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IODINE                                                          493

salivation, vomiting and purging. The vomited matters and stools are dark, yellow or
blue in colour, contain blood and have the peculiar odour of iodine. The lips and the
angles of the mouth are stained yellow. The urine is suppressed or scanty, dark, red-
brown in colour and has the strong smell of iodine. The pulse is small and compres-
sible, the skin is cold and clammy and the patient passes into a state of collapse. Con-
sciousness is retained till death. Severe symptoms from poisoning by potassium iodide
are more frequently seen in patients suffering from goitre. Some people are particularly
susceptible to the poisonous symptoms of this salt even from medicinal doses (5 to 30

Chronic Poisoning.—The symptoms of chronic poisoning sometimes occur from the
continued use of large doses of potassium iodide medicinally, and are known as iodism.
The symptoms are heavy pain over the frontal sinus, running of the nose, salivation,
nausea, vomiting, purging, emaciation, wasting of the breasts, testicles, and other glands
and erythematous patches on the skin.

Eller and Fox1S report a fatal case of iododerma in a man, aged 31 years, with
macules, papules, tubercles, rupioid lesions and fungating and granulomatous ulcerations
on the trunk and extremities. The eruptions commenced a few weeks after the adminis-
tration of three doses daily of 5 grains of potassium iodide and 1/60 grain of arsenic.
This was continued for four months and the patient died from profound iodide intoxi-
cation four months later. Large quantities of iodides were found in the urine during
the month preceding the death, and at the post-mortern examination, in the skin, liver
and kidneys.

Fatal Dose.—One and a half grains of iodine crystals may produce poisonous
symptoms, while six grains may cause death. A woman,19 62 years old, suffered from
oedema glottidis after taking a total of 25 grains of iodine in two days, but she recovered
after an operation of tracheotomy.

One to two drachms of the tincture of iodine may be considered as a fatal dose,
but recoveries have followed large doses of four and six ounces.

The fatal dose of potassium iodide is uncertain. An elderly woman who was being
treated for chronic bronchitis died suddenly after taking three doses of a mixture con-
taining 10 grains of potassium iodide per dose. There were acute oedema and ulceration
of the glottis and acute oedema of the lungs.20

Fatal Period.—The average fatal period is twenty-four hours, but in cases of
poisoning by local application death may be delayed for some days. A case is recorded
in which a young woman died in 24 hours from gangrene of the left tonsil caused by
two applications of the old tincture of iodine to the throat.21

Treatment—Evacuate the stomach by emetics, or wash it out with water containing
starch and albumin or a 5 per cent solution of sodium thiosulphate. Give alkalies,
arrowroot and barley water, and treat the symptoms. Tracheotomy may have to be
performed if death is threatening from oedema of the glottis.

In poisoning by potassium iodide stop its administration, and give large doses of
bicarbonate of sodium or sulphanilic acid, or lessen the dose or double it.

Apply at first alcohol and then a solution of sodium thiosulphate or dilute ammonia
to remove stains produced on the skin by""loolne7~~^

Post-mortem Appearances.—The gastro-intestinal mucous membrane is inflamed,
excoriated and may be coloured brown. The stomach, contents may be coloured blue
owing to the presence of starchy food. The heart, liver and kidneys may show fatty

Chemical Analysis.—If iodine is present in the free state in organic mixtures, it may
be extracted by agitating it with chloroform or carbon bisulphide, and then obtained
by evaporation and sublimation. If in combination, nitric acid may be added and then
iodine may be extracted as above.

Tests.—Free iodine is recognized by its peculiar odour, the violet colour of its vapour,
and by its turning starch paper blue.

Iodides produce a flocculent whitish-yellow precipitate with a solution of silver
nitrate, insoluble in ammonia, but soluble in potassium cyanide. A solution of mercuric
chloride produces a scarlet precipitate, soluble in excess of either. Mixed with chlorine
water and starch, a blue colouration is formed, which disappears on heating but re-
appears on cooling.

Medico-Legal Points.—Acute poisoning by free iodine is a rare occurrence. Acci-
dental cases of poisoning by drinking carelessly tincture or liniment of iodine have

18.   Arch. Derm, and Syph., Nov. 1931,-p. 745; Brit. Med. Jour., Epit, Jan. 16, 193%
p. 12.

19.    Snell and Savin, Lancet, April 9, 1927, p. 759.

20.    Sydney Smith, Forens. Med., Ed. IX, p. 491.

21.   Jour. Amer. Med. Assoc., March 11, 1922, p. 746.    -