SPONTANEOUS RUPTURE OF AN OVARIAN CYST
CAPTAIN, R.A.M.C.; PATHOLOGIST, MILITARY HOSPITAL, WARLINGHAM. THE idea of using tincture of iodine intravenously was suggested to me by Major S. M Cox, R.A.M.C., Chinese Hospital, Moulle. While I was pathologist to No. 4 Stationary Hospital, France, I had been struck by the apparent futility of ordinary routine treatment for bad cases of influenzal pneumonia, and by-the fact that many of these cases were septicæmic in type with comparatively limited involvement ot the lungs, evidenced by
... evidenced by extreme toxicity and cyanosis with comparatively few physical signs in the chest. This latter conclusion was confirmed by the cultivation in many cases of pneumococci from the blood stream. It seemed to me, therefore, that intravenous administration of iodine would be a rational method of treatment. The B. P. tincture was used in doses of from 20-30 minims (22 m. = gr. of iodine). This was diluted with 9 c.cm. of a 0-85 per cent. solution of salt in freshly distilled water and given into a vein at the bend of the elbow in the same fashion as a neokharsivan injection. This was preferably given in the morning, repeated next day, and if necessary the day after. Ten bad cases with definite signs of broncho-pneumonia were treated. Of these nine recovered and one died ; the .latter, in addition to pneumonia, had severe purulent bronchitis for a week before being treated. The drug was tolerated very well, and there were no untoward symptoms except that two patients had a rigor about an hour after the first injection (one of these gave a history of seven attacks of malaria), and another case developed a typical iodine rash. This man had a dose of m xx. on two successive davs, and a final dose of 111. xx. after an interval of four days. The rash appeared on the day after the last dose, but rapidly cleared up in the course of a few days. The therapeutic effect of the iodine was generally shown within 24 hours by a marked fall in the pulse-rate and temperature (the latter resembling a crisis) and a marked change for the better on the part of the patient. The temperature remained normal except, usually, for a slight rise on the evening of the first or second day after. The tongue cleaned rapidly, but the physical signs in the chest cleared up more slowly. The presence of albuminuria was no contra-indication as to the use of iodine ; dense albuminuria in one case cleared up two days after the first dose. It is highly improbable that the iodine given thus into the blood stream has any direct bactericidal action ; the dilution is too high. It is feasible, however. to think that it may have an inhibitory effect on the reproduction of the organisms, at any rate in the blood stream. Taking the total quantity of blood in the circulation as 12 pints, a half-grain dose of iodine would represent a dilution of roughly 230,000. It may, perhaps, be feasible to suggests that the organisms in the act of cell-division would be vulnerable to a solution of that strength. However, it is impossible and quite unjustifiable to draw conclusions from a series of so few cases, but circumstances at the time prevented me from going on with this line of work. 1 can say, however, that I was much impressed by the way in which these ca'es reacted to the iodine. The only excuse I have in publishirg this is the hope that some member. of the profession will take the method up and try it out fully.