Special Selection:

IRON THERAPY, WITH REPORT OF CASES.

W. C. WILLITS, M.D., KANSAS CITY, MO.

While volumes have been written on chalybeate therapy and there has been much controversy upon the absorbability of different forms of iron, much that has been written is purely theoretical. It is from the practical demonstration of things that we get the surest and safest information. It has been repeatedly demonstrated that the tincture of the chloride of iron constipates our patients and in many other ways is an undesirable agent as a routine practice; although if these undesirable after-effects could be eliminated, the therapeutic effects of the tincture are reasonably satisfactory. Many organic preparations have been upon the market, and, without any desire to underrate the efficiency of any product, we desire to cite a few cases showing that in our hands Pepto-Mangan (Gude) has almost invariably proved to be all that could be desired in treating secondary anemia. A very important point in selecting a remedy is to choose one which will not produce after-effects more serious than the original trouble, and by reference to the cases cited, it will be seen that in some of them iron in any form would seem to be contraindicated on account of the great constipation. In none of the cases were there any bad after-effects. These cases are taken from those occurring in a general practice and are not selected with any special reference to this remedy.

Pepto-Mangan is palatable, it is easily absorbed, in no case was there any injury to the teeth, it did not produce nausea; and constipation was not produced in a single case. While these few cases might not in themselves be sufficient upon which to base an opinion as to the value of Pepto-Mangan in secondary anemia, yet much valuable information can be gained by physicians reporting their successes and failures. However, after having used it quite extensively, I am convinced that it is a reliable blood remedy to use in general practice.

CASE 1.-A boy, age 8. His father died of pulmonary tuberculosis; otherwise his family history was good. Two years ago he began to get sick at the stomach in the morning and vomited. He was sleepless and coughed considerably. Temperature, 99.5 deg.; ankles were slightly edematous. Upon

examination it developed that he had a heart murmur systolic in time, but not transmitted. His blood examination showed 3,500,000 red cells, hemoglobin, 50 per cent. There were no physical signs of lung consolidation. No tubercular bacilli found in the sputum. The patient was placed in bed, and a nutritious diet ordered. He was also given Pepto-Mangan (Gude), a teaspoonful four times a day. In a very few days his symptoms began to improve. Although he was nauseated and vomited frequently when I first saw him, this trouble was not increased by the medicine and in a very few days his nausea stopped and did not return. At the end of ten days the heart murmur could not be heard. His color cleared up and he is A second blood count

now well, to all outward appearances. was not made, but from his appearance it is evident that the hemoglobin is near the normal.

CASE 2.-Miss M., age 19. Family history negative, except that one brother died of pulmonary tuberculosis at 22 years of age. She had been healthy until December, 1903, when she caught cold and coughed considerably. She was relieved of the cold, but the cough continued. Expectorates considerably. Normal weight, 105 pounds; now weighs 97 pounds. Temperature is usually normal, but things she has some fever in the evenings, but not every evening. Two or three times she sweat at night, but has not done so regularly. Never expectorated any blood. Is restless at night. Appetite poor; constipated; looks very anemic. Pulse, 90 lying down, 96 sitting, and 100 standing. No signs of consolidation or cavities in the lungs. There are a few rales present, but the expiratory effort is normal. Has a chest expansion of two and a half inches. Blood count showed red cells, 3,040,000; white cells, 4,600; hemoglobin, 60 per cent. While this looked some like tuberculosis, the sputum, on repeated examination, showed no bacilli. She was told to stay in the open air as much as possible, sleep with the windows open, and eat plenty of good nutritious food. She was also placed upon tablespoonful doses of Pepto-Mangan (Gude) four times a day, with marvelous results. In five weeks her blood count showed

red cells, 4,200,000; hemoglobin, 85 per cent. The general symptoms were greatly improved. She went west, but has continued the treatment and an occasional letter informs me that she is now absolutely well, and has greatly increased in weight.

CASE 3-Mrs. S., age 35, married. Has had four children in six years. She complained of headache, backache, and constipation. Was very much run down. Since her menstrual flow had been established after her last child, she has been suffering considerably at her monthly periods. The flow was scant and

only lasted a day or two, whereas in the past she had flowed four and five days. Her mental and nervous symptoms were very bad. Upon several occasions she nearly collapsed mentally. She had anesthesia and hyperesthesis; her memory was very poor, making it altogether a very pitiable case. She was advised to take to her bed. Was later given graduated exercise and placed on tablespoonful doses of Pepto-Mangan (Gude) four times a day. There was at no time any ill effects of the medicine noticed. Her progress was slow, but she gained in weight, her menstrual flow became normal and her nervous and mental symptoms vanished, and her color became much better. While the rest and the exercise must be given some credit in this case, we are inclined to give Pepto-Mangan the greatest amount of consideration in relieving the symptoms.

CASE 4-Miss C., aged 14. Family history negative. Suffering with chorea. She was placed on Fowler's solution and Blaud's pills. Improvement began soon, but owing to the constipating effects of the Blaud's pills, Pepto-Mangan (Gude) was used instead. The improvement was more rapid and she was not troubled with the constipation afterward. This case is briefly cited to show the advantage of Pepto-Mangan over Blaud's pills.

CASE 5.-Miss C., aged 20. Came for examination. The history showed that she had been treated for several different conditions by various physicians, but her chief difficulty was that she would fall asleep at any time of the day or night. There were no premonitory symptoms, but she would be sitting talking to a person and would go to sleep. As soon as she would wake up she would be normal again. At night she would sleep all night, but would toss about the bed, talk and laugh in her sleep. but wake in the morning not knowing that she had done any of these things. She was easily irritated, and her memory was very poor. She had been suffering in this way since she was 12 or 13 years old. Her menstrual flow was very irregular, sometimes missing two or three months. Her blood showed hemoglobin, 65 per cent.; red cells, 3.600,000; white cells, 4,000. She was given advice as to diet, exercise, rest, etc., and placed on Fowler's solution and Pepto-Mangan (Gude), the latter one tablespoonful four times a day. Her progress was very slow indeed. At the end of six months her blood showed hemoglobin, 90 per cent.; red cells, 4,500,000; white cells, 4,000. She did not sleep nearly as much, her menstrual flow was regular, and she slept more quietly at night. However, she was not entirely well. She left the city and I lost sight of her.-The Kansas City Medical Index-Lancet.

Have You a Stomach

under treatment in which there is every evidence of insufficient gastric juice?

Perhaps you have tried pepsin and found it useless.

Have you ever attempted to establish normal gastric secretions by stimulating the digestive glands and exciting the appetite? It's the most natural and effective method of treating these forms of dyspepsia due to gastric insufficiency.

Ext. carnis fl. comp. (Colden) contains a number of the more potent of the so-called chemical or physiological excitants of the digestive glands. Administered twenty minutes before meals, it will stimulate the appetite, increase the quantity and quality of the gastric juice and add tone to the entire digestive tract. Sold by all druggists. Write for literature.

THE CHARLES N. CRITTENTON CO., Sole Agents,
115-117 FULTON STREET, NEW YORK

The profession generally has come to recognize Scott's Emulsion as one of the best available remedies in the treatment of anæmic children and pale young girls. To those who have not tried Scott's Emulsion in such cases we would be glad to refer them to specific cases and would suggest an early trial of Scott's Emulsion in any particularly stubborn case of anæmia, rickets, chlorosis or

marasmus.

SCOTT & BOWNE, Chemists, Toronto. Ontario.

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