feeble powers of digestion, food should always be predigested. Suppositories of peptonized meat are frequently used for this purpose.

Pancreatinum-Pancreatini-Pancreatin. U. S. P.

Origin.-A mixture of the enzymes naturally existing in the pancreas of warm-blooded animals, usually obtained from the fresh pancreas of the hog.

Description and Properties.-A yellowish, yellowish-white, or grayish amorphous powder, odorless, or having a faint, peculiar, not unpleasant odor, and a somewhat meat-like taste. Slowly and almost completely soluble in water, insoluble in alcohol.

Pancreatin digests albuminoids and all proteid substances, and converts starch into sugar. Prolonged contact with mineral acids renders it inert.

Dose.-10-20 gr. (0.6-1.2 Gm.).

Antagonists and Incompatibles.-Strong mineral acids.
Synergists.-Weak alkalies.

Physiological Action.-The four ferments which it contains render it capable, in either weak alkaline or acid media, of digesting nitrogenous substances; emulsifying fats and oils, and resolving them into fatty acids and glycerin; converting starch into sugar; and curdling milk.

Therapeutics.-Like pepsin, it is used as an artificial agent in certain disorders of digestion.

Administration.-It may be given dry, in powder, capsules, or compressed pills, or in solution. It should be administered in combination with an alkali, as the activity of pancreatin is destroyed by acids, and should be given ordinarily from two to four hours after meals, when the chyme has entered the intestine. It may also be administered immediately after eating or with the food, since there is an interval of from fifteen minutes to half an hour after the ingestion of food before the stomach-contents are rendered sufficiently acid by the gastric juice to interfere with the activity of the pancreatin.

For rectal nourishment pancreatin is preferable to pepsin, because of its superior action in predigesting food.

Papain, Papold, or Papayotin.

Origin. The inspissated juice of the unripe fruit of Carica Papaya.

Description and Properties.-A whitish, slightly astringent powder, soluble in water.

Dose.-1-8 gr. (0.06–0.5 Gm.).

Antagonists and Incompatibles.-Tannic and gallic acids. Lead salts and alcohol are incompatible with papain.

Synergists. The digestive ferments.

Physiological Action.-In this it resembles pepsin, though differing from the latter, as well as from pancreatin, in that it is equally active in neutral, alkaline, or acid media. It converts proteids into soluble peptones, and acts as a stimulant to the gastric glands. It converts starch into maltose, and upon false membranes acts more energetically than pepsin. It dissolves intestinal worms. Therapeutics.-Externally.-The uses of papain are more manifold than those of the digestive ferments previously mentioned. Like pepsin, it has been successfully employed to dissolve false membrane in diphtheria and croup. The juice of pineapple, which possesses a ferment (bromelin) similar to that of papain, is a valuable domestic remedy in these diseases. Papain has been used with some benefit in indurated eczema and in syphilitic ulcerations of the tongue. It has been highly recommended by Johnston as a solvent of cerumen: 15 drops (1.0 Cc.) of a solution of 20 grains to 1 oz. (1.2 Gm-30 Cc.) of distilled water are dropped into the outer meatus, and the parts syringed an hour afterward with a solution of boric acid.

Internally, papain may be used for the same purposes as pepsin and pancreatin; yet, while theoretically superior, it is practically inferior to them, fortunately not having supplanted them in actual practice.

Administration.-When used to aid digestion, papain should be given after meals, either in powders, capsules, compressed tablets, or aqueous solution freshly prepared.

GROUP II.-FATS AND OILS.

Oleum Morrhuæ-Olei Mõrrhuæ-Cod Liver Oil.

U.S. P.

Origin. A fixed oil obtained from the fresh livers of Gadus Morrhua L. and other species of Gadus.

Description and Properties.-A pale-yellow, thin, oily liquid, having a peculiar, slightly fishy, but not rancid odor, and a bland, slightly fishy taste. Specific gravity 0.920 to 0.925 at 15° C. (59° F.). Scarcely soluble in alcohol, but readily soluble in ether,

chloroform, or carbon disulphide, also in 2.5 parts of acetic ether. It contains several glycerides, the principal one being olein, traces of iodine, bromine, chlorine, biliary salts, phosphoric and sulphuric acids, a peculiar principle (gaduin), and several alkaloids.

MORRHUOL, a name given by Chapoteaut to a mixture of the various alkaloids and important principles of cod liver oil, occurs as an amber-brown, bitter, aromatic liquid.

Dose.-1-4 fluidrachms (3.8–15 Cc.).

Physiological Action.-Externally and Locally.—It possesses emollient properties, and may be applied to the skin and mucous membranes without causing irritation. It slightly reduces temperature in fever when applied to the body.

Internally.-Fat is a normal and necessary constituent of the body. It is the fuel used to supply force, and those tissues and organs which are the most energetic require the most fat. Consequently, nerves, muscles, and glands are more abundantly furnished with fat than cartilage, and in cases of starvation those structures demanding the greater supply must have it, at the expense of the less highly organized and active tissues-as is seen in the great emaciation preceding the decline of mental powers. The blood contains about one-half of 1 per cent. of fat; the muscles, 3 per cent.; the brain, 8 per cent.; and the nerves 22 per cent. In order, therefore, that the various cells of the body may possess sufficient vitality to withstand by physiological resistance the encroachments of disease and the invasion of pathogenic micro-organisms, this equilibrium must be maintained. Yet this necessary food, fat, is more frequently deficient than any other, from the difficulty either of obtaining a supply or of digesting and assimilating it.

Dr. Hughes Bennett was near the truth in observing that "the main causes of tuberculosis are the dearness of butter and the abundance of pastry-cooks," intimating that the poor and underfed are unable to obtain sufficient fat, while the digestion of the wealthy class is deranged by pastries, so that they are unable to assimilate a proper amount of fat.

Dr. Brunton cites the case of a barrister who before pleading a case invariably took a full dose of cod liver oil, believing that it rendered his mind more active.

Before oils or fats can enter the various cells and act as food, and consequently a source of power, they must be digested and assimilated by the system. The value of an oil is based upon-(1)

Its rate of absorption; (2) its rate of oxidation; (3) its agreeable

taste.

Cod liver oil, while to many persons repugnant in taste, is more readily absorbed and oxidized than any other fat. It has already been prepared by the liver, and therefore partly elaborated, and, owing to the biliary salts which it contains, it passes more readily through animal membranes. Moreover, Naumann has shown that cod liver oil is more easily oxidized than any other oil, rendering this substance almost an ideal ready-made food. Its actions upon the several systems are here considered.

Digestive System.-Large doses disturb the stomach and may even occasion vomiting, but in medicinal doses alone, or in the form of an emulsion, it may be taken usually without discomfort, in some cases even increasing the appetite. In the stomach codliver oil is unaffected, but in the intestines it meets the pancreatic juice, which resolves a portion of it into glycerin and fatty acids, the latter combining with the alkalies of the bile and the intestinal juice to form soaps, while the remaining, and larger, portion is emulsionized by the alkaline secretions of the intestines.

Circulatory System.-The number of red corpuscles is increased and the quality of the blood is greatly improved.

Nervous System.-This shares with the other tissues of the body the general amelioration, the drug being a food and tonic to the brain and nerves.

Respiratory System.-No special action is noticeable other than the natural improvement in the respiratory power incidental to better blood and an increased functional activity of the nerves and muscles.

Absorption and Elimination.-Cod liver oil can be absorbed only after it enters the intestines. The glycerin and fatty acids formed by the pancreatic juice are readily absorbed by the mucous membrane, together with the soaps produced by the action of the bile and the intestinal juice.

The oil remaining, as has been stated, is emulsionized-that is, it is subdivided into minute globules each enclosed in an envelope composed of alkaline albuminate and soap, which has a great affinity for the mucous membrane and carries the oil through the columnar epithelium of the intestinal villi into the lymph-spaces. The osmosis inward of the oil-emulsion is rendered still easier by the action of the bile with which the mucous membrane is bathed.

Oils and fats which are absorbed and not needed for cell-food are deposited beneath the skin as subcutaneous fat, serving as a protection against external cold as well as a reserve supply in case the economy needs more fat than can be taken into the system and assimilated. The weight, therefore, is usually greatly increased under the administration of cod liver oil.

It will be seen that much of the oil taken into the system is oxidized, being subsequently excreted as carbonic acid and water. Temperature. When taken internally the temperature is unaffected, but, as has been observed, when applied to the epidermis the bodily heat is reduced.

Untoward Action. In addition to disturbances of digestion sometimes occasioned by moderate doses, cod liver oil at times produces a vesicular eczema which may spread over the entire body. This eruption is probably caused by the volatile fatty acids which the oil contains.

Poisoning-Cod liver oil possesses no poisonous action.

Therapeutics.-Externally and Locally.-Cod liver oil is much. used by dermatologists in diseases of the skin, being especially serviceable in softening the crusts of eczema. It has been applied to the skin to allay irritation and for the reduction of temperature in the exanthemata. In cases of marasmus and rachitis, and in wasting diseases generally, it is a valuable remedy to sustain the vital energy and improve nutrition, the oil being given in the form of baths.

Daily inunctions are beneficial in chronic scaly skin diseases, while a local application to the chest has seemed at times to influence favorably the course of pertussis. Local applications have also been adopted empirically, and with satisfactory results, in chronic rheumatism and rheumatoid arthritis.

Internally.-For two or three centuries cod liver oil has been used both externally and internally for chronic rheumatism, but it is only since 1841 that it has been employed in the treatment of tuberculosis. While to-day it does not receive the enthusiastic support which attended its introduction in the latter disease, it is nevertheless a standard and highly efficacious remedy in the various forms of the disorder. It is equally valuable in scrofulous affections, and even more potent in rachitis. Chronic bronchitis is perhaps more frequently relieved by its use than by any other internal remedy. Diseases resulting in anemia are usually more benefited by cod liver oil than by other remedial agents. Chronic arthritis,