GROSS ANATOMICAL DISTURBANCES 523 



referred the occurrence of absorptive disturbances to the absence of the pan- 

 creatic juice, the occurrence of glycosuria to insufficiency of the internal 

 secretory activity of the pancreas. In more recent times this question has 

 encountered confusion in the literature. Naturally there occur disturbances 

 of fat and albumin absorption when the production of pancreatic juice is 

 normal, as in profuse diarrheas of different origin, amyloidosis of the intestine, 

 etc. We know further the disturbances of fat absorption in complete cutting 

 off of the bile from the intestine and also the fat stools in certain forms of 

 Basedow's disease; as important differential criteria against both the last- 

 mentioned forms are, since Friedrich v. M tiller's investigations and the 

 observations of v. Nporden's clinic as to Basedow's disease, the disturbance 

 in fat decomposition that occurs on the cutting-off of the pancreatic juice 

 and again the slight holdings in soaps. To this should be added the fact 

 that in typical pancreatic stools, the creatorrhea, that is the more prominent 

 occurrence of striped muscular fibers, dominates the microscopical picture. 

 With this is associated a more distinct loss of nitrogen by way of the feces 

 than is observed in other disturbances of absorption. Finally there have been 

 worked out a series of methods for demonstrating the absence of a proteolytic 

 or amylolytic ferment in the feces obtained after purgation. Many authors 

 have raised objections to these diagnostic postulates, as they have observed 

 cases of disease of the pancreas in which the characteristic disturbances of 

 absorption were absent, in spite of complete cutting-off of the pancreatic 

 juice from the intestine. Thus Deucher, Albu, Ury, Alexander, Keuthe and 

 Brugsch saw normal fat splitting in pancreatic diseases. Also creatorrhea 

 is sometimes absent. We might suppose that in these cases the other diges- 

 tive ferments have entirely taken over the role of the pancreatic secretion. 

 Brugsch explains that on simple occlusion of the excretory duct of the pan- 

 creas there occur no, or only temporary, absorptive disturbances, but more 

 intense disturbances only when the pancreas is completely degenerated, 

 or the gland tissue is for greater part destroyed through carcinoma or ab- 

 scesses, etc. Then only would loss of fat occur up to 60 per cent, and the 

 nitrogen loss up to 20 per cent. This hypothesis, which has indeed not been 

 based on the examination of a definite case, but has been influenced by the 

 views of Lombroso which we have already criticised, is not decisive. I refer 

 only to the previously mentioned case of Gigon, in which the absorptive 

 disturbances set in suddenly on occlusion by stone and lasted until death. 

 The pancreas cannot degenerate in a day; if, however, it has already been 

 markedly degenerated, we cannot readily see how it can have furnished 

 sufficient secretion up to the day on which the occlusion occurred. Too, it 

 seems especially inappropriate to apply off-hand to human pathology the re- 

 sults of animal experiments, which as we have seen are not as yet fully ex- 

 plained. It would indeed be conceivable that the other digestive secretions 

 in the dogs render the pancreatic secretion less indispensable than in man. 



