Case of a woman in good health, who died of iodoform poisoning. On the left leg was a small varicose ulcer which had been dressed with iodoform powder. After this treatment tumefaction set in and the leg became red and painful, and at the end of eight days there was a generalized eruption. Editorial (Revue MEd. de la Suisse Rom., p. 431, '96).
Case of a woman who sustained burns of the thighs and abdomen to which iodoform dressings were applied. After three weeks without other signs of gen eral poisoning a progressive amblyopia appeared, accompanied by atrophy of the temporal half of both disks. Terson (Societe de Biol.; Annales d'Ocnl., Nov., '97).
The toxic effects of iodoform are well illustrated in the three subdivisions of symptoms proposed by McLean: 1. Cutaneous irritation: Eruptions of the skin in erythematous or eczematous form, associated with the pruritus of urticaria.
2. Cerebral disturbances: Headache often very marked; delirium more or less active; melancholia, hallucinations; the pupils occasionally dilated, but more often contracted and motionless; the pulse decidedly accelerated, running early up to 135 to 150 per minute; quality rather small and wiry; rapid in crease of temperature.
3. Syncopal or asthenic form of poisoning: Patient overcome with dizzi ness, mental confusion, great lethargy; weak, rapid pulse; some paralysis of the sphincters, death coming sometimes sud denly by heart-failure.
The quantity thought capable of caus ing death has been estimated at 1 drachm in a case witnessed by Langenstein,but it is probable that in the majority of cases this dose would not prove fatal. Czerny has reported a death after 1 drachms had been taken. It is probable, however, that the susceptibility of the patient bears considerable influence upon the re sults. This susceptibility may, in turn, be to a degree under the influence of the varying conditions of the patient's resist ance, etc. The smallest dose thought to have caused death (1 drachm) should therefore be considered as likely to give rise to dangerous symptoms in any case, although larger doses have been taken with impunity.
Case of a woman who took 2 drachms of iodoform at one dose, with no evil re sults. The only symptoms manifested
were severe headache, griping pains in the abdomen, and purging. The taste in the month and the odor of the drug in the breath of the patient remained for several days. H. W. Fraiienthal (N. Y. .Med. Jour., Jan. 11, '91).
Treatment of Iodoform Poisoning.— The active symptoms of iodoform poi soning may sometimes be prevented by timely measures when the preliminary signs appear. It is important to know, however, whether iodoform intoxication is really present. This may be ascer tained, according to Sasse, by the follow ing means:— A test is made of the urine to note the quantity of iodine which is eliminated by it. A small pinch of powdered calomel is placed upon a saucer, and then a few drops of the urine to be examined are dropped upon it; a mixture of the urine and calomel is then made with a glass rod. If the urine contains a notable amount of iodine there is produced a well-marked yellow discoloration, which should indicate that the iodoform is being absorbed in sufficient quantity to produce danger.
The immediate removal of the drug from the surface in cases of surgical dressing intoxication is of obvious im portance. This can easily be done by means of a warm solution of starch, which takes up all the free iodine that is present. Alcohol and hot water may be used instead. The local conditions are then treated symptomatically, a few doses of bromide of potassium being given internally to assist in counteract ing the poisonous effects.
When a large dose has been taken in ternally, the stomach should be emptied and 20 grains of bromide of potassium given in a half-tumblerful of water. Four 10-grain doses should then follow every hour. This salt is thought to be a positive antidote, owing to its power as a solvent of chloroform.
Twenty-per-cent. solution of bicarbo nate of potassium administered to a ease of iodoform poisoning. The best results followed, the medicine seeming to act as a direct antidote. Behring (Then Gaz., Mar., '88).
Bromide of potash acts as an antidote to iodoform not only as a neutral potash salt, but also by virtue of its specific bromide action. Joseph Samter (Berl. kiln. Woch., Apr. 15, '89).