Read Ebook: 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 by Gairdner William

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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 go?tre considerably in size, after six days' treatment only. An old woman, aged sixty-five, who took this medicine under my care for a go?tre, 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 go?tre 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. 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.

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. 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.

Nuovo metodo di amministratori l'unguento mercuriale ne mali fisici del Dottore Vitantonio Scattigna. Napoli, 1818.

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?

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. 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.

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 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.

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 Pharmacopoeia, 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 , 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 amenorrhoea, 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.

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 . 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.

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.

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.

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.

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.

Take of Hydriodate of Potass, 1/2 dr. Axunge, 1 1/2 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.

"Je l'ai trait? 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 ? la dose d' 1/12 de grain au plus. Son estomac n'en a ?t? nullement affect?, et huit mois apr?s le p?re n'a pas pu r?sister au plaisir de me montrer son enfant. Il me l'a amen? ? Gen?ve, et j'ai vu cet enfant, marchant et courant lestement, le genou droit de la m?me grosseur que le gauche, et aussi serviable que celui-l?."

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