Pepsinum

Volume I — Special Symptomatology

Description. — A peculiar albuminous body secreted by the gastric glands, which has the power not only of coagulating albumen, but also, with the aid of acidulated water, of redissolving it.

Prof. Lionel Beale gives the following simple method of manufacture: "Dissect off carefully the mucous membrane of a perfectly fresh pig's stomach, and place it on a flat board; cleanse it lightly with a sponge and water, so as to remove the particles of food and much of the mucus. Scrape it hard with an ivory knife, so as to squeeze out all the contents from the glands. The viscid mucus thus obtained contains all the pepsin with much epithelium. Spread it upon a piece of glass so as to form a very thin layer, which is to be dried at a temperature of 100° (no higher) F. over hot water. When dry, scrape from the glass, powder in a mortar, and transfer to a well-stoppered bottle."

Prof. Beale recommends the following formula for pepsin prepared by his method: "Take of the powder, five grains; strong muriatic acid, eighteen drops; water, six ounces. Macerate at a temperature of 100° for an hour; filter so as to form a perfectly clear fluid."

Pepsin, prepared by Beale's process, is odorless, nearly free from any disagreeable taste, and twenty-five times as strong as the ordinary commercial pepsin.

There are several brands of pepsin in the market, namely : Boudalt's, Hawley’s, and Sheffer's. The two former are foreign, the latter American. Sheffer's is the most popular. The " Saccharated Pepsin" sold by Bcericke & Tafel, and at our Pharmacies, is a similar preparation. Whatever pepsin is used, if good effects are to be obtained from it, it should be given with acid, unless, indeed, there is reason to believe that this constituent of gastric juice is not wanting. Sheffer advises that his pepsin-solution he prepared as follows : "Take of Pepsin sixty-four grains, water five ounces, and of Hydrochloric acid (dilute) one drachm; after dissolving, add three ounces of glycerine. Mix thoroughly and filter."

Alcohol destroys the digesting power of pepsin, and therefore " wines of pepsin " are inferior preparations of it. The homceopathist, and all other physicians, should avoid all the compound " elixirs," and other proprietary preparations, and use only the powder, or freshly prepared digestive solution. The powder, however, may be combined with an attenuated medicine' in trituration, as I shall hereafter recommend.

In making the digestive solution, water and muriatic acid; or glycerine, water and muriatic acid, should alone be employed with the pepsin.

Officinal Preparations. — (See above.)

Analogues. — Pancreatine {?), Muriatic acid (?), Lactic acid (?).

Pepsin, not being in any sense a drug, but the gastric juice of some animal, is not an agent to be proven, or have any pathogenetic effects.

Rennet, or the dried stomach of calves, has been used from time immemorial for the purpose of coagulating milk. It has been used successfully in domestic practice, and in the hands of physicians, for the cure of dyspepsia, dysentery, and chronic diarrhoea of undigested food, also for vomiting of food in children and adults.

(See Therapeuti-cs.)

Volume II — Special Therapeutics

This agent cannot properly be called a medicine, for by this term we understand an agent that is capable of causing pathogenetic symptoms in a healthy person. But it can be called a remedy. It is very properly observed by Wood, in his chapter on “Digestants,” that “ it is evident that any influence for good which it possesses is dependent upon its solvent power, and that this, therefore, is a measure of its value.”

When we consider the statement of physiologists, that the best article of Pepsin is capable of dissolving only “four times its weight of fibrin at the temperature of the body,” aided by Muriatic acid, and “ that fifteen grains will only effect the solution of ninety grains of boiled white of egg in twelve hours,” we may well exclaim with Wood, who, in commenting on the fact that “grave doctors prescribe for men Pepsin as an artificial solvent in doses of ten grains,” says : “ Evidently one of two things is certain : either the present practice is ridiculously absurd, or else Pepsin acts upon the stomach itself in some way as a stimulant.”

I confess I am at a loss to account for the high estimate which some physicians place upon it. I know many of both schools who habitually prescribe the “ Wine of Pepsin ” in spoonful doses after each meal, and claim good results from its use. But the best physiological chemists assert that alcohol destroys its digestive power. It must be, then, that the apparent benefit is due to the action of the wine alone.

Pepsin has been thrown upon the market in various combinations. The “ Elixir of Iron, Bismuth, Strychnia, and Pepsin” has been lauded in extravagant terms. But chemists assert that the combination of Pepsin in solution with any of the above drugs destroys its value.

I agree with Wood and other authorities, that it rarely benefits loss of digestion in adults. I have thought it aided digestion in delicate women. But the benefit may have arisen from the regulation of the diet and habits of the patient. Generally, other remedies (medicines) are given along with the Pepsin, which still further throws a doubt upon its value.

In a few cases of slow and imperfect digestion in adults I have given the Pepsin in powder, alone, for weeks, and the testimony of the patients went to show that their digestion did improve under its use.

The vomiting of food , which occurs very soon, or an hour or two after meals, is often arrested by the administration of ten or fifteen grains of good Pepsin just before or during meals. The ingesta thus expelled is usually undigested, or undergoing an acid fermentation.

In the vomiting of pregnancy Pepsin often acts with singular efficacy. It does not always cure, but it arrests the vomiting for days or weeks, and affords a grateful alleviation of a distressing symptom.

In lientery, even of adults, and when resulting from serious gastro-intestinal disease, where no cure is expected, the Pepsin in twenty or thirty grain doses will often change the undigested character of the evacuations.

It occasionally happens that the saccharated powder of Pepsin does not act when decidedly indicated. In such cases the failure is due to the lack of Muriatic acid in the stomach. If we now prepare a solution of Pepsin in water (gr. v to 5j), and add dilute Muriatic acid in the proportion of a drop or two to each drachm, and administer it in one or two teaspoonful doses, we shall get satisfactory effects.

I have in many instances given it in combination with Nux vomica, Strychnia, or Bismuth, and believe that when thus administered it resulted in more benefit than when it was given alone, or when the medicines were given singly.

My plan has been to add to 100 grs. of Shaffer’s Pepsin, 10 grs. of Nux vomica 2*, or 10 grs. of the Citrate or Subnitrate of bismuth (crude), or 10 grs. of Strychnia 1° The mixture was carefully triturated twenty minutes. Of these preparations a 5 or 10 grs. dose is ordered to be taken immediately before or after meals.

The selection of the medicine is made according to the symptoms of the patient.

In a few cases I have combined Pepsin with Pulsatilla, Ptelea, or Hydrastin, and believe I have seen good results.

The testimony as to the value of Pepsin in diseases of young children is very strong. Remember that this agent is in no sense a drug. You cannot injure a child by giving any quantity. If it does not digest the contents of the stomach it does nothing at all. I believe the use of Pepsin is much more rational in children than adults. It certainly has a better reputation in the chronic indigestion, and consequent diarrhoea of infants, than the same condition in adults.

I have found it particularly useful when the casein did not coagulate in a loose, flocculent manner, but formed large, sol id masses in the stomach, causing great distress, vomiting, or painful diarrhoea. It will not always remedy this condition, for the reasons given in that excellent little brochure on “ Infant Diet,” by Dr. Jacobi.

Vomiting or diarrhoea of undigested food in infants will often disappear after the administration of a few grains of Pepsin, given before nursing the breast or bottle, or with its regular meals.

If it fails to do this when given singly, prepare it with Calcarea 3X, Pulsatilla 3X, Nux 3X, or China lx, and you will get better results than when either medicine is given alone.

The action of Pepsin is principally exerted upon fibrin, albumen, and casein, but