Papaw.

FINLEY ELLINGWOOD, M. D., CHICAGO

As an assistance to imperfect digestion of almost any form, I have learned to depend upon this remedy. It acts in both acid and alkaline media. It acts promptly without any unpleasant side effects and does not weaken the secretory function of the stomach. It promotes a flow of the normal fluids and retards an excessive output of hydrochloric acid. It is to be regretted that there is not an official preparation of this most efficient remedy.

Its field is wider than that of the other digestives. It is very prompt in its action in controlling pain from indigestion, whether the pain be in the stomach or in the bowels. It acts upon albuminoids, hydrating them and converting them ultimately into peptones. It converts starch with great promptness, the ultimate product being maltose. It emulsifies fats, and has a direct tonic action on the stomach, stimulating the secretion of gastric juice or pepsinogen.

Papaw is distinctly antiseptic in its action, and prevents abnormal fermentative processes from taking place in the stomach and intestines. An important point is that it can be given in conjunction with true antiseptics, when necessary, without its digestive action being checked.

The remedy acts at all temperatures, but attains its maximum activity at a temperature of about 130°F. In several important points it differs from pepsin. The indications for the use of papaw in treating digestive disorders may be summarized somewhat as follows: Actual and relative deficiency of the gastric juice or its constituents. (a) Diminished secretion of gastric juice as a whole, apepsia, anemia and deficient blood supply, wasting diseases, (b) Diminished proportion of pepsin, atonic dyspepsia, atrophy of gastric tubules. (c) Diminution of hydrochloric acid—achlorhydria carcinoma, relative deficiency of gastric juice, overfeeding.

In gastric catarrh. (a) Where there is a tenacious mucus to be removed, thus enabling the food to come in contact with the mucous membrane. (b) Where there is impaired digestion.

In excessive secretion of acid, to prevent duodenal dyspepsia.

In gastralgia, irritable stomach, nausea or vomiting.

In intestinal disorders. (a) In constipation due to indigestion, in diarrhea as a sedative. (b) In intestinal worms; I have not personally verified this, but as the intestinal mucus which shields the worms is removed by papoid, it is easily understood that their removal would naturally result, or would be more readily accomplished after its administration. Hutchinson treated tape worm successfully with five grains of the dried juice twice daily.

In infectious disorders of the intestinal tract. (a) Where there is abnormal fermentation, by its antiseptic action, which may be heightened by combination. (b) Where there are foreign substances present, its detergent effect may be utilized in clearing these out from the intestinal canal by their digestion.

In infantile indigestion, papoid not only readily peptonizes cow's milk, but the resulting curds are also rendered soft and flocculent, resembling breast milk.

In case of obstruction of the esophagus by the impaction of a piece of meat or gristle, a paste of papoid and water produces softening in a short time.

The first indication of this remedy is distress of any character in the stomach after eating. This may range from a simple sensation of fulness or slight distention to extreme agonizing pain from the presence of food. Pain in the intestines occurring from one, to two hours after eating is almost as promptly relieved. It is my practice to give three or four grains at the beginning of the meal in cases where pain has previously appeared, and to repeat the dose near the end of the meal. Later, if pain appears, one or two doses more may be given. During the process of digestion a dose may be given every hour if necessary. In acute or subacute cases, the entire symptoms may be relieved in two or three days, when the remedy may be discontinued.

Where the stomach is weak from prolonged disease, and where prompt nutrition is demanded for rapid restoration of the patient, I give this remedy whether there is stomach disorder or not, in order that a full quantity of the pabulum may be prepared for absorption. It stimulates absorption and increases the appetite. In nervous dyspepsia no remedy is more efficient than this. Its influence is similar to that just described.

This agent is not a remedy for pain occurring before meals, or after the food is digested, or for gastric pain occurring without regard to the taking of food—continuous pain and distress—since these pains are either neuralgic or organic in character. The agent is specifically one for functional disorder.

Ellingwood's Therapeutist, Vol. 2, 1908, was edited by Finley Ellingwood M.D.