DISTURBANCES OF PANCREATIC METABOLISM 681 



Pancreatic Infantilism. Byron Bramwell in 1904 described as a new 

 clinical entity a case of arrested development, which he attributed to 

 pancreatic deficiency. He described a boy of 18 years and 6 months, 

 whose physical development was normal up to 11 years of age and then 

 ceased. He was a bright, intelligent boy, perfectly formed, except for 

 abdominal enlargement. His height was four feet four and one eighth 

 inches, his weight seventy-one and a half pounds. He had had diarrhea 

 for nine years. Under observation his stools were frequent, and fatty 

 and large. The Sahli test for trypsin in the intestine was negative. 

 Under treatment with pancreatic extract for two* years, the diarrhea 

 ceased, the stool became more normal in appearance, the boy grew 5% 

 inches in height, and added 22 Ibs. to his weight. Pubic hair appeared 

 and his sexual development became more normal. 



Rentoul in the same year described a similar case in a girl 18 years 

 of age, whose growth was arrested at the age of eleven years. She had 

 had diarrhea from infancy, with abdominal enlargement. Her stools were 

 described as "of foamy oily nature, very large and floated." In five 

 months' treatment she gained nine and a half pounds and grew two inches, 

 with the development of sexual characteristics. 



Langdon Brown (6) described a like case in a boy of sixteen years who 

 was suffering from a severe form of congenital syphilis. The boy ap- 

 peared to be eight or ten years old. At autopsy a syphilitic pancreatitis 

 with pancreatic atrophy was seen ; there had been no glycosuria. 



Two cases were reported by Thomas. The first a man of twenty-four 

 years with the size and stature of a boy of ten; the second a youth of 

 18 years, who had the appearance of a boy of 8 or 9 years. Both patients 

 suffered from a lasting intractable diarrhea. 



Recently Bullrich described a typical case of pancreatic infantilism 

 with necropsy findings. The boy had been normal and well grown up to 

 his eleventh year when he began to lose weight ; he developed glycosuria 

 at sixteen years. At the age of twenty years he was four feet tall, and 

 weighed forty-seven pounds. For eight months he had a severe diarrhea. 

 The urine contained from 3.8 to 4.5 per cent of sugar. At autopsy, a peri- 

 canalicular cirrhosis of the pancreas and liver were found. The thyroid 

 was undeveloped. Bullrich ascribes the disease to a pluriglandular dis- 

 turbance in which the pancreatic' deficiency preponderated. 



In a similar class may be put the unique case described by Garrod and 

 Hurtley(c) in a boy of six years who from birth had shown a clear cut and 

 typical steatorrhea. The boy was otherwise in good health and spirits 

 and his development was normal for his age. The stools were liquid, fatty 

 and rapidly became rancid in summer. Chemical tests failed to show a 

 deficiency of trypsin. The disturbance of fat metabolism was evident; 

 only 69 to 74 per cent, of the fat in the diet was absorbed. In the feces 

 splitting was fair, 34.2 to 68 per cent; soaps were very low, 0.6 per cent 



