Iodium

Volume II — Main text

Iodine. " Obtained principally from the ashes of sea-weeds, and purified by re. sublimation " (В. Н. Р.). I. Provings.-1 . HAHNEMANN, Chronic Diseases, part iii of original, vol. of translation. Contains 376 symptoms from self and 5 others, and 348 (mainly " curative ") from authors. 2. Desirous ofknowing the effects of Iod. on man, I took, fasting, 10 centgr. in substance, with no effect save the horrid taste and some nausea. Next d. I took 20 centgr. I immediately felt constriction and heat of throat, which lasted h., and soon began to vomit yellowish fluid in which the Iod. could be perceived. No other disturbance of function was noticed. On the 3rd d. I took, fasting,30centgr.

Immediately heat, constriction of throat, nausea, eructations, salivation, and pain at epigastrium ; after 10 m. somewhat copious biliary vomiting and slight colic, lasting 1 h. and then yielding to two emollient enemata. Pulse, previously 70, became 85-90, and fuller. Respiration was ordinarily free, but every now and then an effort seemed needed to expand the chest ; slightly increased heat of skin ; urine was of deeper colour, but normal on testing. Next d. I felt nothing but slight fatigue. (ORFILA, Toxic., sub voce.) 3. HEISTERBERGK, 2 h. after taking 7 dr.* in oz. of water, felt rumbling in intestines and considerable hunger, although he had eaten shortly before taking dose. The rumblings were repeated frequently for a whole h., and then vanished. Same symptoms followed after 8 dr., and in addition loose motion same e. and next m. After 9 dr. same symptoms occurred, and in addition gnawing hunger coming on 2 h. after dose and lasting 2 h. (JÖRG, Materialien.) 4. KNESCHKE, 20 m. after taking 3 dr., noticed slight pressure in region of vertex lasting 10 m.; next meal was eaten with unusual zest, and towards e. loose motion was passed. On April 12th, 1824, at 9 a.m. took 4 dr. in & oz. of water. At 10 a.m. felt slight confusion of head coupled with some pressure in r. halfof forehead, lasting 15 m . At 11 a.m. felt greatest desire for food and was obliged to satisfy it. Bowels acted a second time during e., contrary to custom. After 5 dr. taken as before felt after & h. head slightly confused, and pains in whole frontal region. This lasted I h. and was followed by acute feeling of hunger, relieved only by midday meal. Felt obliged to eat again during afternoon, and in e. ate again ravenously. Same train of symptoms followed doses of6, 7, 8, 9, 10, and 11 dr. (Ibid.) 5. Отто began with I dr. taken in oz. water. After 4 h. was suddenly seized with pressing pain in r. thorax, increased by each inspiration and lasting near 1 h. After 2 dr. noticed immediately salty taste like that of seltzer water in mouth, lasting all this d. and next. After 5 h. felt scraping sensation in pharynx like that caused by eating hips, lasting 1 h. Appetite and digestion increased for 2 d. Took 3 dr. on April 12th at 9 a.m. Salty taste occurred almost immediately and lasted all d., more intensely than after small dose. After 15 m. transient headache. After 1½ h. increased inner warmth of abdomen, especially in region of stomach, and later slight cutting pain, both symptoms together not lasting more than h. Appetite was increased, alvine evacuations pappy and increased in quantity though not in frequency. On 14th, at 9 a.m., took 4 dr. After 15 m. pain in occiput which vanished again immediately. At II a.m. movements in region of stomach and small intestines, endingh. later in feeling of distension ; also at II a.m. pressing occipital headache, relieved by rest and aggravated by walking and other bodily movements, diminishing somewhat at 4 p.m., when it was succeeded by feeling of great emptiness in head, which passed off at 7 p.m. During p.m. some rheumatic pains in nape of neck and arms were noticed. * Of ro per cent, tincture ; Kneschke, Otto, Seyffert, Siebenhaar, and Jörg, used same preparation,

Appetite at midday and in e. was increased. Next d. at 10 a.m. felt same sensation in stomach and intestines , followed by feeling of hunger in same region. Salty taste was hardly noticed,but appetite and alvine evacuations were still increased. On 17th, at 9 a.m., took 5 dr. At 10 a.m. feeling of irritation in alimentary canal, especially in stomach (as if peristaltic movements were quicker and stronger than usual), changing after h. into feeling of distension, but mild and transient. For short time had bitter taste in mouth, but not salty taste ; in head felt for few moments suspicion of commencing occipital headache. For short time chest felt constricted. Appetite for dinner increased. At 2 p.m. slight feeling of congestion towards head, followed by headache lasting h., latter repeated towards 5 p.m., though less severely. Appetite for supper increased. Stools abundant and pappy. Next d. at 9 a.m. felt remnant of irritation in stomach and small intestines ; towards e. for 1 h. had slight headache ; bowels were constipated all d. and only opened next d. after considerable straining, stools being hard. After 6 dr. only symptoms noticed were salty taste, accompanied by increased thirst and unusual hunger, all lasting 2 d. After 7 dr. salty taste occurred and lasted 36 h., very slight constriction of chest ; only abdominal symptoms were increased; heat and very troublesome hunger at midday and e.; bowels not opened ; increased quantity of mucus in nostrils and of saliva in mouth, latter obliging him to spit out frequently. Next d. appetite was still keen ; bowels acted during a.m., stool being loose ; urine smelt very ammoniacal, and secretion ofmucus in mouth and nose was still much increased. b. Otto repeated his experiments in August, beginning with 5 dr. on 20th ; same abdominal symptoms were noticed ; during p.m. constriction of chest came on, and lasted h., during which deep inspiration caused pain, and heart beat stronger and quicker, arterial pulse being smaller and more frequent. Next d. took 6 dr.; abdominal symptoms were repeated, with great hunger and thirst ; during p.m. same chest symptoms appeared, and from noon till e. he passed urine six times, urine being bright yellow, thin, and watery, and each time abundant ; nasal mucus and saliva were also much increased. Next d. last-named symptoms continued to same extent ; thirst was not quite so marked, but hunger remained same ; during p.m. felt headache for short time. Urine and fæces normal. After 8 dr. same symptoms were repeated, and in addition fæces were somewhat liquid. Next d. nasal mucus and saliva were still abundant, and alvine evacuations were more liquid than usual. After 10 dr. same abdominal symptoms occurred, coupled after I h. with slight urging to stool ; other symptoms followed as before, except that circulation was not affected. After 12 dr. besides foregoing symptoms felt rumbling in intestines, but without inclination to stool. Chest symptoms were repeated, but circulation was not affected ; no head symptoms were noticed, and urine was normal ; nasal mucus and saliva were increased as before. Bowels acted several times, fæces being thin. On following d. there was still increased appetite, abundant flow of nasal mucus and saliva, and several thin evacuations of bowels. On 28th concluded his experiments with dose of 15 dr. taken at 8 a.m. At 9 felt confusion of head,

passing on, towards 10, to pressing headache, which lasted till noon. Hunger and thirst and abdominal symptoms followed as before, and during p.m. same chest symptoms, but without circulation being affected. Secretion of nasal mucus, saliva, and urine were also much increased. During p.m. frequent urging to stool, followed by several liquid stools, accompanied with more than usual feeling of movement in intestines, but without actual pain. (Ibid.) 6. SEYFFERT, after 8 dr., noticed only increased flow of saliva, lasting 1 h., and increased appetite for dinner. Same symptoms followed 12 dr., but hunger was not so great. After 10 dr. noticed unpleasant sweetish after-taste, appetite considerably increased ; during p.m. a loose evacuation (he was habitually constipated) and abundant secretion of urine causing frequent micturition. After 12 dr. same symptoms occurred, with exception that first urine passed after dose was darker than usual, and yellowish-green in colour. On August 26th, at 8 a.m., took 15 dr.; soon afterwards noticed same unpleasant after-taste and transient nausea ; at 9 a.m. some transient unpleasant almost cutting sensations in abdomen ; at noon increased appetite for dinner ; during p.m. a loose evacuation and frequent micturition, that passed first being again greenish-yellow in colour. After 18 dr. same symptoms followed, with exception of cutting sensations in abdomen, and increased flow of urine, which were absent ; flow of saliva was also somewhat increased, and feeling of hunger lasted all d. ( Ibid.) 7. SIEBENHAAR, after 6 dr., noticed secretion of mucus in windpipe, increased flow of urine, and fæces softer than usual. Took 8 dr., and noticed after 2 h. increase of urine, lasting 24 h.; appetite was slightly increased ; bowels acted three times during d., stools being soft in consistence. He then took 10 dr., and noticed that all secretory organs were active, mucus in nose and windpipe was increased, and urine, besides being increased in quantity, was more dense than usual, and yielded a very dark deposit on standing. Appetite and bowels were affected as before. (Ibid.) 8. JÖRG took 4 dr. at 8 a.m., ; at 9 a.m. was seized with confusion of head lasting 1 h., and then changing to slight pressing pain, most prominent in temples ; this pain became easier from time to time, but kept returning, and lasted in this way till late in e. Along with this pain unusual movements in abdomen began, proceeding from stomach downwards, and accompanied later on by cutting sensations. At one time it seemed as if these movements pressed upwards towards chest and compressed it considerably, and shortly afterwards more downwards towards pubes, bladder, and testicles. After 5 dr. felt same movements in intestines (after 1½ h.), accompanied by frequent eructations having taste of sulphuretted hydrogen, and by inclination to stool. During p.m. felt repeated sensation of pressing and constriction of chest, as if from breathing sulphurous acid, and towards e. frequent dry cough . On Aug. 29th, at 8 a.m., took 6 dr., which caused irritation of larynx and trachea, latter feeling raw, lasting all d. At 8.30 fell into a peculiar condition ; felt whole body seized with a peculiar quaking feeling, proceeding from stomach towards periphery, and causing sensation as if he would begin to tremble or to sweat all over.

Whole body became actually warmer, the feeling being as ifheat were greatest in region of stomach and spread thence over rest of body. A few m. later this was accompanied by pressing feeling in cardiac region and weight at chest, whereby breathing was embarrassed ; pulsebeats were 6 or 7 above normal ; this condition of general malaise lasted over 15 m. Towards 9 a.m. movements in intestines began , as before, accompanied by some cutting in umbilical region, lasting 1 h ., and followed by pappy evacuation. At 9 a.m. was suddenly seized with pressing headache, especially in r. temple, but soon passing off, and followed immediately by confusion of head, proceeding apparently from spine through nape of neck upwards to head, and lasting 2 h. At same time felt painful pressing mixed with stabbing in region of larynx and sublingual glands, lasting 10 m., but returning several times during d. At 9.30 a.m. felt pressure at chest, amounting occasionally to pain, and causing frequent deep and dry cough . From 10a.m. had frequent calls to urinate, but quantity passed each time was small, and at same time felt considerable irritation of genitals, viz. frequent urging and pressing downwards towards testicles and repeated tickling in glans penis, all lasting till e.; during p.m., in addition to these symptoms, had frequently recurring pressing headache, especially from 1. side of head towards forehead ; constriction, pressing and burning in chest, with much dry cough, rheumatic pains in arms, neck, and buttocks. Bowels acted four times during d., stools being pappy and leaving behind each time for a while slight burning feeling in anus. Slept badly, and next m. found raw feeling and dryness of windpipe still present. On 30th , at 8 a.m., took 7 dr ; very soon felt fulness and distension of stomach, quaking inside abdomen, with its attendant symptoms as before; these lasted nearly 1 h.; at 8.30 confusion of head came on, changing at 10.30 to pressing and occasionally stabbing headache, changing its locality from time to time, and lasting till e. In region of larynx at same time a pressure was felt, not exactly painful, extending to pharynx and giving impression that latter and tonsils were swollen. At 9.30 constriction of chest came on, changing at 10 a.m. into pressing, lasting till midday ; at 3 p.m. stabbing in chest became troublesome and lasted 4 h. During whole d. there was tendency to dry deep cough. Abdominal, renal, and genital symptoms were less marked than after previous dose ; p.m. also frequent rheumatic pains, especially in arms ; nasal mucus was increased. After 8 dr. taken Sept. Ist most of symptoms followed as before, but more mildly. Between 4 and 6 p.m., whilst out walking in the sun, felt rather acute pressing pain in under surface of occiput. Between 9 and II a.m. felt severe cutting in abdominal region, with perceptible forcing downwards in intestines, and same in rectum, flatus and fæces being evacuated with ease in considerable quantity. At 9 a.m. pressure and stabbing in chest, with desire to cough, came on, and during d. frequent dry raw cough was present, but was relieved entirely by going into the open air in hot sun. Stools were frequent and soft. From Aug. 29th till Sept. 2nd had peculiar taste in mouth (bordering upon " salty " ), walls of oral cavity felt drier than natural, although not actually dry. Gums became gradually redder, and teeth more covered

with mucus and yellowish. Feeling in abdomen was on the whole pleasant. (Ibid.) 9. a. From 10 dr. = gr. Stool accelerated, of peculiar smell ; pain in hæmorrhoids comes before and remains after stool. Indolence ofmind, cares only for mechanical work. He always feels as if he should think of something, he knows not what, and nothing comes to his mind. Increased mucus from nose, which is stopped up, but there is no coryza. Frequent yawning; increased thirst for water. Peeling of lips. In the m., when fasting, mouth very slimy. Erections without sexual desire. Nose opener than ever before. Itching, painful piles . Difficulty of thinking and irresolution. Great appetite. Soft, easy stool. He can scarcely wait for dinner and eats very much. After drinking wine, very warm, well, excited, but always as if he would soon be tired. Boring pain on a spot on r. side of scrotum. Great activity of testicles. Flush of burning heat over r. thigh . Burning pain in rectum. Increased colour of face, red hands. Lips painfully dry. Legs go to sleep readily. Excited and yet heavier, lazy, cross . A flat, jelly-like blister on 1. knee. b. From 5 dr. 1 gr. Burning in œsophagus. Pain in l. side of crown. Eructation of air. Jerking, shooting pain over pubic arch. Painful pressure in inner canthus of 1. eye. Painful stitches in abdomen on r. side anteriorly under ribs on inspiration ; recurs several times when breathing deeply. Increased appetite. Excited p.m.; drowsy e. Nose much wider and drier m., all d. stopped up; sense of smell nearly gone ; frequent sneezing as before coryza. Frequent discharge of flatus. Wakes early feeling well. After again going to sleep emission with dreams, thereafter very exhausted. (HERING, Arch. , xiii, 2, 182.) II. Poisonings.- 1 . A man addicted to intoxication took, July 21st, 7.30 p.m., 2 oz. tinct. = 96 gr. I. Soon, burning and pains in fauces and later in abdomen, especially in stomach, followed by vomiting and liquid stools. After 24 h. he lay in bed with upper part of body raised, face very pale, features sunken, eyes projecting, sparkling, not watery, pupils moderately dilated, sensitive to light ; temperature cool, especially ofupper extremities, nose icy cold, skin covered with cool sweat ; abdomen soft, not distended ; bladder empty. The burning pains in stomach and umbilical region not increased by pressure ; buccal cavity pale, dry ; at the root of uvula a narrow, red arch, convexity towards hard palate ; walls of pharynx dry, slightly reddened, velum and tonsils normal ; the expired air smells strongly of iodine, and after h. smells distinctly of brandy. Is perfectly conscious ; noises in ears and heaviness of head ; great precordial anxiety causing him to change position frequently ; collapse and prostration ; respiration quickened ; sharp sound in upper lobes but no râles ; voice weak ; radial pulse hard and thin, carotid pulse small and weak, 120, whilst the heart beats violently, occasionally intermitting. The vomiting comes on with slight retching at first every 10 to 15 m., later at longer intervals, quick but not very copious ; what was vomited was at first dark-coloured, after taking starch and magnesia water vomited thick fluid slightly blue but more white. Drinking and movement seem to

aggravate it ; after each vomiting transient relief, only some nausea in the intervals ; great precordial anxiety. Stools with colic and urging, they are very liquid and reddish brown with great odour of iodine.- 22nd, n. sleepless. In m., increased precordial anxiety ; respiration quicker ; cool temperature ; pulse small, 132 ; great collapse and pallor of features ; speech stammering, voice hoarse, swallowing difficult ; considerable pain in epigastrium, extending to the meteoric abdomen, back, and œsophagus ; vomiting less frequent ; about 3 a.m. the vomit and stool contained much pure blood ; hardly 3 tablespoonfuls of urine in 24 h., of dark brown colour, smelling strongly of I.; great restlessness in bed ; he died perfectly conscious at 4 a.m. on 22nd.-P.M. Jan. 24th. Very little blood in sinuses of head, but a good deal in large veïns and in capillaries of pia mater ; cerebral convolutions very prominent ; cortical matter of brain pale and bloodless, inner substance tough, elastic. Hard and soft palate much injected ; on uvula and velum distinct orange-coloured spots, formed by a thin but firm membrane which is easily detached ; these spots are confluent on the posterior wall of pharynx and extend while gaining in intensity over œsophagus and trachea ; under the membrane the m.m. is hyperæmic but not swollen. The surface of the epiglottis covered with a strong pseudomembrane ; m.m. eroded, dark red, with a number of congested vessels ; the submucous layer ædematous but stiff; the ventriculi Morgagnani closed by swelling and by a similar pseudo-membrane, the m.m. here dark red and injected ; similar but discrete patches of membrane on the vocal cords and the parts of the larynx beneath them, but the trachea free. The whole of the bronchial tubes down to their finest branches inflamed and covered by viscid mucus, the m.m. swollen and injected ; on cutting into lungs there appear numerous small mucous points. Intenseacute emphysema betwixt all lobes and lobules oflungs ; the parenchyma itself bloodless, as also the veins. Heart large ; 1. ventricle thick in its walls ; 1. auricle contains blood, partly fluid, partly coagulated ; in r. ventricle a large clot. The esophagus down to stomach covered by a false membrane, orange coloured, pretty firm, which can be peeled off; the connective tissue below m.m. in some places phlegmonous, purulent. Stomach contains a moderate amount of orange-coloured slimy fluid, its m.m. similarly coloured, very swollen ; the mucous glands show a capillary exudation in the centre of each acinus ; round about the m.m. is studded with small points as if infiltrated with exudation. Duodenal and intestinal m.m. has a similar appearance. (HERRMANN, Petersb. med. Zeitsch., 1869, 11 and 12.) 2. A girl, æt. 164, was tapped for ovarian dropsy on Feb. 5th and again on July 17th. As the fluid again collected it was drawn off, Nov. 29th, at 10.38 a.m., and mixture of 5 oz. tinct. iod. with an equal quantity of water and I drm. iod. pot. injected and allowed to remain for 10 m. in the sac. It took 10 m. to flow out. The patient was put to bed, and on account of pain got th gr. morph. acet. At 5 p.m., having drunk a great deal of water and some milk on account of the great thirst, she vomited. Her cheeks were blue, icy cold, extremities also cold, pulse hardly perceptible, it had risen from 84 to

1. 7 p.m., vomited again, the vomit of a grass-green colour, pulse 96. Thirst continued, urine very scanty.-30th. After midnight vomited, pulse intermittent, 120. On account of pains in abdomen and sleeplessness she got th gr. morph . 10 a.m., pulse hardly to be felt in carotids. Sleep twice disturbed by vomiting ofclear fluid. Hands and face cold, thirst intense. I p.m., pulse 136, temp. 37.0°º, complains of dryness of mouth and throat. 7 p.m., pulse 132, resp. 20. Vomited sour, grass-green stuff. Even while vomiting, mouth remains dry. Afternoon slept, on waking talked incoherently ; urine scanty.-Dec. Ist, 9 a.m. , pulse 132, resp. 24. Vomited twice in the n. The first time the vomit was bluish green, the second grass green, both sour and clear. Gastric region verypainful to touch for some h. after vomiting. Pulse could only be felt in carotids. Cheeks bright red and hot. She had no recollection of having been delirious yesterday. I p.m. , pulse 132, resp. 20, temp. not above 37.1°. Pulse very full and soft, can easily be felt at wrist. No vomiting since m. Complains of pressure in back. Mouth very dry, great thirst. 7 p.m., pulse 132.-2nd, 9 a.m., pulse 144. Vomited towards m. Menses came on 9 d. too early. A bright red, papular eruption on neck and bosom, which faded about noon and left here and there slight desquamations. I p.m., pulse 132, resp. 24, temp. 38.3°.-3rd, 9 a.m., pulse 132, resp. 26. Complains of difficulty of swallowing, fauces dark red, parotid glands swollen, making face appear very broad. On clavicles, large reddish-yellow spots. 7 p.m., pulse 140, resp. 24, temp. 38.6°. After some spoonfuls of milk, vomited.-4th, 9 a.m., pulse 120, resp. 24, temp. 37.2°. Vomited frequently in n. After an enema, 5 liquid stools. Complained of difficulty of breathing. The spots on clavicles darker yellow. Catamenia still going on though scanty. 1 p.m., vomited brown stuff.-5th, 9 a.m., pulse 108, resp. 24, temp. 36.6°. Vomited once at n. and again in m. Complains of short breath. Stomach tender, distended, as also abdomen. 6 p.m., pulse 112, resp. 22, temp. 36.7° . A papular eruption from clavicles to groins, at latter place the spots (size of a pin's head) become more red and confluent. Tonsils red. Nose and mouth dry. Gastric region painful on pressure.-6th, 9 a.m., pulse 96, temp. 36.9°. The spots extend to knees. 7 p.m., has vomited again, urine scanty, clear, amber coloured.- 7th, 9 a.m., pulse 66, resp. 24, temp. 36.7°. Complained of pain in throat, sordes on lips and gums. Tongue slightly furred. Tonsils red. Parotid glands swollen. Spat twice bloody saliva, though she had no cough. Feels pretty well, wants to get up. Eruption has disappeared, got some roast meat for dinner. 7 p.m., pulse 60, resp. 24, temp. 36.6°. Had during d. 7 thin stools and vomited 3 times, was rather hoarse.-8th, 2 a.m., died suddenly. The P.M. revealed nothing of importance. The kidneys only seem rather pale, the cortical substance containing small opaque bodies of brownish or ruby- red colour, and their pelves exhibited red spots the size of a pin's head. (ROSE, Virchow's Archiv, xxxv, 19.) b. A gentleman, æt. 70, had an enlargement of the abdomen which was obscure in its nature, and variously diagnosed as dependent on liquid effusion or a solid growth from the under surface of the liver.

Attacked one d. with rigors and sudden, violent pain, he became jaundiced and collpased, and when seen by me was semi-comatose and apparently dying. Some obscure fluctuation being detected in the enlargement, a trocar was inserted and 21-23 pints of thick, grumous fluid, with some pus, were drawn off, and 16 oz. of pure tinct. of iod. (B. P.) injected, allowed to remain 20 m. in the sac, and then some of it to escape. Severe effects soon followed the injection, salivation, soreness ofmouth and throat, sickness, eructations, headache, giddiness, tinnitus aurium, muscæ volitantes, &c., accompanied by palpitation and pyrexia ; pulse was 140, weak and irregular, temp. 101-8°. Epistaxis occurred twice during the first 36 h.; tightness across chest and pain at epigastrium were complained of, and frequent thin watery stools were passed ; the general condition was one of extreme nervousness, prostration, and unrest. On 2nd and 3rd d. temp., which was highest p.m. , varied from 101 ° to 104° and pulse from 110 to 140. Pains in limbs and in loins set in, and were felt also in the long bones, which presented all the evidence of periostitis ; synovial effusion distended the l. knee-joint ; urine, which was at first pale and profuse, became scanty and bloody, and both it and saliva contained large quantities of iod.; salivary glands were painful and swollen, and palate and fauces sore and inflamed ; there was constant short, dry cough, with more or less aphonia. All these symptoms continued to increase until the end of the 4th d., when an eruption, somewhat like measles, appeared, with apparent relief to many of the urgent symptoms. By the 5th d. the periostitis had considerably subsided, and by the 9th d. most of the other symptoms had disappeared. Iod. was, however, excreted by the urine for about 16 d., and albumen for 25 d. During the whole time nourishment was taken well. After this severe attack convalescence proceeded favourably. (PHILLIPS, op. cit.) 4. Two h. after the injection of a small quantity of the tinct., diluted one-half, into a traumatically-distended tunica vaginalis (the fluid which it contained having first been withdrawn), FONSSAGRIVES saw a swelling of the scrotum, attended with high fever. During the remainder of the day there also appeared irritation of the bronchial tubes, discharge from the nose, redness of the eyes, oedema of the epiglottis, and increased flow of saliva. The fever lasted 5 d. (LEWIN, op. cit.) 5. On Nov. 24th, 1824, I was called to see a robust man of over 40, who for a large goitre had taken without precaution and without consulting anyone a considerable quantity of tinct. When I visited him, he had violent agitation, extreme heat, palpitations, coated tongue, pasty mouth, pulse nervous, tremulous, alternately soft and hard, but always very frequent. He told me that at n. he had erections so constant and violent that he could have satisfied the desires of twenty-five women ; the following days were marked by heat so great that (in November) he remained day and night naked on his bed in a cool room, yet complaining that he burned. A very fatiguing diarrhea had been set up, obliging him at first to go to stool every h. This became moderated, but the inflammatory symptoms increased. He was bled several times, and his blood showed a marked buffy coat ;

after this his tongue became dry, he drank largely, and complained constantly of thirst and of burning all down the digestive tract ; sleep was very restless, dreams distressing, he woke with a start. He emaciated fast, his eyes became cavernous ; he had, from the beginning of his illness, a remarkable trembling of the whole body, but especially of the arms ; the urine, seldom clear, was often red and sedimentous. He con- Upon the palpitations supervened faintings, with cold sweats. tinued thus for 5 weeks, when he died suddenly. No autopsy could be obtained. (ZINK, Fourn. Compl., xviii, 126.) 6. Z- was called to make a P.M. examination of the body of a lady, whose illness had supervened upon the abuse of the tinct., taken for a long time for goitre. Much serum flowed out on opening the peritoneum. The intestines were distended, much inflamed in certain spots, and presenting in others the tint which precedes sphacelus. The stomach showed at its exterior over two thirds of smaller curvature some excoriation ; internally, a general redness, and near pylorus ulceration ; at point corresponding to external excoriation coats were pierced with small holes as if made by pins. Liver was a little increased in size, pale, and of lilac hue ; spleen of natural dimensions, but of dark grey colour, and sprinkled with little black spots. Whole abdominal contents were glued by inflammatory adhesion. Similar appearances were observed in the chest. (Ibid.) 7. A spare woman, æt. 51, having a goitre as large as a fist, took for its removal during 2 mo. Zss of U. S. P. tinct ( = about 15 gr. of iod.). March 6th, 1864, Dr. Hawks was called to see her. She said her strength had failed rapidly during last fortnight ; was unable to ascend stairs ; no appetite ; frequent nausea ; pains in various parts but principally in chest ; dyspnea, palpitation, and dry hacking cough. He found sallow, distressed countenance ; small, very quick, and irregular pulse ; crowing in nares, like vibrations of a string, not synchronous with heart ; bowels regular; urine red and turbid, usual quantity ; tongue brown and dry ; skin cool ; much thirst ; resp. 30 ; hands and feet cold; dyspnea, cough, palpitation and pains all increased by movement. Pains were sharp, quick, piercing, and movable, but there was constant heavy oppressive pain in region of heart. An effort to expand chest produced cough, but no pain ; tenderness of epigastrium ; food distressed her ; trembling of whole body ; sleeplessness ; some emaciation. Perfect rest was ordered ; a starch , milk, and sugar diet; arsenicum and phosphorus as medicine. By 13th nervous excitement had subsided, but emaciation had advanced ; goitre was sensibly diminished. On 16th, attempt to engage in some domestic work brought on asort of shock, and she had to be carried to her room. She had much nausea, for which she took veratrum. 17th.-Nausea relieved ; nervous erethism worse than before ; palpitation so severe as to shake whole body ; tongue hard, dry, and brown ; pulse very small and irregular ; cough severe, sputa thick, yellow, and greenish ; rattling in bronchiæ ; great restlessness and anxiety ; anxious pressive feeling in precordia ; frequent syncope ; skin cool ; resp. 30; thirst ; tenderness in epigastrium ; sleeplessness ; emaciation progressing and goitre diminishing. Hyoscyamus and phosphorus. On 20th nervous agitation

was less, but thirst still severe. Arsenicum and hyoscyamus. She improved up to 27th, when, after eating an egg and several raw oysters, all symptoms returned ; pulsatilla. 28th.-Symptoms show a typhoid character ; palpitation more spasmodic or convulsive ; cough more severe, and usually ending in vomiting of a thick, tenacious mucus ; tongue red tipped ; syncope oftener than formerly ; pulse very irregular and intermittent. Rhus and arsenicum. 31st.-Dyspnea and cough worse. Phosphorus and rhus. April 3rd. Slight chills ; cough and oppression of chest worse ; towards n., slight increase of heat of skin, which feels harsh and dry; dulness on percussion, no true respiratory murmur on either side. 5th.-Slight chill in m. and hot skin towards n., going off with sweat ; sputa brown and streaked with blood ; cough and dyspnea worse, and syncope more frequent ; metallic click discovered in upper part of r. lung. Phosphorus and hepar sulph. From this time she continued to fail, hectic being more pronounced ; on 8th was suddenly attacked with convulsions, followed by nervous rigors ; by 10th these had subsided, but she got excited in telling some story, palpitation and agitation increased, and she died at 6 p.m. P.M. was refused. Emaciation was very great ; goitre nearly gone ; skin saffron yellow. (J. HAWKς, M.D., N. Y. State Hom. Med. Soc. Transactions, vi, 331. ) 8. A blooming young lady, æt. 18, of pale habit, consulted her physician for goitre. Iod. was prescribed externally and internally, the dose being gradually increased to 15 dr. of tinct. thrice daily. Six weeks thereafter she was scarcely to be recognised, so great was the change ; her form was sunken, the mammary glands had entirely disappeared, the countenance was pale and sallow, with blue circles under the eyes. She complained of oppression of the chest, dry cough, palpitation, loss of appetite, and pressure at stomach. The menses, which had always been regular, were suppressed at the next period after taking the medicine, after which time they became profuse, and finally she had at intervals of every 3 or 4 d. a discharge of thin watery blood from the vagina. She was treated with ars. and china, followed by ant. crud. and hepar sulph., and at the end of 6 mo. recovered her health again . (A. h . Z. , xliii, 119. ) 9. A healthy young lady, æt. 19, had a goitre, for which she took Iod., 5 dr. of tinct. m. and e., gradually increasing the dose, and used an ointment of Iod. and K. iod. From zvj-zviij of Iod. were taken, and a corresponding quantity of the ointment applied, during the treatment, which lasted 5 mo. No effect was experienced for 3 mo., when each dose (now 7-9dr.) caused burning and sensation as if throat were filled with vapour of sulphur, obstructing breath. After 4 mo. treatment goitre had considerably diminished in size, but patient had become seriously affected by medicine. She was attacked first by shortness of breath and cough, chest seemed oppressed and as if too narrow ; burning in throat became constant, forcing her to drink often in order to obtain relief; there was moderate perspiration during d., but so profuse at n., especially about neck, that it might be wrung from the clothing (this debilitating sweat continued for nearly a year) . Patient was only able to walk slowly a very short distance, and even

effort of speaking was very exhausting. Oppression of chest became nearly constant, with burning, tearing, and sticking pains, which for first half year extended from chest to both shoulders, but afterwards were confined exclusively to 1. side. Emaciation was extreme, with sallow complexion ; at n. pains in all limbs, restlessness, alternating with anxious and frightful dreams. Menses gradually decreased in quantity during treatment, and on 2nd d. were accompanied by tearing and cutting pains in abdomen ; finally, they ceased altogether, and at times when they ought to have appeared she for 3 mo. had only the pains . They then returned, and at end of 2 years had become normal, save for the pains. But patient was still much emaciated, very irritable, and suffered from continual tearing pain in extremities, mostly upper ones. L. arm is thinner than r., and, indeed, seems completely atrophied ; motion is impaired, and attended with pain in shoulder. (VEHSEMEYER, Med. Jahrbücher, iii, 202.) 10. a. A young English lady, at a boarding-school in Paris, took I. for goitre by advice of her brother, a medical student. 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 in 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, pain in abdomen became more frequent and more severe, and thirst was very distressing. I was sent for early one m. in consequence of an alarming diarrhea which had come on during the n. I found her suffering the most excruciating pain at stomach, violent cramps, and convulsive action of muscles of arms, back, and legs, from which she had scarcely any intermission. Vomiting and purging were almost incessant. The dejections were bloody, slimy, and very scanty, but at first had been copious and fæculent. 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 fear for her life. During 10 d. she remained in a very doubtful state, subject to frequent severe attacks of diarrhea, with intense pain ofthe 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 anything like such extenuation in so short a space of time. b. 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 very violent spasms of the stomach. 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 ofspirits, and since her illness had never felt anything 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. (GAIRD- NER, Essay on Iodine, 1824.) 11. a . There is an effect of I. 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 noted 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 the drug, 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 frequently makes its appearance in a lesser degree even when the medicine acts in a kind and salutary manner. b. In certain persons I. 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 most worthy of attention is a degree of tremor which generally comes on when the patient is under the full influence of the drug. 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 occurs 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 anything straight to his mouth, but the hand moves in a zigzag manner, and with difficulty arrives at the mouth at last. This complaint is generally attended with a hurried articulation, and a small thready pulse. There is commonly great suffering at stomach and confined bowels (in one case a most obstinate suppression of urine). If the medicine be rashly persevered in when this affection has begun to appear, it will go on progressively for weeks and months even though its exciting cause be abstracted ; and when at last it does begin to diminish, the amendment is so slow and gradual that the patient is scarcely conscious of it. I saw two cases ofthis kind with Dr. Peschier, of Geneva, in which the

patients had suffered more than 12 months, and yet their sufferings had undergone little mitigation. 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 Like chorea, however, it is always attended with a constipated condition of the bowels. (Ibid.) 12. Dr. Manson notices that in one example the remedy brought on such troublesome convulsive movements that the man asserted they were " like to twitch him out of bed," and begged for its discontinuance. An analogous example is related by Sir A. Cooper, where 30 dr. of tinct., in divided doses, gave rise to the most unpleasant convulsions, the hands and feet fell into incessant motion, and the patient declared that the whole n. long he resembled a person in the act of fighting or wrestling. Sir B. Brodie asserts that he has known it to occasion paralysis. (COGSWELL, ' Iodine and its Compounds, 1837.) 13. I occupied, 37 years ago, a small student's room, in which I remained for 4-6 h. by d., and for 7-9 h. at n. While absent from it the room was well aired. I was at that time a great collector, and among other objects of interest I had amassed was a phial of the then new substance, Iodine, which stood on a shelf in myroom, closed with a cork, and containing about 10 grm. of the metalloid. During the winter months I experienced the first symptoms of a malady which for a time puzzled the faculty. I grew thin to such a degree as to disquiet my friends and fellow-students ; and the professors whose classes I attended of their own accord questioned me closely on the subject of this extraordinary emaciation, which was as mysterious to me as to them. My skin became pale or rather dull. Sleep, till then natural and regular, was slow of coming on, insufficient and bad, frequently broken by dreams which rapidly succeeded one another. I felt a general excitement, which became greater and greater the longer I remained in my room ; the open air calmed me. Thirst was augmented, but digestion remained normal ; I felt the need oftaking food frequently, to restore failing strength. The sense of general lassitude increased pari passu with the emaciation ; pulse was quick and small. But the most pronounced and annoying symptom was priapism, lasting nearly all n. and frequently accompanied by a painful sensation in the penis. I also felt stiffness and sometimes even pain in lumbar region (there was no albuminuria) . As I have said, both my teachers and myself were at fault as to the cause of these symptoms. During March the mystery was cleared up. I found that the cork which had closed the phial of iodine had become corroded by the drug, which had in consequence completely evaporated. I analysed the air of my room by means of starched paper, and the blue reaction showed the presence of I. in it. (L'Hom. Militante, 3me année, p. 399 ; a communication to the Editor.) 14. [Besides the local irritation caused by the tincture in theprimæ via (already sufficiently illustrated), and the corresponding disturbance of the emunctories during the elimination of the alkaline iodides (see Kali iodatum), Dr. RILLIET describes a third form of iodism. In the cases he gives in illustration the medicinal agent was generally iodide of

potassium in minute doses. One or more of these will be given under the head of that substance, but the general train of symptoms is so obviously the result of iodine itself that his description will be given here.-EDs .] a. The third kind of iodism is a specific intoxication produced by the drug or its compounds, more frequently seen from small than from large doses, and in cases ofgood general health rather than in those of diathetic derangement, more frequent also in some countries than in others, extremely rare in children, and the more to be feared the further advanced are the patients in age. It is the malady described by Coindet under the name of " iodic saturation," by others as " iodic cachexia," or simply " iodism." I adopt this last term, joining with it the word " constitutional " the better to indicate the nature of this morbid state. This iodism may exist in all degrees of severity, but for convenience of description and for practical ends I shall class it under three heads : slight iodism, moderate, grave or very grave. b. Slight iodism.-After the employment of the drug for a shorter or longer time, patients, while congratulating themselves on the diminution of theirgoitre (if they have one), notice that they are getting thin and pale, and that they are weakened ; or rather, their friends notice these things, for they themselves are often deceived by the maintenance, even the augmentation, of their appetite. Upon the emaciation soon follow palpitations, prostration of strength, depression of spirits, sleeplessness, and a nervous susceptibility of more or less pronounced character. These symptoms may remain stationary, and disappear on the cessation of the drug. Sometimes they consist only of loss of flesh and palpitation. c. Moderate iodism. Here, it may be from the medicinal malady not being recognised, the symptoms increase, the emaciation, sadness, insomnia, disposition to be frightened, and the palpitations,get worse ; the appetite fails, or, on the other hand, increases to bulimia. Some patients complain of painful sensations in the stomach and at the attachments of the diaphragm ; they are constipated ; the countenance expresses prostration or a certain degree of excitement. The most careful examination finds no organic cause for this ensemble of symptoms, which persist for a longer or shorter time, but end by gradually disappearing under appropriate treatment and the discontinuance ofthe drug. d. Grave iodism. In this form the symptoms are distinguished only by the rapidity of their supervention and their intensity. The goitre (if present) diminishes or disappears in a few d.; at the same time general emaciation comes on, sometimes with frightful rapidity, so that in a few weeks, even in 8-10 d., the patients are hardly recognisable ; they have become 20 years older. The marasmus is general, but it falls mainly on the glandular organs ; the mammæ and testicles waste. The pulse is quickened ; it is rather small than full, and faster at times than at others. The skin of the face is pale, yellowish, or greenish ; the countenance expresses sadness or anxiety ; the eyes, deeply sunken, with dark circles, are sometimes fixed, sometimes rather wandering. The weakness is great ; the voice is broken ; they tremble, and are breathless at the least movement. The nervous VOL. II . 45

symptoms are very distressing, inquietude, terror, ready weeping, have taken the place of repose of mind, and nightmare is substituted for sleep. Here also no organic change can be detected ; and the appetite persists or even becomes exaggerated or perverted. The patients seldom keep their bed, and here again, under proper treatment, in a few weeks or months there may be a return to health ; but not without traces of the past conflict lasting for some time or for all time. Permanent atrophy of the breasts in women, and of the testes in men, remain to bear witness to the shock the system has sustained. In rare cases, moreover, in spite of all that is done the symptoms persist and grow worse, the brain is more and more implicated, and death supervenes in the midst ofadvanced marasmus . (RILLIET, Mém. sur l' Iodisme constitutionelle, Paris, 1860.) 15. The following are the symptoms I have observed from iodic saturation :-Acceleration of pulse, palpitation, frequent dry cough, insomnia, rapid emaciation, loss of strength ; in others only swelling of legs and tremors, or a painful hardness of the goitre ; sometimes wasting of the mammæ ; remarkable and sustained augmentation of appetite. Treatment has removed these symptoms more readily than I could have expected, but some patients have for a long time retained their thinness, muscular weakness, and pallor. (COINDET, père, in Ibid.) 16. The earliest symptom of iodism is a slight pallor spread over the face, and a drawn look on the features. The patient complains of a feeling of general weakness, and a need of restoratives, which a cordial or a little succulent food relieves for a time. Let a meal be delayed, then there is malaise, drawings, often even sharp pain at the epigastrium ; let it be a full one, and digestion is laborious. The case soon gets worse ; tremor of the hands comes on, at first slight, then more and more pronounced ; there is a very distressing nervous condition which the patients can hardly describe, an internal agitation like that which bad news will cause, or like the disturbance which follows a regretted quarrel or a remorse ; it is impossible to fix the attention on one's reading, drawing, &c.; there are tears or impatience at the least contradiction. Emaciation makes progress day after day till it reaches marasmus ; the pulse quickens and becomes exceedingly feeble ; the least exertion causes oppression, palpitation, vertigo. On the other hand, the most attentive examination fails to discover any material lesion. There is no thirst, and the renal secretion is normal. I have been consulted on behalf of a considerable number of these cases, and no one has died ; nevertheless the cure has been slow and difficult. After 6 mo. of persevering and judicious treatment traces ofthe malady are still perceptible. (COINDET, fils, in Ibid.) 17. Generally speaking, when Iod. begins to disagree with a patient one of the foremost among the bad symptoms is the sensation of giddiness, or headache, or perhaps of both united. One of Dr. Manson's patients suffered so much from giddiness, in consequence of taking 15 dr. doses ofthe tinct. , as to be for 2 or 3 d. confined to bed ; another was rendered drowsy, and complained of feeling intoxicated ; and in a third any quantity of the tinct. above 15 dr. was always pro

ductive of headache and drowsiness . Giddiness was likewise remarked by Dr. Ashwell, in a female affected with a hard tumour of the uterus, to whom he was prescribing Iod., both topically and internally. M. Lugol also, in the performance of some experiments, found many individuals to become affected with stupor and symptoms of intoxication in consequence of accidentally inhaling iodine vapours. (COGSWELL, op. cit.) 18. A bronchocele, dating from puberty, in a young man of 18, was treated successfully with Iod. " It is worthy of remark," says the reporter, " that under the use of this medicine the genitals became as it were atrophic, and that erections and pollutions, to which the patient had formerly been very subject, were never observed during this time." (Lancet, 1828-9, i, 448.) 19. A patient took Iod. for induration of stomach, and there came on gradually complete impotence with wasting of testicles, which symptoms disappeared on leaving off the Iod. (RÖSLER, Med. Corresp. d. Würtemb. aerzt. Ver., vii, No. 23, 183 ; in Frank's Mag., ii, 757.) 20. A girl, æt. 13, affected from childhood with indurated glands, took for that and a hard swelling over r. nipple 10 to 18 dr. of tinct. 3 or 4 times a d. After 3 weeks there came on suddenly voracious hunger and a leucophlegmatic swelling of both eyelids, with much lachrymation and bodily weakness. After leaving off the Iod. these symptoms disappeared. The glands were cured, but the hard swelling in breast remained. (MUHRBECK, Hufeland's Journ., liv., pt. 4, 63 ; in Ibid.) 21. A youth, æt. 19, who had a goitre for three years, took Iod. for a long time. The goitre disappeared, but he got a numbness of upper and lower extremities and much trembling of hands. These symptoms yielded to cold baths. ( FORMEY, Hufeland's Fourn., liv, pt. 6, 95 ; in Ibid.) 22. A woman, æt. 34, took Iod. for goitre. After 4 d. there came on fever with dryness of skin, quick, soft pulse, delirium, subsultus tendinum, floccilation, skin cool. The goitre diminished in size. After 14 d. was able to leave her bed, though still weak. A repetition of the Iod. caused after 3 d. fever, with similar symptoms. ( NAUMANN, Hufeland's Fourn., lv, pt. 1, 69 ; in Ibid.) 23. A delicate, nervous woman, æt. 28, affected with goitre, after taking Iod. for several d., had palpitation of heart, vertigo, twitchings of facial muscles, great prostration, constant feeling of constriction in goitre, incessant urging to urinate, a febrile state with alternate chills and heat, complete anorexia, loss of sleep, emaciation. After taking volatile stimulants for 8 d. she recovered. (SCHMID, Hufeland's Fourn., lviii, pt. 2, 124 ; in Ibid. ) 24. A strong man, æt. 25, 8 years ago took for goitre (which had been partially removed by iodine ointment) 6, 8, and upon the 8th d. 10 dr. tinct. When he had taken 2 doses of the last quantity and had drunk half a pint of wine he was suddenly attacked by pale face, cold sweat, trembling of limbs, constriction of chest, constant inclination to vomit, without actual vomiting ; anxiety, headache, and at last fainting. From that time his digestion, which had heretofore been excellent, was

quite ruined. During the next 2 years he had every d. or every other d., after the ingestion of the slightest meal, indigestion with a headache that often made him unconscious. In after years he got better, but had to be extremely careful of his diet. He is better when he drinks cold water. Milk always disagrees. (SCHNEIDER, Hufeland's Fourn., xci , pt. 1 , 84 ; in Frank's Mag., 1. c.) 25. A lady, æt. 26, of nervous, irritable constitution, wishing to commit suicide, swallowed 2 drm. tinct. Iod. Immediately burning and dryness from throat to stomach, with tearing pains in epigastrium and futile efforts to vomit. Seen 1 h. later the sufferings had increased, face red, eyes watering, pulse contracted, small, concentrated ; extremely acute pains in stomach, aggravated by the slightest pressure. The stomach seemed in a permanent state of contraction. After drinking a quantity of warm water she vomited. On this the pains left the stomach and went into the abdomen, especially along the colon. After a few d. was quite well. (MONTCOURRIER, Rec. period. de la Soc. deMéd., ciii, pt. 3, 333 ; in Frank's Mag., iii, 533.) 26. A woman, æt. 32, hysterical, took for goitre various preparations of iodine. Each time after 14 d. use of the medicine the goitre diminished, but at same time there occurred increased sensitiveness of retina, a kind of photophobia, so that by d. objects appeared in a flaming, fiery red illumination, which dazzled the eyes, and in e. artificial light could not be borne. These symptoms went off on leaving off the Iod., but the goitre then became larger. (Med. Zeit. v. Ver. f. Heilk. in Preussen, 1834, No. 19, 89, in Frank's Mag., i, 65.) 27. A woman, æt. 28, of irritable temperament, and irritability of larynx and lungs, took for goitre at first 4, then after 8 d. 5 dr. m. and n. No effect was produced on goitre, but on 16th d. pains in larynx, cough ; pressure in stomach and quick pulse after eating anything. After leaving off the med. for some weeks she again took it in small doses, then 6 dr. None of the former symptoms appeared, but her complexion changed from yellow to brown, and in a few d. the skin seemed as if smoked. This lasted a considerable time. (VOGEL, Rust's Mag., xiv, pt. 1, 158 ; in Frank's Mag., i, 515.) 28. A woman, æt. 20, took for goitre tinct. Iod. for several months. The goitre disappeared, but there occurred pressive shooting pains in hepatic region, loss of appetite, irregularity of menses, and emaciation. In May there came on quartan ague ; during the pyrexia constant diarrhea. After the 8th attack of ague she became so weak she had to keep her bed. After 3 d. she had continued fever with dry tongue, great restlessness, little sleep, and very small, quick pulse. On sitting up in bed she fainted, the pain in liver more severe and constant ; it was hard but not much swollen. The pain continued, and she died. (SUTTINGER, Ibid., xvi, pt. 1, 113 ; in Frank's Mag. , i, 516.) 29. A woman, æt. 26, otherwise healthy, took for goitre 10 dr. tinct. Iod. 3 times a d. After taking it for 10 weeks had to leave it off on account of pregnancy. Four months after delivery, as she did not nurse her child, she again took Iod. in the same way. After taking it three months with no effect on goitre, she rubbed in iodide of pot. When she had taken the med. 5 months and applied it externally 2

months, she noticed a complete disappearance of the mammæ, with great emaciation of the body but without any diminution ofthe goitre, which, indeed, was rather larger. (REICHENAU, Ibid., xxii, pt. 2, 291 ; in Frank's Mag., 1. c.) 30. A strong tinct. of Iod. was applied to some indurated parotid glands in a young Indian of 17. Five h. after, lad was seized with vomiting and purging ofyellowish fluid containing flocculi ; and next m. all the symptoms of iodism were present,-rapid,feeble pulse, peculiar restlessness and anxiety, intense thirst, burning sensation in abdomen, vomiting and purging, with suppression of urine. His mind was perfectly clear throughout. Death occurred in 30 h. P.M., mucous membrane of stomach and small intestines was studded with small ecchymoses ; liver and spleen large (but he had had malarious fever a month previously) ; lungs contained some frothy,sanguineous fluid, and were somewhat congested. (GILLESPIE, Med. Times and Gaz., 1864, ii, 488.) III. Experiments on animals.-I. A young setter dog commenced with taking gr. twice daily, in the form of pill. The dose was gradually raised, and by the 4th d. amounted to 1 gr., when the animal began to betray a much sharper appetite, suffer the saliva to drop involuntarily, and void urine and fæces in greater abundance. On the 9th d., his daily allowance had risen to 4 gr., which quantity was quadrupled by the 17th d., when-73 gr. having been taken in allthe drug was discontinued. On d. succeeding last dose, the animal scarcely retained any power of locomotion, and in the act of walking, or rather crawling, kept one of the hind feet constantly uplifted. He took little food, and what he did take was with little apparent appetite. In a couple of d., however, he began to revive and walk with less difficulty ; and on the lapse of 5 d. from cessation of the Iod., when the symptoms arising from it were much abated, he was destroyed by means of prussic acid. The viscera of the chest presented nothing abnormal except congestion ofthe lungs, probably attributable to the manner of death. The intestines, before being handled, had for their general aspect a diffused crimson-red tinge, an uncommon degree of contraction, in many places actual constriction, as if with a cord, and here and there a few bluish-grey, oval spots. The stomach was of its usual dimensions, and nearly filled with the food last taken. Its lining membrane presented numerous small rugæ overspread, and having their interspaces filled, with rather tenacious mucus, the sides and apices irregularly marked with dotted patches of crimson, or else brownishred, vascularity. The lining membrane of the intestines, for about 3 ft. from their origin, was remarkably vascular ; oval spots, about the size of a chestnut, then began to occur at every 3 or 4 in., on side opposite to mesentery ; a similar spot at junction with colon was 2 or 3 in. in length, and was expanded at its lower termination over the whole circuit of the gut. These spots were not injected ; they appeared to consist of the agminated glands enlarged, as sometimes noticed in the early progress of fever. The colon was of a leaden colour, deepened at the longitudinal rugæ into black. No unnatural appearances could be traced in the other organs. (COGSWELL, op. cit.)

Volume II — Appendix

Iodum. After I. 9, insert the following :

1. Dr. Lorentz, assistant physician at Militsch, publishes in the Deutsche med. Wochenschrift, No. 45, 1884, as a peculiar case of iodine poisoning the following proving, and I consider it proper to record, as a part of our materia medica, the symptoms which he observed after its external application on himself. OnMay 16th, 1884, at 6.30 a.m., he painted 3 times in succession the back of the r. hand and arm with tinct, iodi, in a space as large as the palm of the hand, for an insignificant sprain. From 6.45 till 7.30 he kept in the open air ; afterwards, while sitting in his room, he observed the sudden appearance ofa violent coryza, with lachrymation and pressing pains in the eyes, soon followed by violent cough and tendency to vomit, together with difficult, almost wheezing, respiration, feeling as if the larynx was constricted externally, and great lachrymation. His feet now began rapidly to swell, so that he could no longer bear the pressure of well-fitting boots, and upon their removal he saw that the soles of the feet were considerably swollen, and walking was in consequence extremely painful. Slight feeling that his head was not right. After h. the coryza, lachrymation, and cough had completely ceased. Temp. 37°3° C. Pulse and cardiac impulse now decreased in force. At 9 a.m. a slight fainting fit, which soon passed away. Heart-sounds very weak, but without anyaccompanying friction-sound or murmur. The apex-beat and pulse could not be felt. He had nolonger complete control of the tongue, as was shown by stuttering and the production of sounds other than those intended. He also heard slowly,so to say, as he required some time to get a clear understanding ofwhat was said to him, in order to answer, as well as to give expression to the answer. He lay upon his bed, andwhen, feeling better, he left it to walk about the room, there was momentary vertigo, followed by complete loss of consciousness ; on coming to, there were convulsive movements of the arms and legs, and the head was drawn backwards. After themotions had ceased he returned to bed, as on standing up once more he experienced the feeling of an approaching attack of vertigo. Coryza, cough, and lach. rymation haddisappeared completely, and there was a slight frontal headache and a violently itching iodine-exanthem. Temp. 37°2° C. Pulse could not be felt. Soon after profuse sweating came on, lasting for about 4 h., whereupon the itching and headache passed off and extreme weakness followed. Another fainting fit occurred, lasting 1 h. (the former one continued 45 m.), leaving adull pain in the occiput. After taking some Hungarian wine the heart could be faintly heard and felt. At 4p.m. the pulse was quite weak, and with long intermissions; at 6 p.m. it was 124 to the m., and at 8 p.m. 100. On the 2nd d. there was only weakness after a restless sleep. Slight attacks of vertigo on rising. Temperature normal. Pulse 76 to 80. The 3rd d. was passed out of bed. The exanthem had disappeared. On the 2 fol. lowing d. during the m., on any quick change of place, and especially on quickly standing up from sitting, there occurred a momentary slight vertigo. On the afternoon ofthe 5th d. he was in his usual good health. (BUCHMANN, A. h. Z., cxi, No. 4.)

Volume IV — Appendix

lODUM.

(See vol. ii, pp. 691 and 756.)

1. 3»

^ . Simon relates that having treated 11 children for '"f favosa by local applications of tinct., in 4 he observed albun)in>^ which disappeared at each cessation of the treatment, and recurrti«*

resumption. Analysis revealed at the same time the presence in he urine of I. itself.* {France Meciicah, Mai, 1876.)

1. Hallopeau reports a case of a child of 4 who took an iodised loluiion of horseradish. She exhibited a pemphigoid eruption of most

Nin^lar character. Several of the bulbie were more than 4 centimetres in diameter, they were grayish and their contents were thick. There was no constitutional disturbance, and the eruption disappeared without leaving any traces. He mentions two other similar cases which had [come under his observation. [L'Hom. Militante^ iii, 414.)

1. About 5 h. after injection of a sol. of I, into the sac of a lumbar abscess, patient had vertigo with impairment of vision ; soon afterwards vomiting of serous mixed with chocolate-like matter occurred, with general malaise, skin moist, extremities cold, pulse small and

Lth ready, resp. hurried, prostration. He continued in this state during and succeeding n. Next d. vomiting continued ; he lay faint and groaning, palpebrae were greatly swollen and had a violet tint ; he complained of a distressing sensation in throat. 22nd. — Expressed • mself as better, though apparently in the same state. The throat ■Ooiced dry merely, but breathing was impeded, especially during respi- '^tion. A rough croupy cough was present, and the voice was

wh

ispering. (Nei-aton, Journ. de Chim. Med.^ Jan., 1854.)

1. A patient with a cancerous ulcer towards root of tongue was ordered 3J of the iodide of starch, each drachm containing i gr. of I., **», and e. After 5 d., as he felt unwell, he was directed to take half the quantity. Early next m. he was seized with dyspnoea, which "Ccame very urgent. When seen countenance was sallow and anxious ; P>jIsc intermittent; on r. side of neck, extending downwards from *r^gle of jaw, there is considerable firm circumscribed swelling, appa- •"cnily not interfering with larynx and trachea. On r. side of chest P^fcussion is dull, especially posteriorly; respiratory murmur through- J^'Jt is feeble, and in front there is loud mucous rale. L. side is simi- **«"Iy, but less severely affected. In e. his pulse flagged ; at 10 p.m. **yspnoea increased ; and at midnight he died suddenly. The friends

g ^^f^used to allow body to be opened, (Lawrie, Land. Mtd. Gax.^

h^. S.,ii,588.)

^H On p. 698, 1. 3 from bottom, for *' b. " read *• 3."

AH,

WOLKE

CE5STEJ

*haved skin of rabbit "'Ot. IV.

has induced albuminuria by applying iodic preparations to s. {Prtsit Mid, Btlge., Nov., 1877, p. j88.)