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