A CONTRIBUTION TO THE 'Imtinic Properties of Dialized Iron BEING EXTRACTS FROM COMMUNICATIONS READ BEFORE THE BOSTON SOCIETY OF TEE MEDICAL SCIENCES AND TIIE BOSTON SOCIETY FOR MEDICAL OBSERVATION. BY ROBERT AMORY, M. D. Or Longwood, Mass. [Reprinted from the Boston Medical and Surgical Journal, April 3d, 1879.] PHILADELPHIA: Lehman & Bolton, Lithographers, Engravers and Printers. 1881. 4- 3 17 6 15 23 1 10 13 21 24* 2 20 16 5 8 9 22 12 27 7 18 lO 28 14- 25 26 11 TN reproducing the very interesting and valuable paper of Dr. Robert Amory, we present to the medical profession positive and scientific testimony to the efficiency of Dialyzed Iron, as made by us, in enriching the blood. We point, with what we think is pardonable pride, to the accumulated evidence of the therapeutic value of this preparation— evidence from all sections of our own country, from Great Britain, Canada and South America. Many practitioners, who had been led by the failure of other methods of administration to abandon the use of iron, have, upon our positive assertions, been induced to make trial of this article, and have found it in the highest degree satisfactory. We have devoted much time and attention to the subject, and have spared no expense in developing this manufacture. We have examined samples of that furnished by other makers, and confidently claim that they are without exception inferior to that which we offer. Hence, we ask physicians who wish to employ this valuable thera- peutical agent to be particular in specifying “Wyeth & Bro.’s Dialyzed Iron.” [copy.] Longwood, Mass., April p, i8yp. Messrs. Wyeth & Bro. Dear Sirs:—In answer to your inquiry as contained in your note of yesterday, I will say that in the experiments which are detailed in the Boston Medical and Surgical Journal for April jd, I used only the solution of Dialyzed Iron manufactured by your firm. Yours, respectfully, (Signed,) R OBER T A MOR Y EXPERIMENTS AND CLINICAL OBSERVATIONS ON THE Htmatinic Properties of Dialyzed Iron* ROBERT AMORY, M. D. Gowers’s hsemacytometer, the instrument I used in the following observations, consists of a glass slide, upon which are ruled squares one- tenth of a millimetre in extent, and these are inclosed in a cell one-fifth of a millimetre in depth. This slide can be used with any microscope, and with a lens of any desirable magnifying power; moreover, the magnified image of the slide may be projected, by means of a prismatic eye-piece, upon a screen. The principle of Malassez’s “ compte-globule ” does not admit of either of these convenient methods of delineation. In addition to the ruled slide, there are two pipettes, one of which holds nine hundred and ninety-five cubic millimetres, and the other five cubic millimetres. The principle and method of using this instrument are, then, based upon the following facts: If a known measure of blood be carefully drawn from an acupuncture, and intimately mixed with two hundred times its volume of a saline solution (specific gravity 1025), having a density sufficient to prevent the corpuscles from imbibing water, and so bursting their envelopes, these corpuscles, separated from each other, will float in this mixture, and will finally settle down to the bottom of the containing vessel or dish. In this manner a small portion of the mixed or diluted blood is placed in the above-described cell, and the corpuscles are allowed to settle to the bottom, so as to be nearly on the same plane as the ruled lines, and are pretty uniformly distributed. The number of corpuscles in ten contiguous squares can then be readily counted, and this sum multiplied by the figure ten thousand will give the number of corpuscles in each cubic millimetre of the pure or originally drawn blood; because ten cubes, each one of which has the dimensions tVxtVxP millimetres, (or -j-i-g- of a cubic millimetre), will contain of a cubic millimetre, and since the original blood was diluted with two hundred volumes, the number of corpuscles actually counted in the ten squares must be multi- plied by two hundred times fifty, or ten thousand, in order to obtain 1 Read before the Boston Society of Medical Sciences, January 21,1879, and the Boston Society for Medical Observation, March 17,187j. Hoematinic Properties of Dialyzed Iron. 3 the number in each cubic millimetre of undiluted blood. If we wish still further to separate the corpuscles from each other, we may use four hun- dred volumes of the diluent to one of the blood, but in that case we must either count the corpuscles in twenty squares and multiply by ten thousand, or count those in ten squares and multiply by twenty thousand. The individual or personal error of vision which is associated with all optical instruments is, perhaps, somewhat difficult to reduce to mathe- matical accuracy, on account of the fact that constant observation fatigues the eyesight, and hence the results of a series of these observations are subject to an inconstant variation. In consequence of this apparent difficulty, I decided to project upon a photographic plate the image of the corpuscles on the ruled slide, then to print from the negatives, and count upon the print the number of these corpuscles, each one being obliterated as soon as counted. To show the range of error of this method of obtaining the propor- tion of globular richness of the blood, I will call your attention to the prints Nos. 1, 2, 3, 4, which were all taken from blood of the same individual from four different punctures, separately diluted, and a sample from each dilution separately photographed. No. 1 shows 4,656,000 corpuscles per cubic millimetre.1 No. 2 “ 4,750,000 No. 3 “ 4,633,000 No. 4 “ 4,673,000 “ “ • The greatest difference between these four results being only 117,000, shows less than three per cent, of variation. Again, in three separate jjhotographs, taken from one sample on the same slide, a field at either periphery, and at its centre, the variation was even less than that above mentioned. Thus, so far as this method is concerned, the error of varia- tion may be placed within three per cent. Hearing from certain members of our profession expressions which indicated a skeptical distrust in regard to the virtues of the solution of dialyzed iron, I was induced to undertake a series of observations upon the hoematinic properties of this medicinal agent, and yet I must frankly acknowledge in advance that my own clinical experience with this form of iron had led me to attach to it a value in simple anaemia, and to place this remedy by the side of Quevenne’s Iron. I have taken pains to inquire how much metallic iron is contained in the so-called dialyzed iron, and learn that a sample of the scaled dialyzed iron, as prepared by one of our large wholesale druggists, has been analyzed by Prof. Charles M. Cresson, of Philadelphia, and that he found it to contain fifty-two 1 A reference to the prints will show not more than sixteen squares represented. On the original photographic prims presented at the meetings the count gave an average for twenty- five or thirty squares. To have reproduced this number of squares in each heliotype print would have required too much room. Hence a discrepancy between the numbers of corpuscles mentioned in the text and what may be counted in the illustrations may be explained. 4 Properties of Dialyzed Iron. per cent, of metallic iron, or over seventeen per cent, more than is con* tained in the sesquichloride of iron ; compared with the sesquichloride, it is equally soluble, keeps without change, does not corrode the teeth or fabrics with which it may be brought in contact, and contains a greater percentage of iron. The manufacturer from whom this sample was obtained claims that his solution of dialyzed iron has over twenty grains of ferric oxide in each ounce of solution, and in proof of this has shown me a certificate from Prof. F. A. Genth, of the University of Pennsylvania, that a sample of his manufacture, which was purchased by the latter from a retail druggist of Philadelphia, contained 21.69 grains of ferric oxide in each ounce of solution. The following table of assays of various iron preparations was made by M. Quevenne. One gramme (fifteen grs.) of the following prepara- tions was soluble in two hundred grammes of gastric juice, in the proportions named : — Of 1.0 iron by hydrogen containing 1.000 pure iron was dissolved 0.102 pure iron. Of 1.0 iron filings “ 1.000 “ “ 0 070 Of 1.0 protosulphate of iron “ 0.210 “ “ 0.056 Of 1.0 protocarbonate “ “ 0.490 “ “ 0.050 Of 1.0 persulphate “ “ 0.250 “ “ 0.046 “ Of 1.0 lactate “ “ 0.190 “ “ 0.040 Of 1.0 protochloride “ “ 0.430 “ “ 0.036 Of 1.0 tartrate of iron and potass “ 0.210 “ “ 0.022 “ Of 1.0 oxide of iron heated to red heat “ 0.700 “ “ 0.016 Forty parts of scaled or dialyzed iron, from which water had been withdrawn without aid of heat, was levigated very fine and placed in an artificial gastric juice prepared as follows: five parts hydrochloric acid and acetic acid, fifteen parts of pure pepsin, with traces of chlorides of sodium, potassium and ammonium; also phosphates iron, lime and mag- nesium, in one thousand parts of water ; and temperature was maintained at ioo° F. for five hours, then filtered through a “fared” filter, dried and weighed, showing a loss of iron amounting to fifteen parts. This shows that 3.00 grammes of scaled dialyzed iron (containing 1.5 grammes, pure iron) are soluble in two hundred grammes of gastric juice. Having thus compared the properties of dialyzed iron with other well known preparations, I will report five cases only, in which I observed its effect upon the globular richness of the blood. These were cases of simple anaemia uncomplicated by organic disease, and none of the indi- viduals were placed upon any regimen of diet or exercise, but were allowed to continue their usual habits of life. My object was to prevent the error of attributing any improvement in health or appearance to an improved diet, or to the more favorable effects of fresh air and exercise. Properties of Dialyzed Iron. 5 I selected those cases in which I could personally observe the individuals from day to day, and could note any peculiarity of symptoms or unusual mode of life. The instrument which I imported from London was so inaccurate that I was forced to abandon it, as well as the reports of three cases in which it was used, and obtained from Prof. W. A. Rogers, of Harvard College Observatory, some very accurately ruled glass slides. I also procured some pipettes, and carefully estimated their capacity, so that I could place more reliance upon their measurements. I took especial care in the photographs herewith presented not to use various pipettes or ruled slides in the same individual; in the few cases in which (owing to accidental breakage) I was obliged to use more than one set of apparatus, the second set was carefully measured anew, so that my comparative results should not be invalidated. The circumstances under which the blood was taken from the patient were a? nearly similar as possible, and I have a strong confidence that the results of my observations are not materially affected by the method of procedure, and that the error of variation may be safely placed within five per cent. I have not the time in this communication to prove the grounds for this statement, nor would it be worth your while to examine the details of experiment which were used to determine my opinion. The pains that have been taken may, perhaps, be better appreciated by the careful examination of two hundred photographs, taken under various circumstances and conditions, among which may be mentioned the tem- perature of the surface after exposure to dry and wet heat and cold; the depth and method of puncture of the skin, blood taken while the patient was depressed by pain or temporary disturbances of other sorts, during the menstrual flow, and before rising from bed in the morning. The variation shown in these photographs is not, to my knowledge, dependent upon any of these disturbing causes. Case I Is that of a woman whose appearance was anaemic, and, as far as I could learn, had no organic disease. An earlier examination of her blood had shown about 3,900,000 corpuscles per c. mm. of blood, but this negative was unfortunately lost. The print No. 5 was taken on the third day after the commencement with the solution of dialyzed iron. I have estimated in this 4,189,000 corpuscles per c. mm., or about eighty- three per cent, of the normal state, of health. At first she took her medicine quite regularly, and in ten days gained 171,000 corpuscles, her blood having attained a per centage of eighty-six. The following six days she took the medicine very seldom, and lost 500,000 corpuscles, and was in the same anaemic condition as before treatment, having a percent- age of seventy-six. From this time onward she took the medicine more faithfully, but still omitting one dose about every two or three days, and in five days regained 440,000 corpuscles, having now a percentage of eighty-four. In another week she gained 60,000, and in four days more 6 Properties of Dialyzed Iron. 160,000, having then a percentage of ninety-six. In the whole period, from December nth to January 10th, this patient showed an increase of 1,000,000 corpuscles, or an improvement of twenty per cent. During the whole time she was under observation she menstruated twice, but appa- rently with very slight effect upon the globular richness of the blood. None of these prints, Nos. 5, 6, 7, 8, 9, 10, 11, were taken during, menstruation :—• No. 5. December 5th, 4,189,000, or 83 per cent. No. 6. “ 13th, 4,360,000, or 87 per cent. No: 7. “ 19th, 3,850,000, or 77 per cent. (Has taken iron seldom.) No. 8. “ 24th, 4,240,000, or 84 per cent. No. 9. “ 31st, 4,630,000, or 92 per cent. No. 10. January 6th, 4,820,000, or 96 per cent. No. 11. “ 10th, 4,860,000, or 97 per cent. Case II Is that of a girl about sixteen years of age, who consulted' me for neuralgia, dizziness, especially during the act of stooping, lassi- tude and general malaise ; she had the habit of awaking with a slight headache, which, towards the latter part of the day, forced her to leave her regular household duties. She had been out to walk two or three times a day, and, like all the other cases, had but slight loss of appetite, a good home, good food, warm clothing, without much requirement for excessive mental or physical work. Her catamenia occurred too frequently — once in three weeks. Without advising any change in diet or occupa- tion, I gave her in water, as in all the other cases, thirty drops of dialyzed iron solution three times a day. I may as well say here that I obtained the solution of dialyzed iron always from the same manufacturer, furnished it directly to each patient, and that it had a uniform standard and purity, so far as I could determine. Its specific gravity was 1042, and in two instances the solid residue was about twenty-four grains to the ounce of solution. The record of Case II is estimated from the prints: — No. 12. December 16th, 4,070,000, or 80 per cent. (Began treatment.) No. 13. “ 20th, 4,220,000, or 84 per cent. No. 14. “ 28th, 4,370,000, or 87 per cent. No. 15. January 6th, 4,620,000, or 92 per cent. (Discontinued treatment.) No. 16. “ 15th, 4,500,000, or 90 per cent. All her anaemic symptoms, above mentioned, gradually disappeared, and she omitted the treatment because she felt well, and up to the present time none of these symptoms have reappeared. Case III Is that of a young woman about twenty years of age, pale and thin in appearance, who has at previous times been much improved by a ferruginous tonic treatment. She complained of languor, dizziness, muscular fatigue, cold, moist hands, painful menstruation, etc. Estimates from prints:— Properties of Dialyzed Iron. 7 No. 17. December 17th, 3,700,000, or 74 per cent. (Began treatment.) No. 18. “ 31st, 4,700,000, or 94 per c