[Reprinted from The Medical News, May 4, 1895.] 
THE TREATMENT OF 0 P t U M - P 0 ! S 0 NI N G 
BY POTASSIUM PERMANGANATE. 
To the Editor of The Medical News. 
Sir : It is now nearly a year since an editorial regard- 
ing the permanganate treatment of opium-poisoning 
appeared in the Journal of the American Medical Asso- 
ciation, May 19, 1894, which concluded with the state- 
ment that " a new antidote to morphin was not urgently 
demanded, since the treatment already in general use is 
very efficient, and, as a rule, successful.1 No argument 
has the power that facts possess, and it is for that reason 
that an answer to this editorial is more appropriate now 
than it would have been a year ago. 
First of all, the expression " a new antidote to mor- 
phin'' is, strictly speaking, incorrect. The editor of the 
Journal should have said "an antidote to morphin was 
not urgently demanded.'' There was no antidote to 
morphin known up to the time I made my humble efforts 
in that direction. Does the writer of the editorial con- 
sider belladonna and its alkaloids as opponents of mor- 
phin ? Can one narcotic be a real opponent to another 
narcotic ? Many authorities, among them Brown- 
Sequard and J. Harley, dispute an antagonism between 
these two narcotics. Harley concludes that in medicinal 
doses the essential effect of morphin (hypnosis) is both 
1 My attention to this editorial was called by Dr. T. S. Car- 
penter's report in your esteemed paper of June 23, 1894, of a 
case of accidental morphin-poisoning, in which the permanganate 
had rendered him signal service. Dr. Carpenter criticises the 
editorial, but from a standpoint differing from mine. 2 
increased and prolonged by the action of atropin, whether 
introduced previously or at any tinfe during the operation 
of the former. Dr. John S. McLain, of Washington, 
in a paper entitled " Narcotics and Narcosis in Children " 
(see Archives of Pediatrics, June, 1893), says: 
" The opinion which has been gaining ground for 
several years seems now well established that belladonna 
and its alkaloids are of little use in the treatment of 
opium-poisoning, W. H. Thompson going so far as to 
state that ' the cases in which the opium-narcosis is 
really dangerous are those in which belladonna is useless, 
if not injurious.' Lenhartz, in his experiments on dogs, 
came to the conclusion that in no case did the alkaloid 
have any effect upon the more dangerous appear- 
ances, the coma, cramps, and convulsions, and hence 
he holds that the opposing power is limited and of no 
avail in serious cases, the atropin increasing the heart- 
depression already brought about by opium, and that 
' the physiologic antagonism between atropin and mor- 
phin is not established by a single authentic observa- 
tion.' Dr. T. D. Smith, of Louisville, Ky., writing upon 
the subject, remarks: ' In order to root out more 
rapidly the prevalent error as to the use of atropin, it 
would be better that it be not mentioned at all in con- 
nection with the treatment of opium-poisoning." 
As to emetics, they cannot be called antidotes in the 
true sense of the word; besides, they are utterly un- 
reliable in narcotic-poisoning, and are simply inducive 
to loss of precious time. Dr. McLain, in the paper above 
mentioned, says "that it is a great mistake to attempt 
to induce vomiting by copious draughts of hot mustard- 
water ; forty grains of ipecac in water, twenty grains of 
zinc sulphate in water, etc., as recommended in many 
of our text-books." Another objection, he says, 
to flooding the stomach with these fluids is that theyr 
themselves serve to dissolve the poison, whatever it 
may be, and hence aid in its more rapid absorption. 3 
On the same ground he objects to copious draughts of 
black coffee. 
On the other hand, I have shown beyond a doubt that 
the contact of permanganate and morphin results in ren- 
dering the latter instantaneously harmless, and therefore 
the permanganate is the only antidote to opium known 
so far. It cannot be styled a new antidote. There does 
not exist an old one. If it does exist, I should like to 
know its name. 
It is with some satisfaction that I now can point to 
about thirty-five cases of opium-poisoning in which the 
antagonist has proved its great value. Yet how much 
quicker would it have acted had it been employed at 
the very beginning of medical assistance, instead of 
allowing so much valuable time to be lost by resorting 
to other plans of treatment. First destroy the poison, 
rid the body of its foe, and then Nature will be ready 
and quick enough to restore impeded functions ; the 
damage will then be repaired without difficulty. To 
remove the obstacle and to annihilate the poison 
should be our very first duties. It is truly a miracle 
that the potash salt did accomplish so much when cir- 
cumstances combined to defeat its success. Even in the 
case I had (see Medical Record, March 2, 1895) my col- 
league legitimately resorted to the usual methods for an 
hour-and-a-half before I had an opportunity to invoke 
the aid of the permanganate. Still the patient compar- 
atively quickly responded to it, and my mind was relieved 
of a great burden ; for, had I lost the patient, the entire 
odium would have fallen upon the salt of permanganic 
acid. 
I shall now make a statement which may create 
severe comment or may place me in the light of an 
enthusiast, but which statement the experience of the 
future will justify and uphold. I say that any physician 
arriving at the side of a person suffering from opium- 
poisoning, who does not at once administer to that person 4 
a sufficient quantity of the permanganate, commits an 
act of gross negligence. 
The ambulance-surgeon should first administer the 
potash salt before conveying the patient to the hospital. 
Is it not unjust, unreasonable, to submit a patient to the 
shaking and rattling of the wagon, which is bound to pro- 
mote the absorption of the poison by the stomach ? 
Every physician, every ambulance-surgeon, should keep 
the permanganate of potash among his emergency 
drugs. Let the stomach-pump alone, for its use only 
increases the cerebral congestion already present. Dis- 
card atropin ; do not superadd one narcotic to another. 
If one need to strengthen the heart-action, resort maybe 
had to strychnin hypodermically. If one wish to give 
coffee, let it be given as an enema. Artificial respira- 
tion is necessary, and let the patient be kept awake, but 
not too forcibly, by the use of cold affusions ; but, above 
all, let us not neglect the thorough and judicious admin- 
istration of the powerful opponent of the narcotic in 
question. 
It should be given to meet three different indications : 
First, it should be given by the mouth, well-diluted, to 
annihilate any opium or its alkaloids that still may be 
in the stomach. If the patient is unable to swallow, the 
antidotal solution can be administered through the nose 
with the aid of a hard-rubber catheter, a piece of rubber- 
tubing, and a funnel. These appliances can easily be 
procured. One grain of Mn20s5K2 annihilates one 
grain of morphin. It should always be diluted to the 
utmost possible degree. The second indication is to de- 
stroy the morphin contained in the circulating blood 
through hypodermic injections of the antidote-again as 
well diluted as possible. The third indication is to 
decompose the alkaloid that returns from the circulation 
to the stomach. This is accomplished by giving the 
patient by the mouth, from time to time, weak solutions 
of the potassium salt, say one grain to a tumblerful of 5 
water. No coffee or other liquids-nothing but weak 
permanganate solutions should enter the patient's stom- 
ach. Such a plan of treatment will not fail to bear 
gratifying results, and these in turn will tend to hasten 
the general acceptance of that important therapeutic 
truth, that potassium permanganate is the antidote to 
opium, its preparations and alkoloids. 
Very respectfully yours, 
William Moor. 
io3 West Fifty-eighth St., New York, 
April 20, 1895.