(15) HARTZELL, T. B., AND HENRICI, A. T.: The dental path: its importance as an avenue to infection. Surg., Gynec. and Obst., 1916, xxii, 18-27. (16) IRONS, E. E.: Some less frequently considered portals of infection in arthritis and iritis. Jour. Amer. Med. Assoc., 1923, lxxx, 1899-1902. (17) LILLIE, H. I., AND LYONS, H. R.: Tonsillectomy in myositis and arthritis. Jour. Amer. Med. Assoc., 1919, Ixxii, 1214-1216.

(18) MAYO, C. H.: Constitutional diseases secondary to focal infections. Dental Rev., 1913, xxvii, 281-297. (19) MAYO, C. H.: Problems of infection. Minn. Med., 1918, i, 414-416. (20) MEISSER, J. G.: Focal infection as a cause of disease of the urinary tract. Jour. Amer. Dent. Assoc., 1923, x, 610-618.

(21) MEISSER, J. G., and BumPUS, H. C.: Focal infections in relation to submucous ulcer of the bladder and to cystitis. Jour. Urol., 1921, vi, 285298.

(22) MOENCH, LAURA M.: The relationship of chronic endocervicitis to focal infection with special reference to chronic arthritis. Jour. Lab. and Clin. Med., 1924, ix, 289–309. (23) MOODY, A. M.: Lesions in rabbits, produced by streptococci from chronic alveolar abscesses. Jour. Infect. Dis., 1916, xix, 515-525. (24) MOOREHEAD, F. B.: The prevalence of chronic mouth infections and their management. Jour. Amer. Med. Assoc., 1916, lxvii, 845–847. (25) MULLIN, W. V.: The accessory sinuses as an etiologic factor in bronchiectasis. Ann. Otol., Rhinol. and Laryngol., 1921, xxx, 683-689.

(26) NAKAMURA, T.: A study on focal infection and elective localization in ulcer of the stomach and in arthritis. Ann. Surg., 1924, lxxix, 29-43. (27) PRICE, W. A.: Dental infections, oral and systemic. Cleveland, The Penton Publishing Co., 1923, 2 vols. (28) RHEIN, M. L.: The retention of devitalized teeth without danger of focal infection. Jour. Amer. Med. Assoc., 1917, lxix, 974-976. (29) ROSENOW, E. C.: Studies on elective localization. Focal infection with special reference to oral sepsis. Jour. Dent. Res., 1919, i, 205–267. (30) ROSENOW, E. C.: Focal infection and elective localization of bacteria in appendicitis, ulcer of the stomach, cholecystitis and pancreatitis. Surg., Gynec. and Obst., 1921, xxxiii, 19-26.

(31) ROSENOW, E. C.: The specificity of the streptococcus of gastroduodenal ulcer, and certain factors determining its localization. Jour. Infect. Dis., 1923, xxxiii, 248-268.

(32) ROSENOW, E. C., AND MEISSER, J. G.: The production of urinary calculi by the devitalization and infection of teeth in dogs with streptococci from cases of nephrolithiasis. Arch. Int. Med., 1923, xxxi, 807–829. (33) THOMA, K. H.: Oral abscesses. Boston, Ritter and Co., 1916, 213 pp. (34) ULRICH, H. L.: The blind dental abscess. Boston Med. and Surg. Jour., 1916, clxxiv, 169.

(35) VON LACKUM, W. H.: Personal communication.

(36) WOOD, G. B.: Tonsillar infection. Amer. Jour. Med. Sci., 1914, cxlvii, 380-388.

P

"Antimony has an interesting history. Paracelsus in the sixteenth century praised it as a panacea and it was used against the plague, etc., perhaps a forecast of its most recent uses. However, numerous deaths caused its formal proscription" (2).

"Antimony and potassium tartrate, or tartar emetic, acts locally on the gastric mucous membrane to induce. nausea and vomiting, but tartar emetic is more actively poisonous when it enters the circulation than are the sulphates of copper and zinc, its systemic effects resembling those of arsenic; but, fortunately, the poisonous actions of antimony are seldom observed after its therapeutic use as it is seldom employed except in small doses as a nauseant. In addition to the usual effects which accompany nausea and vomiting, tartar emetic poisoning is attended with copious watery stools, fall of blood pressure, and slow and labored respiration and depression of the central nervous system ending in collapse and death in rare instances. Some depression of

even with emetic doses, hence it is not well suited for use in debilitated patients. As little as 0.15 gram (2 grains) of tartar emetic has caused death when vomiting failed to occur after its administration" (3).

The stated uses of the drug have been as a nauseant emetic, and, also as a constituent of various expectorant mixtures.

No mention is made, in references consulted, as to its having any value in intravenous therapy.

Its intravenous administration has been adjudged specific by Frontz, for the treatment of Granuloma inguinale (4).

Ross has also found its intravenous administration specific in Granuloma inguinale (5).

No mention is made, however, of its use in any other condition.

From the reports of these men in the treatment of this type of cases; I was prompted to administer it in three cases of Granuloma inguinale, with histories of from eleven months to four years duration. These cases had resisted all therapeutic measures previously tried. The almost miraculous results which were attained in the healing of these cases, provided the idea that this little used drug, in this

field, might be used to advantage in chronic cases which had failed to respond to usual or accepted methods.

Accordingly, its administration was started in a variety of stubborn cases, results of which are given in the reported cases to follow.

To a known amount of Antimonii et Potassi Tartras, C. P., sufficient sterile, distilled water was added to make a 1 per cent solution. An initial, intravenous, injection of 4 cc. of this solution, which corresponded to 40 mgm. of the drug, was given. This was increased 1 cc. (10 mgm.) each day until a maximum of 10 cc. (100 mgm.) was being given daily. Thereafter a 10 cc. dose was administered on alternative days. The occurrence of a typical tartar emetic reaction. caused omission of one day's treatment and revision to the initial dose given, with gradual ascent in amount as before. The progress of the case, being treated, was the only guide as to the amount of tartar emetic administered. In its administration, intravenously, the same technic as is usual to intravenous therapy was followed. It was found from experience that it is a powerful tissue irritant.

The majority of the cases, treated, showed no untoward symptoms following injection, but, in those who bore the drug poorly, nausea and vomiting occurred very promptly after its administration. No rise in temperature was witnessed in the patients, under observation, in the Hospital.

The drug was well-born by most patients to whom it was administered. Ten cubic centimeters, or 100 mgm. was the maximum dosage. The maximum number of 25 treatments were given to one patient and the minimum.

ANNALS OF CLINICAL MEDICINE, VOL. III, NO. 5

number of treatments given to any

one patient was four.

Case reports are as follows:

Granuloma inguinale (3 cases)

Case 1. A colored man, aged fifty-seven, with a large granuloma inguinale, left side. History of four years' duration. Failed to respond to daily dressing, surgery, cauterization or any other method employed for its subjugation over a period of more than two years, under my care. Wassermann was strongly positive when first seen. Adequate anti-luetic treatment was given this man more than two years previous and a negative Wassermann was obtained. Tartar emetic treatment, according to the technic as outlined above, was instituted. No reactions; marked improvement in twenty-four hours, complete healing in ten days. Firm scar, no granulation remaining.

Case 2. A colored man, aged thirty-two. Granuloma inguinale. History of eleven months' duration. Blood Wassermann had been strongly positive, but became negative after adequate anti-luetic treatment. Ulcer was persistent, tartar emetic treatment begun. Patient was discharged as cured after 13 injections, no recurrence three months later.

Case 3. A colored man, aged thirtyeight. Granuloma inguinale. History of

fourteen months' duration. Blood Wassermann changed from strongly positive to moderately positive following anti-luetic treatment. Inguinal ulcer left side per

persisting, 11 treatments of tartar emetic

were administered. Complete healing in eight days. Condition normal, three months later.

Chronic eye cases

Case 4. A white man, aged thirty-s -seven. History of "eye trouble" throughout lifetime and exacerbated past two years. Diagnosed as chronic corneal ulcer, right eye, with no apparent impression with usual antiseptic treatments. No changes were observed, opthalmoscopically, from

the record of examination previous to and after tartar emetic treatment. After administration of 14 injections of tartar emetic, complete healing of corneal ulcer occurred with only a small, slightly visible, cicatrix remaining. The patient claims marked improvement in vision.

Case 5. A colored man, aged twentythree. Chronic conjunctivitis of eight months' duration with frequent acute exacerbations. Smear from eye secretions showed many polymorphonuclears and eosinophiles, but no organisms. This patient was given 13 injections of tartar emetic with 3 reactions occurring. Marked improvement noticeable after fourth dose and continuous until discharged as cured with no recurrence to date.

Ear cases, (3 cases)

Case 6. A white man, aged twentyfour. Mastoidectomy in 1918, deaf left ear. History of continuous purulent discharge for the past two years. Usual irrigations and local treatments were of no avail. Patient was given 9 injections of tartar emetic. Diminution of pus discharge was apparent after second injection. No pus was demonstrable after fifth dose. Discharged as cured. No recurrence three months later.

Case 7. A white man, aged nineteen. Chronic otitis media both ears. Purulent discharge from both ears with serious impairment of hearing. Smear showed a predominance of capsulated diplobacilli. This patient was given 13 injections of tartar emetic with no change in ear condition. Later, he was given 3 intravenous injections of mercurochrome-220-soluble, with no improvement. Following this, patient was given 3 injections of gentian violet, intravenously, and now has no discharge from either ear. This patient has a negative blood Wassermann, but has pulmonary tuberculosis with a positive sputum for B. tuberculosis. His hearing has been markedly improved.

Case 8. A white man, aged twentyeight. Chronic otitis media, left ear.

Mastoidectomy scar, left side. History of purulent discharge for nine months. Pus smear showed a few short chains of streptococci. Partial deafness. After being given 4 injections of tartar emetic patient was reluctant to continue treatment further and was discharged. There was a noticeable decrease of pus after the third injection. Examination three months later showed no pus discharge from ear. Hearing improved.

Skin diseases

Case 9. A white man, aged thirty-seven. Pustular eczema, over extremities, head, rectum and genitals. Blood Wassermann negative, was given 22 injections of 0.1 gram each of silver salvarsan and ammoniated mercurial ointment with some improvement. Protein test, positive for lima bean. Blood sugar content, 120 mgm. per 100 cc. Given 6 injections of tartar emetic; condition aggravated and treatment was discontinued.

Case 10. A white man, aged sixty-seven. Scabies. Given usual treatment for scabies one year previous. Following this treatment, patient persisted in using all forms of ointment which he could obtain, which aggravated his skin condition until a chemical eczema prevailed. This patient was given 6 injections of tartar emetic. The dermatitis became aggravated, apparently, by mineral idiosyncrasy. Present condition, much improved.

Case 11. A white man, aged sixty-seven. Pruritus, traumatica, senile. History of seven years' duration. Lesions from 6 mm. to 2 cm. in diameter discrete and pigmented extending over entire body, save head. Ten injections of tartar emetic were given with some improvement, but later exacerbation occurred. Patient's condition is now normal.

Case 12. A white man, aged forty-nine. Ichthyosis. Generally bronzed skin with pigmented, net-work like appearance. No subjective symptoms. History of twenty years' duration. Ten injections of tartar emetic were given with no improvement.

Case 13. A white man, aged forty-two. Dry eczema area 8 by 10 cm. anterior lower left leg. Blood Wassermann, negative; blood count, normal; urine showing a trace of albumin. Four injections of tartar emetic were given with no improvement. The patient developed erysipelas and tartar emetic treatment was discontinued.

Case 14. A white man, aged thirty-five. Psoriasis. History of one year's duration. Patient was given 6 injections of tartar emetic with slight improvement.

Case 15. A white man, aged twentyfive. Papulopustular acne. History of four years' duration. Patient was given 6 injections of tartar emetic with no improvement.

Case 16. A white man, aged twentythree. Pustular acne, existing since adolescence. Ten injections of tartar emetic were administered with little improvement. Patient was then given 15 injections of equal amounts of tartar emetic and sodium salicylate (20 per cent solution), the maximum injection being 6 cc. of each. There was great improvement three months later.

Case 17. A white man, aged twenty-two. Sycosis vulgaris. History of eight months' duration. Four injections of tartar emetic were given with no improvement.

Case 18. A colored man, aged thirtyseven. Psoriasis. History of two years' duration. Four injections of tartar emetic were given with no improvement.

Case 19. A white man, aged forty-three. Psoriasis. History of one year's duration. Nine injections of tartar emetic were given with some improvement.

Case 20. A white man, aged twentyeight. Moist eczema, right wrist. History of eight years' duration. Said by patient to be aggravated in winter and after 14 injections of tartar emetic he was apparently cured, although he insists that lesion always heals in summer-time.

Adenitis

Case 21. A colored man aged forty-two. Tubercular ulcers, with numerous discharging fistulae over anterior and posterior surfaces of chest and shoulders. History of ten years' duration. Eighteen injections of tartar emetic were given with no improvement.

Case 22. A colored man, aged twentynine. Cervical adenitis. History of five months' duration. His neck was more than twice normal size. Typical tuberculous symptoms existed. An incision on right side of neck was made and drainage of about 75 cc. of pus occurred. Pus discharge was continuous for about one month with apparently very slight decrease in daily amount. Tartar emetic injections were instituted and marked diminution of discharge occurred after the first injection. Pus discharge terminated after second injection with marked decrease in size of neck. Granulation of wound began after third injection. The neck was normal size after fifth injection. Patient was given 7 injections and discharged as cured. The week following healing of neck, tonsils were removed and there has been no recurrence to present time. His general physical condition is improved.

Case 23. A white man, aged forty-three. Cervical adenitis, extending over a period of eight months. Short chains of streptococci were found on examination of pus smear. Blood Wassermann was strongly positive and he was given considerable anti-luetic treatment previous to and during the development of his adenitis and continued through its development. This treatment failed to check its progress and was discontinued. The blood Wassermann is now moderately positive. There were repeated incisions with drainage of constantly accumulating pus. Forty injections of streptococci vaccine (stock) were given with no change. Four injections of mercurochrome-220-soluble were given with no change. Three injections of gentian violet, intravenously, were given with no change. Nine injections of tartar emetic