Iodoformium

Volume III — Main text

lODOFORMUM.

Ter-iodidc of fonnyl, CHI3.

I. Provings. — I. a. Dr. Underwood, Jan. 23rd, 1871, experienced following symptoms while triturating drug up to 3rd potency :

Feeling of warmth in abdomen and rectum, with slight nausea and desire for stool (on four occasions) ; neuralgic pains in forehead (sharp, worse on stooping), in temples, also sharp, extending to behind ears, and in I. knee; dull pains in forehead; aching in decayed teeth (coming and going quickly) ; dryness of throat, with rawness on swallowing; rheumatic pain in r. arm, worse when using it; pain along course of I. crural nerve; stitch pain on r. side of throat and in r. ear; flatulent colic ; easy perspiration on motion \ pain in back, along spine ; dr)'ness and stinging of lips ; fine sharp pains alt over 1 pain in 1. elbow and along !. median nerve, with stitches in 1. shoulder ; dryness of throat, with bitter taste ; pain in nerves of I. hand, worse on t9uching, and in 1. chest ; rumbling in bowels ; nausea; toothache in sound teeth \ sore pam in r. inguinal region ; cough from dryness of throat. Next m., pain in 1. arm as if bruised, worse when touched.

b. Same, June r3th, took i gr. of 2nd trit at 10 a.m. Sense of stiffness in zygomatic muscles, with slight pain, increased by motion and bending forward ; dull pain in malar bones ; sharp pain m upper teeth J stitches in temples (pain seems to sharply define course of nerves) ; weakness of knees on going upstairs i desire as for liquid stool. At noon repeated dose. Neuralgic pains in various parts of body, worse from thinking of them \ continued pains in lumbar region, with weakness when straining ; weakness and pain in knees, worse when standing ; rheumatic pams in both gastrocncmii and in fiexors of

legs ; stitching pains in head and 1. ear ; pain along r. side of dorsal vertebrae ; urine very yellow i Stitch in r. instep and head, and in r. chest through to lower angle of scapula; sharp pain in 1. hand and r. inguinal region ; pain in inside of knees ; flatulent colic and cutting pain in bowels \ rheumatic pain in r. arm. During siesta, confused dreams of accident^ &c. ; better after sleep ; cutting pain in I. ankle when walking in open air ; pains renewed when riding in cars, and again in bed, then also cough and wheezing from mucus in throat; restless sleep, tossing, turning, full of dreams ; headache on waking, pain in eyes, which are bloodshot, objects appear tesselated red (this disappeared after rising) ; violent itching of occiput. Took i dr. of 3rd dil. Sharp cutting in r. inguinal region, with desire for stool j sharp pain in nerves of 1. arm and back ; confusion in head, with slight nausea, feeling of &intne$s, drawing and pressing in malar bones, perspiration on head ; dull pain in forehead, with shooting in r. ear, worse on descending stairs ; wakefulness, jerks and shocks in nerves when trying to sleep ; unusual susceptibility to heat of weather. {Trans, of N, T, State Horn, Med, Soc,^ ix, 237.)

1. J. H — , xt. 24, proved 2X and 3X dils. Took first (i dr.) at ix a.m. From time of taking it till e., sensation as of smelling fumes of iodine, though none had been about him. In 2 h., dull aching, increasing to heavy pain as from strong pressure, in r. lower maxillary bone, lasting 20 m. ; then same sensation in both temples. In 4 h. severe aching in 1. humerus \ muscles around bone felt as if severelybruised. In 4^ h. dull sore pain in apex of r. lung \ on breathing, lung felt as if two ulcerated surfaces were in contact. Took i dr. of 3x at 5 p.m. In 3 h. heavy feeling in head and dull aching atverte* At n. slept soundly till 1.30 a.m., then woke suddenly^ and felt though he were smothering; room felt too close, though freely ve lated; head very heavy, so that he could not lift it from pillow ; 1. pained severely, also 1. leg, particularly at lower half of tibia fibula, extending into foot. This became less in ^ h ; then sen' as if something heavy were resting on chest, preventing its free sion, lasting ^ h., gradually becoming less intense, and as it appearing to diffuse itself in extremities again ; herewith also 1 breast, very severe, at first as if a deep ulcer had formed th< like hand grasping base of heart \ pulse 88. Restless and 1 sleep any more till 4.30, then slept about i \ h., and later h that on waking he could hardly get roused. In m. head still aching now and then ; pain seemed in bones of skull and r side ] r. eye sore and as if bruised. Metallic taste in mo of d., teeth feel sore and as if too long \ aching in 1. brc but less severe than last n. ; 1. arm and leg pain as if bn pain increases muscles feel as if ulcerated. Took another dc after 2 h., very drowsy, and remained so for 2 h. ; afters feel as if a heavy cold had been taken and had settled t' lasting 2 d. after this. For 3 d., flying neuralgic (J. W. Haines, M.D., Ohio Med. and Surg, Rep.^ x, II. Poisonings. — i. Franzeska B — , set. 26, pr hospital 1876 -y she is of medium size, well built, but

in her nutrition. Physical examination shows no abnormity in heart, lungs, or abdomen. Between and above the frontal eminences an ulcer denuding (he pericranium. Suppurating gummata on both sides of the clavicles and on the humerus. On the right clavicle a necrotic bone protrudes. Large suppurating gummata on the tibia. Prescription : ,ibur iodoform pills twice daily (every pill ox grm.) and ungu. iodoform. The result was very satisfactory; she took the pills regularly with the exception of a few d. when they were omitted on account of gastric troubles, so that after having taken 278 pills (278 grm,) the dose was reduced to six pills daily. By the close of March all the gummata were healed with the exception of the large one on the forehead, this necessitating a continuance of the iodoform. Suddenly on April 9th (since entering the hospital she had taken 42 grm. iodoform in 80 d.), 'after a hot bath she felt very dizzy and weak in the legs, and felt unable to knit, as diplopia had set in. This lasted 2^ d. ; a clysma of vinegar and water brought no amelioration ; the pills were left off. She then began to vomit, followed by deep sleep, from which she can be roused only with difficulty to take her meals or to answer the physician ; all appetite gone. This again lasted 2 d. On afternoon of ,.2nd d. transient state of irritation interrupted the somnolence. She lacreams out, leaves her bed, but falls down after walking a few steps, ttalks nonsense unconncctcdly, is unable to hold anything, and sees everything double, a state which already Rhigini designated as ebrietas iodi. After a few h. she becomes more quiet and returns to her somnolence. In 2 d. these paroxysms had reached their acme j the patient complained through the whole night of headache, vertigo when sitting up in bed. The talkativeness steadily increased, and fear of death with anguish was very pronounced. She holds fast to any person near her bed, and bemoans her approaching death. Her body is in constant spasmodic motion ; twitching of facial muscles, deep inspirations alternating with apnoea i towards evening patient is more quiet and conscious, but in n. is restless and sleepless, complaining of headache. Next m. she felt decidedly better, only weak, and diplopia was still present. The functions of the other senses were normal, and the pupils reacted normally. There is not a paralytic symptom, only every movement is made slowly and without energy. When she closes her eyes she cannot stand straight, but oscillates, nor can she walk well. Thus she remained from the gth to the 15th, when a second attack set in with vertigo, vomiting, severe headache, and exquisite diplopia i but this paroxysm lasted only i d.,and by the 21st she could walk alone, and had a good appetite. (Oberlaender, Deutsch, Z.f.pr, Med., 1878.)

1. A woman of nearly 70 suffered for several years from syphilitic ulcers of the fauces with a considerably extensive necrosis of the hard palate. After entering the hospital pil. iodoform 4 twice a day and pencilling the necrotic parts with tinct. cantharidum ( Dieffenbach) were ordered June 6th. On 14th, after having taken 5 grm. iodoform, the first symptoms of somnolence showed themselves. She does not know what she talks, walks with difficulty, like a person drunk. The preceding n. was sleepless, with excruciating pains ia wKciVr. *:1>s.-

cumfcrence of the skull. i6th. — Perfect coma, patient sleeps qui'edv in bed, arms when raised up fall back in a relaxed condition, eyelids hardly offer any resistance to linger. She reacts promptly to cutaneous irritation, trying to ward it off. With great exertion is she roused at the hour of meals, and swallows mechanically the fluid nourishment poured in her mouth ; pulse 80, respiration 20 ; stools regular, some incontinentia urinae,the urine showing slight iodine reaction. During n. she is more restless, delirious, gets up and runs about room ana must be brought back into bed. This comatose state lasted 5 d. After that, when shaken and loudly spoken to, she tries to open her eyes and slowly answers after some time. The next 5 d. her state remained the same ; after that her mind became more clear, she complained of headache, and after many questions she described her state thus : " I always felt tired and worn out ; every motion was difficult. I saw all persons and all objects as through a veil. I recollect the visits of my physician (but not that of my relations); always suffered severe occipital pains and scratching sensation in throat, and thirst" (even touching the occiput and neck was disagreeable to her through all her somnolence). "During the night I always slept quietly " (when, in fact, she was very restless). No diplopia was observed in this case. For a long time afterwards she complained of vertigo and lassitude. (Ibid,)

1. a. ScHEDE says that there are persons who possess a peculiar idiosyncrasy towards Iod., which is not to be found out until, without any warning, it suddenly appears in the most severe symptoms of poisoning, and may lead to the rapid death of the patient, even though its application be immediately suspended. These symptoms are divider* into six groups : — i. There may be elevation of temperature to 10 and more, without other phenomena (so-called "aseptic" fever). In addition to fever, there may be depression of spirits, headache, of appetite, taste of Iod. in mouth, pulse being often very rapid and same time small and compressible. On stopping the drug these f ptoms at once disappear. 3. The pulse-rate may be increased tr or 180, and more. In spite of rapid cardiac action and small with anxiety, &c., amelioration may take place on stopping th' but there is, nevertheless, great danger. This condition may ai the first application of an Iod. dressing, or it may only set toleration has been established for weeks. 4. The alarming of the pulse is accompanied by high fever, yet the sensibil' diminished, and no symptoms of septicxmia arise, but the of administration is not followed by reaction, and death f After severe operations, although the pulse is very good, r; sets in, ending in death. It is, however, a question wh solely due to the iodoform. 6. The most alarming, and, tive frequency of their occurrence, as well as suddennef gerous forms of poisoning, are the disturbances of the ceref which either take the form of acute meningitis, or of 7 order (melancholia, &c.), and tend to a fatal terminatic no particular elevation of temperature take place, and tl the drug has been immediately suspended.

b. KusTER relates several cases of fotal intoxication f

tion of lod. in powder to wounds, in which the symptoms were much the same as those described by Schede, viz. disturbances of the digestive tract ; fever ; a peculiar influence on the central nervous system, characterised by depression, melancholia, dilatation of pupils, apathy, involuntary motions and urination, hallucination, &c. ; rapid collapse and death. [Lond. Med. Record, x, 177.)

1. KocHER has found lod. a dangerous dressing. He has observed no fewer than 23 cases in which, used in the treatment of recent wounds, it acted as a poison. The chief symptoms arc excitement, restlessness, and mental depression. The patient sometimes becomes delirious, and has mental delusions. Attempts are occasionally made to get out of bed and wander. These symptoms at once cease on changing the Iod. for some other dressing. The application of lod. to a large fresh wound may be followed by total loss of memory and impairment of speech. In another case, after extirpation of cancerous disease of the rectum, and application of lod. to tht raw surfaces, the patient became very noisy and violent, and had what resembled an attack of acute mania. K. — has also observed, after dressing with lod., complete loss of consciousness. In this form of poisoning, there is usually great difficulty in getting the patient to take nourishment. The bladder has to be relieved by catheterism ; the limbs, more particularly the arms, become stiiF and contracted ; and Bnally, in very severe cases, collapse may ensue, lod, accelerates the pulse to a high degree. Notwithstanding this, and the mental excitement and restlessness, fever is seldom observed. The patient, after a prolonged toxic action of lod., passes into a chronic condition of restlessness, and suffers much from loss of sleep and impairment of nutrition. The poisoning, as a rule, is much more severe when coming on rapidly afier a surgical operation, than when it is due to the prolonged action of lod. Iodoform differs from pure iodine in its poisonous effects, as it does not give rise to any exanthem or to nasal catarrh, or cause vertigo. It often acts as a poison when it has been applied in small quantities, and when the amount of iodine given off must be far too small to account for such toxic effects. Then, again, the symptoms of iodoform poisoning may persist long after the disappearance of iodine from the urine and other excretions. (Ibid.y p. 236.)

2. In a recent paper in the Allg. IP^ien. med. Zeitsch. two cases in which an eruption was the apparent consequence of the external use of I. have been recorded by Zcissl. An ulcer on the leg of a boy of 3 was dressed with I., the dressing being several times changed in the course of a fortnight. At the end of that time the temp, rose suddenly to 105% and a diffuse erythematous eruption appeared on the flexor aspect of the upper part of each arm and the inner side of each thigh. The affected areas were bright red in colour, the intermediate parts of the skin being normal. The child was somnolent, and vomited some greenish yellow masses. On the 3rd d. after the removal of the I. temp, became normal, and the exanthem gradually faded. During its existence, the urine gave a distinct iodine reaction, and contained some albumen and renal epithelium. The applications being resumed, another attack occurred precisely similar, attended with the same elevaiuo^v c>^ v«.'cc^.v

and albuminuria^ disappearing 5 d. after the cessation of the dressing* Ultimately, however, tolerance of the I. was established. In another case, I. was applied to a fistula connected with carious bone. After a week patient was attacked with an eruption like urticaria^ sharply circumscribed prominent red spots surrounded by reddened skin. Sonae of the raised spots had a diameter of 2 centimetres. They were especially abundant on the flexor aspects of the limbs. Urine contained no albumen. The application was discontinued, and the eruption subsided in the course of a week. (Lancet^ 1882, i, 26.)

1. a. In chronic poisoning by I. the evidences of poisoning develop very slowly and insidiously. There is malaise and possibly some loss of strength, loss of appetite, with occasional vomiting, and above all the patient is weighed down with a sense of depression. There ia usually a moderate degree of fever, and an unusually rapid pulse. The sleep is at first broken, and there is some wandering at night. Headache is not uncommon. In time the patient becomes apathetic and disposed to sleep. He is melancholic, his memory is distorted and impaired, he is troubled by the dread of death, or some impending danger, and takes no interest in his surroundings. He remains in a condition of drowsiness, he wastes, he possibly becomes dirty in his habits, his tongue becomes dry and brown, he makes no complaints, and sinks into a more or less complete state of hebetude. Sonne patients in this condition have lost power of their legs, and all control over their sphincters. Others have been able to be propped up in a chair, and to move about a little (as occurred in one of my own cases) until within a short while of death. In the htz\ cases the patient becomes weaker and weaker, and in time utterly vacuous. He ultimately dies comatose. If the I. be left off, recovery may ensue in time, even when the symptoms have persisted in a marked manner for some time. In this phase of poisoning the progress of the case may be extended over weeks, and possibly over months.

b. In acute cases the symptoms develop much more rapidly, a^ they may indeed appear with some degree of suddenness. There perhaps, in the first place, some malaise, then complaint of headacl which is often intense, and of vertigo. The sleep is broken or patient is quite sleepless. There is excitement and wandering t The temperature is high without appreciable cause, and may rr 104°, 105°, or 106°, The pulse is remarkable in its rapidity, mo often to 150 and 180. There is often albuminuria, the app greatly impaired, and there may be vomiting. In one iristan vomiting was very obstinate. The excitement passes into d' The patient has hallucinations, sometimes hallucinations of g and his symptoms may approach those of acute mania. Ps this condition have been removed to asylums. Among rarci cations are tremor, stiffness of certain limbs, convulsive mc diplopia, and irregular respiration. Patient wastes, and, more and more prostrated, may sink into a comatose conditio In not a few examples the symptoms have developed su have commenced by sudden fever or sudden and intense ' sudden and unaccountable delirium. In some patients t

have very closely resembled those of meningitis — a circumstance that has been most usually noticed in children and young subjects. (Treves, Pract.y Oct., 1886.)

1. In a girl, xt. \ 3, on whom T. had operated for ununited fracture of ulna, and dressed with I., the temp., which had been normal for three weeks, rose to lOO'- in thee, of June ist. *' The entire forearm became evenly swolJen, edematous, and a trifle red/' The next day a crop of vesicles had appeared, about thirty in number, very small, limited to the forearm, and not more numerous in the vicinity of the wound. The e. temperature remained at 100° for six days. No more vesicles appeared, and those present soon became pustular, and by the sixth day were discharging. " On June 5th, a remarkable exanthem appeared." Its appearance had been preceded by intense headache and giddiness. With its development in the e., these symptoms disappeared. The forearm was less swollen. On m. of 6th, "the exanthem covered the left arm and shoulder, the greater part of the face, and nearly the wholcjof the front of the chest, and some parts of both sides of the neck." "The eruption appeared in the form of patches," consisting o( closely-packed papules, of less size than a pin's head, and set upon a pink erythematous base. The papules could be felt as well as seen, and they were paler than the surrounding skin. The patches were irregularly round, and varied in size from a sixpenny to a half-crown piece, and the margins were well defined. There were no catarrhal or other constitutional symptoms after the rash appeared, and the child seemed quite well. The eruption was gone the next d. {Ibid.)

2. a. A man, 7ct, 61, was operated upon for strangulated femoral hernia. During the progress of the case, on Sept. 3rd, 1881, 1, on lint was inserted into a sinus ; on the 7th it was puffed into a sinus. It is recorded that the patient was emaciating rapidly. On Sept. 20th he was feeling low, and could eat no food ; was dull, heavy, and exceedingly drowsy, disinclined to make any exertion ; wandering at n. 26th and 27th. — Temp. ior6^. Pulse 130. Tongue dry and brown. Wasting continues \ patient is passing into a hopeless condition of hebetude and exhaustion. Oct. ist. — Began to mend soon after the I. was discontinued.

b, A burn case ; a man, irt. 34. Urine contained albumen, granular and hyaline casts, and triple phosphates. Dec. X2th. — I. applied. Temp. I0I'6° Pulse 108. i6th. — Burns satisfactory, but bronchitis has set in, and patient is delirious. Pulse 130. 17th. — Temp. 104°. Urine not albuminous. 31st. — Cough is bad, occasionally delirious, is emaciating rapidly. Patient got worse and died Jan. 3 ist. For a week before death pulse ranged from 145 — 155. Broncho-pneumonia and congestion of both bases were found at the autopsy.

f. Burn case ; a boy, at. 4. Admitted Jan. ist, 1882. Ncxtd.l. was begun. Temp. 102*^ ; pulse 150. 5th. — Slept very little last n., and screamed as if suffering from meningitis ; draws up legs a good deal j is suffering from intense headache. He remained in the same condition for the next few d. 9th. — Better, less screaming, more conscious. Temp. I00'4^. loth. — Still screaming in a peculiar way. Pulse 144. 1 2th. — Temperature lower ; more unconscious ^ ver^ ce5.t\ss^. v^Cto..

—"Twitching" and "rolling." 25th.— I. left ofF. 26th.— More restless, but less crying out ; paler ; more conscious. 2nd. — Screaming nearly ceased, takes notice. 17th. — Rational and quite restored to health.

d. Boy with lumbar abscess, which was opened Jan. 21st. Dressed with I. wool. Temp. 992°. 24.th. — Urine X037, loaded with urates. Temp. 99°. 26th. — Temp. 104-6° at 11 a.m. Pulse 138, weak. Skin hot and moist ^ vertical headache, drowsiness, nausea ; breath smells of I. i discharge slight and sweet. The wound was washed out with carbolic acid i this was followed by better sleep, less headache^ and disappearance of the nausea. Urine contains urates, but no albumen. Feb. ist. — ^Went on well till this date. Then pain in occiput and 1. lumbar region set in. Temp. I03'8°. Patient is drowsy, and has no appetite. Then he improved again until X7th. For 36 h. he was drowsy, had headache, nausea, and loss of appetite. Pulse frequent, full, and compressible. Temp, over 103°. After the 36 h. he improved, temp, fell to loi^, and he seemed himself again on the i9ch. 19th, in e., temp, rose to 1056^. A punctiform rash appeared over arms, knees, and dorsal surface of feet. Tongue fiirred| throat sore. 20th. — Rash is faint. Temp. 99*^. Boy became, and remained, quite well. (Beck, Brit, Med. Journ,^ June 17th, 1882.)

1. After dressing a wound of head with I. for 3 weeks (during which there was nothing beyond loss of appetite) the patient suddenly began to behave as if out of his mind. The following d. he continued to calk nonsense, would not take any food, and would not remain in bed. During next n. he tried to run away, and became violent. This lasted till m. He was quieter when visited by Dr. Behring but answered questions unwillingly and hesitatingly. Dr. B — was struck with his wild look and his sunken features. The tongue was thickly coated and not tremulous ; no tremor of hands (he had not been a heavy drinker). Temp, not more than 99°. Pulse 104 and of high tension. The use of potass, bicarb, as an antidote soon relieved the symptoms. He was restless next n. but did not wander. On 3rd d. appetite began to improve. The wound continued to do well. (Diutsch* med. Wochemchr.^ Jan. 31, 1884, p. 68.)

2. A patient had insufflation of I. into tunica vaginalis. Suppuration was set up, with mental condition thus described : " Delusions, dressing himself in strange costumes, imagining himself of a prodigious height and growing rapidly. His ideas were all of an exalted character \ he imagined he had the best tenor voice in the world, and proceeded to hire a large concert hall,*' &c. This patient was sent to an asylum \ recovery took place in four months. (Black, Brit. Med. joum,, 1885, i, 70.)

3. For painful local affections two patients received respectively twice a day for weeks a pessary and a suppository^ each containing gr. V. of iodoform. After a time "they became so gradually uncon* scious, and the loss of power so imperceptibly came on, that gener paralysis was feared. They lapsed into a dreamy state, followed in few days by complete stupor and loss of power over the sphincter They could be roused by great effort to take a little nourishment, bi

soon lapsed into unconsciousness. This condition lasted some days, and passed off, leaving no permanent bad effects.** (Pollock, Pract., 1886, ii, p. 138.)

III. Experiments on anhnab. — I. The large proportion of iodine in this compound has led to its being ranked among the preparations of that substance, but a brief description of its action will throw doubts upon the propriety of this arrangement. Given to dogs in doses of 10 — 15 gr. it occasions* a sort of intoxication followed by depression. The animal lies still, and if he is aroused staggers in walking and then fails upon the side. After a few h. no traces of these effects remain. If the dose amounts to 50 or 60 gr. prostration and intoxication arc succeeded by rapid pulse, with spasms of the limbs and opisthotonos, which occur in paroxysms ending in death. The breath smells strongly of the medicine. These various phenomena appear to show that lod,, by its primary action, at least, should be ranked with the anxsthecics. They give no indication of the large proportion of iodine it contains. (Stille, op. cit.^ ii, 859 )

1. Bivz found that I., in moderate doses, and especially in cats, caused narcotic effects. In poisonous doses it produces acute fatty degeneration of heart, liver, and kidneys, and destroys lile with manifestations of general paralysis and considerable decline of temperature. (Oberlaender, he. cit.)

2. The heart's beats (in a dog) were lessened, and the arterial tension, by the administration of i gramme, slightly increased \ by more than 2 grammes tension was slightly diminished. I'he temperature rose a degree or two after a moderate dose ; it was lowered by a large dose, and tetanic spasms came on. Local anaesthesia, paralysis, and diminution of reflex action occurred in the limbs into which the I. was injected \ universal rigidity, persisting atter section of the cord, set in later. From 3 or 4 grammes there followed : First, profound sleep, photophobia, anesthesia, staggering gait, slight diminution of superficial and deep reflexes, and contracted pupils. Secondly, spasmodic paraplegia, with tremor on exciting voluntary movements, permanent erection of penis, and ccdema of prepuce ; later still a tendency to go backwards^ and to turn round in a small space, was noticed. Thirdly, the animal repeatedly cried out, intense aud general tctaniform contraction set in, with exaltation of the reflex irritability, clonic spasms, rotation of body, dyspnoea, and dilated pupils. The convulsions were uninfluenced by section of the cord. Large doses also cause nausea, vomiting, dysenteric stools, albuminuria, and harnuturia, lessening of the number of and crenation in the coloured corpuscles, fatty degeneration of all the viscera, glomcrulo-nephntis, intense hyperaemia of the cerebro-spinal nervous system, especially of the ffrcy matter, accompanied by changes in the nerve-cells. (Rummo, ^JLanat^ 1883, ii, 119.)

• Tlicic results arc Maitre's. — Eos.

Volume IV — Appendix

lODOFORMUM.

(See vol. ili, p. 1.)

1. II. A boy, zet. 10, had his leg atnputated Tor strumous dl of knee. Sutures held well, save at outer border of wound, at wh point lod. was applied thickly. On 3rd d. child was found slec| and nurse reported him restless during n., and sighing frequen Dressing was changed, and lod. renewed. On same d. the child, having eaten since previous d., was attacked by vomiting several tiin this was bilious and easy. During next few d. all these sympti became more prominent ; child was constipated, and seemed to %\t from its head. The nights were very restless, sleep interrupted sighings and cries like those of meningitis ; there was drowsij during d. ; pupils were unequally contracted, and reacted slowly light. Child was perfectly indifferent, and did not recognise th about him. Later, nocturnal agitation was replaced by tranquil d rium. Temp, oscillated between 37'5° and 38'2°. These sympM continued until the 8th d., pulse being rapid, small but percepti and regular. From the 6th d. the lod. had been discontinued, phenic acid substituted \ on the 7th symptoms had diminished ; on 8th considerable improvement had set in, and all went well from c 9th d. (Cazin, France Medicale, 1888, II, 1637.)

2. A child had tuberculous osteitis of tibia. Place was scrij* and lod. gauze applied. Symptoms appeared on ist n. ; child 'Ti very restless, and did not sleep; it complained of violent pains inlx" Next d., at time of making rounds, child was drowsy, and respooi' with difficulty to questions asked. Pupils were unequally contrarit^ During d. several attacks of bilious vomiting ; pulse irregular and "fT frequent (lOO). These symptoms continued to get worse for J % and with them was constipation. On 5th d. the lod. was left olF, u' the symptoms rapidly became much milder, disappearing compto'l after 3 d. more. While symptoms lasted there was slight fever, wiw e. aggravation, — temp, oscillating during the 5 d. between 3/'"'' 385°. {Ibid., p. .)