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that the physician in attendance at that time had succeeded in curing the rheumatism, and since that her daughter had not been troubled with it. I was also informed by the mother that after this last attack of rheumatism, her daughter had continued to lose fleshi and had grown very pale and weak. The family history, as far as I could learn, was good; the father, mother, and one brother enjoyed the best of health.
On examination the scalp was found covered with sebum, the hairs were dull and lustreless in appearance, and were falling out in large numbers, the conjunctiva was injected, the pupils dilated, the eyelashes long and droopy', the face was pale and haggard, and the maxillary glands were enlarged, with here and there small openings discharging a thin and unhealthy pus. I prescribed a dessertspoonful of cod-liver oil three times a day. In the course of two weeks no improvement had taken place, and I was compelled to omit the cod-liver oil by reason of it disagreeing with her, and substitute for it three-grain doses of the chlorate of potassium four times a day. I advised the contivued use of substantial food, and used locally a mild tar ointment. From this date the improvement was steady, the appetite returned, the bowels became regular, and at the end of a a little more than two months the patient was quite well.
CASE III. In the month of November, 1879, I was called to see a young girl, aged 15, of fair complexion and of healthy appearance. Her parents were in good circumstances; she had been well fed, and had been treated with the utmost attention by her physician, who gave me at the time the following account of her case. Two years previous she had a severe attack of scarlatina, and shortly after, while convalescing, the maxillary glands began to enlarge and the scalp became covered with sebum. This condition had continued to grow worse, notwithstanding the best of care and attention from her physician. At the date of my call I found the scalp covered with patches of sebum, and the hair presenting an unhealthy appearance. The skin around the maxillary region and down the neck was of the natural color in patches, interspersed with red and even violet spots; the glands were hard in some parts, soft and boggy in others, while here and there small openings about the size of a pin could be observed, through which a thin and unhealthy pus escaped. Her physician informed me he had given such medi
cine as be thought would be suitable to her, but without the slightest benefit. Chlorate of potassium in five grain doses was given ; the parts were washed with borax water; no fresh development of the disease showed itself, and in about nine weeks she was quite well.
CASE IV. Emily D., thin and delicate, aged 7, was the subject of severe scrofula, and had been so since her birth. The child's aunt brought her to the Dispensary December, 1879, but could give no history of her case except that both her parents had died from consumption. Iler skin was pale and of a yellow appearance; a thin discharge was detected from the left ear; the maxillary glands were slightly enlarged; a small ulcer existed below the angle of the inferior maxillary of the right side ; another one a little larger, irregular in shape, covered with a watery secretion, was situated on the forearm; the hands and feet were cold, and the abdomen was distended and hard. Twograin doses of the chlorate of potassium were ordered, which were gradually increased to five grains, four times a day, with good food, weak citrine ointment locally, and plenty of exercise. In six weeks the ulcers had disappeared, and the improvement was so narked that the child would scarcely have been recoguized.
CASE V. Willie B., aged 14 months, a scrofulous baby and very cachectic; scalp covered with crusts; maxillary and inguinal glands enlarged, with small inguinal abscess from a broken down gland, and abdomen large. Healthy father and sickly mother. Ordered one grain of chlorate of potassium in arrowroot drink, and increased the dose to two grains, four times a day. Fed the child on milk and arrowroot drink, opened the abscess, poulticed the crusts, and oiled the scalp. Two months later, when I last saw the baby, he was healthy-looking anıl quite free from the disease.
The cases which have been adduced present, I believe, very fair examples of scrofulous disease of the skin as it is met with in practice. I endeavored, prior to using the chlorate of potassium in similar cases to those I have just enumerated, to overcome the disease by following the routine plan of treatment, with but a small percentage of cures. I worked away with cod
liver oil, iron, and quinine, which preparations either interfered with digestion, or ran off by the bowels and so prevented many of my patients from getting well. Many unsatisfactory results in this way finally led me to try the chlorate of potassiuni, and to my astonishment I obtained remarkable results.
My attention was directed to the efficacy of the chlorate of potassium by the beneficial effect that followed its use upon a patient having scrofuloderma who applied to me for treatment for mercurial salivation. I gave the patient a solution of the chlorate of potassium, and was surprised to find as I continued the solution that the scrofulous condition gradually disappeared until the case was cured. I was led by the good result in this case to try the same remedy in other patients, and was agreeably astonished to find continued success in its use.
The chlorate of potassium has a marked influence on all suppurative processes. It prevents and arrests, to a great extent, suppuration. Thus in persons who have had tubercular deposit in the glands of the neck, threatening to end in suppuration, the use of the chlorate of potassium will reduce the inflammation and prevent the formation of pus. In another class of cases of this group in which the formation of pus bas taken place, the influence of the chlorate of potassium is still more conspicuous. For instance, if a child nine years of age has an enlargement of the glands around the inferior maxillary following measles or scarlatina, which by the way is very common, deep-seated suppuration takes place attended with great pain and constitutional disturbance. The skin gradually changes from the normal color to a red, and even a violet, the small tumors feel soft and boggy, and after a time small openings appear, from which issue a thin and unhealthy pus. Now such a troublesome and vexatious condition will quickly give way to the adıninistration of two or three grains of the chlorate of potassium four times daily. The deposition of fresh tubercular material in the glands will be checked, the thin and unhealthy pus will become abundant and laudable; many abscesses about developing will dry up, while those that are open will gradually heal. The chlorate of potassium whilst thus influencing locally the scrofulous condition, will likewise improve the general health by removing all the constitutional disturbances associated with this disease; in which, in many instances, the use of cod.liver oil, iron, and quinine had entirely failed.
As to the mode of administration of the chlorate of potassium, I have usnally given it in from one-half to ten-grain doses dissolved in pure water three or four times daily. In the above doses I find it well borne by the stomach even in those who are very weak and enfeebled. I generally begin with from one-half to one grain one hour before meals, and gradually increase the dose until the patient shows some signs of improvement. The continued use of this drug for a time will increase the appetite, fatten the patient, render a previously dark skin clear and florid, and add tone and vigor to the system. Those who are large, flabby, and apparently vigorous, will improve, as a rule, better under small 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.
The chlorate of potassium evidently changes and improves the quality of the blood, but as a remedy for this affection it has hitherto received very little notice except from Dr. Harkin, of Belfast, in 1860 and 1861. This gentleman, in an admirable paper on the chlorate of potassium in the treatment of consumption and scrofula, published in the Dublin Quarterly Journal of November, 1861, claims perfectly marvellous results by its use in both these affections. Dr. Harkin in this paper cites the cure of several well-marked cases of consumption, refers in a general way to its remarkable action in scrofula, and adds that in its use the blood appears altered in character, its solid constituents, its fibrin and red corpuscles, increase, muscular energy gradually returns, and even a disposition to plethora develops itself.
I not only corroborate what Dr. Harkin has observed upon the action of this remedy, but I think my experience adds additional light on its use in scrofulous disease of the skin. I have as yet been unable to find any full statement of its use in these scrofulous affections, except in the brief account just named. I have therefore, after extensive experience in its use, come to the conclusion that it is the only interval treatment of much good in scrofuloderma, but it must be employed in conjunction with good food, the proper hygienic surroundings, together with a judicious combination of appropriate external means according to the exigencies of each particular case.
This treatment is based upou the assumption that the disease
is caused by an improper state and composition of the blood, which destroys its fitness for the nutrition of the tissues. I further believe that the judicious use of the chlorate of potassium tones up the digestive system, and so furnishes the blood with its proper and essential ingredient with which to repair the natural waste and decay of the tissues. The experience of Dr. W. Nicholson as to the action of alkalies as expressed in the Practitioner of January, 1880, I think fully corroborates the views I have advanced on the effect on the system of the chlorate of potassium.
Dr. Nicholson, in referring to the alkalies in anæmia, thinks that they ought to take the place of iron in the treatment of this affection; that they improve the tone of the digestive system, increasing the appetite, aiding the liver to work, promoting the flow of bile, and clearing the blood and urine from lithates or other sediments and impurities, and there is little doubt that they, more than any other remedy, restore the digestive tract to a state of health, while iron, instead of giving toue, is apt to disorder the digestive tract. This gentleman uses the bicarbonate of potassium in that abnormal state of the blood present in anæmia, and I know that the chlorate of potassium will not only act in the same manner upon anæmia, but also in the various scrofulous affections.
I desire, in concluding this paper, to add that, if judicious treatment be given to those suffering from scrofula before marriage, the extension of the hereditary taint in the issue can be arrested. Many medical men, on the other hand, believe that the extension of the disease can only be arrested by such persons refraining from marriage, and they advise their patients to that effect. Physicians giving such ailvice to tuberculous, sickly, and scrofulous persous, will find that it will not deter them from marrying, even though they may have pointed out to them that the issue of such alliance will in all probability be scrofulous. I think it therefore becomes the iniperative duty of the physician when consulted by scrofulous persons concerning their future welfare, to provide against the extension of the disease by doing all in his power to overcome the disordered function and establish a condition of healthy nutrition before marriage. This noxious state of the system of persons suffering from scrofula, I again repeat, can be best removed by the use of chlorate