PERSISTENT VOMITING OE LABOR 
ARRESTED BY 
TINCTURE OF IODINE. 
by 
LLEWELLYN ELIOT, M.D., 
ASSISTANT PHYSICIAN CENTRAL DISPENSARY, EMERGENCY HOSPITAL, ETC., 
WASHINGTON, D. C. 
Reprinted from The Medical Record, September 24, 1887. 
NEW YORK: 
TROW'S PRINTING AND BOOKBINDING CO., 
201-213 East Twelfth Street. 
1887. PERSISTENT VOMITING OF LABOR ARREST- 
ED BY TINCTURE OF IODINE. 
Gastric disturbance is one of the many unpleasant at- 
tendants upon the pregnant state, only a few women es- 
caping entirely. Ordinarily the vomiting of pregnancy 
ceases in the earlier months, at times, to again appear 
toward the latter end of gestation. Now and again it is 
with difficulty subdued, and frequently abortion or prem- 
ature labor has been induced for its relief. Dr. Thomas 
C. Smith,1 of this city, has reported a case where 
abortion was performed for the relief of excessive vom- 
iting in pregnancy. In this case the emaciation follow- 
ing the gastric disturbance was so great that the patient 
was a veritable living skeleton. Every remedy employed 
had failed, and as a last measure a bougie was passed 
into the uterus, thereby saving the life of the mother at 
the expense of the ovum. 
Dr. John Blake White 3 has reported two cases of 
pernicious vomiting of pregnancy, occurring in the 
same subject, of which I make extracts : Mrs. M , 
aged twenty-three, when the sixth month of utero-gesta- 
tion was reached, had a slight " show," followed by slight 
uterine contractions and constant nausea, vomiting, and 
retching. The uterus was quieted, but the gastric symp- 
toms continued unabated for ten days. Every well- 
known remedy for the relief of the symptoms was re- 
sorted to without any apparent benefit. That which 
seemed in any degree to be of service was carbolic 
1 Smith, Thomas C.: Amer. Jour. Obstet., June, 1886, vol. xix. 
5 White, John Blake : New York Med. Jour , August 7, 1886, vol. xliv., p. 154. 4 
acid, in fraction-drop doses, every half-hour or hour, pro 
re nata, and an occasional morphine suppository. The 
advisability of inducing premature labor was being con- 
sidered when the stomach became more tolerant, and in 
due time convalescence was established. No further 
trouble occurred, and she was delivered naturally at term. 
During the period of her second pregnancy her condition 
continued favorable up to the sixth month of utero-ges- 
tation, when she was again sick with distressing nausea 
and vomiting, but recovered from the attack without any 
serious consequences, and continued in fair health up to 
within two weeks of her expected confinement, March 
19th. He was called March 12th, when she had been 
suffering from nausea and occasional vomiting for sev- 
eral days. Her nausea and retching continued through- 
out the night, and these symptoms assumed a very seri- 
ous aspect. On March 19th, when the patient's con- 
dition appeared to be rapidly becoming critical, and the 
induction of labor seemed to be decidedly the proper 
course to pursue, natural labor set in and resulted in a 
still-birth. The third stage was rapidly and satisfactorily 
accomplished ; the womb afterward contracted firmly, 
and it was hoped that the persistent retching would cease 
after the seemingly exciting cause had been removed. 
The retching soon returned with increased energy, and, 
with the vomiting, continued, in spite of every means to 
control these symptoms, until evening, when the hemor- 
rhagic character of the vomit became manifest. The 
symptoms persisted until death from asthenia super- 
vened, twenty-four hours after confinement. There was 
no septicaemic influence to account for the malignancy 
of the symptoms. 
Sometimes vomiting attends labor, but it causes trouble 
in but a few isolated cases, where, from its persistency, 
exhaustion becomes so great that the contractions of the 
uterus become too feeble to complete the labor. The 
cases recited show the little value attached to the rem- 5 
edies usually employed, and the benefit to be derived 
from the internal administration of tincture. According 
to the teaching of Wood, iodine, when taken internally 
in moderate doses, causes "some gastric uneasiness and 
a disagreeable metallic taste in the mouth ; when larger 
amounts are ingested, the gastric uneasiness may be in- 
tensified into violent vomiting, with increased salivary 
flow, abdominal pains, and sometimes purging." 1 He 
also states, in regard to the internal administration of 
iodine: " Nor should the tincture be given internally, be- 
cause the iodine is precipitated by the watery juices of 
the stomach;"3 but advises the use of the compound 
solution of iodine in doses of five to fifteen drops. The 
rationale of its action, in the class of cases to which refer- 
ence is made, I do not attempt to explain; the fact re- 
mains the same nevertheless. 
The United States Dispensatory3 states : "The tincture 
of iodine is not elegible for internal use;" and further,4 
" the dose of the tincture is from five to fifteen drops, 
but Lugol's solution is a much preferable preparation 
for the internal administration of iodine." 
Bartholow 6 states: "The vomiting of pregnancy can 
sometimes be greatly relieved by drop-doses, every hour 
or two, of the tincture." 
Potter6 writes : "But it is generally used as a local 
application or for injection into cavities;" and further,' 
"and in the vomiting of pregnancy drop-doses of the 
tincture every hour are often efficient." 
Brunton 8 writes : " On account of its irritating action 
on the intestinal mucous membrane iodine is rarely 
given internally." 
1 Wood : Therap. Mat. Med. and Toxicol., p. 411. 2 Ibid., p. 415. 
3 U. S. Dispensatory, fifteenth edition, p. 809. 4 Ibid., p. 1461. 
6 Bartholow: Prac. Treat, on Mater. Med. and Therap., p. 219. 
6 Potter: Handbook Mater. Med., Pharmacy, and Therap., p. 231. 
* Ibid., p. 234. 
3 Brunton : Text-book Pharmacol., Therap., and Mater. Med., p. 559. 6 
Farquharson 1 does not mention its internal use, nor 
does Gubb.2 
The first recorded experience of the use of iodine in 
gastric disturbances which I have met with is by Dr. 
Thomas J. Gaunt,3 who relates a series of successful ex- 
periences with the compound tincture, under the title 
of " The Use of Iodine as a Stomachic Sedative." He 
gave it in doses of from three to five drops. 1 have fre- 
quently obtained the same beneficial results which he 
reported, in cases O! the morning sickness of drunkards. 
If for any reason the compound tincture cannot readily 
be obtained, the simple tincture will answer equally as 
well. 
M , white, aged twenty-six, born in the District of 
Columbia, went into labor with her first child, March 2d, 
at 2 a.m. Her previous history was negative, if we ex- 
cept the usual vomiting attending the earlier months of 
her gestation. When called, at 3.30 a.m., the os was 
dilating, vagina moist, head presenting, membranes in- 
tact, but she was vomiting persistently. Previous to 
my arrival she had been given lime-water, pepsine, 
brandy, ingluvin, and cerium oxalate, without benefit. 
Mustard was ordered over the pit of the stomach, and 
cerium oxalate combined with ingluvin given without 
success. Carbolic acid in half-drop doses failed, as 
did lactopeptine. She was becoming rapidly exhausted 
and the pains had ceased. Whether to administer 
chloral hydrate per rectum, or to administer an an- 
aesthetic and -w terminate the labor, were questions to 
be weighed, when the iodine treatment came to mind. 
Following the advice of Dr. H. B. Hemenway,4 in pro- 
tracted labors-" Posture during Labor"-she was 
propped up in bed, hoping thereby to precipitate the 
1 Farquharson : Guide to Therap. and Mater. Med., edition of 1879. 
3 Gubb: Griffith's Mater. Med. and Pharmacy. 
3 Gaunt, Thomas J.: Amer. Jour. Med. Sc.. April, 1883, p. 413. 
* Hemenway, H. B.: Amer. Jour. Obstet., June, 1886., vol. xix., p. 575. 7 
labor, at the same time the finger being introduced and 
pressed against the anterior lip of the cervix; contrac- 
tions of a feeble character followed, still the vomiting 
continued. At this juncture she was given five drops 
of tincture of iodine in a tablespoonful of sweetened 
water; the effect was magical, for the vomiting ceased 
almost immediately. To make assurance doubly sure 
she was given a second dose in thirty minutes. The 
labor now progressed rapidly, and at five o'clock, three 
hours after the first pains, she was delivered of a male 
child, well developed and healthy. Third stage normal. 
No bad effects followed the use of the iodine. While 
Dr. H. B. Hemenway is credited with the postural treat- 
ment of protracted labors, the idea was not new, as I 
have seen it mentioned briefly in obstetric works, but I 
think the credit of developing the idea belongs to him. 
Dr. Samuel C. Busey,1 of this city, read before the 
Medical Society of the District of Columbia, at a recent 
meeting, a paper on " Persistent Vomiting during Labor 
relieved by Anaesthesia." In this case success followed 
the use of the alcohol, chloroform, and ether mixture, but 
it was necessary to continue the administration to the end 
of labor, as the vomiting recurred upon the suspension of 
the anaesthetic. In the report of remarks made, it ap- 
pears that " the tincture of iodine finally controlled the 
vomiting, but the pains ceased." 4 This is a mistake, as 
the labor progressed to a rapid end after the arrest of the 
vomiting, as appears above. Dr. I,. Mackall3 referred to 
the good effects of administering a cupful of crushed ice, 
swallowed as rapidly as possible ; he had by this means 
allayed gastric irritability as well as promoted efficient 
uterine contractions, and prompt delivery in such cases. 
The use of anaesthetics to lessen the pains in labor, I 
fancy, is a prolific cause of post-partum hemorrhage, 
1 Busey, S. C. : Jour Amer. Med. Assn., April 30, 1887, vol. viii., p. 484. 
2 Eliot, L. : Jour. Amer. Med. Assn., April 30, 1887, vol. viii., p. 492. 
3 Mackall, L. : Jour. Amer. Med. Assn., April 30, 1887, vol. viii., p. 492. 8 
since there is want of discretion and care in their use; 
but the first insensibility were the limit of their action 
they would be far safer. The safest plan is self-adminis- 
tration. The treatment here recited will be of service 
in cases of vomiting of pregnancy, that following a de- 
bauch, and almost any variety of vomiting, and as an 
agent so potent for good deserves a fair trial.