DISTURBANCES OF PANCREATIC METABOLISM 683 



Mosenthal, in a case of chronic pancreatitis (probably due to a pan- 

 creatic calculus) and associated with severe diabetes, studied the effects 

 of gland therapy. Pankreon gave no results, but raw sheep's pancreas 

 prepared as a salad in 50 gni. portions, three times a day, brought a very 

 marked improvement. "The stools changed from those typical of pan- 

 creatic disease to what appeared to be normal movements." (Mosenthal 

 (a).) A dangerous acidosis however intervened to cut short the experi- 

 ment ; Salomon had previously demonstrated increased amounts of acetone 

 in the urine under pancreatic therapy. 



Tileston found some improvement after HC1 therapy; decided benefit 

 mathematically demonstrable was seen after pankreon or raw pancreas 

 feeding (0.2 gin. three times daily). Spriggs and Leigh employed in 

 successive periods practically all the commercial and raw gland forms of 

 pancreas, with little result. They thought that such preparations, with 

 the exception of trypsogen tablets, irritate the intestinal tract and brought 

 no improvement. 



Any doubt however about the benefits of the clinical administration of 

 pancreatic extracts or of the raw gland is answered apparently by the 

 striking improvement shown in the cases of pancreatic infantilism (Brain- 

 well, Rentoul and others). 



In general, opotherapy of the pancreas seems very encouraging, and at 

 least in some of the cases to approach a specific effect. 



The improvement resulting from the oral administration of gland ex- 

 tracts has been held as a proof of the fact that the external secretion of 

 the gland controls digestion and absorption. There is however this fact 

 to consider, that with even excessive feeding of commercial extracts, no 

 ferments were demonstrable in the feces, though the absorption of food had 

 improved. The improvement in absorption after feeding the gland is 

 beyond question. The explanation lies in the fact that both commercial 

 and raw extracts probably contain the hormone of the gland in an active 

 form, just as does thyroid gland or its derivatives for its specific hormone. 



Prognosis of Pancreatic Disease. The prognosis and duration of pan- 

 creatic disease depend in great part upon the etiology and clinical course. 

 In the absence of malignant neoplasms, the characteristic fat and protein 

 absorption derangement in itself does not necessarily shorten life ma- 

 terially. Cases of steatorrhea and creatorrhea of even apparently severe 

 form have been under observation for 26 years (Walker). Spontaneous 

 cure or improvement in the intestinal symptoms is clearly possible 

 as witness the remarkable improvement in the absorptive power of the 

 patient of Glaessner and Sigel when observed a few years later by 

 Keuthe. The disturbance of metabolism that occasionally forms part of 

 the picture of acute pancreatitis may, with clinical postoperative treat- 

 ment, almost disappear, as occurred in the case of abscess of the pan- 

 creas reported by Brugsch and Koenig. 



