CASE X.-Septum Nasi Deformity. Man, aged 25 years, white, protrusion of bony septum about one-half inch below normal. There was occlusion of left nose, owing to lateral displacement of septal cartilage.

During chloroform narcosis, the integument was separated from the bony septum, one-half of the bony septum removed with strong scissors, and the integument and cartilage united with silk worm sutures, but before this was done several linear incisions were made in the septum from above downward, fractured and shoved to the right, so as to allow packing sufficient in the left side to keep nostril open. Recovery was rapid and uneventful, with perfect restoration of the nose, and entire relief from the deformity.

CASE XI.-Septum Nasi Protrusion. Lady, 20 years old, white, with prominent nose and narrow face. The lower end of the septum extended about three-eighths of an inch below its normal position. She complained bitterly of her misfortune, and sought relief.

While under the influence of chloroform, one-half inch of the lower end of the bony septum was removed, with a strong pair of sharp pointed, curved scissors, after separating the integument from it by lateral transfixion with a sharp knife. This done, silk worm sutures were passed through the septal integument, and then through the cartilage, not more than four such sutures being found necessary.

The hemorrhage was quite profuse, but of no consequence. If the nose is plugged, and the throat kept free, no trouble need arise from it; the work should be done rapidly. The result has been perfect, as the deformity has been removed without a cicatrix from knife or needle being seen. The Trinidad, 413 and 415 Broadway.

DR. H. B. LEAVITT is located at Worthington, Ind., and reports a flourishing practice. Dr. Leavitt studied medicine in St. Louis, and has many friends here.

DR. GEORGE J. ENGLEMANN, of Boston, has been appointed a delegate from the United States to the International Medical Congress, which meets at Amsterdam, Holland, in August.

DR. GEO. W. TURNER, formerly of St. Louis, and for a time identified with the FORTNIGHTLY staff, enlisted in Uncle Sam's Hospital Corps about a year ago, and has been stationed in Porto Rico. Since December last he has been down with the pernicious form of typhoid which has been so prevalent in the army. As soon as he is able to travel the doctor will return to the North.

AMERICAN MEDICAL ASSOCIATION. -The section of Materia Medica, Pharmacy and Therapeutics of the American Medical Association urges those who desire to read papers in its department, at the Columbus meeting, June 6th to 9th, to send on their names and the title of paper, at once to the Secretary, who is now making up the final program, LEON L. SOLOMON, Secretary, 323 W. Walnut St., Louisville, Ky.

Therapeutic Observations of the Use of Ferro-Soma

WHIL

tose in Chlorosis.

BY DR. F. WERNER,*

VIENNA.

HILE in former times the various inorganic combinations of iron were chiefly employed in the treatment of chlorosis, efforts have been made. within the last few years to prepare organic combinations. The incentive to these efforts was in one respect the circumstance that iron is taken up into the system in the form of an albuminate, as has been proven by the investigations of Quincke, Kunkel, Gaule, Woltering and others, and, on the other hand, the fact that the organic combinations have the advantage of not exerting a caustic influence upon the mucous membrane, and have also much less troublesome after-effects than the inorganic.

In view of these facts Dr. A. Eichengrün (Pharmaceutische Centralhalle) undertook to prepare a firm combination of iron with an organic substance, namely, somatose, since it could be expected that such a combination of iron with a so readily assimilable albuminous body which had already proven extremely serviceable, would be absorbed with especial facility, and like somatose itself would exert a favorable influence upon the digestive

tract.

Ferro-somatose is a light brown, odorless and almost tasteless powder, readily soluble in watery fluids. The amount of iron in the kinds employed by us amounted to 2 per cent. As the patients took a teaspoonful of the preparation dissolved in milk, coffee or soup, three times daily, the daily quantity of iron-somatose administered amounted on the average, to 10 gm. This corresponds to a dose of about 0.2 gm. of iron, being equivalent to the quantity of iron in nine to ten Blaud's pills. Aside from this, it must be mentioned that the patients during the entire period of observation always subsisted on a mixed diet.

As regards the results obtained from the use of ferro-somatose, this can be readily learned from the following histories of cases. In order to make them as reliable as possible, the numbers given represent the average values determined by at least two examinations. For the purpose of controlling the hemoglobin values which were determined with the Fleischl hemometer, owing to the want of the newer improved instruments, the specific gravity was besides obtained according to the method of Hammerschlag, since, as is well known, the extent of the specific gravity depends chiefly upon the quantity of iron contained in the blood. The different estimates were always made under the necessary precautions at the most suitable time, that is, between 9 and 10 A. M., in order to avoid any influence through digestion leucocytosis.

CASE 1.-J. M., 20 years old, domestic, had suffered since three years from chlorosis. Present condition: general weakness, headaches, vomiting, palpitation of the heart, anemic murmur, tinnitus; no fever.

*From the Fifth Medical Division of the Imperial General Hospital of Vienna (Prof. Dr. Drasche).

Examination December 1st: Hemoglobin 20 per cent; specific gravity 1031; red blood corpuscles 3,640,000; leucocytes 7,812; bodily weight 58 kilos.

Treatment: After nine days' administration of 100 gm. of ferro-somatose, examination December 10th: Hemoglobin 30 per cent; specific gravity 1,039.5; red corpuscles 4,420,000; leucocytes 7,800; bodily weight 60.5 kilos; no subjective disturbances present.

CASE 2.-Emilie J., 18 years old, domestic, had been affected with chlorosis two years ago, which disappeared after ferruginous treatment. Since October, 1897, she has suffered from headaches, fainting attacks and constipation. Face and mucous membranes pale, tinnitus. systolic heart murmurs, especially distinct over the pulmonary artery, anemia of the retina, no fever, no albumin in the urine.

Examination January 6th: Hemoglobin 25 per cent; specific gravity 1037; red corpuscles 4,260,000; leucocytes 6560; bodily weight 54.5 kilos.

Treatment: After thirteen days' use of Mitterbad ferruginous iron water, examination January 20th: Hemoglobin 25 to 30 per cent; specific gravity 1038.5; red corpuscles 4,440,000; leucocytes 6,000; bodily weight 56.7.

Three injections of spermin administered from January 22 to February 8. Examination on January 29th: Hemoglobin 30 per cent; specific gravity 1038; red corpuscles 3,970,000; leucocytes 5312; bodily weight not determined. February 11th: Hemoglobin 35 to 40 per cent; specific gravity 1046.5; red corpuscles 3,710,000; leucocytes 5870; bodily weight 58.7. The patient received 300 gm. ferro-somatose up to March 4th. Examination March 4th: Hemoglobin 55 per cent; specific gravity 1047.5; red corpuscles 4,700,000; leucocytes 5200; bodily weight 61.5.

The subjective disturbances subsided under the use of iron-somatose in the course of the first week, and had completely disappeared in the second week.

CASE 3.-Therese K., 29 years old, domestic, had never menstruated. Since fourteen days patient suffered from vertigo, headache, vomiting, constipation. On leaving her bed she was attacked with fainting. Examination showed a systolic murmur over the base of the heart, and anemia of the retina. A scanty amount of albumin was found in the urine.

Examination January 20th: Hemoglobin 35 per cent; specific gravity 1034; red corpuscles 2,950,000; leucocytes 5625; bodily weight 49.5.

Treatment: During the period from January 21st to February 10th three injections of spermin were given; examination on January 29th: Hemoglobin 35 to 40 per cent; specific gravity 1040.5; red corpuscles 3,930,000; leucocytes 7125; bodily weight not determined February 11th: Hemoglobin 40 per cent; specific gravity 1045; red corpuscles 4,990,000; leucocytes 6000; bodily weight 50 kilos.

From February 12th to March 11th the patient received 300 gm. ferrosomatose. Examination March 3d: Hemoglobin 50 per cent; specific gravity 1050; red corpuscles 6,160,000; leucocytes 6500; bodily weight 53

kilos. March 11th: Hemoglobin 60 per cent; specific gravity 1052; red corpuscles 5,990,000; leucocytes 6370; bodily weight 54 kilos.

Even after four days' use of ferro-somatose a considerable subjective improvement set in. The fainting attacks which previously had been frequent, failed to return. While at first numerous microcytes could be demonstrated in the blood, they were present only in scanty number at the close of the treatment.

CASE 4.-T. H., 15 years old, domestic; had been affected with chlorosis two years before, which had been treated with ferruginous preparations and cured. Menses appeared in the twelfth year, but often remained absent for several months. For a number of months patient had complained of general weakness, vertigo, headache, palpitation of the heart, constipation and amenorhea since three months. The skin as well as mucous membranes were pale, and there was an anemic murmur over the entire heart; no fever, nor albumin in the urine.

Examination December 31st: Hemoglobin 35 per cent; specific gravity 1042.5; red corpuscles 5,033,000; leucocytes 3800; bodily weight 54 kilos.

Treatment: From December 31st to January 14th the patient received 100 gm. ferro-somatose. Examination January 8th: Hemoglobin 45 per cent; specific gravity 1044; red corpuscles, 4,850,000; leucocytes 4000; bodily weight 54.5. January 14th: Hemoglobin 60 per cent; specific gravity 1045.5; red corpuscles 5,700,000; leucocytes 3125; bodily weight 56.2 kilos.

Subjective disturbances had disappeared at the end of treatment.

CASE 5.-Mary P., 19 years old, servant. Menses had been regular, although scanty, since the fourteenth year. Since that time she had been frequently troubled with a feeling of lassitude, headaches, oppression over the stomach and vomiting. Since half a year these subjective disturbances had increased. Objective examination showed general pallor, more forcible apex beat in the anterior axillary line, anemic murmur over the entire heart, tinnitus; no fever, no albumin in the urine.

Examination December 7th: Hemoglobin 20 per cent; specific gravity 1024.5; red corpuscles 3,480,000; leucocytes 4062; bodily weight 59.7 kilos.

Treatment: From December 8th to January 9th patient received 150 gm. ferro-somatose. Examination December 30th: Hemoglobin 25 to 30 per cent; specific gravity 1036.5; red corpuscles 4,800,000; leucocytes 4200; bodily weight 60. January 1st: Hemoglobin 40 per cent; specific gravity 1041; red corpuscles 4,610,000; leucocytes 2340; bodily weight 61.5.

Then from January 15th to February 8th four and one half doses of spermin were administered. Examination on January 22d: Hemoglobin 40 per cent; specific gravity 1041.5; red corpuscles 3,840,000; leucocytes 4687; bodily weight not determined. February 9th: Hemoglobin 40 to 45 per cent; specific gravity 1044; red corpuscles 4,500,000; leucocytes 5900; bodily weight 60 kilos.

In the last week of the ferro-somatose treatment the subjective dis turbances disappeared completely. The blood showed no abnormal ele

ments.

CASE 6.--Agnes A, 24 years old, seamstress; had suffered since seven years with chlorosis, and notwithstanding continued use of iron pills or tinctures was not benefited, so that she finally decided to enter a hospital. She complained of severe weakness, headaches, vertigo, palpitation of the heart, dyspnea on slightest exertion, so that she was compelled to stay in bed for long periods. Objective examination disclosed marked pallor, tinnitus, anemic cardiac murmur and anemic dilatation of the heart, the organ extending two cm. beyond the mammillary line. Slight oedema of the feet, no fever, no albumin in the urine. Examination of the blood revealed pronounced mycrocytes with a very few isolated poicilocytis.

Examination November 11th: Hemoglobin 15 per cent; specific gravity 1024.5; red corpuscles 2,450,000; leucocytes 7200; bodily weight 49 kilos.

Treatment: From November 11th to 30th patient received daily one bottle of Mitterbad ferruginous iron water. Examination December 1st: Hemoglobin 20 per cent; specific gravity 1025.5; red corpuscles 2,580,000; leucocytes 8750; bodily weight 49 kilos.

From December 1st to January 12th ferro-somatose 200 gm. was administered. Examination December 23d: Hemoglobin 28 per cent; specific gravity 1037.5; red corpuscles 3,930,000; leucocytes 2500; bodily weight 49.2. January 4th: Hemoglobin 35 per cent; specific gravity 1043.5; red corpuscles 3,990,000; leucocytes 4063; bodily weight 50.2. January 12th Hemoglobin 40 per cent; specific gravity 1044.5; red corpuscles 4,900,000; leucocytes 4050; bodily weight 50 kilos.

From January 15th to February 8th nine and one-half doses spermin were given. Examination January 31st: Hemoglobin 40 per cent; specific gravity 1039; red blood corpuscles 5,040,000; leucocytes 4825; bodily weight 49.7 kilos. February 9th: Hemoglobin 45 per cent; specific gravity 1043.5; red corpuscles 5,120,000; leucocytes 3750; bodily weight 50 kilos.

From February 9th to 18th the use of ferro-somatose was resumed, 100 gm. being given during this period. Examination February 18th Hemoglobin 50 per cent; specific gravity 1048; red corpuscles 5,510,000; leucocytes 5700; bodily weight 50.5 kilos.

On leaving the hospital, the patient felt considerably improved. After two months she again requested the administration of ferro-somatose, since in spite of the use of other iron preparations, in connection later with rest in bed, subjective disturbances had reappeared, and she considered that improvement could only be brought about through this preparation.

CASE 7.-E. M., 15 years old, had suffered since three months with anemia, headaches, vertigo, tinnitus and gastric disturbances. Examination showed a systolic cardiac murmur, slight cardiac dilatation, and slight œdema of the feet. Menses had not appeared for three months,