The Treatment of Chlorosis and of Rhachitis [Rickets] with Cude’s Pepto-Mangan. BY ED. HOENIGSHMIED, M.D. Chairman of the Amstetten Section of the Medical Association of Bower Austria. [Read at the Meeting of the Amstetten Section on July ai, 1892.] f N PRESUMING to speak before 1 this distinguished assemblage on a form of disease and its treatment, I fully appreciate the difficulty of my task; the more so that the sub- ject is an affection which occurs con- stantly and everywhere, and regard- ing which each one of the esteemed auditors has surely gathered valu- able experience 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 moun- tains, among a class of people who are employed at farming, it is im- possible to trace the causes usually described in text books, such as im- pure air, want of exercise, improper feeding, mental excitation, etc. I forbear, therefore, from discussing these varying hypotheses. We know positively that chlorosis depends on nothing else but an abnormal blood composition [oligocythaemiaj, with a reduction of the red blood corpus- cles to one-half or one-quarter of the normal proportion, the want of oxy- gen and of iron and manganese in the blood. The well-known symptoms are pallor of the skin and of the visible mucous membranes, labored respira- tion, breathlessness caused by the least exertion, rapid exhaustion and reduced muscular strength, cardial, gia, extraordinary desire for indiges- tible things, with loss of appetite and disturbed digestion, eructation, and general physical and mental hyperaesthesia, headaches, ringing in the ears, dizziness, oppressed condi- tion of the mind, pains and cramps ; furthermore, a frequent and thread- like pulse with irregular heart pul- sation, humming in the jugular vein, and colorless, uric-acid-deficient urine of low specific gravity, changes in the sexual functions, amenorrhoea, » dysmenorrhcea, and very often leu- corrhoea. If we consider the symptoms, thus briefly presented, we will find that many of them are also found in rha- chitic children, so far as they can affect childhood, and the rhachitis is mainly due to abnormal blood composition accompanied by an in- fectious nutrition, disturbance of the ossification process. Now, it is immaterial whether the cause depends on the reduced accre- tion or the increased elimination of calcium salts, because the medicinal effort must be directed primarily to convert the abnormal blood combi- nation to the normal, for the suit- able nurture of the body and its or- gans ; in one word, to infuse oxygen, iron, and manganese into the blood to produce red corpuscles THE TREATMENT OF CHLOROSIS AND OF RHACHITIS [RICKETS]. 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 dys- peptic symptoms as in chlorosis ; we see this disease, as also chlorosis, affect individuals who are well nur- tured 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 addition, a specially insufficient nu- trition for the bones [defective ossi- fication], the epiphysis, and the peri- ostes takes place, with exudative 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 al- ready present. In one word, we must bring those remedies into use which will quickly furnish the blood with those compo- nents which it has lost, and which produce the proper nurture of the body : oxygen, iron, and manganese, which rapidly form the red corpus- cles. 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 al- ready 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 at- tention a preparation which, owing to its happy composition, may be called a panacea for chlorosis, anae- mia, rhachitis, and all affections due to abnormal blood composition, and which possesses all attributes to in- fuse the wanting components of the blood in the shortest time, it is done exclusively in the interest of suffer- ing mankind, in the interest of science, and also in the interest of physicians themselves, who certainly evince the greatest desire to bring their patients to convalescence as quickly as possible. Manganese is of as great impor- tance in infusing oxygen into the blood as is iron, and distinguished authorities have repeatedly ex- pressed this opinion, and also main- tained that the cause of the frequent- ly long-continued chlorosis, and allied diseases of the blood, is due to the inability of distributing man- ganese in suitable form to the or- ganism in easily absorbent condi- tion. Many attempts have been made to combine manganese and iron, but most preparations contain inorganic metal salts and are there- fore, as they favor and often produce digestive disturbances, not therapeutic- ally 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 introduction into the blood. It undergoes no chemical change in the system, but is clearly and completely absorbed and taken up by the blood. I have also employed other prepa- rations experimentally, but with none have I achieved even approach- ably 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-Mangan [man- ganese-iron-pepton J, a visible im- provement does not ensue in cases- the: treatment of cheorosis and OF RHACHITIS [RICKETS], of chlorosis, anaemia, rhachitis, etc., the cause for the anaemia must rather be looked for in organic diseases [carcinoma and the like], which it is impossible to cure with medicinal agents. The directions for using this prep- aration 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 dessert- spoonful 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 ; fur- ther, 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 pro- nounced 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 abdomen with depres- sion of the panniculus adiposus ; want of appetite, and irregular pas- sages. In addition, very consider- able swellings of the joints, with de- posits 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, begin- ning with two doses, and later three doses daily. At the end of four weeks the child looked very much improved, and although the swell- ings at the 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 pre- sent. The iron, in combination with manganese and pepton acted as a tonic and blood improver ; the appe- tite was aroused, the meteorism dis- appeared, and thus a reduction of the swellings and a regular strengthen- ing of the joint was achieved. Miss M. S., 23 years old, slender, very anaemic, affected by irregular and usually profuse menstruation, had consulted many physicians re- garding her trouble. All kinds of treatments were undertaken: rhu- barb, iron, quinine, aromatic bitter remedies in various forms [such as powders, pills, drops, and mixtures], were all tried in rotation ; also water cures, baths, and various other die- tetic and medicinal agents ; even the cold water cure of the Kneipp sys- tem was given a thorough trial, but all to no purpose. I thereupon pre- scribed Dr. Gude’s Pepto-Mangan ; and after taking only a few bottles the young lady experienced a decid- ed improvement. The dyspnoea was lessened, the pulse was strengthened, the menstruation became less pro- fuse, and the accompanying pains were no longer so intense ; her appe- tite improved, and with it mental activity. With the continuation 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 mental- ly well-developed and apparently healthy being, fit to make any man happy. Marie R., 38 years old. A sufferer for many years. Consulted me with the remark that probably there was no help for her anyway. She had menstruated since her 15th year ; at first this occurred regularly every THE TREATMENT OK CHLOROSIS AND OF RHACHITIS [RICKETS]. four weeks, lasting two to four days, very profuse, and during the first days painful. After an unusual ex- ertion at field work she was caught in a heavy rain, was thoroughly soaked, and a one day’s menstruation suddenly stopped. After applica- tions of hot baths and internal rem- edies the menstruations were again brought on, but were so severe that the patient was regularly obliged to take to her bed for eight days each time, and was so weakened that it made working impossible. In addi- tion she was regularly afflicted with a mucous menstrual flow for several days before and after her periods. She was pale, pulse light, 120 per minute ; no appetite, passages irreg- ular. The percussion showed no- thing abnormal. The auscultation showed humming in the jugular vein and wavering heart intonations. Her lower extremities were considerably swollen. The patient complained of difficult breathing after the least physical exertion, and also of heart palpitation. Urine free from albumin. Treatment.—Diet regulated, and tincture of strophanthus adminis- tered in drop doses. Then, as all other iron preparations [as I found from an examination of the accu- mulated prescriptions] had been tried without success previously, I prescribed Dr. Gude’s Pepto-Man- gan, a tablespoonful three times daily. For the local affections tam- pons with ichthyol-glycerin were placed in the vagina, and irrigations with the same ordered. The flow was quickly improved, the menstruation became gradually more normal, lasting only three to four days, and the oedema disap- peared ; the appetite was restored, and under continued use of Dr. Gude’s Pepto-Mangan patient en- tirely 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 qual- ities. 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 beechwood) in 3 i. to |vi., 3 i. to $ 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 Drug- gists throughout the United States. M. J. BREITENBACH COMPANY, IMPORTERS AND SOLE AGENTS, 56 &C 53 "W'A.R.FLJmjNT ST.f 3STB3W YORK. P. s. Specify PEPTO-MANGAN (GUDE) and avoid substitution. Prescribe original bottle, l xi.