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Monday, June 11, 2012

Inhalation of Vapors of Iodine

Inhalation of  Vapors of Iodine

source: "Inhalation; it's Therapeutics and Practice", Jacob Solis Cohen, 1867

~archaic terms in blue, with definitions at the end of the post

~illustrations picked up at random from the book, just because I like them:) The last one, in particular, has NOTHING to do with iodine!

The close resemblance between tuberculosis and scrofulosis, and the well-known alterative effects of iodine upon diseases of the latter character, especially as they affect the lymphatics and other glands, readily led to the employment of the same remedy in pulmonary consumption; and the volatile nature of iodine suggested its employment by inhalation, for the treatment of affections of the respiratory organs. This vapor has been found of decided efficacy in confirmed phthisis, and in certain forms of catarrh, by Berton, Sir James Murray, Baudelocque, Huette, Chartroulle, Lugol, Chomel, Laennec, Piorry, Dechambre, Corrigan, Scudamore, and many other well-known authorities.

Piorry read a paper on the subject of the treatment of phthisis by iodine inhalations, before the Academie de Medecine (Comptes Rendus, Jan. 24, 1854, see Ranking's Abstract, vol. 20, p. 70) (Archives Generales de Medecine, March, 1854, p. 361), in which he treats of it in very high terms. M. Piorry, after mentioning the circumstances inducing him to employ inhalations of iodine in the treatment of phthisis, says that the results of the experiments, instituted by himself in conjunction with M. Deyne, an interne of his service, were very satisfactory. A striking amelioration took place in many of their patients, which amelioration was permanent, inasmuch as several patients, mentioned in his work on Practical Medicine, were still in the enjoyment of good health.

The successful treatment of hydrocele and tuberculous diseases of the testicle, by injections of solutions of iodine, led to the inference of obtaining similar benefit in pulmonary excavations, but the difficulty, not to mention the temerity, of attempting the injection of tincture of iodine into a pulmonary cavity, or into the air-passages, led to the plan of employing the vapor of iodine. Sometimes the crystals of iodine were employed to evolve the vapor, and sometimes the tincture of iodine was used. In the former instance, two or three scruples of iodine were placed in a wide-mouthed quart jar, from which the vapor would be disengaged spontaneously with greater or less rapidity, according to the temperature and humidity of the atmosphere.

In other cases, one to three ounces of the tincture of iodine were poured into the jar, which was then heated until the vapors of iodine and alcohol were given off. The patients breathed the vapors, taking one deep sighing inspiration at a time, and repeated the effort from one to two hundred times daily, at appropriate intervals, several successive inspirations producing pain in the larynx and bronchi, with cough, although the single inspirations did not produce much irritation.

With Laennec, who surrounded the bed of his consumptive patients with the varec, in order to procure the iodinized vapor, Piorry, too, employed inhalations of iodine during sleep. He placed several saucers containing iodine about the patient's pillow, or attached a number of vials of iodine to the bedposts, so as to saturate the air with iodine, which is given off in sufficient quantity to blue any starched curtains that may be about the bed.

Piorry calls attention to the circumstance, that if a moist starched paper is interposed between the vessel from which the vapor is being liberated, and the patient's mouth, as he takes an inspiration, it turns blue, while the same air breathed upon the paper, after having traversed the lungs, causes no change; from which fact he infers, that the iodine which enters the lungs is absorbed there. The treatment of Piorry's cases was not confined to the iodine inhalations. Most of them took from twenty to sixty grains of the iodide of potassium by the stomach daily. In cases of supposed adhesions, frictions were resorted to with tincture of iodine, one part to nineteen parts of water. Other remedies, as astringents, opiates, and other narcotics, quinine, &c., were given to fulfil various indications; while a nutritious and reparative diet was employed, to which regimen Piorry gives a preference over all the remedies employed, except the iodine.

Thirty-one patients were thus treated during a period of two years, all presenting in different degrees unmistakable signs of phthisis, with the characteristic sputa, and positive plessimetric and stethoscopic evidences of the disease.

In order to determine with precision the effects of the iodine, some charts were prepared, upon which were marked exact delineations of the parts diseased, and representations of the variations in sound upon percussion, which occurred from day to day. After periods varying from four, six, or twenty days, to from six weeks to four months of the iodine treatment, there was in almost every case a diminution of the extent of the surface over which there was at first feebleness of respiration, dulness, resistance, &c., while at the same time, auscultation indicated an amelioration in the condition of the condensed portions of the lung. Numerous patients with cavities in the lungs were apparently cured.

The ultimate results were : decided amelioration in the symptoms and anatomical characters in twenty cases ; disappearance of the anatomical characters and of most of the symptoms in seven cases; death with or without amelioration in four cases.

M. Piorry's conclusions are as follows:

1st. The inhalation of the vapor and tincture of iodine is useful in the cure of phthisis.

2d. In many cases, such inhalation is followed by a diminution in the extent of the indurated parts surrounding tuberculous deposits, and an amelioration in the general symptoms.

3d. It is probable that tubercle itself disappears under the influence of iodine inhalations.

4th. That inhalations of the tincture of iodine may promote the cure of tuberculous cavities.

5th. That after the softening of tubercles, the resulting cavities may cicatrize spontaneously.

6th. That compression of the thorax over the points of disease indicated by percussion and auscultation, may contribute to the cure of the local lesion, and to the prevention of pyaemia.

7th. That iodide of potassium administered internally, and frictions with diluted tincture of iodine over adherent portions of the lung, are also of great utility.

Sir Chas. Scudamore found the irritating qualities of the gas subdued by the addition of a little tincture of conium at the time of employing the inhalation, a higher heat being necessary to liberate the vapors from the conium than is necessary with iodine alone.

Sir Chas. Scudamore (London Med. Gazette, February, 1840), after ten years' experience with iodine inhalations, had acquired increased confidence in their efficacy. His formula at this time was 6 grs. each of iodine and iodide of potassium, with 2 drachms of alcohol, to 5 ounces of distilled water, adding a little tincture of conium at the time of mixing the solution of iodine with the water for inhalation. He began with a drachm or so of the iodine mixture, two or three times a day, increasing the dose, if necessary.

The vapor of iodine may be inhaled from a solution of the tincture in water, by means of a Wolfe's bottle, or other inhaler, no artificial heat being necessary.

Dr. Berton's method consisted in placing into a flask with two openings, some dilute sulphuric acid, to which is added a quarter or half a grain of the hydriodate of potash ; the iodine vapors are promptly disengaged, and are inhaled by the patient from one of the tubes from the flask, the process of inhalation occupying four or five minutes, and being repeated as often as desirable, even to the number of ten times a day.

Dr. Pereira's experience in phthisis, as well as other chronic pulmonary complaints, has not been favorable.

M. Simon relates (Brit.$ - For. Med.-Chir. Rev., July 1861, from L' Union Medicale, March 16, 1861) the results of a number of cases of phthisis pulmonalis treated by M. Chartroulle with inhalations of iodine, a practice very frequent in Belgium. Under his directions, twenty-eight patients in the hospital were treated by the inhalation of the vapor of pure iodine, and of this number only eleven could be said to have derived no benefit from the treatment. In these unsuccessful cases the pulmonary lesions were not modified, but still, the symptoms were not aggravated in any case. In opposition to the statement that iodine vapor produces haemoptysis, it was found that pulmonary hemorrhage ceased more rapidly under this kind of treatment than under other plans which are more generally employed.

 Seventeen patients derived positive benefit from the iodine treatment, and this improvement was observed not only in relation to the general symptoms, but also to the pulmonary lesion itself, as was proved by percussion and auscultation. Out of the seventeen patients but four might be considered as actually cured. One of these cases of cure is the following: A youth 16 years of age, entered the hospital in such an alarming condition that at first the physicians hesitated to submit him to the iodine inhalations. He was in a state of great emaciation, and his skin was almost constantly covered with profuse perspiration ; he had diarrhea, which had lasted for two months, and he had repeatedly suffered from haemoptysis. There were very extensive indurations in the lungs, and at the apex of the right lung there was a cavity of some size, as was shown by very obvious gargouillement. The expectoration also was characteristic. After resting a few days, this young man was subjected to the iodine inhalations, and all the symptoms which had appeared so serious were soon modified in a most remarkable manner. The general symptoms disappeared first, and the body recovered its plumpness with great rapidity. The perspiration, diarrhoea, fever, cough, and expectoration, were soon relieved or removed, and six weeks after admission into the hospital the patient went out quite well.

Several other cases of the same nature are recorded from both the public and private, practice of M. Chartroulle, and in all of them the beneficial results of iodine inhalations are remarkably exhibited. Dr. Simon, who relates the cases, attributes a great part of the efficacy of the treatment to the apparatus employed for inhalation, which, however, is not described in the paper. By this apparatus, it appears, a degree of precision is given to the treatment which consequently becomes the more efficacious, for a dose of the vapor may be estimated with exactness, and the remedy may be made proportionate to the severity of the disease and the strength of the patient.

Lewin (op. cit., p. 202) had employed vapor of iodine in phthisis several times without any favorable results, but all his cases were in the advanced stage.

The inhalation of iodine vapor has been employed in coryza(the common cold). An army surgeon, M. Luc, seized with very bad coryza, attended by fever, severe cephalalgia, and excessive secretion, determined upon trying the effect of the inhalation of iodine vapor. The coryza first appeared at 9 A. M., and the inhalations were commenced at 3 p. M., being repeated every three minutes during an hour, each lasting about a minute. The headache was first relieved, the sneezing then occurring less frequently, the amount of secretion diminishing, and by 6 P. M., all traces of the coryza had disappeared, except a little burning sensation in the throat. Several of the officers have since tried the means with the same results. The inhalation is effected by placing a bottle of tincture under the nose, the hand supplying warmth enough to vaporize the iodine. (Rev. Med., August 31; Med. Times and Gazette, November 11,1865; The Med. Record, March 1, 1866.)

Dr. A. P. Merrill, of New York, formerly Professor of Materia Medica in the Memphis Medical College, and editor of the Memphis Medical Recorder, has for a number of years made extensive use of the inhalation of the vapors of iodine in mucous inflammations of the trachea and bronchi, led to the treatment by the happy results previously obtained in his own case and that of others, by its local application in a convenient form, in cases of chronic pharyngitis and laryngitis. These cases are reported in the Memphis Medical Record, vol. i, 18523, pp. 8, 21, 113; vol. iii, 1854-5, pp. 133, 187, 228, 285 ; vol. iv, 1856, pp. 252, 377.

Dr. Merrill employs the vapor disengaged directly from the crystals of iodine, which are sufficiently volatile in a current of cold air to afford all the strength of vapor that can be conveniently borne by the patient. I make a few extracts from some communications on this subject, kindly furnished me by that gentleman. " In a case of such inflammation beyond the reach of the brush, I found a patient inhaling the vapor of gum camphor through a common quill, but without much effect. I added a few grains of iodine to the camphor, and then the relief obtained was more decided; but in applying this combination to other cases, I met with a difficulty in the liquefaction of the mixture, and then determined to use each remedy separately, by placing it within a small cane tube, with a little coarse wool in each end to prevent the escape of the medicine. I have used tubes of glass, also, but found them to hold the remedies less securely. The cane tubes have answered an excellent purpose, whether employed through the medium of the mouth or the nasal passages, but more recently I have substituted tubes made of hard rubber, so rounded at the ends as to prevent irritation, and the vapor escapes through several perforations at the extremity. With these tubes, which unscrew at the middle for the introduction of the iodine, the teeth, tongue, &c, are protected from any disagreeable effects of the vapor, and the current may be made to impinge in any desired direction.

" Great benefit is derived from iodine inhalations in the more acute affections of the nasal membranes, such as coryza, hemorrhage, and catarrh. They relieve the habitual catarrh of old people, and are advantageous to public speakers and singers, whose vocal organs have become debilitated from excessive exercise in their vocations, and which sometimes show a tendency to oedema of the glottis, and terminate in aphonia."

Dr. Merrill details (Am. Jour. Med. Sci., Jan. 1866) an interesting case of symptomatic bronchial irritation, in which the iodine inhalations were very beneficial. These were made with tubes of cane in the manner previously described. He considers that the iodine acts in chronic cases by exciting a watery secretion which disengages the viscid mucus which frequently induces coughing by its titillation, and that it relieves hyperemia and hypertrophy. He has found benefit from inhalations of iodine vapor, in croup, in oedema of the glottis, and aphonia.

In cases of children, and people unwilling or unable to inhale properly, he attaches a gum hand-bellows by a rubber tubing to the tubes, and thus forces the vapor into the nasal or laryngeal passages.

Dr. Merrill has kindly furnished me with the following notes of a case of profuse bronchorrhoea, which was suppressed by inhalations of iodine.

"Mrs. McL., aged 70 years, had suffered for several months with cough, constipation, and oedema of the feet and legs, with incontinence of urine. She complained especially of excessive expectoration, which had reduced her almost to a skeleton, and it was with difficulty she could walk across the room. I did not see the matter expectorated, which was so offensive that she declined saving it, but both she and her daughter estimated the quantity latterly at a pint to a pint and a half every morning, for it was only in the morning that her cough troubled her. Beginning at three to four o'clock, it continued several hours, during which time the expectoration was free and profuse, and she often passed the remainder of the day without coughing at all.

"I gave her an inhaling-tube, charged with iodine, to be used frequently during the day and night, and directed her to take one-tenth of a grain of arsenious acid three times a day, together with half a grain of calomel at night. This course was continued twenty days with progressive improvement, when (June, 1867) she was entirely relieved of the bronchial disease, and the iodine inhalations were suspended."

Archaic Terms:

phthisis~ 1. A disease characterized by the wasting away or atrophy of the body or a part of the body. 2. Tuberculosis of the lungs. No longer in scientific use. (free online dictionary)

grains~  64.79891 mg, 1⁄7000 of a pound (wikipedia)

cicatrize~ To heal or become healed by the formation of scar tissue. (free online dictionary)

pyaemia~ a type of septicaemia that leads to widespread abscesses of a metastatic nature. It is usually caused by the staphylococcus bacteria by pus-forming organisms in the blood. Apart from the distinctive abscesses, pyaemia exhibits the same symptoms as other forms of septicaemia. It was almost universally fatal before the introduction of antibiotics. (wikipedia)

conium~ aka poison hemlock. "An old remedy, rendered classical by Plato’s graphic description of its employment in the death of Socrates. The Ascending paralysis it produces, ending in death by failure of respiration, show the ultimate tendency of many symptoms produced in the provings, for which Conium Maculatum is an excellent remedy, such as difficult gait, trembling, sudden loss of strength while walking, painful stiffness of legs, etc. Such a condition is often found in old age, a time of weakness, languor, local congestions, and sluggishness. This is the special environment that Conium chooses to manifest its action. It corresponds to the debility, hypochondriasis, urinary troubles, weakened memory, sexual debility found here."  source:  abchomeopathy

drachm~ 27.34375 gr (sixteenth of an ounce)

hydriodate of potash~ potassium iodate!

coryza~ (Medicine / Pathology) acute inflammation of the mucous membrane of the nose, with discharge of mucus; a head cold
[from Late Latin: catarrh, from Greek koruza]

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