PANCREATITIS: AN ANALYSIS OF TYPES AND CAUSES *

T H E picture brought to mind by the term acute pancreatitis is that of a necrotic, hemorrhagic gland, in the extreme state gangrenous, which has pro-duced an upper abdominal catastrophe with severe pain and tenderness, col-lapse and death. In fact the very names used to designate acute disease of the pancreas carry the significance of extreme disease, thus acute hemorrhagic pancreatitis or, more recently in usage, acute hemorrhagic necrosis, whereas in actual anatomical study neither hemorrhage nor necrosis of conspicuous degree need be found. Consequently, the older name, acute pancreatitis may still be considered a better one to designate the class, reserving qualifying terms for use when they are appropriate. Since Opie1 reported the production of acute hemorrhagic pancreatitis by a gall stone lodged at the ampulla of Vater in such a way as to convert the biliary and pancreatic ducts into a common channel for the flow of bile into the pancreas, the usual conception has been that the mechanics of th