Pancreatin (pancreatinum) is usually obtained from the fresh pancreas of the hog or ox. It contains the specific ferments of the pancreas, and represents its external secretion. There is no evidence that it also represents the internal secretion, and it has no power to check pancreatic diabetes. Its notable actions are those of the enzymes, trypsin, amylopsin, and steapsin. It acts best in an alkaline medium.

The Pharmacopoeia gives tests of its protein and starch-digesting power. It specifies that 1 grain of pancreatin with 5 grains of sodium bicarbonate must be able to peptonize completely 3 ounces of cow's milk at 1040 F. (400 C.) in thirty minutes; that is, it must change the proteins so that the milk will not coagulate on the addition of nitric or acetic acid. It further specifies that pancreatin must be able to change 25 times its weight of starch into substances soluble in water, i. e., into dextrin, maltose, etc. Hence pancreatin would be another important therapeutic agent, but that, like pepsin, it is seldom needed in therapeutics.

When the secretion of gastric juice fails, as in achylia, the choice is left open of administering pepsin and hydrochloric acid, or pancreatin and sodium bicarbonate, to bring about digestion in the stomach. But as a rule no digestant at all is employed.

In the milder form of chronic pancreatitis with emaciation, and in the very rare cases of "pancreatic infantilism," a condition of stunted growth and chronic diarrhea, excellent results are recorded from the administration of pancreatin. Byron Bram-well reported a boy of nineteen with development arrested from the age of eleven and chronic diarrhea for the last nine years. He was bright and intelligent and not a cretin. His urine was free from sugar. Under the influence of pancreatin by mouth he grew five inches in two years and gained 22 pounds. Rentoul had a girl of eighteen, in a similar condition of stunted development, gain 9 1/2 pounds and grow 2 inches in less than five months, at the same time showing decided sexual development and general improvement. Thompson reports two such cases. They are very rare. These results may be due not to the digestive power, but to an effect which the pancreatin may exert upon the activity of other glands, for instance, the thyroid or pituitary. Indeed, because of the discovery of a probable antagonism between the internal secretions of pancreas and thyroid, pancreatin has been employed in hyperthyroidism.

In chronic pancreatitis pancreatin has been of uncertain value, and in checking a pancreatic diabetes has proved a failure. But in some cases it has overcome the failure of fat and protein digestion which regularly accompanies pancreatitis, and so has resulted in improved nutrition and the disappearance of pan-creatitic emaciation. In some cases of fat indigestion with diarrhea, not especially attributable to the pancreas, as in tuberculosis, pancreatin has checked the diarrhea and promoted nutrition.

The chief use of pancreatin, however, is not as a remedy for internal administration, but as an agent for peptonizing milk (and other protein foods) for invalids. A formula for peptonizing milk is:

This is kept warm at a temperature never hotter than the hand can bear continuously without discomfort (115o F.). At the end of fifteen minutes enough peptones are present to give the mixture a faintly bitter taste. At the end of an hour, or sometimes in half an hour, the milk is fully peptonized, that is, will not coagulate on the addition of nitric or acetic acid; it is changed in appearance and has a decidedly bitter taste. To obtain the greatest change of proteins to amino-acids requires twenty-four hours (Short and Bywaters). For gavage or rectal feeding milk should be "fully peptonized"; for administration by mouth it is usually peptonized only fifteen or twenty minutes because of the taste. At the end of the desired time it should be brought quickly to the boiling-point to destroy the enzyme, and should then be kept on ice. The "cold method" of adding the pancreatin and sodium bicarbonate and allowing the milk to stand without warming is uncertain and unscientific.

Pepsin preparations are not suitable for peptonizing, for they invariably contain the coagulating enzyme, rennin, and consequently coagulate the milk.