Iodum, a non-metallic element. (I). Iodine and the iodides.
SUSCEPTIBILITY to the action of iodine varies very much in different individuals. The most constant and conspicuous effects are upon the respiratory and buccal mucous membranes and the skin.
Beginning in the nose, swelling of the mucosa extends up to the conjunctiva and down to the larynx and bronchi; watery discharge, sneezing, feeling of fulness, aching over the frontal sinuses and lachrymation are induced; oedema and ulceration of the larynx may cause dyspnoea, and bronchitis with watery secretion similar to that of the nasal mucous membrane causes cough and dyspnoea. OEdema of the lungs and pleural effusion may develop. The skin rash is chiefly pustular, accompanied by erythema; eczema, vesicles and purpuric spots may also occur.
The iodides are somewhat diuretic and in sensitive subjects may cause albuminuria, cystitis, urethritis and vaginitis. Iodine and the iodides stimulate thyroid secretion, and in this indirect manner may cause many of the symptoms of hyperthyroidism. All the iodides produce iodism irrespective of their basic ion.
Poisonous doses, after injection into cysts, &c., may cause vomiting, thirst, cyanosis, and surface coldness, with skin eruption, small, feeble, rapid pulse, suppression of urine and death. The mucous lining of the digestive tract is found to be swollen and detached from its basement membrane, or at least loosened, and fatty degeneration of the kidneys, heart and liver is produced.
The general effects of the prolonged administration of iodine and the iodides in small and medium doses are as follows: Emaciation and marasmus, atrophy of glandular tissue as found in lymphatic glands (especially the mesenteric),the testes, ovaries and thyroid. This appears to occur after primary stimulation and painless swelling. Prostration with excitability, nervous and muscular trembling, twitching and restlessness come on and are likely to be followed by apathy. Pyrexia, thirst and profuse night sweats are found; also chronic joint affections. The skin becomes dirty yellow in colour, and either dry (with thyroid deficiency) or clammy. Aggravation at night and in a warm room, sleeplessness after 3 a.m., and relief in the open air are characteristic modalities of iodine.
Mental and Nervous.-Nervous excitability and restlessness, mental and bodily, are conspicuous. The prover (or patient) wants to move from place to place. Afterwards, or even accompanying the excitability, sadness, amounting to melancholy,comes on; the patient is anxious and shuns and dreads everyone. With this there will be probably be a general confused feeling with inability for mental effort. In inflammatory conditions delirium may occur.
Head.-Vertigo is frequent.
There are three or four distinctive headaches: (a) Pain as from a tight band round the head; (b) frontal headache, concentrating just above the nose, or on the talking; (c) mid- morning headache, chiefly occipital, worse from movement and relieved by rest; (d) a throbbing headache, felt all over the head, accompanied sometimes by pulsation all over the body and associated with prostration, tremor at the heart and fainting, worse from change of posture or occupation if the change alters the heart-rate, in either direction. In this particular the local symptom of headache does not conform to the general modality of restless desire for change of posture and place.
Eyes.-Protrusion of the eyeballs, as in thyroidism, oedema of the lids, and conjunctival irritation with flow of tears are among the eye symptoms.
Nose.-The catarrh already referred to has the peculiarity of being fluent in the open air (hydrastis) and dry towards evening (especially indoors). It may occur in violent spells with sneezing, lachrymation and even cough, and tight, wheezing breathing.
Face.-The complexion is apt to be of a pale yellow or greenish hue.
Mouth.-The gums are soft and bleeding, the breath offensive, and the tongue has a thick coating.
Throat.-Besides the irritations of the mucosa of fauces and pharynx there is a feeling of constriction which makes swallowing difficult. The inflammation and ulceration of the throat may extend down the oesophagus.
Digestive System.-The most pronounced subjective symptom is ravenous hunger, which cannot be satisfied; in spite of this big appetite the patient continuously lose flesh. Thirst and heartburn also occur. Pain in the upper part of the abdomen and hardness and tenderness on pressure are felt in the epigastrium and either hypochondrium. The inguinal and mesenteric glands may be enlarged. There is a tendency to diarrhoea, with watery and frothy stools, but spells of constipation may alternate with it.
Genito-urinary System.-Urination may be frequent or involuntary. The sexual glands in both sexes (as stated) may become indurated (especially the testicles) and they may become atrophic either secondarily to the swelling of primarily. The latter refers especially to the breasts. Uterine haemorrhage, renewed after or with every stool, and very acrid leucorrhoea, irritating wherever it touches neighbouring skin, are noteworthy.
Respiratory System.-The respiratory symptoms are such as arise from the irritation of mucous membranes already referred to-hoarseness, aphonia, pain in the larynx, with cough which may be croupy. Dyspnoea, especially inspiratory, from constriction or swelling of the glottis may be accompanied by dry, barking cough, as in laryngitis or diphtheria. A patient throws back his head or grasps at the larynx (especially children)- devices instinctively adopted to remove laryngeal obstruction. This is an obvious explanation of the manoeuvre (when it occurs), but the symptoms is of value as indicative of certain drugs, because it does not occur in all patients with laryngeal affections, or under the influence of all larynx-affecting drugs. The laryngeal symptoms are said to be worse in the morning, but there are no very striking modalities in connection with the respiratory system.
Circulatory System.-Precordial anxiety and restlessness, forcing change of position (contrast headache “d”), should be borne in mind. A further degree is the sensation (produced also by cactus, lachesis, &c.) of the heart being grasped or constricted, ” as if in a vice or by a hand” is the provers’ expression, oppressive pain in the cardiac region is somewhat similar. Palpitation occurs from the least exertion or from coughing. Sharp, piercing pains shooting about the chest appear to be neuralgic.
Limbs.-Apart from skin affections in these parts there is little to record. Trembling of the limbs when used, as part of the general prostration; tearing pain in the left elbow, oedema of the feet and acrid foot sweat are the chief symptoms.
Iodine is used by surgeons to disinfect the skin before operations. It is also used a a counter-irritant in inflamed joints, &c., and has the advantage of being both mild and enduring in its action. Internally iodine and iodide of potassium and sodium have been used in goitre, and, when there is a deficiency of iodine in the food or water, to prevent the onset of goitre. In goitrous districts it is given added to table salt in infinitesimal quantities, or administered to children separately in doses of 0-2 grm. for ten days twice a year. The chief use of iodine in orthodox practice has been its administration in the form of iodide of potassium in the treatment of tertiary syphilis. It is invaluable in causing absorption of syphilitic gummata and other low-grade tissues occurring in syphilis from irritation caused by the spirochete of syphilis, such as syphilitic bone disease or ulcerations. Large doses are given for this purpose, 30 to 80 gr. a day, and the results,especially in gummata of the brain, are often striking. It is also of great service in syphilitic arteritis, especially of the aorta, and in angina pectoris and aneurysm due to this condition. The beneficial action of iodides in syphilis is owing to their causing absorption of the diseased products and not to any parasiticidal action on the spirochaetes. It has a curative action in actinomycosis and sporotrichosis, similar to that it has in syphilitic gummata, and has been used a good deal, but will less certain result, in chronic rheumatic affections of the joints and some skin diseases. Iodide of potassium is given in some cases of bronchitis and asthma as an expectorant to render the bronchial secretions less tenacious, and also in cases of chronic lead and mercury poisoning, as it forms soluble salts with these metals and thereby aids in their excretion.
HOMOEOPATHIC experience suggests that subjects with dark hair and eyes (bromine, light complexions), and “scrofulous” persons, especially children, are most sensitive to the influence of iodine. Iodine has been seen to induce (temporarily) a condition of hyperthyroidism, and clinically the group of symptoms forming that picture should be benefited by the drug in minimum doses, provided always that the condition is not due to some form of iodine stimulation. A complex of symptoms may be present calling to mind those due to this drug, and they may have syphilis or tuberculosis as their underlying cause; in either case iodine requires very careful consideration. In many of these conditions it has been used in orthodox practice in substantial doses. This fact, together with a paucity of indicative modalities, accounts for its not being much used in homoeopathic practice, but in some of these cases its use may be unconscious homoeopathy. If this be the case, it would suggest that the dosage of drugs may vary widely and that the same drug may require widely different doses in different maladies, while still “acting homoeopathy.” As “spongia” iodine has a definite place in “croupous” coughs-see that remedy.
The mental condition of iodine patients is characterized by anxiety combined with restlessness. The anxiety is of impending evil or of threatening insanity, and the effort to control such feelings increases them-this is important. Some physical outlet of activity must be found as a safety-valve for the mental tension or “anxiety.” Failing such outlet,sudden irresistible impulses to violence of one kind or another may supervene- impulses to destructiveness, to murder or suicide.
The simplest and readiest outlet for energy is walking-such patients “cannot keep still,” so they “walk night and day” (Kent, op. cit.). While the patient requiring pure iodine soon tires and sweats easily, one requiring an iodide walks long distances without fatigue, reminding one of the irrepressible energy of some general paralysis cases, but not arising from grandiose ideas. Short of this state, verging on insanity, the iodine patient may be excited, always in a hurry (arg. nit. and lilium), impulsive, with a tendency to injure people without any cause. Arsenicum and hepar sulph. patients have similar traits and impulses.
If the patient is wasting and has a shrivelled, sallow appearance, iodine would be additionally indicated, and in this connection one of the iodum modalities comes out-aggravation from warm rooms and heat generally; the patient longs for cold bathing and is comforted by movement.
The headaches of iodine have been described in the pathogenetic section. The throbbings are not confined to the head, but occur in various localities or all over, even to the finger-tips.
Though the patient’s nervous state is soothed by movement the headache is made worse.
Eyes and Face.-In addition to the protrusion of the eyeballs, which should bring to mind iodine as a possible remedy for the case, conjunctivitis, simple and phlyctenular, may require that drug in persons who are suffering from marasmus and are of a strumous or tuberculous “constitution.” Enlarged cervical glands would form an added indication. OEdema of the lower eyelids and of the face immediately below, with dilated facial capillaries, are found in heart cases requiring iodine; bluish lips may also be indicative.
Nose and Throat.-Nasal catarrhs having the peculiarity of being fluent in the open air and dry indoors are curable by iodine; also ulceration of the mucous membrane, with sanious mucous discharge and ozaena. Liability to constant colds in the head without the slightest apparent cause is a feature in iodine candidates. It has been used with success in diphtheria, in follicular tonsillitis (especially as the biniodide of mercury). An aphthous condition of the mouth and throat in debilitated patients suggests iodine as one of the likely remedies. Although swallowing is painful the patient craves food and drink, and is always worse from fasting. A swollen or oedematous uvula may require the administration of this remedy.
Digestive System.-The indigestion benefited by iodine is first, catarrh of the stomach, duodenum and common bile-duct with slight jaundice; it goes on to atrophy of the mucosa, from which little food is assimilated. In spite of occasional vomiting and chronic morning diarrhoea (with pale, offensive stools free from bile) the abnormally large appetite keeps up, but the inevitable loss of flesh persists until it amounts to definite emaciation The abdomen sinks in and enlarged mesenteric glands are revealed. At any early stage empty eructations are annoying, especially night and morning. Another form of stool is watery and frothy, with fatty globules or particles floating in it, suggesting involvement of the pancreas. The underlying cause may be tuberculous. Or a condition resembling hypertrophic cirrhosis of liver develops, with flatulent distension and jaundice, ultimately ending in atrophic cirrhosis and ascites. Exceptionally the bowels may be constipated with ineffectual urging and much flatus.
Respiratory System.-The named diseases in which iodum has proved strikingly useful are: (a) Laryngeal conditions, with “croupy” breathing and “croupy” cough, including simple laryngitis and membranous or diphtherial states, with hot, dry skin; (b) whooping cough; (c) bronchitis; (d) pneumonia, especially of the upper lobe of the right lung when the characteristic sharp pains and other bryonia modalities are absent; (e) phthisis pulmonalis.
Genito-urinary Tracts.-The urinary tract is, perhaps, least affected of any by iodine. Frequent micturition, with large quantities of urine of yellowish-green colour is found in some iodine cases; the polyuria and emaciation have led to its use in diabetes. Incontinence of urine in old people with prostatic hypertrophy may be benefited by the remedy. It has been used in chronic inflammation, induration and hypertrophy of the genital glands in both sexes, but it is not clear for what particular pathological conditions it is most useful. The use of iodine and iodide of potassium for syphilitic gummata has, by some, been claimed as homoeopathic, but the dose if used on pathological grounds requires to be substantial if not massive. It is certainly not a homoeopathic “specific” for tertiary syphilis, and if homoeopathic at all it will only be so in those patients who manifest what has been called the “iodine constitutional state,” which will be summarized later on.
In men, especially old men, it may be indicated where there is present weakness or impotence combined with a state of sexual erethism, whether the testes are atrophied or “hypertrophied.”
In women the drug has been more used homoeopathically than in men. Acridity of secretions is an iodine characteristic, and it is strongly manifested in catarrh of the female genital canal. The leucorrhoea which it causes is extremely excoriating, causing redness and soreness of the muco-cutaneous junction and adjacent skin areas. This discharge itself is thick and slimy and blood- stained, and it is worse near the menstrual periods. The drug has been recommended in cancer of the cervix, but the present writer does not personally know of results to support that recommendation. It may be relied on where the above indications are present in cases of cervical erosions and hypertrophy from uterine subinvolution of the traumatism of repeated child-births. If a small atrophic condition of the breasts is part of a constitutional state (marasmus) indicating iodine then their size or activity may be restored by its exhibition as part of the rehabilitating effect of the drug. If the patient has passed the menopause only an adipose deposit corresponding to improved general nutrition can be expected.
Menorrhagia has been successfully treated by iodum, and one indication in this sphere is recurrent or excessive flow after an action of the bowels.
Fever.-Of febrile complaints those in which iodine is most frequently useful are subacute or chronic malarial cases, influenza induced by damp or chills, respiratory cases as narrated and gouty attacks. Profuse night sweats in debilitated subjects may occur in any of these cases.
Circulatory System.-The heart and vascular symptoms point more to reflected influences and to cardiac myopathy than to valvular lesions. They are violent palpitation and throbbings felt all over the body, precordial pain, oppression, anxiety and restlessness. The heart feels as if grasped as in a vice; the pulse is small, rapid and irregular. The pain, constriction and pulse suggest the usefulness of iodine in some cases of angina.
Extremities.-Pains, twitchings and trembling are at times present as a part of a general depressed condition. Gout in elderly people, with large and tender joints of feet, with acrid foot sweat and oedema, have been benefited by iodine, but only when the iodine leading indications are present.
Skin.-Ulcers with spongy edges, and ichorous or bloody and acrid discharges, also pustular eruptions, due to Staphylococcus aureus or at some stages of small-pox, may require iodine.
General Summary.-A diagnostic bird’s-eye view of iodine as a remedy may be conceived in some such a manner as follows: If a dark-haired, sallow or cachectic, emaciated patient walks into a doctor’s consulting room, obviously weak, short of breath, with an enlarged thyroid, hoarse cough and nasal catarrh, some of these features would be ignored as irrelevant in making a rapid provisional mental diagnosis of his disease-tubercle, cancer, malaria, &c. On the other hand, further detail, subjective and objective, would be required to complete the diagnosis. For the final diagnosis of the homoeopathic remedy,too, other features might be necessary but the picture presented by such a patient would at once suggest to the well-informed therapeutist iodine as one of the remedies to be considered. Enlarged glands in axillae, groins or abdomen in the emaciated patient would be confirmatory of the original suggestion. If such a patient had a ravenous appetite, a restless, hurried disposition, with loss of memory, and some of the mental symptoms narrated earlier, the selection of iodine as a remedy, curative or palliative, would be justified, irrespective of the disease category in which he (or she) were ultimately placed. Relief from eating (to duodenal or other digestive ailments and to some mental symptoms) and aggravation in damp, warm weather or warm rooms (chiefly in respiratory or febrile cases) would further indicate this drug. This temperature modality (aggravation from heat) is important, almost to the exclusion of drugs not having it, ex. gr., arsenicum.
(1) Ravenous hunger with progressive emaciation of the patient.
(2) Constant desire to be eating, which temporarily relieves pain of duodenal ulceration and other digestive and mental symptoms.
(3) Restlessness-compulsion to move about to relieve feeling of impending evil-therefore relief from movement, with exception of head pains which are worse from movement.
(4) Sudden, groundless impulses to do violence to other people or to commit suicide or to destroy property.
(5) Chronicity and sluggishness of complaints.
(6) Glandular enlargements: (a) lymphatic (cervical inguinal, mesenteric, axillary); (b) genital glands (both sexes); (c) mammary; (d) thyroid; (e) salivary (parotid); (f) digestive (pancreas and liver); prostate.
(7) Named diseases with foregoing characteristics:- Tubercle-tabes mesenterica, scrofula and phthisis. Syphilis. Laryngitis and diphtheria. Pertussis, bronchitis, pneumonia. Pericarditis and fatty degeneration or atrophy of myocardium. Diabetes. Jaundice and cirrhosis of liver. Hydrocele, chronic mastitis, menorrhagia. Catarrh of middle ear and Eustachian tube. Ophthalmia, simple, scrofulous and phlyctenular. Joint affections-rheumatic, gouty, gonorrhoeal; synovitis.
At night, especially at and after 3 a.m., and in gouty or rheumatic joint affections. The joints are painful that swell little, there are free night sweats; from warmth generally; morning (laryngeal).
Cold air and cold bathing; while eating.