GENERAL
DIRECTIONS 203
-tively
per c.c. less than 1,000 units of tryptic strength and 2,000 units of
amylolytic power. It must be specially noted that on no account whatever should
the trypsin injection be used without the amylopsin one. The rule is for every
ampoule of 1 c.c. of trypsin (1,000 units) on injection a corresponding amount,
1 ampoule of 1 c.c. of amylopsin (2,000 to 2,400 units), must be employed. The
two injections should be mixed together in the syringe. What, for want of a
better term, may be described as the normal daily dose is 1 ampoule, or 1 c.c.
of trypsin (1,000 units) plus 1 ampoule, or 1 c.c. of amylopsin (2,000 to 2,400
units). If a less dose be deemed necessary, the contents of the ampoule can be
diluted or less used. But the one injection should never be used without the
other, and in the proportion named. On occasion I see no objections to the use
of still stronger injections, but I understand that 1,300 tryptic units per 1
c.c. represents about the maximum strength at present obtainable. As a
scientific man, I do not believe that an injection of, say, 125 tryptic units
or less is of any real value.
It
may be stated here that even with the large amounts of amylopsin injected by Captain
Lambelle in the York case the patient exhibited unfavourable symptoms of
drowsiness, nausea, and vomiting in June, 1909. These may be explained in one
of two ways: Either the amylopsin injection was breaking up into trypsin, or
sufficient amylopsin was not being used, in spite of the large and strong doses
being given. After much consideration of the matter, the writer urges strongly
the two following things. All amylopsin injections employed should have the
maximum strength possible of amylopsin
—which
is, I believe, about 2,400 units per cubic centimetre or ampoule. As shown in
Chapter IX., to all appear-