The further use of potassium iodide in the school in chronic bronchitis and asthma likewise stands unfounded there. But again we find bronchitic and asthmatic states described among the untoward actions of potassium iodide. And by proceeding from the parallel manifestations we find an easy approach to explanation of the favorable action. Iodine is also excreted in traces though the respiratory passages and as every where the liberation of molecular iodine produces inflammatory manifestations with increase of secretion.
The iodine therapy of arteriosclerosis is weakly grounded scientifically, as Romberg’s conception that potassium iodide lessens the viscosity of the blood is not confirmed and a vasodilatation by iodine is uncertain in any case. But even on the fact of favorable action of iodine therapy itself in arteriosclerosis, opinions are divided and many believe that only luetic vascular damages are favorably influenced, but that ordinary arteriosclerosis represents in unjustified field for this therapy. On the other hand, newer animal investigations are cited, which naturally give no explanation. The sclerotic vascular alterations which one can produce through the feeding of cholesterol to rabbits can be prevented by the early use of iodine. The favorable influence on cerebral and coronary sclerosis by iodine is not denied and it is exactly these in which the characteristic symptoms are found in the homoeopathic picture of iodine: headache in old people, chronic congestion, feeling of a tight band, vertigo, worse on bending and in a warm room, rush of blood. Moreover: the heart feels as if stuffed, as if surrounded by an iron band; these are followed by great weakness and fainting. The patient can scarcely breathe and speak.
On the influence, not only on the heart but also the vessels, by organically bound iodine in thyrotoxic disturbances there is no doubt. The increased acceleration thereby can be referred to the favorable occurrence of vascular narrowing.
In experimental organ perfusion with 0.002 per cent iodine there is at first contraction, later widening of the arteries and capillaries. On the isolated heart, inorganic and organic bound iodine effects widening of the coronary vessels if the concentration of iodine is at most 1:100,000. With decreasing concentration up to 1:6,000,000 the acceleration of flow still increases. In men there is also a definite optimum of dose (five milligrams per dose) for the production of vessel widening and for some time exactly these small doses of iodine in combination with chloral hydrate have been recommended in sclerosis. The importance of dose is obvious, because we have already seen that large subcutaneous doses of potassium iodide can effect a mesortitis. Likewise the marked variation of blood pressure with great amplitudes in Basedow, as in disturbed iodine metabolism, also speaks for special involvement of the vessels.
In homoeopathy and iodine compound is used mostly in sclerotic disturbances in which the metallic fraction also has a favorable affinity for the vessel, as aurum iod. or barium iod.
Finally, iodine is occasionally used in the school for chronic metal poisoning with mercury and lead and this is based on an acceleration of the metabolism, the improved solubility of the metal iodide and, through this, the accelerated excretion.
To the named iodine indications based on diagnosis, on which a completely new light falls through their homoeopathic foundation from the symptom picture of iodine, there may be added many others which like-wise give good healing results. The treatment of colds has become well known; then too acne and furunculosis, for which the mixture with sulphur is considered indicated. But also where it is concerned with the resorption of an inflammatory exudates as in a pleurisy, iodine compounds as arsenicum iod. will be employed wtih good results as in homoeopathy. In sudden iodine poisoning (intravenous injection of sodium iodide) inflammatory exudates as pleuritis are observed.
But all enumerations of diagnoses will never fix the therapeutic field of action more precisely but will always permit only turning around in a circle. Only the exact determination of the differentiating characteristics by intentional provings gives the necessary directing lines for therapy.
THE IODINE DRUG PICTURE
The provings on the healthy are found: Hahnemann: Chronic Diseases, 2nd Edition, vol.3, p.376, 1837 by the provers Hahnemann, Gersdorff, Hartlaub and Trinks, Gross and Schreter; Hartlaub and Trinks: R.A.M.L, vol.2, 1838. The provings of Trinks, Schreter, Hartlaub; Jorg: Materrialien Zu einer kunftigen Heilmittellehre, vol. I. p. 437, Leipzing, 1825. Provers: Heisterbergk, Kneschke, Otto, Seyffect, siebenhaar, Jorg; Arch. f.d. hom. Helik. (of Stapf), vol. 13, p. 182. Prover: C. Hering.
GENERAL ACTION AND CONSTITUTION
The general actions of iodine are to be considered as an increase of its physiologic endocrine effect, and also to be placed in parallel with the manifestations of a hyperthyroidism. The metabolic increase through oxidative catalysis express itself in the chief symptom: emaciation in spite of good appetite and much eating; bears waiting for food badly and is better from eating. It is entirely possible that in the therapeutic effect the biphasic action of iodine underlies the situation. Because it is also observed that small doses of iodine can depress the metabolism and in particular nitrogen transformation. But in any case it would explain only a part of the mechanism of the therapeutic effect.
The iodine picture is an example of the oxygenoid constitution of Grauvogl, in which the oxygen influence is increased. Thereby sudden and severe reactions occur. Psychically the unrest, the urge of doing something is cardinal, also the impulse for forcible actions; during rest the patient is anxious. These also refer to the present more than the future. Characteristic is the aggravation from heat, in a warm room, and moreover at rest; amelioration from walking around and in the open air. To the internal unrest belongs the sleeplessness with waves of heat; alternating with anxious, alternating with anxious, fearful dreams; furthermore, trembling of the hands, the facial muscles and eyelids, pulsations and rushes of heat over the entire body, palpitation on the least exertion, heat of the skin, marked outbreak of sweat and under certain conditions also fever, in short, the outspoken picture of hyperthyroidism.
The congestive headache and the vertigo have already been mentioned in cerebral arteriosclerosis and the symptoms of angina pectoris in reference to coronary sclerosis. One might trace them to an end stage following excessive demands upon the vessels. The influence on the lymph glands, the ovaries, the testes and mammary glands has been considered in general. Hardness and indolence of swollen glands in emaciated children are indications for iodine. According to Rademacher, iodine is especially a pancreatic remedy and in any case iodine increases the secretion of the pancreas like that of other glandular organs. If in the sexual glands and endocrine influence of the slowly given off potential iodine reserve still prevails, then in the lymph glands the tissue bound, easily freed iodine forms the actual effective iodine reserve.
In any case these are outstanding for the skin and mucous membrane manifestations. In these fields iodine idiosyncrasy not rarely is manifested. Acne and furunculosis of the skin and the gumma-like formations have been mentioned. The coryza and conjunctivitis are extraordinarily severe. The nose runs when the patient is in the open air; in the evening and in a warm room it is occluded;o there is often pain at the root of the nose; to the may be added paroxysmal sneezing and asthmatic-like attacks. The strongly diluted drops of iodine tincture, which has long been known as an agent for coryza in France, outside of homoeopathy has become generalized for the abortion and avoidance of colds through Bier. The laryngitis with huskiness, aphonia, constrictive pain, is especially characterized by the croupy cough. Likewise edema of the glottis frequently appears in the untoward actions of iodine, usually from inhalations of vapors. For the inspiratory dyspnea in such narrowing of the larynx speaks the report. the child throw his head back and grasps at the throat. In diphtheria iodine compounds are satisfactorily employed because of the marked connection with the throat.
In exudative pleuritis, compounds with iodine come into consideration as has been already mentioned. But also in croupous pneumonia in the stage of engorgement Kafka has reported iodine in D1-D3 as frequently successful. It is said to act abortive. Pneumonia occasionally appears in serve iodine intoxications. The entire picture of the subjective and objective symptoms of a beginning pneumonia up to the expectoration of a blood-streaked sputum is described. The cough with iodine is generally worse in warm rooms and one lying on the back.
On the gastro-intestinal canal iodine has little that is characteristic. Ravenous hunger and tormenting thirst are manifestations of increased metabolism. The other symptoms are vegetative, as nagging pain in the upper part of the stomach which, in combination with the important after eating, has been used as indications for gastric ulcer at times; moreover, a form of watery, foamy diarrhea which may be associated with attacks of constipation with unsuccessful urging. Through certain foods, in particular cold milk, the constipation is again removed. The vegetative diarrhea in Basedow’s disease will also b;e lessened by milk or other foods such, as spinach.
The iodine disturbances in the remaining organs have little that is characteristic. Frequent, light flow of urine accompanies metabolic increase. The urine is said frequently to have a transparent sheen on the surface, a cuticula which is probably due to the increased excretion of phosphates.
On the sexual organs the toxic atrophy is preceded by an irritative phase. Formerly iodine was used as an emmenagogue. Too early and too profuse menses are the most frequent form of menstrual disturbance with iodine. The influence of mammary secretion is also biphasic.
Type: Oxygenoid constitution.
Mental Symptoms: Restlessness, anxiety, urge to action.
Trends of Action: (a) Indirect, endocrine
Thyroid (goiter, Basedow), sexual glands Metabolic increase
Sympathetic excitation (b) Direct Mucous membranes, especially respiratory and throat
Skin: acne, granuloma
Lymph glands: hard indolent swellings
Leading Symptoms and Modalities:
Emaciation in spite of good appetite, ravenous hunger.
Better from satiety. Worse in warmth and from rest.
The dose require exact consideration of iodine sensitivity. The selection is usually taken from the 3rd to 30th potencies.
In iodine compounds the rapidly occurring but not long maintained iodine influence is markedly different. Sodium iodat. is proven and is very rarely used, outside of the lower potencies for securing an organotropic action of iodine.
Potassium iodat. is proven: Hartlaub and Trinks: Reine Arzneimittell vol.3, p. 37, 1831. It possesses a rheumatic pain component besides the organotorpic iodine action; rheumatic pains in the neck, back, and especially the heels and soles of the feet. The chilliness, also neuralgia and marked tendency to edema (which also appears transiently’ in iodine, especially on the eyelids) permit the distinct recognition of the potassium influence; it also directs attention to the nerves, muscles, and connective tissue. There still remains, outside of the organotropic iodine relations, also the iodine modalities, particularly the aggravation from warmth and in general improvement from movement. Aggravation on lying on the diseased side is a potassium modality, like wise the aggravation from damp weather.
Ammonium iodat. (see under ammonium compounds);;unities the iodine influence very acutely to the respiratory passages, threatening inflammation of the larynx, the bronchi, the bronchioles bronchopneumonia with threatening pulmonary edema and impending respiratory paralysis.
Calcium iodat. joins to the lymph glands; it has more chronic affection but acts more acutely than calc. carb.
Barium iodat. has chronic glandular and tonsillar swelling but acts more on the great vessels (aorta); similar is stront. iodat.
Sulphur iodat. is a so-called eutectic mixture, that is, a mixture which remains saturated on freezing and has a constant freezing point as a chemically uniform body. This preparation has preference in skin affections as acne, furunculosis, and herpes tonsurans.
Arsenicum iodat. permits the arsenic manifestations to appear most strongly. Exudative inflammations, pleuritis, pulmonary tuberculosis, acrid secretion, tendency to septic processes and diseases of the blood, great malignancy, great prostration and hectic emaciation are the indications.
The heavy mental compounds of iodine have an accord to the mental. Only the mental actions is more acute and often joined to a site of predilection which is common to the iodine and the individual metal, for example mercur. iodat., the throat; aurum iod., the heart and vessels; stannum iod., bronchi; plumbum iodat., the vessels
Bromine was isolated from the mother liquor of the Mediterranean Sea in 1826 by Ballard. It is often found in the animal organism in slight amounts, particularly in the thyroid. Indeed, the bromine content of the blood is essentially higher than the iodine content. Only in recent times has it become probable that this content of bromine has significance in the human organism for psychic functions.
Bromine is the only element among the halogens which is a fluid under ordinary conditions chlorine is a yellow green gas; iodine, a black crystal. The asphyxiating, suffocating vapors which arise from it irritate the respiratory passages markedly and also provoke intestinal bleeding and produce narcosis in a more marked degree than chlorine. Narcotic toxic manifestations are also observed from iodine vapors. But bromine represents the high point in the narcotic effect of the halogen series. Elementary bromine is also a marked irritant Plus to the skin; forming vesicles and inducing corrosion which heals only slowly.
TRENDS OF ACTION
The mucous membrane of the respiratory passage, the skin, and the central nervous system remain the chief directions of bromine action when it is introduced in the anion form as well as bromine salts. In the organic bromine compounds as bromoform, bromipin, the bromine action rests up on the bromine which is split off and the organic component has according to them aim only a significance in linking bromine, in a definite way.
The effects of massive doses of bromine can be studied in essentials by the alkali salts, and thereby the depressing action on the central nervous system is always pressed into the foreground in therapeutic uses. For this reason bromine salts have an important place as anti-epileptic agents and as drug which are employed as sedatives and for producing sleep.
Before we can detail these actions of bromine salts and consider their explanation more closely we must mention the less observed bromine actions wherein bromine stands very close to iodine. The picture of chronic bromine poisoning, bromism, stands very close to that of iodism in the manifestations evoked on the skin and mucous membranes. The exanthem on the skin has the form of ordinary acne. According to analysis, bromine, just like chlorine will be permanently taken up by the skin when introduced in excessive amounts, and inflammatory skin manifestations in chronic bromism are traced back to the liberated bromine anion, perhaps HBr, which is easily destroyed by the acid reaction of the sweat and the sebaceous glands. Seborrhea and acne are the most common untoward manifestations of the chronic use of bromine. Bromine can be found in the acne pustules. Also pustular eruptions, in whose pus bromine can be discovered, may appear. More rarely the inflammation takes the form of a bromoderma tuberosum, a productive inflammation with subsequent breaking down; from blue-red, nodular enlargements, which rise above the skin, there develop, from the breaking down large, itching, odorous ulcerations. Here also iodine furnishes a comparative manifestation in the granulomatous infiltrations. Very rare is bromoderma nodosum. It looks exactly like erythema nodosum but occurs with fever. Bromine urticaria is also observed.
The catarrh of the mucous membranes, preferably of the conjunctival tissue and the upper air passages, appears in the bromine salts corresponding to their more chronic effect less acutely than with iodine. The secretions with bromine are more coagulated, slimy offensive. According to Krosz, one finds pain in the frontal sinus after large doses of bromine, which may correspond to the frequent involvement of the accessory sinuses in acute iodism. Just as with iodine, marked salivation appears with bromine; furthermore, an offensive bromine stomatitis and inflammation of the pharyngeal mucous membrane gives (as with iodine) early occasion for angina. The catarrh of the larynx and bronchi and the increased liability to pneumonia recur as with iodine.
Irritative events also occur on the other mucous membranes, but do not have much significance. In respect to the stomach it should be recalled that the chlorine in the hydrochloric acid can be replaced by bromine. Similar to iodine, an increase in the appetite has been mentioned and in the homeopathic provings of bromine one also finds, besides vomiting and pains, an empty feeling in the stomach and improvement from eating.
In the center of clinical interest and therefore also the subject of many studies stand the actions of bromine on the central nervous system. The depressive action in animals can increase up to paralysis, especially of the cerebrum, but may also involve the spinal cord, while the peripheral nervous system remains un- influenced. The well known manifestations of large doses of bromine in men are: decrease in thinking and of mental acuteness, slowing of speech, a feeling of lassitude and malaise which increase the tendency to sleep. The reflex excitability is decreased (for example, retching and corneal reflexes); vision is cloudy; diplopia, also an ataxia of speech and other movements may appear moreover, difficulty in heating, and stupor. Also well known is the reduction of libido and potency by bromine. The depression of the intellectual functions precedes disturbances of sensibility and motility. Even if bromine were not valued as a characteristic somnifacient, still Januschle was able to induce a state of narcosis in guinea pigs and rabbits before the state of ataxia and paralysis, through subcutaneous injection of large doses.
With these depressive actions on the central nervous system, which as we shall still see, are not the sole possibility although still the most used practical division, the bromine action in epilepsy stands in obvious association. For explanation of this action a great number of investigations have been undertaken on the behavior of bromine in the organism; in particular the relation of bromine to chlorine to chlorine has been studied. The best survey of this field and the practical elaboration in reference to the sodium chloride diet in bromine therapy are represented by the work of A. Lipschutz.
OPPOSING RELATION OF BROMINE AND CHLORINE
The chief excretion of bromine (as with chlorine) occurs through the kidneys. After excessive administration, bromine (like chlorine) is deposited particularly in the skin so far as discharge from the blood is necessary, and the excretion through the kidneys does not keep pace. Bromine is held in the organism and only very gradually excreted when no more bromine is introduced. If bromine is introduced for a long time, then the out put increases from day to day until finally a bromine equilibrium is reached; that is, as much bromine, is excreted as is introduced. At this point also it seems that the bromine load has reached saturation, which naturally can rest at various levels according to the amount introduced daily. Upon cessation of the introduction, the bromine equilibrium is immediately disturbed since the out put is maintained, though not at the same level. Storage and excretion of the bromine are particularly dependent upon the chlorine intake, particularly in the form of sodium chloride. The less chlorine taken in, the more bromine stored; the greater the ingestion of chlorine, the greater the excretion of bromine. To be considered naturally is that the bromine excretion requires a much greater time than the very prompt chlorine excretion. Whether the kidneys differentiate between the bromine and chlorine ions, that is the bromine is held back or whether the bromine enrichment occurs only through the increased blood bromine by substitution of chlorine with a percentually uniform excretion of bromine and chlorine is not definitely decided. But, in any case, a substitution of chlorine by bromine occurs, because with the introduction of bromine a loss of salt occurs. Likewise the chlorine in the gastric juice is suppressed by bromine and in place of HCL there is HBr. The substitution of chlorine by bromine obviously is equi-molecular.
With the continuous therapeutic use of bromine, about one-third of the chlorine in the blood is displaced; in experimental chronic bromine poisoning of animals, about two-thirds. bromine also seems to collect where chlorine is found in greatest amounts, the blood and the lungs. Since it is possible through excessive intake of slat to increase bromine excretion and since all the manifestations of bromine poisoning can be removed by the introduction of salt; one has spoken of a functional antagonism of chlorine and bromine. To the toxic actions of bromine belong also the suppression of epileptic attacks. The attacks can often be again provoked through the excessive intake of NaCl.
The detoxifying action of equimolecular chlorine salts on bromine salt poisoning can be also shown on Fundulus, a fish which can live in sea water as well as distilled water, but dies in various concentrations of sodium bromide solutions. It has been asserted that bromine poising is nothing more than chlorine deprivation.
According to the studies of Ellinger and Kotake, it is very improbable that bromine poisoning and simple chlorine deprivations (without substitution by bromine) are identical, for although high-grade chlorine deprivation also leads to paralytic manifestations, the remainder of the picture shows considerable differences. It may be assumed that the bromine ions also have an independent action which cannot be explained by mere replacement of chlorine. The more marked swelling of brain tissue by bromide than with chlorides speaks for this. Up to a certain grade bromine can replace the action of chloride. On the surviving frog heart the chlorides of potassium and calcium in the Ringer’s solution can be replaced by the bromides with out functional alterations; likewise the acidity and function of the stomach are improved when an artificially produced chlorine deficit is replaced by sodium chloride deficiency can be removed up to a certain degree by sodium bromide. In the last case it should also be recalled that the addition of sodium can lead to the improvement.