THE VALUE OF GUDE’S PEPTO-MANGAIST IN THE TREATMENT OF ANAEMIA BY HUGO SUMMA, A. M., M. D. ST. LOUTS PROFESSOR OF PATHOLOGY, PATHOLOGICAL ANATOMY, AND BACTERIOLOGY, MARION-SIMS COLLEGE OF MEDICINE PHYSICIAN TO THE EVANGELICAL DEACONESS HOSPITAL PATHOLOGIST TO THE BEBEKAH HOSPITAL Reprinted from the New York Medical Journal for February 9, 1895 Reprinted from the New York Medical Journal for February 9, 1895. THE VALUE OF GUDE’S PEPTO-MANGAN IN THE TREATMENT OF ANAEMIA. By HUGO SUMMA, A. M., M. D., ST. LOUIS, PROFESSOR OF PATHOLOGY, PATHOLOGICAL ANATOMY, AND BACTERIOLOGY, MARION-SIMS COLLEGE OF MEDICINE ; PHYSICIAN TO THE EVANGELICAL DEACONESS HOSPITAL *, PATHOLOGIST TO THE REBEKAH HOSPITAL. The year 1893, with the publication of the results of very careful chemical investigations of the conditions of the blood in various diseases, especially those of the blood itself by Professor von Jaksch (1), the well-known author of the Handbook on Clinical Diagnosis, marks a new era in our understanding’ of the various anaemic processes. Our former vague knowledge of these conditions was molded into definite shape and form chiefly by his successful effort to elucidate all the characteristic features common to the various forms of anaemia. He was thereby enabled as the first one to give a definition of this, up to this time, so pli- able and undoubtedly much-abused term, anaemia. Anaemia, in the broadest sense of the word, includes all those processes characterized by a decrease in the amount of albumin and by an increase of the liquid part of the blood ; in other words, hypalbuminaemia and hy- draemia are conditions present in all forms of amemia, and Copyright, 1895, by D. Appleton and Company. GUDE’S PEPTO-MANGAN IN AN.EMIA. this holds good not only in cases of primary anaemia, like leucaemia and chlorosis, but also in all so-called secondary an*mia. This discovery enables us to understand the hitherto empirical fact that the treatment of anaemia requires not only or exclusively the administration of iron, but that all the metabolic processes, especially the introduction and assimilation of albuminous substances, must be increased, should the treatment be followed by success. But just this part of the treatment is exceedingly difficult, since one of the most constant symptoms which we meet with in the various forms of anaemia is a more or less high degree of anorexia. This anorexia completes the “circulus vitiosus” so frequently observed in clinical pathology—a circulus vitiosus which must be understood in each individual case in order to be amenable to successful treatment. For it is evident that a continuous anorexia will lead to insufficient nutrition, to subnutrition, thereby constantly increasing the condition of hypalbuminamia. The anorexia is, however, a natural sequel* of this ab- normal condition of the blood, in consequence of which, at least in the greater number of cases, the secretion of hydro- chloric acid is decidedly diminished (2). In the treatment of these cases, therefore, we must constantly bear in mind the condition—hypalbumimemia. In order to facilitate the increase of albumin in the blood, notwithstanding the anorexia already existent, its adminis- tration in the form of easily assimilated peptones would be most rational. Prompted by this thought, I began in the spring of 1893 to make use of l)r. Gude’s preparation, known as pepto-mangan, in most all cases of anaemia that came un- der my observation, with the exception of those accom- panying or following chronic infectious diseases, such as GUDE’S PEPTO-MANGAN IN ANASMIA. tuberculosis, or of malignant tumors, such as cancer, etc. I collected from my clinical record thirty-four cases. The greater number of these were closely observed, not only as to the influence of the remedy upon the subjective symp- toms, but also as to its effects upon the blood by careful examinations which I carried out with the aid of Gartner’s haematokrit (3). This excellent instrument, which requires the use of Professor Gartner’s Kreisel (spinning top) centrifugal ma- chine, enables, in a very accurate manner, a determination of the volume percentage of the red blood-cells within about ten minutes. I prefer this method of determining the efficacy of a remedy against anaemia to the old method of counting the red blood-corpuscles. Although, generally speaking, the number of the red blood-corpuscles bear a certain proportion to the volume percentage, yet it would be wrong to identify both. In blood diseases especially, the knowledge of the volume per- centage is undoubtedly of great importance. During the above mentioned period I observed neither cases of leucaemia nor of pernicious progressive anaemia. The thirty-four cases I treated with pepto-mangan were partly cases of chlorosis and partly secondary anaemia, oc- curring chiefly after subacute malaria and typhoid fevers. Of these I select six as paradigmata, as it were. Two of these were cases of chlorosis and four cases were secondary anaemia: Case I.—Miss A. S., aged eighteen years; chlorosis rubra; oligocythemia and oligochromemia; palpitation of the heart; frequent pulse; coated tongue; foetor ex ore ; constipation ; ir- regularity in menstruation; easily fatigued; muscular weakness. At the beginning of treatment, thirty-per-cent, volume; eight days later, thirty-eight per cent.; at the end of the fourth GUDE’S PKPTO-MANGAN IN AN.EMI A. week, forty-eight per cent. Great improvement, slight cata- menial disturbances only remaining. Case II.—Miss E. B., aged sixteen years; puleness of skin and visible mucous membranes; slight dyspnoea, short breath; oligocythaemia and oligochromiemia; palpitation of the heart; tachycardia; anaemic systolic murmurs, increased second pul- monary sound; disturbances in menstruation; tired feeling; sleepy condition. At the beginning of treatment twenty-eight-per-cent, volume of red blood-corpuscles were found; increased within eight days to thirty-five-per cent, volume; after four weeks, forty- five per cent. Apparently complete recovery. Case III.—R. T., aged five years; first treated for subacute malarial disease extending over t wo months. Patient had greatly decreased in weight. No appetite, retarded action of the bowels; great pallor; continuous tiredness and weakness. On examin- ing the blood, I found thirty-five-per-cent, volume of red blood- corpuscles; eight days later they increased to forty-two per cent.; at the end of four weeks to forty-eight per cent. Com- plete recovery. Case IV.—Mrs. A. R., aged twenty-eight years; suffered from chronic malarial disease. Mother of two children, the youngest four months old. Far advanced case of secondary anaemia. Patient unable to do any kind of work. Digestive disturbances. Determination of volume of red blood-corpuscles showed thirty-two per cent., which increased within eight days to thirty-eight per cent., and finally reached forty-five per cent. Great general improvement. Case V.—Mr. T. K., aged nineteen years, butcher. Ty- phoid fever of moderate severity; during this disease pana- ritium of right thumb followed by lymphadenitis axillaris. Slow recovery. Anaemic condition very pronounced. No prominent single feature. General languor. Shortly after pa- tient had entered the period of reconvalescence the blood ex- hibited twenty-six-per-cent, volume of erythrocytes; fourteen days later an increase to but thirty-two-per-cent, volume ; after four weeks, forty-six per cent. Patient now in very good health. GUDE’S PEPTO-MANGAN IN AX A) MI A. Case VL—Mr. T. M., aged twenty-four years, saloon keeper. Ulcus ventriculi rotundum chronicum for seven years. Intense localized pains with frequent attacks of vomiting, sometimes of pure blood. Hyperchlorhydria of moderate degree, 3’2 per cent. Quite pronounced anaemia. After recovery from primary dis- ease the volume of his red blood-corpuscles amounted to thirty- six per cent.; eight days later we found forty-per-cent, volume; finally, fifty-per cent, volume. Patient up to this time was free from symptoms of any kind. In conclusion, I should like to state that similar good results were obtained in the remaining twenty-eight cases. It is especially worth while mentioning that no bad after- effects could be detected. In this connection I call special attention to the absence of constipation that could be traced back to the use of this preparation. The dose varied from a teaspoonful to a tablespoonful three times a day an hour after meals, either in sherry or milk, according to the individual case, especially according to the condition of the digestive organs. 1. Jaksch, R. v., Professor. Ueber die Zusammensetzung das Blutes gesunden und kranken Menschen. Zeitschrift fur Jclinische Medicin, Bd. xxiii, pp. 187-224. 2. Bouveret, L. Traite des maladies de Uestomac, Paris, 1898. pp. 709, 710, with complete enumeration of literature. 3. Friedheim, Dr. Ueber die Volumbestimmung der roten Blutkorperchen vermittelst des Gartner’scben Hamatokrit und der Kreisel-Centrifuge. Berliner Jclin. Wochenschrift, 1893, No. 4. Literature referred to. > g» o Z » > Q c ,r — a k j h a n S z V M m £ » _ ft M “ a r w W s j?5 b 3 p 5 ? pi y 5!i ! 5 < * c p » © D <3 S pi ■ c/5 O H c ps B * g- s' S W S«* g g «* g< E. " O g * n O O O ro P6 £ £ 5 * 0 ca 2 tn M S w ro o o ro *1 C o M ® M «> 3 H* S‘ S3 ’-CJ CTD e=s 5=3 t=s CD l-V Jjsw ?=T Ct> !Z? t=3 j . erf B B B3 « \ s- § g. S 1 CO p3 S CTO. i 53-ca g t 1 2 3» : sr. £ £ ?o S 2. £*18 2 : m r* 3 g* £ P 1 if. SJ *7 ft i: 7 ~ *S a r* ,; z z a as m j = Ss*)!S; X =’?3 £ 5 2. ft «* g- ■ B >2 »33 — 3 Zui Sic p a a o - 2 r* -1 2 tf & ? ® r —1— s -i.T 2 95 r* 3 2 s - £52 p ? p __ 3 .I"||r 1 s- fi-51 I §-111-p f : k I !§ If 13. s? 4* I £ 11 a |»| I 3" § 5^»*■!!&!?■&•:i-717? a =i *iIs s 8s =' -i" — r;'5:,::; 3 x' = 5’ 3 s W52 i 5 £. ? ® s’ c § - 2, » 2 5 § f _f, g. |»s- ? 5 s 1; 7 j % s | = r a * 3 s : 3 -a c t M *2 5 J5 , & ? 2 o 5 g s ? ;&eio 5 : , ">■ i i PSaT?ss5f%5f» £. z--i~ ~?i U-2 ® 1 a S i 5 < - 2 ►>»! r- ■ : s ='£•/ / /'Srs’1’'. o 5 g 2 2. (S B 2. ? X ? g* y 1 i 1j; ~ Z O ~ 5 1.8.3 ?cj g | S-1 6. 5 S ’S .5 8*' % - § ® r l*;inZzlzUt: if 1 -g-3 §• nig> 5 f <| r|3.8> i J- ? 3 * § £ t \ r' 1 = 0 *P s | s- -<~033-„ 2 — _ 3. -. * e =*? -■» 5 n S 3. ? -Z-~xZ* » x 3 • i g 3y B = S*r-S a. s 3-5. =-l3?|.!r$ ?r i 2 5-s.r’» & S8&I.5&1 > S'- i o>3 5 5 d 7' z1' 2 jf v : ' r--' 1 — ®-5»'5CC t " r x r r v -.£3. — wi*rr'“- 1 ? * , 5 > r-3 ■* 3-t; £.5 <52£-2;;x03 Sss-sa.?. «||^ff|-S'»»-gS,fB|9 - 20S.-? = C.-565?s-^«i* c"1 5 — “ 2.J / S “ 3 J 2 a 3 7; 5 > ''■ S Z w * 7 v *" 3 I? 't i J m 8 23 O to r» /• 11 * «*-.*• x fr w !3 •— hi r i _ SI a* 3 * ?• -j —■ 3 r 3 r* "i 3. r- ■ & —SiIpt *‘'1 2. a> 1: 3.—»3 <5 The New York Medical Journal. A WEEKLY REVIEW OF MEDICINE. EDITED by , .FRANK P- FOSTER, M.D. PHYSICIAN who would keep abreast with the advances in 1 medical science must read a weekly medical journal, in which scientific facts are presented in a clear manner;. one for which the articles are written tiy men of learning, and by those who are good and accurate Observers ; a journal that is stripped of every feature irrelevant to medical science, and gives evidence of being carefully and conscien- tiously edited ; ope that bears upon evpry page the stamp of desire tt> elevate the standard of the profession of medicine. . Such a journal fulfills its mission—that -of educator—to the highest degree, for not oply does, it inform its readers of all that is new in theory and practice, but, by means of its correct editing, instructs >thetn in the very important yet rriuch-neglected art ofexpressing their thoughts and ideas in a clear and correct'manner. Tod much stress can not be laid upon this feature, so utterly ignored by the “ average ” medical periodical. Without making invidious comparisons, it cap be truthfully stated that no medical journal in this country occupies the place, in thes'e par- ticulars, that is held by The New York Medical Journal. No other journal is edited with the cape that is bestowed on this; none contains articles of such high scientific value)'cbipmg • as they do'from tlie pens qf the brightest and most learned medical men of America. A glppce at the list of contributors to any volume, or an examination of any issue of the Journal, Will attest the truth of these statements. It is, a journal for the masses of the profession, For the country' as well as for the city practitioner ; it covers the entire range of medicine and surgery. A very important feature of the Journal is the number and character of its illustrations, which are unequaled by those of any other journal in the world. They appear in frequent issues, whenever called for by the article which they accompany, and no expense is spared to make them of superior excellence. Subscription price, $5.00 per annum. Volumes begin in January and July. PUBLISHED BY D. APPLETON & CO-, 72 Fifth Avpnue, New York.