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EFFECTS OF IODIDES ON INFLAMMATORY PROCESSES PAULB. BEESON* Early in this century potassium iodide was regarded as "one of the most important drugs in the Pharmacopoeia" [I]. Although now displaced by many new therapeutic agents, an extensive body of clinical experience remains, showing that this simple compound can exert impressive effects on certain kinds of pathologic processes. This essay deals with the effects of iodides on a peculiar assortment of inflammatory lesions: syphilitic gummata, some mycotic infections, some dermatologie diseases, and skin test reactions. The element iodine was discovered in 1811, and this soon led to trial of iodides in the treatment of many disorders. Kelly says: The variety of diseases for which iodine was prescribed in the early years is astonishing—paralysis, chorea, scrofula, lacrimal fistula, deafness, distortions of the spine, hip-joint disease, syphilis, acute inflammation, gout, gangrene, dropsy, carbuncles, whitlow, chilblains, burns, scalds, lupus, croup, catarrh, asthma, ulcers and bronchitis—to mention only a few. [2] Tertiary Syphilis Within twenty years of the discovery of iodine, the potassium salt was being used with good effect in treatment of tertiary syphilis [3, 4]. Toward the end of the century, Osier's textbook of medicine had this to say: In the treatment of the visceral lesions of syphilis, iodide of potassium is of equal or even greater value than mercury. Under its use ulcers rapidly heal, granulomatous tumors melt away, and we have an illustration of a specific action The author expresses gratitude to Charles Dinarello, Jack Peter Green, J. Trevor Hughes, Allan Lorincz, Daniel Musher, and Lisa Steiner for advice and help in the preparation of this essay. * Address: 21013 NE 122nd Street, Redmond, Washington 98053.© 1994 by The University of Chicago. All rights reserved. 003 1-5982/94/3702-0854$01.00 Perspectives in Biology andMedicine, 37, 2 ¦ Winter 1994 | 173 only equalled by that of mercury in the secondary stages, or by iron in certain forms of anemia, and by quinine in malaria. [5, pp. 182-183] That statement is noteworthy because Osier has always been described as a "therapeutic nihilist." Yet his endorsement was repeated, with minor changes in wording, through subsequent editions of the textbook, into the 1930s (an era when late manifestations of syphilis were encountered more frequently than now). Osier spoke of syphilis as the Great Imitator and advised students always to keep its varied manifestations in mind. He frequently recommended a trial of iodide in disorders of uncertain origin, or in patients with a history of syphilis. Other authorities shared Osier's point of view. In 1927 the first edition of the Cecil textbook of medicine recommended potassium iodide in the treatment of thirty diseases [6]. The most recent edition of the Cecil text (1992) recommends it as the treatment of choice in only one disease: the cutaneous form of sporotrichosis. The drug also receives passing mention in a section dealing with erythema nodosum [7]. This, of course, reflects the facts that specific antimicrobial agents have become available, that syphilitic gummata are now rare, and that surgical treatments are available for syphilitic aortic insufficiency and aortic arch aneurysm. It is improbable that Osier and other respected clinicians of his time were mistaken in their belief that iodide therapy exerted a specific curative effect on syphilitic gummata. Not only could the superficial lesions of skin and mucosa be seen to 'melt away,' but particularly striking were the effects on syphilitic disease of the liver, a disease often manifested by fever. In 1926 McCrae and Caven, of Philadelphia, reviewed their experience with 100 cases of hepatic syphilis. They described gross enlargement and nodularity of the organ and said this about the fever: There was some elevation of temperature in 81 cases of the series . . . The influence of treatment on the fever was very marked in almost all cases . . . This followed the administration of potassium iodide alone in the majority of cases; in some mercury was given also, but the most striking results were obtained with potassium iodide alone. [8] (They cautioned against administration of arsenicals to patients with hepatic disease.) In 1936 Hamman and Wainwright discussed the clinical problem of fever of uncertain origin, based on records of the Johns Hopkins Hospital . They...


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