This section is from the book "A Treatise On Therapeutics, And Pharmacology Or Materia Medica Vol1", by George B. Wood. Also available from Amazon: Part 1 and Part 2.
Passive hemorrhage from the stomach or bowels is sometimes beneficially treated with the chalybeates. To the active hemorrhages from these parts they are inapplicable, in consequence of their excitant property. Even in the passive kinds, they should not be trusted to exclusively in threatening cases; their astringency being too feeble; and at best they are usually prescribed rather to meet some coexisting indication, than simply as haemostatics. This remark, however, though correct as a general rule, is not applicable to the officinal solution of subsulphate of iron, which is powerfully astringent, with comparatively little of the irritant property.
Through the circulation they are supposed to operate beneficially as tonics and astringents in passive hemorrhages, and various excessive secretions, as in haemoptysis, menorrhagia, haematuria, bronchorrhoea, leucorrhoea, spermatorrhoea, etc.; but, though they are often useful in these affections, it is probably more by their influence upon the blood than their direct action on the tissues. They should never be exhibited when the complaint is associated with a plethoric condition of the circulation, and a sound state of the blood.
General debility, independently of any special deficiency of blood, affords an indication for the use of iron as a tonic. But discrimination is necessary. To the cure of acute debility, such as occurs in low fevers, the chalybeates are quite inadequate; operating both too slowlyand too gently for the wants of the system. The preparations of Peruvian bark and serpentaria among the tonics, are much more effectual here. But in the chronic weakness resulting from deficient food, enfeebled digestion, the depressing emotions, previous disease, etc., they act beneficially by gently stimulating the organic functions through the circulation; and when with the debility is connected a special relaxation of the tissues, as in scrofula, and various nameless cachectic conditions of the system. their astringency gives them additional efficacy. But the conditions of debility in which they are indicated, in reference to their tonic and astringent properties, are almost always associated with a defective or depraved state of the blood, in which their reconstructive power is wanted; so that it will be most convenient to consider the several affections under that head.
2. As a reconstructive agent, iron is used whenever the red corpuscles are relatively deficient; and such is the case in all instances of impoverished blood. This condition of the blood has received the not altogether appropriate name of anaemia. In women it is often called chlorosis. Some authors make a distinction between these affections. I have been able to discover none that is essential. In the female, chlorosis sometimes comes on without any appreciable cause, possibly from some derangement of the assimilative functions essentially connected with the peculiarities of the sex; but it is also frequently produced in them, as well as in males, from obvious causes; and there is no difference that I have been able to appreciate in the results. The symptoms are the same, the mode of treatment is the same; and the obscurity of the cause, in certain instances, is not a sufficient ground for assuming a distinct character in the affection. The varieties under which amentia appears are almost infinite. Sometimes it is a pure, original, idiopathic affection; but much more frequently it is associated with other diseases, as their effect, their cause, or a coincident effect of the same cause. In whatever shape it may appear; so far as the anaemia itself is concerned, iron is indicated. It may not always succeed; but it should always be tried when it is desirable to correct the anaemia. Not impossibly, this condition of the blood may sometimes be intended as a safeguard against other affections, perhaps of a hemorrhagic, perhaps of an inflammatory character; and to correct it may involve the patient in the risk of mischief greater than the evils of anaemia itself. In such cases, caution should be observed, in the use of the chalybeates, not to carry them too far; but to endeavour as nearly as possible to preserve a due balance, so that the aims of nature may be effected, without incurring danger in the opposite direction.
Simple anaemia from the loss of blood, excessive secretion, defective supply of food, or inefficient assimilation, is a very common affection, and in general easily recognizable by the paleness of the face, lips, and tongue. For its characteristic symptoms, the reader is referred to works on the practice of medicine. It may be mentioned here, as having a special therapeutic bearing, that, instead of the depressed state of all the functions, which might, a priori, have been anticipated, there is, on the contrary, as a general rule, much and very prominent disturbance of certain functions even more so than in the opposite condition of the blood. A frequent pulse, palpitation of the heart, panting respiration, and varied nervous agitation, are often striking phenomena; and it is of the utmost importance not to mistake these, as they were formerly often mistaken, for evidences of an over-excitement requiring depletory treatment. There are too, very generally, especially in females, bellows murmurs in the heart and large blood-vessels, to be heard by pressing the ear or the stethoscope upon them, which might lead an incautious observer to suspect the existence of organic cardiac disease. Sometimes, when the disease is not yet fully developed, the characteristic paleness of the cheeks may be wanting, and there may even be in the female something of the rose yet remaining. In this condition, those apparent anomalies above referred to, the palpitations the pantings, the hysterical disorders, and especially the cardiac and vascular murmurs, become diagnostic symptoms, by which the nature of the case may often be determined. In all these cases of anaemia, iron is the great remedy; and, were it of no other use as a medicine, it would, from the possession of its extraordinary power over this complaint, be of inestimable value. Not only is the anaemia with its immediate symptoms corrected; but evils of great magnitude', which are apt to flow from a perseverance of the affection, such as dropsy, sterility, organic heart affection, and ultimate death from the unresisted attacks of other diseases, are prevented. A sufficient dose of the chalybeate, repeated three times a day, and continued for six or eight weeks, will very generally cure the complaint entirely. In the course of a week or two the colour will begin to return to the lips and cheeks, the pulse to acquire more stability, the appetite and digestive function to improve; the amelioration of the symptoms will advance regularly; and, at the end of the time specified, a wan, wasted, and desponding girl, apparently in the last stage of debility, and quite incapacitated for the performance of any active duty, will have been converted into a cheerful, rosy, plump, and vigorous young woman, full of energy and hope, and prepared to enter zealously upon the duties of her station. This change is effected merely by restoring the healthy proportion of red corpuscles to the blood. The remedy should be omitted when the cure is completed, for fear of inducing plethora. The only caution necessary is that an observant eye should be upon the individual for some months; and, upon the least sign of a return of the symptoms, the chalybeates should be again recurred to.