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

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satisfactory results, but I recommend it most in cases which assume a
malignant or putrid form; benefit is often obtained by painting the
swollen cervical glands with the liquor ferri.

I have treated many cases of articular inflammation occurring during
scarlatina, and closely resembling articular rheumatism, showing high
temperature and great prostration, with 5 to 10-min. doses of tincture
of perchloride three or four times daily, with excellent results, the joints
being also painted with the liq. ferri perchlor. Meade writes to recom-
mend the same medicine in frequent doses of 10 to 15 min. (Medical
Times, i., 1858); and Arlidge believes it to be not only valuable as a
remedy during the attack, but as a preventive of dropsy (British Medical
Journal, ii., 1871). Fears have been expressed as in the case of diph-
theria of its increasing renal congestion, but I have never seen injurious
effects which could reasonably be traced to it, and Dr. Crighton makes
the same observation (British Medical Journal, i., 1869). He considers
that any risk of this kind may be obviated or lessened by combining
liquor ammonise acetatis with the iron compound, thus assisting the action
of the skin, and I believe the combination to be very serviceable in febrile
and inflammatory cases.

The perchloride has sometimes been used with very good effect to re-
lieve the throat-condition in variola (Medical Record, January, 1873),
and the course of the malady itself seems to have been favorably modified;
half-drachm doses of the tincture were given every four hours in a severe
case occurring in the seventh month of pregnancy, and the patient did
well (Ranking, ii., 1866).



166 MATERIA MEDICA AND THERAPEUTICS.

* Rheumatism, Acute and Subacute. To ascertain the value (or the
reverse) of iron in acute rheumatism, I must refer rather to the expe-
rience of others than to my own. Petrequin seems to have been the first
to use it, and he reported marked advantage from doses of 40 to 80 min.
given in the course of twenty-four hours; he prescribed it with lemonade,
and he made trial also of the sulphate and the citrates (" Traite Pratique
des Eaux Minerales," These, Paris, 1855, p. 533). Dr. Russell Reynolds
led to use the remedy by consideration of its value in erysipelas
brought before the profession a series of eight cases in which the average
duration of high temperature was shortened (to five and a half days as
against fifteen), and in several of which pain was quickly relieved and no
discomfort produced; but, on the other hand, one patient died comatose,
after delirium, and another of pneumonia and pericarditis, while a feeble
or intermittent pulse of 56 to 60 caused anxiety in two of the others; it
is to be noted that most of these patients had some cardiac inflammation
before coming under treatment, yet the results can scarcely be considered
favorable (British Medical Journal, ii., 1869). In another series of cases,
however, Dr. Reynolds was able to record greater success; thus, out of a
total of sixty-five, 44 per cent, of first attacks were convalescent in the
course of a week, and most of those suffering from second, third, or fourth
attacks, in the second week; one-half of the whole number were severe
cases, yet the temperature became normal within fifteen days; hyper-
pyrexia occurred in three, and proved fatal in two, instances (British
Medical Journal, ii., 1872).

If we examine other observations that have been published on this
subject, we find satisfactory results obtained by Mr. Bott (British Medi-
cal Journal, i., 1870), and the record of six cases successfully treated
with perchloride by Dr. Dyce (British Medical Journal, i., 1876); and
Dr. Rose finds the remedy " prophylactic of rheumatism " (Lancet, ii.,
1871), but, on the other hand, of three cases treated by Dr. Buck, one
had urgent dyspnoaa, and one unusual cardiac pain (British Medical
Journal, i., 1870), and of three cases recorded by Mr. Greene, one died
with cardiac lesions, and one had tetanic spasms, so that it seems desira-
ble to ask (with Dr. Trestrail) whether the perchloride given in acute
rheumatism may not increase the disordered blood-condition, and the ten-
dency to embolism, and to embarrassed pulmonary circulation: at least,
we must say that there is at present much more doubt as to the suitabil-
ity of this remedy in acute rheumatism than in erysipelas or diphtheria,
and it has not commanded the same amount of professional confidence;
and yet when the urine is alkaline (as in several of Dr. Reynolds' cases),
and the patient is very anasmic and feeble, tincture of steel seems quite
appropriate; also rheumatic pain is often relieved by it, and it has de-
cided value in the anasmic condition following acute attacks, and in sub-
acute and chronic varieties of rheumatism. The late esteemed Dr. Anstie



IRON. 167

drew attention to its power of cutting short subacute cases as observed
among the out-patients at the Westminster Hospital; in such as were
really rheumatic (and not gouty) in character, with sallow patchy face,
deep furring of tongue, oily moisture of skin, obscure aching of limbs,
slight rise of temperature, and trouble of respiration, he found that 30 to
40-min. doses, given three to six times in the twenty-four hours, often ar-
rested the progress and relieved the symptoms in a few days; this occurred
in seventeen cases out of twenty-nine (Practitioner, September, 1871).

Chronic Rheumatism. Ferrum is useful in primary chronic rheuma-
tism, also in cases when the patient is much reduced in strength and flesh
after an acute attack; it should be continued for some time, for its favor-
able effects are but slowly produced.

Rheumatoid Arthritis. Dr. Garrod recommends iodide of iron " in
some cases of 'rheumatoid arthritis, especially when the joint-pains are
increased by the heat of the bed." I have tried it, but have not myself
seen good results from it.

Anosmia. The various preparations of iron form our most dependa-
ble remedies in ordinary and simple cases of ansemia and chlorosis, and
indeed their good effects are usually so evident that iron was, at one
time, considered a panacea for all forms of these affections, but, in reality,
if prescribed injudiciously, it may not only fail to cure, but may produce
ill-results, and observation of such instances has led some observers to de-
preciate a remedy which had been considered so universally curative.
Thus, Trasbot has recently denied to it any reconstituent or hsematinic
power, while Dujardin Beaumetz holds the employment of iron in anaemia
" une grande illusion therapeutique " (Journal de Therapeutique, 1S7G).
The former observer states that, in experiments on dogs he obtained better
haematinic results from lime phosphate, coffee, and wine, than he did from*
iron, which proved simply exciting; and Dujardin Beaumetz relies upon
an argument of C. Bernard's, that even if the normal amount of iron in
the blood of chlorotics be diminished, it is only by a very small amount
(10 or 20 centigrammes) more than which is introduced, daily in the food:
but the true answer to such observations is, that all theory, and even all
physiological experiment, must stand or fall by the clinical results obtained
on man (Mialhe and others in Gazette Hebdom., Mars, 1S7G), and in the
majority of cases these are satisfactory. The objections of Trousseau were
limited to the use of iron in "false chlorosis" that is to say, in cases
when the suppression of the menses, pallor, etc., were really connected
with incipient phthisis, which malady he found to be accelerated by
ferruginous medicines (" Traite," vol. i.). His observations have been
corroborated by Millet (Bulletin, 1862), but the cases quoted by the latter
author illustrate mainly the injudicious domestic use of certain prepara-
tions without due examination of the patient, and his remarks apply only
to the abuse, not to the medical and proper prescription of the remedy.



168 MATERIA MEDICA AND THERAPEUTICS.

By the terms " anaemia "or " aglobulia,* we understand a condition in
which the red blood-corpuscles are fewer than in normal health ; instead
of being in the proportion of 130 parts per 1,000 of the blood, they may
be at 80 or GO, or even less, and this may arise from direct loss of corpuscles
(hemorrhage), or from insufficient formation of new ones on account of
disease, or bad air, or unsuitable food, and under such conditions the
corpuscles that are formed are small and misshapen. The most marked
symptom of anaemia is pallor, which affects the mucous membranes as well as
the skin, and may be noted in the conjunctivae, the gums, and the lips; other
symptoms are difficulty of breathing, especially on exertion, lassitude,
mental and bodily, malaise, restlessness, dyspepsia, constipation, head-
ache, neuralgia, and palpitation: the pupils are commonly dilated. Some
varieties of anaemia benefit by iron more than others, and it is not easy to
lay down definite rules concerning them. If there be much dyspepsia
this should first be treated by other appropriate means; but on the other
hand, the simple atonic dyspepsia of anaemic persons is very amenable
to iron. Congestive headache is a contra-indication, but the pulsating
acute headache which follows profuse hemorrhage really requires iron
medication; important points for securing its good effects are, to obviate
constipation by aperients if necessary, and to secure sufficient oxygen for
the proper assimilation of the remedy, and I think that many failures in
the treatment of anaemia are traceable to want of management on these
points.

Direct anaemia dependent upon excessive hemorrhage; or the indirect
anaemia which follows loss of animal fluids generally (such as in obstinate
leucorrhcea, empyema, and purulent formations, seminal losses, profuse
perspiration, diarrhoea, prolonged lactation, or too frequent pregnancies);
*also the anaemia produced by acute disease, such as rheumatism, and that
connected with inanition when the albuminous constituents of blood are
really most deficient; all these forms, though complicated with extreme
debility and general hydraemia, may gradually improve with good food,
rest, and pure air (especially if the cause be removed), but iron, given in
suitable doses and not so as to disorder the stomach, will greatly assist
and hasten recovery.

In other cases, the best dietetic measures alone are insufficient, and
iron is indispensable for cure: in the congenital anremia of children born
after profuse uterine hemorrhage, or whose parents were affected with
anaemia, tuberculosis, constitutional syphilis, or other exhausting diseases,
iron is of special value; also in strumous and rachitic cases (when the
iodide or the phosphate is the most suitable form), but it requires to be
continued for a long time. I have always found, in the treatment of
simple anaemia, that when, under the judicious use of iron, etc., the blood
assumes a healthy aspect, and the formidable symptoms disappear, if the
iron medication is not persevered with for a considerable time longer,



IKON. 16 ( J

the malady returns in an aggravated degree. Ansemia arising from severe
and continuous mental strain is best treated by the phosphate conjoined
with cod-liver oil many cases have come under my observation when
this treatment proved highly beneficial. In the anaemia due to mal-hy-
giene, to sedentary pursuits, prolonged residence in a town atmosphere,
or continued exposure to carbonic acid, iron compounds are also markedly
useful. In all these forms their advantage has been often verified by the
enumeration of the blood-corpuscles, and estimation of the amount of
coloring matter.

Idiopathic or " Pernicious " Anaemia is an extremely interesting but
obscure form of disease, connected mainly with the glandular system; it
is insidious and fatal, and iron, at least in the forms usually employed,
has seemed to possess little or no remedial power against it: arsenic, and
perhaps phosphorus, have succeeded better (v. p. 50). Quite recently,
however, benefit has been reported even in this malady from the hypoder-
""mic use of iron, and Da Costa has further exemplified the value of this
resource by the cure of an obstinate case of chlorosis with hypodermic in-
jections of " dialysed iron " in 15-min. doses (British Medical Journal, i.,
1878). I should consider this an additional proof that in many cases
where iron is said to have failed, it is because of its not being given in a
form that can be assimilated.

In ordinary goitre, iron alone is inefficient, and in exophthalmic goitre,
although anaemia is commonly a marked symptom, I have not seen much
advantage from it. In the anaemia of incipient phthisis it must be given
with caution (v. p. 173); and in that connected with diabetes arid malig-
nant or malarious disease, its effects, though often good, are rather un-
certain.

The success of iron in anasmia will clearly vary with the different
causes, forms, and degrees of the malady, and an accurate knowledge of
them is a great help toward cure of the disease, and confidence in the
power of the drug. Cases coming under treatment at an early stage
usually admit of a favorable prognosis, but when the anaemia is congen-
ital, or occurs at the climacteric period, recovery is more uncertain, and
the anaemia of old people (unless when directly consequent on an acute
illness) is the least tractable of all; intercurrent disease, especially if of
febrile or inflammatory character, renders the prognosis as to the anaemic
condition, very doubtful.

It is worth while, even at the present time, to refer briefly to two of
the earliest facts which fixed the value of iron in suitable cases of anaemia.
An endemic malady, apparently unknown at the time (1804), attacked
the workers in the mines of Anzim (coal); it was probably anaemia from
carbonic acid poisoning, for they became pale, feeble, short of breath,
and died of asthenia, or chest disease. Treatment by quinine, opium,
good food, etc., failed to relieve, and four cases were sent to a hospital



170 MATEKIA MEDICA AND THEEAPEUTICS.

in Paris for the opinion of the physicians: of the four men, one died short-
ly, and at the section, Halle, noticing the exsanguine appearance of the
body, thought of iron, and prescribed it for the others, who got well,
and returning home cured their companion's with the same remedy (Que-
venne: " Memoire," etc.). Something similar occurred at the mines of
Schemnitz (metal mines), where the workers at one time died rapidly
with "aneemia, asthma, phthisis, and dropsy," when the epidemic was
stayed with iron medicines by Hoffinger (Ozaman : " Histoire des Epi-
demies ").

Chlorosis. The relationship of chlorosis to anaemia is not exactly
clear, but it has this in common with it that the number of red cor-
puscles is diminished, and that those which are visible are mostly small,
some are shrivelled and irregular, and all are pale-colored; the serum is in
excess: in causation, also, it is allied, as it occurs often in young girls
obliged to live in close, ill-ventilated rooms or workshops, and it has
also, sometimes, seemed directly due to the hemorrhage of the first men-
struation (Wade).

As an entirely primary disease it seldom occurs in any but unmarried
women, and chiefly from thirteen to twenty-four years of age; if it occur
later in life, it is usually traced to frequent confinements coming rapidly
one after another, and especially if the women nurse their children. It
is connected with deranged menstruation and certain sexual causes which
we are at present unable to distinguish accurately: it occurs either before
the menses have appeared, or after symptoms of disordered menstruation
have continued for some months; dysmenorrhoea and leucorrhoea are fre-
quent precursors of it. It is often hereditary; the children of tuberculous
parents and delicate women with irritable nervous systems are the most
susceptible to it: sometimes, in exceptional cases, menstruation is too
frequent and profuse. The patient is subject to most of the symptoms
already described under anaemia, especially dyspnoea, palpitation, head-
ache, giddiness, and dyspepsia: the face is cedematous and pallid, with a
greenish hue; the condition lasts longer than ordinary anaemia, and re-
lapses are still more liable to occur.

The cure of this affection is often readily accomplished with suitable
diet, pure air, exercise, healthy mental occupation, and a steady course
of iron, which latter is almost a specific in all simple cases. It was for-
merly thought that the metal acted by supplying some deficiency in the
blood, or at least by directly increasing the number of corpuscles. Behier
considered that it was always indicated when he found, on microscopical
examination, that the red globules were reduced to a proportion of 80
per 1,000, and to some extent this is a guide. General improvement will
usually occur pari passu with an increase in their number toward the
normal amount, but it must be understood that the action of iron is not
simply a mechanical or chemical one. Claude Bernard has shown by an-



IRON. 171

alysis that the metal, as such, is not always deficient in amount in chloro-
tic blood, and Hayem has shown that the number of corpuscles is not al-
ways diminished before, nor increased after the use of iron; on the other
hand, the latter observer has clearly shown that the size, and color, and
" vital character " of the corpuscles are remarkably improved by it. It
acts, therefore, as a stimulus in some manner peculiar to itself, or, as
others have expressed it, it has a " dynamic or vital influence " which
chemistry alone will not explain (Trousseau, etc. ; see also Physiological
Action).

With regard to the preparation that is most suitable, we may refer to
the observations of M. Coste. He made trial of different forms in 118
cases, fifty-five being of chlorosis, and he concluded that the choice of
any particular one was not in itself important, if irritation of the stom-
ach did not result every preparation that did not irritate produced the
good effects of iron; the reduced metal, taken at meal times in small
quantities, proved on the whole the most satisfactory form, and the ex-
periments of Quevenne, and the observations of Chomel, Trousseau, and
others, are to the same effect. Sydenham obtained remarkable success
with iron filings and iron wine, and, as a rule, we may say that the sim-
pler the form used the better, and chemical theories as to solubility, etc.,
do not guide as to the therapeutical result. The ferrum redactum, the
oxides and proto-salts. especially the carbonate, are certainly to be pre-
ferred in the earlier stages of chlorosis, unless the occurrence of mucous
or other discharges indicate a necessity for astringents: sometimes the
metal itself causes unpleasant eructation, and the oxides are liable to
adulteration, and hence the recently precipitated carbonate, which is not
astringent or irritant, is preferred by many, and in the form of mist.
ferri comp., or Griffith's mixture, has had great repute in the treatment of
ansernic amenorrhoaa. The " Pilules de Blaud " contain carbonate of potash
and sulphate of iron, and have for many years retained a high reputation
in the treatment of chlorosis, especially on the Continent (Nierneyer): his
original memoir, recording thirty successful cases, is republished by Bayle,
and will repay perusal (Biblio. de Th'erapeutique Journal, iv., 1837). I
have but little personal experience of the value of the hydrated oxide, or
" dialysed iron," which seems pure and non-irritant ; the doubts ex-
pressed about it seem to be mainly theoretical (Bouchardat: Bulletin,
January, 1878; Medical Times, 1878; British Medical Journal, ii., 1878).
I have had excellent results from a protochloride, and sometimes the
citrate with ammonia wilt be borne better than any other. Dornetz specially
recommends an albuminate (see Preparations), and in the anaemia so com-
mon in Japan, and traceable to intestinal catarrh, found it better borne
than any other form. I have seldom seen the astringent forms, when
given in a right dose, and at a proper time, produce any injurious effect
on a weak or irritable stomach; indeed, in many such cases I have found



172 MATEKIA MEDICA AND THERAPEUTICS.

them particularly suitable, and we need not be deterred from their use by
fear of irritating effects: astringent preparations, such as the perchloride
and sulphate, should be used in cases of " menorrhagic chlorosis," for it
is found practically better to treat the anaemia in such cases than to omit
iron for fear of increasing hemorrhage (Trousseau). This applies espe-
cially to cases where the discharge is profuse and frequent, but pale and
imperfectly coagulating; but, even when it is florid in character, iron may
be ordered with advantage, if due attention be first given to such svmp-
toms as hepatic congestion and constipation. Astringent preparations
are also useful if there be a tendency to palpitation, general relaxation,
or undue discharges of any kind, and also when impairment of nerve-
power is a marked symptom. Aloes is often added to reduced iron or
iron carbonate, in phlegmatic subjects, and sulphate of magnesia to medi-
cines containing iron sulphate, especially if the patient be plethoric;
sometimes small doses of belladonna will regulate the bowels, preventing
constipation better than either of these aperients. In all cases, success
will depend not upon giving a large quantity of the medicine, but upon
securing its due assimilation; for this purpose, air and exercise are im-
portant, and fatty food certainly aids the digestion of iron (Nasse: Brit-
ish Medical Journal, ii., 1877). Jeannel found that an oleo-stearate of iron,
prepared with the sulphate and white soap, was very well borne: nitro-
hydrochloric acid baths also favor the absorption of iron (Chambers: Med-
ical Times, i., 1862).

It is important in all cases to continue the remedy sufficiently long,
and not to omit it on the first symptoms of improvement; permanent
benefit can seldom be expected under five or six months.

In cases where iron had not been given properly, and when it after-
ward failed to produce due effect, I have found great advantage from
arsenic alone, or in conjunction with iron. Manganese has also been
recommended (Petrequin).

Anosmia of Pregnancy. We consider iron not a direct, but an in-
direct emmenagogue, by virtue of its improving the blood-condition; but
since the continued use of the mineral can cause congestion of the pelvic,
as well as of other organs, it becomes an important question as to whether
its use is admissible or is dangerous during pregnancy. Certainly the
perchloride has been in frequent popular use as an abortifacient, but the
evidence of its power for this purpose is not cogent (v. p. 147). Its use
has often furnished occasion for prosecutions, but few cases of its really
causing abortion are recognized, and, in many of these, as well as when
the sulphate has been used, the effect seems to have followed from violent
irritation of the intestinal canal. It is true that cases in which abortion
is deliberately produced would not, as a rule, find their way into the pub-
lic press; but, allowing for this, I find a general impression gaining ground
that iron may be taken during pregnancy without injurious effects.



IRON. 173

Ramsbotham and Barnes recommend it, the latter stating that he has never
seen harm from it (Lancet, i., 1874, p. 768). It was stated during a recent
trial that 10-gr. doses of ammonio-citrate of iron were dangerous to a
pregnant woman, but Dr. Woodman contradicted this from his own ex-
perience, and Dr. Graily Hewitt said that he and others constantly pre-
scribed it during pregnancy (British Medical Journal, i., 1870). Dr.
Bassett brought before the Obstetrical Society many cases illustrating the
value of the citrate and tartrate of iron in averting miscarriage and serious
hemorrhage in delicate women, and there seems to have been no difference
of opinion upon the subject (Lancet, i., 1874, p. 768): he considers that
the addition of an alkali to the iron medicine renders it better borne, and
points out that aperients should be given occasionally during the course.
I can corroborate the experience of Dr. Bassett, and I think that the
neutral preparations of iron are the most suitable during pregnancy,
though some observers speak well even of the perchloride (Day: British
Medical Journal, i., 1870). Trousseau remarks that iron has no direct
emmenagogue power, and Hirtz has never seen any objection to using



Online LibraryCharles D. F. (Charles Douglas Fergusson) PhillipsMateria medica and therapeutics, inorganic substances; (Volume 2) → online text (page 21 of 40)