680 BURRILL B. CROHN 



lipolytic ferments of the stomach, bile and succus entericus replace the 

 loss of the pancreatic steapsin. Stade showed that under certain condi- 

 tions, gastric juice alone could split fats up to 50 to 60 per cent. The 

 theory that the intestinal bacteria accomplish splitting in the absence of 

 pancreatic juice is refuted by the experiments of Miiller(a) ; he was un- 

 able to obtain more than 9 to 13 per cent of split fats in prolonged experi- 

 ments in vitro. 



Zoja called attention to the low percentage of soaps in the stool of pan- 

 creatic disease, a fact which has been attributed to the diminished cal- 

 cium content of the fat in the disease of secreting pancreas. Hedon and 

 Ville found that after experimental removal of the pancreas in dogs, that 

 soaps disappeared from the stool. Visentini found on tying the pancreatic 

 duct that much fat was lost, most of it as neutral fat and fatty acids. On 

 the other hand, Pratt, Lamson and Marks, Rosenberg and Hedon and 

 Ville found good splitting on tying off the ducts. 



The quantity of soaps in the normal stool varies widely. The chemical 

 methods for analysis of soaps are open to criticism, and it is impossible 

 to deduce from the innumerable analyses in the literature any diagnostic 

 significance in the soap content of the feces. 



Abelmann made the point that in partial extirpation of the pancreas 

 total fat absorption on a moderate fat ration was about 50 per cent ; when 

 the dietary fat intake was liberally increased the fat absorption fell to 

 31.5 per cent. When fat in emulsified form was given (milk) absorption 

 rose to 80 per cent. Sandmeyer, on the other hand, found only 42 per 

 cent of milk fat absorbed, while meat fats varied in absorption between 

 and 78 per cent. Hedon and Ville found that after tying the biliary 

 ducts and performing incomplete pancreatectomy in dogs that only 10 per 

 cent of non-emulsified fat was absorbed, while 22 per cent of milk fat was 

 taken up. 



Some interesting observations have been made by Spriggs and Leigh 

 in a well defined case of chronic pancreatitis. They showed that if the fat 

 intake is doubled, the absorption falls to about half, though the splitting 

 is the same; that the absorption of fat when administered as new milk 

 reaches a much higher figure than when given as cream or butter (non- 

 emulsified form). Hence it is not the character of the fat but its form 

 (emulsification) that benefits its absorption. 



Butter fat was no better absorbed than meat fat, a fact which created 

 surprise, since the fats of low melting point are supposed to be better ab- 

 sorbed than those with higher melting point ( Schmidt (c)). Cod liver oil 

 caused an exacerbation of the subjective distress and diarrhea ; little 

 of the oil was absorbed. 



A marked increase of lecithin excretion was noted by Erhmann in the 

 feces of a case of chronic pancreatitis (3.6 per cent against a normal 

 lecithin excretion of 0.51 per cent). 



