Kalium iodatum

Volume II — Main text

1. A few years ago M. Benedikt made a series of experiments on frogs, by which, however, our knowledge of the remote action of Iod. was not essentially advanced. Like many other poisons, it paralyses voluntary motion in frogs, and produces this effect apparentlyby affecting the spinal cord. (BOEHM, in Ziemssen's Cyclopædia, xvii, 297.) Kali iodatum.-Iodide of potassium. KI. I. Provings.-1 . Hartlaub and TRINKS. (Without name of observer, but probably from Nenning.) In e., very anxious and lachrymose, as ifsome evil were impending, for 2 h.; very peevish and excited, everything goes wrong, and she is ready to quarrel with everyone (17th d.) ; she is frightened at every trifle (5th d.) ; she is very talkative and quarrelsome (12th d.) ; the usual head symptoms, but without vertigo, and some irritation of eyes ; an indescribable pain extends out from l. ear, and if she only moves hand towards ear, without touching it, the pain creeps over whole side of face (e.) ; violent jerking or shooting in r. eye-tooth , scarcely to be endured, frequently lasting for an h., but worst after going to bed till midnight, and at 4-5 a.m., relieved by warmth, aggravated by cold, pain at times so great that it seems as if tooth would break off, or as if a worm were gnawing at it (25th d.) ; after taking accustomed cold milk in m., sudden extremely painful dragging in both groins, so that she was obliged to bend double, frequent yawning,great weariness in thighs, violent griping in abdomen even to thighs, excessive restlessness so that she could not remain in any position, coldness with goose-flesh, anxiety and warmth in head, -followed by eructations and rumbling in abdomen, and stoppage of the catamenia (which had begun), then nausea and pressure in stomach , with urging to vomit, aggravated by moving about, shivering in feet and hands, with heat and sweat in face (14th d.) ; diuresis. ( Arzneimittellehre, iii, 36. ) 2. Dr. COLBY took 15 gr. at one dose. At n., after retiring, but before going to sleep, had terrible spasmodic pain at root of tongue, extending to both sides of throat. For about 15-20 m. pain was excruciating, causing fear that death was impending. There was a sensation as if spasm would close pharynx. ( N. Engl. Med. Gaz ., vii, 25.) II. Poisonings.- 1 . F. R-, at. 35, was admitted at 9.30 a.m. on Oct. 9th in a semi-comatose condition. His face was swollen and deeply congested, and the eyelids puffy and red, as in facial erysipelas . Lips and tongue were extremely livid, tongue being swollen and protruding between teeth. Very little air entered lungs ; there was croupy breathing, and on one occasion cough was typically laryngeal. Pulse was scarcely perceptible. Tracheotomy was performed with great relief. When seen at noon some pustules were observed on face and neck and a papular eruption on back of hands and flexor surface of forearms. Temp. was 99.4°, pulse 100, resp. (easy) 36. Eyelids were less swollen but there was great chemosis. There had been no rigor, pains in loins, or vomiting ; but there was considerable headache. On inquiry it was found that he had had two similar attacks 3 years ago, with sore-throat and pustular rash, but with unaffected breathing. Each

had followed administration of K. iod. This time he had taken same--6 doses of 10 gr. each-for renal affection and rheumatism . After 4th dose he thought he had caught a violent cold, and went to bed. At I a.m. on next n. but one he woke up with sensation of choking and could scarcely articulate. In this state he was brought into hospital. Next d., m. temp. was 102.4°, pulse 130, resp. 21 ; e. , temp. 102.8°, pulse 136, resp. 24. Besides pustules, which looked very like those of variola, there were spots over ear, hæmorrhagiclooking, and evidently containing bloody serum. Uvula was elongated, and mucous membrane somewhat swollen, as if edematous, but there was no eruption on palate or pharynx. Next d. he was better ; laryngoscopic examination showed slight congestion of epiglottis and vocal cords. On 13th temperature was normal and rash had almost disappeared. Cannula had been removed after 48h. (FENWICK, Lancet, 1875, ii, 698.) 2. A syphilitic child, æt. 5 mo. , was given K. iod. After taking one dose of 2½ gr., in abouth. mother noticed it " turn black " about mouth and chin, and similar appearances followed on upper part of face. On being brought to hospital there was observed a large, hard, dark discoloration of lower lip with separate dark spots of purpura around it. There were a few hæmorrhagic spots on 1. arm above elbow ; none elsewhere. While it was watched patches perceptibly increased in size, until in an h. or so scalp and face were well covered. Next d. purpura had become more general, and on 4th d. child died.* (MACKENZIE, Med. Times and Gaz., 1879, i, 173.) 3. A man, æt. 28, with history of venereal disease, and now suffering from swelling of feet, pains in tibiæ, and ecthymatous ulcerations on legs, got 20 gr. ofK. iod., to be taken twice daily. After only 3 doses, he complained in e. of heat, and of burning sensation in face and hands, which were observed to be reddened ; and medicine was discontinued. Seen next d., p.m., it was found that since previous e. an eruption of very large bullæ had made its appearance ; some were 1 in. in diameter ; they occupied back of neck, forehead, face, and back of hands. Some were filled with clear serum, others were turbid, and of reddish or purplish colour, from admixture of blood, while skin around them was somewhat reddened and cædematous . In course of 2 d. most of them had become ruptured, and were drying and disappearing. In evidence of the fact that this eruption was produced by the drug, patient reported that on 3 previous occasions during last year he had taken the iodide, and always with the same unpleasant results. After disappearance of eruption he has felt better, and syphilitic symptoms have improved. (BUMSTEAD, Amer. Fourn. of Med. Sc., N. S., 1xii , 99.) 4. HUTCHINSON describes an eruption resembling hydroa as resulting from K. iod. It is sudden and symmetrical and prefers the face and forearms. There are vesicles and small bullæ, from the size of a shot to that of a pea, or even to that ofhalf a small cherry, and usually * "Kuess is said to have frequently observed hæmorrhages from the lungs during iodine treatment ; while in a few cases metrorrhagia, or habitual increase of the periodic menstrual flow, has been observed. "-Военм, op. cit.

surrounded by an erythematous and sometimes inflammatory swelling ofthe skin. In the earliest stages the papules resemble those ofsmallpox. The vesications become larger, lifting up a very delicate layer of epidermis, which presents no central depression. Their contents become grey and opaque but not distinctly purulent. Although there is no umbilication, yet a peculiar appearance is sometimes assumed by the vesication spreading at its margin and sinking at its centre, the patch then becoming sometimes as large as a shilling. (Trans. of Clin. Soc. of Lond., 1875, p. 152.) 5. The irritative effects on the skin which occur in distant parts of the body after the external application of Iod. also show themselves in many cases after the internal administration of K. iod. In the latter case, however, the multiformity of the eruptions is much more marked than in the former. This particular incidental effect of K. iod. has been well known ever since its introduction into the materia medica, and one therefore finds almost innumerable observations on the subject in literature. They all go to establish as a fact that it often produces eruptions, from simple erythema to petechiæ, with or without fever, occurring either alone or in combination with other abnormal effects of Iod., and disappearing, as a rule, very soon after the use of the remedy is suspended. These eruptions, according to Fischer (Wiener med. Wochenschr., 1859), are divisible into four principal forms. a. Erythematous form. The skin, particularly on the forearms, and also on the face, is reddened, either diffusely, or in circumscribed spots, and its temperature elevated. After discontinuing the drug, this disappears in a few h.; but if its use be persisted in, the eruption may pass into that which is most commonb. The urticaria-like form. Usually on abdomen and extremities, but also on other parts of the body, there appear, without fever, intensely red wheals, but slightly raised, surrounded by an areola, generally collected into groups, only distinguishable from a genuine urticaria by their more intense colour, which is usually described as rose red, and becoming pale on pressure. They disappear after the use of Iod. is stopped, without desquamation. c. The nodulo-pustular form. This is more rarely observed, and occurs most frequently in scrofulous individuals, usually upon the upper half of the body. An itching spot forms, of a deep red colour, which is soon transformed by exudation into a papule, or a bluish-red nodule, with or without an areola. This may persist ; but as a rule there is developed upon it a coloured vesicle filled with clear fluid,or a pustule, which may burst or dry up ; while the papule, on omission of the drug, slowly disappears with desquamation, often leaving behind a bluish-red or marbled pigmentation of the skin. As intermediate forms pure vesicles, acne-like pustules (iodine-acne) , and even furuncles are observed. d. The eczematous form.-This is very rare, and appears especially on the hairy scalp, and in the neighbourhood of the scrotum. e. The petechial form.---Fournier describes this eruption, which he calls iodisme pétéchiale, as very rare. He saw the eruption, which has also been mentioned by Ricord (see II, 8, a), in the majority of cases

during the first 3 d. after the use of K. iod., more rarely from the 3rd to the 6th d. In some individuals it always appeared as soon as the drug was administered, and in one case a new eruption occurred every time the dose was increased. It appeared exclusively on the legs (save once only on the trunk), more profusely on the extensor than on the flexor surfaces. It never attacked the knees or the feet. There are usually as many as 100 discrete patches on each leg. They are miliary, usually of pin-head size, rarely as large as a bean, and cause no general disturbances of any kind. The eruption usually reaches its height in 2-3 d. , and lasts at most 2-3 weeks. (LEWIN, op. cit.) [Fournier adds that all the subjects-15 in number-in whom he had observed the affection enjoyed either a flourishing or a medium condition of general health ; and while all were syphilitic, two thirds of them were exempt from any specific manifestations of the disease at the time when the iodide, which was only administered as a preventive, produced the purpuric eruption . " Iodic purpura " has also been observed in subjects of chronic rheumatism and of cancer-see Med. Times and Gaz ., 1879, i, 280, 502, also following case.-EDs. ] 6. a. It is well known that iod. of pot. occasionally produces a petechial rash, limited generally, as in the following case, to the legs. A case of this kind occurring in University College Hospital, it was considered a good opportunity to learn whether other iodides act in a similar manner and equal degree. The subject was a lad of 17, convalescent from acute rheumatism, and free from fever, to whom, from Dec. 4th, K. i. was given for a few lingering pains in 10 gr. doses thrice daily. On 9th a petechial rash broke out on front and sides of legs and ankles. The spots were numerous, and varied in size from a pin's head to a split pea. Neither on this nor on any subsequent occasion did any spots appear on any part of the body above the knees. Rather sharp blows over the shins did not bruise. The shins were a little tender. Slight coryza preceded the spots by a few d. The medicine was discontinued on m. of 10th, and by 15th spots disappeared. On 18th he began medicine again, and on m. of 20th rash reappeared more abundantly than at first, and coryza set in same e. Similar results followed a third course, after temporary discontinuance of the drug. b. On Jan. 4th, 4 d. after last disappearance of rash, iod. of ammonium was given in same doses. After 2 doses-in 6 h.-petechial spots broke out on both legs. He took a 3rd dose, and then the medicine was discontinued, and the spots disappeared on the 9th. He took later iod. of sodium in 10 gr. doses thrice daily for 4 d. without appearance of any petechiæ or coryza. He then began iod. of ammonium. In 2 h. after Ist dose a few spots were visible on both legs, and next d. they were more numerous and well marked. No other effects save the petechiæ and the coryza were produced by either iodide. (RINGER, Pract. , viii, 129.) 7. Dr. WALLACE treated many syphilitics with K. i., using (to adults) a mixture of zij to zviij of water, a tablespoonful 4 times a d. As incidental effects he noted the following :

a. " Its most common effect, by far, is an increase of appetite, combined with an increase of strength and of spirits . b. " I have sometimes noticed this medicine to cause an increased secretion of saliva, sometimes an increased action of the bowels, and in some cases a remarkable increase of perspiration. I have also known the bowels to be constipated by its use. The most remarkable instance of salivation occurred in a child of 4 . с. " An effect of this medicine which is not very uncommon, and is sometimes troublesome, is a state of throat which the patient calls sore-throat, saying he feels as if he had caught cold ; or else a state of stomach described by the patient as like heartburn, along with which there exist sometimes other symptoms of indigestion, such as flatulency. In some cases there was great indigestion caused. I have also not unfrequently observed a state of irritation of the Schneiderian membrane, testified by a considerable discharge from one or both nares, and uneasiness extending along the nose to the forehead. d. " Sometimes patients, particularly delicate females, under the influence of the drug, lose the power of sleeping as much as is natural to them. A state of watchfulness, in fact, comes on, often accompanied by feelings in the head which are variously described by different persons. They are, however, seldom so severe as to deserve the name of headache . e. " On one occasion two females took, by mistake, double doses. There resulted in both sickness, soreness of throat, colicky pains, vomiting and purging to a slight degree, frequent pulse and exhaustion. In both these symptoms disappeared on the following d. f. " Several patients, while under the full action of the drug, were attacked with an acute pain in the anterior and lower parts of their 1. side, precisely in the centre of the superficies formed by the false ribs, accompanied by some cough and difficulty of breathing. All these patients were bled, and in all the blood was buffed and cupped. There was considerable pain, in one case with dry and brown tongue. In all cases this affection went off without much trouble . g. " In a patient, where the drug had already caused indigestion, with remarkable acidity of stomach, soreness and constriction of pharynx, and emaciation, on resuming the remedy there gradually came on severe headache, rapid and quivering pulse, and a recurrence of the indigestion ; also a peculiar state of the eyes, the pupils being dilated, and both globes in a state of incessant motion, as in a child with congenital cataract. He was quite unable to fix them on any object, and kept his hands constantly over them as if to shade them from the light, yet he said the light did not hurt them. He was very soon seized with symptoms of hemiplegia, this being preceded by muscular tremblings. He continued 2 or 3 weeks in an apparently hopeless state ; the paralytic symptoms, however, then went off; he gained strength, his eyes lost their restless character, pulse became slower and stronger, and headache ceased. I think these symptoms were due to the drug, for they have some resemblance to those which occurred in certain cases where Lugol had given baths of I. dissolved in alcohol. Dr. Jahn, of Meiningen,has also related a case analogous

in many respects, particularly in the quivering of the eyes. " ( Lancet, 1835-6, ii , 7.) 8. a. The skin is unquestionably the tissue most readily impressed by K. iod. Nothing is more common than to see patients under its influence affected with divers eruptions, and more particularly with those of a psydracious character, resembling the pustules of acne, but more widely spread. There are, however, hardly any acute eruptions which may not be simulated by K. iod. One man may have an eczema, another a herpes, others simply an erythema, which in two recent cases has taken the form of e. papulosum in some parts, ofe. nodosum in others. In a case of cancer of the face, where the drug has been given in strong doses, we have seen it on several occasions develop an impetigo on the hairy scalp and a rupia like r. cachectica on the legs and forearms, these symptoms subsiding as soon as the drug was discontinued but reappearing on its resumption. I have several times seen K.iod.give rise to a veritable purpura hæmorrhagica. Several patients only experienced heat, pricking, and sometimes a certain amount of itching. b. The activity of the digestive functions is generally increased, as is also the appetite, hence embonpoint is frequently the result. In certain circumstances injurious effects are produced, one of the most constant of which is pain in the greater curvature of the stomach. This is sometimes very severe, without, however, increasing the thirst, impairing the appetite, coating the tongue, or producing the least reaction of the circulation. The pain is not increased on pressure ; it seems, indeed, to be owing entirely to gastralgia. The appetite is sometimes so enormously increased that it must be regarded as morbid. In some cases actual phlegmasia occurs, either of the stomach or of the alimentary canal ; hence vomiting, diarrhea, and all the symptoms of poisoning. It must be observed, however, that the most frequent action on the mucous membrane of the intestinal canal is a seromucous secretion. There is an analogous effect on the other mucous membranes . c. The author has frequently observed ptyalism occur, which may even become as great as the most severe mercurial salivation ; it generally, however, resembles that which occurs in pregnant women. The saliva is not very viscid. The mucous membrane of the mouth may be a little irritated, but inflammation and ulceration are never produced. The salivary glands are not swollen ; the patients only complain that the saliva has a saltish taste, resembling that of the drug. The breath has never a peculiar odour. d. The functions of the kidneys are generally increased in activity, in a few cases morbidly so, in others they are diminished. In these instances either of increase or decrease of the urinary secretion, the urine is not changed, except that the iodide is present in it. e. The circulation does not seem to be perceptibly affected by the use of this remedy. In some cases when fever was present, this was relieved, sometimes even cured. The author does not consider that this was owing to the direct action of the iodide on the febrile symptoms, but that the disease of which the fever was only a symptom being relieved, it consequently ceased. In some cases which may be

considered as exceptions the circulation was rendered more active, yet apparently not directly, but in consequence of the increased action in the digestive apparatus. With regard to the blood itself, its plasticity seemed to be diminished, thus predisposing to hæmorrhages, which sometimes took place from the nose, lungs, and intestines. f. Its action on the conjunctiva is already universally known. Considerable chemosis and great tumefaction of the eyelids were sometimes observed. The secretion is increased, yet with little or no tendency to suppuration. These effects are more frequently observed at the commencement of the employment of the remedy than when it has been used for some time, and do not occur twice in the same individual . g. All authors are agreed with regard to the increased secretion from the Schneiderian membrane. The bronchie were sometimes found to be affected. The symptoms were those of simple bronchitis ; the expectoration ended, however, as it had begun, without ever becoming purulent. h. The nervous system was affected in some few cases, particularly the brain. The excitement was similar to that produced by spirituous liquors ; indeed, some authors have designated it iodic intoxication. In such instances the locomotive organs of many patients were attacked. Some had spasmodic cramps, slight subsultus tendinum. Guillon informed the author that a medical friend of his believed he had observed a double amaurosis in one man , whose wife, while using the drug, had been similarly affected. i. The action of the medicine on the mucous membrane of the urethra appeared to be not less striking. Ill-cured gonorrhœas sometimes returned, others grew worse. The same phenomena were observed in the mucous membrane of the vagina and uterus. (RICORD, Bull. de Thérap., xxiii, 161.) 9. a. If K. iod. is continued for a long time, or if the patient manifests great susceptibility to its action, we produce a condition termed " iodism." Many persons can take the drug in very large quantities for an almost indefinite time without the induction of iodism, while very small doses, even of a grain or part of a grain, produce it in others. The tissues most frequently and most severely influenced are the mucous covering of the eyes and lining of the nose, frontal sinus, and mouth, with the skin of the face. Some slight running at the nose is first noticed, with occasional sneezing, and a little frontal headache, these symptoms becoming more marked when the conjunctiva is injected, and the tears flow abundantly. The loose tissues about the orbit become swollen, reddened, and oedematous ; and occasionally a peculiar rash appears on the skin of the face, at first noticed around the eyes, after which it attacks the nose and neighbouring parts, and then the chin. The parts in the order here stated are severally most severely affected. The nose is sometimes reddened, especially at the tip, and is rather swollen. The rash does not always present the same appearance. It is often very much like acne, and is always hard, shotty, and indurated, but the papules may be broad and large, and covered with what looks like a half-developed

vesicle or pustule. In the mouth there is redness and injection of the lining of the cheeks, of the throat, soft palate, and tongue, an increased growth and separation of the epithelium covering these parts, and an augmented flow of saliva. b. With some persons the stomach is at the same time deranged, although in the author's own experience this organ often escapes when the face is affected, and vice versa. When the stomach is singled out by the iodide, it induces nausea and a sensation of sinking at the epigastrium, with loss of appetite and sometimes watery diar. rhea. A grain or even less may thus affect the stomach. c. K. iod. sometimes produces distressing depression of mind and body, rendering the patient irritable, listless, dejected, wretched, and unable to take moderate exercise without fatigue, and perhaps with a tendency to fainting. The appetite is generally very bad. These symptoms may arise from a very small dose, and may occur without coryza or irritation of the stomach. (RINGER, op. cit.) 10. Iodides are eliminated very rapidly by the kidneys, salivary glands, probably by all mucous membranes, and by the skin. During the process of elimination iodine is occasionally set free and causes local irritation. This is especially marked in the mucous membrane of the nose and in the skin, but it may occur also in the conjunctivæ, bronchi, and stomach. The irritation of the nasal mucous membrane gives rise to the symptoms generally known as iodism. They consist of running at the nose, and frontal headache, which probably depends upon swelling of the mucous membrane lining the frontal sinuses. There is also frequently running ofthe eyes. Not unfrequently, the bronchial mucous membrane becoming congested, there is cough and pain in the chest. These symptoms are most readily produced by doses of 2-5 gr. , and they may usually be arrested either by discontinuing the medicine or increasing the dose. When the dose is raised to JO gr. the symptoms usually disappear, and I have only seen one case in which they persisted after the dose had been raised to 30 gr. In some persons the congestion is not confined to the nose, but extends to the back of the throat and to the larynx, so that serious symptoms of suffocation may follow. It sometimes gives rise not only to congestion of the bronchial mucous membrane and cough, but to hæmoptysis, exudation into the pleural cavity, and even pneumonic consolidation. (BRUNTON, op. cit.) 11. Of the much-dreaded atrophic influence upon the generative organs a single example presents itself, in a case of cancer recorded by Mr. Nesse Hill (Ed. Med. and Surg. Fourn, 1826, p. 282) . In the space of 4 mo. a large carcinomatous ulcer of the breast had almost completely cicatrised under the use ofK. iod. in the form of ointment, and taken in small quantities internally. By this time both mammæ are stated to have completely disappeared. (COGSWELL, op. cit.) 12. About the year 1840 I treated a young woman with K. iod . for chronic rheumatism ; but, the glands in the neck enlarging, the medicine was omitted. Again in 1854 I gave the iodide to a young lady affected with amenorrhoea; after continuing the medicine for 3 weeks the glands in the neck suddenly enlarged, and that to a degree

highly disfiguring. At least 2 mo. elapsed before the swelling showed the slightest symptoms of subsidence. ( CARTWRIGHT, M. H. R., xii, 411.) 13. A man, æt. 62, very bilious, and from his youth affected with gout, got for sciatica Dij of K. iod. in Ziv of water with directions to take, m., and n., a tablespoonful. After about 8 d. there came on an extremely rapidly growing swelling of the thyroid gland with some sensitiveness to the touch and feeling of oppression. He was, however, ordered to continue the medicine, and in the second week he got all the signs ofendocarditis,oppression,weakness, almost amounting to fainting, tumultuous throbbing, intermitting and unequal beats of heart and pulse, tensive pain across chest. Anorexia and vomiting also set in. On omitting the medicine and taking merc., ars., and sepia, all these symptoms subsided. (GOULLON, A. h. Z., xlv, 63.) 14. I took K. iod. some time back for a rheumatic affection of the acromio-clavicularjoint. I began with 3 gr. ter die. After 3 d. 1 gr. per dose was added, and then another. On m. after the 5 gr. doses had been taken I awoke with uneasy feeling of l. eye. I found edge of orbit at external part tender on pressure, and on inspection eyelids were found swollen and infiltrated on that side. The following m. the r. side was similarly affected ; the tenderness was evidently seated in the periosteum of the orbit and exclusively at the outer part. On 3rd d . a strange sensation was felt, as of a pain extending from outer edge of one orbit to that ofthe other ; and on this I discontinued medicine. (ROODS, Lancet, 1860, i, 479.) 15. A man, æt . 40, affected with contraction and callosity ofbowels, took K. i. by spoonfuls of a mixture of K. i. Эss, aq. dist. Zvj, mucilag. 3j. After each dose he felt in a few m. a peculiar change in his system ; congestion of head, vertigo, contraction of throat, dryness of mouth, anxiety, constant oppresssion of chest, cough, trembling of limbs and staggering as if drunk, so that he had to go to bed. After h. all these symptoms went off. The pulse was tense, hard, not quick. (HORST, Hufeland's Fourn. , xcvi, pt. 4, 97 ; in Frank's Mag., ii, 763.) 16. A lady, between 25 and 30, who in her childhood and first youth had taken with advantage iodic preparations-especially the Wildegg springs for anorexia and a disposition to somnolence, being unable to procure this mineral water, replaced it by pilules each of which contained about 28 centigrammes of K. iod. Of these she took 6 daily. The only iodic symptoms were, from time to time, salivation and nocturnal agitation. After taking the pilules for several weeks, Madlle. X- was seized with a violent gastralgia, which came on suddenly, and lasted several months, accompanied by palpitation and costiveness. The patient left Geneva for the south, and at first her health improved ; but little by little the change of air lost its good effect ; the anorexia and gastralgia reappeared ; and the menses, which had previously been copious, were suppressed. Madlle. X-, remembering that Iod. always revived her appetite, had brought with her the prescription for her pilules ; but the druggist, being unable to decipher it, gave her tinct. of Iod. instead. The lady writes :-" I took 10 dr. in half a glass of eau sucrée. After some h., I began to feel some effect

on the brain ; I was as if I had caught cold, had to use my handkerchief frequently, the saliva flowed freely, and there was a sort of contraction in the jaw, which made me clinch my teeth ; the gums swelled and inflamed, with a general sensation of toothache. There was great excitement of circulation, with violent determination to head and heart, and general trembling. The n. was sleepless, but I craved food anddigested it well, which I had not done for some time. Next d. I wished to continue my medicine, diminishing somewhat the dose, but the same baleful effects followed in the circulation and nervous system, the stomach only continuing better. I ate a little, and drank some lemonade to refresh my mouth, when I immediately felt a very sharp, though only transient, pain at the pit of the stomach. I wished to persevere with the treatment ; but after 4 d. I had to interrupt it, the blood being always in commotion, especially towards head and heart, gums always inflamed, face swollen, nervous tremor, sleeplessness. (RILLIET, op . cit. ) 17. M. V-, æt. 50, tall and stout, and in good health. He had had from youth a goitre, which was very slowly increasing. I prescribed 10 centigr. of K. iod. to 120 grm. of water, a dessertspoonful every m. fasting. Afterthe first dose, M. V- felt an indefinable sense of anguish, of painful drawing together, in the 1. hypochondrium, on a line with the greater curvature of the stomach. The same sensation recurred on the following d. On the 6th d., finding himself far from well and growing thin, he left offthe medicine. I saw him 2 d. later ; he was so changed that at first I did not recognise him. The most remarkable thing was a fixed, wild, uncertain look ; an expression of sadness and lassitude, a discoloured complexion, cheeks wrinkled and pendent. A general feeling of debility and discouragement made work impossible to him ; he had difficulty in walking and keeping upright ; he was inclined to sadness and tears . His sleep was not good, but he had no nightmare. His voice was broken, a little tremulous at times, and a similar tremor affected the limbs ; these and the trunk shared in the emaciation ofthe face. The goitre had shrunk to of its original size. This occurred in April, and in spite of the discontinuance of the medicine and the most appropriate treatment, it was not till the winter that he regained his usual health (and therewith the goitre in its former dimensions) . ( MAUNOIR, in Rilliet, op. cit.) 18. A man of 52, of good constitution and health, had for some years had a goitre which was interfering with respiration. I gave him pilules of K. iod., each containing gr. , and he was to take one daily. However, in 16 d. he had taken 60 pilules ( = 12 centigr.), when he came to consult me. He had an earthy complexion ; the face and neck were emaciated ; eyes sunken and dark-circled ; he had an anxious look (very characteristic) . Bulimia had set in for some time ; there was burning during digestion ; pulse was quick and small, palpitation very annoying, and he was tormented by agitation and general nervousness. The goitre had in great measure disappeared. These symptoms were from no other apparent cause. Under a régime of ice and cold milk they subsided within 2 mo., but the goitre returned to its former size. (D'ESPINE, in Ibid.)

1. Twenty-nine persons, all in good health, took with the salt used at meat and for cooking a Tooth part of K. iod. as a prophylactic againstgoitre. They consumed altogether 110 kilogrammes, i. e. 11 grm. ofK. iod., or 40centigr.to each person. Three ofthese persons showed symptoms of iodism, two ladies of 60 or more, and a gentleman of 45. The latter, in good health and easy circumstances, took the iodised salt from May to July, and again from August to January ( 1851-2). At the beginning of December he began to be indisposed, and did not entirely regain his health till March. The symptoms were emaciation, palpitations, lassitude, sadness, and moral impressions of a distressing character, quite unreasonable and tending to become fixed ideas. There was an indescribable feeling of malaise in the bowels, without anorexia or dyspepsia. Not suspecting the salt, which from accidental circumstances he had suspended since January, he resumed its use during August and September, during which he must have taken about 10 centigr. of K. iod. At the end of September he was attacked afresh and severely. The symptoms he had previously manifested were reproduced in much greater intensity. The chief of them were,-marked emaciation, though the appetite was maintained ; sense of malaise in the stomach, especially at n., accompanied by constipation ; palpitations ; trembling ; fixed look ; bad complexion ; emotional susceptibility, leading even to tears ; disturbed sleep, from which he awakes with a start under a sense as ofsome heavy calamity ; he dreads beginning each d., and the details of daily life are an almost insupportable burden. Though a very tender father, his children were a trouble to him ; he had to make a strong effort over himself to retain them about him, and to avoid being irritable with them. Physical signs in chest and abdomen were entirely absent. The salt was discontinued, and iron and a generous diet prescribed. In November an erythematous eruption appeared on the abdomen, and from this time patient gradually recovered. One of the two ladies affected had similar symptoms; the other only emaciation, palpitation, and insomnia. (RILLIET, op. cit.) 20. A lady of 40, in excellent health, took for goitre 2 pilules daily, each containing gr. of K. iod., some time previously having taken over a gramme in a fortnight with nothing but advantage. This time, when she had taken 20 pilules, she was suddenly seized with severe vertigo, to which she was not at all subject. This did not recur, but it was soon followed by a persistent dimness of vision, black objects floating before the eyes, with hemiopia or micropia. At the same time she had neuralgic pains in the r. side ofthe face and trembling of the limbs. She grew sensibly thinner, slept badly, and was plunged into a profound sadness, feeling herself so very and so unaccountably ill. Her appetite, however, was actually increased, even to bulimia. She would not see a doctor, but after 3 mo. gradually recovered her health. (Ibid. ) III . Experiments on animals.- 1 . a . DevERGIE administered to a dog, through an opening in the œsophagus, zij in zj ofwater. Efforts at vomiting ensued, the animal seemed prostrated and died on the 3rd d. Upon dissection the gastric mucous membrane was found red,

especially at the greater extremity of the organ, and numerous dark striæ ran in various directions. Some spots of ecchymosis existed in the submucous tissue. In another experiment ziij were employed and a ligature was applied to the esophagus. After some indications of pain, the animal became quiet, and grew more and more dull, until, on the 3rd d., it died in a state of complete relaxation. In addition to the lesions found in the first case there were superficial ulcers of the mucous membrane. In other cases submucous emphysema was observed in the stomach . b. In the experiments of Stenbearauch, who gave rabbits zij-3j dissolved in water, the symptoms were slow respiration, a feeble pulse, diuresis, spasms, and death in 1-4 h . c. When a solution is injected into the veins of an animal, death takes place very speedily and is preceded by convulsions. Experiments upon larger and smaller animals (horses and rabbits), performed by various persons, have furnished almost identical results. In most cases the blood is of a bright red colour and shows but little tendency to coagulate. (STILLÉ, op. cit.)

VOL . II . 46

Volume IV — Appendix

KALI lODATUM.

(See vol. ii, p. 710.)

I. 3. Rabuteau found that, under a definite diet, he eliminated J25 — 372 gr, of urea daily. He then took i grm. of K. iod. each d.,

"id found the urea fall to 201 — 294 gr. A similar result was obtained *'th the iodide of sodium, — the diet in both instances continuing unchanged. {Pract., iii, 188.}

II. 21. Prof. Langston Parker records the following cases :

a. A surgeon, st. 47, consulted me for certain symptoms of an old '^Icreal taint. He had taken 10 pr. of K. iod. twice or thrice a d. for "^ years. There was no wasting of testicles j he had sarcocele, clearly ^*'icreal, with a small hydrocele, on one side, on the other side testis **s healthy. There was hypertrophy of the tongue, which was tender, covered with lobes or nodes, and fissured by deep cracks.

t. A German gentleman, who had suffered from secondary syphilis

5 years, and had been treated by Ricord and others, was sent'to me

'^*' an opinion about his tongue. He had taken large quantities of

^. iod. for 4 years. The tongue was tender, swollen, lobulated, and

^Ceply fissured.

c. Another patient had taken 15 gr. daily for nearly 3 years. He Was emaciated and weak ; his appetite was totally gone. He presented I0 symptoms of venereal taint, attributing his indisposition to the prolonged use of the medicine. The testicles were of full size ; the tongue iras affected as above.

d. A gentleman had suffered from constitutional syphilis for 13 years, and had taken large quantities of K. iod. for long periods. The tongue presented the appearances already described ; it was in some parts hard and lobulated, in others fissured by deep cracks. The 1. testis was reduced to the size of a pea ; the r. was of full size and healthy. Virility was not impaired.

Prof. Parker has selected these cases from a mass of others establishing the same conclusions. The peculiar, almost cancerous, appearance of the tongue he believes to be due to the long-continued use of the K. iod. The 4th case is the only one in which he ever saw absorption of the testicle directly the consequence of the same cause. {Edinb, Med. Journ.^ 1852, p. 379.)

1. Dr. Lawrie reports the following cases :

a. A patient labouring under secondary syphilis received a 4 gr. of IC. iod. daily. After taking 3 doses he was seized during the n. with ~ +0

great difficulty of breathing and loss of voice. When seei morning he presented all the symptoms of spasmodic croup.

h. A patient under treatment for the sequelae of an inflaramitory pulmonary attack. He had taken one half of the following mixturein the prescribed dose, when I was sent for to see him during the night: H Pot. Hydriodat. 3J ; Infus. Quass., i lb. ; solve ; S. Jj bis in die. He said he had been suddenly seized with excruciating headache, which he likened to a wedge driven from between his eyes back to the base of the skull ; acute pain in his eyes, with the most profuse secretion « tears I have ever witnessed ; and intense pain in his side {sic, probably nose), which was swollen^ and from which clear serous fluid came in continuous stream.

c, Phagedsena of penis. Jan. 8th. — Patient was ordered 581 K. iod. 3 times daily, and has now taken 5viiss ; complains of pain tl both eyes, hoarseness, pain in chest, cough, and slight difficulty 0 breathing. The eyes exhibit acute conjunctival congestion, sub mucous infiltration, and contracted pupils, and the characters of th respiration are those of subacute bronchitis. The hydriodate was in mediately suspended, and on the 15th he was dismissed cured

d, £. L — , xt. 30, was admitted into the Lock Hospital May 22n 1840, for sinuses after buboes and secondary ulcers on thighs. Sh was ordered the medicine as in Case b, 31st. — A profuse papul eruption has appeared on face ; sores improved. Omit med. Jan "t —Soon after last report eruption disappeared, and the iodfde ffi repeated ; eruption almost immediately returned, and is now profu! Omit med. 8th. — Complains of sore throat, but no redness or swe ing is discoverable. 9th, — During n. was seized with acute dyspofl and hoarseness, pain on pressing trachea, and swelling and pi (inside) of r, submaxillary gland ; pulse full, 103 ; &c. She died th n. Inspection. — -The r. submaxillary gland was enlarged, with incii ent purulent infiltration into the surrounding cellular tissue, especia towards larynx and trachea. Mucous membrane of upper part larynx, rima glottidis and epiglottis cedematous. Mucous membra of trachea and bronchial tubes nearly natural ; r. lung posteriorly het and acutely congested j I, similarly, but less severely affected ; th< was no exudation of lymph from the mucous membrane of the inflai parts. {Lond. Med. Gaz., N. S., ii, 588. 1839-40.)

1. a. A patient, aet. 26, was admitted into the London Hospj with a generalised skin eruption, consisting of swellings varying in from small papules to enormous tuberous masses, some of the lat being ulcerated. The eruption attained its greatest size on the U legs, and upper part of chest. The patient died of exhaustion a tcM later. On enquiry at the hospital in which he was treated previoi to being admitted into the London Hospital, it was found that he been admitted there on account of some swelling in the groin wh was diagnosed as syphilitic. There was no skin eruption at the tii Iodide of potash in 5 gr, doses was ordered, and in a short time eruption began to appear, which was considered to confirm diagnosis of syphilis, and on this account the iodide was increased 10 gr. at the end of a week. Ten d. later it was increased to 15

and later still to 20. He continued it without intermission from July 23rd to October 9th, when mercury was substituted. The eruption had been getting worse the whole time, but as it was throughout considered to be syphilitic the specific was pressed. On careful enquiry there was no reason to suspect that the man had really had syphilis. He lived for about a fortnight after the iodide was entirely left off, but during this time no material change took place in the eruption. (Hutchinson^ Archives efSurg.^ vol. i. No i.*)

1. Celso Peu.izzari, in a paper in the Archives of Dermatology^ July, 1 88 1, p. 263, on some phases of the pathc^enetic action of K. iod., reports a case where a man, aged 30, was for some syphilitic symptoms ordered 15 gr. each e. and and some mercury during the day } the latter he soon left off, but he continued the iodide from March 20th to April 14th, when he became very ill and was admitted for what was supposed to be glanders. He had many large inflammatory nodular masses varying in size from that of a nut to an apple, seated in the subcutaneous cellular tissue. The nodules were round and situated under the skin, so much so that the latter did not take port originally in the morbid process. Abscesses formed, but healed slowly and left cicatrices. On omitting the iodide, the eruption departed, but recurred each time the drug was repeated. (M(»(J(.ow, Drug Eruptionsy New York, 1887.)

2. Besnibr {Annales de Derm, et Syph., 1882) had a patient, a man, «et. 40, who consulted him for an eruption on the palm of the hand which was very difficult of diagnosis, but for which he gave him two grammes of K. iod. daily. This was followed in a week by an eruption on the face and thorax of veritable tumours, varying in size from a small to a large pea. They were of a reddish coppery hue, flabby, almost fungous, and presenting punctate depressions. Incision only gave exit to blood. (A similar condition was observed in a woman, aged 65). {Hid.)

3. Dr. Valanur observed {Journal of Cutaneous and Venereal Diseases^ 1884)) in a woman, set. 49, with mitral disease, who had been given for 4 d. 2^ grammes of the iodide, that she was attacked with acute pain in her buttocks, thigh, calf of leg, and in the dorsal region. Then there appeared upon the parts small indurated nodules of the size of a nut, of a deep red colour, and readily appreciated by palpation. During 3d., they developed in size, one or two attaining the volume of an egg. The iodide was repeated three times, and after each repetition the same symptoms appeared. {Ibid.)

4. Talamon {Journ. de M6d. et Chir.y 1885) reports the case of a woman in whom 2^ grammes of the iodide produced an eruption resembling erythema nodosum. {Ibid.)

5. Hallopeau {VUnion Medical, 1885) observed the development of painful nodes in one of his patients, which was repeated every time he took the iodide of potassium. The tumours were oval in snape, reddish at the surfitce, and painful on pressure } they were chiefly situated over the anterior sut&ce of the thighs. He also had iodic purpura. {Ibid.)

• Two plates ait gives, illustrating this case.'^Eo*,

1. Dr. Prince Morrow himself lost a patient from iodi( poisoning, where tubers were developed, but there was much mo( genera] dermatitis than in Hutchinson's case. {Ibid.)*

2. A peasant woman, ast. 48, came under treatment for nephrii Feb. 25th, 1886. It had attacked her in a subacute form 3 tnont previously, and had not been treated medically. Previously she hi been always healthy. The urine contained much albumen, soo blood, and was in moderate quantity. She had ascites, anasarca^slig swelling of hands, and there was some effusion into the pleural caviti Digestion sluggish, anorexia, hypertrophy of heart. The dropsii symptoms subsided rapidly under the use of hydropathic packings pilocarpin. The blood disappeared from, and the albumen diminisil in, the urine, but continued in it to a certain extent. At the end a weeks the state remained about the same in spite of digitalis infuji and liq. kal. acet. But up to the end of March her general hewas very satisfactory. She was able to leave her bed which she kept for 4 months, and she could enjoy the open air. When the pi carpin began to disagree, she ceased to perspire and had violent voia ing after every dose. The packings were discontinued, and a solutii of K. iod. 6"o : 2000, a tablespoonful 4 times a day, given. Man 30th. — She took 4 tablespoonfuls of the above solution, after whi she had heat and some headache. Next d. she took 3 spoonfuls, then discontinued it in consequence of a severe coryza and a wh pimple on the dorsum of the nose. Seen on April ist (3rd day taking the med.), the following condition was observed. Her p viousjy small and pretty features were swollen and deformetl. 1 nose was twice its normal breadth, lips swollen, eyelids closed by In oedematous overhanging swelling. From the closed lids there cc stantly exuded a thin, dirty pus, which dried into yellowish-bro' crusts, and when the lids were forced open this matter gushed fn them as in blennorrhcea neonatorum. The sight as far as could ascertained was una/Fected. The whole swollen face and the Iw and neck were covered with irregularly placed papulous, pustular ■ bullous eruptions of different forms and sizes, A few of the papn and pustules resembled the iodine acne. Of the bulla; the small was lentil-sized, of dull greyish-white colour ; they rose from ) oedematous skin abruptly, were of a round or oval shape, some w( rather reddish and more transparent like sm^il blood blisters, hU with clear bloody or serous fluid. Some of larger size and irregu shape seemed to be caused by the confluence oi several smaller onfl their contents were more turbid. The largest and most numeroui the blisters were of the size of a thumb-nail, of opaque white colour, filled with clear reddish fluid. The former when opened dischargei drop of clear red or opaque purulent fluid; the nest of the conteo consisting of a whitish-grey^ greasy mass. There were other bull

• Dt, Fox &ays (Train. Clin, Soc, vol. xi) that he has often been ■ supposed syphilis, when the disease has been simply an iodide rash, too. asserti that cases of iodide poisoning " have been mistaken for sy| iodide may be continued, possibly in increasing doses, for the very ctrod' has caused."

^pretty large numbers on the rest of the body, especially the donal aspects of both hands. On the healthy skin the bullae resembled the blisters that arise on gangrenous parts. The lower extremities and back were also similarly affected. There was no pain except a little burning where the blisters were present. But not the skin only, all the mucous membranes that could be seen, as of the nose, tongue, cheeks, and fauces were also covered with whitish, prominent, pemphigous eruption. There was aphonia. Next d. the state was the same. She had slept well, had several diarrhcric stools, the last of which consisted of about 3 tablespoonfuls of pure dark blood. The eruption to-day resembled the gangrenous blisters, they had a bluishred colour, and when opened discharged a clear or opaque fluid, and their bottom was covered with a layer of white greasy substance. The larger whitish bullae on the face were mostly open, and had assumed the form ofdeepish ulcerations covered with macerated flakes. An obscure systolic murmur was heard at the apex of the heart which was not there before. As the sores on the sacrum began to slough, the patient was sent to the hospital. April 5th. — Passed urine and faeces involuntarily. 7th, — Appeared a little better. The bullae commencing to scab over i no new ones had appeared. Great fetor of breath. 8th. — Collapse set in, and she died on the 12th. No p.m. (Wolf, Berliner Kliit. jyochens., August 30th, r886.)

1. A strong young man, ast, 27, who 1 ^ years previously had had an acute kidney attack which had lasted a few weeks, applied to the reporter on May 4th, i88g, on account of a subacute circumscribed periostitis of r. tibia, the consequence of an injury. Saturnine lotion was applied, and he got a solution of 5 grm. pot. iod, in 150 grm. water, a Cablespoonful 3 times a d. After the first dose at 8 p.m., after supper, there came on violent sneezing, coryza, and confusion of head. He tossed about in bed all n., complained of pressure on forehead, and ^drawing pains in sacral region. Early on the 5th the second dose was taken, whereupon he vomited his breakfast and observed red spots on his chest. The 3rd dose was taken at 2 p.m., when he was found in the following state: — Slight confusion, complains of headache, weariness of limbs, especially arms, violent pains in sacrum, anorexia, and metallic taste. Conjunctive highly injected, pupils dilated, sluggish. Tvasal m.m. swollen and secreting copious watery mucus, tongue slightly furred. Over the front of the trunk and arms a measly-like eruption of small red spots. Pulse fullj not easily compressed, 7i. No increase of temperature. Pressure on both renal regions caused shooting pain. Urine sp. gr. 1026, dark colour, contained much albumen, and a small sediment contained fat globules and granular cylinders. The medicine was discontinued. Next m. the eruption had quite disappeared, the pulse quicker and softer, 90, the catarrhal symptoms nearly gone, and nothing but weariness remained. Two days afterwards the urine presented the same pathological conditions which had j>robably existed ever since his attack of nephritis 18 months previously. (Gerson, Miinch, Med. JVochens., June i8th, 1889.)

2. Dr. Gronow, of Breslau, describes a rare form of iodism, with acute cedema of glottis. In all he refers to 9 cases ; two are from his

own practice, the remainder are reported by Foerstcr, Foumii

Fenwick.* and Walachowski. On reviewing these cases, the author

draws the following conclusions : — i. That the cedema, which i$

sudden in arising, takes place early in the administration of the drug,

generally within 24-48 h. ; and that its intensity may be such as to

call for tracheotomy. 2. That the quantity requisite to call forth the

symptoms varies from 3 gr. upwards ; in one case, though there were

slight throat-symptoms earlier, yet it was not till the 6th d.,when 100

grs. (of K. iod.) had been taken in all, that severe dyspnoea set in.

1. That other symptoms of iodism may be quite absent. 4- That

the cause of these exceptional effects is not the presence of impuritio

(iodatcs), but that the pure drug is alone sufficient. 5. That local

laryngeal symptoms could not be shown to be present, so as to prediv

pose the part to the (edematous outbreak. 6. That the phenomena

must be explained by the word idiosyncrasy. 7. That in some cases

the idiosyncrasy persists, but that in others it rapidly disappears, the

patient becoming tolerant of the drug. {Brit. Med. Journ,^ May lOth,

1890: from Therap. Monatschr.^ M2.Tc\ l^<^o.)

1. We have a charlatan in Chicago who administers heroic doses of K. iod. A great many of his patients have afterwards come under my care ; and a large number of them have complained of a peculiar bruised, agonizing aching at the cardiac end of the stomach.f It was not associated with palpitation. (E, M. Hale, Trans, of Amer. Inst, if Horn., 1889, P- 334O

2. Dr. Ehrmann narrates 4 cases in which severe facial neuralgia occurred after K. iod. In the first, the patient, a strong working-man of 35, suffered most intense pain in forehead, face and teeth, with sensitiveness over whole distribution of fifth nerve, after taking 15 p. of the drug.

A second, a man, aet. 42, after taking 30 gr. had pain in forehead and upper jaw, with tenderness in separate branches of the same nerve,

A third patient, a woman, act. 28, suffering from syphilitic periostitis of tibia, after 15 gr. was attacked with violent pains in the sphere of the jch pair.

A fourth, a sewing girl, set. 25, suffering from rupia and pain in the extremities, after 30 gr. had moderate jaw-ache. All the patients had at same time cedema of lids, hyperaemia of conjunctivae and lachry mation. {Neurehgischts Centralblatty April 15th, 1891, p. 248.)