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.”
DEMANGE ON AZOTURIA.
The importance of the study of urology has of late been more fully realized by Medical practitioners, and M. Demange in his thesis (Thése de Paris, 1878) has undertaken to give a full account of the progress of this branch of medical science, being also fortunate enough to be able to enrich it by several new or very little known observations on azoturia. The latter seem the most interesting part of his thesis; we give them here briefly. The normal quantity of urea which must be contained in the urine in the space of twenty-four hours is from nineteen to fourteen grammes. If more or less is excreted, this is caused either by some local or general affection. Some years ago, Bouchard, in studying the causes of loss of flesh in patients suffering from diabetes insipidus, discovered that a large number among them lost an enormous quantity of urea. Having thoroughly examined their symptoms he thought himself fully justified in describing azoturia as a special disease, having peculiar clinical symptoms. The affection begins with a sensation of ravenous hunger, polydipsia or profuse sweating. The thirst is excessive, and the urine passed is generally in proportion with the quantity of drink swallowed by the patient. Its density is from 1000 to 1002. In order to be able to calculate justly the amount of urea lost in twenty-four hours, all the urine passed in twenty-four hours, all the urine passed in this time must be kept and mixed. In some cases it has reached the amount of eighty-seven grammes, a most enormous quantity, which proves that nutrition is very much impaired. Senator Kien and M. Bouchard have shown that what is called extractive matter is eliminated, corresponding to urea in such cases, and that chlorates and phosphates are ejected in a similar proportion. We must, therefore, not be astonished if the patients present general symptoms which are analogous to those of diabetic patients, with the exception of the visual troubles of the latter. Both the crystalline lens and the retina remain intact, and the sight is only influenced by the anæmic state of the brain, which is caused by the dyscrasia, and which in certain cases produces a torpor of the intellect verging on imbecility. As in cases of diabetes mellitus and albuminuria, sometimes the quantity of urea decreases, and even falls below the normal amount.