The astringent preparations of iron are often exceedingly useful in controlling the loss of albumen by the urine: we must remember, however, that it is also possible to do harm by these remedies in renal diseases, and I have seen congestion increased by recourse to them during the acute stage. The best effect is certainly obtained at the decline of this stage, when the urine is free from blood or inflammatory casts, when pain in the back, and in the head, and the general febrile conditions are relieved, but the patient is pallid, weak, and suffering from more or less anaemia and dropsy; then the value of such preparations as the perchloride or acetate is often very marked, both as regards the general health and the discharge of albumen. Dr. Hassall, indeed, attributes these good effects more to a reconstituent action on the blood, "than to any direct astringent power, because he could not detect either the metal, or the acid combined with it (hydrochloric), in his analysis of the urine" (Lancet, ii., 1864). Dr. Parkes was one of the first to show, by quantitative analysis, the gradual lessening and final cure of the discharge of albumen under the influence of perchloride; this was in a subacute case, when the early inflammation had subsided, and hospital nursing and the use of gallic acid had quite failed to relieve (Medical Times, ii., 1854). In all cases of this kind it is desirable to feel one's way with iron preparations, to begin at first with a small dose; and the recommendation of my late friend Dr. Basham, to combine with it the acetate of ammonia, is a very good one. The addition of ergot will increase the astringent effect (v. Gazette Med. de Lyon, October, 1862), and in albuminuria following scarlatina, especially when dropsy is present, tincture or infusion of digitalis, alternately with tincture of perchloride of iron, is a very valuable prescription: it increases the flow of urine, at the same time that by its action on the blood and the capillaries it restrains the transudation of albumen: Dr. Goodfellow and Dr. Cheadle have reported favorable results with it (Medical Times, 1871; Ranking, i., 1873).

In chronic forms of albuminuria iron will require consideration: it is often extremely useful, improving the blood-condition more than any other remedy, and Dr. Lionel Beale testifies to its good effects even in chronic structural change and fatty degeneration (Medical Times, i., 1865, p. 29), but the cases in which it does harm are those with granular kidney, when the heart is large, the pulse hard and of high tension, and when there is much tendency to headache (Dickinson: Lancet, i., 1876). Hirtz says that he has seen it hasten a fatal termination by uraemia, lessening the amount of urine, and increasing that of urea ("Nouv. Dict.," Art. Fer), so that its effects should always be carefully watched: a very important point when ordering iron in any case of albuminuria is to obviate constipation.