International Clinics.-A Quarterly of Clinical Lectures on Medicine, Neurology, Surgery, Gynecology, Obstetrics, Ophthalmology, Laryngology, Pharyngology, Rhinology, Otology, and Dermatology, and Specially Prepared Articles on Treatment and Drugs. By Professors and Lecturers in the Leading Medical Colleges of the United States, Germany, Austria, France, Great Britain and Canada. Edited by Judson Daland, M.D., Philadelphia. Vol. I., Ninth Series. 1899. Philadelphia: J. B. Lippincott Company.

The present volume is filled with the usual number of able and timely articles. The subject of "Cold as an Antipyretic" is presented concisely and forcibly by Horatio C. Wood. The eleven lectures on treatment include hemorrhoids, burns, tabes, uterine fibromas, acute laryngitis, brain-fag insomnia, chronic bronchitis, chronic constipation, tuberculosis, tubercular osteitis, and the care and treatment of phthisical patients. Dr. J. N. Hall contributes an excellent clinical resume of the valvular diseases of the left heart. Dr. Robt. F. LeMond provides a practical and characteristic lecture on interstitial keratitis.

Electro-Haemostasis in Operative Surgery.-By Alexander J. C. Skene, M.D., LL.D., Professor of Gynecology in the Long Island College Hospital, Brooklyn; Gynecologist to the Long Island College Hospital, Etc. New York: D. Appleton and Company. 1899.

This monograph marks a distinct advance in so ably advocating the electric current in place of ligatures. The author has perfected his methods before publishing them, and readers may rely implicitly upon his assertions. The description of instruments and operations is clear and explicit and is exemplified by numerous photogravures and other drawings. The technique of electrohemostasis is fully furnished for ovariotomy, myomectomy, abdominal hysterectomy, ovario-salpingectomy, appendectomy, uterine cancer, pelvic abscess, diseases of the vulva and vagina, extirpation of the mammary and lymphatic glands, tumors of the bladder, urethral affections, rectal hemorrhoids and fissures, and neoplasms of the skin and mucous membranes. The text also comprises two important chapters on asepsis and antisepsis in surgery. Every surgeon should possess a copy of this bock.

Pain of Hyperchlorhydria.-Whenever painful attacks occur from this cause, A. L. Benedict recommends drinking a glassful of cold water (Buffalo Medical Journal), which not only dilutes the acid already present, but checks the tendency to secretion.

GUDE'S PEPTO-MANGAN,

By DR. JULIUS HEITZMANN, Vienna.

The employment of iron preparations, both in essential anaemia (chlorosis), and in the symptomatic forms of this affection produced by severe loses of blood, dates from the earliest times. Long before the chemical relation of this effect was known, these remedies were administered on the ground of pure empirical experience.

When Hannon pointed out the high significance of manganese, as well as of iron, with regard to the absorption of oxygen by the blood, and when this discovery was confirmed by Ruehle, efforts. were made to produce, by combination of both remedies, preparations which would best fulfil the therapeutic indications in all directions.

Former attempts of this kind failed to give the desired results. The aim was to combine both metals in such a form as would enable them to be absorbed throughout the entire extent of the alimentary canal, and at the same time be devoid of disagreeable taste which would prevent their prolonged administration. After a series of experiments made in this direction, I found in the preparation discovered by Dr. A. Gude (Pepto-Mangan-Gude), a remedy which fulfilled the above requisites, and can reccommend it most heartily.

Pepto-Mangan-Gude is a clear, dark, wine-red fluid, having an agreeable, non-metallic, astringent taste. The latter property gives it a great advantage over other similar preparations, for the remedy is always taken with pleasure, and may therefore be administered for a long time without exciting the disgust of the patient. No irritation of the stomach is produced, nor is the digestion disturbed in the least respect; indeed, as regards the latter, a stimulation of the long-absent appetite could be demonstrated within a short time.

The Pepto-Mangan-Gude, usually mixed with some water, if prescribed in doses of two or three dessertspoonfuls, increased to as many tablespoonfuls per day. An especially agreeable manner os administration is by addition of cold milk, which then assumes a light chocolate color and an agreeable taste. Prescribed in this form we obtain from this preparation everything that could be expected from a remedy for anaemia. The Pepto Mangan-Gude may also be mixed with white and sweet wines which contain tannic acid, and an occasional change in the manner of administration is sometimes of advantage, especially in the case of children.

The diet, during the use of this preparation, should consist of milk, meats-especially ham-fowl, soft-boiled eggs, and other easily digested foods. On the other hand, sour and fatty foods, red wines and raw fruits are to be avoided.

The remedy is to be administered for a number of weeks, especially in cases of chlorosis, but in the case of young girls up to 12 years of age it is best to commence with a daily dose of two teaspoonfuls (ten grammes). In adults the dose of the PeptoMangan-Gnde may be increased in a few days to one tablespoonful twice or thrice daily, or even to ten or twenty grammes. The

preparation should be well protected from the light, and preserved in a cool place in a well-stoppered bottle.

I have employed the Pepto-Mangan-Gude with much success both in chlorosis and in cases of anaemia in girls and women, due to loss of blood, menorrhagia, metrorrhagia, inflammation of the pelvic organs, peri- and parametritis, or prolonged leucorrhoea. In almost every instance I observed within a short time increase of appetite, improved nutrition, healthier color of the face, and increase of weight. I was surprised to learn how much more readily the Pepto-Mangan-Gude was taken than similar preparations, without ill effects even after protracted use.

To illustrate my remarks I will cite a few cases:

I will first report a case of chlorosis treated with this remedy, which was under constant observation. The patient, a school girl aged 16, began to menstruate one year ago, but after appearing regularly for three periods the flow suddenly ceased, probably in consequence of mental overexertion, and symptoms of chlorosis soon developed. The various preparations of iron were tried, but were either not well borne or excited so much disgust that they were discontinued by the capricious patient. A milk cure was prescribed, but followed for only a short time. When, however, I resorted to the Pepto-Mangan-Gude, I was surprised to find that the girl took it willingly and that it was well borne. She made a rapid recovery, and after the use of two bottles had regained her former healthy color, while her strength and menstruation returned.

CASE II.-A married lady, aged 24, had acquired-apparently of abortion at a very early period an intense peri- and parametritis with an exudation of the size of a child's head. The latter disappeared almost completely under suitable treatment and rest, so that only a slight induration was present in the parametrium after three weeks. Owing to the considerable anaemia and loss of appetite, however, the patient recovered very slowly, and for this reason I ordered the Pepto Mangan-Gude. A few days after its use the appetite reappeared, recovery ensued rapidly, and five weeks later. her health was completely restored.

CASE III-A married lady, aged 30, had suffered from leucorrhoea due to catarahal inflammation of the vagina for two years, and although the local trouble had been much relieved she continued pale and weak. As her chlorotic daughter at the time was taking the Pepto-Mangan Gude with marked benefit, I advised her also to try this preparation. She followed my advice, and after fourteen days the weak, sluggish, and pale woman seemed as if transformed. She has since regained her former health.

These few cases, which were under continued observation, will confirm what has been said above regarding the manner of application and effect of the Pepto-Mangan-Gude. I regard it as superfluous to cite other cases, since a few closely observed cases teach more than a host of superficial observations.

On the ground of my experience I consider myself warranted in dirrecting the attention of physicians to this remedy, and feel convinced that further trials will give equally favorable results. Even in canses where local treatment is necessary, the PeptoMangan-Gude willprove a valuable auxiliary in our treatment.Allgemeine Wiener Medizinische Zeitung, xxxvi.

DENVER MEDICAL TIMES

VOLUME XIX.

AUGUST, 1899.

NUMBER 2.

ORIGINAL COMMUNICATIONS.

THE URINE IN THE DIAGNOSIS AND PROGNOSIS OF NON-URINARY DISEASES.*

By EDWARD C. HILL, M.D.,

Professor of Chemistry, Uranalysis and Toxicology, Gross Medical College,
Denver, Colorado.

We judge most certainly the condition of a living organism by comparing its intake and its output. The urine is the chief index of metabolism in the human body, and its quantitative examination furnishes clinical evidence of the greatest practical value. Its systematic study in our patients affords accurate data otherwise unobtainable and serves to round out an exact diag nosis and a definite prognosis with the best treatment as a corollary. In this brief paper, founded mainly upon the chemic and microscopic investigation of something over 6,000 urines, it is my purpose merely to emphasize a few of many points of utility to progressive physicians. For the sake of convenience, the subject will be considered according to disease classes.

Specific Infections.-During the febrile stage of all fevers the urine is diminished in quantity and highly acid. The specific gravity is more than correspondingly increased, owing to the absolute excess of urea depending on augmented tissue waste. Uric acid is increased proportionately even more than urea, and uratic deposits are common. The excretion of chlorides a nd phosphates, except in spotted fever, is diminished until the beginning of convalescence. Pigmentation is deepened because of hemolytic changes, and bile pigment is not infrequently present, particularly in small-pox. Hemoglobinuria is indicative of decided destruction of red blood corpuscles; it accompanies severe infections, and is a valuable premonitory sign of scarlatinal hematuria and nephritis. Albuminuria is observed at one time or other *Read before the Colorado State Medical Society, June 20, 1899.

in the majority of cases of fevers generally, but is usually slight in quantity unless nephritis complicates. Albumosuria is occasionally noted, particularly in pyemia and cerebro-spinal meningitis, and a trace of glucose is not uncommon. Hyaline casts are frequent even without supervening nephritis-in the event of which occurrence we find also epithelial, red blood, leucocyte and granular casts. In my experience, chronic pyelitis is a much more frequent sequel of infectious diseases than is chronic nephritis.

The special color test of typhoid urine, known as Ehrlich's diazo reaction, has been ranked by the Lancet as of equal value with Widal's agglutination test. It occurs a day or two earlier than does the serum reaction and it serves quantitatively for prognosis, whereas the serum test is said to have no prognostic significance. The diazo reaction is of special use in differentiating enteric fever from simple enteritis and allied complaints. It is likewise met with in miliary tuberculosis and in severe cases of measles, scarlatina, erysipelas and pyemia, as also in cases of ordinary phthisis which are rapidly progressing to a fatal termination. In all these instances its occurrence is chiefly an item in prognosis.

Hemic and Circulatory Disorders.-The relative value of the vis a tergo is the all important factor in the causation of the urinary changes of circulatory origin. When cardiac hypertrophy exists, and compensation is maintained, there is absolute. increase of both the water and the solids of urine. Failing compensation is marked and measured by decrease of the solid ingredients and by the presence of albumin and hyaline casts, both of which may be made to disappear for a time under the administration of digitalis or other heart tonics. Much the same picture as to the urine presents itself in the secondary cardiac dilatation of valvular disease, and in arterio-sclerosis and the various myocardial degenerations.

Concerning blood changes proper, hematuria, apparently spontaneous, is of rather common occurrence in purpura hemorrhagica, hemophilia and scurvy. A pale, abundant urine, deficient in normal solids, is a feature of chlorosis and anemias. In progressive pernicious anemia, indicanuria is a prominent sign. A small amount of albumin may be encountered in any of the blood dyscrasiae as well as in degenerative lesions of the ductless glands. Remembering the nucleinic origin of uric acid, a great excess of this ingredient in the urine of leukemia is not surprising. Ulcerative endocarditis and hidden pyemic foci may discover themselves first by renal infarcts, with sudden, pronounced albuminuria and blood and pus casts.