DISTURBANCES OF PANCREATIC METABOLISM 675 



sin). The fact of the matter is that even the absence of trypsin from 

 the stool is not pathognomoiiic of pancreatic disturbance since Pratt(fe) 

 found it absent more than occasionally in normal individuals. Nor does 

 the absence of digestion of the cell nuclei in the Schmidt or Kashiwado 

 test necessarily indicate pancreatic disease, particularly when diarrhea is 

 present (Brugsch). 



In one case of achylia gastrica, with fatty stools, Junghans found tryp- 

 sin absent in the duodenal contents ; Von Kem and Wiener describe 

 a similar clinical case but without any corroborative chemical data. Gross 

 (d) pins his faith on the stool tests for trypsin, which he finds present in 

 practically all disturbances and diseases, even intestinal disease. There- 

 fore, in a case of total achylia gastrica with diarrhea, in which fecal tryp- 

 sin was absent, he attributed the diarrhea to the diminished functional 

 activity of the pancreas. Bittorf attributes the occasional diarrhea of 

 achylia gastrica to thyroid overactivity as influencing intestinal motility. 

 He denies the pancreatic etiology as a factor and says that achylia pan- 

 creatica is the rarest of phenomena. 



It is important to note in the literature the array of data against the 

 view of functional hyposecretion of the pancreas. Doblein, using stool 

 tests for trypsin, Koziczkowsky, Eiiiliorn(&), Okada, and Crohn found 

 normal duodenal ferments in cases of complete achylia gastrica. 

 H. Strauss found intestinal metabolism quite normal in cases of apepsia 

 gastrica. 



The general evidence, including metabolism studies, and the newer 

 methods of duodenal content analysis, tend to throw much doubt on the 

 existence of a functional pancreatic achylia. It is far safer as in the cases 

 of Schmidt(a), of Junghans and of Spriggs and Leigh to attribute the 

 metabolism disturbance (steatorrhea) to a pancreatic cirrhosis and atrophy. 

 In fact Schmidt in his later paper, and Spriggs and Leigh, though entitling 

 their contributions as pancreatic insufficiency, both concede a pancreatitis 

 as the basis of the phenomena observed. 



The Theory of an Internal Secretion of the 

 Pancreas that Controls Food Absorption 



Many data have been advanced favoring the theory of the control of 

 pancreatic digestion by an internal secretion of that gland. Conceding 

 the importance of the external secretion of the pancreas for the reduction of 

 proteoses and peptones to amino-acids, and the saponification and splitting 

 of fats, there is still much evidence that favors the view that absorption 

 from the intestinal tract by means of the mucosal epithelium and the 

 lacteals is under the control of an internal secretion or hormone. Favoring 

 the hormone theory have been Lombroso(a), Fleckseder, Rosenberg, Oscar 



