Treatment.—As Immermann remarks, "there is scarcely any point in thera peutics so fully established as the markable efficiency of iron in removing all the symptoms of chlorosis"; but it does not follow that iron should initiate the treatment in every case. Nearly all chlorotics are dyspeptic, and until the digestive disorder is relieved the full benefit of iron cannot be obtained. In cases of atonic dyspepsia, the simple bit ters, such as quassia or gentian or citers of the smooth muscular fibres, such as strychnine or brucia, may be administered before meals or, if there is gastric dilatation, naphthol, bismuth salicylate, or chloroform-water may be administered three or four hours after meals, as recommended by le Gendre, in order to arrest the abnormal fermen tations usually present in that condition. Lavage is rarely, if ever, necessary. Hy peracidity of the gastric juice should be treated with full doses of alkalies—soda, chalk-, lime-water, or magnesia—from one to two hours after meals and eidity with full doses of dilute hydro chloric acid immediately after eating.
The dyspeptic disorders so often met with may become yt serious obstacle to active treatment; such ca=es should be looked upon and treated as simple dys pepsins, until the stomaeh be brought into eondition for the treatment of the chlorosis itself. flayem (1,a Sem. Med., Nov. 4, '91).
The first object is to improve the gen eral condition, then exercise in the open air. A. }loessli (Dent. med. Wocb., Sept. 15, '92).
Such mild laxatives as compound lico rice-powder and cream of tartar. The preparation of iron used will depend upon individual conditions. Bland's pill and the tincture of the chloride of iron are preferred. Arsenic ought not to be used alone, but forms a good adjuvant, especially in the form of arsenical waters, like the Roncegno or Levico. Sulphur, so highly lauded, by Schultz, acts prob ably by stimulating the bowels. Noth nagel (Wiener med. Presse, No. 52, '92).
Sulphur bears very intimate relations to cellular protoplasm, and acts in a more important manner in eblorosis than as a mere laxative. It is indicated wlien iron does not seem to act and when there is not gastro-intestinal irritation. After it has been used for a time, iron ma.y again be administered instead, and with better hope of success than before the sulphur was used. Schultz (Berliner klin. Woch., Mar. 28, '92).
Dietetic treatment of chlorosis. This should vary somewhat, according to whether the patient is lean or fat. Lean patients should be given food "copious in quantity and favoring the deposit of adi pose tissue." This includes large quanti ties of butter and such "amylaceotts foods as do not irritate the stomach," and about 3 ounces of meat per diem.
Unnecessary muscular exertion and ex posure to cold should be forbidden, and in some cases absolute rest may have to be enjoined. The fat chlorotics may be allowed as much as 4 ounces of albumin per diem, and, in addition, no more fat and carbohydrates than will cause the nutritive value of the food to exceed 18 calories per pound of body-weight. Carl von Noorden (Inter. Med. Mag., May, '94).
Milk should be used, or, if this is badly borne, pure water or a hot, weak infusion of tea (hot drinks excite the gastric se cretion), eggs, por(..c of vegetables, lea» fish, fowl, and cooked fruits. One-half hour before the meal a small dose of an alkali, as sodium bicarbonate, 73/4 gra ins, should be prescribed for the purpose of exciting the flow of g,astrie juice. At the same interval after it a Madeira glass of hydrochloric acid in solution in water, 1 to 250. The hydrochloric niay be re placed by lactic acid, 1 or 2 grammes (15 or 30 grains) after meals. It is necessary to forbid the use of wines, cinchona wine, strong beers, alcoholic drinks and stimulating food. If there are gaseous formations, lavage, either of pure water or water contaiuing salicylic acid, 1 per 1000, is indicated. After two to four weeks of this treatment the use of the preparations of iron can be begun. Henri Huchard (Revue Ge-ti. de Clin. et de Ther. Jour. des Prat., Jan. 19, '95).
Rest in bed, when sufficiently pro longed, is of the greatest importance, checking the too rapid destruction of the red globules. The choice of food is made subordinate on account of the dyspepsia which yenerally accompanies chlorosis. There is often an hyperpepsia of medium degree and some dilatation. In such eases the food at first should consist of milk and raw meat; later on, of un der-done eggs, tbe easily digested vari eties of fish, purc'e of green vegetables, and stewed fish. No bread is allowed for four or five weeks. In about 20 per cent. of the eases the gastropathie state is more pronounced and needs more care. Sometimes there is intense parenchy matous gastritis, with marked dilata tion ; ag,ain, there may be a gastritis which has caused diminished glandular secretion and an hypopeptic state. In the former case, in addition to restricted diet, massage is to be used, and lavage also, when abnormal fermentation exists. By the use of these measures it is gen erally possible to begin ferruginous treatment in from two to four weeks. In hypopeptic conditions, however, iron (either Bland's pills or the protoxalate) may be used from the first before meals and hydrochloric acid a half-hour after eating. Rayem (Le Bull. :116d., Apr. 21, '95).