Skin creams and salves

Monday, May 14, 2012

Vin Nourry Iodinated Wine

source: "Boston medical and surgical journal, Volume 164, Issue 2, 1911

Tincture Of Iodine As A Surgical Antiseptic. April 11, 1911

alternate post title~ "Iodine or Amputation?"

source: "Boston medical and surgical journal, Volume 164, Issue 2", 


Tincture Of Iodine As A Surgical Antiseptic.

~From Our Special Correspondent

Paris, April 11, 1911.

Mr. Editor: One of the most surprised preparations in materia medica at the present moment must be our timehonored acquaintance, the tincture of iodine, and there is no gainsaying the fact that it has sufficient grounds for a meditation on the uncertainty of the things of this world. During all the earlier half of the last century this familiar reddish-brown liquid was one of the most important remedies in medical practice, so much so that in 1855 a certain Boinet published a large volume of eight hundred and thirty-five pages about it, entitled "Trait d' Iodotherapie." Already at that time its remarkable antiseptic properties had been noted; fetid pus had been seen to lose its noxious qualities under its influence, and compound fractures had been found to heal without any of the terrible complications so frequent in those times when treated with tincture of iodine. In a word, it seems as though at that period the antiseptic era was on the point of being discovered, in connection with this preparation, some twenty years before the Pasteur-Lister day. The opportunity was there; all that lacked, apparently, was the man with sufficient perspicacity to descry the great discovery that was staring him in the face. That man, however, was not forthcoming. The reign of phenol, sublimate, formal and peroxide began, iodine tincture was practically relegated to the old woman's arsenal, and this marvelous preparation descended very nearly to the level of arnica and chamomile tea!

This period of oblivion lasted for nearly forty years, but now, by the agency of one of those disconcerting turns of the wheel of fortune, tincture of iodine has once more been raised to a position of real eminence in medicine, and suddenly — within the brief space of a couple of years. In this short time it has not only regained the rank in the medical world that it ought never to have lost, but its penetration into the masses has been so deep that it has attained even to such remote regions as the cerebral substance of society women. One of them got her finger-end caught in the door of her carriage the other day and gave it a pretty lively squeeze, producing a small wound par eclatement. When I arrived I remarked in scornful tones, "What in the world did you put arnica on it for?" She was generous in her triumph, that I must allow; for of course she had a lovely chance to make some withering reply. All she said was, "Oh no! that isn't arnica; I drove to the nearest druggist and had the finger painted with iodine!" "The devil you did," thought I; "if these Red Cross lectures continue to rage throughout the land, the future of the medical profession will soon be even less roseate than it seems at present. For the idea is to me not inconceivable that within a delay that is really more or less proximate, the physician is going to have to make his choice between some of the side-branches of his calling, — electricity, radium, x-rays, or mind-treatment, — or harakiri after the scorpion method. Certainly if I had a son who was going in for general medicine, the utmost degree of sympathy at my disposal would be extended toward him, as I think he will see the time when his profession will no longer be a living proposition.

Tincture of iodine, then, has been discovered to be the most marvelous antiseptic known, and, — details that enhance its virtues many times over, — one whose use is simplicity itself, that can be found anywhere and that can be safely put into almost any one's hands. From one point of view it has a similarity with salvarsan in that it is of particular use in very difficult cases, cases that proved almost beyond the resources formerly at our disposal. This will be referred to in a moment; for the present let me cite an instance or two that have come to my ears recently.

One of the younger surgeons here received an urgency call the other day to come at once to such and such a hospital for an amputation. When he arrived he found a man who had got his right hand badly crushed in handling wine barrels, with various fractured bones and wounds, the whole region being, of course, as dirty as possible. It had never occurred to the interne that any other treatment than amputation or disarticulation was to be considered; yet, with simple iodine paintings, this man made a perfect recovery with a quite serviceable hand.

Another surgeon friend of mine went one afternoon to see a lady patient on whom he had operated a short time previously for appendicitis. She told him that her last monthly period had missed entirely and that she was now feeling considerable pain in the pelvis. On examination he found a small mass back and to one side of the uterus, diagnosed extra-uterine pregnancy and told her she must have it removed without delay. That same; evening at ten o'clock he was called to see her again; pain had increased and her condition and appearance had alarmed those about her. The fetal cyst had evidently ruptured during the evening, the patient presented all the signs of serious internal hemorrhage and my surgical friend found himself in presence of as serious an emergency case as any one need desire, as it is not easy in Paris to get anything done in a hurry. However, by dint of heating up the telephone wires he managed to get the patient transported to a clinic and his aids assembled by one o'clock. By that time his unfortunate patient's condition was highly critical, the bleeding was evidently continuing and there was no time to lose. It is easy to conceive that with the former methods of preparing an abdomen for laparotomy, the loss of time, combined with the rough handling necessary to throughly brush and scrub the skin, might have given tliis patient the finishing touch, whereas in this instance, while the surgeon was slipping on his sterilized India-rubber gloves, the assistant simply painted the abdominal surface gently with soft gauze dipped in tincture of iodine and held in a forceps, there was not the slightest delay or mauling of the patient a rapid incision revealed an abdominal cavity filled with blood, the cyst was clamped at once, the usual means of treating severe loss of blood could then be brought to bear, and the surgeon was master of the situation. Such a case as this must, I think, be one of the surgeon's keenest satisfactions, a case in which he is authorized to feel that but for his intervention his patient would have succumbed without doubt in another hour or two. This same man operated an umbilical hernia in a dog for me the other day with the iodine process without even shaving the region; it seems that this is current practice in the experimental laboratories now.

The iodine tincture of the French pharmacies is a one in ten solution in alcohol. It should, whenever possible, be procured fresh; when old it is subject to two secondary processes whereby it becomes stronger and more likely to irritate: the development of hydriodic acid, and concentration through alcohol evaporation. The question is being studied whether it is really necessary to use this one-tenth solution; whether, for instance, this could hot equally well be further extended with alcohol to at least one-twentieth, or whether aqueous solutions obtained with iodide will not be just as efficacious.

 For although it has proved to be one of the safest of all antiseptics, we all know that there are certain patients with a marked idiosyncrasy for iodine with whom small doses produce the most alarming symptoms, and in particular those of edema of the glottis. Thus in the case in point I personally have heard of one patient with whom a most distressing and persistent generalized eczema was brought on by a single application of tincture of iodine; and of another who actually succumbed from acute iodism under the same circumstances. Because, not only is the iodine being applied on normal surfaces, as in the above extra-uterine pregnancy case, or as has been done by different surgeons in emergencies when away from all facilities and they have painted their own hands in order to operate; and not only is it used on open and crushed wounds, and even on extensive denuded surfaces such as burns, but it is applied to severe solutions of continuity, such as a scythe wound, the surfaces being stitched together a few minutes later, and it is also injected into suppurating cavities or fistulas. Under these circumstances a certain amount of the iodine must remain behind; so that if an equal effect can be obtained by a less active solution, it is certainly to be desired that this point should be demonst rated as quickly as possible.
There is a trifling artifice that it is useful to know, in order to have it at one's disposal in instances when a modicum of mind-cure is necessary. Certain families keep tincture of iodine in stock and use it themselves on all occasions, just as others do their precious Pond's Extract or Antiphlogistine. One woman I know here gets Pond's Extract over from America by the demijohn, and has the most absolute faith in its virtues to cure nearly every affection her large household of family and servants presents. To prescribe to such a person a remedy that she is in the habit of using herself would simply be to lose caste in a very precipitous fashion; whereas if you sit down and gravely formulate:

 Metalloidic iodine, 3
   Spirits of chloroform, 30

the effect will be magical, as the druggist will sent her a beautiful cerulean blue solution which you caution her to apply with great care as it is very active, whereas it is in reality nothing but the familiar old one in ten tincture of iodine!

A point that I have been turning over in my mind is whether this preparation may not be excellent for medical use, and in particular for tonsillar affections. The peculiar efficacy of iodine tincture is said to be due to its marked power of penetration, which in turn depends on its alcoholic vehicle; to be really efficacious, then, it should be applied to a perfectly dry surface, all previous cleansing by washing, soaping, etc., impeding its action. Now in the throat a dry surface could scarcely be obtained; but by first carefully wiping off the tonsillar region something approaching such a condition could be produced; besides, the tonsil is not protected by any hard layer of epidermis. I have often used in the throat a preparation consisting in one part of tincture of iodine to two of glycerine, but have never been able to see that it accomplishes very much. This is perhaps due to a peculiarity that we find in phenol, which seems to lose many of its properties, causticity, toxicity, etc., when combined with glycerine. It will be interesting to see how the tonsil reacts to pure tincture of iodine without the glycerine.

I remarked above that the tincture of iodine is particularly effective in the very worst cases, and the type of these is the mechanic or train-hand, who gets one of his extremities mashed in the course of his work. Not only do these accidents present the very worst forms of lesions, — mangled and torn tissues, open articulations and compound fractures;—but the damaged region cannot be otherwise than in the filthiest possible condition. These cases, also, are generally somewhat long in getting to the nearest help, particularly in a railroad accident out on the line. It has really seemed to me worse than useless to attempt to clean up such an affair as a mechanic's hand mashed in a machine. Will not the cleaning send into the open wounds more germs than are there already? My surgical friend assures me that by filling up all the wounds with strips of sterile cotton soaked in some antiseptic fluid, and then operating with care, patience and benzine, the thing can be accomplished; so I suppose we shall have to take his word for it. But however this may be, all doubts of the sort are removed with the iodine process. Here, the less you do the better. No cleaning at all; at the most remove fragments that are bound to go any how, and be chary about this, for I think that the longer we live the greater becomes our respect for what nature can do at a push, then paint everything, — skin wounds, fractures, — carefully with the tincture, not being afraid to go over a surface more than once, and pushing it into every nook and hole. Over that, chiffonmr a lot of light gauze, then some cotton-wool, and a bandage, and the trick is done. 

Nothing simpler could possibly be desired, and a Trousse of this sort, with brief directions, could easily be on every train and in every factory. Strange to say, the pain connected with the application is really insignificant; it can be spread over large burns with equal results. Fancy the revolution this process is going to effect in first-aid ambulances near the firing-line in war time!

What happens, then, after such a dressing as this? The tincture appears to give rise to a profuse serous discharge, which is taken up by the chiffonnee gauze, which must not be protected by any hermetic tissue. Usually such a first dressing can be left in place for twentyfour hours, though of course, if the discharge soaks through the gauze, this can always be removed, and as often as desired. The next day the dressing is changed and the tincture applied again. This daily change is continued so long as the discharge lasts, which is, as a rule, from four to five days. The surfaces then become dry and the dressing and painting need only be done every three or four days.

The cases of recovery that have been reported under this treatment sound really more like fairy tales than serious surgical work. What do you think, for instance, of a compound, comminuted fracture of the leg that had been carefully cleaned, reduced and sewed up by a surgeon, but when his effects failed lamentably and gangrene set in, this was opened by another man, thoroughly painted in every corner, and recovered!


Tuesday, May 8, 2012

Praying for a cure

Hmmmm... an interesting story from an old children's magazine. The moral of this particular story seems to be to be very specific in your prayers.

And to take your iodine!

From  "Golden Hours, A Magazine for Boys and Girls", 1878

LISA rose early, with her mind fully made up. She slipped on her skirt, took her apron and bodice in her hand, and patted down a rocky path which led from Mere Gillott's hut to a spring. Kneeling down by the hand-wide stream which trickled from the spring, she bathed her face, arms, and bosom, and said her prayers, looking toward the east. She wiped her smooth, fresh skin with her apron, and smoothing back her hair, gave it a twist under a kerchief. Then she put on her apron and bodice, and her toilet was made.

Lisa did not know much about the world. She thought all earth was a mountain, with bits of huts dotted here and there, and the universal holidays only such as were kept in her native canton. There was nobody to teach Lisa. She lived in a little hut with Mere Gillott, who was a bent, half-alive old lace-weaver, more ignorant if possible than Lisa herself.

It was a Church holiday, and Lisa had permission from her mistress to spend it in the usual way, in games with the boys and girls, and in company with the whole population, who left work and devoted that day to prayers and feasting and sociability.

After making her toilet she looked very sweet and pretty, though she had neither shoes nor hat. Her wooden shoes must be kept for the cold Winter; her sun-tanned feet must go bare in Summer. Some of the girls who would gather at the festival would wear shoes—real shoes!—but Lisa was not envying them or even thinking of them. She went into the hut. Mere Gillott slept still; her feet moved softly over the earthen floor; she got a thick slice of black bread, a round ball of Swiss cheese and a cup, then she went to the door and called the goat. The goat came near, and Lisa milked some of the thin milk into her cup, and sitting on a stone, ate her breakfast.

The sun was now rising. The air grew lighter, and warm with splendors. Long slants marked distant peaks; the mist rolled cloud over cloud down into hollows. By the time Lisa's breakfast was eaten the sun sprung above the horizon. She now took the garden sickle, and went to the sweet marjoram bed. She cut her apron just as full as she could carry it of sweet marjoram. It was heavy with dew, and Lisa dipped her face into it with delight.

She was now ready to start. But not to the merry-makings which would be kept around the church. She was going up the mountain, on what many would call a superstitious errand. As she came out of the garden, and turned toward the hut to hang up her sickle, the goat clattered up and thrust her nose into Lisa's apron, nibbling the pretty green and white herb.

"Begone, Nanine.'' said Lisa; "this is not for such as thee."

She pulled out a handful for the goat, and hung her sickle on the nail. Then she look the winding and devious path which led up the mountain.

Mere Gillott's hut stood close by the Avail which surrounded an old chalet. Here lived the minister, whose family were all dead, and his housekeeper, a woman so old that nobody in the region pretended to guess at her age. Nevertheless she was still brisk and sharp-eyed. The girls were always glad to sit in groups and hear Mere Grisa talk. Her experiences were marvelous, and they gathered up the very crumbs of her superstition and treasured them.

A few days before the festival Mere Grisa condescended to chat with Mere Gillott. The minister's housekeeper wore a high black cap; the old Gillott had nothing but a black kerchief to her head. Lisa watched them nodding and chattering toothlessly, and wondered how it would seem when she, too, was old. How would she like to have her plump cheeks curve in instead of out? to go bent over, leaning on a stick or crutch? to see her hands and arms shrivel, and all things grow dimmer than they were at present? She did not like the thought. She loved being young and buoyant and strong. She loved to feel her limbs full of spring, and to see such long distances. On the other hand, however, one can not have experiences without growing old, and how all respect the dignified aged!

"It is true," said the somewhat childish old Mere Grisa to Mere Gillott, "I have seen it happen thus again and again. If any one has a heart's desire which he wishes to accomplish, let him try it. Why, there was the mountaineer, Hochuly. His girl wandered from him. Not one in the canton could tell where she was. He roamed aimlessly up the mountains. Not a chamois could tempt him. Then some one—it may have been my great-grandson, Ernst—told him what Mere Grisa knew of the shrine. 'Take an offering there,'said Ernst, 'and you will get your heart's desire.' Hochuly roamed about till, being near the shrine one day, and the words ringing in his ears, he hunts edelweiss and lays it on the shrine. Then, as a Christian man should, he said his prayers, and when he got up from his knees there stood his child Marie, and they flew into each other's arms."

"Yes, yes," said Mere Gillott, "I have heard the tale."

"Where is the shrine, good Mere Grisa?" hastily put in the listening girl.

The old dame peered up at her from under bushy eyebrows.

"And what hast thou to do with a shrine?"

"Why, if folks get their heart's desire by laying such offerings as they can get upon it, I have a heart's desire, and I will go there—yes, and take my ear-rings, if they would do."

"Prut!" ejaculated Mere Grisa. "What are they, little trumpery ear-rings. Art an idol-worshiper, to lay metals and such earth upon a sacred shrine? Take something green and flourishing—something the good God has fashioned, and not a trinket made by man, such as papists deck their waxen figures with. I fear thou ait too rattlebrained to be sound in the faith."

Lisa colored, and her eyes filled.
"I did not know what to take," said she. "My ear-rings are all I have, except my bodice and kerchief and apron and skirt. I would give any thing for my heart's desire."

"Wouldst, eh? Well, what is thy heart's desire, silly thing? A new apron and bodice, and a lover to fill thy head with flattery."

Lisa's face flamed indignantly. "O Mere Grisa! why do you judge me so cruelly? I do not look at any of the young men, and they do not look at me."
"Pooh! it's natural; it's natural", chuckled the old woman.

"And my bodice and apron are quite strong yet," continued Lisa.

"Then what is left for such a chicken as thou art to desire?"

Lisa hung down her head.

"Come, I'll not tell thee where the shrine is unless thou tell what's the heart's desire."

"Mere Grisa, I have a sister—Claire."

"With thy old grandmother, who lives beyond the pass?"

"Yes, Mere Grisa. She is—" Lisa hesitated.

"So I have heard," said the old woman, nodding her head. "Well, and what of that? If she is a cretin it can not be helped."

A tear like an angel's finger traced a bar down Lisa's face. Mere Grisa dimly saw that glistening track; she had a kind old heart.

"Well, child, I was only telling the Mere Gillott that if a believing person goes to the calvary at the light hand side of the Two Brothers' Pass, and takes some little offering in the hand, the heart's desire shall be appeased. It is only a saying in this region. We who are old never expect impossibilities."

"But I know the Two Brothers' Pass," cried Lisa, eagerly, "and I know the shrine. I was once up the mountain as high as that. It is a very old wooden cross fastened in a pile of stones. The figure was blown off it long since, they say."

In consequence of this gossip with Mere Grisa, therefore, the girl set out, as I told you, on this holiday morning, and her destination was not the motherly old church, but the high cross, standing lone on its heap of stones by Two Brothers' Pass.

Lisa clambered cautiously. Her bare feet were hardy, but some of the goat paths were quite steep and full of jagged points. When she had ascended some distance she felt more exhilarated than ever. Some of the people were already gathering to the fete below. Usually Lisa was ready for play and merry-making too. She was too full of her errand, however, to think an instant of play now. She believed that her heart's desire would be given her as soon as she reached the shrine and put down her bundle of sweet marjoram.

"Not on account of the sweet marjoram, though," murmured Lisa. "I did not know any better thing to take. I will ask very distinctly that Claire may be cured, that she may never be a simple cretin any more. What other real heart's desire could I have? I would willingly wear this apron and bodice till I die if Claire could be like other girls. Oh, to see her look up clear and bright at me, instead of dull-eyed, and that horrible pouch hanging from her throat down upon her breast! If Claire were not a cretin, if the goitre were gone, how happy we might be! All our lives we could take such comfort with each other. I wish I had known about this making offerings at the shrine long ago. Why, I would carry sweet herbs up the mountain every day, after my work is done, as long as I live, if Claire could be cured!"

In the simplicity of her heart Lisa continued, as she toiled up and up:
"As soon as I lay the bundle of herb down, I wonder if Claire will stand there cured
as the old mere tells of Hochuly's Marie. Marie appeared to him that moment. How rejoiced I should be! What pleasure it is to look forward to happiness! Shall I take her to the fete? How astonished all would be to see poor Claire standing erect, no goitre upon her poor neck!"

The devious path wove back and forth like a slim shuttle across the dark loom of the mountain. The sun did not grow hot. In that high latitude Lisa would not have been too warm had not exercise opened all her pores. She climbed until past noon, and then sat down for a few moments to rest.

It was a long way to the entrance of Two Brothers' Pass. She never had approached it by this route before, and began to wonder if she were going right. It was much easier to think of making the ascent than to make it.

Lisa had some bread and cheese in her pocket, and she nibbled at it. Then gathering her marjoram closer, she climbed on. Perhaps the lines of her face drooped a little. She grew very tired; but her faith in her errand was great—strong enough to move the mountain itself.

It was late in the afternoon, when the lone wooden cross started out of a cliff side upon her sight. How drear upon its heap of stones! Lisa toiled up to it. Her fair holiday was two-thirds gone. Here was the goal of her efforts. The last quarter league was longer than any other part of her journey. She approached the foot of the pile of stones. It seemed that the story of the region had had other believers.

 Some bunches of dried flowers lay on the stones. A pin-scratched bit of writing was on one of the round stones. Lisa stooped and looked at it, but she could not read, and therefore did not know that it said in blasphemous French:
"Whoever is superstitious fool enough to come here as I did, will go away a convicted fool, but less superstitious."

Lisa looked up at the cross. It must be very lonely in the dark nights. It half-terrified her. She spread down her sweet marjoram on the stones. Then she knelt by it, and told her heart's desire fervently. The mountain echoes handled her little voice very softly. She got up and looked around, really expecting to see Claire, goitreless and lovely, standing close at hand. No one was near her. Her heart turned sick. She got down on her knees again, and waited with a patient waiting. Time moved over the mountain in silence.

"Lisa," called a voice, very tenderly. Lisa turned her head and saw the spiritual, beautiful face of Kaspar, the young mountaineer, who lived nearest her grandmother's hut. He was standing leaning on his alpenstock, his eyes full of sympathetic knowledge of what she was doing. She rose up again, and exclaimed, eagerly:

"Where is Claire?"

"She is cured," said Kaspar, approaching. "I was coming by the Two Brothers' Pass to fetch you to your grandmother's."

"But why didn't Claire come too?" cried Lisa. "When did it happeri? How does she look?"
"I have not seen her since she was changed,"said Kaspar; "but I should think she looked beautiful and happy. You were saying your prayers at the old cross for her, were you?"

"Yes: I was praying that the goitre might leave her, that she might get well and stay so always."

"Well, come with me," said Kaspar; "the change has been made, but you must get accustomed to it."

In time Lisa stood by the bed and looked at her Claire; and the tears trickled down her young, sweet face, but her heart could not break as it might have broken once if she had seen Claire lying before her dead.

The goitre and the idiocy were truly cast off by her sister; even Claire's dead face looked fairer than it ever did in life, and somebody had covered the hideous swelling of her neck. The old grandmother was bustling about the hut; she wiped a tear or two, but Lisa was her favorite, and she did not love the idiot girl as Lisa did.

"She's gone," said the grandmother.

"Cured," breathed Lisa.

"Yes, cured," said Kaspar, putting a hand on her shoulder, "only better cured than you thought to ask for her to be."