The iodides given in relatively small doses, three or four times daily, and con tinued for many months and even years, have the power to retard, modify, and improve subacute and chronic inflamma tory processes in connective tissue of parenchymatous organs like the kidneys, the liver, the lungs, and particularly so the sclerotic disease of the arterial vessels. It appears that this salutary effect is brought about by direct inhibi tion of the proliferation of the connect ive tissue, as well as by subsequent induction of disintegration and fatty metamorphosis of infiltrated corpuscular elements and the removal of the same. It is reasonable to hold that the drug manifests and develops its activity through the lymph-channels and spaces of the affected organs by direct action upon the irritating substances, by stim ulating the vasomotor nerves and in creasing the functional activity of the parts. The favorable influence of the iodides can be clinically demonstrated, and is more decided in arterial sclerosis than in similar disease of parenchyma tous organs, and will show itself fre quently, whether the underlying cause is gout, alcoholism, or syphilis. Leonard 'Weber (The Post-graduate, Oct., '9S).
Iodism. — Coryza and profuse dis charge from the mucous membrane of the upper respiratory tract, ptyalism, and an acneiform eruption generally starting over the shoulder-blades constitute, in the majority of cases, the initiatory symptoms indicating iodism. This may appear after a few doses have been taken in persons who possess a distinct suscepti bility to the drug, but in the majority it is not until the dose administered has be come quite great. In some persons small doses are more likely to cause iodism than large ones. In some patients the active manifestations are much more grave, nausea, diarrhoea, and marked frontal headache being complained of. The skin-eruption may assume many phases, from a simple acne or dermatitis to eruptions simulating those of variola, varioloid, purpura, eczema, etc.
In order that iodism can arise, (1) nitrites must circulate in the blood; (2) the reaction on the mucous membranes must not be alkaline. On this hypoth esis there are three indications for treatment: 1. To attempt to combine the free iodine again. 2. To remove the nitrous acid at the moment of its liber ation from the nitrites. 3. To prevent the formation of free nitrous acid. 4. No way of accomplishing this purpose is found. 5. Nitrous acid is destroyed by sulphanilic acid, with the forma tion of diazo-benzol-sulpho-nitrate, as as serted by Ehrlich. The writer tried 1 V, drachms of sulphanilic acid and V, to 1 drachm of sodium carbonate in 5 fluid ounces, immediately after the appearance of iodism, and obtained the happiest results in a number of cases, thus sup porting Ehrlich's views. Two and one half to 3 drachms of sodium bicarbonate are given within twenty-four hours in two doses. It was found that when potassium iodide and bicarbonate of soda were given simultaneously, no symptoms of iodism appeared, but iodism promptly manifested itself on the with drawal of the bicarbonate of soda. I'voh mann and Malaehowski (Their. Monats., July, '89).
In acute iodism in syphilis the head ache may reach an alarming intensity; vomiting, vertigo, symptoms of cerebral compression, delirium, staggering gait, somnolence, and coma may supervene. One ease showed alarming depression of the heart's action. Neuralgias of the cerebral nerves often occur. These symp toms are probably due to an increased cerebral circulation in vessels which have undergone specific alterations. The best method of obviating unpleasant effects is to give the iodide in milk; belladonna may be added, as well as potassium bro mide. E. Finger (Gazeta Lekarska, No. 24, '91).
Case of a man who took 16 grains of potassium iodide Per diem for sixteen days. Copious watery diarrhea set in as soon as the drug was commenced, though the patient suffered previously from habitual slight constipation, and the diarrhma persisted during the ad ministration of the drug. ceasing only when it was discontinued. The patient was much reduced in weight, but quickly gained flesh when the iodide was stopped. The drug need was pure, containing no free iodine or iodates. D. W. Mont gomery (Sled. News, Dec. 29, '94).
Case of an old syphilitic who was ab solutely intolerant of the potassium salt, even when given in small doses. When 90 grains of sodium chlorate were given each day it was possible to administer 45 grains of potassium iodide without any untoward symptoms. This was con tinued for about forty days. Calomen opoulo (Jour. des I'rat., 1 o. 18, p. 288, '96).
When any of the preparations of iodine arc used internally, the respiratory tract should be watched lest dyspnoea occur from cedema of the glottis. This is cially the case when syphilis is present.
The likelihood of this untoward feature is decreased by the copious use of drink ing-water while the iodides are being taken.
Series of nine cases collected froM the literature which show that in rare cases the internal use of iodide of potassium may suddenly produce such intense (edema of the glottis as to render neces sary the immediate performance of tra cheotomy. In some cases the oedema is so severe as to produce death, although in others it may disappear as rapidly as it occurs. It was shown that the un toward consequence may occur soon after the injection of the drug, and even after small doses. Four cases presented the cedema on the first day, 1 under a dose of 15 grains, 2 under 7 7, grains, and the fourth under as small a dose as 3 grains. Three eases showed the symp toms on the second and the eighth on the sixth day, after doses varying from 30 to 195 grains. It was observed, where cedema occurred, that all other symp toms of iodism were absent, and, fur ther, that age and sex had no influence; that it appeared in otherwise perfectly healthy persons, and that after the dis appearance of the (edema persistence in the use of the drug produced no unfavor able after-effects; so that iodism is not a permanent symptom. CEdenm of the glottis, fatal in a few minutes if not relieved promptly, may supervene on the early administration of the drug, and that the longer the salt is used, the less danger is there of oedema. A. Groenouw (They. Monats., Mar., '90).