Chronic Pancreatitis.

Owing to its association with diseases of the digestive apparatus and the insidious manner of its development, chronic fibrous pancreatitis is rarely ever diagnosed during life, hence it is of little clinical interest.

Etiology.—Among the causes giving rise to fibrous pancreatitis may be mentioned suppurative pancreatitis, terminating in induration; syphilis, especially when congenital; alcoholism; chronic inflammation of the pancreatic duct, frequently the result of extension of chronic gastro-duodenal catarrh;, obstruction of the duct of Wirsung by pancreatic calculi; disease of the vessels, such as arterio-sclerosis or cardiac lesions, and from an extension of chronic peritonitis.

Pathology.—The characteristic feature of this variety is the thickening and fibrous transformation of the interstitial tissue, with the destruction or obliteration of the secreting glandular substance. The entire gland may be involved, or only a portion, especially the head. The gland may be greatly increased in size, being double the weight of the normal organ, or there may be a shrinkage of the newly formed fibrous tissue, giving rise to atrophy. In either case there is induration of the gland, which resists the knife like cartilage.

In color, the gland may be normal, although it is more apt to be yellow, or grayish white.

Symptoms.—There are no characteristic symptoms of chronic pancreatitis. For weeks or months, the symptoms are those of catarrhal gastritis, and consist of loss of appetite, nausea, belching, heartburn, or water-brash, and a sense of fullness or weight in the epigastrium. As these symptoms become more pronounced, emaciation, with its accompanying prostration, becomes a pronounced characteristic.

Pain, deep-seated and of a burning or boring character is experienced to the left of the epigastrium. Constipation, alternating with diarrhea, makes the bowels irregular. Ascites frequently occurs in the advanced stages, and jaundice is not uncommon,

A symptom that is regarded by some as characteristic is glycosuria. Enlargement of the spleen is not uncommon.

Diagnosis.—A positive diagnosis is only made post-mortem.

Prognosis.—This is necessarily grave as to a cure, although the patient may live for several years with a degenerated pancreas.

Treatment.—An important part of the treatment is dietetic. Since the pancreatic secretion is necessary to digestion of fats and starches, it naturally follows that this class of food should be restricted. Pancreatin administered after meals will be found useful. Phytolacca, iris versicolor, and Donovan's solution of arsenic will be found of some benefit.

The carbonated waters have been found useful in stimulating the secretion, and, if too much of the organ is not involved, will no doubt favorably influence the case.

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