William Gairdner

“ With regard to the treatment of the muscular spasms, and the disturbance of the nervous system, we have before described, there is no invariable plan of cure to be followed. Until we are better acquainted with the nature of the affection, it is impossible to apply a remedy to the root of the complaint. All I can do here, therefore, is to point out the means by which I have best succeeded in averting and palliating its painful symptoms. ”

“ EFFECTS OF IODINE.
The discovery of specific remedies has always, and most justly, been considered one of the most important benefits to be conferred on the practice of medicine. Much dispute has been carried on respecting their nature, but all are agreed about their existence. They have been defined by Dr. Young to be medicines which cure diseases, “without any perceptible connexion between the immediate effect and the benefit obtained.” While their operation is thus obscure, the mode of their employment, and their peculiar virtues, must be subjects of much doubt and uncertainty ”

“ In certain persons, indeed, of peculiar habits of body, it cannot be exhibited so as to affect the constitution in any manner, without in some shape or other producing unpleasant nervous symptoms, [Pg 14] such as dimness of vision, indistinct hearing, fallacious touch, insomnia, breathlessness, palpitation, and all the countless forms of inward nervous derangement. But the symptom to which we shall more peculiarly confine our attention, is a degree of tremor which generally comes on when the patient is under the full constitutional influence of iodine. ”

“ We shall first consider the use of iodine in the treatment of bronchocele, the disease for the cure of which it was introduced into practice. All the physicians who have employed it bear unequivocal testimony to its efficacy. It seldom fails of effecting a complete cure, and when it does, it almost always reduces the swelling very considerably. ”

“ Such persons expose themselves to ridicule when we see them reject a remedy so active [Pg 59] as iodine, and continue to trust, for the cure of the severest diseases to which the human frame is liable, to medicines allowed on all hands, and even by themselves, to be absolutely useless.
The value of iodine as a remedy, however, does not depend on the testimony of any individual, however high his name. Its use is established by a long series of facts observed by physicians and surgeons of different countries. ”

“ The affection of the alimentary canal which we have described above, is plainly to be ascribed to the acrid operation of iodine on its mucous membrane. I have never witnessed it in any considerable degree when this medicine had not been taken internally. But I have seen slight pains of stomach, accompanied with copious bilious evacuations, attend its external use. These never proceed to the degree of violence which marks the internal exhibition. Indeed, it is rare to see them in any considerable degree disturb the comfort of the patient. It is not thus when taken into the stomach. ”

“ From the inactivity or obstruction of the absorbent vessels, a great proportion of the chronic disorders of the body take their rise. Medicines, therefore, which act either directly or indirectly on this system, have always been accounted most valuable articles of the materia medica. Unhappily, they too often deceive us in their operation, and, notwithstanding the united studies of many physicians directed to them, the causes of their failure, as well as the circumstances under which they succeed, still remain a problem. ”

“ When iodine acts kindly on the constitution, no other effect will be found to accompany its use, but a diminution of the tumor and a little nervous excitement, which is sometimes not so severe as to become disagreeable. The increase of appetite is a very frequent effect of iodine, and it is sometimes very troublesome, because it is extremely necessary not to indulge it. The diet of the patient should be good, but by no means full, which the occasional voraciousness of his appetite would lead him to adopt. ”

“ The medicines which exert their action on particular textures or systems are extremely few indeed, and the few we possess are so uncertain in their operations, they are liable to such frequent failures, that sceptical [Pg 61] physicians doubt of their efficacy altogether, and even of the efficiency of medicine. There is something peculiarly gratifying to their vanity in supposing themselves freed from the common errors, and above the credulity of the vulgar. Iodine, however, is not liable to the sneers of such narrow minds. ”

“ When the contents of the stomach were not soon thrown off, or were altogether retained, the poison was much more speedily fatal. The animals do not seem to have been affected with any other very remarkable symptom. It is stated that they were much dejected, and manifested suffering, though they did not howl, were not paralyzed or convulsed, and were not affected with any of the more violent symptoms by which poisons commonly show their action on the living body. It is plain that much light is not thus thrown on the effects of iodine when exhibited as a remedy ”

“ A magistrate of Geneva, high in office, robust, corpulent, and of an athletic form, was so much reduced in flesh, that he was not known by his oldest acquaintances. I have seen emaciation, in one case, proceed to such an extent in a short time as is almost incredible. A young English lady, at a boarding-school, at Paris, had for some time been afflicted with goitre. Her brother was prosecuting the study of medicine there. With the characteristic zeal of a young man, as soon as he heard of the wonderful effects of iodine, he determined on making trial of its powers on his sister. ”

“ Here it is better at once to stop short, and confess our ignorance, than, by adventurous speculation and daring theory, lay a foundation for mistakes in practice. This subject certainly presents a fine field for hypothesis, and a tempting one to a theorist. But we leave our readers in possession of the facts, and trust they will not use them with less caution than ourselves. ”

“ Our most important consideration is the cure of these painful affections. In the choleric disease the first remedy of all, and that without which we can have little hope of subduing the disease, is opium. If called early to the patient, before the bowels have yet thrown off their acrid contents, I have generally waited a little before exhibiting opium. ”

“ They possess all the virtues of iodine in a very remarkable degree, but they will be found to fail more frequently than the hydriodatic salts; and, if I may draw any [Pg 42] conclusion from the few trials I have given them, they are more apt to excite disorder in the system. I have generally ordered half a dram of the hydriodate of potass to be united to an ounce and a half of axunge, and desired the patient to rub in a dram of this ointment over the surface of the tumor, night and morning. When the tumor is painful, it is not necessary to rub in. ”

“ By the steady and very liberal use of opium, she recovered to a certain degree; but when I last saw her, many months after her illness, she remained subject to frequent violent spasms of the stomach, [Pg 11] during which opium alone gave her relief. Her nervous system had been much shattered. She repeatedly declared to me that she seldom enjoyed an hour’s respite from the most wretched depression of spirits, and since her illness had never felt any thing like her former buoyancy of mind. ”

“ This preparation can dissolve an additional dose of iodine; a formulary, however, to which I seldom, if ever, have recourse. I have found that the deleterious action of the medicine on the bowels was more marked, in proportion to the quantity of free iodine it contained. For this reason, also, I now seldom have recourse to the tincture, a form much used, because it is less expensive. Practitioners will, in general, find an advantage in confining themselves to the external use of iodine for the cure of bronchocele, and tumors, which do not arise from any vice in the constitution. ”

“ There is commonly great suffering at stomach and confined bowels. [2] When nervous affection first appears the medicine must be most diligently watched, and if the symptoms seem to increase, its use should be instantly put a stop to. If rashly persevered in, the symptoms I have described above will certainly be excited, and then it is vain to withdraw the medicine; the complaint goes on progressive for weeks and months, even though its exciting cause be abstracted ”

“ Yet no medicine varies more in its effects than this. Some persons take it in large doses for a great length of time with perfect impunity; while others, from that peculiar, undescribed and unintelligible state of constitution, called by physicians an idiosyncrasy, are speedily and violently affected by very small doses. Mr. Magendie, whose accuracy is well known, states that he had swallowed a spoonful of the tincture, containing about a scruple of iodine, without any bad effect ensuing. ”

“ A remedy which ought never to be neglected is the warm bath. It will be found a most powerful coadjutor in restrain [Pg 25] ing the violence of the spasms, and in moderating the perturbed action of the stomach.
But the greatest difficulty will be found in treating the second or chronic stage of the complaint, when the symptoms we have mentioned as characterising it are prolonged in a mitigated form. I am inclined to believe, that in this state there is actual ulceration of the mucous membrane of the intestines. ”

“ These accidents were usually imputed by the patients to the iodine they had taken. The Physicians by whose advice the medicine had been given, would not allow this origin of the disease, till a repetition of similar cases determined that the sufferers were right. The vomiting, pain of the bowels, and the cramps of the legs, are extremely severe. They are also with the greatest difficulty allayed, continuing sometimes for many days, and renewed during weeks, and even months, after taking food. The legs sometimes swell in the first instance, and afterwards become rapidly thin and meagre. ”

“ Orfila, whose industry and ingenuity in the study of poisons are well known, has not neglected to examine and note the effects of iodine when given in a large dose. He gave it to different animals in the quantity of a dram and two drams. They were in general seized with violent and frequent vomiting. ”

“ By the use, either of the ointment, or of the solution in the way we have recommended, a soft bronchocele will be discussed in a month or six weeks. Those which are hard, and of old growth, generally take a little longer time, and many of these latter cases cannot be altogether reduced. I have seen two cases, however, [Pg 45] in which the tumors gradually disappeared some weeks after the medicine had been altogether discontinued. Dr. Coindet says, that he has seen several cases of bronchocele, complicated with watery cysts, yield completely to the action of iodine. ”

“ An anodyne embrocation was therefore applied to the [Pg 10] pit of the stomach, fomentations to the feet; and, as soon as it could be got ready, she was placed in a warm bath. This so much quieted the irritation of the stomach, that she was enabled to swallow about thirty drops of laudanum, from which there was a decided alleviation of her sufferings for nearly an hour. During ten days she remained in a very doubtful state, subject to frequent severe attacks of diarrhœa, with intense pain of the bowels. Her emaciation during this time was most extraordinary. ”

“ Such an agent is iodine. Its effects on the absorbent system are incontrovertible. They are as speedy as they are certain, and so powerful are they, that if the medicine be not duly and cautiously managed, we [Pg 35] have already seen what havoc may be the result. A few, a very few, cases have occurred to myself, in which the constitution was altogether insensible to its action; I believe a greater number have occurred to others ”

“ But I know also that it has been hastily rejected, and without trial, by some persons grown old in the practice of physic, who have made their interests decidedly to consist in defending all that is old, and repudiating all that is new. ”

“ In prescribing this medicine, it is very necessary not to lose sight of the effect I have just mentioned. When the tumor is very large, and especially in that kind of bronchocele, in which the principal enlargement of the thyroid gland takes place on its inner surface, where it is in contact with the trachea, the occurrence of inflammation is much to be apprehended. When a very large tumor becomes inflamed, the distress which it occasions, and the disturbance it excites in the constitution, are very consider [Pg 41] able ”

“ I fear, however, that it has also been used by physicians who have not leisure of mind nor time enough for conducting such inquiries as they ought to be conducted. When we consider the silly pretences on which medicines are sometimes forced into fashionable practice, it will not appear wonderful that the investigation of their virtues should not be conducted with much zeal. ”

“ But they were in the poorest class of society, were irregular in their habits, and paid very imperfect attention to the orders of their physician. In one of them, a young woman, fifteen years old, after she had taken fifteen drops of the solution of hydriodate of potass, twice a-day during three weeks, considerable tenderness of the whole abdomen came on, for which I judged it necessary to order the application of a dozen leeches. ”