OKGANOTHEKAPY AND HOKMONOTHEKAPY 149 



therapeutic applications of the pancreas rest on the utilization of the 

 proteolytic, glycolytic, and lipolytic ferments which are present in its 

 external secretion, the pancreatic juice. 



On the surface it would appear a relatively simple matter to utilize 

 these properties of the pancreas in the treatment of the disturbances of 

 digestion and absorption which result from diminution of or entire 

 absence of these ferments in the intestine. In practice, however, such 

 application is rendered difficult, in the first instance, by the fact that the 

 gastric juice acts destructively on the pancreatic ferments 53 and, in the 

 second place, by the fact that even very large amounts of pancreatic prep- 

 arations, which may be brought into the duodenum without having been 

 destroyed by the gastric juice, 54 do not bring about as complete a digestion 

 and absorption of the food ingested as occurs under the influence of nor- 

 mally secreted pancreatic juice. 



The effect of administration of various pancreas preparations on the 

 digestion of proteids and fats has been very thoroughly investigated, both 

 in animals and in human subjects, in whom, as a result of pancreatic 

 disease or obstruction of the pancreatic duct, the entrance of the pancreatic 

 juice into the duodenum has been completely or entirely prevented. While 

 there are some discrepancies in the findings of the different investigators, 

 they have with few or no exceptions been able to demonstrate that the 

 administration to such cases of very large amounts of pancreatic products 

 brings about a more or less marked increase, especially of the proteid 

 absorption and, to a less extent, of the absorption of fat. 



In Ehrmann's case of chronic pancreatitis the ingestion. of 25 grams 

 of pancreatin per diem was followed by an increase of the nitrogen 

 absorption from 57 per cent to 83 per cent of the nitrogen intake, but the 

 microscopic examination of the feces showed there was still very incom- 

 plete digestion of the meat fibers; in two such cases, Gros observed no 

 effects from the daily ingestion of 5 grams of Pankreon, but from twice 

 that amount obtained a rise of the nitrogen absorption from 50 per cent 

 and 40 per cent to 88 per cent and 70 per cent, but very little improvement 

 in the absorption of the fat. In these two cases fresh pancreas also 

 increased the nitrogen absorption markedly but did not alter that of the 

 fat. Glassner and Sigel obtained better results when large amounts (30 

 grams) of soda were given with pancreatin. Tauber, in seven cases 

 of icterus and cirrhosis of the liver, obtained practically no effects from 

 one gram of pankreon three times daily. In Tileston's case of chronic 

 pancreatitis with diabetes, cirrhosis of the liver, and achylia, the adminis- 

 tration of pancreatin caused an improvement in the absorption of both 

 nitrogen and fat. 



63 The lipolytic ferment is only slightly impaired by the gastric juice. 

 "This can be accomplished by administering sufficient alkali to keep the stomach 

 contents neutral. 



