4 HF = SiF4 + 2 H2O. Thereby is the possibility given for the mobilization of silicium in the organism through fluorine. This would show us the way to the first understanding of the extremely striking similarity of acidum fluoricum and calc. fluoricum with that of silicea. If the indicated silicea fails in its action perhaps because of overdosage, then according to homoeopathic experience the fluorine compounds render good service; one knows this type of therapeutic relationship in which two similar agents follow each other well in homoeopathy as a complementary relation. But only extremely rarely are the numerous complementary drug relations chemically so well established as in this case. On can consider that a deadlocked silicic acid metabolism is again mobilized or activated through fluorine if it is only converted at the place from the usual SiO2 into SiF4. This exceptional position ofchoice.
The close chemical relationships of the halogens, that is, the salt formers, can also be found in their effects on the organism. The contrast to the alkalies and earthy alkalies is likewise obvious.
However, there exists between the lightest halogen, fluorine, and the heaviest, iodine, considerable difference in the affinity for hydrogen and oxygen. With fluorine the hydrogen affinity is predominant, with iodine it has become very slight, so that Hl is no longer stabile. Therefore, an increasing affinity for oxygen exists in a series from fluorine to chlorine, to bromine, to iodine.
With increasing atomic weight, the elements of this group gain independence in contrast to other elements under otherwise equal conditions. So fluorine and, in general, also chlorine come into consideration only in the ionic form in action in the organism while iodine certainly and bromine probably unfold important actions in molecular nondissociated form in the organism.
The independent halogen character can be most clearly presented in iodine. For this reason we can best begin with it.
Iodine was separated in the earth in the first demixture of molten lava originally in all layers. It has, moreover, become outstandingly a biophilic element, has increased in living organisms. In the lithosphere, hydrosphere and atmosphere it appears only in traces in company with chlorine and bromine (about 1 part to 10,000 parts of chlorine). In the chalkosphere and siderosphere the amount is even less. As a biophilic element, iodine is obtained also from plant and animal organisms( seaplants, coral, mussels). But one chiefly obtains it from sodium iodate where it arises in company with Chile saltpeter, from plant or animal marine life, perhaps also from volcanic deposits.
The geochemic union of elements from the same related group is an ever-recurring phenomenon. It shows that also in the great chemical laboratory of the earth related elements are separated with just as much difficulty as in the test tube. The common appearance of iodine with chlorine suggests and enrichment in sea water and in sea air. The iodine goes approximately parallel with the total salt content. The decided increase in certain geologic areas (iodine springs!) is traceable to prehistoric plants. Therefore strata containing coal are relatively rich in iodine. Outside of the sea coast where not only the air but also the food is rich in iodine, drinking water obtains significance for the introduction of iodine. Hard calcium-containing water arises from geologic levels (calcium- rich sediment stones), which are very poor in iodine. Apparently there is also an antagonism between calcium and iodine in the organism, because McCarrison could produce in pigeons and enlargement of the thyroid by excessive long-continued administration of calcium.
The greater atomic weight in iodine in contrast to chlorine brings a lessened affinity for hydrogen and therefore iodine appears much less in a dissociated anion from than chlorine. In the organism it has much less ionic action and appears more as a molecule in its organic compounds.
APPEARANCE AND DISTRIBUTION IN THE ORGANISM
Iodine is an element necessary for the mammalian organism but it is not essential for the general electrolytic economy, for the regulation of osmosis and and colloid states, but has specific functions as a catalysor. Corresponding to this is the extent of iodine economy which moves in the range of gamma amounts (1 gamma equals 1/1,000,000 Gm. or 001 milligram). The amount necessary for the maintenance of metabolic equilibrium is about fourteen gammas a day according to v. Fellenberg, but is subjected to considerable individual variations.
In regions where goiter is common, drinking water contains on an average 0-1 gamma per liter, in nongoitrous regions, 1-20 gammas the liter. Iodine is very generally present in plants; formerly it was erroneously believed that it appeared only in sea plants. However, it is still debated whether iodine is a necessary building stone of plants. Yet it is clear that small amounts of iodine promote the growth of plants. It is worthy of note that Chatin, in 1850, found much iodine in Nasturtium officinale which had long been in use against scrofula, tuberculosis and endemic goiter. Iodine also seems to have an influence on the growth of children. From this it might be concluded that in the Spring the thyroid is richest in iodine and children grow most in the Spring. According to Veil, the highest value of iodine in the blood is in May; according to Breitner, in February. This Spring acme is significant for physiologic function as well as the tendency to disease.
The promotion of development of tadpoles is used directly as a test for certain organic iodine compounds. But an acceleration of growth is also observed in mammals.
Baumann found iodine in the thyroid in 1895 and in 1927 Harington and Barger made a chemical determination of thyroxin (tetra- iodophenol ether of tyrosin), to which may be ascribed the chief action of thyroid. Besides this, di-iodo-tyrosin, it appears, has a weaker action.
Iodine is found not only in the thyroid of the organism but probably everywhere. It has been noted in the blood, in the skin and its secretions in the hair, and in almost all organs; only the thyroid, with about three milligrams to one gram of dried substance, is by far the richest in iodine as it contains 1/6-1/7 of the total iodine. In goitrous regions the iodine content of the thyroid is smaller than in nongoitrous regions; in children it is the least but even the thyroid of the new- born is not free from iodine. At puberty the iodine content increases suddenly; between the years of twenty-five and fifty it is highest and then decreases. In women it is higher than in men; in summer, higher than in winter in general. The iodine content of the blood is increased during menstruation. After the thyroid, the skin and hair, ovaries and adrenals are most rich in iodine.
Iodine is taken up with food (water, plants, especially leafy vegetables, animal substances, cod liver oil, eggs) and is absorbed in the upper intestine, and to a slight extent is exhaled from the air. It is taken chiefly to thyroid through the blood which absorbs it and then again gives it up according to the need of the organism. In the thyroid, iodine is found exclusively in organic composition as thyroxin and as di-iodo- tyrosin (the latter a more simple formula and probably a step in the synthesis of thyroxin). Thyroxin is apparently the active principle of the thyroid. However it is probably not free but is contained in an inactive form bound to globulins in the thyroid. In the blood, iodine circulates normally about 65 Percent organic and 35 Percent in inorganic combination.
Iodine is excreted chiefly though the kidneys but also through the bile, faeces, skin (sweat), nasal secretion and, in very small amounts, through the lungs. Inorganic iodine leaves the body much more rapidly than organic iodine, the greater part within 24 hours. It is probable that, under the conditions of the organism in the presence of carbon dioxide, corresponding to the experiments of Binz, iodine dissociates from potassium iodide.
IODINE AND THE THYROID
For the physiologic movement of iodine in the organism, the thyroid is the central laboratory and the regulator of organic combination and absorption. The physiologic significance of iodine is known up to the present only in connection with the thyroid. But this in no way states that thyroid function is exhausted with the regulation of iodine metabolism; on the contrary, the circulation of other elements in the organism, as phosphorus and arsenic and the counterbalance of calcium, will certainly be influenced by the thyroid. But the association- thyroid -iodine economy is especially important and also the best known. The state of the thyroid and iodine metabolism stand in closest reciprocal relation. Thyroxin is probably the most essential oxidative catalysor in the organism among the mobile, humoral forms of hormones (iron on the other hand is the cellularly fixed oxidation catalysor).
The oxidative action of thyroxin comes into expression primarily in the increase of basal metabolism (O2 use). The metabolic increase is bound to destruction of proteins. Moreover, from small doses of iodine there is observed a reversed depression of the previously increased basal metabolism, not only in hyperthyroidism, but in other diseases associated with an increase in cell-destruction processes. Small doses of iodine depress the action of the thyroid and effect an increase in weight; large doses increase thyroid action in rats.
The oxidative catalytic action of iodine in the physiologic organic compound of thyroxin is distinct, that is, produces symptoms in the disturbance of the thyroid. With the excessive flooding of thyroxin out of the thyroid into the blood stream as iodothyroglobulin, which stimulates the sympathetic nerve endings (which thyroxin itself doses not do) the predominance of the oxidative process in the organism increases in a parallel manner; there appear the well-known symptoms of thyrotoxicosis and Basedow’s disease. In the untreated primary hyperthyreosis, the primary Basedow, the goiter is iodine and colloid poor. There also exists a defective property of absorption. In the secondary hyperthyreosis in the colloid nodular goiter, the toxic adenoma, high iodine values are found. In these cases an overproduction also occurs. Reversely, too little or absent output of thyroxin from the thyroid into the blood leads to the symptoms of myxedema, with lowered metabolism and slowed oxidation, etc.
From these opposites the role of thyroxin as an oxidative catalysor becomes distinct in special symptoms of the deficiency or excess in the blood. The common goiter is considered as an adaptation of the thyroid to an insufficient supply of iodine, covering the normal thyroxin formation in spite of small concentration of iodine in the blood. If the thyroxin formation is insufficient or completely absent, then the picture of cretinism develops.
Since in disturbed thyroid function all grades of hyperthyroidism can be produced through proportionately small doses of iodine also in the inorganic form, so the entire picture of thyrotoxicosis belongs to the drug picture of iodine as an iodine effect in thyroid sensitive persons. It represents an indirect metabolic fraction of the iodine drug picture and is characterized though the general actions on the metabolism, vegetative nervous system including the psyche, circulation, and blood picture. This action takes a subacute to chronic course with organic iodine compounds.
IODINE AND THE SEXUAL GLANDS
To the intermediary incretory field of iodine actions also belongs that on the sexual glands. Whether they are subordinate to the thyroid gland or immediately upon the action of iodine is uncertain. In any case, the ovaries and tastes have the highest content of iodine at the height of their functional capacity. By the long continued introduction of iodine in animals, distinct signs of increased activity can be induced in the sexual glands. On the other side one know of the atrophy of the ovaries and testes as the end-effect of chronic iodism.
Iodine pass into the milk, and single observations refer to an increased secretion of milk through small doses of iodine (iodized salt). On the other side it has been reported that the secretion is limited by iodine. This agrees with the final atrophy of the mammary glands in chronic iodine intoxication.
The abortion in swine and the sterility of cows can be attacked by iodine medication. However, the physiologic range in the genital sphere is later and more rarely surpassed than that of the thyroid.
DIRECT ACTIONS OF IODINE
From the indirect, intermediary, incretory actions of iodine one can separate the direct influences of iodine. The organic compounds prepared by the thyroid are note responsible for the symptoms of this kind and they are also different from the actions of thyroxin. Whether the indirect or direct actions appear, is dependent less upon the iodine preparation, since the inorganic compounds of iodine can also produce thyrotoxicosis, and more upon the functional state of the organs, primarily, on the central regulator, the thyroid. But these direct and indirect actions cannot be sharply separated by any means and one can only separate the actions in which the participation of the thyroid is clear or probable from those in which it is apparently absent. The direct actions of iodine refer primarily to the skin, and mucous membranes and, among the latter especially on those of the air passages.
Of the diverse possibilities of iodine influence on the organism, naturally the local mass actions give just as few therapeutic indications as the end states of poisoning (for example cardiac and liver fatty changes, glomerulonephritis). There we no longer find any symptoms in which the special defense processes against iodine activity express themselves. However, the protein coagulation by iodine (iodine tincture, iodoform) plays a role in disinfection and this mass action has been tried internally, particularly in encephalitis lethargica (in the form of Pregl’s solution or Septojod) with more or less success. With the single introduction, particularly of organically bound compounds of iodine, one may have rapid excretion and relative lack of danger. Indeed, it is exactly this rapid excretion of certain iodine compounds which permits their use for diagnostic purposes, for making visible the gallbladder and renal pelvis for x-ray examination (Tetragnost, Uroselektan, Abrodil). For the drug picture of iodine, however, only the reaction of the organism after the resorption of repeated doses of iodine is useful. They are best known as the untoward actions of iodine or its salts with prolonged medicinal use.
If one review the total effect of iodine, so on the one side will be found much more extensive possibilities in use than in the old school, and on the other side more definite than when the indications are shaped only by diagnoses. Likewise, one comes to the basis of its therapeutic effectiveness much more closely by the consideration of the simile rule.
Actually the scientific, exact basis of standard iodine therapy is extremely scanty outside of goiter. And even in the therapy of simple goiter, the theory that one must balance a deficient intake of iodine in insufficient. For the prophylaxis of goiter with iodized salt (with iodine in gamma amounts ), the explanation that an iodine deficit is thereby balanced is not enough. According to McCarrison, one type will be favorably influenced, another not at all, and a third type will be unfavorably influenced, another not at all, and a third type will be unfavorably influenced. If one was concerned with a mere balancing of a deficit in goiter therapy, then the goiter should lessen by sojourn in an iodine-rich air and with iodine- rich food. But actually the therapeutic result depends upon the choice of a suitable preparation and the dose. From this one may conclude that the functional stimulation of the thyroid tissue is the essential and this will not be attained through an iodine supply in general, but only through suitable doses of iodine. Certainly food is also a functional stimulus for the tissue which needs this food but only the utilized, adapted food, according to amount and form.
If these relations are considered, so the homoeopathic iodine therapy of goiter can agree de facto with the standard use. The homoeopathic indications, according to the symptom register of Hahnemann, are swelling of the neck with numerous sensations of tension, oppression and compression of the throat. The basis is that with iodine one can under certain conditions obtain a functional increase and tissue hyperplasia of the thyroid also in the apparently sound. That the adaptability of homoeopathic iodine medication of goiter must be considered not only in respect to the dose but that also the choice of the iodine compound must be based on other, especially constitutional symptoms of the individual patient, is self-understandable (perhaps calcium iod. or barium iod., in the lower potencies in the torpid; spongia, with respiratory oppression, etc.).
In myxedema and cretinism, in which the functionally active thyroid tissue fails, iodine lacks the possibility of stimulating function, but here a feeding with thyroid substance is promising.
The outcome in hyperthyroidism is not uniform. Here the iodine sensitivity in single forms is entirely different. In the iodine thyrotoxicosis which develops from mild stationary forms of Basedow, in part also in previously apparently healthy, but sill predisposed, we have the picture of an iodine intoxication with predominant general disturbances before us; with an interval of a few weeks it progresses often acutely but may be chronic and progressive. With this form iodine therapy would not be homoeopathic but a type of isotherapy. Since with inorganic poisons an immunity of a high grade is possible prophylactically (as with arsenic) through gradually increasing doses, as this is not known of iodine, such a therapy does not come under consideration in the acute stage. By continuous use of iodine the follicles finally atrophy so that, during or after hyperthyroidism, symptoms of myxedema appear. So the sites of action, the thyroid, the sexual and mammary glands, are finally threatened with atrophy with iodine.
In the primary hyperthyreosis (primary Basedow), the goiter is colloid and iodine poor; on the other hand, the blood iodine is markedly increased and here the alcohol-insoluble organic iodine fraction is markedly increased. There exists a defective storage capacity of thyroid gland. Here through inorganic iodine the anomalous iodine metabolism can be regulated, so that the outpouring of secretion of the thyroid is prevented. On this rests the preoperative iodine treatment of Basedow’s disease (after Plummer) which naturally should not continue with the usual doses more than one to two weeks and which may be unsuccessful if operation does not follow at the correct interval.
The action is explained; Through the inorganic iodine, the organic fraction of iodine is displaced from the blood (perhaps to the thyroid). With this decrease of the alcohol-insoluble organic blood iodine the fall in basal metabolism goes parallel and the clinical symptoms of the thyrotoxicosis diminish.
Accordingly, one may well imagine that by a cautious regard for the dosage of iodine a regulation can be obtained after some time in these cases, particularly in the formes frustes, those with a partial Basedow. The therapy of Neisser with small doses of iodine is homoeopathic in principle.
Dangerous for iodine medication, however, are the secondary hyperthyreoses which arise from the colloid nodular goiter (separated by Plummer as toxic adenoma!). In these thyroids a high iodine value is found. There it is concerned with an overproduction of thyroxin. However, clinically these secondary forms cannot always clearly divided from the primary.
The second great field of employment of iodine compounds in the school is the syphilitic new formations in tertiary syphilis, the gumma. These infectious granuloma cannot be sharply separated from diffuse productive inflammations. An infectious new growths which proceed from the interstitial tissue, they cannot always be certainly separated fro the tuberculous granuloma, although in general these contain more giant cells. That iodine compounds can bring these infectious new formations of syphilis into retrogression and melting down has been demonstrated clinically in a manner free from objection. But a scientific explanation for this is entirely lacking. That iodine is enriched in such tuberculous or syphilitic altered tissue in not an explanation. A bactericidal, specific action is not considered by anyone and is not confirmed either by clinical or experimental facts. The strikingly slight sensitivity of luetics toward iodine (thyrotoxicosis in luetics is very rare) in any case offers no explanation. It can be traced back to the marked affinity in mesenchyme which tends to inflammatory reaction.
In the untoward actions of potassium iodide one finds a distinct parallel to the gumma in the iododerma tuberosum, the erythema nodosum like nodules in the skin which proceed form the subcutaneous tissue. These are in any case inflammatory new growths which grow rapidly and may be permeated with pus or ulcerated on the entire surface. Through drying of the secretion a picture may develop which formerly was designated as Rupia (Lewin). This structure, which is very akin to gumma, lessens rapidly after the cessation of the iodine just as a gumma lessens after the introduction of potassium iodide.
A further similarity with tertiary lues is a mesortitis which is observed from the subcutaneous administration of potassium iodide (just like that of adrenal injections). The similarity of the reaction according to nature and type, at one time to the spirochetal poison in the tertiary stage of lues, at the other time to potassium iodide, proves the treatment of productive inflammations and gumma with potassium iodine as homoeopathic. Thereby no explanation of the details of the healing process is gained but only a new point of departure by a new orientation: the possibility of activating syphilitic inflammatory tissue reaction through an inflammatory reaction to iodine which is similar to it, and of bringing it rapidly to resolution.
Likewise is the situation in the iodine treatment of scrofulous swelling of the lymph glands, which is common to both schools. To speak of a solvent action of iodine is merely to cover the lack of clarity by a conception. Among the untoward actions of iodine one finds (Lewin) only swelling of the salivary glands mentioned, but by older homoeopathic observers also other glandular enlargements: axillary glands, of which it is stated that they also lessen under iodine, bronchial glands with compression of the bronchi. Outside of the inflammatory reaction in the interstitial tissue of the gland there can also be drawn to explanation for the especially hard and painless glands as tertium comparationis, the alteration of the blood picture in the sense of lymphocytosis in disturbances of thyroid functions as well as of iodine metabolism. This affinity of iodine of r the lymph glands in general is used in homoeopathy by the employment of such compounds in which the basic fraction also has a relationship to the glands (cal. iod., bar. iod.). Iodine action alone is too transient. The aggravation particularly of erethistic tuberculosis by potassium iodide causing a rapid melting down of the focus and dissemination makes great caution necessary in the treatment of tuberculosis in patients with Basedow trends.