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Title: Essay on the effects of iodine on the human constitution - With practical observation on its use in the cure of bronchocele, scrophula, and the tuberculous diseases of the chest and abdomen
Author: Gairdner, W.
Language: English
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IODINE ON THE HUMAN CONSTITUTION ***
Transcriber’s Notes
Obvious typographical errors have been silently corrected. All other
spelling and punctuation remains unchanged.
Italics are represented thus _italic_.
ESSAY
ON
THE EFFECTS OF IODINE,
ETC. ETC.
LONDON:
PRINTED BY JAMES MOYES, GREVILLE STREET.
ESSAY
ON
THE EFFECTS OF IODINE
ON
THE HUMAN CONSTITUTION;
WITH
PRACTICAL OBSERVATIONS
ON ITS USE IN THE CURE OF
BRONCHOCELE, SCROPHULA, AND THE TUBERCULOUS
DISEASES OF THE CHEST AND ABDOMEN.
BY W. GAIRDNER, M. D.
LONDON:
PRINTED FOR THOMAS AND GEORGE UNDERWOOD,
32, FLEET STREET.
1824.
INTRODUCTION.
The medicine which forms the subject of the following treatise has been
so lately introduced into practice, that few Physicians are acquainted
either with its properties, or with the manner of using it. Almost all
have heard of its effects in discussing bronchocele; and some, rashly
presuming that it cannot be a drug of great power, have prescribed it
without giving themselves the trouble of making any inquiry into the
manner of employing it, or the dangers to which its use is liable.
I have thus seen more than one Physician seriously injured in his
reputation; and I have seen many patients irrecoverably injured in
their health by this subtle and powerful medicine.
Not long since I was informed by a Physician, of great and deserved
eminence, in London, that he had prescribed it to the extent of ten
grains at one dose to a young woman. Most fortunately she was saved by
vomiting. About a year ago, I was consulted on account of a young lady
in the last stage of tubercular pulmonary consumption. She was attended
by a Surgeon, who had bled her to a most unaccountable degree. This
gentleman proposed to me the use of digitalis, which being objected
to, he then proposed successively the use of hemlock and iodine. It
was plain that he was about as well acquainted with the virtues of
one medicine as with those of the other, and not better versed in
the history of the disease he was treating. When a medicine of so
much power is thus in the hands of every person, I trust I shall not
stand in need of apology for having made public the following little
treatise. Its materials have been for some time in my possession; and
I was desirous of delaying yet a little the publication of them; but
certain statements have gone forth to the world, of the great benefits
to be derived from the use of iodine, while the history of its dangers
has been most unaccountably withheld. It is in order to fill up this
hiatus, and at the same time to direct particularly the attention of
Practitioners to the proper manner of using it, with a view to its good
effects, that this essay is written.
Particular circumstances have afforded me opportunities of seeing this
medicine extensively used; and at the same time of witnessing the
bad effects which resulted from the prodigal manner in which it was
first employed. I have also made inquiries respecting its history in
countries which I have not visited. The answers I have received have
not been so detailed and satisfactory as I could have wished: they
have all, however, more or less confirmed the observations I have made
myself, or which have been communicated to me from different parts of
Switzerland and France.
Some persons may, perhaps, desire to see a daily report of the
different cases to which allusion is made in the following pages; but
this would not have been consistent with my plan, which is rather at
the present time to present an essay than a treatise to the public.
Bolton Street, Piccadilly, 4th Dec. 1823.
ESSAY
ON THE
EFFECTS OF IODINE.
The discovery of specific remedies has always, and most justly, been
considered one of the most important benefits to be conferred on the
practice of medicine. Much dispute has been carried on respecting
their nature, but all are agreed about their existence. They have been
defined by Dr. Young to be medicines which cure diseases, “without any
perceptible connexion between the immediate effect and the benefit
obtained.” While their operation is thus obscure, the mode of their
employment, and their peculiar virtues, must be subjects of much doubt
and uncertainty; while the accidents to which they are liable, in
common with other medicines, must occasion great embarrassment and
perplexity. But from the moment their modus operandi can be connected
with any known general law of the constitution, a great part of these
doubts disappear, a light is afforded for directing their good effects,
and a clew is obtained for tracing their injurious properties, and
applying the necessary antidote. The medical history of iodine will
fully exemplify the above observations.
This medicine was first introduced into practice by Dr. Coindet of
Geneva. Whilst making researches for other purposes, he found that the
fucus vesiculosus had been recommended by Russel in the cure of goitre.
From this plant, and other species of the same family, the soda,
with which iodine is generally found combined, is extracted. As the
sponge, whose virtues have long been established by certain experience
at Geneva,[1] is also a maritime plant, Dr. Coindet suspected that
iodine might be the active principle of them both; and by this analogy
he was first led to employ it in the cure of bronchocele. The success
which attended its use in the first instance was very remarkable;
and it seems to have been exhibited cautiously and warily, for some
considerable time had elapsed before the alarm was given of its noxious
effects.
[1] The total inefficacy of this medicine in the hands of
British Practitioners, while its virtues are so palpable and
evident at Geneva, that not only Physicians, but also the
inhabitants in general, are convinced of their reality, had
always surprised me. I was at a loss to account for testimony
so contradictory. It seemed as if medicine were a science so
uncertain and futile, that its plainest facts depend more on
the authority of name than on the substantial evidence of
observation and experiment. I lately obtained an explanation
of this difficulty from a quarter in which I can place
implicit reliance. It seems that the chemists are much in the
habit of substituting charcoal for burnt sponge, of which an
undeniable proof is the fact, that burnt sponge is sold at
an inferior rate to the same article before it has undergone
the process of combustion.—I may also be allowed to state in
this place, that I have sent prescriptions for the hydriodate
of potass to several chemists in London—that my prescriptions
were said to have been made up; but that a few days
afterwards, when I called at their shops, in order to examine
the medicine, I discovered that they were not even aware of
the existence of such a drug. If such frauds continue to be
committed with impunity, the sick had better submit patiently
to their pains, than have recourse to physicians, whose
science is rendered unavailing for the profit of tradesmen.
It may easily be imagined, with what joy the discovery of a certain
remedy for bronchocele was received in a place where that disease is
extremely common. Many used it, and many were delivered from their
unseemly and most inconvenient malady. But this state of things was
not of long duration. Familiarity with the remedy begat too great
liberality in its use, the effects of which were speedily apparent.
Iodine was then looked upon as a specific remedy for goitre. Its effect
upon the system was little known and little attended to. No person
seems even to have considered how it produced its astonishing results.
Its efficacy, however, in the cure of goitre, was soon generally
recognised. Its reputation flew over the city and neighbourhood of
Geneva, and it was taken with the utmost levity, with and without
medical advice. Dr. Coindet justly deplores this abuse, which was the
cause of the unmerited discredit into which the remedy afterwards fell.
When it had been used for some time in this manner, its pernicious
effects began to show themselves; several persons paid for their
temerity with their lives, and many were irreparably injured in their
health. Every day brought to light some new catastrophe, the effect of
iodine; and in the course of a short time its name was associated with
the idea of a most intractable and virulent poison. Neither patient nor
physician dared venture on its employment. It seemed to be one of those
benefits held up to invite the appetite, while its use was denied us.
These melancholy consequences of its indiscriminate and lavish
employment, show that iodine is a medicine of great power, and teach
the necessity of watching and studying its operation. Nothing can
assist us more in forming an accurate estimate of its virtues than a
careful observation of the bad effects which flow from its abuse; and
we shall now, therefore, proceed to consider them in detail.
* * * * *
Some time after the introduction of iodine into practice, a few cases
of severe spasmodic affection of the stomach and bowels occurred.
They were attended with violent and incessant vomiting, excruciating
pain of stomach and bowels, strong spasms of the back and legs. The
tongue was commonly furred, and the bowels sometimes violently purged,
at other times obstinately constipated. The pulse was generally
extremely frequent, small and depressed—the eyes sunk and hollow—the
countenance ghastly and pale. These accidents were usually imputed by
the patients to the iodine they had taken. The Physicians by whose
advice the medicine had been given, would not allow this origin of
the disease, till a repetition of similar cases determined that the
sufferers were right. The vomiting, pain of the bowels, and the cramps
of the legs, are extremely severe. They are also with the greatest
difficulty allayed, continuing sometimes for many days, and renewed
during weeks, and even months, after taking food. The legs sometimes
swell in the first instance, and afterwards become rapidly thin and
meagre. There is another symptom, which, though common to almost all
diseases, is peculiarly the sign of this. The emaciation which attends
this irregular action of iodine is so rapid and so extreme as to strike
terror into the minds both of patients and physician. A magistrate of
Geneva, high in office, robust, corpulent, and of an athletic form,
was so much reduced in flesh, that he was not known by his oldest
acquaintances. I have seen emaciation, in one case, proceed to such
an extent in a short time as is almost incredible. A young English
lady, at a boarding-school, at Paris, had for some time been afflicted
with goitre. Her brother was prosecuting the study of medicine there.
With the characteristic zeal of a young man, as soon as he heard of
the wonderful effects of iodine, he determined on making trial of its
powers on his sister. He did not find much difficulty in persuading her
to become the subject of his experiments, nor did he encounter more
difficulty on the part of the French gouvernante to whose care she
was confided. The remedy succeeded, as usual, in greatly diminishing
the tumour; and for some time no bad effects were apparent. A small
hard knot only remained in the situation which had been occupied by
a considerable swelling before; and the desire to get rid of this
little tumour was the cause of the remedy having been pushed too far.
Its deleterious effects first showed themselves by gnawing pain at
the upper part of the stomach, great anxiety, and oppression. These
symptoms were disregarded, and the remedy was persevered in for a week
longer, during which time the patient became very much emaciated; she
was frequently affected with vomiting, the pain of the abdomen became
more frequent and more severe, and the thirst was very distressing.
I was sent for early in the morning, in consequence of an alarming
diarrhœa, which had come on during the night, and I found her in a
deplorable condition indeed. Her brother, and the mistress of the
boarding-school, were so alarmed at the consequences of their conduct,
that they were quite unfit to give any advice about her treatment; they
could hardly indeed give me a coherent account of what had passed; and
the poor young lady was therefore entrusted to the care of servants.
She was then suffering the most excruciating pain at stomach, violent
cramps, and convulsive action of the muscles of the arms, back, and
legs, from which she had scarcely any intermission. The vomiting and
purging were almost incessant. The dejections were bloody, slimy, and
very scanty, but at first had been copious and feculent. The matter
vomited was of a dark green colour, streaked with blood. The tongue was
loaded with a thick crust, resembling in colour the matter vomited. The
countenance was pale, contracted, and with that peculiar expression
which announces abdominal suffering. The pulse was small, hard, and
frequent, scarcely indeed to be numbered. The whole appearance of
the patient was such as to excite well-grounded fears for her life.
Being quite unable to swallow, four grains of opium were directed to
be thrown into the rectum. They were not, however, long retained, and
were not productive of benefit. An anodyne embrocation was therefore
applied to the pit of the stomach, fomentations to the feet; and, as
soon as it could be got ready, she was placed in a warm bath. This so
much quieted the irritation of the stomach, that she was enabled to
swallow about thirty drops of laudanum, from which there was a decided
alleviation of her sufferings for nearly an hour. During ten days she
remained in a very doubtful state, subject to frequent severe attacks
of diarrhœa, with intense pain of the bowels. Her emaciation during
this time was most extraordinary. The expression of her French nurse,
“_décharnée_,” was literally applicable to her; her arms and body were
almost fleshless—her breasts, which had been large, were now perfectly
flat—the calves of her legs had quite disappeared—and her thighs were
not much thicker than her wrists, when in health. I never witnessed any
thing like such extenuation in so short a space of time. By the steady
and very liberal use of opium, she recovered to a certain degree;
but when I last saw her, many months after her illness, she remained
subject to frequent violent spasms of the stomach, during which opium
alone gave her relief. Her nervous system had been much shattered. She
repeatedly declared to me that she seldom enjoyed an hour’s respite
from the most wretched depression of spirits, and since her illness
had never felt any thing like her former buoyancy of mind. The few
moments of ease she knew were purchased by large doses of laudanum, to
the habitual use of which her sufferings had forced her. She was still
very pale, and her emaciation, though much less, was yet very great.
She was indeed a miserable monument of the effect of iodine. I heard
of this young lady a few weeks ago; she was then much better, had in a
great degree recovered her looks, and was able to leave off the use of
opium almost entirely. Her stomach, however, still remained very weak,
and obliged her to be very careful of her diet. The bronchocele had not
returned; but the small hard swelling mentioned above remained still
very sensible to the touch, but not evident to the eye.
* * * * *
These are the outlines of a very severe case. I trust that such a one
is not likely to occur soon again. But if practice so daring as I have
more than once witnessed in London be repeated, we may very soon see
even worse accidents than the above. These statements, however, are
important, inasmuch as they demonstrate that iodine is not merely a
medicine of specific power against bronchocele, but that it dissipates
this disease, by virtue of its very important action on the whole
absorbent system. I shall take further notice of this property in a
future part of my paper.
There is an effect of iodine to which I have alluded in the case just
quoted, but which is so extremely common, when the remedy has been
pushed to an overdose, that it deserves to be noticed at greater
length. The anxiety and depression of spirits are so great and
persevering as to warrant my considering them as the peculiar effect
of iodine, and not the consequence of the great debility which attends
the violent and inordinate action of this medicine on the constitution.
It is an affection very different from hypochondriacal melancholy,
inasmuch as it dwells principally on the present and has no reference
to the future. Patients have generally described it to me as a sense
of sinking and faintness, which were peculiarly oppressive, and I have
heard them complain of it while suffering the most intense pain, as the
part of the complaint which was yet the most difficult to bear. This
symptom is an almost constant attendant on the violent action of iodine
on the system, and frequently makes its appearance in a lesser degree
when the medicine acts in a kind and salutary manner.
We have now to notice the effect of iodine on the nervous and muscular
systems, and this is by far the most interesting part of our paper.
It is that also on which the greatest degree of doubt and uncertainty
rests.
The nervous and muscular systems are peculiarly exposed to the
irregular action of this medicine. In certain persons, indeed, of
peculiar habits of body, it cannot be exhibited so as to affect the
constitution in any manner, without in some shape or other producing
unpleasant nervous symptoms, such as dimness of vision, indistinct
hearing, fallacious touch, insomnia, breathlessness, palpitation, and
all the countless forms of inward nervous derangement. But the symptom
to which we shall more peculiarly confine our attention, is a degree
of tremor which generally comes on when the patient is under the full
constitutional influence of iodine. This symptom may be reckoned a
good gauge of the degree of nervous excitement which has taken place,
and it is seldom or never absent when that excitement has proceeded to
any considerable degree. It generally begins by a slight trembling of
the hands, resembling that which takes place from the poison of lead;
and if the medicine be incautiously continued, the larger muscles of
the arms, legs, and back become affected. When in this state, the
patient can with difficulty walk, and his progression is a tottering
uncertain motion. He cannot carry any thing straight to his mouth, but
the hand moves in a zig-zag manner, and with difficulty arrives at the
mouth at last. This complaint is generally attended with a hurried
circulation, and a small thready pulse. There is commonly great
suffering at stomach and confined bowels.[2] When nervous affection
first appears the medicine must be most diligently watched, and if
the symptoms seem to increase, its use should be instantly put a stop
to. If rashly persevered in, the symptoms I have described above will
certainly be excited, and then it is vain to withdraw the medicine;
the complaint goes on progressive for weeks and months, even though
its exciting cause be abstracted; and when it does at last begin to
diminish, the amendment is so slow and gradual that the patient is
scarcely conscious of the relief he receives. I saw two cases of this
kind with Dr. Peschier of Geneva, in which the patients had suffered
more than twelve months, and yet their sufferings had undergone little
mitigation. It is of some importance not to provoke a complaint with
so much difficulty allayed; and no one who has not seen it can have an
idea of the slow and imperceptible degrees by which it steals on the
patient. Its first advances generally escape his observation as well as
that of his physician. A slight trembling of the fingers, quivering of
the eye-lids, occasional subsultus of the tendons of the fingers, arms,
and legs, are generally the first symptoms observed, and it behoves
us to be constantly on the watch for them. I have always obliged my
patients to raise an empty glass or any light object to the head.
By this means the smallest degree of unsteadiness in the hand will
commonly be detected. I recommend a light object to be used for this
purpose, because a heavy one tends to give steadiness to the muscles
and to disguise the complaint.
[2] I have seen in one case a most obstinate suppression of
urine. I merely mention the fact, as I have no reason to
believe it to be a common effect of the use of iodine.
This effect of iodine is frequently complicated with the choleric
complaint I have already described; but it is evident that their
proximate cause is different, since they also exist separately. The
nervous affection is most common, if I may trust my observations, in
the mobile constitutions of women; at least nine out of ten cases,
which I have seen, were in women, and by far the greater number in
young nubile girls. In the latter cases the disease generally excites
some hysterical symptoms.
This affection differs from chorea. The patient has no difficulty in
keeping the affected limbs steady, if not called upon to exert them,
and in general exertion is irksome and painful. Like chorea, however,
it is always attended with a constipated condition of bowels. The
evacuations, also, are uniformly hard, scybulous, and dark coloured.
There is certainly a considerable resemblance between the two diseases,
but it would be too much to assert that what has been called their
proximate cause, or their nature, is the same. Such an idea, however,
has been adopted by more than one physician who has seen these cases
along with myself. I mention this, not in order to give weight to the
opinion, but in order to give my readers a more distinct notion of the
form, which the affection we have been considering sometimes assumes.
A statement of this kind is more graphical than many descriptions.
Mr. Orfila, whose industry and ingenuity in the study of poisons are
well known, has not neglected to examine and note the effects of iodine
when given in a large dose. He gave it to different animals in the
quantity of a dram and two drams. They were in general seized with
violent and frequent vomiting. When the contents of the stomach were
not soon thrown off, or were altogether retained, the poison was much
more speedily fatal. The animals do not seem to have been affected
with any other very remarkable symptom. It is stated that they were
much dejected, and manifested suffering, though they did not howl,
were not paralyzed or convulsed, and were not affected with any of the
more violent symptoms by which poisons commonly show their action on
the living body. It is plain that much light is not thus thrown on the
effects of iodine when exhibited as a remedy; yet when considered along
with the appearances after death, we still find a certain analogy. The
stomach was generally found corroded by small ulcers of a linear form,
which had eaten through the mucous coat. Those parts, also, which
were most exposed to the action of the poison, were thinner and more
transparent than the others, and were easily torn asunder. The mucous
membrane in the neighbourhood of the pylorus was found much inflamed,
swelled, and covered with a crust of coagulated lymph.
* * * * *
The affection of the alimentary canal which we have described above, is
plainly to be ascribed to the acrid operation of iodine on its mucous
membrane. I have never witnessed it in any considerable degree when
this medicine had not been taken internally. But I have seen slight
pains of stomach, accompanied with copious bilious evacuations, attend
its external use. These never proceed to the degree of violence which
marks the internal exhibition. Indeed, it is rare to see them in any
considerable degree disturb the comfort of the patient. It is not
thus when taken into the stomach. The case of the young lady related
above, sufficiently shows its deleterious influence. I have never seen
any disease of the bowels which more closely resembled the terrific
descriptions given by the physicians of India, of the sufferings
from the cholera of that country. Yet no medicine varies more in its
effects than this. Some persons take it in large doses for a great
length of time with perfect impunity; while others, from that peculiar,
undescribed and unintelligible state of constitution, called by
physicians an idiosyncrasy, are speedily and violently affected by very
small doses. Mr. Magendie, whose accuracy is well known, states that he
had swallowed a spoonful of the tincture, containing about a scruple of
iodine, without any bad effect ensuing. A child, also, four years old,
swallowed by mistake a tea-spoonful of the same preparation with equal
impunity. These are extraordinary instances, for I have received the
account of the death of a fine boy ten years old, who did not survive
many hours after having swallowed the largest of the above doses. And a
strong man who took this medicine, under my own care, in doses of half
grains three times a-day for one week only, was very soon affected in
such a manner, that, had the medicine not been immediately interrupted,
the most lamentable consequences might have ensued. When this medicine
is given internally, and it is often necessary that it should be thus
exhibited, it must be used with extreme caution, under the sanction and
observation of those who are able to watch its effects, and who are
experienced in its virtues.
I have never seen a case in which the mismanagement of iodine proved
fatal, and cannot, therefore, say whether its long continued use
ulcerates the mucous membrane of the stomach in the human body, after
the manner described by Orfila. I have no reason to believe that it
does, unless the extreme violence of the symptoms, and the obstinacy
of the vomiting, should by some be reckoned proofs of such a state.
I certainly, however, am inclined to believe that the last mentioned
symptom proceeds from inflammation and occlusion of the pylorus, which
Orfila describes as the effect of poisoning by iodine.
It is a much more difficult task to discover a probable explanation of
the manner in which iodine disturbs the actions of the nervous system.
The rationale of diseases, even when we are best acquainted with their
history, is obscure and unsatisfactory. Here it is better at once to
stop short, and confess our ignorance, than, by adventurous speculation
and daring theory, lay a foundation for mistakes in practice. This
subject certainly presents a fine field for hypothesis, and a tempting
one to a theorist. But we leave our readers in possession of the facts,
and trust they will not use them with less caution than ourselves.
One thing only seems probable, that is by its operation on the brain,
either immediately, or through the agency of the nerves, that the
effects we are considering are produced. The similarity of this
effect of iodine to the mercurial erethismus, so well described by
Mr. Pearson, will be evident to all, and is an analogy deserving of
attention and study. I have seen many instances of gilders in Paris
and Geneva affected with mercurial erethismus, closely resembling the
erethismus from the use of iodine.
* * * * *
Our most important consideration is the cure of these painful
affections. In the choleric disease the first remedy of all, and
that without which we can have little hope of subduing the disease,
is opium. If called early to the patient, before the bowels have yet
thrown off their acrid contents, I have generally waited a little
before exhibiting opium. I have done this for two reasons: First, that
I might be certain of all acrid matters having been removed from the
alimentary canal before the prescription of a medicine to quiet its
irritation; and, secondly, because it is with great difficulty that the
opium is retained while the extreme irritation of the disease is going
forward. Emollient and diluting injections will in these cases be found
most useful auxiliaries, both by washing out the inferior portion of
the gut, and by quieting the violent action of the stomach. Hemlock
and hyoscyamus sometimes succeed when opium fails. The case related
at page 7 was much relieved, indeed I may say that the young lady’s
life was saved, by a quarter of a grain of acetate of morphium given
every half-hour. Every other form of opium was tried without effect;
they were not even retained an instant on the stomach. The acetate
of morphium alone could be taken, and it effectually restrained the
disease, which must otherwise have very soon terminated the life of
the patient. This medicine has not, however, answered my expectation
in other cases. I have tried various bitter and astringent medicines
in union with opium, but have found them uniformly injurious during
the first stage of excitement and exacerbation. Afterwards, when the
disease has in some degree abated, this class of medicine will be found
useful. I cannot too strongly caution my readers against the use of
purgatives in such cases. However gentle they may be, their effect is
uniformly and most decidedly noxious. In the first and acute period
of this affection of the alimentary canal, it is almost impossible
to quiet the disturbance which a purgative occasions. A remedy which
ought never to be neglected is the warm bath. It will be found a most
powerful coadjutor in restraining the violence of the spasms, and in
moderating the perturbed action of the stomach.
But the greatest difficulty will be found in treating the second or
chronic stage of the complaint, when the symptoms we have mentioned as
characterising it are prolonged in a mitigated form. I am inclined to
believe, that in this state there is actual ulceration of the mucous
membrane of the intestines. I have only seen one case of this kind, of
which I have given the history above. But several similar instances
have been communicated to me, and they must be of frequent occurrence
wherever iodine is used ignorantly and rashly. In all those cases of
chronic affection of the alimentary canal, with the particular history
of which I have been able to become acquainted, the symptoms differed
widely from those which marked the accession of the disease. Instead
of the small vacillating pulse of the first period of the complaint,
it was bounding and firm, the extremities were no longer cold, nor the
system collapsed; the diarrhœa had assumed a dysenteric form, the fæces
being retained, and the dejections consisting chiefly of maturated
mucus or pus. In such cases, I believe, the conjoined operation of
aperient medicines and opium will be found most advantageous in
quieting the symptoms. By this plan at least I succeeded best in
relieving the single case that has yet occurred to me.
With regard to the treatment of the muscular spasms, and the
disturbance of the nervous system, we have before described, there
is no invariable plan of cure to be followed. Until we are better
acquainted with the nature of the affection, it is impossible to apply
a remedy to the root of the complaint. All I can do here, therefore, is
to point out the means by which I have best succeeded in averting and
palliating its painful symptoms. I have seen ten cases of this kind,
and all of them have seemed to be much more benefited by attention
to diet, air, and exercise, than by any medicines they have taken.
Patients thus affected ought to live much in the open air; their food
should be sparing, mild, and nutritious; and they ought to avoid
carefully the use of wine and ardent spirits. By these means alone,
and the use of mild aperient medicines, two of the cases alluded to
were quickly recovered, although they began in a very threatening
manner. All the others but one were much relieved by the same means.
I therefore consider these simple remedies to be of the greatest
importance, and am convinced that without them no other remedies
will have any effect. Next in importance to gentle exercise in the
open air, and attention to diet, I should place the use of the warm
bath. By means of it the severity of the spasms is very frequently
relieved. The young lady, whose case is related at page 7, used it
daily, sometimes several times in a day, and never without benefit.
She could never enjoy any sleep at night unless she had previously
spent a quarter of an hour in the bath; and to this day she continues
the use of it. Joined to the above remedies, habitual attention must
be paid to the bowels. They should be moved by the gentlest medicines,
and they may often be advantageously acted on by glisters only. This
manner of exhibiting medicine is frequently objected to in England,
because it only empties the lower parts of the larger intestines; but
repeated experience has convinced me, that the mere circumstance of
evacuating the large intestines gives occasion to, and stimulates the
action of, the higher passages. I do not intend to defend the habitual
abuse of enemata which is daily witnessed on the Continent; but, in
this country, I think that their use may be extended with advantage. In
whatever way, however, the bowels are evacuated, it is of the greatest
consequence that they should be acted on by the gentlest medicines
possible. Such, however, is their slowness in this disease, that it
sometimes becomes necessary to use the strongest medicine in order to
effect a mere evacuation; but I have never seen the bowels violently
moved without the highest injury to the patient. My common practice
has been to prescribe small repeated doses of one of the neutral
salts, to each of which I desire five or six drops of laudanum to be
added. By this means it has seemed to me that my purpose was effected
with least violence. I have tried all the medicines of the class of
antispasmodics, and cannot speak in favour of any one of them. They are
either useless or hurtful. The tinctures and ethers are injurious in a
very marked manner and in a very high degree. Various other remedies
will, of course, be suggested to the judicious practitioner by the
peculiar circumstances of each case.
* * * * *
I may seem to some persons to have dwelt too tediously on the poisonous
properties of iodine; but let it be recollected, by those who have
had opportunities of becoming acquainted with its virtues, that this
medicine is as yet almost unknown to the numerous practitioners who
are now daily using it; that it is a medicine of singular power and
efficacy in a great class of disorders, with which the inhabitants of
this country are peculiarly afflicted; that this most useful remedy
may be divested of all its deleterious properties; that, therefore,
it will probably come into general use among us; and they will allow
that I have not bestowed too much time on this important subject. I
wish the details had been more complete, that my experience had been
more extensive, and that I had been better able to satisfy the reader’s
curiosity and my own.
Some of my readers, who have lately been in the habit of using iodine
cautiously, and of watching its effects, may think that I have
overcharged the picture of its baneful properties; but I have been an
eyewitness of all I have written; and I should extend this treatise
much beyond the limits I have assigned to it, did I detail all the
cases that have reached me of the mischief it has produced. I am glad,
however, to add my testimony to that of Coindet, de Carro, and others,
that this medicine may most certainly be deprived of all its hurtful
qualities, by using it cautiously and watching its effect. Like all
other powerful medicines, when its action is not controlled by the
hand of a master, its energies become a source of mischief and ruin,
instead of restoring the blessings of health and strength; but when
well managed, it is a most useful remedy, and a valuable addition to
our materia medica. I have used it myself in a great number of cases,
and I have never yet, in my own practice, had occasion to regret the
occurrence of any of the violent symptoms I have described. I have
more than once discontinued the medicine on finding the pulse become
frequent, small, and depressed, on account of watchfulness, flying
pains of the joints, tremors, or pain at the stomach; but having early
detected these symptoms, they were not allowed to become formidable.
Dr. Coindet states, that he has prescribed the medicine to one hundred
and fifty patients, and that he has never had occasion to observe any
mischief from its use.[3] Dr. Decarro has given it at Vienna to one
hundred and twenty patients; Dr. Erlinger, of Zurich, to seventy;
and Dr. Formey has prescribed it extensively, in Prussia, with the
same favourable results. Dr. Decarro, in his enthusiasm about this
new medicine, seems almost to doubt whether accidents have ever
occurred from its use, though these accidents have been as public
as the day, and the unhappy patients have paid with their lives the
inexperience and rashness of their physicians. Thus far I can agree
with Decarro, that I have never known or heard of any bad effect from
iodine, when it had not been used unadvisedly and injudiciously. It
has been used extensively by Hufeland in Germany, who makes no mention
of its deleterious properties; and a great number of physicians in
London and Paris, and various parts of England and France, have also
lately employed it. They have either not met with the accidents I have
described, or have prudently concealed them.
[3] Dr. Coindet, however, though he must be acquainted with
the sad accidents which have occurred in his native city, has
not yet taken any public notice of them. This silence on facts
so important seems in some degree to invalidate his testimony.
* * * * *
Having now considered the effects of iodine on the alimentary canal
and the nervous system, we are prepared for studying its effect on the
absorbent vessels, by which its use in medicine is indicated. This
is the most important subject which has yet fallen under my review,
and I shall give it as much extension as may be necessary for its
perfect discussion. It has been already seen at pages 10 and 12 that
the lymphatic system is very powerfully and generally stimulated, so
as to occasion a great absorption of all the sebaceous, muscular, and
glandular structures of the body; but it will be seen, in the following
pages, that the action of iodine may be directed exclusively against
tumors, and local disorders, while the healthy structures of the body
remain unaffected.
The absorbent system is distributed over every part of the body. In
the brain alone the vessels of this class have not, hitherto, been
detected and submitted to ocular demonstration by any other anatomist
than Mascagni. But physiological and pathological proofs of their
existence, equal in force to any anatomical evidence, are not wanting
to demonstrate their presence in the central organ of the nervous
system. The office which these vessels discharge, in the nutrition of
the body and removal of its waste, is most important to its healthy
condition; and the influence it exerts, in a state of disease, is not
less considerable. From the inactivity or obstruction of the absorbent
vessels, a great proportion of the chronic disorders of the body
take their rise. Medicines, therefore, which act either directly or
indirectly on this system, have always been accounted most valuable
articles of the materia medica. Unhappily, they too often deceive us
in their operation, and, notwithstanding the united studies of many
physicians directed to them, the causes of their failure, as well as
the circumstances under which they succeed, still remain a problem. A
considerable step towards the solution of this difficulty has, indeed,
been lately taken by Dr. Blackall. Much obscurity, however, yet rests
upon the subject, and a direct medical agent on the absorbent system,
whose effects are speedy, indubitable, and powerful, is a great
desideratum in the art of healing.
Such an agent is iodine. Its effects on the absorbent system are
incontrovertible. They are as speedy as they are certain, and so
powerful are they, that if the medicine be not duly and cautiously
managed, we have already seen what havoc may be the result. A few, a
very few, cases have occurred to myself, in which the constitution was
altogether insensible to its action; I believe a greater number have
occurred to others; but I cannot help thinking that such cases have
been owing, in many instances, either to some fault in the medicine, or
to some inadvertence on the part of the practitioner.[4]
[4] The iodine which is sold in the shops is of very different
degrees of purity, which will probably afford an explanation
of some of the above anomalies. But still after all possible
care has been taken, there will be found a few instances
in which it does not appear to possess any power over the
absorbent system.
We shall first consider the use of iodine in the treatment of
bronchocele, the disease for the cure of which it was introduced into
practice. All the physicians who have employed it bear unequivocal
testimony to its efficacy. It seldom fails of effecting a complete
cure, and when it does, it almost always reduces the swelling
very considerably. The promptitude of its action is at times very
extraordinary. Decarro states, that one of his patients, thirty-eight
years of age, after taking the remedy for seventeen days, had the
circumference of his neck reduced from one foot seven inches and a
half, to one foot three inches and three-quarters. Dr. Coindet relates
a case of a man, fifty years of age, in which this medicine, taken
internally, reduced a very large goître considerably in size, after
six days’ treatment only. An old woman, aged sixty-five, who took this
medicine under my care for a goître, with which she had been affected
nearly forty years, had the circumference of her neck reduced from
twenty-two inches to eighteen, on the twenty-fifth day. Such rapid
diminution in the size of the tumor is not to be always expected. In
some cases a whole month, and even more, elapses before any effect is
visible. In general, however, the powers of the medicine are manifest
at the end of the second week and considerable progress towards cure
has been made at the end of a month. I have endeavoured to find out
whether there was any thing in the constitution of the different
persons under my own observation, or in their state of health, which
rendered them more or less apt to be affected by this medicine. I
have not been very successful in this inquiry. But I found that in
two cases of women afflicted with extensive and very painful varix of
the veins of all the extremities, the effect of iodine was produced
with great difficulty. This fact seemed to coincide with the result
of Mr. Magendie’s very interesting experiments on absorption, and I
accordingly desired one of the persons, to whom I have just alluded, to
lose a little blood from the arm. The effect of the medicine was very
much accelerated by this treatment, but a consequence I did not look
for was also the result of it, viz. the total and sudden disappearance
of the varix, which had commenced during uterine gestation twelve years
before. The goître succeeded the varix after her delivery. I merely
mention the facts of this case, which may suggest useful hints to those
who may meet with a case similarly circumstanced. Since its occurrence,
whenever the medicine is slow in its operation, provided the vessels
be full and plethoric, I desire a little blood to be taken away from
the arm, and I almost invariably find the action of the medicine much
quickened. I have sometimes, also, thought that the cases, in which
blood was taken away, were cured more easily and with less suffering
than the others.
There is, very rarely, any considerable effect produced on the arterial
system by iodine, if it be given with propriety and caution. Sometimes
it accelerates the pulse in a slight degree; it frequently occasions a
little mucous expectoration from the chest, and it often raises nervous
symptoms in delicate subjects, which are very distressing. I saw it
given to a young woman in one of the public hospitals in Paris, in
whom it produced such a state of insomnia that she told me she had not
slept at all for a whole week, though she had been a very good sleeper
before. I have said that it affects the pulse but a little, yet it
sometimes stimulates very powerfully the arterial vessels of the tumor.
This is mentioned by all the authors who have written on iodine, and
is one of the most singular circumstances in its medical history!
This irritation of arterial vessels frequently becomes active
inflammation, requiring the use of bloodletting for its relief. Topical
bleeding will, in general, be found fully competent to remove it.
Indeed, it sometimes happens that when the iodine has lighted up smart
inflammation in the tumor, the arterial system generally is unaffected.
To what is this effect on the vessels of the part to be attributed,
from which the constitution generally is free?
The same is occasionally true of the absorbent vessels. I have
seen some very large tumors discussed, while there was no evidence
whatever of the absorbent vessels in other parts of the body having
felt the influence of the medicine. It is a curious question, to
determine by what law the constitution remains impassive to the action
of a medicine, which affects remote and distant parts through the
constitution. Certain tumors are of so irritable a nature, that a
stimulus, which only serves to rouse the healthy energies of the body,
excites the process of destruction in them. In the quaint language
of a celebrated modern lecturer, “they are irritable beings, if you
touch them they’ll kick.” But this is not the case with many of the
tumors which are dissipated by iodine. Bronchocele, for instance, is
of a slow growth; all the operations which go forward in its structure
are of a very indolent and chronic kind. Such, also, is the case with
the greater number of scrophulous tumors. Yet all of them have been
dissipated, like a charm, by the agency of iodine.
In prescribing this medicine, it is very necessary not to lose sight
of the effect I have just mentioned. When the tumor is very large,
and especially in that kind of bronchocele, in which the principal
enlargement of the thyroid gland takes place on its inner surface,
where it is in contact with the trachea, the occurrence of inflammation
is much to be apprehended. When a very large tumor becomes inflamed,
the distress which it occasions, and the disturbance it excites in the
constitution, are very considerable; and in the second case to which I
have alluded, inflammation of the trachea is very readily excited.[5]
Such cases are easily distinguished by the immovability of the tumor,
and the effect they have in altering the voice. On dissection, the
trachea is sometimes found to have been very much compressed by them.
[5] Dr. Coindet gives an instructive example of this kind.
_Bibliothèque Universelle, Février, 1821_, p. 148.
It is now fit that I should mention the most common and beneficial
methods of using this substance. Dr. Coindet has recommended the
hydriodate of potass as an external application, and my experience
has certainly confirmed his choice. The hydriodate of soda, however,
will be found to answer equally well. Practitioners may choose between
these two remedies. I have used the iodates, but I have found them at
once more inert and more unmanageable. They possess all the virtues
of iodine in a very remarkable degree, but they will be found to fail
more frequently than the hydriodatic salts; and, if I may draw any
conclusion from the few trials I have given them, they are more apt
to excite disorder in the system. I have generally ordered half a
dram of the hydriodate of potass to be united to an ounce and a half
of axunge, and desired the patient to rub in a dram of this ointment
over the surface of the tumor, night and morning. When the tumor is
painful, it is not necessary to rub in. The ointment may be used in the
manner recommended by Scattigna.[6] All that is necessary is to choose
a portion of the surface of the body where the skin is very tender and
thin, and simply to apply the ointment over night. For this purpose,
almost any part of the body which is habitually covered may be chosen;
but in the axilla, and in the inner surface of the thighs close to the
scrotum, the absorption will be found most rapid.[7]
[6] Nuovo metodo di amministratori l’unguento mercuriale ne
mali fisici del Dottore Vitantonio Scattigna. Napoli, 1818.
[7] I have seen, in the hospitals of Naples, the most
decided and unquestionable effects produced by mercury used
in this manner, I have since used it frequently in my own
practice in the same way; and I believe that the mercurial
ointment, thus used, is exempt from much of the inconvenience
occasioned by rubbing. I have seen several persons use it in
this manner with ease, who could not rub in mercury without
much suffering. Scattigna asserts that it is also much more
efficacious than when rubbed in by the common method. His way
of using it is, to extend a scruple of mercurial ointment over
the skin of the axilla before the patient goes to sleep. In
the morning, the whole of it will be found to be absorbed,
and in this way he calculates that as strong an effect is
produced as by a drachm of the ointment. I have used, in a
case of hydrothorax, an ointment of squills in the same way,
which has caused an increased flow of urine, which I had
vainly endeavoured to effect by means of the same medicine
given by the mouth. These statements are at variance with the
experience of Mr. Pearson, which must be allowed to be of much
weight in this matter. Will the difference of climate account
for the discrepancy?
It is a more important question to determine the proper method of
using this medicine internally. From my own experience, I am inclined
to give a decided preference to the solution over the tincture. It is
prepared by dissolving thirty grains of the hydriodate _of potass_ in
an ounce of distilled water. I have generally begun this preparation by
a dose of ten drops, and augmented it gradually to twenty, and, very
seldom, to twenty-five. This preparation can dissolve an additional
dose of iodine; a formulary, however, to which I seldom, if ever, have
recourse. I have found that the deleterious action of the medicine
on the bowels was more marked, in proportion to the quantity of free
iodine it contained. For this reason, also, I now seldom have recourse
to the tincture, a form much used, because it is less expensive.
Practitioners will, in general, find an advantage in confining
themselves to the external use of iodine for the cure of bronchocele,
and tumors, which do not arise from any vice in the constitution. In
a few cases of bronchocele, however, it is necessary to have recourse
to its internal use, especially when the disease exists in a strumous
habit. By the use, either of the ointment, or of the solution in the
way we have recommended, a soft bronchocele will be discussed in a
month or six weeks. Those which are hard, and of old growth, generally
take a little longer time, and many of these latter cases cannot be
altogether reduced. I have seen two cases, however, in which the
tumors gradually disappeared some weeks after the medicine had been
altogether discontinued. Dr. Coindet says, that he has seen several
cases of bronchocele, complicated with watery cysts, yield completely
to the action of iodine. I have only had occasion to see one such case
treated by this medicine. It was somewhat lessened in its bulk, and the
patient was certainly relieved, but the disease was by no means cured.
If the iodine be given internally, it is indispensably necessary to
watch its effects from day to day. No peculiarity of circumstances
whatever can dispense the physician from this care; and if it be
recollected that it is yet a new medicine, that unknown accidents,
to which it is liable, may be discovered by future investigations,
this caution will not appear superfluous. The case related by Dr.
Coindet, to which we have already alluded at page 36, in which a very
powerful and painful effect was produced at the end of the fifth
day, sufficiently evinces the necessity of the watchfulness here
recommended.
When iodine acts kindly on the constitution, no other effect will be
found to accompany its use, but a diminution of the tumor and a little
nervous excitement, which is sometimes not so severe as to become
disagreeable. The increase of appetite is a very frequent effect of
iodine, and it is sometimes very troublesome, because it is extremely
necessary not to indulge it. The diet of the patient should be good,
but by no means full, which the occasional voraciousness of his
appetite would lead him to adopt.
* * * * *
Having established that the use of iodine in bronchocele was owing to
its effect on the absorbent system, it was natural to conclude that it
would be of equal service in the cure of scrophula.[8] Accordingly,
we find that Dr. Coindet made trial of it in the cure of the latter
disease, soon after he had determined its virtues in the former, and
that his experiment was followed by the most satisfactory result. I
have already considered at so great length the general effects of
iodine on the constitution, that little remains for me in this place
but to mention the particular cases in which I have found it useful,
and those in which it has failed my expectations.
[8] On perusing most of our practical, and more especially
our systematic authors, this term will be found of such
latitude and various meaning, that, were they indiscriminately
followed, scrophula might be considered an universal disease.
In this place, we confine our attention to those diseases
which are familiar to all practitioners, scrophulous tumors of
the conglobate glands.
The first case of scrophula in which I made use of this medicine, was
that of a young lady eighteen years of age, who had been affected by
glandular swellings of the neck for nearly eight years. She used the
solution of hydriodate of potass for a month; the dose varied from
ten to twenty drops three times a day, with occasional intermission
of a day when the absorption was going on rapidly. At the end of this
time she had got perfectly rid of her swellings, and she now (two
years since she took the medicine) remains perfectly well. When she
discontinued her drops, so far from having been incommoded by them,
her health was certainly much improved. There remained several little
fistulous sores, which required the assistance of the knife to heal
them. The iodine is not equally efficacious in all cases of this kind.
Great numbers, however, yield rapidly under its use; but many of them,
also, resist its operation. I have never been able to assign even a
plausible reason for this difference of its action in scrophula. In
general, I have found such cases yield more readily to the internal
than to the external use of iodine. The scrophulous glands of children
are not so easily affected by iodine as those of persons who have
attained the age of puberty, and they are also more liable to a relapse.
A female servant in one of the public hotels of Paris, aged
thirty-three, married, who had born several children, shewed me a tumor
of her right breast she had had about two years. It was not attended
with any pain, but had lately somewhat increased, which gave her alarm.
About a year before she had been advised by a surgeon to have it cut
out. This advice gave her so much uneasiness, that she presented
herself at the clinical consultations of M. Dubois. That eminent
surgeon immediately distinguished the tumor to be scrophulous; and
during three months’ treatment, all the usual remedies of this disease
were exhausted without the least effect. A scruple of the ointment of
the hydriodate of potass, placed in the axilla at night, completely
removed the tumor in about six weeks. This is the only case of a
similar kind in which I have used iodine. I have never yet employed it
in scirrhus of the breast.[9]
[9] My friend Mr. Maunoir, of Geneva, informed me that a
little boy from one of the interior towns of Switzerland, was
brought to him on account of a swelling of the knee-joint. He
had already been under the care of several eminent surgeons,
who had all declared the tumor to be a white swelling, and had
recommended the amputation of the limb. Such, also, was the
opinion of Mr. Maunoir; but finding the friends and the boy
himself extremely averse to the operation, he tried the effect
of iodine. In the course of a few weeks the tumor, pain,
and stiffness of the joint were dissipated, and the boy was
running about as formerly.
I was called in the month of February, 1822, to visit a boy five years
old, affected in the following manner. Since the period of his birth,
he had always been weakly, but, for the last two years, had gradually
been falling off in his flesh and strength. He complained of frequent
pains in his bowels, which were alternately confined and purged; the
motions were discoloured and scybalous; he frequently vomited his
food; his abdomen was much swelled; the rest of his body considerably
emaciated; pulse natural; appetite variable, but never great. It
was impossible to doubt, from the appearance of the child, that the
mesenteric glands were enlarged, and I determined to make a very
cautious trial of iodine. It was the first case in which I had used it
for an internal disease, and I therefore watched it with unremitting
care. I began by giving my little patient twelve drops in the day,
which I gradually augmented to twenty, and I had the pleasure of seeing
the abdomen gradually diminish in size, the bowels become more regular,
the evacuations restored to their natural colour, the pain diminish
and vanish, the appetite increase, and at the end of five weeks the
child return to comparative health, without the occurrence of a single
untoward symptom. The only medicine I employed during this treatment,
besides iodine, was occasionally a few grains of rhubarb. At the end
of the five weeks the bowels acted without medicine. I am sorry to
say that I lost sight of this child from this time. The parents were
poor, were probably satisfied with the benefit they had received,
and not willing to incur any farther expense for medicine. I have
since prescribed this medicine in two other cases of disease of the
mesenteric glands. The result was not so satisfactory as in the case I
have just related, but both of them were considerably relieved, and had
they been more attentive to the directions given them, I have little
doubt that they also would have obtained a complete cure. But they were
in the poorest class of society, were irregular in their habits, and
paid very imperfect attention to the orders of their physician. In one
of them, a young woman, fifteen years old, after she had taken fifteen
drops of the solution of hydriodate of potass, twice a-day during three
weeks, considerable tenderness of the whole abdomen came on, for which
I judged it necessary to order the application of a dozen leeches. The
relief was immediate. From the whole appearance of the case, I judged
this feverish attack to be an affection of the mesenteric glands,
similar to what I have described at p. 39.
I have used this medicine in cases where I had good evidence of the
presence of tubercles in the lungs, and I do not doubt that it will
be found to be serviceable in the incipient stages of the disease.
But I much question whether it will prove even innocent in the more
advanced periods of tubercles, when extensive disorganization has taken
place in the lungs. Some cases in which I have prescribed it, were
benefitted in so marked a manner as to have inspired me with hopes of
having at length found a remedy for that hitherto intractable and cruel
malady. Other cases, on the contrary, seemed to be much aggravated by
its use. If I may judge from the cautious expressions of Dr. Baron,
in his work on tuberculous disease, this is nearly the result of his
experience also. It is much to be desired that we had sufficient data
for distinguishing the cases in which its use is beneficial, inert,
and injurious. As yet, the results I have obtained do not entitle me
to come to any very definite conclusion on this subject. Mr. Haden,
in his translation of Magendie’s Pharmacopœia, has given the history
of a case of affection of the chest, in which he seems evidently to
think that tubercles were removed by the agency of iodine. I am glad
to find this case stated by Mr. Haden with his characteristic candour
and caution. It is much to be desired that a series of such cases were
published. They would form the materials on which a just estimate of
the powers of this medicine might be formed. I trust to be able, at no
distant period, to give the result of my experience in this disease to
the public, in such a manner as to establish what are the real virtues
of iodine in the cure of pulmonary tubercles. At present, there is
certainly sufficient ground for making a cautious trial of its powers;
but, if I may trust to my own experience, it is impossible to use it
with too much circumspection.
A young gentleman, aged twenty-six, who had passed four winters in the
south of Europe for a cough, with pain in his chest, and occasional
expectoration of a thick maturated discharge, frequently streaked with
blood, consulted me on account of swelled glands in his neck, which
he had had from his infancy, but which were at that time particularly
troublesome. I desired him to use a solution of hydriodate of potass
in the dose, of twelve drops three times a-day. In the course of two
months, the swellings in the neck, which had pained him from his
infancy, were quite dispersed, and at the same time his sufferings in
the chest were so much diminished that he requested to be allowed to
continue the medicine. I allowed him to use it a fortnight longer, at
the end of which time he was quite free from complaint. He subsequently
had another attack of his chest complaint, and wrote to me from
Thoulouse to request directions for renewing the use of the medicine,
under the care of a French physician. Before my letter reached him,
he was carried off by an attack of some violent complaint, of which
I never could learn the history. I have exhibited this medicine in
several such cases, and frequently with the most marked good effects.
In fine, I have not the smallest doubt of its efficacy in relieving
many diseases of the chest, in which all the general symptoms, as well
as all the local means of exploring the condition of the lungs, which
have lately been so much attended to in France, have given me the
most satisfactory evidence of the presence of tubercles. I will not
yet assert, however, that the use of iodine has been followed by the
absorption of tubercles in the lungs. This important fact must not be
affirmed hastily; but I trust I shall be enabled, at a future period,
to establish it to the satisfaction of every one, or to explain the
beneficial action of the medicine on other grounds.
Dr. Baron, in his work already quoted (p. 221), has related a case
of encysted dropsy of the ovarium, in which the use of iodine was
attended with the most manifest and rapid benefit. I have seen it used
in a case of the same kind, in which a swelling that had been twice
tapped, and which then filled the greater part of the abdomen, was
almost completely removed. The patient, a woman of sixty-two, has
recovered her strength; she has resumed the appearance of health, and
has remained eighteen months free from dropsical symptoms.
I have made trial of iodine in two cases of ascites without benefit.
I have also made use of it in a case of amenorrhœa, according to
Coindet’s advice, without the smallest advantage; nor have I been able
to satisfy myself that it possesses any power over the uterine system.
CONCLUSION.
The liability of iodine to excite great disturbance in the
constitution, has been made an objection to its use. I fear that
this reproach must be shared by all powerful medicines whatever. If
unattended to, or used with levity, any medicine which is capable of
doing good, may also do harm. But if used with due discretion and
properly watched, I have no hesitation in affirming, that iodine may
be employed with as much safety as any of the powerful remedies which
are daily in the hands of the least skilful members of the profession.
But it has been also made a subject of reproach to this remedy that it
is quite inert and useless. I shall not give any further reply to such
a statement than what the foregoing pages contain. But I am credibly
informed that it has been used by several eminent practitioners of
London; who finding it quite inert, had laid it aside as useless[10].
[10] So great have been the ravages committed by the imprudent
use of iodine in the Pays de Vaud, that the government of that
canton has issued an injunction against its sale, excepting
under the signature and responsibility of a physician.
I have already pointed out one source of such mistakes (page 3). I
fear, however, that it has also been used by physicians who have not
leisure of mind nor time enough for conducting such inquiries as they
ought to be conducted. When we consider the silly pretences on which
medicines are sometimes forced into fashionable practice, it will
not appear wonderful that the investigation of their virtues should
not be conducted with much zeal. But I know also that it has been
hastily rejected, and without trial, by some persons grown old in
the practice of physic, who have made their interests decidedly to
consist in defending all that is old, and repudiating all that is new.
Such persons expose themselves to ridicule when we see them reject a
remedy so active as iodine, and continue to trust, for the cure of
the severest diseases to which the human frame is liable, to medicines
allowed on all hands, and even by themselves, to be absolutely useless.
The value of iodine as a remedy, however, does not depend on the
testimony of any individual, however high his name. Its use is
established by a long series of facts observed by physicians and
surgeons of different countries. Wherever it has received a fair trial
from unprejudiced persons, its effects have been so striking and
undeniable as to force assent. It is not one of those remedies which is
adopted by one man, and rejected by another, according to the accident
or caprice of the moment; but one whose effects are written in such
clear and intelligible characters, that _he that runs can read_. Its
applications also are in cases of such common occurrence, that all
practitioners have an opportunity of satisfying themselves of the real
nature of the remedy, and the extent of its powers.
This medicine has also been called an empirical remedy. Of what
importance is it that it should bear this or any other name, by which
the enemies of every thing that is new endeavour to keep others in the
same state of happy ignorance which satisfies their own indolence, and
answers the demands of the common routine of their practice? But in
what respect is it an empirical remedy? Do we know any thing more of
the action of a purgative? It is said to stimulate the larger or the
smaller intestines, and iodine may be said to stimulate the absorbent
vessels; and after we have said this, are we at all wiser than we were
before? The only questions now before us, those which alone appear
worthy of discussion, are, Do we in iodine possess a remedy for the
diseases in which I have said it is useful? and if we do, on which of
the living textures does it seem most particularly to exert its action?
These questions settled, all the rest is of comparatively trivial
importance.
The medicines which exert their action on particular textures or
systems are extremely few indeed, and the few we possess are so
uncertain in their operations, they are liable to such frequent
failures, that sceptical physicians doubt of their efficacy
altogether, and even of the efficiency of medicine. There is something
peculiarly gratifying to their vanity in supposing themselves freed
from the common errors, and above the credulity of the vulgar. Iodine,
however, is not liable to the sneers of such narrow minds. It is a real
“heroic remedy”—a true present from the science of medicine to mankind.
APPENDIX.
I have here thrown into an Appendix a brief account of the different
preparations of which I have had occasion to make mention. It is
chiefly extracted from Magendie’s Formulary, which will be found to
contain sufficient directions for the chemical and pharmaceutical
operations undergone by iodine.
_Tincture of Iodine._
Take of Alcohol, of sp. gr. of .842, 1 oz.
Iodine, 39 gr.
Dissolve.
This preparation should not be long kept, as it readily undergoes
alteration and decomposition. Alcohol varies in its solvent power of
iodine according to its degree of concentration. The frequent opening
of the vessels, therefore, in which it is kept, must occasion a change
in the quality of the tincture, by allowing the evaporation of the
spirit, and thus occasioning a diffusion of undissolved iodine through
this preparation. Mr. Magendie seems also to fear, that a decomposition
of the alcohol may take place from the superior affinity of iodine for
hydrogen. Altogether this is certainly the most objectionable form in
which iodine is used.
_Solution of Hydriodate of Potass._
Take of distilled Water, 1 oz.
Hydriodate of Potass, 30 gr.
Dissolve.
I have generally prescribed these two preparations in cinnamon or mint
water, in which form they are seldom disagreeable to the stomach.
I have avoided, as much as possible, joining them to any tinctures
or infusions, as we are yet in a great degree unacquainted with the
chemical habits of iodine and the different vegetable substances. It
will be sometimes, however, found advisable to use tonics with iodine.
_Ointment of Hydriodate of Potass._
Take of Hydriodate of Potass, ½ dr.
Axunge, 1½ oz. Mix.
NOTE.
Since these pages were put to press, I have received from Professor
Maunoir the following details of the case mentioned at page 49. As
far as I know, it is the only case of the kind on record. I make no
apology, therefore, for inserting it in this place.
“C’est le 18 Mars 1821, que j’ai été consulté pour la première fois
pour le jeune B—— de Soleure, enfant de huit ans, atteint, depuis moins
d’un an, d’un _white swelling_ au genou droit; pour lequel on avoit
employé inutilement vésicatoires, sangsues, topiques résolutifs de
toute espèce, remèdes internes, &c. Il avoit alors une augmentation
considérable dans le volume du genou, que le médecin supposoit avoir
lieu dans les os plutôt que dans les parties molles, et en même tems
une diminution sensible dans le volume de la jambe. L’enfant ne pouvoit
faire un pas sans douleur avec des béquilles; car il y avoit flexion de
la jambe sur la cuisse, je ne sais pas à quel angle, mais impossibilité
d’extension.
“Je l’ai traité par correspondance sans le voir; on lui a fait des
frictions avec l’onguent d’iode, gros comme une noisette, matin et
soir. Il a pris la teinture d’iode à la dose d’ 1/12 de grain au plus.
Son estomac n’en a été nullement affecté, et huit mois après le père
n’a pas pu résister au plaisir de me montrer son enfant. Il me l’a
amené à Genève, et j’ai vu cet enfant, marchant et courant lestement,
le genou droit de la même grosseur que le gauche, et aussi serviable
que celui-là.”
THE END.
LONDON:—PRINTED BY J. MOYES, GREVILLE STREET.
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