ALEXANDER MCPIIEDRAN, Toronto.
PANCREATIN.—Pancreatin (pancre atinum, U. S. P.; extract of pancreas, pancreatic extract) is a mixture of the enzymes existing in the pancreas of warm-blooded animals, usually obtained from the fresh pancreas of the hog. Pancreatin occurs as dry, whitish or yel lowish-white, brittle scales, or oftener as a yellowish-white, amorphous pow der without odor, or having a peculiar odor and a faint, meat-like taste. It is almost completely soluble in water, in soluble in alcohol, soluble in dilute alco hol, and is precipitated from solution by alcohol in excess. It is not an artificial compound. It should be absolutely free from all added substances and contain the ferments as they are naturally asso ciated in the pancreatic glands. Five ferments are to be found in pancreatin: trypsin, which converts albumins, or proteids (of milk, beef, fish, blood, etc.), into peptone in either neutral, alkaline, or slightly acid media; diastase, or amylopsin, which resembles ptyalin very closely and converts starches into dextrin and sugar; an emulsive ferment which emulsifies the fats; steapsin, which splits fats into glycerin and fatty acids; and, finally, a milk-curdling ferment.
Extemporaneous Preparation.—An active preparation may be prepared as follows: The fresh pancreas of a pig, killed about six hours after a full meal, is chopped fine and to it is added four times its weight of dilute alcohol. After standing for twelve hours pour off the liquid portion and filter it. The liquid may be given in doses of 1 to 2 table spoonfuls. Another method, given by Hare, is as follows: Wash and chop up fine a fresh pancreas, and allow it to soak in alcohol for twenty-four to forty-eight hours. After this squeeze out the alcohol and add to the pancreas 10 times its weight of glycerin. Allow it to stand for forty-eight hours and then filter. This may be given in doses of 30 drops in a glass of milk. The solutions or liquid extracts from the pancreas are, however, objectionable and inferior to the dry pan creatin, principally because of the tend ency of these solutions to precipitate and to undergo deterioration owing to the large amount of organic matter present. The diastasic power especially is variable and weak, and tends constantly to dimin ish. Furthermore, these solutions impart their peculiar, repulsive taste to foods, milk, and gruel, etc. For these reasons it is always best to use a dry extract of pancreas (pancreatin).
Physiological Action and Tests for Pancreatin.—The value of a pancreatic preparation depends upon its digestive activity and upon the quality of the re sulting digested product. A pancreatic extract may peptonize milk perfectly, but the peptonized milk may be unfit for food, owing to the development of rancid fatty acids, giving the milk a peculiar, sour, repulsive odor. A good pancreatin should rapidly digest milk, beef, fibrin, and all forms of starchy food. It should convert the casein of milk into peptone without the development of any rancid flavor. The action upon casein may be taken as a satisfactory test of the pro teolytic power of any pancreatin. The activity of a pancreatic preparation upon a proteid may be tested as follows: Place into a flask or bottle 15 grains of sodium bicarbonate, add 5 grains of dry pan creatic extract, or pancreatin; mix well and add 1 pint of milk warmed to 130° F. Shake well and place the bottle con veniently for observation. At first there should be no odor or taste imparted to the milk. In a few minutes the milk will become of a slightly grayish-yellow color which in ten minutes will be more marked, somewhat thinner, and of a distinctly-bitter taste, due to the con version of the casein. This taste is a pure bitter without suggestion of rancid ity. For purpose of comparison, a second flask of milk mixed with the soda and water without the pancreatin may be pre pared. By withdrawing a small portion of the milk from time to time and adding a few drops of acetic acid, the conversion of the casein may be tested by the char acter of the curd formed—from the tough casein, to the light, flocculent pre cipitate, and the final, slight, scarcely perceptible, granular coaguli. The dias tasic power of a pancreatic preparation may be tested as follows: Mix 1 drachm of arrowroot or starch with 5 fluidounces of cold water, and boil well. To a fluid
ounce of this thick starch (at 110° F.) add a grain or two of pancreatin, or dry pancreatic extract, or a few drops of a fluid product, and stir well. The starch should almost instantly become thin and fluid, like water, showing the formation of soluble starch, which is gradually con verted into dextrin and glucose. A prod uct which does not quickly liquefy thick, warm starch-jelly is worthless as a dias tasic agent. (Fairchild's "Hand-book of the Digestive Ferments.") Therapeutics. — Pancreatin is exten sively used in the preparation of pre digested or peptonized foods. It acts best in an alkaline medium, although the use of an alkali is not essential to the action of the pancreatic ferments. To peptonize food is to digest food arti ficially, to submit it to the action of the digestive ferments, whereby changes are effected precisely similar to those which in the living body are essential before it can be absorbed. Flesh and starch foods are incapable of being absorbed until by the action of the digestive juices they have become soluble. Pepsin is not available for household use in artificially digesting food of any kind. Peptonized food is, therefore, not food prepared with pepsin, or necessarily containing a fer ment of any kind; it is digested food. The pancreatic ferments are capable of digesting every known form of food. The peptonizing action is most energetic at about the heat of the body, slow at the temperature of a room (60° to '"0° F.); at a lower temperature, even at freezing, the peptonizing agent is not destroyed, but is simply inactive; at the boiling point (212° F.) it is at once destroyed. Peptonized foods are valuable in all cases where the digestive functions are im paired, during the course of acute fevers. and in chronic wasting diseases. They also fill a useful office during the period of convalescence from acute and exhaust ing diseases. They are therefore valu able in typhoid fever, gastric ulcer, acute dysentery, chronic diarrhcea, gastric ca tarrh, pneumonia, tuberculosis, and dia betes. For infants, peptonized milk or milk prepared by Fairchild's peptogenic milk-powder or by means of Fairchild's extractum pancreatis or peptonizing tubes, is a valuable substitute for moth ers' milk. When rectal alimentation is rendered necessary either from inability to swallow or from inability of the stom ach to retain or digest food, peptonized nutritive enemata become of inestimable value. These may be composed of milk alone or with egg, of egg-albumin, or of beef peptonized before being used.
DIGEsTryE DISORDERS. — Faller Ca ti in doses of 3 to 10 grains in capsule, given about two hours after meals, and preceded by 10 or 15 grains of sodium bicarbonate, will assist insufficient sali vary and intestinal digestion. It is also beneficial in lienteric diarrhoea. In dia betes mellitus dependent upon a lesion of the pancreatic gland (carcinoma or atrophy) the use of pancreatin and of peptonized foods are strongly indicated.
DIPHTHERIA.—In diphtheria pancre atin has been used in spray and powder for the purpose of destroying the false membrane and favoring its expulsion. It is usually combined with sodium bicar bonate (3 parts to 1 of soda) for insuffla tion as a powder; or 15 grains of pan creatin and 5 grains of sodium bicar bonate, with a drachm of glycerin in 1 ounce of water may be used as a spray. The latter should be prepared fresh every few hours. Samuel Johnson has suggested (Jour. Amer. Med. Assoc., July 29, '93) the addition of grain of cor rosive sublimate. Better as a solvent for diphtheritic membrane is the use of trypsin, as it presents the proteolytic ferment of the pancreas in the most active form. Trvpsin may be applied by insufilation, pure or mixed with sodium bicarbonate-4 grains of trvpsin to 1 grain of soda; it may be applied on a moistened brush or probe covered with absorbent cotton; or mixed with water and sprayed: trvpsin, 15 grains; sodium bicarbonate, 5 grains; water, 1 ounce; to be prepared fresh every few hours, or chloroform or pure creasote, 4 drops, may be added as a preservative.