Results of treatment by inhalation of oxygen-gas at half the atmospheric pres sure in three eases of chlorosis in women, all of whom had previously been treated with iron, and one of them witl: arsenic as well. ln one case there were signs of plithisis. Oxygen inhalations were given three times daily with marked improve ment. Iron is not indicated in eases where there is nervous excitement or where digestion is impaired. Such eases do better under arsenic combined with oxygen inhalations diluted with nitro gen. Corish (N. Y. Med. .four., Feb. 13, '97).
Under tile influence of iron adminis tered hypodermically menstruation is re established, and this effect ib dependent upon the general improvement of the organism and the excitant action or hyperaemia induced by the drug. Under the injection of manganese the reappear ance of the menses is more tardy, al though the general health is much im proved. The reappearance of menstrua tion is always followed by an improve ment in the general health and in the blood. Iron and manganese act espe cially as reconstituents. not exclusively upon the hmmoglobin, but also upon the red cells. Arsenic d.oes not materially increase the luemoglobin, but it notably increases the number of red cells. Steffa nelli (Settimana Afed., Nos. 40 ,and 41, '99).
Htemalbumin recommended for the re lief of chlorosis. It is a powder readily soluble in hot water or alcohol, and con tains all the salts and albumins present in the blood. Dose of luemalbumin is 15 grains three times a day. Goliner (Deutsche med.-Zeit.: Med. News, Apr. 15, '90).
Sanguinal recommended very highly in the treatment of ancemia and chloro sis. Sanguinal contains 10 parts of chemically-pure haemoglobin, 46 parts of the normal blood-salts of the human blood, and 44 parts of muscle-albumin. Each pill represents about 75 grains of fresh blood. Victor Reichsberg (Deut sche med.-Zcit., May 21, 1900).
In conclusion, I will describe the method of treatment so strongly advo cated by Sir Andrew Clark. With care ful attention to the diet and a tepid sponge bath, followed by brisk toweling night and morning, he prescribes the following mixture:— 4 Ferri sulphatis, gr. xxiv.
Magnes. sulphatis, 5vj.
Acid. sulph. aromat., 5j.
Tinct. zingib., 5ij.
Infus. gentian comp. vel quassim, M. Sig.: One-sixth part twice daily, about 11 and 6 o'clock.
Occasionally this acid mixture pro duces sickness, dries the skin, and is otherwise ill borne. In such cases he prescribes the following alkaline mixt ure:— 1; Ferri sulphatis, gr. xxiv.
Sodii bicarb., 5ij.
Sodii sulphatis, 3vj.
Tinct. zingib., 3ij.
Spt. chloroformi, 5j.
Infus. quassim, Sig.: One-sixth part twice daily, at 11 and 6 o'clock. Sometimes neither mixture agrees with the patient, in which lie prescribes sulphate of iron in pill with meals and a saline aperient on first waking in the morning. By this plan Clark claims that nine out of ten cases recover in from one to three months, and by careful attention to the bowels, taking twice a week a pill com posed of aloes, myrrh, and iron, the re covery will probably be permanent.
Summary showing the average gain in limmoglobin per week from the use of various agents: Betanaphthol, 2 grains three times daily (antisepsis), 30 cases, 1.85 per cent.; Bland's iron pills, 5 grains three times a day, 31 cases, 5.07 per cent.; cathartics alone, 7 cases, lost 1.50 per cent. Twelve cases treated with Blaud's pills after a course of betanaph thol showed an average weekly increase of 6.70 per cent.; 19 cases treated with Bland's pills without betanaphthol showed an increase of hut 4.50 per cent. Series of 28 cases treated during an aver age period of 4.3 weeks, with 2 grains
of betanaphthol, in tablet form, and 5 grains of Bland's iron pills three times a day. The average gain in Inemoglobin per week was 7.9 per cent., the maxi mum gain being 20 per cent. per week for 2 weeks in one case, 14 per cent. for 3 weeks in another, 13 per cent. for 4 weeks in another, while another patient averaged a gain of 11.4 per cent. per week for 5 weeks. The average amount of limmoglobin possessed by the patients before beginning the treatment was 48 per cent. After 4.3 weeks of treatment it was S2 per cent. Conclusion that the results of combined treatment are con siderably better than those obtained with iron alone, and much better than those obtained with betanaplithol alone. Town send (Boston Med. and Surg. Jour., May 27, '96).
Chlorotic cases can be divided into three classes: Those in which iron is absolutely useless, those in which it is fairly valuable, and those in which it is an absolute necessity. The eases in which it is useless are those which have been deprived of fresh air and sunshine, and only need proper food and out-door life, with stimulant treatment, to regain their health. Those in which it is moder ately valuable are the pseudochlorotics ho have as an underlying cause a tend ency to develop tuberculosis with gen eral debility; but, as a, rule, the more dyspeptic the patient, the less good will iron do. The cases in which the iron is most useful are those in which the patients are devoid of dyspeptic symp toms, when any one of the common iron preparations may be given in large or small doses with advantage. Should there be a syphilitic dyserasia underlying the amemia, mereurials should be admin istered in addition to the iron, preferably the bichloride of mercury. Huchard (Revue de The'r. ISIedico-Chir.; Then Gaz., Sept. 15, '97).
In cases in which there is an accelera tion of the heart-beats recourse has been had to medicaments, diminishing the ap parent action of the heart, such as digi talis. These therapeutic agents have very little success in such cases, their action being only temporary; so that the palpi tations recur; while for some patients digitalis is even hurtful. Dependence should, hence, not be placed upon these agents,but rather upon those acting upon the nervous system,as bromide of sodium, valerian. camphor, etc. (Potain.) The salts of copper are especially valuable in chlorotics with cervical lymphadenitis. Cases without tubercu losis do best under iron or arsenic. But scrofulo-tuberculous cases are most benefited by phosphate of copper. Men dini (Jour. des Praticiens, Apr. 27, 1901).
The practice of Mendini in employing copper salts in chlorosis, amenorrlicea, and cervical lymphadenitis recommended. The acetophosphate is preferred, and in many of the cases under observation for the past twenty-five years marked improvement in the blood condition has resulted. E. Liegeois (Jour. des Prati ciens, vol. xv, p. 225, 1901).
Bone-marrow and ovarian extract have been employed with some success in the treatment of chlorosis, but their value has not, as yet, been sufficiently established to warrant more than an en couragement for further trial.
Ovarian substance tried in several eases. After the first treatment the pa tients complained of pain in the lower abdomen, discomfort, headache, and mus enlar pain. Two had fever and rapid pulse. In three patients the result was good. The general health was improved, the antemia disappeared, the number of blood-corpuscles was increased, and the menses returned. Spillmann and Etienne (Gaz. 'Med. de Paris, No. 35, '96).