DISTURBANCES OF PANCREATIC METABOLISM 670 



crease of diet can be made to bring out fatty stools, and undigested meat 

 fibers. 



Ad. Schmidt very recently makes the statement that fatty stools are 

 more often and earlier a sign of chronic pancreatitis of gall-bladder origin. 

 Tileston found typical "butter stools" in three out of six cases of pan- 

 creatic duct obstruction due to carcinoma ; however, in all six cases, micro- 

 scopic examination of the feces, when carefully and repeatedly performed, 

 showed creatorrhea and steatorrhea to be present. 



The Fractional Composition of the Fecal Fat in 

 Pancreatic Disease 



Normally fat appears in the feces in three forms, namely, neutral fat, 

 fatty acids and soaps. The fat of the food is practically all in neutral 

 form, the digestive splitting of neutral fats into its component fatty acids 

 and soaps is regarded essentially as a function of the pancreatic juice, 

 more particularly of its lipolytic ferment, steapsin. 



In determinations on feces of normal individuals, Miiller(a) found the 

 proportions as follows: neutral fat 24.3 per cent, fatty acids 35.3 per 

 cent, soaps 40 per cent. That is, neutral fat composed about one quarter 

 of the fecal fat. 



In his early analysis of the feces of cases of pancreatic disease, Miiller 

 laid much stress on the disturbance in ratio between these three fractions. 

 He asserted that there was a shifting of the index of fat splitting, so that 

 more fat appeared in the neutral form. In pancreatic disease he observed 

 the percentage of unsplit or neutral fat to rise to 50 to 77 per cent of the 

 total fecal fat. He made an important diagnostic point of this observa- 

 tion. 



Weintraud found 76.8 per cent and 72.5 per cent as neutral fat in two 

 cases of pancreatic disease. Ehrmann found 57 per cent of the fecal fat 

 as split fats, Fitz(c) in 9 of 11 cases in the literature found neutral fat dis- 

 tinctly greater than normal in pancreatic disease. These higher figures for 

 unsplit fats are not confirmed by most of the other authors in the litera- 

 ture. Pratt (&) in 4 out of 7 cases found splitting slightly deficient, but 

 not enough to be of diagnostic importance. Gross (a) found 65 to 87.5 per 

 cent of fats split, Deucher 80 per cent, Keuthe 92.3 per cent, Albu 92 per 

 cent, and Brugsch in only one case out of 15 found fat splitting under 70 

 per cent in pancreatic disease. Spriggs and Leigh found from 80 to 94 

 per cent of fat splitting in a well studied case of atrophy of the pancreas. 



Experimentally, Brugsch found normal splittt.ing at different levels of 

 the intestinal tract of dogs in which the ducts had been tied and the pan- 

 creas caused to atrophy. 



Under these circumstances, it is natural to conclude that the fainter 



