REMEDIAL AND FATAL EFFECTS OF CHLORATE OF POTASSA.
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.”