In acute anremias following gastric, intestinal or duodenal ulcers, epistaxis, &c., to prevent recurrence, the patient should be put upon Calcium Chloride or Lactate.
In the treatment of all secondary hemorrhages an obvious principle is to search out and correct the primary factor causing the drain on the blood, after which the management should follow such general lines as— absolute rest, the administration of highly nutritious liquid foods at short intervals, and a most liberal supply of pure and fresh air. Necessary modifications in feeding are obvious when the anmmia arises from hwma temesis, when rectal feeding will be required. Defibrinated human blood administered hypodermically has been recommended by Ziemssen, and ox blood may be given by the rectum.
Iron is to be given freely in all cases, its best effects being seen in the later stages after acute hremorrhages. Notwithstanding the trumpeting of the host of new organic iron compounds, the older inorganic prepara tions continue to hold their place. When it is necessary to saturate the blood rapidly with iron in all cases of acute anxinia due to hxmorrhage, the best preparation is the B.P. Tincture, the only exception being when the bleeding has been caused by gastric erosion.
As a simple chalybeate for this purpose the following is suitable: R . Tinct. Ferri Perchlor. 3v.
Calrii Chloridi 3iv.
Syrupi Simplicis 5iss.
Aqua Chlorof. ad Sxij. Misce.
Fiat mistura. Cpt. Sss. ex Sii. a,uce ter die p.c.
In less acute cases where the tongue is coated it will be advisable to administer one or more saline purges, and substitute for the above, Tr. Ferri Perchlor., 3v.; Quininx Hydrochlor., gr. xl.; Glycerin., Sj.; Aquae ad 3j. ter die p.c. ex Sij. aquae, or the Citrate of Iron and Quinine may be given in 5-gr. doses in combination with 15 mins. of Tincture of Nux Vomica in r oz. water.
In all chronic antemias, for saturating the blood with iron during prolonged periods there is no preparation more suitable than Bland's Pill, which may be given to the extent of 12 pills in the day, 3 being ad ministered after each meal, and as a rule no constipation follows, and the discoloration of the teeth which is caused by .the liquid preparations is avoided. The system can be also rapidly saturated by iron given in the form of pills containing 5 grs. Reduced Iron, which in gastric troubles may he coated with Keratin, so as to avoid stomach irritation; absorption of the metal takes place in the duodenum, its elimination occurring by the rectal mucosa. Though the daily normal intake of iron does not exceed gr., and the total amount in the body is under grs., the best results can only be obtained by giving much larger doses than can possibly be assimilated.
The importance of oral and intestinal sepsis, overwork in every form, errors in digestion, improper food, impure air, and the action of poisons like lead need not be emphasised further. Intestinal parasites as ankylo stoma produce a profound secondary anemia, and must be destroyed by large doses of Thymol.
Malarial anaemia is intractable, and often fails to be remedied by iron. It is in this form that Arsenic proves so valuable, and it may tu advantage be combined with Iron and Quinine, as in the following pill: Ferri Arsen., gr. -; Quinine Sulph., gr. ij.; Ferri Redact., gr. ij. Misce. St. i. ter die p.c. Arsenic may, in the later stages of most secondary antemias, and even in chlorosis, be advantageously combined with iron, though it cannot be said to possess the same specific action upon the haemoglobin of the blood. The injection of Cacodvlate compounds should be reserved for the perni cious and leukemic types of anaemia.
In bloodlessness associated with neuralgia or nerve troubles the com bination of quinine in large doses with small amounts of iron and arsenic is invaluable, or a teaspoonful of Easton or Fellows' Syrup may be ad ministered thrice daily.
The best routine preparation in the secondary anwmias of childhood is Parrish's Syrup in drachm doses, and where scrofula is present there is no agent so uniformly useful as the B.P. Syrup of Iodide of Iron.
The chronic anaemia of Bright's disease is generally markedly relieved by the administration of the Acetate of Iron, and this can be conveniently prescribed by combining 20 mins. of the Tincture of the Perchloride with each drachm of Mindererus spirit and some glycerin in r oz. water. The anaemia so constantly present in chronic heart affections can be combated by the addition of Reduced Iron to Digitalis in pill form.
When anaemia is associated with obstinate constipation, the Pill of Aloes and Iron may be given in 5-gr. doses night and morning.
Where the irritable stomach objects to any of these preparations, an elegant combination is the Citrate of Iron and Ammonia given in efferves cence with Citric Acid or lemon juice : Ferri et Amnion. C it. 3ij. Acid. Citric. 3iij.
ziuce 3viij. Misce.
St. coch. mag. c. coch. mtg. Mist. Alkalis. ter die post cib. The Alkaline Mixture contains Pot. Bicarb. 3vj., When headache follows the administration of iron,saline purgatives may enable the physician to continue its use, and he may give 5 grs. of the sulphate with 30 grs. of Suiphate of .Magnesia in aerated water with advantage. The treatment of anaemia need not, however, be confined to the official preparations of iron if these do not soon prove satisfactory. The natural iron waters of Buxton, Bath, Altwasser, &c., may be tried with advantage, ur any of the newer organic iron prepara tions may hare a trial.
Glycerophosphates, Cod-Liver Oil, Lactophosphates, Malt Extract, sea bathing, bracing air, and sometimes a short sea voyage and rest from mental work, often work wonders. Massage is also a powerful remedy in improving nutrition and influencing metabolism, and water charged with oxygen has often proved serviceable.
The treatment of chlorusis, though identical with that of all secondary anmmias, will be dealt with under its own heading.