THE 
Subcutaneous Use of Chloride of Gold and Sodium with 
Iodide of Manganese in Pulmonary Tuberculosis. 
By WILLIAM S. BOARDMAN, M. D. [Reprinted from the Boston Medical and Surgical Journal 
of May 17,1894. 
THE TREATMENT OF PULMONARY TUBERCU- 
LOSIS BY THE SUBCUTANEOUS USE OF 
THE CHLORIDE OF GOLD AND SODIUM 
WITH THE IODIDE OF MANGANESE. 
BY WM. S. BOARDMAN, M.D., BOSTON. 
We have read and heard so much about new 
remedies and modifications of new remedies for the 
treatment of phthisis, that now to many the subject 
fails to excite an interest. 
The methods of treatment are too numerous to men- 
tion. One is almost startled by the list of drugs and 
methods proposed, in reading Solis-Cohen’s article on 
“ Tuberculosis,” in “ Hare’s System of Practical Thera- 
peutics.” Yet there must be something beneficial in 
these remedies, even if there is nothing specific. 
The brilliant methods of Koch, dimmed by the 
noxious elements in his tuberculin and brought to a 
glow again by the researches of Klebs and Hunter, are 
undoubtedly more for good than anything hitherto 
proposed. Although we seem so near the desired re- 
sult, it has not yet been obtained in the ideal that was 
first conceived; nevertheless, it behooves us to make 
the most of what we have, while striving for something 
better. 
From the earliest time, the attempt has always been 
made to combat the marasmus of phthisis by dietetic 
and hygienic measures. How slow and uncertain a 
procedure it has been is only too well known to us all. 
If in any way we can aid the process of nutrition and 
maintain or increase the strength of the patient, a 
great deal will be done towards staying the disease, if 
not directly tending to a cure. 2 
One mode of treatment that has been tried consider- 
ably yet spoken of by comparatively few writers, is the 
subcutaneous use of a solution in glycerine, of the 
chloride of gold and sodium with the iodide of manga- 
nese. In March, 1891, an article in the Medical 
Record, by Dr. J. B. White, extolled this combination 
as a treatment for phthisis, and cited a number of cases 
to show the beneficial results obtained. Another 
article in September, 1892, by the same author, ap- 
peared to supplement and confirm the results of the 
first paper, being written in a very earnest and pleas- 
ing manner. As the combination of the chloride of 
gold and sodium with the iodide of manganese, is, under 
ordinary circumstances, likely to result in the forma- 
tion of a precipitate, the author of the above-mentioned 
articles was asked to state the method of preparing 
the solution. Since the process was not given and the 
injection fluid could only be obtained in New York, it 
was thought to be of sufficiently scientific interest to 
the profession to have an analysis of Dr. White’s pre- 
paration; and Mr. Wm. C. Durkee, Ph.G., kindly 
consented to undertake the chemical work with this 
result. 
“ The proximate chemical examination of the injec- 
tion fluid is as follows. It has a dark-amber color, 
with a specific gravity of 1,260, a styptic taste and a 
syrupy consistency. 
“According to Dr. J. Blake White’s statement, each 
drop should contain the equivalent of one-fiftieth of a 
grain of the chloride of gold and sodium, and one- 
fiftieth of a grain of the iodide of manganese, that is, 
each drop should represent one-twenty-fifth of a grain 
of the combined salts. 
“ He does not mention the method of obtaining the 
drop, whether from the bottle or a medicine-dropper; 
and although changes in the viscosity of the liquid 
owing to the temperature, the rapidity with which the 
drops are formed, and the shape of the material from 
which the drop falls largely govern the size, it was 
assumed that a drop from the original five-cubic-centi- 
metre bottle, at about 70° F., and forming at a speed of one in two and a half seconds, would be about the 
size usually obtained and probably intended by the 
quoted statement. 
“ Several careful weighings of ten-drop quantities of 
the liquid were made and the drops found to average 
77 milligrammes each, and supposablv contained one- 
fiftieth of a grain (.0013) of U. S. P. strength of chloride 
of gold and sodium, and the same quantity of iodide 
of manganese, or 169 mg. of each in 10 gm. of injec- 
tion. 
“Ten grammes of the fluid were found to contain 
.01737 gm. of metallic gold, equal to .05352 gm. 
chloride of gold and sodium U. S. P., or about one-third 
the amount claimed. The liquid is composed mainly 
of glycerine, and contains free iodide, iodine in the 
form of iodate (also as iodide), chlorine, sodium, potas- 
sium and manganese. 
“ As the method of preparing the injection fluid 
recommended by Dr. White was not made public, the 
following process has been devised, which yields a 
solution containing the ingredients he has reported as 
useful and of the strength he recommends. Take of 
1 Gold and sodium chloride, D. S. P. . . . 1.69 gm. 
Manganese sulphate 2.44 gm. 
Potassium iodide 4.62 gm. 
Diluted alcohol . 10.0 c. c. 
Glycerine » 
Distilled water j 
of each a sufficient quantity. 
“ Dissolve the gold and sodium chloride and one 
gramme of potassium iodide separately, in sufficient 
glycerine to make each solution weigh 25 gm. using 
only a very gentle heat, if any ; when cold mix the 
two solutions. Dissolve the manganese sulphate in 
sufficient distilled water to make 10 c. c., and 3.62 gm. 
of potassium iodide in sufficient diluted alcohol to make 
10 c. c.; mix the two solutions, and allow the contain- 
ing vessel to stand in powdered ice for several hours, 
to thoroughly precipitate the potassium sulphate. 
Then decant 10 c. c. of the clear liquid into 40 gm. of 
glycerine ; evaporate on a water bath until the total 
i It is best to prepare this chemical or to use an article which is 
known to be of full strength, as market samples were found to con- 
tain less gold than the labels indicated. 4 
weight is reduced to 40 gm., aud add glycerine to make 
50 gm. Mix this solution with the solution of gold 
and sodium chloride, and keep in amber glass-stoppered 
bottles. Each 77 mg. (about one drop) contains the 
equivalent of mg. (one-fiftieth of a grain), of gold 
and sodium chloride and the same quantity of manga- 
nese iodide.” 
The injections were given in the forearm, upper 
arm and subclavicular region by an ordinary hypo- 
dermic syringe. 
The solution prepared has been used in the manner 
advised by Dr. White, the initial dose usually being 
one drop (equal to one-twenty-fifth of a grain of the com- 
bined salts of gold and manganese) diluted with a few 
drops of a one-per-cent, solution of carbolic acid, and 
increased only as the constitutional disturbance re- 
mained at a minimum or ceased to appear after several 
doses. 
In some patients the reaction appeared within two 
hours — as headache, backache and general malaise — 
lasting twenty-four to forty-eight hours; in others it 
was but little marked and disappeared within one or 
two hours after an injection. 
The pulse has been found to be full and slow with 
subnormal temperature in some, while in others the 
pulse was increased in rate with a slight rise in tem- 
perature. 
The local effect varied, in some the solution caused 
considerable inflammation, in others the injection was 
only marked by an induration and slight tenderness 
about the puncture. It seemed to depend upon the 
amount of loose connective-tissue present and the in- 
dividual susceptibility to irritation. 
Cough-mixtures, tonics and hygienic measures have 
also been made use of as opportunity permitted. 
One thing was observed quite generally, as noticed 
by another writer — within two weeks or thereabouts 
after beginning the injections, the appetite was in- 
creased, so much as to cause the remark of the patient 
to the effect. 
The cough and expectoration in some were lessened, TREATMENT WITH SUBCUTANEOUS INJECTIONS OF GOLD AND MANGANESE (Dr. Boardman). 
No. Sex. Age. 
Social Condition. 
Occupation. 
Family History. 
Patient’s History. 
Physical Examination at Beginning of Treatment. 
First Treatment. 
Weight. 
Sputum. 
Last Treatment. 
Weight. 
Sputum. 
Subcus. 
Total Amount. 
Largest Dose. 
Physical Examination at the End of Treatment. 
I. 
Female. 
20 years. 
Single. 
Home-work. 
Mother phthisical, 
one brother died 
of phthisis. 
Has not felt well for 6 months. Cough for 3 months. Loss of flesh 
and strength. Sweats considerably by day. No night sweats. Menses 
regular. . 
Considerable emaciation. Hectic flush. Right clavicle more prom- 
inent than the left. No dulness. Respiration roughened nearly 
everywhere. A few fine moist riles at the left apex. Medium moist 
rales at the right apex anterior. 
Feb. 6, 1893. 
Ill pounds. 
3 iiss-iii. 
No tubercle bacilli 
found. 
11 A. M. 
Pulse 76. 
Temp. 99°. 
Resp. 31. 
June 13,1893. 
108£ pounds. 
(Did weigh 117 lbs. 
after 34 subcus., 
May 6tli.) 
3i-iss. 
Tubercle bacilli 
fairly numerous. 
12.30 P. M. 
Pulse 68. 
Temp. 99.3°. 
Resp. 35. 
50 
112 drops. 
6 drops. 
After 30 Subcus. 
Dulness not marked. Roughened respiration at Left apex anterior 
and over left front. Suspicion of a few occasional fine rales at left 
apex anterior. Harsh bronchial respiration over 2d left interspace. 
(This was the seat of pain 4 weeks ago.) Slightly roughened respira- 
tion at right apex anterior and over upper half of right front. Rough- 
ened respiration in each axilla. Slightly roughened respiration at 
right apex posterior and over upper half of right back. Roughened 
respiration at left apex posterior and over left back. 
After 50 Subcus. 
No dulness, Respiration roughened everywhere. A suspicion of 
fine riles at left apex anterior and over upper left back. 
(Patient feels better.) 
H. 
Female. 
27 years. 
Single. 
Parlor-girl. 
One sister died of 
phthisis. 
Pneumonia 2 years ago; never fully regained her health. Hoarse 
since last fall. No cough. No expectoration. No haemoptysis. No 
sweats. Loss of flesh and strength. Menses regular (1 day, scanty). 
Variable appetite. . 
Respiration roughened everywhere. Fine moist rales over right 
and left upper backs. Ulceration at middle of left vocal cord. 
Feb. 17. 
115 pounds. 
No sputum. 
(Former weight 130 
pounds.) 
11 A. M. 
Pulse 96. 
Temp. 98.8°. 
Resp. 21. 
April 26. 
lllf pounds. 
No sputum. 
12 M. 
Pulse 84. 
Temp. 99°. 
Resp. 21. 
21 
29 drops. 
5 drops. 
No dulness. Fine moist rales at right apex anterior, under right 
clavicle and over upper half of right chest anterior. Respiration 
slightly roughened over lower half of right chest, in right axilla, over 
left chest and in left axilla. Fine moist rales at left apex posterior, 
between left scapula and spine, at right apex posterior and between 
right scapula and spine. Left vocal cord ulcerated nearly its entire 
length and considerably thickened. 
(Patient feels better.) 
III. 
Female. 
19 years. 
Single. 
Paper-box maker. 
Parents died of 
phthisis. 
Cough for 6 months. Occasional night sweats. Fairly strong. 
Menses every 3-4 weeks, and scanty. Appetite poor. 
Relative dulness at left apex anterior and below left clavicle. 
Bronchial respiration at left apex anterior and over upper half of left 
front. Few moist riles over upper half left front Roughened res- 
piration at right apex and over right front. A click heard at right 
apex anterior. Harsh respiration and medium moist rales in left 
axilla. Roughened respiration in right axilla. Bronchial respiration 
at right apex posterior and over upper right back. Roughened respi- 
ration over lower right back. Few clicks heard over upper right 
back. Roughened respiration over left back. Voice sounds near be- 
low left clavicle. Vocal fremitus increased at left front. 
March 6. 
109 pounds. 
(Has weighed 112J 
pounds.) 
3 vi-viii. 
Tubercle bacilli 
present. 
11.45 A.M. 
Pulse 84. 
Temp. 100°. 
Resp. 22. 
May 29. 
98 pounds. 
3 iii-iv. 
Tubercle bacilli 
present. 
12.30 P. M. 
Pulse 88. 
Temp. 100°. 
Resp. 26. 
22 
48 drops. 
6 drops. 
Relative dulness at left apex anterior and below left clavicle. 
Cracked-pot sound under left clavicle. Bronchial respiration at left 
apex anterior and all over left front. Medium and coarse rales at 
left apex anterior and all over left front. Clicks heard at right apex 
anterior and under right clavicle. Roughened respiration over upper 
half of right front. Medium and fine rales in left axilla. Sibilant 
rales in right axilla. Respiration rough and harsh at right apex 
posterior and above right scapula. Clicks heard at right apex pos- 
terior and between right scapula and spine. Fine rilles at left apex 
posterior. Fine and medium rilles over left back Voice very near 
under left clavicle and between right scapula and spine. Vocal fre- 
mitus increased at left front. 
(Patient feels about the same as before treatment.) 
IV. 
Female. 
23 years. 
Single. 
Seamstress. 
Family history not 
obtained. 
No cough. No expectoration. No loss of weight. Menses regular. 
Appetite fair. Loss of strength. 
No dulness. Sibilant rales over left front. Roughened respiration 
all over right back. Few fine rales at right apex posterior. 
March 6. 
100 pounds. 
No sputum. 
12 M. 
Pulse 80. 
Temp. 92.2°. 
Resp. 24. 
April 12. 
99J pounds. 
No sputum. 
12.40 P. M. 
Pulse 92. 
Temp. 98.6°. 
Resp. 23. 
11 
11J drops. 
2 drops. 
No relative dulness. Respiration roughened everywhere. Sibilant 
rilles at upper left front. Voice near between right scapula and 
spine. 
(Patient feels about the same as before treatment.) 
V. 
Female. 
20 years. 
Single. 
Tobacco stripper. 
Father and one 
brother died of 
phthisis. 
Cough seven months. No night sweats. No haemoptysis. No loss 
of weight. Menses regular. Feels fairly strong. No dyspnoea. Ap- 
petite fair. 
Dulness at right apex, anterior and posterior, and below right 
clavicle. Cracked hot sound over 2d right interspace (near sternum). 
Bronchial respiration over right front and back, and left back. 
Roughened respiration over left front. Few medium rales at right 
apex anterior, over upper right front, in right axilla, and between 
right scapula and spine. Suspicion of rales between left scapula and 
spine. Voice very near below right clavicle. 
March 11. 
119J pounds. 
3 i. 
Tubercle bacilli 
present. 
12.45 P. M. 
Pulse 108. 
Temp. 100°. 
Resp. 24. 
April 22. 
113 pounds. 
3L 
Tubercle bacilli 
present. 
12 M. 
Pulse 96. 
Temp. 99°. 
Resp. 24. 
17 
23 drops. 
4 drops. 
Dulness at right apex anterior below right clavicle, at right apex 
posterior and over upper half of right back. Cracked-pot sound over 
2d right interspace Bronchial respiration over upper half of right 
and left chest, anterior and posterior. Broncho-vesicular respiration 
in right axilla. Roughened respiration in left axilla and over lower 
right and left back. Respiration rather amphoric over 2d right inter- 
space. Medium rales at right apex anterior, over upper right front 
and in right axilla. Numerous clicks at right apex posterior and 
over upper right back. Suspicion of fine rfiles at left apex posterior. 
Occasional fine rales at left apex anterior. Medium rales below left 
clavicle. Voice very near at upper right chest, anterior and pos- 
terior. 
(Patient feels better.) 
VI. 
Female. 
29 years. 
Married. 
(3 children, young- 
est 3 months old.) 
Home-work. 
Family history neg- 
ative. 
-Cough 7 months. No haemoptysis. Occasional sweats. Has lost 
flesh. Does not feel weak. Menses regular. No dyspnoea. Appe- 
tite poor. 
Hectic flush. Considerable emaciation. Right clavicle more prom- 
inent than left. Relative dulness not marked. Broncho-vesicular 
respiration at left and right apex anterior. Slightly roughened res- 
piration at left apex posterior. Fine moist rales at each apex ante- 
rior. Sibilant riles at left apex anterior, in right axilla and over 
right back. Moist rales between right scapula and spine. Pleuritic 
stitch and few pleural rales in right anterior axillary line. 
March 14. 
92 pounds. 
3 iii-iv. 
Tubercle bacilli 
present. 
1.30 P M. 
Pulse 100. 
Temp. 100°. 
Resp. 26. 
May 25. 
88£ pounds. 
3 iss-ii. 
Tubercle bacilli 
present. 
12.30 P. M. 
Pulse 76. 
Temp. 98. 4°. 
Resp. 25. 
17 
29 drops. 
5 drops. 
Relative dulness not marked. Respiration slightly roughened be- 
low left clavicle, bronclio-vesicular at right apex anterior and over 
upper right front, bronchial at right apex posterior, roughened above 
right scapula, slightly roughened at left apex posterior and over upper 
left back. Clicks heard at left apex. Few fine moist rales at left 
apex anterior. Numerous flue rales at right apex anterior. Fine 
rales under right clavicle Suspicion of fine rales at right apex 
posterior. Fine rilles between right scapula and spine. Voice nearer 
over right upper front and back. Vocal fremitus increased over right 
upper front and back. 
(Patient feels better.) 
VII. 
Male. 
43 years. 
Single. 
Baker. 
Family history neg- 
ative. 
Cough 3 months. No expectoration. No haemoptysis. Night 
sweats for the last two months. Has lost flesh. Appetite poor. 
Right clavicle more prominent than left. Relative dulness not 
marked. Broncho-vesicular respiration at right apex and over right 
front. Rather harsh respiration over right front near sternum. Bron- 
cho-vesicular respiration in left axilla. Increased vesicular respiration 
in right axilla. Roughened respiration in right anterior axillary 
line. Broncho-vesicular respiration over upper half left back. Sibi- 
lant rales at left apex and over left front. Medium and fine rales at 
left apex anterior and over left front. Medium rales in left axilla. 
Sibilant rales over upper half left back. Medium and fine rales over 
upper half left back. 
March 20. 
115 pounds. 
No sputum. 
2 30 p. M. 
Pulse 80. 
Temp. 97.4°. 
Resp. 24. 
June 8. 
115 pounds. 
No sputum. 
12.30 P. M. 
Pulse 88. 
Temp. 99.8°. 
Resp. 22. 
25 
79 drops. 
6 drops. 
Coughs less than before. No expectoration. Still sweats a little at 
night. Appetite poor. No relative dulness. Slightly roughened 
respiration over middle of left front and at lower part of right axilla. 
Fine moist rales at left apex anterior and under left clavicle. Sibilant 
rales over left front. Right apex and front chiefly negative. Fine 
moist rales in left axilla. Signs chiefly negative in right axilla and 
over right back. (Very fine crepitation at inferior angle of right 
scapula.) Fine moist rales at left apex posterior. Occasional sibilant 
rales over left back. 
(Patient feels better.) 
VIII. 
Male. 
34 years. 
Single. 
Laborer. 
Family history neg- 
ative. 
Cough 2 years. Pneumonia in November, 1892. Cough now mod- 
erate. Expectoration mostly mucus. No night sweats (formerly had 
them). Has lost flesh (gaining now). Appetite fair. 
Relative dulness not especially marked. Roughened respiration 
over right front and in each axilla. Harsh respiration at right apex 
posterior. Roughened respiration over right back and over lower 
half left back. Fine moist rfiles at left apex anterior and below left 
clavicle. Occasional fine rales at right apex anterior. 
Larynx. Thickening of interarytenoid fold. Enlarged and im- 
movable right arytenoid. No movement of right vocal cord. 
April 17. 
166 pounds. 
(Former weight 195 
pounds.) 
3 v-vi. 
Tubercle bacilli 
present. 
1 P. M. 
Pulse 76. 
Temp. 97°. 
Resp. 24. 
June 23. 
169 pounds. 
3 ii-iii. 
Tubercle bacilli 
present. 
11 A. M. 
Pulse 64. 
Temp. 96°. 
Resp. 24. 
15 
30 drops. 
3 drops. 
Relative dulness not marked. Bronclio-vesicular respiration at left 
apex anterior. Slightly roughened respiration over left front. 
Bronclio-vesicular respiration at right apex anterior. Roughened 
respiration over right front and in each axilla. Broncho-vesicular 
respiration at right apex posterior. Roughened respiration over right 
back. Slightly roughened respiration at lower left back. Fine moist 
rilles at left apex anterior, under left clavicle and at right apex an- 
terior. Few fine moist rilles above left scapula. Larynx about the 
same as before. 
(Patient feels better.) 
IX. 
Male. 
35 years. 
Married. 
Laborer. 
Family history neg- 
ative. 
Cough 4£ months. Expectoration scanty, muco-purulent. Haemop- 
tysis 4 years ago. Has lost flesh. Appetite poor. Relative dulness 
not especially marked Roughened respiration in right axilla. Bron- 
cho-vesicular respiration at left apex posterior, over left back, and at 
right apex posterior. Roughened respiration over right back. Sus- 
picion of fine rilles at left apex anterior. Medium rales at right apex 
anterior. Suspicion of fine rales at left apex posterior. Sibilant 
rilles over left and right backs. Fine rales at right apex posterior. 
April 18. 
121J pounds. 
(Former weight 146 
pounds.) 
3 ii. 
No tubercle bacilli 
found. 
1.30 P. M. 
Pulse 76. 
Temp. 98°. 
Resp. 34. 
June 24. 
116J pounds. 
3 H. 
Small number of 
tubercle bacilli 
present. 
1 P. M. 
Pulse 84. 
Temp. 98.7°. 
Resp. 30. 
21 
67 drops. 
6 drops. 
No relative dulness. Bronclio-vesicular respiration at left apex an- 
terior. Slightly roughened respiration over upper half of left front. 
Bronclio-vesicular respiration at light apex anterior. Slightly rough- 
en eii respiration over right front anu in each axilla. Bronclio-vesicular 
respiration at right apex posterior, over upper half of right back, at 
left apex posterior and above left scapula. Occasional tine rales at 
right apex anterior. Occasional tine and medium rilles at right apex 
posterior and between right scapula and spine. 
(Patient feels better.) 
X. 
Male. 
46 years. 
Married. 
Furniture mover. 
Family history neg- 
ative. 
Cough one year. Expectoration muco-purulent. No haemoptysis. 
Dyspnoea on exertion. Night sweats. Has lost flesh. Appetite good. 
Relative dulness not marked. Bronchial respiration at left apex 
and over left front, at right apex posterior and over right and left 
backs. Broncho-vesicular respiration at right apex anterior and over 
right front, and in each axilla. Fine, moist rales at left apex ante- 
rior. Medium, moist rilles over left front. Fine and medium rales at 
right apex anterior, over right front, at right apex posterior, and 
over right back. Fine rales in left axilla and over upper half left 
back. Medium rales in right axilla. 
April 19. 
U7i pounds. 
3 iss. 
Tubercle bacill 
present. 
1.20 P. M. 
Pulse 88. 
Temp 99°. 
Resp. 28. 
June 16. 
117 pounds. 
3 v. 
Tubercle bacilli 
present. 
15 
45 drops. 
4 drops. 
Relative dulness not marked. Bronclio-vesicular respiration at left 
apex anterior. Bronchial respiration over upper half of left front. 
Bronclio-vesicular respiration at right apex ant. and over right front 
and in each axilla. Bronchial respiration at right apex posterior, 
over right back, at left apex posterior and over left back. Fine moist 
rilles at left apex anterior. Few sibilant rales at left apex anterior. 
Fine moist rales over upper half of left front. Medium moist rales at 
right apex anterior, over right front and in right axilla. Fine moist 
rales in left axilla. Medium moist rilles at right apex posterior, over 
right back and over upper half of left back. 
(Patient feels “ slightly better.”) SUMMARY OF ALL CASES TREATED AND RESULTS. 
Sex 
How long Sick 
Age 
Social Condition 
Fam. Hist, 
of 
Phthisis 
Bacilli 
in 
Sputum 
No Bacilli 
in 
Sputum 
Examina- 
tions of 
Sputum 
not made 
Duration 
of 
Treatment 
Number 
of 
Injections 
* Result on Examination 
Subjective Result 
S. 
M. 
Wid. 
Better 
Not Imp. 
Worse 
Better 
Not Imp. 
Worse 
1 
Females, 16 
2 mos. to 2 yrs. 
16 to 40 yrs. 
9 
6 
1 
9 
5 
4 
7 
1 to 128 days 
1 to 50 
2 
0 
3 
8 
8 
0 
1st Stage, 44 . . < 
( 
Males, 28 
2 mos. to 2 yrs. 
19 to 58 yrs. 
19 
8 
1 
9 
21 
0 
7 
1 to 72 days 
1 to 37 
1 
9 
2 
9 
IK 
1 
( 
Females, 2 
6 to 18 mos. 
28 to 35 yrs. 
0 
2 
0 
1 
2 
0 
0 
10 to 44 days 
7 to 5 
0 
0 
0 
0 
i 
1 
2d Stage, 8 . . < 
( 
Males, 6 
6 mos. to 3 yrs. 
29 to 54 yrs. 
3 
2 
1 
4 
4 
0 
2 
1 to 33 days 
1 to 15 
0 
l 
0 
3 
3 
0 
3d Stage, 2 . . 
Females, 2 
7 mos. to 3 yrs, 
20 to 35 yrs. 
1 
0 
l 
2 
2 
0 
0 
42 to 52 days 
4 to 17 
0 
0 
2 
1 
0 
1 
20 females, 34 males; total, 54. 
Av. 13 mos. 
Av. 3l£ yrs. 
32 
18 
4 
25 
34 
4 
16 
Av. 30 days 
Av. 9 
3 
10 
7 
21 
30 
3 
Group I. — Patients Treated with Gold and Manganese. 
Sex 
Largest Dose. 
Total Amount 
Injected. 
* Result on Examination 
Subjective Result 
Better 
Not Imp. 
Worse 
Better 
Not Imp. 
Worse 
1st Stage, 32 . . j 
Females, 16 
.24 gr. 
1 to 122 gtt. 
2 
0 
4 
8 
8 
0 
Males, 16 
.24 
1 to 79 
1 
3 
0 
6 
10 
0 
2d Stage, C . . | 
Females, 2 
.08 
4 to 6 
0 
1 
1 
Males, 4 
.16 
1 to 52 
2 
2 
0 
3d Stage, 2 . . 
Females, 2 
.16 
1 to 23 
0 
0 
2 
1 
0 
1 
20 females, 20 males; total, 40. 
3 
3 
6 
17 
21 
2 
Group II. — Patients Treated with Hunter’s Mod. B. 
( 
Females, 0 
1st Stage, 12 . . 1 
Males, 12 
.125 gm. 
.005 to 1.855 gm. 
0 
6 
1 
3 
8 
1 
( 
Females, 0 
2d Stage, 2 . . | 
Males, 2 
.075 
.025 to .076 
0 
1 
0 
1 
1 
0 
3d Stage, 0 . . 
0 
0 
No females, 14 males; total 14. 
0 
7 
1 
4 
9 
1 
Group III (taken from Group I).— Patients Treated First with Gold and Manganese, 
and Later with Hunter’s Mod. B. 
( 
Females, 4 
.100 gm. 
.025 to 1.095 gm. 
1 
1 
0 
3 
1 
0 
1st Stage, 9 . . { 
( 
Males, 5 
.020 
.005 to .050 
0 
0 
0 
0 
5 
0 
( 
Females, 0 
.. 
2d Stage, 0 . . \ 
l 
Males, 0 
3d Stage, . . . 
Females, 1 
.170 
5.430 
0 
0 
1 
0 
1 
0 
5 females, 5 males; total, 10. 
1 
1 
1 
3 
7 
0 
* The result on physical examination could not be ascertained In every case, since some patients stopped their visits 
unexpectedly, before a final examination could be made. in others not appreciably affected. Night-sweats usu- 
ally ceased. The general appearance and feelings of 
the patients improved, and they did not hesitate to 
declare themselves greatly benefited. 
On making a physical examination of a patient after 
a few injections, the former condition of things may 
be somewhat aggravated. At such a time I have found 
the signs more marked, especially the auscultatory 
signs ; later the results were variable. 
The theory that the preparation of gold is eutrophic, 
while the manganese is anti-auaemic, seems to be well 
borne out. That an improvement can be secured in 
some cases I feel quite confident, but as to complete 
and permanent recoveries I am not so certain. 
The exact way in which these injections affect the 
pulmonary tissue is more or less a matter of conject- 
ure ; nevertheless, the remedy appears to act as a tonic 
to the waning strength of the patient, also to cause a 
certain amount of irritation and inflammation around 
the foci of infection (as sometimes shown by bloody 
sputum after a large dose), which may eventually re- 
sult in an encapsuling of the pathological portions, or 
their replacement by dense fibrous tissue. 
However, be it as it may, the subcutaneous use of 
the chloride of gold and sodium with the iodide of 
manganese certainly improves the majority of patients 
subjectively; and if a cure does not result, they are 
at least in a most promising condition for treatment by 
modified tuberculin or its allied products. The strong- 
est argument in favor of this treatment is the fact that 
when properly given no injury can be done, while 
there is great probability of an improvement if not a 
cure. 
Appended is the full report of ten cases treated by 
gold and manganese, also the tabulated report of fifty- 
four cases, — some having been treated with gold and 
manganese, and some with Hunter’s modification B. 
(kindly furnished by Dr. Trudeau of Saranac Lake, 
N. Y.). 
In regard to the latter method of treatment, I will 
briefly state, that while not obtaining the results of 6 
Dr. Trudeau, I found much in its favor to warrant a 
further trial. 
I have also been using for several months Klebs' 
Tuberculocidin, and so far with considerable satisfac- 
tion. 
In connection with this paper, I wish to thank Dr. 
E. M. Greene for his valuable services in the exami- 
nation of sputum, and Dr. F. C. Cobb for laryngeal 
work, also Mr. Wm. C. Durkee, Ph.G., for most per- 
fect chemical work, and Dr. E. O. Otis for kindly 
suggestions.