PERMANGANATE OF POTASSIUM 
IN THE TREATMENT OF LEG 
AND OTHER ULCERS. 
By G. MAXWELL CHRISTINE, M.D. 
Philadelphia, Pa. 
Read before the Homoeopathic Medical Society 
Germantown. 
Reprinted from the North American 
Journal of Homceopathy. 
March, 1897. Reprint from The North American Journal of Homccopathy, March, 1896. 
PERMANGANATE OF POTASSIUM IN THE TREATMENT 
OF LEG AND OTHER ULCERS* 
By G. MAXWELL CHRISTINE, M. D. 
THE treatment of ulcers of the leg, and particularly of all 
septic ulcers of pronounced sluggish type, is frequently so 
unsatisfactory, that it will probably not be amiss for me to 
present a contribution on the subject. 
A few years ago a man presented himself at the Harper Hospital 
Dispensary of this city with varicose leg ulcers of such septic char- 
acter, that the air of the room soon became so befouled I sought for 
a deodorant to apply to the gangrenous sloughs. Among the 
standard preparations of the dispensary was one of a saturated 
solution of permanganate of potassium, from which iirigating solu- 
tions were made. Not waiting to dilute the preparation I poured 
some of it on the ulcers, with the result that the odor was quickly 
subdued. This done, I placed over the ulcers a compress and 
bandage and sent the patient home to return the following day. On 
his return, there was a decided change for the better in the char- 
acter of the ulcers. After clearing away the sloughs with scissors 
and a Volkman spoon, I became impressed with the belief that an- 
other application of the permanganate solution would prove benefi- 
cial. This time I not only poured it on, but rubbed it in with 
pledgets of cotton held in dressing forceps, over which I dusted a 
powder of iodoform one part and boracic acid nine parts. Over this 
was put a layer of gauze, a pad oi oakum and tight bandage. The 
man got well so speedily under this treatment applied at short in- 
tervals, that I was led to believe that the permanganate was the 
special factor in the improvement. After this, every sluggish leg 
ulcer was put under this routine treatment with uniformly brilliant 
results. 
From thus treating varicose leg ulcers, I passed to the treatment 
by the same methods, of ulcers other than of the varicose variety, 
and situated in other localties than the leg. The permanganate 
proved to be of great service, and was soon found to occupy a field 
of usefulness apparently all its own. 
I have instituted the use of the permanganate in the Surgical 
Dispensary of St. Luke's Hospital of this city, and have been able 
Philadelphia, Pa. 
* Read before the Homoeopathic Medical Society of Germantown. 2 
Papers in Medicine. 
to study its action and to determine fairly well the indications for 
its use, and to note its limitations. 
The employment of potassium permanganate in the treatment 
of ulcers and septic wounds is no new thing, every surgeon being 
familiar with it as an excellent antiseptic wash and irrigant. It is 
even probable that it has been and is being used in strong solu- 
tion in the manner recommended in this paper; but the books on 
surgery give it no notice except in practically weak dilution as a 
wash. 
As a powder over fresh wounds, I presume nothing has yet re- 
placed iodoform-, and its efficacy even in septic wounds or on septic 
surfaces, is much believed in. But there are many objections to 
the use of iodoform, two being uppermost-its odor and its powers 
of intoxication-which faults so far limit its sphere of action as to 
cause its use to be abandoned by many surgeons. Furthermore, 
iodoform is not a germicide and is not stimulating-two important 
qualities that it is necessary any substance of great use in the treat- 
ment of sluggish septic ulcers shall be possessed of. 
Iodoform "sterilizes the soil in which bacteria might develop, and 
neutralizes or destroys bacterial products." It is this power which 
gives to iodoform its value. Aristol and other antiseptic powders 
have been pitted against iodofoi m as having equal or superior quali- 
ties, but it is doubtful if any one of them has succeeded in excelling 
iodoform, except in not possessing intoxicating or poisonous proper- 
ties, and in not affecting persons possessed of an idiosyncrasy. 
But while iodoform is designed to sterilize the soil of a wound 
not already pyogenic, and to destroy pyogenic products in a wound 
already septic, in the treatment of septic ulcers and wounds these 
two qualities are insufficient. The soil is not to be made sterile 
until tlie bacteria have been destroyed, and iodoform has feeble if any 
powers in this direction. Its power is protective-not destructive. 
Hence, we must seek for another agent;-one that possesses germi- 
cidal powers in conjunction with other properties essential to the 
purpose of a local septic-ulcer medicament. Among the long list of 
such substances, I select permanganate of potasshem as the most 
valuable because of its germicidal and stimulating properties in 
addition to its possession of sterilizing powers, of ability equally 
with iodoform to destroy bacterial products, and of freedom from 
an intoxicating tendency. 
In the effort to obtain a germicidal substance that is non-poison- 
ous and non-irritating, surgeonshave done considerable experiment- 
ing. Hydrogen peroxide lately occupied a prominent place in this Permanganate of Potassium : Christine. 
3 
respect, and is very much used. But it is probable that while hy- 
drogenperoxide is of value, its usefulness is restricted. 
Its work is too superficial and frequently fails most woefully in 
its intended mission. The effervescence which it produces is, in 
my estimation, apt to be harmful in that it pushes the bacteria and 
their products further into the tissues, thus augmenting the circle of 
their activity. This is a theory, but it seems plausible. I would 
not discard hydrogen peroxide, but I think I comprehend its limita- 
tions, and I employ it according to my understanding of its action. 
Dry antiseptic powders placed on an ulcer, tend to crust it over, 
and the pyogenic discharges will frequently be found beneath the 
crust or scab, often tending to penetrate deeper and spread wider. 
Hence, ulcers so treated, frequently assume an aggravated form, 
need very careful watching, and are slow to heal. 
In typical leg ulcers, I do not believe there are any dusting 
powders that are so useful as to warrant universal confidence. 
Even if valuable, they all lack in one or more essentials, and the 
cure, under their use, is slow and tantalizing. 
'I have given permanganate of potassium, in strong solution an 
extended trial not only for the purpose of fixing its value but of de- 
termining its limitations, and I am now prepared to assert as to its 
efficacy and to state, in general terms at least, its indications. 
The efficacy of permanganate of potassium resides, as already 
mentioned, in the two great essentials of germicidal and stimulating 
properties. Warren has well stated that an ulcer, which he very 
properly classes as "one of the infective inflammations,'' is a solu- 
tion in "continuity of the skin or the mucous membrane which shows 
no tendency to heal. An ulcer has been defined as molecular death 
to the part it owes its existence-in fact, to an excess in action of 
the retrograde changes over those of repair.'' He further states 
that ' ' the process is closely allied to that known as necrosis or 
gangrene. '' 
These definitions furnish the groundwork for treatment, and 
any departure from the indications they point out, must result in a 
lessened value to the treatment instituted. 
In the first place, the treatment of an infective inflammation de- 
mands a destruction of the infective agent. Permanganate of potas- 
sium in strong solution, does this, probably by its oxidizing proper- 
ties, without in any manner robbing the normal neighboring tissue 
of any of its vitality. Hydrogen peroxide has been accused of dis- 
turbing the vitality of contiguous tissues, and I have more than a 
few times witnessed evidences of this. The permanganate, properly 4 
Papers in Medicine. 
used, has none of this tendency, and confines its destructive or in- 
hibiting influence to the causative pathological processes of the part. 
This being assumed to be true, the permanganate is not only an 
effective but also a safe agent. 
In the second place, the ulceration being a retrograde movement 
of the molecular processes in the part, in order to obtain a cure, life 
must be imparted to the tissues, and the retrograde processes be 
made to change to those of progression or repair. Therefore, we 
need not only a germicide to kill the bacteria and remove the infec- 
tion, but also a stimulant which shall check the retrogression and 
impart vitality to the forces of repair. In a strong solution of 
permanganate of potassium, we have this stimulating property to an 
extent not harmlessly possessed by any other medicament. 
In the third place, the treatment of ulcers needs the property of 
inhibiting the tendency to a further bacterial action. The perman- 
ganate provides this, though possibly not so fully as do some other 
agents, but sufficiently so to be, in my opinion, worthy of con- 
fidence. 
The deodorizing property ofpermanganate of potassitem is * im- 
portant, and in the treatment of many forms of ulcers, is an- 
other factor in its favor. Large varicose leg ulcers accompanied 
with the usual septic and cedematous features, are the best types 
of ulcers for the exemplification of the powers of treatmentby/er- 
manganate of potassium. 
I will assume for clinical purposes that such a case is before me, 
and will proceed to outline its treatment according to the perman- 
ganate method. 
The patient, a woman, comes with both varicosed legs ulcerated 
at the usual site, the ankles. They have been troubling the patient 
for three or four years, and several forms of treatment have been 
tried, sometimes with relief, but more often with aggravation. The 
legs and feet are cedematous, and surrounding the ulcers are large 
patches of dermatitis, the result of excoriating inflammatory dis- 
charges. The veins are greatly varicosed, the ulcers being the result 
of the varicosity. The ulcers are gangrenous, and the air of the room 
is soon loaded with the foul odor. The ulcers are large, two on one 
ankle and three on the other. The bases of the ulcers are greenish 
black. The legs are sore, and walking or standing is almost impos- 
sible, owing to the venous and cedematous swelling. Life has become 
burdensome to the patient, and she has applied to us for relief, 
despairing, however, that she will find it. Permanganate of Potassium : Christine. 
5 
At the outset of the treatment ulcers of this or any other 
type, a green soap and water cleaning should be given, and we 
do this as thoroughly as possible, after which we dry the parts with 
a towel. The odor of the ulcers is so foul that we quickly get rid of 
as much of the loose necrosed tissue with scissors and forceps or 
with a Volkman spoon, as the patient permits, securing anaesthesia 
if necessary with ethyl chloride spray. This cureting, if done com- 
pletely, need never be repeated. 
Irrigation will not again be used until the ulcers are well, water 
being to leg ulcers what it is to eczema, an irritant. Sometimes, 
however, a cleansing with bichloride solution is necessary. 
Now having gotten rid of the necrosed tissue I employ a saturated 
solution of the permanganate of potassium. Pouring some in a small 
glass I saturate in it a ball of absorbent cotton held in forceps, 
which I now apply to the ulcers, leaving no part untouched, includ- 
ing the edges in the application, but avoiding the eczematous skin. 
I repeat this until the ulcers are black and take up no more of the 
solution, and I now rub the cotton into the ulcers, to be sure that 
the application is thorough. 
This application is painful, but if done deftly, holding the leg 
firmly and promising the patient that it will pain for only one or 
two minutes, few patients will complain. I now place over the 
ulcers sterile gauze compresses, encircling the limb and including 
all of the eczematous skin. The compresses should be four or six 
thicknesses, and applied evenly. I do not advise any powder over 
the ulcers, but if the eczema is scaly, diachylon ointment may be 
thinly spread on the gauze, and placed over the affected area. This 
will moisten the skin and facilitate repair. Ordinarily, the eczema 
improves under the simple application of a plain dressing. 
I have now treated the ulcers and partly dressed them/ 4-**- 
now proceed to a very important part of the treatment, namely, the 
bandages. I have special views respecting the bandaging of leg 
ulcers. I never use reverses, believing they tend to create ridges in 
the skin, and to impede owHaoc, venous and lymphatic circulation. 
I use two bandages, one about four inches and the other about six 
inches wide. 
With the patient seated on the top of a table, I extend the leg 
and begin with the four-inch bandage to fasten the gauze dressing 
in place by three circular turns. The tension I employ, through con- 
siderable, is not enough to constrict the ankle too tightly, but suffi- 
cient to give uniform pressure over the ulcers. The bandage is 
now swept down over the instep to the base of the toes, made to en- 6 
Papers in Medicine. 
circle the foot, passing up over the instep, back to the foot above 
the heel, now around over the instep, now back over the heel, then 
over the instep again, making one or two tight turns, and then 
covering the whole of the calf up to the knee-joint by figure of 
eight turns, not once using reverses. The whole of the leg below 
the knee has now been snugly covered to the toes by the bandage, 
and if the bandage is rightly applied no part is unduly constricted, 
every portion is covered, and the leg is encased in a bandage giving 
considerable but even and comfortable pressure. I now use the 
second or broad bandage, making the first turns around the calf, 
sweeping down around the ankle, then covering all of the first 
bandage from the ankle up to the knee, by figure of eight turns, 
without reverses. This bandage I use principally to keep the first 
in place. It also aids in securing even pressure. 
The end of the bandage is fixed by a safety pin, and I now treat 
the other leg as I treated the first. The patient is told to put on 
her shoes and go about her work, to return in two days. When 
she comes back the day after to-morrow, the leg will be found bet- 
ter and the ulcers will again be treated by the permanganate oj 
potassium solution, and the necessary dressings applied. The treat- 
ment should be every two days. Soon the edges of the ulcers will 
shrink, the oedema of the feet and legs will begin to subside, the 
dermatitis will improve, and the ulcers will fill up with granulation 
tissue. The permanganate can now be stopped, and the sub-iod/ide 
of bismuth powdered freely over the ulcers over which a dry gauze 
dressing can be applied with the usual bandage. The permanganate, 
however, is to be continued until all required stimulation is secured. 
This woman has suffered intensely for several months, because 
her ulcers haUMiot been given proper treatment or did not have 
proper care on her part, but I will assure her that if she will follow 
my directions, I will cure her legs of the ulcers, and will make life 
once more worth the living. 
I have gone over this case as I would in a clinic, in order the 
better to illustrate the treatment. The method is very simple and 
clean, and is not obnoxious in any sense. 
Internal medication, when indicated, must not be forgotten; and 
the hygiene of the patient must be given due attention. 
The bandaging is, of course, an important part in the treatment; 
but the prime factors are the germicidal and stimulating effects of 
the permanganate. This I have proven, I believe, satisfactorily to 
myself by substitution of other substances for the permanganateand 
noting the results, which have always been in favor of the latter. Permanganate of Potassium : Christine. 
7 
From the treatment of leg ulcers by the permanganate, I have 
naturally passed to the treatment of other infective and sluggish 
ulcers or non-granulating wounds; and I have met with the same 
satisfactory results as above noted. It borders on the marvellous 
to see how, in old sluggish ulcers that seem to defy treatment, a 
saturated solution of permanganate of potassium, will, when applied 
freely and proper dressings used, cause granulating tissue to spring 
up and soon fill in the cavities. I know of nothing that in this re- 
spect is its equal. The limitations of the treatment are to be noted 
where granulations assume a superabundancy and need trimming 
down, as it were ; the sub-iodide of bismuth and balsam of peru treat- 
ment, is now appropriate,-the powder being dusted on the ulcer or 
wound, and a gauze compress, saturated with balsam of peru in cas- 
tor oil (i to io), with a protective of paraffine paper over it, and 
bandaged to the part. This dressing is repeated about every two 
days until cure takes place. 
I have lately cured syphilitic ulcers which defied every other 
method, by the permanganate solution, sub-iodide of bismuth and 
balsam treatment, of course, conjoined with the proper internal 
medication. 
However partial I may be to the value of this drug in ulcerated 
tissues, I am not so infatuated with it as not to be willing to notice 
its defects, if it has any. I have watched carefully for defects, and 
thus far have failed to find any. Its limitations are, as I have stated, 
defined by the no longer need for stimulation. If persisted in after 
this point has been reached, harm may ensue by the over production 
of granulating tissue; but intelligent comprehension of the indica- 
tions will avert this issue. 
Discussion. 
Dr. W. G. Steele said that the paper interested him very much, 
as he had experienced many of the difficulties referred to by the 
author in the treatment of ulcers. He had tried all the various 
methods generally employed, and often found that what would cure 
in one instance would fail in another. He had found a ten per cent, 
solution of phosphoric acid of considerable service. A solution of 
tartaric add locally applied, had likewise been of value. A solution 
of bromine, 1-200, had been frequently used by him and others with 
good result. Bovinine had its champions, and much of value could 
be said of it. Electrozone was a deodorizer of marked efficiency, and 
seemed to have the power to encourage healing. Finely powdered 
acetanilid dusted over the ulcer has given him good results; and so 
has a powder of boradc add and acetanilid. Dr. Steele believed that 
in permanganate of potassium he would have another friend, and he 8 
Papers in Medicine. 
would be pleased to give it a trial according to the directions laid 
down by Dr. Christine. 
Dr. J. Landreth Thompson was very much interested in the 
reading of the paper. Glycerine had been employed by him as the 
permanganate had been used by Dr. Christine with about the same 
result. Like the permanganate, glycerine appeared to carry the 
granulating process to a certain point beyond which it did no good 
and often harm. The balsam of peril va four per cent, mixture in 
castor oil, was a valuable adjuvant. He applied it on four or five 
thicknesses of gauze, and found, when it was removed in a day or 
so, that the ulcer had quite a clean look, the balsam favoring the 
absorption of the discharges, thus preventing tbeir irritation of the 
ulcer. Aristol valuable as a dusting powder, particularly after 
other applications had gotten the ulcer fairly well filled up, and 
needed only a skinning over. Diachylon ointment thinly spread over 
the ulcer and neighboring tissue, kept the tissues clean and soft, 
thus favoring circulation. Formalin-gelatine, a substance lately 
brought to his attention, was giving him good results in favoring the 
filling up of sluggish ulcers. Dr. Thompson did not agree with the 
author of the paper in his teaching not to use reverses on leg 
bandages. He used them and did not believe bandages could be 
successfully retained on legs without reverses. Reverses favored 
even compression, and made the bandage firm. He sometimes used 
starch bandages, which he employed mostly when the discharges 
had fairly well stopped, so that they could be retained for several 
days. 
Dr. Willard Reading referred to simply cerate combined with a 
small amount of carbolic acid as having done him good service in the 
treatment of leg and other sluggish ulcers. He had used the per- 
manganate in the form of powder or crystal. Powdered phenacetine 
has been used by him in the manner acetanilid had been used by 
others. 
Dr. Charles Mohr deprecated the employment of local agenc- 
ies without seeking to cure by the administration of the indicated 
homoeopathic remedy. It was a failing that surgeons had in not relying 
more on internal medication and less on local treatment. He had 
treated very many ulcers of the type referred to to-night with excel- 
lent results, using the precaution, of course, to keep the parts clean 
by the use of proper antiseptics, and supporting the parts when pos- 
sible by a bandage. Acute ulcers got well without local treatment, 
and so will many chronic ulcers if they are kept clean and internal 
treatment alone relied on. Pulsatilla was a standard remedy with 
Dr. Mohr for old leg ulcers, and he had witnessed marvellous results 
following its employment. 
Dr. Shoemaker employs carbo veg. as a dusting powder, and 
could certify to its efficiency when so used. 
Dr. J. R. Mansfield placed great confidence in aristol, nuclein 
and protonuclein as dusting powders. 
Dr. J. R. Closson suggested the employment ofpapoid. Permanganate of Potaseium : Christine. 
9 
Dr. Malin, the President of the Society, commended the results 
obtained by Dr. Christine in his use of the permanganate. 
Dr. Theodore Gramm was very much interested in the perman- 
ganate. It had been a favorite study with him for many years. It 
had gained considerable repute under the teaching of Howard Kelly 
in preparing the hands for operation. Permanganate of potassium 
very freely gave up its oxygen in contact with decomposing tissue, 
and this was the secret of its value. Oxalic add was used not alone 
for its cleansing the hands from the stain of the permanganate, but 
because it also gave up its oxygen and assisted thepermanganate va 
altering putrefactive and other pathogenic changes. The dark color 
imparted to the skin by the frequent use of the permanganate was 
an evidence that its action had gone on as far as it could, and to this 
point it should always be pushed and then stopped. 
Dr. Christine, in closing, opposed the employment of most 
powders, particularly aristol, because they, and aristol in particular, 
caused a caking over of the ulcer and the confinement of pus under- 
neath, which if not speedily liberated would penetrate into adjoin- 
ing tissue and enlarge the ulcer. He maintained the statement he 
made that reverses should not be used on leg bandages for ulcer, be- 
cause, try as one might, they creased the skin and prevented proper 
venous and lymph return. It had even been recommended to use a 
single piece of bandage material cut to fit the leg and foot, and held 
in place, after snug application, bv tapes. The theory of this is good, 
but the successful application is very doubtful. The principle 
to use as broad a bandage as possible and of firm material, 
to take in the whole leg and foot from the knee to the base 
of the toes, and without reverses, seemed to Dr. Christine to 
be an improvement on other plans. Dr. Christine had found 
the permanganate to have certain limitations, but they were easily 
explained. The power to stimulate possessed by the permanganate 
was transferred to that of irritation if the stimulation was carried 
beyond the point of necessity. Superabundant granulations were, 
therefore, to be carefully watched for and inhibited, by either stopping 
the permanganate or the employment of some other agent. He 
instanced several cases in which futile effort had been made to en- 
courage granulation by other methods, the permanganate finally do- 
ing the work required. One was a case ofexposed skull from which 
the periosteum had been denuded. The permanganate caused 
granulations to spring up around the wound and there was a provi- 
sionial periosteum with a rapid filling up of the wound space. In this 
case it had seemed hopeless to get nature to do the repair, and a 
plastic operation was about to be done, when the permanganate did 
the work. In another case, the permanganate caused granulations 
to spring up in an old operative wound for tubercular femur disease, 
that resisted every other effort; but the granulations were white and 
tended to degenerate. Subsequently the bone was found diseased, 
and the wound naturally refused to heal. But it was interesting to 
note the prompt response on the part of the wound to throw out 
granulations after the application of permanganate. Though in this 10 
Papers in Medicine. 
case, the granulations were useless, it gave the speaker's faith in the 
efficacy of the drug much encouragement. 
Dr. Christine urged a fair trial of the permanganate in all septic 
wounds that show a proneness to sluggishness. Attention to details, 
however, are just as essential in this treatment as in any other 
surgical work. He believed the permanganate to be the best of all 
germicides for application to septic ulcers and wounds, and that the 
stimulating properties it possesses give it a value surgeons should 
avail themselves of more than they do- 
lt is-to be remembered that in sensitive or urethristic ulcers, there 
w already stimulation enough, and the application of permanganate 
iould add to the irritation. Distinction must, therefore, be made 
setween a sluggish ulcer and one of the urethristic type, for if the 
permanganate is used in the latter, it will disappoint the user. 
In all accidental wounds, particularly of the lacerated character, 
the application of the permanganate after the usual washing, adds a 
cleansing and stimulating element that has done him frequent good 
service. It is especially useful when these wounds show evidences 
of sloughing. 
Dr. Christine stated that there was much more to be said about 
permanganate of potassium in ulcer and wound treatment, but the 
intended length of his remarkshad already been exceeded.