Charles D. F. (Charles Douglas Fergusson) Phillips.

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well; in another, with irregular dilatation, and large varicose clusters
about the knee, the same method of injection above and below was
equally successful (Medical Press, July 14, 1869). Brainard's experi-
ments on the formation of clot in veins under the use of sulphate were
very satisfactory (loc. cit); and Gross, speaking of naavus, and discourag-
ing the use of perchloride, yet says that by " Monsel's solution any case
of arterial or venous tumor, unless very bulky, may generally be promptly
and effectually cured" ("System of Surgery"); this would seem suffi-
cient to warrant a further trial.

Haemorrhoids. The perchloride is not only frequently of service as a
styptic injection into the rectum to relieve bleeding from internal haem-
orrhoids, but has been used sometimes by direct injection into the tumors,
and has cured when other expedients have failed (Colles: Dublin Journal,
June, 1874). Monsel's solution succeeded equally well in two cases of
large external piles under Mr. Morgan (Medical Press, 1869). Haemor-
rhoids occurring in anaemic or debilitated patients with copious bleeding,
are in my experience often well treated by the internal administration of
the perchloride.

Relaxed and Discharging Surfaces Relaxed Throat, etc. The liquor
ferri perchloridi, with a little glycerin added, is a good astringent locally
and internally in catarrhal sore throat, and in relaxed conditions of fauces
with mucous secretion: also in the cedematous, honey-combed condition
which remains after follicular tonsillitis, or more serious throat inflamma-
tions.

Leucorrhaza. In catarrhal and relaxed conditions of the vaginal mu-



158 MATEKIA MEDICA AND THERAPEUTICS.

cous membrane, injections containing about 1 dr. of the tincture, or 10 gr.
of sulphate of iron in each % pint of water, are often useful, but they have
the drawback of staining linen. When the leucorrhcea is mainly depend-
ent upon general debility, the internal administration of iron is often
sufficient to relieve, without any injection; and in severe cases, occurring
in anaemic and cachectic females with cedematous swelling (from excessive
blood-losses), I have found the citrate of iron and quinine useful. Mont-
gomery commonly recommended the pernitrate for leucorrhoea.

Gonorrhoea. In the chronic stages of urethral inflammation, sulphate
of iron forms a good injection. I recommend about 12 gr. with -J oz. of
laudanum, in 8 or 10 oz. of water a little to be used three times a day;
another form, recommended by Dr. Ringer, contains ^ dr. of the per-
chloride tincture, with 1 dr. of laudanum in pint water. " It often
speedily checks the discharge, and relieves pain on micturition." Baru-
del, writing from a large experience, would absolutely restrict the local
use of perchloride to chronic cases, but he advocates it internally for all
forms of urethritis, acute and chronic (Medico- Chirurgical Review, i.,
1859, p. 244). I would not myself recommend its use, even internally,
in acute stages, but in the later ones of gonorrhoea, or gleet, full doses
of 10 to 15 min. are of real advantage. Pereira recommended the remedy
in combination with tincture of cantharides.

Phagedcenic TTlceration. The combined internal and external use
of tinct. ferri perchloridi is advised by Ricord (Medical Times, i., 1859).
Roget adduced instances of it curing chancre when applied early, and he
maintained that the local use of an acid solution directly after exposure
would prevent gonorrhoeal, and even syphilitic contagion (" Traite sur le
Perchlorure de Fer," 1860, Paris). Rabuteau speaks favorably of the
remedy substituting only citric acid for the more irritant hydrochloric.
He adopts the following formula ]J. Tinct. ferri perchloridi (30 Beaume,
= 0.879 sp. gr.), 12 grammes; acidi citrici, 4 grammes; aquae, 24 grammes:
solve f. lotio.

Spermatorrhoea. For seminal losses occurring in the young and de-
bilitated, tincture of iron is of great use; it should be given in full doses
twice daily, and preferably not at night; plenty of outdoor exercise
should be conjoined with its use.

Enuresis. When this occurs in scrofulous children, or in those
affected with worms, the perchloride or phosphate of iron gives ready
help. One teaspoonful of Parrish's food, twice daily, in water, is an ex-
cellent remedy for the nocturnal as well as the diurnal form when arising
from irritability of the mucous membrane of the bladder. The alterna-
tion of iron with tincture of belladonna, or bromide of potash, acts still
better if there be much spasm of the sphincter, and combination with ergot
has also succeeded well (Guimaud: Bulletin de Tfierapeutique, v., 63).
Da Costa strongly recommends the bromide of iron in this malady.



IRON. 159

Vesical Catarrh. There can be no doubt that iron has a special de-
termination to the mucous membrane of the urinary tract, and my own
experience, as well as that of others, has proved its great value in
catarrhal affections of the bladder. The carbonated iron waters of
Schwalbach are especially recommended (Schmidt's Jahrb., 1877, Bd.
clxxiv., p. 84), and are certainly less irritant than the acid preparations.
In cases of catarrh and hemorrhage, following the injudicious use of the
catheter, weak injections of tinct. ferri, retained for about half a min-
ute, check the Hemorrhage and cure the catarrhal condition (Medical
Times, ii., 1870; see also Hasmaturia). Other instances of the value of
iron in vesical catarrh are reported by Vigla (Medical Times, 1857-58).

Purulent Ophthalmia. Bathing with ferric lotions and painting with
the tinct. ferri have proved useful in chronic purulent conditions of the
conjunctiva, and similar treatment has sometimes dispersed corneal opa-
cities and healed scrofulous corneal ulceration (Gazette des Ilopitaux,
February, 1862).

Skin Diseases. In congestive and exudative forms of skin disease
much benefit may be obtained from the tincture of iron; thus, severe
pruritis may be relieved by it (Lancet, ii., 1874, p. 715). In a case of
chronic infiltrated eczema, when tarry preparations had failed, painting
with the tincture, and afterwards with collodion, not only cured the in-
tense itching, but also the malady itself, leaving only a dry and brown,
but sound skin, and I have seen a case of pityriasis rubra in which the
intensely red, dry, and scaly condition was more relieved by the applica-
tion of this remedy combined with glycerin than by anything else.
Lichen agrius is also relieved by it. Devergie drew attention to its value
in chronic pustular disorders, such as rupia, ecthyma, and impetigo or
pustular eczema (Medical Times, ii., 1860), in which it may be locally
applied as well as taken internally. It is a good application forvariolous
pustules (Medical Times, ii., 1856, p. 498, Ranking, ii., 1866), and has
favorably influenced the course of anthrax; a striking case is reported by
Dauvergne (Bulletin, 1867).

Herpes. Baudon found immediate good results from painting the
vesicles of herpes with tinct. ferri perchlor, and glycerin; he recommended
opening the larger vesicles for the application, but Gressy obtained
equally good results without opening them, using a concentrated alcoholic
solution, which gave rapid relief (Bulletin, t. Ixiii.). An ointment con-
taining 6 to 10 gr. of sulphate of iron in the ounce is recommended by
Palmer (Medical Times, ii., 1861, p. 24).

Ringworm. The local use of iron in ringworm is an old practice,
which has been recently revived (British Medical Journal, i., 1877).
After cleansing the part, tincture of perchloride may be painted upon it
three or four times, at a day or two's interval; a brown scale forms, which
should be left undisturbed, glycerin will lessen the sense of dryness and



160 MATERIA MEDICA AND THERAPEUTICS.

constriction. I have found this treatment succeed in slight and recent
cases; also in old ones, after more active remedies had been used, and
it has the advantage of being not so unpleasant as some other applica-
tions.

Onychia In-growing N^ails. Very successful results have been ob-
tained by using the perchloride locally; for instance, a delicate girl, who
had suffered for several years and undergone removal of the nail and
most ordinary modes of treatment without relief, was cured mainly by
the use of an ointment made with perchloride, and a few applications of
the solid compound: the latter gives pain and requires to be almost im-
mediately washed away (Bulletin, 1853). The persulphate has been used
in other cases (Medical Times, ii., 1868, p. 257).

Necrosis of Bone. Injections of perchloride have a good effect in
chronic sinuses; sometimes they act better when manganese is added
(British Medical Journal, ii., 1871).

Ulcerations. In chronic indolent ulceration the perchloride is a good
stimulant; also the carbonate, finely powdered, has been applied in sub-
stance to old and excavated ulcers of the leg, and with good bandaging
has succeeded well (Lancet, i., 1862). The salicylate of iron is said to
indie a useful lotion (Edinburgh Medical Journal, 1877).

Hospital Gangrene. The perchloride and Monsel's solution have been
largely used as local applications, especially in military practice. Sal-
leron gives a very favorable report of these from experience in the Cri-
mean hospitals and elsewhere (Buisson, " Traite, " etc., and Medico-Chir-
urgical Review, ii., 1860). A "gangrenous throat" was also treated
successfully with perchloride ( Medico- Chirurgical Review, i., 1861).

Polypus Tumor. The perchloride has been applied, it is said suc-
cessfully, to the cure of polypus nasi by injections, and by continued con-
tact (Boston Medical and Surgical Journal, 1861). It has been injected
also into the substance of tumors, and one case is on record when it was
selected for injection into a laryngeal growth, but, a drop of the fluid es-
caping, sudden death followed from laryngeal spasm ( Union Medicale,
1873).

Erysipelas. Preparations of iron have been largely used, both exter-
nally and internally, in the treatment of this malady. A strong ointment
or lotion of the sulphate (about 1 in 4) was . recommended by Velpeau
after many comparative trials with other remedies; it does not, however,
always prevent the extension of the inflammation (Bulletin, 1855). Mr.
Hulke recommends a lotion containing 10 gr. in the ounce (British
Medical Journal, ii., 1871). The application of equal parts of liq. ferri
and spiritus vini rect. would seem still more valuable (Oswald White,
British Medical Journal, i., 1876); and Mr. Foster, of Leeds, obtained so
much success by painting the ordinary tincture of perchloride over ery-
sipelatous surfaces, that this plan became known as the " Leeds method; "



IRON. 161

it was applied also to inflamed lymphatics, breasts, etc., and seems to
have been especially useful in erysipelas after vaccination (Lodge, Medi-
cal Times, i., 1875). Mr. Hamilton Bell was the first to publish cases of
remarkable benefit from the internal administration of the same remedy,
or rather of the old " tincture of muriate of iron; " he gave 20 to 30 drops
every three hours, so that sometimes 2 oz. were taken in eight days
(Edinburgh Monthly Journal, 1852). In severe cases of "idiopathic"
erysipelas, the spread of inflammation was arrested, the pulse lowered,
and the fever relieved, and equally good results were reported by Balfour,
Begfcie, and other eminent men; and although Lehmann writes more re-
cently in praise of the treatment (Lancet, i., 1880), we cannot concede to
ferrum the " specific " virtue in erysipelas that has been claimed for it,
nor is it the best remedy for every case. Todd curtly denied its efficacy
(Medical Times, i., 1860); also H. Bennet and Estlander found it useless
in traumatic cases (Medical Times, ii., 1871).

Dr. Marshall (Dover), after relating two acute cases well cured by
20-min. doses (and purging), states that he has found the remedy of less
use in the traumatic form (British Medical Journal, i., 1872). The
limited experience of Parkes need not weigh with us, because his cases
received only 10-min. doses or less, and were therefore not tests of the
method in question; but Aran, commenting on ten satisfactory cases re-
corded by Mathez (These, Paris, 1857), points out that iron is not the best
remedy for young, robust subjects with high fever.

It is fair to add that Mr. C. Bell still maintains its very great value in
all forms of erysipelas, and attributes the failures of other practitioners
to the use of too small doses, or of less excellent preparations; he states
that under his own care patients have recovered so soon as the old " tinc-
ture of muriate " was substituted for the modern " perchloride." The
former, made with sesquioxide and hydrochloric acid, contains more free
chlorine and some protochloride of iron, but the present tincture of the
B.P. is a more definite preparation; any difference in curative power can
be ascertained only by clinical experience, and Mr. C. Bell's observations
deserve attention (Edinburgh Medical Journal, August, 1876). Some
observers have sought an indication for iron in the locality affected, find-
ing it least useful for erysipelas of the head or trunk; but Pirrie has ob-
tained the best results in such cases. I think that in choosing a remedy
for erysipelas we should look rather to the general constitution of the
patient, the nature of the tissues affected, and the character of the in-
flammation; thus, I find iron to be really. the best remedy in anaemic,
weak patients, or in lymphatic constitutions when there is rapid extension
or flitting of the inflammation, when the affected surface is dark-red or
bluish, when the pyrexia is slight, and when, owing to debility, the attack
tends to linger.

In the erysipelas consequent on surgical operations it is also useful if
VOL. II. 11



1C2 MATEKIA MEDICA AND THERAPEUTICS.

the subject has been reduced by long-continued suppuration or other cau-
ses of exhaustion. I believe it has also some prophylactic power.

Diphtheria. This malady is clearly allied to erysipelas, and has been
successfully treated by the same preparations of iron, both locallv and
internally. Some of the earliest observers recommended the application
of perchloride to the seat of exudation, on the ground of the effused
membrane being parasitic (Jodin, Laycock), but fungus elements are not
essential to diphtheria, and other physicians, regarding exudation as only
one sign of constitutional infection, discouraged the use of such local
means as might irritate: Trousseau, for instance, was disappointed $n a
strong tincture of perchloride used " as a caustic," and such application
is not to be recommended; his remarks, however, do not apply to the
use of a more dilute form, for blood-poisoning may occur from the affect-
ed surfaces, and I entirely agree with Dr. Heslop, Sir William Jenner,
Dr. George Johnson, and others, that judicious local disinfection is very
important and advantageous; various remedies may serve, but the gentle
application of diluted ferric solutions has given very good results in com-
petent hands. Dr. Nelson (New York), after ample experience of several
methods of treatment, expresses the strongest conviction in favor of local
applications of Monsel's solution (liq. ferri subsulphatis) diluted with gly-
cerin and water; among forty cases thus treated he had only three deaths
(New York Medical Journal, January, 1874). Dr. Billington, in an
excellent practical essay, maintains that diphtheria is at first a local affec-
tion, and to be treated most successfully by early local disinfection; he has
used lime-water, carbolic acid, etc., but gives a decided preference to the
tinct. ferri perchlor., 2 parts, to 1 of glycerin; this he paints especially
over the tough adherent membranes, and'all adjacent parts. Three hun-
dred cases treated upon this principle show a large percentage of recov-
eries, and other physicians corroborate Dr. Billington's results (New
York Medical Record, March 25, 1876).

Bertheau describes, in a recent thesis, a severe epidemic of " diphthe-
rite " affecting two hundred and twenty people (Indre), and in which the
most useful of all the means employed was the local application of tinct.
ferri perchlor. (30 Beaume); when the membrane was unusually thick,
this was painted on three or four times daily (" Du Traitement de Diph-
therite," etc., Paris, 187G). Dr. Fera applies the finely powdered sulphate
of iron freely to the affected part, and attributes to this the successful
termination of eighty cases, while De Sabbata speaks in equally favorable
terms of the use of an acid solution of the same salt (London Medical
Review, November, 1876).

Referring now to my own experience, I find detailed notes of twenty-
seven consecutive cases of diphtheria, in which the perchloride was used
locally or internally; for the local application I employed an atomizer
with equal parts of the solution and water, and continued its use for five



IKON. 163

to ten minutes every hour or two. In six cases no internal medication
was ordered, but, besides using the spray, the throat was swabbed out
with solution of perchloride mixed with an equal part of glycerin, two or
three times in twenty-four hours. The age in these six cases varied from
five to nine years, and five of them recovered; but the attack lingered
longer, and its course was more unsatisfactory, and convalescence more
tedious than in other instances when internal treatment was conjoined:
one child, aged four years, had nasal diphtheria, and sank on the third
day. In another series of six cases, including children of from two to
seve"n years, I gave minute doses of iodide of mercury (^ to -j^gr.) and
also liquor arsenicalis, and used freely a spray of perchloride of iron lo-
cally, and these six cases did well. The remaining fifteen, varying in age
from two to ten years, were also treated by the spray, and in addition
they received from 10 to 20 min. of the liquor ferri perchlor. every one
or two hours, and of these cases twelve recovered. Nine of the total
number had albumen in the urine on being first seen by me, and three,
hsematuria; another had severe epistaxis, and all showed much exhaus-
tion, with more or less dyspno&a and delirium. The iron given internally
seemed to exert a sedative effect on the circulation, lowering the fre-
quency of the pulse, and rendering it more full and forcible. I have never
seen hemorrhage, or albuminuria, or congestive symptoms of any kind
which could fairly be traced to its action, and am indeed satisfied that its
effect on the course of the disease is beneficial, though we cannot, any
more than in erysipelas, consider it a "specific."

Admitting, however, that twenty-seven cases do not furnish sufficient
basis for a positive conclusion, it will be desirable to review briefly the
experience of previous observers. This we shall find to be strongly in
favor of the iron treatment. Dr. Godfrey, of Enfield, reported three
cases of " diphtherite " treated by the perchloride at the very commence-
ment of the epidemic, and speaks of it as the best remedy (Lancet, ii.,
1857). It was strongly recommended to the profession at about the
same time by Aubrun, in France, and soon after by Dr. Ileslop in this
country (1858-59). The mortality before that date was most severe
thus, of twenty-six cases related by Aubrun, and treated without iron,
twenty-two died. In the next series of cases, in which he used the
remedy both internally and locally, out of twenty-seven three only died,
and in another series of twelve cases there were no deaths at all ( Gazette
des Hopitaux, 1859); nor does it seem that any natural lessening of vir-
ulence in the epidemic accounted for this striking and suggestive differ-
ence.

Aubrun was most particular in his method of administration, ordering
one or two teaspoonfuls of a solution every five to fifteen minutes through
the day and night, for the first three days of the attack, " because usually
membranes would be detached, or would cease to form after that time "



164 MATERIA MEDICA AND THERAPEUTICS.

then the medicine could be taken less frequently ( Comptcs Rendus,
I860, t. li.). Da Silva, commencing with only the local application of
perchloride, soon found improved results from using it internally, and
recorded many successful cases ( Gazette des Hopitaux, Fev., 1859). Is-
nard was a still more earnest advocate for this treatment. Following

O

Aubrun in the principle that " iron strengthened the vital power " he
reasoned also that it might prevent exudation just as it might hemor-
rhage, rendering the blood more plastic and also less liable to contami-
nation (blood-poisoning) : and, acting as an alterative on the mucous
membrane of the respiratory tract it was better than alkalies, for they
were too slow in action and too lowering; it should be given early and
repeatedly so as to influence the blood-condition as soon as possible; in
support of his reasoning he adduced thirty-nine cases, of which thirty-five
got well in a natural manner, and two after tracheotomy. Dr. Heslop,
after referring to the then excessive mortality of diphtheria, and the
failure of all accepted modes of treatment, records several striking cases
of recovery from almost hopeless conditions under the internal use of
tinct. ferri perchlor: he conjoined with it local applications of dilute
hydrochloric acid: at the same time that he praises the remedy, he cau-
tions against regarding it as " a specific " (Medical Times, i., 1858). Mr.
Pound relates equally favorable results (British Medical Journal, i.,
1858), and Mr. Houghton (Dudley) contributes four striking cases of re-
covery under very unfavorable conditions (Dublin Journal, February,
1859). A very severe epidemic in the fen country was controlled, accord-
ing to Mr. Stiles, by the same treatment (British Medical Journal, ii.,
1858), and, of fifty-six cases, reported by Mr. Prangley, two only died after
commencing the remedies: he used iodine locally and perchloride with
potash chlorate internally. Mr. Salter contributed additional testimony
to the same effect, and altogether the change of tone, and of the amount
of mortality recorded in writings of this period, abundantly testify to the
benefit derived from iron tincture, allowing even for accidental circum-
stances. Mr. Fisher attaches much importance to the use of a prelimin-
ary emetic or purge (Lancet, ii., 1862), and Dr. George Johnson, agreeing
that treatment with perchloride internally is the most successful of all,
conjoins with it local chlorine applications (Lancet, i., 1875). Sir W.
Jenner, careful to place mere medical treatment in a subordinate position,
states that in his experience benefit has accrued from the perchloride, as
from other medicines, only in certain cases suited for it (" Clinical Lec-
tures"), while Dr. Wade expresses some distrust of the remedy, fearing
it may increase the renal congestion, for he has found, in fatal cases,
more pronounced alteration in the kidneys of patients treated by iron
than in others (Lancet, ii., 1862): he would prefer iodide and chlorate of
potash. Certainly there are arguments in favor of Dr. Wade's view, but
it is not supported by my own experience, and I think it will be conceded,



IRON. 165

that the illustrations and authorities already given, furnish ample 'evi-
dence of the value of perchloride of iron in diphtheria. The appearance
of albumen, blood, or tube-casts in the urine does not contra-indicate the
use of iron in this disease, but, on the contrary, calls for its administration;
and when blood or tube-casts are present the iron should be given in con-
junction with nitric or hydrochloric acid: under the same conditions
stimulants should be judiciously regulated, but seldom withdrawn. Or-
dinary diuretics are injurious, but as a rule demulcents should be freely
taken. Patients should be well nourished with beef-tea, soups, eggs,
milk in any form, chicken panada, etc., and ice sucked or swallowed is
very agreeable and relieves the painful condition of the fauces: the skin
should be kept clean and warm, and the house and room well ventilated;
aperients, as a rule, weaken the patient and cause an extension of the
exudation in the throat; all these and other matters as they arise should
be carefully attended to during the administration of any iron prepara-
tion in diphtheria.

Scarlatina Scarlatinal Angina Variola. In many of these cases
I have used the perchloride internally, and applied it to the throat mixed
with equal parts of glycerin and water, or through an atomizer, with



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