DISTURBANCES OF PAXCREATIC METABOLISM 663 



4. The preservation of a viable graft of pancreatic tissue anywhere in 

 the body, though not connected with the intestinal lumen, serves materially 

 to maintain and preserve absorption. This power is exercised in the 

 nature of an internal secretion. 



5. The degree of secondary atrophy of the pancreatic remnant deter- 

 mines the absorption power of the intestine. 



Disturbances in Human Metabolism Resulting from 

 Disease of the Pancreas or Obstruction of Its 

 Ducts 



We have seen in the preceding section, that one of the most difficult 

 questions to answer during the experimental studies was the one that con- 

 cerned the patency or non-patency of the pancreatic ducts after attempts 

 at artificial production of a complete blockage of pancreatic secretion. 

 This debatable question is carried down with us in a consideration of 

 the metabolism disturbances accompanying human diseases of the gland 

 and its duct system. The literature on the subject abounds with studies 

 of metabolism in pancreatic disease, but always the question arises : "Was 

 the pancreatic disease actively present when so reported clinically, and 

 were the ducts actually blocked at the time when the experiment in metabo- 

 lism was performed ?" This ever recurring question brings into doubt 

 many of the case reports found in the literature. Furthermore, unless 

 an autopsy had been performed soon after the observations had been made, 

 we remain in the dark regarding the state of functional activity of the 

 gland parenchyma at the moment of the experiments. 



A further complication is introduced when we consider that the close 

 anatomical relationship between the common bile duct and the pancreatic 

 duct, causes an obstructive jaundice to be a very common concomitant to 

 the obstruction of the pancreatic duct. Obstructive jaundice gives rise 

 to distinct metabolic disturbances, being itself mainly characterized by 

 a diminished ability on the part of the intestine to emulsify and absorb 

 the fats. In the careful studies of Friedrich Miiller(a), it was noted that 

 simple obstructive jaundice resulted in a diminution of the fat absorp- 

 tion, nitrogen absorption remaining approximately normal. In normal in- 

 dividuals Miiller found the stool to consist of 22.7 per cent of fat; in 

 simple icteric individuals the fat content of the stool rose to 49.1 per cent. 

 Fat absorption in normal persons was found to be 91.1 per cent; in icterus 

 only 45 per cent of the ingested fat was absorbed. Ad. Schmidt (6) found 

 these figures rather high, and reports for simple icterus a fat loss of only 

 25.9 per cent of the ingested fats. 



The arrangement of the main pancreatic duct and the existence in man 

 of an accessory duct, the duct of Santorini, has often raised the question 



