It is very important to have a clear conception of the mischief which may be thus caused. As iodoform, or some corresponding chemical, will probably continue to have an important place in the antiseptic method of surgical dressings, and as it is also much employed in medical practice, the practitioner should learn to recognize the untoward symptoms. "Eseter, of Trieste," says Lou-guet, "had a case of death from the iodoform-mania." But many deaths have since followed from the too lavish use of this agent. An idiosyncrasy is observed in some subjects—a special susceptibility to the action of the iodides in general, and to iodoform in especial. It sometimes happens that this idiosyncrasy develops suddenly and without warning, and the toxic symptoms occur at once, death quickly ensuing, although the remedy is suspended (Schede). When the action of iodoform is unfavorable, the symptoms observed have been as follows: 1. Rise of temperature to 104° Fahr., or even higher. 2. In addition to fever, there will be headache, loss of appetite, a rapid pulse, low tension of the vessels, etc., but the symptoms in both classes will quickly disappear if the remedy is discontinued. 3. In this form of iodoform-poisoning, the pulse is quick, reaching even 180, and is feeble; there is much depression of the forces in general, and the condition of the mind is anxious, restless, and melancholic. These symptoms may be caused in some subjects by the first application of iodoform, or may come on after an apparent tolerance has been established, 4. In this group of toxic cases, the same symptoms occur as in the third, viz., high fever, melancholia, etc., but the termination is quickly fatal, although the application of the remedy is stopped. 5. In this group, the symptoms of a profound depression come on, and death speedily occurs in a condition of collapse. In many examples of this kind, it may well be a question whether this accident is not due to the injury of operative procedures. 6. In the more formidable results of iodoform applications, very decided cerebral symptoms have been observed. These have been described by Schede and Küster more especially, and are mentioned by them in connection with the several classes of iodoform-poisoning above referred to. There is, however, a condition of the cerebrum caused by iodoform-poisoning characterized by disordered stomach, high fever, dilated pupils, melancholic depression, stupidity of mind, involuntary evacuations, hallucinations, etc.

Notwithstanding the above-described forms of poisoning have a real existence, it is held by Mundy, Czerny, Küster, and others, that now and then, probably frequently, a septicaemic state, and undiscovered complications, are responsible for the symptoms attributed to iodoform. Making due allowance for such an error, there are still examples of the toxic effects of iodoform; hence the need of proper caution in using it topically.

Treatment of Iodoform Intoxication

The first step consists in the withdraws of the application, and every adherent particle should be at once removed. The powers of life should be supported by a judicious use of stimulants, and especially by small doses of the tincture of opium, frequently repeated. Elimination should be promoted by diluents freely administered.

The most important point as regards prophylaxis is to avoid too lavish use of the agent. Schede says that large flesh-wounds should not be filled with iodoform, for then it can be removed only with the scab. Granulating surfaces absorb less, but here the danger of intoxication also exists. Mundy advises that a small quantity only of the powder be dusted over the wound, that the dressings be allowed to remain, and that close sutures and tight bandages be avoided. It appears that caution is needed in the application to the amputated breast, and in all operations involving the peritonaeum. As to quantity used, we are guided by the results following lavish use. Three hundred grammes in one case (Beger), 100 to 200 grammes (Henri) in another, have induced poisoning. Death followed the use of 35 to 40 grammes (542 to 620 grains) in a case of operation involving the peritonaeum (Küster).

Von Mosetig-Moorhof has employed iodoform in several thousands of surgical cases without a single instance of poisoning, and he attributes this favorable result to the fact that he has not used large quantities of the remedy, that the wound was not subjected to pressure, that the dressings were frequently changed, and that carbolic acid was not used at the same time.

Mode of Applying Iodoform

The simplest mode consists in merely dusting the powder over the surface, wound, or sore, to be acted on. A common tin pepper-box or an insufflator may be utilized for this purpose. Gauze or absorbent cotton may be saturated with an ethereal saturated solution of iodoform and applied according to the methods of Lister. Iodoform and tannin may be applied in any desired proportion after they have been thoroughly triturated together. Iodoform may also be suspended in a mixture with gum—with glycerin and gum-tragacanth. As the odor of this substance is so diffusive and persistent, various means have been resorted to for its removal or modification. The essential oils, the balsams of Peru and tolu, essences of all kinds, menthol, eucalyptol, and thymol, have been employed with varying success; of these, thymol appears to be the best, for, while it modifies the odor, it less impairs the antiseptic qualities. The mixture of iodoform and thymol may be in any desired proportion. Lindemann advises the following mixture: Iodoform, 1 part; balsam of Peru, 3 parts; and vaseline, 8 parts: or iodoform, 1 part; balsam of Peru, 3 parts; alcohol, glycerin, or collodion, 12 parts. Recently, pulverized roasted coffee has been shown to be very effective, and this material does not impair the peculiar qualities of iodoform, as many of the disguises now used do.