AN/EMIA: 
ITS TREATMENT BY A NEW PRE- 
PARATION OF IRON.* 
BY 
REYNOLD W. WILCOX, M.A., M.D., 
PROFESSOR OF CLINICAL MEDICINE AT THE NEW YORK POST-GRADUATE 
MEDICAL SCHOOL AND HOSPITAL, ASSISTANT VISITING 
PHYSICIAN TO BELLEVUE HOSPITAL. 
When one considers the frequency of pathological con- 
ditions of the blood, no apology is necessary for presenting a 
paper upon -this subject. These conditions are found in all 
grades and classes of people; the pampered daughter of the 
millionaire is no more exempt than the shop-girl; our foreign- 
born suffer equally as the native population. 
In the discussion of this question, I prefer to follow the 
classification of Oppenheimer and Graber: 
1. Simple Anaemia Where both the corpuscles and 
haemoglobin are diminished. 
2. Chlorosis: Where the corpuscles are normal and 
haemoglobin diminished (females). 
3. Primary Chlorosis or Pernicious Anaemia: Where 
the corpuscles are diminished and the haemoglobin relatively 
increased. Perhaps this might be better stated by saying 
that the percentage of decrease of corpuscles is greater than 
that of haemoglobin, which latter may fall to 20 per cent 
* Read before the Section in General Medicine of the New York 
Academy of Medicine, April 19, 1892. and reprinted from the New York 
Medical Journal, 1892, Vol. LV., p. 512. 2 
The symptomatic varieties of Ansemia may be due to many 
causes. 
1. Haemorrhage. 
2. Pathological discharges—e. g., prolonged lactation, 
sexual excesses, profuse menstruation, suppuration, albumin- 
uria, diabetes, watery diarrhoea. 
3. Malignant growths. 
4. Toxic and infective processes, such as the fata) 
cases of pernicious anaemia, reported by Koran, from car- 
bonic-dioxide poisoning; from tea, coffee, tobacco, alcohol, 
syphilis, tuberculosis, or myxoedema. Here should also be con- 
sidered those cases of auto-infection designated faecal anaemia 
by Sir Andrew Clark. 
5. Animal parasites. 
6. Obstacles to taking food which are mechanical, in 
their nature. 
7. Dyspepsia. 
8. Venous stasis in cardiac and pulmonary disease. 
9. Impaired sanguinification in diseases of cytogenic 
organs, malaria, leukaemia, or Hodgkin’s disease. 
10. Fever. 
Etiology: Predisposing causes: 
1. Sex. female. 
2. Age: infancy and youth, old age. 
3. Constitution: so-called irritable weakness. 
Exciting causes: 
1. Deficient supply of food. 
2. Want of light and air. 
3. Excess or defect of bodily exercise. 
4. Unusual states of temperature; hot or cold tempera- 
tures. 
5. Increased expenditure of unoxidized material, physio- 
logical discharges; menstruation cr lactation. 
6. Psychical influences: depressing emotions. 
The symptomatology of antenna may be divided into the 
General- dropsy, loss of body weight, fever. 
Alimentary: retching, vomiting, atonic dyspepsia, con- 
stipation, sometimes diarrhoea. 
Circulatory: palpitation, faintness, prsecordial distress, 
hiccough. 3 
Respiratory: dyspnoea, slight cough without expectora 
tion. 
Integumentary: pallor, hyperidrosis. 
Genito-urinary: polyuria, variable menstruation, sexual 
torpidity 
Nervous, irritable weakness, morbid hyperaesthesia; head- 
aches, tinnitus, neuralgia, convulsions, delirium. In regard to 
oedema, however, Benczkr and Csatasy found that in the 
anaemia of Bright’s disease the amount of haemoglobin was not 
consonant with that of oedema. 
The physical signs of anaemia are practically two, so far as 
the circulatory apparatus is concerned. 1. The bruit de didble 
of Bouillaud or the Nonnengerdusch of Skoda is due to slack- 
ness of the venous wall and a comparative emptiness of the 
vessels. This murmur is intensified with deep inspiration, 
arrested by forced expiration or coughing; it is better heard 
and is more musical when the patient is standing or sitting 
than when recumbent. The vibratory sensation, the fr/misse- 
ment cataire of Laennec is due to vibrations of the walls of the 
veins which are imparted to them by the vibrations of the 
blood. The muscular contraction produced by turning the 
head on its axis, strengthens the bruit; so does also light 
pressure of the stethoscope. The jugular veins can always be 
compressed by the belly of the omo-liyoid muscle, so that the 
presence of the murmur must be determined by an avoidance 
of these conditions. I prefer to accept Hamernyk’s theory, 
that these murmurs are produced by the whirling movement 
of the blood in the jugular bulb at the lower end of the in- 
ternal jugular veins, and that these veins have a different sized 
lumen along their course, and at the termination of the sinus 
venosus, which explains these eddies. 
2. The cardiac anaemic murmurs are due to functional 
disorder of papillary muscles, and are ventriculo-systolic. 
Balfour believes that these murmurs in the pulmonary area 
are really due to mitral regurgitation, which in turn is due to 
defective nutrition of cardiac muscle and dilatation of ventri- 
cular cavity, so that we may sav that in the lighter grades of 
anaemia the murmur in the neck is heard, as it becomes greater 
that in the second left intercostal space appears. When this 4 
condition becomes extreme, then we obtain intra-ventricular 
murmurs, and these are heard at the apex. It is interesting to 
note that in the following recorded cases, as the percentage of 
haemoglobin increased, the murmur at the apex was the first 
to disappear, with further improvement, that in the second 
left intercostal space followed, and wheu the percentage ap- 
proached the normal, the bruit de diable, last of all, vanished. 
The composition of the blood has recently received con- 
siderable attention. Gorup-Besanez states that the blood of 
man contains one part of iron to two hundred and thirty parts 
of red blood corpuscles, quoting the analysis of C. Schmidt. 
Schmaltz, in his investigations concerning the specific gravity 
of human blood, found that it varied from 1,059 in the male to 
1,056 in the female, the annual variation being only three 
one-hundreths. Ingestion of 1000 cubic centimeters of physio- 
logical solution of salt had a very short and feeble influence. 
The specific gravity may fall to 1,030 in ansemia and cancerous 
cachexia; it varies according to the haemoglobin it contains In 
serious disease of stomach, the mass of the blood itself is 
diminished on account of inanition. In phthisis and cardiac 
disease, its density is increased because of the slowing of the 
peripheral circulation. Jones finds a resemblance between his 
specific gravity curves and those of Leichtenstern for haemo- 
globin, and explains that the variations of these substances 
are closely related to those of specific gravity. Hence the 
determination of the haemoglobin by means of the color is 
accurate, because it is dependent upon the specific gravity and 
number of corpuscles. 
Meyer and Pernou found that the iron in the liver cells of 
a foetus was ten times greater than in a grown animal, showing 
that it might be stored there to provide for future growth. 
Jacobi injected iron in the blood vessels of dogs and rabbits 
and found that ten per cent, of it was excreted by bowels, liver 
and kidneys. Of that deposited, fifty per cent, was found in 
the liver, the rest in spleen, the kidneys, the walls of the intes- 
tine and other organs. It was all removed from the blood, 
however, in two or three hours after administration. The 
fact that the excess of iron is stored in the liver may be looked 
upon as a physiological, not a pathological process. 5 
In estimating the value of a remedy for the increase of the 
iron in the liajmoglobin, it is necessary that we should not trust 
entirely to the physical examination of the heart and the blood 
vessels, the color of the mucous membrane and of the skin, but 
also should have an exact method of measuring the haemo- 
globin in the blood. Daland has shown conclusively, what I 
have for some time more than suspected, that the methods of 
counting blooc-corpuscles, namely, Gower’s or the use of the 
Thoma-Zeiss liaemacytometer, give such variable results from 
the same specimen of blood, not only when examined by differ- 
ent observers, but as well when several portions are examined 
by the same observer, that the results are by no means satisfac- 
tory. Besides it is extremely trying work for the eyes, and I 
have for some time abandoned making estimations of( the 
number of blood corpuscles. In the haemoglobinometer made 
by Reichert, of Vienna, which I show, we have not only sim- 
plicity of operat ion, but, I believe, accuracy in ascertaining the 
amount of haemoglobin contained in the given specimen of 
blood. 
The technique of this instrument is simple; however, 
to insure accuracy of results, certain precautions must be 
taken. In the examination of the blood in the cases that I am 
narrating to-night, the time from 11 a. m. to 1 p. m. was 
selected. My light was a gas jet, four-foot burner, five feet 
distant. I made use of the same capillary tube for all exam- 
inations. The fingers from which the blood is taken, should be 
cleansed with ether and thoroughly dried. The cut was made 
with a sharp-pointed tenotomy knife. The blood should flow 
freely, and the wrork should be done quickly, so that clots do 
not form. The finger must not be squeezed. The capillary 
tube must be filled at one attempt. Use water for dilution at 
the temperature of the body, and clean the tube at time of 
using. Discharge the blood and water into the cell slowly, so 
as to avoid bubbles and marked meniscus at the edge, filling, 
however, both divisions of the cell to the same level. The water 
should be discharged with steady current, so as to thoroughly 
diffuse the blood into the menstruum. Turn the color-wedge 
from light to dark and note the reading, then lurn from dark 
to light and make a second reading, w hich should correspond 6 
with the first. Do not refer to a past record before an examina- 
tion. Above all things, the examination should be made 
quickly and neatly. In this method of recording our results 
we are unbiased by any statement of the patient, and are also 
independent of any deception in the estimation of the color of 
the mucous membranes, which readily simulates that of health 
in those cases, by no means infrequent, where a febrile reaction 
accompanies anaemia. 
In successfully treating anaemia it is necessary to fulfill 
the indicatio catisalis, thus presupposing a consideration of 
the subjects mentioned above. The indicatio morbi brings up 
the consideration of food, which should be nourishing and 
easily digested, mostly nitrogenous; exercise in the open air, 
the amount to be regulated; the breaking off of bad habits; 
and the treatment by remedies. 
In recent times it has been observed that the haemoglobin 
of the blood has increased after moderate bleeding. Dogiel, 
on the strength of experiments upon dogs, confirms the deduc- 
tions of Scholz that moderate bleeding, with say ten or fifteen 
leeches, does not alter arterial the blood tension, but if it is re- 
peated every three or four weeks the patient gains in weight 
and the number of blood corpuscles increases. Yogt and 
Schtcliberbakoff also found the haemoglobin to be increased 
under similar circumstances. Schubert treated a number of 
cases of chlorosis by blood-letting and hot baths. The vene- 
section was at the rate of seven to fifteen grains to the pound of 
body weight for each bleeding. The patient was kept in bed 
from twenty-four to forty-eight hours after the operation, and 
this treatment was repeated once or twice each year. The 
treatment with laxatives has at times been followed by so much 
success that Hamilton has said that if he were compelled to 
treat anaemia by either laxatives or chalybeates he would use 
the former. In Sir Andrew Clark’s theory that anaemia arises 
in a large number of cases from auto-infection—in other words, 
that a large number of anaemias are of faecal origin—there is 
certainly some proportion of truth; however, the most rigid 
and extraordinary antisepsis, which nowadays can be readily 
obtained by naphthaline, salicylate of bismuth, or beta-naph- 
thol, does not seem to meet with the success that we should 7 
expect, although quite recently Pick has professed to have 
obtained good results in chlorosis from this method. My own 
personal experience is, that it will succeed in only in a limited 
number of cases, so at the present time we can say that neither 
in blood-letting nor in laxatives, nor yet in securing intestinal 
antisepsis, can we hope to obtain so brilliant results as in the 
administration of iron. 
In giving iron we have, up to this time, been hindered by 
certain apparently insurmountable difficulties. The organic 
salts of iron have had but a limited use, owing to their com- 
parative inefficiency. The inorganic salts of iron have hitherto 
presented many disadvantages. Blaud’s pills, so much lauded 
and popularized by Niemeyer, certainly fail in a considerable 
number of cases. Notwithstanding the large amount of iron 
which one can administer in them, in many instances improve- 
ment does not follow their prolonged and uninterrupted ad- 
ministration. I am inclined to think that the potash is partly 
responsible for this, since it is, as we know, one of the agents 
that promote waste. The tincture of the chloride of iron 
has easily held the first place in popularity and efficiency. 
Combined with phosphoric acid, when well borne by the stom- 
ach, its therapeusis is unassailable. The formula of Flint has 
been for many years one of my favorites. The coated tongue, 
the feeble digestion, and constipation are supposed to contra- 
indicate the use of iron. I would rather say that these condi- 
tions call for a previous purgation and correction of the diges- 
tion, preliminary to a course of ferruginous treatment. On the 
other hand, I am quite as strongly opposed to the administra- 
tion of a laxative at the same time with iron, such as is fre- 
quently found in its association with aloes, because the metal, 
being slowly absorbed, requires a slow passage along the 
intestine. I believe that there is no doubt that large doses of 
iron are less constipating than small ones, but I do not believe 
that the final result—namely, the absorption—is so satisfac- 
tory. Iron is absorbed more rapidly in catarrhal conditions of 
the alimentary tract, and in those cases tends to accumulate in 
the liver. Castellino has found, in his experiments, that 
haemoglobin is absorbed rapidly, is always well borne, in- 
creases the number of red cells and the specific gravity of the 8 
blood, and improves the general condition. If the haemoglo- 
bin, however, is stopped before the normal condition is 
reached, its effect is only fugitive. In secondary anaemia it 
fails completely, in that its effects are only transitory. It is 
more rapid in its action than any other iron preparation. Ob- 
viously the use of this preparation will be extremely limited. 
The iron found in wines is too small to be considered, yet I 
am in the habit of prescribing wines, and especially Schrei- 
ber’s dietetic Tokay, for my patients. 
Since, then, we are of the opinion that iron is our sheet- 
anchor in the treatment of anaemia, and since all preparations 
hitherto used have been either inefficient or have presented cer- 
tain disadvantages, we come now to a consideration of a pre- 
paration which, I think there is no reasonable doubt, will revo- 
lutionize the treatment of anaemia, in that the objections to the 
strong preparations have been done away with. Dr. George W. 
Weld, of New York, realizing the great injury done to the 
teeth by the tincture of the chloride of iron, set about obtaining 
a preparation which, while retaining all the therapeutic effects, 
should present none of the disadvantages. After years of ex- 
perimentation, this preparation lias been put on the market by 
Parke, Davis & Co. under the name of Weld’s syrup of chloride 
of iron. - It was found with the officinal tincture that the acid 
would attack the enamel of the teeth, and, curiously enough, 
in Smith’s experiments, when two drachms of the tincture were 
added to an ounce of water, the destructive energy upon the 
calcium salts of the teeth was increased, and it was found that, 
of iron preparations the chloride was the most harmful, the 
syrup next, and the wine the least of all. Other preparations 
of iron, which are bland, are by no means so valuable as the 
tincture of the chloride of iron. I have tested, clinically, all 
the albumenates and peptonates of iron, and all are objection- 
able because, on the one hand, they are inefficient, frequently 
requiring administration for many months, and, in the second 
place, give rise to extremely bad-smelling flatus. If you add 
water to a simple solution of iron chloride, which is devoid of 
other acid, you get the basic salts of iron in free hydrochloric 
acid. Weld has shown that these basic salts of iron are not 
soluble in strong acids, so that they protect the teeth in the same 9 
way that alcohol and syrup do; when, however, water is added, 
these salts are dissolved and the acid then attacks the enamel. 
Thus it is seen that it is the free hydrochloric acid that is so de- 
tractive to the teeth. In Weld’s iron this excess of acid, which is 
unnecessary for perfect solution of the iron salt, is removed, and 
in no way does this impair the therapeutic value of the prepar- 
ation, because the hydrochloric acid is again added to it from 
the gastric fluids. It is easily assimilated, better tolerated than 
the old tincture of the chloride, because it does not produce 
nausea; gives rise to no disagreeable eructations; and contains 
no alcohol save that which is found in the tincture, of which 
one-half an ounce contains only twenty drops. The constipa- 
tion, which is noticeable with all iron preparations, is easily 
corrected by equal parts of fluid extract of cascara sagrada 
and glycerin the proper dose to be determined by experiment. 
Each fiuidounce of Weld’s syrup of the chloride of iron 
contains forty drops, equaling twenty-four minims, of the 
tincture of the clileride of iron of the United States Pharma- 
copoeia. It is not pretended that Weld’s syrup will not stain 
the teeth; soft-boiled eggs, salads, etc., will of themselves stain 
the teeth; but it can be asserted that Weld’s syrup will not 
injure the enamel of the teeth. On using a tooth-brush the 
surface is always found intact, even after month-long immer- 
sion in this preparation. Weld’s syrup of the chloride of 
iron is simply the tincture of the chloride of iron, United 
States Pharmacopoeia, with the excess of acid neutralized and 
a certain amount of syrup of gaultheria added to improve the 
taste. The following cases will illustrate its usefulness: 
Case I.—January 15, 1892.—H. B. C., United States, 
aged 24, single, no occupation. Glycosuric fourteen months 
ago. Under Martineau’s treatment sugar disappeared from 
the urine in three months, and has not returned. Has suffered 
from polyuria; the daily amount of urine sixty to ninety-five 
ounces. Complains of dull headache in the afternoon; suffers 
backache when walking, nausea and occasional vomiting, 
trembling; and pains in limbs. Slight cough without expec- 
toration, dizziness, and fainting spells. Dyspnoea which is 
marked on ascending stairs. Her diet has not been restricted. 
Physical Examination.—Pallor; lips bloodless, not cede- 10 
matous. Pulse 92, small and weak. Amemic murmur in 
right side of neck, also in second left intercostal space. Apex 
beat weak, otherwise normal. Liver easily felt at edge of 
ribs. No enlargement of spleen. Urine, ninety-four ounces; 
free from albumin, sugar, and casts. Specific gravity, 1.018; 
acid. Reichert’s liaemoglobinometer, seventy-eight per cent. 
Ordered Weld’s iron, two drachms three times daily. 
February 13th: Reichert's hoemoglobinometer, eiglity-five 
per cent.; quantity of urine, fifty ounces, normal. Anaemic 
murmur has disappeared from left intercostal space. Improve- 
ment marked as regards symptoms and faintness. Pulse good, 
82, and of fair volume. Ordered Weld’s iron, three drachms 
three times daily. 
March 14th: Reichert’s liaemoglobinometer, ninety-one 
per cent.; much improvement in headache and backache. No 
nausea nor vomiting; cough, however, still continues. Less 
dyspnoea; pulse 72, of good force; murmurs have both dis- 
appeared; urine sixty-two ounces. Ordered two drachms 
Weld’s iron three times daily. 
April 11th: Symptoms are entirely relieved. Urine fifty- 
five ounces, specific gravity 1.017, no sugar, albumin, bile or 
casts. Liver normal in size. Reichert’s liaemoglobinometer 
ninety-eight per cent. Discharged, cured. 
Case II.—January 19, 1892.—L. D., aged seventeen, 
single. Sick one year. Complains of headache, which is 
frontal, constant, sharp, but not enough to keep awake at 
night, sometimes worse in middle of day. Pulse weak. She 
is languid, disinclined to exertion, sometimes dizzy, but never 
faints. No cough; formerly palpitation, marked shortness of 
breath, hands and feet cold. No appetite, no distress after 
eating. Bowels regular every day. Catamenia anticipate two 
or three days. Flows four days, not profuse, of good color. 
No urinary or bowel symptoms. 
Physical Examination.—Pulse 72, weak, small, and of low 
tension. Tongue pale and flabby; teeth indent the edges. 
Bruit de diable in right side of neck. Ventriculo-systolic 
murmur in second left intercostal space. Apex beat weak, 
diffused, shortened, somewhat irregular in force and rhythm 
on exercise. Reichert’s liaemoglobinometer sixty-six per cent. 
Ordered Weld’s iron, two drachms three times daily. 11 
February 4tli: Headache yesterday; is now fourteen days 
over period. Pulse seventy-two, better. Still has anaemic 
murmurs. Reichert's haemoglobinometer seventy-six per cent. 
Ordered Weld’s iron, two drachms three times daily. 
February 23d: Has not felt quite so well during last week 
owing to loss of sleep caused by death of father. Pulse now 
weaker in force, rhythm is .good. Sounds at apex weaker 
also. Anaemic murmur not so loud as before; heard in neck 
and at second left intercostal space. Period last week as 
usual. Reichert’s haemoglobinometer eighty-four per cent. 
Ordered Weld’s iron, two drachms three times daily. 
28th: Has felt very much better since last report. An- 
a;mic murmurs cannot now be heard. Reichert’s haemoglo- 
binometer ninety-three per cent. Ordered Weld’s iron, three 
drachms three times daily. 
March 15th: Richert’s haemoglobinometer nirety-seven 
per cent. 
April 3d: Pulse 68, good; lips of excellent color. 
Richert’s haemoglobinometer one hundred and two per cent. 
Discharged, entirely well. 
Case III.—January 23, 1892.—M. McC., United States, 
aged seventeen, single. Sick three weeks. Vomiting con- 
stantly, whether stomach is full or empty. Vomits a whitish 
matter, never bloody. Pain in head, in both temples; not 
always present, but worse on vomiting. Dizziness on going 
up stairs, also dyspnoea. Short dry cough, which is slight; 
palpitation of heart on walking; appetite fair. Bowels very 
constipated, no urinary symptoms. Menstruation very irreg- 
ular, last three months ago, and continued two days, without 
pain; discharge pale and scanty. Sleeps well and is drowsy 
in day time. Has pains about heart. 
Physical Examination.—Tongue clean, pale, and flabby, 
Conjuncdvie pearly. Lips pale, no swelling of feet. Pulse 
90, feeble, compressible; slight amende murmur in right side 
of neck, also in second left intercostal space. Apex beat weak, 
with but little impulse. Reichert’s luemogl obi nometer sixty- 
three per cent. Ordered Weld’s iron, half an ounce three times 
daily. 
February 7th: Has felt better, headaches and dizziness 12 
better, shortess of breath less marked. Anaemic murmur in 
second intercostal space has disappeared. Reichert’s hoemo- 
globinomneter seventy-four per cent. Ordered Weld’s iron, 
three drachms three times daily. 
24th: Has not taken medicine for two days. Nausea has 
returned; heart sounds, however, are better. Reichert’s lisemo- 
globinometer eighty-eight per cent. Ordered Weld’s iron, two 
drachms three times daily. 
March 3d: No nausea, no vomiting; dizziness absent; 
very little shortness of breath. Pulse 72; of good volume and 
regular; no anaemic murmurs. Reichert’s liaemoglobinometer 
ninety-one per cent. Ordered Weld’s iron, one drachm three 
times daily. 
29th: Reichert's liaemoglobinometer ninety-eight per cent. 
Discharged upon patient’s statement that she feels perfectly 
well. 
Case IV.—January 24th, 1892, C. B., United States, aged 
eighteen, single; sick one year. Menstruation at thirteen, 
always irregular, recurring three to eight weeks, lasting five 
or six days, profuse. For last six months has had her periods 
every fourteen days lasting eight to ten days profuse, but 
little leucorrhoea. Headaches at times, constant, worse in 
morning. Dizziness, palpitation of heart, fainting on one oc- 
casion, fainting feelings frequently, shortness of breath on as- 
cending stairs, pain in stomach almost all the time, poor appe- 
tite of late. Pain under the right shoulder. As a rule food 
does not distress her. Bowels move regularly every day. Be- 
fore each menstruation there is an attack of diarrhoea. Loss 
of flesh and strength. 
Physical Examination.—Pulse 88, broad, weak, irregular 
in force and rhythm. Conjunctive jaundiced, pupils fully 
dilated. Lips pale, tongue clean and pointed. An anemic 
murmur in neck, but none in the second left intercostal space. 
At the apex there is a shortened first sound varying in inten- 
sity and irregular in rhythm. Reichert’s hemoglobinometer 
fifty-six per cent. Ordered Weld’s iron, three drachms, three 
times daily. 
February 14tlx: After an interval of sixteen days, she 
flowed six days, first three days are as usual, the last three 13 
there was an improvement. Pain during first day in stomach, 
some headache but less than formerly. Less pain in stomach, 
no diarrhoea. Reichert’s haemoglobinometer seventy-one per 
cent. Ordered Weld’s iron, two drachms three times daily. 
21st: Headache, dizziness, fainting feelings are all im- 
proved, appetite good. Reichert’s haemoglobinometer seventy- 
nine per cent. Ordered two drachms Weld’s iron, three times 
daily. 
March 12tli: At her last period she flowed six days; her 
head aches very little, dizziness better, there is no palpitation, 
nor fainting; no shortness of breath, and very little pain in 
stomach, food does not distress; pulse 72, heart beats stronger 
than at last report. The murmur in neck is less loud. 
Reichert’s haemoglobinometer eighty-seven per cent. Ordered 
Weld’s iron, two drachms, three times daily. 
22d: No murmur now heard, and she has greatly im- 
proved in appearance and feelings. 
April 4tli: No headaches; and she has slight dizziness, 
and is restless at night. Pulse 68, good. Reichert’s haemoglob- 
inometer one hundred and three per cent. Discharged well. 
Case V.—January 26th, 1892, E. H., Ireland, aged nine- 
teen, single Sick five weeks. She was a tea fiend. Vomited 
after eating, but not at other times. Pain in stomach before 
vomiting. The matter vomited is food unchanged. Belches 
wind. Bowels irregular, constipated, move two or three times 
a week, pain before movement, head aches in left frontal 
region, dizziness, shortness of breath on walking, violent 
palpitation on ascending stairs. Menstruation absent for two 
months, usually irregular, five to seven weeks, flows three 
days, color good, no pain. Has been losing flesh of late, and 
her appetite poor. 
Physical Examination.—Pulse 92, weak, compressible, 
small. Conjunctivse pearly. Tongue pale, tremulous, flabby. 
Anaemic murmur in neck, also in second left intercostal space. 
Apex beat and sounds normal. Reichert’s haemoglobinometer 
forty-nine per cent. Ordered Weld’s iron, three drachms three 
times daily. 
February 24th: No vomiting nor stomach pain, headache 
absent, palpitation and dizziness improved. Anaemic mur- 14 
mur in neck, also in second left intercostal space. Reichert’s 
hsemoglobinometer sixty-five per cent. Ordered Weld’s iron, 
two drachms three times daily. 
March 10th: Has returned to tea drinking and has some 
vomiting, otherwise improved. Anaemic murmur in second 
left intercostal space is now absent. Reichert’s haemoglobi- 
nometer seventy-eight per cent. Ordered Weld’s iron, two 
drachms, three times daily. Tea was forbidden.. 
15th: Considerable improvement; vomiting has com- 
pletely disappeared; murmurs now heard only in neck. Reich- 
ert’s haemoglobinometer ninety-one per cent. Ordered Weld’s 
iron, two drachms three times daily. 
April 12th. This patient has not yet reported, but, judg- 
ing from her improvement, she is now well. 
Case VI.—February 4th, 1892, L. C., United States, aged 
eighteen, single. Sick two weeks. Two weeks ago she had a 
cold in chest, cough, expectoration which was whitish, hard to 
raise. Dizziness, shortness of breath. In menstruation, con- 
siderable pain but nothing else unusual. Headaches on top of 
head, sometimes fainting feelings. Obliged to sit down sud- 
denly. Bowels very constipated. Poor appetite. Food dis- 
tresses her; nausea. 
Physical Examination.—Pulse 93, small, feeble, slightly 
irregular. Conjunctivae pale, pearly. Mucous membrane 
anaemic. Tongue coated, tremulous and flabby; anaemic 
murmur in neck and second left intercostal space and rough- 
ened respiration. Reichert’s haemoglobinometer fifty-two per 
cent. Ordered Weld’s iron, three drachms three times daily. 
18th: Much improved, but still is weak; shortness of 
breath and headache still present, but not so marked. Cough 
and expectoration less; appetite much improved; bowels now 
regular; food does not distress her. Pulse 90, of fair volume, 
respiration normal; anaemic murmur in second left intercostal 
space less marked. Reichert’s haemoglobinometer seventy per 
cent. Ordered Weld’s iron, three drachms, three times daily. 
March 15th: Murmur heard only in neck, and that is not 
marked; slight cough, dyspnoea absent. Reichert’s haemo- 
globinometer eighty-two per cent. Ordered Weld’s iron, two 
drachms, three times daily. 15 
April 6th: Feels perfectly well. Reichert’s hsemoglo- 
binometer ninety-five per cent. Iron to be continued in same 
dosage for two weeks. Discharged from observation. 
Case VII.—February 12, 1892. S. M. F., United States, 
aged thirteen, single. Sick one year. Complains of headache, 
dizziness, languor for several months; fair appetite; sweets 
easily coat tongue; constipation, sometimes palpitation. Cold 
does not result in cough, but tonsils rapidly enlarge. Has not 
menstruated. 
Physical Examination.—Pale, skin soft, easily grasped, 
blue veins showing on forehead. Conjunctivae pearly; lips 
pale; mucous membrane the same. Anaemic murmur in 
neck, also in second left intercostal space. No pulmonary 
signs; abdomen full. Scapulae prominent. Expansion one- 
half inch in chest, showing thirty-six inches on expiration; 
muscles soft. Pulse 78, weak. Reichert’s haemoglobinometer 
ciglity-three per cent. Ordered full diet, pulmonary gymnas- 
tics, and Weld’s iron, one drachm, three times daily. 
March 7th: Great improvement in appearance as regards 
muscles, but still anaemic murmurs are present. Abdomen 
less protuberant; scapulae less prominent. Reichert’s haemo- 
lobinometer eighty-seven per cent. Ordered Weld’s iron, two 
drachms, three times daily. 
21st: Chest expansion two inches, in expiration its 
measurement is twenty-nine inches. No murmurs. Cheeks 
and lips of good color, pulse 72, good. Reichert’s haemo- 
globinometer ninety-two per cent. Ordered Weld’s iron, two 
drachms, two times daily. 
April 10th: Chest expansion, two inches, in expiration 
its measurement is twenty-nine and one-half inches. Feels 
very well. Reichert’s haemoglobinometer ninety nine per cent. 
The iron discontinued. 
Case VIII.—February 8, 1892: M. S., France, aged 
thirty-two, widow. Sick one month. Always healthy; for 
last month headache in temples, constant; sleep interrupted 
by it. Vomiting of food and mucus for two days; some 
pain in stomach; poor appetite; bowels regular every day. 
Of late some dry cough; palpitation on exertion, never 
dyspnoea. Loss of flesh; no swelling of feet; sometimes 
fainting feelings. 16 
Physical Examination.—Tongue pale and flabby; mucous 
membranes pale; anaemic murmur in neck, also in second 
left intercostal space; apex sounds weak, pulse 90 and weak. 
Menstruation regular, but scanty and pale. Reichert’s haemo- 
globinometer sixty-six per cent. Ordered Weld’s iron, two 
drachms, three times daily. 
22d: Less headache and vomiting; palpitation now sel- 
dom; no fainting, pulse 88, heart sounds better, though appe- 
tite still poor; no murmur in second left intercostal space. 
Reichert’s liaemoglobinometer eighty-five per cent. Ordered 
Weld’s iron, three drachms, three times daily. 
March 16th: Appetite has much improved. Pulse 72, 
good. Reichert’s haemoglobinometer ninety-six per cent. 
Ordered Weld’s iron, two drachms, three times daily for two 
weeks and then report if not perfectly well. 
Case IX.—February 11, 1892: E. S., United States, aged 
nineteen, single; sick six months. Cough, not severe, does 
not keep her awake at night; no vomiting; expectoration 
whitish, scanty and easy to raise, generally only in morning; 
palpitation of heart; shortness of breath, however, is absent. 
She has lost flesh and more strength; headaches, which are 
constant. She never faints; has cold hands and feet, but no 
dizziness; appetite good, food does not cause distress; consti- 
pation; has no menstrual symptoms except scanty flow and 
cramps. 
Physical Examination.—High-pitched inspiration and ex- 
piration at right and left apices; whispering bronchophony; 
crepitant rales down to upper border of third rib; rest of 
chest normal. First and second sounds of heart accentuated. 
Anaemic murmur in neck, slight; soft-blowing ventriculo- 
systolic murmur at apex. Pulse 72, weak but regular. Lips 
pale, cedematous; mucous membranes pale. Reichert’s haemo- 
globinometer, seventy-one per cent. Ordered Weld’s iron, 
three drachms three times daily. 
February 25th: Cough improved; expectoration yellow- 
ish. No palpitation or shortness of breath. Feet now cold, 
but not the hands. Has had no menstruation since January 
15th. Pulse 66, of better volume; lips not so pale. Reichert’s 
haemoglobinometer, eighty-five per cent. Ordered Weld’s 
iron, three drachms three times daily. March 10th: Has but little cough and scanty expectora- 
tion. No coldness of feet. Has menstruated since last report, 
color improved, otherwise no change. No murmurs either in 
neck nor at apex. Reichert’s haemoglobinometer, ninety-four 
per cent. Ordered Weld’s iron, three drachms three times 
daily. 
23d: Feels first-rate; no headaches, no coldness of hands 
or feet. Pulse 68, good. Inspiration less high-pitched; no 
wliisphering bronchophony; no rales. Pulmonic second sound 
slightly accentuated. Reichert’s haemoglobinometer, one 
hundred and two per cent. To stop iron; discharged well. 
Case X.—Feb. 11th, 1892: M. O’B., United States, aged 
seventeen, single. Sick five weeks. Suffered from chorea 
three years ago, with repetitions each spring. Constant head- 
aches at vertex which keep her awake at night. Shortness of 
breath on exertion; palpitation, which is fluttering, on ascend- 
ing stairs; also pain about waist; frequently fainting, dizzi- 
ness, sometimes ringing in ears; appetite poor; food distresses 
after eating; nausea, but no vomiting; bowels regular; cold 
hands and feet. No disturbance in menstruation, except 
cramps. The feet swell; also face. 
Physical Examination.—Lips pale, oedematous. Pulse 96, 
weak and irregular. Anaemic murmur in neck, also ventriculo- 
systolic murmur at second left intercostal space and at apex. 
Reichert’s haemoglobinometer, fifty-one per cent. Ordered 
Weld’s iron, three drachms three times daily. 
February 25th: Slight chorea in left side of face and left 
arm. Headache better; do not keep her awaac nights, as 
present. No pain nor palpitation of heart; dizziness on two 
occasions; feet still cold; has not been unwell for five weeks; 
feet do not swell, neither does face. Pulse 84, more regular. 
Murmurs still present. Reichert’s haemoglobinometer, seventy- 
two per cent. Ordered Weld’s iron, two drachms three times 
daily. 
March 17th: Menstruation since last report; but not un- 
usual. Shortness of breath improved. No palpitation1} 
Appetite good; no distress after eating. Pulse 72, still weak. 
Murmur at apex very faint. Chorea diminished. Reichert’s 
haemoglobinometer, eighty per cent. Ordered Weld’s iron, 
two drachms three times daily. 
17 18 
30th-, Chorea less marked. Murmurs only in neck. 
Pulse 68, better force. Reichert’s haemoglobinometer, ninety- 
one per cent. To continue with Weld’s iron for one month. 
Case XI.—February 14th, 1892: A. C., United States, 
aged twenty-one, single; sick four years. Tubercular family 
history. For last two years has been subject to colds. Cough 
usually not marked, save in the morning; no expectoration; 
appetite poor; never distressed after eating. She sometimes 
complains of dizziness and faintness; sometimes dyspnoea and 
palpitation, especially on exertion. Four years ago she had 
infiltration of right apex, which was presumably tubercular. 
Physical Examination.—Slight dullness over right apex; 
increased transmission of voice sounds, especially the 
whispered voice; markedly high-pitched and prolonged in- 
spiration; no rales. Pulse 92, weak. Pupils dilated, con- 
junct vae pearly. Anaemic bruit in neck on right side; no 
heart murmurs. Reichert’s haemoglobinometer, fifty-three 
per cent. Ordered Weld’s iron, three drachms three times 
daily. 
March 7th: No cough; appetite good; no dizziness, no 
faintness, no shortness of breath and very little palpitation, 
save on ascending stairs; no headaches. Her food does not 
distress her after eating; bowels regular every day. Reichert’s 
haemoglobinometer, seventy-one per cent. Ordered Weld’s 
iron, two drachms three times daily. 
20th: Appetite excellent; feels generally better. Pulse 
68, good. Lips, good color; no anaemic bruit in neck, and all 
pulmonary signs have improved markedly, Reichert’s hoemo- 
globinometer, eighty .eight per cent. Ordered Weld’s iron, 
two drachms three times daily. 
April 10th: Has markedly improved. Pulse 66, good 
force and volume. Reichert’s haemoglobinometer, ninety-nine 
per cent. Ordered to omit all medication. 
Case XII.—February 16th, 1892. K. M., United States, 
aged nineteen, single. Sick three months. Always well until 
this. Complains of shortness of breath on exertion, palpita- 
tion of heart; throbbing in epigastric region, and sometimes 
coldness of hands and feet; headaches on top of head, con- 
stant, but worse on being tired; dizziness, sometimes weak 19 
and fainting spells. She has no cough nor expectoration, no 
swelling of feet; is regular in menstruation, pain before flow 
for three days, flow becoming more scanty and pale; appetite 
good, bowels constipated, no distress after eating. 
Physical Examination.—Pulse 103; weak. Skin and con- 
j unctivae pale. Tongue clean, tremulous, and flabby. Loud 
anaemic murmur in right side of neck. Rough blowing mur- 
mur in second left intercostal space. First sounds of heart 
weak; tenderness of liver, but no enlargement; spleen 
normal; no pulmonary signs. Reichert’s haemoglobinometer 
forty-six per cent. Ordered Weld’s iron, three drachms, 
three times daily. 
March 15th No shortness of breath, palpitation improved, 
feet still cold; has had one attack of headache which lasted 
three days; no fainting. Last menstruation was, as usual, of 
scanty flow with pain. Appetite has markedly improved; an- 
aemic murmur in neck and second intercostal space still present, 
although not so loud. Reichert’s haemoglobinometer sixty-two 
per cent. Ordered Weld’s iron, three drachms, three times 
daily. 
March loth: Shortness of breath the same; headaches 
improved, also palpitation. Pulse 71, good. Reichert’s hae- 
moglobinometer seventy-four per cent. Ordered Weld’s iron, 
one-half ounce, three times daily. 
April 2d: Has no symptoms excepting occasional head- 
aches. Pulse 68, good. No murmurs. Reichert’s haemoglo- 
binometer ninety eight per cent. Patient discharged well. 
In making an analysis of these cases, we may say that the 
cause of the anaemia in Case I was a state of malnutrition fol- 
lowing diabetes and arising in the liver. Cases II, VI, and XII 
evidently became anaemic through overwork, loss of fresh air 
and sunlight. Case IV is accounted for by the menorrhagia 
from which she suffered and which was cured during the last 
week of observation by curetting of the uterus under ether; 
her improvement, however, dated from the commencement of 
the treatment by iron. Dyspepsia evidently was the cause of 
the anaemia in Case III, which could well be named as one of 
Sir Andrew Clark’s faecal anaemias. I believe that the cure 
was obtained quite as readily with the administration of iron 20 
as it would have been with beta-naphthol, and I speak after 
considerable experimentation with intestinal antiseptics. Case 
X developed her usual spring chorea while under treatment, 
yet the attack was mild and improved rapidly. Case V was a 
tea fiend, and a great portion of the result could be justly as- 
signed to the breaking off of the habit. Cases VI, IX, and XI 
were of the tubercular diathesis, and Case VII should be added 
here, as the condition was one of hypotrophy such as has 
recently been described by Solis-Cohen. Iron, when change 
of life, scene, and habit can be obtained, is certainly a most 
valuable prophylactic. In all these cases outdoor exercise was 
insisted upon, for iron to be of the most value must be 
sunned; regular hours for sleep and meals, and a nitrogenous 
diet prescribed, and the bowels regulated by cascara sagrada 
and glycerin. 
1. In anaemia, iron is by far the best remedy. 
2. Of all preparations, the tincture of the chloride is the 
most valuable. 
3. This preparation is objectionable in that it excite* 
nausea, disgust and vomiting, stains and destroys the teeth. 
4. These disadvantages are obviated in Weld’s Syrup 
of the Chloride of Iron. 
5. In removing these disadvantages, it# therapeutic 
efficacy is not in any way impaired. 
(190 Madison Ave., April 12th, 1892. 
CONCLUSIONS. 
Dr. George W. Weld said that the preparation was practi- 
cally non-alcoholic; the only alcohol in the syrup, so-called, 
was the alcohol contained in ordinary tincture of chloride of 
iron, each half-ounce containing twenty drops. Regarding 
the name of syrup of chloride of iron, when one came to taste 
it, one would discover that it was not a syrup in the sense of 
the other syrups, which, as everybody knew, were apt to de- 
range the stomach. In regard to its acidity, it is acid in 
reaction, and necessarily so to hold the basic salt of the iron in 
solution, for the moment any solution of iron was brought to 
DISCUSSION. 21 
a neutral point there would be precipitation of the basic salt, 
which in this case would be the hydrated oxide. The syrup 
was not acid enough to destroy the enamel of the teeth or to 
cause nausea or vomiting. Strictly speaking, there were five 
ingredients in the preparation—iron, saccharine matter, alcohol, 
oil of gaultheria, and an alkali used to neutralize the free 
drochloric acid. The oil of gaultheria and the hydrochloric 
acid were present in a very small percentage. Practically, 
then, there were only three ingredients—the alcohol, the iron, 
and the syrup. Some six or eight years before, in experiment- 
ing with tincture of chloride of iron, the speaker had placed a 
tooth in the tincture, and, on taking it out, after three hours, 
been very much surprised that the enamel was not destroyed 
in the slightest degree, because he had heard a great deal about 
the injurious effects of this particular preparation. He had 
thought it very strange, and had concluded there must be 
some mistake, but, in order to make sure, he had left it in for 
twenty-four hours, and on taking it out had again found that 
the enamel was not at all injured. Then his attention was 
called to an old experiment—that of putting zinc into strong 
sulphuric acid, when the zinc was not harmed in the least, but 
the moment water was added there was an immediate and 
powerful effect of the sulphuric acid. He then added some 
water to the tincture of chloride of iron and put the tooth 
into it. The enamel was entirely destroyed. [The speaker 
showed a number of teeth that had been immersed in solutions 
of tincture of chloride of iron of various strengths, which 
strikingly illustrated the destructive action upon the enamel.] 
Dr. A. H. Elliot said that his interest in this subject was 
purely from a chemical standpoint. Some six or seven years 
before, Dr. Weld had gotten him interested in his endeavors to 
counteract the injurious action of tincture of chloride of iron 
upon the teeth, and, in order to get a thoroughly good idea of 
what he was working upon, he han made an examination of a 
lot of enamel of teeth, in order to see the kind of material that 
was being acted upon by tincture of chloride of iron. Then 
his attention was called to the fact that acids generally acted 
very rapidly upon this enamel; in fact, as near as he could 
remember, one of the first experiments of the kind had been 22 
with a five-per-cent, solution of acetic acid—pretty good 
vinegar. In that case the teeth were attacked to such an ex- 
tent that about five or six per cent, of the enamel was dissolved 
by this simple acid. Other acids would destroy the enamel as 
well, the effect varying with the strength, provided, of course, 
there w as no grease or alkali oh the teeth to protect them. 
Then Dr. Weld had called the speaker’s attention to the fact 
that he had concluded that he could add Vichy water to the 
tincture of chloride of iron, and thus counteract the acidity. 
Although this had rather amused him as a chemist, neverthe- 
less he had done it, and had found out afterwrard by making 
experiments that he could neutralize the free hydrochloric acid 
in the tincture of chloride of iron by adding bicarbonate of 
sodium, w hich Dr. Weld was practically doing by the addition 
of Vichy water. By adding too much bicarbonate of sodium 
the point of neutrality would be passed, and the solution 
would then, or course, become distinctly alkaline. This 
naturally would not do, as precipitates w ould be thrown dowm, 
and the preparation be made entirely useless. It became 
necessary, therefore, to add the bicarbonate of sodium very 
carefully so that only the free hydrochloric acid would be 
neutralized, but the solution will be acid in reaction, in order 
to hold the salt of iron in suspension. The difficulty that Dr. 
Weld had met with in using Vichy wrater, or, rather, the diffi- 
culties, as there were two, had been, first, that he did not know 
the strength of the tincture of chloride of iron, for, although 
the druggists said it wras made according to the United States 
Pharmacopoeia, we all knew that there were variations in the 
amount of the free acid. In the second place, he did not know 
the strength of the Vichy water, so he could never tell just 
how much Vichy water to add to the tincture of chloride of 
iron, unless he had the Vichy water analyzed every time. So 
that this method of counteracting the corrosive action of the 
tincture of chloride of iron was not always successful, although 
it could be used in a number of cases, and he did use it in that 
way. The speaker had then thought that, if one could use 
the bichloride of sodium carefully and find out how much to 
add to a stipulated amount of tincture of the chloride of iron, 
the free hydrochloric acid could be neutralized, and yet the 23 
preparation still retain its acidity. Tliis saturation point had 
been found and syrup of gaultheria added. The speaker still 
had a preparation of tincture of chloride of iron that had been 
treated by this method several months before, and there was 
not the slightest evidence of precipitation of any of the in- 
gredients of the solution, whereas preparations of tincture of 
chloride of iron treated with Vichy w ater would precipitate if 
kept for any length of time. 
He had obtained from various places in the city a number 
of samples of tincture of chloride of iron from pharmacists 
who were reliable. The actual amount of the solid chloride 
of iron averaged from 8.6 to 14.7 percent.; so one could im- 
agine what the preparations were. According to the United 
States Pharmacopoeia, tincture of chloride of iron should con- 
tain about thirteen per cent, of the dry chloride. The acid 
over and above that necessary for the solution of the iron in it 
—for it must be remembered that metallic iron required a cer- 
tain amount of hydrochloric acid to clear it—averaged from 
nothing in one to a sample which contained ten per cent, more 
than was necessary. A sample of syrup of chloride of iron 
obtained in the open market had been handed to him, and he 
had found no free acid in it, but more bicarbonate of sodium 
than appeared to be necessary. This had caused a curious 
chemical phenomenon to take place in the syrup—namely, the 
hydrochloric acid had acted on a portion, with the result that 
sodium chloride had been formed. But this had resulted in 
this one .preparation of the syrup, something that had been 
entirely unlooked for, but that added to the efficacy of the 
syrup, for in this preparation there were the bicarbonate of 
the sesquioxide of iron and the protochloride of iron—a very 
curious and happy outcome, from a chemical standpoint. 
Dr. J. C. Smith had used Reichert’s luemoglobinometer 
for several months at the same time with Gowers’s, and was 
positive that the first-named instrument is not only more accu- 
rate in results, but also far easier of manipulation. 
Dr. A. S. Dana spoke of a patient who, on March 2d, had 
been suddenly attacked with a severe chill, followed by very 
acute pleuritic pain in the left side. At the end of two weeks 
a purulent collection broke into the bronchial tubes, and large 24 
quantities of pus were evacuated. The patient w as very much 
emaciated, and liis anaemic condition became extreme, with 
severe cough, profuse night-sweats, and a very irritable stom- 
ach. He was immediately put on the use of tablespoonful 
doses of syrup of chloride of iron every four hours, and the 
dose was increased to three tablespoonfuls, with gratifying 
results. The cough was relieved to a great extent, the anaunic 
condition wTas rapidly improving, the stomach took kindly to 
the iron, and the patient was on the road to rapid recovery. 
He had been taking during the proceeding two weeks an 
amount averaging seven ounces and a half of the syrup every 
twenty-four hours, without any stomach irritation. The 
speaker mentioned also the case of a child, three months old, 
that had pronounced diarrhoea, milk passing through with the 
stools in an apparently undigested condition. The abdomen 
was much distended, and there were nausea and vomiting. 
After using the usual remedies with no apparent effect, the 
speaker had resorted to Weld's syrup of chloride of iron 
giving teaspoonful doses every twTo hours. The improvement 
was marked, almost from the beginning, the nausea and vomit- 
ing were checked, the tympanites subsided, and the com- 
plexion of the child entirely changed for the better. In a 
number of other cases he had had unusual success with the 
syrup. 
Dr. C. E. Quimby called attention to a preparation of 
ozone, and said he believed it was now possible to make a 
permanent solution of ozone in a neutral menstruum.