Therapeutic Action.—The chalybeate or ferruginous preparations are found to be of much importance in certain states of the system. So far as its physiological effects are concerned, the Iron, so long as it retains its metallic form, is supposed to be inert, or at least to exert but a feeble influence upon the system. It is probable, however, that its mechanical action upon the bowels, when in a metallic state, may stimulate them to healthy action, give increased tone and vigor, and thus prove beneficial. It is also said to be useful in removing worms, which it is supposed to do mechanically. These effects are by no means its most important ones in a therapeutic and physiological point of view. When the metallic Iron is taken into the stomach it readily oxidizes, and thereby acquires its most prominent powers. Acids, acid wines and fruits, assist in giving activity to the metal, by promoting the chemical changes upon which its value as a remedial agent depends, and for the same reasons alkaloids and their carbonates are inadmissible, while the patient is using Iron. During its oxidization, hydrogen gas is evolved, giving rise to unpleasant eructations. By the internal use of this metal the stools are rendered black. Notwithstanding the changes which the Iron undergoes by oxidation in the system, yet it does not acquire poisonous qualities by these changes, like most other metals.
Most of the chalybeate preparations are possessed of astringency, in addition to their more prominent tonic and alterative properties. They diminish excessive secretions from the mucous membranes, as the gastro-intestinal, giving tone to the bowels, while at the same time they render the alvine discharges more consistent, and not unfrequently cause constipation. The sulphate and chloride of iron are more irritating than any other preparations of this metal, and are regarded even as poisonous; they are, however, very feeble poisons when compared with the mercurial and cupreous salts, and are likewise more decidedly astringent than any of the other ferruginous preparations.
By the use of chalybeates the blood becomes more florid, or acquires a scarlet color, owing to the increased number of its particles of coloring matter; and the crassamentum also gains in volume, as well as in firmness or density.
These physical and chemical alterations in the sanguiferous fluid render it more stimulating to the organs, and hence the improvement in their functions arising from the use ot the iron. The salutary changes attending it are not speedy, but slow and gradual, owing to its very tardy absorption into the system.
Preparations of iron are contraindicated in cases of irritation or inflammation of the alimentary canal, likewise in plethoric habits, with a tendency to apoplexy and inflammatory affections. On the contrary, they are indicated when there is a soft lax state of the solids and muscular fiber, in feebleness or inertia of the organs, and in leucophlegmatic habits; in cases of anaemia and chlorosis they are indicated, and are of primary importance in effecting a cure.
Dose.—From five to twenty grains, in electuary.
The metallic iron, in the form of "filings," is inert in its uncombined state; at all events it exerts but a feeble influence upon the animal economy. Its sanative powers are attributable to the chemical changes which it undergoes in the system. By the union with an acid, or some other agent, in the system, the iron becomes oxidized, and thus acquires its activity as a therapeutic agent. There can be no doubt, however, that the metallic iron will prove useful in cases where there is torpor in the alimentary canal from want of tone and excitement, as in some forms of dyspepsia, and constipated and sluggish states of the bowels. It is also said to be anthelmintic, and is supposed to act mechanically upon the worm.
Ferri Oxidum Squamae.
Dose.—From five to twenty grains.
The Scales of the Oxide of Iron, found at the anvil of the blacksmith, are possessed of the general properties of the chalybeates. They are formed when iron is heated to redness, and consist of a mixture of monoxide and sesquioxide of iron in varying proportions. They are used in domestic practice in cases of amenorrhoea, chlorosis, etc., mixed in molasses or honey, or put into wine. They are considered unfit for use, however, until reduced to a fine powder, when they are united with other agents, forming the next preparation, Ferri Oxidum Nigrum, or Black Oxide of Iron.
Ferri Oxidum Nigrum.
Dose.—Five to twenty grains, two or three times a day.
The Black Oxide of Iron is a chalybeate preparation long and extensively used. It is exhibited in the same cases as the other ferruginous preparations. It is tonic, and said to be useful in promoting the menstrual secretion, hence administered in chlorosis, anemia, and other cachectic states. Royle says, "It has the advantage of being a compound of the protoxide, which is usually considered the most efficacious."
Ferri Carbonas. Sub-Carbonate of Iron.
Dose.—From grs. v. to ℥ij., as a tonic, alterative, and emmenagogue.
This preparation is not a true carbonate, but a ferric oxyhydrate. It is extensively employed, and is considered applicable to all cases in which the chalybeates are indicated.
Dr. Carmichael recommended it highly in cancerous diseases. Mr. Hutchinson reports many cases of neuralgia, especially facial neuralgia, in which it proved eminently beneficial; and Dr. Dunglison and many others fully corroborate these reports.
In chlorotic affections, scrofulous diseases, general cachexia, amenorrhoea, chorea, epilepsy, dropsy, and many chronic diseases of long duration, especially when the blood becomes reduced in quantity, and impaired in quality, as in protracted intermittents, remittents and nervous diseases, great advantage has been derived from its exhibition. It is an antidote to arsenious acid, although not so effectual for this purpose as the hydrated oxide.
Ferri Sulphas. Sulphate of Iron.
Dose.—From one to five grains in the form of a pill.
Therapeutic Action.—The Sulphate of Iron is tonic, astringent, emmenagogue and stimulant, possessing many properties in common with the other ferruginous preparations; consequently its remote effects upon the system correspond with those attending the employment of preparations already named. Its local action is that of a powerful astringent, and if given in a concentrated form, it acts as an irritant by virtue of its chemical action on the tissues.
It is employed topically, either in the form of a solution or powder, as a styptic, to arrest hemorrhages from bleeding surfaces. The solution is frequently applied to ulcerated surfaces and to mucous membranes, to lessen profuse discharges. In leucorrhoea, gonorrhoea, gleet, ophthalmia, etc., and as a gargle in ulcerated states of the mouth and fauces, it may be resorted to with advantage. The solution is also employed in various eruptive and herpetic affections as a wash, as in the case of herpes circinatus, poisoning from Rhus, etc. For this purpose from one to ten grains may be added to one ounce of water.
Ferri Carbonas Saccharatus. Vallett's Ferruginous Mass.
Dose.—From one to ten grains in the form of pills.
The Saccharine Carbonate of Iron is one of the most valuable ferruginous preparations. It is soluble in the fluids of the stomach, and hence is readily absorbed, it is especially valuable in chlorosis and anemia, where the indication is to increase the red corpuscles of the blood; but it may also be employed wherever a preparation of iron is indicated.
Ferri Ferrocyanidum. Prussiate of Iron.
Dose.—From three to six grains.
Prussiate of Iron possesses the properties of the other preparations of iron, and in addition to these, it is regarded as a valuable antiperiodic. There can he no doubt but that it possesses this last property in a notable degree. Dr. Zollickoffer recommended it as a more certain, prompt, and efficacious remedy in intermittent and remittent fevers than the Peruvian bark. Though we can not go so far as that, we would be willing to state that, combined with quinine, it will add at least one-fourth more power to the agent. We employ it in preference to any other preparation of iron in chronic disease, when there is any tendency to periodicity.
Ferri Oxidum Hydratum. Sesqui-Oxide of Iron.
This preparation of iron is similar to the anhydrous sesqui-oxide, or precipitated carbonate, in its general properties, and may be exhibited with advantage in the same cases in which that was recommended. It is not used, however, to any considerable extent as a substitute for that and the other chalybeate preparations in general use.
Its antidotal powers to the arsenious acid, entitles it to our especial attention as a toxicological agent. It unites with the arsenious acid, forming an insoluble arseniate of iron, and hence prevents its corrosive effects upon the gastro-intestinal mucous membrane. Its efficacy, as an antidote to this poison, has been fully shown by experiments made upon animals, and also by the successful results which have attended its employment in cases of poisoning in the human subject.
Twelve parts of the oxide or hydrate, prepared by ammonia and administered in the form of a pulpy mass, by mixing with water, are required to neutralize or render inert one equivalent of the arsenic. The dose of the pulpy hydrate to an adult is one tablespoonful every five or ten minutes, and to children a dessertspoonful; repeat it until the urgent symptoms subside.
Tinctura Ferri Chloridi.
Dose.—From ten to thirty drops in water.
Therapeutic Action.—The Tincture of Muriate of Iron is considered one of the most active, certain and valuable preparations of iron. It is decidedly tonic, and an energetic astringent and styptic, and if the dose is large it is an irritant poison, owing to the great amount of free hydrochloric acit contained. If taken in large doses, its action is to disorder the stomach.
In addition to the tonic and alterative properties of this agent, which, in common with other chalybeates, it posseses, it has astringent and diuretic properties in a high degree.
It is advantageously employed as a tonic and alterative in scrofula, rachitis, tabes arising from extensive ulceration or suppuration, and attended with hectic fever and night-sweats; in tabes mesenterica, tabes dorsalis, chlorosis, cachectic habits, in all cases of anaemia, in many chronic, and also in the convalescent forms of many acute diseases. In asthenic dropsies it is likewise useful, especially when it arises from loss of blood, or from amenorrhoea.
It seems to act specifically upon the genito-urinary organs, as it appears by the increased urinary secretion, and by its effects upon the kidneys, bladder, urethra, and prostate gland. In cases of leucorrhoea, chronic gonorrhoea, gleet, etc., it has been found beneficial. In dysuria, or retention of urine, arising from a spasmodic stricture of the urethra, Pereira recommends it. In this case the dose is ten drops every ten minutes until relief is obtained. The same writer has used it associated with the tincture of cantharides, in the latter stages of gonorrhoea, with advantage, after other remedies had failed. In passive hemorrhages from the kidneys, bladder or uterus, it is found valuable, and is likewise employed in chronic diarrhoea, dysentery and cholera infantum, attended with relaxation of the intestinal exhalants, in which cases its tonic and astringent powers have, in some instances, rendered it an exceedingly important remedy. For this purpose it may be given in small doses, associated with a few drops of the tincture of opium or paregoric.
One of the principal uses of this remedy is to antidote the poison of erysipelas, which it does in a very marked manner. In the olden time it was thought to be a true specific for the disease, but a further study has shown that erysipelas (like other named diseases), is not always the same. Many cases are met by this remedy, some by Rhus; others by Veratrum; and others still by sulphite of soda.
Tincture of Muriate of Iron is indicated by the deep color of the part, and by the deep red of the tongue. With these indications it can be administered in doses of gtt. v. to ʒss., every two or three hours, and a local application of the remedy pure or diluted with glycerine.
To one who has not studied the specific action of remedies, the action of this medicine will be a revelation. We are called to a patient who has erysipelas, and find a pulse of 120, small and hard, a temperature of 104°, a dry skin, scanty urine, constipated bowels, tongue dry, brown and fissured, nervous system excited, and inability to sleep. We administer the single remedy, tincture of muriate of iron; the pulse comes down to 90, temperature to 100°, the skin softens, the urine is increased in quantity, the tongue moistens and cleans, the nervous system is relieved, and the patient sleeps. All from one remedy, and a remedy that has not been recommended for these purposes.
Ferri Iodidum. Iodide of Iron.
Dose.—From three to ten grains.
Iodide of Iron is a valuable therapeutic agent, possessing both the properties of the iron and iodine; it is the mildest tonic in which the latter agent can be used. It is indicated as a tonic and alterative, in scrofulous or other cachectic affections, if there is much debility, with a soft and relaxed state of the muscular fiber, and an exsanguine appearance of the surface. It promotes the appetite, facilitates digestion, in some cases proves laxative and diuretic; at the same time, we obtain the resolvent and alterative influence of the iodine. We have employed it in secondary syphilis, where there was great prostration of the system, with decided advantage, and in such cases as these, would strongly recommend it.
The best forms in which this agent can be administered, are the Syrup of Iodide of Iron in doses of ʒss.; or the Syrup of Iodide of Iron and Manganese, in doses of from ten drops to half a drachm.
Dose.—From ten drops to half a drachm.
Acetate of Iron is formed by dissolving the sesquioxide of iron in acetic acid. It is a deep red liquid, having an acid chalybeate taste. It possesses the properties of the other ferruginous preparations, and in addition, others, which render it valuable in certain conditions of the system. Thus in typhoid and typhus fever when the system becomes prostrated, it may be used to good advantage, the acetic acid being one of our best antiseptics. It is also a very valuable preparation of iron in the treatment of scorbutis, and especially valuable in those low cachectic states of the system, sometimes produced by secondary syphilis. In this last case we would especially recommend its trial.
Dose.—From ten drops to one drachm.
The Pernitrate of Iron is obtained by dissolving iron in nitric acid; it forms a dark red solution, with a very astringent taste.
This preparation of iron was introduced by Mr. Kerr, who considers it a very powerful astringent and mild caustic. He thinks that in addition to an astringent quality, it possesses the property of diminishing the irritability and tenderness of the mucous membranes with which it may come in contact. The remote effects are haematinic and tonic, like other chalybeates. He introduced it as a valuable remedy for chronic diarrhoea both in children and adults, and whether accompanied with vomiting or not. With the exception of dysentery and the diarrhoea which succeeds typhus, he found it useful in almost every case of diarrhoea.
We employed it in a case of chronic diarrhoea, contracted in the South, of two years standing, with entire success, after having failed with the usual remedies. We also use it as a local application in inflammation of the cervix uteri, and we think with marked benefit. It deserves further investigation.
Ferri et Potassii Tartras.
Dose.—From ten grains to half a drachm.
The Tartrate of Iron and Potash is a very eligible preparation of iron, in consequence of its slight taste and ready solubility. Its agreeable taste and the facility with which it may be administered, render it a convenient and appropriate remedy in diseases of childhood. In its general action upon the system it corresponds with most of the chalybeates, but is less astringent than some. It is also said to be milder in its action on the vascular system.
Ferri Phosphas. Phosphate of Iron.
Dose.—From five to ten grains.
The Blue Phosphate of Iron, though one of the sparingly soluble preparations of iron is possessed of many of the properties of that agent. A perfectly soluble scaled phosphate of iron is now made by a process similar to that used in making the citrate of iron, and this is officinal in the Pharmacopoeia. It is preferred by some to all other preparations in those cases of nervous irritability, complicated chlorosis, with anaemia, and other diseases, where there is general debility of the system.
Dose.—From two to ten grains.
Citrate of Iron is one of the best ferruginous preparations, and may be employed in all cases where iron is indicated. This and the acetate before mentioned we consider preferable to any where there is a cachectic condition of the system, as in scrofula, scorbutis and secondary syphilis. It may also be employed with very good effect in chlorosis, especially in those cases where there is a fetor of the breath and a constant yellow coat upon the tongue, with pale, spongy gums.