Essays on the effects of iodine in scrofulous diseases, including an inquiry into the mode of preparing ioduretted baths

Front matter

« M

Sain 1 , ieltutt.

YALE MEDICAL LIBRARY

Part I. On The Treatment Of Scrofulous Diseases By Iodine

AUTHOR'S INTRODUCTION I

Report by MM. Ma«endie, Serres, and Dumeril, to the Academic Royale des Sciences .1

Observations on some of the Pharmaceutical Preparations of Iodine . . . . .9

Effects of Iodine on the Animal Economy . . 15

Refutation of pretended Objections to its use in Medicine 22

CASES ILLUSTRATIVE OF THE EFFICACY OF

IODINE— or,

§ I. in Tubercular Scrofula . . . ib.

§n. in Ophthalmia and Coryza . . 31

§m. in Scrofulous Abscesses . . 34

§ iv. in Cutaneous Scrofula . . 36

1. Scrofulous Ulcers .... "ii

2. Esthiomenic or Corrosive Scrofula . . 39 § v. in Scrofulous Caries ... 45

Recapitulation . . . • , . .48 xii CONTENTS.

Part II

AN INQUIRY INTO THE EFFECTS AND MODE OF EMPLOYMENT OF IODURETTED BATHS IN SCRO- FULOUS DISEASES.

AUTHOR'S ADVERTISEMENT, PREAMBLE, &c. . 51 Experimental Inquiry, &c. . . • .55

EXPERIMENTS TO ASCERTAIN THE RESPEC- TIVE ACTION OF THE HYDRIODATE OF POT- ASH AND IODINE IN IODURETTED BATHS 62

Baths with Hydriodate of Potash alone . . 64

Baths with Iodine alone .... 65

Baths with the Tincture of Iodine . . 70

Baths of Iodine and the Hydriodate of Potash . 75

CASES ILLUSTRATIVE OF THE PECULIAR USES

OF IODURETTED BATHS ... 76

Of the Administration of Baths according to various Ages 83

Part III. On The Treatment Of Scrofulous Diseases By Iodine

ADVERTISEMENT 85

Second Report by MM. Magendie and Dumeril to the Aca-

demie Royale des Sciences .... 86

INTRODUCTION 89

CONTENTS. X111

CASES AND OBSERVATIONS DEMONSTRATING THE EFFICACY OF IODINE—

Page § i. in Scrofulous Tubercles • . . 91

§ ii. in Ophthalmia and Coryza . 99

§ ill. in Cutaneous Scrofula : —

1 Scrofulous Ulcere .... 104

'■i Estliiomenic or Corrosive Scrofula . . ill

$ iv. in Scrofula of the cellular Tissue . . 115

§ v. in Scrofulous Caries .... 126

On the Efficacy of Exercise in Cases of White Swelling of

the Feet, Knees, Hips, &c. . . . 149

Cases improved, though not cured, by Iodine . . 150

Cases illustrating the Application of Iodine in some forms of Venereal Affections . . . . 155

ON THE MODE OF PRESCRIBING THE PREPARATIONS OF IODINE.

1. Ioduretted Ointments ..... 169

2. Ointment of Proto-Ioduret of Mercury . . . 170

3. Solution for external I'se . . . . 17 1

4. Rubefacient Solution ..... 172 ii. Ioduretted Cataplasms . . ■ . .17 1

7. Caustic Iodine ...... 173

Tabular View of the Proportions of Iodine and Hydriodate of Potash and Water in Baths for Children and Adults . 180

XIV CONTENTS.

Appendix

Summary of Cases treated by M. Bermond, of Bourdeaux,

with Iodine and Hydriodate of Potash . 182

Cases treated by M. Lemasson, interne at the Hopital St.

Louis, with Iodine and Opium . • 1°°

Cases of Syphilitic Ulceration treated by the Proto-Toduret of

Mercury, by- Professor Biett, at the Hopital St. Louis 201

Case of Carcinomatous Ulceration, treated with the Deuto- Ioduret of Mercury, by M. Breschet, at the Hotel Dieu . .... 204

Therapeutic Effects of the Ioduret of Lead . . 205

Chemical Properties of Iodine, the Hydriodate of Potash,

and Iodurets of Lead and Mercury . 208

Adulterations of Iodine and Hydriodate of Potash . 212

3. Ioduret of Lead .... 215

4. Iodurets of Mercury . . . . . 216

ON THK

EFFECTS OF IODINE

SCROFULOUS DISEASES.

Part I. Author's Introduction

I could with difficulty describe the painful sensations I endured, when, ten years since, I was first appointed Physician to the H6pital St. Louis. I felt that, however extensive my previous experience might have been, it was not adequate to the successful treatment of the numerous diseases which were daily to become the objects of my care.

It also seemed to me essential to the due discharge of the new function which I was called upon to exercise, that I should undertake some special researches on the discrimination and treatment of those chronic maladies to which, in our days, the too exclusive name of " cutaneous diseases " has been applied. In pursuit of this conviction I first directed my attention to scrofulous affections.

B

& AUTHOR S INTRODUCTION.

I found additional motives to encourage me in this particular investigation, in the multitudes of patients thus afflicted, in the difficulties with which the subject was encompassed, and in the pity I ever felt for those labouring under an evil too often regarded as utterly incurable, and consequently abandoned to all the misery of their fate.

Of whatever nature and degree of certainty were the ideas I had previously acquired, during many laborious years, concerning the diagnosis of these affections, I was soon forced to admit that the therapeutic trials I had made of the ordinary remedies of the materia medica, were not more satisfactory to me than they had been to my predecessors. I found, also, that my contemporaries experienced a similar want of success ; I, therefore, was necessitated to participitate in the common opinion of the incurable nature of scrofulous diseases.

But the natural regret which associates itself with the reflection that the woes of our fellow-creatures are beyond the reach of mitigation, inspired me with the resolution to search diligently after new remedial agents.

With this intention, for two years back, I have sought an antidote for scrofulous maladies, in the new substance termed iodine, in which M. Coindet had already found a successfu remedy for goitrous tumours. In my early essays, my success was, doubtless, of a decided character ; but I deemed my object of too serious and elevated an order to permit me to embrace an easy conviction of its having been attained. I therefore repeated the experiments, and multiplied them to such an extent, that I was, at length, fully persuaded of the conclusiveness with which they established the antiscrofulous virtues of iodine. It was then that I commenced my special course of instruction on this class of diseases, and on the new method of treatment, which, though still incomplete, already offered consolation to all scrofulous patients j

ACADEMIC ROYALE DES SCIENCES, 3

a fact which I deemed my duty to lose no time in announcing.

But before I presented my researches to the Royal Academy of Science, I waited until my experiments had been continued for seventeen months, in order to obtain positive proof that there existed no anticipation of the results 1 communicated. That degree of certainty has now been fully acquired, and my assertions found exact, by M.M. Serres, Magendie, and the learned and illustrious reporter M. Dumeril. These three distinguished individuals, having been appointed commissioners by the Royal Academy, have witnessed, at the Hopital St. Louis, the several proofs of every thing advanced in my memoir ; and they have also kindly examined the materials from which I am preparing a second treatise, which will speedily be published.

ACADEMIE ROYALE DES SCIENCES.

REPORT ADDRESSED TO THE ROYAL ACADEMY OF SCIENCE, ON A MEMOIR BY M. LUGOL ON THE USE OF IODINE IN SCROFULOUS DISEASES.

Read by M. Dumeril.

M.M. Serres, Magendie, and your reporter, proceed to lay before the Academy an account of a Memoir (presented by M. Lugol, Doctor in Medicine) on the Use of Iodine in Scrofulous Diseases.

In the first place, we would remind our hearers that the scrofulous affections, long known under the names of " cold humours," or " the evil," constitute a class of those slow,

b 2

4 REPORT BY MM. MAGENDIE, &C,

unsightly, and often hereditary diseases, which strike despair into whole families, from the ahsolute rarity of their cure, and from the irremediable light in which they are regarded by the majority of physicians, and by the hospital regulations. Hence, also, the afflicted patients submit themselves to the illusive practices suggested by superstition ; for, though medicine has successively tried all the remedies with which she is acquainted (the number, and even the absurd variety, of which attest too strongly the want of a certain method of cure), it must still be confessed, that up to the present time an efficacious mode of treatment remained to be made known.

Sometimes this disease is external and visible, and shows itself under the skin by swellings, which are slowly developed, become softened, burst, and remain ulcerated for a lengthened period, and thus produce callous and incurable scars j it takes its place in the substance of the integuments, which it renders deformed and disgusting ; attacks the ears, the eyelids, the nostrils, and the lips, which become horribly tumid, or are corroded to such an extent as utterly to disfigure human nature.

Sometimes, more deeply hidden, the scrofulous habit attacks the bones and their articulations, obstructs the canals which transport the lymph and chyle, or produces in the lungs, and most important organs, tubercles which ultimately soften, and degenerate into purulent centres, thus giving rise to serious morbid alterations in the living economy, which eventually yields to the effects of the disease.

Such is an abridged view of the frightful malady to which M. Lugol, with zeal, perseverance, and success, has opposed a remedy, not absolutely new, but which had never previously been administered with so much method and precaution, to such a number of individuals at once, or with such evident and decided success.

M. Lugol is one of the distinguished physicians attached to

TO THE ROYAL ACADEMY OF SCIENCE. p

the Hopital Saint Louis, the only hospital in Paris where a great number of scrofulous patients are admitted for internal treatment. This circumstance explains how, in the short period of seventeen months, from the 10th of August, 1827, to the 31st December, 1828, M. Lugol has been enabled to collect the detailed cases of upwards of 100 patients; in whom he, of course, found great variety in the seat and intensity of the disorder.

Before your commissioners proceed to give an analysis of the memoir, they deem it right to declare, that they have not at all confined themselves to the scrutiny of its contents ; but that they have seen, examined, and questioned the patients under treatment, and have also visited some of those reported cured or convalescent, — that all the author's assertions have been found scrupulously exact, — that many of the patients who were under treatment when the Memoir was finished, have since been completely cured.

Without restricting ourselves to the order followed by M. Lugol in his Treatise, we proceed to make known its principal results.

In the first place we may observe, that he uses two preparations of iodine : the one, exclusively intended for internal administration, is a solution of this simple substance in distilled water. The others are proper for external application, whether as ointments for ulcers, pomade for frictions, or watery solutions of varied strength, for collyria, lotions, and injections.

The motives which have induced M. Lugol to employ by preference the agtteous solution of iodine, appear exceedingly plausible. So 'active a medicine can scarcely be administered in an hospital without inconvenience and uncertainty, except in the form of a drink. The alcoholic tincture and sirop of iodine present many disadvantages in the exact measurement and distribution of their doses, while a pint, or

6 REPORT BY MM. MAGENDIE, &C,

half a pint, of distilled water, containing in solution a little common salt, and a fixed quantity of iodine, affords us an easy, precise, and economical method of dispensing the remedy. Two degrees of this solution intended for the patients, and designated by the name of " Mineral Water " No. 1 and No. 2, the first containing two-thirds of a grain, and the second one grain of iodine in solution, have furnished the means of dosing exactly from day to day, and of recognising the effects of what was previously employed. Thus, half of No. 2 is the first allowance, the entire of No. 1 the second, and, finally, the whole of No. 2.*

As to the preparations intended for the external treatment, these are unctuous substances of a certain weight, and associated in determined and successively increasing proportions with iodine, ioduret of potassium (hydriodate of potash), or with the proto-ioduret of mercury.

These simple means have sufficed M. Lugol for the treatment and cure of numerous cases, twelve of which, selected from the different species of scrofulous affections, are described in the Memoir. Three relate to ulcerated tubercles, cured in three, seven, and twelve months. Two cases are also described of opthalmia and coryza, one of which yielded to a treatment of forty- six days, while the other was prolonged to the ninth month. A case of fistulous abscess deeply situated in the cellular tissue, has required nearly a year's care. Four cases are also recorded by M. Lugol, of that frightful form of the disease most usually denominated " dartre rongeante," but which the author names the

* It will be seen, in the third part of this Memoir, that the author subsequently altered his formula, and substituted for it a solution of iodine in the hydriodate of potash. The first prescription, however, cannot be omitted here, so closely is it interwoven with the treatment of the twelte interesting cases in the first Memoir. Additional reasons, stated in the Appendix, concur to render the account of this simple solution of iodine a subject of considerable importance. — Translator's Note,

TO THE ROYAL ACADEMY OF SCIENCE. /

esthiomenic (or corrosive) scrofula. Finally, a case of scrofulous caries is detailed. This last form has generally heen found very intractable. M. Lugol is only able to advance this single case of cure. It will be remarked, also, that the proto-ioduret of mercury was used, and that there still remains a small fistula as yet unhealed, but which appears to have a tendency to cicatrisation.*

All these cases are given at great length, they present complete accounts of the history and symptoms of the patients at the time of their first examination, and before the treatment was commenced. Many of the cases have been figured, and a record is presented of the modifications which have supervened during the treatment, as noticed twice every month, until the cure or discharge of the individual.

The author of the Memoir has carefully noticed the effects produced by the iodine on the animal economy. Applied externally, its local action has always been very sensible : it determines on the surfaces of the ulcers a feeling of smarting, accompanied with painful itchings. This application to the diseased surfaces changes their appearance, and frequently produces as appreciable an effect as that determined by mercury on venereal ulcers. Moreover, the mode of its action does not appear to be invariably the same : sometimes the iodine seems to melt down and resolve the tubercles, sometimes, on the contrary, it urges them on to rapid suppuration. At other times the painful sensation appears to diminish in proportion to the healing of the surfaces, an effect which is perhaps dependent on habit ; nevertheless, some ulcers remain sensible while the curative process is not at all established.

Internally administered, and always in small doses, and

* In tko Third Part of the Treatise many additional cases are recorded of the successful treatment of caries, hypertrophy, and spontaneous luxation of the bones.— Translator's Note.

8 REPORT BY MM. MAGENDIE, &C.

with the most prudent slowness, the ioduretted water constantly excites the appetite, and appears to increase the urinary and salivary secretions. Sometimes, but very rarely, it has become purgative to so considerable an extent that its use was necessarily suspended, at different intervals, from two to three days each. In other and still rarer cases, in which the solution of iodine appeared to occasion pain in the stomach, the wine of quinquina, given according to the directions of M. Coindet, in a dose of two or three ounces, put an end to the troublesome symptoms. M. Lugol, however, always declined as much as possible this association of remedies, in order to avoid complexity in the results of his treatment.

Iodine, administered in this diluted form, has never caused emaciation nor produced the expectoration of blood or other accidents, which many have imputed to its action.

From the contents of the first Memoir it appears that M. Lugol has treated with iodine alone, in seventeen months, at the Hopital St. Louis, 109 scrofulous patients, of which 61 were males and 48 females.

That at the close of last year, 39 (29 males, 10 females) were still under treatment.

That 30 (17 males, 13 females) had quitted the hospital with marked improvement.

That in four cases (2 males, 2 females) the treatment was ineffectual.

Finally, that 36 (13 males, 23 females) were discharged ^completely cured.

The author concludes, from all the facts he has collected, and the researches he has conducted, that iodine deserves to be considered as the most efficacious remedy in scrofulous diseases, since it has constantly arrested their progress, or at least exercised a salutary action in the treatment of all tuberr cular tumours, even when it has not evidently accomplished

PREPARATIONS OF IODINE. 9

their cure. He therefore believes that the introduction of this remedy into medicine is one of the most valuable acquisitions the healing art has made in modern times.

We shall then confine ourselves to say, that after having made ourselves acquainted with the facts cited in the memoir, we have been enabled to confirm the evident action of the remedy; and that we believe M. Lugol to have effected a work of great utility by availing himself of the facilities afforded by his situation, in seeking for a remedy for a disease hitherto so deplorable and desperate. We consequently propose to the Academy to encourage this physician to persevere in the researches which he has hitherto pursued with so much zeal and sagacity.

(Signed) Serues,

Magendie, and l> cm Kin i.. Reporter.

The Academy adopts the conclusions of this report. (Signed) Baron G. Cuvier,

Perpetual Secretary, Counsellor of State, Grand Officer of the Legion of Honour, ice. &c.

Chapter I

OBSERVATIONS ON THE PHARMACEUTICAL PREPARATIONS OF IODINE, PRESCRIBED IN THE FIRST MEMOIR.— THEIR ACTION ON THE ANIMAL ECONOMY.

Having established the anti-scrofulous virtues of iodine, I proceed to allude to some of its pharmaceutic preparations. We shall then study their action on the animal economy.

10 REMARKS ON SOME OF THE PHARMACEUTICAL

§ I. — PHARMACEUTICAL PREPARATIONS OF IODINE.

Considering the multitude of combinations which this body forms, and its powerful taste in the minutest quantity, I thought it would prove a very active remedy, and that much caution should be exercised in the experiments I was about to institute, in order that no pretext should be afforded to the exclamations of those persons who have an instinctive aversion to all innovations.

For these reasons 1 declined to follow the methods of administration hitherto adopted ; and as to the dose, the maximum at which I arrived is much inferior to that advised by M. Coindet in the treatment of goitre.

The two preparations most generally adopted are the tincture of M. Coindet, physician of Geneva, and the sirop of M. Henry, chief apothecary to the civil hospitals of Paris.

The tincture of iodine is ordinarily prescribed in drops, of which ten, fifteen, or twenty, are given daily. It has been calculated that twenty drops contain a grain of iodine, so that the majority of patients usually take three grains a day to the end of the treatment.

In certain private cases this preparation of iodine may doubtless be administered, where the physician actually assists in its employment; but it would show little knowledge of the measure of human patience, to believe that this mode of administration could be accurately followed in a public establishment, to an immense number of patients daily.

Another consideration has induced me to exclude the use of the tincture. I have been consulted by patients in the provinces, where this tincture, as yet little known, must be prepared with much diversity, so that a determined quantity of the liquor not giving a determined dose of the remedyj

PREPARATIONS OF IODINE. 11

the treatment cannot be conducted with certain data, and unpleasant effects may thus be produced.

The same reflections are applicable to the sirop of iodine of M. Henry. In some cases its use may be watched, but security cannot be obtained in its daily employment on the large scale.

In town practice, moreover, another difficulty presents itself with regard to the sirop : according to its author this preparation contains three grains to the ounce ; but unless we can generalise the use of measure-glasses, we shall always be deceived by trusting to the conventional measures of the spoonful, &c.

It is generally admitted that an ounce of water fills two spoons, and that a spoonful of sirop weighs an ounce. I can, however, affirm that this is not the case; two spoons may differ more than half, either from diversity in capacity or in the mode of filling them. 1 speak according to an experiment often repeated in the treatment of venereal diseases, for which, in counting by spoonsful, I have found such important mistakes to occur that I was obliged to renounce this method of measuring the sirop or liquor of Van Swieten.

These remarks will appear less frivolous if it be considered, that having the intention of giving iodine to an immense number of patients ; wishing, above all things, to avoid the accidents which so active a remedy might occasion, I thought it right to take the necessary dispositions, in order to avoid the complications which might arise from its irregular administration.

The mode of preparation which I regard as the most certain is the state of perfect solution in distilled water, observing always not to extend the quantity of the vehicle much bevond that necessary to obtain the perfect solution, because the distilled water, being indigestible itself, may produce some inconvenience.

12 SUPERIOR EFFECTS OF SMALL DOSES.

At first I fixed this vehicle at a pound, in this I dissolved half a grain, two-thirds of a grain, or a grain of iodine, in order to have at my disposition three degrees of the same remedy, to be used according to the individuals and periods of treatment.

Besides, I have sought to render this solution still more assimilable by the addition of twelve grains of the chloruret of sodium, an addition which probably compensates also for the absence of air in the distilled water ; a deficiency which produced less inconvenience than I anticipated, and which was never sufficient to oblige me to change this mode of prescription.

I have denominated these three degrees of the solution as ioduretted mineral water, No. 1, 2, and 3. In all cases I commenced by No. 1, seldom proceeding to 2 till the second month of treatment. I have by no means given No. 3 to all scrofulous patients, and I have never had occasion to pass this last dose of one grain per day.

The clinical experiments of which I have given the history, have all been performed with the three degrees of this mineral water ; but afterwards, not losing sight of the necessity of diminishing the quantity of the vehicle as much as possible, I became accustomed only to prescribe the 2d and 3d No. of the preparation. These two degrees may serve for the administration of iodine according to the same graduation which I previously observed with the three. It will be sufficient to begin with the second, No 3, which at first will serve for two days ; we may then return to No. 2 and 3, which the patients may take in a single day. In this manner the dose will be half a grain at commencing, and gradually two-thirds of a grain and one grain every twenty-four hours.

It will be seen that I have stopped far short of the maximum dose administered by M. Coindet, who gives it to the

OBJECTIONS TO THE TINCTURE OF IODINE. 13

extent of three grains a day. Although this precedent was before me, I could not induce myself to imitate it, for I found that the patients were sufficiently excited and improved by the smaller doses I gave them ; and I even judged by the particular effects produced under my immediate observation, that the increase of the dose might be attended with dangerous results.

I shall not omit to mention a particular circumstance which caused me to understand all the difference of action produced even by the slightest increase in the quantity of the remedy. I have seen scrofulous patients on whom the ioduretted ointment No. 1 was nearly inactive, but who could with the utmost difficulty endure the application of No. 2. Of this description was Melanie Augi'e, who endured a feeling of almost insupportable smarting for two or three hours, when she rubbed the tubercles with No. 2, and who nevertheless insisted on using it on account of the inactivity of No. 1. This difference was produced by an increase of one-sixth in the quantity of iodine. The highest number, in fact, produced so intense a local action, that I was obliged to suspend its application often for twenty-four or thirty-six hours, in order to prevent local accidents.

This contemplation of the external mode of action of iodine directed me in its internal use, and confirmed the caution I observed from the very commencement of my experiments.

I avoided the tincture of iodine for another reason besides those already described. It is usual to prescribe this remedy in an aqueous vehicle! The whole of the iodine is consequently precipitated in the pure solid state, in which form it may produce intense excitement in the stomach, if we may judge bv our knowledge of its external effects. This observation applies still more forcibly to the sirop, which contains the iodine only in a state of suspension. It is, I feel con-

14 10DURETTED OINTMENTS AND SOLUTIONS.

vinced, in consequence of the employment of such modes of dispensing, that accidents have ever occurred, or prejudices arisen against the remedy. Tartar emetic, corrosive sublimate, and other powerful remedies essential to the treatment of numerous diseases, have been found to produce bad effects before their apt dose and due mode of preparation were discovered. Even yet, such evils follow when the necessary indications which should regulate their use are neglected, or improper methods of administration pursued.— Iodine, thus, would long have been a source of more harm than utility, had not the indications it may fulfil, and the rules according to which it should be prescribed, been diligently sought for in suitable conditions.

But whatever merit may be possessed by the preparations thus recommended for internal use, they do not answer a purpose of frequent occurrence in scrofulous cases, viz.— that of local treatment. I, therefore, at first, prescribed a particular ointment, of three different strengths, composed of hydriodate of potash and iodine.

IODUIIETTED OINTMENT.

Jt, Fresh Lard tb ij . . lb ij . , ft ij

Hydriodate of Potash J iv ,. Jv ,. Jv

Iodine 3 iv . . 3 xiv . . 3 xvi

Afterwards I made use of a solution of iodine, which occasionally forms a valuable substitute for the preceding ointment, especially in scrofulous ophthalmia;, and for the injection of fistulous canals.

IODUBETTED SOLUTION »OIl EXTERNAL USE.

R Iodine gr. 2 . . gr. 3 . . gr. 4

Distilled Water .. ftj .. ft ij .. ftiij

As to the dressings and iodine frictions, I have been enabled by care to regulate the proportions of iodine and

EFFECTS OF IODINE ON THE ANIMAL ECONOMY. 15

liydrioilate of potash in the several degrees of the ointment and solution, but I found it almost impossible to assign a fixed dose daily to each patient, from the variable condition of the parts and the necessary diversity to be observed in the quantity or repetition of the application. During the first months of my experiments, I dressed ulcers or rubbed the tumours twice a day ; but afterwards, I remarked in several cases that two such local irritations were too much in such a short interval. One dressing daily is therefore only practised, unless in particular cases of profuse suppuration, which very frequently attends fistulous ulcers, symptomatic of scrofulous caries of uncertain extent.

§ II.— EFFECTS OF IODINE ON THE ANIMAL ECONOMY.

1. — External Local Effects of Iodine.

The external employment of iodine ordinarily produces intense local action, and often causes a prolonged sensation of prickling and smarting, especially severe on bathing days.

In many cases this action terminates by a fit of itchiness, short in proportion to the duration and the degree of pain first experienced.

A few days are sufficient to change the aspect and improve the condition of ulcers, whether suppuration be produced or not. We have observed this repeatedly in a vast number of cases ; the following examples will illustrate the rapidity with which the local changes occur : —

Two scrofulous patients, — one Scieure", since cured ; the second Hastard, afterwards dismissed convalescent, were each affected with ulcerated cervical tubercles, in the month of May, 182S.

Scieure had an ulcer an inch in length, of oval form, deeply seated in a tubercle of the same shape ; the edges

16 EXTERNAL LOCAL EFFECTS OF IODINE;

were red, bleeding, projecting about two lines over the base, which was fungous, and bathed in scrofulous pus.

In Hastard the principal ulcer was round, soft, its edges unequal, thin, red, and bleeding, generally level with, but in some points below, the centre, which suppurated profusely.

Scieure's ulcer was at the left side of the neck ; Hastard's at the right : so that, looking from one patient to another, we had two different examples of scrofulous ulceration in its most striking form. The appearances in these cases struck me so much that I wished to have them delineated by Dr. Carswell,* an able anatomist, who possesses the highest degree of perfection as a pathological painter ; but that gen* tleman having been detained at La Charite by similar labours, he could not at once comply with my request; and when ten or twelve days of the treatment had elapsed, the ulcers had so changed that they were no longer objects of delineation, both being then in a rapid progress of cure.