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; while the accidents to which they are liable, in common with other medicines, must occasion great embarrassment and perplexity. But from the moment their modus operandi can be connected with any known general law of the constitution, a great part of these doubts disappear, a light is afforded for directing their good effects, and a clew is obtained for tracing their injurious properties, and applying the necessary antidote. The medical history of iodine will fully exemplify the above observations.
This medicine was first introduced into practice by Dr. Coindet of Geneva. Whilst making researches for other purposes, he found that the fucus vesiculosus had been recommended by Russel in the cure of goitre. From this plant, and other species of the same family, the soda, with which iodine is generally found combined, is extracted. As the sponge, whose virtues have long been established by certain experience at Geneva,[1] is also a maritime plant, Dr. Coindet suspected that iodine might be the active principle of them both; and by this analogy he was first led to employ it in the cure of bronchocele. The success which attended its use in the first instance was very remarkable; and it seems to have been exhibited cautiously and warily, for some considerable time had elapsed before the alarm was given of its noxious effects.
It may easily be imagined, with what joy the discovery of a certain remedy for bronchocele was received in a place where that disease is extremely common. Many used it, and many were delivered from their unseemly and most inconvenient malady. But this state of things was not of long duration. Familiarity with the remedy begat too great liberality in its use, the effects of which were speedily apparent.
Iodine was then looked upon as a specific remedy for goitre. Its effect upon the system was little known and little attended to. No person seems even to have considered how it produced its astonishing results. Its efficacy, however, in the cure of goitre, was soon generally recognised. Its reputation flew over the city and neighbourhood of Geneva, and it was taken with the utmost levity, with and without medical advice. Dr. Coindet justly deplores this abuse, which was the cause of the unmerited discredit into which the remedy afterwards fell. When it had been used for some time in this manner, its pernicious effects began to show themselves; several persons paid for their temerity with their lives, and many were irreparably injured in their health. Every day brought to light some new catastrophe, the effect of iodine; and in the course of a short time its name was associated with the idea of a most intractable and virulent poison. Neither patient nor physician dared venture on its employment. It seemed to be one of those benefits held up to invite the appetite, while its use was denied us.
These melancholy consequences of its indiscriminate and lavish employment, show that iodine is a medicine of great power, and teach the necessity of watching and studying its operation. Nothing can assist us more in forming an accurate estimate of its virtues than a careful observation of the bad effects which flow from its abuse; and we shall now, therefore, proceed to consider them in detail.
Some time after the introduction of iodine into practice, a few cases of severe spasmodic affection of the stomach and bowels occurred. They were attended with violent and incessant vomiting, excruciating pain of stomach and bowels, strong spasms of the back and legs. The tongue was commonly furred, and the bowels sometimes violently purged, at other times obstinately constipated. The pulse was generally extremely frequent, small and depressed—the eyes sunk and hollow—the countenance ghastly and pale. 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. There is another symptom, which, though common to almost all diseases, is peculiarly the sign of this. The emaciation which attends this irregular action of iodine is so rapid and so extreme as to strike terror into the minds both of patients and physician. 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. He did not find much difficulty in persuading her to become the subject of his experiments, nor did he encounter more difficulty on the part of the French gouvernante to whose care she was confided. The remedy succeeded, as usual, in greatly diminishing the tumour; and for some time no bad effects were apparent. A small hard knot only remained in the situation which had been occupied by a considerable swelling before; and the desire to get rid of this little tumour was the cause of the remedy having been pushed too far. Its deleterious effects first showed themselves by gnawing pain at the upper part of the stomach, great anxiety, and oppression. These symptoms were disregarded, and the remedy was persevered in for a week longer, during which time the patient became very much emaciated; she was frequently affected with vomiting, the pain of the abdomen became more frequent and more severe, and the thirst was very distressing. I was sent for early in the morning, in consequence of an alarming diarrhœa, which had come on during the night, and I found her in a deplorable condition indeed. Her brother, and the mistress of the boarding-school, were so alarmed at the consequences of their conduct, that they were quite unfit to give any advice about her treatment; they could hardly indeed give me a coherent account of what had passed; and the poor young lady was therefore entrusted to the care of servants. She was then suffering the most excruciating pain at stomach, violent cramps, and convulsive action of the muscles of the arms, back, and legs, from which she had scarcely any intermission. The vomiting and purging were almost incessant. The dejections were bloody, slimy, and very scanty, but at first had been copious and feculent. The matter vomited was of a dark green colour, streaked with blood. The tongue was loaded with a thick crust, resembling in colour the matter vomited. The countenance was pale, contracted, and with that peculiar expression which announces abdominal suffering. The pulse was small, hard, and frequent, scarcely indeed to be numbered. The whole appearance of the patient was such as to excite well-grounded fears for her life. Being quite unable to swallow, four grains of opium were directed to be thrown into the rectum. They were not, however, long retained, and were not productive of benefit. An anodyne embrocation was therefore applied to the 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. The expression of her French nurse, “décharnée,” was literally applicable to her; her arms and body were almost fleshless—her breasts, which had been large, were now perfectly flat—the calves of her legs had quite disappeared—and her thighs were not much thicker than her wrists, when in health. I never witnessed any thing like such extenuation in so short a space of time. 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, 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. The few moments of ease she knew were purchased by large doses of laudanum, to the habitual use of which her sufferings had forced her. She was still very pale, and her emaciation, though much less, was yet very great. She was indeed a miserable monument of the effect of iodine. I heard of this young lady a few weeks ago; she was then much better, had in a great degree recovered her looks, and was able to leave off the use of opium almost entirely. Her stomach, however, still remained very weak, and obliged her to be very careful of her diet. The bronchocele had not returned; but the small hard swelling mentioned above remained still very sensible to the touch, but not evident to the eye.
These are the outlines of a very severe case. I trust that such a one is not likely to occur soon again. But if practice so daring as I have more than once witnessed in London be repeated, we may very soon see even worse accidents than the above. These statements, however, are important, inasmuch as they demonstrate that iodine is not merely a medicine of specific power against bronchocele, but that it dissipates this disease, by virtue of its very important action on the whole absorbent system. I shall take further notice of this property in a future part of my paper.
There is an effect of iodine to which I have alluded in the case just quoted, but which is so extremely common, when the remedy has been pushed to an overdose, that it deserves to be noticed at greater length. The anxiety and depression of spirits are so great and persevering as to warrant my considering them as the peculiar effect of iodine, and not the consequence of the great debility which attends the violent and inordinate action of this medicine on the constitution. It is an affection very different from hypochondriacal melancholy, inasmuch as it dwells principally on the present and has no reference to the future. Patients have generally described it to me as a sense of sinking and faintness, which were peculiarly oppressive, and I have heard them complain of it while suffering the most intense pain, as the part of the complaint which was yet the most difficult to bear. This symptom is an almost constant attendant on the violent action of iodine on the system, and frequently makes its appearance in a lesser degree when the medicine acts in a kind and salutary manner.