In a paper read before the Medical Society of the State of New York,
(_Medical Record_, March 5th), Dr. Jacobi reviews in a very careful
manner the remedial effects of chlorate of potash, and calls attention
also to what he considers the dangers of large dosages so commonly
employed by physicians and patients.
Sir James Y. Simpson, introduced chlorate of potash on the theoretical
ground of its employment in chemistry to develop oxygen, to supply
oxygen to the blood on the part of the fœtus in cases of placentitis.
Many years ago, Isambert and Honie, found chlorate of potash eliminated
without any change, and in large quantities, even as much as 95 or 99
per cent. of the amount administered, in the various secretions of the
body; that is in the urine, the saliva, the tears, the perspiration, the
bile, and now and then even in the milk; no oxygen was developed at all.
The theory of Simpson was long ago given up, because it was found out
that the same redness was produced in the blood by other alkalies.
Its principle value consists in its effect upon catarrhal and follicular
stomatitis; further, in mercurial stomatitis, the former being a
frequent and the latter a rare disease in infancy and childhood.
“In regard to [the employment of chlorate of potash] diphtheria, I can
give [my position] in a few words. It is this: that chlorate of potassa
is a valuable remedy in diphtheria, but that it is not _the_ remedy for
diphtheria. There are very few cases of diphtheria which do not exhibit
larger surfaces of either pharyngitis or stomatitis than of diphtheritic
exudation.”
There are also a number of cases of stomatitis and pharyngitis, during
every epidemic of diphtheria, which must be referred to the epidemic,
perhaps as introductory stages, but which still do not show the
characteristic symptoms of the disease. * * * *
The dose of chlorate of potassa for a child two or three years old
should not be larger than half a drachm in twenty-four hours. A baby of
one year or less should not take more than one scruple a day. The dose
for an adult should not be more than a drachm and one-half, or at most
two drachms, in the course of twenty-four hours.
The general effect might be obtained by the use of occasional larger
doses; but it is best not to strain the eliminating powers of the
system. The local effect cannot be obtained with occasional doses, but
only by doses so frequently repeated that the remedy is in almost
constant contact with the diseased surface. Thus the dose, to produce
the local effect should be very small and frequently administered. It is
better that the daily quantity of twenty grains should be given in fifty
or sixty doses than in eight or ten: that is, the solution should be
weak, and a drachm or a half-drachm of such solution can be given every
hour or every half hour, or every fifteen or twenty minutes, care being
taken that no water is given soon after the remedy has been administered
for obvious reasons. He referred to these facts with so much emphasis
because of late an attempt has been made to introduce chlorate of
potassa as the main remedy in bad cases of diphtheria—and, what is
worst, in large doses.
As early as 1860, Dr. Jacobi advised strongly against the use of large
doses of chlorate of potassa. * * * * The treatment is dangerous and
because of the largeness of the dose of the chlorate given.
After reviewing the opinions of several writers who have extolled
chlorate of potassa in large doses, and having pointed out the real
solution of so many having succumbed to nephritis or similar symptoms,
he concludes:
“The practical point I wish to make is this, that chlorate of potassa is
by no means an indifferent remedy; that it can prove and has proved
dangerous and fatal in a number of instances, producing one of the most
dangerous diseases—acute nephritis. We are not very careful in regard to
doses of alkalies in general, but in regard to the chlorate we ought to
be very particular. The more so as the drug, from its well-known either
authentic or alleged effects, has arisen or descended into the ranks of
popular medicines. Chlorate of potassa or soda is used perhaps more than
any other drug I am aware of. Its doses in domestic administration are
not weighed but estimated; it is not bought by the drachm or ounce; but
the ten or twenty cents worth. It is given indiscriminately to young and
old, for days or even weeks, for the public are more given to _taking
hold_ of a remedy than to _heed warnings_, and the profession are no
better in many respects. Besides, it has appeared to me, acute nephritis
is a much more frequent occurrence now than it was twenty years ago.
Chronic nephritis is certainly met with much oftener than formerly, and
I know that many a death certificate ought to bear the inscription of
nephritis instead of meningitis, convulsions or acute pulmonary œdema.
Why is that? Partly, assuredly, because for twenty years past diphtheria
has given rise to numerous cases of nephritis; partly however, I am
afraid, because of the recklessness with which chlorate of potassa has
become a popular remedy. Having often met medical men unaware of the
possible dangers connected with the indiscriminate use of chlorate of
potassa or soda, I thought this Society would excuse my bringing up this
subject. It may appear trifling, but you who deal with individual lives,
which often are lost or recovered by trifles, will understand that I was
anxious to impress the dangers of an important and popular drug on my
colleagues, and through them on the public.”