Volume 1

Treatise on therapeutics / A. Trouseau and H. Pidoux.

  • Armand Trousseau
Date:
1881
Catalogue details

Licence: Public Domain Mark

Credit: Treatise on therapeutics / A. Trouseau and H. Pidoux. Source: Wellcome Collection.

    15/316 (page 7)
    we hâve repeatedly seen patients whose death seemed to us due to the untimely use of préparations of iron. It is easy to see, a priori, that by increasing the stimulant properties of the blood in a healthy person, we prédisposé him to diseases to which he had no previous tendency. It is also easy to understand how a woman, whose blood bas lost three-quarters of the normal amount of globules, may, while sufiering from the accidents which belong to chlorosis, enjoy a ceitain immunity from the diseases which attack by preference persons whose blood is nch in these éléments. In some instances, women, though strongly predisposed by constitu- tion or inheritance, hâve escaped ail complaints of the chest for several years, while in a chlorotic condition5 but when subjected to treatment with iron, acute phthisis bas quickly followed the cure of the chlorosis. These are positive facts, and they hâve been so often repeated in our sight, that we now refuse to give the préparations of iron to chlorotic women, if they hâve previously had suspicious sÿmptoms of the chest, or hâve tuberculous parents. In these cases we try to support the strength by neurosthenic tonies, and we are not in haste to use iron, which often is speedily fatal. We desire not to be understood, liowever, as systematically excluding the préparations of iron from the treatment of pulmonary phthisis. It is important to dravv a distinction. We confidently State, as the resuit of many observations, that iron is usually injurious in the first period of this malady; we inean when the development of the tubercles is accompanied by pronounced phenomena of congestion or of irritation of the apparatus of respiration or circulation, as hæmoptyses, rough cough, fever with dryness of the skin, sharp pains in the chest, etc. In these conditions, iron, often given as an article of routine treatment, on account of the weakness and the poverty of blood, is formally contra-indicated, as is the tonie and analeptic regimen. But at a later stage the case is changed. If a patient, for instance, has been weakened by repeated or abundant hæmoptyses, and his expec- toration, sweating, diarrhœa, etc., hâve exhausted him, the iron prépara- tions will then be properly used, to give a little vigor to the languid digestive and assimilative functions. Unhappily, however, in these cases, iron loses a great part of the wonderfuL virtues which it possesses in chlorosis and in accidentai anæmia succeeding simple hæmorrhage. But, while it accomplishes nothing against the tuberculous diathesis itself, it is sometimes useful by helping the unhappy patient to struggle for a time with the cachectic state, which is more injurious to him than the local lésion. The greatest circumspection must be used in these cases. Circum- stances may seem imperiously to dernand the use of iron, but it will not alwavs be well borne, and in general, it is far from being so harmless as many practitioners imagine. These remarks apply with especial force