ANAEMIA : 
ITS CAUSE AND TREATMENT 
WITH PEPTO-MANGAN 
(DR. GUDE'S). 
BY 
House Physician to the Winyah Sanitarium, Asheville, 
GEORGE D. BARNEY, M.D., 
N. C. (formerly of Brooklyn). 
Neto Yorft fHebi'cal /Journal 
REPRINTED FROM THE 
for December 7, 1895. Reprinted from the Nero York Medical Journal 
for December 7, 1895. 
ANAEMIA: 
ITS CAUSE AND TREATMENT WITH PEPTO-MANGAN 
(DR. GUDE'S). 
GEORGE D. BARNEY, M. D., 
HOUSE PHYSICIAN TO THE WINYAH SANITARIUM, ASHEVILLE, N. C. 
(FORMERLY OF BROOKLYN.) 
Anaemia is a disease that we find in all classes and con- 
ditions of the human family, females in excess, of every 
nation and clime, its victims made up as an average of 
childhood, youth, and old age. 
Classification of Anaemias.-1. Simple anaemia, where 
both the haemoglobin and the corpuscles are diminished. 
2. Chlorosis, where we find the haemoglobin diminished 
and the corpuscles normal. 
3. Primary chlorosis or pernicious anaemia, where the 
corpuscles are diminished and the haemoglobin is relatively 
increased. Perhaps it might be better stated by saying 
that the percentage of decrease of corpuscles is greater than 
that of the haemoglobin, which latter may fall to twenty per 
cent. 
The symptomatic varieties of anaemia may be due to 
many causes: 
1. Haemorrhage. 
2. Pathological discharges, such as prolonged lactation, 
Copyright, 1895, by D. Appleton and Company. 2 
PEPTO-MANGAN IN ANAEMIA. 
sexual excess, profuse menstruation or suppuration, albu- 
minuria, diabetes, and watery diarrhoea. 
3. Malignant growths. 
4. Toxic and infective, such as carbonic-dioxide poison- 
ing, from tea, tobacco, coffee, alcohol, tuberculosis, and 
syphilis. 
5. Animal parasites. 
6. Obstacles to taking food which are mechanical in 
their nature. 
7. Dyspepsia. 
8. Venous stasis in cardiac and pulmonary disease. 
9. Impaired sanguinification in diseases of cytogenic 
organs, malaria, leucaemia, or Hodgkin's disease. 
10. Fever. 
-Predisposing causes : 
1. Sex: females in excess. 
2. Age : childhood, youth, and old age. 
3. Constitution : those having a weak and irritable con- 
stitution. 
Exciting Causes.-Deficient blood supply ; want of light 
and air; excess or defect of body exercise; unusual states 
of temperature ; increased expenditure of unoxidized mate- 
rial ; menstruation or lactation; psychical influences; de- 
pressing emotions. 
The symptomatology of anaemia may be divided into 
the dropsy, loss of body weight, and fever. 
Alimentary.-Retching, vomiting, atonic dyspepsia, con- 
stipation, sometimes diarrhoea. 
Circulatory.-Palpitation of the heart, faintness, prae- 
cordial distress, hiccough. 
Respiratory.-Dyspnoea, slight cough without expecto- 
ration. 
Gcnito-urinary.-Polyuria; variable menstruation; sex- 
ual torpidity. PEPTO-MANGAN IN ANJEMIA. 
3 
The composition of the blood has recently received a 
very considerable attention. Gorup and Besanez state 
that the blood of man contains one part of iron to two 
hundred and thirty parts of the red blood-globules. C. 
Schmaltz, in his investigations, says : " The specific gravity 
of the human blood varied from 1-059 in the male to 1'056 
in the female," and he also says the ingestion of a physio- 
logical solution of salt, a thousand cubic centimetres, had a 
very feeble and short influence on the circulation. 
In anaemia and cancerous cachexia the specific gravity 
may fall to 1'030; it varies according to the amount of 
haemoglobin it contains. 
In serious disease of the stomach the mass of blood is 
diminished on account of inanition. 
In phthisis and cardiac disease its density is increased, 
because of the slowing of the peripheral circulation. 
Meyer and Pernou found that the iron in the liver cells 
of the foetus was ten times as great in amount as in the 
grown animal, showing that it might be stored there to 
provide for future growth. 
Jacobi injected iron into the blood-vessels of dogs and 
rabbits, finding that ten per cent, was excreted by the bowels, 
liver, and kidneys. Of that deposited, fifty per cent, was 
found in the liver, the rest in the spleen and kidneys, also 
walls of the intestines and other organs ; it was all removed 
from the blood two or three hours after the administration. 
The excess of iron stored in the liver may be looked 
upon as a physiological and not a pathological process. 
In estimating the value for the increase of iron in the 
haemoglobin, it is quite necessary that we do not trust en- 
tirely to the physical examination of the heart and blood- 
vessels, the color of the mucous membranes, and condition 
of the skin. We should have an exact means of measuring 
the haemoglobin of the blood. 4 
PEPl'O-MANGAN IN ANtEMIA. 
Richert, of Vienna, makes a haemoglobinometer which 
is quite as accurate as any in ascertaining the amount of 
haemoglobin contained in a given specimen of blood. 
No doubt but what the future has in store many im- 
proved methods to thoroughly examine blood. 
You will find, upon examination of blood taken from a 
case of anaemia, the haemoglobin diminished, and, as the 
patient grows worse, or rather the anaemia progresses, next 
reaching a chlorotic state, we examine the blood again, and 
find the corpuscles diminishing. 
Anaemia is the sneak thief of all diseases. How gradu- 
ally it creeps through the system to weaken and debilitate, 
leaving vital energy more or less diminished ! 
How often we see cases of headache, impaired vision, 
neuralgia, pulmonary diseases, indigestion, constipation, 
loss of appetite, and a lack of energy in general, all of 
which originated as anaemia; and the suffering patient does 
not realize how gradually they slip along into these condi- 
tions, whereas, if taken in time, much suffering could have 
been avoided. 
Let us now look and examine at what the post-mortem 
knife has revealed-a liver degenerated, enlarged to twice 
the normal size, the edges thickened and rounded, the sur- 
face smooth, the tissue touch firm, inelastic, more or less 
translucent and of a brownish-yellow color. 
This degeneration usually commences in the walls of 
the intralobular blood vessels, causing them to become 
thickened and -translucent; the liver cells are squeezed by 
the thickening of the vessels, and may become atrophied, 
sometimes completely so; indeed, it has been stated by 
some observers that the liver cells may also become waxy ; 
they not infrequently undergo fatty degeneration ; the blood 
contained in the liver considerably diminished, nearly or 
entirely absent. PEPTO-MAXGAN IN ANAEMIA. 
5 
Now, then, we will examine the kidneys. Here we 
find the most common and yet most important form of 
kidney disease-a state of diffuse nephritis. The kidney 
varies in size, the capsule is opaque and more or less ad- 
herent, the surface is finely or coarsely nodular; in the 
tubes the epithelium is changed, especially in the tubes of 
the cortex, the walls are swollen, finely or coarsely granu- 
lar or fatty, or completely broken down, or the seat of 
hyaline degeneration; the tubes containing cast matter, 
also blood, pus cells, and small, flat, nucleated; in places 
the tubes are denuded of epithelium, the walls thickened, 
or they may be the seat of waxy infiltration ; in the stroma 
there is a new growth of connective tissue; this is usu- 
ally found in patches about the Malpighian bodies and the 
blood vessels in the cortex; the walls of the arteries are 
thickened. 
The next organ to examine, and not by any means least 
in importance-the heart. Here we find a transformation 
of the muscle fibres of the heart into fat, which has col- 
lected in the fibres. This degeneration is sometimes quite 
universal, but more frequently occurs in patches, and may 
lead to a thinning of the walls, or to rupture of the heart, or 
to inability to fulfill its functions, and is often the cause of 
sudden death. These conditions may be secondary to 
hypertrophy of the heart, to inflammation of the heart 
muscles or to pericarditis, to disturbances of the circulation 
in the coronary arteries by inflammation or atheroma, and 
very many times are due to a deteriorated condition of the 
blood. 
In speaking upon the aetiology of anaemia, we may say 
that many times there is a deficient amount of proper food 
taken; the hygienic surroundings are unfavorable to good 
health ; excessive work, improper rest, mental anxiety, pro- 
longed and frequent nocturnal emissions, excessive nursing 6 
PEPTO-MANGAN IN AN/EMIA. 
or excessive menstruation, chronic intestinal catarrh, Bright's 
disease, diabetes, and malaria. 
To successfully treat anaemia it is necessary to fulfill 
the indicatio causalis-presupposing a consideration of the 
subjects mentioned. 
The indicatio morbi brings up the consideration of food, 
which should be nourishing and easily digested, mostly 
nitrogenous; exercise in the open air, the amount of which 
should be somewhat regulated ; the breaking off of bad 
habits, and treatment by remedies. 
In recent times it has been observed that the haemoglo 
bin of the blood has increased after moderate bleeding. 
Dogiel, on the strength of experiments upon dogs, confirms 
the deductions of Scholz that moderate bleeding, say with 
ten or fifteen leeches, doesnot alter the arterial tension; 
but if this is repeated every three or four weeks the 
patient gains in weight and the number of blood corpuscles 
is increased. 
Vogt also found the haemoglobin to be increased under 
similar circumstances. 
Schubert treated a number of cases of chlorosis by 
bloodletting and hot baths. The venesection was at the 
rate of seven to fifteen grains to the pound of body weight 
each bleeding. The patient was kept in bed from twenty- 
four to forty-eight hours after the operation, and this 
treatment was repeated once or twice each year. 
Treatment with laxatives has at times been followed 
with much success. 
Hamilton says that if he were compelled to treat anae- 
mia by either laxatives or chalybeates he would use the 
former. 
It is Sir Andrew Clark's theory that anaemia arises in a 
large number of cases from self-infection, or, in other 
words, a large number of anaemias are of faecal origin. PEPTO-MANGAN IX ANJEMIA. 
7 
There is, no doubt, a good deal of truth in that statement. 
However, the most rigid and extraordinary antisepsis, 
which nowadays can be readily obtained by naphthaline, 
salicylate of bismuth, or beta naphthol, does not meet with 
the success that we should expect, although quite recently 
Pick has professed to have obtained good results in chlo- 
rosis from this method. My experience thus far is that 
the method of treatment by laxatives and bloodletting will 
be satisfactory in a limited number of cases only. How- 
ever, it is safe to say that neither in bloodletting nor in 
laxatives, nor yet in securing intestinal antisepsis, can we 
hope to obtain such brilliant results as by the administra- 
tion of iron. 
In giving iron we have up to this time been greatly 
hindered by certain apparently insurmountable difficulties. 
Blaud's pills, so much lauded and popularized by Nie- 
meyer, certainly fail in a considerable number of cases. 
Notwithstanding the large amount of iron which one can 
administer in them, in many instances improvement does 
not follow their prolonged and uninterrupted administra- 
tion. I am inclined to think that the potash is partly re- 
sponsible for this, since it is, as we all know, one of the 
agents that promote waste. 
The tincture of the chloride of iron has easily held the 
first place in popularity and efficiency. Combined with 
phosphoric acid, when well borne by the stomach, its 
therapeusis is unassailable. 
The formula of Dr. Flint has for many years been a 
favorite. 
When we find a coated tongue, feeble digestion, and 
constipation, the tincture of iron is contraindicated. I 
should rather say that these conditions called for a previ- 
ous purgation and corrected digestion preliminary to a 
course of ferruginous treatment. 8 
PEPTO-MANGAN IN AN2EMIA. 
Castellino has found in his experiments that hemo- 
globin is absorbed rapidly, is always well borne, increases 
the number of red cells and the specific gravity of the 
blood, and improves the general condition. If the admin- 
istration of the hemoglobin, however, is stopped before 
the normal condition is reached its effect is only fugitive. 
Tn secondary anemia it has failed completely in that 
its effects are only transitory. The use of this preparation, 
however, is extremely limited. 
Since I am of the opinion that iron is our sheet an- 
chor in the treatment of anemia, and since all the prepara- 
tions hitherto used either have been inefficient or have 
presented certain disadvantages, I come now to a consid- 
eration of a preparation which I am convinced will revolu- 
tionize the treatment of anaemia. Inasmuch as there are 
objections to strong preparations, Dr. A. Gude, of Leipsic, 
Germany, realizing the great injury done to the teeth, also 
the constipating effect that the tincture of the chloride of 
iron has, set about obtaining a preparation which, while 
retaining all the therapeutic effects, should present none of 
the disadvantages. 
His preparation is neutral in reaction, of an agreeable, 
non-astringent, mildly aromatic taste, being miscible with 
wine or milk. 
It is a solution of manganese iron-peptone ; as an or- 
ganic combination of peptonates, here we have the digested 
albuminous compounds of iron, added to which is manga- 
nese, altogether making a most excellent specific in anae- 
mia and chlorosis. 
This preparation immediately passes through the ali- 
mentary ducts and is at once taken up by the blood ; it is 
not a burden to the stomach to disturb digestion. I have 
found after using this preparation for one week its restora- 
tive influence upon the digestion and circulation, its prompt PEPTO-MANGAN IN ANEMIA. 
9 
action being due to the happy combination of manganese 
with iron, thus infusing oxygen, iron, and manganese 
into the blood, producing the red corpuscles. 
I take much pleasure in presenting you the record of a 
few cases in which pepto-mangan (Gude's) was used : 
Case I.-M. B., aged five years, had been treated for sub- 
acute malaria for two months past. She complained of head- 
ache, dizziness, and languor; appetite poor; coated tongue ; 
palpitation of the heart; has chills at times; the bowels are 
constipated, pulse weak ; the muscles are flabby ; the condition 
of the skin is pale, the veins are poorly filled, the mucous 
membranes are very pale, the lips white, the eyes sunken ; 
the expression of the face is careworn and haggard. I ordered 
pepto-mangan, one drachm, four times a day, seven weeks 
after which she made a complete recovery. 
Case II.-Miss R., aged seventeen years, schoolgirl. For 
the past two or three months she has been running a down- 
ward course; the mucous membranes of the eyes and lips are 
pearl color; the cheeks are devoid of color, pale, and care- 
worn ; there is loss of appetite, constipation, feeble circula- 
tion ; she has frontal headaches and dizziness, with slight 
cough ; the suggestion of food makes her feel sick at the stom- 
ach; the menstruation is scant and very irregular, with con- 
siderable pain. At times her mother says she is very irritable, 
crying for almost nothing; she is very easily frightened ; dur- 
ing the day she grows drowsy and will lie down and sleep 
for an hour or two; in the afternoon she comes home from 
school tired and irritable and suffering from headache. 
In this case I ordered pepto-mangan combined with 
liquor potassii arsenitis, or Fowler's solution; of the former 
tw'O drachms, and the latter, one minim, four times daily. At 
the end of the first week there was slight improvement gen- 
erally; at the end of the second week still improving, and at 
the end of the four weeks marked improvement. In nine 
weeks discharged with complete recovery. 
Case III.-Miss V., a young lady, nineteen years of age, 
unmarried; the family history is excellent. She suffers with 10 
PEPTO-MANGAN IN ANJEMIA. 
severe headaches, is sick at the stomach ; loss of appetite, con- 
stipation ; is extremely nervous; she faints easily; the men- 
struation is irregular and scanty; the circulation is poor, the 
extremities are cold ; at times she has palpitation of the heart 
and is dizzy; the complexion is washed-out, pale, and care- 
worn ; the lips are almost colorless. This case is more inter- 
esting, inasmuch as she had been under the care of several 
doctors and there was quite a difference of opinion. The 
specialist corrected the vision with glasses in hopes that the 
headaches would diminish, but without avail; sulphate of 
quinine had been used unlimitedly, Warburg pills, and, in fact, 
the treatment for malarial disease was vigorously used and no 
improvement was observed. Under the conditions I resolved 
to use pepto-mangan in tablespoonful doses, four times a day, 
in milk. Improvement made its appearance in less than a 
week; at the end of two weeks a most decided improvement; 
at the end of four weeks the headaches had disappeared, the 
appetite was excellent, the bowels were regular, the face was 
filled with animation and color, the lips were red, the eyes 
bright, and in eight weeks' treatment she made a complete 
recovery. 
Case IV.-E. D. P., aged twenty-two years; single ; sick 
one year; menstruation at thirteen, always irregular, recur- 
ring every three to eight weeks, lasting five or six days, and 
profuse. For the last six months she has had her periods 
every fourteen days; profuse ; slight leucorrhoea; headaches 
at times constant, worse in the morning; dizziness, palpita- 
tion of the heart, fainting, shortness of breath on ascending 
the stairs, pain in the region of the stomach; appetite very 
poor; pain under the right shoulder; food distresses her; 
the bowels are constipated; the pulse is 88, weak, irregular; 
the lips are pale, the tongue is coated. Pepto-mangan (Gude's) 
was used in two-drachm doses four times daily; improvement 
showed itself in about a week; in two weeks was still im- 
proving, and at the end of six weeks she made a complete re- 
covery. 
Case V.-II. S. B., a schoolboy, fifteen years of age; pale 
and sickly for the past three months; no appetite; tongue PEPTO-MANGAN IN AN2EMIA. 
11 
coated; eyes dull and heavy; facial expression haggard and 
careworn, cheeks pale, lips devoid of color; extremities are 
cold; the circulation poor; the pulse weak and irregular. 
He complains of headaches after school, is sick at the stom- 
ach, dizzy at times, and very nervous, also irritable; has no 
desire for food; he likes candy and cake better. 
In this case pepto-mangan (Gude's) was ordered in one- 
drachm doses five times daily. In about ten days improve- 
ment presented itself; in three weeks was still improving, and 
at the end of the seventh week he was discharged as making 
a complete recovery. 
Case VI.-Mrs. M. S. P., a married woman, twenty-seven 
years of age, the mother of three children, the youngest five 
months old; quite advancedin the secondary stage of anaemia; 
she is unable to attend to her household duties, owing to her 
weak and generally run-down condition, having headaches, 
neuralgic pains about the shoulders; tired, at times sleepy; 
constipated; tongue flabby and coated; the menstruation ab- 
sent since the birth of the last baby five months ago; has pal- 
pitation of the heart; the appetite poor; cooking makes her 
sick at the stomach. 
She is pale, the facial expression haggard, the eyes are dull 
and sunken, the lips without color, the circulation weak, pulse 
irregular, and extremities cold. 
Pepto-mangan (Gude's) was ordered in tablespoonful doses 
four times daily in sherry wine, and in a week's time the im- 
provement was very marked, and in about nine weeks she 
made a complete recovery. 
Case VII.-Mrs. A., aged fifty-two years, married, has had 
six children, the youngest twelve years of age. For the past 
two years her health has been failing, she having lost about 
eighty pounds. Her family history is good. The appetite 
had been poor for the past year and a half, bowels consti- 
pated; she began to show signs of mental derangement about 
a year ago, when nothing seemed to suit her; at times she 
would be herself; at night she was unable to rest or sleep, 
getting up and walking up and down the room, moaning. At 
times she would cry and moan for two or three hours at a 12 
PEPTO-MANGAN IN ANJEMIA. 
time; this was usually in the morning. This state of melan- 
cholia was growing gradually worse, her so-called well spells 
getting shorter in duration. Suddenly she would go off into 
a crying spell, then moaning and sighing. 
The circulation was weak, the pulse 110; the skin was dry 
and flabby; the eyes were dull; the facial expression was 
careworn and haggard; the tongue was coated and flabby; 
the complexion was waxy; the lips were without color and 
thin. 
The liver being rather sluggish in its function, I gave a 
powder made up of hydrarg. chlor, mit., gr. iv; pulv. ipecac., 
gr. i; pulv. zingiberis, gr. ; salol, gr. ij; and sodii bicarbo- 
nat., gr. ij. This was given at bedtime, the following after- 
noon commencing upon a mixture of sulphate of codeine 
gr. and pepto-mangan (Gude's), a tablespoonful, in a small 
wineglassful of sherry wine, four times a day. 
During the first week the patient began to show slight 
signs of improvement, at the end of the second week still fur- 
ther improvement, and at the end of the first month her 
daughters were able to take her out for a carriage ride through 
the park, and this was the first time in thirteen months that 
she had been outside of the house. Her appetite is improv- 
ing ; the condition of the skin and complexion is much better, 
tbe eyes are brighter, the so-called bad spells are growing 
shorter, she rests and sleeps quietly through the night. Al- 
together the prognosis is most favorable to a complete recov- 
ery within the next two months. 
Case VIII.-Miss R., aged nineteen years. She has been 
sick for the past three months; always well until this; com- 
plains of shortness of breath on exertion, palpitation of the 
heart, coldness of hands and feet; is tired most of the time ; 
has fainting spells; she is regular in menstruation; has pain 
before the flow for three days; the flow is becoming more 
scanty and pale; appetite fair ; bowels constipated ; the skin 
and conjunctivae pale; tongue coated, tremulous, and flabby; 
first sounds of the heart weak; tenderness over the liver, but 
no enlargement; pulse weak and irregular. Pepto-mangan PEPTO-MANGAN IN AN2EMIA. 
13 
(Gude's) in two-drachm doses five times a day was given, and 
in about nine weeks she made a complete recovery. 
In concluding I might add that in the medical treat- 
ment of anaemia, also chlorosis, we find a specific in the 
combination of iron and manganese as prepared by Dr. A. 
Gude, and I congratulate him upon the excellence of the 
preparation, as it has proved a most efficient and valuable 
one. 
The disadvantages in all other preparations of iron are 
obviated in pepto-mangan ; in removing these disadvan- 
tages its therapeutic efficacy is not in any way impaired. The New York Medical Journal. 
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