ON THE

EFFECTS OF THE CARBONATE OF IRON

IN

THE ULCERATED UTERUS.

BY WM. GAMAGE, JUN. M. D.

THE advancement of correct knowledge in medicine, has been retarded by indiscriminately confounding those diseases which have a resemblance only in some unessential particulars. This has arisen sometimes, probably, from inattention to the character of the disease, and sometimes it has been designed. A desire to enjoy the satisfaction of having written a book, has, undoubtedly, induced many to christen with the name of some formidable disease, cases, which bear to it only a sort of likeness; and ascribe their successful treatment to their administration of a medicine not in common use in that disease. An effect of this practice, instead of adding to the stock of information, is to increase the labour of investigation after truth. Another effect has been to give a surreptitious reputation to some article of the materia medica, which, after disappointing the hopes of the sanguine, and wearying the patience of the careful observer, has again sunken to its wonted insignificance.

Cancer, a disease which has baffled the powers of medicine, so far as they are yet known, has afforded a convenient cloak for this kind of deception, and it has not been unimproved. The mountebank dignifies with it the most simple tumours, and the most common ulcers, which he cures by his secret nostrums: and men of a more respectable standing sometimes descend to similar practices; first probably deceiving themselves, and then the public.

These remarks were excited by reading a book, entitled “An essay on the effects of the carbonate of iron on cancer," published by Mr. Carmichael, of Dublin, in 1806. We do not, however, place this gentleman in either of the above mentioned classes, as he seems to have been actuated by the best intentions. But that total want of discrimination between apparently similar, but really different diseases, observable in his essay, is seriously to be lamented.

Very few of the cases reported by Mr. Carmichael, either in his essay, or in the Medical and Physical Journal, and no one, which exhibits his brilliant success, has, as we conceive, any well marked relationship to the disease, under which he chooses to rank them. They are, however, formidable in their character, and have not, we believe, been easily reduced to the control of medicine. We are therefore obliged to Mr. Carmichael for the increased ability, which we gain over them by the introduction of the preparations of iron, as remedies; and he probably would have gained quite as much reputation, had he permitted each variety of disease to appear in its own natural garb.

The object of this communication is not to criticise that gentleman, but to offer additional evidence in behalf of the carbonate of iron, not as a specific for cancer; experience commands the most decided protest against it, as a remedy in that disease, when in consequence, any more effectual mean would be delayed. In two cases of cancer of the uterus, two of the breast, and in one of the parotid gland, it was administered with care and perseverance, without the least apparent benefit.* Oppor

* In one of the cases of the uterus, the disease was in a very advanced stage, previous to the administration of this medicine. In the other, it had progressed only so far, as to evince its genuine character; but its advancement to a fatal termination appeared to be uninterrupted by the carbonate of iron. In this case, before the destruction of the patient, the scirrhosity had extended along the whole vagina, and on one side involved the inferior extremity of the external labium-In the one case of the breast, ulceration had taken place, and the disease had gone far beyond the reach of the knife; in the other, the glands of the breast were in the scirrhous state, the skin in contact with the scirrhous part, and a discoloration had commenced in it; but a probability of a cure by the knife still remained, could the patient have been persuaded to consent to the operation. In

tunities of giving it a trial in all the variety of ulcers, in which Mr. Carmichael used it, have not occurred to me; but I have prescribed it with the happiest effects in a disease, which I will take the liberty of denominating the phagedenic ulcer of the uterus.*

This disease bears in many points a resemblance to the carcinomatous state of that organ, and especially, in its advanced stages, its effects are very similar. The most certain mark of distinction, appears to me to be the different degrees of hard, ness produced in the part by each disease; the sensation to the touch arising from the hardness of the ulcerated, is so obvious, ly different from that arising from the flinty hardness of the carcinomatous state. Some of the most prominent symptoms of the ulcerated uterus are soreness in the hypogastrium, bearing down pains, weakness in the small of the back, shooting pains from hip to hip, (this symptom is not always present, and when it is, it is not to be compared with the distressing, lancinating pain, which uniformly accompanies the carcinoma of this organ) some degree of enlargement of the os tineæ, and fundus uteri, irregularity in the catamenia, and a constant leucorrheal discharge. As the disease advances, great emaciation takes place; the counte nance is sallow and distressed, pulse small and feeble, there is a constant drizzling of blood, and a sanious discharge per vaginam, the labia of the os tineæ feel uneven, and the patient is subject to paroxysms of pains, like the parturient, accompanied with great hemorrhage.

The following cases are examples of this disease.

CASE I.

In June, 1807, E. T. aged about 22, applied to me for advice on account of severe pain and weakness in the small of her

the case of the parotid gland, the disease had advanced too far for extirpation.

Besides the carbonate, I used in these cases the sulphate and the muriate of iron. I have not tried the phosphate nor the oxy-phosphate, which have been favourite preparations with Mr. Carmichael.

* One case, which appears to me to be of this description, is reported in the essay above mentioned, as successfully treated by the carbonate of iron, Mr. Carmichael, however, denominates it cancer of the uterus.

back, accompanied with a constant bearing down of the uterus. She had been afflicted in this way for a long time, and she said she had had, for a number of years, a whitish or yellowish discharge per vaginam, interrupted only by the catamenia, which had generally been irregular, in great quantities, and attended with indescribable sufferings. She was emaciated, countenance pale, pulse quick and feeble. Conceiving that these symptoms might be the effects of a long continued leucorrhæa, I prescribed for that complaint. In the course of two or three months, she gained something in her general health; but there was very little amendment in her disease, the weakness, pain and discharge continued, as at first. Suspecting a more serious difficulty than at first occurred to me, I made an examination per vaginam; this was unnaturally dilated, and there was some degree of prolapsus uteri ; the os uteri was thickened, hard and uneven to the touch; the fundus, as was ascertained by examination per rectum, was of a very unnatural size. I immediately prescribed the carbonate of iron in the form of an electuary, with conserve of roses in doses of half a drachm thrice in a day. In this dose it caused no inconvenience, and after taking it for some time, she found herself much relieved. She continued to take it, irregularly however, for nearly two years; but I did not know the result of the case, till in Nov. 1810, I learned, from her situation at that time, that she had no remains of her old complaint.

CASE II.

Feb. 11th, 1808-Mrs. C. a woman of feeble constitution, but whose occupations were laborious, and who had borne two or three children without any uncommon difficulty, was taken with severe parturient pains, which, after an hour's suffering, expelled from the uterus about a quart of a substance resembling in colour and consistence calf's feet jelly, adhering by a pretty firm membrane, like the cellular. Great hemorrhage preceded and accompanied this expulsion, but ceased immediately after it; and when I arrived, she was tolerably easy. I made an examination per vaginam, and found the os uteri hard and very little dilated; I could however introduce my finger, but discovered

nothing remaining in the uterus of a firmer consistence than what had already come away. The hypogastrium exhibited no fullness, or hardness. She informed me, that she presumed she had been pregnant about three months; but she was not certain; for during the last six weeks, there had been, constantly, a little show of blood per vaginam.

She was very weak on the 12th, but recovered in a short time, so as to attend to her family. She continued, however, to have a drizzling of blood per vaginam, and on the 10th of March a profuse hemorrhage came on, preceded by some bearing down pains. Some ragged pieces of a substance of a firmer consistence than coagula, and resembling flesh, were expelled, the largest not bigger than the thumb, and the hemorrhage ceased. The labia of the os uteri were thickened and hard; the internal situation of the uterus could not be ascertained; its fundus was. enlarged and hard. An anodyne was directed, and the aromatic sulphuric acid, three drachms in 24 hours.

On the 12th, 13th, and 14th, small pieces of the fleshy substance came away, accompanied with blood, sometimes with pain, and sometimes without the knowledge of the patient. These repeated evacuations reduced her to extreme weakness; she fainted often, and life could with difficulty be supported. In addition to the acid, half an ounce of the powder of cinchona divided into doses, was given every 24 hours, with wine, porter, &c. She was gaining a little strength, till on the 28th she had a considerable hemorrhage, and more pieces of the fleshy substance were expelled. This again reduced her very low. Appetite bad, had some cough, a flush of heat occasionally come on the skin; pulse 120, and feeble. Quantity of bark increased to six drachms.

No important change took place till April 8th. She had a severe rigour, which was followed by a copious discharge of a serous fluid, with a bloody and offensive matter of more consistence, and some small pieces of the fleshy substance. This occurred in about the same quantity regularly for three or four mornings in succession, and then ceased, except a small discharge of offensive matter, which continued. The os uteri still remained hard, and on one side was very uneven, and seemed