MAYO ROBSON (of Leeds) was of the opinion that pancreatic affections are much more common than usually suspected. In his judgment, it is important, in cases of suppuration, to reach the pancreas from behind. To reach the principal pancreatic duct, he incises the second part of the duodenum and opens the end of the duct at the papilla. Chronic pancreatitis may resemble cancer closely, not only symptomatically, but to the naked eye on the post-mortem table.
It is important to distinguish cancer of the head from that of the body or tail. Especially in the young, do not too hastily refuse operation because of the belief that the disease is cancer, since, if the disease happens to be chronic pancreatitis, operation will aid recovery. Ablation of the organ for cancer is rarely pos sible or proper, except when the disease is limited to the body or tail, and then only if the operation is done early. But the fact remains that some cases, operated on supposedly for cancer, re covered and are now well, is a proof that the disease was chronic pancreatitis. This fact leads Robson to advise operation in all cases not too advanced, especially in the young or vigorous. In cysts Robson advises incision and evacuation.
A parallel exists between the inflammatory diseases of the liver and pancreas. While accepting Fitz's classification of pan creatitis pathologically, yet Robson, for clinical purposes, divides the disease into the acute, subacute, and chronic forms. Etiologi cally, the cause (both essential and immediate) is bacterial infec tion ; but a number of extrinsic causes may be present, e.g., gas troduodenal catarrh, wounds, lithiasis, etc. Infection almost always enters through the ducts. Robson believes that surgical intervention is as necessary in acute pancreatitis as in any other form, and should be undertaken as soon as the diagnosis is made. If there is much epigastric distention, it is good practice to make an exploratory incision in the left costovertebral angle.
Robson insists on the importance of chronic interstitial pan creatitis, often confounded with cancer and amenable to cure by operation. He believes that this disease is a regular concomitant of stones lodged in the common bile-duct, and that on their re moval it often persists.