An organic compound of iodine with vegetable albumen, i.e., iodo-glidine, has been somewhat extensively used in gout, as being non-depressant. Said to undergo almost complete disruption in the intestines, it is slowly absorbed without toxic symptoms. Iodo-casein and seroden, a combination of iodine with blood proteins, are similar preparations, with which, if necessary, the alkaline iodides may be replaced.
More recently the advantages of collosol preparations of iodine have been emphasised, and these colloidal solutions, unquestionably, have an increasing sphere of usefulness in all cases of gout where iodine is indicated. It has been truly said, collosols “are not new drugs, they are simply familiar drugs in a new form—a form in which their therapeutic potency is greatly heightened while their undesirable properties are reduced to vanishing point.”
Doubtless, collosols exist in a form very meet for assimilation, inasmuch as they conform to the essentially colloidal character of all the normal fluids and secretions of the organism. Moreover, toxins or bacterial poisons appear also to exist in colloidal form, and also, according to A. B. Searle, “to a large extent in the reactions which create immunity.”
These physical similarities between collosols and the bodily fluids and tissues ensure their ready assimilation with minimal constitutional disturbance. Inasmuch as the colloidal state, too, predicates low chemical affinity, the combination and absorption of collosol preparations take place gradually and uniformly.
For internal administration colloidal iodine is prepared in aqueous suspension. It is stated that the whole of the iodine is absorbed in molecular combination with protein. An iodo-amino acid results, and ultimately reaches the blood-stream. Arrived there, it, through its reducing action on lipoids, exerts an alterative effect.
The dose of collosol iodine ranges from 1-4 teaspoonfuls daily after meals. It does not cause nausea if the amount be slowly increased, and only exceptionally does it set up iodism. In these respects it has an undoubted advantage over the alkaline iodides. As to whether they will wholly usurp the place of this latter is, I think, very doubtful; this, if only for the convenience with which the alkaline iodides lend themselves to combination with other alterative remedies. But in individuals intolerant of iodide of potassium they are excellent substitutes when the indication is to improve and modify the general metabolism.
Lastly, too, apart from their use in chronic gouty arthritis, we have to recollect that the iodides are the most reliable means we possess of influencing the renal and vascular changes so often associated with gout. Garrod doubted if they possessed any power of promoting the dissipation of uratic deposits, but their power of eliminating lead must not be lost sight of when treating gout in the subjects of plumbism. Obviously, when invoked for this purpose or to arrest or retard degenerative processes in kidneys and vessels, their administration must be continued for long periods—six to eight weeks. The same persistence, too, is demanded to remove the inflammatory products in the joints. Simultaneously or alternately short courses of atophan—30-40 grains for two to three days in a month or oftener in more severe cases—will also be of help in dislodging articular deposits in the form of tophi.
Guaiacum.—Many years ago, Sir Alfred Garrod[62] highly eulogised the value of this drug in the treatment of chronic gout. Said he, “There is no remedy of which I can speak so confidently. I have known patients who have been confined to their beds for many weeks with asthenic chronic gout so far recover within two or three days under the use of this remedy as to be able to walk about.” He held that it exerted a specific action on the fibrous tissues, and advocated its exhibition in chronic forms of gout with feeble circulation. He adds the further interesting differentiation regarding the employment of guaiacum as opposed to iodide of potassium. Both these drugs he held valuable when the fibrous coverings of the joints were especially affected. If the articular pains were increased by warmth, iodide of potassium is “peculiarly indicated”; but, under such circumstances, “the use of guaiacum is either altogether contra-indicated or, at least, it should be administered in combination with iodide of potassium or some other saline.”
As to its mode of action, Bain noted that, while the excretion of urea fell somewhat, that of uric acid was markedly increased. But he found, also, that “neither the phosphorus pentoxide nor the bases showed a corresponding increase—thereby denoting that this drug probably acts, not by increasing the production of uric acid, but by eliminating a part of that stored in the blood.” Moreover, it was noted that the increased uric acid excretion did not cease with cessation of the drug, but continued for some time after, the patient’s condition meanwhile undergoing amelioration. Bain considers that his researches confirm the opinion arrived at, on empirical grounds, by Sir Alfred Garrod—that guaiacum was a powerful prophylactic agent in gout.
Returning to its method of exhibition, it must be admitted that it is most unpalatable when given in the form of a mixture, and is preferably prescribed in a cachet or tablet. The resin of guaiacum may be given in doses of from 5-15 grains, and the larger doses may excite nausea or purging. In smaller amounts, however, it merely exerts a beneficial laxative effect; it is also useful in cases where the liver is torpid. This latter action may be reinforced by simultaneous administration of calomel in fractional doses.