666 BURR1LL B. CROHN 



nitrogen 81 per cent. Fats were split in all cases to the extent of 60-80 

 per cent. 



Weintraud, in a case of pancreatic cirrhosis verified at autopsy, found 

 a fat absorption of 78 per cent and a nitrogen absorption of 55 per cent; 

 there was considerable interference with fat splitting, 72-76 per cent being 

 neutral fat. Glaessner and Sigel in a case of chronic pancreatitis found 

 fat absorption reduced to 43.9 per cent, nitrogen absorption 58.5 per cent. 



The observations of Brugsch are important. He found: 



Fat Abs. N Abs. 

 Carcinoma of pancreas with obstructive 



jaundice 15 per cent 61 per cent 



Abscess of pancreas-jaundice absent 40.3 79. 



Carcinoma of pancreas-jaundice absent 38. 80. 



Closure pancreatic duct-jaundice absent 30. 74.6 



In four cases of closure of bile duct alone (stone, etc.), without par- 

 ticipation of the pancreas in any way, Brugsch estimated a control figure 

 of 55 per cent for fat absorption and 92 per cent for nitrogen absorption 

 in icterus. Brugsch regards any figure for fat absorption of less than 

 40 per cent as due to a diseased pancreas. 



In a case of subacute pancreatitis, Brugsch and Koenig found fat ab- 

 sorption varying from 27.8 to 40.3 per cent ; a few weeks later, when much 

 improved in health, the patient was able to absorb 73.9 per cent of the 

 ingested fat. 



Ernst Meyer, in a case of carcinoma of the pancreas with obstructive 

 jaundice, found nitrogen absorption reduced to 34-41 per cent, fat absorp- 

 tion reduced to 38 per cent. 



The experience of Gigon is instructive, for in a case with pancreatic 

 cirrhosis nitrogen absorption was 57 per cent, fat 79.5 per cent. He con- 

 cluded that pancreatic disease did not materially interfere with food ab- 

 sorption. The exact status of the gland and the question of the patency 

 of the ducts must however remain unsettled in such a case. 



Wijnhausen(a) contributes the first metabolism study in which the fer- 

 ments of pancreas were investigated. He determined in a case of carci- 

 noma of the pancreas that both trypsin and amylase were markedly dimin- 

 ished, indicating an obstruction of the ducts. Under these conditions he 

 found fat absorption only 26.4 per cent, nitrogen absorption 07.1 per 

 cent. 



Ehrmann observed a case of pancreatic cirrhosis with closure of the 

 pancreatic ducts, in which the jaundice had been relieved by a cholecystoen- 

 terostomy. The stools were characteristic of pancreatic disease, that is, 

 they contained a large excess of muscle fibers and were fatty and typically 

 oily in appearance. Mathematically expressed, there was a loss of 42.8 



