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. I have only seen one case of this kind, of which I have given the history above. But several similar instances have been communicated to me, and they must be of frequent occurrence wherever iodine is used ignorantly and rashly. In all those cases of chronic affection of the alimentary canal, with the particular history of which I have been able to become acquainted, the symptoms differed widely from those which marked the accession of the disease. Instead of the small vacillating pulse of the first period of the complaint, it was bounding and firm, the extremities were no longer cold, nor the system collapsed; the diarrhœa had assumed a dysenteric form, the fæces being retained, and the dejections consisting chiefly of maturated mucus or pus. In such cases, I believe, the conjoined operation of aperient medicines and opium will be found most advantageous in quieting the symptoms. By this plan at least I succeeded best in relieving the single case that has yet occurred to me.
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. I have seen ten cases of this kind, and all of them have seemed to be much more benefited by attention to diet, air, and exercise, than by any medicines they have taken. Patients thus affected ought to live much in the open air; their food should be sparing, mild, and nutritious; and they ought to avoid carefully the use of wine and ardent spirits. By these means alone, and the use of mild aperient medicines, two of the cases alluded to were quickly recovered, although they began in a very threatening manner. All the others but one were much relieved by the same means. I therefore consider these simple remedies to be of the greatest importance, and am convinced that without them no other remedies will have any effect. Next in importance to gentle exercise in the open air, and attention to diet, I should place the use of the warm bath. By means of it the severity of the spasms is very frequently relieved. The young lady, whose case is related at [page 7], used it daily, sometimes several times in a day, and never without benefit. She could never enjoy any sleep at night unless she had previously spent a quarter of an hour in the bath; and to this day she continues the use of it. Joined to the above remedies, habitual attention must be paid to the bowels. They should be moved by the gentlest medicines, and they may often be advantageously acted on by glisters only. This manner of exhibiting medicine is frequently objected to in England, because it only empties the lower parts of the larger intestines; but repeated experience has convinced me, that the mere circumstance of evacuating the large intestines gives occasion to, and stimulates the action of, the higher passages. I do not intend to defend the habitual abuse of enemata which is daily witnessed on the Continent; but, in this country, I think that their use may be extended with advantage. In whatever way, however, the bowels are evacuated, it is of the greatest consequence that they should be acted on by the gentlest medicines possible. Such, however, is their slowness in this disease, that it sometimes becomes necessary to use the strongest medicine in order to effect a mere evacuation; but I have never seen the bowels violently moved without the highest injury to the patient. My common practice has been to prescribe small repeated doses of one of the neutral salts, to each of which I desire five or six drops of laudanum to be added. By this means it has seemed to me that my purpose was effected with least violence. I have tried all the medicines of the class of antispasmodics, and cannot speak in favour of any one of them. They are either useless or hurtful. The tinctures and ethers are injurious in a very marked manner and in a very high degree. Various other remedies will, of course, be suggested to the judicious practitioner by the peculiar circumstances of each case.
I may seem to some persons to have dwelt too tediously on the poisonous properties of iodine; but let it be recollected, by those who have had opportunities of becoming acquainted with its virtues, that this medicine is as yet almost unknown to the numerous practitioners who are now daily using it; that it is a medicine of singular power and efficacy in a great class of disorders, with which the inhabitants of this country are peculiarly afflicted; that this most useful remedy may be divested of all its deleterious properties; that, therefore, it will probably come into general use among us; and they will allow that I have not bestowed too much time on this important subject. I wish the details had been more complete, that my experience had been more extensive, and that I had been better able to satisfy the reader’s curiosity and my own.
Some of my readers, who have lately been in the habit of using iodine cautiously, and of watching its effects, may think that I have overcharged the picture of its baneful properties; but I have been an eyewitness of all I have written; and I should extend this treatise much beyond the limits I have assigned to it, did I detail all the cases that have reached me of the mischief it has produced. I am glad, however, to add my testimony to that of Coindet, de Carro, and others, that this medicine may most certainly be deprived of all its hurtful qualities, by using it cautiously and watching its effect. Like all other powerful medicines, when its action is not controlled by the hand of a master, its energies become a source of mischief and ruin, instead of restoring the blessings of health and strength; but when well managed, it is a most useful remedy, and a valuable addition to our materia medica. I have used it myself in a great number of cases, and I have never yet, in my own practice, had occasion to regret the occurrence of any of the violent symptoms I have described. I have more than once discontinued the medicine on finding the pulse become frequent, small, and depressed, on account of watchfulness, flying pains of the joints, tremors, or pain at the stomach; but having early detected these symptoms, they were not allowed to become formidable. Dr. Coindet states, that he has prescribed the medicine to one hundred and fifty patients, and that he has never had occasion to observe any mischief from its use.[3] Dr. Decarro has given it at Vienna to one hundred and twenty patients; Dr. Erlinger, of Zurich, to seventy; and Dr. Formey has prescribed it extensively, in Prussia, with the same favourable results. Dr. Decarro, in his enthusiasm about this new medicine, seems almost to doubt whether accidents have ever occurred from its use, though these accidents have been as public as the day, and the unhappy patients have paid with their lives the inexperience and rashness of their physicians. Thus far I can agree with Decarro, that I have never known or heard of any bad effect from iodine, when it had not been used unadvisedly and injudiciously. It has been used extensively by Hufeland in Germany, who makes no mention of its deleterious properties; and a great number of physicians in London and Paris, and various parts of England and France, have also lately employed it. They have either not met with the accidents I have described, or have prudently concealed them.
Having now considered the effects of iodine on the alimentary canal and the nervous system, we are prepared for studying its effect on the absorbent vessels, by which its use in medicine is indicated. This is the most important subject which has yet fallen under my review, and I shall give it as much extension as may be necessary for its perfect discussion. It has been already seen at [pages 10] and [12] that the lymphatic system is very powerfully and generally stimulated, so as to occasion a great absorption of all the sebaceous, muscular, and glandular structures of the body; but it will be seen, in the following pages, that the action of iodine may be directed exclusively against tumors, and local disorders, while the healthy structures of the body remain unaffected.
The absorbent system is distributed over every part of the body. In the brain alone the vessels of this class have not, hitherto, been detected and submitted to ocular demonstration by any other anatomist than Mascagni. But physiological and pathological proofs of their existence, equal in force to any anatomical evidence, are not wanting to demonstrate their presence in the central organ of the nervous system. The office which these vessels discharge, in the nutrition of the body and removal of its waste, is most important to its healthy condition; and the influence it exerts, in a state of disease, is not less considerable. 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. A considerable step towards the solution of this difficulty has, indeed, been lately taken by Dr. Blackall. Much obscurity, however, yet rests upon the subject, and a direct medical agent on the absorbent system, whose effects are speedy, indubitable, and powerful, is a great desideratum in the art of healing.
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 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 cannot help thinking that such cases have been owing, in many instances, either to some fault in the medicine, or to some inadvertence on the part of the practitioner.[4]
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. The promptitude of its action is at times very extraordinary. Decarro states, that one of his patients, thirty-eight years of age, after taking the remedy for seventeen days, had the circumference of his neck reduced from one foot seven inches and a half, to one foot three inches and three-quarters. Dr. Coindet relates a case of a man, fifty years of age, in which this medicine, taken internally, reduced a very large goître considerably in size, after six days’ treatment only. An old woman, aged sixty-five, who took this medicine under my care for a goître, with which she had been affected nearly forty years, had the circumference of her neck reduced from twenty-two inches to eighteen, on the twenty-fifth day. Such rapid diminution in the size of the tumor is not to be always expected. In some cases a whole month, and even more, elapses before any effect is visible. In general, however, the powers of the medicine are manifest at the end of the second week and considerable progress towards cure has been made at the end of a month. I have endeavoured to find out whether there was any thing in the constitution of the different persons under my own observation, or in their state of health, which rendered them more or less apt to be affected by this medicine. I have not been very successful in this inquiry. But I found that in two cases of women afflicted with extensive and very painful varix of the veins of all the extremities, the effect of iodine was produced with great difficulty. This fact seemed to coincide with the result of Mr. Magendie’s very interesting experiments on absorption, and I accordingly desired one of the persons, to whom I have just alluded, to lose a little blood from the arm. The effect of the medicine was very much accelerated by this treatment, but a consequence I did not look for was also the result of it, viz. the total and sudden disappearance of the varix, which had commenced during uterine gestation twelve years before. The goître succeeded the varix after her delivery. I merely mention the facts of this case, which may suggest useful hints to those who may meet with a case similarly circumstanced. Since its occurrence, whenever the medicine is slow in its operation, provided the vessels be full and plethoric, I desire a little blood to be taken away from the arm, and I almost invariably find the action of the medicine much quickened. I have sometimes, also, thought that the cases, in which blood was taken away, were cured more easily and with less suffering than the others.