672 BURRILL B. CROHN 



metabolism, for even in this extensive neoplastic destruction of the paren- 

 chyma of the gland protein metabolism does not suffer so extensively as 

 does fat digestion. 



That metabolism suffers in proportion to the incapacitation of the 

 parenchyma is apparent in the observations of the author in a case previ- 

 ously reported (Crohn(c) ) in which the diagnosis of carcinoma of the head 

 of the pancreas was made by duodenal content analysis (total exclusion of 

 bile and ferments). For several weeks no marked disturbance took place ; 

 but as later the new growth invaded and destroyed gradually the entire 

 gland, typical fatty stools, and creatorrhea made their appearance. The 

 destruction of the gland was confirmed by careful autopsy study. Fried- 

 rich M tiller (a), whose absorptive experiments are the first known to us, de- 

 scribed cases of complete absence of pancreatic juice from the bowel with- 

 out fatty stools (steatorrhea). Franke found that after surgical removal 

 of a carcinoma involving the head and body of the pancreas, no glycosuria 

 or fatty stools were produced, apparently sufficient of the processus lienalis 

 remaining to maintain metabolism balance. This remarkable surgical 

 experiment confirms similar experimental procedures on dogs. 



That there is no mechanism in the body that can take over the func- 

 tion of the gland is shown by the fact, pointed out by Allen (a), that Sand- 

 meyer's dogs, with only atrophic remnants of gland remaining, gradually 

 developed in the course of many months glycosuria and impaired food 

 metabolism. 



The carcinoma cases in human beings are analogous examples. 



Friedrich Miiller held that the poor absorption was due to poor diges- 

 tion and preparation of the food in the intestine, as evidenced by dimin- 

 ished saponification; later observers have refuted this contention. 

 Brugsch (d) experimentally demonstrated normal protein metabolism and 

 amino-acid formation in dogs with ligated ducts; and numerous experi- 

 mental and clinical observers have shown normal percentage of fat splitting 

 and saponification in the intestines in pancreatic disease (Brugsch, Tile- 

 ston, Pratt and others). 



The claim of Bondi and Bondi that epithelial degeneration took place 

 in the mucosa of the intestinal tract has found no confirmation and few 

 believers. Nor will interference with intestinal and gastric motility ac- 

 count for the symptoms of disturbed nutritional equilibrium as suggested 

 by Brugsch (d] and others. 



Attempts have been made to explain the maintenance of food absorp- 

 tion in cases with duct obstruction, on the basis that absorption from the 

 obstructed ducts of the stagnant though active ferments takes place, with 

 re-excretion through the intestinal wall. Pfliiger and Abelmann were the 

 main exponents of this doctrine. Experimentally at least, when the ducts 

 are tied, trypsin is absent from the intestine ( Brugsch (d), Werzberg, Lorn- 



