Part 28

Iron was not regarded as of special medicinal value by the ancients. The alleged administration of the rust of iron by Melampus was apparently looked upon as a miracle, and though this instance is often quoted as the earliest record of ferruginous treatment, it does not appear to have been copied. Classical allusions, such as that of the rust of the spear of Telephus being employed to heal the wounds which the weapon had inflicted, which is referred to by Homer, can hardly be treated as evidences of the surgical skill of that period. Iron is not mentioned as a remedial agent by Hippocrates, but Dioscorides refers to its astringent property, and on this account recommends it in uterine hæmorrhage. He states that it will prevent conception; it subsequently acquired the opposite reputation. The same authority, as well as Celsus, Pliny, and others, allude to a practice of quenching a red-hot iron in wine or water in order to produce a remedy for dysentery, weak stomachs, or enlargement of the spleen.

The later Latin physicians made very little use of iron or its compounds. Oribasius and Aetius write of the uses of its oxide outwardly in the treatment of ulcers, and Alexander of Tralles prescribes both an infusion and the metal in substance for a scirrhus of the spleen. He was probably the earliest physician who discovered its value as a deobstruent. Rhazes, the Arab, gave it in substance, and in several combined forms, but Avicenna regarded iron as a dangerous drug, and suggested that, if any had been accidentally taken, some loadstone should be administered to counteract any evil consequences.

Vitriol (sulphate of iron and sulphate of copper) was the iron medicine most in use up to the sixteenth century; but it was not given with the special intention of giving iron. Paracelsus had great faith in the Arcanum Vitrioli, which, indeed, appears to have been sulphur. He also introduced the use of the magnet, but only externally. It was in the century after him that the salts of Mars came into general medical use. In the course of the seventeenth and eighteenth centuries the preparations of iron became very numerous. Iron filings brought into an alcohol, that is very finely powdered, were much employed, sometimes alone and sometimes saccharated, or combined with sugar candy. Crocus martis was the sesquioxide, æthiops martial was the black oxide, and flores martis, made by subliming iron filings and sal ammoniac, yielding an ammoniated chloride of iron, was included in the several British pharmacopœias of the eighteenth century.

The association of iron with Mars probably influenced the early chemical physicians in their adoption of iron salts in anæmic complaints, and as general tonics. The undoubted effect of iron remedies in chlorotic disease was naturally observed, and the reputation of the metal was established for the treatment of this condition long before it was discovered that iron is an invariable constituent of the human body. When this physiological fact came to be recognised it was supposed that the action of iron salts was explained; but, in fact, the investigations of the last century have only tended to make this theory doubtful.

It is known that in health the proportion of iron in the body is fairly constant. An average man’s blood contains about 38 grains, almost all of which is contained in the hæmoglobin. He requires from one to two grains every day to make up for waste, and this he gets in the meat and vegetable food which he absorbs. The vegetables obtain iron from the soil, and animals acquire it from the corn, roots, or grasses which they eat. So far as is known it is from these sources only that human beings assimilate the iron they require. It is very doubtful whether a particle of the iron administered in any of the multitudinous forms which pharmacy provides is retained. A noted modern physiologist, Kletzinsky, says “From all the hundredweights of iron given to anæmics and chlorotics during centuries not a single blood corpuscle has been formed.” For all that there is no medical practitioner of any considerable experience who has not found directly beneficial results follow the administration of these medicines in such cases.

To Sydenham and Willis, two of the most famous physicians of the seventeenth century, the general employment of iron as a medicine may be traced. Sydenham, in his treatise on hysteric diseases, which, he says, are occasioned by the animal spirits being not rightly disposed, and not as some supposed by the corruption of the blood with the menstrual fluid, points out that the treatment must be directed to the strengthening of the blood, for that is the fountain and origin of the spirits. In cachexies, loss of appetite, chlorosis, and in all diseases which we describe as anæmic, he recommends that if the patient is strong enough recourse should be had first to bleeding, this to be followed by a thirty days’ course of chalybeate medicine. Then he describes, much the same as modern treatises do, how rapidly iron quickens the pulses, and freshens the pale countenances. In his experience he has found that it is better to give it in substance than in any of the preparations, “for busy chemists make this as well as other excellent medicines worse rather than better by their perverse and over officious diligence” (Pechey’s translation). He advises 8 grains of steel filings made into two pills with extract of wormwood to be taken early in the morning and at 5 p.m. for thirty days; a draught of wormwood wine to follow each dose. “Next to the steel in substance,” he adds, “I choose the syrup of it prepared with filings of steel or iron infused in cold Rhenish wine till the wine is sufficiently impregnated, and afterwards strained and boiled to the consistence of a syrup with a sufficient quantity of sugar.”

Dr. Willis had a secret preparation of iron of which Dr. Walter Harris, physician in ordinary to Charles II, in “Pharmacologia Anti-Empirica” (1683), writes:--“The best preparation of any that iron can yield us is a secret of Dr. Willis. It has hitherto been a great secret and sold at a great price. It was known as Dr. Willis’s Preparation of Steel.” Dr. Harris thinks it will not be an unacceptable service to the public to communicate this masterpiece of that eminent and ever famous man. “It was no strained stately magistery, no sublimation or salification, no calcined crocus, and no chemical mystery; but an easy and a natural way of opening this hard body that it may open ours.” It was given particularly for the removal of obstructions. The formula was equal parts of iron filings and crude tartar powdered and mixed with water in a damp mass in a glazed earthen vessel. This was to be dried over a slow fire or in the sun; wetted and dried again; and this process repeated four or five times. It might be given in white wine, or made into a syrup, or into pills, electuary, or lozenges. Dr. Willis preferred the crude tartar because the cream of tartar sold by the druggists was generally a cheat, often combined with alum. The crude could be bought at 6d. to 8d. per lb. In the apothecaries’ shops cream of tartar was sold at 3s. to 3s. 6d. per lb.

Quincy (1724), who frequently offers explanations of the exact way in which medicines exercise their remedial power, thus scientifically describes the action of iron in removing obstructions:--“Mechanics teach nothing more plainly than that the momenta of all percussions are as the rectangles under the gravities and celerities of the moving bodies. By how much more gravity then a metalline particle has more than any other particle in the Blood, if their celerities are equal, by so much the greater will the stroke of the metalline particle be against everything that stands in its way than of any other not so heavy; and therefore will any Obstruction in the Glands and Capillaries be sooner removed by such particles than by those which are lighter. This is a way of reasoning that is plain to the meanest Capacity.”

Tartarised iron has always been a favourite form for its administration. The Balls of Mars (boules de Mars, or boules de Nancy), still a popular medicine in France, are a tartarised iron prepared by a complicated process. First, a decoction of vulnerary species is made from 12 parts of water and 2 of the species. This is strained and poured on 12 parts of pure iron filings in powder. The mixture is evaporated to dryness and powdered. On this powder another decoction, 18 of water and 3 of species, is poured, and 12 parts of red tartar added. This compound is evaporated to the consistence of a firm paste, and a third decoction, 35 water and 5 species, is added to 25 of the paste and 25 of red tartar. This is evaporated to the proper consistence to make balls, which are usually about 1 oz. or 2 oz. in weight. They are kept to dry and then wrapped in wrapper. They are taken in doses of 4 to 5 grains much as Blaud’s pills are taken here. Sometimes the balls are dipped in water until a brown colour is imparted to the liquid. This water is also used as an application to bruises.

Mistura Ferri Composita was adopted in the P.L., 1809, from the formula of his anti-hectic mixture which Dr. Moses Griffith, of Colchester, had published thirty or forty years previously. Paris quotes it as a successful instance of a medical combination which could not receive the sanction of chemical law; and he testifies to the opposition offered on that ground to its official acceptance, but adds that subsequent inquiry had proved that the chemical decompositions which constituted the objections to its use were in fact the causes of its utility. It yields a protocarbonate of iron in suspension, and a sulphate of potash in solution. The compound of iron is in the state in which it is most active.

As evidence of the faith in ferruginous waters as tonics of the generative system, Phillips quotes from the thesis of Dr. Jacques, of Paris, a curious marriage contract said to have been common at one time among the burghers of Frankfort to the effect that their wives should not visit the iron springs of Schwalbach more than twice in their lives for fear of being too fruitful. The story looks suspiciously like an advertisement of Schwalbach.

Tincture of perchloride of iron acquired its reputation in the 18th century from the secret medicines known as La Mothe’s “gouttes d’or,” and Bestucheff’s Nerve Tincture (see page 321). The formula of the latter, published by the Academy of Medicine of St. Petersburg, was corrected by Klaproth, and under various names and in different forms found its way into all the pharmacopœias. Klaproth’s process was to dissolve powdered iron in a mixture of muriatic acid 3, and nitric acid 1; evaporate to dryness, and then leave the mass to deliquesce to a brown liquor. Mix this with twice its weight of sulphuric ether. The saturated ethereal solution to be mixed with twice its volume of spirit of wine, and kept in small bottles exposed to light until the liquid acquired the proper golden tint. A similar preparation is retained in the French Codex under the title of ethereal-alcoholic tincture of muriate of iron.

Reduced Iron, or Iron reduced by hydrogen, was first prepared by Theodore Quevenne, chief pharmacist of the Hôpital de la Charité, about the year 1854. Pharmacological experiments were made with it by himself in association with Dr. Miquelard. It was believed at first that the metallic iron obtained by the process described, which was to heat the hydrated oxide of iron in a porcelain tube to dull red, and then to pass a current of hydrogen through the tube, was absolutely pure, and from experiments on dogs they came to the conclusion that the metal in this form was more assimilable than any of its salts. It had besides the advantage of being almost tasteless. Quevenne’s treatise describing the process and the experiments was published in 1854 under the title of “Action physiologique et therapeutique des ferrugineux.” Later investigations, while supporting the original opinion to a great extent as to the assimilability of the reduced iron, established that the product is not and cannot be pure. Dusart showed in 1884 that the proportion of actual iron could not exceed 87 per cent., and was not likely to be more than 84 per cent. Oxides, and carbonates of iron were inevitable, while sulphur, arsenic, phosphorus, and silicon were probable contaminations from the gas.

Citrate of Iron in scales was introduced by Beral, of Paris, in 1831. His formula is given in the _Pharm. Jnl._, vol. I, p. 594.

Syrup of Phosphate of Iron was introduced in a paper read to the Medical Society of London in 1851 by Dr. Routh, and Mr. Greenish subsequently described to the Pharmaceutical Society the process by which it was prepared. The formula was afterwards improved by Mr. Gale, and his process was adopted in the B.P. It has since been modified.

A solution of iodide of iron was first employed in medicine in this country by Dr. A. T. Thomson some time in the ’30’s of the nineteenth century. It was introduced into the London and Edinburgh Pharmacopœias in the form of a solid salt, and in the latter also in the form of a solution. Neither of those preparations could be preserved from decomposition, and the first suggestion of a syrup appears to have been made in Buchner’s Repertorium in 1839, and soon after by other experimenters. Dr. Thomson gave a formula for a syrup of iodide of iron to one of the earliest meetings of the Pharmaceutical Society in 1841, reported in the first volume of the _Pharm. Jnl._

LEAD.

Lead is one of the ancient metals and was associated in classical writings with Saturn. The lead compounds used by the ancients in medicine were white lead or ceruse (carbonate and hydrate), and litharge (oxide). Ceruse is supposed to owe its name to cera, and to mean waxy; litharge is from Greek, and means silver stone; it was regarded as the scum of silver. Red lead or minium was also used to some extent in the form of an ointment.

Although not much used now as a medicine for internal administration, lead in various forms has been tried and advocated by doctors, usually as a sedative. The Pil. Plumbi c. Opio is what remains in our Pharmacopœia of these recommendations. Galen mentions lead as a remedy in leprosy and plague, and little bullets of lead were at one time given in cases of twisted bowels. The sedative property of lead salts has caused them to be prescribed for neuralgia, hysteria, and convulsive coughs; Goulard, recognising the anticatarrhal and astringent effects of the acetate, recommended it in urethritis; and on the theory that lead poisoning and phthisis were incompatible French practitioners at one time hoped to find in lead a remedy for tuberculosis.

Litharge was the basis of most of the popular plasters, and a century or two ago there were about a hundred of these either official or in demand. Litharge was called lithargyrum auri or lithargyrum argenti, according to its colour; but the deeper tint was only the result of a stronger fire in preparing the oxide. White lead was an ingredient in several well-known old ointments, the unguentum tripharmacum of Mesuë, which was the ceratum lithargyri of Galen, the unguentum nutritum, the unguentum diapomphologos, in which it was associated with pompholyx or oxide of zinc, and others. To a large extent these ointments were superseded after Goulard’s time by the unguentum Saturninum which he introduced. The ointment of Rhazes was composed of white lead, wax, and camphor dissolved in oil of roses. He also ordered the addition of the white of an egg to every half-pound, but this came to be omitted as it caused the ointment to become odorous. The Mother’s Ointment (onguent de la Mère) has long been a favourite ointment in France for promoting suppuration, and it is included in the Codex. It was made empirically by a nun at the Hotel Dieu, named La Mère Thecle, and as it became much sought after she furnished the formula. It is made by heating together mutton suet, lard, and butter, and when vapours are being exhaled, finely powdered litharge is sifted into the fats, causing a violent effervescence. Some wax and pure black pitch are afterwards added. The process has been studied by several pharmacists, and the conclusion come to is that the fats are decomposed and a number of fatty acids with some acroleine are produced. The operation is a rather dangerous one, especially if there is any naked light in the vicinity.

Magistery of Saturn was a white lead precipitated from a solution of the acetate by carbonate of potash. This was the principal ingredient in the Powder of Saturn devised by Mynsicht. The other components of this powder, which was recommended in phthisis and asthma especially, were magistery of sulphur (lac sulphuris), squine root, flowers of sulphur, pearls, coral, oatmeal, Armenian bole, flowers of benzoin, olibanum, sugar candy, saffron, and cassia.

The chief apostle of lead in medical practice was Goulard, whose name has become inseparably associated with the solution of the acetate. Some account of the bearer of this familiar name, and of his medicinal preparations of lead will be found in the section on Masters in Pharmacy.

QUICKSILVER

is first alluded to in Greek writings by Theophrastus, about 315 B.C., but it was certainly known and used medicinally by the Chinese and in India long before. Apparently, too, it was known by the Egyptians. Dioscorides invented the name hydrargyrum, or fluid silver, for it. Pliny treats it as a dangerous poison. Galen adopted the opinion that the metal is poisonous, but states that he had no personal knowledge of its effects. With these authors argentum vivum was the term generally used to mean the native quicksilver, while hydrargyrum was more usually employed to describe the quicksilver obtained from the sulphide, cinnabar. Ancient writers appear to have regarded the two substances as distinct. Dioscorides points out that cinnabar was often confused with minium (red lead). The name Mercury, and the association of the metal (or demi-metal, as it was often regarded) with the planet and with its sign, formerly associated with tin, dates from the middle ages. It is mentioned first in this connection in a list of metals by Stephanus of Alexandria, in the seventh century.

ARABS USED MERCURY MEDICINALLY.

The Arabs, who inherited the medical lore of the Greeks, and probably added to this in the case of mercury knowledge acquired from India, were much interested in mercury. In the chemical works attributed to Geber not only the metal itself, but its compounds, red precipitate and corrosive sublimate, are described. Much use of mercury was made by the Arabs in the form of ointments for skin diseases, for which Mesuë recommended it, and Avicenna was probably the first physician to express doubt in regard to the poisonous nature of the metal. He observed that many persons had swallowed it without any bad effect, and he noted that it passed through the body unchanged.

MERCURY PRESCRIBED INTERNALLY.

Fallopius (1523-1562) remarks that in his time shepherds gave quicksilver to sheep and cattle to kill worms, and Brassavolus (1500-1554) states that he had given it to children in doses of from 2 to 20 grains, and had expelled worms by that means. Matthiolus (died 1577) relates that he had known women take a pound of it at a dose with the object of procuring abortion, and says it had not produced any bad result.

FRICTIONS AND FUMIGATIONS.

Sprengel fixes the year 1497 as that in which mercury was first employed externally for the cure of syphilis. Frictions, fumigations, and plasters were the earliest forms in which it was employed. Berenger de Carpi, a famous surgeon and anatomist of Bologna, who practised in the early part of the sixteenth century, is said to have made an immense fortune by inventing and prescribing frictions with mercurial ointment for syphilis. John de Vigo was a strong partisan of fumigations in obstinate cases. His fumigations were made from cinnabar and storax. It is not quite clear whether this physician gave red precipitate internally in syphilis. He expressly indicates its internal use in plague.

MERCURY A REMEDY FOR SYPHILIS.

Peter Andrew Matthiolus, born at Sienna in 1500, died at Trent in 1577, latterly the first physician to the Archduke Ferdinand of Austria, a botanist and author of “Commentaries on Dioscorides,” was, according to Sprengel, the first who is known for certain to have administered mercury internally. Paracelsus, however, was without doubt the practitioner who popularised its use. He gave red precipitate, corrosive sublimate, and nitrate of mercury, and describes how each of these was made. Sprengel credits him also with acquaintance with calomel, but other authors do not recognise this in any of his writings.

VIGO’S PLASTER.

The Emplastrum Vigonium was a highly complicated compound, which was held in great veneration and is the subject of innumerable comments in the pharmaceutical writings of the sixteenth, seventeenth, and eighteenth centuries. Charas, Lemery, Baumé, and others modified and simplified it. John de Vigo was a native of Naples, where he was born about 1460, and he became the first physician of Pope Julius II. His plaster still figures in the French Codex, and contains 600 parts of mercury by weight in 3,550 parts. This made into a liquid with olive oil and spread on calico makes the sparadrap of Vigo, in which form it is most frequently used, as an application to syphilitic eruptions.

Ambrose Paré gives the earliest formula for Vigo’s plaster, which was then called Emplastrum Vigonium seu de Ranis. It was looked upon as a masterpiece of combination. First 3½ oz. of earthworms were washed in water, and afterwards in wine. Then they and twenty-six live frogs were macerated in 2 lb. of odoriferous wine, and the whole was boiled down to two-thirds of its volume. A decoction of camel’s hay (andropogon schœnanthus), French lavender, and matricaria (chamomilla) was then mixed with this wine. Meanwhile 1 lb. of golden litharge had been “nourished” for twelve hours with oils of chamomile, dill, lilies, and saffron; these were melted down with 1 lb. each of the fat of the pig, calf, and viper. Human fat might be used instead of that of vipers. Juices of elder root and of elecampane with euphorbium, frankincense, and oil of spike were then worked in and the whole melted with white wax. Lastly, quicksilver extinguished by turpentine, styrax, oil of bitter almonds, and oil of bay, were added. In Lemery’s time the minimum proportion of mercury was 1 drachm to 1 oz. of the plaster. There was also a simple Vigo’s plaster made without mercury. In the Codex formula the worms, the frogs, the fats, the herbs, roots, and oils have all gone, but some more aromatic resins are added.

THE FIRST MERCURIAL PILLS.

The first formula for mercurial pills was one which Barbarossa II, a famous pirate and king of Algiers, and admiral of the Turkish Fleet under Soliman, Sultan of Turkey, sent to Francis I, king of France, some time in the second quarter of the sixteenth century. The recipe was published (says Dr. Etienne Michelon, of Tours, in his “Histoire Pharmacotechnique de Mercure”) in 1537 by Petrus de Bayro, physician to the Duke of Savoy. He does not give the exact formula, but Lemery quotes it as follows:--

“Best aloes, and quicksilver extinguished by rose juice, aa 6 drachms;

“Trochises of agaric, ½ oz.; selected rhubarb, 2 drachms;

“Canella, myrrh, mastic, aa 1 drachm; musk, amber, aa 1 scruple;

“Make a mass with Venice turpentine.”

Lemery says you cannot kill the mercury with rose juice, but must use some of the Venice turpentine.