although there may be sharp, lancinating pains, they will be confused with those due to hepatic colic. The presence of fat in the stools, sugar in the urine, and pain in the left costal border rather than the right, would suggest calculi in the pancreas rather than in. the liver.

The treatment would be surgical.

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