DISTURBANCES OF PANCREATIC METABOLISM 677 



siderable assuming the character of an oily substance resembling fat, which 

 either passes separately from the bowels or soon divides itself from the 

 general mass and lies on the surface, sometimes forming a thick crust, 

 particularly about the edges of the vessel (steatorrhea)." Similar observa- 

 tions have been made by Fles, Oser(fr) and others. 



To be strictly characteristic, the stools should be not only fatty, but 

 large. The average weight of a normal stool (fresh state) of an individual 

 on mixed diet, is 131 gms. (Pettenkofer and Voit(a)) of which 25.9 per 

 cent or 34 gms. is solid substance. Schmidt (a), found normally the 

 weight of fresh stool, collected over a 3-day period, on a prescribed 

 "Schmidt diet," to be as follows : 



Pratt found in two cases of obstructive jaundice with malignant, dis- 

 ease of the pancreas, that the weight of dried feces over a metabolism 

 period of three days was 419 gms. in one case, and 355 gms. in another. 

 In a patient with fatty diarrhea and glycosuria presumably of pancreatic 

 origin but without icterus, the feces weighed 438 gms. 



In a case of pancreatic insufficiency carefully studied Spriggs and 

 Leigh report: "The weight of the largest individual stool (fresh) was 

 1,944 gms. ; the greatest amount of feces passed in 24 hours being 2,649 

 gms." or almost six pounds. 



The stools are rarely watery ; they do not resemble the stools of enter- 

 itis, or of fermentation diarrhea, or of gastrogenous diarrhea originating 

 from achylia gastrica. Pancreatic stools are formed stools, fatty, heavy; 

 liquid oil often runs off the side of the mass or collects on the surface of 

 water. The color is a pale yellowish white or a mixture of clay color and 

 streaks of yellow oil. 



The color is not very different from that of a simple acholic stool, so 

 much so that the attention of Walker was early called to the fact that the 

 bile duct was freely open in one of his cases of pancreatic atrophy, yet the 

 stools were colorless. He attributed this to some chemical reduction of 

 the hydrobilirubin, though it is likely that the high fat content accounts 

 for much of the pallor of the feces. The stools of tropical sprue or of 

 tabes mesenterica may resemble pancreatic stools but the condition is 

 easily clinically differentiated. 



Microscopically, pancreatic stools are seen to contain much neutral fat 

 floating as globules of highly refracting, oily material. Free fat in the 

 feces is pathognomonic of pancreatic disease (providing of course that oil 

 is not being administered either as a food or medication). Obstructive 



