Iodophilia

IODOPHILIA, the property of cells to absorb and retain free iodine in their protoplasm for a certain period of time. This property was first noticed by Ehrlich and Gabritschewsky in neutrophilic leukocytes and was explained by the presence of glycogen in them. However, Zollikofer subsequently discovered that the iodine-absorbing substances of the cells are closer to amyloid than to glycogen. The reaction is performed either in air-dried preparations by mounting them in an iodine-gum solution, or by exposing dry preparations to crystalline iodine vapours in a chamber, followed by mounting them in levulose syrup. One can also perform a vital reaction according to Zollikofer on undried smears in a chamber, followed by mounting in levulose syrup. Iodophilia occurs also under normal conditions and thus does not indicate cell degeneration. Its diagnostic value in pathology is limited. Only a highly pronounced reaction is of significance, which may serve as an indication of intoxication or suppuration, but not always. Positive results can be obtained in miliary tuberculosis, perityphlitis, chlorosis, diabetes, etc. IODOFORM (Jodoformium, Ph VII), CHJ₃, triiodomethane (formyl triiodide), molecular weight 393.804, contains 96.7% iodine; small, foliated, shiny, dry crystals or a fine crystalline powder of a lemon-yellow colour, greasy to the touch, with a sharp, highly unpleasant odour. Almost insoluble in water (1:14,000 at 15°), soluble in 100 parts of cold and 10 parts of boiling 90% alcohol, in 10 parts of ether, and 25 parts of chloroform. Highly soluble in fats: e.g., it dissolves in 22 parts of olive oil. It melts at 115–120°; at a higher temperature, it decomposes, releasing violet vapours containing iodine, hydrogen iodide, and other decomposition products. It is obtained by the action of iodine in the presence of an alkali on numerous organic substances, especially alcohol and acetone. Alcoholic and other (ether, chloroform) solutions of iodoform easily decompose in the light and under the action of air, releasing iodine. Iodoform has become very widely used as an agent in the treatment of wounds, ulcers, etc., due to a number of valuable properties. Its disinfecting action is explained by the cleavage of iodine from the dissolved iodoform in wound secretions and body fluids. The same occurs when iodoform solutions are applied to a wound. Thus, iodoform acts as a depot from which iodine is gradually released, inhibiting the development of microbes and acting particularly energetically on tubercle bacilli. The latter, however, if quickly removed from a wound treated with iodoform and transferred to an appropriate nutrient medium, are not deprived of the ability to develop. When applied, no toxic effect of iodine on the tissues is observed due to the small amounts of released iodine; on the contrary, a stimulating effect has been established, promoting the formation of granulations and reducing secretions. Due to its chemical activity, the resulting iodine destroys organic substances in the wound secretion, including bacterial toxins, and has a deodorising effect. Iodoform possesses some analgesic action, which should also have a favourable effect on healing processes. One should note the pharmacodynamic and therapeutic similarity of iodoform to some newer agents proposed for wound treatment that release another halogen—chlorine, such as Dakin's solution and chloramines. Iodoform itself has almost no disinfecting action, and on media containing iodoform, many bacteria, including tubercle bacilli, can develop, although some (such as cholera vibrios) suffer in the process, probably due to the cleavage of iodine. An essential property of iodoform is its ability to dissolve in lipoids; therefore, iodoform dissolves in wound secretions. The iodine formed from iodoform is partly retained on the wound surface and in the wound secretion, and partly absorbed in the form of albuminates and other organic compounds, as well as iodide salts. In the urine, when iodoform is used, a longer presence of iodide salts and organic iodide compounds is detected than when iodine preparations are used. Likewise, after iodoform treatment, iodine is found in the saliva, sweat, and sputum, as well as in the brain. At the same time, the aforementioned secretions do not exhibit the smell of iodoform. The question of the absorption of undecomposed iodoform is not definitively resolved. Such absorption is supported by the fact that after the application of iodoform, phenomena of both iodism—acne and catarrh of the mucous membranes (coryza)—and specific symptoms of iodoform poisoning, manifested in cerebral phenomena, can be observed. In animal experiments, prolonged use of iodoform leads to an increase in iodine in the thyroid gland, similar to what is observed with doses of free iodine. Apparently, increased activity of the thyroid gland also plays a certain role in the symptom complex of iodoform poisoning (e.g., in the acceleration of the pulse). With respect to iodoform, idiosyncrasy is observed in some individuals, manifested in a rash on the areas of skin near the site of iodoform application. According to Bloch, when such sensitive skin is transplanted to normal people, the increased sensitivity is preserved. Internally, iodoform (0.05–0.2 per dose) is used very rarely: in the treatment of syphilis and as an intestinal disinfectant. The main application is external, but even this has recently become more limited due to the unpleasant odour of iodoform, as well as due to the introduction into therapy of a number of agents proposed to replace iodoform, including a number of organic (mostly aromatic) iodine compounds. Of these, however, not all are capable of releasing iodine and therefore are hardly equivalent to iodoform. Such are losophan, nosophen, loretin, vioform, and sozojodol. Among the iodine compounds that cleave iodine are iodol, novoiodin, isoform, aristol, and europhen. Externally, iodoform is used as a dusting powder per se on wounds and ulcers and as insufflations into the nose, larynx, and ear (especially in tuberculosis and syphilis); in the form of injections into joints in 10% emulsions and suspensions in glycerin, oil, or vaseline; on small wounds in the form of iodoform collodion (1:15); and for the drainage of fistulas and wound cavities in the form of iodoform gauze and cotton wool. — Compounds of iodoform used as dusting powders to replace pure iodoform: 1) Iodoformogen (Knoll) — a protein compound containing 10% iodoform, with a weak odour; it slowly cleaves iodine on the wound surface, sterilised at 100°. 2) Iodoformin — a compound of iodoform with urotropin; odourless. 3) Ecaiodoform — a mixture of iodoform and paraformaldehyde (0.5%). 4) Iodoform gauze, Tela Jodoformii, is prepared by soaking gauze in an ether-alcohol solution of iodoform, followed by drying at room temperature in the dark. It contains about 10% iodoform. Store protected from moisture and light. 5) Iodoform cotton wool, Gossypium jodoformiatum, is prepared like the gauze. Sometimes, for the sake of economy, instead of a mixture of ether and alcohol, hot (about 70°) alcohol is used to dissolve the iodoform. It contains 10% iodoform. Store like the gauze. 6) Iodoform emulsion, Emulsio Jodo-jodoformiata (1 part of Iodine pure, 9 parts of Iodoform, and 90 parts of Glycerin), has been proposed for bone tuberculosis for injections into the cavum ischio-rectale in doses of 5–10 cm³; for children, 3–8 cm³ once or twice every two weeks. Iodoform poisoning, in addition to the phenomena of iodism, is expressed in mild cases by general restlessness, a depressive state, insomnia, and headache. Patients complain of a persistent taste and smell of iodoform. Vomiting is observed. In more severe cases, following these symptoms, mental disturbance suddenly appears, accompanied by hallucinations of persecution, which can drive the patient to suicide. Usually, melancholy is replaced by attacks of manic excitement. Convulsions are observed. The pulse is usually accelerated. Sometimes there is an increase in temperature. Death occurs in a few days or weeks due to cardiac weakness and pulmonary oedema. Less frequently, poisoning proceeds in a comatose and soporific state without phenomena of excitement. To treat poisoning in mild cases, it is sufficient to remove the iodoform from the wound surface. In severe cases, due to the late appearance of symptoms of poisoning, this may not be sufficient to prevent a fatal outcome; to limit the formation of free iodine, the administration of sodium bicarbonate at 0.5–1.0 every hour has been proposed.

A. Likhachev. Detection in forensic cases. Iodoform is distilled with water vapor, imparting a characteristic odor to the distillate. The distillate is extracted with ether. The ether extract is evaporated at room temperature. Upon microscopic examination, the residue after evaporation of the ether presents characteristic hexagonal plates, stars, etc. Analogous to chloroform, iodoform gives reactions with resorcinol in the presence of caustic alkali (pink or red coloration) and with aniline in the presence of an alcoholic solution of caustic soda (isonitrile odor) (see also Chloroform). Iodoform-glycerin emulsion entered common practice for the treatment of tuberculous abscesses and fistulae from the time Mikulicz and, simultaneously with him, Verneuil recommended the use of iodoform in surgical tuberculosis. Initially, a 10% suspension of iodoform in glycerin was used exclusively (Jodoformii 10.0, Glycerini 100.0), where the glycerin is sterilized, and then crystalline or well-purified powdered iodoform is added to it with gradual stirring. Many authors do not sterilize the glycerin, relying on the antiseptic properties of iodoform-glycerin (iodoform decomposes from sterilization). Before use, the emulsion is shaken well, stored in a dark container, and used fresh. — Method of application. A cold abscess is punctured with a thin trocar or a thick needle with a stylet. The technical execution of the puncture has a direct influence on the resolution of the abscess. Absolute asepsis, creating an oblique channel during puncture, performing it within healthy skin, and withdrawing the needle so as not to infect the puncture site — all these requirements must be met very pedantically to avoid a subsequent fistula. After the puncture is performed in compliance with these requirements and the pus is aspirated, the emulsion is poured in, the needle is quickly removed, and a pressure bandage is applied. Some authors increase the amount of emulsion for adults up to 50.0–80.0, and for children up to 5.0–10.0. The introduction of such large quantities is based on the low resorptive capacity of the abscess walls. Usually, no more than 20.0–30.0 is introduced, repeatedly evacuating pus in the amount of 50.0–100.0. Children tolerate such injections quite well, and the amount of emulsion can be increased individually. The reaction to the introduction of the emulsion is sometimes quite significant and is expressed by local soreness, elevation of temperature, rapid pulse, and headache; vomiting is observed less frequently. The reaction lasts 1–2 days; in children, with cautious dosage, it often does not occur at all. The danger of intoxication when introducing iodoform-glycerin emulsion is small and is caused mainly by the action of glycerin. In addition to the indicated symptoms of reaction, hemoglobinuria occurs in individual cases. In more severe cases, serious changes in the urine are noted: a change in color with intense staining, and the appearance of hyaline and granular casts. To a lesser extent, iodoform itself has an unfavorable effect if moderate doses of the emulsion are introduced. When introducing up to 100.0, severe phenomena with a fatal outcome have been noted. Wieland, in his case, along with toxic psychosis, observed a temperature up to 39.6°C, a pulse of 180, extreme pallor, convulsive twitching, phenomena of iodism, and the presence of protein in the urine. To eliminate severe phenomena of intoxication, it is necessary to carefully monitor the urine before and after the introduction of the emulsion. Large doses should not be introduced. The unfavorable effect of glycerin is easily avoided by replacing glycerin with various types of oils: Ol. Olivarum, Ol. Amygdalarum. In addition to introducing the emulsion into the cavity of abscesses, it is also widely used for injections into tuberculous fistulae, although here its action is somewhat weaker, since the factor of prolonged exposure of iodoform to tuberculous granulations is eliminated. Some authors note that the action of iodoform-glycerin emulsion consists not only in its liquefying property, but also in that, by promoting resorption, it exerts a favorable influence on the local tuberculous focus with its iodine element. Furthermore, iodoform-glycerin emulsion with the addition of iodine (Tincturae Jodi 1.0 is added per 10.0 of emulsion) is also used for injection into muscles or into the cavum ischio-rectale (the Hotz-Grekov method). Here it exerts a general effect on the tuberculous organism. Currently, iodoform emulsions of a more complex composition, in which glycerin as an irritating substance is excluded, compete with the iodoform-glycerin emulsion of classical composition. Calot's emulsion of the following composition deserves attention: Olei Olivarum — 70.0, Aetheris sulfur. — 30.0, Kreosoti — 5.0, Guajacoli — 1.0, Jodoformii — 10.0. Method of preparation of Calot's emulsion: the oil is boiled for half an hour. If it is of good quality, it does not blacken. After cooling, creosote, guaiacol, and crystalline iodoform are added to the oil with constant stirring in a mortar without prior sterilization. Finally, pure ether is added. A completely transparent liquid emulsion is obtained, which must be stored in a dark container, slightly warmed, and shaken before use. Calot's emulsion is usually introduced into abscesses in an amount of 10.0–15.0 in adults and 5.0–8.0 in children after preliminary aspiration of pus according to the general rule. More can be introduced into fistulae, if possible, and the emulsion is introduced into the fistula directly from a syringe (without a needle) or by means of a thin drainage tube, one end of which is attached to the syringe, and the other is introduced into the fistula. The opening of the fistula is immediately plugged with a cotton plug and tightly pressed with a firm bandage. Chaklin's experience and literature data speak for a very favorable effect of Calot's emulsion (serious complications were never observed by Chaklin). Tuberculous fistulae, not only of bone origin but also in soft tissues, heal stably after a series of injections (15–20), which can be repeated every 3–4 days, i.e., at each new dressing. The introduction of Calot's emulsion into abscesses is performed less frequently and requires a definite system and strict pedantry. When the contents of the abscess are very thick (the abscess is not yet mature), Calot also uses a solution of camphor-naphthol in glycerin (Camphor-naphthol 2.0, Glycerini 12.0), which has a liquefying effect. After several injections of camphor-naphthol, one can switch to the creosote-iodoform emulsion of the indicated composition. — Instead of iodoform, formalin, trypsin solution, etc., are also used. However, the most deserved place is occupied by iodoform-glycerin and iodoform-oil emulsions of various compositions, which enjoy a good reputation among surgeons and orthopedists engaged in the treatment of surgical tuberculosis.

V. Chaklin.