IODINE IN THE TREATMENT OF

MALARIA, KALA-AZAR AND SMALL-POX.

By J. J. A. BRACHIO,

MAJOR, I.M.D.,

Civil Surgeon, Birbhum.

Readers of the Indian Mcdical Gazette may remember a paper which I published in 1914 on my experience in the treatment of cholera with iodine. Since then I have used iodine exclusive- ly for cholera and have struck nothing better. On return from military duty to civil employ

in January 1921, I was faced by an embarrassing problem, there was a general hue and cry from all quarters that the district was being depopu- lated by malaria, and every one was shouting for quinine and more quinine, and the difficult/ was that at that time there was a shortage of Gov- ernment quinine and what could be got was being sold at Rs. 49 or Rs. 50 per

&

pound. Worse than ever, as the price of quinine had gone up, our funds had inversely gone down. It very often happened that such money as we could raise was sent back with a note that there was no quinine in stock.

In consequence of this state of affairs I had to look about for a substitute, and the first thin" I did was to turn to iodine which had served me so efficiently on several other occasions in

cholera, small-pox, influenza, intestinal colic, diarrhoea, dysentery and a host of otlier complaints with which I shall deal with later. The results were most gratifying. And now in the Suri Jail quinine is a thing of the past, and iodine has prac tically taken the place of all other drugs for the

treatment of fevers, bowel complaints, and septic conditions.

Owing to long ingrained prejudice, I have not enforced the adoption of my practice in the Suddar Hospital or the Police Hospital, where quinine is sometimes used, but this is gradually dying down as results become apparent. In the district and out-lying dispensaries, owing to the same prejudice, I have found a good deal of diffi- culty in persuading my assistants to depart from the beaten track of prescribing fever mixture for fever, or astringent mixture for diarrhoea, or triple powder for dysentery. These people will admit that quinine is the correct thing for malaria, but they will go on prescribing fever mixture for days and sometimes for weeks, whilst waiting for an opportunity to obtain quinine, in the mean- time calling the disease by such euphemistic terms as typhoid remittent, or typho-malaria; and when they do prescribe quinine it is usually in doses that have no effect and which amount to a waste of

good money. It has also been my experience that the patient of these days is not satisfied with his doctor unless he prescribes some preparation with a high sounding name such as novarseno- billon or hormotone: whereas the ordinary house- hold remedy iodine is far too commonplace to be accepted.

Malaria as it exists to-day may be regarded as the greatest scourge that has ever existed in India. India by virtue of being an agricultural country encourages the spread and endemicity of malaria. It is the masses in the villages that are affected most. It is the poor that suffer most. And it will take ages and ages to educate the masses to

protect themselves from its attacks. So the next best thing to do is to give the individual a remedy that will cure him when he has actually been at- tacked. And that remedy must be accessible to rich and poor alike.

The medical profession universally believes that quinine is the only antidote for malaria, and it seems almost ludicrous to try and supplant its

leading position, more especially with such a com- monplace drug as iodine, which for generations has been regarded as a poison internally, and an anodyne externally. In fact when about a year

ago I mentioned to some of my medical friends in Calcutta that I was using tincture of iodine for the treatment of malaria, some of them looked at me in such a way as if to imply that they regard- ed my sanity with some suspicion.

All authorities agree that nothing less than 20

grains of quinine per day is of any use in the treat-

ment of an adult suffering from a malarial attack; some are in the habit of prescribing 10 grains three times a day. It is also suggested that to

properly treat an attack of malaria the victim

should undergo a four months' course

before he can be safely considered cured.

Where, outside the army, is such a thing possible? Even if our benevolent Govern-

ment could afford- to provide all the quinine that is necessary and were to enlist an army of

312 THE INDIAN MEDICAL GAZETTE. [July, 1923.

conscientious enthusiasts to distribute the quinine to the stricken, only about one per cent, of the afflicted would turn out on the first day to receive it and in the course of a week none except those who were actually suffering from fever would turn up at the distribution centres. So it is obvious that this expensive, prolonged and dis-

agreeable method of treatment should be replaced by something which does not require an army of enthusiasts, which will be less expensive and last but not least will be less disagreeable.

Quinine costs Rs. 30 per pound nowadays, whereas tincture of iodine costs about Re. 1 per pound.

Quinine is given in ten grain doses three times a day, and a course of treatment should last over four months. Tincture of iodine has been given by me in ten drop doses, three times a day, and need be continued for about ten days only. Taking the dosage and time of treatment as equal for argument's sake, then for the cost of every patient treated with quinine, thirty patients could be treated with iodine.

It has been my experience that unless spon- taneous recovery occurs, which sometimes hap- pens even with no quinine at all, an ordinary at- tack of malaria with a week or ten days' treatment often relapses. I have found that an attack of fever treated with iodine does not relapse. Cases that resisted oral treatment with iodine up to the fourth or fifth day, were given one or two in- travenous injections of a quarter grain of iodine, which was sufficient to bring the temperature to normal and to keep it there.

Quinine as a drug is positively abhorred by all for its taste, and dreaded by most for its after- effects. Iodine has nothing objectionable in

taste, nor have I even seen any undesirable phy- siological effects follow on its use.

All the above-noted points are worthy of con- sideration.

In the Suri Jail hospital in 1921 I had 73 ad- missions from malaria and several of these were

relapses. In 1922 when iodine was the routine treatment for all fever cases, I had 23 admissions and no relapses. It may be noted that quinine as a prophylactic had been discontinued al-

together during 1922. I could subjoin a few dozen case-sheets and

temperature charts to illustrate my contention, but they are all very much alike, and I feel sure would serve no useful purpose, and take up an

unnecessary amount of space. A number of these case-sheets and temperature charts were shown to Dr. Bentley, Director of Public Health, Bengal, and Colonel Hamilton, i.m.s., Officiating Inspector-General of Prisons, at their visit to

Suri. One interesting fact has come under observa-

tion in the jail. A patient who had been admit- ted several times for fever before I started the iodine treatment, had a relapse and had to be admitted into hospital after I had started the iodine treatment. As was now the routine treat-

ment he was put on to ten drops of iodine three times a day, but to my disappointment after seven days of iodine his fever continued unabat- ed. This man's (blood films showed in- numerable crescents, so I concluded that

perhaps iodine had no effect on crescents, and

fearing that I had lost a considerable amount of time already, and feeling badly beaten, I very reluctantly reverted to quinine and his tempera- ture dropped to normal in twenty four hours. Of course this might have been due to the quinine or to the cumulative effect of the iodine or might even have been an instance of spontaneous cure. But not caring to subject the patient to any risk I continued the quinine for a week, after which I gave him three intravenous injections each of half a grain of iodum once a week, and now it is 8 months since he has had any treatment and he has had no relapse, as was formerly the case.

Kala-azar.

The above results and a few others where the

spleens were enormously enlarged and where malarial parasites were not found led me to try the iodine method in cases of kala-azar with the

happiest results. And though the present anti-

mony method is- an accepted fact in the treat-

ment of kala-azar I beg to submit that the weeks and months of monotonous waiting, sometimes? indeed?to no purpose, become wearisome and intolerable to the sufferer, and to his friends and relations, who often lose heart and abandon the treatment long before recovery sets in. With this fact in view, I hasten to lay before the pro- fession a resume of my experience and observa- tions in the treatment of kala-azar with iodine % the mouth and intravenously, with a view to lose no time and with the hope that some of the work- ers interested in this subject who are better pro- vided with material, equipment and facilities will put the method to the test and express their verdict. The method is as follows. I prepare the fol-

lowing solution:? Iodum .. .. grs. 6. Pot. Iod. .. .. grs. 6.

Aqua distillata .. .. oz. 1.

40 minims of the above solution contain half a

grain of iodum. This quantity is injected intra- venously every other day up to five injections and then ten drops of tincture of iodine is given by mouth three times a day for a week. Before the fifth injection has been given there appears a

marked diminution in the size of the spleen. Nourishing food and tonics may be given to com- plete recovery. My thanks are due to Dr. Harendra Nath Sen,

who has carried out the spleen puncture and aldehyde tests, and to Dr. Nagendra Nath Das Gupta of the Jail hospital and Dr. Aughore Nath Das of the Police hospital, who have carried out the treatment and have kept records.

Jui?y, 1923.] COMPLICATION IN KALA-AZAR : CHATTERJEE. 313

It has been our experience that the sernm taken from a blister also coagulates with formaldehyde in cases where the blood serum is positive, but is not affected in cases where the blood serum is

negative. Smaix-pox.

Since 1913 I have been using tincture of iodine externally and internally in the treatment of

small-pox. The benefit of this method was first evidenced in an epidemic of small-pox, which broke out in the town of Suri in 1913, when T

was the Chairman of the Suri Municipality. I, with my Sanitary Inspector, used to visit every house where a case of small-pox had occurred and paint the patients with tincture of iodine twice

daily. And to some of the very bad cases who consented to take internal treatment a mixture of ten drops of the tincture was given to be taken three times a day. It is probably known that most of ignorant patients regard an attack of

small-pox as a visitation from the spirits, and do not like to take any treatment that will interfere with the will of the spirit. In a previous epidemic in the town 175 cases had occurred and there had been 75 deaths. On this occasion there were

only 35 attacks and no deaths. The most marked feature Sbout the treatment was that in no single house affected did a second case occur, whereas in one house where the patient had homeopathic treatment there were three more cases. In sub-

sequent years whenever small-pox broke out in

any locality I provided the Inspectors and Sub- Inspectors of vaccination with a bottle of iodine each and sent them out. They always reported most satisfactory results.

Recently when I was stationed in Lucknow, small-pox broke out in^ epidemic form amongst the men of the 10th Middlesex Regiment. Hav- ing had some experience of small-pox I was put in charge of the small-pox ward. I used tincture of iodine freely and with the happiest results. My experience is that the free use of iodine at

any stage of the disease cuts short the attack, reduces its virulence, and renders it absolutely innocuous. Knowing how the poorer class of Indian live and how loath they are to part with their bedding, and quilts, I have found that where iodine has been used freely no other persons in the house have been infected, which I am inclined to think is due to the iodine completely sterilising the patient and his bedding. Another feature is that the patients treated with iodine before the

suppurative stage sets in do not pit; even others treated in the later stage pit very slightly.

Carbuncle. Iodine has been used for a long time as an

application for boils, whitlows and carbuncles. But recently I had two very bad cases of large carbuncles one on the side of the neck, and an- other on the back. Free incisions were made, but in the neck case it was considered inadvisable to go very deep. So instead half a grain of iodine was given intravenously; the effect was like magic.

DYSIiNTlvRY and Diarrhoea. It is now the routine practice at Suri that when

a case of bowel trouble is admitted into the Jail Hospital, he first gets a dose of castor oil, which is followed by tincture of iodine ten drops three times a day. He never needs any other treatment. There used to be in Jails what is known as the

post-dysentery gang. This used to be considered

very necessary in former days. But since I

started the iodine treatment I have done away with this and we have had no ill effects.

Gonorrhoea. It is far too early to pass a verdict in this dis-

ease, but recently I received into the Jail an

under-trial prisoner suffering from a profuse gonorrhceal discharge of five months' duration. Smears showed innumerable gonococci. I order- ed that none of the old forms of treatment either internal or local were to be given, and gave him half a grain of iodum intravenously every other day with the result that where the discharge used to pour out profusely 10 days ago, he can scarcely squeeze any out now. After the fourth injec- tion there was considerable improvement in the local condition and the smear shows very few

gonococci. He is still under treatment.

Tubercle. I hope to publish later a separate report on my

experience in the treatment of tubercle with iodine.