Test tube experiments show that pepsin hydrolyzes proteins in acid solutions; that pancreatin digests protein in alkaline liquids, and that diastase converts starch into sugar. Based on these facts, it was assumed that these ferments would aid digestion. This assumption was correct if limited to certain cases of dyspepsia in which it can be shown that certain ferments are absent or deficient. But this limitation was not realized or remembered; on the contrary, the indiscriminate use of digesting ferments in all kinds of cases of indigestion became widespread and still continues, although to a less extent. Herein lies the great disappointment that has followed the use of these ferments.
More recently hormones were discovered, and while their importance has not been fully worked out, it has been assumed that they are responsible for the secretion of digestive ferments, and that in their absence this secretion fails. Without waiting for proof of this assumption, that is, that digestive failure is due to lack of hormones, proprietary medicine promoters are already placing on the market various secretion specialties.
As an example of this new class of specialties and of the unfounded claims made for them, your referee presents the following report on Secretogen Elixir and Secretogen Tablets offered to physicians by the G. W. Carnrick Company.
Secretogen Elixir is said to contain pancreatic secretin obtained from the duodenum with 1⁄10 of 1 per cent. of hydrochloric acid. Secretogen Tablets are said to be prepared from pure secretin and succus entericus obtained from the epithelial cells of the duodenum. The claims for Secretogen are based on the physiologic action of secretin as described by various observers. To determine whether these claims are justified it becomes necessary to review the evidence advanced to prove that secretin stimulates the digestive glands.
Secretin is a hormone, a chemical substance produced by the action of hydrochloric acid on a previously formed substance, “prosecretin,” contained in the cells of the intestinal mucous membrane, especially of the duodenum. Secretin is absorbed by the blood and carried to the pancreas, liver and intestinal mucosa, which are thereby stimulated to produce their characteristic secretions, namely, bile, pancreatic juice and succus entericus. When secretin is injected into the blood, it causes an increase in the flow of these secretions. Some observers have claimed that secretin is absent in cases of diabetes in which the pancreas is still found normal. Wentworth[80] reported several cases of marasmus in which he found no evidence of prosecretin. This deficiency, he believes, is the cause of this disease.
The Carnrick Company, adopting the foregoing views, namely, that secretin is necessary to secure the normal action of pancreas, liver and intestine, as proved, placed on the market their specialty “Secretogen,” to take the place of the missing secretin.
The foregoing conclusion cannot, however, be sustained. There are numerous cases in which no hydrochloric acid is produced in the stomach and hence—as it is produced by the action of hydrochloric acid—no secretin can be produced in the intestine. Yet in these cases the pancreatic juice and bile are secreted in normal amounts and digestion goes on normally after the food leaves the stomach. In such cases the pancreas and liver must be stimulated to secretion by some other mechanism than secretin.
The proof that the absence of secretin is characteristic of diabetes or of marasmus is not yet available. Sweet and Pemberton[81] found that many circumstances interfered with the extraction of secretin, so that the mere failure to obtain it in a given case is not proof of its absence, unless the various inhibiting influences are given due consideration. The conclusions reached by these authors are that “the evidence so far adduced that secretin is absent in some varieties (of diabetes) does not seem conclusive,” and that “the specific absence or deficiency of secretin in marasmus seems to remain as yet unproven.”
The favorable reports of Moore[82] in regard to the use of secretin in diabetes are not confirmed by the experience of Foster[83] in five cases, or by the case reported by Dakin and Ransom.[84]
In regard to the use of secretin in intestinal disorders, the G. W. Carnrick Company refers to an article by J. W. Beveridge.[85] An examination of this article shows it to be unscientific and uncritical. The author presents four cases to “demonstrate the peculiar potency exercised by secretin.” Of the first he says: