The Treatment of Chlorosis by Iron and some Other Drugs
Authors: R. Stockman
Journal: BMJ (1893)

IT is generally agreed that chlorosis may be cured by the administration of iron preparations by the mouth, but opinions differ widely and fundamentally as to the way in which the cure is brought about.So long ago as 1821 Wohler advanced the opinion that iron is not absorbed from the alimentary canal, because he failed to detect it in the urine after giving it per o8, while Kletzinsky (1854) experimenting on himself, and finding in his fmeces as much iron as het had previously swallowed, came to the same conclusion.These views have received support from a considerable number of cotemporary and later observers.On the other hand, Becquerel, Herberger, Naase, Quevenne, and many others have believed it to be absorbed, but no rigorous proof of its absorption has ever been given.It is unnecessary to discuss the older literaturp, as the whole question has been reworked in recent years with iimproved methods and much greater accuracy.At the present time there are three chief thieories as to the modus operandi of iron.I. THB ABSORPTION THEORY.Iron being an essential constituent of the red blood corpuscles, it has been very generally assumed that it must be absorbed, since it cures certain conditions in whith the iron of the blood is deficient.To support this view there is now a considerable amount of experitental evidexnce, but after examining it in great detail I have come to the conclusion that most of it must be rejected.Recent researches have shown that the sources of fallacy are exceptionally numerous, that they have only lately been fully realised, and that therefore most of the earlier experiments and results are quite inconclusive.The following, however, appear to be more to the point.Coppola1 fed cocks on a diet contain- ing no iron, having selected these animals because they have large blood corpuscles in which changes can be readily ob- served.The hiemogloblin fell rapidly, but the red corpuscles were not diminished in number, although, just as in chlorosis, there were many irregularly-shaped.small,andpale onesamong them.In one experiment the haemoglobin fell in seven days from 420 to 330, and then 25 milligrammes lactate of iron was added to the dipt daily; after five days the haemoglobin had risen again to 650.He concludes that inorganic iron must be absorbed and go to form haemoglobin.Cervello 2 gave a dog 0.015 g. ferric chloride, and in two hours and a-half recovered only 0.006 g. ferrous chloride from the gastro-intestinal canal, but this experiment has never been confirmed.Further, Kunkel 8 fed two dogs on a similar diet, but to one gave iron in addition.After some time he killed them, and on determining the amount of iron in the various organs he found that the liver and other organs of the dog which had taken iron along with its food contained considerably more than those of the other dog.Experiments on mice gave similar results.He himself, however, points out that this experiment is not conclusive, as the iron administered might only improve digestion and allow the iron of the food, which is in organic combination, to be more freely absorbed.The same objpction applies to the results of Lewald's4 and Bistr,w's ' experiments.They gave 1 Lo Sperimentale, 65, 127, 1890.Sul valore fisiologico_e terapeutico del ferro inorganico.