Compliments of the Author. 
PEROXIDE OF 
HYDROGEN 
IN SUPPURATIVE CONJUNCTIVITIS 
AND MASTOID ABSCESSES, WITH 
A REPORT OF TWO OASES. 
IX 
By A. E. PRINCE, M. I)., 
OF JACKSONVILLE, ILL. 
REPRINT. 
ST. LOUIS, MO., 
St. Louis Medical and Suhoical 
J ournal. 
March, 1884. Peroxide of Hydrogen in Suppurative Conjunctivitis and 
Mastoid Abscesses, with a Report of Two Cases. By A. E. 
Prince, M. D., of Jacksonville, III. 
Feeling that the merits of peroxide of hydrogen as acleansing 
agent in suppurating cavities are not sufficiently appreciated by 
the medical public, I am prompted to make a few remarks con- 
cerning its action, report a case of gonorrhoeal ophthalmia and 
suggest a purpose for which it has, perhaps, not heretofore been 
employed, viz., the treatment of mastoid abscesses. 
Anyone having no practical familiarity with this singular and 
inexpensive agent, will be well repaid for obtaining a small 
quantity and repeating a few startling, yet simple chemical exper- 
iments, which will illustrate the activity and utility of the article. 
Since its discovery by Thenard, in 1818, it claimed the atten- 
tion of none but the professional chemist, until it was taken up as 
a remedy for various constitutional diseases, among which diabetes 
and phthisis figure most prominently, and which were supposed 
to be influenced by the peroxide, on the hypothesis of antagonism 
between the life-giving principle of nascent oxygen and the 
devitalizing tendency of disease. It appeared, only to go into 
temporary oblivion after exhausting the enthusiasm of its expo- 
nents, who used it extensively and submitted it to the profession 
with highest praises; for its supposed medicinal virtues were based 
upon false theory, and the vaunted cures were not substantiated 
when subjected to the dispassionate observation of those, who 
were uninfluenced by hypothetical predilections in its favor. It 
is as a local therapeutic agent that it has asserted its supremacy, 
and secured the attention of medical pioneers in all departments 
of medicine. 
The reader will be made intelligent by a glance at the sub- 
stance itself, after which he will appreciate its applications. Physi- 
cally it is like water, transparent, colorless, limpid, odorless and 
tasteless, with sp. gr. 1452, remaining liquid at zero. Chemically 
it is one molecule of water connected by a feeble bond of affinity 2 
to an atom of oxygen, and is obtained by the action of hydrochloric 
acid on peroxide of barium: Ba02-f-2HCl=Ba Cl2+H2 02. 
To its instability does it owe its importance as a therapeutic 
agent. In the presence of a variety of substances, as gold, silver 
and platinum, fibrin and cellular tissue, it is decomposed into 
water and oxygen, becoming at the same time a powerful oxi- 
dizer. Sugar and starch are decomposed with the development 
of carbon dioxide. Albumen, gelatin, urea and cutaneous tissues 
have no effect on it; while another class of bodies, as ammonia, 
hydrocyanic acid, tobacco and aconite, absolutely increase its sta- 
bility and restrain its oxidizing influence on other substances. 
The injection of a small quantity into venous or even clotted 
blood produces a phenomenal demonstration, for the immediate 
liberation of the gas tears up the clot and liberates the corpuscles 
from their fibrinous connection, while it converts the venous char- 
acter into the appearance of arterial blood, which remaining in 
the solution, becomes gradually more and more transparent. 
The microscopic examination of clotted blood is greatly facili- 
tated, and we venture to suggest that in this relation the perox- 
ide of hydrogen may become of value in the department of foren- 
sic medicine. The fact that most concerns us, is the remarkable 
power possessed by a drop of pus to decompose this agent with 
the liberation of nascent oxygen, which directly adheres to and 
attacks all the adjacent tissue for which it has an affinity, and 
it thus becomes a powerful bacterial destroyer. In volume the 
liberated gas is twelve times that of the peroxide employed, and 
its influence on the pus is most easy of microscopic demonstration. 
As an antiseptic this is far inferior to iodoform, with which it 
has the inestimable quality in common, of producing little or no 
irritation, when used about tender organs. Yet it is armed with 
a quality which gives it pre-eminence over all other antiseptics, 
and destines it to a position of prominence in the armamentarium 
antisepticum. The difficulty under which antiseptic medicaments 
have labored, has been the impossibility of successfully applying 
the agent in an unirritating form, so that it might come in con- 
tact with and destroy the disease germs, and it is in surmounting 
this difficulty in the department of dentistry, that this unique 
quality has been brought before our attention. Among the 
difficulties with which the dentist has been obliged to contend, 
is the management of alveolar abscesses, situated, as they are, at 
the bottom of the alveolar cavity and accessible only through 3 
the root canal of the tooth. In peroxide of hydrogen the dent- 
ist has found an effective remedy, and its use in this connection 
forms so excellent an illustration of the properties of this agent, 
that it seems of some importance to give it in this connection. 
Alveolar abscesses are essentially septic in their nature and 
originate, usually, from decaying pulps, and the familiarity of 
every practitioner with their chronicity and inaccessibility 
needs no mention to cause him to appreciate their obstinacy and 
the commensurable efficiency of peroxide of hydrogen, by which 
the septic condition of the cavity is destroyed and the abscess 
caused to heal by one application made in the following manner: 
After removing the pulp and passing a broach through the canal 
of the root into the abscess cavity, a drop of the liquid is injected 
by means of Farrar’s syringe. The cavity of the crown is then 
immediately closed with softened gutta-percha, before which, 
underpressure of the finger, the liquid is driven into the abscess 
cavity. Upon coming into contact with the pus in the foetid 
cavity, the liberated gas permeates it throughout, and by the con- 
tinued evolution of the gas the cavity is emptied of its contents, 
which boil out at the fistulous opening so thoroughly mixed that 
the appearance is that of foam or froth ; while the remnant not 
thus removed is rendered so thoroughly antiseptic that the heal- 
ing process proceeds uninterruptedly. This result is by some 
attributed to the cleansing quality alone, claiming that its anti- 
septic properties are so weak as to be scarcely taken into 
account. However this may be, it will not be denied that it 
fills an important place in ocular and aural therapeutics, as illus- 
rated by the following two cases, which are types of classes in 
each of these departments, the disastrous consequences of which 
are but too frequent in the present state of our knowledge. 
Case I.—Mr. , Waverly, 111., set. 22, gonorrhoeal oph- 
thalmia of right eye. Thus far the other had not become affected 
and steps were taken to prevent its contamination. The lids 
were swollen and somewhat cedematous, while the chemotic 
condition of the conjunctiva caused the upper third of the cornea 
to be absolutely concealed from view. Touched with a probe in 
attempting to inspect the underlying corneal surface, this red 
polypoid projecting tissue was found to be dense and infiltrated, 
so that the attempted inspection was fruitless, though the probe 
could be passed under it without difficulty. The visible cornea 
appeared normal. The eye was in the greatest jeopardy from a 
threatened Ssemisch (crescentic) ulcer, so common in these cases. 4 
The history of the discussions concerning the etiology of 
these ulcers present two leading theories, following which the 
plans of treatment would be almost diametrically opposed. 
According to the older h}'pothesis, the ulceration and gangrene 
of the cornea is due to the swelling and infiltration of the tis- 
sue about the cornea preventing its nutrition, by interfering 
with the surrounding circulation, and also by the superim- 
posed pressure of the swollen lids and infiltrated tissue. Accept- 
ing this position, the treatment has been to divide tho tissues 
and relieve the tension and pressure. Canthoplasty is recom- 
mended, and it has been proposed to divide the upper lid verti- 
cally, and with sutures through the free angle and plasters to 
the forehead, retain the two halves of the lid in a permanently 
inverted position, until the danger of corneal complication was 
over. 
The advocates of the other and more recent hypothesis, 
assume the position that these ulcers and corneal destructions 
are due to the invasion of septic and specific agencies between 
the layers of the cornea, and that the multiplication of these micro- 
organisms establishes suppurative processes, the natural historyof 
which is so familiar to all students in this department of medi- 
cine. Actuated by this latter hypothesis, the reasons for which 
cannot be given in this limited space, it was determined not to 
make any incision, but to rely solely on an antiseptic line ol 
treatment. Cold, according to comfort, was fortified by the 
insufflation of pulverized iodoform twice a day, and after each 
application a few drops of peroxide of hydrogen were injected 
between the lids with a pipette, and the lid quickly closed upon 
its withdrawal. In contact with the pus, the oxygen was imme- 
diately liberated in volumes sufficient to fill and distend the 
entire conjunctival sac, and presumably force the iodoform into, 
and the pus out of all the conjunctival folds and recesses, and 
effectually antagonize, for tho time, the specific condition of tho 
entire mucous tract. After each application, the matter was 
removed from the edges of the lid by absorbent cotton, a drop 
of a ono per cent, solution of atropia applied, and the eyo cov- 
ered with a pledget of absorbent cotton soaked in a 25 per 
cent, aqueous dilution of laudanum, and changed according to 
the inclination of tho patient. After each treatment there was 
a feeling of comfort and freedom from pain, and his condition 
did not get worse from the commencement of the treatment. 
Upon about the eighth day, the swelling having abated consid- 
erably, it was possible to inspect the cornea, and one may 
imagine my surprise on finding a deep crcscntic excavation of tho 
cornea extending through ninety degrees of its circumference, 
and presenting every appearance of healing, which went on 
without interruption to final and complete recovery. 
I do not present this recovery from a most critical and 
andgerous state (even worse than was anticipated) as a demon- 5 
stration of a generality, but as a suggestion, based on further 
experience with gonorrhoeal ophthalmia and ophthalmia neona- 
torum, which may possibly be welcome to some, who, like 
myself, had come to believe that the heroic treatment of incision 
and caustic solutions is not the only and, perhaps, not the best 
way of treating these grave affections of the eye. 
I have no fault to find with Ssemisch section in crescentic ulcer, 
for in numerous cases have I felt that the salvation of a threat- 
ened eye was due to it; but looking back on this case, it appears 
difficult to conceive how the operation could have been made 
with success, or made at all, had one been aware of the presence 
of the ulcer, for the infiltrated and overhanging mass was so 
dense and inflexible as to preclude inspection. In just such cases, 
at least, do we feel assured that it would be impossible to obtain 
with any known agent, what is so elegantly, painlessly and 
efficiently accomplished by the partnership of the non-irritating 
antiseptics, iodoform and hydrogen-dioxide. 
For another illustration of this unique quality of peroxide 
of hydrogen, mention will be briefly made of its application in a 
case of mastoid abscess, which came under my observation in 
May, 1883. 
Case II.—Julia, 8 months old, daughter of Dr. P., Manches- 
ter, 111. Suppuration following scarlatina had existed about ten 
weeks, when the mastoid became invaded and continued to grow 
worse, until it assumed a serious aspect with marked symptoms 
of septic poison. When it came under observation the child had 
become much emaciated with continued fever and loss of 
appetite. Examination revealed absence of the drum membrane, 
exceedingly offensive pus, granulations in the t}7mpanic cavity, 
with swelling, redness and heat over the mastoid. These symp- 
toms established the presumption, if not the certainty, that the 
disturbance wras caused by a quantity of confined and foetid pus, 
somewhere among the mastoid cells. Acting on this conception 
of tho case, a drill was passed through the mastoid directly into 
the tympanic cavity. A fenestrated cataract spoon was then 
placed in the drum cavity, with the opening in the line of the 
direction of tho drill, which was then withdrawn, and a flexible 
lead wire passed along its track until the end reached the fenes- 
trum of the spoon, by the removal of which its extremity was 
directed into the meatus. By the aid of the angular forceps, it 
was then easily drawn out and turned down on the cheek, as seen, 
in Fig. 1. It was now possible, through the cutaneous opening(£») 
in the mastoid, to inject antiseptic solutions which escaped from 
the external meatus (c.) This usually successful manoeuvre failed 6 
to remove the source of irritation, which being a cavity of pus out 
of the line of the drainage wire (see cut) there was no opportu- 
nity for the liquid medicament to find entrance and expel it. 
Fig. 12. 
Having learned of the peculiar property of peroxide of hydro- 
gen, this seemed to be a case for demonstrating its superiority, 
and without knowing any precedent for the proceeding, the 
capacity of my hypodermic syringe was injected by the side of 
the lead wire, the finger of the remaining hand being held over 
the external meatus. Upon withdrawing the syringe, and pre- 
venting the escape of the liquid, the liberated oxygen must have 
penetrated every accessible recess of the mastoid cells, with 
the same force that caused it to boil out of the external openings, 
baffling all efforts to restrain it The conduct of the agent was 
in every respect satisfactory, and the quantity of pus dislodged 
by this tumultuous effervescence proved it to have reached the 
seat of trouble, and the intimate mixture of gas and pus, which 
appeared as a yellow froth at the points of escape, reminds us of 
its behavior under the microscope, where it is seen that no cell 
escapes its disturbing action. By repeated injections, so long as 
any pus remains, the oxygen will continue to be liberated; hence 
by the absence of the evolution of gas, an evidence exists that 
the cavity is completely empty, and the surface freed from the 
presence of pus. The constitutional symptoms commenced forth- 
with to improve, and the case went on to final recovery with no 
other than the usual treatment with boric acid, finely powdered, 
without glycerine, blown into the ear with a quill and packed, after 
first thoroughly cleansing and drying, and this alternated with 
the strongest obtainable alcohol for toughening the mucous 
membrane and causing the shrinkage of the granulations. 7 
Submitting this index to the possibilities of this invaluable 
agent, the appended references may be of value to any who desire 
to investigate the subject to which the above is but an inadequate 
introduction.* 
On leaving this subject, we desire to acknowledge our obliga- 
tion to G-. V. Black, I). D. S., Jacksonville, and A. W. Harlan 
D. D. S., Chicago, who have used this agent extensively, and 
through whom was made known to us this inestimable quality in 
which the septic microbe finds a potent antagonist. 
*Peroxide of hydrogen in dentistry, by A. W. Harlan, D. D. S., In- 
dependent Practitioner, March, 1883. 
Transactions of International Medical Congress, 1881, Vol. III., A. 
W. Coffin. 
Peroxide d’Hydrogene, by P. Bert and Regnaud. Trans, of Acade- 
mic des Science, 1881-82. 
Also Journal de Medicine de Paris, for 1882-83, has numerous refer- 
ences. 
Peroxide of Hydrogen in contagious ophthalmia by LeRoy Walker, 
M. D., New York Medical Record, Aug. 25, 1883. 
Peroxide d'hydrogene, by Dr. A. Aubean in L’Odontologie, Aug., 
1882, translated by A. W. Harlan, Chicago, for Ohio State Journal of 
Dental Sciences, Feb., 1883. 
Without the association of pulverized iodoform, favorable experience 
with hydrogen peroxide has been recorded in the eye clinics of Wecker 
and others, of Paris. The Saint Louis 
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