H 



NA TURE 



[November 24, 1892 



and excretion of the poison from the body. Here as in 

 the specific infective diseases generally our want is an 

 antiseptic that will help to kill bacteria, directly or in- 

 directly, and that will not damage, but will even give 

 healthy stimulation to the tissue cells. 



In this new method of treatment it appears to be 

 •claimed that in certain periodate salts we have substances 

 which act not only on the bacillus (as bactericides) in 

 the alimentary canal, but also directly on the " toxines," 

 bringing about their oxidation into less complex and 

 more stable non-poisonous substances, which can be 

 readily excreted by the kidneys, or may be got rid of 

 directly from the intestineal tract. It is also claimed, 

 but apparently with very little reason, that the periodate 

 salts have some direct action on the nerves ; this, however, 

 is mere conjecture, and the arguments offered in support 

 of this hypothesis are far from convincing. In the Times 

 article it is stated that "there are two principal drugs 

 employed — the crystals of periodate " (of what .'') " which 

 are powdered, and a periodate of iron. The last-named is 

 used in such cases as demand an extra strong nerve or 

 cardiac stimulant treatment, and where there are severe 

 neuralgic symptoms. The first is used in several ways : 

 first as a powder to disinfect the alimentary tract ; second 

 as a plain water solution, prepared by boiling copiously, 

 and used as a beverage by patients to wash out the 

 stomach in severe vomiting, which abates as soon as the 

 walls of the stomach begin to absorb the fluid, whereby 

 the nervous energy is stimulated, in from two minutes to 

 an hour or two ; for transfusion under the skin, and, in 

 cases of collapse, into a vein, for restoration of the sus- 

 pended circulation of the blood ; third, an acid solution 

 of the powdered crystals of much greater strength than 

 the plain watery preparation is found to stimulate the 

 liver and kidney and gall bladder, promoting a free secre- 

 tion of bile." 



It is supposed that by this treatment the body is flushed 

 and sweetened as it were, and so far the treatment would 

 be rational enough could it be thoroughly carried out. 

 Far greater reliance might have been placed on the evi- 

 dence put forward had the initiator of this treatment been 

 content to place on record facts, instead of attempting to 

 formulate a theory for everything, as his theories whilst 

 giving evidence of his undoubted enthusiasm, indicate 

 only too plainly that where he gets beyond the use of the 

 test tube he is compelled to draw largely on his imagina- 

 tion for many of his facts and most of his explanations. 



As regards thepercentage of recoveries mentioned, it 

 must be remembered that towards the end of an epidemic 

 the fatal cases always form a much smaller proportion 

 -of the total cases than during the earlier stages of the 

 outbreak. The people most susceptible to the attack of the 

 disease, i.e. those with damaged hearts, kidneys, and 

 lungs, have already succumbed, the weaklings have been 

 cleared out of the way, and but the fittest and comparat- 

 ively well-nourished remain. Attempts have been made 

 to ameliorate the wretched surroundings of those most 

 prone to take the disease ; the poor are better fed and 

 better able to withstand the ravages of the cholera or- 

 ganism ; the " cholera fright," at first a most potent factor 

 in the preparation of patients for cholera, has to some 

 ■ extent subsided ; the cases are not only much less numer- 

 ous, but they are of a milder type and a less fatal char- 

 acter. Then, too, after the first few batches of patients 

 come in (amongst which the mortality is always extremely 

 high) there ensues a kind of panic amongst the authori- 

 ties, and the treatment consists of little more than placing 

 the patient in a ward along with others suffering from the 

 same disease, in order to get them away from their healthy 

 companions ; other treatment is for long of the most 

 meagie description, and it is only when hygienic con- 

 ditions have been improved, mode of transport organ- 

 ized, and hospital accommodation arranged that the 



NO. 1204, VOL. 47] 



medical authorities have time to devote to the treatment 

 of individual patients. As soon as patients do obtain 

 such individual treatment and attention the percentage 

 of fatal cases rapidly declines 



These periodates, analogous salts to the chlorates, are 

 apparently the direct heirs to the qualities that at one 

 time were ascribed to the chlorates, for which it was 

 claimed that they had great power of supplying oxygen 

 for the transformation of poisonous products in the body. 

 It was found, however, that these chlorates when admin- 

 istered in large doses made their appearance in the se- 

 cretions in a very slightly altered condition ; not only so, 

 but they exerted an exceedingly deleterious effect on the 

 blood, reducing the haemoglobin to methaemoglobin, and 

 stopping the respiration and bringing about a fall of the 

 blood pressure to zero. This periodate, which is ap- 

 parently extremely insoluble except in acids, may be 

 tolerated in small doses, but its physiological action, 

 especially when administered in large doses, can scarcely 

 yet have been studied. 



As to the action on the kidneys through the nervous 

 system, we have as yet little or no evidence that there is 

 any direct action of the nerves on the secretion by the 

 kidneys except through the vaso-motor system. It is 

 usually maintained that the suppression of urine in 

 cholera is due primarily to the extremely low general 

 blood-pressure owing to the rapid abstraction of the fluid 

 elements of the blood brought about by the passage of 

 watery stools, but also in part to the irritative action on the 

 secreting cells of the kidney of the cholera toxines, as a 

 result of which secretion is more or less paralyzed. In 

 order to overcome this stoppage of excretion by the kid- 

 neys, the practice of injecting warm normal saline solution 

 has in recent epidemics been practised with some suc- 

 cess, especially when boldly and repeatedly carried 

 out. This treatment has the additional advantage that it 

 not only supplies fluid to the parched tissues, but also 

 increases the volume of blood on which the heart may 

 contract and helps to wash away the specific poison. It 

 is utilized to a very great extent in the new method 

 described in the Times, but whether the periodates are 

 better than common salt as a substance with which to 

 raise the specific gravity of the warm water, yet remains 

 to be determined. As yet the details supplied are far too 

 meagre to allow of any definite o linion as to the value of 

 this periodate treatment being arrived at. 



It is fortunate that we have no cholera epidemic with 

 us at present, otherwise we should have a right to com- 

 j plain that the Times has been made the medium through 

 which what must be a very imperfect — ^and certainly from 

 a physiological point of view — incorrect theory, has been 

 presented to the public, and it will be well to await the 

 exact accounts of those who have been entrusted with 

 the carrying out of the treatment in the wards of the 

 Seamen's Hospital, and the results of fuller chemical 

 physiological, and therapeutic experiments, minutely 

 detailed and recorded, before we allow ourselves to be 

 buoyed up by hopes which, previous experience has 

 taught us to fear, may be very summarily and completely 

 dashed. We hope that we may have no opportunity of 

 testing the value of this new treatment in England, but 

 there is too much reason to fear that, abroad, oppor- 

 tunities in abundance will be afforded during next spring 

 and summer. 



How much of the success obtained in Hamburg is to be 

 ascribed to the factors above mentioned, and how much to 

 the careful treatment and nursing of confident medical 

 men, inspired by the enthusiasm of the " inventor " or pro- 

 moter of the "periodates," it is difficult to say, and we 

 shall await with interest, but with well disciplined and 

 chastened expectation, the report of the German doctors 

 mentioned in the Times on the results of their obser- 

 vations. 



