ammonium as a regent. It was thus found
that iron is absorbed exclusively in the duo-
denum, and this applies both to the iron in
the food and that administered medicinally.
It was detected in the duodenal epithelium
and in the stroma of the duodenal ephithe-
lium and in the stroma of the villi, and is
visible even to the naked eye. Further-
more, iron is found deposited especially in
the liver cells, in a form perceptible on mi-
croscopical examination, and in rare cases
could be detected by microscopical means
in the cortical tubules of the kidneys.

These investigations of Quincke have
demonstrated incontestably that the favor-
able results which have been obtained, since
olden times, from the administration of iron
are actually attributable to its absorption,
and not, as Bunge would have it, to acci-
dental circumstances, to diet alone, or even
suggestion. Control experiments in this
direction with indifferent medicaments are
readily carried out, and were repeatedly
mentioned at the Congress of 1895. It
should be added that these control experi-
ments were followed by no change, or only



by a transient improvement in the condi-
tion of the patient.

At the last Congress for Internal Medi-
cine, the subject of therapeutics of iron
was so thoroughly ventilated by the fore-
most clinicians, as well as numerous physi-
cians in late years, that a new contribution
would appear superfluous. This subject,
however, is of such immense importance to
the general practitioner, that a cumulation
of material is necessary in order to eliminate
the least doubt as to the efficacy of a the-
rapeutic measure which, oiiginating at first
on the basis of speculation, and later sup-
ported by the results of empirical observa-
tions, has finally been demonstrated to be
of value by exact experimentation.

In the following I will only discuss the
clinical aspects of the question. I was en-
couraged in undertaking this work by my
honored teacher, Dr. Mackenrodt, who has
assisted me in every possible way. In the
management of chlorosis and anaemia and
the host of sequelae of these diseases, the
physician would be powerless if he had not
in iron a specific, or at least a potent and
indispensable adjunct to his other therapeu-
tic resources. The patients, who belong
for the most part to the working classes,
give in the main the same group of symp-
tons : amenorrhea, scanty or profuse, weak-
ening, irregular, usually premature, menses ;
headache, anorexia and dyspepsia ; neural-
gias, and almost invariably marked lassi-
tude, which interferes markedly with their
ability to work. In these cases prompt and
radical help must be afforded, in order to
restore to the patients their full working
capacity as soon as possible. It is well
known that the therapeutic value of the
various iron preparations differs greatly.
This is shown «/r/or/ by the abundance
of manufactured products of this kind. My
experience relates chiefly to three prepara-
tions, pilulae chinini cum ferro, formula
magistralis of Berlin, liquor ferri albumi-
nati, and the neutral Pepto-Magan (Gude).
My results with the first of these three
remedies have been indifferent, while with
the liquor ferri albuminati of the pharma-
copia they were somewhat better. I have
instituted accurate examinations, however,
with only Gude's Pepto-Mangan, and the
data given further on relate to this remedy
alone. Owing to my limited experience
with the many other preparations employed
by various authors, I would not designate
the Pepto-Mangan as a universal remedy,
or as the only efficient preparation.

Still another remark : there can be no
doubt that our medical intervention, no
matter of what kind, is materially assisted
by physical impressions. This applies es-



616



THE CHARLOTTE MEDICAL JOURNAL.



pecially to our female patients, who are ex-
tremely susceptible to mental influences of
this character. Hence, it may readily oc-
cur at the commencement of treatment that
the previous disorders are less strongly felt,
and it is therefore unfortunate that an ob-
jective criterion for the existing improve-
ment is not at our disposal, as such we
would regard regular examinations of the
quantity of h;Bmoglobin in the blood. In
the observations reported these were made
with Gower's hiemoglobinometer. This
instrument is very convenient, and is supe-
rior to Fleischl's apparatus for the use of
the general practitioner, especially on ac-
count of its cheaper cost. The tests are
very exact ; any existing errors are the less
to be considered since they occur uniformly
and in about the same degree during the
entire course ot the experiments.

That dietetic treatment alone may be
successful in anaemic and chlorotic pa-
tients was laid down as a dictum by Im-
mermann and Reinert at the Congress for
Internal Medicine of 1895. It is natural
to suppose that poor and ill-nourished per-
sons would gain in strength under the in-
fluence of a proper and invigorating diet;
nevertheless, after eight to fourteen days a
cessation in the improvement occurs and
the old disorders return. These authors,
as well as Nothnagel and V. Ziemssen,
consider an invigorating diet as only a valu-
able adjunct; both of the latter, moreover,
regard rest in bed for several weeks as an
important factor in the cure. Since several
years Mackenrodt has also instituted a large
series of observations of this kind, not yet
published, in which, for purposes of con-
trol, he employed quantitative estimation
of the htemoglobin. It was found bv him
that under the influence of hygienic and
dietetic regulations alone the quantity of
haemoglobin in the blood increased only at
the commencement of treatment, and then
only in a dilatory manner.

In the case of one of my patients I pro-
ceeded as follows : I prescribed Pepto-
Mungan (Gude), one teaspoonful three
times daily after meals, and regulated the
diet in accordance with the directions fur-,
nished with preparation. Sour and fatty
foods, as well as raw fruits, are to be avoid-
ed under all circumstances. Fritsch (Dis-
eases of Women, 1892, pp. 469) advises,
indeed, that the desire for acids manifested
by chlorotics should be gratified. Accord-
ing to my experience, however, this craving
for acids is to be regarded as a pathologi-
cal condition of the alimentary tract, which
is made worse by further supply of acids,
bul can be successfully overcome by an un-
stimulating diet. In cases where the social



conditions in any way permitted, I allowed
the patient to take a small glass of red wine
three times daily, but never during a period
of one hour before and after the adminis-
tration of the medicament, in order to pre-
vent the combination of the tannic acid con-
tained in the wine with the iron. The use
of potatoes was restricted as much as pos-
sible, at least, during the first four weeks.
Furthermore, I resorted to the dietetic reg-
ulations customary in these cases, but
changed them to advantage when, as so of-
ten happens, obstinate constipation was
present, following in this respect the sug-
gestions of Hebra, which have recently been
again advocated by Ruge (Transactions of
the Obstetrical and Gynecological Society
of Berlin, i. III, 1896), and obtained gen-
erally excellent results. In contrast to sev-
eral authors who made it a practice to re-
move any existing dyspepsia before resort-
ing to the use of iron, I have followed the
method of v. Ziemssen and Baumler,
of at once administering iron — unless the
presence of a severe gastric affection, es-
pecially ulcer of the stomach, could be posi-
tively determined — and observed as early
as the end of one or two weeks an increase
of appetite and subsidence of the gastric
disorder.

I would lay especial stress upon syste-
matic exercise in the open air. I ordered
the patients, who, with but two exceptions,
were treated out of bed, to take a stroll at
midda}^ at first of five to ten minutes dura-
tion. At the end of three to four days they
were allowed to remain outdoors for five to
ten minutes longer.

After each walk they were advised to
take off their corsets, put on their slippers,
and rest for an hour on the sofa. Under this
treatment the lassitude invariably vanished
after a time.

In the manner thus described I have
treated in all about sixty patients. In
twenty-four cases I instituted quantitative
estimations of haemoglobin at regular inter-
vals of three, five, or eight days. Under
normal conditions the quantity of haemo-
globin in woman amounts to 12.59 P^''
cent, when estimated in comparison with
the other constituents of the blood. Among
my cases the lowest amount met with was,
in a single instance, 30 per cent, of the nor-
mal, that is to say, of the above 12.59 P^*"
cent. Next to this was the following case
with 32 per cent, of the normal.

Miss W. G., twenty-two years old, seam-
stress, related that she had been under treat-
ment for four years for chlorosis. Since
the age of nineteen her menses had been
scanty, occuring before the usual time, and
of three to eight days' duration. On Sep-



THE CHARLOTTE MEDICAL JOURNAL.



51?



tember 26, 1895, a re/not io secundinarum
occurred, after an abortion induced in the
fourth month. At present she complains
of darting pains in the upper portions of
the lungs, headaches, and rapid loss of
strength.

January 9, 1896, antemic appearance: physical
examination, especially of lungs, negative.
Quantity of haemoglobin, 32 per cent. Or-
dered Pepto-Mangin (Gude), diet, etc.

.lanuary 13, 1896, considerable improvement of
the general condition. Hasmoglobin, 45 per
cent.

Januaj-y 17, since previous day, diarrhoea, due
to gross errors in diet, troublesome eructa-
tions. Ordered tinct. opii. 15 drops three times
daily. Haemoglobin, 47 per cent.

January 21, improved after use of tinct. opii.,
no more gastric pains or eructations. Head-
aches have completely disappeared, lassitude
less marked. Hai'moglobin, 55 per cent.

January 31, condition unchanged, ceased men-
struating on previous day, the flow having
lasted five days.

February 8-28, patient feels well and no longer
complains of pains in the lungs. Appetite
and bowels regular. Haemoglobin, constantly
55 per cent.

March 5, no change. Hoemoglobin, 62 per
cent.

March 11, Haeoioglobin, 68 per cent.

March 27, Huemoglobin, 77i per cent.

Unfortunately, as in most of these cases,
the patient's visits ceased as soon as she felt
entirely capable of going to work. As a
matter of fact, the increase of haemoglobin
in this case was tardy, as in four other cases
in which the quantity at the beginning was
34' 35' 37 '^"*^ 3^ P^'' cent, of the normal.
In eighteen other instances in which the
initial amount was higher, viz : 42-75 per
cent, of the normal, progress was more
rapid as a rule.

This is most strikingly illustrated in the
following case :

Miss C. B,, aged fifteen years, complains
of violent headaches, visual disorders, loss
of appetite, a feeling of pressure over the
stomach, constipation and general lassitude.

June 2, 1896, status praesens: mucous mem-
branes pale; physical examination, negative:
heart, normal; quantity of Haemoglobin, 45
per cent. Prescribed as in above case.

June 9, headache has disappeared; condition
otherwise unchanged. Haemoglobin, 45 per
cent.

June 16, improvement. Haemoglobin, 51 per
cent.

June 23, decided improvement. Haemoglobin,
55 per cent.

July 8, patient free from complaints: cheeks
ruddy; lips and conjunctiva red. Haemoglo-
bin, 78 per cent.

July 23 and September 24, continued good
health.

I also derived exceedingly favorable re-
sults from the use of Pepto-Mangan (Gude)
in patients who came to us for operations
after having been exhausted by protracted



hemorrhages. Of course convalescence in
such cases is delayed ; the system recuperates
but slowly from the double injury inflicted
by the losses of blood and the operative in-
tervention. Digestive disturbances are es-
pecially apt to be troublesome. In these
cases ferruginous medication often produces
remaikable improvement.

I cannot close this paper without calling
attention to the beneficial influence exerted
by Pepto-Mangan (Gude), in anaemic neu-
ralgias, and as an illustration of its effects in
this class of cases, add in brief the follow-
ing history of a case :

Mrs. K., aged thirty-five years, very pale
and ill-nourished, suffers from intercostal
neuralgia on the left side.

January 30, 1896, quantity of Hitmoglobin, 68
per cent, of the normal.

February 5, in the mean time has sutTered on
two days with violent headaches; intercostal
neuralgia persists; appetite good; no gastric
disturbances. Haemoglobin, 69 per cent.

February 12, no longer troubled with headaches,
with exception of one attack of neuralgia, in
the area supplied by the left supra-orbital
nerve; paroxysms of pain on the left side of
chest have become less frequent. The lassi-
tude has subsided. The mucous membranes
are still anaemic. On the whole the patient
feels better and more vigorous than before
the commencement of treatment. Haemo-
globin, 75 per cent.

February 18, considerable improvement of neu-
ralgias; no headaches, nor digestive disturb-
ances. General health impi'oved. Menses
appear earlier than previously, this being the
second day of the flow. Haemoglobin, 73 per
cent.

February 26, during the preceeding days tran-
sient deterioration of her condition, owing to
mental excitement. Menstrual period has
been normal. Haemoglobin not estimated.

March 2, patienl no longer complains Inter-
costal neuralgias have ceased to occur, except
on rare occasions. Haemoglobin, 73 per
cent.

March l;3, health good in general. Iron dis-
continued on account of gastric disturbances,
which are said to result from excitement.
Ordered strict diet and iron to be resumed.

March 19, complete restoration to health. Hae-
moglobin, 82 per cent.

That the final estimates did not yield the
normal quantity is not surprising since it is
frequently somewhat reduced even in
healthy persons. At any rate, the objec-
tive and subjective state of the patients in
the above case, as well as in the others not
reported in detail, afforded the impression
that a radical cure with complete restora-
tion of the ability to work has been ef-
fected.

It must be conceded that in matters of
therapeutics it is always difficult to appre-
ciate correctly the relation of cause and ef-
fect, and to eliminate the factor of acci-
dents in estimating the efficiency of any
plan of treatment. And in order to arrive



518



THE CHARLOTTE MEDIOAL JOURNAL.



at a positive and unbiased decision, it is
necessary to resort to a series of observa-
tions and control experimeuts of so great
an extent that the single observer, even
though he have at his disposal a vast
amount of material, is only capable of fur-
nishing a small contribution in the discus-
sion of these questions. Furthermore, a
certain amount of latitude must always be
allowed to individual judgment.

Yet while fully conscious of these limi-
tations I think I am justified in asserting
that in my therapeutic trials with Pepto-
Mangan I obtained all that can be rationally
demanded. And I further consider myself
warranted in stating that in view of the
unquestionable necessity of ferruginous
medication in certain troublesome constitu-
tional affections this preparation acts as a
most efficient and useful auxiliary to our
therapeutic efforts.- Thcrap&zitische Monat-
shefte, May, 1897.



Sessions of the Army Medical School
Discontinued.

It is understood that the great need of
medicjxl men in the Philippines will pre-
vent the reestablishment of sessions of the
Army Medical School at the Army Medical
Museum during the coming winter. The
course of this school was calculated to sup-
plement the training given by the medical
colleges of the country and was of the
greatest value in giving systematic instruc-
tion to young medical officers in various
subjects, particularly military medicine,
surgery and hygiene, and in organization
and army regulations, which they other-
wise learned only through long experience.
It is much to be regretted that the needs of
the service will not permit a resumption of
the sessions of the school at the present
time. — Boston Medical and Surgical your-
nal.



The American Drus Store.

The American Druggist reproduces the
following from .Seumas MacManus' "Im-
pressions of America'' :

"I forgot to enumerate the corner drug-
store in the list of ills that shorten life in
America. And it does not deserve to be
forgotten, for it certainly divides honors
with its rival, the quick lunch. Yet, on re-
flection, I do believe that the latter has the
heavier score to its credit. And, scientifical-
ly, it is the more interesting of the two.

"Now, I have not seen any American
mortality returns, and do not know what
are the proportion ascribed to the different
causes of death ; but after close observation
and mature deliberation, I have, for my own



use, drawn up a mortality table, which I am
prepared to vouch for, and from which, if
the official figures differ, the official figures
are decidedly misleading. Here is my table
(and I challenge doubt), calculated on the
basis of every loo deaths in the Eastern
States of America :

Cause. Mortality.

Epidemic and pulmonary diseases,
love, accident, murder, suicide,

etc. 7.5

Coffee and meat 20.0

Corner drug-store 20.0

Quick lunch restaurant 40.0

Brooklyn trolley 11.5



Total 100. o

— The Dietetic and Hygienic Gazette.



Medicine as a Profession.

D. John M. Dodson, in an address re-
cently delivered before the Sunset Club of
this city (Chicago) said that in this country
there is about one doctor to every 600 of
population, while in foreign countries the
ratio is about twice as high. The average
salary of a physician in a large city is
approximately $3,000 a year, while in the
country districts the average is about $1,000
a year. To a young man studying the
proposition of entering a profession, if he
has merely the question of making money
in mind, there are other walks of life which
offer larger inducements. The highest
possible return that he knows of in the
profession is about $80,000. There are two
doctors in Chicago who makes more than
$50,000 annually, 10 who makes more than
$35,000, and 100 who make from $10,000
to 30,000 each year. The opportunities for
original research and investigation are
great. There has been a great advance in
medical education, but there is much for
the profession to learn, and one of the most
important things is preventive medicine.
He believes the time is near at hand when
the physician will be paid by his client not
alone for the curing of disease, but for its
prevention. — Medical News.



An attack of appendicitis may be a mild
one, but, if it is, the surgeon does not know
it until the attack is over. As long as the
attack lasts severe symptoms may arise at
any moment. So-called mild cases often
have remarkably rapid fatal results. The
only rule to follow is fhat if the severity is
increasing, operation is immediately neces-
sary, vvhereas if it is distinctly diminishing,
we are justiaed in waiting. — International
yournal of Surgery.



THE CHARLOTTE MEDICAL JOURNAL.



519



An Excursion of Normal P. Appendectomy.

The St. Louis Medical Review (March
17) sent out Normal Prophylactic Appen-
dectomy with letters of introduction to "a
majority of the best surgeons of this coun-
try." Among eighty-nine surgeons, one,
a Kentuckian, bowed down to the man of
straw, while another, a Cincinnati surgeon,
made thirteen rachitic genuflexions. Half
a dozen asked it to call again when the ap-
pendices were out, and the rest more or less
respectfully kicked it. Two spoke Greek
to it, and Dr. Howard Kelley, always
polite, spoke of speaking Greek, but didn't.
Many called it hard names, as they should
not have done, seeing that it had good
clothes and a respectable introduction. The
story of its adventures fills fourteen pages,
though the country was saved before the
St. Louis surgeons were through with it. A
surgeon in Nebraska said to it, "Let us have
peace," and it replied, "Baldheaded colons
are the price of epityphlitic peace." Over
its pathetic remains the editor pronounced
a noble threnody.

This important question being now
settled, we escape the necessity of further
inquiry as to how many icemen would, if
N. P. Appendectomy held the field, be re-
duced to the practice of surgery for a liveli-
hood. — Maryland Medical yournal



Treatment of the Navel.

The chief principles to be observed in
the treatment of the navel following birth
are, according to A. Ahlfeld ( Ce7itralbl. f.
Gyn., No. 13, p. 337), shortening of the
cord to the recognized minimum, touching
up the stump and vicinit/ of the navel with
95 per cent, alcohol, then placing a layer of
sterilized cotton which is to remain on for
five or six days, only being removed incase
of its becoming moist with urine. Espe-
cially may it be noted that after the birth
of the child the cordis to be cut about 3 to
4 inches from the navel, after carefully ty-
ing it off with linen tape. Then, after the
bath, the secondary shortening is to be per-
formed. This consists in tying off the cord
about 2-5 inch from the navel and a little
beyond this the cut is made. Now the
aforementioned moistening with alcohol is
to be done and the sterile cotton wrapped
over it. The author never uses silk liga-
tures for tying off the cord, as it frequently
happens that a hematoma of the cord fol-
lows a too tightly applied silk thread. The
suggestion that a cautery-scissors be used
to cut off the cord about one-half inch from
the child's abdomen, Ahlfeld scores as be-
ing too dangerous in its application. —
I Medical News.



Vaginal Douching.

In Gould's Year Book of Medicine and
Surgery for 1900, Byron Robinson, M.D.,
of Chicago, 111., in advocating the use of
vaginal douching says that when properly
used it is capable of doing a vast amount
of good, but much depends upon the
amount of the fluid, the degree of heat, etc.
He advises a foutain syringe with a four
foot lead and holding at least four gallons
and at a temperature of 103 degrees Fah-
renheit, and increased until as hot as can be
borne. Begin with three quarts and in-
crease one pint a day until four gallons are
taken. He also advises that some astringent
preparation be used to check waste of
secretions. For this purpose Micajah's
Medicated Uterine Wafers are especially
useful. They are astringent in action, thus
contracting the vessels and tissues, and
they check waste of secretions. They pre-
vent reaction after douching and stimulate
the mucous membranes. They are anti-
septic and should always be used in con-
nection with the vaginal douche for the
above reasons.



Dishonest Doctor Convicted.

Dr. Adolph Zeil, of Berlin, was found
guilty on April 3nd of the charge of having
made money by incapacitating young men
for military service. His plan was to ad-
minister on the day before the examination
such drugs as would accelerate the heart's
action. The prospective recruit would be
rejected on the ground that he was suffering
from heart disease. Zeil had "treated"
350 in this way. He was sentenced to one
year's imprisonment and the various civil-
ians and military surgeons who were impli-
cated were each sentenced to a few months'
imprisonment. — Medical News.



W. C. Frederick, M. D., Lono, Ark.,
says : I have used S. H. Kennedy's Extract
of Pinus Canadensis (Dark), one to three
of water, in sore throat from cold, with
splendid results, and have now under treat-
ment a little boy, three years old, suffering
from strumous diathesis, who has been af-
flicted over a year with otorrhea. Have
been using as an injection two drachms of
S. H. Kennedy's Extract of Pinus Cana-
densis to four drachms of water, three to
five drops," two or three times a day, the ear
previously cleansed with castile soap. The
little fellow commenced to improve from
the very start, and is rapidly improving
daily; the discharge has almost ceased. He
has been on this treatment for about two
weeks.



520



THE CHARLOTTE MEDICAL JOURNAL.



A Thoughtless Public.

Dr. Butler, in the Doctor's Magazine for
March, calls attention to the unfamiliarity
of people generally with the infinite detail
necessary to the completion of scientific
researches and to the accumulation of scien-
tific facts. There is, however, for the medi-