No.424.

LONDON, SATURDAY, OCTOBER 16. [1831-32.

Essays on the Effects of Iodine in ScrofulousDiseases, including an Inquiry into the

Mode of preparing Ioduretted Baths. Trans-lated from the French of M. Lugol, Phy-sician to the Hopital St. Louis. By W.B. O’SHAUGHNESSY, M.D. With an Ap-pendix by the Translator, containing nu-merous additional Cases, &c. &c. 8vo.

pp. 220. London. Highley. 1831.

Essays on the Ejects of Iodine in ScrofulousDiseases, including an Inquiry into the

llodenf’preparingIoduretted Baths. Trans-lated from the French of 1B1. Lugol, Phy-sician to the 1-16pital St. Louis. By W.B. 0’SitauaHVESSY, M.D. With an Ap-pendix by the Translator, containing nu-merous additional Cases, &c. &c. 8vo.

pp.220. London. Ilighley. 1831.FEw works have appeared within late yearson the Continent of Europe which havesucceeded more completely in riveting theattention of French medical practitioners,than the three memoirs by M. Lugol nowtranslated into the English language. By M.Lugol the reputed anti-strumous virtues ofiodine were first tested on a scale commen-surate with the importance of the object,and la the spirit of research and undauntedperseverance which the difficulty of the in-vestigation required. Fame here, as in manyother cases, had supplied an antidote to a

z’

destructive malady, but the mode of apply-ing the remedy still remained a disappoint-ing enigma, the solution of which happilyseems at length to have been accomplished,if we are to credit the statements made by M.Lugol, and solemnly authenticated by MM.Magendie, Serres, and Dumeril, the com-mission appointed by the Institute of Franceto investigate the nature and extent of thesuccesses in the treatment of scrofula whichM. Lugol pretended to have achieved. Inthe analysis of the work we proceed to offer,these points will be sufficiently elucidated,and our readers enabled to estimate the mo-tives which induced that eminent body toaward lI. Lugol a munificent pecuniary re-compense for his " prosecution of mquiriesfraught with so much value to mankind."*

Report by MM. Magendie and Durneril on M,Lngol’s third uiemoir.

The clinical experiments conducted at

the Hopital St. Louis are described by M.Lugol in three separate memoirs. Of thesethe first published in 1829, which con-

sists of, 1. An investigation into the effectsof iodine when internally or externally ap-plied to the human body. 2. Of observa-tions on the comparative effects of variouspreparations of that substance, and deduc-tions thence drawn as to those which

should be preferred for medicinal uses.

3. Of formulas for the different exigencies oftreatment; and, fourthly, of several casesillustrative of the practical conclusionsdrawn from the preceding inquiries.On the first head we are afforded much

important information on points previouslymisunderstood or unknown. We find inthe multitudes of cases treated for monthsor years at the Hôpital St. Louis, that notone of those accidents occurred which popu-lar rumour has attributed to the agency of

iodine ; that instead of the dreaded emacia-tion and absorption of cellular substance,glands, &c., fulness of person was, on the

contrary, induced, even in many caseswhere the hospital allowance of food wasinferior to the solicitations of appetite-that instead of the aggravation of puimo-nary tubercles, induction of hsemoptysie,and other thoracic maladies, these diseasesnever supervened ; and even when presentfrom other causes, sustained not the leastexacerbation by the use of ioduretted pre-parations. Concerning the local effects ofiodine on the skin, or scrofulous sores,

swellings, &c., M. Luol’s remarks are ofmuch importance, we therefore quote thepassage from the version now before us.

EXTERNAL LOCAL EFFECTS OF IODINE.

" The external employment of iodine or-dinarily produces intense local action, andoften causes a prolonged sensation of prick-ling and smarting, especially severe on

74

bathing days. In many cases this actionterminates by a fit of itchiness, short in

proportion to the duration and the degreeof pain first experienced. A few days aresufficient to change the aspect and improvethe condition of ulcers, whether suppura:tion be produced or not. We have observedthis repeatedly in a vast number of cases ;the following examples will illustrate therapidity with which the local changes occur :- Two scrofulous patients,-one Scieure,since cured; the second Hastard, afterwardsdismissed convalescent, were each affectedwith ulcerated cervical tubercles, in themonth of May, 1828. Scieure had an ulceran inch in length, of oval form, deeplyseated in a tubercle of the same shape ; theedges were red, bleeding, projecting abouttwo lines over the base, which was fungous,and bathed in scrofulous pus. In Hastardthe principal ulcer was round, soft, its

edges unequal, thin, red, and bleeding,generally level with, but in some points below, the centre, which suppurated pro-fusely. Scieure’s ulcer was at the left sideof the neck ; Hastard’s at the right: so that,looking from one patient to another, we hadtwo different examples of scrofulous ulcera-tion in its most striking form. The appear-ances in these cases struck me so much thatI wished to have them delineated by Dr.Carswell,* an able anatomist, who possessesthe highest degree of perfection as a patha-logical painter ; but that gentleman havingbeen detained at La Charite by similar la-bours, he could not at once comply withmy request; and when ten or twelve daysof the treatment had elapsed, the ulcershad so changed that they were no longerobjects of delineation, both being then in arapid progress of cure. It is not exaggera-tion to say that iodine changes the appear-ance of scrofulous ulcers sometimes more

quickly than mercury modifies that of sy-philitic sores. We have even seen ulcerscicatrised too quickly ; that is to say, be-fore the complete resolution of the tubercles;but this is not so troublesome a result as

might beanticipated, for the iodine resolvesthe tubercles quite as well as it excites

suppuration. We have also seen old cica-trices gain the level of the skin, lose theirmorbid colour, and again resume the nor-mal colour of the cutaneous tissue. The

young woman Courriot, whom we cured ofan ozcena and ophthalmia of the right eye,had two old scars on the upper third of thesternum, of a red colour, deep, and puck-ered ; both these became pale, and reachedthe level of the surrounding skin. Theskin, when rubbed with iodine, becomesof a reddish-yellow colour, from the absorp-

* Now Professor of Morbid Anatomy in the Uni-versity of London.

tion of the remedy, its presence in thecutaneous tissue, and its injection into thecapillary vessels. The epidermis soon be-comes detached in layers of various sizes,so that the ointment comes into immediatecontaçt with the true skin. In general,this effect of the ointment is in proportion tothe degree of its local action. Nevertheless,the suppuration of the scrofulous tubercles,under the influence of iodine, is subject tomany secret cenditions which I have notyet been able to comprehend. I have fre-

quently seen tuberculous ulcerations curedafter copious suppuration ; sometimes, also,recent cicatrices, still of a fistulous kind,suppurating copiously, and much of the ad-joining textures mixed with the discharge.But it would be wrong to conclude that thesuppuration of tubercles was nothing morethan the breaking down of their own sub.stance. If such were the case, the suppu-ration should always be proportionate to theextent of the tubercle ; and when this focuswas once voided, its walls would cohere byihe plastic inflammation. But such is notthe progress observed to take place in thescrofulous tubercle. It suppurates by aninternal impulse, which may either be gene.ral, or reside in themselves, but which isnot always in proportion to their volume.The suppuration is perhaps a secretion ana-logous to the mode of development of thetumour itself within the cyst which servesfor its nutritive organ. The suppurationdoes not necessarily remove with it thesource of the tubercle.

" It should not be lost sight of, in the

study of this disease, that a tumour is

usually composed of several tubercles, whichcommunicate together before they form acommon swelling enclosed in the same cyst;that in certain cases the limits of the tu-mour are more distant and deeply-seatedthan they appear to the touch, so that afistula which we might believe to terminatein a minute and separated tubercle maycommunicate through this with another ofvariable size. All these anatomical detailsbeing taken into consideration, it will beseen that the suppuration is not in a certainratio to the bulk of the tumour, and that itsometimes continues as a secretion, thoughthe cysts are not freed from the tubercularmatter they contain; and, finally, that inthe cases where they are evacuated, theymay be speedily filled with new tubercularcontents. I shall conclude what I have toadvance on the local external action ofiodine by saying that it lessens in activityaccordingly as the surfaces heal. This de-crease of action cannot be regarded as aneffect of habit, for we have had patients

under treatment for a year in whom theiodine acted as powerfully as ever on thestill diseased surfaces, but had no effect

75

when the cure was more advanced, or en-

Itirely complete."The internal effects of iodine vary re- i

markably according to the doses employed,and sometimes according to peculiarities inthe patient. The general or specific effect,or that, the proximate mode of operation ofwhich evades detection by our senses, seemsto be a remarkable increase of appetite,which keeps pace with the decrease of themorbid symptoms. More intelligible con-sequences are also occasionally witnessed,such as slight purging’ and powerful diu-resis. Sometimes also salivation ensues.

We speak now of the effects of the medici-nal sniall doses recommended by the author,and the strict observance of which he em-

phatically enjoins, as the sole mode bywhich iodine can succeed in the cure or

alleviation of scrofula.

" With iodine it will be the same as withall other medicines which cannot effect acure unless administered in proper season,in fit dose, and in appropriate form. It willbe the same with iodine as with mercury,which only cures syphilis where adminis-tered under certain conditions,-with pur-gatives, so much neglected in the presentday,-with bleeding, bark, opium, and regi-men. The application of these remedies al-ways remains subordinate to circumstances,

Iindependently of which they become preg-nant with danger, even in the very cases inwhich their due employment would havebeen efficacious, or was even the sole butcertain method of cure."

The pharmaceutical preparations of iodinereceive prominent attention. M. Lugol ar-guing from his observations on the externaleffects of iodine, and the necessity of theexact admeasurement of the quantities to

be employed, repudiates the tincture ofiodine altogether, since it seldom or neveris equable in its strength, and is so

abundantly precipitated by water, that all

its iodine almost certainly becomes deposit-ed on the mucous membrane of the stomach,producing severe symptoms of gastric irri-tation, and totally contradicting the bene-ficial agency the remedy would exert if

kept in sufficient solution, and allowed to

be tranquilly absorbed. Similar objectionsapply to the sirop. Lastly, M. Lugol re-commends either of two forms of adminis-

tration, to the latter of which he justlygives the preference, when its ingredients

can be obtained in a pure state. -In the fol-

lowing extracts one of these formulae is de-scribed :-

One of the modes of preparation whichI regard as the most certain is the state ofperfect solution in distilled water, observ-

ing always not to extend the quantity of thevehicle much beyond that necessary to ob-tain the perfect solution, because the dis-tilled, water, being indigestible itself. mayproduce some inconvenience. At first Ifixed this vehicle at a pound, in this I dis-solved half a grain, two-thirds of a grain, ora grain of iodine, in order to have at mydisposition three degrees of the same

remedy, to be used according to the indi-viduals and periods of treatment. I havesought to render this solution still moreassimilable by the addition of twelve grainsof the muriate of soda, an addition which

’ probably compensates also for the ab-sence of air in the distilled water, a de-

ficiency which produced less inconveniencethan I anticipated, and which was never

sufficient to oblige me to change this modeof prescription. I have denominated thesethree degrees of the solution as iodurettedmineral water, No. 1, 2, and 3. In all casesI I commenced, by No. 1, seldom proceeding- to 2 till the second month of treatment. Ihave by no means given No. 3 to all scrofu-t lous patients, and I have never had occasion- to pass this last dose of one grain per day.- It will be seen that I have stopped far shortof the maximum dose administered by M.Coindet, who gives it to the extent of threegrains a day. Although this precedent wasbefore me, I could not induce myself toimitate it, for I found that the patientswere sufficiently excited and improved bythe smaller doses I gave them; and I evenjudged by the particular effects producedunder my immediate observation, that theincrease of the dose might be attended withdangerous results." I shall not omit to mention a particular

circumstance which caused me to under-stand all the difference of action producedeven by the slightest increase in the quan-tity of the remedy. I have seen scrofulouspatients on whom the ioduretted ointmentNo.l was nearly inactive, but who couldwith the utmost difficulty endure the appli-cation of No. 2. This difference was pro-duced by an increase of one-sixth in the

quantity of iodine. This contemplation ofthe external mode of action of iodine di-rected me in its internal use, and confirmedthe caution I observed from the very com-mencement of my experiments."A preferable form, when the ingredients

can be obtained pure, is the following:-I I subjoin a tabular view of the consti-

76

tution of these solutions, graduated in threedifferent proportions, so that the iodine

may be given internally in the progressivedose of half a grain, three-fourths of a

grain, or four-fifths of a grain daily.IODURETTED MINERAL WATER.

No.1. No.2. No.3.

R Iodine ............ gr. gr. i gr. 1¼Hydriodate of potash gr.1 gr. ij gr. ij Distilled water.... gviii 3viii 3viiiThis solution is perfectly transparent,

of a beautiful orange colour, and keeps fora considerable time. Children drink it

readily when it is mixed with a little sugar,but this addition should only be made at themoment of the administration of the medi-cine, as in the course of a few hours aftersugar is added, decomposition takes place,the liquid becomes colourless, and its ac-tivity is partly destroyed. I commence theinternal treatment with half a grain of

iodine ; for this proportion I prescribe two-thirds of the mineral water No. 1. In thesecond fortnight I gave the entire of thisnumber ; that is, three-fourths of a graindaily, varying the dose within narrow limitsaccording to the peculiarities of the case.During the fourth fortnight, or in the be-ginning of the fifth, I give a grain daily,and usually I continue this quantity to theend of the treatment. In some cases I have

prescribed one grain and a quarter, stillmore rarely I have increased the dose to agrain and a half, but I have never gone be-yond this quantity daily."

From the contents of the first memoir, itilppears that by the first of these formulae,M. Lugol had, at the period of its publi-cation, treated 109 scrofulous patients inseventeen months at the Hopital St. Louis.That at the close of the preceding year, 39were yet under treatment, that 30 had quit-ted the hospital with marked improvement;that iu four cases the treatment was ineffec-

tual ; finally, that 36 were discharged com-pletely cured.*

The remaining part of the first memoir isoccupied by twelve minutely-detailed cases,viz., three of tubercular scrofula, or thatform of the disease characterised by glan-dular enlargements and encysted tumours ;two of scrofulous ophthalmia and coryza; oneof scrofulous abscess, and five of scrofulousulceration, including that frightful varietytermed bv Alibert "dartre rongeante," andby lI. Lugol, esthiomenic or corrosivescrofula. Lastly, one cause of scrofulous

See M. illagendie’s Report to the AcadewitRoyale des Sciences.

caries is described; in all these, iodine wasemployed with decided success. We do

not at present extract any of those cases,

being compelled by our limits to restrictourselves to little more than an outline ofthe memoirs.The second essay, published in 1830, is

an inquiry into the effects, mode of prepa.ration, &c., of ioduretted baths in scrofu.lous maladies. In this we first meet an

experimental examination into the appro.priate materials for the construction of

bathing troughs, from which the author con-cludes, that unpainted wood is the onlyunobjectionable substance for this purpose.We are next presented with an epitome ofnumerous case.,, treated by iodine bathsalone with perfect success. Thirdly, wefind an extensive series of curious and im-

portant experiments, showing that a solu-

tion of iodine in hydriodate of potash, is theonly proper form for the composition of thebath ; and that the hydriodate of potash isperfectly inactive,only serving as a solventfor the iodine. Five cases are then givenin greater detail, illustrating the signaltherapeutic value of these baths, and.

lastly, a table is given of the quantities ofiodine, the hydriodate of potash and waternecessary for baths, calculated according tothe age of the patient, and the capacity ofthe reservoir.The third essay, published in May 1831,

is far more voluminous and important thanits predecessors. In this we find the re-sults of the author’s more matured and ex-tended researches, preceded by a secondhighly complimentary report by MM. Ma-gendie and Dumeril, who officially su-

perintended M. Lugol’s practice at the Hô-

pital St. Louis. In this memoir we find

thirty minutely-detailed cases of scrofu-lous affections, classified according to thesame method pursued in the first essay. Ofthese, the most remarkable is a group of tencases of dreadful disease of the bones andtheir articulations, in which the iodine

treatment, including the proto-ioduret of

mercury, exerted the most beneficial effects.Three cases of syphilis are also given,which resisted mercury, but were cured byiodine. Lastly, we find a pharmaceuticalhistory of the various modes of using iodine

, internally and externally, of preparing localioduretted baths, cataplasms, &c., the oint-

77

ments of iodine, and the proto-ioduret ofmercury. We extract the formulæ for the

composition of this preparation :-The following Z3 formiilze express the

quantities of the ingredients in the severalstrengths of the ointment which I am in thehabit of prescribing ;-

R Proto-ioduret of mer-cury .............. 9ii.. 9iii.. 9iv

Fresh lard .......... 3ii.. 3ii .. ii.° This ointment is, when properly pre-

pared, of a canary-yellow colour; some-

times it presents a dead-green tint, whichis owing to the presence of some protoxideof the metal. At other times its colour ap-proaches to the orange, from the deuto-ioduret being formed. The latter admix-ture must be carefully avoided, the deuto-ioduret of mercury being nearly as escha-rotic a preparation as the deuto-chloruret orcorrosive sublimate. The syphilitic aspectof the esthiomenic form of scrofula first ledme to use this compound, and the good ef-fects I experienced from its application,induced me to extend its use to all cases ofexternal scrofulous disease. We may ob-serve incidentally, that many forms of scro-fula imitate syphilitic diseases, and thatsyphilitic parents not uufrequently engen-der scrofulous children. This ointment hasalso the advantage of causing little or no

local pain in ordinary cases ; sometimes,but rarely, it is true that it occasions quiteas intense and permanent smarting as theointment of the simple iodine alone."

In the preceding analysis we have re-stricted ourselves to the consideration ofM. Lug’ol’s essays, which, as well as theEnglish version, are now before us. On

comparing them together, we believe wecan safely say, that the translator has pre-served every fact and observation of anyconsequence in his author’s ’work, while heseems to have used the pruning knife withfreedom in the repression and excision ofthe disagreeable exuberancies of style, andflights of description, in which even thebest Gallic writers on medical subjects sofrequently transgress.The translator has also -added a copious

Appendix containing numerous additionalcases. Some of these, treated with iodine

simply, are extracted from a paper publish-ed by M. Bermond in the Transactions ofthe Medical Society of Bourdeaux, and anoutline of which has already appeared inthis Journal. A second and most importantset of cases are selected from a voluminous

’ essay on the combination of opium withiodine, published by M. Lemasson, in theJournal Hebdomadaire for September of thepresent year. Thirdly, we find cases ofsyphilitic and carcinomatous ulcerationtreated with the proto-ioduret of mercury,by Professors Biett and Breschet, at the

Hopital St. Louis and the Hotel Dieu.

Fourthly, an account is given of the thera-peutic properties of the Ioduret of Lead,a substance which seems endowed with

powerful anti-scrofulous properties, and towhich we recently solicited the attention of

our readers.The whole volume is wound up by achemical description, by the translator, ofiodine, the hydriodate of potash, the iodu-rets of lead and mercury, with minute di-

rections for the preparation of these sub-stances. The adulterations to which the

hydriodate of potash is subjected in thiscountry are fully described, processes for

their detection afforded, and satisfactoryproof given that an impure hydriodate ofpotash will completely frustrate all the

pharmaceutical or clinical experiments per-formed with preparations of iodine.The only remaining point we shall notice

is the check the translator gives the publicon proprietors of bathing establishments. Asthe passage is short and to the point, weplace it before our readers :-" I trust I have now said nearly enough to

guard the public and the medical practi-tioner from the mortifying effects of thisshameful practice. All M. Lugol’s expe-rience has been placed in vain before thecommunity, unless this sophistication bediligently sought for, and its authors effi-ciently punished.* As it is more than pro-bable that the management and preparationof ioduretted baths will fall into the hands

’ of the proprietors of large bathing con-cerns, it is highly desirable that the patientshould possess the means of ascertainingwhether the baths are properly prepared,that is, whether they contain free iodinedissolved in pure hydriodate of potash. Forthis purpose the bather may procure a spe-cimen of the water, and add to it, whencold, a cold solution of starch in excess : a

if free iodine be present, the blue colourwill be produced, and the filtered colourless

liquid will yield a yellow precipitate withthe acetate of lead. As the patient’s sen-sations will be his principal guide to the

* When the hydriodate of potash is found to beadulterated, Logol’s aqueous solutions (see formuloain Part 1.) should be used in the internal treatment.

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quantity of free iodine necessary to excite

Ithe cutaneous action of the remedy, I donot feel it necessary to describe here themode of analysis by which the quantitiesof the respective ingredients in a givenquantity of water may be ascertained.The analysis is, moreover, so complicatedthat I could scarcely hope to render it in-telligible but to practised chemists, whoof course do Dot require the information."With these extracts and analysis, we for

the present submit this work to the atten-

tion of our readers. The value of the bookis scarcely a matter of opinion, for that mustbe decided on by practical trials and practicalmen. If by their verdict our own opinionof the importance of M. Lugol’s researchesbe corroborated as fully as we expect, weshall then not hesitate to declare that M.

Lu,,-ol has effected a great public good, andth.it his translator, independently of theAppendix, has done the members of the

medical profession in Great Britain a corre-sponding service by submitting that author’slabours to their immediate observation.

INTRODUCTORY LECTUREON

VETERINARY MEDICINE

AND SURGERY:

BY MR. YOUATT.

DELIVERED AT THE

UNIVERSITY OF LONDON,

Wednesday, October 5, 1831.GENTLMEN,-When, in the beginning of

the present year, I had the honour to appearin this place as a permitted lecturer on vete-rinary medicine and surgery, I thought it aproud day for the degraded and undervaluedprofession to which I belonged. I felt trulygrateful to the Council of this excellent in-stitution, that they, first among the univer-sities of England, bestowed, although per-haps but for a little while, their fosteringpatronage on this disregarded branch ofscience,-a branch of science, however,connected with many of the rational enjoy-ments of life-with human medicine, andthe agricultural interests of the country.

I will not now speak of the deep feelingof responsibility that alternately stimulat-ed and depressed every mental energy whenI stood first and alone in such a place, theimperfectly-recognised advocate of an art towhich from habit, as well as from a convic-tion of its importance, I was ardently attach-

ed but I will speak of the kind encourage* ment I experienced from some of the profes-sors whom I now see before me, which I somuch needed, and’which they, unsolicited andbeyond what I dared to hope, bestowed; andI will speak too of the uniform attentionand expression of regard which I receivedfrom a class, small, indeed, but which didnot disgrace even this institution ; and theirmanifest improvement in veterinary science,creditable to themselves, and the most

dearly-cherished reward they could yieldtheir preceptor ; and I will tell them thatif ever their object and mine is accomplish.ed, and the veterinary art is permitted toassert her just rank, there is one who willnever forget how mainly they were in.strumental in accomplishing this purpose,and the recollection of them will be asso-ciated with some of the happiest, becausethe most useful hours of his life.And now, Gentlemen, when I can stand

before you the appointed lecturer on veteri-nary medicine and surgery-when the tem-porary shelter is exchanged for a permanentabode-when the art I am to teach is ac-

knowledged to be a legitimate branch ofmedical and scientific education-when theclaim of relationship is sanctioned by thosewho are the best judges of the degree ofconsanguinity, I can only say in behalf ofmy profession and myself, that we are thank-ful-that we will endeavour not to disgracethe alliance, and that we will become, al-

though inferior, yet zealous, and we trust,not quite unsuccessful labourers in the causeof science and humanity.

In the prospectus of the University, vete-rinary surgery stands acknowledged as oneof the divisions of the medical school.While I am grateful for this I must be per-mitted to maintain that it is an act of justicethat has been too long delayed in our schoolsand by the public. The veterinarian had

perhaps contributed to the refusal of theclaim, by his lack of education, or his un-professional bearing or conduct,-too glar..ing and too degrading’, I must confess, intimes past. Many centuries, however, havenot elapsed since our elder brethren of themedical profession were not much bettereducated, and but little more worthy of re-spect. They have attained the rank in so-ciety to which they are justly entitled, andwe are attempting to follow them haud pas--sibus equis, but surely, we trust, althoughslowlv.

In the earliest period of medical historyveterinary surgery was acknowledged as abranch of the medical profession. If we maybelieve the annals of very ancient times,Chiron, the son of Saturn, and the preceptorof Æsculapius, obtained the name of Cen-taur, a strange compound of man and horse,not only, as is commonly said, on account of