108 W. R. BLOOR 



the amount of fat absorbed falls off, but not to the extent that would be 

 expected from the loss of such an important secretion. Also, as has 

 been rioted many times, the fat which is found in the feces in these cases 

 is almost entirely present as fatty acids, indicating that the other hydro- 

 lytic agents present (see previous discussion, pages 1S9-1D2) and also prol>- 

 ahly bacteria very effectively take on the work of the pancreatic Jipase. 

 Complete extirpation of the gland produces much more marked effects 

 than exclusion of the secretion. Emulsified fats are better utilized than 

 non-emulsified and feeding of pancreas improves the utilization of both. 

 With regard to complete extirpation various factors complicate the situa- 

 tion, such as shock of operation, deprivation of the internal secretion, 

 both of which are severe in their effects on the animals, the inability to 

 digest and utilize other foodstuffs, which results secondarily in a failure 

 to utilize fat, the efficiency of the pancreatic secretion in forming emulsions 

 which are stable in the faint acidity found in the intestine, the disturbance 

 in the intermediary metabolism of fat which results in an accumulation 

 of fat in the liver and other tissues and the slowing of the emptying of the 

 stomach in the absence of pancreatic secretion. 



Taking all the evidence together there can be no question that the 

 intestinal secretion of the pancreas is an indispensable factor in the proper 

 digestion and absorption of fat. Whether its internal secretion is of 

 equal importance cannot be stated at the present time. Lombroso found 

 that fat absorption was not much affected by stopping the pancreatic 

 secretion or on extirpation, if a small portion of the gland were left in 

 place, from which he reasons that it is the internal secretion which is of 

 importance. On the other hand, it is well known that in severe diabetes 

 where the carbohydrate tolerance is very low, that fats are readily digested 

 and absorbed, and indeed in such amounts that they cannot be taken care 

 of in the blood, resulting in the extreme and lasting lipemia which is 

 occasionally reported. The lipemia may be the direct result of the absence 

 of internal secretion, resulting in failure of the intermediary fat metab- 

 olism or a secondary effect of the failure to utilize carbohydrate. 



The Bile. The importance of the bile in the digestion of the fats 

 has been extensively studied. Early experiments by Claude Bernard and 

 Dastre demonstrated the probable necessity of both bile and pancreatic 

 secretion for effective fat absorption. Work by Bidder and Schmidt, 

 Rohrnann and others have shown that exclusion of the bile from the in- 

 testine may result in fat losses up to 85 per cent of the fat fed. In 

 icterus with complete exclusion of bile there is considerable loss of fat, 

 but not to the extent observed in operative exclusion. The importance of 

 bile in fat absorption seems thus to be well established. As to its function 

 in this relation evidence has been brought forward by Moore and Rock- 

 wood to show that one very important part which it plays is in increasing 

 the solubility of the fatty acids and soaps produced by hydrolysis of the 



