THE USE GE PEPSINE 
IN THE 
DIARRHOEA OF INFANTS. 
BY 
JAMES S. HAWLEY, M. D., 
- i':. f 
Greenpoint, L. I. THE USE OF PEPSINE 
IN THE 
DIARRKEA OF INFANTS. 
In speaking of the cases of infantile diarrhoea, Dr. West, in liis 
Treatise on the Diseases of Infants, makes the following remarks : 
“ You will observe that the period of the greatest prevalence of 
diarrhoea coincides exactly with the time during which the process 
of dentition is going on most actively, and that more than half of 
all the cases of diarrhoea occur in children between the ages of 
six months and two years. 
“ The older writers on medicine, whose notice this fact did not 
escape, attributed the disturbance of the bowels to a sort of sym- 
pathy between the intestinal canal and the gums, swollen and ir- 
ritated by the approach of the teeth to their surface. It must be 
borne in mind that there exists, during the period of teething, a 
more abiding cause, which strongly predisposes to its occurrence. 
All parts of the digestive canal, and of its dependencies, are un- 
dergoing an active evolution to lit them for the proper assimila- 
tion of the varied food on which the young being will soon have 
to subsist. Just as the salivary glands are now developed, and 
pour out saliva in abundance, so the whole glandular system of 
the intestines assumes a rapidity of growth and an activity of 
function, which, under the influence of comparatively slight ex- 
citing causes, may pass the just limits of health. In too many 
instances, causes fully adequate to excite diarrhoea are abundantly 4 
supplied in the excessive quantity or unsuitable quality of the 
food with which the infant is furnished; for it is forgotten that 
its condition is one of transition, in which something more than 
ordinary care is needed, while in accordance with that humoral 
pathology so popular among the vulgar, the profuse secretion from 
the irritated glands is regarded as the result of a kind of safety- 
valve arrangement whereby nature seeks to moderate the consti- 
tutional excitement attendant upon teething.” 
Here we have tliefons et origo of infantile diarrhoea, an abid- 
ing, ever-present, predisposing cause, always ready to be quick- 
ened into activity by innumerable excitants. Errors of diet or de- 
pressing and. painful emotions—as anger, fear, grief or anxiety; 
food, improper in quantity or quality ; perturbing medicines and 
over-heating occupations on the part of the mother. The same 
errors of diet, changes of temperature and constitutional vices on 
the part of the infant, are ever ready and frequently occurring 
exciting causes. . 
This condition of transition which the teething infant exhibits 
is everywhere impressed upon animated nature. In the human 
family we have not only the great transition state of the alimen- 
tary and digestive systems at the period of dentition, in which we 
are now more particularly interested, but later the state of transi- 
tion which attends the full development of the reproductive func- 
tions in which the nervous system is more particularly excited and 
liable to mal-development, and later still in life the second evolu- 
tion in the generative system, when its functions, having fulfilled 
the order of nature, cease their activity. Again the mental func- 
tions and sentient system are in jeopardy. This danger to life 
and function which attends the great physical transitions in the 
human race, finds its counterpart in the inferior creation. In 
insect tribes, the various transformations from egg to larva, from 
larva to chrysalis, from chrysalis to the winged insect, are each and 
all attended by dangers and destruction of life. Each shedding 
of the shell of the Crustacea or skin of the reptile is a period of 
danger and frequently of death. Thus all nature speaks the same 
language and harmonizes with the teachings of science, that the 
periods of great change in the functions of the body are also per- 
iods of great danger. The proper functions of an organ or sys- 
tem of organs seem in whole or in part suspended or imperfectly 5 
performed during the period occupied by organic evolution. In 
other words, while the organ or system of organs, is being devel- 
oped, or modified in structure, nature finds it necessary to rest 
from its labors, or materially diminish its activity. 
In the normal condition of the human body the powers of 
nature are ample to carry on all necessary processes during the 
periods of evolution incident to the full development of the sys- 
tem. The vital machinery acquires sufficient momentum to car- 
ry its lagging and burdened wheels by the centres of obstruction 
which are met in each great developmental revolution. But in 
the artificial and morbid condition in which a large portion of 
infantile humanity is found, slight obstructions bring the mach- 
inery to a dead stand or waste its powers in ineffectual attempts 
to continue its action. 
This, to continue the figure, is the moment when the engineer 
by his lever may complete the revolution, and again all goes for- 
ward in harmonious action. This is the critical moment when a 
grain of sand or a drop of oil may increase or diminish the fric- 
tion till on the one hand its motions may cease forever ; or, on 
the other, proceed with its revolutions till its destiny is fulfilled. 
Premising, then, that the great predisposing cause of infantile 
diarrhoea is the state of evolution which the digestive system and 
its dependencies aro undergoing during the period of dentition, 
the question of therapeutics becomes one of comparative sim- 
plicity, and the evident duty of the physician is to allay that irri- 
tation of the organs which is exhibited in vomiting and purging, 
first, by the removal of all extraneous sources of disturbance, 
such as food, improper in quantity or quality, by protecting the 
skin from too sudden and frequent changes of temperature, sec- 
ondly, by sedatives, to subdue the excitement which the foregoing 
causes may have induced, and which, in the enfeebled condition 
produced by the transition state, are self-propogating, and lastly, 
to impart to the struggling and overwhelmed digestive apparatus 
that assistance which will enable it to convert food from the char- 
acter of a foreign, and therefore irritant, material, into nutriment 
which will reinvigorate the natural forces and enable them toaccom- 
plisli successfully the great and necessary evolution through which 
they are passing. Happily the practice of administering excitants 
to the already over-stimulated glandular system, has nearly passed 6 
away. Hydr. cretce, and Hydr. chlor., are therapeutical'foimulae 
seldom penned by one who opens liis eyes to the light of physio- 
logical or rational therapeutics in infantile diarrhoea. As sedatives 
to the over-excited mucous membrane and glandular system of the 
stomach and bowels, the* preparations of opium and the salts of 
bismuth stand preeminent. When irritation, without pain, exists, 
bismuth most promptly and satisfactorily allays it; but when 
accompanied with pain, the addition of a minute portion of opium 
becomes a necessary complement to its effectiveness. 
We have now briefly noticed, in outline, the first two conditions 
of treatment, viz.: the removal of external causes of irritation, 
and the allaying of the morbid excitement which has sprung from 
their agency; and it may be asked if the natural functions will not 
now resume their offices, and the health of the patient be restored. 
Doubtless such would be the case did not the system labor under 
the combined effects of the transition state of dentition, and the 
impairment of strength due to the morbid causes above enume- 
rated, and for which the correctives have been proposed. But the 
circle of remedies is not yet complete. The key-stone of the 
arch is wanting, and if left thus incomplete, will tumble back into 
the disorder and confusion from which it has been raised. The 
ingesta themselves become, for want of digestive and assimilative 
power, irritants to the sensitive and debilitated organs. Instead 
of affording nutriment to fortify the system against the dangers of 
the crisis through which it is passing, the food going through the 
intestinal canal in an undigested form, becomes, itself, an irritant, 
and adds another morbid cause to those already existing. This is 
not all: the food does not always remain a simple, foreign sub- 
stance, inducing irritation, but undergoes putrifactive decomposi- 
tion, adding new and more active sources of disease. 
Here, then, is the gap in which we are to stand. And what are 
the weapons we are to use ? Tonics and stimulants, as indispensi- 
ble as they often are, here become awkward and doubtful. They 
are indirect and secondary—whips to stimulate lagging energies 
and not power to perform the labor and lift the burden. Here the 
happy thought of Corvisart comes to our relief. The very func- 
tion which is crippled, we can replace ; the very strength which is 
exhausted, we can supply. By the administration of pepsine, we at 
once convert the ingesta into nutriment. They not only cease to 7 
be irritants to the digestive'organs, but are absorbed into the cir- 
culation, and become sources of power instead of weakness. 
Now, we have fullfilled all the indications. First, to remove all 
sources of irritation from the quantity or quality of tlieingesta, or 
change of temperature. Secondly, allaying irritation by sedatives. 
Thirdly, artificial digestion by the administration of pepsin. This 
simple but effective treatment is not new, but has more than once 
been presented to the professsion for its* approval. 
In support of its efficacy, especially that portion which relates 
to artificial digestion, and which thispaper is particularly intended 
to illustrate, a few cases will be brought forward. The first case 
is one reported in the Revue Medico Chir. de Paris, Dec., 1856. 
M. X , aged 4 years, was admitted into the Hospital of St. 
Eugenie on the 23d of November, 1854, under the care of M. 
Barthez. For many months this child had suffered from frequent 
diarrhoea, until it was emaciated and debilitated to the last degree. 
The appetite was voracious and the stools contained much undi- 
gested food. In the first instance, M. Barthez tried the effect of 
properly adjusted diet, with small dozes of trisnitrate of bismuth, 
but without avail. He then tried the pepsine, giving a dose 
(grs. v) at the commencement of a meal composed of the ordinary 
food of the hospital. On the following day (the 1st of December) 
the stools were of a better color, and in other respects more nat- 
ural than they had been before ; encouraged with this result, the 
same quantity of pepsine was ordered to be given before each 
meal. 
Dec. 3d. No stool. This was the first day without a motion 
for many months. 
Dec. 4th. Still no stool. The pepsine discontinued. 
Dec. 5th. Two somewhat fluid motions, although there was no 
change in the diet. There was, however, no undigested matter in 
the motions. The child was much better in every respect. 
Three weeks afterwards the child was discharged cured. M. 
Barthez, however, did not return to the pepsine, but contented 
himself with small doses of the trisnitrate of bismuth. 
This case led M. Corvisart to try the effects of that remedy in 
the diarrhoea of very young infants. 
2d. Case. Alexander Lang, born on the 2d of August, 1855, 
was seized on the 25th of October, with diarrhoea, after a very 8 
obstinate attack of erythema and eczema. This diarrhoea was 
accompanied with frequent hiccough and vomiting. On the 3d of 
November 8 grs. of pepsine were given night and morning. On the 
4th the same treatment was continued ; and now the vomiting and 
purging have disappeared, the stools have become natural, the 
child take the breast with avidity. The pepsine discontinued. 
Nov. 22d. The vomiting and purging have returned. M. Oor- 
visart has again had recourse to the pepsine. 
Nov. 23d. The vomiting and purging have ceased, and the 
stools are natural. From this time the little patient went on well. 
JVL Corvisart adds, that many cases of the kind have fallen 
under his notice, and that the acidified form of the pepsine, which 
he himself tried, was quite as efficacious in these cases as the neu- 
tral form proved to be in the hands of M. Barthez. 
The writer has been in the habit of administering pepsine in the 
diarrhoea of fed and teething infants for several years, with 
marked success. 
Notes of former cases not having been preserved, a few which 
have occurred in the last few days must suffice. 
July 19th. Thomas Kennedy, aged 15 months, has had diarrhoea 
a week, is fed, passages watery and contain undigested food. 
K Am. Pulv. Pepsine. Sub nit. bismuth, aagrs. 5 every 3 or 4 
hours. 
This single prescription terminated the disease. 
July 20. John Kneister, aged 18 months, is teething, diarrhoea 
has existed ten days, passages very watery and-frequent, and con- 
tain undigested milk. 
K Am. Pepsine. Sub nit. bismuth, ail grs. 5 every 4 hours. 
This case was also relieved by a single prescription of ten 
powders. 
August 2d. P. Quigley, aged 8 months, has had diarrhoea a 
week, and been treated by another physician by astringents and 
opiates without benefit. 
JJ, Am. Pepsine. Sub nit. bismuth aa 3 in 10 powders, to be 
given every 3 or 4 hours. 
This case also recovered completely under this single prescrip- 
tion. 
August 5th. Mary Duryee, aged 11 months, has four incisors 
on each jaw, but no marked signs of the approach of other teeth. 9 
Has suffered considerable from diarrhoea for two weeks. On the 
5th the diarrhoea increased alarmingly, accompanied by vomiting 
and great prostration, as wTell as pain. The vomiting was allayed 
with liq. bismuth, and the following prescription made: 
IJ Am. Pepsine. Sub nit. bismuth, aa 3 j. Pulv. opii, gr. i, 
divided into 12 powders, and one given every 2 to 4 hours, 
according to circumstances. 
This treatment, with slight modifications, according to pain or 
frequency of the discharge, has been continued to the present 
time, (Aug. 10th,) with nearly complete relief to all the symptoms, 
and she is now out of danger. 
August 5th. Pobert Kelly, aged 9 months, is teething, has had 
protracted diarrhoea and vomiting, is much emaciated, and passes 
large quantities of undigested milk, which are highly offensive. He 
has been for some time under treatment before coming to me. 
Pepsine and bismuth were prescribed in the usual manner and con- 
tinued three days, when the child died. It is to be noticed in this 
case that the coagulated milk disappeared from the stools on the 
second day, showing the efficiency of the pepsine. 
The only remaining case to which I will allude is one rather of 
infantile inanition than of true diarrhoea. 
July 28th. D. 1ST , an infant two wrneks old, said to have 
been born in a plump and healthy condition. Its present state is 
one diametrically opposite. Its face is thin and skinny, exhibiting 
painfully the bony outline. It has thin, muddy, but not frequent 
alvine discharges, and vomits whatever it swallows, even to half a 
teaspoonful of its mother’s milk. It lies stupid, with its eyes 
closed, and refuses the breast. It also has an intense muguet. In 
this extremity I ordered three grains of pepsine to be given every 
three hours, and half a teaspoonful of the mother’s milk to be ad- 
ministered with great frequency. The following morning I found 
the mother, through utter hopelessness, had greatly neglected my 
directions. It was only through much persuasion and the coopera- 
tion of a friendly neighbor that she was induced to pursue the 
treatment. During that day the vomiting ceased, and on the fol- 
lowing day the child took the breast and retained and digested its 
nourishment. From this day it steadily improved in condition, 
and its diarrhoea and muguet disappeared. 10 
On the 8th inst., one week after my last visit, I was called to see 
its mother, and could hardly have recognized the infant which so 
lately had seemed in the last stage of inanition. Its face had 
acquired a comparative fulness, its color was restored, it nursed 
well and freely, and seemed as likely to live and thrive as any 
infant. This child was simply starving to death. What led to its 
condition of inanition I could not satisfactorily learn, but its state 
seemed most hopeless. This case illustrates, in a remarkable man- 
ner, how little assistance will restore the digestive faculty to its 
normal activity, and enable it to perform its functions unassisted. 
Without adding cases of a similar kind from our own experi- 
ence, which would, perhaps, extend the list to a tedious length, we 
take pleasure in submitting the testimony of Dr. R. E. Van Gieson 
in favor of the efficacy of the preparation of pepsine in the diseases 
under consideration. The Doctor, in furnishing us with his notes, 
remarks : “ I have found pepsine peculiarly fitted for the treat- 
ment of that fearful scourge of children, cholera infantum, after 
the more profound and violent initial symptoms have been sub- 
dued by direct sedatives, such as hydrocyaic acid, ice, creosote, 
and the like. It has seemed to me that when the vomiting and 
purging have by such measures been arrested, that the whole 
gastro and intestinal tract is utterly incapable of assimilating 
even the blandest articles of aliment. We stand, as it were, be- 
tween the danger of starvation on the one hand, and the peril 
of again irritating the intestines to the evacuation of exhausting 
discharges by the administration of food. Just here pepsine is the 
remedy. By its aid we can secure the digestion of food which 
would otherwise irritate. So long as the stomach is disposed to 
remain quiet, we need not feel alarmed if for a day or two the dis- 
charges per rectum are somewhat frequent. An astringent and 
opiate suppository will control this, and in the meanwhile we are 
gradually bringing the intestinal tract to its normal condition, 
i. e., digestion. 
“ Another great advantage arising from the use of pepsine in 
this disease, has been rendered apparent by a careful comparison 
of cases treated by the most approved method in vogue some eight 
years ago. The medical gamut was then sedatives, opiates, astrin- 
gents, tonics. It yielded good results, but the cases were a long 
time in getting well. There came a period when the pernitrate of 11 
iron and the salts of quinia seemed almost powerless. This might 
he the third week or the third month in the disease. There was 
no particular irritation of the stomach, but unless the astringent 
was given with great, regularity and in augmented doses, the dis- 
charges still continued. In these protracted cases the gastroin- 
testinal system seems but a passive tube, through which the food 
passes pretty much as it entered the mouth, giving but little nour- 
ishment to the patient, and much annoyance to the atonized vis- 
cera. In these cases pepsine is very clearly indicated, and will 
slowly, but quite certainly, aid in the digestion of judiciously 
selected nutriment, until the system can recuperate sufficiently to 
manufacture its own pepsine, when the artificial substitute can be 
withdrawn. The annexed case illustrates the foregoing remark 
in a very clear manner : 
C. II., aged 13 months, hand fed, chiefly on condensed milk for 
last ten months ; central and lateral incisors through; first came 
under my care July 29th. Past history : Has been under treat- 
ment by another physician for a week. Was taken in the begin- 
ning with vomiting and purging, which were in a measure subdued 
by the treatment. The child was then pronounced better, and the 
visits discontinued. 
Present condition : The child is much emaciated, face shrunken, 
and of that senile appearance so indicative of the ravages of 
cholera infantum. The stomach is still irritable, and the bowels 
operate from 5 to 8 times in twenty-four hours. Discharges simi- 
lar to chopped spinage. The child craves drink constantly. 
Bismuthi sub nit. pepsine, (American,) aa 3 i; make xii pow- 
ders ; S one every three hours; ice cold milk punch every three 
hours. 
30th. • Discharges diminished but still fcetid. Thirst dimin- 
ished, stomach less irritable, no vomiting during the night. Con- 
tinue treatment, with addition of ice cold mutton broth. 
31st. Discharges diminished and less foetid, no vomiting; 
withdrew the punch and substituted milk in barley water. 
If, pepsine, 3 i; make xii powders and give as before, with 
plenty of open air. 
Under this treatment the child has steadily improved. The 
discharges are growing firmer in consistency each day, and vary 
in frequency from one to three in twenty-four hours. The appe- 12 
tite being now fair, and the discharges nearly normal, the pepsine 
wrill be withdrawn, and port wine and tincture cinchona sub- 
stituted. 
Of course the writer does not intend to exalt pepsine to the 
position of a specific in infantile diarrhoea. It is only claimed that 
its use is one step in the right direction ; that it is capable of 
removing one of the principal predisposing causes, to wit: the 
impairment of the digestive function by the evolution which occurs 
at the period of dentition, and of preventing the irritation which 
attends the passage and decomposition of undigested food. 
A favorite observation of the writer is, to mark the gradual 
disappearance of undigested food and fetor from the evacuations, 
feeling assured that so much at least is well and in the right direc- 
tion, whether the case proceeds favorably or not. Many other 
considerations influence the course of the disease, and these indi- 
cations must be met by their proper remedies, according to the 
judgment of the practitioner. 
I will close this hasty and imperfect paper by commending pep- 
sine to a fair trial in the treatment of infantile diarrhoea, espec- 
ially during the period of dentition. It has no noxious or per- 
turbing qualities. It has physiological reasons in its favor, and 
has to some extent, borne the test of experience.