Pepsina porci, the pepsin of the hog, was one among the first of the
animal products to be used in medicine, and many physicians, not well
versed in organic chemistry, supposed that in it they possessed a
sovereign remedy for indigestion in all its forms and stages, and the
confirmed dyspeptic had only to apply the specific to have his digestive
apparatus restored to its youthful health and vigor. Unfortunately for
this view and for the sufferers, the fact was overlooked, or not duly
appreciated, that pepsin is only one of several substances which Nature
employs in the complete digestion of food, and that the products or
secretions of several different glands have a part in the process, each
of which is essential to the proper preparation of food for the
nourishment of the human body.
It has been estimated by competent observers that as great a proportion
as seventy-five per cent of all the intractable cases of dyspepsia in
this country are caused primarily by faulty saccharification of the
starchy foods which constitute such a large portion of the diet of the
American people. This being the fact, is it any wonder that the
administration of pepsin alone should fail to give relief in many cases?
It fails because the fault lies, not in the stomach, but in the salivary
and other glands whose secretions possess the amylolytic property, and
the remedy is the administration of substances that will restore that
property to the secretions, or which possess it in and of themselves.
Until quite recently the practitioner was compelled to rely for this
purpose upon the various malt extracts upon the market, the diastatic
power of which was so feeble that the service they rendered was but
slight. What was needed, and for which many of the most patient
investigators were searching, was a diastase which would do for the
starchy elements of the food what pepsin does for the proteids. The
digestion of food in man has been the subject of much patient and
methodical study and investigation during the last two decades, notably
by Ewald, Kellogg, Hayem, and Winter, and others, resulting in the
placing of the therapeutics of disordered digestion upon an exact
scientific basis. It is not, however, necessary for the purposes of this
paper to go very deeply into the minutæ; a superficial survey will
suffice.
Digestion begins in the mouth with the act of mastication, the presence
of food in the mouth, or even the thought of it, acting upon the
salivary glands to produce a free flow of saliva, which, being
thoroughly incorporated with the food by the act of mastication, exerts
its peculiar influence upon the starchy constituents, converting them
into dextrose, maltose, etc. This amylolytic action lasts but a short
while, the ptyalin of the saliva being active only in neutral or
slightly alkaline media; consequently when the food reaches the stomach
and peptic digestion begins, its effect ceases.
The saccharification of the starchy elements of the food before reaching
the stomach serves to separate or disentangle them, as it were, from the
proteids, and deliver the latter to the stomach in the condition most
favorable to the action of the gastric ferment or pepsin.
The stomach, after a variable length of time, during which the peptic
ferments accomplish their allotted task more or less thoroughly and
completely, delivers the resultant mass over to the small intestine,
where the secretions from the pancreas, liver, and intestinal glands, by
finishing the transformation of the starch begun before the stomach was
reached, emulsifying the fatty constituents, etc., complete the complex
work of digestion.
It will be seen from the foregoing that the derangements of digestion
may, for ordinary clinical purposes, be divided into three classes, each
of which is distinct from either or both of the others, although they
shade into each other by imperceptible gradations, so that there are no
well-defined boundary lines separating them. The first class includes
all those cases which are characterized by a deficiency, in quality or
quantity, of the salivary secretion, and a consequent failure of or
interference with the digestion of the starchy elements of the
food—amylaceous dyspepsia. The second includes those in which there is
difficulty in the digestion of the proteids, due to a variety of
causes—gastric dyspepsia. In the third is placed those cases in which
the trouble is located below the stomach, and are caused by inability of
the pancreas and other glands to normally perform their
function—intestinal indigestion.
One constantly meets with cases belonging to each of these varieties,
and he must correctly diagnose each case if he would apply the treatment
necessary to produce the best results. For the present, however, we have
only to do with the first variety, as my object in the preparation of
this paper is to direct the attention of the profession to a new
diastatic ferment which acts with as much or even greater energy upon
the amylaceous foodstuffs as does pepsin upon the proteids.
Such a substance has long been a desideratum with those who treat many
dyspeptics, and who have been compelled to content themselves with malt
extracts with which the market is supplied. The substance referred to
was discovered by a Japanese chemist, Jokichi Takamine, not as the
result of accident but while working scientifically with that exact end
in view, and is now supplied to the profession by Parke, Davis & Co.
under the name of Taka-Diastase. The writer has had frequent occasion to
use it since it was first brought to his notice about a year and a half
ago, and in that time has not had a single case in which its
administration was not attended by the very best results. Notes of
several cases were kept, three of which will be presented here as the
most appropriate conclusion.
CASE 1. L. A., white male, age thirty-eight, a barber by occupation,
consulted me first in the fall of 1894. He was at that time, as he had
been for several years, the victim of a most obstinate and intractable
form of dyspepsia. He had been a coal miner until forced by ill health
to quit that for some lighter occupation. He, however, continued to grow
worse until, when coming under my care, he was very much emaciated,
weak, nervous, and irritable, his stomach unable to retain any thing
save the blandest articles of diet, and those only in small quantities.
Treatment was begun by regulating his habits, diet, etc., and putting
him on an emulsion of bismuth subnit. and pepsin pur. immediately after
eating, and tr. nux vom., hydrochloric acid, and tr. colomba before
eating. His condition improved somewhat under this treatment, but only
to a limited extent, and it became evident that more efficient measures
must be resorted to if we hoped to accomplish permanent good. It had
been noted that a meal, however scant, composed mainly of starchy
substances was always productive of an acute attack, and acting upon
this suggestion extract of malt was added to the remedies he was using,
and, to a certain degree, with good effect. He, however, did not go on
to complete recovery, but the improvement ceased at a certain point, and
in spite of continued treatment with the remedies mentioned his
condition remained about stationary. Unable to work, morose, cross, and
irritable, existence was a burden to himself as well as family and
friends. At this juncture my attention was attracted to Taka-Diastase
and a supply was at once procured. The patient was given a number of
capsules containing five grains each, with instructions to take one
capsule at the beginning of each meal, continuing the bismuth and pepsin
mixture as before, immediately after eating. In a very short time
improvement was discernable, and from that time was rapid and
continuous. The treatment was kept up, with the addition later on of
ferruginous and bitter tonics, until there could be no doubt of his
complete and permanent restoration to health. He has now been at regular
work in the shop for several months, and says that he “never felt better
in his life.”
CASE 2. Mrs. J. H., a white woman, aged forty-six, wife of a well-to-do
farmer. Until within the last year or two had enjoyed the best of
health, and was inclined to stoutness in consequence. Dyspeptic symptoms
had troubled her more or less during the time mentioned, and of late had
increased in severity so much that she asserted, at the time she
consulted me, that if she dared to eat any thing at all she suffered the
greatest agony in consequence. A neighboring physician had treated her
for some weeks previous to her visit to my office, and, as I afterward
learned, had given her the regulation treatment with pepsin, bismuth,
hydrochloric acid, etc., with results so discouraging that she had lost
all hope of receiving any benefit from “doctor’s medicine,” as she
called it, and it was only at the urgent solicitation of husband and
friends that she came to me for treatment, being careful to inform me
that she had no idea I could help her in the least.
Her case was diagnosed “amylaceous dyspepsia,” and she was given
Taka-Diastase in eight-grain doses, half of which was to be taken before
eating and the remainder during or after, with tr. nux vom. and
hydrochloric acid, in moderate doses, _ter in die_.
Despite her determination not to be benefited by “doctor’s medicine,”
the improvement was prompt and continuous, and so manifestly due to the
treatment that she soon forgot or overcame her antipathy, and with
characteristic inconsistency now asserts that it is impossible to get
along without it. She eats three meals regularly every day, and suffers
no inconvenience whatever in consequence.
CASE 3. W., a white male, aged forty, had never had any serious illness,
and digestion had been especially good until about four weeks before
consulting me. At that time he, in company with some friends, ate quite
heartily of watermelon. He had always eaten watermelon freely and with
impunity prior to that occasion. It did not agree with him so well that
time, and in a few hours he was seized with an acute gastralgia of the
most severe character, and from that time to the present he has had more
or less trouble of that kind, even a very small quantity of food,
especially if it be of a starchy nature, giving rise to the most
distressing symptoms.
The diagnosis of amylaceous dyspepsia was also made in this case, and he
was at once put upon the Taka-Diastase in doses of five grains given
with the meals, and temporarily excluding starchy foods from his diet as
much as possible without too great inconvenience. There was also great
torpidity of the liver, and for that he was given sod. phosphate in
teaspoonful doses every morning before breakfast, taken in a gobletful
of hot water. Under this treatment improvement was satisfactory and
rapid, and with the addition of bitter tonics later on he was ultimately
restored to complete health.
_Remarks._ Case 1 was an example of that class with which, prior to the
introduction of Taka-Diastase, the general practitioner was too often
compelled to acknowledge his inability to cope successfully. In them
there is difficulty in the digestion of both amylaceous and proteid
substances, and the remedies usually recommended were efficacious only
so far as digestion of the latter was concerned, and did not reach the
former at all. The cure was incomplete, and must have remained so until
the substance we have been considering, or something analogous to it,
was furnished the physician with which to complete it.
Cases 2 and 3 were examples of the first class mentioned above, viz.,
amylaceous dyspepsia, and while under treatment with pepsin, etc., they
were considered the most intractable of all; under Taka-Diastase they
yield rapidly, and are cured in a surprisingly short time.