668 BURRILL B. CROHN 



absorption between 45 and 50 per cent in the first case, and over 70 to 

 73.8 per cent in the second case. This also in face of the fact that Gross 

 forced huge amounts of fat in his test diets. Apparently, while some dis- 

 turbance takes place, even in advanced chronic pancreatitis some func- 

 tional ability to absorb food is always retained. 



Ehrmann and Kruspe emphasize particularly the nitrogen loss in 

 a case of chronic sclerosing pancreatitis with stricture of the duct of Wir- 

 sung. This loss amounted to over 34 per cent and corresponded to the 

 marked diminution in trypsin in the intestinal tract. They refer all 

 changes in fat and nitrogen absorption to the obstruction of the duct and 

 deny the theory of the control of absorption by an internal secretion. 



Pratt found a fat loss of 58.9 per cent in a case of chronic pancreatitis 

 with obstruction of the ducts, and a fat loss of 79.9 per cent in a case of 

 cancer of the pancreas with occlusion of the ducts. Pratt mentions one case 

 of carcinoma wherein a patent accessory duct of the Santorini was found ; 

 here the fat loss was only 28.8 per cent. 



In a most typical case of pancreatic insufficiency due to chronic pan- 

 creatitis Spriggs and Leigh observed oily defecations amounting in weight 

 to the enormous figure of 1,000 to 2,649 grams. Fat excretion ranged be- 

 tween 55 and 99 per cent of the fat intake. 



Crohn(c) found in a case of acute pancreatitis with entire destruction 

 of the body and tail of the gland but preservation of a portion of the head, 

 that fat absorption suffered but little, 91.6 per cent of the ingested fats be- 

 ing absorbed. In neither chronic pancreatitis nor carcinoma of the head 

 of the pancreas were severe disturbance seen. In all of his cases, the 

 pancreatic ferments were tested for in the fresh duodenal contents removed 

 by duodenal tube; the ferments were uniformly either absent or only 

 weakly present. 



In discussing and critically reviewing this list of observations it is 

 essential to again remind ourselves that in many of the cases no mention is 

 made of the patency of the duct at the time of the metabolism study; 

 that many cases were not observed at autopsy, the clinical diagnosis alone 

 determining the nature of the malady. Even autopsy descriptions often 

 fail to detail the condition of the gland, and microscopic studies are rare. 

 Under these handicaps, it is generally agreed that conclusions are unsatis- 

 factory and often confusing. 



In order to facilitate a study of the data in the literature the cases pub- 

 lished have been tabulated and are presented in tables 1, 2, 3, 4, and 5. 



Thus arranged in groups one may attempt to draw certain conclusions. 



In simple closure of the nancreatic duct (Table I) wherein it has 

 been shown by ferment studies or by pathological examinations that the 

 pancreatic secretion has been excluded from the bowel, we will note that 

 fat losses vary from 19.7 per cent to as high as 73 per cent, and nitrogen 

 loss from 25.4 per cent to 50.9 per cent. Thus there appears to be a defi- 



