External

Solutions of the sulphate, chloride, nitrate and Liquor Ferri Subsulphatis (Monsel's solution), are the most valuable local astringents we have. It matters very little which of these is used. In England the solution of the chloride is perhaps oftenest employed. Either is of service in many cases - for example, to stop haemorrhage from leech-bites, from the nose, from piles, or from the uterus, as in the haemorrhage of malignant disease. A convenient way to apply them is on lint or cotton soaked in the solution, and a cavity such as the nose or uterus may be plugged with the lint. These preparations form very disagreeable clots, which readily decompose and give rise to septic infection. The aqueous solution of the chloride has been used as a spray for haemoptysis, but as it may excite coughing, it is not to be recommended. It is very useful as an astringent for painting on the fauces, pharynx or tonsils in inflammation of these parts. It may, for this purpose, be diluted with an equal quantity of water, or a solution of 1 part of ferric chloride in 4 of glycerin may be used. It has been advised to paint erysipelatous skin with the tincture of ferric chloride. A solution of the sulphate (1 to 480) has been used in gleet.

Internal

Gastro-intestinal tract. - The astringent preparations may be swallowed in cases of severe bleeding from the stomach, such as that of malignant disease, ulcer or cirrhosis. If the bleeding is profuse, a drachm 4. c.c. of Liquor Ferri Chloridi with a drachm 4. c.c. of glycerin, to facilitate swallowing, may be given every hour or oftener, and this will sometimes apparently save a patient's life. For less serious haemorrhage smaller quantities will suffice. Intestinal haemorrhage may also be treated in the same way.

The tendency of ferric salts to constipate is usually overcome by the addition of some purgative; thus, magnesium sulphate is commonly given with the chloride, and aloes is often prescribed with ferrous sulphate in a pill. This method, however, interferes with the time during which iron remains in the intestines, and it is better to administer the laxative separately, so that the dose can be regulated according to circumstances. The ferric salts have been given for diarrhoea, but there are many drugs more suitable for this symptom. Chronic constipation is often very effectually treated by a pill of ferrous sulphate and extract of nux vomica, but probably the efficient purgative in it is the nux vomica, although some claim that large doses of ferrous sulphate will overcome chronic constipation. At least the constipating effect of the ferric salts is often much exaggerated.

A rectal injection of a fluid drachm 4. c.c. of the tincture of ferric chloride to half a pint of water 240. c.c. kills threadworms the patient being in the knee-chest position.

Arsenical poisoning is best treated by the humid ferric oxide, which should be freshly prepared by mixing together 3 fl. oz. 90. c.c. of Liquor Ferri Tersulphatis with 1 oz. 30. gm. of sodium carbonate diluted with water. Half an ounce 15. c.c. should be given every five or ten minutes. An insoluble arsenite is formed, and may be gotten rid of by a thoroughly purgative dose of magnesium sulphate or some other simple purge. A dose of common salt or of sodium bicarbonate, followed by 1 fl. oz. 30. c.c. of dialyzed iron, useless as an iron preparation, diluted with water, is also efficient in poisoning by arsenic. A better method of using iron for this purpose is given on p. 193. Blood. - The great use of iron salts is to restore the amount of haemogloblin and the number of red corpuscles in anaemia, especially chlorosis. They are useless in pernicious anaemia, and generally of little value, if any, in the anaemia of leucocythaemia, exophthalmic goitre, or Hodgkin's disease. All other common forms of anaemia are secondary to some definite cause, such as haemorrhage, lead poisoning, scurvy, etc., and are treated by the removal, if possible, of the cause of the anaemia, but recovery may be aided by the administration of iron. Ferric chloride and ferrous sulphate are two of the most efficacious preparations, and pills containing a grain .06 gm. of the dried sulphate, with aloes or nux vomica, if constipation is present, are very valuable. It is usual to begin with one pill containing one grain .06 gm. of the dried ferrous sulphate thrice a day, but gradually the number of pills may be increased till three or four are taken at a dose. This method of large doses of the sulphate often appears to cure more rapidly than smaller doses. If these astringent preparations cause indigestion, any of the milder preparations may be substituted. The carbonate may be given in pills in rapidly increasing doses, or the dose of reduced iron, conveniently given on bread and butter, may be pushed. Mistura Ferri Composita Griffith's Mixture is a disagreeable preparation to take and to look at, and the inky character of the aromatic mixture makes it undesirable. The styptic taste of some of the preparations, especially the astringent ones, may be concealed by giving them with a drachm 4. c.c. of glycerin, which acts by its viscosity and by reducing some of the ferric to a ferrous salt. It is often added to the tincture of the chloride. The scale preparations hardly ever disagree; they are therefore used for patients with a delicate digestion, and for such it is much better to make no attempt to rapidly increase the dose, but to depend on small doses spread over a long period. Mineral waters containing iron (such as those of La Bourboule and Levico) or the red wines may be given in such cases. Flitwick water, however, contains a good deal of iron. Often iron and quinine citrate is prescribed as a pill; powdered tragacanth and syrup form the best excipient. Treatment of anaemia by iron leads, of course, to the improvement of the numerous symptoms, such as amenorrhoea, constipation, dyspepsia, etc., which are dependent upon the anaemia. That form of neuralgia which is associated with anaemia usually yields to iron. Easton's syrup (see p. 194) is a very popular preparation; it is used for anaemia, and to promote the health and appetite during convalescence after long illness. A pill very similar to the syrup, and containing iron phosphate, 1 gr. .06 gm.; quinine, 1 gr. .06 gm.; strychnine, 1/32 gr. .002 gm.; concentrated phosphoric acid 1 1/2 m. .10 c.c.; liquorice powder to 5 gr. .30 gm. is prepared. It is called Easton's pill or Pilula Trium Phosphatum. A similar tablet is in the market. Ferrous iodide has been given, sometimes apparently with success, in cases of rheumatoid arthritis, but it must be continued thrice daily for many months. A pill is often preferable to the syrup, as that so readily changes. Two grains .12 gm. may be made into a pill in the same way as that advised for the yellow mercurous iodide, and one or two such pills be given thrice a day. Large doses of iron (10, .60 c.c. or even 20 minims, x.20 c.c. of the tincture of the chloride every hour or two) have been given in diphtheria and other forms of bad sore throat, such as hospital sore throat, apparently with considerable benefit. Erysipelas has been treated in the same way. Fever due to other causes is said to contra-indicate the use of iron.

Kidney

Iron salts are reported to have a feeble diuretic action, but this is doubtful. The chloride is often given empirically for all forms of Bright's disease. Whether it does good is at present undecided.

Iron should always be administered when the stomach is full (after meals) excepting when given for follicular tonsillitis, diphtheria, erysipelas, gastric haemorrhage or arsenical poisoning. Occasionally a patient is found who cannot take iron in any form, because of the headache and indigestion caused by it.

The Different Preparations Of Iron

These have already been classified into astringent and non-astringent. There are some, viz., the iodide, the phosphate, the iron and quinine citrate, and the iron and strychnine citrate, the value of which depends in part at least upon their other ingredients. The arsenate must be given in such small doses to avoid arsenical poisoning that it is probable that the iron in it has no effect. Hence arsenous acid may just as well be given, and this is commonly done. Ferric phosphate, which always contains some free phosphoric acid, is an excellent haematinic. It is used largely for children, because the syrup of it is very pleasant in taste, and also because it was formerly believed that the phosphoric acid would aid the growth of bones, especially in cases of rickets. Parrish's food, known also as Squire's chemical food, and Dusart's syrup both have for their chief ingredient ferric phosphate; the dose of each is 1/2 to 2 fl. dr.; 2. to 8. c.c. Ferrous iodide has been introduced for cases in which we wish to gain the benefit of both elements, but the proportion of iron to iodine is small (1 to 9). It is especially liable to damage the teeth. The iron and quinine citrate combine the virtues of both iron and quinine. It is a favorite, mild preparation for slight cases of anaemia, but must not be prescribed with alkalies, as they precipitate the quinine. Ferratin (not official) is claimed to be the characteristic iron compound of the liver. It is an acid albuminate, prepared artificially, and is used in dose from 1 1/2 gr.; .10 gm. to 8 gr.; .50 gm. No evidence experimental or clinical, has as yet been brought forward, which, outside of theoretical reasoning, makes the superiority of this over the older iron compounds probable, (Wood). Since it is practically tasteless it is easily administered. Practically all of the albuminates and peptonates to be found in the shops are worthless as haematinics.