Kali Iodatum

Authorities. 59, Belgian Journal (Lancet, 1848 (2), p. 213'), a man, jet. thirty-five years, took it for five months for acne indurata on the forehead, which it cured; 60, Prof. A. Fournier, Med. Times and Gaz., Oct., 1877 (Afner. Journ. Med. Sci., Jan., 1878, p. 263), general effects; 61. Dr. Colby, Pub. Mass. Horn. Med. Sac., vol. iv, 31, took one dose of 15 grains of Hydriodicum.

He suffered from a painful sensation of heat in his feet; iu a few days this increased, and was accompanied by a trembling of the limbs and feeling of intoxication; his movements were uncertain from a tottering of his lower extremities ; there were vertigo, dulness of the eyes, feeble, and often double vision, with a sensation of turning round. All these phenomena persisted for several weeks. Shortly after, the power of moving his lips and cheeks was lost, and he was unable to masticate. He had also vague feelings iu the head, back, and limbs, which he could not describe. A day or two afterwards his gait was still faltering, with vertigo and feeble vision ; the countenance was that of a drunkard ; speech thick and indistinct; eyes apparently protruded, and a loss of appetite,^®.—In a paper contributed to the Revue MensueUe de Med. el de Cliir., September, 1877, Prof. A. Fournier, of the St. Louis Hospital, observes that while among the numerous and various phenomena which may follow the ingestion of Iodide of potassium, there are some which are of common occurrence and well known ; there are others which have either escaped attention, or have only been imperfectly described. Among these may be ranged, he believes, a cutaneous affection, consisting in the production of small miliary, non-pruriginous, sanguineous spots, proceeding after the manner of purpura, and to which he proposes to give the name of iodic purpura, or petechial iodism. That the appearance of the exanthem, and the taking of the Iodide are not a mere coincidence, he concludes from the following observations: 1. In all cases the purpura has appeared a very short time (from one to six days) after commencing the Iodide. 2. In some of the patients the same purpuric eruption has been produced several times after each new administration of the Iodide, and in three of these it occurred every time the medicine was used. Two cases are detailed in which this was the case three or four times. 3. In another case in which the purpura was produced on three successive occasions, it was found in all these that whenever the dose was notably increased, a marked aggravation or additional production of the eruption ensued.

As to the characteristics of this eruption, in all the patients the wellknown appearances of purpura, and the impossibility of effacing them by pressure with the finger, were distinctly present, the petechial color due to extravasation being very obvious. The seat of the eruption, with one exception (when it was on the thorax, and that only), was in all the cases on the legs only, being always more confluent on their anterior than on their posterior part. It never descended to the foot, or extended beyond the knee. This purpura seems to assume an eminently discrete form, few spots being usually observed, about a hundred of these on each limb constituting the maximum of confluence, fifty or sixty, or even less, being the number usually observed. On the successive appearances the purpuric spots are even yet fewer in number. This rarity of confluence, and the especial localization of the exanthem about the anterior tibial region, impart to this variety of purpuric affection a somewhat peculiar physiognomy of its own. It is always a miliary purj)ura, that is, a petechial eruption of the smallest extent, resembling in size a millet-seed, the head of a pin, or at most, and that rarely, a grain of corn, or a small lentil. The spots are usually of a regular rounded form, and less often oval or irregular in form, and notched. The eruption never advances beyond this petechial and miliary condition. The spots are quite level with the skin, seemingly incorporated with the integument, the appearance of which they only modify by their bright color. Like as in purpura vulgaris, these spots give rise to neither local nor constitutional disturbance, inducing neither heat, pain, nor pruritus. Thus there is a great chance of this eruption passing unperceived, and it is always by accident that the patients have observed its existence, while undressing at the bath,etc.,so that many cases have no doubt escaped the notice of patients and their attendants. The eruption comes on at an early period of the iodic treatment, and has completed its course iu two or three days, at the end of which period it ceases to increase in confluence, even when the use of the medicine is continued. It remains for a certain time in the condition of purpurine petechiae, after which the spots undergo the ordinary changes of color observed in cutaneous hemorrhages, finally disappearing at the end of two or three weeks. When under the inliueuce of a large dose of the Iodide, a new purpuric outbreak is produced ; the intruding eruption is easily distinguished from that which has preceded it by the bright purpurine color of its spots, contrasting with the faded condition of the prior spots. It has a curious appearance, this intermixture in the same locality of petechiae of different ages, with difference of color corresponding to the periods of their appearance.

This purpura is certainly a rare accident, or rather phenomenon, for there are few remedies which are more employed than the Iodide of potassium ; and if iodic purpura were not almost an exceptional occurrence, it must have attracted the attention of observers. Professor Fournier, who, during the few years since he first became aware of its existence, has carefully sought for it, has not met with more than some fifteen cases.

All the subjects of the affection hitherto met with enjoyed either a flourishing or a medium condition of health ; and although some of them seemed affected with a certain degree of “ lymphatism,” none could be said to suffer from anaemia or scrofula, and none had presented anterior haemorrhagic proclivities. Any of these who were the subjects of syphilis exhibited only benign or medium forms of this, two-thirds of the cases being exempt from any specific manifestation of this disease at the time when the Iodide, which, in fact, was administered only as a preventive, produced the purpuric eruption. Further, in a negative point of view, neither sex, age, occupation, nor external temperature seemed to have exerted any influence. Nor can the eruption be attributed to excess of dose, since most of these patients had not taken more than 15 grains of the Iodide when the eruption had manifested itself. Still, quantity is not a matter of indifference, for when a given dose has been followed by purpura, a kind of tolerance of the remedy seems to be established, and no further manifestation ensues. But let the dose be much increased, doubled, for example, and a newoutbreak of purpura may be immediately produced, although this is less confluent and less important than that which preceded it. But it is probably the individual predisposition which predominates over all the etiology, for however unknown and impenetrable in their nature, the existence of idiosyncrasies in regard to the action of certain remedies and articles of diet is beyond doubt. Iodic purpura in its nature takes its place in the group of affections termed by M. Bazin, provoqnees indirectes or pathogenetiques. It is a medicinal eruption which ranges nosologically with the roseola from Copaiba, the erythema from Belladonna, the exanthems from Arsenic, the acne from Iodine, etc.,®“.—At night, after retiring, had a terrible spasmodic pain at the root of the tongue, extending to both sides of the throat. For about fifteen or twenty minutes the pain was excruciating, causing a fear that death was impending. I here was a sensation as if a spasm would close the pharynx,®'.