Very often I meet with women who cannot take iron, either because it disturbs the stomach, causes headache, or constipates, or else because they have been told never to take iron.  In the latter case I simply add five grains of the pyrophosphate to each ounce of malt, and give it thus for a month unknown to the patients.  It is then easy to make clear to them that iron is not so difficult to take as they had been led to believe, and when it has ceased to disagree mentally I find that I am able to fall back on the coarser method.  If iron constipate, as it may and does often do when used in these large doses, the trouble is to be corrected by fruit, and especially pears, by the pill of the watery extract of aloes and ox-gall already mentioned, by extracts of cascara or of juglans cinerea, which may be added to the malt extract ordered with the meals, or by enemata of oil, or oil and glycerin, or a glycerin suppository.  The instances in which iron gives headache and sense of fulness are very rare when the patient is undergoing the full treatment described, and, as a rule, I disregard all such complaints, and find that after a time I cease to hear anything more of these symptoms.

Unless some especial need arises, iron, in some form, is the only drug I care to use until the patient begins to sit up, when I order nearly always sulphate of strychnia, in rather full doses, thrice a day, with iron and arsenic.

Probably no physician will read the account I have here detailed of the vast amount of food which I am enabled to give, not only with impunity from dyspepsia, but with lasting advantage, without some sense of wonder; and, for my own part, I can only say that I have watched again and again with growing surprise some listless, feeble, white-blooded creature learning by degrees to consume these large rations, and gathering under their use flesh, color, and wholesomeness of mind and body.  It is needless to say that it is not in all cases easy to carry out this treatment.

When the full treatment has been reached, and kept up for a few days, I begin to watch the urine with care, because if the patient be overfed the renal secretion speedily betrays this result in the precipitation of urates.  When this occurs at all steadily, I usually give directions to lessen the amount of food until the urine is again free from sediment.

Nearly always at some time in the progress of the case there are attacks of dyspepsia, when it suffices to cut down the diet one-half, or to give milk alone for a day or two.  Diarrhoea is more rare, and has to be met in like manner; or, if obstinate, it may be requisite to give the milk boiled.  Occasionally the rapid increase of blood is shown by nasal hemorrhage, which needs no especial treatment.

Perhaps I shall make myself more clear if I now relate in full the diet-list of some of my cases, and the mode of arranging it.

I take the following case as an illustration from my note-book: