Successful Treatment of DIABETES MELLITUS A disease so rich in complications of all kinds as diabetes necessarily presents a difficult problem in the way of treat- ment. So many factors may enter into the situation that it is entirely beside the mark for any claim to be made that there is a "specific" for the disease. As Cammidge says: "No disease necessitates such a careful balancing of all the details of each separate case. The metabolic powers of the patient, the condition of his alimentary tract, the functional capacity of his pancreas, the state of his nervous system) and his environment must be severally and col- lectively considered in forming a conclusion as to the advice that should be given him for his conduct in the future." Now a remedy may have much to commend it from a theoretic standpoint and yet may fail when put to actual clinical test, so the question asked by a busy practitioner: "Does it give results?" probably reveals the attitude of the professional mind toward a remedy for diabetes, and makes clinical reports of more than ordinary value. Reports from hundreds of physicians indicate that Tryp- sogen is the most rational and the most successful treat- ment for diabetes mellitus ever devised. The relationship of diabetes to disease or functional incapacity of the islands of Langerhans of the pancreas, which has been so thor- oughly demonstrated, makes Trypsogen a logical remedy, besides which the profound influence of Trypsogen upon digestion and assimilation and its inhibitory effect upon the formation of toxic substances in the intestinal tract emphatically justifies its use in the treatment of diabetes. 2 SUCCESSFUL TREATMENT Recent researches by Weichselbaum and MacCallum have tended to confirm the importance of the part played by the internal secretion of the pancreas in carbohydrate metabol- ism. In examination of the pancreas in 183 cases of dia- betes, Weichselbaum found in every one distinct and characteristic lesions in the islands of Langerhans. Com- plementary to this, in an even larger number of control cases representing many different diseases, no corresponding changes .were found. In an editorial of December 23, 1911, the Journal of the American Medical Association, commenting on his work says: "In view of the constancy of his findings, the abundance of controls and the repeated observation that even extreme atrophy of the acinous structures of the pancreas is not associated with diabetes when the islands are intact, Weichselbaum's work would seem to be almost conclusive in establishing the islet theory of the etiology of diabetes." "The influence of internal secretions upon carbohydrate metabolism admits of no question." Garrod. Lancet, March 9, 1912. "There can be no doubt that the cause of the non-utilisa- tion of dextrose is the absence from the organism of some internal secretion of the pancreas." Leonard Hill, "Recent Advances in Physiology and Bio-Chemistry." The first evidences of improvement following the admin- istration of Trypsogen are a marked increase in weight and strength, and a decrease in the twenty-four-hour volume of urine. The percentage of sugar may not decline much at first but if the decrease in volume is noted it will be seen that the amount of sugar lost has been materially reduced, for if the volume has decreased one-half and the per cent, of sugar remains the same, then only one-half as much sugar is being excreted. Trypsogen has been on the market for over seven years, and we have had the opportunity of observing a great many cases, and it has been noted that the physicians who use the Trypsogen treatment faithfully, push the dosage OF DIABETES MELLITUS 3 and stick to it, usually have very fine reports to make of its success, whereas those who doubt its efficacy and are not so thorough and persistent, but pin their faith mostly to collateral treatment such as a starch-free dietary, the giving of opium and its alkaloids, etc., are not so successful. Should the response to Trypsogen not be as prompt as expected it is well to look for underlying complications,- syphilis, etc.,-which may require appropriate treatment to render Trypsogen effective. DOSAGE OF TRYPSOGEN IN DIABETES, AND SUGGESTIONS AS TO DIET. As the digestive secretions are deficient in diabetes and the pancreas overworked and in a state of fatigue, it is important to begin the Trypsogen treatment with as long a period of fasting as conditions permit, particularly in cases without marked emaciation and weakness. This should be accompanied by thorough purging, preferably with saline eliminants, to rid the organism of auto-toxic material. This treatment allows the digestive glands to rest and tends toward recovery of their functions. Two Trypsogen Tablets should be given four times a day during this period of fasting, after which the dosage should be increased to three Tablets after each meal, then to four, and so on, until the patient is taking at least five to seven Trypsogen Tablets after each meal. If after four weeks of treatment as outlined above, there has not been a marked improvement in symptoms, another fasting period with purging should be prescribed during which two Tryp- sogen Tablets four times a day should be administered as before, after which the dosage should be increased to from seven to eight Tablets or more, after each meal. After there has been a decided improvement in symptoms the dosage may be reduced gradually as improvement seems to warrant. 4 SUCCESSFUL TREATMENT Diet : Following the fasting the total amount of food consumed should be reduced to correspond with the patient's power of digestion and assimilation. Meat should be omitted at first, and only a minimum amount of meat and other nitrogenous food allowed thereafter. It is now known that the same amount of sugar is obtained by the organism from meat as from starches. The by-products of proteins, particularly the acids, are dangerous to the organism, hence the amount of meat and other nitrogenous food consumed should be reduced to a minimum. Gigon, Falta and others have shown that a glycosuria persisting under a carbohydrate-free diet may disappear if the protein is cut down. In diabetes the appetite is often abnormal, because the body is losing the needed sugar, hence it is important that the food should not be of a high nutritive proteid value. One of the chief reasons why oat- meal is so well tolerated and so successful is because a large amount of water is incorporated in the process of cooking it, so that the patient cannot overeat. Another reason for the success of the "oatmeal cure", "rice cure", "potato cure", "bread cure", etc., is that a patient limited to one kind of food will not eat as much as when taking a variety. Some authorities say that the benefit from these "diet cures" comes mostly from the exclusion of meat. It is generally considered wise also to omit cane-sugar. Fats should be used in moderation, as in excess they also pro- duce acids dangerous to a diabetic and tend to derange di- gestion. They should be eaten with starchy foods. Green vegetables are desirable as they contain a small proportion of nutriment and can be eaten more freely to satisfy hunger. They also contain the food salts in the most assimilable form and in the purest condition. Further, owing to the large amount of excrementitious material they contain they are valuable in aiding elimination. Thorough cooking and thorough mastication of all vegetable and starchy foods is very important. Oatmeal and other breakfast cereals OF DIABETES MELLITUS 5 should be cooked at least six hours in a double steam- cooker. Where there are great thirst and polyuria, the disappear- ance of sugar may be promoted by washing out the stomach. This diminishes the thirst and polyuria and often results in a decreased excretion of sugar.-J. P. Sawyer. It is important that all the organs of elimination, espe- cially the bowels, should be kept active and free. The neces- sity for large Trypsogen dosage and persistent, thorough treatment in diabetes and allied conditions is apparent when we consider that malnutrition has usually existed for a long time before the clinical urinary symptoms are in evidence. This necessity for large dosage is emphasized when we re- call that the pancreas, whose enzymes are deficient in this disease, secretes normally into the duodenum at least 27 ozs. of its digestive juice in twenty-four hours, or 9 ozs. to each meal (Robson & Cammidge), and presumably its internal secretions are proportionally large, hence if we would supplement a deficiency of these secretions we must prescribe large dosage. Instructions to the patient should be definite and impera- tive as to dosage and time of taking, and a bottle of 500 or 1,000 should be prescribed in preference to a smaller size. The patient then does not expect improvement before he has taken the entire bottle. New York, June 3, 1911. "Male, aged about 50, Contractor and Builder: Began treatment for diabetes mellitus in 1907. His general health was very much impaired and he was unable to at- tend to business. I put him on Trypsogen from 2 tablets t.i.d. to 6 maximum. There was marked improvement in general health from the start, and the volume of urine be- came nearly normal; sugar greatly decreased. "At the present time there is only a slight trace of sugar in the urine; his general health is very good, and the patient is able to attend to business." 6 SUCCESSFUL TREATMENT New York, April 2, 1912. The following is from a man of established reputation, the assistant physician and physiological chemist in a large New York City hospital: "I have used Trypsogen in perhaps two dozen cases of diabetes, and while skeptical at the start, have to confess that its use was followed by benign results in every case. I prescribed Trypsogen with gold and arsenic in cases that were inclined to be anemic, and in order to satisfy myself that the improvement following its use was not entirely due to the gold and arsenic it contained, put the other cases on Trypsogen without gold and arsenic, and I obtained good results in both series of cases. While it certainly causes an increase of carbohydrate tolerance, I am not pre- pared to state just how it acts, but I am confident that Trypsogen is of great value in the treatment of diabetes mellitus. I always prescribe the 500-size, as a smaller num- ber is useless in providing a clinical estimate of its value. "Were I in Germany I would have no hesitation in pub- lishing my findings over my own signature, but for obvious reasons could not do this in the United States, so kindly withhold my name." New York, March 1, 1912. "In response to your request for a further report on the case of diabetes mellitus treated with Trypsogen, I would say that on May 12, 1911, I reported to you that three years previous I placed this patient, a woman aged 55 years, upon Trypsogen; maximum dose four tablets t.i.d. The sugar in the urine at that time was about 5 per cent. "Although the sugar has not entirely disappeared, the volume of urine is very nearly normal. Her weight has increased and general health has very much improved. A liberal diet, barring only sugar and pastry, was allowed in this case. The patient is still doing well at the present time." OF DIABETES MELLITUS 7 Dr. formerly practicing in Pittsburg, Pa., reports the successful use of Trypsogen in his own case as follows: "Three years ago I was in very bad shape, with diabetes, passing 2% cpiarts urine in 24 hours, legs showed signs of diabetic gangrene. I went to Philadelphia for consultation with Dr. who made a careful examination and found 15.2 grs. sugar to the ounce. My weight normally around 225 pounds had gone down to 162 pounds. Dr. said if you were a young man I would give you three to six months to live. I was then 57 years old. He advised me to stop practice and treat myself thoroughly and said, 'There is only one thing for diabetes-Trypsogen'. My brother-in- law gave the same advice, also a cousin; both physicians. "I took Trypsogen two years when sugar was reduced to 1 gr. instead of 15 grs. to the ounce and my weight was 190 instead of 162. I have held my own during past year, have resumed my practice and feel like a buck. I could never take more than eight tablets at a dose." Bloomsburg, Pa., May 9, 1912. "I have used Trypsogen in several cases diabetes with most excellent results, and in last case with remarkable results. "Patient-male-age 25 years, lives in country about 30 miles from here. When I first saw him did not expect him to pull through. Acetone odor very pronounced on breath and in urine. Had a voracious appetite, eating about all the time, had lost 25 to 30 pounds; was voiding 5 gals, of urine in 24 hours with high per cent, of sugar. "Put him on three Trypsogen Tablets t. i. d. (never went above this) allowed him to eat almost anything he wanted as he was so weak and emaciated was afraid to put him on rigid or even a restricted diet. Allowed him potatoes and bread and plenty of green vegetables. Had him under treatment for 8 months. Had by then regained almost his normal weight, appetite normal, urine 2 quarts in 24 hours and although still showing slight trace of sugar, 8 SUCCESSFUL TREATMENT I do not consider this symptom of serious importance in view of improvement in general condition. Have not seen case for four weeks, as he went back home, but heard from him recently, he was at work and doing well and taking on weight." New York, January 9, 1912. "Mrs. M., 48 years of age, came under my care July 15, 1911. Her weight, which had averaged 249 pounds, had decreased to 203 pounds, and she presented all the clinical symptoms of diabetes with marked thirst; sugar, large per- centage; volume of urine, six pints per diem and over; she was in very bad shape. "I put her on six Trypsogen Tablets three times daily, in- creasing the dosage to eight. Within a month the sugar disappeared entirely, and has remained so, with slight occasional lapses due to eating potatoes; otherwise she is on a mixed diet. Her weight is 215 pounds, and general condition is good." New York City, March 21, 1912. "Mrs. L. D. (housewife), 51 years old, came under my observation as consulting physician November 18, 1907. Her history showed that she had lost 35 pounds in two and one-half years; physical appearance was particularly bad due largely to loss of sleep from intense itching and the frequent desire to urinate at night. The quantity of urine voided was about two and one-half times above normal, and all medication had been fruitless. I advised half-dram doses of sodium bicarbonate every three hours for two days along with thorough administration of the sulphates. Fol- lowing this I gave her three Trypsogen Tablets every three hours, day and night. The minimum amount of proteids was ordered, and all cane-sugar excluded from her dietary. Improvement was slow at first, the only thing noticed being a reduced quantity of urine voided with longer intervals of urination. After three months' treatment with Trypsogen OF DIABETES MELLITUS 9 the sugar was reduced from 2 per cent, to slightly under 1 per cent.; the specific gravity, which originally had been 1044, was reduced to 1031. The patient gained 18 pounds in weight and in all respects was greatly improved. "This treatment has been continued and at the present time the specific gravity is 1026, and the itching and fre- quent urination have entirely ceased." "Mr. N. M. consulted me May 26, 1905, complaining of loss of weight, loss of appetite, and a general feeling of ill-health. His normal weight was 162 pounds,-but at the time he came to me he weighed 134 pounds. Upon physical examination and urinalysis I found he was suf- fering with diabetes mellitus; urinalysis revealed over 1 per cent, of sugar,-specific gravity 1040, and the volume voided was twice above normal. "Patient showed great mental disturbance when informed of my diagnosis, saying that he had just lost an uncle with the same disease, and that he would dispose of his business interests as he felt that the outcome was the same in all cases. "I prescribed three Trypsogen tablets every four hours, reducing his proteids materially and giving only a moderate amount of starches. After two weeks of this treatment, he said he felt some better; the specific gravity had dropped to 1037. Treatment was continued for several months, dur- ing which time I saw him every four weeks, always noting some degree of improvement; he gained eight pounds in the first three months. At the expiration of a year and a half his condition was such that he decided to enter into business again, which he aid; and he has led a particularly active life from that time on. "Specific gravity at the present time is 1026, quantity of urine voided practically normal, and his weight and general condition are the same as before he was taken ill. "I think that Trypsogen was a most important factor in the treatment of these two cases." 10 SUCCESSFUL TREATMENT New York, N. Y. "On April 29, 1911, the following case came under my observation: A man employed in a brewery in Brooklyn, age about 50 years, suffering with diabetes mellitus; the great toe on each foot was in gangrenous condition. I put him upon Trypsogen, two tablets t.i.d., which was sub- sequently increased to five. After two months' treatment the patient increased at least fifteen pounds in weight, his general health was greatly improved, and his toes com- pletely healed. "Diet was not restricted, but sugar was omitted. The sugar did not entirely disappear from the urine but the volume of urine decreased and the patient's general health was so much better that he was discharged from treatment. If he had cut out beer entirely it is quite possible the sugar would have disappeared from the urine. "Patien4- is in first class condition,-March 1, 1912." New York City, Jan. 9, 1912. "February 11, 1911: Male, aged 55 years; complained of pains in calves and back. Examination of urine showed sugar in large percentage; volume 3 to 4 pints daily; he had decreased in weight from 210 to 171 pounds. I put him on Trypsogen, increasing the dosage to 8 tablets three times a day. He has taken 3,000 tablets. The sugar dis- appeared entirely after fifteen days with occasional reap- pearances until September 20th, since which date there has been no trace. "This patient now weighs 196 pounds, and is much better in general health; the irritability, which was so marked, has disappeared, and there are no more lancinating pains. He is apparently well today, and is on a mixed diet." "Practice of Medicine",-Prof. H. V. Halbert, M.D. (from chapter on treatment of diabetes) :-"Before enter- ing a discussion of the remedies which pertain to specific indications, I will report a method of treatment which has, OF DIABETES MELLITUS 11 been usually successful in my work during the past two years. For this purpose I will select three cases for illus- tration. One was a man beyond sixty who was passing six per cent, of sugar and voiding 4,000 cc. of urine in twenty-four hours; he suffered also with marked gangrene in the right toe. The next case was a man past forty who had made his annual pilgrimage to Carlsbad for two or three years, with only slight improvement from this and dietetic care. The last case was a young woman under thirty who had suffered with diabetes for about a year. All of these cases were typical and require no further de- scription. The first case, after six months' treatment, is voiding only 1,600 cc. of urine in twenty-four hours and the sugar amounts to only 0.6 per cent., while the gan- grenous toe has been amputated with a perfect healing of the parts. The other two cases are eliminating no sugar in the urine and all are improving in strength and flesh. Aside from dietetic considerations in each case, I have em- ployed the following treatment: Trypsogen (each tablet containing trypsin, ptyalin, amylopsin and bromide of gold 1-100-gr., bromide of arsenic 1-200-grain) two to five tab- lets after meals and syzigium, first decimal potency, four grains six times daily." Butte, Montana, February 17, 1911. "I wish to report my experience with your Trypsogen, which has been interesting and important, and far more positive in results than any other line of treatment sug- gested. I developed the diabetic condition fifteen years ago, at the age of 45, which soon very seriously interfered with my business and the course of my life. I had constant treatment, change of climate, visits to the springs, a trip abroad, etc., with very little result, the sugar persisting, 4 to 5 per cent. Some five years ago I began to take Tryp- sogen, which I continued a large part of the time since, with complete disappearance of the sugar. It is a notable fact that in the course of this treatment I had a well-defined, 12 SUCCESSFUL TREATMENT most severe type of pneumonia with abscess of the upper lobe of the right lung, but it did not result in death; in fact, I have been under continued improvement. So far as the diabetes is concerned, however, I have noticed at times a tendency to some return of the sugar, especially during the hot weather of last summer. I was not discouraged by this, being thoroughly well-pleased with the results obtained. It is but reasonable to suppose that a chronic condition of disturbed nutrition would require time and persistence. "I propose to start in on a more extended campaign in the direction mentioned, and will report again. I wish to re- peat, however, that the result already obtained with Tryp- sogen has been most highly satisfactory and far better than any other line of treatment suggested."-Dr. . Stockton, Cal., November 21, 1911. "Regarding the diabetic case mentioned, I unfortunately have kept no record, but the general rase stands out unmis- takably:-Duration undetermined,-perhaps several years; the general pains; prostration; extreme nervous irritation; loss of weight;-all such symptoms extreme;-sugar, 6 per cent, and more; age 45. There has been careful regulation and some restriction of diet, Trypsogen making up the re- mainder of the treatment,-which is still continued. From a serious bed-ridden condition, improvement has been gradual but steady, to a full resumption of business, and for some months now an entire absence of sugar. With all the serious prognosis in such cases, I see no reason why this recovery should not be permanent." Sacramento, Cal., December 12, 1911. "I have used Trypsogen in large amounts with persist- ence in seven well-defined cases of diabetes. The diet was at first restricted, but thereafter regulated, with more free- dom. In one case, 80 years old, there has been entire dis- appearance of sugar for twelve months, with the exception of one examination in which there was but a trace; but this OF DIABETES MELLITUS 13 promptly disappeared following further use of Trypsogen. "In another case, a lady aged 45, with abscess and other complications,-all conditions very severe,-sugar has been absent for twelve months. "In these cases general nutritive improvement was marked, and present conditions are most encouraging. "In a case of a young child, Trypsogen and all other treat- ment seemed of no avail,-death ensued in a few weeks. Of other cases still under treatment I would speak with re- serve but I might say conditions are encouraging." Vancouver, Wash., May 19, 1911. "In reference to my diabetic case: In June a year ago, I found the man strongly diabetic, the duration of condition unknown; specific gravity 1032, sugar over 8 per cent.; gangrene of little toe of right foot and necrosis of bone, which I amputated. In December I found the big toe on each foot tending strongly to gangrene. Put him on Tryp- sogen in January and after sixty days the sugar entirely disappeared as did also the infected condition of the toes. Since the first of March the patient declares himself well; still using Trypsogen. "The course of this case is notable as being entirely dif- ferent from the usual prognosis given in books and from any experience I have had in my practice." Sharon, Pa., Feb. 27, 1912. "I have two cases of diabetes mellitus on Trypsogen at present ; both are doing well. The more important case is a young man about 32, a machinist by trade, who came to me about a year ago. When I first examined the urine, I was startled, for I had never before seen so much sugar in any specimen. The patient had lost about 20 pounds, had an excessive thirst, voracious appetite, and was passing from 7 to 8 quarts of urine in twenty-four hours. "I started him on Trypsogen, 2 tablets four times per diem and also restricted his diet; gradually increased the 14 SUCCESSFUL TREATMENT dosage to two tablets every four hours, then every three hours, and finally every two hours before I procured very marked results. The symptoms began to clear up, sugar decreased, and at the last examination about two months ago no sugar at all was in evidence; this was after ten months' treatment. Patient is now working six days a week, and overtime, and shows no symptoms whatever; he is back to his normal weight, 142 pounds." New Brighton, Pa., Feb. 24, 1912. "I have cases on Trypsogen at present; one I have been treating for two years,-a very bad case when she first came to me; sugar not so high but nutrition poor, los- ing weight, polyuria, etc. She began to improve after be- ing put on Trypsogen, 12 tablets a day. Later, she de- veloped diabetic cataract, and was operated upon a few months ago with success. I did not put her on restricted diet but allowed her to eat what she wanted with no bad results. Sugar, which was at first 4 per cent., is now down to 0.3 per cent. "I am satisfied that she progressed so well without dietetic restrictions owing to Trypsogen. I consider it the treat- ment 'par excellence' in diabetes." Hot Springs, Ark., April 12, 1911. "I take great pleasure in reporting the following gratify- ing results from the use of your product Trypsogen: "Mr. J. B., aged 46, normal weight 270 pounds, dropped to 210 pounds, and complained of headache, dizziness, and frequent urination; specific gravity 1042, volume of urine voided two gallons in twenty-four hours, sugar over 4 per cent. I placed him upon Trypsogen tablets, five after meals, and in six weeks' time the symptoms all disappeared, and there was a gain in weight of twelve pounds. The man left the city in good shape,-in fact, better than he had been in years. Subsequent reports show continued improve- ment, and I expect a complete recovery." OF DIABETES MELLITUS 15 New York, May 16, 1911. "The following case of diabetes mellitus came under my care. The patient was a man 25 years old. He had been re- fused insurance on account of sugar in the urine-about 3 per cent. After some weeks of observation I put him on Trypsogen, maximum dose four tablets t.i.d. for four weeks. I stopped the treatment for two weeks and then resumed for a period of eighteen months. The urine became free of sugar, and the patient was then, and is now, in fine condition. He has been accepted for insurance. "Up to the present date, January 4, 1912, there has been no recurrence of diabetic symptoms." Steubenville, O. Have used Trypsogen successfully on two cases of diabetes mellitus. First was that of young man 22 years of age, whose urine for 1 % years previous to treat- ment showed large amounts of sugar, and whose weight had steadily decreased from 160 pounds to 145 pounds, with failing general health so marked could offer but little hope to his parents. This patient was put on Trypsogen and a strict diet with pure water in abundance, and after treat- ment for one year showed complete recovery; nor has he shown any tendency to relapse up to the present time, which is one year from time he was discharged. Specific gravity of urine showed 1018, as against 1032 at beginning of treatment. Butler, Pa. Dr. reports having treated a case of diabetes occurring in a girl aged 14 exclusively with Tryp- sogen, and with complete success. This girl had been in ill health for a year previous to treatment, with constantly in- creasing amount of sugar in urine and steady decrease in bodily weight. Health finally became so poor that parents had to keep her from school, and while in this condition she was put under Trypsogen treatment; improvement speedily followed. After several months, weight had increased to 16 SUCCESSFUL TREATMENT normal, and repeated tests failed to show a trace of sugar in the urine, nor has it yet reappeared, after several weeks' discontinuance of treatment. Patient has returned to school. Trypsogen is carried in stock by all prominent chemists throughout the English-speaking world. The following series of monographs on metabolism, con- taining the results of the latest and most authoritative re- search, can be procured from the parties named below upon request: No. 1-Diabetes Mellitus, Trypsogen Treatment. No. 2-Diet in Diabetes Mellitus. No. 3-Complications and Sequelae of Diabetes Mellitus. No. 4-Salivary and Pancreatic Ferments Not Destroyed in the Stomach. No. 5-Enzyme Therapy. No. 6-Enzyme Therapy in Tuberculosis. No. 7-The Mechanism of Digestion (In preparation). No. 8-Successful Treatment of Diabetes Mellitus (this pamphlet). G. W. Carnrick Co., 31 Bartholomew Close, Lon- don, E. C. Framjee & Son, i Sassoon Bldg., Opp. Mint, Fort, Bombay. Ayers, Baker & Co., 27 Swanston Street, Melbourne. Lennon, Limited, Cape Town. Benson, Smith & Co., Honolulu. Stahl & Rumcker, Manila. E. Del. Mar., Cairo and Alexandria. Correspondence is invited on points of special interest, and we solicit reports of your experience with Trypsogen. G. W. CARNRICK CO., Manufacturing Chemists, 29-31 Sullivan Street, New York City.