On the Occurrence of the Fat-splitting Ferment in Peritoneal Fat Necroses and the Histology of These Lesions

The relation which exists between certain dise~es of the pancreas and fat-necrosis has been emphasized especially by Fitz in his comprehensive studies of pancreatiti8. According to this author ~ disseminated fat-necrosis in the abdominal cavity is comparatively infrequent in the suppurative form of pancreatitis, while it is relatively common in the hmmorrhagic and the gangrenous varieties. Ba]ser,~ who first directed especial attention to this condition, of which he gave a full description, found it in 5 out of 25 autopsies either within the interacinous tissues of the pancreas or in the adjacent or distant adipose tissues. Since this time, fat-necrosis has be6n observed by a large number of pathologists in cases in which gross disease of the pancreas has been wanting at autopsy. In these instances the necroses are limited, as a rule, to the immediate neighborhood of the gland, although at other times they have been found more widely disseminated when such disease of the pancreas existed. Still more recently, and now that acute suppurative or necrotic pancreatitis has become a field for surgical interference, the condition has been encountered at the operating table. The coincidence of disease of the pancreas with the occurrence of fat-necrosis in the peritoneum on the one hand and the proximity of the necrotic areas to the pancreas on the other hand lent support to the view, quite early advanced, that a relation of cause and effect must exist between the gland and this pathological process. The first attempt, which may be regarded as at all successful, to prove this