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diff --git a/old/68406-h/68406-h.htm b/old/68406-h/68406-h.htm deleted file mode 100644 index c7ef4f6..0000000 --- a/old/68406-h/68406-h.htm +++ /dev/null @@ -1,2517 +0,0 @@ -<!DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Strict//EN" - "http://www.w3.org/TR/xhtml1/DTD/xhtml1-strict.dtd"> -<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" lang="en"> - <head> - <meta http-equiv="Content-Type" content="text/html;charset=utf-8" /> - <meta http-equiv="Content-Style-Type" content="text/css" /> - <title> - The Project Gutenberg eBook of Essay on the Effects of Iodine on the Human Constitution, by E Gairdner, M. D.. - </title> - <link rel="coverpage" href="images/cover.jpg" /> - <style type="text/css"> - -body { - margin-left: 10%; - margin-right: 10%; -} - -h1 -{ - margin-top: 2em; margin-bottom: 2em; - text-align: center; - font-size: x-large; - font-weight: normal; - line-height: 1.6; -} - - h2,h3{ - text-align: center; - clear: both; - } - -.half-title { - margin-top: 2em; margin-bottom: 2em; - text-align: center; - font-size: x-large; - font-weight: normal; - line-height: 1.6; - } - -div.chapter {page-break-before: always;} -h2.nobreak {page-break-before: avoid;} - -/* Paragraphs */ - -p {text-indent: 1em; - margin-top: .75em; - text-align: justify; - margin-bottom: .75em; - } - -.spaced {margin-top: 3em; margin-bottom: 3em;} - -hr { - width: 33%; - margin-top: 2em; - margin-bottom: 2em; - margin-left: 33.5%; - margin-right: 33.5%; - clear: both; -} - -hr.tb {width: 45%; margin-left: 27.5%; margin-right: 27.5%;} -hr.chap {width: 65%; margin-left: 17.5%; margin-right: 17.5%;} -hr.small {width: 25%; margin-left: 37.5%; margin-right: 37.5%;} -@media print { hr.chap {display: none; visibility: hidden;} } - - -.pagenum { /* uncomment the next line for invisible page numbers */ - /* visibility: hidden; */ - position: absolute; - left: 92%; - font-size: smaller; - text-align: right; -} /* page numbers */ - - -.blockquot { - margin-left: 5%; - margin-right: 10%; -} - -.center {text-align: center;} - -.smcap {font-variant: small-caps;} - -.fs4 {font-size: 1.2em;} - -/* Footnotes */ - - .footnotes {border: dashed 1px;} - - .footnote { - margin-left: 10%; - margin-right: 10%; - font-size: 0.9em; - } - -.footnote .label { - position: absolute; - right: 84%; - text-align: right; - } - -.fnanchor { - vertical-align: super; - font-size: .8em; - text-decoration: none; - white-space: nowrap - } - - -/* Transcriber’s notes */ - -.transnote { - background-color: #E6E6FA; - color: black; - font-size:smaller; - padding:0.5em; - margin-bottom:5em; - font-family:sans-serif, serif; - } - - </style> - </head> -<body> -<p style='text-align:center; font-size:1.2em; font-weight:bold'>The Project Gutenberg eBook of Essay on the effects of iodine on the human constitution, by W. Gairdner</p> -<div style='display:block; margin:1em 0'> -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 <a href="https://www.gutenberg.org">www.gutenberg.org</a>. 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. -</div> - -<p style='display:block; margin-top:1em; margin-bottom:0; margin-left:2em; text-indent:-2em'>Title: Essay on the effects of iodine on the human constitution</p> -<p style='display:block; margin-left:2em; text-indent:0; margin-top:0; margin-bottom:1em;'>With practical observation on its use in the cure of bronchocele, scrophula, and the tuberculous diseases of the chest and abdomen</p> -<p style='display:block; margin-top:1em; margin-bottom:0; margin-left:2em; text-indent:-2em'>Author: W. Gairdner</p> -<p style='display:block; text-indent:0; margin:1em 0'>Release Date: June 25, 2022 [eBook #68406]</p> -<p style='display:block; text-indent:0; margin:1em 0'>Language: English</p> - <p style='display:block; margin-top:1em; margin-bottom:0; margin-left:2em; text-indent:-2em; text-align:left'>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)</p> -<div style='margin-top:2em; margin-bottom:4em'>*** START OF THE PROJECT GUTENBERG EBOOK ESSAY ON THE EFFECTS OF IODINE ON THE HUMAN CONSTITUTION ***</div> -<hr class="chap" /> -<div class="transnote"> - -<h3>Transcriber’s Notes</h3> - -<p>Obvious typographical errors have been silently corrected. All other -spelling and punctuation remains unchanged.</p> - -<p>The cover was prepared by the transcriber and is placed in the public -domain.</p> - -</div> - - -<p class="half-title">ESSAY<br /> - -ON<br /> - -THE EFFECTS OF IODINE,<br /> - -ETC. ETC. -</p> - - -<p class="center spaced"> -<small>LONDON:<br /> -PRINTED BY JAMES MOYES, GREVILLE STREET.</small> -</p> - -<hr class="chap" /> -<div class="chapter"></div> - - -<h1> -ESSAY<br /> - -<small>ON</small><br /> - -THE EFFECTS OF IODINE<br /> - -<small>ON</small><br /> - -THE HUMAN CONSTITUTION;</h1> -<p class="center"> -<small>WITH</small><br /> -<br /> -<span class="fs4">PRACTICAL OBSERVATIONS</span><br /> -<br /> -<small>ON ITS USE IN THE CURE OF</small><br /> -<br /> -BRONCHOCELE, SCROPHULA, AND THE TUBERCULOUS<br /> -DISEASES OF THE CHEST AND ABDOMEN.</p> - -<hr class="small" /> -<p class="center"><span class="smcap">By</span> W. GAIRDNER, M. D.</p> -<hr class="small" /> - -<p class="center">LONDON:<br /> -PRINTED FOR THOMAS AND GEORGE UNDERWOOD,<br /> -32, FLEET STREET.<br /> -<br /> -1824.</p> - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> - -<p><span class="pagenum" id="Page_v">[Pg v]</span></p> - -<h2 class="nobreak" id="INTRODUCTION">INTRODUCTION.</h2> -</div> - - -<p>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.</p> - -<p><span class="pagenum" id="Page_vi">[Pg vi]</span></p> - -<p>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<span class="pagenum" id="Page_vii">[Pg vii]</span> -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.</p> - -<p>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,<span class="pagenum" id="Page_viii">[Pg viii]</span> -or which have been communicated to me from -different parts of Switzerland and France.</p> - -<p>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.</p> - -<p><small>Bolton Street, Piccadilly, 4th Dec. 1823.</small></p> - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_1">[Pg 1]</span></p> - -<h2 class="nobreak" id="ESSAY">ESSAY<br /> - - -<small>ON THE</small><br /> - -EFFECTS OF IODINE.</h2></div> - - -<p>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<span class="pagenum" id="Page_2">[Pg 2]</span> -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.</p> - -<p>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,<a id="FNanchor_1" href="#Footnote_1" class="fnanchor">[1]</a> is also a maritime plant,<span class="pagenum" id="Page_3">[Pg 3]</span> -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.</p> - - -<p><span class="pagenum" id="Page_4">[Pg 4]</span></p> - -<p>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.</p> - -<p>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<span class="pagenum" id="Page_5">[Pg 5]</span> -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.</p> - -<p>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.</p> - -<hr class="tb" /> - -<p>Some time after the introduction of iodine -into practice, a few cases of severe spasmo<span class="pagenum" id="Page_6">[Pg 6]</span>dic -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<span class="pagenum" id="Page_7">[Pg 7]</span> -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<span class="pagenum" id="Page_8">[Pg 8]</span> -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;<span class="pagenum" id="Page_9">[Pg 9]</span> -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<span class="pagenum" id="Page_10">[Pg 10]</span> -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, “<i>décharnée</i>,” -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,<span class="pagenum" id="Page_11">[Pg 11]</span> -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.</p> - -<hr class="tb" /> - -<p>These are the outlines of a very severe<span class="pagenum" id="Page_12">[Pg 12]</span> -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.</p> - -<p>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,<span class="pagenum" id="Page_13">[Pg 13]</span> -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.</p> - -<p>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.</p> - -<p>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,<span class="pagenum" id="Page_14">[Pg 14]</span> -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<span class="pagenum" id="Page_15">[Pg 15]</span> -pulse. There is commonly great suffering -at stomach and confined bowels.<a id="FNanchor_2" href="#Footnote_2" class="fnanchor">[2]</a> 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<span class="pagenum" id="Page_16">[Pg 16]</span> -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.</p> - -<p>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<span class="pagenum" id="Page_17">[Pg 17]</span> -number in young nubile girls. In the -latter cases the disease generally excites -some hysterical symptoms.</p> - -<p>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.<span class="pagenum" id="Page_18">[Pg 18]</span> -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.<span class="pagenum" id="Page_19">[Pg 19]</span> -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.</p> - -<hr class="tb" /> - -<p>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<span class="pagenum" id="Page_20">[Pg 20]</span> -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<span class="pagenum" id="Page_21">[Pg 21]</span> -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.</p> - -<p>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.</p> - -<p>It is a much more difficult task to dis<span class="pagenum" id="Page_22">[Pg 22]</span>cover -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.</p> - -<p><span class="pagenum" id="Page_23">[Pg 23]</span></p> - -<hr class="tb" /> - -<p>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<span class="pagenum" id="Page_24">[Pg 24]</span> -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 restrain<span class="pagenum" id="Page_25">[Pg 25]</span>ing -the violence of the spasms, and in moderating -the perturbed action of the stomach.</p> - -<p>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<span class="pagenum" id="Page_26">[Pg 26]</span> -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.</p> - -<p>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<span class="pagenum" id="Page_27">[Pg 27]</span> -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 <a href="#Page_7">page 7</a>, -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 fre<span class="pagenum" id="Page_28">[Pg 28]</span>quently -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<span class="pagenum" id="Page_29">[Pg 29]</span> -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.</p> - -<hr class="tb" /> - -<p>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<span class="pagenum" id="Page_30">[Pg 30]</span> -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.</p> - -<p>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<span class="pagenum" id="Page_31">[Pg 31]</span> -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.<a id="FNanchor_3" href="#Footnote_3" class="fnanchor">[3]</a> 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 -<span class="pagenum" id="Page_32">[Pg 32]</span>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.</p> - -<hr class="tb" /> - -<p>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<span class="pagenum" id="Page_33">[Pg 33]</span> -give it as much extension as may be -necessary for its perfect discussion. It has -been already seen at <a href="#Page_10">pages 10</a> and <a href="#Page_12">12</a> 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.</p> - -<p>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,<span class="pagenum" id="Page_34">[Pg 34]</span> -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.</p> - -<p>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<span class="pagenum" id="Page_35">[Pg 35]</span> -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.<a id="FNanchor_4" href="#Footnote_4" class="fnanchor">[4]</a></p> - -<p>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,<span class="pagenum" id="Page_36">[Pg 36]</span> -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 observa<span class="pagenum" id="Page_37">[Pg 37]</span>tion, -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,<span class="pagenum" id="Page_38">[Pg 38]</span> -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.</p> - -<p>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<span class="pagenum" id="Page_39">[Pg 39]</span> -all the authors who have written on iodine, -and is one of the most singular circumstances -in its medical history!</p> - -<p>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?</p> - -<p>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<span class="pagenum" id="Page_40">[Pg 40]</span> -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.</p> - -<p>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 consider<span class="pagenum" id="Page_41">[Pg 41]</span>able; -and in the second case to which I have -alluded, inflammation of the trachea is very -readily excited.<a id="FNanchor_5" href="#Footnote_5" class="fnanchor">[5]</a> 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.</p> - -<p>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<span class="pagenum" id="Page_42">[Pg 42]</span> -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.<a id="FNanchor_6" href="#Footnote_6" class="fnanchor">[6]</a> 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.<a id="FNanchor_7" href="#Footnote_7" class="fnanchor">[7]</a></p> - -<p><span class="pagenum" id="Page_43">[Pg 43]</span></p> - -<p>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 <i>of potass</i> in an ounce of -distilled water. I have generally begun this -preparation by a dose of ten drops, and<span class="pagenum" id="Page_44">[Pg 44]</span> -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,<span class="pagenum" id="Page_45">[Pg 45]</span> -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.</p> - -<p>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 <a href="#Page_36">page 36</a>, 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.</p> - -<p><span class="pagenum" id="Page_46">[Pg 46]</span></p> - -<p>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.</p> - -<hr class="tb" /> - -<p>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.<a id="FNanchor_8" href="#Footnote_8" class="fnanchor">[8]</a> Accordingly, we find that<span class="pagenum" id="Page_47">[Pg 47]</span> -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.</p> - -<p>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<span class="pagenum" id="Page_48">[Pg 48]</span> -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.</p> - -<p>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<span class="pagenum" id="Page_49">[Pg 49]</span> -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.<a id="FNanchor_9" href="#Footnote_9" class="fnanchor">[9]</a></p> - -<p><span class="pagenum" id="Page_50">[Pg 50]</span></p> - -<p>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<span class="pagenum" id="Page_51">[Pg 51]</span> -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 appear<span class="pagenum" id="Page_52">[Pg 52]</span>ance -of the case, I judged this feverish -attack to be an affection of the mesenteric -glands, similar to what I have described at -<a href="#Page_39">p. 39.</a></p> - -<p>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<span class="pagenum" id="Page_53">[Pg 53]</span> -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.</p> - -<p>A young gentleman, aged twenty-six, -who had passed four winters in the south of -Europe for a cough, with pain in his chest,<span class="pagenum" id="Page_54">[Pg 54]</span> -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<span class="pagenum" id="Page_55">[Pg 55]</span> -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.</p> - -<p>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.<span class="pagenum" id="Page_56">[Pg 56]</span> -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.</p> - -<p>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.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_57">[Pg 57]</span></p> - -<h2 class="nobreak" id="CONCLUSION">CONCLUSION.</h2> -</div> - - -<p>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 prac<span class="pagenum" id="Page_58">[Pg 58]</span>titioners -of London; who finding it quite -inert, had laid it aside as useless<a id="FNanchor_10" href="#Footnote_10" class="fnanchor">[10]</a>.</p> - -<p>I have already pointed out one source of -such mistakes (<a href="#Page_3">page 3</a>). 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<span class="pagenum" id="Page_59">[Pg 59]</span> -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.</p> - -<p>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 <i>he that runs can -read</i>. 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.</p> - -<p>This medicine has also been called an -empirical remedy. Of what importance is<span class="pagenum" id="Page_60">[Pg 60]</span> -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.</p> - -<p>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<span class="pagenum" id="Page_61">[Pg 61]</span> -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.</p> -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_62">[Pg 62]</span></p> - -<h2 class="nobreak" id="APPENDIX">APPENDIX.</h2> -</div> - - -<p>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.</p> - -<div class="blockquot"> -<p class="center"> -<i>Tincture of Iodine.</i></p> -<p> -Take of Alcohol, of sp. gr. of .842, 1 oz.<br /> -<span style="margin-left: 4em;">Iodine, 39 gr.</span><br /> -Dissolve. -</p></div> - -<p>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 diffu<span class="pagenum" id="Page_63">[Pg 63]</span>sion -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.</p> - -<div class="blockquot"> -<p class="center"> -<i>Solution of Hydriodate of Potass.</i></p> -<p> -Take of distilled Water, 1 oz.<br /> -<span style="margin-left: 4em;">Hydriodate of Potass, 30 gr.</span><br /> -Dissolve.</p></div> - -<p>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.</p> - -<div class="blockquot"> -<p class="center"> -<i>Ointment of Hydriodate of Potass.</i></p> -<p> -Take of Hydriodate of Potass, ½ dr.<br /> -<span style="margin-left: 4em;">Axunge, 1½ oz. Mix.</span> -</p></div> - -<hr class="chap x-ebookmaker-drop" /> - -<div class="chapter"> -<p><span class="pagenum" id="Page_64">[Pg 64]</span></p> - -<h2 class="nobreak" id="NOTE">NOTE.</h2> -</div> - - -<p>Since these pages were put to press, I have received -from Professor Maunoir the following details of the case -mentioned at <a href="#Page_49">page 49</a>. 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.</p> - -<p lang="fr">“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 <i>white swelling</i> -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.</p> - -<p lang="fr">“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.”</p> - - -<p class="center spaced">THE END.</p> - - -<p class="center">LONDON:—PRINTED BY J. MOYES, GREVILLE STREET.</p> - -<div class="footnotes"> - -<div class="footnote"> - -<p><a id="Footnote_1" href="#FNanchor_1" class="label">[1]</a> 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.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_2" href="#FNanchor_2" class="label">[2]</a> 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.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_3" href="#FNanchor_3" class="label">[3]</a> 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.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_4" href="#FNanchor_4" class="label">[4]</a> 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.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_5" href="#FNanchor_5" class="label">[5]</a> Dr. Coindet gives an instructive example of this -kind. <i>Bibliothèque Universelle, Février, 1821</i>, p. 148.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_6" href="#FNanchor_6" class="label">[6]</a> Nuovo metodo di amministratori l’unguento mercuriale -ne mali fisici del Dottore Vitantonio Scattigna. -Napoli, 1818.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_7" href="#FNanchor_7" class="label">[7]</a> 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 -<span style="margin-left: 0.5em;">in my own practice in the same way; and I</span><br /> -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?</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_8" href="#FNanchor_8" class="label">[8]</a> 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.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_9" href="#FNanchor_9" class="label">[9]</a> 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.</p> - -</div> - -<div class="footnote"> - -<p><a id="Footnote_10" href="#FNanchor_10" class="label">[10]</a> 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.</p> - -</div> -</div> - -<div style='display:block; margin-top:4em'>*** END OF THE PROJECT GUTENBERG EBOOK ESSAY ON THE EFFECTS OF IODINE ON THE HUMAN CONSTITUTION ***</div> -<div style='text-align:left'> - -<div style='display:block; margin:1em 0'> -Updated editions will replace the previous one—the old editions will -be renamed. -</div> - -<div style='display:block; margin:1em 0'> -Creating the works from print editions not protected by U.S. copyright -law means that no one owns a United States copyright in these works, -so the Foundation (and you!) can copy and distribute it in the United -States without permission and without paying copyright -royalties. 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