DISTURBANCES OF PANCREATIC METABOLISM 667 



per cent of nitrogen and 50.16 per cent of fat, a marked increase over the 

 normal. The splitting of the fats was not affected. 



The results so far tabulated record all positive interference with ab- 

 sorption as a result of disease or obstruction of the ducts. The following 

 case of Keuthe seems to be a notable exception. His observations refer to 

 a case of advanced atrophic pancreatitis resulting from numerous pan- 

 creatic calculi. The ducts were destroyed or blocked, as well as the paren- 

 chyma of the gland. The islands of Langerhans seemed well preserved. 

 In this case the fat absorption was 91.2 per cent, splitting of neutral fats 

 into fatty acid and soaps above normal. In spite of the fact that the 

 clinical symptoms of pancreatitis were present, namely, diarrhea, weak- 

 ness, emaciation and intermittent glycosuria, no deficiency in fat ab- 

 sorption was demonstrable. 



This observation is more remarkable since the subject of the experi- 

 ment is the same patient upon whom Glaessner and Sigel four years previ- 

 ously had studied metabolism. (See above.) At that time the latter had 

 found marked interference with fat and nitrogen absorption. 



Brugsch(d) who had contributed some exhaustive experiments on ani- 

 mals had also an opportunity to study the disturbances in human metab- 

 olism. He regards losses of fat up to 45 per cent and of nitrogen up to 11 

 per cent as attributable merely to closure of the common bile duct. 

 Amounts above this figure he considers as due to pancreatic disease. Thus 

 in a case of carcinoma of the pancreas (duct blocked) with absent ferments 

 in stool and regurgitated stomach contents, he found a fat loss of 60 per 

 cent and a nitrogen loss of 36 per cent. At autopsy the entire gland tissue 

 was diseased. 



Similarly in a case of Albu's in which the whole gland was replaced 

 by scirrhus carcinoma, only 21 per cent of fat was absorbed ; .the stools were 

 typically fatty and contained a large excess of undigested muscle fibers. 



These last two reports are very instructive; in the first, there was a 

 blockage of the duct and a pathological change of the parenchyma. In 

 the second case (Albu) the destruction of the entire parenchyma is re- 

 flected in the enormous fat loss in the stool. 



In a series of five authenticated cases (Tileston) in which both ducts 

 were closed by carcinoma at the head of the pancreas fat absorption was 

 distinctly impaired ranging between 24.4 per cent and 51.9 per cent ; nitro- 

 gen absorption ranged between 38 per cent and 85.5 per cent. Blockage 

 of the ducts, with the apparently necessitated atrophy of the glands, thus 

 seems to produce a real disturbance in the absorption. Tileston is willing 

 to accept a 50 per cent fat loss as attributable to the jaundice, but regards 

 everything above this as a sequel of pancreatic disease. 



Oskar Gross (a) studied carefully two cases of chronic pancreatitis, one 

 of which, at autopsy, had pancreatic calculi and atrophy of the gland. 

 Nitrogen absorption was 51 per cent, 68.9 per cent and 63.5 per cent; fat 



