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

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iron in the anasmia of pregnancy, though he has not found it very useful
(" Diet, de Med.") ; altogether we must conclude that the older fears of
injury from its moderate medicinal use were unfounded.

Phthisis. A great deal of fear has been expressed about the use of
iron in this malady, and it has been said by eminent observers to hasten
and aggravate its course, especially when given in full doses and in the
early stages (Trousseau, Millet: Bulletin de Ttierapeutique, 1862, etc.).
If there be acute pyrexia and evidence of pulmonary congestion, leading
to florid haemoptysis, then I think that iron is better avoided, because it
can increase blood-pressure and congestion, and stimulates blood-forma-
tion, and in any case it should be given with much caution during the
early stages of the malady, and special attention should be directed to
supplying at the same time any deficiency of fatty food, and to securing
a due supply of oxygen (Dobell: British Medical Journal, i., 1867).
Iodide of iron is one of the best preparations to use, especially in " scrof-
ulous phthisis," and it should be combined, if possible, with cod-liver or
other oils. In later stages of phthisis, all are agreed as to the value of
iron in relieving many of the most distressing symptoms and much assist-
ing any measure of recovery that can be obtained: the astringent prep-
arations control purulent formations and discharges of various kinds,
such as expectoration and passive htemoptysis, diarrhoea, and profuse
perspiration, and they often improve the strength and the appetite.
Bonorden used the sulphate in a number of cases, giving from 2 to 4
gr. every two hours for several days at a time: the dose seems large,
but he obtained very good results (Schmidt's Jahrb., May, 18.52). Dr.
Thompson employed chiefly the perchloride at the Brompton Consumption
Hospital, and calculated the effects of iron medication in more than 1,500



174 MATEEIA MEDICA AND THERAPEUTICS.

cases, 54.6 per cent, were found " improved," 23 per cent, much im-
proved, and only 21 per cent, not improved. He does not give the de-
tails of any cases, nor does he mention the stages of the disease when
iron was used, but states generally that the patients grew stronger, and
were able to eat better, and suffered less from flatulence, diarrhoea, night-
sweats, and haemoptysis: he considers that iron is clearly required in the
treatment of phthisis, because " it improves the condition of the blood,"
and he advocates its continued but moderate use " as a food " (Practi-
tioner, vol. i.). Others have written special treatises in favor of this
medication. Dr. Cotton obtained favorable results from the iodide and
ammonio-citrate (Medical Times, i., 1860), and Sir Thomas Watson rec-
ommends iron in non-inflammatory forms of phthisis, " and finds the
mist, ferri comp. very useful when it is well borne: " if sweating be pro-
fuse, he uses the perchloride. Dr. Cameron recommends the basic iodate
of iron as better than the iodide: it contains 51 per cent, iodine and 11
per cent, iron (Dublin Quarterly, May, 1869).

Chronic Bronchitis Emphysema. In chronic bronchitis, with pro-
fuse expectoration, I have found iron compounds, especially the perchlo-
ride and the phosphate, often useful; besides improving the general
health, they lessen the amount of secretion and modify its character. In
emphysema the perchloride is often valuable for its tonic power and its
action on the capillaries, as well as for improving the impaired blood-
condition.

Cardiac Disease. Cardiac pain and dyspnoea may often be relieved
by iron preparations, which act probably in an indirect manner i.e., by
improving the blood in the first instance, hence their advantage is seen
most in cases of anaemia: in such conditions, occurring after acute rheu-
matism, even the physical signs murmurs, etc. may improve under a
course of iron (Jones: Medical Times, 1861). Increased frequency of
pulse is not, in itself, a contra-indication, but only when increase of
tension is also detected. In mitral disease with dropsy, the acetate or
perchloride is especially useful if combined with diuretics: in fatty de-
generation of the heart, in any form of chronic valvular disease, and in
dilatation, iron is often serviceable, especially when combined with dig-
italis.

Serous Effusions Dropsy. Iron acts powerfully in dropsy resulting
from a state of anaemia or hydraemia of the system, and good effects may
be obtained from 3 to 5 gr. of ferrum redactum taken at meal times, or
15 to 30 min. of tincture of perchloride about half an hour after meals.
Dropsy dependent upon mitral disease is best treated by iron and digitalis
(in addition to purgatives), and dropsy connected with albuminuria is
very amenable to the same combination: it should not be used during
acute renal congestion (cf. Rotta: "Fer en Hydropisie," Anmiaire de
Th'erapeutigue, 1857). Husemann praises it in "cachectic dropsy," and



IRON. 175

in that form which is connected with chronic nephritis and amyloid de-
generation of the kidney. Dr. Anstie has written strongly in favor of
the tincture of iron -in chronic pleuritic effusion, and my own experience
quite corroborates his observations.

AlbuminurioL The astringent preparations of iron are often exceed-
ino'ly useful in controlling the loss of albumen by the urine: we must
remember, however, that it is also possible to do harm by these remedies
in renal diseases, and I have seen congestion increased by recourse to
them during the acute stage. The best effect is certainly obtained at the
decline of this stage, when the urine is free from blood or inflammatory
casts, when pain in the back, and in the head, and the general febrile con-
ditions are relieved, but the patient is pallid, weak, and suffering from
more or less anaemia and dropsy; then the value of such preparations as
the perchloride or acetate is often very marked, both as regards the gen-
eral health and the discharge of albumen. Dr. Hassall, indeed, attributes
these good effects more to a reconstituent action on the blood, " than to
any direct astringent power, because he could not detect either the metal,
or the acid combined with it (hydrochloric), in his analysis of the urine"
(Lancet, ii., 1864). Dr. Parkes was one of the first to show, by quanti-
tative analysis, the gradual lessening and final cure of the discharge of
albumen under the influence of perchloride; this was in a subacute case,
when the early inflammation had subsided, and hospital nursing and
the use of gallic acid had quite failed to relieve (Medical Times, ii., 1854).
In all cases of this kind it is desirable to feel one's way with iron prepara-
tions, to begin at first with a small dose; and the recommendation of my
late friend Dr. Basham, to combine with it the acetate of ammonia, is a
very good one. The addition of ergot will increase the astringent effect
(v. Gazette M'ed. de Lyon, October, 1862), and in albuminuria following
scarlatina, especially when dropsy is present, tincture or infusion of
digitalis, alternately with tincture of perchloride of iron, is a very valu-
able prescription: it increases the flow of urine, at the same time that by
its action on the blood and the capillaries it restrains the transudation of
albumen: Dr. Goodfellow and Dr. Cheadle have reported favorable re-
sults with it (Medical Times, 1871; Ranking, i., 1873).

In chronic forms of albuminuria iron will' require consideration: it is
often extremely useful, improving the blood-condition more than any
other remedy, and Dr. Lionel Beale testifies to its good effects even in
chronic structural change and fatty degeneration (Medical Time*, i.,
1865, p. 29), but the cases in which it does harm are those with granular
kidney, when the heart is large, the pulse hard and of high tension, and
when there is much tendency to headache (Dickinson: Lancet, i., 1870).
Hirtz says that he has seen it hasten a fatal termination by uraemia, less-
ening the amount of urine, and increasing that of urea ("Nouv. Diet.,' 1
Art. Fer), so that its effects should always be carefully watched: a very



176 MATERIA MEDICA AND THERAPEUTICS.

important point when ordering iron in any case of albuminuria is to ob-
viate constipation.

Chyluria. The perchloride of iron has sometimes proved very useful
in cases of this kind, even when they have lasted for several years {Lan-
cet, ii., 1862).

Diabetes. Carbonated iron waters are much esteemed as adjuvants
in the management of diabetes; and Dr. Mackey informs me that the
bromide of iron, or rather a combination of bromide of potassium and
citrate of iron, has given better results than any other medicine in his
experience. Of course, the diet and hygiene must be regulated, and
when we can more accurately distinguish the varieties of the malady we
may find that certain medicines are more appropriate to some forms than
to others, but meanwhile I believe the bromide of iron is available in any
ordinary chronic case: I have frequently seen the general health improve,
and the amount of sugar grow less under its use.

Dyspepsia. Although iron is contra-indicated in cases of acute and
irritative dyspepsia and mal-assimilation, yet certain forms of " atonic
dyspepsia " which are connected with debility and impaired blood-condi-
tion are well treated by it. There are the general symptoms of anaemia,
and also a sense of weight and heaviness after food, and impaired appe-
tite, rather than of acute pain, and the preparations usually most suitable
are such as the citrate or ammonio-citrate combined with soda and ca-
lumba, or reduced iron with nux vomica: the headache which often ac-
companies this condition is also relieved by these medicines: when there
is much general relaxation, or gastric catarrh of chronic character, the
perchloride, preferably with quassia, is valuable. In the dyspepsia of
chlorosis, iron will often not agree if the tongue be furred, or the urine
loaded; but if these conditions are present only in a minor degree, then
the citrate may be used in effervescence with soda (Budd: "On Dyspep-
sia "). Dr. Milner Fothergill, in an article " When not to give Iron,"
insists on the importance of clean tongue and freedom from " bilious-
ness; " and he quotes Sir J. Fayrer to the same effect (Practitioner,
1877); he remarks also that toleration of it diminishes with age.

Diarrhoea. In simple cases, occurring in weakly children, and con-
tinuing after preventable causes have been removed, the vinum ferri is a
mild but very useful astringent tonic, which is often sufficient both to
stay the discharge, and to prevent its recurrence. In more serious cases
of chronic mucous diarrhoea with slimy, bloody, offensive stools, and te-
nesmus, whether met with in adults or in children, the best preparation is
the liquor ferri pernitratis, in doses of from 1 to 5 drops, as originally rec-
ommended by Neligan, and I have seen also much benefit from its use in
the colliquative diarrhoea of phthisis. Dr. Graves specially advised it in
the " nervous diarrhrea " which is liable to occur from emotional causes,
and is more frequent in women: in cases with nausea and impaired ap-



IRON. 177

petite, calumba may be well added to the iron (British Medical Journal,
ii., 1870; Dr. Cookc).

Dysentery. I cannot recommend iron preparations during the acute
stage of dysentery, for I believe there are much better remedies, but
some practitioners have found iron valuable. Bandon reports twelve
cases suffering with tormina and very frequent sanguineous stools, which
were treated by 12 to 30 min. doses of steel tincture internally, at the
same time that about 12 min. with water (and sometimes laudanum) were
injected; these cases were much relieved or cured within a week (Bulle-
tin de Therapeutique, folio 71). Blanvillon corroborated these results
(Gazette des Hopitaux, No. 130), and the same medication was largely
used during the last German war (Lancet, ii., 1870): as a general rule, it
is better restricted to chronic stages of dysentery, and for the anaemia
and debility attendant upon this condition it is of great value.

Cholera. Iron is one of the numberless remedies recommended for
cholera, but I have very little personal experience of its use: it would, of
course, not be depended upon alone, and Robiquet has reported a num-
ber of successful cases treated by the citrate and by reduced iron with
quinine; frictions, and warmth, and nutriment being also conjoined (-Tow-
nal de Medecine, October, 1873; Practitioner, vol. xi., p. 452).

Nervous Disorders Hypochondriasis, etc. The nervous system na-
turally suffers when it does not receive a due supply of healthy blood:
depression and a sense of oppression will be felt, and hysterical and hy-
pochondriacal symptoms will be more or less pronounced: in such cases,
iron is often a valuable adjunct to other treatment, and is especially suit-
able when combined with bromides. In the nerve-symptoms which com-
monly occur in women at the climacteric period, including restlessness,
anxiety, fluttering and sinking at the epigastrium, giddiness, clavus, and
sometimes menorrhagia, the perchloride, with or without bromide, relieves
much.

Dipsomania. Morbid craving for drink, and alcoholic insomnia, have
been controlled by drachm doses of tincture of iron when many other
remedies have failed (Medical Times, i., 1875). The sulphate has also
given relief in such cases, especially when combined with aromatics.

Neuralgia. Before the introduction of many modern remedies for
neuralgia, large doses of the carbonate or oxide of iron were much relied
upon, and when there is a chlorotic anaemic condition of system they are
of service. I should not myself consider iron a remedy for " idiopathic
neuralgia," but some observers have attributed to it almost a specific
power, especially in neuralgise of the fifth nerve: thus, Mr. Hutchinson
recommends it in "prosopalgia," and, according to Schobelt, the phosphate
of iron acts well in neuralgia of the teeth: the citrate of iron and quinine
is a very good form when the remedy has to be long continued.

When neuralgia of the stomach occurs in anaemic or chlorotic patients,
VOL. II. 12



178 MATERIA MEDICA AND TIIERAPEUTICS.

who complain of cramping pain and distension, accompanied with nausea
and vomiting of mucus and water, principally before breakfast, and of
frequent acid and insipid eructations after meals iron is useful, espe-
cially when the neuralgia depends on loss of blood or on protracted diar-
rhoea; I have notes of many such cases cured by it.

Chorea. When this disorder is dependent upon anaemia, iron is clear-
ly indicated, and may prove of great service, as it did in the hands of
Elliotson, who used large doses of oxide {Medical Times, i., 1869, p. 136).
Sir T. Watson recommends the carbonate. Many cases occur about the
time of commencing puberty, and others evince obscure rheumatic symp-
toms: and in these also iron is useful, but it often acts better when taken
in conjunction with arsenic.

Epilepsy. Ferruginous medicines were at one time esteemed in the
treatment of epilepsy or of attacks resembling it, but as diagnosis be-
came more exact, and as more reliable remedies were discovered, iron
passed out of use. Brown-Sequard taught that although it might im-
prove the blood-condition, it tended to aggravate the malady itself; and
H. Jackson, after much observation, expressed the same opinion. Dr.
Gowers, writing more recently, acknowledges that it is sometimes the
case, but, on the other hand, he has found that iron has a true place in
the therapeusis of epilepsy: he has observed benefit from it in cases that
are on the borderland between epilepsy and hysteria, and in others when
the attacks were limited to the night-time, and in many of these cases
the improvement was fairly permanent: he suggests, and I should think
very plausibly, that it acts, like other metals (as silver or zinc seems to
do in such cases), as a nerve-tonic, rather than simply by hsematinic
properties (Practitioner, October, 1877). Fabre has published a thesis
showing the value of the medicine (" Fer contre 1'Epilepsie," Paris, 1853).
On the whole, we may conclude that iron has been unduly discredited in
epileptic or epileptiform conditions. I think that when it arises from
onanism, or when a patient is anaemic, it should be used, but generally in
combination with bromides.

Constitutional Syphilis. This malady, like all others in which a poi-
sonous material circulates in the blood, much impairs the condition of
that fluid, rendering the corpuscles fewer, smaller, and paler; and, in such
cases, iron becomes very serviceable, though it will not take the place of
more special remedies for the principal disease. Ricord recommended
the potassio-tartrate even in primary syphilis, and especially for phage-
dsenic ulceration in debilitated subjects: the theory sustained in opposition
to him by certain French writers, that iron aids the development of the
malady, is not tenable. The iodide of iron I have found very useful in
the later stages of syphilis in cachectic subjects.

Struma Rachitis. In the different forms of disease included under
these headings, and characterized by enlarged or suppurating glands,



IRON. 179

irritable mucous membranes, caries, and swelling of knee and elbow joints,
emaciation, etc., iron, although much lauded by Hufeland, is not so ser-
viceable when given alone as are certain alteratives iodine, lime, etc.
but when combined with such remedies it is of great value for the ca-
chexia, anaemia, and torpor of the blood-forming glands, which are usual
accompaniments; I have, indeed, found the iodide of iron to be an excel-
lent remedy for most affections of a scrofulous type. The perchloride,
as already mentioned, is a good external application for discharging
glands. The vinum ferri, or an alkaline citrate with arornatics, is very
useful in the mucous diarrhoea of rachitic children.

Worms. The astringent tonic effect of perchloride on the gastro-in-
testinal mucous membrane, renders it a good adjunct to purgative treat-
ment for these parasites, and a useful prophylactic. When diluted, it
may be injected into the rectum for destroying ascarides: I generally use
about 1 dr. of the liquor in 4 oz. of infusion of quassia: a stronger solu-
tion is liable to cause unnecessary pain.

PREPARATIONS AND DOSE. Iron preparations, especially the liquid
astringent forms, discolor the teeth and stain the tongue black they
should be taken through a glass tube: glycerin lessens the rough astrin-
gent taste, and a gargle of milk will relieve it (Guibout). A lotion of
quadroxalate of* potash (^ dr. in pint of rose-water) will remove the
black staining.

Mistura ferri aromatica (made with iron wire, cinchona, calumba, and
aromatics): dose, 1 to 2 fl.oz. Vinum ferri (made with iron wire and
sherry): dose, 1 to 2 fl.dr. and upward. Ferrum redactum: dose, 2 to
6 gr. for adults; to 1 gr. for children. Trochisci ferri redacti: each
lozenge contains a grain of reduced iron. Reduced iron may be taken
with advantage during a meal, the powder being mixed up with the food.

Ferri oxidum magneticum : dose, 3 to 5 gr. or more. Ferri peroxidum
hydratum : dose, 10 to 60 gr. or more in treacle or honey. Emplastrum
ferri Chalybeate plaster (contains hydrated peroxide of iron, Burgundy
pitch, and lead plaster). Ferri peroxidum humidum : dose, 2 to 4 dr.

Ferri carbonas saccharata : dose, 5 to 20 gr. or more. Mistura ferri
composita (contains sulphate of iron, carbonate of potash, nutmeg, sugar,
and rose-water): dose, 1 to 2 fl.oz. Pilula ferri carbonatis (contains sac-
charated carbonate of iron and confection of roses) : dose, 5 to 20 gr. or
more.

Ferri iodidum: dose, 1 to 5 gr. or more. Syrupus ferri iodidi (con-
tains iodine 2 parts, iron 1 part, with sugar and water): dose, 20 to GO
min. : each fluid drachm of the syrup contains nearly four grains and a
half of iodide of iron. Pilula ferri iodidi : dose, 3 to 8 gr. or more;
one grain of iodide of iron is contained in about 3 gr. of the pill.

Ferri sulphas : dose, 3 to 5 gr.: the "Pilules de Blaud" contain car-
bonate of potash with sulphate of iron. Ferri sulphas exsiccata: dose,



180 HATEKIA MEDICA AND THERAPEUTICS.

4- to 3 gr. or more (3 gr. with 2 of manna make a good pill). Fcrri sul-
phas granulata : dose, 3 to 5 gr.

Ferri arsenias: dose, y'g- gradually increased to gr. in pill. Ferri
phottphas: dose, 5 to 10 gr. Syrupusferri phosphatis : dose, 1 dr. and
upward (contains soda and phosphoric acid with 1 gr. of the iron salt in
each fl. dr.; is colorless when fresh).

Liquor ferri perchloridi fortior : dose, 3 to 10 min. Liquor ferri
perchloridi ' (contains 1 part of the last-mentioned to 3 of distilled water,
Lp. gr. .995): dose, 10 to 30 min. or more. Tinctura ferri perchloridi
(contains 1 part of the stronger solution to 3 of rectified spirit, sp. gr.
.995): dose, 10 to 30 min. or more. Ferri pernitratis liquor : dose, 30 to
60 min. Ferri per sulphat is liquor (chiefly used in preparing other ferru-
ginous salts).

Ferri et ammonias citras: dose, 5 to 10 gr. or more. Vinum ferri
citratis (prepared with orange wine): dose, 1 to 4 dr. Ferrum tartara-
tum : dose, 5 to 20 gr. Ferri et quinice citras : dose, 5 to 20 gr. Tinc-
tura ferri acetatis: dose, 5 to 30 min.

[PREPAKATIONS, U. S. P. Ferrum redactum Mistura ferri compo-
sita: myrrh, sugar, each 60 gr., carbonate of potassium 25 gr., sulphate
of iron 20 gr., spirit of lavender -\ fluidounce, rose-water 74- fluidounces;
dose, 1 to 2 fluidounces; Pilula ferri carbonatis : sulphate of iron 8
troyounces, carbonate of sodium 9 troyounces, clarified honey 3 troy-
ounces, sugar 2 troyounces, boiling water 2 pints, syrup sufficient;
dose, 2 to 10 grains; Ferri subcarbonas ; Trochisci ferri subcarbonatis
(they contain 5 gr. each of the subcarbonate); Emplastnim ferri / Ferri
chloridum ; Liquor ferri chloridi; Tinctura ferri chloridi; Ferri ci-
tras; Liquor ferri citratis ; Ferri et ammonii citras ; Ferri et ammonii
sulphas / Ferri et ammonii tartras / Fcrri et potassii tartras / Ferri et
quinice citras / Ferri et strychnia? citras ; dose, 3 to 5 gr. ; Syrupusferri
iodidi ; Pilula ferri iodidi ; Fcrri lactas ; Ferri oxalas ; dose, 2 to 3
gr. ; Liquor ferri nitratis Fcrri oxidum hydratum (used as an antidote
to arsenic); Ferri phosphas ; Ferri pyrophosphas ; Ferri sulphas ; Ferri
sulphas exsiccata ; Liquor ferri subsulphatis (MonseVs styptic) ; Liquor
ferri tersulphatis (used in preparations); Pilulce/ ferri con/posifce : myrrh
36 gr., carbonate of sodium, sulphate of iron, each 18 gr., syrup sufficient:
make 24 pills; Ferri sulphuretum.]

' The tincture of perchloride often becomes turbid, which is due to it not contain-
ing sufficient chlorine, part of this gas being driven off by the long process of evap-
oration which is required in order to drive off nitric acid; the quantity of aci.l
ordered in B.P. is 25 per cent, over the quantity required by chemical calculation,
and Schacht finds that by using less (20 per cent, less) he obtains a preparation having
less hyponitrons ether, and which keeps better (Pharmaceutical Journal, September,
1872). The U. S. Pharmacopoeia specially provides for the development of muriatic
ether in the tincture.



MERC UK Y. 181

7?he non-officinal preparations are very numerous, and include the
following:

Preparations of Tisy (French): these are all proto-salts, and are sent
out in capsules as of Fer iodure, etc.; analysis shows the quantity con-
tained in each capsule to be very small, and not constant (Practitioner,
vol. vii.).

Preparations of Creuse (American): these are double salts, such as a
phosphate with ammonio-citrate non-astringent: he has also a tasteless
iodide and chloride (Pharmaceutical Journal, May, 1873, and February,
1874).

Preparations of JRobiquet (French): these are double salts, as a citro-
ammoniacal phosphate; they are not definite in composition. Prepara-
tion of Bechamp (French): this is a peroxychloride, obtained by treating
neutral perchloride with a varying quantity of peroxide; it is tasteless,
not caustic or irritant, but haemostatic (Medical Record, 1874, p. 795).
The preparations of Lebarqui, JBravais, /Squire, Chateaud, and Man-
yhan are different forms of oxide " dialysed," " soluble," colloid. Van
den Corpuffs preparation is a double citrate of iron and magnesia (Bel-
gian): that of Saquet is a pyrophosphate with soda, ammonia, and malt
extract. Lightfoofs solution is said to be a magnetic phosphate.

Besides these, we have in more common use Bromide of iron : dose,



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