According to Dr. Haig, of London, who has done so much to increase our knowledge of lithmmic conditions, "iron cures anmmia by clearing the blood of uric acid." When iron fails to cure chlorosis, he recommends its suspension and the administration of mercurials and salicylates until the blood is cleared of uric acid, after which improvement may occur, without the resumption of iron.
There has been much discussion con cerning the mod-us operandi of iron in chlorosis. A study of a few cases, per haps even of one, will lead the reflecting physician to the conclusion that the cause of chlorosis is not a deficient sup ply of iron, but something that interferes with its assimilation. Nearly all our food-substances contain iron, and there is probably no drinking-water in which traces of it cannot be found. It is evi dent, therefore, that there is something that interferes with the assimilation of the iron which is abundantly present in the food of chlorotic persons.
TJntil quite recently, no satisfactory explanation could be given of the effi cacy of iron in chlorosis and especially of the necessity of administering it in large doses, for it was known that very little of the drug was absorbed. Nearly all the iron given by the mouth can be recovered in the freces, and, therefore, it would appear that a large portion of the drug is wasted and that equally good results might be obtained by its use in small doses. This, however, is not the case, and, thanks to the investigations of Bunge, we have, at the present time, at least a working-hypothesis on which to base our employment of the metal. In the first place, our food, which contains all the iron we need, does not contain it in inorganic form, but in an exceedingly complex organic combination. Now, in chlorosis, as is so emphatically insisted upon by Sir Andrew Clark, digestive disturbances are exceedingly common. Abnormal fermentations and decompo sitions take place in the gastro-intestinal tract which give rise to the formation of quantities of sulphides. These decom pose the iron contained in the food and completely- unfit it for the purposes of nutrition. By administering an inor ganic preparation of iron we protect the orcranic combinations of that metal in the food, for the sulphur in the intestine combines with. the iron administered, and allows that normally contained in the food to be absorbed. This theory of Bunge also explains why it is sometimes necessary to administer colossal doses of iron, for, in such cases, the decomposi tions in the intestine are usually active, sulphur is formed in large quantity and requires a proportionally large amount of iron to take it up.
It is only proper to add that Bunge's theory has lately been contested by Ralph Stockman, of Edinburgh, who claims to have cured cases of chlorosis with sulphite of iron, and who contends that bismuth, manganese, and other drugs which are just as capable of absorbing sulphuretted hydrogen as is iron, are inert in chlorosis. Stockman, nevertheless, acknowledges that the promptest curative effects are obtained with inorganic preparations of iron.
There has been a great deal of dis cussion concerning the relative merits of organic and inorganic preparations of iron, and there can be little doubt that both are effective. The protoxalate is a favorite preparation of certain emi nent French practitioners, while others claim that the best results are obtained with the sulphate, either alone or com bined with potassium carbonate, as in the well-known pill of Bland. For my own part, I am accustomed to place the most reliance on the inorganic salts of iron, although I have obtained good re sults with both the malate and the lac tate. So far as iron is concerned, the efforts of pharmacists seem, of late, to be directed toward the production of preparations which resemble the organic iron compounds of the food. This seems a misdirection of endeavor, for it is just this iron of the food which is not assim ilated by chlorotics.
All preparations of iron do not act identically. They may be divided into five groups: (1) the ferrocyanides, which have no action; (2) the blood from an organism of the same species. which may be useful during a certain period; (3) hremoglobin in solution, which probably penetrates rapidly into the circulation and is assimilated; (4) the ferruginous salts of vegetable acids, whielt, at least by subcutaneous injection. are taken up by the circulation, and deposited in the liver; (5) insoluble preparations and fer ric-oxide salts, which dissolve in the stomach and later form albuminates and absorbable iron. Bland's pills and acid lactate of iron have seemed to be the most active in chlorosis. A daily dose of 1 to 1 V, grains is sufficient. For hypodermic injection a 5-per-cent. solu tion of ferric citrate may be used, a quantity containing from 1 to 1V, grains being injected daily. Quineke (La Presse MC;(1.. Apr. 10, '95).