TREATMENT OE LEUKOMAIN-POISONING. 
BY 
B. K. RACHFORD, M.D., 
OF CINCINNATI, O.; 
PROFESSOR OF PHYSIOLOGY AND CLINICIAN TO CHILDREN’S CLINIC, 
MEDICAL COLLEGE OF OHIO. 
FROM 
THE MEDICAL NEWS, 
September 7, 1895. [Reprinted from The Medical News, September 7, 1895.] 
TREATMENT OF L E U K 0 M A IN - P 0 IS 0 NIN G. 
By B. K. RACHFORD, M. D., 
OF CINCINNATI, O.; 
PROFESSOR OF PHYSIOLOGY AND CLINICIAN TO CHILDREN’S CLINIC, 
MEDICAL COLLEGE OF OHIO. 
In previous papers1 I have shown that para- 
xanthin and other leukomains of the uric-acid group 
are etiologically related to true migraine and kin- 
dred diseases, such as migrainous epilepsy and mi- 
grainous gastric neurosis. For the etiology and 
symptomatology of these diseases the reader is re- 
ferred to these papers, as it is my purpose in this 
communication to speak only of the treatment of 
these conditions. 
The outline of treatment that I shall present is 
one in which I have learned to have much confi- 
dence and one that I am anxious to submit to the 
judgment of medical men everywhere, in order that 
I may the more quickly determine its value and its 
limitations. 
The medicinal treatment is the important and 
indispensable part of the treatment and consists of 
two prescriptions, which are used simultaneously: 
Take—Potassium permanganate . 20 grains. 
Make 20 pills and coat with salol.2 
One of these is to be taken three times a day one hour 
after meals. 
1 The Medical News, Phila., May 26 and October 3,1894, 
and Transactions of the Association of American Physicians, 
vol. x, 1895. 
2 Mr. Bange, a pharmacist, uses the following formula for coat- 2 
Take—Sodium salicylate . . 2 drams. 
Dry sodium phosphate . 4 “ 
Dry sodium sulphate . 10 “ —Mix. 
A teaspoonful, more or less, is to be taken in a glass 
of seltzer-water each morning. 
The foregoing prescriptions can be given con- 
tinuously for months at a time. In one case in 
which the treatment was eminently satisfactory I 
continued this treatment without a single day of 
interruption for four months. I am not sure that it 
is necessary to have the pills of potassium perman- 
ganate coated with salol, as I believe I have gotten 
the same good results with the uncoated pills. I 
have used the salol-coated pills on the theory that 
this coating would enable the potassium perman- 
ganate to pass through the stomach and be dissolved 
in the small intestine, and in this way act as an in- 
testinal antiseptic. But the special purpose for 
which it is given is to neutralize poisonous leuko- 
mains circulating in the blood. (See previous 
papers.) 
In the second prescription it is important to have 
pure salts of sodium. These salts will not be so 
unpalatable if taken in cold seltzer-water. The 
seltzer-water can be obtained in siphon and used as 
directed. It is not an important part of the treat- 
ment, and is used for the most part to make the 
“salts” more palatable. Water may therefore be 
substituted for the seltzer-water without, in any way, 
detracting from the efficacy of the treatment. In 
this prescription the quantities of the three sodium- 
ing the pills with salol: Salol, 4 parts ; shellac, 1 part; alcohol, 40 
parts. 3 
salts may be changed to suit individual cases, the 
formula as given being the one that I almost inva- 
riably use, and I have rather preferred to vary the 
dose to suit individual cases than to rewrite the pre- 
scription with the quantities of the ingredients 
changed. 
When there is considerable constipation it is 
necessary to give a heaping teaspoonful of the salts 
to produce the cathartic action which is necessary 
in the treatment of these cases. If a small dose of 
salts produces excessive catharsis, the dose may be 
diminished or the prescription rewritten with less 
of sodium sulphate and more of the phosphate. But 
I have often noted that the gouty diarrhea, which 
many of these patients have, is cured rather than 
exaggerated by these salts. The “ salts ” should be 
given every morning for a considerable period of 
time. 
The relief that follows the treatment outlined is 
immediate. It is a common experience for patients 
not to have a single so-called “nerve-storm ” after 
being put upon it. It will often accomplish remark- 
able results without the aid of any dietetic or hy- 
gienic treatment. 
The dietetic treatment is very important and should 
always be adopted as an aid to the medicinal treat- 
ment. The diet to be observed is as follows : Fresh 
meat once a day, with fish, eggs, milk, fruit, and 
vegetables. I ordinarily direct the patient as to 
what he should not have, telling him to avoid beer, 
wine, meat-soup, and meat, except one piece of 
fresh meat at dinner. Apart from this he may have 
anything he wishes within the limits of his digestive 4 
capacity. Not infrequently the medicinal treatment 
already outlined very much widens the range of the 
digestive capacity of the patient, so that he can eat 
freely of many fruits and vegetables which pre- 
viously he had learned to fear. 
The hygienic treatment is also important in 
many cases and consists simply of a warm alkaline 
bath each morning and plenty of exercise in the 
open air. I usually direct the patient to take a 
warm alkaline bath as soon as he arises in the morn- 
ing, and the bath should, when convenient, be 
followed by an alcohol rub. A handful of sodium 
bicarbonate and one of sodium chlorid thrown into 
an ordinary bath-tub of hot water will make the 
water sufficiently alkaline. The alkaline bath has 
not appeared to me to be necessary in the treatment 
of migrainous conditions, and it is not my routine 
to prescribe it under these conditions; but I have 
found it a very useful, if not a necessary, adjunct to 
the other treatment in' certain so-called gouty con- 
ditions of the muscles and joints. A discussion of 
the manner in which the alkaline bath produces 
good results is not within the scope of this paper. 
Exercise in the open air is always a valuable aid 
in the treatment, but it is by no means always prac- 
ticable, and it is, therefore, well to know that ex- 
cellent results may, as a rule, be obtained without 
it. Many cases are, in the beginning of the treat- 
ment, physically unable to take open-air exercise, 
and many of them are confined to hospitals and 
other institutions where this phase of the treatment 
cannot be very satisfactorily carried out. 
In the foregoing outline I have not attempted to 5 
write a complete chapter on the treatment of leuko- 
main-poisoning, but only to call attention to a line 
of treatment that I believe to have some specific 
influence in the treatment of this condition. This 
treatment can be combined or alternated with 
any other, as the individual case may demand. 
The conditions that I believe can be benefited or 
cured by this treatment are as follows : 
i. 7rue migraine,1 which I believe to be a form 
of leukomain-poisoning, can almost certainly be 
relieved by this treatment. In these cases the treat- 
ment should be kept up uninterruptedly for from 
four to six weeks, and then every other week for from 
four to six weeks longer, and after this for one week 
in every month for a few months, when diet and 
exercise may be depended upon to complete the 
cure. I have now under treatment ten cases of 
migraine, all of which have been completely re- 
lieved of their paroxysmal attacks, as the following 
illustrative cases will show: 
CaseI.—Mrs. G., aged thirty-five years, the mother 
of two children and the wife of a laboring-man, is 
a hard-working German woman, who has suffered 
from sick-headache ever since she can remember. 
During the past few years she has had an attack 
almost every week. These attacks would send her 
to bed, and keep her there from twelve to thirty-six 
hours. On her sick-headache days her husband 
would have to cook and do the housework. 
On May ioth this woman was placed under treat- 
ment, and this has been continued, as already 
described, to the present time (July 25th). This 
1 Loc. cit. 6 
case had only the medicinal treatment, no dietetic 
or hygienic treatment being attempted. Since this 
treatment was begun she has not lost a day from 
work, has not had a paroxysm of sick-headache, and 
has never been so well since she can remember. 
Case II.—Mrs. E., a German woman, thirty- 
three years of age, is a meat-eater and beer- 
drinker. Her mother and one of her sisters have 
migraine, and she is and has been for many 
years a great sufferer from the same disorder, hav- 
ing an attack about every two weeks.1 She was 
placed under treatment on April 20th, and the 
treatment has been continued till the present time 
(July 25th) without a single paroxysm of sick-head- 
ache, and during this period she has been for the 
first time in many years perfectly well. 
Case III.—Mrs. M., aged thirty-five years, has 
had an attack of migraine about every two weeks 
for many years. During the past few years these 
attacks have been so severe that life had become 
scarcely worth the living. The attacks always come 
on at the menstrual period, and as a rule once in the 
intermenstrual period.2 She has been under treat- 
ment from April 4th to July 25th, and during this 
time she has been free from headache and quite well. 
2. Migrainous epilepsy, which I have dem- 
onstrated to be a form of leukomain-poisoning, 
can always be benefited and often cured by the 
treatment already detailed. This disorder, which I 
have fully described in my previous papers,8 is a 
1 For a full history of this case, see The Medical News, 
November 3, 1894, under the heading “ Specimen No. 7.” 
2 For a full history of the etiology and symptomatology of 
these attacks, see Transactions of the Association of American 
Physicians, vol. x, 1895. 
3 Loc. cit. 7 
form of epilepsy that occurs as a sequel to migrain- 
ous headaches of former years, or the epileptoid 
attacks may at times take the place of or alternate 
with the migrainous headaches. It is my belief 
that many of the cases of so-called hystero-epilepsy 
belong to this class, and can therefore be either 
benefited or cured by the treatment. In migrain- 
ous epilepsy the treatment should be continued 
somewhat longer than in true migraine, and the 
potassium-permanganate prescription is, I believe, 
of prime importance in the treatment of these cases. 
My experience with this type of cases, however, 
has not been sufficient for me to judge of the vena{ 
or limitations of the treatment. I have a number of 
such patients under my care at the present time 
with every promise of success from the treatment, 
but they have been under observation for too short a 
time to justify any conclusions as to permanent 
benefit to be derived from the treatment. The fol- 
lowing case will illustrate: 
Case IV.—Miss F., thirty years of age, has 
a neurotic family history. She is a fairly well- 
nourished girl, with no evidence of mental impair- 
ment. She has had sick-headache since she was a 
child, and during the past six or seven years she has 
occasionally had epileptoid attacks instead of the 
migrainous headaches. These epileptoid attacks 
have been growing more frequent of late, so that at 
the present time she never fails to have one at her 
menstrual period, and not uncommonly one in the 
intermenstrual interval. The migrainous headaches 
have also continued, and rarely does the woman 
pass a week without remaining in bed one day on 
account of an attack. Formerly the attacks of sick- 8 
headache always came at the menstrual as well as 
during the intermenstrual periods, but now the 
menstrual epilepsy replaces the menstrual headache. 
The attacks of epilepsy are usually followed by some 
headache, but not by the nausea and vomiting that 
accompany the attacks of true migraine. The urine 
of this patient passed during and immediately after 
an attack of migrainous epilepsy and migrainous 
headache contained paraxanthin and xanthin in 
great excess. 
The treatment was the same as has been outlined, 
and commenced on May 23d. The woman has 
passed two menstrual periods without a symptom of 
epilepsy, and with the exception of one slight 
attack of headache she has been quite well to the 
present time. 
3. Leukomain gastric neurosis is a well-known 
form of migrainous disease that I have described in 
a previous paper, in which I gave the evidence upon 
which I based the conclusion that this was one of 
the manifestations of leukomain-poisoning.1 
Case V.—Mrs. P., aged thirty-four years, is the 
mother of three children. She had “ always been a 
sufferer from sick-headache ” up to November, 
1894. At that time frightful gastric attacks took 
the place of the migrainous headaches. These gas- 
tric attacks were very sudden in their onset, and 
were attended with great pain and with vomiting 
of mucus. They continued with increasing fury till 
relieved by hypodermic injections of morphin. 
1 For a full description of the etiology, symptomatology, and 
course of this phase of leukomain-poisoning, the reader is referred 
to my article in the Transactions of the Association of American 
Physicians, vol. x, 1895, where the case of “ Mrs. P.’’ is given 
with careful detail. 9 
They recurred about every two weeks till, during 
March and April, they were so frequent and so 
severe that the patient was in bed more than half 
the time. 
On April 15th this patient was placed on the 
treatment that has been outlined in this paper, and 
it has been continued up to the present time (three- 
and-a-half months). During this period the patient 
has not had the slightest symptom of leukomain- 
poisoning. 
The result in this case was truly remarkable, and 
never have I seen the treatment of any disease fol- 
lowed by more specific results. For this reason I 
wish especially to ask for a trial of this treatment in 
cases of leukomain gastric neurosis. 
4. Hypochondriasis and neurasthenia in patients 
having a gouty inheritance are often entirely re- 
lieved by the treatment already given. 
Case VI.—Mr. R., a middle-aged man, who had 
always been a good liver, came to my office last 
May to get relief from more or less constant pain 
in the abdomen. He was mentally depressed and 
so despondent about his condition that he could 
not be convinced but that he had some incurable 
abdominal disease. He was moody, irritable, and 
peevish, and did not think that medicines would do 
him any good. Knowing that there was a strong 
gouty tendency in this man’s family I prescribed 
the treatment outlined, and he so promptly recovered 
that in three weeks he was entirely well. 
5. Constant headache, sciatica, and intercostal and 
other neuralgias when occurring in the gouty can 
very commonly be relieved by the treatment de- 
scribed. 10 
Case VII.—Mr. S., aged fifty years, has been a 
great sufferer from myalgia and neuralgia for years. 
About five years ago he had an attack of acute gout, 
and since then he has had several very severe and 
prolonged attacks of “muscular rheumatism.” 
When he sent for me he had been suffering from an 
attack of sciatica and intercostal neuralgia for about 
two months, which had persisted in spite of good 
medical attention. This man entirely recovered 
after one month of treatment. The dietetic and 
hygienic treatment was as carefully looked after in 
this case as the medicinal. 
Case VIII.'—Mrs. Y., aged thirty-seven years, 
has for years suffered from severe headache accom- 
panied by nausea and sometimes vomiting. During 
the past nine years these attacks have occurred 
every two or three weeks, and have very often been 
so severe that the phenacetin and codein that she is 
accustomed to take gave her little relief. 
On June 15 th she was suffering from a headache 
that had continued almost uninterruptedly for three 
weeks ; she had no nausea and no vomiting in this 
attack. Codein and phenacetin, of which she had 
taken a great deal, gave her only temporary relief. 
At this time Dr. Jones mentioned the case to me, 
and I advised the medicinal treatment described in 
this paper. This was done, and two days later the 
headache had ceased and the patient’s general con- 
dition was very much better. The treatment was 
continued for a short while, and up to the present 
time (July 29th) the woman has remained quite 
well. 
In this communication I have not attempted to 
give a clinical picture of every phase of leukomain- 
1 I am indebted to Dr. Robert J. Jones, Interne at the Cincin- 
nati Hospital, for the notes of this case. 11 
poisoning in which the treatment here detailed may 
prove beneficial, but have only sought to indicate 
the class of morbid conditions in which benefit 
may be expected from it. 
Of the value of this treatment in articular gout I am 
not prepared to speak, although I have unpublished 
evidence that the leukomain plays a part in this dis- 
ease. It is also my belief, founded upon the evi- 
dence given in previous papers, that many so-called 
uremic manifestations, including eclampsia, are in 
great part due to paraxanthin-poisoning, and for 
this reason I think that potassium permanganate 
given hypodermically might be of value in the 
treatment of puerperal and other eclampsias of 
uremic origin. I shall be under obligations for 
clinical reports on this treatment. 
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