674 BURRILL B. CROHN 



Achylia Pancreatica, Hypochylia Pancreatica; Pancreatic 



Insufficiency 



Under these various titles have been described cases in which there 

 exists a functional diminution of the external secretion of the pancreas. 

 The clinical or pathological picture was first noted by Ad. Schmidt (6) ; in 

 certain cases of achylia gastrica he attributed the accompanying diarrhea 

 to pancreatic insufficiency. lie studied four cases of achylia gastrica with 

 loose diarrheal movements. The cases were put upon a test diet, known, 

 and now generally employed for the detection of pancreatic disease under 

 the name of the "Schmidt (a) Diet." 4 Upon this diet he observed dimin- 

 ished or absent trypsin in the stool, as well as a positive Schmidt nuclear 

 test. Reasoning from this he takes the stand that the pancreas is at fault 

 and is responsible for the diarrhea. In later years Schmidt (6) describes 

 cases of achylia pancreatica independent of achylia gastrica and associated 

 with steatorrhea. 



Gross (a) is inclined to agree with Schmidt; while he found neither 

 creatorrhea nor steatorrhea to be present, he did find diminution of tryp- 

 sin by stool tests. The point is made by both Gross (d) and Matko that 

 hydrochloric acid medicinally prescribed causes improvement in the diar- 

 rhea, and the loose conclusion is drawn that the improvement results as a 

 sequel to the natural stimulation of pancreatic secretion by its physio- 

 logical excitant, hydrochloric acid. Pratt(fr) is inclined to deny achylia 

 of the pancreas on the basis that steatorrhea and creatorrhea are absent in 

 the achylia gastrica and are essential equivalents to the absence of the 

 external secretion of the gland. Hypochylia pancreatica he suggests 

 as a better name, indicating a partial rather than a total functional sup- 

 pression of pancreatic juice. 



To admit of the fact that pancreatic secretion varies in strength of 

 ferments, in normal individuals or in those mildly sick with various com- 

 plaints, would tend to invalidate much of the work upon which the diag- 

 nosis of pancreatic disease has been founded. Following the teaching of 

 Rehfuss we are free to admit wide ranges of acidity for gastric secretion 

 in normal individuals. The same range of alkalinity may possibly obtain 

 for pancreatic secretion in normal humans, yet the exact chemical work 

 of McClure seems convincing that under normal conditions the ferments 

 of the pancreas are excreted in constant concentration (Crohn(o.) ). Matko 

 speaks of conditions of hypochylia, achylia, hyperchylia pancreatica, etc., 

 though his basis for such classifications is insufficient (stool tests for tryp- 



4 In studying pancreatic disease it is essential that a standard uniform diet be 

 employed. For this purpose the diet proposed by Ad. Schmidt is generally accepted. 

 It consists of 1.5 liters of milk, 100 gins, of zwieback, two eggs, 50 gins, of butter, 125 

 gms. of lean beef, 190 gms. of potatoes, 80 gms. of oatmeal, and contains 2-3 gms. of 

 table salt. 



