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Deutsche Zeitschrift fiir N ervenhcilkunde , xxxi, 47J, 1906. 4. C. D. Fox. Journal of Abnormal Psychology, v, i. 5. W. G. Spiller. Ibidem, i, 6. 6. A. Forel. Hypnotism. 34 W'est Eighty-third Street. SOME CLIKIC.\L STUDIES IN THE PEPSIN AND DIASTASE CONTENT OF URINE. How Much Does Viagra Cost At Walmart Pharmacy By Edward How Much Does Viagra Cost At Walmart Pharmacy H. Goodman, M. D., ' Philadelphia. il-'rom the Laboratory of Dr. John H. ilusser.) Many papers have been devoted to the question of the practical value to be obtained from the esti- mation of the urinary ferments, especially pepsin and diastase, and after perusing the literature one is forced to the opinion that but little benefit, iliag- nostically and prognostically, is to be derived from the study. Not only by clinicians, but also by physiologists, have the origin, amount, and signifi- cance of these two ferments been studied, and it would seem of some interest to draw briefly an his- torical sketch of the most important work done to date. PEPSI X. To Briicke (i) (quoted by Ellinger and Scholz) is generally accredited the honor of having discov- ered the presence of pepsin in the urine, by noting that a fibrin flake placed in urine acidified with hy- drochloric acid was dissolved. Whence the pepsin came, he did not definitely state, but he supposed it to be the unused pepsin which was absorbed from the intestine and later excreted in the urine. This extremely valuable observation apparently aroused but little interest, for not until twenty years later do we find any attention whatsoever being devoted to the subject. At this time Griitzner (2) was able to isolate from the urine a diastatic, a proteolytic, and a co- agulating ferment by making use of a discovery of von Wiitich that fibrin was able to absorb ferments from a liquid if allowed to remain in the latter. He made a few observations on the quantities of ferment which are of themselves of small signifi- cance, but which led to important studies by his pupils, Sahli, Gehrig, and Hoffmann. Sahli (3) found that there were variations in the pepsin output, but that these were in direct relation to the time of day and to food. The greatest amount was found How Much Does Viagra Cost At Walmart Pharmacy in the urine collected in the morning before breakfast, while the smallest oc- curred in the hours immediately following the after- noon meal. Sahli believed that the urinary pepsin was identical with that of the gastric juice, being absorbed directly from the cells or else absorbed with other products of digestion. Gehrig (4) confirmed Sahli's work, but made a curiously simple observation, which it seems in- 778 GOODMAN: PEPSIN AND How Much Does Viagra Cost At Walmart Pharmacy DIASTASE IN URINE. credible that the latter sliould have overlooked, namely, that the time of day of itself played no role in determining the quantitative output of pepsin, but that all the influence could be ascribed to the food. He differs with Sahli as to the origin of the ferment, and believes it is absorbed from the glands of the stomach as propepsin and is converted into pepsin either by the renal epithelium or by the ac- tion of the urine itself. Hoffmann (5) agreed with the findings of Geh- rig, but was unable to suggest an explanation for the diminution of pepsin after a meal. As is well known, the urine is alkaline at this time, and since Langley (6) found that a very weak alkaline solu- tion suffices to destroy the ferment, it might a priori be explained on this basis. He, however, was able to render his urine strongly alkaline by taking sodium bicarbonate, but with no effect on the pepsin output. He holds that the urinary pepsin is a pro- duct of the gastric glands and is not merely the unused ferment absorbed from the intestine. Leo (7) was able to show b}- an ingenious though rather coarse experiment, that pepsin was present in the first third of the small intestine and had disappeared in the middle third. A lapse of twenty years ensued before Leo's work excited comment, but then Grober (8 and 9) was able to confirm fully the former's obsen^ations by work more carefully planned and sedulously executed. Still later, Loeper and Esmonet (10") oft'ered fur- ther proof of the destructive action of the duodenal mucous membrane on pepsin, and found that mere contact of an isolated segment of the duodenum with How Much Does Viagra Cost At Walmart Pharmacy a pepsin solution diminishes its strength one quarter. It would seem improbable from these ob- servations that the pepsin could be' absorbed in an active condition from the intestinal canal. It must be presumed, since there is no note to the contrary, that the older authors regarded the gastric and urinary pepsin as identical, but definite proof was first offered by Delezenne and How Much Does Viagra Cost At Walmart Pharmacy Frouin (11). They made comparative studies of the pep- sin output in animals deprived of the stomach, and in animals in which the stomach was so iso- lated that food passed directly from the oesophagus into the duodenum, while the gastric secretion was drawn from the stomach by means of a fistula. In the gastrectomized animals no pepsin was found, while in those with the isolated stomach it was al- ways present, and they aver that this proves the identity of the gastric and urinary pepsin. In order to demonstrate that the presence of the ferment was not due to the length of time the gastric juice re- mained in the stomach, they withdrew it at inten^als of six hours, finding pepsin, however, always pres- ent in the urine. To prove that it is not absorbed from the intestine, they gave .550 c.c. of the gastric