CHEM. LIB. RS 356 A724 A 557455 • . . * . . LIST OF PREPARATIONS PAGE LIQUID PEPTONOIDS 1 DRY PEPTONOIDS-SOLUBLE 16 LIQUID PEPTONOIDS WITH CREOSOTE 21 CASCARA-PEPTONOIDS 26 IODO - PEPTONOIDS 30 O PHOSPHAGON 34 PHOSPHO-CAFFEIN COMP. LACTOPEPTINE 43 44 HEMABOLOIDS 61 HEMABOLOIDS-ARSENIATED (With Strychnia) 72 BOROLYPTOL KOLA-CARDINETTE 80 85 Notes on the Composition, Therapeutic Indications and Practical Advantages OF THE Pharmaceutical Preparations MANUFACTURED BY The Arlington Chemical Company The N. Y. Pharmacal Association The Palisade Manuf'g Company OF YONKERS, N. Y. : t COPYRIGHT, 1909, BY THE ARLINGTON CHEM 'CAL COMPANY YONKERS, N. Y. I LIQUID PEPTONOIDS "O NE of the most striking differences between the olden and the more recent modes of treatment of disease is the careful attention bestowed upon the diet at the present day, for it is now recognized that the proper selection of food, both solid and fluid, is of as much importance as the use of medicaments.” This has been of course more quickly recognized and realized in infant feeding but it is now coming to be ap- preciated that in organic disease, Diabetes, Gout, Rheu- matism, Tuberculosis, and cachectic conditions, much de- pends upon proper feeding, and that more is to be gained by increasing nourishment and thus improving the general condition of the patient than by reliance upon drugs alone. In acute conditions of disease, such as Sepsis, Inflamma- tion, Pneumonia, Typhoid Fever, Influenza, the Exanthe- mata, etc., when the organism staggers under an attack from without upon the part of pathogenic organisms, or the body mechanism is jarred and thrown out of co-ordinate harmony of action by some disturbance of function, or failure of process originating from within, there is grave danger that the importance of proper feeding may be un- derestimated. Yet, it is in just such a case that the issue depends to a great degree upon the sustaining of the body until it can fight its own battles and attend to its own shortcom- ings, while it cannot fight and forage at the same time. While it is true that many diseases are more or less self-limited, tending to recover without much medication, it has been claimed that patients when attacked by severe acute disease can get along very well without much atten- tion to feeding or are even better off for withholding all nourishment. Experience has shown, however, that such treatment results in prolonged convalescence and slow re- covery of normal health and strength. Any physician in active general practice will admit 1 The Arlington Chem Ca Yorkers, N.Y. 253374 LIQUID PEPTONOIDS that even in cases of illness of short duration and uncertain etiology, conditions are often met with, in which there is rapid loss of strength and recuperative power out of all proportion to the pathological changes involved, and that in such cases much is to be gained by careful attention to regular feeding. When fever is present, there is loss in body-weight, urea is increased, appetite is lessened or lost, gastric juice, pan- creatic and biliary secretions deficient in quantity and qual- ity, and excretion is lessened. Infectious fevers are characterized by toxic destruction of body proteins, the products of which, acting upon the hunger centres of the brain, destroy appetite and the de- sire for food. Formerly, this was not understood and be- cause patients did not desire food or rebelled at the very thought of it, they were thought to do well if left un- nourished for a time. Modern conception of dietetics, however, recognizes that this is dangerous. The patient is allowed less to live upon his own tissues and results are decidedly better under carefully selected feeding. To avoid nausea, vomiting and gastro-intestinal irrita- tion, as well as to lessen the strain upon the excretory functions, nourishment must be given to the patient in sufficient quantity and properly suited to digestive power. Patients are sometimes allowed to drift into critical con- ditions by improper feeding. Many have been lost because those in charge of them, not knowing how to feed, either withheld nourishment altogether, gave it in insufficient. amounts or in unsuitable form. The requirements of nu- trient material intended for such use are: 1. It must be relatively small in bulk and concentrated as much as possible. 2. It should be in liquid form, palatable and aseptic. 3. It should be predigested and ready for immediate assimilation and absorption without digestive effort. 4. It should be free from waste material or irritating residue. 2 The Arlington Chem Ca Yonkers, NY LIQUID PEPTONOIDS 5. It should be easily prepared and capable of wide modification to suit individual taste. 6. It should be of fixed and definite composition and food value. Liquid Peptonoids, the pioneer of the large number of commercially prepared nutrient preparations, was con- ceived, manufactured and marketed for the purpose of furnishing an agent of practical clinical value in the many cases of acute illness or debilitated conditions where it is impossible or impracticable to depend upon or- dinary food-stuffs. It has been described as an Emergency Nutrient or Auxiliary Food Tonic upon the understanding that its claims for nutrient value and therapeutic efficiency apply to conditions met with in disease and are not to be taken to apply to the normal individual or his requirements when in health. Liquid Peptonoids represents a fixed and definite quan- tity of the two essential elements of nutrient material, viz., Protein (5.25%) and Carbohydrates (11.3%) derived from the three principal natural food-stuffs, Beef, Milk and Wheat, together with 2.5% Cane Sugar. Its Protein con- tent exists in the form of Peptones and Propeptones, ob- tained by methods which are distinctly physiological in character and approximate practically those of normal human digestion and in which the digestive principles of gastric and pancreatic juice are the only agents used. So- called chemical methods of digestion are not employed. The Carbohydrates, in like manner, are present in the form of Lactose and Dextrose, which together with the small proportion of cane sugar present, do not favor or induce fermentation or flatulence. Liquid Peptonoids is free from extractive or waste ma- terial, an important point, as it does not irritate or throw increased work upon impaired or overtaxed excretory func- tions. It is absolutely aseptic, permanent and uniform. The minimum amount of alcohol necessary for pre- servative purposes is employed in preference to wine or 3 The Arlington Chem Ca Yonkers, N.Y. LIQUID PEPTONOIDS other menstrua and ensures uniformity of composition, freedom from tannic acid, tartrates and other extractives. Carefully selected stomachic and aromatic carminatives, completely mask the food taste of the peptones, and give to it the flavor of an agreeable cordial. It will be retained by stomachs that reject all other forms of food. It requires no preparation, being immediately available, without preparation, and can be added to other media or modified in many ways without impairing its therapeutic efficiency. THERAPEUTIC ADVANTAGES PALATABILITY, which has been brought to a point of absolute perfection. This advantage cannot be too highly emphasized for it is of the highest importance to preserve the patient's appetite and desire for nutriment in any of the disorders or diseases in which a reconstructive food of this sort is indicated. COMPLETE PREDIGESTION.-In all forms of disease at- tended by constitutional depression, the digestive functions are correspondingly weakened. Under such circumstances, it is necessary to allow the patient to take only such food as can be readily digested and absorbed, therefore, a pep- tonized food is indicated until the alimentary functions are restored to their normal vigor. PEPTOGENIC POWER.-Not only does this preparation afford a predigested food, but it also stimulates the peptic glands, the formation of gastric juice and aids in the digestion of other foods. SUFFICIENT CONCENTRATION.-This advantage is self- evident to every physician and renders it possible to nourish a patient for a considerable length of time, during critical stages of severe illness, when all other forms of food are absolutely refused. GENERAL RECONSTRUCTIVE EFFECT.-"Existence is but a succession of wastes and repairs," and when the indi- vidual is unable, by reason of disease or exhaustion after 4 The Orlington Chem Ca Yonkers, NY. LIQUID PEPTONOIDS disease, to make up the lost tissue caused by increased waste incident to fever, etc., Liquid Peptonoids is im- peratively demanded. SUSTAINING AND FORTIFIANT ACTION Liquid Peptonoids contains by weight 14.56% alcohol. This amount is required for preservative purposes and also is just sufficient to produce, when the preparation is given in proper dosage, a mildly stimulating effect upon appe- tite and digestion, tone up the general system and in critical conditions of acute illness act as a therapeutic agent, which is recognized in all text books upon Dietetics or Practice of Medicine. It should be borne in mind that Liquid Pep- tonoids is intended for use as a medicinal food adjunct, employed according to therapeutic indications in indicated dosage. On account of its rapid absorption and complete oxida- tion, alcohol furnishes immediately available calorie value. Atwater and Benedict have conclusively shown that it may be used in the economy in place of isodynamic quantities of carbohydrates or fats. Therefore, when used according to its therapeutic indi- cations and in doses suited to the condition in which it should be employed, Liquid Peptonoids possesses in its alcoholic content not only a valuable adjuvant to its nu- trient, peptogenic and restorative properties, but a logical and rational medicinal value. COMPARATIVE NUTRIENT VALUE Comparison of Liquid Peptonoids with those nutrient agents in common use for feeding the sick and which have to be prepared in the kitchen or in the sick room, such as Soups, Broths, Egg Albumin Water, Barley Water and even Milk in its various forms, will reveal many advan- tages possessed by the commercially prepared product. Beef extracts, soup and even beef juice, when prepared 5 The Arlington Chera Ca Yonkers, NY LIQUID PEPTONOIDS under the best of conditions, contain a relatively large amount of extractive matter compared to the quantity of protein available as nutriment. As has been stated, “The recent experiments of Pawlow have shown that meat ex- tracts are powerful exciters of gastric secretion. They are thus calculated to rouse appetite and aid in the di- gestion of food with which they may be taken. This is indeed their true function both in health and disease; they are flavoring agents and their proper place is in the kitchen and not at the bedside. While the title of food is applied to them, yet they are such only in theory." It should also be realized that they contain extractive or waste material, which is often decidedly harmful by its action upon the kidneys, etc. Beef Juice, regarded by many as possessing considerable nutrient value, furnishes, under the most favorable condi- tions, less than 3% of available protein and almost as much extractive material. Egg Albumin Water, while useful as a drink, furnishes only about 1.5% coagulable protein when given diluted as is generally advocated. It should be remembered in this connection that coagulated white of egg is not prac- tically pure albumin, as is often understood, but contains on an average only 12% protein. The actual nutrient value of Barley Water, Toast Water, etc., is practically too small to estimate. They are useful as drinks. Even Milk, which has been regarded by many as an ideal food, and is often cited as a standard for comparison, has many practical disadvantages and shortcomings. While a fluid outside the body, it forms in the stomach, during digestion, more or less tough, leathery curds, which in dis- ease irritate the mucous membrane, resist the action of the impaired digestive juices and favor bacterial growth. In health, during normal digestion, from 8-10% of the solids in milk are eliminated in the stools. Ewald states that for a man in health a pure milk diet is slow starvation, and 6 The Arlington Chem. Ca. Yonkers, Nip LIQUID PEPTONOIDS Rubner that the stool is larger on a milk diet than when meat or eggs alone are given. In Typhoid Fever with constipation, the entire casein of the milk may often be recovered in the form of curds from the stools. When diarrhoea is present, milk often passes through and is not absorbed. Milk requires diges- tion; a period of 3½ hours is often required for complete digestion in the stomach. Milk is a common carrier of infection, always contains bacteria, which thrive in the fecal bulk which is formed during digestion, leading often to putrefaction the products of which set up more or less irritation. The variation of the total solids-and several nutrient elements of milk-is subject to wide range, often as high as 30%. Many people, sick or well, cannot take milk in any amount. Many cannot digest it. It often produces sore mouth. It will be appreciated, therefore, that in many cases, when patients cannot take milk at all, or only in amounts insufficient to supply enough nutrient material to provide for the wants of the body, Liquid Peptonoids is of de- cided value. It is free from all or any of the disadvantages of milk and as will be seen later possesses sufficient nutrient value to render it of real service in replacing tissue waste and furnishing heat or energy besides its restorative and sustaining properties. For purposes of comparison the actual nutrient content of the commonly used food agents or kitchen foods and that of Liquid Peptonoids is given in tabulated form. It will thus be evident that Liquid Peptonoids exceeds each and every one of such agents in the amount of total solids, protein and carbohydrates. It must be remembered also in this connection that the nutrient content represents, being predigested, a much larger amount of the raw or undigested material (51 grammes of peptone equal 35 grammes of lean beef or 44 grammes of hard boiled white of egg, and are immediately assimilated and ab- 7 The Arlington Chem Ca Yorkers, NY. LIQUID PEPTONOIDS sorbed). Hutchinson declares: "We may now say with confidence that peptones are fully capable of playing the part in nutrition ordinarily taken by protein provided they are given by the mouth." Also that peptones are regularly formed during the process of normal digestion, represent practically the completed products of proteo- lytic digestion and as such are ready to be re-synthesized into substances capable of being distributed directly to the tissues. The practical clinical value of Liquid Peptonoids as a Nutrient Agent. Total Solids. Protein. Carbo- hydrates. Fat. Ash. Water. % do % % % % % Milk 12.8 3.5 4.9 3.7 0.7 87.2 Buttermilk 9. 3.0 4.8 0.5 0.7 91. Whey. 7. 1. 5. 0.3 0.7 93. Beef Juice 4.28 2.19 2.09 95.72 Beef Tea. 3.72 1.02 2.70 96.28 Barley Water 0.23 0.09 0.06 0.05 0.03 99.77 Egg Album. Water 1.5 1.5 98.5 Alcohol Liquid Peptonoids 20.0 5.25 13.8 14.56 0.95 62.5 nutrient and energy producer may be expressed in the following manner: Liquid Peptonoids is often given in doses of one table- spoonful every hour, or two tablespoonfuls every two hours, amounting to twelve ounces in twenty-four hours. This is by no means the maximum amount which can be or has been frequently employed. Twelve ounces 375 grammes Liquid Peptonoids con- tain 19.68 grammes protein and 51.75 grammes carbo- hydrates, or a total nutrient value of 71.43 grammes. The calorie value (including that of the contained alcohol) is 754.58. It is plain, therefore, that by furnishing such an amount of nutrient and calorie value, Liquid Peptonoids theo- retically considered is worthy of employment. Clinical ex- 8 The Arlington Chem Ca Yonkers. N.Y. LIQUID PEPTONOIDS perience for a period of many years has amply proved its practical efficiency. INDICATIONS FOR USE Liquid Peptonoids is indicated in all conditions when an emergency nutrient or auxiliary food is called for, when there is bodily prostration, depression of digestive, circulatory and other functions, when diminution in qual- ity and quantity of gastric and intestinal juices results in inability to take care of the simplest forms of ordinary food, or when nausea and food loathing prevent ordinary feeding. NAUSEA AND VOMITING from any cause-in Preg- nancy, Sea Sickness, Alcoholism, Nervous Dyspepsia, Gastric Ulcer or Cancer, or during the gastro-intestinal perturbation incident upon acute indigestion, ptomaine poisoning, etc. Liquid Peptonoids, by virtue of its con- centration of predigested, immediately absorbable and as- similable nutrient, may be given in small quantities at fre- quent intervals, and will be retained where all other forms of food are rejected. DIARRHEA AND DYSENTERY-When digestive function is upset and the liability to fermentation and putrefaction in the bowel increased, Liquid Peptonoids, being aseptic and requiring no digestive action, will be promptly ab- sorbed, thus keeping up strength and preventing the ex- treme weakness and prostration. When SEVERE NAUSEA exists and the stomach is so irri- table as to reject anything given per os, the following method will often prove successful: Heat a tablespoon over alcohol lamp or gas jet, plunge the tip into cold water, in order to chill it enough to prevent burning the lips or tongue, pour in the dose of Liquid Peptonoids, and allow it to become heated to blood temperature and administer. When the patient is in a stupor or so weak that feeding is difficult, Liquid Peptonoids may be dropped between the lips, or allowed to trickle upon the tongue, while gentle 9 The Arlington Chem Ca Yorkers. N.Y. LIQUID PEPTONOIDS massage of the larynx will promote swallowing movements. In many instances, especially in children, where medicine is given in small amounts, it may be palatably given in a dose of Liquid Peptonoids. For RECTAL FEEDING, one ounce of Liquid Peptonoids dissolved in three ounces of warm, normal salt solution, is introduced slowly through a soft catheter, inserted into the rectum a distance of three or four inches. A piston or bulb syringe should not be used and the bag of the fountain syringe should never be elevated more than thirty inches better twelve inches or less. Nutrient enemata given in this way will be retained. THE ACUTE INFECTIOUS DISEASES-Pneumonia, Influ- enze, Rheumatism, etc., are characterized by a sudden severe attack upon the vital forces. Bodily prostration and depressed circulatory and gastro-intestinal functions make judicious feeding imperative to maintain strength, replace tissue waste and furnish mild stimulation. The dry mouth, parched tongue and diminished activity of the digestive function, overburdened excretion and toxemia indicate that only liquid food capable of rapid absorption should be employed. Liquid Peptonoids is an ideal nu- trient in such conditions, being ready for use without preparation, uniform in strength and nutrient value, and ready for immediate metabolism. SEPSIS AND INFLAMMATORY DISEASES rapidly reduce the vitality and recuperative power of the patient, and call for the additional element of stimulation in addition to sup- plying adequate nutriment on account of the extreme pros- tration and weakness of the patient. This is furnished in Liquid Peptonoids so combined with actual food material as to render it of great practical value. ACUTE AND POST-OPERATIVE FEEDING offers another field in which Liquid Peptonoids has for years demonstrated its efficiency and worth. DURING THE "NO-MILK" SEASON in infantile gastro- enteric cases, the child's nutrition is conserved, its resist- 10 The Arlington Chem Ca Yorkers, N.Y. LIQUID PEPTONOIDS ance increased and its general vitality supported by the addition of Liquid Peptonoids to the egg water or cereal decoctions employed in such conditions. Its mildly stimu- lating effect tends to prevent prostration and the child emerges from the attack in better shape than when the policy of starvation is adopted. It is also of extreme value added to the milk, in small doses, for bottle fed in- fants, who suffer from malnutrition or faulty assimilation. By such means the child is often enabled to assimilate its milk better, and the gain in strength and flesh is marked. IN THE AGED AND INFIRM, when the digestive power is enfeebled, and the diet has to be reduced in quantity and concentrated in nutrient value, Liquid Peptonoids will prove of extreme value. It may be given either with or between meals, and partaking of the nature of a nutrient cordial will often be relished and taken when there is dis- taste for ordinary food. Especially is this the case when exertion results in sudden fatigue or prostration, in which condition the stomach is unable to digest or take care of ordinary food. IN TYPHOID FEVER, the gastric juice is deficient in qual- ity and amount, the intestinal mucous membrane easily irritated, tympanites and toxemia are present. When diarrhoea is a prominent symptom and pyrexia and nervous disturbance present to any degree, it is rational to select that form of nutrient which requires no digestive effort, leaves no residue, and is immediately available to replace tissue waste. Clinical experience has for years demon- strated the value of Liquid Peptonoids in the dietetic treat- ment of this disease. While in mild cases, in which the enteric disturbance is slight, it is possible to employ eggs, gruels, toast and similar light diet; in the severe forms ac- companied by marked bowel involvement, nutrient material must be free from any tendency to aggravate these con- ditions. Liquid Peptonoids is preferable to milk. IN THE EXANTHEMATA the greatest danger to be appre- hended during the acute infectious diseases in childhood 11 The Arlington Chem Ca Yonkers, N.Y. LIQUID PEPTONOIDS is the appearance of Sequellæ and the first object should be to prevent this by proper attention to feeding, in order to maintain the child's strength and increase its power of resistance and recuperative force. Liquid Peptonoids is in every way adapted to such use. It is nutritively adequate, easily and entirely absorbed and assimilated, sustaining and mildly stimulating, peptogenic and palatable, ready to use without preparation and will be relished when food loathing exists. Being extractive- free, it does not favor renal irritation and will be retained. when there is nausea and vomiting. IN WASTING DISEASES it should be appreciated that Liquid Peptonoids contains sufficient nutrient material to render it of great value as an auxiliary food in Cancer, Marasmus and all Cachectic conditions. Furthermore, it entails no digestive effort, throws no strain upon excretory function, is immediately available and tends to counteract the progressive weakness and pros- tration. Given in small doses at frequent intervals, it maintains strength, combats asthenia and sustains the patient at a period when it is often difficult to administer sufficient nourishment in ordinary ways. IN PROTRACTED CONVALESCENCE. Cases slow to con- valesce and marked by Asthenia, Adynamia and Atony, as a rule, suffer from anorexia and food loathing, thus making it difficult to carry out the first indication for treatment, viz., to improve nutrition. Liquid Peptonoids, on account of its sustaining, res- torative and mildly stimulating properties, is a valuable auxiliary food, which may be enjoyed with benefit in con- nection with ordinary feeding. Its pleasant taste, easily modified to prevent monotony, and its thorough predigestion allow it to be taken for long periods. It is peptogenic, extractive free, and will be tolerated when the stomach is irritable and the appetite capricious. IN RECTAL FEEDING, when for any cause it is deemed 12 The Arlington Chem Ca Yonkers, NY LIQUID PEPTONOIDS advisable to administer no food per os, Liquid Peptonoids is an ideal agent. On account of its concentration, it can be used in small bulk, without sacrifice of food values. It does not irritate the bowel and is rapidly and completely absorbed. Economically considered, Liquid Peptonoids is the best preparation that can be used since it is tolerated and uti- lized when other food agents are rejected. It is always ready for use, requires no preparation, is absolutely uni- form and aseptic, contains no extractive or waste material, and can be easily modified to suit any palate. DOSAGE THE DOSE of Liquid Peptonoids is subject to wide variation and depends entirely upon the character of each individual case. One tablespoonful may be given every hour or two hours, or the quantity may be increased to more than double this amount. Children in proportion. In Erysipelas, Diphtheria, Sepsis, severe Pneumonia or Typhoid, the dosage may be increased far beyond the ordinary quantity. The use of this preparation depends upon a clear conception of its actual nutrient value, and the needs of the case in hand. Perfunctory use will often fail to give satisfaction, in fact, when failure follows its use, it is due to faulty and insufficient dosage. For gen- eral guidance it may be kept in mind that one ounce of Liquid Peptonoids is equal in nutrient value to about three ounces of milk-and as regards protein content to three drams of scraped beef-or three and one-half drams of coagulated white of egg. ADMINISTRATION Liquid Peptonoids should always be given cold—or hot -never at ordinary room temperature. In severe Tonsillitis, Diphtheria, etc., when the throat is sore and painful it is grateful and soothing when given hot. 13 The Arlington Chem Ca Yorkers, N.Y. LIQUID PEPTONOIDS Acutely ill patients as a rule take Liquid Peptonoids best undiluted. It should be borne in mind that in such cases the tongue is more or less coated, the secretions of the mouth scanty and the sense of taste blunted or en- tirely lost. Hence the aromatic elements in Liquid Pep- tonoids are of service and prevent the complaint of lack of taste or insipidity. For this reason, patients will usually relish under such conditions, what in health or during con- valescence is sometimes easily tired of or distasteful. When, for any reason, it is desirable to modify the taste of Liquid Peptonoids, satisfactory results can generally be obtained. DILUTING THE PRESCRIBED DOSE WITH water—plain or carbonated, milk-iced or hot, coffee, tea, ginger ale, etc., ADDING TO PRESCRIBED DOSE Orange, lemon, grape or other fruit juice, salt, pepper, celery salt, powdered cinnamon, etc., GIVING IN Clam, oyster or tomato bouillon, or in beef tea made from some of the beef extracts or chicken or mutton broth. HOT PEPTONOIDS To a small teacup half full of boiling water add one tablespoonful of Liquid Peptonoids, one teaspoonful of fresh lemon juice, and a little sugar if desired. PEPTONOIDS BOUILLON-HOT To one teacup half full of boiling water, add two table- spoonfuls of Liquid Peptonoids, flavor to suit with celery salt or salt and pepper. Put PEPTONOIDS JELLY-ORANGE small box gelatin, juice and peel of one orange, one pint of cold water into a dish and allow to stand for one hour. Put in double boiler on the fire, add one table- spoonful of sugar and stir until dissolved. Strain through 14 The Arlington Chem Ca Yonkers, N.Y. LIQUID PEPTONOIDS linen, add four ounces Liquid Peptonoids and stir well, pour into mould and set on ice. 4 Soak box gelatin in cupful of cold water for one hour. Add 1 ounce fresh celery to 2 cups of cold water, put in a double boiler and simmer hour; add 1 teaspoon- ful of salt, 2 dashes of pepper and the soaked gelatin; stir until dissolved. Remove from the fire; add 4 ounces of Liquid Peptonoids; stir, and strain through linen into a mould, set on ice. PEPTONOIDS WINE JELLY 4 Take of best gelatin, 1 of a small box; cold water, 4 tablespoonfuls. Soak for a few minutes. Add boiling water, 8 tablespoonfuls; sugar, 2 tablespoonfuls; good sherry wine, Liquid Peptonoids, of each 8 tablespoonfuls. Set aside to cool. If desired, the sherry wine may be omitted or the juice of one lemon may be added. PEPTONOIDS COFFEE JELLY Take of best gelatin, 1 of a small box. Cold water, 4 tablespoonfuls. Soak for a few minutes. Add boiling coffee, 8 tablespoonfuls; sugar, according to taste; Liquid Peptonoids, 8 tablespoonfuls. Set aside to cool. 15 The Arlington Chem Ca Yothers, NY DRY PEPTONOIDS-(SOLUBLE) T HAT preference has been shown, in the past, for nutrient preparations in liquid form, is due in great part to the fact that the problem of how to obtain in solid or powder form soluble and immediately assimilable nutrient material, consisting of the protein and carbohy- drate elements of ordinary food-stuffs, has only recently been solved. Beef preparations in the form of extracts, jelly, meal or powder have been marketed, but the lack of palatability, tendency to decompose, and presence of extractive waste material have prevented their becoming popular. Milk or cereal powders, except as made the basis of the so-called infant foods, and for such use requiring solution in water, have not proven of much value in feeding adult patients. Yet there are many cases in which there is urgent need for concentrated nutrient material, which can be used in small bulk, without the presence of alcohol, either per se-which requires extreme palatability—or added to milk or other vehicles. Also for use during voyages, expeditions, camp life, etc., when food has to be carried in small bulk and most concen- trated form. With this in mind, the makers of Liquid Peptonoids. have, after years of experimentation, perfected and made practical the preparation Dry Peptonoids-(Soluble), which represents a degree of concentration and actual nutrient value hitherto unattainable. COMPOSITION Dry Peptonoids-(Soluble) exists in the form of a dry, finely granular, completely soluble powder. It consists of practically 100% of immediately available food material, approximately 40% protein (albumoses and propeptones) from beef, milk and wheat, together with their completely converted, promptly absorbable carbohydrates (lactose, dextrose and maltose, 53%) and nutrient salts, 7%. 16 The Arlington Chem Ca Yonkers, NY DRY PEPTONOIDS-(SOLUBLE) It therefore contains all of the available nutrient prin- ciples of these three standard foods except the fats. No other substance enters into its composition. It is absolutely stable and aseptic but contains no preservative agents-be- ing completely and effectively sterilized during manufact- The digestive conversion of these nutrient principles is accomplished by physiologic, i.e., proteolytic and dia- static methods only. It is entirely free from beefy taste or odor. ure. Not only is Dry Peptonoids-(Soluble) considerably richer in nitrogenous substances than most natural food material, but nine-tenths of the Nitrogen present is in the form of soluble, non-coagulable, diffusible proteins. The small residual quantity of other N. compounds includes no more than traces of the ordinary meat bases so that the preparation is free from Creatin, Creatinin, Xanthin and Purin bodies. The mineral constituents (ash) include 5.5% chlorine in the form of soluble chlorides and lime salts equivalent to 4.9% calcium oxide, also 0.5% sulphur and 0.9% phos- phorus in the form of soluble compounds, referable in large part to proteids and phosphates in the food mate- rial used. Dry Peptonoids-(Soluble) is very readily and almost completely soluble (less than 1% insoluble residue) in cold or hot water, milk, wine, etc. It contains no unconverted starch or indigestible mate- rial, and its taste is not sufficiently marked to prevent its being added to other food agents, by which it is thor- oughly and completely disguised. DRY PEPTONOIDS-(SOLUBLE) COMPARED WITH ORDINARY FOOD-STUFFS Reference to the following table will show that Dry Pep- tonoids-(Soluble) far exceeds the ordinary food-stuffs, in its protein and carbohydrate content, as well as in its calorie value. 17 The Arlington Chem La Yorkers 177. DRY PEPTONOIDS-(SOLUBLE) Food Material As Purchased. Refuse. Water. Protein. % % % % চাৎ % Beef. 16.3 52.6 15.5 15.0 0.8 910 Beef Soup 92.9 • 4.4 0.4 1.1 1.2 120 Mutton. 18.4 51.2 15.1 14.7 0.8 890 Chicken 25.9 47.1 13.7 12.3 0.7 765 Whole Egg. White of Egg. 11.2 65.5 13.1 9.3 0.9 635 86.2 12.3 0.2 0.6 250 • Milk • • Bread. Potatoes Dry Peptonoids- (Soluble). 87.0 3.3 4.0 5.0 0.7 310 35.3 • 20.0 9.2 62.6 1.8 1.3 53.1 1.1 1200 0.1 14.7 0.8 295 • 1.5 40.0 51.5 7.0 1729 DOSAGE Dry Peptonoids-(Soluble) is generally given in doses of 3 ss. every two hours or 3 vi. in 24 hours. 3 vi. (192 grammes) Dry Peptonoids-(Soluble) contains protein 76.80 grammes, carbohydrate 101.76 grammes, with a calorie value of 722.49. This dosage may frequently be doubled and it will be appreciated from the above that where so used it surpasses in every way the natural food agents. Dry Peptonoids- (Soluble) may also be used in connection with Liquid Pep- tonoids-being freely soluble in the latter, so that it is possible and practical to give in a bulk of 12 oz. of fluid— in which is dissolved 6 oz. of soluble powder-protein 96.96 grammes, carbohydrate 153.60 grammes, with a calorie value (including that of the alcohol content of Liquid Peptonoids) of 1516.21. In sickness there is a lessened requirement for carbohy- drate and the use of fat in any amount is often impracti- cable, hence the carbohydrate and alcohol value (220.80) thus available becomes important. The total calorie value 1516.21 exceeds the figures usually given as required by a sick patient, viz., 1,300-1,450 calories, 18 The Arlington Chem Ca Yonkers, N.Y Fat. Carbohy- drates. Ash. Fuel Value Per Pound. DRY PEPTONOIDS-(SOLUBLE) DRY PEPTONOIDS-(SOLUBLE) IS INDICATED especially in all conditions when for any reason the great- est amount of nutrient material in the smallest bulk is necessary. In gastric ulcer or cancer, vomiting in preg- nancy, alcoholism, seasickness, nervous dyspepsia, acute gastritis, etc., when the presence of anything, even water, in the stomach results in irritation and vomiting-Dry Peptonoids-(Soluble) may be given dry upon the tongue in teaspoonful or larger doses at frequent intervals and will be promptly dissolved and absorbed. To supplement the use of Liquid Peptonoids in acute illness, either given alone or dissolved in the former or in milk, wine, broths, etc. It may also be spread upon bread in the form of a sandwich and given to children or invalids. In Tuberculosis it may be rubbed up with cream, thus securing an indicated quantity of fat and eaten as a paste or spread upon bread, etc. For rectal feeding Dry Peptonoids-(Soluble) is of espe- cial service not only on account of its concentrated nutrient value but also because it is completely soluble and imme- diately absorbable without irritation. In the aged it is of particular service since it offers a valuable amount of nourishment in small bulk and does not require digestion. While traveling, or upon expeditions, or in camp, its concentration, palatability and the fact that it requires no preparation render it of practical value. SUGGESTIONS FOR USING DRY PEPTONOIDS-(SOLUBLE) IN FEEDING PEPTONOIDS HOT Add to a teacup of hot water three heaping tablespoon- fuls of the powder, add salt and pepper, or celery salt if desired, and serve. 19 The Alington Chem Ca Jokers. N BarM DRY PEPTONOIDS-(SOLUBLE) PEPTONOIDS ICED HOLM Chill the above mixture thoroughly or make into ice. PEPTONOIDS-COFFEE Add two tablespoonfuls of the powder to black coffee and serve either as café noir or with milk or sugar or both. PEPTONOIDS CONSOMMÉ Add two tablespoonfuls of the powder to a cup of con- sommé and season. PEPTONOIDS IN MILK Dissolve a heaping tablespoonful of the powder in four of milk, add an equal quantity of seltzer or vichy and serve. PEPTONOIDS EGGNOG Dissolve two tablespoonfuls of the powder in a tumbler of milk, add yolk of one egg well beaten, tablespoonful of whisky or brandy and after shaking add the white of the egg. EGG AND PEPTONOID MIXTURE Rub together yolks of two eggs, two tablespoonfuls of Dry Peptonoids-(Soluble) and four drams sugar. Add two ounces of brandy and four ounces of cinnamon water. Dissolve two tablespoonfuls of the powder in half a cup of milk. Add the yolks of two eggs and season. Let stand in pan of hot water until set into a custard. Rub two tablespoonfuls of arrowroot, two tablespoon- fuls of Dry Peptonoids-(Soluble) with a little milk into a smooth paste. Put three-quarters of a pint of milk over the fire and bring to a boil. Stir in the paste until it thickens. Put into a mould and cool. PEPTONOIDS COFFEE JELLY Half a package Tryphosa, add to this three or four tablespoonfuls of Dry Peptonoids-(Soluble). Pour on to this one-half pint boiling coffee, stirring constantly. Pour into a mould and chill. 20 The Arlington Cham Ca Yonkers, NY. LIQUID PEPTONOIDS C WITH CREOSOTE REOSOTE obtained during the distillation of beechwood tar is antiseptic, anesthetic, expector- ant, astringent and antipyretic. It has a special selective sedative action upon the nerves of the stomach and thus allays gastric irritability and nausea. It exerts a sedative action upon the bronchial mucous membrane, being eliminated largely by the lungs, and acts as a stimu- lant to bronchial secretion, also as a sedative to the entire respiratory tract. Its slow solubility and difficulty of ab- sorbtion cause it to be carried into the intestinal tract and render it an efficient intestinal antiseptic. It improves ap- petite and digestion and prevents or relieves flatulence. It is to some extent bactericidal. Coultman claims that tu- bercle bacilli are destroyed by blood containing one part of Creosote in 2000, and it forms soluble compounds with the toxic albuminous by-products of the tubercle bacillus which are easy of elimination. Almost all observers are agreed that if not possessed of specific properties it exerts a most wholesome influence. The most serious drawbacks and obstacles to the use of Creosote, especially in large doses for any length of time, have been- 1. Its extremely pungent and disagreeable taste. 2. Its tendency to disturb digestion and produce irrita- tion. COMPOSITION It has been found possible and practical, however, to com- bine both Creosote and Guaiacol with Liquid Peptonoids, in such a manner as to produce a preparation that contains two minims of pure Beechwood Creosote and one minim of Guaiacol to each tablespoonful. The disagreeable caustic irritant taste is entirely disguised and covered and this combination made the most palatable method of administer- 21 The Arlington Chom. Ca Yonkers, NY. LIQUID PEPTONOIDS WITH CREOSOTE ing the drug. Not only this, but the irritant action of the drug upon mucous membranes is done away with, and stom- achic toleration ensured by combination with Liquid Pep- tonoids, which seems by reason of its peptogenic action to assist in the toleration and retention of the drug and to promote rapidity of absorbtion, besides furnishing nutrient re-enforcement. Liquid Peptonoids with Creosote is not a simple mixture of the drug and the nutrient menstruum, but its smoothness and palatability are due to the employment of a special ve- hicle by means of which a combination is effected in such a way that the disagreeable effects of the drug are prevented and removed. Liquid Peptonoids with Creosote by virtue of the pecu- liar combination of Creosote and Guaiacol with the nutrient elements is free from the objections of the use of the drug alone, given in milk, capsules, etc. The disagreeable taste is effectively disguised and covered, the burning acrid sen- sation and local effect upon mucous membranes rendered bland and non-irritant so that it is practicable in the great majority of cases to employ the combination in sufficient. dosage for a proper length of time to secure definite clinical results. INDICATIONS FOR USE Potter states that as an antiseptic expectorant in chronic basilar cavity Creosote seems to have greater efficiency than any other remedy. Ellingwood (Materia Medica & Therapeutics) states:“ In purulent pneumonitis with formed cavities it is a superior agent. The combination of Liquid Peptonoids and Creo- sote is a palatable and nutritious combination in this stage of the disease. Its antiseptic and stimulating influences are apparent from the first." It is also claimed that Creosote destroys in the stomach the tubercle bacilli which exist in sputum which has been swallowed, and thus tends to prevent further infection. Phthisical patients often suffer from gastro-intestinal dis- 22 The Arlington Chem Ca Yonkers, N.Y. LIQUID PEPTONOIDS WITH CREOSOTE turbance, fermentation, etc., which is favorably influenced by Creosote. In Bronchitis, especially the chronic form, accompanied by a profuse expectoration almost amounting to bronchor- rhea, Liquid Peptonoids with Creosote will be found of great value. Especially in the Bronchitis of old people, accom- panied by what is known as Winter Cough, it is an effective remedy; also in the acute (dry) forms of bronchial inflam- mation characterized by paroxysmal dry cough, extreme soreness over the bronchi and scanty expectoration. In this condition often a marked feature of the so-called "taking cold" Liquid Peptonoids with Creosote in small doses at fre- quent intervals will quiet cough, relieve soreness, restore secretion and promote expectoration, without increasing the stomachic irritation which is a feature of such cases. The combination has proven of value in many cases of Whooping Cough, and should be employed in all cases of Measles, in which the cough and bronchial irritation per- sist, and tend to become chronic. The possibility of this condition becoming tubercular should always be kept in mind. Friedenwald and Ruräh "Diet in Health and Dis- ease" advise the use of Liquid Peptonoids with Creosote in Marasmus in children. In acute pneumonia Creosote and its derivatives have re- cently come into general notice, and have been used quite extensively by many physicians in different parts of the world during the past ten years. Drs. Cassoute and Cor- gier, of Marseilles, France, in a published report state their belief that pneumonia in all its complicated forms has lost its danger in the presence of the various deriva- tives of Creosote. Dr. I. L. Van Zandt, of Fort Worth, Tex., began using Creosote in pneumonia as early as 1894, never having heard of its previous use in this disease, and being led to do so by observing a marked improvement in a pneumonia pa- tient to whom he had given Creosote for intestinal disturb- ance. Subsequent trials greatly impressed him with its ef- 23 The Arlington Chern Ca Yorkers, N.Y. LIQUID PEPTONOIDS WITH CREOSOTE ficacy, and he has done more than any other physician in America to advocate the treatment and bring it into public favor. It is owing in great measure to his persistent ef- forts that its merits are now recognized by a large propor- tion of the most progressive therapists of this country. He believes that, "The use of Creosote and Carbonate of Creo- sote in the treatment of acute pulmonary inflammations is one of the greatest life-saving discoveries of the Nineteenth Century." Liquid Peptonoids with Creosote is also of value in obsti- nate nausea and vomiting, in Pregnancy, Seasickness, etc. In gastro-intestinal fermentation and flatulence, especially in chronic gastric irritability accompanied by belching of gas, or sour eructations, which is aggravated by the com- mon practice of taking soda in large doses, Liquid Pepto- noids with Creosote relieves promptly. The same is true of the so-called yeasty stomach and the fermentation which follows undue indulgence in sweets, candy, etc. In intestinal fermentation leading to Diarrhoea, the sum- mer diarrhoea of infants and children, ileocolitis, etc., Liquid Peptonoids with Creosote is of proven clinical value. Summer diarrhoea in children will often yield promptly if all feeding is cut off absolutely for a time and the patient put upon Liquid Peptonoids with Creosote, which is aseptic -preventing any further infection-nutrient-by virtue of its Peptonoid content and antiseptic and anti-fermenta- tive. It has been favorably mentioned in this connection by Holt "Diseases of Children," and Friedenwald & Ruräh "Diet in Health and Disease." Liquid Peptonoids with Creosote has also been used with excellent results in Typhoid Fever in which its nutrient and antiseptic properties are especially indicated. Also in Chronic Diarrhoea and Dysentery. Creosote was advocated as a remedy in Phthisis by Reich- enbach in 1833 and its use revived by Bouchard and Gim- bert in 1877. Since that time it has been more or less ad- vocated and condemned. Opposition to its use had been 24 The Arlington Chem Ca Yorkers, TI.Y. LIQUID PEPTONOIDS WITH CREOSOTE founded upon the unpleasant results which followed its ad- ministration in enormous doses, in the attempt to saturate the patient with the drug, a method of treatment at present regarded as useless and unnecessary. Given in this way, it proved unpleasant to patient and those associated with him, and resulted in a reaction against the use of the drug. Modern sentiment and practice is, however, in favor of its moderate use. Anders, in his latest work upon practice states "According to the results reported from all quar- ters of the world, creosote thus employed alone enjoys the confidence of the profession, and in common with numerous other observers, I have found its continued use to be fol- lowed by lessened cough and expectoration, lessened fever and by a lessening or cessation of the night sweats with a gain of strength and weight as the natural consequences. In my hands its beneficial results have been manifested at the end of two or three weeks. Following in the main, the practice of Trudeau, who has used the drug quite as ex- tensively as any other American physician, I gradually re- duce the dose to and maintain it at 5-6 drops, t.i.d." Valentine gave Creosote in a number of cases of Diabetes Mellitus, beginning with a daily dose of four drops and in- creasing to ten. Sugar disappeared and did not return with a starch of saccharine diet. It has also been used in Bright's disease, and some reported good results. The palatability and freedom from irritation of Liquid Pepto- noids with Creosote renders it an ideal form for such use where renal irritation must be avoided. DOSAGE The dose of Liquid Peptonoids with Creosote is as a rule one tablespoonful 3 to 6 times per day-children in pro- portion. It may be given in larger doses at shorter inter- vals when it is desirable or necessary to push the drug. It may also be used as a vehicle to which additional creosote may be added. Chem 25 , NY. The Arlington YorkersCa CASCARA-PEPTONOIDS C ASCARA SAGRADA has been lauded as a laxative, much clinical work done upon it, and yet, in the minds of many physicians, has come to be regarded as an uncertain quantity, prone to succeed or fail accord- ing to no definite rule. The reasons for this are to be found: 1. In the variation in quality and active principle of the bark employed. The true active principle of Cascara has not yet been definitely determined. That the bark contains certain resins and extractive substances, which exert an unfavorable action upon the gastro-intestinal tract, pro- ducing griping, etc., is well known. 2. The great demand for this drug has led to the use of an inferior quality of bark, or even to the substitution of that of the Rhamnus Frangula (Buckthorn). 3. In the effort to cover the disagreeable taste, the physiological activity of the drug is altered or destroyed and to counteract this other agents, senna, aloes, etc., have been added. It has been clearly shown that Cascara should always be given alone and not in combination with other laxatives or purgatives. Its dose should be varied to suit each individual case, and calls for careful discrimination upon the part of the physician and a comprehensive understanding of its physio- logical action. Cascara Sagrada acts upon the sympathetic nervous system, especially the solar plexus, stimulating the nutri- tive and assimilative forces, increasing the digestive proc- esses generally. Also upon the vaso-motor system, stimu- lating the glandular apparatus of the intestinal tract to more normal secretion. It increases peristaltic action, ex- ercises a direct influence upon the musculature of the in- testinal wall, and restores normal elasticity and tone to the 26 The Orlington Chem Ca Yonkers, N.Y. CASCARA-PEPTONOIDS relaxed bowels, i.e., natural vermicular motion and peri- staltic action. It does not mechanically liquify and empty the intestinal canal but acts by restoring normal function. Hence it is a true tonic laxative. Hare declares that Cascara should not be employed as a purgative. When the intestine is stimulated by a bolus within its cavity, the musculature above the point stimulated is excited, while that below is inhibited (Howell). Consequently, when there is a defi- ciency of fluid within the bowel whereby its contents be- come unduly dry and solid, the effect is at first to excite increased peristalsis, which in turn obeys the physiological law that overstimulation of muscle fibre produces exhaus- tion and atony, and obstinate and chronic constipation. results. This is particularly true of those of a sedentary habit, who take little exercise, and drink little fluid. Again, it has been shown that although peristaltic move- ments continue after section of the extrinsic nerves, the ap- plication of cocaine, nicotine, etc., prevents their occurrence. (Howell); so in like manner the toxins generated by in- testinal fermentation and putrefaction-generally in- creased in chronic constipation-exert a paralyzing effect upon normal peristalsis. The continued use of strong purgatives, which by their action produce local irritation, while the irritated bowel seeks to expel the offending substance, produces in time by overstimulation of peristalsis inhibition and atony or worse. Cascara does not do this. In fact, it has been found that Cascara is the only agent whose action is not accompanied by an excess of mucous (an evidence of irritation) in the stools (Austin). Cascara should then be employed only in those cases in which there is an atonic condition of the bowel, which is to be toned up and so influenced by the drug as to regain its normal state. The physiological action of Cascara Sagrada is, there- fore, that of a tonic laxative and the indications for its use are to correct deficient innervation, stimulate nutritive 27 The Arlington Chem Ca Yonkers, N.Y. CASCARA-PEPTONOIDS and assimilative forces and influence the musculature of the intestinal wall. Many physicians suggested its combina- tion with a nutrient agent like Liquid Peptonoids not only for the purpose of covering the disagreeable bitter taste and rendering it more palatable, but also since it has been found that as in the case of creosote, iodine, etc., the pepto- genic action of the Peptonoids and the presence of nutrient material favors prompt absorption and promotes physio- logical action, while preventing irritation. Such combina- tion allows the drug to be used without any modification or alteration in the shape of aromatics or other agents and lessens the liability to griping or other symptoms of irrita- tion. COMPOSITION Each tablespoonful represents 30 minims of the Fluid Extract of old Cascara Sagrada, together with 1 minim Ti. Nux Vomica, thus combining the nutro-tonic virtues of Liquid Peptonoids with the tonic laxative properties of old Cascara bark and the stimulating effect of Nux Vomica upon the gastro-intestinal musculature. INDICATIONS Cascara Peptonoids is indicated in chronic constipation, due to deficient innervation, atony of the intestinal muscu- lature, leading to impaired peristalsis and torpidity. Gastro-intestinal catarrh, with deficient tone of the mucous membrane, sub-acute or chronic diarrhoea, depend- ent on deficient liver action and relaxed conditions of the bowel are benefited by its use, for a considerable length of time, in doses as indicated by the severity of the individual case. DOSAGE It should be given in small doses 3 ss to 3 ij four times per day, decreased as effect is noted. In some cases it may be given in tablespoonful doses at night, until its action 28 The Arlington Chem Ca Yonkers, NY CASCARA-PEPTONOIDS begins to be noted, then reduced as rapidly as possible. It should be borne in mind that when Cascara does good and is indicated, it can be reduced in dosage in proportion as its physiological effects are obtained. Failure is gen- erally due to lack of patience to persist in its use in small doses until its action is fully secured. In the temporary constipation of pregnancy or that fol- lows convalescence from acute diseases or operation, Cas- cara Peptonoids is valuable given in doses of two teaspoon- fuls to one tablespoonful at night. 29 The Arlington Chem Co Yorkers Ti.Y IODO-PEPTONOIDS (LIQUID) E VERY physician is acquainted with the great thera- peutic value of iodine and the difficulties which frequently attend its successful administration in the shape of iodides. The unpleasant taste, the frequent stomachic intolerance and danger of producing iodism from continued use, especially in cases requiring increas- ing dosage, are too well known to require extended com- ment. Although iodine in some form has been for many years one of the most tried and trusted agents in the physician's armamentarium, the thoughtful therapeutist, while ap- preciating its advantages, has deprecated its unfortunate by-effects, especially when prescribed as iodides. Every physician has observed, more than once, the symptoms of iodism, such as coryza, acne-like eruption, nausea, intolerance by the stomach, anorexia, deranged digestion, etc., and has no doubt wished that some method could be devised whereby he could push the dose without so unfortunately disturbing the patient. A decided im- petus was given to the study of this subject by the dis- covery that the wonderfully beneficial results produced by thyroid feeding in cases of myxedema, cretinism, etc., have been due in large part to the peculiar organic form of iodine contained in the thyroid gland. The physiological and clinical experimentation which followed this discovery has proved that an organically combined form of iodine is not only more certain in its therapeutic action than are the inorganic forms, but that it is also decidedly more free from the tendency to produce the unfortunate by- effects above alluded to. COMPOSITION IODO-PEPTONOIDS is presented to the profession as a palatable, non-irritant and thoroughly reliable method of prescribing iodine, free from the above-named disadvan- 30 The Arlington Chem Co Yonkers, NY IODO-PEPTONOIDS tages. It is a definite organic chemical combination of Beef, Milk and Wheat peptones, each fluidounce containing 20 grains Iodo-Peptonoids, of which 10 per cent is Iodine. One tablespoonful therefore contains 1 grain of Iodine. The iodine in Iodo-Peptonoids is not merely in solution, but exists in organic combination with the Peptonoids, which renders it free from stomachic irritation and ready for immediate absorption and assimilation. THERAPEUTIC ACTION The therapeutic action of Iodo-Peptonoids is the same as that of iodine and the iodides, and the preparation may, in a general way, be termed an "alterative." It acts prin- cipally by stimulating tissue change, and by increasing cellular oxidation tends to bring about the absorption and dissipation of newly formed pathological tissue. Iodine even in small doses is irritant to the stomach, and for this reason cannot be safely administered for the purpose of obtaining its constitutional effects. The alka- line iodides being very soluble are quickly absorbed by the blood and as quickly excreted, especially by the air passages, often setting up coryza, acute bronchorrhea, etc. When, however, iodine is intimately combined with an organic base as in Iodo-Peptonoids, the compound passes directly into the blood, and acts promptly as an alterative, INDICATIONS FOR USE The many therapeutic applications of Iodo-Peptonoids, include the various diseased and disordered conditions for which the iodides have heretofore been prescribed. CIRCULATORY DISORDERS, Such as poorly compensated valvular disease, respond to the steadying or equalizing effect of Iodo-Peptonoids upon the arterial tension; be- cause of this same effect the preparation is serviceable in a majority of cases of arterio-sclerosis, aneurism, acute and chronic aortitis, arterial fibrosis, angina pectoris, 31 The Arlington Chem Ca Womens NY IODO-PEPTONOIDS chronic valvular disease, etc.; also as a cardiac tonic, espe- cially in fatty degeneration of the heart. Among the various AFFECTIONS OF THE RESPIRATORY TRACT in which Iodo-Peptonoids is especially indicated may be mentioned asthma, chronic pleurisy, chronic bronchitis with emphysema, to hasten the absorption of pneumonic consolidations when there is tardy resolution and deficient vital reaction; also in chronic coryza, ozena, syphilitic laryngeal ulcer, laryngismus stridulus, etc. IN SYPHILITIC, TUBERCULOUS OR THE SO-CALLED STRUMOUS" DIATHESIS, Iodo-Peptonoids is the remedy par excellence because of the prompt and pleasant action of the contained organic iodine. It will be found of much value in syphilitic periostitis, meningitis, endar- teritis, gummata, etc. ARTHRITIC AFFECTIONS of a chronic nature, such as gout and gouty rheumatism and chronic enlargement of the joints, as well as NERVOUS AFFECTIONS of syphilitic origin, such as locomotor ataxia, etc., are all suitable con- ditions for its administration. The iodine treatment of GOITRE should always be faith- fully tried before resorting to surgical procedures, and Iodo-Peptonoids is a valuable method of prescribing it in such cases because of the organic character of the com- bination. Many cases of Syphilis after being placed upon iodides. in increasing doses reach the point of intolerance, the stomach becomes irritable, and there is evidence of anemia and severe constitutional depression which is a result of continued administration of the drug. In such cases a change from the iodides to Iodo-Peptonoids will generally be followed by marked benefit. The stomach becomes tolerant, the general nutrition is improved (due to the nutrient element of the Peptonoids) and the patient toned up so that if necessary the iodides may be resumed. Iodo-Peptonoids also will be found a valuable vehicle to which may be added considerable amounts of the iodides, 32 The Arlington Chem Ca Yonkers, N.Y. IODO-PEPTONOIDS which in this way will be better tolerated and whose ad- ministration may be continued over a longer period of time. IN CHRONIC LYMPHATISM Iodo-Peptonoids will be found of much service because of its power of reducing indolent glandular enlargements. Moderate doses act as a gastro- intestinal tonic and sedative. Iodo-Peptonoids will be found a superior method of pre- scribing iodine for all cases of LOCAL SYPHILITIC MANI- FESTATIONS, such as chronic psoriasis, rupial ulcers, and specific skin affections of all kinds. IN CHRONIC PARENCHYMATOUS NEPHRITIS iodine has been highly recommended with the object of bringing about disintegration and dissipation of the newly formed con- nective tissue. As a continuous administration of iodine is necessary in almost all of the conditions for which it is indicated, the profession should, and no doubt will, wel- come a preparation like Iodo-Peptonoids, wherewith the effects desired may be more promptly and safely obtained than heretofore, and at the same time without any of the disagreeable effects produced by the iodides. DOSAGE The average does of Iodo-Peptonoids is from 1 to 4 drams several times per day according to indications Children in proportion. Chem 33 N.Y. The Arlington Yorkers Ca PHOSPHAGŌN IMPORTANCE OF PHOSPHORUS IN THE ORGANISM B OUCHARD has said that no cell can even exist without Phosphorus, since this element is universally found in all animal life, either as mineral phosphates or in organic combination, such as nucleins, nucleo albu- mins, lecithin, protagon, etc. Phosphorus enters the body in organic combination in the form of nucleins, nucleo pro- teids, lecithin, protagon and possibly glycerol-phosphoric acid, but a larger quantity is taken in as mineral phosphates in the food. Phosphorus leaves the body chiefly in the urine, where it is present chiefly as phosphates of the al- kalies, and a smaller quantity of phosphates of the alka- line earths. A very small proportion is present in organic combination. Since the phosphorus of the urine comes so largely from the simple passage through the system of the mineral phosphates taken in the food, it follows that varia- tions in the quantity eliminated are more apt to be connected with the diet than with metabolism of body material. The idea once held that the quantity of Phosphorus eliminated is principally dependent upon the metabolism of nervous. tissue was soon abandoned. It will be seen, therefore, that the practice of attempting to administer Phosphorus, in its inorganic form-Phosphorus as such, Phosphoric Acid, Hy- pophosphites, etc.—is to a certain extent unphysiological, since these forms, like those ingested in the foods—are to a great extent eliminated and excreted in the urine. Recent investigation tends to emphasize the importance of the nuc- leins and related bodies and to confirm the view that the phosphates found in all the organs and tissues of the body are to a great degree in chemical combination with the pro- tein matter. 34 The Arlington Chem Co Yourers, 'N.Y. PHOSPHAGŌN NATURE AND COMPOSITION OF LECITHIN When the body stores up protein a proportionate amount of phosphoric acid is retained for the new protoplasm, while in destruction of protein, the phosphoric acid corres- ponding to it is eliminated. Whenever the amount of phos- phates in the urine exceeds 0.15 per 100 c.c. there is reason to suspect excessive breakdown of tissue. The commonest and most universal form in which Phosphorus in organic form exists in the body is Lecithin, which forms a part of every cell and especially in the brain and nerves. It is found in muscles, blood corpuscles, lymph, pus-cells, bile, etc. It exists in all vegetable cells. Milk contains about 0.50 per liter where it exists in a colloidial state. Heating to 76° C. produces an alteration of its lecithins and at 110° C. they are destroyed. Chemistry of Lecithins: Lecithins are not very stable and decompose rapidly in the presence of heat or alkalies. Chemically, Lecithin is formed by the combination of the base Cholin with Glycerophosphoric Acid, in which two of the hydroxyl hydrogens have been replaced by the radical of a fatty acid. Glycerophosphoric Acid is formed by the action between Glycerin and Phosphoric Acid, thus HO CзH,HO 5 HO (H₂PO3)HO OH CSH,OH O-PO,H₂ If the two Hydroxyl Hydrogens of the Glycerophos- phoric Acid are replaced by the radical of a fatty acid, for instance, Stearic Acid, we get Distearyl Glycerophosphoric Acid. CH2.O-C,,H35 CO CH.O-C₁7H35 CO OH CH₂.O-POOH By combining this with Cholin, Lecithin is obtained, or more correctly, Distearyl Lecithin, for the radical of other 35 The Arlington Chem Ca Yonkers, N.Y. PHOSPHAGŌN fatty acids may take the place of the stearyl and thus form different Lecithins. The formula for Distearyl Lecithin is therefore (Strecker). CH2.0-C₁₂H35 CO CH.O-CHasCO CH2.O-PO-O.C₂H, 35 он (CH3)3 N OH но Lecithins, however, are not identical, differing in the fatty acid radicals present. It is very difficult to obtain a pharmaceutically reliable lecithin, furthermore there is good reason to expect that such a complex phosphorized organic compound would be broken up during the process of diges- tion, the phosphorus converted into phosphoric acid and excreted by the urine as phosphates. The investigations of Miescher show conclusively that the formation of tissue lecithin and nuclein arises by inde- pendent synthesis from proteins and phosphates. The best results are to be expected from the administration of phos- phorized organic compounds closely related to those existing already in the tissues, or as it may be expressed the antece- dents of lecithin, which may be easily converted by physio- logical synthesis into tissue lecithin, nuclein, etc. per- Stoklasa and Siegfried have shown that the real reason why infants rarely thrive as well on cow's milk as on human milk is because of the great disparity in the amount of their respective phosphorus constituents. In human milk the centage of phosphorus in organic combination greatly ex- ceeds that in inorganic phosphate. In cow's milk the re- verse is the case. Stoklasa has also demonstrated the fact that phosphorus-bearing organic compounds practically identical with those of human milk exist in seeds. Gilbert has tested the value of the organic phosphoric principle in grains. His clinical experience with the organic phosphorus derived from the cereals applied to the treat- ment of pathologic conditions due to defective assimilation or excessive elimination of phosphorus shows that out of 36 The Orlington Chem Ca Yonkers, NY. PHOSPHAGŌN 200 patients thus treated he has followed 75 for a suffici- ently long period to fully establish the direct nutritive and dynamic properties, the latter manifested in the stimula- tion of the general nutrition of the tissues and cells. Alkaline and neutral phosphatic medication cannot be taken up for any length of time by the digestive organs. Basic phosphate may do harm by increasing difficulty of assimilation and favoring insoluble deposits in the tissues. Hypophosphites require oxidation, whereas the addition of H2SO4 or HCL merely liberates existing phosphoric acid from phosphates and phosphoric acid itself, according to good authorities, in order to be utilized for metabolism must be converted into the organic form of glycero-phos- phoric acid. This can be done in the laboratory and so save the strain upon the organs of assimilation of the pa- tient. With provision made for a supply of organic phos- phorus derivatives from seeds, acid glycero-phosphates aid in re-establishing normal acidity of the blood and urine and prevention or correction of phosphaturia. The fact that the brain and spinal cord are rich in lecithin would suggest at once the possibility of obtaining from this source some phosphorized organic products which should be of practi- cal therapeutic value. The organs, tissues and secretions of animals were ex- tensively employed as therapeutic agents in ancient times and modern physio-chemical research has made more ra- tional and accurate estimation of the value of organic therapy possible. It is possible and practical to obtain from carefully selected aseptic animal tissues, such as the brain and cord, etc., phosphorus-bearing compounds, which may be ad- ministered by the mouth and apparently possess thera- peutic value, when used in connection with other forms derived from cereals or synthetically prepared. A consideration of the clinical bearing of the preceding facts regarding the source of phosphorus and its value in the economy will show that the first important point in Chem 37 , N.Y. The Arlington YonkersCa PHOSPHAGON phosphorus therapy is the necessity of prescribing this substance, not per se, or in inorganic combination, but in the more complicated yet more natural physiological forms, in intimate organic combination, in order to secure absorp- tion and systemic appropriation by synthesis. In other words to furnish these substances, which may be regarded as the antecedents of lecithin, protagon etc., in such form as to escape destruction by digestive processes, from which the body can construct its highly organized phosphorus bearing tissues. For such purposes Phosphagōn is intended. COMPOSITION Phosphagōn may be defined as a "Natural Nerve Nutri- ent" containing organic phosphorus bearing bodies, in the form of lecithin antecedents, which after entrance into the body can be synthetically metabolized into physiological activity. These phosphorus bearing bodies are obtained partly from seeds (ext. cereals) partly from synthetically pre- pared phosphorus (co-glycero phosphates) and partly from carefully selected aseptic animal tissues (cerebro-medullary ext. bovine). Each fluidounce of Phosphagōn represents the equivalent of 8 grains of phosphoric anhydride in organic combina- tions, together with 16 minims tincture nux vomica as a tonic and stimulating adjuvant. Phosphagon is a limpid straw colored liquid of exceeding palatability, resembling that of a fine cordial, without any suggestion of medicinal or drug flavor. Its therapeutic action like all phosphorus combinations is not immediate and the effect of its use is manifested only after continued systematic employment in small doses. Its clinical value can be conclusively demon- strated in properly selected cases in which it is properly administered. THERAPEUTIC INDICATIONS The therapeutic sphere of Phosphagōn is wide. In gen- eral terms it is indicated in all conditions in which the 38 The Arlington Chem Ca Yonkers, N.Y PHOSPHAGŌN vitality and nutrition of the nervous system have been im- paired or reduced, whether by functional nervous strain or organic disease. Phosphagōn will be found a vitalizing restorative and nutrient tonic in cases of neurasthenia, brain-fag from mental over-exertion or cerebrasthenia. This condition develops gradually with irritation and exhaustion of the nervous system, which at first disappears after rest and sleep, but later becomes permanent. If there is heredi- tary taint, or circumstances are unfavorable, the need for sleep increases, the depression is greater until every mental act becomes an effort and the patient is in no condition to make a decision of any sort. It is a condition of psychic. weariness. The memory is unclouded and judgment unim- paired. By making an effort the patient can rouse himself for a time. This condition is found in brain workers, espe- cially in teachers, students, professional men and women, and is increasing among business men. It is insiduous in its onset, and for some time before a physician is consulted the patient generally resorts to stimulants which only aggravate the condition. Treatment naturally demands rest, change of scene, hydrotheraphy, electricity, etc. Drugs per se are of little value. Clinical experience has shown conclu- sively the value of Phosphagōn, given in small doses at regular intervals, continued for some time. It acts as a nerve nutrient and tonic and its beneficial effects are un- accompanied or followed by reaction or depression. Gen- eral nervous overstrain, the so-called nervous prostration, hysteria and insomnia, due to depressed nerve force, are benefited by Phosphagōn. In the more severe nervous af- fections, tabes dorsalis and various structural diseases of brain and cord, Phosphagōn will contribute sufficient nut- rient and tonic value to aid materially in making good the excessive drain upon the nervous system. In both physical and mental asthenia, Phosphagōn acts as a force producing agent and assists in placing the patient in a better condi- tion to utilize general reconstructive measures, such as feed- ing, tonics, etc. Phosphatic albuminuria so often asso- 39 The Arlington Chem Ca Workers N.Y PHOSPHAGON ciated with a depressed nervous condition is markedly bene- fited by Phosphagōn. It is also indicated in the general nervous depression resulting from alcoholic excesses, func- tional impotency due to nervous exhaustion or overwork, excessive use of tobacco, etc. It possesses erogenic action only in those cases, in which improvement of the depressed or exhausted nervous centers by tonic and nutrient treat- ment is to be expected. The constitutional cachexiae or dyscrasiae such as accompany cancer, tuberculosis, etc., often respond markedly to the invigorating action of Phos- phagōn, in the sense that the various vital functions are better performed, the mind made clearer and general nu- trition improved. Cases of protracted convalesence, espe- cially following pneumonia, typhoid and particularly in- fluenza and malaria often respond promptly to Phos- phagōn. Phosphagōn also possesses decided galactagogue proper- ties, in those cases in which deficiency in quantity and qual- ity of the secretion depends upon lowered general tone and nerve exhaustion. This is especially the case with women who, having had no difficulty with their first child, find after a second pregnancy that the milk is scanty and of poor quality. The preparation is also of marked value in counteracting the effects of prolonged lactation, or in the case of mothers who need nervous re-enforcement during any stage of the nursing period. Phosphagōn is also of value in the case of breast and bottle fed infants, who fail to thrive and although digest- ing and apparently assimilating the milk, still do not gain in flesh or weight. In such cases the addition of a small quantity of Phosphagōn diluted with an equal part of water to the milk at each feeding-or given to the infant previous to nursing, will be followed by prompt and satis- factory results. Modern conception as to the paramount causative factor in the promotion of rachitis in infants emphasizes the fact that imperfect and faulty milk, supplied in the form, either 40 The Arlington Chem Ca Yorkers, N.Y. PHOSPHAGON of cow's milk, condensed milk or the various infant foods, is often responsible for this condition. It is significant in this connection to note, as has already been stated, that milk when heated loses a large proportion of its lecithin, and also that the percentage of phosphorus in inorganic combinations is in cow's milk greatly in excess of that in organic form, and it has been explained that inorganic phosphates in the food are not absorbed but excreted in the urine. Furthermore, phosphorus bearing organic com- pounds practically identical with those of human milk exist in certain seeds (such as are used as the source of lecithin antecedents in the manufacture of Phosphagōn). When adding Phosphagōn to milk, it is best to previously dilute it with an equal part of water. Therefore, Phosphagōn is rationally indicated in the treatment of rachitis, not only on account of its natural organic phosphorus bearing content, but also for its palat- ability and entire absence of irritating effects. While many pediatrists deny the value of phosphorus in the treatment of this condition, it is probably because the element has been given in the inorganic form and the fact that as such it is apt to produce irritation has prevented its administra- tion in sufficient quantity to secure results. Careful clinical tests with Phosphagōn have demonstrated beyond question its practical value in rachites. Cases put upon it have responded promptly, have gained in weight, with cessation of sweating and other symptoms, while the preparation was being given with prompt relapse when its use was sus- pended. Phosphagōn is also of great value as a mild re- constructive tonic in elderly people. It will be remembered that in the aged disassimilation exceeds assimilation, this state of affairs setting in at the age of sixty or before. The nervous substance participates in atrophy (which is also secondary to some extent to alter- ations in the blood vessels). The tissues of the aged also contain an excess of inorganic phosphorus which has re- placed the organic phosphorus of the adult cell life. 41 The Arlington Chem Ca Yorkers, N.Y. PHOSPHAGŌN In theory, therefore, lecithin appears to be a remedy for old age. Practically clinical experience with Phospha- gōn has shown it to be of marked service. The practicing physician often meets with cases, of elderly people, who without any appreciable lesion or causative factor discov- erable, begin to lose interest in life, appetite fails, and apathy appears. If neglected such cases rapidly decline but in many instances response to small doses of Phospha- gōn is prompt and improvement follows. Children who are growing rapidly and who, in accordance with the pres- ent methods of education are kept in school and pushed beyond their physical and mental strength are benefited by small doses of Phosphagōn regularly administered over a considerable period of time. DOSAGE The dose of Phosphagōn is from one to four teaspoon- fuls three or four times per day. Emphasis is laid upon the facts that the dose should be small and results to be ex- pected only after regular and protracted use. The very nature of the preparation and its therapeutic indications should enable this to be appreciated. When failure follows its use, even in properly selected cases it is generally due to failure to observe these points. Rationally used in suit- able cases, Phosphagōn is a valuable agent to furnish na- tural, easily assimilable organic phosphorus bearing bodies in elegant and palatable form. 42 The Arlington Chem Ca Yonkers, N.Y PHOSPHO-CAFFEIN COMP. C OMBINES the analgesic and sedative action of Antipyrin and Sodium Bromide in such a way that any unpleasant after effects are prevented by the Caffein present and its therapeutic value increased by the presence of Phosphoric Acid and Ext. Apii Grav. Dulc. It is a granular powder, which effervesces completely when added to water, forming a pleasant and refreshing draught. Each dessertspoonful contains Caffein Acid Phosphoric Antipyrin Ext. Apii Grav. Dulc. Sodium Bromide aa grain aa 1 grain 7 grains Phospho-Caffein Comp. is indicated in Headache, Neu- ralgia, Insomnia, Neurasthenia, etc., whenever sedative and analgesic action is required. It does not disturb the stom- ach, acts promptly and does not seem to lose its effects when frequently used, or to require increased dosage. The usual unpleasant after effects of sedatives are entirely overcome. Dose: For an adult 1 to 2 heaping teaspoonfuls in half a tumbler of water, children in proportion. Drink when effervescence nearly ceases. Repeat dose, if not relieved, once at expiration of 15 minutes and again in a half hour, if required. 43 The Crlington Chem Ca Yankora N.Y LACTOPEPTINE RECENT ADVANCES IN THE PHYSIOLOGY OF DIGESTION. HE continued secretion of gastric juice depends upon the production in the pyloric mucous mem- brane of a specific substance or hormone (chemical messenger) which by means of the blood stream is carried to all parts of the stomach and excites the activity of the various secreting cells in the gastric glands. The maxi- mum flow of pancreatic juice occurs in the third hour, when the largest amount of chyme is passing from the stomach into the duodenum. A substance formed in the mucous membrane of the upper portion of the small in- testine, under the influence of acid, is carried in the blood stream to the pancreas, acts as a chemical messenger and stimulates the pouring out of pancreatic juice. Trypsin, the enzyme of the pancreatic juice, is not formed in the gland as such, but in the form of a zymogen -or enzyme maker, which in turn is converted into fully formed trypsin by the action of a ferment, which is found in the mucous membrane of the upper portion of the small intestine. This action of converting a zymogen or enzyme maker into the fully formed ferment is known as Activation and such an agent as an Activating Agent. The simultaneous presence in the gut of bile and pan- creatic juice is ensured by the presence of one and the same chemical messenger. The other ferments of the in- testinal juice are connected with the digestion of carbo- hydrates. Of these, invertase transforms cane sugar into. dextrose and levulose. Maltase converts maltose into dextrose. In young mammals, or in those in whom milk forms a staple article of diet, there is another fer- ment, lactase, which converts milk sugar into galactose and dextrose. Another ferment named by Cohnheim, 44 The N.Y.Pharmacal Ass'n Yonkers, N.Y. LACTOPEPTINE $ erepsin is found in the intestinal mucous membrane and has to do with the further digestion of albumoses and pep- tones and their conversion into amino-acids. It will be appreciated, therefore, that digestion consists of a number of more or less delicate and intricate processes, and is not, as was formerly taught, a more or less mechan- ical outpouring of various juices, involving a few simple changes in reaction. Furthermore, that during these pro- cesses there must be something more than a mere transitory activity of enzymes that ceases when the reaction changes. Besides the action which is described as activation, there is another known as inhibition, whereby different ferments are inhibited or temporarily rendered inactive, but which under proper conditions can become active again. Activa- tion on the one hand-inhibition on the other. This cannot, for obvious reasons, be demonstrated in the ordinary test tube experiment and will explain why such a test is far from showing the actual physiological process. It is, therefore, not only of little practical value but may easily be made the basis of false and erroneous conclusions., THE NATURE AND ACTION OF ENZYMES Enzymes are complex organic compounds, whose exact composition is unknown, since it has not been possible to obtain them in pure enough condition for analysis. They bear little or no analogy to drugs and chemicals and differ from them in many important ways. In any given solution they never completely destroy the substance upon which they act; the products of their activity as they accumulate finally prevent the enzyme from acting further, until such products are removed when the enzyme becomes active again, and the process is continued. The extent of the chemical change produced is independent of the amount of enzyme present. This differs from most substances where the reverse is the case. This will explain one great fallacy-that the method of Pharmacol 45 , N. Y. The NY. YonkersAwie LACTOPEPTINE estimating pepsin strength is an evidence of its entire phy- siological value. The actual method of operation of enzymes is not clearly established. It is believed that they act either as hydro- lytic agents, or as catalytic agents, i.e., the enzyme enters into a chemical reaction, but is not changed or destroyed and remains in its original condition. Enzymes are also on the other hand inhibited by the action of other enzymes or agents. Bile for instance in- hibits the action of pepsin. Indeed such action is essen- tial in connection with duodenal digestion, because pepsin in turn inhibits the action of pancreatic ferments. It has been demonstrated that pancreatin can act either in an acid, neutral or alkaline medium. It has also been shown clinically that a perfectly prepared extract of bile or pancreatic ferment can and does pass through the stomach without losing digestive power or other property and when brought into its natural place of activity resumes its action and become of therapeutic value. This property of inhibition will also explain the fallacy of another frequently met with statement, viz., that mix- tures of pepsin and pancreatin destroy each other. Since pepsin inhibits the action of pancreatin it is but natural that test tube experimentation fails to demonstrate pan- creatic activity. But that the pancreatic property is de- stroyed and cannot resume its activity when reaching a proper medium is by no means tenable in the light of recent work upon this subject. There is every reason to believe, that artificially ob- tained forms of the digestive enzymes contain beside their demonstrable proteolytic or amylolytic action other prop- erties both in the way of activating and inhibiting ele- ments. This is the more reasonable on account of the well- known fact that it is impossible to obtain any enzyme in an absolutely pure state. Much naturally depends upon the method and care taken in the preparation of pepsin, pan- creatin, etc. and this will serve to explain a frequently met 46 The NY Pharmacol Ano 'Yonkers Ts."Y. LACTOPEPTINE with fact that different grades and forms of the same en- zyme exhibit different degrees of action. To attempt to judge the value of an enzyme by its action in a test tube where conditions cannot under any known method be made to resemble in any way the normal process is anything but scientific. To assert that failure to demonstrate definite re- sults under such conditions means that the combination is unscientific and uncalled for is to ignore the fundamental facts and principles of normal digestion. With this in mind it will be clearly understood that from a combination of enzymogenic agents properly prepared and combined as in Lactopeptine, it is perfectly rational to expect positive therapeutic action even though such action cannot be completely demonstrated by in vitrio ex- periment. An intelligent comprehension of the complicated and ever changing nature of the digestive process, secretions and ferments stimulating the production and secretion of other ferments, inhibiting and exciting each other into chemical activity and producing changes in the food with. swiftness and accuracy, cannot but emphasize the utter use- lessness of any attempt to measure or simulate the natural process by artificial test. The proof of the pudding is in the eating and the prac- tical clinical value of any preparation of whatever char- acter lies in the clinical results obtained. After all, specu- lation and theorizing must yield to experience. Lacto- peptine secures results superior to those obtained from the use of any one of its ingredients used separately or in ordi- nary combination. That it can so act is to be explained by the development of our recent improved knowledge and un- derstanding of the nature and action of enzymes. That it does so act is a time proven fact. THE FALLACY OF TEST TUBE EXPERIMENTATION With these facts in mind, it will be easy to appreciate the absolute impossibility of obtaining from any test tube -¿ 47 The NY Pharmacal Au 'Yonkers Ti Y. LACTOPEPTINE experimentation a test which will even approximately show what takes place in the body, not only in health, but espe- cially when these diterent functions have been modified by disease or derangement. Such experiments involve a great fallacy. The usual method is to take a certain quantity of albu- min, enzyme, acid and water in fixed proportions to pro- duce a definite amount of so called digestive effect in a known time at a fixed temperature. This is used as the control and the substance to be tested is subjected to like conditions and the results compared. How is it possible in this way to even approximate the natural processes which are subject to much variation in degree and efficiency even under normal conditions and infinitely more so in disease? The very accuracy of the proportions of the mixture in the test tube, the fact that they are fixed, that absorption and removal of digestive products are impossible, variation in degree of reaction and temperature prevented, and the vital element of the blood current with its activating and stimulating effect entirely absent, render test tube experi- mentation of little real value in indicating in any way what actually takes place in the body. Shattuck has very pertinently said, "Experimental evi- dence must be very strong to warrant us in absolutely throwing over clinical evidence.” The real test of the actual therapeutic value of pepsin, pancreatin and the like, either alone or in combination, is clinical not laboratory, is practical not based on theory. Other agents which partake more or less of the nature of enzymes are tested physiologically and so long as it is im- possible to reproduce and duplicate the actual physiological means, conditions and surroundings whereby and wherein the complex processes of even normal digestion take place, so long will it be of little practical value to attempt to estimate the effect of such agents as are contained in the enzyme group. The truth of this is most strongly emphasized and proven 48 The NY Pharmacal Avin 'Yonkers, M.Y. LACTOPEPTINE by the fact that in spite of failure to exert test tube ac- tion or respond to such tests, the very agents so tested will, when clinically employed, yield results which are easily and convincingly noted. "By results is the truth established" and the effects of such attempts to measure the value of enzyme action by in vitrio experimentation leading to biased judgment and erroneous conclusions may and does favor and develop therapeutic nihilism which is non-scientific, non-progress- ive and unworthy of the age in which we live. INCOMPATIBILITY-PHYSIOLOGICALLY CONSIDERED Alcohol in excess precipitates pepsin and in a proportion of 10% retards or inhibits digestion IN A TEST TUBE not because it destroys the ferment, for if such a solution be placed in contact with an animal membrane, the alcohol dialyzes through and the ferment becomes active. Pepsin and pancreatin are incompatible theoretically, yet results follow their combined use that are not obtainable other- wise. The statement that pepsin and pancreatin cannot exist in the same combination and that in such a case they destroy each other is often made. Physiologically we know that the contents of the upper portion of the small intestine must be more or less acid for a long time after the stomach contents begin to pass into the duodenum, that pepsin inhibits but does not destroy the action of pancreatin and that the latter may act either in an acid, alkaline or neutral medium. Nature rarely fails to so order her processes as to avoid useless labor and un- necessary loss. Cases that show the presence of pepsin after the test breakfast and which, therefore, would not seem to require it as a therapeutic agent, are often bene- fited especially when it is given in large doses. Pancreatin often relieves symptoms which point plainly to the small intestine as the seat of the indigestion and evidently passes through the stomach without being destroyed. Pharmaco- logical incompatibility is one thing. Physiological inhibi- Pharmacal 49 , N.Y. The NY. YonkersAnn LACTOPEPTINE tion and activation is another. Since it can be demonstrated that enzymes are by nature and action essentially different in their operation and are subject to different laws than is the case with chemical substances or drugs, it would appear decidedly incompatible with scientific truth and accuracy to attempt to judge them by the standards of chemistry or pharmacy. Criticism directed against combinations of di- gestive and enzymogenic agents such as are represented by Lactopeptine emanates from the laboratory of the chemist or pharmacist not from the practicing physician. The ex- perience of the latter has led him to use the preparation in certain cases, which he has seen benefited by the combina- tion. He has found by experience and observation that he may expect results from its use that are absolute, positive and certain. Furthermore, that such results are better than can be secured by the use of any of its ingredients used alone or in ordinary combination. It should be borne in mind that there is often an essential difference between chemical action and physiological action, that it is often impossible to even approximate by in vitrio experiment the normal process as it takes place in the body; furthermore, that modification of normal process induced by impairment or disturbance of function or organ, is so protean in nature and variable as to degree, as to render it impossible to predict with certainty what will or will not take place in a given case. Consequently, empiricism, which has in the past formed almost the sole basis of therapeutics, is now a prominent feature of our drug giving, and will, in future, remain a valuable guide to practical and successful treatment of dis- ease. In the words of a prominent clinician-"If we except a few drugs, not by any means all of the so-called specifics, we still give remedies because experience has taught us that they are 'good for' certain diseases or symptoms. Practi- tioners in general accept the teachings of experience or 50 The NY Pharmacal Quis Yonkers, M."f LACTOPEPTINE empiricism and base their therapeutic endeavors upon that even if they are unable to explain how they do so." Another clinician writes:- "To-day in my judgment we are becoming victims, as it were, of too much science and too little art in medicine. Of course it is a good thing to have science to its uttermost and profit as much and as well as may be by her teachings. But we must not be in a hurry to believe absolutely the re- sults of the best laboratory findings as applied to the art of medicine, until thoroughly tried and proved to be true by the actual daily work of the clinician.” "The ultimate aim of all medical research," as Fothergill declared, "is the treatment and prevention of disease." The supreme test of our knowledge of drugs is in the application of them. If it comes to be the clinical observer against the laboratory experimenter, the clinician is the court of last resort. Bedside observation must prove or disprove, modify, con- tradict or confirm the conclusions which have been arrived at by laboratory experiments. This is particularly true of Lactopeptine. COMPOSITION AND PHYSIOLOGICAL ACTION LACTOPEPTINE represents a combination of digestive and enzymogenic agents in proper proportions to secure results. The enzymes used are the best that can be manufactured and not only this, but in their method of preparation, the makers have perfected methods which assure the purity and physiological value of these agents. It is claimed that such a combination is of value to restore digestive harmony and aid in the digestion of food, not by virtue of any of its several ingredients acting independently as such, but by means of a proper combination of digestive and enzymo- genic agents to secure results by stimulating impaired func- tion and activating gland secretion. Pharmacal 51 , NY The NY "YonkersO LACTOPEPTINE THERAPEUTIC INDICATIONS LACTOPEPTINE POWDER is indicated in that wide range of cases of gastro-intestinal indigestion, or disordered func- tion in which the taking of food is accompanied or followed by uneasiness, discomfort, pain, or other evidences of de- rangement of normal function. It is a matter of clinical every day experience that despite the attempts on the part of those who pay special attention to digestive diseases to classify and arrange all such cases, under distinctive groups depending upon some demonstrable cause such as hyper- chlorhydria, hypochlorhydria, etc., etc., as shown by the test breakfast, clinical testing of withdrawn stomach con- tents, etc., the physician in active practice finds many cases that are difficult to diagnose according to these methods, and in which treatment indicated for relief fails more or less entirely. Many cases when treated empirically gain relief when ultra scientific methods fail. The forms of gas- tro-intestinal derangement of function are so protean, the same individuals varying capacity to take care of ingested food at different times, and the ever present personal factor which cannot be left out of consideration, all serve to ex- plain why in many cases, so called scientific treatment fails to relieve and empiricism succeeds. Hence the popularity and extensive use of Lactopeptine which has been clinically employed for more than a quarter of a century. It fre- quently relieves, when the disturbance appears to be gastric or intestinal, or a combination of the two, in acute as well as chronic cases, in infancy as well as in old age, or middle life. All of which goes to confirm the claim that its virtue depends upon stimulation of impaired function, activation of secretion and correction of disturbed digestive action, all of which, while demonstrated clinically, cannot be shown by laboratory test tube experimentation. Lactopeptine Powder should be given in doses of twenty grains, before or after meals, according to indications, and repeated as often as desired or necessary. The size of the dose may be increased and cases have been reputed in which 52 The N.Y.Pharmacal amin Yonkers, N.Y. LACTOPEPTINE the dose was increased to half a dram or even a dram in some instances. Lactopeptine Powder is also of practical value for use as an excipient, to increase the bulk of medicine given in small doses in powder form, e.g. divided doses of calomel, etc., etc. Also given with calomel as a base instead of sugar or milk or soda bicarb., it will prevent to a great extent the nausea so often induced by calomel. In nursing infants, who develop gastro-intestinal disturb- ance, and do not digest the milk well, Lactopeptine Powder dusted upon the nipple before each nursing will often prove satisfactory. Gastro-intestinal rebellion during the summer months especially, induced or favored by immoderate indul- gence in iced drinks, under or over ripe fruit, candy, irregu- lar eating, etc. may be often quelled by the use of Lacto- peptine Powder. It is also of value as a corrective and preventive of gastro-intestinal irritation, diarrhoea induced by changes in drinking water, or change of diet while traveling, etc. LACTOPEPTINE TABLETS LACTOPEPTINE TABLETS contain 5 grains of the powder lightly compressed, with an agreeable pineapple flavor. Perhaps the strongest endorsement of the value of Lacto- peptine is the fact that the tablets are carried by many physicians, who by the nature of their profession are sub- ject to irregular hours for meals, and the consequent eating of too much or too little food, in a hurry—with interrup- tions and thus prone to suffer from more or less gastro-in- testinal uneasiness or distress. Lactopeptine Tablets are furnished in glass, in two sizes, large (100) and small (50). The dose is 4-6 tablets re- peated if necessary. ELIXIR LACTOPEPTINE LACTOPEPTINE ELIXIR is probably the most extensively employed form of administering this combination, especially Pharmacal 53 , NY. The NY. YonkersAssis LACTOPEPTINE to children on account of its extreme palatability and as a handsome and delectable vehicle in which to prescribe irri- tant or unpleasant tasting medicaments. It contains 38 grains of Lactopeptine Powder to the ounce, is of an agree- able color, and extremely pleasant taste. Hobart Amory Hare declares: "The medical practitioner who prescribes ever so wisely and appropriately for a patient, but who is utterly re- gardless as to his combinations of drugs so far as taste is concerned will sooner or later see a more ignorant man take from him that practice which his greater wisdom entitled him to, but which is driven from him by his own errors in this matter." Nothing serves better to emphasize the difference between the old fangled methods of prescribing unpalatable and even nauseous drug mixtures and the modern use of pleas- ing and palatable combinations, than the use of what are known as elixirs, i.e., sweetened aromatic and spirituous preparations containing active medicinal substances. While there are to be found only a few elixirs that are official, the use of this form of medicament by the rank and file of the profession has been and is constantly increasing, until it has assumed huge proportions. To compare the old infusion, decoctions, fluid extracts, etc., with the modern elixirs is to realize that "Times change and customs keep step with progress." It is significant also that credit for this improvement belongs and must be con- ceded to the manufacturing pharmacist. The patient is quick to notice that the prescriptions writ- ten by some physicians come to him in a form that is at- tractive to the eye and pelasant to the taste. He appre- ciates this and concludes that the prescriber is up-to-date and modern in his methods, whereas, if the reverse is the case, the doctor is judged to be careless or "behind the times." Children, especially, are critical as regards medicine, in- 54 The NY Pharmacal Anx Tombers, NY. LACTOPEPTINE valid patients are unduly fastidious, it may be, but must be catered to, and what is more important, the palatable, at- tractive medicine will be taken more faithfully and with more regularity than a nauseous mixture "whose every dose makes worse the next." Again, most of the irritation or lack of toleration, fol- lowing the administration of certain drugs, may be avoided by giving them in a more pleasant vehicle. For this pur- pose, there is nothing so useful, practical and agreeable as Elixir Lactopeptine. It may be added to almost any pre- scription, and by its attractive color and pleasant taste, im- proves the physical properties of the combination. It exerts a peculiar protective action upon the gastric mucous mem- brane and promotes prompt absorption. The unpleasant taste and irritating effects of Iodides, Bromides, Salicylates, etc., are successfully covered and prevented. Each Fluid Drachm of ELIXIR LACTOPEPTINE (N.Y.P.A.) Will "carry" nicely. Potassium Iodide - Sodium Iodide Sodium Salicylate Potassium Bromide Sodium Bromide Chloral Hydrate Antipyrin - gr. V gr. v gr. viiss gr. x gr. x gr. v-x gr. v-x forming permanent and palatable solutions. MILK PEPTONIZATION A SIMPLE, PRACTICAL AND EFFICIENT Method Although the peptonization of milk has long been re- sorted to in infant feeding, the physician often hesi- tates to order this procedure because of the troublesome manipulation incident to the use of peptonizing tubes, etc. This objection has been a real and serious one, especially when dealing with ignorant or careless mothers or attend- 55 The NY Pharmacal Am's Yonkers, NY. LACTOPEPTINE ants. There is, therefore, a demand for a simple and ready method of milk peptonization which cannot be misunder- stood. During the summer of 1899 a series of careful experi- ments in one of the largest Children's Hospitals in New York demonstrated the practical utility of Elixir Lactopep- tine as a peptonizing agent, especially as applied to infant feeding. The readiness and simplicity of the method is its strongest recommendation. All that is necessary to accom- plish results practically equivalent to those obtained with the more complicated processes is to add from ten to thirty drops Elixir Lactopeptine (according to age of child) to the contents of the child's bottle, after heating and imme- diately before feeding. The heat of the stomach starts the peptonizing process, and in a short time the casein is thrown down in fine, flocculent coagula, closely approximating the curds of human milk. This simple and efficient proced- ure is worthy of careful attention during the summer months, especially among the poorer classes, where double boilers and thermometers are unknown and unprocurable. LACTOPEPTINE COMBINATIONS Lactopeptine is also furnished in combination with va- rious medicinal agents, experience having demonstrated that in many instances, advantages in the nature of pala- tability, uniformity, stability and clinical activity were to be obtained superior to those to be expected from extempo- raneous compounding. Such combinations have in every case been the result of practical suggestions from practic- ing physicians, and their continued use for many years is the best evidence of their clinical value. ELIXIR LACTOPEPTINE WITH PHOSPHATES OF IRON, QUININE AND STRYCHNIA Contains Lactopeptine 32 grains, phosphate iron 4 grains, phosphate quinine 4 grains, phosphate strychnia 1/16 grain to each fluidounce. 56 The NY Pharmacal Avin "Yonkers, NY LACTOPEPTINE A powerful general and reconstructive acid tonic, which promotes appetite, increases strength, and tones up the ner- vous system, especially adapted for use in asthenic con- ditione following convalescence from acute diseases, Post- Malarial Cachexiae, Anemia, etc. The combination is stable, does not precipitate or change in taste which is pe- culiarly pleasant, the bitterness being sufficiently covered and blended so as to be not marked and less persistent than with ordinary combination of these agents. The dose is one or two teaspoonfuls in a wine glass of water after each meal. ELIXIR LACTOPEPTINE WITH BISMUTH Contains Lactopeptine 32 grains, bismuth sod. tartrate 8 grains to the fluidounce. Combines the digestive and gas- tro-intestinal sedative action of its ingredients in an ex- tremely palatable, permanent and erective form. one or two teaspoonfuls after each meal. Dose- LIXIR LACTOPEPTINE WITH STRYCHNIA AND BISMUTH Contains Lactopeptine 32 grains, bismuth sod. tartrate 8 grains, strychnia 1/16 grain to the fluidounce. Combines the digestive, gastro-intestinal sedative and nerve tonic action of its ingredients. Dose-one to two teaspoonfuls after each meal. ELIXIR LACTOPEPTINE WITH GENTIAN AND CHLORIDE OF IRON Contains Lactopeptine 32 grains, gentian 8 grains, tr. erri chloridi 30 minims to each fluidounce. An effective and elegant method of administering the chloride of iron, without irritation and combined with the stomachic tonic effects of gentian in permanent palatable solution. Dose -one to two teaspoonfuls after each meal. LIQUID LACTOPEPTINE Contains Lactopeptine 38 grains to the fluidounce in a gylcerin menstruum with only 3% of alcohol by volume. 57 The NY.Pharmasal Awn Yonkers, N.Y. LACTOPEPTINE A valuable form in which to give Lactopeptine in solu- tion, when for any reason the presence of alcohol is contra- indicated. Dose-two to four teaspoonfuls immediately before or after each meal. SYRUP LACTOPEPTINE WITH PHOSPHATES Each fluid ounce represents Lactopeptine 32 grains, Phosphates of Iron, Lime, Soda, Potash, each 8 grains. Dose-one to two teaspoonfuls after each meal. SUBSTITUTION "Imitation is the sincerest form of flattery but it is also, in the shape of substitution, the greatest curse of modern commercial life." Generally it is the best, and therefore the most successful, best selling product, that is counter- feited, its value denied, and its makers assailed as monopo- lists, etc., by a host of imitators, who seek to use its success, as a means to pilfer a proportion of its profits. Failure to secure clinical results from the use of Lacto- peptine in any of its forms is generally due to the fact that the physician, even though he specifies N.Y.P.A. does not see to it that the original and genuine preparation is dispensed upon his prescription. Lactopeptine, being the most successful, is also probably the most universally imi- tated article of its class. The question of substitution is of importance to the phy- sician in many respects. The physician owes it to his pa- tient and to himself not only to prescribe what his knowledge and judgment suggest as best indicated in each individual case; but his duty is not entirely performed until he makes certain that his patient gets the very best to which he is entitled. Substitution is neither ethical, altruistic, honest, just nor right, nor from a commercial viewpoint expedient and wise. It is significant that the claims made for the substituted article are that it is "just as good"-and that it is cheaper in price, not that it is purer, more efficient, better made— 58 The NY Pharmacal Quin "Yonkers, N.Y. LACTOPEPTINE and therefore, obeying a well-known industrial law, more expensive. The druggist who substitutes on physicians' prescrip- tions, does not allow substitution in his own household, or upon himself-in fact he is apt to be ultra-particular in this respect. He would not, in case of sickness, take or allow those dear to him to take inferior drugs and medicinal agents even if such were less expensive or returned a larger profit. The doctor likewise. Both doctor and druggist depend for their business upon the faith and trust of the public in their honesty, integrity and intention to give the best of service for value received. The same prescription, taken to a number of different stores and filled, will be differently compounded and vary in taste, appearance, quality and price. The Proprietary Preparation is the same in any city, town, state or county and its price practically uniform. Therapeutic results depend upon the activity, purity and reliability of the medicinal agents used. Poor drugs, in- differently compounded and of inferior value, may nullify the greatest skill in diagnosis, or judgment in prescribing. Expected results do not follow, the physician loses faith in the action of drugs, and in himself. The patient also ascribes failure to the doctor, becomes dissatisfied and calls upon another physician. It is significant that with very few exceptions the best class of pharmacists, who are proud of their profession and jealous of their personal and business reputation and char- acter, will not permit substitution, or countenance it, in any way. REMEDY FOR SUBSTITUTION The remedy for substitution is simple and easily made effective. It rests entirely with the physician, who alone makes it possible. The druggist respects the physician who closely watches the filling of the prescription he writes, and the latter's refusal to patronize him if found to be 59 The NY Pharmacal un Yonkers, NY LACTOPEPTINE substituting appeals to him through his pocket, in a way that argument, warning, or prosecution does not. If, therefore, the physician will perform in full his duty to his patient, he will quietly but firmly insist that his pre- scriptions are filled with what he specifies, will see to it that such prescriptions are sent only to those pharmacists whom he knows to be honest and reliable, refusing to patronize anyone found to be substituting. Substitution will cease, and the siren song of the substitutor will be heard no more in the land. Therefore, when prescribing Lactopeptine in any form, it is advisable to specify N.Y.P.A. and then to make sure that such only is dispensed. 60 The NY Pharmacal Osin "Yonkers, NY. HEMABOLOIDS I N order to determine the actual value of any form of iron, it is necessary to bear in mind its functions in the system, its physiological action, its behavior under nor- mal conditions of health and then the modifications pro- duced in this process by disease, before arriving at any conclusions as to the exact form and value of ferruginous medication. Iron is the oxygen carrier and distributor par excel- lence. This office of iron is all important and can have no substitute. "Without iron in the blood we could not breathe." Without iron in the blood we would be asphyx- iated. It carries new life to the tissues and removes toxic substances from them. ASSIMILATION OF IRON In the stomach most iron bearing substances are changed into a chloride by the HCl of the gastric juice. The greater portion of this passes on through the intestinal canal, com- bining with sulphur compounds to form sulphides, and is excreted in the stools. A portion is absorbed by the intestinal epithelium and reaches the blood by way of the lymph channels, is deposited in the spleen, where it may undergo some changes, is again taken up by the blood and deposited in the liver and perhaps in the bone marrow. In the liver it is converted into higher forms and stored up in that organ, forming what is known as the "Iron Reserve." When there is deficiency of iron in the system, this reserve is drawn upon and the iron compounds utilized in forming hemoglobin. When there is no deficiency, the accumulated excess is again taken up by the blood from the liver, carried to the cecum and large intestine by the epithelium of which it is finally excreted. Regarding the transformation of iron compounds after absorption into hemoglobin, little is known except that it 61 The Palisade Mfg Ca Yonkers, N.Y. HEMABOLOIDS Food-stuff. takes place in the spleen, in bone marrow and probably in the liver. In the destruction of red blood corpuscles, pro- tein bodies holding iron in combination are deposited in the cells of the liver, spleen, bone marrow and kidney. Iron is excreted as phosphate in the gastric juice, in bile (in considerable amounts), probably in the intestinal juice and in the urine. SOURCE OF IRON IN HEALTH The Source of iron in health, in the absence of medica- tion, is obviously the natural food-stuffs and it is signifi- cant that those articles of food, most depended upon by man, are as a rule rich in iron bearing bodies, as will be appreciated by reference to the following tables : Total Ash % of Fresh Sub- stance. Fresh Sub- stance equal to 1 gram Iron. Fe₂0,% of Ash. Fe % of Ash. Lentils • • Beans 3.04 3.55 2348 12575 2.00 1.4 71.4 .4256 0.32 0.224 446.4 .0795 Peas. 2.58 6457 0.86 0.6 166.6 .1548 Spinach 2.09 2043 3.35 2.342 42.7 .4895 Potatoes 0.98 13300 1.10 0.769 130.3 .0754 • Eggs 1.12 32830 0.39 0.272 367.7 .0305 Milk (Human) 0.45 127000 0.25 0.175 571.5 .0079 Milk (Cows) 0.71 45875 0.44 0.307 325.7 .0218 Bread (Wheat) 1.09 21532 0.61 0.426 234.7 .0464 Bread (Rye) 1.46 3856 2.54 1.776 56.3 .2593 Beef. Mutton Pork. Veal. • • 1.07 30440 0.44 0.85 38318 0.44 0.307 325.7 0.72 45236 0.44 0.307 325.7 .0221 1.33 24500 0.44 0.307 325.7 .0408 0.307 325.7 .0328 .0261 It will be seen that of all nutrients, many have a larger iron content than milk, especially human milk. This is apparently the reverse of what is to be expected, since milk forms the only nourishment for the growing ani- mal, in which the requirement for iron is greatest. The other inorganic constituents are present in this medium in 62 The Palisade Mfg Ca Yonkers, N.Y. Amount of Ash equal to 1 gram Iron. Amount of Iron contained in 1000 grams of HEMABOLOIDS practically the same proportion as they are required in the nursling. The solution of this anomaly is found in the fact that at birth the infant possesses in store for future use a large amount of iron, in fact, the amount of iron is proportionately greatest at birth and decreases with the birth of the child. The mother elaborates for the use of the infant a large reserve supply of iron, a fact which accounts for the anemia of pregnant women and is an excel- lent and rational indication for suitably selected iron medi- cation during that state. ACTION OF IRON IN HEALTH Iron is an essential element of the red blood cell, and is found in the various articles of ordinary diet. Iron has been called the great respiratory food. All the active tissues and organs consume a certain amount of oxygen in the discharge of their functions, but the muscular system is especially dependent upon oxygen for its activity. Mus- cular tissues are the moving apparatus of bodily mech- anism in all its forms, respiration, circulation, arterial, venous and lymphatic. The entire alimentary canal is a muscular organ. Secretion is not dependent upon oxygen but muscular movement is, and without the latter, secretion. will come to a standstill. Oxygen is the motor power of the muscles. Of all the muscular work done by the body, four-fifths is done by the involuntary muscles and the re- mainder by the voluntary. It is easy, therefore, to see the importance of hemoglobin, or the iron portion of it, as an oxygen carrier. It has long been known that the general metabolism of the animal body is largely dependent upon oxidation, and that iron is an essential constituent of the oxygen-carrying hemoglobin of the blood. Bunge showed in 1884 that in egg yolk the iron is firmly combined with the phosphorized protein to which he gave the name "hematogen." The general com- position of this compound approaches closely to that of the typical nucleo-proteins, and numerous observa- 63 The Palisade Mfy Ca Yonkers. N.Y HEMABOLOIDS tions have indicated that both phosphorus in the form of nucleo-proteins and iron in some firmly bound organic com- bination occur, especially in those cells in which metabolism appears to be most active, such as the secreting cells and the leucocytes. That iron is a normal constituent of the nucleo-proteins is generally accepted. In his recent work on proteids, Mann states: "Iron is contained in most, if not all, nucleo-proteins, and if we except the iron present in the hemoglobin, the main bulk of the remaining iron concerned in metabolism is con- tained in the nucleo-proteins.” The iron-holding constituents of the body which are especially connected with the metabolic processes are of very complex constitution, belonging mainly to the group of compound proteins, and the iron in them is held in firm organic combination. The normal materials for the pro- duction of these substances in the body are the similar iron- protein compounds of the food. The human body of sixty to seventy kilograms is sup- posed to contain about three to three and five-tenths grams of iron, the greater part of which exists as a constituent of the hemoglobin of the red blood corpuscles, while much of the remainder is contained in the chromatin substance of the cells. Notwithstanding the constant and varied activities of the iron compounds in the body, the amount of iron so metabolized as to be eliminated is small-in fasting experi- ments, seven to eight milligrams per day. Hence the daily waste of iron probably amounts to only two or three parts per thousand of that contained in the body. The small amounts of iron katabolized and eliminated are normally replaced by the organic iron compounds of the food. The food-iron is absorbed from the small intestine, deposited mainly in the liver, spleen, and bone marrow, and is finally eliminated almost entirely through the intestinal walls, only a very small proportion leaving the body by way of the kidneys. 64 The Palisade Mfg Ca Yonkers, NY. HEMABOLOIDS ACTION OF INORGANIC IRON Inorganic compounds of iron given by the mouth are also absorbed to some extent by the intestine and stored in the same organs and eliminated by the same paths as the food-iron. To what extent the inorganic iron thus absorbed is actually assimilated and utilized by the body to replace the iron of hemoglobin and chromatin is still a disputed question. Undoubtedly the administration of inorganic iron may increase the hemoglobin content of the blood, especially in cases of anemia, but it is held by many, and probably most of the best authorities, that in such cases the iron acts by stimulating the blood-forming organs rather than by actually entering into the composition of the blood formed. Extended series of feeding experiments upon growing animals of different species have indicated in the great ma- jority of cases that inorganic iron, if used at all in the production of hemoglobin in the growing animal, is greatly inferior for this purpose to the organic iron compounds of the normal food. Practically, the body is dependent upon the iron of the food for the maintenance of its iron equi- librium. Experiments to determine the amount of food-iron re- quired for the maintenance of equilibrium in healthy men. indicate that this amount is largely dependent upon the nature of the food and the amounts of the inorganic con- stituents which it contains, but under ordinary conditions lies between six and twelve milligrams per day. Under cer- tain conditions, however, much larger amounts appear to be necessary, and it is always to be remembered that the amount required for the maintenance of equilibrium is a minimum rather than a normal figure. Even with healthy adults it is probable, and with growing children and anemic persons it is plain, that an allowance more liberal than the minimum which suffices for maintenance is necessary for the best re- sults. In those cases of anemia in which the iron content of the blood is greatly reduced, obviously the food must furn- 65 The Palisade Mfg Ca Yonkers, N.Y. HEMABOLOIDS ish sufficient iron to allow for considerable storage of this element before normal conditions can be regained. In such cases the regeneration of hemoglobin is often stimulated by inorganic iron, but, according to Abderhalden, the effect of inorganic iron is greater, the greater the amount of food-iron supplied. While there is still some doubt as to the relative effect of medicinal and food-iron, the greater part of the experimental work emphasizes the importance of the latter, and indicates that it is often desirable to select food with reference to the amount of iron which it contains. IRON IN DISEASE Any departure from the normal, either in the form of functional disturbance or organic disease of the digestive or hemopoietic systems, or of the blood itself, modifies in many important respects both absorption, assimilation and excretion of iron. Thus, disturbances of digestion are bound to affect the metabolism of iron when given as a remedy. Deranged function of the liver, spleen and intestinal glandular mech- anism are usually associated, so that iron acts as an irri- tant, producing constipation and stomachic disturbance, putrefactive changes occur in the intestinal canal, toxins are formed, which give rise to headache, loss of appetite, impaired nutrition and finally production or aggravation of anemia itself. Infectious diseases may alter the chemical composition of substances ingested. This is most marked in the gastro-in- testinal tract and may be brought about either by abnor- mal chemical changes in the material ingested, or by abnor- mal absorption or synthesis of the digestive products. Not only may infection alter the intake of material through abnormal putrefactive processes, but it probably may do so by altering intestinal absorption as well. It is possible that local changes may so modify the intestinal mucosa that substances not normally taken up are absorbed and those normally absorbed rejected. 66 The Palisade Mfg Ca. Yonkers, N.Y. HEMABOLOIDS Hutchinson has stated that the more the anemias are studied, the more it will be found that toxins of some sort play a part in their causation, and the motto should be "Look for the toxin," whether of endogenous or exogenous origin. It may be set up by bacteria in the intestines, or developed from tissue waste under certain conditions. The consensus of opinion at the present time is that the condition described as anemia, in its several forms, is due largely to disturbances of digestion, absorption and consequent meta- bolism. Experimental work upon animals has shown that inor- ganic iron given for a long period of time, in larger quan- tities than can be digested, becomes an irritant to the stom- ach and upper intestinal tract, lessens materially the amount of muscle work that can be performed, that there is a deposit of metallic iron in the tissues, and like other metals, lead, mercury, arsenic, etc., it exerts an unfavorable action upon glandular tissues. Friese of Berlin claims that inorganic iron, when forced into the system in large doses, often produces a condition similar in many respects to the chlorotic state. The point of vital importance is, therefore, that the medicinally intended iron shall approximate in form the iron-bearing nucleo-proteids of the natural food-stuffs. The idea of obtaining these iron-bearing nucleo-proteins in a sufficiently concentrated form has been patiently and carefully investigated and after much experimentation has been rewarded with success. The finished product has been termed Hemaboloids, a preparation in which the iron is contained in and combined with vegetable nucleo-proteins, reinforced by predigested albuminoids (Peptones) Bone Marrow Ext. and Nuclein, which render it Hematinic, Reconstructive, Nutrient and Antiseptic. The advantage of employing iron as contained in this preparation, is not only its freedom from irritation, constipating effects, or from disturbing digestion, but also because the iron is ready for immediate absorption and assimilation, even when the gastro-intestinal functions are 67 The Palisade Mfg Ca Yonkers, N.Y. Uor M HEMABOLOIDS deranged and impaired, making metabolism of iron in its crude form difficult or impossible. COMPOSITION OF HEMABOLOIDS HEMABOLOIDS is a light brown, limpid fluid of pleasant taste and odor and of slightly alkaline reaction. One tab- lespoonful represents Iron (Masked or Nonionic 0.69 grs.) (Ionic . Nucleo-proteids and Proteids Bone Marrow Extract Nuclein 0.92 grains .0.23 grs.) 9.6 66 12.0 66 0.1 66 Seventy-five per cent of the iron content is in stable, or- ganic combination with vegetable nucleo-proteins (non- ionic form), the remaining 25 per cent is more loosely combined (ionic form). The iron-bearing nucleo-proteins are extracted, separ- ated by precipitation, redissolved and ferrated, the solu- tion sterilized, assayed and combined with readily assimil- able albuminoids, bone marrow extract and nuclein. PROPERTIES Hemaboloids is, therefore, by virtue of its constituents, hematinic, nutrient and reconstructive. It does not irri- tate the gastro-intestinal tract, does not disturb digestion, constipate or affect the teeth, is ready for immediate as- similation, and is absorbed promptly without throwing any strain upon already over-burdened organs. Iron-proteins can be precipitated by the addition of a weak acid, and made to redissolve again immediately when the solution is rendered alkaline. Clinical proof of its easy assimilation is found in the fact that it is active in infancy and old age-two condi- tions in which iron often fails, and also that it is retained, absorbed and increases hemoglobin percentage and red cell count, when inorganic forms irritate or fail to show results. 68 The Palisade Mfg Ca Yonkers. M.Y. HEMABOLOIDS Conditions which call for the employment of iron as a therapeutic agent are generally accompanied by more or less impaired nutrition, enfeeblement of digestive and as- similative processes, sluggish circulation and loss of strength and vigor. This condition, which constitutes a prominent feature in the history of anemia, calls for the employment of more or less concentrated, easily absorbed and assimilated nutriment. With this in mind Hemaboloids has been re-inforced by the addition of Predigested Albu- minoids (Peptones) which not only furnish Eutrophic value but favor the prompt and complete absorption of the iron and prevent any tendency to local irritation or constitutional disorder. Dixon Mann was the first to employ the glycerin ex- tract of Red Bone Marrow in the treatment of severe anemia. Markedly beneficial effects followed its use. These were recognized however, to be manifested in the way of an increase in the number of the red blood corpuscles and this seems to be the limit of its action, so that it is not to be regarded as a hematinic but rather as a reconstructive and of value only as an adjuvant. As such it forms one of the constituents of Hemaboloids. Aulde has emphasized the value of Nuclein (Yeast) in the treatment of simple Anemia, Chlorosis, Typhoid Fever, debility from any cause, convalescence from acute disease Pneumonia, Influenza, etc., where it is claimed to act as a natural antiseptic by destroying the toxic products which may accumulate through faulty elimination and as a na- tural bactericide to resist microbic invasion. It will be readily appreciated therefore why Nuclein has been added to Hemaboloids and also that this preparation is therefore. more than an iron preparation on the one hand and far superior to any single form of any of its constituents on the other. The combination of hematinic, nutrient, recon- structive and antiseptic agents which go to make up Hema- boloids was rationally conceived, practically effected and has been clinically justified. 69 The Palisade Mfg Ca Yonkers, N.Y. HEMABOLOIDS THERAPEUTIC INDICATIONS The therapeutic indications for Hemaboloids are to in- crease the hemoglobin and red blood corpuscles, by furnish- ing an easily digestible, promptly absorbable and non-irrita- ting form of iron, which most nearly approximates that present in the natural foodstuffs, together with nutrient and reconstructive properties. IN CHLOROSIS, when used alone, Hemaboloids often proves inferior to the frankly inorganic salts of iron, such as Blaud's Pills, Reduced Iron, etc. This is to be antici- pated since the chlorotic form of Anemia is characterized by a great deficiency in hemoglobin and its symptoms point to the influence of toxins and toxic substances produced in the intestinal tract and absorbed from it. Hence the administration of inorganic iron in doses, logically and physiologically far in excess of any possible power of ab- sorption, is followed by improvement, on account of the power of iron so given to combine with and render insoluble and inert such products of abnormal digestion. It is sig- nificant, however, that as has been clinically demonstrated, the use of Hemaboloids in connection with the other forms of iron, shortens the course of the disease, secures more rapid improvement and tends to prevent relapse, showing that guarded as it were by the local action of the crude form of iron, the food iron content of Hemaboloids is preserved for absorption and assimilation. When, on account of gastric irritability, it is impracti- cable to employ the inorganic forms of iron, Hemaboloids may be employed with success. In those cases which resist iron alone and yield to its combination with arsenic and strychnine, the combination of Hemaboloids with these agents is indicated. The remaining forms of the so-called Primary Anemias, Progressive Pernicious Anemia, etc., call for the employ- ment of Arsenic as much or even more than iron, and will be considered under Hemaboloids-Arseniated (with Strychnia). THE SECONDARY ANEMIAS-whether due to inanition, 70 The Palisade Mfg Ca Yonkers, M.Y. HEMABOLOIDS excessive albuminous discharges, hemorrhage or toxemia, from inorganic agents, such as lead, arsenic, mercury, etc., or from acute infectious diseases (Typhoid, Diphtheria, Rheumatism) or chronic (Malaria, Syphilis, Tuberculosis) are markedly benefited by Hemaboloids, both on account of its prompt and easy assimilation, but especially for its ad- ditional nutrient and reconstructive effects. In such cases, much depends upon regular and continuous dosage over a considerable period of time, so that palatability and free- dom from irritation, constipation, etc., are important ad- vantages. Hemaboloids is particularly adapted for use in the Anemia of Pregnancy, or that following prolonged lacta- tion, also after surgical operations, septic infection or pro- tracted convalescence. It is of extreme value in the anemia of infants and children, Malnutrition, Marasmus, the Tu- bercular Diathesis, following the Exanthemata, etc. It has been said that "after sixty, iron is of little value, is not borne well or assimilated." Hemaboloids is an exception and will be found of marked advantage in elderly cases. It adds no tax to the failing digestive effects, does not de- range the bowels and its contained nutrient and reconstruc- tive elements are of great service. ADYNAMIC AND ASTHENIC CONDITIONS met with in con- firmed invalids and those of relaxed fibre and uncertain strength are frequently benefited by Hemaboloids. DOSAGE THE DOSE is one tablespoonful (which represents an amount of iron equal to that in 20 minims (1.33c.c.) Tr. Ferri Chlor.) after each meal and at night. Children in proportion. HEMA BOLOID TABLETS For convenience, Hemaboloids is furnished also in tablet form, in two sizes, small, containing 50, and large contain- ing 100 tablets. Four tablets represent one tablespoonful of the liquid form. 71 The Palisade Mfg Ca Yonkers, NY. HEMABOLOIDS-ARSENIATED T (WITH STRYCHNIA) HE employment of Arsenic as a therapeutic agent dates back to the early days of medicine. It is gen- erally classed as an organic or disease medicine and so acts in the majority of cases. Yet, it does possess prop- erties which entitle it to be considered also as a functional or symptom medicine. Arsenic appears to have the power of altering the chemical changes or metabolism which occur in cells during life and on which their functions depend. While circu- lating in the blood, it is carried to every organ and tissue of the body and affects markedly the nervous system and muscles, the mucous membranes and the skin (Brunton). Experimentally, arsenic has been found, when given in moderate doses, to produce a stimulating effect upon red bone marrow, causing it to increase and replace the yellow marrow, and the number of red cells appears to be increased. Stockman does not believe that arsenic is a hematinic. It has been classed as a protoplasm poison and its action in preserving the tissues, when used as an embalming fluid or for injecting cadavera, seems to indicate that it acts by preventing tissue degeneration, so that the apparent increase in the red cells under its use seems in reality to be due to its action in preventing their destruction, rather than their formation. Chittenden and Hill declare that arsenic in medicinal doses disinctly decreases tissue change. Experimentally it has been apparently proven that the drug diminishes the hemolytic action of the liver. In small doses arsenic is a stomachic and general tonic, promotes appetite and digestion, increases the cardiac action, the respiratory power and intestinal secretions. It stimulates peristalsis, exalts mental activity and the sexual appetite. It also acts as a nervous excitant and as a stimulant to the trophic nervous apparatus. Its medicinal action upon 72 The Palisade Mfix Co Yonkers, M.Y. HEMABOLOIDS-ARSENIATED (With Strychnia) the skin is marked, when the superficial layers are involved. It seems to be useless when all four layers are affected. It seems to produce fatty degeneration in exudative material, particularly in the air cells and bronchi and exerts a marked antiperiodic effect. Toleration is as a rule good. Women and children ap- pear to be more susceptible to it than men. Much depends upon the method of administration. Certain individuals exhibit a marked idiosyncrasy to its action, no matter how given or combined. The action of arsenic as an organic or disease medicine, and that in many instances it assists that of iron and vice versa, suggested the combination of these elements and has been found clinically valuable, especially if strychnia is added. These agents have been termed the Tonic Trinity. During the circulation of arsenic in the blood, it is probable that its action may be determined and directed to one part or another of the body, by other substances taken at the same time. A well marked instance of this kind of action is known in the case of mercury, which when given with alcohol, seems to be directed to the nervous system and to exert its action especially upon the latter. This may explain the beneficial effects of iron and arsenic when given together in severe cases of Anemia. If given much diluted or in small medicinal doses, arsenic produces little or no local irritation of the gastro-intestinal tract. It is absorbed into the blood and passes to the liver before it enters the general circulation. In the liver it may act to lessen or inhibit the hemolytic changes which are going on in that organ. After entrance to the general circulation, it may act upon the heart, muscles and nerves, then again passes in the blood stream to the stomach, intestines, respiratory passages, mucous membrane of the eyes, skin, etc., by which means it is eliminated and if in toxic quantity pro- duces local symptoms of irritation. If only small or med- 73 The Palisade Mfg ea Yonkers, NY. HEMABOLOIDS-ARSENIATED (With Strychnia) icinal doses are taken daily, the whole of the arsenic so given may be eliminated and may be taken for months without any harm. If given when the stomach contains food at meal-time, or combined with nutrient material, it is so diluted and promptly absorbed that it does not pro- duce any local irritation. Accordingly the makers of Hemaboloids, recognizing the call for such a combination, and in response to many sug- gestions and requests from physicians, placed upon the market HEMABOLOIDS-ARSENIATED (WITH STRYCHNIA) One tablespoonful represents, in addition to the ingre- dients of Hemaboloids plain, 1/40 grain arsenious acid and 1/80 grain strychnia. The preparation is stable and absolutely permanent. Separation or precipitation of the arsenic does not occur, and a further advantage of the combination is that so combined with nutrients, etc., the irritating effects some- times met with in using cruder forms are entirely done away with. Bearing in mind that the easy digestion and absorption of the drug are rendered possible by combining it with nutrient material, it will be seen that the so-called cumulative effects of arsenic are due in all probability to the deposit of undigested arsenic in the tissues, after con- tinued doses of the drug given for a long time, which is sub- sequently absorbed and exerts its physiological effects. Combined with nutrient and reconstructive elements, this is very much less liable to occur, and this explains why the use of Hemaboloids-Arseniated (with Strychnia) is very rarely followed by any such action, and is then met with only in those cases where an idiosyncrasy exists, or as a result of improper dosage. The amount contained in a tablespoonful (1/40 grain) also permits of its use in dram doses, or less or more, in children, or in cases when the average dosage has to be cut down. 74 The Palisade Mfix Ca Yonkers, N.Y. HEMABOLOIDS-ARSENIATED (With Strychnia) THERAPEUTIC INDICATIONS The therapeutic indications for the use of Hemaboloids- Arseniated (with Strychnia) are similar in most respects to those calling for Hemaboloids plain. It should be recognized, however, that inasmuch as one of the most important therapeutic properties of arsenic is its power to inhibit or prevent tissue waste and hemolysis, Hemaboloids-Arseniated (with Strychnia) is especially valuable in those conditions of Anemia, primary or sec- ondary, in which there is blood or cellular degeneration accompanied by a cachectic condition, e.g., in Sepsis, Malig- nant Disease, Malaria, Syphilis, Tuberculosis, etc. A point of considerable importance, which has been em- phasized by ample clinical experience, is that in many cases, especially those that call for the administration of arsenic for a long period of time, it will be found ad- visable to alternate the use of Hemaboloids plain with the form containing arsenic and strychnia. Thus the former may be employed for a week, followed by the arseniated for two or three weeks, then the plain form for a week, and so on. Arsenic is indicated in all severe forms of Anemia. While not a hematinic, its action as a tonic, as an inhibitant of tissue change, in preventing red cell destruction, etc., is valuable and its combination with iron often secures re- sults unobtainable by iron used alone. As a reconstructive in the anemia that accompanies or follows severe consti- tutional diseases, it should always be used. In Chlorosis, arsenic is thought to act primarily on the nervous symptoms which accompany the disease and in a secondary degree in the Chlorosis itself. Stockman points out that arsenic is known to have a remarkable effect in increasing the number of red blood corpuscles in some cases of pernicious anemia, of leukemia, and of lymphadenoma, although not infrequently in these diseases the blood condition is not perceptibly improved by its administration. As regards its action as a hema- 75 The Palisade Mfg: Ca Yonkers, NY. HEMABOLOIDS-ARSENIATED (With Strychnia) tinic in pernicious anemia and other morbid conditions, experiments point very conclusively to a stimulation of the bone marrow. In these cases, however, although it may increase the number of blood corpuscles, it does not affect the real cause of the disease, and, therefore, must be con- sidered as a purely symptomatic method of treatment. Hemaboloids-Arseniated (with Strychnia) should be used in all cases of severe anemia of any form. The fact that cases fail to respond to ordinary iron or arsenic medica- tion does not contra-indicate its use, as this special combina- tion often produces results in obstinate cases that resist all ordinary medication, due not only to the natural character of the drug elements but to the contained nutrient and reconstructive agents. Arsenic is of great service in the treatment of intermit- tent fever. Under certain conditions it is superior to quinine. The exact conditions under which the superiority of arsenic to quinine, or the reverse, is evinced, have not been thoroughly cleared up, but the following considerations may prove of service: 1. Arsenic is the most valuable remedy we possess in the intermittents which have resisted quinine. 2. Recent cases of intermittents are cured by arsenic when quinine has failed, though, as a rule, quinine is its superior. 3. In old and inveterate cases of intermittent fever arsenic is more efficacious than quinine. It is particularly useful in those obstinate and long-standing cases of quar- tans, where quinine has had a prolonged trial without re- sult. 4. Arsenic has been warmly recommended by Isnard as superior to quinine in malarial cachexia, not a rare dis- order. Arsenic will not supersede quinine as a remedy for periodical fevers, as the latter possesses a wider therapeutic range over the intermittents, especially those which con- stitute the malarial fevers of warm climates. Hemaboloids-Arseniated (with Strychnia) is of especial 76 The Palisade Mfg Ca Четивесть, HEMABOLOIDS-ARSENIATED (With Strychnia) service in post-malarial anemia and in those cases of chronic malarial infection met with frequently, whose symptoms are atypical, often unrecognized for a time as of malarial origin, and yield only to combined iron and arsenic treat- ment. United testimony of many independent observers is in favor of arsenic being awarded a permanent place in the treatment of neuralgias, especially when due to malarial intoxication and when it comes on in periodical attacks. Such neuralgias are obstinate and inveterate, difficult to cure, and arsenic combined with iron often relieves more quickly than quinine. Arsenic is also quite as useful in cases of recent neuralgia which do not yield to quinine. Anstie speaks highly of arsenic in different forms of neuralgia that stimulates one of the varieties of Angina Pec- neuralgia that simulates one of the varieties of angina pec- toris. Reinberg states that arsenic is particularly valuable in cases where uterine or ovarian disease is at the bottom of the neuralgia, especially if the patient is anemic. Neu- ralgia has been described as "the cry of a nerve for food" and it is recognized that nutrient and reconstructive treat- ment is of quite as much importance as the mere relief of symptoms. Hemaboloids-Arseniated (with Strychnia) combines all of these properties and will be found of prac- tical clinical value. Bazin considers arsenic the best remedial agent in the herpatic diathesis and particularly recommends arsenious preparations or waters containing arsenic for psoriasis. Gubler believes in the utility of this medicine in certain skin diseases only. Nothangel says the usefulness of arsenic in scaly skin diseases is beyond doubt, and many other observers confirm this opinion. Arsenic cannot be depended upon in skin diseases of a syphilitic origin. It has been employed in most of the chronic dermatoses, and in many successfully. It does most in eczema and psoriasis; arsenic in these cases is more efficacious than any other rem- edy, but there are cases which are not cured, especially when 77 The Palisade Mfg Ca Yonkers, N.Y. HEMABOLOIDS-ARSENIATED (With Strychnia) arsenic has been administered in small doses internally. Frequently a cure is effected, by a joint internal and ex- ternal treatment. Amelioration is rarely visible before the arsenic has been in use for a fortnight; and weeks or months may elapse before complete recovery takes place. Relapses occur, but they, as a rule, soon yield to treatment. In eczema, arsenic is not so curative as in psoriasis, but it is useful in the chronic forms, which have assumed a thickened or scaly appearance. When the eczema is acute an increase of the disease is to be feared under arsenical treatment. Arsenic is also of value in certain cases of acne, especially in debilitated subjects. Along with scaly skin diseases there will be trouble with mucous membranes, a ten- dency to asthenia and alternate bronchitis, chronic bron- chitis, and emphysema. Arsenic in such conditions does well. The discoloration in the skin, known as moth patches or liver spots is often removed by a course of arsenic. For use in such conditions, Hemaboloids-Arseniated (with Strychnia) is peculiarly adapted. In old and obstinate cases of chorea, arsenic has been found an excellent remedy. In recent cases, however, it is not so commonly given since these frequently improve simply by rest in bed and appropriate diet. Success with arsenic in the treatment of chorea is not to be depended upon as absolutely certain; nor can the conditions under which arsenic is beneficial be accurately defined. It must be observed that juvenility is not a contra-indication. It may here be affirmed with certainty that chorea is an affec- tion more amenable to arsenic than any other remedy. Rom- berg thinks it foremost among curative agents, able to arrest the disease in a short time. Scrofulous ophthalmia is another disease which often yields rapidly to a short course of arsenic. The redness of the margins of the eyelids disappears, as do the swelling and agglutination. The discharge of acrid tears, the sen- sitiveness to light, and the inflammation of the conjuctiva abate. The ulcer of the cornea, which so commonly ac- The Palisade Mfg Ca Yonkers, 7.7. 78 HEMABOLOIDS-ARSENIATED (With Strychnia) companies this disorder, is healed and it puts a stop to lymph exudations, which are so frequent. Leube, relying upon the physiological action of arsenic as determined by Saikowsky, employed it in diabetes mel- litus, and observed diminution in the quantity of sugar in the urine, and an improvement in the general health. Popoff confirms these results, he also finds a diminution in the quantity of urine and sugar. Good results have also been reported from the use of arsenic in chronic bronchitis with profuse expectoration, whooping cough, asthma, chorea, epilepsy, angina pectoris and other spasmodic nervous diseases. It has proven of value in the early stages of pulmonary phthisis, also catarrhal pneumonia probably by causing fatty degenera- tion of the exudate in the alveolar cavities. DOSE One tablespoonful t.i.d. as ordered by the physician. Children in proportion. HEMABOLOIDS-ARSENATED (WITH STRYCHNIA) TABLETS For convenience, Hemaboloids-Arseniated (with Strych- nia) is furnished also in tablet form, in two sizes, small, con- taining 50, and large containing 100 tablets. Four tablets represent one tablespoonful of the liquid form. 79 The Palisade Mfg Ca Yonkers, N.Y. BOROLYPTOL A tions. NTISEPTIS is a part of the scheme of nature, and antiseptic agents are found in the food man eats, the air he breathes, and even in his secretions and excre- In the words of a famous teacher, "three places will always require antiseptics, the mouth, the gastro-intestinal and the genito-urinary tracts.” It is hardly necessary to point out that the mouth, the "vestibule of the body," is the means of approach to the system most open to bacterial invasion, that the oral cavity with its warmth and moisture is an ideal incubating cham- ber, and the chinks, crannies and crevices between and about the teeth ideal breeding places for germ life. The nasal passages likewise offer an easy means of ingress to patho- genic organisms and, under modern conditions of every- day life, fail miserably to screen or guard the lungs and through them the general circulation against microbic at- tack or invasion. The gastro-intestinal tract also furnishes an ideal container, as well as a favorable culture medium for the development of various toxines and irritant prod- ucts, which indeed are formed as a part of or in the course of normal digestion, and, so soon as Nature's neutralizing agents are allowed to fall off in quantity and quality are readily absorbed. It needs but a mention of the names of Neisser or Noeggerath and a reference to their work to enable one to appreciate the importance of the genito- urinary tract in the production of many and more or less serious conditions, so that, even leaving out the importance of antiseptics in surgery, it will readily be appreciated that enough remains to render the question of antisepsis of real importance to the general practitioner of medicine. The difficulty has been to find an agent which is suffi- ciently powerful and active to destroy bacteria or the prod- ucts of their growth, or the toxines generated by chemical reactions, without affecting the tissues themselves, or pro- ducing irritating or toxic effects by absorption. 80 The Palisade Mfg Ca Yonkers, N.Y. BOROLYPTOL Formaldehyde (Formic Aldehyde) CH₂O is a gaseous aldehyde obtained by the oxidation of methyl alcohol. It has a low specific gravity, mixes with air and is soluble in water and alcohol. It was discovered by Hofmann in 1867 by passing a mixture of methyl alcohol vapors and air over a glowing platinum spiral. If these vapors be led into water until the latter is saturated, a 40% solution is obtained. As ordinarily furnished Liquid Formaldehyde (Formalin) contains not less than 37% by weight of ab- solute formaldehyde in aqueous solution, 1 part by vol- ume added to 40 of water makes a 1% solution of formal- dehyde. To prevent polymerization it should be mixed. with an equal quantity of a saturated solution of boric acid, a 2% solution of borax or glycerin. Formaldehyde is powerfully antiseptic and disinfectant, ranking next below mercuric chloride as a germicide and preferable to it in being practically non-toxic to the higher animals. Its very power renders it possible to use it suffi- ciently diluted to avoid tissue irritation or injury without sacrifice of germicidal power. Taken internally in small amounts, it does not possess any toxic properties. As a deodorant it is very efficient, entirely removing the smell of H₂S and destroying the peculiar methyl-mercaptan odor of fecal matter. 2 Boric Acid is feebly germicidal, but in dilute solution. (1-140) is antiseptic and stimulant and has a soothing effect on mucous membranes. Combined with glycerine or in the form of Aceto-Boroglyceride it is of great value. Pinus Pumilio, Eucalyptus, Myrrh, Storax and Benzoin are well known, time proven, clinically valuable, antiseptic agents, excellent examples of Nature's forethought in fur- nishing in a natural, agreeable and attractive form bal- samic constituents which are fragrant and agreeable in odor, healing and soothing to the tissues and may be given internally. FORMULA BOROLYPTOL has been characterized as a happy thought 81 The Palisade Mfg Ca Yonkers, N.Y. BOROLYPTOL and a refined preparation for use of refined people. It is a colorless, limpid, fragrant solution containing Formaldehyde 0.2%, Aceto-boro-glyceride 5.0%, Pinus Pumilio Eucalyptus Myrrh active balsamic constituents. Benzoin Storax It does not stain the most delicate fabric, has a charac- teristic pleasant and refreshing odor and taste, and may be used full strength or diluted with many times its bulk of water. The vitality of the tissues is not affected, irri- tation and pain are not produced, and a soothing and healing effect is noted. It is deodorant. It does not tar- nish metals, gold crowns or instruments. Bacteriological tests have been repeatedly made by many investigators, using different methods, with the result that it has been uniformly shown that the germicidal strength of Boro- lyptol approximates that of a 1-1000 solution of mercuric chloride. It can be given internally with entire safety. Objection has been made to the use of solutions con- taining Formaldehyde, in the nasal cavities, owing to the fact that in some instances considerable irritation or pain has been produced. It is not generally understood that this is due in great part to the fact that when such effects were produced the solution was not isotonic, i.e., its specific gravity was not the same as that of the blood plasma. Given two liquids of different specific gravities, when separated by an animal membrane, osmotic action is set up, variations in pressure follow, affecting in turn the terminal nerve filaments and producing pain. In many instances, especially for use upon mucous membranes, it is advisable to employ Borolyptol in an isotonic solution. This can be easily prepared, desired alkalinity is secured, 82 The Palisade Mfg Ca Yonkers, NY. BOROLYPTOL the germicidal strength is not impaired and the irritation and pain prevented. In order to make 100 c.c. of an isotonic solution of Borolyptol in distilled water of from 5%-50% strength, add to the diluted Borolyptol common salt in the following proportions: Borolyptol. Salt. Distilled water q. s. ad. % Borolyptol in resulting iso- tonic solution. 5 C.C. 4.25 Grammes 100 C.C. 5% 10 4.15 100 10% 15 4.05 100 15% 20 3.95 100 20% 25 3.85 100 25% 30 (6 3.75 100 30% 35 3.65 100 "" 35% 40 45 尚宫 3.55 (6 100 40% 3 45 190 45% " 50 3.35 100 (6 50% INDICATIONS FOR BOROLYPTOL As a wet dressing in minor surgical work, burns, der- matitis, toxic mechanical or solar, bites or stings of in- sects, urticaria, pruritus, venereal sores, indolent ulcers, eczema also for scarlet fever, measles, and especially smallpox. As an irrigating fluid for stomach, bowel, bladder, urethra, vagina, old sinuses or abscess cavities. As a nasal douche or spray (in isotonic solution) for cleansing and antiseptic purposes in coryza, rhinitis, hay fever, dust infections or irritation. As a spray, gargle or mouth wash in tonsillitis, diphtheria, phthisis, typhoid fever, etc., both for patient and prophylactic use by nurse and physician. As a disinfecting solution in and about the sick room, and as a deodorant. To serve as a solution in which to keep clinical thermometer, hypodermic syringes, etc. Borolyptol is admirably adopted for daily use as a prophylactic dentafrice or mouth wash. The importance of frequent, effective disinfection of the oral cavity is com- 83 The Palisade Mfp Ca Yonkers, N.Y. BOROLYPTOL ing to be realized. The fact that the oral cavity forms an ideal incubating chamber, in which varieties of patho- genic organisms thrive, has made the gospel of the mouth bath imperative. Persistence of bacteria in the mouth long after the patient has recovered from infectious dis- ease, renders such an individual a menace to all with whom he comes in contact. Preservation of the teeth and main- tenance of the gums in a healthy condition is of prime importance. Disordered digestion leading to offensive breath, or local conditions in mouth or nasal cavities, often require deodorants. Borolyptol is an ideal agent for this purpose. It is both pleasant in taste and fragrant in odor, is deodorant, bastericidal in weak solution, and by virtue of the contained formaldehyde hardens the gums and allays the irritation produced by the use of tobacco, strong condiments, etc. It has absolutely no corrosive or irritant action, and does not tarnish gold crowns, or attack fillings. Internally, Borolyptol may be given in doses of one to two drams in a wine glass of water in gastro-intestinal fermentation, flatulence and diarrhoea. It corrects promptly the “yeasty” eructation from disordered stomachs. Given in the above dosage immediately after the administration of calomel, Borolyptol will destroy the offensive fetor of the stools. In cystitis, Borolyptol given in one dram doses every two hours until the odor appears in the urine, often clears up the urine promptly and tones up the bladder. For use after shaving, added to the bath or used as a shampoo, especially in cases of dandruff or scalp irritation, Borolyptol is not only pleasant and agreeable, but pos- sesses actual and demonstrable value. 84 The Palisaden. Y. Yonkers, KOLA-CARDINETTE K OLA as a therapeutic agent possesses advantages which have in many instances been underestimated. In common with other agents of its class, Kola tends to retard retrograde metamorphosis of body tissues, stimulates mental processes and acts as a sedative to the nervous system. Its great value lies in the fact that when properly employed it does not cause depression or reaction. Its combination with Cinchona, a vegetable bitter and stomachic tonic, has been frequently advocated. Nux Cereal Phosphates increase its sustaining properties by contributing strength and resistance to nerve tissues. Vomica also adds tonic and mildly stimulant effect. KOLA-CARDINETTE combines these elements in the form of an elegant and attractive cordial, which being palatable and free from any disagreeable suggestion of medicinal character will be taken and relished by the most fastidious patient. Each fluidounce of Kola-Cardinette represents Kola 30 grains. Cinchona, 1 grain. Nux Vomica, 1 grain. Cereal Phosphates, 5 grains. INDICATIONS In Shock, medical or surgical, when a quickly diffusible yet safe stimulant is necessary, Kola-Cardinette is a prompt invigorant without reaction. Atonic dyspepsia, accompanied by loss of appetite, chronic diarrhoea and bodily weakness with more or less mental depression. Asthenic or Adynamic conditions, following acute dis- ease, Protracted Convalescence, Cachectic Conditions. Neurasthenia, or Nervous Exhaustion, Insomnia, "Brain 85 The Palisade Mfg Ca Yonkers, N.Y. } KOLA-CARDINETTE Fag," in which the nervous forces are depressed and mental vigor impaired. In the aged and infirm, or in Invalidism, when it is important that any stimulating effect should not be fol lowed by depression. The beneficial effects of Kola in toning up and strengthening the vocal organs has long been recognized. For this reason Kola-Cardinette is of value to counteract nervous strain and physical exhaustion entailed by singing, public speaking, etc. DOSAGE One to two tablespoonfuls from three to four times daily. It may be poured over cracked ice and sipped slowly or shaken up with an egg, chilled and served. UNIV. OF MICHIGAN, MAY 19 1913 * 86 mtx q The Palisade Mfg Ca Yonkers, M. INDEX ગ LIQUID PEPTONOIDS Composition. Therapeutic Advantages Comparative Nutrient Value Table of Nutrient Values. Indications for Use Dosage and Administration Modifying Taste of DRY PEPTONOIDS SOLUBLE Composition. Page Page 3 Composition of 4 Physiological Action of 5 Lactopeptine Powder 9 13 • . 14 LACTOPEPTINE (Continued) Therapeutic Indications of Lactopeptine Tablets Elixir Lactopeptine 51 .51 52 • . 53 54 Elixir Lactopeptine as a vehicle . 54 Milk Peptonization 55 LACTOPEPTINE 16 • Compared with other Food-stuffs 17 Table of Nutrient Values- Dosage Indications for Use Suggestions for Using • LIQUID PEPTONOIDS WITH CREOSOTE Composition. Advantages and Indications for Use Dosage • 18 • 19 19-21 ..21 22 • . 25 COMBINATIONS: Lactopeptine Elixir with Phos. Iron, Quin. and Strych. • 56 Lactopeptine Elixir with Bismuth 57 Lactopeptine Elixir with Strych. and Bismuth • Lactopeptine Elixir with Gen. and Chlor. of Iron Lactopeptine Liquid Lactopeptine Syrup with Phosphates Substitution • . 57 · 57 57 58 .58 . 59 . 26 28-29 Assimilation of Iron Source of Iron in Health Table. 6 CASCARA-PEPTONOIDS Cascara, Action of . Composition of-Indications- Remedy for Substitution. HEMABOLOIDS Dosage • Composition IODO-PEPTONOIDS Therapeutic Action-Indications for Use Dosage • 30 31 . 33 Action of Iron in Health Action of Inorganic Iron . Iron in Disease Composition of, Prope Therapeutic Indicati Dosage TABLETS HEMABO IATE .34 Physio Medical Library Com 35 TH 38 Γ • RS 38-42 42 356 A724 Arlington Chen, co. Preparations - PHOSPHAGŌN Importance of Phosphorus in the Body Nature and Composition of Lecithin. Composition of Therapeutic Indications Dosage • • PHOSPHO-CAFFEIN COM Composition-Indications for Use and Dosage. • LACTOPEPTINE Physiology of Digest Nature and Action e Fallacy of Test T ment. Incompatabil UNIVERSITY OF MICHIGAN 3 9015 06454 5729 · 85 .86