Prophylaxis commands a wide and grateful field in the prevention of chlorosis, because under proper care vicious tendencies undergo an improvement in the growing organism. The principal considerations are care for sufficient and correct nutrition, the correct distribution of work and recreation, sufficient stay in the open air, and abundant sleep. Further directions on this subject are given on page 1:37. It should be emphasized, however, again and again that the growing body should not be compressed into a narrow corset.
therapy is of special importance when fairly marked blood changes have been demonstrated. The iron therapy, inaugurated in Germany, by von Niemeyer, has retained its advocates in spite of Bunge's adverse criticism.
Now, how does the iron take effect? The fact that even chlorotic patients obtain sufficient iron in the ordinary mixed diet is certain, be cause the organism contains 3 Gm. of iron, the feces contain 0.007-0•00S Gm., and Hoffmann estimated the daily total loss of iron at 0.06 Gm.; and this figure may still be too high. It follows that the cells of chlorotic patients do not assimilate sufficient quantities of the iron contained in the articles of nutrition in the shape of nucleo-albumin. What then is the effect of the inorganic iron? Formerly it was thought that it was not absorbed, from which originates the theory that it protects the organic iron from decomposition by combination with and that it exer cises a tonic effect upon the stomach. But the ferric nucleo-albumin of the food by no means undergoes ready decomposition, and, besides, iron introduced subcutaneously was supposed to have a beneficial effect. Recently the fact has been established (Muller) that also the organic iron compounds in medicinal closes can be absorbed and intro duced into the organism by way of the general circulation. Indeed they served to increase the amount of iron in experiments on animals which had been deferrated by food containing but little iron; it was even an improvement on the iron contained in ordinary food. It is said that an increase of the nucleated red blood corpuscles in the bone marrow was demonstrated, which was regarded as showing an irritant effect upon the bone marrow. On the other hand, to supply with iron, cells which did not possess sufficient iron for constructive purposes is an entirely different matter from giving an additional iron salt to chlorotic persons whose bone marrow cannot assimilate a naturally sufficient. quantity.
At any rate, the iron therapy has obtained a secure foundation through the recent experiments, and it is probable that the irritant effect of the iron upon the blood forming vessels, which had been assumed in theory to exist by Harnack and von Noorden, exists in fact. Possibly also the "fattening with iron" acts as an irritant..
What kind of iron preparation should be administered? There are two kinds to be considered: (1) those which arc changed into oxide salts by acids, inducing gastric hydrochloric acid, and into this category belong metallic iron, oxide salts, protoxide salts and ferric albuninates or peptonates; (2) compositions more highly constituted and more difficult to disintegrate.
Formerly it was said that the organic preparations are better ab sorbed and the building up of haemoglobin in the organism is facilitated. The investigations above referred to, however, are in favor of inorganic or rather such iron preparations as are decomposable in the intestine. Grawitz reports having observed granular degeneration of the red blood corpuscles after the introduction of blood preparations.
Apprehensions as to the consequences of the iron therapy; black ening of the teeth, heaviness in the stomach and other gastric and intes tinal disturbances, do not seem justified when sufficient caution is used. All iron preparations are to be taken on a full stomach with the excep tion of chalybeate waters which will be dealt with later; chalybeates and iron tinctures are administered through a glass tube and the mouth should be frequently cleansed and rinsed during the iron treatment on account of the iron deposit within the mouth. Should the feces assume a very black color, Henoch recommends to diminish the dose. Fats and acids, however, need not inspire apprehension. The treatment should last from 4 to 6 or S weeks, commencing and ending gradually; if necessary, the treatment is to be repeated after four weeks. As a rule, the daily dose for the adult is 0.1 Gm. (1 . grains) metallic iron in the preparations ; chil dren receive less in proportion. Character, percentage of iron and dose arc shown in the following table according to Quincke and von Noorden: Inorganic Iron Preparations and Simple Ferro-Albumin Compositions.