Destroys Pus and any Morbid Element with which it comes in contact, leaving the tissues beneath in a healthy condition.

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Charles Marchand

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The Modern Management of Malarial Anemia.-One of the most obstinate forms of anemia with which the physician has to contend is that which succeeds malarial infection. This particular form of anemia is, unquestionably, due directly to the structural changes induced by the protozoon parasite. While a mild form of anemia is a common, if not invariable, consequence of malarial infection. there is a severe type, termed malarial anemia, which not infrequently occurs. This latter variety usually responds slowly to curative measures; and, since its existence renders the individual a fit subject for recurring malarial manifestations upon the slightest exposure, the importance of its cure cannot be too strongly emphasized. The doctrine of the latency of malarial poisoning in the human body is rapidly gaining in popularity. Some authorities even go so far as to claim that a person who has once been inoculated with the malarial protozoa never completely recovers. Whether this be true or not, it is certain that the protozoon prarsite does exert an influence which tends, for a great length of time, to lower vitality and render feeble the powers of resistance to renewed attacks. This is especially true in the case of women, children and persons of advanced age. Recent investigations unite in ascribing the cause of malarial anemia to the liberation of hemoglobin from the red corpuscles in the blood vessels. The pigmentation resulting from this liberation of hemoglobin is one of the characteristics of malarial infection. And while the coloring matter may remain in the blood stream, it usually infiltrates into the cells and neighboring tissues. The deposit of pigment is especially great throughout the tissue of the liver and spleen. The thickening and softening of the mucous membrane of the stomach which always attends malarial infection, seems likely to contribute, at least to some extent, to the development of anemia. In every instance the degree of the anemia is in direct ratio to the amount of the hemoglobin liberated from the red corpuscles. fact explains the philosophy of effecting repair by the administration of iron, the hemoglobin-contributor. Whether or not the protozoon parasite is ever completely eliminated from the economy remains an unanswered question. But it is now universally conceded that the protracted administration of iron does render the indivi. dual partly, if not completely, exempt from a return of malarial manifestations of an aggravated type. Far more so, in fact, than does quinine. Indeed, we have good. cause to believe that iron does exert a destructive influence upon the malarial protozoa and increases the immunity of the individual. While it is the chief aim of the physician to make up the deficiency of the hemoglobin in these subjects by the administration of iron, it is distinctly important, coincidently, to increase the appetite and augment the capacity to appropriate the food ingested. To this end, discrimination in the selection of the form of iron to be employed is vitally essential. The acid solutions of the drug are ineligible because of the fact that they cannot be engaged for a long period without harmfully affecting the secretion of the digestive juices and adding to the morbid state of the mucous surfaces or the alimentary tract. Furthermore, the continued use of acid products of any sort are certain to diminish the alkalinity of the blood, thus depressing, to a very considerable extent, the nutritive processes. Then, too, headache which is an ever disturbing factor in these cases, is intensified by all substances of an acid reaction. The strongly alkaline preparations of iron, while less objectionable than the acid ones, are open to fault for the reason that they induce constipation, and in this manner favor auto-intoxication. By far the most effectual form of iron in the treatment of malarial anemia is that which is neutral in reaction and available for immediate absorption. The organo-plastic form of iron, as found in pepto-mangan (Gude), certainly fulfils the requirements of the physician with greater promptness and uniformity than any other product thus far evolved. This preparation-pepto-mangan (Gude)—is by all means the most potent hemoglobin-producing form of iron, and it undoubtedly surpasses other ferruginous products as an invigorator of the digestive and nutritive functions. These assertions are easily confirmed by the microscope. It is also an accepted fact that pepto-mangan (Gude) does not induce constipation, and it seems to materially hasten repair of the mucous surfaces of the alimentary tract resulting from the structural changes incident to the malarial infection, In short, pepto-mangan (Gude) is of inestimable value in the treatment of malarial anemia by virtue of its manifold advantages over other preparations of iron. If this preparation is administered for the proper length of time, the individual gains substantially in strength, flesh, physical and mental energy.

Iodalia an Efficient and Pleasant Alterative.-(By A. H. Ohmann-Dumesnil, A. M., M.E., M.D., Ph.D., St Louis.)—Without wishing to enter into a long consideration of the different varieties and classes of alteratives, their advantages and disadvantages, it may be best to plunge in medias res and take into consideration that one which is universally conceded to be the best general alterative and the one which produces the effects attributed to this class of remedial agents better than any other. The one here meant is iodine; a most useful and, at the same time, much abused remedy, which is unfortunately but too little understood, and is so potent in its beneficial effects when properly applied in the proper cases. Dr. Nicholas Senn in a paper on "Iodine in Surgery," says, "in the treatment of so-called scrofula and lupus, iodine internally and locally commanded the confidence of the profession for more than a half century before the bacillus of tuberculosis was discovered." It may be further mentioned that iodine has been found efficient in the form of injections

It

An

in joint affections, seropurulent in nature, in tubercular peritonitis, locally in erysipelas, in anthrax, etc., but beyond all doubt its most extensive and successful employment, internally, has been in the treatment of syphilis, more especially in that form known as the tertiary. It is here that it has most fully and thoroughly demonstrated its action as an alterative and it is destined to remain the remedy par excellence in this condition for many years to come. As a rule iodine is administered internally in the form of iodides, although it is also given pure in many cases. has been observed, however, that the salts of iodine, formed by its combination with alkalis, are all more or less irritating. This is due beyond doubt to the alkalies with which the iodine is combined and these symptoms are so marked that they are easily recognized, more especially so far as the objective signs are concerned. Devices have been employed to prevent the usual gastric disturbance, such as taking the iodide in large quantities of milk and the ingestion of large quantities or bicarbonate of soda between meals to prevent the toxic influence of the alkaline salts of iodine. These are fairly good for a short time, but the symptoms of an untoward nature will manifest themselves despite all the precautionary measures taken. The cause of all these disturbances is beyond all doubt dependent upon the alkali which the salts contain and the problem which has been presented was to made a purely organic salt whose action would be as good if not superior from a therapeutic point of view and which would be unirritating, locally as well as constitutionally. other disadvantage observed in all these iodides, as well as in pure iodine, is the lack of palatability observed in these remedies. We cannot here follow the evolution of the process of experimentation which finally led to the elaboration of a galenical iodo-tanic preparation. A product of definite composition which was always constant was the result. It was found, however, that the combination of iodine and tannin is very hygroscopic and not easily desiccated with any uniformity. This led to a further series of experiments by saccharating it and thus attaining its inalterability. This much having been attained it was an easy matter to make a series of experiments and thus demonstrate the physiologic and therapeutic action of the remedy. The name which was adopted for this saccharated tannate of iodine was iodalia, and it is under this name that it is marketed to-day. It is by no means a secret remedy, as its chemical name sufficiently indicates its nature and its strength, which is uniform, is that of six centigrams of iodine to five grammes of salt, or approximately one grain to every teaspoonful. In appearance it is a white granular salt, not heavy and pleasantly sweet to the taste. may be taken in milk, water or wine, and is pleasant in this form. It does not in the least disturb the stomach and is very easily assimilated, as proven by the fact that iodine may be found in the urine a half hour after its ingestion. The writer has not yet received any complaints concerning any untoward effects, although he has ordered comparatively large doses to be taken. Its effects are prompt, but perhaps the recital of a few cases will be best.

It

Case 1. A young man, unmarried, 24 years of age, was referred to me by two physicians, as their efforts had proved unavailing. The patient, when I saw him, was then, anemic, weak and had almost despaired of ever recovering. He had a case of malignant syphilis. The nose and throat were well advanced in ulceration, there was paralysis of the soft palate and the deglutition of liquids was almost an impossibility, not to mention solids. There was perforation of the hard palate,a destruction of the ossicles of the ear and consequent deafness, and altogether he was in a pretty dilapidated state. On inquiry his history developed the fact that he had acquired syphilis three years previously and had no doubt, been insufficiently treated, with the result of the tertiary symptoms which I saw. The patient was immediately placed on iodalia in doses of two teaspoonfuls in water before each meal. This treatment was persisted in, and two months after its inception he presented a bright appearance, he had gained weight, he could eat with ease and he felt better morally and physically. The result so far was a revelation, not only to the patient, but to his former physicians as well. He is still under treatment.

Case 2. A young lady, unmarried, aged 22, was troubled with an intractable case of acne. She had been treated by a large number of competent men with but little result of a favorable nature Upon examination I discovered that the acne was of an atonic form, the patient herself not being in good physical condition. The cervical lymphatics were markedly enlarged, and upon further examination other glands in the same condition were found. This was the solution of the lack of success which had followed the treatment of other physicians as well as of mine. Having determined the cause of the trouble I ordered her to take one teaspoonful of iodalia in water before each meal and was pleasantly rewarded by seeing the eruption nearly well and the tuberculous glands much diminished in size in about three weeks. She will be continued under this treatment for some length of time, more especially as she feels better in all respects.

The indications for the use of iodalia are very simply told. It is indicated in all conditions in which iodine is employed. The list of conditions is too long to be enumerated here. It embraces all those in which alteratives are employed. Among the principle ones are syphilis, localized tuberculosis, lymphatism, arterio-sclerosis, etc. Iodalia is a remedy well worth remembering as an unchangeable iodotannic saccharate, which is easily assimilated and never injures the gastric mucous membrane or produces untoward symptoms.-Abstract from St. Louis Medical and Surgical Jour

nal