676 BURRILL B. CROHN 



Gross (a) and Brugsch. Those to whom the importance of the external 

 secretion is paramount include Pfliiger, Burkhardt, and Visentini ; Pratt 

 and his co-workers have never failed to emphasize the importance of the 

 pancreatic juice reaching the intestine as the main factor in maintaining 

 metabolism balance. 



Allen says : "Neither of these hypotheses can be considered as fully 

 established, and probably neither can be accepted in full form. The first 

 gives suitable consideration to the external function of the pancreas, which, 

 if not indispensable, is yet highly important. The second probably goes 

 too far in attributing to the pancreas a special function governing absorp- 

 tion, but is correct in assuming that the pancreas has several 'functions, 

 some of which may perhaps be performed by the acinar cells." 



One specific internal secretion of the pancreas is conceded, namely, 

 the hormone that regulates carbohydrate metabolism. Complete pancrea- 

 tectomy invariably gives rise to severe diabetes, as the fundamental work of 

 von Mering and Minkowski(a), and Sandmeyer has proven; the retention 

 of as little as one tenth of the gland will prevent total diabetes. Further- 

 more, while not absolutely proven, the control of sugar metabolism is 

 conceded to reside in the islands of Langerhans. 



Yet there is no relationship between the clinical evidence of disturbance 

 o;f the internal secretion that controls carbohydrate metabolism and that 

 that controls intestinal metabolism. Only a small percentage of cases of 

 well defined pancreatic disease have glycosuria (Fitz 11 out of 29 cases) 

 and surely only the very rarest case of diabetes shows a disturbance of 

 fat and nitrogen absorption indicative of pancreatic disease. If the carbo- 

 hydrate regulatory function resides in the islet cells, then the absorptive 

 hormone must be secreted elsewhere, and probably as a function of the true 

 acinar cells of all, or of some part of gland. 



That some other tissue or gland may function for the pancreas, or 

 participate in its action is suggested by the work of McClure, \ r incent 

 and Pratt who found that in the absence of all pancreatic tissue, some ab- 

 sorption of fat and protein may still continue. 



The Signs of Disease of the Pancreas 



Clinically speaking, disease of the pancreas, however produced, is 

 recognized in its fully developed chronic form by certain characteristic 

 features. These signs include fatty diarrhea, that is numerous large, 

 abundant oleaginous stools containing much partially digested pro- 

 teid material, mainly meat fiber. "Fatty stools" as a symptom of pan- 

 creatic disease was described by Richard Bright in 1833. His own 

 words best portray his meaning: -""The condition to which I refer is a 

 peculiar condition of the alvine evacuation, a portion more or less con- 



