Topical Treatment of Diphtheria 
and Chemical Solution of 
the Membrane. 
SULPHATE OF IRON AND SALICYLIC 
ACID. 
BY 
A. W. NELSON, M.D., 
OF NEW LONDON, CONN. 
Reprinted from " The Journal of the American Medical 
Association," March 22, 1890. 
CHICAGO : 
Printed at the Office of the Association. 
1890. Topical Treatment of Diphtheria 
and Chemical Solution of 
the Membrane. 
SULPHATE OF IRON AND SALICYLIC 
ACID. 
BY 
A. W. NELSON, M.D., 
OF NEW LONDON, CONN. 
Reprinted from "The Journal of the American Medical 
Association," March 22, 1890. 
CHICAGO : 
Printed at the Office of the Association. 
1890. TOPICAL TREATMENT OF DIPHTHERIA 
AND CHEMICAL SOLUTION OF THE 
MEMBRANE.-SUBSULPHATE OF 
IRON AND SALICYLIC ACID. 
The New York Medical Journal, January, 1874, 
published "Forty Cases of Diphtheria Treated by 
Local Application of Sulphate of Iron." The 
present writer in that paper says : "About 1865 I 
became confident that some local treatment would 
best cure the disease, and often wondered what 
chemical re-agent would destroy and counter- 
act the source of fever, the putrid mucus, pseudo- 
membrane, continuously exuding, and at the 
same time not cauterize and irritate the still liv- 
ing, although infiltrated, membrane of the throat. 
. . . . Creosote suggested itself to be considered 
(this was just before the carbolic acid discovery 
or invention), but it was not tested. Another 
agent, the subsulphate of iron, Monsel's styptic, 
in some now forgotten way was brought to no- 
tice. My first application to the throat in diph- 
theria determined with me its efficiency, etc. . . . 
"You will sometimes induce a little vomiting 
at first, an effect not injurious-on the contrary, 
possibly beneficial in ridding the stomach of poi- 
sonous mucus swallowed before, etc." 
The tincture of chloride of iron has usually 4 
been given, 3 to 10 drops in a little water, with 
the local application of the subsniphate, and this 
line of general treatment has undoubtedly largely 
prevailed, in this country at least. Dr. Whitta- 
ker, Cincinnati, 1881, gives nineteen cases treated 
in the same manner, with circumstantial detail. 
The Journal of the American Medical As- 
sociation, Nov. 30, 1889, commends the local 
treatment editorially, and in the treatise, "Diph- 
theria and Intubation," by Drs. Billington and 
Dwyer, 1889, the first topical application named 
is Monsel's styptic. 
Prudden, in his exhaustive paper, "Etiology of 
Diphtheria," {American Journal of Med. Sciences, 
May, 1889,) advises local applications without in- 
dication of the agent. In the same number 
D'Espine {Rev. Mid. de la Suisse Romande, No. 
1, 1889) advises irrigation with a dilution of sali- 
cylic acid, 1 or 2 in 1,000, or in infants, 1 in 
1,000 or 1,500. Several mixtures have been used, 
as also pepsin and tripsin, to effect solution, some- 
times with good results, according to reported 
cases. 
In a large number of diphtheritic throats with 
enlarged glands of the neck, there is much necro- 
sis of the membrane and fetor, and little doubt of 
the nature and specific origin of the disease. The 
best men may sometimes be deceived in the milder 
cases. The subsulphate application, however, is 
very effectual in both the severe and mild forms. 
Not as frequently we observe a different con- 
dition- a diphtheritic membrane firmly attached 
in the fauces, whitish and blueish, not necrosed, 
without fetor, gradually spreading from tonsil to 
velum and uvula and palatal arch, and behind 
and beyond sight in the post nares. The living 
internal structures sometimes are slightly swollen; 
the lymphatics of the neck, as I have observed, 5 
considerably swollen. Great weakness and appre- 
hension accompany this condition, and the usual 
remedies have little effect. 
There can be no doubt here as to the specific 
nature and origin ; nor can there be much doubt 
that it is the same in specific nature as the 
pseudo-membrane of croup. Here the two dis- 
eases meet and become identical, except in loca- 
tion. 
About a year since my attention was attracted 
to the use of salicylic acid in solutions and oint- 
ments for corns of the feet. I tested the pure 
acid several times, especially in the troublesome 
soft corns between the toes. The part was moist- 
ened once a day and the acid rubbed in for a few 
days. The hypertrophied tissues would grow 
smaller and disappear, and sometimes the epider- 
mis near would desquamate, but without sore- 
ness of the underlying derma. The effect was 
quite perfect. 
Case i.-April last I had a case of diphtheria, 
and it occurred to me to apply the acid pure. It 
was applied hourly to the patch on the tonsil, 
where it stuck from hour to hour, enveloped in 
the moisture of the parts, but gradually thinning 
the deposit and limiting its extent. It was the 
child of very poor parents, and after three days 
the mother reported such improvement that it 
was not again seen. The child recovered soon. 
Case 2.-June 4. L. J., girl, aet. 8; well-marked 
membrane over one tonsil, with slight necrosis of 
deposit only; enlargement of lymphatics of neck ; 
some fever; no appetite. Powder of salicylic acid 
hourly, and ft tinct. ferri chloridi oiv, hydrarg. 
bichloridi, gr. ij, ; gtt. iij in a teaspoonful of 
water every hour or two ; acid every two hours at 
night. Continued nine days, with occasional in- 
termissions of some hours, when the membrane 6 
would again appear, again to melt under the acid. 
No extension of the membrane while the acid 
was used. No complaint of the peppery stinging 
of the remedy. Towards the last, after disap- 
pearance of membrane, used also, bismuthi 
subnitratis 5ss, olei minthae piperis, vj, 
Make a fine powder. Dust the throat every hour 
or two. 
For a little space beyond the part affected by 
the membrane the salicylic acid whitens the mu- 
cous surface, but without inconvenience and with- 
out any invasion of the disease. The surface soon 
again recovers. The little patient was seen daily 
twice from June 4th to nth, and to 13th once 
daily, and last on the 15th. No sequences. 
Case 3.-Sept. 4. Mrs. H., set. 33 ; considera- 
ble fever ; enlarged glands of neck ; weak ; patch 
on one tonsil and near it. 
ft. Tinct. ferri chloridi 3iv and hydrarg. bichlor- 
idi, gr. ij, gtt. iv in aqua 3j hourly or two- 
hourly. Acid applied every hour or two; some- 
times not so often. Complains of its stinging; 
membrane constantly recurs upon omission of 
acid. Finally applies remedy hourly with regu- 
larity, when the throat is no longer painful and 
the acid does not sting, and the deposit thins and 
disappears. 
Mrs. H., a woman of intelligence, did not at 
first like the remedy, but seeing its benefit in the 
appearance and the lessened sensitiveness of the 
affected parts she became enthusiastic and thor- 
oughly cooperated. She was visited twice daily 
for about nine days till Sept. 12th, when the 
tendency of the membrane to recur ceased. The 
bismuth mixture was then used with comfort. 
A solvent of the membrane without irritation 
of the living structures seems to be found in the 
salicylic acid-much better than the subsulphate, 7 
whenever the membrane does not necrose and 
break down. The subsulphate hardens, in that 
way killing the acting membrane, rather than 
acting by solution. Creosote might act well but 
for its tendency to extend deeply. 
The question of destructive action upon bac- 
teria has not been discussed. It can in these in- 
stances be affirmed without discussion, and the 
treatment is considered from a different stand- 
point. 
Hourly use of the acid, which is a very light 
powder, does not affect the youngest patient un- 
favorably by the amount swallowed or absorbed.