From the “ New York Medical Journal,” May /S, /BSg. 
A TONIC FORMULA. 
AUSTIN FLINT, M.D., LL.D., 
PROFESSOR OF PHYSIOLOGY IN THE BELLEVUE HOSPITAL MEDICAL COLLEGE, NEW YORK ; 
VISITING PHYSICIAN TO BELLEVUE HOSPITAL. 
In the New York Medicae Journae for July 31, 1886, Professor Allard 
Memminger, of Charleston, S. C., published a short article on “ Bright’s Disease 
of the Kidneys successfully treated with Chloride of Sodium.” The salt is 
given in doses of ten grains three times daily, the doses being increased by ten 
grains each day until they amount to fifty grains each. It is then diminished 
to sixty grains in the day and continued. I employed this treatment in a few 
cases, but did not meet with the full measure of success noted in four cases re- 
ported by Professor Memminger, although in some instances there was consider- 
able improvement. The suggestion by Professor Memminger, however, and 
his theory of the mode of action of the sodium chloride, pointed to a possible 
deficiency, in certain cases of disease, in the saline constituents of the blood. 
Under this idea, I prepared a formula in which most of the important inorganic 
salts of the blood are represented, with an excess of sodium chloride and a 
small quantity of reduced iron, the various salts, except the sodium chloride, 
being in about the relative proportion in which they exist in the normal circu- 
lating fluid. I first used this preparation in the form of powder, giving ten 
grains three times daily, after eating. It was afterwards put up in gelatine cap- 
sules, each containing five grains, but these absorbed moisture so that they 
would not keep well in warm and damp weather. The preparation is now, in 
the form of sugar-coated tablets, all under the name of saline and chalybeate 
tonic. I usually prescribe two tablets three times daily, after eating. In a few 
cases, six tablets daily have produced some ‘ ‘ fulness ’ ’ of the head, when I 
have reduced the dose to one tablet three times daily. The following is the formula that I finally adopted, the product of which 
may be put up in capsules : 
Saline and Chalybeate Tonic. 
Sodii chloridi (C. P.) 5 iij ; 
Potassii chloridi (C. P.) gr. ix ; 
Potassii sulph. (C. P.) gr. vj ; 
Potassii carb. (Squibb) gr. iij ; 
Sodii carb. (C. P.) • . gr. xxxvj ; 
Magnes. carb gr. iij ; 
Calc. phos. prascip 3 ss ; 
Calc. Carb gr. iij ; 
Ferri redacti (Merck) , . gr. xxvij ; 
Ferri carb gr. iij-; 
M. In capsules, No. 60. 
Sig. : Two capsules three times daily, after eating. 
I first used this tonic in a case of simple anaemia in Bellevue Flospital, in 
July, 1887. In this case the anaemia was profound and the pallor excessive. It 
had existed for several weeks; there was loss of appetite, and the patient, a 
female about thirty years of age, was very weak and unable to leave the bed. 
A powder of ten grains was given three times daily, and this, with good diet, 
constituted the only treatment. In forty-eight hours the patient was sitting 
up, with a fair appetite and improved appearance, notably in color. At my 
next visit, two days later, she had left the hospital and was greatly improved. 
Since the Summer of 1887, I have given the tonic in nearly every case in 
private practice in which a chalybeate was indicated. In many cases I have 
not been able to watch the effects of the remedy, and in many I kept no 
records. In thirty-three cases which I have noted as cases of anaemia, with 
loss of appetite, etc., I have more or less complete records. In twenty-two 
cases, I noted very great improvement, in twelve cases improvement not so 
well marked, and in one case no improvement. • , 
I have also records of five cases of chronic Bright’s disease of the kidneys 
in adults in which the tonic was the only medicinal remedy employed. The 
following is a brief report of these cases : 
Case I.—Male, intemperate, height five feet seven inches,weight in health 
two hundred and sixteen pounds, age twenty-eight. He had lost about sixty 
pounds in weight within nine months, weighing now one hundred and fifty-five 
pounds. The urine had a specific gravity of 1.012 to 1.015, and was loaded with 
albumin. There were granular casts in abundance. He was put upon the 
‘ ‘ tonic, ’ ’ ten grains three times daily, and told to stop drinking. After about 
six weeks of “ moderate ” drinking, but constant use of the tonic, he had 
greatly improved. He then began drinking heavily and stopped the tonic. 
About a week after this, the urine had a specific gravity of 1.021, there was a 
very small quantity of albumin, with no casts. He then resumed the tonic and 
drank less. •In three days, he was much improved. The urine had a specific 
gravity of 1.024, with a faint trace of albumin, and no casts. I saw the patient 
about five months after the beginning of treatment. He had been taking the 
tonic regularly for the past three months, but had frequently drunk to excess. 
He was, however, much improved and had gained seven pounds in weight. His urine had a specific gravity of 1.022, with no albumin (or the faimest trace), 
and no casts. About ten weeks after this he had been drinking heavily and 
had a mild attack of delirium tremens. His urine had a specific gravity of 
i.oio}4 with six grains and a half of urea to the ounce. There was no albumin 
and there were no casts. Under the treatment for alcoholism, he improved 
rapidly and was out in three days. Within the last year, I have seen the patient 
casually from time to time, but have not had an opportunity of examining the 
urine. He looks well and says he is in perfect health, but he still drinks, and 
sometimes to great excess. 
Case II.—This patient was about fifty years of age, looking in fair health, 
whose urine I examined in September, 1886, and found a trace of albumin. In 
February, 1888, I examined the urine and found a specific gravity of 1.012 and 
a considerable quantity of albumin, but no casts. I then ascertained that for 
several months he had drunk about a bottle of whisky daily. He was directed 
to stop drinking and take of the tonic two capsules three times daily. Three 
weeks after he had taken the tonic regularly, the urine was normal, and had 
a specific gravity of 1.024. I had reason to think that the patient continued to 
drink to excess, but I could not keep the case under observation. 
Case lll.—The patient was a widow, thirty-eight years of age. About six 
weeks before she came under observation she noticed that her sight was failing ; 
she could not distinguish faces, and did not go alone in the streets. The urine 
was abundant, with a specific gravity of 1.011 % and a small quantity of albu- 
min. She had lost considerable flesh within the past two months. There was 
a mitral systolic with an aortic diastolic murmur, but no enlargement of the 
heart. There was slight oedema of the feet. She was put upon the use of the 
tonic, two capsules three times daily. In a week I saw her again. There was 
no marked change. She complained of want of sleep, and was directed to 
take five grains of acetanilide at night, and to reduce the tonic to one capsule 
three times daily. She left the city and went to a village in Ontario for the 
summer. In January, 1889, eight months after, she wrote for a renewal of the 
tonic prescription, and said she had been perfectly wTell until within a few 
days, but gave no details. 
Case IV.—A clergyman, fifty years of age, of perfectly temperate and 
regular habits, had become “ run-down ” from over-work and had lost twenty- 
three pounds in weight within seven or eight months. Within a few weeks, 
albumin had been discovered in the urine. On physical examination, I found 
nothing abnormal except the urine and a reduplication of the first sound of 
the heart. The urine had a specific gravity of 1.022, with albumin in consider- 
able quantity, and a few hyaline casts of medium size. He was put upon the 
use of the tonic, two sugar-coated tablets three times daily, after eating. He 
went to Bermuda, January 20, 1889. On April 1, 1889, he returned from Ber- 
muda, feeling “ perfectly well.” He brought a report of a number of exami- 
nations of his urine, which showed a small quantity of albumin and no casts. 
On April Ist, the urine had a specific gravity of 1.021 with a moderate quantity 
of albumin. He had taken the tonic regularly since January 29th. 
Case V.—A widow, fifty-nine years of age, about ten years ago began to 
lose weight rapidly. Since that time she had lost about twenty pounds. About 
five years ago she noticed a considerable increase in the quantity of urine, with excessive thirst. The history was that of a dietetic diabetes, but the disease 
was recognized only a few days before she came under my care. The urine 
had a specific gravity of with a large quantity of albumin and six 
grains and a half of sugar to the ounce. There were no casts, and the quantity 
of urea was four grains to the ounce. There was slight oedema of the feet. 
Under a strict anti-diabetic diet for two days, the sugar disappeared from 
the urine, the specific gravity was 1.013, and the quantity of albumin was 
slightly diminished. The quantity of urea was six grains to the ounce. The 
oedema had disappeared. She was then put upon the use of the tonic, one 
capsule three times daily. 
Four days after, the tonic was increased to two capsules three times daily, 
and the patient was allowed to have a little bread. The urine contained no 
sugar, but the quantity of albumin wras unchanged. 
Nine days after she came under treatment, the urine had a specific gravity 
of 1.015 X, with a faint trace of sugar, and the quantity of urea was six grains 
and three-quarters to the ounce. The quantity of albumin was very much 
diminished. 
Two days after, the quantity of urine was normal, specific gravity 
urea six grains and a half to the ounce, albumin in small quantity, a trace of 
sugar, no casts. 
The general diabetic symptoms disappeared on the second day of treatment. 
These five cases of albuminuria are reported wdth reference only to the 
effects of the “saline and chalybeate tonic.” In all cases the tonic seemed to 
exert an influence on the quantity of albumin in the urine, which was specially 
marked in Case I. 
In the great majority of the cases of anaemia, etc., in which iron was 
strongly indicated, the tonic seemed to act much more promptly and favorably 
than the chalybeates usually employed. In a certain number of cases in which 
patients stated that “they could not take iron in any form ” the tonic produced 
no unpleasant effects. 
We manufacture these pills, both plain and sugar-coated. 
Their extensive use -would seem to confirm all the claims made 
for them by Dr. Flint. 
John Wyeth & Brother, 
Chemists, 
PHILADELPHIA.