effect manifests itself even within a short time by an increased oxygenation of the blood. At the same time, this chalybeate, as already mentioned, causes no digestive disturbances and does not injure the teeth.

In regard to the daily dose of iron, Quincke maintains that it should range from 34 to 11⁄2 grains of Fe. Most clinicians prescribe commonly 4 grains, which considerably exceeds the maximum dose recommended by Quincke. Some of them, like Niemeyer and Trousseau, give even 7 grains of metallic iron daily; hence Pepto Mangan (Gude) should be prescribed in doses of one tablespoonful three times daily for adults, and one teaspoonful twice daily for children up to twelve years, after meals. Sour, fatty foods and red wine should be avoided during its administration. The preparation is much relished by all patients, and it is my custom to administer it to children in water, or, better, in cold milk with the addition of sugar, in which form it is very palatable.

After this brief introduction I will describe a number of cases which have been treated by me with Pepto-Magnan:

CASE I-Mary B., 16 years old, has complained since a week of general debility and lassitude. She is very pale and restless, has no appetite, and suffers from headache and a feeling of pressure in the stomach. She is constipated, and the menses are irregular. Diagnosis, chlororis. Under the use of Pepto-Mangan (Gude), one tablespoonful three times daily, from August 2 to September 2, the red blood cells increased from 2,480,000 to 5,000,000; the hemoglobin from 20 to 50 per cent., and the bodily weight from 98.9 to 106.8. After a week, the appetite was good, no headache; at the end of the second week, no further disturbances; menses not painful, and lasting only three days (formerly five days). After four weeks, the patient discharged cured.

CASE II.-Anna H., 23 years old, has suffered for three years from chlorosis, with irregular menstruation, palpitation of the heart, a feeling of weakness, and occasional syncope. Physical examination showed the presence of anæmic murmurs over the heart, as well as a venous murmur; no fever or oedema. Giving Pepton Mangan (Gude), one tablespoonful three times a day from August 4 to September 14, the red

blood cells increased from 3,750,000 to 4,200,000; the hemoglobin from 35 to 70 per cent; and the bodily weight from III to 118. Appearances of menses after absence of 12 weeks; subjective disturbances have disappeared.

CASE III.-M. W., 16 years old, has suffered since a year from headaches, dyspnoea, tinnitus aurium, vertigo, and gastric disturbances. There was marked pallor of the face and of the mucous membranes; systolic murmurs over the mitral and pulmonary valves, with dilatation of the heart. No fever; spleen not palpable. Diagnosis, severe chlorosis. From August 5 to September 1, under same treatment, the increase of red blood cells was from 2,250,000 to 4,250,000; hemoglobin from 25 to 45 per cent.: and the bodily weight from 105 to 116. The subjective symptoms rapidly subsided, the appetite improved, and the stools became regular. The menses reappeared in the second week of treatment after having been absent for a year.

nose.

CASE IV.-M. P., 15 years old. Menses absent since onehalf year; always scanty. Vicarious hemorrhages from the Since three months the patient has suffered from dyspnoea, vomiting, cardiac palpitation, general weakness, headaches, feeling of dullness, and sleeplessness.

Physieal exam

ination reveals anæmic murmurs, moderate dilatation of the heart, venous murmur. From August 5 to September 14, the change was as follows with same treatment: Red blood cells from 2,400,000 to 5,200,000; hemoglobin from 20 to 50 per cent.; and the bodily weight from 94 to 106. After the first week improvement set in; at the end of treatment disappearance of all disturbances. Increase of bodily weight, 12 pounds.

CASE V.-J. K., 18 years old.

Chlorosis. Anæmic murmurs, cardiac dilatation, loss of appetite, insomnia, general lassitude and headaches. From August 10th to September 12th with Pepto-Mangan (Gude) as above, the red blood cells increased from 2,200,000 to 3,300,000; hemoglobin from 35 to 60 per cent.; and the bodily weight from 104 to 114. At the end of the first week appetite vigorous; headaches had subsided. At the end of the fourth week no disturbance of any kind.

CASE VI.-A. N., 19 years old, has suffered from chlorotic disorders since two years. Improvement occurred under a milk diet and a sojourn in the country. Since five months the patient again complains of disturbances; palpitation of the heart, lassitude, headache, vertigo, tinnitus and constipation; anæmic murmurs and venous hum perceptible. From August 17th to September 22nd the change under use of Pepto-Mangan (Gude) one tablespoonful three times daily was red blood cells from 4,500,000 to 4,200,000; hemoglobin from 25 to 45 per cent., and the bodily weight from 107 to 115. The subjective symptoms diminished after a few days. The disturbances disappeared, the appetite improved, and the stools became regular.

CASE VII.-J. R., 20 years old, has suffered from chlorosis since two years. Status præsens: General lassitude, palpitation of the heart, a feeling of pressure in the stomach, difficulty in breathing; menses irregular as well as dysmenorrhoea. In the last three months all the disturbances have become more intense. From August 22nd to September the changes under scientific treatment were: Red blood cells from 4,250,000 to 5.300,000; hemoglobin from 30 to 60 per cent.; bodily weight from 104 to III. The disorders have disappeared, the appetite is good, and the bowels regular; no anæmic heart

murmurs.

CASE VIII.-L. N., 19 years old, complains of headaches, cardiac palpitation, vertigo; scanty menses. With same treatment from August 28th to October 1st, the red blood cells went from 2,500,000 to 4,300,000; hemoglobin from 40 to 70 per cent.; bodily weight from 108 to 114. The subjective disorders have vanished; menses more abundant.

CASE IX.-J. M., 16 years old, has suffered since two months from palpitation of the heart, dyspnoea, feeling of pressure in the stomach, vertigo, tinnitus and headaches. There is a slight cardiac palpitation, with systolic murmurs and a venous hum. Anorexia and constipation are present. The menses have been irregular since a year. From September 2nd to September 29th, under the same therapeutic measures the red blood cells increased from 4,500,000 to 4,950,000; hemoglobin from 35 to 55 per cent., and the bodily weight

from 100 to 104. Menses regular; bowels normal; no disturb

ances.

CASE X.-Z. F., 30 years old, had a miscarriage two weeks previously, with profuse hæmorrhage. After a month's treatment completely restored to health, and an increase of weight of four pounds.

CASE XI.-A. N., 6 years old; rachitis and anæmia. Under treatment an increase of weight of two-thirds of a pound. Much better appearance.

CASE XII.-J. W., 30 years old. Pulmonary tuberculosis and anæmia. After two weeks' administration of PeptoMangan (Gude), an increase in weight of two pounds and an increase in hemoglobin of 15 per cent.

CASE XIII.-K. L., 50 years old. Cancer of the stomach, cachexia and anæmia. During three weeks' use of PeptoMangan (Gude) the patient felt better, the appetite had improved, and there was increase of weight of two-thirds of a pound.

CASE XIV.-A. B., 14 years old. Chlorosis; hemoglobin 40 per cent. After two weeks' treatment, hemoglobin 85 per cent.; disappearance of all disturbances.

CASE XV.-F. K., 18 years old. Chlorosis; hemoglobin 35 per cent.; after two weeks' treatment 50 per cent.

CASE XVI.-E. J., 5 years old. Anæmia following scarlatina. After eight days' treatment with Pepto-Mangan (Gude) the patient developed a vigorous appetire, and recovered so rapidly that he could be discharged cured at the end of the second week.

Altogether, twenty-three cases of anæmia were treated with Pepto-Mangan (Gude), of which twelve showed a normal hemoglobin per cent. of the blood after fourteen days, five after three weeks, and five after a month. On the other hand, one of the patients who had hereditary trouble (her father having suffered from pulmonary disease) was discharged only improved, the blood, after two months' treatment with PeptoMangan (Gude), showing only an increase of hemoglobin to 75 per cent. This was probably a case of tuberculosis which simulated an obstinate or severe chlorosis at its beginning. Furthermore, two cases of acute anæmia after profuse

hemorrhages were treated with Pepto-Mangan (Gude). A favorable result was obtained as early as the end of the first week. In one instance the patient felt so well that only the fear of further hemorrhage constrained him to stay in bed for another week. In the case of three women who had miscarried during the early months of pregnancy, and were making a very slow recovery from the resulting aaæmia, I was able to obtain a complete recovery after four weeks' administration of Pepto-Mangan (Gude). In six other instances of weakness and anæmia following acute and chronic disease (tuberculosis, carcinoma, scarlet fever, etc.), a disappearance of the feeling of weakness and a considerable improvement of the general health could be observed in every instance.

The histories cited above will afford conclusive evidence of the high therapeutic value of Pepto-Mangan (Gude). Unpleasant concomitant effects and disagreeable sequelæ were never observed during the use of the remedy. Eructations, pressure in the stomach and nausea were never noticed.

In conclusion I would say that Pepto-Mangan (Gude) is a valuable and reliable blood-building remedy, which can be recommended for general use in appropriate cases.

Clinical Reports.

SUMMER DIARRHEAS OF CHILDREN AND THEIR TREATMENT.

BY M. A. AUERBACH, PH.G., M.D.,

Medical Inspector, Department of Health, New York City.

The importance of these demand a separate consideration. Three forms, more or less distinct, can be recognized, viz., acute dyspeptic diarrhoea, cholera infantum and acute entero-colitis.

Acute Dgspeptic Diarrhea.-This disease is entirely due to errois in diet, which do not necessarily consist in the substitution of unnatural foods for the mother's milk. The mother's milk