The Treatment of Chlorosis and of Rhachitis [Rickets] with Glide’s Pepto-Mangan. BY ED. HOENIGSHMIED, M. D. Chairman of the Amstetten Section of the Medical Association of Lower Austria. [Read at the Meeting of the Amstetten Section on July 21, 1892.] TN PRESUMING to speak be- J- fore this distinguished assem- blage on a form of disease arid its treatment, I fully appreciate the difficulty of my task; the more so that the subject is an affection which occurs constantly and every- where, and regarding which each one of the esteemed auditors has surely gathered valuable experi- ence himself. We come across chlorosis in all varieties and conditions of life; as often among the well-to-do and rich as among the impecunious and poor. With us in the country and mountains, among a class of people who are employed at farm- ing, it is impossible to trace the causes usually described in text books, such as impure air, want of exercise, improper feeding, mental excitation, etc. I forbear, there- fore, from discussing these varying hypotheses. We know positively that chlorosis depends on nothing else but an abnormal blood com- position [oligocythsemia], with a reduction of the red blood corpus- cles to one-half or one-quarter of the normal proportion, the want of oxygen and of iron and man- ganese in the blood. The well-known symptoms are pallor of the skin and of the visible mucous membranes, labored respi- ration, breathlessness caused by the least exertion, rapid exhaustion and reduced muscular strength, cardialgia, extraordinary desire for indigestible things, with loss of appetite and disturbed digestion, eructation, and general physical and mental hyperaesthesia, head- aches, ringing in the ears, dizzin- ess, oppressed condition of the mind, pains and cramps; further- more, a frequent and threadlike pulse with irregular heart pul- sation, humming in the jugular vein, and colorless, uric-acid-defi- cient urine of low specific gravity, changes in the sexual functions, amenorrhcea, dysmenorrhoea, and very often leucorrhoea. If we consider the symptoms, thus briefly presented, we will find that many of them are also found in rhachitic children, so far as they can affect childhood, and the 2 THE TREATMENT OF CHLOROSIS AND OF RHACHITIS [RICKETS). rhachitis is mainly due to ab- normal blood composition accom- panied by an infectious nutrition, disturbance of the ossification process. Now, it is immaterial whether the cause depends on the reduced accretion or the increased elimi- nation of calcium salts, because the medicinal effort must be di- rected primarily to convert the abnormal blood combination to the normal, for the suitable nur- ture of the body and its organs; in one word, to infuse oxygen, iron, and manganese into the blood to produce red corpuscles. Thus only is it possible for the blood to perform its functions of properly nurturing bones and joints, precipitating the necessary salts for general formation in correct form and amount, and to eliminate only the surplus. In rhachitis we see the same dyspeptic symptoms as in chloro- sis; we see this disease, as also chlorosis, affect individuals who are well nurtured and possess ample fat supply, and we arrive at the conclusion that in one, as in the other, a changed blood composition exists, only with the difference that in rhachitis, in ad- dition, a specially insufficient nu- trition for the bones [defective ossification], the epiphysis, and the periostes takes place, with exu- dative formation on the joints. The first object of therapeutics is to remove the disease symptoms, to restore the disturbed functions of the organs to their normal action, and in rhachitis to prevent exudation, or rather to remove the exudations already present. In one word, we must bring those remedies into use which will quickly furnish the blood with those components which it has lost, and which produce the proper nurture of the body: oxygen, iron, and manganese, which rapidly form the red corpuscles. In iron we certainly possess a specific; but few forms of iron are borne well and readily absorbed by the blood, while, on the contrary, they often serve to increase the already present digestive disturbances. In consequence, we often see persist- ent chlorosis continued for years, without being able to effect even the least improvement. If, therefore, I bring to your attention a preparation which, owing to its happy composition, may be called a panacea for chlor- osis, anaemia, rhachitis, and all affections due to abnormal blood composition, and which possesses all attributes to infuse the wanting components of the blood in the shortest time, it is done exclu- sively in the interest of suffering mankind, in the interest of science, and also in the interest of phy- sicians themselves, who certainly evince the greatest desire to bring their patients to convalescence as quickly as possible. Manganese is of as great im- portance in infusing oxygen into the blood as is iron, and distin- T1IE TREATMENT OF CHLOROSIS AND OF RHACHITIS [RICKETSJ. 3 guished authorities have repea- tedly expressed this opinion, and also maintained that the cause of the frequently long - continued chlorosis, and allied diseases of the blood, is due to the inability of distributing manganese in suitable form to the organism in easily absorbent condition. Many at- tempts have been made to com- bine manganese and iron, but most preparations contain inorganic metal salts and are therefore, as they favor and often produce di- gestive disturbances, not thera- peutically suitable. This preparation of Dr. A. Gude (Chemist), of Leipsic, contains the important manganese in the most favorable combination with iron and peptone for ready introduc- tion into the blood. It undergoes no chemical cha?ige in the system, but is clearly and completely ab- sorbed and taken up by the blood. I have also employed other pre- parations experimentally, but with none have I achieved even ap- proachably similar good results. On the basis of my so-far-noted experiences, I venture to say that if, after the use of one or two bottles of Dr. Gude’s Pepto-Man- gan [manganese-iron-pepton], a visible improvement does not ensue in cases of chlorosis, anae- mia, rhachitis, etc., the cause for the anaemia must rather be looked for in organic diseases [carcinoma and the like], which it is impos- sible to cure with medicinal agents. The directions for using this preparation are as follows: Adults should take, when beginning, twice, and after a week three times daily, a tablespoonful in milk, water, coffee, chocolate, or sweet wine. Children, two or three times daily a dessertspoon- ful or less according to age. All sour or fat dishes, uncooked fruits and sour wines, as well as red wines, should be avoided. On the other hand, it is recommended to eat all kinds of milk dishes, roasts, venison, light bread and other wheaten and farinaceous foods; further, to drink sweet wines, not sour or white wines, or good beer. I beg to add the record of a few cases. A. St., 4 years old. Besides pronounced pallor of the skin and the visible mucous membranes, showed a small, thread-like pulse, murmurs of the heart and in the jugular vein, a large, bloated ab- domen with depression of the panniculus adiposus; want of ap- petite, and irregular passages. In addition, very considerable swell- ings of the joints, with deposits on the epiphysis; in short, all the indications of extreme anaemia and rhachitis. The child, formerly very active and full of life, had been unable for weeks to walk. Treatment. — Regulation of diet, and Gude’s Pepto-Mangan, beginning with two doses, and later three doses daily. At the end of four weeks the child look- ed very much improved, and although the swellings at the 4 THE TREATMENT OK CHLOROSIS AND OF RHACHITIS [RICKETS], joints continued it was able to stand and make attempts to walk. Now, after a relatively short time, the child is as happy and as full of life as before, and only traces of the joint swellings are still present. The iron, in combination with manganese and pepton acted as a tonic and blood improver; the appetite was aroused, the me- teorism disappeared, and thus a reduction of the swellings and a regular strengthening of the joint was achieved. Miss M. S., 23 years old, slen- der very anaemic, affected by ir- regular and usually profuse men- struation , had consulted many physicians regarding her trouble. All kinds of treatments were un- dertaken: rhubarb, iron, quinine, aromatic bitter remedies in va- rious forms [such as powders, pills, drops, and mixtures], were all tried in rotation; also water cures, baths, and various other dietetic and medicinal agents; even the cold water cure of the Kneipp system was given a tho- rough trial, but all to no purpose. I thereupon prescribed Dr. Gude’s Pepto-Mangan; and after taking only a few bottles the young lady experienced a decided improve- ment. The dyspnoea was lessened, the pulse was strengthened, the menstruation became less profuse, and the accompanying pains were no longer so intense; her appetite improved, and with it mental activity. With the con- tinuation of the treatment the young lady, in the same ratio as her physical condition improved, became more lively and light- hearted, and now presents the picture of a physically and men- tally well-developed and appa- rently healthy being, lit to make any man happy. Marie R., 38 years old. A sufferer for many years. Consult- ed me with the remark that pro- bably there was no help for her anyway. She had menstruated since her 15th year; at first this occurred regularly every four weeks, lasting two to four days, very profuse, and during the first days painful. After an unusual exertion at field work she was caught in a heavy rain, was tho- roughly soaked, and a one day’s menstruation suddenly stopped. After applications of hot baths and internal remedies the men- struations were again brought on, but were so severe that the pa- tient was regularly obliged to take to her bed for eight days each time, and was so weakened that it made working impossible, in addition she was regularly af- flicted with a mucous menstrual flow for several days before and after her periods. She was pale, pulse light, 120 per minute; no appetite, passages irregular. The percussion showed nothing abnor- mal. The auscultation showed humming in the jugular vein and wavering heart intonations. J ler lower extremities were consider- ably swollen. The patient com- plained of difficult breathing after the least physical exertion, and TIIE TREATMENT OF CHLOROSIS AND OF RHACIIITIS [RICKETS]. 5 also of heart palpitation. Urine free from albumin. Treatment. — Diet regulated, and tincture of strophanthus ad- ministered in drop doses. Then, as all other iron preparations [as I found from an examination of the accumulated prescriptions] had been tried without success pre- viously, I prescribed Dr. Gude’s Pepto-Mangan, a tablespoonful three times daily. For the local affections tampons with ichthyol- glycerin were placed in the va- gina, and irrigations with the same ordered. The flow was quickly improv- ed , the menstruation became gradually more normal, lasting only three to four days, and the oedema disappeared; the appetite was restored, and under continued use of Dr. Gude’s Pepto-Mangan patient entirely recovered, and can again fully perform her duties. In all cases where I have tried Dr. Gude’s Pepto-Mangan I have found it a most valuable remedy, and I beg of you, esteemed friends, to convince yourselves also of its excellent qualities. T. Byron De Witt, M. D. San Francisco, Cal, February 5th, 1894. GENTS: — I have used Gude’s Pepto-Mangan in combination with creosote (Merck’s beech wood) in 3 i. to vi., 3 i. to 3 viii. I have prescribed in cases of pulmonary tuberculosis with hemorrhagic diathesis, with marked benefit to patients. More recently I have used it in suppurative phthisis, and have been much pleased to witness the diminished catarrhal suppuration. It is taken by patients without difficulty, and agrees well with the most sensitive stomachs, even in larger doses than indicated above. Yours truly, T. BYron De Witt. GUDE’S PEPTO-MANGAN can now be had of all Druggists throughout the United States. M. J. BREITENBACH COMPANY, IMPORTERS AND SOLE AGENTS, 50 & 58 WARREN ST., NEW YORK. P. S. Specify PEPTO-MANGAN (GUDE) and avoid substitution. Prescribe original bottle, 3 xi. GUDE’S PEPTO-MANGAN. (Liquor Mangano-ferri Peptonatus Gude.) The Uses and Effects of Gude’s Manganiferous Iron Peptone. BY DR. JULIUS HEITZMANN. VIENNA. ' I ’'HE employment of iron pre- parations both in essential anaemia (chlorosis), and in the symptomatic forms of this affec- tion produced by severe losses of blood, dates from the earliest times. Long before the chemical relation of this effect was known, these remedies were administered on the ground of pure empirical ex- perience. When Hannon pointed out the high significance of manganese, as well as of iron, with regard to the absorption of oxygen by the blood, and when this disco- very was confirmed by Ruehle, efforts were made to produce, by combination of both remedies, pre- parations which would best fulfill the therapeutic indications in all directions. Former attempts of this kind failed to give the desired results. The aim was to combine both me- tals in such a form as would en- able them to be absorbed through- out the entire extent of the ali- mentary canal, and at the same time be devoid of disagreeable taste which would prevent their prolonged administration. After a series of experiments made in this direction I found in the pre- paration discovered by Dr. A. Gude (Pepto-Mangan—Gude), a remedy which fulfilled the above requi- sites, and can recommend it most heartily. Pepto-Mangan—Gude is a clear, dark, wine-red fluid, having an agreeable, non-metallic, astringent taste. The latter property gives it a great advantage over other similar preparations, for the re- medy is always taken with plea- sure, and may therefore be ad- ministered for a long time without exciting the disgust of the patient. No irritation of the stomach is pro- duced, nor is the digestion distur- bed in the least respect; indeed, as regards the latter, a stimula- tion of the long-absent appetite could be demonstrated within a short time. The Pepto-Mangan—Gude, usu- ally mixed with some water, is THE USES AND EFFECTS OF LIQUOR MANGANO - FERRI PEPTONATUS. 7 prescribed in doses of two or three dessertspoonfuls, increased to as many tablespoonfuls per day. An especially agreeable manner of administration is by addition of cold milk, which then assumes a light chocolate color and an agree- able taste. Prescribed in this form we obtain from this preparation everything that could be expected from a remedy for ansemia. The Pepto-Mangan — Gude may also be mixed with white and sweet wines, excepting the red wines which contain tannic acid, and an occasional change in the manner of administration is sometimes of advantage, especially in the case of children. The diet, during the use of this preparation, should consist of milk, meats — especially ham — fowl, soft-boiled eggs, and other easily digested foods. On the other hand, sour and fatty foods, red wines, and raw fruits are to be avoided. The remedy is to be adminis- tered for a number of weeks, espe- cially in cases of chlorosis, but in the case of young girls up to 12 years of age it is best to com- mence with a daily dose of two teaspoonfuls (ten grammes). In adults the dose of the Pepto-Man- gan— Gude may be increased in a few days to one tablespoonful twice or thrice daily, or even to ten or twenty grammes. The preparation should be well pro- tected from the light, and preser- ved in a cool place in a well- stoppered bottle. 1 have employed the Pepto- Mangan— Gude with much suc- cess both in chlorosis and in cases of ansemia in girls and women due to loss of blood, menorrhagia, metrorrhagia, inflammation of the pelvic organs, peri- and parame- tritis, or prolonged leucorrhoea. In almost every instance I obser- ved within a short time increase of appetite, improved nutrition, healthier color of the face, and increase of weight. I was sur- prised to learn how much more readily the Pepto - Mangan— Gude was taken than similar prepara- tions, without ill effects even after protracted use. To illustrate my remarks I will cite a few cases: I will first report a case of chlorosis treated with this remedy, which was under constant obser- vation. The patient, a school girl aged 16, began to menstruate one year ago, but after appearing re- gularly for three periods the flow suddenly ceased, probably in con- sequence of mental overexertion, and symptoms of chlorosis soon developed. The various prepara- tions of iron were tried, but were either not well borne or excited so much disgust that they were discontinued by the capricious pa- tient. A milk cure was prescribed, but followed for only a short time. When, however, I resorted to the Pepto-Mangan—Gude I was sur- prised to find that the girl took it willingly and that it was well borne. She made a rapid reco- very, and after the use of two bottles had regained her former 8 THE USES AND EFFECTS OF LIQUOR MANOANO-FERKt PEPTONATUS. healthy color, while her strength and menstruation returned. Case II. — A married lady, aged 24, had acquired — appa- rently of abortion at a very early period—an intense periand para- metritis with an exudation of the size of a child’s head. The latter disappeared almost completely under suitable treatment and rest, so that only a slight induration was present in the parametrium after three weeks. Owing to the considerable anaemia and loss of appetite, however, the patient re- covered very slowly, and for this reason I ordered the Pepto-Man- gan— Gude. A few days after its use the appetite reappeared, recovery ensued rapidly, and five weeks later her health was com- pletely restored. Case III. — A married lady, aged 30, had suffered from leu- corrhcea due to catarrhal inflam- mation of the vagina for two years, and although the local trouble had been much relieved she continued pale and weak. As her chlorotic daughter at the time was taking the Pepto-Mangan— Gude with marked benefit, I advised her also to try this preparation. She follo- wed my advice, and after four- teen days the weak, sluggish, and pale woman seemed as if trans- formed. She has since regained her former health. These few cases, which were under continued observation, will confirm what has been said above regarding the manner of applica- tion and effect of the Pepto-Man- gan—Gude. 1 regard it as super- fluous to cite other cases, since a few closely observed cases teach more than a host of superficial observations. On the ground of my expe- rience I consider myself warranted in directing the attention of phy- sicians to this remedy, and feel convinced that further trials will give equally favorable results. Even in cases where local treat- ment is necessary the Pepto-Man- gan—Gude will prove a valuable auxiliary in our treatment. — All- gemeine Wiener medizinische Zei- tung, xxxvi. GUDE’S PEPTO-MANGAN can now be had of all Druggists throughout the United States. M. J. BREITENBACH COMPANY, IMPORTERS AND SOLE AGENTS, 50 Sc 58 WARUEN ST., NEW YORK. P. S. Specify PEPTO-MANGAN (GUOEJ and avoid substitution. Prescribe original bottle, 5 */.