Progress in the Diagnosis of Pancreatic Diseases

Abstract

A modern physician, when reading the papers of the nineteenth century and the first twenty years of the twentieth, may be astonished by the limited approaches to diagnosis then available: a detailed history, palpation, observation of the patient’s general condition, measurement of vital signs, especially body temperature, and a rudimentary urinalysis were practically the only diagnostic approaches. There was an almost complete absence of biochemical determinations and tests of function and, for practical purposes, simple roentgenograms were unavailable, not to mention advanced imaging techniques. Diagnosis was difficult, uncertain, and often without a rational basis. After the discovery of general anesthesia in 1843, exploratory laparotomy often became the only means to escape the diagnostic dilemma. Most diagnoses were made at autopsy. In such a milieu, autopsy became not only the major modality of diagnosis but also the principal basis of clinical teaching, including the “continuing education of the physician.” Autopsy was the important modality of retrospective diagnosis long before the introduction of the microscope revolutionized the contribution of the pathologist.

See also Chapter 3, “The Endocrine Pancreas.”