Physiological Iodine *
Iodine as an Essential Element in the Animal Organism: Its Influence on Normal Metabolism: Its Relation to Glandular Activity, Control of Blood Pressure and Senility
By A. JUDSON QUIMBY, M.D., New York.
Iodine is one of the elements, widely distributed in nature and usually found in the form of salts or organic combination. It is one of the halogen group. It is univalent, with a molecular weight of 125.9. Its principal source is from the mother liquor of Chilian saltpetre, and the ashes of seaweed, these ashes being known as kelp. "Kelp is the ash left on the burning of seaweed" (1). Iodine is found in practically all sea foods and plants, it is also found free in sea water. It is found in the air in organic form, which may explain some of the invigorating properties of sea air. It is widely distributed in the soils, but the extreme solubility of its salts tend to reduce rapidly its proportion in the land.
The iodine preparations for internal administration consists of the soluble salts and the tincture of iodine, although the latter is popularly known as an external counterirritant and antiseptic.
The iodides, usually in the form of potassium iodide, have been rendered famous in the treatment of syphilis and its complications. At this point I wish to dismiss the subject of syphilis, forgetting that the disease exists, or that the iodides were ever used in its treatment. By so doing, a better conception of the essential physiological action of iodine and its influence upon the body metabolism and resistance to disease processes can be conveyed.
Early in my career as a student the opportunity was given me to interest myself in chemistry, and especially pharmaceutical and physiological chemistry. Therefore, when the time came in my life when I wakened to the fact that I was living a simple animal existence, without due consideration to some of the results of civilization's deteriorating influence, I was inspired to search into and experiment upon myself in such a way as to combat some of the evil results of artificial feeding and confinement in our modern homes.
Having picked up considerable information with regard to the physiological action of the various elements, I recalled that there was a constant tendency in our literature to dwell upon the efficiency of the iodides in modifying the effect of arteriosclerosis, and that it was common procedure to give the iodides in arteriosclerosis. Also, I recalled that peoples who lived along the coast and indulged freely in sea food were immune to certain diseases, and were an unusually rugged type. A physician recently informed me that he had made inquiries among seafaring men, and had found that arteriosclerosis, apoplexy and high blood pressure were very rare, and he thought perhaps the explanation of this lay in the constant absorption of minute quantities of iodine. In addition, I knew that a great many of the old time so-called spring tonics, which were so successfully prescribed by the old practitioners, contained small quantities of potassium iodide. Also, as you probably all recall, it has been mentioned that possibly one of the reasons for the efficiency of cod liver oil as a tonic and as a restorative and alterative, is that it contains traces of iodine compounds. All these points led me to think that it was not merely the quantity of iodine administered that accomplished results, but that it was a small amount given over prolonged periods that resulted in the greatest accomplishment of good. Therefore, I set myself to administer it in some form in small quantities. Knowing the sensitiveness that arises within a person to whom the use of the iodides is suggested, and also the question that would naturally come should one be accused of taking the iodides, I recalled that the tincture was a favorite method of administering iodine in small quantities, and adopted the tincture as a medium for taking iodine.
After having practised on myself for two or three years with this, and having acquired some general practice, I began to experiment in a small way with several patients who exhibited signs of vascular changes and also kept in mind the tonic properties of iodine in the management of cases needing tonic treatment. It has now been sixteen years since I first administered it with the same object. During that time I have accumulated an experience, both personal and general, which has convinced me that iodine is the most vital and efficacious element in the organism, and also that it is the element most frequently lacking in its physiological quantities.
Later in my personal experience, and especially that of rontgenology, my work exposed me to an uncommon degree to the effects of the x ray, the character of my work involving a vast amount of fluoroscopic examinations. At present, after nineteen years of x ray work, I regard myself as being in fully as good physical condition, or even better, than I was ten to fifteen years ago. The great credit of this I attribute to the consistent use of iodine. The x ray might be likened to that destructive flame of life referred to in Rider Haggard's She, precipitating a premature ageing of the organism. I regard iodine as the greatest inhibiting agent of those things which contribute to the end result, called senility. Therefore, I give practically all the credit for my present condition to the fact that I have maintained my iodine content through my rontgenological career.
Practically all the writers look upon iodine as an excitant or stimulant to the person receiving it, and therefore to be administered with conservatism for fear of the results usually found in the use of stimulating agents.
The experience and observations of Paul Bourcet are the most illuminating of any writer from whom we were able to quote. In 1899-1900 in a thesis read before the French Academy of Medicine, he gave a very thorough analysis of iodine and its action, as observed by himself and others. In conclusion Bourcet states that he believes that iodine comes externally, all the elements around us contain iodine, sea, earth and air, and all our food, and therefore, every day we get a certain quantity. He believes that iodine exists elsewhere than in the thyroid and parathyroids, but in minute quantities. When one part of the system contains too much iodine, he believes it is passed off. He believes iodine acts as a leavening agent, having antiseptic qualities.
Quoting from Maurice Lossedat, where he refers to Lortat-Jacob: "Iodine merits being considered as the specific medication of the lymphoid tissues, of which it arouses and increases the activities." Again quoting Lossedat: "The remarkable properties of iodine make it a precious medication, one of the most important of our therapeutic arsenal, one whose applications tend to become more and more enlarged."
One of the most complete books on the thyroid and thymus that has ever been published has been written by Crotti. His analyses of the experimental work of the various writers is very complete, but his views are conservative, and he does not give much credit to the theory that iodine is vital in metabolism, and especially he is conservative in his views as to its value in the general welfare of thyroid cases. But his conception is that generally held by the surgeon, except among those who are exceedingly liberal.
I think the general attitude towards the thyroid and the iodine content has been influenced very much by the various chemical analyses that have been undertaken to determine the contents of the average thyroid. This can be a great source of error, and the proof of it is in the fact that the thyroid gland varies as to, the place of residence, the mode of living, or the disease processes that may be taking place within the individual, and the prolongation of shock preceding death.
Postmortem specimens are usually taken from subjects who have died at the termination of an illness, or some active disease process, or after having been subjected to stress and strain. In any of these conditions the iodine content of the thyroid gland is used up, and if the antemortem strain has been prolonged, would naturally be very low in the element iodine.
I think we must realize that the water supply and food intake of the individual is a factor in determining the amount of iodine found in the organism, and especially in the thyroid gland. A great amount of literature has been written recently pertaining to this phase. When we speak of the mode of living of the individual and its influence upon the iodine content of the thyroid gland, we must consider the activities of the person, as to whether they live in such a way as to use up their iodine content. It is my belief that our iodine content is constantly varying, its contents being subject to, first, the amount that we receive, and second, the amount that we excrete. The amount that we receive is determined by the character of our food and the manner of its digestion and assimilation, and the amount that we excrete being determined by the strenuousity of our lives, and the influence upon our body metabolism, whether they be infections or dissipations. The amount of iodine received in the organism is determined by locality and diet. Locality varies the amount of iodine in the soil, from which we receive our water, fruit and vegetables. The iodine content of water has been proved in analyses to be very variable. It has been suggested with excellent foundation that the value of mineral springs may be determined by the minute quantities of iodine present. This has been referred to in a recent article by Emery Hayhurst (2). The resume in this article of this phase is complete.
In thinking of the iodine represented in food, I think we can vastly increase the list of fruit and vegetables which are supposed to contain traces of iodine, and I think the value of fruit in this particular has been ignored, especially some varieties. As I recall, the pharmacopoeia speaks of the values of certain roots and other iodine containers, and one of these is sarsaparilla, which is supposed to have a relatively large per cent, of iodine, and is listed among the alteratives.
The article by Hayhurst mentioned above suggests that our iodine supply be furnished with our salt, but I question this method of procedure in regulating iodine supply, except after determination of the individual's appetite for salt. If we attempt to furnish the essential iodine through the table salt supply, as suggested by him, an excess may be furnished one individual, and another may not obtain sufficient for his needs. I can cite cases in which the patients had an exaggerated appetite for salt; these cases can only be determined by appropriate tests. My reason for making this statement is that I believe that our demands for iodine are determined in a great measure by our activities. The greater the quantity of iodine consumed by increased functional activities, the greater the proportion of iodine needed. The indications for iodine have almost a constant similarity with those observed as indications of overstress and strain, among which can be mentioned exhaustion, the overtraining or going stale, as the expression is, of the athlete, and the manifestations of hypertension, which we see in the strenuous type of individual. I would here suggest that it is possible when the athlete, the prize fighter or some one subject to intensive physical training goes stale, he has used up this iodine content, is calling upon his reserve, and is not assimilating the proper amount.
My reason for this is in a measure due to some personal experiences. I have observed that when in great strain, and prolonged physical and mental effort, if a small quantity of iodine is taken, the sense of relief is immediate, and distress relieved very promptly; and if taken at bedtime the sense of well being and restored vitality is present the following clay. Also, if after a prolonged period of work, extending over two or three months, the individual has reached the stage where the need of relaxation and rest is very vital, he is supplied with small quantities of iodine, the restoration to a sense of restored efficiency and power to carry on work is very rapid. Among the consequences the increase in years brings to all of us, we find changes in blood pressure. We see that there is generally a tendency for an increase, occasionally the so-called esthenic type will be found to decrease. In the majority of cases with which I have come in contact, there has been increase in pressure, with all the systemic complications that will arise from an arterial heart and kidney distress. Although my practice has not permitted me the observation of a large number of cases, I cannot recall one single instance of high pressure that was not reduced when the iodine was properly administered in an amount suitable to meet his physical needs, and this was without regard to any regulation of diet, or rest in bed, the usual manner of handling these cases. Perhaps my good fortune has kept me clear of cases with extensive complications such as advanced renal changes. The physiological action of iodine has never been fully determined, all writers declaring that no method so far presented can solve this question. Numerous theories have been proposed, the one of Bourcet, that it is a leavening agent, approaching nearest to an explanation of the needs of its presence.
Two additional theories to explain the lack of iodine may here be proposed: Firstly, the food absorbed may be low in iodine content, but in addition the capacity of the individual's digestive system to admit the absorption of the existing iodine in the food may be reduced by the putrefactive changes in his system, which render the chemical constituents nonabsorbable.
Secondly, the number of functionating thyroid cells may be reduced by sclerotic changes subsequent to disease, or the absence of the proper amount of iodine with which to function, and the remaining cells being called upon to absorb iodine from the blood stream must have a higher percentage of iodine within the organism from which to abstract the necessary amount. That is, if the blood supply through the thyroid gland does not have an increased proportion of iodine dissolved in it, the remaining functionating thyroid cells are unable to abstract it.
Until the chemical problems in this matter are solved, we must accept the clinical experience, which is our best criterion, and give consideration to the things which occur within the patient to whom iodine is administered.
The first subjective symptoms that the individual has, following iodine administration, when there is a need for this element, is a sense of well being and of comfort, with a tendency to increase in exuberance of spirit and ambitions. The respiratory action is more active, and sensations somewhat similar to those experienced when oxygen or ozone is inhaled, occur. This is so characteristic that I have frequently heard it so expressed by patients, and have experienced it myself.
The second effect is that of an increase in the cutaneous circulation, most manifest in the patient who has a cold skin, whether dry or moist. If the hands and feet are cold, the circulation is increased, the willingness to do work and the ability to accomplish results is more manifest. If, in the lag and exhaustion that follows an unusually driving period of work, a few drops of tincture of iodine are administered for several days, the effect is almost equal to a weekend rest in restoring the mental and physical activities. Of course, at this point we may well mention that such restoration cannot harden the muscles and restore physical strength to the degree that proper exercise will produce, the greatest benefit being derived from the combination of both iodine administration and reasonable exercise.
How many of us have seen the exhausted business man attempt to reinvigorate himself in a short period of rest and strenuous athletics to which he is not accustomed? We frequently see these men almost as haggard at the end of ten days' vacation as at the end of a winter's hard work. This can be greatly changed if suitable measures accompany the vacation periods. Often the mere exertion incidental to vigorous exercise may exhaust the organism by depriving it of the essential restorative agent, "iodine."
Third, the results attained from the administration of thyroid extract can so thoroughly prove iodine to be essential to the animal organism, if we give credit to the iodine content of the thyroid gland.
Fourth, the effect of iodine administration upon the circulatory system and its associated organs can be accepted as evidence that iodine plays a very prominent part in the distribution of the blood supply. We have noted that it increases the skin circulation, that it increases glandular activity, that various functions are activated, Bourcet referring to its diuretic properties. It also increases the secretion of bile.
Fifth, the general effect of iodine on the organism in relation to ageing, which, as we must recognize, begins the day we are born with the deposit of connective tissue, and general sclerotic changes which end in the socalled senile state. As mentioned heretofore, the x ray evidently hastens all these processes, and I wish here to lay emphasis upon the importance of considering the proper amount of iodine as the most vital element in combating senile changes incidental to our growth, and those constitutional disturbances that accompany thejife of the active rontgenologist.
All this being so, we can draw some conclusions as to the function of iodine in the animal economy. I will go one step farther than Bourcet, who describes it as a leavening agent, and say that it is the activating or underground wire, which regulates the capillary circulation throughout the organism, and lack of this agent simply means that the capillaries contract, and do not permit active circulation in the part that they should supply with a swiftly flowing blood stream. Contraction of the arterioles evidently occurs throughout the organism, in all parts where they can be spared to the best advantage, leaving the rest of the organism to functionate more freely. This, naturally, decreases the power of the body to carry on full functional activities, and when the iodine supply is sufficiently reduced exhaustion occurs, and the organism must be put at rest until a sufficient amount of iodine is absorbed.
One of the effects of the decrease in iodine supply, and the contraction of the capillaries, is the increase in the effort of the driving forces of the circulation to propel the blood in its proper channels. This occurring rapidly, and for long periods, results in a rise in pressure, and arteriosclerosis, which is Nature's attempt to maintain a continuously contracted vascular system. Nature reinforces the walls of the bloodvessels with connective tissue till finally they become motionless, and subject to increased strain and stress. Calcification occurs, with all the accompanying senile changes. The senile depredations are general throughout the organism, the capillaries that should have been active in aiding elimination and promoting functional activities do not contract, and round cell infiltration occurs in these areas.
Also the general sclerosis that is observed in the aged, as in all degenerative changes, is retarded by rest, because while resting the circulatory system is relaxed, and the iodine reserve is being built up. Ageing can be retarded by the maintenance in the organism of an iodine supply proportionate to the needs of the individual, this I have had ample manifestations of in my rather long experience with this element.
There are various methods of administering iodine; we can use almost any salt or solution of the element. The most logical method of administration that I have so far discovered has been in the form of a tincture. The tincture is one that I have used for fifteen years, and have found it entirely satisfactory in all cases where iodine was indicated. This is a modification of our standard tincture of iodine. The formula is as follows:
Iodine crystals gr. xxx
Ammonium iodide gr. xx
Alcohol oz. ss
Glycerin ad. oz. q.s oz. i
M.F.T. glass stopper, pipet dropper bottle. S. one to four drops in a glass of water, once a day.
The alternative method of administration is to give the patient his month's supply in one week, dividing the dose into seven parts to be taken daily, diluted with water. The former method is preferable, but the individual's peculiarities in temperament must be considered in administering drugs. Very few patients need more than two drops a day, or seven drops for seven days within the month. The average person of middle age, weighing 150 pounds, requires one drop a day.
The prescription given above has been prescribed many hundreds of times by medical associates, with general approval, and has been found very satisfactory by them in it's constitutional effect, and freedom from gastric disturbance.
In combating this hypoiodized state, we must get away from the common practice of attempting to saturate the patient by serially increasing the dose. Instead of increasing this dose drop by drop each day, my frequent practice has been to start on about four drops for four days, and then decrease to one or two drops as indicated by the character of the patient. This produces a prompt restoration of the essential physiological iodine, and allows a continuation of a sufficient amount to satisfy the needs of the organism.
If we would estimate the quantity of iodine taken in the human economy in a year, we would probably find it to be about one ounce of the element. By following this procedure we add from thirty to sixty grains to the yearly supply, which, for ordinary purposes, will suffice the indications of the average weight adult.
•Read before the Benjamin Rush Medical Society, April 1, 1922. Read in part before the Section in Ophthalmology, New York Academy of Medicine. October 16, 1922, in the discussion of Dr. G. H. Bell's paper, The Reform Diet as a Therapeutic Measure in Ophthalmic practice.
1. National Standard Dispensatory.
2. Hayhurst, Emery: Jour. A. M. A., Jan. 7, 1922. 40 East Forty-first Street.
1 This complete paper, with translations from the European writers and case reports, will be published in reprints.
source: New York Medical Journal, 1922