A NEW AND PERFECTED ENTERIC PILL. DT LOUIS WALDSTEIN, M. D. REPRINTED FROM THE Weto Journal for September 8, 189J/.. Reprinted from the New York Medical Journal for September 8, 1801^. A NEW AMD PERFECTED ENTERIC PILL. By LOUIS WALDSTEIN, M. D. It has long been considered desirable to reach the in- testines, especially the upper tract, by medicines which, taken by the mouth, would pass the stomach without being dissolved. The experiments made by Unna, of Hamburg, with a keratin coating, as well as those made by others with various fatty substances with a high melting point, shrllac, salol (Dieterich), etc., have not proved successful. The trend of the modern treatment of intestinal dis- turbances is directed toward the neutralization or destruc- tion in a chemical sense of those soluble toxic principles (ptomaines) which are the products of the metabolism in- duced by the numerous forms of micro-organisms which we have recognized as the cause of enteric fevers and of putrefactive changes in the intestinal contents. Further- more, recent investigations have made it appear more than probable that certain symptoms in nervous complaints, functional chiefly, in neurasthenia, melancholia, insomnia, and many more, even epileptic seizures, may be in great part due to the effect of soluble toxic material absorbed from the intestinal tract. As far as I may be permitted to Copyright, 1894 by D. Appleton and Company. A NEW AND PERFECTED ENTERIC PILL. announce my own opinion, I should say that my observa- tions have put the intimate causal connection here referred to beyond a doubt. This is not the moment to refer to definite instances, as I am still continuing researches in this direction ; but since the number of cases, however large, of one practitioner is much too small to reach gener- ally acceptable conclusions, and since T consider the sub- ject of great practical importance, 1 thought it well to call the attention of practitioners, more especially those who have hospital facilities, to the pill which has seemed in my hands to meet all the requirements of a true enteric pill. When Unna first published his results I began to em- ploy various methods of coating pills, assisted by a number of druggists of this city ; but in whatever combination or proportion the various substances, insoluble in dilute acid and soluble in dilute alkaline liquids, were employed, the coating was incomplete, friable, or withstood, when per- fectly seasoned, the action of the enteric fluids and passed through almost unchanged. The coating which I now employ, and which answers all purposes required of such a mass, is a mixture of shellac and salol dissolved in alcohol. This mixture can be spread over a pill in a very thin layer and remains un- changed and perfect without becoming brittle for an indefi- nite time. In order to determine the behavior of pills treated in this manner I have given methylene blue and found by lavage of the stomach that it remained undissolved quite as well as in acidulated gastric juice in the laboratory ex- periment, and that, on the other hand, the faeces and urine passed were colored. Small doses of intestinal cathartics act much more promptly than if they were administered in the usual manner. I am unable to say at present, how- A NEW AND PERFECTED ENTERIC PILL. 3 ever, what effect, if any, can be observed if typhoid fever or enteritis were systematically treated with antiseptic remedies protected by the coating I am recommending in this imperfect manner. I propose making a thorough trial in various cases of self-intoxication from ptomaines as well, including some forms of eczema and urticaria, which have, I am quite sure, their origin in the intestinal canal. It will also prove useful to follow the late Sir An- drew Clark in treating with the enteric pills those anaemias which are caused by faecal retention. Among the pills which I have caused to be made is in- cluded one containing extractum pancreatis and bicarbo- nate of sodium, to be tried in those cases of diabetes mellitus presumably dependent upon diseases of the pan- creas. I do not pretend to give here an exhaustive list of indi- cations for intestinal medication ; they will suggest them- selves to the reader; nor is it the object of the present pre- liminary communication. I wish merely to facilitate the work along these lines by communicating to the profession my confidence in my new pill coating and to invite their collaboration. In order to bring this easily within the reach of those most interested, I have requested Mr. M. J. Breitenbach, of this city, to keep in stock a supply of “ enteric pills,” for which I have furnished some formulae that may prove most acceptable for preliminary work. In conclusion, I take much pleasure in acknowledging the helpful courtesy of Mr. Breitenbach during the several stages of my experiments. 450 Madison Avenue. The New York Medical Journal. A WEEKLY REVIEW OF MEDICINE. EDITED BY FRANK P. 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