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dried to form scales. They are not well-defined chemical compounds. There
are [nine the Soluble Phosphate, Iron and Potassium Tartrate,] Iron and
Ammonium Citrate, [Iron and Strychnine Citrate, Iron and Ammonium Tar-
trate, the Citrate, Iron and Quinine Citrate, the soluble Iron and Quinine
Citrate, the soluble Pyrophosphate.

22. FERRI PHOSPHAS SOLUBILIS. Soluble Ferric Phosphate.
It consists of Ferric Phosphate, with some Oxides.

SOURCE. Dissolve Ferric Citrate, 50 ; in distilled water, 100 ; add
Sodium Phosphate, 55. Evaporate and dry on glass.

CHARACTERS. Thin, bright green, transparent scales, having an acidu-
lous, slightly saline taste. Solubility. Freely and completely in water.

Dose, i to 5 gr. ; .06 to .30 gm.

Preparation.

Syrupus Ferri, Quininae et Strychnin* Phosphatum. Syrup
of the Phosphates of Iron, Quinine and Strychnine. Synonyms.
Easton's Syrup. Syrupus Trium Phosphatum. Dissolve Soluble Ferric
Phosphate, 20 ; in water, 50 ; and add Phosphoric Acid, 48 ; Quinine
Sulphate, 30 ; and Strychnine, T 2 ff ; with Syrup, Glycerin and distilled
water, to 1000.

Dose, Yz to i fl. dr. ; 2. to 4. c.c.

23. FERRI ET POTASSII TARTRAS. Iron and Potassium Tar-
trate. Synonyms. Potassio-Ferric Tartrate. Tartarated Iron.

SOURCE. Add solution of Ferric Sulphate, 100 ; in water, 1300 ; to Am-
monia Water, 1 10 ; with water, 250 ; filter, add water, 1 500 ; heat with Po-
tassium Bitartrate, 38 ; and filter. Dry the precipitate on glass.

CHARACTERS. Thin, transparent, garnet-red to reddish-brown scales,
having a sweetish, slightly ferruginous taste. Solubility. Very soluble in
water, insoluble in Alcohol.

IMPURITIES. Ammonia and Ferrous Salts.

Dose, 5 to 15 gr. ; .30 to i.oo gm.]

24. FERRI ET AMMONII CITRAS. [Iron and Ammonium Ci-
trate. Synonym. Ammonio- Ferric Citrate.

SOURCE. From evaporation of a solution of Ferric Citrate, loo ; with
Ammonia Water, 40 ; to consistency of syrup. Dry the precipitate on glass.

CHARACTERS. Thin, transparent, garnet-red scales, having a saline,



THE SALTS OF IRON. 195

mildly ferruginous taste, deliquescent. Solubility. Very soluble in water;
insoluble in Alcohol.]

IMPURITIES. Tartrates and alkaline salts.

Dose, i to 5 gr. ; [.06 to .30 gm.]

Preparation,

[ Vinum Ferri Citratis. Wine of Ferric Citrate. Iron and Am-
monium Citrate, 40 ; Tincture of Sweet Orange Peel, 150 ; Syrup, 100 ;
White Wine, to 1000.

Dose, i to 2 fl. dr. ; 4. to 8. c.c.

25. FERRI ET STRYCHNINE CITRAS. Iron and Strychnine

Citrate.

SOURCE. Dissolve Iron and Ammonia Citrate, 98 ; in distilled water,
100 ; and Strychnine, I ; Citric Acid, I ; in distilled water, 20. Mix the solu-
tion, evaporate to the consistency of syrup and spread on plates of glass.

CHARACTERS. Thin, transparent, garnet-red, to yellowish-brown scales,
having a bitter, slightly ferruginous taste. Solubility. Completely in water.

Dose, i to 3 gr. ; .06 to .20 gm.

26. FERRI ET AMMONII TARTRAS. Iron and Ammonium
Tartrate. Synonym. Ammonio-Ferric Tartrate.

SOURCE. Add solution of Ferric Sulphate, 100 ; to Ammonia Water,
no ; diluted with cold water, 250; filter, dissolve the precipitate in Tartaric
Acid, 29, dissolved in distilled water ; filter and evaporate to a syrupy con-
sistence and dry on glass.

CHARACTERS. Thin, transparent scales, from garnet-red to reddish-
brown, having a sweetish, slightly ferruginous taste. Solubility. Very solu-
ble in water ; insoluble in Alcohol.

Dose, 5 to 15 gr. ; .30 to i.oo gm.

27. FERRI CITRAS. Ferric Citrate.

SOURCE. By evaporation of the Solution of Ferric Citrate to a syrupy
consistency and drying on glass.

CHARACTERS. Thin, transparent, garnet-red scales, odorless, having a
slightly ferruginous taste and an acid reaction. Solubility. Completely in
water ; insoluble in Alcohol.

Dose, i to 5 gr. ; .06 to .30 gm.]

28. FERRI ET QUININE CITRAS. [Iron and Quinine Ci-
trate.

SOURCE. Dissolve Ferric Citrate, 85 ; in distilled water, 160 ; dissolve
Quinine, 12 ; and Citrate Acid, 3 ; in distilled water, 20 ; mix these solutions,
evaporate to a syrupy consistency and dry on glass.



196 INORGANIC MATERIA MEDICA.

CHARACTERS. Thin, transparent, reddish-brown scales of a bitter, mildly
ferruginous taste. Solubility. Slowly but completely in water. Contains at
least 11.5 per cent, of dried Quinine.]

IMPURITIES. Alkaline Salts and other alkaloids instead of quinine.

Dose, 2 to 10 gr. ; [.12 to .60 gm.

29. FERRI ET QUININE CITRAS SOLUBILIS. Soluble
Iron and Quinine Citrate.

SOURCE. Dissolve Ferric Citrate, 85 ; in distilled water, 160; by heat-
ing ; add Quinine, 12 ; Citric Acid, 3 ; previously triturated in distilled water,
20 ; mix these solutions and stir with Ammonia Water, 50 ; evaporate to a
syrupy consistency and dry on glass.

CHARACTERS. Thin, transparent scales, of a greenish, golden-yellow
color, having a bitter, mildly ferruginous taste ; deliquescent.

Dose, 2 to 10 gr. ; .12 to .60 gm.

Preparation,

Vinum Ferri Amarum. Bitter Wine of Iron. Soluble Iron and
Quinine Citrate, 50 ; Tincture of Sweet Orange Peel, 1 50 ; Syrup, 300 ;
White Wine to 1000.

Dose, i to 4 fl. dr. ; 4. to 15. c.c.

30. FERRI PYROPHOSPHAS SOLUBILIS. Soluble Ferric
Pyrophosphate.

SOURCE. By solution of Ferric Citrate, 50; Sodium Pyrophosphate, 50;
in distilled water, 100 ; evaporation and drying on glass.

CHARACTERS. Thin, apple-green, transparent scales, odorless, having an
acidulous, slightly saline taste, and a slightly acid reaction. Solubility.
Freely in water ; insoluble in Alcohol.

Dose, i to 5 gr. ; .06 to .30 gm.]

31. FERRI ARSENAS. [B. P. Not official.] Iron Arsenate.
[3Fe(FeO)AsO 4 +i6H 2 O=lo86.74.] It consists of both ferrous and ferric
arsenates, with some oxide.

SOURCE. Mix hot solutions of Sodium Arsenate and Iron Sulphate, add
Sodium Bicarbonate to neutralize the free Sulphuric Acid that is formed when
Iron Arsenate is precipitated.

CHARACTERS. A greenish, amorphous powder, insoluble in water.

I MPUR ITI ES. Sulphates.

Dose, ^y to y z gr. ; [.004 to .03 gm.] as a pill.

32. [FERRUM DIALYSATUM. Dialyzed Iron. (Not official.)
SOURCE. By heating a solution of Ferric Chloride with Ammonia, Ferric

Hydrate being precipitated, this being redissolved by agitation, is placed in a



THE SALTS OF IRON. 1 97

dialyzer and suspended in water, which is renewed so long as it shows a trace
of Hydrochloric Acid.

COMPOSITION. Its composition varies from Fe-jClg, laFe-jOj to Fe-jClg,
95Fe. 2 O 3 , and is a 10 per cent, solution of Ferric Oxychloride in water.

CHARACTERS. A reddish-brown liquid, free from astringent, styptic taste.

Dose, 10 to 30 m. ; .60 to 2.00 c.c.]

INCOMPATIBLES OF IRON SALTS IN GENERAL. All substances containing
tannic or gallic acid form an intense black with ferric salts. Preparations of
iron are therefore incompatible with all vegetable astringent solutions, and the
only infusions with which they can be prescribed are infusions of quassia and
of calumba. It is a common mistake to forget that because of its tannin, the
tincture as well as the infusion of digitalis makes an inky mixture with iron
preparations. Such a mixture may be clarified with a little diluted phosphoric
acid, but after a few days a slight precipitate of ferric phosphate falls. Ferric
salts render mucilage of acacia gelatinous.

Alkalies and their carbonates, lime water, calcium carbonate, magnesia and
[magnesium] carbonate give green precipitates with ferrous, and brown with
ferric salts.

ACTION OF IRON AND ITS SALTS.

External: Solutions of iron salts are antiseptic. They have
no action on the unbroken skin, but when applied locally to the
abraded skin, sores, ulcers, and mucous membranes, the [ferric]
salts are powerful astringents, because they coagulate
albuminous fluids, both those discharged from the surface and
also those in the tissue itself. There is no direct effect on the
walls of the vessels, but the contraction of the coagulated albu-
min compresses them and diminishes their calibre. Partly for
this reason, but still more because these iron salts quickly cause
the coagulation of blood, and the clot thus formed plugs the
bleeding vessels, they are the most perfect local haemostatics
we possess, and will often arrest very severe haemorrhage.
[Ferric] chloride, the nitrate, and sulphate are all very strongly
astringent ; but the scale preparations, reduced iron, the carbon-
ate, iodide, phosphate and acetate are so very feebly astringent
that they are never used as local applications ; in fact, to most
persons they are non-astringent. Ferric oxides have the prop-
erty of converting oxygen into ozone, and are therefore disin-
fectant.

Internal. Mouth. Preparations of iron have a styptic



198 INORGANIC MATERIA MEDICA.

taste, the teeth and tongue may be blackened when they are
taken, owing to the formation of ferrous sulphide, the sulphur
being derived from the food and the tartar on the teeth ; hence
it is advisable to take iron preparations through a glass tube [and
immediately afterwards to brush the teeth. The free acid in the
tincture of ferric chloride will destroy the enamel of the teeth,
even if diluted with eight parts of water.] The astringent pre-
parations have, when locally applied, the same action on the
mucous membrane of the mouth as on the raw skin.

Stomach. Whatever form of iron is given by the mouth, it is
converted in the stomach into ferric chloride, with probably a
little ferrous chloride. Long experience has shown that ferric
chloride is to the physician a most valuable preparation of iron ;
probably this is because it will not abstract hydrochloric acid
from the gastric juice, as is the case with all other preparations
of iron. It is often stated that an iron albuminate is formed in
the stomach ; this is incorrect, and when the iron albuminate is
given by the mouth it will be converted into a chloride in the
stomach. Although whatever form of iron is administered ferric
chloride is formed in the stomach, the choice of the preparation
is a matter of great importance, for if strongly acid salts are
given, the acid set free after the formation of the chloride will
act as a caustic, and damage the mucous membrane ; even the
preparations of the chloride may do this, for they [always] con-
tain a considerable amount of free acid. These facts explain
why iron preparations, especially the acid ones, so often cause
headache, nausea, loss of appetite, and other symptoms of severe
indigestion. We also learn why experience has taught that the
sulphate, which is so often used, should be given in the form of a
pill, for this, if specially coated, is not dissolved till the intestine
is reached, and the acid is harmless in the alkaline solutions of
that part of the alimentary canal. Further, we see why the pre-
parations which are either not acid at all or only very slightly
acid, such as reduced iron, dialyzed iron, [not official], ferrous
carbonate and the scale preparations, do not as a rule cause in-
digestion [but it can also be said that they are generally not so
efficient as the stronger preparations. However, this free acid



THE SALTS OF IRON. 199

may be neutralized by the addition of sodium bicarbonate, so
that the tincture of ferric chloride will be acid only so far as the
basic ferric chloride has an acid reaction ; nor does this neutral-
ization impair its therapeutic properties, for hydrochloric acid is
added to it in the stomach. An effective preparation is now
made, in which these disadvantages of the tincture of ferric
chloride are removed, which is known as Weld's syrup of ferric
chloride.] Ferric chloride is very astringent, hence the astrin-
gent effect on the stomach of iron salts. The non-astringent
preparations can only be astringent in proportion to the amount
of ferric chloride formed from the gastric juice ; but if large
quantities of astringent preparations are given, the excess which
is not decomposed by the gastric juice will add its astringency
to that of the ferric chloride formed in the stomach.

Intestines. On passing into the intestines, the contents of
which are alkaline from sodium carbonate, ferric chloride be-
comes ferric oxide, which remains in solution owing to the pres-
ence of organic substances ; ferrous chloride is converted into
ferrous carbonate, which is also soluble. Lower down in the
intestine, by the action of the sulphur compounds, the nascent
hydrogen, and other readily oxidizable products of decomposi-
tion there present, these iron compounds are converted into fer-
rous sulphide and tannate (the tannic acid being derived from
the vegetables in the food), and as such are eliminated with the
faeces, which are turned black. Large amounts of the astringent
preparations have a constipating effect ; this may be owing
to there being an excess of them, for the oxides and carbonates
are non-astringent preparations.

Absorption. Iron is certainly taken up from the alimentary
canal, for the growing child gets from its food all the iron neces-
sary for its increase in weight, but as the total amount of iron in
the adult body is only about 38 grains [2.46 gm.], it is probably
absorbed very s'owly in very minute amounts, and as iron in
food exists as organic compounds, there is no doubt about the
absorption of organic iron.

Whether, however, inorganic iron salts can be absorbed has
been much discussed. The prevailing opinion, founded chiefly on



2OO INORGANIC MATERIA MEDICA.

histological evidence, now is that they can be taken up by the intes-
tinal epithelium and passed into the leucocytes of the blood in mi-
nute particles. A little of this iron is deposited in the spleen, but
more goes to the liver, where it is built up into complex bodies
one of which is called haematin which are the precursors of
haemoglobin ; where in the body this is finally made is not known,
but the red marrow utilizes it to make red blood -corpuscles.

The other opinion is that inorganic iron salts are not absorbed.
The chief reason for this view is that the giving of such salts by
the mouth does not lead to more iron in the urine ; but we now
know that this is because in such a case the excess of iron taken
up is excreted into the intestine as an organic compound, and as it
has been shown that under all circumstances the bile contains the
merest traces of iron this excretion must take place by the intes-
tinal mucous membrane.

Blood. It is often stated that the administration of iron
causes, in healthy subjects, an increase in the number of red
blood-corpuscles, but this is very doubtful. Probably in health
it has little or no effect on the blood.

Iron salts injected into animals subcutaneously or directly into
the veins cause gastro-intestinal irritation and paralysis from de-
pression of the central nervous system. Part of the iron is
stored up, but much is excreted by the gastro-intestinal mucous
membrane.

In certain forms of anaemia (a condition in which the amount
of haemoglobin and the number of corpuscles are diminished),
especially chlorosis, the administration of iron rapidly improves
the blood in both respects. It is therefore said to be haema-
tinic ; and as an improvement in the quality of the blood leads
to an improvement in the functions of all the organs of the body,
iron is also called a tonic. Tonics are drugs which indirectly
improve the action of the several organs of the body ; usually
they act by improving the quality of blood or by aiding diges-
tion, and thus rendering the digestion and absorption of the food
more easy {see p. 115). If, as already stated, inorganic iron is
directly taken up by the intestinal epithelium and passed to the
leucocytes, the benefit in anaemia is easy to understand. But



THE SALTS OF IRON. 2OI

we have seen that some believe that inorganic iron is not ab-
sorbed, and if this be so, it is at first sight difficult to understand
how it can benefit anaemia. As the organic iron in food must
be absorbed we may conclude that it is in some way or other
protected from decomposition in the alimentary canal, if we be-
lieve that the inorganic compounds which would result if they
were decomposed are incapable of absorption. Bunge's hypoth-
esis is, that in some forms of anaemia, especially chlorosis, organic
salts of iron taken in the food are in some way split up in the
intestines so as to be incapable of absorption. In those anaemic
conditions which can be benefited by iron the administration of
the inorganic salts prevents the decomposition of the organic
salts in the food by fixing the decomposing agents, which, ac-
cording to Bunge, are chiefly alkaline sulphides and forming iron
sulphide. This, he says, is supported by the fact that to cure
chlorosis rapidly, enormous doses of iron are often found to be
necessary ; for example, a patient will take 6 gr. [.4ogm.] of re-
duced iron three times a day, or 18 gr. [1.20 gm.] a day. Now,
the whole amount of iron in the blood of an ordinary healthy
woman is about 38 gr. [2.46 gm.], for there is only one atom of
iron in a molecule of haemoglobin, which contains considerably
over 2000 atoms. Supposing she had lost half her haemoglobin,
if the iron given were simply absorbed, one day's treatment
would speedily restore her health, but it is well known that weeks
are often required. But if this view were correct we should ex-
pect that bismuth, manganese, or arsenic, by fixing the decom-
posing agents, would cure chlorosis as efficiently as iron. It has
been stated that they will, but Stockman has published results
that point in a contrary direction, and he has shown that iron
sulphide will cure chlorosis, although on Bunge's hypothesis, it
should not ; for it will not fix the decomposing agents if they
are alkaline sulphides. Further, many think that it is not nec-
essary to give large doses of iron to cure chlorosis. Iron injected
subcutaneously cures chlorosis, but this does not [point] in one
direction more than another, for it may be excreted into the in-
testine, and there fix the alkaline sulphides. On the whole, the
evidence seems against Bunge's view.



2O2 INORGANIC MATERIA MEDICA.

Remote effects. As iron in anaemic subjects increases the
amount of haemoglobin, more oxygen is carried to the tissues,
and thus the whole body shares in the benefit of a course of iron,
which has also been thought to have a direct effect on the
kidneys as a mild diuretic, and a direct effect in promoting the
menstrual flow. These actions are, however, slight, and may be
due to the general improvement in health. Iron salts have been
given to produce abortion, but without any result. Remote
astringent effects have been attributed to them, but there is no
satisfactory proof that they have any ; and, indeed, when we
remember that very little if any iron is absorbed in an astringent
form, and it cannot exist in the blood in such a form, we should
hardly expect that iron salts could be remotely haemostatic or
astringent. Iron is chiefly stored in the spleen, lymphatic
glands, liver and marrow ; possibly it is by stimulating the ac-
tivity of this that iron cures chlorosis.

Excretion. One milligramme [ g ' ? gr.] of iron is eliminated
daily in the urine, and this remains constant under all circum-
stances. Any excess of elimination following subcutaneous in-
jection, or excessive absorption from the intestine, takes place
through the intestinal mucous membrane.

THERAPEUTICS OF IRON AND ITS SALTS.

External. Solutions of the sulphate, chloride, nitrate and
Liquor Ferri Subsulphatis (Monsel's solution), are the most
valuable local astringents we have. It matters very little which
of these is used. In England the solution of the chloride is
perhaps oftenest employed. Either is of service in many cases
for example, to stop haemorrhage from leech-bites, from the nose,
from piles, or from the uterus, as in the haemorrhage of malig-
nant disease. A convenient way to apply them is on lint or
cotton soaked in the solution, and a cavity such as the nose or
uterus may be plugged with the lint. [These preparations form
very disagreeable clots, which readily decompose and give rise
to septic infection.] The aqueous solution of the chloride has
been used as a spray for haemoptysis, but as it may excite cough-
ing, it is not to be recommended. It is very useful as an astrin-



THE SALTS OF IRON. 2O$

gent for painting on the fauces, pharynx or tonsils in inflamMa-
tion of these parts. It may, for this purpose, be diluted with
an equal quantity of water, or a solution of i part of [ferric]
chloride in 4 of glycerin may be used. It has been advised to
paint erysipelatous skin with the tincture of [ferric] chloride. A
solution of the sulphate (i to 480) has been used in gleet.

Internal. Gastro-intestinal tract. The astringent prepara-
tions may be swallowed in cases of severe bleeding from the
stomach, such as that of malignant disease, ulcer or cirrhosis.
If the bleeding is profuse, a drachm [4. c.c.] of Liquor Ferri
Chloridi with a drachm [4. c.c.] of glycerin, to facilitate swal-
lowing, may be given every hour or oftener, and this will some-
times apparently save a patient's life. For less serious haemor-
rhage smaller quantities will suffice. Intestinal haemorrhage
may also be treated in the same way.

The tendency of [ferric] salts to constipate is usually over-
come by the addition of some purgative ; thus, magnesium sul-
phate is commonly given with the chloride, and aloes is often
prescribed with [ferrous] sulphate in a pill. [This method, how-
ever, interferes with the time during which iron remains in the
intestines, and it is better to administer the laxative separately,
so that the dose can be regulated according to circumstances.]
The ferric salts have been given for diarrhoea, but there are many
drugs more suitable for this symptom. Chronic constipation is
often very effectually treated by a pill of [ferrous] sulphate and
extract of nux vomica, but probably the efficient purgative in it
is the nux vomica, although some claim that large doses of
[ferrous] sulphate will overcome chronic constipation. [At
least] the constipating effect of the ferric salts is often much ex-
aggerated.

A rectal injection of a fluid drachm [4. c.c.] of the tincture
of ferric chloride to half a pint of water [240. c.c.] kills thread-
worms [the patient being in the knee-chest position].

Arsenical poisoning is best treated by the humid ferric oxide,
which should be freshly prepared by mixing together 3 fl. oz.
[90. c.c.] of Liquor Ferri Tersulphatis with i oz. [30. gm.] of
sodium carbonate diluted with water. Half an ounce [15. c.c.]



2O4 INORGANIC MATERIA MEDICA.

should be given every five or ten minutes. An insoluble arsenite
is formed, and may be gotten rid of by a thoroughly purgative
dose of magnesium sulphate or some other simple purge. A dose
of common salt or of sodium bicarbonate, followed by i fl. oz.
[30. c.c.] of dialyzed iron, [useless as an iron preparation], di-
luted with water, is also efficient in poisoning by arsenic. [A
better method of using iron for this purpose is given on p. 193.]
Blood. The great use of iron salts is to restore the amount of
haemogloblin and the number of red corpuscles in anaemia, espe-
cially chlorosis. They are useless in pernicious anaemia, and
generally of little value, if any, in the anaemia of leucocythaemia,
exophthalmic goitre, or Hodgkin's disease. All other common
forms of anaemia are secondary to some definite cause, such as
haemorrhage, lead poisoning, scurvy, etc., and are treated by the
removal, if possible, of the cause of the anaemia, but recovery
may be aided by the administration of iron. [Ferric] chloride
and [ferrous] sulphate are two of the most efficacious preparations,
and pills containing a grain [.06 gm.] of the dried sulphate, with
aloes or nux vomica, if constipation is present, are very valuable.
It is usual to begin with one pill containing one grain [.06 gm.]
of the dried [ferrous] sulphate thrice a day, but gradually the
number of pills may be increased till three or four are taken at a
dose. This method of large doses of the sulphate often appears
to cure more rapidly than smaller doses. If these astringent pre-
parations cause indigestion, any of the milder preparations may
be substituted. The carbonate may be given in pills in rapidly
increasing doses, or the dose of reduced iron, conveniently given
on bread and butter, may be pushed. Mistura Ferri Composita
[Griffith's Mixture] is a disagreeable preparation to take and to
look at, and the inky character of the aromatic mixture makes it
undesirable. The styptic taste of some of the preparations, espe-



Online LibraryWilliam Hale-WhiteMateria medica, pharmacy, pharmacology and therapeutics → online text (page 17 of 67)