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-