Over-action.-Evidence of the over-action of iron is a feeling of fullness in the head, headache, constipation, and sometimes a tendency to hemorrhage and to profuse menstruation. There is no poisoning from iron unless a dose of styptic iron is taken into the stomach, and then the only action would be that of acute irritation.

Uses.-Iron as a styptic or astringent is now rarely used, as the clots formed are likely to decompose and cause infection, unless they are soon carefully removed; this is especially true in nose-bleed. Other treatments of hemorrhage are generally better. The hemostatic action of iron preparations is due to a precipitate of albumin which forms a clot; it is not due to a true fibrin coagulation.

For its astringent action the tincture of iron is an old and good treatment for relaxed or inflamed conditions of the throat and tonsils, but iodine and silver preparations are now generally used.

TREATMENT OF ANEMIA

The main condition for which iron is used is anemia, and it is useful in all forms, but most efficient when the hemoglobin content of the blood corpuscles is low, as in chlorosis. As above stated, it does not matter much which preparation of iron is given, the body will metabolize most any organic or inorganic iron. The dose ordinarily need not be large, and the general condition of the patient will almost always improve, unless there is some serious repeated destruction of the red corpuscles. The most deadly destructive organism for red corpuscles is the streptococcus hemolyticus, which is so frequently present in acute infections, and is so often present in the disease that causes the greatest number of deaths at the present time, namely, pneumonia.

Not every patient who is pale is anemic; not every patient who has no appetite and whose nutrition is low needs iron. On the other hand, the great majority of patients who are run down, or who are convalescing from some serious disease, are anemic, and do need iron; but very frequently an increased amount of meat or of vegetables that carry large amounts of iron, as greens, will soon improve the anemia.

Symptoms of anemia, besides the positive finding of a low blood count and a low hemoglobin content, are dyspnea, paleness of the face, especially pale gums, bluish sclerotics, and in women, amenorrhea. Anemic patients often suffer from neuralgias, which are cured by the administration of iron.

Whatever the kind of anemia present its cause should be sought, and no matter of how much benefit the administration of iron may be, the anemia will recur unless the cause is removed. Besides the more serious diseased conditions, as tuberculosis, cancer, and actual hemorrhage (as from hemorrhoids, gastrointestinal ulcers, too profuse menstruation, etc.) chronic suppuration is a frequent cause, as are also focal infections and albuminuria.

TO INCREASE THE URIC ACID EXCRETION

PHENYLCINCHONINIC ACID

CINCHOPHEN. ATOPHAN

This drug occurs in small needles or as a white or yellowish powder, insoluble in water, and the dose is 0.30 Gm. (5 grains).

At the present time this is the most active drug we possess to cause an increase in the uric acid output. It is a stimulant to the kidneys, increases the amount of urine, and under its action the uric acid of the blood is decreased in amount.

From the action of cinchophen the urine may contain such a large amount of uric acid crystals that severe irritation and even renal colic is caused. Consequently, the amount of the drug given should not be as large as formerly used, and 0.30 Gm. (5 grains) is a large enough dose, given two or three times a day. At the same time, the patient should take an alkali, best the bicarbonate of sodium.

Cinchophen may quiet the pain of acute gout and sometimes acts very satisfactorily in other forms of joint pains.

PART IV

THE ENDOCRINE GLANDS AND ORGANOTHERAPY

Preparations of the Endocrine Glands.-(a.) Those that have recognized positive therapeutic value.-Thyroid; parathyroid; pituitary; suprarenal; corpus luteum.

(b) Those that have therapeutic value but not as evident, hence not as generally accepted.—Ovaries, placenta; mammary; testicles; thymus; pineal.

(c) Glandular tissues that have important functions, but whose extracts have not been shown to have therapeutic value other than that of foods or digestants.-Pancreas; spleen; secretin; liver; kidneys; parotid; prostate; lymph glands; brain; meat extracts; nuclein.

GENERAL CONSIDERATIONS

To understand both the rational and the experimental therapeutic uses of endocrine gland preparations the clinician must note the normal functions of these glands and the symptoms and signs of their dysfunction. Hence to decide that one or more endocrine glands are abnormal the clinician must know the physiology and pathology of these glands as far as laboratory, clinical and post-mortem experience has developed.

To determine the physiologic condition of these glands in an individual one must learn to study the patient and his previous history with the object of developing a picture that will show normal or abnormal endocrine gland activities. Toward that end details of the physical condition and previous development of the individual, as well as details of his habits, mental attitude and general mentality must be ascertained and outlined. A careful study of the activities of the endocrine glands is very profitable for both physician and patient, as the right treatment for the cure of his abnormal condition may thus be made evident. Such a careful study of patients will not only

show gross types of hyper- and hypo-secretions of the different endocrine glands, but will also discover signs of slightly increased or slightly diminished secretions.

The lines of investigation may be suggested as follows:

Sex; age; size; general build.

General characteristics of the family; family history.

Babyhood: rate of growth; babyhood food; eruption of teeth. Childhood: rate of growth; character of food preferred; fat deposits; ability to study and learn; likes and dislikes of work, play and amusements; age of development of secondary sexual characteristics.

Age of puberty: growth of hair, axillary and pubic; in the male, date of change of voice and growth of beard; in the female, date of beginning of menstruation and development of the mammary glands.

Adult: social life; temperament; temper; food best liked; food cravings; digestive disturbances; urinary peculiarities; habit of perspiration; sexual life.

Physical examination: note mentality; build of body, head, trunk, legs; fat deposits; facial type; spacing of eye-brows; external genitals.

Skin: texture; sensations; pigmentation; hair.

Mouth: arch of palate; spacing of teeth; tonsils; adenoids. Glands: thyroid; mammary; thymus; lymph glands.

It should be recognized that when one gland is mal-functioning others are also disturbed and may thus cause atypical conditions.

Under the discussions of the various endocrine gland activities the types of disturbances caused by their mal-function will be described, but a few indications of endocrine disturbances are here mentioned. However, the student is urged to refer to books on endocrinology for detailed descriptions of endocrine pathology.

With good thyroid activity the teeth are generally white and well formed. If the thymus, and perhaps the parathyroids, are insufficient, calcium nutrition may be disturbed, and the teeth show pitting and imperfect enamel. If the anterior pituitary

hypersecretes, the teeth are likely to be wide spaced. Pigmentations on the teeth as pigmentations everywhere, on the skin and mucous membranes, show cortical disturbance of the adrenals. Large canine teeth seem to be associated with increased adrenal secretion, and normal sized lateral incisors show normal gonads.

Many of the endocrine glands take part in the production of hair, more especially the thyroid, the adrenals and the gonads. The thyroid seems to have a special function in controlling the amount of hair on the scalp and upper parts of the body, and also determines the character of the eye-brows. When the thyroid subsecretes there is a diminished amount of hair development, the hair falls out, or it does not grow normally on the body. When this gland is only mildly insufficient the eye-brows are very thin, while when the eye-brows are heavy and meet at the bridge of the nose there is increased adrenal secretion. Cretins generally have a normal or increased amount of hair on their heads, although a myxedematous patient may have entirely lost the hair from the scalp. Increased thyroid secretion may sometimes show lessened hair development and sometimes an increased hair development, the variations probably due to associated other glandular disturbances, as increased adrenal secretion always increases the growth of hair on the body. Coarse hair is due to increased adrenal secretion, and Kaplan states that abnormally colored hair, as blond hair in a Spaniard and black hair in a Swede, is due to disturbed adrenal secretion. Also he states that the majority of red-haired individuals have increased adrenal secretion.

The ovaries and testicles seem to control the amount of pubic and axillary hair, while the testicular secretion also seems to cause the growth of hair on the face, i.e., the beard and mustache. In testicular insufficiency there may be very little hair on the body yet a good deal on the head, and eunuchs have a large growth of hair on the scalp. A growth of hair on the face in females is generally due to ovarian disturbance, and at the menopause many women have hair develop on the chin. In pituitary disturbances there may be patches of hair as well as