Southern Branch
of the
University of California
Los Angeles
Form L 1
FlC
This book is DUE on the last date stamped below
MAYS 193*
15 1933
NOV SB 1938
MOV id 1940
JAN 1 9 194|3
JUN 1 6 19
Form L-9-15w-8,'24
FAIRCHILD'S HAND-BOOK
OF THE
DIGESTIVE FERMENTS
AS REMEDIES, PER SE
AS SURGICAL SOLVENTS
AND IN THE
PEPTONISAT10N OF MILK AND OTHER
FOODS FOR THE SICK
THE MODIFICATION OF COW'S MILK TO THE
STANDARD OF HUMAN MILK
BY THE FAIRCHILD PROCESS
FAIRCHILD BROS. & FOSTER
NEW YORK
%2 & 84 FULTON STREET
LONDON WESTERN DEPOT
SNOW HILL BUILDINGS IIO RANDOLPH STREET, CHICAGO
Copyrighted by
FAIRCHILD BROS. & FOSTER,
1892, 1893 and 1894.
fHE MANY AND IMPORT ANT USES OF THE DIGESTIVE
FERMENTS described in this hand-book, afford strik-
ing evidence of the progress made in their develop-
ment in recent years. The introduction of the Fairchild
digestive preparations and processes marked an era in
applied physiological chemistry. It was the practical
beginning of our appreciation of the value of digestive
ferments, of their scope and service in the nutrition of the
sick. If, as it has been said by its founder, the art of medi-
cine owes its existence to a recognition of the fact that
food and regimen proper in health were unsuited to the
sick, surely the art of medicine has made a great advance
in learning to effect digestion by proxy ; by borrowing from
the lower animals the organic principles by which food may
be converted into the soluble form requisite for the nutrition
of the sick.
The modern application of digestive ferments by the
Fairchild process to the pre-digestion of food for the sick,
may be considered as direct and scientific a develop-
ment of the resources lying at our hands, as is the art of
cookery itself, by which we seek to adapt food stuffs to the
needs of mankind.
In no direction has a digestive ferment been of more
positive benefit than in the preparation of infant food. The
use of a digestive ferment as the essential factor in the
preparation of an artificial human milk, was first suggested
by us and brought to a practical form in the Peptogenic
Milk Powder.
In this process, the milk designed for the less highly
organised animal is raised to the soluble form characteristic
3
of woman's milk and necessary for the human infant ;
whilst the secondary and quantitative variance is accurately
adjusted.
So strong is our conviction of the soundness of the prin-
ciples upon which this method is based, and of the accuracy
with which it is brought into practice, so conclusive the
evidence of its beneficent results in actual use, that we feel
constrained to urge its claims to consideration as a means of
obtaining a complete and exclusive substitute for breast
milk.
As surgical solvents, the digestive ferments justify serious
attention, for they are potent, are painless in their work, and
invade and liquefy dead tissue straight down to living ones,
where their action ends abruptly ; they impart, moreover, a
distinct stimulus to the healing process.
Engaging in the manufacture and study of the digestive
ferments with an enthusiasm based upon conviction of their
valuable properties and possibilities as therapeutic and pep-
tonising agents, we have been happy to see them win so
important a place in practical medicine.
The Fairchild preparations are each and all the result of
persistent, careful, special work, and we believe them to be
not only the original, but the best for all purposes designed.
They have long been conceded to be the standard.
We desire to take this occasion to express again our
appreciation of the confidence and recognition so gener-
ously accorded our efforts by the medical profession. It is
no less a source of pleasure to us that so many of the best
pharmacists find our products worthy of their preference.
FAIRCHILD BROS. & FOSTER.
Revised Edition, April, 1894.
CONTENTS
DIGESTIVE FERMENTS GENERAL CHARACTERISTICS.
Action of ; Limit of energy ; Changes of alimentary substances
by digestion ; In a dry form, should not be hygroscopic ; Dry
ferments compatible with substances which would injure them in
solution ; Dry compounds as subject to assay as the separate fer-
ments from which prepared ; Relation to temperature ; In solution ;
Incompatibility of solutions of mixed ferments pp. 14-18
ALCOHOL and the digestive ferments ; Action of strong and diluted ;
Value as a preservative pp. i8-2o
INHIBITANTS. The influence of drugs and dietary substances upon the
process of artificial digestion ; The relation of test tube experi-
ments to the conditions of body digestion ; necessity of dis-
tinguishing between substances which retard the process of arti-
ficial digestion and substances which destroy the ferment, .pp. 21-24
INCOMPATIBLES. Substances and conditions which destroy the digestive
ferments ; Pepsin and bismuth in solution pp. 25-27
ANTISEPTICS ... pp. 27-28
41 JUMBLES." Character of the commercial digestive compounds, their
good effects due to pepsin and acid p. 28
VEGETABLE FERMENT. Its inferiority in comparison with pepsin in
acid media and pancreatic extract in alkaline or neutral. . .pp. 29-30
GASTRIC FERMENTS. Pepsin, its action upon albumen ; Peptic peptone ;
Pepsin inert in alkaline solution ; Pepsin and soda ; Practical uses
of pepsin pp. 30-32
MILK CURDLING FERMENT of the Gastric Juice. Its action upon
caseine ; Significance in the digestive process pp. 32-34
PANCREATIC FERMENTS. Trypsin, Action of ; Tryptic peptones ; Pan-
creatic diastase ; Identity of diastase from all sources in properties
and action ; Uses of Emulsive Ferment ; Curdling ferment
pp. 34-40
DOSAGE of digestive ferments pp. 40-41
6
FAIRCHILD PREPARATIONS of the Digestive Ferments | Uniformity and
reliability ; Their repute based upon actual, demonstrated proper-
ties ; Commercial imitations and substitutes therefor pp. 41-44
PEPSIN IN SCALES AND POWDER. Conformity to Pharmacopoeia re-
quirements. Pepsin in scales first introduced by Fairchild. A
uniformly excellent product pp. 44-45
PEPSIN SACCHARATED. Original standard of strength ; Present
standard p. 45
GLYCERINUM PEPTICUM. A pure glycerin extract from the gastric
membrane, free from alcohol, antiseptics, sugar or flavoring ; The
' best soluble form of pepsin p. 46
ESSENCE OF PEPSINE, Fairchild's Obtained by direct maceration from
the fresh calf rennet ; Special value as a remedy in disorders of
infancy, and dyspepsia of adults ; As a means of administering
drugs which disturb the digestive functions and impair the appetite ;
As a practical rennet agent pp. 47-49
MEDICATED JUNKET. Suggested by Dr. Delavan ; Milk-curd made with
Fairchild's Essence containing Potassium Iodide in solution, the
curd holding iodide suspended in a very agreeable form pp. 49-50
PEPSIN TESTING pp. 51-54
PANCREATIC PREPARATIONS. Extractum Pancreatis containing all the
ferments of the pancreas in an active and available form ; As a
remedy per se ; As a diastasic, proteolytic and emulsifying agent ;
Its special value in intestinal indigestion pp. 54-59
TRYPSIN, Fairchild's. As a solvent of diphtheritic membrane. . . .p. 59
DIASTASIC ESSENCE OF PANCREAS, especially for the digestion of fari-
naceous foods p. 60
PEPTONISING TUBES, for the preparation of Peptonised Milk, etc. .p. 61
DIRECTION SLIPS. For prescribing Peptonised Milk, etc p. 61
PEPTOGENIC MILK POWDER p. 62
TESTS for pancreatic preparations pp. 62-64
DIGESTIVE TABLETS, Fairchild's. Pepsin Tablets ; Pepsin and Bismuth
Tablets ; Pepsin, Bismuth and Pancreatic Tablets ; Pepsin and
Pancreatine Tablets ; Pepsin and Diastase Tablets ; Pepsin, Bis-
muth and Nux Vomica Tablets ; Compound Ox Gall Tablets ; Pan-
creatic Tablets ; Compound Pancreatic Tablets ; Peptonate of Iron
Tablets ; Ferroglobin Tablets pp. 64-69
PEPTONISING PROCESS. Simplicity, economy and practicability of ;
Use of soda in ; Reasons for diluting milk in pp. 69-74
USES OF PEPTONISED FOODS. In Typhoid Fever ; pneumonia ; gastric
ulcer ; acute dysentery ; diabetes ; tuberculosis ; chronic diarrhoea ;
gastric catarrh ; value as exclusive diet even in active life. pp. 75-78
PEPTONISED MILK. Ideal food for the sick pp. 79-80
;'NUTRITIVE ENEMATA. Milk, beef, etc pp. 80-8 1
< PANOPEPTON Bread and Beef Peptone ; a properly digested, complete
nutrient pp. 82-85
SURGICAL USE of the Digestive Ferments. As solvents for false
fibrinous membrane, coagula, muco-pus, necrotic and carious bone ;
applied in aural cavity, urethra, bladder, etc pp. 85-92
PEPTOGENIC MILK POWDER. For the preparation of humanised milk,
Identical with normal human milk in physical, chemical and physio-
logical properties ; Rationale of the process ; Agency of the diges-
tive ferment as an innocent, practical, and only known means of
converting caseine into the soluble form characteristic of the
albuminoids of human milk pp. 93-96
INFANT FOODS. Only practical point of inquiry ; How do they compare
with breast milk when prepared for the nursing bottle ; Fresh cows'
milk only practical basis for making an infant food ; Milk Foods,
etc. ; Impossibility of drying pure milk pp. 96-97
Cows' MILK. Proven inherently indigestible for an infant's stomach ;
Common methods of preparing it for infants ; Liebig's Food ;
Farinaceous Food pp. 97-99
COMPARATIVE COMPOSITION OF Cows' AND HUMAN MILK. Differ-
ence in their physical characters, digestibility, behavior with gastric
juice, directly due to difference in their albuminoids ; significant
difference also in proportion and quantity of nutritive materials
pp. 99-100
USE OF PEPTOGENIC POWDER. Includes the preparation of an exact
quantitative imitation of human milk, exact qualitative change of
albuminoids and subsequent destruction of the ferment, pp. 100-101
DIRECTIONS FOR "HUMANISED MILK"; in health and in feeble
digestion pp. 101-102
COMPOSITION OF "HUMANISED MILK." Remarkably like average
breast milk in chemical constitution, reaction, density, color, taste
and in behavior under all conditions p. 102
DIGESTIBILITY OF "HUMANISED MILK"; Not unnaturally easy of
digestion ; as digestible as mothers' milk ; adapted for feeble diges-
tion by increasing the pre-digestion of the caseine. ...pp. 103-104
CHOLERA INFANTUM. Whey as a temporary food in pp 104-106
How LONG SHOULD Infant be fed upon humanised milk ; Human-
ised milk the only food suitable during entire nursing period. p. 106
How TO WEAN the bottle fed baby , pp. 106-107
As A PARTIAL SUBSTITUTE for Breast Milk ; Humanised milk most
successful partial food, because so like breast milk p. 107
No SPECIAL EFFECT upon the Bowels from " humanised milk "
pp. 107-109
CHANGING THE FOOD ; Evil of going from one food to another without
definite knowledge or basis of selection pp. 109-111
RICH MILK from one cow ; Cream : Temperature of the water bath ;
Milk tastes bitter ; Milk curdled when boiled pp. 111-114
CONDENSED MILK pp. 114-115
STERILISED MILK. Character of ; Effect of sterilising process ; less
digestible and far less nutritious than fresh milk pp. 115-117
COMPARATIVE ANALYSES average of 80 samples of woman's milk and
of " humanised milk," by Dr. Albert R. Leeds p. 118
FAIRCHILD'S PRACTICAL RECIPES ; For peptonising food for the sick ;
Nutritive value of milk compared with beef tea, extracts of beef,
etc pp. 119-120
PEPTONISED MILK. Warm process ; Cold process ; Hot, as a bever-
age ; Effervescent ; Special for jellies, punches, etc. ; Punch ;
Lemonade ; Peptonised milk gruel ; Peptonised porridge ; Beef ;
Oysters ; Junket and whey with Fairchild's Essence of Pepsine ;
Partial digestion of farinaceous foods at the table pp. 121-127
LIST OF FAIRCHILD'S PREPARATIONS p. 128
FAIRCHILD'S HAND-BOOK
DIGESTIVE FERMENTS.
11
IIS
2. 3 6 o o
In the digestive ferments, we have to deal with an en-
tirely distinct class of agents, bearing little or no analogy
to drugs and chemicals. They are not known to exert any
action in the body other than that concerned in the con-
version of alimentary substances into soluble and absorb-
able forms. By this action alone we know them and can
determine their presence.
No digestive ferment has been absolutely isolated, conse-
quently the chemical constitution of these principles is yet
a matter of conjecture. We do not know how they per-
form their marvellous work, nor the exact chemical formula
of the various derivatives of digestion. These limitations
to our knowledge of the digestive ferments do not impose
any limitations upon their practical use ; for we are able to
extract them from the digestive juices or secreting glands
and to preserve them indefinitely as reliable agents of the
materia medica. In the test tube and under operative
conditions, they may be made to convert food stuffs, just
as they do within the living body. We know well the con-
ditions under which they act, what is unfavorable to their
action, what is directly destructive to them.
We can as unerringly detect the presence of pepsin or
diastase as that of morphia or strychnia. We can readily
ascertain the digestive power or value of any given product.
The physical changes of alimentary bodies under artificial
digestion are so characteristic, so apparent to sight and
taste, that they afford convenient and familiar evidence by
which the peptonising process may be as readily regulated
as that of cooking.
It is indeed marvellous that we should be able to so
readily utilise these organic principles of the vital process
of digestion.
12
Notwithstanding these facts, there still exists an im-
pression that there are peculiar difficulties attending the
practical use of the digestive ferments. This has been in a
large measure due to current fallacious statements and
theories, and to erroneous deductions from the immense
array of experiments presented, especially concerning those
showing the influence of medicinal and dietetic agents
upon the digestive ferments and upon the artificial digestive
process. The truth is that the digestive ferments may be
prescribed with the same certainty, as drugs and chemicals ;
with as definite and well grounded anticipation, with as
little difficulty as regards incompatibility.
The digestive ferments find their entire use in four dis-
tinct directions.
As therapeutic agents as remedies for indigestion.
As peptonising agents for the artificial digestion of
food.
As surgical solvents for the effectual and painless solu-
tion of morbid tissue, pus, diphtheritic membrane, etc.
For the preparation of " humanised milk " an artificial
human milk.
As remedies per se, as aids to the digestive process
within the body, the main concern of the physician is
to avoid prescribing the digestive ferments with sub-
stances which injure them. In the discussion of " Incom-
patibles," these are conveniently summarised for reference.
The fact that a certain agent retards or even inhibits
artificial digestion, by no means indicates that this agent is
not to be mixed with the ferment or prescribed in conjunc-
tion with it. The influence of the so-called " inhibitants "
is ascertained in the test tube, where the action of each
ferment is clogged even by the products of digestion and
retarded by substances which in the stomach would have
13
no influence whatever. In the chapter on " Inhabitants,"
the relation of these experiments to the conditions of body
digestion and the deductions to be drawn therefrom are
fully discussed.
In the artificial digestion of foods, the relation of tem-
perature to the digestive ferments is of great importance,
as simply by its regulation, we may hold the ferments in a
latent form, may obtain their energetic action, or instantly
and permanently check action at any given stage.
For the solution of morbid tissue, we have but to employ
the special ferment indicated, in its proper vehicle, and
remove by irrigation both the ferment and the dissolved
matter.
The employment of a digestive ferment as the essential
factor in the preparation of an artificial human milk, is not
by any means to be understood as simply yielding an
artificially digested food for infants, in the sense that foods
perfectly wholesome and digestible for healthy persons are
rendered suitable for the sick by artificial digestion. On
the contrary, it is a process by which cow's milk, primarily
unfit for the most vigorous, healthy, infant digestion, and
dissimilar to human milk in physiological, chemical and
nutritive properties, is brought to an active resemblance to
mothers' milk in every detail in density,, color, taste,
chemical composition and digestibility.
This highly important and successful application of the
digestive ferments was first suggested by us and brought
to a practicable form suitable for household use. The
rationale of this process is fully described in the chapter
on the Peptogenic Milk Powder. A thorough consideration
of the facts there presented must lead to the conclusion
that the process is based upon correct premises ; is accu-
rately carried out on the basis of adequate study of the
14
physiological characteristics and comparative analysis of
cow's and of human milk, and of the action of the digestive
ferments.
The certainty with which the Fairchild preparations of
the digestive ferments act, either upon alimentary bodies,
or morbid tissues, affords sufficient proof that the digestive
ferments are not necessarily variable or unreliable agents.
Our work with the digestive ferments has been of that
practical character involved in the production of these
organic principles in the most active and best form ; and
in the invention and development of preparations and
processes for their application. In the following pages, we
have sought to present the salient facts concerning the
digestive ferments in the whole range of their relations
to the conditions and agents with which they are prac-
tically brought into contact, and to describe the proper
methods for their employment as therapeutic and pepton-
ising agents.
DIGESTIVE FERMENTS.
GENERAL CHARACTERISTICS.
The digestive ferments belong to the class of soluble
unorganised ferments, possessing no power of self-nutrition
or self-multiplication. They differ entirely in their mode
of action from living ferments, such as yeast or bacteria.
Their action is further unaccompanied by the phenomena
ordinarily associated with fermentation. They may be
described as agents capable of setting up between sub-
stances, under conditions of moderate temperature, a chem-
ical action of which these substances are incapable without
the intervention of the ferment. The digestive ferments
probably belong to the proteid class, or are closely related
thereto. At present in the most active form in which they
15
are practically obtained, they are found to correspond in
behavior and constitution to proteid bodies. They are all
soluble in water, and by simple infusion of the fresh gland
or the secreting membrane, we may obtain active solutions
which exhibit in the proper media all the behavior of the
natural juices. The digestive ferments possess enormous
energy, being capable, even in the form in which they have
been practically separated, of converting into solution
many thousand times their weight of alimentary substance.
Stress has been laid upon the fact that a ferment after
having performed a certain amount of digestion may be
recovered and made to repeat its work, and it has been by
some writers assumed that the power of a ferment is limit-
less. Even if this theory were true, it has no bearing upon
ordinary operations with a digestive ferment upon its corre-
lated substance, for the purpose of determining its extent of
energy under practical conditions, or of utilising its force
for any practical purpose. For instance, for the artificial
solution of alimentary substances, and morbid tissues,
etc., or as aids to digestion. Nor is it of any significance
as to the role of the ferment in the normal process of
digestion.
It is, however, a fact that the digestive ferment has a
definite, ascertainable limit of energy ; its power is used up
just in proportion to the work done.
When under certain conditions favorable to digestion,
with arbitrary proportions of alimentary substance and
media, a point is found at which a given amount of ferment
leaves a large excess of substance unaffected, it is because
the ferment has lost all its power. Thus in a series of
experiments with increasing ratio of substance to ferment,
we ascertain the relative as well as actual power of pepsin
or of diastase.
The characteristic action of the digestive ferment is
16
the conversion of alimentary substances into the peculiar
soluble form essential to their absorption. But the action
of the ferments is not restricted to alimentary bodies ;
the proteolytic ferments, both of the stomach and the
pancreas gland, are capable of digesting albuminous or
fibrinous substances, such as false membranes, coagula, etc.
It is under physiological conditions that the ferments
produce changes which can otherwise only be approximated
under high temperature and chemical reagents ; as, for
instance, in the making of peptones or glucose by prolonged
boiling with acid. By the action of the digestive fer-
ments alimentary bodies undergo visible and profound
changes in their physical properties, of great physiological
significance, rendering them highly susceptible of osmosis,
whilst their chemical composition is but slightly altered.
In order to distinguish the digestive ferments from living
or organised ferments, Kuhne proposed to call them
enzymes, and further it has been proposed to distinguish
their action as enzymatic, in contrast to true fermentation.
But these terms have but little practical recognition, and
the distinctions between digestive ferments and living,
yeast, or germ ferments, are now so well understood that
the use of the term " digestive ferments " really leads to
little confusion.
In a dry form the digestive ferments permanently retain
their properties. For inasmuch as water is essential to the
action of the digestive ferment so the presence of water is
essential to its reaction with any other substance. Moisture
and heat are favorable to their decomposition. An essential
quality of dry products of the digestive ferments is, that
they shall not be prone to absorb moisture shall not be
hygroscopic. They should never be prescribed in combina-
tion with deliquescent salts, peptone, etc. A digestive
ferment may properly be combined in a dry form with sub-
stances with which it should not be brought into contact in
17
solution. Thus dry pepsin will not be injured by contact
with soda bicarbonate.
Obviously in a dry form, the digestive ferments are with-
out action towards each other. Therefore, a mixture of
these ferments should retain, and under proper conditions,
must exhibit the behavior characteristic of each one of the
ferments contained. For with several ferments placed in a
digesting mass, those under conditions unfavorable to action
have no possible interference with the action of the partic-
ular ferment for which the conditions are appropriate. A
digestive compound is therefore, in every particular, as
subject to assay as the separate ferments from which it is
prepared. For instance, if a powder contains " pepsin,
pancreatine and diastase," it should in acidulated water,
give all the results of the contained quantity of pepsin, in
an alkaline medium it should digest fibrin or milk, and in a
neutral or alkaline solution liquefy gelatinous starch. What-
ever theory or opinion may be held concerning the propriety
of such combinations, it must certainly be obvious that
their value as digestive agents must as much depend upon
the possession of the digestive properties of the various
ferments, as the value of a preparation of pepsin or of pan-
creatic extract is measured by the degree in which it ex-
hibits peptic or pancreatic activity.
The digestive ferments are inert but not injured, at a low
temperature. They bear prolonged exposure to the freez-
ing-point without becoming impaired. In solution, at the
ordinary temperature of a room, 70 "F., they act slowly
favorably at the temperature of the body, and increas-
ingly up to about 130 F., when as the temperature rises
they sharply diminish in activity until at about 160 F.,
they are quite destroyed.
Pepsin is active only with acid ; pancreatic ferments in
neutral, alkaline and feebly acid solutions.
It is impossible to prepare a menstruum suitable for
the solution and preservation of mixed ferments of the
pancreas and the stomach. If we mix active solutions of
the stomach and of the pancreas and test the mixture after
it has been set aside at the ordinary temperature of the
room for a few days, it will be found that the mixture no
longer represents all the digestive ferments as contained
in the original solutions. If the reaction of the solution
of the mixed ferments has been neutral or alkaline, the
pepsin will have been destroyed ; if acid, the pancreatic
ferments will have lost their properties. It may be said,
therefore, without qualification, that the whole class of
fluid mixtures of gastric and pancreatic ferments are un-
scientific, and invariably devoid of most of the ferments
they purport to contain.
ALCOHOL AND THE DIGESTIVE FERMENTS.
The digestive ferments vary so little in their behavior
with alcohol, that they may all be said to bear a common
relation to it. They are insoluble in alcohol, soluble in
diluted alcohol and precipitated from solution by alcohol in
excess.
To effectually employ alcohol as a precipitant of the
ferments, they must be held in a concentrated solution, to
which the stronger alcohol must be added in such a volume
as to give the largest practicable percentage of absolute
alcohol. The ferments so recovered, may again be re-
dissolved in water.
That alcohol does not destroy the ferments, may be
seen in the method commonly employed by physiological
chemists, in extracting the ferments in a pure solution
convenient for experimental purposes. The mucous mem-
brane or gland is first exposed to alcohol which washes,
hardens and dehydrates it ; then to a solvent (glycerin
19
preferably) which takes up the ferment largely free from
inert extractives, coloring matter, etc.
But notwithstanding the fact that alcohol is thus recom-
mended in leading works on physiology, we have been
unable to convince ourselves that strong alcohol does not
exert a direct injurious action on the ferments. The alco-
hol separated ferment does not exhibit the activity which
it should theoretically possess, calculated upon the degree
of isolation and the known assayed ferment power of the
original infusion of the gland. But the degree of activ-
ity suitable for the physiological chemist, who simply
requires solutions of the ferments capable of exhibiting the
characteristic reaction, is no doubt far inferior to the
standard attained by the manufacturing chemist in apply-
ing ferments to practical purposes.
From a pharmaceutical standpoint, alcohol bears in some
respects the relation to the digestive ferments that it does
to many drugs. A watery infusion from the stomach, like
all other infusions of organic substances, will soon de-
compose and the ferments therein will lose all activity
unless there is some preservative added. A hydro-alcoholic
menstruum serves as useful a purpose in extracting the
digestive ferments as it does in extracting the active prin-
ciple of drugs. The first desideratum of fluid preparations
is that they should present effective doses in a moderate
volume. With a menstruum containing say 15 to 20 per
cent, of pure spirit, all the ferments may be extracted and
preserved in an effective form for medicinal purposes
or for use in the artificial digestion of food. It is not
by any means a sufficient cause for the rejection of this
class of preparations, merely that they contain alcohol
up to say 20 per cent, of volume. In the percentage
sufficient as a preservative, alcohol does not necessarily
injure the ferments or render them inert. As present in this
20
proportion it becomes an insignificant factor in so far as it
affects the value of a digestive fluid, owing to the dilution
it will receive in practical uses.
We must require of such a preparation as the essential
ground of its employment, that it shall exhibit actual diges-
tive power, the characteristic action of the ferment which it
purports to represent, when submitted to the identical con-
ditions used in assaying the dry ferments themselves.
The solutions or liquid extracts from the pancreas are
objectionable and inferior to the dry Extractum Pancreatis,
not because of the 20 p. c. of alcohol, but because of
the tendency of these solutions to precipitate, to undergo
deterioration owing to the large amount of organic matter
they contain. The diastasic power is especially variable
and weak, and tends to constantly diminish. These solu-
tions further impart their peculiar repulsive taste to foods,
milk, gruel, etc., and consequently they have found little
usage, and now are entirely superseded by the Extractum
Pancreatis.
The influence which alcohol exerts upon the artificial
process of digestion, its bearing upon the proper use of
alcohol in fluid preparations of the digestive ferments, will
be discussed when we come to consider the subject of
inhabitants or substances which retard artificial digestion
in the flask or test tube.
That many of the class of preparations, such as wines,
elixirs,etc., are inefficient, is not due to thepresenceof alcohol,
but for the reason that they have not been properly pre-
pared, or have been made from commercial products
originally deficient in digestive properties. For this class of
preparations of the digestive ferments will be found to vary
very much, as do galenical preparations generally, according
to the skill and technical knowledge exercised in their
manufacture.
21
INHIBITANTS.
No question concerning the digestive ferments has
been given more attention than the influence of medici-
cinal and dietary substances upon the process of artificial
digestion. It has been the subject of many experiments
and raised many speculations. We have had elaborate
tests, giving the exact observed degree of retardation
exhibited by a great variety of drugs and chemicals,
some of which would scarcely by any chance ever be
mixed with a digestive ferment in practice ; also of the
effect of alcohol, wine, spirits, beer, tea, cocoa, coffee,
whey, sugar, common salt, etc. That various observers
reach conflicting results and conclusions is due to the
fact that no two employ digestive fluids of the same
strength or follow precisely the same method in detail.
Whilst these experiments are very interesting and attrac-
tive, the real point of inquiry must be to determine their
practical bearing in medicine and pharmacy. There is a
very necessary distinction to be drawn between the
action of substances upon the ferments direct and upon
the digestive process. It is of the greatest importance
to the physician and the pharmacist to know the agents
which destroy the ferment when brought into contact
with it. But as to the practical significance of this whole
class of experiments showing the retarding effect of sub-
stances upon the process of digestion, we must consider
what relation or resemblance exists between the condi-
tions in the test tube and in the living body. We must
ask why and how these agents retard digestion and if
they are likely to produce similar results when they are
taken into the body. The common method of experi-
ment is to take, say with pepsin for illustration, a definite
amount of the ferment, albumen, acid and water up to an
arbitrary volume, the proportions adjusted to produce a
known amount of digestion in a definite time at blood
22
heat. This constitutes the control test. Into this mix-
ture, in a series of tubes, are added the agents to be
tested and the effect upon digestion noted. These con-
ditions in the test tube imitate those of the digestive
tract in temperature and in media ; they differ therefrom
in material points. In the test tubes, the very accuracy
of the proportions of the mixture, whilst essential to cor-
rect observation in experiments, in reality involves a great
fallacy. Water is essential to all physiological action ;
water is the only fluid in which and by which a digestive
ferment can act upon an alimentary substance. In the
stomach and intestinal canal there is not an arbitrary fixed
volume of liquid, which may be to a definite and known
degree altered by the addition of any substance. In the
normal digestive apparatus, the ferment may be said to
act in a current of water ; there is a constant secretion
of digestive juices during the entire period of action.
There is meanwhile a marked fluctuation in the reaction
and the composition of the digesting mass, owing to the
very complex nature of the substances of food and the
more or less definite chemical changes and combinations
formed therefrom. The products of digestion, the saline
constituents of food, are continuously absorbed in the
digestive tract, leaving the digestive juice unhampered
in its work. In the test tube, in the "control," the
first essential is a fixed volume of water. Now if in
another tube, we add a substance which reduces the pro-
portion of water to any marked extent, we shall find, as
may only be anticipated, that we get less digestion. A
tube containing 80 per cent, of water and 20 per cent, of
alcohol or glycerin or sugar or peptone, will give less
result, not because these substances injure the ferment,
but because they cannot replace water, because of the
lessened value of the media for digestive action. Pure
glycerin exerts no injurious action upon a ferment, but
23
the ferment cannot transform albumen into peptone in
glycerin. Again, we see in artificial digestive operations
that when the fluid has become saturated with the prod-
ucts of digestion, the ferment can act no further ; not
because peptone injures pepsin or maltose injures dias-
tase, but because the water can take up no more and has
no further power as a medium for the ferment. Pure
alcohol in excess is a precipitant of pepsin, of albumen
and of peptone. About 10 per cent, absolute alcohol dis-
tinctly retards digestion in a test tube, but not because it
is in this percentage injurious to the ferment. On the
contrary, as already shown, in the proportion of 15 to 20
per cent, it affords a most valued preservative of infusion
of the ferments. Other substances retard digestion sim-
ply because they reduce or change the reaction of the
media, as shown for example in peptic digestion by the
fact that if the saturating power of an added substance
is compensated for by the addition of free acid to the
percentage of the control, little or no retardation is found.
The retarding influence of certain substances is modified
by. the strength of the digestive fluid for instance, by
the proportion of the pepsin to the albumen. If we take
the utmost limit of albumen which a grain of pepsin can
digest in several hours, say 2,000 grains, we shall find
the digesting mass much more sensitive to salt, for
instance, than one containing a grain of the same
pepsin to 200 grains albumen ; the percentage of salt
being the same in each case. This would seem to show
that a powerful digestion is not affected like a feeble
digestion the retardation is relative not absolute. In
the behavior of common salt in artificial peptic digestion,
we have an illustration of the inadequacy of tests of
" inhibitants " as guides to therapeutic uses of the
digestive ferments, or as explaining or approximating, to
the digestion in the body. Salt strongly retards the
24
action of pepsin upon albumen in the test tube. It
does not injure the ferment. On the contrary, it is
a well known precipitant and preservative of pepsin.
Salt inhibits digestion in a percentage which does
not throw out the pepsin, nor affect the solvent
action of water upon peptone, nor alter the reaction of
the digesting mass. In view of these facts and of the
universal use of salt as a condiment and antiseptic, we
are at a loss to explain its retarding effects in artificial
digestion and cannot believe it to exert any similar effect
in the stomach.
The stomach, moreover, is endowed with the power of
maintaining the physiological conditions essential to diges-
tion. The ingestion of an alkali may neutralise morbific
acids and provoke the secretion of the acids of digestion.
Acids form various combinations with proteids and bases
of food substances. Substances may, like alcohol, retard
digestion in a test tube, yet stimulate the secretions of the
mucous membrane or be so rapidly absorbed as to have
but a passing effect in so far as they become a factor in
the digestive process, or in altering either the composition
or reactions of the digesting mass. In the medicinal use
of the most pronounced retarding substances, they will
seldom or never be so given as to impart to the digestive
fluids the percentage which has been found inhibitory in
the test tube. There are few soluble medicinal substances
which, in some proportion, do not exhibit retarding action
under test tube conditions. Experience, long in advance
of these experiments in artificial digestion, has disclosed
the disturbing effects upon digestion of both dietary and
medicinal substances, due to conditions quite apart from
those of the test tube, and in which these experiments
afford but little practical significance.
25
INCOMPATIBLES.
SUBSTANCES AND CONDITIONS WHICH DESTROY THE
DIGESTIVE FERMENTS.
It is remarkable that there exists so little difficulty
in the practical use of the digestive ferments. It is not
considered a hardship that nitrate of silver must foe ex-
cluded from light, or anaesthetics from evaporation ; or
that hypodermic solutions must be freshly prepared.
Whilst the incompatibility of drugs and chemicals extends
to the formation of dangerous compounds from simple
mixtures, the digestive ferments have practically but
one sort of incompatibility to be avoided in dispen-
ing or prescribing; that of substances or influences
which render them inert. The manufacturer should
not offer and the physician will not knowingly prescribe
combinations, which are or are likely to become inert by
the time they reach the patient's hands. Of all the con-
ditions and substances with which the digestive ferments
are brought into contact in their practical use, we may
conveniently summarise those which render the ferment
inert.
A digestive ferment should never be mixed with water
or any fluid of a higher temperature than can readily
be borne by the mouth. In the peptonising process, in
" sprays," in " surgical solvents," too high temperature
should be carefully avoided. Pepsin is destroyed in alka-
line solutions with lime water, sodium bicarbonate,
aromatic spirits of ammonia, etc. All ferments in solution
soon decompose unless in the presence of an antiseptic.
Therefore, a mixture of trypsin, or pancreatic extract,
water and soda can not be expected to keep indefinitely.
The ferments should not be mixed undiluted with strong
alcoholic tinctures, or astringents. Pancreatic ferments
should not be placed in acid mixtures. Pepsin and pan-
26
creatic ferments should not be mixed together in solu-
tions acid or alkaline. These mixed ferments can not
be permanently held in an active form in any solution
elixir or whatever it may be called.
In using a digestive ferment, it does not matter whether
the ferment is in solution or suspended in a mixture ;
whether the substance with which it is mixed is known
to retard digestion in a test tube ; the main point is that
the ferment shall not be destroyed that it be exhibited
in an active form.
PEPSIN AND BISMUTH IN SOLUTION.
Bismuth in solution is incompatible with pepsin. Pep-
sin and the insoluble salts of bismuth, the subnitrate
or the subcarbonate, is one of the most efficient and gen-
erally used combinations. Obviously these salts of bis-
muth exert no influence upon pepsin in the dry state, nor
are 'they injurious to the ferment when mixed with it in
the fluid form. Therefore the bismuth subnitrate may be
properly given, for instance, in Fairchild's Essence of
Pepsine, or in the Glycerinum Pepticum. But the soluble
salt of bismuth, the ammonia citrate, cannot be combined
with pepsin in solution without rendering the ferment
inert, as we pointed out ten years ago. This fact has
been repeatedly adduced by pharmaceutical writers, and
the elixirs of pepsin and bismuth have quite lost their
vogue ; there is but a very limited demand for them.
Before the digestive valuelessness of this pepsin and bis-
muth elixir was known, the main attention of pharmacists
was directed in the endeavor to overcome the chemical
or pharmaceutical incompatibilities of this combination.
This was due to the use of hydrochloric acid as a solvent,
or to pepsin containing this acid, and an unstable solu-
tion of bismuth was thus yielded in spite of the neutralisation
with ammonia. Consequently the employment of citric
acid which gives a satisfactory pharmaceutical preparation
has been advocated, and from time to time new formu-
las for elixir of pepsin and bismuth appear. But however
combined or skillfully prepared, it will be found that the
bismuth in solution has rendered the ferment inert. The
elixirs of pepsin and bismuth are invariably found upon
assay to be completely devoid of any digestive action.
The good they do is from the bismuth, alcohol, the
aromatics, etc. Consequently this elixir of bismuth and
pepsin should be discarded, and it is to be regretted
that it has found a place in any " formulas," and thus
encouragement given to a palpably improper combina-
tion.
ANTISEPTICS.
The influence of antiseptics upon the digestive ferments
is of great practical importance. Alcohol, glycerin and
common salt are the most available technically both in
the pharmaceutical preparations of the digestive ferments
and the preservation of solutions of peptonised products.
Brine extracts the rennet and some of the pancreatic fer-
ments. Other antiseptics, borax, boracic acid, salicylic acid,
thymol, etc., render infusions of the ferments stable. But
this class of antiseptics should not be resorted to, for every-
where in food stuffs, beverages, etc., they are distrusted and
not permitted as a substitute for alcohol. They are not
permissible unless directed by the physician. There are
antiseptics which may be so freely used in a digesting
mass as to prevent all ulterior or putrefactive changes
and yet not interfere with the action of the digestive
ferments. Creosote is remarkable for this property
and when introduced in the pancreatic digestion of milk,
28
fibrin, etc., the usual digestive transformation takes place
without the occurence of fermentative changes, even after
many hours. Pure creosote is therefore justly regarded
as a most valuable medicinal antiseptic to prevent fermen-
tative changes, especially in the intestinal tract.
"JUMBLES."
There is a certain class of digestive compounds which
have been aptly characterised and condemned by Fother-
gill as unscientific "jumbles." There is an objection
to these jumbles more serious than any based upon theory
as to the propriety of mixing up all the agents of diges-
tion with acids and milk sugar. Indeed, there has never
been any conclusive argument against efficient combina-
tions of the various ferments, and many physicians employ
tablets of " Fairchild's " Pepsin and Pancreatic* Extract.
So whatever our theory about digestive compounds,
certainly a compound can be judged only by its actual
digestive value, just as we judge or value the single fer-
ments. Nothing can be easier than to triturate powders
of pepsin and pancreatic ferments, and such a mixture
will exhibit all the properties of each one of the fer-
ments. Notwithstanding this, most of these compounds,
"pepsin, pancreatine, diastase and acids," do not contain
any other ferment besides pepsin ; consequently there
can be no escape from the conclusion that their value
as remedies depends solely on the pepsin and acid they
contain. Such compounds have been again and again
condemned for their defective and deceptive character by
competent medical and pharmaceutical writers. There is a
fallacy that is fast being ventilated, in the pretence that
such compounds possess peculiar remedial or "clinical"
value, in spite of their failure to show digestive action. The
use of these compounds is one of the strongest evidences
of the value of pepsin, even when diluted with milk sugar.
29
VEGETABLE FERMENT.
The property of certain vegetable " milk juices," of
softening or liquefying fibrin and albumen, has long been
known. It has been of speculative interest to the botanist
and physiologist ; but these exceptional instances of the
presence in plants of a proteolytic ferment of no discover-
able relation to their nutrition is without physiological
significance. It is of practical import to the physician
only to the extent in which these vegetable substances
may prove to possess any superiority to the animal
proteolytic ferments. These vegetable principles have
been the subject of considerable experiment in various
quarters without the appearance, to our knowledge, of any
data showing their especial utility or availability. On
the contrary, they have been deemed far weaker than the
animal ferments. In order to ascertain for ourselves the
properties and comparative value of the vegetable prod-
ucts we, years ago, obtained specimens of dried milk
juice, and the so-called active principles thereof, and sub-
jected them to assay in acidulated water, under the usual
range of conditions competent for pepsin, and with
alkaline and neutral water, under the conditions suitable
for pancreatic extract. Subsequently we have, from time
to time, tested specimens submitted to us by parties pro-
posing to introduce the vegetable product on the market.
Again recently, our attention has been brought to the
subject, and we have repeated careful tests of the vegeta-
ble ferments as found in the market. As a result of these
many tests, we have invariably found all specimens, papa-
yotin, papaine, papoid, etc., of such very slight activity in
comparison with either pepsin or pancreatic extract, that
we have always declined to introduce the vegetable prod-
uct, and have never found reason to undertake its manu-
facture. The vegetable ferment exhibitits no new, peculiar
30
or superior property either as regards media or character of
action. Considered as a "vegetable pepsin," its value must
rest upon its action in acidulated water, for pepsin has no
action except in acid ; here papayotin or papoid is prac-
tically inert. Considered as a ferment capable of action
comparable with trypsin, its value must rest on its action in
neutral or alkaline media ; here it is of very feeble
power. As a peptoniser of beef, fibrin, egg albumen o*
milk, its action is so slight and unsatisfactory as to be of
no practical utility. The claims advertised, that a cer-
tain vegetable product acts in acid or alkali, in " less
water " are simply preposterous. Water is essential to all
physiological action. The simplest tests under various
ranges of acidity, alkalinity, all ranges of temperature, of
proportions of water, will at once show that the " vegeta-
ble " ferment possesses no immunity from the conditions
governing all ferment action. The most remarkable thing
about the "vegetable pepsin" is that its value is in an
inverse ratio to the claims made for it, and the prices
asked for it.
THE GASTRIC FERMENTS.
PEPSIN.
Pepsin, the peculiar digestive principle of the stomach,
is active only in the presence of an acid, and most potent
with the acid of normal gastric juice and with the percent-
age of free acid present at the height of gastric
digestion. Its action is, however, by no means in-
separably associated with hydrochloric acid, but it acts
freely with a wide range of acidity with both mineral
and organic acids, lactic, tartaric, etc. Even the faintest
acidity is sufficient to call forth its action, which is
not greatly modified at points either slightly above or
below the free acid of the normal media. Pepsin digests
but one class of substance, proteids, all forms of which
31
it is capable of converting into peptone. Various forms of
proteids show some varying behavior under the influence of
the artificial gastric juice. Coagulated egg albumen goes
into solution from the surface gradually and only upon
prolonged contact does the excess of albumen show any
notable softening effects or gelatinous appearance. Raw
fibrin or fresh meat, instantly swells in contact with acidu-
lated water, and then undergoes softening and solution.
Boiled fibrin or flesh behaves like boiled egg albumen. If,
however, the raw albumen has been previously dissolved in
water and then boiled, we obtain a gelatinous or mucilagi-
nous albumen, which upon contact with the active ferment
almost instantly becomes thinner and soon goes into com-
plete solution. The ferment here behaves almost identi-
cally as does diastase with gelatinous starch, and the
resulting solution will contain various forms of soluble
albumen and peptone, just as the starch solution will
contain soluble starch and dextrin. The peptic digestion
of albumen is a gradual, progressive transformation into
peptone, with various intermediate forms of soluble albu-
men, the percentage of peptone depending greatly upon
the proportion of ferment to the albumen and the duration
of the digestion. Gastric digestion ceases at peptone ;
there is no further change or splitting up of the peptones
as in the case of pancreatic digestion. Pepsin is not only
inert in alkaline solutions, but is destroyed with merely
sufficient alkali (such as for instance, sodium bicarbonate,)
to give an alkaline reaction. It is not possible by subse-
quent acidulation or any treatment, to bring the ferment
to show the slightest activity.
PEPSIN, ITS PRACTICAL USES.
Pepsin is not available for peptonising food for the
sick, in the household. Its action is not only restricted to
32
albuminous substances, but acid being indispensable, the
product is for this reason unsuitable as a food. In the
laboratory this ferment may be and is commonly utilised,
for there the acids are separated and the products clarified,
properly. But the terms " peptonised " and peptone are so
fixed in the popular mind in association with pepsin, that
many continue to regard a peptonised food as one made
with pepsin or containing pepsin. Pepsin is useless in the
artificial digestion of milk. Pepsin cannot be used for the
artificial digestion of food at the table in the way that the
Extractum Pancreatis may be. Pepsin is, however, useful
for the solution of fibrinous membrane, coagula, etc., and is
much employed as a surgical resource. For its use in this
direction, see " Surgical Use of the Digestive Ferments."
The exhibition of acid in conjunction with pepsin depends
much on circumstances, for it cannot by any means be
held to be always indispensable. Normal gastric juice
contains both free acid and pepsin. An artificial gastric
juice for digestion in a flask, can only be obtained by com-
bining these two agents. But the stomach cannot be dealt
with as with a beaker glass. We see the good effects from
the administration of pepsin without acid or in such faintly
acid solutions as Fairchild's Essence of Pepsine. If a
physician sees indication for the administration of soda, as
in acidity of the stomach, and for pepsin to aid digestion,
these two remedies may be combined dry without regard
to the fact that in an alkaline solution pepsin is inert. For
it is not supposable that an amount of soda sufficient to
impart an alkaline reaction to the entire gastric contents
would ever be given.
MILK CURDLING FERMENT OF THE
GASTRIC JUICE.
The gastric juice contains a distinct principle which has
the power of curdling or coagulating milk. It is not known
33
to have any other property ; consequently it cannot be con-
sidered a digestive ferment in the sense that it effects any
change in the constitution of an alimentary substance.
Whilst many studies have been made and theories advanced
concerning the action of this ferment, of the changes milk
undergoes in coagulation by it, we can only say of this
ferment as of others, we do not know how it acts ; we know
it to be a true ferment. A solution of this ferment heated
to 170 instantly loses all activity. Its action is not, like that
of pepsin ferment, dependent upon the intervention of an
acid. It curdles neutral or even faintly alkaline milk. It may,
like pepsin, be extracted by acidulated water. Therefore, we
may obtain both ferments in an active, permanent solution.
In remarkable contrast to pepsin it is not precipitated by
common salt. A brine extract is commonly employed in
the use of " rennet " in cheese making. These salt infusions
of the rennet are devoid of all peptic activity. Pepsin has
no curdling property, and whatever milk curdling action a
preparation of pepsin may show is due entirely to the
true curdling ferment associated with it. Notwithstand-
ing this fact, the impression still obtains that pepsin should
curdle milk. The question has been raised as to the value
or function of this ferment in the natural process of diges-
tion, seeing that the gastric juice contains acid which
itself, it is said, should coagulate milk. But it is a fact that
milk does not by any means behave with acid precisely as
with the curdling ferment ; in the one it is entirely a chem-
ical change, in the other a physiological change wrought
instantly, and accompanied by no change in the chemical
constitution of the caseine. Further it is of great signifi-
cance, it seems to us, to find that this ferment exists in the
greatest activity in the stomach of the suckling animal.
This is so well known, that it is always the " milk rennet "
which is used from which to prepare rennet liquids. The
stomach of the hog contains but a trace of the ferment, and
34
pure pepsin from this source is invariably useless for
curdling milk. It would, therefore, seem quite likely that
this ferment plays no insignificant part in the digestion of
milk. By its action the caseine is thrown out in the form of
coagula, most susceptible to the action of the gastric juice,
whilst the whey, containing the salts and milk sugar and
the soluble forms of albuminoid, passes freely along the
digestive tract, where it undergoes assimilation without the
need of any digestive change. In the young suckling, fur-
thermore, the pancreas is but partially developed. In this
curdled milk we see that the caseine is reduced to a con-
dition analogous to that in which the flesh foods of the
adult are presented to the stomach. If the milk were not
curdled, either by acid or rennet, certainly there would be
no obstacle to the free passage of the fluid milk along
the infant's digestive tract. It is not, then, without pur-
pose, this curdling ferment in the stomach of the suckling
animal.
The liquid rennets of the shops prepared from salted
vinous menstruum do not contain pepsin and have been so
inferior and variable in curdling activity that they have
fallen into disuse.
THE PANCREATIC FERMENTS.
TRYPSIN.
THE PROTEOLYTIC FERMENT OF THE PANCREAS.
The pancreas juice contains a principle which may be
said to be the analogue of pepsin, in that it is capable of
converting all forms of proteids into peptone. It differs
markedly from pepsin in important particulars. Whilst it
is most active in an alkaline solution, it is also energetic in
a neutral solution, and digests milk freely without addi-
tion of alkali. Thus, it is not restricted in its media to the
35
reaction characteristic of the fresh pancreas juice, having
on the contrary, as will be seen, a wide range of action.
Whilst in a feebly acid solution, especially with organic
acids, it is found to exhibit action upon fibrin and albumen,
free hydrochloric acid is far from being favorable to tryptic
action.
Trypsin yields various soluble products and peptones
which do not materially differ from those of peptic diges-
tion, but unlike pepsin it gives still further normal prod-
ucts by the transformation of peptone into leucin and
tyrosin.
Trypsin has a special affinity for the proteids of milk,
showing proportionately more activity upon caseine than
upon other proteids. In the Extractum Pancreatis, trypsin
is presented as naturally associated with the other fer-
ments of the gland. We have also made a special prepar-
ation of trypsin as a solvent for diptheritic membrane.
THE DIASTASE OF THE PANCREAS.
The starch digesting principle of the pancreatic juice
presents no known difference from the ferment of the
saliva, or of germinating grain (malt) in the media or
method of its action, or in the result of its action. Like
every known form of diastase, it gradually converts gelati-
nous starch into soluble starch, dextrines, glucose or malt
sugar. It is active in neutral or alkaline reactions. We
cannot therefore, distinguish one form of diastase from
another merely by its behavior, and whatever views may
be held regarding diastase as a remedy, must apply to
this ferment from whatever source it appears. We have
no means of knowing definitely to what degree of con-
version starch is carried in the natural process of diges-
36
tion, but there is no doubt that its complete transfor-
mation into glucose is not essential to its assimilation ;
physiological experiments show that the highly diffusible
dextrines and soluble starches are absorbed into the
blood, and there is every ground to suppose that a very
considerable portion of the products of starch digestion
are absorbed long before they could reach their ultimate
conversion. The influences of various substances upon
diastase are, as in the case of all ferments, largely mod-
ified by the proportion of ferment and by the presence of
products of digestion, etc., so that, whilst in the labora-
tory we fix the retarding influence of definite percentages
of acids or of alkali under arbitrary conditions, we must
not overlook the insufficiency of such data as bearing upon
the actual conditions of digestion within the body.
The incompatibility of acid and diastase does not afford
sufficient ground for the assumption that the starch digest-
ing principle finds no field for action in the stomach. The
gastric juice is absolutely inert upon starch ; the major
part of farinaceous matter is in a form incapable of solu-
tion during the short contact with the salivary diastase in
the mouth ; the stomach contents have at the outset of
normal digestion but a feebly acid reaction, and the acidity
only reaches its maximum point an hour or so after the
ingestion of food. In view of all these facts, the conclu-
sion is reasonable, that the stomach affords opportunity for
such preliminary digestion of starch as fits it for further
conversion in the intestinal tract.
USES OF PANCREATIC DIASTASE.
The practical identity of the pancreatic and salivary
diastase being established, it follows that we may as
reasonably exhibit an active extract of the pancreas in
37
deficiency of salivary digestion, as we may exhibit pepsin
in feeble gastric digestion.
The most rational way of supplementing deficient sali-
vary digestion is to add the active pancreatic preparation
to farinaceous food at the table. No taste is imparted to
the food, no suggestion whatever of " medicine," and under
its influence the starch is rapidly softened, and converted
into a soluble form which will insure its proper digestion.
For children and the aged and convalescent, this method is
especially recommended. For faulty intestinal digestion of
starch, the Extractum Pancreatis or DiastasicEssence should
be given immediately after meals, and repeated in an hour
or two. In the Extractum Pancreatis the starch digesting
principle is accompanied with ferments which digest air
other forms of aliment, and which are often indicated in
connection with diastase. In the Diastasic Essence of
Pancreas, the starch digesting principle is presented in
an exceedingly active, agreeable and practically isolated
form, and it, therefore, may be advantageously resorted to
in cases where it is not desired to adminster the other fer-
ments of digestion. For intestinal indigestion of starch, the
diastasic ferment may best be given just previous to taking
food, and again about two hours after food. The diastasic
ferment given just previous to or with meals promotes
the preliminary starch digestion, that which is normally
effected by the salivary diastase ; given after the force
of gastric digestion is lessened, it promotes the secondary
or pancreatic digestion of starch. The Pancreatic Tab-
lets and the Diastasic Essence are especially commended
as a means of exhibiting this ferment.
THE EMULSIVE FERMENT.
The characteristic action of the emulsive ferment is the
conversion of oils or fats into a minute state of division or
38
emulsification. The emulsification and absorption of the
minutely divided molecules are successive steps, precisely as
the conversion or hydration of albumen is antecedent to its
absorption. Whether there is also any chemical change in
the fat by action of the ferment, may be said to be a moot
question. If a fat or oil is macerated for some hours at
the temperature of the body with fresh pancreas juice or
with minced pancreas and then strained, it will be found
that the pancreatised fat will instantly form a thick, creamy
emulsion when shaken with an equal quantity of water.
The pancreatic juice when taken from the gland soon under-
goes change and shows an acid reaction, and it has been
asserted that when the development of these fatty acids is
prevented, there is no occurence of these acids in the
treatment of fat under the influence of the emulsive fer-
ment. As the chief and characteristic behavior is the
breaking up of the fat into emulsion or creamy form,
so doubtless is the greater part of, fat assimilated
direct without undergoing any conversion. It is a
curious fact that this, the least available and the least
practically important pancreas ferment, has been the
one to which attention had been chiefly directed prior
to the introduction of the Extractum Pancreatis.
The " pancreatines " found in commerce bore no
other reference to any digestive action or use than
their asserted property of emulsifying cod liver oil,
whilst they were completely deficient in the other fer-
ments of the gland. The emulsive ferment is not
capable of effecting the permanent admixture of oil
with water, as may be done by purely mechanical
agents, such as gums, etc. The pancreatic liquors,
as well as the commercial pancreatine, are of only
the slightest emulsive value. The Extractum Pan-
creatis is in this, as in other ferments of the gland,
39
the most active product. If a few grains of the Ex-
tractum Pancreatis be well shaken with one or two
drachms of warm water, and an ounce of cod liver oil or
pure olive oil, and allowed to stand in a warm place for
five or six hours, it will be found that this oil will then
form a creamy emulsion with water ; upon standing, this
emulsion will gradually separate, but may again be emul-
sified by agitation. When the use of the gummy and
starchy, sweet emulsions are contra-indicated, The Ex-
tractum Pancreatis may be utilised as already described,
or it may be given immediately after the pure oil or the
usual emulsions.
THE MILK CURDLING FERMENT OF THE
PANCREAS.
The pancreas contains a ferment which curdles milk
slightly acid, neutral or alkaline. As associated with the
other ferments of the pancreatic juice or in an active
extract of the pancreas, such as Fairchild's Extractum
Pancreatis, it cannot be practically utilised in the same
manner as the rennet ferment in the preparation of curds
and whey. The proteolytic ferment will attack the curded
caseine and soon dissolve it.
If a few (five) grains of Extractum Pancreatis be
added to pure lukewarm milk (say four ounces), a soft
curd will be almost instantly formed. If the milk is
permitted to stand at rest, the curd will not cohere and
separate in a mass from the whey as in rennet curdling,
but will gradually become softer, will float in the milk
and finally disappear. If the milk is stirred with a
rod or spoon, the curd is instantly broken up into
minute particles suspended in the milk, and soon under-
40
goes digestion, the milk acquiring the characteristic color
and taste of peptonisation.
THE DOSAGE OF DIGESTIVE FERMENTS.
The digestive ferments having no drug action, no
property comparable to that by which the doses of
remedial agents are in general regulated, a small dose
differs from a large dose only in degree, not in character of
effect produced. There is no such relation of effect to dose
as in the case of drugs, such as ipecac, calomel, strych-
nine, etc. We cannot expect, therefore, to fix any
arbitrary range of dose as with drugs with distinct
measurable action upon the body. In the days of the
saccharated pepsins and pancreatines, large bulk with minute
quantities of true ferment were given ; with the introduc-
tion of Fairchild's preparations of unprecedented activity, a
few grains became the generally employed dose, and the
tendency seems to be, as these products are more and
more improved in potency, that the doses are rather dimin-
ished. Doubtless there has obtained in the past some
impression that large doses of pure ferments might not be
harmless ; but neither in medical literature nor in anything
that we know of the physiology of digestion, nor from the
extended opportunity for learning the results of the practi-
cal use of the digestive ferments, does there appear any
tenable ground for this assumption. It has existed only
as a vague theory, and as a surmise of possibilities. The
animal digestive ferments find a place in materia medica,
because they display upon food substances under con-
ditions closely conformable in temperature and in reaction
to those of the body, the action characteristic of the normal
digestive secretions. Properly introduced into the living
digestive tract, we may then expect that they will exert
precisely the same effects as the naturally secreted
ferment. A large dose of pepsin artificially introduced
into the process of digestion can no more attack the
stomach membrane than will the natural gastric juice.
The sufficient dose to supplement deficient digestion
must vary largely and the dose need only be reg-
ulated by considerations of the amount required to effect
the purpose. That habitual use of a ferment may rationally
be resorted to, in order to produce tranquil digestion for
those patients whose digestion is susceptible to disorder, or
impaired by care, anxiety and sedentary occupation and
similiar influences is beyond question. What expedient
more practical or innocent ? Certainly far less likely to be
harmful, than persistent " drugging."
THE FAIRCHILD PREPARATIONS
OF THE
DIGESTIVE FERMENTS.
The uniform character, activity and reputation, of
the Fairchild Preparations of Digestive Ferments are
sufficient evidence, of the fallacy of the statements
sometimes advanced, that the digestive ferments are
necessarily variable and unreliable agents. The fact
is that Fairchild's digestive ferments are second only
in uniformity to the alkaloids and chemicals. They
are more definite and uniformly reliable than most
drugs, or galenical preparations therefrom, extracts,
tinctures, etc. The status of these preparations of the
digestive ferments, moreover, does not depend simply
upon medicinal properties, so difficult to determine for
all agents except those which have a distinct action upon
the body. They are valued for reason of definite
demonstrated and applied digestive properties.
42
The Fairchild special products have been put for-
ward with definite methods for accomplishing certain
practical results. As a record of more than ten years of
experience, not an instance has occured where one of our
preparations has failed to perform this work has disap-
pointed the anticipation of the physician. Not a package
of the Extractum Pancreatis nor a Peptonising Tube has
proven inert upon milk or starch. The surgeon who sees
the potent solvent action, of Fairchild's pepsin upon
morbid tissue ; the physician who sees the absolute
certainty with which the Extractum Pancreatis may
be applied in peptonising milk, etc., will not doubt these
agents possess substantial claims to therapeutic use.
The Fairchild preparations are the result of original
special work given to the digestive ferments. Each and
every product offered to the medical profession has been
carefully prepared to meet certain requirements and to
fulfill a definite purpose.
We have especially sought to avoid all incompatible
compounds, and do not supply these even if having popu-
lar sale, and we do not needlessly multiply the variety of
preparations. For all the important purposes for which
the digestive ferments are now applied, the Fairchild
preparations have been either originated, or been the
means employed, on account of their well-known
superiority.
The commercial products of the digestive ferments will
differ in character, in grade of activity, in purity, according
to the skill, knowledge, and purpose of the manufacturer.
Some are made to supply a demand for cheap preparations ;
others to imitate in physical characteristics products which
have become eminent for value.
43
The Fairchild preparations being almost exclusively
dispensed upon the prescription of the physicians, we
have with a due regard to the interest and convenience of
the pharmacist, supplied them in bulk whenever practica-
ble. This fact has, however, only afforded better oppor-
tunities to that class of manufacturers who find it
impossible to make a market for their goods on the score
of merit, but who, as in every " line," prefer to trade
upon the reputation of standard products by the substitu-
tion of inferior and " cheap " imitations. These inferior
products are urged upon the pharmacists as the " same
thing," " gives you extra profit ;" if " Fairchild's is not
specified, use ours ;" although it is plain that the physi-
cian even when not specifying Fairchild's really means
and expects to get Fairchild's, owing to his long reliance
upon them years before the appearance of so many prepa-
rations under the same titles.
Owing to the great reputation and use of Fairchild's
Essence of Pepsine, this preparation has been the especial
object of imitation.
The title, Essence of Pepsin, has been applied to
preparations entirely dissimilar and inferior in properties
to the original Essence of Pepsine.
In many instances, upon complaint of physicians, we
have examined these dishonest imitations which have
been substituted even when Fairchild's is specified, and
found them often inert upon milk, of weak peptic power
and of a distinctly unpalatable character. In view of the
very important properties and uses of this Essence as a
means of administering drugs, preparing whey, etc., to
correct digestive disorders of infancy, the substitution
of these worse than useless preparations Inflicts serious in-
jury injury upon the patient, the physician, and the
44
manufacturer upon whom the physician relies. Further
the same price is charged the customer as for the original
article which leaves no question as to the real purpose
of this infamous practice. We desire to take this occasion
to say that in contrast to this, the great body of pharma-
cists not only religiously regard the wishes of the pre-
scriber, but many of them, we are glad to know dispense,
and use generally, Fairchild's preparations by their own
preference. Seeking no other market than that caused
by the preference for Fairchild's preparations, we desire to
protect ourselves, the physician and his patient, from the
substitutes and imitations. We, therefore, ask the "favor,
that the physician will distinctly specify Fairchild's when
he wishes them, and in case of any dissatisfaction that he
will send to us for examination the preparation dispensed.
FAIRCHILD'S PEPSIN.
IN SCALES AND POWDER.
Fairchild's pepsin conforms in all particulars to the re-
quirements of the U. S. Pharmacopoeia, in activity, solu-
bility, and physical properties. It is freely soluble, perma-
nent, free from disagreeable odor and taste. One grain
will digest 3000 grains of albumen according to the officinal
method of valuation.
As the originators of " Pepsin in Scales," we deem it a
matter for congratulation that "pepsin " is now, for the first
time, officinal, and thus placed where it obviously long ago
should have been, among the recognised therapeutic agents
of the Materia Medica. Hitherto, owing to the fact that
there has been no officinal and mandatory standard of value,
there have been many very inferior and often worthless
products sold and dispensed as " pepsin." The saccharated
45
having been the only officinal preparation, absurdly weals
doses of the ferment itself have too often been used.
There is every reason to believe that pepsin will in-
crease in reputation as a therapeutic agent, now that it
is obligatory to dispense a preparation of i to 3000
strength.
In order to obtain the best results and to insure a
uniformly excellent product, the physician is requested to
prescribe "Fairchild's" pepsin.
SACCHARATED PEPSIN.
The saccharated was for years the best known and most
used form of pepsin. The original standard of strength
was that 10 grains should digest about 150 grains of albu-
men. In the 1880 revision of the Pharmacopoeia, it was
made the first and only officinal form of dry pepsin, and it
was required that i grain should digest 50 grains of
albumen. According to the new Pharmacopoeia (1890)
saccharated pepsin must contain 10 per cent, of a i to 3000
pepsin and 90 per cent, of milk sugar i grain of this to
digest 300 grains albumen. In view of the facility with
which Fairchild's pepsin can be mixed with milk sugar to
any desired dosage, there seems little use for " Saccharated
Pepsin," except to give a reasonable, definite standard for
a product hitherto of but little value. Fairchild's Sacchar-
ated Pepsin conforms fully to the Pharmacopoeia require-
ments.
46
GLYCERINUM PEPTICUM.
(FAIRCHILD.)
Glycerin possesses peculiar value as at once an extrac-
tive and preservative of the digestive ferments. For this
purpose it has long been used in the physiological labora-
tory and the glycerin extracts have been preferred for ex-
perimental purposes. Fairchild's Glycerinum Pepticum is
the first commercial product in which glycerin has
been utilised to prepare a concentrated, stable solution of
pepsin, direct from the mucous membrane. This Glyceri-
num Pepticum presents the peptic ferment in the most
isolated form in which it has ever been produced in solu-
tion for practical purposes, containing no alcohol, sugar,
flavoring or antiseptic other than the pure glycerin. It is
a clear, bright extract, remarkably free from color, odor
or taste, freely soluble without cloudiness in all proper
menstrua or media. It is notably devoid of the peculiar
disagreeable characteristics of the glyceroles of peptone
pepsin. It is by far the most convenient and useful for
all purposes where pure pepsin is required in solution ; for
extemporaneous mixtures, for experimental purposes, for
applying pepsin as a surgical solvent, for preparing offici-
nal solutions. It is quite agreeable, even in pure or acidu-
lated water and may be given in wines, elixirs, etc. It
is especially convenient for the physician who finds it
desirable to dispense medicines and for hospitals and
dispensaries. For the manufacture of all the usual pep-
sin fluids, wines, elixirs, liquors, etc., it is far preferable,
gives a more stable and agreeable preparation than ob-
tainable by any other form of soluble pepsin. Twelve
minims are capable of digesting 2,000 grains albumen
under usual conditions.
47
ESSENCE OF PEPSINE,
(FAIRCHILD.)
A SOLUTION OF THE ESSENTIAL ORGANIC INGREDIENTS Of
THE GASTRIC JUICE, EXTRACTED DIRECTLY FROM
THE PEPTIC GLANDS OF THE STOMACH.
Fairchild's Essence of Pepsine is obtained by direct
extraction from the fresh calf rennet in a menstruum
which possesses, in the highest degree, the properties of a
vehicle and a preservative of the peptic and the milk
curdling ferment.
The Essence of Pepsine is a remarkably agreeable,
diffusible, aromatic stimulant ; yet holds in solution both
the active ferments of the fresh gastric juice. It is but
faintly acid, not in the least heavy with sweet, leaves upon
the palate not the least pronounced impression of any pre-
dominant flavoring. It is free from all suggestion of
animal origin, and further, imparts a delicate flavor and
aroma to milk-curd or junket, whey and cold milk.
Pepsin, like many another remedy, gains by judicious
association of corrigents, and only second to the actual
agents of digestion are the aromatics skillfully combined.
The salutary influence of savory substances and the re-
markably malevolent effect of some discordant flavor
are common experiences even in health ; dyspeptics are
especially sensitive to digestive disturbances out of all
proportion to the apparent cause. The usual pharma-
ceutical preparations, the elixirs, wines, cordials, and so
forth, are generally poor examples of what a blend of
proper aromatics should be. Many of these preparations,
produced in imitation of Fairchild's Essence, are so dis-
tasteful as to greatly militate against the good effects which
might be derived from any ferment they may contain.
Fairchild's Essence of Pepsine has long been the most
48
Useful and successful of all pepsin preparations. It is
found of peculiar value for three distinct purposes as a
remedy for indigestion in adults and infants ; as a means
of administering drugs which disturb the digestive func-
tions and impair the appetite ; as a practical rennet agent.
For infantile digestive disorders Fairchild's Essence of
Pepsine is especially effective ; it not only aids digestion,
but corrects flatulency and vomiting. It is, therefore,
far more innocent and effective than the usual domestic
and empirical remedies for colic, etc. ; certainly in-
finitely preferable to soothing cordials. In cholera infantum
it presents the most, valuable properties stimulant, car-
minative, and digestive, and is far better than alcoholic
stimulants, per se. For persons of habitually weak diges-
tion it proves the most acceptable and potent resource.
The usual dose for an infant is from 5 to 10 drops, and
from i to 3 teaspoonfuls for an adult.
That Essence of Pepsine is of great service in aiding
the tolerance of drugs sucli as iodides, bromides, mercur-
ials, etc., is well known. Here it is not only important to
give pepsin, but the ferment must be in such a form as to
overcome the repulsion caused by the ingestion of these
drugs. The Essence of Pepsine has proven of the greatest
possible service in the administration of such drugs, be-
cause of its digestive and grateful stomachic properties.
It is confidently relied upon for this purpose by many phy-
sicians. As a vehicle simply, the Essence is by far the
best in use. Drugs which give unsightly mixtures or
which completely overcome the agreeable qualities of the
Essence should be given in separate form, to be immedi-
ately followed by one or two teaspoonfuls of the pure
Essence, thus gaining the greatest advantage of its
agreeable qualities.
The efficacy of the Fairchild's Essence for administering
49
iodide of potash and the certainty with which the Essence
is used in making milk curd or junket, has led to the suc-
cessful experiment of using this essence junket itself as a
vehicle for the iodide of potash. The method of preparing
this medicated junket is given on page 50.
Further practical uses of Essence of Pepsine in prepar-
ing whey, junket, etc., as food for invalids and in cholera
infantum, are given in Practical Recipes.
Fairchild's Essence of Pepsine was the first medicinal
preparation ever offered of the two gastric ferments, peptic
and milk curdling. This pharmaceutical product from
the fresh stomachs has only been obtained by many years
of experience and skill, and utmost care and nicety in
manipulation.
The wine and elixir of pepsin obtained as they have
been, by dissolving absurdly small proportions of sacchar-
ated or other pig pepsins in wine, etc., are practically use-
less. The more recent class of " essences," etc., made in
imitation of Fairchild's, to fill the prescriptions for Essence
where Fairchild's is not actually specified, are greatly
inferior in every respect to the original Essence of Pepsine.
They are obviously made from peptone pepsins dissolved
in " elixir bodies," are inferior in every important respect,
quality, flavor, pepsin and rennet action. Many physicians
who have for ten years and more used Fairchild's Essence,
naturally expect thie will be dispensed when they order
Essence of Pepsine, but it is now very important to specify
Fairchild's. The substitutes cost the patient the same price
as the genuine.
MEDICATED JUNKET.
JUNKET WITH POTASSIUM IODIDE, MERCURIALS, ETC.
The use of junket as a vehicle for the exhibition of
iodide of potash was first suggested by Dr. D. Bryson
50
Delavan of New York, in a paper which appeared in the
New York Medical Record, Nov. 28th, 1891. Dr. Dela-
van found by dissolving the iodide in Fairchild's Essence
of Pepsine, and adding this to a small quantity of warm
milk, that the curd which was instantly formed completely
enveloped the salt in a thoroughly diffused form, and gave
no taste or suggestion of its presence. It was found by
this writer that the iodide could thus be freely adminis-
tered without the disturbance of digestion so character-
istic of this most distinctly repulsive chemical.
Subsequently we tried Fairchild's Essence of Pepsine,
used in the manner suggested, in preparing junket with
Potassium Bromide, Sodium Salicylate, Iodide of Potash
with Biniodide Mercury, Chloral Hydrate, etc., and with all
these found the Essence to at once yield an agreeable,
jelly-like curd. We have in this junket, as prepared with
Fairchild's Essence of Pepsine, a distinct acquisition to our
means of administering a class of drugs which it is of the
utmost importance to be able to give in a form which does
not disturb the stomach. Wherever it is desirable, this
junket may be used to convey the iodide, mercurials, etc.,
without the knowledge of the patient as to its medicinal
character. This is the formula best adapted for prescrip-
tion :
! Potassium Iodide f 3 ii.
Essence of Pepsine, Fairchild's f iii.
Add one teaspoonful to a wine-glas of warm milk, and
take the resulting curd (after meals, or at such times as
desired to order it). From 5 to 10 grains Salicylate Soda,
or Potassium Iodide, with ^ to grain Mercury Biniodide,
may be ordered to each fluid drachm of the Fairchild's
Essence.
51
PEPSIN TESTING.
Notwithstanding the immense study which has been
given to pepsin, no satisfactory chemical test for it has
ever been established. The more we learn about the
digestive ferments, the stronger becomes the conclusion
that they are all some form of albuminoid matter, as they
are themselves the product of albuminoid cells. A chem-
ical test for pepsin must be one very sharply distinguished
from all other reaction of albuminoids; must be the unmis-
takable evidence of the living ferment. For a ferment
may have been subjected to influences which have quite
destroyed its activity and not appreciably altered its
physical or chemical characteristics. Whilst we may dis-
cover some peculiar reaction for pepsin, it is scarcely
possible that we can ever assay pepsin by chemical analysis.
As pepsin appears in commerce, the ferment is associated
with substances readily distinguished, such as common salt,
milk sugar, hydrochloric acid and starch. If these are in
obviously large proportion, the inference will be that the
products are weak, yet this is by no means certain, for a
saccharated pepsin may prove more active than a so-called
" pure pepsin," in which the ferment is either injured in the
process of manufacturing, or presented in a very large
proportion of gelatin, albumen, or peptones. The peptone is
the product of the self-digestion of the lining membrane in
acidulated water with heat ; the ferment thus dissolves the
proteid matter in which it is secreted, or which maybe added,
just as diastase dissolves the starch in the germinated barley
or malt. There is thus a distinct analogy between maltose
(malt extract) containing free diastase, and peptone contain-
ing free pepsin. The peptone is objectionable to just that
degree that it dilutes the pepsin, renders it hygroscopic and
52
prone to spoil. The chemical treatment, the condensation
by heat of the peptone solution to a scaling consistence may
account for the great variation in activity of some of these
products possessing practically identical physical prop-
erties. At present we can only test pepsin by its action on
albuminous matter in acidulated water. The form of albu-
men most uniform, convenient and satisfactory is the
white of egg. It is but a few minutes' work to form
some opinion of any brand or specimen of pepsin, by ascer-
taining if it has any marked action on gelatinous egg
albumen in warm acidulated water. Gelatinous albumen,
made by dissolving fresh white of egg in cold water and
boiling well and adding the acid, digests much more rapidly
than coagulated albumen. It forms a thick, opaque muci-
lage, very similar to gelatinous starch and behaves with
pepsin just as gelatinous starch does with diastase ; the
active ferment converting it instantly into a thin, watery
solution. Thus the physician or pharmacist can at least
readily discover an inert or worthless product. To determine
the actual digestive power of any product, it is necessary to
test it upon albumen under definite conditions well known
to be favorable to the action of the ferment, employing a
sufficient quantity of albumen to leave such an excess as to
make sure that the ferment has exhausted its activity. There
is a very important relation between the proportion of acid,
water and albumen. This should be so adjusted as to give a
definite, proper percentage of free acid in the mixture. The
albumen alkali neutralises a certain amount of the acid ; the
acid forms certain combinations with the albumen at
various stages of digestion. A test mixture may appear to
have less acid than another, yet have more acid, owing to
the small proportion of albumen to acidulated water and
vice versa. The parts of acid to parts of water must then
be regulated according to the proportion of albumen to
53
acidulated water. In tests adjusted to start with ex-
actly parallel quantities of ferment and albumen and
acid, the results will vary with the volume of water.
The larger the proportion of water within limits,
the more digestion ; with too little water the fluid
soon becomes clogged with the products of diges-
tion. The acid hydrochloric U. S. P. of commerce
varies in percentage of absolute acid. Therefore it is well
to employ acid of a known strength and to use the same
specimen of acid in a series of experiments. The quantity
of albumen necessary for a series of tests should all be
prepared at one time. The water, acid and albumen
always mixed before adding the pepsin. Pepsin acts upon
albumen at from 60 F. to 140 F., and the rapidity of
digestion keeps pace with the temperature up to 130 F.
At blood heat the results give more significance as to the
effect of the ferment in the body. Five or six hours, the
usual time, also provides ample opportunity for a full
practical test. But the pepsin which gives best results at
105, will give the best results at 130 and it would be
practicable to make a test which at 130 might be equiva-
lent to the usual test, be much quicker and equally
reliable.
It is sometimes proposed to test pepsin by the amount
of peptone formed. This, whilst theoretically exact, is im-
practicable and unnecessary. There are a variety of soluble
derivatives of albumen not well understood and difficult and
tedious of assay even with experience. Solution is the char-
acteristic effect the pepsin which converts the most albu-
men into solution is the most active and will have formed
necessarily the most of all soluble products, peptones, etc.
No two published tests at the present time call for exactly
the same proportions ; the same product will give varying
54
results in each test. It is very important, therefore, that
we should have a standard test and that the digestive
power stated for each and every pepsin, or preparation of
pepsin, should be that determined under the standard
conditions. Whatever the quantity of albumen used
(according to the strength of the pepsin) the ratio, the
proportion of albumen, water and acid should always be
the same. We have employed these proportions : Coagu-
lated Egg Albumen, 150 grains (10 Gm.), Water, i fluid
ounce (29.7 c.c.), Hydrochloric Acid, 5 minims (0.3 c.c.)
In the comparative tests it is essential that the condi-
tions shall be exactly alike in each test. The mixtures
should all be prepared cold in bottles of the same size and
well shaken to secure uniform conditions before adding
the pepsin. Then the ferment added and all the flasks
placed at once in a warm chamber with constant tem-
perature of 105 F. on an automatic shaker. The pro-
portion of albumen dissolved, the percentage left at close
of test affords fair evidence of the digestive value of
each specimen.
EXTRACTUM PANCREATIS.
(FAIRCHILD.)
This extract of the pancreas presents all the active
principles of the gland in the form of a dry, whitish
powder. It is not an artificial compound, it is absolutely
free from all added substances, and contains the ferments
as they are naturally associated.
55
The Extractum Pancreatis which we originated in i8Si
was the first product offered to the medical profession
containing all the pancreas principles in a pure, dry
powder. It was originally far more active and available
than any other pancreatic product (the pancreatines were
practically useless), and since then, the Extractum Pan-
creatis has shown the result of the persistent efforts to
increase its efficiency and refinement. It is not too much
to say that probably no remedial agent introduced during
this decade has been of greater importance and value in
practical medicine. Whilst the complex digestive action
of the pancreatic juice was well known to physiologists,
it had been but little utilised previous to the introduction
of Fairchild's Extractum Pancreatis.
By means of the Extractum Pancreatis, the pancreas
ferments are now effectively administered and are steadily
advancing in repute as therapeutic agents. The Extractum
Pancreatis has further been the means and the basis of all
the great progress made in the peptonising process, which
has revolutionised the feeding of the sick and provided the
long sought means for the conversion of caseine to the
requirements of the infant's stomach and to the standard
of mothers' milk.
As a solvent for diphtheritic membrane and as a " sur-
gical solvent," the Extractum Pancreatis has been so
successfully applied, as to merit far more extended use
and promise a still wider increase of utility. The Extractum
Pancreatis is by far the best simple product from the
gland and inasmuch as " pancreatines " are often unfit
for medicinal uses and are for the most part valueless,
it is well worth while to avoid disappointment by speci-
fying Extractum Pancreatis, Fairchild.
The Extractum Pancreatis presents all the digestive
56
ferments of the pancreas in an exceedingly active form
viz.:
TR YPSIN, which converts albumens (of Milk, Beef, Fish,
Blood, etc.} into Peptone in either neutral, alkaline, or
slightly acid media.
DIASTASE, which converts starches into dextrine s and
sugar.
THE EMULSIVE FERMENT, essential to the assimila-
tion of fats and oils.
THE MILK-CURDLING FERMENT.
This EXTRACT OF THE PANCREAS contains all
these digestive principles in such a degree of activity that their
presence and their action upon various food substances can be
quickly demonstrated.
EXTRACTUM PANCREATIS.
AS A REMEDY PER SE.
' ' The pancreatic secretion is the most energetic and general in its
action of all the digestive juices. It unites in itself the action of the
saliva and the gastric juices, besides having properties of its own."
T. LAUDER BRUNTON.
In view of the very partial transformation of carbo-
hydrates and proteids by the salivary and gastric juices,
preliminary to further and complete digestion by the
pancreas juice, it would seem that an active extract of
pancreas should possess remedial value of corresponding
importance. The use of the pancreas ferments as aids to
digestion has, however, been much prejudiced by theoreti-
cal views, and especially by the erroneous impression that
they are only active in alkaline media. The questions as
to whether the pancreatic ferments are capable of exerting
any influence upon food in the presence of the gastric
juice, the effects of the gastric juice upon them, have
57
been the subject of much experiment and discussion, result-
ing in conflicting theories and conclusions ; some asserting
that the pancreas ferments can resist the gastric juice,
others that they are therein rendered permanently inert.
That in the flask the pancreatic ferments are destroyed by
free hydrochloric acid plus pepsin, is, we think, beyond
question. In discussing the compatibility and value of
solutions of the mixed ferments (gastric and pancreatic) we
pointed out the fact that in a solution with pepsin and acid,
the pancreatic ferments gradually become inert, the practical
lesson being plainly that the chemist should not offer, nor the
physicians accept, remedies of this class. But to determine
the bearing of these facts upon the exhibition of the pan-
creatic ferments, it is necessary to consider (as in the case
of all such experiments) the relations which the test tube
conditions bear not only to those of normal digestion,
but to the abnormal conditions which call for the ad-
ministration of the ferments. Our present knowledge
of the phenomena of normal gastric digestion plainly
shows that there are opportune intervals for the presumably
effective introduction of the pancreatic ferments. This is
admitted even in the most conservative estimates of their
utility. There is the resource of specially adapted
pharmaceutical products. There is a marked difference
in the nature and degree of the acidity of gastric juice
during stomach digestion. There are always organic
acids set free from the food, and thus replacing a por-
tion of the hydrochloric acid ; the hydrochloric acid is
not free and uncombined, and the gastric juice does
not correspond in its behavior to a simple solution of
similar percentage of free hydrochloric acid in water.
The presence of the products of digestion both pro-
teids and carbo-hydrates may greatly influence the be-
havior of these ferments when brought into contact. In
a word, in the phenomena of digestion we have factors
58
which materially differ from those of laboratory experiments
and must necessarily, therefore, qualify the deductions
therefrom. Among those physicians who have given
practical trial to the Extractum Pancreatis in intestinal
indigestion, carefully regulating the mode of adminis-
tration, there exists no question of its distinct therapeutic
value. The feebler the digestion the less the question
of interference of the gastric juice is to be considered.
The Extractum Pancreatis is to be regarded first, as adias-
tasic agent ; second, as a digestive of albuminous food ;
third, as the only means of administering the ferment
which digests fat. Foster's Physiology says, " there is no
means of distinguishing the amylolytic ferment of the
pancreas from ptyalin." Therefore, the Extractum Pan-
creatis may be given as aid to digestion of starches
either at the outset of, or at proper intervals after
gastric digestion. Given at the interval after eating,
when the gastric action has subsided, and the ingesta
freely passing into the duodenum, the pancreatic extract
(in the form of tablets preferably) may be effectively
administered in intestinal indigestion. In cases of almost
complete abeyance of the digestive functions, as in
fevers, etc., the stomach affords the necessary condi-
tions for the action of the pancreas ferment which may be
given mixed with a suitable food, such as milk, cold or
warm. In such cases, it will be found on trial that no
preliminary digestion (peptonisation) is necessary to
insure the proper conversion of the food without taxing
or disturbing the stomach itself. This is not stated on
the basis of theory, but as supported by actual clinical
experience.
The Extractum Pancreatis may be given in three to
five grain doses in powder mixed with food, in capsules,
or Fairchild tablets, or in suitable combination. The
Extractum Pancreatis has been, upon theoretical and practi-
cal grounds, recommended in the treatment of diabetes.
As a rational remedy for insufficient salivary digestion, for
intestinal indigestion, it is constantly gaining the confi-
dence of the profession.
T R Y PS I N .
(FAIRCHILD.)
ESPECIALLY PREPARED AS A SOLVENT FOR
DIPHTHERITIC MEMBRANE.
This product presents the proteolytic ferment of the
pancreas in the most active form obtainable.
Trypsin has the property of digesting fibrin with
great rapidity.
It is most effective in a slightly alkaline solution, but
may be effectively applied direct to fibrinous membrane,
etc., either dry or in pure water.
It is an entirely innocent and non-irritant substance,
and does not attack the healthy or non-fibrinous tissue.
In its application to the throat all the conditions are
.favorable to its physiological action.
Trypsin will be found to be a powerful solvent of
diphtheritic membrane in all cases in which it is prac-
ticable to bring it in contact with the membrane.
Trypsin is especially useful in cases where acid media
is not admissible, and is to be chosen also in all situations
where the smallest possible bulk of solvent agent is
desirable.
Trypsin may be applied by insufflation, pure or mixed
with sodium bicarbonate four grains Trypsin to one of
soda ; or may be taken up on a wetted brush or probang,
or mixed with water and sprayed ; Trypsin, gr. 15, soda
bicarb., gr. 5, water, f I i, to be prepared fresh every
few hours, or chloroform or pure creosote, 4 drops, may
be added as a preservative. For further details, see sur-
gical use of the digestive ferments, p. 83, et seq.
60
DIASTASIC ESSENCE OF PANCREAS.
(FAIRCHILD.)
THE MOST ACTIVE, RELIABLE AND AGREEABLE AGENT FOR
THE DIGESTION OF FARINACEOUS FOODS.
This preparation has been made with the especial pur-
pose of obtaining the diastase or starch-digesting principle
in an active and agreeable form.
The need had been often expressed to us by physicians,
of a purely diastasic preparation by means of which they
might assist the digestion of starch without at the same
time introducing other digestive agents, or in any other way
interfering with the process of digestion.
In meeting these requirements, this Essence has, we be-
lieve, been found peculiarly serviceable. It acts upon
starch with great energy and promptness.
Inasmuch as the diastase of the pancreatic juice acts upon
starch in a manner precisely similar to that of the saliva,
this Diastasic Essence may be confidently expected to
compensate for insufficient salivary digestion. For this
purpose it should be given at meal time either im-
mediately before or with the food. When the intestinal
digestion of starch is at fault, it should be given an hour or
so after food.
This Essence of Pancreas is gratefully aromatic and
acceptable to the most delicate stomach, and will be found,
therefore, more efficient and agreeable as a diastasic agent
than the thick, sweet extracts of malt.
It will sometimes be advantageous to mix the diastasic
essence directly with the foods, such as oatmeal, rice, etc.,
especially for children who, owing to defective dentition or
ill health, evince difficulty in the digestion and assimilation
of starchy foods at an age when it is desirable that milk
should no longer be the sole article of diet.
The Essence should never be added to food when too
hot to be borne agreeably by the mouth.
Usual dose, one or two teaspoon/ it Is.
PEPTONISING TUBES
(FAIRCHILD.)
FOR THE PREPARATION OF PEPTONISED MILK AND OTHER
' PREDIGESTED FOOD FOR THE SICK.
(EXACT SIZE.)
Use the contents of each tube for peptonising one pint
of milk.
These tubes of " peptonising powder " are the most
convenient means for prescribing and using the Extractum
Pancreatis for the purpose of peptonising milk.
By this means the peptonising powder is supplied in an
accurate and portable form, secured from deterioration,
and dispensed at a moderate fixed price.
Each package contains complete directions for prepar-
ing peptonised milk, beef, gruel and a great variety of
foods for the sick by means of the Fairchild Practical
Recipes.
The tubes can be sent by mail. Retail price, 50 cents
per box of one dozen tubes.
FAIRCHILD'S "DIRECTION SLIPS"
PEPTONISED MILK, BEEF, GRUELS, ETC.
For the convenience of the physician we devised these
"direction slips" in small pads of proper size for the vest
pocket. The pad contains a number of slips of direc-
tions for each sort of food peptonised milk by the cold
process, and for jellies, for punches, etc.; peptonised
gruel, peptonised beef, junket, whey, etc.
By this means the physician is enabled to leave with
the patient or nurse plain printed directions for the
special food and method he may desire to order. These
direction slips have proven very acceptable to the profes-
sion. We shall be pleased to send them by mail upon
request.
62
PEPTOGENIC MILK POWDER
VIELDS A FOOD FOR INFANTS WHICH IN PHYSIOLOGICAL,
CHEMICAL AND PHYSICAL PROPERTIES IS ALMOST
IDENTICAL WITH HUMAN MILK, AND AFFORDS
A COMPLETE SUBSTITUTE THEREFOR
DURING THE ENTIRE NURSING
PERIOD.
. By means of the Peptogenic Milk Powder and process,
cows' milk is so modified and pre-digested as to con-
form remarkably in every particular to normal human
milk, thus affording a " humanised milk," exactly suited
to the functions of infant digestion, calling forth the
natural digestive powers of the stomach and supplying
every element of nutritfmi competent for the nourish-
ment and development of the healthy nursing infant.
It is also a peculiar feature of this method that the
milk may be given just that degree of digestibility suitable
to especial requirements, in cases of naturally feeble
digestion and during the disorders of infancy.
The Peptogenic Milk Powder is put up in $1.00 and in
50 cent packages, and sold by the principal drug houses in the
United States and Canada. Sample can of the Peptogenic
Powder and pamphlet will be sent gratis upon request.
Correspondence solicited.
TESTS FOR PANCREATIC PREPARATIONS.
The pancreatic juice and the gland itself are well
known to be extremely subject to decomposition, hence
the greatest care and skill are required in manufacturing
available medicinal products from this source. The
value of a pancreatic preparation must depend not only
upon its digestive activity, but upon the character, the
quality of the digested product it yields. A pancreatic
extract may convert the caseine of milk into peptone, yet
63
the peptonised milk be quite unfit for food, owing to the
development of rancid fatty acids, giving the milk a pecul-
iar repulsive odor characteristic of regurgitated milk from
a sour stomach. A pancreatic preparation which produces
such a result with milk, is plainly unfit for any medicinal use.
We have in the past not infrequently had occasion to
examine such commercial " pancreatines." A good pan-
creatic extract should rapidly digest milk, beef, fibrin and
all forms of starchy food, should convert the caseine of
warm milk into peptone without the development of any
rancid flavor whatever. The action upon caseine may be
taken as a sufficient test of the proteolytic power upon
any proteid. The activity and quality of a pancreatic
preparation may be readily tested in the following manner :
Put into a flask 15 grains of sodium bicarbonate and
4 fluid ounces of cold water, add 5 grains of Extractum
Pancreatis, mix well and add one pint of milk warmed
to 130 F. Shake well and place the bottle convenient
for observation. At first there should be no foreign
odor or taste imparted to the milk. In a few moments
the milk will become of slightly grayish yellow color,
which in ten minutes will be more marked and the milk
thinner and of a distinct bitter taste, due to the conver-
sion of the caseine. This taste, even when peptonisation
is complete, is a pure bitter without any suggestion of
fermentation or rancidity. By having another flask of
the milk mixed with the soda and water without ferment,
the progress of the digestion may be, by comparison, more
readily observed. These physical changes of milk, during
peptonisation, are so characteristic, that anyone familiar
with the process, may very readily regulate the process
accordingly. By withdrawing a small portion of the
milk from time to time and adding a few drops of
acetic acid, the conversion of the caseine may be tested,
64
by the character of the curd formed from the familiar
tough caseine, to the light, flocculent precipitate, and the
final slight, scarcely perceptible, granular coaguli.
To test the diastasic property of a pancreatic prepar-
ation, prepare thick, gelatinous starch, by mixing a drachm
of arrowroot or starch with five fluid ounces of cold water,
and boiling well. To a fluid ounce of this mucilage (at
110 F.), add a grain or so of the pancreatic extract or a
few drops of a fluid product and stir well. The starch
should become almost instantly thin and fluid, like water,
showing the forn ~tion of soluble starch, which is grad-
ually converted into dextrine and glucose. A product
which does not quickly liquefy thick, warm starch jelly
is worthless as a diastasic agent.
THE FAIRCHILD DIGESTIVE TABLETS.
A PORTABLE AND EXACT FORM OF DOSAGE OF THE
DIGESTIVE FERMENTS.
These tablets are unique in form, agreeable to the
taste and easily carried about in the pocket. They are
offered as a means of exhibiting the digestive ferments in
divided doses and at the particular interval after the in-
gestion of the food, which gives the most favorable con-
dition for their action. The advantages of this method
of administration are apparent, especially in duodenal
dyspepsia. The tablets should preferably be swallowed
whole.
The various combinations are supplied in small vials
and it is recommended that they be prescribed in original
bottles. The directions of the physician will be affixed
by the druggist in place of our label, if so desired ; but
it will be economical to the patient to order the original
vial. They are also supplied in large vials in any quan-
tity desired.
65
PEPSIN TABLETS.
(FAIRCHILD.)
Each tablet contains one grain of our pure Pepsin in
Scales, combined with acids and appropriate aromatics.
Dose one or two tablets immediately after eating and
repeated when required.
These tablets afford a means of re-enforcing the gas-
tric digestion at frequent intervals after the ingestion of
food. The advantages of this method of administering
the peptic ferment have been well advanced in an editorial
in the New Remedies, from which we quote; and the need
of an available preparation for the purpose having been
urged upon our attention, we originated these Pepsin
Tablets which have proven very useful and greatly
appreciated.
" Still another fact exists, although it has apparently been lost sight
of in practice, and is rarely or never mentioned by writers on disorders
of digestion, viz.: that much better results will follow the administra-
tion of the pepsin in divided doses during the process of digestion, and
at intervals of a few minutes, than when it is given in one dose. The
reason for this is the fact that as peptones are formed in the stomach,
they are absorbed or passed through the pylorus into the intestine, and
carry with them a certain proportion of the ferment which produces' this
change, and that in a case where the gastric juice is of notably poor
quality, and artificial pepsin is employed, the digestive action, which
at first may be quite efficient, grows weaker and weaker, and fresh sup-
plies of pepsin are required from time to time to maintain the pro-
cess. * * * " JVetv Remedies.
PEPSIN AND BISMUTH TABLETS.
(FAIRCHILD.)
Each tablet contains one grain of pure Pepsin (Fair-
child) and two grains of Bismuth Subnitrate.
Pepsin and Bismuth constitute one of the most efficient
and generally used combinations in the treatment of
66
dyspepsia. In these tablets these remedies are presented
in an exact, agreeable and efficient form.
The well-known chemical incompatibilities between
Pepsin and Bismuth, in solution, and the criticisms justly
urged against such a combination, have led some to the
impression that this objection is true of Pepsin and Bis-
muth mixtures generally.
There is no question of incompatibility between Pepsin
and Bismuth, except as relates to the Ammonia Citrate in
solutions, a salt of Bismuth, moreover, which is greatly
inferior to the Subnitrate. The Bismuth Subnitrate is well
known to be very beneficial in certain forms of dyspepsia,
and its properties are in no way inimical to the action of
the gastric juice or to that of artificial peptic agents
administered in conjunction with it.
USUAL DOSE. One or two tablets immediately before or
after each meal, or at any time when suffering from indigestion.
PEPSIN, BISMUTH AND PANCREATIC TABLETS.
(FAIRCHILD.)
Each tablet contains Pepsin (Fairchild), i^ grains,
Ext. Pancreatis (Fairchild), \\ grains, Bismuth Subnitrate,
2 grains.
USUAL DOSE. One or two of these tablets should be taken
either shortly before or after meals, as may prove best suited to
the particular case.
"PEPSIN AND PANCREATINE" TABLETS.
(FAIRCHILD.)
Each tablet contains Pepsin (Fairchild), 2 grains,
Extractum Pancreatis (Fairchild), 3 grains,
This formula has been prescribed for some years by
physicians of this city under the name of " Pepsin and
Pancreatine," and we have supplied them uncoated for
dispensing. The increasing demand made it necessary
for us to prepare them in a manner uniform with our other
digestive tablets, in order to permanently protect them
from change.
The coating is perfectly soluble, and does not interfere
with their digestive action.
One tablet, three times a day, is generally prescribed as a
dose.
PEPSIN AND DIASTASE
(FAIRCHILD.)
IN TABLETS, EACH CONTAINING TWO GRAINS.
This combination, which is original with us, is the only
preparation in which the pure diastasic and peptic ferments
have, we believe, been united in an active form. The
value and appropriateness of this combination is apparent.
It is certainly in clearest accordance with physiological
principles. It is a well-ascertained fact that diastase,
whether obtained from saliva, the pancreatic juice, or from
germinated grain, acts upon starch in an identical manner
and under identical conditions. " Pepsin and diastase "
may, therefore, be given with every anticipation of benefi-
cial results in cases of dyspepsia, where both the salivary
and gastric digestion are at fault.
This combination is prepared with our pure pepsin, with-
out admixture of malt sugar, starch or other substance, and
in such a manner that an ordinary dose contains an
efficient proportion of the diastasic ferment.
This product is not to be classed among those sacchar-
ated " digestive compounds " which purport to contain "all
the agents of digestion " diastase included. It is sufficient
here to say that not one of them contains an appreciable
quantity of diastase from any source. If a preparation
contains active diastase, it must liquefy gelatinous starch
at the temperature of the body.
One or more tablets for a dose at meal time, or when suffer-
ing from indigestion.
PEPSIN, BISMUTH AND NUX VOMICA
TABLETS.
(FAIRCHILD.)
Each tablet contains Fairchild's Pepsin, 3 grains, Bis-
muth Subnitrate, 2 grains, Extract Nux Vomica, grain.
COMPOUND OX GALL TABLETS.
(FAIRCHILD.)
Each tablet contains Inspissated Ox Gall (Fairchild),
2 grains, Extractum Pancreatis (Fairchjld), 2 grains, Ex-
tract Nux Vomica, \ grain.
These two combinations having been much prescribed,
we have manufactured them in our tablet form by request.
PANCREATIC TABLETS.
(FAIRCHILD.)
Each tablet contains 3 grains Fairchild's Extractum
Pancreatis.
COMPOUND PANCREATIC TABLETS.
(FAIRCHILD.)
This tablet, originally designed for the treatment of
intestinal indigestion, has proven of great service and has
69
been for some years extensively prescribed. The pure
Extractum Pancreatis is here combined with bismuth sub-
nitrate, highly esteemed in allaying irritability of the ali-
mentary tract, and with ipecac, which, in small doses, is
the most admirable stimulant of the intestinal digestion.
Each tablet contains Extractum Pancreatis (Fair-
child), 2 grains, Bismuth Subnitrate, 3 grains, Powdered
Ipecac, -j^ grain.
One or two tablets for a dose, an hour or two after eating.
PEPTONATE OF IRON
(FAIRCHILD),
IN TABLETS, EACH CONTAINING THREE GRAINS.
Dose for an adult, usually one tablet thrice a day after
meals.
FERROGLOBIN TABLETS.
Ferroglobin contains the element iron, united with
the proteid matter, as a constituent of the molecule itself,
thus presenting this important principle in a form pecul.iar
to the blood and impossible to produce artificially. Ferro-
globin, therefore, may be considered to offer many advan-
tages over any chemical compound of iron or any of the
mixtures of iron and albumen. Ferroglobin, in distinction
from all such artificial compounds, presents the organic,
physiological ferruginous element of the blood. It is
recommended in all anaemic conditions where it is desired
to administer iron in a perfectly soluble and assimilable
form. It is prepared with the utmost care and offered in
tablet form as the most permanent and acceptable prepa-
ration for medical use.
Each tablet contains 2 grains of pure Ferroglobin.
THE PEPTONISING PROCESS.
To peptonise food is to artificially digest food, to submit
it to the action of the digestive ferments, by which means
70
changes are effected precisely similar to those which in the
living body are the essential preliminary to its absorption.
For the two great types of food stuff, flesh and starch foods
are incapable of being absorbed until they have become
soluble by the action of the digestive juices, and thus
capable of passing through the walls of the alimentary
canal. This characteristic action of the digestive ferments,
the conversion of insoluble and unabsorbable substances
into soluble and assimilable, is seen in the artificial
digestion of food.
The fibre of beef is seen to gradually soften and dis-
solve ; thick, well-boiled, gelatinous starch (gruel) is
seen to quickly dissolve, become thinner and watery. Fari-
naceous foods as ordinarily prepared, such as oatmeal,
wheaten grits, rice, dipped toast, more slowly soften and
dissolve. Albuminous substances, such as the caseine of
milk, etc., acquire when completely digested, a bitter taste
from the peptone ; the farinaceous foods become sweeter
from the maltose or starch sugar.
Cooked food is in general more susceptible to digestion
than raw food, both in the body and in the flask. To pep-
tonise food is then but to go a step beyond what has
always been sought, in the special care and devices given to
the cooking of food for the sick.
Each ferment has its special correlated food substance
and this it will digest in a flask, just as in the alimentary
canal. In discussing the ferments in detail, we have already
had occasion to point out that pepsin is not available for
household use in artificially digesting food of any kind.
Peptonised food is, therefore, not food prepared with pep-
sin, or indeed necessarily containing a ferment of any
kind, it is digested food ; the agent of digestion may or
may not be retained in an active form after its work has
been utilised.
71
The pancreatic ferments are capable of digesting every
known form of food ; and as made available in the Fairchild
Extractum Pancreatis, Peptonising Tubes and other special
forms, may be applied with marvelous facility for pepton-
ising food for the sick by the Fairchild process, with the
ordinary conveniences of the sick room.
The peptonising action is most energetic at about the
heat of the body, slow at the temperature of a room (60 to
70 degrees F.) ; at a lower temperature, even at freezing,
the peptonising agent is not destroyed, but is simply in-
active. At the boiling heat it is at once killed.
Therefore we may peptonise milk by the cold process,
in which the major work of the peptonising agent is done
after the milk is taken into the stomach ; or by the warm
process in which the milk is partially digested and then
cooled to check digestion ; or after peptonising to a cer-
tain point the ferment is to be destroyed by boiling.
This boiled or scalded peptonised food contains now
no active ferment, no artificial help to digestion ; we have
removed the food from further influence of the peptonising
agent, just as we remove food from the fire after cooking.
It will be seen, therefore, in the Fairchild's practical
recipes that we have various simple methods, according to
the degree of peptonising required, to suit the conditions
of a case.
The effects of the peptonising process are as plain to
sight and to taste, as are the effects of cooking and afford
as simple evidence by which it may be regulated. It is in
truth easier to tell when a pint of milk is peptonised to
suit a given case, than it is to tell when an egg is boiled
"soft," or "well done" or when a steak is properly
broiled,
72
The peptonising powder always acts uniformly under
given conditions ; those conditions are exceedingly simple
and attainable.
It is of the greatest importance at the beginning, to
follow the directions to the letter. With familiarity with
the process, with its effects, with a clear idea as to the
conditions essential and the object to be accomplished,
then one may take one's " own way " to reach the desired
result, to please, or agree with, any patient.
For instance, if peptonised milk should be required in
an emergency, the powder may be mixed in a saucepan
with warm water and warm milk and kept warm over a
fire, say for five minutes, stirring briskly, and sipping fre-
quently so as to take care that the milk is not overheated
and the ferment thus destroyed. Thus in a few minutes
peptonised milk may be so prepared as to be of the
utmost service in affording urgently required absorbable
nourishment. It may be given hot, or if required cold, ice
it. Sometimes it will be found that the milk will agree
(when made by the warm process), if it is put on ice the
moment the milk becomes warm in the bottle, because the
milk thus becomes sufficiently peptonised before it becomes
chilled.
There is an exaggerated notion of the " trouble " of the
peptonising process, probably because of the novelty of
this application of physiological principles. But it is in
reality an exceedingly simple process. It would be difficult
to instance any of the commonest cooking operations so
simple as mixing a powder, water and milk together and
keeping it in a warm place (water bath or other) for a
few minutes. If soluble, easily digestible, absorbable food
is, as by all conceded, the chief desideratum, how shall we
so simply, surely and safely obtain it as by the peptonising
ts
process ? It is certainly far easier to peptonise food than to
prepare most of the jellies, beef teas and delicacies in old
time vogue for the sick. The peptonised foods have saved
more lives in the ten years in which the Fairchild process
has been in use, than all the other kinds of special foods for
the sick that are made. It is scientific, practical, successful.
If it chances that at the first attempt or occasionally, the
milk becomes " too bitter," surely this is no more reason
for condemning the process or rejecting it, than it would
be to reject cooking because of the even greater difficulty
of boiling an egg "twice alike" or of roasting meat "to
a turn."
THE USE OF SODA IN THE PEPTONISING
PROCESS.
As we have already explained, the use of an alkali is
not essential to the action of the pancreatic ferments.
In the digestion of milk by the peptonising ferment the
caseine undergoes gradual conversion, and at a certain
point acquires the peculiar property of coagulating at the
boiling temperature.
The caseine at this stage of its conversion is in the con-
dition most generally suitable for digestion in the stomach ;
it is no longer caseine and does not act like caseine and yet
not completely peptone ; for peptone does not coagulate
when boiled. It is in fact a peculiar partially transformed
albuminoid which has been called meta-caseine, and it
has been found that this may be prevented from coagu-
lating from boiled milk by simply rendering it alkaline.
Consequently by the use of a small quantity of soda
bi-carbonate we are enabled to boil the milk, and thus
check digestion at any requisite stage without coagu-
lating the altered caseine. It is seldom necessary to
T4
boil peptonised milk for adults except under circum-
stances when ice is not available to check the pepton-
ising action. This addition of soda is also wholesome, it
neutralises the almost invariable acidity of cow's milk and
keeps it sweet.
THE REASON FOR DILUTING MILK IN THE
PEPTONISING PROCESS.
In the Fairchild process for peptonising milk we direct
that the peptonising powder shall first be mixed with
water and then added to the milk ; the object being to so
dilute the milk that it will not be curdled by the digestive
agent. The action of the pancreas curdling ferment,
which we have described on page 37, is a hindrance to the
artificial digestive process ; for milk will peptonise more
readily, be more convenient for use, if kept fluid by the
simple expedient of diluting it with a small proportion of
water.
The addition of water in this proportion is not in the
least objectionable. For the great majority of cases in
which peptonised milk is resorted to as a diet, the addi-
tional water is a distinct advantage, for here it is that a
fluid food is of the utmost importance. It means that the
patient takes with every pint of milk four ounces of water,
and water is, in fevers, etc., the very thing required. It is not
so much concentrated food, as assimilable comprehensive
nourishment that is essential. In the special process for
peptonising milk for infants, we direct the definite dilu-
tion necessary to yield a food containing the proportion
of water found in human milk.
75
USES OF PEPTONISED FOODS.
It is no longer necessary to adduce " clinical experience "
in support of the value of peptonised foods. Since we first
had the honor to call the attention of the medical profession
to the " Use of the Extractum Pancreatis in the Preparation
of Peptonised Foods for the Sick," 'these foods have quite
fulfilled their great promise of usefulness.
In a word, when the physician finds nutrition to be a
factor in the treatment of a case, this is where peptonised
foods are his chief resource. In peptonised milk, beef,
gruels, etc., by the Fairchild process, the physician finds
the food for the sick at once the most useful, economical,
and congenial to direct for his patient. For the foods pep-
tonised are the foods with whose composition and special
nutritive properties and value, he and all mankind are
familiar.
If the digestive functions are impaired, or even com-
pletely in abeyance, what other method of supplementing
them so certain and so innocent ? It is the most rational
conceivable resource to thus accomplish digestion by proxy
to the degree only necessary to render the food assimilable.
With returning health, the patient neither desires nor re-
quires peptonised foods. The use of peptonised food
reduces to a minimum the inroads which acute and wasting
diseases make upon the system. The physician rationally
anticipates a better convalescence, a quicker renewal of
normal digestive power, for that patient whose nutrition has
suffered the least degree of impairment. Let anyone com-
pare the average results of the treatment, for instance, of
" Typhoid " with the use of peptonised milk, with the results
under the use of any other food.
76
There is the record of ten years, of innumerable cases
in the use of veritable peptonised foods by the Fairchild
process, without the citation of a single case of unfavorable
sequelae attributable to the use of these foods.
In experiments also with animals fed upon peptonised
foods, there is no evidence of inability to return readily to
the digestion of ordinary food. There was on one side a
mere unsupported conjecture as to what might be the effect
of protracted feeding of peptonised foods ; on the other,
we know its beneficial effect after ten years of experience
as a therapeutic resource ; we know that we do with un-
qualified benefit to the sick, subject food to preliminary
digestion, and thus set disease at defiance in so far as it
affects the most vital functions of digestion and nutri-
tion.
That peptonised milk is competent for the complete
nourishment of adults in active life suffering from gastric
ulcer, or subject to chronic diarrhoea, is abundantly proven,
and many instances have occurred in the past ten years
where patients have found this their only resource for
nutrition. We especially call attention to these typical
cases, the personal experience of practising physicians who
have been enabled to pursue their profession and maintain
vigorous life by subsisting solely on peptonised milk for
years, under circumstances where otherwise " life had been
a burden " from suffering.
" The history of this case of Acute Dysentery which had
" progressed from acute suffering to exhaustion, emaciation
" and hopelessness ; which was not permanently benefited,
" but only controlled by the numerous drugs used against
" it, and which was at last cured by a simple diet of pre-
" digested milk rigidly adhered to by the help of obstinate
"will-power, has appeared to me unique and therefore of
" use to the profession at large. It demonstrates that by
" recourse to the artificial process of digestion, we may
" present proper nutriment to our patients under conditions
" so unfavorable even as to render futile all other thera-
" peutic measures, climatic and medicinal. It proves
" further, as will be shown, that tinder a prolonged exclu-
"sive diet of so fluid an aliment as milk diluted with water
" and with its caseine converted into soluble peptones,
" health and activity may be maintained."
" Upon this diet, of milk peptonised by Fairchild's
" method, the patient has now been living exclusively for
" more than two years. His general condition is excellent.
" The functions of the bowels are performed with ease
" and regularity, his muscular system has regained its
" former degree of average development, and he bears, with
" the same ease, as do his fellows, the fatigues of either
" business or pleasure."
" As a physician of seventeen years of active practice,
" I have fully convinced myself of the great value of your
" ' Pure Digestive Ferments ' particularly your ' Ex-
" tractum Pancreatis.' But my most valuable experience
" has resulted from my own personal experience. For
" three years I have suffered with gastric ulcer and
" Chronic Gastritis with frequent acute attacks. Life was
" intolerable and seemed about to terminate when I began
" washing out my stomach with medicated water and
"resorted to a diet of 'peptonised milk.' For 37 months I
" have lived absolutely upon peptonised milk, porridge and
" gruel."
In acute and wasting diseases, Typhoid, Pneumonia,
Gastric Ulcer, Diabetes, Tuberculosis, Chronic Diarrhosa,
78
Pyloric and Intestinal Obstruction, Gastric Catarrh, etc.,
as a food both preparatory and subsequent to important
surgical operations, peptonised milk, gruel, etc., are the
classical resource. In times of great fatigue and nervous
prostration, when the strength is exhausted by severe strain
of work and anxiety, when, as it is expressed, one is " too
tired to eat," then peptonised milk has the most remarkable
restorative power. See "Hot Peptonised Milk." {Practical
Recipes. )
In Typhoid Fever, peptonised milk promises, and
proves the "ideal food"; it precludes all accumulation
of unassimilable matter in the digestive tract and meets
every requirement. It affords also the best vehicle and
the most agreeable for the exhibition of the spirits, whisky,
brandy, etc.
We do not recommend peptonised milk for feeding
nursing infants, nor the use of the Peptonising Ttibcs, for
preparing peptonised milk for infants. In " petonised
milk " (with the tubes), there is no attempt to adjust the
milk quantitatively to a correspondence with human milk,
nor to attain the definite proper conversion of the caseine.
There is no reason, therefore, for using for an infant this
method of peptonising milk designed for adults, when in
the Peptogenic Milk Pou'der the process is, in every detail,
adjusted to the analysis of normal human milk.
Humanised Milk as prepared with the Peptogenic Milk
Powder is frequently preferred by the physician as a food
for adults in phthisis, Bright's disease, etc., because it is so
fluid and agreeable, and yet richer in nutritive matter than
pure cow's milk or peptonised milk.
79
PEPTONISED MILK.
Peptonised milk, some ten years ago practically un-
known, is to-day by farthe most important and the most used
by the medical profession of all foods for the sick. The
reason for this is shown in the great value of milk as a
comprehensive nutrient, in its availability and cheapness.
In truth, a pint of peptonised milk contains more actual
peptone, more total nutritive substances, than the same
bulk of many so-called concentrated beef elixirs, wines,
etc., which cost a dollar per pint. Milk contains every
element of nutrition in a form naturally fitted for absorp-
tion, with the exception of its caseine. Therefore, it is
apparent that by changing the caseine into soluble pep-
tone, we obtain an ideal food for the sick.
Caseine is, of all albuminoids, the most difficult and
impracticable of artificial digestion by pepsin and acid,
either as existing naturally in milk or as separated there-
from by acid or rennet, and treated just as we should
treat egg albumen, fibrin, etc. Caseine is, moreover,
unquestionably more difficult of digestion, even in the
stomach, than other albuminoids, such as of fish, beef,
egg, etc.
It is not a little remarkable that milk, "the type of a
complete aliment," should prove so marvelously susceptible
to artificial digestion by means of the proteolytic ferment
of the pancreas, for thus the caseine of milk can be at
will brought to any desired degree of conversion without
rendering the milk repulsive in taste or appearance. In
fact, peptonised milk, when prepared according to the
directions with the peptonising tubes, is quite as agree-
able as raw milk, and better relished by most persons.
By the " cold process " no artificial taste whatever is im-
parted to the milk. Peptonised milk is milk with its
80
caseine converted into peptone by the process of arti-
ficial digestion. The object of the directions given for
peptonising milk is to submit its caseine to the action
of the digestive ferment under the definite simple condi-
tions by which it may be digested to any suitable degree
of conversion.
When well peptonised, the milk will be found to have
become thinner and of a greyish yellow color, and to have
a slight, peculiar and by no means disagreeable taste
characteristic of peptonisation. Wholesome peptonised
milk should not have the slightest rancid flavor or odor.
It is very seldom necessary to peptonise the milk to
the point at which the bitter taste is developed. It must
be borne in mind that the peptonising process goes on as
long as the milk is warm ; therefore it is necessary to
transfer the bottle promptly from the warm bath to the
ice chest, in order to check digestion. For various methods
of preparing peptonised milk, for making it an agreeable
beverage, see Fairchild's " Practical Recipes."
NUTRITIVE ENEMATA.
Peptonised Foods are peculiarly adapted for rectal
alimentation. In the rectum is presented every condition
essential to the conversion and complete absorption of the
peptonised food, etc., without irritation or complication.
In times past it has been recommended to prepare beef,
etc., for enemas by mixing it into a pulp with the fresh
pancreas gland. To-day, in the Extractum Pancreatis or
the Peptonising Tubes, we have the means of quickly and
conveniently preparing milk, beef, eggs, etc., as absorbable
enemas capable of sustaining life for an indefinite time.
81
MILK ENEMATA.
Milk may be introduced as soon as it is mixed in the
ordinary proportion with the peptonising powder, and as
it is usually required warm, a very considerable degree of
pre-digestion will take -place whilst bringing the milk to
proper temperature ; or best, the powder should be mixed
with ready warmed milk.
Peptonised milk may be very conveniently prepared
by the cold process, and when required the proper
quantity may be warmed and injected.
EGG ENEMATA.
Dissolve the white of an egg in thrice its bulk of warm
water ; add 'the contents of a peptonising tube and stir
well, and inject at once. An egg, white and yelk, may be
thoroughly mixed with a pint of milk and peptonised
in the usual manner, and thus afford a very nutritious
enema.
BEEF ENEMATA.
Take a tablespoonful of minced lean beef, add to four
tablespoonfuls of cold water, and gradually heat to boil-
ing. Now rub all through a fine sieve or colander, and
when luke-warm add the contents of a peptonising tube,
and it is ready for injection. It may be made more fluid
if desirable.
PANOPEPTON ENEMATA.
Panopepton possesses every desirable quality for nutri-
tive enemata. It contains all the soluble and digestible
constituents of bread and beef. It is made ready for use
simply by dilution with three or four parts of warm water ;
is readily absorbable and non-irritant and has been used
with such success as to conclusively demonstrate its value.
PANOPEPTON.
BREAD AND BEEF PEPTONE.
Having been the first to realise the value and scope of
the digestive ferments as artificial agents of digestion, and
the originators of the Fairchild process, which has become
familiar in every household for the peptonisation of food
for the sick, we have not failed to perceive the great need
for a true, ready-made peptonised food. Peptonised foods
by the Fairchild process have long been recognised as su-
perior to all others available, the only objection being the
necessity of preparing them fresh every day when required.
In Panopepton we present to the profession a new,
complete and perfect peptone, one which we are confident
will meet every requirement. Panopepton is the entire
edible substance of prime, lean beef and best wheat flour,
thoroughly cooked, properly digested, sterilised and con-
centrated in vacuo. The trimmed and cooked beef is
subjected to digestion strictly to the point of complete
solution of its albuminoids and the cooked wheat to the
solution of both its gluten and starch. Panopepton is,
therefore, the quintessence of peptones, containing all the
nutrients of these two great types of food, beef and bread,
fused into a delicious restorative.
The superiority of peptones from cooked foods over
any form of raw, unsterilised beef is obvious. Sterilisation
is an essential feature of the process for Panopepton,
peptones not being coagulable at the boiling temperature,
as are all other forms of albuminoids. Expressed juice of
beef is instantly coagulated by heat, showing the fact that
its albuminoids require conversion into complete solution
before they are fit for absorption.
Panopepton is completely soluble and absorbable and
responds to every test of true peptone and will satisfy the
most exact and scientific scrutiny as to its qualities in every
particular.
As significant of the technical skill and care with which
the Panopepton is prepared, we call attention to the im-
portant fact that it is free from cane sugar or condiments,
its agreeable flavor being purely characteristic and like that
of roast beef juice and crust of bread.
83
Digestion is a process of solution, the slight mechanical
operation concerned, being merely to expose increased
surface to the solvent action of the digestive juices. By
digestion only are we enabled to convert into solution the
bulk, the actual substance, of food stuffs and thus fit them
for appropriation by the system. We cannot by maceration
or infusion with water, dissolve or extract the real nutritious
substance of beef. The starch (the carbohydrate) of flour
or bread, likewise, can be made soluble only by digestion.
Panopepton contains not only such extractives, salts and
savory matters, as are found in beef juices, beef tea, etc.,
but further and peculiarly, a solution of the whole substance
of beef and bread.
For many years the peptonisation of beef and wheat has
been the subject of experiment and study by us, for we
considered that in these combined albuminoids and carbo-
hydrates only could we seek for a true and complete food.
If, for the nutrition of the body in health, every form of
alimentary substance is essential, why should we in disease
resort solely to albuminoids or digested albuminoids, except
in the cases where especially indicated. The experience of
the human race is expressed in the saying, "bread is the
staff of life."
The rank which peptonised milk holds as a food for
the sick is due especially to the fact that milk is the " type
of complete aliments," (Dujardin-Beaumetz) ; is " com-
plete in itself." (Pavy). Panopepton is the first food for
the sick which may be relied upon to replace milk, for like
milk, it affords all the elements requisite for the nutrition
of the body.
The uses of such a peptonised food product as Pano-
pepton are so obvious that it is only necessary to suggest
the directions in which it will be found of inestimable
value. Panopepton is the food par excellence, for invalids ;
in all acute diseases, fevers, etc. ; in convalescence ; for the
large class of persons who from feebleness, or deranged
digestion, or antipathy to ordinary foods, require a fluid,
agreeable and quickly assimilable food. As a restorative
from fatigue, for sleeplessness due to care and anxiety, or
stress of mental work, Panopepton is a most potent recon-
84
structive, to which immediate response is felt. Panopepton
is preserved in a sound sherry, without added alcohol, and
is at once a grateful stimulant and food.
A wineglass of Panopepton, with a small biscuit or
cracker, will be found the best lunch or supper for the
brain worker, when too tired for the tolerance or digestion
of ordinary foods. For invalids travelling and under any
circumstances where it is inconvenient to prepare food foi
the sick, Panopepton may be relied upon. In seasickness
it is especially acceptable. Panopepton will be found to
be of the most agreeable flavor when taken cold, conse-
quently we recommend keeping it in a cool place, although
it will keep perfectly for an indefinite time under ordinary
conditions.
It is obviously quite impossible to state an arbitrary
dose of Panopepton under the wide range of conditions in
which it is to be employed ; for the quantity and frequency
of administration is to be determined by the indications of
each case. In inanition, due to protracted inability to
tolerate food, we have known five drops of Panopepton,
diluted with carbonic water, and gradually increased up to
teaspoonful doses every few hours, to have fairly rescued
the patient from the last stages of exhaustion. Its restora-
tive effect under such circumstances has been little short
of miraculous.
Panopepton presents not only the best means of resisting
and repairing the inroads of disease, but of restoring the
natural digestive functions, and helping the convalescent to
resume a normal diet.
Panopepton should not be mixed with milk or any other
food, and whatever diet is ordered in conjunction there-
with, the Panopepton is to be taken pure or with cracked
ice, carbonic water or wines.
For infants during summer complaint, Panopepton is a
food rationally indicated and may be given in doses from a
few drops to half a teaspoonful according to circumstances.
For adults, the usual portion should be a dessert or
tablespoonful several times a day and at bedtime.
85
THE SURGICAL USE OF THE DIGESTIVE
FERMENTS.
It is a fact long known, that the action of the proteo-
lytic ferment of the gastric juice is not confined to purely
alimentary substances, but is capable of dissolving albumin-
ous matter in the various forms occurring in false fibrinous
membrane, in sloughing and diseased tissues, etc.
" Gastric Juice was many years ago employed by Dr. P.
" S. Physick, the celebrated surgeon of Philadelphia, with
" considerable success, as a local application to cancers and
" sloughing ulcers, with the view of removing the dead bone
" and flesh, correcting the offensive odor, and yielding a
" healthy stimulus to the diseased surface. It has also been
" used with success by Dr. Ellsworth, of Hartford, Conn.,
" for dissolving a portion of tough animal food, which had
" become impacted in the oesophagus of a lad affected with
" stricture of that passage. The gastric juice of a pig was
" used." {Boston Med. 6 Surg. J^ourn., April 17, 1856.)
The purely physiological functions of the digestive
ferments and their application as agents of digestion
of alimentary substances, have naturally more engaged
the attention both of the medical profession and those
who have sought to perfect the means and the method of
utilising them in this most practical direction. Meanwhile
the surgical application of the digestive ferments has
too long failed of that attention which the least sanguine
estimate of their value must show them eminently worthy
of. In recent years we have given considerable atten-
tion to this subject, and from time to time supplied the
ferments in the best form available for this purpose.
Medical literature shows the record of the successful use
of Fairchild's pancreatic extract and pepsin in the throat,
in the auditory canal, in ulcers, sloughing wounds, in the
bladder, etc. A novel and most important application of
86
the digestive ferments in gonorrhoea and urethral stricture
has been made by a physician who has found Extractum
Pancreatis the most successful agent. Applied dry it ad-
heres to the mucous membrane, and finds sufficient
moisture for its effective action. The extract is pref-
erably mixed with sodium bi-carbonate say i grain to 5
of the Extract. In this situation, as in all others observed,
the ferment seems to exert no action upon normal tissue.
A record of many cases has already been made, and the
subject is still under investigation. A case has also been
reported to us of the successful treatment of stricture of
the oesophagus by application of the Extractum Pan-
creatis with sodium bi-carbonate. In diphtheria, we have
every reason to believe that the best results are to be ob-
tained by the insufflation of the dry Extractum Pancreatis
mixed with Sodium Bi-carbonate ; thus applied, it adheres
well to the mucous membrane, which affords sufficient
secretion as a medium for the solvent action. Dr. Robert T.
Morris, a well-known surgeon of this city, seeing the
remarkably successful use of Fairchild's pepsin, by
his suggestion in the treatment of a crushed liver, was
led to undertake scientific investigation and extended
practical trial of the digestive ferments as solvents in surgi-
cal cases. Subsequently Dr. Morris undertook a series of
experiments, to test the solvent power of pepsin upon
carious bone previously decalcified by subjection to dilute
hydrochloric acid, with the view to remove dead bone
without subjecting a weak patient to a dangerous or
deforming operation. Succeeding in these experiments,
Dr. Morris made practical use of this new surgical resource
with complete success, the pepsin liquefying the carious
bone and exerting no action upon normal bone.
The results of Dr. Morris' investigations are published
in the New York Medical Journal, April n, 1891 : "The
action of pancreatic extract and pepsin upon sloughs,
8?
Coagula and muco-pus ;" and March 19, 1892 : "The re-
moval of necrotic and carious bone with hydrochloric acid
and pepsin."*
The grounds on which the digestive ferments are
applied in surgery are admirably stated by Dr. Morris as
follows :
"It is not easy to see at a glance the whole field for digestive fer-
ments in surgery, but we know that they are bland and harmless in any
proportion, and that they will liquefy dead tissues close down to the liv-
ing ones, and that there their action will end abruptly."
From Dr. Morris' paper the following typical cases
summarised :
"A resource was brought into play a few weeks ago, when I had
occasion to make suggestions relative to the treatment of a crushed
liver. Portions of the organ, which were dark and sloughing, remained
so firmly attached that their removal was dangerous, and the pultaceous
lining membrane of the enormous abscess seemed to invite all manner of
microbe guests. The idea of liquefying the dead tissues with a digestive
ferment came into mind, and this being suggested, was carried into
effect by the family physician, who injected into the abscess cavity a
solution of scale pepsin, and, writing to me afterward, said : ' The pep-
sin did mighty good work. It broke up all dead tissues, rendering them
mostly liquid, and changed the color from brown to straw-color. The
liquefied substances were easily washed out through the drainage tube.
The wound was sterilised daily afterward with hydrogen peroxide, and
the patient recovered without a bad symptom." "
" Dr. C. N. Haskell liquefied two grammes of tough lining membrane
from the tuberculous abscess of a case of hip joint-disease, with pepsin
in fifty-five minutes."
" Dr. C. D. Jones, of Brooklyn, poured a solution of pancreatic extract
(pancreatic extract, 2 dr.; water 8 ozs.) into the abscess cavity of a case
of hip-joint disease one week after the operation of excision had been
performed. He then wrote me as follows : ' The solution was allowed
to remain in place half an hour, and the result was remarkable. Upon
irrigation, I washed out numerous shreds of broken-down ligamentous
tissue and many spicula of dead bone that had become imbedded in the
*Reprints of these papers will be sent on application to us.
88
Soft tissues and that had previously escaped both irrigator and currette.
The wound was then flushed out with hydrogen peroxide, and this treat-
ment was followed by a marked improvement in the patient's general
condition.'"
" In one case in which the bladder contained blood-clots and the
catarrhal mucous membrane discharged ropy muco-pus, pepsin injected
for the purpose of liquefying the clots not only fulfilled its mission in
that direction, but unexpectedly cleared out the muco-pus and left the
interior of the bladder quite clean. The process was repeated as soon
as the muco-pus again became abundant, and the patient experienced a
feeling of relief after the simple cleansing that pepsin afforded."
"After much experimentation I have finally adopted a method of work
which seems to be complete. An opening is made through soft parts by
the most direct route to the seat of dead bone, and if sinuses are present
they are all led into the one large sinus if possible. The large direct
sinus is kept open with antiseptic gauze and the wound allowed to remain
quiet until granulations have formed."
"Granulation tissue contains no lymphatics, and absorption of septic
materials through it is so slow that we have a very good protection
against cellulitis. The next step consists in injecting into the sinus a two
or three per cent, solution of hydrochloric acid in distilled water. If the
patient is confined to bed, the injections can be made at intervals of two
hours during the day ; but if it is best to keep the patient up and about,
the acid solution is thrown into the sinus only at bed-time. In either
case the patient is to assume a position favorable for the retention of the
fluid. Decalcification takes place rapidly in exposed layers of dead bone,
and then comes the necessity for another and very important step in the
process. At intervals of about two days an acidulated pepsin solution is
thrown into the sinus (I use distilled water, f iv ; hydrochloric acid,
m t xvj ; Fairchild's pepsin, 3 ss.), and this will digest out decalcified
bone and caseous or fatty debris in about two hours, leaving clean dead
bone exposed for a repetition of the procedure. The treatment is con-
tinued until the sinus closes from the bottom, showing that the dead bone
is all out."
" Even in distinctly tuberculous cases the sinuses will close if appara-
tus for immobilising diseased parts and tonic constitutional treatment are
employed, as they should be in conjunction with our efforts at removing
the dead bone."
" If suppuration is free in any cavity in which we are at work, it is
89
well to make a routine practice of washing out the cavity with peroxide
of hydrogen before each injection."
Pepsin is the ferment which will probably give the best
results in all cases where the acid essential to its operation
is not objectionable, and where the swelling of the fibrin-
ous matter, which instantly occurs on contact with the
acid is not an objection. This behavior of acid would
siometimes be considered unfavorable, as in the auditory
canal, in the throat and in the urethra ; but in abscess
cavities, etc., this is no objection on the contrary, the
acid seems itself a salutary agent, giving a healthy stim-
ulus to the diseased surface, and is, moreover, antiseptic.
Further, the action of this acid-pepsin digestion ceases at
the production of peptone. These pepsin peptones do
not themselves readily undergo putrefactive changes
whilst the solution remains acid. The pancreatic fer-
ments acting upon all these forms of proteid encountered
in surgical cases, are very effective in water without the
intervention of an alkali, but their action is accelerated in
an alkaline solution so slight as one part sodium bicar-
bonate to 500 of water. Moist fibrin can as quickly be
digested by Extractum Pancreatis plus alkali as with
pepsin plus acid, by simply adjusting the quantity of the
ferment to attain the desired result. There is no possible
cause for hesitancy in using the ferment as freely as
necessitated ; there is no other effect than its digestive
action, which ceases when no morbid tissue remains to
work upon. The soda itself is in many instances as
clearly indicated and as useful, for instance in the
urethra, in the bladder, in the throat, etc., as the acid is in
the cases suitable for pepsin.
In the surgical use of the digestive ferments, it is
absolutely essential to follow as closely as possible the
conditions most favorable to the action of the particular
ferment utilised. At the outset, probably no better
90
guidance can be had than the procedure developed by
practical experience in the use of the digestive ferments,
as applied in this artificial digestion of albuminous matter
in the test tube.
In using pepsin, the intervention of acid, from one half
to one per cent, hydrochloric acid, U. S. P. to the volume
of water is essential. Extractum Pancreatis may be used
with simple water, or with water rendered slightly alkaline
with soda bi-carbonate, say 5 grains to each fluid ounce.
The surgeon, then, in the normal range of media and
action of the peptic and pancreatic ferments, is enabled to
use an effective solvent, either acid, neutral or alkaline, as
best adapted to the case in hand.
The most favorable temperature for the preparation and
for the action of the digestive fluids can be readily ascer-
tained by any attendant without the use of the thermom-
eter, by using water heated to the point at which it can be
borne by the whole hand (115 F.), or not too hot to be
swallowed with comfort, about 130 F. This gives a tem-
perature of 115 or 130 F., at which they act better than
at the body heat, and the water should always be brought
to the proper temperature before adding the digestive fer-
ment. This avoids all risk of injuring the ferment.
If there is no cavity to hold the solvent in contact
with the matter to be digested, the solvent should be
applied by copious sprays, frequently repeated. In cav-
ities, repeated applications are preferable, as otherwise the
digestive fluid may become saturated with the products of
digestion, and thus cease to act. It is also to be noted
that the irrigation should follow as quickly as possible the
liquefaction of the tissues.
The solvents should invariably be freshly prepared for
each application^ as the ferments mixed with the water are
91
Hot only prone to decomposition and to become inert, but
if mixed with cold water and then brought to the proper
temperature each time required, they are very apt to
be injured by overheating. With warm water, it is but a
moment's work to prepare just the quantity required for
each application.
In using pepsin, we strongly recommend Glyccrinum
Pepticum, both for convenience and efficiency, as contain-
ing the ferment in a highly concentrated, pure glycerin
extract, instantly soluble in any desired proportion and
especially convenient for spraying.
GLYCERINUM PEPTICUM
AS A SURGICAL SOLVENT.
In any convenient glass, mix one teaspoonful of Glycer-
inum Pepticum with one fluid ounce of warm water, say at
115 F., and 4 drops acid hydrochloric c. p. (16 drops dilute
acid U. S. P.). Apply by injection, spray, etc., as most
suitable.
FAIRCHILD'S PEPSIN
AS A SURGICAL SOLVENT.
Mix 5 grains of Fairchild's pepsin in powder perfectly
smooth with a teaspoonful of water, then add an ounce of
warm water, stirring well. Add 4 drops acid hydro-
chloric c.p. and apply as required.
EXTRACTUM PANCREATIS
AS
A SURGICAL SOLVENT.
Mix in any convenient glass, 5 grains Extractum Pan-
creatis to each fluid ounce of warm water, first carefully
92
stirring the powder with a teaspoonful of the water, to a
perfectly smooth mixture. At the option of the surgeon,
soda bi-carbonate, about 5 grains to each fluid ounce,
may advantageously be added.
It is by no means essential that these or any arbitrary
proportions shall be observed. These quantities specified
can be readily approximated without weighing. If it is
found desirable to write a prescription for the solvents,
the following formulas will be found satisfactory :
Glycerinum Pepticum 2 fl. ozs.
Acid Hydrochloric c.p 64 minims.
Aqua-Destillata 6 fl. ozs.
M, S. Pour the quantity necessary for each application
into an equal quantity of water, heated to about 115 F.,
or as hot as can be borne by the whole hand and apply as
directed.
Extractum Pancreatis 3 drs.
Soda Bi-carb i dr.
M, Divide in wax papers No. 12.
Mix one powder with a gill of warm water and prepare
fresh for each application as directed.
In preparing these solvents with water, it is well to
use that which has been well boiled or distilled.
Extractum Pancreatis i dr.
Soda Bi-carb 15 grains.
M, Divide in wax papers No. 12. Apply dry as directed.
FAIRCHILD'S
PEPTOGENIC POWDER AND PROCESS;
ITS DEVELOPMENT AND RATIONALE.
It is now nearly ten years since we introduced a
method of preparing an imitation of woman's milk, based
upon the agency of a digestive ferment in effecting the
physiological conversion of the caseine of cows' milk into
the soluble and diffusible form, in which the albuminoids
exist in human milk.
This purely physiological action of the digestive fer-
ment can be controlled or checked at will by regulating the
temperature to which the ferment is subjected. Under
favorable conditions, the ferment acts until its power is
spent; by simply raising the temperature of the digesting
mixture to about 160 F., it is instantly destroyed and
thus becomes an inert substance, insignificant in amount
and resembling in chemical and physiological properties
so much albumen.
The digestive ferment has no other action, no proper-
ties at all comparable to those of a drug or chemical.
The pancreas ferment, trypsin, has a remarkable affinity
94
toward milk, digesting its caseine with great rapidity with-
out altering its other elements and without rendering the
milk repulsive. Milk so treated is known as " peptonised
milk " and as made available by the Fair child products and
process, has long since become the chief reliance of the
medical profession as supplying an ideal food for the sick.
The value of peptonised milk was immediately recog-
nised as a resource for the feeding of an infant with natur-
ally feeble or disordered digestion, and experience only
confirmed the promise of its great usefulness.
After some years of practical experience with the pepto-
nising process, and seeing the great facility with which
caseine could be brought to any desired degree of digestion,
the idea occurred to us that this process promised the
solution of the problem of preparing an adequate substitute
for woman's milk; as opening the way for the qualitative and
quantitative adjustment of cows' milk to a correspondence
with human milk to a degree never before attempted.
In order to prosecute the undertaking, we entrusted the
necessary expert investigation to Dr. Albert R. Leeds, well
known to have made especial study of the composition of
human milk and of the infant foods.
Dr. Leeds found that under the influence of the diges-
tive ferment, the caseine could be so altered as to impart a
new and peculiar property to the milk ; that the milk
became in its physical characteristics, density, color, taste,
and in its behavior with acids and with gastric juice,
remarkably like mothers' milk. The albuminoids of this
converted milk under analysis showed a close resemblance
to the albuminoids of woman's milk, thus adding a final proof
to the theory that the differences in the physical properties
and in the behavior and digestibility of cows' and human
milk, are directly dependent upon the character of their
albuminoids.
95
Here then was an agent for the physiological conversion
of the caseine, an expedient far more effective, natural and
convenient than any hitherto devised, and which made
possible the construction of an artificial human milk, by
carrying out the further important modifications indicated
by the results of comparative analysis.
As a final result, we were able to offer the Peptogenic
Milk Powder and method which were found by Dr. Leeds,
as stated in his report, " to yield a ' humanised milk ' which
in physical characteristics and chemical constitution
approaches very closely to woman's milk." Thus we intro-
duced a method of preparing a substitute for mothers'
milk, which is the direct result of scientific study and investi-
gation and which fairly represents the present status of
knowledge and attainment ; the only food for infants which
in its development and accomplishment, conforms to the
universally accepted postulate that the best artificial food
for an infant is that which in the highest degree resembles
mothers' milk.
After ten years of practical experience, study, and
investigation since its introduction, during which time we
have had abundant means of ascertaining the results of its
actual use as an exclusive substitute for mothers' milk, we
feel the strongest conviction that it affords an artificial food
for infants which is entirely adequate for the nourishment
and development of an infant during the nursing period.
We have, during these years, given unremitting investiga-
tion in every direction which might enable us to attain the
utmost perfection of detail in the approximation to the
natural food of an infant.
We submit the Peptogenic Powder and method solely
upon this ground, as a scientific, practical and successful
method of modifying cows' milk to the known composition
96
of human milk. Upon this ground, we ask the considera-
tion of every physician interested in providing food for
infants deprived of breast milk.
THE POINT OF VIEW ON INFANT FOODS.
In infant feeding, as in many other subjects, scientific
standards are in advance of practical usage. So whilst
everywhere it is premised that mothers' milk is the best
food for an infant, we see that foods which are wholly made
up of substances foreign to milk, foods which were never
designed to resemble human milk, continue to be bought
and used without a question as to how they resemble the
food for which they are to be substituted.
We ask the physician therefore to submit the infant
foods of the shops to the practical point of inquiry. How
do they resemble mothers' milk when prepared for the
nursing bottle ? No " infant food " as it is found in com-
merce, resembles mothers' milk, or can take the place of it.
The " infant foods " of commerce may be fairly divided
into two distinct classes :
First Those which do not contain any milk and which
are to be made ready for the nursing bottle by admix-
ture with cows' milk.
Second Those which contain milk, the dried and condensed
milk foods, all of which are directed to be prepared for
the nursing bottle simply by the addition of water.
When mixed for use according to the "directions " of
the manufacturer the "infant foods" differ from human milk
obviously in physical properties, and by analysis will be
found invariably deficient in milk fat, milk sugar and milk
salts, which deficiency is not by any means compensated
for by the malt sugar or baked flour which imparts thick-
ness and sweetness to the food.
97
Another important question is : Shall we use fresh
milk or commercial milk products as the basis for the prepa-
ration of an infant food ?
From our standpoint, we can at present find no other
basis than fresh milk, for we have not thus far found that
milk can be so treated as to afford a stable commercial pro-
duct, from which a close approximation to mothers' milk
can be prepared.
We hold to the view that milk is materially altered by
drying. That it will not on the addition of water, have re-
stored to it even the physical characteristics of the original
milk ; that the dried caseine of the milk will not again dis-
solve in the water ; that the milk fat cannot be dried
successfully ; that it will in this state, soon become rancid.
It has for these reasons never been found possible to
dry pure unskimmed milk as a marketable product, even
for ordinary culinary and dietetic purposes.
Milk condensed without sugar or other preservative has
been found apt to spoil quickly after the package is opened.
Sweetened condensed milk contains a large amount of cane
sugar and when such milk is diluted with the proper
amount of water, it is much too sweet and thick. It is in
common practice diluted so as to be greatly deficient in the
real elements of milk.
COWS' MILK AS A FOOD FOR INFANTS.
In seeking a food for an infant deprived of breast milk,
cows' milk has been instinctively resorted to as the sub-
stance nearest to it in apparent properties and design. But
notwithstanding these similarities, cows' milk has proven
inherently indigestible for the infant stomach and inade-
quate to replace woman's milk. Hence the problem of infant
feeding. Hence the infant foods of commerce. Finding
that cows' milk forms an indigestible curd, various expedients
98
have been employed to overcome this. Among these, is
the use of an alkali such as lime water, to form soluble
or alkaline albuminates, to give the milk an alkaline reaction
and also to retard the curdling action of the gastric juice.
The most familiar and common method has been to
thicken milk with baked flour, or farinaceous foods to
keep the curds from forming a mass. But the effect of
these substances is purely mechanical, they do not alter
the character of the caseine, they " thicken," but do not
enrich milk. It is simply adding a new difficulty without
overcoming the original one.
Liebig, seeing that starch was not suited to an infant's
digestion, that the nursing infant is not endowed with the
power to digest starch, proposed to utilise the starch digest-
ing ferment of malt its diastase for the artificial diges-
tion of starch. Thus he gave us the method of treating
wheat flour with a fresh infusion of malt and bicarbonate
of potash, by which the starch is dissolved and converted
into malt sugar. This, in brief, is the origin of the Liebig
foods, by which we are now supplied with a ready-made
malted or digested flour for addition to fresh milk.
But there being no starch nor digested starch (maltose,
dextrins, etc.) in milk, human or animal, whilst there is
in all milk found available a sugar peculiar to milk alone,
there remains neither reason nor necessity for giving starch
or digested starch to the nursing infant.
Therefore, from the standpoint of to-day,Liebig's method
cannot, on theoretical grounds, be considered to afford an
approximation to mothers' milk, nor has it in long practical
experience proven a solution of the problem of infant
feeding.
In the futile attempt to overcome the indigestibility of
caseine, milk has often been so diluted as to render it in-
capable of properly nourishing an infant. The addition of
99
water does not alter the character or behavior of caseine.
Many in diluting the milk, have added nothing to attempt
to compensate for the dilution of the sugar and the fat,
at the beginning deficient in quantity.
Such in brief, are the methods long in practice for the
preparation of fresh cows' milk for infants. So that whilst
the selection of animal milk for the bottle feeding of infants
has been dictated by its resemblance to the natural food,
we have gone on adding to it substances foreign to all milk
and unsuited to the digestive functions and nutrition of an
infant.
It has taken us a long time to get to the present stand-
point, that "an infant food approaches perfection in the
degree in which it resembles human milk."
If many infants have, by virtue of superior resistance,
been capable of appropriating sufficient nourishment from
cows' milk in the various forms, how many have perished
by artificial feeding ! It is not here necessary to " make a
oase " in order to offer a remedy.
COMPARATIVE COMPOSITION OF COWS' AND
HUMAN MILK.
Modern chemical and physiological investigation clearly
reveals the reason why cows' milk is not suitable for the
human infant. We see the significance of the difference
found to exist in the composition of human and cows'. milk,
that the milk of each is peculiarly adapted for the purpose
for which it is designed. We now know that cows' and
human milk differ in the total quantity of nutritious mate-
rials and in their relative proportions. Cows' milk contains
less total solids, less fat, less milk sugar and twice as much
albuminoids. In cows' milk, there is a larger proportion
of the element of nutrition which^creates and supports
100
muscular energy and activity ; in human milk there is a
larger proportion of sugar and fat.
Breast milk is uniformly and persistently alkaline.
Cows' milk is more or less acid, and its acidity becomes
more and more marked by keeping.
In cows' milk the greater part of the albuminoids is
caseine, the substance which is curded by rennet and pre-
cipitated by acid the cheesy portion.
In woman's milk the greater part of the albuminoids
exists in a soluble or peptone-like form, which is incapable
of coagulation or precipitation. The small fraction that is
coagulable gives with acid or gastric juice minute, mobile,
flocculent particles.
Thus it appears that in cows' milk there is not only a
preponderance of albuminoids, but their quality is such as
to demand a degree of digestive power to which the infant
organism is unequal.
Milk is a vital secretion, and human milk the more
highly elaborated, in its digestibility and its nutritive
qualities, in conformity with the requirements of the highly
organised being for whose nutrition it is destined.
It is the caseine, therefore, which has proven the obsta-
cle to the practical employment of milk as a food for infants,
for the sugar and the fat of milk exist in a form ready for
absorption and in a form peculiar to milk alone.
THE USE OF THE PEPTOGENIC MILK POWDER
FOR THE PREPARATION OF "HUMANISED MILK"
INVOLVES THREE DISTINCT STEPS:
. First To prepare with Peptogenic Powder, cows' milk,
water and cream, a mixture which has the quantitative
composition of average human normal milk.
101
Second To subject this mixture to the action of the digestive
principle by which the albuminoids (caseine, etc.) are
converted into such form as to become identical with
those of human milk.
Third To then destroy the digestive ferment by simply
raising the temperature of the milk to the boiling
point. This heat also destroys the bacteria and ren-
ders the milk practically sterile during the time
required for use 24 hours.
DIRECTIONS FOR "HUMANISED MILK."
No. i.
FOR THE DAILY FOOD OF A HEALTHY NURSING INFANT.
Put into a clean granite ware or porcelain lined saucepan,
four small measures*, or one large measure of the Peptogenic
Powder, half pint of cold water, half pint of cold fresh
milk, and four tablespoonfuls of cream. Place the sauce-
pan on a hot range or gas stove and heat with constant
stirring until the mixture boils. The heat should be so ap-
plied as to make the milk boil in ten minutes
Keep in a clean, well-corked bottle in a cold place.
When needed, shake the bottle and pour out the desired
portion and heat to the proper warmth for feeding luke-
warm.
No. 2.
SPECIALLY PREPARED FOOD FOR INFANTS WITH FEEBLE
DIGESTION OR WHEN SUFFERING FROM DISORDERED
STOMACH AND BOWELS, AS IN CHOLERA
INFANTUM, ETC.
Put into a clean bottle, four small measures*, or one large
measure of the Peptogenic Powder, half pint of cold water,
half pint of cold, fresh milk and four tablespoonfuls of cream.
* Each large can of Peptogenic Milk Powder contains a large and a small
measure. Put the Powder into the measure with the blade of a knife, shaking it
down firmly so as to well and evenly till the measure.
The small can contains the small measure only.
Shake well, place the bottle in a pail or tin kettle of water
(at least a gallon) as hot as can be borne by the whole hand
(115 F.), and keep the bottle there for 30 minutes.
Then pour all into a sauce pan and quickly heat to boiling
point with constant stirring.
Keeping and feeding in the same way as directed in
No. i.
COMPOSITION OF " HUMANISED MILK."
" Humanised milk " contains the amount of milk sugar,
fat, albuminoids, ash and water found in mothers' milk. It
possesses the peculiar alkaline reaction due to the proper
proportions of those various mineral and saline constituents
which are always normally present in woman's milk, and
which are essential elements in the nutrition of the infant,
being vitally necessary to the development of its osseous
system. It resembles mothers' milk remarkably in its
physical properties, and under every known method of test,
it is found to behave in the manner characteristic of aver-
age normal breast milk.
We do not advise varying the proportions according
to the age of the child. In the careful study of the facts
brought out by the many analyses now extant of woman's
milk, made during the entire period of lactation, there does
not appear a sufficient variation in the quality of the milk,
or in the ratio of its constituents, to afford a practical
ground for making any variation in an artificial food.
It may logically be assumed therefore, that the average
composition of human milk is the most practical and scien-
tific basis for the fabrication of a food for the average
infant, permitting the bottle-fed infant, like the nursing
infant, to take food in such quantities and at such inter-
vals as best conduces to its health.
103
DIGESTIBILITY OF "HUMANISED MILK."
"Humanised milk" presents to the infant's stomach a food
which requires the same exercise of the natural digestive
functions as required for mothers' milk the caSeine has
undergone no greater amount of artificial digestion than is
necessary to bring it to the soluble condition characteristic
of the albuminoids of mothers' milk. It is not in the least
giving a milk unnaturally easy of digestion. There enters
the infant's stomach no artificial aid to digestion, no pep-
sin, no digestive ferment of any kind ; for after the ferment
has accomplished a certain work in the conversion of the
caseine, it is then destroyed and has no further influence
upon the food has nothing more to do with the digestion
of the milk in the stomach than has the fire by which the
milk was heated.
HOW TO ADAPT THE MILK FOR INFANTS
WITH FEEBLE DIGESTION.
In order to adapt this " humanised milk " to the stomach
of an infant with naturally feeble digestion, or with diges-
tion disordered by teething, summer complaint, etc., the food
is not to be specially diluted, it is simply necessary to reg-
ulate the degree of conversion of the caseine to insure its
digestion and assimilation. This is accomplished by leav-
ing the milk for a longer time at the temperature suitable
for the action of the ferment before boiling the milk.
Therefore in directions No. 2, we direct 30 minutes in the
warm water bath before bringing the milk to the boiling
point. In extreme cases, the caseine may be, by longer
digestion, (40 to 50 minutes) so converted into a soluble
form that the milk becomes capable of absorption with-
out the least tax upon the stomach.
As the child recovers strength, the degree of this
104
conversion is gradually decreased until it is able to assimi-
late milk which has the digestibility of mothers' milk. By
this means a sick infant is not deprived of nutrition in the
attempt to find a food which it can tolerate.
There is also another expedient which has been found
successful in the many cases of infants who seem to have
practically no digestive power. This is to give the
"humanised milk" containing the ferment in an active form
and thus capable of effecting the subsequent changes of
the food essential to its assimilation. Mix the Peptogenic
Powder, water, milk and cream in the regular proportions,
cold, then place the bottle directly on ice. When required,
shake well, pour out only the necessary quantity and heat
carefully over a flame until it is just warm enough for the
nursing bottle. Do not boil it and do not let it get hotter
than is agreeable to the mouth. This method should
always be used when the food by Directions i or 2 is not
properly assimilated by the infant. After the child has
become strong enough, then gradually return to Directions
No. i.
CHOLERA INFANTUM.
The Peptogenic Milk Powder is too often brought first
into use in a case when the infant is suffering from cholera
infantum or from severe disturbances of digestion, aggra-
vated by improper food and the system weakened by lack of
nutrition. Even in such cases, relief is often immediately
found in the administration of the specially prepared
"humanised milk." (See directions No. 2). Give very slowly
and in very small quantities at each feeding. But many
times the case presents the entire alimentary tract in a
condition highly favorable to the fermentation of milk and
equally unfavorable to its absorption. Hence, milk may
add fuel to fire.
105
In consequence of these facts it has become the prac-
tice to discontinue milk entirely for a time, in the endeavor
to give rest to the digestive functions and to promote the
effects of the purely medicinal measures. The difficulty
here is to find a substitute for milk which will afford
adequate nutrition.
WHEY AS THE TEMPORARY FOOD IN
CHOLERA INFANTUM, ETC.
"We strongly recommend " Whey " as affording by far
the most satisfactory temporary food in Cholera Infantum.
This opinion is based not only upon its composition,
but also upon some seven years of practical experience of
its use. Whey contains, in a greater or less degree, every
element of nutrition and in a perfectly assimilable form.
It contains the soluble albuminoids, milk sugar and saline
constituents of the milk. It is thus not giving a diluted
milk. The milk has only been deprived of itscaseine and
the greater portion of its fat. Whey is therefore unques-
tionably far more suitable for the nourishment of a child
than beef juices, beef foods, etc., or any other food which has
ever been suggested as a temporary substitute for milk.
As prepared with Fairchild's Essence of Pepsine, it is x not
only most palatable, but the contained Essence is also of
great value as a remedy. For very young infants, it should
be prepared with one teaspoonful of Essence to a pint of
warm milk. For older infants it may be prepared with a
teaspoonful to a half pint of milk and thus the proportion
of the Essence of Pepsine may be made available for its
remedial properties in conjunction with the whey. The
Essence of Pepsine is accompanied by simple directions
for the preparation of whey. Whey should be given
from the nursing bottle, like the ordinary food.
lor,
The Essence of Pepsine affords the ideal digestive and
carminative stimulant for disorders of infant digestion. It
is generally given in 5 to 10 drop doses in a teaspoonful
of pure water or with a teaspoonful of the whey or
"humanised milk."
HOW LONG SHOULD THE BABY BE FED ON
"HUMANISED MILK."
Only that food is a proper substitute for breast milk
which is capable of the nutrition of an infant during the
entire nursing period. "Humanised milk," being equivalent
to average healthy breast milk, should be the exclusive
food of an infant just as long as it wou,ld ordinarily take
breast milk. The soundness of this theory and this
practice has been proven by experience by results.
It is found that there is a disposition on the part of
parents to hurry the child along to what they fancy to be
a " richer " food, to milk "thickened " with prepared foods,
etc. To which we reply that "humanised milk" is not de-
ficient in any element for the perfect development of an
infant, that it is as rich as human milk, and richer than
cows' milk in every constituent save the caseine ; that
mothers' milk ought to be the safest standard for a food
up tp the time of weaning.
HOW TO WEAN THE BOTTLE-FED BABY.
An infant should be weaned from the bottle gradually
just as from the breast. At an age at which a nursing
child would ordinarily be given a little oatmeal, hominy
or rice, the bottle-fed infant should be given these fari-
naceous foods.
Begin with one feeding a day of well boiled oatmeal or
rice, or some well baked potato mixed with " humanised
milk." Feed with a spoon. Increase gradually to several
107
times a day, or until the bottle is no longer required. Now
begin to prepare the food with ordinary pure fresh cows'
milk instead of with the " humanised milk" until you accus-
tom the child to live entirely upon pure milk and farinaceous
foods. But the less meat the better, until the child is two
or three years old, say many of the physicians most expert
in infant feeding.
"HUMANISED MILK"
AS A PARTIAL SUBSTITUTE FOR BREAST MILK.
In many cases it is found desirable or necessary to
resort to bottle-feeding as a partial substitute for breast
milk; here the "humanised milk" is the only food which
can be properly given.
It is so identical with pure breast milk that no injury
results to the child, it is taken as readily as the breast
milk, and this alternate feeding produces no disturbance
of the digestive functions. It is so much better than faulty
breast milk, that it is often of the greatest value, both to
the infant and mother to resort partially to a food which
properly nourishes the child and relieves the mother of an
undue tax upon her strength. No good result can come
from compelling a child to take several times a day, thick,
sweet malt sugar or starchy food, foods which load and
distend the stomach, and the rest of the time the thin, di-
gestible fluid mother's milk.
Many a mother would gladly and profitably be relieved
in a measure of the strain of nursing, if it could be
accomplished without prejudice to the child, and this can
be done by means of "humanised milk."
"HUMANISED MILK" HAS NO SPECIAL EFFECT
UPON THE BOWELS.
The " humanised milk " has no especial tendency to
produce either costiveness or looseness of the bowels.
108
Either one of these conditions may appear according to
the constitution of the child or as dependent upon various
reasons, just as may occur when taking breast milk.
Sometimes especially in hot weather an infant requires
water to keep its bowels in good order and for its well
being in general. A little calcined magnesia or a little
flake manna dissolved in the milk when ready for feeding,
is a good remedy for constipation. Or use oatmeal water
in place of plain water in preparing the " humanised
milk." Take one table-spoonful of thoroughly cooked
oatmeal (as ordinarily prepared for the table) and stir
well into half a pint of hot water ; strain. Constipation is
sometimes immediately relieved by heating the milk to
170 F. instead of to the boiling point ; this lower tempera-
ture is equally effective in killing the digestive ferment
and in sterilising the milk.* Hold the fresh milk mixture
in a saucepan over a flame, stirring constantly till it is
heated to 130 F., remove from heat for three to five
minutes, then place over the flame again and stir constantly
till the milk reaches 170 F. the whole process not to take
more than 10 minutes. Then pour the milk into a clean,
well-corked bottle.
One of the most simple and frequently effective expe-
dients for loose bowels is to thicken the milk for a few
feedings with thick arrowroot gruel, made by mixing the
arrowroot with cold water and then boiling it for a long
time till very smooth and well cooked. The so prepared
gruel is to be added to the " humanised milk " when it is
ready for feeding to the child. Its use should only be
continued for a few feedings until the trouble is remedied.
Colic, loose bowels with flatulence, are greatly relieved by
the use of Fairchild's Essence of Pepsine given in from 5
to 10 drop doses in a teaspoonful of water just before
* For this purpose buy the cheap dairy thermometer, all glass and
plainly marked to 170 F,
109
feeding. It may be so given several times during the day,
but not continued beyond the necessity for its use. If
there is persistent diarrhoea, it is a case for the physician ;
it requires skilful medical treatment.
"CHANGING THE FOOD"
AS AN EXPEDIENT IN GETTING ONE THAT WILL AGREE.
It must be held that having a food equivalent to
mothers' milk, we should use it like mothers' milk and
as far as possible treat all variations of function and dis-
turbances of health just 'as we would if the child were
taking breast milk. The average healthy infant, fed from
birth upon " humanised milk " is no more likely to suffer
from digestive disorders than the infant fed upon breast
milk. In either case, irregularities of bowels, flatulence,
etc., are to be met by proper hygienic and medicinal meas-
ures not by changing food. Indeed, the "humanised
milk " is often advantageously substituted for faulty
breast milk and successfully alternated with healthy breast
milk. But the difficulty is that foods are for the most part
selected (?) hap-hazard the food which " sells the most,"
or is the most advertised, or the food upon which a
friend's child has been brought up, etc. The result we see
is that in numberless instances coming to our knowledge,
it is a history of one food after another, as many foods
sometimes as the infant is months or even weeks old.
These cases present the utmost difficulty when medical
advice is finally sought ; every possible variety of compli-
cation is encountered. In these cases, even good breast
milk would not at once be successful.
An infant accustomed to the unnatural distention,
irritation or stimulus to the alimentary tract from the
presence of bulky, thick, insoluble "farinaceous" foods,
110
or " milk foods " composed of dried milk and baked flour
in which both caseine and starch are in a practically
unassimilable form, will not immediately adapt itself
perfectly to a thin food like mothers' milk. If the entire
mucous membrane is in a catarrhal condition, even breast
milk itself would undergo ulterior change before it could
be absorbed. It is a question of therapeutics as well as
of food.
From the use of such empirical foods and empirical
feeding has come the dictum, sometimes uttered " No
food suitable for all cases all foods must be tried."
There is something superficially attractive about this
proposition, but has it any place in a rational, scientific
system of infant feeding? Too much insisted upon, does
it not make any food good enough to sell ? Is it not a
palpably empirical standpoint ? To what purpose then
the comparative study and analysis of animal milk, and of
the method of approximating it to the composition of
human milk ? Of what significance then, the theoretically
accepted and unassailable postulate that mothers' milk is
the standard of perfection?
Whatever part food in all its varieties plays in the
therapeutics of infant feeding, there can be no escape
from the logic of the proposition that the food practically
identical with mothers' milk should be the food chosen for
the artificial nourishment of an infant from birth.
Such a food is yielded by the Peptogenic Milk Powder
and as such, it deserves the wide and general use so long
given to empirical foods to foods palpably unlike mothers*
milk in physical characteristics and widely dissimilar in
chemical composition.
It is often said that there are infants who will live on
Ill
anything and there are certainly also many with constitu-
tions so feeble, so prone to disease that no care avails to
succor. Whilst the empirical foods are used as broadcast
as they are advertised and thus largely for average
healthy infants, the "humanised milk " finds principal use
in cases brought to the attention of the physician after
failure with a variety of foods.
Peptogenic Milk Powder is the most successful food for
sick and feeble infants, simply because it is the most
like mothers' milk and it is the best food for healthy infants
for the same reason. Why should the best food be selected
only for the sick and feeble infant, the best food is the
right food for the healthy infant also. " Just as the twig is
bent the tree's inclined," and it is difficult to exaggerate
the influence of proper feeding in the development and
future health of the child.
RICH MILK FROM ONE COW.
The formula and process for the preparation of " human-
ised milk," given, are based upon results obtained with ordi-
nary, fresh cows' milk, as supplied by reputable dealers in
all large cities. With this milk the best results are in prac-
tice obtained, both in the behavior of the milk with the
Powder, and as a food. But we find that people are apt to
obtain, when possible, the rich milk of Alderney cows, or
one cow's milk. With this milk there is very apt to be
trouble. It is not nearly so readily approximated to human
milk as the ordinary mixed cows' milk. The richness of
such milk is valuable when it is concerned in cheese mak-
ing, but quite the contrary in preparing milk for a bottle
fed infant. We believe that our views and our experience
II-J
in this particular are in accordance with the best medical
opinion at the present time.
CREAM.
The use of cream is not an indispensable condition to
the employment of the Peptogenic Milk Powder. It is nec-
essary with this as with every other food if we wish to get
the amount of fat contained in human milk.
The use of cream is urgently advised. It should not
be dispensed with upon an impression (for which there is no
foundation in fact) that the cream is " too rich " for a child.
A certain proportion of fat is provided in the natural food
of an infant, and in a condition ready for absorption. It
sustains important functions in the digestive process of an
infant aside from that of nutrition.
" Skimmed milk" forms a peculiarly firm and tough
curd "hickory curd " as it is called. The presence of
the cream undoubtedly aids the digestibility of milk,
especially for infants. It gives mobility and softness to the
curds, preventing the aggregation of large impenetrable
masses. It is a significant fact that whilst every " infant
food " sold, or the food as prepared with them, is deficient
in cream, the use of cream is not directed except in the
Fairchild process.
If it is found inconvenient to use cream, it is bettel
to use the Peptogenic Milk Powder without cream than to
resort to some other food, not only deficient in cream, but
deficient and inferior in other respects also.
113
THE TEMPERATURE OF THE WATER BATH.
The object of the immersion in the water bath, in
Directions No. 2, is to bring the milk (in the bottle) to about
blood heat conveniently and without risk of over-heating.
The water in the "bath " should be about 115 F.
The average temperature tolerable at which the whole
hand can be immersed in water for one minute is about
115 F. It is seldom that any person can endure it more
than a few degrees hotter. This expedient is, therefore,
convenient and reliable for ascertaining the proper temper-
ature of a vessel of water. Those who prefer may use the
ordinary thermometer. " Dairy thermometers" or "bath
thermometers," just the thing, may be purchased for a
small sum.
The pail used for the hot water bath should hold a
sufficient quantity of water to come up above the mixture
in the bottle. It is not meant that the pitcher or pail of hot
water containing the bottle of milk should be set in a warm
place with the purpose of maintaining the same heat as
started with. The water bath should stand in any con-
venient place at ordinary temperature of the room.
MILK TASTES BITTER.
" Humanised milk " properly prepared by the regular
Directions No. i will not taste bitter ; the milk may
become bitter if it is too slowly heated to the boiling
as for instance, over a low fire. To avoid bitterness, in
Directions No. 2, it is simply necessary to reduce time in
water bath and to boil quickly.
114
In preparing the milk for cases of cholera infanturrt
and cases of exceedingly feeble digestion, it is often
desirable to digest the milk thirty minutes or so before
boiling it. This milk (Directions No. 2) may taste bitter
because of the very complete digestion of the caseine ;
but it is seldom refused by the infant, and if so, it may be
sweetened with milk sugar, which may be bought of the
druggist.
MILK CURDLED WHEN BOILED.
If a fine, granular curd appears in the " humanised
milk " when it is mixed and boiled according to directions,
it is because the milk is stale, or is too rich, or has not
been mixed with the full amount of water. If the milk is
fresh and is fit for use and has been properly diluted,
it will not curd.
We find that people are apt to leave out the proper
amount of water, because they think it is " too much."
THE USE OF CONDENSED MILK WITH
PEPTOGENIC MILK POWDER.
Milk deprived of a definite proportion of water by
evaporation, should theoretically become again like cows'
milk in composition, by the addition of water. But in prac-
tice the condensed milks of commerce do not meet these
anticipations. They cannot replace fresh whole milk as a
basis for " humanised milk." We find no reason to recom-
mend condensed milk when ordinary fresh milk is obtain-
able. Sweetened condensed milk should never be used :
115
it contains a large amount of cane sugar. The best con-
densed milk is usually not more than four times the
strength of pure milk.
If it is absolutely necessary to use condensed milk, one
part of pure unsweetened milk should be first mixed with
from two and a half to three parts of water, and may
then be presumed to be equivalent to cows' milk. Then
to 8 ounces of this mixture add 8 ounces of water and the
cream and Peptogenic Milk Powder in the usual manner.
In other words, we first require to dilute pure, unsweetened
condensed milk with about 7 parts of water, and to each
pint of this diluted milk should be added 4 tablespoonfuls
of cream and one large measure of the Peptogenic
Powder and treated in the usual manner.
STERILISED MILK.
Sterilised milk has recently attracted much attention
as a food for infants and as the basis of a food.
The sterilisation of milk has been advocated for the
following reasons, viz. : That milk in the udder contains
no germs ; that the suckling is presumed to receive from
a healthy source germless milk.
But normal sterile milk and sterilised milk differ in very
significant particulars the first is a product of nature, the
other prepared by prolonged subjection to boiling under
pressure.
Presuming that the process of sterilisation has been
successfully conducted, and presuming that no other
change has been produced by the sterilisation, theoretically
sterilised milk precisely resembles pure, germless cows'
milk.
116
But it is important to investigate the effects really pro-
duced upon cows' milk by the process of sterilisation, by
boiling milk in a flask excluded from air for 30 to 45
minutes.
As a matter of fact, important changes are produced
in the milk by this treatment. It is found that the
amount of coagulable albumen is increased, that the milk
is altered in its properties, and in its behavior and that
these changes altogether indicate that milk is rendered
more indigestible by sterilisation. The result of expert
chemical investigation of sterilised milk at the present
time may be said to be decidedly unfavorable to it as a
substitute for breast milk.
By sterilisation, the ratio or sum of nutritive constitu-
ents of milk is not changed ; its constituents are not
in any degree brought to a greater resemblance to those
of human milk.
Having, during the past few years, made careful and
repeated examinations of sterilised milk, and with very
considerable opportunities of becoming acquainted with
the results of its practical use as a food for infants, we
are unable to recommend sterilised milk. In fact, we have
felt constrained to advise our correspondents against its
use. One of the characteristic experiences reported has
been that sterilised milk often proves incapable of afford-
ing adequate nourishment, especially for infants with im-
paired digestion. Such infants, although frequently fed
with sterilised milk and in ample quantity, do not thrive,
and evince a constant craving for food. Furthermore,
the process for the use of Peptogenic Milk Powder, in
which we recommend that the milk be brought simply to
the boiling point, practically renders the milk sterile, free
from germs and entirely suitable for the food of an infant
117
for the length of time in which it is required, twenty-four
hours or more. Even a much lower temperature, 160 to
170 F., is perfectly effective for all practical purposes;
it kills the germs and kills the digestive ferment and con-
sequently checks digestion. This temperature was pro-
posed by Pasteur for the destruction of germs and the
preservation of foods, and the process, as practically
employed, is known as Pasteurisation. We have found
that milk so prepared with the Peptogenic Powder and
" Pasteurisation " will keep for 24 hours or more without
change, simply corked in an ordinary bottle. We have
very often had occasion to recommend this method as a
substitute for sterilised milk, and with perfect success.
There remains consequently no necessity whatever for
submitting milk to the sterilising process. In this opinion,
we believe that we have the concurrence of all experts,
both chemists and physicians, who have given careful in-
vestigation to this subject.
Average of An-
alyses 80
Samples of
Woman' s Milk.
118
HOBOKEN, N. J., June 14, 1884.
Water. Fat. Milk Sugar. Albuminoids. Ash.
86.73 4 I 3 6 -94 a. 0.2
Analysis \
"Humanised I
Milk" as made > 86.2 4.5 7. 2. 0.3
*uith Peptogenic^
Milk Powder. )
April ist, 1891.
Messrs. FAIRCHILD BROS. & FOSTER.
DEAR SIRS:
It is now some seven years since I made my
original report to you, in which I stated that I found the
Peptogenic Milk Powder to yield a " humanised milk,
which in taste, physical characteristics and chemical con-
stitution approaches very closely to woman's milk."
During this time, I have at frequent intervals analysed
the humanised milk as prepared with the Peptogenic
Powder ; have made many analyses of milk and of " infant
foods," and have studied the various methods of treating
milk for the artificial feeding of infants. As a result of
this experience, I feel confirmed in the conviction that the
Peptogenic Milk Powder with the method given is the
most exact, natural and practical means at present known
of rendering cows' milk suitable as a comprehensive
substitute for woman's milk.
Yours truly,
ALBERT R. LEEDS, PH.D.
Professor of Chemistry, Stevens Institute of Technology,
Hoboken, N. J.
119
PRACTICAL RECIPES
FOR
PEPTONISED FOODS FOR THE SICK,
MILK, GRUEL, BEEF, OYSTERS, JELLIES,
PUNCHES, ETC.,
BY THE FAIRCHILD PROCESS.
These recipes are designed to facilitate the preparation
of peptonised milk and other artificially digested foods.
Their preparation requires only the simplest culinary uten-
sils, and no more care or skill than that expended in mak-
ing the ordinary foods for the sick, so long in vogue.
Of their infinite superiority, not only as material for
nutrition, but in adaptability for digestion by the sick, it is
scarcely necessary to speak.
Peptonised Foods are the chief reliance of the medical
profession, both in private and hospital practice, for the
feeding of the sick. And it is greatly to be hoped that
the very fallacious ideas prevalent among the laity as to
what constitutes a food for the sick, will, in spite of
tradition and habit, give way to the more salutary and
enlightened views now reached in the progress of medical
science.
The subject of nutrition is now recognised to be of
first importance in the treatment of disease. The sick re-
quire veritable food and digestible food. There are no
" active principles " of food which can be extracted like
alkaloids from drugs. By the Fairchild peptonising pro-
cess foods which are found adequate for the nourishment
of the healthy and vigorous may be adjusted to the func-
tions of digestion enfeebled by chronic ailments, or wholly
interrupted by acute diseases, fevers, etc.
120
THE NUTRITIVE VALUE OF MILK AS COMPARED
WITH BEEF TEA, EXTRACTS OF BEEF, ETC.
Milk contains sugar ready formed for absorption ; fat in a condition
perfectly adapted for assimilation ; mineral substances essential to nutri-
tion of the bony structure ; and a due proportion of albumen, or flesh form-
ing element caseine.
One pint of milk contains over two ounces of actual dry, solid nutri-
tious substance.
" Beside the trifling amount of proteid material, and the fat (which lat-
" ter is guarded against with great care) the beef tea then only contains
" the salts of the muscle, the hematin and allied pigments, traces of
" sugar perhaps, some lactic acid, and the nitrogenous extractives, creatin
' ' and its congeners.
' ' As the original half pound of muscle will contain but forty to sixty
4 ' grains of salt, and ten to twelve of nitrogenous waste products, the
" beef tea certainly contains no more."
PROF. BAUMGARTEN, M.D.
" The valuation by most persons outside the medical profession, and
" by many within it, of beef tea or its analogues, the various solutions,
" most of the extracts and the expressed juice of meat, is a delusion and
" a snare which has led to the loss of many lives by starvation. The
" quantity of nutritive material in these preparations is insignificant or
" nil, and it is vastly important that they should be reckoned as of little
"or no value, except as conducive indirectly to nutrition by acting as
" stimulants for the secretion of the digestive fluids or as vehicles for
" the introduction of nutritive substances. Furthermore, it is to be con-
" sidered that water and pressure not only fail to extract the alimentary
" principles from meat but the excrementitious principles, or the prod-
" ucts of destructive assimilation, are thereby extracted. A few years
" ago, a German experimenter declared that he produced fatal toxaemia
" in dogs by feeding them with this popular article of diet."
DR. AUSTIN FLINT, SR.
So much then for this " strength " that so many people fancy they get
out of the beef, by the maceration in cold water, simmering and boiling.
How much less does the beef weigh than at the beginning ?
It is the flesh that gives value to the beef, wherein it differs from fari-
naceous foods. The flesh is not soluble in water. The water extracts
some of the salts of the beef, some coloring matter, extractives, etc., and
the now tasteless flesh is discarded. Beef tea, beef extract, is utterly
incapable of properly nourishing the body in -health or disease. Milk
does supply every element of nutrition, the elements that are found in
the most diverse forms of food.
121
RECIPES.
PEPTONISED MILK.
WARM PROCESS.
Into a clean quart bottle put the powder contained in one of the pep-
tonising tubes, and a teacupful of cold water, shake, then add a pint of
fresh cold milk and shake the mixture again. Place the bottle in water
so hot that the whole hand can be held in it without discomfort for a min-
ute (or at about 115 F.).
Keep the bottle there ten minutes.
At the end of that time put the bottle on ice to check further digestion
and keep the milk from spoiling.
Place the bottle directly in contact with the ice.
Ten minutes in the hot water-bath gives sufficient time for the
predigestion of the milk in ordinary cases.
If there is any evidence that the milk requires more digestion, it is only
necessary to let the milk stand a longer time in the hot water-bath.
COLD PROCESS.
Mix the peptonising powder in cold water and cold milk, as usual, and
immediately place the bottle on ice, without subjecting it to the water-
bath or any heat.
When needed pour out the required portion, and use in the same man-
ner as ordinary milk.
It is recommended to try the milk prepared by the COLD process, in those
cases in which food is not quickly rejected after ingestion, but in which the
digestive functions are impaired, or even practically suspended. It has
been found in many such cases that the peptonising principle exerts suf-
ficient action upon the milk in the stomach to insure its digestion and
proper assimilation. If the milk so prepared be not well borne, or any
evidence appear of its imperfect digestion, it should be sufficiently pre-
digested peptonised by the usual warm process.
Milk by the " cold process " is especially suited for dyspeptics and per-
sons who ordinarily find milk indigestible. This milk has no taste or
evidence of the presence of the peptonising agent.
PARTIALLY PEPTONISED MILK.
Put into a clean granite ware or porcelain lined saucepan the powder
contained in one of the Fairchild peptonising tubes, and a teacupful (gill)
of cold water ; stir well, then add a pint of fresh cold milk. Place the
122
saucepan on a hot range or gas stove and heat with constant stirring until
the mixture boils. The heat should be so applied as to make the milk boil
in" ten minutes. When cool, strain into a clean bottle, cork well and
keep in a cool place. When needed, shake the bottle, pour out the
required portion, and serve cold or hot as directed by the physician in
charge.
N. B. Milk thus prepared will not become bitter.
HOT PEPTONISED MILK, AS A BEVERAGE.
Into a clean quart bottle put the powder contained in one of the Pep-
tonising Tubes, and a teacupful of cold water, shake, then add a pint of
fresh cold milk and shake the mixture again. Place the bottle on ice un-
til the milk is required for use. When needed, pour the portion to be
used into a saucepan and heat as hot as can be agreeably sipped.
If required for immediate use, the peptonising powder, cold water and
cold milk may be thoroughly mixed in the saucepan and heated to the
proper temperature for drinking.
At this temperature (during the heating) the peptonising powder acts
with great rapidity, and in a few minutes a hot peptonised milk may be
prepared which will be sufficiently digested for the majority of cases.
Hot peptonised milk is the most grateful, nourishing and bracing bev-
erage for invalids, dyspeptics, diabetics and consumptives.
It is especially useful with breakfast, and at any time when suffering
from a sense of exhaustion with an intolerance for solid foods.
It is very acceptable to persons who require nourishment before sleep-
ing and may be used at the table instead of ordinary milk with tea 01
coffee.
EFFERVESCENT PEPTONISED MILK.
Put some finely cracked ice in a glass and then half fill it with cold
apollinaris, vichy, clysmic or carbonic water as preferred, then quickly
pour in the peptonised milk and drink during effervescence.
Peptonised milk may be made agreeable to many patients by serving
with a little grated nutmeg, sweetened, or flavored with a little brandy,
etc.
SPECIALLY PEPTONISED MILK.
FOR JELLIES, PUNCHES, ETC.
FOR ALL RECIPES WHERE THE MILK IS TO BE MIXED WITH FRUIT JUICES
OR ACIDS.
Mix the peptonising powder, water and milk, in a bottle, and place in
123
& hot water-bath exactly as directed in the warm process recipe. Not*
let the bottle remain in the hot water for one hour, then pour into a
saucepan and HEAT TO BOILING. This specially peptonised milk is now
ready for use in making jellies, etc. It may be immediately used if re-
quired hot, or set aside on ice for punches, etc.
In peptonising milk for all these recipes in which lemon juice or acid
is to be used, it is necessary to carry the process to the point at which
the milk will not curdle with acid. Hence the one hour digestion.
Do not fail to boil the milk immediately after the one hour in water-bath
in order to kill the peptonising ferment which would otherwise digest the
gelatine when added and thus prevent the milk from forming a jelly.
The bitter taste of the milk so peptonised, is entirely absent from the
jellies, punches, etc., and these foods containing milk in a completely
digested form are not only agreeable, but exceedingly assimilable.
PEPTONISED MILK JELLY.
First take about half a box of Cox's Gelatine and set it aside to soak in
a teacupful of cold water until needed.
Take one pint of hot "specially" peptonised milk and dissolve in it
about a quarter of a pound of sugar, or sufficient to taste, next add
the gelatine and stir until dissolved.
Pare one fresh lemon and one orange, and put the rinds into the hot
peptonised milk.
Squeeze the lemon and orange juice into a glass, strain, and iix it
with two or three tablespoonfuls of best St. Croix Rum, or brandy, etc.,
as may be preferred.
Lastly add the juices and the spirits with stirring.
Strain all through a colander and when cooled to a syrup consistency,
so as to be almost ready to " set," pour into tumblers or jelly moulds and
put in a cold place.
It is important not to pour the milk into the moulds until it is nearly
cool, otherwise it will separate in setting.
This jelly has a delicious flavor, is highly acceptable to invalids and
convalescents at the period when they tire of liquids and crave more sub-
stantial food.
Good St. Croix Rum is generally preferable to other spirits in making
jellies, punches, etc.
PEPTONISED MILK PUNCH.
Prepare a punch from peptonised in the same manner as from or-
1-24
dinary milk, using St. Croix or Jamaica Rum, Whiskey or Brandy as pre-
ferred, and served with grated nutmeg.
This is a good way :
Take a goblet about one-third full of fine crushed ice, pour on it a
tablespoonful of St. Croix- Rum, a dash of Curaroa, or other liquor that
is agreeable to the taste, then fill the glass with peptonised milk, stirring
well, sweeten to taste, grate a little nutmeg on top.
PEPTONISED MILK LEMONADE.
Take a goblet one third full of cracked ice, squeeze on it the juice of a
lemon, and dissolve sufficient sugar, then fill the glass with specially pep-
tonised milk, stirring well.
Make this lemonade of equal parts of peptonised milk and mineral
water, instead of milk alone, if you prefer, first pouring the water, lemon
juice, etc., on the ice, and then filling the glass with the milk.
This makes an effervescing punch that is very agreeable.
PEPTONISED MILK GRUEL.
Mix smoothly a heaping teaspoonful of wheat flour or arrowroot, with
half pint of cold water. Then heat with constant stirring until it has
boiled briskly for several minutes.
Mix with this hot gruel one pint of cold milk and strain into a small
pitcher or jar, and immediately add the contents of one "peptonising
tube," mix well. Let it stand in the hot water-bath, or warm place, for
20 minutes, then put in a clean quart bottle and place on ice
This milk gruel may be used in the same manner and for the same pur-
pose as plain peptonised milk.
The flavor of this milk gruel is very agreeable ; the taste of the pep-
tone being masked by the digested arrowroot or flour, the peptonising
powder digesting both the farinaceous matter and the milk.
PEPTONISED MILK WITH PORRIDGE.
To a dish of porridge of oatmeal, rice, hominy; etc., as prepared
for the table, add a sufficient quantity of hot or cold peptonised
milk.
It will aid in the digestion of farinaceous foods for young children, as
well as supplying the milk in a form especially adapted for children with
defective digestion.
125
PEPTONISED BEEF.
Take one-quarter pound finely minced, raw lean beef, or same weight
(of equal portions) of beef and chicken meat mixed.
Cold water, half a pint.
Cook over a gentle fire, stirring constantly until it has boiled a few
minutes.
Then pour off the liquor, for future use, and beat or rub the meat to a
paste, and put it into a clean fruit jar or bottle with half a pint of cold
water and the liquor poured from the meat.
Add
Extractum Pancreatis 4 measures (20 grains).
Soda Bicarb I measure (15 grains).
Shake all well together, and set aside in a warm place, at about no" to
115, for three hours, stirring or shaking occasionally ; then boil quickly.
It may then be strained, or clarified with white of egg, in usual man-
ner. Season to taste with salt and pepper.
For great majority of cases it will not be required to strain the pep-
ionised liquor, for the portion of meat remaining undissolved will have
been so softened and acted upon, by the pancreatic extract, that it will
be in very fine particles and diffused in an almost impalpable condition.
Thus in a form readily subject to digestion in the stomach.
FARINACEOUS materials may also be advantageously used in the prep-
aration of the peptonised soup, by simply boiling a sufficient quantity of
flour, arrowroot, etc., with a half portion of the water used in above re-
cipe, and mixing all together meat, gruel, Extractum Pancreatis and
Soda. The Extractum Pancreatis will, at the same time, digest both
starch and meat.
This has a more agreeable flavor than that made of meats alone.
Jelly also may be made of peptonised beef.
Be sure to boil the peptonised beef, after three hours in warm place,
otherwise the digestion will progress until it is spoiled.
PEPTONISED OYSTERS.
(Originally suggested by DR. N. A. RANDOLPH.)
Take half a dozen large oysters with their juice and half a pint of
water. Heat in a saucepan until they have boiled briskly for a few min-
utes. Pour off the broth and set aside.
Mince the oysters finely, and reduce them to a paste with a potato
masher in a wooden bowl.
126
Now put the oysters in a glass jar with the broth which has been set
aside and add
Extractum Pancreatis 3 measures (15 grains).
Soda Bicarb i measure (15 grains).
Let the jar stand in hot water or a warm place where the temperature
is not above 115 degrees, for one and a half hours.
Then pour into a saucepan and add half a pint of milk.
Heat over the fire slowly to boiling point.
Flavor with salt and pepper, or condiments, to taste and serve hot.
There will be found but very small bits of the oysters undigested, and
these may be strained out or rejected in eating the soup, but will not be
unacceptable to the stomach, except in very rare cases.
The milk will be sufficiently digested during the few minutes which
will elapse before the mixture boils, if heated gradually.
Be sure to boil the peptonised oysters to finish the process.
JUNKET, OR CURDS AND WHEY,
WITH
FAIRCHILD'S ESSENCE OF PEPSINE.
Junket, the soft jelly-like curded milk as prepared with Fairchild's Es-
sence of Pepsine, is a delicious delicacy for invalids, convalescents and
dyspeptics. It is especially acceptable and appropriate in convalescence,
when the liquid foods have become tiresome and repulsive. This
junket gives the grateful and wholesome sense of substance, whilst it
does not oppress the digestion.
Take half a pint of fresh milk heated lukewarm, add one teaspoonful
of Essence of Pepsine, and stir just enough to mix. Pour into cus-
tard cups, let it stand till firmly curded ; may be served plain or with
sugar and grated nutmeg.
AS A'DESSERT, junket when served with cream, sweetened and flav-
ored with nutmeg or wine, is far more toothsome than more elaborate
dishes and has the merit of requiring but a few minutes and no special
skill in its preparation.
JUNKET OF MILK AND EGG,
MADE WITH
FAIRCHILD'S ESSENCE OF PEPSINE.
Beat one egg to a froth and sweeten with two teaspoonfuls of white
sugar, add this to half a pint of warm milk ; then add one teaspoonful of
121
Essence of Pepsine, let it stand till curded. This milk and egg junket
is a highly nutritious and agreeable food.
WHEY
MADE WITH
FAIRCHILD'S ESSENCE OF PEPSINE.
Take half a pint of fresh milk heated lukewarm, (about 115 F) add one
teaspoonful of Essence of Pepsine and stir just enough to mix ; when
firmly curded, beat up with a fork until the curd is finely divided, now
strain and the Whey is ready for use. Whey contains in solution the
soluble albuminoids, the sugar and the salts (mineral constituents) of the
milk and a small portion of fat.
It is therefore a nutritious fluid food peculiarly useful in many ail-
ments and always valuable as a means of variety in diet for the sick.
It is frequently resorted to as a food for infants to tide over periods of
indigestion, summer complaints, etc. Whey is in some cases indicated
with wine or brandy and may then be mixed with the spirit.
Whey, or curds and whey, as made with Fairchild's Essence of Pepsine
is superior to that made with liquid rennet, because of the peptic as well
as the curdling activity of the Essence, and is moreover far more acceptable
to the stomach. (For use of Whey in Cholera Infantum see pages 96-97.)
THE PARTIAL DIGESTION OF FARINACEOUS FOODS
AT THE TABLE.
To a saucer of well-cooked porridge of oatmeal, wheaten grits or rice,
etc., as warm as proper to be eaten, add one to two teaspoonfuls Dias-
lasic Essence of Pancreas. Stir for a few minutes until thoroughly mixed,
before eating it.
The Diastasic Essence must not be added to very hot food, for if hot-
ter than can be agreeably borne by the mouth, the digestive principle
will be destroyed.
Extractum Pancreatis may be added in exactly the same manner, using
a measure full of the dry Extractum Pancreatis instead of the teaspoon-
ful of Diastasic Essence. The powder imparts no taste or odor to the
food and is handy to use. It further contains every digestive principle
those capable of digesting milk, fat, etc., and thus will aid in the diges-
tion of the ordinary foods taken at the same meal with the porridge.
PEPSIN IN SCALES,
PEPSIN IN POWDER,
ESSENCE OF PEPSINE,
SACCHARATED PEPSIN,
GLYCERINUM PEPTICUM,
EXTRACTUM PANCREATIS,
DIASTASIC ESSENCE OF PANCREAS,
PEPTONISING TUBES,
PEPTOGENIC MILK POWDER,
PANOPEPTON,
PANCREATIC TABLETS,
COMPOUND PANCREATIC TABLETS,
PEPSIN TABLETS,
PEPSIN AND EXTRACT PANCREATIS TABLETS,
PEPSIN AND BISMUTH TABLETS,
PEPSIN, BISMUTH AND PANCREATIC TABLETS,
PEPSIN, BISMUTH AND Nux VOM. TABLETS,
PEPSIN AND DIASTASE TABLETS,
PEPTONATE OF IRON TABLETS,
COMPOUND Ox GALL TABLETS,
FERROGLOBIN TABLETS,
TRYPSIN,
UC SOUTHERN REGIONAL LIBRARY FACILITY