Reprints from Journals of the Past: Iodine and its salts in pneumonia

The worthy chairman of the Bureau of Clinical Medicine informs me that the members appointed to that Bureau selected pneumonia as the theme for their essays or for discussion. This narrows down the field of my subject, the clinical use of iodine salts, and gives me an opportunity to confine myself to iodine in pneumonia. My venerated and venerable friend, Dr. John Kafka of Prague, already fought many a battle in defense of the practice of iodine in pneumonia, as detailed in his classical work, "Homeopatische Therapie."

This eminent author writes, "We hinted already when treating of croup, of bronchitis, and pleuritis, what remedies are useful to combat croupous inflammations. In relation to croupous pneumonia, iodine and its salts take front rank. The results of physiological pharmacodynamics show here considerable trouble in the respiratory process, manifesting themselves by anguish, oppression of the chest, with burning, tearing and lancinating pains -- when breathing, a sensation as though a great obstacle had to be removed in order to dilate the thorax; cough with difficulty of breathing, stitches in chest and expectoration streaked with blood; dyspnoea with pain when taking a deep inspiration, though physical examination or toxicological experiments do not demonstrate pneumonia. Under Kali iodium we meet decided symptoms of pneumonia, though the symptoms-codex gives us more symptoms hinting to pleuritis. Pure iodine, in the first or third dilution, at the beginning of localization, 8-10 qt. in a glass of water, a tablespoonful every half or full hour, according to the intensity. of the case, is as sure to remove the whole trouble as Antimonium tart is in pleuropneumonia. After four to six doses have been taken, the dyspnoea ceases and with it the oppression and the pain; the cough loosens, the fever declines and the pulse moderates, a mild perspiration sets in, followed by a sensation of `bien aire.' Examining the patient now, one finds all the objective symptoms of pneumonia, but the progress is stopped, it retrogrades with ease, loose, rarely purulent sputum, so that in four and twenty hours, cough and expectoration cease."

The same effect has Kali hydroiod in pleuro-penumonia, where the failure of Antimonium tart shows that the inflammation is of eruptive nature. It shows the same beneficent action in secondary croupous pneumonia during the course of bronchitis, when phosphorus fails to relieve. Kali iodium is also an excellent remedy where pneumonia sets in with delirium, and Belladonna fails to do any good, and it is equally indicated in croupous pneumonia located at the apexes of the lungs with danger of tuberculous deposits, in consequence of hereditary or constitutional disposition.

The most intense febrile heat is no contraindication, for as soon as localization begins, the sphere of the action of Aconite ceases. The higher the fever, the more refined and divided the dose of Iodine must be, for strong doses are sure to aggravate the fever and the local symptoms. Kafka's work appeared 25 years ago, and when I had the pleasure to embrace him a few years ago in his own home, he reiterated to me the assertion of the curative influence of iodine and its salts in croupous inflammations. He has practiced successfully for nearly 60 years. What experience he must have gathered, and we may well believe his word and follow his advice. Yet, what are the symptoms of any croupous inflammation and of croupous pneumonia in particular?

It is a pity that the differential diagnosis between croupous inflammation and diphtheria is still the subject of frequent discussion and weighty authorities can be enumerated for either opinion; it is a pity that some even deny at the present moment the zymotic origin of croupous pneumonia, and bacteriology still has many a battle to fight before these parasites will be acknowledged the source of all evil.It is a pleasure that just in pneumonia the expectant treatment of the Vienna school has shown to the so-called regulars their wickedness, and foolishness, and heroic treatment belongs to bygone years. It is a pleasure to record that in the same city, "on the blue Danube," the homeopathic treatment of pneumonia gained its laurels, even over expectant treatment, and may we hope that the essays before us may put still more clearly before us the individualities of the different drugs.

Most clinicians define croupous pneumonia as an acute inflammatory process of the lungs running a typical course, leading to an infiltration of the pulmonary alveoli and bronchioles with a coagulable fibrinous croupous exudation. We need not mention the three stages of extensive hyperaemia, of red and gray hepatization, and the final purulent infiltration, which every senior must recapitulate at his final examination. Our aim is either to prevent such dire accidents, and restore health during the primary stage of disease. The question looms up, will iodine and its salts respond to this indication?

Our old friend Raue in his classical work, Dr. A.K. Crawford in Arndt's encyclopedia, Jousset in his lectures, Baker in his pathology, one and all give iodine and its salts the cold shoulder in the treatment of croupous pneumonia, and still the very pathogenesis of the drug verifies the assertion made by Kafka.

There appeared a year or two ago at Paris a thesis "Pour le Doctoral in Medecine" by an American, Dr. Elizabeth N. Bradley, on iodine, and this thesis was highly praised in French and German journals, the latter only, with their old-fashioned prejudices, feeling sorry that it emanated from a woman. The learned doctor showed that all the haloides, introduced directly into the blood, evince an action on the capillary circulation. Experimentally Blake showed that in the lungs it causes such a retraction of the blood vessels that circulation is impaired, followed by degeneration of the tissues and exudation in the bronchi. Rumor found that iodine diminishes the number of contractions of the ventricles, varying according to the dose; it comes slowly with small doses, but when three or four centigrams were used in his experiments on frogs, the pulsation diminished and the heart stopped in diastole. All authors agree that iodine and its salts produce degeneration of the tissues. Biez Hagyer and others found fatty degeneration of the heart and of its epithelium, of the liver and kidneys.

In observations made on patients taking iodine, the same circulatory troubles were observed which physiologists had demonstrated in their experiments -- palpitation without organic disease, pulse at first 130-160, small, weak, imperceptible, fainting, dyspnoea, collapse, death. In nonfatal cases are seen the non-murmurs in the jugulars, photophobia and diminution of vision, buzzing in the ears, veins more or less visible, cyanosed lips, icy cold extremities, general cyanosis, capillary hemorrhages, epistaxis, hamoptoe, production and rupture of hemorrhoids, bloody stools, hematuria, conjunctival ecchymosis, anemia, either from anorexia or from sanguinous lesions.

In relation to the respiratory organs, he remarks that iodine and its salts cause coryza, at first, dry cough, then copious mucous expectoration, which may even become bloody. Many patients complain of dyspnoea, and weak respiration, which may become rapid, difficult and whistling. Santus reports two cases of asthma and one of laryngismus stridulous, Nealton one of oedema of the glottis.

In giving iodoform, Koenig and others witnessed pneumonia and oedema pulmonarium from its use. The patient often complains of a retrosternal or thoracic pain. Anxious respiration and even pulmonary hemorrhages are recorded by Jahr and Sebert. In relation to the nervous system, iodoform produces narcotism in frogs and cats, and in toxic doses it produces fatty degeneration of heart, liver and kidneys, with all the phenomena of a general paralysis and a considerable fall of temperature. Iodide of sodium, even in small doses, causes narcosis of the brain in animals. This salt is a poison for the respiratory centers. Large doses cause primary paralysis of the heart.

In humans, tincture of iodine causes headaches, a stunned feeling, oppression, apathy, a state of extreme prostration, fainting away, trembling, clonic and tonic epileptiform convulsions, paraphasia, and delirium. Similar symptoms were observed from salts of iodine and iodoform.

Dr. Bradley mentions everywhere her authorities and thus proves her statements. How true is the remark of Jurgensen (Ziemssen's Encyclopedia, Vol. I, p. 152, Germ. ed.): The danger which threatens a patient suffering from croupous pneumonia lies primarily in the heart of the patient. Death arises from insufficiency of the heart.

The pneumonic exudation causes obstacles in the lesser circulation, hence the right ventricle has more work to perform.
The changes which a pneumonia produces in the lungs diminishes the strength of the lungs to carry on the circulation.
The surface by which blood and air mix together in the lungs is diminished and more labor is required to keep up their necessary interchange.
As its expression, we meet the fever showing itself by increased labor of the heart, and hence directly injuring the heart. Then it is from first to last the heart which bears the burden of the disease, and our aim must be:
(1) To prevent the heart to become weakened.

(2) To fight the fatal outcome of such debility. This is just the point where Jurgensen and Kafka so beautifully agree.

We must not allow the heart to become weakened, says Jurgensen, and Kafka teaches here that pure Iodium at the beginning of localization, no matter how high the fever may be, is our sheet-anchor, our only safeguard. The time for Iodium and Kali iodium has passed us as soon as hepatization sets in, and Phosphorus, that great tonic of the heart, must then take its place.

In comparing the symptoms of croupous pneumonia with those of iodium and its salts, we see in Allen:

42. Confusion of the head with great aversion to mental work.
51. Congestion to the head with headache relieved by eating.
61. Violent throbbing headache.
96. Hair falls out.
113. Weak eyes, as if they lay deep in orbits.
136. Weakness of vision.
160. Coryza.
171. Epistaxis.
191. Flushed face, hot and red face.
198. Sallow, distressed countenance. 551. Edema of glottis. 570. Croupy cough.
580. Respiration accelerated and difficult.
590. Feeling of suffocation.
594. Sudden dyspnoea, with pain on deep inspiration, during which the heart beats more violently and rapidly than usual and the pulse smaller and more rapid.
600. Constriction of chest changing to pressure.
619. Great precordial anxiety.
626. Violent palpitation and other nervous disorders.
631. Rapid feeble pulse.
In his materia medica, Lippe lists cough with expectoration of large quantities of mucus, which is frequently bloody, rattling of mucus in chest, with roughness under the sternum and oppression of the chest, sensation of weakness in the chest and heart; difficulty of expanding chest on taking an inspiration, sensation as if heart was squeezed together, internal dry heat, with external coldness.

If my time was not limited, most assuredly your patience, too, must be considered. Still I think to have demonstrated that Kafka does not deserve the carelessness with which most authors treat the sage advice of this Nestor of Homeopathy, but let us recall that there is a time for everything, and Hahnemann teaches, "Machs nach, aber Machs genau nach."

International Foundation for Homeopathy.

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By S. Lilienthal

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