THE SUCCESSFUL TREATMENT OF ANAEMIA, WITH EFFECT SHOWN BY IN- CREASE OF RED CORPUSCLES AND HAEMOGLOBIN- BY H. P. LOOMIS, M. D, A NEW PREPARATION OF IRON IN THE TREATMENT OF ANAEMIA, WITH EFFECT SHOWN BY INCREASE IN NUMBER OF RED CORPUSCLES AND AMOUNT OF HAEMOGLOBIN. BY H. P. LOOMIS, n. D., Professor of Pathological Anatomy, Director of the Pathological Lab- oratory, Physician and Curator to Bellevue Hospital, New York. Read before the New York Academy of Medicine, Section on General Medicine, APRIL, 18th, 1893. Dr. H. P. Loomis Related a series of ex- t ' periments to determine the value of Pepto-Mangan (Gude’s) in the treatment of anaemia. It is a well-known fact, he said, that in the haemoglobin of the red blood-corpuscle manga- nese is always found. Opinions differ as to its significance. At the present time the majority of observers attribute to it an oxygenating function, some claiming that quantitatively it is more active than iron. It certainly gives off oxygen more readily than iron. Hence it has long been held that its introduction into the body would increase assim- ilation. As early as 1838 Kugler recommended the man- ganese salts in scrofula, for he had noticed in chlo- rine bleaching establishments that those who hand- led the manganese salts enjoyed an immunity from diseases of the skin, bones, or glands. For a long time, and by a number of observers, manganese has been recommended in ansemia and chlorosis, as it has been found by analyses of blood in these con- ditions that the manganese is diminished in some cases proportionately more than the iron. In spite of the high recommendation from various sources of the theoretical indication for manganese in ansemia it has not been extensively used on account of the 3 difficulty which attended its absorption. The vari- ous combinations of iron and manganese which I have employed have yielded far from satisfactory results; almost invariably they have produced digest- ive disturbances after a short time. About a year ago my attention was called to a new combination of iron and manganese, which was being extensively used in Germany. Extraordinary results were claimed for the preparation in chlorosis and anaemia by Professor Ruehle, of Bonn, and Dr. Ascher, of Hamburg. I gave the preparation a care- ful trial, and the results obtained were exceedingly satisfactory. Believing, however, that the only ac- curate test of improvement in such conditions as an- aemia is an increase in the amount of haemoglobin and the number of red blood corpuscles, I made a series of examinations in regard to this point. In most of the cases in which the preparation was given the blood was examined before, during, and after its use had been stopped. The Thoma-Zeiss apparatus for counting blood-corpuscles was used. At least three fields of sixteen squares each were counted from each specimen of blood, and the aver- age number of corpuscles in each square obtained. In this way the number of corpuscles in each cubic millimetre of blood was estimated. This is the most accurate method of determining the number of cor- puscles in a given quantity of blood with which I am acquainted. The normal number of corpuscles to 4 each cubic millimetre of blood is estimated at 4, 200,000. The amount of haemoglobin was estimated by Henocque’s haematoscope, and also by the spectro- scope. In normal blood there is about fourteen per- cent. or fourteen grains of oxyhaemoglobin in each one hundred grains of blood. To thoroughly estimate the advantages of the pre- paration eight persons with marked anaemia were se- lected, and careful notes of the cases taken while un- der treatment No other medicine was given. In some of the cases the results obtained were much better than had previously been obtained with other preparations of iron. The preparation of iron and manganese referred to is what is known as the “Liquor Mangano ferri Pep- tonatus Gudes”—or, as is written on a prescription, Pepto-mangan “Gude”—a clear, dark-sherry-colored neutral fluid, non-astringent and of mild aromatic taste, prepared by Dr. Gude, a chemist of Leipzig. The dose prescribed was a tablespoonful after meals in milk or in sherry wine. It is claimed that the combination of the iron and manganese with a pep- tone has decided advantages over the albuminate of iron in its permanency and ease of assimilation. Each tablespoonful of the mixture contained three grains of iron and one grain of manganese. The following are the histories of the cases, with the results obtained: 5 Case I.—D. G , female, aged seventy-eight, entered Bellevue Hospital suffering with pelvic cel- lulitis, the symptoms of which disappeared at the end of a week. The patient was fairly well nourish- ed, but with an excessively pale, waxy color. Exam- ination of blood showed eight per cent, of haemoglo- bin and 3,900,000 corpuscles to a cubic millimetre. After thirty-four days taking the preparation the amount of haemoglobin had increased to eleven per cent., and the corpuscles to 4,800,000. Case II.—E. W , aged seventeen, had the most profound anaemia after recovering from a severe at- tack of scarlet fever. Examination of blood showed six and one-half per cent, haemoglobin, and 2,533,000 corpuscles to a cubic millimetre. After taking the preparation forty days, the amount of haemoglobin had increased to ten per cent., and the corpuscles to 4,500,000. Case III.—A. W , female, aged twenty-two, had been excessively anaemic for over a year; com- plained of headaches, ringing in ears, dizziness, neu- ralgic pains, no organic lesion. Blood showed seven percent, haemoglobin and 3,520,000 corpuscles to a cubic millimetre the corpuscles themselves were changed, some being microcytes and poikilocytes. After twenty-three days the treatment was stopped as the haemoglobin was normal in amount and the cor- puscles had increased to 5,000,000 to each cubic mil- 6 limetre. The result in this case was the most pro- nounced of any. Case IV.—Charles M , aged twenty-one, sub- acute pleurisy lasting six weeks, very anaemic; no fever, some loss in flesh. Had taken syr. ferri iodidi for a month, with but slight improvement in general appearance. Haemoglobin eight and one-half per cent.; corpuscles 3,800,000 to each cubic millimetre. At the end of twenty days, when the treatment was stopped, the haemoglobin had increased one and one- half per cent., and the corpuscles to 4,600,000; the fluid in the chest had disappeared. Case V.—F. B , female, aged twenty-two, was admitted to the hospital suffering from insufficiency of the mitral valve. Presented the pale and anaemic appearance seen in cardiac disease. After the patient had improved so that she was up and about the ward she was put on the pepto-mangan (Gude). The ex- amination of the blood at that time showed eight and one-half per cent, of haemoglobin, and 2,600,000 corpuscles to the cubic millimetre. After taking the preparation twenty-five days the haemoglobin was eleven per cent., and the corpuscles 4,000,000 per cubic millimetre. Case VI.—B. M , aged twenty-four, suffering from primary anaemia and menstrual disturbances. No organic lesion. Haemoglobin ten per cent., cor- puscles 3,000,000 per cubic millimetre. After taking the preparation forty-three days the amount of hae- 7 moglobin remained at ten per cent., but the corpus- cles had increased 1,200,000 per cubic millimetre. Case VII.—C. V , aged fifteen, presented the ordinary appearances of the anaemic girl at the age of puberty. No organic lesion. Haemoglobin eight per cent., corpuscles 2.800,000. The examination of the blood after taking the pepto-mangan (Gude) forty days showed that the haemoglobin was normal in amount, and that there were 4,000,000 corpuscles to each cubic millimetre of blood. Case VIII.—M. M , female, aged twenty-four; six weeks after ovariotomy ; presented a markedly anaemic appearance. Had shown a slight improve- ment in color after taking Blaud’s pills for three weeks. These were stopped, and the iron and man- ganese preparation given. Examination of blood showed eight percent, haemoglobin, and 3,200,000 corpuscles per cubic millimetre. After forty-eight days the haemoglobin had increased two and a half per cent., and the corpuscles 1,300,000. In most cases the pepto-mangan (Gude) had no constipating effect. Of the eight cases in which ac- curate notes were kept, all showed a marked im- provement both in the increase in the amount of hae- moglobin as well as increase in the number of red blood-corpuscles. The average increase of the hae- moglobin was 2.2 per cent., and of the red blood- corpuscles 1,258.000. 8 • • Compliments of * • M. J. BREITENBACH COMPANY, AGENTS FOR THE = AMERICAN CONTINENT== 56-58 Warren St., New York.