There is, notwithstanding the conflict ing theories, no reasonable doubt that a part, at least, of the beneficial effect of iron in anwmia is due to its local action upon the digestive organs and especially the stomach.
In eases in which the gastric contents are already too acid during digestion iron accentuates the hyperacidity of the gastric juice and aggravates thc dyspep tic symptoms which are usually present in anremia and chlorosis. In these cases the digestive affection must bc set right before iron is administered. In eases, boa ever, in which the secretion of HO is normal or diminished, iron may often do good service in stimulating the gastric mucous membrane to secretion. Buz dygan (Wien. klin. Wadi., No. 3], '97).
l'h, re art n‘o indications in the treat ii.( f ammina: to furnish needed ma tt nal to flit. blood and to increase Fi n...I.\ ri,;inilation of food. 'rile first in dication is int t mith small doses (1 or zrains) of reduced iron or of the car bonate: as it has been estimatNl that the t. tal amount of iron contained in the normal human blood of an adult is only al out 39 grains, a larg,c amount cannot I.e taken up and assimilated by that fluid. Clinical experience bas shown that the second indication is best met by the ex hibition of the astringent preparations, as the sulphate and chloride, and of these we find that large doses act more cer tainly and quickly in many cases of ammnia. especially when the tongue is broad. flabby, white (from pallor), and indented on the sides by contact with the teeth. The sulphate is one of the best preparations to increase the appetite and improve the digestion, unless the stom ach proves intolerant. When feeble di gestion is combined with sluggish in testinal action the addition of aloes as in the pil. aloe et ferri is recommended. Squire's "mist. ferri laxans" also contains a laxative tending to antagonize these untoward conditions:— 1), Iron sulphate. '2 grains.
Magnesia sulphate, 1 drachm. Dilute sulphuric acid, 3 rninirns. Spirit of chloroform, 20 minims. Peppermint - water, to make ounce.—M.
Syrup of the chloride of iron, in its therapeutic properties and value, is iden tical with the tincture; but as a restora tive agent it is- more easily assimilated, and more likely to be tolerated, by the mucous membrane of weak stomachs than the old form of the chloride, while it is less harmful under prolonged use. G. W. Weld (Ther. Gaz., '92).
If the tongue is heavily coated, the breath offensive, and the bowels consti paled, the administration of iron should he preceded by a purge. some cases,
however, even though there be no sign of dirvstive disorder, the stomach will not tolerate any bid the blandest prepara tions. suet; as the lactate or the potassio tartrate. whiell are t he least constipa of the varions preparations of iron. When well borne, one of the best preparations of iron is the sulphate. It is generally administered in pill form, with equal parts of potassium car bonate. Such a pill is _Maud's. In the ancemia dependent upon malarial poison ing iron may be advantag,eously com bined with quinine or arsenic. The cit rate of iron and quinine, or the arsenate of iron—the latter in doses of '/4„ grain, three or four times daily; the former in doses of 2 to grains, thrice daily—may be employed. In the am-emia which is so common an attendant of syphilis an excellent combination is the tincture of the chloride of iron and corrosive subli mate, as in theJollowing prescription:— Tinet. ferri ehloridi, 1/, ounce. Hydrarg. chloridi corros., 1 grain. Glycerime, 1/2 ounce.
Aqua., 3 ounces.
M. Sig.: One teaspoonful in water, thrice daily, after meals. In the amemia of heart disease iron may be combined with digitalis. The two drugs may be given iu pill form, in which eas.e the powdered digitalis should be employed; or the tincture of the chloride of iron and the tincture of digitalis may be combined. F. P. Henry (Mcd. and Slug. Reporter, Apr. 24, '97).
The indiscriminate use of iron as a tonic without attention to the particu lar indication results in many unsatis factory effects which are charged to the account of iron. As a luematinic it must be recognized as a superior rem edy, but it must be given in small doses, so that the degree of irritation shall not exceed that of gentle stimulation. When impaired nutrition is the domi nant factor, it may be used in nearly all cases. The addition of nuelein from ahimal sources is recommended in acute a.s well as in chronic cases of dyscrasia, thus favoring cell activity. This is espe eially valuable in cases of catarrh of the mucous membrane, and stress is also laid upon the use of the arsenate in these cases on account of the influ ence which arsenic has upon systemic metabolism. Attention is called to the exceptional value of iron in combination with zinc as a protoplasmic stimulant. J. AuIde (St. Louis Courier of Med., vol. xxvi, p. 224, 1902).