Metaplastic changes in the visceral pleura in a case of fibrocystic disease of the pancreas.

Fibrocystic disease of the pancreas was first described by Landsteiner in 1905, and it is of interest, that intestinal obstruction was one of the features of his case. Since then, and particularly in the past two decades, many well authenticated cases have been described. Andersen (1938), described three clinicalsyndromes as being associated with essentially the same pathological lesion in the pancreas. The first was characterized by intestinal obstruction in the first week of life (meconium ileus); the second by respiratory infection in the first six months of life; and the third by the development of the coeliac syndrome in later childhood. The division into these types has been generally supported both by authors considering all phases of the disease (Andersen, 1939; Deem and McGeorge, 1941; Jeffrey, 1941; Wolman, 1942; Farber, 1942 and 1943; Markel, 1944; Menten and Middleton, 1944; Baggenstoss and Kennedy, 1945; Pugh, 1945; Andersen and Hodges, 1946; Bodian, 1946; Macgregor and Rhaney, 1948; Torgersen, 1948; Jones, 1949; Matheson, 1949; Andersen, 1949), and by those concerned only with meconium ileus (Dodd, 1936; Sobel, 1941; Sprenger, 1942; Farber, 1944a and b; Swenson and Ladd, 1945; Glanzmann, 1946; Hiatt and Wilson, 1948). The case described here is remarkable for the occurrence of intestinal obstruction at the age of 7 months. It appears to be the first recorded instance in which this feature has developed so late in infancy. Case Report J.R., a boy aged 9 weeks, was referred to hospital on February 29, 1949, from a welfare centre which the mother FIG. had attended because of feeding difficulties. The birth weight was 6 lb. 9 oz. and the infant had been breast fed. From the age of 3 weeks there had been a persistent, troublesome cough with attacks of diarrhoea and failure to gain weight. On admission the weight was 7 lb. 7 oz. The stools appeared green and undigested but pathogenic bacteria were not isolated on culture. The urine was normal and the haemoglobin 76% (Haldane). Stool examinations were negative for trypsin, and radiographs of the chest showed catarrhal changes in both lungs. The diagnosis of fibrocystic disease of-