« SebelumnyaLanjutkan »
An experience extending over more than twenty years has thoroughly convinced him of its efficacious action. The action of the chlorate as an hæmastatic is given by Dr. Harkin, in the following words: “It increases the fibrin of the blood, adds to its plasticity and chemico-vital constituents, and also tends to restore the contractile power of the capillaries and smaller vessels."
In ovarian dropsy it has been used by some with asserted success, and it is supposed to have removed the disease or have prevented its further development. In general dropsy-particularly when due to renal diseases—its action is said to be well marked.
Although the chlorate of potassium has been given by many to test its action in syphilis, yet, after a fair and impartial trial, I believe it will only benefit those syphilitie cases who are run down in health by its action on the digestive canal and its effects on the blood. I have as yet failed to discover any curative action on the syphilitic virus itself; but do think it is a valuable adjuvant in the conditions just cited. Trousseau, however, states in his lectures on syphilis of infants : “ It was proposed to give calomel in very small doses, particularly at the time when it was hoped that, by combining it with chlorate of potassium, we should be able to avert salivation in the adult and diarrhea in the infant. I am not sufficiently well informed in relation to the advantages of this method of treatment to recommend you to adopt it; but I may say, that I am inclined to believe, that the addition of chlorate of potassium would, at least for adults, lessen the antisyphilitic action of the perchloride of mercury.” (Trousseau's Clinical Medicine, Vol. IV. pp. 350, 351).
The chlorate of potassium which occurs in crystals acts, I think, decidedly better when used in this form, or when freshly powdered. When this drug is powdered for some time, as is usually sold in the stores, I believe it is not so active in its effect as in its crystallized state. If the salt is given in small doses, it will pass quickly and more readily into the circulation, taken before meals, diluted with water. If, on the other hand, very large doses are administered, it will probably be better borne by the stomach after meals. It is best given dissolved in simple water, although its taste, which is not at all unpleasant, may be entirely disguised by adding to the salt an effervescent powder, and mixing the latter with lemonade, milk, or a neutral mixture; and the bitter infusions and tinctures are also good vehicles for chlorate of potassium. The dose will vary according to the affection and the condition of the patient. I usually give it in from one-half to thirty-grain doses every one, two, or three hours, freely diluted with water. In the above doses, it is well borne by the stomach, even in those who are very weak and enfeebled. I generally begin with a small dose, and gradually increase it until the patient shows some signs of its effect, or I see improvement in the disease. Those who are large, flabby, and apparently vigorous, will improve, as a rule, better under smaller doses, as large amounts will sometimes serve still more to increase the quantity of fat on the body. On the other hand, the pale, weak, and enfeebled will bear much larger doses, and will often increase very rapidly in weight.
SALICYLATE OF POTASSA IN ACUTE RHEU
MATISM AND DYSPEPSIA.
By M. DONNELLY, M.D.,
In the New York Medical Record of March 6, 1880, I briefly introduced to the notice of the profession a new remedy for the cure of acute rheumatism and dyspepsia, naming the drug Salicylate of Potassa. Two and a half years' trial of its merits has proven the correctness of the opinion I then held of the usefulness of this remedy.
Previous to the introduction of salicylic acid, the treatment of acute rheumatism by alkalies proved at once correct in principle, safe and certain in practice; to neutralize the acid and restore the blood to its normal alkalinity, was, although a slow course, a most satisfactory one in the completeness of recovery, and freedom from cardiac disease.
But in these days of rapid thought and lightning-like progress slow measures are very unpopular, and when the rapid treatment of acute rheumatism by salicylic acid was introduced, it was hailed as a great boon, and the profession hastened to prescribe it as in perfect keeping with the spirit of the times.
It was soon found, however, that very large doses of salicylic acid were required to obtain the desired result; and what was worse, such doses caused in a large percentage of cases serious heart complications, so that it soon began to be regarded as an unsafe drug in acute rheumatism.
The salicylate of soda superseded the acid, and was found a safer remedy, yet not quite free from danger of inducing pericarditis and endocarditis; for though the combination of the acid with soda promised well in theory, it has, however, disappointed the expectations looked for, and, I believe, because the salicylate of soda, being a neutral salt, is not sufficiently alkaline to
correct the acidity of the blood in acute rheumatism; and so long as the blood remains acid the danger of heart disease will exist, and may manifest itself at any moment.
This theory has been proven correct by experiments made by Drs. Findlay and Lucas, Senator and MacLagan, published in London Lancet, showing that the treatment of acute rheumatism by salicylate of soda, gave the most prompt relief and checked the progress of the disease; but there resulted an increase of pericarditis and endocarditis, with depression over the simple alkaline course.
My experience with the salicylate of soda coincides with the above experiments, and in some cases of old heart disease it produced derangements of that organ so alarming as to cause me to employ it with the greatest caution; yet I was convinced that there was great merit in salicylic acid provided it could be employed with safety; and so I began making experiments, with the hope of finding some alkali that would unite with . salicylic acid in greater proportion than soda, so as to produce, if possible, a thoroughly alkaline salicylate : this desideratum I found in the old reliable alkali for rheumatism, the bicarbonate of potash.
Two parts of bicarbonate of potash and one part of salicylic acid dissolved in a little water formed a neutral solution; the potash was then increased in quantity until one part of salicylic acid united with two parts of the bicarbonate of potash, say ten grains of acid to twenty grains of the alkali in a drachm of water, formed a clear alkaline solution. This solution was evaporated to dryness, leaving a strongly alkaline salt of a grayish color and sweetish taste, soluble in double its weight of water, which I named salicylate of potassa—an alkaline salicylate with an excess of bicarbonate of potash.
Owing to the excess of the potash, this salt will be subject to change, and should always be prepared fresh in solution, according to the following formula:
R. Acid. salicylic, 5iij
Potassa bicarb., 5vi
This solution is made by rubbing the acid and potash together with water in a mortar, to allow the escape of carbonic acid, which is liberated in the chemical change. Tincture of