Poisoning by Iodine.—A small dose of iodine produces no uneasiness apart from a metallic taste which is sometimes persistent. When large doses are taken, the symptoms of iodism appear; and a marked sensation of burning may be ex perienced in the gastric region and along the oesophagus. Great thirst is com plained of. There is increased sexual ex citement. Nausea, vomiting, cramps, and purging may be induced. There may be tinnitus, shooting pains, and in creased flow of urine. When a poisonous dose is taken, these symptoms are aggra vated; there is great pallor and later on cyanosis, anuria, and the pulse is thready, and there is marked prostration. The vomited matter is tinged yellow and the urine, if any can be obtained, dark brown; there is increasing nervous ex citement, spasm, and finally a comatose state.
The application of iodine over large surfaces has also induced toxic symp toms; its injection into morbid growths likewise.
The quantity of iodine capable of causing toxic symptoms varies greatly. While large doses drachms) have been taken without producing marked effect, one scruple has induced violent symptoms. Its absorption is extremely rapid; O'Shaughnessy found iodine in the urine four minutes after its injection. The toxic effects are transmissible to a nursing infant.
Two cases related in which absorption of the tincture of iodine applied to the vaginal mucous membrane occurred. In the first case symptoms of intoxication appeared in six minutes. In the second case the application of iodine to the cer vical cavity, in the course of treatment for an affection of the genital organs, resulted in the diminution in size of a goitre. Repin (Revue MM. de la Suisse Rom., July 20, '93).
Case of acute and fatal iodine poison ing in a man, aged 70 years, who suffered from arteriosclerosis, chronic interstitial nephritis, and hypertrophy of the left ventricle, and who ten years before had contracted severe syphilis. On December 3d and 4th he was given 15 grains of sodium iodide. This was followed by iodism and iodine acne. On the same day appeared subconjunctival petechim, swell ing of the mucous membrane of the nose and throat, dyspncea, and swelling of both testicles. On December 7th the Hares ulcerated; the urine contained al bumin, hyaline and granular casts. No iodine was found in the urine. On De cember 10th there occurred inflammatory infiltrations in the skin of the face and trunk; a phagedmnic ulcer formed on the lower lip; the skin of the trunk and extremities was covered with small ab scesses and vesicles containing turbid, yellowish-green serum. This condition was followed by double hydrothorax, pulmonary oedema, and death. At the necropsy the following changes were found: Pemphigus of the skin and mu cous membrane of the oesophagus, chronic interstitial nephritis, hypertrophy and dilatation of the heart, sero-fibrinous pericarditis, double hydrothorax, oedema of brain and lungs, chronic perisplenitis, and commencing cirrhosis of the liver. The explanation of the case is that, owing to the diseased state of the kid neys, the iodine was not eliminated, and the amount retained was sufficient to cause death in such a broken-down sub ject. Franz (Brit. Med. Jour.; Wiener klin. Woch., No. 23, '99).
Treatment of Iodine Poisoning.—The usual antidote employed is starch, but white of egg or milk are, according to Trousseau, indicated by the greater ity of proteid substances for iodine. The
stomach should be emptied soon after the use of either of these substances to reduce the intensity of the subsequent effects. The other symptoms present should be treated on general principles, the tend ency to collapse being combated by ap propriate stimulants injected per rectum and hypodermically.
Therapeutics.—Iodine and its prepara tions are extensively used, but in syphilis, one of its salts, the iodide of potassium, may be said to be invaluable, especially in the tertiary form and all the mani festations of the disease in which the various organs are involved. As the in dications are thoroughly reviewed under each special heading, including SYPHI LIS, more than a reference here would be superfluous. The best plan is to adminis ter in increasing doses, beginning with 10 grains, three times a day, gradually increasing the dose by 1 grain a day until the limit of toleration is reached. Many patients reach 1 drachm and beyond, especially if plenty of pure spring-water is drunk simultaneously.
The indications for the administration of iodine are clearly given by Comby. Iodine is considered a specific in heredi tary syphilis and in the tardy symptoms of acquired syphilis. In the initial and secondary stages mercury alone is suffi cient; in the tertiary stage iodide of potash is indicated. An exception is made in the hereditary syphilis of the newborn, in whom the exhibition of iodide of potash should be begun early. Not only should positively syphilitic children receive iodine, but all who have suspicious symptoms, as coryza, exostoses, etc., or a cachexia which appears without apparent cause, or when the child is prematurely born, or the mother has had frequent abortions. In convulsions, pseudoparalysis, meningeal symptoms, etc., it is also indicated. The adminis tration of iodine in children with gummy tumors, disease of bone, perforation of the soft palate and hmmoglobinuria is, of course, clearly indicated. Finally, in all parasyphilitic symptoms (Fournier), as hydrocephalus, cerebral tumors, par tial epilepsy, etc., iodine is valuable.
In metallic poisoning iodide of potas sium, by forming soluble salts with mer cury and lead, causes these metals to be eliminated from the system. In painter's colic, therefore, wrist-drop, and other manifestations of lead poisoning and mer curial poisoning it serves an inestimable purpose. At times, however, either of these metals may lie practically dormant in the tissues, and suddenly find them selves brought into activity by the iodide of potassium, signs of severe poisoning following. When, therefore, there is good reason for the belief that consider able lead or mercury is lying in the system, the treatment should be started with small doses; this can then be very gradually increased—considerable water should be drunk to assist the process of elimination and . reduce, by lowering as much as possible the specific gravity of the urine, lesions of the kidney.
It is generally accepted that sodium iodide is preferable to potassium iodide in all diseases of the respiratory tract and for certain rheumatic pains. The potas sium salt is badly tolerated in many in stances of hepatic disease, but is unde niably good in these cases. Where the patients do not tolerate iodide of potas sium well, the employment of iodide of sodium first prepares them for the potas sium salt.