664 BURRILL B. CROHN 



whether in disease of the pancreas and blockage of the main duct, the ac- 

 cessory duct cannot, take over its function and maintain in that way the 

 permeability of the duct system. In the dissection of fifty cadavers, Clare- 

 mont has shown that in 76 per cent of the cases the duct of Santorini is 

 either failing anatomically or, when present, is functionally inactive and 

 impervious. In 4 per cent of the cases, the Santorini duct was independent 

 and pervious but drained only a small fragment of the gland. In most 

 of the other cases, both main and accessory ducts were closely related and 

 communicated the one with the other, so that a disease process that 

 affected one would undoubtedly have affected the other. The actual autop- 

 sies in cases of diseases of the pancreas have practically always failed to 

 find an active patent accessory duct taking over the function of the dis- 

 abled main duct. Pratt (6) mentions one instance only wherein this was 

 observed. 



One meets in the literature metabolism studies on cases in which the 

 diagnosis of pancreatic disease rests solely upon the basis of certain clinical 

 tests or on the outcome of one or more of the various laboratory procedures 

 for establishing such a diagnosis. Among the more important of these are 

 the presence of an excess of neutral fat in the stool causing the classic pic- 

 ture of "fatty stools," and the presence of an abundance of undigested 

 muscle fibers (crcatorrhca). 3 Ad. Schmidt devised a test based upon the 

 inability of the intestine in pancreatic disease to digest the nuclei of muscle 

 tissue (beef-cube test) ; this test was modified by Kashiwado who utilized 

 thymus gland and demonstrated in the feces the undigested and undis- 

 solved cells and nuclei. On a similar plan are the tests of Sahli who 

 utilized a gelatin capsule containing iodoform, or salol, the capsule being 

 dissolved supposedly only in the intestine and in the presence of pancreatic 

 ferments (trypsin). 



More recently attempts have been made to test directly for the presence 

 of the pancreatic ferments in the stool, in the urine, the blood and in duo- 

 denal or stomach contents. An olive-oil breakfast was utilized by Volhard 

 to induce regurgitation of duodenal contents into the stomach, the material 

 extracted being examined for tryptic activity. The diastatic activity of 

 the feces and of the urine were made the basis of a test introduced by Wol- 

 gemuth, and amplified and observed by Wijnhausen(6), Gross(er), T. R. 

 Brown(o.), and others. By this latter method, obstruction or disease of 

 the pancreas is evidenced by an increased amylolytic activity in the feces. 

 These latter methods of direct examination for pancreatic ferments, while 

 promising much, have failed of being decisive or giving clear-cut indica- 

 tions of pancreatic disease. 



Of late it has become possible to obtain directly the contents of the 

 duodenum by means of a specially devised tube (Einhorn(a), Gross(6), 

 Hemmeter), and thus to test for the presence or absence of pancreatic 



3 These phenomena will be separately considered in a later section. 



