The first case of scrophula in which I made use of this medicine, was that of a young lady eighteen years of age, who had been affected by glandular swellings of the neck for nearly eight years. She used the solution of hydriodate of potass for a month; the dose varied from ten to twenty drops three times a day, with occasional intermission of a day when the absorption was going on rapidly. At the end of this time she had got perfectly rid of her swellings, and she now (two years since she took the medicine) remains perfectly well. When she discontinued her drops, so far from having been incommoded by them, her health was certainly much improved. There remained several little fistulous sores, which required the assistance of the knife to heal them. The iodine is not equally efficacious in all cases of this kind. Great numbers, however, yield rapidly under its use; but many of them, also, resist its operation. I have never been able to assign even a plausible reason for this difference of its action in scrophula. In general, I have found such cases yield more readily to the internal than to the external use of iodine. The scrophulous glands of children are not so easily affected by iodine as those of persons who have attained the age of puberty, and they are also more liable to a relapse.
A female servant in one of the public hotels of Paris, aged thirty-three, married, who had born several children, shewed me a tumor of her right breast she had had about two years. It was not attended with any pain, but had lately somewhat increased, which gave her alarm. About a year before she had been advised by a surgeon to have it cut out. This advice gave her so much uneasiness, that she presented herself at the clinical consultations of M. Dubois. That eminent surgeon immediately distinguished the tumor to be scrophulous; and during three months’ treatment, all the usual remedies of this disease were exhausted without the least effect. A scruple of the ointment of the hydriodate of potass, placed in the axilla at night, completely removed the tumor in about six weeks. This is the only case of a similar kind in which I have used iodine. I have never yet employed it in scirrhus of the breast.[9]
I was called in the month of February, 1822, to visit a boy five years old, affected in the following manner. Since the period of his birth, he had always been weakly, but, for the last two years, had gradually been falling off in his flesh and strength. He complained of frequent pains in his bowels, which were alternately confined and purged; the motions were discoloured and scybalous; he frequently vomited his food; his abdomen was much swelled; the rest of his body considerably emaciated; pulse natural; appetite variable, but never great. It was impossible to doubt, from the appearance of the child, that the mesenteric glands were enlarged, and I determined to make a very cautious trial of iodine. It was the first case in which I had used it for an internal disease, and I therefore watched it with unremitting care. I began by giving my little patient twelve drops in the day, which I gradually augmented to twenty, and I had the pleasure of seeing the abdomen gradually diminish in size, the bowels become more regular, the evacuations restored to their natural colour, the pain diminish and vanish, the appetite increase, and at the end of five weeks the child return to comparative health, without the occurrence of a single untoward symptom. The only medicine I employed during this treatment, besides iodine, was occasionally a few grains of rhubarb. At the end of the five weeks the bowels acted without medicine. I am sorry to say that I lost sight of this child from this time. The parents were poor, were probably satisfied with the benefit they had received, and not willing to incur any farther expense for medicine. I have since prescribed this medicine in two other cases of disease of the mesenteric glands. The result was not so satisfactory as in the case I have just related, but both of them were considerably relieved, and had they been more attentive to the directions given them, I have little doubt that they also would have obtained a complete cure. 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. The relief was immediate. From the whole appearance of the case, I judged this feverish attack to be an affection of the mesenteric glands, similar to what I have described at [p. 39.]
I have used this medicine in cases where I had good evidence of the presence of tubercles in the lungs, and I do not doubt that it will be found to be serviceable in the incipient stages of the disease. But I much question whether it will prove even innocent in the more advanced periods of tubercles, when extensive disorganization has taken place in the lungs. Some cases in which I have prescribed it, were benefitted in so marked a manner as to have inspired me with hopes of having at length found a remedy for that hitherto intractable and cruel malady. Other cases, on the contrary, seemed to be much aggravated by its use. If I may judge from the cautious expressions of Dr. Baron, in his work on tuberculous disease, this is nearly the result of his experience also. It is much to be desired that we had sufficient data for distinguishing the cases in which its use is beneficial, inert, and injurious. As yet, the results I have obtained do not entitle me to come to any very definite conclusion on this subject. Mr. Haden, in his translation of Magendie’s Pharmacopœia, has given the history of a case of affection of the chest, in which he seems evidently to think that tubercles were removed by the agency of iodine. I am glad to find this case stated by Mr. Haden with his characteristic candour and caution. It is much to be desired that a series of such cases were published. They would form the materials on which a just estimate of the powers of this medicine might be formed. I trust to be able, at no distant period, to give the result of my experience in this disease to the public, in such a manner as to establish what are the real virtues of iodine in the cure of pulmonary tubercles. At present, there is certainly sufficient ground for making a cautious trial of its powers; but, if I may trust to my own experience, it is impossible to use it with too much circumspection.
A young gentleman, aged twenty-six, who had passed four winters in the south of Europe for a cough, with pain in his chest, and occasional expectoration of a thick maturated discharge, frequently streaked with blood, consulted me on account of swelled glands in his neck, which he had had from his infancy, but which were at that time particularly troublesome. I desired him to use a solution of hydriodate of potass in the dose, of twelve drops three times a-day. In the course of two months, the swellings in the neck, which had pained him from his infancy, were quite dispersed, and at the same time his sufferings in the chest were so much diminished that he requested to be allowed to continue the medicine. I allowed him to use it a fortnight longer, at the end of which time he was quite free from complaint. He subsequently had another attack of his chest complaint, and wrote to me from Thoulouse to request directions for renewing the use of the medicine, under the care of a French physician. Before my letter reached him, he was carried off by an attack of some violent complaint, of which I never could learn the history. I have exhibited this medicine in several such cases, and frequently with the most marked good effects. In fine, I have not the smallest doubt of its efficacy in relieving many diseases of the chest, in which all the general symptoms, as well as all the local means of exploring the condition of the lungs, which have lately been so much attended to in France, have given me the most satisfactory evidence of the presence of tubercles. I will not yet assert, however, that the use of iodine has been followed by the absorption of tubercles in the lungs. This important fact must not be affirmed hastily; but I trust I shall be enabled, at a future period, to establish it to the satisfaction of every one, or to explain the beneficial action of the medicine on other grounds.
Dr. Baron, in his work already quoted (p. 221), has related a case of encysted dropsy of the ovarium, in which the use of iodine was attended with the most manifest and rapid benefit. I have seen it used in a case of the same kind, in which a swelling that had been twice tapped, and which then filled the greater part of the abdomen, was almost completely removed. The patient, a woman of sixty-two, has recovered her strength; she has resumed the appearance of health, and has remained eighteen months free from dropsical symptoms.
I have made trial of iodine in two cases of ascites without benefit. I have also made use of it in a case of amenorrhœa, according to Coindet’s advice, without the smallest advantage; nor have I been able to satisfy myself that it possesses any power over the uterine system.
CONCLUSION.
The liability of iodine to excite great disturbance in the constitution, has been made an objection to its use. I fear that this reproach must be shared by all powerful medicines whatever. If unattended to, or used with levity, any medicine which is capable of doing good, may also do harm. But if used with due discretion and properly watched, I have no hesitation in affirming, that iodine may be employed with as much safety as any of the powerful remedies which are daily in the hands of the least skilful members of the profession. But it has been also made a subject of reproach to this remedy that it is quite inert and useless. I shall not give any further reply to such a statement than what the foregoing pages contain. But I am credibly informed that it has been used by several eminent practitioners of London; who finding it quite inert, had laid it aside as useless[10].
I have already pointed out one source of such mistakes ([page 3]). 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 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. Such persons expose themselves to ridicule when we see them reject a remedy so active 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.