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-The Project Gutenberg eBook of Essay on the effects of iodine on the
-human constitution, by W. Gairdner
-
-This eBook is for the use of anyone anywhere in the United States and
-most other parts of the world at no cost and with almost no restrictions
-whatsoever. You may copy it, give it away or re-use it under the terms
-of the Project Gutenberg License included with this eBook or online at
-www.gutenberg.org. If you are not located in the United States, you
-will have to check the laws of the country where you are located before
-using this eBook.
-
-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: W. Gairdner
-
-Release Date: June 25, 2022 [eBook #68406]
-
-Language: English
-
-Produced by: The Online Distributed Proofreading Team at
-             https://www.pgdp.net (This file was produced from images
-             generously made available by The Internet Archive)
-
-*** START OF THE PROJECT GUTENBERG EBOOK ESSAY ON THE EFFECTS OF
-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.
-
-*** END OF THE PROJECT GUTENBERG EBOOK ESSAY ON THE EFFECTS OF IODINE
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