PERMANGANATE OF POTASSIUM■: 
ITS ACTION AND USES. 
BY 
PROFESSOR OF MATERIA MEDICA, GENERAL THERAPEUTICS, AND HYGIENE, IN THE 
JEFFERSON MEDICAL COLLEGE OF PHILADELPHIA, ETC. 
ROBERTS BARTHOLOW, M.D., LL.D., 
FROM 
THE MEDICAL NEWS, 
November 22, 1884. PERMANGANATE OF POTASSIUM : 
ITS ACTION AND USES. 
There is a general feeling of uncertainty regard- 
ing the real value of the permanganate of potassium 
as a remedy. Sharing in this to some extent, and de- 
sirous of arriving at definite conclusions, I have 
undertaken to collect the available evidence. This 
consists, chiefly, of clinical observation, and my own 
has been supplemented by such published experiences 
as have rewarded my search of authorities. 
The prime objection of contemporary writers is, 
that permanganate is so quickly decomposed on 
coming into contact with organic matter, that its 
powers must then cease. I have, however, given rea- 
sons for supposing that the diffusibility of this salt is so 
rapid, that it has some action on the blood. For 
example : When used locally for the bite of a venom- 
ous serpent, the poison is destroyed, notwithstanding 
the organic matter in which it is enclosed. Before 
discussing its actions and uses, its physical and 
chemical qualities should be stated. 
According to the United States Pharmacopoeia, 
permanganate of potassium occurs in “deep, purple- 2 
violet, or nearly black, needle-shaped rhombic prisms, 
of a metallic lustre, permanent in the air, odorless, 
having a sweet, afterward disagreeable, astringent 
taste, and a neutral reaction. Soluble, with the ex- 
ception of a scanty brown residue, in 20 parts of 
water at 590 Fah. (150 C.), and in 3 parts of boiling 
water. ’ ’ 
According to the new notation, permanganate of 
potassium is represented by the formula K2Mn208; 
and to the old, KO.Mn2Or It is remarkable for 
the quantity of oxygen which it contains, and for the 
readiness with which it yields it up in its most active 
form, or as ozone;—yields it up so readily that it is 
one of the reagents used to determine the presence 
of organic matter in potable wafers. This process 
illustrates one of the functions performed by per- 
manganate of potassium in the human economy. 
The fine purple color of the solution of this salt in 
pure water is quickly discharged when brought into 
contact with organic matter; the oxygen seizes on 
and oxidizes the organic matter, and the perman- 
ganate is reduced correspondingly, the color chang- 
ing to a dirty brown. It is this oxidizing power for 
which this salt is now employed as a deodorant and 
antiseptic. 
The foul odors arising from decomposing organic 
matter are due chiefly to the compounds of hydrogen 
with sulphur and phosphorus—the sulphide and phos- 
phide of hydrogen and some other products. The 
oxygen in its nascent state seizes on the hydrogen, 
and sulphur and phosphorus are set free, whence the 
destruction of odor. The chemical action which re- 
moves foul odors, does not, necessarily, imply the 
destruction of germs and other materies morbi. Bac- 
teria, micrococci, and other minute organisms, so 
often associated with the ordinary products of putre- 3 
factive decomposition, are now known to be the 
cause of, or at least to convey, the poison of some 
diseases. Active oxygen, or ozone, or nascent oxy- 
gen, has an oxidizing or destroying action on some 
of these pathogenic agents, and hence permanganate 
of potasssum, whilst a deodorant, is also antiseptic. 
Brought in contact with snake poison it destroys 
its toxic power. Thus, as Lacerda was the first to 
show, if inserted into the wound made by a noxious 
reptile, the poison is decomposed, and, consequently, 
has no effect on the system.1 Lacerda, it is true, 
supposed that this agent would prove equally effec- 
tive when administered by the stomach—that it 
would antagonize and render harmless the poison 
introduced at any point; but this supposition has 
proved to be erroneous. The effect of permanganate 
of potassium on animal poison is chemical; it is anti- 
dotal, but not physiologically antagonistic; and 
hence to be effective it must be brought into imme- 
diate contact with the poison, which is oxidized and 
its power thus destroyed. 
Brought in contact with the tissues of the body, 
permanganate of potassium has an effect determined 
by the condition of the part. On the unbroken in- 
tegument external and internal (mucous membrane), 
it does not have an irritant action, but the oxygen 
readily assails the uncovered tissue. It stains the 
skin a brownish color, and applied to an abrasion 
causes considerable smarting and burning, and is 
very superficially caustic. In small doses (two or 
three grains) well diluted, it does not irritate the 
stomach, but if the dose be large and in a solution 
too concentrated it causes local heat, a sense of irri- 
tation, even burning pain. The effect of a large 
1 Bulletin Gen. de Therap. Vol. ioi, p. 325, and vol. 104, p. 556. 4 
dose, insufficiently diluted, is, doubtless, chiefly 
local; but if given in sufficient water on an empty 
stomach, diffusion into the blood probably takes place 
to some extent. 
The systemic action of permanganate of potas- 
sium may be studied in several modes: the effect of 
the salt as a whole; the effects of its chief constitu- 
ent, active oxygen or ozone. 
It has been alleged that this salt cannot act be- 
yond the stomach, because there its oxygen must be 
appropriated by the organic matter contained in 
that organ and the mucous membrane, but certain 
physiological and clinical facts support the opinion 
above expressed regarding its diffusion into the 
blood. Yulpian1 has studied the effects produced 
by this remedy when thrown directly into the veins. 
This mode of experimentation is open to many ob- 
jections. The bulk of the material injected into the 
veins, were it water merely, must, and as we know, 
does have an effect on the functions of the circula- 
tory organs. Furthermore, the emboli produced 
by the chemical action of the salt on the formed 
elements and on the fibrin, must of necessity cause 
serious disturbances at widely separated points and 
in various functions. The results he noted were of 
two kinds, consisting of chemical changes in the 
blood, and the effects of the salt at the points of 
elimination. In the first category were pulmonary 
infarctions, dissolved corpuscles, bloody urine and 
ecchymoses; in the second, were congestion of the 
gastro-intestinal mucous membrane, and of the kid- 
neys. Obviously such experiences are not char- 
acteristic, for they follow the injection into the 
blood of various chemical agents. 
1 Bulletin G6n. de Therap. Vol. 102, p. 251. 5 
As the chief, if not the only therapeutic effects of 
permanganate of potassium, are due to its oxygen, it 
is most important to ascertain the effects of this 
agent. The modern investigations, especially those 
of Demarquay1 and Hayem,2ofFrance; Waldenburg,3 
of Germany; Birch4 and Mackey,5 of England; and 
A. H. Smith,6 of New York, have thrown a flood of 
light on the actions and uses of this agent. More re- 
cently the researches of Binz7 on the effects of ozone 
have been successful in clearing up much of the mystery 
surrounding the physiological actions of this peculiar 
form of oxygen. The results of the action of oxy- 
gen thus studied, are quite in harmony with a priori 
conceptions. On the most superficial view, it would 
be regarded as a vital stimulant, and as an agent 
promoting the activity of the combustion process in 
all parts of the body. This notion of its actions 
is supported by investigation made by the various 
observers above mentioned. 
The recent studies of Binz8 of the effects of ozone, 
are peculiarly instructive. He finds that ozone has 
a hypnotic action, a calmative effect on the central 
nervous system, due, he supposes, to an impression 
on the cells of the gray matter, whereby their func- 
tional activity is suspended. In some trials on his 
own person, he experienced the following results: 
his respiration became deeper and more easy and he 
1 Essai de Pneumatologie Medicale, etc. Paris, 1866. 
2 Bull. Gen. de Therap. 
* Die locale Behandlung der Krankheiten der Athmungsorgane. 
Berlin, 1872. P. 620 et seq. 
4 The Therapeutic Action of Oxygen. London, 1857, and 
British Med. Journal, December 24 and 31, 1859. 
5 The Practitioner. Vol. 2, p. 278. 
6 The New York Medical Journal. Vol. 71, p. 152. 
7 Berliner klin. Wochenschrift, No. 43, 1882. 
8 Ibid., op. cit. 6 
had that feeling of well-being produced in the healthy 
by the respiration of a pure and exhilarating atmos- 
phere. Some drowsiness came on, with an agreeable 
languor, and afterwards there was experienced some 
heaviness in the head (hebetude), together with a 
general sense of fatigue, but no other disagreeable 
sensations. 
The powers possessed by the permanganate of 
potassium as a general stimulant are well exhibited in 
the active emmenagogue property which it has been 
shown to possess by Drs. Ringer and Murrell. In cases 
of amenorrhoea due to deficient activity, it seems to 
promote the function in a remarkable degree. The 
same power, which can so stimulate the sexual func- 
tions, must, when exerted in other directions, prove 
equally effective. 
Mode of prescribing permanganate of potassium. 
As this salt is so readily decomposed, yielding up 
its oxygen to [any organic matter present, it is ob- 
viously necessary to be very careful in preparing and 
administering it. It should be given dissolved in 
pure water, or in compressed tablets or pellets. I 
have used the compressed tablets of Messrs. John 
Wyeth & Brother, of Philadelphia, which contain no 
excipient, and are, therefore, entirely free from 
objection, the material being simply compressed 
without the addition of any foreign material. They 
are readily administered in this form, or they can be 
dissolved in pure water, whenever a solution is de- 
sired. These tablets are typically adapted to the 
purpose—indeed present advantages not possessed by 
any other possible mode of administration. 
Ordinary distilled water after standing a few hours 
exposed to the air, begins to exhibit evidences of 
turbidity, due to the growth of an organism, a peni- 
cillum, and after some days it becomes so much 7 
clouded with organic matter as to be unfit for the 
solution of permanganate of potassium. River water 
or rain water boiled and filtered may suffice for im- 
mediate use, but whenever it can be obtained, fresh 
distilled water should be emploved for this purpose, 
A pellet of this salt may be used to determine the 
requisite freedom from organic matter. Dropped 
into the water under examination, the beautiful 
violet color imparted to it should not be discharged. 
The prompt disappearance of the color signifies the 
presence of chemical agencies fatal to the permanence 
of the salt. The solution should be well diluted 
when taken, and should be given when the stomach 
is empty. A small dose repeated at short intervals, 
say a grain or two every half-hour, until four or six 
grains have been taken, is preferable to the exhibition 
of this amount at one dose. Given in this way, and 
commencing the administration in about four hours 
after meals, the diffusion of the salt into the blood 
is, probably, secured. There are two periods during 
the day, when the administration of the remedy can 
be practised—the proper interval after breakfast, and 
after dinner or luncheon. The same considerations 
should govern the administration of the pellets or 
compressed pills, undissolved, and sufficient pure 
water should be taken after them. 
Therapeutic applications. On the chemical ac- 
tions of permanganate of potassium we have a sure 
basis on which to construct a systematic therapy. 
The readiness with which this salt parts with its oxy- 
gen, is urged against its real utility as a remedy, but 
for reasons already given it is concluded that this 
action does not occur with sufficient promptitude to 
prevent its diffusion into the blood to some extent, 
otherwise we should in vain try to account for its 
practical utilty. 8 
Having more or less irritating quality, perman- 
ganate of potassium is contraindicated in cases of 
acute inflammation of the stomach. It is specially 
indicated in chronic gastric and gastro-intestinal 
catarrh, accompanied by fermentative changes in 
the food. Eructations of gas, vomiting of a yeast- 
like material containing sarcince, and an acid fer- 
mentation of the starchy and saccharine constituents 
of the food, are relieved often very promptly by the 
administration of this salt. As the action is intended 
to be restricted to the stomach contents, the proper 
time for the administration of the remedy is two or 
three hours after meals. 
When the catarrhal process extends into the duo- 
denum, and involves also the bile-ducts, this remedy 
has seemed to be highly efficient. Beside the evi- 
dences of stomachal and intestinal indigestion there 
is present more or less biliousness, manifested in a 
muddy complexion, yellow conjunctiva, high-colored 
urine and a general malaise due to the presence in 
the blood of immature materials and unoxidized 
products of the retrograde metamorphosis. This is a 
very common state of things and is the- result of 
several factors; improper feeding, catarrh of the 
gastro-intestinal and hepatic mucous membrane, and 
imperfect preparation of the food for absorption. 
The permanganate, in this condition of things, does 
good in several directions : it checks fermentation of 
the food elements prone to this process, acts favor- 
ably on the catarrh of the mucous membrane, but 
especially promotes oxidation in the tissues under- 
going metamorphosis, and whilst it thus stimulates 
metabolism, helps to consume in the normal way the 
products of waste. Uric acid which appears in the 
urine, under the action of permanganate of potas- sium is converted into urea, the form in which it is 
normally excreted. 
9 
It follows from the foregoing considerations, that 
permanganate of potassium is a remedy of great value 
in lithcemia. Clinical experience is quite in har- 
mony with physiological deductions. In giving this 
remedy in this affection, two purposes may be accom- 
plished by it: the catarrh of the mucous membrane 
and the fermentation of the foods may be favorably 
influenced, and the insufficient oxidation manifested 
by an excess of urid acic in the urine, may be wholly 
relieved. 
It follows, also, from the foregoing considerations 
that permanganate of potassium must be useful in an 
affection cognate to lithsemia—the hepatic form of 
glycosuria, and in this instance, again, clinical experi- 
ence confirms physiological observation. The special 
field of its usefulness in relation to diabetes, is in 
those cases in which there appears to be both over- 
production of glycogen, and insufficient consump- 
tion, or combustion, or oxidation of this material. 
It will be found most beneficial in the obese subjects 
of glycosuria, in whom the presence of much uric 
acid in the blood signifies at the same time inade- 
quate preparation for absorption of certain food con- 
stituents and a supply of oxygen insufficient to 
convert uric acid into urea. In other forms of dia- 
betes, especially of nervous origin, permanganate of 
potassium has no beneficial effect. 
For the same reason that this salt is useful in 
lithsemia and glycosuria, it is a remedy for obesity. 
According to the observation of the writer, there is 
no remedy more effective than this in the treatment 
of obesity, and for the relief of the disorders of diges- 
tion which have a pathogenic relation to this malady. 
Of course, certain changes in the diet must be made 10 
and active exercise enjoined, but the good effects of 
the remedy are manifest without any aid from a 
change in diet and from exercise. The methodus 
modendi, is, so to speak, of the physiological order. 
The surplus and useless material, such as under ex- 
isting circumstances is transformed into fat, is oxi- 
dized and consumed, and is excreted as carbonic 
acid and water. As it acts thus, to increase the per- 
formance of a function, obviously the curative effect 
is an exercise of a physiological power, and different 
from all the usual remedies for obesity, does not 
operate injuriously if used with the least discretion. 
One of the most important therapeutical applica- 
tions of the permanganate of potassium, and a 
recent discovery, is in the treatment of avienorrhoea. 
We owe this valuable improvement, as indeed many 
others, to Drs. Ringer and Murrell. They have 
shown that this remedy is remarkably certain when 
applied in suitable cases. Given in doses of two to 
five grains three times a day, for several days preced- 
ing the menstrual molimen, this agent is quite sure 
to start the flow. The kind of case to which the 
permanganate is adapted is that characterized by 
torpor, anaemia, or deficient activity of the menstrual 
apparatus. On the other hand, it is contraindicated 
whenever an acute congestion or a general condition 
of sthenic reaction exists. Confirmatory evidence 
has been offered in this country, as well as in Eng- 
land and on the Continent. For example, we find 
the following coming from Russia; Dr. S. M. Lvaff 
prescribed it in ten cases of amenorrhoea. In seven of 
these the remedy succeeded—the menstrual function 
was restored to its normal activity.1 The good re- 
sults achieved by the use of the permanganate in 
1 Medidnskt Vestnik, No. 43, 1883. Quoted. 11 
amenorrhoea induced Dr. A. Y. Vargunin to essay 
its administration in dysmenorrhoea, characterized by 
scanty menstruation and anaemia. In this case, also, 
the result was fortunate, and complete relief was ob- 
tained.1 Congestive or mechanical dysmenorrhoea 
are conditions not suitable for the action of such a 
remedy. 
It is probable that functional impotence in the male 
will be improved by this remedy, provided the con 
ditions present are those of anaemia and depression. 
Topical and Disinfectant Uses.—Permanganate of 
potassium has long been known as a disinfectant and 
deodorizer. Since the agency of minute organisms, 
as bacteria, bacilli, micrococci, etc., in setting up 
septic processes in the body, has been established, 
the various substances employed as disinfectants have 
been assigned to different relative positions, for now 
the important point is to procure the death of the 
living germs and their progeny. An agent destroy- 
ing foul odors does not necessarily, does not indeed 
usually, destroy the germs of disease. 
The permanganate of potassium is to be classed 
with the “deodorizers” rather than with the “anti- 
septics.” From this point of view it is an “elegant” 
disinfectant. In an elaborate research on the anti- 
septics and their power to destroy bacteria, Bucholtz2 
does not include this salt amongst the list of agents 
possessing the power to destroy bacteria and similar 
organisms. Again, M. Ratimoff,3 in a paper on 
antiseptics and the results of their use in surgical 
practice, has, also, ignored the permanganate, not 
1 Vratch, No. 3, 1884. Quoted. 
2 Antiseptica und Bakterien. Archiv f. experimentelle. Patho- 
logic und Pharmakologie. Band iv. p. 1. 
3 Archives de Physiologic normale et pathologique. Vol. 4, 
3d series, p. 142. 12 
mentioning it amongst those agents that have true 
antiseptic power. The most thorough, and from the 
modern point of view the most scientific, treatment of 
the subject of antiseptics is the essay of Dr. Miguel.1 
He assigns permanganate of potassium to a group con- 
taining the salts of lead, zinc, nickel, and cobalt, alum, 
tannin, the mineral acids, and other agents. The 
first group is composed of “substances eminently 
antiseptic;” the second of “substances very strongly 
antiseptic;” the third of “substances strongly anti- 
septic;” the fourth of “substances moderately anti- 
septic; ” the fifth of “substances feebly antiseptic,” 
and the sixth of “substances very feebly antiseptic.” 
Permanganate of potassium, in a list of 91 agentshaving 
•qualities more or less antiseptic, stands 44, the bichlo- 
ride of mercury being first. The important point, 
however, to be determined, in respect to the powers 
•of any antiseptic, is its effect on the vitality of living 
germs or microbes. In the attempt to ascertain this 
■quality of any antiseptic, certain precautions must 
be observed if the results are to possess any real 
value. These precautions have been well stated in a 
memoir of N. Jalan de la Croix,2 whose experimental 
inquiry was conducted under the observation of Prof. 
Dragendorff. 
Bacteria developed in different liquids do not pos- 
sess the same power of resistance to the action of 
antiseptics ; they resist more successfully when con- 
tained in their native fluid than when in culture 
solutions. The same facts are true of the spores, 
which are sterilized with more difficulty in their 
1 Bui. Gen. de Th6rap. Vol. 107, p. 80 et seq. 
2 Das Verhalten der Bacterien das Fleisch-Wassers gegen einige 
Antiseptica. Archiv fur experimenlelle Pathologic und Phar- 
macologic. 1881. Pp. 175 and 225. native element than when transplanted into foreign 
fluids. 
13 
Most of the experiments made have been with 
microbes contained in culture-fluids; for example, 
the very able and elaborate research made by Dr. 
Sternberg.1 Under these circumstances the results 
are better than can be achieved from the use of the 
same antiseptics in disease, cceteris paribus. Stern- 
berg assigns to bichloride of mercury (mercuric 
bichloride) the first place as an antiseptic; yet he 
puts permanganate of potassium second. Whilst bi- 
chloride is effective in the proportion of i part in 
20,000 of fluid, the permanganate of potassium acts 
to the same degree in the proportion of x part to 
833 of solution. The bichloride is, therefore, about 
twenty-five times more efficient. We must acknowl- 
edge a certain sense of scepticism in examining these 
experiments of Dr. Sternberg, as able and well-con- 
sidered as they unquestionably are. We find it diffi- 
cult to understand why liquor zinci chloridi has no 
germicide actipn, whilst a 2 per cent, solution of the 
same is effective in the proportion of 1 part to 50. 
As the experiments of Dr. Miguel have been more 
recently performed, and the conditions insisted on 
by Jalan de la Croix more perfectly observed, we 
may rather accept his conclusions in regard to the 
real value of permanganate of potassium as a ger- 
micide. 
As a deodorant, and so far a disinfectant, this 
agent has a large sphere of usefulness in medical 
practice. Sufficiently concentrated, it has an effect 
on the constitution of certain animal poisons. The 
fact first ascertained by Lacerda—that permanganate 
1 Experiments to Determine the Germicide Value of Thera- 
peutic Agents. By Geo. M. Sternberg, M.D., U. S. A. American 
Journal of Medical Sciences, April, 1883. 14 
of potassium decomposes and renders harmless the 
poison of venomous snakes—seems to contradict the 
results of the experimental investigations regarding 
its germicide power. The destruction of the animal 
poison takes place on contact, but the same agent is 
completely inefficient when acting through the whole 
mass of the blood. It is, however, a question of the 
strength in which the permanganate is used. Topic- 
ally, it is possible to make applications strong enough 
to decompose animal poisons without, at the same 
time, injuring the textures to which they are ad 
herent. 
In gonorrhoea, leucorrhoea, and suppurating buboes, 
a strong solution—five to ten grains to the ounce— 
is an efficient remedy. It has proved to be especially 
so in gonorrhoea. When the attack is recent, the 
solution should not be stronger than two grains to 
the ounce, but, the more chronic, the stronger the 
injection may be made, of course within reasonable 
limits. In suppurating buboes, the contents of the 
sac should be drawn off with an aspirator if still 
intact, or thoroughly evacuated if ruptured, and the 
cavity filled with the stronger solution mentioned 
above. 
Lacerda’s experience with permanganate in snake 
poison renders it almost certain that in the corre- 
sponding poison of syphilis the local application of 
this remedy at the earliest moment to an infecting 
chancre may be productive of the best results. In 
all forms of unhealthy and sloughing syphilitic sores 
—in sloughing phagedsena, for example—it deserves 
more extended use than has heretofore been made. 
Finely pulverized, it can be dusted thoroughly over 
the diseased surface and introduced into all the 
sinuosities. By the same mode of application it 
can be used in lupus and epithelioma, and will, doubt- 15 
less, be found more effective than the chlorate of 
potassium, which, applied in this way, has lately 
been much urged on the attention of the profession. 
As a disinfectant and deodorant, a solution of two 
to five grains to the ounce is useful in otorrhoea, 
ozcßna, fetid breath, fetid sweat of the axilla and feet, 
and in general wherever on the surface of the body 
there are odorous discharges and emanations. For 
general disinfectant purposes it is rather an expensive 
agent, even if equal to the active and cheaper agents 
now utilized for this purpose. 
As has been already stated, permanganate of potas- 
sium is the most generally useful test for determining 
the presence and amount of organic matter in pota- 
ble waters, a standardized solution being employed. 
It may, also, be used to free drinking water from 
dangerous impurities when the drinking of contami- 
nated water may be imperative.