670 



BURRILL B. CROHN 



the disease showed an ability to absorb over 90 per cent of the fat ingested, 

 though the intake here was 101 gms. or double that of the preceding case. 

 It is just such contradictory facts that make it so difficult to deduce con- 

 clusions. 



TABLE III 

 FAT AND NITROGEN EXCRETION IN CHRONIC PANCREATITIS 



Chronic pancreatitis these were cases of simple primary cirrhosis of 

 the pancreas or of interstitial pancreatitis secondary to neoplastic obstruc- 

 tion of the Wirsungian duct. The fat losses range from 5.6 per cent to 6.9 

 per cent, averaging again 39.8 per cent, a rather high figure for the latter. 

 In most of these cases a complete atrophy of the gland is present. It would 

 appear, however, that the mere presence of the gland in the body is a highly 

 efficient means for preserving at least a fair degree of absorption. This 

 fact is emphasized in the article by McClure, Vincent and Pratt who 

 state: "After the complete removal of all pancreatic tissue from an ani- 

 mal, the absorption of considerable amounts of fat can still take place." 



In a case of Crohn, there was present a primary intralobular cirrhosis 

 of the pancreas : the ferments in the duodenal content were present very 

 weakly. At autopsy, a primary connective tissue proliferation was seen 

 invading the acini of the gland, destroying the secreting tubules and caus- 

 ing a cicatricial stenosis of both main pancreatic duct as well as of the 

 common bile duct in its course through the head of the organ. No very 

 considerable metabolism disturbance is seen ; fat excretion is 34.7 per 

 cent which in the face of the icterus is not exorbitant and nitrogen loss 

 16.4 per cent. Again, we conclude that it requires a very extensive destruc- 

 tion of the gland to produce the typical metabolism disturbances. Inter- 

 stitial pancreatitis, the more common form, such as is secondary to choleli- 

 thiasis, syphilis, etc., does not apparently give rise to absorption 

 disturbance. 



Pancreatic Calculus and Its Sequel, Table IV. Probably no single 

 cause is more potent in producing an extensive cirrhosis of the gland than 

 is pancreatic calculus; the stone or more usually stones occupy the main 

 duct system, completely blocking the excretion of the pancreatic juice and 



