be the trouble in chlorosis, larger doses of iron may be of value, as furnishing something that will control or change the abnormal chemical reactions.

One of the most useful iron preparations is the saccharated oxide of iron (Eisenzucker), which may be obtained in tablets representing 3 grains. One or two of these tablets a day is sufficient, and it is readily taken by children or any other patient.

Action. Some solid and some liquid preparations of iron are styptic to mucous membranes and to broken or moist skin. Other preparations of iron are astringent only as they tend to produce constipation.

Probably most forms of iron are more or less changed in the stomach to a chloride by the action of the hydrochloric acid, and, provided the preparation is not irritant or too strong, the appetite improves. But little iron from any one dose is absorbed and metabolized by the body, most of it passes through the intestines and out of the body with the feces as sulphides and often tannates. The iron may be absorbed from the upper part of the intestine partially as a chloride and partially as a carbonate. A large part passes on through the intestines, is changed to a sulphide and renders the feces black. The larger part of the absorbed iron is carried by the blood to the epithelial cells of the large intestine and is there excreted.

Iron is probably more or less of a stimulant to the red bonemarrow. This is especially true when there is anemia and the red cells are diminished in number. If iron is given to a patient who is normal, with appetite and nutrition good, with blood count sufficient and hemoglobin content perfect, it does not seem to cause plethora, i.e., it does not increase the red cells or the hemoglobin. On the other hand, if the patient is plethoric, the administration of iron is likely to cause fullness of the head, perhaps headache, and sometimes hemorrhage, especially from the nose. The flow of blood is increased by the administration of iron during the menstrual period.

While most of the systemic iron is excreted through the cecum and large intestine, small amounts occur in the urine, in the saliva, and in the perspiration.

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