I believe this method to be the most speedy and certain way of eradicating syphilis, and to prevent at the same time a loss of flesh and vigor of the body that unquestionably follows pouring mercury or iodide of potassium into the stomach. The latter organ, together with the intestinal canal, becomes irritable, the secretions become deranged, and the patient is usually debilitated and broken down, in all respects, after he recovers from a successful course of syphilitic elimination; the aftereffect being almost as bad, in many instances, as the former disease, or, in case any trace of the syphiloderm remains, the system is too weak to pursue further the internal administration of the drug.

It is my belief, where the hypodermic use of the sublimate has failed, it has been entirely due to the carelessness of the operator. As a rule, physicians do not care to go through the procedure I have just described in giving the injection. They do not seem to share in the desire to make the treatment successful, and give as an apology the length of time that would be consumed before the result is reached.

I recommend the subcutaneous method of treating syphilis because my results have been so good, and from the experiments I have made, my conclusions for its use are

First, The accuracy and preciseness of the dose. By the stomach, corrosive sublimate changes into an insoluble albuminous precipitate, and does not remain long enough in the body to become absorbed, and hence much of it is lost; so, no matter how precise you may be in administering the drug by the mouth, it is almost certain that some of it passes away unabsorbed. By the hypodermic method this is entirely done away with; the precise dose is taken up by the absorbents into the system, and after its object has been attained is eliminated through the proper

channels.

Second, By its use we preserve the healthful action of stomach and bowels. The internal action of drug, on these organs, I have already shown.

Third, Its use. That we may use it in almost all cases-in fact in all-without any baneful results, is conclusive to its application.

In conclusion, I will relate some of the reasons which render the method distasteful to many physicians.

First, A dirty syringe or a rusty needle produces inflamma

tion, and an abandonment of the method by one. Again: A short needle, or a failure to drive it into the cellular tissue, has caused an abscess and non-success to another. The care to scatter the solution when injected, or to force out the air in the needle, gives pain to the patient, and discourages a third one. The building up the system with tonics and good food, and the use of the sublimate at the same time, has been overlooked by the fourth, and the result drops below his expectation. The peculiar susceptibility of some persons to certain drugs, in very small doses, are lost sight of, the mercury suddenly poisoning the patient, and the physician condemns the method,—and so on ad infinitum.

Such, in a few terms, are some of the prominent causes why this potent and valuable method has failed in the hands of some of the American practitioners; and if they would only have patience and try in an experimental manner (by beginning from the very smallest doses upward, and with great care), their results would be more gratifying. It is not with haste that such methods can be tried and rejected, but one must take time and trouble, and study each phase of their peculiarities, and then with certainty arrive at a decision.

VOL. XXXIII.-9.

THE THERAPEUTIC ACTION OF POTASSIUM

CHLORATE.

BY JOHN V. SHOEMAKER, A. M., M. D.,

PHILADELPHIA, PA.

THE questioned action of the chlorate of potassium as an important therapeutic agent, by many practitioners, who have either failed to test thoroughly the virtues of this valuable drug, or have unjustly condemned it on account of reported deaths from its use, has prompted me to relate an extended experience with it. Observations upon the positive action of chlorate of potassium (or any drug) cannot be made by following any routine method of its administration. It is a powerful, energetic, and active drug, and its virtues will not be known by those who always give it in very small doses under all circumstances, neither can one hope or expect to obtain its medicinal effects by pouring it into the system in an indiscriminate manner, without regard to the peculiar idiosyncrasy that a large number of individuals have for very many valuable and generally accepted useful drugs. It should always be administered first with a very small dose, gradually increased, and never given to patientsas a very excellent physician has expressed it—" as if pouring it into a rat-hole." If administered in the above manner its tolerance and effect can be observed, and the dose can be increased or decreased according to the requirements of the

case.

Chlorate of potassium was discovered at the end of the last century (1786) by Berthollet, and was used for the first time in therapeutics by Foureroy in 1796, with the idea that it might transmit some of its oxygen to the body. At its introduction this salt was principally recommended as an antidote to scurvy. In 1819 Chaussier proposed it as a remedy in croup. It had

completely fallen into oblivion, when Dr. Blanche, repeating the experiments made in 1847 by Hunt and West with this medicine, in the treatment of gangrene of the mouth and pseudomembranous stomatitis, was led to try it in the treatment of pseudo-membranous sore-throat and croup. Dr. Isambert made this salt a subject of an inaugural thesis, and spoke of its use in membranous sore-throat, and it was, although less satisfactory than in the treatment of ulcero-membranous stomatitis, nevertheless encouraging (Trousseau's Clinical Medicine, Vol. II., p. 573). "From that time on there were found numerous methods for its application in the most varied diseases. It was used externally as well as internally. Externally partly as a mouth wash, partly as a dressing; and particularly in the latter application, it received from several authors favorable commendation, respecting its action in ulcerated cancerous tumors" (Dr. Franz Brenner, Wein Med. Wochenschrift). Chlorate of potassium, as a topical remedy in carcinoma, was first tried by Tedeschi, as early as 1847, with such marked effect that his procedure soon found enthusiastic supporters, especially among the French profession. The communication of Bergeron, Milon, and Blondeau in the Union Medicale of 1863, No. 154, gave full credit to the efficacy of chlorate of potassium in the treatment of cancroid. Their method consisted in applying to the ulcerated surface either a four per cent., or a concentrated solution of the drug. In a case of scirrhus of the nose in a woman 82 years, Bergeron observed a perfect cure after a treatment of four months. The cicatrization started from the edge of the ulcer; the latter healed entirely, leaving a flat, white, solid cicatrix. A year later, Debout published in the Bulletin de Therapeutique, LXVI., January 15, 1864, the remarkable results of his experience with the use of chlorate of potassium in caneroidal affections, which were fully corroborated by the subsequent publications of Leblané, Cooke, Charcot, Delpech, and Michon. The local application of chlorate of potassium was combined by Charcot with the internal use of the drug, in daily doses of thirty grains. This method, totally neglected in Germany, was again brought to the notice of the profession by Professor Burow, Sen., of Königsberg. In the Berliner Klinische Wochenschrift, No. 6, 1873, he published his experience with the topical application of chlorate of potassium in several cases of carcinoma. The beneficial results which he obtained by this