Ferrum. (Fe.) Iron (including also the acetate and carbonate). Triturations and dilutions.
IRON is present in nearly all the organs and tissues of the body in minute amount but the greater part is found in the blood and is an indispensable constituent of the haemoglobin. The amount estimated to be present is a healthy human adult is from 40 to 55 grains, and this quantity is maintained by absorption from the food of one twenty to one-sixth of a grain per diem, the same amount being excreted daily in the urine and faeces, but mainly in the faeces. Iron is absorbed fro m the duodenum and is excreted by the caecum and colon. The small amount excreted normally by the kidneys is not increased when large quantities of iron are given through the mouth. The greater part passes through the intestines unchanged and any increase in what is absorbed is stored in the liver, from which it slowly passes into the blood and is excreted by the bowel.
When iron is given in material doses its first effect is to stimulate the blood-making organs and increase the number of red corpuscles, but on prolonging the administration stimulation is followed by exhaustion, the red corpuscles and albumin are decreased, the blood becomes more watery and the condition of anaemia results. Coincident with the primary stimulation there is hyperaemia of the head, with sensations of fulness and throbbing, the face becomes red, the blood-vessels distended, and possibly, epistaxis occurs. The amount of hydrochloric acid in the stomach is increased and a sensation of warmth is experienced, there is anorexia or, more characteristically, the appetite becomes ravenous, eructations of gas and fluid of a greasy flavour or of mouthfuls of food,and pressive pain in the the stomach come on after and each meal. The abdomen feels sore, the liver and spleen are tender and diarrhoea of lienteric, watery blood-tinged and painless stool follows, accompanied by a certain degree of tenesmus. There are also tickling in the fossa navicularis and urging to urinate at the neck of the bladder. The eructations from the stomach excite a tickling cough, which in turn may cause vomiting. The pulse usually becomes slower and fuller and rather tense. The mind is excited, and mental and bodily energy are increased for a time. Ill-humor and intolerance of opposition and hindrances accompany the excitability. Afterwards weakness and fatigue follow with depression, loss of memory, and desire for solitude. The senses are hyperaesthetic till overpowering drowsiness succeeds this state. Throbbing all over the body and a tendency to haemorrhage display the erethistic condition of the circulation. When animals are poisoned with iron, breathing is first accelerated and then slowed and difficult, vomiting and diarrhoea occur and blood is seen in the evacuations of the stomach and bowel. Increasing weakness is followed by central paralysis and death, accompanied by weak convulsive movements, ends the scene. Post- mortem, the mucous membrane of the stomach and intestines is found to be swollen, congested and dotted with extravasated blood.
Anaemia.- Ferrum has had its chief place in therapeutics as a remedy for anaemia. In the orthodox school it has been given as a direct stimulant to the production of red blood-cells and their haemoglobin, and with undoubted success in large numbers of cases. It is in chlorosis and the secondary anaemias, in which the deficiency in more marked than the diminution of red blood- corpuscles, that it has been proved so valuable. In pernicious anaemia and in anaemias caused by toxins where haemolysis of the red cells is the main feature, iron is of little service. too long an administration of it may exhaust the recuperative powers of the blood and bring back an anaemia more troublesome to deal with than the original disease.
Ferrum has been found equally effectual ion anaemias when given in minute and even infinitesimal doses as when administered in the large doses of ordinary practice, but to be successfully used in these minute doses the cases must be carefully discriminated and the drug given on the indications furnished by the provings and supplemented by clinical practice. Bearing in mind the general action of the drug as given above we will fill in the picture from these sources as we proceed to the consideration of its employment in affections of the different parts of the body.
Head-The general mental excitability and liability to be unduly irritated and depressed have been already mentioned and we pass on to the headaches for which ferrum should be given. These are due to a determination of blood to the face and head, with vertigo,m worse on descending; red, flushed face, throbbing arteries, pressing or hammering pains, felt mostly in the forehead and temples, but also in the occiput, especially on coughing. the headache is worse from quick movement, noise and coughing and is relieved by pressure, by the open air and lying down. Belladonna has a hyperaemic headache accompanied by red face, intolerance of sound, worse from lying down and from not being associated with pallor of the mucous membranes, as is ferrum. the ferrum headache is usually a pseudo-hyperaemic one, that is to say, there is hyperaemia of the head with a deficiency of blood in all other parts: it is the kind of headache that follows large losses of blood, such as occur after menorrhagia and post-partum haemorrhage (china). the red face easily gives place to pallor, and while with belladonna the face is burning hot as red, the heat of the face with ferrum is not at all commensurate with its red colour, the cheeks are flushed but the lips and mucous membrane of the conjunctive and mouth are pale.
Digestion-The stomach affections for which ferrum is suitable are usually secondary to anaemia and certain indications should be present. there is a desire for ale, brandy and stimulants in general but especially for brandy, and an aversion from eggs and sour things: ravenous hunger is often present though sometimes there is an entire absence of appetite. Pressive pains are felt in he stomach after each meal and there are eructations, often tasting of rotten eggs, and mouthfuls of food may be regurgitated. Whilst eating, diarrhoea may compel the patient to leave the table. Sometimes the food of the day will be retained in the stomach and vomited about midnight. The vomiting is easy, sudden and painless. There is usually some colic, and diarrhoea may follow; it often occurs at night, consists of liquid stools containing undigested food, and is perhaps blood-tinged. The stools are accompanied by considerable urging and may be frequently repeated. Sometimes they consist of small, hard, greenish lumps that are evacuated with much effort. ferrum has been found useful in the prolapsus ani of when the modalities mentioned above are present, especially “diarrhoea coming on while eating,” and occurring after midnight.
In the urinary sphere ferrum has gained well-earned reputation for constant urging to pass water and inability to retain it, occurring in th daytime only, relieved by sitting and still more by lying down. In the form of ferrum picrate it is very useful in the irritability of the bladder due to an enlarged prostate, on which it appears to exert a favorable influence.
Respiratory- In the chest iron causes a feeling of oppression (phos), with a desire to breathe deeply, and slight stitches through the lungs. There is an irritable sensation in the larynx and behind the manubrium which excites hacking and cough, and vomiting may ensue. cough comes on after every meal. thee are mucous rales behind the sternum, viscid mucus is expectorated and perhaps black blood. Cough is worse from lying down (hyoscy., mang.). asthmatic breathing ,may be present, which is relieved by moving about. ferrum has been used in phthisis florida and in haemoptysis from suppressed menses.
Sexual- It is a remedy much employed for anaemic girls who are rendered so by menses that, though delayed, are too profuse and long tasting. It is also sometimes indicated in anaemia , where there is amenorrhoea. In another form of disturbed menstruation the periods are painful, preceded and accompanied by labour-like pains; the flow is watery, interspersed with lumps and may intermit fort a day or two and then start again, and varices in the legs when present are worse during the period. The patient is much exhausted after wards and is very likely to have a bad headache. Leucorrhoea is usual and is generally bland.
skin-acne of the head, face and neck has been benefited by ferrum.
In the circulatory system, besides the general erethistic state and the sensation of pulsation all over the body, attacks of palpitation occur which have the peculiarity of coming on while the patient is sitting and of being relieved by slowly walking about. In most cases the pulse is slow but full and of increased tension.
In the limbs are various neuralgic and rheumatic pains, notably of the shoulders and hips. The shoulder pains are in the deltoids, are worse from movement and too light covering and better from external warmth; those in the hip joint are as if bruised when touched and they shoot down along the tibia, they are worse in bed and compel the patient to get up and walk about (rhus). cramps of the calves occur, which are worse during rest, especially at night. Sitting still bring on a general restlessness of the limbs, which is relieved by slowly walking about. Edema of the ankles will be present in cases of anaemia.
Ferrum is a remedy for epistaxis when occurring in anaemic subjects with rush of blood to the head; it comes on most usually after rising.
In the fever for which it is suitable there are during the chill thirst, icy cold feet and red face (ign.) ; relief is obtained from eating. The patient feels worse during the sweat, which is copious and stains the linen yellow (graph). In all stages he is better from slowly moving about. Ferrum is an antidote for many of the complaints brought on from overdosing with quinine (puls) and from the immoderate use of tea (chin., selen., thuja).
Locally iron has been used as a styptic in the form of the perchloride. It acts by the formation of a plug of albuminate of iron which blocks the mouths of the patent vessels. Care should be taken that clot is removed and the oozing orifices exposed or the plug will not be formed in the right place. It is not a styptic much in use now. The sulphate of iron is sometimes used in massive doses as an astringent in diarrhoeas and dysentery.
(1) Redness of face, with pallor o mucous membranes
(2) Relief from slow motion
(3) Aggravation of complaints after midnight
(4) Blood-vessels distended; veins varicose.
(5) Complaints from haemorrhage or loss of animal fluids
(7) Haemorrhages of various kinds.
(8) Complaints aggravated or brought on by eating.
(9) Weak and complaining women and children when the face tends to become fiery red.
(10) Fever with sweat staining linen yellow
From sudden and quick motion, jar, cold air, eating I(except chill), eggs, brandy, sour things, tea, at midnight, during perspiration, while at rest esPecially while sitting still, descending (headache), coughing (headache).
From open air (headache), walking slowly about (puls), pressure (headache), solitude (mental symptoms), external warmth (except neuralgia of face, neck and teeth).