SURGICAL TUBERCULOSIS.— It is in the treatment of tubercular conditions amenable to surgical interference that iodoform finds its main application as a curative agent.
In the treatment of joint-tuberculosis our associate editor, Dr. L. S. Freeman, recommends, with many other able sur geons, a 10-per-cent. suspension in olive oil. His directions may be summarized as follows: Absolute cleanliness should be observed. The iodoform should be soaked for twenty-four hours in a 1 to 1000 solution of bichloride of mercury, which is stirred occasionally with a glass rod to make sure that the solution touches every particle of the powder. It is then filtered, employing a filter-paper through which has been poured a quan tity of boiling water. The remains of the bichloride are then washed away with sterilized water. The iodoform is removed from the filter with a surgically clean knife, and rubbed up with the oil in a sterilized mortar, about 4 per cent. going into solution and 6 per cent. re maining in suspension. The oil is best rendered germ-free by keeping it at the boiling-point for about half an hour. If the mixture is kept in a dark place in a sterilized bottle stopped with germ-free cotton, it will not deteriorate for a long time.
The injections should be made both into the joint-cavity and into the sur rounding infected tissues. It is best to but partially withdraw the needle and in sert it in a new place rather than to make a number of punctures in the skin.
If tubercular pus is present, it should first be withdrawn.
One syringeful of a 10-per-cent. sus pension of iodoform is an average dose. It is well to begin with a moderate quan tity and watch carefully for symptoms of iodoform poisoning—which, however, seldom appear.
In general, the injections can be re peated every two or three days over a period of several weeks, and then con tinued at intervals of a week or two.
The following formula given for an iodoform emulsion for injection into tuberculous fistulte: Iodoform, 3 parts; starch, 1 part; mix until a fine powder is obtained and add glycerin, 20 parts; water, 12 parts; heat gradually, stirring the mixture constantly, up to 271.4° F. The emulsion of 10 per cent. thus ob tained is very stable, while that ordi narily prepared by triturating iodoform in glycerin and heating is very unstable, the iodoform soon precipitating. R. H.
Lucy (Brit. Med. Jour., Jan. 7, '93).
Twenty-one tuberculous abscesses, with 16 complete cures, treated by routine of iodoform in sterilized oil or glycerol, a 10-per-cent. solution. Abscesses in tuber cular arthritis, accompanied with grave suppuration, were most rebellious to the iodoform injections. Four cases had symptoms of poisoning, 2 of which had attacks of acute nephritis. Wieland (lleut. Zeit. f. Chir., xli, 4, 5).
In 39 cases of tuberculosis involving the wrist, treated by iodoform injections after the manner originated by Bruns, 24 were permanently cured, while, with 15 more, other measures had to be re sorted to.
Iodoform was used in the form of an olive-oil emulsion of a strength of 10 to 20 per cent., and in the granulating form of the malady from 30 to 120 minims were injected; but where abscesses had been emptied, from 3 to 9 drachms were employed. Briegel (Belt. Z. klin. Chir., B. 20, '93).
In tubercular laryngitis the local use of iodoform has also been followed by excellent results. The ulcerative sur faces being carefully cleared of their muco-purulent discharges by a detergent spray, the ether solution of iodoform recommended by Elsberg (1 part of ether and 4 parts, crystallized, of iodoform, shaken in a red bottle) is then topically applied. This should be repeated fre quently. In hemorrhagic disorders com plicating tuberculous processes it is also of value. In tubercular aural diseases its use is as satisfactory as it is elsewhere.
Seven cases of tuberculous laryngitis cured by general treatment and lactic acid and iodoform locally. Bernengrun (Arch. Laryn., ii, p. 2; Quart. Med. Jour., Jan., '96).
Two cases of primary tuberculosis of the larynx cured by spraying with a solution of iodoform in ether following a spray of cocaine. To be efficient the iodoform treatment must be adopted before ulceration takes place. Newman (Jour. of Laryn., Mar., '96).
Excellent results in two cases of early phthisical luemoptysis from the use of iodoform in eucalyptolized oil, beginning with a daily dose of V, grain. The hm moptysis ceased by the third day. Gallot (Gaz. Hebdom. de Med., Sept. 1, '98).