This section is from the book "Materia Medica And Therapeutics Inorganic Substances", by Charles D. F. Phillips. Also available from Amazon: Materia medica and therapeutics.
The various preparations of iron form our most dependable remedies in ordinary and simple cases of anaemia and chlorosis, and indeed their good effects are usually so evident that iron was, at one time, considered a panacea for all forms of these affections, but, in reality, if prescribed injudiciously, it may not only fail to cure, but may produce ill-results, and observation of such instances has led some observers to depreciate a remedy which had been considered so universally curative. Thus, Trasbot has recently denied to it any reconstituent or haematinic power, while Dujardin Beaumetz holds the employment of iron in anaemia "une grande illusion therapeutique" (Journal de Therapeutique, 18TG). The former observer states that in experiments on dogs he obtained better haematinic results from lime phosphate, coffee, and wine, than he did from iron, which proved simply exciting; and Dujardin Beaumetz relies upon an argument of C. Bernard's, that even if the normal amount of iron in the blood of chlorotics be diminished, it is only by a very small amount (10 or 20 centigrammes) more than which is introduced daily in the food: but the true answer to such observations is, that all theory, and even all physiological experiment, must stand or fall by the clinical results obtained on man (Mialhe and others in Gazette Hebdom., Mars, 1S7G), and in the majority of cases these are satisfactory. The objections of Trousseau were limited to the use of iron in "false chlorosis" - that is to say, in cases when the suppression of the menses, pallor, etc., were really connected with incipient phthisis, which malady he found to be accelerated by ferruginous medicines ("Traite," vol. i.). His observations have been corroborated by Millet (Bulletin, 1862), but the cases quoted by the latter author illustrate mainly the injudicious domestic use of certain preparations without due examination of the patient, and his remarks apply only to the abuse, not to the medical and proper prescription of the remedy.
By the terms "anaemia"or "aglobulia," we understand a condition in which the red blood-corpuscles are fewer than in normal health; instead of being in the proportion of 130 parts per 1,000 of the blood, they may be at 80 or GO, or even less, and this may arise from direct loss of corpuscles (hemorrhage), or from insufficient formation of new ones on account of disease, or bad air, or unsuitable food, and under such conditions the corpuscles that are formed are small and misshapen. The most marked symptom of anaemia is pallor, which affects the mucous membranes as well as the skin, and may be noted in the conjunctivae, the gums, and the lips; other symptoms are difficulty of breathing, especially on exertion, lassitude, mental and bodily, malaise, restlessness, dyspepsia, constipation, headache, neuralgia, and palpitation: the pupils are commonly dilated. Some varieties of anaemia benefit by iron more than others, and it is not easy to lay down definite rules concerning them. If there be much dyspepsia this should first be treated by other appropriate means; but on the other hand, the simple atonic dyspepsia of anaemic persons is very amenable to iron. Congestive headache is a contra-indication, but the pulsating acute headache which follows profuse hemorrhage really requires iron medication; important points for securing its good effects are, to obviate constipation by aperients if necessary, and to secure sufficient oxygen for the proper assimilation of the remedy, and I think that many failures in the treatment of anaemia are traceable to want of management on these points.
Direct anaemia dependent upon excessive hemorrhage; or the indirect anaemia which follows loss of animal fluids generally (such as in obstinate leucorrhoea, empyema, and purulent formations, seminal losses, profuse perspiration, diarrhoea, prolonged lactation, or too frequent pregnancies); also the anaemia produced by acute disease, such as rheumatism, and that connected with inanition when the albuminous constituents of blood are really most deficient; all these forms, though complicated with extreme debility and general hydraemia, may gradually improve with good food, rest, and pure air (especially if the cause be removed), but iron, given in suitable doses and not so as to disorder the stomach, will greatly assist and hasten recovery.
In other cases, the best dietetic measures alone are insufficient, and iron is indispensable for cure: in the congenital anaemia of children born after profuse uterine hemorrhage, or whose parents were affected with anaemia, tuberculosis, constitutional syphilis, or other exhausting diseases, iron is of special value; also in strumous and rachitic cases (when the iodide or the phosphate is the most suitable form), but it requires to be continued for a long time. I have always found, in the treatment of simple anaemia, that when, under the judicious use of iron, etc., the blood assumes a healthy aspect, and the formidable symptoms disappear, if the iron medication is not persevered with for a considerable time longer, the malady returns in an aggravated degree. Anaemia arising from severe and continuous mental strain is best treated by the phosphate conjoined with cod-liver oil - many cases have come under my observation when this treatment proved highly beneficial. In the anaemia due to mal-hy-giene, to sedentary pursuits, prolonged residence in a town atmosphere, or continued exposure to carbonic acid, iron compounds are also markedly useful. In all these forms their advantage has been often verified by the enumeration of the blood-corpuscles, and estimation of the amount of coloring matter.
Idiopathic or "Pernicious" Anoemia is an extremely interesting but obscure form of disease, connected mainly with the glandular system; it is insidious and fatal, and iron, at least in the forms usually employed, has seemed to possess little or no remedial power against it: arsenic, and perhaps phosphorus, have succeeded better (v. p. 50). Quite recently, however, benefit has been reported even in this malady from the hypoder-mic use of iron, and Da Costa has further exemplified the value of this resource by the cure of an obstinate case of chlorosis with hypodermic injections of "dialysed iron" in 15-min. doses (British Medical Journal, i., 1878). I should consider this an additional proof that in many cases where iron is said to have failed, it is because of its not being given in a form that can be assimilated.
In ordinary goitre, iron alone is inefficient, and in exophthalmic goitre, although anaemia is commonly a marked symptom, I have not seen much advantage from it. In the anaemia of incipient phthisis it must be given with caution (v. p. 173); and in that connected with diabetes and malignant or malarious disease, its effects, though often good, are rather uncertain.
The success of iron in anaemia will clearly vary with the different causes, forms, and degrees of the malady, and an accurate knowledge of them is a great help toward cure of the disease, and confidence in the power of the drug. Cases corning under treatment at an early stage usually admit of a favorable prognosis, but when the anaemia is congenital, or occurs at the climacteric period, recovery is more uncertain, and the anaemia of old people (unless when directly consequent on an acute illness) is the least tractable of all; intercurrent disease, especially if of febrile or inflammatory character, renders the prognosis as to the anaemic condition, very doubtful.
It is worth while, even at the present time, to refer briefly to two of the earliest facts which fixed the value of iron in suitable cases of anaemia. An endemic malady, apparently unknown at the time (1804), attacked the workers in the mines of Anzim (coal); it was probably anaemia from carbonic acid poisoning, for they became pale, feeble, short of breath, and died of asthenia, or chest disease. Treatment by quinine, opium, good food, etc., failed to relieve, and four cases were sent to a hospital in Paris for the opinion of the physicians: of the four men, one died shortly, and at the section, Halle, noticing the exsanguine appearance of the body, thought of iron, and prescribed it for the others, who got well, and returning home cured their companions with the same remedy (Que-venne: "Memoire," etc.). Something similar occurred at the mines of Schemnitz (metal mines), where the workers at one time died rapidly with "anaemia, asthma, phthisis, and dropsy," when the epidemic was stayed with iron medicines by Hoffinger (Ozaman: "Histoire des Epidemics").