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of theories, and, as Millikin well says, we can do no better in the present state of our knowledge our knowledge than accept menstruation habit which has been nailed upon our race by hereditary, and which. is for us an ultimate biologic fact.

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Normal menstruation in temperate climates generally begins in the fifteenth year. In the tropics it appears much earlier, so that in Mexico one may see a grandmother of only 20 years. Within the Artic Circle Eskimo girls do not generally arrive at puberty until the eighteenth year. City girls usually have the menstrual flow earlier than do hard working country girls, in whom muscular exercise has the same derivative effect on the pelvic blood supply as too intense devotion to study. The time, amount and character of the menstrual flow vary normally within wide limits. The menstrual cycle for different individuals ranges in perfect health from two to six weeks. The average duration in the temperate zone is about four days. Soaking more than three napkins daily is considered abnormal. Anemic girls, as a rule, tend to menorrhagia; chlorotic ones, to scanty menstruation. Clots are present when the amount of blood is great, or the mucous and fatty acids scanty. A periodic white menstruation, from supersecretion of the uterine glands, is not infrequently noticed in the intervals midway of menstruation.

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gans, and this in turn upon a blood supply insufficient in quality or in quantity.

In the great majority of cases, therefore, our efforts to aid nature in effecting the transformation of the girl into a woman, should be in the line of a happy balance of nutrition between the special female organs and the body as a whole.

Hygenic measures are of the first importance. Fresh air and sunshine are always in order. Exercise is especially indicated for the fat and flabby clorotic girl, and her diet should be restricted in sugars and starches. The highly active, intellectual girl must rest from her studies and try to become a little lazy. lazy. Proper precautions should be taken in regard to reasonable care of the person at the time of the monthly periods. Yet the physician should beware of unduly alarming his little patient, and so bringing about a condition of hypochondriacal valetudina rianism. Simple cleanliness is certain to do no harm, but good. The conservation of the general health and vigor is the chief factor in maintaining safe and easy menstruation.

In spite of hereditary defects, if the physician could have full control of the diet, clothing, hygiene and environments of the little girls in his clientele up to the date of puberty, but little if any medication would be then required. Unfortunately however, the lack of harmonious development in the preadolescent period necessitates considerable medical attention to secure a normal course for the critical metamorphosis of puberty, whose influences, as Dudley re

marks, are fundamental, not only in the reproductive organs, but in the entire woman. Actual pain at the menstrual period in the young virgin may be considered always pathologic, and the same is true of menorrhagia or very scanty menstruation. Such abnormalities of function should direct our attention to the state of nutrition especially. The obese, chlorotic girl must take more exercise; the thin, delicate, sensitive girl, more rest. Fresh air and sunshine are needed in every instance. Red meat, eggs and other blood-forming foods should be taken in such quantities as can be well borne. The appetite for wholesome nutriment should be encouraged, if need be, by stomachic stimulants, such as the official elixir of strychnin, pepsin and bismuth. The use of bromides, coal-tar analgesics and diffusible stimulants at the menstrual periods can be regarded only as a temporary makeshift.

The most constant and positive clinical sign of imperfect puberty is deficiency of the blood in red corpuscles and hemoglobin, the chlorotic type being perhaps more common than the simple anemic in relation to menstrual disorders. Hemic defects and malnutrition act reciprocally as cause and effect. The oxidizing life of the blood is in the iron it contains, with about one-twentieth as much manganese. The total iron of the adult body amounts to but 2.5 or 3.5 grams, chiefly in the form of hemoglobin. The normal daily content of iron in the food of an average diet, is, according to Stockman, from five to ten milligrams. When absorbed,

as in health, this food-iron replaces

the metal continually lost by disintegration of blood corpuscles and excretion. The round of iron in the body seems to be from the duodenum to the mesenteric glands, thence to the thoracic duct, the general blood current and the spleen, from where it passes to the liver to be synthetized into hemoglobin for the red cells, on the breaking down of which the dissociated iron is eliminated by way of the large intestine.

The use of iron in anemic and chlorotic conditions is, of course, a cardinal principle in therapeutics. In girls becoming women to supply a deficiency of erythrocytes or hemoglobin, one might infer at first thought that the best method would be to administer hemoglobin, that is, blood in some form. Chemistry proves, however, that when hemoglobin is taken into the stomach it is changed by the acid there to hematin (causing the coffee-ground color of small gastric hemorrhages), which according to Cloetta, passes down the alimentary tract without being absorbed.

Most authorities conclude that inorganic compounds of iron in order to be absorbed must first be changed to albuminates by combining with food matters. All albuminous substances are hydrolyzed to peptons before they are capable of absorption. Hence it follows that a peptonate of iron is the preparation most likely to be readily and completely absorbed and assimilated. The best remedy of this composition, I think, is Gude's Pepto-Mangan, which I have used for the past ten years with great satisfaction, particularly

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of a really meritorious remedy is immediately followed by
the unwarranted and most damaging dissatisfaction of Imi-
tations and Substitutions, which flood the market almost
beyond the physician's comprehension, it therefore behooves
us to kindly and particularly request not only the specification
(Gude), but the prescribing of ORIGINAL BOTTLES by
every physician who desires to employ in his treatment

Pepto-Mangan ("Gude)

which is the original and only true organic preparation of iron and manganese, and the source and foundation of all the exceptional and positive therapeutic merit experienced in this product. Imitations with similar sounding names, but dissimilar in every other respect, are mischievous enough, but in nefariousness are

yet unequal to substitution and the substitutor, against whom

the physician's only assurance is an original bottle.

GUDE'S PEPTO-MANGAN has, since its introduction to the Medical Profession of the World, always proved its superiority over other blood-making compounds, and furthermore will always substantiate all the statements so highly commending its value.

As this certainty in efficacy has won for this preparation the confidence and reliance of the physician, we, to protect you, your patients and ourselves against such conscienceless methods, earnestly ask the prescribing of original bottles only. This request, though seemingly of little importance, will be significant in view of the astounding knowledge that 75% of the manufacturers are not only offering but selling gallons and kegs of so called "Just as Good" iron mixtures, which have not undergone and dare not undergo either the scrutiny of the physician or examination by the chemist.

While there is only one Pepto-Mangan

which is never supplied in any form of package other than our

. . . regular eleven-ounce hexagonal bottle, .

you will readily surmise the intent of these imitation preparations which are wholly unknown to the Medical Profession, and agree with us in the importance of the above request.

Any one offering Pepto-Mangan in bulk form, either intentionally or unintentionally practises substitution; hence our solicitation for your co-operation against this harmful, unjustifiable, and inexcusable fraud.

M. J. BREITENBACH COMPANY

53 WARREN STREET NEW YORK.

in the hemic and nutritive disorders weight, about 150,000 red cells

of female puberty.

This neutral solution contains three grains of iron and one grain of manganese in each tablespoonful. The latter ingredient is doubtless to be credited with a large part of the nearly specific effect of the remedy in functional menstrual derangements. The preparation is pleasant to the eye, agreeable to the palate and has the great advantage over inorganic iron compounds of not corroding the teeth, deranging digestion nor inducing constipation. According to the nature and severity of the case, the dose varies from a teaspoonful to a tablespoonful. It is well taken in milk or sherry just after meals.

The following brief clinical

notes may serve to illustrate the facts above stated. The blood count in each instance was made with the Thoma-Zeiss hemacytometer; hemoglobin was calculated by the Hammerschlag specific gravity method.

and 3 per cent. hemoglobin. and was discharged cured in ten weeks.

CASE 2. Alice R., 18 years, rather stout but pale, with greenish tinge; complained of palpitation and breathlessness on slight exertion; menstruation barely begun and scanty. She was made to take gradually increasing exercise on her bicycle, a cool bath every morning, less carbohydrates and more proteins in her diet, and' Pepto-Mangan (Gude) in the dose above mentioned. She recovered from all her morbid symptoms within four months, and has since married and gave birth to two healthy children.

CASE 3. Olive M., 13 years, blonde, thin, active, sensitive, a hard student, just beginning to menstruate, the flow being scanty and accompanied with pain. The blood count was 63 per cent. of normal, the color index 57 per cent. Under treatment similar to that mentioned in the first case, I need hardly remark she became round and rosy, menthat the blood findings at the alti-struated freely and easily, took on tude of Denver are normally higher than at points near sea level.

CASE 1. Jose K., 15 years, thin, delicate and somewhat strumous, had menstruated irregularly and intermittently for sixteen months; erythocytes 3,600,000, hemoglobin 58 per cent. She was taken out of school, put on a diet largely protein, given aloin, strychnin and belladonna pills for her bowels, and for her blood, Pepto-Mangan (Gude), a dessertspoonful four times daily after eating. Under this treatment she made an average weekly gain of 14 pounds in

17 pounds in weight and raised the blood findings above the normal at sea level, all within eight months.

In conclusion the writer would like to emphasize the peculiar physiologic efficacy of Pepto-Mangan (Gude) in aiding young girls to a normal womanhood, when the crisis of puberty is complicated with any defect in blood-making and nutrition. Its action is prompt and pleasant, and the clinical benefits derived from its use are readily apparent to all concerned. In curable cases it is as nearly specific as any combination of drugs could be.

CONTENTS.

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A New Agent for the Treatment of Alopecia Areata. By Granville MacGowan, M. D.,
Professor of Dermatology in the University of Southern California
The Communicability of Bovine Tuberculosis to Man-The Consensus of Medical
Opinion as Opposed to the Recent Declarations of Prof. Koch. By Geo. Thomas
Palmer

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Anæmia, Nervous Exhaustion,
Malnutrition, are the pleas of
impoverished nature for

GLYCERINE

GRAY'S TONIC COMP

THE PURDUE FREDERICK CO., No. 15 Murray St., N. Y.

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