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ON THE COMPARATIVE MEDICINAL EFFECTS OF THE SALTS OF IRON.
606 within the teeth, and without any mark of indentation. The cord-mark was well defined, and, like parchment, dry, brown, and hard. At the upper edge of the groove, on the right side, was a thin line of congestion. This appearance was absent on the lower edge at this side, and it did not exist at all on the left side. There was no ecchymosis under the groove. The direction of the cord-mark was remarkable ; it was very deep at the posterior part of the neck, just over the atlas, and extended in a direction from above dowtitvards and forwards on each side, to the posterior edges of the sterno-mastoid muscles, a little below the angle of the jaw ; anterior to this there was no mark whatever excepting one broad, hard patch, just under the chin, where the knot had made
its impression. As had been anticipated from the symptoms, there were found in the abdomen the appearances resulting fram acute peritoneal inflammation ; the inflammation had originated in the neighbourhood of the diseased uterus, a small ulcer having perforated that organ at its
posterior part near the vagina.
acquainted, where death was supposed to have been caused by this forcible bending of the head backwards, is mentioned by Devergie, vol. ii., p. 477, 2nd edit. In this case, however, the body was not opened, and both Esquirol and Devergie doubt the truth of the explanation offered of the cause of the absence of all the external signs of death by clyspncea, viz., the luxation of the cervical vertebrse. The present case, however, renders that explanation more probable. It shows, moreover, that an injury may be done to the neck, in hanging, sufficient to interfere with the functions of the spinal marrow, but without the occurrence of rupture of the ligaments or processes. We had not time to examine the head, but it is almost certain that no congestion would have been found. The entire absence of all external signs, the fact that no constriction was made on the neck, in front of the sternomastoid muscles, and the injury found within the spinal canal, all tend to show that no cerebral congestion could have taken place. Manchester-street, July 21, 1844.
am
mucous coat of the stomach was throughout uninand pale. ON THE COMPARATIVE MEDICINAL EFFECTS In the chest, the lungs were found of ordinary size and OF THE SALTS OF IRON. colour ; the depending parts showed no unusual engorgeROBERT H. POWELL, M.B. no blood when cut into the By and squeezed ment ; exuded ; large veins were not congested, and in the right side of the heart there was rather less blood than is generally ON reflecting upon the various salts of iron in common found ; the left ventricle was contracted, but contained use, it appeared to me that practitioners in medicine for the most part select for administration those preparations about as much blood as the right. The appearances met with seemed to warrant the con- of iron containing a maximum of oxygen, forming salts of elusion that neither dyspnoea nor cerebral congestion had the peroxide. Now I think it will be found, on careful observation, been the cause of death. There was an entire absence of all those marks, some of which, at least, are com- that the preparations of this metal, in a lower state of monly found when death has been produced by the pres- oxidation, are more suitable for those cases in which iron sure of the cord upon the air-passages, or on the is most beneficial, and peculiarly indicated. If your valuable space permits, I shall take a cursory cervical vessels ; and, indeed, the position of the cordtnark was such that this pressure could hardly have been review of the principal ones. The tincture of the sesquichloride of iron, as is well exerted. Between the sterno-mastoid muscles and the chin no indentation had been made, while, below the known, contains a persalt of this metal, and though a occiput, and extending some way towards these muscles, very useful preparation as an astringent and tonic, proves the indentation was very deep. It will be found that with often too irritating to the mucous membrane of weakly a cord in this position, and with the knot pressing firmly anemic subjects ; it may be observed that there exon the chin, almost any amount of upward force may ists a small quantity of a proto salt in solution, which it be used without effect upon the respiration or cerebral derives from the same existing in the sesquioxide from circulation. which this tincture is formed, which probably imparts It seemed probable, then, that the spinal marrow had some of its efficacy t it. been injured, and examination showed that such injuries The same remarks apply with regard to the sesquioxide ’had taken place about the upper part of it as would be of the London Pharmacopoeia, which, according to my sufficient to account for death. There were ecchymoses experience, disagrees with most persons using it, its bulk about the deep muscles, over the second and third cervi- appearing to oppress the enfeebled stomach; and its cal vertebrse. The five first vertebrae were then removed, beneficial effects being very slowly evinced, which again and on opening the canal ecchymosis was found in the may arise from the small quantity of protoxide prevented sheath of the spinal marrow, at a part corresponding to from further oxidation by the sesquioxide, during the these external injuries. At the left side, and exterior to precipitation, mechanically enclosing a small amount of the sheath, was an extensive effusion of blood, firmly the protocarbonate unchanged. The tartrate of iron, of the London Pharmacopoeia, coagulated. The spinal marrow having become generally softened it was impossible to ascertain the existence again, contains this metal in the state of a persalt; of any particular softening at this part-there was no though occasionally plescribed, it is not, according to my appearance of bruising of its texture. The odontoid experience, found a preparation possessing much tonic process was firmly retained in its place, none of its liga- properties; that prepared by a process followed in Dublin ments having given way, nor were there any marks of contains a mixture of proto and pertartrate of iron, and fracture of the vertebrae, nor of laceration of their liga- will be found a more energetic tonic than the former. The aromatic mixture of iron, still in occasional use, ments, but there was an unusual degree of mobility between the third and fourth vertebrae, as though the again, contains chiefly salts of the peroxide (the tannate and gallate) with small quantities of proto salts, and ligaments had been stretched. This case is interesting in many points. It affords an possesses very questionable medicinal effects ; those, pro.instance of suicidal suspension in a person exhausted bably, arising from the salts of cinchonine and quinine, and debilitated by continued disease to such an extent as together with the aromatic ingredients entering into its to have rendered it very improbable that the necessary composition. exertion could be made without more noise and disturbThe sulphate of iron, another preparation in daily use, ance than here took place; but it is of more importance though not a pure protosalt of iron, will be found to ,to, notice that under circumstances where so little force possess very active tonic properties, which apparently could have been used there should have been so much seem to augment in the ratio of the quantity of metal injury about the spine. The body was not heavy, and present in the state of protoxide ; the bluish green acid, the fall, if any, could have been but trifling. The pecu- crystals containing the greatest amount ; the pale-green, liar position and direction of the cord, which were such neutral ones, being probably composed of a mixed oxide, ,that the force employed must have operated in bending combined with sulphuric acid; this preparation, likethe head and the two upper vertebrae abruptly back- wise, as is well known, often disagrees with the digestive .wards, will explain the cause of this effect upon the organs of many. The iodide of iron, as usually obtained from manufacspine. The only instance of suspension with which I
The
.jected
607 hint at the possibility of tubercular absorption, while the, adventitious deposit was as yet unsoftened. And the third contained three cases of consumption ia its very advanced stages, and were reported only to show how, at times, very unexpected results arise, even late ia this intractable malady Against any imputation ofabsm’d assumption, I thought I had pretty well guarded myself, by the few lines which succeeded the report of those three cases ; but as it apparently suits certain parties in our profession to be inspired with a holy horror of the man, who thinks that medicine, beyond the mere treatment of symptoms, can be of the least use in consumption. You will much oblige me by here appending, as a note, the paragraph I refer to.* Of the eleven cases reported under the first head, out died in October, 1842. Three of them I have been unable for a long time to trace. The remaining seven are, alive, and comparatively well, subject only to the occasional inconveniencies which result, and ever must result, from a condition of lung, partially impaired, and always prone to disease. In the majority of these seven, the physical state of the lung appears to remain stationary. The advantage gained has seemingly arisen from the non-extension of disease. One exception to this alone occurs in the case of Mary Lucas. The physical signs before reported are in character the same, but so far as the ear can contrast sounds at such a distance of time, they are less marked, and the inference from them less decided. At all events, she is robust and well. The last time I saw her was three weeks ago ; she then applied, in consequence of a slight but acute 11 cold," from which very simple treatment speedily freed her. Of three cases, contained in the second class, I can give an account of two only. The first, named Bull, was ia gentleman’s servant, and consequently of migratory habits ; I have not heard of him for two years. The second and third (Stanley and Vivers), are alive, and im the enjoyment, the one of good, the other of tolerable, health. Stanley was a young girl, who has since gone to service, and though still slender in form, and sallow in complexion, fulfils somewhat laborious duties without discomfort, and is free from pectoral symptoms. The second of the two (Vivers) is a highly nervous person, and liable to occasional attacks of hysteria, but presents no symptoms of pulmonic disease. In neither instance do the physical signs essentially vary now from those
is far from being a pure protoiodide, much peroxide, free iodine, mixed with a variable amount of the proto salt. Mr. Donovan, of Dublin, has recommended a process, published in the " Dublin Medical Press," which insures an almost genuine protoiodide. The acetate tincture of iron, much used on the other side of the channel, when properly prepared (which is a matter of much difficulty), will be found a most useful therapeutic agent, well agreeing with most persons requiring the use of this metal. From some researches of Dr. Aldridge, of Dublin, published in the 11 Dublin Journal," some years past, it would appear that this preparation contains a protoacetate of iron in combination with acetate of potass, !! which, from galvanic action, prevents the iron from passing into a higher state of oxidation, by its electro: positive condition. ’The green carbonate of iron, as found in the mistura ferri comp., contains a notable quantity of a proto salt; its very general efficacy need scarcely be adverted to. I may here notice the carbonate of iron with sugar, which seems to have the remarkable property of preventing further oxidation, it is, I believe, an efficacious tonic. And lastly, iron, as found in chalybeate waters, notwithstanding the inconvenient bulk of the menstruum, in the state of pure protoxide in combination with carbonic acid, is very generally allowed to be the most effectual
turing druggists, containing
ferruginous agent. On reviewing these several preparations, it will be apparent that their efficacy would seem to be in the ratio of
,
’
the proto salt present in each. What exact part iron plays in the process of sanguification remains to be discovered (it is to be hoped that this abstruse physiological question will, ere long, admit of elucidation, through the strides making in organic chemistry by the renowned Liebig, and other continental chemists), but the fact is certain, that the red particles of the blood are increased in a very apparent manner, and most probably this action, if not absolutely necessary, is facilitated by the metal being in a state of minimum oxidation. I have not noticed, in the above short review, the citrates, their chemical and therapeutic properties not having been yet sufficiently tested by the profession. Tunbridge Wells.
originally given.
ON THE USE OF ALKALIES IN CONSUMPTION. By J. S. CAMPBELL, M.D.
It would appear, therefore, that of fourteen cases which I reported nearly three years ago, and described as fair average examples of phthisis in its early stages, one only IN the year 1841, I published a work on the subject of is known to be dead, nine known to be living, and four Tuberculous Consumption, which THE LANCET reviewed whose fate is entirely unknown. Since then I have with some degree of favour in the nineteenth number of treated about four hundred more of the same kind, on the that Journal for 1841 -2. same principles, but must, at present, be content to say, I therein took occasion to enter on a good many points simply that results have, in my own belief, been highly connected with the pathology, as well as treatment of satisfactory. that formidable disease, but one of my leading objects I need scarce add, that one and all of the cases named was to express a strong belief in the value of an alkaline have been essentially treated by the caustic alkali, supertreatment, when perseveringly employed. Since that adding, as far as circumstances permitted, a close attenperiod I have not published a line on the subject, though tion to the various points of accessory practice, which I both my own additional experience and the reports I before attempted to lay in detail before the profession. In have received from others have gone far to confirm my the majority of examples there might be recommended former convictions. -without much hope of execution-pure air, light but In conformity with the usual practice, I then thought nutritious diet, proper clothing, and, equal to all, perit proper to illustrate my views by recording some cases, haps, a due regulation of stimulants, both in quality and taken from many others I might have printed; but I feel * « In 80 perfectly convinced that no plan of treatment in this reporting this and the two preceding cases, I disease ought to be received with any confidence, unless could desire most emphatically to disclaim any wish to have them considered as examples of what usually occurs a certain amount of permanence can be connected with presumed benefit, that up to this period, as already when an alkaline treatment is persevered in ; or of what indeed occurs under any treatment whatsoever; so far named, I have entirely abstained. On these grounds will oblige me by inserting this letter, chiefly intended to from this, these three cases are by far the most marked show how the cases, originally reported nearly three examples of benefit I have seen from treatment, when this was commenced after the second, or reactive stage of ye-trs ago, now remain. They were then arranged under three heads. phthisis had been fully established ; but even these few The first head contained eleven, presumed to be fair may, if properly viewed, hold out to us a useful lesson, examples of phthisis in its early stages. The sympathetic and direct our attention to a remedy, of whose efficacy as well as physical evidence on which I rested was there when employed early, I cannot entertain any doubt given. whatever."-(Campbell on Tuberculous Consumption, The second contained three only, my object being to p. 400.) ,
you
its impression. As had been anticipated from the symptoms, there were found in the abdomen the appearances resulting fram acute peritoneal inflammation ; the inflammation had originated in the neighbourhood of the diseased uterus, a small ulcer having perforated that organ at its
posterior part near the vagina.
acquainted, where death was supposed to have been caused by this forcible bending of the head backwards, is mentioned by Devergie, vol. ii., p. 477, 2nd edit. In this case, however, the body was not opened, and both Esquirol and Devergie doubt the truth of the explanation offered of the cause of the absence of all the external signs of death by clyspncea, viz., the luxation of the cervical vertebrse. The present case, however, renders that explanation more probable. It shows, moreover, that an injury may be done to the neck, in hanging, sufficient to interfere with the functions of the spinal marrow, but without the occurrence of rupture of the ligaments or processes. We had not time to examine the head, but it is almost certain that no congestion would have been found. The entire absence of all external signs, the fact that no constriction was made on the neck, in front of the sternomastoid muscles, and the injury found within the spinal canal, all tend to show that no cerebral congestion could have taken place. Manchester-street, July 21, 1844.
am
mucous coat of the stomach was throughout uninand pale. ON THE COMPARATIVE MEDICINAL EFFECTS In the chest, the lungs were found of ordinary size and OF THE SALTS OF IRON. colour ; the depending parts showed no unusual engorgeROBERT H. POWELL, M.B. no blood when cut into the By and squeezed ment ; exuded ; large veins were not congested, and in the right side of the heart there was rather less blood than is generally ON reflecting upon the various salts of iron in common found ; the left ventricle was contracted, but contained use, it appeared to me that practitioners in medicine for the most part select for administration those preparations about as much blood as the right. The appearances met with seemed to warrant the con- of iron containing a maximum of oxygen, forming salts of elusion that neither dyspnoea nor cerebral congestion had the peroxide. Now I think it will be found, on careful observation, been the cause of death. There was an entire absence of all those marks, some of which, at least, are com- that the preparations of this metal, in a lower state of monly found when death has been produced by the pres- oxidation, are more suitable for those cases in which iron sure of the cord upon the air-passages, or on the is most beneficial, and peculiarly indicated. If your valuable space permits, I shall take a cursory cervical vessels ; and, indeed, the position of the cordtnark was such that this pressure could hardly have been review of the principal ones. The tincture of the sesquichloride of iron, as is well exerted. Between the sterno-mastoid muscles and the chin no indentation had been made, while, below the known, contains a persalt of this metal, and though a occiput, and extending some way towards these muscles, very useful preparation as an astringent and tonic, proves the indentation was very deep. It will be found that with often too irritating to the mucous membrane of weakly a cord in this position, and with the knot pressing firmly anemic subjects ; it may be observed that there exon the chin, almost any amount of upward force may ists a small quantity of a proto salt in solution, which it be used without effect upon the respiration or cerebral derives from the same existing in the sesquioxide from circulation. which this tincture is formed, which probably imparts It seemed probable, then, that the spinal marrow had some of its efficacy t it. been injured, and examination showed that such injuries The same remarks apply with regard to the sesquioxide ’had taken place about the upper part of it as would be of the London Pharmacopoeia, which, according to my sufficient to account for death. There were ecchymoses experience, disagrees with most persons using it, its bulk about the deep muscles, over the second and third cervi- appearing to oppress the enfeebled stomach; and its cal vertebrse. The five first vertebrae were then removed, beneficial effects being very slowly evinced, which again and on opening the canal ecchymosis was found in the may arise from the small quantity of protoxide prevented sheath of the spinal marrow, at a part corresponding to from further oxidation by the sesquioxide, during the these external injuries. At the left side, and exterior to precipitation, mechanically enclosing a small amount of the sheath, was an extensive effusion of blood, firmly the protocarbonate unchanged. The tartrate of iron, of the London Pharmacopoeia, coagulated. The spinal marrow having become generally softened it was impossible to ascertain the existence again, contains this metal in the state of a persalt; of any particular softening at this part-there was no though occasionally plescribed, it is not, according to my appearance of bruising of its texture. The odontoid experience, found a preparation possessing much tonic process was firmly retained in its place, none of its liga- properties; that prepared by a process followed in Dublin ments having given way, nor were there any marks of contains a mixture of proto and pertartrate of iron, and fracture of the vertebrae, nor of laceration of their liga- will be found a more energetic tonic than the former. The aromatic mixture of iron, still in occasional use, ments, but there was an unusual degree of mobility between the third and fourth vertebrae, as though the again, contains chiefly salts of the peroxide (the tannate and gallate) with small quantities of proto salts, and ligaments had been stretched. This case is interesting in many points. It affords an possesses very questionable medicinal effects ; those, pro.instance of suicidal suspension in a person exhausted bably, arising from the salts of cinchonine and quinine, and debilitated by continued disease to such an extent as together with the aromatic ingredients entering into its to have rendered it very improbable that the necessary composition. exertion could be made without more noise and disturbThe sulphate of iron, another preparation in daily use, ance than here took place; but it is of more importance though not a pure protosalt of iron, will be found to ,to, notice that under circumstances where so little force possess very active tonic properties, which apparently could have been used there should have been so much seem to augment in the ratio of the quantity of metal injury about the spine. The body was not heavy, and present in the state of protoxide ; the bluish green acid, the fall, if any, could have been but trifling. The pecu- crystals containing the greatest amount ; the pale-green, liar position and direction of the cord, which were such neutral ones, being probably composed of a mixed oxide, ,that the force employed must have operated in bending combined with sulphuric acid; this preparation, likethe head and the two upper vertebrae abruptly back- wise, as is well known, often disagrees with the digestive .wards, will explain the cause of this effect upon the organs of many. The iodide of iron, as usually obtained from manufacspine. The only instance of suspension with which I
The
.jected
607 hint at the possibility of tubercular absorption, while the, adventitious deposit was as yet unsoftened. And the third contained three cases of consumption ia its very advanced stages, and were reported only to show how, at times, very unexpected results arise, even late ia this intractable malady Against any imputation ofabsm’d assumption, I thought I had pretty well guarded myself, by the few lines which succeeded the report of those three cases ; but as it apparently suits certain parties in our profession to be inspired with a holy horror of the man, who thinks that medicine, beyond the mere treatment of symptoms, can be of the least use in consumption. You will much oblige me by here appending, as a note, the paragraph I refer to.* Of the eleven cases reported under the first head, out died in October, 1842. Three of them I have been unable for a long time to trace. The remaining seven are, alive, and comparatively well, subject only to the occasional inconveniencies which result, and ever must result, from a condition of lung, partially impaired, and always prone to disease. In the majority of these seven, the physical state of the lung appears to remain stationary. The advantage gained has seemingly arisen from the non-extension of disease. One exception to this alone occurs in the case of Mary Lucas. The physical signs before reported are in character the same, but so far as the ear can contrast sounds at such a distance of time, they are less marked, and the inference from them less decided. At all events, she is robust and well. The last time I saw her was three weeks ago ; she then applied, in consequence of a slight but acute 11 cold," from which very simple treatment speedily freed her. Of three cases, contained in the second class, I can give an account of two only. The first, named Bull, was ia gentleman’s servant, and consequently of migratory habits ; I have not heard of him for two years. The second and third (Stanley and Vivers), are alive, and im the enjoyment, the one of good, the other of tolerable, health. Stanley was a young girl, who has since gone to service, and though still slender in form, and sallow in complexion, fulfils somewhat laborious duties without discomfort, and is free from pectoral symptoms. The second of the two (Vivers) is a highly nervous person, and liable to occasional attacks of hysteria, but presents no symptoms of pulmonic disease. In neither instance do the physical signs essentially vary now from those
is far from being a pure protoiodide, much peroxide, free iodine, mixed with a variable amount of the proto salt. Mr. Donovan, of Dublin, has recommended a process, published in the " Dublin Medical Press," which insures an almost genuine protoiodide. The acetate tincture of iron, much used on the other side of the channel, when properly prepared (which is a matter of much difficulty), will be found a most useful therapeutic agent, well agreeing with most persons requiring the use of this metal. From some researches of Dr. Aldridge, of Dublin, published in the 11 Dublin Journal," some years past, it would appear that this preparation contains a protoacetate of iron in combination with acetate of potass, !! which, from galvanic action, prevents the iron from passing into a higher state of oxidation, by its electro: positive condition. ’The green carbonate of iron, as found in the mistura ferri comp., contains a notable quantity of a proto salt; its very general efficacy need scarcely be adverted to. I may here notice the carbonate of iron with sugar, which seems to have the remarkable property of preventing further oxidation, it is, I believe, an efficacious tonic. And lastly, iron, as found in chalybeate waters, notwithstanding the inconvenient bulk of the menstruum, in the state of pure protoxide in combination with carbonic acid, is very generally allowed to be the most effectual
turing druggists, containing
ferruginous agent. On reviewing these several preparations, it will be apparent that their efficacy would seem to be in the ratio of
,
’
the proto salt present in each. What exact part iron plays in the process of sanguification remains to be discovered (it is to be hoped that this abstruse physiological question will, ere long, admit of elucidation, through the strides making in organic chemistry by the renowned Liebig, and other continental chemists), but the fact is certain, that the red particles of the blood are increased in a very apparent manner, and most probably this action, if not absolutely necessary, is facilitated by the metal being in a state of minimum oxidation. I have not noticed, in the above short review, the citrates, their chemical and therapeutic properties not having been yet sufficiently tested by the profession. Tunbridge Wells.
originally given.
ON THE USE OF ALKALIES IN CONSUMPTION. By J. S. CAMPBELL, M.D.
It would appear, therefore, that of fourteen cases which I reported nearly three years ago, and described as fair average examples of phthisis in its early stages, one only IN the year 1841, I published a work on the subject of is known to be dead, nine known to be living, and four Tuberculous Consumption, which THE LANCET reviewed whose fate is entirely unknown. Since then I have with some degree of favour in the nineteenth number of treated about four hundred more of the same kind, on the that Journal for 1841 -2. same principles, but must, at present, be content to say, I therein took occasion to enter on a good many points simply that results have, in my own belief, been highly connected with the pathology, as well as treatment of satisfactory. that formidable disease, but one of my leading objects I need scarce add, that one and all of the cases named was to express a strong belief in the value of an alkaline have been essentially treated by the caustic alkali, supertreatment, when perseveringly employed. Since that adding, as far as circumstances permitted, a close attenperiod I have not published a line on the subject, though tion to the various points of accessory practice, which I both my own additional experience and the reports I before attempted to lay in detail before the profession. In have received from others have gone far to confirm my the majority of examples there might be recommended former convictions. -without much hope of execution-pure air, light but In conformity with the usual practice, I then thought nutritious diet, proper clothing, and, equal to all, perit proper to illustrate my views by recording some cases, haps, a due regulation of stimulants, both in quality and taken from many others I might have printed; but I feel * « In 80 perfectly convinced that no plan of treatment in this reporting this and the two preceding cases, I disease ought to be received with any confidence, unless could desire most emphatically to disclaim any wish to have them considered as examples of what usually occurs a certain amount of permanence can be connected with presumed benefit, that up to this period, as already when an alkaline treatment is persevered in ; or of what indeed occurs under any treatment whatsoever; so far named, I have entirely abstained. On these grounds will oblige me by inserting this letter, chiefly intended to from this, these three cases are by far the most marked show how the cases, originally reported nearly three examples of benefit I have seen from treatment, when this was commenced after the second, or reactive stage of ye-trs ago, now remain. They were then arranged under three heads. phthisis had been fully established ; but even these few The first head contained eleven, presumed to be fair may, if properly viewed, hold out to us a useful lesson, examples of phthisis in its early stages. The sympathetic and direct our attention to a remedy, of whose efficacy as well as physical evidence on which I rested was there when employed early, I cannot entertain any doubt given. whatever."-(Campbell on Tuberculous Consumption, The second contained three only, my object being to p. 400.) ,
you