THE TREATMENT OF SCR0F0L0US DISEASES 
OF THE SKIN. 
By John Y. Shoemaker, A.M., MIX, 
OF Fill LADE LrillA. FA. 
Lv referring to this important and vexatious disease upon this 
occasion, I have omitted the description of its course, which has 
already been so ably discussed by many modern writers, and have 
simply confined my remarks to a brief but practical account of its 
treatment. It was the indefinite and uncertain action of many of 
our standard preparations upon scrofulous disease of the skin that 
induced me to study carefully the action of other remedies upon this 
disease. After several years of practical work with the various re- 
midies, I have concluded to bring the result of my labor before this 
Section in order to lead, if possible, into further investigation of the 
subject. 
The literature of scrotuloderma presents a large number of reme- 
dies which are regarded by their advocates as specifics for this dis- 
ease. Leeches, issues, blisters, the iodides, the mercurials, cod-liver 
oil, iron, quinine and barium have each had their respective sup- 
porters. Having repeatedly failed to cure many of those who ap- 
plied to me for relief by using the remedies just named, I was finally 
led to try the chlorate of potassium internally with the most happy 
results. I claim, after watching the action of this remedy in a 
large number of cases of scrofulous disease of the skin, some of 
which are included in this paper, that the chlorate of potassium over- 
comes the morbid condition in the system that leads to the develop- 
ment of various lesions,of the skin. The following cases are a few 
of many that have come undes my notice, and will illustrate the 
value of the above-named remecp. 
Case I. A lad aged 13, rather stout, and of sallow 
came under my observation at the Pennsylvania Free dispensary 
for Skin Diseases in February, 1818. At this time his skin was 
harsh and his expression was haggard and worn. The most promi- nent part of the disease involved the nose, which was somewhat 
enlarged, and the tip was covered with exuberant granulations that 
extended down on both sides of the alae and likewise passed up 
into the mucous surface of both anterior nasal outlets. These flabby 
granulations were covered with a thin pus and bled freely on 
being touched. In addition, the upper lip and the buccal re- 
gions w'ere the seat of several dull, red, tubercular formations, 
and the glands around the inferior maxillary were slightly enlarged. 
These morbid conditions, together with the old scars that were 
scattered over both the face and neck, w'ere a sufficient tell-tale of 
the disease. Upon inquiry I learned from the patient that he lived 
with his parents and two sisters in a small court in the lower part 
of the city. Not being able to obtain much of the family history 
from the boy, who was very dull in intellect, I called at his home 
to make further inquiry-into his case. I found the family, consist- 
ing of the father, mother, the lad, and two sisters, living in two 
small and very cleanly rooms. The mother had every appearance 
of good health, and stated that her husband was sound in every re- 
spect and only one fault, which was that of occasionally getting 
drunk. I examined the two sisters of the boy and found them free 
from all signs of scrofulous disease. 
After some effort the mother informed me that during the period 
of her pregnancy with the boy she frequently suffered from hunger, 
by reason of the father being drunk and not supplying the neces- 
saries of life. At the time of the boy’s birth he was unhealthy, and 
had occasionally during his first and second years, been deprived of 
the proper food. I succeeded, after repeated attempts, in meeting 
the father of the lad, who was healthy in every wav, and frankly ac- 
knowledged his little weakness for getting drunk, but strongly pro- 
tested that he had never been afflicted with any venereal trouble. 1 
therefore concluded that the boy’s condition was due to a disor- 
dered state of the blood, beginning very probably in intra-uterine 
life from improper nutrition. 
I began the treatment by using internally, small doses of the ac- 
cepted remedy, cod-liver oil, but was compelled to discontinue its use 
in a short time, owing to the oil disagreeing with the stomach. The 
iodide of potassium had the same elfect, and the corrosive chloride 
of mercury ran off by tlJP bowels. • I finally concluded to discon- 
tinue for a time all constitutional treatment, and to try the use alone 
of local readies. I began the local treatment by puncturing and 
scarifying the surface; used, also, in turn pressure, blisters, the 
mercurials, the iodides, the sulphate of copper, and various other astringents., and as soon as the disease would disappear at one point, 
it would go on even more violently at another. 
Six months were consumed in this way in trying the various in- 
ternal and local remedies, and all to no purpose, as the patient’s con- 
dition remained unchanged. After these repeated trials and failures 
with many of the old remedies for this disease, I made up my mind 
to try the chlorate of potassium, a remedy which had already proved 
very efficacious in some lighter cases of scrofulous disease of the 
skin under my care. 
I began the new treatment by giving the patient two grains of the 
chlorate of potassium three times daily; the dose was gradually in- 
creased until he could take five grains four times daily. In the 
course of two weeks the spots became lighter in color, the skin 
clearer, and this state of improvement continued until my patient 
was entirely cured in the month of November, 1878. In this I 
began the treatment with a mild aperient, ordered a substantial diet, 
and applied the sulphate ot copper to the granulations once a week. 
Case II. Mary VV., aged 19, came under my care at the same 
Dispensary, in September, 1878. She was brought to me b}r her 
mother for enlarged maxillary glands, loss of appetite, and great 
weakness. Her complexion was sallow, and she was very thin. Her 
medical history w'as as follows ; she had been ailing ever since she 
was three years of age; about that time the mother noticed small 
lumps around the neck, and an eruption on the scalp as the child 
was recovering from scarlatina. Her mother further stated that after 
this attack her child would improve for a time, and afterwards, 
upon the slightest change in the weather, would be seized with 
rheumatism, which was always followed by great prostration, loss 
of appetite, and either diarrhoea or constipation. The patient had 
continued from time to time to suffer from rheumatism, until about 
one year ago, when she was seized with even a more severe attack 
than at any previous period. The mother, who was very intelligent, 
added that the physician in attendance at that time had succeded in 
curing the rheumatism, and since then that her daughter had not 
been troubled with it. I was also informed by the mother that after 
this last attack of rheumatism, her daughter had continued to lose 
flesh and had grown very pale and weak. The family history, as 
far as I could learn was good; the father, mother, and one brother 
enjoyed the best of health. 
On examination the scalp was found covered with sebum, the hairs 
were dull and lustreless in appearance, and were falling out in large 
numbers, the conjunctiva was injected, the pupils dilated, the eye- lashes long and droopy, the face was pale and haggard, and the 
maxillary glands were enlarged, with here and there small openings 
discharging a thin and unhealthy pus. I prescribed a dessertspoon- 
ful of cod-liver oil three times a day. In the course of two weeks 
no improvement had taken place, and I was compelled to omit the 
cod-liver oil by reason of it disagreeing with her, and substitute for 
it three grain doses of the chlorate of potassium four times a day. I 
advised the continued use of substantial food, and used locally a 
mild tar ointment. From this date the improvement was steady, 
the appetite returned, the bowels became regular, and at the end of 
a little more than two months the patient was quite well. 
Case III. In the month of November, 1879, I was called to see 
a young girl, aged 15, of fair complexion and of healthy appearance. 
Her parents were in good circumstances; she had been well fed,and 
had been treated with the utmost attention by her physician, who 
gave me at the time the following account of her case. Two years 
previous she had a severe attack of scarlatina, and shortly after, 
while convalescing, the maxillary glands began to enlarge and the 
scalp became covered with sebum. This condition had continued to 
grow worse, notwithstanding the best of care and attention from 
her physician. At the date of my call I found the scalp covered 
with patches of sebum, and the hair presenting an unhealthy ap- 
pearance. The skin around the maxillary region and down the neck 
was of the natural color in patches, interspersed with red and even 
violet spots; the glands were hard in some parts, soft and boggy 
in others, while here and there small openings about the size of a 
pin could be observed, through which a thin and unhealthy pus 
escaped. Her physician informed me he had given such medicine 
as he thought would be suitable to her, but without the slightest 
benefit. Chlorate of potassium in five grain doses was given ; the 
parts were washed with borax water; no fresh development of the 
disease showed itself, and in about nine weeks she was qiiite well. 
Case IV. Emily D., thin and delicate, aged 7, was the subject 
of severe scrofula, and had been so since her birth. The child’s 
aunt brought her to the Dispensary December, 1879, but could give 
no history of her ease except that both her parents had die’d from 
consumption. Her skin was pale and of a yellow appearance; a 
thin discharge was detected from the left ear; the maxillary glands 
were slightly enlarged; a small ulcer existed below the angle of the 
inferior maxillary of the right side; another one a little larger, ir- 
regular in shape, covered with a watery secretion, was situated on the forearm; the hands and feet were cold,and the abdomen was dis 
tended and hard. Two grain doses of the chlorate of potassium 
were ordered, which were gradually increased to five grains, four 
times a day, with good food, weak citrine ointment locally, and plenty 
of exercise. In six weeks the ulcers had disappeared, and the im 
provement was so marked that the child would scarcely have been 
recognized. 
Case Y. Willie B., aged 14 months, a scrofulous baby and very 
cachetic; scalp covered with crusts; maxillary and inguinal glands 
enlarged, with small inguinal abscess from a broken dowm gland; 
abdomen large. Healthy father and sickly mother. Ordered one 
grain of chlorate of potassium in arrowroot drink, and increased 
the dose to two grains, four times a day. Fed the child on milk 
and arrowroot drink, opened the abscess, poulticed the crusts, and 
oiled the scalp. Two months later, when I last saw the baby, he was 
healthy-lcoking and quite free from the disease. 
The cases which have been adduced present, I believe, very fair 
examples of scrofulous disease of the skin as it is met with in 
practice. I endeavored, prior to using the chlorate of potassium 
in similar cases to those I have just enumerated, to overcome the 
disease by following the routine plan of treatment, with but a small 
percentage of cures. I tried cod-liver oil, iron, and quinine, which 
preparations either interfered with digestion, or ran off by the 
bowels and so prevented many of my patients from getting well. 
Many unsatisfactory results in this way finally led me to try the 
chlorate of potassium, and to my astonishment I obtained remark- 
able results. 
My attention was directed to the efficacy of the chlorate of 
potassium by the beneficial effect that followed its use upon a 
patient having scrofuloderma who applied to me for treatment for 
mercurial salivation. I gave the patient a solution of the chlorate 
of potassium, and was surprised to find as I continued the solution 
that the scrofulous condition gradually disappeared until the case 
was cured. I was led by the good results in this case to try the 
same remedy in other patients, and was agreeably astonished to 
find continued success in its use. 
The chlorate of potassium has a marked influence on all sup- 
purative processes. It prevents and arrests, to a great extent, sup- 
puration. Thus in persons who have had tubercular deposit in the 
glands of the neck, threatening to end in suppuration, the use of 
the chlorate of potassium will reduce the inflammation and pre- vent the formation of pus. In another class of cases of this group 
in which the formation of pus has taken place, the influence 
of the chlorate of potassium is still more conspicuous. For 
instance, if a child nine years of age has an enlargement of the 
glands around the inferior maxillary following measles or scarla- 
tina, which, by the way, is very common, deep-seated suppuration 
takes place attended with great pain and constitutional distur- 
bance. The skin gradually changes from the normal color to a red 
and even a violet, the small tumors feel soft and boggy, and after a 
time small openings appear, from which issue a thin and unhealthy 
pus. Now such a troublesome and intractable condition will 
quickly give way to the administration of two or three grains of 
chlorate of potassium four times daily. The deposition of fresh 
tubercular material in the glands wrill be checked, the thin and un- 
healthy pus will become abundant and laudable; many abscesses 
about developing will dry up, while those that are open will gradu- 
ally heal. The chlorate of potassium whilst thus influencing local]}' 
the scrofulous condition, will likewise improve the general health 
by removing all the constitutional disturbances associated with this 
disease; in which, in many instances, the use of cod-liver oil, iron, 
and quinine had entirely failed. 
As to the mode of administration of the chlorate of potassium, 
I have usually given it in from one-half to ten-grain doses dissolved 
in pure water three or four times daily. In the above doses I find 
it well borne by the stomach even in those who are very weak and 
enfeebled. I generally begin with from one-half to one grain one 
hour before meals, and gradually increase the dose until the patient 
shows some signs of improvement. The continued use of this drug 
for a time will increase the appetite, fatten the patient, render a 
previously dark skin clear and florid, and add tone and vigor to the 
system. Those who are large, flabby, and apparently vigorous, will 
improve, as a rule, better under small doses, as large amounts will 
sometimes serve still more to increase the quantity of fat on the 
body. On the other hand, the pale, weak and enfeebled will bear 
much larger doses, and will often increase very rapidly in weight. 
The chlorate of potassium evidently changes and improves the 
quality of the blood, but as a remedy for this affection it has hith- 
erto received very little notice except at the hand of Dr. Harkin, 
of Belfast, in 1860-61. This gentleman, in on admirable paper on 
the chlorate of potassium in treatment of consumption and of scro- 
fula, published in the Dublin Quarterly Journal of November, 
1861, claims perfectly marvellous results by its use in both these 
affections. Dr. Harkin in this paper cites the cure of several well- marked eases of consumption, refers in a general way to its re- 
markable action in scrofula, and adds that in its use the blood ap- 
pears altered in character, its solid constituents, its fibrin and red 
corpuscles increase, muscular energy gradually returns, and even 
a disposition to plethora developed itself. 
I not only coroborate what Dr. Harkin has observed upon the ac- 
tion of this remedy, but I think my experience adds additional 
light in its use in scrofulous disease of the skin. I have as yet been 
unable to find any full statement of its use in these scrofulous affec- 
tions, except in the brief account just named. I have, therefore, 
after extensive experience in its use, come to the conclusion that it 
is the only internal treatment of much good in scrofuloderma, but 
it must be employed in conjunction with good food, the proper 
hygienic surroundings, together with a judicious combination of 
appropriate external means according to the exigencies of each 
particular case. 
This treatment is based upon the assumption that the disease is 
caused by an improper state and composition of the blood, which 
destroys the fitness for the nutrition of the tissues. I further be- 
lieve that the judicious use of the chlorate of potassium tones up 
the digestive system and so furnishes the blood with its proper 
and essential ingredient with which to repair the natural waste 
and decay of the tissues. The experience of Dr. W. Nicholson as 
to the action of alkalies as expressed in the Practitioner of Janu- 
ary, 1880, I think, fully coroborates the views I have advanced as 
to the effect on the system of the chlorate of potassium. 
Dr. Nicholson, in referring to the alkalies in anaemia, thinks that 
they ought to take the place of iron in the treatment of this affec- 
tion ; that they improve the tone of the digestive system, increas- 
ing the appetite, aiding the liver to work, promoting the flow of 
of bile, and clearing the blood and urine from lithates or other 
sediments and impurities, and there is little doubt that they, more 
than any other remedy, restore the digestive tract to a state of 
health, while iron, instead of giving tone, is apt to disorder the 
digestive tract. This gentleman uses the bicarbonate of potassium 
in that abnormal state of the blood present in anaemia, and I know 
that the chlorate of potassium will not only act in the same manner 
upon anaemia, but also in the various scrofulous affections. 
I desire, in concluding this paper, too add that, if judicious treat- 
ment be given to those suffering from scrofula before marriage, the 
extension of the hereditary taint in the issue can be arrested. 
Many medical men, on the other hand, believe that the extension of 
the disease can only be arrested by such persons refraining from marriage, and they advise their patients to that effect. Physicians 
giving such advice to tuberculous, sickly and scrofulous persons, 
will find that it will not deter them from marrying, even though 
they may have pointed out to them that the issue of such alliance 
will in all probability be scrofulous. 
I think it therefore becomes the imperative duty of the physician 
when consulted by scrofulous persons concerning their future wel- 
fare, to provide against the extension of the disease by doing all in 
his power to overcome the disordered function and establish a con- 
dition of healthy nutrition before marriage. This noxious state of 
the system of persons suffering from scrofula/ I again repeat, can 
be best removed by the use of chlorate of potassium internally, 
together with good food, suitable Irygienic surroundings, and ap- 
propriate external means. 
If the chlorate of potassium be employed, with the aids just 
named, upon persons afflicted with scrofula, it will be found that 
the remedy will fulfil all that I have claimed for it, and will place 
such individuals in such a healthy condition that in case of mar- 
riage the issue will be sound and healthy. 
The Use of Chlorate of Potassium, 
Physicians who have used the Chlorate of Potassium will do 
the Author of this reprint a very great favor 1)3- sending him an 
account, or a few notes, oftheir experience with it, either internally 
or externally in any disease. 
Address JOHN V. SII OEM A K HR, .UP., 
1031 Walnut Street, Philadelphia, Pa.