Charles D. F. (Charles Douglas Fergusson) Phillips.

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unless the urine is rendered alkaline. There is a marked difference in
different compounds as to their production of alkalinity: thus, a single
dose of 40 gr. of acetate alkalinized the urine in a few hours, and then
was not all changed, but of the bicarbonate several drachm doses were re-
quired. In febrile diseases, salines, such as nitrate of potash, may cause
at first marked lessening of excretion, afterward increase (Parkes: Medical
Times, i., 1855). In cases of irritant poisoning by the potash salts of the
mineral acids, suppression of urine has occurred, probably reflex in char-
acter.

SYNERGISTS AND ANTAGONISTS. The other alkalies are allied in
chemical action to the salts of potash, and acids are the chemical antago-
nists. Gubler suggests that soda is antagonistic to potash (dynamically)
in its action on the blood and on respiratory combustion, because potash
only, not soda, is contained normally in corpuscles, and under certain
conditions may be replaced by the latter when given in full doses.

THERAPEUTICAL ACTION (EXTERNAL). Caustic potash has been used
in surgery for the same purpose as other powerful caustics, and has the
special characteristics of being deliquescent and of dissolving and deeply
penetrating the tissues; parts near the seat of its application should there-
fore be protected by plaster, or by oil, and the cauterized place should be
sponged with dilute vinegar to prevent undue action. The slough caused
by it is leathery, soft, dark-colored, and moist, not dry like that of nitrate
of silver: it separates after a variable time, according to its thickness.

Issues Abscess Bubo, etc. For the purpose of making an issue, or
of opening a large collection of matter, such as a chronic or " cold "
abscess, caustic potash was formerly often, and for the latter purpose is
still occasionally, used. Macnamara has found better results from it than
from the knife in opening bubo (Ranking, i., 1872), and others recom-
mend it in carbuncle. It causes pain but no hemorrhage, and makes a
good free opening for the escape of the slough.

Caries Necrosis, etc. Caustic potash and concentrated solutions of
the carbonate have been recommended in these conditions, but sulphuric
acid is to be preferred (Medical Times, ii., 1860; Lancet, i., 1870). In
ununited fracture, potash has been used to vivify the ends of the bones.



POTASSIUM. 275

Varix Ncevus. It is said to have the power of obliterating the
trunk of a varicose vein (Bonnet), and also of destroying superficial naevi
(Wardrop); but the application is painful, and is apt to leave a very evi-
dent cicatrix. Powdered nitrate of potash kept in contact with the
naevus, is said to give a better result in slight cases.

In Hospital Gangrene, the part may be first dressed with the solid
caustic, and afterward with a lotion containing it in gradually diminish-
ing proportion 400 cases are said to have been treated successfully by
this means (Restelle: British and Foreign JReview, October, 1850). Lo-
tions of permanganate and of chlorate are also valuable.

Strumous Vlceration. In strumous ulceration of superficial and indo-
lent character, with livid undermined edges, and affecting extensive
surfaces on the trunk or extremities, caustic potash lightly applied to
the margin often stimulates to satisfactory healing.

Lupus. For cases of ulcerative lupus in which the strumous char-
acter is most marked, caustic potash is sometimes a good agent; we do
not apply it generally for lupus about the face, because of the un-
sightly cicatrix which is apt to follow its use; but in Vienna it is in fre-
quent request, and is found to succeed when other remedies have failed.

Epithelioma. The disadvantage of the deliquescent character of pot-
ash may be obviated, and its efficacy rather increased by combination
with caustic lime, two parts of the latter to one of the former constitut-
ing "Vienna paste;" it should be kept dry, and moistened only with a
little spirit as required. Epithelioma affecting the lip has been sometimes
cured by successive applications of this caustic, but it is painful and
tedious. The chlorate, given internally and applied locally, has also been
said to arrest and cure epithelioma^ and certain Paris surgeons especially
have reported well of the local use of concentrated solutions. I have ob-
served several cases treated in this manner, but without substantial benefit.
Uterine Vlceration. Pure caustic potash has been applied to ulcera-
tions and hyperplasise of the cervix uteri, and although disastrous results,
such as contraction and cicatrix have occasionally followed, it may be of de-
cided service, in skilled hands, not only for irregular ulcerative conditions,
but also in chronic cervicitis with induration (areolar hyperplasia); in such
cases it may be applied about every ten days for several times, and free
injections of vinegar and water should be used afterward. Dr. Henry
Bennet recommended it or the lime compound " as a last resource," and
the Vienna paste is sometimes serviceable. French surgeons use the
same remedy, with an additional quantity of lime, carefully prepared in
lead or iron tubes (caustic of Filhos, of Robiquet).

Primary Syphilitic Ulcers, Warts, etc., have been sometimes destroyed
by caustic potash. The bichromate is very useful for this purpose.

Urethral Stricture has been treated by the application of caustic pot-
ash to the affected part, and in some cases of cartilaginous hardness, and



276 MATERIA MEDIC A AND THERAPEUTICS.

of unusual irritability, it apparently proved useful with due precautions
but the majority of modern surgeons rightly, I think, object to any
direct caustic application in such cases.

Leucorrhoea Gonorrhoea. In the former affection, when the dis-
charge is profuse and strongly alkaline, and either transparent or white,
coming probably from the glands of the cervix uteri, a weak alkaline in-
jection (1 dr. of bicarbonate to the pint), thoroughly applied, will often
relieve; but injections of chlorate (2 dr. to the pint) act better, especially
if the discharge be at all purulent (American Medico- Chirurgical Review,
November, 1858). The permanganate should be used if there be a dis-
agreeable odor.

In gonorrhosa, injections of the permanganate (1 to 5 gr. to the
ounce) have been highly praised, especially in the second stage (Medical
Times, ii., 1862). In many cases they certainly act well, but care should
be taken to begin with a weak solution, for I have known pain and irri-
tation produced by such injections. Besides the local applications of
potash salts, the scalding and burning pain in micturition may be much
relieved by the bicarbonate, or perhaps better by the acetate and nitrate,
given internally with mucilage, etc.; it is said even that the attack may
be cured by them (Lancet, ii., 1850, p. 507). In chronic cystitis with
fetid urine, injections containing chlorate (4 gr. to 1 oz.) are recom-
mended by Braxton Hicks.

In-growing Nail, etc. This troublesome affection may be well treated
by means of dilute liquor potassae (2 dr. to the ounce of water) constantly
applied on lint, between the nail and the soft tissues, so as to thin the
nail and render it flexible, when it can be rubbed or pared away (Norton :
Lancet, i., 1869).

Unhealthy Wounds. Several compounds of potash have valuable dis-
infectant and also alterative properties, especially the permanganate
(Condy's fluid) and the chlorate, and when used in the form of lotion
prove of the greatest service in removing fo3tor and promoting healthy
action. For the bites of rabid animals its penetrating and alkaline
powers render liquor potassse valuable; in snake-bite especially it should
be applied locally as well as given internally; it fluidifies the blood and
promotes bleeding from the bitten part (v. p. 285).

Stomatitis Diphtheria. In aphthous conditions and unhealthy ul-
cerations about the gums, palate, or tonsils, gargles containing the
chlorate or permanganate are very good (v. p. 283). In diphtheria, both
these salts have proved of great service (Ranking, i., 1865). A useful
proportion of the permanganate for local application is about 10 gr. to
the pint of water.

Eczema. A weak lotion of bicarbonate of potash (or of soda), 30
to 60 gr. in the pint, will often relieve the early discharging stages of ec-
zema, and a stronger application (caustic potash, 5 to 20 gr. in the ounce)



POTASSIUM. 277

is a useful stimulant to patches in the chronic stage; although painful, it
markedly relieves the itching, which is often worse than pain. The Ger-
man school especially have reduced to a system the application of potash,
in the form of their sapo viridis (" schmeier-seife "), which is made by
boiling some animal oil with potash and its carbonate; it forms a soft
amber-green compound, more elegant than our " soft soap." Of this a
general bath is prepared with 1 dr. to the pint, a second strength (1 dr.
to |- oz. of water) is used for infiltrated subacute patches, and a third
(1 dr. to 2 dr. of water) acts as a caustic for very chronic cases; besides
these the German codex contains a " spirit of soap," etc. The solution
of selected strength should be thoroughly brushed in, and the irritation
quickly relieved by a stream of cold water. The use of such remedies is
painful, and causes profuse serous secretion from the part; before com-
mencing a course of them, vascular irritation should be subdued by cold
water, etc., and afterward it will be found desirable to use some emolli-
ent, such as glycerin or oil, otherwise the skin becomes harsh and dry.
There can be no doubt that in some chronic forms, and especially in
chronic eczema of the scalp, the soft-soap treatment gives remarkably
good results (Medical Times, i., 1860.)

Sebaceous Disorder Acne, etc. In cases of greasy skin and of ob-
structed follicles, soft soap is a good remedy. In the former it cleanses
and tends to lessen secretion; in the latter it dissolves obstruction, but it
should be used cautiously if much inflammation be present. Alkaline
drops or injections are useful for softening and evacuating hardened ceru-
men in the meatus.

Scabies Ringworm. Preparations of potash (soft soap, etc.) are in-
directly useful in parasitic disorders by softening the epidermis and
removing secretion, and thus allowing the more direct contact of sulphur
or similar remedies, hence the carbonate is a frequent ingredient in po-
mades for scabies. The sulphocyanide of potassium is a direct parasiti-
cide, and has been commended by Dr. Gee in ringworm ( oz. in 8 oz. of
water).

Psoriasis. The diffused forms of this disease may be much relieved
by alkaline baths (potash and soda carbonates together, of each 3 oz. in
the bath), and thickly accumulated scales may be removed by frictions
with soft soap. Oil of cade may be usefully combined with the same
remedy (soft soap, rectified spirit, oil of cade, equal parts). Ilebra ap-
plies to severe cases a daily friction with soft soap for many days, not
using a bath during the course, but keeping the patient in blankets.
This is, however, a painful process, on account of the great tension of
skin induced whenever strong potash applications are made to the gen-
eral surface.

Lichen Urticaria, etc. Weak solutions of potash salts or liquor po-
tassse relieve the itching and irritation of these disorders, also of pruritus,



278 MATEEIA MEDICA AJSTD THERAPEUTICS.

and to some extent of pruritus vulvae. A lotion made by boiling oz.
of potassa sulphurata in 1 pint of water, is very useful.

Rheumatism, etc. The carbonate of potash, dissolved in a bath of
warm water, is often useful to relieve pain in the joints, and irritable
eruptions in rheumatic and gouty subjects. The sulphuret of potash, on
the other hand, furnishes a bath which stimulates especially the mus-
cular system, and has proved useful in plumbism, in locomotor ataxy,
and other forms of paralysis; it has the distinctive properties of sulphur.
The silicate of potash, or " liquid glass," applied on saturated band-
.ages, makes an excellent splint for fractures (Darby: Medical Times, ii.,
1870).

THERAPEUTICAL ACTION (INTERNAL). Dyspepsia. In cases of irrita-
tive dyspepsia, especially when occurring in stout and rheumatic or
gouty persons, and marked by red tongue, acid eructations, or pyrosis,
with nausea and discomfort after meals, the liquor potassas or bicarbon-
ate of potash, taken at that time (after meals), often gives relief; in
gouty cases, and when the urine is loaded, they are to be preferred to
soda. In cases of atonic dyspepsia, however, with pale coated tongue
and much weight after food, small doses of alkali are best given before
a meal, and if continued for some time should be combined with a bitter
infusion. In cases of " biliousness," with yellowish complexion and con-
junctiva?, headache, nausea, etc., and even in actual catarrhal jaundice,
salts of potash are good adjuvants (Golding Bird, Bartholow). Dr.
Todd recommended the sulphuret (10 gr.) when the " mucous follicles
were implicated."

In vomiting connected with the condition just described, or with
other functional or even organic gastric disorder, or occurring at the com-
mencement of inflammatory fevers, the bicarbonate of potash is advan-
tageously given in effervescence with citric acid.

Acid Poisoning. In cases of poisoning by the mineral acids, bicar-
bonate of potash may be employed not only to neutralize the acid, but
as an emetic, by giving first a large dose of the alkali, and a suitable
quantity of citric acid some minutes afterward. The amount of car-
bonic acid evolved distends the stomach so as to assist discharge of its
contents.

Lithiasis Calculus. In cases of excessive secretion of uric acid,
potash salts are useful by assisting oxidation of the acid to some extent,
and also by furnishing a base with which the acid is readily eliminated
in a soluble form; they should be considered, however, rather palliative
than curative, and attention should be equally directed to diet and hy-
giene during their use.

The continued administration of potash had, at one time, much repu-
tation in the treatment of uric acid calculus, and Dr. William Roberts
(Manchester) has shown, by careful experiments, that benefit may be ex-



POTASSIUM. 279

pected from it under certain conditions. It is specially adapted for renal
calculi which cannot be reached in any other way, and for small vesical
calculi consisting either of uric acid or of cystine. The acetate and cit-
rate of potash are the best to use, and in order to secure a sufficient and
continuous alkalescence of the urine, 30 gr. for children, 40 gr. for adults,
of either salt must be taken at intervals of about three hours. This
quantity will give to the urine an alkalinity equal to 3 or 4 gr. of carbon-
ate in the pint, which may be kept up for several weeks without injury
to the general health, but the urine must be frequently examined, and if
it become ammoniacal the treatment should be omitted.

As an illustration of its occasional value may be cited the case of the
Rev. V. Harcourt, who, at the age of eighty, continued it for three
months, rendering the urine alkaline to the extent of 20 to 25 gr. per
pint, with relief to many painful symptoms, and with much advantage
(Medical Times, ii., 1869). For phosphatic calculi, potash is, of course,
unsuitable.

Skin Disease. Several forms of cutaneous disease are connected with
a gouty or rheumatic diathesis, especially forms of eczema and psoriasis;
in such cases the urine is often scanty and loaded, and then alkaline
diuretics are of service. Mr. Easton has shown the advantages of the
acetate (Edinburgh Monthly Journal, May, 1850); the liquor potassas is
also given successfully.

Acute Rheumatism. Up to comparatively recent times, alkaline
treatment, by potash especially, was accepted as the best for rheumatic
fever. Among its principal supporters, Dr. Fuller claimed that it would
prevent cardiac lesions, for such lesions did not occur in any of a large
number of cases thoroughly brought under the influence of alkalies
(Lancet, ii., 1862). He argued that these remedies not simply neutralized
abnormal acidity, but restored normal alkaline conditions, maintained
fibrine soluble, exerted a sedative influence on the circulation, and favored
complete metamorphosis of tissue; he pointed out, also, that for a fair
trial correct diagnosis was essential, and that true rheumatism should not
be confounded with the gonorrhceal affection, with rheumatic gout, pyae-
mia, etc., and such a mistake would account for failures; he approved of
a compound prescription thus, I. Liq. ammon. acetat. 3 ij., soda? bi-
carb. 3 iss., potas. acetat. 3 ss., with citric acid in effervescence.

Sir Thomas Watson recommended liquor potassas, arid Dr. Parkes
made use of it (Medico- Chirurgical Revieic, 1864), but it is not really so
suitable as the neutral salts. Todd preferred the bicarbonate or acetate
in -J-dr. doses every three hours (Ranking, i., 1869). Dickinson has writ-
ten in favor of the same method, and Golding Bird in favor of the ace-
tate specially, while Dr. Basham was a constant advocate of the nitrate
(Lancet, 1848, and ii., 1862); he used large doses, from 1 to 3 oz. daily,
in 4 pints of barley water. Dr. Wade found the best results from a com-



280 MATEEIA MEDICA AND THERAPEUTICS.

bination of these two salts in moderate doses, 15 to 20 gr. of acetate with
8 to 10 of nitrate, and other observers have corroborated his experience
(Fleischman: Lancet, i., 1869, etc.). On the other hand, Dr. Sutton con-
cluded that none of these remedies could influence the course of rheuma-
tic fever, or prevent heart-complications, though they might allay pain
(" Medico-Chirurgical Transactions," vol. Hi.). Dr. Ringer, from his own
observation, came to a similar conclusion, while Dr. Ridge and others
have argued that they are injurious (Medical Times, ii., 1871). No doubt
the continued use of large doses may induce depressing anaemia, and con-
sequent tedious convalescence, and now that the salicylates and other
remedies are better known, we are not so dependent on alkaline medica-
tion; it must, however, be held a valuable resource in cases marked by
high degree of acidity and loaded urine, and its judicious use may greatly
relieve. In my own practice I commonly combine iodide of potassium
with bicarbonate in effervescence.

Ague. Nitrate of potash has been given successfully in ague 10 gr.
every two or three hours (in brandy) ; it increases the secretions, notably
the perspiration and urine, and is said to be as sure a specific as quinine,
leaving even less tendency to relapse! (Ranking, i., 18G9).

Specific Fevers. Alkalies, especially in effervescence, greatly relieve
the thirst and other distressing symptoms in various fevers, and they
promote elimination by the skin and the kidneys, etc. The chlorate has
been recommended in enteric fever by Chomel, but has not been largely
given; in scarlet fever, I, with others, have found it of much advantage
(Watson, Copland); even in yellow fever, in the later stages, it is said to
do good (Medical Times, i., 1875).

Diphtheria. Chlorate of potash in full doses, either alone or combined
with iodide, has seemed very useful to many observers (Squire, Hillier,
Perrin, Henoch, Vogel). I quite agree with them; I have for twenty
years used it more or less with advantage. In America, it is commonly
given with chloride of ammonium. Recently Dr. Ciattaglia (Rome) has
recorded his very successful results with doses of 10 to 15 grammes daily;
but in addition he thoroughly applied to the affected part a wash of
chloral 1 dr. in 5 of glycerin (Lancet, i., 1876).

The permanganate of potash has also proved useful in diphtheria, as
well internally as locally (Copland: Lancet, i., 1863, p. 151, and Ranking,
i., 1865, p. 55). I can add my testimony to its value, though it is right
to recognize the statements of Dr. II. C. Wood, that he "has never seen
the chlorate do a particle of good in such maladies as scarlet fever, diph-
theria, etc.," and with regard to th permanganate, "as immediate de-
composition of it must occur in the stomach, the absurdity of its internal
use needs only to be pointed out " (" Elements of Therapeutics," 473
586).

Croup. Liquor potassas has been used in croup both locally and in-



POTASSIUM. 281

ternally. Certainly it will dissolve fibrinous membrane outside the body,
and to some, but not to a great, extent may be available in the form of
spray ( or 1 dr. to 1 oz. of water). It has been compared to mercury
in its constitutional effect of fluidifying secretion and of promoting ab-
sorption, but it acts too slowly to be depended upon for so acute a mal-
ady as croup. Iodide of potassium is more effective, and the acetate of
potash seems to have sometimes acted well. The bichromate I have oc-
casionally used locally and internally, with excellent effect, in true mem-
branous croup.

Pneumonia. The nitrate of potash is said to be valuable in the early
stages {Dublin Quarterly Journal, July, 1873), but as Dr. Jones, who
commends it, used also antimony and ipecacuanha, we cannot verify its
precise effects.

Bronchitis Catarrh. When expectoration is scanty, viscid, and
brought up with difficulty, either in early or later stages of bronchitis,
alkalies often relieve, and may be taken with other expectorants. The
liquor potassae in doses of 10 to 15 min. is one of the most suitable forms:
the nitrate is also useful, and is commonly combined with Dover's pow-
der, or with antimony and tinct. camph. co. (Graves: "Clinical Lectures").
Laborde has found the chlorate very .serviceable, both in acute and chronic
catarrhal bronchitis: it modifies and dilutes the expectoration, which
gradually lessens in amount; the respiratory sounds become normal, the
cough is relieved, and appetite improved (Bulletin, October, 1864). In
ordinary catarrh I have found the chlorate a very good remedy; it is rec-
ommended also by Dr. Sedgwick (British Medical Journal, i., 1873).

Asthma. The inhalation of fumes of "nitre paper" is often valuable
in this malady, and I, with others, strongly recommend it, especially for
spasmodic asthma, though it is often available also in the bronchitic form,
if congestion be not very acute. The paper may be made with thick
blotting-paper, saturating it in a hot solution of nitrate of potash (4 oz.
to pint), then drying and dividing it as required. In some cases a lit-
tle of this is sufficient, and a less strength of solution is desirable, but in
others relief is not obtained till the room is filled with the vapor ( Times,
i., 1874, p. 64). Dr. Murrell has recently reported much relief from thick
strong papers covered with crystals of nitrate or chlorate; when lighted
they give out "dense volumes of smoke" (British Medical Journal, i.,
1881). Sometimes, however, especially if there be extensive or active
congestion, such treatment proves irritant, and its first use therefore re-
quires watching.

Pertussis. The carbonate of potash was at one time in good repute
in the treatment of whooping-cough, but we cannot expect more from it
than the thinning of tracheal and bronchial secretion, and a slight seda-
tive effect on the mucous membrane. The acetate has been especially
recommended (Practitioner, vol. ii.), also the sulphuret; the latter is giv-



282 MATERIA MEDIC A AND THERAPEUTICS.

en in doses of 1 gr. per year up to four years, after that age in the pro-
portion of gr. per year. It is important that its solution should be
freshly prepared: it is rather nauseous, and acts sometimes as an emetic,
but if continued for four or five days will usually do good (Ranking, i.,
1869, p. 65).

Phthisis. The value of chlorate of potash in phthisis has been much
disputed: by some it has been esteemed a specific, ana though it really
cannot be called so, it has the power of relieving at least some of the
symptoms. Dr. Fountain introduced it with the hypothesis that it gave
up oxygen to the blood (v. Physiological Action), 'and seems to have
found benefit from the salt, not only in consumption, but in various dis-
orders with impeded respiration (Medical Times, ii., 1859, American
Journal, I860). 1 Dr. Harkin records that in the first or second stages of
phthisis doses of 5 to 20 gr. improved color and strength, and diminished
cough and diarrhoea (Dublin Quarterly, November, 1861). Dr. Symonds
considered it of service in promoting the healing of vomicae (British
Medical Journal, i., 1868), and Spender, pointing out that full doses may
readily be given, because of its great solubility in boiling water, "regrets



Online LibraryCharles D. F. (Charles Douglas Fergusson) PhillipsMateria medica and therapeutics, inorganic substances; (Volume 2) → online text (page 34 of 40)