THE LIBRARY 
 
 OF 
 
 THE UNIVERSITY 
 OF CALIFORNIA 
 
 LOS ANGELES 
 
 GIFT OF 
 
 SAN FRANCISCO 
 COUNTY MEDICAL SOCIETY
 
 A HANDBOOK 
 
 LOCAL THERAPEUTICS 
 
 GENERAL SURGERY, BY RICHARD H. HARTE, M.D., 
 
 DEMONSTRATOR OF OSTEOLOGY AND SYNDESMOLOGY, UNIVERSITY Of PENNSYLVANIA ; SURGEON TO 
 
 THE EPISCOPAL AND ST. MARY'S HOSPITALS; CONSULTING SURGEON 
 
 TO ST. TIMOTHY'S HOSPITAL. 
 
 DISEASES OF THE SKIN, BY ARTHl/R VAN HARLINGEN, M.D., 
 
 PROFESSOR OF DISEASES OF THE SKIN IN THE PHILADELPHIA POLYCLINIC AND COLLEGE FOR GRADUATES 
 
 IN MEDICINE; LATE CLINICAL LECTURER ON DERMATOLOGY IN JEFFERSON MEDICAL 
 
 COLLEGE; DERMATOLOGIST TO THE HOWARD HOSPITAL. 
 
 DISEASES OF THE EAR AND AIR-PASSAGES, BY HARRISON ALLEN, M.D. 
 
 CONSULTING PHYSICIAN TO THE RUSH HOSPITAL FOR CONSUMPTION; LATE SURGEON TO THE 
 PHILADELPHIA AND ST. JOSEPH'S HOSPITALS. 
 
 DISEASES OF THE EYE, BY GEORGE C. HARLAN, M.D., 
 
 SURGEON TO WILLS EYE HOSPITAL, AND TO THK EYE AND EAR DEPARTMENT OF THK PENNSYLVANIA 
 
 HOSPITAL; EMERITUS PROFESSOR OF DISEASES OF THE EYE, 
 
 PHILADELPHIA POLYCLINIC, ETC. 
 
 EDITED BY 
 
 HARRISON ALLEN, M.D, 
 
 PHILADELPHIA: 
 
 P. BLAKISTON, SON & CO.,. 
 
 1012 WALNUT STREET. 
 1893.
 
 COPYRIGHT, 1893, BY P. BLAKISTON, SON & Co. 
 
 PRESS OF WM. F. FELL & Co., 
 
 1220-24 SANSOM ST., 
 
 PHILADELPHIA
 
 330 
 
 PREFACE, 
 
 A number of circumstances induced the authors to undertake the pre- 
 paration of this book. It was known that no text was available in which 
 the local actions of drugs were not subordinated to their general actions. 
 In the lines of special medicine, as represented in General Surgery, 
 Dermatology, Otology, Rhinology, Laryngology, and Ophthalmology, 
 it was believed that the topical uses of drugs are among the most 
 important to which they can be put, and that statements concerning 
 them from experienced practitioners would be acceptable to the pro- 
 fession. It was further assumed that the changes brought about by 
 the theories of asepsis had made it desirable that the entire range of 
 local medicaments be revised. 
 
 Of late years, through the extraordinary activity of chemists, the num- 
 ber of agents which affect tissues locally has been greatly increased. 
 Many of these substances are yet on trial. To present a succinct account 
 of their sources and properties would appear to be a useful effort. 
 
 The book is intended more as a guide to treatment than as a disquisi- 
 tion on local medication. Conceding the value of many new drugs, the 
 authors have faith in the judgments of the older practitioners who 
 secured good results from limited resources. Neither have remedies 
 of the household been ignored, as really valuable hints for local treatment 
 may be gleaned from among them. 
 
 While it is acknowledged that errors of judgment may have been com- 
 = mitted in excluding some drugs whose properties have been praised, a 
 ; greater error would have been to endorse imperfectly attested novelties. 
 
 The divisions of the main subjects are seen occasionally to overlap. 
 
 ' It is hoped that the instances in which this occurs will tend to' reinforce 
 
 the teaching rather than to weaken it. Procedures are noted which are 
 
 usually treated of in books on minor surgery (as in the account of fixation 
 
 of dressings) ; as well as descriptions of the systematic actions of drugs 
 
 (as in lard and the actions of fats). "Anesthetics" and "bleeding" 
 
 it must be conceded are on the border line between local and general 
 
 j therapeutics. 
 
 Since a book on the local actions of drugs will be naturally used for 
 * reference, the plan of the United States Pharmacopoeia has been followed, 
 
 624247
 
 X PREFACE. 
 
 and when practicable, definitions have been quoted from this authority. 
 But it was not thought always advisable to accept so admirable a guide. 
 Thus petroleum is taken as a general heading, under which the sub-titles 
 rhigolene, kerosene, petrolatum, and paraffin appear. 
 
 It would have been easy, with the facilities at hand, to load the book 
 with literary references, but none have been made except to give honor 
 where honor is due, and to invite the reader to consult original com- 
 munications. 
 
 The latest authorities have been followed in the spelling of technical 
 words. For the most part the final "e" of terms such as glycerin 
 and gelatin has been dropped. The names of unofficial preparations so 
 far as possible are left in the forms selected by the authors cited. Thus 
 the formulae for medicated cottons are embraced under the name of 
 "cotton-wools," as designated by Woakes. 
 
 Each author is responsible for special statements made by him, while 
 the authors unite in approval of all general statements. With a full 
 appreciation of the importance of the intricate and varied information 
 conveyed, they resolved to submit all pharmaceutical and chemical 
 statements to rigid scrutiny. They deem themselves fortunate in having 
 obtained for the pharmaceutical data a critical revision at the hands of 
 Dr. George I. McKelway, Obstetrician and Gynecologist to the Phila- 
 delphia Hospital, whose experience, first as a pharmacist and afterward 
 as a physician, renders his aid peculiarly acceptable ; and for the chemical 
 data the assistance of Henry Trimble, Professor of Analytical Chemistry, 
 Philadelphia College of Pharmacy. As the sheets have passed through 
 the press they have been carefully revised by the latter, especially as to 
 the composition of many of the recently announced preparations. 
 
 The authors are indebted to many sources for information. Dr. Allen 
 wishes especially to acknowledge courtesies received from W. E. Cassel- 
 berry, of Chicago; S. H. Chapman, of New Haven; S. Solis- Cohen and 
 James Truman, of Philadelphia ; S. Johnston, of Baltimore ; F. Hinkle, 
 of Buffalo; and E. L. Shurly, of Detroit. Messrs. Frank E. Morgan 
 and Henry A. Borell, of Philadelphia, rendered valuable aid in giving 
 the composition of unofficial formulae. 
 
 The carefully prepared index is the work of Dr. Thomas F. Branson, 
 Resident Physician of the Pennsylvania Hospital.
 
 INTRODUCTION. 
 
 On the Local Action of Remedies. Since much of the success 
 of local medication depends upon the method adopted and the manner 
 in which details are carried out, the following general comments may 
 prove useful : 
 
 (1) All forms of inspissated secretions, desquamations and filth are 
 in themselves exciting causes of disease ; therefore the selected lotion, 
 unguent, or powder is not to be applied until surgical cleanliness is 
 secured. The skin is to be freed from detritus and fat, and, so far as is 
 practicable, the mucous membrane from mucus. The surface, if that of an 
 ulcer, should be cleansed of exudates. 
 
 (2) In congestion it must remain a matter of judgment whether or not 
 to deplete the blood-vessels before the employment of an anodyne or 
 an astringent. It is certainly true that an agent will often fail on a region 
 where the smaller vessels are constricted when it will succeed on one 
 where they are of normal diameter or even dilated. 
 
 (3) It is necessary to remember that agents act in exact correlation 
 to the structures to which they are applied. Bone, periosteum, or the 
 mucous membrane covering the alveolar processes and the roof of 
 the mouth, must be attacked by stronger preparations than are safe to be 
 used on the conjunctiva or the urethra. Even different regions of the 
 general skin surface demand that discrimination be exercised in the 
 choice of strength of remedies. To enforce the value of this remark, 
 it is only necessary to contrast such localities as the sole, the palm, the 
 scalp, and the region of the nape of the neck, with the scrotum, the 
 perineum, the eyelids, and the mammae. A drug may excite in the one 
 instance, but excoriate or destroy in the other. 
 
 (4) Unless the constringing effect of cold be especially indicated, 
 local applications should be of the temperature of the body, or slightly 
 above it. Elevation of temperature may make the difference between 
 success and failure. As a rule, all inhalations should be warm. Lotions 
 to the nostrils and the throat are almost always increased in efficacy if 
 the temperature is raised to 140 F. 
 
 (5) Thf. local uses of drugs, other than those which act as germicides, 
 are subject to sharp limitations. Few of them are free from evil effects 
 
 xi
 
 Xll INTRODUCTION. 
 
 consequent upon prolonged use. It is well to recall the possibility of 
 undue absorption of the agent, as in the case of nitrate of silver, and 
 that the parts may become accustomed to the first impression made 
 upon them, and no longer respond. In the case of astringents and exci- 
 tants, it is best to begin with mild formulae, and if the case does not 
 improve steadily, to increase the strength of the drug or exchange it for 
 another of the same group. Emollients are often abused. Warm water 
 dressings, poultices, etc., when long continued do more harm than good. 
 The evils arising from the undue action of cold are universally recog- 
 nized. Over use of stimulating applications often occurs in the treatment 
 of chronic inflammation of the mucous surfaces. 
 
 The use of drugs which entail habit-effects, such as opium, cocaine, 
 ether, chloroform, etc., must be carefully watched. 
 
 Remedies which are interchangeable are termed succedanea. An exten- 
 sive range of succedanea in the possession of the physician naturally 
 increases his resources. 
 
 (6) The recognition of conditions under which the processes of the 
 economy are conducted is essential to the intelligent use of many local 
 remedies. Special reference is here made to those which act by imbibi- 
 tion, osmosis, and digestion. 
 
 (7) The value of inunction is increased by gentle rubbing and friction; 
 by well-directed pressure, as shown in the use of the tampon and bougie 
 in the nasal passages, the uterus and the vagina ; by still more persistent 
 yet equable force, as that exerted by a bandage firmly adjusted to a limb ; 
 or even by a heavy weight, such as that of a sand-bag on the groin. 
 Remedies whose actions are thus controlled will accomplish results 
 which are sought for in vain when they are independently exhibited. 
 
 Even the aid of electricity is called into play to secure the absorption 
 of recalcitrant medicines. Cataphoresis , or anodal diffusion, which are 
 the terms given to this phenomenon, demands especial notice. B. W. 
 Richardson {Med. Times and Gaz., 1859) described under the name of 
 ' voltaic narcotism" phases of local anaesthesia determined by an 
 electrical current. Solutions of morphine, aconitin, and chloroform were 
 used. Hermann Munk (Arch. f. Anat. und PhysioL, 1873) placed the sub- 
 ject of cataphoresis upon a scientific basis. Valuable clinical contributions 
 have appeared in this country, notably papers by F. Peterson (Med. 
 jRec., January 31, 1891) (from whose writings this account is condensed), 
 and J. L. Corning (N. Y. Med. Journ., November 6, 1886). The chief 
 drugs used for local anaesthetic impressions are cocaine hydrochloride, 
 chloroform, and aconitin in the treatment of NEURALGIA and for minor 
 operations on the skin. Iodide of potassium, iodide of lithium, and 
 diluted tincture of iodine have been successfully exhibited in the treat-
 
 INTRODUCTION. xiii 
 
 ment of SYPHILIS. Peterson extols the use of salts of lithium notably, 
 the chloride, the benzoate, and the citrate for RHEUMATISM and GOUTY 
 SWELLINGS. Among mercurials, the imidosuccinate and the bichloride 
 maybe mentioned. 
 
 The following tentative classification of the action of local remedies 
 may be found useful. 
 
 All remedies act locally, (i) By restoring the normal functions, e.g., 
 by stimulating the blood to flow through a congested region, or by exciting 
 gland-action and thus promoting secretion. 
 
 (2) By protecting a denuded surface, thus giving it rest. A protectant 
 is also of use in excluding microbes and irritating constituents of the 
 atmosphere. 
 
 (3) By means of absorption from the surface ; thus constricting the 
 small blood-vessels and checking hemorrhage; producing changes in the 
 iris by instillation in the conjunctival sac ; creating anodyne impressions 
 on peripheral nerve-ends for the relief of pain ; inducing counter- 
 irritation and transudation of serum, as in the action of vesicants. 
 
 (4) By destroying tissues, as in the action of caustics. 
 
 But since remedies are rarely simple in their actions, a few remarks on 
 the more important of these are here introduced. 
 
 The action of astringents is complex in the effects upon mucous sur- 
 faces. The first effect, doubtless, is to coagulate the albumin ; the 
 second is to constrict the arterioles ; the third is to excite the parts. A 
 fourth and less evident effect than the foregoing is to cauterize the tissues. 
 All the more powerful astringents are thus caustic in full strength when 
 applied to delicate structures, such as polypoid growths of the middle 
 ear. The list of caustics would be greatly increased if all the agents 
 which had such destructive effects were herein enumerated. 
 
 Astringents also probably act by direct excitation of terminal nerve fila- 
 ments. When used in strong solution, or in excess, it is easy to discern 
 why an astringent may become an irritant. The coagula are somewhat 
 dense and not always easily removed ; they may light upon sensient 
 surfaces and behave as foreign bodies. It is well, therefore, after the use 
 of astringents (especially on a mucous surface) to flush the parts carefully 
 with a neutral or slightly alkaline solution. Care must be taken to pre- 
 vent destruction of the olfactory regions by the indiscriminate use of 
 astringents. Astringents are not easily dissolved in an oily fluid. (See 
 lodo- Tanning 
 
 The secretion of mucous glands tends to macerate and in a measure 
 to remove exudations; not only is this the case, but the local remedy, 
 especially if it be of an astringent character, acts upon the secretion by 
 i
 
 XIV INTRODUCTION. 
 
 coagulating the albumin, thus converting a transparent, varnish-like, 
 tenacious liquid, which covers the tissues with a uniform layer, into a 
 white and opaque mass, enabling the physician to readily remove it. It 
 is probably owing to this fact namely that most astringents coagulate 
 albumin that this group of agents is of such marked value in the 
 treatment of catarrh. While haemostatics constrict the vessels in the 
 region to which they are applied, they in some instances excite vaso- 
 motor reflexes by which vessels can be constricted in a remote region. 
 For example, cold applied to the skin of the back of the neck is well 
 known to have a tendency to constrict smaller blood-vessels in the nose 
 or lungs and thus aid in arresting an attack of epistaxis or haemoptysis. 
 Wet compresses to the skin of the side of the throat are useful in con- 
 trolling inflammation of the mucous membrane of the mouth and 
 pharynx. 
 
 Alkalies in weak solution, besides acting as solvents of tenacious 
 mucus, are often germicides, as is seen in the destruction of the microbe 
 of APHTHAE. It is probably true that they thus prove useful in controlling 
 superficial inflammations and in favorably modifying catarrhal states. 
 
 Concentrated preparations of alkalies are caustic, as, indeed, are most of 
 those agents which in general therapeutics are classed as alteratives. 
 Alkalies, by their affinity for water and their solvent action on tissues, 
 act mainly by abstracting the water and will destroy skin or other 
 structures to a considerable depth. Caustic alkalies are more solvent 
 and destructive than the remaining members of the group. They possess 
 widely diffusive power. 
 
 The term solvent (dissolvent), while one convenient to use is not of 
 much significance in describing the action of a remedy ; ordinarily it 
 implies the conversion of a solid (unabsorbable) into a liquid (absorbable) 
 form as the dissolving of a concretion by an acid ; but it often implies 
 diluting an inspissated or tenacious secretion or exudate. It is evident that 
 the normal secretions may thus dilute, as well as lotions or other watery 
 preparations. Digestive solvents act in the presence of animal ferments. 
 
 General Remarks on the Methods of Using Remedies. 
 
 Among the methods of using local remedies may be named the follow- 
 ing : 
 
 Powders blown upon the affected part (applied particularly to the use 
 of "snuff") are said to be insufflated; when flirted on an exposed 
 surface they are said to be dusted. 
 
 When a fluid is broken up to form a fine vapor, it is said to be vapor- 
 ized ("nebulized"). Many vaporized fluids are volatile. When a
 
 INTRODUCTION. XV 
 
 current is broken up to form a relatively coarse medium it is said to be 
 atomized. Atomized particles of water are thrown with the force of 
 compressed or heated air by appropriate apparatus termed atomizers or 
 sprayers. 
 
 The use of smoke when inhaled constitutes fumigation, though this term 
 is also employed to express the application to the skin of a volatile disin- 
 fectant, and to describe the use of vaporized mercury in the treatment of 
 SYPHILIS. The local application of an oil or fat constitutes inunction. 
 
 The use of brushes in dusting powders or applying lotions and pig- 
 ments has given way in great measure to the employment of dossils 
 {pledgets} of cotton. These are much more cleanly, and are practically 
 without cost. Cotton in its various forms and fabrics is extolled by 
 modern writers for many uses in local medication. (See Gossypium.} 
 Medicated cottons (often spoken of in the text as "cotton-wools") 
 meet numerous indications in the form of tampons. In like manner the 
 use of sponges as tents and absorbent dressings has been largely super- 
 seded. 
 
 A liquid when used to lave a large surface is called a lotion ; when for 
 receiving the body it constitutes a bath; when used in establishing a 
 continuous flow (irrigation), as in flushing the ear, nasal chambers, 
 the uterus, vagina, etc., it is described as a douche ; when especially 
 adapted to rinsing the mouth and pharynx it forms a gargle ; when used 
 as a paint it forms a pigment. While convenient for domestic use the 
 douche can be a mischievous agent, especially in the treatment of the 
 nasal passages and the external ears. Otitis media has been often 
 induced by the first-mentioned use and vertigo and pain by the last,. If 
 used at all it needs the utmost caution. The body of water in the 
 receiver is often too large and placed too high. No greater degree of 
 pressure on the current in the nozzle should be permitted than is de- 
 manded to secure a return flow. 
 
 Pigments may be either oily or aqueous, though it is more common to 
 speak of anointing when an oily substance is applied in bulk. 
 
 An ointment is " a topical application of such consistence that it may 
 be easily rubbed on the skin, becoming gradually liquefied." (Nat. Med. 
 Dictionary.} A fatty base is assumed. 
 
 The use of the term paste is reserved for a mass of the consistence of 
 an ointment, which is for the most part a convenient means of controlling 
 the effects of powerful caustics. (See Vienna Paste, London Paste, 
 Conquoirf s Paste, .) 
 
 General Remarks on the Uses of Ointments, Plasters, 
 Douches, etc., in General Surgery. Ointments and cerates are not 
 now employed to the same extent in surgical therapeutics as formerly,
 
 XVI INTRODUCTION. 
 
 although when skillfully used they are valuable agents. Like many help- 
 ful topical applications, they have been abused. All varieties of bases or 
 fatty substances have been employed for making ointments, but lard, 
 petrolatum, and lanolin are now usually preferred. Whatever base is 
 selected it must be fresh and of the best quality. Care should be exer- 
 cised that when medicinal agents are added thereto they should be in the 
 finest possible state of subdivision and free from particles of "grit, v etc. 
 When extracts are added, if not uniformly soft they should be made so by 
 trituration with water or alcohol, according to their nature. When pro- 
 perly made an ointment should be of the consistence of butter at a 
 temperature of 60 F., and when placed in contact with the body should 
 gradually soften. Many ointments if kept long become rancid, which 
 renders them valueless. This condition is often masked by the addition 
 of substances by the dispenser in order to disguise odor. Ointments 
 are employed in surgery to meet one or more of the following indi- 
 cations: 
 
 1. As unirritating and protective dressings to wounds and granulating 
 surfaces. 
 
 2. As stimulating and protective dressings to chronic and indolent 
 ulcers. 
 
 3. As means of impressing the glandular system with resolvent 
 agents. 
 
 4. As means of affecting certain portions of the system with alterative 
 or constitutional remedies. 
 
 5. To induce counter-irritation. 
 
 6. To secure astringent and sedative effects on mucous surfaces. 
 
 The results obtained from the use of ointments depend largely upon 
 the manner in which they are employed. If used as a protective dress- 
 ing to wounds or granulating surfaces an ointment is best applied by 
 being evenly spread on the smooth side of patent lint or Canton flannel, 
 from one-twelfth to one-sixteenth of an inch in thickness. When a sur- 
 face is to be covered the cloth on which the mass is spread should be so 
 fashioned as to cover only the selected spot. If the covered surface be 
 of large size, a few fenestra? should be made so as to permit the escape of 
 discharges. On each reapplication of the ointment the skin should be 
 thoroughly cleansed with turpentine, soap and water, and alcohol. If 
 such a course be pursued, the activity of the agents will be maintained 
 and their absorbing powers increased. 
 
 The absorption of an ointment by the skin, especially over a large 
 area, can be greatly facilitated by covering the selected surface with a 
 properly prepared flaxseed poultice. In peritonitis the absorption of 
 mercurial ointment by this method has been sufficient to affect the gums 
 in twenty-four hours.
 
 INTRODUCTION. Xvii 
 
 When the absorption of the ointment is to be accomplished by 
 friction or inunction, the character of the base is important ; it should 
 readily soften with the temperature of the body and should not become 
 tenacious or gummy with friction. This is one of the objections urged 
 against lanolin when employed in its pure state. This difficulty can be 
 successfully met by the addition of a small portion of olive oil. Since 
 the flexor surfaces of the limbs are rich in absorbents this region is pre- 
 ferable for the employment of such a method. 
 
 The inunction should not be applied twice in succession to the same 
 surface, which should be permitted to be free from the unguent for 
 twenty-four hours after the skin has been thoroughly cleansed. Irritation 
 of the skin or hair follicles frequently follows. 
 
 Ointments are frequently applied to the mucous surfaces of the genito- 
 urinary tract and the rectum. To apply an unguent to the male urethra 
 requires some mechanical contrivance, of which many are to be found in 
 the shops. A simple method of applying an ointment (see Zinci oxidutri), 
 is by means of a properly prepared olive-pointed bougie, or by having the 
 ointment dispensed in a collapsible tube, such as are employed by artists 
 for holding colors. On the end of such a tube a piece of rubber 
 tubing of small calibre is placed which is gently inserted into the urethra. 
 By firm and gentle pressure the ointment is thus forced far back in the 
 canal with little difficulty. When it is desired to apply an unguent to 
 the rectum and the anal margin, it may be done best by anointing 
 the finger and gently inserting it through the sphincter. If it is desired 
 to impress the surfaces higher up, a suppository of cocoa-butter will be 
 found more convenient. 
 
 Plasters (emplastra) are employed (i) as a means of support after the 
 approximation of broken or cut surfaces, and for the retention of 
 dressings; (2) to produce counter-irritation, (3) for the exhibition and 
 administration of remedies. 
 
 Most plasters contain litharge and olive oil, or resinous substances, 
 which at ordinary temperatures are firm and non-adhesive (soap plaster 
 is soft at ordinary temperature), but which when exposed to a higher 
 temperature than the body soften and become adhesive, and when placed 
 in contact with the skin adhere firmly. In heating plasters, either for the 
 purpose of spreading or for application, the temperature should never be 
 raised beyond 212 F., or decomposition may be produced and volatile 
 substances upon which the virtues of the preparation depend may be 
 driven off. Plasters are usually spread on leather, sheep skin, chamois, 
 or muslin, according to the purpose for which they are intended. A 
 plaster spread on leather is ordered when it is to be applied to 
 unbroken skin, and when the relief of pressure, or the necessity of 
 support is indicated. A plaster spread on muslin is used as a dressing
 
 XV111 INTRODUCTION. 
 
 on an abraded or ulcerated surface, or as a protectant on the approxi- 
 mated edges of a wound. Plasters spread on muslin and incorporated 
 with India-rubber to insure adhesive properties have of late been 
 introduced. When well made these are efficient, but, unfortunately, 
 many such plasters for sale in the shops are worthless. On the whole, it 
 is best to rely upon plasters made after the directions of the U. S. P. 
 Plasters are sometimes perforated with small holes to allow portions of 
 the skin to be exposed to the air. In selecting plasters for surgical 
 dressings, as in fixation apparatus for chronic diseases of the hip joint 
 in children, it is often advisable to perforate the plasters used in making 
 extension before applying them to the skin, especially when they are to 
 be kept long in position. It must be remembered in the employment of 
 plasters containing substances of the class of belladonna, opium, etc., 
 that toxic impression has ensued in persons having delicate skins, or in 
 subjects exhibiting idiosyncrasies to the effects of the drugs employed. 
 
 Douches and injections are applied in surgery to the mucous surfaces of 
 the rectum and genito-urinary tract for their sedative, astringent, deter- 
 gent, and antiseptic effects. It must be borne in mind that the sensibility 
 of the mucous surfaces vary according to the part affected ; thus, solutions 
 that can be readily borne by the vagina will prove unbearable to the 
 bladder or urethra. To secure the best results, explicit directions must be 
 given in ordering any special line of treatment, which, in nearly all cases, 
 is carried out by the patient. Most of the unsatisfactory results obtained 
 are attributable to ignorance or inability to carry out the directions 
 given. The male genito-urinary tract is frequently the seat of specific 
 inflammation, to which an immense amount of indiscriminate and mis- 
 judged medication is applied. Before ordering an injection or douche, 
 the point of disease should be localized, and all attempts concentrated as 
 much as possible upon the affected part. 
 
 Injections should be administered immediately after urinating, which 
 in itself tends to cleanse and flush the mucous surfaces ; so that when a 
 medicated solution is thrown into the canal its full effect can be produced 
 on the lining membrane. The patient should be in the sitting posture, 
 well forward on the edge of a chair. The penis should be held between 
 the thumb and fingers of the left hand, the former directly above the 
 meatus. By gentle pressure the meatus is opened, the nozzle of the 
 syringe is introduced, and its contents are thrown into the urethra. 
 Upon its removal the meatus is closed with the fingers. While in this 
 position, gentle stroking pressure is made over the under surface of the 
 penis with the right hand, which will insure the solution's coming in con- 
 tact with all portions of the canal. 
 
 With some persons care must be exercised that the fluid which may 
 carry before it septic materials, or in itself be a source of irritation, is not
 
 INTRODUCTION. xix 
 
 thrown into the bladder. To obviate such an accident the patient should 
 sit on a folded towel or compress, which will cut off the deep urethra. 
 
 When it is desired to impress certain portions of the urethra with strong 
 solutions, they are best conveyed by specially prepared instruments with 
 long nozzles, or through a speculum. 
 
 All medicated solutions should be diluted, their strength being gradu- 
 ally increased by reducing the amount of water according to the sensations 
 of the patient. 
 
 In douches and injections we possess convenient means of making 
 topical applications to the bladder. Many instruments have been 
 devised, known as two-way catheters, which will insure the passage of a 
 continuous current. Theoretically these would appear to fill all indica- 
 tions. We have found that satisfactory results can be obtained by the 
 use of a soft English catheter, which is the least irritating, and conse- 
 quently the best for the patient. A rubber bottle, holding about four 
 ounces, and fitted with nozzle and stop-cock, or a tight-working hard 
 rubber syringe, the nozzle of either of which is easily introduced into the 
 catheter, is used, and the desired amount of fluid is gently and slowly 
 thrown into the bladder (two or three ounces probably sufficing), and 
 allowed to remain there for a short time. This process may be repeated 
 two or three times, until the return fluid indicates that the object 
 intended has been attained. Care must be exercised that air does not 
 find admission into the fluid, as its presence tends to decompose the 
 urine, especially if bloody. (For vaginal douching or injecting see 
 Aqua, p. 95.) Douches or injections are employed in the rectum for a 
 great variety of purposes, as for the removal of impacted faeces or asca- 
 rides, or to convey medicated or nutritive substances. If it is desired 
 that fluid should extend far up the bowel, the patient should be in a 
 recumbent posture on the left side, with the hips slightly elevated. The 
 fluid is preferably thrown from a fountain syringe held at a slight eleva- 
 tion above the pelvis. This will insure a slow but steady current, allow- 
 ing the mucous surfaces to become gradually accustomed to it, whereas, 
 if rapidly thrown in, the fluid will soon be rejected. 
 
 General Remarks on Local Treatment of Diseases of the 
 Skin. External applications to the skin are intended either to remove 
 debris or effete matters, and so to allow of the direct application of 
 remedies to the diseased parts, or they are employed with a curative 
 intent. 
 
 Among the first class are baths, wet compresses, poultices, etc. 
 
 Those applications, which are intended to act directly upon the diseased 
 parts, are sedative, astringent, stimulant, alterative, caustic, and parasiticide. 
 
 Sedative applications are usually applied in the form of lotions, baths,
 
 XX INTRODUCTION. 
 
 or powders. Some few ointments are directly sedative in their effect. 
 In acute inflammatory conditions lotions are usually acceptable. 
 These may be evaporating, or may be applied in such a manner as 
 to afford heat and moisture as well as a soothing influence. Where 
 there is much fluid exudation powders are sometimes employed to 
 check this, but their siccative effect is sometimes disagreeable, and they 
 should then be followed by a mild inert unguent. 
 
 Ointments made with lard are rarely to be employed as sedatives in 
 acute inflammatory conditions of the skin, because they become decom- 
 posed very easily and develop the fatty acids, which are highly irritating. 
 Petrolatum should usually form the base of sedative ointments. 
 
 Astringent remedies used in the treatment of diseases of the skin, 
 like the sedative remedies, are ordinarily employed in the form of 
 powders and lotions. Few remedies employed in the form of ointment 
 exercise any decided astringent effect upon the skin. Perhaps an ex- 
 ception may be made in favor of those containing tannic acid. 
 
 Stimulant remedies are ordinarily employed in the form of oint- 
 ments. The vigor and thoroughness of their application is an im- 
 portant element in their successful use. 
 
 Caustic applications are employed in both the solid and liquid form. 
 Their effect ranges from the most superficial removal of the epidermis to 
 a distinctive effect upon all tissues with which they come in contact. 
 The choice of a caustic in any given case must be made with due delibera- 
 tion, for, when applied wrongly, mischief may be wrought which is 
 irremediable. 
 
 The severer caustics should never be used in the neighborhood of the 
 larger blood-vessels or of important structures, and no caustic of high de- 
 structive power should be used upon a mucous membrane unless this can 
 be previously made dry and the part to be operated upon can be thor- 
 oughly isolated. 
 
 Parasiticide remedies are divided into two classes those intended to 
 destroy animal parasites and those intended to destroy vegetable para- 
 sites. These remedies are easily applied and have only a limited range. 
 They should never be of such a character as to injure the skin. 
 
 The remedies intended to cure the vegetable parasitic diseases cf the 
 skin are almost always of such a character as to cause desquamation 
 of the epidermis. Indeed, it is asserted, upon high authority, that we 
 have, strictly speaking, no true parasiticides applicable to the vegetable 
 parasites growing upon the skin, but that all the so-called parasiticides 
 act simply by causing an exfoliation of the epidermis, which carries the 
 parasite bodily away with it. 
 
 However this may be, the manner of application of the parasiticidal 
 remedies is more important than their choice. Unless thoroughly
 
 INTRODUCTION. Xxi 
 
 brought into contact with the offending organism, but little effect can be 
 expected. 
 
 In connection with the general subject of the topical application of 
 remedies to the skin, medicated soaps (see p. 397). may be mentioned. 
 These should have a well-made and non-irritating base, to which the 
 medicament may be added. Soaps form a very imperfect vehicle by 
 which to convey drugs to the deeper layer of the skin, but they may be 
 used to advantage as a preliminary to other treatment. 
 
 Baths are employed both to remove the products of disease, as scales, 
 crusts, etc., and to act directly upon the skin. 
 
 Simple baths of warm water soften the epidermis and allow the removal 
 of waste material and of the products of exudation. Baths are also used 
 as a vehicle to facilitate the introduction of medicinal agents. The 
 application of warm water also has a sedative effect upon the skin. (See 
 Baths, pp. 98, 456.) 
 
 General Remarks on Local Treatment of Diseases of the 
 Respiratory Tract. While the lotion implies a lavement for medicinal 
 purposes to a portion of the skin or mucous membrane, the gargle is 
 restricted to the method of self-use of a lotion to make direct application 
 to the pharynx. Lotions are used as gargles or by the syringe and 
 douche. 
 
 In order to gargle the pharynx with effect, the fluid is carried into the * 
 throat as in the act of swallowing. The first and second parts of this act 
 are completed, but as the fluid is about to pass from the pharynx to the 
 oesophagus it is regurgitated (the inclination of the head forward facili- 
 tating) and the fluid is ejected from the mouth and nasal chambers. 
 
 The value of the gargle depends upon the force exerted by the muscles 
 of the pharynx. When this is impaired either by not being called into 
 play, as in the instinctive avoidance of pain, in inflammation and 
 cancer, or in paresis, as in the sequelae of diphtheria, gargling is an unreli- 
 able means of treatment. In the young and the aged its significance is 
 almost nil. Old people with stiff necks (all persons with torticollis) do 
 not like to gargle. Gargling, when well performed, is efficient in dis- 
 tributing the lotion throughout the recesses of the side spaces of the 
 pharynx in a manner more thorough than is possible in any other way. 
 The fact must be conceded, however, that the practitioner is never sure 
 of such a result being secured. Many patients frankly acknowledge 
 their inability to clean the throat by this means. M. Mackenzie denies 
 that the gargle is of any use in disease which exists behind the mouth. 
 Since sprays have been so generally introduced the gargle is less used 
 than formerly. Bremen (Monats. fur Ohrenheilk., No. 4, 1887) claims
 
 XX11 INTRODUCTION. 
 
 that the fluid can be thrown directly into the bronchi. It is to be con- 
 ceded that sprays, since they are independent of the volition of the 
 patient, possess advantage over the gargle. Yet they are apt to excite 
 distress if they are used under a high degree of compression, do not 
 reach the recesses at the side of the pharynx and are liable to variations 
 in intensity and size of atoms (drops) ; and the spray apparatus is so apt 
 to get out of order that directions are often futile. Two kinds of sprays 
 are named, the coarse and the fine. The coarse spray is preferable in 
 the treatment of nasal, naso-pharyngeal, and oro-pharyngeal conditions, 
 since the force by which the fluid is driven dislodges tenacious secretions. 
 But in the treatment of the larynx and lungs the coarse spray is not so 
 satisfactory, as it is too heavy to be influenced by the current of inspired 
 air and readily condenses upon the walls of the pharynx and soft palate. 
 The number of times each spray inhalation should be used in the throat 
 varies according to circumstances. If intended to promote suppuration 
 by means of moist heat the application of sprays should be kept up con- 
 tinuously if practicable at least should be used as often as can be done 
 with comfort. For CHRONIC LARYNGITIS it should be used three or four 
 times a day and about five minutes each time. M. Mackenzie considers 
 that the best times for using steam inhalations are night and morning, 
 allowing five minutes for each exposure. Six inspirations should be taken 
 in a minute. 
 
 An inhalant is a remedy which is diffused in the air and is drawn in the 
 nose, mouth, and throat by the act of breathing. It is thus opposed to 
 the spray, in which the remedy is thrown in. 
 
 It may be accepted tentatively that no form of the vapor of water can 
 be relied upon to carry medicinal agents in the respiratory passage further 
 than the larger divisions of the bronchial tubes. 
 
 It is far different with volatile substances. The vapor of ether and 
 chloroform and of the numerous volatile oils presumably reaches the 
 alveoli of the lungs and is absorbed by the pulmonic vessels. Many of 
 the volatile oils yield stimulating inhalants, which are conveniently com- 
 bined with steam. These are indicated in chronic inflammation, accom- 
 panied with hyper-secretion. In the judgment of many practitioners 
 stimulating inhalations are of doubtful worth, since the agents cannot be 
 used in strength sufficient to relieve the symptoms without exciting 
 spasm of the glottis or other irritative effect. This is less true than 
 formerly, owing to the increase of the number of agents from which 
 selections can be made, while for the sedative and antispasmodic inhal- 
 ants, whether used in the medium of steam or otherwise, no doubt 
 remains of their value in many conditions of disease. Nevertheless, 
 inhalations must be used with discrimination to insure safety and suc- 
 cess.
 
 INTRODUCTION. XX111 
 
 Steam is the favorite inhalant. It is a convenient means of diffusing 
 moist heat. Like other forms of water, it tends to dilute mucus and 
 thus diminish its irritative power. It removes the sense of dryness so 
 common in acute affections of the throat. In TONSILLITIS it favors the 
 formation of pus, and is thus indicated when it is desired to hasten sup- 
 puration. Its use is contraindicated in PHARYNGITIS when there exist 
 relaxed states of the glands and membranes, with hypersecretion. It will 
 be observed that the uses and abuses of steam are much the same as those 
 of moist heat in other forms than steam. It can be variously medicated 
 by the use of apparatus known under the name of steam sprayers. 
 
 Steam should be inhaled, i. e., should not be forced in the nose and 
 throat. By reason of this, steam, the vapor arising from the surface of 
 water (ordinarily at the temperature of 145 F.), is often borne when 
 sprays excite irritation. In many individuals with irritable mucous mem- 
 branes, when an attempt is made to spray the throat the tongue instinct- 
 ively ascends at its basal half and occludes the passage of air. To 
 properly use the spray in such cases the mouth should be wide open and 
 the tongue depressed. If difficulty is experienced the nostrils must be 
 closed. If the trachea and bronchi are to be reached the inspirations 
 must be deep. 
 
 The term fumigation is employed for sublimated vapors from mineral 
 substances as well as for nascent fumes arising from the destruction by 
 ignition of organic substances. 
 
 Fumes of medicated cigarettes can be drawn into the middle ear by the 
 Valsalva method. (McNaughton Jones.) 
 
 Mercurial fumigation has been perfected by the late Mr. Langston 
 Parker, of Birmingham, and is spoken of highly by Lee, Duncan and 
 others. It acts in three different directions: i. by the introduction 
 of mercury into the system; 2. by diaphoresis ; 3. by the topical effect 
 of the remedy. 
 
 Troches (Trochisci : Lozenges) are official (U. S. P.). The directions 
 which are usually given for their manufacture is to mix the medicinal 
 agent with a small proportion of powdered tragacanth and a large pro- 
 portion of powdered sugar, and then to make a mass by rubbing the 
 resulting powder with liquid (either water or syrup) until a mass is 
 obtained. This is cut with suitable hand dies or by machinery into 
 troches usually weighing from ten to fifteen grains. Mackenzie used 
 black currant paste in place of sugar as the vehicle for the medicaments. 
 Black currant paste is made by expressing the juice from black currants 
 and mixing it with sugar. It is, a delightful vehicle for such purpose. 
 Troches are now made almost universally in a different way from that
 
 XXIV INTRODUCTION. 
 
 directed by the Pharmacopoeia ; dry powders are mixed and then sub- 
 jected to compression {tablets} in elaborate machines built for the pur- 
 pose. The term tablet is also given to a compressed powder from which 
 a lotion is made. 
 
 Troches act locally upon the walls of the mouth, pharynx, and oeso- 
 phagus. 
 
 Pastilles (gelatin discs) are lozenges composed of gelatine and glycerin. 
 They are variously medicated. W. M. Whistler (Med. Times and Gazette, 
 1878) states that pastilles are especially suited to cases of inflammation 
 of the tongue or palate; the mucilaginous nature gives much relief in 
 dryness of the throat ; the soft consistence renders them particularly 
 useful in cases of cesophageal disease. (See articles "Gelatin" and 
 "Glycerin.") 
 
 Powders. Powders to be efficient as protectants must be moderately 
 hygroscopic, such as starch and sugar, boric acid, etc., and the bulk of 
 the mass employed must bear a fixed relation to this quality. Many 
 powders, such as talc and lycopodium, take up moisture by imbibition 
 without themselves undergoing change. Powders must not be used too 
 fine, else the particles mat and form hard masses, beneath which con- 
 cealed accumulations of discharges occur. On the upright walls of the 
 nose, pharynx, and trachea very fine powder is less apt to retain position 
 than one that is used in a coarser form. 
 
 Powders are indicated in acute inflammation of the pharynx, since 
 their disposition is to diffuse by muscular action and motion of the adja- 
 cent parts. They afford a safe means of applying substances of caustic 
 strength in the pharynx and larynx. Salts of copper, lead, zinc, and 
 mercury should be used with great caution in form of powder, since it is 
 impossible to know how much of the agent may be swallowed ; on the 
 other hand, topical applications may be employed with a view to secur- 
 ing not only a topical but a general effect ; this is especially the case 
 in the treatment of syphilitic affections. In diphtheria the effect of 
 calomel applied on the exudate is measured by the character of the 
 stools. 
 
 Insufflations into the trachea can be best made by advising the patient 
 to take dej? p inspirations at the time the powder is thrown in. If the 
 instrument is pushed into the glottis it is, of course, possible to have the 
 powder pass into the trachea. (Schaffer.) 
 
 M. Mackenzie especially commends the use of powders in tracheal 
 affections. They are less apt to excite spasm than are liquids. A mass 
 the size of a bean may be thrown at a sitting. 
 
 That powders introduced into the nose can be inhaled is apparent
 
 INTRODUCTION. XXV 
 
 when the results of inhalation of coal dust in miners, particles of steel 
 in knife-sharpeners, etc., is remembered. According to Beltz (Archiv 
 fur Kinderheilk., Bd. x, Heft 5), WHOOPING COUGH" can best be treated 
 by insufflation of powders into the nasal chambers. 
 
 General Remarks on the Local Treatment of Diseases of 
 the Eye. Topical applications to the eye are detergent, soothing, 
 astringent, stimulating, caustic, antiseptic, mydriatic, or myotic ; and are 
 made by means of solutions, ointments, oils, or powders. 
 
 Solutions used in eye practice are known as collyria. The term " col- 
 lyria" was used bj Hippocrates and Galen to designate solid medica- 
 ments of a cylindrical form, intended for introduction into the vagina, 
 anus, ears, and nose a kind of suppository or bougie. Later it was 
 applied to all kinds of topical applications made to the conjunctiva, 
 whether fluid, solid, or in powder, but is now limited to solutions dropped 
 into the eye, and is practically synonymous with the popular expression, 
 "eye drops." Collyria are ordinarily applied by means of the pipette 
 with small rubber bulb, but, if this is not at hand, a simple glass tube 
 or quill will answer the purpose nearly as well. While the patient's 
 head is thrown backward, the lower lid is gently drawn down and the 
 solution dropped into the lower cul-de-sac of the conjunctiva. It should 
 be remembered that the strength of the application cannot be regulated 
 by the amount of fluid used, as not more than one or two drops will be 
 retained in the conjunctival sac. Usually an excess does no harm, but 
 when the mydriatics are used not more than two or three drops at most 
 should be applied. As an additional precaution against the constitu- 
 tional effects of the drug, it has been recommended to press the end of 
 the finger over the lachrymal canals for a few minutes, to prevent the 
 passage of the fluid into the nose and throat. When it is desired to act 
 upon the lachrymal passages, they should first be emptied by pressure 
 upon the sac, and the solution should then be applied freely to the inner 
 canthus. 
 
 When it is desired to flush the conjunctival sac for cleansing and anti- 
 septic purposes, as before, during, and after an operation, and in purulent 
 cases, a larger tube with an ounce rubber bulb is a very convenient instru- 
 ment. The sponge is not now much used. The old " eye cup," whose 
 edges fit within the margins of the orbit, is an easy and pleasant means 
 of making free applications of soothing washes. The eye douche, for 
 directing a spray against the closed lids, may be made by attaching a 
 nozzle, perforated with small holes, to a rubber tube connected with a 
 cup, or the "fountain syringe," to be held above the head; bu-t it is 
 now generally superseded by the atomizer.
 
 XXvi INTRODUCTION. 
 
 Oils are applied with the pipette, or by means of a pledget of absorbent 
 cotton. Ointments, when intended for the margins of the lids only, 
 should be used in very small quantity, to avoid irritating the conjunc- 
 tiva. A little is taken on the end of the forefinger and the edges of the 
 lids are simply anointed, so that there shall be a delicate film of the 
 ointment between them when they are closed. When it is intended to 
 act upon the cornea, a piece of the ointment the size of a pin's head may 
 be placed directly upon it, or be applied to the conjunctival surface of the 
 upper lid. 
 
 Powders were formerly " insufflated," or blown from a glass tube or 
 a quill upon the eyeball, but are now always " dusted " from a camel's- 
 hair brush. The handle of the brush is held between the forefinger and 
 thumb, while the brush is struck sharply with the little finger of the same 
 hand. 
 
 Drugs may also be applied to the eye in the form of soluble solids. 
 Medicated gelatin discs for this purpose have long been made by Savory 
 and Moore, of London, and were occasionally used in Philadelphia some 
 fifteen or twenty years ago, but of late years seem to have been entirely 
 abandoned. They contained atropine, eserine, and pilocarpine. Atten- 
 tion has recently been called to the subject by C. A. Wood, of Chi- 
 cago, and, under his direction, the Messrs. Wyeth, of Philadelphia, after 
 careful and prolonged experimentation, have prepared a series of com- 
 pressed and gelatinized discs containing all the substances ordinarily used 
 in external applications to the eye. The list includes eighty discs medi- 
 cated with various drugs, either singly in different proportions, or in 
 combination. To modify the disturbing effect of cocaine upon the 
 corneal epithelium, the discs containing that substance are made of gelatin ; 
 all the others are made by compression, and are formed of dried flaxseed 
 mucilage combined with boric acid. 
 
 The chief advantage claimed for these discs is that, by means of their 
 slow solution, the drug is maintained continuously in contact with the 
 conjunctiva, instead of being, in great part, carried off by the overflow of 
 tears, as is the case with aqueous solutions. This consideration is espe- 
 cially important in the case of mydriatics ; and, further, in the case of an 
 expensive drug, like homatropine, or of one likely to cause troublesome 
 constitutional disturbance, like duboisine, it is evidently desirable to use 
 the least possible quantity that will ensure the desired effect. Perhaps 
 the most useful of the discs is that medicated with homatropine and 
 cocaine. It contains one-fiftieth grain of each drug : the same quantity 
 that is held by one minim of a twenty per cent, solution. It promises to 
 be very convenient in refractive work. A second disc may be added, if 
 it is thought necessary, after the first has dissolved. Wood recom-
 
 INTRODUCTION. XXvii 
 
 mends the introduction of an eserine disc (gr. -j-J-^-) after completing the 
 examination. 
 
 For the application of astringents, stimulants, and antiseptics to the 
 conjunctiva, most surgeons will probably prefer to use aqueous solutions. 
 
 The discs are easily applied by taking one on the point of a moistened 
 camel's-hair brush and placing it against the conjunctiva of the ball. 
 The eye should be closed while absorption is going on.
 
 LIST OF ABBREVIATIONS. 
 
 U. S. P. United States Pharmacopoeia. 
 U. S. D. United States Dispensatory. 
 Br. Ph. British Pharmacopoeia. 
 M. B. Merck's Bulletin. 
 
 M. Mackenzie, refers to " Diseases of the Throat and Nose," 1880. Am. Ed. 
 Lefferts, refers to " A Pharmacopoeia for the Treatment of the Diseases of 
 the Larynx, Pharynx, and Nasal Passages," New York, 1888. 
 
 XXVlll
 
 LOCAL THERAPEUTICS. 
 
 ACACIA. Gum Arabic. 
 
 A gummy exudation from various species of Acacia. Gum Arabic is slowly soluble in 
 its weight of cold water. Solutions of gum arabic to be elegant should always be made 
 with cold water, as the use of hot water results in a dark-colored solution. The best 
 form of the gum for solution is the granular powder to be obtained in the shops. Gum 
 arabic is precipitated from its solutions by alcohol, by subacetate of lead, solution of ferric 
 chloride, and concentrated solution of borate of sodium. It is insoluble in alcohol, in 
 ether, and in oils. 
 
 Diseases of the Ear, Nose, and Throat. Powdered acacia, when 
 used in a pure form, acts as a protectant. It slowly dissolves in the mucus, 
 which it increases in density ; in this manner it serves to diminish excite- 
 ment when from any cause the mucus assumes a serum-like character. The 
 powder acts mechanically as a vehicle in the distribution of an insoluble 
 drug, such as subnitrate of bismuth ; it aids also in retaining drugs for a 
 longer time than would otherwise be the case upon the moist membranes 
 of the nose and throat. Gum acacia forms the basis of many pastilles, 
 and even when not medicated, as is the case with the "gum drop " of 
 the confectioner, it allays COUGH when this symptom is due to the reten- 
 tion of mucus on the posterior laryngeal region or the vocal cords. The 
 syrup is often added to cough mixtures to effect a similar object. Jack- 
 sort 's cough mixture, which is composed of the diluted syrup of acacia to 
 which a small proportion of morphia is added, acts, for the most part, 
 through the local impression made on the tissues. 
 
 Pulverized acacia is an ingredient of Ferrier' s snuff in the proportion 
 of two drachms of acacia, six drachms of the subnitrate of bismuth, and 
 two grains of sulphate of morphine. 
 
 ACIDUM CHLORACETICUM. Chloracetic Acid. 
 Three forms are known : 
 
 Mono chloracetic acid, C 2 H 3 C1O 2 
 
 Di chloracetic acid, C 2 H 2 C1 2 O 2 
 
 Tri chloracetic acid, C 2 HC1 3 O 2 
 
 The various chloracetic acids are, as can be seen, glacial acetic acid (HC 2 H 3 O 2 ), in 
 which respectively one, two, and three atoms of hydrogen are replaced by chlorine. 
 2 I 7 .
 
 1 8 LOCAL THERAPEUTICS. 
 
 The mono and tri acids are crystalline solids ; the di acid is liquid. They all form 
 salts soluble in water. 
 
 CHLORACETIC ACID. 
 
 Diseases of the Skin. Monochloracetic acid forms an admirable 
 caustic in the treatment of superficial EPITHELIOMATA. It seems to have 
 a selective affinity for the diseased tissues, and its action can be strictly 
 limited. It may be applied with a bit of stick or on a probe armed with 
 cotton. Its action is not deep and it must therefore be applied at fre- 
 quent intervals. It is less suitable than the stronger caustics, particularly 
 caustic potassa, for large and deep growths, but is safer when the disease 
 is close to some important organ, as the eye, when the action of the 
 caustic must needs be circumscribed. Monochloracetic acid likewise 
 forms an excellent caustic for VERRUCA and CONDYLOMATA and for small 
 
 NxEVI. 
 
 Diseases of the Ear. Applied freely to AURAL POLYPI, chlor- 
 acetic acid constitutes, on the whole, the best means for their destruction. 
 According to W. B. Dalby, " if the pain after using the caustic is severe, 
 it subsides immediately after using a syringe full of water. Eight or ten 
 applications may be required ; these may be made every day for a time 
 and then less frequently." Dalby insists that treatment should be con- 
 ducted for long periods, and also that assiduous care should be exercised 
 in cleansing the middle ear, no matter what agent is used to destroy the 
 growths. 
 
 Diseases of the Eye. Monochloracetic acid is a valuable caustic 
 in the treatment of EPITHELIOMATOUS ULCERS of the eyelids in cases in 
 which excision is, for any reason, impracticable. It should be used in 
 saturated solution (deliquesced crystals), and may be applied, by means 
 of a pledget of absorbent cotton on the end of a small probe, to the 
 whole surface of a small ulceration or about the margin of a more 
 extensive one. It produces little reaction, and the application is usually 
 almost painless. Repeated applications may be necessary but are easily 
 borne. In several discouraging cases, cicatrization has been produced 
 which has remained quite firm for many months. 
 
 TRICHLORACETIC ACID. 
 
 Trichloracetic acid was introduced into medicine by Stein (Wiener 
 Med. Blatter, March 20, 1890). 
 
 It is used as a caustic and stimulant. 
 
 Diseases of the Skin. Lanz (Monatsch. f. P. Derm., Oct. i, 1891) 
 states that trichloracetic acid is one of the best applications for VERRUCA, 
 especially in infants and young children. It causes little or no pain, and 
 the wart often dries up and drops off after a single application. NJEVI, 
 both VASCULAR and PIGMENTARY, may be removed by trichloracetic acid,
 
 ACIDUM ACETICUM. 19 
 
 a very superficial and scarcely noticeable scar remaining. ATONIC ULCERS, 
 particularly of a venereal character, are much improved by the applica- 
 tion of trichloracetic acid as a stimulant. 
 
 Diseases of the Nose. Ehrman (Wiener Me d. Blatter, March 20, 
 1890) applies a moist crystal to INTRA-NASAL HYPERTROPHIES by means 
 of a silver probe, which is then rubbed over the part which it is desired 
 to cauterize. The tissues are whitened by the acid ; the eschar separates 
 within a week's time. The agent is of the same character of causticity 
 as chromic acid, but according to this writer is more manageable. O. F. 
 Brown (Amer. Rhinological Assn., 1886) has also invited attention to this 
 caustic. J. W. Gleitsman (Med. Record, 1891, 312) speaks highly of it. 
 He prefers an aluminium rod, which is so fashioned that a cup-shaped 
 depression exists at the free end, to any other form of applicator. The 
 excavation is filled with the crystals. The pain arising from the use of 
 the acid is insignificant, and can be readily controlled by a ten per cent, 
 solution of cocaine. The caustic is remarkable for the dryness and 
 compactness of the eschar, which is thrown off at a period varying from 
 two to seven days. The agent has been used successfully in all forms of 
 nasal and pharyngeal hypertrophy, as well as in aural polypi. 
 
 ACIDUM ACETICUM. Acetic Acid. 
 
 The acetic acid of the U. S. Ph. is really a solution of acetic acid in water, containing 
 36 per cent, of absolute acetic acid. The acetic acid of the Ph. Br. is also a solution in 
 water, containing 33 per cent, of absolute acetic acid. 
 
 In the Ph. Br., malt vinegar (acetum) is official, and contains from four to five per 
 cent, of absolute acetic acid. Vinegar is not official in the U. S. Ph., but in its stead is 
 " diluted acetic acid," containing six per cent, of absolute acetic acid. 
 
 Acetic acid is six times as strong as is diluted acetic acid. Acetic acid was formerly 
 commonly called " No. 8 Acetic Acid," because, until a late revision of the U. S. Ph., 
 diluted acetic acid was made by diluting one measure of acetic acid by seven measures 
 of water, and the result was a liquid about equal in acetic acid strength to vinegar. 
 According to Squibb the No. S acetic acid is " commonly sold, whether demanded or not, 
 both in the arts and for medicinal and dietetic purposes." He found it to vary from 22 to 
 32 per cent, in strength. There is also official, glacial acetic acid, which is " nearly or 
 quite absolute acetic acid." The formula for glacial acetic acid is HC 2 H 3 O 2 . 
 
 Pyroligneous acid of the U. S. Ph. is crude acetic acid, and contains, in addition to a 
 proportion of absolute acetic acid, creosote and empyreumatic oils. 
 
 Vinegar enters into composition of St. John Long's Liniment. 
 
 ACIDUM ACETICUM DILUTUM. Diluted Acetic Acid. 
 Diluted acetic acid is disinfectant, haemostatic, solvent, and mildly 
 excitant. The effect upon the mucous membranes of the throat and 
 nose is to increase the determination of blood to the parts, and to insure 
 activity of the secretions (Rossbach).
 
 20 LOCAL THERAPEUTICS. 
 
 General Surgery. Acetic acid, properly diluted, is a useful injec- 
 tion in some cases of CHRONIC CYSTITIS. The strength should be eight or 
 ten minims to the fluidounce of water. Thompson recommends, as most 
 useful after the use of nitrate of silver: R. Plumbi acetat., 9ij; Acid, 
 acetic, dil., 3vj ; Acid, carbolic., 5ss; Aq. dest, %iv. One drachm of 
 this mixture is to be added to four ounces of water and injected once or 
 twice a day. 
 
 Engelmann ( Medical Record, November 24, 1888) has used acetic acid 
 in a three to five per cent, solution, AS A DISINFECTANT IN OBSTETRICAL 
 PRACTICE in preference to carbolic acid or corrosive sublimate, regarding 
 it as more diffusible than the latter and less injurious to instruments, 
 and equally with it as free from danger to the patient. The skin of the 
 hand is rendered particularly soft and pliable. 
 
 T. H. Harvey has prepared an acetized cotton of five, twelve-and-a-half, 
 and twenty per cent, strength, to be used as a haemostatic in place of the 
 usually prepared styptic cotton. This cotton should be kept moist in 
 air-tight bottles. 
 
 Diseases of the Skin. Acetic acid is employed in the treatment 
 of skin diseases in three forms : Glacial Acetic Acid, Diluted Acetic Acid 
 (U. S. P.), and Vinegar. 
 
 Acetic acid of the U. S. P. is employed in the treatment of several 
 diseases of the skin. In PSORIASIS it is valuable in removing the scales 
 and in preparing the ground for future treatment. In CONDYLOMATA it 
 has been used by hypodermic injection, but no data have been published, 
 so far as we know, to establish its value in the cure of these growths. 
 Unna uses the following prescription for CONDYLOMA of the external 
 genitals: R. Acidi salicylici, 3ss; Acidi acetici, fgj. 
 
 This mixture is to be applied twice daily by means of a small brush or 
 a tuft of cotton on an applicator. The pain it causes is slight, and 
 Unna prefers it to any other treatment. 
 
 Diluted acetic acid, in the form of distilled vinegar, goes to make up a 
 wash highly recommended in ALOPECIA PRJEMATURA. What part the 
 drug plays cannot be explained, unless it be to act as a solvent to the 
 pityriasic exfoliation which commonly accompanies this affection. One 
 formula, the long and successful use of which has established its value, is 
 the following: R. Tinct. cantharidis, fSvj ; Tinct. nucis. vomic.,fgss; 
 Aceti destillat., fgiss; Glycerini, f3ij ; Aquae, ad fgvj. 
 
 In the form of vinegar, the diluted acetic acid has been very highly 
 recommended in DERMATITIS from sunburn. Another employment of 
 vinegar, or diluted acetic acid, which we have found valuable, is in the 
 destruction of nits in PEDICULOSIS of the scalp and pubis. After the 
 living animals have been destroyed, the nits or ova remaining cling to 
 the hairs, and if not destroyed will hatch out in a few days. Diluted 
 acetic acid destroys them.
 
 ACIDUM ACETICUM. 21 
 
 Diseases of Ear, Nose, and Throat. Diluted acetic acid in the 
 form of vinegar is a popular vehicle for exhibiting many remedies designed 
 to affect the throat locally. M. Mackenzie uses a gargle composed of 30 
 minims of the diluted acid to 1 8 minims of glycerin in an ounce of water. 
 In the last stage of the ANGINA OF EXANTHEMATA this mixture is especially 
 indicated. It has even had its advocate in PHLEGMONOUS INFLAMMATION 
 of the throat ; but many more valued agents are here available. F. Engel- 
 mann ( Centralblatt fiir Klin. Med., 1886, No. 14) recommends acetic acid 
 in the local treatment of DIPHTHERIA. In the list of medicines for our 
 selection, many must take the preference to one which is so diffuse in its 
 effects and whose odor is so penetrating. The diluted acid has been 
 injected successfully into the TONSIL to reduce HYPERTROPHY. Equal 
 parts of vinegar and water placed on a stove charges the sick-room with a 
 vapor which is grateful in ACUTE CORYZA. 
 
 S. J. Bumstead speaks highly of diluted acetic acid in controlling the 
 COUGH of LARYNGITIS and as a solvent in the treatment of CROUP and 
 DIPHTHERIA. For the first named he uses the old domestic form of 
 diluting vinegar with molasses or honey and employing it as a gargle. 
 For the diseases last named he prefers the form of steamed vapor, by 
 heating vinegar in large trays or pans. 
 
 Vinegar is a valuable haemostatic. It has been used with especial 
 benefit in EPISTAXIS. The vinegar can be injected in the nostril, or 
 tampons of lint or absorbent cotton saturated with the agent can be 
 carried into the nasal passage. The diluted acetic acid, one part of the 
 acid to five of water, will represent a strength suitable for use in absence 
 of vinegar. Stronger vinegar also acts as an excellent counter-irritant 
 when applied to the skin of the throat in ANGINA. Diluted vinegar may 
 be drunk freely in ^SOPHAGITIS when due to an alkali. 
 
 Diseases of the Eye. Largely diluted acetic acid is a pleasant 
 and useful application in ACUTE CONJUNCTIVITIS. Ten drops of the acid 
 in an ounce of distilled water may be combined with from two to four 
 grains of acetate of morphine. 
 
 A frequent form of injury of the eye is by LIME IN THE CONJUNCTIVAL 
 SAC. If the patient is seen immediately after the accident, the eye should 
 be thoroughly cleansed with diluted acetic acid, or vinegar, which is 
 always at hand, in the proportion of 3j to 3j of water. 
 
 ACIDUM ACETICUM GLACIALE. Glacial Acetic Acid. 
 
 Glacial acetic acid should consist of over 99 per cent, of absolute acid 
 (HC 2 H 3 O 2 .) It should form a clear mixture with an equal volume of oil 
 of lemon. Much of that in commerce will not respond to this test, as it 
 is only from 70 to 80 per cent, in strength. 
 
 Glacial acetic acid is a powerful caustic. Applied to the skin it pro-
 
 22 LOCAL THERAPEUTICS. 
 
 duces intense redness, followed by rapid vesication. The impression is 
 painful. The acid must be used with caution, as its action extends to con- 
 siderable depth and a severe sore may ensue. On horny growths it 
 exercises a solvent action without the production of a distinct slough or 
 eschar. It seems to soften, gelatinize, and dissolve the horny epithelium. 
 On mucous surfaces it induces a white albuminate. Glacial acetic acid 
 is also classed as a parasiticide. 
 
 Diseases of the Skin. Asa caustic, glacial acetic acid is sometimes 
 employed in the treatment of WARTS and CORNS. A few drops applied 
 twice daily, will, after a time, complete their destruction. Its action in 
 this regard is somewhat milder than that of other caustics. On HORNY 
 GROWTHS it exercises a solvent action without the production of a dis- 
 tinct slough or eschar. In small N^EVI the action of glacial acetic acid 
 is often very satisfactory. It is best applied on the point of a sharpened 
 stick, which is bored into the nsevus patch at one or several points. The 
 slight pain caused by the application passes away in a few moments. 
 But little subsequent reaction is noticed. Piffard has found a mix- 
 ture of equal parts of glacial acetic acid and glycerin of use in the 
 smaller patches of LUPUS ERYTHEMATOSUS, where it seems to stimulate 
 absorption of the morbid deposit. In TINEA UNGUIUM, glacial acetic 
 acid is also employed for its parasiticide effect. The affected nail 
 is scraped down as near to the quick as possible and then the acid is 
 applied. This softens the horny tissue of the nail and penetrates to the 
 fungus, which it appears to destroy. Glacial acetic acid has been recom- 
 mended in the treatment of various NEW GROWTHS, but we are inclined 
 to think its effect inferior to that of other caustics. Glacial acetic 
 acid is employed in the treatment of TINEA TONSURANS, a drop of the 
 acid being introduced into each of the individual hair follicles, when only 
 a few of these remain affected in stubborn cases. Its action here is 
 probably merely caustic, as it causes softening and exfoliation of the 
 layers of epithelium which are infiltrated with fungus. 
 
 Diseases of Ear, Nose and Throat. Glacial acetic acid is one 
 of the most useful agents employed for reducing HYPERTROPHIES OF THE 
 NASAL Mucous MEMBRANE. The indication for its selection is the presence 
 of inflammatory products in the submucous tissue and proliferation of the 
 epithelial layer. Such a condition commonly results from a neglected 
 catarrh, or the prolongation of the subacute stage of an ACUTE CORYZA. 
 It is contraindicated where the membranes are in a highly excited state 
 from an acute inflammatory attack, or where the erectile element of the 
 membrane is of marked degree. When the fibrous character of hyper- 
 trophies is well defined, acetic acid is less efficient than is chromic acid, or' 
 the electro-cautery. In making an application with the acid to secure a 
 cautery-effect the parts should be cleansed and a drop of the glacial acid
 
 ACIDUM ARSENIOSUM. 
 
 2 3 
 
 is carried on a dossil of cotton which is firmly wrapped upon a cotton 
 carrier. The parts become instantly white from the coagulation of the 
 albumin in the tissue. Pungent pain with lachrymation ensues which 
 lasts for a few moments only. A second application should not be made 
 until the first eschar falls off; the time for this varies, but is usually 
 about three days. Owing to the diffusive character of acetic acid it is a 
 difficult agent to manage in making application to the posterior ends 
 of the turbinals. OTITIS MEDIA has been known to ensue upon its too free 
 employment. Equal parts of glacial acetic acid and carbolic acid form 
 the basis of inhalation in ACUTE CORYZA (M. A. Fritsche, Berlin, Klin. 
 Wochenschrift, 1887, No. 27). The same writer employs the drug alone 
 in the proportion of two parts of the acid to twelve of water. Glacial 
 acetic acid in the strength of ten drops to an ounce of water can be used 
 as an agent to immediately follow an application of caustic potash to 
 prevent its over action. 
 
 The danger of the too free use of stronger forms of acetic acid in the throat 
 may be illustrated by the following accident. A boy aged two years swal- 
 lowed a mouthful of "vinegar essence," which was instantly followed by 
 painful deglutition and vomiting on swallowing food. The pharynx, 
 mouth, and larynx became swollen ; the latter was covered with punctiform 
 extravasations which were especially numerous on the epiglottis. The 
 child recovered. 
 
 PYROLIGNEOUS ACID. 
 
 A dark brown liquid having a strong smoky smell. It consists essentially of acetic acid 
 diluted with more or less water, and holding in solution chiefly tar and empyreumatic oil, 
 with pyroxilic spirit and probably a small proportion of creasote. It is made by the de- 
 structive distillation of wood. 
 
 Diseases of the Skin. Containing both acetic acid and creasote, 
 pyroligneous acid possesses the properties of both these substances in the 
 treatment of diseases of the skin. It has been employed successfully in 
 the treatment of PRURITUS, particularly PRURITUS OF THE SCROTUM, being 
 used in a diluted condition (i to 30) at first and gradually strengthened. It 
 is soluble in water and in glycerin, or may be used in ointment (Piffard, 
 " Mat. Med. and Ther. of the Skin" p. TO). Its use in PSORIASIS has 
 been recommended (Jarisch, Med. Jahrb., 1878, p. 511), but is not to be 
 undertaken without caution, as absorption and poisoning may take place 
 if used over too large a surface. 
 
 ACIDUM ARSENIOSUM. 
 
 When the names "arsenic" and " white arsenic " are used in medical treatises, acidum 
 arseniosum is the product referred to. It is freely soluble in from 30 to 80 parts of water 
 at 15 C. (59 F.) and in 15 parts of boiling water, in hydrochloric acid, the alkalies and 
 their carbonates, but sparingly soluble in alcohol and glycerin.
 
 24 LOCAL THERAPEUTICS. 
 
 Liquor acidi arseniosi (a one per cent, solution in two per cent, hydrochloric acid) and 
 liquor potassii arsenitis (a one per cent, solution of arsenious acid combined with potassium) 
 are official. 
 
 Diseases of the Skin. Arsenious acid is employed locally on the 
 skin as an escharotic. Dupuytren recommended a powder of i part 
 arsenious acid and 24 parts calomel in EPITHELIOMA and FOUL ULCERS. 
 
 Arsenious Acid is employed as an escharotic in CANCERS. R. Arsenici 
 sulphid, pts. Ixx; Sanguinis draconis, pts. xx; Acidi arseniosi, pts. viij. 
 This is made into a paste with water. Its application is painful and not 
 without danger. 
 
 Arsenic is the chief ingredient in many, secret remedies for the same 
 affection. It is usually combined with some substance intended to dissolve 
 the horny epidermis, as it will scarcely, if at all, act through this. 
 
 The famous Poudre caustique de Frere Cosme ou du Rousselot is : R . Acidi 
 arseniosi gr. x; Hydrarg. sulphid. nig., 9 ij ; Pulv. carbo. animalis, gr. x. 
 M. This powder is mixed with mucilage at the time of using. 
 
 The external part of "Febures remedy' 1 for CANCER consists of ten 
 grains of arsenious acid dissolved in a pint of distilled water, to which is 
 added an ounce of extract of conium, three fluid ounces of solution of 
 sub-acetate of lead, and a fluid drachm of tincture of opium. With this 
 the cancer is washed every morning. (U. S. Disp.) 
 
 "Juselmond's arsenical powder" is: R. Antimonii sulphuret, pts. xvj ; 
 Acidi arseniosi, pt. j. M. Melt in a crucible. When cold reduce the 
 mass to powder and add five parts extract of opium. 
 
 "Manec's paste' 1 is composed as follows: R. Acidi arseniosi, gr. xv; 
 Hydrarg. sulphid. nig., gr. Ixxv ; Spongia usta, gr. xxxv. This is made 
 into a thick paste with a few drops of water. 
 
 Billroth ( Grundriss der Chirurgie, V. i, p. 303) in MULTIPLE SARCO- 
 MATOUS DEGENERATION of the lymphatic glands has used parenchy- 
 matous injections of five minims Fowler's Solution ( = -fa gr. arse- 
 nious acid) diluted with ten minums of distilled water combined with the 
 internal use of the remedy with success, and the same treatment has been- 
 found useful in SARCOMA OF THE SKIN. 
 
 ACIDUM BORICUM. Boric Acid. Boracic Acid. Homberg's 
 
 Sedative Salt. 
 
 Boric acid is made by decomposing solutions of borax (biborate of soda) with strong 
 hydrochloric acid, and purifying. It is "soluble in 25 parts of water, and in 15 parts of 
 alcohol at 15 C. (59 F.), in three parts of boiling water, and in five parts of boiling 
 alcohol." (U. S. P.) It is also soluble in volatile oils, but is insoluble in ether. Hot 
 glycerin dissolves boric acid freely, forming the substance known as boroglycerinum. 
 See Article " Boroglycerinum." 
 
 Boric acid is sometimes contaminated with free hydrochloric acid and with chloride of
 
 ACIDUM BORICUM. 25 
 
 sodium. These result from the imperfect carrying out of its process of manufacture, and 
 both can be removed by washing it with cold water. 
 
 A borated cotton is prepared by steeping absorbent cotton in solutions of the acid, vary- 
 ing in strength from 15 to 45 per cent. 
 
 Boric acid, according to Dr. Sternberg, is inefficient as a germ- 
 destroyer, but has considerable antiseptic properties. It is also a pro- 
 tectant, exsiccant and detergent. 
 
 General Surgery. Boric acid was introduced as an agent in anti- 
 septic surgery by Sir Joseph Lister, in 1872. It is used in dry powder in 
 concentrated solutions and ointments, and in borated lint and borated 
 cotton. Unlike most antiseptic agents, boric acid is bland and unirritat- 
 ing, and will allow the natural process of healing to go on without interrup- 
 tion. It can be readily used in any of the preparations mentioned above. 
 We have used the dry powder by dusting over the part when a tendency 
 to excoriation existed, such as is often seen after surgical dressings where 
 two cutaneous surfaces are in contact with each other, or where the sur- 
 face or end of a splint comes up into the axilla. As a preventive of 
 BED-SORES, after the unbroken skin has been thoroughly washed with 
 alcohol or some stimulating application, boric acid may be dusted over 
 the entire back with great advantage. In the treatment of BURNS, boric 
 acid is very useful. After the removal of the dressing, the granulations 
 should be thoroughly cleansed with a warm saturated solution. Then 
 the ulcerated surface may be dressed with an ointment of the strength of 
 a drachm to an ounce of lard or simple cerate, spread on lint. This 
 forms an agreeable dressing, and one that, owing to its antiseptic prop- 
 erties, can be borne a long time without becoming foul. With many 
 surgeons, boric ointment has taken the place of zinc ointment as a bland 
 and protecting dressing to granulating surfaces. A saturated solution of 
 boric acid will often prove useful for a local dressing after the eschar 
 made by the galvano-cautery or acid nitrate of mercury. These remarks 
 are particularly applicable to the treatment of PHAGED^ENIC CHANCRE. 
 In CYSTITIS, where the urine has a tendency to become ammoniacal, the 
 bladder may be washed out with solutions of boric acid, in strengths vary- 
 ing from five to ten gr. to the ounce of water, twice daily, with success. 
 This procedure is of service in the treatment of CYSTITIS occurring 
 in fractures of the spine. In injecting the bladder, it should always be 
 borne in mind that this organ is normally distended by urine, drop by 
 drop, from the ureters ; consequently that all injections into the bladder 
 should be made slowly, and never exceed four ounces in quantity. If 
 this rule is carried out, but little difficulty or discomfort will result. 
 
 In the treatment of GONORRHOEA boric acid has been used in saturated 
 solutions as an injection, but, as a rule, the results are not nearly so
 
 26 LOCAL THERAPEUTICS. 
 
 satisfactory as when a more decided astringent is used, e. g., lead or 
 zinc. W. C. Aboly (Afedical Record, November 26, 1887) reports 
 the results of treatment in GONORRHOEA by injecting into the urethra 
 a paste made by mixing one part of boric acid with three parts of 
 glycerin through a soft English catheter, inserted as far back as the 
 prostate, and withdrawn slowly, filling the urethra with the paste. In 
 this method it is important that the bladder should be previously emptied 
 of all urine, as the paste causes in the urethra a desire to urinate, which, 
 however, soon passes away. Of the 30 patients treated by Dr. Aboly 
 
 27 were cured. Of the remaining three, two had strictures which were 
 afterwards dilated. H. A. Slocum {Medical News, December 18, 1886), 
 has called attention to the use of tampons of cotton covered with boric 
 acid, in the treatment of profuse and offensive LEUCORRHCEA, in dispensary 
 patients at the Jefferson Medical College Hospital. Boric acid is also used 
 with success in VAGINITIS. The tampons are allowed to remain in the 
 vagina for forty-eight hours. In the treatment of ENDOMETRITIS, Duke 
 (British Medical Journal, December 20, 1891) introduces into the uterus 
 powdered boric acid by means of a specially prepared piston, the applica- 
 tion being made every three or four days. He states that ten or twelve 
 applications will usually cure a case of the disease. W. W. Potter has 
 substituted boric acid for iodoform in gynaecological practice. He finds 
 boric acid delays decomposition of uterine and ovarian discharges, and 
 that a tampon charged with it can be retained for a week without discom- 
 fort or annoyance. In his experience it has been of service in cases where 
 STERILITY existed ; and he believes that it exerted such chemical action 
 upon the uterine secretions that fecundation became possible. 
 
 Diseases of the Skin. Boric acid being an antiseptic, the effort 
 has been made to substitute it for carbolic acid in the treatment of diseases 
 of the skin ; but its action is not the same, although it is useful in certain 
 cases when carbolic acid is inadmissible. 
 
 Powdered boric acid may be added to the ordinary dusting powders, 
 starch, oxide of zinc, etc., employed in INTERTRIGO. In some cases it 
 may be employed alone with advantage. 
 
 Lister's boric acid ointment is composed as follows : R. Acid. Boric., 
 Cerae Albae, aa 5ij ; Ol. Amygdala Dulcis, Paraffin, aa 3iv. M. 
 
 Russell Sturgis {Boston Med. and Surg. Jour., February 25, 1888) has 
 used boric acid in INFANTILE ECZEMA with great success. When there 
 is much vesiculation and discharge, he directs the crusts to be removed 
 and then pure boric acid is dusted upon the moist and inflamed surface. 
 The serous flow is increased for the first twenty-four hours, but then 
 diminishes. The application is washed off and renewed twice daily for 
 several days, and as soon as the skin is able to bear an ointment, one of
 
 ACIDUM BORICUM. 
 
 2 7 
 
 boric acid, two drachms, and lanolin, one ounce, is employed, by which 
 the acid is kept in contact with the skin better than if used in powder. 
 The unruptured vesicles should be slit open. 
 
 Boric acid is also used in the treatment of HYPERIDROSIS, particularly 
 in sweating of the feet, when decomposition takes place and BROMIDROSIS 
 results. The stockings are soaked every evening in a three-per-cent. 
 solution of boric acid, dried, and used the next morning. A change is 
 made every other day. 
 
 Diseases of the Ear, Nose and Throat. Boric acid, while one 
 of the least irritating of the agents employed in checking DISCHARGES 
 FROM THE MIDDLE EAR, is open to objection wisely urged against it that 
 the discharge may convert the impalpable powder into a firm resistant 
 plug. Instances are known in which pus has been retained in the middle 
 ear, with resultant mastoid disease. In some cases (according to Pierce, 
 Med. Chronicle, Manchester n, 34, 1885) it causes pain and after the first 
 retention an increase of semi-purulent outflow. Schwartze {Naturforscher 
 Versammlung zu Berlin, Sept., 1886, also Archiv f. Ohrenheilkunde) claims 
 that even in solution, four grains to the ounce, the acid may bring about 
 the same disastrous result by reason of the peculiarity that it forms with the 
 secretion a tenacious mass and prevents the outflow of fluid from the middle 
 ear. The drug appears to have its best opportunity for good in chronic 
 otorrheal conditions in which the discharge is small in amount. After 
 thorough cleansing of the affected parts a fine powder made from the 
 crystals often has a most satisfactory effect. If the caking of the powder 
 proves under any circumstances objectionable, the coarsely broken up 
 crystals may be substituted. No similar limitation to the above is recog- 
 nized in the selection of boric acid in affections of the AUDITORY MEATUS. 
 An ointment (grains ten to the ounce) is useful in overcoming the irritation 
 following the use of lotion of bichloride of mercury. It may be combined, 
 indeed, with the drug last named, as an injection for acute ECZEMA of the 
 external auditory canal. Combined with Hebra's diachylon (each one part 
 to cosmoline two parts) it constitutes an admirable application for CHRONIC 
 ECZEMA of the outer ear passage. In the treatment of ASPERGILLUS boric 
 acid proves to be efficient. It is especially useful after the use of a bi- 
 chloride of mercury lotion. Since an opening in the tympanic membrane 
 is present as a rule in cases in which the parasitic plant is lodged in the 
 ear, the same precautions are demanded in using the acid as in OTORRHEA. 
 Boric acid is useful in the local treatment of TONSILLITIS, either alone or 
 combined with a vegetable astringent. The pure powdered acid thrown 
 into the nose causes pain and lachrymation. The untoward effect may be 
 controlled by the addition of a small quantity of morphine. It is usually 
 ordered diluted two-thirds with an indifferent excipient. It is especially 
 useful in CHRONIC RHINITIS of children. The plug of cotton used in tarn-
 
 2 8 LOCAL THERAPEUTICS. 
 
 poning the nose retains its purity if previously saturated in a solution of 
 boric acid, ten grains to the ounce of water. L 1 Union Medicale, Jan. 
 loth, 1891, contains the following prescription : Powdered boric acid, 
 drachm one-half, combined with an equal quantity of salicylate of sodium 
 to which one grain of cocaine is added : to be used as a snuff in HAY 
 FEVER. 
 
 In the pharynx boric acid lotions may be used in the proportion of 
 eight grains to the ounce of water. Or the powder, either pure or diluted, 
 can be thrown into the naso-pharynx. J. C. Mulhall (Trans. Am. Laryn. 
 Ass'n, 1889) recommends that boric acid (as much as can be taken up by 
 the liquid = 16 grains to the ounce represents, at ordinary temperature, a 
 saturated solution) be added to Baudry's solution of carbolic acid and 
 compound solution of iodine in the local treatment of DIPHTHERIA. 
 According to Da Costa (" Potter's Therapeutics ") boric acid holds second 
 place only to thymol in the treatment of this disease. S. Johnson, 
 of Baltimore, strongly recommends boric acid in five per cent, solution 
 as a gargle for acute pharyngitis. 
 
 Pastilles of boric acid are prepared by adding two grains to each mass 
 of glycero-gelatin. Glycero-gelatin is a ten per cent, solution of gelatin 
 in glycerin, which solidifies on cooling. 
 
 Boric acid, two grains; glycerin, two minims, added to glycero-gelatin, 
 one scruple, is recommended by Whistler for APHTHOUS AFFECTIONS of 
 the mouth and throat. 
 
 Diseases of the Eye. Boric acid has been extensively used in 
 ophthalmic surgery as an antiseptic, and at one time was considered an 
 efficient germicide. The latter claim has been generally abandoned. 
 Sattler, in a series of bacteriological experiments with the various washes 
 used by ophthalmic surgeons as antiseptics, proved boric acid to be en- 
 tirely destitute of germicidal properties (Anna/es d* Oculistique, t. 91, p. 
 165.) It is still classed among the antiseptics, though its exact position is 
 perhaps not yet defined, and it is at least a valuable aseptic application 
 whose unirritating character especially recommends it in operations upon 
 the eye. During EXTRACTION OF CATARACT and other operations on the 
 eyeball, the conjunctival sac may be freely and frequently douched with 
 a warm saturated solution (about one part to thirty). 
 
 Boric acid is much used in the treatment of CONJUNCTIVITIS, either 
 alone or in combination with borax, alum, sulphate of zinc, or cocaine. 
 
 Finely powdered, it is sometimes' dusted on the inner surface of the 
 eyelid in TRACHOMA. 
 
 Borated lint is made by dipping lint into a saturated solution of boric 
 acid. It is not a good application for the eye, as it becomes stiff and 
 starchy in drying.
 
 ACIDUM CARBOLICUM. 
 
 2 9 
 
 BOROGLYCERINUM. Boroglycerin. 
 
 Boroglycerin is made by adding boric acid to glycerin in the pres- 
 ence of intense and prolonged heat. Its introduction is credited to 
 Barff. Boroglycerin is a solid, containing about 40 per cent, of boric 
 acid. It is readily soluble without precipitation in glycerin or water, 
 and hence affords a convenient means of presenting any desired propor- 
 tion of boric acid. A 50 per cent, solution of boroglycerin is a gly- 
 cerin of syrupy consistence. In this form it is kept on hand by 
 druggists, and dispensed under the name of " Glyceritum Boroglycerini." 
 
 Boroglycerin is seldom used in full strength. For the treatment of 
 open wounds it is a non-irritating and powerful antiseptic. Mr. Barwell 
 employs it in a watery solution for washing out ABSCESS CAVITIES. 
 Sir Henry Thompson speaks highly of boroglycerin used in a watery 
 solution as an injection for CYSTITIS. It may be used in the proportion 
 of one to fifty of water. 
 
 Diseases of the Ear, Nose, and Throat. The indications for 
 the use of boroglycerin are not distinct from those of boric acid. It is 
 a favorite application with some physicians. It appears to be especially 
 adapted to APHTHOUS or HEMORRHAGIC ULCERATED SURFACES IN THE 
 NASAL CHAMBER. It is an admirable application to the lines of incision 
 in the after-treatment of operations on the nasal septum. 
 
 Diseases of the Eye. Boroglycerin (50 per cent.) is a useful applica- 
 tion in GRANULAR OPHTHALMIA, painted on the everted lid with a camel's 
 hair brush or a small pledget of absorbent cotton. Gauze saturated with a 
 25 per cent, solution makes a clean and neat dressing after operations on 
 the eyelids. 
 
 ACIDUM CARBOLICUM. Carbolic Acid. Phenol. Phenic Acid. 
 Phenylic Acid. Phenylic Alcohol. 
 
 "A product of the distillation of coal tar between the temperatures of 180 and 190 C. 
 (356 to 374 F.)." U. S. P. 
 
 Several grades are in the market, of which No. I is the purest made by the manufac- 
 turer whose name may be attached. Nos. 2, 3, 4, and 5 are less and less pure according to 
 number. Nos. I and 2 are both crystalline ; Nos. 4 and 5 contain varying proportions of water 
 and cresylic acid, and are quite dark in color. They contain, also, proportions of tar oils 
 and tar acids. The crystalline acid become pinkish or brown under, exposure to light or 
 air. The liquid carbolic acids, even when sold as pure, contain about ten per cent, of 
 water or alcohol added to liquefy the crystalline acid. Carbolic acid is " soluble in 20 
 parts of water at 15 C. (59 F.). It is very soluble in alcohol, ether, chloroform, benzol, 
 disulphide of carbon, glycerin, and fixed and volatile oils." U. S. P. The No. i or the 
 No. 2 are the only acids that should be used for surgical purposes, as they are the only 
 ones that entirely dissolve in water. The crystallized acid is best liquefied by putting the 
 bottle in warm water, and upon its liquefaction, adding five or ten per cent, of water or
 
 30 LOCAL THERAPEUTICS. 
 
 alcohol to maintain it in a fluid condition. Crude carbolic acid (Acidum carbolicum 
 crudum) is also official in U. S. P., with the thought that it would be used externally or 
 for disinfection. 
 
 A carbolated cotton is prepared by steeping absorbent cotton in a solution of carbolic 
 acid. 
 
 Carbolic acid enters into the composition of DobelFs solution, if, indeed, its value does 
 not almost entirely depend on it. The following is the formula: R. Sodii boratis, 
 one drachm; glyceriti acidi carbolici (U. S. P. 1870), two drachms; sodii bicarbonatis, 
 one drachm ; water, one-half pint. 
 
 Carbolic acid is a stimulant and anti-fermentative. It rather prevents 
 the formation of gases than destroys the odors which are caused by their 
 presence. In weak solution it produces a peculiar cooling and analgesic 
 impression. In a pure form it is a caustic. While carbolic acid is a para- 
 siticide, the germicide properties often claimed for it are not uniformly 
 accepted. Carbolic acid closely resembles creasote in its general proper- 
 ties, but is more powerful (Mandl). Concentrated preparations coagulate 
 albumin and gelatin. It should never be prescribed in concentrated forms, 
 notwithstanding the inconvenience of using large quantities of weak solu- 
 tions. Numerous accidents have occurred by its being taken in mistake 
 for other medicine, and severe caustic effects ensue by its accidental appli- 
 cation to the lining membrane of the nose and throat. The antidotes to 
 burning or poisoning by carbolic acid, either internally or externally, are 
 solutions of a soluble sulphate, e.g., sulphate of magnesium and sulphate 
 of sodium. Saccharate of lime is also highly commended as an antidote, 
 but this is not usually to be found in the shops. 
 
 General Surgery. In antiseptic surgery carbolic acid for a long 
 time held the foremost place, until the more general adoption of solutions 
 of mercuric chloride. It still plays an important part in the antiseptic 
 mode of treatment, particularly in cases in which mercurials cannot be 
 used. Owing to the sharp corroding effect of all solutions of these salts 
 on metallic substances, solutions of carbolic acid are to be preferred in 
 disinfecting instruments prior-to an operation. 
 
 As an antiseptic carbolic acid possesses the essential requisite of being 
 a poison to those low forms of life which determine putrefaction, and it 
 retains this power, even when diluted to such a degree as to be almost 
 entirely unirritating to the tissues. It is also volatile, and its vapor is 
 efficacious as an antiseptic. 
 
 Koch finds that chlorine, bromine and corrosive sublimate are decidedly 
 more efficacious in destroying the BACILLUS SPORES OF SPLENIC FEVER 
 than carbolic acid. Where gases or heat cannot be employed, he recom- 
 mends a mercuric salt, such as the mercuric chloride, sulphate or nitrate. 
 Of these a solution of one part to a thousand of water kills the resisting 
 spores in ten minutes, and one part in 15,000 is strong enough to kill 
 micro-organisms. To accomplish the same result a very much stronger
 
 ACIDUM CARBOLICUM. 31 
 
 solution of carbolic acid must be employed. The ordinary five per cent, 
 (or i to 20) solution, which is used in the majority of surgical operations, 
 requires more than a day to destroy the spores of anthrax. To use 
 solutions stronger than this is impracticable, because of the benumbing 
 influences that are produced on the hands of the surgeon, and also the 
 increased danger of absorption. These results are, however, rare, since 
 it is customary to regard a three per cent, solution in water as able to 
 destroy all germs in a few seconds or minutes. The surgeon washes his 
 hands and cleanses his instruments in such a solution, believing that he 
 has thereby rendered them free from living organisms. We see now, 
 however, that beyond the mere mechanical effect of washing, such precau- 
 tions are of no avail whatever in the case of organisms as resistant as are 
 anthrax spores. 
 
 Carbolic acid cannot, therefore, be regarded as a reliable disinfectant, 
 since it has not the power of destroying resisting spores under the condi- 
 tions of practical disinfection. Schotte and Gaertner have shown that to 
 destroy putrefaction-organisms in dry objects, 15 grains of carbolic acid 
 vapor to the cubic metre are required, so that disinfection of rooms by 
 this method is impracticable. 
 
 Carbolic acid dissolved in oil and alcohol is inert. Anthrax spores 
 were found to be unaffected after lying for upwards of three months in a 
 five per cent, solution of carbolic acid in oil, and equally so by seventy 
 days exposure to a five per cent, solution in alcohol. Even the sensitive 
 anthrax bacilli were not destroyed by a five per cent, solution of carbolic 
 acid in oil. 
 
 If carbolic acid comes in contact with substances containing water, for 
 instance the tissues of the body, doubtless part of it will be taken up and 
 exert some antiseptic action. In all other cases, as when it is sought to 
 disinfect dry objects, such as instruments, silk, cat-gut, etc., by carbolized 
 oil, there is no effect on even the least resisting micro-organisms, beyond 
 that due to the oil itself. 
 
 Bearing in mind that carbolic oil is inert, and that a two to five per 
 cent, solution can make no impression upon spores in the brief time 
 occupied by a surgical operation, and further that in order to prevent 
 bacterial growth the carbolic acid must be present in the proportion of 
 i to 400, it cannot any longer be a matter of surprise that in spite of the 
 most scrupulous antiseptic precautions, bacteria often appear under a 
 carbolized dressing. 
 
 The strength of the two solutions of carbolic acid that are in general 
 use in surgery is i to 20 and i to 40 ; the former is used for washing and dis- 
 infecting recent wounds, suppurating surfaces, abscess cavities, etc. It 
 is also used in the spray diluted to half strength with steam (i to 40). The 
 weaker solution is used for a bath to place instruments in during opera-
 
 32 LOCAL THERAPEUTICS. 
 
 tion. It is objectionable, as it in time discolors bright instruments, and 
 soon destroys their cutting surfaces. For this purpose we have abandoned 
 its use during the last year at the Episcopal Hospital in Philadelphia, and 
 substituted the boiling of instruments in distilled water (made slightly 
 alkaline with soda or ammonia, which prevents in a measure the discolor- 
 ation brought about by boiling), trusting to the purifying effect of moist 
 heat. In using the stronger carbolic acid solution, surgeons find great 
 inconvenience from the unpleasant benumbing effect produced by having 
 the fingers moistened by it even for a short period of time, in cold 
 weather causing the hands to chap greatly. The more recent practice 
 of Listerism is to use carbolic acid spray so as to keep the wounded surfaces 
 under a fine mist of carbolic acid (i to 20) diluted with steam to i to 40, 
 while carbolized oil cat-gut (by preference that prepared in chromic acid) 
 is used for the ligation of arteries. The dressing in vogue is (i) specially 
 prepared oiled silk on which a number of coats of dextrin have been 
 painted, as a protection from the irritating effects of the acid ; (2) a 
 coarse gauze made of cheese-cloth, impregnated with a mixture of car- 
 bolic acid, paraffin, castor oil, resin and alcohol. About eight layers of 
 the gauze are laid over the wound, which has previously been thoroughly 
 cleansed with the i to 20 solution. Over this is laid a piece of mackintosh, 
 wrung out of a solution of the same strength, and the entire dressing is 
 retained by means of a bandage made from the gauze. 
 
 For a number of years a solution of carbolic acid in olive oil (i to 10) 
 has been used in the Pennsylvania Hospital. Lint saturated with this 
 mixture is laid over the wound. Although worthless compared to the 
 more modern antiseptic dressings, it is an exceedingly bland, clean, and 
 pleasant application, especially to some varieties of BURNS and for the 
 packing of sinuses about the rectum after operations for the cure of FIS- 
 TULA. A similar preparation of carbolic acid and oil, though weaker 
 (i to 20) is largely used to anoint instruments in urethral surgery, being 
 much more convenient than cosmoline, the slight amount of carbolic 
 acid having a sedative effect on the urethral mucous membrane. 
 
 "Lund's Oil" is a favorite preparation in England for ANOINTING 
 CATHETERS. It consists of olive oil and castor oil, each one ounce; 
 carbolic acid, one drachm. It will be found usually more convenient in 
 making solutions of carbolic acid to first dissolve it in glycerin, as then 
 the globules of the acid are more readily broken up when they come in 
 contact with water. In making solutions for baths for instruments, etc., 
 (i to 40 and i to 20) the strength can readily be judged very accurately 
 by the taste, by applying a little of the solution on the end of the finger 
 to the tongue ; by this means much time and trouble are saved. 
 
 Carbolic acid locally applied is an anaesthetic. A. H. Smith painted 
 on his forearm a spot an inch in diameter, with an 85 per cent, solution
 
 ACIDUM CARBOLICUM. 
 
 33 
 
 of carbolic acid. For a minute it caused a slight burning, then the 
 skin became quite numb, whitened, and shriveled ; at this point he made 
 an incision one-half an inch long without feeling the knife, the wound 
 healing as usual. Three hours afterward he thrust, without pain, a 
 needle into the skin ; and next he applied a blister to the carbolized 
 skin without causing pain or vesication. He found that in incising 
 WHITLOWS this application greatly lessened the pain. 
 
 A strong carbolized solution is an exceedingly good application to 
 relieve the pain in superficial BURNS, care being taken to guard against 
 absorption, should the surface be of large extent. 
 
 Hiiter has used in his clinics carbolic acid hypodermically in the treat- 
 ment of ERYSIPELAS (carbolic acid, one grain, distilled water, 80 minims). 
 This solution is used in traumatic erysipelas ; five or six injections of 
 1 6 minims each are made in the healthy skin at several points around the 
 erysipelatous patch. They are repeated during the day, and the treat- 
 ment is pursued until the fever subsides and there is an arrest of the 
 erysipelatous inflammation. 
 
 Carbolic acid topically applied is useful in ANTHRAX. It may be 
 injected into the neighborhood of the pustule (two to three minims of a 
 two per cent, solution), twice a day for two or three days, a compress 
 soaked in a solution i to 20 being frequently applied. Some advise painting 
 over the part with strong acid. 
 
 Many attempts have been made to introduce carbolic acid as a sub- 
 stitute for the tincture of iodine in the treatment for the radical cure 
 of HYDROCELE. It was a favorite injection with the late R. J. Levis, 
 at the Pennsylvania Hospital, and has also been employed at the Massa- 
 chusetts General Hospital. It may be used with advantage in very 
 small hydroceles, employing from 20 minims to one-half ounce in glycer- 
 in. It is less severe, but not nearly so reliable an injection as the 
 tincture of iodine, recurrence after its employment being much more 
 common. It should never be used if chronic orchids or much thickening 
 of the sac is suspected, or in old or enfeebled persons. In NEURALGIA, 
 relief may be obtained by painting the course of the painful nerve with 
 a strong solution of carbolic acid. It has also been advised to inject 
 hypodermically small quantities of the drug in close proximity to the seat 
 of pain. In an obstinate case of SCIATICA, Dr. Levis painted the course 
 of the sciatic nerve with the pure acid, with the effect of producing great 
 amelioration. 
 
 Diseases of the Skin. Carbolic acid is much employed in the 
 
 treatment of diseases of the skin, chiefly as an antipruritic, in which it is 
 
 surpassed by no other remedy with which we. are acquainted. Bulkley 
 
 (The Local Use of Tar, etc., in the Treatment of Skin Diseases. Arch. 
 
 3
 
 34 LOCAL THERAPEUTICS. 
 
 Sfi. and Pract. Med,, April, 1873), believes this to be due to its stimu- 
 lating effect and also to a specific benumbing of the sensory nerves. 
 
 Pure carbolic acid acts powerfully upon the skin, but its effects are 
 superficial. It coagulates the albumin and so produces a white surface, 
 the depth of which may be increased by repeated applications (Bulkley). 
 Dr. Bill, of the United States Army, has used carbolic acid as a local an- 
 aesthetic, having been able to lay bare the radial artery of the arm, in his 
 own case, without pain. We have now, however, better local anaesthetics 
 (see Cocaine, Rhigolene). Bill first applies, for fifteen minutes or half an 
 hour, a weak solution of carbolic acid, either by compresses or soaking 
 the whole part, then traces with a camel's hair brush dipped in the strong- 
 est acid the course of the intended incision (Amer. Jour. Med. Sci., 
 1870; October, 1870, p. 573). 
 
 As an antiseptic in FOUL and INDOLENT ULCERS a lotion of eight to 
 fifteen grains to the ounce is often useful. It may also be added to the 
 linimentum calcis (See Calx.) used in BURNS. 
 
 In PRURITUS and CHRONIC ECZEMA carbolic acid is one of the most effi- 
 cient antipruritic remedies we possess. A lotion containing three 
 drachms of carbolic acid, an ounce of glycerin and a pint of water will 
 be found most useful in a great number of pruritic skin diseases. 
 
 Combined with caustic potassa carbolic acid acts not only as an anti- 
 pruritic but also as a discutient, aiding in the disappearance of INFIL- 
 TRATED PATCHES of ECZEMA. The following formula, suggested by Bulk- 
 ley, we have often used with satisfactory results: R. Acid carbolic, 
 31] ; Potas. caustic, %} ; Aquae, gv (by weight). M. Ft. Sol. It 
 should be used much diluted at first, and afterwards strengthened as the 
 patient can bear it. 
 
 Carbolic acid has been largely used as a parasiticide. In the animal 
 parasitic diseases we have so many other satisfactory remedies that we need 
 rarely have recourse to carbolic acid excepting to combat the PRURITUS 
 which sometimes follows the disease itself. 
 
 In TINEA TONSURANS, however, carbolic acid is one of the most effi- 
 cient remedies. It may be used in various strengths, combined with 
 glycerin. In older children the carbolized glycerin, one part of car- 
 bolic acid to two of glycerin, may be applied to the patches of RING- 
 WORM, while a weaker solution, one part to eight of glycerin, may be 
 applied to the scalp generally as a preventive. Weaker solutions should 
 be used in younger children. 
 
 In DERMATITIS CONGELATIONIS (chilblain), Lassar recommends the 
 following: R. Acid carbolic., grs. xvss; Ung. plurnbi, Lanolin, aa 3 V > 
 Ol. amygdali, fSiiss; Ol. lavanduli, gtt. xx. M. 
 
 Bulkley has often used, with very good results, an ointment of carbolic
 
 ACIDUM CARBOLICUM. 35 
 
 acid, )j to 3J, in FROSTED FINGERS and TOES (ERYTHEMA CALORICUM) 
 with ulceration, the pain subsiding at once and healthy reparative action 
 ensuing. 
 
 Frankel (Wien Med. Presse, October, 1888), recommends carbolic 
 acid for the removal of WARTS. 
 
 The skin surrounding the wart should be covered with cotton, and 
 thus protected. Then by means of a glass rod the liquid carbolic acid 
 should be applied to the wart, and allowed to dry. No pain is felt. In a 
 few days a part of the wart will fall off; renew its application until all 
 has been removed. 
 
 Diseases of the Ear, Nose, and Throat. In the treatment of 
 OTORRHEA, carbolic acid acts as a disinfectant and stimulant in lotions 
 of strengths varying from one to five drops of the acid to an ounce of 
 water. An equal quantity of sulphate of zinc may be added. A two per- 
 cent, solution has been instilled in the exposed meatus to relieve the pain 
 of OTITIS. The weaker solution alone should be employed in ACUTE PER- 
 FORATIONS OF THE TYMPANIC MEMBRANE. Objections are urged against 
 its use, from its liability to irritate the skin of the external meatus. The 
 pure acid may be applied with a probe to GRANULATIONS OF THE Mu- 
 cous LINING OF THE MIDDLE EAR. H. Hartmann (Deutsch med. Woch- 
 enschrift, No. 13, 1887, P- 4 I 4)> recommends the use of a 10 per cent, 
 solution of carbolic acid and glycerin in acute OTITIS MEDIA ; it not only 
 reduces discharge, but relieves pain. 
 
 It is not without its advocates in DIPHTHERIA. A pigment of three 
 grains to the ounce of water, or one part of the acid to three or five of 
 the alcohol, may be used. Gaucher (Brit. Med. Journal, November 23, 
 1889, P- TI ^5) claims that a pledget of cotton wrapped on a cotton car- 
 rier, soaked in a preparation of four scruples (5.2 grammes) of carbolic 
 acid, three drachms (n grammes) of alcohol, and one-half ounce (15.5 
 grammes) of castor oil, pressed on the false membrane, desiccates it, and 
 renders the removal easy ; after its removal the solution may be employed 
 once a day. M. Broudel (Gaz. des Hopitaux, December n, 1886), em- 
 ploys a somewhat similar preparation. Falkenheim (Verein fur wissen- 
 schaftliche Heilkunde in Konigsberg, November 5, 1888), injects the acid 
 into the substance of the tonsil in this disease. 
 
 As an inhalation or spray, in strength of four to eight grains to the 
 ounce, carbolic acid is used in the treatment of CROUP. A five per cent, 
 solution is occasionally used as a spray in BRONCHITIS. In all affections of 
 the respiratory passages in which there is great fetor, arising from con- 
 stantly renewing sources, as in SYPHILIS, CARCINOMA OF THE LARYNX, 
 GANGRENE OF THE LUNGS, BRONCHORRHCEA, PYOPNEUMOTHORAX, etc., 
 carbolic acid inhaled in proportions of three to six drops to half a pint 
 of water gives good results.
 
 36 LOCAL THERAPEUTICS. 
 
 The value of the acid in NASAL AFFECTIONS has led to combinations 
 being made with other agents of repute. Thus Hager adds one part of 
 the acid to three of absolute alcohol, one of caustic ammonia and two 
 distilled water, the mixture being preserved in a dark stoppered vial. The 
 preparation is known as " Hager 1 s Anticatarrhal Mixture. ' ' A few drops 
 on blotting paper folded in a cone shape is held to the nose, the eyes are 
 closed and deep inspirations are taken. 
 
 Percy Boulton has proposed to combine the properties of carbolic acid 
 and iodine as follows: R. Tinct. iodinii comp., n^ xlv; Acid carbolic 
 cryst., TTL vj ; Glycerini, g j ; Aqua, destillat., v. 
 
 A peculiar penetrating odor results from this union which to many 
 persons is disagreeable. The physician's office and dwelling becomes 
 fairly saturated with it if the prescription is in common use. A similar 
 preparation to the above is in high repute in Germany for treatment of 
 FISSURE OF THE TONGUE. G. Lefferts modifies the mixture by adding to 
 a drachm each of carbolic acid and iodine, one ounce each of powdered 
 charcoal and camphor. A sufficient quantity of benzoin is added to 
 make a paste, and 20 drops of oil of lavender are added to correct the 
 odor. The preparation is to be inhaled through the nose from a wide- 
 mouthed, glass stoppered bottle. Moure (La Tribune Medicale, 1889,) 
 adds 15 grains of carbolic acid to 45 of crystallized resorcin, largely 
 diluted in water to which a small proportion of glycerin has been added. 
 (300 grains aqua and 500 grains glycerin.) 
 
 Carbolic acid can be used in great strength in the nose when applied 
 in small quantity to selected surfaces. But in the form of the lotion the 
 strength must be graded by the amount which can be borne comfortably 
 upon the lips and the pharynx. Thus, a pigment of 10 to 20 grains to 
 the ounce might be applied to the interior of the nose with safety when 
 a strength so great would excite irritation of the lips and the throat. 
 
 In directing carbolic acid to be use'd in the form of a nasal bougie, 
 one-half grain is usually introduced in each mass. Boulton's solution 
 may be used in this way : one-quarter minim of the deliquesced crystals 
 is added to five minims of Lugol's solution. 
 
 Carbolic acid has been employed by E. F. Henderson (St. Louis Med. 
 and Surg. Journal, Jan. 1886 28) as an injection to HYPERTROPHIES OF 
 THE INTERIOR OF THE NOSE. Rumboldt (St. Louis Medical Archives, 
 1873) places carbolic acid at the head of the list of remedies for local 
 application in the treatment of ACUTE and CHRONIC INFLAMMATION OF THE 
 THROAT AND NOSE. He recommends from two to five grains to the ounce 
 of water. In his judgment a slight smarting sensation should ensue after 
 each application. 
 
 Crystals of carbolic acid rendered soluble by heat are used in treating 
 sinuses leading through gum tissue to bone. Cure of PYORRHEA ALVEO-
 
 ACIDUM CARBOLICUM. 37 
 
 LARIS can be effected by the persistent use of this agent. It is also known 
 that ALVEOLAR ABSCESS can be successfully treated if the pure acid can be 
 forced through the root in the sac of the old abscess and allowed to escape 
 by the fistulous tract. Thorner {Trans. Ohio State Med. Soc., 1889), for 
 TONSILLITIS, paints the parts with a preparation of carbolic acid, tannic 
 acid, each 30 grains to the ounce, combined with a small proportion of mor- 
 phine. The haemostatic properties of carbolic acid have received little 
 attention. As a coagulant of albumin, and astringent it doubtless will 
 have value in concentrated preparations. A. Jamison {Brit. Med. Jour., 
 April 21, 1888) found a preparation of one-half drachm of the acid 
 to an ounce of glycerin checks slight BLEEDING FROM THE PHARYNX. 
 
 A solution of carbolic acid, one to forty, will often be found a very 
 pleasant mouth-wash in CANCEROUS DISEASE OF THE TONGUE, and other 
 foul conditions involving the buccal cavity. 
 
 A mixture of carbolic acid and collodion is useful in TOOTHACHE due 
 to an exposed and inflamed pulp. A jelly is made by melting some 
 crystalline carbolic acid in a test tube, then adding an equal part of 
 collodion. A portion of this preparation on cotton is inserted into the 
 cavity of the painful tooth, with sometimes aggravation of the pain, but 
 in a few seconds it begins to diminish and then soon ceases (Ringer). 
 
 In CHRONIC LARYNGITIS accompanied with diminished secretion carbolic 
 acid is one of the best topical remedies ; a mixture of one-half to a drachm 
 of the crystals to an ounce of glycerin is prepared and the remedy 
 applied directly by a brush or cotton pledget to the interior of the larynx. 
 Usually, however, the acid is used by inhalation to any point below the 
 level of the pharynx. Twenty drops to forty in a pint of water with a 
 small amount of glycerin is inhaled at 140 F. for correction of FETOR 
 and as a soothing preparation in SYPHILITIC ULCERATIONS and CARCINOMA. 
 But twenty-five to thirty grains to the ounce have been recommended 
 (one-fourth to one-half) by Moritz. {St. Petersburg Med. Wochen., 
 1876, 39.) 
 
 As we have seen, the vapor from stronger preparations of the acid may 
 be drawn within the respiratory passages in many of its inflammatory 
 states. As an inhalant in WHOOPING-COUGH Sajous recommends the 
 formula: R. Acidi carbolici, tt^ij; Alcoholis, Succ. conii, aa n^xx; 
 Aquas, Oss, at 140 F. 
 
 Lozenges and pastilles of carbolic acid contain a fourth of a grain to 
 a grain of the drug. 
 
 An application of carbolic acid of a 30-per-cent strength, employed 
 by a practitioner who desired to remove by its means an exudation upon 
 the tonsil, which was in a state of follicular inflammation, immediately 
 caused a light opalescent color to appear on the parts; the uvula became 
 irregularly spotted with patches of a dense white hue and the velum
 
 38 LOCAL THERAPEUTICS. 
 
 became cedematous. The agent had no effect upon the exudation. Two 
 conclusions can be drawn from such an imprudent application ; first, 
 it entirely failed to accomplish the object which the practitioner had 
 in view, and secondly, it masked the characteristic appearance of the 
 disease. 
 
 Inhalations of carbolic acid mingled with air at a high temperature are 
 said by A. E. Samson ("Antiseptic System," London, 1871, p. 91) to 
 possess decided advantages over any other means of using this agent as a 
 local application in PHTHISIS or BRONCHITIS. The carbolic acid is liquefied 
 by the addition of alcohol and the liquid allowed to fall a few drops at a 
 time upon an appropriately heated surface. An ordinary thick tea-cup or 
 egg-cup, which has previously been heated in the oven or by allowing a 
 small quantity of alcohol to burn in the cup until it is extinguished, is 
 first prepared, then the mixture of carbolic acid and alcohol is poured a 
 few drops at a time while the patient inhales the resulting vapor. The 
 first effect is a slight disposition to increase the cough ; soon, however, 
 tolerance is established ; the COUGH is diminished, the EXPECTORATION 
 is decreased, and the FETOR is corrected. The treatment is not adapted 
 to instances in which haemoptysis is likely to occur. Tissie (Revue de 
 Laryng. d' Otol. et de Rhinol., May i, 1891) employs carbolic acid in 
 combination with aqua ammonia and alcohol as an inhalant. Five grams 
 each of the acid and ammonia water are added to ten grams of alcohol 
 in 15 grams of water. A few drops are poured upon a piece of absorb- 
 ent paper and inhaled. 
 
 Diseases of the Eye. Carbolic acid being more irritating and less 
 efficient than some other antiseptics, is not much used by ophthalmic sur- 
 geons except to disinfect their hands and instruments. For the latter 
 purpose a four per cent, solution is used. The keen edges of delicate 
 knives, however, are liable to be impaired by it, and boiling water or 
 alcohol with careful wiping with absorbent cotton is preferable. 
 
 The late Dr. Williams, of Cincinnati, strongly recommended carbolic 
 acid as a caustic in the treatment of INDOLENT OR SLOUGHING ULCERS OF 
 THE CORNEA. He applied it by means of the end of a small probe dipped 
 into the pure acid. 
 
 " Glycerite of carbolic acid' 1 (one part to four not official), has been 
 recommended as an application to GRANULAR LIDS, but has not met with 
 general acceptance. 
 
 " PHENOL SODIQUE." 
 
 "Phenol Sodique " is a proprietary article. It is here conveniently 
 treated under the general heading of carbolic acid. In its preparation a 
 crude carbolic acid-phenol, together with a group of hydrocarbons, ethers 
 and acids (notably cresylic acid) obtained by the distillation of coal tar, is 
 neutralized by the addition of soda, the result giving a non-irritating
 
 ACIDUM CHROMICUM. 
 
 39 
 
 sedative mixture. Lint or gauze may be saturated with " phenol sodique," 
 diluted with water, and used in the treatment of WOUNDS, ABRASIONS, 
 etc. Undoubtedly " phenol sodique " possesses many of those antiseptic 
 properties which are found through the entire series of the phenylic com- 
 pounds. In the treatment of BURNS " phenol sodique " added to cosmo- 
 line, equal parts, is regarded by many practitioners as a cleanly, sedative 
 dressing, containing many of the properties of carbolic acid. 
 
 ACIDUM CHROMICUM. Chromic Acid. 
 
 Chromic acid, or, more properly, chromic anhydride, is " in the form of anhydrous, 
 acicular crystals, of a brilliant crimson red color, and of acid metallic taste, deliquescent, 
 and very soluble in water, forming an orange red solution." U. S. D. " On contact, 
 trituration, or warming with strong alcohol, glycerin, spirit of nitrous ether, and other 
 easily oxidizable substances, it is liable to cause sudden combustion or explosion." U. 
 S. P. Chromic acid is occasionally contaminated with sulphuric acid, sometimes con- 
 taining as high as seven per cent. It should be practically entirely free from sulphuric 
 acid, as is contemplated by the Pharmacopoeia. 
 
 Pure chromic acid and solutions of about two drachms to the fluidounce 
 of water are escharotic. Thus used this agent is a powerful caustic. It 
 oxidizes the tissues and abstracts their moisture. Its action is slow. When 
 used on a surface the sensibility of which is unobtunded chromic acid is 
 followed by burning pain which, however, is of shorter duration than 
 that of most caustics. Weak solutions are stimulant and alterative. 
 
 General Surgery. Chromic acid is commonly used in solution with 
 water or in a paste made with charcoal and water. It was introduced as 
 an escharotic by Mr. Marshall, as a substitute for nitric acid and acetic 
 acid, for the removal of SYPHILITIC WARTS, VEGETATIONS, and SMALL 
 DERMAL GROWTHS. Different strengths may be employed according to 
 the effect that is to be produced ; two drachms to the fluidounce of water 
 will, as a rule, be a sufficiently strong destructive agent. The solution is 
 best applied by means of a pointed glass rod, or, where a large quantity 
 is required, by a glass tube drawn to a point. Only so much should be 
 applied as will saturate the diseased growth, avoiding the surrounding 
 healthy mucous membrane or skin. Although it may not destroy the skin 
 or mucous membrane, it may give rise to an unnecessary amount of 
 inflammation. Any superfluous acid may be removed with a piece of wet 
 lint. We have often found that a small piece of adhesive plaster, in 
 which a hole has been cut large enough to allow the growth to protrude 
 through it, will protect the surrounding skin from the action of the agent. 
 
 The first effect of the acid, when applied to WARTS, is to produce a 
 slight pain. If, however, an ulcerated surface is touched, the pain is of 
 a burning character, but not so intolerable as that produced by nitrate of
 
 40 LOCAL THERAPEUTICS. 
 
 silver or nitric acid. If the pain should be severe, the application 
 of olive oil will at once alleviate it. After its use, the best immediate 
 dressing is dry lint applied to the surface of the growth, and after this 
 zinc ointment. Under the influence of chromic acid morbid growths 
 rapidly dissolve or waste away. In some cases one application will 
 suffice, but if the warts are large repeated cauterizations are necessary. 
 In using this method care must be exercised, as in several instances death 
 has followed the application of chromic acid to a large number of con- 
 dylomata at a single sitting. We have found chromic acid of great value 
 in treating small SALIVARY FISTUL/E. It is applied by heating a delicate 
 silver probe almost to redness and inserting it into the crystals of the acid, 
 which melt and adhere, leaving a smooth coating of chromic acid on the 
 instrument. This can be inserted along the fistulous tract, which in a 
 short time will start up a growth of granulations, closing the sinus. 
 
 SESSILE PILES, where there is a bright granular patch of mucous mem- 
 brane which bleeds at the slightest touch, can be cured by the application 
 of chromic acid. After the patient has been etherized, the sphincter 
 stretched, and the patch exposed with the speculum, the surface is well 
 dried with cotton and the acid is painted on with a glass brush, care being 
 taken that none comes in contact with'the skin or margin of the anus. 
 A morphine suppository is then introduced to prevent pain or spasm. A 
 superficial slough usually comes away in the course of a few days without 
 being noticed, and the granulating surface left contracts and obliterates 
 the deeper parts of the vessels. (Moullin.) 
 
 Chromic acid is used in the preparation of CATGUT LIGATURES, in order 
 to make them resist the absorbing influences of the tissues. They are pre- 
 pared in the following manner : Place catgut in ether for forty-eight 
 hours ; then immerse in the following for forty-eight hours, and place in 
 dry, sterilized, tightly-closed vessels, or carbolic acid, i to 20: R. Acid 
 chromic, gr. ss ; Acid carbolic, gr. c; Alcohol, f 3j ; Aquae, f3xj. 
 
 Diseases of the Skin. Chromic acid is sometimes used in sub- 
 stance upon the surface of EPITHELIOMATOUS AND LUPOID ULCERS. In 
 TINEA CIRCINATA it is applied in solution, one drachm of the acid to 
 an ounce of water A single application usually suffices. It is also use- 
 ful in other VEGETABLE PARASITIC SKIN DISEASES. 
 
 In CONDYLOMATA and VERRUCA ACUMINATA a solution of two drachms 
 to the ounce of water is effectual, though somewhat painful. In ordinary 
 CORNS and WARTS this solution, or even a stronger one, may be used with 
 advantage. It has also been employed as a stimulant in CHRONIC ECZEMA, 
 but we think that other stimulants, as solutions of potassa caustica, 
 nitrate of silver, tincture of cantharides, lactic acid, etc., are better. 
 
 Chromic acid has been successfully employed in the treatment of 
 HYPERIDROSIS, particularly in sweating of the feet. The application of a
 
 ACIDUM CHROMICUM. 41 
 
 10 per cent, solution (gr. j to fj water), repeated every three or six 
 weeks, is said to be sufficient to prevent any inconvenience. A limited 
 experience has shown us that this remedy, although useful, is not certain 
 to cure the affection. A further experience may, however, establish its 
 usefulness among other remedies. 
 
 Chromic acid has also been recommended as an application to the 
 interior of CYSTIC TUMORS, and would, therefore, probably prove valuable 
 in sebaceous tumors of the skin. 
 
 Diseases of the Ear, Nose, Throat, etc. Chromic acid is used 
 in the mouth, throat, and nose, for caustic or stimulant purposes. As a 
 caustic, the acid is valuable in the treatment of FIBROUS HYPERTROPHIES 
 and POLYPOID GROWTHS of the mucous membranes. It is of special 
 efficacy in the reduction of HYPERPLASIA 'OF THE TURBINALS. Owing 
 to the fact that it contains no sulphuric acid, Merck's preparation of 
 chromic acid is to be preferred. The crystals can be crushed on the end 
 of a delicate spatula and carried to the selected spot, or fused on the end 
 of a metallic probe, as in the case of the nitrate of silver. Bresgen pro- 
 vides a probe the end of which is covered with cotton ; on this point he 
 lays some crystals of the acid and ^gain covers the whole with a layer of 
 cotton ; when applied a short time to the required spot, the acid dissolves 
 and the desired end is obtained. A. W. MacCoy has devised an instru- 
 ment which conceals the fused acid borne on the end of a stylet within a 
 cannula composed of a spiral spring of composition metal. The entirely 
 deliquesced crystals which constitute a concentrated solution of the acid is 
 of caustic strength, but is much milder in its effects than the fused or 
 crushed crystals. According to Squibb (The Ephemeris, July, 1883), 
 chromic acid is an active oxidizing agent. The product of oxidation is an 
 insoluble and inert oxide of chromium. The caustic effect is strictly self- 
 limited. So powerful an agent cannot be used without careful attention to 
 details. It is necessary to remember that the acid must not be applied 
 to large surfaces at one sitting ; that the part must be freed from mucus so 
 as to prevent this secretion acting as a medium to distribute an irritating 
 fluid elsewhere. In making applications to the larynx it is necessary to 
 remember that enough of the dissolved acid may pass into the pharyngeal 
 mucus and be swallowed to induce nausea if not a toxic impression. 
 The parts therefore should be flushed with a weak alkaline solution 
 directly after the application is made. In intra-nasal use the acid is 
 capable of exciting artificial catarrh, accompanied with edema. The 
 odor is unpleasant and with some patients prohibitory. 
 
 The caustic effect is active when exhibited on NASAL POLYPUS. F. 
 Donaldson (Arch, of Laryngology, 1883, 4,175) carries the acid by means 
 of pointed glass probes directly into the substance of the growth. Verneuil 
 praises chromic acid in TUBERCULOSIS OF THE TONGUE and ICHTHYOSIS.
 
 42 LOCAL THERAPEUTICS. 
 
 In the treatment of ENLARGED TONSILS B. Fraenkel thrusts fine needle 
 points into the crypts. Woakes {Lancet, 1890) uses a saturated solution 
 for injection into RANULA. A cure is rapidly accomplished. 
 
 Chromic acid is also of good repute in the treatment of CHRONIC 
 LARYNGITIS. Sajous believes it to be especially indicated when the 
 affected parts are covered with arborescent vessels. The network of 
 vessels is destroyed without causing cicatrices or plastic inflammation of 
 the deeper tissues. W. C. Jarvis {Trans. Laryngology, 1884) especially 
 recommends this agent for the treatment of LARYNGEAL PAPILLOMATA. 
 The remedy has distinct limitations. 
 
 Solutions have also been used as lotions for the nasal passages in HAY- 
 FEVER. One part to twelve may be applied to granulating surfaces. 
 H. McNaughton Jones mentions a lotion of ten to twenty grains to the 
 ounce for a stimulating wash to the naso-pharynx. A lotion of ten grains 
 to the ounce has been proposed by R. A. Sterling (Australian Med. 
 Journal, April, 1885) for SYPHILITIC ULCERS of the throat and nose. 
 Moullin recommends for CHRONIC SUPERFICIAL GLOSSITIS, chromic acid, 
 gr. xx-fSj, painted over the tongue once or twice a week : this will be 
 found a satisfactory means of dealing with the condition. In SYPHILITIC 
 LARYNGITIS the acid may be used with advantage, according to Escam- 
 bert, in the proportion of one part of the acid to eight of water. 
 
 Diseases of the Eye. Chromic acid may be used to remove WARTS 
 ON THE EYELIDS or as an application to small EPITHELIAL ULCERS. It is 
 applied by means of a splinter of wood or a glass rod, or a small pledget 
 of absorbent cotton on the end of a fine probe. 
 
 ACIDUM CITRICUM. Citric Acid. 
 
 " Colorless, right rhombic prisms, not deliquescent except in moist air, efflorescent in 
 warm air, odorless, having an agreeable, purely acid taste, and an acid reaction." 
 (U. S. P.) It is soluble in three-fourths of its weight of cold and half of its weight of 
 boiling water; in its weight of alcohol and half its weight of boiling alcohol; insoluble 
 in pure ether, arid in chloroform, benzol, and benzin. It is apt to be adulterated or sub- 
 stituted by tartaric acid. This fraud is easily detected by the addition of a solution of 
 potash to a solution of the suspected acid, when if tartaric acid is present, bitartrate of 
 potassium will be precipitated. 
 
 Diseases of the Skin. Citric acid, as well as juice of the lemon, 
 or lime, have been employed in the local treatment of several different 
 skin affections. The pain accompanying some forms of EPITHELIOMA is , 
 said to be assuaged by lotions containing five or six grains of citric acid 
 to the ounce of water. 
 
 Lemon or lime juice, pure or diluted, has been employed to loosen the 
 fatty plugs in COMEDO, to hasten the cure in TINEA KERION, to allay
 
 ACIDUM GALLICUM. 
 
 43 
 
 the itching and stinging of URTICARIA, and also as a local application in 
 SUDAMEN, or " PRICKLY HEAT," and in PRURITUS. The modus opei" 
 andi of the drug in these affections has never been explained. 
 
 Diseases of the Mouth, Throat, etc. From its agreeable taste 
 citric acid enters into the composition of confections and lozenges, each 
 mass containing two grains of the agent. Citrate of potash may take its 
 place. 
 
 ACIDUM GALLICUM. Gallic Acid. 
 
 Like tannic acid, gallic acid is obtained from galls, and really is a product of the action 
 of a ferment in the presence of water upon tannic acid, converting it into gallic acid. It 
 is in delicate, shiny, acicular crystals, almost colorless. " It is inodorous, of a sourish, as- 
 tringent taste, and of an acid reaction." (U. S. D.) " It is soluble in loo parts of cold 
 and three of boiling water, in four and five-tenths parts of alcohol, in one part of 
 boiling alcohol, in three parts of absolute alcohol and 39 parts of absolute ether." 
 (U. S. D.) A solution of 40 grains to the ounce in glycerin may be diluted by water 
 without precipitation. Unlike tannic acid, it does not precipitate solution of gelatin. The 
 only official preparation is the ointment (Unguentum Acidi Gallici), containing ten per 
 cent, of gallic acid. 
 
 Gallic acid has the local properties of tannic acid ; while a weaker 
 astringent than it, it possesses the advantage of being less irritating. 
 
 General Surgery. As a topical astringent application gallic acid 
 is greatly inferior to tannic acid, as it does not coagulate albumin. 
 
 D. H. Agnew recommends equal parts of gallic acid and iodoform as a 
 dusting application in the treatment of CHANCROIDS. This combination 
 is especially useful when the sore has an indolent appearance and a ten- 
 dency to sero-purulent discharge. Equal parts of the ointment of gallic 
 acid and ointment of stramonium is one of the most serviceable topical 
 applications for EXTERNAL PILES. In a great majority of cases this, in 
 conjunction with either hot or cold water sitz-baths, twice daily, and the 
 use of a mercurial, will relieve the patient in a short time. Agnew also 
 advises the use of gallic acid and glycerin as a prophylactic in the treat- 
 ment of delicate and TENDER NIPPLES, care being taken that the breast 
 is thoroughly cleaned before nursing. 
 
 Diseases of the Throat. Some writers believe that the addition 
 of one-third gallic acid to two-thirds tannic acid in local treatment of the 
 inflammations of the nose and throat, diminishes the irritative effects of 
 the latter without lessening its astringent properties. Used in the form 
 of a lozenge, each mass should contain two grains of the agent.
 
 44 LOCAL THERAPEUTICS. 
 
 ACIDUM HYDROCHLORICUM. Hydrochloric Acid. 
 Muriatic Acid. 
 
 " A liquid composed of thirty-one and nine-tenths of absolute hydrochloric acid and 
 sixty-eight and one-tenth of water." (U. S. P.) 
 
 Absolute hydrochloric acid is a gas, and the official hydrochloric acid, as will be 
 seen, contains approximately 32 per cent, of this gas dissolved in water. It is " a 
 colorless, fuming liquid, of a pungent, suffocating odor, an intensely acid taste, and a 
 strongly acid reaction." (U. S. P.) It emits white fumes when exposed to the air, 
 owing to the escaping hydrochloric acid gas uniting either with the moisture of the at- 
 mosphere or with any ammonia that may be therein. Commercial hydrochloric acid is 
 not fit even for external use, because of its impurity. Hydrochloric acid combines with 
 all the alkalies, and most earths, with oxides and with carbonates, forming salts. It is 
 incompatible with solutions of sulphide of potassium, nitrate of silver, and subacetate of 
 lead. Dilute hydrochloric acid is official and is composed of six parts of hydrochloric 
 acid mixed with 13 parts of water. 
 
 Hydrochloric acid is a mild escharotic and stimulant. 
 
 General Surgery. Hydrochloric acid, though belonging to the 
 group of strong acids, occupies but a small space compared with the other 
 acids as a topical application. For caustic purposes it is practically use- 
 less, and consequently is never employed. It is, however, of great service 
 for softening plaster-of-Paris bandages, so that they may be easily divided 
 with an ordinary knife. It is usually applied with a glass pipette to the 
 part that is to be cut through. In the absence of a pipette, a small swab 
 of cotton on the end of a stick may be saturated with acid and drawn a 
 few times over the surface of the bandages. In this way thick, heavy 
 bandages may be readily separated with little effort. 
 
 Hydrochloric acid is of great service in the removal from the fingers 
 and nails of the stains following the use of permanganate of potash. 
 It is used in the preparation of sponges for surgical purposes. (See 
 Spongia.) Andrews (Kansas City Medical Record, September, 1887,) 
 advocates the REMOVAL OF SEQUESTRA by injecting dilute hydrochloric 
 acid through the cloaca, thus dissolving the dead bone. In OSTITIS 
 and CARIES, Chassaignac advises the use of the acid for the REMOVAL 
 OF THE CRUMBLING BONE. It may be injected, or applied by means of a 
 cotton swab. In CYSTITIS, when the urine is very alkaline, with a large 
 amount of phosphatic deposits, as is often seen in cases of fracture of 
 the vertebrse, injections of hydrochloric acid, from one-half to one 
 minim to a fluid ounce of water is of service. 
 
 Diseases of the Ear, Nose and Throat. Hydrochloric acid 
 when employed pure is a caustic on mucous surfaces. As such it is 
 employed in NOMA AND PUTRID SORE THROAT. Diluted with three parts 
 of honey it constitutes one of the older applications for DIPHTHERIA 
 (Bretonneau). A stimulating gargle is formed by adding ten minims of
 
 ACIDUM HYDROCYANICUM ACIDUM LACTICUM. 45 
 
 the dilute acid and 24 minims of glycerin to an ounce of water. The 
 teeth would be injured by prolonged use of such a preparation. Hydro- 
 chloric acid is but little employed in the throat or nose. It is a weak 
 caustic the eschar soon falling off. 
 
 ACIDUM HYDROCYANICUM DILUTUM. Diluted Hydrocyanic 
 Acid. Prussic Acid. 
 
 " A liquid composed of two per cent, of absolute hydrocyanic acid and 98 per cent, 
 of alcohol and water." (U. S. P.) " A colorless liquid, of a characteristic odor and 
 taste resembling those of bitter almonds, and having a slightly acid reaction." (U. S. P.) 
 It should be kept in well stopped bottles and not exposed to the light. The preparation 
 known as Scheele's medicinal hydrocyanic acid is two and a half times as strong as the 
 official diluted acid, containing as it does five per cent, of absolute hydrocyanic acid. 
 
 Diseases of the Skin. Hydrocyanic acid is employed as a sedative 
 in URTICARIA, PRURITUS VULV^E, ECZEMA and ERYTHEMA. It is commonly 
 applied as a lotion in the proportion of half a drachm to a drachm of th6 
 diluted acid to the ounce of water. Its effect is uncertain and variable. 
 Its chief advantage over other antipruritic sedative applications is in 
 its agreeable odor. It should not be employed over an abraded surface, 
 and hence should rarely be employed in eczema and only with some cau- 
 tion in pruritus vulvas. In ERYTHEMA MULTIFORME, when itching is 
 present, the hydrocyanic acid lotion is useful, and it often relieves the 
 annoying symptoms of URTICARIA. 
 
 Cyanide of potassium is sometimes employed instead of hydrocyanic 
 acid, in ointment of the strength of six grains to the ounce of cold cream, 
 or in lotion of the strength of two grains to the ounce of water. 
 
 Diseases of the Throat. Diluted in the strength of three drops of 
 dilute hydrocyanic acid to a half pint of water at a temperature from 
 80 F. to 120 F., a preparation is obtained which is recommended by 
 M. Mackenzie, Lefferts and Sajous as a potent sedative in the SPASMODIC 
 IRRITATIVE COUGH in the first stage of PHTHISIS, as well as in attacks of 
 ASTHMA and HAY FEVER. A few inhalations will often arrest a severe 
 paroxysm. 
 
 ACIDUM LACTICUM. Lactic Acid. 
 
 Lactic acid of pharmacy is a " liquid composed of 75 per cent, of absolute lactic 
 acid, and 25 per cent, of water. It is a nearly colorless, syrupy liquid, having an acid 
 taste, and an acid reaction. " (U. S. P.) 
 
 Lactic acid is a caustic to highly organized tissues and a solvent for 
 horny epithelium. It also possesses mild antiseptic properties. 
 
 General Surgery. Lactic acid was not much used as a topical 
 application in surgery until Mosetig-Moorhof brought it into prominent
 
 46 LOCAL THERAPEUTICS. 
 
 notice as a slow destructive agent in the treatment of EPITHELIOMA, 
 LUPUS and TUBERCULOUS ULCERATIONS. According to his statement we 
 have in lactic acid, when applied locally, a slow caustic action, destroy- 
 ing only the diseased part and not affecting the healthy tissue, and result- 
 ing in a short time in the complete removal of all affected tissue. A 
 great deal of evidence is brought to bear that these statements are not 
 correct, and that lactic acid is equally destructive to healthy and diseased 
 tissue. 
 
 Cheron (Gaz. de Gynecol., February i, 1888) recommends it in the 
 treatment of VAGINAL ULCERATION that has resisted other means of 
 treatment. It has been used in TUBERCULOUS ULCERATION OF THE 
 TONGUE. Lactic acid, 80 parts; water, 20 parts, brushed daily over the 
 ulcerated surface with a camel's hair brush. (Rev. de Therap, April i, 
 1889.) 
 
 Diseases of the Skin. Lactic acid in a pure concentrated form 
 has been used successfully in the treatment of TYLOSIS. The fluid is well 
 rubbed in by the aid of a brush of cotton or lint tied to a short stick. 
 The effect of the application is to soften the overgrown epidermic masses, 
 which easily peel off after a few days' treatment. The hypertrophy 
 returns, but by persistence a cure eventually results, according to Knocke. 
 {Jour. Cut. and Ven. Dis., v, 1887, p. 122.*) 
 
 Lactic acid has also been used in VERRUCA, CHLOASMA and LENTIGO. 
 In the case of the two latter the acid should be diluted with three parts 
 of water. 
 
 In LUPUS VULGARIS lactic acid, applied pure or made into a paste with 
 salicylic acid, has been employed with success. A piece of lint wet with 
 the lactic acid, or a thin layer of the paste, is applied to the diseased part 
 and then covered with gutta percha, the surrounding healthy tissue 
 having been protected by ointments or gutta percha solution. After 24 
 hours the dressing is removed, the resulting ulcer dressed with iodoform 
 gauze, and this dressing remains for 48 hours. Lactic acid is then once 
 more applied and the procedure repeated. 
 
 Mosetig-Moorhof ( Cbl. f. Chir., 1885, p. 193) appears to have been the 
 first to find that concentrated lactic acid brought in contact with 
 fungous granulations changed these into a soft blackish mass. Applied 
 to LUPUS, EPITHELIOMA and FLAT PAPILLOMA, the entire tissue, stroma 
 and all, became changed to a blackish mass. The acid is applied as 
 above, pure or made into a paste with salicylic acid. The application 
 is to be made at intervals of 12 hours. 
 
 Diseases of the Ear, Throat, and Nose. To produce the caustic 
 effect of lactic acid in the nose, mouth, and throat the agent must be 
 used pure. Solutions of varying strengths are demanded in other clinical 
 conditions. Victor Lange {Archives of Otology, vol. 17, No. i) applies
 
 ACIDUM LACTICUM. 
 
 47 
 
 lactic acid, 15 to 30 per cent., with good results in CHRONIC SYPHILITIC 
 CONDITIONS OF THE MIDDLE EAR. It corrects odor and diminishes the 
 discharge. C. Astier {Rev. Gen. Clinique et de Therap., February 7, 
 1899) recommends lactic acid for HYPERTROPHY OF THE NASAL Mucous 
 MEMBRANE. The author employs two parts of the acid to one of water. 
 Jellinek ( Centralblatt f. Laryngologie, 1886) finds the acid available 
 for small, recent, SHALLOW ULCERS and SOFT INFILTRATIONS, also in 
 GRANULAR PHARYNGITIS, ATROPHIC and HYPERTROPHIC CATARRH. Rafin 
 uses an eighty per cent, solution of lactic acid in the local treatment of 
 LUPUS in the nasal passage. Cartaz recommends it in the treatment of 
 NASAL TUBERCULOSIS. In NASAL DIPHTHERIA a spray of a drachm of the 
 acid to the ounce of water is spoken of highly by M. Mackenzie. In 
 the more usual pharyngeal form of this disease a weaker preparation will 
 suffice, viz., a strength of twenty minims to the ounce of water. If the 
 child does not permit spraying, the preparation may be used as a pigment. 
 Reports vary as to the value of lactic acid in TUBERCULOUS ULCERATION 
 of the tongue. Poncet {Lyons Medical, January, 1887) found it to be 
 painful, while it proved to be futile, in his attempts to heal the ulcer. On 
 the other hand, Rafin {Ibid., July 8, 1888) extols its use. Applications 
 made twice daily for six weeks resulted in a cure. A solution of a strength 
 of eighty per cent, was employed. . ' 
 
 H. Krause {Berliner klin. Woe hens chrift, 1885, 462) called attention 
 to this drug as a local remedy for LARYNGEAL PHTHISIS. He was led to 
 make a trial from its known value in the treatment of LUPUS. It is now 
 by most observers accepted as one of the best of topical applications in 
 the condition named. J. Sedziak {Journal of Laryngology and Rhinology, 
 1889, 232) claims in 73.3 per cent, more or less favorable effects, follow 
 its use. The cases in which failure was noted were those which had 
 been under observation but a short time, or in which there had been ex- 
 tensive complications prohibiting the free use of the acid. Even in the 
 most unfavorable circumstances he states that the applications facilitate 
 deglutition. The acid is used in strengths varying from ten to one 
 hundred per cent. It is well to begin with a weak solution and 
 gradually increase its strength, since it is known that in some cases irrita- 
 tions of a high grade may follow if a sound mucous membrane be involved 
 in an application. The solution is usually applied by the brush. A sen- 
 sation of burning may ensue which may have a duration of several hours ; 
 this in a measure is assuaged by the subsequent applications of cocaine, of 
 ten or fifteen or twenty per cent. If much hardened infiltration be pres- 
 ent, it is well to precede the application by scarification or curetting. 
 On soft infiltration lactic acid acts more quickly than on the hard, and 
 with especial rapidity upon ulcerated surfaces; it appears to be thus 
 applicable in ULCERS which exist on the vocal cords. Dysphagia is almost
 
 48 LOCAL THERAPEUTICS. 
 
 always diminished and sometimes ceases. The applications are recom- 
 mended to be made every second day at first, but subsequently every day. 
 Laryngeal spasm can be overcome by an application of cocaine, from ten 
 to twenty per cent. Since the effect of cocaine upon laryngeal structures 
 is transient, the acid should be used soon after the analgesia is developed. 
 If ulceration be present, the acid should be rubbed on the ulcerated 
 places thoroughly. The action of the lactic acid on secretions in which 
 blood enters is to color them brown. It is not easy to make applications 
 of lactic acid on the epiglottis, and it is probably due to this that affec- 
 tions of the epiglottis are more or less resistant to the acid. Before 
 making applications, the parts should be cleansed and all masses of 
 tenacious mucus removed. 
 
 Hering was the first to employ the acid by parenchymatous injections. 
 He especially indicates its use in the case of mushroom growths on the 
 posterior region ; also, in cases of recent extensive INFILTRATION OF THE 
 EPIGLOTTIS. Krause injected under the mucous membrane a solution of 
 30 per cent, to the amount of three to five drops, but subsequently, owing 
 to the inflammatory action of the acid, he diminished it to 10 per cent. 
 G. Major, of Montreal, prefers a 20 to 30 per cent, solution, 15 to 20 
 minims of which are injected at each sitting. He employs it with ad- 
 vantage in a case of primary tubercular deposit ; it proves to be almost 
 painless, the swelling disappearing in about three days. Cure is not to 
 be expected, but the arrest of the process is sometimes accomplished, 
 and if used before perichondritis sets in, the patient can be made 
 comfortable. C. H. Knight {Jour. Amer. Med. Ass'n, 1890, 90) applies 
 a 50 per cent, solution of lactic acid in LARYNGEAL PHTHISIS, and 
 gradually increases from this strength up to applications of one hundred 
 per cent. While laryngeal ulcers of tubercular origin are cured by this 
 agent, Knight holds that the pulmonary conditions remaining unrelieved 
 are liable to cause relapse. 
 
 In inhalation, lactic acid is employed in solution of one-half to two 
 per cent. 
 
 ACIDUM NITRICUM. Nitric Acid. 
 
 " A liquid composed of 69 r 4 ff per cent, of absolute nitric acid and 30^ per cent, of 
 water." (U. S. P.) Nitric acid has the specific gravity of 1.420, and should be color- 
 less. If it is sufficiently concentrated it emits white fumes on exposure to the air. 
 Diluted nitric a,cid is official, and is one part of nitric acid mixed with six parts of water. 
 
 Nitric acid is a caustic and stimulant. 
 
 General Surgery. Strong nitric acid, when applied to any living 
 organism, acts as a powerful caustic and escharotic. It communicates a 
 permanent yellow stain to the cuticle. Owing to its chemical activity,
 
 ACIDUM NITRICUM. 49 
 
 nitric acid fumes were used at one time as a disinfectant, but they have 
 long since been superseded by more active and reliable agents. 
 
 Nitric acid is more extensively used as an escharotic than any other 
 of the mineral acids, its action being easily controlled. It is best 
 applied with a small glass rod or splinter of wood (which may be wrapped 
 with cotton if a more liberal use of the drug is desired), or what will 
 be found convenient with a twig taken from a broom. Its caustic 
 action is easily stopped by covering the cauterized surface with sweet oil. 
 In HOSPITAL GANGRENE and PHAGEDENIC ULCERATION, nitric acid has 
 long been held in high repute. In treatment of hospital gangrene it is 
 important that the sloughs should be thoroughly broken up (as by intro- 
 ducing the blades of a pair of dressing forceps, closed and then opening 
 them), so that the acid may find its way through the sloughing mass 
 down to healthy tissue. By this method much prompter and better 
 results will be obtained than if the acid is applied only to the surfaces 
 of the sloughs. 
 
 Nitric acid has long been employed, as first recommended by Well- 
 bank, in the treatment of PHAGEDENIC ULCERATION, especially of a 
 venereal character. In this method of treatment it is important that the 
 ulcerated surface be thoroughly cleansed and dried, and the surrounding 
 parts protected by a thick coating of cosmoline or oil, to prevent the 
 acid from coming in contact with them, after which a small swab of 
 cotton, fastened to a splinter of wood, is saturated with the acid and 
 carefully pressed into every portion of the ulcer. After permitting it to 
 remain upon the tissues for half a minute, during which time the pain is 
 severe, its action may be quickly stopped by applying a pledget of cotton 
 saturated with sweet oil. After this a cold water dressing may be 
 applied. In the removal of VENEREAL WARTS, we are in the habit of 
 quickly snipping them off with a pair of scissors, and then touching their 
 bases with a drop of nitric acid. This mode of treatment is prompt, 
 efficient, and not very painful. 
 
 In CHRONIC CYSTITIS, especially when the urine is very ammoniacal, 
 the injection of one or two drops of nitric acid, diluted with an ounce of 
 water, very slowly thrown into the bladder, was first proposed by Benja- 
 min Brodie, and is still commended by Sir Henry Thompson. After 
 the bladder has been washed out twice the nitric acid and water (a 
 slightly acidulated solution, containing a small portion of morphine) 
 should be injected and retained as long as possible. Should hemor- 
 rhage occur, tannic acid may be substituted for the nitric acid. 
 
 Nitric acid is sometimes employed for the removal of HEMORRHOIDS ; 
 
 but is suitable only for the small strawberry piles containing a number of 
 
 vascular twigs which bleed freely on the slightest irritation. Such 
 
 piles may be exposed with the speculum, touched with acid, and then 
 
 4
 
 50 LOCAL THERAPEUTICS. 
 
 covered with sweet oil. The removal of other forms of hemorrhoidal 
 tumors can be effected best by means of the ligature or clamp. 
 
 Nitric acid is a useful application in the treatment of PROLAPSE OF 
 THE RECTUM, and is recommended for this purpose by Cripps, Agnew, 
 Kelsey, and Allingham. It is, however, of little service except in the 
 case of children. The action of nitric acid on the prolapsed rectum can 
 be well understood if we recall the way in which prolapse generally 
 begins. The mucous coat is attached to the muscular coat by loose, con- 
 nective tissue, so that there is considerable mobility of the one coat upon 
 the other. Partial prolapse is the result of the gradual stretching of the 
 submucous tissue. In complete prolapse, after the mucous coat has 
 slid as far as possible, it drags upon the muscular coat and produces 
 e version of the bowel. The action of the nitric acid is to create inflam- 
 mation with resulting exudate into the loose connective tissue, and the 
 formation of new contractile, fibrous material, which binds the two coats 
 firmly together. 
 
 The application of nitric acid for prolapse of the rectum is made by 
 first carefully cleaning the bowel and then applying fuming nitric acid 
 freely over the mucous membrane, care being taken to avoid the skin. 
 The bowel should then be greased and returned, and a pad placed over 
 the anus. 
 
 Nitric acid is recommended by Thomas as an efficient caustic in cases of 
 CANCER OF THE CERVIX UTERI, which are not subjected to surgical opera- 
 tion. The acid is applied thoroughly to the whole diseased surface, and 
 a pad of cotton saturated with glycerin is placed over it. This applica- 
 tion produces a decided slough and destroys many of the blood-vessels 
 which have proved the sources of hemorrhage. Thomas states that such 
 an application should be repeated once in every 'two or three months. 
 
 Nitric acid has been employed by Atthill, Goodell, and others with 
 advantage in cases of FUNGOID GRANULATION and EXCESSIVE HEMOR- 
 RHAGE OF THE UTERUS. It is introduced by means of cotton on the 
 applicator. 
 
 In CANCER OF THE UTERUS, West speaks highly of a lotion of nitric 
 acid, a drachm to the pint of water, to check profuse discharge. 
 
 Diseases of the Skin. The strong nitric acid of the Pharmacopoeia 
 is used as a caustic in some diseases of the skin. It deoxidizes the tissues, 
 depriving them also of water and leaving a dry, charred eschar. It is 
 employed in the destruction of EPITHELIOMA, VERUCCA, N^EVI, and other 
 new growths. The acid is best applied by means of a pointed splinter of 
 wood, the excess being carefully wiped off with cotton. In destroying 
 warts care must be taken not to allow the action to go too far, or a slough 
 with consequent cicatrix may result. Likewise hemorrhage may follow 
 on the separation of the slough when njevi have been destroyed by
 
 ACIDUM NITRICUM. 51 
 
 nitric acid, so that it is not desirable to use it in extensive growths of 
 this kind. 
 
 Diluted nitric acid may be employed for the removal of CHLO- 
 ASMA. It must be used, however, with some caution. The object is 
 simply to cause such exfoliation of the skin as may suffice to remove the 
 pigmentary matter. If the action goes a little deeper, a slough with 
 resulting cicatrix may ensue. 
 
 Nitric acid, pure or slightly diluted, may be employed for the removal 
 of PIGMENTARY N^vi or small MOLES. In this affection it is scarcely 
 possible to remove the disease entirely without producing a cicatrix, and 
 the patient should be forewarned of this probable result. 
 
 Diluted nitric acid is employed as a lotion in PRURITUS. Liveing sug- 
 gests the following formula : R. Acid nitric, dilut., f^iij ; Tinct. opii, f^ij ; 
 Aquae, ad Oj. M. As a lotion to ULCERS, it is employed in the strength 
 of twelve minims to the pint of water. Nitric acid is also employed in 
 baths (see BATHS). 
 
 Diseases of the Ear, Throat, and Nose. The topical action of 
 nitric acid in the throat, mouth, and nose is, in the main, confined to its 
 caustic effect. To secure this, the undiluted acid must be selected. It is 
 more diffusible than any other acid which is used for caustic purposes. 
 It resembles acetic acid and chromic acid in the character of the eschar 
 produced, but its application excites more pain than does either of these 
 agents. It may supplant them in the destruction of hypertrophied nasal 
 mucous membrane. The degree of diffusibility of nitric acid renders it 
 unfit for use in the destruction of AURAL POLYPUS, while presenting some 
 advantages over agents, whose actions are more limited, in endeavoring to 
 cover the sinuous surface of a PHAGEDENIC ULCER with a protectant eschar. 
 Hence, it is frequently used in the local treatment of NOMA and PUTRID 
 SORE THROAT. The pure acid is carried on the end of a match or glass 
 rod and rubbed firmly into the parts. Roosa states that he has suc- 
 ceeded in removing CERUMEN by the use of fuming nitric acid, after 
 having failed with both alkaline solution and oils. Since the introduc- 
 tion of peroxide of hydrogen this remedy should be discarded. S. 
 Hartwell Chapman believes that nitric acid can be employed in the same 
 indications as chromic acid for the destruction of growths in the nasal 
 chamber, and in the treatment of CHRONIC CATARRH accompanied with 
 free discharge. 
 
 ACIDUM OXY-NAPHTHOICUM (Alpha). 
 
 " White, inodorous, micro-crystalline powder; soluble in 30,000 parts of cold water; 
 more readily soluble in aqueous solutions of the bicarbonates or of ammonium, which 
 hen enter into combination with it. More readily soluble in alcohol, chloroform, benzol f 
 and oils, both fixed and volatile." {Merck's Bulletin.)
 
 52 LOCAL THERAPEUTICS. 
 
 Oxy-naphthoic acid is obtained in combination with sodium by heating 
 a-naphthol-sodium with carbonic acid, and is related to a-naphthol as sali- 
 cylic acid is to phenol. It is irritating to the nasal passages. 
 
 It has marked antizymotic properties, and is said to be five times 
 stronger than salicylic acid. It is not used internally. 
 
 This remedy has not as yet been generally taken up by physicians, 
 and with regard to it, as to other remedies, substitutes for iodoform, 
 etc., recently introduced by distinguished German observers, it must be 
 remembered that these are proprietary preparations, and that (the dis- 
 tinguished German physicians) frequently have some pecuniary interest in 
 their manufacture. All such preparations must, therefore, be received 
 with caution. 
 
 A similar preparation has been made from /3-naphthol, /9-naphthoic 
 acid. 
 
 Diseases of the Skin. Oxy-naphthoic acid was introduced by 
 Schwimmer (Wien. Med. Wochenschr., Nos. 3 to 5, 1890) as a remedy 
 in SCABIES, PARASITIC SKIN DISEASES, and PRURIGO. 
 
 The formula recommended in scabies is : R. Acidi oxy-naphthoici, 
 Pulv. cretae, Saponis viridis, aa 9iv, Adipis, ad gj. M. 
 
 This preparation is not irritating to the skin, and in no way toxic. It 
 can be used upon children. Although the drug rapidly reaches the 
 circulation and is excreted in the urine, Schwimmer has never observed 
 renal irritation. 
 
 In SCABIES the acid is said to kill the acarus in three or four days, 
 but the eczema accompanying the disease requires further treatment. 
 
 A similar ointment made with adeps alone has been employed by 
 Schwimmer successfully in PRURIGO. 
 
 ACIDUM PHOSPHORICUM. Phosphoric Acid. 
 
 Phosphoric acid is defined in the U. S. P. as " a liquid composed of 50 per cent, of 
 ortho-phosphoric acid and 50 per cent, of water." There was formerly official in the 
 U. S. P. a solid phosphoric acid which was called " Glacial Phosphoric Acid." It is 
 metaphosphoric acid, HPO S , and is gradually changed to the ortho- variety when dissolved 
 in water. This change is hastened by the application of heat. Because of its constant 
 impurities it has been dropped, and the present 50 per cent, solution, which for several 
 years had been known and sold as " Syrupy Phosphoric Acid" has been made official. 
 Phosphoric acid is a " colorless liquid, without odor, of a strongly acid taste and reac- 
 tion. Specific gravity 1.347." (U. S. P.). Glacial Phosphoric Acid" is a white, uncrys- 
 tallizable, fusible solid, inodorous, very sour to the taste, slowly deliquescent, slowly 
 soluble in water ; soluble also in alcohol. " ( U. S. D.) It is 88 T 8 5 per cent, of phosphoric 
 oxide combined with H T 2 5 per cent, of water. Diluted phosphoric acid is an aqueous 
 solution of phosphoric acid in water, containing 20 per cent, of the official phosphoric 
 acid (equivalent to 10 per cent, of ortho-phosphoric acid).
 
 ACIDUM PYROGALLICUM. 
 
 53 
 
 Diseases of the Skin. A solution of 50 grains phosphoric acid to 
 the ounce of distilled water has been used by Grossich in the treatment 
 of ULCERS. The ulcer is covered with lint dipped into this solution, 
 and the dressing is renewed three or four times a day. The treatment is 
 said to be peculiarly successful in SCROFULOUS ULCERS. Grossich also 
 injects a hypodermic syringeful of the same solution into TUBERCULOUS 
 GLANDS of the neck, which, he says, become reduced in size within 24 
 hours. 
 
 A diluted solution of phosphoric acid has been recommended in the 
 treatment of ECZEMA OF THE LIPS. It should be employed with great 
 caution. Its effect is the same as that of other stimulants; in strong 
 solution it is caustic, or nearly so. 
 
 ACIDUM PYROGALLICUM. Pyrogallic Acid. Pyrogallol. 
 
 An acid obtained by the decomposition of gallic or tannic acid by heat. " It is in 
 white, shiny scales, inodorous, very bitter, soluble in two and one-fourth parts of water, 
 and readily dissolved by alcohol and ether." (U. S. D.) 
 
 Pyrogallic acid is caustic and parasiticide. It, however, cannot be 
 employed with impunity over large surfaces, as absorption may take place 
 with poisonous effect. 
 
 General Surgery. Pyrogallic acid is not unlike chrysarobin in its 
 action. It seems to have a good effect in promoting CICATRIZATION and 
 CONTRACTION OF ULCERS. If the area is large, only a small portion 
 should be treated at a time. M. Vidal has announced that pyrogallic 
 acid is an excellent application to CHANCROIDS, especially if there is a 
 tendency to phagedenic action. It may be applied in alcoholic solution, 
 or in ointment made with cosmoline, in strengths varying from ten per 
 cent, to an equal part. The solution may be applied by saturating a 
 pledget of absorbent cotton. 
 
 Diseases of the Skin. Pyrogallic acid was originally introduced by 
 Jarisch ( Wien Med. Wochensch., 44 and 45, 1878) as a substitute for chry- 
 sarobin in the treatment of PSORIASIS. An ointment of 100 grains to the 
 ounce will sometimes produce, it is said, a deep caustic effect ; we fre- 
 quently, however, use 60 grains to the ounce without the slightest 
 untoward result. In the strength of a drachm to the ounce it stains the 
 skin a dirty brown color and gives it a leathery appearance. The epi- 
 dermis exfoliates in a week or two. It can be applied without pain to 
 excoriated spots and causes no inflammation of the surrounding skin. Its 
 action upon the lesions of psoriasis is less rapid than that of chrysarobin, 
 but it is quite as efficient. It whitens the diseased patches and leaves a 
 brownish or blackish stain round them. 
 
 Pyrogallic acid is employed in powder or in strong ointment (sjj-ijad
 
 54 LOCAL THERAPEUTICS. 
 
 ,5 j) as a caustic in the treatment of EPITHELIOMA. The crusts or horny 
 epithelium covering the diseased patch having been removed by scraping 
 or the application of caustic potassa, the ointment is applied, spread 
 upon a rag cut out somewhat smaller than the area to be operated upon, 
 and secured firmly to its place. This is renewed daily, the debris being 
 scraped away. The pyrogallic acid seems to have a selective affinity for 
 the diseased tissue. Its effect should be watched and not allowed to go 
 too far. A number of applications are usually necessary, but the caustic 
 is almost or entirely painless. 
 
 In the VEGETABLE PARASITIC DISEASES, particularly in PARASITIC SYCO- 
 SIS, an ointment of 20 to 30 grains to the ounce is very effective. 
 
 Pyrogallic acid has been used in the treatment of LUPUS VULGARIS, in 
 the form of ointment, one drachm to the ounce. Also in the treatment 
 of PHAGEDENIC ULCERS. These are first scraped and then an ointment 
 of one hundred grains to the ounce is applied. 
 
 ACIDUM SALICYLICUM. Salicylic Acid. 
 
 " A crystalline acid obtained by the combination of the elements of carbolic acid with 
 those of carbonic acid gas, and subsequent purification, or from natural salicylates, such 
 as the oils of wintergreen and sweet birch." (Ph. Br.) 
 
 The first process spoken of was patented in all countries by Prof. Kolbe, its discoverer, 
 and is practically the only process used, as obtained in any other way its cost is several 
 times greater than it is by this method. The patent has recently expired in this country. 
 Salicylic acid, when pure, is in " fine, white, light, prismatic, needle-shaped crystals, 
 permanent in the air, free from odor of carbolic acid, but sometimes having a slight 
 aromatic odor, of a sweetish and slightly acid taste, and an acid reaction." (U. S. P.) 
 " It is soluble in 450 parts of water and two and a half parts of alcohol; in 14 parts of 
 boiling water; very soluble in boiling alcohol; also soluble in two parts of ether, two 
 parts of absolute alcohol, and in 80 parts of chloroform." (U. S. P.) A ten per cent, 
 alcoholic solution may be diluted with water without precipitation. It is much more 
 soluble in solutions of some neutral salts than it is in water ; for instance, in solution of 
 citrate of ammonium, phosphate of sodium, nitrate of potassium, and sulphate of sodium. 
 It unites with bases to form salts of which the salicylate of sodium is the best known. 
 Salicylates of the alkaloids are recommended for hypodermic use, with the theory that 
 the combined salicylic acid will prevent decomposition of the solutions. Its power of 
 preventing decomposition and fermentation is well known. An ointment of salicylic acid 
 is official in the Ph. Br., containing one part of the acid in twenty-eight of the ointment. 
 
 The salicylic acid prepared from the natural oils of wintergreen and sweet birch, has a 
 slightly higher melting point than that prepared synthetically by Kolbe's process, and is 
 as a rule much purer. It is, therefore, almost devoid of the unpleasant effects that follow 
 the administration of the ordinary acid, no matter how much the latter may be purified 
 by dialysis or other means. 
 
 A salicylated cotton (Thiersch's) is prepared by steeping absorbent cotton in a solution 
 of salicylic acid. The proportion of acid in the solution is not fixed, and may vary from 
 three to ten per cent.
 
 ACIDUM SALICYLICUM. 55 
 
 Salicylic acid is antiseptic and a parasiticide. It possesses a peculiar 
 property in softening epidermis. It is also mentioned as having astrin- 
 gent properties, but probably on insufficient grounds. 
 
 General Surgery. Salicylic acid has long been known, but only of 
 late years has it come into general use in surgery as a topical application. 
 Kolbe found that a 0.04 per cent, solution had considerable influence in 
 preventing milk from souring. Bucholz states that a 0.15 per cent, 
 solution is sufficient to prevent the development of bacteria in ordinary 
 organic mixtures; 0.3 to 0.4 per cent, destroys bacteria in vigorous 
 growths. (Wood, p. 620.) The salicylate of sodium is about equal in 
 efficiency to the pure acid. 
 
 Dr. Miller found that one per cent, of salicylic acid was sufficient to 
 check the action of ptyaline on starch ; while ten per cent, of carbolic 
 acid was required to produce the same effect. There appears to be little 
 doubt that salicylic acid is largely used as a preservative of fresh meat 
 during the heated seasons, especially the so-called "western meat." 
 
 Mr. Callander, after a year's trial of salicylic acid in the wards of St. 
 Bartholomew's Hospital, abandoned it, as much inferior to carbolic acid. 
 
 The following solutions were used at St. Bartholomew's Hospital : Phos- 
 phate of sodium, 3 parts; Salicylic acid, i part; Water, 50 parts. 
 Salicylic acid, i part ; Olive oil, 49 parts. Salicylic acid, i part ; Bicar- 
 bonate of sodium, ^ part; Water, 100 parts. Salicylic acid, 10 parts; 
 Borax, 18 parts; Water, 100 parts. A 25 per cent, solution which will 
 bear dilution with water may be prepared. 
 
 R. Acidi salicylic., ^ij ; Sodii biborat., 3]; Glycerini, q. s. Mix the 
 acid and borax, then add glycerin to one fluidounce with four drachms of 
 glycerin, and heat gently until dissolved. (Wood, Ed. 8, p. 639.) 
 
 An ointment of salicylic acid, in the strength of one-half to one 
 drachm in one ounce of cosmoline may be employed with most satis- 
 factory results in the treatment of ERYSIPELAS. The ointment is applied, 
 spread on lint, and the part is enveloped in raw cotton. Watson 
 Cheyne employs a cream composed of salicylic acid, 2 parts ; carbolic 
 acid, i part : glycerin, 10 parts, to be smeared over superficial WOUNDS 
 and ABRASIONS. In the treatment of CHANCROID, salicylic acid has been 
 extensively employed. Angloda speaks of it in the highest terms. After 
 the ulcer is thoroughly cleansed with an antiseptic solution, the powdered 
 acid should be thoroughly dusted over its surface. 
 
 H. Von Hebra (Annals de Derm, et de Syph., May, 1890) does not 
 regard the use of salicylic acid for the treatment of CHANCROIDS so 
 favorably, stating that the acid produced too much irritation when dusted 
 over their surfaces, and when used in ointment the healing is slow, and 
 it is no better than iodoform, the formation of bubo being just as frequent. 
 Dr. Cheron recommends the following as a very efficient injection in
 
 56 LOCAL THERAPEUTICS. 
 
 deodorizing the fetor of UTERINE CANCER. R. Acidi salicylic., gr. ij ; 
 Sodii salicylat., gr. xl ; Tinct. eucalyp., f^iss; Acid, aceti, fgiss ; to be 
 added to two pints of water and used as a douche every four hours. 
 
 Salicylic acid may be employed with advantage in the treatment of 
 UTERINE CANCER, to correct the fetor. It is used by means of a cotton 
 tampon thoroughly impregnated with the drug, which is changed twice 
 daily. In conjunction with this a vaginal douche of a three per cent, 
 solution of creolin should be used. 
 
 Salicylic acid has been employed by injection for the removal of 
 ASCARIDES. R. Acid, salicylic., 333 ; Sodii bicarb., gss; Aquae, Oj. To 
 be thrown into the bowel. An enema should be first given, cleansing the 
 bowel of all fecal matter, and then the solution just described should be 
 used. It is also used as an injection in DYSENTERIC DIARRHCEA in children, 
 in the proportion of i part to 300. 
 
 Diseases of the Skin. The employment of salicylic acid as an ex- 
 ternal agent in the treatment of skin diseases dates from about 1875, 
 when it was recommended for MOIST ECZEMA of the scalp and face. Las- 
 sar ( Monatschrift f. Prakt. Dermatol., 1883, p. 97) recommended its use 
 in paste as well as ointments in ECZEMA RUBRUM and in IMPETIGO CON- 
 TAGIOSA of children. It has also been employed successfully in PSORIA- 
 SIS, LUPUS and PARASITIC AFFECTIONS. Salicylic acid has been employed 
 also to prevent the extension of ERYSIPELAS. 
 
 The action of salicylic acid in the softening and removal of excessive 
 epidermic growths and in favoring the normal proliferation of epithelium 
 has been made the subject of investigation by several dermatologists, 
 notably Unna {Monatschrift f. Prakt. Dermatol., 1882, No. 4). 
 
 In the treatment of FAVUS, epilation, followed by the inunction of 
 a solution of 10 to 25 grains of salicylic acid in an ounce of castor oil, has 
 been found effectual. 
 
 In TINEA TONSURANS and TINEA CIRCINATA, as well as in TINEA VER- 
 SICOLOR, an alcoholic solution of salicylic acid, of 40 to 50 grains to 
 the ounce, painted on, has been highly recommended. A similar solution 
 in liquor gutta percha may be used on non-hairy parts of the body. 
 
 In PITYRIASIS of the scalp and in SQUAMOUS ECZEMA (ECZEMA SEBOR- 
 RHCEICUM of the face) an ointment of 20 grains of salicylic acid in an 
 ounce of ichthyol has been used to advantage. A combination of salicylic 
 acid with sulphur, in the proportion of 20 to 40 grains of the former and 
 a drachm of the latter in an ounce of vaseline, we have found equally 
 advantageous in similar cases. 
 
 Mixed with starch, oxide or carbonate of zinc and other powders, as 
 in the following formula, salicylic acid forms an excellent application in 
 the treatment of HYPERIDROSIS. R. Acid, salicylic., ^ij ; Zinc. carb. 
 precip., iv ; Magnesii ust?e, ~;iv, Lycopodii 5iss. M.
 
 AC1DUM SALICYLICUM. 57 
 
 In the treatment of some forms of SUBACUTE and CHRONIC ECZEMA, 
 particularly about the face and scalp, or elsewhere when there is an 
 abundant purulent discharge with decomposition, the milder ointments 
 of salicylic acid, alone or combined with mild astringents, are found of 
 the greatest service in checking the discharge and in keeping the parts 
 from becoming foul-smelling. The following formulae may be suggested : 
 R. Acid, salicylic., grs., x-xx ; Vaselini, j. M. R. Acid, salicylic., 
 grs. x-xx ; Pulv. zinci oxidi, sss-^j ; Adipis, gj. M. 
 
 P. Szadek {International Klin. Rundschau, June 7, 1889) recommends 
 a plaster of 15 grains of salicylic acid to the ounce of soap plaster, in 
 CHRONIC INFILTRATED ECZEMA OF THE EXTREMITIES. He recommends a 
 similar plaster, or an alcoholic solution of 40 or 50 grains to the ounce in 
 PSORIASIS. We prefer an ointment of half a drachm to a drachm to the 
 ounce, but do not consider this preparation equal to chrysarobin or pyro- 
 gallic acid as a local application in this disease. 
 
 A solution of one drachm salicylic acid, four drachms glycerin and 
 an ounce and a half of alcohol has been employed successfully in the 
 treatment of LICHEN PLANUS. 
 
 In NON-PARASITIC SYCOSIS (or COCOOGENIC SYCOSIS) an ointment of a 
 drachm of salicylic acid to the ounce of lard, has been employed by 
 Heitzmann with marked success. 
 
 In ACNE Heitzmann uses the following ointment: R. Acid Salicylic., 
 gr. v; Sulphuris precipitat., 3ss~3j; Adipis, gj. M. An alcoholic solu- 
 tion of 15 grains to the ounce, diluted considerably at first, softens COME- 
 DONES and aids in their removal. 
 
 In PRURITUS, particularly of the anus, a lotion of three to five grains to 
 the ounce gives relief in some cases. 
 
 The most remarkable action of salicylic acid is, however, upon the 
 epidermis and epithelium. It softens and loosens thickened masses of 
 epidermis in an extraordinary manner, leaving behind a raw but not 
 inflamed surface. It is therefore peculiarly useful in the treatment of IN- 
 DURATED ECZEMA, especially of the PALM AND SOLE, and also in the treat- 
 ment of TYLOSIS, VERRUCA, CALLOSITAS, etc. In these conditions the 
 " india-rubber dermal plasters 11 manufactured in this country are equal, 
 in most cases, to those especially manufactured under Unna's supervision. 
 A piece of salicylated rubber plaster applied to the skin over a WART or 
 CORN soon adheres and may be kept in contact for several days, when 
 it may be removed, the softened epidermis scraped and fresh applications 
 made as long as is necessary. 
 
 When the India-rubber plasters cannot be procured, the following 
 preparation will serve a similar purpose: R. Acid, salicylic., giij ; Crea- 
 soti, ^vj ; Cerae et adipis, aa q. s. The wax and lard are only added in 
 sufficient quantity to give consistency to the mixture. The addition of
 
 58 LOCAL THERAPEUTICS. 
 
 creasote aids materially in the curative effect of the plaster, especially in 
 ECZEMA. 
 
 In the treatment of small WARTS and CORNS, the following procedure 
 is very effectual : The part is moistened with an antiseptic solution, 
 covered with a thick layer of powdered salicylic acid, and over this is 
 placed several thicknesses of the finest borated lint, bound down with 
 gutta percha or some convenient bandage. The dressing is not removed 
 for four or five days. It can then be renewed if the growth has not been 
 destroyed. 
 
 Diseases of the Ear, Nose, and Throat. Merck's dialyzed acid 
 is said to be the most agreeable to the palate and the least irritating to the 
 tissues. A three per cent, solution in alcohol is an admirable application 
 in ASPERGILLUS of the outer auditory meatus. Salicylic acid is recom- 
 mended by H. McNaughton Jones (Lancet, n, 1890) as a wash in the 
 strength of three grains to the ounce of warm water for OTORRHEA asso- 
 ciated with recent perforations in the tympanic membrane, and is held by 
 this writer in preference to carbolic acid. In the form of a powder one 
 part may be added to three parts of boric acid. J. McMunn (Brit. Med. 
 Journal, Dec. 14, 1889) combines salicylic acid with tannic acid and subni- 
 trate of bismuth as a snuff for ACUTE CORYZA, in proportion of about three 
 grains to the drachm. The agent may, however, be mixed with one or 
 more parts of some indifferent material, such as starch, and insufflated in 
 CHRONIC NASAL CATARRH. It is especially useful in cases in which fetor 
 is present. 
 
 In INFLAMMATION OF THE FAUCES, salicylic acid is of especial value in 
 cases in which the exudate on the gland is of a character which makes it 
 probable that a diphtheritic element is present, since the agent is also of 
 use in removing the membrane in DIPHTHERIA. Haberkorn applies the 
 pure powder to the surface of the tonsil. Gonsalez places salicylic acid in 
 the first rank as a local medicament in the nasal form of the disease. The 
 agent can be used in solution as a wash, for either the throat or the teeth. 
 The acid is more irritant to the tissues than boric acid. In naso-pharyn- 
 geal catarrh a lotion of salicylic acid, from one to two grains to the ounce, 
 is serviceable. It can be exhibited in combination with bicarbonate of 
 sodium in the form of a gargle. Each lozenge and nasal bougie contains, 
 as a rule, one grain of the acid. Salicylic acid is said by G. P. Field 
 (Year Book of Treatment, 1885) to take the place of boric acid in cor- 
 rection of ear discharges. 
 
 It is useful in FETOR OF THE BREATH, in the proportions of five grains 
 to the ounce of warm water. A similar preparation corrects offensive 
 expectoration, especially in PHTHISIS. Barthold recommends it in 
 CATARRHAL STOMATITIS and in THRUSH. This author claims the acid to 
 be anaesthetic in stomatitis, calming the gnawing and burning pain
 
 ACIDUM SULPHUR1CUM. 
 
 59 
 
 after rupture of the vesicles. The solution he recommends is one part 
 of the acid dissolved in alcohol to 250 parts of water. 
 
 Diseases of the Eye. Salicylic acid has not been extensively used 
 in ophthalmic surgery. Its solubility is said to be greatly increased by 
 the addition of a neutral salt. A solution of five per cent, of salicylic 
 acid and five per cent, of borax has been recommended as an antiseptic 
 application for the eye. If this were really a solution of salicylic acid, 
 25 grains to the ounce would probably be much stronger than the eye 
 could bear ; but chemical tests made by Dr. Zimmerman, resident surgeon 
 of the Wills Hospital, show that it contains very little, if any, of this 
 acid, but is simply a solution of salicylate of sodium and boric acid. As 
 salicylate of sodium is not an antiseptic, whatever virtue the preparation 
 may have must be attributed only to the presence of boric acid. 
 
 ACIDUM SULPHURICUM. Sulphuric Acid. 
 
 The U. S. P. defines it as " a liquid composed of not less than 96 per cent, of absolute 
 sulphuric acid, and not more than four per cent, of water," and describes it as " a color- 
 less liquid, of an oily appearance, inodorous, strongly caustic and corrosive, and having a 
 strongly acid reaction." Diluted sulphuric acid is official and is made by diluting one 
 part of sulphuric acid with nine parts of water. 
 
 Sulphuric acid is a powerful corrosive of animal and vegetable tissues, 
 abstracting the watery elements and leaving the carbon untouched. Diluted 
 sulphuric acid, when applied to granulating or bleeding surfaces, acts as 
 an astringent. 
 
 According to Squibb, the local effect of sulphuric acid in the form of a 
 caustic is continuous and injuriously irritant. Its effects are more pro- 
 longed than are those of almost any other caustic ; the irritation often 
 persists through the process of sloughing. 
 
 General Surgery. The acid has been recommended as an applica- 
 tion in CARIES, as a solvent to the lime salts in the diseased bone, and as 
 a cautery. The effect is to remove products of diseased action and invite 
 the parts to create a surface which is disposed to heal. 
 
 The strong acid, owing to its affinity for water, is seldom used as an 
 escharotic alone. Combined with powdered charcoal, forming a paste, 
 it was at one time a favorite caustic application with D. Hayes Agnew in 
 the treatment of CHANCRE, being retained in position by means of 
 adhesive plaster. 
 
 Owen Pritchard {Lancet, October 25, 1890) speaks highly of it 
 as superior to all escharotics for the destruction of CANCEROUS GROWTHS, 
 especially in the class of patients where operative interference is not 
 advisable, or for persons who refuse to submit to a cutting operation. 
 Michel 's paste is made by taking one part by weight of an indifferent
 
 60 LOCAL THERAPEUTICS. 
 
 excipient and three parts by weight of strong sulphuric acid (fuming) 
 and mixing together on a glass slab, forming a paste. Pritchard claims 
 that this mixture will accomplish as much in an hour as any other 
 escharotic will in a week. When properly applied, it will completely 
 destroy the largest TUMORS OF THE BREAST in from eight to ten hours. 
 On the evening previous to the application, a blister is applied, removing 
 all the epidermis, after which cocaine, not to exceed a grain and a half 
 is applied. At the same time a hypodermic injection of morphine is 
 given. After the cocaine has taken effect, a cake of the paste an inch 
 thick and of sufficient size to cover the tumor, is applied. If these 
 precautions are pursued, no pain is experienced. As soon as the tumor 
 is destroyed, the cavity is cleaned out and filled with asbestos, covered 
 with zinc ointment. It usually takes ten or twelve days for the 
 eschar to separate, and during the latter part of the time the wound 
 should be syringed twice daily with some disinfecting solution. Care 
 must be exercised in applying the paste, to place the patient in a per- 
 fectly level position ; otherwise the acid will gravitate to the lower side, 
 and a portion of the growth will not be destroyed. The surrounding 
 skin must be protected by collodion. Any fluid oozing from the part 
 must be carefully removed with a piece of blotting paper or cotton. 
 
 In CARIES and OSTITIS involving the head of the tibia and other bones, 
 Mr. Pollock advises the use of sulphuric acid, wiped through the cavity 
 by means of a swab made of cotton on the end of an aluminum applicator. 
 In SYPHILITIC CARIES, especially of the skull, where exfoliation is slow, 
 Mansel Moullin advises the use of strong sulphuric acid as a means of 
 hastening the separation of the diseased bone. In the BITES of RABID 
 ANIMALS, W. Frazer regards the strong acid as one of the best of caustics 
 that can be employed. 
 
 In RHEUMATISM and CHRONIC JOINT AFFECTIONS, an ointment com- 
 posed of a fluid drachm of sulphuric acid to an ounce of lard, is said to 
 have given great benefit. 
 
 Diseases of the Ear, Nose and Throat. Elixir of vitriol has 
 been used as a caustic on ENLARGED TONSIL. Six parts of sulphuric acid 
 and four parts of diluted spirits has been recommended by Kohls for 
 EPISTAXIS. 
 
 ACIDUM SULPHUROSUM. Sulphurous acid. 
 
 Sulphurous acid is " a liquid composed of about three and a half per cent, of sulphurous 
 acid gas (sulphurous oxide), and about 96^ per cent, of water." (U. S. P.) Sulphurous 
 oxide is " an irrespirable gas of a suffocating odor, familiar to every one as that of burning 
 sulphur, which is converted into it by combustion." (U. S. D.) The official acid is 
 decomposed with the formation of sulphuric acid by exposure to the air, or by exposure 
 to sunlight, and consequently, should be freshly procured when desired. It unites with 
 bases to form sulphites and bisulphites.
 
 ACIDUM SULPHUROSUM. 6 1 
 
 General Surgery. .Sulphurous acid as a topical application in 
 surgery occupies but a small place, except for its germicidal properties 
 when used in a gaseous state. 
 
 Vallin, one of the highest authority on disinfectants and disinfection, 
 regards sulphurous acid, obtained by the combustion of sulphur in free 
 air, as occupying almost the first place among veritable disinfectants; 
 this statement being made ten years ago. The use of this agent 
 has come down to us from the most remote ages ; no other gaseous disin- 
 fectant is so extensively used. (See in this connection Sternberg's 
 Report to American Public Health Association, p. 52.) 
 
 Thus, as can be seen, we have in sulphurous acid gas a cheap, reliable 
 and easily applied disinfectant capable of destroying micro-organisms, 
 but not their spores. As but few contagions contain spores, it is likely 
 that sulphurous acid, when concentrated, is an efficient disinfectant 
 if applied for sufficient time. Sternberg has proven by experiment 
 that the gas acts much more freely when the air is loaded with moisture. 
 In order to diffuse sulphurous acid through the air, it is well to secure a 
 large iron pot, which is placed in the centre of the room upon a number 
 of bricks, or, what is better still, in a tub containing from four to six 
 inches of water, or in a box partially filled with wet ashes. When every- 
 thing is in readiness the sulphur may be ignited after wetting with alcohol, 
 or by dropping into the vessel a few live coals carried on a shovel from the 
 kitchen range. In a few moments sulphurous acid gas is being rapidly 
 evolved. The heat which is generated from the side of the pot vaporizes 
 the water, and this keeps the air loaded with moisture all through the 
 process. Should any of the molten sulphur boil over no harm will follow, 
 as might happen if it fell on a board floor. 
 
 The acid may be employed in a saturated solution for the purpose of 
 destroying germs in the excretions of the sick ; but in corrosive sublimate 
 we have a remedy so much more convenient and efficient, that it is 
 seldom used for this purpose. 
 
 The so-called sulphur cure^ brought so prominently forward by Dewar, 
 consists mainly of varied applications of this acid. Thus in ERYSIPELAS 
 he employs equal parts of sulphurous acid and glycerin, stating that it 
 relieves the " burning " and arrests the spread of the inflammation. The 
 same treatment, which he regards as much more efficient than that with 
 carbolic acid, may be applied to WOUNDS and ULCERS. 
 
 Diseases of the Skin. Sulphurous acid is occasionally employed in 
 the local treatment of the VEGETABLE PARASITIC DISEASES. 
 
 In TINEA CIRCINATA, particularly in that variety known as BURMESE 
 RINGWORM, where the affection chiefly attacks the groins and insides of 
 the thighs, lotions of sulphurous acid are often useful. 
 
 Also in TINEA VERSICOLOR the lotion of sulphurous acid is an excellent 
 remedy.
 
 62 LOCAL THERAPEUTICS. 
 
 Diseases of the Ear, Nose and Throat. In the strength as sold 
 in the shops sulphurous acid is a reliable agent in the treatment of SYPH- 
 ILITIC ULCERATIONS OF THE RESPIRATORY PASSAGES. The indications for 
 its use are first that the bones be not involved ; secondly, that oedema- 
 tous inflammation of the surrounding parts be subdued. The pain atten- 
 dant upon its free application is but slight and the affected parts may be 
 mopped daily. It often acts like a charm on Mucous PATCHES. Slightly 
 diluted it is of great value in MERCURIAL STOMATITIS. Placed in a 
 sprayer which is put in connection with a compressed air cylinder, per- 
 mitting the atomized liquid to be driven with force, the acid is effica- 
 cious in breaking up the detritus which accumulate on the tongue in many 
 diseased states of the mouth and throat. Forty to sixty drops may be used 
 at one treatment by spray. It holds a secondary position in the treat- 
 ment of LARYNGEAL PHTHISIS, though spoken of highly by Bassols and J. 
 Solis Cohen. To make a weak impression it may be exhibited in lem- 
 onade as a gargle. H. McN. Jones employs a two per cent, solution 
 as an injection in CHRONIC NASAL CATARRH. F. E. Hitchcock (Phila. 
 Med. Times,' May 21, 1881) recommends that equal parts of sulphurous 
 acid and water be used in form of a spray in DIPHTHERIA. This pre- 
 paration may be also used as a gargle. 
 
 Fresh preparations of the acid are highly pungent, and the patient 
 should be warned not to take deep inhalations during the treatments. 
 
 Inhalations of sulphurous acid are, however, recommended for a variety 
 of conditions, in the main inflammatory, of the respiratory tract. 
 Among these may be named CATARRHAL PHARYNGITIS and CHRONIC 
 BRONCHITIS. It holds a questionable position in the treatment of 
 APHONIA. 
 
 ACIDUM TANNICUM. Tannic Acid. Tannin. 
 
 Tannic acid is a glucoside obtained from many vegetable astringents. The official 
 tannic acid of both the U. S. P., and Ph. Br. is made from galls, and is distinguished 
 from that occurring in leaves, barks, etc., by the name of Gallotannic Acid, while the 
 others take the name of the source from which they are derived, as Quercitannic Acid, 
 from oak bark. " Tannic acid is solid, uncrystallizable, white or slightly yellowish, 
 inodorous, without bitterness, very soluble in water, less soluble in alcohol and ether 
 especially when anhydrous, insoluble in the fixed and volatile oils." (U. S. D.) It is 
 also very soluble in glycerin, and almost insoluble in absolute ether, chloroform, benzol, 
 and benzine. It is incompatible with alkaloids, gelatin, albumin, and solutions of 
 tartrate of antimony and potassium, and with ferric salts, with which it forms a black 
 precipitate (the old-fashioned ink.) It does not react with the salts of the ferrous oxide. 
 If it is rubbed with the chlorate of potassium, the mixture explodes with great violence, 
 hence these drugs should never be ordered in powder together, and if they are prescribed 
 in the same solution, they should be dissolved separately. From tannic acid is prepared 
 Styptic Collodion (containing 20 per cent, of tannic acid in the diluted collodion).
 
 ACIDUM TANN1CUM. 63 
 
 Troches of Tannic Acid (containing each one grain of tannin) and the Ointment of 
 Tannic Acid (containing 10 per cent.) See Qiiercus alba. 
 
 The effect of tannic acid resembles more closely that of alum than it 
 does that of any other mineral astringent. It is more irritating, however, 
 than the agent last named. This effect can be reduced in a measure 
 by combination with borax and a small proportion of carbolic acid. A 
 paste prepared by mixing tannic acid two-thirds and gallic acid one-third 
 is thought by some practitioners to be superior as a haemostatic powder 
 to one in which only tannic acid enters. It enters in combination with 
 gun-cotton and ether, and in this form is known as styptic collodion. 
 (See Section on General Surgery.) 
 
 A combination of the effects of tannic acid and carbolic acid is 
 obtained as follows: to a half pint of water add one drachm of tannic 
 acid and two grains of carbolic acid ; filter thoroughly with care. Gly- 
 cerite of tannic acid is useful in the proportions of glycerin five parts 
 and tannic acid one part. 
 
 A tannated cotton is prepared by steeping absorbent cotton in a solu- 
 tion of tannic acid. * 
 
 Liideritz {Berlin Klin. Wochenschrift, 1890) claims that tannic acid is 
 antiseptic, and that through its presence infusion of coffee is antiseptic. 
 
 Tannic acid is of especial value on mucous membranes and on abraded 
 or superficially ulcerated skin surfaces. It is noted that many of its 
 indications are found in localities where sound integument joins a mucus- 
 or ichor-yielding lesion, as at the nostril, anus or vulva, and the 
 margins of ulcers, fissures, etc. 
 
 Rosenstirn found that an application of a solution of tannin to the 
 mesentery of a frog actually increased the diameter of the vessels. 
 L. Lewin {Medicinische Woe hens chrift, April, 1881, p. 202) believes that 
 the astringent effect of the acid is best secured by a powder containing 
 tannin or by the acid used in a pure form, and that solutions of tannin 
 (especially those in which tannin-albuminates have been formed and the 
 precipitate again dissolved in an excess of albumin) constitute a means by 
 which tannin can be applied to the economy without astringent effects 
 following. He makes a statement that tannin-albuminates when formed 
 in the tissues as a result of local application are gradually absorbed in 
 the albumin-bearing states of the tissue fluids and of the blood. 
 
 General Surgery. In fissures it is recommended that a strong 
 solution of chlorate of potassium and tannic acid be applied (see intro- 
 ductory note), or a glycerite of tannin, in which chlorate of potassium is 
 dissolved may be painted over the surface with a camel's hair brush. 
 This is a most satisfactory way of employing these agents. D. Hayes 
 Agnew held tannic acid in high esteem as the foremost of chemico-vital 
 haemostatics, owing to its power of coagulating albumin.
 
 64 LOCAL THERAPEUTICS. 
 
 In ULCERATING CANCER of the breast with a tendency to bleed, the 
 part should be dusted over with finely powdered tannin, and then covered 
 with a bland dressing of zinc ointment and cotton. 
 
 B. W. Richardson has called attention to a styptic solution which he 
 calls styptic colloid. It consists of a strong solution of tannin in alcohol 
 mixed with collodion. This forms an elegant application to restrain 
 oozing of blood from large surfaces, and as a protectant in contused and 
 lacerated wounds, especially of the SCALP. Tannic acid has been used 
 by Milkolsky (Deutsch Med. Wochenschr., August, 1888) as a local appli- 
 cation for BURNS of the first and second degree, in the form of the 
 following mechanical admixture: R. Acidi tannici, gj ; Alcohol., f^j ; 
 yEther., f^viiss. This is painted over the part until a firm membrane has 
 formed, and the painting is repeated twice daily and covered with a dry 
 compress. Afterward the surface of the wound is dusted over with 
 iodoform. 
 
 Philip Miall has employed strong solutions of tannic acid in the treat- 
 ment of INGROWING TOE NAILS. R. Acid, tannic., 3] ; Aquae, ^vj, dis- 
 solved by gentle heat and painted on the soft parts twice daily. In three 
 weeks a patient so treated had grown a nail of proper length and breadth, 
 after spending many hours on his feet daily without pain. . 
 
 In diseases of the rectum, such as FISSURE and PROLAPSUS, tannic acid 
 may be employed with great advantage, in the former by separating the 
 parts and dusting over the surface, and in prolapse, as Alison suggests, 
 by applying a strong aqueous solution of tannin. This is especially indi- 
 cated when there is much relaxation of the parts. In FISSURE OF THE 
 ANUS, the glycerite of tannin may be used night and morning, introduced 
 on lint. In UNINFLAMED PILES, tannic acid ointment, combined with 
 extract of belladonna, may be used with great advantage. 
 
 In the genito-urinary tract, tannic acid is extensively employed, either 
 by itself or in conjunction with other remedies. In the latter stages of 
 GONORRHOEA, a five to ten grain solution in rose water may be used as an 
 injection, as advised by Van Buren and Keyes. Ricord recommends: 
 R. Zinc, sulph., Acidi tannici, aa gr. xv; Aquae rosae, f^vj, to be 
 injected twice daily. 
 
 In GLEET, tannate of glycerin is often of great service, especially 
 when applied locally to the inflamed spot through a speculum or by means 
 of a deep urethral syringe, the exact spot having previously been located 
 by means of the panelectroscope. The same treatment, according to 
 Mansell Moullin, is very effectual in the treatment of PROSTATITIS and 
 PROSTATORRHCEA. 
 
 VENEREAL WARTS may be destroyed by dusting their surfaces daily 
 with tannin after washing with chlorinated soda (Agnew). Snipping 
 them ^away with a pair of sharp scissors, and dusting their bases with
 
 ACIDUM- TANNICUM. 65 
 
 tannic acid, and touching with nitric acid will always prove a reliable 
 means of dealing with these affections. In GONORRHCEA in the female, 
 after a thorough cleansing with a solution of either alum or tannin, the 
 vagina should be packed with lint dusted over with powdered tannic 
 acid. An important feature in this treatment is the separation of the 
 vaginal walls. 
 
 In specific URETHRITIS in the female, bougies covered with tannic 
 acid are, according to Dr. Hicks, one of the most efficient means of 
 treatment. The best method of preparation is to take a medium-sized 
 gum catheter, moisten it with mucilage of acacia, place it in powdered 
 tannin, and allow it to dry; after which it may be used by inserting it, 
 and allowing it to remain while the tannin is slowly dissolved by the 
 secretions. In the same manner it may be applied to the male urethra or 
 prostate. CHRONIC VAGINITIS of children is often greatly benefited by 
 the application of tannate of glycerin. Tannate of glycerin is a useful 
 application in cases of EROSION ON THE CERVIX UTERI, and also in cases 
 of CHRONIC CERVICAL ENDOMETRITIS. Tannic acid, one grain to the 
 ounce of water, has been used with advantage in cases of CYSTITIS accom- 
 panied by abundant mucous discharge. 
 
 Diseases of the Skin. Tannic acid is employed in the local 
 treatment of skin diseases when an astringent effect is desired. 
 
 In SEBORRHCEA CAPITIS, Morrow recommends the following prepara- 
 tion : R. Acid, tannic., gj; Glycerin i, f^j ; Vaselini, ^ij ; Ung. aquae 
 rosae, j. M. 
 
 In HYPERIDROSIS of the feet, a drachm or more of finely powdered 
 tannic acid to the ounce of lycopodium or fuller's earth forms an efficient 
 dusting application. 
 
 Dissolved in collodion, as in Richardson's styptic colloid, tannic acid 
 forms an admirable application in CONDYLOMATA, in PERNIO and in some 
 cases of ERYSIPELAS. 
 
 Diseases of the Ear, Throat and Nose. As a result of experi- 
 ments upon the trachea of living animals, by J. Rossbach {Berliner 
 Wochenschrift, 1882), the effect of tannic acid was found to be similar to 
 that of alum. Under its influence the membrane became pale ; the epi- 
 thelial covering instead of being colorless and transparent, as is normal, 
 assumes a peculiar bluish white or whitish appearance. The underlying 
 vessels were distinctly less red than in the normal state, but whether they 
 are narrowed or widened could not be demonstrated. The secretion 
 appeared to be lessened. The epithelial covering became dry and glis- 
 tening. 
 
 In the treatment of diseases of the ear, tannic acid is but little used. 
 In CHRONIC PERICHONDRITIS of the auricle, a preparation of tincture of 
 iodine one part and tincture of galls two parts, may be freely painted 
 5
 
 66 LOCAL THERAPEUTICS. 
 
 over the skin of the affected parts. Tannic acid is one of the agents 
 occasionally selected in the treatment of AURAL POLYPUS. 
 
 Tannic acid is of great value in the treatment of INFLAMMATION OF THE 
 THROAT. It is ordinarily employed in subacute PHARYNGITIS and 
 LARYNGITIS, in the form of the glycerole, having the strength of one 
 drachm of the acid to an ounce of glycerin. It is best applied two or 
 three times a day with the brush, sponge, or by a dossil of absorbent 
 cotton, a few drops sufficing. In a lotion of a strength of about ten 
 grains to the ounce is recommended by some writers in more acute 
 conditions. Nasal washes are weaker and range in proportion of the 
 acid to water from three to five, or as much as 15 grains. But as a 
 rule, it may be said that one of the numerous drugs which contain tannic 
 acid, such as Rhus glabrum, Pomegranate, Geranium maculatum, etc., 
 is to be preferred, since no manipulation of the acid proves to be so 
 agreeable to the patient as a natural combination into which an aromatic 
 principle enters. Wines containing tannic acid may be used as gargles 
 for relaxed throats. Claret wine is popular in this connection. Cam- 
 erite wine, of Greek vintage, is rich in tannic acid and is serviceable as a 
 gargle in conditions where astringency combined with stimulant is more 
 marked than where claret is indicated. 
 
 For EMPYEMA OF THE MAXILLARY SINUS, after drainage has been estab- 
 lished one to five grains of tannic acid may be used to the ounce of water, 
 as a lotion. Lozenges and nasal bougies contain from one grain to a 
 grain and a half of the agent. A nasal tampon may be freely powdered 
 with the acid. Snuffs contain about one part of the acid to four or five 
 parts of excipient. The following is the composition of Dobeir s snuff : 
 one drachm to an equal proportion of camphor, white sugar and high- 
 dried Welsh snuff. Tannic acid is reputed to destroy NASAL POLYPI. 
 In the connection last named, Bryant recommends it as an insufflation, 
 but the galvano-cautery, chromic acid and trichloracetic acid now largely 
 supersede it. It also serves as a valuable dressing in the GRANULATION 
 OF ULCERS. A solution of 20 grains to the ounce has been employed by 
 Bell {Canada Medical Record, February, 1884), as an injection to the 
 substance of POLYPUS. Infusions of tea and coffee when allowed to 
 simmer are found to contain tannic acid, and, as these forms of beverage 
 are commonly partaken of, the effects upon the throat are occasionally met 
 with in the form of persistent pharyngeal irritation. In this way it is 
 ascertained what the evil effects of tannic acid may be, when prolonged, 
 even in the event that weak preparations of the drug have been prescribed. 
 The haemostatic properties of tannic acid are of use in the nose and 
 throat. A ten per cent, solution will suffice. Its properties are increased 
 by the addition of alum. It is not often directed in EPISTAXIS, but is 
 free from objection. One part of iodoform, combined with two or three
 
 ACIDUM TANNICUM. 67 
 
 of tannic acid, carefully triturated, is used as an insufflation in CHRONIC 
 NASAL CATARRH, as recommended by Bartholow. 
 
 Mr. Druitt recommends tannin for the cure of APHTHOUS ULCER OF 
 THE MOUTH, and for modifying mercurial salivation, especially when 
 accompanied with spongy, relaxed gums. R. Acidi tannici, 3]; Mel. 
 rosae, f^ij ; Aquae, fgvj ; to be used as a mouth wash. Mr. Druitt regards 
 it as one of the most reliable remedies for TOOTHACHE, when this 
 depends upon a carious condition of the tooth. R. Acidi tannici, 9j ; 
 Mastich, gr. x ; yEtheris, fgss. After scarifying about the root of the 
 tooth with a fine lancet, a small pinch of cotton is saturated with the 
 above solution and packed into the cavity. 
 
 A gargle of the acid in the proportion of ten grains to the ounce is of 
 value in checking capillary oozing after tonsillotomy and uvulotomy. 
 
 As a gargle one drachm of tannic acid combined with two drachms of 
 chlorate of potash, an ounce of honey of roses added to a pint of boil- 
 ing water makes an efficient gargle.* The following formula, which is 
 known in Philadelphia as GoddarcT s Astringent Gargle, is one of the most 
 agreeable forms which exhibit the combined effects of tannin and alum : 
 R. Aluminis, ^ij ; Cort. granati, gss; Petal rosae rub., ^j ; Mellis, 3j ', 
 M. Aquae Bull., gvj. Glycerin may substitute for the honey. The mix- 
 ture can be used without dilution, or with an equal quantity of water. 
 
 Owing to its disposition to coagulate mucus and excite irritation in 
 concentrated preparations, tannic acid is no longer used in the local 
 treatment of CROUP and DIPHTHERIA. M. Loiseau (Gaz. Medicate de 
 Paris, 1861) however, claims that the drug can be directed with advan- 
 tage in diphtheria, diluted one-half with starch. 
 
 In the treatment of HYPERTROPHY OF THE TONSIL the powdered acid 
 may be rubbed in with a spatula or fine brush. But such a method must 
 be tedious and uncertain. M. Mackenzie believed that a solution of one 
 to five grains to the ounce of water is, on the whole, the best spray for 
 CHRONIC LARYNGITIS. As a haemostatic in the form of a spray the drug 
 may be used in a strength as high as ten grains to the ounce. 
 
 E. F. Ingals accepts tannin as the best astringent to use in TUBER- 
 CULAR LARYNGITIS in equal proportions with morphine and carbolic acid. 
 (Trans. Ninth Inter. Med. Con., Wash., iv, 1887.) 
 
 Diseases of the Eye. Tannic acid is much employed in ophthalmic 
 surgery as an astringent. It diminishes the secretion from an INFLAMED 
 CONJUNCTIVA and contracts and condenses the membrane when swollen 
 and relaxed. " Its astringent action is probably due to coagu- 
 ation of albumin and a ' tanning ' of all the tissues to which it is 
 applied." In chronic CONJUNCTIVITIS, or in the later stages of the acute 
 
 * See Introduction, for caution.
 
 68 LOCAL THERAPEUTICS. 
 
 form, a solution of from two to five grains to one ounce may be dropped 
 into the eye, or it may be painted on the everted lid in the strength of 
 from ten to thirty grains. If the palpebral conjunctiva is much thickened 
 or trachomatous, the best form of application is the solution in glycerin, 
 as the hygroscopic property of the latter increases the effect. The full 
 strength of glycerite of tannin may be used (Glycerinum Acidi Tannici 
 B. P., one part to four). Powdered tannin is sometimes dusted on the 
 inner surface of the lid. In either case it should be washed off before 
 the lid is allowed to close. 
 
 ACIDUM TARTARICUM. Tartaric Acid. 
 
 Tartaric acid is "an acid prepared from the acid tartrate of potassium." (Ph. Br.) 
 It is " nearly or entirely colorless, transparent, monoclinic prisms, permanent in the air, 
 odorless, having a purely acid taste, and an acid reaction. It is soluble in seven-tenths 
 part of water, and two and five-tenths parts of alcohol at 15 C. (59 F.); in five-tenths 
 part of boiling water, and two-tenths part of boiling alcohol." (U. S. P.) It is 
 " incompatible with salifiable bases and their carbonates ; with salts of potassium, with 
 which it produces a crystalline precipitate of bitartrate; and with the salts of lime and 
 lead, with which it also forms precipitates. (U. S. D.) 
 
 According to Potter, tartaric acid locally used converts the membrane 
 in DIPHTHERIA into a gelatinous mass, which is easily expelled. 
 
 ADEPS. Lard. 
 
 " The prepared internal fat of the abdomen of Sus scrofa, purified by washing with 
 water, melting, and straining." (U. S. P.) 
 
 Although the Pharmacopoeia directs the " internal fat^of the abdomen," yet in the shops 
 the purified commercial lard is used, which is made from the subcutaneous fat as well 
 as from that of the abdomen. Much that is sold for lard is a compound of stearine and 
 cotton-seed oil. When heated this compound gives the offensive odor of heated cotton- 
 seed oil. Lard is adulterated by water, starch, alum, and quicklime (which are added 
 to make it heavier and whiter). Common salt, is mixed with lard to preserve it. 
 
 ADEPS BENZOINATUS (benzoinated lard, U. S. P.) is made by digesting two parts 
 of coarsely powdered benzoin in 100 parts of melted lard (below 60 C., 140 F.) for 
 two hours and straining. It is the base of many of the ointments of the United States 
 Pharmacopoeia. 
 
 Lard, the most common of emollients in general use, forms the basis 
 of nearly all ointments used in surgery as topical applications. The 
 action of lard, or simple ointment, is mechanical, protecting the sore 
 or wound from the irritating influences of the air, which increases the 
 inflammation already present. For the most part, all fats have the same 
 physical properties, differing only as to the melting-point. Fats and oils 
 are used to lubricate and soften the skin, and when rubbed in thoroughly
 
 about an articulation which has become stiff from injury or disuse will often 
 assist in restoring its function. Any perfectly bland oil or fat may be used 
 for this purpose. Mutton suet and goose grease have long been held in 
 high repute in domestic medicine. They are valuable for the reason that 
 when properly prepared, they are less apt to become rancid than are other 
 fats. It must be remembered that the blandest fat, when it becomes rancid, 
 is irritating, and will do much more harm than good. It is important in 
 the selection of a fat for the preparation of an ointment that one should 
 be chosen which will soften at the temperature of the body, but at that 
 temperature will not become fluid. Thus, we have in lard a fat admirably 
 suited for the preparation of ointments. In hot weather, white wax, yellow 
 wax, or spermaceti may be added to lard to prevent its becoming fluid. It 
 is important that lard for all medical purposes should be free from salt. 
 Benzoic acid is frequently added to lard to prevent its becoming rancid. 
 We have seen lard as an inunction used with success in the treatment of 
 MARASMUS. Fats and oils are sometimes rubbed into the skin of the whole 
 surface with a view to their absorption, so as to administer to the nutrition 
 of the body. One of the pleasantest fats for this purpose is cocoanut oil. 
 Fats and oils are sometimes rubbed into the skin to prevent the sweating 
 in low, debilitating diseases, as PHTHISIS. 
 
 AETHER. Ether. Sulphuric Ether. 
 
 "A liquid composed of about 74 per cent, of ethyl oxide, and about 26 per cent, of 
 alcohol containing a little water." (U. S. P.) Its specific gravity is 0.750. There is 
 official in the U. S. P. sEther, as defined above, and ALther fortior, which is defined 
 as " a liquid composed of about 94 per cent, ethyl oxide, and about 6 per cent, of alcohol 
 containing a little water, and of a specific gravity not higher than 0.725 at I5C. (59 F.)". 
 
 It is contemplated that the official ether should be used in preparing certain pharma- 
 ceutic preparations, into the finished products of which it does not enter; but for medicinal 
 purposes, either for administration by the stomach or for hypodermic use, and specially for 
 anaesthesia, cether fortior is the article to be used. Ether is soluble in all proportions 
 in alcohol, chloroform, benzol, benzin, and the fixed and volatile oils, and dissolves in 
 eight times its volume of water at 15 C. (59 F.). It boils at 37 C. (98. 6 F.)" (U. 
 S. P.). Its vapor, either alone or mixed with air, is highly inflammable. It should be 
 remembered that its vapor is heavier than the atmosphere, and if it be used at night the 
 lights should be placed as near the ceiling as may be, and if it is poured from one vessel 
 to another this should be done close to the floor. 
 
 General Surgery. The first surgical operation, beyond the extrac- 
 tion of a tooth, in which ether was used as an anaesthetic was the removal 
 of a tumor by Dr. John C. Warren at the Massachusetts General 
 Hospital, the anaesthetic being administered by W. T. G. Morton. 
 
 The choice of an anaesthetic for a surgical operation lies between ether 
 and chloroform (we naturally here exclude nitrous-oxide gas), both being
 
 70 LOCAL THERAPEUTICS. 
 
 agents equally capable of producing insensibility, although in the case 
 of the latter the effect is brought about much more rapidly and with less 
 discomfort to the patient. So dangerous is chloroform and so safe is ether 
 that there is no excuse for the use of the former agent under ordinary 
 circumstances. The reason of the safety of ether is that, unlike chloro- 
 form, it does not suddenly paralyze the normal heart. It may kill by 
 producing asphyxia ; but this it does slowly, and in most cases after 
 warning which can be overlooked only through the utmost carelessness. 
 If so unfortunate a result takes place, artificial respiration should at once 
 be practised and continued for a long period. 
 
 If definite rules are obeyed, many inconveniences which attend the use 
 of ether may be avoided. The patient should not be allowed solid food 
 for at least six hours before its inhalation ; he should be in the recumbent 
 position while inhaling, and all garments about the neck and chest 
 loosened. If the patient is a female, the corsets should be entirely unfas- 
 tened. If possible, all the clothing should be removed except that ordi- 
 narily worn in bed, so that when nausea follows anaesthesia there may be 
 no likelihood of soiling the clothing. Care should be taken that the 
 mouth is clear of every foreign substance. It is well to smear sweet oil or 
 cosmoline about the mouth and nose, as the contact of the ether may 
 cause slight excoriation. 
 
 Various mechanical contrivances have been devised for the administra- 
 tion of ether. It is probably true that the best inhaler is that of O. H. 
 Allis, of Philadelphia. The advantage of an inhaler lies in the fact that 
 it is saving of ether ; while, on the other hand, except care be exercised, 
 it may become foul. Patients of the better class prefer to be anaes- 
 thetized by means of a fresh napkin or towel. In our experience, 
 nothing is found more satisfactory than an ordinary towel folded in 
 the shape of a hollow cone, with a piece of stiff paper between the 
 outer layers of the towel, so as to keep the cone in shape after it has 
 become saturated with the drug. The materials for such an inhaler are 
 always at hand ; and, if the cone be properly made, it is both economical 
 and efficient. Some surgeons administer ether by laying a flat, folded towel 
 over the nose and mouth a plan which allows but slight space for the 
 evaporation of the ether, and possesses the disadvantage of being slow, 
 uncomfortable to the patient, and wasteful. In the Massachusetts General 
 Hospital a hollow cone-shaped sponge is used. 
 
 In administering ether the patient should be informed that it may 
 cause a slight choking sensation, which bodes no harm, is of tem- 
 porary duration and will soon pass away. About half an ounce 
 should be sprinkled over the inner side of the cone, which should 
 then be held over the face, a short distance from the nose, thus per- 
 mitting the vapor to be well diluted with air. In a short time the
 
 air passages become accustomed to the slightly irritant effect of the ether, 
 and then the cone may be held down close over the nose and mouth, the 
 ether being administered in as concentrated a form as possible. In this 
 way a person may be completely anaesthetized with scarcely a struggle. 
 When the conjunctiva is insensible to the touch of the finger, when 
 muscular relaxation is complete and the breathing tends to become ster- 
 torous, the stage of complete anaesthesia has been reached. At this point 
 the quantity of ether poured in the cone should be reduced, or none 
 should be added for a few minutes, subsequent additions being made only 
 at times and in quantities necessary to keep the patient unconscious for 
 the desired length of time. The first effect of inhalation of ether is an 
 acceleration of the pulse and respiration, increase of the activity of the 
 salivary glands, with a disposition to muscular movements, which frequently 
 require restraint; the brain, too, is excited, and the patient may cry out. 
 These symptoms demand continuance of the administration of the ether, 
 and not its withdrawal. If the patient has taken solid food before the ether- 
 ization, vomiting is now likely to occur. If this should happen, the cone 
 should be withdrawn from the face ajid the patient's head and body be 
 turned well over to one side, while the mouth and throat are freed as 
 quickly as possible of all vomited matters by means of a sponge fastened 
 to the end of a stick, or held in the blades of a pair of forceps. In the 
 absence of these, the finger covered with a fold of towel or napkin will 
 suffice. 
 
 The second stage of ether narcosis may be considered to begin with 
 complete loss of consciousness, and the patient soon passes into perfect 
 relaxation, with a slow, regular respiration. The stertorous breathing that 
 is noticed if the drug is forced a little further is due to paresis of the 
 muscles of the palate, and, as a rule, is a warning to give less ether. 
 
 The face during etherization is somewhat congested; marked pallor and 
 lividity are always indications of failure of the heart's action or of the respi- 
 ration, and when these signs appear the administration of the ether should 
 be suspended. It is the habit among some anaesthetizers to cover the entire 
 face and cone with an additional towel, to prevent loss by evaporation. 
 This is a reprehensible practice, as it removes from view one of the best 
 guides to the patient's condition. It is not an uncommon occurrence 
 when a patient is anaesthetized, for muscular relaxation to be so complete 
 that the tongue falls backward, the glottis closes, the face becomes cyan- 
 osed, and the pulse frequent and irregular. Death may be threatened from 
 asphyxia. In this event the head should be extended and the jaw pressed 
 forward from behind with the thumb on the angles. It is rarely necessary 
 to drag the tongue forward by means of a volsella forceps or tenacula, 
 as is often done in clinics. 
 
 Should so unfortunate an accident as apparent asphyxia occur, artificial
 
 72 LOCAL THERAPEUTICS. 
 
 respiration should be practiced. The respiratory action may be excited 
 by the use of the electric current, one electrode being placed over the 
 larynx and the other over the epigastrium. Hypodermic injections of 
 atropine and strychnine have been followed by good results. Efforts at 
 resuscitation in these cases should be persevered in for at least half an 
 hour, as apparently hopeless cases have been saved by the use of these 
 means. The time that is required to produce complete anaesthesia varies. 
 If the ether is properly administered, it can usually be accomplished in 
 from five to twelve minutes. During recovery from the effects of anaes- 
 thesia some patients become very excited ; others awake as from a quiet 
 sleep. The latter mode of recovery is always to be desired, and it is to 
 be encouraged by refraining from all attempts to arouse the patient when 
 disposed to sleep. After arousing from the effects of the anaesthetic, 
 nausea and vomiting are common sequels, but seldom require remedies. 
 Should nausea persist, as it sometimes does in hysterical persons, a 
 hypodermic of morphine will usually suffice to quiet it. 
 
 Ether must not be administered to a female without the presence of a 
 third party, if possible one of her own sex, since it is known that women 
 often acquire fixed delusions which can only be met by testimony abso- 
 lutely proving their falsity. If possible, ether should not be administered 
 to persons who are far advanced in renal disease, as the partial elimination 
 of the drug by the kidneys is a great tax on these organs. While the 
 patient is under the influence of the anaesthetic the body should be kept 
 covered with a blanket and free from exposure to drafts, as in this relaxed 
 state pneumonia or pleurisy is easily contracted. Care must be taken to 
 prevent the ignition^of ether from the actual cautery in operations about 
 the mouth. The anaesthetizer should never pour any fluid on the cone, 
 for the purpose of beginning anaesthesia, without first assuring himself of 
 the character of the drug. A patient on recovering from an anaesthetic 
 should never be left alone, but should be watched for several hours after 
 the administration of the agent. When a patient ceases to breathe, or 
 to hold the breath, as is so often the case in the first stage of anaesthesia, 
 a little ether should be poured over the epigastrium, its rapid evaporation 
 having the same effect as though ice-water was thrown upon the surface ; 
 it will cause the patient to take a deep inspiration and immediately 
 thereafter to breathe regularly. 
 
 Ether may be used hypodermically as a diffusible stimulant in the 
 treatment of shock. Thirty minims should be given at once, and may 
 be repeated every ten minutes until four or more doses are administered. 
 We have found it of great service exhibited in this way at intervals during 
 operations following railroad injuries, when reaction has been imperfect. 
 It is also of service in the threatened collapse following POST-PARTUM 
 HEMORRHAGE. The needle causes a little pain at the point of insertion,
 
 AETHER. 
 
 73 
 
 which soon passes away without further discomfort. Kums, of Antwerp 
 recommends the subcutaneous use of ether in NEURALGIA, employing 
 15 minims of ether, or of a mixture of ether and alcohol. The injection 
 should be made as near as possible to the site of pain, the fluid being 
 pressed through the tissues with the finger. He has thus cured RHEUMATIC 
 NEURALGIA, SCIATICA, and TORTICOLLIS. 
 
 Attention has been called by S. H. Savage {Brit. Med. Jour., Decem- 
 ber, 1887) to dementia following the administration of ether. Romans, 
 of Boston, has observed the same effect, the dementia occurring about a 
 week after the administration and lasting about five weeks. 
 
 Dr. Jno. H. Packard has described, under the name of " first insensi- 
 bility " from ether, a condition of brief duration, in which such opera- 
 tions as the opening of an ABSCESS or FELON can be performed without 
 pain. The patient is instructed to hold up his arm during the inhala- 
 tions ; on the relaxation of the arm the incision may be made. Various 
 attempts have been made to induce anaesthesia by the rectum, but it has 
 often caused dangerous diarrhoea and even death, so that its use is to be 
 deprecated. The ether spray has long been used as a means of producing 
 local anaesthesia by partially freezing the selected part. This method 
 may be of service as a preliminary step to the opening of- small ABSCESSES, 
 etc. An equally good effect can be produced with rhigoline. The fol- 
 lowing mixture has been extolled: R. Chloroformi, f^x ; Ether, fxiv; 
 Menthol, 3J. We have used this mixture and think it would be improved 
 by reducing the menthol one-half. 
 
 Diseases of the Skin. Sawyer {Lancet, July 12, 1890), on the 
 ground that medicinal substances are more readily absorbed when dis- 
 solved in ether and painted on the skin, proposes that an ethereal tincture 
 of belladonna should be made of the same strength as the linimentum 
 belladonna? (B.P.), substituting ether for rectified alcohol and the root for 
 the leaves, since this preparation does not discolor the skin. He also 
 recommends ethereal preparations of iodine and menthol, the latter one 
 drachm to the ounce. Such medicaments are likely to be of use in 
 localized PRURITUS and in URTICARIA. Ethereal tincture of capsicum, 
 made as this writer suggests, is a stimulant in ALOPECIA. 
 
 Ether is sometimes used as an injection for the cure of SEBACEOUS 
 CYSTS. Five to ten drops are injected, by means of a hypodermic syringe, 
 into the body of the tumor, the point of the needle being moved 
 around so as to break up its contents. This is to be repeated daily until 
 inflammation sets in. 
 
 Diseases of the Ear, Nose and Throat. A spray of ether may be 
 thrown upon the mucous surfaces in ACUTE CATARRHAL PHARYNGITIS, as 
 quoted by Schech. {Diseases of the Mouth, Throat and Nose, p. 99.) 
 Concato and Bufalini recommend that the spray be thrown every two
 
 74 LOCAL THERAPEUTICS. 
 
 hours, for three or four minutes, from a Richardson apparatus. Ether is 
 recommended by Voillemier as a remedy for EPISTAXIS in children. A 
 wet compress should be saturated with the agent and applied to the fore- 
 head. Equal parts of ether and water, or alcohol, may be used as a seda- 
 tive and antispasmodic inhalant. A teaspoonful of the mixture is added 
 to a pint of water at 80 F. 
 
 .ETHER ACETICUS. Acetic Ether. 
 
 Acetic ether is prepared in very much the same way as is the ordinary sulphuric ether, 
 except that in addition to the alcohol used acetate of sodium is also in the still, and from 
 the simultaneous freeing of the acetic acid and ether, acetic ether is produced. Most of 
 that found in the shops contains alcohol and water, and has an acid reaction which does 
 not belong to the pure compound. It has the properties of the ordinary ether with the 
 addition of the very pleasant acetous odor. Cautions that have been given concerning 
 the use of sulphuric ether apply also to its use. 
 
 Acetic ether may be substituted for ether in the above preparation. 
 Keene uses the acetic ether in CATARRHAL DISEASES OF THE MIDDLE 
 EAR. 
 
 AGARIC. Boletus. Touch Wood. Spunk. Tinder. 
 
 The article known under the above names is the agaric of the oak the Boletus ignia- 
 rius, a fungus found upon the bark of the oak tree. The inner part is used, and is 
 prepared by slicing and beating with a mallet until soft and readily torn. It is known 
 in France under the name of " Amadou" and as there prepared resembles old buckskin. 
 
 Agaric is haemostatic and protectant. 
 
 General Surgery. Owing to the light, tough, and spongy character 
 of agaric it has long been employed as a compress to arrest bleeding from 
 slight wounds, as from LEECH-BITES, for which purpose it may be placed 
 over the bleeding point and retained with a piece of adhesive plaster or 
 bandage. Owing to its physical properties it has also been employed as a 
 compress -in INGROWING TOE NAILS ; a piece being cut to a wedge shape 
 and forced into the subungual space, and retained there by means of 
 adhesive plaster. For this purpose we should say that it would be greatly 
 inferior to cotton thoroughly packed under the nail and then saturated 
 with collodion and allowed to dry, making a firm, unyielding, perfectly 
 fitting mass, thoroughly capable of supporting the nail. 
 
 Boletus, when cut in button-shaped masses and saturated with chlorate 
 or nitrate of potassium, forms what can be used as a MOXA, as a counter- 
 irritant in CHRONIC JOINT AFFECTIONS ; although for this purpose at the 
 present day the use of the Paquelin cautery has entirely superseded the 
 use of the moxa, being more reliable and less painful. 
 
 Diseases of the Nose. B. Robinson (New York Med. Journ.,
 
 ALCOHOL. 
 
 75 
 
 September 24, 1887, also Trans. Am. Laryng. Assn., 1887), employs 
 agaric in plugging the nose in EPISTAXIS. 
 
 ALCOHOL. 
 
 "A liquid composed of 91 per cent, by weight (94 per ce.nt. by volume) of ethyl 
 alcohol (C 2 H.HO; 46), and 9 per cent, by weight (6 per cent, by volume) of water. 
 Specific gravity 0.820 at 15.6 C. (60 F.) and 0.812 at 25 C. (77 F.)." (U. S. P.) 
 
 Alcohol is miscible in all proportions with water, glycerin, and ether; dissolves the 
 essential oils freely, but dissolves fixed oil very sparingly indeed. Castor oil is about the 
 only fixed oil freely soluble in it, and this only when the alcohol is of full strength. It 
 dissolves also iodine, and many balsams and resins. Absolute alcohol forms ethylates 
 with potassium, sodium, and lithium. All deliquescent salts, except carbonate of potas- 
 sium, are dissolved by it, as are also, freely, many of the chlorides. 
 
 The " Alcohol Dilutum" of the U. S. P. and the " Spiritus Tenuior " of the Ph. Br. 
 are mixtures of alcohol and water, containing the first 55 per cent, of water by weight, 
 and the latter 51 per cent. Absolute alcohol is pure anhydrous ethylic alcohol. 
 
 Alcohol is incompatible with chromic acid and with permanganate of potassium. 
 
 When alcohol is kept in prolonged contact with the skin, evaporation 
 being prevented, a sense of heat and superficial inflammation is produced. 
 Alcohol coagulates albumin and hardens animal tissues by abstraction of 
 water, and, hence, is of value, at times, in forming a thin, protective, air- 
 excluding layer, which promotes healing. 
 
 General Surgery. The stimulating action of alcohol upon the capil- 
 laries when applied locally causes them to contract without marked coagu- 
 lation or clotting of the blood, and has caused alcohol to be regarded as 
 one of the most desirable of haemostatics, as it always leaves the wound 
 to which it has been applied clean and free from clots or anything which 
 will prevent primary union. Alcohol, diluted with equal parts of a i to 
 1000 solution of corrosive sublimate, is of great service in controlling 
 capillary oozing after amputations. In this way two objects are accom- 
 plished the checking of all oozing and the thorough disinfection of the 
 wound. Alcohol, however, is in itself aseptic, since it is destructive to 
 most life forms. In cases demanding immediate action it is often the 
 only agent that is accessible. At one time it was with Ashhurst a favorite 
 dressing for amputations, the stump being thoroughly enveloped with lint, 
 saturated with equal parts of alcohol and water. We have employed a 
 similar dressing, with the addition of a small quantity of corrosive sublimate 
 (i to 2000) for granulating surfaces in which a high stage of inflammation 
 has been present. It seems especially serviceable in cases which have been 
 long poulticed, as is frequently seen in neglected FELON. Equal parts of 
 alcohol and water form a convenient evaporating lotion. Alcohol is also 
 a valuable remedy in the treatment of CONTUSIONS about the face, with 
 much ecchymosis. For the removal of the latter Agnew advises the use of
 
 76 LOCAL THERAPEUTICS. 
 
 equal parts of alcohol, water, and nitrate of ammonium (five grains to the 
 fluidounce), the part to be kept covered with lint saturated with the 
 solution. It is most useful as a stimulating, astringent wash for parts 
 exposed to pressure, in order to prevent the formation of BED SORES. 
 For this purpose it may be used diluted with equal parts of water, and 
 should be applied with friction. Often the addition of alum will tend 
 to harden the skin and make it less liable to fissure. 
 
 Alcohol (or what is used in many of our hospitals common whisky, 
 on account of its cheapness) is employed to great advantage in SPONGING 
 THE LIMB IN CASES OF FRACTURE, after the removal of the bandages, 
 adding greatly to the patient's comfort by restoring the cutaneous 
 functions. In the bloody oozing which is often seen in CARCINOMA of 
 the breast, alcohol compresses are often used with most satisfactory 
 results. UTERINE HEMORRHAGE may often be controlled by placing a 
 sponge saturated with alcohol in the cavity of the uterus and causing the 
 viscus to contract. Absolute alcohol is one of the very best materials in 
 which to preserve CATGUT LIGATURES, as it keeps them firm and does not 
 interfere with their flexibility, while bichloride of mercury and carbolic 
 acid render them brittle and weak. 
 
 A mixture of alcohol and white of egg also forms an excellent appli- 
 cation in the earliest stages of threatening BEDSORE. It is to be applied 
 frequently with a fine brush, and renewed as it dries until an albuminous 
 coating is formed over the excoriated surface. Alcohol has also been 
 used as an antiseptic and for dressing ULCERS and ATONIC SORES. 
 
 Diseases of the Skin. Alcohol is employed in diseases of the 
 skin as a local anaesthetic and as an adjuvant to various lotions. The 
 anaesthetic effect depends, in all probability, upon the cold which its 
 rapid evaporation produces. Employed alone or with the addition of 
 chloroform, alcohol is often of benefit as a lotion in URTICARIA and 
 some forms of ERYTHEMA, especially ERYTHEMA CALORICUM, or FROST 
 BITE. R. Chloroformi, f^ iv; Alcoholis, f^iv. M. 
 
 As an astringent, alcohol acts by hardening the tissues of the skin, 
 and is thus useful in preventing maceration in cases of HYPERIDROSIS 
 and in other complaints. 
 
 Holgate, of New York {Arch, of Pediatrics, 1889), treats N^vus by 
 the injection of five to seven minims of 95 per cent, alcohol. The 
 naevus is encircled by a ring on which pressure is exerted to arrest the 
 circulation. The point of the syringe is gradually withdrawn during the 
 injection. The tumor solidifes and the tissues shrink. The injection is ' 
 repeated at intervals of several weeks until the disappearance of the 
 growth has been effected. 
 
 Diseases of the Ear, Nose, and Throat. Alcohol (95 per cent.) 
 has been recommended for the treatment of OTORRHEA. Opinions have
 
 ALCOHOL. 
 
 77 
 
 varied with respect to its efficacy. Since the introduction of boric acid and 
 corrosive sublimate treatment the remedy has fallen into disuse; it would 
 appear to be especially indicated in those cases which, after treatment by 
 antiseptic methods and careful cleansing, yet remain unhealed. In a 
 word, in the late stage of the antiseptic treatment if the discharge after 
 cleansing be not diminished, the use of alcohol in the above-named 
 strength stimulates the surface, deposits a'coagulate of mucin in the dis- 
 charge, and corrects odor. It appears to have a special disposition to 
 destroy ASPERGILLUS, and some of its value in the treatment of otorrhea 
 may depend on this factor. In the beginning of the treatment caution 
 should be used, as in some individuals alcohol in almost any strength 
 causes irritation. Absolute alcohol has been tested for the treatment 
 of AURAL POLYPUS, but very properly has fallen into disuse. It is diffi- 
 cult to restrict its action, and instances are known in which inflammation 
 has extended into the middle ear and caused a clot to form in the lateral 
 sinus. (Schwartz, Naturforscher Versammlung zu Berlin, September, 
 1886.) 
 
 The first effect of strong alcoholic preparations on the mucous mem- 
 brane is to constrict capillaries and induce pallor; the secondary effect is 
 to dilate the vessels (Mandl). According to Zaufel ( Wiener Med. Presse, 
 No. 50, 1883), alcohol in the form of spiritus rectificatus acts most 
 happily, sometimes, in mammilliform perforations of the tympanum. 
 
 Absolute alcohol is often diluted with glycerin, since the mixture 
 serves better the purpose of local application than when used pure. It 
 may be joined in proportion of one of the alcohol to four to ten parts of 
 glycerin, or even of equal parts. Such a mixture forms a convenient 
 medium for exhibiting the effects of boric acid, salicylic acid, and 
 carbolic acid. In the weaker preparations these act somewhat alike ; the 
 carbolic acid being the least well borne on skin surfaces or in the auditory 
 meatus and the nostril. 
 
 The commercial alcohol has been praised by C. Seiler as a remedy in 
 the treatment of CHRONIC NASAL CATARRH. J. Solis Cohen practically 
 admits its value in the treatment of DIPHTHERIA, in making the assertion 
 that the popular tincture of chloride of iron owes its efficacy to alcohol 
 rather than to iron. It has also been used as a mouth wash in NOMA. 
 Claret wine as a gargle in relaxed states of the throat probably owes its 
 virtue to the alcohol present, aided by a small proportion of tannic acid. 
 
 G. Vivian {Phila. Med. Times. May 21, 1881) recommends alcohol as 
 an inhalant in DIPHTHERIA. He has never seen any constitutional 
 effect arise from its use, although as much as a quart a day may be 
 employed. 
 
 Diseases of the Eye. The delicate cutting instruments used in 
 ophthalmic surgery can be readily cleaned and made aseptic without
 
 78 LOCAL THERAPEUTICS. 
 
 injury to their edges by thorough wiping with absorbent cotton saturated 
 with alcohol. As an additional precaution they are sometimes previously 
 immersed in boiling water. During an operation they can be kept on a 
 napkin saturated with alcohol, or in a rack over a layer of alcohol con- 
 tained in a shallow pan or waiter. 
 
 Alcohol, though perhaps the most perfect of aseptic fluids, is not 
 antiseptic, and even alcoholic solutions of antiseptics are without value 
 as germicides (Koch, Sattler, and others). Alcohol at any rate is too 
 irritating for application to the eye. 
 
 ALDEHYD. Dehydrogenated Alcohol. 
 
 Acetic Aldehyd is here to be understood. It is " a colorless, mobile, inflammable 
 liquid, having a rather pungent, ethereal, and suffocating odor." (U. S. D.) Its 
 specific gravity is 0.79. Aldehyd " mixes in all proportions with water, alcohol, and 
 ether, and is rapidly converted into acetic acid by exposure to the air." (U. S. D.) 
 When desired pure it is prepared by a very complex process from alcohol. 
 
 Diseases of the Throat, etc. Aldehyd is sedative and probably 
 astringent to the respiratory tract. As an inhalant it may be employed 
 in the proportion of 80 minims to the ounce of water. For the pharynx 
 a preparation of aldehyd, two parts ; carbolic acid, one part ; and 
 glycerin, five parts may be applied with a brush ; or aldehyd and 
 glycerin may be employed in equal parts. Lennox Browne claims that 
 aldehyd arrests excessive secretion of mucus. 
 
 ALTH^A. Marshmallow. 
 
 "The root of Alth&a officinalis," (U. S. P.) Marshmallow root yields a yellowish 
 white powder, containing much starch and mucilaginous matter, and some saccharine 
 matter. The powder is bland, soothing, and non-irritating, and is an excellent vehicle for 
 more active remedies. 
 
 General Surgery. A decoction of marshmallow is occasionally 
 used as a sedative injection to allay IRRITATION in the vagina and rectum. 
 The root is used in France for children to "cut teeth on," as orris root 
 is used elsewhere. 
 
 Diseases of the Throat, etc. Althaea acts in diseases of the 
 throat as a demulcent. It is not often prescribed. The so-called marsh- 
 mallow confection of the shops is composed of gum arabic. Pastilles 
 containing althaea are known under the name of "Pastilles guimauve." 
 Althaea is occasionally employed to weaken astringents when it is desired 
 to use these agents in the form of powders.
 
 ALUMEN. 79 
 
 ALUMEN. Alum. 
 
 In the U. S. P. the sulphate of aluminum and potassium is official. In the Ph. Br. both 
 this salt and the sulphate of aluminum and ammonium are official. They are regarded 
 as equal in therapeutic value. Alum is " soluble in ten and five-tenths parts of water at 
 15 C. (59 F.), and in three-tenths part of boiling water, and is insoluble in alcohol." 
 (U. S. P.) 
 
 It is " incompatible with the alkalies and their carbonates, lime-water, magnesia and 
 its carbonate, tartrate of potassium, and acetate of lead." (U. S. D.) 
 
 ALUMEN EXSICCATUM (burnt alum, dried alum, desiccated alum, dehydrated alum, 
 alumen ustum) is alum freed from its water of crystallization by heat. As an exsiccant 
 it, of course, should be used dry. 
 
 Alum and carbolic acid are sometimes united, as follows : alum, two drachms ; car- 
 bolic acid, one-half drachm ; water, one pint. 
 
 Alum is astringent, exsiccant, and mildly caustic. It is an important 
 member of a group of remedies which have the property of coagulating 
 albumin. 
 
 Alum is used as a haemostatic, and to check too profuse formation of 
 mucus or pus. Alum acts by constricting vessels and by causing the 
 formation of coagula on wounds. It has but slight penetrative power. 
 It is efficient as an astringent to newly made vessels in granulation tissue. 
 In this way it tends to lessen secretion and to stay capillary bleeding. 
 When used as an exsiccant, it absorbs moisture from the tissues. It is 
 particularly useful in the minor fluxes and inflammations of childhood, 
 and of those adults in whom the tissues are delicate. 
 
 General Surgery. As a haemostatic alum may be used in the milder 
 forms of bleeding, as from PILES, LEECH-BITES or SMALL WOUNDS, as 
 well as in HEMORRHAGE FROM THE UTERUS. Powdered alum should be 
 dusted on the bleeding part, or applied in strong solution. Dried alum 
 acts as a mild caustic, being much less powerful than are the salts of 
 zinc or copper. It is sometimes used to destroy exuberant granulations. 
 Alum is an excellent application to small BED SORES ; the following 
 formula is useful: Alum, %ss; camph., ^ij ; the whites of four eggs. 
 Alum added to whisky or diluted alcohol renders either of these sub- 
 stances much more effectual as a topical application to surfaces of the 
 body exposed to pressure, and the combination will sometimes prevent 
 the formation of a BED SORE. A solution of alum (half a drachm or a 
 drachm to the pint) is often used as an injection in cases of RELAXATION 
 OF THE VAGINAL Mucous MEMBRANE, LEUCORRHOZA, (whether from 
 disease of the vagina or of the cervix), and in ACUTE GONORRHOEA in 
 women. In the disease last named, it can be directed as a douche, or 
 the vagina may be packed with strips of lint saturated with the weaker 
 solution (one-half drachm to one pint). It is, however, often more irri- 
 tating than are other astringents.
 
 8o LOCAL THERAPEUTICS. 
 
 In PROCIDENTIA RECTI of children it is sometimes useful to wash the 
 mucous membrane with a lotion composed of one drachm of alum added 
 to a pint of decoction of oak bark. 
 
 In VULVITIS of children, few remedies, according to Ringer, can be 
 compared to the injection of a solution of alum (forty grains to a pint 
 of water) followed by its use as a wash, kept constantly applied to the 
 external parts. 
 
 Diseases of the Skin. Alum has very little effect on the unbroken 
 skin, except to harden it slightly. To parts from which the epidermis 
 has been removed it causes a film of coagulated albumin to form, and 
 produces contraction of the tissues and vessels. 
 
 Hydrated alum in powder is sometimes employed in SWEATING OF 
 THE SOLES OF THE FEET. Burnt alum is also used for the same purpose, 
 combined with salicylic acid: R. Pulv. aluminii usti, gv. ; pulv. acidi 
 salicylici, sijss; pulv. amyli, ^xv; pulv. talci, gxx. M. A solution of 
 alum with sulphate of zinc is sometimes prescribed as an astringent lotion 
 in ERYTHEMA INTERTRIGO and ECZEMA: R. Aluminis, grs. xx; zinci sul- 
 phat. grs. x ; glycerini, f^j ; aquae rosae, ad fsiv. M. D. H. Agnew speaks 
 highly of sulphate of zinc and alum for PRURITUS AMI. Equal parts of 
 these salts are placed in an earthen vessel and heated sufficiently to drive 
 off their water of crystallization, or until they become a confluent, hard 
 mass. From half a drachm to one drachm of this substance, powdered 
 and dissolved in a little water, should be thrown into the rectum. In a 
 few minutes it will destroy the itching. It is stated that by this means 
 cures have been effected after the futile application of many other drugs. 
 A solution of ten grains to the ounce of water forms a convenient wash. 
 The powder of burnt alum is sometimes employed as a mild escharotic to 
 reduce exuberant granulations. In ONYCHIA the following wash has proved 
 useful : R. Pulv. aluminii usti, grs.iij ; zinci sulphat., grs.ij ; plumbi sub- 
 acetat., grs.ij ; aquae, f$j M. 
 
 Diseases of the Ear, Nose and Throat. J. Rossbach {Berliner 
 Wochenschrift, May 15, 1882) found that a solution of alum (strength not 
 given) caused, after five minutes, loosening of the epithelial cells of the 
 membrane of the trachea of living animals. 
 
 Pulverized burnt alum is of value in destroying the stump left after the 
 removal of an AURAL POLYPUS. A delicate probe is moistened and inserted 
 in the powder. The quantity which adheres is carried to the desired spot. 
 The drug may be used freely. A lotion of one-half grain to the ounce is 
 prescribed in the treatment of diffuse INFLAMMATION OF THE EXTERNAL 
 EAR. In OTORRHEA, dependent upon a recent perforation in the tympanic 
 membrane, alum should be used sparingly. In the experience of A. H. 
 Buck {Trans. Otological Soc. , 1873) a weak solution, forced into the tym- 
 panic chamber by injection was followed by mastoid disease. Redoes not
 
 ALUMEN. 8 1 
 
 state, however, that a similar complication would not have occurred had 
 another medicine been used. A powder composed of burnt alum and starch, 
 to which a small quantity of oxide of zinc has been added, is a popular 
 remedy for moist ECZEMA and other forms of diffuse inflammation of the 
 external auditory passage. Alum must be used with caution in the 
 external ear, owing to the fact that if the powder has taken up moisture 
 from the affected surfaces it is apt to remain as a dry, hard plug, and if 
 much discharge is present may prevent its escape. On this account 
 some practitioners have discarded this agent, but used it on selected 
 surfaces (as for example on GRANULATIONS, POLYPUS STUMP, etc.) it 
 is both efficient and safe. On the whole, it is best to weaken the 
 powdered drug either with an indifferent agent or with one having a 
 slightly different action on the parts. 
 
 In the nose, alum has been used in the proportion of from two to five 
 grains to the ounce in PURULENT NASAL CATARRH. Thirty grains to the 
 ounce forms a solution of appropriate strength in preparing a cotton 
 tampon. 
 
 Alum may be used as a gargle in PHARYNGITIS, in a strength from ten 
 to fifteen grains to the ounce. The pure powder of burnt alum may be 
 rubbed in the tonsil in FOLLICULAR INFLAMMATION. F. L. Ives prefers 
 alum to all other astringents. Fifteen grains to the ounce of water form 
 a suitable preparation to be used as a pigment for chronic inflammation 
 of the pharynx and larynx. It is one of the most reliable remedies in 
 the relaxed edematous condition accompanied with congestion at the end 
 of an attack of ACUTE ANGINA, MERCURIAL STOMATITIS. Its use should 
 not be prolonged, because of its destructive action on the teeth. It has 
 long been a domestic remedy for " SORE THROAT." A little glycerin, 
 molasses or honey may be added to the lotion. To increase the astrin- 
 gency one of the vegetable drugs which contain tannic acid is often 
 added. A wash of three grains to the ounce has been recommended 
 as a palliative for ADENOID GROWTH of the naso-pharynx when operative 
 procedures are not practicable. 
 
 Since writers recommend strengths of fluids in CHRONIC LARYNGITIS of 
 from one to sixty grains to the ounce, it is evident that more than a single 
 purpose is met by preparations so varying in strength. Tauchfuss recom- 
 mends the inhalation of alum in CROUP. 
 
 Insufflations of powdered burnt alum are almost always effective in 
 removing mucus from the arytenoid prominences in ACUTE LARYNGEAL 
 CATARRH. So weak a preparation as two grains to the drachm of 
 powdered acacia or starch may suffice. Equal parts of alum and sulphur, 
 powdered, blown into the throat at the moment of a deep inspiration, 
 is recommended in LARYNGEAL DIPHTHERIA. In the form of a powder 
 6
 
 82 LOCAL THERAPEUTICS. 
 
 burnt alum, as this is found in the shops, should always be used. The 
 chief value which the powdered alum has over the solution is that it 
 acts as an exsiccant ; the drier the powder the more efficiently it meets 
 this indication. The conditions to which alum especially responds are 
 two in number; first, the presence of mucus, in which there is more 
 or less of the tenacious fibrinous mass poured out from inflamed muci- 
 parous glands. Hoarseness arising from the presence of bands of 
 tenacious mucus between the vocal cords can be relieved by insuffla- 
 tions of powdered burnt alum. A small portion of morphine is 
 sometimes added to the powder with advantage if there be much 
 attendant cough. The alum coagulates the mucin of the material and 
 converts it into an albuminate which is not tenacious and is easily 
 removed. The second indication for its administration is less exact, 
 viz., the relaxed appearance of the membrane due to a moderate amount 
 of cedema in the tissues in the last stage of ACUTE CATARRH. Many 
 other astringents are here equally, if not more, efficient. If not followed 
 by good results at once the alum had better be discontinued; the primary 
 effects are those to be sought for. 
 
 Powdered alum mixes well with a number of other powders, among 
 which, in addition to the above, may be named iodoform, boric acid, 
 sodium borate, and salicylic acid. According to H. McNaughton Jones, 
 two parts each of alum and boric acid added to four parts of sodium 
 borate form a powder, twenty grains of which added to an ounce of 
 water may be employed as a gargle. Alum is a weak haemostatic to the 
 mucous membrane of the respiratory tract. It may be employed as a 
 gargle after tonsillotomy. For free EPISTAXIS it cannot be relied upon, 
 though it is of service in slight capillary oozing. 
 
 Alum is warmly recommended by W. E. Casselberry as an insufflation 
 in CHRONIC PHARYNGITIS accompanied with irritative cough, in the 
 following form : powdered alum, acacia, sugar of milk, equal parts. 
 
 Lozenges of alum each contain from one to two grains. 
 
 Diseases of the Eye. Alum is a useful astringent in CONJUNCTI- 
 VITIS with mucous or purulent discharge. Acute conjunctivitis with only 
 aqueous secretion is best treated with cold water applications or hot 
 stupes and soothing detergent washes of boric acid, either alone or 
 combined with borax, or, if there be much irritability or burning, with 
 cocaine. Severe chronic cases usually require more stimulating applica- 
 tions. Alum is best adapted to acute or mild chronic cases with more 
 or less discharge, the amount and character of which may determine 
 the strength of the solution and the frequency of its application. In 
 MUCO-PURULENT CONJUNCTIVITIS it may be used in solution of from 
 one-half to two grains to one ounce, combined with ten grains of boric
 
 AMYGDALA. 83 
 
 acid, dropped freely into the conjunctival sac three or four times a day. 
 From two to four grains of morphine solution is sometimes an agreeable 
 addition. In OPHTHALMIA NEONATORUM one or two grains of alum may 
 be added to the boric acid wash, with which the eye is thoroughly 
 cleansed every hour or two. In the GONORRHCEAL OPHTHALMIA of adults 
 it may be used in the same way in rather stronger solution, though in this 
 disease most surgeons prefer bichloride of mercury. Alum (one-half 
 grain to one ounce) may be conveniently combined with atropine when 
 conjunctival inflammation complicates cases of IRITIS or KERATITIS. 
 Some authorities (Tweedy, Brunton) have claimed that alum has a 
 tendency to increase ulceration of the cornea by "a. solvent effect upon 
 its cementum." This charge can hardly be considered proved, but 
 such cases usually bear irritating applications badly, and demand anti- 
 septic rather than astringent treatment. In CHRONIC PALPEBRAL CON- 
 JUNCTIVITIS the solid crystal of alum is a useful application. It is dipped 
 in water and passed over the everted eyelid, which should be washed 
 before it is allowed to close. Crystals cut into pencils and fitted with 
 handles are supplied by druggists. 
 
 " Alum curd" is used to prevent ecchymosis after contusion of the eye- 
 lids. It is made by adding powdered alum to milk or white of egg until 
 a curd is formed. It is a grateful application but should not be relied 
 upon to the exclusion of scarifications and ice. 
 
 AMYGDALA. Almond. 
 "MIXTURE OF ALMOND." 
 
 To prepare this the almond is first "blanched" by immersing it in hot water for a 
 minute or two, which softens the adherent skin and it is then readily removed by the 
 fingers. The almond is then put into a mortar, beaten with acacia and sugar, and triturated 
 with water (added little by little) until a thorough mixture is formed. This is strained, 
 and that which passes through the strainer forms the " mixture of almond." If a pro- 
 portion of bitter almond be used with the sweet almond, some oil of bitter almond is 
 generated, which gives a pleasant odor to the preparation. Made in this way the 
 preparation will not keep, and requires either the addition of salicylic acid or a pro- 
 portion of alcohol to prevent it from spoiling. " Mixture of almond " is used as a 
 vehicle for the application of more active medicinal cosmetics. 
 
 OLEUM AMYGDALAE EXPRESSUM. 
 
 " A fixed oil expressed from bitter or sweet almond." U. S. P. The process is simply 
 the pressing of the cleaned almond between warm iron plates. (By mixing crushed bitter 
 almond and water, the volatile product called in the Pharmacopoeia " Oil of Bitter 
 Almond" is generated and can be Separated by distillation. It must be carefully distin- 
 guished from the expressed oil, as it is irritant and poisonous). 
 
 The oil of sweet almond is a favorite menstruum for the dilution of menthol, creasote 
 and naphthol.
 
 84 LOCAL THERAPEUTICS. 
 
 General Surgery. Almond oil, when pure, forms a bland prepara- 
 tion which may be applicable for the same purposes as sweet oil. 
 
 Diseases of the Skin. In addition to entering into the composition 
 of several valuable ointments the oil of almond is used as a bland appli- 
 cation to the inflamed skin, and especially to soften crusts and scales pre- 
 paratory to more active treatment. Carbolic acid is sometimes added to 
 almond oil as a local treatment in PRURITUS. (See Ol. Olivse.) 
 
 UNGUENTUM AQU;E ROS;E. Cold Cream. 
 
 K . Expressed oil of almond, ^v; spermaceti, ^j ; white wax, ^j; rose water, 
 !f iij. Melt together by means of water bath, and stir the mixture constantly while 
 cooling. 
 
 FARINA AMYGDALAE. Almond Meal. 
 
 This is usually prepared either from sweet almonds, or from sweet and bitter almonds 
 together, by blanching them (i.e., removing the epidermis by immersion in hot water), 
 then either grinding them to a meal in a suitable mill as they then are (in which 
 case the product is an oily meal), or pressing them between hot plates to remove the 
 oil, and then grinding the "cake." If a proportion of bitter almond be employed, 
 the meal when mixed with water will give off the odor of oil of bitter almond; 
 otherwise, it is odorless. The oily meal soon becomes rancid, but when fresh is more 
 demulcent than is the meal made from the expressed cake. A less elegant almond meal 
 is made by grinding the cake left after the commercial expression of oil of sweet 
 almond. This meal is brown in color, because of the non-separation of the epidermis. 
 
 Diseases of the Skin. Both the bitter and the sweet almond are 
 used in the treatment of skin diseases. The crushed kernel of the bitter 
 almond is employed in the form of cataplasm applied in cases of PRURITUS 
 VULWE, while the oil has been employed dissolved in water of the strength 
 of one drop to the ounce, to allay general pruritus. The virtue of bitter 
 almond is due to the hydrocyanic acid it contains. 
 
 The mixture of sweet almond is used as a vehicle- for various lotions, 
 particularly those employed upon the face. 
 
 Almond meal gives a peculiarly soft and soothing quality to water, and 
 is often used in washing the hands when chapped or eczematous. 
 
 AMYL NITRIS. Nitrite of Amyl. 
 
 " A liquid produced by the action of nitric or nitrous acid on amylic alcohol, which 
 volatilizes between 262 and 270 F. It consists chiefly of nitrite of amyl. It should 
 be stored in hermetically-sealed vessels, or in well stopped bottles, and in a cool, dark 
 place." (Ph. Br.) "It is insoluble in water, but soluble in all proportions in alcohol 
 ether, chloroform, benzol, and benzin." (U. S. P.) * 
 
 Nitrite of amyl is antispasmodic. Upon the skin it acts the part of an 
 irritant.
 
 AMVL NITRIS. 85 
 
 Nitrite of amyl is used either by inhalation or subcutaneously. Its 
 ready volatility interferes with its use externally in the form of liniment, 
 as recommended by Kurz, of Florence {Practitioner, February, 1882) ; 
 because, when it is thus employed, the patient cannot fail to inhale more 
 or less of its vapor, and in this way may come under its influence to a dan- 
 gerous extent. All persons are not affected alike by nitrite of amyl, some 
 being able to inhale ten drops without inconvenience, while a drop will 
 affect others, producing great giddiness. The first dose should always be 
 taken under medical supervision. It should be borne in mind that the 
 symptoms increase for a minute after the withdrawal of the agent. As a 
 rule anaemic persons bear much larger doses than those who are not 
 anaemic. The patient should always be seated while inhaling nitrite of 
 amyl. Patients after a time become habituated to its use, so that the 
 dose has to be rather increased or repeated. 
 
 In ANGINA PECTORIS, nitrite of amyl, since its use was suggested by 
 Richardson in 1864, has held a foremost place among our modern appli- 
 ances for the relief of this distressing complaint. Three to five drops 
 are to be placed upon a handkerchief and held under the nostril. 
 The promptness with which this agent acts is marvelous in 3 large 
 majority of cases. If it fails as of course, it sometimes does recourse 
 must be had to chloroform. In SPASMODIC ASTHMA and CARDIAC DYS. 
 PNQEA, we have employed nitrite of amyl by inhalation with benefit. 
 
 In EPILEPSY, according to the testimony of S. Weir- Mitchell and 
 others, nitrite of amyl may be employed with advantage as a palliative. 
 Immediately upon the aura being felt, a few of the pearls containing the 
 drug may be broken upon a handkerchief and the contents inhaled, or 
 a few drops may be taken from a small phial. In PUERPERAL CONVUL- 
 SIONS, W. F. Jenks found nitrite of amyl efficient, but liable to induce 
 uterine relaxation. In LUMBAGO a ten per cent, solution may be injected 
 into the back, with the most happy results, relieving both the pain and 
 stiffness. In CHLOROFORM POISONING, nitrite of amyl inhalations have 
 been employed with advantage. 
 
 Diseases of the Ear, Throat and Nose. Nitrite of amyl is used 
 as an inhalant in ASTHMATIC ATTACKS, and to overcome SPASM OF THE 
 GLOTTIS. Eight minims of the drug may be added to an ounce of 
 alcohol. A teaspoonful of this mixture is mixed with a pint of water 
 at 100 F. Chloroform, however, is a superior agent. One of the chief 
 uses for the inhalation of nitrite of amyl is to overcome the toxic im- 
 pression of cocaine. {Journal of Laryngology and Rhinology, Vol. i, 
 1887, P- l6 6.) 
 
 The inhalation of six drops of the nitrite of amyl from a hand- 
 kerchief is found valuable at the beginning of an attack of HAY- 
 FEVER. {L 1 Union Medicate, January loth, 1891.)
 
 86 LOCAL THERAPEUTICS. 
 
 AMYLUM. Starch. 
 
 In the U. S. P., wheat starch alone is official. (" The fecula of the seed o Triticum 
 vu/g-are"). In the Ph. Br., however, the starch of wheat (Triticum vulgare and T. 
 sativuni), of Indian corn (Zea mays), and rice (Oryza saliva), are all official. Corn 
 starch is drier and more absorbent than is wheat starch. Rice starch is practically unused 
 in this country, the " Fleur de Riz" sold under the name of " baby powder," being 
 usually made from corn or wheat starch. 
 
 Starch is sometimes adulterated with or substituted by potato starch, and rarely mixed 
 with carbonate and sulphate of lime, and with water. 
 
 Starch powder is protectant and demulcent. In addition, it forms a 
 convenient vehicle for the distribution of insoluble powders, such as 
 oxychloride of bismuth, subnitrate of bismuth, etc. As an ingredient of 
 snuffs, etc., it is usually employed in combination with powdered acacia, 
 which renders it more adherent. 
 
 General Surgery. Starch poultices are of service for the softening 
 and removal of dried secretions about the scalp and face. A bandage 
 saturated with starch is used in surgery, where a fixed dressing is desirable 
 to lend greater firmness or solidity to the ordinary roller bandage. When 
 the starch bandage is applied two rollers are necessary, the inner one 
 being saturated with thick starch, and the outer one being left dry. 
 The starch bandage requires from thirty to forty hours to dry, and for 
 this reason it is not so convenient as plaster-of-Paris, which has almost 
 entirely superseded it. We have found starch of service smeared on 
 bandages which are used for retaining extension apparatus on the leg 
 and thigh, thereby rendering them smooth and preventing displacement. 
 Starch in solution is a valuable menstruum for the administration of 
 sedative applications or remedies in various diseases of the rectum ; for 
 instance, in an attack of PILES, when the inflammation is confined to a 
 slight oedema and redness of the external folds, an injection of thin, warm 
 starch, particularly when combined with belladonna or opium, is a 
 soothing application. Injections of laudanum and starch water have 
 long been held in high repute in cases of DYSENTERY and DIARRHCEA. 
 In this way starch, from its bland nature, may be of service in rectal 
 medication in country practice. Two to four ounces can be readily 
 thrown into the rectum and retained there without inconvenience. 
 
 Diseases of the Skin. Wheat starch is the form commonly used 
 in making applications to the skin, though corn starch is also employed. 
 
 Alone or in combination with other absorbents, finely triturated starch 
 prevents CHAFING. Its action is even thought to have slight sedative and 
 astringent properties. Starch, when boiled with water to a jelly, has a 
 demulcent and soothing effect on the skin, and in the form of starch 
 baths, with or without the addition of bicarbonate of sodium, is of value
 
 ANTHRAROBIN. 87 
 
 in ACUTE ECZEMA, PRURITUS, and other inflammatory diseases. (See 
 Baths.} 
 
 A starch poultice is made by mixing the dry starch with enough water 
 to make a paste. Boiling water is then poured on the mass and the mix- 
 ture, being briskly stirred the while, is heated for some minutes. The 
 resulting gelatinous paste is spread on tarletan or thin cloth. It should 
 be uniformly translucent and without lumps. The poultice should be 
 thick, and it is better to cover it with paraffin paper, oiled silk, or other 
 impermeable covering, to prevent too speedy desiccation. The addition 
 of thirty grains of boric acid to the ounce of starch, in making the starch 
 poultice, converts it into a disinfectant application. 
 
 Starch poultices are very useful to remove crusts, etc., without pro- 
 ducing irritation, in inflammatory conditions of the skin. 
 
 As starch readily decomposes in the presence of heat, moisture, serum, 
 ichor, etc., the addition of a few grains of salicylic acid to starch powders 
 is advisable, where there is any discharge. 
 
 A teaspoonful of dried starch dissolved or mixed in a quart of water 
 makes a convenient lotion for macerating the crusts in ECZEMA OF THE 
 SCALP in infants. Two or three folds of linen soaked in this fluid are 
 placed upon the scalp and covered with a rubber cloth. One or two 
 drachms of boric acid may be dissolved in this quantity of lotion to 
 counteract decomposition. The application is renewed from time to 
 time until the skin is soothed and prepared for other forms of treatment. 
 
 ANTHRAROBIN. Desoxyalizarin. 
 
 Anthrarobin is " a product of the deoxidation of alizarin. It is a yellowish-white 
 powder, insoluble in water, soluble in alcohol or dilute alkaline solutions." (National 
 Medical Dictionary.) 
 
 Anthrarobin is parasiticide and alterant. 
 
 Diseases of the Skin. Anthrarobin was introduced by Behrend as 
 a substitute for chrysarobin. Its action is similar, but much less ener- 
 getic than that of the agent last named, but it is without its objectionable 
 irritating or poisonous qualities. Thus it may be used over extensive 
 surfaces with impunity. It causes a brownish discoloration of the skin 
 and nails, and indelibly stains muslin and linen. Applied to the face it 
 not only discolors the skin, but sometimes give rise to a slight burning 
 feeling; it excites no serious irritation, excepting occasionally in the 
 case of infants. 
 
 As a parasiticide, it has been used successfully in ERYTHRASMA, TINEA 
 CIRCINATA, and TINEA VERSICOLOR. It has also been used in PSORIASIS, 
 and by Bronson in CHRONIC ECZEMA and ULCERS. The alcoholic solu-
 
 88 LOCAL THERAPEUTICS. 
 
 tion, one drachm to the ounce, decomposes in a few days, but when fresh 
 is efficient. Anthrarobin is, however, commonly employed in an oint- 
 ment of half a drachm to the ounce, or in the form of powder applied 
 to ulcers. 
 
 ANTHEMIS. Chamomile. 
 
 " The flower heads of Anthemis nobilis collected from cultivated plants" (U. S. P.). 
 Chamomile contains a bitter principle, of an acid character, and an essential oil. The 
 oil appears to be the active constituent. 
 
 Diseases of the Ear and Throat. A fomentation of chamomile 
 flowers is an ancient simple in domestic practice for OTALGIA. Chamo- 
 mile has a secondary position among topical agents in affections of the 
 respiratory tract. Inhalations of a hot infusion may be used as an adju- 
 vant in ACUTE SORE THROAT in children, in which a spasmodic element 
 is present. 
 
 Diseases of the Eye. A small bag of thin flannel, containing 
 chamomile flowers, dipped in a hot infusion of this herb, forms a con- 
 venient means of applying moist heat in ophthalmic practice. 
 
 ANTIMONII OXIDUM. Oxide of Antimony. 
 
 " A heavy, grayish-white powder, permanent in the air, odorless and tasteless, almost 
 insoluble in water, and insoluble in alcohol" (U. S. P.). 
 
 Diseases of the Throat. One to five grains, in the form of a 
 powder, is recommended by J. Solis Cohen in CHRONIC LARYNGITIS. It 
 is described as a relaxant. 
 
 ANTIMONII ET POTASSII TARTRAS. Tartrate of Antimony and 
 Potassium. Tartar Emetic. 
 
 Tartrate of antimony and potassium is rubefacient, counter-irritant, 
 and vesicant. 
 
 General Surgery. Tartar emetic is occasionally used, locally, in 
 the form of the ointment, as a rubefacient. Spread on lint it excites on 
 the skin a characteristic inflammation, at first papular, then vesicular, 
 and lastly pustular. The eruption thus runs the course of that of small- 
 pox and simulates it closely; it often leaves minute scars. 
 
 An ointment of the drug was formerly ordered when a powerful and 
 persistent irritant action was desired, but its use is to be deprecated, as 
 the blister it produces is unusually severe and liable to be followed by an 
 ill-conditioned ulcer. 
 
 Rigley {Obstet. Jour., Sept., 1877) speaks highly of the use of the
 
 ANTIFEBRINE ANTIPYRIN. 89 
 
 tartar emetic ointment over the seat of the disease in SUBACUTE 
 OVARITIS. 
 
 Diseases of the Throat. Although the effect ordinarily induced 
 by tartar emetic on the respiratory passages is a constitutional one, it is 
 sometimes convenient to administer the drug in the form of a lozenge, 
 in combination with another agent. Thus, S. Hartwell Chapman orders 
 ^-J-g- of a grain of the antimony salt with -^ of a grain of codeine, in the 
 form of a lozenge, in ACUTE INFLAMMATION OF THE THROAT, when 
 accompanied with fever. 
 
 ANTIFEBRINE. Acetanilid. 
 
 General Surgery. Antifebrine has been used locally as an appli- 
 cation for the treatment of CHANCRE and CHANCROID, but iodoform, 
 or black wash, will, as a rule, be found a more satisfactory means of 
 treatment. 
 
 ANTIPYRIN.* Dimethylphenylpyrazolon ; Phenazonum Ph. Br. 
 Phenazone is in the form of pearl white crystalline scales. It is bitterish in taste, 
 readily soluble in water, soluble in about fifty parts of ether, and very soluble in chloro- 
 form and alcohol. Under the name of Phenazonum (Phenazone) it has been recently 
 added to the British Pharmacopoeia. 
 
 Antipyrine is sedative, moderately analgesic and haemostatic. 
 
 General Surgery. R. Robinson (Rev. Gen. de Clin. et de. Therap., 
 March, 1890) reports a case in which a ten per cent, solution applied to 
 the cervix controlled UTERINE HEMORRHAGE after other remedies had 
 failed. A fifty per cent, solution of antipyrin, injected at .the point of 
 greatest distress, has been used hypodermically for the relief of pain 
 in LUMBAGO, SCIATICA and INTERCOSTAL NEURALGIA. (Wiener Med. 
 Wochen., March 1889.) 
 
 It has also been used with starch on a tampon to relieve the pain ot 
 UTERINE CANCER, which it does very effectually. A mixture of antipy- 
 rine, two parts, and vaseline, three parts, in an ointment, has been applied 
 to ULCERATING CANCER OF THE BREAST with a tendency to bleed, with 
 asserted benefit. Washing the parts with a five to twenty per cent, 
 solution of antipyrin is of service to control the capillary oozing after 
 operations. Glinsky (Brit. Med Jour., May, 1889) has tried antipyrin 
 for hemorrhage with unsatisfactory results. It was applied in powder, or 
 
 * Antipyrin is the copyrighted name of this chemical when made by a special patented 
 process, and Antifebrine is the copyrighted name of Acetanilid.
 
 90 LOCAL THERAPEUTICS. 
 
 in plugs saturated with a five to ten per cent, solution. A one-half per 
 cent, solution has been used with asserted advantage in GONORRHOEA. 
 
 Diseases of the Ear, Nose, and Throat. F. W. Hinkle (N. Y. 
 Med. Jour., Oct. 20, 1888), believes that antipyrin is a valuable adju- 
 vant in the treatment of NASAL CATARRH. A four per cent, solution 
 may be sprayed into the nostril. At first a slight smarting sensation is 
 produced, but the subsequent impression resembles that of cocaine. In 
 a recent communication to one of us, Dr. Hinkle reasserts his statement 
 respecting the effect of antipyrin in irritable states of the mucous mem- 
 brane. It is a mild sedative, and free from the inconvenience and 
 objections of cocaine. It is not contra-indicated in solutions of this 
 agent, but appears to increase its value. The impression is less decided 
 than is the case with cocaine, while more persistent. Subsequent 
 observers claim that this impression is due to its absorption into the 
 system ; the effect, therefore, is not strictly local, since the internal 
 administration of the drug produces a similar effect upon the nasal 
 mucous membrane. Occasionally subjects will be found who cannot 
 permit the use of antipyrin in any strength, it proving to be with them 
 irritating. 
 
 Haemostatic properties have been claimed for antipyrin. Both Hinkle 
 and Henorque (Gaz. hebdom., Jan. 13, 1888, p. 29) employ for this pur- 
 pose a strength of one part to five. It appears to be especially useful in 
 checking bleeding from a CANCEROUS ULCER. B. Robinson (N. Y. Med. 
 four., Sept. 24, 1887) recommends antipyrin in capsules for epistaxis, in 
 strength of solution varying from five to fifteen grains to the ounce of 
 water. Its analgesic effects are increased by combining with it a small 
 portion of morphine. In this manner H. Snow {Brit. Med. Jour., Feb. 
 16, 1889) has employed it in the treatment of MALIGNANT GROWTHS OF 
 THE MOUTH- AND TONGUE. 
 
 Diseases of the Eye. Antipyrin has been used with asserted good 
 effect in clearing up CORNEAL OPACITIES. As it has been dusted on the 
 cornea with calomel, its effects cannot be separated from those of this 
 old standard remedy. 
 
 AQUA. Water. 
 
 The uses of water in the local treatment of disease are numerous. 
 Apart from the indirect aid secured by cleansing foul surfaces, water can 
 be employed, according to the temperature to which it is raised, to 
 answer a variety of indications ; in a word, it is a convenient means of 
 controlling degrees 'of heat. Dry heat (ordinarily obtained by radiation 
 from a metallic surface) can be maintained by passing previously heated 
 water through flexible metallic tubes (Leiter tubes). Water exerts no 
 specific action on living tissue ; it acts by presence, or by its temperature.
 
 AQUA. 91 
 
 General Surgery. Water, since the earliest time, has held an im- 
 portant place in local therapeutics, forming, with other substances, the 
 basis of nearly all liquid preparations. When employed as an adjuvant 
 it is important that water should be as pure as possible. Many running 
 waters and well waters, owing to the nature of the surrounding soil and 
 proximity to decomposing animal and vegetable substances, are unfit for 
 surgical purposes. 
 
 Distilled water of the shops is considered to be pure, although it fre- 
 quently partakes of the character of the still through which it passes, and 
 thus may contain in solution salts or oxides of lead, iron, or copper. In 
 hospital practice, distilled water may be collected from the " steam 
 plant," ordinarily employed in conveying steam for purposes of heating 
 the buildings. The water may be collected from the iron pipes of dis- 
 tribution, or from the "exhaust" of the engine, when it will be found 
 to contain small globules of oil. Under all circumstances it is well to 
 filter and boil distilled water before using. Closely stoppered glass 
 bottles are the best vessels in which to preserve distilled water. 
 
 In the absence of distilled water, spring, rain, river or cistern water 
 may be substituted. Such water should be filtered and boiled before 
 being used in flushing serous cavities. It is important that it be freshly 
 prepared. 
 
 Water acts chiefly as a direct means of modifying temperature ; if 
 applied cold it abstracts heat from the body, and is a sedative. Water 
 at a higher temperature than the body maybe considered to act as a 
 stimulant. As it is a property of all living organisms to react against 
 what tends to depress them,, cold applied to the body, in a certain 
 measure and for a fixed time, produces a diminished activity of function, 
 but this is followed by a greater degree of activity than that which origi- 
 nally existed. In this manner the primary effect of heat and the second- 
 ary effect of cold resemble each other. Hence it may be seen that 
 different degrees of heat and cold may produce various grades of effect, 
 from a mild to a powerful stimulation, and thence to the destruction of 
 vitality. 
 
 Celsus mentions the value of cold water in arresting HEMORRHAGE, and 
 that the healing of slight wounds is facilitated by the application of a 
 sponge saturated with cold water. 
 
 In the treatment of CONTUSED and LACERATED WOUNDS, water dress- 
 ings are held in high repute. They may readily be combined with 
 germicidal or deodorizing agents. The simplest way of applying a water 
 dressing is, after adjusting the parts, to apply over them pieces of old 
 linen or lint which have been saturated with water, renewing them as 
 often as they become deprived of their moisture. 
 
 The following method is recommended when irrigation is resorted to :
 
 92 LOCAL THERAPEUTICS. 
 
 A piece of rubber cloth, fashioned into a gutter so as to convey the 
 redundant fluid into a vessel at the side of the bed, and to prevent the 
 bed and patient from becoming wet, is placed beneath the affected part. 
 A vessel containing the water is placed at a slight elevation and a few 
 strips of lint are carried over the side to the selected dressing. The fluid 
 will find its way by capillary attraction along the lint and diffuse itself 
 through the dressing, and run off, when this has been surcharged, on the 
 rubber cloth. Another method is to have a suitable vessel provided with 
 a stop-cock, which will permit the water to escape in a small stream, or 
 by drops, as the attendant may desire. 
 
 It is important that the water should not fall from a height, as the 
 constant dropping often causes distress. Cold water was extensively used 
 in GUNSHOT WOUNDS during the late war between the States, and, as a 
 primary dressing, answered a good purpose. If too long continued, 
 however, it produces a depressing influence on the part, the granulations 
 become pale and flabby, and exhibit an indisposition to heal. It is 
 difficult to state positively what should be the temperature of the water 
 to be employed. As a rule the feelings of the patient are to be consulted. 
 If cold water causes a sense of chilliness and discomfort, it should at once 
 be changed for warm water, or be discontinued. Cold water is usually 
 preferable in the early stage of inflammation, when it will assist in pro- 
 moting resolution, but is not desirable when suppuration is impending, 
 or when danger of gangrene is imminent. 
 
 Warm water is of service in the early treatment of severe LACERATED 
 and CONTUSED WOUNDS, where the vitality of the part is threatened. It 
 is here best applied by irrigation ; care will be required to keep it at the 
 desired temperature. Some practitioners prefer to irrigation that the 
 tissues involved be immersed in a bath of warm water. 
 
 The effect of either heat or cold may be obtained indirectly by the use 
 of a Petitgand or Letter' s coil, by a rubber bag filled with water, or, if 
 cold be desired, one filled with broken ice. The latter method is 
 extensively used in the treatment of CONCUSSIONS or THREATENED 
 INFLAMMATION OF THE BRAIN, in order to reduce as much as possible 
 the vascularity of the meninges. 
 
 In temporary, non-reducible HERNIA, which if left to itself may soon 
 become strangulated, the ice bag, or in its absence, cold water on 
 a lint dressing, will in many cases prove a satisfactory application. 
 Not infrequently a scrotal hernia thus treated will spontaneously disap- 
 pear after an application to the scrotum for two or three hours. In all 
 cases of strangulated hernia, when it is necessary to wait for the arrival 
 of the surgeon it is well to apply cold to the tumor, as a means of pre- 
 venting inflammation. 
 
 In severe SPRAINS and CONTUSIONS OF THE ARTICULATIONS there may
 
 AQUA. 93 
 
 be lesions of the synovial vessels, or of the membrane itself. At the 
 best, contusions exist in the subserous vessels which, becoming hyperemic, 
 may induce an attack of arthritis. The first indication, therefore, in the 
 treatment of sprain is to control the impending inflammation. This can 
 be satisfactorily accomplished by elevating and surrounding the articu- 
 lation with cloths saturated with cold water or by an ice-bag. If a 
 patient is seen immediately after the injury is sustained, great relief may 
 be secured by the application of a firm roller bandage about the joint ; 
 if the injury is in the ankle, the bandage should be carried from the toes 
 to the knee. Cold, elevation, and pressure produce tonic contraction of 
 the walls of the vessels, lessen the weight of the column of blood, and 
 furnish mechanical support to the vessels themselves. As a consequence, 
 they diminish the tendency to serous extravasation and swelling, and 
 favor speedy restoration of normal functions. 
 
 If the tension and throbbing of the joint do not soon begin to subside 
 after the employment of cold applications, these must be immediately 
 changed for hot ones. In severe pains Agnew states that he usually finds 
 that warm applications give the greater comfort. 
 
 As a means of controlling HEMORRHAGE, particularly the oozing of 
 blood from the surface of a wound, or that occuring from the flaps of a 
 stump after the principal vessels have been tied, cold water, or even ice 
 water, was frequently used by the older surgeons. When such a stimula- 
 ting effect of cold is desired it is best to project the water forcibly against 
 the bleeding surfaces from the nozzle of a syringe, for this produces a 
 stimulating effect by the impact of the water as well as by the cold. This 
 is also an excellent means of controlling the oozing following the opera- 
 tion for lithotomy. Care must be taken not to continue the local use of 
 cold too long, as serious depression may follow. Water as hot as can be 
 borne, namely, at a temperature from 110 to 130 F., is now more used 
 as a haemostatic than cold water, especially for the control of capillary 
 oozing. This means of treatment was favorably brought to notice by the 
 late Charles T. Hunter, of Philadelphia. We are in the habit of wetting 
 a towel or napkin in hot water, squeezing out the redundant fluid and 
 placing it against the bleeding surface, retaining it there with firm pressure 
 for a short time. After its removal the surface will present a blanched 
 appearance. In cases of oozing after the wound has been closed with 
 stitches, and the drainage-tube has been inserted, the wound can be 
 slightly distended by obstructing one end of the tube and injecting hot 
 water through the other, permitting the water to remain for a minute and 
 then draining it off. Care must be exercised, especially when a patient 
 is under the influence of ether, that the water does not scald the part. 
 
 In abdominal and pelvic surgery PROFUSE BLEEDING FROM TORN ADHE-
 
 94 LOCAL THERAPEUTICS. 
 
 SIGNS can be arrested by flushing the abdominal cavity with water at a 
 temperature of 110 F. 
 
 In the use of water as a haemostatic, it must be remembered that the 
 entire success of the method depends upon the fact that the water is used 
 either hot or cold, tepid water or lukewarm water having a tendency to 
 encourage bleeding. 
 
 For sterilizing instruments before and after operations, hot water is 
 extensively used in the absence of a hot-air sterilizer. No danger need 
 be apprehended of removing the temper from steel instruments, as some- 
 times happens when heated air is used. This method is, however, open 
 to the objection that in a short time hot water will discolor steel instru- 
 ments, although this can be almost entirely obviated by adding a small 
 quantity of bicarbonate of soda or ammonia to the water. Keeping the 
 instruments in the hot bath is preferable to placing them in a solution 
 of carbolic acid. 
 
 In making aqueous solutions for hypodermic medication, sterilized 
 water is always to be preferred. The danger of causing local irritation 
 is in this way lessened. 
 
 HEMORRHOIDS are frequently treated with cold water injections. It 
 was a favorite remedy with Sir Benjamin Brodie, and is recommended by 
 Curling and Kelsey. The water injections have a twofold object : One 
 is to soften and break up the fecal masses, and the other to increase the 
 tonicity of the muscle-fibres, both of the bowel and of the dilated 
 blood-vessels. Brodie advised half a pint of cold water fresh from the 
 pump as a lavement every morning after breakfast, to be kept in the rec- 
 tum as long as possible. Van Buren advises that the patient should first 
 inject into the bowel three-fourths of a pint of tepid water, with a view 
 to bringing the motions readily away. After the evacuation has been 
 effected four ounces of cold water are to be injected. The enema may 
 be retained or passed. 
 
 In CONSTIPATION a simple enema of cold water is frequently used, to 
 which may be added soap and sweet oil, or glycerin. The method is of 
 service in cleansing the lower bowel previous to operations about the 
 genito-urinary tract, both in males and females. The use of an enema 
 is of great service to persons of active habit, who are temporarily con- 
 fined to bed, as in case of fracture of the leg, etc. In many of these cases 
 the rectum will be found engorged with fecal matter purgatives by the 
 mouth having little effect until the accumulation is removed by an injec- 
 tion of warm water and soap. However, the daily use of an enema as a 
 routine practice is to be discouraged, as the bowel becomes accustomed 
 to the unnatural stimulus, and fails to normally respond. 
 
 Plain hot water is of frequent use in washing out the bladder. In
 
 AQUA. 95 
 
 doing this it should always be remembered' that a healthy bladder, and 
 much more an inflamed one, can be irritated by the introduction of large 
 and rigid instruments. The viscus is accustomed to be distended grad- ' 
 ually by the urine; and the aqueous distention should conform, at least 
 in some respects, to that process. Thompson advises, when washing out 
 the bladder for CYSTITIS, etc., never to introduce at one time more than 
 two ounces, and even this quantity is sometimes too large. A flexible 
 catheter should be used, and the water should be at a temperature of 
 100 F. The fluid should be thrown in very slowly, and the injection 
 repeated several times until the fluid comes away clear. As Thompson 
 states, washing out the bladder may be either an efficacious mode ot 
 treatment, or a mere contrivance for inducing serious irritation. The 
 propriety of washing out the bladder, either with plain or medicated water, 
 is considered by Agnew to be of doubtful propriety. Plain warm water 
 is often used as an injection in the early stages of GONORRHOEA, before 
 the mucous membrane will bear stimulating or astringent applications. 
 It is also an efficient application to the integument of the penis in 
 this disease. Bumstead, Taylor, and Milton (" Milton on Gonorrhoea," 
 p. 21) advise that the water be as hot as can be borne. Thus applied, in 
 the early stages of the disease, the weight felt about the testicles disap- 
 pears, the pain on making water and using injections is assuaged, and 
 the prepuce and glans rapidly regain a normal temperature and color. 
 The patient should immerse the organ in a cup of hot water for a few 
 minutes after urinating, and before and after using an injection. In the 
 treatment of PHAGEDENIC CHANCROID, prolonged hot water Sitz baths 
 used for many hours are recommended by Hill and Cooper (p. 486). 
 When it involves the penis, the organ may be immersed in a suitable 
 sized bottle or a rubber bag, frequently changed, and kept at as high a 
 temperature as the patient can bear. 
 
 In addition to the above, it has been thought advisable, at the risk 01 
 slight repetitions, to include at this place a separate section on the use of 
 hot water in gynecology. For a. full understanding of these beneficial 
 effects of hot water the profession is indebted to Emmet. This writer 
 states that heat, unless at a temperature which would destroy the parts, 
 does not act as promptly in causing contraction of blood-vessels as 
 does cold. In fact, its immediate effect is to cause relaxation and to 
 increase the congestion of the parts, but if its application be prolonged, 
 reaction ensues and contraction takes place. In other words, the reac- 
 tion from heat is contraction. The immediate effect of cold upon the 
 capillaries is contraction, and with reaction comes dilatation ; but the 
 reverse is true of heat which causes first dilatation and secondarily con- 
 traction. It is considered that, except in displacements of the uterus, 
 more can be accomplished in the treatment of diseases of women by the
 
 g6 LOCAL THERAPEUTICS. 
 
 use of hot water and carefully regulated general treatment, than by all 
 other means combined. The general opinion of gynecologists is in 
 accord with this view. The old practice of using cold, or even iced water, 
 for vaginal injections has been largely superseded. The "fountain" 
 syringe, the vaginal irrigator, or the Davidson syringe can be used for 
 administering the vaginal douche. The shank of the straight tube should 
 be five inches in length. The extremity should have small openings, 
 but no opening should be at the end. In the opinion of some practi- 
 tioners an especial advantage obtains from an interrupted stream of 
 water. In the sitting posture no good beyond the mere cleaning is 
 obtained from the douche, and it is not free from danger, since the 
 water may enter the uterus, which now lies in a changed axis to the 
 vagina with slightly dilated os. But when the woman is placed in the 
 knee-chest, or in the dorsal position with the hips elevated, the action of 
 gravity is brought into play. The vagina is thus kept fully distended by 
 the weight of the water ; the hot water will be in contact with every 
 portion of the mucous membrane under which the capillaries lie, and 
 the pelvic veins will be emptied and only the surplus can run off. It 
 is impossible for the woman to derive full benefit from the hot douche 
 when administered by herself. If the douche is given for the relief of 
 venous congestion, the temperature of the water should be hot, com- 
 mencing at 100 and gradually increasing every day until 120 is 
 reached. A large quantity of water should be used for the injection 
 at least a gallon. In cases of pelvic inflammatory trouble, it should be 
 administered two or three times a day. It is best for the patient to 
 remain in the recumbent position for some time afterward, and for this 
 reason it is well to administer the last injection at bed-time. 
 
 The indications for the use of douches are : to cleanse the intra- 
 vaginal cervix and vagina of morbid secretions ; to medicate these 
 surfaces with emollients, etc. ; to contract the blood vessels, and to 
 diminish congestion of the cervix and its surroundings in the manner 
 detailed. Vaginal injections sometimes, though not often, create pain 
 or uneasiness. In some cases this cannot be explained; in others, 
 however, as above stated, it is due to the entrance of the fluids in the 
 cervical canal, when this is patulous, or to pressure of the nozzle on a 
 tender ovary or pelvic tumor, or upon a specially sensitive uterus. The 
 pain is generally avoided by altering the position of the nozzle and 
 diminishing the temperature of the water. 
 
 Diseases of the Nose, Ear, and Throat. By its presence water 
 tends to soften or dissolve exudates or tenacious mucus, the removal of which 
 is not only necessary for comfort, but enables other topical remedies to be 
 applied, with increased prospects of success. By its temperature water 
 exerts the same effect upon the inflammatory process of the parts, as is
 
 AQUA. 97 
 
 seen elsewhere in the body. Some degree of force is required to dis- 
 engage morbid secretions of the pharynx and larynx ; when these are 
 excessive, water should be thrown by the use of compressed air from a 
 hand-bulb, from a small steam boiler through atomizing tubes, or from a 
 syringe. The compressed air also drives minute drops of water among 
 partially detached epithelial cells, and aids in separating the products of 
 diseased action from the parts to which they are adherent. Copious 
 flushings, with slightly medicated or diluted solutions driven from a 
 domestic syringe, is recommended by J. C. Mulhall. {Tr. Amer. 
 Laryng. Asso., 1889, 118.) This writer uses water as a topical agent, 
 especially in DIPHTHERIA. It should be used every hour, in the waking 
 state, as above indicated. The patient must not be permitted to rest 
 more than three hours without it. Irrigating the surfaces of the pharynx 
 in TONSILLITIS with the ordinary carbonated water (sold under the name 
 of "soda water "), permitting it to flood the throat through the ordinary 
 syphon bottle, has been proposed by S. Johnson. {Ibid., 144.) 
 
 A. H. Buckmaster (N. Y. Me d. Jour., Jan. 22; 1887) has successfully 
 treated cases of ACUTE SUBMUCOUS LARYNGITIS by douching the larynx 
 with water at 120 F. 
 
 After scarification of the inflamed tissues, the serous products are more 
 easily expelled by the use of warm water under compression than in any 
 other way. The remedy is valuable in (EDEMA of the glottis. 
 
 Water, when used very hot, need not be exhibited under compression. 
 Gargles of hot water have long enjoyed a reputation in domestic medicine 
 for TONSILLITIS. Applications to the skin of the region of the larynx are 
 of antiquity in the treatment of CROUP. B. Robinson urges its employ- 
 ment in EPISTAXIS, especially when this exists as a complication of 
 atrophic rhinitis. 
 
 The heat of steam is of advantage in local therapy in addition to the 
 mechanical features already alluded to. It acts favorably on the mucous 
 surfaces in DIPHTHERIA. In suppurative TONSILLITIS it favors the forma- 
 tion of pus ; its employment is indicated in the same conditions in which 
 moist heat would be used in favoring the formation of an abscess on the 
 periphery of the body. 
 
 Ice held in the mouth is useful in ACUTE LARYNGITIS and PHARYNGEAL 
 DIPHTHERIA. (See p. 100.) Cold compress also may be applied to the 
 neck. 
 
 C. Seiler recommends pure spring water, notably, the water of Cres- 
 son Springs, Pa. , as a local remedy in NASAL CATARRH ; otherwise, 
 native medicinal waters or waters which are medicated are not treated of 
 in this section. 
 
 Diseases of the Eye. Fizir {Transactions of Ophthalmological 
 Society, 1886) claims that hot water gives better results.than iced cloths 
 7
 
 98 LOCAL THERAPEUTICS. 
 
 in GONORRHCEAL OPHTHALMIA. He uses hot fomentations for half an 
 hour at a time, every one, two, or three hours, and in some cases the 
 application is continuous by letting hot water trickle from a tube. In 
 OPHTHALMIA NEONATORUM, intermittent hot applications can be much 
 more conveniently applied than can continuous cold. Leiter tubes 
 afford a convenient means of applying dry heat to the eye. In the 
 Heidelberg Ophthalmic Hospital such coils are connected with hot 
 water-pipes extending along the wall of the ward, behind the heads of 
 the beds. Ordinarily, one of the most convenient means of application 
 is the small hot-water rubber-bag. 
 
 BATHS.* 
 
 By the term bath, in medicine, is implied the employment of water as 
 a remedy by the immersion of all or of large portions of the body. In 
 the instance last named, baths receive the names of the regions to which 
 they are applied, as, for example, hip-bath (sitz-bath), foot-bath, etc. The 
 terms sponge-bath, shower-bath, and the like, are also in common use. 
 Properly speaking, those last named are not immersions, but are of a like 
 significance, since the bath, to be efficient, must comprise copious flush- 
 ings of the body surface. The cold bath is composed of water at the 
 temperature of 40 to 65 F., the cool bath, 65 to 75 F., the tepid bath, 
 85 to 94 F., the warm bath, 94 to 98 F., and the hot bath, 98 to 
 112 F. 
 
 General Surgery. The Cold Bath. The cold bath is antipyretic. 
 It rapidly absorbs heat from the body by cooling and moistening a dry, 
 heated skin, thus enabling surface radiation to take place under favorable 
 conditions. At first the respiration rates and the pulse rates are acceler- 
 ated, but they soon become retarded. A peculiar roughened condition 
 of the skin ("goose flesh") appears, due to the contraction of the 
 erectores pilorum muscles. The cutaneous vessels are constricted. After 
 a cold bath, if the subject be in good health, an agreeable reaction 
 occurs, accompanied by a sense of warmth, the restoration of the vessels 
 to their normal size and renewed bodily and mental vigor. A cold bath 
 when applied to an already weakened system, increases the depression, 
 and there is no reaction. 
 
 Cold baths are resorted to, in the main, to reduce the high temperatures, 
 of TYPHOID FEVER and SUNSTROKE. In the disease last named the 
 temperature runs up to 106 and 110 F. If such degrees of body-heat 
 be not rapidly reduced, death is inevitable. The patient should be at 
 once immersed in a cold bath, or the skin be kept constantly wet with 
 cold water. The moment the temperature becomes normal the cold 
 
 * For Medicated Baths see Appendix.
 
 AQUA. 99 
 
 applications are stopped, the patient is wrapped in a blanket and placed 
 in bed in a cool room. 
 
 The Hot Bath. The hot bath is, per contra, used to raise the tempera- 
 ture of the body. The cutaneous vessels are dilated, the skin becomes 
 reddened, and a tendency to perspiration is favored. These conditions 
 may persist for some time after removal from the bath. When too much 
 blood has been invited to the brain, a hot bath will tend to expel it. 
 The hot bath is especially useful in overcoming a disposition to INSOMNIA. 
 It is also of value in overcoming SPASM, especially spasm of the involun- 
 tary muscle fibres constituting the muscular coats of the canals of the 
 viscera. It is often resorted to to overcome COLIC dependent on pro- 
 longed muscle contraction in the biliary ducts, ureters, bladder, small 
 intestine, etc. 
 
 HERNIAL PROTRUSIONS which have resisted attempts at taxis, as ordi- 
 narily regulated, often yield to the repetition of this method, when the 
 patient is immersed in a bath as hot as can be borne for fifteen minutes. 
 A similar procedure is of value in the REDUCTION OF DISLOCATIONS ; 
 though the relaxing effect of heat is less evident upon muscles of the vol- 
 untary than upon the involuntary set. 
 
 Hot hip-baths and foot-baths are in use in domestic practice, as deriva- 
 tives in PELVIC CONGESTION, and as remedies to invite blood away from 
 the viscera in the first stage of FEVER. 
 
 The baths ordinarily employed in diseases of the skin are composed of 
 water alone or containing medicinal substances in solution. 
 
 Diseases of the Skin. The cold and cool baths are employed in 
 the treatment of MILIARIA or "prickly heat." The patient remains in 
 the bath a longer or shorter time according to the heat of the weather, 
 and then on getting out is carefully dried without rubbing, and the skin 
 is dressed with some astringent or sedative powder, as McCall Anderson's 
 camphor powder: R. Pulv. camphora, 3j j Pulv. amyli ; Pulv. zinci 
 oxidi, aa gss. M. 
 
 Lukewarm and moderately hot baths diminish irritability of the pe- 
 ripheral ends of the sensory nerves. For this reason such baths are useful 
 in those skin diseases in which PRURITUS is -a prominent symptom. In 
 the simple pruritus of old age or in the pruritus connected with disease of 
 the liver, or in winter pruritus (PRURITUS HIEMALIS), the simple warm 
 bath often is beneficial. The warm or hot bath should usually precede 
 the employment of more decided antipruritic remedies. The addition 
 of indifferent substances, as starch, bran, oat- or corn-meal, serves to soothe 
 the inflamed skin in ECZEMA, particularly where the skin has been broken 
 leaving a moist surface. Here crude water alone sometimes irritates the 
 skin, while the addition of some starchy substance soothes and relieves 
 pain and itching. With a similar end in view, alkalies are added to
 
 100 LOCAL THERAPEUTICS. 
 
 baths, their soothing effect being probably due to some osmotic action, 
 similar to that which takes place when carbonate of sodium solution is 
 employed as a dressing for burns. In the intense DERMATITIS OF BURNS 
 and in skin affections like PEMPHIGUS, where the patient is more or less 
 flayed, the continuous tepid bath as devised by Hebra, offers a medium in 
 which the patient can live without such anguish as constantly tortures him 
 when exposed to the air, and even with some greater chance for recovery. 
 
 Very little true absorption either of water or of substances contained 
 in it takes place in the bath, but a certain amount of imbibition of water 
 and of substances dissolved in it may occur, as far as the superficial layers 
 of the epidermis are concerned. Such imbibition is much favored by 
 warmth, previous washing of the skin with soap, and repeated immer- 
 sions. The palms and soles appear to absorb more rapidly than other 
 parts of the body. Gases and volatile matters dissolved in water may 
 be absorbed through the skin. Sulphurous acid and free iodine are thus 
 taken into the system, through the skin, in baths, while free carbonic 
 acid is absorbed either not at all or only in minute quantities. 
 
 The plain warm-water bath is useful in macerating the epidermis and 
 preparing it for the reception of oleaginous and other preparations. In 
 ICHTHYOSIS great relief is gained by prolonged daily tepid baths, followed 
 by the use of emollient ointments. 
 
 The simple warm bath, or the warm bath containing carbonate of 
 sodium, finds its place in the treatment of skin diseases, accompanied by 
 the formation of crusts and scales over a considerable portion of the 
 body. Maceration detaches these masses and prepares the skin for the 
 more direct application of remedies. ECZEMA PUSTULOSUM, ECTHYMA, 
 some of the SYPHILODERMATA, PSORIASIS, and similar diseases, may be 
 treated thus. 
 
 The imbibition of water and watery solutions by the superficial layers 
 of the epidermis is taken advantage of -in the treatment of PARASITIC 
 DISEASES, particularly SCABIES. Here the medicated water does certainly 
 penetrate far enough to destroy the itch insect and its ova, and no further 
 penetration is needed. 
 
 The employment of vapor baths to facilitate the penetration of medici- 
 nal substances, is exemplified in the treatment of SYPHILODERMATA by 
 the mercurial vapor bath. (See Appendix.) Here the body, immersed 
 in hot, watery Vapor until free perspiration takes place, is in a fit condi- 
 tion to absorb the mercurial vapor disengaged simultaneously. 
 
 ICE. 
 
 Ice is refrigerant and analgesic. It constricts the calibre of small 
 
 vessels, and thus acts as a haemostatic, antisecretant, and antiphlogistic. 
 
 Diseases of the Mouth, Throat, Etc. Pieces of ice held in the
 
 AQUA. 101 
 
 mouth allays the sensation of thirst. Small lumps can be slipped be- 
 tween the lips of a sleeping infant, in ACUTE ANGINA, and the little 
 patient be kept comfortable by the inflamed structure being thus bathed 
 with cold water. HEMORRHAGES FROM THE MOUTH, THROAT, AND NOSE, 
 and even from the LUNGS, are indirectly controlled by allowing pieces of 
 ice to dissolve in the mouth. Cold, wet compresses are useful applications 
 to be made to the skin of the neck, where disposition to recurrent 
 CATARRHAL PHARYNGITIS is marked. 
 
 Opinion is quite uniform as to the effect of prolonged use of cold in 
 ACUTE EDEMA OF THE UVULA. Thus, when in the course of treatment 
 with the galvano-cautery, such edema is sometimes developed, a piece of 
 ice held in the mouth checks the condition more rapidly than is possible 
 by any other means ; in like manner in threatened EDEMA OF THE 
 LARYNX, cold applications over the larynx are indicated ; in this connec- 
 tion Letter's coil may be named. The use of this apparatus is warmly 
 recommended by W. E. Casselberry. Uniform cold in the early stage of 
 DIPHTHERIA would appear to be indicated to arrest the development of 
 the bacteria. Samuel Johnston approves of the persistent use of ice applied 
 in this stage of the disease. 
 
 Diseases of the Eye. The local application of cold, by contract- 
 ing the walls of the blood-vessels and diminishing nervous irritability, is 
 a powerful and valuable agent in the treatment of ACUTE INFLAMMATIONS 
 OF THE EYE. It is most useful in traumatic cases and in high grades of 
 CONJUNCTIVITIS, notably the gonorrhceal form. It may be applied dry, 
 by means of small ice bags or by cold water being passed through coils 
 of metallic or rubber tubes ; but wet applications are more convenient 
 and generally efficient. The simplest apparatus consists of a bowl of 
 iced water, or, better, a lump of ice, by the patient's side, and some 
 pledgets of lint or linen. The latter should not be folded more than 
 once, and should be changed every few minutes, as, if left on too long, 
 particularly if their thickness prevents rapid evaporation from the linen 
 fold, the surface next the eye becomes warm and an alternation of heat 
 and cold is produced, which may do more harm than good. The appli- 
 cation should be continuous, since vascular reaction follows the removal 
 of the cold. Care should be taken not to continue this treatment too 
 long. The sensations of the patient are generally a pretty safe guide, 
 and it is not well to insist upon a continuance of the application when 
 it ceases to be agreeable. As a rule, cold should not be used when there 
 is a tendency to slough. 
 
 (For a few additional references to ice, see Aqua, p. 92.)
 
 102 LOCAL THERAPEUTICS. 
 
 AQUA AMMONITE, U. S. Water of Ammonia. 
 
 " An aqueous solution of ammonia, containing ten per cent., by weight, of the gas." 
 (U. S. P.) Two strengths of ammonia water are official. The one named above, con- 
 taining ten per cent., and the aqua ammonia fortior, containing twenty-eight per cent., by 
 weight, of the gas. Both are solutions of gaseous ammonia in water. 
 
 The Ammonia Liniment (linimentum ammoniae, U. S. P.), is prepared by taking 
 thirty parts of the water of ammonia and seventy parts of cotton-seed oil, and mixing 
 them. A liniment prepared by some pharmacists is made by substituting lard oil for the 
 cotton-seed oil. 
 
 Aqua ammoniae is stimulant and vesicant. 
 
 Diseases of the Skin. The stronger solution goes to form the 
 vesicating ammoniacal ointment of Gondret. R. Adipis, pts. xxxij ; Ol. 
 amygdalae dulcis, pts. ij. Melt by a gentle heat and pour into a wide- 
 mouthed bottle, then add aqua ammoniae fortior (25), pts. xvij. Mix, 
 with agitation, until cold. Aqua ammoniae is chiefly employed as a con- 
 stituent of hair lotions in ALOPECIA PREMATURA. The vesicating ammo- 
 niacal ointment might be employed with advantage in ALOPECIA AREATA. 
 It is also employed as a constituent of some of the stimulating liniments 
 employed in the treatment of CHILBLAINS. 
 
 AQUA CHLORI. Chlorine Water. 
 "An aqueous solution of chlorine, containing at least four-tenths per cent, of the gas." 
 
 (U. S. P.) 
 
 Chlorine water is germicidal and deodorant. 
 
 General Surgery. Chlorine water was formerly much used as a 
 dressing in GANGRENOUS or SLOUGHING WOUNDS, but it has been largely 
 supplanted by other antiseptics. 
 
 Diseases of the Mouth. Chlorine water may be used as a gargle 
 and mouth-wash, in strength of i to 8 parts of water, in APHTHOUS 
 STOMATITIS, etc. 
 
 Diseases of the Eye. Sattler, in his experiments with the micro- 
 coccus taken from the lachrymal canal {Anna!, d' Oculist, 1884, p. 164), 
 found that chlorine water surpassed all other antiseptics. Its unstable 
 character, however, would prevent it from being a convenient therapeutical 
 agent, even if it were not too irritating for application to the eye. 
 
 AQUA LAURO-CERASL Cherry-laurel Water. 
 
 Cherry laurel water is made by distilling water from the finely chopped and bruised 
 leaves of the Cherry-laurel. It is official in the Ph. Br. It contains one-tenth of one 
 per cent, of absolute hydrocyanic acid. It resembles water in appearance, but has the 
 odor of hydrocyanic acid, the odor common to wet bitter almonds, peach kernels, cherry- 
 laurel leaves, etc.
 
 ARGENTI HYPOSULPHIS ARGENTI NITRAS. 103 
 
 Diseases of the Ear. Cherry-laurel water is a favorite prescription 
 in Germany, for OTALGIA and, combined with tincture of iodine, as an 
 application to DIFFUSE INFLAMMATION OF THE AURICLE. 
 
 ARGENTI HYPOSULPHIS. Hyposulphite of Silver. 
 
 Hyposulphite of silver is a stimulant and alterative. 
 
 Diseases of the Throat. A union of hyposulphite of silver with 
 hyposulphite of sodium is recommended by E. Watson ("Topical Medi- 
 cation of the Larynx," 1854, 35) in place of the nitrate of silver in the 
 treatment of inflammation of the throat. While weaker than the salt last 
 named he claims that it is more agreeable to the taste, and does not 
 stain. 
 
 ARGENTI NITRAS. Nitrate of Silver. 
 
 Lunar Caustic is pure nitrate of silver moulded into appropriate form. Diluted nitrate 
 of silver ("mitigated stick"), official in the U. S. P., is composed of equal weights of 
 nitrate of silver and nitrate of potassium fused together and moulded. 
 
 " Nitrate of silver is soluble in eight-tenths part of water and in twenty-six parts of 
 alcohol at 15 C. (59 F.) " U. S. P. It should be kept in dark amber-colored vials, 
 since exposure to light reduces it to the black oxide of silver. A like reduction takes 
 place when solutions of nitrate of silver are brought in contact with animal tissues or 
 vegetable fabrics. The stains of the oxide of silver can be removed by mopping the 
 spots with a solution of cyanide of potassium, or one of one part each of bi-chlonde of 
 mercury, and of chloride of ammonium in ten parts of water. When the black spots 
 discolor the skin they can be removed by touching them with the tincture of iodine, and 
 washing away the iodide of silver thereby formed with a solution of caustic potassa or 
 water of ammonia. 
 
 Nitrate of silver is incompatible with so many substances that when solutions of it are 
 required they should be made with distilled water, as the chlorides in ordinary water, 
 however pure, will otherwise precipitate part r all of it from solution. Excessive action 
 of nitrate of silver on animal tissues can be controlled by sopping them with a solution of 
 common salt. 
 
 Nitrate of silver is caustic, excitant, astringent, and haemostatic. 
 Strengths of nitrate of silver sufficient to prove astringent are also apt to 
 be irritative. Thus, when used on mucous surfaces, the agent is liable 
 to excite the mucous glands, if not increase the inflammation. Under 
 other conditions the irritating quality of the drug acts to advantage, and 
 it is often selected when an excitant, at the same time astringent, effect is 
 desired. Nitrate of silver is a weak caustic on the most delicate tissues, 
 but is a futile one on tough, resistant tissues. It is an astringent and 
 haemostatic through the direct constricting effect it exerts on the calibres 
 of the smaller vessels, and in the pressure made on them by the hygro- 
 scopic albuminate created by the salt.
 
 104 LOCAL THERAPEUTICS. 
 
 General Surgery. Nitrate of silver, in stick, crystal, or solution, is 
 in general use. As a stimulant application to CHRONIC ULCERS it has 
 long been held in high repute. Its successful employment, however, 
 depends largely on the manner in which it is applied and the strength 
 in which it is used. 
 
 In treating ulcers it is used in the form of the stick (or crayon) with 
 which the granulating surface is gently penciled over. If a destructive 
 action is desired, to remove EXUBERANT or FUNGOUS GRANULATIONS, the 
 crayon must be carried deeply. Such an application will frequently 
 cause the granulations to bleed freely, but the bleeding soon ceases on 
 the removal of the crayon. Nitrate of silver is especially valuable as a 
 stimulant for CHRONIC LEG ULCERS and for CHRONIC ULCERS following 
 burns. Care must be exercised in applying it to the ulcers when cicatri- 
 zation has begun, not to encroach on the delicate pink line which 
 surrounds and lies between the granulations and the skin, since this line 
 answers to the layer of the newly formed epithelial cells. Any contact 
 here with the agent will cause a slight superficial slough and retard the 
 cicatrizing process. When the solid stick or a strong solution comes in 
 contact with fresh granulations, the part touched becomes whitened and 
 a thin film of albuminate of silver is formed. For convenient manipu- 
 lating of the crayon, it is best placed in a porte-caustique made of hard 
 rubber, or inserted in the end of a quill. It should never be placed in 
 the metallic porte-caustiques that are sold in the shops, as they soon 
 become corroded. 
 
 Solutions of nitrate of silver can be used in strengths from ten to 
 sixty grains to the fluidounce as a stimulating application to ULCERS, 
 BURNS, and WOUNDS. It is most conveniently applied with a camel's- 
 hair pencil, or a swab made of absorbent cotton on the end of a stick. 
 It is preferable to pour out the amount required in a small vessel, thus 
 preventing any tendency to contaminate the sensitive solution by a soiled 
 brush or swab. We have often found it of service in a weak solution 
 (from two to five grains to the ounce of water) painted over the delicate 
 granulations following large BURNS, which have a great tendency to bleed 
 on the removal of dressings. It appears to harden the granulations and 
 control hypersensitiveness and to promote cicatrization. 
 
 In small punctured WOUNDS such as are caused by the bite of a dog, 
 the application of the nitrate of silver often does harm by the premature 
 formation of a crust which prevents the escape of blood or serum. The 
 indication to cauterize the wound usually sought for in making the appli- 
 cation in the cases of suspected RABIES is imperfectly met, since the 
 caustic effect of silver is insufficient to destroy the infected tissue. 
 Brunton (" Pharm., Therap. and Mat. Med.," Am. Ed., 1885, 349) cites 
 the case of a boy dying of hydrophobia in six weeks after a bite which,
 
 ARGENTI NITRAS. 105 
 
 five minutes after its infliction, had been thoroughly cauterized with 
 nitrate of silver. 
 
 Nitrate of silver is used in a variety of ways on cutaneous surfaces. 
 Higginbottom strongly recommends its local application in ERYSIPELAS. 
 He states that no agent is so safe or efficacious. Before applying it, the 
 parts should be thoroughly cleansed with soap and water, then with 
 simple water, and afterward dried. Then a solution of twenty grains to 
 the ounce should be painted over the parts two or three times, and be- 
 yond it on the healthy skin to the extent of two or three inches. It is 
 important that the skin be thoroughly clean, as any particle of soap left 
 will decompose the solution. In twelve hours it will be seen whether the 
 solution has been well applied. If any of the inflamed surfaces be found 
 unaffected, it must be reapplied. Stronger solutions (160 grains to the 
 ounce) may be painted over the affected parts and a little beyond it, 
 or a line drawn around them a little outside the borders, with the solid 
 stick. The alteration produced in the tissues underneath this line is said 
 to prevent the extension of the inflammation beyond the limit thus formed 
 (Brunton loc. cit., p. 576). Stiikovenkoff experimented upon forty-two 
 patients with the nitrate of silver treatment and concluded that it short- 
 ened the duration of the disease one-half. Polotebnow repeated these 
 experiments on sixty more cases but with unfavorable results. The nitrate 
 of silver, he asserts, can neither stop the erysipelatous process in the skin, 
 reduce the fever, prevent renal complications nor shorten the period of 
 albuminuria. Our own impression is that this remedy is of limited value. 
 
 As a prophylactic in ONYCHIA and FELON, nitrate of silver, if applied 
 early by painting over the finger several times a solution of twenty to 
 thirty grains to the ounce, is often used ; but we have found it a less 
 satisfactory remedy than is tincture of iodine. 
 
 BED-SORES may be prevented by painting the threatened but unbroken 
 skin, as soon as it becomes red, with a solution of nitrate of silver ten 
 grains to the ounce. (See Emplastrum Plumbi). 
 
 Mason has followed with much success the plan of applying a sharp 
 pointed stick of nitrate of silver to the base or under surface of the granu- 
 lations of INGROWING TOE-NAIL ; after doing this he carefully inserts a 
 small piece of lint soaked in black wash, and envelops the entire toe in a 
 water dressing. Agnew advises the application of a fifty per cent, crayon 
 of nitrate of silver to the ulcer at the bottom of an obstinate FISSURED 
 NIPPLE; the part should be thoroughly cleansed, care being taken to 
 carry the agent into every crevice, and afterward to wash the parts with a 
 little milk or water, when a few dressings of oxide of zinc ointment will 
 usually complete the cure. 
 
 In RANULA in children it is sometimes difficult to dissect out the sac.
 
 106 LOCAL THERAPEUTICS. 
 
 In such cases the anterior surface may be snipped away with a pair of 
 scissors and the remaining inner surface may be wiped over with a solid 
 stick of nitrate of silver, which will often destroy the cyst. 
 
 In the treatment of EPIDIDYMITIS, if no amelioration is experienced 
 after the lapse of thirty-six hours, the scrotum should be blistered by 
 drawing a number of lines with nitrate of silver longitudinally over its 
 posterior surface. In twenty-four hours each cauterized tract will present a 
 vesicated surface, the pain of which can be materially lessened by a hot 
 water dressing. 
 
 BALANO-POSTHITIS is at times associated with a contracted prepuce. 
 This condition may be mistaken for gonorrhoea. If there be little ardor 
 urinae, with much preputial swelling and little tendency to erections, a 
 balano-posthitis may be diagnosed. An injection of nitrate of silver 
 (twenty grains to the ounce), thrown in with a syringe between the glans 
 penis and the prepuce, after having previously washed out all the purulent 
 and sebaceous matter with warm water, will promptly cure the inflamma- 
 tion. If the surfaces are excoriated and can be reached, Bumstead 
 advises penciling the part lightly with the solid stick of nitrate of silver. 
 As an application to the urethra in GONORRHCEA, nitrate of silver has 
 long been highly recommended by many surgeons. For the abortive 
 treatment of the early stages, it was commended by Debeney, of France, 
 and Carmichael, of England, in the strength of ten to twenty grains to 
 the ounce. In our opinion, it is applicable only when the disease is 
 limited to the fossa navicularis. In attempting to abort GONORRHCEA, 
 the urethra is previously cleansed with plain water, and then the solution 
 is thrown in from a rubber syringe, care being taken to constrict the canal 
 between the thumb and finger, thus shutting off the healthy from the in- 
 flamed mucous membrane. The effect of the injections is manifest 
 in a few hours ; the discharge becomes copious and purulent, and 
 considerable scalding is felt on passing water. In the course of forty- 
 eight hours, the discharge grows thin and watery, and is likely to be tinged 
 with blood. It is now time to stop the injections, and to wait for a few 
 days, to see how much good has been accomplished. If this line of treat- 
 ment meets with success, the discharge will gradually cease, and will stop 
 in from three to five days. It is usually not wise to resort to this form of 
 treatment save in exceptional cases, where the patient is willing to submit 
 to the additional pain, risk and inconvenience, which may be incurred. 
 This method often leads to the formation of stricture, gangrenous inflam- 
 mation, prostatitis, orchitis, etc. The abortive method by the milder 
 injection (one-fifteenth of a grain to the ounce), with injections once in 
 every two or three hours, is much more to be commended and less pain- 
 ful, and the results will, as a rule, be more satisfactory. In all applica-
 
 ARGENTI NITRAS. 107 
 
 tions of nitrate of silver to the urethra, care should be exercised that the 
 parts be as clean and free from any deposit as possible, "owing to the ease 
 with which the solution may become decomposed. 
 
 Much has been written about the injection treatment of ACUTE GONOR- 
 RHOEA by nitrate of silver, by Friedheim and Neilson. The treatment 
 with the nitrate, in solutions of 1-4000 (one grain to nine ounces), and 
 never stronger than 1-2000 (one grain to four ounces), was instituted 
 early in every instance. The immediate effect was to increase the puru- 
 lent character of the discharge, a result which, in the course of four days, 
 was followed by a marked change in the secretion, which then became 
 thinner, whiter, less in amount, and was found to contain more epithe- 
 lium. The influence upon the gonococci is said to have been pronounced 
 by the time this change in the character of the discharge was manifest, 
 and they shortly afterwards disappeared completely. According to Neis- 
 ser's experience, nitrate of silver stands at the head of the list of remedies 
 for GONORRHOZA, bichloride of mercury taking a second place. Not only 
 was the silver found to produce anti-bacterial results, and to decrease the 
 inflammatory phenomena, but it appeared to exercise an especial influence 
 in preventing the complication of EPIDIDYMITIS. After a fair trial of the 
 silver, if the discharge continues, the strength of the injection may be 
 increased to one grain to four ounces, or it may become necessary to 
 alternate with sulphate of zinc, or some other simple astringent. 
 
 Much can be said of the value of silver in CHRONIC GLEET when 
 this depends upon an ulcerated spot in the deep portion of the 
 urethra, which can be seen by the use of Leiter's panelectroscope. In 
 such a case either a strong solution (one drachm to one ounce) or the 
 solid stick may be carried down through the instrument and applied 
 directly to the spot. A few applications in this manner are usually fol- 
 lowed by satisfactory results. The same treatment in CHRONIC PROSTA- 
 TORRHCEA, due to the inflammation having invaded the prostatic ducts, 
 will usually be of service and give relief, after injections to the deep 
 urethra have failed. In delicate applications of this sort the same result 
 may be obtained by the use of a silver probe, tipped with nitric acid and 
 applied to the part. 
 
 In H^EMATURIA and CHRONIC CYSTITIS Sir Henry Thompson has found 
 that washing out the bladder with a solution of one-fourth of a grain to 
 one ounce is one of the most valuable of remedies. In INCONTINENCE 
 OF URINE in children, especially in confirmed cases, in which the chil- 
 dren have arrived at the age of puberty, an application of two grains to 
 the ounce to the prostatic urethra has been found serviceable after other 
 means have failed. 
 
 In SPERMATORRHCEA E. Home was the first to recommend the use of
 
 108 LOCAL THERAPEUTICS. 
 
 nitrate of silver in strong solution, twenty grains to the ounce. It is 
 recommended to use it by means of an applicator. 
 
 The solid stick is sometimes applied with great advantage to INDOLENT 
 BUBOES, all the sinuses being wiped out with a well-pointed stick, or 
 touched with a strong solution, sixty grains to the ounce, and then 
 packed with iodoform gauze. 
 
 In SUBACUTE and CHRONIC DYSENTERY the treatment by injections of 
 silver consists, in the main, in thoroughly cleansing the bowel with large 
 enemata of warm water, and then injecting a solution of ten to twenty 
 grains to the pint of water, by means of a long, flexible tube carried well 
 up and into the colon. Great care is required in inserting the tube, in 
 order not to wound or perforate the inflamed and delicate mucous mem- 
 brane. The injection should be made from a reservoir of glass or a 
 rubber bag, held at an elevation of four feet above the patient, who 
 should be placed in the recumbent position, on the right side, with the 
 hips elevated. This will be more apt to insure the passage of the solu- 
 tion. In order to insure its reaching as high a point as possible, the 
 fluid must pass slowly, as this will enable the colon to gradually accom- 
 modate itself to its presence. With care, from three to four quarts 
 may be injected. It is wise to begin with a weaker solution than 
 that named above, but this may be gradually increased in strength up to 
 a drachm to the pint, as recommended by H. C. Wood. When the 
 ulcerations are lower down in the rectum, the same effect can be attained 
 by means of an ordinary rubber syringe. In ulcerations just within the 
 sphincter, an application of the solid stick, or a strong solution applied on 
 cotton, or through a speculum, will often be found an efficient means 
 of treatment. 
 
 Diseases of the Skin. Nitrate of silver applied to the skin in a 
 solid form acts as a mild escharotic. It causes exfoliation of the epider- 
 mis, and even a slough. Applied to the skin which has been previously 
 deprived of its epidermis, its action is stronger. It coagulates the albu- 
 men of the tissues and gives rise to a dry slough, usually separating after 
 a time by exfoliation. 
 
 In strong solutions, nitrate of silver acts with almost as much power as 
 in the solid form, but as the solution is diluted the escharotic action of 
 the application gives place to an astringent effect, with constriction of 
 the capillary blood vessels. 
 
 The solid stick of nitrate of silver is used in Germany as an application 
 in LUPUS VULGARIS. The diseased tissue is thoroughly scraped with a 
 sharp spoon and then the nitrate of silver stick is bored into the diseased 
 tissue and rubbed over the surface at all points. 
 
 The solid stick is also employed to cauterize the base of WARTS after
 
 ARGENTI NITRAS. 1 09 
 
 their removal by the sharp spoon or other means, and also to aid in the 
 destruction of MILIA, SEBACEOUS CYSTS and MOLLUSCUM EPITHELIALE or 
 CONTAGIOSUM. As an escharotic to destroy .WARTY GROWTHS, nitrate 
 of silver is inferior to other caustics, as acetic and chloracetic acids, 
 lactic acid, nitric acid, caustic potassa, etc.; but its action is sufficient 
 when only a superficial effect is desired. 
 
 The weaker solutions of nitrate of silver are employed for their stimu- 
 lant effect, or to excite mild substitutive inflammation. In fact, even 
 the stronger solutions, or the solid stick, may be used for this purpose. 
 
 In CHRONIC ECZEMA, single patches, stubborn to ordinary treatment, 
 may sometimes be made to take on healthy action by painting their sur- 
 face with solution of ten to thirty grains to the ounce of water. 
 
 In other cases a saturated solution may be employed, when the skin is 
 thick and hard, or even the solid stick may be lightly rubbed over the 
 surface, care being taken to prevent over-action by the use of wet com- 
 presses or sedative lotions if required. FISSURED ECZEMA, whether in 
 the form of cracked lips, or fissures in the neighborhood of the anus, in 
 the ends of the fingers, or elsewhere, are best treated by cauterization 
 with a sharp point of solid nitrate of silver. This is momentarily 
 painful and should be followed by the application of a soothing oint- 
 ment or lotion. In ECZEMA OF THE SCROTUM a solution of ten to 
 thirty grains nitrate of silver in an ounce of spiritus setheris nitrosi, 
 painted on in one or more coats, often relieves the patient and aids the 
 cure. If it leaves the skin too stiff, a soothing ointment may afterwards 
 be rubbed in. 
 
 In SUPERFICIAL INFLAMMATIONS, other than erysipelas, H. C. Wood has 
 used the concentrated solution, 160 grains to the ounce, to advantage. 
 ("Therapeutics," 5th ed., 1883, p. 53). 
 
 Diseases of the Ear, Throat and Nose. M. J. Rossbach {Ber- 
 liner Wochenschrift, May 15, 1882) found that a four per cent, solution 
 of nitrate of silver painted upon the mucous membrane of the trachea of 
 a healthy living animal, instantly covered the parts a deep white so that 
 it was impossible to see the blood vessels. In a rabbit in which the 
 lining of the trachea was already inflamed, the same result ensued. By 
 repeated drying of the affected spot it was seen, after a little, that minute 
 vessels appeared through the white circumscribed deposit. Upon the 
 web of a frog's foot nitrate of silver caused a very decided narrowing of 
 the blood vessels, but Rossbach was not able to discern any such change 
 in the trachea. It is probable, however, that the vessels contract and 
 that this result is as conspicuous as is the coagulation' of the albumen in 
 the tissue; the amount of mucus is diminished. In the larynx the effect 
 is the same as in the trachea. In the nose and naso-pharynx the local 
 effect of nitrate of silver is much more irritative ; instead of being followed
 
 110 LOCAL THERAPEUTICS. 
 
 by diminution of secretion the amount of outflow of mucus is increased. 
 Nitrate of silver also aids in arresting bleeding, and is an excitant to 
 absorption of the products of inflammation. 
 
 Varying strengths of nitrate of silver are employed. Those usually 
 named are one, two, five, ten, twenty, forty, sixty, eighty and one hun- 
 dred grains, or a saturated solution which is represented by four hun- 
 dred grains to the ounce of water. Any solution of a strength above 
 forty grains is often spoken of as a stronger or concentrated solution. 
 Weak solutions convert transparent mucus into a white, less tenacious 
 fluid, while stimulating the membranes on which the secretion rests. The 
 stronger solutions destroy the epithelium. The coagulum is soon 
 detached, thus presenting advantages over more adherent forms caused 
 by application of solution of the salts of iron. The caustic impression of 
 nitrate of silver is superficial ; concentrated solutions coagulate the 
 albumen in the submucous tissue to a slight depth. The eschar is at 
 first white, then gray. All solutions are stable only when kept away 
 from the light by being placed (small quantities at a time) in a bottle 
 covered with blue paper. The action of the light is to decompose the 
 nitrate and to substitute for it the oxide of silver, which is said to be 
 comparatively useless. 
 
 Perhaps there is no remedy in the entire list of local therapeutics con- 
 cerning which a greater variety of opinion has been expressed than is the 
 agent now under consideration. It is a favorite remedy of many practi- 
 tioners in the local treatment of the nose and larynx ; rarely used by some, 
 while discarded by others. Doubtless, the extensive range of drugs which 
 have been introduced of late years for local medication have greatly 
 limited the value of this time honored agent. 
 
 In using the pure salt the following method is recommended : A small 
 quantity is melted in a platinum crucible or test-tube. The warm 
 roughened end of a platinum or aluminium probe is inserted in the 
 molten mass, thereby causing a small quantity to firmly adhere. Such 
 an applicator can be used without danger of any portion of the solid 
 becoming defached. A saturated solution is readily obtained (when 
 a small quantity only is needed) by rubbing a piece of a sponge on a 
 crystal of the salt, by such means the dangers arising from the use of the 
 brittle fused stick is avoided. J. Solis Cohen refers to a case of fatal 
 laryngitis caused by dropping a piece of nitrate of silver into the larynx. 
 This writer commends for application to the pharynx what he terms the 
 "caustic pencil," which is a safe and admirable method of applying 
 nitrate of silver. 'The pencil is in the form of a lead pencil, the nitrate 
 of silver being enclosed between two pieces of wood, after the manner 
 of the stick of plumbago. 
 
 The cautery effect of the solid stick is comparatively weak. It is not
 
 
 ARGENTI NITRAS. Ill 
 
 powerful enough to destroy aural polypi, or the coarse granulations on an 
 old ulcerated surface. It is admirably adapted, however, to coagulate 
 the albumen on the surface of an ulcerated patch, giving rest to the 
 parts, and, by creating a protectant, lessens pain and diminishes conges- 
 tion and inflammation. It is, thus, chiefly used in ULCERATIONS OF THE 
 LARYNX, especially of the parts defining the aperture, including the 
 epiglottis. It has'little or no value in removing recent, infective exudates, 
 though Gonzales Domingo (Gaceta Medico, Catalana, Barcelona, Sept., 
 1886) claims that it is useful in DIPHTHERIA. In closing superficial FIS- 
 SURES of the lips and tongue, and in obliterating congeries of small 
 vessels in limited area by coagulating the connective tissue between them, 
 the solid stick is in high repute, and often takes the place of the knife 
 in removing blood from the affected spot. Keene recommends it in this 
 way as a destructant of AURAL FURUNCLE when seen in the first stage. 
 
 As a haemostatic it is of use only when the blood escapes from 
 a small abrasion or ulcer. Under such conditions it acts promptly. 
 Thus it often checks an EPISTAXIS. Since the albuminate which 
 stops a bleeding vessel is thin and is soon absorbed, nitrate of silver 
 cannot take rank as a haemostatic with those styptics which "tan" 
 the connective tissue. It may be applied fused on .the end of a 
 probe, or a silver probe may be dipped in nitric acid. Care should be 
 exercised in using fused nitrate of silver on the vocal cords; cicatricial 
 nodules are described as following its use, especially when large areas are 
 covered (C. E. Sajous, Trans. Laryng. Ass'n, 1878). Reflex spasm has 
 been noted as a result, which may be now largely avoided by previously 
 sponging the parts with a ten per cent, solution of cocaine. 
 
 When the mitigated stick in any fixed strength is converted into a 
 powder by scraping with a sharp knife, a convenient form is obtained 
 for insufflation. More commonly, however, powders are prepared by 
 mixing the fused nitrate of silver, which has been triturated, with starch, 
 lycopodium, or sugar of milk. Herzog("Der acute und chronische 
 nasenrachen Catarrh," etc.) employs boric acid as the agent for dilution, 
 and claims good results in the treatment of ACUTE and CHRONIC INFLAM- 
 MATION OF THE NASO-PHARYNX. 
 
 "The introduction into the glottis with a sponge saturated with the 
 crystals of nitrate of silver, of the strength of forty, fifty, or even sixty 
 grains of the salt to the ounce of water, does not produce, ordinarily, as 
 much disturbance as the accidental imbibition into this cavity of a few 
 drops of tea or pure water." ^H. Green, "A Treatise on the Diseases 
 of the Air-passages" etc., 1858, p. xvi.) While this is undoubtedly true, 
 nitrate of silver, in almost any strength of solution, applied to the inte- 
 rior of the larynx, may cause violent spasm of the muscle of the glottis, 
 and the physician should never be off his guard with respect to this possi-
 
 112 LOCAL THERAPEUTICS. 
 
 bility. If spasm should occur, the patient should be enjoined to keep 
 perfectly calm, and attempt to draw air into the lungs. Should this fail, 
 a few drops of nitrite of amyl should be placed on a handkerchief, and 
 the patient again urged to make another attempt at an inhalation. 
 
 In OTORRHCEA, nitrate of silver is employed, in the strengths of one 
 grain to ten grains to the ounce. It is instilled in the external meatus, 
 in PERFORATION OF THE TYMPANUM, or carried by means of Blake's- 
 syringe directly into the middle ear through the perforation in the tym- 
 panic membrane. A. H. Buck (Trans. Otological Soc., 1873, P- 7 2 ) ^> e ~ 
 lieves " that nitrate of silver should rank as one of the safest reagents to 
 employ in stimulating the tympanic mucous membrane to healthy action." 
 
 Nevertheless, degrees of strengths which are appropriate for one part 
 of the affected mucous surface may over-excite an adjacent one. In ad- 
 dition, the tenacious mucus may be converted into a tough coagulum and 
 disguise the appearance of the underlying parts. Asa rule, a quantity of 
 the mitigated stick of desired strength should be scraped so as to form a 
 powder, to be applied by a probe or cotton-carrier to the selected spot. 
 For ACUTE INFLAMMATION OF THE EXTERNAL MEATUS, weak solutions, 
 from one to two grains to the ounce, are efficient (Kramer). In MOIST 
 ECZEMA, from ten to twenty grains to the ounce are well borne (W. H. 
 Dalby). In the coarse fibroid granulations which sometimes surround the 
 orifice in a neglected AURAL CATARRH, with purulent discharge through 
 the tympanic membrane, a solution of thirty to sixty grains to the ounce 
 can be used with advantage. In the condition named, the solution should 
 be carefully mopped on the growths, and the meatus subsequently flooded 
 with a weak sodium chloride solution. Nitrate of silver is less frequently 
 used in the Eustachian tube, though Kirchner recommends a weak solu- 
 tion in CHRONIC INFLAMMATION OF THE LINING MEMBRANE. Forty 
 grains, in solution, is claimed by O. D. Pomeroy (Med. Record, 1871, p. 
 31) to be an efficient application to POLYPUS of the middle ear. 
 
 Perhaps nitrate of silver is used more frequently in this country for the 
 treatment of FOLLICULAR CHRONIC PHARYNGITIS than is any other agent. 
 Its value has been tested for so many years that its reputation may be con- 
 sidered well established. After the mucus has been removed the agent 
 is, as a rule, applied in solutions, the strength varying from forty to sixty 
 grains. The hypertrophied masses are to be carefully sought for and each 
 touched with the medicine carried to the affected spots on the end of a 
 cotton carrier, sponge, or other proper instrument. The mucus is coagu- 
 lated and the submucous infiltrations are actively absorbed. Mackenzie 
 advises that in GRANULAR PHARYNGITIS the separate nodules be incised 
 and the solid stick be carried to the interior. On the whole, the agent is 
 less efficacious in the naso-pharynx. The parts are here more easily 
 excited by nitrate of silver, than is the case in the oro-pharnyx a fact
 
 ARGENTI NITRAS. 113 
 
 doubtless owing to the delicate layer of epithelium on the upper surface 
 of the velum as compared to that on the under surface or in the oro- 
 pharnyx. Sixty grains to the ounce has been employed with good effect 
 in ERYSIPELAS OF THE THROAT and PHARYXGEAL SYPHILIS. Five to ten 
 grains to the ounce is a useful lotion for injection in (ESOPHAGEAL 
 SPASM. According to M. Mackenzie "three or four injections made on 
 alternate days will effect a cure or relieve the parts so much that bougies 
 can be subsequently used." 
 
 A weak ointment of nitrate of silver mixed with cosmoline smeared -on 
 a flexible bougie is recommended by J. Solis Cohen, for INFLAMMATION 
 OF THE (ESOPHAGUS. 
 
 Formerly nitrate of silver in concentrated solution was used in the 
 treatment of ADENOID GROWTHS in the naso-pharynx. The suffering 
 caused sometimes by this application was extreme. Such practice is now 
 generally abandoned. For the treatment of Mucous PATCHES of the 
 pharynx a solution of sixty grains to the ounce makes a desirable appli- 
 cation. In the mouth the use of nitrate of silver is limited to a few 
 conditions. The solid stick or a concentrated solution lightly applied to 
 ULCERATED APHTHOUS or SPECIFIC Mucous PATCHES will generally be 
 followed by a prompt cure. The treatment is unsuitable to infancy. 
 The inflamed tags of gum tissue about the cavity of a recently extracted 
 tooth are successfully treated by the same means. On the tonsils nitrate 
 of silver is of marked value in a strength of twenty grains to an ounce 
 carefully applied to each recess of depression. In TONSILLAR HYPER- 
 TROPHY and DIPHTHERIA the agent is worse than useless. As a cautery 
 it is ineffective. The action of fused crystals upon the crypts is that of 
 an astringent, not that of a caustic. Indeed, it is often not even astrin- 
 gent, but excitant. 
 
 In ACUTE CORYZA a lotion or powder in the strength of two grains to 
 the ounce may be thrown in the nose. But excessive sneezing sometimes 
 follows its use. In the PURULENT CATARRH of children the remedy can 
 be employed with increased probability of success. Tags of inflamed 
 tissue, bright red in color and exceedingly vascular, created by the action 
 of the saw in intra-nasal surgery, are often the source of secondary hemor- 
 rhage ; they should be carefully sought for by about the fourth or fifth 
 day after the operation and touched with the solid nitrate of silver or its 
 saturated solution. The preparations of iron appear to have little effect 
 upon such formations. A. Nelaton ("Pathologic Chirurgicale," Paris, 
 2d ed., 1874, vol. in, p. 748) uses nitrate of silver in the local treatment 
 of NASAL POLYPUS. The use of this agent in the treatment of CHRONIC 
 NASAL CATARRH does not appear to be uniformly endorsed. C. Seiler 
 asserts that it should never be used ; but Michel, Schrotter, and Niemeyer 
 as well as numerous other writers, claim its value. It is probable that Ger-
 
 114 LOCAL THERAPEUTICS. 
 
 man physicians may find a less highly developed neurotic disposition to 
 exist among their patients than is the case with practitioners in America. 
 Be this as it may, the agent is apt to excite the parts if introduced in the 
 nose in the proportions demanded in the successful treatment of CHRONIC 
 NASAL CATARRH. With caution, however, the nitrate of silver treatment 
 may be successfully essayed if the mucous membrane of the nose is measur- 
 ably free from erectile tissue. Thus, it is of value on the middle turbinated 
 bone, but less efficient on the inferior turbinated bone ; it is distinctly ser- 
 viceable in OZ^NA, but irritating in diseases which are accompanied with 
 vaso-motor excitement. Again, in inflammatory states, accompanied with 
 infiltration of the septum and the middle turbinated bone (as in the late 
 stages of SECONDARY SYPHILIS or TERTIARY OSTITIS of the nasal passages), 
 no agent is comparable to the nitrate of silver; the single precaution to 
 be taken in its use is not to cover too large a surface at one sitting, lest 
 an artificial coryza ensue. To neutralize the action of the drug, the parts 
 should be flushed with a solution of sodium chloride. Careless use of 
 the nitrate of silver on the interior of the nose may be followed -by inflam- 
 mation which may extend into the pharynx, but the same danger attends 
 any local agent, and is especially true of the galvano-cautery, which agent 
 some authors are inclined to laud at the expense of the nitrate of silver. 
 To apply nitrate of silver on small areas of surface with precision, it is 
 recommended to melt the fused stick. A probe of convenient size is 
 covered with the fluid and carried directly to the parts, or a small piece 
 of cotton may be wrapped around the end of a delicate cotton carrier 
 and dipped in the saturated solution. 
 
 " Nitrate of silver in solutions varying in strength from one-half grain 
 to sixty grains to the ounce has long been a standard remedy for the treat- 
 ment of CHRONIC LARYNGITIS, especially in forms where inflammation 
 exists on the vocal cords." (Horace Green, " On Bronchitis," New York, 
 1846.) Of the wide range of distinctions indicated by these varying 
 strengths it is impossible here to speak. As a rule, weaker preparations 
 suffice, but in the hands of skillful practitioners the stronger ones are 
 not only useful but appear occasionally to be demanded. It is most 
 efficient in cases accompanied by secretion. In DRY LARYNGITIS, 
 chloride of zinc (^2'-) is the better drug. In using silver an alkali should 
 be used first, to remove the mucus. Not more than a drop or two drops 
 of the solution should be used at a time ; these may be soaked up 
 on a piece of absorbent cotton or sponge (held in a sponge-holder), 
 and carried directly to the affected surfaces. The application may 
 be made twice or three times a week. Care should be taken to avoid 
 spasm of the larynx, but if the patient shows any inclination to 
 such spasm occurring, astringents should not be used until a local appli- 
 cation of cocaine has first been made on the laryngeal mucous membrane.
 
 ARGENTI NITRAS. 115 
 
 According to the peculiarities of individuals, spasms may occur on the 
 employment of the agent in almost any strength, but the likelihood of its 
 occurrence is in proportion to the strength of the preparation. Some 
 observers do not employ cotton in making such applications, believing 
 that a sponge or brush is to be preferred. A fear is expressed by 
 these writers that small threads may become detached and dis- 
 tressing cough ensue. With care, however, such accidents can be 
 avoided. The objection to the brush appears to be that no substance 
 once touching the affected region should be used a second time ; it 
 would be costly to have brushes in numbers, while the cotton is inex- 
 pensive. The sponge is a much harsher substance than either the brush 
 or cotton, and used in small pieces may often prove, in the treatment of 
 the larnyx in young persons, rather difficult to manage. 
 
 C. Seiler claims that the strong solutions of nitrate of silver, say sixty 
 grains to the ounce, have an anaesthetic effect, and are better borne than 
 weak ones. We have had no experience in such effects, but would suggest 
 they should be used over small surfaces at a time, and be neutralized with 
 sodium chloride ; in some instances we have used stronger solutions to the 
 walls of the pharynx ; great pain has followed. 
 
 S. Solis-Cohen is of the opinion that after laryngitis has in great part 
 subsided, there may remain irregular pinky strips on the vocal bands, or 
 a slight congestion of the parts, which prevents the patient from resum- 
 ing, with comfort, full use of the voice. Cohen asserts this condition is 
 an indication for the topical use of a weak solution of nitrate of silver. 
 He employs ten grains to the ounce, and employs the agent by sponge, 
 or cotton wad, or brush, directly to the affected parts, at intervals of two 
 or three days. Patients becoming accustomed to the method, may have 
 the strength increased to those as strong as forty to sixty grains to the 
 ounce. The stronger applications may be made at longer intervals, say 
 one to two or three weeks (Trans. Amer. Laryng. Ass'n, 1889). 
 
 As high as eighty grains to the ounce has been used by Gibbs in the 
 treatment of ERYSIPELAS OF THE LARYNX. Nitrate of silver, in "strong 
 solution," is in repute (Horace Green, " Polypi of Larynx and CEdema 
 of the Glottis," 1852) in CEDEMA OF THE LARYNX, but is inferior in 
 efficacy to scarification. As a hsemostatic in HEMORRHAGE from the 
 vocal cords, nitrate of silver (thirty to forty grains to the ounce) is rec- 
 ommended by C. E. Bean (.A 7 ". Y. Me d. Jour., Sept. 4, 1887). In spray- 
 ing the larynx or throat with nitrate of silver, it is necessary to protect 
 the face and teeth from the stains. The drug is now little used in the 
 local treatment of LARYNGEAL PHTHISIS. Strong solutions have been 
 used for the purpose, however, namely, from sixty to one hundred and 
 twenty grains to the ounce. Techernoff (St. Olga Hos. Rep., 
 uses a two per cent, solution in SYPHILITIC LARYNGITIS.
 
 Il6 LOCAL THERAPEUTICS. 
 
 A twelve per cent, solution is one of the older methods in the treat- 
 ment of MEMBRANOUS CROUP. 
 
 Before the days of laryngoscopy a mixture of nitrate of silver and 
 lycopodium was inhaled from a small receiver placed far back into the 
 pharynx. The strength of the powder varied from one per cent, to twelve 
 per cent. 
 
 Inhalations of the nascent forms of nitrate of silver have been recom- 
 mended by Bidenkap in the treatment of CHRONIC INFLAMMATION OF THE 
 LINING MEMBRANE OF THE RESPIRATORY TRACT. A writer in the 
 Journal of Laryngology and Rhinology, 1887, page 322, believes that this 
 method should be restricted to the treatment of CHRONIC BRONCHITIS 
 and EMPHYSEMA and recommends the following plan : One part of 
 nitrate of silver to three parts of ammonic nitrate are placed in a small 
 crucible or evaporating dish, the whole heated by a spirit lamp. Each 
 inhalation should last no longer than from thirty to forty-five minutes. 
 The atmosphere of the room being suffused with minute portions of 
 nitrate of silver capable of discoloring all white textures they light upon, 
 care should be taken to protect clothing, etc. 
 
 Diseases of the Eye. Nitrate of silver is perhaps more extensively 
 used than any other collyrium, and, though in modern practice it is applied 
 less freely and generally than of old, as the indications for its use have been 
 more clearly outlined, it has mainly held its own for many generations. 
 In the treatment of INFLAMMATORY DISEASES OF THE CONJUNCTIVA it 
 would be better to be deprived of any or every other topical application 
 than of this old and well-tried agent, for by judiciously varying the 
 strength of the applications and the manner of making them we can get 
 the effect of an astringent, caustic, stimulant or antiseptic. 
 
 Simple ACUTE CONJUNCTIVITIS is better treated with milder applica- 
 tions, such as boric acid, borax, alum and tannin, but in the more 
 chronic form the nitrate is a most useful remedy. It is not well borne 
 by the cornea and, according to some authorities, may cause permanent 
 opacity where there are ulcerations, by its actio,n in coagulating albumen. 
 It should, therefore, not be dropped into the conjunctival sac in stronger 
 solution than one or two grains to the ounce, and as a rule should be 
 applied by the surgeon or under his immediate supervision, as its long 
 continued use will cause an immovable and most unsightly staining 
 of the conjunctiva. Some years ago it was not uncommon to meet 
 with patients disfigured by this local argyria for life, but such an occur- 
 rence is now fortunately very rare. 
 
 In the CHRONIC FORMS OF SIMPLE CONJUNCTIVITIS the mucous lining 
 of the upper lid is most affected, and the application should be made to 
 it directly, by means of a brush, or, better, of a pledget of absorbent 
 cotton on the end of a fine probe or small stick, as the latter may be
 
 ARGENTI NITRAS. Iiy 
 
 thrown away when once used, and all danger of communicating infection 
 to other patients avoided. When the upper lid is everted the lower can 
 be pushed up under the posterior edge of the cartilage and the ocular 
 conjunctiva and the cornea be thus completely protected. From two to 
 four grains, occasionally if a stronger impression is desired ten grains, 
 to the ounce may be applied in that way. The lid should be washed 
 with absorbent cotton and warm water before it is allowed to close, but 
 this should not be done too quickly ; an instantaneous removal may 
 almost neutralize the effect of a strong solution, and the impression made 
 by an application may be decidedly varied by the time it is allowed to 
 remain in contact with the conjunctiva. If a strong solution has been 
 used it is well to neutralize it with salt water. In granular ophthalmia 
 nitrate of silver is used more freely, and is the main dependence in its 
 treatment. The late Dr. Littell, for many years surgeon to the Wills 
 Hospital, who paid much attention to that subject, and had an excep- 
 tionally long and extensive experience with it, used to say that he had 
 faithfully tried every remedy suggested for a quarter of a century, but 
 always found himself relapsing to the nitrate. Modern ophthalmic sur- 
 gery has not yet found anything that promises to permanently replace it, 
 though the treatment may be favorably varied by the occasional sub- 
 stitution of other applications, such as bichloride of. mercury, alum, copper 
 sulphate, tannin, sulphate of zinc, and boroglyceride. The strength of 
 the solution, as well as the length of time it is allowed to remain in contact 
 with the conjunctiva, must be determined by the condition of the latter, 
 and some experience is required so to regulate as to get the best effect. 
 Five and ten grain solutions are the most generally useful, though ten or 
 twenty may sometimes be used with advantage. The solid " mitigated 
 stick " is more efficient than very strong solutions, and its action is more 
 easily localized. It consists of nitrate of silver and nitrate of potash 
 fused together. The argenti nitras dilut. of the U. S. P., contains 
 fifty per cent, of the silver salt, but the "mitigated caustic" of the 
 B. P. (argenti et potass, nit.) containing thirty-three per cent, is more 
 generally used. This remedy should be used with caution, and it should 
 be remembered that the object is rather to stimulate the granular masses 
 to absorption than to "destroy" them, though the nitrate has also an 
 astringent and mild caustic effect. Its advantage as a caustic is its super- 
 ficial action, as by its property of coagulating albumen it forms a protect- 
 ing film, which prevents deeper penetration. It should be neutralized 
 with salt water or oil before the lid is replaced. When the palpebral con- 
 junctiva is much thickened, and the " granulations" are very prominent, 
 careful scarification, now perhaps too much neglected, is often useful, and 
 some surgeons think well of the galvano-cautery. When these surgical 
 means are used, care must be taken not to involve the sub-conjunctival
 
 Il8 LOCAL THERAPEUTICS. 
 
 tissue, and thus increase the cicatricial contraction, which is one of the 
 worst results of the disease. 
 
 In PURULENT CONJUNCTIVITIS, also, nitrate of silver is generally con- 
 sidered the most efficient application. In the earlier stages, while the 
 discharge continues watery, serous or sanious, and the conjunctiva has a 
 glazed appearance, it should not be used. Iced cloths should be 
 continuously applied, and thorough cleanliness insured by frequent 
 bathing with mild astringents or antiseptics. Some surgeons prefer the 
 continuous or intermittent application of hot water, to the cold. When 
 the discharge becomes distinctly purulent and the conjunctiva is swollen 
 and velvety, the nitrate may be applied to the entire lid, in the manner 
 already described. In the case of adults, a ten-grain solution is most 
 frequently employed. Usually one application in twenty-four hours will 
 be sufficient, but in bad cases it may be well to repeat it twice a day. A 
 one-grain solution is sometimes dropped into the eye every hour or two, 
 in addition. 
 
 The same principles apply to the treatment of OPHTHALMIA NEONATO- 
 RUM. The use of iced clothes is impracticable, but hot stupes (112 F.) 
 applied for ten or fifteen minutes at a time, three or four times a day, are 
 useful. In many cases a two- or four-grain solution will be strong 
 enough, particularly if it is used more than once a day ; but if the dis* 
 .charge is very abundant and the source of contagion is gonorrhceal, ten 
 grains may be needed. Great attention has recently been given to the 
 prevention of this disease, which has been the most fruitful of all the 
 causes of blindness. The method of Crede, of Leipsic, which has 
 attracted much notice, is founded on the powerful antiseptic properties 
 of nitrate of silver, which is said to destroy the gonococcus and prevent 
 contagion. He applies one drop of a two per cent, solution between the 
 lids of the child immediately after birth. As a result of this treatment, 
 the percentage of cases of ophthalmia in the Lying-in Hospital of Leipsic 
 was reduced from 7^ to o.y z . The question has arisen in several 
 European States, whether this practice should not be made obligatory by 
 legal enactment ; but this somewhat heroic prophylaxis is scarcely nec- 
 essary in the better class of patients, and it may well be left to the judg- 
 ment of the attending physician to employ it only when the mother is 
 known to be suffering with a blennorrhoeal discharge, and to content 
 himself in other cases with perfect cleanliness insured by washing the 
 eyes with a solution of bichloride, boric acid or borax, or with simple 
 warm water.
 
 ARGENTI IODIDUM ARISTOL. ng 
 
 ARGENTI IODIDUM. Iodide of Silver. 
 
 " This is a new officinal salt, which may be readily prepared by adding a solution of 
 iodide of potassium to one of nitrate of silver, and washing and drying the precipitate, 
 which should be kept in dark amber-colored vials, protected from light." (U. S. D.) 
 
 Diseases of the Eye. Iodide of silver has usually been added to 
 the list of applications in the treatment of TRACHOMA. {Ophthalmic 
 Record, No. '3.) 
 
 ARISTOL. Di-iodo-di-tymol. Annidalin. 
 
 " Aristol is a light brown, fine, adhesive, inodorous powder, containing 45.8 per cent, of 
 iodine. It is readily soluble in ether and in fatty oils, slightly soluble in alcohol; 
 it is insoluble in water or in glycerin. It is readily decomposed by heat and 
 exposure to light. It is soluble in collodion." As the iodine is held very loosely in 
 combination, almost any other substance for which iodine has affinity liberates it, 
 so that as a dressing for wounds its use is confined for^ the most part to the com- 
 mercial powder, to the form of the soluble collodion, or to mixture with fats. 
 
 Aristol should never be prescribed in conjunction with starch, caustic alkalies, car- 
 bonates, or with substances which possess affinity with iodine, such as ammonia, the 
 metallic oxides, corrosive sublimate, etc. 
 
 Aristol is antiseptic and protectant. 
 
 General Surgery. Aristol has been introduced in general surgery 
 as a substitute for iodoform. It is odorless, and in all cases harmless in 
 action. While it may be pleasanter for the patient, it is not nearly so 
 active a remedy in the treatment of VENEREAL SORES as is iodoform. 
 In the treatment of WOUNDS (by dusting over the part, or used in pre- 
 pared gauze) it serves as a protectant. 
 
 Diseases of the Skin. In Eichoff's opinion (Monatsch.f. Pr. Der- 
 matol., No. 2, January 1890) aristol possesses the valuable properties of 
 both iodoform and thymol to a higher degree than either of its compo- 
 nent parts. This appears to give it the advantage over chrysarobin and 
 pyrogallic acid in the treatment of diseases like psoriasis, when an exten- 
 sive area is to be acted on and absorption may take place. 
 
 Aristol has been employed with success by some German physicians in 
 PSORIASIS, the vegetable parasites of the skin, and in ULCERS, whether 
 simple or syphilitic, also in LUPUS and EPITHELIOMA. 
 
 While generally conceded to be valuable in syphilitic and other ULCERS, 
 the virtues of aristol have been disputed by many observers. Its effect 
 appears to be cornifying only, and it does not seem to act upon the 
 deeper layers of the skin nor to destroy new growths. 
 
 J. J. Levick {Medical News, July 25, 1891) found good results from 
 powdering the hands in DERMATITIS VENENATA (rhus poisoning) with
 
 120 LOCAL THERAPEUTICS. 
 
 aristol. He suggests that it may prove useful in the treatment of VARI- 
 OLOUS ERUPTION. 
 
 Diseases of the Ear, Throat and Nose. Insufflations of the 
 powder of aristol have been employed by Rorer {Archives Internationales 
 de Laryngologia, 1890, No. 2) for ACUTE CATARRHAL OTITIS. Lo wen- 
 stein (//. klin. Rundschau, May, 1890) has used aristol in the treatment 
 of OZ^ENA, in a ten per cent, ethereal solution (in the proportion of a 
 drachm to the ounce) with good results. It also proves- available for 
 CHRONIC NASAL CATARRH, by being dissolved in one of the forms of 
 petrolatum. Exhibited as a flexible collodion, one drachm to the 
 ounce, W. C. Phillips (N. Y. Med. Jour., May 23, 1891) applies aristol 
 in CHRONIC ATROPHIC RHINITIS in OZ^ENA and in ULCERS OF THE 
 SEPTUM, both specific and non-specific. The agent is highly extolled 
 by some practitioners in the treatment of SYPHILIS OF THE NOSE, 
 accompanied with ulceration, when used in the form of a powder and 
 blown on the parts. The objections to iodoform are obviated and the 
 powder does not as a rule irritate. A small proportion of morphine may 
 be added to the mass or it can be combined with borax and tannic acid. 
 
 Aristol has come largely into use as an adjuvant in the after-treatment 
 of intra-nasal operations. Cotton plugs, if covered with cosmoline and 
 thoroughly dusted with aristol, remain free from odor a longer time and 
 with less irritation than if prepared in any other way. A. B. Kirkpatrick, 
 of Philadelphia, claims that aristol prevents the formation of exuberant 
 granulations, after operations on the nasal septum. In LARYNGORRHCEA, 
 aristol may be blown into the larynx. 
 
 Diseases of the Eye. Aristol has been recommended as an 
 antiseptic dressing in operations upon the eyelids and ENUCLEATION OF 
 THE BALL, as a substitute for iodoform ; experience has still to prove if 
 it is equally effective. It is unirritating, even to the conjunctiva, and may 
 be dusted freely on the parts involved in the operation. 
 
 It has also been recommended in the treatment of PHLYCTENULAR . 
 CONJUNCTIVITIS, dusted upon the ulcer in the same manner as calomel 
 has long been used. An ointment containing five grains of aristol to 
 one drachm of cosmoline is said to be of value in BLEPHARITIS MAR- 
 GINALIS and in ECZEMA OF THE EYELIDS. 
 
 ARNICA. Arnica. 
 
 Both arnica flowers (Arnica Flores).&n& the root (Arnica Radix), respectively the 
 " flower heads " and " the rhizome and the rootlets " of Arnica montana, are official in 
 the U. S. P. " Tincture of Arnica " is a tincture of arnica flowers, containing the 
 activity of twenty parts of the flowers in one hundred of alcohol. There is also official 
 in the U. S. P. and Ph. Br. a Tinctttre of Arnica Root, that of the U. S. P. contain- 
 ing the activity of twenty parts of the root in one hundred of tincture. When "tincture 

 
 AURI ET SODII CHLORIDUM BALSAMUM PERUVIANUM. 121 
 
 of " arnica is spoken of in America, the tincture of the flowers is always intended ; in 
 Great Britain, the tincture of the root is meant. An Extract of Arnica Root (of un- 
 certain strength) and a Fluid Extract of Arnica Root (of which one cubic cm. 
 represents one gram of arnica root) are also official. (U. S. P.) 
 
 General Surgery. The tincture of arnica is a popular application 
 for relief of SPRAINS, BRUISES AND EXTERNAL INFLAMMATIONS ; yet 
 violent erysipelatous inflammation has been known to follow its use. 
 This is likely to occur if the application is covered with an impermeable 
 dressing, which prevents evaporation. It is said that the infusion or 
 decoction of arnica is not so liable to produce local irritation as is the 
 tincture. Notwithstanding its popular reputation, there is nothing to 
 show that arnica is superior, as a local application, to laudanum and 
 water, lead water, and other sedative lotions. 
 
 Diseases of the Mouth. Arnica is described by Leffmann ("Ameri- 
 can System of Dentistry," m, 695) as a stimulant in inflammation of the 
 mucous lining of the mouth. Equal parts of tincture of arnica and 
 glycerin diluted with water is employed by dentists. 
 
 AURI ET SODII CHLORIDUM. Chloride of Gold and Sodium. 
 
 " A mixture composed of equal parts of dry chloride of gold and chloride of sodium." 
 (U. S P.) It is " of a golden yellow color, and, when crystallized, is in long prismatic 
 crystals, unalterable by exposure in the air." (U. S. D.) It is soluble in water. It 
 should be protected from light. The chloride of gold can be dissolved out of the double 
 salt by alcohol. 
 
 Chloride of gold is antiseptic and escharotic. It bears a resemblance in 
 therapy to the bichloride of mercury. 
 
 Diseases of the Throat, etc. J. Solis Cohen ("Diseases of the 
 Throat ") refers to this agent as a substitute for the nitrate of silver in the 
 treatment of inflammation of the pharynx. It can be used in strengths 
 varying from fifty to sixty grains to the ounce of water. A solution of 
 the chloride of gold is employed in dentistry to overcome the sensitive- 
 ness of dentine. 
 
 Diseases of the Eye. Chloride of gold was some years ago 
 strongly recommended as an application in GRANULAR LIDS, substituting 
 nitrate of silver, but did not survive the test of clinical trial and soon 
 'went out of use. 
 
 BALSAMUM PERUVIANUM. Balsam of Peru. 
 
 " A balsam obtained from Myroxylon Pereira. A thick liquid, brownish-black 
 in bulk, reddish-brown and transparent in thin layers, having a syrupy consistence, a 
 somewhat smoky, but agreeable and balsamic odor, and a warm, bitter, afterward acrid 
 taste.- It is entirely soluble in five parts of alcohol." (U. S. P.) It is insoluble in
 
 122 LOCAL THERAPEUTICS. 
 
 henzin ; readily miscible with chloroform or glacial acetic acid. Balsam of Peru is 
 adulterated with various substances, such as Canada turpentine, castor oil, copaiba, and 
 alcohol. A solution of balsam of Peru in alcohol is sometimes sold for it. 
 
 Balsam of Peru is protectant, sedative, and parasiticide. 
 
 Diseases of the Skin. Balsam of Peru is employed as a mild 
 antipruritic and parasiticide, usually in combination with other applica- 
 tions. 
 
 In PRURITUS VULWE Tausky recommends : R. Bals. Peru., 3] ; pulv. 
 acaciae, gij ; ol. amygdalae, ^iss ; aqua rosarum, j. M. Sig. Apply 
 freely with a brush, eight or ten times a day, to the itching parts. 
 
 In SCABIES Balsam of Peru may be used alone, or in combination with 
 other remedies, as in the following formula recommended by J. C. 
 White, of Boston : R. Bals. Peru, j ; flor. sulphuris, gij ; naphtollis, 
 3j ; vaselin, sj. M. 
 
 In the form of one-half drachm to an ounce of cosmoline, balsam of 
 Peru forms an admirable base when it is desired to use iodoform in the 
 shape of an ointment. 
 
 Diseases of the Nose and Throat. Balsam of Peru is used by 
 Ebstein as a local application in ATROPHIC RHINITIS. Cotton tampons are 
 soaked with it and carried in the nasal chambers. A pigment of eighty 
 grains of the balsam to an ounce of ether is used by M. Mackenzie in 
 TONSILLAR DIPHTHERIA. It has a remarkably efficacious effect when 
 used as an inhalation in laryngeal phthisis {Journal of Laryngology 
 and Rhinology, 1887.) Schmidt {Ibid., p. 162) recommends steam 
 inhalations containing 20-30 drops of the following mixture to a pint 
 of hot water: Balsam of Peru, 10 grms ; alcohol, 5 grms. It may be 
 applied locally to the ulcerative stage of the disease just named. Mixed 
 with elastic collodion, it may protect tubercular ulceration of all parts 
 of the tongue and adjacent parts. (Schnitzler, Congres de Laryngologie, 
 Paris, Sept., 1889.) It may be variously combined with astringents. 
 
 Rosenberger {Therap. Monatschrift, p. 10, 1888), recommends it in 
 white patches (IDIOPATHIC LEUCOPLASIA) of the oral cavity. He finds 
 it anesthetic, and calculated to restore the diseased tissues to their 
 normal condition. The balsam, which must be pure, is laid thickly on 
 the affected parts with a camel's hair brush. It sometimes gives rise to 
 slight burning with increased salivation, but must be retained in the 
 mouth three to five minutes, and should be repeated several times 
 daily. Thirteen cases treated thus resulted favorably, or at least im- 
 proved greatly. 
 
 Balsam of Peru forms the main ingredient of the so-called Mistura 
 Oleo-Balsamica, as per ensuing formula: R. Oil of lavender, oil of 
 cloves, oil of cinnamon or cassia, oil of thyme, oil of lemon, oil of 
 mace, oil of orange flowers, each i part ; balsam of Peru, 3 parts ; alco-
 
 BALSAMUM TOLUTANUM BELLADONNA. 123 
 
 hol, 240 parts. Mix, and macerate for several days, shaking often, then 
 filter. 
 
 Other preparations are known under the same name as above. Two 
 formulae are herewith presented : 
 
 R. Oil rue, n^x ; oil cedrat, cinnamon, cloves, lavender, mace, mar- 
 joram, of each n^xx ; balsam Peru, ss ; alcohol, Oss. 
 
 R. Oil cinn., cloves, lavender, lemon, neroli, nutmeg, thyme, each 
 n^xx; bals. Peru, 3J ; alcohol, Oss. 
 
 BALSAMUM TOLUTANUM. Balsam of Tola. 
 
 " A balsam obtained from Myroxylon toluifera. A yellowish or brownish-yellow, 
 semi-fluid or nearly solid mass, transparent in thin layers, brittle when cold, having 
 an agreeable, balsamic odor, and a mild, aromatic taste. It is entirely soluble in alco- 
 hol ; almost insoluble in water and in benzin." (U. S. P.) It is one of the constitu- 
 ents of the Compound Tincture of Benzoin. (Turlington's Balsam, Friar's Balsam, 
 Wade's Balsam.) A Tincture of Tolu is official; it contains ten per cent, of the 
 balsam. 
 
 The balsam of tolu is a protectant antiseptic and alleviates cough. 
 
 Diseases of the Throat. M. Mackenzie uses a solution of one to 
 five as a varnish on DIPHTHERITIC DEPOSITS ; the membrane should be first 
 dried with blotting paper before the application is made ; of the balsam 
 eighty grains, ether one ounce, as a pigment, to be applied with a brush 
 to the diphtheritic deposits on the tonsils and pharynx. Vapor inhala- 
 tions of tolu are recommended for the treatment of CHRONIC PHARYN- 
 GITIS. A lozenge of the balsam is prepared in the proportion of one-fifth 
 of a grain. In the form of a tincture tolu is sometimes added to sprays. 
 Owing to its tenacious character a small proportion suffices. 
 
 BELLADONNA. Belladonna. 
 
 In both the U. S. P. and Br. P. the leaves as well as the root of Atropa belladonna are 
 official. In the U. S. P. the alcoholic extract and the tincture are made from the leaves 
 the plaster and the fluid extract from the root. In the Br. P. the extract, the succus, and 
 the tincture are made from the leaves, and the alcoholic fluid extract, the liniment, and 
 atropine are made from the root. The preparations of belladonna used externally in this 
 country are the Alcoholic Extract (of uncertain strength), Tincture of Belladonna (fif- 
 teen parts of belladonna leaf in one hundred parts of tincture), Atropine, the Plaster 
 (one hundred parts of belladonna in one hundred parts of the plaster) ; the Ointment, 
 made by incorporating ten parts of the alcoholic extract of belladonna, softened with six 
 parts of diluted alcohol in eighty-four parts of benzoinated lard; and, rarely, the Fluid 
 Extract (one gramme of belladonna root in one cubic centimetre of fluid extract), 
 and the Liq. Atropince Su/phatis. 
 
 Atropine is characterized by " colorless or white, acicular crystals, permanent in the 
 air, odorless, having a bitter, acrid taste, and an alkaline reaction." (U. S. P.) It forms
 
 124 LOCAL THERAPEUTICS. 
 
 salts with acids, in which form it is medicinally used, the salt in general use being the 
 sulphate. The sulphate of atropine is soluble in 0.4 part of water and 6.5 parts of alcohol. 
 
 The decomposition products of atropine are tropine and tropic acid. Derived from 
 tropic acid is the substance known as homatropine ; the hydrobromate of homatropine is 
 much used as a mydriatic. This salt is soluble in ten parts of water. 
 
 An Oleate of Atropine is in the trade. 
 
 " Ladenburg has exhaustively studied the several sources of atropine, and the allied 
 alkaloids that exert a mydriatic action, and found that there are three alkaloids, atropine, 
 hyoscyamine, and hyoscine, which possess the common formula : C 17 H 23 NO 3 , and in 
 belladonna root, belladonnine, C 17 H 23 NO 4 . Of these, atropine occurs in Atropa belladonna 
 and in Datura stramonium ; hyoscyamine in these plants, and also in Hyoscyamus niger 
 and Duboisia myoporoides. Hyoscine is found in Hyoscyamus niger alone, and bella- 
 donnine in belladonna root alone." (U. S. D.) 
 
 The popular preparation known as Baume Tranquille, and recommended for OTALGIA 
 when instilled into the outer ear, is an infusion in olive oil of narcotic and aromatic plants. 
 The narcotics are belladonna, conium, hyoscyamus, and stramonium, with some opium 
 added. The aromatics are sage, wormwood, lavender, and thyme. 
 
 Belladonna is sedative, antispasmodic, mydriatic, resolvent, and anti- 
 secretory. 
 
 General Surgery. Belladonna is known to possess the power of 
 ARRESTING THE SECRETION OF MILK. It is employed with advantage when, 
 the mother being unable to suckle her child, the breasts become swollen 
 and painful, and threaten to suppurate unless the tension of the ducts be 
 relieved. If the milk cannot be drawn off artificially, the secretion must 
 be suppressed. The drug should be applied before inflammation has set 
 in, in which case the swelling and pain in the breast generally subside in 
 a few hours, and the gland becomes soft and painless. Even if inflamma- 
 tion has already begun and the breasts have become tense, shining, hard, 
 knotty, red, and acutely painful, an ointment of belladonna should be 
 applied, and over it a warm flaxseed poultice, the entire breast being 
 thoroughly supported. This treatment, continued for forty-eight hours, 
 will often arrest the formation of pus. The method should be employed 
 in all cases, no matter how far the mastitis has advanced. Even when 
 the agent fails to prevent suppuration, it reduces the inflammatory process 
 and lessens pain. Where belladonna ointment is objectionable on account 
 of its peculiar odor and its liability to soil the clothing, similar results can 
 be obtained by hot fomentations of rose water with atropine in solution 
 of four grains to the ounce, care being taken to watch the systemic effect 
 as shown by dilatation of the pupil and dryness of the mouth. 
 
 The addition of belladonna to iodine ointment increases its efficiency in 
 the treatment of ADENITIS. A useful prescription in this condition is the 
 following: Ii. Ung. plumbi iodidi, and ung. belladonnae, equal parts. This 
 may be rubbed thoroughly into the inflamed part twice a day. An oint- 
 ment composed of equal parts of ung. belladonnse and ung. hydrargyri, 
 is almost universally used in the hospitals of Philadelphia in the treat-.
 
 BELLADONNA. 125 
 
 ment of CHRONIC INFLAMMATORY CONDITIONS about the ARTICULATIONS. 
 It is of great service in conjunction with blisters, and rest in the treat- 
 ment of CHRONIC SYNOVITIS OF THE KNEE JOINT. After counter-irritation, 
 the part is to be enveloped in lint, on which is spread a thick coating of 
 the ointment covered with waxed paper and firmly bandaged. John 
 Ashhurst often uses this treatment with great success in the local treat- 
 ment of PERITONITIS, the abdomen being covered with lint on which has 
 been spread the ointment, and the whole enveloped with a large hot 
 poultice. The application should be continued until slight ptyalism is 
 induced. 
 
 In the treatment of BOILS, CARBUNCLES, and ABSCESSES, it is an excel- 
 lent plan to smear the inflamed tissues with an ointment composed of 
 equal parts of extract or ointment of belladonna and glycerin, and on 
 this dressing to superimpose a hot poultice. Belladonna plaster is 
 largely used for the relief of PLURODYNIA, INTERCOSTAL NEURALGIA, 
 PLEURISY, and muscle pains of RHEUMATISM. It is also applied over 
 the region of the heart in functional and organic diseases of that 
 organ. The skin must be thoroughly cleansed with soap and water, 
 and afterward washed with alcohol or vinegar. This will insure the 
 plaster adhering, and at the same time promote absorption of the drug. 
 The same effect may be obtained from the use of either the liniment 
 or the ointment of belladonna. Care must be exercised in the appli- 
 cation of belladonna to large surfaces that have been denuded of 
 epithelium. Belladonna used for its constitutional or its local effect, 
 is much more active and prompt when in contact with the mucous 
 membranes than when applied to the cutaneous surfaces. The extract 
 of belladonna in conjunction with tannic acid, in the proportion of one 
 or two grains of the extract to eight or ten of the acid, is recommended 
 by Trousseau in LEUCORRHCEA with accompanying ulceration of the os 
 uteri, the agent appearing to arrest the abundant secretion from the 
 mucous glands. The mixture may be wrapped in cotton, or made into 
 a suppository with cocoa butter, and placed in contact with the os. 
 When the condition is associated with much pain, the following in- 
 jection yields good results: R. Sodii bicarb. ,3J; tinct. belladonnae, 
 |ij ; Aquae, Oj. M. The syringe should be introduced as far as possi- 
 ble, while the patient lies on the back with the buttocks elevated on a 
 pillow. 
 
 In the genito-urinary tract of the male belladonna is of great service, 
 especially for the relief of SPASMODIC STRICTURE OF THE URETHRA, or 
 SPASM OF THE NECK OF THE BLADDER, following over distention, a con- 
 dition often met with after a debauch. It is also of value in the pre- 
 paratory treatment of strictures of small calibre, especially those of an 
 irritable nature. In all classes of conditions it is imperative that the
 
 126 LOCAL THERAPEUTICS. 
 
 patient should be brought under the influence of the drug, preferably by 
 means of a suppository of half a grain of the extract of belladonna 
 inserted into the rectum about half an hour before the proposed introduc- 
 tion of the instrument. In many cases what would otherwise be an 
 impermeable stricture, can readily be passed. In some cases of tight 
 stricture it is advisable to smear the instruments with the ointment of 
 belladonna instead of sweet oil. By this means the local effect of the 
 drug is supposed to be made more prompt and active. Care, however, 
 ought to be exercised that too much of the drug does not find its way 
 into the system from the mucous membrane of the urethra. It must be 
 remembered that belladonna is of little service when the retention of 
 urine is due to an enlarged prostate, as it has a tendency to paralyze the 
 vesical expulsive muscles ; and where the desire to pass water arises from 
 the presence of urine which the bladder fails to expel, the difficulty 
 is only aggravated by belladonna. In STRANGURY following the ab- 
 sorption of cantharides from large blisters, and also from the use of 
 turpentine, belladonna combined with opium will prove a satisfactory 
 remedy. In irritable spasms and neuralgic conditions belladonna may 
 be combined with advantage with opium and camphor. 
 
 In ORCHITIS immediate relief may be obtained by enveloping the tes- 
 ticle in lint on which has been spread a thick coating of belladonna oint- 
 mentj and applying over this fomentations of hot water. In CHORDEE 
 Mr. Hill recommends a suppository of extract of belladonna and 
 morphine. 
 
 In FISSURE OF THE ANUS Dupuytren states that belladonna is of service 
 in inducing relaxation of the sphincter. It may be applied in a supposi- 
 tory, or the following : R. Ext. belladonna, plumbi acetatis, aa 3J; adipis, 
 3vj. M. Sig. Applied three or four times daily. In the treatment of 
 HEMORRHOIDS belladonna is incorporated with many ointment bases. 
 The following prescription is used at the University of Pennsylvania Hos- 
 pital : R. Ext. belladonnae, gr. x; ext. stramonii, 353; acid, tannici, 
 gr. viij ; adipis, |j. M. Ung. The selected part should be washed 
 before the application of the ointment. When the hemorrhoids are 
 accompanied with much itching, the following ointment may be found of 
 service: R. Ung. hydrarg. nitratis, ^j ; ung. belladonnae, gvij. Ailing- 
 ham recommends that when the masses are inflamed they be anointed 
 with equal parts of extract of opium and of belladonna, and then be 
 covered with a hot poultice, though in some cases a cold application 
 may be found to be more grateful. 
 
 Diseases of the Skin. Belladonna is employed in the treatment 
 of HYPERIDROSIS. and in affections of the skin where excessive sweating 
 interferes with the action of other remedies. In excessive sweating of 
 the palms and soles, or of the axilla, groins, etc., the tincture may be
 
 BELLADONNA. 
 
 127 
 
 painted on the previously dried surface once a day, and followed by the 
 use of an astringent powder. 
 
 The dried and powdered extract of belladonna may be employed as a 
 dusting powder, and is particularly useful in ECZEMA of the groins, thighs, 
 scrotum, anus, and neighboring parts, especially when occurring in the 
 summer season and accompanied by excessive sweating. It should be 
 carefully mixed with a dessicant powder, as oxide of zinc, subnitrate of 
 bismuth, starch, or fuller's earth. The proportion should be one to two* 
 drachms to the ounce of the excipient. 
 
 The extract of belladonna may be employed alone. (The official 
 ointment is 48 grains to the ounce, but in referring to English works 
 it is well to remember that the British preparation is nearly twice as 
 strong.) It is found useful as a dressing in painful ulcers, and also in 
 other painful conditions of the skin, as in ECZEMA OF THE ANUS. It has 
 a certain value also in PRURITUS ANI. The constitutional effects should 
 be guarded against. 
 
 Atropine is employed for the same purposes as belladonna. Its external 
 employment is rare ; usually it may be substituted by belladonna. 
 
 Diseases of the Ear, Nose, and Throat. Solutions of atropine, 
 in three to five grains to the ounce, are of value in RHEUMATIC OTAL- 
 GIA. One or two drops may be instilled at a time. Although its 
 use is not contra-indicated by an opening in the tympanic membrane, it 
 is necessary to bear in mind the ease by which the medicine may pass down 
 the Eustachian tube to the pharynx. E. D. Williams recommended the 
 atropine treatment as one of the best at our command. Keene recom- 
 mends atropine as a remedy for TINNITUS. The liquor atropii diluted 
 with an equal quantity of water may be injected by the Eustachian 
 catheter. T. F. Rumbold {Trans. Amer. Rhinol. Ass'n, 1886) uses a 
 strength of five grains to the ounce in the local treatment of HAY FEVER. 
 A few drops are directed to be placed on a pledget of cotton and in- 
 serted in the nostril. Mixed with cocoa butter, atropine, one-twentieth 
 of a grain, or one-quarter of a grain of the alcoholic extract of bella- 
 donna, may be exhibited in the form of a NASAL BOUGIE. For the treat- 
 ment of ACUTE RHINITIS the powdered leaves enter into the composition 
 of a snuff, as follows : pulverized leaves one scruple, morphine sulphate 
 two grains, pulverized acacia a half ounce. Atropine is occasionally em- 
 ployed in the local treatment of LARYNGEAL PHTHISIS. Inhalations of 
 water, in which a small proportion of tincture of belladonna has been 
 added, relieves the pain of CHRONIC LARYNGITIS. 
 
 Diseases of the Eye. Atropine is always used in the form of the 
 soluble sulphate or salicylate, the alkaloid itself being very sparingly 
 soluble in water. It is useful as a powerful local anodyne, but chiefly 
 by its action in dilating the pupil and paralyzing the muscle of accom-
 
 128 LOCAL THERAPEUTICS. 
 
 modation. Its exact mode of action is not yet definitely determined. It 
 is known to be local. It must be absorbed and reach the iris directly 
 before it can act. The aqueous humor of an atropinized eye contains 
 sufficient atropine to dilate the pupil of another eye. It causes my- 
 driasis when applied to the eye immediately after death, or, in experi- 
 ments upon animals, after removal of the brain and spinal cord. Its 
 action is upon unstriated muscle, and it does not affect the pupil of birds 
 whose iris muscular fibres are of the striated kind. 
 
 It is erroneously stated that atropine dilates the pupil by paralyzing 
 the sphincter fibres and stimulating the radial ; the former being under 
 the control of the oculo-motor nerve, and the latter of the sympathetic. 
 The existence of dilator muscular fibres in the iris, however, may now 
 be considered extremely doubtful, and is positively denied by some of 
 the best authorities. According to these authorities the dilatation of the 
 pupil is the result of elastic contraction, and the only structure of the iris 
 that takes an active part in it is the posterior limiting membrane, which 
 is the only one not thrown into folds when the pupil dilates. (Fuchs, 
 v. Graefe Arch., xxxi, p. 89, and Oph. Rev., Jan., 1886.) It is not easy, 
 however, on this view to account for the following facts, viz.; that mydriasis 
 from pathological or experimental paralysis of the third nerve is increased 
 by the application of atropine ; that the pupil dilated by atropine im- 
 mediately contracts when the sympathetic nerve is severed and dilates 
 again when the nerve is excited by faradization ; or that cocaine, which 
 is supposed to produce mydriasis by its excitant effect on the sym- 
 pathetic, increases the dilatation of an atropinized eye. Gaskell (Jour- 
 nal of Physiol., Jan., 1886) thinks that in the sphincter muscle of the 
 iris we have an example of a muscular structure supplied by two nerves 
 of opposite character, the one motor and the other inhibitory, and that 
 dilators of the pupil act upon the latter. According to this view atropine 
 increases paralytic mydriasis by inhibition of the tonic contraction of 
 the sphincter muscle. 
 
 Some observers have thought that the vaso-motor action of atropine, 
 in contracting the iris blood-vessels, is an important factor in producing 
 mydriasis. 
 
 Belladonna is extensively used in ophthalmic surgery. As a mydriatic 
 the full effect of atropine may be rapidly obtained by a solution of 
 four grains to the ounce. When one drop of this is instilled in the 
 conjunctival sac of a healthy eye, the dilatation of the pupil com- 
 mences in less than fifteen minutes, and attains its maximum, with 
 complete immobility, in twenty or twenty-five. When it is desired 
 to dilate the pupil merely to facilitate ophthalmoscopic examination, a 
 much weaker solution should be used, as mydriasis produced by the 
 strong application does not completely disappear for nearly, or quite,
 
 BELLADONNA. 
 
 129 
 
 two weeks. A solution of a quarter of a grain to the ounce produces 
 dilatation in half an hour, and the effect passes off in three or four days. 
 Atropine is now, however, not so much used as formerly, for this purpose, 
 as homatropine or cocaine involves much less inconvenience to the patient. 
 Its most important therapeutic application is in the treatment of IRITIS, 
 in which it is the remedy above all others. The great danger in this 
 disease is adhesion of the iris to the lens capsule, and, in a large propor- 
 tion of cases, is practically over when the pupil is once well dilated and 
 its margin is thus withdrawn from contact with the lens. Unfortunately 
 the action of the drug is resisted and too often cannot be induced unless 
 the application is used at the commencement of the affection. The 
 absorption of atropine by the cornea is diminished by the increased intra- 
 ocular tension, and even before adhesions have occurred the hyperae- 
 mic and oedematous iris responds slowly and imperfectly to the action of 
 the mydriatic. This action is materially promoted by the local abstrac- 
 tion of blood by means of leeching or cupping at the temple. When 
 there is great increase of tension, paracentesis of the cornea is useful. 
 Freshly formed adhesions may often be broken up, and even when the 
 adhesions are firmer, partial and irregular dilatation can usually be 
 obtained. In specific iritis, obstinate synechise sometimes yield after the 
 administration of mercury. A solution of four grains to the ounce is 
 generally used, and in most cases three or four applications a day are 
 sufficient. In some cases it is necessary to repeat them more frequently, 
 even every two or three hours, or a more decided effect may be obtained 
 by making the application every fifteen minutes for an hour three times 
 a day. A solution of eight grains to the ounce is sometimes used by the 
 surgeon, but is not often entrusted to the patient. Even the weaker 
 solutions must be used with care, as in specially sensitive subjects consti- 
 tutional poisoning may result. The danger of this is diminished by 
 pressure on the puncta with the end of the finger during the application. 
 In cases of NUCLEAR CATARACT, with the periphery of the lens com- 
 paratively clear, great improvement of vision is often secured by keeping 
 the pupil continuously dilated with atropine instilled two or three- times 
 a week. By this proceeding and the careful correction of any existing 
 defect of refraction, patients are often enabled to enjoy useful sight for 
 months, or even years, before the whole lens becomes involved in the 
 opacity. 
 
 -In the treatment of PHLYCTENULAR KERATITIS, which is usually accom- 
 panied by considerable ciliary irritation with contraction of the pupil, 
 atropine is valuable as a powerful sedative, and by putting the pupillary and 
 accommodative actions of the eye at rest. A one- or two-grain solution 
 may be combined with ten grains of boric acid, or, if there is much 
 9
 
 130 LOCAL THERAPEUTICS. 
 
 conjunctival discharge, with half a grain of alum. In wounds involving 
 the cornea and iris, a four-grain solution is commonly used. Atropine is 
 useful in most cases of KERATITIS, particularly in the acute form, with a 
 painful and irritable condition of the eye. In cases of INDOLENT COR- 
 NEAL ULCER, or SLOUGHING OF KERATITIS, or when the intraocular ten- 
 sion is much increased, eserine sometimes acts better. This subject has 
 been much discussed, but the indications for the use, in corneal affections, 
 of these two drugs, so opposite in their action, are not yet definitely for- 
 mulated. The surgeon will, in many cases, have to be guided by the 
 teachings of his own experience, or by trial. Superficial ulcerations are 
 best checked by the actual cautery, while in extensive sloughing involv- 
 ing the deeper layers of the cornea, a free " Saemisch incision" often 
 offers the only hope of success. Compresses and hot stupes are import- 
 ant aids in the treatment. In the case of a penetrating ulcer or wound 
 near the centre of the cornea, dilatation of the pupil is indicated to pre- 
 vent prolapse of the iris. 
 
 Atropine is not now nearly so generally used as formerly after CATARACT 
 EXTRACTION, and is thought to increase the tendency to prolapse of the 
 iris, particularly in the case of operation without iridectomy. Many 
 surgeons use eserine to draw the iris away from the corneal wound. After 
 the incision is healed, however, atropine is useful by dilating the pupil and 
 contracting the blood-vessels of the iris. If iritis sets in its use is imper- 
 ative. Dilatation of the pupil before the operation is secured by the ap- 
 plication of cocaine, which is now almost universally used for its anaesthetic 
 effect. It is customary to apply atropine both before and after the opera- 
 tion for solution. 
 
 Atropine acts more slowly on the accommodation than on the pupil. 
 According to Bonders a four-grain solution commences to act in about 
 fifteen minutes, but complete paralysis is not attained until more than 
 an hour and a half. There is a full return of accommodation in eleven 
 days, rather earlier than the restoration of the pupil's action. As, how- 
 ever, there is a decided variation in the susceptibility of different indi- 
 viduals, and a ciliary muscle irritated by excessive strain resists the action 
 of the drug, to be sure of the full effect it is customary to make the appli- 
 cation three times a day for a day or two. Attained in this way the effect 
 does not usually disappear entirely in much less than two weeks. This 
 property of atropine has occasionally a therapeutic value in cases of spasm 
 of the accommodation, or when it is desired to relieve the EFFECTS OF 
 EXCESSIVE ACCOMMODATIVE STRAIN by a period of complete rest, but its 
 most important use is in the determination of the refraction. The action 
 of mydriatics in suspending the accommodation is invaluable to ophthal- 
 mic surgeons in their optical work, as the contraction of the ciliary
 
 BELLADONNA. 13! 
 
 muscles introduces an unknown and varying factor, which is liable to 
 vitiate the most careful calculations, and in .young subjects no certainty 
 can be reached while this muscle is allowed full play. 
 
 Patients are occasionally met with in whom the application of atropine 
 produces a peculiar form of conjunctivitis. The conjunctiva is congested 
 and the eye is irritable and watery, and the follicles in the conjunctival 
 folds are sometimes enlarged. There is usually, also, erythematous in- 
 flammation of the skin of the lids and cheek. This form of conjunctivitis 
 is, in very rare cases, produced by a single instillation, and results from 
 a too prolonged use of the drug, perhaps more frequently than is generally 
 supposed. Kroener {Oph. Rev., Jan., 1882) thinks that atropine conjunc- 
 tivitis is of septic origin, and is due to the FUNGOID GROWTHS found in 
 solutions that have stood for some time, and recommends the addition of 
 carbolic acid (i to 1000) to keep the solution clear. This view is not 
 generally adopted. 
 
 A more serious danger is the tendency of atropine to induce GLAUCOMA. 
 This it is thought to do by increasing the thickness of the iris and crowd- 
 ing its periphery into the angle of the anterior chamber, thus impeding 
 the escape of fluids by way of the space of Fontana. The irritation of 
 excessive light through the dilated pupil, when the eye is not protected, 
 may be another cause. Atropine should never be applied when there is 
 suspicion of glaucoma, and its use in the case of old people should be 
 cautious, and at first tentative, in weak solutions, except when iritis makes 
 an immediate and decided effect imperative. The now universally ad- 
 mitted fact that atropine may increase intraocular tension is in apparent 
 contradiction to the opinion of the earlier observers that it reduces it by 
 contracting the blood-vessels and diminishing secretion. It seems prob- 
 able, however, that it diminishes pressure in the healthy eye, but, by the 
 mechanical effect of the dilated pupil, increases it " in the eye predisposed 
 to glaucoma, because the angle of the ariterior chamber is already dan- 
 gerously narrow" (Priestly Smith). Stocker, of Lucerne (Oph. Rev., 
 vol. vi, p. 359) states positively, as the result of numerous experiments 
 with the manometer on curarized cats, that under physiological conditions 
 atropine always produces a decided fall in the intraocular pressure, thus 
 confirming the viewof Graefe, Wegner, Adamiick, Griinhagen, and Pfliiger. 
 
 HOMATROPINE. 
 
 Hydrobromate of homatropine, a derivative of atropine, has of late 
 years been extensively used as a means of suspending the accommoda- 
 tion. It is likely, to a great extent, to supplant all other mydriatics in 
 ordinary refraction work ; as while equally efficient its effects last less than 
 one-fourth as long as those of atropine, and about half as long as those 
 of duboisine, and the danger of inconvenience from constitutional poison-
 
 132 LOCAL THERAPEUTICS. 
 
 ing is practically nil. Conjunctival hyperaemia and a slight burning sen- 
 sation usually follow its use, but are much less marked now than at the 
 time of its first introduction, probably on account of improvement in 
 the process of manufacture. There has been much difference of opinion 
 among ophthalmic surgeons as to its reliability, and the subject has been 
 a good deal discussed, but numerous and careful observations have shown 
 that those who find it inefficient do not use it in a way to secure its full 
 effect. Used as it is customary to use atropine, duboisine, or hyoscyamine, 
 it is certainly much less reliable than those mydriatics. The most prac- 
 tical and convincing test of the comparative value of homatropine is 
 that made by E. Jackson (Phila. Med. News, July 24, 1886), who first 
 corrected the refraction of fifty-two eyes under homatropine and after- 
 ward subjected the same eyes to careful testing with other mydriatics. 
 He claims that a 2 per cent, or 2^ per cent, solution used in the proper 
 way paralyzes the accommodation just as certainly and thoroughly as a i 
 per cent, solution of atropine or a ^ per cent, solution of duboisine. 
 
 A solution of from ten to sixteen grains to the ounce should be em- 
 ployed. The former is probably sufficient, but some surgeons think that 
 the latter gives greater security of prompt action ; the only objection 
 to it is the expense. From three to five applications should be made at 
 intervals of ten or fifteen minutes. The effect commences in from ten 
 to twenty minutes, is usually complete in less than an hour, and lasts 
 from one and a half to four days. In exceptional cases, which are per- 
 haps not very infrequent, it may last longer than the latter period. At 
 the present writing a young man presents himself, in whom the action of 
 the iris and ciliary muscle is still decidedly impaired at the end of four 
 and a half days, and de Schweinitz (Oph. Rev., Dec., 1890) reports 
 a case in which recovery was not complete for nearly six days. There 
 is, however, very rarely any serious inconvenience after the second day. 
 For therapeutic purposes homatropine is inferior to the other mydriatics, 
 and when choroidal and retinal congestion resulting from accommodative 
 strain renders prolonged rest necessary, there is nothing so satisfactory as 
 atropine. To dilate the pupil for ophthalmoscopic purposes, a solution 
 of one grain to the ounce is sufficient and causes little inconvenience. 
 
 As to the danger of exciting glaucoma, homatropine has probably no 
 advantage over the other mydriatics but the shorter duration of its 
 effects. A case of glaucoma following its use is recorded by Hodges 
 {Arch, of Ophthal., vol. xiv, p. 42), and in the Trans, of the Am, 
 Ophthal. Soc'y for 1890 (Harlan) is reported a case in which transient 
 pulsation of the retinal arteries was repeatedly produced by it. 
 
 Several cases have been reported in which the effect of homatropine 
 and of atropine was unusually prolonged. {Trans. Am. Ophthal. Soc'y,
 
 BENZINUM BENZOIN. 1.33 
 
 The supraorbital pain of IRITIS and CYCLITIS is relieved by the appli- 
 cation of belladonna ointment to the brow, and this may be particularly 
 useful in cases in which the alkaloids are not well borne by the conjunc- 
 tiva. A convenient mode of applying belladonna externally is to give 
 the extract the proper consistency by means of water or glycerin, spread 
 it on the skin and cover it with tissue paper. 
 
 BENZINUM. Benzin. Benzine. Petroleum Ether. 
 
 "A purified distillate from American petroleum, consisting of hydrocarbons, chiefly of 
 the marsh-gas series, having a specific gravity of from 0.670 to 0.675, an ^ boiling at 50 
 to 60 C. It is a transparent, colorless, diffusive liquid, of strong characteristic odor, 
 slightly resembling that of petroleum, but much less disagreeable. It is insoluble in 
 water, soluble in about six parts of alcohol, and readily so iu ether, chloroform, benzol 
 and fixed and volatile oils. It is highly inflammable, and its vapor, when mixed with air 
 and ignited, explodes violently. Benzin, when evaporated 6n the hands, should leave 
 no odor." (U. S. P.) The odor of benzin is penetrating and unpleasant. 
 
 This substance should not be confounded with the article known as benzol or benzene, 
 which is a derivative of coal-tar. 
 
 Benzin is refrigerant and rubefacient. 
 
 General Surgery. Benzin evaporates so rapidly that local tem- 
 perature can easily be reduced, by a spray, to below the freezing point. 
 The spray produced by a hand atomizer will diminish sensibility and 
 secure local anaesthesia so well that this method may be used as a substi- 
 tute for etherization in small surgical operations. In doing this care must 
 be exercised, as the freezing process may be carried too far and produce 
 frostbite, or even sloughing. The action of benzin, applied with fric- 
 tion, resembles that of turpentine. Benzin is sometimes applied on 
 flannel, or with friction, for the relief of RHEUMATIC and NEURALGIC 
 PAINS. 
 
 On account of its low cost benzin is commonly used in the Paquelin 
 thermo-cautery, although the lighter hydrocarbons, as gasolin and rhig- 
 olin, will answer a similar purpose. 
 
 BENZOIN. 
 
 " A balsamic resin obtained from Slyrax Benzoin." (U. S. P.) 
 
 Benzoin is soluble in " five parts of moderately warm alcohol, and also in solution of 
 potassa." (U. S. P ) " It is precipitated from its solution in alcohol by water. It imparts 
 to boiling water a notable proportion of benzoic acid." (U. S. D.) Benzoin preserves 
 fats from oxidation, and is for this purpose a constituent of many ointments. It is 
 employed in pharmacy in preparing Benzoinated Lard (two parts of benzoin digested in 
 one hundred parts of hot lard) : Tincture of Benzoin (one part of benzoin to five parts 
 of alcohol); and Compound Tincture of Benzoin (containing benzoin, aloes, storax, and
 
 1 34 LOCAL THERAPEUTICS. 
 
 balsam of tolu). In evidence of the popularity of benzoin, it may be mentioned at this 
 place that the compound Tincture of Benzoin is known also as Waders Balsam, Friar's 
 Balsam. Jesuit' 's Drops, Turlington's Balsam, Elixir traumaticum of Baume de Cotn- 
 mandeur de Permes, etc. 
 
 The composition of the compound tincture of benzoin is as follows : 
 B- Pulv. benzoini, ,^iiiss; pulv. aloes purif., gr. cclx ; pulv. styracis, ^iiss; bals. 
 tolutani, 3'j-^j; alcoholis, q. s. ad Oij. 
 
 A powder can be made from this preparation by pulverizing the mass resulting upon 
 the evaporation of the alcohol. 
 
 Benzoin is antiseptic, protectant, and slightly stimulating. Its pecu- 
 liar aroma is agreeable to most persons, and renders the local use of 
 benzoin available in affections of the respiratory mucous surface. It is 
 moderately stimulating to granulating surfaces and open wounds. Benzoin 
 makes no toxic impression. Benzoic acid (^. #.) is more inviting than 
 the resin. 
 
 General Surgery. The principal preparation of benzoin in common 
 use is the compound tincture. When this is applied to the skin (as with 
 a brush), the alcohol soon evaporates, leaving parts covered with a film 
 of benzoin, which, if sufficiently thick, makes a good protectant. The 
 compound tincture has been recommended (Ashhurst and Bryant) in the 
 treatment of compound fractures, a small piece of lint being saturated 
 with the preparation and placed over the wounds. It is largely used in 
 the same way to close punctures in the skin after tenotomy. Compound 
 tincture of benzoin, in conjunction with collodion, makes a reliable 
 means of retaining dressings on small wounds, e.g., those of the face, 
 the scalp, etc. Such a preparation can be made by evaporating the 
 compound tincture to dryness in a water bath, and redissolving the resi- 
 due in collodion. Its efficacy is increased by introducing a few fibres of 
 cotton or fine gauze, after the first layer is painted over the selected sur- 
 face and then covering all with a second coating. We frequently add to 
 it iodoform, which it dissolves, thus increasing the antiseptic properties 
 of this agent. 
 
 Diseases of the Skin. R. W. Taylor has employed the compound 
 tincture of benzoin as a vehicle for the application of bichloride of mer- 
 cury in RINGWORM OF THE THIGHS, etc. His formula, which we have 
 used with satisfaction, is as follows: R. Hydrarg. bichlor., gr. ij-iv; 
 tinct. benzoin, comp., fgj. M. A brush is passed through the cork and 
 the solution is painted on the affected part once or twice daily. 
 
 The compound tincture of benzoin relieves the irritation accom- 
 panying FROSTBITE ; it is in like manner used with success in CHAPPED 
 NIPPLES. Equal parts of the compound tincture and glycerin form 
 an available application for CHAPPED HANDS AND LIPS.
 
 BENZOIN. 
 
 135 
 
 Diseases of the Nose, Throat, etc. Benzoin is used in the 
 respiratory tract in the form of the powdered gum, the compound tincture, 
 and benzoated lard. 
 
 Michel, of Hamburg (59. Versammlung der Deutschen Naturforscher 
 und Aerzte, 1886), believes that when applied to the nostrils pulverized 
 benzoin may check the evolution of WHOOPING COUGH. But since he 
 recommends that a small proportion of nitrate of silver and sulphate of 
 quinine be added, it becomes difficult to ascertain the impression made by 
 the benzoin. 
 
 In the form of the compound tincture, benzoin is largely used in 
 CATARRHAL AFFECTIONS OF THE PHARYNX AND LARYNX. In the form of 
 a gargle eight drops to an ounce of water are recommended to obtain a 
 minimum impression. Equal parts of the tincture and water may be pre- 
 scribed, the patient diluting to suit the taste. In the form of inhalation 
 forty to sixty minims are added to a half pint of, water at 145 F. It 
 can be used freely. The indications for the above fluid preparations are 
 either acute inflammation or the relaxed condition which is often found 
 at the end of an acute attack. It is, moreover, valuable in the irritability 
 of the general mucous surfaces of the throat attending inflammation of 
 any grade. In vocalists who suffer from hoarseness, the result of over- 
 use of the throat, it is one of the most popular of remedies. The tincture 
 makes a good application to spongy gums. 
 
 M. Mackenzie uses a solution of one part of gum benzoin to five parts 
 of spirit as a varnish to DIPHTHERITIC DEPOSITS ; the membrane should 
 be first dried with blotting paper before the application is made. 
 
 F. Barker found the tincture of benzoin promptly efficacious in the 
 EPISTAXIS of young children after other remedies had failed. The 
 application is followed by some pain, both in the nose and the ear of 
 the affected side, which soon passes off. The compound tincture mixes 
 well with glycerin and cosmoline. In the latter form it has been used 
 by A. S. Houghton {Jour. Am. Med Ass'n, Nov. 7, 1885) as an in- 
 halant. 
 
 A. Kebbell (Brit. Med. Jour., Feb. 28, 1885) claims that to hold a 
 bottle containing tincture of benzoin to one nostril and close the other, 
 the patient inspiring deeply, relieves troublesome symptoms and cuts 
 short attacks of acute coryza. 
 
 Inhalations of benzoin are very popular in acute catarrhal inflammation 
 of the upper respiratory passages. The compound tincture is ordinarily 
 used in the proportion of one drachm to a pint of water at 140 F. The 
 sedative action is increased by the addition of a half drachm of chloro- 
 form. If an increased stimulating effect is desired, a drachm of the oil 
 of the Pinus tyfoesfrisuny be added (LefFerts). A convenient domestic 
 form of inhalation for acute inflammation of the throat is the following :
 
 136 LOCAL THERAPEUTICS. 
 
 Add a teaspoonful of the tincture to a half pint of hot water. A cone, 
 made of paper or some other convenient substance, is placed over the 
 top of the vessel and the steam is allowed to escape through the 
 truncate apex. The mouth is placed over this opening and the steam 
 is inhaled. 
 
 The irritation of the fumes of nitrate of potash (g. v.~) is mitigated by 
 admixture with the vapor of benzoin. 
 
 ACIDUM BENZOICUM. Benzoic Acid. 
 
 Benzoic acid is made, by sublimation and purification, from benzoin, and, also, by 
 boiling benzoin with an alkaline liquid, thus forming a benzoate and precipitating the 
 benzoic acid therefrom by means of hydrochloric acid. It is also made synthetically from 
 toluol naphthaline and suint, a greasy substance obtained from wool. Pure benzoic acid 
 is inodorous ; that prepared from the balsam by sublimation is contaminated with a pro- 
 portion of an aromatic oil, which gives it the well known odor of benzoin. 
 
 "Benzoic acid is soluble in 500 parts of water and three parts of alcohol at 15 C. 
 (59 F.), in 15 parts of boiling water and one part boiling alcohol; also soluble in three 
 parts of ether, in seven parts of chloroform, and readily soluble in disulphide of carbon, 
 benzol, benzin, and oils." (U. S. P.) It forms freely soluble salts with solutions of 
 potassa, soda, and ammonia, and from solutions of these salts is precipitated, by the 
 mineral acids. 
 
 Benzoic acid, in solution in the proportion of i to 287 (0.348 per 
 cent.), prevents the development of bacteria taken from meat infusion. 
 Its action, however, is feeble compared with that of the other parasiticides, 
 although it is claimed to be fully as poisonous to bacteria as salicylic or 
 carbolic acid. 
 
 Benzoic acid is a stimulant, and even an irritant to raw dermal sur- 
 faces. 
 
 Diseases of the Skin. Benzoic acid is an excellent local applica- 
 tion in URTICARIA. R. Acid, benzoic., 333; Aquae, Oj. M. 
 
 General Surgery. Benzoic acid in saturated solution is said to 
 yield excellent results as an injection into old SINUSES. 
 
 Diseases of the Nose and Throat. Benzoic acid in most respects 
 is an exchangeable therapeutic agent with gum benzoin, but it is well 
 to remember that it is more irritating. Owing to its solubility, it is avail- 
 able for lotions. Benzoic acid may be used as a substitute for boric 
 acid. A drachm added to boiling water may be used as an inhalant night 
 and morning in BRONCHITIS and CHRONIC PHTHISIS; it eases cough and 
 lessens expectoration. 
 
 A small portion of benzoic acid added to borax and table salt makes 
 an agreeable addition to a lotion for irritative forms of CHRONIC NASAL 
 CATARRH, unaccompanied by tenacious or muco-purulent discharge. 
 The following is a formula for general guidance: R. Sodii boratis, 
 sodii chlor., aa ij ; acidi benzoici, gr. x; ft. chart., No. j. To a half
 
 BENZOL BISMUTHI BORAS. 
 
 137 
 
 tumbler of water add a half teaspoonful each of the powder and glycerin. 
 Use freely as a lotion. 
 
 The irritating qualities of iodine as an inhalant are in a measure con- 
 trolled by adding 16 grains of benzoic acid to an ounce of the tincture 
 of iodine. A teaspoonful is placed in a pint of water at 140 F. G. M. 
 Lefferts recommends the following for ACUTE ANGINA: benzoic acid 
 three grains; kaolin, twelve grains. Rub together and add tincture of 
 tolu, eighteen drops; water, one ounce. Shake and make up the 
 quantity with water to one ounce. A teaspoonful in a pint of water at 
 140 F. for each inhalation. 
 
 Benzoic acid is recommended by W. D. Miller (" Micro-organisms of 
 the Human Mouth," Phila., 1890) as an antiseptic to arrest dental 
 caries. 
 
 Lozenges containing benzoic acid are agreeable in taste and serve a 
 useful purpose in SUBACUTE PHARYNGITIS and LARYNGITIS. Each lozenge 
 contains one-half a grain of the agent. The red balm of Gilead balsam 
 contains benzoic acid and probably derives its efficiency therefrom. 
 
 BENZOL (C 6 H 6 ). Benzen. Benzene. Benzole. Phenylhydride. 
 
 " Benzol is a colorless, limpid liquid, possessing an agreeable odor. Its specific gravity 
 is 0.85. It congeals at 32 F., and boils at 176 F." (U. S. D.) It dissolves sulphur, 
 phosphorus, iodine, and most resins and fats. It also dissolves some alkaloids, quinine, 
 morphine, strychnia, and others. This is not the article known as benzin, which is obtained 
 from petroleum oil, nor has it any relation to benzoin or benzoic acid. These misappre- 
 hensions concerning it are widespread. When benzol or benzene is spoken of in works 
 on chemistry, the substance now under consideration is intended. It is prepared from 
 coal-tar. 
 
 Benzol is an active antiparasiticide but does not affect the skin. 
 
 Diseases of the Throat, Etc. A drachm of benzol to the ounce 
 of water is similar in its action to benzoin, but is slightly more stimu- 
 lating as an inhalant. It may be administered in the presence of a little 
 carbonate of magnesia and six minims of the oil of cassia (Lennox 
 Browne). 
 
 BISMUTHI BORAS. Borate of Bismuth. 
 
 Diseases of the Nose, Throat, Etc. Borate of Bismuth infre- 
 quently substitutes the subnitrate of bismuth in powders for the relief of 
 catarrhal states of the nose, pharynx, and larynx.
 
 138 LOCAL THERAPEUTICS. 
 
 BISMUTHI OLEAS. Oleate of Bismuth. 
 
 Diseases of the Skin. Bismuth oleate enters into the composition 
 of a very excellent soothing ointment, brought into notice some years 
 ago by McCall Anderson, and to which the name of this distinguished 
 dermatologist is given. 
 
 McCall Anderson's ointment is composed as follows: R. Pulv. bis- 
 muthi oxidi, 3j ; acidi oleici, gj ; cerae albse, jiij ; vaselini, 3j~3J j OK 
 rosae, q. s. 
 
 The oxide of bismuth and oleic acid are heated together in a capsule 
 until combination takes place, and then the other ingredients are added 
 with stirring. Properly made the ointment should be of the color and 
 consistence of fresh butter, with an agreeable odor. Next to the Ung. 
 diachylon (Hebra) it is the most soothing of ointments. 
 
 BISMUTHI OXYCHLORIDUM. Oxychloride of Bismuth. 
 Oxychloride of bismuth is an impalpable, neutral, insoluble, non- irritating powder. 
 It is preferable to the subnitrate for local use, because of the much greater fineness of its 
 powder, the property that it has of adhering very closely to mucous surfaces, and the 
 fact that it is absolutely non-irritating. Oxychloride of bismuth is the principal ingredient 
 in many cosmetic powders. It gives a peculiar pearly, glossy whiteness to the skin. 
 
 Diseases of the Skin. Bismuth Oxychloride has been recommended 
 as an application in CHLOASMA and other pigmentary derangements of 
 the skin. 
 
 Diseases of the Throat. H. McNaughton Jones recommends that 
 a half grain of the oxychloride of bismuth be used in NASAL and 
 PHARYNGEAL INFLAMMATION by insufflation, in two or three grains of 
 powdered starch. M. Mackenzie prefers this salt to the subnitrate. 
 
 BISMUTHI SUB-BENZOAS. 
 
 General Surgery. Bismuth sub-benzoate is a white powder with an 
 aromatic odor. It has been introduced by Dr. Fenger {Lyon Medical, 
 March 2, 1890) as a substitute for iodoform in the topical treatment ot 
 CHANCRE. A slight burning sensation is experienced upon applying it, 
 but this soon passes away. In from three to six days the chancre assumes 
 a healthy appearance and pursues a rapid progress toward cure. 
 
 BISMUTHI SUBCARBONAS. Subcarbonate of Bismuth. 
 Subcarbonate of bismuth is " a white or pale yellowish -white powder, permanent in 
 the air, odorless, and tasteless, and insoluble in water or alcohol." (U. S. P.)
 
 BISMUTHI SUBIOD1DUM BISMUTHI SUBNITRAS. 139 
 
 Diseases of the Throat. Subcarbonate of bismuth three grains, 
 acetate of morphine one-quarter grain, forms the basis of a pastille, recom- 
 mended by Whistler in acute and subacute CATARRH OF THE LARYNX, 
 PHARYNX, TONSILLITIS, etc. It is also employed as a sedative in LA- 
 
 RYNGEAL PHTHISIS. 
 
 For Sub-gallate of Bismuth see Dermatol. 
 
 BISMUTHI SUBIODIDUM. Subiodide of Bismuth. Iodide of Bis- 
 
 muth. Oxyiodide of Bismuth. 
 An odorless, tasteless, insoluble, amorphous, light brownish-red powder. 
 
 General Surgery. Subiodide of bismuth was brought into notice 
 by Ogg {British Med. Jour., 1887) as a substitute for iodoform. While 
 inferior to the latter in its effect, it has the advantage as regards odor. 
 In SYPHILITIC, CHANCROIDAL, or SIMPLE ULCERS it may be applied in 
 powder. When a foul ulcer exists, which cannot often be dressed, it may 
 be packed with the subiodide of bismuth and sealed up. 
 
 Diseases of the Ear, etc. The subiodide of bismuth is by some 
 practitioners preferred to boric acid in the dry treatment of CHRONIC 
 OTITIS MEDIA. 
 
 BISMUTHI SUBNITRAS. Subnitrate of Bismuth. 
 
 Subnitrate of bismuth is " a heavy, white powder, permanent in the air, odorless, 
 almost tasteless, showing a slight acid reaction when moistened on litmus paper, and 
 insoluble in water or in alcohol." (U. S. P.) It is slightly acid and minutely crys- 
 talline. 
 
 Subnitrate of bismuth is protectant, sedative, slightly astringent, and 
 antiseptic. 
 
 In the treatment of diseases of the skin and mucous surfaces the sub- 
 nitrate of bismuth is being substituted by many practitioners for the oxy- 
 chloride of bismuth (q. v.}. 
 
 General Surgery. Mixed with glycerin to the consistency of a 
 thick pigment and spread on patent lint, Subnitrate of bismuth is useful 
 in the treatment of SCALDS and BURNS. The lint should be covered with 
 oil silk or rubber ; or the powder may be dusted over ABRASIONS and 
 SUPERFICIAL WOUNDS. It allays the irritation of the ulceration accom- 
 panying an INGROWING TOE-NAIL. 
 
 Bumstead regards the Subnitrate of bismuth as an ingredient of an ex- 
 cellent injection in the last stages of GONORRHCEA. The drug is best 
 administered suspended in mucilage or glycerin. A formula is herewith 
 given: R. Bismuthi subnitratis, 3] ; mucilaginis cydonii, f^ss; Aquae,
 
 14 LOCAL THERAPEUTICS. 
 
 f^vss. M. It is necessary to remember that this preparation will occa- 
 sionally clog the urethra, and excite uneasy sensation in the part until 
 urine is voided. Subnitrate of bismuth forms the basis of an urethral 
 suppository in the treatment of GLEET, and of a vaginal tampon in the 
 treatment of LEUCORRHCEA. Houghton and King bear testimony to the 
 great value of enemata, in which the drug enters, in TROPICAL DYSEN- 
 TERY ; half a drachm of bismuth subnitrate and half a drachm of pow- 
 dered acacia should be mixed in two fluidounces of water and injected 
 once or twice daily, according to the severity of the case, the mass to 
 be retained. The severe tenesmus and tormina are relieved in a short 
 time. Trousseau employs one part of the salt with three parts of gly- 
 cerin as an application to FISSURE OF THE ANUS. The pigment here 
 acts as a foreign body, keeping the sides of the fissure apart and allowing 
 healing to take place from the bottom. 
 
 Diseases of the Skin. Subnitrate of bismuth should not be em- 
 ployed in connection with any sulphur preparation, as this results in 
 staining the skin. In fact, such discoloration occasionally takes place on 
 the face and elsewhere, about the sebaceous follicles, from some reaction 
 between their contents and the drug. 
 
 The finely powdered subnitrate of bismuth is employed as a dusting 
 powder, usually alone, but sometimes combined with other powders of 
 similar action, or with simple starch. In INTERTRIGO or CHAFING it is 
 particularly useful ; also in some forms of ERYTHEMA, when a powder can 
 conveniently be applied, and in CHAPPED HANDS or NIPPLES. When 
 there is any discharge from the skin, powdered bismuth subnitrate should 
 rarely be used, as it, like most powders under such circumstances, is apt 
 to cake. 
 
 Lotions containing bismuth subnitrate are very useful in ERYTHEMA, in 
 erythematous ECZEMA, in inflammatory ACNE, and similar conditions, 
 v The following lotion, when the sedative and astringent effect of the bis- 
 muth subnitrate is supplemented by the anti-pruritic effect of the prussic 
 acid, is a valuable remedy: R. Bismuthi subnitratis, 3J-ij ; acidi hydro- 
 cyanici, dil., fgj ; aquae aurantii flor., ad. fgiv. M. 
 
 In ointment with vaseline or cold cream, in the proportion of half a 
 drachm to a drachm of the bismuth subnitrate to the ounce of ointment, 
 this forms an excellent application in ECZEMA, IMPETIGO, and other in- 
 flammatory skin-diseases, accompanied by weeping or suppuration. Its 
 antiseptic properties here find application in preventing infection. 
 
 Diseases of the Nose, Throat, etc. Subnitrate of bismuth may 
 be selected as an agent to give bulk to powders containing iodoform, 
 with the light, flake-like scales of which it easily mixes and enables the 
 substance to be retained upon the surfaces on which there is excess of 
 secretion. One of the favorite uses of the drug is to snuff it up the nos-
 
 BISMUTHI TANNAS BISMUTHI TRINITRAS BLEEDING. 141 
 
 tril in ACUTE CORYZA. It gives temporary relief to the sense of disten- 
 tion and heat. The subnitrate of bismuth enters into the composition 
 of Ferrier 1 s snuff, in proportion of six drachms of bismuth, two drachms 
 of powdered acacia, and two grains of muriate of morphine. Of this 
 quantity one-quarter to one-half may be used in twenty-four hours, or one 
 part of the drug may be added to acacia, starch, lycopodium, or 
 even Venetian talc (Trousseau). Combined with the yellow oxide 
 of mercury, subnitrate of bismuth is useful in the form of anointment in 
 ECZEMA of the nostrils. In the treatment of PHARYNGITIS and LARYN- 
 GITIS, accompanied with hypersecretion, subnitrate of bismuth is of the 
 same value as in the treatment of CORYZA. Whistler has suggested its 
 use in the form of a pastille. It has been especially recommended in 
 CHRONIC (ESOPHAGITIS ; one pastille can be taken every half hour. 
 
 In the proportion of five grains to an ounce of rose water, to which a 
 little glycerine has been added, subnitrate of bismuth is an agreeable 
 mouth wash in SUPERFICIAL GLOSSITIS and in. APHTHAE. 
 
 BISMUTHI TANNAS. 
 
 Tannate of bismuth is prepared by triturating the moist hydrate from 44 parts of sub- 
 nitrate of bismuth with 20 parts of tannic acid. After the mixture has stood an hour or 
 two it is washed, and then dried at a gentle heat. The product consists of 53 per cent, 
 bismuthous oxide and 47 per cent, of tannic acid. It is insoluble, and therefore, nearly 
 tasteless. 
 
 Diseases of the Nose, etc. Tannate of bismuth is used by some 
 French physicians as an astringent for the nasal mucous membrane. 
 {Jour, de Med.de Paris, 1890.) 
 
 BISMUTHI TRINITRAS. Trinitrate of Bismuth. Bismuth Nitrate. 
 A crystalline salt deposited from solutions of bismuth in nitric acid. The form in 
 which it is usually used is that of the glycerite, made by dissolving sixty grains of 
 crystallized nitrate of bismuth in one ounce by weight of glycerin without heat. It can 
 be diluted with its own weight of water without precipitation, but larger quantities of 
 water precipitate it. 
 
 According to H. McNaughton Jones, the trinitrate of bismuth is an 
 ingredient of Ferried s snuff. 
 
 BLEEDING. 
 
 General Surgery. In the pre-an aesthetic days of medical practice, in 
 order to produce muscular relaxation, patients were bled up to the point 
 of syncope before attempting the reduction of a dislocation. To-day 
 bleeding is so seldom practiced that many physicians have never per- 
 formed or even seen the operation of phlebotomy. Jiirgensen, in his
 
 142 LOCAL THERAPEUTICS. 
 
 exhaustive article on the subject, in von Ziemssen's Therapeutics, makes 
 the following statement : " What I have seen of it (bleeding) has been 
 incapable of leaving any douht in my mind that this treatment is seldom 
 and perhaps never imperative." It is far different from local depletion. 
 Two forms are yet in vogue, viz., leeching, and scarification with cupping. 
 
 Leeching. The use of leeches is indicated when it is desired to ab- 
 stract blood from localities which, from their position, or from excessive 
 tenderness, makes it difficult to be operated upon by the knife. In order 
 to imitate as near as is practicable the conditions under which these ani- 
 mals secure their food, the skin over the selected locality should be care- 
 fully cleansed, especially should all traces of soap be removed, and of 
 such pungent medicaments as turpentine, liniments, etc., otherwise the 
 animals will refuse to bite. A little blood or milk smeared upon the skin 
 will often induce leeches to take hold. Medicinal leeches are of two 
 kinds, the Swedish and American. The former are much the more power- 
 ful and, at least in the treatment of adults, are, as a rule, preferred. Each 
 abstracts from one-half ounce to an ounce of blood. The American leech 
 is one-sixth the strength of the European. Where a number of leeches 
 are to be applied, as over the abdomen in nervous persons, where each 
 bite causes alarm, the leeches may be placed in a half tumbler of cold 
 water, and by an adroit movement the tumbler may be inverted on the 
 part and the leeches will attach themselves rapidly; the water may be 
 drained away and caught in a pledget of absorbent cotton. It is not 
 uncommon for leech bites to continue bleeding. This bleeding may be 
 controlled by pressure, Monsel's solution on cotton, styptic cotton, or, if 
 these fail, by the application of the actual cautery. Leeches should not 
 be applied where the skin is delicate or loose, as on the eyelids or scrotum. 
 They are often employed with great advantage in the early stage of PERI- 
 TONITIS. The application of a dozen Swedish leeches over the distended 
 and tender abdomen, followed by hot poultices, will frequently be fol- 
 lowed by the most happy results. In ACUTE SYNOVITIS of the knee joint, 
 accompanied by much pain and throbbing, the application of half a 
 dozen leeches will often be of service, and will assist in cutting short an 
 attack which, under ordinary circumstances, might be of long duration. 
 In PROSTATITIS, accompanied by pain and throbbing, the application of 
 a few leeches to the perineum, in conjunction with other remedies, is often 
 productive of good results. It has been advised by some authorities to 
 apply the leeches to the anterior wall of the rectum, but this requires 
 unusual skill in dealing with these animals. 
 
 Cupping. This mode of securing a local loss of blood is now rarelj 
 used, and since, in order to make it efficient, it involves a previous scarif 
 cation of the skin, the reader is referred for its consideration to worl 
 on minor surgery.
 
 BLEEDING. 143 
 
 While DRY CUPPING is, properly speaking, not a form of bleeding, 
 since the blood obtained by enforced extravasation is again absorbed, the 
 method can be conveniently considered in this place. In dry cupping 
 the blood is brought to the surface by the application of a hollow glass 
 bell, from which the air has been exhausted. Various forms of cupping 
 apparatus, which, however, are soon liable to get out of order if not 
 kept in constant use, are offered for sale. An ordinary stout drinking 
 glass serves a convenient purpose. A little cotton or a few drops of 
 alcohol are placed within it (if the agent last named is employed, it must 
 not be in amount sufficient to run down to the sides) and then ignited. 
 While this is burning the glass is placed on the desired spot. The instant 
 it touches the skin the flame is extinguished and the glass adheres firmly ; 
 in a few moments the integument is deeply drawn into the mouth of the 
 vessel, and soon the blood will be seen approaching the surface, leaving 
 a dark welt beneath the skin. The glass should remain in position from 
 five to ten minutes. If many small hairs are on the skin the cup will not 
 hold well, as a slight amount of air will leak in, causing it to lose its 
 grasp. Dry cupping of the chest is often of service in the early stages 
 of PNEUMONIA. We have seen patients unable to lie down, with hurried 
 respiration, and face flushed, after the application of half a dozen large 
 cups over the surface of the chest, assume the reclining position and 
 pass into a quiet sleep. If the individual be thin, and the ribs prominent, 
 large cups will not adhere, and smaller ones must be employed. Under 
 these circumstances narrow-mouthed ale glasses will be found satisfactory. 
 In NEPHRITIS and RENAL CONGESTION accompanied with suppression of 
 urine, dry cupping over the loins will often be followed by good results. 
 Four or five large cups will suffice. 
 
 Diseases of the Ear, No.se, and Throat. The abstraction of 
 blood from the ear is confined to the region of the tragus. It is true 
 that incisions are made on the lining membrane of the external auditory 
 meatus or the tympanic membrane, but in these localities the removal 
 of the blood is incidental. 
 
 Blood is ordinarily removed by leeches for the relief of ACUTE OTITIS 
 MEDIA. From a half ounce to an ounce may be taken. The relief 
 obtained by this simple procedure is often great and not infrequently 
 aborts an acute attack. Should the tension and pain be due to accumu- 
 lation of mucus in the tympanic chamber the procedure does not take 
 precedence of paracentesis. 
 
 Bleeding is of use in the treatment of CHRONIC NASAL CATARRH. 
 As a rule the form associated with hypertrophy of the mucous membrane 
 presents the best indications for depletion. That this statement is not 
 without exceptions is evident from the fact that the blood-vessels in the
 
 144 LOCAL THERAPEUTICS. 
 
 forms in which the parts are atrophied are often distended in parts with 
 venous blood. However we may explain the fact, the conclusion is tem- 
 perate that in both of the above-named forms of chronic nasal disease the 
 local loss of blood not infrequently is followed by marked benefit to the 
 patient. In HYPERTROPHIC CATARRH the blood is removed by pricking 
 here and there the distended surfaces. This ordinarily is best accomplished 
 at the anterior end of the inferior or of the middle turbinated bone, as 
 well as the region which answers to the line of junction of the triangular 
 cartilage with the perpendicular plate of the ethmoid bone. In ATROPHIC 
 CATARRH the points to be selected for depletion are almost uniformly on 
 the septum, pretty well up and directly in front of the middle turbinated 
 bone. In order to obtain relief the parts must bleed rather freely, that is 
 to say, from two drachms to a half ounce or even an ounce. The hemor- 
 rhage generally stops spontaneously. If the parts are depleted a second 
 or third time in intervals let us say of a week the amount of blood lost 
 is never so large as at the first bleeding. In lithaemic persons, particularly 
 in high livers, it is remarkable how prompt and permanent is the relief 
 which is sometimes obtained by single bleeding. So far as we have 
 observed subjects of the class named generally exhibit the signs of catarrh 
 of the congested hypertrophic type. 
 
 Some forms of TINNITUS AURIUM accompanied with congested states of 
 the ears are best treated by local depletion from the middle turbinal at its 
 posterior part. The parts selected should be thoroughly cocainized and 
 the knife carried well back to the end of the turbinal as seen from in 
 front. The temporary character of the benefit in this way secured indi- 
 cates that a tinnitus due to structural changes in the middle ear is greatly 
 intensified by the condition of the associated vessels. 
 
 We are led to believe that a great deal of the relief which is obtained 
 by intra-nasal operation, especially in conditions where the amount of 
 interference seems to be out of proportion to the results obtained, can be 
 attributed to the free loss of blood which accompanies the operation. 
 
 W. C. Glasgow (Trans. A. Laryng. Ass'n, 1887, 150) recommends 
 systematic depletion of the nasal mucous membrane for FRONTAL HEAD- 
 ACHE of congested type, associated with nasal disease. A simple bleed- 
 ing may serve to relieve the headache, or the bleeding may have to be 
 repeated in a week or a month. Dr. Glasgow has seen few cases which 
 were not relieved by such local extraction of blood. The amount lost at 
 each sitting rarely exceeded one ounce. W. H. Daly (Trans. Am. 
 Laryng. Ass' n, 1888, p. 192) resorts to systematic depletion of the nasal 
 mucous membrane in CHRONIC NASAL CATARRH, extracting from one-half 
 to three ounces of blood at a sitting. He reports by this unaided treat- 
 ment results of reduction of tissues, restoring normal nasal respiration. 
 
 Scarification is often resorted to for relief of tension and pain in ACUTE
 
 BOUGINARIA. 145 
 
 PHLEGMONOUS TONSILLITIS. The large superficial tortuous veins which 
 lie at the base of the tongue in old people are opened with benefit in 
 CHRONIC PHARYNGITIS. 
 
 Intra laryngeal scarification is occasionally employed in ACUTE LARYN- 
 GITIS of high grade, accompanied with products of infiltration. The 
 incisions for the relief of (EDEMA OF THE GLOTTIS incidentally relieve 
 by the moderate loss of blood which follows upon the incision. 
 
 Diseases of the Eye. General bleeding is not often called for in 
 the treatment of diseases of the eye, but the local abstraction of blood 
 is useful in many cases. It is accomplished by means of leeching or 
 by the use of the artificial leech of Heurteloup. From two to four 
 leeches may be applied to the temple; not too near the eye and never on 
 the lids, as they produce cedema and ecchymosis of the delicate and 
 loosely attached skin, and the bites sometimes excite excessive irritation. 
 The artificial leech is really a cupping instrument in which a long glass 
 cylinder is substituted for the ordinary cup, and the air is exhausted by 
 a piston worked with a screw. It draws blood much more rapidly than 
 do leeches, and is considered more efficient than leeching, particularly 
 when it is desired to affect the deeper circulation of the eye. The patient 
 should be kept quiet in a darkened room for some time afterward. Fre- 
 quent repetitions are often necessary. The effect of local bleeding is most 
 marked in IRITIS, but it is often useful in ACUTE CHOROIDITIS and 
 RETINITIS. Repeated applications of the artificial leech are recom- 
 mended by some surgeons in the treatment of the CHOROIDITIS of PRO- 
 GRESSIVE MYOPIA. In case of rapid increase of myopia with symptoms 
 of irritation, one or two ounces of blood may be taken every three or 
 six days for several weeks, the patient abstaining from all use of the 
 eyes, and remaining in a darkened room or going about with smoked 
 glasses. 
 
 BOUGINARIA. Bougies. 
 
 General Surgery. Medicated bougies will be found of service in 
 the treatment of certain inflammatory conditions of the mucous mem- 
 branes, especially those of the genito-urinary tract, and of the rectum. 
 They will often succeed when other methods fail. The object of the 
 use of bougies is to keep the mucous surfaces apart, and at the same time 
 to apply the selected medicament to advantage. For this purpose Charles 
 L. Mitchell, Manufacturing Chemist of Philadelphia, has introduced to 
 the drug trade various forms of medicated gelatine bougies. As a base 
 gelatine is preferable to cocoa-butter, since it does not become rancid, and, 
 owing, to its animal nature, is more readily absorbed. Urethral bougies 
 are manufactured for use in the treatment of GONORRHOEA, GLEET, etc., 
 in two sizes, six and one-half inches and three inches. The diameter is
 
 146 LOCAL THERAPEUTICS. 
 
 three-sixteenths of an inch. The longer variety presents advantages in 
 cases where the whole of the mucous membrane of the urethra is involved. 
 Bougies should be used but once a day (on retiring), and may be applied 
 by the patient. The surface of the bougie should be moistened. A 
 "bougie-hood" is a convenience, and is a necessity to preserve cleanli- 
 ness. In the treatment of SUBACUTE GONORRHOEA the bougie may be 
 medicated, as follows : Sulphate of zinc, gr. % ; carbolic acid, gr. 
 y& ; hydrastis canadensis, gr. i ; extract of belladonna, gr. i ; fluid 
 extract of gelsemium, gr. y z . For treatment of UTERINE CATARRH 
 and DYSMENORRHCEA, medicated intra-uterine pencils are recommended. 
 They are short, yet possess sufficient elasticity to permit a certain amount 
 of force in their introduction. The large pencils (3 inches in length and 
 T \ in diameter), are employed in cases of PUERPERAL UTERUS, CHRONIC 
 CATARRH, etc., where the os is patulous, the cervical canal dilated, and 
 the womb enlarged. The small pencils (3^ inches in length and y 1 ^ in 
 diameter), favored by Engelmann {Weekly Med. Rev., March 14, 1885), 
 are designed for use in CERVICAL CATARRH and DYSMENORRHOEA, where 
 the uterus and cervical canal are normal in size or nearly so. They are 
 applied by the ordinary long dressing forceps or a special "carrier." 
 VAGINITIS and LEUCORRHCEA are successfully treated by means of a hollow 
 vaginal suppository which is two and one-half inches in length and one 
 inch in diameter. Cotton may be inserted to enable them to hold their 
 form. A suppository so shaped possesses distinct advantages ; its light- 
 ness allows its retention until completely absorbed ; it does away with a 
 great amount of unnecessary material which interferes with cleanliness; 
 it melts slowly, and the cotton maintaining the shape increases the thera- 
 peutic effect of the drug; it can be introduced by the patient. For 
 INTERNAL HEMORRHOIDS, CATARRHAL STATES and ULCERATION OF THE 
 RECTUM, a rectal bougie is used. Each bougie is cigar-shaped, and is 
 thus adapted for insertion and prevented from slipping out. The mass 
 is sufficiently large to distend the rectum and relieve the congestion of 
 the veins and the muscular irritability so commonly met with in diseases 
 of the rectum. Antiseptic treatment of FISTUL/E has been provided for 
 by the manufacture of " iodoform fistula crayons." By their continued 
 use a cure is often obtained without recourse to operation. The crayons 
 are made in various sizes. They contain 33 per cent, of iodoform mixed 
 with a compound of gelatine and glycerine. They are very flexible, and 
 may be introduced into the most tortuous tract. Preparatory to using, 
 the crayon should be oiled and then inserted with a twisting movement. 
 The projecting end is then cut off and the suppository held in place by 
 an iodoform pad. 
 
 Diseases of the Ear, Nose, etc. Bougies act in two ways. First 
 by retaining for a much longer time than can be in any other manner
 
 BRAN. 147 
 
 secured the contact of medicinal agents upon the diseased surfaces and 
 secondly by exerting more or less pressure against inflamed tissues. 
 Medicated bougies are little used for the purpose of medicating the 
 Eustachian tube. Unguents smeared upon the tip of an Eustachian 
 catheter answers the limited indications for such medicament. In the 
 nasal chambers they have a wider range of usefulness. They are often 
 employed to dilate the lower part of the nasal passage and when com- 
 posed of dissolvable substances, require no subsequent attention. (See- 
 Oleum Theobromtz and Gelatin.^) A gelato-glycerine bougie is described 
 by G. H. Mackenzie (Br. Med. Jour., May 16, 1885). G. Catti 
 {Allgemeine Wiener Medizinische Zeitung , June, No. 26, 1876), has called 
 special attention to the subject of nasal bougies. Each bougie should be 
 from eight to twelve centimetres long and four to six millimetres in 
 width, and one end somewhat thinner than the other. Since the 
 depth of the nasal passage varies in different individuals it is neces- 
 sary to have the bougie no longer than the distance between the an- 
 terior and posterior opening ; this can be determined by careful rhino- 
 scopic inspection. Bougies should remain in the nose from one to four 
 hours; at the end of this time the substances are, in the main, dissolved. 
 A small piece of absorbent cotton should be placed in the nostril in order 
 to prevent an outflow of mucus. 
 
 BRAN. 
 
 The ground husk of the wheat grain mixed usually with a very small proportion of 
 starch. It constitutes from one- quarter to one-third of the weight of the grain. 
 
 General Surgery. Owing to its convenience and cheapness bran 
 makes a serviceable surgical dressing for the treatment of compound 
 FRACTURES. Barton's bran dressing is particularly useful in compound 
 fractures of the leg accompanied with much discharge. It is thus applied: 
 Inside of an ordinary fracture box of suitable size is placed a sheet of oil- 
 cloth, or in its absence a piece of muslin ; on this a layer of fine, clean 
 bran is spread about two inches deep. The fracture being reduced, the 
 limb is laid in the box with a pad of cotton placed beneath the tendon 
 Achillis and round each malleolus ; a layer of the same material surrounds 
 the limb below the knee. The sides of the box are then brought up and 
 secured, and more bran is dusted and packed about and over the leg 
 until the box is filled. The fractured limb is thus evenly supported on all 
 sides. Over the wound or broken skin any suitable dressing may be ap- 
 plied. Once a day the sides of the box are let down, and without disturb- 
 ing the limb the solid bran is removed with a spoon and replaced with 
 fresh material. 
 
 The bran dressing makes firm and equable pressure, and controls the
 
 148 LOCAL THERAPEUTICS. 
 
 tendency to hemorrhage. It can be employed in conjunction with the 
 antiseptic method, the limb being first dressed with the antiseptic gauze, 
 and the bran packed around the limb as above directed. 
 
 In the treatment of simple fractures of the femur, long, thin bags filled 
 with bran may substitute sand bags as padding for the long splint of the 
 Liston apparatus. We have found that good support may be given to 
 the limb by the use of a bran bag with this splint running from below 
 the ankle to the axilla, and the short splint passing from the ankle to the 
 perineum and retained by means of a splint cloth. 
 
 In the absence of the air-pillow, small, circular pads may be made and 
 filled with bran and placed under the back to relieve pressure, for the pre- 
 vention of bed-sores. 
 
 In OBSTETRIC PRACTICE a shallow bag made of cheese cloth and filled 
 with bran will be found a satisfactory means of absorbing discharges. It 
 may be placed over the rubber sheet. At the termination of the labor it 
 is readily slipped from under the patient, leaving the bed clean and dry. 
 It is superior to old blankets and comfortables, such as are ordinarily used 
 for this purpose. A flat bag filled with bran and heated in an oven is a 
 satisfactory means of applying dry external heat and a good substitute for 
 the rubber hot-water bag. It is light and easily borne, and adapts itself 
 to all parts of the surface of the body where it may be placed. Dry, ex- 
 ternal heat may be applied to the trunk in this way in the treatment of 
 shock; it assists in hastening reaction, and adds to the comfort of the 
 patient. 
 
 BROMOFORM. 
 
 Bromoform (CHBr 3 ) is produced by the action of bromine on alcohol in the presence 
 of an alkali. It is a colorless liquid boiling at 151 C and solidifying at 2.5 C. Its 
 specific gravity is 2.83 at 10 C." (U. S. D.) 
 
 Diseases of the Throat. S. Solis-Cohen commends the use of 
 bromoform in FOLLICULAR TONSILLITIS as well as in OZ^ENA. 
 
 BROMOL. Tribromphenol. 
 
 Bromol is formed in the well-known test for phenol by the use of bromine water. On 
 the addition of bromine water to a dilute aqueous solution of phenol, a crystalline precip- 
 itate of tribromphenol is formed. It has the formula C 6 H 2 Br 3 OH, in which three atoms 
 of bromine replace three atoms of hydrogen in phenol. 
 
 Bromol is a white, crystalline solid, melting at 95 C. It is insoluble in water, but freely 
 soluble in alcohol, ether, chloroform, and glycerin. 
 
 This substance has been recently recommended by Rademaker as an 
 antiseptic.
 
 BROMUM. 
 
 149 
 
 General Surgery. Grimm has shown that when applied to recent 
 WOUNDS bromol has an irritating, almost caustic, effect. In TUBERCULOUS 
 ULCERATION granulations are stimulated. Rademaker {Therap. Monat- 
 shefte, No. 3, 1891) dusts the powder on the ulcer, or employs it in a solu- 
 tion in olive oil, 1-30, or in ointment i-io. 
 
 BROMUM. Bromine. 
 
 " A liquid, non-metallic element obtained from sea water and from saline springs." 
 (Ph. Br.) " Bromine is a volatile liquid of a dark-red color when viewed in mass, but hya- 
 cinth red when viewed in layers. Its taste is caustic, and disagreeable. It boils at about 
 63 C. (145.4 F.), forming a reddish vapor resembling that of nitrous acid." (U. S. D.) 
 It dissolves in thirty-three parts of water at ordinary temperatures, but is more soluble in 
 alcohol, ether, chloroform, and bisulphide of carbon. It dissolves freely in aqueous solu- 
 tion of bromide of potassium, and a solution so made is available for external application. 
 
 Bromine is a caustic. Its fumes are violently irritative to the respir- 
 atory tract and their presence in the air excites lachrymation. The odor 
 is intolerable to most persons. 
 
 General Surgery. Bromine finds its most important use in general 
 surgery as an escharotic. Bonnet and Glover were the first to call atten- 
 tion to this agent as a substitute for iodine in the treatment of scrofulous 
 conditions, but experience has failed to establish its usefulness. 
 
 Goldsmith introduced it in the treatment of HOSPITAL GANGRENE 
 during the late civil war. Probably no topical application has greater 
 effect in arresting the advance of this disease. D. H. Agnew com- 
 mends its use in the highest terms, but advises that preliminary to its 
 application the patient be etherized ; then all disorganized tissue should 
 be removed with a pair of scissors and forceps, and the parts washed 
 with a disinfectant. Next a mop or swab, made by fastening a piece 
 of lint or cotton on the end of a stick, should be dipped in undi- 
 luted bromine and worked into all the interstices of the slough ; or, if 
 this is too compact, it should be broken up with a director, or a pair of 
 dressing forceps be thrust in and opened, and a small quantity of the 
 bromine injected into the opening from a small glass syringe. Where 
 the parts are rapidly breaking down, as in the ulcerative variety, the 
 simple application of bromine to the circumference of the diseased 
 tissue will be sufficient to arrest the destruction. 
 
 Bromine may also be used in the form of a vapor, the surface to be 
 acted on being covered with dry lint, upon which is placed a cloth 
 dipped in pure bromine, and the whole covered with oiled silk. Bromine 
 acts by producing an eschar, the separation of which may be hastened 
 by enveloping the part in a charcoal poultice. As a topical application 
 in CANCER OF THE UTERUS and other FOUL ULCERS, a solution of bro-
 
 150 LOCAL THERAPEUTICS. 
 
 mine in alcohol has been recommended by Routh and others. Bromine 
 is also used in GANGRENOUS VULVITIS and in some forms of PHAGE- 
 D^ENA. In the main acid nitrate of mercury will usually fulfill the indi- 
 cations of bromine while possessing none of its disagreeable properties. 
 
 Diseases of the Throat, Nose, etc. The vapor of bromine is 
 claimed by Potter to have value in the treatment of NASAL CATARRH. 
 
 Bromine in a pure form, or in any of the proportions proposed by 
 Goldsmith, is not available for treatment of the mucous surfaces. One of 
 us instituted a series of observations on the effect of bromine on indu- 
 rated nodules of the pharynx. Small glass tubes of the pattern seen in the 
 Zaufal speculum were employed and a cotton carrier, the end of which 
 was wrapped with a pledget of cotton, was inserted into the pure bromine, 
 and introduced into the tube, which, being carried to the selected spot, 
 enabled the observer to bring the cotton against the pharynx without per- 
 mitting the fumes to escape. The application caused a yellowish-white 
 coagulation on the membrane, which was quite superficial, and produced 
 a shallow impression on the parts as compared with any .one of the 
 caustic agents described elsewhere. (See Chromic Acid, Caustic Potash^ 
 and Caustic Soda,~) 
 
 Its value as an application to DIPHTHERITIC DEPOSITS must be quite 
 secondary. In young children its use would not be free from danger. 
 Bromine fumes can be conveniently employed in solutions of bromide 
 of potassium. Two parts each of bromine and bromide of potassium 
 are added to one hundred parts of water. A sponge is saturated with the 
 fluid and the fumes inhaled in DIPHTHERIA, and PHAGED^ENA of the throat. 
 Ozanam recommends a proportion of one grain of bromine to five of 
 bromide of potassium. 
 
 BRUCINE. 
 
 Brucine is an alkaloid obtained from Nttx vomica, and from the bark known as false 
 Angustura bark. It is without odor, but of a permanent, harsh, and bitter taste. It 
 is soluble in eight hundred and fifty parts of cold and five hundred parts of boiling water, 
 very soluble in alcohol, whether hot or cold ; but insoluble in ether and the fixed oils, and 
 only slightly dissolved by the volatile oils. 
 
 Brucine is analgesic. 
 
 Diseases of the Ear, Throat, etc. C. H. Burnett (Trans. Amer. 
 Otolog. Society, 1885) and Seiss (Therapeutic Gazette, Jan. 1886) use a 
 five per cent, solution, applied by a cotton pledget in FURUNCLE OF THE 
 EXTERNAL MEATUS and SUPPURATION OF THE EAR. The effect is more 
 lasting but less certain than that of cocaine. According to T. J. Mays a 
 five per cent, solution of brucine applied to the mucous membrane of the 
 mouth caused insensibility of the part. A twenty-five per cent, solution 
 obtunded the normal sensibility of the skin of the back of the hand.
 
 BRYONIA CADMIUM IODIDE CAFFEA. 15 I 
 
 A solution thus prepared may be painted over a superficial ABSCESS 
 prior to making an incision ; but brucine is inferior in this respect to co- 
 caine and rhigoline. 
 
 BRYONIA. Bryonia. Bryony. 
 
 " The root of Bryonia alba, and of Bryonia dioica, Linne." (U. S. P.) The Tincture 
 of Bryonia is official. 
 
 Diseases of the Nose, etc. Bryonia is probably haemostatic and 
 like in its action to ergot and hamamelis. In this way it is likely it may 
 be made of use in EPISTAXIS. {Jour, de Med., 1891.) 
 
 CADMIUM IODIDE. Iodide of Cadmium. 
 
 Iodide of cadmium occurs in large, white crystals, soluble in water and alcohol. The 
 reaction is acid. 
 
 Cadmium iodide possesses the therapeutic properties of iodine and 
 the advantage of not staining the skin. 
 
 General Surgery. The drug may be prescribed in the form of an 
 ointment, a drachm to an ounce of cosmoline or lanoline, with advantage 
 in the treatment of ADENITIS (Garrod), whether strumous or sympa- 
 thetic. The preparation is bland in character, and iodine is freely 
 absorbed. It is preferable to the ointment of iodide of lead, which in 
 sensitive subjects may cause lead poisoning. Applications may be applied 
 at night and washed off the following day. 
 
 Diseases of the Ear, Mouth and Throat. A wash of two 
 grains to the ounce of water is recommended for otorrhoea. Iodide of 
 cadmium may be used upon indurated states of the oral mucous membrane 
 in the strength of seven grains to two drachms of collodion. (J. W. 
 White, "Dental Therapeutics.") 
 
 CAFFEA. Coffee. 
 
 "The seed of Caffea arabica." (U. S. P.) The most important constituent is the 
 alkaloid, Caffeine, The article usually sold as caffeine is really theine, with which caffeine 
 is chemically and therapeutically identical. Theine is obtained from different varieties of 
 Tkea, usually from parts of cargoes which have been spoiled for domestic use in transit, 
 by wetting or other misadventure. 
 
 In the process of roasting, coffee loses considerable moisture, which 
 carries with it some caffeine, the fat, sugar, and tannin are destroyed, and 
 some empyreumatic volatile oils are produced. Thoroughly ground and 
 freshly roasted it is protectant, moderately analgesic and deodorant. 
 Luderitz {Berlin. Klin. Wochenschrift, March, 1890) found that in a pure
 
 152 LOCAL THERAPEUTICS. 
 
 infusion growths of bacteriological origin were rapidly destroyed. A 
 cup of coffee left in a room remains almost free from micro-organisms 
 for a week or more. The antiseptic property of coffee is probably not 
 due to the caffeine but to the empyreumatic oils developed by roasting. 
 {Jour. Amer. Med. Ass'n, 1890, p. 692.) 
 
 Diseases of the Ear, Throat, etc. Coffee is in good repute as an 
 agent to cover the odor of iodoform. M. Gougenheim (Z<? Progres Medi- 
 cale, Oct. 31, 1885, p. 337) employs it for its analgesic properties in 
 LARYNGEAL PHTHISIS. F. Guerder {Brit. Med. Jour., July 31, 1886) 
 adds to dried, finely pulverized coffee an equal proportion of boric acid 
 as an insufflation in WHOOPING COUGH. H. McNaughton Jones recom- 
 mends for AURAL ECZEMA an ointment of iodoform and fresh coffee one 
 part, glycerine and oil of almonds each two parts, and vaseline ten parts. 
 
 CALCII CARBONAS PR^ECIPITATUS. Precipitated Carbonate of 
 Calcium. Precipitated Chalk. 
 
 Precipitated carbonate of calcium is made by the mutual decomposition of solutions 
 of carbonate of sodium and chloride of calcium. " A very fine, white, impalpable pow- 
 der, permanent in the air, odorless and tasteless, and insoluble in water or alcohol." 
 (U. S. P.) 
 
 GRETA PR^PARATA. Prepared Chalk. 
 
 " Native friable carbonate of calcium, freed from most of its impurities by elutriation." 
 (U. S. P.) It usually occurs in the form of small cones of a dirty white color, soft, free 
 from grit, and readily pulverized under the fingers. It is an impure carbonate of calcium, 
 containing a proportion of magnesium salts, usually a small proportion of iron salts, and 
 some sulphate of calcium. Precipitated carbonate of calcium is a purer product, and 
 hence is preferable for most purposes. 
 
 Chalk is employed as a desiccant and mild astringent, also as a mild 
 alkali to neutralize acids and to assuage the irritative effects of fatty 
 decomposition. 
 
 General Surgery. Precipitated chalk is often used in dusting-pow- 
 ders, and as a desiccant and protective application to old BURNS and 
 ULCERS. Dr. Hood (Lancet, October i, 1887), recommends the follow- 
 ing ointment for the treatment of CANCER as bland and unirritating : 
 R. Gretas praepar., giij ; olei amygdal., gij. The chalk is to be intimately 
 mixed with the oil, then two ounces of lanoline are to be added. This 
 may be applied twice daily, spread on lint. 
 
 Diseases of the Skin. The dry powdered chalk is an ingredient of 
 several powders employed in ERYTHEMATOUS ECZEMA, particularly about 
 the genitalia where the free secretion of sweat and the natural heat of the 
 parts tends to keep up irritation and to hasten the decomposition of such 
 applications as may be made. The rapid formation of fatty acids in
 
 CALCII CHLORIDUM. 153 
 
 these localities makes it desirable that ointments and powders should con- 
 tain some alkali, or they may do harm by their rapid decomposition. 
 
 For the same purpose powdered chalk is employed in soothing, astrin- 
 gent washes as one of the ingredients. (See Zinci carbonas, Zinci oxidum, 
 Bismuthi subnitras). The following excellent lotion of Startin, used in 
 ECZEMA and ACNE, is an example of the use of chalk in this connection : 
 R. Pulv. zinci carb. praecipitat., gj ; pulv. cretae praeparatae, 31; glycerini 
 foiij ', acid, hydrocyanic, dilut., f^ss ; liquor, calcis, f^iij ; aquae rosse, 
 ad. fsviij. 
 
 Prepared chalk enters into the composition of an ointment somewhat 
 similar to the ung. cretce comp. of the old London pharmacopoeia, which is 
 said by Liveing to be an excellent preparation. It is composed as follows : 
 R. Emplast. plumbi, gvj ; cerae flavae, 3] ; olei olivae, f^v. Dissolve 
 together and add, stirring constantly, the following : Cretae praeparatse 
 giij ; acid, acetic, dilut., fgj., the dilute acetic acid being first mixed 
 with the chalk. This is employed in IRRITABLE SUBACUTE ECZEMA. 
 
 The addition of a drachm of prepared chalk to an ounce of lard makes 
 a convenient chalk ointment, and chalk also enters into the composition 
 of Wilkinson's ointment as an adjuvant (see Picis). 
 
 Sir Dyce Duckworth has recommended the following " chalk ointment" 
 as an excellent application in ERYSIPELAS: R. Cretae praeparat. seu cretae 
 praecipitat., adipis aa j. M. The lard should be melted and the chalk 
 slowly added and beaten in. Lard will take up two and a half times its 
 weight of chalk, but the even proportions make a better ointment. Half 
 a drachm of carbolic acid to the ounce may be added. This ointment 
 is applied, by means of the finger, to the affected parts, which are then 
 covered with plain lint or boric lint. 
 
 Diseases of the Mouth, Throat, etc. Carbonate of calcium, forms 
 the basis of many dentifrices on account of its antacid and astringent action 
 on the gums and the mucous membranes of the buccal cavity. Garretson 
 recommends the following formula as a tooth powder: R. Cretae praep- 
 aratae ; pulv. iridis Florentinae, aa 3 ss ; pulv. ossis sepiae, 3 ij ; olei 
 limonis, q. s. 
 
 Prepared chalk enters into the composition of a lozenge used to over- 
 come ACIDITY OF THE MOUTH AND PHARYNX. Each lozenge contains 
 four grains of the agent. 
 
 CALCII CHLORIDUM. Chloride of Calcium. 
 
 " Chloride of calcium deprived of its water by fusion at the low red heat. It should be 
 preserved in well-stopped bottles. It is in colorless, slightly translucent, hard, and friable 
 masses, very deliquescent, odorless, having a hot, sharp, saline taste, and a neutral or 
 faintly alkaline reaction. It is soluble in one and five-tenths parts of water, and eight 
 parts of alcohol at 15 C (59 F.) ; very soluble in boiling water, and soluble in one and 
 five-tenths parts of boiling alcohol." (U. S. P.)
 
 154 LOCAL THERAPEUTICS. 
 
 Diseases of the Skin. Chloride of calcium is employed in solu- 
 tion as a sedative lotion in ECZEMA. It forms the chief ingredient in 
 some German mineral waters, and is more employed in Germany than 
 elsewhere. It is the. clear fluid which remains when the sediment of 
 oxide of mercury is allowed to settle in lotio nigra ; and probably some, 
 if not a large part of, the virtues of that lotion may be due to the solu- 
 tion of chloride of calcium. 
 
 CALCII HYDRAS. Hydrate of Calcium. Hydrate of Lime. Slaked 
 
 Lime. 
 
 Slaked lime is made by pouring one part of water on two parts of lime in a metal 
 vessel and permitting it to cpol. The product should be preserved in well-stopped 
 bottles. 
 
 Slaked lime is a solvent and antacid. It also appears to act mechani- 
 cally in breaking up exudates. 
 
 Diseases of the Skin. Slaked lime is one of the ingredients of 
 Spender's lime ointment, which is made by incorporating four parts of 
 washed slaked lime with one part of fresh lard and three parts of olive 
 oil previously warmed together. 
 
 Diseases of the Throat, etc. Slaked lime has long been popular 
 in this country as a remedy in MEMBRANOUS CROUP and DIPHTHERIA for 
 removing the exudation from the throat. It has been advocated in the 
 main by J. Solis-Cohen. 
 
 In order that the fumes arising from the slaking of lime shall be efficient 
 in removing the membranes from the trachea, it is necessary they should 
 be copious. The action appears, according to Dr. Geiger, of Dayton, 
 Ohio, to be mechanical, small particles of lime drying up the edges of 
 the partially detached shreds so that the watery vapor gets under to accel- 
 erate the separation. Cohen directs that several lumps be placed in a 
 bucket which is carried to the bedside of the patient and hot water 
 poured upon the masses until they are barely covered. A funnel-shaped 
 newspaper or a stout bag with one corner cut off should be placed over 
 the vessel with the outlet directed toward the patient's mouth. The 
 eyes should be protected. If cough or emesis is excited large quantities 
 of membrane may be expelled. Inhalations should be repeated every 
 half hour or oftener. 
 
 CALCI HYPOPHOSPHIS. Hypophosphite of Calcium. 
 Diseases of the Lungs. An inhalation of the hypophosphite of 
 calcium when mixed in the proportion of one ounce of the salt to an
 
 CALCII PHOSPHAS PR^CIPITATUS CALCII SULPHAS. 155 
 
 equal quantity of glycerine in three ounces of water is recommended by 
 A. S. Houghton (Journal of American Medical Association, November 
 7, 1885). 
 
 CALCII PHOSPHAS PR^ECIPITATUS. Phosphate of Calcium. 
 Phosphate of calcium is prepared by digesting burned bones with diluted hydrochloric 
 acid, and treating the filtered solution with ammonia water, which precipitates the phos- 
 phate in a finely divided state. The precipitate is then well washed, to remove the 
 soluble ammonium chloride which is formed at the same time. Phosphate of calcium 
 should dissolve completely in hydrochloric or nitric acid without effervescence. 
 
 General Surgery. Doubenski (Bui. Gen. de Therap.,vo\. i, 1890), 
 and others have used the phosphate of calcium with a little free phos- 
 phoric acid, one to one hundred, in the treatment of TUBERCULOUS 
 ULCERATIONS, and succeeded in effecting a cure where other remedies had 
 failed. Non-ulcerated infiltrated masses were injected, with the object in 
 view of inducing calcification of tuberculous products. In many cases 
 the results were satisfactory. COLD ABSCESSES and FISTULOUS TRACTS 
 were treated by packing with gauze soaked with the solution of five parts 
 to one hundred. 
 
 Diseases of the Nose, etc. M. Mackenzie recommends phos- 
 phate of calcium to give bulk to powders to be used as snuffs or other 
 insufflations. 
 
 CALCII SULPHAS. Sulphate of Calcium. Gypsum. Plaster of 
 
 Paris. 
 
 The Ph. Br. directs that this salt be made from the native sulphate of calcium by dehy- 
 drating it by heat. As found in commerce it is a white powder, nearly insoluble in 
 water, and having the property of solidifying with even so much as twice its weight of 
 water, and of expanding during the solidification. 
 
 General Surgery. Plaster of Paris is one of the most important 
 articles employed in many of the fixed dressings, intended to correct 
 deformities or to retain the ends of broken bones in apposition. A 
 common way of using it for this purpose is in what is known as the 
 Bavarian splint, which is made by pouring liquid plaster between two 
 pieces of blanket or flannel previously fitted to the injured member, and 
 united by a seam at the part which goes to the back. In fracture of the 
 leg the limb is placed on the blanket, the inner layer of the dressing 
 material is brought up and pinned in the front of the shin and on the 
 dorsum of the foot. The bones are then put in position, a slip of bandage 
 confines the upper, while a second and separate piece holds the lower 
 part of the blanket or flannel, thus making, as it were, two closed sacks,
 
 156 LOCAL THERAPEUTICS. 
 
 one on each side of the limb. Plaster of Paris is now mixed with water 
 to the consistency of thick cream, and quickly poured in between the 
 folds of the blanket on either side. Before the plaster sets the surgeon 
 can readily mold it evenly over the surface of the limb, after which the 
 entire mass may be retained by a few additional turns of bandage and 
 allowed to dry. When it is desired to inspect the parts, all that is 
 necessary is to cut the turns of the bandage and pull the edges of the 
 plaster asunder, when the two halves fall apart, the seam at the back 
 acting as a hinge. Swelling of the limb is thus accommodated by the 
 hinge behind and the opening in front, and the danger of undue pressure 
 avoided. Should an external wound demand an opening in the plaster, 
 it can readily be made by cutting a window in both thicknesses of 
 blanket, and stitching their edges together to prevent the escape of 
 plaster. This form of fixed dressing is the only one which should be 
 applied to a recent fracture. 
 
 The plaster-of- Paris bandage or roller is made by thoroughly incorpor- 
 ating plaster of Paris with the mesh of a loose texture, such as cheese-cloth 
 or crinoline, the latter being most commonly employed. The fibre is then 
 made into a loose roller or bandage, from three to five yards in length, 
 containing a small amount of plaster between the folds. When this is to 
 be used, the limb is covered with a close-fitting stocking or bandage, 
 and the plaster roller is submerged in water, and, when thoroughly 
 soaked, is removed and squeezed as dry as possible, and applied in spiral 
 turns around the limb. When the application is complete the dressing 
 is covered with a little dry plaster of Paris. Such a bandage has the 
 advantage of becoming firm in from fifteen minutes to a half hour, 
 and constitutes one of the best forms of immovable dressing. It is well 
 suited to all fractures of the leg after the inflammatory swelling has sub- 
 sided. If the plaster is old, the hardening process may be hastened by 
 the addition of a small handful of salt, or by placing the plaster in an 
 oven in a shallow pan (for a few hours before using) until it is thoroughly 
 dry. 
 
 CALENDULA. Marigold. 
 
 "The fresh, flowering herb of Calendula ojficinalis '." (U. S. P.) The only official pre- 
 paration is the tincture made by displacing twenty parts of the herb with sufficient alcohol 
 to make one hundred parts. 
 
 Calendula is a weak astringent. 
 
 General Surgery. The bruised leaves, made into a poultice, have 
 been applied with asserted advantage as a dressing for painful CANCERS of 
 the breast. A tincture has been used in the treatment of SPRAINS and 
 CONTUSIONS, being similar in its action to tincture of arnica, though it is
 
 CALX. 157 
 
 less active than that preparation. It is possible that if alcohol had been 
 employed, results equally good might have been obtained. 
 
 Diseases of the Nose. Marigold is used by T. F. Rumboldt (St. 
 Louis Med. Archives, 1873) as an ingredient of a wash ; in the strength 
 of one ounce of the tincture to eight ounces of water to which has been 
 added one scruple of carbolic acid and one ounce of glycerine in the treat- 
 ment of ACUTE NASAL PHARYNGEAL CATARRH. The efficacy of this 
 preparation is probably due to the carbolic acid it contains. 
 
 A glycerole of marigold is available. 
 
 CALX. Lime. Unslaked Lime. 
 
 "An alkaline earth, oxide of calcium, with some impurities, obtained by calcining chalk 
 or limestone so as to expel carbonic acid." (Br. Ph.) Lime is " soluble in seven hundred 
 and fifty parts of water at 15 C. (59 F.) and in thirteen hundred parts of boiling water, 
 and insoluble in alcohol." (U. S. P.) Lime-water, made by stirring milk of lime (i. e. 
 slaked lime mixed with water) in water, permitting it to settle and pouring off the clear 
 liquid, is a saturated solution of lime, and contains, as above staled, one part in seven hun- 
 dred and fifty. The ordinary lime-water and oil (Linimentum Calcis, U. S. P.) is made by 
 shaking together equal parts of cotton-seed oil (or linseed oil) and lime-water, thus form- 
 ing a weak insoluble soap. Lime fresh from the kiln is known in medicine as caustic 
 lime. Equal parts of caustic lime and caustic soda constitutes" London Paste." (See 
 Sodium.'] Equal parts of caustic lime and caustic potassa constitutes Potassa cum Cake, 
 q. v. 
 
 Lime is an astringent to open surfaces, especially to the fissures and to 
 the junctions of the skin and the mucous membrane; it is an antacid, of 
 low diffusion power ; it is a caustic, and acts by its attraction for water 
 which it takes from the tissues. 
 
 General Surgery. Unslaked lime is a powerful caustic. It is rarely 
 used by itself. Lime and caustic potash form what is known as Vienna 
 paste, q. v. 
 
 Diseases of the Skin. Caustic lime enters into the composition of 
 Vlemingckx's solution. (See Calx Sulphurata.} 
 
 The preparations of Calx are : Liquor Calcis ; Syrupus Calcis ; Potassa 
 cum Calce. 
 
 LIQUOR CALCIS. Solution of Lime. Lime Water. 
 
 " An aqueous solution containing about fifteen hundredths per cent, of hydrate of cal- 
 cium." It should be kept in well stopped bottles. It is used in the preparation of lint- 
 mentum calcis, which is made by shaking together equal parts of lime-water and cotton- 
 seed oil. A similar liniment is made from lime-water and linseed oil. 
 
 The action of lime-water is astringent, alkaline, and antiseptic; at the 
 same time, either by itself or in conjunction with other substances, it 
 makes a bland and pleasant dressing for granulating surfaces.
 
 158 LOCAL THERAPEUTICS. 
 
 General Surgery. In the treatment of BURNS lime-water holds high 
 rank. It forms the chief ingredient of Carron oil, which consists of equal 
 parts of lime-water and linseed or olive oil. Carron oil was first used in 
 the Carron Iron Works in Scotland, and has long had a great reputation 
 in the treatment of BURNS and SCALDS. When the oil is mixed with 
 lime-water it forms a creamy substance which is spread on old linen or 
 muslin, and covered with oiled silk or waxed paper. It is customary to 
 speak of this as a filthy dressing ; but we cannot see that it is any less 
 cleanly than other applications, while it is certainly a bland and soothing 
 application to this class of injuries. It is in general use in the hospitals of 
 Philadelphia. When the sloughs have separated and the surface is covered 
 with granulations (which are delicate and have a tendency to bleed), appli- 
 cations of lint soaked in lime-water will be found a satisfactory means of 
 treatment. We have noticed in these conditions that on changing the 
 dressing from zinc ointment to boric acid ointment, and then to lime-water, 
 the granulations appear to keep more healthy, and the cicatrizing process 
 to advance more rapidly than when one line of dressing is alone pursued. 
 Lime-water, owing to its alkalinity and astringency, is often used as a 
 wash in LEUCORRHCEA, VAGINITIS, and GLEET. When the discharge is 
 abundant lime-water is of service in the acute stage ; but in chronic condi- 
 tions it is inferior to bichloride of mercury (i to 8000), and to tannic acid. 
 Lime-water is used with advantage as an injection to destroy SEAT-WORMS. 
 When employed for this purpose it is important to distend the lower bowel 
 as much as possible with the fluid, so as to unfold the mucous membrane 
 and to bring the agent in contact with all the surfaces, thereby thoroughly 
 cleansing them as well as exposing every parasite to the action of the 
 remedy. 
 
 Black-ivash (lotio nigra), a non-official but efficient dressing of VENE- 
 REAL SORES, is made by shaking up a drachm of calomel with a pint of 
 lime-water. Lint saturated with this mixture may be wrapped about the 
 glans penis. This dressing is especially applicable where much inflam- 
 matory action exists. CHANCROIDAL BUBOES that have suppurated are 
 often packed with lint that has been previously saturated with black-wash. 
 
 Yellow-wash (lotio flava, aqua phagedsenica) is made by adding half a 
 drachm of corrosive sublimate to a pint of lime-water. This combina- 
 tion is less often used than is black- wash. It is more stimulating, and 
 thus may be employed in the treatment of CHANCROIDS that have a 
 phagedenic tendency. The efficiency of both preparations depend on 
 the black, and the yellow oxide of mercury, which result from the action 
 of the lime-water on the salts with which they are made. 
 
 Diseases of the Skin. Lime-water enters into the composition of a 
 number of local preparations employed in the treatment of skin diseases. 
 Among these black-wash, is one of the best local applications in acute
 
 CALX CHLORATA. 
 
 159 
 
 inflammatory diseases of the skin. In all forms of ACUTE ECZEMA it gives 
 the greatest relief. It shares its pre-eminence as a sedative only with 
 dilute lead water, and the solutions or emulsions of the fluid extract of 
 grindelia robusta. In employing black-wash the bottle containing it should 
 be well shaken, and rags wetted with the lotion should be dabbed for some 
 minutes on the affected parts or else laid on and allowed to evaporate. 
 After a time oxide of zinc ointment may be applied as suggested by White, 
 of Boston, but in some cases no ointment can be endured by the skin, and 
 the wash should be used alone as an evaporating lotion. 
 
 Yellow-wash, is employed as a dressing in FOUL and especially in 
 SYPHILITIC ULCERS. It is a strong stimulant and detergent. 
 
 Lime-water enters into the composition of a number of lotions e. g., 
 Startin's lotion given under " Greta " when it is usually added to preserve 
 a neutral or alkaline condition of the mixture. 
 
 Diseases of the Throat. Lime-water can be used x in full strength 
 or diluted. It aids in loosening viscid secretions. Glycyrrhiza is a popular 
 adjuvant in correcting its unpleasant alkaline taste. (See Calcii hydras.} 
 
 Lime-water forms a permanent mixture with glycerine and carbolic acid. 
 In this form it is useful in the treatment of CROUP. 
 
 CALX CHLORATA. Chlorinated Lime. 
 
 " A compound resulting from the action of chlorine upon hydrate of calcium, and con- 
 taining at least twenty-five per cent, of available chlorine." (U. S. P.) It is quite soluble 
 in water when fresh, but if exposed, and the chlorine allowed to escape, it becomes less 
 soluble. Chlorinated lime attacks metals. Its activity may be increased by sprinkling 
 on it, or adding to its solution, a proportion of one of the stronger acids, preferably sul- 
 phuric acid. 
 
 Chlorinated lime is a disinfectant and germicide. Its powers of 
 destroying foul odors renders it useful in sick rooms, hospital wards, 
 etc. It is also employed in disinfecting cesspools, water closets, etc. 
 
 We believe that the terms "chloride of calcium" and "chloride of 
 lime,' r when used by medical writers, are equivalent to chlorinated lime. 
 
 General Surgery. The solution of chlorinated lime as a wash (half 
 a drachm to the pint) was formerly used to correct FETID DISCHARGES 
 from the uterus, vagina, and rectum. Its place has been largely taken by 
 corrosive sublimate. The latter, however, while a better germicide, is not 
 so active a deodorizer. The solution should never be of such strength as 
 to cause pain. 
 
 Diseases of the Ear, Throat, etc. Solutions of chlorinated lime 
 in the strength of two grains of the salt to an ounce of water are useful 
 
 destroying colonies of ASPERGILLUS in the external meatus. Largely
 
 l6o LOCAL THERAPEUTICS. 
 
 diluted it may be used as an inhalant in putrid conditions of the respira- 
 tory passages. A solution of chlorinated lime removes FETOR OF 
 THE BREATH. It is of special advantage in this connection in DIPH- 
 THERIA. J. Solis-Cohen recommends that five grains of chloride of 
 calcium be added to an ounce of the decoction of krameria ; two or 
 three drachms diluted with equal quantity of water may be injected 
 night and morning for FETID NASAL CATARRH. W. Horner introduced 
 the practice of using a solution of a teaspoonful of chloride of lime to a 
 wineglass of water as an injection in FETID OZJENA.. 
 
 SYRUPUS CALCIS. Saccharate of Lime. Calx Saccharata. Saccharated 
 
 Lime. 
 
 Saccharate of lime is made by dissolving sixteen parts of sugar in forty parts of dis- 
 tilled water, adding five parts of caustic lime, digesting three days with occasional stirring, 
 filtering and evaporating. (U. S. D.) 
 
 A Syrup of Lime (syrupus calcis) is official (U. S. P.) containing five parts of lime in 
 one hundred parts of the syrup. This syrup contains from twenty to forty times as 
 much lime in solution as does lime-water. 
 
 Diseases of the Skin. Latour {Bull. Soc. de Therap., 2 s. vn, 
 1880) has recommended a saccharated glycerole of lime as being very 
 soothing to inflamed surfaces. It has been used in BURNS and also in 
 ERYSIPELAS of the face. It is composed of fifty drachms of caustic lime, 
 one hundred drachms of powdered sugar, four pints of water, and one 
 hundred drachms of glycerine. The sugar and lime are intimately mixed 
 in a mortar, the water being gradually added meanwhile, and the mixture 
 repeatedly shaken in a flask for twenty-four hours. It is then filtered, the 
 filtrate is mixed with the glycerine, and the whole evaporated to two pints. 
 This is diluted for use, and is employed in a mixture with almond oil. It 
 will dissolve gelatine. 
 
 Diseases of the Throat. Saccharate of lime is recommended by 
 Gomez de la Mata (Gazeta de Optalmologia, Otologia y Laryngologia, 
 July, 1886), as an insufflation in DIPHTHERIA. 
 
 CALX SULPHURATA. Sulphurated Lime. Sulphide of Calcium. 
 " A mixture (commonly mis-named Sulphide of Calcium), consisting chiefly of sulphide 
 of calcium, and sulphate of calcium in varying proportions, but containing not less than 
 thirty-six per cent, of absolute sulphide of calcium.' 1 (U. S. P.) " It is a grayish-white 
 or yellowish-white powder, gradually altered by exposure to air, exhaling a faint odor of 
 hydrosulphuric acid, having an offensive, alkaline taste, and an alkaline reaction ; very 
 slightly soluble in water, and insoluble in alcohol." (U. S. P.) 
 
 Diseases of the Skin. Sulphurated lime is one of the active 
 ingredients in the well-known Vlemingckx' s solution: JJ. Calcis vivae,
 
 CAMPHORA. l6l 
 
 lb. % ; sulphuris, Ib.ss. Boil with five pints of water and evaporate to 
 three pints. This lotion is much used in vegetable parasitic diseases, as 
 TINEA VERSICOLOR, and in animal parasitic diseases, as SCABIES. It is 
 also occasionally employed in the local treatment of PSORIASIS. It is too 
 strong to use at first in most cases and should be diluted with three to six 
 parts of water. It has a disagreeable odor, resembling rotten eggs, but is 
 often very rapid and effectual. 
 
 CAMPHORA. Camphor. 
 
 "A stearopten derived from Cinnamomum camphora, and purified by sublimation." 
 Camphor is "readily soluble in alcohol, ether, chloroform, disulphide of carbon, benzin, 
 the fixed and volatile oils, and sparingly soluble in water." (U. S. P.) It is readily pu'- 
 verized by moistening with a few drops of alcohol or ether and triturating. Cam- 
 phor is a constituent of a number of liniments : Camphor Liniment, ^Belladonna Lini- 
 ment, Soap Liniment, Compound Mustard Liniment, and also of the Spirit of Cam- 
 phor, in which it is present in the proportion of ten per cent. 
 
 The addition of camphor to alcohol or ether to saturation increases the solubility of 
 iodoform (q. z/.) in either of these fluids from one and a quarter parts to ten parts. Cam- 
 phor is dissolved in retinol in proportion 1-20. 
 
 Camphor is antiparasitic, anaesthetic to unbroken skin, but irritating in 
 concentrated solutions to delicate structures like mucous membranes. It 
 is soothing if used in weak solution. In concentrated solution it is irri- 
 tating, and may even cause inflammation and sloughing. 
 
 Under the general heading of Camphor will be considered Camphor ; 
 Campho-Phenique ; Camphorated Menthol ; Oleum Camphora ; Acidum 
 Camphoricum ; Camphorated Chloral ; Camphorated Naphthol. 
 
 General Surgery. In general surgery camphor has never been used 
 to any extent as a topical application other than in the form of liniments. 
 For the relief of CHORDEE, a suppository containing five grains of cam- 
 phor at night, or the same combined with from one-twelfth to one-eighth 
 of a grain of morphine will usually be found a very satisfactory mode of 
 treatment. In STRANGURY following blisters the combination of camphor 
 and belladonna given in a suppository will prove an agreeable means of 
 relief. 
 
 A clyster of camphor is an effective remedy for SEAT WORMS. Netter 
 and other French surgeons have spoken highly of the use of powdered 
 camphor applied freely to the sloughing surfaces in the treatment of hos- 
 pital and senile GANGRENE. It may be freely dusted over the surface 
 of a flaxseed and charcoal poultice. A poultice of flaxseed over which 
 morphine and camphor have been dusted, applied hot to the cheek, will 
 often relieve a NEURALGIC TOOTHACHE. Camphor is a favorite domestic 
 remedy, used either in the form of the spirit of camphor or camphor 
 ii
 
 1 62 LOCAL THERAPEUTICS. 
 
 liniment, the latter containing one part of camphor and four parts of 
 cotton-seed oil. These are to be found in almost every household, and 
 are used for the relief of BRUISES, SPRAINS, etc. 
 
 Soap liniment is a mild liniment, popular by itself or combined with 
 more stimulating preparations, and is used largely both by the profession 
 and laity. Soap liniment cleanses the skin from adhesive substances that 
 may be left after removing plasters, etc. Shampooing of a limb in cam- 
 phorated soap liniment after the removal of a FRACTURE DRESSING adds 
 greatly to the comfort of the patient. After the embrocation is used, 
 the parts should be washed with soap and water, dried with gentle friction, 
 and just before the reapplication of the dressing be sponged with equal 
 parts of alcohol and water, or with bay rum. 
 
 Camphorated mercurial ointment (Scott's dressing) is composed as 
 follows : Camphor, 3] ; mercurial ointment, 3j. Its use is indicated in 
 SYNOVITIS with effusion. The ointment is applied to the affected parts 
 on lint ; over this are laid four strips of adhesive plaster and the whole is 
 enveloped with a starch or plaster bandage, thus immobilizing the joint, 
 and allowed to remain in position for a week or more. Camphor is used 
 in combination in many tooth powders, and leaves a fresh, pleasant taste 
 in the mouth. The persistent use of it is said, however, to cause the 
 teeth to become brittle. 
 
 A preparation composed as follows : Camphor, five parts ; chloral 
 hydrate, two parts, and cocaine hydrochlorate, one part, is recommended 
 as a local application in NEURALGIA. 
 
 Diseases of the Skin. Camphor is employed chiefly as an anaes- 
 thetic in diseases of the skin accompanied by burning and itching. 
 Powdered camphor forms an ingredient of a very useful dusting 
 powder known as " McCall Anderson's Powder," used in ERYTHEMA, 
 ERYTHEMATOUS ECZEMA (!NTERTRIGO), and URTICARIA. This is composed 
 as follows: R. Pulv. camphorse, 3J-ij; pulv. amyli, pulv. zinci oxidi, 
 aa 535. M. It is important that the camphor should be in an impalpable 
 powder. 
 
 Powdered camphor has been used with success in FOUL ULCERS, and 
 particularly in HOSPITAL GANGRENE. It also enters into the composition 
 of several very useful lotions. (See Kummerfeld' 's Lotion, under Sulphur.') 
 
 Diseases of the Ear, Throat, and Nose. The vapor of cam- 
 phor has been employed by Keene in the treatment of TINNITUS. It is 
 blown into the middle ear by means of the Eustachian catheter. Camphor 
 is an ancient remedy for ACUTE CORYZA. It can be used by inhalation, one 
 drachm in a tumbler of boiling water or an ingredient of a powder, am 
 is of especial value in the first stage of the attack. The sniffing of the 
 vapor from the crude gum is of repute in the treatment of FETID CORYZA, 
 for a long time neglected, but of late years its reputation has been revived.
 
 CAMPHORA. 1 63 
 
 The dosage of camphor in powder is small. A few drops of the spirit of 
 camphor may be placed on a piece of sugar and administered internally. 
 The effect produced probably combines a local with a general effect. 
 The following inhalant for OZ^ENA is much used in France according 
 to Moure (La Tribune Medicate, November 7, 1889) : Camphor, 
 eight grammes; tincture iodine, ten grammes; iodide of potash, two 
 grammes ; tar, twelve grammes ; alcohol, 90, one hundred grammes ; 
 water, two hundred and fifty grammes. Camphor is compatible with 
 tannic acid. The following formula is recommended by Lefferts for 
 acute coryza in infants : Camphor, pulverized, two drachms ; tannic acid, 
 one-half drachm ; sugar of milk, one-half ounce. Camphor is an 
 ingredient of a snuff recommended by H. Dobell ("Winter Cough," 
 London, p. 204, ist ed., Appendix p. 172) in proportion of one drachm to 
 an equal quantity of tannic acid, white sugar and high dried Welsh snuff. 
 To a nasal tampon, camphor to the extent of twenty grains' may be added. 
 
 In the treatment of diseases of the pharynx where a mild excitant 
 and antispasmodic are needed camphor is useful. It may be ordered in 
 the form of a gargle, four minims of the spirit to an ounce of water. 
 The mistura camphoras is recommended by M. Mackenzie, combined with 
 tannic acid and a little alcohol. J. Morris Lewis recommends camphor 
 water as a detergent gargle. 
 
 In the treatment of LARYNGITIS camphor is frequently used as an 
 inhalant. It assists nitrate of potassium in overcoming SPASM of the 
 LARYNX, TRACHEA and the BRONCHIAL TUBES. One drachm of the spirit 
 added to three drachms of alcohol in the presence of one ounce of water 
 forms an agreeable combination. The spirit of camphor may be added 
 to other stimulating inhalants. It appears to qualify their action in a 
 peculiar manner. The eyes must be protected in the use of inhalants 
 containing camphor, since its vapor is irritating to the conjunctiva. 
 
 Lozenges of camphor ordinarily contain about one-twentieth of a grain 
 of the gum. 
 
 " Camphor Wool:" Cotton, one drachm; glycerin, ten minims; 
 aether, rect., one ounce. Mix the glycerin with the tincture, saturate the 
 wool with the liquid and dry. 
 
 For oil of camphor, see Oleum camphorce. 
 
 Diseases of the Eye. Camphor water in combination with borax 
 and largely diluted with water, was much employed by the late Dr. Dyer 
 in the treatment of CONJUNCTIVITIS. 
 
 OLEUM CAMPHORS. Oil of Camphor. 
 
 " The volatile oil obtained from Camphora officinarum" (U. S. P., 1870.) A liquid 
 of light brownish-yellow color, having the odor and taste of camphor, and the specific 
 gravity of 0.940. It is soluble in all the solvents of camphor.
 
 164 LOCAL THERAPEUTICS. 
 
 Oil of camphor is a by-product in the manufacture of ordinary camphor. It consists of 
 terpene, eugenol, safrol, cineol, camphor and other compounds. The commercial oil 
 frequently contains only the terpenes, the other products having been removed. 
 
 Sajous recommends the oil of camphor as an inhalant in PUTRID EX- 
 HALATIONS. 
 
 ACIDUM CAMPHORICUM. Camphoric Acid. 
 
 Camphoric acid is produced by boiling camphor in nitric acid. It is in thin, colorless, 
 scale-like crystals, or in large, limpid, monoclinic crystals. It has an acid taste, is soluble 
 in alcohol and ether. Fats and fixed oils dissolve it very sparingly. 
 
 H. A. Hare (Phila. Medical News, July, 1891 ) has recently called attention to this agent. 
 Camphoric acid is devoid of taste, is soluble in 160 parts of cold water, and in 10 parts of 
 boiling water, and does not excite the sense of burning which is characteristic of camphor. 
 Nothing is said of the external use. 
 
 Diseases of the Throat, etc. Camphoric Acid has been recom- 
 mended by M. Niesel (Deutsche. Med. Wochenschrift, vol. XL, 1888, 
 quoted in Joum. of Laryngology and Rhinology, 1889) for application to 
 catarrhal conditions of the mucous membrane of the pharynx and larynx. 
 
 CAMPHO-PHENIQUE. Phenol-camphor. Carbolized Camphor. 
 
 Carbolic acid will take up about three times its weight of the gum, and the result is a 
 thin, clear, oily fluid with a strong odor of camphor and a faint odor of carbolic acid. 
 
 Campho-phenique is a powerful local anaesthetic when applied to abraded 
 surfaces, or when a few drops are injected under the skin. It is an anti- 
 septic. 
 
 Diseases of the Skin. Campho-phenique has been used as an anti- 
 septic surgical dressing. Joseph Mathews (Ky. Med. Soc., 1890) extols 
 campho-phenique in the treatment of PRURITUS ANI, applied with equal 
 parts of zinc ointment as often as may be necessary. Itching disappears 
 under its use as if by magic. Occasionally he applies the agent in full 
 strength with no detriment to the skin or mucous membranes. Milliken 
 (Therapeutic Gazette, December 16, 1889) recommends campho-phenique, 
 one part, with olive oil, two parts, as an application in ERYSIPELAS, the 
 surface of the skin to be kept anointed with the oil. It is alleged that, 
 mixed with ether in equal proportion and injected into a forming BOIL, 
 the inflammatory process is aborted. 
 
 Diseases of the Throat, etc. Campho-phenique has been used 
 with success in DIPHTHERIA, by painting over the surface of the throat with 
 a swab of cotton saturated with the fluid. 
 
 CAMPHORATED MENTHOL. 
 
 Diseases of the Ear and Nose. S. S. Bishop (Jour, of the Anier. 
 Med. Ass'n, vol. xvn, Oct. 24, 1891, p. 636) describes, under the title 
 of " Camphorated Menthol," a combination (equal parts) of menthol
 
 CAMPHORA. 165 
 
 crystals and gum camphor. A clear, oleaginous liquid is reported as 
 resulting from this mixture. Twenty per cent, of this liquid, combined 
 with eighty per cent, of lanoline, were found to blanch and constrict the 
 nasal mucous membrane. It appears also to have analgesic properties. 
 Indications for its use, therefore, are those of cocaine. Dr. Bishop has 
 found it useful also in ACUTE LARYNGITIS, two inhalations of a five per 
 cent, solution were followed by satisfactory results. 
 
 R. Seiss highly recommends the following combination as a soothing 
 spray to the nasal chambers : Camphor, gr. iv ; menthol, gr. j ; terebene, 
 n^ivj liq. albolene, 3iv. M. 
 
 J. Alexander Randall writes in approval of injections of camphorated 
 menthol in liquid cosmoline in the Eustachian tube for CATARRHAL 
 DEAFNESS. 
 
 CAMPHORATED CHLORAL. 
 
 Under this name is known a syrupy liquid which results from triturating 
 together equal parts of camphor and chloral. Its action is soothing. It 
 is sometimes used as a local application to the skin in PRURITUS. 
 
 General Surgery. Painted on the skin by means of a camel's-hair 
 brush, or rubbed on the skin, camphor-chloral usually affords relief in 
 NEURALGIA, especially of the superior maxillary and inferior maxillary 
 divisions of the fifth pair of nerves. It is said to allay SPASMODIC COUGH 
 when painted over the larynx. The mixture of chloral and camphor thus 
 prepared has decided solvent properties for other substances. Morphine 
 will dissolve in it in the proportion of ten grains to the fluid drachm, and 
 may be used to increase its efficiency. Chloroform may be added to it 
 without separating its ingredients, thus forming a modified chlorodyne 
 mixture which may be taken internally. 
 
 Camphor-chloral will take up morphine, atropine, and other alkaloids 
 in large quantity. The solution containing the alkaloids can be mixed 
 with chloroform without precipitation. This constitutes a topical appli- 
 cation of great power, which can be utilized in the treatment of PAIN and 
 INFLAMMATION. It may be painted over the affected part or applied by 
 means of a pledget of cotton saturated with the mixture, which should be 
 covered with oiled silk and kept in position as long as it can be borne. 
 The formula used by R. Bartholow is as follows : R. Camphorae, chloral is, 
 aa 555. Mix and add morphinae, 9j ; atropinae sulph., gr. v. When 
 dissolved, add slowly chloroformi, 353. Oleum camphorse, or camphor 
 and lard rubbed together (sj-Sj), is an excellent application to PAINFUL 
 and SWOLLEN BREASTS during lactation. 
 
 CAMPHORATED NAPHTHOL. 
 
 Camphorated naphthol consists of camphor, i part ; naphthol, 2 parts, 
 triturated together, dry. It is freely dissolved in retinol. M. Blanchard
 
 I 66 LOCAL THERAPEUTICS. 
 
 speaks highly of its antiseptic properties, and advises its use as a topical 
 application for slight wounds, etc., as being non-toxic in its action. It 
 is also used as an antipruritic in skin diseases. 
 
 CAMPHORATED SALOL. 
 
 Camphorated salol is a mixture of two parts of powdered camphor and 
 three parts of salol. A gentle heat is applied until all the ingredients are 
 melted. Camphorated salol is a colorless liquid, insoluble in water, but 
 very soluble in ether, chloroform, and in oils. It rapidly decomposes when 
 exposed to the air and light. 
 
 Diseases of the Ear. Pegou employs camphorated salol in the 
 treatment of OTORRHCEA. It is applied pure on the end of a cotton 
 tampon. 
 
 CANNABIS INDICA. Indian Hemp. 
 
 Cannabis indica owes its medicinal properties in largest degree to its resin, and in less 
 degree to a volatile oil. 
 
 The local action of Indian hemp is that of a sedative. Indian hemp 
 is included by W. H. Beverly {Brit. Med. Jour., September 6, 1884) as 
 an ingredient of a powder for insufflation in HAY FEVER. 
 
 CANTHARIS. Cantharides. Spanish Fly. 
 
 The Spanish Fly is a beetle "about one inch (25 mm.) long and a quarter of an inch 
 (6 mm.) broad, with ample, membranous, transparent, brownish wings; elsewhere of a 
 shining coppery-green color ; the powder is grayish-brown, and contains green shining 
 particles." (U. S. P.) The vesicating principle has been isolated, and is called canthari- 
 din. The official preparations of cantharides are the Cerate (thirty-five parts of can- 
 tharides in powder in one hundred parts of the finished product, the other ingredients being 
 yellow wax, resin, and lard); the Ceratum Extracti Cantharidis (in the preparation of 
 which there is first made an extract of cantharides, and this extract added to a mixture 
 of yellow wax, resin, and lard, so that each one hundred parts contains the extract 
 from thirty parts of cantharides) ; Charta Cantharidis (which is paper coated with 
 a cantharidal plaster of the strength of one part of cantharides to sixteen of plas- 
 ter) ; Collodium Cum Cantharide, prepared by making a strong chloroform tincture of 
 cantharides and adding it to flexible collodion, so that one rrundred parts of the finished 
 product shall contain the blistering principle of sixty parts of cantharides; Linimentum 
 Cantharidis (made by digesting fifteen parts of cantharis in oil of turpentine sufficient 
 to make one hundred parts, and straining) ; and Tinctura of Cantharidis (containing 
 five parts of cantharides in one hundred parts of alcohol). 
 
 Cantharis is counter-irritant, and may be vesicant, and rubefacient, 
 according to the method of use. 
 
 General Surgery. Cantharis is exceedingly irritating when applie 
 to the skin, causing first redness with burning, then free vesication an<
 
 CANTHARIS. 167 
 
 pain, and, if kept in longer contact with it, deep inflammation and slough- 
 ing. Cantharis in some of its various preparations is the most reliable 
 means of producing vesication. The effect varies with different persons, 
 depending upon the condition of the skin and the part to which the 
 blister is applied. The primary action of a blister is that of a stimu- 
 lant to the body generally and to the individual organs in the neighbor- 
 hood of which it is applied, but if allowed to remain long enough to 
 produce much vesication it depresses the bodily powers in proportion to 
 the amount of serum withdrawn from the vessels. 
 
 Precautions are necessary in ordering blisters : in pregnancy ; in per- 
 sons of scorbutic, purpuric, or other hemorrhagic disposition; in general 
 debility ; in very young or very old persons. 
 
 They should never be applied over an acutely-inflamed joint, to the 
 chest in the first stage of pneumonia, over some specialized skin -surfaces, 
 as the scrotum or the skin of the mamma, over bony prominences or 
 where the healing processes are apt to be retarded. 
 
 A blister should never be permitted to remain for more than twelve or 
 twenty-four hours. As a rule, it is removed at the end of six or eight hours, 
 even if vesication is not marked, and a soft flaxseed poultice applied. 
 With good material the selected surface will be found covered with 
 large blebs. These should be carefully pricked at their most depen- 
 dent part and the serum allowed to drain away, thus permitting the raised 
 cuticle to settle back to its old place on the true skin. The part should 
 then be dressed with a layer of dry cotton, kept in place with a few strips 
 of adhesive plaster. If treated in this manner, the healing of a blister is 
 almost painless. The use of flying blisters, after the method of Brodie, 
 is preferable to keeping a single blistered surface raw with irritants. 
 In some persons STRANGURY may arise from very slight contact with any 
 form of cantharides. To obviate this condition, a blister should always 
 be removed as soon as decided pain is felt, and the part dressed with a 
 soft, moist dressing as above stated. A thin piece of paper or muslin 
 may be applied between the blister and the skin. When using a blister, the 
 patient should drink freely of demulcents, and the action of the kidneys 
 be encouraged. In very sensitive persons, where a blister is indicated, it 
 may be produced without pain by painting with cantharidal collodion. 
 Previous to the application of the poultice the part may be sprinkled over 
 with a little morphine rubbed up with starch. 
 
 In PNEUMONIA and PLEURISY blisters are frequently employed with 
 great advantage, although authorities are at variance, as to the stage of 
 the disease in which they are useful. Some writers assert that blisters 
 during the febrile stage increase fever. In our experience such is not 
 the case. Care must be exercised in the applications, not permit- 
 ting them to be too large, or to remain on long enough to give the
 
 1 68 LOCAL THERAPEUTICS. 
 
 patient much inconvenience or pain. There can be no doubt that a care- 
 fully applied blister will often relieve pain and quiet cough in either of 
 the above named affections ; patients will frequently fall into a quiet sleep. 
 
 Large " flying " blisters over the chest favor the absorption of fluid in 
 HYDROTHORAX ; they seem to stimulate the absorbents to action, aid 
 in the removal of effused fluid and lessen the risk of the disease be- 
 coming chronic. Light flying blisters will usually relieve the troublesome 
 intercostal pains which accompany CHRONIC PLEURISY. 
 
 In PERICARDITIS the application of a blister over the region of the 
 heart is often followed by relief of pain and dyspnoea. In certain forms 
 of PHTHISIS, especially the chronic form, in which fibroid degeneration 
 of the lung is to be dealt with, when the cough is paroxysmal, violent, 
 and distressing, counter-irritation over the seat of the disease will fre- 
 quently markedly relieve the symptoms. As a rule, for this class of 
 cases, painting the skin over the apex of the lung with iodine is a much 
 better means of producing counter-irritation than the application of blis- 
 ters. In weak persons the withdrawal of large quantities of serum is 
 not free from danger. 
 
 In NEURALGIA a blister over the course of the affected nerve is of 
 service, especially in some forms of SCIATICA. Cantharis is superior to 
 mustard, croton oil, iodine, etc., as a means of producing counter-irrita- 
 tion in this condition. Some forms of FACIAL NEURALGIA may be 
 relieved by a small blister applied behind the ear, near the point at 
 which the nerve makes its exit from the stylo-mastoid foramen. A few 
 flying blisters, each as large as a silver dollar, will often relieve the 
 obscure neuralgic pain in the region of the ovaries, which is so common 
 in nervous, hysterical women. 
 
 DISEASES OF THE BRAIN AND SPINAL CORD of an inflammatory charac- 
 ter (e. g., meningitis), when in the subacute or chronic stage, are often 
 benefited by the application of blisters to the nape of the neck, or along 
 the course of the cord, a little to one side of the spinous processes of the 
 vertebras. In carefully selected cases of serous apoplexy a blister may 
 be of service, but in the hemorrhagic variety it is of little or no value. 
 In all cases their effect should be carefully watched. If the effect of 
 vesication is desired in the region of the head or neck of a restless 
 patient it is best produced by means of the cantharidal collodion, two or 
 three coats being painted on, the desired size, with a camel's-hair brush. 
 A blister applied to the epigastrium is occasionally useful in allaying 
 PAIN and OBSTINATE VOMITING due to disease of the stomach. In SYNO- 
 VITIS, the application of blisters is often restored to. The blisters should 
 never be large, and should not be permitted to remain on long enough to 
 produce ulceration. More advantage can be derived from small, fre- 
 quently applied, light blisters, than from larger or more profound ones.
 
 CANTHARIS. 169 
 
 These remarks are especially applicable to the treatment of CHRONIC SYNO- 
 VITIS of the knee-joint with effusion. The treatment pursued is as fol- 
 lows : About four blisters, the size of a silver dollar, are applied by means 
 of cerate or collodion above and below the patella. The limb is then 
 placed on a splint and firmly retained by a bandage, decided pressure 
 being made on the region of effusion. After the completion of vesica- 
 tion, the joint is enveloped with an ointment of equal parts of mercurial 
 ointment and belladonna ointment spread on lint, and protected with 
 oiled silk or waxed paper, and then firmly reapplied to the splint. The 
 dressing is changed every other day, the skin being thoroughly cleansed 
 with soap, water, and alcohol. About the fourth day the blisters are re- 
 applied, a fresh site being selected. Firm pressure is always kept up, as 
 it hastens the absorption of fluid. As soon as the effusion and pain have 
 disappeared, a firm plaster-of-Paris bandage is applied and retained from 
 four to six weeks, the patient being permitted to walk about." 
 
 Blisters are of established reputation in the treatment of RHEUMATISM ; 
 a number of flying blisters, if applied in proximity to a painful and 
 tneder joint, quickly remove the pain. It was formerly much more the 
 custom to blister freely in attacks of ACUTE RHEUMATISM than it is at the 
 present day. The advocates of free vesication assert that it modifies 
 and shortens the attack, and lessens the danger to heart complications. 
 CHRONIC MUSCULAR RHEUMATISM, affecting certain muscles or groups of 
 muscles, may be benefited by the application of small flying blisters in 
 the course of the nerve supplying the part. 
 
 PERIOSTITIS of the larger bones, e. g., the tibia, may be benefited by 
 counter-irritation with cantharis. After the removal of the blister the 
 part should be dressed with an ointment made of equal parts of bella- 
 donna ointment and mercurial ointment. Too much dependence must 
 not be placed on this method of treatment ; if, after a fair trial, the pain 
 and swelling are not relieved a free incision through the periosteum may 
 be necessary. 
 
 In PERITONITIS and some forms of ENTERITIS blisters may be applied 
 with advantage, not, however, in the acute stages of the disease, when 
 the application of leeches are of greater service. Where peritonitis is 
 general a blister 3x5 in., or larger, may be applied over the seat of 
 intense pain, and covered with a light, hot flaxseed poultice enveloping 
 the entire abdomen. Care should be exercised that the pain of the 
 disease does not mask what ordinarily might arise from a blister ; for it 
 might be allowed to remain on too long if reliance is placed upon the 
 patient's sensations. After its removal the site of the blister may be dressed 
 with mercurial ointment spread on lint, after which the abdomen may be 
 covered with a poultice. By this means a bland dressing is applied, and 
 the beneficial effects of the mercury are also obtained.
 
 170 LOCAL THERAPEUTICS. 
 
 In CHRONIC OVARITIS a small blister in that region is sometimes very 
 effectual when other measures have failed. In GLEET the application of 
 a blister to the penis is strongly advised by Mr. Milton. Care must be 
 exercised that none of the blistering substance, either collodion or cerate, 
 shall escape and inflame the scrotum. It must also be borne in mind that 
 the delicate skin of the penis is easily vesicated. A blister applied to the 
 perineum, along the course of the urethra, is often of service in PROSTA- 
 TITIS and catarrhal conditions of the prostatic ducts, frequently spoken 
 of as PROSTATORRHCEA. 
 
 The habit of MASTURBATION IN CHILDREN, if early detected, may 
 often be counteracted by keeping the penis sore by frequent applications 
 of cantharidal collodion. This should always be done under the care of 
 a physician. 
 
 In PHLEBITIS of the superficial veins, especially of some of the large 
 venous trunks, such as the long saphenous, a blister applied over the 
 course of the inflamed vessel reduces the inflammation, hastens absorp- 
 tion or liquefaction of the coagulated blood, and assists materially in the 
 restoration of the circulation through the obstructed vessels. 
 
 In POISONED or DISSECTING WOUNDS of the hand, where the materies 
 morbi has a tendency to travel along the course of the lymphatic vessels, 
 invading each chain of glands in turn, and where its course is marked 
 by a dark line on the flexor surface of the forearm, a blister completely 
 encircling the arm is sometimes of service if applied early in the disease. 
 Treatment appropriate to the local condition must be vigorously pursued. 
 
 Diseases of the Skin. Cantharis is used in the form of the 
 ordinary blister, and also in the form of the acetum cantharidis, the tinc- 
 tura cantharidis, and collodium cum cantharide. 
 
 In ALOPECIA AREATA blisters are used on the bald patches by the 
 employment of one or another of the above preparations; they are 
 repeated from time to time until the new hair begins to grow. In N^EVI 
 of small size repeated blistering often causes inflammation, with subsequent 
 closure of the dilated blood-vessels. Old and horny patches of chronic 
 ECZEMA are likewise induced to take on more acute action by the use of 
 blisters, after which they may be cured by soothing ointments. 
 
 Circumscribed patches of TINEA TONSURANS and of TINEA CIRCINATA 
 may be removed by blistering. 
 
 As a rubefacient the tincture of cantharides, diluted with several parts 
 of alcohol, etc., is employed in all forms of ALOPECIA and in PITYRIASIS 
 of the scalp. The following formula, which may be strengthened by the 
 addition of a larger proportion of the tincture of cantharides, is popular : 
 R. Tinct. cantharidis, f^ij ; olei ricini, 9j ; alcoholis, ad. fj. M. 
 This may be rubbed into the bald patches of ALOPECIA AREATA once or 
 twice daily.
 
 CAPSICUM. 
 
 171 
 
 In ALOPECIA PREMATURA and in PITYRIASIS CAPITIS, a vigorous sham- 
 pooing (see Spiritus Saponis Kalinus) should precede the employment of 
 the cantharidal mixture, which may then be applied to various parts of 
 the scalp, by means of a dropper, and thoroughly brushed in. 
 
 Diseases of the Ear and Throat. It was formerly the practice to 
 blister the mastoid region in OTITIS MEDIA. While more precise methods 
 applicable directly to the affected parts are now in vogue, it is well to 
 remember the advantage to be derived from the use of a blister in the 
 region named, under some conditions. Blisters are rarely used in the 
 treatment of laryngeal affections. W. K. Simpson has found advantage 
 follow the application of a blister over the larynx in a case of ACUTE 
 LARYNGITIS of gonorrhoeal origin, accompanied with dyspnoea. In this 
 case salicylic acid had failed to do good. Some practitioners find ad- 
 vantage in placing the blister as far down the neck as the episternal 
 notch. 
 
 Diseases of the Eye. Blisters are not now nearly so much used as 
 formerly in ophthalmic therapeutics. They are sometimes very useful in 
 obstinate cases of CHRONIC INFLAMMATION, WITH MARKED IRRITABILITY 
 OF THE EYE and persistent pain. They are applied to the temple or 
 mastoid, and when continued counter-irritation is desired may be alter- 
 nated in these two localities. The most convenient form of application 
 is by means of cantharidal collodion painted on with a brush. When 
 the bleb is ruptured, a piece of surgeon's lint, cut of proper form and 
 spread thickly on the smooth side with simple cerate, cosmoline, or 
 lanoline, makes a neat dressing, which will adhere without support if 
 smoothly applied. 
 
 CAPSICUM. Capsicum. 
 
 " The fruit of Capsicttm fastigiatum ." (U. S. P.) 
 
 The official preparations of capsicum are the Fluid Extract (one gramme in one 
 hundred cubic centimetres) ; the Oleoresin (procured by percolating capsicum with ether 
 and evaporating off the ether); the Tincture (containing the activity of five parts of 
 capsicum in one hundred parts of the product) ; and the Emplastrum (resin plaster 
 spread on muslin and coated with oleoresin of capsicum). 
 
 Capsicum is counter-irritant, rubefacient, and excitant. It possesses, 
 in addition, peculiar properties which clinically associate it with some 
 astringents, such as tannic acid and nitrate of silver. Its use is especially 
 indicated in acute inflammations of superficial parts, either of skin or 
 mucous membrane. 
 
 General Surgery. The oleoresin of capsicum, when applied to the 
 skin, produces in a few minutes intense pain and redness, and finally 
 destroys the cuticle. As a counter-irritant it is inferior to cantharides ; 
 as a local remedy its field of usefulness is usually confined to domestic
 
 172 LOCAL THERAPEUTICS. 
 
 medicine. Dr. Buck states that an efficient way of applying capsicum is 
 to infuse a handful of the crushed pods in half a pint of hot water for 
 from twenty-four to thirty-six hours ; then strain and bottle for use. He 
 applies a piece of lint soaked in this liquid to the affected part, and 
 covers it with gutta-percha or oiled silk. It never vesicates, and even a 
 stronger preparation than the one named may be used. The effect is 
 often striking an attack of acute TORTICOLLIS is relieved in ten minutes. 
 Capsicum is also of service in recent LUMBAGO, NEURALGIA, " RHEU- 
 MATIC PAINS," etc. Powdered capsicum, thickly sprinkled on a moist 
 handkerchief or on a piece of moist brown paper, and applied to the 
 skin, is an efficient counter-irritant. 
 
 The capsicum plaster of the Pharmacopoeia is an agreeable application 
 to some of the mild RHEUMATIC PAINS often felt on the anterior portion 
 of the chest after driving. 
 
 McDonald speaks highly of an ointment composed of two drachms of 
 capsicum and an ounce of lard in subacute and chronic RHEUMATISM, when 
 rubbed into the affected part with a gloved hand night and morning. The 
 first thorough application often gives relief. Lumbermen and teamsters 
 wear powdered capsicum in their stockings as a preventive of cold feet. 
 
 Diseases of the Skin. The tincture of capsicum is employed as a 
 rubefacient in the various forms of ALOPECIA, being used in a diluted con- 
 dition, as the tincture of cantharides is employed. It has the advantage 
 of not producing vesication. Applied pure or somewhat diluted to the 
 skin, it relieves CHILBLAINS (ERYTHEMA CALORICUM). 
 
 Diseases of the Throat. Capsicum is used in the form of the 
 diluted tincture in RELAXED UVULA, either as a pigment or a gargle, in 
 the proportion of a half ounce of the tincture to eight ounces of rose- 
 water, though double this strength has been used. It is also of slight 
 repute in PHARYNGITIS SICCA. The so-called "hot drops," No. 6 of the 
 Thomsonian practice, is a composition of capsicum, myrrh, and golden 
 seal. It is indicated in relaxed state of the mucous membrane of the 
 pharynx in subacute inflammation. In the ANGINA of scarlet fever this 
 gargle has been for many years in repute in domestic practice in the 
 United States. A stronger preparation may be prepared by adding two 
 tablespoonfuls of the powder to a pint of boiling water and vinegar equal 
 parts, to which a teaspoonful of sodium chloride has been added. A 
 powder of fifteen grains of capsicum and ten grains of carbonate of 
 ammonia has been employed by M. Granville as a snuff in the treatment 
 of HAY FEVER. We do not recommend this. Capsicum is contra- 
 indicated in deep-seated, acute, phlegmonous inflammation. Capsicum 
 lozenges contain one-half minim of the tincture. 
 
 A few drops on a dossil of cotton, inserted in the hollow of the tooth, 
 is an excellent remedy for TOOTHACHE.
 
 CARBO LIGNI. 
 
 173 
 
 CARBO LIGNI. Charcoal. 
 
 " Charcoal prepared from soft wood." (U. S. P.) The shoots of the poplar tree or 
 the shoots of the willow tree are the usual source of medicinal charcoal. The first is 
 much used in France and the last in this country. Charcoal contains carbon in proportion 
 varying from sixty-five to eighty per cent. Charcoal is a black, tasteless, porous, brittle, 
 insoluble, and infusible substance, possessing a remarkable power of absorbing gases. 
 
 Charcoal is absorbent, disinfectant, and probably deodorant and 
 haemostatic. Its action is imperfectly understood. It is often used 
 as a diluent of caustics and as a convenient means of conveying dry 
 heat. Japanese hand warmers consist of small, flat metallic boxes, in 
 which a mild form of heat is maintained for several hours by the slow 
 combustion of Japanese .carbon. They may be utilized when the pro- 
 longed use of dry heat is indicated. 
 
 General Surgery. Charcoal employed for topical purposes is always 
 in a powdered form, and to obtain the best results from its use it is im- 
 portant that it should be powdered immediately after removal from the 
 kiln. If this has not been done it may be reheated to expel the gases 
 condensed in its pores, which would tend to impair its absorbing proper- 
 ties. Charcoal is largely employed in surgery in making the well-known 
 "charcoal poultice." One part of charcoal is incorporated with three 
 parts of flaxseed meal, which is made up like an ordinary poultice. 
 Another method is to dust powdered charcoal thoroughly over the sur- 
 face of a flaxseed poultice. Though this is frequently done, the method 
 is greatly inferior to incorporating the flaxseed meal and charcoal together. 
 
 A charcoal poultice is a serviceable dressing for GANGRENOUS and 
 SLOUGHING SORES, correcting the fetor and arresting the process of ulcer- 
 ation. It has been asserted that when charcoal is moistened, as in a 
 poultice (its pores being filled with moisture), it loses, to a great extent, 
 its property of absorbing or oxidizing gases, and its power as a deodor- 
 izer is impaired. In foul, gangrenous sores, where the odor is offensive 
 with ordinary dressings, or even with the charcoal poultice, this may be 
 corrected by placing loosely over the dressing a small flat bag made of 
 cheese cloth and filled with powdered charcoal. Dry charcoal retains 
 its power of absorbing gases for a long time. Exposure to a dull, red 
 heat restores its gas-absorbing properties. 
 
 For caustic purposes charcoal is often made into a paste with some of 
 the stronger acids, such as sulphuric, and placed over the part that is to 
 be destroyed. The caustic action can be regulated by the amount of 
 charcoal present. It has been employed where these agents have been 
 used in the treatment of HARD CHANCRE. 
 
 Diseases of the Throat, etc. Charcoal forms the essential feature 
 in the Stenhouse respirator. A layer of coarsely powdered charcoal is
 
 174 LOCAL THEARPEUTICS. 
 
 held between two sheets of silvered wire gauze. The object is to destroy 
 morbific particles in the atmosphere and to protect the lungs from their 
 presence. Beyond entering into the composition of dentifrices charcoal 
 is little used locally about the mucous membranes of the head. J. W. 
 White asserts that it has haemostatic properties. Charcoal is of slight 
 service as a deodorant in FOUL BREATH. 
 
 Diseases of the Kye. The Japanese hand warmer is an admirable 
 piece of apparatus for keeping up a high degree of dry heat in threatened 
 SLOUGHING KERATITIS, etc. It is light in weight and can be readily 
 borne when placed on the eye on a thin layer of cotton or a pad of 
 folded lint. 
 
 CATECHU. 
 
 " An extract prepared from the wood of Acacia catechu." (U. S. P.) 
 It should be noted that the Ph. Br.' calls catechu " an extract from Uncaria gam- 
 bir," which is an entirely different product from that recognized by the United States 
 Pharmacopoeia. There are many varieties of catechu, all of which have, however, 
 similar medicinal effects. Their activity depends on the presence of catechutannic acid. 
 Catechu is inodorous, and has an astringent and bitter taste. Alkaline salts are said to 
 diminish, if not destroy, its efficacy. Tincture of Catechu contains twelve parts of 
 catechu and eight parts of cinnamon, in one hundred parts of the finished tincture. 
 
 Catechu is astringent. 
 
 General Surgery. In CHAPPED NIPPLES the tincture of catechu is an 
 efficient application. The nipple being thoroughly cleansed in warm 
 water, the tincture is applied with a camel's-hair brush or a little cotton. 
 In LEUCORRHOEA the infusion of catechu is often used as a vaginal wash, 
 once or twice daily, and has been found useful in lessening the quantity of 
 the discharge. 
 
 Diseases of the Throat. Catechu may be used in the respiratory- 
 mucous surface wherever the use of an astringent is indicated. In solu- 
 tion it does not form so clear a preparation as does Kino or Krameria. It 
 more frequently enters into the composition of lozenges. Each lozenge 
 contains from one to two grains of pale catechu. 
 
 In ptyalism and other forms of inflammation of the gums, a piece of 
 catechu allowed to dissolve slowly in the mouth is often of service. 
 
 Catechu Wool: "Cotton-wool," one drachm; glycerin, ten minims; 
 tr. catechu, vel kino, vel rhatany, one ounce. Mix the glycerin with the 
 tinctures, saturate the wool with the liquid, and dry. 
 
 CAUTERY. 
 
 By the term cautery is meant a method of treatment by which albumen in living 
 tissues is coagulated, or the tissues themselves destroyed by fire. 
 
 The actual cautery is used for its counter-irritant, destructive, and haemostatic action, and 
 forms one of the most powerful means which the surgeon possesses. It may be applied
 
 CAUTERY. 
 
 '75 
 
 either in a simple or complicated manner, as by the heating of any metallic or non- 
 destructible substance to the required temperature by fire, or by the use of some of the 
 more elaborate chemical or electrical apparatus. The common method of its application 
 is by irons of various shapes heated to a red or white heat in a charcoal furnace. A 
 gas cautery has been introduced, by which a jet of burning gas may be directed to the 
 desired spot. The galvano-cautery, owing to the variety and delicacy of its means of 
 application, offers to the surgeon a means of dealing with many conditions which could 
 not be attempted with the more primitive instrument. The electrical current may be ob- 
 tained either from the chemical or storage battery. For the general use of the surgeon, 
 Pacquelin has introduced a cautery in which the heat is maintained by throwing the vapor 
 of some hydrocarbon (as benzin) upon spongy platinum which has been previously 
 heated. This ingenious apparatus forms a compact, convenient, and easily regulafed 
 means of cauterizing, and has almost superseded the use of the galvanic cautery in 
 general surgery. The temperature at which a cautery should be used depends altogether 
 upon the object in view. If used for its counter-irritant and destructive effect, it is best 
 employed at a high temperature, as from a bright red to a white heat ; if for its haemo- 
 static action, the cautery should not exceed a dull, cherry-red. Otherwise, the blood- 
 vessels will be seared through so rapidly that a very imperfect clot will be formed, and 
 bleeding will re-occur. Care should be exercised in the use of the cautery, never to 
 employ it when the temperature is below a dull red heat, as the tissues will adhere to the 
 iron, and on its withdrawal a portion of the burned part will be removed, causing unne- 
 cessary pain. 
 
 General Surgery. In ARTICULAR as well as OSSEOUS DISEASE Mr. 
 Barwell speaks highly of the use of the actual cautery, heated to white- 
 ness, as a counter-irritant. The agent is of especial value in that ob- 
 stinate class of joint diseases which, if not corrected, will soon perma- 
 nently impair the integrity of the parts. The effect produced by the 
 actual cautery is apparently similar to that produced by blisters and other 
 revulsives, although it is a more powerful method. As a rule, the pain 
 caused by the cautery is momentary, less, indeed, than that following the 
 application of a blister. The contact of the heated wire or rod should 
 be for as brief a time as possible, as the object in view is to create a 
 superficial ulcer which will rapidly heal. (See remarks on flying blister, 
 p. 169.) It must be borne in mind that the cautery is not applicable to 
 the early stages of inflammation, neither is it of any service in the sup- 
 purative stage. It is best adapted to the long-standing, deep-seated in- 
 flammations. Absolute rest of the part affected should always be enjoined 
 after the use of the cautery. 
 
 For its destructive effect the actual cautery is often employed by the 
 surgeon when the parts involved are very vascular and the use of a 
 cutting instrument is contra-indicated. In CANCER OF THE UTERUS 
 the entire surface of the growth may be altered and much temporary 
 relief obtained by the careful employment of the Pacquelin cautery. 
 The electro- ecraseur in action is similar to the ordinary instrument, the 
 only difference being a series of mechanical devices, by which the loop
 
 176 LOCAL THERAPEUTICS. 
 
 of the ecraseur is maintained at a low degree of temperature, so that the 
 wire slowly burns its way through the part to be removed, if properly 
 used, leaving a dry, seared stump. By this method the uterine neck and 
 other vascular parts may be removed without hemorrhage. A similar 
 method is applicable to CANCER OF THE TONGUE. To obtain the best 
 results, a low degree of heat must be maintained otherwise the vessels 
 will be opened so rapidly that a satisfactory clot will not be formed and 
 hemorrhage will ensue. 
 
 As a hczmostatic the value of the actual cautery has long been recog- 
 nized. The ancients employed a large flat stone at a red heat to control 
 bleeding from the stump in amputations. The cautery to-day, as a haemo- 
 static, has a very extensive range of employment, especially in positions 
 where the application of a ligature is impossible, as in bleeding from 
 the internal maxillary artery in the removal of the upper jaw. The 
 temperature must be relatively low and the contact with the bleeding part 
 be longer than for other purposes, to insure the thorough closing of blood- 
 vessels. In the treatment of HEMORRHOIDS the cautery is extensively 
 employed, especially where Smith's clamp is used and the pile is removed 
 with scissors. The base is thoroughly seared with a hot iron, thereby 
 controlling all bleeding. As a rule, the pain following the procedure is 
 much less than in the use of the ligature so extensively employed in this 
 country. The advocates of these procedures are so strongly arrayed 
 on either side that the prudent surgeon will select for operation the 
 method best suited to the individual case. In PROLAPSE OF THE REC- 
 TUM, Van Buren recommends linear cauterization with the cautery, the 
 resulting cicatrices serving to contract the bowel. The employment 
 of nitric acid (q. v.~) will, as a rule, be found a more satisfactory means 
 of dealing with this troublesome condition. 
 
 Diseases of the Skin. The actual cautery is sometimes employed 
 in the treatment of LUPUS, EPITHELIOMA, and N^EVUS. A convenient 
 instrument is that figured in Piffard's "Materia Medica and Therapeutics 
 of the Skin " (N. Y., 1881, p. 232). It consists in a small, curved rod 
 of steel or iron, about the size of an awl, with a small globe of metal 
 near the point, to retain the heat. This is inserted in a shank, and can 
 be heated as desired, over a spirit lamp. 
 
 Some caution is necessary in using this or any cautery in large naevi, as 
 bleeding may follow if the tissues are too rapidly destroyed. 
 
 The " Pacquelin thermo-cautery " is employed for the same purpose. 
 The construction of this cautery is based upon the property of platinum 
 and some other rnetals of becoming immediately incandescent, when 
 raised to a certain degree of heat, in contact with a mixture of air and 
 the vapor of some volatile hydrocarbons, and of maintaining this incan- 
 descence so long as the contact of the mixture exists.
 
 CAUTERY. 177 
 
 The apparatus consists of a couple of rubber bulbs and tubes, such as are 
 used in atomizers, a glass receptacle for benzine, and a long, hollow cham- 
 ber with a perforated wooden handle, through which the vapor is blown. 
 By an arrangement of interior tubes the mixed vapor of air and gas is 
 carried around and over a metallic point. This varies in size and shape, 
 according to the use for which it is intended. This point is heated in an 
 alcohol flame, and then the gases are blown over it by the peculiar appa- 
 ratus. By working the bulbs with more or less rapidity, the point is 
 maintained at any degree of heat required. (See "Reference Handbook 
 of the Medical Sciences," art. "Cauterization.") 
 
 The Pacquelin cautery can be used for all the purposes for which the 
 actual cautery is employed. 
 
 A more convenient instrument for cauterization in diseases of the skin 
 is the electro-cautery. 
 
 A battery having some arrangement whereby the intensity of the cur- 
 rent can be varied at will is required, and a holder to which platinum 
 knives, spirals, etc., are to be attached as desired. The platinum points 
 should not be heated beyond cherry-red. Scarification can be used by 
 this cautery in LUPUS VULGARIS and in LUPUS ERYTHEMATOSUS with very 
 satisfactory results. Small N^EVI, WARTS, hairy or other MOLES, the 
 tumors of MOLLUSCUM EPITHELIALE, and other growths can be very 
 readily and satisfactorily removed by the electric cautery. The only 
 objection to its use is that patients are apt to be afraid of it, as of the 
 knife. The glow of the cautery and the smell of burning flesh give at 
 times unnecessary alarm to timid persons. For that reason the chemical 
 caustics, where these can be employed, are more satisfactory. 
 
 (For further description of the electro-cautery, see Van Harlingen, 
 "Handbook of Skin Diseases," 2d ed., Phila., 1889.) 
 
 Diseases of the Ear, Nose, and Throat. The phenomena which 
 attends the use of cautery on the mucous surfaces are as follows : If the 
 cautery be applied to the epithelium, the fire rapidly whitens the selected 
 spot and dense white fumes escape, which have the characteristic ammoni- 
 acal odor of singed hoofs. If applied to the deeper layer of the mem- 
 brane, or to the submucous tissues, the selected surface has a black color, 
 due to the charring of the tissue ; it has a black centre surrounded by an 
 areola of white color, caused by the coagulation of albumin on the 
 tissues between the charred spot and untouched parts. When a pit-like 
 depression is made, the sides may alone be charred. The eschar is the 
 part which, being so disorganized by the heat, sloughs off in a few days, 
 leaving an ulcer which rapidly heals. Should the eschar be confined to 
 the epithelial layer, the parts will heal without cicatrix, but should the 
 burning penetrate the connective tissue, then the white cicatrix is inevit- 
 able. The compact tissue, as the derm and mucoperiosteum, is more
 
 178 LOCAL THERAPEUTICS. 
 
 readily charred than the less compact, such as the polypoid and adenoid 
 tissue, the tonsil, etc. 
 
 Foulis obtained good results by heating a piece of wire, mounted upon 
 a wooden handle, in the flame of an alcohol lamp and touching the 
 pharyngeal and tonsillar surfaces, but such a method would be difficult, 
 if not impossible, to apply to any of the more concealed surfaces, such 
 as those of the nasal chamber, middle ear, and larynx. By the aid of a 
 platinum loop heated by a current of electricity we are enabled to use 
 the battery in a more accurate and satisfactory manner. Electrodes of 
 shapes and sizes appropriate to the special surfaces to which the cautery is 
 applied have been devised, so that every kind of surface in the neighbor- 
 hood of the nose, and the throat, no matter how remote, can be reached. 
 Platinum possesses marked advantages in not rapidly fusing and in 
 quickly cooling after being heated. Thus, when an application is 
 made within the larynx or at a locality far within the nasal chamber, 
 little or no danger is incurred of burning the surfaces which are passed 
 in transit. Apart from these considerations, the degree of heat developed 
 in the platinum loop can be controlled absolutely by the strength of the 
 current. The first effect of forcing a weak current of electricity through 
 a loop is to change its bright, silver-like aspect to a black color. This 
 tarnished appearance of the platinum corresponds to what is known as 
 " black-heat." While free from risks of creating cicatrices, black heat 
 is the weakest and most painful form of cautery and is employed by 
 practitioners only when it is desired to lightly touch the epithelial layer. 
 When the parts can be anesthetized by cocaine, the objections to the 
 pain of the black heat are, in the opinion of some observers, overcome ; 
 nevertheless, it is exceptionally employed. When held against muco- 
 periosteum for a moment only, the electrode evolving black heat has 
 no cautery effect whatever, but simply induces the milder effects ot 
 caloric. 
 
 J. Solis-Cohen (Transactions of the International Congress, 1881, Vol. 
 in, page 269) claims that the electro-cautery when used thus to secure a 
 superficial effect excites an "alterant" effect by modifying the nutrition 
 of the deep-seated tissues ; hence, this writer recommends that the agent 
 be employed in a variety of morbid conditions of the nasal mucous 
 membrane and that of the pharynx, as one would employ rubefacients 
 and counter-irritants on the general skin-surface of the body. Especially 
 is this method indicated in a state of engorgement about the follicles of 
 the pharyngeal mucous glands. S. Hartwell Chapman, of New Haven, 
 believes that he can remove opacities in the tympanic membrane, as well 
 as obtain destructions of growths within the tympanic chamber, by touch- 
 ing them with the heated platinum loop ; it can be used safely also as an 
 excitant in some forms of DRY and ATROPHIC NASAL CATARRH.
 
 CAUTERY. j 70 
 
 When it is desired to destroy infiltrated tissues, and the physician can 
 safely remain indiffere'nt whether or not submucous structures are involved 
 (as, for example, in the destruction of hypertrophy of the middle turbi- 
 nated bones) the wire can be heated to the next degree, which is that 
 in which the loop becomes of a brilliant red color, and is known as 
 "rose-heat," or "cherry-heat." A bright rose-heat- becomes a dull rose 
 the moment the wire touches the mucous membrane, so that it is impor- 
 tant to bear in mind that the burning strength of the wire is discounted 
 the moment the loop touches the selected surface. Most observers prefer 
 the "cherry-heat " or "rose-heat," and are content to produce a white 
 linear eschar. W. E. Casselberry (Journal of American Medical Asso- 
 ciation, February 8, 1890), after defining such eschar, draws the instru- 
 ment a second and a third time in the same direction as the first, but 
 always at subsequent sittings ; he, in this way, determines the position of 
 a cicatrix which is designed to bind down the neighboring parts by attach- 
 ment to the bony base. By the use of the electrode carried to the " rose- 
 heat " in a similar way, the cautery is admirably adapted to arrest bleeding. 
 It is absolutely necessary in such conditions that the heat be sufficient to 
 coagulate albumin. The agent acts precisely in the same manner as when 
 we use strong solutions of nitrate of silver. 
 
 The degree of heat developed in the loop beyond that of " rose-heat " 
 is that of bright yellow, or " white heat." " White heat " is so brilliant 
 that the eye is impressed with the scintillations radiating in all directions 
 from the metal. This step of incandescence is attended with great risk to 
 the instrument, since fusion of the metal will occur if it lasts for more 
 than an instant. White heat is rapidly destructive of all tissues save that 
 of bone, and even this will yield on wafer-like turbinals if a thick and 
 powerful electrode be employed. 
 
 The ordinary effect of white heat on living tissue is to produce hemor- 
 rhage. It may be employed for the purpose of depletion where patients 
 have refused to permit the use of the knife ; playing such a role, MYXO 
 MATOUS MASSES, when too bulky to be conveniently seized by the snare 
 or the forceps, can be incised in various directions and the several clumps 
 disposed for subsequent evulsion. But such adaptation possesses no ad- 
 vantage over the ordinary means of incision, and were it not for the 
 availability of the battery (/. <?., being constantly on hand for the impera- 
 tive demands of special practice) such use would not be thought of. In 
 some instances where a cautery application to the tonsils is indicated, a 
 rapidly destructive effect can be produced by white heat when the employ- 
 ment of any other form would be followed by distress. 
 
 The shape of the platinum loop is made to vary according to the use 
 to which it is put. As a rule, the loop is flattened, when it receives the 
 name of the " knife electrode." The two sides of the loop may be
 
 l8o LOCAL THERAPEUTICS. 
 
 acutely compressed, but the wire remain in the round. This form retains 
 a greater degree of strength than any other, and can be forced into inter- 
 vening resisting spaces, and even be made to destroy small surfaces of 
 bone. A spiral form may be made out of the loop, which results in a 
 compact moxa-like surface, which can be used on a variety of surfaces, 
 but it is more especially adapted for the destruction of soft, degenerated 
 tonsil-tissue. All things remaining the same, the larger and thicker the 
 loop the greater the difficulty to heat it and the greater power demanded 
 of the battery. It therefore becomes desirable to have the electrode 
 delicate in plan and one which represents the least degree of resistance 
 to the current. All these details, however, belong to the instrument- 
 maker rather than the physician, and have but indirect relation to the 
 subject of local therapeutics. 
 
 The galvano-cautery knife can be used to break down membranous 
 obstructions of the posterior nares ; such applications, however, in com- 
 mon with all of similar character near the orifice of the Eustachian tube, 
 must be conducted with extreme caution to avoid cellulitis, which is apt to 
 follow, with resultant suppurative inflammation of the middle ear. After 
 the removal of NASAL POLYPUS, the pedicle can be cauterized by the 
 galvano-cautery and the blood-vessels securely closed. 
 
 Limitations of the use of the cautery in 'the nose and throat are now 
 to be considered. The first of these, as already mentioned, is the danger 
 of exciting diffuse cellulitis. This effect of the cautery never occurs in 
 the nasal chamber unless sub-mucous tissues are opened. Hence, speak- 
 ing within the limits of the judgment which determines all surgical pro- 
 cedures, the cautery can be applied with safety in this region of the body 
 where superficial effects are alone secured and sub-epithelial structures 
 remain intact. To a less precise degree the same is true of the tonsils, 
 but it is difficult to make definite statements respecting these organs, 
 since the class of cases reporting for treatment is one notorious for the 
 frequency in which idiopathic inflammation occurs, and an inaccurate 
 observer is liable to confound coincidence with sequence. Cautery appli- 
 cations are apt to create excitement in the pharynx from inability to keep 
 the throat at rest ; hence, traumatisms, even if excited by the cautery 
 applied within the tonsils and pharynx, are more apt to be followed by 
 inflammation than is the case in any other region. Even with these 
 disadvantages the cautery can be safely used on the tonsils with the pre- 
 caution of covering a small part of the surface with the loop at each visit. 
 The least tractable of any portions of the mucous membrane are the folds 
 of the palate ; the slightest burn of either anterior or posterior fold is 
 almost certain to be followed by irritation, if not, indeed, a sharp grade of 
 inflammation.
 
 CAUTERY. l8l 
 
 The second danger is the creation of dry, irritable cicatrices. This 
 can be averted by the use of the black or dull rose-heat. 
 
 The third danger is the liability to the occurrence of vaso-motor 
 reflexes. These are rare, but may cause anxiety for twenty-four hours. 
 They have largely disappeared, since the introduction of cocaine. 
 
 The fourth and, in reality, the only serious danger is that of encranial 
 involvement. All things remaining the same, the nearer the operator 
 passes in treatment from the plane of the floor of the nasal chamber to 
 that of the roof, the greater become the difficulties of conducting active 
 local treatment. The more abrupt the narrowing of the chamber, the 
 greater becomes the distress should pressure effects develop. The 
 patient also incurs risk by the possible involvement of the veins which 
 convey blood from the nasal chambers to those tributary to the encranial 
 venous sinuses. Reflex phenomena, the result of intra-nasal cauteriza- 
 tions, are almost entirely confined to the surface of the nasal chamber as 
 defined by the ethmoid. As a rule, applications which would be entirely 
 safe to make at the plane of the inferior meatus, or to any part of the 
 inferior turbinal, would not be free from danger at the end of the middle 
 turbinal or to any part above these. For example, a hygroscopic eschar 
 lying on the inferior turbinal would be entirely innocent of causing dis- 
 tress, when a similar mass overlying the middle turbinal might exert so 
 extreme a degree of pressure as to create cephalalgia, or even to excite 
 cellulitis, which, extending to the longitudinal sinus, might have a fatal 
 result. Several cases have been reported of disease of the contents of 
 the brain-case from traumatism developed in the nasal chamber. Although 
 these are excessively rare, the caution cannot be too earnestly enjoined 
 that while surgical measures at the plane of the ethmoid are safe as are 
 operations, let us say, of all grades within the region of the middle ear, 
 yet they should be conducted with the same precaution as in that region 
 of the body, and all applications of the cautery must be carefully 
 watched. 
 
 The galvano-cautery has been used with good results in DIPHTHERIA. 
 F. Bloebaum {Deutsch. Med. Zeit., Jan. i, 1892) places it at the head of 
 local applications. Out of forty cases only one proved fatal. 
 
 Diseases of the Eye. The actual cautery is of great value in the 
 treatment of some conditions of the cornea. Spreading ULCERS and 
 sloughing processes of the cornea are now generally admitted to be of 
 septic origin (Homer, Klinische Monatsbl. f. Augenheilk., Vol. xn, 
 p. 432 ; Leber, Centralbl. f. Med. Wissensch., 1873, P- I2 9 etc -J> an d 
 " the natural therapeutic indication is to destroy the infecting material. 
 Nothing else accomplishes this so certainly, promptly, and safely as the 
 judicious application of the actual cautery. It may be made entirely 
 painless by cocaine, or even without it, and the use of cocaine in these 

 
 1 82 LOCAL THERAPEUTICS. 
 
 conditions of the cornea may sometimes be questionable ; no very severe 
 suffering is occasioned. It has been successfully used in SERPENT ULCERS, 
 SLOUGHING KERATITIS, CORNEAL ABSCESSES with or without hypopyon, 
 INFECTED WOUNDS, and obstinate cases of PUSTULAR KERATITIS. Slough- 
 ing of the flaps after cataract extraction may sometimes be checked by 
 prompt cauterization. It also affords the best prospect of success in 
 cases of CHRONIC INDOLENT NON-VASCULAR ULCERS and CORNEAL 
 FISTULA. Applied to the apex of the cone in conical cornea, it has been 
 claimed that it produces an ulcer whose cicatrization prevents further 
 bulging. The anterior chamber should not be penetrated. 
 
 The galvano-cautery is preferred by some surgeons, but has no great 
 advantage over a properly-shaped instrument of steel or platinum wire, 
 while it is handled with less ease and freedom than the latter and does not 
 admit of the same precision and delicacy of touch. A probe or strabis- 
 mus hook may be used in an emergency. The thermo-cautery of Pac- 
 quelin has also been used, but is not well adapted to the purpose. The 
 use of the actual cautery in the treatment of ULCERS of the cornea was 
 first recommended by Martinache, of San Francisco, in 1873, but did not 
 attain a recognized position in ophthalmic surgery until some years later. 
 Though a number of authors have written strongly in its favor, it is not 
 even yet so generally adopted as it should be. (Knapp, Trans. Am. Oph. 
 Soc'y, 1885; Nieden, Archives of Ophthal., Vol. xin, p. 31.) 
 
 CERA FLAVA. Yellow Wax. 
 
 " A peculiar concrete substance prepared by Apis mellifica. Yellow wax melts at 63 
 to 64 C. (145. 4 to 147.2 F.). It is insoluble in water, soluble in thirty-five parts 
 of ether, and in eleven parts of chloroform, in oil of turpentine, and in fixed and vola- 
 tile oils, and in boiling alcohol." (U. S. P.) White wax is a constituent of Ceratum 
 Cetacei, Charta Cantharidis, and Unguentum Aqutz Rosce, and yellow wax of many of 
 the cerates, ointments, and plasters of the Pharmacopoeia. 
 
 Wax bleached by exposure to " moisture, air, and light," thus avoiding chemical 
 bleaching, constitutes CERA ALBA (White Wax, " Yellow Wax, bleached." 
 
 Wax is protectant ; by its tenacious character it serves under a limited 
 group of conditions as a haemostatic. 
 
 General Surgery. Wax is not used by itself to any extent as a local 
 dressing in surgery, although it is often incorporated with ointments in hot 
 weather to give them a proper consistency. It is also frequently, though 
 improperly, added to cocoa-butter in the preparation of suppositories with 
 the effect of making the mass insoluble in proportion to the amount of 
 wax added. Such suppositories are worse than useless, and when inserted 
 in the rectum not only disappoint the physician by the failure of the drug 
 which is incorporated with the suppository to act, but oftentimes induce
 
 CERII OXALAS CETRARIA CRINOLINE. 183 
 
 local irritation. Wax is one of the ingredients in making Lister's 
 carbolized gauze, which is impregnated with crystallized carbolic acid 
 i part, common resin and white wax, of each 4 parts. (Cheyne, "Anti- 
 septic Treatment of Wounds," p. 43.) We have used this gauze, but 
 much prefer one from which the wax is omitted, which is a much softer 
 and pleasanter dressing to deal with. It consists of castor-oil, i part; car- 
 bolic acid, 2 parts; resin, 8 parts, and alcohol, 45 parts. The gauze is 
 saturated with this preparation, allowed to dry, and then packed in 
 air-tight jars. A piece of wax' should be in every general operating 
 case, as it is of use in preparing ligatures. At one time all silken 
 or linen ligatures were thoroughly waxed before being applied to 
 vessels, but at the present day the use of the catgut ligature has super- 
 seded them almost entirely. All large ligatures for tying PILES or N^EVI, 
 etc., should be thoroughly waxed before using, which makes them much 
 less liable to slip in tying, and renders the knots more secure. A con- 
 venient means of arresting HEMORRHAGE from the cut end of bone, 
 especially the end of the tibia after an amputation of the leg, is to drive 
 forcibly a small piece of wax, the size of a split pea, into the cancellated 
 structure of the bone at the bleeding point. 
 
 CERII OXALAS. Oxalate of Cerium. 
 
 " It is a white, granular powder, permanent in the air, odorless and tasteless, insoluble 
 in water or alcohol, but soluble in hydrochloric acid." (U. S. P.) 
 
 Diseases of the Nose, etc. The oxalate of cerium can be used, 
 according to F. H. Bosworth, in the form of a powder, in the proportion 
 of twenty grains to the ounce of acacia in CHRONIC CATARRH of children. 
 
 CETRARIA. Iceland Moss. 
 
 " The dried lichen, Ceiraria Islandica." (Br. Ph.) The plant is without odor and 
 has a slightly bitter taste. Iceland Moss contains a peculiar starch known as lichenin, 
 a bitter principle, and other unimportant constituents. Lichenin is insoluble in cold water, 
 but readily soluble in hot water. Boiling water dissolves out everything soluble in Ice- 
 land Moss, and the solution gelatinizes on cooling. 
 
 Iceland Moss is used as an ingredient of a throat lozenge. 
 
 CRINOLINE. Quinoline. Leucoline. 
 
 " Chinoline is an alkaloid prepared by the destructive distillation of quinine or cincho- 
 nine with potassium hydrate, and also, synthetically, by the action of sulphuric acid and 
 glycerin upon nitro-benzol and aniline,.or a mixture of these two latter substances. It is a 
 colorless, strongly refractive, oily liquid, having a specific gravity of 1.081 at 10 C." (U.
 
 184 LOCAL THERAPEUTICS. 
 
 S. D.). It has an unpleasant odor which is compared to that of the oil of bitter almonds. 
 " Chinoline is sparingly soluble in cold water, more so in hot water; insoluble in alcohol, 
 and mixes in all proportions with ether, bisulphide of carbon, methylic alcohol, etc. It 
 also dissolves camphor and resins. It forms crystallizable salts with acids, the tartrate 
 now being a commercial article." (U. S. D.) 
 
 Chinoline is antiseptic. In this respect it is an agent " stronger anti- 
 septic than sodium salicylate, carbolic acid, quinine, boric acid, sulphate 
 of copper, or alcohol. In four-tenths per cent, solution it arrests the 
 putrefaction of blood and the curdling of milk. By a one per cent, 
 solution the coagulability of the blood was completely destroyed." (U. 
 S. D.) 
 
 General Surgery. Domat (Journ. de Med., Paris, June 10, 1888) 
 regards a 1-150 solution of the tartrate of chinoline as a very useful 
 injection in GONORRHCEA. 
 
 Diseases of the Ear, Throat, etc. Chinoline is recommended 
 in the treatment of OTORRHCEA. C. H. Burnett advises its union with 
 salicylic acid in the proportion of one of chinoline to ten, or of boric 
 acid one to fifteen. Its use has been advocated also in a five per cent, 
 solution in the local treatment of DIPHTHERIA. 
 
 Chinoline has been employed in the treatment of GANGRENE of the 
 dental pulp, by introducing small plugs of cotton soaked in a twenty 
 per cent, solution of Merck's tartrate of chinoline. Over this is placed 
 a piece of absorbent cotton sprinkled with powdered chinoline. The 
 dressing is changed every other day, the cavity being washed out with a 
 solution of permanganate of potassium. (London Med. Times, June 15, 
 1885.) 
 
 " CHLORAL." Hydrate of Chloral. Chloral Hydrate. 
 
 The United States Pharmacopoeia incorrectly calls the hydrate of chloral "chloral." 
 So that, under the name of chloral, the hydrate is always supplied in the United States. 
 The name chloral should be applied to an anhydrous product. Hydrate of chloral is 
 found in the market in two forms the crystals and the plates. The crystalline is to 
 be preferred because of its greater purity, though for external medication, while less 
 active than the crystalline, that of the plates may often suffice. 
 
 Hydrate of chloral volatilizes in the air and, consequently, should be kept in well-stopped 
 bottles. 
 
 The official chloral is " freely soluble in water, alcohol, ether, and also soluble in four 
 parts of chloroform, in glycerin, benzol, benzin, bisulphide of carbon, fixed or volatile oils. 
 It liquefies when mixed with carbolic acid or with camphor." (U. S. P.) 
 
 For the property of union .between chloral and camphor see Cam- 
 phorated chloral. 
 
 " Chloral " is antiseptic, anaesthetic, and vesicant. 
 
 General Surgery. Owing to the irritant properties of chloral it has
 
 CHLORAL. 185 
 
 been made use of for blistering. It is said to be as efficacious for this 
 purpose as is cantharis, for which it may be substituted in treating persons 
 who object to cantharis on account of the pain it produces. In using 
 chloral for a blister, the drug should be powdered and a layer of it spread 
 on adhesive plaster, taking care to leave a wide margin. The chloral is 
 then warmed over a gas-jet, and as soon as it melts it should be applied 
 to the previously anointed skin. This mode of blistering causes no 
 unpleasant sensations, owing to the anaesthetic properties of chloral. 
 The application should not be permitted to remain on longer than 
 fifteen minutes. Its vesicating properties probably depend on the break- 
 ing up of the chloral by the alkalinity of the skin and its secretions 
 into chloroform and formic acid. All things considered, the use of 
 chloral as a vesicant is not to be commended. If left too long in contact 
 with the skin it may cause sloughs, the risk of which is increased by the 
 freedom from pain and consequent absence of warning to the patient. 
 
 Marc See {Journ. Amer. Med. Assoc., April 25, 1891) has made use 
 of chloral hydrate in the treatment of 200 cases of HYDROCELE. He 
 employs a ten per cent, solution, one ounce of this being thrown slowly 
 into the sac. In two or three days a large effusion occurs, which is soon 
 absorbed. 
 
 Cregny (Gaz. de Gynecol., May i, 1888) has secured good results by 
 the following treatment for ANAL FISSURE : The lower bowel is emptied 
 and a pledget of lint soaked in a twenty per cent, solution of chloral is 
 then lodged in the fissure. This remains until it is expelled by the 
 movement of the bowels, when a second application is made. 
 
 Four grains to the ounce forms a solution used by Mitropolsky in 
 CRACKED NIPPLES. 
 
 The antiseptic properties of chloral have long been recognized. Con- 
 sequently it is used as a wash for FOUL ULCERS, BURNS, CANCERS, and 
 also as a vaginal douche in CANCER OF THE UTERUS. In strength of 
 five to ten grains to the fluid ounce it forms an admirable antiseptic and 
 sedative dressing for wounds, being applied on lint soaked in the solution 
 and covered with oiled silk or waxed paper. 
 
 Injections of a one per cent, solution of chloral have been used with 
 success in treating GONORRHOEA. In nearly all cases pain and erections 
 are controlled in a few days. It will, however, occasionally fail. 
 
 Ore has proposed intravenous injections of chloral as a substitute 
 for ether and chloroform anaesthesia in surgery and as a means of com- 
 bating TETANUS. This plan has been carried out by himself and others 
 with asserted good results; but from the danger attending the use of 
 chloral in this way, and from the fact that inhalations of ether and 
 chloroform are both safer of application, it has never come into general 
 use.
 
 1 86 LOCAL THERAPEUTICS. 
 
 Chloral exerts great influence on fibrin, and has been used to coagulate 
 the blood in VARUS. But intravenous injection of the drug may produce 
 thrombi, and for this reason its use is to be deprecated. 
 
 Diseases of the Skin. Chloral is antiseptic and sedative in its 
 local action. In URTICARIA the following formula has proved useful as a 
 local application: R. Chloral hydrat., ^iij ; aq. laurocerasi, f^viij. 
 It is employed in the local treatment of BROMIDROSIS and HYPERIDROSIS, 
 a solution of chloral in water, the strength of ten to thirty grains to the 
 ounce, being commonly employed. A concentrated solution of chloral 
 in water has sometimes been employed in stubborn VENEREAL ULCERS. 
 
 Spohn has asserted that chloral is the best local application in 
 FURUNCLE. Compresses of cotton moistened with a solution of one 
 drachm of chloral in four drachms each of glycerin and water are kept 
 constantly applied. 
 
 Camphorated chloral is made by rubbing up equal parts of chloral and 
 camphor, which melt together, forming a thick liquid. This may be 
 mixed with wax and lard in due proportions to form an ointment of ten 
 to fifteen grains to the ounce. This is useful in PRURITUS where the skin 
 is unbroken. (See p. 165.) 
 
 Diseases of the Throat. Chloral hydrate has been used by Gomez 
 de la Mata (Revista de Laryngologia, Otologia y Rhinologia, Barcelona, 
 Oct., 1888) as one of the ingredients of a wash, in combination with 
 carbonate of soda and borate of soda for the nasal chambers in OZ^ENA. 
 It has been employed also as an antiseptic in the form of a lotion in the 
 treatment of DIPHTHERIA, in the strength of a one per cent, solution. 
 E. J. Moure uses a weak solution as a douche in PHARYNGITIS SICCA. 
 Chloral removes fetor and aids in softening deposits in DIPHTHERIA. A 
 pigment composed of twenty-five grains of the drug to a drachm of syrup 
 is recommended by M. Mackenzie. 
 
 A few grains of chloral placed in the cavity of a carious tooth will 
 usually relieve TOOTHACHE. Several cases are reported where this treat- 
 ment cured HEMICRANIA. (Practitioner, May, 1881.) 
 
 CHLORALUM. 
 
 Under this name a trade preparation was in vogue a few years ago. 
 It is now little used. Chloralum is a solution of chloride of aluminum. 
 F. P. Atkinson (Practitioner, Jan., 1887) uses chloralum, pure or slightly 
 diluted, in the treatment of NASO-PHARYNGEAL CATARRH.
 
 CHLORINE CHLOROFORMUM. 187 
 
 CHLORINE. (See Calx Chlorata.} 
 
 Diseases of the Throat. Chlorine is administered in diseases of 
 the respiratory tract either in form of nascent fumes or through the medium 
 of water the latter phase being known as "chlorine water." Chlorine 
 gas can be evolved at the time of its being used by the addition of 
 dilute hydrochloric acid to chlorinated lime ; one-half to two drachms of 
 the lime to be placed in an open vessel and the acid poured upon it. 
 Chlorine gas is recommended in the treatment of PHTHISIS and in 
 CHRONIC BRONCHITIS associated with copious expectoration and emphy- 
 sema. E. L. Shurly recommends that the patient be placed in a 
 small room, the air of which is saturated with moisture arising from a 
 spray of a saturated solution of sodium chloride ; when this has been 
 accomplished the fumes of chlorine are permitted to escape in the apart- 
 ment. It is claimed that this admixture of the watery vapor of the 
 solution of sodium chloride with chlorine renders the preparation more 
 respirable ; ten to thirty minutes suffices for a treatment. The patient is 
 instructed to breathe through the nose, keeping the mouth closed, and to 
 refrain from talking. If coughing occurs the treatment should terminate. 
 One to three inhalations may be given daily. 
 
 Chlorine water has had for many years a reputation as a local sedative 
 in the SORE THROAT of SCARLATINA and MALIGNANT PHARYNGITIS. 
 Largely diluted (one drachm to a pint of water) it can be used as an 
 inhalant. It forms an admirable disinfectant to any part of the respira- 
 tory passages, and can be used in the nose in FOETID CORYZA or as a 
 spray to the affected parts as well as a gargle in the treatment of DIPH- 
 THERIA. It is best that the water should be at a temperature of 140. 
 J. Merces (Lancet, October 30, 1886) especially recommends chlorine 
 water for the treatment of DIPHTHERIA ; one-half drachm of hydro- 
 chloric acid is added to a drachm of chlorate of potash in a six-ounce 
 vial ; while the nascent fumes are being generated the vial is filled with 
 water ; an ounce of this mixture can be used at one time as a gargle every 
 three hours. 
 
 CHLOROFORMUM. Chloroform. 
 
 Both Chloroformum venale and Chloroformum purificatum are official (U. S. P.), with 
 the intent that the purified should be produced from the commercial, and the purified alone 
 used for purposes of inhalation. Purified chloroform is described as " a heavy, clear, 
 colorless, diffusive liquid, with a characteristic, pleasant, ethereal odor, a burning, sweet 
 taste, and a neutral reaction. It is soluble in about two hundred parts of water, and in 
 all proportions in alcohol or in ether, also in benzol, benzin, and fixed or volatile oils. 
 Its specific gravity is 1.485 to 1.490 at 15 C. (59 F.). It boils at 60 to 61 C. (140 
 to 142 F.)." (U. S. P.)
 
 1 88 LOCAL THERAPEUTICS. 
 
 Chloroform in bulk is rubefacient and parasiticide. In the form of 
 vapor it is anaesthetic, sedative, and antispasmodic. 
 
 Chloroform was introduced into practice as an anaesthetic by the late 
 James Y. Simpson in 1847, an d from that date to the present time it has 
 held a foremost place with English and Continental surgeons. Notwith- 
 standing adverse criticisms, chloroform holds its own against many claim- 
 ants for favor. In most cases its administration is agreeable to the patient 
 and rapid in action ; complete insensibility is obtained with little laryn- 
 geal or bronchial irritation, and almost entire absence of nausea ; it is 
 economical both in the amount required to be used in each administra- 
 tion as well as in the first cost, while its concentrated character makes it 
 invaluable for field operations. But these advantages are overbalanced 
 by the danger which attends its use, so that its employment under ordi- 
 nary circumstances is unjustifiable. It causes death without warning, and 
 so suddenly that no forethought or skill can guard against the result. It 
 is fatal alike to the robust and the weak, to the well and the diseased. 
 Previous harmless inhalations are no guaranty against its treacherous 
 action. When death from chloroform-inhalation takes place, it is from one 
 of two causes : First, from a gradual paralysis of the respiratory muscles 
 induced by the action of the drug on their controlling centres ; second, 
 from cardiac syncope, the heart at one moment beating well, and at the 
 next moment ceasing to beat forever. This cardiac syncope constitutes 
 the great danger of chloroform, since, when the respiratory centres are 
 affected, we can watch the state of the breathing, and following out 
 certain rules, danger can be averted ; but when death takes place from 
 cardiac syncope, there is no warning. 
 
 Chloroform narcosis is usually divided into three stages. The first of 
 these is similar to alcoholic intoxication ; it usually is very short, but in 
 persons of intemperate habit it may be violent and prolonged, and to 
 entirely overcome this may be fraught with danger. In this stage, although 
 consciousness be not lost, sensation is blunted. It is soon followed by 
 the second stage, which is that of complete anaesthesia. Consciousness 
 and the sensibility are abolished, the muscles are relaxed, and the patient 
 lies quiet. This is the stage in which operations are performed. The 
 third stage is one of profound narcosis, with stertorous breathing, muscu- 
 lar relaxation, and abolition of all reflexes. This condition is accom- 
 panied with great danger, and the anaesthetic should never be pushed so 
 far, except under peculiar circumstances. 
 
 The pulse in chloroform narcosis is not always a reliable guide. At first 
 it is apparently strengthened or quickened ; in the second stage it is about 
 normal in frequency, but weakened ; in <he third stage it may be rapid 
 and weak. 
 
 Chloroform is best administered on an empty stomach, or three or four
 
 CHLOROFORMUM. 189 
 
 hours after a light, readily absorbed meal. It is usually well to administer 
 a little brandy in water about twenty minutes before the inhalation. Every- 
 thing tight about the chest, neck, and abdomen should be loosened or 
 removed ; the patient should lie on his back, with the chest well exposed- 
 Artificial teeth should be removed. Serious results have followed neglect 
 of this precaution. 
 
 Various appliances are used for administering chloroform. It is some- 
 times poured over a sponge enclosed in a cone made of a towel or napkin. 
 We think it is best given from a folded handkerchief or a piece of lint, 
 held at first five or six inches from the nose, and then brought as near as 
 an inch, but never allowed to touch. Not more than from a half to one 
 fluidrachm of chloroform should be poured on the napkin at once. To 
 prevent evaporation a towel is often thrown loosely over the operator's 
 hand and the patient's face. This should never be done, as one of the 
 principal dangers in administration is the concentration of the vapor. 
 Hence, the administerer should constantly bear in mind the importance of 
 allowing a sufficient admixture of air, and his attention should never for 
 a moment be withdrawn from his work. The pulse, the respiration, and 
 the color of the face are three important .things to be closely watched. 
 The average amount of chloroform required for an ordinary operation is 
 from half an ounce to one ounce, though it is stated that as much as 
 twenty ounces can be administered in two hours without unpleasant con- 
 sequences. Various inhalers have been devised in order to regulate the 
 amount of chloroform used and to secure the proper admixture of air. 
 The one devised by Clover is probably the best. On the appearance of 
 the first sign of danger, e.g., failing pulse, lividity of the face, irregular 
 gasping respiration, or stertorous breathing, the administration should be 
 stopped, and the patient should be allowed to breathe fresh air. When 
 respiration is arrested, the tongue should be drawn forward with a pair of 
 forceps, or, what is equally good, the inferior maxilla should be drawn or 
 pushed forward, as by so doing the muscles that are attached to the lower 
 jaw, the larynx and hyoid bone, are drawn upon and open the larynx 
 more freely than is done by simply drawing the tongue forward. If 
 these measures fail, any pillows that may be under the patient's head 
 should at once be withdrawn, and artificial respiration should be started 
 and persisted in for at least half an hour. It is considered best by many 
 authorities, in cases of heart failure, to place the body at an angle of forty 
 degrees, with the head downward to favor the passage of arterial blood 
 to the brain. This can readily be done by raising the feet of the bed 
 or table and placing them on two chairs. The alternate dashing of hot 
 and cold water on the chest, neck, and face is often efficacious. Fara- 
 dization of the diaphragm, by placing one pole at the pit of the stomach 
 and the other over the larynx and the root of the neck, has acted well
 
 1 90 LOCAL THERAPEUTICS. 
 
 in some cases. Nitrite of amyl should be used as a means of restoring 
 the heart's action. Ammonia injected into a vein and digitalis given 
 hypodermically may be used to stimulate the heart's action. The 
 administration of alcohol is (as a rule) contra-indicated. 
 
 From experiments it has been proved that persons in sound sleep 
 may be chloroformed without being wakened. Anaesthesia cannot be pro- 
 duced on any one partially awake, or sleeping lightly, without his knowl- 
 edge. Chloroform should never be administered to a woman without the 
 presence of a third party, preferably one of her own sex. 
 
 It has been suggested by some authorities that a mixture of chloroform 
 and ether acts with advantage and avoids the evils of both agents. The 
 "A. C. E. mixture," once much used in England, consists of ether 
 (aether) three parts, chloroform two parts, alcohol one part, the alcohol 
 aiding in making a more perfect mixture and causing equal evaporation. 
 From our experience we do not think that more benefit is derived from 
 mixed vapors than is obtained from the use of a single anaesthetic, while 
 serious consequences have followed the use of mixtures, which would not 
 have occurred had the surgeon confined himself either to chloroform or 
 ether. 
 
 General Surgery. In obstetric practice the value of chloroform 
 inhalations has been universally recognized, and we believe that no 
 fatal cases have followed. It is not now used in all stages of labor, 
 or carried to the same extent as it was formerly, for experience has 
 shown that in the early stages it materially interferes with the uterine 
 contractions. While it unquestionably annuls suffering, it frequently 
 tends in a marked degree to diminish the force and frequency of the 
 pains, and consequently to retard labor. In administering chloroform 
 during the propulsive stage of labor, it should be given intermittently, 
 using a few drops on a handkerchief as a pain comes on. During the 
 acme of pain the patient inhales freely, and as the pain dies away the 
 napkin should be removed, so that in the interval between the pains the 
 effect of the drug passes off. Bearing in mind the tendency of chloro- 
 form to produce uterine relaxation, more than ordinary precautions should 
 always be taken against post-partum hemorrhage. (Play fair.) 
 
 In PUERPERAL CONVULSIONS chloroform-inhalation is frequently use- 
 ful. Charpentier found that, in nearly seventy-five per cent, of the cases 
 in which he employed it, it had the effect of diminishing or arresting the 
 attacks, only one case proving fatal. 
 
 In the treatment of NEURALGIA, R. Bartholow has found chloroform 
 extremely valuable, and it is most effective when used by the method of 
 deep injections as proposed by him. This consists in injecting, in the 
 neighborhood of the affected nerve, from five to fifteen minims of pure 
 chloroform. Rarely does any local mischief result from these injec-
 
 CHLOROFORMUM. jgi 
 
 tions, except a temporary induration. He has procured apparently per- 
 manent relief by this means in long-standing cases of neuralgic pain affect- 
 ing the superficial divisions of the fifth pair of nerves. Pain in superficial 
 nerves may be relieved by the local application of chloroform. The 
 following prescription is useful: R. Chloroformi; tinct. aconit. rad. ; 
 aa fsss; liniment, saponis, fgj. M. Ft. linimentum. A piece of flannel 
 moistened with this is applied to the painful part, evaporation being 
 prevented by covering with oiled silk. Chloroform is frequently used as 
 a means of producing counter-irritation in OVARIAN NEURALGIA, and other 
 obscure pains, by placing from twenty to thirty drops under a watch 
 crystal, and keeping it in contact with the skin for a short time. 
 
 We have used a mixture of menthol, 3] ; chloroform, ^x ; ethejr, xv, 
 as suggested by Dobisch, in a spray, for its local anaesthetic effect in minor 
 surgical operations. The anaesthetic effect is said to last from two to six 
 minutes. It does not possess any advantage over rhigolene spray, and to 
 many persons the odor of menthol is unpleasant. Chloroform liniment is 
 a valuable preparation as a stimulant application in OLD SPRAINS and 
 CONTUSIONS. 
 
 Curling commends a combination of chloroform and zinc ointment 
 with a wash of sulphuret of potash (gj to gviij of lime-water) in PRURITUS 
 ANI. In IRRITABLE RECTAL ULCER this writer also speaks highly of the 
 following ointment : R. Chloroformi, 3J-ij ; zinc, ox., gss ; ol. olivae, 3] ; 
 cerat. cetacei. M. Ft. ung. 
 
 Diseases of the Skin. Chloroform is employed as a local anaesthetic 
 chiefly in URTICARIA. Used as a lotion with alcohol in the proportion 
 of a drachm to the ounce, it often gives relief. 
 
 In PRURITUS an ointment of one drachm of chloroform to the ounce 
 of lard is occasionally found useful. 
 
 Chloroform is also used as a parasiticide in PEDICULOSIS PUBIS. A piece 
 of lint saturated with chloroform is placed over the pubis and covered 
 with oiled silk. All pediculi are at once killed, the ova are afterward 
 removed with vinegar. 
 
 Diseases of Ear, Nose, and Throat. The vapor of chloroform 
 may be thrown in the ear by Eustachian catheter for TINNITUS. Later 
 observers place little reliance on this therapeutic application. For 
 OTALGIA a rubefacient effect is produced by rubbing chloroform liniment 
 over the mastoid region. A few whiffs of the vapor of chloroform will 
 sometimes relieve the distress of the first stage of ACUTE CORYZA. On 
 the whole, chloroform is the most reliable agent which can be employed 
 in the destruction of MAGGOTS IN THE NOSTRILS. It can be diluted in 
 about an equal proportion of water and thrown in the nasal chamber. 
 The ulcers of SORE THROAT are treated by applications of a lotion com- 
 posed of one part of chloroform to twenty of water (J. S. Cohen).
 
 192 LOCAL THERAPEUTICS. 
 
 SPASM OF THE GLOTTIS is more quickly overcome by inhalations of the 
 vapor of chloroform than by any other means. The patient breathes the 
 vapor as in the induction of general anaesthesia, until the spasm relaxes ; 
 as a rule four or five inhalations suffice. When it is desirable to order an 
 inhalant containing chloroform, it is advised that chloroform diluted one- 
 half with alcohol be added to hot water in the proportion of one-half 
 drachm to two drachms to the pint. 
 
 The vapor is indicated in IRRITATIVE COUGH which appears to be in 
 excess of the cause. Such "useless cough " is particularly annoying at 
 night. A few drops of chloroform may be poured on the sponge of a 
 Yeo inhaler before retiring, or placed in a half pint of water at 145 F., 
 and inhaled. Chloroform also allays the cough of INCIPIENT PHTHISIS. 
 In SPASMODIC ASTHMA chloroform-inhalations short of anassthesia are 
 often of value. There is no agent which relieves so large a number of 
 cases. When it does not cure it is of value in affording temporary respite. 
 The more promptly it is given in a paroxysm the better ; for, if a spasm 
 has existed for a time, it is apt to recur as soon as the influence of the 
 chloroform has passed off. A few drops at the first indication of an 
 attack may act as a preventive. It should always be administered under 
 medical supervision. A mixture composed of an ounce of tincture of 
 aconite, ten grains of menthol, and one drachm of chloroform, forms a 
 mixture which, when applied freely to the gum tissue about a tooth, 
 permits minor operations to be performed without pain. Leffmann 
 ("American System of Dentistry," in, 699). 
 
 CHRYSAROBINUM. U. S.; Br. Chrysarobin. Goa Powder. 
 
 " A mixture of proximate principles (commonly misnamed Chrysophanic Acid) ex- 
 tracted from Goa Powder, a substance found deposited in the wood of the trunk of 
 Andira araroba." (U. S. P.) It is a " pale orange yellow, crystalline powder, perma- 
 ment in the air, odorless and tasteless, almost insoluble in water, only slightly soluble in 
 alcohol, readily soluble in ether and in boiling benzol. In solutions of alkalies it is solu- 
 ble with a yellowish-red or reddish-yellow color, which is changed to red by passing air 
 through the liquid." (U. S. P.) It stains fabrics indelibly. It is the substance from 
 which Chrysophanic Acid is made. Chrysophanic Acid occurs in yellow needles or plates. 
 It is soluble in alcohol, ether, or benzol ; alkalies also dissolve it. It is one of the sub- 
 stances to which rhubarb owes its yellow color. The official ointment is too strong for 
 use, and should be diluted with four parts of lard. (Lancet, October 19, 1889.) 
 
 The action of chrysarobin on the skin is that of a "reducing" agent. 
 It has a strong affinity for oxygen, which it abstracts from the tissues, 
 and thus becomes converted into chrysophanic acid. 
 
 General Surgery. Kassabudski has used chrysarobin with success in 
 the treatment of HEMORRHOIDS. His method of treatment is as follows : 
 The parts are first washed with a carbolized or creolin lotion, and then
 
 CHRYSAROBINUM. 193 
 
 dried with absorbent cotton ; after which the following ointment is 
 applied: Chrysarobin, 6 parts; iodoform, 3 parts; ext. of belladonna, 
 6 parts; vaseline, 15 parts. In the treatment of internal piles, if very 
 sensitive and liable to bleed, a suppository of tannic acid may be used 
 and followed by one composed of chrysarobin, one grain ; iodoform, half 
 a grain ; extract of belladonna, one-eighth grain ; cocoa butter, a sufficient 
 quantity. After pursuing this treatment for a few months the piles will 
 be found shriveled up. 
 
 Diseases of the Skin. Goa powder was introduced some years ago 
 from India as a remedy for RINGWORM. It was soon found to have a 
 beneficial influence upon other affections of the skin, and its virtues 
 being ascertained to be due to the chrysarobin contained in the powder 
 this preparation gradually took the place of the latter. 
 
 Occasionally conjunctivitis occurs during the use of chrysarobin, 
 whether from the direct irritative action of the drug or through absorp- 
 tion is not known. 
 
 Some persons have a peculiar idiosyncrasy to the drug, and its appli- 
 cation gives rise to severe dermatitis with fever and occasionally 
 symptoms of poisoning, shown by vomiting, diarrhoea, and a tendency to 
 oedema of the lungs, indicating an irritative action on the mucous mem- 
 branes. 
 
 Chrysarobin is employed in the treatment of PSORIASIS, the VEGETABLE 
 PARASITES of the skin, particularly TINEA CIRCINATA and TINEA SYCOSIS, 
 and in CHLOASMA. 
 
 In psoriasis the scales are cleansed off by the use of soap or a solution 
 of salicylic acid in alcohol (9j ad fj), and then the drug in the form 
 of an ointment of ten to forty grains to the ounce of lard is rubbed 
 thoroughly in. The face and scalp, as also the genitals, are to be avoided in 
 these inunctions, as they are peculiarly liable to inflammation. If the 
 disease is spread over the body the inunctions should not be too extensive 
 at first until the effect on the patient has been ascertained. 
 
 Usually, after a three or four days' course of treatment, the inunctions 
 having been made twice daily, the diseased patches are found perfectly 
 smooth and destitute of scales, and of a peculiarly blank white color, 
 while the surrounding skin is sharply defined by an area of a violaceous 
 tint. The parts should then be allowed to rest for a time until it is ascer- 
 tained whether the disease has been removed. If the treatment is pro- 
 longed inflammatory action results. 
 
 In addition to the danger of exciting inflammation of the skin, chrysa- 
 robin has the disagreeable quality of staining clothing, etc., with which 
 it comes in contact, an indelible yellow or purple color. For this reason 
 it has been superseded bypyrogallic acid, naphthol, and other drugs infe- 
 rior to it in effect upon the psoriatic patches, but without this drawback.
 
 I 9 4 LOCAL THERAPEUTICS. 
 
 Besnier has suggested painting the PSORIATIC PATCHES with a solution 
 of chrysarobin in chloroform, fifty grains to the ounce. When this is 
 dry it is covered with the liquor gutta-perchse (ten per cent, white gutta- 
 percha to ninety per cent, chloroform), which protects the clothing from 
 the action of the chrysarobin. This application, however, is not so efficient 
 as is that of the chrysarobin ointment. 
 
 In CHLOASMA, LENTIGO, etc., a solution of twelve per cent, chrysarobin, 
 in chloroform may be painted in successive layers upon the affected skin 
 previously cleansed with soap in alcohol. When the layer of chrysarobin 
 has dried upon the skin, it is to be coated with liquor gutta-perchse. The 
 applications are to be renewed when worn off. Not only chloasma and 
 lentigo, but even PIGMENTARY N^EVI may sometimes be removed by this 
 application. In the latter an ointment of salicylic acid should first be 
 applied to soften and cleanse the warty surface. 
 
 Chrysarobin has been recommended in LUPUS ERYTHEMATOSUS and in 
 ALOPECIA AREATA. In our experience, however, it has not proved success, 
 ful in either of these affections. The ointment is the best form to employ 
 chrysarobin in alopecia areata, while the solution or suspension in chloro- 
 form or liquor gutta-perchae is best adapted to use in lupus erythematosus. 
 
 Chrysarobin is an admirable application in the vegetable parasitic dis- 
 eases of the skin. In TINEA CIRCINATA a solution of five to ten grains 
 to the ounce of collodion painted on the patches causes their speedy dis- 
 appearance, while an ointment of twenty to forty grains to the ounce of 
 lard carefully rubbed into the affected parts in TINEA SYCOSIS will often 
 produce the happiest effect in a surprisingly short space of time. 
 
 CIMICIFUGA. Actsa. Black Snakeroot. 
 
 The rhizome and rootlets of Cimicifuga racemosa. Its preparations are Ext. Cimici- 
 fugcE Fluidum and Tinctura Cimicifugce. 
 
 According to Ringer, who includes it under Actaea, cimicifuga is useful 
 " in MILD and MALIGNANT SORE THROAT, and that troublesome and ob- 
 stinate disease in which the mucous membrane of the pharynx is quite 
 dry and spotted over with inspissated mucus." 
 
 COCAINA. 
 
 An alkaloid extracted from Erythroxylon Coca. The salt formed by combining the 
 alkaloid with hydrochloric acid is known as the hydrochlorate, or more properly as the 
 hydrochloride. When cocaine is spoken of or prescribed, this salt is usually understood, 
 as the uncombined alkaloid is almost insoluble in water, and is rarely, if ever, found in the 
 shops. Hydrochloride of cocaine occurs in nearly colorless, acicular crystals, and is freely 
 soluble in water and alcohol. It is dissolved in retinol in proportion 130. In the pres- 
 ence of iodide compounds, chloride of zinc and chlorate of soda, it becomes milky. When
 
 COCAINA. 195 
 
 dissolved in alcohol it readily mixes with castor oil and rhigolene. (A. Stabler, Phila. 
 Med. News, April 16, 1887.) The other salts of cocaine that have been found useful 
 are, the hydrobromide, borate, phenate (q. v.), salicylate, oleate, and nitrate. The last 
 named is useful when it is desired to use the alkaloid in conjunction with silver nitrate. 
 The oleate has been prepared in a crystalline condition, but as found in commerce is liable 
 to be of varying strengths. 
 
 Cocaine is analgesic and ischaemic. It is used in the main to induce 
 anaesthesia for purposes of surgical application and exploration, and to 
 secure temporary constriction of the smaller blood-vessels. After the 
 impression last named ceases a stage of dilatation ensues. It is thus 
 hemostatic only in its primary impression, the secondary impression 
 tending to induce bleeding. A cocainized surface is at first paler and 
 more compressed than is the normal, and afterward it becomes reddened 
 and somewhat turgescent. Since dilated states of vessels favor secretion 
 it follows that the secondary impression of cocaine is accompanied by 
 increased outflow when the application has been made to a gland-bearing 
 surface. 
 
 The effects above named will be varied by the peculiarities of the anatomical region, 
 habits of patients, etc. Thus pallor is more noticeable in the conjunctiva than elsewhere. 
 The constricting and dilating effects in erectile tissues are especially marked in the nasal 
 chambers, and the secretory effects are often noticeable in the larynx where the untoward 
 result of a full impression is noticeable in the impaired quality of the voice. 
 
 An over-impression of cocaine may arise from almost any strength of solution, though 
 it is more apt to occur in concentrated preparation ; markedly toxic symptoms have been 
 known to follow upon an injection of a few drops of a four per cent, solution into the 
 urethra, while, on the other hand, cases are reported where large quantities of the drug 
 have been injected without producing any unsought-for effect. H. C. Wood mentions a 
 case where ten grains were taken hypodermically by a man while on a debauch without 
 fatal results. COCAINE INTOXICATION is characterized by vertigo, depression, nausea, 
 difficult articulation, followed by restlessness. Flushes of heat are sometimes complained 
 of. The duration of the impression lasts from five to eight hours. Delbose and Droz 
 (Rev. Med. de la Suisse Romande, June, 1889) claims that deaths can be attributed to 
 cocaine poisoning. The writer last named reports five cases. In all operations demand- 
 ing the use of the knife it is well after an application of cocaine to allow the parts to 
 bleed freely after incision to remove as much as is possible of the drug from the circulation. 
 It has been noted that persons addicted to alcoholic stimulants are peculiarly suscepti- 
 ble to the action of cocaine. Cocaine intoxication appears to be oftener seen after appli- 
 cation about the head than elsewhere. For the relief of cocaine intoxication inhalations 
 of the nitrite of amyl, should be resorted to, and the impression of caffeine secured, while 
 the patient's strength is being sustained. Among other measures than the above may 
 be mentioned the exhibition of belladonna, the inhalation of the vapor of ammonia, and 
 external friction. 
 
 General Surgery. The indications for the use of cocaine in relieving 
 pain and relaxing spasm are numerous. On the whole, the specific effects 
 are best exhibited on the mucous membrane of the genito-urinary tract
 
 196 LOCAL THERAPEUTICS. 
 
 and rectum, and to parts of the body where the circulation can be under 
 the control of the operator, as in the extremities. 
 
 Wende {Jour, de Med., Paris, January 15, 1888) recommends lanolin, 
 containing four per cent, cocaine, as an application for BURNS. He states 
 that it forms a protectant, anodyne dressing that is easily managed. 
 Cocaine being insoluble in fatty substances, it is advisable, where it 
 is to be used in ointments, to first dissolve it in oleic acid and afterward 
 to add to it the other substances in small quantities at a time. Treated 
 in this way, cocaine may be mingled with greasy substances and a homo- 
 geneous preparation obtained. All things remaining the same, the 
 impression of cocaine is of use in proportion as the pain is of an 
 irritable and exciting character. It is of special value on mucous 
 surfaces in the regions near skin surfaces, e.g., the vagina, urethra, and 
 rectum, etc. A few indications will be given for its use in the female 
 genito-urinary tract. In estimating the value of cocaine in gynecology, 
 it must be remembered that its field is limited, as there are many women 
 who are too sensitive and too apprehensive to be kept quiet during a pro- 
 tracted operation by anything short of general anaesthesia. According to 
 Polk, cocaine may be of service in operations on the uterine cervix. In 
 this connection may be mentioned incisions, forcible dilatation of the 
 canal, the application of caustics, or the use of the curette. Even in 
 commencing CANCER the free application of the actual cautery can 
 be made if the sensibility of the part has been previously blunted with 
 cocaine injections, three to five minims of a four per cent, solution, 
 into the region that is to be operated upon. In the vagina more care 
 must be exercised, owing to the greater sensitiveness of the tissues. 
 Satisfactory results are obtained in the treatment of small VESICO-VAGINAL 
 FISTULA. Four minims of a four per cent, solution are injected on either 
 side of the fistula half an inch away. The mucous membrane of the 
 vagina and bladder is then freely painted with the solution, after which 
 the tissues can be excised without pain. 
 
 In the removal of super-sensitive URETHRAL CARUNCLES a four per cent, 
 solution of cocaine may be successfully injected at their lines of attach- 
 ment. In like manner CHANCROIDS and CHANCRES may be painlessly 
 cauterized after painting the surfaces several times with a four per cent, 
 solution. In VAGINISMUS it is of special service applied in the form of 
 an ointment (five grains to the ounce) to the vagina and vulva a short 
 time before coitus or the introduction of a speculum. Nagura has 
 used cocaine with satisfactory results in obstetric practice. According 
 to this writer, the drug not only shortens labor, but also annuls pain. 
 Doleris (Therapeutic Gazette, 1889, p. 733.) is reported by Fischel (in 
 the Wiener Median. Presse, April 26, 1886) to have applied it to the 
 vaginal mucosa and the external genitals in aqueous solution or in the
 
 COCAINA. 197 
 
 form of an ointment, the strength in either case being four per cent. The 
 amount used was from forty to sixty drops of the solution and from forty- 
 five to sixty grains of the salve. In this manner practically painless 
 delivery was effected in thirteen out of fifteen primiparae. 
 
 A similar class of indications is to be noted in the genito-urinary tract 
 of the male, but perhaps to a less degree than above shown. Otis and 
 many others use cocaine with advantage in urethral surgery to facilitate 
 the passage of sounds or bougies and the stretching and cutting of 
 strictures, also for the relief of ardor urinae in GONORRHOEA. In all 
 these conditions it may be injected by means of a small syringe. If 
 the effect of the drug is required in the deep urethra, a piece of a soft 
 English catheter may be conveniently attached to the end of the 
 syringe and carried down to the desired point, the solution being slowly 
 injected in advance of the instrument. We have sometimes used in a 
 sensitive urethra, preparatory to the passage of a bougie, a probe tipped 
 with a swab of cotton, which was saturated with a ten per cent, solution 
 of cocaine, and carried slowly and gently down the urethra to the point of 
 stricture, and then removed. German (Lancet, February 28, 1885) speaks 
 in the highest term's of cocaine injected into the bladder in CHKONIC CYS- 
 TITIS with frequent micturition. One-third of a grain of the drug in four 
 or five ounces of water was retained in the bladder for ten minutes. The 
 freedom from pain lasted for about twenty-four hours, but without effect 
 on the disease. 
 
 In SOUNDING FOR STONE in an irritable bladder, cocaine may be used 
 by injecting a solution containing ten grams in four ounces of water. 
 This will usually allay the sensibility. A case of LITHOTRITY is reported 
 {Lancet, January 17, 1885), in which after an injection of cocaine, as 
 above directed, a painless operation was performed in fifteen minutes. 
 
 Cocaine has been used with considerable success in CIRCUMCISION, the 
 circulation being controlled either with a rubber cord around the penis, 
 or with a pair of Ricord's forceps adjusted tightly over the redundant 
 prepuce, after which from ten to fifteen drops of a four per cent, solution 
 were injected into the cellular tissue of the prepuce about the line of the 
 proposed incision. If care is exercised in following this method, none of 
 the solution will find its way into the general circulation, and the opera- 
 tion is painless. 
 
 In the treatment of HYDROCELE by iodine injections, Spilmann (Gaz. 
 Medicale de Paris, May 10, 1890) recommends the injection into the 
 cavity of the tunica vaginalis of a ten per cent, solution of cocaine which 
 is allowed to remain for a short time, after which the sac is tapped with a 
 trocar, and then injected with, iodine. By this means the entire sac is 
 brought under the influence of the drug, the quantity of the fluid injected 
 varying with the volume of the hydrocele.
 
 198 LOCAL THERAPEUTICS. 
 
 In the treatment of RECTAL DISEASE of both sexes cocaine is of estab- 
 lished value. FISTULOUS TRACTS may be slit up without causing pain 
 after packing them with cotton soaked in a twenty per cent, solution 
 and allowing the cotton to remain fora short time. If the opening is too 
 small to admit of packing, each tract may be injected with the solution 
 from the nozzle of a small syringe, after which it can be opened and 
 treated as if the patient were under a general anesthetic. In examina- 
 tions for ulcers and fissures a probe wrapped with a pledget of cotton 
 saturated with a ten per cent, solution of cocaine may be gently intro- 
 duced into the rectum before the introduction of the speculum, and the 
 cotton may be allowed to remain for about ten minutes, after which a 
 finger or instrument may be introduced. EXTERNAL HEMORRHOIDS, with 
 great protrusion and pain, may be painted with a ten per cent, solu- 
 tion a few minutes previous to the necessary manipulations for their 
 reduction. 
 
 Cocaine was much used at one time in the Pennsylvania Hospital in 
 operations for the removal of small tumors etc. The method employed 
 was as follows : The circulation was controlled by a rubber band placed 
 on the proximal side of the part to be operated upon ; then several hypo- 
 dermic injections of a four per cent, solution were thrown into the tissues. 
 After all necessary steps were completed bleeding was encouraged, in order 
 to remove as much as possible of the drug. When more than one digit is 
 to be removed, the greater quantity of cocaine is necessarily an element of 
 danger, and suggests the preference of a general anaesthetic. Operations 
 for the relief of DUPUYTREN'S CONTRACTION OF THE FINGERS, for the 
 OPENING OF FELONS and PALMAR ABSCESSES, and for the removal of 
 SMALL NEOPLASMS, can be done with safety under cocaine as well as 
 minor operations on the leg, thigh, forearm, and arm. In such cases a 
 drachm of a four per cent, solution can be used with safety. For opera- 
 tions upon the trunk, when the rubber tube cannot be used, immediate 
 absorption of the drug renders greater precaution necessary. If for this 
 class of cases cocaine be preferred to ether or chloroform, the technique 
 of the operation will differ materially from that described above. Take 
 the removal of a fatty tumor as an example. In the proposed line of 
 incision the needle point should be carried into the deeper layers of the 
 skin (not into the subcutaneous fat, for it is desired to reach the end of 
 the sensory nerves in the papillary layer), and one-half to one minim 
 should be forced out ; then the needle should be advanced a fourth of an 
 inch, and the injection again essayed, and so on, as far as the needle will 
 reach from the original puncture. The needle is then re-inserted and the 
 process just described repeated until the line of anaesthesia is established. 
 By this means an incision as long as three inches may be made without 
 pain.
 
 COCAINA. 
 
 I 99 
 
 This method may be employed in the removal of SMALL NEOPLASMS, 
 MOLES, CICATRICES, etc., covering an area of not more than three or four 
 square inches. The anaesthesia is almost instantaneous, and is evidenced 
 by the pallor of the overlying skin. After the removal of the growth, it 
 is well not to check too quickly any capillary oozing. 
 
 Diseases of the Skin. Cocaine is employed in diseases of the skin 
 for its anaesthetic effect alone. Under ordinary circumstances neither the 
 crystallized hydrochloride of cocaine nor its solution will penetrate the 
 epidermis. If, however, a strong solution of the drug is placed upon 
 the unbroken skin and a current of electricity, from five to twenty cells 
 of the ordinary constant-current battery, is passed, the anaesthetic influence 
 of the cocaine appears to penetrate a short distance. This circumstance 
 is taken advantage of in the removal of SUPERFLUOUS HAIRS. 
 
 When the true skin or a mucous membrane is exposed to the influence 
 of the cocaine, anaesthesia results, from the absorption of the drug. 
 
 In PRURITUS, particularly in PRURITUS OF THE VULVA, a condition of 
 hyperaesthesia is sometimes induced which is difficult to allay. Nervous 
 crises result, when the influence on the general nervous system is so great 
 as to produce an almost epileptiform attack. 
 
 Under these circumstances a strong solution of cocaine, in even a small 
 quantity of the finely powdered drug, applied to the clitoris will permit the 
 employment of astringent washes or other preventive measures directed 
 to the removal of the exciting cause. 
 
 No fear need be entertained in these cases of any constitutional effects, 
 unless the drug be frequently repeated and in considerable quantities. 
 
 As an anaesthetic to prevent pain in the application of caustics, cocaine 
 hydrochloride is of marked value. A strong solution applied to the sur- 
 face of an IRRITABLE ULCER, or to an EPITHELIOMATOUS ULCER, will dull 
 the sensibility of the parts to such an extent that a strong caustic can be 
 applied with little or no suffering on the part of the patient. The anaes- 
 thetic effect is transitory. 
 
 A convenient formula for the use of oleate of cocaine in PRURITUS 
 ANI, etc., is the following: R. Cocain. oleat., gr. vj ; lanolin, gvss; olei 
 olivae, 355. M. 
 
 Diseases of the Ear, Nose, and Throat. Applications of solutions 
 of cocaine upon any portion of the mucous surface of the nose and throat 
 are followed by diminished redness, pallor of the membranes owing to 
 the constriction of the blood-vessels,* and also by a slight sense of numb- 
 ness. The effect is in no sense diffusive. In the pharynx and larynx a 
 
 * Cocaine sometimes does not constrict blood-vessels, as in CEoEMATOUS CHRONIC 
 INFLAMMATION, and in some forms of MEMBRANOUS RHINITIS. F. H. Potter (Journal 
 Laryngology, March, 1889).
 
 200 LOCAL THERAPEUTICS. 
 
 peculiar dry sensation is also acknowledged and complaint is made of a 
 disposition to useless swallowing ; in some instances the feeling is one as 
 though the throat was being grasped from without, or as if it were obstructed 
 by a foreign body. Three to five minutes are required to produce com- 
 plete anaesthesia, though from fifteen to twenty minutes may be demanded 
 for deep impressions. 
 
 Keegan has reported its use in HYDROPHOBIA. A five per cent, solu- 
 tion was painted freely over the back of the pharynx and upper portion 
 of the larynx, and in five minutes the patient was able to drink twelve 
 ounces of milk and eight of water. The following day the application 
 was repeated, and a large amount of fluids was readily swallowed. The 
 patient subsequently died of heart failure. 
 
 Less than twenty per cent, solutions appear to be futile in operations on 
 the ear ; about five minutes is required before it is fairly absorbed. A 
 four per cent, solution dropped in the ear will occasionally control TIN- 
 NITUS AURIUM (Year Book of Treatment, 1885). S. M. Burnett {Archives 
 of Otology, No. i, 1887) finds cocaine useful only in superficial inflamma- 
 tion of the outer and middle ear. G. P. Field (Year Book of Treatment, 
 1887) thinks nothing less than a twenty per cent, solution of hydro- 
 chloride of cocaine is of any use in these affections. A. G. Hobbs 
 (Archiv Otology, 1885) throws a four per cent, solution into the middle 
 ear in painful affections of the auditory apparatus. He claims that the 
 tympanic membrane acts as a poor conducting medium. 
 
 In the nostrils solutions of cocaine have varied use. As an aid to diag- 
 nosis it is almost indispensable, since the erectile tissue is constricted 
 and thereby permits the deeper parts to be illuminated. A two to five 
 per cent, solution suffices for the purpose. To avoid the unpleasant sen- 
 sation which ensues when the agent is applied to the pharynx no excess 
 should be allowed in making applications. Hence the cotton carrier 
 is to be preferred to the syringe or the atomizer. Sajous applies the 
 cocaine by applying paper pledgets to the interior of the nostril which 
 have been previously immersed in a two per cent, ointment made with 
 cosmoline. In the form of a powder, cocaine may be diluted in any 
 desired proportion with bismuth subnitrate, starch, or sugar of milk. 
 Dilution with magnesium carbonate breaks up the hydrochloride. H. C. 
 Wood recommends the use of the NASAL BOUGIE, which carries the agent 
 mixed with cocoa butter or glycerin. It is not likely that by this means 
 the drug reaches a plane above the level of the inferior turbinated bone. 
 J. M. Mackenzie (Trans. Am. Laryng. Ass'n, 1887, p. 159) asserts that 
 when cocaine is habitually over-used the nasal mucous membrane per- 
 manently assumes a peculiar puffy appearance. 
 
 The addition of one and a half grains of cocaine to one hundred 
 parts of indifferent medium forms an ingredient of a snuff for NASAL
 
 COCAINA. 201 
 
 CATARRH. Rabow {Deutsch. Med. Wochenschr., 1886, p. 77). A small 
 quantity of cocaine added to Dobell's solution (boric acid being substi- 
 tuted for borax) is sometimes useful in aborting ACUTE CORYZA. 
 
 The use of cocaine in the nostril is in the main to constrict the erectile 
 tissue and the sensitive nerve-endings in ACUTE CORYZA and in HAY 
 FEVER. During the stage of congestion of coryza the relief obtained from 
 its application is immediate. In this instance the spray or lotion or pow- 
 der is preferable to the direct application. In the acute exacerbation of 
 HAY FEVER in like manner solutions of cocaine, varying from one to five 
 grains to the drachm of water, affords marked relief. Rumboldt (Amer. 
 Rhinolog. Ass'n, October, 1886) speaks of the congestion which sometimes 
 ensues after prolonged use of the agent in this disease. Cocaine habit is 
 easily induced by the use of cocaine on the nasal mucous membrane and 
 the systematic employment of the remedy in CHRONIC NASAL CATARRH 
 accompanied with obstruction to breathing should be interdicted. A 
 twenty per cent, solution is used by Sajous as an application in UVULITIS. 
 J. N. Mackenzie (N. Y. Med. Journal, October 3, 1885) believes that co- 
 caine applied to the pharynx produces isolation of the " temperature sense." 
 After complete analgesia had been produced the subjects were able to 
 distinguish between hot and cold applications. 
 
 The larynx is less susceptible to the action of the drug than either 
 the pharynx or the nose, and anassthesia is here less easily induced. 
 A solution of a strength from ten to twenty-five percent, is recommended 
 for adults, a five per cent, solution in women and nervous persons and in 
 children. Gougenheim (Societe Therapeutique, April 27, 1887). 
 
 A twenty per cent, solution mixed with an equal quantity of listerine 
 is recommended by Sajous as a local application in ACUTE LARYNGITIS 
 attended with submucous infiltration. " The antiseptic action of listerine 
 adds greatly to the detergent effect of the mixture and renders it less liable 
 to undergo alteration." 
 
 The most important indication for cocaine in laryngeal diseases is the 
 treatment of TUBERCULOSIS. No agent equals it in overcoming the DYS- 
 PHAGIA which is so commonly present in the last stage of the disease. A 
 spray of cocaine a few moments before food is taken enables the patient 
 to swallow with comparative comfort. It may be combined with morphine. 
 Cocaine may be used in insufflation in the proportion of one to ten to the 
 bulk of indifferent material, or it may be combined with iodoform or 
 iodol. A powder composed of two-thirds of boric acid with one-third 
 iodol is efficacious. 
 
 Cocaine applications to the larynx are often made to induce anaesthesia 
 prior to operation, such as curetting or intralaryngeal removal of TUMORS. 
 For this purpose it is recommended that a solution from ten, twenty to 
 twenty-five per cent, be employed. The fluid can be painted over the
 
 202 LOCAL THERAPEUTICS. 
 
 affected surfaces, sprayed or injected by a Heryng or Krause's syringe 
 directly into the masses to be treated: 
 
 In the local treatment of the paroxysms of WHOOPING COUGH cocaine 
 has a well-sustained reputation. According to J. Prior {Berlin Klin. Woch- 
 enschr., 1885) the frequency of the paroxysms is remarkably diminished 
 after the use of a ten to twenty per cent, solution. In the judgment of 
 American observers this strength is much too high to be used with safety 
 in children. L. E. Holt (N. Y. Med. Journal, October 23, 1886) believes 
 that a four per cent, solution is the maximum strength that should be used. 
 
 The use of cocaine upon the vocal cords should be practiced with 
 extreme caution when exacting use of the voice is expected a short time 
 afterward. T. A. De Blois {Trans. Amer. Laryng. Ass'n., 1887, p. 156) 
 speaks with emphasis of the distressing influence resulting from the 
 neglect of this precaution. There appears to be a certain amount of 
 relaxation of the vocal cords produced, so that, although the pain sub- 
 sides, it does not seem to give tone to the parts. 
 
 The disposition for cocaine to excite secretion of the laryngeal glands 
 can be overcome, according to Sajous, by inducing the desired local 
 anaesthesia quickly by the use of small quantities of a strong solution 
 rather than by the prolonged use of a weak preparation. 
 
 Compressed tablets of cocaine ordinarily contain from one-quarter of 
 a grain to two grains. Lozenges contain one-twelfth to one-sixth of a 
 grain of the drug. 
 
 Diseases of the Eye. Since Koller called attention to the anaes- 
 thetic effect of cocaine upon the eye, in 1884, it has naturally attracted 
 much attention, has been the subject of a number of experimental and 
 clinical observations by various authors, and has acquired an important 
 place in ophthalmic surgery. For the suppression of CONJUNCTIVAL 
 and CORNEAL SENSATION a four per cent, solution is most frequently 
 used ; a stronger solution is rarely employed, and some surgeons claim 
 that a two per cent, solution, while more safe, is, if properly applied, 
 equally efficient. After a single application of the former, anaesthesia 
 appears in from ten to twenty minutes, and lasts about ten minutes. 
 Usually two or three instillations are made at intervals of five or ten 
 minutes, and this produces a partial anaesthesia also of the iris, as the 
 result of absorption. Subcutaneous and subconjunctival injections are 
 not now much used, as their results have been found to be sometimes 
 dangerous and never very satisfactory. 
 
 Dilatation of the pupil commences in about ten minutes after the appli- 
 cation of a four per cent, solution, reaches its maximum in about an hour, 
 and disappears in from ten to twenty hours. It is preceded by slight 
 contraction. Incomplete reflex contraction to bright light remains. 
 Cocaine produces dilatation of the pupil chiefly, if not entirely, by stim-
 
 COCAINA. 203 
 
 ulation of the sympathetic nerve, though some authorities think that it 
 has also some paralyzing effect on the iritic filaments of the oculo-motor. 
 Mydriasis from section of the third nerve, as also that from atropine, is 
 increased by it. It has no effect on the pupil when the sympathetic is 
 divided, and fails to act in birds, whose iris muscles are striated. Its effect 
 on the accommodation is comparatively slight. Widening of the palpe- 
 bral fissure, similar to that found in exophthalmic goitre, and the sup- 
 pression of winking are supposed to be due to contraction of Miiller's 
 involuntary orbital muscular fibres, though some influence may be attrib- 
 uted to absence of reflex from the anaesthetised cornea and conjunctiva. 
 Cocaine increases the absorbing power of the cornea, probably by dimin- 
 ishing the amount of fluid in its lymph spaces. Anaemia of the con- 
 junctiva and diminished secretion of tears are results of contraction of 
 blood-vessels, and decreased intraocular tension may be due to the same 
 cause. The latter effect in healthy eyes is generally admitted, but seve- 
 ral cases have been reported in which glaucoma was said to be induced 
 by its use. It is possible that the mechanical effect of a widely dilated 
 pupil (see article on atropine) might hasten the onset of an attack of 
 glaucoma, but the cases reported are much too few, compared to the 
 enormous number of applications of cocaine made daily all over the 
 civilized world, to exclude the probability of coincidence. The danger 
 of constitutional effects resulting from the application of cocaine to the. 
 eye is so slight that it may practically be disregarded. A few cases have 
 been recorded in which some inconvenience was occasioned, but in none 
 were the symptoms alarming (Frost, Am. Jour. Med. Sd., April, 1887). 
 
 A real danger, however, is sometimes met with in its effects upon the 
 cornea, whose nutrition seems to be profoundly influenced by strong 
 solutions. Some surgeons have thought that a loss of firmness and elas- 
 ticity of the cornea, a flaccid condition, produced by its use, might 
 interfere with the accurate coaptation of incisions, but no serious diffi- 
 culty seems to have been experienced from this cause. Its occasional 
 injurious effect upon the corneal epithelium is well established. Disturb- 
 ance of this causes loss of polish and haziness of the cornea, with super- 
 ficial depressions due to thinning of the epithelial layer and consequent 
 slight derangement of refraction, or there may be vesication or desquama- 
 tion. The whole corneal epithelium has been raised in a bleb. Even in 
 these cases there is not usually any permanent injury if the cocaine is 
 promptly discontinued. The loss of moisture is at least an important 
 factor in producing this condition, and in experiments on animals des- 
 quamation has been prevented by keeping the eyes closed. Cases have 
 been reported in which the anaesthesia lasted for several days. (Annal. 
 d' Oculist, 1885.) Deeper corneal lesions are more rare, but in quite a 
 number of cases the use of cocaine has been followed by interstitial
 
 204 LOCAL THERAPEUTICS. 
 
 opacity in the form of striped keratitis. In relation to the latter, the 
 question has been raised whether the opacity was the direct effect of 
 cocaine, or was rather induced by other applications made at the same 
 time, particularly of bichloride of mercury, whose action on the deeper 
 layers of the cornea was facilitated by the increased absorption, which is 
 one of the results of cocainization. Wurdinger (Frost, Ibid.~) found 
 that solutions of borax, boric acid, corrosive sublimate, and even of 
 common salt, produced the same kind of turbidity in the cocainized 
 cornea. 
 
 Mittendorf (Am. Ophlhal. Soc., 1888) reports three cases in which 
 cocaine caused ACUTE CONJUNCTIVITIS, with tense, swollen lids, and 
 profuse muco-purulent discharge, similar to that occasionally met with as 
 an effect of atropine. This must be attributed to a very rare idiosyn- 
 crasy, but the tendency to subsequent hyperaemia necessitates caution in 
 prescribing cocaine for continuous use, particularly in strong solutions. 
 Cocaine has been accused of inducing panophthalmitis after cataract 
 extraction, but the reports of cases on which this charge is based are few 
 and do not rigidly exclude other possible causes. 
 
 Cocaine is a convenient and safe mydriatic for ophthalmoscopic pur- 
 poses. As it only slightly impairs the accommodation, and its effect on 
 the pupil passes off in a few hours, it can often be used when other 
 mydriatics are inadmissible. It is easy to neutralize its effects by 
 eserine, and it is well to do so when there is any suspicion of a tendency 
 to glaucoma. According to Jackson, its effect on the pupil is neutralized 
 by one-fiftieth of its weight of eserine, while Jessop's estimate is one- 
 twenty-sixth. It is probably not possible to strike an exact balance, but, 
 practically, a solution of half a grain to the ounce of eserine may be 
 depended upon to obviate any inconvenience from the use of the four 
 per cent, solution of cocaine. 
 
 Therapeutically, the value of cocaine as an anodyne is limited by the 
 transient character of its action and the inconveniences and even dan- 
 gers that may result from its too frequent or long-continued use. In 
 small proportions (one or two grains to the ounce) it maybe conveniently 
 and safely added to astringent or antiseptic washes to modify their irri- 
 tating effects, and full anaesthesia greatly facilitates the application 
 caustics or the use of the actual cautery. It is frequently combined witl 
 atropine in the treatment of IRITIS, not only for its anodyne effect, bi 
 because it assists in dilating the pupil both by its own action upon tl 
 iris and by increasing the absorbing power of the cornea. 
 
 Cocaine, however, finds its widest field of usefulness in operath 
 ophthalmic surgery. The anaesthesia produced by it in the conjunct^ 
 and cornea is complete, and any operation involving these tissues only is 
 rendered absolutely painless. It is almost universally used in extractu
 
 COCAIN^E PHENAS COLLOD1UM. 
 
 205 
 
 of cataract and in iridectomy. The pain caused by cutting the iris is 
 not entirely avoided, but is much diminished if several applications have 
 been made. In tenotomy of the external ocular muscles cocaine should 
 be dropped occasionally into the wound as the operation proceeds. It 
 has been used in some cases of ENUCLEATION, but is not to be recom- 
 mended in this operation unless there are strong contraindications to the 
 use of ether. Injections of cocaine by means of Anel's syringe give 
 much relief in probing the lachrymal duct. In operations on the con- 
 junctiva, even under ether, cocainization is useful in diminishing HEMOR- 
 RHAGE. 
 
 COCAINE PHENAS. Phenate of Cocaine. 
 
 Phenate of cocaine is a new compound of phenol and cocaine, but 
 little used as yet in this country. The combination appears to be a favor- 
 able one, owing to the therapeutical properties of phenol, thus differing 
 from hydrochloric acid, which is only useful in rendering the cocaine freely 
 soluble. When fr.eshly prepared it is of a soft consistence and has an 
 agreeable phenylic cdor. Phenate of cocaine is soluble in alcohol (50) 
 and in ether. From the alcoholic solution aqueous solutions may be 
 obtained. 
 
 Diseases of the Nose, Throat, etc. It possesses all the proper- 
 ties of the hydrochloride of cocaine as the effects of this salt are observed 
 upon the nose and pharynx. It is much more agreeable to the taste than 
 is the hydrochloride, and we are inclined to think it will prove to be the 
 preferable agent in laryngological work. It is added to boric acid, salts 
 of bismuth, etc., as an ingredient of nasal snuff. {Jour, de Mtd. de 
 Paris, April 3, 1892.) 
 
 COLLODIUM. Collodion. 
 
 Collodion is made by dissolving a gun cotton, pyroxylin, in ether containing a little 
 alcohol. Collodion dissolves nearly all the substances that alcohol or ether will dissolve, 
 so that many collodions are made. The following are official in the United States Pharma- 
 copoeia : Cantharidal or Blistering Collodion (made by percolating cantharides with 
 chloroform and adding collodion) ; Flexible Collodion (made by adding five per cent.'of 
 Canada turpentine and three per cent, castor oil to collodion) ; two parts of glycerin to 
 one hundred of collodion produces a somewhat similar substance; Styptic Collodion 
 (" Richardson's Styptic"), made by dissolving twenty parts of tannic acid in a mixture of 
 collodion, alcohol, and ether to make one hundred parts.* Collodions containing iodine, 
 chloride of mercury, iodoform, etc., are also used. 
 
 *This formula is a modification of Richardson's "Styptic Colloid" which was com- 
 posed as follows: &. Acid tannic., ^ iv; alcohol, absolut., ffljcx; setheris, n\c; collodii, 
 q. s. ad f^j. M.
 
 206 LOCAL THERAPEUTICS. 
 
 General Surgery. Collodion was introduced into surgery as a sub- 
 stitute for adhesive plaster by Maynard, of Boston. Its action is twofold: 
 first, drawing together and holding in apposition the edges of a wound, 
 and, second, preserving them from contact with the air. When used in 
 the form of the gauze and collodion dressing, which was introduced into 
 practice in Philadelphia by the late P. B. Goddard, it is much more perma- 
 nent than the ordinary plaster. The gauze and collodion dressing is thus 
 employed : Strips of tarlatan or mosquito netting, or what is better 
 Donna Maria gauze, about half an inch to an inch wide and three to five 
 long, are laid across the lips of the wound, previously washed and dried, 
 and secured with collodion applied with a camel's hair brush first to one 
 end, then, when this is firmly adherent and dry, to the other. With 
 neatness and care a superficial wound can be closed in this way almost 
 .as firmly and accurately as by the use of sutures. The strips will remain 
 for a long time, as the dressing is impermeable to water, and the 
 wound may be hermetically sealed by extending the application over 
 the surface as well as on either side. A styptic collodion may be 
 made by dissolving tannin in it. It may be used with advantage in cases 
 in which there is a tendency to ooze. Carbolic acid or iodoform may be 
 combined with collodion to conform to the antiseptic mode of dressing. 
 In superficial wounds about the face and scalp the collodion and gauze 
 dressing will be found most convenient. It is open to the objection that 
 pertains to all adhesive dressings which are applied to the shaven scalp or 
 face, namely, that in a few days the short hairs grow up underneath and 
 cause the entire dressing to become loose. 
 
 A. Hewson ("The Use of Earth in Surgery") claims that collodion 
 makes a dressing so firm that any degree of traction necessary may be 
 made from it. According to this writer, it should not be, as a rule, 
 brought in contact with the lips of a wound unless it is expected that 
 union be other than that by first intention. In wounds that cannot be 
 readily inspected the lips can be brought firmly together by the aid of 
 collodion gauze and yet the oozing escape through the meshes. Venice 
 turpentine is sometimes used in the arts to diminish the contractility in 
 the collodion film ; such a preparation is unsuited for surgical purposes. 
 Its use has been known to excite inflammation and vesication. Collodion 
 is very useful to retain small antiseptic dressings about the face. The 
 dressing is applied in the usual manner, covered with cotton, aroi 
 the edge of which collodion is painted, causing it to adhere firmlj 
 to the skin. If thought necessary, the entire mass may be coated wit! 
 the collodion, but painting the edges will ordinarily suffice. The cor 
 tractile character of collodion makes it of service in the treatment of sma 
 BOILS and PIMPLES. In such cases the collodion, applied in the earlU 
 stage, is often effectual in arresting their development. Should it fail
 
 COLLODIUM. 
 
 207 
 
 effecting this, it should be still persevered with, as it allays the pain and 
 irritation and apparently hastens the curative process. Its success is 
 mainly due to the pressure that it exerts. If pus should accumulate beneath 
 this covering, causing pain, the collodion should be incised and the pus 
 allowed to escape, and the subsequent treatment carried out under the 
 antiseptic method. Contractile collodion (to which a little iodine may 
 be added) painted over the inflamed part in ACUTE GOUT will relieve the 
 pain, though for a short time it increases it. Too many coats must not 
 be applied, as the contraction is great and dragging on the skin results. 
 Care must be exercised not to include superficial hairs, as they excite 
 unnecessary pain during the contraction. 
 
 Hill and Cooper have advised the application of several coats of con- 
 tractile collodion over the scrotum in EPIDIDYMITIS. The ether acts as a 
 slight counter-irritant, and after evaporating leaves a thick film of collo- 
 dion over the skin. This contracts and slightly compresses the part 
 within. The collodion may be applied once or twice daily while the 
 acute stage continues. If the patient attempts to move about the testi- 
 cles should be supported in a suspensory bandage well lined with cotton. 
 In the latter stages of the disease, in our experience, nothing is better to 
 remove and hasten the absorption of the inflammatory products than 
 pressure made by strapping with adhesive plaster. 
 
 In INCONTINENCE OF URINE in boys it has been advised to apply a 
 little collodion by means of a camel's-hair brush over the orifice of the 
 prepuce, and thus close the exit for the escaping urine. When it is 
 desired to void urine the little ridge or plug of collodion is easily 
 removed with the finger nail. A fortnight's use will sometimes suffice 
 for a cure. 
 
 In INGROWING TOE NAIL, collodion, as used by Jno. Neill, is a valu- 
 able means of treatment. The cutting of the affected nail is pro- 
 hibited, and growth is encouraged ; cotton is then firmly packed under 
 the free end with a flat probe, passing between the nail and granulations, 
 raising the nail as far from the surface of the toe as possible. After cot- 
 ton has been thoroughly packed under and around the nail, the entire 
 mass is saturated with collodion and allowed to dry, forming a firm 
 wedge, which protects the toe on all sides from the encroachment of the 
 nail. Over this are applied a few strips of adhesive plaster, which pre- 
 vent escape of the cotton from its position. With care, in the course 
 of a fortnight, obstinate cases may be almost entirely cured. If this 
 method of treatment is faithfully carried out evulsion will rarely have to 
 be resorted to. 
 
 For a reliable combination of collodion and benzoin as a dressing and 
 protectant, see "benzoin." Painful FISSURES of the handsy lips, and
 
 208 LOCAL THERAPEUTICS. 
 
 other parts of the body may be brought together and protected bj col- 
 lodion until they have a chance to heal from the bottom. 
 
 Diseases of the Skin. The flexible collodion is used as a protectant 
 in CHAPPED NIPPLES and fingers, and also, occasionally, in abrasions and 
 fissures connected with some forms of ECZEMA and in CHILBLAIN. The 
 ordinary collodion is used in N^vus on account of its contracting power. 
 It has also been used in FURUNCLE, ERYTHEMA and ERYSIPELAS. It is, 
 however, chiefly used as a vehicle for the conveyance of various medi- 
 caments to the skin. 
 
 An iodoform coliodion (three scruples to one fluidounce) is occasion- 
 ally employed as an antiseptic dressing in ABRASIONS, etc. 
 
 In ECZEMA RUBRUM INFANTILE one of the best applications is the fol- 
 lowing: R. Picis liquidae seu ol. cadini, 3] ; collodii, f^j. A camel's- 
 hair brush should be inserted in the cork and the parts should be painted 
 one or more times daily. In that very common form of infantile eczema 
 when the cheeks are found to be inflamed, weeping and excoriated from 
 scratching, this application is superior to ointments of any kind, because 
 it acts as a protectant and cannot be rubbed off. On its first application 
 some smarting occurs, but this soon ceases and great relief is commonly 
 experienced. The paint should not be allowed near the outer canthus 
 of the eye. 
 
 In EPHILIS, or FRECKLES, the following solution may be employed : 
 R. Zinci sulpho-carbolat., gr. v; alcoholis, f^ss ; collodii, f^j ; M. This 
 should also be supplied with a camel's-hair brush in the cork, and may be 
 painted on the freckles at night. 
 
 A solution of eight grains of the bichloride of mercury to the drachm 
 of collodion forms a caustic application for the treatment of small NJEVI. 
 A ring of pure collodion should first be painted around the nsevus to 
 protect the healthy integument. A single application is usually suffi- 
 cient. A dry eschar forms and becomes separated in a few days. 
 
 Cantharidal collodion (U. S. P.) is used in ALOPECIA AREATA and in 
 circumscribed patches of CHRONIC ECZEMA to excite an acute inflamma- 
 tory condition. Its effect is that of an ordinary blister of cantharides, 
 but is more convenient of application. 
 
 Diseases of the Ear, Nose, Throat, etc. Flexible collodion is used 
 as a protectant in ZOSTER attacking the external auditory passage. (Keene.) 
 
 A saturated solution of tannic acid and gun cotton in ether can be 
 used as a styptic and protectant. It can be applied with a brush or 
 mixed with an equal quantity of ether, and with care even used in the 
 form of a spray. The following table of the proportion of various agents 
 which are available for combination with collodion will prove useful.* 
 
 -.._.... ^ _._. . 
 
 *" Dental Therapeutics," J. W. White.
 
 CONIUM. 209 
 
 With creasote, I minim to 2 drachms. 
 
 With carbolic acid, 2 minims to 2 drachms. 
 
 With quinine, 2 grains to 2 drachms. 
 
 With iodine, 5 grains to 2 drachms. 
 
 With morphine, I grain to 2 drachms. 
 
 A mixture of collodion and carbolic acid is used for TOOTHACHE where 
 pulp is exposed. 
 
 Diseases of the Eye. Collodion forms a neat dressing for wounds 
 about the eyelids or brow. A strip of fine gauze is laid across the wound 
 and collodion is painted over it with a brush. It forms a protective 
 coating arid its contraction brings the edges of the wound in close appo- 
 sition. This property of contraction can also be made useful in cases of 
 ENTROPION of the lower lid from relaxation of the skin, such as is some- 
 times met with in old people. It is freely painted over the skin, either 
 with or without the interposition of gauze or of a thin layer of absorbent 
 cotton. 
 
 CONIUM. Hemlock. 
 
 " The full-grown fruit of Conium maculatum, gathered while yet green." (U. S. P.) 
 Conium contains a volatile alkaloid, Conine (Conia). Conine is " a yellowish, oily liquid, 
 of a very acrid taste and a strong, penetrating odor, compared to that of the urine of 
 mice. It is volatile and is freely soluble in alcohol, ether, the fixed and volatile oils, and 
 slightly so in water." (U. S. D.) The pure alkaloid, and the hydrochloride which is 
 freely soluble in water, are used in medicine. The official preparations of Conium are 
 Abstraction Conii (one part representing two parts of the drug), Extractum Conii Alco- 
 holicum (of uncertain strength), Extractum Conii Fluidum (one cubic centimetre repre- 
 senting one gramme of the drug), Tinctura Conii (containing the activity of fifteen parts 
 of the drug in one hundred parts of the tincture). It is one of the ingredients of baume 
 tranquille. 
 
 Conium is sedative. 
 
 General Surgery. Conium has long been employed locally in 
 medicine, especially in the treatment of CANCER, for which the older 
 surgeons have held it in high esteem. S. W. Williams, of Massachusetts 
 {American Journal of the Medical Sciences, ix, 1879), quoted by A. 
 Stille, reports six cases of ulcerated cancer of the breast, all but one 
 of which were healed under its use. The drug, when applied locally, 
 possesses some sedative properties. A poultice composed of two parts of 
 bruised hemlock leaves and six parts of flaxseed meal, with boiling water, 
 has been used as a soothing dressing for painful swellings. The poultice 
 should be applied with caution where there are abrasions or ulcerations, 
 for fear of too active absorption. 
 
 In CANCER, hemlock has fallen into disuse as a curative agent by mod- 
 ern surgeons, but the pain of ulcerating cancer of the breast may be 
 mitigated by the use of hemlock poultices, while lint, saturated with 
 14
 
 210 LOCAL THERAPEUTICS. 
 
 succus conii and placed over the diseased surface, may prove useful as an 
 anodyne dressing (Waring). 
 
 In uterine and ovarian diseases conium has been found of service. In 
 UTERINE CANCER Dewees advised an injection of the extract, three fluid 
 ounces to one pint. Meadows regards conium as the best anodyne for the 
 generative tract, especially in ovarian MENORRHAGIA, for which he 
 advises that a vaginal suppository of one or two grains of conium, made 
 with glycerin one part and gelatin four parts, be introduced once or 
 twice daily. In TRAUMATIC TETANUS Johnston, of Baltimore, has em- 
 ployed conium hypodermically with asserted success, injecting every two 
 hours fifteen minims of a solution composed of two minims of conium, 
 one minim of dilute sulphuric acid, and one drachm of water. 
 
 Diseases of the Throat, etc. Conium is held in high repute as a 
 sedative in affections of the throat. Succus conii two drachms, water 
 one pint to twenty ounces, form the basis for an inhalant which appears 
 to be specially adapted for the relief of pain in ACUTE LARYNGITIS. 
 English writers recommend the addition of twenty grains of sodium car- 
 bonate to the fluid, since this agent sets free the con inc. 
 
 Harley uses conium to produce relaxation of the cesophagus in cases 
 of impacted foreign bodies. (Leffmann, Amer. System of Dentistry, Vol. 
 iii, p. 694.) Conium has a disagreeable, mouse-like odor, which renders 
 its use in the nose and throat objectionable to some persons. 
 
 COPAIBA. 
 
 The oleoresin of Copaifera langsdorffi and other species of Copaifera. (U. S. P.) 
 
 Copaiba is protectant, antiseptic, and antiphlogistic. 
 
 General Surgery. Copaiba was largely used a hundred years ago 
 in the London hospitals as a topical application for the treatment of 
 chronic and INDOLENT ULCERS. Within the last two years its use has 
 been revived by Dr. Beach, in the Massachusetts General Hospital, in 
 the treatment of similar conditions. Cotton waste, or charpie, saturated 
 with the balsam, is laid on the ulcer and retained by a firm bandage. It 
 is claimed that it is especially adapted to the flat, pale, granulating 
 surfaces that commonly result from the EVULSION OF THE SCALP, EXTEN- 
 SIVE BURNS AND SCALDS, OPERATIONS for the removal of NECROSED BONK, 
 etc. 
 
 Diseases of the Throat. Twenty-five minims in a half pint of 
 water may be dropped in the presence of one-half drachm of magnesia. 
 A drachm of this added to a pint of hot water is used for inhalation.
 
 COTOIN COUMARIN CREASOTUM. 211 
 
 COTOIN. 
 
 Cotoin is an alkaloid obtained from different species of Goto bark. " It is sparingly 
 soluble in cold water, more soluble in hot water, insoluble in benzin, very soluble in alco- 
 hol, chloroform benzol, acetone, and bisulphide of carbon. It occurs in large, glistening, 
 laminated crystals of a pale yellow color." (U. S. D.) 
 
 Diseases of the Nose, etc. The effect of cotoin is described by 
 E. L. Shurly (JW. Y. Meet. Journal, September n, 1886) as a powerful 
 irritant when applied to the pharyngeal an'd nasal membranes; he 
 believes that when diluted with either starch or sugar one part to three 
 or four is particularly well-adapted to the treatment of ATROPHIC 
 CATARRH. 
 
 COUMARIN. 
 
 A crystallizable substance obtained from the seed of Dipteryx odorata and Couma- 
 rouna odorata. (Tonka Bean.) It is freely soluble in alcohol, ether, chloroform, and 
 bisulphide of carbon, and is also soluble in hot water, from which it is deposited on 
 cooling. 
 
 Coumarin has been proposed for covering the odor of iodoform. 
 
 CREASOTUM. U. S. Br., Creasote. Creosote. 
 
 " A product of the distillation of wood tar." (U. S. P.) It is an oily liquid, of a 
 reddish amber color, smoky odor, caustic taste, and neutral reaction. Its physiological 
 action and antiseptic properties are almost identical with those of carbolic acid. The best 
 creasote is known as " Beech-wood creasote" and is made from the tar resulting from the 
 distillation of beech-wood.* The older the article the better it is tolerated. Creasote 
 is "soluble in about eighty parts of water at 15 C. (59 F.) to a somewhat turbid 
 liquid, and in twelve parts of boiling water. It dissolves in all proportions in absolute 
 alcohol, ether, chloroform, benzin, disulphide of carbon, or acetic acid." (U. S. P.) 
 Solutions should be made in the presence of glycerin. 
 
 The peculiar odor of creasote can be modified by combining with camphor in propor- 
 tion of twenty grains to the ounce of creasote. 
 
 The following tests will prove of value : " One volume of liquefied carbolic acid con- 
 taining five per cent, of water forms with one volume of glycerin a clear mixture, which 
 is not rendered turbid by the addition of three volumes of water. If one volume of 
 creasote be mixed with one volume of glycerin a nearly clear liquid will result, from 
 which the creasote will be separated by the addition of one or more volumes of water." 
 (U. S. P.) 
 
 Creasote is caustic, haemostatic, antiseptic, deodorant, antipruritic, 
 analgesic, astringent, yet strongly excitant. 
 
 * W. C. Glasgow ( Trans, of the American Climatological Association, 1 891, 263) states 
 that after trying various articles sold under the name of creasote he is convinced that the 
 English beech-wood creasote, prepared by Morsen, is the dnly one adapted for medicinal 
 purposes.
 
 212 LOCAL THERAPEUTICS. 
 
 General Surgery. Creasote water has been used locally as a haemo- 
 static, and is of value as a wash for FOUL SORES and SLOUGHING ULCERS. 
 In advanced stages of CANCER of the uterus West advises a lotion made 
 of one drachm of creasote and one pint of mucilage as having a marked 
 influence in removing the offensive odor. 
 
 WARTS are said to be removed by creasote freely applied and kept in 
 situ for two days by a strip of adhesive plaster. It requires to be subse- 
 quently used until desquamation ensues. 
 
 In GANGRENOUS STOMATITIS creasote may be applied after the removal 
 of the slough. Koch advises the following ointment in the treatment 
 of ERYSIPELAS : Creasote and creolin, each f^j ; iodoform, giv ; lanolin, 
 x; the ointment to bespread evenly with a camel's-hair pencil in a thin 
 layer over the affected part ; the part is to be covered with rubber cloth 
 or gutta-percha. 
 
 A one per cent, solution of creasote in combination with boric acid 
 has been used as an injection for GONORRHCEA. The efficacy of this pre- 
 paration depends in great part upon the germicidal effects. ' 
 
 Diseases of the Skin. Creasote has often been confounded with 
 carbolic acid, as if it were an impure variety of the latter, but its thera- 
 peutic effects are somewhat different. 
 
 In its pure state it may be brushed over INDOLENT or GANGRENOUS 
 ULCERS beneficially, but placed in contact with the healthy skin for ten 
 or twenty minutes it induces superficial inflammation. It has been em- 
 ployed to remove NJEVI, applied two or three times a day, more or less 
 diluted. Excoriation, ulceration, and gradual disappearance of the nsevus 
 ensues, leaving a smooth and sound cicatrix. (Bulkley, " The Local Use of 
 Tar and Its Derivatives," Arch. Set. and Pract. Med., April, 1873.) 
 According to Bujalsky, N^vi may be removed by penciling them twice 
 daily for some weeks. 
 
 The chief value of creasote is as an ANTIPRURITIC. It is superior in 
 this respect to carbolic acid, but its acrid and penetrating odor is a bar 
 to its general use. Tilbury Fox recommends the following formula for 
 use in PITYRIASIS CAPITIS : R. Creasoti, n^xxx; glycerini, fgiij ; aquae, 
 fv-fgviij. M. 
 
 In CHRONIC PSORIASIS Squire recommends an ointment of two parts 
 creasote and one part white wax, to be rubbed in night and morning. 
 We think, however, that this is much too strong to use without great 
 caution, in consideration of the caustic properties of the pure drug. Til- 
 bury Fox used an ointment of six drops of creasote with six grains of the 
 red oxide of mercury to the ounce of lard in PSORIASIS. 
 
 IN CHRONIC ECZEMA creasote ointment, ten grains to the ounce, is 
 useful to allay itching. It may also be employed in lotion for this pur- 
 pose.
 
 CREASOTUM. 213 
 
 In ERYTHEMA CALORICUM (chilblains) Devergie advised the following 
 ointment: R. Creasoti, liq. plumbi subacetat., aa Tt^x; ext. opii, gr. jss ; 
 adipis, gj. M. Creasote has also been recommended in ERYSIPELAS, in 
 the strength of two drachms to the ounce of lard ; a rather strong appli- 
 cation, we think, but an almost specific effect has been claimed for it. 
 
 In TINEA SYCOSIS White recommends the following : R. Creasoti, n^xv ; 
 ung. hydrarg. nitrat., 3} ; flor. sulphuris, |ss ; adipis, j. M. To be 
 applied every night after depilation, in connection with the use of sul- 
 phurous acid as a lotion in the morning. 
 
 Diseases of the Ear, Nose, and Throat. In the strength of two 
 minims to an ounce of lard creasote has been used in CHRONIC ECZEMA 
 of the auditory meatus. Creasote and glycerin, in equal parts, is effect- 
 ive as an excitant in FETID CATARRH OF ATROPHY. The mixture should 
 be applied to small surfaces of the membrane with a brush or cotton car- 
 rier. (Ferreri.) A small proportion of creasote may be added to Lugol's 
 solution for use upon the tonsil when chronically inflamed. Its exhibi- 
 tion is indicated in the tumid vascular states which often persist after 
 long-retained pellets of solid secretion have been removed. It acts as an 
 astringent and antiseptic. Creasote checks OOZING after tonsillotomy. 
 In the larynx creasote has long been used as a local medicament in 
 ulceration, either simple or when due to a bacillar cause. Cadier com- 
 bines creasote one part, alcohol four parts, glycerin sixty parts to ULCERS 
 of the vocal cords and of the posterior region. A gargle containing one 
 to two drops of creasote to an ounce of water is recommended by H. 
 McNaughton Jones as a disinfectant and stimulant. 
 
 As an inhalant creasote is one of our most efficient local remedies in 
 CHRONIC BRONCHITIS when dilatation of the bronchi favor the retention 
 of mucus. Four or six minims of creasote mixed with a little magnesium 
 carbonate may be added to a half pint of water. 
 
 Creasote is a powerful excitant. Under its influence the vessels become 
 relaxed and hypersemia is induced. (A. Israi.) Its exhibition, therefore, 
 is indicated when the lung is known to be hypersemic, but is contra- 
 indicated where a tendency to hemorrhage exists. 
 
 In CHRONIC LARYNGEAL CATARRH an indication likewise exists for its 
 administration. It has been used in three per cent, solution as an intra- 
 pulmonary injection in PHTHISIS. The medicament consists of three per 
 cent, solution of creasote in oil of sweet almond ; of this ten minims are 
 injected in a cavity or solidified apex. After fifty such injections a fatal 
 accident occurred, due, as was found by post-mortem examination, to the 
 walls of the cavity being pierced by the hypodermic needle, retaining the 
 puncture as an orifice allowing a free passage of inspired air to enter in 
 the pulmonary cavity. Such methods, therefore, 'for the relief of phthisis 
 are not to be repeated in the light of this experience. (R. T. French,
 
 214 LOCAL THERAPEUTICS. 
 
 Philad'a Medical News, November 29, 1890.) W. C. Glasgow (/. c.} 
 recommends a creasote ointment (proportions not given ; vaseline being 
 used as a base) to be applied freely to the chest in PULMONARY PHTHISIS. 
 Such a treatment is an adjuvant to the internal administration of the 
 drug. A lozenge may contain one-half minim of the drug. 
 
 A small quantity dropped in boiling water may be inhaled for OZ^ENA. 
 A saturated solution* of iodine and creasote is recommended by J. W. 
 White as a stimulant to gum tissue and bone. It is also an escharotic to 
 coarse GRANULATIONS and FIBROID EXUDATES. It is useful in the treat- 
 ment of SYPHILITIC ULCERS of the mouth and pharynx involving bone. 
 
 When mixed with vaseline, in the proportion of one-twentieth to one- 
 tenth, Cadier (British Med. Jour., February 22, 1890) claims anaesthetic 
 properties for creasote in the treatment of LARYNGEAL PHTHISIS. As a 
 steam inhalant in CHRONIC CONGESTION of the larynx and trachea the 
 following preparation may be used : eighty minims of creasote, forty 
 grains of magnesium carbonate rubbed up in an ounce of water. Add 
 a teaspoonful of this mixture to a pint of water at 140 F. and inhale. 
 (Lefferts.) The following formula is recommended by Mandl in making 
 a watery solution of creasote : Creasote, six to eight drops ; alcohol, five 
 grammes; glycerin, twenty grammes, and water three hundred grammes. 
 For use as a spray, to fifteen ounces of water a drachm and a half of crea- 
 sote is added in the presence of one ounce of glycerin. In the form of 
 inhalation E. L. Shurly uses one drachm of creasote, two ounces of com- 
 pound tincture of benzoin in the presence of four drachms of tincture of 
 lupulin. One drachm of this should be added to one pint of hot water 
 and inhaled. Ten drops of creasote added to eight ounces of boiling 
 water forms an admirable inhalation which should be used immediately. 
 
 As a local anaesthetic creasote is largely used by dentists for aching 
 teeth with sensitive dentine, and as an application to exposed nerve pulps, 
 the remedy being applied on a little absorbent cotton and inserted into 
 the cavity of the tooth, from which all debris of food has been removed 
 by syringing with warm water. In the absence of creasote, the same 
 result can be obtained with carbolic acid and collodion. 
 
 CREOLINE. Creolin. 
 
 Creoline is one of the cresols, and the cresols are a homologous series of the phenols. 
 " A blackish-brown, thick, alkaline, almost syrupy liquid, freely soluble in alcohol, chlo- 
 roform, and ether, forming with water a milky, opaque emulsion. It consists principally 
 of coal tar, with some resin soap, fat soap, and caustic soda." (" Nat'l Med. Die.") 
 Creoline masks the odor of iodoform. 
 
 Creoline is antiseptic, disinfectant, and haemostatic. It is excitant or 
 antiphlogistic according to the strength in which it is used.
 
 CREOLINE. 
 
 215 
 
 Creoline possesses the advantage over many agents of its class in being 
 benign,* non-volatile, and cheap. 
 
 The antiseptic properties of creoline have been studied by von Esmarch 
 (Centralbl. f. Bakteriologie, 1887, Bd. ii, pt. 95 ; Centralbl. f. Bakteri- 
 ologie und Parasitenkunde, Bd. ii, 10, n), who found that a one-fifth per 
 cent, solution destroyed the power of micro-organisms, even though the 
 spores were dry, the necessary time varying from ten minutes to four 
 days, according to the method of exposure and the strength of the 
 solution. In the course of his experiments, solutions of creoline were 
 used on fluids containing cholera, typhus, and anthrax bacilli. In a 
 large majority of cases creoline was much more active than carbolic acid 
 or the weaker solutions of bichloride of mercury. It was also noticed 
 that as a deodorizing agent creoline was superior to carbolic acid. The 
 same authority states that the drug is non-poisonous to animals, even 
 when administered in large doses. The experiments of Eisenberg (Brit. 
 Med. Jour., Nov. 10, 1888) confirm those of von Esmarch, save that his 
 results proved creoline more powerful in destroying anthrax bacilli, 
 while those of von Esmarch made carbolic acid the more efficient agent. 
 Lerumscan (London Med. Recorder, May 21, 1888) is emphatic in his 
 assertion that creoline is inoffensive to both man and the lower animals, 
 while its germicidal powers are ten times those of carbolic acid, and even 
 more powerful than corrosive sublimate. 
 
 Kortum (Berliner Klinische Wochenschrift, Nov. 14, 1887) has used 
 creoline extensively, and finds it a satisfactory antiseptic, having at the 
 same time deodorizing, stimulating, calming, and curative properties. 
 He uses -a two per cent, solution in preparing the hands for operation. 
 The part is washed with a similar solution, and, as it is non-corrosive, he 
 recommends it for the immersion of instruments, but for the purpose 
 named it is objectionable, since the watery solution is opaque. 
 
 Kortum (/. c.~) claims success in the treatment of INDOLENT ULCERS. 
 He cites many cases where the cure of large ulcers advanced so rapidly 
 that in eight days a surface only two and one-third inches long by one- 
 third of an inch wide remained. For small wounds and ulcers it may be 
 applied also through the medium of collodion. 
 
 Spaeth (Wiener Medizinische Presse, No. 8, 1888) reports good results 
 from creoline in a variety of conditions. Gauze is employed dipped in a 
 
 * It is necessary to state that a death, probably due to creoline, is reported from Rosen- 
 bach's ward, at Breslau. ( Wiener Med. Presse, November 1 1 , i 888.) The symptoms were 
 vomiting, sweating, unconsciousness, and collapse. The vomitus was brownish-green in 
 color and smelled strongly of creoline, as did also the urine. Symptoms of carbolic acid 
 poisoning were present at autopsy. A second doubtful cdse of poisoning is reported. 
 Spaeth took eight grammes per day, with no symptoms, and has administered as much as 
 fifty grammes a day to a dog without results.
 
 2l6 LOCAL THERAPEUTICS. 
 
 two per cent, solution and covered with compresses of wool. The 
 cases so treated embraced examples of severe BURN, varicose ULCERS, and 
 septic wounds. In a patient suffering from PYAEMIA after amputation of 
 the thigh, and who was succumbing to infection despite the use of the 
 antiseptic dressings, reaction under creoline dressings in two days occurred, 
 with complete recovery. Other German writers highly recommend creo- 
 line as an antiseptic surgical dressing. 
 
 Koch recommends the use of the following : R. Creoline one part, iodo- 
 form four parts, lanolin ten parts, in the treatment of ERYSIPELAS ; the oint- 
 ment to be spread not only on the affected area, but an inch to an inch 
 and a half around it. It is believed that the iodine set free by the com- 
 bination is an important factor in the results obtained. C. J. Rothe 
 {Jour. Amer. Med. Assoc., p. 228, vol. ii, 1890) has abandoned the use 
 of carbolic acid and iodine in erysipelas, and substitutes an ointment 
 containing three per cent, of creoline. 
 
 In one per cent, solution creoline has been used as an injection in 
 GONORRHCEA by Lutaud {N. Y. Med. Jour., March 28, 1891), Kortum 
 {Berliner Klinische Wochenschrift, Nov. 14, 1887), an d Margariths 
 (Lancet, Aug. 18, 1888), with reported success. The former recommends 
 the following prescription in the later stages of GONORRHOEA and LEU- 
 CORRHOSA: R. Creolini, %ss ; ext. hydrast. Canaden., 333; aquae, f^iv. 
 M. Sig. fjij added to pint of warm water and used as injection. 
 
 Th. Parvin {Med. News, Nov. 30, 1889) has used creoline injections 
 in CYSTITIS with success, though he considers the two per cent, solution 
 too strong to begin with, recommending a one-half per cent, solution. 
 Jefsner {Lancet, January 14, 1888) approves of a one-half per cent, solu- 
 tion, and cites a case that had resisted other treatment that readily 
 yielded to creoline. 
 
 Minapou\us( Wiener Med. Presse, Nov. 25, 1888) has employed creoline 
 in his obstetric practice, varying the strength of the solution from one-half 
 to two per cent. He used this solution as an injection in the vagina 
 before and after labor, and for disinfecting the hands and instruments. 
 Of 140 cases thus treated, two were severely and nine slightly infected; 
 while of 140 cases in which bichloride was used, three were severely and 
 13 slightly infected. From these results he considers that creoline com- 
 pares favorably with corrosive sublimate. Born ( Centralbl.f. Gyncekologie, 
 No. 20, 1888) confirms the high opinion held of creoline by Minapoulus, 
 citing 124 cases, in all of which favorable results were obtained. Baumm 
 {Centralbl. f. Gyncekologie , No. 20, 1888) has employed this agent with 
 favorable results. He considers a two per cent, solution rather strong, 
 and mentions one case in which fainting occurred, followed by sickness, 
 ringing in the ears, and giddiness, while later the urine passed was dark- 
 colored. He detected no peculiar odor of the urine. Although a post-
 
 CREOL1NE. 217 
 
 partum hemorrhage had occurred which might produce these symptoms, 
 he thinks it possible that they were due to creoline poisoning. Hirst, in 
 his lectures to the class at the University of Pennsylvania, commends 
 creoline as the safest antiseptic used in midwifery, and of equal efficiency 
 to bichloride of mercury. Chiron {Gazette de Gynecologic, May i, 1889) 
 has used this antiseptic extensively in female BLENNORRHAGIA and ENDO- 
 METRITIS with success. 
 
 Wackez {Therap. Monatsh., June, 1889) has used creoline as a dress- 
 ing, but complains that a peculiar eczematous rash appeared on the third 
 day, followed by large blebs. A similar action was noted by Boschmeyer 
 {Therapeutic Gazette, p. 632, 1890), who adds that children are more 
 susceptible than adults to this complication. 
 
 Diseases of the Skin. Creoline has been recommended as an anti- 
 septic and parasiticide. 
 
 It has been employed in ointment, half a drachm to the ounce of lard 
 in SCABIES. It is said to cure the disease very quickly, without irritating 
 the skin. 
 
 Diseases of the Ear, Nose, and Throat. L. Lichwitz (Le Bul- 
 letin Medicale, No. 78, 1888) believes that creoline is useful in the strength 
 of one part to one thousand for OTORRHEA. Urbantschitsch recommends 
 ten drops to a half litre of water. The solution can be greatly increased 
 in strength. The fact that solutions of creoline are opaque is objec- 
 tionable, since the presence of the fluid at the bottom of the meatus 
 disguises the appearance of the parts and changes the color of the dis- 
 charges. All observers agree that secretion lessens. One of the advan- 
 tages acknowledged is the retention of antiseptic powers below that 
 strength which excites irritation of the tissues. A. Eitelberg ( Wiener 
 Med. Presse, 1888, No. 13) recommends a solution of ten drops to a 
 half litre of warm water for syringing the ear and for applications to the 
 auditory passage in active INFLAMMATION. Schnitzler used it extensively 
 in form of a gargle, one to five per cent., in different diseases of the 
 throat. A gargle of a two per cent, solution of creoline is advocated for 
 DIPHTHERIA by Roos, and Amon ( Miinchener Med. Wochenschr., 1888, 
 26). Owing to its cheapness it' is well adapted for dispensary practice. 
 An efficient though not an agreeable gargle can be made by adding two 
 to five drops in a glass of water. 
 
 Many observers recently have recommended creoline in OZ^ENA, 
 CHRONIC NASAL CATARRH, and PHARYNGITIS SICCA ; a solution of one 
 per cent, is sufficiently strong. Pleskoff prepares tampons ten to fifteen 
 centimeters long and about the thickness of the little finger, which, after 
 being wrung out in the creoline solution, are inserted deep into the an- 
 terior nares and allowed to remain for twenty minutes, in ATROPHIC 
 CATARRH. In PHARYNGITIS SICCA the tampons are inserted as far as the
 
 21 8 LOCAL THERAPEUTICS. 
 
 posterior nares, so that they project into the naso-pharynx. E. O. Otis 
 {Boston Med. and Surg. Journal, 1889, 599) also recommends its use in 
 PHARYNGEAL CATARRH. A solution stronger than two per cent, may 
 excite continuous burning, and a solution of from two to five per cent, 
 smarting, if applied to the nose. The same writer uses creoline in ordinary 
 cases of PHARYNGEAL NASAL CATARRH. A solution of a strength of one 
 to two drops in a tumbler of warm water, using the solution with a nasal 
 syringe, suffices. Langmaid has found creoline to be irritating, and 
 believes that its use should be restricted to chronic cases which need 
 stimulation, and the effect should not be continued long. 
 
 Schnitzler {Deutsche Med. Wochenschrift, Aug. 16, 1888) approves of 
 its use as an ingredient in a gargle for ACUTE TONSILLITIS. 
 
 F. W. Koehler {Med: Record, Jan. 19, 1889) speaks highly of creo- 
 line in the local preventive and curative treatment of infectious throat 
 diseases. The author employs it as a gargle of one to two per cent, 
 solutions. 
 
 In a solution of from two to three per cent, it is found to possess 
 haemostatic properties. It appears to be especially adapted in HEMOR- 
 RHAGE from mucous membranes. Plugs, which have been previously 
 saturated in such a solution, can be worn for a week without removal. 
 
 As an inhalant in PHTHISIS, in the form of creoline vapor, it destroys 
 the fetor and diminishes expectoration. Its effects are nil in arresting the 
 progress of the disease (Sedziak). 
 
 A trade preparation containing creoline, known as Jeyes' Sanitary 
 Compound, is used as a germicide. Creoline is the basis of another pro- 
 prietary article known as Jeyes' Surgical Soap. It has the merit of being 
 cheap, harmless, and efficient. 
 
 Diseases of the Eye. Creoline has been used in PURULENT CON- 
 JUNCTIVITIS, KERATITIS, and PHLYCTENULAR OPHTHALMIA, in one or two 
 per cent, solutions, and as an ointment with cosmoline in CILIARY BLEPH- 
 ARITIS. It resembles carbolic acid in its therapeutic effects, but is less 
 irritating. Its use has not been general, and further experience is required 
 to establish its value. It has been recommended as a disinfectant of 
 instruments, but the opacity of the emulsion that it forms with water is 
 an objection. 
 
 CUBEBA. Cubeb. 
 
 " The unripe fruit of Cubeba offidnalis (nat. ord. Piperaceai)." (U. S. P.) The prepa- 
 rations are Extractum Cubeba Fltiidum, Oleoresina Cubeba, Tinctura Cubeba. 
 
 Cubeb is a stimulant to the nasal mucous surface. 
 Diseases of the Nose and Throat. The preparations of cubeb 
 have the same general properties. Finely powdered and blown into the
 
 CUBEBA. 
 
 219 
 
 nostrils by an insufflator, it is of established repute for CHRONIC NASAL 
 CATARRH. It is, nevertheless, of little value other than a palliative to 
 the sense of oppression attendant on turgescence of the membranes. The 
 best remedy for such a condition is the galvano-cautery. Chewing the 
 berries of cubeb has long been a remedy of popular repute in fatigue of 
 the larynx following'prolonged speaking. 
 
 Inhaling the smoke arising from the burning of cubeb has been for 
 many years a popular remedy for the relief of distresses arising from TUR- 
 GESCENCE OF THE Mucous MEMBRANE OF THE NOSE. Smoking cigars in 
 which cubeb is diffused, inhaling vapor of cubeb from pieces of cotton, 
 or other substance saturated with it, or swallowing small pieces of sugar 
 on which oleoresin has been dropped, are useful ; but now with the many 
 admirable topical agents in the relief of this affection and the great im- 
 provement in the surgical means resorted to in their treatment, cubeb 
 has taken a much less important position than formerly ; at best it may 
 be said it excites a peculiar effect on the mucous membrane which is agree- 
 able to the patient and has a transient effect in constricting the arterioles. 
 
 Lozenges containing cubeb are sold prepared by different manufac- 
 turers, in the proportion of one-sixteenth to one grain of oleoresin ; 
 one-half of a grain enters into each Spitta's lozenge.* The amount 
 is, therefore, so variable that care should be taken in directing them 
 to be purchased. W. Murrell {Brit. Med. Jour., 1885, Dec. 12) uses as 
 an inhalant for WINTER COUGH the oil of cubeb joined with oil of 
 sandalwood and pure terebene in the presence of vaseline. 
 
 OLEUM CUBEB^E. Oil of Cubeb. 
 
 " A volatile oil distilled from cubeb. A colorless, or pale greenish, or yellowish liquid, 
 having the characteristic odor of cubeb, a warm, camphoraceous, aromatic taste, and a 
 neutral reaction. It is soluble in an equal weight of alcohol." (U. S. P.) 
 
 Diseases of the Throat, etc. As an inhalant oil of cubeb, in the 
 proportion of ten minims to a half ounce of water, a small quantity of 
 magnesium carbonate being added to better maintain the diffusion, may 
 be employed. A teaspoonful of the mixture should be added to a half 
 pint of water, heated to 150 F. It is a valuable stimulant in LARYNGITIS, 
 accompanied with relaxed membranes and hypersecretion. 
 
 *Req: Oleoresin of Cubeb 3J. 
 
 Oil of Sassafras, tt\,xv. 
 
 Ext. Licorice, 5j. 
 
 Gum Arabic, 3 ss. 
 
 Sugar, gvj. 
 
 Syr. Tolu q. s. to mass. 
 Fiat troch. No. cxx. 
 
 Spitta's lozenge was originally made with about two grains of powdered cubeb in 
 each. The present U. S. P. formula is modeled after that of Spitta, but contains ^ 
 grain of the oleoresin instead of two grains of the powder.
 
 220 LOCAL THERAPEUTICS. 
 
 In addition to the above, cubeb combines agreeably with tolu, sassa- 
 fras, glycyrrhiza, potass, chloras, rhatany, and oil of lemon. A nasal 
 tampon, saturated with a mixture of tincture of cubeb, one ounce, gly- 
 cerin, ten minims, has been proposed by M. Mackenzie. 
 
 "Cubeb Wool." Cotton, one drachm; glycerin, ten minims; tr. 
 cubebae, one ounce. Mix the glycerin with the tincture, saturate the 
 wool with the liquid and dry. 
 
 CUPRI NITRAS. Nitrate of Copper. 
 
 Nitrate of copper is prepared by dissolving copper oxide in diluted nitric acid. The 
 clear solution is decanted from the sediment and evaporated to crystallization. The blue 
 crystalline salt is very soluble in water, has a caustic metallic taste, and cauterizes the 
 skin. 
 
 Diseases of the Mouth. Flemming has used nitrate of copper 
 in TUBERCULOUS ULCERATION of the tongue, and claims a cure. 
 
 CUPRI SULPHAS. Sulphate of Copper. Blue Vitriol. Bluestone. 
 
 Sulphate of copper occurs in " large, translucent, deep-blue, triclinic crystals, efflores- 
 cent, odorless, having a nauseous, metallic taste and an acid reaction. It is soluble in 
 two and six-tenths parts of water at 15 C. (59 F.), and five-tenths of boiling water, 
 and insoluble in alcohol." (U. S. P.) 
 
 Sulphate of copper pencils are made in several ways, one is the turning in the lathe 
 of suitable masses of sulphate of copper, another is the mixing together of one part of 
 powdered potassa-alum and two parts of powdered sulphate of copper, fusing and 
 moulding. Still another is to rub together four parts of powdered sulphate of copper 
 and one of powdered borax ; there results a plastic mass, which may be shaped to any 
 desired form, and soon after hardens. Crystals of sulphate of copper may be rubbed 
 with a piece of cloth under a stream of water until the desired shape is obtained. 
 
 General Surgery. In the treatment of CHRONIC INDOLENT LEG 
 ULCERS, such as are often found in persons broken down from intemperate 
 habits and neglect, a solution of sulphate of copper (blue-wash), five or ten 
 grains to the ounce of water, can be used with advantage. The following 
 method is recommended : First poultice the parts for several days in order 
 to remove all devitalized tissues. After the surface is fairly clean it is 
 enveloped with lint soaked in the solution. Oiled silk or waxed paper over- 
 lies the lint, and a firm bandage is applied from the toes to the knee. 
 
 The action of the sulphate of copper on open, granulating surfaces is to 
 coagulate the albumin, and thus a thin, insoluble coating is formed, 
 which takes the place, in a measure, of the lost cuticle, and so pro- 
 motes the healing process. Sulphate of copper, like many other metallic 
 salts, constricts the blood-vessels and lessens the blood-supply to the 
 part. It may even arrest HEMORRHAGE from small vessels, although for
 
 CUPRI SULPHAS. 221 
 
 this purpose it is inferior to other substances, such as alcohol or hot 
 water. 
 
 Sulphate of copper has long been a remedy among sailors for the treat- 
 ment of CHANCROIDS. A small lump of the crystal is broken up and 
 the surface of the chancroid is covered with the coarsely-powdered salt, 
 which is retained by means of a bandage. Under this treatment the sore 
 changes its character and heals up rapidly. 
 
 Sulphate of copper has long been used with great advantage, as an 
 injection, in the treatment of the latter stage of GONORRHCEA. It should 
 not be used stronger than two grains to the ounce at first. It forms one 
 ingredient of Berkley Hill's " four sulphate " mixture. This preparation 
 is composed of: Sulphate of copper, sulphate of zinc, sulphate of iron, 
 and sulphate of alumina, of each ten grains, and water seven fluid-ounces. 
 We frequently use, with success, at the Pennsylvania Hospital, the 
 following injection : R. Cupri sulph., gr. xij ; tinct. opii, gj ; aquae, gv. 
 The patient is always instructed to begin by diluting this to one-half 
 strength with water, and to inject the solution three times daily, after 
 urinating. Injections of sulphate of copper solutions (from five to fifteen 
 grains to the ounce) are often of service in RECTAL ULCER. 
 
 Diseases of the Skin. Several of the salts of copper are employed 
 as applications in diseases of the skin. Their effect is usually astringent 
 and, to a mild degree, parasiticide. The sulphate of copper applied in 
 the solid crystal is a stimulant or mild caustic, and acts favorably in 
 INDOLENT ULCERS, Mucous PATCHES, and in FISSURES. The aqueous 
 solution, twenty grains to the ounce, is sometimes used as a lotion in 
 CHRONIC ECZEMA. Besnier, in crusted ECZEMA OF THE SCALP, removes 
 the crusts by means of compresses wet with starch water (a teaspoonful to 
 the quart) covered with rubber cloth, adding a drachm of boric acid to 
 the quart of starch water if the crusts are foul. When inflammation has 
 disappeared a lotion of four grains of sulphate of copper to the ounce of 
 water is employed to complete the cure. 
 
 Blanc employs an ointment of thirty grains of the oleate of copper to 
 the ounce of lard in RINGWORM of the scalp. 
 
 An ointment of the sulphate of copper was formerly employed, but 
 possesses no advantages over other astringent remedies. 
 
 Diseases of the Ear, Throat, and Nose. A solution of sulphate 
 of copper, ten to twenty grains to the ounce, may be dropped in the ear 
 in the treatment of PURULENT OTORRHCEA, accompanied with PERFORA- 
 TION OF THE TYMPANIC MEMBRANE. It appears to act much the same as 
 solutions of nitrate of silver of equivalent proportions, and may serve as 
 an efficient alternative with these preparations. Kircher employs weak 
 solutions in CHRONIC SALPINGITIS. Stronger lotions are borne within the 
 naso-pharynx, for example, in amounts of a half drachm to an ounce of
 
 222 LOCAL THERAPEUTICS. 
 
 water. Its use is indicated in acute inflammation with submucous infil- 
 tration, such as is found in SYPHILITIC ANGINA and in the last stages of 
 TRAUMATISMS. In PHAGEDENIC ULCERATION applications in the strength 
 of a scruple to two drachms to the ounce of water is approved by T. F. 
 Rumbold. (St. Lout's Archives, 1873.) When EPISTAXIS is due to ulcera- 
 tion B. Robinson uses a similar solution mopped over the affected spots. 
 Ten grains to the ounce forms an efficient lotion for recent APHTHOUS 
 ULCERATION of the mouth ; in chronic or recurrent forms of this condi- 
 tion the crystal may be used. 
 
 As an astringent gargle, ten to fifteen grains to the ounce can be borne. 
 It appears to be especially adapted for diffuse CELLULITIS, as in ERYSIPE- 
 LAS, BITES OF INSECTS, Toxic IMPRESSION, etc., as well as in all forms of 
 ANGINA in which the connective tissue is involved, hence it is of value in 
 PHAGEDENIC ULCERATION of the pharynx, whether of specific or other 
 origin. The same strength of solution may be painted with advantage 
 over the gums in STOMATITIS. 
 
 In FCETID CORYZA a lotion of strengths varying from one-half grain to 
 ten grains to the ounce are advantageous. 
 
 Diseases of the Eye. Sulphate of copper is occasionally employed 
 as a collyrium, in the proportion of half a grain to two grains to the 
 ounce, in the treatment of CHRONIC CONJUNCTIVITIS, but its more general 
 use in ophthalmic surgery is in the form of crystal, applied to the everted 
 lid in TRACHOMA. This was formerly in almost universal use, but is less 
 so now, as most surgeons consider it a more painful and less efficient 
 remedy than are solutions of nitrate of silver or the "mitigated stick." 
 In cases under treatment for a long time, however, it is necessary to vary 
 the applications, and the traditional "blue-stone" is often efficient. 
 It is dipped in water and passed over the everted lid, which should be 
 washed before it is allowed to close. 
 
 The "Lapis divinus," composed of equal parts of sulphate of copper, 
 nitrate of potassium, and alum moulded into a pencil, is not often pre- 
 scribed. 
 
 CYDONIUM. Cydonium. Quince Seed. 
 
 " The seed of_ Cydonia vulgaris." (U. S. P.) The mucilage of quince seed (Mucil- 
 ago cydonii U. S. P.) is made by macerating two parts of quince seed for half an hour 
 in one hundred parts of cold, distilled water and straining without pressure. 
 
 Diseases of the Eye. The mucilage of quince seed was formerly 
 much used, either alone or as an addition to sedative and astringent 
 washes, in ACUTE CONJUNCTIVITIS. It is a soothing application, but has 
 a disagreeable effect if allowed to dry upon the lashes, and should not be 
 used in too large proportion. One or two drachms may be added to six 
 ounces of water.
 
 DERMATOL DEXTRIN. 
 
 223 
 
 DERMATOL. Basic Gallate of Bismuth. Subgallate of Bismuth. 
 
 Dermatol is a trade name for a basic bismuth galiate. It forms a fine, yellow powder, 
 without odor or hygroscopic properties. It contains fifty-five per cent, bismuth oxide. It 
 is practically insoluble. It is employed pure as a powder, united with other desiccants, 
 or exhibited in form of an ointment or collodion (1.5 : 10). 
 
 Dermatol is protectant, desiccant, and antiseptic. 
 
 General Surgery. R. Glaeser (Semaine Med., 1891, No. 27) 
 employs dermatol as a desiccant ; while checking serous exudation it 
 stimulates granulations. (J/. B., October, 1891.) 
 
 Doernberger {Therap. Monatshefte, February, 1892) uses dermatol in 
 the form of an ointment in the treatment in the second degree of BURN. 
 A. Bluhn (ibid., December, 1891) treats CARBUNCLE after incision with 
 advantage by applications of the dry powder. 
 
 Diseases of the Skin. Dermatol is recommended by Rosenthal 
 (Monatsh. f. D. u. Syph., i, 1891) as a substitute for iodoform, on 
 account of its stability in air and light, its non-poisonous and its anti- 
 septic qualities, its want of odor, and its drying and healing effect on 
 WOUNDS. It has not, as yet, been employed extensively in dermatology, 
 but is thought likely to prove useful in affections accompanied by profuse 
 secretion, as SEVERE BURNS, MOIST ECZEMA, ULCERS, etc. 
 
 The following formulae are suggested: Dermatol, 3J ; lanolin, gij ; 
 vaseline, gvj. M. Dermatol, pulv. oxide of zinc, aa gr. 1 ; vaseline, j. 
 M. Dermatol, 9j ; pulv. oxide of zinc, amyl, aa ^iiss ; vaseline, j. 
 
 Diseases of the Ear, Throat, etc. Doernberger and Chaniavsky 
 use dermatol pure or united with boric acid in OTORRHOSA. Dermatol is 
 recommended by F. Bloebaum (Deutsche Med. Zeit., January i, 1892)33 
 an excellent application to BURNS resulting from the use of the galvano- 
 cautery in the pharynx. 
 
 DEXTRIN. Artificial Gum. 
 
 Dextrin is produced by the action of acids or diastase on starch. It is freely soluble in 
 both hot and cold water, and forms an exceedingly adhesive, mucilaginous solution. It 
 occurs in commerce in three forms, that of a concentrated solution, as a white powder, 
 and in yellowish- white lumps somewhat resembling gum arabic. 
 
 General Surgery. Dextrin is one of the substances used in the 
 coating of Lister's protective. The "protective" consists of oiled silk 
 coated with copal varnish ; over the surface of which, when dry, a mixture 
 of dextrin one part, starch two parts, and of cold aqueous solution of car- 
 bolic acid (1-20) sixteen parts, is applied. The object of the treatment 
 is to render the oiled silk impervious to the carbolic acid (^. z/.). By 
 this means the carbolic acid is distributed evenly over the surface instead 
 of being disposed in globules, as would otherwise be the case.
 
 224 LOCAL THERAPEUTICS. 
 
 DUBOISIA. 
 
 A small tree (Duboisia myoporoides], a native of Australia. The leaves are medicinal. 
 They contain the alkaloid duboisine, which is chemically identical with hyoscyamine, but 
 physiologically is much stronger. (See Belladonna.} The sulphate is the salt most 
 frequently used. 
 
 Diseases of the Eye. Duboisine has recently come into quite 
 general use as a mydriatic. Its physiological action on the iris and ciliary 
 muscle is the same as that of atropine, except that it is more prompt and 
 energetic and of shorter duration. The latter peculiarity recommends 
 it particularly where it is desired to paralyze the accommodation for the 
 estimation of refraction. A solution of two grains to the ounce of the 
 sulphate or salicylate of duboisine paralyzes the accommodation as com- 
 pletely as a four-grain solution of atropine, and more quickly, while its 
 effects last only about half as long as those of atropine. Recovery takes 
 place in from five to seven days. 
 
 The objection to its use is its greater tendency to produce constitu- 
 tional disturbance. Alarming symptoms have frequently been produced 
 by the instillation of four-grain solutions and occasionally by the use of 
 much weaker ones. It is exceptional, however, for unpleasant results to 
 follow the use of a two-grain solution, and this proportion is quite suffi- 
 cient to insure the full effect of the drug. This, used three times the day 
 before and once on the day of the examination, may be relied upon to 
 produce complete paralysis of accommodation for testing the refraction. 
 
 Duboisine is said to act well in some cases in which the irritating effect 
 of atropine upon the conjunctiva precludes the use of the latter, but the 
 greater danger of constitutional poisoning and the shorter duration of its 
 effects upon the eye prevent it from competing with atropine as a thera- 
 peutic agent. Like the other mydriatics, it must be used with caution 
 where there is suspicion of increased intraocular tension. Duboisine is 
 generally considered to be identical with hyoscyamine. Wood, in the 
 recent edition of his "Therapeutics," states that the most recent chemical 
 researches seem to show that there are three mydriatic alkaloids atro- 
 pine, hyoscyamine, and hyoscine daturine and duboisine being mix- 
 tures of these. 
 
 ERGOTA. Ergot of Rye. 
 
 " Ergot is the sclerotium of Claviceps purpurea, replacing the grain ot Secale cereale" 
 (U. S. P.) Ergot is not the altered grain of the rye, as is usually believed, but is a parasitic 
 fungus growing in the rye head. It contains a large proportion of fixed oil (oil of ergol\ 
 which is procured by percolating the ergot, either with ether or benzin, and evaporating the 
 solvent. Ergot contains ecboline and ergotine, which exist in it combined with ergotic 
 acid. Ergotinine, a colorless, crystallized alkaloid, has also been separated, and sclerotic 
 acid, or sclerotinic acid, has been separated by Dragendorff.
 
 ERGOTA. 225 
 
 Other chemists have found ergotic acid, sphacelic acid, and the alkaloid cornutine. The 
 question as to the value and identity of these principles is obscure. The article usually 
 sold as Ergotin is not an alkaloid, but is a solid extract, and should be so designated. A 
 Solid Extract of Ergot (of uncertain strength), a Fluid Extract (one cubic centimetre 
 of which represents the activity of one gramme of ergot), and the Wine of Ergot (con- 
 taining the activity of fifteen parts of ergot in one hundred of wine) are official. 
 
 General Surgery. Ergot may be used with great advantage hypo- 
 dermically (Squibb's fluid extract, n\J to gr. j) in HEMORRHAGE FROM THE 
 INTESTINE in typhoid fever. Ergotin, given hypodermically in five-grain 
 doses, is occasionally of service in checking oozing after operations 
 involving the hand and foot, where elevation and pressure have failed. 
 Schunking {CentralbL f. Gynakol., February 15, 1888) recommends 
 the treatment of uterine fibroids with injections, with an absolutely 
 clean hypodermic needle, of fresh, pure solutions of ergotin, into 
 the central part of the anterior lip of the uterus ; the injection not to 
 go deeper than one-fourth of an inch, and care being taken not to 
 insert the needle into the tumor or the body of the uterus. Ergot is 
 extremely useful in POST-PARTUM HEMORRHAGES, arresting the bleeding 
 by producing firm contraction of the uterus, and by its influence on the 
 blood-vessels. It is the most valuable of remedies in uterine hemorrhage, 
 checking the bleeding when other remedies have failed. In these condi- 
 tions ergot is usually given by the mouth in full doses. Where a very 
 prompt and decided action is demanded, either ergotin or the fluid 
 extract may be given hypodermically. Eldridge and others advise the 
 use of ergot by injection in the treatment of GONORRHOEA. Fluid ext. 
 ergot, one part ; water, five parts. In rare cases the use of ergot, by this 
 means, may be productive of good results, but as a rule the injection 
 of lead and zinc will prove a more satisfactory means of dealing with 
 this affection. 
 
 In PROLAPSUS OF THE RECTUM, D. H. Agnew and Langenbeck advise, 
 before resorting to more radical measures, the hypodermic use of the 
 concentrated fluid extract of ergot, introduced into the submucous tissues 
 of the rectum, the dose being about five to seven grains of the drug, or 
 its equivalent ; the injections to be repeated every second day for two 
 weeks. 
 
 Langenbeck advises a similar method of treatment in cases of HEMOR- 
 RHOIDS, injecting ergotin beneath the rectal mucous membrane. This 
 mode of treatment is based on the property possessed by the drug of ex- 
 citing contraction of the muscular walls of the blood-vessels. Langen- 
 beck also carried out the same idea in the treatment of ANEURISM, by 
 injecting into the subcutaneous tissues external to the sac a concentrated 
 preparation of ergotin, with the hope of producing muscular contraction 
 of the walls. He cites a case in which an old aneurism of the radial
 
 226 LOCAL THERAPEUTICS. 
 
 artery was cured in eight days. Most probably the success attained was 
 due rather to an inflammatory condition occasioned by the drug in the 
 cellular tissues than to its physiological action on the muscular fibres of 
 the sac. In such a treatment from seven to ten drops of Squibb's fluid 
 extract may be used not oftener than once in two or three days, under 
 the most favorable circumstances. We have used ergot in suppository, in 
 cases of ENLARGEMENT OF THE PROSTATE GLAND, but for the most part 
 with negative results. 
 
 Diseases of the Skin. Ergot has been recommended in the local 
 treatment of EPITHELIOMA. The drug, reduced to an impalpable pow- 
 der, is dusted on in a thick layer thrice daily, and is followed by the 
 application of a rag moistened with the following lotion : R. Acidi car- 
 bolici, {3] ; acidi sulphurosi, glycerini, aa fj ; aquae ad f giv. The ration- 
 ale of the action of ergot in this case does not appear. Bulkley recom- 
 mends this drug in CARBUNCLE in the following combination : R. Ext. 
 ergotae, ij ; pulv. zinci oxidi, ^ss ; ung. aq. rosae, ^ij. M. 
 
 Diseases of the Nose and Throat. T. A. De Blois {Arch. Laryn- 
 gology, 1883, vol. iv, p. 22) recommends injections of ergotin in the 
 submucous tissues of NASAL HYPERTROPHIES. 
 
 W. C. Dabney {Am. Journ. Med. Sci., July, 1879) employs ergot in 
 the following combination for PHARYNGITIS: Ext. of ergot (Squibb's), 
 gr. xx ; tincture of iodine, f 3] ; glycerin, f j. 
 
 In the use of ergot in the form of a lozenge, each mass may contain 
 five grains of the drug. 
 
 ERYTHROPHLEINE. 
 
 Erythrophleine is an alkaloid extracted from Erylhrophleunt guineense (sassy bark, an 
 African ordeal poison). The hydrochloride of erythrophleine occurs in the form of yel- 
 lowish-white crystals, and is soluble in water. 
 
 Diseases of the Eye. Erythrophleine is described by Lewin, of 
 Berlin {Therapeutic Gazette, March 15, 1888), as a powerful local anaes- 
 thetic whose effects upon the eye are insensibility of the cornea and 
 conjunctiva and contraction of the pupil. He used a solution of the 
 hydrochloride of from .05 to .25 per cent, in experiments upon cats, 
 dogs, rabbits, and guinea-pigs, and states that its action began in 
 fifteen or twenty minutes and lasted for several hours, in some cases, 
 indeed, for two days. He found that three drops of a solution containing 
 one and a half grains to 2000 drops of water would produce anaes- 
 thesia. He concludes that "Erythrophleine is, however, a poison, 
 and, apart from its truly wonderful anaesthetic properties, it also influ- 
 ences the heart, and therefore caution is necessary." Tweedy (London 
 Lancet, 1888, pp. 249 and 346) experimented with the hydrochloride
 
 ERYTHROXYLON ETHYL BROMIDE. 
 
 227 
 
 on the human eye and failed to produce any decided anaesthesia. Solu- 
 tions of .25 and .50 per cent, caused some pain and irritation, with 
 ciliary injection and dilatation of the pupil. He also noted blurred 
 vision and a circular colored halo around an artificial light due to disturb- 
 ance of corneal epithelium. 
 
 Other observers have confirmed Lewin's conclusions in whole or in 
 part, while still others have denied them. The fact probably is that the 
 drug has not yet been definitely isolated, and that the preparations used 
 by different experimenters have not been identical. There is a pretty 
 general admission of its irritating effects when applied to the eye. Its 
 present status is, albeit, that of a very uncertain remedy, and it has no 
 standing as a competitor of cocaine. 
 
 ERYTHROXYLON. Coca. 
 
 Erythroxylon is the name given to "the leaves of Erythroxylon Coca." (U. S. P.) It 
 owes its activity to the presence of cocaine (<?. v.). The fluid extract is official, and one 
 cubic centimetre of it represents the activity of one gramme of coca leaves. 
 
 Coca possesses in a mild form the properties of cocaina. The alkaloid has almost 
 entirely superseded the crude drug. 
 
 Diseases of the Throat, etc. The concentrated infusion of coca 
 leaves is recommended by J. Solis-Cohen (JV. Y. Med. Journ. , 1886) as 
 a substitute for cocaine in gargles and sprays. The fluid extract is also 
 useful for relieving TURGESCENCE OF THE NASAL Mucous MEMBRANE. 
 Nachtigall recommends the use of cigarettes made from the leaves for 
 ASTHMA. 
 
 A lozenge containing two grains of the leaves can be procured. 
 
 ETHYL BROMIDE. Bromide of Ethyl. Hydrobromic Ether. 
 " A colorless, very volatile liquid, not inflammable, having an agreeable odor and a 
 pungent, saccharine taste." (U. S. D.) It boils at 104 F. It is made, after several pre- 
 cautions have been observed, by the action of bromine on alcohol in the presence of phos- 
 phorus. It liberates free bromine when long kept. 
 
 Bromide of ethyl is anaesthetic. It should be used with caution. 
 
 General Surgery. An effort was made to introduce it as a substi- 
 tute for ether by the late R. J. Levis, who claimed that it possessed all 
 the advantages of chloroform without any of its dangerous properties. 
 For about six months it was employed in his wards at the Pennsylvania 
 Hospital, but, after a fair trial, it was found not as safe or reliable as 
 ether, death sometimes following its employment. Its mode of action is 
 quite similar to that of chloroform. Its administration should never be
 
 228 LOCAL THERAPEUTICS. 
 
 preceded or followed by that of chloroform.* As a local anaesthetic 
 bromide of ethyl has been used in the form of a spray. 
 
 Diseases of the Ear, Nose, and Throat. E. L. Shurly (IV. K 
 Med. Jour., September u, 1886) believes that ethyl bromide should be 
 placed in the group of inhalants for the relief of COUGH. It is not quite 
 so efficacious as chloroform, but causes less general anaesthesia. S. Hart- 
 well Chapman recommends bromide of ethyl as an analgesic. Mixed 
 with glycerin, it may be used in the outer-ear passage in OTALGIA. 
 (H. McNaughton Jones.) 
 
 ETHYL IODIDE. Iodide of Ethyl. Hydriodic Ether. 
 Ethyl iodide is prepared by distilling a mixture of five parts of absolute alcohol, ten 
 parts of iodine, and one of phosphorus. Care must be observed in mixing these ingredients, 
 and the iodine should be added last, in small quantities at a time. It is a colorless liquid 
 (though it is apt to become colored by the liberation of iodine), has a penetrating, ethereal 
 odor, is not inflammable, is dissolved by alcohol and ether, but is only sparingly soluble 
 in water. It boils at 158 to 160 F. 
 
 The Vapor acts as a powerful antispasmodic, and exerts upon the econ- 
 omy the impression of iodine. It is recommended to place a capsule in 
 the handkerchief, crush it, inhale the vapor, and repeat in ten minutes, 
 or thrice daily. After the patient acquires confidence, inhalations can be 
 made directly from a small vial. It is without depressant or toxic effect. 
 
 Diseases of the Ear, Nose, and Throat. The vapor of hydri- 
 odic ether is recommended by H. McNaughton Jones in the treatment of 
 CATARRHAL DEAFNESS. It is of value where the impression of iodine is 
 indicated in morbid states of the bronchi and lungs, and appears to be 
 of especial use in ASTHMA. It tends to the absorption of lymphatic exu- 
 dations and indirectly aids in diminishing cough dependent upon irrita- 
 tive excess of secretion. Ten to fifteen drops may be inhaled several 
 times a day. S. Solis Cohen (N. Y. Med. Jour., March 6, 1886) recom- 
 mends ten minims or more on a sponge, for inhalation, in SYPHILITIC 
 COKYZA, LARYNGEAL PHTHISIS, and in allied pharyngeal affections. A 
 writer in L 1 Union Medicale (January 10, 1891) recommends that ten drops 
 of the iodide of ethyl be inhaled from a handkerchief in HAY FEVER. 
 
 Iodide of ethyl is also employed in ASTHMATIC SEIZURES or the DYSP- 
 
 *The claims of bromide of ethyl have been examined lately with more favorable 
 results than above stated. E. E. Montgomery (Therap. Gaz., June 15, 1892) claims 
 to have administered it in nearly five hundred cases with satisfaction.. Five per cent, 
 only of these cases exhibited nausea and vomiting in a marked degree. An unpleasant 
 result of its use is the exceedingly disagreeable garlic-like odor on the breath of the patient, 
 for forty-eight hours after administration. See also articles in Therap. Monafsh/., 1888, 
 and PitUburg Med. Rev., 1889.
 
 EUCALYPTUS. 229 
 
 NCEA OF PHTHISIS, and, according to See, is prompt and satisfactory in its 
 action. In CHRONIC BRONCHITIS inhalations have proved of service in 
 the hands of R. M. Lawrence* (N. Y. Med. Rec., June, 1880, 685) by 
 increasing secretion and allaying spasm. According to the observations 
 of this writer, the drug is incapable of producing anaesthesia upon man. 
 In his own person it failed to produce drowsiness after half an hour's 
 trial. 
 
 EUCALYPTUS. 
 
 The preparations of eucalyptus referred to in this hook are as follows: Oil of Euca- 
 lyptus, Eucalyptol, resin of Eucalyptus, and the Fluid Extract of Eucalyptus. Since the 
 medicinal properties of these preparations are much the same, they will not be treated 
 separately. 
 
 OIL OF EUCALYPTUS. 
 
 " The volatile oil is distilled from the fresh leaves of Eucalyptits globulus and other 
 species of Eucalyptus." (U. S. P.) It is a " colorless, or a very pale, yellowish liquid, 
 having a characteristic aromatic odor and a pungent, spicy, and cooling taste. It is solu- 
 ble in an equal weight of alcohol." (U. S. P.) 
 
 EUCALYPTOL. 
 
 Eucalyptol is not identical with oil of eucalyptus, as is generally believed, but is an 
 oxygenated constituent of that oil. It is separated from the oil by fractional distillation, 
 the portion coming over between 170 and 178 C. constitutes eucalyptol. It is purified 
 by redistillation from caustic potash or chloride of calcium, and then boils at 176 to 
 177 C. It is colorless, slightly soluble in water, and very freely soluble in alcohol, and 
 diffuses through paraffin. It arrests amoeboid movement of the white corpuscles. 
 
 Eucalyptus is an antiseptic, possessing the valuable property of rarely if 
 ever inducing toxic impression. It is well to remember, however, the 
 case of Dr. Owen (Australian Med. Jour., September 15, 1885), in which 
 a child, seventeen months old, was poisoned by swallowing a few drops 
 of the fluid extract. Eucalyptus is antiseptic, sedative, detergent, and 
 probably astringent. Ringer claims that its antiseptic properties increase 
 with age. 
 
 RESIN 'OF EUCALYPTUS. 
 
 Dammar has been used in place of the resin of eucalyptus with much 
 more satisfactory results, and seems to be fairly trustworthy as an anti- 
 septic. 
 
 General Surgery. Oil of eucalyptus is used as an antiseptic in 
 surgery in the treatment of wounds and ulcers in conditions similar to 
 those where carbolic acid is indicated. It has been urged by Dr. Schultz, 
 of Bonn {Centralbl. fiir Chirurgie, January 24, 1880), that its antiseptic 
 properties are three times as great as those of carbolic acid carbolic acid 
 
 *The article by Lawrence is the best monographic account of this drug.
 
 230 LOCAL THERAPEUTICS. 
 
 preventing putrefaction when present in the proportion of one to 200 
 parts, the oil of eucalyptus accomplishing the same effect when present in 
 one to 666 parts. Bing has found that it hinders the passage of white 
 blood-corpuscles out of the vessels ; therefore, on Cohnheim's theory, 
 it is capable of arresting SUPPURATION. It has been substituted by Lister 
 for carbolic acid in making gauze, but, owing to its volatile nature, it 
 keeps badly if exposed to the air. 
 
 Oil of eucalyptus can be used on the scrotum, or in patients who are 
 especially susceptible to carbolic acid or corrosive sublimate. It has 
 been employed as an ointment, with cosmoline or lard, in the strength of 
 3ss to 3j, an d this may be used as are salicylic or boric acid ointments. 
 The ointment may be especially useful in the treatment of BURNS, as it 
 tends to sterilize the discharge. 
 
 In CANCER, accompanied with much odor and foul discharge, the oil 
 of eucalyptus has been used with success. IN ULCERATED CANCER OF THE 
 BREAST an ointment composed of iodoform, one drachm ; oil of euca- 
 lyptus, one ounce ; vaseline and paraffin, of each one ounce, spread on 
 lint, will be found a satisfactory dressing. A tampon of cotton saturated 
 with a solution of glycerin and oil of eucalyptus is serviceable in UTERINE 
 CANCER. 
 
 Diseases of the Nose, Throat, etc. As an agent controlling in- 
 flammation of mucous surfaces it is placed by W. B. Ketchum {Thera- 
 peutic Gazette, 1886) above that of nitrate of silver and iodine. It is 
 recommended that the fluid extract be diluted with an equal quantity 
 of glycerin and painted upon the affected parts. In this connection it 
 has received high encomiums in the local treatment of TONSILLITIS and 
 PHARYNGEAL DIPHTHERIA (Brondel, Gaz. des Hopitaux, December u, 
 1886), as well as in the ANGINA OF SCARLET FEVER. C. N. Palmer em- 
 ploys the pure fluid extract on DIPHTHERITIC PATCHES. APHTHOUS SORES, 
 as well as those of CANCRUM ORIS, are also relieved by the same applica- 
 tion. For the condition last named ten drops may be added to a half 
 tumbler of water. 
 
 As a spray in the pharynx and mouth, where a disinfectant effect is to 
 be combined with one which is soothing and antiseptic, Hardwicke 
 recommends the following : Oil of eucalyptus, one drachm ; terebene, 
 two drachms; alcohol, one and a half ounces. In the opinion of W. E. 
 Casselberry one-fourth per cent, to one per cent, of the oil suffices for 
 use in the nasal chambers. Lint dipped ia eucalyptol has proved to be 
 an admirable application to TUBERCULAR ULCERATION OF THE TONGUE. 
 A little over a fortnight sufficed to secure cicatrization. (Poncet, Lyon 
 Medical, January, 1887.) M. Mackenzie employs one part of eucalyptus 
 to two of starch as a powder in PHARYNGITIS SICCA. As an inhalant in 
 DIPHTHERIA and PULMONARY GANGRENE and WHOOPING COUGH, Bon-
 
 EUROPHEN. 231 
 
 amy {Bull. Therapeutique, vol. i, 1887) employs eucalyptus, as follows: 
 Sixty grammes of eucalyptus leaves added to a litre of boiling water. 
 The atmosphere of the room is completely saturated. The oil of euca- 
 lyptus is preferred by A. S. Houghton. (Jour. Am. Med. Ass'n, Novem- 
 ber 7, 1885). This writer combines a drachm of the oil with an ounce of 
 liquid cosmoline. Lennox Brown recommends the following inhalant : 
 Oil of eucalyptus, one to three drachms; magnesium carbonate (light), 
 thirty to ninety grains ; water, three ounces. Eucalyptus is recommended 
 by W. D. Miller as an antiseptic to arrest DENTAL CARIES. 
 
 In the form of a lozenge eucalyptus is prescribed. Each lozenge con- 
 tains from one to three grains of the extract, or one-eighth of a minim 
 of the oil. 
 
 EUROPHEN.* lodo-di-iso-butyl-ortho-cresol. 
 
 Europhen is obtained by the action of iso-butyl-ortho-cresol in alkaline solution in iodine. 
 It is a fine, yellow powder, of an aromatic, saffron-like odor, insoluble in water and in 
 glycerin, readily soluble in alcohol, in ether, in chloroform, and in oil, containing 28.1 
 per cent, of iodine. It is permanent in the dry state, but when heated with water to 
 70 C. (158 F.), or when left in contact with moisture at ordinary temperature, it gives 
 off free iodine. One part of europhen will cover as much surface as will five parts of 
 iodoform." (M. B., September, 1891.) It should be kept from the light, in a dry place. 
 It is used ordinarily in the form of a powder or an ointment. 
 
 Europhen is protectant and alterant. It possesses many of the proper- 
 ties of iodine, while free from odor and poisonous properties. 
 
 General Surgery. Europhen can be used in proportion of three 
 parts of the powder to seven of olive oil as an excipient dressing for 
 BURNS. 
 
 Diseases of the Skin. As a substitute for iodoform, europhen has 
 been used as an application in ULCERS, particularly VENEREAL and 
 SYPHILITIC LESIONS, CONDYLOMATA, SCROFULODERMA, LUPUS, and DER- 
 MATITIS CALORICA, with success. Eichoff, who has studied its clinical 
 employment, says that it is without effect in eczema, psoriasis, and 
 favus. {Therap. Monatshefte, No. 7, 1891). Europhen seems to have 
 a peculiarly destructive effect upon the Staphylococcus pyogenes aureus. 
 (Siebel.) 
 
 Diseases of the Nose and Throat. Europhen, used by insuffla- 
 tion, is recommended in NASAL CATARRH of children. It appears to be 
 useful in reducing the hypersecretion following surgical procedures within 
 the nasal chambers. According to Loewenstein {Therap. Monatsh., 
 September, 1891) europhen has value in EPISTAXIS due to erosion of the 
 
 *Not to be confounded with Europhin (Phenyl-Ethylic-Urethane) (M. B., January, 
 Iftftl).
 
 232 LOCAL THERAPEUTICS. 
 
 nasal septum. S. Johnston recommends the drug as an insufflation to the 
 surfaces of SYPHILITIC ULCERS of the nasal passages. 
 
 FERRI CHLORIDUM. Chloride of Iron. Ferric Chloride. Per- 
 chloride of Iron. Sesquichloride of Iron. 
 
 Chloride of iron occurs in masses yellowish-orange in color and of crystalline structure. 
 It is deliquescent, very soluble in water, and soluble also in alcohol and ether. Its reac- 
 tion is acid. A solution of chloride of iron containing thirty-seven and eight-tenths per 
 cent, of the anhydrous salt is official, as is also the familiar Tincture of the Chloride of 
 Iron, which is now made by dissolving thirty-five parts of solution of chloride of iron in 
 sufficient alcohol to make one hundred parts. A styptic cotton is prepared by steeping 
 absorbent cotton in chloride of iron solution and drying. 
 
 Perchloride of iron is a powerful astringent and styptic. According to 
 M. Delteau, it is the most powerful haemostatic known. 
 
 General Surgery. Chloride of iron has been used in the treat- 
 ment of aneurism, naevi, varicose veins, etc. In ANEURISM, injections 
 of the perchloride was first advised by Pravaz, of Lyons. According to 
 his recommendation, twenty drops of a solution of the agent are to be 
 injected slowly, by means of an ordinary hypodermic syringe, in an 
 aneurism containing three or four ounces of blood. While coagulation 
 is taking place (usually the work of about ten minutes), and for at least 
 one hour afterward, the circulation through the sac must be arrested by 
 pressure both above and below the tumor. If no inflammatory action is 
 excited in the sac and pulsation still remains, the injection may be 
 repeated in four or five days. Holmes states that out of eighteen cases 
 in which this mode of treatment was pursued, four terminated fatally, the 
 cause of death being gangrene of the sac and phlebitis. Such a method 
 of treatment is inferior to compression or the use of the ligature, and 
 should never be considered except when other means of controlling 
 the circulation have failed. For the cure of N^EVUS, injections of the 
 chloride solution have been effectual ; and, when successful, it has the 
 advantage of leaving only a slight scar. In the case of naevus as well as 
 in aneurism, it is impossible to tell where the coagulum formed by the 
 action of the iron salt on the blood may be swept by the blood current. 
 Consequently the method is fraught with danger ; and, except in special 
 cases, it should always give way to safer means of treatment. In the 
 case of VARICOSE VEINS in the extremities, the use of injections is to 
 be deprecated. The solution of the chloride form has been used by 
 Maupin and others in HOSPITAL GANGRENE with asserted good results ; 
 though, as a rule, bromine and nitric acid will be found more satisfactory. 
 In the treatment of POST-PARTUM HEMORRHAGE, Barnes employed with 
 success injections of the chloride in the strength of one part to three
 
 FERRI CHLORIDUM. 
 
 2 33 
 
 of water. It is gently thrown up to the fundus of the uterus from the 
 nozzle of a Davidson or fountain syringe. Care should be taken to remove 
 blood clots.* In the absence of a syringe a sponge saturated with the 
 mixture tied to the end of a stick or piece of whalebone may be gently 
 wiped around the inside of the uterus. Chloride of iron may also be 
 used with great advantage to control HEMORRHAGE FROM UTERINE CAN- 
 CER, UTERINE POLYPI, etc. Sometimes it is necessary to tampon the 
 vagina with strips of lint previously soaked in a solution of the chlo- 
 ride. In doing this, it is well to saturate only the first two or three 
 pieces, and for the remainder to use dry lint ; otherwise, on removal a 
 hard, unyielding mass will be found obstructing the vagina and often 
 adherent to the vagina walls. One objection to the use of the chloride 
 of iron as a topical application in uterine diseases is, that unless very much 
 diluted it excoriates the mucous membrane of the vagina. To obviate 
 this, Baum adds four grains of carbonate of sodium to the ounce of 
 the chloride. Sodium chloride is formed, and according to Baum, the 
 haemostatic action of the iron is intensified rather than diminished by the 
 neutralizing effect on the soda. 
 
 The tincture of the chloride of iron has been regarded by many as a 
 specific for ERYSIPELAS ; and this has led to its being used locally in the 
 treatment of this affection by painting the surface of the bkin over and 
 around the inflamed area. We question, from our experience, if any 
 benefit is to be derived from this mode of treatment, as its action 
 appears to be entirely negative. If desired, it can readily be applied by 
 means of a camel's hair brush or a small cotton swab. 
 
 For the removal of SEAT WORMS from the rectum, an enema con- 
 taining a half drachm to a pint of water is very efficient. The tincture 
 of the chloride of iron has been used with some success in the treatment 
 of CYSTIC GOITRE, 10-20 m. being injected from a hypodermic syringe 
 every three or four days. HEMORRHOIDAL TUMORS are often injected 
 with a few drops of the tincture of the chloride of iron from a hypoder- 
 mic syringe after the method of Mr. Colles. This mode of procedure is 
 not applicable to all varieties of piles, and is best suited to small, single, 
 pedunculated projections just beyond the verge of the anus. 
 
 Diseases of the Skin. The chloride of iron is ordinarily employed 
 in the form of tincture of the chloride (U. S. P.) for the destruction of 
 WARTS (VERRUCA), particularly venereal warts or CONDYLOMATA. 
 
 In ONYCHIA the tincture brushed on several times a day is found of 
 benefit. 
 
 The following formula has been highly recommended as an external 
 
 * The modern aseptic methods of arresting uterine hemorrhage are superior to those here 
 commended. Nevertheless, in an emergency it is well to remember the efficacy of chloride 
 of iron.
 
 234 LOCAL THERAPEUTICS. 
 
 application in HYPERIDROSIS of the feet: R. Ferri chloridi, 535; 
 glycerini, 9iv; ol. bergamot., fSiiss. It is a strong application and 
 should be applied with caution. A mixture of equal parts of chloride 
 of iron and opium is commended by Monin as an application for 
 eradicating CORNS. 
 
 Diseases of the Ear, Nose, Throat, etc. Chloride of iron is 
 astringent, haemostatic, and caustic. It is commonly used in solution. 
 Concentrated solutions are alone caustic. 
 
 Various forms of styptic cotton or paper are in the market. Styptic 
 paper is ordinarily made by mixing with the paper pulp, during the 
 process or manufacture of the material, some solution of ferric chloride. 
 A styptic collodion is prepared by adding one part of the crystal of 
 chloride to six of collodion. The haemostatic properties of chloride of 
 iron are increased by the addition of a little table salt. 
 
 As a caustic, chloride of iron is of use in the destruction of aural 
 polypus. B. Robinson (Nasal Catarrh, p. 165) recommends chloride 
 of iron in treatment of naso-pharyngeal hypertrophies ; G. T. Maxwell 
 (N. Y. Med. Record, October i, 1868) injects the fluid directly into the 
 mass. As an astringent nasal plug one-half ounce of the tincture and 
 ten minims of glycerin is used in saturating the cotton. 
 
 The tincture of chloride of iron is accepted by F. T. Kidder {Med. and 
 Surg. Reporter, November 8, 1890) as the most useful of all the remedies for 
 TONSILLITIS. The author gives it with glycerin two drachms of iron 
 to two ounces of glycerin ; a teaspoonful every two hours. This, doubt- 
 less, acts in great part locally ; the medicine, being swallowed, has an 
 advantageous effect on the entire economy, or the remedy may be applied 
 directly to the tonsils by a brush. 
 
 It is also an admirable remedy in CHRONIC LARYNGITIS. In the strength 
 of thirty to sixty grains to the ounce used with the brush by M. J. Asch 
 {Trans. American Laryngological Ass 1 n, 1887) in hoarseness of professional 
 singers. A single application will often put the parts in very good con- 
 dition. 
 
 For general purposes, when an astringent application is needed to the 
 pharynx and larynx, a strength of solution of tincture of iron one-half 
 drachm to a drachm to the ounce of water will serve a useful purpose. 
 
 For HAEMOPTYSIS a spray of five grains to the ounce of water may be 
 ordered, or it may be used as a spray inhalant. 
 
 A lozenge containing the tincture of iron is prepared. Each lozenge 
 exhibits one and a half minims of the agent. . 
 
 Some writers recommend a local application of thirty grains to the 
 ounce, with a little glycerin, to be used to the mucous membrane of the 
 naso-pharynx in CHRONIC INFLAMMATION. This is much stronger than 
 need be. From three to five grains will suffice.
 
 FERRI ET AMMONII SULPHAS FERRI SUBSULPHAS. 235 
 
 This agent has long been one of the remedies generally relied upon in 
 the local treatment of DIPHTHERIA. Lunin, in 1882, found the best results 
 following its use. A convenient form is to add one drachm of the tincture 
 to two ounces of syrup. This can be given as an internal remedy, but 
 the tenacjous character of the mucus causes the remedy to cling to the 
 walls of the pharynx and thus, pressing downward, secures a local appli- 
 cation. W. Porter {Trans, Amer. Laryngological A ss'n, 1887) advocates 
 a much stronger preparation namely, equal parts of the tincture with 
 glycerin. The application should be made every two or three hours. 
 
 Chloride of Iron Wool : Cotton-wool, one drachm ; glycerin, ten 
 minims; tr. fer. chlor., one ounce. Mix the glycerin with the tincture, 
 saturate the wool with the liquid, and dry. 
 
 FERRI ET AMMONII SULPHAS. Sulphate of Iron and Ammonium. 
 
 Ferric Alum. 
 
 It occurs in "pale violet, octahedral crystals, efflorescent on exposure to air, odorless, 
 having styptic taste and a slightly acid reaction. Soluble in three parts of water at 15 
 C. (59 F.) and in eight-tenths part of boiling water; insoluble in alcohol." (U. S. P.) 
 Sulphate of iron and potassium is also sold under the name of " ferric alum." 
 
 Ferric alum is a powerful astringent. 
 
 General Surgery, Ferric alum often substitutes alum in practice, 
 as it is more astringent. It is devoid of the stimulating effects of the iron 
 salts. It is in requisition as a vaginal wash in the treatment of LEUCOR- 
 RHCEA and VAGINITIS. A saturated hot solution may be employed as a 
 haemostatic. 
 
 Diseases of the Ear,, Nose, and Throat. Keene recommends a 
 solution of eighty grains to the ounce for CHRONIC LARYNGITIS. In a 
 solution of four grains to the ounce of water ferric alum is a useful 
 astringent in CHRONIC NASAL CATARRH. It stains linen, and on this 
 account is not so popular as are some other forms of astringents. In the 
 strength of three grains to the ounce it may be used as a spray in PHARYN- 
 GITIS and LARYNGITIS. 
 
 FERRI SUBSULPHAS. Monsel's Salt. Basic Ferric 
 
 Sulphate, Fe 4 O(SO 4 ) 5 . 
 
 It occurs in the form of " thin, transparent scales, is of a reddish-brown color, very 
 deliquescent, and very soluble in water." (U. S. D.) There is official, in the United 
 States Pharmacopoeia, a "liquor ferri subsulphatis " which contains forty-three and 
 seven-tenths per cent, of the salt. It is usually known as " Monsel's solution," from 
 M. Monsel, who first called attention to its properties as a styptic, in 1852. A haemostatic 
 absorbent cotton is prepared by steeping absorbent cotton in solutions of subsulphate of 
 iron forty-five per cent.
 
 236 LOCAL THERAPEUTICS. 
 
 Monsel's salt is a powerful astringent, styptic, and caustic. To pro- 
 cure the escharotic effect, the powder must be used pure ; its use in this 
 relation is restricted to soft polyps of the ear and nose. Moderate amount 
 of sloughing ensues after its use as a styptic, and a hard, resistant clot is 
 formed with the blood upon the bleeding surface. In this way too free 
 use of the powder is accompanied by distress, if not actual inflammation 
 of adjacent parts, while the attempts to remove the mass may excite 
 renewed hemorrhage. 
 
 General Surgery. Monsel's solution is very similar in its action to 
 the chloride of iron. It is easy of application and rapid in action, 
 hence it holds a high place in popular esteem. Yet caution is needed in 
 employing it. In the application of Monsel's solution to a bleeding 
 point, it is important that the smallest quantity possible should be intro- 
 duced into the wound. It is best that a small pledget of lint or cotton 
 be introduced directly into the bleeding spot and retained in position for 
 some time. When a large quantity of the solution is poured into a bleed- 
 ing wound it is likely to form a hard, disagreeable crust or coating of 
 coagulated blood over the entire surface, and bleeding may go on con- 
 cealed by this mass for a long time. In obstinate HEMORRHAGE FROM THE 
 UTERUS, where other measures have failed, the vagina maybe tamponed 
 with pieces of lint saturated with the Monsel's solution (using the precau- 
 tion described in speaking of chloride of iron) or a sponge may be 
 saturated and held in contact with the bleeding point. Cotton in which 
 the dry Monsel's salt has been thoroughly incorporated may be substi- 
 tuted for the solution. 
 
 Diseases of the Skin. In dermatology the use of Monsel's solution, 
 except occasionally in the treatment of INDOLENT ULCERS, is as an appli- 
 cation in ONYCHIA. The following formula, suggested by Bulkley, is 
 useful in ONYCHIA and PARONYCHIA: R. Liq. ferri subsulphatis, fgj; 
 ung. aquae rosse, 3j. M. 
 
 Diseases of the Nose, Throat, etc. In arresting bleeding from 
 the tonsil instances have been known of the hard clots disengaging them- 
 selves from the side of the throat and falling into the larynx, causing fatal 
 asphyxia. (Gross's "System of Surgery," n, 551.) Hencejthe powder 
 should be used with discrimination and no more employed than is abso- 
 lutely required to control the bleeding points. 
 
 Four grains of the salt to the ounce of water has been employed as a 
 nasal wash in CHRONIC CATARRH. One part to three have been used to 
 form a powder to be used in CHRONIC PHARYNGITIS. This powder is re- 
 commended by M. Mackenzie as an insufflation in CANCER OF THE 
 (ESOPHAGUS. Under .its influence the growth is powerfully constringed 
 and the lumen of the oesophagus temporarily widened thus directly as- 
 sisting the physician in introducing food into the stomach. Sixty grains
 
 FERRI SULPHAS. 237 
 
 to the ounce have been employed in HEMORRHAGE FROM THE VOCAL 
 CORDS. 
 
 The properties of the subsulphate of iron are available in the form of 
 the liquid ferri subsulphatis (Monsel's solution). Powerful astringent or 
 styptic effects in the larynx are perhaps more easily controlled by the 
 powder than the liquicj though much must be left to the judgment of 
 the physician. 
 
 FERRI SULPHAS. Sulphate of Iron. Green Vitriol. Copperas. 
 
 " Large, pale, bluish-green, monoclinic prisms, efflorescent and absorbing oxygen on 
 exposure to the air, without odor, having a saline, styptic taste and an acid reaction. 
 Soluble in one and eight-tenths parts of water at 15 C. ($9 F.) and in three-tenths parts 
 of boiling water; insoluble in alcohol. It fuses when quickly heated. When slowly 
 heated 10-115 C. (239 F.) it falls to powder and loses thirty-eight and eighty-six hun- 
 dredths per cent, of its weight." (U. S. P.) Copperas is impure or commercial sul- 
 phate of iron. 
 
 Sulphate of iron is astringent. It is irritating and should be used with 
 caution on mucous surfaces. 
 
 General Surgery. The impure sulphate of iron is an important dis- 
 infectant, although, according to recent experiments, it is not germicidal. 
 To obtain the most prompt action, the iron should be used in solution 
 or dusted in fine powder. 
 
 In the treatment of RECTAL HEMORRHAGE, where the parts are inflamed, 
 an injection composed of two grains of sulphate of iron to the ounce 
 of water, used daily, will be found of service. Moullin advises an 
 ointment of the sulphate of iron, half drachm to one ounce, alone or 
 combined with the ointment of hyoscyamus or opium. An injection of 
 the sulphate (two grains to the fluidounce) may be used daily for a week 
 or more in treating PROLAPSE OF THE RECTUM. In ERYSIPELAS, Velpeau 
 employed the sulphate of iron (an ounce to a pint of water) as an external 
 application, in forty cases. In every case the active symptoms were 
 controlled in from twenty-four to forty-eight hours. It must not be 
 forgotten that the eruption in one spot is usually limited to four days, 
 and that curative topical agents are lauded from a lack of knowledge 
 of the natural history of the affection. With regard to applications 
 in erysipelas, it is a good rule, as pointed out by Reynolds, to avoid 
 anything which shall expose the skin to varying temperatures, or which 
 shall interrupt its functions. 
 
 Sulphate of iron has long been used in the treatment of CHANCRES and 
 other VENEREAL SORES, by dusting them" with finely-powdered salt, and 
 then enveloping them in linen. This is a favorite treatment with sailors. 
 The healing process progresses rapidly.
 
 238 LOCAL THERAPEUTICS. 
 
 Diseases of the Ear, Nose, and Throat. In the form of an 
 ointment, in the strength of twenty grains to the ounce, this agent is valu- 
 able in the last stage of ERYSIPELAS of the auricle. A weaker preparation 
 viz. , two grains to the ounce is used by Sexton in CHRONIC ECZEMA 
 of the auricle. In the proportion of one part to twenty, sulphate of iron 
 may be used as a powder in the treatment of CHRONIC CORYZA and 
 OZ^ENA. In the strength of one-eighth of a grain to two grains to 
 the ounce it is used as a spray to the larynx in CHRONIC LARYNGITIS 
 accompanied by hypersecretion. Much more powerful solutions are 
 named as, for example, a half drachm to a drachm to the ounce but 
 their effects should be carefully observed, and no indications are available 
 for such uses. 
 
 FLUORESCEIN. Resorcin-phtalein. 
 
 Fluorescein is one of the numerous coal-tar compounds. It is prepared by heating to 
 200 C. for a few minutes, equal weights of resorcin and phthalic anhydride, and adding 
 the product to water. The resulting solution has an intense yellowish-green fluorescence. 
 Fluorescein occurs in dark brown crystals, which forms with ammonia a red solution 
 with a green fluorescence. It is not very soluble in water or alcohol. 
 
 Diseases of the Eye. The use of fluorescein has recently been intro- 
 duced as a guide to the application of the actual cautery in SLOUGHING 
 KERATITIS. It marks out the precise area requiring cauterization, by 
 giving a greenish tint to the portions of the cornea deprived of epithe- 
 lium. " The finest divisions radiating from the ulcer into the clear cornea 
 are by means of fluorescein exhibited to the naked eye with a distinctness 
 formerly to be attained only by means of a lens or corneal microscope. 
 Thus the lateral spreading, and also the depth of the ulcer, are clearly 
 shown, the green tint of the floor of the ulcer standing out sharply against 
 the yellow pus on the posterior layers of the corn'ea and in the anterior 
 chamber." {Oph. Review, August, 1891, p. 240.) 
 
 Two per cent, of fluorescein can be dissolved in a three and a half per 
 cent, solution of carbonate of soda. 
 
 FRAXINUS. Ash. 
 
 Many species of Fraxinus have been used. Fraxinus excelsior and Fraxinus 
 americana, which are respectively the systemic names for the European and the Ameri- 
 can ash, are the principal medicinal forms. The bitter principle, " fraxin " or " paviin," 
 has been extracted from the European varieties. The leaves have been used as antidote 
 to snake bite. 
 
 An unofficial ointment of fraxinus is recommended by Michel (Co- 
 logne) as an embrocation to the ULCERS left after cautery treatment of 
 the pharynx.
 
 FUCHSIN GALANGAL GELATINA. 
 
 239 
 
 FUCHSIN. Fuchsine. 
 
 "Fuchsin is one of the older coal-tar products, having a complex base. It occurs in 
 the form of large crystals of greenish lustre, which dissolve in water, with a carmine-red 
 color." (U. S. D.) Commercial fuchsin, according to Elliot (Jour. Cutaneous and 
 Gen. Urin. Dis., July, 1892), contains arsenic. The article used for local medication 
 must be chemically pure. 
 
 Diseases of the Skin. Elliot (/. ^.) recommends fuchsin in the 
 form of an ointment (grains, five to the ounce) for FACET'S DISEASE OF 
 THE NIPPLE. 
 
 Diseases of the Throat, etc. A saturated solution of fuchsin, in 
 combination with a i-iooo solution of corrosive sublimate, is recom- 
 mended by K. Bogroff (Vratch, April 18, 1891) as a local application in 
 MYCOSIS OF THE TONSIL. A two per cent, solution is employed as a 
 spray in PHARYNGITIS associated with phthisis. 
 
 GALANGAL. China root. India Root. Galanga. 
 There are two varieties described '' galanga major " and " galanga minor." The 
 first is derived from Mamnta galanga, the second from Alpinia officinarum. Each 
 contains a volatile oil and a resin, both of which are soluble in alcohol. The drug, 
 however, is usually employed either in substance or in infusion. 
 
 Diseases of the Nose. Galanga is a stimulant. It is used to ex- 
 cite sluggish states of the circulation and to encourage secretion of 
 mucous glands. In the treatment of NASAL ATROPHIC CATARRH and 
 PHARYNGITIS SICCA it enters into the composition of a powder in the 
 proportion of equal parts of the powdered root and acacia or of starch. 
 
 GELATINA. Gelatin. 
 
 Gelatin is extracted from various animal substances by treating them with boiling water 
 and then straining and evaporating the solution. The common forms of gelatin consti- 
 tute glue, and the more carefully prepared, from better selected material, the various 
 forms of medicinal gelatin. It is soluble in hot water, with which it forms the familiar 
 jelly on cooling; it is also soluble in hot glycerin. It is insoluble in cold water and in 
 alcohol. 
 
 All substances containing tannic acid are contraindicated in prescribing gelatin. 
 
 Gelatin is employed in making the ordinary court plaster by brushing a solution of one 
 part of gelatin, in twelve parts of water, over thin silk stretched on a frame, one side of 
 which has been previously treated with an alcoholic solution of benzoin to make it water- 
 proof. Glycerin is often added to the gelatin to prevent cracking. 
 
 General Surgery. Gelatin capsules, which may be obtained of 
 almost any size, may be used as a satisfactory substitute for cacao- 
 butter in suppositories, either for rectal or vaginal medication. To hasten 
 the effect, the medicated solution may be placed in the aqueous solution or 
 suspended in starch-water and then immediately introduced.
 
 240 LOCAL THERAPEUTICS. 
 
 In making fixed dressings for surgical purposes, gelatin is employed in 
 the same manner in which starch is. The addition of chalk to gelatin 
 gives more solidity to the dressing, but on the whole it is inferior to 
 plaster of Paris. 
 
 Diseases of the Skin. Gelatin is employed in the treatment of 
 skin diseases in baths (one pound dissolved in three quarts of boiling 
 water to thirty gallons of water) or combined with glycerin as a jelly. 
 
 Glycerin jelly is made by boiling together one part of gelatin and 
 three or four parts of glycerin until they form a translucent mass. Of 
 this as much as may be called for is taken and dissolved by steaming. 
 The medicinal ingredient, having in the meantime been finely rubbed up 
 when requisite, with water or glycerin, is then added to the liquefied 
 jelly and the resulting compound well shaken until it becomes a tenacious 
 fluid, which may be moulded into tablets or poured into a vessel, the 
 former mode of preparation being suitable for the soft and the latter for 
 the hard jellies. 
 
 The jellies can be melted at a low temperature and painted on the skin 
 with a brush. They form smooth, comfortable dressings, and may be 
 found useful when ointments cannot be conveniently applied. 
 
 They are much employed by some dermatologists. We find them 
 inconvenient of application excepting in a hospital, where all the neces- 
 sary water-baths etc., can be easily obtained. 
 
 The exact proportions of the ingredients of the soft glycerinated jellies 
 are five per cent, gelatin, 20 to 30 per cent, glycerin and 60 to 70 per 
 cent, water. To these are added the medicinal agent in the proportions 
 required, usually five to ten per cent. 
 
 The hard jellies contain ten per cent, gelatin, 40 to 80 per cent. 
 glycerin, and 25 to 40 per cent, water. They are used by dropping a 
 little boiling water on the surface of the cake of jelly and using a camel's- 
 hair pencil to take up the rapidly drying solution and paint it on the 
 affected parts. 
 
 Diseases of the Nose. Gelatin is useful as a medium for carrying 
 iodoform to the interior of the upper portion of the nasal chamber. For 
 this purpose the preparation should be freshly made, and mixed in any 
 desired quantity. Old preparations of gelatin are apt to become stiff 
 and do not easily dissolve. 
 
 Gelatin forms the basis of NASAL BOUGIES. When combined with an 
 equal quantity of glycerin and water, it is known as " gelato-glycerole." 
 It can be medicated or made to assume, by the aid of moulds, a variety 
 of forms. This agent can be carried to any part of the nose ; it is of 
 special value when retained in the space between the middle turbinated 
 bone and the septum. It here slowly dissolves. 
 
 Menthol forms an efficient compound with gelatin for NASAL BOUGIES
 
 GELSEMIUM GERANIUM. 241 
 
 (Rosenberg, Berliner klin. Wochenschrift, 1885, No. 48). It relieves 
 nasal reflex neuroses. 
 
 S. Spicer (Brit. Med. Jour., September 13, 1890) applies glyco-gelatin 
 cylinders to hollow oval vulcanite plugs ; they can be variously medi- 
 cated. 
 
 GELSEMIUM. Gelsemium. Yellow Jasmine. 
 
 "The rhizome and rootlets of Gelsemium sempervirens ." (U. S. P.) A fluid extract 
 (one cubic centimetre of which represents one gramme of gelsemium) and a tincture 
 (one hundred parts of which represents fifteen parts of gelsemium) are official. 
 
 Diseases of the Eye. Gelsemium has been recommended for use 
 in ophthalmic therapeutics as a MYDRIATIC. Tweedy {Lancet, 1877, vol. 
 I, p. 852) found that a solution of four grains of the hydrochloride to 
 the ounce would produce maximum dilatation of the pupil in from fifty 
 to seventy minutes, but that to ensure complete " paralysis of the accom- 
 modation within three hours, a solution of at least eight grains to the 
 ounce must be used every fifteen minutes for the first hour, and every 
 half hour afterward." He claims for it an advantage in refractive work 
 in the fact that sufficient accommodation to enable the patient to read 
 returns in from ten to fifteen hours, and that in thirty hours it is practi- 
 cally restored, although the pupil remains dilated for several days ; but 
 the time demanded by the slowness of its action is sufficient objection to 
 its use in practice, and, as Wood suggests, such frequently repeated 
 applications of a strong solution may not be without danger of poisoning 
 by absorption. The introduction of homatropin has, at any rate, set 
 aside any claims that it might have had. 
 
 In a number of cases, in which the external muscles were tested before 
 and after its use, gelsemium was found to have had a depressing effect 
 upon the external rectus. In one case recorded, this muscle, as tested by 
 prisms, had lost half its power. 
 
 GERANIUM.* Geranium. Cranesbill. 
 
 " The rhizome of Geranium maculatum." (U. S. P.) A fluid extract (one cubic 
 centimetre of which represents one gramme of geranium) is the only official prepara- 
 tion. The drug deteriorates on keeping, and is best when collected in April. 
 
 f 
 
 Geranium is astringent. 
 
 General Surgery. A decoction is made by boiling an ounce of the 
 
 drug to the pint of water, thus forming an astringent lotion, which is 
 
 i 
 
 * Not to be confounded with rose geranium (Pelargonium roseutri). Essence of rose 
 geranium is one of the numerous agents which have been proposed to cover the odor of 
 iodoform. Five minims of the essence may be added to each drachm of iodoform. 
 16
 
 242 LOCAL THERAPEUTICS. 
 
 employed as a wash in LEUCORRHCEA. Its use is for the most part con- 
 fined to domestic medicine. 
 
 Diseases of the Nose, etc. T. F. Rumboldt (St. Louis Med. 
 Archives, 1873) finds the fluid extract of geranium, in the strength of 
 one drachm to eight ounces of water, a valuable astringent in acute cases 
 of NASO-PHARYNGEAL CATARRH, accompanied with excessive secretion. 
 Whenever a mild impression is indicated, this drug will answer a useful 
 purpose. 
 
 GLYCERINUM. Glycerin. 
 
 " A liquid obtained by the decomposition of fats or fixed oils and containing not less 
 than ninety-five per cent, of absolute glycerin. A clear, colorless liquid, of syrupy con- 
 sistence, oily to the touch, hygroscopic, without odor, very sweet and slightly warm to 
 the taste, and neutral in reaction. It is soluble in all proportions in water and in alcohol, 
 also in a mixture of three parts of alcohol and one part of ether, but insoluble in ether, 
 chloroform, benzol, or fixed oils. Its specific gravity should not be less than 1.250." 
 (U. S. P.) " It dissolves bromine, iodine, the iodide of sulphur, the chlorides of potassium 
 and sodium, the fixed alkalies, and some of the alkaline earths, and a large number of 
 neutral salts" (U. S. D.), as well as pepsin and the vegetable acids, creasote, carbolic 
 acid, quinine, tannic acid, morphine, and nearly all substances which are in themselves 
 soluble in water. 
 
 Glycerin is used in order to increase the specific gravity of fluids which are exceedingly 
 diffused, such as tincture chloride of iron, etc. It is often mixed with carbolic acid, equal 
 parts, and from this fifty per cent, mixture the various solutions of carbolic acid are made 
 for disinfecting instruments, etc., the glycerin rendering the acid more readily dissolved 
 in water than would otherwise be the case. 
 
 Glycerin is bland and unirritating as a rule, but in some subjects the drug will produce 
 severe smarting, either of the skin or mucous membrane. When diluted, one to five, 
 this objection no longer obtains. It must be remembered that the preparations of the 
 shops may contain glucose, alkalies, lime, chlorine, etc. 
 
 The sweet taste of glyce/in is conveniently covered by water or lemon juice. 
 
 Glycero-gelatin contains ten per cent, of gelatin, and solidifies on cooling. 
 
 Glycerin is protectant, antiseptic, and relieves cedematous congestion 
 by abstracting moisture from the tissues. 
 
 General Surgery. Glycerin is valuable as a preventive against 
 BED-SORES. The part exposed to pressure should be washed twice daily 
 with tepid water, carefully dried with a soft towel, and gently rubbed 
 over with glycerin, or, if the skin be broken, glycerin-cream. A draw 
 sheet made of linen, of sufficient width to admit of firmly tucking it 
 into both sides of the bed, prevents the formation of folds or creases. 
 It is important that this treatment should begin before the onset of red- 
 ness or tenderness. In the treatment of COLD ABSCESS injections of iodo- 
 form and glycerin (i-io) after the manner of Billroth are satisfactory. 
 After the cavity is evacuated the fluid is thrown through the cannula of 
 the aspirator. The application is to be repeated as long as iodoform is
 
 GLYCERINUM. 243 
 
 found in the urine. (See lodoform?) In contused and lacerated WOUNDS 
 OF THE FACE, where a water dressing is employed and kept in contact 
 by wet pieces of lint or linen, the addition of a drachm of glycerin to the 
 ounce will assist in keeping the cloths moist. The agent is often em- 
 ployed in urethral injections in the treatment of GONORRHOEA. Ordinarily, 
 it is medicated with subnitrate of bismuth or opium. Thus, ext. opii, 
 9ij > glycerini, f^j ; aquae rosse, giij. (Bumstead.) 
 
 Glycerin is employed in the manufacture of medicated pessaries and 
 bougies used in the treatment of GLEET. In obstinate CONSTIPATION, 
 glycerin added to warm soapsuds will often excite peristaltic action in 
 the lower bowel when pure water will be ineffective. The employment 
 of a glycerin suppository made with soap, is also commended. The 
 suppository soon dissolves, leaving glycerin free in the rectum. A similar 
 effect can be obtained by placing the agent in a capsule and inserting 
 in the bowel. Glycerin may be injected, diluted with oil or water, equal 
 parts, high up the rectum, by first gently inserting a soft catheter, eight 
 to ten inches into the bowel, and attaching a small syringe. This is a, 
 successful means of dealing with the constipation following enteritis. 
 
 The use of the drug as a means of depletion was introduced into gynae- 
 cology by J. Marion Sims. A small tampon of cotton is saturated with 
 glycerin and inserted in the vagina ; a free watery discharge ensues, 
 thereby relieving capillary engorgement and cedema. " An anaemic 
 patient will gain strength from the constant presence of glycerin in the 
 vagina, although the discharge excited by it may be greater than the 
 previously existing leucorrhcea, and the fact can only be explained on 
 the supposition that the glycerin arrests the escape of the more essential 
 constituents of the blood. It has also the same power as hot water, 
 although in a less degree, of exciting capillary contraction, for any 
 surface which has been long in contact with the glycerin will be 
 found shriveled and blanched in appearance." (Emmet.) In cases of 
 EROSION OF THE* CERVIX or of ENDOMETRITIS, whether cervical or gen- 
 eral, especially when connected with a condition of congestion or of 
 subinvolution of the uterus, and in the tenderness due to congestion 
 of the Fallopian tubes, ovaries, or broad ligaments, glycerin gives marked 
 relief. The drug should always be of the best quality. The impure 
 article used in the arts frequently causes a vaginitis as severe as that 
 produced by gonorrhoea. To make the application a tampon of cotton, 
 or, as Emmet prefers, of oakum, to which a string is attached, should be 
 saturated with the agent and placed in the vagina against the cervix. The 
 patient should be told to remove it in five or six hours when it becomes 
 dry and irritating. As it is desirable that the woman should remain quiet 
 during the depletion of the uterus and pelvic vessels, it is well to make 
 the application in the evening, and to have the tampon removed in the
 
 244 LOCAL THERAPEUTICS. 
 
 morning. Glycerin and iodine are in common use in gynaecology, and 
 are applicable in many phases of uterine disease. 
 
 Glycerin is a useful ingredient in lotions or ointments for the relief 
 of PRURITUS ANI and ULCERATION OF THE RECTUM. It can be admin- 
 istered in various strengths. 
 
 Diseases of the Skin. Glycerin is employed for softening crusts 
 and masses of epithelial debris preparatory to local medical treatment of 
 the underlying lesiors, and also to give "body " to certain washes and 
 lotions. 
 
 It should be mixed usually with a little water, especially when employed 
 as a protective against CHAPPED HANDS or in fissures of the skin, as pure 
 glycerin is at times irritating. Glycerin is sometimes employed as an 
 emollient in BATHS, half a pint to a pint being added to thirty gallons 
 of water. 
 
 Glycerin also enters into the composition of certain excellent toilet 
 soaps, and combined with gelatin forms the basis of a number of appli- 
 cations. (See Gelatin?) 
 
 A glycerin ointment is made as follows: R. spermaceti, ss; cerae 
 albce, 3J ; olei amygdalae, f|ij; glycerini, fgj. Melt the spermaceti and 
 wax with the oil of almonds at a moderate heat ; pour into a Wedgewood 
 mortar and rub together until cold. This ointment is employed in 
 DERMATITIS FROM COLD, CHAPPED HANDS, etc. 
 
 Diseases of the Ear, Nose, and Throat. Glycerin is chiefly 
 employed in lotions, mouth-washes, etc., to increase specific gravity, to 
 favor exosmosis, and to diminish the irritable effects of certain drugs. It 
 aids in retaining medicine in contact with the mucous membrane of the 
 nose and throat for a longer time than when employed in a simple aque- 
 ous solution. 
 
 A preparation consisting of borax, gr. xl ; glycerin, fgjj water, f^iv, 
 will cure FISSURE OF THE TONGUE which has resisted other means of 
 treatment. It may be employed in the strength of one part glycerin to 
 four of water, with the addition of a little lemon juice, to relieve the 
 glazed tongue in low types of disease ; the mouth may be constantly 
 swabbed out with it, adding greatly to the comfort of the patient. Gly- 
 cerin will often cure THRUSH. 
 
 Its disposition to abstract moisture from the tissues renders it a valuable 
 adjuvant in the treatment of NASAL HYPERTROPHIES if for any reason 
 reduction by cauterization be undesired. A tampon soaked in a solution 
 of glycerin, one part to four of water, is here of efficacy. The pro- 
 portion of glycerin may be increased until it stands in equal amount with 
 water. (C. F. McGahan, Med. Times and Register, November 9, 1889.) 
 Glycerin softens collections of CERUMEN in the external auditory meatus. 
 A few drops instilled before retiring renders the manipulation of extraction
 
 GLYCERINUM. 245 
 
 of the mass the following day a matter of easy performance. It is also of 
 use in PRURITUS and NEURALGIA of the outer ear passage. It has been 
 used pure in CHRONIC NASAL CATARRH. 
 
 Rauchfuss recommends it as a topical application in CHRONIC LARYN- 
 GITIS OF CHILDREN. In the proportion of one part to eight it is often 
 used in gargles and lotions. Preparations which contain glycerin should 
 be slightly warmed before being used in atomizer or inhaler, since the 
 diminished density of the glycerin under moderate heat increases the 
 ease with which the mass can be distributed. 
 
 A solution of glycerin in water, in the proportion of thirty-three per 
 cent., is found a convenient one to use in many inhalants. Diluted 
 glycerin slowly swallowed relieves the painful deglutition of CHRONIC 
 LARYNGITIS. 
 
 Diseases of the Eye. Glycerin is considerably used in ophthalmic 
 surgery as an excipient, particularly in glycerole of tannin (q. z/.) ; it also 
 enters into the composition of boroglyceride (q. #.). These preparations 
 are valuable applications in GRANULAR OPHTHALMIA and other forms of 
 palpebral CONJUNCTIVITIS, and the hygroscopic action of the glycerin adds 
 much to their efficiency, especially where the palpebral conjunctiva is 
 osdematous. This same property unfits it for use, unless freely diluted 
 in collyria, for acute general conjunctivitis. 
 
 GLYCERITES. 
 
 The Glycerite of Starch, Glyceritum Amyli (U. S. P.), is made by first rubbing and 
 then heating together (below 144 C. 291 F.) one part of starch and nine parts of 
 glycerin. It is an elegant vehicle for the application either of the contained glycerin 
 or for the exhibition of other substances. 
 
 Glyceritum vitelli (glycerite of yolk of egg) is also official, and is made by rubbing 
 together forty-five parts of the yolk of egg and fifty-five parts of glycerin. This 
 is also known as " glyconin." In the British Pharmacopoeia, glycerinum acidi carbolici, 
 glycerinum acidi gallici, glycerinum acidi tannici, glycerinum boracis, are official, and are 
 all made of the strength of one ounce by weight of the medicaments to four fluidounces 
 of glycerin, and two fluidounces of water. Glycerinum aluminis (one ounce of alum 
 and five fluidounces of glycerin), glycerinum plumbi subacetatis (a solution of subacetate 
 of lead in glycerin, being of about the strength of the official liquor plumbi subacetatis 
 (Goulard's Extract), and glycerinum tragacanthse (one hundred and ten grains of traga- 
 canth in a fluid ounce of glycerin) are also official in the Br. Ph. 
 
 / 
 
 Glycerite of yolk of egg applied to the skin, forms a varnish which 
 
 effectually prevents the action of air. It is unalterable. This prepara- 
 tion has never been much used, but is likely to prove an agreeable substi- 
 tute for greasy protective applications in ERYSIPELAS, FISSURED NIP- 
 PLES, etc. (See Ovum.} 
 
 General Surgery. Glycerite of carbolic acid is a convenient prepa- 
 ration from which carbolized solutions can be made.
 
 246 LOCAL THERAPEUTICS. 
 
 At one time at the Pennsylvania Hospital an attempt was made to sub- 
 stitute glycerite of starch, to which a small proportion of bichloride of 
 mercury had been added, for zinc and boric ointment in the treatment 
 of SUPERFICIAL ABRASIONS and ULCERATIONS, with the hope that wounds 
 could be more readily washed and cleaned. The dressing did not prove 
 as satisfactory as had been hoped for. Glycerite of starch may be em- 
 ployed with advantage where a moist or wet dressing or a light poultice 
 might be advisable, as in SUPERFICIAL BURNS or ERYSIPELATOUS INFLAM- 
 MATIONS. 
 
 Diseases of the Skin. Glycerite of Starch (sometimes called 
 " plasma ") is a valuable emollient in some cases of ACUTE ECZEMA, espe- 
 cially ECZEMA of the SCALP and EARS, and offers an admirable preliminary 
 treatment in these cases. 
 
 The glycerite of starch is a good substitute for lard or cosmoline as a 
 base for ointments. It does not easily become spoiled and keeps for a 
 long time. It has been recommended to prevent pitting in VARIOLA. 
 The glycerite of carbolic acid is a useful application in TINEA TONSURANS. 
 
 The glycerite of tannin may sometimes be employed when an astrin- 
 gent application is required. 
 
 Recently H. von Hebra has brought forward a class of preparations 
 which he calls " Saponated glycerin preparations." They will be found 
 described under soaps. 
 
 French dermatologists combine one part of tartaric acid with twenty 
 parts of the foregoing to form " glycerole tartarique," a soothing appli- 
 cation in ECZEMA. 
 
 GLYCYRRHIZA. Liquorice Root. Licorice. 
 
 "The root of Glycyrrhiza glabra." (U. S. P.) Liquorice root contains a large pro- 
 portion of a substance called Glycyrrhizin, which is very sparingly soluble in cold water 
 and- very freely soluble in boiling water, with which it forms a jelly as it cools. To this 
 substance liquorice root owes its taste and flavoring properties. 
 
 Ammoniated Glycyrrhizin (official in the United States Pharmacopoeia) is glycyrrhizin 
 separated from liquorice root and combined with ammonia, and is in " dark brown or 
 reddish- brown scales, inodorous, of a very sweet taste, and soluble in water and in alco- 
 hol." (U. S. P.) 
 
 Glycyrrhiza is often employed to dilute astringents when desired to use these agents in 
 the form of powder. 
 
 It enters into the composition of a favorite lozenge in the proportion of from one to 
 four grains of the extract to each mass.
 
 GOSSYPIUM. 247 
 
 GOSSYPIUM. Cotton. 
 
 Cotton is "the hair of the seed" of Gossypium herbaceum "and of other species of 
 Gossypiiim." (U. S. P.) The cotton contemplated by the United States Pharmacopoeia 
 is " absorbent cotton " or cotton freed from the oil and other impurities ; it is usually 
 prepared by boiling with a solution of an alkaline soap, washing this out thoroughly, 
 possibly washing again with a weak solution of caustic potash or soda, washing this out, 
 pressing, and drying. When dried absorbent cotton is thrown upon water it should 
 immediately absorb the latter and sink. From the seeds of the cotton plant a fixed oil 
 is expressed, which is much employed for soap making and as an adulteration of and a 
 substitute for olive oil. The oil also is official and enters into the composition of the 
 ammonia, lime, camphor, and subacetate of lead liniments. 
 
 Cotton-seed oil is largely used, among other oils, as an adulterant to linseed oil. It is 
 less innocent than any other agent so introduced, since it has a bad effect upon the skin. 
 
 Styptic cotfon-may be prepared by first passing the cotton through in a 
 four per cent, solution of soda ; then washing, drying, and subsequently 
 dipping two or three times in a weak solution of the chloride of iron 
 and again drying. It is then teased out with the fingers, leaving a brown, 
 cottony mass, thoroughly impregnated with the salt of iron. 
 
 Under Gossypium will be treated the subjects : Raw Cotton ; Absorb- 
 ent Cotton ; Gauze ; and Paper. 
 
 RAW COTTON. 
 
 General Surgery. Raw cotton is so familiar that description is 
 unnecessary. Owing to the oil it contains, it will not absorb water, and 
 consequently is practically useless for washing or cleansing wounds. It 
 is employed chiefly as a padding for splints, and for protecting the ex- 
 tremities and cutaneous surfaces from contact with the air. Raw cotton, 
 laid over the chest in layers two inches thick, forms a good chest dress- 
 ing in PNEUMONIA. In the local treatment of ERYSIPELAS, one of the 
 best methods is to keep the part wrapped in raw cotton ; for the tem- 
 perature of the part should be as nearly uniform as possible, and the 
 cutaneous functions assisted. Painful and sensitive RHEUMATIC JOINTS 
 in old people are often relieved by being wrapped in raw cotton, which 
 is retained by means of a bandage. Cotton is often employed as a pro- 
 tective dressing for BURNS with advantage, if the burn is of the first or 
 second degree ; but it may irritate if in contact with a vesicated surface. 
 Yet it at times forms one of the best dressings for BLISTERED 'SURFACES, 
 laid evenly over the part and retained by the clothing or a bandage. 
 
 ABSORBENT COTTON. 
 
 General Surgery. Absorbent cotton is now employed extensively 
 in the washing and cleansing of wounds in the place of sponges. Small 
 pledgets on an aluminium applicator are in use in gynaecology for carry-
 
 248 LOCAL THERAPEUTICS. 
 
 ing medicated applications within the uterine cavity. Washed cotton is 
 always to be preferred where an aqueous solution is directed or for the 
 absorption of bloody or serous discharges. It is inferior to raw cotton for 
 the padding of splints, or for use as a protectant. 
 
 Absorbent cotton has been medicated in a variety of ways. Cotton 
 prepared with corrosive sublimate is probably the most used, and forms 
 an important factor in the antiseptic dressing of wounds. Borated, 
 salicylated and iodoformized cotton may be substituted, according to the 
 wishes of the surgeon. Styptic cotton is of service rolled into a small 
 pledget and laid directly over a bleeding point, or a thin layer may be 
 placed on the surface to aid the formation of a clot. It may be of service, 
 also, in cases of bleeding from small wounds of the venous sinuses in 
 operations on the brain. All medicated cottons, it is assumed, are free 
 from septic material, and are always to be preferred for the making of 
 tampons or the plugging of wounds. Laid over the gauze and retained by 
 bandages, they constitute antiseptic dressings. 
 
 Diseases of the Ear and Nose. The advantage formerly sup- 
 posed to accrue from ARTIFICIAL EAR DRUMS can now be obtained by 
 pledgets of cotton or a circular piece of lint adapted to the orifice. It 
 would appear that this advantage is not to imitate a portion of the 
 tympanic membrane, but to serve as a protectant to the mucous lining of 
 the middle ear. Absorbent cotton in some forms of auditory discharge 
 (especially those that occur in very young children) becomes clogged 
 by tenacious muco-pus and acts as plugs to the meatus. It may, there- 
 fore, serve in a manner directly opposite that which is expected. When 
 such disposition is noted it is necessary to anoint the conch with lard or 
 cosmoline before using the cotton, or, what perhaps is better, discard it 
 and substitute lamb's wool. Soft cotton thread can be medicated for 
 application to the middle ear. Kirchner denominates " sublimate cord " 
 a thread of cotton rendered absorbent and saturated in corrosive subli- 
 mate solution (q. #.). Hopmann, of Cologne (Berlin Klin. Woch., No. 
 42, 1888), uses cotton tampons for the treatment of NASAL POLYPUS. 
 Cotton tampons may be used conveniently in the nostril in the shape of 
 absorbent lamp-wick. To be used in the nose they can be soaked in 
 solutions of bichloride of mercury, 1-3000 or 1-5000. 
 
 Diseases of the Eye. Absorbent cotton is very extensively used 
 in ophthalmic surgery, and, in the interest of economy and cleanliness, 
 has almost banished sponges and brushes. A little pledget twisted on 
 the end of a probe or cotton holder or small stick answers all the purposes 
 of a brush and can be thrown away when it has been once used. Cotton 
 is also universally used for eye compresses and for the application of hot 
 stupes. 
 
 It is a convenient means of applying dry heat in ophthalmic practice.
 
 GOSSYPIUM. 249 
 
 A mass as large as the fist, or even larger, heated by a stove or lamp or 
 vessel of boiling water (frequently changed) can be used for the purpose. 
 
 On the whole, this form of applying dry heat is preferable to any other, 
 and is of especial value in the relief of pain in INFLAMMATORY or NEURAL- 
 GIC AFFECTIONS OF THE EYE and for the preservation of vitality in flaps 
 that threaten to slough after plastic operations on the lids. For the 
 former purpose the application is usually intermittent, lasting twenty 
 minutes to a half an hour, and repeated several times a day ; for the 
 latter, it should be continuous, even during the night. 
 
 "Hot stupes" or "fomentations" are generally applied by means 
 of small pads of cotton saturated with hot water and renewed every 
 two or three minutes or oftener. The temperature of the water must 
 be kept up either by gas or alcoholic flame or by the occasional addi- 
 tion of boiling water, and its degree may be generally determined by 
 the sensations of the patient and should be as high as he can bear it 
 without discomfort. The attendant should be cautioned not to blister 
 the skin of the lids, as the patient may consider it necessary to bear the 
 pain of the application, or his sensations may be blunted to it by the 
 greater pain of the disease. Water at a temperature of 120 F. is usually 
 easily borne, and some surgeons use it as high as 140. The susceptibility 
 of different individuals varies greatly, and tolerance is much increased by 
 use. 
 
 Absorbent cotton is especially valuable for applying moist heat in 
 ACUTE INFLAMMATION OF THE EYELIDS, with conjunctival discharge." 
 The great advantage of the use of cotton is that the moment the mass of 
 material is soaked with the infectious discharge it can be thrown away; 
 hence the chances of infection are largely diminished. 
 
 In IRITIS hot stupes relieve pain, particularly in the rheumatic form, 
 and promote absorption of inflammatory exudations. They may be used 
 for twenty minutes or half an hour three or four times a day, or oftener if 
 the relief is decided. In some cases dry heat may be more acceptable. 
 The sensations of the patient are often the best guide as to which or 
 whether either is to be used. Hot fomentations give more relief in 
 HORDEOLUM and ABSCESS OF THE EYELIDS than any other remedy, and 
 their frequent application is sometimes preferred to continuous poulticing 
 in DACRYOCYSTITIS, but their greatest value is in the treatment of/SLOUGH- 
 ING KERATITIS, in which their use may be considered indispensable. In 
 the latter instance a cotton compress is usually kept on the eye in the 
 intervals of stuping, which may be repeated every two or three hours, and 
 other remedies, such as atropine or eserine, the Ssemisch incision, or the 
 actual cautery, will, of course, be resorted to according to the judgment 
 of the surgeon. Frequent bathing with hot water allays the irritation of 
 ACUTE CONJUNCTIVITIS, and some surgeons use hot stupes instead of cold 
 applications in the severe forms of PURULENT OPHTHALMIA.
 
 250 LOCAL THERAPEUTICS. 
 
 GAUZE. 
 
 General Surgery. Gauze is usually a sheer material, known in the 
 trade as cheese cloth, or tobacco cloth. Having a very open mesh, it 
 absorbs well the materials with which it is impregnated, or the discharges 
 from a wound when applied as a dressing. It can be easily obtained, is 
 cheap, pliable, and forms a pleasant dressing when in contact with wounds. 
 It is readily impregnated with various materials to render it antiseptic. 
 Almost any variety of gauze may be obtained from dealers in surgical sup- 
 plies. The most common and generally employed is the corrosive subli- 
 mate gauze, which is prepared by soaking clean cheese cloth, freed from all 
 oily matter, in a solution of corrosive sublimate of the strength of i-iooo 
 for twenty-four hours. It is then cut into pieces the desired sizes and 
 packed in closely-covered glass jars. If gauze has been long kept and 
 exposed to the air, it is well to resoak it in a 1-2000 solution of corrosive 
 sublimate before using. Corrosive sublimate gauze, when applied in con- 
 tact with a wound and covered with wax paper or mackintosh, will some- 
 times irritate the skin. It should be anointed, therefore, with boric acid 
 ointment or vaseline. In wound-treatment with corrosive sublimate gauze, 
 two dressings are employed, the superficial and the deep, each usually 
 composed of eight layers of the gauze. Often the deep dressing is applied 
 moist and is much smaller than the superficial, which is preferably used dry. 
 
 lodoform gauze is prepared by incorporating into the meshes of steril- 
 ized gauze powdered iodoform ; it should then be carefully rolled up and 
 packed in a glass jar. A mixture (5-50 per cent.) of iodoform and 
 glycerin can be made, in which strips of gauze are immersed. This pre- 
 paration is convenient for packing bone cavities, fistulous tracts, etc. 
 
 Carbolized gauze, the variety which was first introduced by Lister as a 
 surgical dressing, is made by soaking clean gauze for a few hours in a 
 mixture composed of: Resin, i pound ; alcohol, 5 pints; castor oil, 24 
 ounces; carbolic acid, 12 ounces. 
 
 The excess is removed by passing the cloth through a clothes-wringer 
 and then packing away for future use in glass jars. 
 
 The double cyanide of mercury and zinc gauze is more difficult to pre- 
 pare than the other varieties, requiring the following : Potass, cyanide, 
 130 grains; mercuric cyanide, 251.7 grains; zinc sulph., 268.9 grains; 
 haematoxylin, 1.3 grains; sol. ammonia, 6 minims; gauze (prepared, 
 cleansed), 10 ounces ; bichloride of mercury solution, 7.6 pints; distilled 
 water, q. s. {Br. Med. Jour., Nov. 9, 1889. 
 
 In charging gauze with this substance, 100 grains of the salt are 
 dissolved in four pints of a 1-4000 bichloride solution, which will give 
 from two to three per cent, of the cyanide to the dry gauze. It should 
 be freshly prepared and used moist. The advantages claimed for it 
 are that it is unirritating to the skin, and as the antiseptic is insoluble, 
 it is not washed out by the wound discharges. Those who have employed
 
 GOSSYPIUM. 251 
 
 it claim that it possesses decided advantages over the bichloride gauze. 
 (Wharton, " Minor Surgery," p. 117.) 
 
 The best material for the collodion dressing is tarlatan.* 
 
 PAPER. 
 
 General Surgery. Paper has been introduced into surgery as a 
 substitute for lint, on account of its^ cheapness. Porous varieties resem- 
 bling blotting paper, and capable of absorbing a large amount of fluids, 
 have been manufactured ; hence, it is suitable for applying wet dress- 
 ings, as lead water and laudanum, etc. When once saturated, owing 
 to its friable character, it cannot be reapplied. Waxed paper, made 
 by immersing sheets of tissue paper in hot wax or paraffin, which, when 
 cooled, forms a thin coating which makes it impervious to water, is 
 universally employed as a substitute for oiled silk in hospital practice. 
 Owing to its cheapness it can be discarded after each application. Be- 
 cause of its extreme thinness, it is advisable to use several layers, other- 
 wise the moisture soon makes it way through. 
 
 Parchment paper has been introduced as a substitute for mackintosh in 
 the Lister antiseptic gauze dressing. When first removed from the pack- 
 age, it is soft and pliable, but on drying becomes crisp. The paper, 
 when applied over wet dressings to prevent the escape of moisture, appears 
 to fulfill all purposes for which oil silk has served. 
 
 Diseases of the Skin. Paraffin paper is employed as a dressing 
 in some forms of skin disease accompanied by crusting and exfoliation, 
 with the object in view of macerating the skin and thus loosening the pro- 
 ducts of disease. In other cases it is employed as a protectant. Paper is 
 valuable in applying ointments and moist dressings. It is superior to 
 rags and cloths. The paper is to be cut into pieces of the appropriate size, 
 spread with the selected ointment and closely applied to the surface, being 
 kept in place by a bandage. In affections of the fingers and toes, as well 
 as the limbs generally, paraffin paper is easily adapted to the inequalities 
 of the skin surfaces. The fact that it soon becomes friable and torn, is 
 an advantage, as it ensures more frequent change of dressings, and conse- 
 quent cleanliness. 
 
 Diseases of the Nose, etc. Blotting paper rolled between the 
 fingers and introduced into the nostrils is recommended by Sajous for 
 removal of secretion from nasal passages in young children. It has 
 been suggested also as a material for making tampons for arresting NASAL 
 
 * A. Hewson (" The Use of Earth in Surgery,'' p. 19) strongly recommends a silken 
 texture known in the trade as Donna Maria gauze. The strips should always be cut 
 along the woof of the material, that is to say, lengthwise, and of the width usually 
 employed with the resin or adhesive plaster.
 
 252 LOCAL THERAPEUTICS. 
 
 HEMORRHAGE. Before soaking in a solution of nitrate of potash, paper 
 should be cut in strips three inches long by half an inch broad. It is next 
 dipped in the solution in a cylindrical vessel four inches high and two 
 in diameter. The paper should then be ignited and the smoke inhaled 
 by repeated deep inhalations. Nitrated papers, according to Lefferts, 
 should be kept in tin foil or prepared in small quantities as required. 
 (See Potassii Nitras.} 
 
 GRINDELTA. 
 
 " The leaves and flowering tops of Grindelia robusta." (U. S. P.) Grindelia con- 
 tains an essential oil somewhat resembling in odor the oil of turpentine, a resin, and some 
 crystals with an alkaline reaction. The constituents of this plant have not been tho- 
 roughly investigated. The single official preparation is the fluid extract, one cubic centi- 
 metre of which is equivalent to one gramme of the drug. 
 
 Grindelia is a mild astringent and sedative. 
 
 General Surgery. The surgeon may find this drug of service as a 
 topical application in conjunction with other remedies, especially com- 
 bined with creoline in the treatment of VAGINITIS, LEUCORRHCEA, and 
 GONORRHCEA. The following mixture is recommended by Shoemaker : R. 
 Ext. grindeliae fld., half fluid ounce; creolini, two drachms; aquae, q. s., 
 ad. six fluidounces. As a urethral injection in GONORRHOEA and GLEET it 
 will be well to begin with a solution about one-half the strength. Diluted 
 with water or glycerin the fluid extract has been used with asserted 
 advantage in the treatment of CHRONIC or INDOLENT ULCER, and may be 
 applied by saturating lint and applying it as an ordinary water dressing, 
 covered with waxed paper and retained by a bandage. 
 
 Diseases of the Skin. The fluid extract is useful in the external 
 treatment of inflammatory conditions of the skin. In DERMATITIS 
 VENENATA or RHUS POISONING, in ACUTE ECZEMA, and in ERYSIPELAS, 
 it is of great value, and ranks, in our opinion, with lead water in the 
 class of cases for which the latter application is commonly employed. 
 It is to be employed in a condition of considerable dilution ; a lotion 
 of half an ounce of the fluid extract to the pint of water is that which 
 we have found generally useful. There are several preparations in the 
 market of somewhat different appearance when diluted with water. We 
 have not, however, observed any marked variation in their therapeutic 
 effect. The lotion is commonly applied on cloths and allowed to evaporate. 
 It should not be covered with an impermeable dressing. 
 
 Diseases of the Throat, etc. W. P. Gibbons gives grindelia in 
 the treatment of ASTHMA, but the impression is maintained by internal 
 administration. It is probable, however, that some of the good effects 
 described by him are due to a local action upon the nerve ends of the 
 pharyngeal and laryngeal surfaces.
 
 GUAIACI RESINA GUACO. 
 
 253 
 
 GUAIACI RESINA. Guaiac. 
 
 " The resin of the wood of Guaiacum officinale." (U. S. P.) The resin of guaiac comes 
 in irregular vitreous masses of dark olive color, and possesses an acrid taste. It is readily 
 pulverizable and yields a light, clear powder which becomes green upon exposure. It is 
 very sparingly soluble in water, soluble in alcohol, ether, and alkaline solutions; it is 
 also soluble in sulphuric acid. It consists of guaiaconic acid, guaiaretic acid, guaiac 
 beta-resin, gum, coloring matter, etc. The Tincture of Guaiac (one hundred parts con- 
 taining the activity of twenty parts of the resin), and the Ammoniated Tincture (made with 
 aromatic spirit of ammonia as menstruum) of the same strength, are official. 
 
 Diseases of the Throat. Guaiac has long had a high reputation 
 in the treatment of FOLLICULAR TONSILLITIS and QUINSY. An addition 
 of an astringent increases the efficacy of the drug, especially if it is essayed 
 in the first stage of the disease. Used as a gargle the ammoniated tincture 
 is the most palatable of the preparations. A teaspoonful of the tincture 
 may be added to a half glassful of milk and used as a gargle every two 
 or three hours. The exhibition of guaiac in the form of a lozenge has 
 been long accepted by practitioners as desirable when the grade of 
 inflammation is low. The following recipe from a Swedish formula is 
 offered as a good example of a guaiacl ozenge : Pulverized resin of guaiac 
 seven parts ; sugar, seventeen parts ; " cocoa paste," twenty-five parts. In 
 the American market each lozenge may contain one and a half to two 
 or three grains of the resin. 
 
 GUACO. 
 
 Guaco is a name given a product of various plants, obtained in Central America, South 
 America, and the West Indies, belonging to the genera Mikania and Aristolochia. 
 (U. S. D.) 
 
 Guaco is antipruritic. 
 
 Diseases of the Skin. Butte (Bull, de la Polycl. de Paris, 1890 ; 
 Monatshefte f. Prakt Dermatol., Bd. xn, p. 188) has recommended the 
 local employment of the watery extract of guaco as an antipruritic in 
 PRURITUS and ECZEMA. 
 
 Its use is contraindicated in acute moist eczema, as it is irritating in 
 this condition. The drug is also employed internally. Its effecf is due 
 to the paralyzing effect which the extract of the plant exerts upon 
 sensory nerves. The following formula is recommended : R. Guaco, 
 gr. xxx ; sodii bicarbonat., gr. v ; aquae, gr. M. Boil fora quarter of an 
 hour ; then macerate for an hour and decant. This lotion is to be 
 applied lukewarm as a wash or a compress may be wet with it. 
 
 The same drug is commended for internal uses in skin diseases, but 
 this remedy has been introduced so recently that no corroborative experi- 
 ments have been as yet published.
 
 254 LOCAL THERAPEUTICS. 
 
 GURJUN. Gurjun Balsam. Wood Oil. 
 
 Gurjun balsam is an oleoresin which exudes from excavations in Dipterocarpus turbi- 
 natus and other species of Dipterocarpus. The tree is a native of East India. 
 
 The balsam is a thick, viscid liquid, of a reddish-brown color; soluble in chloroform" 
 acetone, volatile oils, and carbon disulphide, and partly soluble in benzin, alcohol and 
 ether. In many respects it resembles copaiba, to which it is often added as an adultera- 
 tion. It contains volatile oil, gurjunic acid, a crystalline resin, and a bitter principle. 
 
 Diseases of the Skin. Gurjun oil (balsamum dipterocarpii} is em- 
 ployed externally in the treatment of LEPROSY, being applied in the form 
 of a mixture with an equal part of lime-water and thoroughly rubbed into 
 the surface of the body, especially such parts as are affected. The inunc- 
 tion should be made daily for the space of one or two hours. The external 
 application is usually accompanied by the internal administration of the 
 same drug. (Dougal, " Report on the Treatment of Leprosy with Gurjun 
 Oil," Calcutta, 1874. Quoted by Piffard.) 
 
 Gurjun oil has likewise, been recommended by Wilson in CANCER 
 (Lancet, vol. i, 1874, p. 694), in LUPUS (Lect. on Dermatology, vol. iv, 
 London, 1875, P- 68), and in infiltrated ECZEMA and PSORIASIS by R. 
 W. Taylor. It has not, however, come into general use in other diseases 
 than leprosy. 
 
 GUTTA-PERCHA. 
 
 "The concrete exudation of Isonandra gutta." (U. S. P.) " Gutta percha is plastic 
 above 60 C. (140 F.), very soft at the temperature of boiling water, insoluble in water 
 or alcohol, soluble in chloroform, oil of turpentine, disulphide of carbon, benzin, or ben- 
 zol." (U. S. D.) 
 
 LIQUOR GUTTA-PERCHA. Solution of Gutta-percha.* 
 This is a nine per cent, solution of gutta-percha in commercial chloroform. Ten per 
 cent, of carbonate of lead is shaken with the solution, and after its subsidence the clear 
 liquid is decanted. The carbonate of lead is added because it has the property of uniting 
 with and carrying to the bottom the coloring matter. On account of the volatility of the 
 chloroform and the viscidity of the solution it cannot be filtered, and the above addition 
 is an easy and practical method of clarification. 
 
 General Surgery. The solution of gutta percha in chloroform 
 (liquor gutta-perchae) is sometimes useful as a protectant, and may be 
 useful in retaining light dressings about the face. 
 
 Gutta-percha is used to a slight extent in making special splints, e. g., 
 for fracture of the inferior maxilla, and sometimes for the digits. Rub- 
 ber is prepared for use in sheets, from which pieces the desired size may 
 
 * In Germany this preparation goes by the name of " trautnaticin, v
 
 LIQUOR GUTTA-PERCHA. 255 
 
 be cut and moulded into shape by placing in hot water. When properly 
 moulded the splint should be plunged into cold water, where it immedi- 
 ately hardens and remains permanently in shape. Hard rubber is largely 
 used in the manufacture of trusses, possessing advantage over the covered 
 steel band (viz., that of cleanliness), while it can be worn in the bath. 
 
 When applied to the skin it forms a thin elastic film. It may be used 
 in SMALL CUTS, CHAPPED HANDS and NIPPLES. 
 
 Diseases of the Skin. Liquor gutta-percha has long been 
 employed in this country as a protectant to the surface of the skin in 
 slight abrasions or excoriations, and in FISSURES of the lips, nipples, tips 
 of the fingers, etc. In case of FISSURED ECZEMA a light cauterization 
 with nitrate of silver followed by the application of liquor gutta-perchse 
 often brings about a cure in a remarkably short space of time. 
 
 As a vehicle for the convenient local use of various medicaments liquor 
 gutta-perchse answers admirably, as in following formula: R. Ol. cadini, 
 3J ; liquor gutta-perchse, ad f^j. M. A camel's-hair brush is inserted in the 
 cork for convenience of application. This pigment is an admirable dress- 
 ing for some forms of ECZEMA. In INFANTILE ECZEMA RUBRUM it is 
 very useful, particularly upon the cheeks, where it forms an antipruritic 
 and impermeable dressing, which cannot be rubbed off, as ointments 
 usually are, by the movements of the infant. 
 
 Chrysarobin offers a very convenient mode of treating PSORIASIS, though 
 not so efficient as an ointment. 
 
 TINEA TONSURANS, if not too deep-seated, and especially TINEA CIR- 
 CINATA may be rapidly cured by this application. A good formula is : R. 
 Chrysarobini, gr. 1; liq. gutta-perchae, f^j. M. It makes a mixture or sus- 
 pension. A coating of pure liquor gutta-perchae may be painted over this 
 application to protect the clothing. 
 
 As a vehicle liquor gutta-perchse does not present any marked superiority 
 to collodion, q. v. After using both we conclude that for all practical 
 purposes they are equally useful. . . 
 
 " RUBBER PLASTER."* 
 
 General Surgery. Rubber plaster is one of the most convenient 
 forms of adhesive plaster for the field as well as the office. It is rolled 
 on spools of various widths, and can be applied without heating. It 
 keeps well in all climates. The adhesive part of this variety of plaster 
 consists of gutta-percha 2 parts; Burgundy pitch, i part; gum gal- 
 banum, i part. Rubber being the base, it will become neither too hard 
 
 * It is convenient to include at this place the section on India-rubber (Caoutchouc), 
 though far removed in the Materia Medica.
 
 256 LOCAL THERAPEUTICS. 
 
 nor too soft, and it seems to retain its properties indefinitely. It is, how- 
 ever, open to the serious objection of being irritating, if kept long in 
 contact with the skin, especially when it is employed for extension, main- 
 tained in the treatment of fractures of the lower extremity. 
 
 All stages of irritation, from an erythema to deep ulceration of the 
 skin, may be produced. In conditions where a plaster is to be kept long 
 in contact with the skin, resin plaster is to be preferred. Rubber plaster, 
 from its very adhesive properties, is of service when applied over a band- 
 age, assisting to keep the turns in place. It is especially useful in 
 retaining fracture dressings in the case of young children. 
 
 H^EMATOXYLON. Hematoxylon. Logwood. 
 
 Logwood is the " heart-wood of Hamatoxylon camfec&tanum." (U. S. P.) Its impor- 
 tant constituents are a resin, hsematoxylin, a volatile oil, and tannic acid. An extract 
 (Extractum Hrcmatoxyli) of uncertain strength is official. 
 
 Hematoxlyon is astringent. It enters into the composition of a 
 lozenge, each lozenge to contain two grains of the drug. 
 
 HAMAMELIS. Witch-hazel. 
 
 " The leaves of Hamamelis virginica." (U. S. P.) The only official preparation is 
 the fluid extract, which contains in each cubic centimetre the activity of one gramme of 
 the drug. 
 
 The articles sold in- this country under the various names of Pond's Extract, Distillate 
 of Witch-hazel, Hamamelis, etc., originated in homoeopathic practice, and are believed 
 to be weak alcoholic distillates. The volatile oil contained in the drug imparts a peculiar 
 odor to the distillate, but it is not known to possess medicinal properties. 
 
 The virtues of hamamelis are in the main dependent on the tannic 
 acid therein contained and on the alcohol by which it is dissolved. Its 
 preparations, therefore, are astringent and stimulant. The properties 
 other than those above named are sedative, soothing, slighfly anodyne, 
 refrigerant and hemostatic. 
 
 The local effect of hamamelis is secured in convenient form by mixing 
 equal parts of the fluid extract and glycerin ; the mixture should be 
 thoroughly shaken each time before using. 
 
 General Surgery. As a topical application for SPRAINS, BRUISES, 
 SUPERFICIAL INFLAMMATIONS, etc., the distillate has an extensive domestic 
 use. It is much inferior to lead water and laudanum. Hamamelis has 
 attained some reputation as a hemostatic. Consequently it is regarded 
 as a valuable dressing for superficial WOUNDS and as a reliable agent in 
 the treatment of CAPILLARY HEMORRHAGE, the bleeding from the sockets 
 of extracted teeth, etc.
 
 HAMAMELIS. 
 
 257 
 
 In the treatment of LEG ULCERS depending on a varicose condition of 
 the veins, it is considered of service in relieving pain. It is applied, as are 
 all wet dressings, by soaking lint in the distillate and retaining it by means 
 of a bandage. Dujardin-Beaumetz believes that the drug here exerts 
 some influence over the muscular walls of -the vessels. Hector Guy and 
 others assert that it possesses no special physiological action on the vas- 
 cular system. Distillate of hamamelis has been used with benefit as a 
 rectal injection in the treatment of HEMORRHOIDS. Owen {Brit, Med. 
 Jour., January, 1887), has reported the results obtained from forty-three 
 physicians who had had favorable experience in the use of the .distillate in 
 this way, two to four drachms being frequently injected through the 
 day. 
 
 An ointment of hamamelis (twenty to thirty grains of the extract to 
 the ounce of lard) will be found to be a soothing application to FISSURE 
 OF THE RECTUM and FISSURED ANUS. The distillate properly diluted 
 has been used as an injection into the bladder in cases of HEMORRHAGE 
 dependent on the pressure of a vascular growth. Preston extols hamame- 
 lis in the treatment of PHLEGMASIA DOLENS. 
 
 Diseases of the Skin. In some forms of ACUTE ECZEMA and PRU- 
 RITUS, and especially as a local application in URTICARIA, witch-hazel, 
 either in the form of the fluid extract much diluted, or, preferably, in 
 the form of the distillate, has a beneficial effect. It should be applied 
 on cloths as an evaporating lotion. 
 
 Diseases of the Nose. The employment of hamamelis in the 
 treatment of nasal catarrh is not general. In combination with chlorate 
 of potash and glycerin G. Y. McCracken, of Philadelphia, finds it a 
 valuable aid in the treatment of CHRONIC NASAL CATARRH. M. Mac- 
 kenzie employs the tincture one-half ounce, glycerin ten minims, as a 
 means of saturating a tampon of cotton for PLUGGING THE NASAL CHAM- 
 BERS. 
 
 "Hamamelis Wool." Cotton, one drachm; glycerin, ten minims; 
 dis. hamamelis, half an ounce. Mix the glycerin with the tincture, satu- 
 rate the wool with the liquid, and dry. 
 
 Diseases of the Eye. The distillate of hamamelis is a pleasant 
 anodyne and sedative application to the eye, and, applied to the Closed 
 lids in the form of " Pond's extract," is quite a favorite popular pre- 
 scription in ACUTE CONJUNCTIVITIS, and in the irritation of over-use or 
 accommodative strain. Pieces of soft linen wet with it are placed on 
 the lids and frequently renewed. For application to the conjunctiva it 
 should be diluted with one or two parts of water, and may be used with 
 boric acid or borax. An excellent soothing and slightly astringent pre- 
 scription is : Borax, fifteen grains ; boric acid, one-half drachm ; mucilage 
 sassafras pith, one-half ounce ; distilled extract of hamamelis, one and 
 17
 
 258 LOCAL THERAPEUTICS. 
 
 one-half ounces; distilled water, one ounce, to be used freely with an 
 eye-cup. 
 
 HUMULUS. Hops. 
 
 The strobiles of Humuhis hipulus. The efficacy of hops as a sedative depends on the 
 presence of lupulin, which consists in turn of a volatile oil associated with a resin. 
 Fresh hops are always much richer in lupulin than old stock. 
 
 General Surgery. Hops are employed in the form of poultices, and 
 have long enjoyed a reputation for relieving pain. The poultice is best 
 prepared by moistening with hot water the hops contained in a gauze 
 bag, the desired size and shape, constituting what is known in domestic 
 medicine as the hop pillow. A hop poultice may be employed, with 
 great advantage over the heavier flaxseed poultice, in ABDOMINAL INFLAM- 
 MATIONS. It should be covered with waxed paper to retain the moisture. 
 It is also indicated in ORCHITIS, either due to mumps or specific inflam- 
 mation. Applied to the penis in GONORRHOZA it will assist in preventing 
 CHORDEE. 
 
 Diseases of the Throat, etc. Hops have long been used as 
 a domestic remedy in INFLAMMATORY SWELLINGS of the upper respira- 
 tory passages. A little weak vinegar poured upon a pillow containing 
 the hops may be placed near the patient's face and the fumes inhaled. 
 Lupulin can be used in a similar manner. It is often employed in the 
 first stage of ACUTE CORYZA. As an inhalant for ACUTE LARYNGITIS 
 the following is recommended: R. Ext. lupulini, one ounce; sodii 
 carbonat. exsiccat., one scruple; aquse, one pint. In ACUTE LARYN- 
 GITIS, if rapidly progressive and accompanied with great pain, hot inhala- 
 tions containing five grains of lupulin to the ounce of water are strongly 
 recommended by W. E. Casselberry. 
 
 Diseases of the Eye. A small bag of thin flannel, containing hop 
 leaves and dipped in a hot infusion of this herb, forms a convenient 
 means of applying moist heat in ophthalmic practice. 
 
 HYDRARGYRI CHLORIDUM CORROSIVUM. Corrosive Chloride 
 of Mercury. Corrosive Sublimate. Mercuric Chloride. 
 
 Corrosive sublimate is in " heavy, colorless, rhombic crystals or crystalline masses, 
 permanent in the air, odorless, having an acrid and persistent metallic taste and acid 
 reaction ; soluble in sixteen parts of water and in three parts of alcohol at 15 C. (59 F.), 
 in two parts of boiling water, in one and two-tenths parts of boiling alcohol, and in four 
 parts of ether." (U. S. P.) 
 
 The addition of equivalent weights of chloride of ammonia or chloride of sodium 
 renders corrosive sublimate, because of the formation of a double salt, much more quickly 
 and freely soluble than it is alone. The double chloride of mercury and ammonia is 
 called "sal alembroth"
 
 HYDRARGYRI CHLORIDUM CORROS1VUM. 
 
 2 59 
 
 Albumin is an antidote for corrosive sublimate, since it forms a comparatively harmless 
 and insoluble compound with it. Solutions of corrosive sublimate are neutralized by their 
 contact or admixture with secretions, such as those in leucorrhcea or with cancerous ichor. 
 On account of the albumin present it is also neutralized by blood, serum, and muscle 
 fibre. The addition of a small portion of tartaric acid to the solution prevents the forma- 
 tion of an albuminate, and so increases its antiseptic power. It should be remembered, 
 however, that "tartaric acid bichloride solution " is, by the very fact that the bichloride 
 is not converted into an insoluble albuminate, much more rapidly and certainly absorbed 
 than is the ordinary solution, and that risk of toxic impression attending its use is thereby 
 increased. 
 
 Yellow iv.ash (lotio flava, aqua phagedaenica) is made by mixing one-half drachm of 
 corrosive sublimate with eight fluidounces of lime-water. Collodions containing corrosive 
 sublimate in proportions varying from ten to forty per cent, are sometimes used. Tablets 
 containing nearly equal parts of corrosive sublimate and chloride of ammonium, and so 
 weighted that one dissolved in a pint of water furnishes a solution of one part of corrosive 
 sublimate in 1000 parts of the solution, are much used in surgery. The various surgical 
 dressings, gauzes, cottons, wools, catgut, silks, etc., impregnated or made antiseptic by 
 corrosive sublimate, are familiar and are too numerous to be enumerated. 
 
 Bichloride of mercury is antiseptic, antiparasitic, discutient, excitant, 
 and caustic. 
 
 It is, on the whole, the most valuable of the germicides. While by 
 actual test less destructive than the biniodide of mercury, it possesses 
 advantages in its cheapness and degree of solubility. 
 
 According to the observations of Sternberg, Koch, and Jalan de la Croix, 
 solutions of 1-10,000 to 1-40,000 destroy the spores of bacilli. It is well 
 to state that Klein (7%<? Practitioner, October, 1884) denies the germicidal 
 properties of corrosive sublimate. In regard to the power of chloride to 
 destroy the microorganisms of pus it ranks relatively to other germicidal 
 agents as follows : Bichloride solution acid, 0.005 P er cen t. > permanganate 
 of potash, 0.12 percent.; carbolic acid, i percent.; zinc chloride, 2 per 
 cent.; creasote, 0.5 per cent.; iodine, 20.2 per cent. (Sternberg, " Re- 
 port to the American Pub. Health Ass'n," 1888, p. 50.) 
 
 Laplace has found that the addition of small quantities of hydrochloric 
 acid (five parts in 1000) to solutions of the bichloride of mercury has the 
 same disinfecting power in albuminous as in non-albuminous fluids. For 
 convenience corrosive sublimate is usually carried in solid form in the 
 compressed tablet where tartaric acid is substituted for the hydrochloric 
 acid in the same quantity. 
 
 In hospital practice a ten per cent, solution may be kept on hand, from 
 which any dilution desired can be prepared. A compressed pellet, 
 containing seven and one-half grains, being added to a pint of water 
 makes a solution of i 1000, which will be found a convenient and 
 reliable means of preparing solutions for 'use in private practice. Anti- 
 septic bichloride solutions are used in strengths from 1-500 to 1-5000. 
 The stronger solutions, 1-500 and i-iooo, are only used for disinfecting
 
 260 LOCAL THERAPEUTICS. 
 
 the hands and skin. For irrigating wounds and small abscess cavities 
 1-2000 is generally employed. When continuous irrigation is kept up, 
 and when the bichloride is employed in large cavities, a much weaker solu- 
 tion, 1-5000 or .1-10, ooo, should be used. To get the best results the sur- 
 geon must see that the solutions are freshly prepared, for if left exposed to 
 the air for several days a chemical change takes place, slowly converting 
 the bichloride into the proto-chloride. It has been found that a 1-10,000 
 hot solution is more active in destroying pus formation or for cleansing 
 purposes, than 1-2000 used cold ; hence all preparations for irrigation 
 should be employed as hot as can be borne with comfort. 
 
 General Surgery. In the preparation of cases for operation thor- 
 ough cleanliness is first secured by shaving the part, and vigorously scrub- 
 bing it afterward with soap and water or turpentine ; it is then washed 
 with a strong solution of corrosive sublimate i-iooo, and, if time permit, 
 a wet compress wrung from a warm solution is laid over it and retained 
 with a bandage until exposed preparatory to the operation. By this 
 means the skin and hair follicles are cleansed. In cases of CONTUSED 
 and INCISED WOUNDS the same procedure is followed, the wound 
 being washed by a stream of bichloride solution thrown from an irri- 
 gator or from the nozzle of a syringe. When the hemorrhage is con- 
 trolled the edges of the wound are approximated by means of a suture, 
 either of wire, silk, or catgut. Chinese silk is to be preferred, viz., that 
 which has been sterilized by boiling in a solution of corrosive sublimate, 
 1-2000, afterward in distilled water, and kept for use in alcohol. If 
 this method of preparing sutures is carried out the risk of formation of 
 " stitch abscesses" will be eliminated. 
 
 Some disadvantages must be acknowledged in the use of corrosive 
 sublimate, as, indeed, is the case with all other powerful germicides. In 
 the first place, there exists the possibility of producing toxic effect in per- 
 sons unusually susceptible to the action of the drug. Serous membranes 
 absorb readily. For this reason the washing of the pleural and abdom- 
 inal cavities with bichloride solutions is contraindicated. If- such 
 flushing be resorted to it is well to thoroughly remove all excess of 
 fluid by rewashing with distilled water. The following case of acute 
 poisoning is reported by W. Weiss : A large, fatty tumor had been 
 removed. The wound was washed with a one per cent, solution of the 
 chloride and dressed with sublimate gauze. In a few hours vomiting 
 began, accompanied with sharp abdominal pains, death following on the 
 third day. The autopsy revealed acute gangrenous inflammation of the 
 colon and ilium, with parenchymatous degeneration of the kidneys. 
 Several cases are reported where death has followed washing out of the 
 uterus in obstetric practice, and also where hypodermic use of the drug 
 was employed.-
 
 HYDRARGYRI CHLORIDUM CORRO3IVUM. 261 
 
 Corrosive sublimate solutions and dressings are often very irritating to 
 delicate skins. Under such conditions the gauze should be applied dry. 
 The parts may be dusted over with boric acid. 
 
 Bichloride solutions are unsuitable as disinfecting baths for instruments. 
 During operations it is important that all cutting instruments should be 
 kept out of the irrigating solution, as in a very short time their edges are 
 destroyed. 
 
 Concerning the treatment of wounds which have become purulent 
 before coming under the care of the surgeon, it is necessary to remember 
 that the wound must be thoroughly washed daily, with a warm bichloride 
 solution, 1-2000, and the part dressed with as much care as if non- 
 infected. In a short time the discharge of pus will gradually cease, 
 and the wound remain clean and odorless. After a wound has become 
 infected carelessness in dressing will cause the infection to continue unal- 
 leviated through the course of the treatment, delay the healing process, 
 and expose the patient to the risk of septicaemia. 
 
 In the successful treatment of a wound it is imperative to have perfect 
 drainage (usually by means of the rubber or glass drainage-tube, cat- 
 gut, or horse hair). After the proper approximation of the edges the 
 surface for a considerable distance around should be covered with the 
 bichloride gauze (^. v.~), twelve to sixteen layers in thickness, covered over 
 with a thick covering of cotton prepared with the bichloride, and the 
 part supported by a firm bandage. Many surgeons are in the habit of 
 moistening one-half of the gauze in a 1-2000 solution and removing the 
 excess of water by pressure, while others use both layers dry. If the gauze 
 is known to be freshly prepared and kept in a closed glass jar the latter 
 is much the preferable method. The gauze not being surcharged 
 with moisture readily absorbs all serous discharge, which occurs in 
 wounds during the first twenty-four hours. Again, dryness is not 
 favorable to the growth of micro-organisms. In the treatment of LACER- 
 ATED and CONTUSED WOUNDS involving especially the hands and 
 feet, where the vitality of the parts are much impaired, and where 
 acute or secondary gangrene may occur, irrigation should be carried 
 out as spoken of under the head of Aqua (q. #.), except that the fluids 
 should be sterilized and corrosive sublimate added, making a solution 
 of a strength from i-iooo, 1-10,000, used either warm or cold, as 
 the judgment of the surgeon may dictate. By the pursuance of this 
 method of treatment many limbs can be saved which otherwise would be 
 sacrificed, and the development of tetanus in great part prevented. In 
 treating the BITES OF ANIMALS the wound should be encouraged -to bleed 
 freely, and then flushed with a solution of bichloride of mercury, 1-2000. 
 The fluid is preferably thrown with some force from the nozzle of a 
 syringe. If the animal is known to be rabid it is best to eoccise the tissue
 
 262 LOCAL THERAPEUTICS. 
 
 around the wound, wash out with the corrosive solution, and then cau- 
 terize with a hot iron. 
 
 In the genito-urinary tract corrosive sublimate has an extensive field of 
 use, depending almost entirely upon its antiseptic properties. In the 
 treatment of GONORRHCEA J. W. White {Public Clinic} is in the habit 
 of using an injection of solution of corrosive sublimate in strength from 
 one-quarter to one-half grain to an ounce in combination with boric 
 acid, and sulphocarbolate of zinc. The following prescription is also 
 recommended: R. .Hydrarg. bichlor., gr. ii-iv ; zinci sulph. carbolat., 
 gr. ii-x ; acidi borici, 3] ; hydrogen, peroxidum, j ; aquae, q. s., ad. sviij. 
 Bichloride of mercury is used in varying strengths up to as high as i-iooo 
 with the object of aborting the disease. We have seen solutions of 1-2000 
 cause severe pain and increase the grade of inflammation in the first stage 
 of ACUTE GONORRHCEA. E. L. Keys (" Genito-Urinary Disease with 
 Syphilis," p. 66) states that he has never been able to entirely arrest a 
 true gonorrhoea at once with corrosive sublimate, or to kill the micro- 
 coccus. The irrigating of the urethra in a mild solution (1-20,000, 
 1-40,000), as advised by Halstead, to be used with a fountain syringe, is 
 often followed by good results. In our experience the treatment with 
 bichloride solutions is inferior to that obtained from solutions of salts 
 of zinc and lead, with opium. 
 
 In SPECIFIC VAGINITIS or GONORRHCEA, in the female, the solution of 
 corrosive sublimate has been found a reliable means of treatment. It can 
 be borne much stronger than in the male, as a rule, without causing 
 pain. It may be used in strength from 1-4000 to 1-10,000, beginning 
 with the weaker solution. Corrosive sublimate is in constant use as an 
 antiseptic in uterine and vaginal surgery, as, for example, in operations for 
 lacerated cervix, ruptured perineum, etc., as well as for flushing the 
 uterus after childbirth. In obstetric practice creolin {q. v.*) is being sub- 
 stituted largely for this agent with equally good results and little danger 
 of producing toxic symptoms. 
 
 Diseases of the Skin. Bichloride of mercury has been long and 
 extensively used in the local treatment of diseases of the skin. 
 
 In hypertrophic affections of the epidermis, as LENTIGO, a solution of 
 two to four grains of bichloride of mercury to the ounce of alcohol 
 painted on the skin a number of times successively causes an exfoliation, 
 which, in time, relieves the skin of the brown discoloration. A solution 
 of ten to twenty grains to the ounce of collodion is effectual in the 
 removal of superficial N^EVI and XANTHOMA. In TELANGIECTASIS a twenty- 
 grain solution painted on daily for several successive days causes the 
 formation of a white crust, which after a time separates and the growth 
 is found to have been destroyed. Such solutions must be used with 
 great caution.
 
 HYDRARGYRI CHI.ORIDUM CORROSIVUM. 
 
 203 
 
 As a parasiticide, a lotion of one grain of the bichloride to an ounce of 
 vinegar destroys PEDICULUS PUBIS and PEDICULIS CAPITIS, and, at the 
 same time, the ova of these parasites, which cling to the hairs. In TINEA 
 CIRCINATA and in small patches of TINEA VERSICOLOR a solution of two to 
 four grains of the bichloride in an ounce of the compound tincture of 
 benzoin, painted on the affected parts once or twice a day, as recommended 
 by Taylor, of New York, is efficacious. A solution in alcohol of similar 
 strength may be painted on the smaller patches of RINGWORM of the 
 scalp. Recently electricity, applied from the negative pole of a constant 
 current battery has been employed to facilitate the penetration of this 
 parasiticide. Such applications should be made cautiously, and not over 
 too large a surface at any one time for fear of absorption with toxic effect. 
 
 In ERYSIPELAS, Eppstein {Therap. Monatshefte, No. 4, 1891) has used 
 a one per cent, ointment of this salt in lanolin with excellent results. 
 
 White, of Boston, has recommended the employment of an ointment of 
 ten to forty grains of bichloride of mercury to the ounce of lard, or of a 
 solution of similar strength in castor oil as an application in LUPUS 
 VULGARIS. 
 
 A mixture of bichloride of mercury with creasote has been described 
 under the latter head. It is an efficient application in LICHEN PLANUS 
 and LICHEN RUBER. 
 
 Bichloride of mercury enters into the composition of a famous lotion 
 formerly, and still to some extent, employed in the treatment of ACNE, 
 under the name of " Gowland's lotion." It is composed as follows: 
 R. Hydrarg. bichlor., gr. vij ; alcoholis, n^xx; misturae amygdalae, 
 ad fgiv. M. 
 
 Diseases of the Ear, Nose, and Throat. In the treatment of 
 OTORRHEA a solution of from 1-10,000 to 1-3000 is held in high esteem. 
 Late writers (Schwartze, Laplace, and C. Behrens) employ tartaric acid 
 to lessen the coagulating of tissue, in the following formula: R. Hydrar- 
 gyri bichlor., gr. ss (0.032 grammes); acidi tartarici, grains xx (1.29 
 grammes) ; aquae, ounces iv (124.4 grammes). One-tenth of one percent, 
 to one per cent, solution according to J. Gottstein {Archives of Otologv, 
 vol. xin, 1884) is sufficient to sterilize the ear. In place of instillation, W. 
 Kirchner (Monatschr. f. Ohrenheilkun.de, August, 1885, 229) saturates a 
 delicate cotton string or cord about two millimetres in thickness in a weak 
 solution of corrosive sublimate. Remembering the powerfully toxic charac- 
 ter of the preparation care should be exercised in the use of corrosive 
 sublimate in the middle ear, no matter what strength is used. The 
 recognition of the bacillar nature of AUDITORY FURUNCLE renders the 
 advice to saturate the wound made after incision with a lotion of bichlo- 
 ride of mercury (i- 10,000, 1-3000) fruitful of good results. ACUTE 
 ECZEMA of the auditory passage is treated by Miot and Baratoux (Rev.
 
 264 LOCAL THERAPEUTICS. 
 
 gen. de Clin. et de Therapeut., January, 1889) by a solution of corrosive 
 sublimate 1-200 ; boric acid, 1-35 ; sodium bicarbonate, 1-200. 
 
 Maas' Mixture is as follows : Corrosive sublimate, 5 parts ; sodium chlo- 
 ride, 500 parts; glycerin, 200 parts. 
 
 In the treatment of nasal affections corrosive sublimate is not in such 
 general use as in that for diseases of the ear. One of its most important 
 applications is for the DESTRUCTION OF MAGGOTS in the nasal chamber 
 and adjacent sinuses. In proportions sufficient to be of use as a germ- 
 icide it is also irritating. Nevertheless, W. C. Jarvis speaks highly of 
 it in the treatment of CHRONIC CATARRH. Gottstein, in the treatment 
 of OZ.ENA, inserts a nasal tampon wet with a weak solution. Gomez de 
 la Mata employs a solution of 1-6000 in the same affection. 1-4000 
 has proved in the hands of the writer to be unmanageable. Its use 
 should be always followed by a soothing wash. Bouchut recommends 
 the following snuff in ATROPHIC RHINITIS : Hydrarg. bichl. and oxide 
 of mercury each one part ; sugar twenty parts. 
 
 Bichloride of mercury is one of the most powerful deodorizers of se- 
 cretions of the mouth that is known. It is recommended by W. D. 
 Miller (" Micro-organisms of the Human Mouth," p. 234) to be used as 
 a mouth wash for DENTAL CARIES and FETOR in the proportion of 
 1-2000. The objection urged against this, that a risk of toxic impres- 
 sion is incurred by the solution being swallowed, is not valid. The taste of 
 the bichloride is conveniently disguised by rose water. Under any 
 circumstances great care should be exercised in prescribing it, nor should 
 it be used for a long time. 
 
 CROUPOUS DISEASES generally can be treated by the same means. 
 
 J. Bryson Delavan recommends a solution of 1-2000 in local appli- 
 cation to tonsil crypts which are known to be affected with LEPTOTHRIX 
 BUCCALIS. PHLEGMONOUS TONSILLITIS is asserted to be of bacterial origin 
 and is appropriately treated with a spray of hydrarg. bichlor. i-iooo ; 
 local application is made with a brush to the affected surfaces. A spray 
 of 1-5000 can be used in ordinary PHARYNGITIS, recommended by J. J. 
 E. Maher (Med. Rec., November, 1890), and as a gargle by many writers. 
 SYPHILITIC PHARYNGITIS has long been treated by this agent. Charles 
 Bell's gargle (" Institutes of Surgery," 1837) (" Dunglison's Am. Med. 
 Lib.," 1840, 352) is as follows: R. Hydrarg. oxymurat. (bichlor.), four 
 grains; spirit, rectif., two drachms; decoct, cinchon., six ounces; mel. 
 rosse, tinct. myrrhae, aa two ounces. A spray of bichloride of mercury 
 i-iooo is recommended by S. Johnston. This is greatly in excess 
 of what would be prudent for the average case of SYPHILIS OF THE 
 PHARYNX. 
 
 The local use of bichloride of mercury in the treatment of DIPHTHERIA 
 is one which of late years has been crowned with success at the hands
 
 HYDRARGYRI CHLORIDUM CORROSIVUM. 265 
 
 ot careful observers. In addition to its well-known value as an internal 
 medicament in this disease, it is doubtless useful as a local application. It 
 is necessary to estimate the influence exerted by the local medicament 
 by absorption, in order that the impression may not be added exter- 
 nally to that given internally at the same time. E. N. Oatman, of 
 Nyack, N. Y. (J. Lewis Smith, N. Y. Co. Med. Ass'n, December, 1887), 
 recommended that the solution of one part to about 4000 (about two 
 grains to the pint) be employed. A cotton carrier is the best instrument 
 by which the solution can be brought in contact with the affected surfaces. 
 Two grains to a pint constitutes a strength recommended by Potter for 
 DIPHTHERITIC DEPOSITS. . A strength of 1-10,000 has been used in DIPH- 
 THERIA (Massei, Deutsche Med. Zeitung, 1881). W. Porter {Trans. 
 American Laryngological Ass 1 n, 1887) speaks highly of a warm spray in 
 the treatment of this disease. Since it is of importance to bear in mind the 
 amount of the drug which can be borne by the system at any time, the 
 following table has been drawn up by Dr. L. Smith {N. Y. Co. Med. 
 Ass'n, December, 1887). 
 
 To a child of two years one-sixth grain. 
 
 " " four " one fourth " 
 
 " " six " one-third " 
 
 " " ten " one-half " 
 
 J. N. Mackenzie {Trans. Ninth International Med. Congress, Wash- 
 ington, 1887, vol. iv) and J. L. Porteous {Edin. Med. Jour., May, 
 1887) employ a similar spray in LARYNGEAL PHTHISIS. A. S. Houghton 
 directs a preparation for spray inhalation, composed as follows : Hydrarg. 
 bichlor., four grains; ammon. chl., ten grains; glycerin, two ounces; 
 aqua, eight ounces. 
 
 Diseases of the Eye. The bichloride of mercury has been more 
 extensively used in ophthalmic surgery than any other antiseptic. Its 
 limitation is found in its irritating effect upon the eye, which prevents the 
 application of such strong solutions as are used by general surgeons. 
 According to Guaita {Annals d' Oculist, 1886, p. 275), solutions of 
 1-7000 instilled in the eye cause no perceptible irritation; of 1-5000 
 cause slight burning and congestion ; of 1-2000 decided congestion 
 with severe burning sensation, and stronger solutions than i-iooo 
 should never be used in this way. In the strength of 1-300 painted 
 on the everted eyelid it is slightly caustic ; rather less so than silver 
 nitrate 2-100 (about ten grains to one ounce). Sattler, in bacterio- 
 logical experiments with micrococci taken from the lachrymal passages, 
 found that a solution of 1-5000 of bichloride entirely stopped the multi- 
 plication of germs in two or three minutes. This solution is generally 
 well borne by the conjunctiva, particularly if cocaine is used, and is
 
 266 LOCAL THERAPEUTICS. 
 
 preferred by many surgeons to any other antiseptic wash in operations 
 upon the eye. The brow and the closed eyelids are first disinfected, 
 after careful washing with soap and water, with a stronger solution (i- 
 2000), and the conjunctival sac is freely douched with the 1-5000 wash 
 before, and, by some surgeons, during and after the operation. Others, 
 after the first thorough disinfection, prefer to use boric acid. The 
 application of bichloride has been thought by some to cause corneal 
 opacity, especially when used in connection with cocaine (see article on 
 Cocaine), and the danger of this is to be considered when strong solutions 
 are used. When injected into the anterior chamber, after cataract extrac- 
 tion, there is little doubt that it has caused striped keratitis, and its use 
 in this way has been generally abandoned. Its free application to the 
 cavity of the orbit after enucleation of the eyeball is particularly recom- 
 mended. 
 
 The bichloride has long been used as a collyrium in CONJUNCTIVITIS. 
 It was the chief ingredient in the Mackenzie wash (1-12,000), and is now 
 a favorite application in purulent ophthalmia in solutions of about 1-5000, 
 or weaker. The conjunctival sac is washed with it every two or three 
 hours. 
 
 Dujardin, in 1884, strongly recommended bichloride in the treatment 
 of trachoma, painted on the everted lid, as silver nitrate is applied, 
 in solution of 1-250. This treatment has since been discovered by 
 several other surgeons, who have used various strengths, and it may be a 
 useful addition to the list of remedies in this chronic and obstinate 
 affection. 
 
 HYDRARGYRI CHLORIDUM MITE. Calomel. Mild Chloride of 
 Mercury. Mercurous Chloride. 
 
 "A white, impalpable powder, permanent in the air, odorless and tasteless, and insolu- 
 ble in water, alcohol, or ether." (U. S. P.) 
 
 " Black wash " (lotio nigra) is made by adding a drachm of calomel to a pint of lime- 
 water and shaking thoroughly. It should be well shaken each time before using. 
 
 Calomel is discutient, stimulant, and desiccant. 
 
 General Surgery. Calomel is the form of mercury now usually 
 employed for FUMIGATION. It should be especially prepared and abso- 
 lutely pure. Various complicated apparatus have been devised for its 
 administration, but nothing can be better than a simple porcelain dish 
 with two compartments, one containing from twenty to thirty grains of 
 calomel and the other about two ounces of water, suitably held over 
 a spirit lamp, over which is placed a cane-seated chair. The patient is 
 seated surrounded by a loose cape or blanket fitting tightly around the 
 neck. The calomel is sublimed by heat and deposited with water on the
 
 HYDRARGYRI CHLORIDUM MITE. 267 
 
 patient's skin. When the process is completed the patient is wrapped in 
 a flannel gown without washing or drying, and placed at once in bed. 
 This method has the same advantages as that by inunction, and is 
 efficient. Both have the disadvantage of being more troublesome than 
 administration by the mouth. 
 
 Black wash forms an admirable stimulating dressing for VENEREAL 
 SORES, especially in the early inflammatory stage, or after cauterization 
 with one of the stronger acids. It is best applied by pieces of lint or 
 old linen saturated with the solution and applied several times daily. The 
 mixture should be well shaken before using. 
 
 The powder of calomel may be dusted over the surface of VENEREAL 
 ULCERS where the action is indolent, and is often productive of satisfactory 
 results. 
 
 Diseases of the Skin. Among the mercurial preparations calomel 
 is one of the most commonly used in the treatment of diseases of the skin. 
 
 In the form of ointment, from five to twenty grains to the ounce, it 
 forms an admirable discutient and stimulant application in SUBACUTE 
 AND CHRONIC ECZEMA, and in some of the syphilodermata. In SUB- 
 ACUTE ECZEMA OF THE HANDS an ointment of five to fifteen grains 
 of calomel to the ounce of oxide of zinc ointment forms an admir- 
 able application. If applied in cases where the eruption is of an acute 
 inflammatory character the calomel ointment often proves too stimulating. 
 In any case care must be taken not to apply it over too large a surface, 
 as salivation occurs more frequently with this than with any other prepa- 
 ration of mercury. 
 
 Calomel has been used as a hypodermic application in SYPHILIS, 
 but it has not in our hands proved satisfactory. It is difficult to 
 reduce the drug to a sufficiently fine powder to become suspended 
 in the liquid, and we think that abscesses are more likely to result at 
 the point of injection than with other preparations. It is said that the 
 gradual absorption of the nearly insoluble salt ensures its gradual and 
 regular entrance into the economy, but we have not observed the pro- 
 longed action of the drug asserted by its advocates. The following is the 
 formula usually recommended: R. Pulv. hydrarg. chlor. mite, gr. jf; 
 glycerin., n^xv. M. For a single injection. A similar one is f' R. 
 Hydrarg. chlor. mite, gr. jss-ij ; pulv. acacise, gr. \ ; aq. destillat., n^xv. 
 M. Two injections of this amount on successive days in the region 
 of the nates, and then three weeks' interval occurs before a similar 
 amount is again employed. 
 
 F. H. Kane (Dubl. Jour. Med. Sd., November, 1874) has devised an 
 apparatus by which the vapor of sublimed calomel can be directed on 
 any part of the skin. Three to five grains are heated in a glass-bulbed 
 tube with a fine point, and as the vapor begins to rise a current of air is
 
 268 LOCAL THERAPEUTICS. 
 
 blown through the tube by a rubber hand-ball carrying the vapor with it. 
 Walter 'G. Smith (Br. Med. Jour., May 7, 1881) has likewise used this 
 apparatus with satisfaction. 
 
 Diseases of the Ear, Nose, and Throat. Calomel has a reputa- 
 tion second only to that of the bichloride in the treatment of OTORRHCEA. 
 The parts should be first washed out thoroughly with a solution of bichlo- 
 ride of mercury and the calomel used subsequently as an insufflation 
 ( Year Book of Treatment, 1885). Black wash is often employed as a remedy 
 for ECZEMA of the auricle. Calomel in the proportion of five to eight 
 grains to an ounce of powdered sugar or bismuth subnitrate, is a favorite 
 remedy with many practitioners for inflammatory states of the interior of 
 the nose. It is especially indicated in CHRONIC PURULENT CATARRH 
 of children and in SYPHILIS. Calomel is of repute in the local treat- 
 ment of DIPHTHERIA. The powder may be floated on a teaspoonful of 
 cold water and the whole conveyed to the open mouth. While the bulk 
 of the powder adheres to the sides of the tonsils and pharynx a small 
 portion will be swallowed. This method of treatment has been popu- 
 larized by W. H. Daly {Trans. American Laryngological Ass'n, 1889). 
 A similar treatment is efficacious in the treatment of CROUP. Thrown 
 upon the vocal cords by insufflation, calomel has been found useful by 
 Tchernoff (Sf. Olga's Hospital Reports, 1888, p. 19) for SYPHILITIC 
 LARYNGITIS. 
 
 Diseases of the Eye. Calomel is a valuable local application in 
 PHLYCTENULAR OPHTHALMIA, though, as it is insoluble, the rationale of its 
 action is not easily understood. That it is something more than a mechan- 
 ical irritant has been shown by experiments in which inert powders were 
 substituted without producing the same effects. It is used as a fine, dry 
 powder, and is dusted directly upon the ulcer from a camel's-hair brush. 
 The brush is held between the forefinger and thumb and " flicked " with 
 the little finger of the same hand. Calomel should not be used when 
 there is much ciliary irritation, shown by photophobia, lachrymation, 
 and contracted pupil, but after this has been subdued by atropia and other 
 remedies. It is also useful in CHRONIC VASCULAR KERATITIS and PANNUS, 
 and in small indolent ULCERS and SUPERFICIAL OPACITIES (nebula) OF 
 THE CORNEA. 
 
 HYDRARGYRI IODIDUM RUBRUM. Red Iodide of Mercury. 
 
 Biniodide of Mercury. Mercuric Iodide. 
 
 "A scarlet-red, crystalline powder, permanent in the air, odorless and tasteless, almost 
 insoluble in water, soluble in 130 parts of alcohol at 15 C. (59 F.), and in 15 parts of 
 boiling alcohol ; also soluble in solutions of iodide of potassium or of mercuric chloride." 
 (U. S. P.)
 
 HYDRARGYRI IODIDUM RUBRUM. 269 
 
 The red iodide of mercury is antiseptic, germicidal, resolvent, irritant, 
 and, in strong impression, almost caustic. 
 
 General Surgery. Biniodide of mercury in its irritant properties 
 resembles corrosive sublimate, and its uses are similar. It has been 
 strongly advocated as an antiseptic in preference to the bichloride by 
 Bernardy, of Philadelphia, and others. It undoubtedly possesses great 
 germicidal properties which equal, if they do not exceed, those of the 
 bichloride. Limitations to its usefulness lie in its expense and relative 
 insolubility. In comparing the germicidal properties of the various mer- 
 curial salts, we quote the experiments, which were carried out with 
 accuracy, by Sternberg and Abbott. (Am, Pub. Health Rep., p. 51.) 
 
 Active. Failed. 
 
 Biniodide, 1-20,000 1-40,000 
 
 Bichloride, 1-15,000 1-20,000 
 
 Protiodide, 1-10,000 1-20,000 
 
 Yellow oxide, i-iooo 1-2000 
 
 Black oxide, 1-500 I-iooo 
 
 Calomel, ... i-ioo 
 
 Blue mass, . i-ioo 
 
 In the treatment of BRONCHOCELE, Monat, MacNamara, and others 
 have had marked success with this drug. These writers direct that an 
 ointment, fifteen grains to the ounce, be rubbed over the surface of 
 the goitre, which should then be exposed to the sun's rays as long as 
 can be borne. Within half an hour a smarting sensation is complained 
 of, in an hour a blister is formed, which is to be treated in the usual way. 
 The good effects of the iodide continue long after the blister has healed, 
 and the tumor decreases day by day for several weeks. 
 
 Diseases of the Skin. The red iodide of mercury is employed in 
 dermatology in the form of " Rochards' ointment," which is composed of 
 four grains of iodine melted with ten grains of calomel, until combination 
 takes place, and then rubbed up with an ounce of lard. 
 
 This is strongly stimulant, almost caustic in character. It is sometimes 
 used in the treatment of small, chronic patches of LUPUS ERYTHEMATOSUS. 
 
 Diseases of the Nose and Throat. The iodide of mercury is of 
 use in the treatment of SYPHILITIC ULCERATIONS of the mouth and throat. 
 Moloney {Australian Med. Journal, February 15, 1885) advises a fresh 
 mixture of one-half grain to the ounce of water, to which has been added 
 one drachm of acacia mucilage. J. S. Cohen employs a lotion for the nose 
 in the treatment of OZOENA. It has been used in the form of a powder in 
 SYPHILITIC CORYZA. C. R. Illingworth (British Med. Journal, Novem- 
 ber 3, 1888) uses biniodide of mercury, one part to two thousand, as a nasal 
 douche and spray in the same diseases. G. W. Major (N. Y. Med. Jour- 
 nal, September 24, 1887), values it in the form of an ointment to be used
 
 2 JO LOCAL THERAPEUTICS. 
 
 over the region of the larynx, in inflammation tending to ankylosis of 
 the cricoarytenoid articulations. Biniodide of mercury is offered for sale 
 in the form of compressed tablets, in combination with potassium iodide. 
 Each tablet contains six grains of both salts. In the proportion of one 
 part to a quart of water the tablet represents a solution of 1-2500. It 
 may be used as a germicide. 
 
 Diseases of the Eye. The red iodide of mercury has been exten- 
 sively used as an antiseptic in ophthalmic surgery, in the preparation 
 known as Panas 1 solution, which consists of the red iodide i part, alco- 
 hol 400 parts, and water 20,000 parts. It is difficult to understand why 
 this infinitesimal proportion of the salt should be preferred to the familiar 
 solutions of the bichloride, particularly as antiseptics of established repu- 
 tation are said, by good authorities, to lose their germicidal properties 
 when dissolved in alcohol. Some chemists have even claimed that the 
 biniodide is precipitated when added to the water, and is not to be 
 detected in the Panas' solution. 
 
 HYDRARGYRI IODIDUM VIRIDE. Green Iodide of Mercury. 
 
 " A dull green to greenish-yellow powder, becoming more yellow by exposure to air, 
 and darker by exposure to light, odorless and tasteless, almost insoluble in water, and 
 wholly insoluble in alcohol or ether." (U. S. P.) 
 
 Diseases of the Skin. The green iodide of mercury in an ointment 
 of two to fifteen grains to the ounce of lard has been used as a stimulating 
 application in ACNE. 
 
 HYDRARGYRI OXIDUM FLAVUM. Yellow Oxide of Mercury. 
 
 Yellow Mercuric Oxide. 
 
 " A light orange yellow, heavy, impalpable powder, permanent in the air, and turning 
 darker on exposure to light, odorless, and tasteless, insoluble in water or alcohol, but 
 wholly soluble in nitric or hydrochloric acid." (U. S. P.) This authority contemplates 
 an impalpable powder, one which shall not show crystalline structure under the micro- 
 scope. From this oxide an oleat.e of mercury (oleatum hydrargyri) is made which con- 
 tains ten parts of yellow oxide of mercury in combination with enough oleic acid to make 
 one hundred parts. An ointment of yellow oxide of mercury ^Unguentum Hydrargyri 
 Oxidi Flavi) containing ten parts of the oxide in one hundred parts of the ointment is 
 also official. 
 
 The yellow oxide of mercury is alterative and (according to A. Rose, 
 Med. Record, April 25, 1885) antiseptic. 
 
 Diseases of the Skin. The yellow oxide of mercury is employed 
 in the same way as the red oxide, but has the advantage of occurring in 
 the form of an impalpable powder. An ointment of this salt of the 
 strength of ten to twenty grains to the ounce or even stronger forms an
 
 HYDRARGYRI OXIDUM FLAVUM. 271 
 
 excellent stimulating application to small patches of ECZEMA. The fol- 
 lowing ointment is valuable in ECZEMA OF THE EYELIDS : R. Hydrarg. 
 ox. flav. gr. vj. ; vaselini, ^iv. M. A small quantity may be placed under 
 the edge of the lids. 
 
 Diseases of the Ear, Nose, and Throat. An ointment of the 
 yellow oxide of mercury is a valuable application for PRURITUS of the 
 external auditory passage. Wilde conceived that it was more efficient 
 when cod-liver oil was substituted for neat's foot oil. One grain of the salt 
 with one drachm of cosmoline, to which one-half grain of hydrochloride of 
 morphine may be added, forms the basis of an ointment which is highly 
 recommended by C. S. Turnbull {Med. and Surg. Reporter, February 19, 
 1881) as an application in CHRONIC RHINITIS as well as to the external 
 meatus in which there is an absence of cerumen. It takes the place of 
 the cerumen besides acting upon the infiltrated walls of the passage. 
 TurnbuU's statement agrees with the experience of the writer, who has 
 found that the official ointment is much too strong for use in the nose. 
 One drachm of yellow oxide of mercury to nine drachms of oleic acid is 
 recommended by Lefferts as an external application to FIBROUS GOITRE 
 or of the INDURATED CERVICAL GLANDS. S. Johnston believes that this 
 compound is valuable where a mercuric impression is desired in the local 
 treatment of RHINITIS after the exhibition of more active remedies. 
 
 Diseases of the Eye. The yellow oxide of mercury is particularly 
 adapted for ointments intended to be applied to the eye, as, being an 
 impalpable powder, it does not act as a mechanical irritant. It was 
 introduced into ophthalmic therapeutics by Pagenstecher, and the oint- 
 ment is sometimes known by his name. It has been used by different 
 surgeons and in different conditions, in proportions varying from half a 
 grain to four grains to the drachm of any unirritating ointment, as vase- 
 line, lard, amyloglycerin, lanolin, etc. The most generally useful 
 strength is a grain to the drachm. In SIMPLE ACUTE CONJUNCTIVITIS, 
 with a tendency to incrustation of the lashes, one-half grain to one drachm 
 answers well, while in CHRONIC BLEPHARITIS MARGINALIS, two grains- to 
 one drachm will be more efficient, but should be applied only along the 
 roots of the cilia and not be allowed to enter the eye. It is in inflamma- 
 tions of the margins of the lids that mercurial salts are most useful', and 
 the " yellow ointment " is an almost universal favorite in the treatment 
 of these affections. It is usually applied at bed-time, and allowed to 
 remain in contact with the margins of the lids during the night. In 
 PHLYCTENULAR OPHTHALMIA the ointment may be applied directly to the 
 eyeball by introducing a piece the size of a large pin-head beneath the 
 upper lid. Its use in connection with massage has also been highly 
 recommended in the treatment of CORNEAL OPACITIES, CHRONIC KERA- 
 TITIS, and PANNUS.
 
 272 LOCAL THERAPEUTICS. 
 
 HYDRARGYRI OXIDUM RUBRUM. Red Oxide of Mercury. Red 
 
 Precipitate. Red Mercuric Oxide. 
 
 " Heavy, orange-red, crystalline scales, or a crystalline powder, becoming more yellow 
 the finer it is divided, permanent in the air, odorless, and tasteless, insoluble in water or 
 alcohol, but wholly soluble in nitric or hydrochloric acid." (U. S. P.) No matter how 
 carefully triturated or levigated, the microscope shows that the salt retains its crystalline 
 character. Hence, ointments of the salt are more irritating than are those of other forms 
 of mercury. On the other hand, the permanence of the crystals adapts the red oxide to 
 uses on indolent surfaces when an excitant effect is desired. It is one of the most poison- 
 ous preparations of mercury. In action it is both stimulant and escharotic, employed 
 either as a dusting powder or an ointment.. An ointment (Unguentum Hydrargyri Oxidi 
 Rubri), containing ten parts of the oxide in one hundred parts of the ointment base, is 
 official. 
 
 General Surgery. In SYPHILITIC ULCERATIONS where the granula- 
 tions are indolent the surface of the sore may be dusted with equal parts 
 of the red oxide of mercury and starch, or be dressed with the ointment ; 
 this proves an excellent application, stimulating the surfaces and rapidly 
 changing the character of the discharge and hastening the healing process. 
 Care must be exercised not to expose too large a surface at once, as the salts 
 may become absorbed and induce salivation. The red oxide of mer- 
 cury may be employed as a dusting powder in the treatment of CHAN- 
 CROID SORES in place of iodoform ; it possesses the advantage of being 
 free from odor. An ointment (ten grains to one ounce) has been highly 
 recommended by T. Smith. The mass is spread on lint and applied to 
 the skin over an INFLAMED BUNION, to hasten the absorption of fluid in 
 the bursa. 
 
 Diseases of the Skin. The red oxide of mercury is an admirable 
 stimulant employed in ointment of five to twenty grains to the ounce in 
 circumscribed patches of CHRONIC ECZEMA. On account of the diffi- 
 culty of obtaining the drug in an impalpable powder the yellow oxide 
 has of late largely taken its place. 
 
 Diseases of the Nose. This agent is of great value in the treat- 
 ment of ECZEMATOUS and other inflammations of the external nose and 
 the interior of the nostrils. A favorite prescription of Trousseau for 
 CHRONIC CORYZA was a powder thrown up the nostril, of forty grains of 
 the finely powdered drug added to an ounce of sugar. 
 
 Diseases of the Eye. The red oxide of mercury, in the form of 
 ointment, was formerly much used in ophthalmic surgery, but of late 
 years has been generally supplanted by the yellow oxide. It may be used 
 in the same way as the latter.
 
 HYDRARGYRI OXYCHLORIDUM HYDRARGYRUM. 273 
 
 HYDRARGYRI OXYCHLORIDUM. Oxychloride of Mercury. 
 
 Mercuric oxychloride is prepared by boiling a solution of corrosive sublimate with 
 oxide of mercury. The solution is filtered and cooled to 60 C., when a whitish precipi- 
 tate separates out, consisting of several oxychlorides of mercury. Most of these oxy- 
 chlorides are insoluble in alcohol, and are by this liquid separated from corrosive sublimate. 
 
 Diseases of the Eye. Chibert (Annal. d' Oculist, ci, 252) claims 
 that the oxychloride of mercury is superior to the bichloride as an 
 antiseptic in .ophthalmic surgery, because it is better borne by the 
 tissues and does not injure instruments. He bathes the eye freely with a 
 solution of one to fifteen hundred, and states that the most delicate 
 instruments are not injured by immersion for ten minutes in a solution of 
 one to one hundred. 
 
 The oxychloride was recommended by Lawrence, nearly sixty years 
 ago, as an application in the treatment of PURULENT OPHTHALMIA, in the 
 strength of one or two grains to the ounce ; and was the chief ingredient 
 in the "aqua conradi " (oxymuriate of mercury, gr. j ; mucilage quince 
 seed, 3J ; tinct. of opium, gj ; rose water*, ad vj), which, twenty years 
 ago, was a favorite prescription on the Continent for CONJUNCTIVITIS. 
 
 HYDRARGYRI SUBSULPHAS FLAVUS. Yellow Subsulphate of 
 Mercury. Turpeth Mineral. (Hydrargyri Sulphas Flava. Pharm., 
 1870.) Basic Mercuric Sulphate. 
 " A heavy lemon-yellow powder, permanent in the air, odorless, and almost tasteless, 
 
 insoluble in water or alcohol, but soluble in nitric or hydrochloric acid." (U. S. P.) 
 
 Diseases of the Skiri. Turpeth mineral is used by French physi- 
 cians in the treatment of ALOPECIA and PITYRIASIS CAPITIS, being em- 
 ployed in ointment of the strength of ten to fifteen grains to the ounce. 
 
 Diseases of the Ear. F. W. Hinkle recommends, in the earliest 
 stage of ACUTE INFLAMMATION of the MIDDLE EAR, an ointment of yellow 
 sulphate of mercury, one grain to the ounce, applied freely about the 
 pharyngeal orifice of the Eustachian tube and vault of the pharynx. 
 
 / 
 
 HYDRARGYRUM. Metallic Mercury. Quicksilver. 
 " Shining, silver-white metal, liquid at temperature above 40 C. ( 40 F.), odor- 
 less and tasteless, and insoluble in ordinary solvents, but soluble in nitric acid without 
 residue. Specific gravity 13.5." (U. S. P.) 
 
 In its pure state mercury appears to be almost an inert substance, as 
 large quantities of it have been taken without producing any effect. But 
 when it is subdivided, broken into minute particles, its action is much 
 more energetic. 
 18
 
 274 LOCAL THERAPEUTICS. 
 
 General Surgery. When rubbed into the skin in minute subdivi- 
 sions its action is increased. It is readily taken up into the system 
 through the cutaneous absorbents, and has been detected in all the secre- 
 tions, as the blood, urine, saliva, and milk. If the use of mercury (either 
 local or general) is prolonged with the purpose of impressing the system, 
 it produces a specific effect upon the salivary glands known as mercurial 
 salivation (ptyalism). In salivation emaciation ensues, the blood becomes 
 watery and loses its power of coagulation. In saliva, under the same sys- 
 temic condition, Simon found an increase of the solid matters, and 
 Bostock states that it is less viscid than in a healthy state, and contains a 
 substance analogous to coagulated albumen. 
 
 Mercurials hasten the absorption of morbid fluids and materials of low 
 organization, e.g., the albuminous materials which are deposited by 
 syphilis. In small quantities mercury undoubtedly possesses a tonic action 
 and increases the number of red blood corpuscles. Its use is specially 
 indicated in SYPHILITIC ANAEMIA. Various constitutional effects are noted 
 from the cutaneous absorption of the drug. Miners and artisans who are 
 exposed daily to contact with ifs salts, suffer from palsy, wrist-drop, etc. 
 In some cases the prolonged exposure has produced a condition similar 
 to scurvy, manifested by emaciation, general loss of strength, alopecia, 
 and aching pains in the bones. Owing to idiosyncrasy, some subjects are 
 unable to use mercury in any form without serious consequences. A case 
 is reported of exfoliation of the jaw and death ensuing upon the use of 
 three drachms of the ointment rubbed into the skin. When the system 
 is in a low, broken-down state the action of all mercurials is to be depre- 
 cated. Children and old persons are difficult subjects to bring under its 
 influence. Persons in robust health likewise resist its influence. In some 
 inflammatory conditions, as of the brain and peritoneum, a patient will 
 often withstand the influences of the drug for a long time. 
 
 The local employment of mercury relates to its value when used in the 
 treatment of SYPHILIS and kindred states, as a parasiticide, and as a 
 remedy for inflammation. 
 
 EMPLASTRUM HYDRARGYRI. Mercurial Plaster. 
 
 Mercurial plaster is made by incorporating thirty parts of mercury, first, with ten parts 
 of olive oil and ten parts of resin melled together, and, afterward, with fifty parts of 
 melted 'lead plaster, so that the finished plaster contains thirty per cent, of mercury. 
 
 General Surgery. Mercurial plaster is useful as a surgical dressing 
 in cases of articular diseases, such as CHRONIC SYNOVITIS, etc. Its effi- 
 cacy depends upon three conditions: i. Its mechanical support to the 
 affected part; this is sufficient, provided the plaster is spread on firm 
 leather and is of sufficient thickness; 2. Its mild, counter-irritant action,
 
 HYDRARGYRUM. 275 
 
 which tends to relieve the deeper vessels of their blood, and in that way to 
 diminish inflammation ; 3. The specific alterative effect from the absorp- 
 tion of mercury, on account of the dilated state of the cutaneous vessels. 
 The continuous use of this preparation of mercury may cause slight 
 ptyalism, consequently the surgeon should be constantly on the alert 
 for such symptoms, especially in susceptible subjects. It should be 
 discontinued on the first approach to any tenderness about the gums. 
 Mercurial plaster has long been used with success for the removal of 
 SYPHILITIC NODES and GLANDULAR ENLARGEMENTS. It appears to assist 
 in reducing the size of the spleen in malarial poisoning. 
 
 But on the whole it may be said that the belladonna and mercurial 
 ointment (q. #.) has superseded the use of mercurial plaster in most 
 cases. 
 
 UNGUENTUM HYDRARGYRI. Blue Ointment. Mercurial Ointment. 
 
 Blue ointment is made by incorporating metallic mercury with lard. 
 This preparation of mercury is probably the one most generally used as 
 a topical application, in order to rapidly bring the system under the direct 
 influence of the drug. In the treatment of SYPHILIS, Keys prefers mer- 
 curial ointment of the Pharmacopoeia in preference to any made with 
 lanolin. He says, " The oleates which I formerly used I have given up. 
 They irritate the skin more frequently than ordinary mercurial ointment." 
 According to Brodie, mercury used by inunction neither gripes nor 
 purges, and the general impression is well borne as compared to other 
 methods. 
 
 It is used in the " Kur " at Aix-la-Chapelle, and to this circumstance the 
 reputation of this locality is largely due. About half a drachm of the 
 ointment is rubbed upon the skin by a trained attendant for periods 
 ranging from twenty to thirty minutes at a time. The course is usually 
 a month. It is customary to advise patients to return after the lapse of 
 a few months to complete the cure. Excellent results are obtained in this 
 way in many cases that have baffled ordinary methods of treatment. As 
 Mr. Hutchinson (" Syphilis," p. 57) believes, everything that is done at 
 Aix can be done equally well at the patient's home, provided that all pre- 
 cautions are preserved. 
 
 In conducting mercurial inunction the following details will prove 
 useful. The ointment should be rubbed into different places on succes- 
 sive days and so avoid the tendency to cutaneous irritation. Generally 
 it is best borne on the sides of the chest and abdomen, although- the 
 axilla, the groin on the inside of the thighs, where the skin is delicate, 
 are favorite localities. There is no doubt that absorption is more rapid 
 when applied to the groin and axilla, but in a short time a troublesome 
 eczematous eruption is developed about the roots of the hair follicles.
 
 276 LOCAL THERAPEUTICS. 
 
 The best time for the inunctions is in the evening. The patient should 
 put on a flannel gown and retire without bathing. 
 
 In dispensary practice, where many persons are prescribed for who are 
 not apt to obey directions, we advise that a piece of ointment about the 
 size of a hazelnut be smeared over the sole, after which the stocking 
 is replaced. 
 
 In subacute SYNOVITIS, especially of the knee joint, with effusion, no 
 remedy has met with warmer approbation than the persistent use of 
 the ointment of mercury. Mr. Adams uses inunctions over blistered 
 surfaces. In chronic cases the following, known as Scott's dressing, 
 is recommended : R. Ung. hydrarg., gj ; camphor, 3]. This prepara- 
 tion is also known as the Cerat Hydrarg. Comp. (London Ph.) This 
 dressing, when conjoined with firm pressure and complete rest, is 
 often followed by excellent results. Equal parts of mercurial and 
 belladonna ointments, spread on lint and laid over the injured surface, in 
 the subacute and chronic stages of articular disease, is also an admirable 
 dressing. It possesses the antiphlogistic and absorbent properties of mer- 
 cury and also the local sedative effect of belladonna. In PERITONITIS 
 after counter-irritation has been made either with turpentine or blisters 
 over the surface of the abdomen, much good can be obtained by covering 
 the abdomen with the belladonna and mercury ointment. It should be 
 spread on lint and overlaid by a hot poultice. The same treatment is 
 applicable to PELVIC CELLULITIS. In ANGIOLEUCITIS following dissecting 
 wounds the course of the inflamed lymphatics may be* covered with mercurial 
 ointment spread on lint, the limb being placed at rest. If the invasion is 
 along the lymphatics of the upper extremity it is well to surround the arm 
 above the highest point of inflammation with a circular blister, one inch 
 in width. In the treatment of ERYSIPELAS the use of mercurial ointment 
 is advised by Velpeau and Ricord and others, although it may be ques- 
 tioned if it possesses advantages over other more cleanly applications that 
 are advised. Mercurial ointment, or a combination of it with belladonna 
 ointment, is valuable in absorbing indurations following an attack of 
 SYPHILITIC ORCHITIS or EPIDIDYMITIS. In JAUNDICE in the newborn baby 
 R. A. F. Penrose advises the use of the ointment spread on the roller 
 which is worn next to the skin. In ADENITIS mercurial ointment has 
 been used with a fair amount of success, but, on the whole, may be con- 
 sidered less efficient than are the preparations of iodine. 
 
 Diseases of the Skin. Metallic mercury is employed in the treat- 
 ment of skin diseases under the form of the well-known unguentum 
 hydrargyri. This preparation is employed in the treatment of INFANTILE 
 SYPHILIS. A piece the size of a large hickory nut is spread upon a flannel 
 belly-band, and renewed daily until the band becomes stiff, when a new 
 one is employed. This is readily absorbed and affords a convenient
 
 HYDRARGYRUM AMMONIATUM. 
 
 277 
 
 method of introducing mercury into the system without interfering with 
 the digestion. 
 
 In palmar and plantar syphilis the following plaster is useful : R. Hy- 
 drarg. gr. c; terebinth., gr. c; emplast. plumbi, gr. ccl ; resini pini, 
 gr. 1. M. It is very tenacious, and when applied should be kept in 
 contact with the thickened skin as long as it will adhere. 
 
 Diseases of the Chest. Stristower {Berl. Klin. Wochensch., 1891, 
 No. 22) claims that inunction on the chest walls in PULMONARY PHTHISIS 
 is followed by remarkable diminution in the bacilli of the sputum, while 
 the general condition of the patient improves. 
 
 HYDRARGYRUM AMMONIATUM. Ammoniated Mercury. 
 
 White Precipitate. Mercurammonium Chloride. 
 
 Ammoniated mercury is composed of " white, pulverulent pieces, or a white powder, 
 permanent in the air, odorless and tasteless, and insoluble in water or alcohol." (U. S. P.) 
 An ointment (Unguentum Plydrargyri Ammoniati), containing ten parts of ammcniated 
 mercury in one hundred parts of the ointment, is official. 
 
 Ammoniated mercury is discutient, stimulant, and parasiticide. 
 
 Diseases of the Skin. Ammoniated mercury is employed in the 
 form of an ointment. In the proportion of five to twenty grains to the 
 ounce, it is a valuable application in TINEA CIRCINATA and TINEA TON- 
 SURANS, also in SCALY SYPHILITIC ERUPTIONS and in PSORIASIS. In some 
 conditions of CHRONIC ECZEMA the ointment of ammoniated mercury is 
 of value. 
 
 The official ointment has always been made of an impracticable 
 strength. It will rarely be possible to employ the drug in ointment of a 
 greater strength than twenty grains to the ounce. A stronger form is 
 apt to excite dermatitis, and even weaker ointments at times cause sali- 
 vation if employed over too large *a surface. 
 
 The ten- to twenty-grain ointment of ammoniated mercury is particu- 
 larly useful in PSORIASIS OF THE SCALP AND FACE, being one of the few 
 efficient ointments which do not discolor the skin. 
 
 Diseases of the Ear and Nose. Ammoniated mercury is used by 
 Sexton for CHRONIC ECZEMA of the auricle. B. Robinson (N. Y. Med. 
 Journal, September 29, 1887) employs the ointment with vaseline for a 
 base in loosening crusts in ATROPHIC RHINITIS. It is of especial value in 
 the treatment of ECZEMA OF THE NOSTRIL. 
 
 EMPLASTRUM AMMONIACI CUM HYDRARGYRO. 
 
 
 
 This plaster unites the stimulating and alterative properties of both 
 drugs. It was at one time extensively employed in the later stages of 
 SYNOVITIS of the knee-joint, spread on leather and retained firmly
 
 278 LOCAL THERAPEUTICS. 
 
 by a bandage, the joint being fixed with a posterior splint. Since 
 the introduction of mercurial and belladonna ointment, it is not so often 
 employed as formerly, although it may be applied to a joint, and the 
 entire articulation enveloped in a plaster-of-Paris bandage, which is left 
 undisturbed for several weeks. 
 
 HYDRARGYRI NITRAS. Nitrate of Mercury. 
 
 The salt is obtained by concentrating and crystallizing the solution. It is rarely used. 
 (For properties, vide infra.') 
 
 Diseases of the Nose, Throat, etc. J. S. Cohen recommends the 
 use of nitrate of mercury (one part to ten of water) as a topical applica- 
 tion to the vocal cords in CHRONIC LARYNGITIS. The same writer refers 
 to a local treatment of FCETID CORYZA, by applying a solution of fifteen 
 grains of the drug with fifteen drops of fuming nitric acid in about six 
 drachms of warm water. 
 
 LIQUOR HYDRARGYRI NITRATIS. Solution of Nitrate of Mercury. Solu- 
 tion of Mercuric Nitrate. Solution of Pernitrate of Mercury. 
 
 " A liquid containing about fifty per cent, of mercuric nitrate with some free nitric 
 acid." (U. S. P.) It is made by dissolving forty parts of red oxide of mercury in forty- 
 five parts of nitric acid and fifteen parts of water. 
 
 Acid nitrate of mercury is an active caustic. 
 
 General Surgery. Acid nitrate of mercury was at one time gener- 
 ally used for the cauterization of VENEREAL SORES. It is now, in the 
 main, restricted to the treatment of PHAGED^ENIC ULCERATIONS. It 
 is also recommended in the treatment of NOMA, especially in children 
 the subject of SYPHILIS. Its employment is not unattended with danger, 
 as it has been known to produce salivation. A case is recorded (Lancet, 
 January 3, 1874) in wh'ich severe totfic symptoms followed the appli- 
 cation to a surface less than two inches in diameter. In ULCERATION 
 OF THE CERVIX UTERI, especially when depending on any venereal 
 condition, an application of the acid nitrate will be found a prompt 
 and reliable agent. West states that he has used the acid nitrate with 
 benefit on OBSTINATE SIMPLE ULCERATION OF THE Os UTERI when 
 covered with fungous granulations. Care must be exercised, however, in 
 the application of such an agent to the uterus that portions of the 
 vaginal canal do not come in contact with the solution ; neither should 
 it come in relation with the speculum except that it be made of glass or 
 rubber. After applications of the drug to the uterus it is best to have 
 a small compress of cotton saturated with oil to neutralize excess, or 
 a tampon of cotton saturated .with black wash or carbolized oil. As a 
 rule, the applications are not painful.
 
 OLEATUM HYDRARGYRUM. 279 
 
 Diseases of the Skin. Nitrate of mercury is usually employed in 
 the form of the liquor hydrargyri nitratis. (U. S. P.) It can be applied 
 on a bit of stick wrapped around with absorbent cotton, which can be 
 thrown away after use. It is employed in the treatment of ACNE, small 
 MOLES, and NJEVI, ROSACEA, and, in a more or less diluted form, in 
 SCROFULOUS ULCERS, CONDYLOMATA, and Mucous PATCHES. 
 
 Diseases of the Ear, Nose, and Throat. The acid nitrate of 
 mercury is recommended by Roosa for the destruction of AURAL POLYPI. 
 
 It serves an admirable purpose in the treatment of SYPHILITIC ULCERA- 
 TION OF THE NASAL SEPTUM. S. Johnston recommends one part of this 
 agent to eight of water as an application to SYPHILITIC ULCERS OF THE 
 PHARYNX. The drug can be used pure or in proportion of one part 
 to five of water, as an application to SYPHILITIC LARYNGITIS. It has 
 been used with success in proportion as strong as one to three, or as 
 weak as one to ten, in making applications to the lining membrane of the 
 ventricle of the LARYNX after the removal of epitheliomatous outgrowths. 
 
 UNGUENTUM HYDRARGYRI NITRATIS. Citrine Ointment. 
 
 Citrine ointment is regarded by many of the older surgeons as a valu- 
 able stimulating ointment. By keeping long it decomposes, changes its 
 color, and becomes irritating, so that it should be used only when freshly 
 made. It may be diluted to any extent with lard. It can be used in 
 the treatment of INDOLENT ULCERS FOLLOWING BURNS. It has been 
 employed with considerable success in the abortive treatment of WHITLOW 
 or other inflammatory conditions involving the fingers. The method is 
 to cover the finger with the ointment one-eighth of an inch thick. Over 
 this is placed a broad strip of adhesive plaster. The dressing may remain 
 for twenty-four hours, after which time no further treatment is necessary. 
 {Med. and Surg. Reporter, April 14, 1888.) 
 
 Diseases of the Skin. Citrine ointment, more or less diluted, 
 forms an admirable stimulant application in CHRONIC ECZEMA and other 
 localized skin affections. 
 
 OLEATUM HYDRARGYRUM. Oleate of Mercury. .' 
 Oleate of mercury was introduced by Marshall as a substitute for mercurial ointment, 
 which it closely resembles. Ten parts of the yellow oxide of mercury are added in suffi- 
 cient oleic acid to make one hundred parts. As a pharmaceutical product it is superior to 
 the mercurial ointment. To obtain a satisfactory and stable preparation it is important 
 that a pure oleic acid should be employed, otherwise decomposition will take place and 
 metallic mercury form at the bottom of the vessel containing it. 
 
 General Surgery. Oleate of mercury has been especially com- 
 mended in CHRONICALLY INFLAMED JOINTS, and in INFLAMMATORY INDU-
 
 280 LOCAL THERAPEUTICS. 
 
 RATIONS. It is more irritating than blue ointment and is, therefore, 
 usually combined with morphine in the proportion of a grain to the 
 drachm. 
 
 The oleate of mercury is commonly employed as a substitute for mer- 
 curial ointment on account of its greater cleanliness. It forms an excel- 
 lent method for the constitutional treatment of SYPHILIS by inunction. 
 It is also a reliable parasiticide, particularly in TINEA TONSURANS. 
 
 In BROMIDROSIS of the axillae a few applications of a ten per cent, 
 oleate of mercury ointment to the skin previously cleansed with alcohol 
 is often of benefit. 
 
 HYDRARGYRI SALICYLAS. Salicylate of Mercury. 
 
 Mercuric salicylate is prepared by mixing solutions of mercuric sulphate and barium 
 salicylate. The resulting precipitate of salicylate of mercury is a fine, white, insoluble 
 powder, without odor or taste. It forms soluble double salts with the chlorides, bromides, 
 and iodides of sodium or potassium. 
 
 Diseases of the Skin. The salicylate of mercury has recently been 
 employed in the treatment of SYPHILITIC ULCERS. A lotion of five grains 
 each salicylate of mercury and carbonate of potassium to the ounce of 
 distilled water and an ointment of sixteen grains of the mercurial salt to 
 the ounce of vaseline are recommended. 
 
 MERCURIAL BATH. 
 
 The mercurial vapor may be generated from metallic mercury, calo- 
 mel, mercury with chalk, the bisulphuret, the gray oxide, or the binoxide, 
 from a scruple to three drachms of which are required for each bath, the 
 quantity being proportioned to the effect desired. (Bumstead and Taylor, 
 "Venereal Diseases.") 
 
 Taylor prefers calomel (q. v.\ which should be perfectly pure. An 
 apparatus should be employed by which watery vapor is first disengaged, 
 and later the mercurial vapor. The treatment is of advantage in exten- 
 sive pustular or crusted SYPHILODERMATA, but owing to the inconvenience 
 attending its use it has not been extensively employed. 
 
 An apparent exception to the rule of non-absorption of salts in watery 
 solution is found to obtain in the case of infants treated for HEREDITARY 
 SYPHILIS by baths of corrosive sublimate. The child is placed in an ordi- 
 nary wash-tub of water in which ten grains of corrosive sublimate have been 
 dissolved. A sufficient quantity will be absorbed, after several such baths 
 have been taken on successive days, to influence the system in a manner 
 favorable to recovery. (For accounts of Baths see Appendix.}
 
 HYDRASTIS. 2 8l 
 
 HYDRASTIS. Hydrastis. Golden Seal. 
 
 Hydrastis is " the rhizome and rootlets of Hydrastis canadensis." (U. S. P.) The 
 drug contains three alkaloids, hydrastine, berberine and canadine. " Hydrastine crystallizes 
 in brilliant, one-sided prisms, which are white or colorless when pure, inodorous and almost 
 tasteless in consequence of their insolubility in the saliva, but which become bitter and 
 somewhat acrid in saline combination. It is nearly insoluble in water, but is readily 
 dissolved by alcohol, ether, chloroform, and benzol. It has an alkaline reaction and forms 
 salts with acids, most of which are readily soluble in water." (U. S. D.) 
 
 Berberine, to which hydrastis owes its yellow color, is in the form of a yellow powder, 
 having a bitter taste, soluble in about a hundred parts of cold water, less soluble in cold 
 alcohol, freely soluble in both hot alcohol and hot water, and not at all soluble in ether. 
 It forms sparingly soluble salts with hydrochloric and sulphuric acid, and a freely soluble 
 salt with acetic acid. The hydrochloride is the salt most used. Canadine occurs in white 
 needles; the sulphate is the most desirable salt. A resinous substance obtained by treat- 
 ing an infusion with hydrochloric acid is sometimes sold under the name of hydrastin. 
 It is a mixture containing resin, hydrastine, and berberine, and becauseof the uncertainty 
 of its composition should not be used. 
 
 General Surgery. Much of the virtue of this drug is probably due 
 to berberine. The fluid extract has been used locally in FISSURE OF THE 
 ANUS and in ULCERATED CONDITIONS OF THE RECTUM. It has also been 
 used in LEUCORRHCEA and VAGINAL and UTERINE ULCERATIONS. The 
 hydrochloride of hydrastine apparently possesses virtues similar to those of 
 ergot. It is used hypodermically in five and ten per cent, solutions. The 
 injections are said neither to cause pain nor discoloration of the tissues. 
 Falk has reported twenty-six cases where he has employed it in this 
 manner with more satisfactory results than with ergotine. 
 
 Diseases of the Nose, Throat, Mouth, etc. Hydrastis has had 
 for a long time a reputation in domestic medicine in relieving excited 
 states of the mucous membranes. Hence, the suggestion has been made 
 that its properties may be useful in the local treatment of CATARRH of the 
 upper respiratory tract. The fluid extract is bitter and not free from irri- 
 tating properties. A solution of hydrochloride of hydrastine in the pro- 
 portion of twenty grains to a pint of water forms a preparation of which 
 one-third diluted with two-thirds of water can be used locally upon the 
 affected parts. 
 
 Leffmann (Amer. Sys. of Dentistry, p. 726) claims that hydrastis is anti- 
 septic in proportion of one drachm of the tincture to an ounce of water. 
 It is found to be a useful application in all INDOLENT and OFFENSIVE 
 ULCERATION OF THE MOUTH AND THROAT. 
 
 Potter ("Therapeutics") and S. H. Chapman recommend hydrastis in 
 the local treatment of SUBACUTE NASAL CATARRH. A drachm of the 
 fluid extract may be added to eight ounces of water and used as a lotion. 
 
 Hydrastis is mentioned by manufacturers of chemical preparations
 
 282 LOCAL THERAPEUTICS. 
 
 for the trade to be of value when used either locally or generally. It 
 enters into the composition of nasal bougies, each bougie. containing five 
 minims of the fluid extract ; yet many practitioners are skeptical as to its 
 value. According to E. L. Shurly (JV. Y. Me d. Journal, September n, 
 1886), it is worthless. 
 
 Diseases of the Eye. Hydrastine has been recommended as a 
 stimulant in sluggish forms of CHRONIC CONJUNCTIVITIS, but has not been 
 much used. A solution of four or five grains to the ounce is applied 
 to the everted lids. 
 
 HYDROGENII PEROXIDUM. Hydrogen Dioxide. Peroxide of 
 Hydrogen. Solution of Peroxide of Hydrogen. 
 Solution of Hydroxyl. 
 
 Peroxide of hydrogen is usually made by decomposition of hydrated peroxide of 
 barium by sulphuric acid. For use in the field E. R. Squibb & Sons prepare materials for 
 the extemporaneous preparation of the solution. A mixture of barium dioxide and of 
 phosphoric acid is made. To remove the small proportion of barium (probably in the 
 condition of an acid phosphate of barium) a small quantity of dilute sulphuric acid is 
 added. Peroxide of hydrogen is employed in the arts for bleaching, and is the substance 
 which, under v.irious names, is sold for bleaching the hair. It must, therefore, be employed 
 with caution in surgical applications to the head and face. It should be remembered 
 that it effervesces not only with pus, but with blood and serum. 
 
 The preparation furnished is a ten- or fifteen-volume solution, that is to say, about 
 three per cent, aqueous solution H 2 O 2 .* This is, however, apt to contain a proportion of 
 hydrochloric acid, so that it should be further diluted with one or two parts water. 
 (S. Solis-Cohen, N. Y. Med. Journal, March 6, 1886.) 
 
 Peroxide of hydrogen is unstable. It should be kept in a cool, dark place, and it is 
 better for the bottles to be small, so that what is not used may not be exposed to the 
 atmosphere. 
 
 " Solutions should be kept loosely corked so that the oxygen of decomposition may 
 leak out, or the cork be easily blown out, because in this way the risk of dangerous explo- 
 sion is avoided, whilst the decomposition is not retarded by keeping the oxygen in." 
 (Circular of Squibb & Sons.) 
 
 Peroxide of hydrogen is antiseptic, f slightly stimulating, and, by 
 virtue of its remarkable property of effervescing in the presence of pus, 
 
 *This preparation appears to be sold entirely on the amount of available oxygen that 
 is, the volume of free oxygen which a volume of the solution will yield. A fifteen volume 
 solution will yield fifteen volumes of oxygen. As the commercial article rarely if ever 
 yields over ten volumes of oxygen, it is safe to use it of full strength, notwithstanding the 
 fact that the manufacturers claim their product to yield full fifteen volumes. The term 
 per cent, has come to be used instead of volume, and very improperly. There can be 
 no such thing as a ten per cent, solution of hydrogen peroxide. Volume is always 
 intended. The per cent, is rarely above two or three. 
 
 f In this connection see P. Gabier ("Trans. Internal Med. Congress," Berlin, 1890.)
 
 HYDROGENII PEROXIDUM. 283 
 
 mucus, cerumen, and blood, cleanses diseased surfaces while exerting 
 no injurious effect upon the cells. By removing enveloping fluids and 
 septic clots, it enables the physician to make subsequent applications of 
 other drugs. Miguel, indeed, places peroxide of hydrogen at the head 
 of the list of antiseptic agents. The following table shows the relative 
 strengths of the four most powerful germicides : 
 
 Biniodide of mercury, 0.025 
 
 Biniodide of silver, 0.03 
 
 Hydrogen dioxide, 0.05 
 
 Bichloride of mercury, 0.07 
 
 Judging from the writings of enthusiastic observers, some of the results 
 claimed may mislead ; nevertheless, if the drug be used with intelligence, 
 it is an excellent remedy. B. W. Richardson, who introduced the agent 
 into practice (Asclepiad, January, 1891), found that to venous blood 
 deprived of fibrin it imparts oxygen. Fibrin and cellular tissues cause it 
 to evolve oxygen ; sugar and starch are decomposed. Albumin, gelatin, 
 urea, have no effect on it. 
 
 General Surgery. Peroxide of hydrogen may be applied either by 
 means of an atomizer, syringe, or a small swab of clean, absorbent cotton 
 on a splinter of wood, according to circumstances. The uses to which 
 it may be put are numerous in the treatment of wounds. 
 
 Peroxide of hydrogen is especially efficacious in the removal from 
 granulating surfaces of small superficial sloughs (which cause the lesion 
 to exhibit a dull gray appearance) seen in CHRONIC LEG ULCERS, INDO- 
 LENT SUPPURATING BUBOES, and in FISTULOUS TRACTS. Owing to its 
 non-irritating properties, it may be employed with advantage in the 
 cleansing of large articular cavities. In EMPYEMA it especially recom- 
 mends itself in preference to other antiseptics for washing out the affected 
 cavity. In abdominal surgery, especially when connected with either 
 inflammatory or septic collections of matter, it is efficient. The wound 
 should be injected with the pure solution, or diluted one-half with distilled 
 water. After cleansing, the cavity may be packed with gauze saturated 
 with the solution and dressed after the usual antiseptic method. C. Noble 
 commends the peroxide of hydrogen for cleansing the hands preparatory 
 to'abdominal operations, especially when the skin about the fingernails 
 has become horny or rough from too frequent washing or from prolonged 
 contact with antiseptic solutions. In CYSTITIS, where pus is voided with 
 the urine, peroxide of hydrogen may be employed as an irrigating solu- 
 tion in strength of two ounces of the fifteen volume solution to a pint of 
 distilled water. Great care must be exercised not to over-distend the 
 bladder. Peroxide of hydrogen has been employed as an injection in 
 GONORRHCEA, but the results obtained have not been satisfactory, as
 
 284 LOCAL THERAPEUTICS. 
 
 reports would lead one to believe. It will be found of service in the 
 cleansing and treating of VENEREAL SORES, as CHANCROIDS, etc. In 
 PUERPERAL SEPTIC ENDOMETRITIS Grandin speaks highly of peroxide of 
 hydrogen for flushing the uterus after it has been curetted. 
 
 Diseases of the Skin. Peroxide of. hydrogen has a limited field 
 of employment. Applied to FOUL and TORPID ULCERS it freshens the 
 surface, and stimulates granulations ; it has likewise been employed for 
 the removal of discoloration of the skin, as CHLOASMA. 
 
 Diseases of the Ear, Nose, Throat, etc. The fifteen-volume 
 solution is generally diluted about one-fourth for the throat, nose, or 
 pharynx. It can be directed in full strength in dissolving CERUMEN, 
 and with care the commercial solution can be applied to the tonsils. 
 
 It is of especial value in cleansing the middle ear, notably the tympanic, 
 attic, and external auditory passage. A six per cent, solution may be used 
 as a convenient strength in the beginning of the treatment. The solu- 
 tion can be gradually increased. (W. A. Dayton, Arch, of Otology, vol. 
 xiv, 1885.) The tonsil, the thicker tissue over the middle turbinated 
 bone, the surface of a syphilitic ulcer, are often covered with tenacious 
 mucoid masses, which render ineffective local medication of the diseased 
 structures. Such exudates can be easily removed by the peroxide. The 
 agent has less influence on the deposits of tonsillitis than on other forms. 
 W. C. Glasgow (Trans. Am. Laryng. Ass'n, 1889) uses peroxide of 
 hydrogen as a spray on the deposits of DIPHTHERIA. It is of great value 
 in the laryngeal form of the disease. In Philadelphia the employment 
 of the peroxide as thus indicated is in accordance with the practice of 
 most physicians. 
 
 W. C. Phillips (Med. Record, April n, 1891, 423) claims that this agent 
 has haemostatic qualities and is indicated after intra-nasal operations. The 
 undiluted solution should be sprayed in the nose, where it will mix with the 
 blood and form a firm clot, when HEMORRHAGE is arrested by pressure. 
 
 Diseases of the Eye. Landolt (Archives d* Ophthalmol. , 2, 385) 
 considers the peroxide of hydrogen a powerful antiseptic and a remedy of 
 great value in ocular therapeutics. He claims that it promptly arrests 
 suppuration and seems to deprive it of its septic character, while it is 
 better borne by the cornea and conjunctiva than any official germicide. 
 He recommends it particularly in PURULENT OPHTHALMIA, DIPHTHERITIC 
 CONJUNCTIVITIS, SLOUGHING ULCERS OF THE CORNEA, and SUPPURATION 
 OF THE LACHRYMAL PASSAGES. He uses a three per cent, solution (three 
 per cent, by weight, about equal to the fifteen-volume solution in common 
 use), which may be employed with safety ; concentrated solutions * 
 
 * At the Will's Hospital, Philadelphia, a 50 per cent, strength of the fifteen-volume 
 solution is used.
 
 HYDROXYLAMINE HYDROCHLORIDE HYOSCYAMUS. 285 
 
 may cause haziness of the cornea. In PURULENT OPHTHALMIA a few 
 drops are instilled in the conjunctival sac four or five times a day. In 
 SLOUGHING KERATITIS Landolt aids the separation of the slough, after 
 applying the peroxide, by gentle friction with the lid. In SUPPURATION 
 OF THE LACHRYMAL PASSAGES the solution is forced through them by 
 means of the small lachrymal syringe. 
 
 Other observers have made similar claims for this drug, but it has not 
 yet passed the experimental stage, and something must be allowed for the 
 enthusiasm for new remedies. 
 
 HYDROXYLAMINE HYDROCHLORIDE. 
 
 The base, hydroxylamine, of this crystalline salt is only known in solution, and differs 
 from ammonium hydrate by two hydrogen atoms. Ammonium hydrate has the formula 
 NH 4 OH, and hydroxylamine NH 2 OH. The hydrochloride, NH 2 OH.HC1, appears to 
 be the only form in which it is used medicinally. 
 
 It occurs in colorless crystals, which readily absorb moisture from the air. It is solu- 
 ble in an equal weight of water, in fifteen parts of alcohol, and readily soluble in glycerin. 
 In many respects it resembles ammonium chloride, from which it is distinguished by 
 forming a clear solution with twenty parts of absolute alcohol, while the ammonium chlo- 
 ride is sparingly soluble in that liquid. 
 
 Hydroxylamine hydrochloride is parasiticide and excitant. 
 
 Diseases of the Skin. Hydroxylamine was introduced by Eichoff 
 {Monatsh. f. Prakt. Dermatol., January i, 1889) as a "reducing agent." 
 He considers it a valuable remedy in the vegetable parasitic diseases of 
 the skin, TINEA CIRCINATA, TINEA TONSURANS, TINEA FAVOSA, and TINEA 
 VERSICOLOR. 
 
 After washing the affected parts with soap and water, these are painted 
 thrice daily with the following pigment : R. Hydroxylamin. hydrochloridi, 
 gr. j ; alcoholis, glycerinse, aa fgj. M. 
 
 Binz agrees with Eichoff in recommending this remedy, and asserts it 
 to be a substitute for chrysarobin. He uses it in LUPUS, PSORIASIS, and 
 PARASITIC SYCOSIS. Fabry also recommends it, while Groddeck (Monat- 
 shefte f. Prakt. DermatoL, 1890, p. 162) regards it as useless and dan- 
 gerous. 
 
 HYOSCYAMUS. 
 
 " Hyoscyamus is composed of the leaves of Hyoscyamus niger, collected from plants 
 of two years' growth." (U. S. P.) The leaves contain two alkaloids hyoscyamine 
 and hyoscyine. " Hyoscyamine crystallizes in colorless, transparent, silky needles, is 
 inodorous, of an acrid, disagreeable taste, slightly soluble in water, and very soluble in 
 alcohol and ether." (U. S. D.) The salts sulphate, hydrobromide, etc. are freely 
 soluble in water. Hyoscyine is usually employed in the form of the hydrobromide, 
 which is freely soluble in water. (See Belladonna?)
 
 286 LOCAL THERAPEUTICS. 
 
 Hyoscyamus is sedative. 
 
 General Surgery. Hyoscyamus is employed locally in surgery for 
 the same purposes as is belladonna. It is used in the form of a sup- 
 pository combined with opium in the treatment of CYSTITIS, to relieve 
 both the pain and spasm of the bladder. In Europe, where the fresh 
 leaves are readily obtained, hyoscyamus is often applied in the form 
 of a lotion or fomentation, for the relief of painful HEMORRHOIDS, 
 GLANDULAR ENLARGEMENTS, RHEUMATIC SWELLINGS, and NERVOUS 
 HEADACHE. The drug has long possessed a reputation in the treatment 
 of neuralgic affections, but, as a rule, more prompt and active results 
 can be obtained from belladonna. 
 
 HYOSCYAMINE. 
 
 Diseases of the Eye. The effects of hyoscyamine upon the eye are 
 practically the same as those of duboisine. Indeed, some good authori- 
 ties consider these alkaloids to be in all respects identical, while others, 
 admitting their chemical identity, still claim that there are differ- 
 ences in their therapeutic action. Hyoscyamine has been said to be less 
 likely to cause unpleasant constitutional effects, when used as a mydri- 
 atic, than duboisine, but as it has not been so extensively employed as the 
 latter, this question cannot be considered decided. 
 
 HYDRIODATE OF HYOSCINE. 
 
 The hydriodate of hyoscine is the most powerful of the mydriatics, but 
 is comparatively little used in ophthalmic surgery, because of its activity 
 as a poison. A half per cent, solution applied to the conjunctiva is said 
 to be liable to cause toxic symptoms, but this proportion has been fre- 
 quently used in the Wills Eye Hospital without unpleasant effects. It is 
 claimed for it that it will sometimes relieve IRITIC and CYCLITIC PAIN 
 when the other mydriatics have failed. It is used in solutions of from 
 one-half grain to two grains to the ounce. 
 
 Diseases of the Throat, etc. Preparations of hyoscyamus may 
 be substituted for those of opium for the relief of pain in CHRONIC LARYN- 
 GITIS. It forms a constituent of an anodyne lozenge. 
 
 Hyoscyamus is one of the ingredients of baume tranquille. 
 
 ICHTHYOCOLLA. Isinglass. 
 
 The swimming bladder of Acipenser kuso, Linnaeus, and of other species of Acipenser. 
 
 In separate sheets, sometimes rolled, of a horny or pearly appearance ; whitish or yel- 
 lowish, semi-transparent, iridescent, inodorous, insipid ; almost entirely soluble in boiling 
 water and in boiling diluted alcohol. 
 
 The solution in twenty-four parts of boiling water forms, on cooling, a transparent 
 jelly.
 
 ICHTHYOL. 287 
 
 Emplastrum Ichthyocollce is the single official preparation. 
 
 Isinglass is demulcent and protective. 
 
 General Surgery. Emplastrum Ichthyocollae. Isinglass Plaster. 
 Court Plaster. Besides forming a protectant for recent cuts and abra- 
 sions, isinglass plaster maybe employed to hold the edges of wounds 
 together when the parts have been thoroughly cleaned and adjusted. 
 It should be used fresh, as it dries and cracks very quickly on exposure. 
 An air-tight box is useful to preserve it. The application of a little gly- 
 cerin and water will often improve an old piece. " Mechanics' Arnica 
 Plaster " is an isinglass plaster spread on thin kid. It is about the only 
 plaster that deserves the name of " waterproof." If well applied, it will 
 keep its place in spite of moderate washing with warm water, soap, and a 
 nail-brush. After washing, the edges are loosened and may be clipped 
 off. The rest, with a little care, can be utilized for some time. With 
 each washing a little of the plaster is sacrificed ; but it will be some time 
 before the last of it is lost. It is valuable in the treatment of CHAPPED 
 KNUCKLES and RHAGADES. 
 
 * - . 
 
 ICHTHYOL. Ichthyol-sulphonate of ammonium. 
 
 Ichthyol is the trade name given to various salts of sulph-ichthyolic acid. 
 
 " In the dry distillation of a bituminous mineral containing fossil fish a tarry product 
 is obtained. On treating this with sulphuric acid, and subsequently neutralizing with 
 sodium or ammonium carbonate, ichthyol is obtained. This is a red-brown, syrupy 
 liquid, of a bituminous odor and taste. Water or a mixture of equal volumes of alcohol 
 and ether dissolves it to form a clear, red-brown liquid of a faintly acid reaction. Pure 
 alcohol or ether dissolves it only partially; petroleum benzin takes up only a small quan- 
 tity. It unites with fat and vaseline in all proportions." (U. S. D.) It contains about 
 fifteen per cent, of sulphur.* 
 
 In a case reported by Bergeris a toxic impression from ichthyol ensued upon its use in 
 the form of an intra-uterine injection. After remaining in collapse for twelve hours the 
 patient recovered. (See Thiol.) 
 
 * While this book was going through the press a'monograph by Fessler (" Die Wirkung 
 Ichthyols bei Erysipel und vorwandten Krankheiten," Miinchen, 1892) was received. 
 The following abstract from this important study is herewith appended to the above 
 account : 
 
 " From the distillation of a bituminous shale found in the Tyrol, and which is chiefly 
 composed of the remains of fossil fishes, a mineral oil is obtained containing a high per- 
 centage of sulphur. This oil is transparent, of a brownish-yellow color, with a sea-green 
 fluorescence. It has a specific gravity of 0.865, an d boils at a temperature of 100 to 
 225 C. Analysis shows it to contain 77.25 per cent, carbon, 10.52 per cent, hydrogen, 
 10.72 per cent, sulphur, and i.io per cent, nitrogen. The sulphur is intimately combined 
 with the oil. By treatment of this oil with concentrated sulphuric acid a certain quantity 
 of sulphur and oxygen becomes combined with it, and thus sulph-ichthyolic acid results. 
 This substance is soluble in water, of a greenish-black color and strong odor, and a syrupy, 
 stringy consistence. It combines with sodium, potassium and ammonium."
 
 288 LOCAL THERAPEUTICS. 
 
 Ichthyol is sedative, ischaemic, parasiticide, and probably disinfectant. 
 Its use is especially indicated in superficial diffuse inflammations of low 
 type. An elaborate statement of the properties of ichthyol can be found 
 in Merck 1 s Bulletin, January, 1892, p. 41. (See also Unna, Monatschr. 
 f.prakt. Dermatolog., v, 1886.) 
 
 General Surgery. When applied freely to the skin in a pure form, 
 ichthyol produces a slight irritation and sense of burning. It is asserted 
 to possess peculiar alterative properties, and also the power of penetrating 
 the skin and affecting the deeper tissues beneath, particularly the par- 
 enchymata of glands. Excellent results are obtained from ichthyol in the 
 treatment of ERYSIPELAS. Von Nussbaum commends the following plan : 
 Take of ichthyol and lanolin equal parts and spread over the affected 
 surface. The surface is then enveloped in salicylated cotton. The 
 progress of the disease is arrested and the pain lessened. Bitieff (Rev. 
 de Therap.^ April i, 1888) uses ichthyol as a pigment, combined with 
 collodion, as follows : Take of collodion fifteen parts,, ether and ichthyol 
 each one part. 
 
 In employing ichthyol in erysipelas, the affected part should be cleansed 
 with soap and water, and then washed with a i-iooo solution of bichlo- 
 ride of mercury. The ichthyol, pure or diluted with vaseline or lanolin, 
 should then be spread thickly over the affected part, and covered with 
 cotton batting. 
 
 Ulrich (quoted in Lancet, November i, 1890) has tested the relative 
 merits of the treatment by means of ice compresses, painting with tar, and 
 with a solution of ichthyol, ether, and collodion painted on the affected 
 surfaces. The mean duration of the disease under ichthyol was 6.8 days, 
 while under the ice and tar methods it was 8.3 and 9.3 respectively. The 
 relapses were less numerous under the ichthyol treatment. 
 
 In ERYSIPELAS Unna has obtained very satisfactory results from the use 
 of an ointment of equal parts of ichthyol and vaseline. A pigment of the 
 following composition has likewise been found useful: R. Ichthyollis, 
 setheris, aa f^ss ; collodii, fgj. M. 
 
 D. H. Agnew used ichthyol with great advantage in a fifty per cent, 
 ointment in the treatment of LYMPHATIC ENLARGEMENTS; thoroughly 
 rub into the affected parts, the ointment to be kept in contact, spread 
 on lint. It is also useful in SYNOVIAL INFLAMMATIONS, either involving 
 the articulations or the sheaths of the tendons. The articulation is 
 immobilized by means of a splint, the ointment consisting of equal 
 parts of ichthyol and lanolin, spread upon lint and laid over the affected 
 joint, covered with oil-silk and retained by means of a firm bandage. 
 
 Freund (Z* Union Medicale) strongly advises ichthyol in the treatment 
 of all INFLAMMATORY CONDITIONS OF THE FEMALE GENITAL ORGANS, 
 applied in the form of an ointment.
 
 ICHTHYOL. 289 
 
 It must be borne in mind that ichthyol is recommended in many con- 
 ditions in which, before its introduction, preparations of iodine, mercury, 
 etc., were indicated. 
 
 Diseases of the Skin. The ichthyol-sulphonate of ammonia was 
 introduced into medical use by Unna. It has been found of use in the 
 treatment of a number of skin diseases, sometimes appearing to exert a 
 disinfectant or parasitic effect. 
 
 In certain forms of ACNE ROSACEA, when there is a hard, knotty acne 
 on a dusky bluish-red and swollen base, with thick epidermis and little 
 pus-formation, where there are few comedones and considerable venous 
 enlargement, a strong preparation of ichthyol (twenty grains to a drachm 
 suspended in an ounce of water, or mixed with an ounce of vaseline) 
 may be applied once or twice daily with good effect. The ichthyol soap, 
 mentioned under the head of soaps may also be used in these cases. 
 
 When the rosacea is of a non-erythematous type, ichthyol can only be 
 employed in a much more dilute form. 
 
 In ACNE with COMEDONES, we have sometimes used a lotion or emulsion 
 of three or four grains of ichthyol suspended in an ounce of water, and 
 applied at night with good effect. It produces a slight discoloration of 
 the skin, however, and in some cases adds markedly to the disfigurement 
 by intensifying the color and accentuating the presence of the comedones. 
 
 In some cases of SQUAMOUS and VESICULAR ECZEMA, with unbroken 
 skin, very dilute lotions and ointments of ichthyol are said to be useful. 
 
 In PITYRIASIS OF THE SCALP stronger ichthyol ointments and lotions 
 are employed. 
 
 Ichthyol has been directed in the local treatment of PSORIASIS, but 
 we have found it much less effectual than other remedies in this disease. 
 
 In PARONYCHIA and in CONTUSIONS Lorenz employs ichthyol pure or 
 with an equal quantity of water with excellent effect. He asserts that it 
 prevents discoloration in the latter condition. 
 
 In ULCERS, particularly VARICOSE ULCERS OF THE LEG, Unna finds 
 ichthyol of use, but we have failed to get satisfactory results in the cases 
 in which it was prescribed. 
 
 A similar pigment has been used successfully to prevent the pitting of 
 VARIOLA ; acts favorably in FURUNCLE. 
 
 In PRURITUS VULV^E, particularly when connected with vulvitis, a 
 lotion of one drachm of ichthyol to the ounce of water is said to be of 
 service. 
 
 Of late certain ichthyol "varnishes" have been brought forward as 
 affording an easy and efficacious method of applying the remedy. 
 
 The pure drug, apart from its unsightliness and objectionable odor, 
 will not dry even if spread in a thin layer, but remains for hours moist 
 and sticky. Ichthyol collodion promised better, but the irritation which
 
 290 LOCAL THERAPEUTICS. 
 
 is caused by removing it is such as to more than counterbalance its bene- 
 ficial effects. 
 
 To attain the desired end, Unna suggests the following: R. Ichthyolli, 
 9iv; amyli, 9iv; sol. albumin concent., n^v-viij ; aquae ad fgj. M. 
 
 The starch is first moistened with the water, the ichthyol is then well 
 rubbed in, and finally the albumin is added. 
 
 This preparation dries quickly and new coats can be added. It is 
 useful in IRRITABLE ACNE, ROSACEA, SEBORRHGEA, LUPUS ERYTHEMATO- 
 sus, ECZEMA ERYTHEMATOSUM, and ERYSIPELAS. 
 
 The parasiticide effects of ichthyol upon the streptococcus of ERYSIPE- 
 LAS, and also upon the staphylococcus pyogenes met with in FURUNCLE, 
 ACNE, IMPETIGO, etc., have been proved by Fissler in a series of care- 
 fully conducted experiments. 
 
 Diseases of the Ear, Nose, etc. Ichthyol possesses marked 
 advantage in the treatment of diffuse inflammation of the external 
 auditory meatus and auricle. A twenty per cent, strength with cosmo- 
 line base is admirable in ULCERATION OF THE SEPTUM and of FISSURE 
 AT THE EDGES OF THE NOSTRIL. In the proportion of one grain to six 
 ounces of lime water ichthyol has been recommended in the treatment 
 of PURULENT RHINITIS. 
 
 IODOFORMUM. lodoform. 
 
 lodoform is a product of the action of iodine on a mixture of alcohol and a solution of 
 carbonate of potassium. (Ph. Br.) lodoform is a light-yellow, flocculent powder, having 
 a peculiar, penetrating, disagreeable odor. It is practically insoluble in water; is " soluble 
 in eighty parts of alcohol at 15 C. (59 F.), in twelve parts of boiling alcohol, in five 
 and two-tenths parts of ether, and in chloroform, benzol, benzin, bisulphide of carbon, 
 and in fixed or volatile oils." (U. S. P.) It is usually employed in the condition of a 
 powder, sometimes, however, in solution in ether or collodion. lodoform collodion solu- 
 tion contains five per cent, of iodoform. 
 
 lodoform cotton is prepared by steeping absorbent cotton in a seven and a half per cent, 
 solution of iodoform. 
 
 It is claimed that iodine is set free from iodoform when it is applied to a moist surface, 
 and that upon this property the efficacy of the agent depends. 
 
 Iodoform is protectant, analgesic, alterative, and, to at least some forms 
 of bacilli, germicide. 
 
 lodoform was introduced to the profession by Bouchardat {Manuel de 
 Matter e Med., Paris, 1856). 
 
 Agents which have been Recommended to Cover the Odor of lodoform. 
 Among the statements made in this connection may be included the fol- 
 lowing : Ehrmann (Brit. Med.Journ., September 29, 1888) recommends 
 an admixture of tar with iodoform, and it is said the result gives a spicy 
 odor, resembling neither ingredient. This, it is claimed, may be further
 
 IODOFORMUM. 291 
 
 disguised by the addition to the powder of liquid styrax. Oppler {Revue 
 de Therapeutique, December 15, 1885) adds one part of copper sulphate to 
 two of iodoform. Gillette {Revue de Therapeutiqne, December 15, 1885) 
 to one hundred parts of iodoform combines one of sulphate of quinine 
 and three of powdered wood charcoal. Cantrelle {Med. News, May 18, 
 1889) uses with every fifteen grains of iodoform three-fourths of a grain 
 of menthol and one drop of essence of lavender. Jaksch {Wiener Med. 
 Presse, No. 142, 1888) recommends a two per cent, admixture of creolin 
 with iodoform. Among other agents may be mentioned ground coffee, 
 balsam of Peru, oil of bitter almond, oil of cade, thymol, coumarin, 
 attar of rose, oil of bergamot, and oil of coriander ; of the agent last 
 named eight drops may be added to a drachm of the drug. A serious 
 objection to the use of many of the deodorants could be found in the 
 addition of a septic material to one assumedly sterile. 
 
 The Toxic Impression of Iodoform. Numerous instances are on record 
 of the toxic effect being produced by the local application of the drug. 
 It appears to be more quickly absorbed than are other forms of iodine 
 preparations. If a disposition to toxic effect from a moderate quantity 
 be obtained, iodoform should be abandoned. 
 
 Iodoform is with some individuals irritative to the skin, and may excite 
 dermatitis. 
 
 As an example of suddenly induced iodoform intoxication, the follow- 
 ing account is inserted at this place. Schuster (Berliner Klin. Wochen., 
 No. 20, May 15, 1882) took twenty deep inhalations from a glass tube 
 open at both ends, in which a quantity of iodoform was held between 
 two pieces of cotton ; suddenly a violent pressure was felt in the region 
 of the forehead, as though the experimenter had been struck from with- 
 out. All objects appeared to be of a black color ; great mental uneasi- 
 ness and anxiety ensued. The effect gradually passed off, leaving no 
 sequelae. 
 
 Doubtless many subjects have succumbed to the poisonous effects of 
 iodoform, and have been regarded as dying of the affection for which 
 the drug was exhibited. Notably has this been so in the case of the 
 aged. Willimar ( Centralblatt fur Chirurgie, No. 50, 1886) found that 
 out of seventy-nine cases of poisoning, fifty per cent, occurred in 
 persons between sixty and seventy years old, and .twenty-one per cent, in 
 cases over seventy years of age. The very young are also susceptible to 
 the toxic impression. 
 
 According to Treves (Practitioner, October, 1886) the conditions favor- 
 able for poisoning are clean, granulating wounds or burns, abscess cavities, 
 fistulse, and sinuses; cases in which the powder is applied under pressure 
 or covered with impermeable dressings, as well as in instances in which 
 the drug comes in contact with mucous surfaces, as may occur after
 
 2Q2 LOCAL THERAPEUTICS. 
 
 dressing the wound in colotomy. The symptoms of poisoning may 
 appear shortly after the application of the powder, or be deferred for 
 days or weeks. Two forms of poisoning occur, the acute and the 
 chronic. 
 
 In the acute form the symptoms are violent and generally develop 
 suddenly. Vertigo, headache, sleeplessness, and delirium follow. The 
 temperature rises, the pulse ranges from 150 to 180 in the minute, vomit- 
 ing and even mania ensue. The patient wastes, and may die in a state 
 of exhaustion, attended by coma. 
 
 In the chronic form, malaise, loss of strength, depression of spirits, 
 slight fever, a rapid pulse, and headache are prominent symptoms. The 
 patient becomes apathetic, melancholy, weak, and apprehensive. This 
 train of symptoms may extend over a period of from a week to months 
 before dissolution. 
 
 General Surgery. The views held on the antiseptic value of iodoform 
 have markedly changed in the past few years, owing to the results obtained 
 by the experiments of Heyreand Roosing. (Forts chrift fur Medizin, No. 
 2, 1887.) These writers demonstrated that not only is iodoform not germi- 
 cidal, but that micrococci freely develop within it. Many observers, 
 however, assert that when brought in contact with the free fluids of the 
 body, an equable temperature of the body being preserved, free iodine, 
 which is germicidal, is liberated. 
 
 Bruns ("Kept, xvi German Surg. Congress," in Centralblatt fur 
 Chirurgie, 1887, No. 25) has demonstrated the value of iodoform in the 
 treatment of TUBERCULOSIS. It would appear as though it had a selective 
 action on the characteristic bacillus. After its exhibition Nauwerck (op. 
 '/.) demonstrated that the bacilli disappeared. The tubercular layer of 
 the abscess wall became necrotic and in time was replaced by normal 
 granulations. Nevertheless, the practice of treating wounds with iodo- 
 form, for the purpose of preventing bacterial invasion, is delusive. 
 
 In COLD ABSCESSES, especially those of tubercular origin, iodoform acts 
 admirably. A preparation composed of iodoform one part and olive oil 
 ten parts is recommended to be used as an injection. After a period 
 varying from one to two months, the abscess gradually diminishes in size 
 and finally disappears. The length of time required to accomplish a 
 cure is frequently a cause of failure, since the surgeon, losing faith in the 
 treatment, is disposed to abandon it before it has been fairly tried. In 
 very large abscesses cure is exceptional before two to four months. 
 In the last five years Bruns (Arch, fur Klin. Chirurg., Bd. XL, Heft. 4) 
 has treated upward of a hundred cold abscesses by means of iodoform 
 injection, and eighty per cent, have been cured. Since it has been 
 claimed that relapse is common from apparent cure, the cases treated two 
 or three years ago were again examined. In all the cure was permanent.
 
 IODOFORMUM. 
 
 2 93 
 
 Excellent results have been obtained also by the use of iodoform injec- 
 tions in TUBERCULAR JOINT AFFECTIONS. Cures followed in many cases, 
 according to the reports of Bruns, Wendelstadt, Krause, and Mosetig 
 von Morrhof. For these injections a ten to twenty per cent, mixture of 
 iodoform and olive oil, freshly prepared and sterilized, should be em- 
 ployed. This is never followed by sufficient absorption to occasion toxic 
 symptoms. When the disease takes the form of PARENCHYMATOUS SYNO- 
 VITIS, with marked fungous outgrowth, the injection is thrown in the 
 joint cavity and into the fungous masses by several punctures, from two 
 to six cubic centimetres of the mixture being forcibly driven in. When 
 there is effusion into the joint, or abscesses have formed after puncture 
 and evacuation, a quantity of the mixture, sufficient to moderately fill 
 the cavity, is injected, from ten to thirty cubic centimetres frequently 
 being required. There is but slight reaction following the treatment, 
 and fixation of the joint is not necessary. Parenchymatous injections 
 are repeated at intervals of eight days; when cavities are treated, two to 
 four weeks should elapse between each injection. Pain frequently dis- 
 appears in a few weeks, but improvement in other respects is a matter of 
 considerable time. The motion of the joint is often completely restored. 
 More than half the cases thus treated may be expected to recover. In 
 the treatment of LUPUS, Chicken {Lancet, April 23, 1887) and O'Neill 
 {Brit. Med. Jour., November 22, 1890) speak favorably of the use of 
 iodoform. The ulcerations are first scraped with a blunt knife or spoon, 
 and then rubbed well with an ointment composed of one part of the 
 drug and seven parts of excipient. 
 
 Selitski {Lancet, July 3, 1886) and Koch {Wiener Klin. Wochenschrift, 
 No. 27, 1889) have used ointment of iodoform in ERYSIPELAS. Not only 
 was the affected part covered, but the healthy skin also, for a distance of 
 two or three inches. After several applications, a fall of temperature 
 took place, the disease was limited, the part gradually resumed its normal 
 contour, and the skin its color. 
 
 It has been suggested to employ the drug suspended in collodion, a 
 drachm to the ounce, and painted, over the affected skin. 
 
 Terrier {Le Progress Medicale, December i, 1888) and Mosetig von 
 Morrhof have reported good successes in PARENCHYMATOUS GOITRE' from 
 the injection of one to two grammes of a mixture of iodoform, one part, 
 ether, five parts, and olive oil, nine parts; injections being practiced at 
 intervals of from three to four days. 
 
 MALIGNANT PUSTULE has been successfully treated, according to 
 Whitehead {Brit. Med. Jour., March 2, 1889), Rinonapoli {Bolletin 
 delta R. Accad. Med. ch. di Napoli, No. 3, 1889) and others by the 
 hypodermic injection of a ten per cent, ethereal solution into the base of 
 the tumor. A severe burning sensation is experienced, which is, how-
 
 294 LOCAL THERAPEUTICS. 
 
 ever, soon followed by permanent relief from suffering. In the course 
 of a week the mass disappears, and all that remains is a dry, black 
 slough, which can be readily removed. 
 
 In SUPPURATING BUBOES Pantain (Journal of Cutaneous and Genito- 
 Urinary 'Diseases, 1889) has practiced the evacuation of the cavity 
 through a very small incision, and the injecting through the opening, 
 after the manner of the Viennese, an ethereal solution of iodoform, or 
 the drug suspended in oil or melted vaseline. The opening is then 
 plugged or covered with an impermeable dressing. 
 
 In CHANCRES, in CHANCROIDS, and in SYPHILITIC and all other ULCER- 
 ATIONS, iodoform has been freely used either in the form of the dry 
 powder, in pencils, in ointments, in ethereal solutions, or in oils and col- 
 lodion. It is true that the treatment of ulcers by iodoform applications 
 has been disappointing, and writers who believe in the curative powers 
 of the drug under other conditions acknowledge that in the lesions 
 named the constant exudation washes away the medicament. The 
 fact, however, remains that few clinicians now use iodoform in open 
 ulcerations. 
 
 Iodoform has also been largely used in BURNS (Rottenberg, Therap. 
 Monatshefte, March, 1891); it is claimed that the pain is rapidly 
 allayed, and that restitution of the part takes place at least as quickly as 
 under the use of any other drug. It is used both in the form of a dusting 
 powder and in a ten per cent, ointment. The claims of its curative powers 
 in GONORRHCEA by Winternitz (Med. Record, December 26, 1883), 
 Thiery (Le Progres Medicate, March 3, 1887) and others, have not been 
 sustained. Bockhart {Monatshefte f. prakt. Dermat., January, 1886) con- 
 cludes, and with his opinion we concur, that iodoform is of no value in 
 gonorrhoeal affections. Chandelux (Lyon Medicate, June 5, 1887), Frey 
 and Mosetig-Moorhof {Centralbl, fur Chirurgie, August 18, 1889) speak 
 highly of the use of iodoform in CYSTITIS. Owing to its analgesic and 
 deodorant properties, they think it particularly suited to this affection ; 
 after the bladder is flushed with warm water, a tablespoonful of the fol- 
 lowing mixture in a pint of warm water is injected: Iodoform, 50 parts; 
 glycerin, 40 parts; distilled water, 10 parts; tragacanth, % part. The 
 injection to be repeated every third day. 
 
 In VAGINAL and UTERINE ULCERATIONS iodoform has proved satis- 
 factory to some observers. In UTERINE CANCER it is said to relieve 
 pain, and in a measure to correct the fetor of the discharge. According 
 to Schauta {Lancet, November 9, 1889) iodoform gauze has been used 
 with good result in POST-PARTUM HEMORRHAGE. For tamponing the 
 vagina, etc., iodoform cotton and gauze are still popular. Gersung 
 ( Centralblatt f. Chirurgie, July 30, 1887) uses for the drainage of wounds 
 wicking impregnated with iodoform.
 
 IODOFORMUM. 295 
 
 Diseases of the Skin. On account of its odor iodoform is not 
 often employed in the treatment of diseases of the skin other than those 
 of a syphilitic character. 
 
 In ULCERATIVE SYPHILODERMATA, iodoform, placed in the carefully 
 cleansed cavity of the ulcers, lessens pus-formation, and aids in the 
 reparation of tissue. 
 
 In simple ULCERS of the lower extremity iodoform is often of great 
 value. The ulcer, being thoroughly cleansed with antiseptic washes, is 
 sprinkled thoroughly with iodoform and then covered with an occlusive 
 dressing, which may remain in place some days, a great advantage in 
 patients treated outside of a hospital, as it allows the physician to keep 
 the dressing under his own control. 
 
 In the APHTHOUS VULVITIS of children a small quantity of iodoform is 
 dusted upon the parts with a camel's-hair pencil. The labiae are then 
 separated from one another by a bit of patent lint ; rapid amelioration 
 results. 
 
 It has also been used in PRURITUS VULWE, as a powder. 
 
 Iodoform sometimes gives rise to dermatitis, the extreme itching of 
 which may be allayed by sponging with hot water, or, when possible, 
 plunging the part into hot water for a few moments. 
 
 Iodoform is of service in the treatment of skin diseases, such as LUPUS, 
 where the disease appears to depend upon, or to be constantly asso- 
 ciated with, the presence of bacilli. (T. Lauder Brunton, "Modern 
 Therapeutics," p. 74.) 
 
 Diseases of the Ear, Nose, Throat, etc. Iodoform is one of the 
 most valuable topical applications in ulcerated conditions in high grades 
 of HYPER^ESTHESIA which forbid the administration of powerful astrin- 
 gents; the light scales fall upon the most sensitive surfaces without 
 exciting distress, while they serve as a protectant from the air. Though 
 not antiseptic, iodine doubtless induces conditions which are not favor- 
 able for the development of pyogenic bacteria. 
 
 Iodoform, in the nature of a powder, is not a very fine preparation ; 
 it is apt to flake and its scales to become matted, while the disagree- 
 able odor prevents one handling it with the same ease as other drugs ; 
 iodoform, therefore, is less frequently applied than is the case with the 
 closely allied iodol. 
 
 Iodoform has been used with special advantage in SYPHILITIC ULCERA- 
 TION and ULCERS resulting from the breaking down of tuberculized 
 tissues. It can be used pure, or, as is perhaps best where there is exces- 
 sive secretion, mixed with an equal amount of subnitrate of bismuth 
 and a little gum arabic ; the first of these agents gives increased weight, 
 and the second enables it to adhere better than it otherwise would to the 
 affected surface.
 
 296 LOCAL THERAPEUTICS. 
 
 lodoform is of value in OTORRHEA accompanied with perforation of 
 the ear drum. It is often used in conjunction with boric acid by 
 being dusted upon the affected surfaces. Care should be taken to pre- 
 vent it caking and retaining the discharge, which this agent possesses 
 in common with boric acid. Delstanche (Archiv. f. Ohrenheilk., 22) 
 asserts that iodoform is useful for the treatment of CHRONIC CATARRH, 
 combined with vaseline and inserted in the Eustachian tube by means of 
 bougies. 
 
 The practice of using an iodoform solution in ether was introduced by the 
 late Louis Elsberg, of New York. lodoform may be conveniently suspended 
 in glycerin in the treatment of CROUPOUS RHINITIS of children. Gottstein 
 distributes the powder through gauze tampons in the treatment of OZJENA. 
 It may be thrown in the nasal chamber by insufflation one grain of the 
 agent sufficing for an application. H. Allen has used with advantage 
 cakes of gelatin with which iodoform is mixed. These can be shaped by 
 scissors to any desired shape, and carried well within the nostril by 
 forceps. They are especially adapted for the treatment of infiltrations, 
 confined, as is often the case, to the region of the middle turbinal. Nasal 
 bougies of the same composition, or made with cacao butter, contain 
 from two to five grains. The iodoform may be combined with one- 
 quarter of a grain of the extract of belladonna. A. Jacobi {Archives of 
 Pediatrics, February, 1889) applies daily over the parotid gland in MUMPS 
 iodoform collodion, one in eight or ten. lodoform is used in the treat- 
 ment of diseases of the respiratory tract, especially by insufflation in 
 LARYNGEAL PHTHISIS. It is usually employed in a pure form, though a 
 small proportion of one of the salts of morphine may be mixed with it. 
 Thus exhibited it may remain from one to two hours, and not only acts 
 as a cleanser, but gives rest to the ulcerated parts' by covering them 
 with a light powder ; it also appears to exert a retarding effect upon the 
 progress of the disease. It is indicated in any stage, but appears to 
 yield the best results where superficial ulcerations exist upon the aryte- 
 noid masses. The application can be made once or twice daily. It 
 is necessary to remember that, though unlikely, iodoform intoxication 
 may be induced. Fifteen grains have been known to cause this accident. 
 (F. Konig, Centralblatt f. Chir., Nos. 7 and 8, 1882.) This may repre- 
 sent an amount beyond the danger line. From two to three grains thrown 
 upon the parts from once to twice daily are safely used. A four per 
 cent, solution of iodoform in turpentine is employed as an inhalant in 
 PHTHISIS and CHRONIC BRONCHITIS. 
 
 lodoform is recommended as an insufflation into the trachea after trache- 
 otomy is performed for DIPHTHERIA. (G. Shirres, Lancet, July 24, 1886.) 
 It is also employed as an inhalant when putrid exhalations are present in 
 the trachea and bronchi. Whistler suggests that iodoform be applied to
 
 IODOL. 297 
 
 the throat through the medium of glyco-gelatin ; one grain being present 
 in each pastille mixed with one minim of glycerin. 
 
 lodoform lozenges are sold in this country, each mass containing one- 
 half grain, of the drug. 
 
 Diseases of the Eye. lodoform is highly thought of by some sur- 
 geons as a remedy in SLOUGHING KERATITIS, and has also been used in 
 PURULENT OPHTHALMIA. It is dusted upon the eye in powder or 
 applied as an ointment with vaseline one drachm to one ounce. It 
 should not be relied upon in serious cases of corneal ulceration to the exclu- 
 sion of atropine or eserine, the actual cautery, hot stupes, or the Ssemisch 
 incision. It forms an efficient dressing after operations on the lids or 
 enucleation of the eyeball, and may be freely dusted on the parts involved 
 in the operation. Its powers as an antiseptic have probably been over- 
 rated. 
 
 IODOL. Tetraiodopyrrol. 
 
 "A yellow-brown, shining powder, composed of long, prismatic crystals; soluble in 
 alcohol, in three parts of absolute ether, chloroform, and fatty oils, soluble in water only 
 in the proportion of one to five thousand." (U. S. D.) It is dissolved in retinol in 
 the proportion of one to fifty. It is decomposed by light and heat. Mazzoni's solution 
 is composed as follows: lodol, one part; alcohol, sixteen parts; glycerin, thiity-four 
 parts. lodol is odorless and tasteless. 
 
 lodol is a substitute for iodoform. Like the drug last named, it 
 is protectant, but the local effect is slightly irritating, and its germi- 
 cidal properties are so feeble as to be practically nil. Probably owing 
 to a less rapid rate of absorption than that of other preparations of iodine, 
 iodol is usually said to be free from the danger of toxic impression. 
 
 The following case, however, must be remembered : Padlin (ffygiea 
 Swedish, May, 1887) observed that in twelve hours after dressing a case 
 of necrosis of the clavicle with iodol the patient became dizzy, and finally 
 delirious. The following morning the pulse rose to 139 and the tempera- 
 ture to 102 F., with vomiting and purging. A small amount of albumin 
 and iodine were found in the urine. The wound was carefully washed 
 and the dressing changed to boric lint. The symptoms continued for four 
 days, with traces of iodine found in the urine for two weeks. ,' 
 
 General Surgery. Iodol is used for all purposes for which iodoform 
 is indicated. It may be dusted over wounds as an impalpable powder, or 
 used in ointment, solution, or upon gauze. Owing to the absence of 
 odor iodol possesses advantages over iodoform in the treatment of 
 VENEREAL SORES. 
 
 Pick (Therap. Monatshefte, No i, 1887) obtains good results from 
 iodol in the treatment of SUPPURATIVE ADENITIS after scraping. He 
 reports cases of GUMMATOUS and INDOLENT ULCERS which have improved
 
 298 LOCAL THERAPEUTICS. 
 
 rapidly under the action of the drug. Cerna has had satisfactory results 
 from the action of iodol on SYPHILITIC ULCERATIONS. He employs it 
 either in powder or solution. The following is recommended : iodol, 
 one part; alcohol, three parts: or, iodol, one part; alcohol fourteen 
 parts; glycerin, thirty-two parts (see Mazzoni's solution) : or as an oint- 
 ment, iodol, one part ; vaseline, six parts. It is claimed for iodol that 
 it does not form crusts with the exudations from wounds, and that on the 
 removal of the dressing the granulations are found to be healthy. 
 
 Diseases of the Skin. As an odorless -and tasteless substitute for 
 iodoform this drug was introduced in dermatological practice a few years 
 ago, but without obtaining a foothold as an efficient agent. 
 
 The pure powder may be employed in ULCERS, and the ointment or 
 pigment in cases where iodoform might be appropriately used. The fol- 
 lowing formulae have been suggested : Iodol, gr. xv ; alcohol, f:jiv ; 
 glycerin, fgij. Iodol, gr. xl ; alcohol (94 per cent.), f^j ; ether, fgiv ; 
 pyroxylin, gr. xvj ; castor oil, tt^xxv. M. 
 
 Diseases of the Ear, Nose, Throat, etc. R. N. Wolfenden 
 {Practitioner, vol. xxxvni, May, 1887) states that iodol contains seven 
 per cent, less iodine than iodoform, but parts with it more readily. The 
 properties are those of iodoform, but it is without toxic effect. He 
 believes that it is as efficient clinically as iodoform, and can be used for 
 that drug. 
 
 As a pigment, iodol can be conveniently combined with glycerin, 
 one drachm each, and the mass diluted in seven drachms of oleum 
 petrolatum. 
 
 Iodol, however, is more commonly employed in the form of a powder. 
 The mass is extremely light, and can be easily carried to the desired 
 spot. It acts, in the main, as a protectant. For application to the ear it 
 is praised by Stetter. {Archives f. Ohrenheilkunde , 1887.) The indica- 
 tions for its employment are the same as iodoform. Turnbull claims 
 that it is a stimulant, but is much less efficacious than either iodoform or 
 boric acid. It may be thrown pure in the maxillary sinus for treatment 
 of EMPYEMA. In combination with magnesium carbonate it may be insuf- 
 flated in CHRONIC NASAL CATARRH of children. 
 
 Iodol forms an admirable protectant for CHRONIC ULCERATIONS of the 
 NASAL SEPTUM. A pigment of iodol, in sufficient quantity to form a paste 
 with cosmoline suffices. The single objection to its use is the color of the 
 mass, which may cause an unsightly spot to appear at the edge of the 
 nostril, as the heat of the body causes the ointment to diffuse. A two 
 per cent, solution has been employed as a spray in the nostril for the 
 relief of paroxysms of sneezing. 
 
 By reason of the disagreeable odor of iodoform and the liability of 
 sufficient quantity being swallowed to affect the appetite, attempts have been
 
 IODUM. 299 
 
 made to substitute iodol for this agent in the treatment of LARYNGEAL 
 PHTHISIS. For this purpose both the pigment and powder have been 
 used. 
 
 W. Lublinski {Deut. med. Wochenschr., December 23, 1886) found that 
 iodol was well tolerated, and claims that neither cough nor spasm follow its 
 application. He reports that it is more rapid in its effects than either 
 tannic acid, boric acid, or lactic acid. The base of the ulcer becomes 
 more even, the erosion is arrested, and the general health improved. The 
 drug has also been recommended by Sokolowski. {Gazett Lekarska, 
 No. 38, 1888.) E. L. Shurley (N. Y. Med. Journal, September n, 
 1886) believes that iodol has little or no effect in arresting ULCERATION. 
 In his treatment, a minimum preparation is desired, namely, iodol, one 
 part; alcohol, sixteen parts; and glycerin, thirty-four parts; but there is 
 no objection to using the substance pure in the form of insufflation . The 
 powder can be thrown on the affected surface daily, or from two to three 
 times a week. It may be said tentatively that iodol may be substituted 
 for iodoform in the local treatment of LARYNGEAL PHTHISIS. But its 
 superiority to that agent has not been demonstrated. 
 
 A lozenge of one-half grain of iodol to each mass has lately been intro- 
 duced in the trade. It is probably of little value. 
 
 Diseases of the Eye. Iodol has been recommended as a substitute 
 for iodoform in ophthalmic practice. It is applied in the same manner 
 as the latter. The advantages claimed for it are that it is free from the 
 very disagreeable odor of iodoform, and that it is less likely to cause 
 constitutional disturbance, probably because it is absorbed less rapidly. 
 It has not yet been extensively used. 
 
 IODUM. Iodine. 
 
 " Heavy, bluish-black, dry and friable, rhombic plates of a metallic lustre, a distinctive 
 odor, a sharp and acrid taste, and a neutral reaction. It is sparingly soluble in water, 
 soluble in about eleven parts of alcohol at 15 C. (59 F.), very soluble in ether, 
 disulphide of carbon, and chloroform. It is slowly volatilized at ordinary temperatures." 
 (U. S. P.) 
 
 " Lugofs iodine lotion consists of from two to four grains of iodine, and double that 
 quantity of iodide of potassium, dissolved in a_pint of water. Lugol's mbef a tieni" iodine 
 solution is formed by dissolving a half ounce of iodine and an ounce of iodide of 
 potassium in six fluid-ounces of water. Lugol's caustic iodine solution is made of iodine 
 and iodide of potassium each an ounce dissolved in two fluid-ounces of water." (U. S. D.) 
 It is important that these three solutions be not confounded. Iodine paint is tincture of 
 iodine spontaneously evaporated to half its bulk. 
 
 Among the official preparations of iodine for local use may be named the following : 
 Liquor lodi Compositus (containing five parts of iodine, ten parts of iodide of potassium, 
 in one hundred parts of the solution), Tinctura lodi (containing eight parts of iodine in 
 one hundred parts of the tincture), Unguentum lodi (containing four parts of iodine and
 
 300 LOCAL THERAPEUTICS. 
 
 one part of iodide of potassium, in one hundred parts of the ointment). A compound 
 tincture of iodine was official in the " U. S. P.," 1870, and was much used ; the formula 
 is, iodine, half an ounce, and iodide of potassium, an ounce, alcohol, one pint. 
 
 In the German "Pharmacopoeia" the " tinctura iodi decolorata " is official, and is 
 made by taking ten parts each of iodine, hyposulphite of sodium, and distilled water, 
 heating them gently until the solids are dissolved, adding sixteen parts of spirit of 
 ammonia and seventy-five parts of alcohol, and allowing the preparation to stand for 
 three days before filtering and using. Such a preparation is a solution of an iodide and 
 should not be regarded as a substitute for iodine. 
 
 The combination of iodine and carbolic acid (iodine, two grains; carbolic acid, two 
 grains; ol. petrolatum, one ounce) is preferred by many practitioners to either of these 
 substances used separately. 
 
 Iodized cotton is prepared by steeping absorbent cotton in a five per cent, solution of 
 iodine. 
 
 Iodine is alterant, rubefacient, vesicant, caustic, antiseptic, and para- 
 siticide. 
 
 When iodine is applied to the skin or mucous membrane, it is irritant 
 or caustic. It stains the skin yellow, creates a sensation of warmth if in 
 small quantity, or burning if in larger quantities, and excites a superficial 
 inflammation followed by desquamation. In some subjects the applica- 
 tion of the tincture of iodine results in vesication. Pure iodine kept in 
 contact with the tissues produces a brown, dry eschar. The vapor of 
 iodine is often irritating to the mucous membranes of the air passages, 
 causing increased flow of mucus, and even spasm of the glottis. As a 
 simple counter-irritant iodine is frequently employed where it is desired 
 to maintain a mild, persistent influence. 
 
 General Surgery. The tincture is the preparation that is generally 
 used. It is best applied by painting over the part with a camel's-hair 
 brush or a swab. Differences obtain between individuals as to the degree 
 of susceptibility of iodine. For those of a sanguine temperament, in 
 whom the skin is fair and the hair light, the stronger preparations must 
 be used with caution. If an application causes pain, the iodine should 
 be washed off with alcohol, whisky, cologne, or, what is best, a solu- 
 tion of iodide of potassium, and the pain subdued by the application 
 of a starch poultice. A crop of itching papules will often follow the use 
 of iodine under ordinary conditions. The tincture of iodine, as a 
 counter-irritant, is applied to the chest as a paint in PLEURISY, both to 
 abort an attack and to aid the absorption of fluid. In CHRONIC PHTHISIS 
 it is of service to allay harassing COUGH and to check secretion. Where 
 rapid change is going on in the lung its use is contraindicated. 
 
 Painted over the front and back of the chest, it often affords relief in 
 CHRONIC BRONCHIAL CATARRH by easing the cough and lessening the 
 expectoration. It may be applied over any portion of the chest affected 
 with pleurodynic pains, and followed with a belladonna plaster. A mus-
 
 IODUM. 
 
 301 
 
 tard poultice is often preferable, as it can be renewed should the pain 
 return. The following ointment is used with success in the treatment of 
 CHRONIC PNEUMONIA, to hasten resolution : Iodine, gss ; iodide of 
 potassium, 3] ; lanolin, j. It is to be rubbed thoroughly over the 
 affected portion of the chest. Ringer states that iodine ointment is often 
 used to remove non-inflammatory pains of the chest, but these not being 
 always of the same nature, discrimination must be exercised. When the 
 pain is situated in the muscles (MYALGIA), and these are tender on 
 pressure, while the skin may be pinched without pain, the ointment is 
 indicated, but if the tenderness is situated in the skin (PLEURODYNIA), 
 belladonna is to be preferred. 
 
 Injections of iodine through a long nozzled hypodermic syringe directly 
 into the substance of the lung (as in small cavities near the apex) have 
 been used by W. Pepper in PHTHISIS, but the results have been, as a rule, 
 negative. 
 
 In EMPYEMA injections of solutions of iodine were formerly used to 
 remove the great fetor produced by the decomposition of pus, and 
 at the same time to diminish the suppuration. The same use has often 
 been made of them in the treatment of large ABSCESS CAVITIES. The em- 
 ployment of antiseptic treatment in these conditions has, in a measure, 
 rendered the use of iodine unnecessary, though, on the whole, the iodine 
 treatment is superior to the bichloride of mercury, as mild solutions 
 induce salivation. 
 
 Iodine may be used with advantage painted over joints in CHRONIC 
 RHEUMATISM, CHRONIC GOUT, or CHRONIC SYNOVITIS ; in the latter condi- 
 tion it is of service, especially when brought to the point of counter-irrita- 
 tion. Acting as a blister, it relieves pain and assists in the absorption 
 of fluid. It often causes distention of the joint, the good effect not 
 becoming apparent for several days. The sudden increase of the swelling 
 may be considered as a favorable indication of the success of the applica- 
 tion. After the counter-irritant effect has been produced, and the skin has 
 become tender, we usually apply an ointment of equal parts of ung. 
 belladonnse and ung. hydrargyri spread on lint and retained firmly by 
 a bandage, the entire joint being thus fixed. 
 
 Injections of tincture of iodine, either pure or diluted, have been used 
 in the treatment of EXTENSIVE SEROUS ARTHRITIC EFFUSION unaccom- 
 panied with inflammation. A portion of the effused liquid should be 
 first evacuated by means of an aspirator, or small trocar and cannula intro- 
 duced through a valvular incision ; the iodine is then injected through 
 the cannula, not more than a drachm (if in the knee joint) of the 
 tincture being used at one time. After the fluid has been allowed to 
 remain for a few minutes it is removed, care being taken not to admit 
 air, and the wound being immediately sealed with collodion. This
 
 3^2 LOCAL THERAPEUTICS. 
 
 mode of treatment is favorably spoken of by Erichsen. As the plan 
 is necessarily attended with some risk, it should not be employed except 
 in chronic cases which have resisted other modes of treatment, and in 
 which the distention of the joint is productive of great inconvenience. 
 In ABSCESS 'OF A JOINT occasionally advantage may be derived by 
 injecting dilute tincture of iodine and afterward washing it away. As 
 a rule, better results in a similar condition may be obtained by using a 
 weak solution of corrosive sublimate. In traumatic, as well as in gouty 
 or rheumatic TENDO-SYNOVITIS, iodine is serviceable. A few coats of 
 the tincture of iodine painted over the affected surface, and the part 
 put at rest, will usually be all that is necessary to effect a cure. In 
 extreme cases the counter-irritant effect of the iodine, followed by an 
 application of belladonna and mercury ointment, will prove satisfactory. 
 
 In COMPOUND GANGLION, after the evacuation of the contents, we have 
 found tincture of iodine injected into the sac an available means of 
 treatment. Care should be exercised to leave as small a quantity in 
 the sac as possible for fear of exciting too great an inflammatory action, 
 and by so doing impairing the use of the tendons. If suppuration should 
 occur, a free opening must be promptly made and the case treated as one 
 of palmar abscess. In simple ENLARGEMENT OF A JOINT, the result of 
 pressure, tincture of iodine may be used with advantage by painting over 
 the surface, or, as in HOUSEMAID'S KNEE (if the fluid has been removed) 
 by tapping. Iodine may be injected into the sac to excite inflammation. 
 
 In the treatment of SPINAL MENINGOCELE the only plan which 
 has met with success is the injection of a preparation containing 
 iodine, known as Morton's fluid. This is composed as follows : Iodine, 
 ten grains; potassium iodide, thirty grains; glycerin, one fluidounce. 
 About one-half the contents of the cyst is drawn off with a fine trocar and 
 cannula, and from one-half to two drachms of the fluid are injected, the 
 opening being closed with collodion. Similar operations have been essayed 
 in ENCEPHALOCELE, but only where the sac is small or pedunculated are 
 there any prospects of cure. 
 
 Tincture of iodine has been used with success in GOITRE. This method 
 succeeds best with the SOFT or CYSTIC GOITRE, though it has been used in 
 the hard or fibrous variety. Eight to ten drops of the tincture should be 
 thrown into the substance of the tumor with an ordinary hypodermic 
 syringe, preferably into different parts of the growth, every three to five 
 days. (Agnew.) The object of employing the injection is to induce a 
 grade of inflammation which, instead of going on to suppuration, shall 
 result in the obliteration of the gland by a new formation of con- 
 nective tissue, both within and between the walls of the cysts. As an 
 injection for the radical cure of HYDROCELE, no substance has met 
 with such success as the tincture of iodine. The method usually the
 
 IODUM. 
 
 33 
 
 most satisfactory is that advised by Syme, and which, if properly 
 carried out, rarely fails. After the tunica vaginalis has been thoroughly 
 drained of its fluid contents through the cannula, one fluidrachm to 
 three fluidrachms of the pure tincture of iodine, according to the size 
 of the sac, is injected through the cannula by means of a properly- 
 fitting hard rubber syringe, or a gum-elastic bag with a nozzle and 
 stop-cock. After the injection the cannula should be gently removed, 
 care being exercised not to allow the escape of the fluid, which should 
 be diffused over the surface of the sac by gently rubbing between the 
 fingers for a few seconds. Some surgeons use the tincture largely 
 diluted, and allow the solution to flow out through the cannula before 
 the latter is withdrawn. A good deal of pain usually follows the opera- 
 tion, and the scrotum commonly swells to its original size in the course 
 of a few days, the swelling then subsiding until the cure is completed. 
 The pain may be controlled by an opium suppository inserted in the 
 rectum, and the patient kept in the recumbent posture for three or four 
 days. 
 
 Tincture of iodine has been used, for its stimulating effect, in the treat- 
 ment of incomplete ANAL FISTULA by injecting it into the tract. As a 
 rule, it will not be found so reliable a means of treatment as a free inci- 
 sion and packing, thus allowing the tract to heal from the bottom. It 
 is only to be advised in those individuals who object to operative inter- 
 ference. 
 
 Iodine injections are used in the treatment of OVARIAN CYSTS. 
 They were first successfully employed by Alison, of Indiana, in 1846. 
 Boinet and other European surgeons have popularized them by their 
 writings. They employ one hundred parts each of tincture of iodine 
 and water, and four parts of iodide of potassium. After tapping 
 the cyst and withdrawing its contents, from four to ten ounces of the 
 solution are injected, the liquid being withdrawn in about ten or fifteen 
 minutes. This mode of treatment, according to Peaslee, should be 
 reserved for cases of UNILOCULAR CYSTS with clear serous contents, in 
 which tapping has been previously employed at least once. Owing to 
 advancement in abdominal surgery, this mode of treatment should npt be 
 considered, except under peculiar conditions. 
 
 In CHRONIC OVARITIS Lawson Tait recommends that, during the inter- 
 menstrual periods, counter-irritation be made with the tincture of iodine 
 to a spot on the skin about two and a half inches in diameter in the 
 region of the ovary. It should be applied every morning and evening as 
 long as the patient can bear it, then discontinued for a time, to be again 
 repeated as often as necessary. He states that he has seen patients pursue 
 such a course for months, and that in the majority of cases it proved 
 efficient.
 
 304 LOCAL THERAPEUTICS. 
 
 In CHRONIC METRITIS and CHRONIC ENDOMETRITIS, dependent on a 
 granular condition of the cervical canal and accompanied with erosion 
 of the os, iodine is a reliable means of treatment. It excites the capillary 
 circulation of the whole uterus to recuperative activity, cures the erosion 
 and causes absorption of inflammatory products in the submucous tissues. 
 It is employed in the form of the official tincture ; a variety of this known 
 as Churchill's tincture ; iodine chloral ; combined with glycerin; or in 
 the form of iodized cotton. The formula for Churchill's tincture is 
 herewith given : Iodine, gr. Ixxv ; potassium iodide, syss ; alcohol, ij.* 
 The so-called " iodized chloral phenol " is composed of iodine 5ss, crvs . 
 tals of carbolic acid and chloral each $j. The iodine and chloral are 
 first mixed and the carbolic acid added. The application to the uterine 
 canal is best made by an aluminium probe armed with a small swab of 
 cotton saturated in the solution. (W. Goodell.) When combined with 
 glycerin the iodine treatment is ordinarily conducted by a tampon. Byford 
 ("Diseases of Women," p. 428) commends the use of an iodized cot- 
 ton. This is made by mixing crystals of iodine with cotton and placing 
 in a well-stoppered bottle in a warm place, when the drug will become 
 volatilized and diffuse itself uniformly through the cotton. It may be 
 applied to the cervix and allowed to remain for twenty-four hours ; the 
 cotton is renewed every fourth or fifth day. 
 
 In the treatment of PERIOSTITIS and OSTEITIS, iodine applied for its 
 counter-irritant effect will be often of service, especially in the early stage 
 of either of these affections. We have found it useful after painting 
 with the tincture of iodine, until the counter-irritant effect has been pro- 
 duced, to cover the region with belladonna and mercurial ointment 
 spread on lint, the affected part to be kept as quiet as possible, while 
 iodide of potassium is administered internally. A few days of such treat- 
 ment will be followed, as a rule, by marked relief, especially in that class 
 of patients where a strumous element is present. 
 
 In NEURITIS relief may be given by painting a number of coats of 
 tincture of iodine over the course of the painful nerve, and repeating 
 until the application becomes too painful to bear. If pain should be 
 severe, a hypodermic injection of atropine and morphine is given, pre- 
 ferably near the seat of pain. 
 
 ONYCHIA may often be aborted by painting thoroughly the entire 
 finger, as soon as the slightest pain has manifested itself, with tincture 
 of iodine. A convenient alternative is to insert the finger into a 
 wide- mouthed bottle containing the tincture and allow it to dry. 
 
 * A similar preparation to the Churchill tincture is called Lawson Tail's tincture. It 
 is composed as follows : Iodine and iodide of potassium, each 3 ij ; alcohol and water, 
 each i.
 
 IODUM. 
 
 3S 
 
 This may be repeated three to four times in the course of the day. If 
 applied early in the disease it seldom fails to effect a cure. Sometimes a 
 BOIL may be aborted in the same manner by painting around it an area 
 of tincture of iodine sufficiently thick to cause considerable counter- 
 irritation. It is preferable to apply the iodine a little distance from the 
 seat of inflammation. If in twenty-four hours relief is not experienced, 
 it is best to envelop the part in a hot flaxseed poultice. 
 
 For the removal of excessive callus after fracture, Switzer, an 
 English army surgeon, has reported a case where a large amount of 
 deformed callus has disappeared under inunctions of compound iodine 
 ointment. It would be proper to try the sorbefacient effect of this remedy 
 before radical measures are pursued. In ununited fracture, friction and 
 counter-irritation with iodine are often useful in encouraging a healthy 
 reaction about the ends of the broken bones. Of eleven cases mentioned 
 by Norris, five were cured. 
 
 In all GLANDULAR SWELLINGS, whether of a simple strumous or syphilitic 
 nature, the various preparations of iodine have been always held in high 
 repute ; the tincture and some forms of the ointment are the forms that 
 have yielded the greatest success. If persistently and carefully applied 
 to the part before suppuration lias commenced, resolution, in a large 
 majority of cases, will be brought about, provided constitutional measures 
 are persisted in. 
 
 In the treatment of the VENEREAL BUBO the tincture of iodine has 
 been long in use; many of its failures are due to the improper time 
 and manner of its employment. As a prophylactic, it is important 
 that as soon as the slightest tenderness is experienced in the groin the 
 patient be placed at rest, and the surface of the skin round the sen- 
 sitive glands be painted with three coats of the tincture of iodine, not 
 over the inflamed glands, but in a circle three inches in width surround- 
 ing the affected gland on the next vascular area, as taught by J. Ash- 
 hurst ; by this means the vascularity of the part is greatly reduced. If 
 much induration exists, a hot flaxseed poultice, will often assist in 
 hastening resolution. In the hospital practice in Philadelphia CHRONIC 
 INDURATED BUBO is commonly treated by the use of an ointment of 
 iodide of lead,* one drachm; ext. of belladonna, one-half drachm; 
 lanolin, one ounce, rubbed thoroughly into the groin. After this a piece 
 of lint, on which a sufficient coating of the ointment has been spread, 
 is laid over the affected part, and on this the weight of a small shot- or 
 sand-bag is applied, the patient to be kept in a recumbent position until 
 all tenderness has disappeared. 
 
 * It is convenient to compare the effects of iodine with those which result from the use 
 of salts into which iodine enters. But, at best, such comparisons are inexact. 
 20
 
 306 LOCAL THERAPEUTICS. 
 
 In CERVICAL ADENITIS a similar preparation to the above may be used, 
 or in its stead the official iodine ointment, diluted with equal parts ot 
 belladonna ointment. It is, however, objected to by patients, owing to 
 its tendency to stain whatever it touches. For this reason the iodide of 
 cadmium ointment has been substituted, although in our experience it is 
 not so active a preparation. After suppuration is announced, the external 
 use of iodine is useless. 
 
 Diseases of the Skin. Iodine is employed in the external treatment 
 of diseases of the skin as a discutient and parasiticide. The pure drug 
 is not employed alone. 
 
 The tincture of iodine (U. S. P.) is used in the treatment of RING- 
 WORM of the scalp or body, one or more coats being applied with a brush 
 to the affected patch. 
 
 Iodized glycerin, composed of a drachm of iodine dissolved in a solu- 
 tion of a drachm of iodide of potassium in an ounce of glycerin, is occa- 
 sionally applied as a dressing in parasitic skin diseases. It is too strong 
 for ordinary use. 
 
 Coster' s paste is composed of two drachms of iodine and six drachms 
 of oil of cade. Applied in recent cases of TINEA TONSURANS, it forms a 
 crust, which when removed pulls off the diseased hairs with it. 
 
 Diseases of the Ear, Nose, Throat, etc. The local effect of 
 iodine, in non-irritating proportions, on the mucous membrane of the 
 respiratory tract is to absorb exudations in or about gland tissue, especi- 
 ally of the lymphoid (adenoid) type. Should, however, any fibroid 
 change be found associated with these conditions iodine is worthless. The 
 inability always to determine when this change has set in often leads 
 the practitioner to make a vain attempt to resolve fibroid degeneration 
 with iodine or its preparations. 
 
 In concentrated forms iodine is excitant and even corrosive. It is 
 known to be of value in certain phases of chronic inflammation. But 
 the action is not understood. Some writers describe it as astringent. It 
 gives tone to spongy states of mucous membrane in contact with bone ; 
 such, for example, as gum-tissue, the roof of the naso-pharynx, the car- 
 tilage of the Eustachian tube, lining membrane of the nose, and its acces- 
 sory sinuses. 
 
 In recession of the gums, attendant upon PYORRHCEA ALVEOLARIS, 
 A. Stille recommends the application, with a camel's-hatr brush, after 
 each meal, of an aqueous solution of iodine, fifteen grains ; water, one 
 ounce, the mouth to be immediately washed afterward. But this use of 
 iodine has been largely supplanted by more powerful germicides. 
 
 A serious objection to the use of iodine arises from the fact that it is 
 not easily taken up, and it is difficult to fix a strength at which it ceases 
 to be irritating ; in order to be efficient, iodine must be quickly absorbed.
 
 IODUM 
 
 307 
 
 If, after trial, it is found it has not given relief it is well to wrap the 
 end of an electrode, whose size and shape adapt it to the purpose, with 
 absorbent cotton dipped in a weak solution of the compound tincture 
 of iodine or of Lugol's solution, and attaching the electrode to the 
 negative pole in the form of a sponge held to the cheek, while the 
 physician inserts the positive electrode in the nasal chamber, or in the 
 throat, as the case may be. Special care should be taken to prevent 
 any of the iodine from entering the larynx, since it is irritating to 
 the mucous membrane and excites laryngeal spasm* Iodine mixed 
 with glycerin assuages to some extent the irritative effect. It may be 
 employed in proportion of equal parts of iodine, glycerin and iodide 
 of potassium. 
 
 Compound tincture of iodine, when mixed with carbolic acid, glyc- 
 erin and water, constitutes the Boulton solution.* It is useful in condi- 
 tions in which the administration of iodine is indicated. The odor of 
 the compound is to many persons unpleasant. It may be used in forms 
 of inflammation of mucous surfaces in which infiltration-processes are 
 present. 
 
 lodism, as a result of local use of iodine in the throat, nose, and mouth, 
 must be rare. The following instance, however, is worthy of credence : 
 After a daily application for ten days of diluted compound tincture of 
 iodine to the glottis, the cervical glands became swollen and ulceration 
 occurred on the lips and the mucous lining of the cheeks. (Eben Watson.) 
 
 Iodine is very diffusive. The part to which it is applied should be first 
 dried and a small quantity of the selected preparation painted on the 
 spot. Solutions of iodine are not altered by vegetable astringents, and are 
 compatible with solutions of the salts of zinc. The combinations last 
 named have received the sanction of von Troeltsch as stimulants. 
 
 In using strong preparations of iodine a little laudanum lessens the 
 pain. 
 
 A dilute preparation of iodine with iodide of potassium (Lugol's solu- 
 tion) is used for a variety of purposes. It forms the basis of a gargle 
 in MERCURIAL STOMATITIS (three drachms of the tincture, fifteen grains 
 of iodide of potassium, to eight ounces of water), and as an injection in 
 EMPYEMA OF THE MAXILLARY SINUS. 
 
 In the treatment of diseases of the ear iodine is of high repute. 
 H. McNaughton Jones (Lancet, 1889, vol. n) places it in a position 
 second only to corrosive sublimate as a local remedy in CHRONIC SUP- 
 
 * R. Tr. iodinii comp., tt^xlv; acid, carbolici, IT^vj ; glycerini, ^ij; aquae, ^ v. The 
 iodine color,gradually disappears and the solution becomes colorless in from eight to ten 
 hours. At a low temperature the change occurs more slowly. (J. W. White, " Dental 
 Materia Medica," p. 67.)
 
 308 LOCAL THERAPEUTICS. 
 
 PURATION OF THE MIDDLE EAR. A solution containing one grain of 
 iodine and five grains of iodide of potassium in an ounce of water 
 is of value in the treatment of ECZEMA OF THE AUDITORY PASSAGE. 
 The vapor of iodine is carried into the middle ear by means of 
 the Eustachian tube in SUBACUTE CATARRHAL DEAFNESS. It can be 
 driven into the tube by the catheter, or "snuffed up" through the 
 nasal passage and the Valsalva method of inflation used at once. The 
 tincture of iodine, one drachm, chloroform, one-half ounce, is recom- 
 mended by C. S. Turnbull as an agent to be applied as above indicated. 
 The details of this method are as follows : Take a one-ounce, ground- 
 stoppered vial, place a piece of absorbent cotton within it, so as to half 
 fill the vial, pour upon the cotton the preparation. The patient inhales 
 from the mouth of the vial through the nostril, or, as the writer expresses 
 it, it is "snuffed up" the nostril, the patient at the same time making a 
 quick Valsalva effort, so that the vapor may be forced in the tympanum ; 
 this procedure is often of special benefit in cases where patients from any 
 cause may not be able to receive office treatment ; it has proved successful 
 in proportion to the perseverance and intelligence of the subject. The 
 vapor is also of repute in the treatment of ACUTE CORYZA. A few crys- 
 tals of iodine in a tube open at both ends (plugged with cotton to prevent 
 the crystals from falling out) is held in the hand, the warmth of which 
 disengages the vapor which is inhaled. The stronger tincture of iodine 
 reduces FUNGOID HYPERTROPHIES on the border of syphilitic ulceration 
 of the nasal septum and hard palate. 
 
 Nasal bougies of iodine contain five to ten minims of the compound 
 liquor of iodine. To this proportion of iodine one-quarter minim of 
 carbolic acid may be added. Samuel Johnston especially recommends 
 iodine in the treatment of CHRONIC PHARYNGITIS in the following 
 compound: Tr. iodine, one-half drachm ; carbolic acid, ten minims; 
 glycerin and water, each one and a half ounces. 
 
 Preparations of iodine have been long used in treatment of the sur- 
 faces of hypertrophied TONSILS. In our judgment these are useless. 
 Lugol's solution has been injected in the masses with a hypodermic 
 syringe. Such treatment is often followed by speedy reduction of the 
 mass. The rationality of this treatment is based on the fact that repeated 
 inflammations, to which hypertrophy of the tonsil is subject, cause the 
 outer portion of the gland to be resistant, and occupied with interlacing 
 scar-like bands. It is not to be expected that a remedy can be ab- 
 sorbed under such conditions. When, however, an agent is thrown into 
 the soft substance composing the interior, it may be more readily taken 
 up. Equal parts of tincture of aconite and tincture of iodine form a 
 favorite formula of dentists for inflammation about the root of a 
 tooth, the application to be made to the gum in the neighborhood.
 
 IODUM. 
 
 39 
 
 F. P. Atkinson {Practitioner, January, 1887) uses an iodine gargle of 
 twenty to twenty-five minims of Lugol's solution to an ounce of water in 
 QUINSY. Herzog {Verein der Aerzte, in Steiermark, December 10, 1888) 
 applies the official tincture in reducing HYPERTROPHY of the LINGUAL 
 LYMPHOID MASSES. Tincture of iodine is one of the best remedies for 
 Mucous PATCHES. 
 
 As an inhalant in CHRONIC LARYNGITIS, with diminished secretion, 
 iodine has long been held in high esteem. Lugol's solution may form 
 the basis of the preparation to be used, thus : Lugol's solution, one-half 
 ounce; glycerin, three ounces; water, ten ounces. The glycerole of 
 iodide may be substituted. Waring-Curran recommends the following in 
 DIPHTHERIA as an inhalant : Four grains iodine, four grains iodide of 
 potassium, four drachms of alcohol, and four ounces of water. G. 
 W. Major (IV. Y. Med. Journal, September 24, 1887) extols iodine in 
 painful states of the crico-arytenoid articulation. In LARYNGEAL PHTHISIS 
 iodine corrects in a measure the attendant infiltration and inflammatory 
 effects, but exerts no check on the progress of the disease. It must, 
 therefore, be regarded as a palliative. Nevertheless, it has its advocates 
 as an agent of the same class with lactic acid and iodoform. (See 
 J. Schnitzler, Wien. med. Presse, Nos. 15 to 26, 1884.) Equal parts 
 of benzoated lard, and ointment of iodine, rubbed in the skin over the 
 larynx, serve an admirable purpose in children, in whom a local effect of 
 iodine on the throat is desired. 
 
 Carbolized iodine, according to W. C. Glasgow, is a soothing applica- 
 tion for relieving CONGESTION OF THE VOCAL CORDS when rest is impos- 
 sible. {Trans. Amer. Laryvgological Ass 1 n, 1887.) 
 
 " Iodine Wool : " Cotton wool, one drachm; glycerin, ten minims; 
 tr. iodine, half an ounce. Mix the glycerin with the tincture, saturate 
 the wool with the liquid, and dry. 
 
 lODOTANNIN. 
 
 lodotannin according to A. Stabler {Med. News, Philadelphia, April 
 16, 1887) is prepared by dissolving as much tannin as a saturated 
 tincture of iodine will hold. The advantage of iodotannin is that it^vill 
 dissolve in castor oil, thus overcoming a difficulty of distributing astrin- 
 gents in this medium. lodotannin can be mixed with castor oil in any 
 proportion ; the mixture in turn can be combined with rhigolene. Three 
 minims of the tincture of iodine in the presence of twelve minims of 
 glycerin and tannin added to an ounce of water, is also a convenient 
 form. 
 
 CAMPHORATED IODINE. 
 
 One-half ounce of tincture of iodine, thirty minims of stronger solution 
 of ammonia, and three and a half drachms of spirit of camphor are com-
 
 310 LOCAL THERAPEUTICS. 
 
 bined. After four days filter. A teaspoonful to a pint of water at 80 F. 
 is employed as a stimulating inhalant; it is also used by the Valsalva 
 method in CHRONIC AURAL CATARRH. (Leffert's Pharm.) 
 
 IODINE SODIUM CHLORIDE. 
 
 Von Kaczorowski {Deutsche med. Wochenshr., Nos. 33-35, 1885) 
 recommends iodine chloride of sodium solution (one per cent, sodium 
 chloride, one-fifth of one per cent. tr. iodine), one-half to a tea- 
 spoonful every half to quarter of an hour, for the arrest of bacterial 
 disease of the mouth in connection with the gums and teeth. (See 
 also W. D. Miller, " Micro-organisms of the Human Mouth," p. 236.) 
 
 IPECACUANHA. 
 
 " Ipecacuanha is the root of Cephaelis ipecacuanha." (U. S. P.) The preparations 
 in use for local medication are : Extractum Ipecacuanhse Fluidum ; Pulvis Ipecacuanhas 
 et Opii ; Trochisci Ipecacuanha ; Trochisci Morphinae et Ipecacuanb.se. 
 
 Diseases of the Throat, etc. Ipecacuanha stimulates the mucous 
 glands of the respiratory tract, and exhibits a tendency to convert tena- 
 cious irritative mucus into a fluid more normal in its consistence. Hence, 
 its impression is valued in the late stages of an ACUTE CATARRH, whether 
 of primary origin or a recurrent condition engrafted upon a chronic 
 inflammation. Ipecacuanha is usually administered by the stomach, but 
 that its local exhibition is also of value is evident. Ringer speaks highly 
 of spray inhalations of ipecacuanha in obstinate "WINTER COUGH" and 
 BRONCHIAL ASTHMA. The wine is used pure, or variously diluted. The 
 first inhalation is apt to excite paroxysm of coughing, which generally sub- 
 sides, but the spray should be continued ; the patient soon becomes accus- 
 tomed to it, and inhales freely. Both cough and expectoration decrease in 
 a few days, and dyspnoea improves. In order to insure only a topical 
 effect, the patient must eject the preparation and rinse the mouth at each 
 pause in the administration, for the wine collects, and if swallowed is 
 apt to cause nausea and even vomiting. 
 
 Lozenges of ipecacuanha are furnished. Each official lozenge con- 
 tains one-fourth of a grain of the powder. 
 
 JEQUIRITY. Abrus. Prayer Beads. Jumble Beads. 
 
 The seeds of Abrus precatorius. The seeds are of a scarlet color with a black patch 
 about the hilum, are not poisonous when swallowed, but excite inflammatory conditions 
 when the infusion or a powder is brought in contact with wounds or placed under the skin. 
 An infusion made by macerating three parts of the seed in five hundred parts of cold 
 water, with five hundred parts of hot water afterward added, and filtered, is sometimes 
 used in the eye to produce an ophthalmia. There have been isolated from the seeds
 
 JEQU1RITY. 31I 
 
 abrin, which is supposed to be composed of paraglobulin and alpha-phyta-albuminose. The 
 latter is believed to be identical with papain. It is now thought that the ophthalmia is 
 caused by abrin, and not, as was at first believed, by a bacillus. (See British Med. Jour., 
 January, 1884, pp. 476-564.) Martin has shown the jequirity poison to be an albumose. 
 (T. Lauder Brunton, " Modern Therapeutics," p. 47.) 
 
 Diseases of the Eye. Jequirity was introduced into ophthalmic 
 practice by De Wecker about ten years ago, and has been extensively used 
 in the treatment of GRANULAR OPHTHALMIA, particularly of the corneal 
 pannus accompanying this disease. It has been long known that good results 
 may sometimes be obtained in desperate cases of TRACHOMA by inducing 
 an acute purulent conjunctivitis, after the subsidence of which, under 
 treatment, there is a contraction of the granulations, with a marked clearing 
 up of the opaque cornea. This treatment was occasionally resorted to 
 by the older surgeons, who inoculated the affected eye with the discharge 
 from a case of puruleni ophthalmia. This involved serious danger not 
 only to the patient, but to others who might be subjected to contagion, 
 and it is claimed that equally good results may be obtained from " jequirity 
 ophthalmia," which is less severe, more easily controlled, and not con- 
 tagious. A peculiar form of inflammation, accompanied by more or less 
 pain and lachrymation, and the formation of a croupous membrane, 
 occurs usually within twenty-four hours of the application of the drug. 
 Careful treatment with soothing washes or iced cloths may be necessary 
 to control it if it prove excessive. Jequirity is used in the form of 
 infusion, made by macerating the crushed seeds in cold water for from 
 three to twenty-four hours, according to different authorities, and in a 
 proportion of from one to five per cent. A strength of two or three per 
 cent, and a maceration of six hours are perhaps the most generally 
 approved. The infusion is unfit for use if kept too long, and some sur- 
 geons have insisted that it should be freshly prepared each day, while 
 others use it when several weeks old, and claim that it can be kept even 
 longer by the addition of a little boric or carbolic acid, which does not 
 impair its efficacy. Its action is chemical, and is not dependent on 
 micro-organisms. 
 
 The application is made to the everted lid by means of a pledget of 
 absorbent cotton, and is repeated every day until the full effect is' pro- 
 duced. Sometimes several applications a day may be necessary, but it is 
 well to commence with a weak infusion, and not to make the second 
 application for forty-eight hours, as the susceptibility of different patients 
 varies greatly. 
 
 Extended experience has shown that flabby, succulent granulations are 
 not favorably affected by this treatment, and it is contra-indicated by a 
 purulent discharge or by an ulcerated cornea, or one that is free from 
 vascularity. Its application may be practically limited to cases of
 
 312 LOCAL THERAPEUTICS. 
 
 INVETERATE TRACHOMA with dense granulations and pannus. This remedy 
 is not altogether free from danger, and should be used only in properly 
 selected cases and under careful and skillful management. With these 
 limitations it is a valuable addition to ophthalmic therapeutics, and one 
 that is perhaps not now resorted to so often as it should be. 
 
 JUJUBE. Jujube Paste. 
 
 When properly made it is prepared from a decoction of the fruit of Zizyphus vulgaris, 
 by dissolving in it sufficient gum arabic and sugar to bring it to a proper consistence. As 
 ordinarily made and sold, however, jujube paste is prepared only of gum arabic and 
 sugar pleasantly flavored. It is, however, of equal activity with the true paste. 
 
 Jujube is demulcent and forms the basis of a lozenge for use in irritated 
 states of the mouth and throat. 
 
 * 
 
 KAOLIN. 
 
 Kaolin is a hydrated silicate of aluminum. It is a cream-white claj, which forms an 
 impalpable powder entirely free from grit. 
 
 Kaolin is a protectant. It also serves to suspend oils in water. 
 
 General Surgery. Maizee (Lancet, June 23, 1888) has employed 
 kaolin in the treatment of MASTITIS. It is applied over gauze and is 
 said to be a satisfactory means of maintaining low temperature. It is 
 also used as an absorbent in wounds accompanied with purulent dis- 
 charge. 
 
 Diseases of the Skin. Kaolin alone or in combination with other 
 indifferent, sedative, or astringent powders, or substances otherwise medi- 
 cated, is employed as an application to the skin in various forms of ERY- 
 THEMA and ECZEMA, and other inflammatory skin diseases. It possesses the 
 advantage over starch and some other powders of not becoming rancid and 
 irritating when brought into contact with the secretions of the skin. A 
 similar powder is the "terra cimolise," or fuller 's earth. 
 
 Kaolin is sometimes employed in the form of paste to replace oint- 
 ments in certain cases of ECZEMA RUBRUM of the leg, and similar affec- 
 tions, when greasy applications are for any reason contraindicated. The 
 following formula is found useful: R. Kaolin, ^iiss; olei lini, fgiss; liq. 
 plumbi subacetatis, fj. M. This forms a gray paste of a putty-like odor 
 and is convenient of application. 
 
 In ACNE with COMEDO, the following paste has been recommended : 
 R. Pulv. kaolin, ^iv ; glycerini, f^iij; aceti, fgij. M. 
 
 Diseases of the Throat, etc. Lefferts prefers kaolin to magnesium 
 carbonate in suspending oil for purposes of inhalation. One-half grain 
 of kaolin is sufficient for each drop of oil.
 
 KA\VA KINO KRAMERIA. 313 
 
 KAWA. Kava. Ava. 
 
 The root of Piper methystictim. Kava contains a volatile oil, a resin, a crystalline 
 principle called kavahin, or methysticin, which is somewhat analogous to piperin and 
 cubebin. A solution of kavva resin used locally induces anaesthesia. In this way it is 
 analogous to cocaine. As compared to the agent last named, it possesses a disadvantage, 
 inasmuch as the first effect of the application is to cause pungent pain. Kawa is insoluble 
 in water and glycerin. 
 
 An extract of kawa is claimed by N. Weinstein ( Wien. med. Blatter, 
 No. 26, 1887) to have anaesthetic properties on mucous surfaces. 
 
 KINO. Kino. 
 
 " The inspissated juice of Pterocarpus marsupium." (U. S. P.) " Kino is without odor, 
 and has a bitter, highly astringent taste, with a somewhat sweetish after-taste." (U. S. D.) 
 It is soluble in cold water, more soluble in hot water; soluble in alcohol, and nearly 
 insoluble in ether. The tincture is apt to gelatinize when long kept. Tincture of kino, 
 containing the activity of ten parts of the kino in one hundred parts of the finished tinc- 
 ture, is the single official preparation. 
 
 Kino is a powerful astringent. Its efficacy depends upon the presence 
 of kino-tannic acid. 
 
 General Surgery. An infusion of kino is sometimes employed as a 
 wash in LEUCORRHCEA. Powdered kino is occasionally employed as a 
 topical application in CHRONIC ULCERS. 
 
 Diseases of the Nose, Mouth, Throat, etc. Kino is less agree- 
 able to the taste than is krameria, and is, therefore, less commonly pre- 
 scribed than the agent last named in affections of the nose, mouth, and 
 throat. It, however, is active and reliable, and it is claimed in its behalf 
 that in the form of a powder it can arrest hemorrhage when other astrin- 
 gents have failed. Hence, German physicians praise it in the treatment 
 of EPISTAXIS. In the form of a lozenge it is occasionally used. Each 
 mass contains two grains of the aqueous extract. Since its efficacy depends 
 upon kino-tannic acid, it should not be combined with gelatin. " Kra- 
 meria-kino-catechu wool : " Cotton, one drachm; glycerin, ten minjms ; 
 tr. catechu, vel. kino, vel. rhatany, one ounce. Mix the glycerin with the 
 tincture, saturate the wool with the liquid, and dry. 
 
 KRAMERIA. Krameria. Rhatany. 
 
 " The root of Krameria triandra and Krameria tomentosa." (U. S. P.) The root 
 contains tannin, starch, saccharine matter, and krameric acid. The drug owes its 
 virtue to the tannin. The following preparations are official: an extract (of uncertain 
 strength) ; a tincture (containing the activity of twenty parts of krameria in one hundred
 
 314 LOCAL THERAPEUTICS. 
 
 parts of the finished tincture), and a fluid extract (one cubic centimetre of which 
 represents the activity of one gramme of the drug). 
 
 Krameria is-one of the most agreeable of the vegetable astringents. It 
 possesses the advantage over many other agents of its class in making a 
 clear mixture with water. 
 
 Diseases of the Nose, Throat, etc. A gargle is prepared by 
 adding four ounces of the tincture to a half pint of water at 100. An 
 astringent nasal tampon is made by mixing one-half ounce of the 
 tincture with ten minims of -glycerin, and saturating a mass of absorbent 
 cotton of convenient size. In the form of a nasal bougie three grains 
 of the fluid extract are contained in each mass. A few drops added to 
 an equal quantity of Cologne water, and appropriately diluted, forms 
 an agreeable mouth-wash, where the membrane lacks tone. Krameria 
 lozenges are often prescribed. One grain is directed to be combined 
 with the base in each mass. A favorite lozenge, with some practitioners, 
 is to exhibit krameria, cubeb, carbolic acid, and potassium chlorate. 
 Gelatin is unsuitable for combination with krameria. 
 
 " Krameria-kino -catechu Wool : " Cotton, one drachm; glycerin, ten 
 minims ; tr. catechu, vel kino, vel rhatany, one ounce. Mix the glycerin 
 with the tincture, saturate the wool with the liquid, and dry. 
 
 LACTUCARIUM. Lactucarium. 
 
 " The concrete milk juice of Lactuca virosa." (U. S. P.) The fluid extract is the 
 only official preparation, and of it one cubic centimetre represents the activity of one 
 gramme of lactucarium. 
 
 Lactucarium is a mild anodyne. " It is almost devoid of narcotic 
 properties." (U. S. D.) 
 
 Diseases of the Throat. Lactucarium is used as a lozenge, each 
 mass to contain one grain of the drug. It is indicated in painful con- 
 ditions of the pharynx, which are unaccompanied with high grades of 
 inflammation. Lactucarium may be combined with other anodynes, as 
 follows : Extract of lettuce, one and one-half grains ; codeine, one-half 
 grain ; extract hyoscyamus, one-half grain. 
 
 LAMB'S WOOL. 
 
 Lamb's wool is a substitute for absorbent cotton in some clinical con- 
 ditions of the ear. It is also useful in protecting the nasal passages from 
 irritative currents of air. The more elastic character of the hair, as 
 compared to cotton-fibre, enables a pledget of wool to act as a sieve as 
 well as a plug. With some persons, however, it proves to be irritative.
 
 LAMINARIA. 
 
 315 
 
 LAMINARIA. Sea-tangle. 
 
 A sea weed (Laminaria digitata) found upon the shores of Great Britain. It has a 
 stem from six to fifteen feet in length and of about an inch to an inch and a half in 
 diameter at its largest part. The stem shrinks to a marked degree in drying. The dried 
 pieces, wheji again moistened, quickly regain their natural size. This property makes 
 laminaria valuable for the manufacture of tents and bougies. The plant is one of the 
 sources of iodine, which it contains in large proportion. When burned it produces a 
 superior, fine-grained charcoal. , 
 
 Laminaria is hygroscopic. 
 
 General Surgery. When lodged in the uterus laminaria slowly 
 expands the cervical canal, which in this way usually becomes accessible to 
 the finger for diagnostic purposes. The value of the agent in the main 
 relates to the management of some of the after-consequences of abortion, or 
 the post-partum retention of the products of conception. It is largely 
 employed by some practitioners in facilitating the application of local 
 remedies to the endometrium. The use of the tent is always accompanied 
 with more or less risk, and is not employed without extreme caution. 
 It must not be introduced into the uterus when there is any evidence of 
 pelvic inflammation. 
 
 When used by themselves, the tents are liable to be forced out of the cer- 
 vical cavity. W. Goodell is in the habit (when the condition of the os 
 uteri will admit) of using two or three laminaria and one sponge tent. 
 The latter assists in retaining the dilating mass in the canal. Laminaria 
 should not be inserted while the patient is in the consulting or out- 
 patient room, but in a hospital ward or bed-room, and the patient should 
 be in bed while the tent is in the cervix. It should never be used just 
 prior to or during the monthly period. Before introduction the vagina 
 should be douched with a mild bichloride-solution, 1-8000, or a two per 
 cent, creolin-solution. It is important that each tent should have attached 
 a piece of strong twine, which will materially assist in its removal. The 
 tent should always be removed in twelve hours, and the vagina washed 
 with an antiseptic solution. If the cervix is not sufficiently dilated for 
 the desired object, another may be employed. There is more danger 
 accompanying the second and third introduction than with the first, so 
 that it is desirable that the cervical canal should be tightly filled at the 
 first treatment, and thus avoid the necessity for another manipulation. 
 (Doran, " Gynaecological Operations," p. 79.) To insure purity Dirner, 
 of Buda-Pesth, immerses laminaria in a one per cent, alcoholic solution 
 of corrosive sublimate. 
 
 Diseases of the Ear and Nose. Small laminaria tents have been 
 used for dilating openings in the tympanic membrane preparatory to 
 treatment of the middle ear. Bougies of the same material are employed
 
 316 LOCAL THERAPEUTICS. 
 
 in maintaining patulency of the Eustachian tube (Keene). Nasal bougies, 
 have been introduced into narrowed nasal passages, but the effects are 
 transitory. 
 
 LANOLIN. Adeps Lanze Hydrosus (Ph. Br.). 
 
 Lanolin is a copyright name applied to a product made by a patented process from the 
 cholesterin fats of wool, and introduced into medicine by Liebreich. It is a saponaceous, 
 fatty substance, absorbing at least its weight of water, not decomposable, and perfectly 
 bland and non irritating. It has been some'what hastily claimed that lanolin is more 
 readily absorbed through the skin than is any other base, but the experiments made to 
 determine this point have been incomplete, and the results contradictory. Its blandness 
 and the quality of combining with large proportions of water make lanolin a valuable 
 vehicle for external applications. It is insoluble in water, partly soluble in alcohol, but 
 readily soluble in ether. 
 
 General Surgery. Lanolin is a popular basis for ointments in the 
 treatment of INGUINAL or CERVICAL ADENITIS. 
 
 Diseases of the Skin. Lanolin has been recommended as an 
 inunction in DRY and WASTED CONDITIONS OF THE SKIN. It is said 
 to remove wrinkles in the aged, but this assertion has not been con- 
 firmed. It is sometimes employed in massage, and is useful in CHAPPED 
 HANDS. 
 
 As a vehicle for the administration of drugs by inunction, lanolin has 
 been highly praised. In the opinion of some observers lanolin appears to 
 possess superior penetrating power over the ointment bases usually em- 
 ployed. 
 
 Lanolin sparingly dissolves many medicinal substances; it is rather 
 stringy and clinging, and should be mixed with fat or with vaseline. 
 About one part of vaseline or lard to five parts of lanolin form a con- 
 venient proportion. 
 
 On the other hand, a small proportion of lanolin added to an ointment 
 or to vaseline gives the mass firmer consistence. Lanolin, two parts; 
 benzoinated lard, one part, is extolled in ECZEMA of the auditory passages. 
 The rather disagreeable odor excludes the use of lanolin about the nostrils. 
 
 Diseases of the Eye. Lanolin has been used in ophthalmic sur- 
 gery for ointments of yellow oxide of mercury, etc., but has no well- 
 established superiority over cosmoline or lard. 
 
 LIMONIS SUCCUS. Lemon Juice. 
 " The freshly expressed juice of the ripe fruit of Citrus limonum" (U. S. P.) 
 
 Diseases of the Nose, Throat, etc. Fanchon (Med. Record, 
 October 5, 1889) recommends the local application of lemon juice in 
 EPISTAXIS. He found it efficacious after plugging the nostrils had
 
 LI NUM. 
 
 failed. Bonatny (Bull. Therapeutique, April 30, 1887) an d Gomez de la 
 Mata (Gaceta de Oftalmologia, Otologia y Laryngologia, Jirly, 1886) uses 
 this agent as an application in DIPHTHERIA. The use of lemonade is 
 indicated in ^ESOPHAGITIS, dependent upon the action of an alkali. 
 
 LINUM. Flaxseed. Linseed. 
 
 The seed of Linum usitatissimum. Flaxseed, when reduced to a powder, forms the 
 ground flaxseed of the U. S. P. It is of a dark gray color and highly oleaginous. When 
 mixed with hot water it forms a soft, slightly adhesive mass. Much of the linseed of 
 commerce is simply "cake-meal" left after the extraction of linseed oil, which is made 
 by compressing the ground seeds. This cake-meal is unfit for medical purposes, not 
 only because of its poverty in oil, but owing to the fact that exposure to the air has caused 
 it to become rancid. The U. S. Pharmacopoeia directs that flaxseed for medical purposes 
 should be freshly ground and free from unpleasant and rancid odors, and should con- 
 tain at least twenty-five per cent, of oil. 
 
 Flaxseed is demulcent and protective. When used in the form of a 
 poultice it is a convenient means of retaining heat and moisture, as well 
 as of maintaining degrees of heat higher than that of the part upon which 
 it is applied. 
 
 General Surgery. A flaxseed poultice, when properly made, is 
 soft, moist, and bland. Its effects can be obtained from warm water, 
 but the method of applying the agent last named, as a rule, is less conveni- 
 ent. Poultices are frequently employed in the early stages of PHLEGMONOUS 
 and SUPERFICIAL INFLAMMATIONS, adding greatly to the comfort of the 
 patient and assisting in the softening and future absorption of the inflam- 
 matory products. The action, while sedative, is less efficient than a 
 cold-water dressing. Nevertheless, experience has demonstrated that a 
 carefully applied hot poultice will often cause resolution where a cold- 
 water dressing would in time be followed by suppuration ; and the differ- 
 ence in the comfort to the patient is great. If the inflammation has 
 advanced and suppuration is threatened, poultices hasten the pus-forming 
 process. When the tissues are in the stage of high tension, which 
 precedes the suppurating stage, the application of a hot poultice gives 
 relief from pain by relaxing the tissues. The impression made ^tipon 
 the peripheral nerves may also be transmitted to the nerve centres and 
 reflected upon internal organs. It is by this means that warm, moist 
 applications relieve pain in internal and distant parts which have no 
 direct anatomical connection with the integument. 
 
 Poultices, like many other valuable therapeutic agents, are often 
 abused by being used too long ; in which case the skin becomes white, 
 wrinkled, and sodden, small boils or pustules form, and the blood-vessels 
 lose their tone. Over-poulticing of wounds or ulcerations induces granu-
 
 318 LOCAL THERAPEUTICS. 
 
 lations to become pale and flabby, and the healing process to be delayed. 
 Applied indiscreetly to an inflamed joint, poultices may promote suppura- 
 tion and lead to disorganization. 
 
 Poultices have long been prescribed to relieve tension and promote 
 resolution in the treatment of BOILS and CARBUNCLES, but they are strongly 
 suspected of multiplying such lesions by furnishing favorable condi- 
 tions for the development of the germs of morbid processes. Poultices 
 are especially serviceable for cleansing FOUL, SLOUGHING SORES, or to 
 hasten the separation of SLOUGHS. In the treatment of serous inflamma- 
 tion. of the great cavities, like the pleura or peritoneum, large, hot poul- 
 tices are often of service. In treating PERITONITIS, the poultice should 
 be of sufficient size to cover the entire abdomen, and is applied as hot 
 as it can be borne, and covered with oiled silk. In PLEURISY and PNEU- 
 MONIA, the poultice should cover the anterior and posterior portions of 
 the chest, forming what is known as the " jacket-poultice," which may be 
 encased in thin flannel made into a sort of double bag, which is cut to the 
 shape of the individual, secured in front with safety pins, and supported 
 over the shoulders with tapes. Chest poultices are especially convenient 
 in treating children. Poultices may have added to them a small quantity 
 of mustard or some other stimulating material. Made in this way they 
 act as counter-irritants. In inflammation of the lungs poultices are un- 
 doubtedly of great service; but, unless they can be carefully attended to 
 by trained attendants, they may chill the patient. 
 
 LINI. Oil of Flaxseed. Linseed Oil. Flaxseed Oil. 
 " A fixed oil expressed ir vm flaxseed without the aid of heat." (U. S. P.) 
 
 General Surgery. Linseed oil is a bland, unirritating oil, but little 
 used as a topical application, except for making " carron oil ;" this is com- 
 posed of equal parts of linseed oil and lime-water (see Aqua calcis). A 
 preparation somewhat similar to "carron oil," known as linimentum cal- 
 cis, does not now contain linseed oil. Linseed oil, owing to its rapid 
 drying properties, leaving a thin, impervious, resinoid coating, with no 
 tendency to crack, is employed in the preparation of such protective 
 substances as oiled silk, oiled paper, etc. 
 
 While the Pharmacopoeia directs that Linum should be restricted to 
 flaxseed, three articles cannot be consistently treated under any other 
 head. Therefore, at this place will be considered the subjects of Lint, 
 Charpie, and Oakum. 
 
 LINT. 
 
 Lint is of two kinds, domestic and patent. The former is prepared by 
 scraping one surface of old linen with a table-knife until its surface be-
 
 LITHII CARBONAS. 
 
 3 J 9 
 
 comes soft. The patent lint is made by the removal of the transverse 
 threads of new linen, and scraping them longitudinally. It is used for 
 the application of lotions or cerates to wounds or other injuries. In the 
 use of lint with either of the above agents, it is well to cover it with 
 waxed paper, in the case of lotions, to prevent evaporation taking place 
 too rapidly, and with cerate to save the outer dressings, and the clothing 
 of the patient. As an absorbent it is little used, since other dressings are 
 cheaper and more efficient. 
 
 CHARPIE. 
 
 General Surgery. Charpie, a surgical dressing prepared by unravel- 
 ing coarse linen, was at one time popular in the profession, particularly 
 as a dressing for granulating wounds. During the Civil War large quan- 
 tities of this substance were used. It was mostly prepared by house- 
 wives from their old table linen. It is much inferior to lint. 
 
 OAKUM. 
 
 General Surgery. This common, useful, and cheap preparation is 
 made from old hempen ropes. These are picked to pieces, and form, 
 when carefully prepared, an efficient dressing. The absorbent power of 
 this substance is marked, hence oakum is much used in the treatment of 
 SUPPURATING WOUNDS. The odor is agreeable. It is extensively employed 
 as a padding for splints, in fracture boxes, as compresses, and in the 
 form of pads or rings to prevent pressure on various parts of the body, as 
 around BED SORES and beneath the tendo-Achillis. Oakum threads enter 
 into the formation of the seton, in CHRONIC ARTHRITIS a process of 
 counter-irritation more in vogue formerly than at the present day. 
 
 LITHII CARBONAS. Carbonate of Lithium. 
 
 Carbonate of lithium is " a light, white powder, soluble in 130 parts of water at 15 C. 
 (59 F.), and in about the same proportion of boiling water; insoluble in alcohol." 
 (U. S. P.) 
 
 Carbonate of lithium is resolvent of chalky deposits of gout. 
 
 General Surgery. Garrod has been successful in the removal 
 of GOUTY DEPOSITS in the hands and fingers by the application of a solu- 
 tion of five grains of carbonate of lithium to the ounce lint being soaked 
 in this and kept constantly applied to the part. A strong solution of a 
 lithium salt is applied with the intention of converting the urates in the 
 tissues into the soluble urate of lithium. The treatment is especially 
 useful when the skin is broken. Under ordinary circumstances this is 
 difficult to heal, owing to the urates being held in the connective tissue 
 and slowly escaping through the wound.
 
 320 LOCAL THERAPEUTICS. 
 
 LYCOPODIUM. Lycopodium. 
 
 " The sporules of Lycopodium clanatum and of other species of " Lycopodium." (U. S. 
 P.) " A fine powder, pale yellowish, very mobile, inodorous, tasteless, floating upon 
 water and not wetted by it, burning quickly when thrown into a flame." (U. S. P.) 
 
 Lycopodium is often mixed with various substances, such as pollen, starch, talc, dex- 
 trin, and even sand. 
 
 Lycopodium acts as.a protectant. 
 
 Diseases of the Nose and Throat. Lycopodium may be used as 
 an excipient in the composition of snuffs. Its extreme lightness makes it 
 somewhat difficult to manipulate. A snuff composed of equal parts of 
 lycopodium, gum arabic, and bismuth subnitrate, is in good repute for 
 NASAL CATARRH. Lycopodium may be thrown up the naso-pharynx in 
 combination* with sodium chloride and sodium bicarbonate. (Kirchner.) 
 
 LYSOL. 
 
 That product of the distillation of coal-tar which comes over between 190 and 200 
 C. (which is the distillate in boiling point next above carbolic acid) is dissolved in fat 
 and saponified by beating with an alkali. The product is a German patented article 
 known under the fanciful name of lysol. It is a brown, oily-looking liquid, with an 
 aromatic, creasote-like odor. 
 
 Lysol contains about fifty per cent, of cresols, and forms a clear, saponaceous solution 
 with water ; it is also soluble in alcohol, benzin, chloroform, and glycerin. 
 
 The superiority of lysol over carbonic acid consists in its complete solubility in water, 
 and its saponaceous character, whereby it becomes especially suitable for the immersion 
 of instruments, and for use as a surgical soap. It is claimed that it is five times more 
 efficient than carbolic acid, and eight times less poisonons. It is allied in many of its 
 properties, as well as in composition, to creolin. A lysol wadding and gauze, as well as 
 a lysol-soap are included in German trade-lists. 
 
 MAGNESII CARBONAS. Carbonate of Magnesium. 
 " Light, white, friable masses, or a light, white powder, odorless and tasteless, insolu- 
 ble in alcohol, and almost insoluble in water, to which, however, it imparts a feebly 
 alkaline reaction." (U. S. P.) 
 
 Diseases of the Ear, Throat, etc. Magnesium carbonate is used 
 as an indifferent agent to protect sensitive surfaces or to aid in the sus- 
 pension of oily substances in aqueous solutions in the proportion of one- 
 half grain to a grain of the drug to a minim of oil. It also enters into 
 the composition of powders to be used as insufflations when it is desired 
 to diffuse the effects of such agents as cocaine and iodol. The dried 
 powdered carbonate will often cure an obstinate DERMATITIS of the EX- 
 TERNAL AUDITORY PASSAGE after all active remedies have failed. It is 
 simply dusted lightly on the affected parts, and renewed every third day.
 
 MASTICHE MATICO MENTHOL. 321 
 
 Magnesium carbonate also serves a valuable purpose as an antidote to the 
 effects of PHOSPHORUS POISONING in the throat. M. Mackenzie recom- 
 mends that the agent be given in drachm doses every fifteen minutes 
 until the breath ceases to be phosphorescent. An important use of 
 magnesium carbonate is the aid it gives in distributing oils through watery- 
 media. The reader is referred in this connection to the articles on oils. 
 
 MASTICHE. Gum Mastiche. Mastic. 
 
 "A concrete, resinous exudation from Pistacia lentiscus." (U.S. P.) "Mastic is 
 wholly soluble in ether, chloroform, and oil of turpentine, scarcely soluble in the fixed 
 oils, and insoluble in water." (U. S. D.) Alcohol absorbs about nine-tenths of it, but 
 leaves undissolved a resinous substance to which the name of masticin or beta-resin of 
 mastic is applied. The portion soluble in alcohol is called the alpha-resin of mastic or 
 mastichic acid. ' 
 
 Mastiche is a protectant and styptic. 
 
 General Surgery. Mastiche is often employed as a temporary filling 
 for CARIOUS TEETH, in the form of a solution consisting of ether, one 
 part, mastiche, four parts. When properly dissolved it is of an oily 
 consistency. A small piece of cotton the desired size is saturated with 
 the solution and evenly and carefully pressed into the cavity, which has 
 previously been thoroughly cleansed. 
 
 Diseases of the Throat, etc. M. Mackenzie uses a solution, one 
 to five, as a varnish on DIPHTHERITIC DEPOSITS.' The membranes should 
 be dried with blotting paper before the application is made. 
 
 MATICO. Matico. 
 
 The leaves of Artanthe elongata, Miquel. (U.S.P.) They are aromatic, spicy, and slightly 
 bitter. The Extraction Matico Fluidum and the Tincttira Matico are official. 
 
 Matico is styptic and haemostatic. It is an old remedy for EPISTAXIS, 
 but is now almost entirely discarded. 
 
 MENTHOL. Menthol. Peppermint Camphor. 
 
 Menthol is a "stearoptene obtained by cooling the oil distilled from the fresh herb of 
 Mentha arvensis and Mentha piperita" (Ph. Br.) Oil of peppermint upon long 
 standing or exposure to extreme cold deposits a camphoraceous substance, which is 
 menthol. It occurs " in colorless acicular crystals, usually more or less moist from ad- 
 hering oil, or in fused crystalline masses. Its melting point should not exceed 1 10 F. 
 It has the odor and flavor of peppermint, producing warmth on the tongue, or, if air is 
 inhaled, a sensation of coolness. It is sparingly soluble in water, and readily soluble in 
 rectified spirit." (Ph. Br.) 
 
 Menthol is analgesic, antiseptic, and appears to exert a specific im- 
 21
 
 322 LOCAL THERAPEUTICS. 
 
 pression upon mucous tissues infiltrated with the products of the bacillus 
 of tubercle. 
 
 General Surgery. Menthol has of late obtained reputation as an 
 anaesthetic. Rubbed into the affected part, it relieves NEURALGIC PAINS 
 when they are superficial and peripheral in their origin. It enters into 
 the composition of the Chinese remedy, "Po-ho-yo." " Po-ho-yo " is 
 applied directly to the affected part in the relief of TOOTHACHE. It is 
 also of repute in relieving GOUTY PAINS. Menthol is extensively used in 
 the form of a crayon in the treatment of FRONTAL HEADACHE and NEU- 
 RALGIA. After its application a sense of cold is experienced, but persistent 
 use will irritate. Menthol dissolved in chloroform and ether in the fol- 
 lowing proportions, menthol, one drachm; chloroform, ten drachms; 
 ether, fifteen drachms, is a useful analgesic. It can be applied to the 
 skin over an abscess, or to the skin over a sebaceous cyst prior to ex- 
 cision, etc. Morris {Lancet, 1881), has shown menthol to be a germicide. 
 Russel (Medical Record, November, 1885) affirms that menthol has a 
 remarkable power of controlling SUPERFICIAL INFLAMMATIONS. He 
 applies an ethereal solution from ten to fifty per cent, two or three times 
 daily, with a camel's-hair pencil, with the effect of controlling the forma- 
 tion of CARBUNCLES, BOILS, and SMALL ABSCESSES. Langaard {Therap. 
 Monatshefte, March, 1887) who has made a careful study of menthol, 
 regards it as a valuable sedative when applied locally to marginal BURNS 
 and PAINFUL HEMORRHOIDS. It may be used, as Macdonald recommends, 
 in a ten per cent, alcoholic solution, or an ointment consisting of men- 
 thol, one part; olive oil, half part ; lanolin, eight and a half parts. The 
 action of the ointment is more permanent than the crayon. On mucous 
 membranes the following ointment may be applied : menthol, one part, 
 dissolved in olive oil, three parts; lanolin, six parts. In the treatment 
 of BURNS, menthol, one part, dissolved in olive oil, nine parts ; lime-water, 
 ten parts, may be spread on lint or old linen and applied. Girard {Brit. 
 Med. Journ., April, 1888) used equal parts of iodoform and menthol in 
 the treatment of TUBERCULAR ULCERATIONS in bone and the soft parts, 
 with more satisfactory results than where iodoform alone is used. 
 
 Diseases of the Skin. Menthol is employed as an antipruritic in 
 PRURITUS, URTICARIA, and ECZEMA. Elvy recommends a tincture of five 
 to twenty grains of menthol to the ounce of alcohol, and -a liniment of 
 twenty-five grains menthol to half an ounce each of lanolin and olive oil. 
 Dubreuilh recommends an ointment of five to twenty-five grains to the 
 ounce of oxide of zinc ointment in subacute, itching ECZEMA. In 
 severe PRURITUS a solution of fifty grains of menthol in an ounce of 
 olive oil has proved useful, the effect lasting from half an hour to a day. 
 Sometimes if used over a large surface menthol produces an intolerable
 
 MENTHOL. 
 
 323 
 
 sensation of cold. It cannot be employed with propriety on mucous 
 membranes or on abraded surfaces in the strength usually used in appli- 
 cations to the skin. 
 
 Diseases of the Ear, Throat, etc. Menthol in ten to fifteen per 
 cent, oily solution arrests FURUNCLE in the auditory passage. Cholevva 
 {Monatschr. f. Ohrenheilk., March, 1892) has invited attention to the 
 properties as applicable to auditory disease. 
 
 The vapor of menthol from a twenty per cent, solution can be forced 
 into the middle ear in CHRONIC AURAL CATARRH. The solution is best 
 made by dissolving in alcohol. (Adolf Bronner, Sajous 1 Annual of Med. 
 Science, vol. iv, 1890, c. 25.) No remedy for CORYZA is in higher 
 repute than menthol. It is the basis of many proprietary articles, for use 
 as sprays or inhalants. Menthol can be used by insufflation mixed with an 
 equal quantity of magnesium oxide. It is often rubbed on the skin about 
 the external nose, lip, and brow for the relief of secondary distressing 
 sensations which accompany NASAL CATARRH. F. H. Potter (Trans. 
 Amer. Med. Ass'n, 1889) recommends the use of menthol in atrophic 
 states of the lining membrane of the nose. Liquid petrolatum in which 
 menthol has been dissolved can be used as a spray. Three grains of 
 pulverized menthol in one hundred grains of an indifferent medium forms 
 the basis of a snuff for CATARRH recommended by Rabow. {Deutsche 
 med. Wochenschrift, 1886, No. 5.) A small proportion, say one grain 
 to two ounces, is an agreeable addition to a lotion to be used in ACUTE 
 PHARYNGITIS and RHINITIS. S. Solis-Cohen employs menthol in a wide 
 range of purposes in five to ten per cent, solutions. He claims that it is 
 both cleansing and soothing in CATARRH of various grades. It can be 
 applied conveniently by means of cotton, sponge, or any form of spray 
 largely diluted in benzoinated petrolatum. Kutznetzoff (JRusskaia Medit- 
 zina, No. 17, 1890) recommends menthol in the local treatment of 
 DIPHTHERIA. 
 
 C. H. Knight {Jour. Amer. Med. Ass'n, December 14, 1889) reports 
 twenty cases of LARYNGITIS treated with menthol. This observer dis- 
 solved the drug in cosmoline, one drachm to an ounce, and employed 
 it in the form of a spray or vaporization. Nearly all the cases in which 
 the remedy was essayed were relieved and many were cured. The 
 treatment appears to be especially well adapted to persons of a nervous 
 temperament and in the absence of acute inflammation and oedema of the 
 parts. The same author (ibid., January, 1890, p. 89) recommends that 
 menthol be used in solution in oleum petrolatum in proportion of a half 
 drachm or a drachm to the ounce. Even with the weaker solution 
 irritation and cough is at times excited, while some cases bear the 
 stronger solution without much complaint. Ten to twelve drops may be 
 inhaled from the surface of steaming hot water, or a few drops may be
 
 324 LOCAL THERAPEUTICS. 
 
 thrown over the ulcerated surface with a laryngeal spray or syringe, or the 
 application may be made directly with a pledget of cotton. On the 
 whole, the most effective method is that of inhalation from an ordinary 
 nebulizer or vaporizer ; the mixture being inhaled for a few minutes 
 every half hour. 
 
 Rosenberg {Berliner klin. Wochens., No. 26, 1887) found menthol 
 valuable in LARYNGEAL PHTHISIS after an extended trial. The remedy 
 was used in the form of a solution, viz. : a half drachm to a drachm of 
 a twenty per cent, solution in oil being thrown upon the affected parts 
 once or twice a day in the beginning of the treatment, the interval 
 between the applications being gradually increased. When ulceration is 
 present treatment by inhalation can be resorted to. Five drops of a 
 twenty per cent, solution may be used every hour with marked benefit. 
 Ossendovsky (Meditzinskoic Obozrenie, No. 5, 1889, p. 484) uses menthol 
 in ten to thirty per cent, oleaginous solution rubbed into the parts by 
 Heryng's cotton-wool brush either once daily or thrice weekly. It is 
 well to begin with a ten per cent, solution and gradually pass to stronger 
 ones. A strength of from forty to fifty per cent, is practicable, but repre- 
 sents the maximum strength, since a thirty per cent, solution as a rule 
 represents the limit of safety, for intense local irritation may supervene 
 when a forty per cent, solution is used. Blumenau {Jour, of Laryng. 
 and Rhinology, 1889, p. 256), however, claims satisfactory results in 
 painting TUBERCULAR ULCERS with a solution as high as fifty per cent. 
 Irritative phenomena were of shorter duration than those ensuing after 
 applications of lactic acid. A. B. Thrasher {Cincinnati Lancet and 
 Clinic, June 22, 1889) employs a ten to twenty per cent, solution by 
 cotton application, or in a vaseline spray. This writer finds such a com- 
 bination of especial value in overcoming DYSPHAGIA OF LARYNGEAL 
 PHTHISIS. A method of treatment for ULCERATIONS OF THE LARYNX has 
 been proposed by Gougenheim and Glover {Journal of Laryngology and 
 Rhinology, September, 1890, p. 365), in which the effects of menthol and 
 creasote are combined ; one part of menthol is added to one to five parts 
 of creasote in five parts of oil of sweet almond.* It is reported that 
 such a mixture painted upon the affected surfaces is especially valuable 
 in the treatment of LARYNGEAL ULCERATIONS. It may also be used by 
 insufflation mixed up with equal parts of magnesium oxide. It may also 
 
 * The proportions of the formula in the original paper stand as follows : 
 
 Sweet oil of almond, loo grammes. 
 
 Menthol 20 ' 
 
 Sweet oil of almond, loo " 
 
 Creasote lo " 
 
 Mix the two solutions in water bath.
 
 MOLLIN TINCTURA MOSCHI MUSCARINE. 325 
 
 be inhaled from Schreiber's apparatus. Ossendovsky claims that menthol 
 is a reliable anodyne. 
 
 In inhaling menthol for TRACHEITIS the following method is com- 
 mended : Place the drug in a Florence flask or a wide-mouth bottle which 
 retains two tubes through the stopper : one of the tubes is used for inhala- 
 tion and the other to establish a current of air. Raise to a moderate tem- 
 perature (113 F. [45 C.] ). The bottle is now filled with white fumes. 
 Inhalations are made carefully and slowly lack of this precaution will 
 excite choking sensations. Each treatment should consist of five or six 
 inhalations several times a day. Menthol in substance may be used in a 
 solid form, as in relieving the pain of a CARIOUS TOOTH. 
 
 MOLLIN. 
 
 Mollin is a soft soap containing an excess of fat with glycerin. It is prepared by 
 saponifying, without heat, one hundred parts of cocoanut oil with forty parts of potas- 
 sium hydrate solution (specific gravity 1.145), an ^ tnen adding thirty parts of gly- 
 cerin. It is yellowish white, of a smooth consistence, free from rancidity, and readily 
 removed from the skin by warm or cold water. 
 
 Diseases of the Skin. Kirsten ( Monatshefte f. prakt. Dermatol. , 
 No. 8, 1886) and Kahn {Berlin, klin. Wochens., September 8, 1890) 
 have recommended this substance as a vehicle for cutaneous medi- 
 cation. It is stable, neutral in reaction, unirritating, and mixes well with 
 medicaments of various kinds. On account of its stability, Kirsten 
 believes that mollin may supersede ointments, such as ung. hydrarg., etc., 
 for use in warm climates. 
 
 We have employed mollin as a vehicle, but do not find it to possess 
 any advantages over those already in use. It resembles H. von Hebra's 
 " glycerinum saponatum." (See Sapo.} 
 
 TINCTURA MOSCHI. Tincture of Musk. 
 
 " Musk, ten parts; alcohol, forty-five parts; water, forty- five parts; diluted alcohol, a 
 sufficient quantity to make one hundred parts." (U. S. P.) 
 
 The tincture of musk, one part added to eight parts of " mixtura oleoso- 
 balsamica," of the German Pharmacopoeia, with two grains each of 
 acetic acid and carbolic acid, is recommended by M. A. Fritsche {Berlin 
 klin. Wochenschrift, 1887, No. 27) for inhalation in ACUTE CORYZA. 
 
 MUSCARINE. 
 
 Muscarine is an alkaloid obtained from a fungus (Agaricus or Amanita mtiscarius). 
 It has also been obtained as a derivative from brain substance. It and its nitrate 
 are uncrystallizable. The nitrate is a hygroscopic brownish-yellow liquid, viscid and 
 soluble in water.
 
 326 LOCAL THERAPEUTICS. 
 
 Diseases of the Eye. Muscarine is a decided myotic, but has not 
 been much used in ophthalmic practice. It is said to act more ener- 
 getically on the ciliary muscle than on the pupillary. It may be used in 
 solution of from one to four grains to the ounce. 
 
 MUSCARINE SULPHATE. 
 
 E. L. Shurly (JV. Y. Med. Jour., September n, 1886) believes that 
 one-fiftieth to one-tenth grain of this agent to the ounce of water is use- 
 ful as a spray in relieving irritation in NASO-PHARYNGEAL CATARRH. 
 
 MYRRHA. Myrrh. 
 
 " A gum resin obtained from Bahamodendron myrrha." (U. S. P.) Myrrh forms 
 an emulsion-like mixture with water, and is dissolved, with the exception of its impurities 
 and a gummy substance, by alcohol, ether, and solutions of the alkalies; it contains a small 
 proportion of volatile oil, a large proportion of resin, and a little gum. A tincture of myrrh 
 is official and represents twenty parts of myrrh in one hundred parts of alcohol. 
 
 Myrrh is detergent and astringent. 
 
 General Surgery. As a vaginal wash in VAGINAL and UTERINE 
 CATARRH, tincture of myrrh, a fluidounce to the pint of water, will often 
 be found efficacious. 
 
 Diseases of the Mouth, etc. Myrrh has long been employed, either 
 alone or in conjunction with other remedies, as a mouth-wash in cases of 
 PTYALISM, or when the gums from other causes have become spongy, with 
 a tendency to recede from the teeth. A serviceable mouth-wash, which 
 we have employed for the above-mentioned conditions, is : Potass, chlor., 
 gij ; tinct. myrrhce, f^ij ; aquae, q. s. fgvj. It is also of value as a stimulat- 
 ing wash in CARIES and NECROSIS, accompanied with offensive discharge. 
 Owing to the fact that the precipitated resin adheres to the teeth and 
 gums, its employment in the mouth has been criticised, but the advan- 
 tages it offers over other detergents make it still a favorite with prac- 
 titioners. The following recipe obviates the employment of alcohol : 
 Pulverized myrrh and alum, each one drachm ; conserve of rose, one 
 ounce. A bolus of convenient size to dissolve in the mouth. 
 
 Myrrh is used also as a component of a powder for insufflation, as well 
 as in the form of a tincture diluted for use as a gargle. In the last-named 
 exhibition it has been for a long time an ingredient in a gargle, for ANGINA 
 accompanied by oedema, either when found in acute or sub-acute condi- 
 tions, in the proportion of one-half ounce to about a pint of water. The 
 tincture of myrrh is recommended by C. Seiler in the treatment of 
 
 OZ/ENA.
 
 MYRTUS NAPHTHALINUM NAPHTHOL. 327 
 
 MYRTUS. Clove-Bark. 
 
 Clove-bark is obtained from a tree (probably Myrtus acrt's, order Myrtaceae) which 
 grows in the West Indies. 
 
 M. Mackenzie employs an oil of clove-bark as an inhalant six minims 
 to the ounce in inflammatory affections of the throat. 
 
 NAPHTHALINUM. Naphthalene. Naphthalin. 
 
 Naphthalene is a compound of carbon and hydrogen, and is a typical member of the 
 naphthalene series of hydrocarbons, just as benzene is a typical member of the benzene 
 series. It is prepared from the fractions in the distillation of coal-tar which come over 
 between 180 and 250 C. From these fractions it separates as a dark- colored mass, and 
 is then purified by repeated treatment with sodium hydrate and sulphuric acid. Finally 
 the purification is completed by repeated sublimation. 
 
 Naphthalene occurs in large, shining, crystalline scales, having a peculiar, penetrating 
 odor, and .a burning, aromatic taste. It is insoluble in water and slowly soluble in cold 
 alcohol, but is readily soluble in hot alcohol, in ether, chloroform, carbon disulphide, and 
 fixed and volatile oils. 
 
 Naphthalene is stimulant, antiseptic, and parasiticide. 
 
 General Surgery. It has been employed with good results as an 
 antiseptic in the treatment of WOUNDS. Henri Lasserre ( Wiener med. 
 Presse, October 13, 1889) advises naphthalene in place of iodoform in 
 CHRONIC ABSCESSES and ADENITIS, the solution being easily made by 
 the addition of a little alcohol. The following formula is commended : 
 Naphthalene, two drachms ; alcohol, two fluidounces ; water, four fluid- 
 ounces. The water should be added hot and the whole filtered. Since 
 the crystals will clog the syringe the preparation must be warmed before 
 using. After the evacuation of the abscess the cavity should be gently 
 distended with the solution. 
 
 Diseases of the Skin. Naphthalene has been highly recommended 
 in the treatment of PARASITIC skin diseases, particularly SCABIES. It is, 
 however, not equal to naphthol, while its extensive application is by no 
 means without danger, Schwimmer having reported a case of fatal 
 nephritis resulting from its use. It is sometimes fraudulently or ignor'antly 
 substituted for naphthol in prescriptions. 
 
 NAPHTHOL. Iso-naphthol. Beta-naphthol. 
 
 There are two naphthols which are related to naphthalene, just as phenol or carbolic 
 acid is related to benzene. 
 
 They are prepared by the action of fuming sulphuric acid on naphthalene for several 
 hours at 200 C. By this treatment the two naphthalene-sulphonates are formed ; these 
 are combined with calcium and separated from each other by repeated crystallization. By
 
 328 LOCAL THERAPEUTICS. 
 
 converting them into sodium salts and fusing with sodium hydrate the alpha- and beta- 
 naphthols result. 
 
 Beta-naphthol is the best known, and it is the one which bears the name of naphthol. 
 It occurs as colorless, lustrous, scaly crystals, or as a white, crystalline powder. Its odor 
 has a faint resemblance to phenol, and the taste is transient and somewhat burning. 
 
 Naphthol is soluble in alcohol, ether, chloroform, oils, and alkaline liquids; scarcely 
 soluble in cold water, but soluble in hot water to the extent of six grains in one fluid 
 ounce. 
 
 Alpha-naphthol resembles the beta- compound in most of its physical properties. 
 
 Naphthol is antiseptic. (Bouchard, quoted in Therap. Gaz., 1888, p. 
 241.) Its slight degree of solubility protects from possibility of toxic im- 
 pression, while it remains efficient as a germicide. It is five times as 
 strong as carbolic acid and three times as strong as creasote, and is much 
 safer than corrosive sublimate. 
 
 General Surgery. This mixture is employed in the treatment 
 of wounds and granulating surfaces. At the Massachusetts General 
 Hospital it substitutes flaxseed in making poultices. Lint is saturated 
 with a solution and applied. 
 
 Diseases of the Skin. The effect of naphthol on the epidermis is 
 slightly loosening. A strong application causes light brown discoloration 
 and exfoliation of epidermis. Its influence upon HYPERTROPHIED EPI- 
 DERMIS, as in PSORIASIS, is somewhat similar to that of chrysarobin and 
 pyrogallic acid, but naphthol is less efficient than either of the agents 
 named. 
 
 Naphthol was introduced by Kaposi ( Wien med. Wochens., July, Nos. 
 22 and 23, 1881, and ib. No. 31, 1882) as an application in PSORIASIS. 
 He employed an ointment of eighty grains to the ounce with success. 
 We repeated Kaposi's experiments with naphthol in PSORIASIS* and 
 found that a naphthol soap, composed of two drachms of naphthol in an 
 ounce of sapo viridis acted satisfactorily in cleansing the scalp of psoriatic 
 scales, while an ointment of naphthol, one drachm to the ounce of lard, 
 succeeded in removing the patches from the body. 
 
 Further experience, however, seemed to indicate naphthol as possessing 
 only an inferior power for the removal of psoriasis eruption, while if used 
 over an extensive surface symptoms of poisoning have been known to 
 appear, preceded by a cloudy discoloration of the urine. However, naph- 
 thol must be regarded as one of our best local remedies in some cases of 
 PSORIASIS when chrysarobin and pyrogallic acid cannot, for any reason, be 
 employed. 
 
 In SCABIES Kaposi recommends: Naphthol, giv; sapo viridis, Sjss; 
 pulv. cretae 9ij; adeps, sviij. M. 
 
 In hospital practice a single energetic application is made of this oint- 
 
 * " Experiments in the Use of Naphthol," etc. Am. Jour. Med. Set., October, 1883.
 
 NAPHTHOL. 
 
 3 2 9 
 
 ment over the affected parts, after which the skin is thoroughly powdered 
 with starch and wrapped in a linen sheet. A single day is enough for 
 patients under this treatment. 
 
 Few can endure an application so heroic. We find the following a 
 better formula for average cases of SCABIES : R. Naphthollis, sulphuris 
 precip., aa 3J ; adipis, sviij. The patient takes a hot bath with soap, 
 and after drying anoints himself thoroughly with the ointment. Clean 
 underclothing is then put on. The subsequent treatment consists in 
 nightly inunctions, the same underclothing being worn for a week. At 
 the end of that time a bath is taken and the patient is inspected. If 
 any traces of scabies remain the treatment is gone through with for 
 another week. One to two weeks' treatment generally cures walking 
 cases. Toward the last the proportions of naphthol and sulphur should 
 be diminished, as irritation is apt to be set up in persons with sensitive 
 skins if the stronger preparation is continued. 
 
 Naphthol has been employed in the treatment of ECZEMA. An oil 
 with naphthol (five grains to the ounce of olive oil) has been used in 
 IMPETIGINOUS ECZEMA of the scalp, and an ointment of naphthol, a few 
 grains to the ounce, have been employed in the treatment of SQUAMOUS 
 ECZEMA, but, in our experience, without much good result. 
 
 In PRURIGO and in ICHTHYOSIS naphthol has been used with some 
 benefit. 
 
 In ACNE, HYPERIDROSIS, and in the vegetable parasitic skin diseases 
 naphthol has been employed with success. We have found it effective 
 in TINEA CIRCINATA, having employed it in the strength of about a 
 drachm to the ounce. 
 
 In the PITYRIASIS CAPITIS naphthol is an efficient remedy. It may 
 be employed in the form of the oil, or soap. 
 
 Allen (JV. Y. Med. Record, May 21, 1887) recommends naphthol in the 
 treatment of FOUL ULCERS, especially those of a syphilitic character. 
 He prefers it to iodoform. In IMPETIGINOUS ECZEMA connected with 
 PEDICULOSIS CAPITIS, in PEDICULOSIS VESTJMENTORUM, and in PRURITUS, 
 Allen likewise found naphthol useful. 
 
 Diseases of the Mouth, Throat, etc. Naphthol is recommended 
 by dentists for the correction of FOUL BREATH in diseases, of bacterial 
 origin, of the gums and teeth. 
 
 In a group to which naphthol belongs may be mentioned the fol- 
 lowing, concerning which exact information is wanting. Naphthaline 
 is recommended by Kutznetzoff (Russkaia Meditzina, No. 7, 1890) for 
 the local treatment of DIPHTHERIA. A. P. Favitzky (Journal of Laryn- 
 gology and Rhinology, June, 1890) claims that /9-naphthol mixed with oil 
 of sweet almond, one-half drachm to the ounce, has an anaesthetic effect 
 in LARYNGEAL PHTHISIS. The solution is prepared from a half to two
 
 330 LOCAL THERAPEUTICS. 
 
 drachms of the drug, and one ounce of the oil of sweet almond. 
 (Medilzenskoie Obezrenie, No. 19, 1889, p. 585.) 
 
 Diseases of the Eye. Vignes (Annal d' Oculist, vi, 251) strongly 
 recommends naphthol as an antiseptic in ophthalmic surgery. He uses it 
 in four per cent, solution (40 to 1000, with 2 grammes of alcohol), and 
 claims that it is superior to the bichloride of mercury on account of its 
 unirritating character and entire freedom from danger to the cornea. 
 
 CAMPHORATED NAPHTHOL. 
 
 Camphorated naphthol is prepared from one part of beta-naphthol and two parts 
 camphor. The mixture forms a brownish, transparent liquid. 
 
 Diseases of the Nose, Throat, etc. Fernet (Le Progres Medicale, 
 March 9, 1889) found that by mixing one part of naphthol and two 
 parts of camphor a greasy liquid is formed, which he claims is of service. 
 It is relied on by some practitioners to prevent suppuration in ACUTE 
 TONSILLITIS after all other measures have failed. This writer {Bull, et 
 Memoires de la Societe de Therapeutique, February 27, 1889) has employed 
 camphorated naphthol successfully in TUBERCULAR ULCERATIONS OF THE 
 TONGUE. The daily application greatly improved an ulceration in a man 
 aged forty. Ruault {Archives de LaryngoL, 1889, p. 73) used camphor- 
 rated naphthol in vaseline as a local application to the turbinated bones 
 in OZ/ENA. 
 
 HYDRONAPHTHOL. 
 
 This is a product claimed to be derived, by reduction, from beta-naphthol. It is said 
 to have all the antiseptic powers of the naphthols without their toxic properties. 
 
 It is soluble in alcohol 1-2 parts, in cold water i-noo parts, and in hot water 1-300 
 parts. It also dissolves in benzol and the fixed oils. 
 
 Hydronaphthol is a germicide* and deodorant. It resembles creolin 
 and carbolic acid in its general effects, but is held by its votaries to be 
 superior to these agents, since it is without a disagreeable odor and can 
 be used without exciting irritation or danger of toxic impression. 
 
 Diseases of the Skin. Hydronaphthol has been recommended as a 
 germicide by Dockrell (Lancet, November 30, 1889). He considers it 
 superior to bichloride of mercury, and employs it in the form of a plaster for 
 the cure of RINGWORM OF THE SCALP. The scalp is shaved, washed with 
 a hydronaphthol soap, and, after drying, a ten per cent, hydronaphthol 
 plaster is applied in narrow strips, so as to cover in the affected area. 
 Outside the margin of the patch of strips a melted ten per cent, hydro- 
 naphthol jelly is painted, so as to exclude the air. At the end of four days 
 
 * For experimental research see Stackler and Dubrief. (Bull Gin. Thlrap., March 
 30, 1892.)
 
 NUX VOMICA. 331 
 
 the plaster is removed. A twenty per cent, plaster may then be substi- 
 tuted after washing, etc., as before, and after four days this may again be 
 replaced by a ten per cent, plaster. The remainder of the scalp is to be 
 anointed with a five per cent, hydronaphthol ointment, morning and 
 evening. Dockrell claims the best results from this plan of treatment. 
 
 Diseases of the Mouth, Throat, etc. James Truman, of 
 Philadelphia, uses hydronaphthol as a mouth wash and a preventive of 
 DEN T TAL CARIES, and in the treatment of " PULPITIS, DECOMPOSED PULPS, 
 GINGIVITIS, and in PVORRHCEA ALVEOLARIS." The progress of the 
 obstinate affection last named is arrested so long as the affected surfaces 
 are kept under the influence of the drug. The following formula is 
 recommended for general use ; a slightly weaker mixture can be used as a 
 mouth wash : Hydronaphthol, gr. xvj ; alcoholis, 3] ; water, 3j. Add a 
 teaspoonful to a half pint of water and use freely. It is recommended 
 to make up in small quantities, since the preparation is not stable. 
 
 J. V. Shoemaker (Proc. Phila. Co. Aled. Soc., October 17, 1883) com- 
 mends " naphthol " for the treatment of DIPHTHERIA. Hydronaphthol 
 is probably intended. 
 
 Hydronaphthol is used by W. C. Caldwell as a spray for DIPHTHERIA 
 in combination with papain and hydrochloric acid as follows: R. Papain, 
 3ij ; hydronaphthol, gr. iij ; acid, hydrochloric, dil., n^xv; distilled 
 water, iv. 
 
 NUX VOMICA. 
 
 " The seed of Strychnos nux vomica." (U. S. P.) Nux vomica is one of the sources 
 of strychnine, to which alkaloid it owes its activity. 
 
 STRYCHNINA. Strychnine. (Strychnia, U. S. P., 1870.) 
 Strychnine is described as being in " colorless, octahedral, prismatic crystals, or white 
 crystalline powder, permanent in the air, odorless, having an intensely bitter taste and an 
 alkaline reaction. Soluble in sixty-seven hundred parts of water and in one hundred and 
 ten parts of alcohol at 15 C. (59 F.) ; in twenty-five hundred parts of boiling water and 
 in twelve parts of boiling alcohol ; also soluble in six parts of chloroform, but almost 
 insoluble in ether or in absolute alcohol." (U. S. P.) 
 
 For medicinal purposes a salt of strychnine should always be prescribed 
 rather than strychnine, which, as will be seen from the account, is pfacti- 
 cally insoluble. Sulphate of strychnine (strychninse sulphas) is the one 
 commonly used. It is soluble in ten parts of water at ordinary tem- 
 perature, and in two parts of boiling water ; it is also soluble in twenty- 
 six parts of glycerin. 
 
 General Surgery. In INCONTINENCE OF URINE the tincture may be 
 applied to the perineum. Lint is saturated with it and retained as a wet 
 dressing. Henry Thompson advises such a method in cases in which 
 belladonna has failed.
 
 332 LOCAL THERAPEUTICS. 
 
 Diseases of the Nose. M. Mackenzie (" Diseases of the Throat 
 and Nose," Amer. edition, Philada., 1884, vol. ii, p. 461) uses strych- 
 nine in the proportion of one-twenty-fourth to one-sixteenth of a grain in 
 an indifferent medium by insufflation in ANOSMIA. 
 
 NYSSA. Tupelo. 
 
 The root of Nyssa Aquatica. From this substance tupelo tents are made. It is 
 asserted that tupelo expands more readily than either sponge or laminaria. Tupelo wood 
 comes in pieces six inches long, three-quarters of an inch wide, and one-sixteenth of an 
 inch thick. 
 
 Tupelo is hygroscopic. 
 
 General Surgery. A tupelo tent was proposed by G. E. Suss- 
 dorff. {Richmond and Louisville Journal, 1879.) ^ expands to about 
 double its compressed size, but less powerfully than does the sponge 
 tent. Tupelo is preferred by some practitioners to other forms of tents, 
 since it is not liable to become offensive from the decomposition of 
 secretions. 
 
 Diseases of the Nose, etc. According to J. W. Gleitmann {N. 
 Y. Med. Jour., November 9, 1889), the manner of application is simple. 
 After the nostril is thoroughly cleansed with a disinfectant solution and 
 anaesthetized with cocaine, a piece of tupelo is cut the required size and 
 introduced into the nasal chamber. After remaining in position for 
 fifteen to twenty minutes the expansion is accomplished and the piece 
 is removed. After a second cleansing, a piece of tin foil, which also can 
 easily be shaped according to the requirements of the case, is inserted, 
 and the patient is dismissed. The tin foil maintains the increased 
 diameter of the nasal chamber and can be kept in place with impunity. 
 
 OLEUM ANACARDII. Cashew-nut Oil. 
 The oil of Anacardium occidental, a tree growing in the West Indies. 
 
 Diseases of the Skin. Cashew-nut oil is an exceedingly irritant 
 application. It is used in tropical countries as a stimulant in various 
 forms of ulceration, and especially in the local treatment of LEPROSY. 
 The oil is applied to the anaesthetic spots until a blister is almost pro- 
 duced, also to the tubercles until they open. The lesions are then dressed 
 with Gurjun oil, q. v. 
 
 OLEUM CAJUPUTI. Oil of Cajuput. 
 
 Oil of cajuput is " a volatile oil distilled from the leaves of Melaleuca cajuputi. A 
 light, thin, bluish-green, after rectification, colorless Hquid, of a peculiar, fragrant, some- 
 what camphoraceous odor, an aromatic, bitterish taste, and a neutral reaction. Freely 
 soluble in alcohol." (U. S. P.)
 
 OLEUM CALAMI OLEUM CARYOPHYLLI OLEUM CINNAMOMI. 333 
 
 General Surgery. Oil of cajuput, like other highly-stimulating, 
 essential oils, relieves TOOTHACHE when introduced into the cavity of a 
 carious tooth. Diluted with equal parts of olive oil, it has been employed 
 as an embrocation in MUSCULAR RHEUMATISM. 
 
 Diseases of the Throat, etc. Eight minims to the ounce of water, 
 in the presence of a little magnesium carbonate or alcohol, is recom- 
 mended by M. Mackenzie as a moderately stimulating inhalant. 
 
 OLEUM CALAMI. Oil of Calamus. 
 An oil distilled from the rhizome of Acorns Calamus. 
 
 Diseases of the Throat. The oil of calamus is one of the best of 
 stimulating oils which are adapted for inhalation. Five minims may be 
 added to the ounce of water, in the presence of two grains of magnesium 
 carbonate, and a teaspoonful of the mixture diluted in a pint of water at 
 140 F. 
 
 OLEUM CARYOPHYLLI. Oil of Cloves. 
 
 " A volatile oil distilled from cloves." (U. S. P.) Oil of cloves is prepared by the 
 repeated distillation of cloves with water, in which salt has been dissolved in order to 
 heighten its boiling point ; the oil afterward is separated from the distilled oil and water. 
 Freshly prepared oil of cloves is colorless; it soon becomes yellowish, and old examples 
 are brown. It is freely soluble in alcohol, ether, chloroform, benzol, benzin, and disulphide 
 of carbon. Its specific gravity is from 1.03 to 1.06; when pure, it sinks in water. It has 
 the peculiar property, when mixed with an alcoholic solution of potassa, of congealing 
 entirely and losing the clove odor. This is one test of its purity. 
 
 General Surgery. Oil of cloves, when applied locally, acts as a 
 counter-irritant and local anaesthetic, but it is inferior to many other sub- 
 stances. It is often used to benumb sensitive dentine, or even exposed 
 pulp in CARIES of the teeth. Dropped on a piece of cotton and placed in 
 the cavity it will often relieve TOOTHACHE. 
 
 OLEUM CINNAMOMI. Oil of Cinnamon. 
 
 Oil of cinnamon is " a volatile oil distilled from Cinnamon." (U. S. P.) Two oils of Cin- 
 namon are official, namely, the oil distilled from Cinnamomum zeylanicum (Ceylon cinna- 
 mon, or true cinnamon) and the oil distilled from an undetermined species of cinnamon 
 grown in China (oil of Cassia, infra]. The oil of cinnamon of the Br. Ph. is obtained from 
 the first-named source. Differences in the quality, flavor, as well as price of the two oils 
 is to be noted. The best oil of Ceylon cinnamon is ten times the more costly. The Cey- 
 lon oil is rarely used, the oil of Cassia being substituted. Both oils are soluble in alcohol 
 and the other solvents of essential oils, and are used to give odor and taste to various 
 medicinal and cosmetic preparations. 
 
 According to Mackenzie, six minims of the oil of cinnamon to the
 
 334 LOCAL THERAPEUTICS. 
 
 ounce of water, in the presence of a little magnesium carbonate, con- 
 stitutes a moderately stimulating inhalant. 
 
 OLEUM CASSIJE. Oil of Cassia. 
 
 A volatile oil distilled from undetermined specimens of Cinnamon grown in China. 
 (See Oil of Cinnamon.) 
 
 General Surgery. C. Black {Medical News, December, 1890), in a 
 paper on essential oils in surgery, speaks highly of the oil of cassia as 
 possessing antiseptic properties. It is not as powerful as is the bichloride 
 of mercury, but, on the other hand, fewer objections can be urged against 
 it. A convenient form for exhibition of the properties of oil of cassia is 
 an aqueous solution, prepared by distributing the oil in distilled water by 
 magnesium carbonate and filtering. Or it may be mixed with boric acid 
 and applied as a dry dressing. It may also be incorporated in an ointment 
 with vaseline, in strength of from half a drachm to a drachm to the ounce. 
 
 Diseases of the Throat, etc. In the opinion of M. Mackenzie 
 the oil of cassia assists the effect of nitrate of potassium in fumigation, in 
 overcoming a disposition to SPASM OF THE PHARYNX, TRACHEA, AND 
 BRONCHI. One drachm added to nine drachms of alcohol may be em- 
 ployed to moisten the strips of paper prepared by steeping in a solution 
 of nitrate of potassium. Used alone it is slightly stimulating. F. P. Nor- 
 way {Therapeutic Gazette, May 16, 1892) claims that the oil of cassia is 
 of value in the treatment of ACUTE ANGINA. G. V. Black adds a small 
 amount of the oil to peroxide of hydrogen in disinfecting the abscess 
 cavity in TONSILLITIS. 
 
 OLEUM COCOIS NUCIFER^:. Cocoanut Oil. 
 
 This is a fixed oil, derived from the seed of Coco nucifera. It is of the color and 
 consistence of lard, of a peculiar and, when fresh, pleasant odor. It is largely used 
 in the manufacture of soap. It is open to objection, however, on account of the odor 
 which it leaves on the hands, since the oil easily becomes rancid. If rancid cocoanut 
 oil be present the soap will have a peculiar, acrid, disagreeable taste. Cocoanut oil 
 must not be confounded with cacao butter. (See Oleum Theobromas.) 
 
 General Surgery. Owing to its physical properties and agreeable 
 odor, cocoanut oil is extensively employed by masseurs when the skin 
 is delicate and the cutaneous absorption of an oily substance is to be 
 desired, as in cases where cod-liver oil cannot be taken internally. 
 
 OLEUM GAULTHERLE. Oil of Gaultheria. Oil of Wintergreen. 
 An oil distilled from the leaves of Gaultheria procumbens. The odor of the oil of 
 gaultheria is penetrating. One minim added to a pint of water, to which two ounces 
 of glycerin have been added, will suffice to produce distinct impressions.
 
 OLEUM JUNIPERI. 335 
 
 Oil of birch distilled from Betula lenta is chemically and physically identical with oil 
 of wintergreen. The artificial oil of wintergreen is often a mixture of several compound 
 ethers, and is in no way to be compared with the natural oils of wintergreen and birch. 
 
 Oil of wintergreen is stimulant, antiseptic, and deodorant. 
 
 Diseases of the Mouth, Throat, etc. In a proportion of one 
 drop to two or three ounces, oil of gaultheria has of late years become 
 popular as an agent to impart flavor to lotions and gargles. It also has 
 an appreciable value as an ingredient of an embrocation for use in cases 
 in which a rheumatic element is present. Oil of wintergreen is recom- 
 mended by W. D. Miller as an antiseptic to arrest DENTAL CARIES. The 
 following forms the basis of an agreeable spray in painful SUBACUTE IN- 
 FLAMMATION OF THE PHARYNX. Req. Eucalyptol and oil of wintergreen, 
 each one grain ; menthol, two grains ; oleum petrolatum, two ounces. 
 Use in an atomizer. 
 
 Each lozenge of gaultheria contains the one-twentieth of a minim of 
 the oil. 
 
 OLEUM JUNIPERI. Oil of Juniper. 
 
 "A volatile oil distilled horn Juniper." (U. S. P.) It is distilled from the berries and 
 tops of the plant, although it is contemplated that it be distilled from the berries alone. 
 " It is soluble in twelve parts of alcohol, forming a turbid liquid." (U. S. P.) 
 
 Oil of juniper is stimulant. 
 
 General Surgery. Oil of juniper wood* is employed in the prepara- 
 tion of catgut ligatures, the gut being immersed for a week and then 
 transferred to absolute alcohol, in which it should be kept until required 
 for use. 
 
 Diseases of the Throat, etc. Oil of juniper berries is recommended 
 as a stimulant in vocal disability. It is used as a steam inhalation at 140 
 in CHRONIC LARYNGITIS. Twenty minims may be added to an ounce of 
 water in the presence of a little magnesium carbonate. A teaspoonful of 
 this mixture may be added to a pint of water at 140 F. as an inhalant. 
 When thus exhibited it induces constriction of the pulmonary vessels, 
 and is thus indicated in HYPER^MIA. (A. Israi.) 
 
 OLEUM CADINI. Oil of Cade. 
 An empyreumatic oil obtained in the destructive distillation of Juniperus oxycedrus. 
 
 Oleum cadini is stimulant. 
 
 Diseases of the Ear. A drachm of the oil of cade may be added 
 to an ounce of the ointment of ammoniated mercury and employed in 
 CHRONIC ECZEMA of the auricle. It may be mixed with an equal quantity 
 of alcohol for local application to the external meatus for PITYRIASIS. 
 (See Pix.) 
 
 * Only the best quality of the oil of juniper wood should be used.
 
 336 LOCAL THERAPEUTICS. 
 
 OLEUM LIMONIS. Oil of Lemon. 
 
 Oil of lemon is a " volatile oil extracted by mechanical means from fresh lemon peel." 
 (U. S. P.) It is also procured by immersion of lemon peel in warm water and removing 
 the oil which rises to the top, as well as by finely grating the peel and permitting the oil 
 to separate at the bottom of the vessel containing it. Oil of lemon soon becomes rancid. 
 It is wise to add to it a proportion of alcohol, say five to eight per cent. 
 
 Oil of lemon is stimulant and deodorant. 
 
 Diseases of the Throat, etc. Oil of lemon is recommended by 
 Lefferts to cover the odor of cubeb ; one drop of the oil is added to 
 three of the oil of cubeb. 
 
 OLEUM MENTH^E PIPERIT^E. Oil of Peppermint. 
 "A volatile oil distilled from peppermint." (U. S. P.) The oil is distilled from the 
 leaves of Mentha piperita. On long standing or exposure at a low temperature, oil of 
 peppermint deposits stearoptene-menthol or peppermint camphor. (See Menthol.) 
 
 OLEUM MENTHA VIRIDIS. Oil of Spearmint. 
 
 " A volatile oil distilled from Spearmint." (U. S. P.) The oil is distilled from the 
 leaves of Menlha viridis. 
 
 Both of the above-named oils are sedative and anodyne. Yet the 
 maximum impression is irritant. 
 
 General Surgery. The local action of the oil closely resembles that 
 of menthol. Oil of peppermint is an old remedy for FACIAL NEURALGIA. 
 A piece of cotton saturated with the oil is laid over the affected part, 
 covered with a piece of oil silk or sheet caoutchouc, and retained by a 
 bandage. Care must be taken not to leave it in contact with the skin too 
 long, as this agent, in common with other essential oils, is capable of pro- 
 ducing an irritant effect. Merely painting the skin with a camel's-hair 
 brush or a small tuft of cotton will sometimes be found beneficial. In 
 DENTAL CARIES a small pledget of cotton saturated with the oil and 
 placed in the cavity of a tooth after it has been thoroughly cleansed will 
 be found as efficient in relieving pain as oil of cloves, and much more 
 permanent than chloroform. Oil of peppermint is sometimes added to 
 liniments for its local sedative effect. 
 
 Diseases of the Skin. The oil of peppermint is employed in the 
 treatment of affections of the skin, attended by PRURITUS, when the skin 
 is not broken. It is an anaesthetic simply. It has been highly recom- 
 mended in PRURITUS VULVJE, but we are inclined to think that it will 
 usually cause more pain than benefit on muco-cutaneous surfaces. 
 
 Diseases of the Throat. Oil of peppermint is employed in the 
 form of a lozenge, each mass containing one-twentieth of a minim.
 
 OLEUM MORRHU.* OLEUM MYRISTIOE OLEUM MYRTI. 337 
 
 OLEUM MORRHU.E. Cod-liver Oil. 
 
 Cod-liver oil is " a fixed oil obtained from the fresh livers of Gadus morrhuce, or other 
 species of Gadus." (U. S. P.) Cod-liver oil is not soluble in alcohol, but is readily 
 soluble in ether. According to the researches of Dejongh, it contains " a peculiar sub- 
 stance named gaduin, oleic, stearic, and palmitic acids, with glycerin, butyric, and acetic 
 acids, various biliary principles, iodine, and traces of bromine." (U. S. D.) 
 
 General Surgery. Cod-liver oil has been used by inunction with 
 asserted advantage in the treatment of SCROFULOUS ENLARGEMENTS. 
 Better results can be obtained by the use of iodine ointment, and, if it 
 can be retained by the stomach, by the internal administration of the oil. 
 
 Diseases of the Skin. Cod-liver oil is used in the treatment of skin 
 diseases, to soften crusts, etc. Olive oil answers a similar purpose, and 
 possesses the advantage of being free from disagreeable odor. A plaster 
 into which cod-liver oil enters is much used by French dermatologists in 
 the treatment of ECZEMA. 
 
 Diseases of the Ear and Throat. Cod-liver oil is sometimes 
 applied in DRY ECZEMA of the external auditory passage ; it is also used as 
 a basis for " the brown citrine ointment." It is held by Wilde, of Dub- 
 lin, and by A. D. Williams, of Cincinnati, that this form of the ointment 
 of the yellow oxide of mercury is more useful than those forms into which 
 lard or neat's-foot oil enters. 
 
 Cod-liver oil may be substituted for olive oil in relieving DYSPHAGTA OF 
 CHRONIC LARYNGITIS. 
 
 OLEUM MYRISTIC^E. Oil of Nutmeg. 
 
 " A volatile oil distilled from nutmeg {Myristica fragrans). A colorless or pale, yel- 
 lowish liquid, having the characteristic odor of nutmeg, a hot, spicy taste, and a neutral 
 reaction. Sp. gr. about 0.930. It. is readily soluble in alcohol." (U. S. P.) Spiritits 
 Myristica is official. 
 
 Oil of nutmeg, while pungent, is a stimulating anodyne. 
 
 General Surgery. In CHRONIC RHEUMATISM and OLD SPRAINS the 
 oil of nutmeg is often added to soap liniment, and forms a satisfactory 
 and stimulating embrocation. 
 
 Diseases of the Mouth, etc. A few drops of the oil of nutmeg 
 upon cotton inserted into the cavity will often give relief to the pain 
 of a CARIOUS TOOTH. 
 
 OLEUM MYRTI. Myrtle Oil. 
 
 This is a volatile oil distilled from the leaves and flowers of Myrtus communis. It is 
 of a yellowish or greenish-yellow color, has a specific gravity of 0.891, and consists of a 
 hydrocarbon and myrtol. Myrtol is the constituent to which the peculiar, properties are 
 22
 
 338 LOCAL THERAPEUTICS. 
 
 due. It is that portion which distills between 160 and 180 C. It is said to be composed 
 of dextro-pinene and eucalyptol. 
 
 Diseases of the Throat, etc. According to M. Mackenzie, six 
 minims of the oil of myrtle added to the ounce of water, in the presence 
 of three grains of magnesium carbonate, may be used in the proportion 
 of a tea^poonful to a pint of water at 40 F. , as a stimulating inhalant in 
 ACUTE TONSILLITIS. 
 
 OLEUM OLIV^E. Olive Oil. Sweet Oil. 
 
 " A fixed oil expressed from the ripe fruit of Olea europea." (U. S. P.) Cotton-seed 
 oil, poppy oil, colza oil, groundnut oil, and lard oil are used in immense quantities as sub- 
 stitutions for olive oil ; since, with the exception of the common adulterant, cotton-seed 
 oil, which is slightly irritating, all these varieties of oil have many of the properties in 
 common with olive oil. The U. S. D. gives tests for the detection of adulterations. 
 By exposure to the air olive oil soon becomes rancid. Olive oil enters into the com- 
 position of several cerates, ointments, and plasters, notably Emplastrum Pluinbi and 
 Unguentum Diachylon. 
 
 Olive oil is emollient and protectant. 
 
 General Surgery. Carbolized oil, consisting of a five to ten per 
 cent, solution of carbolic acid in sweet oil, was at one time extensively 
 used in the treatment of wounds. Since it has been shown that the amount 
 of acid employed is ineffective, so far as any antiseptic properties are 
 concerned, the practice has been abandoned. Sweet oil was in exten- 
 sive use as a wound dressing, especially after amputation, by the older 
 surgeons. It had the advantage of being bland and unirritating and not 
 allowing the dressing to adhere to the cut surfaces. Olive oil forms one 
 of the substances in repute for the preparation of instruments used in the 
 surgery of the mucous cavities. In the treatment of unusually tight 
 STRICTURES OF THE URETHRA the injection of a little sweet oil with a 
 syringe will often prove more serviceable than anointing the instru- 
 ment. 
 
 As an emollient, sweet oil is largely employed in enemata. It has 
 a special tendency to soften scybalae and assist in their removal. It 
 also serves in the reducing of the irritation which accompanies the. pres- 
 ence of SEAT WORMS. 
 
 Diseases of the Skin. Olive oil enters into the composition of a 
 number of preparations employed in the local treatment of skin diseases. 
 Employed alone, it is useful to soften CRUSTS and SCALES and to remove 
 EPITHELIAL DEBRIS as a preliminary to more active treatment. 
 
 Olive oil enters into the composition of unguentum diachylon. It must 
 be of the best quality here and perfectly fresh, or the result is not satis- 
 factory. 
 
 Olive oil in connection with carbolic acid forms an admirable applica-
 
 OLEUM PINI SYLVESTRIS. 339 
 
 tion in PRURITUS AMI : R. Acidi carbolici, gr. c ; olei olivae, ad fgj. M. 
 The olive oil is sometimes replaced by almond oil, but there is practically 
 no difference between the two. 
 
 Diseases of the Ear, etc. Olive oil is used for softening CERUMEN, 
 but it is less efficacious than glycerin. It serves as a convenient vehicle 
 for the application of iodine in instances in which the tincture is contra- 
 indicated. A grain of iodine may be added to an ounce of oil. In this 
 form it is recommended by Kramer for HERPETIC INFLAMMATION OF THE 
 EXTERNAL MEATUS. It also destroys insects which have lodged in the 
 external meatus. Olive oil relieves PAINFUL DEGLUTITION. 
 
 Diseases of the Eye. Olive oil is a useful application to the eye 
 in the treatment of LIME BURNS of the cornea and conjunctiva, or for 
 the limitation of the action of caustics applied by the surgeon. It has 
 also a soothing effect in recent abrasions of the cornea, and may be 
 advantageously used in these cases as a menstruum for cocaine. 
 
 OLEUM PINI SYLVESTRIS. Oil of Fir. 
 
 This article is official in the Ph. Br. and is defined to be the oil distilled from the 
 fresh leaves of Pinus sylvestris. The leaves of this tree, either alone or with the leaves 
 of species of other European firs and pines, are, when beaten with mallets, converted 
 into a condition in which they can be roughly felted, and the product is known as " fir- 
 wool." A fluid extract, or a solution of the oil in alcohol, is sold under the name of 
 " fir-wool extract." Since " fir-wool " most probably derives its efficacy from the oil of 
 fir contained in it, the two agents are here considered under one head. 
 
 The oil of fir is stimulant, antiseptic, and deodorant. 
 
 General Surgery. "Fir-wool" is much used in Germany and 
 among the Germans in this country as a wrap for parts attacked by 
 RHEUMATISM, whether articular or muscular; it is usually sprinkled with 
 the oil of fir. 
 
 Diseases of the Throat, etc. An admirable stimulant inhalant is 
 prepared by adding ten drops of the oil of fir to a pint of water at 140. 
 A little magnesium carbonate (a scruple to the ounce) may be added. 
 As a steam inhalation the same ingredients as above can be used in 
 CHRONIC LARYNGITIS. The oil when inhaled induces powerful constric- 
 tion of the pulmonary vessels, and is thus indicated in HYPERJEMIA. It 
 appears to be more potent than either of its succedaenea, oil of turpentine 
 or oil of juniper. (A. Israi.) One-half to one per cent, may be said to 
 be the average strength of solution for the use of this agent. (W. E. 
 Casselberry.) It can be used much stronger, forty drops to the ounce, 
 as a mild stimulant and disinfectant in POTRID SORE THROAT and DIPH- 
 THERIA. H. MacNaughton Jones recommends a stimulating gargle of 
 four to eight drops to the ounce of water.
 
 34 LOCAL THERAPEUTICS. 
 
 OLEUM RICINI. Castor Oil. 
 
 Castor oil is " a fixed oil expressed from the seed of Ricinus commtmis" (U. S. P.) 
 Castor oil is soluble in an equal weight of alcohol, and in all proportions in absolute 
 alcohol or glacial acetic acid. 
 
 Castor oil is emollient and protectant. 
 
 General Surgery. Castor oil is used in England as the basis of a 
 preparation for anointing bougies, catheters, etc. Murchison speaks 
 highly of an application of two parts of castor oil and one part of balsam 
 of Peru spread on lint and laid over SUPERFICIAL ULCERATIONS. It 
 should be changed several times a day. 
 
 Diseases of the Skin. Castor oil has one advantage over the 
 other oils commonly used in making applications to the skin (ol. olivae, 
 ol. lini, ol. amygdalae) that it is soluble in alcohol. This characteristic 
 makes its employment peculiarly convenient in many cases where an 
 oleaginous adjuvant is required. In lotions and other applications on 
 the scalp it is desirable to employ an oily material to correct the drying 
 effect of the soaps and similar remedies used in ECZEMA, PITYRIASIS, 
 SEBORRHCEA, etc. The addition of ten to sixty drops of castor oil to an 
 ounce of an alcoholic solution ordinarily suffices. 
 
 Glycerin is often substituted for castor oil in lotions for the scalp ; but 
 rarely, we think, with the same good effect. 
 
 Diseases of the Mouth, etc. Five drops of castor oil to the ounce 
 of collodion forms a protectant to ABRASIONS about the lips. 
 
 Diseases of the Eye. Dr. John Green {Trans. Am. Oph. Soc., 
 1875) nas recommended castor oil as a menstruum for applying atropine 
 to the eye, on the ground that it ensures a longer contact of the drug 
 with the cornea than is possible with the aqueous solution, which is rapidly 
 washed away by the flow of tears. As the sulphate is not readily soluble 
 in oil, he recommends the substitution of the alkaloid, and directs one 
 grain of atropine to be dissolved in two minims of alcohol and mixed 
 with fresh castor oil in any desired proportions. This preparation is 
 particularly applicable to cases of ABRASIONS or PAINFUL ULCERS OF THE 
 CORNEA. 
 
 OLEUM RUSCI. (See/ 3 /*.) 
 
 OLEUM RUT^E. Oil of Rue. 
 
 " A volatile oil distilled from Ruta graveolens (Linn). Oil of rue is soluble in an equal 
 weight of alcohol." (U. S. P.) 
 
 Oil of rue is a stimulant. 
 
 Diseases of the Throat, etc. Oil of rue is recommended by 
 Potter as an inhalation in CHRONIC CATARRHAL LARYNGITIS.
 
 OLEUM SANTALI OLEUM THEOBROM^E OLEUM THYMI. 341 
 
 OLEUM SANTALI. Oil of Santal. Oil of Sandal Wood. 
 
 " Oil of santal is a volatile oil distilled from the wood of Santalum album." (U.S.P.) 
 It is " a pale yellowish or yellow liquid, of a peculiar, strongly aromatic odor, a pungent 
 and spicy taste, and slightly acid reaction; specific gravity, about 0.945. It is readily 
 soluble in alcohol." (U. S. P.) It is apt to be adulterated or sophisticated with oil of 
 cedar-wood, which has a specific gravity of 0.948. 
 
 The Brit. Pharm. gives its specific gravity as 0.96, the Indian Pharm. as 0.98. The 
 examination of a number of specimens of oil known to be pure sandal- wood oil proves 
 that the specific gravity is from 0.96 to 0.99 ; so that the specific gravity as given by the 
 U. S. P. is too light. 
 
 Oil of santal is antispasmodic and sedative. 
 
 Diseases of the Throat, etc. According to M. Mackenzie, oil of 
 santal reduces the irrkative action of nitrate of potassium fumigation in 
 overcoming spasms of the larynx, trachea, and bronchial tubes. The oil is 
 used by W. Murrell {Brit. Afed. Journal, December 12, 1885) for WINTER 
 COUGH in form of inhalation, in combination with petrolatum, oil of 
 cubeb, and terebene. 
 
 Six minims of the oil to the ounce are exhibited as an inhalant. 
 Inhalations of steam impregnated with the oil are useful for soothing the 
 throat in PHLEGMONOUS INFLAMMATION. 
 
 OLEUM THEOBROM^E. Oil of Theobroma. Cacao-butter. 
 
 Cacao-butter is " a fixed oil expressed from the seed^of Theobroma Cacao" A yellow- 
 ish white solid, having a faint, agreeable odor, a bland, chocolate-like taste, and a neutral 
 reaction. It melts between 30 and 35 C. (86 to 95 F.) (U. S. P.) It is apt to be 
 adulterated with paraffin, stearin, tallow, etc. It is especially important when butter 
 of cacao is used as a basis for suppositories, that the pure article be employed. The 
 adulterants raise its melting point to above the temperature of the human body, and 
 consequently suppositories made with cacao-butter so manipulated do not melt and are 
 useless. 
 
 Cacao butter is emollient and protectant. 
 
 Diseases of the Nose. -^-Cacao-butter is admirably adapted for 
 serving as a vehicle for the application of drugs in the nasal chamber. 
 (H. C. Wood, Therapeutic Gazette, January, 1889.) 
 
 OLEUM THYMI. Oil of Thyme. 
 " A volatile oil distilled from Thymus vulgaris" (U. S. P.) 
 
 One minim of the oil of thyme and three minims of the oil of anise, 
 added to a half pint of water with a little carbonate of magnesium, 
 are useful in cases of cough arising from dilated bronchi. (See Thymol.}
 
 342 LOCAL THERAPEUTICS. 
 
 OLEUM TIGLII, U. S. Croton Oil. 
 
 " Croton oil is a fixed oil expressed from the seeds of Croton tiglium" (U. S. P.) 
 It is soluble in alcohol, ether, disulphide of carbon, and oil of turpentine. 
 
 The application of croton oil to the skin causes irritation, inflamma- 
 tion, and a papular eruption which soon becomes pustular. A persistent 
 impression is almost of caustic strength. 
 
 General Surgery. Croton oil was at one time much employed to 
 excite counter-irritation, being a simple agent and rapid in its action. If 
 it is used for this purpose, it should be diluted with four parts of sweet 
 oil and one of almond oil. The action of the mixture is less prompt 
 than that of pure croton oil, but the resulting inflammation is milder. 
 It is often added to tincture of iodine (a drachm to the ounce) and 
 painted over the apex of the lung as a counter-irritant in INCIPIENT 
 PHTHISIS. It also gives relief when painted over the seat of pain 
 in PLEURODYNIA and INTERCOSTAL NEURALGIA. Great care should be 
 exercised in the use of croton oil in any strength, and it should never be 
 applied on delicate skin, such as that of the scrotum or the mammary 
 gland. 
 
 A liniment of croton oil is official in the British Pharmacopoeia. It 
 contains one part of the oil, and three and one-half parts each of oil of 
 cajuput and alcohol. The liniment applied to the chest affords relief to 
 dyspnoea in PHTHISIS and CHRONIC BRONCHITIS. 
 
 West advises a liniment made of one part of croton oil and ten 
 parts of camphor liniment in congestive DYSMENORRHCEA and CHRONIC 
 CONGESTION OF THE UTERUS. It is recommended to be sponged over 
 the sacrum twice daily ; the application irritates the skin and affords 
 relief without producing a troublesome eruption. 
 
 Diseases of the Skin. Croton oil is employed for the destruction 
 of small, superficial N^EVI, when it acts by exciting an inflammation, the 
 products of which close the enlarged blood-vessels. It has likewise been 
 used to destroy small patches of TINEA TONSURANS, being introduced into 
 the hair follicles on a gold or platinum needle. The violent inflammation 
 set up destroys the fungus, but also leaves scars. 
 
 OLEUM VALERIANS. Oil of Valerian. 
 " A volatile oil distilled from Valerian." (U. S. P.) 
 
 Oil of valerian is antispasmodic. 
 
 Diseases of the Throat, etc. Two minims of the oil of valerian 
 to a half pint of water, to which a little carbonate of magnesium has been 
 added, is an effective inhalant in hysterical LARYNGEAL SPASM.
 
 OUABAIN OPIUM. 
 
 OUABAIN. 
 
 343 
 
 Ouabain is a glucoside prepared from the wood of Acocanthera ouabaio, a tree indig- 
 enous to the east coast of Africa (Mountains of Comal). It has also been prepared from 
 the seeds of a species of Strophanthus. 
 
 Ouabain occurs in while crystals, having a slightly bitter taste, soluble in hot, but 
 scarcely soluble in cold water. It is soluble in moderately concentrated alcohol, but 
 insoluble in anhydrous ether, chloroform, and absolute alcohol. 
 
 An extract of the wood of the ouabaio tree has been used by the natives as an arrow 
 poison. 
 
 Diseases of the Eye. Ouabain has made some claim to rival 
 cocaine as a local anaesthetic. Panas (Arch, d* Ophth., 1890, March- 
 April) found that it produced corneal anaesthesia, lasting three or four 
 hours without dilatation of the pupil, in rabbits, but caused no loss of 
 sensation in the human eye. 
 
 OPIUM. Opium. 
 
 Opium is " the concrete, milky exudation, obtained in Asia Minor by incising the unripe 
 capsules of Papaver somniferum.'' 1 (U. S. P.) 
 
 " On exhausting a hundred parts of opium, previously dried at a temperature of 105 
 C. (221 F.), with cold water, and evaporating the solution to dryness, an extract is 
 obtained which should weigh between fifty-five and sixty parts." (U. S. P.) The pow- 
 dered opium is defined as ' Opium dried at a temperature not exceeding 85 C. (185 F.) 
 and reduced to a moderately fine powder.' Powdered opium for pharmaceutical or medi- 
 cinal uses should contain no less than twelve nor more than sixteen per cent, of morphine." 
 (U. S. P.) 
 
 Among the official preparations may be mentioned the following: Acetum Opii (con- 
 taining the activity of ten parts of powdered opium in one hundred parts of the vinegar, 
 and flavored with a little nutmeg and sugar); Tinctura Opii (of the same strength), 
 Tinctura Opii Deodorata (of the same strength), Vinum Opii (of the same strength, but 
 containing a proportion of cinnamon and cloves), Extractum Opii (of uncertain strength), 
 and Emplastrum Opii (containing six parts of extract of opium in one hundred parts of 
 a mixture of Burgundy pitch and lead plaster). 
 
 Opium contains a number of alkaloids; the principal one is morphine, and of less im- 
 portance are codeine and narceine. It is necessary to consider in this article morphine 
 and codeine. 
 
 Under the head of "opium wool" Woakes (/. t.) mentions the following formula: 
 " Cotton- wool," one drachm; glycerin, ten minims; tincture of opium, half an ounce. 
 Mix the glycerin with the tincture, saturate the wool with the liquid, and dry. 
 
 The local impression of all the preparations of opium is anodyne. 
 Those mentioned in this article will include: Papaver; Pulvis opii ; 
 Tinctura opii ; Vinum opii ; Morphina ; Morphinae acetas ; and Codeine.
 
 344 LOCAL THERAPEUTICS. 
 
 PAPAVER. Poppy Heads. 
 
 Diseases of the Ear, Nose, Throat, etc. Fomentations of an 
 infusion of poppy heads is an old domestic remedy for OTALGIA. 
 
 OPII PULVIS. Powdered Opium. 
 
 General Surgery. Powdered opium, or the dried watery extract, 
 which is about twice the strength of the crude drug, is extensively em- 
 ployed, made in a suppository of cacao butter, in the treatment of 
 PELVIC INFLAMMATIONS. A suppository containing opium is a favorite 
 means of administering the drug after operation for the removal of 
 HEMORRHOIDS. Also in many of the operations about the genito-urinary 
 tract a suppository of opium has a soothing and quieting effect, especially 
 after the introduction of a bougie or catheter; it often prevents the occur- 
 rence of urethral chill, so common with some patients. In the treatment 
 of BOILS and CARBUNCLES, Shillitoe recommends the local application of 
 extract of opium, in the consistency of syrup. The extract must be 
 anointed over the part several times during the day. Used early, it will 
 often cause a boil to abort. Subsequently a plaster, composed of equal 
 parts of soap, opium, and mercury, is spread on leather and applied to 
 the affected spot. Should suppuration set in an opening may be made 
 through the plaster and a poultice placed over the entire mass. Opium 
 mixed witli nutgall ointment will be found a valuable treatment of painful 
 and bleeding PILES. Care should be taken to keep the contents of the 
 bowels in a soluble condition. 
 
 TINCTURA OPII. Laudanum. 
 
 Laudanum was employed extensively in the treatment of WOUNDS. Lint 
 saturated in a preparation of equal parts of laudanum and water was 
 applied to the lesions and covered with waxed paper to prevent evapora- 
 tion. Pure laudanum is a favorite dressing with some surgeons as a 
 primary dressing for the treatment of stumps. The double effect of a 
 moist and soothing medicament is thus obtained. This dressing is now 
 largely superseded by lotions of bichloride of mercury. In the absence 
 of antiseptic dressings laudanum will be found particularly serviceable in 
 treatment of wounds of the hand. Laudanum is frequently added to 
 flaxseed poultices to allay the pain of SUPERFICIAL INFLAMMATION. Suffi- 
 cient may be absorbed in this way to produce sleep. In SPRAINS and 
 CONTUSIONS a combination of laudanum and lead-water is of established 
 merit. The following formula is herewith given : R. Tinct. opii ; liq. 
 plumbi subacet. dil., aagij ; aquae, q. s. Oj. For convenience, equal parts 
 of laudanum and Goulard's extract may be kept on hand, and water added 
 in sufficient quantity. The relief afforded by this means of treatment in the
 
 OPIUM. 
 
 345 
 
 first twenty-four hours is striking. In cases of FRACTURE, where there is 
 much contusion of the soft parts, relief to pain is afforded by enveloping 
 the part in laudanum and lead-water before adjusting the limb to the 
 splint. Care should be taken that the dressing is not continued for too 
 great length of time, as it may have a tendency to delay union by pre- 
 venting the necessary amount of inflammatory deposit about the ends of 
 the fragments. In the absence of suppositories, laudanum mixed with 
 starch water will be found a reliable way to administer opium in the 
 relief of pain in PELVIC INFLAMMATIONS. It is important that the 
 rectum be previously emptied. In the treatment of GONORRHOEA laudanum 
 is frequently added to the injection for its soothing effect, in the propor- 
 tion of one part to five. Laudanum is often added to the tincture of 
 iodine, especially when the use of this agent is to be prolonged, and 
 when the sedative and alterative action is desired, as in the treatment of 
 PERIOSTITIS and PAINFUL SYPHILITIC NODES. 
 
 VINUM OPII. Wine of Opium. 
 
 Diseases of the Eye. Wine of opium was much used by surgeons 
 of the last generation as a collyrium in the treatment of CONJUNCTIVITIS. 
 In the chronic form of the disease it was employed pure, and in the acute 
 form was diluted with three or four parts, or more, of water. It has 
 entirely passed out of use, but might sometimes be found a convenient 
 and useful application. 
 
 MORPHINA. Morphia. Morphine. 
 
 Morphine is usually employed either in the form of the sulphate, the hydrochloride, or, 
 more rarely, the acetate. The sulphate of morphine is the salt in general use. It is " soluble 
 in twenty-four parts of water and in seven hundred and two parts of alcohol, in seventy- 
 five hundredths part of boiling water, and one hundred and forty-four parts of boiling 
 alcohol." (U. S. P.) The hydrochloride of morphine has the same solubility in water, 
 but is dissolved by sixty-three parts of alcohol. The acetate of morphine is the most solu- 
 ble salt when freshly prepared. It dissolves in twelve parts of water and in sixty-eight 
 of alcohol. 
 
 General Surgery. When morphine is spoken of, the sulphate is 
 always understood, unless otherwise specified. Notwithstanding its simi- 
 larity in effect to opium, the morphine salts cannot be substituted in all 
 cases for the crude drug. They are chiefly indicated for the relief of 
 pain or nervous irritability, to induce tranquillity, and where immediate 
 action is desired. 
 
 A common mode of administering morphine is by a suppository made 
 with cacao butter. So much of the impression ordinarily sought for is 
 local, that it is held to be appropriate to include some account of it in 
 this place. The dose by the rectum is about the same as by the mouth,
 
 346 LOCAL THERAPEUTICS. 
 
 one-fourth of a grain. Nausea and gastric irritability, which occasionally 
 follow the ingestion of the drug by the mouth, are often avoided. 
 
 The absorption of morphine by the rectum is not so rapid as when taken 
 by the mouth, although the difference is but slight, provided the bowel is 
 free from impacted faeces. The endermic method has practically been 
 supplanted by the use of the hypodermic syringe, while it remains true 
 that in certain conditions a blistered surface may be dusted over with 
 almost any powder containing morphine, or a granulating surface may 
 be similarly treated ; absorption from this source is not so likely to 
 occur as in other methods. The therapeutic uses of morphine are many. 
 In the treatment of SHOCK, either as the result of traumatism or of surgical 
 operations, morphine is a most valuable remedy, and is more efficient 
 when given hypodermically than by the mouth or rectum. The exhibition 
 must be conjoined with the use of cardiac stimulants and external heat. 
 It is not infrequently the case that attempts are made to combat this 
 dangerous condition without the use of morphine, the reason attributed for 
 its non-administration being that the patient is not complaining of pain. 
 But morphine acts as a stimulant to the nervous system, which in turn 
 immediately affects the circulation. It is not unusual to see reaction begin 
 immediately after its administration. The dose can be usually a little 
 larger, one-fourth of a grain, and repeated, if necessary. In the treatment 
 of SCIATICA, LUIMBAGO, and other NEURALGIC AFFECTIONS no remedy 
 promises so speedy a cure or relief from pain as the subcutaneous injections 
 of morphine often with or without atropine. An available combination is 
 as follows : Morphinae sulph., gr. one-sixth ; atropinae sulph., gr. -j^. It 
 is important that the injection should be administered near the seat of pain 
 or in the course of the affected nerve. In obstinate SCIATICA injections deep 
 in the substance of the muscle, or into the nerve sheath, have been often 
 productive of good results when other measures have failed. The endermic 
 method has been employed by sprinkling morphine over a blistered surface 
 along the course of the affected nerve, but the results obtained are not so 
 satisfactory as when the morphine is injected with a syringe. Morphine is 
 of special value in the treatment of CHORDEE. Berkeley Hill advises the 
 subcutaneous injection of one-fifth of a grain on retiring. In obstinate 
 cases of the affection we have added one-sixth of a grain to a suppository 
 containing belladonna and camphor with gratifying results. In CYSTITIS 
 morphine is available, especially when its action is aided by the use 
 of hot hip baths. Sir Henry Thompson commends the form of admin- 
 istration by suppository. In HEMORRHOIDS the addition of a small 
 amount of morphine to the ointment of nutgalls will often relieve the pain 
 resulting from this troublesome affection. 
 
 Diseases of the Ear, Nose, Throat, etc. In the nose morphine, 
 or the watery extract of opium is ordinarily employed. Nasal bougies
 
 OPIUM. 
 
 347 
 
 may contain one-quarter of a grain of morphine, or one grain of the extract. 
 NASAL HEADACHE can be sometimes relieved by insufflating one-eighth 
 grain of morphine every two or three hours. Ferrier 1 s snuff contains about 
 one grain of morphine to an ounce of an indifferent medium, such as an 
 ounce of pulverized acacia and six drachms of subnitrate of bismuth. In 
 a second formula of this nostrum the proportion of morphine is stronger, 
 viz. : Morphine, one grain to a half ounce mixture composed of sub- 
 nitrate of bismuth, three drachrns, and pulverized acacia, one drachm. In 
 yet a third the proportions are as follows : One grain of morphine to two 
 drachms, namely, one each of subnitrate of bismuth and powdered 
 acacia. This want of uniformity in the preparation is sufficient reason, 
 in the judgment of the writer, to discard it. In proportion of about 
 one-fifth of a grain to one drachm of indifferent medium tartrate of mor- 
 phine has been used in overcoming the pain and throbbing of ACUTE 
 RHINITIS. It may be combined advantageously with cocaine. 
 
 No preparation of opium for use in the nasal chamber should be long 
 continued. Owing to the readiness with which the drug is absorbed 
 from the mucous membrane, and the danger thereby incurred of the con- 
 traction of the opium habit, the following note is of interest : J. B. 
 Mattison (Med. and Surg. Reporter, December 13, 1890) relates the case 
 of a gentleman who, to relieve an attack of migraine, sniffed up the 
 nostril five to ten drops of a solution, in the strength of ten grains of 
 morphine to an ounce of water. He gradually increased the dose until 
 he used as much as a drachm of the drug daily. This was his stipend 
 for a period of eighteen months. All the opiate effect was thought to 
 have been obtained through the nasal membranes, as special care was 
 taken to prevent swallowing the mixture, and whatever amount passed 
 into the mouth was ejected. 
 
 One-quarter of a grain, diluted with starch, is a palliative in ERYSIPELAS 
 of the pharynx. 
 
 One of the chief uses of morphine in the treatment of diseases of the 
 respiratory passage is the alleviation of pain in LARYNGEAL PHTHISIS. It 
 is also employed as a preliminary to the use of chromic acid in the interior 
 of the larynx, lodoform is the medium usually selected as an excipient, 
 though it may be thrown upon the affected parts in any indifferent, sub- 
 stance. From one-sixteenth to one-half a grain may be employed at a 
 time. A few drops of the camphorated tincture of opium or an equivalent 
 quantity of the watery extract in an ounce of water may be used as an 
 anodyne in the form of a spray in CHRONIC LARYNGITIS. 
 
 Following upon an application of morphine to the larynx patients often 
 complain of a sensation of dryness. It need not be of a grade sufficient 
 to contraindicate the use of morphine, but it should always be in the 
 mind of the physician, in order that remedies to overcome it may be
 
 348 LOCAL THERAPEUTICS. 
 
 available. The use of hot inhalations of benzoin, a spray of saturated 
 solution of potassium chlorate, gargling with warm milk, etc., as a rule, 
 suffices to relieve the distress. Morphine should be finely triturated to 
 use in insufflation. 
 
 While morphine is a well known and effective agent for the relief of 
 pain on the mucous surfaces, it should never be used on the vocal cords 
 four hours before an exciting use of the organs of speech, as in preaching 
 or singing. (Sajous.) 
 
 Morphine enters largely into the composition of lozenges in painful 
 conditions of the throat and in laryngeal cough. Each lozenge contains 
 from one-twenty-fourth to one-twentieth of a grain of morphine or one- 
 tenth of a grain of the powdered opium or the extract. Lozenges of 
 Dover's powder usually contain two grains of the essential ingredients. 
 Wistar 's cough lozenge is composed as follows : Powdered opium, one- 
 tenth grain; oil of anise, one-thirty-second of a grain ; extract of lico- 
 rice, one grain. Jackson* s pectoral syrup contains morphine and acacia. 
 It probably acts in great part locally upon the inflamed structures about 
 the aperture of the larynx. 
 
 MORPHINE ACETAS. 
 
 Diseases of the Eye. Acetate of morphine is a convenient anodyne 
 in ACUTE CONJUNCTIVITIS, combined with acetate of zinc or acetic acid 
 or with both. Five grains of acetate of morphine, half a grain of acetate 
 of zinc, and ten drops of dilute acetic acid to the ounce of water make 
 an excellent wash. 
 
 CODEINA. Codeia. Codeine. 
 
 " An alkaloid prepared from opium. It occurs in white or yellowish white, more or 
 less translucent, rhombic prisms, somewhat efflorescent in warm air. Odorless, having 
 a slightly bitter taste and an alkaline reaction. It is soluble in eighty parts of water at 
 15 C. (59 F.) and in seventeen parts of boiling water. Very soluble in alcohol and in 
 chloroform ; also soluble in six parts of ether and in ten parts of benzol, but almost insol- 
 uble in benzin." (U. S. P.) 
 
 Diseases of the Throat. Codeine is recommended by S. H. Chap- 
 man as an ingredient in the form of a troche. He exhibits the agent in 
 the proportion of one-fiftieth of a grain in each lozenge in the presence 
 of one-twenty-fifth of a grain of gum camphor and one-fourth grain of 
 extract of glycyrrhiza. 
 
 ORIGANUM. Wild Marjoram. 
 
 Origanum vulgare. The oil of origanum exhibits properties in common with the 
 other volatile oils. 
 
 The oil of wild marjoram is aromatic and stimulant. 
 
 Diseases of the Throat. M. Mackenzie states that five minims to
 
 OVI ALBUMEN OVI VITELLUS. 
 
 349 
 
 the ounce constitute a moderately stimulating inhalant. Oil of marjoram 
 is not often used alone. It is sometimes combined with the impression of 
 benzoin, lupulus, etc. S. H. Chapman exhibits the oil in the presence of 
 an equal quantity of oil of thyme. A few drops are added to a pint of 
 water, at 140 F., for inhalation in LARYNGITIS. 
 
 OVI ALBUMEN. OVI VITELLUS. Fowl's Egg. 
 Glyceritum Vitelli is official. (U. S. P.) 
 
 Both the albumen and the yolk of the fowl's egg are emollient and 
 protectant. The shell may be used for the purposes for which chalk is 
 ordinarily substituted. 
 
 General Surgery. The "white of egg," either pure or mixed with 
 wheat flour, when thinly spread over the surface and allowed to dry, 
 forms an impervious coating resembling collodion, and, like it, when 
 rendered aseptic, can be used for closing the external wound in com- 
 pound fracture. It may also be used with gauze for holding together 
 the edges of wounds, and in the absence of starch and plaster-of-Paris 
 the albumen may be used in stiffening bandages. The roller is thor- 
 oughly saturated and applied in the same manner as in the case of 
 plaster-of-Paris. 
 
 "White of egg," mixed with oil and water to form an emulsion, 
 has been used as a topical dressing in the treatment of ERYSIPELAS 
 and BURNS; coagulated with alum it forms "alum curd " (see p. 83), 
 which may be used as an emollient and astringent application. Thejj><?/ 
 is a soft, bland substance with a slightly alkaline reaction suspended in 
 water. The yolk is commonly used as a vehicle for many substances 
 (such as turpentine) in rectal medication. It is employed in 6 1 /. John 
 Long' s liniment. The formula for this old preparation is as follows : Spirit 
 of turpentine, one fluid ounce ; vinegar, three fluid ounces ; and the yolk 
 of one egg. Placed in a bottle and thoroughly shaken it forms a creamy 
 emulsion, with a peculiar but not unpleasant odor. This liniment is 
 slightly rubefacient and is used as an embrocation for the chest in the 
 BRONCHITIS OF CHILDREN. It should be rubbed in thoroughly with the 
 hand before a fire. If a more marked effect than the one named is 
 desired, a piece of flannel may be saturated and allowed to remain over 
 the chest. This has a similar effect to that produced by the turpentine 
 stupe. 
 
 Diseases of the Ear. The thin membrane which lies between the 
 egg-shell and the albumen has been used in the preparation of artificial 
 " ear drums."
 
 350 LOCAL THERAPEUTICS. 
 
 PAPAIN. Papayotin. Papoid. (The name Papayotin is also applied 
 to the dried papaw juice, from which papain is prepared.) 
 
 The fruit of Carica papaya, or South American melon tree, yields a milky juice which, 
 upon standing, separates into two layers. From the lighter of these is extracted, by pre- 
 cipitation with alcohol, the albuminous substance, papain. It has, in common with pepsin, 
 the property of digesting fibrine. It is alleged that it acts best in alkaline solutions 
 (pepsin acts only in acid solutions), and that it will peptonize two hundred times its own 
 weight of fresh blood fibrine, and that seven grains of it will digest a pint of milk in an 
 hour and a half. 
 
 Solutions, to be efficient, must be fresh or combined with non-toxic 
 agents, having preservative powers, e.g., glycerin, boric acid, camphor, etc. 
 
 Papain is a digestive solvent. 
 
 Diseases of the Skin. Papain has been employed to prepare the 
 skin, in ECZEMA PALMARUM, for the employment of other remedies. 
 The following formula has been recommended: R. Papain, gr. 
 xij ; sodii biborat., gr. v; aquae, f^ij. M. To be painted on 
 the thickened skin twice daily. When the epidermis is thoroughly 
 softened it may be scraped, and other remedies (see Pix, salts of mercury, 
 etc.,) applied. In this connection we do not think the drug offers any 
 advantage over salicylic acid (q. v.} for the purpose above mentioned, 
 and it is not so easily employed. 
 
 Diseases of the Ear, Throat, etc. Johnston (JEdin. Me d. Jour., 
 January, 1890) recommends papain as a SOLVENT OF CERUMEN, in 
 about the proportion of a scruple of the agent to an ounce of distilled 
 water. Fifteen drops are instilled into the outer meatus, and an hour 
 afterward the parts are syringed with a solution of boric acid. Papain, 
 from its powerful properties as a solvent to moistened fibrine, has been 
 recently employed (A. Jacobi, Med. Record, February 25, 1886) in 
 removing the membranous exudate in DIPHTHERIA. E. L. Shurly (IV. 
 Y. Med. Jour., September u, 1886) is skeptical as to the effects of papain 
 as a solvent in this disease. On the other hand, it is thought by J. 
 C. Mulhall (Trans. Am. Laryng. Assn., 1889) to be superior to trypsin. 
 
 Schwemmer (Revue des Publications Medicales, December, 1888) has 
 had marked success with papain in the treatment of FISSURE OF THE 
 TONGUE, after failure with chromic acid, nitrate of silver, and iodoform. 
 He employs a solution of from one to two parts of papain to ten parts 
 each of glycerin and water, applied five or six times a day, the fissures 
 to be previously dried with a pledget of absorbent cotton. No macera- 
 tion takes place, and the epithelium soon recovers. It has been used 
 with benefit also in the treatment of SYPHILITIC ULCERATIONS OF THE 
 TONGUE. A lozenge composed of Papain, gr. y% ; cocaine, gr. * ; 
 potass, bicarb., gr. ^, is procurable.
 
 PETROLEUM. 
 
 351 
 
 LIQUOR PEPSINI. Solution of Pepsin. Liquid Pepsin. 
 " Saccharated pepsin, forty parts ; hydrochloric acid, twelve parts; glycerin, four hun- 
 dred parts ; water, five hundred and forty-eight parts ; to make one thousand parts. 
 Dissolve the saccharated pepsin in the water, previously mixed with the hydrochloric 
 acid, add the glycerin, let the mixture stand twenty-four hours, and filter. Solution of 
 pepsin should be perfectly clear, of a slight yellowish color, and an agreeable, acidulous 
 taste. It should not become mouldy, nor acquire a disagreeable, fetid odor, when kept for 
 some time." (U. S. P.) 
 
 General Surgery. An artificial digestive juice based upon the 
 above has been employed by Norris (IV. Y. Med. Jour., Mar. 19, 1892) 
 for the removal of dead bone and other neurotic tissue from suppurating 
 tracts. An opening is made in the soft parts by the most direct route 
 to the seat of disease. If it be possible the sinuses are made to connect 
 and kept patulous by plugs of antiseptic gauze. A three per cent, 
 solution of hydrochloric acid (q. #.) in distilled water is then injected. 
 Should the patient be confined to bed, injections can be made every 
 two hours during the day ; under other conditions they may be made at 
 bedtime. After decalcification of the exposed bone is accomplished the 
 tracts are flushed with peroxide of hydrogen solution, or, in lieu of this, 
 with one of bichloride of mercury, let us say 1-2000, and a preparation 
 of pepsin, one-half drachm ; hydrochloric acid, sixteen minims; distilled 
 water, four ounces, employed. Digestion of the bone and tissue debris 
 is completed in about two hours. The procedure is repeated at the 
 end of two days. 
 
 PETROLEUM. Oleum Petras. Rock Oil. 
 
 Petroleum is an oily liquid, found at or near the surface in many parts of the world. It 
 is usually of a dark-green color by reflected light, and reddish-brown by transmitted light, 
 and is composed of hydrocarbons chiefly of the marsh-gas series. 
 
 By fractional distillation petroleum yields uncondensable gaseous products, rhigolene, 
 gasoline, benzine, and kerosene; and there are obtained from the residues petrolatum, 
 and paraffin. 
 
 Under the head of petroleum will be treated Rhigolene ; Kerosehe ; 
 Petrolatum ; and Paraffin. 
 
 RHIGOLENE. 
 
 Rhigolene is a name given to the lighter distillates from petroleum, namely, those which 
 boil at a temperature of about 65 F. It should be kept in a cold place in strong bottles, 
 securely corked ; the heat of the hand is more than sufficient to cause it to boil. It is 
 most inflammable, and the highly diffusible vapor when mixed with atmospheric air is 
 exceedingly explosive. It is a dangerous article, unless care is exercised with it. 
 
 Rhigolene is anaesthetic, refrigerant, and congelant. It is employed
 
 352 LOCAL THERAPEUTICS. 
 
 for feeding the Pacquelin cautery, although benzin answers the purpose 
 as well. 
 
 General Surgery. Rhigolene was introduced by W. B. Richard- 
 son, of London, as an excellent local anaesthetic. When sprayed on the 
 skin it rapidly reduces the temperature to fifteen degrees; in this way 
 cutaneous insensibility is obtained and facilities presented for the per- 
 formance of minor surgical operations. It has not, however, been used 
 as extensively as its merits deserve. 
 
 Diseases of the Nose. Inflammatory reaction does not, in the 
 judgment of W. C. Jarvis, occur when rhigolene is sprayed in the nasal 
 chambers. A. Stabler {Medical News ', Philadelphia, April 16, 1887) has 
 recommended a mixture of rhigolene and oil as a vehicle for a spray. 
 Two dradims of rhigolene (by measure) are added to the selected oil and 
 sprayed upon the affected surfaces. The mixture is described as non- 
 irritating, and in most cases acts as a mild anaesthetic. It possesses the 
 advantage over pure rhigolene of being less ignitable. The following 
 drugs are readily soluble : Balsam of copaiba, oil of cubeb, camphor, 
 eucalyptol, iodine, iodol, iodoform, menthol (crystals), naphthalene 
 (crystals), phenol (crystals), resorcin, oil of sassafras, salol, oil of tur- 
 pentine, and thymol. 
 
 KEROSENE. Coal Oil. 
 
 Kerosene is protective and probably weakly antiseptic. Aided by fric- 
 tion to the skin it is also rubefacient. 
 
 General Surgery. Kerosene has but a small field as a topical appli- 
 cation in surgery. By saturating a flannel cloth and enveloping the skin 
 over the affected parts, it is used in domestic medicine as a rubefacient in 
 BRONCHITIS, PLEURISY, and RHEUMATIC PAINS about the articulations. Its 
 action is similar to, although not nearly so active as, that of oil of turpen- 
 tine. It usually conveys a sense of warmth and comfort to the part to 
 which it is applied, causing redness of the skin without vesication. The 
 disagreeable odor will prevent kerosene becoming popular. In railroad 
 surgery it is a favorite dressing for fresh incised and contused WOUNDS, 
 the injured part being enveloped in clean cotton-waste, over which kero- 
 sene is poured to saturation. 
 
 PETROLATUM. Cosmoline. Vaseline. 
 
 Under the names of cosmoline, vaseline, etc., there are sold various semi-sclid 
 hydrocarbons, obtained from the residue left after the manufacture of petroleum. 
 Wherever these words occur it is understood that petrolatum is the official synonym. 
 Petrolatum is obtained by the purification of the residuum from certain oils that have had 
 the lighter portions (gasoline, kerosene, etc.) removed by distillation in a vacuum. This 
 residue, on standing, becomes solid, and is purified by melting and passing through ani- 
 mal charcoal. Petrolatum is also obtained by purifying the solid substance which sepa-
 
 PETROLEUM. 
 
 353 
 
 rates from certain crude oils while stored in large tanks. The title, Petrolatum (U. S. P.), 
 is intended to do away with these many names and to cover a product which shall be 
 equivalent to all of them. As defined by the U. S. P., petrolatum is " a semi-solid sub- 
 stance consisting of hydrocarbons, chiefly of the marsh-gas series (C 16 H 34 , etc. ), obtained 
 by distilling off the lighter and more volatile portions from American petroleum and 
 purifying the residue. Melting point about 40 to 51 C. (104 to 125 F.), the 
 first constituting the softer, and the second the firmer variety. When petrolatum is pre- 
 scribed or ordered without specifying its melting point, the low melting variety, which 
 liquefies at 40 C. (104 F.), is to be dispensed." The Pharmacopoeia further 
 describes it as " a yellowish or yellow fat-like mass, transparent in thin layers, more or 
 less fluorescent, especially when melted, completely amorphous, tasteless, and odorless, or 
 giving off at most only a faint petroleum odor when heated, and having a neutral reaction. 
 It is insoluble in water, scarcely soluble in alcohol, or in cold, absolute alcohol, but solu- 
 ble in sixty-four parts of boiling absolute alcohol, and readily soluble in ether, chloroform, 
 disulphide of carbon, oil of turpentine, benzin, benzol, and in fixed or volatile oils." The 
 Ph. Br. contemplates a purer product, and describes it as being of a white color and free 
 from odor, even when heated. 
 
 Petrolatum is a bland and un irritating unguent, and is often employed 
 as a substitute for lard in the preparation of ointments. It is stated by 
 the manufacturers that it is unalterable when exposed to the air. Such, 
 however, is not the case, as exposure will cause it to acquire a disagree- 
 able coal-tar odor. 
 
 Cosmoline and vaseline are trade names for forms of petrolatum. While 
 slight differences obtain between these two articles for most purposes in 
 the practice of medicine, they are similar substances. Both words are 
 in this country in general use. 
 
 Some authorities have asserted that petrolatum is unabsorbable and 
 therefore not well adapted to this purpose; but Luff (" Revue Internal, 
 de Bibliograph. Med.," January 25, 1891), as the result of a series of 
 experiments, claims that it forms the best ointment for the promo- 
 tion of absorption. Iodide of potassium applied externally, when 
 mixed with cosmoline, appeared in the urine in an hour ; when 
 mixed with lard, in nine hours, and when mixed with lanolin, not at all. 
 Similar comparative results were obtained with carbolic acid and with 
 resorcin. 
 
 General Surgery. Vaseline is used in surgical practice as a substi- 
 tute for lard as a basis for making ointments, especially with substances 
 like the salts of lead, mercury, and zinc, and iodide of sulphur, which 
 make lard rancid. 
 
 Liquid cosmoline, obtained from the residue after incomplete distillation 
 of petroleum, is a valuable substitute for sweet oil for anointing sounds, 
 catheters, and uterine instruments, as it is not liable to become rancid. 
 Vaseline is also largely used to anoint instruments. As a basis for 
 -ointments it is for the most part inferior to lard or lanolin. It is a pro- 
 23
 
 354 LOCAL THERAPEUTICS. 
 
 tectant to cutaneous surfaces, to prevent maceration from the prolonged 
 use of poultices, water dressings, or on wounds where irrigation is being 
 used. It is largely used by professional swimmers to smear over the body, 
 to protect the skin before entering the water. It is valuable to anoint the 
 hands and fingers in making post-mortem examinations of the thoracic 
 and abdominal cavities to prevent septic material from finding its way 
 into small cracks or fissures in the skin. In the same way it is valuable 
 in making digital, rectal, and vaginal examinations in persons suffering 
 from syphilis. Cosmoline may be incorporated with crystals of carbolic 
 acid in the strength of a drachm to the ounce. In BURNS, plain vaseline 
 has long been in use, and as a simple, bland, non-irritating dressing, is 
 applied spread on lint or old linen, or thickly spread over the part. 
 We consider it inferior to zinc or boric ointment as a topical application 
 in these conditions. It is a soothing dressing for SUPERFICIAL BURNS in 
 the following ointment : R. Sodii bicarb. , 3] ; cosmoline, gj. Cosmoline 
 is a favorite domestic remedy for superficial wounds, abrasions, and 
 contusions, and is applied directly to the'affected part. Cosmoline is a 
 useful substance for anointing bright steel surgical instruments to prevent 
 rusting. 
 
 In the treatment of ERYSIPELAS, where an unguent is desired, cos- 
 moline is to be preferred, as it interferes less with the cutaneous function. 
 
 Diseases of the Skin. Vaseline is of a consistence which renders 
 it available in dermatological practice. 
 
 Much controversy has arisen as to the relative penetrability into the 
 skin of lard, petrolatum, and lanolin. None of the experiments thus 
 far made are conclusive. There is practically little difference between 
 these different vehicles. 
 
 The comparative tenuity of vaseline renders it convenient to use as an 
 excipient in the preparation of unguents for the scalp. Otherwise it 
 possesses no particular advantages over lard. An ointment of equal 
 parts of vaseline and oxide of zinc ointment is convenient for use in 
 cold, weather. 
 
 Diseases of the Eye. Cosmoline is extensively used for ointments, 
 particularly of yellow oxide of mercury, intended to be applied to the 
 cornea. Cosmoline is unirritating, and is often applied to the edges of 
 the eyelids at night to prevent their adhesion by the accumulation and 
 drying of conjunctival discharges. Spread on linen or gauze, it is placed 
 next the eye, under compresses, to facilitate their removal. F. M. Wilson, 
 of Bridgeport, Connecticut, commends its use in GONORRHCEAL OPH- 
 THALMIA, and claims that it not only gives comfort to the patient, but 
 diminishes the discharge and facilitates its escape from the eye. It should 
 be used frequently and introduced freely beneath the upper lid, so that 
 the ball is bathed in it.
 
 PETROLEUM. 
 
 355 
 
 PETROLATUM LIQUIDUM. Liquid Petrolatum. Oleum Petrolatum. Liquid 
 Vaseline. Paraffinum Liquidum. "Albolene." " Benzoinol (!)." 
 
 Liquid petrolatum is in extensive use as a medium for dissolving many medicaments 
 when for any reason it is designed to employ a liquid in preference to a solid fatty medium. 
 It might be denned to be a liquid ointment base. In the development of the local thera- 
 peutics of the respiratory tract liquid petrolatum holds a prominent place. It forms the 
 basis of applications made in the form of a spray. In spraying oily fluids (especially 
 liquid petrolatum and castor oil) it is imperative that a sprayer made expressly for the 
 purpose be used. A number of ingenious models have been introduced into the 
 trade. 
 
 Petrolatum Liquidum is an oily fluid, obtained by distilling off the lighter 
 portions of certain kinds of petroleum in a vacuum, and purifying the 
 residue with animal charcoal. Its composition is similar to petroleum, 
 except that the hydro-carbons have a lower boiling point. They are 
 liquid at ordinary temperatures.* 
 
 PARAFFIN. 
 
 Paraffin is one of the many by-products from the residues after the distillation of coal 
 oil. In the pure state it is a white, waxy substance, midway in density between wax and 
 tallow. Its melting point varies, depending, as it does, largely upon the temperature at 
 which it has been prepared. 
 
 General Surgery. Paraffin is employed in surgery in the same 
 manner as wax ; owing to its cheapness, it is supplanting wax in many 
 ways. When it is necessary to protect substances from the action of 
 the air, paraffin is often employed. Tissue paper coated with paraffin 
 is extensively used as an impervious protection to prevent evaporation 
 in wet surgical dressings, and has largely superseded the use of oiled 
 silk. Paraffin is often added to ointments to give consistency in hot 
 weather. Owing to the rapidity with which it cools, paraffin is some- 
 times applied in a liquid state to inject CYSTS which have become 
 ruptured or have been punctured and their contents evacuated. The cysts 
 are re-distended by being injected with the paraffin, which, on cooling, 
 affords a good opportunity for the careful dissection of the cyst-wall. 
 
 Diseases of the Skin. Paraffin is used chiefly as an adjuvant to 
 give ointments a stiff consistence. The following formula for the treat- 
 ment of ECZEMA PLANTARUM will serve as an example : R. Acid, salicylic, 
 paraffin, aa 3'j 5 cerse albae, oj > olei amygdalae dulcis, f^iijss. M. This 
 makes a firm preparation which can be spread like plaster upon muslin. 
 
 Paraffin paper is employed very extensively in dermatological practice. 
 It is soft and pliable, does not fissure very easily, and can be applied 
 to the most irritable skin without danger. Ointments and even soft 
 
 * " Terraline " is a trade name for a form of petroleum, intermediate in consistence 
 between petroleum and liquid petrolatum.
 
 356 LOCAL THERAPEUTICS. 
 
 plasters may be spread upon paraffin paper, which being cleanly and effi- 
 cient, should almost always be preferred to cloths in applying ointments. 
 As the ointment is not absorbed by the paraffin paper, it exercises all its 
 virtue upon the skin instead of being partly wasted. 
 
 PHENACETINUM. Phenacetine. 
 
 A crystalline substance produced by the action of glacial acetic acid on para-pheneti- 
 dine ; the latter is obtained from phenol. In constitution phenacetine is closely allied to 
 acetanilide. Phenacetine occurs in colorless, tasteless, inodorous, glistening, scaly crystals. 
 It is sparingly soluble in cold water, more freely soluble in boiling water, and soluble in 
 about fifteen parts of alcohol. 
 
 Diseases of the Nose. S. Johnston employs phenacetin as an 
 ingredient of a powder in which subcarbonate of bismuth and powdered 
 acacia enter, in the treatment of ACUTE RHINITIS. 
 
 PHYSOSTIGMA. Calabar Bean. Ordeal Bean. 
 
 " The seed of Physostigtna venenosum." (U. S. P.) Physostigma is the source of the 
 alkaloids known under the names of Eserine, or Physostigmine, and Calabarine. The 
 existence of the last is questionable. Eserine occurs in colorless tabular crystals, which 
 are readily soluble in ether, alcohol, chloroform, and sparingly soluble in water. The 
 Sulphate of Eserine or Physostigmine is the form in which it is usually used, though the 
 salicylate is official. The sulphate is freely soluble in water, while the salicylate requires 
 130 parts of water to dissolve it. 
 
 Physostigtna is reputed to increase the secretion of the salivary glands, 
 skin, and mucous surfaces generally. Eserine is a powerful excito-motor 
 agent when applied to the eye. 
 
 ESERINE. 
 
 Diseases of the Eye. Eserine causes contraction of the pupil and 
 spasm of the ciliary muscle by its property of stimulating unstriped mus- 
 cular fibres. It temporarily diminishes the mydriasis resulting from 
 pathological or experimental paralysis of the third nerve, and increases 
 the myosis due to paralysis of the sympathetic. Its effects are more tem- 
 porary than those of the stronger mydriatics, and when the latter are 
 overcome by its use they subsequently reassert themselves. In complete 
 ciliary paralysis by atropine and in the mydriasis induced by hyoscine 
 eserine has no effect. (Jessop.) 
 
 Eserine begins to contract the pupil and to cause accommodative 
 spasm in about five minutes, and reaches its maximum effect in from 
 twenty to forty-five minutes. Its effect on the accommodation lasts 
 only a few hours, in the pupil rather longer, sometimes several days.
 
 PHYSOSTIGMA. 
 
 357 
 
 In strong solutions it causes pain in the eye and head, ciliary congestion, 
 twitching of the orbicularis, and occasionally spasm of the external mus- 
 cles ; if constitutional effects have been induced, giddiness and faintness 
 are added to these symptoms. The sulphate is the form most in use. Its 
 solution becomes red after standing for a time and loses some of its 
 efficacy. The salicylate is said to be more permanent. It is usually pre- 
 scribed in solutions of from one-tenth of a grain to a grain to the ounce. 
 For continued use even weaker solutions are sometimes preferred, but when 
 a rapid and decided effect is sought, two or four grains may be needed. 
 The susceptibility to its unpleasant effects varies greatly in different 
 individuals. 
 
 Pfliiger states that eserine increases the intraocular tension of a 
 normal eye, but that it diminishes tension in the early stages of 
 GLAUCOMA is universally admitted. (See article on Atropine.) It is 
 not to be compared in this respect to iridectomy or sclerotomy, and has 
 little effect in advanced stages of the diseases when the paralyzed muscu- 
 lar fibres of the iris fail to respond to it ; but will sometimes check the 
 commencement of an acute attack, and should always be used when for 
 any reason an operation must be avoided or postponed. When it fails 
 to contract the pupil, it may do harm by increasing the flow of blood to 
 the iris and inducing irritating spasm of the ciliary muscles. Some 
 authors have advised against its use in the hemorrhagic form of glaucoma. 
 It is often used after cataract extraction, particularly without iridectomy, 
 to withdraw the iris from the wound, and for the same purpose is indi- 
 cated in peripheral perforation of the cornea from ulceration or punc- 
 ture. It has been recommended in weak solutions in some cases of 
 accommodative ASTHENOPIA without refractive errors, or after these have 
 been carefully corrected. In PARALYSIS OF ACCOMMODATION and PARA- 
 LYTIC MYDRIASIS its effect is temporary, lasting only a few hours, and with 
 little tendency to permanent result, as it stimulates the periphery of the 
 nerve fibres, but does not reach the cause of the trouble, which usually lies 
 further back. Ability to read may be temporarily restored, but generally 
 convex glasses answer this purpose better. 
 
 In some cases of ULCER OF THE CORNEA and of sloughing KERATITIS 
 eserine produces prompt improvement when atropine has failed. Much 
 discussion has arisen as to the comparative merits of these apparently oppo- 
 site remedies, but the indications for the use of one rather than the other are 
 not yet definitely formulated. It may, however, be concluded that eserine 
 is not usually well borne when there is acute inflammation, or much ciliary 
 irritation, and that it is to be avoided if the corneal disease is complicated 
 with iritis. Increased intraocular tension is an indication for its use.
 
 358 LOCAL THERAPEUTICS. 
 
 PILOCARPUS. Jaborandi. 
 
 "The leaflets of Pilocarpus pennatifolins." (U. S. P.) The single official prepara- 
 tion is a fluid extract (Extractum Pilocarpi Fluidum), one cubic centimetre representing 
 the activity of one gramme of pilocarpus. Pilocarpus owes its activity to an alkaloid ,pilo- 
 carpine. The hydrochloiide is official (U. S. P.); it is soluble in less than two parts of 
 water. In the Br. Ph. the nitrate is official ; it is soluble in eight or nine parts of water. 
 
 Diseases of the Skin. The fluid extract of jaborandi has been 
 used as an application in ERYSIPELAS. We have employed it in the 
 following formula, but without marked success : R. Ext. jaborandi fluid., 
 fgiij ; tinct. opii, glycerini, aa f^ss. M. Sig. Paint over the affected parts 
 every four hours. 
 
 In ECZEMA the fluid extract has also been used alone as a local applica- 
 tion with success. 
 
 Both jaborandi and pilocarpine have been used locally in the treatment 
 of ALOPECIA, but the accounts of their value have been too vague to be 
 satisfactory. In some cases this remedy has been combined with some 
 other application of well-proved value, as tincture of cantharides, and the 
 favorable result has been credited to the pilocarpine in jaborandi, an 
 entirely unjustifiable deduction. 
 
 Diseases of the Throat, etc. Pilocarpine has lately come into 
 use as an internal remedy for conditions in which a diminution of normal 
 secretion is a pathological factor. J. C. Dunlop (Brit. Med. Jour., June 
 7, 1890) has proposed its employment as a hypodermic injection for mixed 
 middle ear and labyrinthine disease of long standing. The reputed value 
 of the agent, when thus employed, has led observers to search for a local 
 use as well. 
 
 Gomez de la Mata (Gaze/a de Oftalmologia, Otologia y Laryngologia, 
 July, 1886) recommends pilocarpine to be used, either pure or mixed, with 
 glycerin, carbolic acid, to promote detachment of the false membranes 
 in DIPHTHERIA. Weltering {Monatschrift f. Ohrenheilk,]\i\y, 1886) sug- 
 gests the subcutaneous injection in CEDEMA OF THE GLOTTIS. 
 
 Pilocarpine, in the proportion of one-fortieth of a grain to each mass, 
 has been used in the form of a lozenge for the relief of dryness of the 
 throat. The drug acts by increasing the amount of mucus. Care must 
 be taken not to confound the sensation of dryness for the actual desicca- 
 tion of the membrane, since patients frequently complain of the throat 
 being dry when in truth its surface is covered by excess of secretion. J. 
 Solis-Cohen uses one to five minims of the fluid extract of jaborandi to the 
 ounce of water as a spray to the larynx in inflammation accompanied with 
 diminished secretion. 
 
 Diseases of the Eye. The hydrochloride of pilocarpine is a decided 
 myotic, but much milder in its action than is eserine. It is unirritating,
 
 PINOL PINUS CANADENSIS PIPER. 359 
 
 and some authorities claim that it is entirely free from the tendency to 
 produce iritis which sometimes forbids the use of eserine. It has no 
 noticeable effect upon the thoroughly atropinized eye, and is not depended 
 upon as a remedy in glaucoma, but is useful when a gentle and prolonged 
 stimulation of the ciliary muscle is desired, as in CILIARY PARESIS and 
 in cases of accommodative ASTHENOPIA which are free from refractive 
 error or in which the asthenopia persists after such error has been properly 
 corrected. It is used in solution of from two to five grains to the ounce. 
 
 PINOL. 
 
 A trade name used to designate the oil of the leaf of Pinus Pumilio. It possesses 
 qualities similar to the oil of Pinus sylvestris (<j. v.). 
 
 Diseases of the Throat, etc. Pinol is used for inhalation in the 
 treatment of CHRONIC and SUBACUTE LARYNGEAL and PHARYNGE.VL CON- 
 DITIONS. 
 
 PINUS CANADENSIS. Hemlock. Hemlock Spruce. 
 Hemlock, or Canada pitch, is " the resinous exudation of Abies canadensis" (U. S. P.) 
 In addition the bark abounds in tannic acid, and contains also a notable proportion of a 
 volatile oil (the oil of spruce, oil of hemlock). Emplastrum Picis Canadensis (U. S. P.) 
 is composed of Canada pitch, nine parts, and yellow wax, one part. An extract of the 
 bark is also in use. 
 
 Hemlock is astringent and stimulant. 
 
 Diseases of the Throat, etc. T. F. Rumboldt (St. Louis Archives, 
 1873) use d the extract of Pinus canadensis in the strength of one-half 
 drachm to two drachms to a carbolic acid solution, in the strength from 
 two to five grains to the ounce, for an astringent action where the 
 mucous secretions are abundant and the membranes lack tone. A lozenge 
 of the extract of Pinus canadensis is in the market. Each mass contains 
 one grain of the preparation. 
 
 PIPER. Pepper. Black Pepper. 
 
 "The unripe fruit of Piper nigrum." (U. S. P.) The powder known as "black" 
 pepper is procured by powdering the whole unripe berry. " White " pepper is made 
 from the ripe berry. Pepper contains an oleoresin, an alkaloid (piperine), a volatile oil, 
 gum, and extractive matter. Of these the alkaloid and oleoresin are official. The latter is 
 made by exhausting pepper with stronger ether, and distilling or evaporating the ether. 
 Preparations of black pepper, free from adulteration, are difficult to obtain. 
 
 Pepper is stimulant. 
 
 General Surgery. Pulverized pepper, when rubbed on the skin, 
 increases the circulation ; it is sometimes added to sinapisms. In old
 
 360 LOCAL THERAPEUTICS. 
 
 people who suffer from COLD EXTREMITIES a small amount of ground 
 pepper is worn in the storking with comfort. 
 
 Diseases of the Throat, etc. Pepper is used by Mandl in INFIL- 
 TRATION and ELONGATION OF THE UVULA and in PARALYSIS and FUNGOUS 
 STATES OF THE TONGUE. Potter mentions a pepper plaster which is 
 recommended to be worn about the neck or chest as a means of inducing 
 mild counter-irritation. 
 
 PIX BURGUNDICA. Burgundy Pitch. 
 
 " The prepared resinous exudation of Abies excelsa (Norway spruce)." (U. S. P.) 
 Burgundy pitch is also obtained from Abies picea (European silver fir). Pix Burgundica 
 is a constituent of Emplastrnm Ferri, Emplastrum Galbani, and Emplastrum Opii. 
 Emplastrufit Picis Burgundies is made by taking nine parts of Burgundy pitch, one 
 part of yellow wax, melting them together, and straining. Emplastrum Picis cum Can- 
 tharide (warming plaster) is made by taking ninety-two parts of Burgundy pitch and 
 eight parts of cerate of cantharides, melting them together, and straining. 
 
 Burgundy pitch is slightly stimulant and rubefacient. It is rarely 
 vesicant. 
 
 General Surgery. When applied to delicate skins Burgundy pitch 
 produces a papillary eruption, and by prolonged use may excite vesi- 
 cation and ulceration. Even when not exciting irritation, it may cause 
 intolerable itching. Emplastrum Picis Burgundicse is extensively employed 
 for a variety of chest pains, as the result of " cold," and is especially service- 
 able in protecting the chest from the danger of atmospheric changes 
 complained of by persons suffering from PHTHISIS. In LUMBAGO and 
 CHRONIC RHEUMATIC PAINS a pitch plaster worn over the affected part 
 is often of service and a source of comfort to the patient. 
 
 PIX LIQUIDA. Tar. Wood Tar. 
 
 "An empyreumatic oleoresin obtained by the destructive distillation of the wood of Pinus 
 palustris and of other species of Pinus." (U. S. P.) By distillation taryields pyroligneous 
 acid (see Acidum Aceticum) and oil of tar (which also see) ; it contains a great variety of 
 compounds, of which creasote is one. Tar is soluble in the volatile and fixed oils, in 
 solutions of potassa or of soda, in ether and in alcohol. Unguentum Picis Liquidae (tar 
 ointment) is made by melting together equal parts of tar and suet and straining. 
 
 Tar is mildly antiseptic, discutient, stimulant, astringent, parasiticide, 
 and antipruritic. On the hypertrophied epidermis of PSORIASIS and 
 CHRONIC ECZEMA tar has a dissolving effect to a certain extent, and also to a 
 slight degree a " keratoplastic " influence ; that is, it favors the growth of 
 healthy epidermis. 
 
 Under the caption of tar will be considered Oleum Picis Liquidse and 
 Tar Water.
 
 FIX LIQUID A. 26l 
 
 OLEUM PICIS LIQUIDS. Oil of Tar. 
 
 " A volatile oil distilled from tar." (U. S. P.) It has the odor and taste of tar, and 
 unless recently made is of a dark reddish-brown color. The preparations sold under the 
 name of oil of tar probably owe their efficiency to the creasote they contain. 
 
 Oleum cadini (q. v.~), is derived from the juniper tree of France; and 
 Oleum rusci, or oil of birch, is derived from the white birch of Russia. 
 
 There is little or no difference in the medicinal effect of these various 
 forms of tar, but some are thought to have a more agreeable odor than 
 others. 
 
 Diseases of the Skin. The external uses of tar in the treatment of 
 skin disease has been known since ancient times, and during the greater 
 part of the present century it has been, next to sulphur and mercurial 
 preparations, perhaps the most commonly employed of all cutaneous 
 remedies. Of late years some of the derivatives of coal tar have 
 replaced it on account of its disagreeable qualities, but there are certain 
 virtues in the tarry preparations which are not possessed by more 
 agreeable remedies and which recommend them in a number of skin 
 affections. 
 
 Wood tar is chiefly employed in medicine, although coal tar, " picis 
 mineralis," enters into one preparation, at least, of considerable value, 
 ' liquor carbonis detergens." * 
 
 In the treatment of CHRONIC PSORIASIS the scaly patches are cleansed 
 with soap, or, if numerous, by a hot bath, and the pure liquid tar (pix 
 liquida) is rubbed into each one thoroughly every day. Sometimes 
 an ointment of a drachm or more of pix liquida to the ounce of lard 
 is employed in the same way. Occasionally the tar is combined with 
 sulphur, a drachm of each to the ounce of lard. The well-known 
 " Wilkinson's ointment," as modified by Hebra, is composed as fol- 
 lows : R. Sulphur, praecip., picis liquid., aa^vj ; saponis viridis, adipis, 
 aa 3xvj ; pulv. cretae, giv. M. This is an excellent local remedy in 
 psoriasis and is also employed in SCABIES. It should be used diluted at 
 first on tender skins. 
 
 In CHRONIC ECZEMA tarry preparations are highly useful. The formulse 
 given above may be ordered, or, in milder cases, an ointment substituted 
 of half a drachm to a drachm of tar to the ounce of oxide of zinc ointment. 
 ( Vide infra.} In the CHRONIC ECZEMA OF CHILDREN an ointment of half a 
 drachm of liquid tar, or of oil of cade with half a drachm of precipitated 
 sulphur in an ounce of oxide of zinc ointment, forms an admirable appli- 
 cation. 
 
 * For a considerable portion of the earlier part of this article we are indebted to an 
 excellent paper by Bulkley (" The Local Use of Tar, etc." Archives of Sci. and 
 Pract. Med., April, 1873).
 
 362 LOCAL THERAPEUTICS. 
 
 The liquid preparations of tar are very convenient for use in many 
 cases of CHRONIC ECZEMA. They may be easily diluted to any degree, 
 and therefore may be employed in more acutely inflammatory conditions 
 than the stronger ointments above mentioned. It is to be remembered, 
 however, that tar and tarry preparations are rarely, if ever, to be used 
 in acute eczema. 
 
 A solution of tar, with caustic potassa, introduced by Bulkley under 
 the name of " liquor picis alkalinus," is an admirable application in 
 CHRONIC PAPULAR ECZEMA, especially when diffused over large surfaces. 
 It is composed as follows: R. Picis liquidae, gij ; potassae causticae, 3] ; 
 aquae, f^j. M. This is much too strong to be used undiluted except in 
 the rarest cases, as it is almost caustic. For ordinary use one ounce of 
 this solution may be diluted with fifteen ounces of water, this may be 
 strengthened or weakened, as the case may require. 
 
 A somewhat more elegant tarry preparation is the " liquor carbonis 
 detergens" It is a proprietary preparation, but is closely imitated by the 
 following formula: R. "Picis mineralis," gij ; alcoholis, f^ij ; strain 
 and add liq. ammoniae fort, TTLviij ; glycerini, f^vj ; aquae destillatae, ad. 
 fgxij. M. It may be employed in full strength or diluted. 
 
 Another liquid preparation of tar is the following: Picis liquidae (or 
 ol. cadini), 3] ; collodii, fgj. M. 
 
 This preparation should be put in a tightly-stopped bottle, with a 
 camel's hair brush inserted in the cork, for convenience of application. 
 Painted on small patches of sub-acute or chronic eczema, the collodion 
 quickly dries and forms a protective covering, while the tar acts as an 
 antipruritic. This preparation is of peculiar value in INFANT.ILE ECZEMA, 
 especially of the face, when it may be used even in acute cases. The ap- 
 plication gives momentary pain, but afterward great relief, and, unlike 
 an ointment, it cannot be rubbed off by the struggles of the child. 
 
 It should not be applied near the eye, and the physician should make 
 the first application with due precautions against ignition. The appli- 
 cation leaves a light-brown stain, which is objected to at times by vain 
 parents, but it is so superior to other forms of treatment that it is by 
 all means to be preferred. 
 
 Tar may be combined with mercurial preparations in some cases with 
 advantage. An ointment of ten to twenty grains of the yellow oxide of 
 mercury, a drachm of oil of cade, and an ounce of oxide of zinc ointment 
 forms an excellent application in small patches of chronic eczema with 
 infiltration. It is to be rubbed in in small quantity very firmly. 
 
 The tarry preparations are of value in PRURITUS. The various formulae 
 given above may be employed, but the lotions are preferable. 
 
 As a parasiticide tar is not of great value ; it is usually combined with 
 iodine ($. v.) or some other alterative.
 
 FIX L1QUIDA. 363 
 
 Diseases of the Nose, Throat, etc. The vapor of oil of tar may 
 be used in the treatment of ACUTE CORYZA. It can be also prescribed as 
 an inhalant in any of the conditions in which creasote is indicated. Ten 
 minims may be added to a half ounce of water to which ten grains of 
 magnesium carbonate have been added. It is a useful preparation when 
 inhaled in proportions of one teaspoon ful of the mixture to a half pint 
 of water at 150 F. The following may be substituted : Oil of tar, half a 
 drachm ; liquid petrolatum, one ounce. Inhale. A. S. Houghton. (Jour. 
 Am. Med. Ass'n, November 7, 1885.) 
 
 Oleum picis in the proportion of one drachm to six ounces of liquid 
 petrolatum is used by Shurly. Directions are given to mix these ingredi- 
 ents by the aid of gentle heat, and filter. One drachm each of the oil of tar 
 and bicarbonate of sodium added to a pint of boiling water is a useful spray 
 in irritation of the respiratory passage. The water and oil of tar should 
 be first mixed and allowed to boil three minutes ; after the mixture is 
 cool the bicarbonate of sodium is added and the whole filtered. 
 
 Lozenges of tar contain one to seven grains in each mass. Various 
 combinations of tar and expectorants are to be found in the trade. 
 
 Oil of tar is sometimes prescribed in the form of a lozenge, in the pro- 
 portion of one-half minim to each mass. 
 
 TAR- WATER. Aqua Picis Liquidae. 
 
 Diseases of the Throat, etc. Tar-water may be used in the form 
 of tar-water, glycerole, or vapor. 
 
 As a spray in CHRONIC LARYNGITIS, LARYNGEAL PHTHISIS, and CHRONIC 
 PHARYNGITIS and LARYNGITIS tar-water forms an admirable adjuvant with 
 borax, boric acid, or resorcin. Moure (La Tribune Medicale, 1889) has 
 revived its use in OZ^ENA, and presents the special claim of its value 
 when combined with small proportions of Lugol's solution and camphor. 
 
 The vapor inhalation of tar has long been of use in ACUTE INFLAMMA- 
 TION OF THE LARYNX AND PHARYNX. The use of tar in disinfecting the 
 sick-chamber in DIPHTHERIA is secured by J. C. Mulhall (Trans. Amer. 
 Laryng. Ass 'n, 1889) in the following manner: A gas stove is introduced 
 into the room which will hold two vessels. Into each is poured a half gallon 
 of water. Into each of these in turn a half pint of pine tar and a lable- 
 spoonful of oil of turpentine is stirred. As steam is generated water is occa- 
 sionally added, so that the half-gallon mark is maintained. The amount 
 of tar will be sufficient for the entire treatment, but to each vessel there is 
 added every hour a tablespoonful of the oil of turpentine. This treat- 
 ment is credited to be unassociated with strangury. The room selected 
 for the fumigation should be previously disinfected with sulphur. Mulhall 
 accredits this plan in its essential details to Delthil.
 
 364 LOCAL THERAPEUTICS. 
 
 PLUMBI ACETAS. Acetate of Lead. Sugar of Lead. 
 " Colorless, shining, transparent, prismatic crystals or scales, efflorescent and attracting 
 carbonic acid on exposure to air; having a faintly acetous odor, a sweetish, astringent, 
 after-metallic taste, and a faintly acid reaction ; soluble in one and eight-tenths parts of 
 water and in eight parts of alcohol at 15 C. (59 F.)." (U. S. P.) Because of the 
 facility with which subacetate of lead is decomposed, it is used in medicine only in solu- 
 tion. Ceratum Plumbi Subacetaiis (Goulard's cerate) contains twenty parts of solution 
 of subacetate of lead, with camphor cerate enough to make one hundred parts. (A more 
 soothing application would be one in which the camphor is omitted.) Linimenlum 
 Plumbi Subacetatis is made by mixing forty parts of solution of subacetate of lead with 
 sixty parts of cotton-seed oil. The official preparation is the Liquor Plumbi Subactfatis 
 (Goulard's extract), which is a concentrated solution of subacetate of lead ; from this is 
 made Liquor Plumbi Subacetatis Dilutus (lead-water) by taking three parts of the 
 stronger solution and distilled water sufficient to make one hundred parts, or one fluid- 
 drachm of liquor plumbi subacetatis, and distilled water, five fluidounces. The difference 
 in strength of these two preparations, and the similarity of their names, make it necessary 
 that they should be carefully distinguished. 
 
 Acetate of lead is astringent and sedative. It reduces hyperaemia and 
 lessens inflammatory action. It must be remembered that concentrated 
 solutions of the subacetate are irritant. 
 
 General Surgery. Solutions of the subacetate of lead have long 
 been employed as topical applications in external acute inflammations. 
 Although chemically incompatible, they are associated with opium, 
 forming the well-known " lead-water and laudanum," so generally used 
 for the treatment of SPRAINS, CONTUSIONS, and SUPERFICIAL INFLAM- 
 MATIONS. According to authorities, its application is contra-indicated 
 where the skin is broken, as absorption is likely to occur. From 
 an extensive use of the preparation, we are inclined to place little 
 dependence upon this statement, and consider the combination one 
 of the best which can be made in SEVERE CONTUSIONS or sprains 
 accompanied with laceration, a condition constantly occurring in dis- 
 pensary practice. Lint or old linen rags are saturated in the solution 
 (excess of fluid being squeezed out) and the affected part covered to 
 prevent evaporation, and the whole is retained in position by a bandage. 
 The effect produced in twenty-four hours is marked. For incised, lace- 
 rated, or contused wounds other forms of dressing are preferable. In 
 ERYSIPELAS relief will be secured, according to Agnew, by the application 
 of lead-water and laudanum to the affected part. An ounce each of 
 laudanum and the solution of the subacetate of lead and enough 
 water to make a pint is commended. In GONORRHCEA acetate of lead 
 is extensively employed, either alone or in conjunction with other 
 astringents. It is used at the Pennsylvania Hospital in combina- 
 tion with sulphate of zinc. The following will be found useful : 
 R. Plumbi acet., zinci sulph., aa gr. xij \ tinct. opii., f 5] ; aquse,
 
 PLUMBI ACETAS. 
 
 365 
 
 q. s. fgvj ; diluted if necessary at first. In CHRONIC CYSTITIS Sir Henry 
 Thompson regards warm solutions of the acetate of lead (one- fourth grain 
 to the ounce), when the urine is alkaline, as one of the best of mild in- 
 jections. Goulard's extract, or the solution of the subacetate of lead, 
 resembles closely the acetate. As before stated, it is largely employed 
 in making lead-water and laudanum. Equal parts of the extract and 
 laudanum form a convenient means of dispensing; water may be added 
 as required. A poultice is made by saturating the crumbs of stale bread 
 in Goulard's extract; it is applied cold. The official liquor plumbi sub- 
 acetatis dilutus is too weak to be of much service. SYPHILITIC WARTS and 
 small vegetations often wither slowly and painlessly under a daily appli- 
 cation with a camel's hair brush of Goulard's extract. Equal parts of 
 extract of hyoscyamus and Goulard's cerate form an ointment which 
 can be applied gently with the finger to HEMORRHOIDS after the parts have 
 been bathed with warm water. This preparation was a favorite with the 
 late Prof. Carson, of Philadelphia. 
 
 Diseases of the Skin. Dissolved in water, in the proportion of 
 two to three drachms to. the pint (with the addition of a drachm of 
 dilute acetic acid if the solution be desired clear), the acetate of lead 
 forms an excellent sedative and astringent lotion in HYPERIDROSIS, 
 BROMIDROSIS, and in ACUTE ECZEMA, ERYSIPELAS, DERMATITIS, PRURITUS 
 VULWE, and all acute inflammatory diseases of the skin. It is not so 
 satisfactory a sedative, however, as is the solution of the subacetate of 
 lead. " Burow 1 s liquid" is composed of five grains of alum, twenty-five 
 grains of acetate of lead, and five hundred grains of distilled water. 
 
 The acetate of lead is sometimes employed in the form of an ointment. 
 In DERMATITIS CALORICA, or CHILBLAIN, the following soft ointment 
 has been used to advantage: R. Plumbi acetat., 9iiss; cerse flavae, giss; 
 ol. rapi., f sj ; ovi. vitell., j. M. 
 
 An excellent ointment, when palm oil can be procured of the best 
 quality, is the following: R. Plumbi subacetat., gr. v; pulv. zinci oxidi, 
 gr. x ; hydrarg. chlor. mitis, gr. v; ung. hydrarg. nitrat.,gr. x; ol. palmae, 
 31] ; ung. adipis benzoinat., gss. M. Although the acetate of lead is 
 only one of several ingredients, this seems the proper place to introduce 
 this excellent combination. It is slightly stimulant, and is useful in 
 SUBACUTE and CHRONIC ECZEMA. 
 
 The subacetate of lead is more decidedly sedative than the acetate, and 
 is therefore generally useful. In the form of liquor plumbi subacetatis it 
 must generally be diluted with water, or employed as the liquor plumbi 
 subacetatis dilutiis. 
 
 Glycerole of the subacetate of lead was suggested by Squire. It is an ex- 
 cellent remedy when diluted with glycerin, or used as an ointment (one- 
 half to one drachrn to the ounce of lard) in ECZEMA OF THE LEG. The
 
 366 LOCAL THERAPEUTICS. 
 
 glycerole of lead contains one hundred and seventy-two grains of (he 
 acetate to the ounce. It should be diluted with four parts or more of 
 glycerin before being used. 
 
 In ECZEMA OF THE EYELIDS Mittendorf employs, after removing the 
 crusts with oil and warm water, a lotion of six drops of the liquor plumbi 
 subacetatis in half a tumbler of water, applied five or six times a day, for 
 five minutes at a time. This is used in connection with the ointment 
 of the yellow oxide of mercury mentioned under hydrargyri oxidum 
 flavum. 
 
 The "lead water and laudanum" of hospital use is composed of: 
 R. Liq. plumbi subacetatis dilut., fsj-f^iij ; tinct. opii, f^ij-f^iv ; aquae, 
 ad Oj. M. This is employed in all acute inflammatory diseases of the 
 skin, particularly in DERMATITIS VENENATA. 
 
 Diseases of the Ear, Nose, and Throat. The acetate of lead is 
 used in the treatment of ECZEMA of the external ear, in the form of oint- 
 ment. W. B. Dalby approves of the liquor plumbi subacetatis in the 
 treatment of granulations on the tympanic membrane or within the tym- 
 panic chamber. It is important to remember* that a deposit takes place, 
 and it is best not to direct a treatment to be conducted for a long time. 
 
 In the proportion of two grains to the ounce of indifferent material 
 acetate of lead can be insufflated in the treatment of PURULENT RHINITIS 
 of children. Twenty to thirty minims of the weaker solution to the 
 ounce of water forms an astringent lotion for the larynx and pharynx. 
 Schnitzler employs acetate of lead in the local treatment of TUBERCULAR 
 ULCERATIONS of the larynx. The dilute solution of the subacetate of 
 lead is commonly used in the affections of the upper air tract in the form 
 of a glycerole. TOOTHACHE may sometimes be immediately relieved by 
 inserting one or two grains of the acetate of lead into a carious tooth. 
 
 Diseases of the Eye. Acetate of lead was formerly much used in 
 collyria for CONJUNCTIVITIS, and has been recommended as a remedy in 
 TRACHOMA, rubbed, in fine powder, into the conjunctival surface of the 
 lid. It is, however, a dangerous remedy, from its liability to form insolu- 
 ble deposits, if there are ulcers of the cornea, and its use has been gene- 
 rally abandoned. The liquor plumbi subacetatis is a useful application 
 in the treatment of acute inflammation of the skin of the lids, particu- 
 larly in cases of RHUS POISONING. It may be used in the proportion of 
 an ounce to a pint of water. 
 
 PLUMBI CARBONAS. Carbonate of Lead. White Lead. 
 
 " A heavy, white, opaque powder or pulverulent mass, permanent in the air, odorless, 
 
 tasteless, and insoluble in water or alcohol." (U. S. P.) The single official preparation 
 
 is the Unguentum Plumbi Carbonatis, which is made by rubbing ten parts of carbonate 
 
 of lead, in very fine powder, with ninety parts of benzoinated lard. When ground with
 
 PLUMBI IODIDUM. 
 
 367 
 
 linseed oil, carbonate of lead forms the familiar substance known as " white lead," which 
 is used as a paint. 
 
 Carbonate of lead is sedative, astringent, and protectant. 
 
 General Surgery. " White lead" forms an admirable dressing for 
 the treatment of small, inflamed, and excoriated surfaces, protecting them 
 from the action of the air by forming an impervious coating. In BURNS 
 and SCALDS carbonate of lead was a favorite dressing with the late S. D. 
 Gross. It is used pure or brought to the consistence of cream with 
 sweet oil. It is of easy application. Care must be exercised that too 
 large a surface is not covered, as toxic absorption may result. Rawlins 
 (Med. News, October 5, 1889), reviving the methods of Freer, speaks 
 highly of carbonate of lead in the treatment of ERYSIPELAS, when painted 
 over the inflamed as well as the adjacent healthy skin. He states that it 
 promptly relieves pain and tends to limit the spread of the disease. 
 
 Diseases of the Skin. The powder of carbonate of lead is some- 
 times used as a local sedative and astringent in ACUTE INFLAMMATORY 
 CONDITIONS OF THE SKIN. 
 
 Diseases of the Ear. White lead is a valuable remedy for INFLAM- 
 MATION OF THE EXTERNAL AURICLE, especially when the attack ensues 
 upon exposure to cold. 
 
 PLUMBI IODIDUM. Iodide of Lead. 
 
 " Iodide of lead is a heavy, bright citron-yellow powder, permanent in the air, odor- 
 less and tasteless, and of a neutral reaction. Soluble in about 2000 parts of water at 15 
 C. (59 F.), and in about 200 parts of boiling water; very slightly soluble in alcohol, 
 but readily dissolved by aqueous solutions of the acetates of alkalies and by solutions of 
 chloride of ammonium." (U. S. P.) An ointment is official. 
 
 General Surgery. Iodide of lead has long been supposed to have 
 the resolvent properties of iodine, and when prescribed it is usually with 
 this object in view. In SCROFULOUS ENLARGEMENT OF THE GLANDS Cot- 
 terau and De Lisle consider it the most efficacious of all the iodine salts, 
 as it does not produce the cutaneous irritation so noticeable in other 
 iodine preparations. We have employed it extensively in the form of the 
 officinal ointment to be rubbed in twice daily in the treatment of rion- 
 suppurative ADENITIS. 
 
 J. Ashhurst accomplishes the same object by painting the surface with 
 tincture of iodine, and then applying soap plaster spread on chamois 
 skin ; the free iodine unites with the lead in the soap plaster to form the 
 iodide of lead. Tumefied lymphatic glands of the groin are often quickly 
 reduced by applying the official ointment, and placing over the region a 
 weight of a couple of pounds in the form of a bag filled with sand or 
 shot.
 
 368 LOCAL THERAPEUTICS. 
 
 PLUMBI NITRAS. Nitrate of Lead. 
 
 Nitrate of lead occurs in "colorless, transparent or white, nearly opaque, octahedral 
 crystals, permanent in the air, odorless, having a sweetish, astringent, after-metallic taste 
 and an acid reaction, soluble in two parts of water at 15 C. (59 F.), and in eight-tenths 
 part of boiling water, almost insoluble in alcohol." (U. S. P.) 
 
 Nitrate of lead is an astringent and disinfectant. Lidoyen's disin- 
 fectant fluid consists of one drachm of nitrate of lead added to one 
 ounce of water. This solution is prepared extemporaneously by dissolv- 
 ing a scruple of carbonate of lead in sufficient nitric acid for solution and 
 adding a pint of water. 
 
 Nitrate of lead acts as a disinfectant by decomposing the sulphuretted 
 hydrogen and by being in turn converted into sulphuret of lead. Thus 
 it destroys odors arising from the gas just named, but does not arrest 
 putrefaction. Solutions attack actively the solder of lead pipes \ for this 
 reason it should not be left in traps. 
 
 General Surgery. Nitrate of lead is held in high esteem in the 
 treatment of ONYCHIA. As advised by Moerloose and Vanzetti, the nail 
 is to be trimmed to the level of the ulcer, and the powdered nitrate of 
 lead dusted over the surface. The agent forms a thick crust, which sepa- 
 rates in a few days, leaving a healed or rapidly-healing surface. It is of 
 great service, also, in the treatment of the ulcer, after evulsion of the 
 nail, in INFLAMMATION OF THE MATRIX, an affection common among 
 poor and ill-conditioned emigrants. After the removal of the nail, which 
 is usually loose, the ulcer is sprinkled with the powdered nitrate of lead, 
 and over this is placed zinc ointment, spread on lint. Satisfactory results 
 are obtained in the treatment of ERYSIPELAS by nitrate of lead, in the 
 form of a solution, in the strength of from ten to twenty grains to the 
 ounce of water. 
 
 Diseases of the Skin. Nitrate of lead is occasionally applied to 
 EXCORIATED SURFACES, and a solution made in the proportion of ten 
 grains to an ounce of water and colored, probably with alkanet root, 
 has been used on the Continent of Europe as a secret remedy in SORE 
 NIPPLES, CHAPPED HANDS, CRACKED LIPS, etc. (U. S. D., i5th ed.). 
 Ward employs a lotion twice or thrice daily in sloughing and indolent 
 ulcers. {Prov. Med. and Surg. Jour. , October 15, 1851.) 
 
 A solution of nitrate of lead in glycerin, ten grains to the fluidounce, 
 is useful in EXCORIATED NIPPLES. 
 
 Diseases of the Throat. The nitrate of lead has a secondary posi- 
 tion as a local astringent. It is sometimes used in the treatment of 
 CHRONIC LARYNGITIS. A pigment may be prepared in the strength of 
 five grains to the ounce.
 
 PLUMBI OXIDUM. 369 
 
 PLUMBI OXIDUM. Oxide of Lead. Litharge. 
 
 " A heavy, yellowish, or reddish-yellow powder or minute scales, permanent in the air, 
 odorless, tasteless, and insoluble in water or alcohol. When heated in contact with 
 charcoal, it is reduced to metallic lead." (U. S. P.) 
 
 Emplastrum fuscum, or " universal plaster," consists of two parts each of finely- 
 powdered red oxide of lead and of olive oil ; after boiling, one part of yellow wax and one 
 per cent, of camphor are added for some purposes. It is put up in cakes and boxes and 
 sold as a secret preparation under different names. 
 
 EMPLASTRUM PLUMBI. Lead Plaster. Diachylon Plaster. 
 Lead plaster is made by boiling together oxide of lead, olive oil, and water in suitable 
 proportions until a plaster is formed. "Lead plaster is white, pliable, and tenacious; 
 free from greasiness or stickiness. It should be entirely soluble in warm oil of turpen- 
 tine (absence of uncombined oxide of lead)." (U. S. P.) 
 
 General Surgery. Oxide of lead is not employed alone, though 
 in combination with oils and fats, which it saponifies, it forms the basis 
 of many plasters. Bockart {Med. News, March 7, 1891) advises the 
 following for the treatment of VENEREAL VEGETATIONS : Oxide of lead, 
 four grains; saturated solution of potassa (at 100 F.), two drachms. 
 The mixture to be applied by means of a glass rod or a splinter of wood, 
 and then covered with a small compress. Contact with the growths for 
 five minutes softens the mass and permits its easy removal. The skin 
 should then be protected with iodoform or one of its substitutes. 
 
 Strapping the skin with broad pieces of lead plaster is an excellent 
 remedy for BED SORES. Large sores frequently heal under this mode of 
 treatment. 
 
 Diseases of the Skin. The impure oxide of lead or litharge is 
 ordinarily employed in dermatological practice, although there is no 
 reason why, for most purposes, it cannot be replaced by the precipitated 
 oxide. 
 
 It is one of the ingredients entering into the composition of "Hebrtfs 
 diachylon ointment" where it occurs as an oleate or oleo-stearate of lead. 
 This ointment is one of the most soothing and agreeable applications 
 employed in dermatology. It is prepared as follows: R. Olei olivse 
 optimae, f xv ; lithargyri, svi-giij ; aquae, q. s. 
 
 The oil is to be mixed with a pint of water, and heated by means of a 
 steam bath to boiling, the finely-powdered litharge being sifted in and 
 stirred continually ; the boiling is to be kept up until the minute particles 
 of litharge have entirely disappeared. During this process a few ounces 
 more of water are to be added from time to time, so that when completed 
 water still remains in the vessel. The mixture is to be stirred until cool. 
 It should be of a putty-white color and of the consistence of butter. The 
 best olive oil and the finest litharge only should be employed. (Duhring.) 
 24
 
 370 LOCAL THERAPEUTICS. 
 
 This ointment becomes rapidly rancid, and must be kept in a cool place 
 until wanted. 
 
 The Unguentum diachylon, as usually dispensed, is an inferior preparation, 
 and often unfit for use. 
 
 Employed as a dressing, after the use of sapo viridis, unguentum dia- 
 chylon forms one of the best applications in the treatment of some forms 
 of ACUTE and SUBACUTE ECZEMA, particularly that form known as ECZEMA 
 RUBRUM. 
 
 Recently a preparation called caustic lead has been recommended as a 
 superior application to CONDYLOMATA. It is composed of one part of 
 litharge and thirty parts, by weight, of a thirty-three per cent, solution 
 of caustic potassa. The mixture should be well shaken before using. 
 
 In applying this caustic the warts should be cleansed with some anti- 
 septic solution and dried. The caustic solution is then applied on a 
 cotton swab, care being taken not to allow it to spread to the surround- 
 ing healthy parts. The condylomata are destroyed completely, and the 
 charred masses can be wiped off the skin in a few minutes with dry cot- 
 ton. The raw surfaces remaining are to be dressed with iodoform. 
 
 The process, though quick, must be painful, and perhaps the parts should 
 be previously brushed over with a strong solution of cocaine. 
 
 Though called "caustic lead," the virtues of this preparation are prob- 
 ably those of a solution of caustic potash. 
 
 POTASSA. Potassium Hydrate. Caustic Potash. 
 
 Potassium hydrate is prepared by decomposing potassium carbonate with milk of lime 
 (calcium hydrate). The solution is evaporated and the fused residue cast into sticks, in 
 which form it is found in the shops, often under the name of " stick potash." It is offi- 
 cially described as " a white, hard, and dry solid, generally in the form of pencils, very 
 deliquescent, odorless, or having a faint odor of lye, of a very acrid and caustic taste 
 and a strongly alkaline reaction. Soluble in 0.5 part of water and in two parts of alcohol 
 at 15 C. ; very soluble in boiling water and in boiling alcohol." (U. S. P.) 
 
 The official preparations are Liquor Potassse and Potassa cum Cake. 
 
 Caustic potassa is a powerful, painful, and diffusive escharotic, quickly 
 destroying the life of the part with which it comes in contact. It appears 
 to act by abstraction of the water from the tissues as well as by saponifi- 
 cation of the fats, though it destroys all tissues other than bone and teeth 
 indiscriminately. The first effect of the caustic is to turn the parts a 
 dirty ashen to a black color. The eschar formed is soft if not gelatinous, 
 and usually separates in from six to ten days. 
 
 Caustic potassa generally occurs in the form of clumsy crayons, which 
 can be cut down or sharpened before they are used. By holding a stick 
 under running water it is also rapidly reduced to convenient size. In 
 operating, the stick of caustic potassa is wrapped up in a piece of cloth
 
 POTASS A. 
 
 371 
 
 or paraffin paper, or is fastened in an instrument made for the purpose, 
 only the point being left exposed. This is then touched, lightly at first, 
 to the surface to be operated upon, the debris being wiped away with 
 absorbent cotton. As the caustic is pushed deeper, a boring motion 
 can be employed. 
 
 Another convenient means of dealing with the crayons is to pick them 
 out of the bottle in which they are kept with a pair of dressing forceps, 
 and while in the grasp of the instrument, to encircle one end with a few 
 turns of adhesive plaster, thus giving a firm and safe hold for further 
 handling. 
 
 General Surgery. Caustic potash, if applied to the unbroken skin, 
 soon melts, causing intense pain until the power of the caustic is de- 
 stroyed. Owing to the dangers attending its diffusion and the difficulties 
 of manipulation, this agent, as a rule, is not often employed, except where 
 a very active and destructive action is desired. When a large surface is to 
 be covered the Paquelin cautery is to be preferred. In vicious INCURVA- 
 TION OF THE NAIL caustic potassa is one of the best agents for the destruc- 
 tion of the matrix. If not destroyed the new nail will be deformed. A 
 small crayon is quickly insinuated around the matrix, the cavity is then 
 packed and the parts covered with lint saturated with carbolized oil. In 
 FISTULA IN ANO it is often a good plan, after the laying open of the sinus, 
 to wipe the entire tract with the caustic, thus making a superficial slough 
 and preventing the premature closure of the cut edges. In MALIG- 
 NANT PUSTULE cauterization with this agent is recommended. In 
 CHANCROIDAL BUBO, which has gone on to suppuration, and when the 
 timidity of the patient will not permit the use of the knife, the contents 
 may be evacuated by placing a piece of adhesive plaster, in which a 
 small hole has been cut in the centre, over the place at which the bubo is 
 pointing. In this opening a small piece of caustic potassa, the size of a 
 pea, is lodged, and retained by another piece of plaster. In a short time 
 the caustic will have eaten its way through the abscess wall. In RABIES, 
 D. H. Agnew(" Surgery," vol. I, p. 225) advised the thorough cleansing 
 of the wound with a solution of carbolic acid (i-io), and then cauteriza- 
 tion with caustic potassa. Bollinger, after estimating the value of cauteri- 
 zation, concludes that only thirty-three per cent, of persons thus treated 
 fall victims to the disease, while eighty-three per cent, of those in whom 
 it is not practiced die. 
 
 Diseases of the Skin. Caustic potash is the most efficient caustic 
 employed in dermatology. It should always be kept in mind that the 
 action is diffusive, and the operator should stop short of the point to 
 which he wishes the cauterization to extend. A small vessel containing 
 vinegar or dilute acetic acid should be at hand, the thorough applica- 
 tion of which will arrest the action of the caustic at once. After a little
 
 372 LOCAL THERAPEUTICS. 
 
 experience the operator can estimate with accuracy how much beyond 
 the point of actual contact the action of the caustic will extend. 
 
 In operating upon small EPITHELIOMATA, or other growths, the sur- 
 rounding skin should be protected by adhesive plaster or oil, as the 
 deliquescent fluids carry the potash for some distance over the surface 
 with the result of causing superficial inflammation and annoyance. 
 
 The slough and other debris should be removed so far as possible after 
 an operation with caustic potash, and the resulting wound treated anti- 
 septically. 
 
 Caustic potash must never be employed upon the mucous membranes, 
 or only with the utmost care, since its action spreads rapidly and 
 indefinitely over moist surfaces. In operating near the orifices of the 
 body great precaution must be observed to prevent the liquefied caustic 
 potash producing irremediable destruction. 
 
 Diseases of the Ear, Nose, and Throat. Caustic potash has been 
 employed to destroy AURAL POLYPI, but such use of this powerful agent 
 cannot be free from danger. Fortunately, we have many other means by 
 which we can successfully destroy these outgrowths. If, in the judgment of 
 the physician, it is necessary to apply caustic potash, it is well to remem- 
 ber Clark's injunction, that a layer of cotton moistened with acetic acid 
 lay along the walls of the meatus; the object of this is to neutralize the 
 excess of alkali. Caustic potash has also been used by Michel, of 
 Cologne, in treating spots of degeneration in OZ^ENA. He also employs it 
 in SYPHILITIC ULCERATIONS OF THE PHARYNX. He does not mention 
 details, but it would appear to be a difficult agent to manage, either in 
 the nose or the pharynx. 
 
 LIQUOR POTASS^E. Solution of Potassa. Solution of Caustic Potash. 
 " An aqueous solution of hydrate of potassium, containing about five per cent, of the 
 hydrate. A clear, colorless liquid, odorless, but having a very acrid and caustic taste 
 and a strongly alkaline reaction. Specific gravity about 1.036." (U. S. P.) 
 
 General Surgery. In INGROWING TOE-NAIL Norton has found ad- 
 vantage in the application of dilute liquor potassse (two drachms in one 
 ounce of water). A pledget of absorbent cotton is saturated with the 
 solution and gently pressed between the upper surface of the nail and the 
 soft tissues. The superficial cells are softened, and can easily be wiped 
 away, and in a short time the nail can be scraped without causing pain. 
 
 Diseases of the Skin. Solution of caustic potassa of various 
 strengths is employed in the treatment of skin diseases, chiefly for the 
 purpose of softening and dissolving the horny epithelium, or as a prepa- 
 ration for the action of other remedies. 
 
 In ECZEMA of the external meatus a solution of ten grains to the
 
 POTASSA CUM CALCE. 
 
 373 
 
 ounce is lightly brushed over the surface and washed off as a pre- 
 liminary to the employment of an ointment. A similar application is 
 sometimes made to the edges of the eyelids when eczematous. 
 
 In CHRONIC ECZEMA, especially when occurring in circumscribed 
 patches, a solution of ten to sixty grains of caustic potassa to the ounce 
 of water, well-rubbed in and then washed quickly off, to be followed by 
 a soothing ointment, often hastens the cure. 
 
 Bulkley's "Liquor Picis Alkalinus" (see Pix), composed of two 
 drachms caustic potassa, one drachm tar, and five drachms water, is an 
 admirable preparation. It should be diluted with five to twenty parts 
 of water before using. 
 
 Diseases of the Ear and Throat. In the proportion of one 
 part to ten of water, liquor potassa is useful in softening IMPACTED CE- 
 RUMEN. For all purposes, when an alkaline solution is needed about 
 the ear, Von Troeltsch employs four to forty drops of liquor potassae to 
 an ounce of water. In one part to four of water, it is recommended by 
 M. Mackenzie for DIPHTHERIA. 
 
 POTASSA CUM CALCE. Potash with Lime. Vienna Caustic. 
 
 Vienna Paste. 
 
 It is made by rubbing together equal parts of potassa and lime. Vienna paste is 
 more easily manipulated, but is weaker than caustic potassa. 
 
 General Surgery. Vienna caustic is usually made into a paste with 
 alcohol, spread on plaster, and placed over the selected part. M. Piedag- 
 nel states that the action may be rendered nearly painless by the addition 
 of one 'part of morphine to three parts of the powder ; he adds chloroform 
 to form a paste. In a short time the skin becomes a dull white color, and 
 at the end of fifteen minutes it is carbonized. If the paste is retained, the 
 slough formed will be about as thick as the layer of caustic employed. 
 Vienna paste is often resorted to for the destruction of CARCINOMA. A 
 clean surface is formed, which heals rapidly. Nevertheless, caustics are to 
 be recommended only in cases of extension of superficial ulceration, or in 
 instances where, for special reasons, excision is contraindicated. Vienna 
 paste has been a favorite caustic for the treatment of VARIX with many 
 surgeons. The method of applying the agent is to take several narrow 
 pieces of adhesive plaster, in which a number of small holes are cut. 
 These are applied, at short distances apart, over the course of the veins ; 
 the holes are filled with the paste and covered with a second piece of 
 plaster, which must be entire. Filhos has introduced the paste, moulded 
 into crayons, thus rendering them more manageable, as they can be coated 
 with melted gutta-percha. Vienna paste is to be preferred for cauterizing 
 the neck of the uterus.
 
 374 LOCAL THERAPEUTICS. 
 
 Diseases of the Skin. This preparation is rarely employed in 
 America as a dermatological application. It is, however, sometimes used 
 to destroy EPITHELIOMATA and other MORBID GROWTHS. 
 
 Diseases of the Ear. Toynbee recommends Vienna paste for the 
 destruction of AURAL POLYPI. It appears to be, in this connection, a 
 more painful application than the Soda cum calce. 
 
 POTASS A SULPHUR ATA. Sulphurated Potassa. Sulphide of Potas- 
 sium. Potassii Sulphuretum. (U. S. P., 1870.) Sulphuret 
 
 of Potassium. Liver of Sulphur. 
 
 Sulphurated potassa has " a faint, disagreeable odor, a bitter, alkaline, repulsive taste, 
 and an alkaline reaction ; it is soluble in about two parts of water at 15 C. (59 F.), with 
 the exception of a small residue; it is soluble in alcohol, the latter leaving undissolved 
 the accompanying impurities." (U. S. P.) "The aqueous solution is an orange- yellow 
 color, and exhales the odor of hydrosulphuric acid." (U. S. D.) 
 
 Sulphuret of potassium is parasiticide, and is an antidote to the salts of 
 lead. 
 
 General Surgery. This salt is employed with benefit in the treat- 
 ment of CHRONIC LEAD POISONING. A bath at the temperature of 100, 
 in which the drug is dissolved (in the proportion of from fifteen to thirty 
 grains to the gallon of water) is recommended. If possible, the bath 
 must be administered in a porcelain-lined tub. The patient is immersed 
 half an hour. The bath may be repeated every second or third day. 
 After immersion, the body is thoroughly washed with warm soapsuds. 
 
 Diseases of the Skin. Sulphurated potassa is chiefly employed in 
 the form of a lotion (fifteen to thirty grains to the fluid ounce), bath (two 
 to four ounces to thirty gallons), and ointment (half a drachm to the ounce 
 of lard). It has been employed in the treatment of SCABIES and the other 
 ANIMAL and VEGETABLE PARASITIC SKIN DISEASES. 
 
 POTASSII BROMIDUM. Bromide of Potassium. 
 
 Bromide of potassium is " odorless, having a pungent, saline taste, and a neutral 
 reaction." (U. S. P.) 
 
 Bromide of potassium is sedative, detergent, and antispasmodic. 
 
 General Surgery. J. W. Blight (Practitioner, February, 1874) 
 speaks highly of an injection of bromide of potassium in the treatment of 
 GONORRHOEA : B. Potass, bromid., gij ; glycerini, fgss : aquae, fvj ; 
 a syringeful every four hours. In painful HEMORRHOIDS Ferrand found 
 immediate relief afforded by compresses saturated with bromide of potas- 
 sium four parts, glycerin twenty parts. In fine powder it has been dusted 
 over INDOLENT ULCERS with asserted benefit.
 
 POTASSII BICHROMAS POTASSII CHLORAS. 375 
 
 Diseases of the Throat. Bromide of potassium is an admirable seda- 
 tive to the throat ; it prepares the pharynx for examination and relieves 
 the sense of weariness arising from excessive COUGHING ; a strength of 
 from ten to twenty grains to the ounce of water suffices. The solution 
 may be also employed directly upon the vocal cords. Bromide of potas- 
 sium is associated with chlorate of potassium as a gargle or inhalant in 
 PHARYNGITIS. J. McNeal, of Gettysburg, Pa. (Phila. Med. Times, May 
 21, 1881), recommends the following as an inhalant in DIPHTHERIA : To 
 one pint of water add one drachm of potassium bromide, two drachms of 
 potassium chlorate, and twenty grains of carbolic acid. 
 
 POTASSII BICHROMAS. Bichromate of Potassium. 
 This compound of chromic acid and potassium occurs in " large, orange-red, trans- 
 parent, four-sided, tabular prisms, permanent in the air, odorless, having a bitter, dis- 
 agreeable, metallic taste, and an acid reaction. Soluble in ten parts of water at 15 C. 
 (59 F.), and in 1.5 parts of boiling water; insoluble in alcohol." (U. S. P.) 
 
 Diseases of the Throat, etc. A gargle of one-eighth of a grain 
 of the salt to an ounce of water is sometimes effective in the SUBACUTE 
 PHARYNGITIS of puberty. 
 
 POTASSII CARBONAS. Carbonate of Potassium. 
 
 This salt was formerly exclusively prepared by lixiviating wood ashes. At present, in 
 addition to the above source, a considerable quantity is made from the sulphate and 
 chloride of potassium found at Stassfurt, Germany. 
 
 Potassium carbonate occurs as " a white, crystalline or granular powder, very deliques- 
 cent, odorless, having a strongly alkaline taste and an alkaline reaction. Soluble in one 
 part of water at 15 C. (59 F.), and in 0.7 part of boiling water; insoluble in alcohol. 
 The aqueous solution strongly effervesces on the addition of acid." (U. S. P.) 
 
 Carbonate of potash is antipruritic and antacid. 
 
 Diseases of the Skin. Carbonate of potassium is employed as an 
 alkaline lotion, two or three drachms to the pint of water, or as an oint- 
 ment, ten grains to a drachm in an ounce of lard. 
 
 In baths, ten to sixteen ounces may be dissolved in thirty gallons of 
 water. The carbonate of potassium preparations are used in ECZEMA, 
 DERMATITIS, PSORIASIS, URTICARIA, and other pruriginous diseases. 
 
 POTASSII CHLORAS. Chlorate of Potassium. Chlorate of Potash. 
 Chlorate of potassium exhibits " colorless, monoclinic prisms or plates of a pearly 
 lustre, permanent in the air, odorless, having a cooling, saline taste and a neutral reac- 
 tion ; soluble only in sixteen and five-tenths part of water at 15 C. (59 F.) (thirty grains 
 to the ounce of water) and hi two parts of boiling water; only slightly soluble in 
 alcohol." (U. S. P.) The only official preparation is the trochisci potassii chloratis,
 
 3?6 LOCAL THERAPEUTICS. 
 
 each of which contains five grains. Chlorate of potassium should not be mixed in the 
 dry state with organic substances, sulphur, or ammonium chloride, as explosions frequently 
 result. 
 
 Chlorate of potash is detergent. It is said by M. Mackenzie to be 
 antiseptic and by Lefferts to be astringent and stimulant. When applied 
 in crystals or saturated solution to mucous membranes and ulcerated sur- 
 faces, it is irritant. 
 
 Chlorate of potash mollifies the unpleasant impression excited by some 
 drugs, such as creolin, creasote, resorcin, etc. It also lessens the effect 
 of astringency on gustatory surfaces. Hence it is often employed as an 
 adjuvant. 
 
 General Surgery. Various attempts have been made to use solution 
 of chlorate of potash in the treatment of FOUL and INDOLENT ULCERS, 
 but with slight success. In phagedenic conditions the drug is often 
 dusted on the affected parts twice daily. Relief is afforded in cases of 
 HEMORRHOIDS by gently injecting into the rectum half an ounce of a 
 saturated solution, to which fifteen drops of laudanum are added. 
 
 Diseases of the Skin. A solution has been employed as a local 
 application in MOIST ECZEMA and FOUL ULCERS. 
 
 A saturated solution of chlorate of potassium in water (thirty grains to 
 the ounce) has sometimes been employed successfully in the treatment of 
 EPITHELIOMA, and the powdered salt has also been used, but this remedy 
 has not found general favor. 
 
 Diseases of the Nose and Throat. Chlorate of potash is often 
 substituted for borax in D-obeir s solution. As a pure lotion it may 'be 
 ordered in the proportion of twenty grains to the ounce of water in 
 ACUTE CORYZA. Michel, of Cologne, employs it in OZ^ENA. It has an 
 important position in the local treatment of DIPHTHERIA, and is usually 
 stated, but upon insufficient grounds, to be a solvent of the membrane. 
 Chlorate of potash is extensively employed in various AFFECTIONS OF THE 
 MOUTH, and is of special value in simple and mercurial salivation and 
 in APHTHOUS ULCERATION. It is especially useful in morbid states of 
 the gum dependent on carious teeth. It may be employed freely in 
 a saturated solution, to which a little tincture of myrrh is added. 
 The same strength solution is used in the pharynx and larynx as in the 
 nose. The mixture is placed in a six-ounce vial, which, while the nas- 
 cent chlorine is being generated, is filled with water. An ounce of the 
 mixture is to be used as a gargle every three hours. J. Merces (Lancet, 
 October 30, 1886) recommends that a drachm of chlorate of potash be 
 mixed with a half drachm of hydrochloric acid for the treatment of 
 DIPHTHERIA. Chlorate of potassium is employed in affections of the 
 oral cavity, in the form of five-grain tablets, of which several daily 
 may be allowed, one after another, to slowly dissolve in the mouth.
 
 POTASSII CITRAS POTASSII CYANIDUM. 377 
 
 As a preventive of Mucous PATCHES, the remedy may be employed 
 in this way in the earlier months of SYPHILIS and to prevent MERCU- 
 RIAL STOMATITIS. A solution of twenty grains to the ounce of water 
 may be used as a gargle with the same object in view. In STOMATITIS, 
 mercurial or otherwise, in HERPES OF THE BUCCAL CAVITY, and in 
 SYPHILITIC Mucous PATCHES chlorate of potash forms an excellent 
 application. Two drachms of the drug to eight ounces of water makes 
 it efficient in ACUTE ANGINA. It may be combined with tannicacid* 
 (see p. 62) or alum. Chlorate of potash is in good repute in the 
 treatment of PHARYNGITIS. However, it cannot be employed for a 
 long period, owing to the circumstance that the influence on the system 
 is depressing. In the treatment of CHRONIC PHARYNGITIS, therefore, 
 it has been generally abandoned. (Thos. F. Rumboldt, Sf. Louis 
 Archives, December, 1873.) ^ n CHRONIC LARYNGITIS a spray of five to 
 twenty grains to the ounce of water is useful. It is a favorite ingredient 
 of a lozenge in excited states of the throat. From two to five grains 
 are contained in each mass. 
 
 POTASSII CITRAS. Citrate of Potassium. Citrate of Potash. 
 
 " A white, granular powder, deliquescent on exposure to air, odorless, having a 
 slightly cooling, alkaline taste and a neutral or faintly alkaline reaction. Soluble in 0.6 
 part of water at 15 C. (59 F.) and very soluble in boiling water; very slightly soluble 
 in alcohol." (U. S. P.) 
 
 Diseases of the Mouth. Citrate of potash is detergent and 
 sialogogue ; it is often prescribed in the form of a lozenge, three grains 
 in each mass. 
 
 POTASSII CYANIDUM. Cyanide of Potassium. Cyanide of Potash. 
 
 " White, opaque amorphous pieces, or a white, granular powder, deliquescent in 
 damp air, odorless when perfectly dry, but generally of a peculiar, characteristic odor, 
 having a sharp, somewhat alkaline and bitter almond taste and a strongly alkaline reac- 
 tion. The commercial salt is soluble in two parts of water at 15 C. (59 F.) and in 
 one part of boiling water. It is but sparingly soluble in alcohol." (U. S. P.) 
 
 Cyanide of potassium is sedative and antipruritic. It removes stains 
 of nitrate of silver from the skin. Owing to its highly poisonous char- 
 acter, it must be used with caution. 
 
 * In associating chlorate of potassium with tannic acid care must be observed that it is 
 done only in solution. If the dry powders are mixed, explosions will occur on the 
 slightest provocation.
 
 378 LOCAL THERAPEUTICS. 
 
 Diseases of the Skin. The virtues of CYANIDE OF POTASSIUM are 
 dependent upon the hydrocyanic acid it contains. (See Acidum Hydro- 
 cyanicum.") The salt is employed as a lotion, dissolved in water, in the 
 strength of two grains to the ounce in PRURITUS VULVJE. An ointment 
 of cyanide of potassium, six grains, with one grain of cochineal as a 
 tincture to an ounce of cold cream, is sometimes applied for the relief of 
 PRURITUS and URTICARIA. This preparation should be kept in the dark 
 and used cautiously upon broken skin. 
 
 POTASSII IODIDUM. Iodide of Potassium. Iodide of Potash. 
 
 The crystals of iodide of potassium are "colorless, translucent, cubical, slightly deli- 
 quescent, having a peculiar, faint odor, a pungent, saline, and afterward somewhat bitter 
 taste, and a neutral reaction. Soluble in 0.8 part of water and in eighteen parts of alco- 
 hol, at 15 C. (59 F.); in 0.5 part of boiling water and in six parts of boiling alcohol." 
 (U. S. P.) The ointment (Unguentum Potassii lodidi), containing twelve parts of 
 iodide of potassium in one hundred parts of ointment, is official. 
 
 Iodide of potassium is absorbent and alterative. 
 
 General Surgery. Iodide of potassium is employed but little as a 
 local application in surgery. We have obtained satisfactory results at the 
 Episcopal Hospital from an ointment composed of three parts of iodide 
 of potassium to the ounce of lanolin, as a substitute for iodide ointment in 
 the treatment of INGUINAL ADENITIS, combined with pressure of three to 
 four pounds from a bag of shot placed over the groin, which had been 
 previously covered with the ointment spread on lint the whole retained 
 by a spica bandage. The time required to accomplish resolution has 
 been shorter than that required by other modes of treatment. In the stiffen- 
 ing following injuries about the articulations, so common in rheumatic 
 persons, the ointment has been found useful when rubbed thoroughly 
 into the affected part twice daily. Its action may be enhanced by soaking 
 the limb in hot soapsuds for half an hour, and on its removal from the 
 bath rubbing it with the ointment. 
 
 Diseases of the Ear and Throat. The local applications of 
 iodide of potassium in the respiratory tract are few in number. A solu- 
 tion of two to ten grains to the ounce has been used for injection through 
 a catheter in thickening of the lining membrane of the Eustachian tube. 
 
 V. Gautier (Soc. Med. de Geneve also Rev, Med. de la Suisse, Rom., 
 March 20, 1888) reports two cases in which local applications of iodide 
 of potassium to a cyst of the thyroid region induced chronic iodism. A 
 spray of five grains to the ounce of water has been employed in CHRONIC 
 LARYNGITIS with diminished secretion.
 
 POTASSII NITRAS POTASSII PERMANGANAS. 
 
 379 
 
 POTASSII NITRAS. Nitrate of Potassium. Saltpetre. 
 
 Nitrate of potassium is " colorless, transparent, six-sided, rhombic prisms, or a crys- 
 talline powder, permanent in the air, odorless, having a cooling, saline, and pungent 
 taste, and a neutral reaction. Soluble in four parts of water at 15 C. (59 F.) and in 
 0.4 part of boiling water ; almost insoluble in alcohol." (U. S. P.) 
 
 The " Charta Potassii Nitratis " (nitrate of potassium paper) is official. It is pre- 
 pared from white, unsized paper dipped in a solution of twenty parts of nitrate of potassium, 
 and eighty parts of water and dried. 
 
 Diseases of the Throat, etc. Nitrate of potassium in the propor- 
 tion of one drachm to the pint of water is a useful ingredient in a gargle 
 in the late stage of PHARYNGITIS. This agent enjoys a high reputa- 
 tion for relaxing the paroxysms of ASTHMA, especially where they are 
 dependent upon excited conditions of the nasal mucous membrane. It is 
 ordinarily employed by inhaling the fumes from burning paper which has 
 been previously saturated in a strong solution of the salt. Nitrate of potas- 
 sium is often administered in the presence of the fumes of stramonium. 
 S. Ringer and W. Murrell {British Medical Journal, June 6 and June 
 23, 1888) recommend ordinary blotting paper for this purpose; it should 
 consist of six thick layers which have been dried after being steeped in a 
 saturated solution of nitrate of potassium and chlorate of potassium. The 
 paper may be sprinkled with compound tincture of benzoin, tincture of 
 sumbul or essence of camphor, oil of cassia, or oil of cinnamon. Ac- 
 cording to M. Mackenzie, nitrate of potassium is conveniently exhibited 
 in solution. The No. i solution of this writer is composed of thirty 
 grains to the ounce of water, the No. 2 is forty-five grains to the ounce, 
 and the No. 3 is sixty grains to the ounce. 
 
 POTASSII PERMANGANAS. Permanganate of Potassium. 
 
 " Deep, purple-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 exception of a scanty, brown residue, in 
 twenty parts of water, at 15 C. (59 F.) and in three parts of boiling water. It is de- 
 composed by alcohol." (U. S. P.) 
 
 For convenience in hospital practice a saturated solution (twenty-four grains to 'the 
 ounce) is kept on hand. A solution of permanganate of potassium constitutes Candy's 
 Fluid. 
 
 Permanganate of potassium is antiseptic, deodorant, and detergent, 
 Permanganate of potassium in substance, or strong solution, acts as a 
 stimulant or mild escharotic ; but when well diluted it causes neither pain 
 nor irritation. It readily parts with its oxygen, hence it is valuable as a 
 deodorant. According to Demarquay, it possesses little or no power in 
 arresting the putrefactive process, but when thrown in contact with decam-
 
 380 LOCAL THERAPEUTICS. 
 
 posing substances it has the power of seizing upon the products and com- 
 bining with them or oxidizing them. According to Sternberg, it is evident 
 that the permanganate of potassium has antiseptic and germicidal prop- 
 erties ; in this. connection, however, it is seldom used. 
 
 General Surgery. Solutions of the permanganate of potassium have 
 long been regarded as one of the best detergent and deodorizing washes in 
 all foul, gangrenous, and ill-conditioned ulcerations. For general purposes 
 a half drachm to a drachm of a saturated solution may be added to a quart 
 of tepid water. The solution should be distinctly purple, yet permit a 
 silver coin to be seen at a depth of two inches. In special cases stronger 
 solutions, namely, ten grains to the ounce of water, may be employed. 
 The introduction of corrosive sublimate has led to the less frequent em- 
 ployment of permanganate of potassium. Yet, owing to its non-toxic pro- 
 perties, it will always hold a distinctive place in local therapeutics. It is 
 a most valuable agent in solution to correct the fetor in the buccal cavity 
 following fracture of the jaw, and after amputations of the tongue. The * 
 foul discharges of cancer, especially of the uterus and vagina, are cor- 
 rected by the permanganate of potassium. Hot solutions, of the strength 
 of two drachms to the pint of water, will be found of service. S. Weir 
 Mitchell recommends the permanganate of potassium as an antidote to the 
 venom of serpents. 
 
 Diseases of the Skin. Permanganate of potassium is used in solu- 
 tions of fifteen to sixty grains to the pint of water as a dressing for FOUL 
 ULCERS and in a weak solution as an application in BROMIDROSIS. 
 
 Diseases of the Ear, Nose, etc. Permanganate of potassium is 
 prescribed, ordinarily, in a strength varying from one to five grains to the 
 ounce of water. One grain to the ounce is used as a disinfectant in 
 DISCHARGES FROM THE MIDDLE EAR ; four grains to the ounce in NASO- 
 PHARYNGEAL CATARRH ; five grains to the ounce for FCETID CATARRH and 
 FOUL BREATH. Three grains to the ounce is used as a gargle in CANCER 
 OF THE TONGUE, DIPHTHERIA, and in PUTRID SORE THROAT, as well as a 
 spray in CHRONIC LARYNGITIS, with excess of secretion. Hill and Cooper 
 speak highly of this agent in SYPHILITIC ULCERS of the mouth and 
 throat. 
 
 POTASSII TARTRAS. Tartrate of Potassium. Tartrate of Potash. 
 " Small, transparent, white, monoclinic crystals, or a white powder, somewhat deliques- 
 cent, odorless, having a saline, slightly bitter taste, and a neutral reaction. Soluble in 
 0.7 part of water at 15 C. (59 F.) and in 0.5 part of boiling water; almost insoluble in 
 alcohol." (U. S. P.) 
 
 Diseases of the Throat, etc. Tartrate of potash is a sialogogue. 
 It is an agreeable ingredient to a lozenge each mass containing three 
 grains.
 
 PULSATILLA PUMEX PYOKTANIN. 
 
 PULSATILLA. 
 
 " The herb of Anemone Puhatilla and A. pratensis, Linn., and of A. patens, Linn. var. 
 Nuttalliana, Gray." (U. S. P.) 
 
 Pulsatilla has long had a doubtful position as an internal remedy for 
 perverted functions of the mucous membranes. 
 
 Diseases of the Nose, etc. Potter mentions, without critical com- 
 ment, its use in the form of a weak, warm infusion in ACUTE NASAL 
 CATARRH, accompanied with muco-purulent discharge. 
 
 PUMEX. Pumice. Pumice Stone. 
 Pumice is a felspathic volcanic scoria. 
 
 When the hands are kept for a long time in contact with carbolized 
 solutions, the epidermis becomes roughened and forms a nidus for the 
 collection of foreign matter, which cannot be removed with an ordinary 
 nail-brush. In this condition pumice will be found valuable for thorough 
 cleansing, so necessary before all antiseptic procedures. 
 
 Diseases of the Skin. Pumice powder enters into the composition 
 of soaps, which are employed in the treatment of sluggish ACNE and 
 COMEDO. 
 
 PYOKTANIN. Pyoctanin. Methyl-violet.* 
 
 Pyoktanin is a derivative of a diphenylamine compound. It is one of the aniline 
 colors. 
 
 Pyoktanin ordinarily comes in the form of a powder, though crayons of various shapes 
 and sizes are procurable. A broad, cone-shaped crayon protected by a wooden-box cov- 
 ering, as well as a narrow, pencil-like form, may be mentioned in this connection. 
 " Pyoktanin crayons may be mended by simply wetting the severed surfaces with water 
 and pressing them together gently; when dry they will cohere." (M. B., January, 1891, 
 p. 14.) Solutions should not be more than four days' old, and should be kept in colored 
 glass bottles. 
 
 Pyoktanin is antiseptic and moderately analgesic. It possesses the 
 advantage over many germicides of not coagulating albumin ; on th*e 
 other hand, it stains the skin. For removal of the discoloration one 
 may use spiritus saponatus or a ten per cent, solution of castile soap in 
 alcohol (or even common soap washing the parts afterward with alcohol), 
 or Labarraque's solution (M. B. [/. ^.] ). Riesmeyer (Sf. Louis Courier 
 of Medicine, November, 1890) claims that pyoktanin exerts a favorable 
 
 * " Yellow pyoktanin " is a substance belonging to the group of aniline dyes, known 
 as auramines. Its properties are reported to be similar to those of methyl-violet, but it is 
 less frequently used in practice than the agent last named.
 
 382 LOCAL THERAPEUTICS. 
 
 influence over wounds healing by granulation ; especially is the tendency 
 to exuberant pullulations held in check, while no necrotic effect is ex- 
 hibited on the nascent epithelial cells. 
 
 General Surgery. Pyoktanin was introduced by Stilling, who 
 believed the drug to be capable of penetrating tissue and acting upon 
 deeply-seated micro-organisms. That the dye is absorbed by the micro- 
 organisms has been demonstrated. Fessler found that the germs were 
 destroyed in fifteen minutes by exposure to a solution of i-iooo. It 
 has been claimed that it sterilizes the pus of suppurating wounds and 
 abscesses. However, it is not so active a germicide as is corrosive subli- 
 mate or carbolic acid. Being practically non-poisonous, pyoktanin offers 
 a valuable means for the cleansing of large suppurating cavities, such as 
 those of EMPYEMA, where the employment of more potent agents is liable 
 to be followed by toxic symptoms. For this purpose it may be employed 
 in strength of i-iooo or 1-2000. If used for the disinfection of instru- 
 ments a much weaker solution may be used. When employed for the irri- 
 gation of wounds it should be applied until the tissues are of a deep color. 
 Good results are said to have followed the injection of a weak solution in 
 GONORRHCEA. Mosetig-Moorhof (Wien med. Presse, 1891, No. 6) 
 reports encouraging results from the use of pyoktanin in dissipating 
 SARCOMA and CARCINOMA. Nance commends the drug for parenchyma- 
 tous injections of a one per cent, solution. 
 
 Diseases of the Skin. Von Sehlen has succeeded in curing a 
 severe case of EPITHELIOMA by means of pyoktanin applied in substance. 
 The application was at first quite painful, so that applications of cocaine 
 and antipyrine had to be employed. 
 
 Galezowski has used pyoktanin in a one per cent, solution in water in 
 the treatment of EPITHELIOMA OF THE EYELID. 
 
 Pyoktanin completely arrests the development of the Staphylococcus 
 areus, and is therefore likely to be a good topical application in FURUN- 
 CLE, COCCOGENIC SYCOSIS, and other parasitic skin diseases. 
 
 Pyoktanin has come into general use in veterinary medicine in the 
 treatment of foot and mouth disease. 
 
 "Diseases of the Ear, Nose, and Throat. The properties of 
 pyoktanin make it available in the treatment of suppurative conditions 
 of the middle ear. The many admirable agents already accredited have 
 caused pyoktanin to be used less than its merits warrant. The highly 
 diffusible character of its solutions might render their presence in the 
 outer ear passage objectionable. R. Barclay (St. Louis Courier of Medi- 
 cine, 1890, III, 216) uses pyoktanin (i-iooo), for ten minutes or more, 
 by instillation in the external meatus for the suppurative stage of OTITJS 
 MEDIA. The author reports eight cases. In an average of eleven days' 
 treatment marked amelioration or cure resulted in all. Bresgen (Deutsche
 
 PYOKTANIN. 283 
 
 med. Wochensch., 1890, No. 24) claims value for pyoktanin in over- 
 coming hypersesthesia of the nasal mucous membrane. The writer also 
 recommends that solutions be used after galvano-cautery applications. 
 
 Pyoktanin is of special value in the treatment of EMPYEMA OF THE 
 FRONTAL SINUS and of the ANTERIOR ETHMOID CELLS. A ten per 
 cent, solution can be thrown into the sinus, or, as recommended by 
 Cholewa {Therap. Monatshefte , 1891, p. 189), it is carried in substance 
 by a delicate silver probe, armed with the pyoktanin, directly into the 
 sinus. Favorable results are reported. A strength of solution similar to 
 the above is used by R. P. Lincoln {N. Y. Med. Jour., October 31, 1891) 
 in NASAL DIPHTHERIA with success after all other remedies had failed. 
 Forty-eight hours after the first application all trace of the membrane 
 had disappeared. The same writer found satisfactory results follow its use 
 in OZ^ENA, both in syphilitic and non-syphilitic forms. 
 
 In the pharynx the indications for its exhibition are found in ULCERA- 
 TION, PURULENT DISCHARGES, DIPHTHERIA, and APHTHAE. A fifty per 
 cent, solution may be applied to the recesses of the tonsil ; it destroys the 
 micro-organisms there lodged and relieves the irritability of the parts. 
 Jgenicke uses a saturated solution of pyoktanin in DIPHTHERIA. The 
 preparation is gently rubbed upon the infected surfaces once every two or 
 three hours. It possesses an advantage over other antiseptics in clinging 
 to the exudate for a long time. Capart {Jour, of Laryngology and Rhi 
 nologia, August, 1891, p. 343) claims that TUBERCULAR ULCERATION OF 
 THE SOFT PALATE was healed by local application of pyoktanin. J. 
 Schleinmann (Berl. klin. Wochenschr., August 18, 1890, No. 33) and 
 Bresgen {Deutsche med. Wochenschr., No. 4, 1890) heat probes dipped 
 in the powder and rub them on the ulcers of LARYNGEAL PHTHISIS ; it 
 promotes cicatrization. 
 
 Diseases of the Eye. Stilling {Revue General d ' Ophthalmol. , 
 1890, No. 4 and No. 6) makes strong claims for the aniline colors, as 
 antiseptics, in ophthalmic surgery. He considers them superior to all 
 other antiseptics, on the ground that they are unirritating and harmless, 
 that they are more diffusible, and that they do not form precipitates 
 with pus. He claims that they not only prevent suppuration, but check 
 it when established by permeating the tissues in which it has taken place. 
 He prefers the methyl-violet, and uses it in solution of one to one 
 thousand, and in some cases much stronger. He claims astonishing 
 results from its use, especially in SLOUGHING KERATITIS, and recommends 
 it in PURULENT CONJUNCTIVITIS, CORNEAL ULCERS, PARENCHYMATOUS 
 KERATITIS, SEROUS IRITIS, DISSEMINATE CHOROIDITIS, and SYMPATHETIC 
 OPHTHALMIA. Most other observers have been much less enthusiastic. 
 Some have maintained that it is a weak antiseptic and practically useless, 
 and others that it is not so unirritating as he claims, and that it some-
 
 384 LOCAL THERAPEUTICS. 
 
 times does harm. Extensive testing in Graefe's clinic {Arch. Ophthal., 
 January, 1891, page 143) gave unfavorable results. Wanscher (Thera- 
 peutisehe Monatshefte, February, 1891, Phila. Mcd. News, April 25, 1891) 
 confirms Stilling's claims as to the pus-killing properties of pyoktanin, 
 and considers it one of our most valuable remedies in PURULENT OPH- 
 THALMIA, but is doubtful of its efficacy in IRITIS and CHOROIDITIS. He 
 uses a one per cent, solution of methyl violet, and insists upon the im- 
 portance of frequent applications, instilling it every two or three hours 
 until the tissues are thoroughly stained. There is no permanent staining ; 
 the color disappears quickly. 
 
 The valuable property of diffusibility is generally conceded to pyok- 
 tanin, and, if experience should establish its antiseptic qualities, will make 
 it a useful addition to our list of external remedies, particularly for appli- 
 cation to regions difficult of access, such as the lachrymal passages. 
 
 PYRETHRUM. Pyrethrum. Pellitory. 
 
 " The root of Anacydus pyrethrum." (U. S. P.) It contains an acrid resin, an acrid 
 fixed oil, a proportion of tannin, gum, etc. The official preparation is the tincture, which 
 contains the activity of twenty parts of pyrethrum in one hundred parts of the tincture. 
 
 Pyrethrum is sialagogue and stimulant. 
 
 Diseases of the Mouth, etc. Pyrethrum is sometimes employed 
 for the relief of TOOTHACHE, either by chewing a piece of the root, or by 
 applying a small pledget of cotton saturated with the tincture into the 
 cavity of a carious tooth. For RELAXATION OF THE UVULA pyrethrum 
 has long had a reputation in domestic medicine. A small quantity of 
 the root can be chewed. In CHRONIC LARYNGITIS, with diminished 
 secretion, ten minims of the tincture can be added to an ounce of water 
 and sprayed upon the vocal cords. Lozenges of pyrethrum contain one 
 grain of the root in each mass. 
 
 PYRIDINE. 
 
 Pyridine is a liquid, with a peculiar, strong odor, and is obtained from many sources, 
 among them bone oil, coal tar, and tobacco. It is used by inhalation, and being volatile, 
 the air of a room, at a temperature of 68 to 77 F., may be quickly impregnated with its 
 vapor by placing a small quantity of it on a hot plate. 
 
 Diseases of the Throat, etc. Pyridine is employed by S6e as an 
 inhalation to relieve the paroxysms of ASTHMA in children. (Quoted in 
 Med. and Surg. Reporter, March 21, 1891.) One or two teaspoonfuls 
 may be placed on a plate and the fumes inhaled, holding the face closely 
 over it for twenty to thirty minutes.
 
 QUERCUS ALBA QU1LLAIA QUININA. 385 
 
 QUERCUS ALBA. White Oak. 
 
 " The bark of Qnercus alba." (U. S. P.) White oak bark is used in medicine for the 
 large proportion of tannin which it contains. The bark of all the other oaks likewise 
 contains much tannin, but Q. alba is the official species. (See Acidum Tannicum.) 
 
 Diseases of the Skin. Infusion of white oak bark is used as an 
 astringent in several diseases of the skin. In DERMATITIS VENENATA it 
 forms a useful application. In PURPURA also the infusion is often used 
 locally. Its action in this affection is not deep enough to be available. 
 In flabby and ill-conditioned ULCERS the decoction of oak bark has been 
 used with advantage. 
 
 QUILLAIA. Quillaia. Soap Bark. 
 
 " The bark of Quillaia saponaria." (U. S. P.) Soap bark contains a peculiar princi- 
 ple known as saponin, which, when shaken with water, has the quality of making the 
 water milky and frothy, as does soap. Saponin is soluble in water, weak alcohol, but 
 insoluble in volatile oils, and ether. 
 
 Diseases of the Skin. The tincture of Quillaia saponaria is em- 
 ployed to cleanse the scalp in PITYRIASIS before the application of the 
 more strictly medicinal agents. It is considered by some authorities 
 superior to soap for this purpose. 
 
 Diseases of the Nose and Mouth. Soap bark infusion may be 
 added to mouth washes and gargles to impart to them a lather-like appear- 
 ance. The active principle, saponin is employed in solution by Valen- 
 tin {CorrespondenzblattfurschweizerAerzte, No. 5, 1887) in the treatment 
 of CHRONIC NASAL CATARRH if the secretion is deficient. The powdered 
 bark has been used as a snuff, but the practice cannot be recommended. 
 
 QUININA. Quinine. 
 
 Quinina is " an alkaloid prepared from different species of cinchona." (U. S. P.) The 
 uncombined alkaloid is rarely used in medicine. The salts most commonly employed 
 are the sulphate, which requires for its solution seven hundred and forty parts of water ; 
 the bisulphate, soluble in about ten parts of water ; the hydrochloride, soluble in th'irty- 
 four parts of water, and the hydrobromide, soluble in about sixteen parts of water. 
 
 Quinina in weak solution is antiseptic, since it is one of the most 
 active agents in arresting movements of protoplasms. It also destroys 
 infusoria. It is, moreover, stimulant, and has some repute in covering the 
 odor of iodoform. 
 
 General Surgery. Ledetsch {Jour, of Cutan. and Genito-Urin. 
 Dis., 1888) has employed quinine solution as an injection in the treat- 
 ment of GONORRHCEA of long standing. He advises the use of the 
 
 25
 
 386 LOCAL THERAPEUTICS. 
 
 following mixture: Quinine bisulph., i part; glycerin, 25 parts; 
 distilled water, 74 parts. 
 
 Diseases of the Skin. The only local use of quinine in derma- 
 tology is in the treatment of ALOPECIA. Quinine hair-washes are fre- 
 quently advertised by apothecaries, with the idea, probably, of imply- 
 ing a local "tonic" effect upon the scalp. That there is, however, 
 some virtue in such preparations would appear from the fact that they 
 are recommended by several dermatologists of repute. The influence 
 of quinine upon the scalp is, however, probably purely stimulant and 
 not specific in any way. It is possible that in parasitic forms of 
 alopecia quinine may act as a parasiticide, but this action has never been 
 proved. 
 
 Bulkley recommends in ALOPECIA: R. Quininse sulphatis, 9j ; zinci 
 sulphatis, gr. x; tinct. cantharidis, f giij ; alcoholis absolut., glycerini, 
 aa f^iv; spiritus myrcise, ad f3vj. M. 
 
 Another formula often employed is: R. Quininse sulphat.,3J; tinct. 
 nucis vomicse, f^ij ; aq. rosae, spiritus myrciae, aa f 3]. M. An ointment 
 of quinine (gj ad 5]) has been employed in DERMATITIS VENENATA. 
 
 Diseases of the Throat, Nose, etc. Quinine at one time, through 
 the recommendation of Helmholtz, enjoyed a reputation as a local remedy 
 in HAY FEVER. Sir Andrew Clark (Lancet, June, 1887) employed a 
 mixture composed of glycerite of carbolic acid, one ounce ; hydrochloride 
 of quinine, one drachm, and one-thousandth part of bichloride of mercury. 
 It has been used as a spray in the treatment of DIPHTHERIA. C. Seiler 
 speaks well of it in the treatment of OZ^ENA. WHOOPING COUGH is 
 treated by Michel {Deutsche med. Wochenschr., 1886) by a powder com- 
 posed of hydrochloride of quinine and benzoin thrown within the nasal 
 passages. An oleate of quinine forms the basis of an inhalant. Gargles 
 of quinine are of old-time repute in the treatment of TONSILLITIS 
 and DIPHTHERIA. Truman applies an ointment of quinine to FUNGOID 
 GRANULATIONS OF THE GUMS and to all PURULENT CONDITIONS OF THE 
 ORAL Mucous MEMBRANES. Tannate of quinine forms the basis of a loz- 
 enge, each lozenge to contain one to two grains in each mass. 
 
 Cinchona bark enters into the composition of many tooth powders. 
 
 RESORCIN. 
 
 When any one of a number of resins, galbanum, sagapenum, asaloetida, ammoniac, 
 etc., are fused with potassium hydrate, an organic body is obtained which is resorcin. 
 It is also obtained in other ways, notably by fusing sodium benzol disulphonale with 
 caustic soda. 
 
 Resorcin is crystalline in structure, soluble in water, glycerin, and (to five per cent.) 
 in olive oil. It is not soluble in chloroform or rhigojene.* 
 
 * J. Andeer (St. Petcrsb. med. Wochenschr., No. 22, 1890).
 
 RESORCIN. 
 
 387 
 
 Resorcin is slightly antiseptic, parasiticide, and analgesic; its action 
 resembles that of cocaine, but it is a much feebler agent. It is even said 
 to be vesicant and caustic. Most of these properties exist rather as indica- 
 tions of the action of the drug than as actual qualities which may be made 
 therapeutically useful. "Weak solutions harden the skin; strong ones 
 macerate and destroy it." (Helbing.) 
 
 "Resorcin, when triturated in equal quantity with antipyrine, forms a 
 honey-like paste." (M. B., August, 1891.) Its solution must be kept in 
 dark bottles. (Ibid., September, 1891.) 
 
 General Surgery. Resorcin is non-irritant to the unbroken skin, 
 and is not injurious to instruments. It is employed in surgical practice 
 as a substitute for carbolic acid, but is inferior to this agent as an 
 antiseptic. 
 
 The drug used should be snow white and colorless in solution. It 
 should be dissolved in distilled water in the proportion of one per cent., 
 and kept well corked in opaque bottles, small quantities only being 
 prepared at a time. A two per cent, solution succeeded in arresting 
 HOSPITAL GANGRENE when other remedies had failed. (Hallopeau, Soc. 
 de Therap., 1892.) 
 
 In the treatment of GONORRHCEAL CYSTITIS, with neutral or alkaline 
 urine, a one per cent, solution of resorcin injected into the bladder relieves 
 promptly. Leblond treats CHANCRE by dusting powdered resorcin on 
 the ulcer each day, continuing the application as long as the base of the 
 sore has a grayish color. Healing begins, as a rule, in five days. A 
 dressing is then applied of a five per cent, solution. Abscess cavities are 
 flushed with the solution named, and afterward dressed with the powder. 
 
 In the treatment of URETHRITIS, Mummich uses an injection of a three 
 per cent, solution of resorcin. After the discharge has diminished, which 
 is usually the case in four or five days, the number of injections is 
 increased to three or four during the day and one at night, but soon the 
 number is gradually diminished until the discharge ceases. It is well to 
 continue the injections for some time after the cessation of the discharge. 
 
 Diseases of the Skin. In its action upon the skin, resorcin belongs 
 to the class of remedies known as " reducing agents," having the prop- 
 erty of that form of chemical action upon the tissues. It is employed as 
 a PARASITICIDE, also in SUBACUTE ECZEMA and CHRONIC ECZEMA in 
 ULCERS,* and for softening HORNY GROWTHS, INFILTRATIONS OF THE SKIN 
 and as a CAUSTIC in EPITHELIOMA. 
 
 Dreckmann (Monatshefte /. prakt. DermatoL, Bd. x, 9, p. 389) uses 
 resorcin in water-dressings. The affected region is covered with absorbent 
 cotton-wool or lint soaked in a weak solution (five to thirty grains to the 
 
 * H. W. Stelwagon. Jour. Cut. and Ven. Dis. t l886,p. 326.
 
 388 LOCAL THERAPEUTICS. 
 
 ounce) of resorcin in water, and over this a covering of impermeable 
 material, as rubber cloth or oil-silk, is fixed. The lint is to be moistened 
 from time to time with the solution. The method has the advantages of 
 the water-dressing combined with the mild action of resorcin. It is 
 especially useful in HORNY ECZEMA OF THE PALM AND SOLE, and has also 
 been found helpful in PRURITUS SENILIS. For CIRCUMSCRIBED MOIST 
 ECZEMA this dressing may also be used with advantage. Occasional 
 inunction with fats will prevent too great maceration. 
 
 Resorcin is occasionally employed either in the form of powder or 
 in strong ointments for the relief of EPITHELIOMA. The ointment 
 should consist at first of equal parts of resorcin and vaseline, and is 
 subsequently weakened. Eschars or sloughs form, which may be removed 
 by applications of an ointment of iodoform and vaseline (3J-j). 
 
 We think, however, that resorcin is by no means sufficiently active to 
 prove a useful remedy in epithelioma. We have other caustics, much 
 more valuable, well known, and long tried, as caustic potassa and the 
 stronger acids. 
 
 We have attempted the relief and the removal of tuberculous warts and 
 ulcers TUBERCULOSIS CUTIS by means of resorcin, but without success. 
 In such cases lactic acid has succeeded where resorcin has failed. (See 
 Acidum Lac ft cum.) 
 
 Caesar Boeck ( Monatshefte f. prakt. DermatoL, 1886, Bd. v, p. 93) 
 recommends resorcin in powder, pure or mixed with sugar or boric acid, 
 as an application in POINTED CONDVLOMATA, particularly of the genitals. 
 A solution in ether and collodion, one drachm to six, may be used, 
 though it is not so efficient as the powder. A solution of twenty to thirty 
 grains of resorcin to the ounce of water is available where the skin is 
 sensitive. As idiosyncrasy cannot be known beforehand the patient must 
 be seen daily at first. 
 
 Similar preparations are employed in the treatment of ULCERS and 
 PHAGEDENIC SORES. 
 
 Diseases of the Ear, Nose, and Throat. In the treatment of 
 CHRONIC SUPPURATION OF THE MIDDLE EAR, one part of powdered re- 
 sorcin is added to eight parts of boric acid and dusted upon the affected 
 surfaces. Pollitzer {Rev. Mens. de Laryng. d' Otol. et de Rhinolog., 
 October 15, 1889) recommends a three per cent, solution for irrigation 
 of the middle ear in INFLAMMATION OF THE ATTIC. C. Burnett employs 
 a small quantity in finely pulverized boric acid as an insufflation to meet 
 the same indications. 
 
 Resorcin is extensively used in the treatment of both ACUTE and 
 CHRONIC NASAL CATARRH. A. B. Thrasher (" Trans. Ninth International 
 Med. Congress," vol. iv, 1887) employs it in the treatment of CHRONIC 
 NASAL CATARRH. It is helpful in the form of a lotion, of strength vary-
 
 RETINOL. 3 8 9 
 
 ing from two to ten per cent. Two grains to the ounce forms the 
 basis of a lotion for PHARYNGITIS. E. L. Shurly (TV. Y. Med. Journal, 
 September n, 1886) uses this agent in various conditions in PHARYN- 
 GITIS and SYPHILITIC ULCERATIONS, as well as in LUPUS. It may be 
 directed in the form of a spray or ointment, one part to four or six. 
 He employs it either in a pure form or in combination with tar water. 
 In DIPHTHERIA the affected surfaces may be painted every hour with a ten 
 per cent, solution of resorcin in glycerin. 
 
 In a solution of seven grains to the ounce, Sajous (Jour. Amer. Med. 
 Ass'n, May 3, 1890) recommends it for reduction of HYPERTROPHIC 
 (EDEMA of the vocal cords in ACUTE LARYNGITIS. The writer claims 
 that this is the limit to which the solution should be carried, since if the 
 agent is used in greater strength it causes a sensation of dryness, while 
 weaker solutions are ineffectual. The solution should be applied with an 
 atomizer every two hours the first day, and afterward three times daily. 
 
 Tymonsky ( Monatsschrift fur Ohrenheilkunde, May, 1891, No. 5, p. 
 153) finds resorcin the most convenient remedy to use in the treatment 
 of the ulcerative stage of LARYNGEAL PHTHISIS. Daily applications of an 
 eighty per cent, solution are made. 
 
 On the whole resorcin appears to be adapted to subacute and chronic 
 disease rather than acute. A scruple to the ounce of water has much the 
 same effect as carbolic acid in the treatment of NASAL CATARRH. A five 
 to ten per cent, solution can be sprayed in WHOOPING COUGH, ASTHMA, 
 BRONCHITIS, LARYNGEAL ULCERS, etc. (A. Eichler, Med. and Surg. Rep., 
 1891, No. 5.) 
 
 Resorcin enters into an antiseptic tooth-powder which is popular in 
 France. 
 
 Diseases of the Eye. Resorcin has been recommended as an anti- 
 septic in ophthalmic surgery, but it has not been very much used. It is 
 less irritating than carbolic acid, but probably less efficient as a germi- 
 cide. A five per cent, solution is said to be very well borne by the con- 
 junctiva. It may be applied to the edges of the eyelids in OPHTHALMIA 
 TARSI in an ointment of one drachm to one ounce. 
 
 RETINOL. Rosinol. Resinol. 
 
 Retinol is a distillation product of Burgundy pitch. It was discovered by Pelletier 
 and Walter in 1838. Retinol, when pure, is simply a hydrocarbon of the formula C M H M 
 in the form of a viscid fluid similar in appearance to castor oil, with a peculiar odor, and 
 a specific gravity of 0.900; it boils at 238 C. (460.4 F.). 
 
 Retinol is a non-irritating and stable antiseptic. It is used as a solvent 
 for phosphorus. It dissolves carbolic acid and creasote in every propor- 
 tion. It is also a solvent in a lesser degree for camphorated naphthol,
 
 390 ' LOCAL THERAPEUTICS. 
 
 salol, camphor, cocaine hydrochloride, chrysophanic acid, iodol, naph- 
 thol, and aristol. It is not soluble in water. F. Vigier {Bull. Gen. de 
 Therap., 1891, Nos. 5 and 7). The drug has as yet attracted little 
 notice. 
 
 General Surgery. Balzer and others have recently employed retinol 
 in the treatment of VAGINITIS, SYPHILITIC and VARICOSE ULCERS, etc. 
 
 Retinol has been recommended as an antiseptic, and as a vehicle for 
 the application of other antiseptics. 
 
 Diseases of the Skin. In PRURITUS the following is said to give 
 relief: R. NaphtholyS, 9j ; retinol, saponis mollis, aa gr. cc; pulv. cretae 
 prep., 9ij. M. 
 
 RHUS GLABRA. Rhus Glabra (Rhus Glabrum, Pharm., 1870). 
 Sumach. Shumach. 
 
 " The fruit of Rhus glabra" (U. S. P.) Sumach berries, as they are commonly 
 called, have a pleasant, sour, astringent taste. They contain free malic acid, malate of 
 calcium, much tannic and gallic acid, a red coloring matter, and a volatile oil. While the 
 fruit is the only official part of the plant, some practitioners prefer an infusion made from 
 the inner bark of the root. The single official preparation is the fluid extract (extractum 
 rhus glabrse fluidum), one cubic centimetre of which represents the activity of one 
 gramme of the crude drug. An infusion is prepared by adding an ounce of the ripe 
 berries or an equal amount of the inner bark of the root to a pint of water. A small pro- 
 portion of alum is added with advantage. 
 
 "Rhus glabra is an astringent. 
 
 Diseases of the Throat. Rhus glabra is a valuable agent in the 
 treatment of ACUTE INFLAMMATION, arising from any cause, of the 
 mouth, tonsils, and pharynx. Thus it is one of the remedies for QUINSY. 
 It is efficient in MERCURIAL STOMATITIS. The fluid extract, in the pro- 
 portion of two drachms to four ounces of water, to which two scruples of 
 potassium chlorate have been added, is one of the best of remedies when 
 used as a gargle for ACUTE PHARYNGITIS. Lozenges of rhus glabra 
 contain three grains of the extract in each mass. But fresh preparations 
 are more efficient. 
 
 ROSA GALLICA. Red Rose. 
 
 " The petals of Rosa gallica collected before expanding." (U. S. P.) They contain 
 gallic and tannic acid, a volatile and fixed oil, coloring matter, and other unimportant 
 constituents. The following preparations are official : 
 
 Confectio Rosa. This is made by beating together red rose leaves, sugar, honey, and 
 rose water ; Extractum Rosce Fluidum (one cubic centimetre representing the activity of 
 one gramme of rosa gallica) ; Mel ROSCE (honey of roses), prepared by percolating red rose 
 with diluted alcohol, evaporating to a fluid extract, and mixing eight parts of this with 
 ninety-two parts of honey.
 
 ROSA CENTIFOLIA - SABINA - SACCHARUM. 391 
 
 ROSA CENTIFOLIA. Pale Rose. 
 
 " The petals of Rosa centifolia." (U. S. P.) It is from the petals of this rose that 
 rose water (Aqua ROSCE) is made by distilling and redistilling water from the fresh petals. 
 Rose water, however, is rarely, if ever, made in this country at all, but is imported from 
 the south of France. Rose water ointment, or cold cream (Unguentum Aquce ROSCE}, 
 is made by mixing thirty parts of rose water with an ointment composed of expressed oil of 
 almond, spermaceti, and white wax. 
 
 Rose leaves and pharmaceutical preparations made from them form 
 mildly aromatic astringent remedies. The attar of rose is employed to 
 cover the odor of iodoform. 
 
 Diseases of the Throat, etc. The compound infusion of rose is 
 recommended by F. P. Atkinson {Practitioner, January, 1887, p. 38) as 
 a gargle in FOLLICULAR TONSILLITIS. A lozenge is sold which contains 
 two grains of powdered rose leaves, or one in which from one to four 
 grains of rose leaves is in combination with from one to four grains of 
 alum. 
 
 SABINA. Savine. 
 
 " The tops of Juniperus sabina." (U. S. P.) The medicinal property of savine is 
 due to its volatile oil, which is defined as " a volatile oil distilled from savine." Alcohol 
 dissolves it freely. The Extractum Sabinse Fluidum (one cubic centimetre of which 
 represents the activity of one gramme of savine) is official. 
 
 Savine is an irritant. 
 
 General Surgery. Savine is employed in the form of an ointment 
 for the purpose of keeping up a discharge from blistered surfaces. For 
 this purpose it is preferable to cantharides. 
 
 OLEUM 
 
 Diseases of the Skin. The only use of oil of savine in dermatology 
 is as a stimulant in ALOPECIA " PITYRODES." Pincus, an excellent author- 
 ity, has used it in the proportion of five to thirty drops in an ounce of 
 alcohol. It is rubbed into the scalp, and also applied by compresses. 
 Its action is simply that of a stimulant to the superficial cutaneous circu- 
 lation. 
 
 SACCHARUM. Sugar. Cane Sugar. 
 
 " The refined sugar of Saccharum officinarum." (U. S. P.) 
 
 White cane sugar, when finely pulverized, is a ptotectant, and by slowly dissolving in 
 mucus increases its specific gravity. The first effect of sugar on inflamed tissues is to 
 slightly irritate this is probably due to the rapidity with which the agent imbibes 
 moisture from the already partially dried and heated membranes. When diluted, one 
 part to five parts of a light menstruum, such as magnesium carbonate, flowers of sulphur, 
 or lycopodium, sugar is received without resistance upon the most sensitive tissues.
 
 39 2 LOCAL THERAPEUTICS. 
 
 Sugar is preservative, when dissolved in the proportion of two pounds to a pint of dis- 
 tilled water, and hence can be said to be antiseptic. 
 
 General Surgery. Donnhersser {Schmid? s Jahrbiicher, July, 1889) 
 commends sugar as a DRESSING FOR WOUNDS. It is dusted over the 
 lesions, or applied in a sac made of sterilized muslin from which all 
 oily matter is removed. In the treatment of TUBERCULAR ULCERS iodo- 
 form is mixed with sugar. 
 
 C. Z,\Qm(Monatsst;h,f. Ohrenheilk, etc., xxvi, 275) recommends mixing 
 crude, unrefined honey with oatmeal to form a paste, for application to 
 superficial inflammations. If abscess occurs the pus is evacuated by 
 incision, and the dressing of honey-paste renewed. A similar use of 
 honey for WHITLOW is an old domestic remedy in Germany. 
 
 Diseases of the Throat, etc. In DIPHTHERIA sugar is often thrown 
 upon the abraded surfaces of the tonsil after the removal of the exudate. 
 To increase the specific gravity of a gargle sugar can take the place of 
 glycerin. 
 
 THERIACA. Molasses. Treacle. 
 
 " The uncrystallized residue of the refining of sugar." (Ph. Br.) Two varieties of 
 molasses are known West India and sugar-house molasses. Each consists of uncrystal- 
 lizable sugar, usually a proportion of crystallizable sugar, coloring matter, and water. 
 
 Molasses and other saccharine solutions are bland and unirritating, 
 and when applied to cutaneous surfaces act as protectants. 
 
 General Surgery. In domestic medicine molasses has attained some 
 reputation as a dressing for BURNS, especially those of the first degree. 
 It is conveniently applied by saturating old linen or lint, and then envel- 
 oping the injured part, or by dipping the affected surface in a vessel con- 
 taining the molasses, then covering it with raw cotton, and retaining by 
 a bandage. The cleansing of the burnt surface is at any time easily 
 effected. 
 
 SACCHARUM LACTIS. Sugar of Milk. 
 
 Sugarof milk is obtained from the whey of cow's milk by evaporation, and purified by 
 recrystallization. " Soluble in seven parts of water at 15 C. (59 F.), and in one part 
 of boiling water; insoluble in alcohol, ether or chloroform." (U. S. P.) 
 
 Diseases of the Nose, Throat, etc. Sugar of milk is often used 
 as an excipient in diluting powdered tannic acid, borax, bismuth sub- 
 nitrate, and nitrate of silver in insufflations to the nose, pharynx, and 
 larynx.
 
 SALOL. 
 
 393 
 
 SALOL. Phenyl Salicylate. 
 
 " Salol is a white, crystalline, coarse powder, with an odor of oil of wintergreen, and a 
 slight taste of carbolic acid. It is sparingly, if at all, soluble in water ; soluble in alcohol, 
 ether, petroleum spirit, and fatty oils." (U. S. D.) Salol is soluble in retinol in pro- 
 portion I-IO. 
 
 Salol is antiseptic. In external application it is a feeble agent. To some extent it 
 may be accepted as a substitute for iodoform. It possesses advantages over this agent in 
 having almost no odor, and being without toxic properties. Some observers are of the 
 opinion that salol is inert unless it is decomposed, and that the efficacy it possesses is due 
 to carbolic acid. That good results, however, have been secured by its use is proven by 
 abundant testimony, and, it is claimed by European observers, that it may be used as 
 a succedaneum for iodoform. 
 
 General Surgery. Salol is recommended by Corner (Lancet, May 
 4, 1889) as a DRESSING FOR WOUNDS, especially those which are associ- 
 ated with fracture and dislocation. The part is cleansed with a 1-20 
 solution of carbolic acid, and then dusted with powdered salol. Feilchen- 
 feld (Lancet, March 20, 1887) has used salol successfully both internally 
 and externally. In an obstinate case of VENEREAL BUBO, which had 
 resisted the stronger caustics, salol was efficient. 
 
 Fato and Cabatelli (Bulletin Medical, February 10, 1889) use salol in 
 the treatment of BURNS, in the proportion of three parts of salol to one 
 hundred parts of lanolin, the dressing being renewed every three days. 
 The ointment allays pain and prevents inflammatory reaction. Kiezer 
 (Jour. Amer. Med, Assoc., ii, 1889, p. 927) treated with success an 
 obstinate VARICOSE ULCER by dusting with one part of salol to twelve 
 parts of powdered starch. 
 
 Diseases of the Skin. Salol has been used by Schwimmer as a sub- 
 stitute for iodoform in VENEREAL, SYPHILITIC, and SIMPLE ULCERS with 
 success. It is without disagreeable oder, and while not diminishing sup- 
 puration to a marked extent, acts favorably in suppurative sores and favors 
 healthy granulation and the growth of epithelium. It is applied in powder, 
 and may be combined with one-half its bulk of powdered starch to favor 
 adhesion. Salol is not so effective when mixed with glycerin or in the 
 form of ointment. 
 
 Saalfeld has employed salol (R. Salol, 9H>ss ; vaselin, gj) in ECZEMA 
 with excellent results. Also in SYCOSIS SIMPLEX (Sycosis coccogenica). 
 
 Diseases of the Nose and Throat. E. J. Frome (La Tribune 
 Medicale, 1889) employs for OZ^NA an ointment composed as follows: 
 Salol, four grammes ; oleum petrolatum, one hundred and fifty grammes. 
 Salol is recommended by Beschorner (^Gesellschaftfur Natur- und Heil- 
 kunde zu- Dresden, November 3, 1888) as an ingredient of a powder to be 
 used by insufflation for TUBERCULAR LARYNGITIS. 
 
 The following constitutes a mouth wash popular in Germany : Salol,
 
 394 LOCAL THERAPEUTICS. 
 
 two grammes; menthol, three grammes ; ol. menth. piper, three grammes ; 
 spirit anisi, nine grammes ; alcohol, two hundred grammes. 
 Salol enters into an antiseptic tooth-powder. 
 
 SALVIA. Salvia. Sage. 
 
 " The leaves of Salvia offidnalis." (U. S. P.) Sage contains a volatile oil and tannic 
 acid besides other unimportant constituents. The single official preparation into which it 
 enters is Vinum Aromaticum. Sage is one of the ingredients of baume tranquille. 
 
 Sage is an aromatic astringent. 
 
 Diseases of the Nose and Throat. Sage has been used for a 
 long time in domestic practice in the form of an infusion (" sage tea"). An 
 ounce of the leaves is added to a pint of hot water, honey, alum, and 
 vinegar being added. Such a preparation is a cheap and efficient gargle 
 for ACUTE INFLAMMATION OF THE MOUTH AND THROAT. D. H. Agnew 
 {Therapeutic Gazette, 1885, p. 17) reports a case of CHRONIC CATARRH AL 
 RHINITIS, accompanied with profuse purulent discharge, which yielded 
 to douches of infusion of sage. An oil of sage is prepared, ten minims 
 of which to an ounce of water in the presence of magnesium carbonate 
 constitutes a stimulating inhalant. 
 
 SAMBUCUS. Elder. 
 " The flowers of Sambucus canadensis. Linn." (U. S. P.) 
 
 Elder is demulcent and protectant. 
 
 Diseases of the Nose, etc. Extract of elder can be mixed in the 
 proportion of four parts alum two parts to a mass of sixteen parts of 
 oleum petrolatum to form an emollient and slightly astringent ointment, 
 which is suitable for application to the interior of the nostril in ECZEMA. 
 
 SANGUINARIA. Sanguinaria. Blood Root. 
 
 "The rhizome of Sanguinaria canadensis collected in autumn." (U. S. P.) San- 
 guinaria contains an alkaloid, sanguinarine, which is " a white, pearly substance of an 
 acrid taste, very sparingly soluble in water, soluble in ether, and very soluble in alcohol." 
 (U. S. D.) 
 
 Sanguinaria is a stimulant and escharotic. 
 
 Diseases of the Nose. In a pure form sanguinaria is a severe 
 excitant to the nasal mucous membrane. Its violence is mitigated by 
 mixing two drachms of the powder with twice the amount of pulverized 
 acacia, or one part of sanguinaria may be added to three parts of starch. 
 The powder thus formed is recommended by some practitioners to be
 
 SAPO. 
 
 395 
 
 blown within the nasal chambers in the dry form of ATROPHIC RHINITIS. 
 A nasal bougie, designed to accomplish a similar purpose, is prepared by 
 adding two minims of the fluid extract to each mass. The pure powder 
 is asserted to be escharotic to fungoid conditions of the mucous mem- 
 brane. The drug is little used. 
 
 SAPO. Soap. 
 
 " Soap is prepared from soda and olive oil. A white, or whitish solid, hard, yet easily 
 cut when fresh, having a slight, peculiar odor, free from rancidity; a disagreeable, alkaline 
 taste, and an alkaline reaction. Readily soluble in water and in alcohol." (U. S. P.) 
 
 Sapo Viridis. Green Soap. 
 
 " Soap prepared from potassa and fish oils. A soft, greenish-yellow, unctuous jelly, 
 having a peculiar odor, which should be free from rancidity, and an alkaline reaction. 
 Soluble in water and in alcohol, without leaving more than a small residue of insoluble 
 matter." (U. S. P.) 
 
 Tinctura Saponis Viridis. Tincture of Green Soap. 
 
 " Green soap, sixty-five parts; oil of lavender, two parts; alcohol, a sufficient quantity 
 to make one hundred parts. Mix the soap and oil of lavender with thirty-three parts of 
 alcohol, and let the mixture macerate until the soap is dissolved ; then filter through paper, 
 adding alcohol through the filter, until one hundred parts of tincture are obtained." 
 (U. S. P.) 
 
 Soap is solvent, antiseptic and detergent. 
 
 General Surgery. Soaps are employed in general surgery for their 
 detergent properties. For this purpose all that is necessary is a fairly pure 
 article which is free from essential oils. Castile soap is the form in com- 
 mon use. At the Pennsylvania Hospital, a "soft soap" is prepared 
 by dissolving Castile soap in water with the aid of a little heat ; it is 
 kept in a jar, and can be readily applied to the selected part upon a piece 
 of oakum or cotton. After turpentine has been applied for the purpose 
 of removing resinoid particles (as from old plasters or ointments), the skin 
 should be washed with soap and water. If permitted to remain on the 
 surface, the soap will often cause cutaneous irritation. In the stiffness fol- 
 lowing OLD SPRAINS and FRACTURES, so common in injuries about the 
 wrist and ankle, especially in persons advanced in life, placing the part in 
 as strong a bath of hot soapsuds as can be borne (while the limb is 
 immersed, to employ a gentle massage and friction) is efficacious. The 
 temperature of the bath should be maintained by frequent additions of 
 hot water. Each manipulation should last for at least an hour. By pur- 
 suing this method of treatment hands and wrists whose functions have 
 been destroyed are restored to comparative usefulness. In RECTAL 
 and VAGINAL EXAMINATIONS, filling the subinguinal spaces with soap 
 will prevent the lodging of unpleasant secretions. In CONSTIPATION,
 
 396 LOCAL THERAPEUTICS. 
 
 where a large mass of feces has lodged in the lower bowel, a copious 
 enema of soap and warm water is useful (see Aqua). The soap should 
 be dissolved freely, since it assists in lubricating the impacted masses, 
 while it stimulates the bowel to contraction. In infants a small sup- 
 pository of Castile soap, made by paring a piece to the required size, and 
 gently inserting it beyond the sphincter, will usually have the desired 
 effect. For disinfection of the hands excellent results can be obtained 
 by the thorough use, with a stiff nail-brush, of a pure, non-odorous 
 soap, and afterward employing an antiseptic. As a rule, such a course 
 is to be preferred to the use of "medicated soaps." In the so-called 
 bichloride of mercury soap the mercury forms an oleate which is not 
 active as a germicide, while it may unite with albumin, which will render 
 the soap useless. Advantage, however, has been taken of the solubility 
 of the biniodide of mercury in iodide of potash ; a soap thus prepared 
 is known as the "soluble biniodide soap." 
 
 John Thompson (J3r. Med. Jour., May 12, 1888) states that one 
 gramme of soap in 120 c.c. of water proved to be rapidly destructive of 
 all infecting organisms. 
 
 Diseases of the Skin. The ordinary soda-soap of the Pharmaco- 
 poeia, " Castile soap," is an excellent detergent. It is used in derma- 
 tology to cleanse the skin of dried serum, pus, blood, and epidermic 
 scales, the results of inflammatory action. 
 
 But the enormous increase in the number of spurious Castile soaps 
 placed upon the market of late years renders it difficult to obtain a pure 
 article. The practitioner should obtain samples of the purest soaps of a 
 reliable pharmacist, and decide which best suits his purpose.* 
 
 Sapo viridis, on account of the excess of alkali contained, has a solvent 
 effect on the horny layer of the skin, and exposes the lower layer of the 
 epidermis. In CHRONIC ECZEMA, particularly when much itching results 
 from the retention of exudations, this symptom may be relieved by 
 sapo viridis well rubbed into the skin. The result of this application is 
 to inflame the skin, and, therefore, so soon as the object of laying bare 
 the lower layers of the epidermis is accomplished, as may be seen from 
 the profuse oozing and weeping (with a slight bloody discharge), the soap 
 should be completely washed off with warm water, and a soothing oint- 
 ment, as the diachylon ointment of Hebra, or the oleate of bismuth 
 ointment, (McCall Anderson's ointment) applied. 
 
 Sapo viridis is sometimes used in INFILTRATED ECZEMA and other 
 
 * The best soap to use when the skin is highly inflamed and irritable is the " Basis-" 
 Seife " of Unna. This is said to contain an excess of fat, but the statement has been 
 questioned. It is certainly more likely than any other soap to be neutral, and will be 
 found a valuable agent in cleansing irritable surfaces.
 
 SAPO. 
 
 397 
 
 chronically diseased conditions of the skin to remove infiltration, or, in 
 other words, to act as a discutient. In employing soap in this manner it 
 must be remembered that the deep effect is desired with as little irritation 
 'of the surface as possible. The soap, therefore, should be worked into 
 the skin and not rubbed across its surface. 
 
 The tinctura saponis viridis (U. S. P.) is essentially the same as the 
 spiritus saponus kalinus of Hebra, excepting that the latter is made from 
 the original sapo viridis as manufactured by the peasants of the Black 
 Forest in Germany, and which is imported largely to this country. 
 Although its composition may not be uniform, this soap is always to be 
 preferred to the preparation of the U. S. P., whether for use in substance 
 by itself or as the spiritus saponus kalinus. 
 
 Medicated soaps are those by means of which various drugs are brought 
 into intimate contact with the skin, and, perhaps, also into a position 
 where a certain amount of absorption can take place. Many of these 
 have been pressed upon the attention of the medical profession, and their 
 virtues have even been lauded by physicians of some note, especially in 
 Germany, with much persistence. Medicated soaps, as a rule, are of 
 poor quality and irritating to the skin. Those introduced by Unna 
 and by Eichoff, and called "superfatted" soaps, are, however, made 
 of excellent materials and by a scientific method, and are tolerated by 
 the skin to a greater degree than any others. Unna's soaps are superfatted 
 by the addition of an excess of olive oil up to four per cent. Eichoff's 
 soaps are superfatted by a mixture of two parts of lanolin to three parts 
 of olive oil up to five per cent. 
 
 Resorcin, salicylic acid, sulphur, tar, creolin, ergotin, creasote, men- 
 thol, ichthyol, benzoic acid, and other drugs have been introduced into 
 these soaps, and within the restricted limit of their capacity for usefulness 
 have proved valuable adjuvants in the treatment of skin diseases. 
 
 In all such affections of the skin as VESICULAR and PUSTULAR 
 ECZEMA, ACNE, IMPETIGO, ECTHYMA, FURUNCULOSIS, ULCERS, etc., the 
 use of an appropriately medicated soap forms a valuable preparation for 
 the more active treatment to follow. As a means of introducing drugs 
 into the general system, or even as a method of application when a deep 
 action is desired, soap is not to be compared as a vehicle to fatty agents. 
 
 Under the name of "glycerinumsaponatum," H. von Hebra describes 
 a preparation which he considers useful in the treatment of skin diseases. 
 
 Chemically pure glycerin mixed with ninety-five per cent, cocoanut 
 oil soap gives a solid body which becomes fluid when warmed. Castile 
 soap can be substituted for cocoanut oil soap. The saponated glycerin is 
 made by warming the dried soap with perfectly pure 28 B. glycerin (sp. 
 gr. 1.242) over a warm bath and filtering while hot. It forms, when cold, 
 a faint yellow, transparent, more or less elastic mass, which is almost
 
 398 LOCAL THERAPEUTICS. 
 
 colorless, and melts at the temperature of the body. A little of this 
 preparation rubbed on the hands removes FISSURES and ROUGHNESS. It 
 melts readily in water. Several medicated preparations of this saponated 
 glycerin are described by Hebra. 
 
 A combination of twenty-four grains of salicylic acid to the ounce of 
 this preparation makes a good application for the removal of excessive 
 epidermic growth, as in TYLOSIS, CHRONIC ECZEMA, and is also an effi- 
 cient parasiticide, in TINIA CIRCINATA and FAVUS. 
 
 Resorcin and salicylic acid, in the proportion of twenty-four grains of 
 each to the ounce of saponated glycerin, forms a good combination. 
 The base should be melted and the salicylic acid first incorporated, and 
 then, at a lower temperature, the resorcin. Both dissolve entirely. This 
 is an excellent application in PITYRIASIS CAPITIS, acting both as a soap and 
 as an ointment. 
 
 Similar combinations can be made at will. (Cf. Hebra's article in 
 Sajous 1 Annual of the Univ. Med. Sd., Vol. iv, 1891, p. A 57. Also 
 " Mollin " (p. 325) in this work.) 
 
 Diseases of the Mouth, etc. Dental soaps dissolve fatty substances 
 without attacking the teeth. They should have a neutral or slightly alka- 
 line action. (W. D. Miller, " Microorganisms of the Human Mouth," 
 1890, 236.) 
 
 EMPLASTRUM SAPONIS. Soap Plaster. 
 
 Soap plaster is made by incorporating with ninety parts of lead plaster ten parts of soap. 
 It has the physical qualities of lead plaster, but is believed by some to be more bland. 
 
 General Surgery. Soap plaster should be spread on strong linen or 
 thin leather (Chamois skin), and be one-eighth to one-fourth of an inch 
 in thickness. It is employed in surgery to prevent abrasions and to pro- 
 tect from undue pressure. Much of the soap plaster sold in the shops is 
 worthless, being but little better than adhesive plaster. Soap plaster has 
 little adhesiveness, but when heated slightly beyond the temperature of 
 the body easily conforms to any surface. It is a useful dressing in cases 
 of threatened BED SORES when applied over the threatened region and 
 retained by broad strips of adhesive plaster. In the treatment of sprains 
 of joints an efficient support can be obtained from soap plaster moulded 
 to the articulation and secured by a bandage. Should a resolvent effect 
 be desired, the surface of the joint is painted with tincture of iodine 
 before the soap plaster is applied, with the intent that the combination will 
 result in the formation of iodide of lead. This is a favorite mode of 
 treatment with Ashhurst. When splints are applied, as after the ope- 
 ration of resection of the knee, soap plaster is one of the best of sup- 
 porting surfaces devised upon which to rest the limb.
 
 SASSAFRAS SCOPOLEN1NE. 
 
 399 
 
 A number of plasters in good repute in domestic medicine may be 
 employed in the same manner as soap plaster. " Logan's plaster," con- 
 sisting of two and one-half pints of sweet oil, four ounces of butter, 
 twelve ounces of Castile soap, -and sixteen ounces of litharge. This is 
 boiled over a slow fire until it becomes of a dark brown color ; sixteen 
 ounces of carbonate of lead are then added, and the heat is continued 
 until a suitable consistency is obtained ; two ounces of mastich complete 
 the mass. 
 
 SASSAFRAS. 
 
 " The bark of the root of Sassafras officinalis. Nees." (U. S. P.) 
 The following preparations of sassafras are official : Mucilago Sassafras Medulla ; and 
 Oleum Sassafras. The mucilage of the pith is prepared as follows: " Sassafras pith, two 
 parts (or thirty-six grains) ; water, one hundred parts (or four fluidounces) ; macerate for 
 three hours and strain." (U. S. P.) The necessity of the long maceration is obviated 
 by cutting the pith in very small portions and shaking it with the water; a few minutes 
 suffices to make the mucilage by this plan. Oil of sassafras is " a volatile oil distilled from 
 sassafras." (U. S. P.) 
 
 The bark is not employed as such in local therapy. The properties of 
 the pith and the volatile oil are essentially different, yet it is convenient 
 to treat of both under a single head. 
 
 Sassafras pith is demulcent. The oil is an aromatic stimulant. 
 
 Diseases of the Throat, etc. Black {Dental Review, 1889) recom- 
 mends for INFLAMMATION OF THE GUMS due to bacteria, and accompanied 
 with fetor, a mixture composed of three parts of oil of sassafras, two parts 
 of wintergreen, and one of carbolic acid. Oil of sassafras enters into the 
 composition of the official trochisci cubebse. Lozenges are sold which 
 contain from one-tenth to one-sixth of'a minim of the oil in each mass. 
 
 Diseases of the Eye. Mucilage of sassafras pith is a popular 
 domestic remedy in the treatment of injuries of the eye and ACUTE 
 CONJUNCTIVITIS. Cloths wet with it are kept upon the closed eyelids, "or 
 it is applied to the conjunctiva. It is soothing when freshly applied, but 
 should not be allowed to dry upon the lashes, as it stiffens them disagree- 
 ably, and may even glue the lids together if not well diluted. Half an 
 ounce of the official mucilage to from three to six ounces of water makes 
 an agreeable addition to washes of borax, boric acid, or alum. 
 
 SCOPOLENINE. 
 
 An alkaloid present in Japanese belladonna (Scopolia Japonica). 
 
 Diseases of the Eye. Pierdhony (Noveaux Remldes, 1886, No. 
 3, p. 61) states that the mydriatic form of scopolenine is superior to that 
 of atropine, and recommends its use in ophthalmic practice. He also
 
 400 LOCAL THERAPEUTICS. 
 
 claims that it is free from liability to produce the conjunctival irritation 
 which sometimes follows the use of atropine. As, however, this effect of 
 atropine is only met with exceptionally in a very small proportion of the 
 enormous number of cases in which the drug is daily used, this claim can 
 have no basis until scopolenine has been much more extensively tested. 
 It has not been much used in practice. 
 
 SINAPIS ALBA. 
 
 " The seed of Sinapis alba. Linn." (U. S. P.) 
 
 SINAPIS NIGRA. 
 
 " The seed of Sinapis nigra. Linn." (U. S. P.) 
 
 It is convenient to treat of the two forms of mustard under a single article. 
 
 Sinapis is rubefacient and vesicant. Powdered mustard, applied 
 locally to the skin, acts as a decided irritant. Any degree of effect may be 
 produced by it, from moderate excitement to severe blistering. 
 
 General Surgery. On account of its convenience, mustard is exten- 
 sively used in domestic medicine ; it is one of the most available 
 substances to produce a mild revulsive effect. Mustard should not be 
 permitted to vesicate, since the pain occasioned is severe, the serous 
 discharge slight in amount, and the resulting ulcer difficult to heal. 
 Mustard is usually employed in the form of a plaster, made by incorpor- 
 ating equal parts of the powdered mustard with ground flaxseed or flour, and 
 bringing it to the proper consistency with tepid water. The mass is then 
 spread upon a piece of old muslin, covered with a portion of the same 
 material, and applied to the selected part. Another " convenient method 
 is to take a newspaper, folded to a little larger than the desired size, and 
 tear open the front piece so that it can be folded back like a flap, leaving 
 one edge attached ; next, to spread upon the thick portion the mustard, 
 leaving the edges free, and then to close the flap upon it and fold the 
 edges back to the desired shape." (H. C. Wood, "Therapeutics.") 
 
 " Mustard leaves " are for sale, and are much employed in place of the 
 mustard plaster. They require only to be moistened before being used. 
 As a rule, the effects of the "mustard leaves" are more severe than are 
 those of the plaster, and it is often necessary to apply two or three layers 
 of muslin or paper between them and the skin. In this way they 
 can be borne for a long time, and the results are more persistent. 
 When a mustard plaster is applied to affect deep-seated organs, as in 
 PNEUMONIA, PLEURISY, or PERITONITIS, such action is desirable. In 
 BRONCHITIS in children, accompanied with congestion, the entire chest 
 may be enveloped in a jacket-plaster or poultice for a short time, in
 
 SODA SODII BENZOAS. 
 
 401 
 
 order to thoroughly redden the skin. On the removal of the plaster the parts 
 should be sponged off with tepid water and the chest wrapped in raw 
 cotton. A mustard bath, in the strength of a drachm to the gallon, 
 when properly used, is of service, especially in children, upon the reces- 
 sion of the RASH IN MEASLES OR SCARLET FEVER. The familiar mustard 
 foot-bath is of service in aiding the breaking up a COLD, or in relieving 
 a CONGESTIVE HEADACHE, although the application of a mustard 
 plaster to the nape of the neck, as a rule, will be more effectual. In 
 OBSTINATE VOMITING one can derive benefit from the application of a 
 mustard plaster to the epigastrium. The mustard hip-bath is of service 
 in arrested CATAMENIA, and may be used to redden the thighs and but- 
 tocks a few days before and during the missing period. The patient 
 should remain from a half hour to an hour, twice daily, in the bath. In 
 ULCERATING UTERINE CARCINOMA benefit has been derived by using a 
 vaginal douche of hot water (see Aqua, p. 96) to which a little mustard 
 has been added, of sufficient strength to produce a slight sense of tingling. 
 
 SODA. Sodii Hydras. Caustic Soda. 
 
 Sodium hydrate is prepared by boiling together slacked lime and solution of sodium 
 carbonate. The resulting solution is separated from the sediment, evaporated, and cast 
 into sticks. It is often known in the shops as stick-soda. The purified compound is 
 prepared by dissolving the commercial caustic soda in alcohol, which forms a clear solu- 
 tion of the pure sodium hydrate, while the impurities remain undissolved and subside. 
 The solution is evaporated in a silver dish and moulded into sticks. 
 
 Sodium hydrate is soluble in 1.7 parts of cold water and 0.8 part of boiling water; it 
 is very soluble in alcohol. 
 
 SODII BENZOAS. Benzoate of Sodium. 
 
 "A white, semi-crystalline, or amorphous powder, efflorescent on exposure to air ; odorless, 
 or having a faint odor of benzoin ; of a sweetish, astringent taste, free from bitterness, 
 and having a neutral reaction. Soluble in 1.8 parts of water, and in forty-five parts of 
 alcohol at 15 C. (59 F.), in 1.3 parts of boiling water, and in twenty parts of boiling 
 alcohol." (U. S. P.) 
 
 Benzoate of sodium is antiseptic in the proportion of twenty grains to 
 the ounce of water. Prosser James {Lancet, July 4, 1885) states that it 
 possesses anaesthetic and analgesic properties. 
 
 Diseases of the Nose and Throat. A solution of ten to twenty 
 grains to the ounce is antiseptic and stimulant. It also makes an agree- 
 able impression on inflamed surfaces of the throat, and overcomes the 
 sense of constriction and dryness which is so commonly complained of 
 in these conditions. Brondel ( Gazette des Hopitaux, December 1 1, j 886) 
 recommends highly the use of a powder containing ten percent, benzoate 
 26
 
 402 LOCAL THERAPEUTICS. 
 
 of sodium for local application to the tonsils in DIPHTHERIA. He claims 
 that in its use exudates become less adherent and hygroscopic, ajid are 
 detached, leaving the surface beneath cicatrized. In the proportion of 
 six grains to the ounce of water, to which a small proportion of chlorate 
 of potassium and glycerin has been added, Shuriy recommends benzoate of 
 sodium as a spray for ACUTE INFLAMMATION OF THE THROAT AND NOSE. 
 
 SODII BICARBONAS. Sodium Bicarbonate. Bicarbonate of Sodium. 
 
 Bicarbonate of Soda. Baking Soda. 
 
 A practically pure bicarbonate of sodium is contemplated extraneous matter not more 
 than one per cent. It is described as "soluble in twelve paits of water at 15 C. (59 
 I''.) and insoluble in alcohol; it is decomposed by hot water." (U. S. P.) Sodii Bicarbo- 
 nas Venalis is official. It contains not more than ninety five per cent, of the pure salt. 
 It is rarely used. \Vhen bicarbonate of sodium is administered with hot water a caustic 
 solution of carbonate of sodium is formed. Bicarbonate of sodium enters into the compo- 
 sition of DobelPs solutivin. 
 
 Bicarbonate of sodium is antacid, protectant, mildly antiseptic, and 
 detergent. 
 
 General Surgery. Bicarbonate of sodium in saturated solution has 
 been lauded as a dressing for BURNS. It is much inferior to carron oil or 
 ointment of oxide of zinc, in burns of the first and second degree. 
 In INFLAMMATORY RHEUMATISM involving the articulations benefit can 
 be derived from enveloping the parts in lint saturated with a solution 
 composed of bicarbonate of soda, ten grains ; tincture of opium, one flui- 
 drachm ; water, one fluidounce. The dressing is covered with raw cotton. 
 In GONORRHOZA Castellan (Journ. of Cutan. and Gen.-Urin. Dis., 1887) 
 injects a solution of bicarbonate of sodium, eight to ten per cent., 
 three to four times a day; the treatment is based on the hypothesis that 
 while gonococci thrive in an acid medium they soon die in one which 
 is alkaline. The discharge even in chronic cases became alkaline in a 
 week, lessened rapidly, and soon stopped. 
 
 Diseases of the Skin. Borax is sometimes substituted for the 
 bicarbonate of soda and carbonate of soda, but possesses no advantage 
 over these preparations. 
 
 Diseases of the Ear, Nose, and Throat. Bicarbonate of sodium 
 neutralizes acid secretion and increases the specific gravity of mucus 
 formed in acute inflammation. The older writers believed that this 
 agent liquefied tenacious mucus, and thereby enabled the patient to more 
 easily remove it. But one to two per cent, solutions of this agent were 
 observed by M. J. Roosbach (Berliner Wochenschrift, 1882, No. 19) to 
 make scarcely any change on the mucous lining of the trachea of a living 
 cat, while A. H. Buck {Trans, of the Atner. Otological Soc., 1873)
 
 SODII BICARBONAS. 403 
 
 concludes that even saturated solutions have no influence as solvents over 
 abnormal mucoid masses. On theoretical grounds, therefore, the useful- 
 ness of sodium bicarbonate in the treatment might be disputed, but long 
 experience has fixed its value as an efficient agent in CATARRHAL IRRITA- 
 TIONS. Five to twenty grains to the ounce of water are indicated in 
 OTITIS MEDIA accompanied with purulent discharge. The solution 
 should be gently warmed and thrown up the Eustachian tube or instilled 
 in the external meatus. Hinton removes collections of inspissated mucus 
 by copious irrigation of a solution similar to the one named, the fluid passing 
 from the external meatus to the middle ear, and thence by the Eustachian 
 tube to the pharynx. The parts being thus washed out every other day 
 for a fortnight, are prepared for subsequent treatment by astringents 
 or desiccants. Dissolved in a mucilaginous medium, such as flaxseed 
 makes, sodium bicarbonate proves to be a useful lotion in ECZEMA OF 
 THE EXTERNAL AUDITORY PASSAGE. In the proportion of four grains 
 to the ounce of water it is recommended by Miot and Baratoux (.Rev. 
 Gen. de Clin. et de Therap., January, 1889, p. 43) in diffuse ACUTE 
 INFLAMMATION OF THE EXTERNAL AUDITORY MEATUS. Ten grains to 
 the ounce of water, to which a drachm of glycerin is added, may be used 
 in softening HARDENED CERUMEN. Miot {Rev. Mens. de Laryngologie, 
 etc., No. 4, 1885). As the ingredient ofasnuff it enters into a number of 
 proprietary medicines, among which, particularly, may be mentioned 
 Weidemeyc's snuff, which is alleged to be composed of sodium bicarbonate 
 mixed with a little powdered cochineal. 
 
 .As a nasal wash five grains to the ounce of water makes an efficient 
 wash in NASAL CATARRH, accompanied with thick secretion. It is one of 
 the ingredients in " Dobell's solution." Sodium bicarbonate in union with 
 sodium chloride and salicylic acid forms a useful compound in the treat- 
 ment of ATROPHIC RHINITIS. C. Seiler (Med. Rec., February 18, 1888, 
 p. 182) has proposed that the bicarbonate of soda be one of the ingredi- 
 ents of a lotion which is composed as follows: Sodium bicarb., 5viij ; 
 sodium bibor., ^viij ; sodium benzoate, sodium salicylas, aa, gr. xx ; 
 eucalyptol, thymol, each gr. x ; menthol, gr. v; oil of wintergreen, gtt. 
 vj ; glycerin, gviiiss ; alcohol, gij ; and water, q. s. to make 16 pints.* 
 
 Forcheimer (Archives of Pediatrics, February, 1889) recommends that 
 before an antiseptic wash be employed in the mouth for the removal of 
 fungi, as in THRUSH or APHTHAE, the parts be carefully washed with a 
 weak solution of bicarbonate of sodium. This agent has long had a repu- 
 tation for the cure of TONSILLITIS/* The patient may rub the tonsil with 
 the finger, which has been previously moistened with a quantity of the 
 salt According to W. J. Baker {British Medical Journal, April 9, 
 
 * These ingredients enter into the composition of " Seller's Antiseptic Tablet."
 
 404 LOCAL THERAPEUTICS. 
 
 1887), if this procedure be repeated every five minutes the first hour 
 and every hour for the rest of the day it will give relief even under 
 conditions when suppuration seems to be inevitable. S. Michailoff 
 (Meditsina, No. 21, 1889, p. 4) recommends the powdered salt in 
 GRANULAR TONSILLITIS and PHARYNGITIS. The author appears to have 
 had extensive experience and claims that improvement always ensued ; 
 a majority of cases were cured by the treatment, the period varying 
 from a fortnight to six weeks. The author appears to especially allude 
 to the large tonsils of childhood. Rovira y Oliver (Gaceta Medico, 
 Catalana, No. 7) confirms the above statement. He attributes the efficacy 
 to the neutralization of the acidity of the secretion as well as to the 
 solvent impression on the tenacious mucus of the crypts. The agent 
 should be applied every two or three hours. The author mentions a 
 toxic impression by over-use, but does not give details. A five to ten 
 per cent, solution of bicarbonate of sodium spoken of by W. D. Miller 
 (" Micro-organisms of the Human Mouth," loc. cit.} as the best appli- 
 cation for THRUSH. The salt constitutes the basis of a lozenge, each 
 mass to contain three grains of the drug. 
 
 SODII BISULPHIS. Bisulphite of Sodium. 
 
 " Opaque, prismatic crystals, or a crystalline or granular powder, slowly oxidized and 
 losing sulphurous acid on exposure to air, having a faint, sulphurous odor, a disagreeable, 
 sulphurous taste, and an acid reaction. Soluble in four parts of water and in seventy-two 
 parts of alcohol at 15 C. (59 F.) ; in two parts of boiling water and in forty-nine parts 
 of boiling alcohol." (U. S. P.) The fresh salt of sodium bisulphite must be used in thera- 
 peutic combinations. 
 
 Diseases of the Skin. A five per cent, solution of the bisulphite 
 of sodium in combination with one per cent, solution of carbolic acid 
 has been used in the DERMATITIS from Rhus toxicodendron. 
 
 SODII BORAS. Borate of Sodium. Borax. 
 
 Borax " is soluble in sixteen parts of water at 15 C. (59 F.), in 0.5 part of boiling 
 water; insoluble in alcohol. At 80 C. (176 F.) it is soluble in one part of glycerin." 
 (U. S. P.) Borax enters into the composition of Dobell's solution. The presence 
 of borax increases the solubility of boric acid. M. Jaenicke, by dissolving equal parts 
 of borax and boric acid in boiling water, produced a preparation known v&boro-borax. 
 It resembles boric acid, but is of greater solubility. 
 
 Borax in its action is not unlike boric acid. It is absorbent, antiseptic, 
 and sedative. In the form of a powder it is, in addition, absorbent, and 
 protectant, hence it is of value in treating acute inflammations of the 
 mucous surfaces.
 
 SODII BORAS. 
 
 405 
 
 General Surgery.' The ERUPTION which appears on the mucous 
 membrane of the VULVA in young girls, and sometimes extends up as far 
 as the cervix uteri, can be cured, according to Sir James Simpson, by the 
 injection of a solution of borax, five to ten grains to the ounce of hot water. 
 In LEUCORRHCEA an injection of a quart of hot water, in which a couple 
 of drachms of borax have been dissolved, is of service. In this connec- 
 tion borax is an efficient succedaneum for alum or tannic acid. In 
 CHRONIC CYSTITIS, Sir H. Thompson commends an injection composed 
 of borax, one ounce ; glycerin, two ounces ; of the mixture two or three 
 drachms can be added to four ounces of water. In GONORRHCEA a solu- 
 tion of from ten to fifteen grains to the ounce of water has been employed 
 with benefit. 
 
 Diseases of the Ear, Nose, Throat, etc. Two grains of borax 
 to the ounce of water, to which a little glycerin has been added, is a 
 favorite prescription for cleansing the naso-pharynx. As an insufflation 
 in irritated states of the mucous surfaces of the nose and throat, three 
 grains may be used at a time. Each ounce of water in a lotion may con- 
 tain five grains of borax. A preparation of similar strength is injected 
 in the Eustachian tube for CATARRHAL DEAFNESS. The slightly alkaline 
 reaction obtained aids in restoring a neutral or acid secretion to one of 
 normal character, at the same time that the solution gives increased 
 density to the thin, irritating discharge of an ACUTE NASAL CATARRH. 
 It may be used alone, but is commonly exhibited with drugs having a 
 somewhat similar effect. The following is efficacious in CHRONIC NASAL 
 CATARRH accompanied with infiltration : Two ounces each of borax and 
 sodium chloride, and ten grains of benzoic acid. A half drachm of 
 this powder is added to a glass (half pint) of warm water, in which a 
 little glycerin has been stirred. To be used freely. One of the most 
 common uses of borax is in the removal of APHTHA which affects the 
 mouths of nursing children. Dewees employed equal parts of borax and 
 finely-powdered sugar, dusted over the part every two or three hours. A 
 pinch of the preparation, in lieu of the above, may be placed on the 
 tongue. A mixture of honey and borax (mel boracis, Br. Ph.) is popular. 
 In CRACKED TONGUE, Brinton found the following of service : Borax, 
 forty grains ; glycerin, one ounce ; water, four ounces. Employ as a wash. 
 Borax enters largely into the composition of gargles prescribed for INFLAM- 
 MATION OF THE PHARYNX. It is also an ingredient of a lozenge contain- 
 ing two to three grains. 
 
 Diseases of the Eye. Borax forms an excellent aseptic applica- 
 tion in CONJUNCTIVITIS. It may be advantageously combined with boric 
 acid. Five grains of borax and ten of boric acid to the ounce of water 
 make an agreeable and useful wash, particularly in the ACUTE FORM OF 
 CONJUNCTIVITIS. In the CHRONIC FORMS it may be used frequently and
 
 406 LOCAL THERAPEUTICS. 
 
 freely by the patient in addition to other applications made at longer 
 intervals by the surgeon. 
 
 SODII CARBONAS. Carbonate of Sodium. Washing Soda. 
 
 Carbonate of sodium is prepared on a very large scale from the common salt of sea-water 
 and from cryolite, a mineral found in Greenland. Carbonate of sodium is official in a 
 crystalline form, with 62.9 per cent, of water of crystallization, and as a dry, white powder, 
 sodii carbonas exsiccatus, in which fifty per cent, of the water has been removed by heat. 
 
 The crystals effloresce on exposure to dry air, and fall to a white powder. They are 
 soluble in 1.6 parts of water at 15, and in 0.25 part of boiling water. A fragment of the 
 salt imparts an intense yellow color to a non-luminous flame. 
 
 Diseases of the Skin. The carbonate of sodium in lotions is some- 
 times employed in inflammatory skin diseases, although inferior to most 
 other local applications commonly used. It is dissolved in water in the 
 proportion of two to three drachms to the pint, and applied on cloths 
 as an evaporating lotion. 
 
 " Washing soda" is added to a bath in the proportion of four ounces 
 of the salt to thirty gallons of water in the treatment of ECZEMA and 
 other inflammatory types of diseases in which PRURITUS is a conspicuous 
 symptom. 
 
 Carbonate of sodium may be used to advantage for the purpose of 
 softening the crusts in INFANTILE ECZEMA CAPITIS, applied on cloths and 
 covered with oiled silk. If combined with an antiseptic and deodorant 
 it prepares the way for subsequent active medical treatment. The following 
 formula may be used: R. Sodii carb., 3]; liq. sodse chlorinat., f|jj ; 
 aquae, ad. fsxij. M. 
 
 SODII CHLORIDUM. Chloride of Sodium. Table-Salt. 
 
 " It is soluble in 2.8 parts of water at 15 C. (59 F.) and 2.5 parts of boiling water; 
 almost insoluble in alcohol." (U. S. P.) 
 
 Common salt applied to the skin acts as a rubefacient and stimulant. 
 It has long been recognized as possessing antiseptic properties, and hence 
 it is extensively employed for the preservation and packing of meats. It 
 is also solvent and protectant. Sea-salt, made by evaporating sea-water, 
 is employed in the proportion of one pound to four gallons of water. 
 This gives about the strength of sea water, and is regarded as a valuable 
 tonic and excitant in depraved states of the system, especially in children. 
 
 General Surgery. As a means of removing the ECCHYMOSIS follow- 
 ing contusions, especially what is known as a " black eye" an efficacious 
 mixture consists of table-salt, three drachms ; chloride of ammonium, one 
 drachm ; dissolved in six ounces of bay water; lint or old linen rags to
 
 SODII CHLORIDUM. 
 
 407 
 
 be saturated and kept constantly over the part. In the treatment of the 
 STINGS OF INSECTS, such as bees, wasps, etc., a saturated solution of 
 table-salt used as a lotion will afford relief. An application of solution of 
 ammonia is, on the whole, more efficient. Table-salt is often applied to 
 leeches to cause them to cease biting. Solutions injected into the rectum 
 will dislodge leeches which sometimes make their entrance while the 
 individual is bathing. Salt given in an enema of water to children is an 
 effectual remedy for THREAD WORMS. A few ounces of a solution of 
 sodium chloride, in strength of a drachm to a pint of warm water, is 
 highly commended by Reginald Harrison as a solvent for the tenacious 
 cystic mucus so frequently found associated with enlargement of the pros- 
 tate gland. A similar lotion is of value in removing masses of dried 
 secretion on muco-cutaneous surfaces. 
 
 Diseases of the Skin. As a stimulating bath chloride of sodium is 
 employed in the strength of eight pounds to thirty gallons of water, 
 which is about the strength of sea water. 
 
 Its employment in baths as an application to various skin diseases, par- 
 ticularly ECZEMA, has been strongly urged by Piffard {Jour. Cutaneous and 
 Venereal Diseases, v, 1887, p. 421). He says that the addition of 
 half a pound to a pound of rock-salt to a bath of twenty-five gallons 
 makes the water agreeable instead of being irritating to the skin of ecze- 
 matous patients. A proportion of ten pounds of salt to the bath is, 
 according to Piffard, appropriate in FURUNCULOSIS, SUBACUTE ECZEMA, 
 PSORIASIS, the IRRITABLE SUMMER RASHES, in URTICARIA, in the SCROFU- 
 
 LODERMATA, and ULCERATIVE SYPHILODERMATA. 
 
 Diseases of the Ear, Nose, and Throat. A solution of five 
 grains to the ounce may be injected into the tympanic chamber in PURU- 
 LENT OTORRHCSA. Largely diluted two drachms to the pint chloride of 
 sodium is used to dislodge tenacious mucus. It forms a cheap and con- 
 venient remedy, but is open to the objection that, when the agent is 
 habitually employed, the membranes lose tonicity. Weak lotions coun- 
 teract the over-effects of application of nitrate of silver. By increasing 
 the specific gravity of the thin, acrid discharges of ACUTE CORYZA 
 solutions of chloride of sodium may be added to the list of remedies for 
 this disease. It is an ingredient of the popular mixture of carbolic acid, 
 borax, and bicarbonate of soda in the treatment of CHRONIC NASAL 
 CATARRH. Valentin ( Correspondenzblatt fur schweizer Aerzte, No. 5, 
 1887) treats Oz^NAby irrigating with salt solution. A spray of from five 
 to ten grains to the ounce is an admirable adjuvant in the treatment of 
 CHRONIC LARYNGITIS accompanied by diminished secretion. 
 
 Diseases of the Eye. Common salt is a favorite domestic remedy 
 in mild cases of CONJUNCTIVITIS, and a very good one. About ten 
 grains to the ounce of water is a good proportion, and the eyes may be
 
 408 LOCAL THERAPEUTICS. 
 
 bathed with it frequently and freely. A weak solution is, perhaps, the 
 best fluid for washing out the anterior chamber after extraction of cata- 
 ract. Three grains to the ounce is about the proportion of salt in the 
 normal aqueous humor. 
 
 SODA CUM CALCE. Soda with Lime. London Paste. 
 The National Formulary directs that London paste be made by mixing equal parts of 
 soda and lime in fine powder. It is sold either in the form of powder or small crayons. 
 
 London paste is a powerful caustic. Its action is similar to that of 
 potassa cum calce (q. v.), but is claimed to be less diffusive, and, there- 
 fore, safer. When moistened with alcohol it is an efficient caustic to 
 apply to small areas within the external auditory meatus. 
 
 Diseases of the Nose, etc. M. Mackenzie recommends London 
 paste for the destruction of HYPERTROPHIES BOTH OF THE NASAL CHAM- 
 BERS AND TONSILS. It is, however, inferior to chromic acid, acetic acid, 
 or the galvano-cautery, but is efficient, through persistent use, in reduc- 
 ing the size of the fibroid masses. 
 
 SODII ETHYLAS. Ethylate of Sodium. Sodium Alcohol. 
 
 Caustic Alcohol. 
 
 Ethylate of sodium is made by dropping small pieces of metallic sodium into absolute 
 alcohol kept at a temperature of 50 F. until reaction ceases; the liquid is then heated to 
 100 F., and sodium again added; it is again cooled to 50 F. and the same quantity 
 of absolute alcohol added as that with which the process started. The product is a 
 fifty per cent, solution of ethylate of sodium. It should be kept in a cool place in a 
 well-stoppered bottle, and applied either by a glass rod or piece of dry wood. 
 A solid form of the ethylate of sodium is available. 
 
 B. W. Richardson (Proc. r. Ass'n Ad. Set'., 1870, and Pharm. 
 Jour, and Trans., 1878, ix, p. 485), who introduced ethylate of sodium 
 to the profession, states that the sodium is oxidized by the oxygen of the 
 water of the tissues to form sodium hydrate, the hydrogen of the water 
 going to reconstitute the common or ethylic alcohol. 
 
 Diseases of the Skin. Richardson (loc. cii.} commends this caustic 
 in the treatment of some diseases of the skin. 
 
 Applied to dry parts of the body surface it is comparatively inert, causing 
 only slight tingling and redness. But, so soon as the part to which it is 
 applied gives up a little water, caustic soda is produced in contact with the 
 skin in proportion as water is eliminated, and there proceeds a gradual 
 destruction of tissues which may be moderated so as to be scarcely per- 
 ceptible, or may be so intensified as to act almost like a cutting instru- 
 ment.
 
 SODII HYDRAS. 409 
 
 The action of the sodium and potassium alcohols is less painful than 
 would be expected, and when pain is felt it may be quickly checked by 
 dropping upon the part a little chloroform, which decomposes the ethylate. 
 The addition of an alcoholic solution of opium, likewise, is said to lessen 
 the pain of the application. 
 
 Ethylate of sodium may be applied upon surfaces rendere'd anaesthetic 
 by cold, either by the application of ice or frozen by rhigolene spray. 
 
 The action of ethylate of sodium on the blood is, according to Rich- 
 ardson, rapid and marked. The red corpuscles are brought into a state 
 of solution, crystallization of the haematin and related substances almost 
 instantly takes place, while the white corpuscles are acted on very 
 slowly. 
 
 Ethylate of sodium may be kept in a solution of half saturation in a 
 glass-stoppered bottle, and should be applied by means of a glass rod, 
 the end of which is somewhat pointed. 
 
 It has been used successfully in the removal of small and moderate- 
 sized NJEVI and TELANGIECTASES. A thin, dry eschar is formed. After 
 some days this can be removed and further applications made until the 
 growth is destroyed. It leaves a smaller cicatrix than that produced by 
 any other caustic. It has also been recommended in NJEVUS, EPITHE- 
 LIOMA, LUPUS, and other new growths, but it has not proved superior 
 to other agents of its class in the cure of these affections. 
 
 Diseases of the Nose. The caustic effect of the sodii ethylate 
 appears to be more manageable than that of caustic potassa. Richard- 
 son (loc. <://.) (The Asclepiad, i, No. 3, 1884) recommends it for the 
 destruction of NASAL POLYPUS. The following direction is abridged from 
 this writer's statements: Saturate a piece of cotton with sodium ethylate 
 and apply to the selected spot for two or three minutes, and withdraw. 
 The mass of polypi may be almost immediately destroyed ; then touch 
 lightly the bases of the outgrowths with the same material. The applica- 
 tion is described as being accompanied with slight burning pain, though 
 occasionally moderate hemorrhage ensues. 
 
 SODII HYDRAS. Hydrate of Sodium. Caustic Soda. 
 General Surgery. Caustic soda, being less deliquescent, possesses 
 some advantages over caustic potassa. The indications for the use of these 
 agents are in all respects similar.
 
 410 LOCAL THERAPEUTICS. 
 
 SODII HYPOSULPHIS. Hyposulphite of Sodium. 
 Sodium Thiosulphate. 
 
 Hyposulphite of sodium, which is more correctly called sodium thiosulphate, is prepared 
 by boiling a solution of carbonate of sodium with sulphur. 
 
 The purifiedproduct occurs in " large, tolorless, transparent, monoclinic prisms or plates, 
 efflorescent in dry air, odorless, having a cooling, somewhat bitter, and sulphurous taste, 
 and a neutral or faintly alkaline reaction. Soluble in 1.5 parts of water at 15 C. (59 F.), 
 and in 0.5 parts of boiling water, in the latter case with partial decomposition ; insoluble 
 in alcohol." (U. S. P.) 
 
 Hyposulphite of sodium is antiseptic and is destructive of parasitic 
 fungi of the tricophyton group. It is mildly analgesic.* 
 
 General Surgery. Polli, of Milan, employs hyposulphite of sodium 
 in the treatment of zymotic diseases, such as ERYSIPELAS, etc., in solu- 
 tions of the strengths of one to two ounces to the pint of water. It is 
 also a reliable preservative. The same writer states that corpses can be 
 kept for anatomical purposes for weeks in solutions of the hyposulphite of 
 sodium without undergoing change in color or density. In GANGRENOUS 
 and FOUL ULCERATIONS a solution of the drug, one to five or ten parts 
 of water, and kept in contact with the involved surfaces by lint, corrects 
 fetid odor and establishes a healthy action. Injections of weak solutions 
 of the hyposulphite of sodium are productive of good results in CHRONIC 
 CYSTITIS, a disease which so frequently accompanies enlargement of the 
 prostate gland, with resultant retention and decomposition of urine. 
 
 Diseases of the Skin. The hyposulphite of sodium is employed 
 as a parasiticide in the VEGETABLE PARASITIC DISEASES OF THE SKIN. In 
 TINEA VERSICOLOR and in TINEA TRICOPHYTINA CRURIS, and other forms of 
 ringworm the remedy is of decided value. It is usually employed in oint- 
 m.nt or in a watery solution, one drachm to the ounce. Although mild 
 in its effects, it has the advantage over most of the other vegetable para- 
 siticides of being quite innocuous and unirritating. The following 
 formula was recommended by Tilbury Fox, not only for the affections 
 above named, but also in PRURITUS VULV^E : R. Sodii hyposulphitis, 
 o' v j glycerini, f5J ; aqure, q. s. ad fvj. M. Sig. Lotion. 
 
 Diseases of the Throat, etc. Thirty grains of the hyposulphite 
 of sodium added to an ounce of water forms a gargle suitable for use in 
 DIPHTHERIA. (Potter.) 
 
 SODII SALICYLAS. Salicylate of Sodium. 
 
 " Small, white, crystalline plates, or a crystalline powder permanent in the air, odorless, 
 having a sweetish, saline, or mildly alkaline taste, and a feebly acid reaction. Soluble in 
 
 * A similar effect may be obtained with the sulphite of sodium, q. v.
 
 SODII SILICAS. 411 
 
 1.5 part of water and in six parts of alcohol at 15 C. (59 F.) ; very soluble in boiling 
 water and in boiling alcohol." (U. S. P.) 
 
 Salicylate of sodium is an antiferment and possesses antiseptic properties, 
 though not to the same extent as does salicylic acid. It is slightly 
 analgesic. (Prosser James, Lancet, July 4, 1885.) It is unirritating and 
 readily absorbed. 
 
 General Surgery. Inglessis has employed a six per cent, solution 
 in glycerite of salicylate of sodium in the treatment of ERYSIPELAS, the 
 affected part to be covered with lint saturated with the solution, and then 
 covered with raw cotton. 
 
 Diseases of the Nose and Throat. Since in the internal treat- 
 ment of RHEUMATIC AFFECTIONS salicylate of sodium is of repute, it has 
 been assumed that the same remedy would be valuable in the local treat- 
 ment of ACUTE RHEUMATIC PHARYNGITIS and LARYNGITIS. The drug 
 serves a useful purpose in NASAL DIPHTHERIA in a wash in the proportion 
 of twenty grains to the ounce. A. C. Baily {Boston Med. and Surg. 
 Journ., October 25, 1888) employs a gargle for PHARYNGITIS in the pro- 
 portion of five grains to the ounce of water. 
 
 SODII SILICAS. Silicate of Sodium. Silicate of Soda. Liquid Glass. 
 " Silicate of sodium (Na.,SiO 3 , or frequently Na. 2 Si 4 O 9 ) is made by fusing one part of 
 silica, fine sand, or powdered flint and two parts of dried carbonate of sodium, mixed in 
 powder, in an earthenware crucible, and pouring out the fused mass on a stone slab to 
 cool. This is pulverized and treated with boiling water to dissolve the soluble part. The 
 solution is filtered and concentrated, so as to form crystals on cooling. These are then 
 purified by dissolving them in water heated to 37.7 C. (100 F.), filtering the solution, 
 and concentrating it so that it may recrystallize. The commercial solution of silicate of 
 sodium usually contains about twenty per cent, of silica and ten per cent, of soda." 
 (U. S. D.) 
 
 Silicate of sodium is protectant. It is employed for the same purposes 
 as are starch and plaster-of- Paris in fixing dressings. 
 
 General Surgery. Silicate of sodium is employed satisfactorily in 
 retaining in position the. turns of the bandage adapted to make extensions 
 on the thigh, either in fracture of the femur or hip disease. After the 
 dressings are adjusted the bandaged portion of the limb is brushed over 
 with the solution, which is allowed to dry. Each individual turn of the 
 bandage is thus fixed, so that a single application of the agent suffices 
 during the treatment. When it is desired to secure more than ordinary 
 rigidity the following plan is recommended : The limb is first enveloped 
 in a roller bandage ; over this is applied (preferably with a brush) a solu- 
 tion of silicate of sodium, having a syrupy consistence. A second roller 
 bandage is then adapted to the parts, and it in turn is covered with the
 
 412 LOCAL THERAPEUTICS. 
 
 liquid glass solution. The slow rate at which the preparation dries 
 (namely, from six to twelve hours) constitutes the main objection to the 
 use of this agent. Of late years it has been nearly supplanted by the 
 more rapidly-setting plaster of Paris. 
 
 SODII SULPHIS. Sodium Sulphite. Sulphite of Sodium. 
 
 Sulphite of Soda. 
 
 "Colorless, transparent, monoclinic prisms, efflorescent in dry air, odorless, and having 
 a cooling, saline, and sulphurous taste and a neutral or feebly alkaline reaction. Soluble 
 in four parts of water at 15 C. (59 F.), and in 0.9 parts of boiling water; only sparingly 
 soluble in alcohol." (U. S. P.) 
 
 Sulphite of soda is germicide. 
 
 General Surgery. Sulphite of soda has been advocated by J. C. 
 McMullen in a solution of ten grains to the ounce of water as an injec- 
 tion in the treatment of GONORRHOEA. 
 
 Diseases of the Skin. The sulphite of sodium is sometimes employed 
 instead of the hyposulphite, but it possesses no advantage, above the 
 former preparation. 
 
 Diseases of the Mouth, Throat, etc. One drachm to the ounce 
 of water can be used as a gargle in STOMATITIS and as an application 
 to APHTHAE (W. Jenner, Med. Times and Gaz., vn, 1853, 183), Mucous 
 PATCHES, ULCERS OF THE TONSILS, and DIPHTHERIA. A similar solution 
 is used in NASAL DIPHTHERIA. (Potter.) 
 
 SODII SULPHOCARBOLAS. Sulphocarbolate of Sodium. 
 " Colorless, transparent, rhombic prisms, permartent in the air, odorless or nearly so, 
 having a cooling, saline, somewhat bitter taste, and a neutral reaction. Soluble in five 
 parts of water and in one hundred and thirty-two parts of alcohol at 15 C. (59 F.) ; 
 in 0.7 part of boiling water and in ten parts of boiling alcohol." (U. S. P.) It should 
 be remembered that the soluble sulphates or diluted sulphuric acid are the chemical 
 antidotes for carbolic acid poisoning, forming sulphocarbolates, which are innoxious. 
 U. S. D. states that this salt is inert. 
 
 Sulphocarbolate of sodium is a mild astringent and germicide. 
 
 Diseases of the Throat, etc. Lefferts claims that one-half drachm 
 to eight ounces of water, to which has been added an ounce of glycerin, 
 forms a valuable gargle in RELAXED STATES OF THE TH>ROAT following 
 ACUTE ANGINA. Waring recommends a similar preparation in the treat- 
 ment of DIPHTHERIA.
 
 SODII SULPHORICINATIS SODII HYPOCHLORIT1S. 413 
 
 SODII SULPHORICINATIS. Sulphoricinate of Sodium. 
 "A brown, syrupy liquid which readily dissolves in water and alcohol. It forms a 
 good solvent for iodine, iodoform, etc." (Helbing.) 
 
 Diseases of the Throat. This drug has been used by A. Joseas 
 (La Med. Moderne, April 28, 1892) in combination with carbolic acid 
 (eighty grammes of the former to twenty of the latter) for DIPHTHERIA. 
 
 SODII HYPOCHLORITIS. 
 
 This is a very unstable salt, and consequently is only known in the following solu- 
 tion : i 
 
 LIQUOR SoDiE CHLORATVE. Solution of Chlorinated Soda. Liquor 
 Sodae Chlorinatae. (Pharm. 1870.) Labarraque's Solution. 
 
 " A clear, pale-greenish liquid, of a faint odor of chlorine, a disagreeable and alkaline 
 taste, and an alkaline reaction; specific gravity, 1.044. Addition of hydrochloric acid 
 causes an effervescence of chlorine and carbonic acid gas." (U. S. P.) This solution is 
 prepared by double decomposition between solutions of chlorinated lime and sodium 
 carbonate, whereby insoluble calcium carbonate and soluble sodii hypochloritis are 
 formed. The latter is decanted from the precipitate, and should be preserved in well- 
 stopped bottles, protected from the light. Liquor sodse chloratae destroys the elastic 
 property of cotton fibre and sponge. The chlorine odor left on the skin after use can 
 be corrected by washing with a lotion of sodii hyposulphis. (M. ., January, 
 1891, p. 14.) The addition of carbolic acid in any proportion produces a mixture 
 cif a peculiar penetrating and, to most persons, disagreeable odor. The best solution 
 is prepared for the market in quart bottles. In a number of specimens of the drug 
 examined by Sternberg, the amount of chlorine varied from 3.80 to 0.03 per cent. Since 
 the properties of the preparation depend upon the amount of chlorine present, it is 
 dtsirable that the liquid, when prescribed, be freshly made, and the date plainly marked 
 upon the label. 
 
 The solution of chlorinated soda is a stimulant, detergent, and a pow- 
 erful disinfectant and parasiticide. 
 
 General Surgery. As an application to GANGRENOUS SURFACES, the 
 solution of chlorinated soda may be applied in a strength of one drachm 
 to the ounce of water, or it may be used in full strength in the prepapa- 
 tion of a common flaxseed poultice. In the treatment of APHTHOUS and 
 PHAGEDENIC ULCERATIONS OF THE MOUTH, which have assumed a slough- 
 ing character, the following will be found of service: R. Liq. sodii 
 chlorinat., tinct. myrrhae, aa f^ss; aquae rosae, f^j ; aquae, f^vj. The same 
 prescription is of service in STOMATITIS of ptyalism, in ulcerated gums 
 of SCURVY, etc. In foul discharges from the vagina, a douche, composed 
 of the solution of one fluid ounce to one pint of water, is efficient. 
 
 Diseases of the Skin. The solution of chlorinated soda has a 
 restricted use in dermatology in affections of the skin, accompanied by
 
 414 LOCAL THERAPEUTICS. 
 
 profuse suppuration and breaking down of the {issues. It may be added 
 to cataplasms and wet dressings employed to macerate the crusts in 
 PEDICULOSIS CAPITIS and CRUSTED ULCERATIVE SYPHILODERMATA. 
 
 Diseases of the Ear, Nose, and Throat. The solution of chlo- 
 rinated soda is one of the most valuable agents in our possession for the 
 correction of fetor in the ear, nose, and throat. It may be employed in 
 the strength of fifteen to twenty drops to the ounce as a lotion, gargle, or 
 spray. It is useful, when largely diluted, to kill LARVAE of insects which 
 have invaded the external auditory meatus. (Roosa.) It is especially 
 indicated in OZ^ENA and "PHARYNGITIS SICCA." It is also of value in 
 conditions accompanied by sloughing, such as are met with in NoiMA and 
 the ANGINA of SCARLET FEVER, since, in addition to the disinfectant 
 properties, it acts as a solvent to the sloughing masses. With care a 
 strength as great as two drachms to the ounce can be borne in FETID 
 CORYZA. Should a stronger preparation be demanded, as in the treatment 
 of DIPHTHERIA, it is best to apply it as pigment. 
 
 Diseases of the Eye. The solution of chlorinated soda has been 
 highly recommended as an antiseptic application to the eye in the propor- 
 tion of one part to seven or ten of water. In the former strength it is 
 applied, on pledgets of cotton, directly to the everted lids or to SLOUGH- 
 ING ULCERS OF THE CORNEA ; for using freely as a wash, the weaker 
 solutions may be still further diluted. It has not been extensively used. 
 
 SOZOIODOL AND ITS COMPOUNDS. 
 
 " Sozoiodol is a compound of iodine with paraphcnol-sulphonic acid, which only differs 
 from sozolic acid, or orthophenol sulphonic acid, in the position of the hydroxyl and 
 sulphonic group." (T. Lauder Brunton, " Modern Therapeutics," 1892.) Sozoidol con- 
 tains three of the strongest antiseptics: iodine, sulphur, and carbolic acid. It forms salts 
 of mercury, potassium, sodium, and zinc. These appear to be pure and non-irritating. 
 Sozoiodol has not been thoroughly studied, and its properties not always separately treated 
 from the bases with which it unites. It resembles iodoform in many respects, but is 
 without odor. It is non-toxic. 
 
 Sozoiodol is described as being astringent, germicidal, and disinfectant. 
 
 According to Suchannek (jCorrespondbl. fur schweizer Aertze, xix, 
 1889, 283), a two per cent, solution of sozoiodol arrests the development 
 of pyogenic coccii in gelatin. 
 
 General Surgery. Sozoiodol may be applied in powder, either pure 
 or mixed with talc, combined with lanolin (i-io), or in solution (two 
 grains and upward). It may be used as an adjuvant to a protectant dres- 
 sing of cotton. In open wounds which have become putrescent, sozoiodol 
 possesses advantage over other agents. E. Ostermeyer {Deutsch. med. 
 IVochenschr., October 10, 1889) uses sozoiodol in the treatment of BURNS. 
 This writer claims that it possesses advantages over iodoform. It is
 
 SOZOIODOL AND ITS COMPOUNDS. 415 
 
 slightly analgesic, and prevents suppuration. The vesicles are punctured, 
 and a mixture of sozoiodol and starch (i-io) dusted over the exposed 
 surfaces. The favorable action of the remedy can be detected within 
 twenty-four hours. Sozoiodol is also used in the treatment of INDOLENT 
 ULCERS. In two cases presenting identical features, Nitschmann (//. 
 klin. Rundschau, No. 32, 1891 ; see also Therap. Gaz., February, 1889) 
 treated one with iodoform and the other with sozoiodol, and found the 
 latter the more efficient agent. The formula commended by this writer 
 is as follows : Ten parts of sozoiodol to one of lanolin. 
 
 Diseases of the Nose, Throat, etc. Sozoiodol, according to 
 M. A. Fritsche (Therapeut. Monatsheft., June, 1888, p. 283). has value 
 in the local treatment of "PHARYNGITIS SICCA " and CHRONIC LARYN- 
 GITIS. Claims are also made that it aids in healing TUBERCULAR ULCER- 
 ATIONS. 
 
 Suchannek recommends it in the treatment of CHRONIC NASAL 
 CATARRH, accompanied with scanty secretions. Insufflations of a powder" 
 composed of one part of the salt to seven of talc are preferred. The 
 powder may, however, be weakened and yet retain its efficiency, so as 
 to represent one part to twelve, or even one to fifteen. 
 
 HYDRARGYRI SOZOIODOLAS. Sozoiodolate of Mercury. 
 
 This salt forms a lemon yellow powder, soluble in water in the proportion of one part 
 to five hundred ; more readily soluble than sodium chloride. 
 
 Sozoiodolate of mercury, in the strength of i-io, is said to be caustic. 
 
 General Surgery. Troemner credits it with value in the local treat- 
 ment of SYPHILIS. H. Suchannek recommends it in proportion of 1-20 
 and i-io for SYPHILITIC ULCERATION ; it is to be applied directly by a 
 dossil of cotton to the selected surface. 
 
 Diseases of the Skin. Nitschmann (Wien klin. Wochenschr., 1891, 
 No. 26) used a ten per cent, solution of the Sozoiodolate of mercury 
 as a lotion in TINEA VERSICOLOR, and also in hypodermic injection for 
 SYPHILITIC ERUPTIONS. The formula he employs is the following: K. 
 Hydrarg. sozoiodol., gr. viij ; potas. iodid., gr. xvj ; aquae destityat., 
 n^c. M. A " Pravaz syringeful " (HLXV) of this is injected once a 
 week. 
 
 Diseases of the Throat, etc. Suchannek commends this salt in 
 the local treatment of TUBERCULAR LARYNGITIS. 
 
 POTASSIUM SOZOIODOL. Sozoiodolate of Potassium. 
 
 This salt of sozoiodol occurs in long, white, acicular crystals, soluble in fifty parts of 
 water. The solution is acid to litmus paper, and gives a bluish violet color with ferric 
 chloride. Exposure to light causes the aqueous s-olution to darken.
 
 41 6 LOCAL THERAPEUTICS. 
 
 Diseases of the Nose, etc. H. Suchannek (Correspondenz-Blatt 
 
 f. schw. Aertze, 1889, xix, 283) claims that this salt combined in equal 
 proportions with talc, or one of the salt to two of talc, possesses distinct 
 advantages over other astringent and alterative powders in the treatment 
 of CHRONIC NASAL CATARRH. 
 
 SODII SOZOIODOLAS. Sozoiodolate of Sodium. 
 
 The sodium salt of sozoiodol occurs in white, well-defined, prismatic crystals. These 
 crystals are soluble in fourteen parts of water. The solution darkens on exposure to light, 
 has an acid reaction, and gives a violet color with ferric chloride. This salt is more adhe- 
 sive and more soluble than the sozoiodolate of potassium. 
 
 Sodium sozoiodolate is astringent and alterative. 
 
 Diseases of the Nose, etc. In proportions of one part of the 
 salt to two of talc, H. Suchannek (loc. cit.} extols a powder, to be 
 insufflated in the treatment of CHRONIC NASAL CATARRH, associated 
 with muco-purulent or purulent discharges. 
 
 ZINCI SOZOIODOLAS. Sozoiodolate of Zinc. 
 
 Zinc sozoiodalate forms colorless, acicular crystals, with six molecules of water. The 
 salt is soluble in twenty parts of water, and in alcohol. 
 
 Sozoiodolate of zinc is stimulant and astringent. 
 
 General Surgery. In GONORRHCEAL URETHRITIS sozoiodolate of 
 zinc is recommended. It is indicated in VAGINITIS when daily treatment 
 is impossible. A tampon saturated with the ointment (i-io) is an avail- 
 able form. Satisfactory results have been obtained by the use of the 
 powder in cases of CATARRH of the UTERINE CERVIX. 
 
 Diseases of the Skin. Schwimmer has used the zinc preparation 
 in simple ULCERS. 
 
 Diseases of the Throat, etc. A writer in the L' Union Med., 
 1890, recommends sozoiodol of zinc one part, talc ten parts, as a snuff for 
 ATROPHIC RHINITIS. Suchannek also commends this salt in HYPERTROPHIC 
 CHRONIC NASAL CATARRH accompanied with diminished secretion, and 
 as an excitant in ATROPHIC RHINITIS, and "PHARYNGITIS SICCA." The 
 salt possesses the additional characteristic that in connection with excite- 
 ment of the nasal mucous membrane it softens crusts and diminishes fetor. 
 In the same combination, in the proportion of one of the salt to twelve of 
 the talc, in HYPERTROPHIC NASAL CATARRH. In the proportion of one to 
 twenty it may be employed locally in SYPHILITIC ULCERATION OF THE NOSE 
 AND PHARYNX.
 
 SPIRITUS /ETHERIS NITROSI SPIRITUS ODORATUS SPONGIA. 417 
 
 SPIRITUS ^ETHERIS NITROSI. Spirit of Nitrous Ether. Sweet 
 
 Spirits of Nitre. 
 
 " An alcoholic solution of ethyl nitrite, containing five 'per cent, of the crude ether." 
 (U. S. P.) 
 
 Sweet spirit of nitre is refrigerant and parasiticide. 
 
 Diseases of the Skin. The Spiritus ^Etheris Nitrosi is employed 
 as an application in DERMATITIS VENENATIS. A rag or sponge wet with 
 the ether, applied to the pubis and covered with oiled silk, kills PEDICULI 
 PUBIS at once. 
 
 SPIRITUS ODORATUS. Perfumed Spirit. Cologne Water. 
 A Cologne water is official (U. S. P.), but the formulas of the best apothecaries are 
 more popular. One of these, which yields a product practically indistinguishable from 
 the celebrated " Farina Colognes," is as follows : 
 
 Take of oil of bergamot, 400 rr^. 
 
 lemon 400 n^, 
 
 orange, 400 n^. 
 
 lavender, 48 TTL- 
 
 rosemary, 96 tr^. 
 
 neroli (bigarade), 144 TT^. 
 
 neroli petite grain 192 rt^. 
 
 extract of orange flowers, 800 \^. 
 
 " jessamine, 200 rr^. 
 
 oil of verbena, 24 1TL. 
 
 Alcohol sufficient to make one gallon. 
 
 All the ingredients must be of the best. The alcohol is to be absolutely without odor. 
 That which is known in commerce as " Cologne spirit " is best adapted to this purpose. 
 
 General Surgery. Cologne water is frequently employed in domes- 
 tic medicine as a lotion for BRUISES or CONTUSIONS. It is a useful pre- 
 paration (though to many persons the constant odor left after using it 
 becomes disagreeable) to apply as a liniment after the removal of surgical 
 dressings in the same way in which whisky or alcohol is employed. It is 
 soothing in HEADACHE, applied to the temples and allowed to evaporate. 
 
 Diseases of the Mouth, Throat, etc. A few drops of Cologne 
 water may be added to medicated fluids to be inhaled. It is an agreeable 
 addition to many gargles. 
 
 SPONGIA. Sponge. 
 
 For the preparation of sponges for ordinary surgical use the reader is referred to the 
 U. S. D. For bleaching, the method pursued at the Pennsylvania Hospital has been 
 found satisfactory. The sponge, after being thoroughly beaten, to remove all sand 
 and loose matter, is placed in a ten per cent, solution of muriatic acid (fj| xij-gal. j) for 
 twenty- four hours, afterward to be thoroughly freed from acid by frequent washings. 
 27
 
 41 8 LOCAL THERAPEUTICS. 
 
 Then to be placed in a solution of permanganate of potash ( ^iiss to the gal.). After a 
 second washing the deeply-stained sponges are placed in a solution of oxalic acid, 3 xxxj 
 to the gallon of water, to which is added sulphuric acid, f ^ ss, and allowed to remain 
 until bleached. After again thoroughly washing, they may be packed away dry in clean, 
 stopped glass jars, or kept in a five per cent, solution of carbolic acid. In this way 
 the cheaper grade of sponges may be employed for surgical operations. 
 
 General Surgery. Sponges are of use in surgery in consequence of 
 their softness and the property they possess of absorbing liquids. Sponges 
 are especially valuable in removing the flowing blood from incisions made 
 in operations, since the quick absorption of blood enables the surgeon 
 to see clearly the tissues that are exposed. In abdominal section flat 
 sponges, six to eight inches in diameter, are used as a means of protect- 
 ing the intestine from the chilling .influence of the atmosphere. In the 
 modern method of dressing wounds (especially in hospital practice) 
 absorbent cotton, oakum, tow, etc., largely supplant the employment of 
 sponge. A sponge tent is prepared by taking a piece of conical 
 sponge, and when in a moist state evenly wrapping it with stout thread, 
 thus compressing the mass somewhat into the form of a cylinder ; 
 when dry the wrapping is removed and the sponge placed in hot 
 wax. On introduction into a canal (let us say of the cervix uteri) 
 the heat of the body melts the wax and releases the sponge, which by 
 imbibition of moisture causes dilatation of the parts to take place. 
 Sponge tents are inferior to those made from laminaria. In the uterine 
 cavity it is well to introduce at least one sponge tent with the laminaria, 
 as the former will prevent the mass of tents from slipping from the cavity, 
 which so often happens if the agent last named is employed. (See 
 Laminaria.) D. J. Hamilton (Edin. Med.Journ., November, 1881) advo- 
 cates the introduction- of a layer of sponge, which has been rendered 
 thoroughly aseptic, in the treatment of LEG ULCER; he employs the best 
 quality of sponge. The edges are inserted beneath the undermined edges 
 of the lesion, and over this is applied an antiseptic dressing. At first 
 there is evidence of purulent formation, which is followed by granulations 
 passing into the sponge. On the fifth day the edges become firm and 
 the ulcer is occupied with organized material. At the end of three 
 months only small portions of sponge are visible, and by four months 
 all have disappeared. The granulating surface now hastens to cica- 
 trize. A solution of carbolic acid (one to twenty) is used for irrigating 
 the ulcer at each dressing. XV. Hall has successfully employed sponge 
 grafts for closing OLD SINUSES. In the opinion of Ferguson every pur- 
 pose can be accomplished by leaving the sponge in the tract for a few 
 days and then detaching it, so that it is doubtful whether it acts 
 otherwise than as a stimulating dressing. 
 
 Diseases of the Nose. Sponge may be used to dilate a narrowed
 
 SPONGIO-PILINE STAPHISAGRIA STRAMONIUM. 419 
 
 nostril, to serve as a tampon against the walls of the chamber in the 
 treatment of FETID CATARRH, and to act as a plug in the posterior nares 
 either for the arrest of bleeding or as a preliminary measure to irrigation. 
 For all these uses the most compact pieces possible of the finest sponge 
 should be selected. The principle of the tampon for the relief of FCETID 
 CATARRH (see Gossypiuni), which has been discussed by Gottstein, 
 appears to have been practiced by J. Solis- Cohen in the form of sponge 
 compresses. 
 
 SPONGIO-PILINE. 
 
 Spongio-piline was in use a number of years ago for taking the place of poultices. It 
 consisted of a thick cloth or felt, on the back of which was a layer of rubber, and on the 
 face a layer of sponge. This sponge was felted in and then shredded, so as to make a 
 pile, or nap. The sponge side, when well moistened with hot water, acted as a poultice, 
 the moisture being kept in by the rubber back. It has almost entirely gone out of use, 
 and has disappeared from the stores. 
 
 Diseases of the Eye. Spongio-piline is a convenient means of 
 employing moist heat in ophthalmic practice. 
 
 STAPHISAGRIA. Stavesacre. 
 
 " The seed of Delphinium staphisagria." (U. S. P.) It contains a fixed oil as well 
 as an alkaloid. The oil is efficient but is not available. An ointment, unguenium 
 staphisagria, is official in Ph. Br. It is made by digesting one part of stavesacre-seed 
 in two parts of benzoinated lard, in a water bath for two hours, and straining. 
 
 Stavesacre is parasiticide, while non-toxic to the host. 
 
 Diseases of the Skin. The coarsely-ground seeds of Stavesacre, 
 in the proportion of three parts to five of lard, digested for twenty-four 
 hours at a temperature of 212 F. and strained, yield an ointment which 
 is valuable in the destruction of PEDICULOSIS CAPITIS and PEDICULO- 
 SIS CORPORIS. It does not, however, kill the ova. The fluid extract, 
 diluted with vinegar, in the proportion of a drachm to the ounce, 
 accomplishes both objects. Stavesacre kills the mature animals and the 
 vinegar the ova. In attacking the head-louse the scalp must be cleansed 
 from time to time, during the treatment. No parasiticide is effective, in 
 destroying the body-louse unless the clothes are subjected to a heat sufficient 
 to destroy the ova. 
 
 STRAMONIUM. Jamestown Weed. 
 
 Both the leaves and the seeds of Datiira stramonium are official. The alkaloid 
 (daturine) is obtained usually from the seeds. There are two daturines known, the 
 heavy and the light. The heavy daturine is a mixture of atropine and hyoscyamine; 
 and light daturine is hyoscyamine.- Hence, the alkaloids called daturine are atropine or 
 hyoscyamine, or mixtures of them. (See Belladonna^ 
 
 Stramonium is one of the ingredients of baume tranquille.
 
 420 LOCAL THERAPEUTICS. 
 
 Stramonium is anodyne and antispasmodic. The over-impression is 
 highly toxic. 
 
 General Surgery. The leaves of stramonium are applied either in 
 the form of fomentations or cataplasms. In CANCEROUS ULCERATIONS the 
 following ointment is used at the Middlesex Hospital, and is effective in 
 relieving pain : it is made by taking fresh stramonium leaves, one-half 
 pound ; lard, two pounds, mixing the bruised leaves with the lard and 
 exposing to a mild heat, and straining through lint. The ointment thus 
 prepared is spread on lint and applied to the part. In PAINFUL NODES 
 and swellings a stramonium leaf, soaked in spirit and laid over the part, 
 will often prove effective. An ointment composed of equal parts of extract 
 of stramonium and Goulard's cerate is a remedy of established value for 
 painful HEMORRHOIDS. A small portion is applied twice daily, after ablu- 
 tion. Equal parts of ointment of stramonium and of nut-gall may be 
 substituted. 
 
 Diseases of the Ear and Throat. Stramonium has held a high 
 position as a local remedy in SPASMS OF THE GLOTTIS and in ASTHMA. 
 The smoke from the burning leaves may be inhaled. A convenient 
 means of using it is to draw the fumes into the lungs through a pipe filled 
 either with the pure leaves, or a mixture of the same with tobacco. The 
 impression is ordinarily combined with that of nitrate of potassium. The 
 effect should be carefully watched, since the poisonous properties of 
 the drug may be easily induced. The smoke from about a half ounce of 
 the leaves may be inhaled at a single sitting. The number of sittings is 
 determined by the attendant circumstances. A sensation of heat in the 
 lung, or fullness about the head, or nausea, are indications that a maxi- 
 mum impression has been obtained. E. L. Shurly (TV. Y. Med. Journal, 
 September n, 1886) believes that a solution of the strength of one one- 
 hundredth to one-fiftieth of a grain of daturine is of value in the treatment 
 of INFLUENZA. 
 
 Diseases of the Eye. Daturine is a doubtful MYDRIATIC. The 
 preparations found in the shops under that name are probably either identi- 
 cal with one of the other alkaloids, a mixture of several of them, or the 
 product of chemical processes. 
 
 DATURA TATULA. 
 
 Diseases of the Throat, etc. Similar in properties to those of 
 stramonium are inhalations of Datura tatula. Fumigation from the leaves 
 is recommended by M. Mackenzie for SPASM OF THE GLOTTIS. .
 
 STROPHANTHUS STYRONE SULPHUR. 42 1 
 
 STROPHANTHUS. 
 
 The seed of Slrophanthus hispidus. The kombe arrow poison is made from this seed. 
 Strophanthin is the active glucoside. " It is a white, crystalline powder, neutral in 
 reaction, intensely bitter, freely soluble in water, less so in rectified spirit, and nearly 
 insoluble in ether and chloroform." (U. S. D.) 
 
 Strophanthus is analgesic. 
 
 Diseases of the Eye. Numerous experiments on animals have 
 shown that Strophanthin produces an anaesthetic effect upon the cornea. 
 Various observers have reported different results of experiments on the 
 human eye, but all agree that the drug is too irritating to be introduced 
 into practice. 
 
 STYRONE. Storone. 
 
 Styrone occurs in balsam of Peru and in storax ; it is presented in two forms, crystal 
 and liquid, both having the same virtue, the crystals being the more expensive. Styronf 
 has an agreeable odor, somewhat like that of frankincense, and is non-poisonous. It is 
 somewhat soluble in water, and freely soluble in alcohol and ether. H. H. A. Beach 
 {Boston Med. and Surg. Jour., August I, 1889) has called special attention to this agent. 
 
 Styrone is antiseptic and analgesic. 
 
 General Surgery. For disinfecting FOUL or ULCERATING SURFACES a 
 solution of 1-12 has given satisfaction. After excision of the mammary 
 gland in the female, the wound healed in ten days, under a dressing of 
 charpie soaked in the solution last named. (Beach.) The same writer used 
 styrone successfully in PYOTHORAX. After resection of a rib the cavity 
 was at first flushed with a 1-200 solution, the strength being gradually 
 raised to 1-40. When used as a spray styrone is of service in cases of 
 ulcerating CANCEROUS GROWTHS. An emulsion, with olive oil, wafer, or 
 liquid vaseline, may be freely applied to WOUNDS if the undiluted drug is 
 irritating. 
 
 Diseases of the Ear. According to Cheltsoff {Bolinitchnayagazeta, 
 Botinka, May 9, 1890) styrone is of value in the treatment of OTOR- 
 RHOZA. A scruple is added to an ounce of alcohol. One part of this 
 mixture is diluted with seventy of water and injected. The remedy arts 
 rapidly ^n promoting cure in cases in which bichloride of mercury and 
 alcohol have failed. 
 
 SULPHUR. 
 
 Three forms of sulphur are official. Sulphur Sublimatum (sublimed sulphur), 
 which " is sulphur prepared from crude or rough sulphur by sublimation " (Ph. Br.) ; 
 Sulphur Lotum (washed sulphur) ; and Sulphur Prsecipitatum. Precipitated sulphur is 
 " a very fine, yellowish-white, amorphous powder, odorless and almost tasteless, insoluble 
 in water or in alcohol, but completely soluble in a boiling solution of soda, or in 
 disulphide of carbon." (U. S. P.) The same description applies to sulphur loturu,
 
 422 LOCAL THERAPEUTICS. 
 
 except that it is said to be of a citron yellow, and, with the same exception, and the 
 additional one that it has a slight odor and taste, to sulphur sublimatum. An ointment 
 of sulphur (thirty parts to seventy parts of benzoinated lard) is official. (See Thalinin.} 
 
 Sulphur is, first, an antiseptic and parasiticide, and, second, a kerato- 
 plastic agent, favoring the reproduction of the horny epithelium. It acts 
 also as a vehicle in the composition of powders. It possibly possesses 
 obscurely defined alterative properties. 
 
 General Surgery. Sulphur has been employed in the treatment of 
 SCIATICA by Cowden. In a patient treated by this writer, where one-half 
 grain doses of morphine, combined with one-sixtieth of a grain of 
 atropia, failed to give relief, the affected limb was covered with precipi- 
 tated sulphur, and in a short time profuse sweating occurred, with marked 
 diminution of pain. The treatment was repeated for two nights. A 
 second patient, who otherwise could not move in bed, was cured. 
 Duchane {Therapeutic Gazette, 1888, p. 626) also reports success with 
 this treatment. The odor of the urine partook strongly of sulphuretted 
 hydrogen. 
 
 Diseases of the Skin. Sulphur is one of the oldest and best known 
 remedies used in the external treatment of diseases of the skin. 
 
 As a parasiticide its effect upon SCABIES is well known. A few thorough 
 inunctions of the Unguentum Sulphuris (U. S. P.) will, in most cases, 
 suffice to arrest the disease, so far as the parasite is concerned. There 
 remains, however, to be treated, the ECZEMA, or DERMATITIS, rather, which 
 accompanies the disease. This is rather aggravated than allayed by the 
 use of strong sulphur ointment, so that the treatment of such cases is 
 often unduly prolonged, unless the sulphur ointment is suspended. For 
 this reason a milder sulphur ointment is preferable, and in most cases 
 this should be combined with some agent which, while in itself parasiti- 
 cide, will also cure the dermatitis. Such a combination is found in the 
 ointment of naphthol and sulphur. The following combination is recom- 
 mended by J. C. White, of Boston : R. Flor. sulphuris, gij ; /?-naphthol, 
 3J ; bals. Peru, vaseline, aa |j. M. (See "Naphthol"} 
 
 In Germany, "HelmericW s Ointment" has been largely used. This is 
 composed as follows: R. Sulphuris, ^ij ; potas. carb., 3] ; adipis, gj. M. 
 
 Vlemingckx 1 s Solution (see below) is sometimes employed in SCABIES. 
 
 In this country an ointment of one drachm of the flowers of sulphur to 
 the ounce of lard will generally be found strong enough. 
 
 In the treatment of the vegetable parasitic diseases, especially TINEA 
 VERSICOLOR, sulphur may be employed with success. The form of Vlem- 
 ingckx 1 s Solution is most convenient for this purpose. This is composed 
 as follows: R. Calcis vivse, 3J ; sulphuris sublimat., giss ; aquae, foxiij. 
 M. The lime, first slacked, is thoroughly mixed with the sulphur and the 
 mixture is then heated with the water, thoroughly stirring until incor-
 
 SULPHUR. 423 
 
 porated. The whole mixture is then boiled down to one fluidounce 
 and filtered. Usually it should be considerably diluted, as it is almost 
 caustic when made by the above formula. Vlemingckx's solution is 
 sometimes employed in the local treatment of PSORIASIS, a small portion 
 of the lotion, more or less diluted, being well rubbed into the patches 
 daily. 
 
 In the treatment of COMEDO the following combination has been found 
 useful : R. Sulphuris, glycerin i, potas. carbonat., alcoholis, aetheris, aa p. 
 aeq. M. The parts are taken by weight. The mixture is to be well 
 rubbed into the part with friction. 
 
 Sulphur forms a prominent element in the preparations employed in 
 the treatment of ACNE. In the form of ointment alone, or combined 
 with camphor, this drug is useful. The following formula is an example : 
 R. Sulphur prsacipitat., gss; pulv. camphorae, gr. x; ung. aquae rosae, %j. 
 M. A somewhat similar preparation, in the form of a lotion, is the fol- 
 lowing : R. Sulphur praecipitat., gr. xxx ad. 3] ; pulv. camphorae, gr. xv ; 
 alcoholis, f^ij ; aquae, ad. f^j. M. An excellent wash in many forms of 
 Acne is that known as " Kummerfeld's Lotion": R. Sulphur praecipi- 
 tat., ^ij ad. iv; pulv. camphorae, gr. x ad. xx; pulv. tragacanth., 9j 
 ad. iiss ; aquae calcis, aquae rosae., aa f^ij. M. 
 
 In PSORIASIS, sulphur is employed in combination with tar in the prep- 
 aration known as "Wilkinson's Ointment'." R. Sulphur praecipitat., 
 picis liquidae, aa gr. Ixvj ; pulv. cretae preparat, gr. xliv ; saponis viridis, 
 adipis, aa ^ss. M. This ointment is also useful in TINEA TONSURANS 
 and in some cases of INFILTRATED ECZEMA. It is a favorite European 
 remedy for SCABIES. 
 
 Sulphur soaps are of more value than most medicated soaps, though 
 their effect is feeble compared to that of other vehicles of administration. 
 (See Sapo.*) 
 
 Even before the knowledge that so many inflammatory and particularly 
 pustular diseases of the skin were dependent upon bacteria was established, 
 it had been found that sulphur was of value in these affections. We 
 therefore find it employed in ECZEMA, SYCOSIS, IMPETIGO, ECTHYMA, and 
 similar affections with success. Ointments of one-half to two drachms to 
 the ounce are usually valuable in these diseases. In the ECZEMA OF 
 CHILDREN a sulphur and tar ointment, half a drachm of each to the ounce 
 of oxide of zinc ointment, is of high value. 
 
 Diseases of the Nose and Throat. Flowers of sulphur act the 
 part of an indifferent substance in the composition of a powder to be 
 used by insufflation in the nasal chambers. E. J. Moure recommends a 
 similar powder in the treatment of "PHARYNGITIS SICCA." It is also 
 much employed in the south of Europe as a domestic medicine, as a
 
 424 LOCAL THERAPEUTICS. 
 
 local remedy in DIPHTHERIA. A lozenge is offered for same, which con- 
 tains two grains of sulphur to the mass. 
 
 OLEUM LINI SULPHURATUM. Sulphur Balsam. 
 This preparation is made by boiling sulphur with linseed oil. 
 
 Sulphur balsam is an old form of securing the local effect of sulphur 
 upon the tissues. 
 
 SULPHURIS HYPOCHLORITUM. Hypochloride of Sulphur. 
 
 Sulphur hypochloride is a mixture of sulphur chloride and sulphur. Sulphur chloride 
 is prepared by passing dry chlorine over dry sulphur. 
 
 Diseases of the Skin. Hypochloride of sulphur, two drachms, 
 combined with carbonate of potassium, ten grains ; lard, one ounce, and 
 oil of bitter almond, ten drops, has been employed in the treatment of 
 ACNE. 
 
 SULPHURIS IODIDUM. Iodide of Sulphur. 
 
 " Iodide of sulphur is a grayish-black solid, generally in pieces having a radiated, 
 crystalline appearance, the characteristic odor of iodine, a somewhat acrid taste, and a 
 faintly acid reaction. It is insoluble in water, but very soluble in disulphide of carbon ; 
 also soluble in about sixty parts of glycerin. Alcohol and ether dissolve out all the 
 iodine, leaving the sulphur. When exposed to the air it gradually loses iodine." (U. 
 S. D.) 
 
 Iodide of sulphur is alterative. 
 
 Diseases of the Skin. Iodide of sulphur enters into the composi- 
 tion of an ointment sometimes employed in the treatment of ACNE. 
 Ten grains to a drachm are incorporated with an ounce of lard. 
 
 SUMBUL. Sumbul. Musk Root. 
 
 " The root of Ferula sumbul." (U. S. P.) It contains two volatile oils, two balsamic 
 resins, angelic and valerianic acids. The single official preparation is the tincture, which 
 contains the activity of ten parts of sumbul in one hundred parts of alcohol. 
 
 Sumbul is a nervous stimulant and antispasmodic. 
 
 Diseases of the Throat, etc. Sumbul is employed by M. Mac- 
 kenzie in the form of the tincture. One drachm is added to nine of 
 rectified spirits ; nitrate of potassium paper (q. v.) is moistened therewith. 
 It mitigates the irritative effects of the inhalation of the fumes of the 
 burning paper in the treatment of SPASM OF THE LARYNX, TRACHEA, AXD 
 BRONCHIAL TUBES.
 
 TABACUM TALCUM TERRA. 
 
 425 
 
 TABACUM. Tobacco. 
 
 " The commercial dried leaves of Nicoliana tabacum. Linne." (U. S. P.) Tobacco 
 relaxes muscular tension, and thus aids in those clinical conditions in which muscle fibres 
 cannot be relaxed by the will. Ether and chloroform have largely taken its place. 
 
 Tobacco holds a secondary position as an antispasmodic, sedative, 
 sternutatory, and excipient. In the local use of tobacco care must be 
 taken to avoid the easily induced toxic impression. 
 
 General Surgery. An infusion of tobacco is recommended for the 
 relief of PRURITUS VULWE and PRURITUS ANI. It has also been used in 
 the form of an ointment in painful HEMORRHOIDS. Tobacco stupes or 
 enemata are aids in the reduction of HERNIA. Deaths have resulted 
 from the use of tobacco enemata for SEAT WORMS. 
 
 Diseases of the Nose, etc. Tobacco is one of the ingredients of 
 Dobeir s snuff. Formerly tobacco was of good repute in the treatment of 
 CHRONIC CATARRH, but it is now little used. It occasionally aids the 
 impression of stramonium in the treatment of SPASMODIC ASTHMA, or it 
 may be substituted for this drug. Its action is irregular and often disap- 
 points. Puffing tobacco smoke into the external auditory passage is an 
 old domestic remedy for OTALGIA. 
 
 TALCUM. Talc. French Chalk. Tailor's Chalk. Venetian Talc. 
 A magnesium silicate; an insoluble, inert, and incombustible powder. The National 
 Formulary gives a recipe for its purification to fit it for use as a filtering medium. Pow- 
 dered talc is largely used as a face-powder, either alone or combined with other cos- 
 metics. 
 
 Talc is protectant and excipient. 
 
 Diseases of the Ear and Nose. Talc is often used in INFLAMMA- 
 TION OF THE EXTERNAL AUDITORY MEATUS. Diluted with bismuth sub- 
 nitrate it forms the basis of a snuff for FETID CATARRH. (Trousseau.) 
 
 TERRA. Earth. 
 
 Earth, when relatively free from organic matter and prepared by being 
 passed through a fine sieve, acts the part of a mild protectant and disin- 
 fectant. A. Hewson ("Earth as a Topical Application in Surgery," 
 Philadelphia, 1872) employed powdered earth for a variety of purposes 
 in general surgery. 
 
 Mud has long been in popular repute as a vulnerary and as a protectant 
 application to swellings resulting from the stings of insects.
 
 426 LOCAL THERAPEUTICS. 
 
 TEREBINTHINA. Turpentine. 
 
 " A concrete oleoresin from Pinus australis, Michaux, and from other species of 
 Pinus. * * In yellowish, tough masses, brittle in the cold, crummy-crystalline in 
 
 the interior, of a terebinthinate odor and taste." (U. S. P.) 
 
 The subjects treated of in this place are the following : Resina ; Em- 
 plastrum resinae ; Oleum terebinthinae ; Terebene ; and Terpinol. 
 
 RESINA. Resin. Colophony. Rosin. 
 
 " The residue left after distilling off the volatile oil from turpentine. A transparent, 
 amber-colored substance, hard, brittle, with a glossy, shallow, conchoidal fracture, and 
 having a faintly-terebinthinate odor and taste. It is soluble in alcohol, ether, and fixed 
 or volatile oils." (U. S. P.) 
 
 The ceratum resina (containing thirty-five parts of resin, fifteen parts of yellow wax. 
 and fifty parts of lard) is official, as is the emplastrum resince, which contains fourteen 
 parts of resin in eighty parts of lead plaster mixed with six parts of yellow wax. (See 
 Carbolized Gauze.} 
 
 General Surgery. Resin is not employed in surgery in the pure 
 state, although in conjunction with other substances it forms the basis of 
 plasters, chief among which is the adhesive, or resin plaster. The resin 
 cerate is one of the best dressings for INDOLENT GRANULATIONS, especially 
 those following BURNS and SCALDS. It is frequently employed as an early 
 dressing to BLISTERED SURFACES to prevent their healing. The compound 
 resin cerate or " Deshler's Salve," as it is commonly known, is a more 
 stimulating ointment. Both of the resin cerates are extensively employed 
 as dressings for FURUNCULUS INFLAMMATION. 
 
 Diseases of the Throat, etc. M. Mackenzie uses a resinous solu- 
 tion in ether, one to five, as a varnish on DIPHTHERITIC DEPOSITS ; the 
 membrane should be first dried with blotting paper. 
 
 EMPLASTRUM RESINCE. Resin Plaster. Adhesive Plaster. 
 This is the lead adhesive plaster which was universally used before the introduction 
 of the rubber adhesive piaster, and which, because it is less irritating to sensitive skins, is 
 still preferred by some practitioners. It is made by adding to eighty parts of lead plaster 
 fourteen parts of resin and six parts of yellow wax. It is then spread on a muslin pre- 
 pared for the purpose. 
 
 Adhesive plaster, while based upon the lead plaster, is rarely, if ever, 
 used for the purposes of exhibiting the impression of oxide of lead, and is 
 therefore here included under the head of terebinthina, since the resin 
 which enters into its composition also gives the preparation its official 
 name. 
 
 General Surgery. To obtain the best results from adhesive plaster, 
 the material must be freshly cut from a roll which has been kept in a tin
 
 TEREBINTHINA. 427 
 
 box or other close-fitting receptacle. The plaster is best heated over an 
 alcohol lamp or against the side of a vessel containing hot water (the 
 smooth or non-adhesive side being placed in contact with the heated sur- 
 face until the plaster is thoroughly softened), when it must be immediately 
 applied to the skin. Placing a strip of adhesive plaster around a stove- 
 pipe, with the adhesive side out, will often prove practicable in private 
 practice. When strips are used which from their great length it is incon- 
 venient to heat, the plaster surface can be softened by rubbing it over 
 with a bit of raw cotton moistened with chloroform or ether. 
 
 Adhesive plaster may be worn for weeks at a time without producing 
 cutaneous irritation. Hence it is to be preferred to rubber plaster for 
 making extension for fracture of the thigh, or for affections of the hip 
 joint. Firmly applied over an ULCER and supported by a bandage, 
 it forms a reliable method of dealing with LEG ULCERS due to varicose 
 veins. Adhesive plaster is extensively employed in the treatment of frac- 
 tured ribs and contusions of the chest. A number of strips about two 
 inches wide are applied parallel to the ribs, beginning at the lowest and 
 passing up to the axilla. Each strip is to be applied with firm trac- 
 tion, and extend from the vertebral column to a point a little beyond 
 the median line in front. Marked relief is afforded by this procedure. 
 In fracture of the clavicle in children a dressing of adhesive plaster 
 will be found a satisfactory means of keeping the ends of the bone in 
 position. 
 
 Sayres' dressing for fractured clavicle is made from adhesive plaster. 
 
 OLEUM TEREBINTHIN/E. Oil of Turpentine. 
 
 "A volatile oil distilled from turpentine." (U. S. P.) It enters into the composition 
 of St. John Long's Liniment. 
 
 Oil of turpentine is rubefacient, counter-irritant, antiseptic, haemo- 
 static, and aids in diminishing mucous secretion. Rossbach (Berlin klin. 
 Wochenschr., No. 20, May 15, 1882) found that a two per cent, solution 
 of the oil applied to a mucous surface tended to relieve determination of 
 blood. When applied to the skin, evaporation being prevented, ojl of 
 turpentine is an irritant, causing redness and smarting, which will, if un- 
 checked, induce sloughing. It is much employed as a counter-irritant, 
 especially when a large surface is to be acted upon. When a decided 
 impression is demanded cantharides will be found preferable. It is the 
 opinion of some observers that it possesses antiseptic properties, but this 
 is not confirmed by the experiments of Koch. 
 
 Oil of turpentine is a powerful deodorant of iodoform. 
 
 General Surgery. Oil of turpentine forms the basis of an efficient 
 stupe, which may be applied in one of the following ways: (i) A piece
 
 428 LOCAL THERAPEUTICS. 
 
 of flannel is wrung out of boiling water and liberally sprinkled with the 
 oil, then applied to the affected part and allowed to remain from five to 
 twenty minutes, according to the sensitiveness of the skin. If not skil- 
 fully prepared there is danger of either chilling or scalding the patient. (2) 
 a vessel containing the oil is placed in hot water ; a piece of flannel, wrung 
 from the oil, is then applied to the skin. A turpentine stupe is of service in 
 BRONCHITIS. It is also valuable in relieving CONGESTION OF THE LUNGS 
 following tracheotomy. No counter-irritant offers a prospect of useful- 
 ness in PERITONITIS equal to that obtained by frequently applied stupes, 
 immediately followed by large, hot flaxseed poultices. An excellent 
 laxative enema is composed as follows : Oil of turpentine, one ounce ; 
 olive oil, two ounces ; hot soapsuds, one pint. The oil renders the mass 
 more active than it would otherwise be. 
 
 R. Hargis {Med. News, March 3, 1888) extols oil of turpentine as a 
 dressing for LACERATED WOUNDS and CONTUSIONS. Pledgets of cotton 
 or lint are placed on in position and retained by a bandage. The second 
 dressing consists of one part of the oil and two parts of linseed oil, applied 
 in a way similar to the above. 
 
 Since oil of turpentine readily removes remnants of old ointments, 
 plasters, etc., it is often resorted to as a means of preparing the skin for 
 the incisions of surgical operations. After the part has been rubbed with 
 cotton saturated with the agent, it should be washed with soap and water. 
 In the after-treatment of fracture, when the extension apparatus has been 
 removed, a small amount of the oil rubbed on the skin will dissolve par- 
 ticles of plaster, etc. 
 
 Diseases of the Skin. Oil of turpentine is occasionally used as a 
 stimulant in ALOPECIA AREATA, when it is diluted with one of the bland 
 oils, and also in PSORIASIS. In neither of these affections, however, has 
 it gained general approbation. It has also been employed in the treat- 
 ment of TINEA TONSURANS. It is employed pure, but with some caution, 
 on account of its strongly stimulating properties. 
 
 Diseases of the Ear, Throat, etc. Diluted with almond oil, or 
 olive oil, oil of turpentine is used as an injection in the treatment 
 of caries. Cecchini (Annals Univ. di Med. e Chir., August, 1885 ; 
 Centralbl.f. Chirurg., 1886, p. 2) claims that it is of special value in the 
 treatment of CARIES of the TEMPORAL BONE. Applications should be made 
 every three or four days. As the carious process ceases, the oil of turpen- 
 tine should be substituted by solutions of boric acid. M. Mackenzie uses 
 equal parts of oil of turpentine and glycerin in the treatment of APHTHAE. 
 In DIPHTHERIA it has long been a favorite preparation with some practi- 
 tioners. M. Lewentaner ( Centralblatt fur klin. Medicin, 1887, No. 3), 
 Lunin, J. Lewis Smith (N. Y. Co. Med. Assn., 1887) may be mentioned 
 in this connection. In the form of a gargle Erichsen (" System of Surg-
 
 TEREBINTHINA. 
 
 429 
 
 ei 7>" P- 7*9) uses il f turpentine suspended in mucilage for HEMOR- 
 RHAGE after excision of the TONSILS. Under its property of diminishing 
 secretion, oil of turpentine used as a pigment in LARYNGITIS, which is 
 accompanied by excessive secretion, is highly commended by M. Mack- 
 enzie. The vapor diffused through the apartment in which the patient is 
 confined is a favorite means of J. Solis-Cohen for arresting COUGH and 
 giving rest to ACUTE CATARRHAL INVASION OF THE LARYNX. Or a mix- 
 ture of coal tar and turpentine may be burnt in the apartment in which 
 the patient is and the fumes inhaled in DIPHTHERIA. The oil may be 
 sprinkled about the carpet, under the bed, or on the clothing. It is also 
 of value in CHRONIC INFLAMMATION OF THE LOWER RESPIRATORY TRACT, 
 and has been used in localized diseases in the larynx, trachea, and 
 bronchi, and even in the lung itself. The dose is five minims of the oil 
 to a pint of water at 150 F., taken by inhalation. Brondel (Gaz. des 
 Hopitaux, December n, 1866) recommends oil of turpentine for treat- 
 ment in the latter stages of DIPHTHERIA, after the membranes have been 
 removed. Oleum terebinthinse, on being inhaled, causes the lungs to 
 become pale, due to constriction of the pulmonary vessels (A. Israi), and 
 is thus indicated in HYPER^EMIA and HYPERSECRETION. 
 
 TEREBENE. 
 
 Terebene is produced by treating oil of turpentine with sulphuric acid. It separates 
 as an oily layer; is purified from the acid by being passed through carbonate of lime, and 
 rectified by distillation. It boils, according to different authorities, at from 156 to 180 
 C. It is insoluble in water, and is best prescribed in emulsion. 
 
 Terebene, according to Murrell (British Med. Jour., July 24, 1884), 
 is antiseptic and germicide, 1-450 being capable of keeping in check the 
 growth of the yeast plant. 
 
 General Surgery. Berlin extols the advantages of terebene mixed 
 with equal parts of olive oil, or oil of almonds (as employed by 
 Vaucher, of Geneva), in the treatment of CANCER OF THE UTERUS. It 
 is applied by means of small cotton tampons saturated with the agent 
 and left in contact with the diseased surfaces for several days. It shquld 
 then be removed. After the use of a detergent douche the agent is 
 reapplied. 
 
 Diseases of the Throat, etc. Terebene is used as an inhalant in 
 chronic affections of the lower respiratory passages when a stimulating 
 and antiseptic effect is desired. Twenty drops from a napkin may be 
 inhaled daily. It is especially adapted to chronic irritative WINTER 
 BRONCHIAL COUGH, which is free from complication. In like manner it 
 tends to allay the cough of LARYNGEAL PHTHISIS. From five to forty 
 minims of terebene may be added to an ounce of water in the presence
 
 43 LOCAL THERAPEUTICS. 
 
 of twenty grains of magnesium carbonate. A teaspoon ful is mixed with 
 a pint of water and inhaled at 140 F. for ten minutes night and morning. 
 (Lefferts.) W. W. Hardwicke {Lancet, November 2, 1889) advises com- 
 bining terebene with oil of eucalyptus and alcohol as a spray in WHOOP- 
 ING COUGH. 
 
 TERPINOL AND TERPIN-HYDRATE. . 
 
 " When turpentine oil is left in contact with concentrated hydrochloric acid a dihydro- 
 chloride is formed (C 10 H 16 2HC1). This forms rhombic plates insoluble in water and 
 decomposed by boiling with alcoholic potash with formation of terpinol (C 10 H ]6 ) 2 H 2 O." 
 (U. S. D.) It is an agreeable, aromatic liquid, insoluble in water, and is best adminis- 
 tered in emulsion. 
 
 Terpin-hydrate and terpine are other chemical products of terebinthina 
 and possess similar medicinal properties. 
 
 Diseases of the Throat. Terpin-hydrate is believed to have a 
 specific effect on the bronchial mucous membrane, and thus to be adapted 
 for use as an inhalant in CHRONIC TRACHEITIS and CHRONIC BRONCHITIS. 
 Terpinol in the proportion of two minims to the ounce of water may be 
 used as a cleansing gargle. Terpin-hydrate in the proportion of five 
 minims to each mass is used in the form of a lozenge. 
 
 THILANIN. Brown Sulphurated Lanolin. 
 
 Thilanin is the name given a substance which represents the reaction of sulphur on 
 lanolin. It is a commercial preparation. It is alleged to contain three per cent, of sul- 
 phur. It has been introduced as a substitute for boric-lanolin and bone-vaseline. It is a 
 yellowish brown unctuous substance of the consistence of lanolin, containing three per cent, 
 of sulphur. (M. B., February, 1892, p. 116.) 
 
 Diseases of the Skin. Thilanin has been used with success in ACUTE 
 ECZEMA OF THE FACE and eczema of children. In SYCOSIS also thilanin 
 has been employed with advantage. Also in ACNE ROSACEA and DERMA- 
 TITIS, caused by chysarobin. In other cases it has failed, and it must be 
 said to be still upon trial. 
 
 THIOL. 
 
 Thiol is prepared by heating the brown-colored paraffin oils, having a specific gravity 
 of 0.890 to 0.900, with sulphur at 215 C. The sulphur combines with the unsaturated 
 hydrocarbons only, and the resulting compounds, by means of suitable solvents, are 
 removed and treated at a low temperature with concentrated sulphuric acid, which con- 
 verts them into compounds soluble in water. By further cooling thiol separates out, and 
 after removal is evaporated in vacua to a syrupy consistence, or to a dry powder. 
 
 The liquid thiol should be of such concentration as to contain about forty per cent, of 
 the dry powder, when it will have a specific gravity of 1.082 at 15 C. 
 
 Thiol is miscible with water or glycerin, but only partly dissolved by alcohol or ether. 
 In many respects it resembles ichthyol, but is not known to be identical with it. It is free 
 from the disagreeable odor of ichthyol.
 
 THIOL. 
 
 43 i 
 
 The solid thiol occurs either in dry powder or in scales. The addition of a little glyce- 
 rin to water aids in the solution of this solid substance. 
 
 Thiol is antiseptic and protectant. 
 
 General Surgery. Thiol has been used in RHEUMATIC ARTHRITIS 
 and other affections of rheumatic nature, as well as for CONTUSIONS, 
 BURNS, SCALDS, ERYSIPELAS, FROSTBITE, ULCERS, etc. The following 
 ointment, constitutes a convenient form for its exhibition : Thiol and 
 vaseline, each one drachm; lanolin, one ounce; or it may be used as a 
 powder, viz. : thiol sice., one drachm; zinci oxid., two drachms; amy- 
 lum, one ounce ; talc, two ounces. 
 
 Gottschalk ( Centralblatt f. Gyncekologie, March 21, 1891) has used thiol 
 in the treatment of ENDOMETRITIS, PERIMETRITIS, and VAGINITIS with 
 success, his method being to place tampons saturated with a ten or twenty 
 per cent, glycerin solution of the drug within the vagina, at the same 
 time anointing the abdomen with an ointment of similar strength. 
 
 Diseases of the Skin. Schwimmer ( Wien klin. Wochens., 1890, 
 No. 18) employs the semi-fluid form of the drug suspended in water in 
 the proportion of one to three in HERPES ZOSTER, PAPULAR ECZEMA, 
 and DERMATITIS HERPETIFORMIS. He also finds the dry powdered thiol 
 useful as an application in ERYTHEMA MULTIFORME. 
 
 In DERMATITIS HERPETIFORMIS the ruptured vesicles were painted twice 
 daily by means of a brush with the suspension of thiol (one to three). 
 The fluid dried completely in a few minutes. Repeated layers of the 
 paint were laid on for several days, resulting in marked diminution of 
 the burning and itching. When washed off, the vesicles had dried up 
 and pigmentation only remained. 
 
 In ERYTHEMA MULTIFORME the lesions were first painted with the sus- 
 pension of thiol and then dressed with the pure powder. 
 
 In several cases of moderate ACNE and ACNE ROSACEA when the disease 
 was limited it yielded to thiol under Schwimmer's observation in a few 
 weeks. In similar cases treated by others little or no benefit was gained. 
 
 In MOIST ECZEMA RUBRUM Schwimmer gained much benefit by the use 
 of an ointment of one part of liquid thiol to ten of lard. 
 
 The chief advantage which thiol has over ichthyol is that it is odorless, 
 but so far as our experience with this remedy goes it is inferior in value to 
 ichthyol. 
 
 THIORESORCIN. 
 
 Diseases of the Skin. Thioresorcin has been employed as a sub- 
 stitute for iodoform. Being non-poisonous and without smell it should 
 have some advantages over the latter drug. It is employed as a dusting 
 powder and as an ointment made with vaseline to the strength of fifty 
 to one hundred grains to the ounce in ECZEMA, PSORIASIS, and SCABIES.
 
 432 LOCAL THERAPEUTICS. 
 
 THUJA. Arbor Vita*. 
 
 " The fresh tops of Thuja occidentalis. Linn." (U. S. P.) The white cedar of 
 North America. A tincture and an essential oil are procurable. 
 
 Arbor vitse is excitant and absorbent. 
 
 General Surgery. The fresh leaves of arbor vitae used as a poultice 
 is a domestic remedy of alleged value in INDOLENT ULCERATIONS. Pif- 
 fard commends a tincture in the treatment of GLEET. 
 
 Diseases of the Skin. This drug has been used successfully in the 
 treatment of PAPILLOMATOUS GROWTHS (verrucce and condylomata). A 
 few drops of the tincture given internally thrice daily and a compress 
 wet with the tincture outwardly applied have removed VENEREAL WARTS 
 which have resisted the usual treatment. Having employed this drug 
 successfully in several cases by external use alone we consider it worthy 
 of further trial. 
 
 Diseases of the Throat, etc. The essential oil of arbor vitse is 
 employed by S. Hartwell Chapman in the proportion of a few drops to a 
 pint of water in the temperature of 140 as an inhalation in ACUTE 
 PHARYNGITIS ; it may be combined with the familiar inhalant benzoin, 
 to which a little infusion of hops has been added. E. L. Shurly (N. Y. 
 Med. Jour., September n, 1886) finds that a spray of the fluid extract is 
 useful in shrinking INTRALARYNGEAL PAPILLOMATA. It should be applied 
 twice daily for several months. 
 
 THYMOL. Thymic Acid. 
 
 Thymol is a stearoptene obtained by a refrigeration or other process from the volatile 
 oil of thyme and some other volatile oils. It has the appearance of moist granular cam- 
 phor ; it is scarcely soluble in water, very soluble in alcohol, also in ether, benzin, benzol, 
 chloroform, and in the fixed and volatile oils. When mixed with camphor it liquefies. 
 
 Thymol is antiseptic, disinfectant, stimulant, antipruritic, and para- 
 siticide. It is not poisonous. The odor of thyme is at times a disadvan- 
 tage, since dressings into which it enters attract flies. Many persons 
 object to the persistency of the odor. 
 
 General Surgery. Thymol has been employed by Spencer Wells as 
 an antiseptic in OVARIOTOMY, and is preferred by him to carbolic acid, 
 using a spray of i-iooo, the other solutions being of similar strength 
 for sponges, instruments, and other antiseptic purposes. In the application 
 to BURNS thymol in strength of one to three thousand has been added to 
 ointments, such as oxide of zinc, boric acid, etc. It is asserted that 
 sloughs soon separate under this treatment, and that healthy granulations 
 are formed which rapidly cicatrize. The scars appear to be less irritable 
 than when carbolic acid is prescribed.
 
 THYMOL. 
 
 433 
 
 Thymol has been used with advantage to correct OFFENSIVE LOCHIA. 
 In INFLAMMATION and ULCERATION ABOUT THE NECK OF THE UTERUS a 
 tampon of cotton saturated with glycerine and thymol i-iooo to 1-3000 
 are indicated. Sponges are conveniently preserved in a solution of one 
 part of thymol in sufficient quantity of alcohol added to one thousand 
 parts of water. 
 
 Diseases of the Skin. Thymol was introduced in 1878 by Crocker, 
 of London (New Remedies, April 16, 1878), as a remedy in certain skin 
 diseases. 
 
 Crocker proposed the following formulae: R. Thymolis, gr. v-xxv ; 
 vaseline, 3j- M. Solve. R. Thymolis, gr. v; alcoholis, glycerini, 
 aa fj ; aquae, ad. f^viij. M. R. Potassii thymolat,* gr. v-9iv; aquas, 
 fgviij. M. 
 
 When the vaseline ointment is stronger than twenty grains to the ounce 
 the thymol should be first dissolved in alcohol in the proportion of one 
 minim to the grain. 
 
 Thymol is an irritant to the skin in a concentrated form, but when the 
 strength is properly adjusted it is said to afford an agreeable substitute for 
 tar. 
 
 In PITYRIASIS CAPITIS Crocker recommends: R. Thymolis, 33 ; liq. 
 potassae, f^j ; glycerini, f^ss; aq. sambuci, fjviij. M. 
 
 In ECZEMA G. H. Fox, of New York, recommends the following : 
 R. Thymolis, gr. v; ung. aquae rosae, 3j. M. 
 
 In TINEA TRICOPHYTINA CAPITIS (ringworm of the scalp) Besnier, of 
 Paris, uses: R. Thymolis, gr. viij ; glycerini, f^iv ; alcoholis, fgiv ; 
 aquae, ad. f^viij. 
 
 In PSORIASIS Crocker begins with an ointment of five grains to the 
 ounce, gradually increased to thirty grains to the ounce. 
 
 Diseases of the Nose and Throat. Thymol is used in the treat- 
 ment of the nose and the throat as a substitute for carbolic acid. It is especi- 
 ally useful (i-iooo or 1-3000) in PHARYNGITIS and LARYNGITIS of the 
 exanthemata, particularly when associated with putrid exhalation. As a 
 mouth wash thymol is effective in removing the odor of tobacco after 
 smoking. After the septic coagulant in DIPHTHERIA is removed a /pre- 
 paration of thymol, from two to twenty grains to the ounce of water, 
 either alone or in the presence of five grains of carbolic acid or a little 
 glycerin, is a treatment commended by Da Costa and S. Johnston. 
 
 R. W. Seiss {Med. News, April 2, 1887) finds that one half grain of 
 thymol by the addition of one-half drachm of alcohol and a drachm 
 and a half of glycerin to the ounce of water forms a preparation of mini- 
 
 * The thymolate of potassium results from mixing a saturating solution of. potassium 
 hydrate with thymol. 
 28
 
 434 LOCAL THERAPEUTICS. 
 
 mum strength from which a therapeutic effect can be expected. A 
 stronger solution is composed as follows : Five grains of thymol to one- 
 half ounce each of alcohol and glycerin. The reporter believes that 
 such preparations are of use in the treatment of ATROPHIC NASAL 
 CATARRH. Weak solutions may be employed in the form of a spray, but 
 stronger ones only by means of cotton carriers. Magnesium carbonate 
 aids in the diffusion. Lefferts proposes the following : Six grains of 
 thymol in a drachm of alcohol to the ounce of water, to which has been 
 added three grains of magnesium carbonate ; a teaspoonful to a pint of 
 water at 140 F. as an inhalant. Thymol excites the flow of blood 
 through the lungs, the parts becoming reddened during inhalation. (A. 
 Israi.) 
 
 Thymol is also used extensively by Volckmann as follows, as a spray : 
 Thymol, one part ; alcohol, twenty parts ; glycerin, twenty parts ; and 
 water, one thousand parts. Thymol, according to W. D. Miller, ("Micro- 
 organisms of the Mouth") arrests DENTAL CARIES. 
 
 TRYPSIN. 
 
 t Trypsin is a ferment present in the pancreatic juice. It has the prpperty of digesting 
 proteids and is active only in neutral or alkaline solutions. 
 
 Trypsin is a digestive solvent. 
 
 Diseases of the Throat. Trypsin has been used especially in dis- 
 solving (/. <?., digesting) the DIPHTHERITIC EXUDATION. It is tenacious in 
 character when mixed with mucus and readily adheres to the parts to which 
 it is applied. When smeared upon the tonsils the ordinary act of degluti- 
 tion will not dislodge it. Since trypsin acts only when it remains neutral 
 or is alkaline, J. Lewis Smith (N. Y. Med. Ass'n, December, 1887) has 
 proposed the use of the following preparation : 
 
 R. Sodii benzoat., 3J-ij ; soda bicarb., sij-iij ; trypsin, 3] ; ol. euca- 
 lypti, 3J ; liq- calcis, Oj. 
 
 A simpler formula is herewith given : 
 
 R. Trypsin, gr. xxx; sodii bicarb., gr. x; aquae dest., j. Make a 
 smooth mixture and apply with a brush or by spraying. Samuel Johnson 
 recommends the following : Thirty grains each of trypsin and bicarbonate 
 of sodium, to an ounce of water in which one-quarter of a grain of corro- 
 sive sublimate and a drachm of glycerin has been added. Warm the 
 mixture and use a soft brush ; when the membrane begins to soften 
 apply a spray of peroxide of hydrogen, one part to six, every hour.
 
 TUMENOL ULMUS. 435 
 
 TUMENOL. 
 
 A. petroleum product discovered by Spiegel. It occurs in the form of a dark-brown or 
 brownish-black liquid; a " tumenol sulphone ;" an oil; and a powder, "tumenol sul- 
 phuric acid." {Pkarm. Journ. and Trans., November, 1891.) 
 
 It has recently been brought forward by Neisser as a partial substitute for ichthyol. 
 (Deutsck. med. Wochenschr., No. 45, 1891.) 
 
 Tumenol is antiseptic, antipruritic, and parasiticide. 
 
 Diseases of the Skin. Moist compresses soaked with a two per 
 cent, solution of the tumenol-sulphuric acid have been found useful in the 
 treatment of ACUTE RECURRENT ECZEMA of the hands and face. In the 
 form of a five to ten per cent, paste tumenol oil has proved of use 
 in SUPERFICIAL ULCERATION, IMPETIGO, and PEMPHIGUS. An ointment 
 of similar strength with five per cent, of zinc oxide and nitrate of bis- 
 muth with lard as a base has been employed by Neisser with success. 
 
 Tumenol also acts as an antipruritic. A ten per cent, tincture made 
 up with equal parts of either alcohol, glycerin or water, relieves the itch- 
 ing of ECZEMA, PRURITUS, and PRURIGO. 
 
 Tumenol lacks the penetrating anti-parasitic and absorption-promoting 
 effect of ichthyol. There is, therefore, according to Neisser, no indication 
 for its use in erysipelas, or in the local treatment of exudations or infiltra- 
 tions. 
 
 ULMUS. Elm. Slippery Elm. 
 
 " The inner bark of Ulmus fu/va." (U. S. P.) Elm bark contains an abundance of 
 mucilaginous matter, which is readily extracted by water, but not precipitated by alcohol. 
 It contains tannic acid, a trace of essential oil, to which its p2Culiar odor is due. Fat 
 melted in the presence of elm bark is preserved. Mucilago Ulmi is official; it is made 
 by macerating six parts of the sliced dried elm bark in one hundred parts of boiling water 
 for two hours and straining. 
 
 Elm is demulcent and hygroscopic. 
 
 General Surgery. Elm makes a soothing poultice. It can be em- 
 ployed for all purposes where flaxseed is indicated. Pieces of the bark 
 can be compressed and made into tents of required shapes and used as 
 substitutes for sponge and sea-tangle in dilatation of fistulous tracts, stric- 
 tures, the cervix uteri, etc. 
 
 Diseases of the Throat, etc. Elm is used in the form of a lozenge, 
 three to five grains in each mass, as an adjuvant in the treatment of 
 PHARYNGITIS.
 
 436 LOCAL THERAPEUTICS. 
 
 VERATRINA. Veratrine. Veratria. (U. S. P., 1870.) 
 
 " An alkaloid or mixture of alkaloids prepared from the seeds of Asagraa officinalia. 
 A white, or grayish-white, amorphous, rarely crystalline powder, permanent in the air, 
 odorless, of a distinctive acrid taste, leaving a sensation of tingling and numbness on the 
 tongue, causing contraction of the fauces, and highly irritant to the nostrils. Veratrine is 
 very slightly soluble in cold or hot water, but imparts to it an acrid taste and a feebly 
 alkaline reaction. In boiling water it strongly cakes together without melting. It is 
 soluble in three parts of alcohol at 15 C. (59 F.), very soluble in boiling alcohol ; also 
 soluble in six parts of ether, in two parts of chloroform, in ninety-six parts of glycerin, 
 and in fifty-six parts of olive oil." (U. S. P.) Two preparations are official, Oleatum 
 Veratrina: (containing two parts of veratrine dissolved in ninety-eight parts of oleic acid) 
 and the Ungnentum Veratrince (containing four parts of veratrine dissolved in six parts 
 of alcohol and incorporated with ninety-six parts of benzoinated lard). In practice, more 
 than six parts of alcohol is necessary to dissolve the veratrine; better solvents than alcohol 
 are chloroform and acetic acid. 
 
 Veratrina is revulsant and parasiticide. When brought in contact with 
 cutaneous surfaces, it is exceedingly irritating, producing a feeling of 
 warmth followed by a sense of tingling. 
 
 General Surgery. In NEURALGIA, especially in Tic DOULOUREUX, 
 the ointment of veratrine rubbed into the affected part until it causes a 
 sense of tingling, is often productive of great relief. Veratrine, twenty- 
 five grains; alcohol, six drachms; glycerin, two drachms; painted 
 along the course with a camel's hair brush twice daily. It should not be 
 applied if inflammatory symptoms are present. (Waring.) 
 
 Diseases of the Ear, Nose, etc. E. Peugnet (Amer. Jour, of 
 Syphilog. and Dermatolog., 1872, Vol. in, p; 209) uses veratrine in the 
 treatment of ASPERGILLUS. Two grains of veratrine with one-half ounce 
 each of rose-water and glycerin to which ten minims of acetic acid have been 
 added, is penciled over the infected surfaces. Veratrine is employed by 
 dentists as an obtundent of sensitive dentine. 
 
 Diseases of the Eye. Veratrine has been highly commended by . 
 some ophthalmic surgeons as a remedy in ORBITAL NEURALGIA and in 
 ASTHENOPIA. It is applied to the temple and brow in the form of oint- 
 ment, containing from one to four grains to the drachm, according to 
 the degree of irritation desired and the sensitiveness of the skin. The 
 proportion in the official ointment is one part in twenty-six and a half. 
 Great care is necessary to keep it out of the eye, as it causes a violent 
 and persistent conjunctivitis. The oleate (1-50, U. S.) is an elegant 
 preparation. 
 
 It is doubtful whether this drug has any therapeutic effect (as an exter- 
 nal application) that cannot be attributed to the counter-irritation that it 
 produces.
 
 XANTHOXYLUM YERBA REUMA ZINCI ACETAS. 437 
 
 XANTHOXYLUM. Xanthoxylum. Prickly Ash. 
 
 " The bark of Xanthoxylum fraxineum and of Xanthoyxlum carolinianum." (U. 
 S. P.) The constituents of the prickly ash bark are a volatile oil, a resin, a gum, and a 
 crystalline principle xanthoxylin. The official preparation is a fluid extract (one cubic 
 centimetre of which represents the activity of one gramme of the bark). 
 
 Prickly ash is stimulant and sialogogue. 
 
 Diseases of the Mouth, Throat, etc. Inhalations from hot infu- 
 sions of prickly ash have long been used in domestic medicine for ACUTE 
 CATARRHAL SORE THROAT. A decoction of the bark is employed for 
 application to ULCERATION OF ORAL Mucous SURFACES (J. W. White, 
 " Dental Materia Medica.") 
 
 YERBA REUMA. 
 
 The leaves of Waukenia grandiflora. Yerba reuma contains a resin, a peculiar astrin- 
 gent principle, and a large percentage of sodium chloride, to the combination of which 
 its therapeutical properties are largely attributable. 
 
 Yerba reuma is astringent. 
 
 Diseases of the Throat and Nose. Yerba reuma may be used in 
 the form of a gargle, which is composed of the fluid extract of the herb 
 diluted with three times its bulk of water. An ounce of the tincture (in 
 the strength of four ounces of the fluid extract to the pint of alcohol) 
 added to three ounces of water and used as an injection, is reported to be 
 efficient in some CATARRHAL AFFECTIONS OF THE NOSE. 
 
 ZINCI ACETAS. Acetate of Zinc. 
 
 Acetate of zinc is " soft, white, micaceous, or pearly six-sided tablets or scales, some- 
 what efflorescent in dry air, having a faintly acetous odor, a sharp, metallic taste, and a 
 slightly acid reaction. Soluble in three parts of water and in thirty parts of alcohol at 
 I 5 C. (59 F.), and in 1.5 parts of boiling water, and in three parts of boiling 
 alcohol." (U. S. P.) 
 
 Acetate of zinc is astringent. 
 
 General Surgery. Acetate of zinc resembles the sulphate of zinc 
 in its action. Solutions are often employed as injections in GONOR- 
 RHCEA in the strength of two to five grains to the ounce of water. A solu- 
 tion containing a mixture of acetate of lead and sulphate of zinc is 
 recommended by Sir Astley Cooper, notwithstanding that a double decom- 
 position takes place between the ingredients. The preparation is a 
 valuable one after the acute stage of the disease is passed. 
 
 Diseases of the Skin. The acetate of zinc has been employed in
 
 438 LOCAL THERAPEUTICS. 
 
 the form of an astringent wash in ERYTHEMA and ECZEMA by the late 
 Tilbury Fox. He recommends the following formula : R. Zinci acetat., 
 gr. ij ; aquae rosae, f^j. M. 
 
 Diseases of the Nose and Throat. M.Mackenzie claims efficacy 
 for the acetate of zinc in a solution of the strength of five grains to the 
 ounce of water in CHRONIC LARYNGITIS. 
 
 Diseases of the Eye. The effect of the acetate of zinc upon the 
 eye is much the same as that of the sulphate of zinc, though it is rather 
 less irritating. 
 
 ZINCI CARBONAS PR^ECIPITATUS. Precipitated Carbonate 
 
 of Zinc. 
 
 Precipitated carbonate of zinc is " a white, impalpable powder, permanent in the air, 
 odorless and tasteless, insoluble in water or in alcohol, but soluble in acids with copious 
 effervescence." (U. S. P.) An impure precipitated carbonate of zinc was official (U. 
 S. P., 1850) under the name of calamiha (Calaraine). The name calamine is sometimes 
 erroneously applied to the pure preparation. The precipitated carbonate of zinc thus takes 
 the place of " calamine," which is one of the oldest of local remedies. Calamine is 
 gritty and impure, so that the practitioner, in employing the formulas of the older books, 
 will do well to substitute for it the precipitated carbonate of zinc. 
 
 Precipitated carbonate of zinc is slightly sedative and -astringent. 
 
 Diseases of the Skin. Carbonate of zinc is employed in the form 
 both of lotion and ointment. In ACUTE ECZEMA, when there is no dis- 
 charge, and in most other active inflammatory conditions of the skin, the 
 following will be found of use: R. Pulv. zinci carbonat. praecipitat., 
 pulv. zinci oxidi, pulv. amyli., aa giv; glycerini, fgiv ; aquse, ad 
 f^viij. M. 
 
 A somewhat similar composition is recommended by Crocker in 
 ACUTE INFLAMMATORY CONDITIONS OF THE SKIN : R. Pulv. zinci carb. 
 praecipitat., 9viij; pulv. zinci oxidi, ^iv ; glycerini, f^ij ; aquas rosae, 
 ad fviij. 
 
 Among the ointments containing carbonate of zinc, "Turner's Cerate" 
 was formerly highly prized; it is composed essentially as follows: R. 
 Calaminae praeparatae, cerae flavae, aa giij ; adipis, Ib j. Melt the lard 
 and wax together, and when, on cooling, they begin to thicken, add the 
 calamine and stir until cool. Calamine, however, is often sophisticated, 
 and is apt to make a gritty ointment. 
 
 A formula better adapted for modern use, is: R. Pulv. zinci car- 
 bonat. ,^ij; ung. adipis, gx. M. This, like the lotion, is a cooling 
 .ointment in acute inflammatory conditions of the skin.
 
 ZINCI CHLORIDUM. 439 
 
 ZINCI CHLORIDUM. Chloride of Zinc. 
 
 Chloride of zinc is a " white, crystalline powder, or white, opaque pieces, very 
 deliquescent, odorless, having a very caustic, saline, and metallic taste, and an acid reac- 
 tion. The salt is very soluble in water and in alcohol, forming a clear or only faintly 
 opalescent liquid. This opalescence is removed by the addition of a few drops of hydro- 
 chloric acid." (U. S. P.) For composition of Canquoin's caustic (" Pate de Canquoin," 
 Codex), vide infra, p. 441. 
 
 In England a popular form of chloride of zinc, for purposes of disinfection, is known 
 as Sir W. Burnett* s Fluid. 
 
 Chloride of zinc is caustic, astringent, excitant, disinfectant, and 
 slightly haemostatic, according to the strength of the preparation. 
 
 The caustic action of chloride of zinc is mainly due to its powerful 
 affinity for water. When brought in contact with the tissues in a con- 
 centrated form it destroys them, by robbing them of their water of con- 
 stitution. The affinity for water being fully satisfied, the caustic action 
 ceases, and another influence comes into play, namely, the affinity of 
 the salts of zinc for organic matter. In this way a compound is formed 
 between the solids and fluids at the surface (of a wound, for instance) 
 which prevents decomposition and inhibits the rapid changes incident 
 to suppuration, while not impairing the reparative process. In these 
 respects chloride of zinc resembles carbolic acid, and is, equally with it, a 
 valuable curative agent. 
 
 If for any reasons, as in attacking resisting morbid masses involving 
 the skin, a chloride of zinc paste be demanded, the formula of Jules Felix 
 (commended by Crocker) can be used with advantage : R. Zinci chloridi 
 exsiccat., grs. ex ; amyli, grs. xxvij ; farinae tritici, grs. cxij ; hydrargyri 
 bichlor., gr. j; iodol, grs. x; croton chloral, grs. x; camphor, bromid., 
 grs. x ; acid, carbolic, cryst., grs. x. Mix in a mortar, in powder, then 
 gradually add enough distilled water to make a homogeneous paste of the 
 consistence of putty. It will keep a long time. The hands should be 
 moistened in applying it, and the paste allowed to remain on from six to 
 twenty-four hours. The bichloride of mercury, iodol, and the croton 
 chloral can be omitted without materially affecting the action. 
 
 In the main, chloride of zinc, when employed as an escharotic, can be 
 readily managed by the use of specially prepared lint. The following 
 procedure is recommended : Steep a piece of sheet lint in a saturated 
 solution of the salt (the fluid resulting after placing a few drops of water 
 on a clump of crystals) and dry. Pieces of convenient size are cut off 
 from the sheet and applied to the part which it is desired to cauterize. 
 Lint thus prepared will keep for a long time if placed in a tight-fitting 
 box and preserved from moisture. 
 
 Owing to the deliquescent character of the chloride of zinc its properties
 
 440 LOCAL THERAPEUTICS. 
 
 for other than caustic purposes are best secured in solution. These are 
 usually simple in character, at most a small quantity of glycerin only being 
 added. The effects of the solutions are in direct ratio with their strengths, 
 and bear an exact relation to the character of the tissues to which they are 
 applied. 
 
 General Surgery. Chloride of zinc is a valuable escharotic in the 
 treatment of CANCER. In cases which do not permit of operation " Can- 
 quoin's paste " may be laid over the exposed surface and allowed to remain 
 from six to twenty-four hours. Haberlin finds a marked amelioration of 
 the condition of the parts in UTERINE CANCER upon application of the 
 paste on cotton held against the cervix by a vaginal tampon. E. 
 Van de Warker has revived a method of using chloride of zinc in uterine 
 cancer after amputation of the cervix. The following description is con- 
 densed from "Mann's American System of Gynecology:" The cervix 
 is removed at the vaginal junction, extending, however, with knife or 
 scissors to the os internum. Hemorrhage is checked by packing the cavity 
 with masses of cotton prepared by immersion in a solution of persulphate 
 of iron in the proportion of one to three of water and squeezed nearly 
 dry. This dressing should be removed on the third day. The canal and 
 uterine cavity are then packed with pledgets (pieces about the size of a 
 chestnut) of absorbent cotton soaked in chloride of zinc solution. Two 
 strengths are in use ; one of five drachms to the ounce, and a second 
 of equal parts of the salt and water. The weaker solution is used when 
 the uterine walls are thin, to avoid danger of involvement of the peri- 
 toneum ; the stronger solution is indicated when the walls are of 
 normal thickness. The thickness of the uterine walls can be gauged 
 at the time of operation by introducing the finger into the uterine 
 cavity and a sound into the bladder and rectum. To protect the 
 vagina and the vulva, they should be anointed before the operation 
 with a pomade containing one part of bicarbonate of sodium to three 
 of cosmoline. The pain following the application of the escharotic 
 is often severe, requiring hypodermic injections of morphine. The 
 packing should be removed on the second or third day, when this can 
 be done without force ; but when the dressing is firmly cemented, it is 
 better to wait a day or two longer. The slough separates in from five 
 to ten days. If the strong solution has been employed, the slough is 
 thrown off in a single piece. Cicatrization is complete in from two to 
 four weeks, and is followed by marked contraction of the uterine 
 cavity. In a case of cancer of the cervix and body of the uterus, we 
 recently employed the stronger solution. By its action a slough comes 
 away in one piece the shape and size of the interior of the uterus. The 
 complete relief of pain, hemorrhage, and discharge was marked, and 
 continued for many months. The cautery treatment should not take
 
 ZINCI CHLORIDUM. 441 
 
 the place of methods of extirpation when these are practicable. Munde 
 treats ENDOMETRITIS by mopping out the cavity of the uterus with a 
 five per cent, solution of zinc chloride, the applicator being introduced 
 several times to be sure that no part remains untouched. Afterward the 
 cervix is covered with iodoform, the vagina freely anointed with cosmo- 
 line, and the patient placed in bed. In a week or ten days the sloughs 
 separate, when a second application of twenty grains to the ounce may be 
 made. J. Ashhurst paints the wound after excision of a malignant 
 growth with a solution of chloride of zinc, fifteen grains to the ounce of 
 water. 
 
 Sharpened crayons or "arrows" are also introduced concentrically 
 about superficial neoplasms, as recommended by Maisonneuve. Hypo- 
 dermic injections may be substituted (J. Y. Simpson). 
 
 In the treatment of HYDROCELE M. Potaillon employs a i-io solution. 
 The claim is made that the application is less painful than the injection 
 of tincture of iodine, and that the results are equally good. Lloyd 
 commends an injection of a fluid composed of one grain of chloride 
 of zinc to the ounce of water in the treatment of GONORRHOEA. The 
 application is repeated in six hours, absolute rest being enjoined. 
 Ringer recommends for the same disease an injection composed of 
 two grains of chloride of zinc and water one pint, to be employed 
 hourly. If used in the first stage of the attack, the symptoms disappear 
 within twenty-four or forty-eight hours. Rest, if possible, should be 
 enjoined. If frequent exhibitions cause pain in the testicles, these 
 should be supported with a well-fitting bandage. A strong solution of 
 the chloride of zinc is extolled in irrigating POISONED WOUNDS received 
 in dissection. 
 
 Diseases of the Skin. The late Mr. Startin, of London, employed 
 the following combination in some " ULCEROUS " and " TUBERCULOUS " 
 affections: R. Pulv. zinci chloridi, giv ; pulv. antimonii chloridi, ^ij ; 
 pulv. amyli., ^j ; glycerini, q. s. 
 
 " Canquoirf s Paste," a well known preparation, is prepared, accord- 
 ing to different authorities, in a variety of ways. The U. S. D. con- 
 tains the following formula : R. Zinci chloridi, j ; pulv. amyli (exsiccat.), 
 ^ij-iij-iv; aquae, n^xxx-xl-f^j. M. The amount of water is estimated 
 in each case as sufficient to form a paste, the caustic strength, of course, 
 being greater in each proportion given above. 
 
 Another formula is herewith given : R. Zinci chloridi, j ; zinci oxidi, 
 3J ; amyli (exsiccat.), ^j ; aquae, fej. Mix the oxide of zinc and the flour, 
 and then rub up in a mortar with the water. To be kept in a glass-stop- 
 pered bottle, covered with powdered starch. 
 
 A. Ure employs anhydrous sulphate of calcium instead of flour to 
 dilute the chloride of zinc.
 
 442 LOCAL THERAPEUTICS. 
 
 Diseases of the Ear, Nose, Throat, etc. For free use over large 
 surfaces, especially where the parts to be affected are covered for the most 
 part by thin raucous membrane, the weaker preparations of chloride of 
 zinc, namely, from two to five grains to the ounce, are alone used. A 
 lotion for OTORRHCEA is instilled in the strength of two grains to the 
 ounce. In EMPYEMA OF THE MAXILLARY SINUS a strength of one grain 
 in an ounce of water suffices. For the nasal chamber this may be 
 slightly increased, though weak solutions should be first used and the 
 parts accustomed gradually to the effects of stronger ones. As a gargle 
 the proportions of one grain to the ounce is not often exceeded. 
 
 In treating surfaces which are lymphoid in character, and which exhibit 
 the effects of chronic inflammation or have undergone fibroid degenera- 
 tion, solutions of chloride of zinc to be astringent, or even excitant, 
 must be stronger than those above enumerated. Thus, in SYPHILITIC 
 PHARYNGITIS, a pigment of twenty grains to the ounce is recommended. 
 In non-specific CHRONIC PHARYNGITIS the solution should be somewhat 
 weaker, namely, about fifteen grains to the ounce. An application with 
 a cotton carrier of twenty to forty grains to the ounce, may be used 
 to the separate rounded masses of induration about the orifices of glands 
 in CHRONIC FOLLICULAR PHARYNGITIS. Sluggish ABSCESSES of the roof 
 of the mouth and gums are successfully treated by solutions of forty 
 grains to the ounce. If a cartilaginous or fibrous structure be inflamed, 
 a yet stronger preparation is well borne. Hence, strengths of from thirty 
 to sixty grains to the ounce may be applied over small areas of an 
 ULCERATED TRIANGULAR SEPTAL CARTILAGE, or to the vocal cords or 
 epiglottis in CHRONIC LARYNGITIS. The haemostatic and disinfectant 
 properties of chloride of zinc are but little used in the respiratory tract. 
 J. W. White (" Dental Materia Medica ") speaks of twenty grains to the 
 ounce being haemostatic to the gums. 
 
 The caustic effects are rarely sought for on mucous surfaces. Erichsen 
 ("System of Surgery," Am. ed., Vol. n, 386) refers to its employment 
 in the destruction of NASAL POLYPUS. A twenty per cent, solution is 
 used by Wilhelmy (Deutsch. med. Wochenschr., February 4, 1892) in 
 DIPHTHERIA. Pieces of absorbent cotton, held in an appropriate holder, 
 are saturated with the pigment and rubbed in the affected surfaces. The 
 treatment is remarkably efficient, though severe pain ensues. Florin (Za 
 Pratique Med.,vi, No. 21 ; abst., Ther. Gaz., 1892, 483) advises, indeed, 
 that a saturated solution be applied in this disease. The claim is made 
 that the salt attacks ulcerated surfaces only. Four drachms each of 
 chloride of zinc and the powdered yellow Peruvian bark are mixed with 
 honey to make a thick paste, and applied by a brush with freedom to the 
 parts. The false membrane is removed and a dense non-absorptive albu- 
 minate of zinc is formed in the deeper tissues.
 
 ZINCI IOD1DUM ZINCI NITRAS. 443 
 
 Diseases of the Eye. Chloride of zinc is a useful remedy in the 
 different forms of CHRONIC CONJUNCTIVITIS, and may often be advan- 
 tageously alternated with nitrate of silver, in the same proportions, as an 
 application to the everted lid in TRACHOMA. Only rather weak solutions 
 (from one-quarter of a grain to two grains to the fluidounce of water) 
 should be given to patients to instil into the conjunctival sac. 
 
 ZINCI IODIDUM. Iodide of Zinc. 
 
 Iodide of zinc is " a white or nearly white granular powder, very deliquescent, odor- 
 less, having a sharp saline, and metallic taste, and an acid reaction; very soluble in water 
 and in alcohol." (U. S. P.) 
 
 Iodide of zinc is escharotic, astringent, stimulant, antiseptic, and 
 probably parasiticide. 
 
 Diseases of the Skin. The stimulant properties of iodide of zinc 
 are sometimes taken advantage of in the treatment of ACNE. The follow- 
 ing formula may be employed : R. Zinci iodidi, gr. v; vaseline, j. 
 
 Diseases of the Nose and Throat. According to Lefferts, a mix- 
 ture of 240 grains of iodide of potassium and 480 grains of iodine and 
 three drachms of water added drop by drop to 200 grains of sulphate of 
 zinc, and 140 minims of distilled water forms an escharotic iodide of zinc 
 which is well adapted for use in the throat and nose. A solution of 
 fifteen grains to the ounce is recommended by S. Johnston as a lotion in 
 the treatment of POST-NASAL CATARRH. In a strength varying from five 
 to twenty grains to the ounce, iodide of zinc is astringent. J. J. Ross 
 employs a solution of thirty grains to the ounce as a pigment in the 
 reduction of TONSILLAR HYPERTROPHY. 
 
 ZINCI NITRAS. Nitrate of Zinc. 
 
 This salt is best prepared by neutralizing nitric acid with oxide of zinc. It occurs in 
 colorless, prismatic crystals, which deliquesce on exposure to air, and are soluble in water 
 and in alcohol. 
 
 Diseases of the Skin. Tilbury Fox advised this remedy in the 
 treatment of the severe and chronic forms of LUPUS ERYTHEMATOSUS 
 according to the following formula: R. Zinci nitratis, giss; aqua 
 destillat., fgj ; glyceriti amyli, ^j ; farinae tritici, 3]. M. Sig. Make 
 a paste. The zinc salt is here in the proportion of one to three, but 
 it may be increased to one to two in severe cases. The parts are 
 covered with the paste, and if pain is produced a poultice is applied and 
 the raw surface is dressed with ung. zinci oxid., or ung. diachylon. When 
 the sore has dried up or crusted over, the caustic may, if necessary, be 
 re-applied.
 
 444 LOCAL THERAPEUTICS. 
 
 ZINCI OXIDUM. Oxide of Zinc. 
 
 Oxide of zinc is " a soft, pale-yellowish, nearly white powder, permanent in the air, 
 odorless and tasteless, insoluble in water or in alcohol, but soluble in acids without effer- 
 vescence (absence of carbonate.)" (U. S. P.) The single official preparation is the 
 ointment Unguentum Zinci Oxidi, made by mixing twenty parts of oxide of zinc with 
 eighty parts of benzoinated lard. (See p. 68.) 
 
 Oxide of zinc is desiccant, mildly astringent, and slightly sedative. 
 
 General Surgery. Oxide of zinc is often applied to BLISTERS and 
 to BURNS of the second degree. It also hastens the process of healing 
 of wounds by granulation. In "BRUSH-BURN," which, while painful, is 
 not apt to be a serious injury, zinc ointment spread on 4int forms an 
 excellent protectant. The ointment is available in the treatment of 
 indolent ULCER OF THE LEG. The edges of the ulcer are first anointed 
 and strips of adhesive plaster applied in the usual way. In CANCER- 
 OUS ULCERATION of the mamma, zinc ointment, to which a little 
 carbolic acid has been added, makes a soothing dressing. It should 
 be applied at least every day, after the part has been cleansed with soap 
 and water, and the surrounding portions of the skin bathed with 
 alcohol. ANAL FISSURES and RHAGADES are best relieved by the 
 insertion of a small portion of zinc ointment or powder. Ball {Albany 
 Medical Annals, June, 1886) reports favorably of applications of oxide 
 of zinc ointment for deep-seated CHRONIC URETHRITIS. The formula 
 is as follows : Oxide of zinc, three drachms ; simple cerate, two 
 drachms; lard, three drachms. The ointment is applied by filling 
 the space between the bulb and the end of the shaft of an olive-pointed 
 bougie, carrying the instrument down the urethra to the desired distance, 
 and retaining it in position until the ointment has melted. A cure is 
 effected in about a month. 
 
 A combination of oxide of zinc and the bichloride of mercury has 
 . been proposed by Benjamin. It is advised that the oxide of zinc be ster- 
 ilized by exposure to a temperature of 200 F., and combined with the 
 bichloride of mercury, in the proportion of two ounces of the former to 
 one grain of the latter. The powder cau be used as a succedaneum for 
 lodoform. 
 
 Diseases of the Skin. Oxide of zinc enters into the composition 
 of a number of powders, lotions, pigments, and ointments. 
 
 The powder is often useful as an astringent in ERYTHEMATOUS and 
 VESICULAR ECZEMA. It is somewhat too astringent, however, in its effect 
 upon sensitive skins and should be mixed, in such cases, with powdered 
 starch, kaolin, or a similar indifferent excipient. The addition of a little 
 camphor powder is of advantage when the skin is unbroken and there
 
 ZINCI OXIDUM. 
 
 445 
 
 is much burning 'and itching. The following formula is useful : R. Pulv. 
 camphorae, 3] ; pulv. zinci oxidi, pulv. amyli, aa gss. M. The least 
 degree of grittiness in the powders selected may cause irritation. 
 
 In the form of sedimentary lotions, oxide of zinc has long been em- 
 ployed alone or combined with other astringents and sedatives. The 
 following are approved formulae for use in ACUTE ECZEMA, DERMATITIS, 
 IRRITABLE ACNE, and other ACUTE INFLAMMATORY CONDITIONS OF THE 
 SKIN: R. Pulv. zinci oxid., ^ij ; glycerini, f^ij ; liquor plumbi, f^iss; 
 aquas calcis, Oss. M. R. Pulv. zinci oxidi, gij ; pulv. zinci carb. 
 praecip., %ss; glycerini, fgij ; aquae rosae, Oss. M. 
 
 " Pastes " or " pigments " of oxide of zinc have been much employed of 
 late years. The following combination, into which the oxide of zinc enters, 
 is a particularly useful remedy in ECZEMA RUBRUM, where the weeping 
 is not excessive. Applications must be made for several successive days, 
 without removal, of the following preparation : R. Pulv. zinci oxidi, gr. 
 D ; pulv. acid, salicylici, 3] ; acid, carbolici, 3] ; mucilaginis acacise, gly- 
 cerini, aa gr. cc ccl. M. 
 
 Among other kinds of "pastes," which maybe employed are those 
 recommended by Lussar, of which the ensuing recipe is an example: 
 R. Acidi salicylici, gr. x ; pulv. zinci oxidi, amyli, aa 31] ; vaselini, giv. 
 M. The salicylic acid is an incidental addition. This and similar 
 "pastes" (ointments) are useful in hot weather, when fatty ointments 
 disagree. This formula will be found a little stiff in cool weather. 
 
 Oxide of zinc enters into the composition of a number of ointments. 
 Of these the oxide of zinc ointment of the Pharmacopoeia is that most gener- 
 ally known and most indiscriminately employed in the local treatment of 
 diseases of the skin. It was first brought into use by the eminent English 
 dermatologist, Erasmus Wilson. The slightest grittiness in oxide of zinc 
 ointment should cause its rejection. 
 
 Oxide of zinc enters also into the composition of several compound 
 ointments which are of value in the treatment of diseases of the skin, and 
 which may properly be noted in the present place. One of these is the 
 following, recommended by Neumann in SEBORRHCEA and PITYRIASIS, 
 where the skin is inflamed. (It need hardly be said that this and ,all 
 ointments containing oxide of zinc are out of place on the scalp unless 
 the hair is cut short.): R. Pulv. zinci oxidi, 3] ; pulv. plumbi carbonat., 
 3J ; spermaceti, j; ol. olivse, q. s. M. Make a soft ointment. 
 
 An excellent preparation is the following: R. Pulv. zinci oxidi, 
 mellis, aa 9ij ; cerae flavae, ^ij ; olei amygdalae, f^vj. M. 
 
 In cold weather the ordinary oxide of zinc ointment may with advan- 
 tage be made up with an equal part of cosmoline or vaseline. 
 
 Oxide of zinc ointment forms the succedaneum to black wash in J. C. 
 White's admirable treatment of acute eczema. (See Hydrarg. Chlor, Mite.}
 
 446 LOCAL THERAPEUTICS. 
 
 Diseases of the Ear and Nose. One drachm of the oxide of 
 zinc combined with an ounce each of powdered alum and starch forms 
 an admirable protectant for ACUTE ECZEMA of the auricle. 
 
 The following preparation was a favorite with Wilde for the treatment 
 of CHRONIC INFLAMMATION OF THE AURICLE : Req: Acetate of lead, 355; 
 oxide of zinc, 3] ; mild chloride of mercury, 353; nitrate of mercury 
 ointment, J ; lard (washed), |ss; pure palm oil, |ss. M. With many 
 cases this severe treatment is not absolutely necessary, and the mild 
 mucilaginous applications the ear being covered by oil-silk have been 
 attended with success. 
 
 The ointment of oxide of zinc is an admirable application to the skin 
 of the external nose. In the form of a powder it is often combined with 
 nitrate of bismuth. Such a combination proves useful chiefly as an exsic- 
 cant. It may be dusted upon excoriated skin-surfaces or even carried 
 up the nostril as in an application to SEPTAL ULCERS. It forms a paste 
 with water which is convenient to manipulate. 
 
 Diseases of the Eye. Oxide of zinc ointment is indicated in ECZE- 
 MATOUS CONDITIONS OF THE EYELIDS, and is much used for the relief of 
 inflammation of the skin caused by irritating discharges from the eyes, 
 particularly in the OPHTHALMIA OF STRUMOUS CHILDREN. In some 
 cases the dry powder dusted on the surface of the skin answers better 
 than the ointment. 
 
 ZINCI SALICYLAS. Salicylate of Zinc. 
 
 A salt obtained by adding oxide of zinc to a hot aqueous solution of salicylic acid as 
 long as it is dissolved. On filtering the solution hot and allowing to cool, the salt crys- 
 tallizes in long, satiny needles. It is soluble in twenty parts of cold water, and is freely 
 soluble in hot water, alcohol, and ether. 
 
 Salicylate of zinc is an astringent. 
 
 Diseases of the Nose, etc. This salt is employed in the form of 
 a nasal bougie for the treatment of NASAL CATARRH ; each bougie to 
 contain one grain of the agent. 
 
 ZINCI SULPHAS. Sulphate of Zinc. 
 
 Sulphate of zinc exhibits " small, colorless, right rhombic prisms, or acicular needles, 
 s!owly efflorescing in dry air, odorless, having a sharp, saline, nauseous, and metallic 
 taste, and an acid reaction. It is soluble in 0.6 parts of water at 15 C. (59 F.), and in 
 0.3 part of boiling water; insoluble in alcohol." (U. S. P.) 
 
 Sulphate of zinc is caustic and irritating, astringent and stimulant, 
 hsemostatic, and probably antiseptic. An ounce of the salt dried and 
 finely pulverized, mixed with a drachm of glycerin, is a painful escharotic.
 
 ZINCI SULPHAS. 447 
 
 Sulphate of zinc has less affinity for water than the chloride of zinc, and, 
 therefore, is weaker in its action as a caustic than the agent last named. 
 In common with other salts of zinc, it forms an insoluble compound with 
 albumen. It is an astringent in solutions of from two to five grains to 
 the ounce. Thus exhibited, it diminishes secretion from excited mucous 
 surfaces and hastens the formation of granulations in ill-conditioned 
 sores. 
 
 General Surgery. It is claimed that sulphate of zinc has anti- 
 septic properties, and in this way is of value as a vulnerary. Hewston and 
 Tichbourne {Br. Med. Jour., November 8, 1890) prepare a dressing of 
 four layers of dry gauze; the powdered sulphate of zinc is freely dis- 
 tributed between them and the whole applied to the selected surface. 
 Sulphate of zinc is used in the preparation of the Liqueur de Villate,* 
 which is extensively employed to assist in the removal of CARIOUS and 
 NECROTIC BONE. A small quantity of the fluid is injected into the 
 sinuses. It is, however, claimed by some that only the outer portion of 
 the bone is decalcified, and that the solution does not come in contact 
 with the more deeply seated portions. An acidulated pepsin solution 
 (jj. v.^) may be kept in contact with the walls of the sinuses to act the 
 part of a solvent. 
 
 Sulphate of zinc has an established reputation in the treatment of 
 GONORRHCEA. In the opinion of eminent practitioners, it is the best local 
 remedy in our possession. It is necessary to begin the injections with a weak 
 solution, and increase the strength gradually as tolerance is established. 
 In the early stage of the disease one-half a grain of the salt to the ounce 
 of water will suffice. The sulphate of zinc can be employed with satis- 
 faction in conjunction with acetate of lead. (See Plumbi Acetas.} In 
 GONORRHOEA in the female, it is important that the surfaces of the vagina 
 should be kept apart. For this purpose lint cut in long strips is soaked 
 in an initial solution of four grains to the ounce, and introduced into the 
 vagina through a speculum ; the region about the os uteri is first packed, 
 that near the vulva being gently distended as the instrument is withdrawn. 
 The strength of the solution is gradually increased, until it represents 
 fifteen grains to the ounce. In each dressing the lint is allowed to remain 
 for about eight hours. 
 
 In CHRONIC URETHRITIS IN THE FEMALE, Braxton Hicks has employed 
 with success sticks of sulphate of zinc, introduced into the urethra and 
 permitted to remain there for five minutes. When GONORRHCEA affects 
 the rectum, injections of sulphate of zinc, a drachm to the pint, will be 
 found useful. The same authority has also employed this preparation in 
 
 * The following formula is preferred: R. Zinc, sulph., cupri sulph., aa gr. xv; liq. 
 plumbi subacetatis, f^ss; acid acet. dil., f 3 Hiss.
 
 448 LOCAL THERAPEUTICS. 
 
 LEUCORRHCEA of the UTERINE CERVIX. The sulphate of zinc was extolled 
 by Sir James Y. Simpson as a caustic in CANCER OF THE UTERUS, but it 
 appears to possess no advantages over the chloride of zinc. 
 
 Diseases of the Skin. T. Fox recommends the following combina- 
 tion in ERYTHEMA INTERTRIGO and in ECZEMA : R. Zinci sulphat., grs. 
 x; pulv. aluminis, 9j ; glycerini, f 3J ; aq. rosae, f.^viiss. M. 
 
 A solution of thirty grains of sulphate of zinc to the ounce of water, as 
 suggested by Hardaway, of St. Louis, forms one of the very best lotions 
 for application in DERMATITIS VENENATA. A more dilute lotion is often 
 of value in ACUTE ECZEMA. 
 
 Diseases of the Ear, Nose, Throat, etc. Diffuse inflammation 
 of the external ear is treated by Keene with sulphate of zinc, in the pro- 
 portion of one-fourth of a grain to the ounce of water. Should ulcer- 
 ation be present, stronger solutions, namely, in strengths from one to 
 four grains to the ounce of water, can be used. (Roosa.) FURUNCLES 
 in the auditory meatus demand a strength from thirty to sixty grains to 
 the ounce. Sulphate of zinc is also well adapted for ACUTE or RECENT 
 CASES of CHRONIC SUPPURATION of the middle ear. A simple uncom- 
 plicated OTORRHCEA requires but a strength of two grains to the ounce, 
 but a strength of five grains to the ounce is often well borne. W. E. 
 Dalby warmly commends a similar solution for the treatment of the 
 middle ear in CHRONIC AURAL CATARRH, in which there is a perforation 
 of the tympanic membrane. If pain ensues, the lotion may be combined 
 with twenty minims of liquid extract of opium to the ounce of water, or, in 
 its place, of a weak solution of carbolic acid. A solution of two grains to 
 the ounce may be thrown up the Eustachian tube in the treatment of TUBAL 
 CATARRH. Three grains to the ounce may be used in ACUTE CORYZA as 
 a spray; as high as ten grammes can be employed for FETID CORYZA. It 
 is available for the arrest of EPISTAXIS in strengths of from fifty to sixty 
 per cent. It must be used with care as a pigment, with good illumination 
 of the parts, small surfaces only being covered. As in the case of chlo- 
 ride of zinc, weak solutions are best borne in the sinuses. Thus one 
 grain to the ounce of water suffices for treating EMPYEMAOF THE MAXIL- 
 LARY SINUS. In small quantities, equal parts of sulphate of zinc and 
 sugar of milk, together with a small portion of powdered acacia, forms a 
 convenient powder for insufflation in CHRONIC PHARYNGITIS. It is but 
 little used. Notwithstanding its unpleasant taste, a gargle is sometimes 
 directed to be used, in the strength of one to five grains to the ounce 
 of water. In GANGRENOUS ULCERATION of the mouth in children, sul- 
 phate of zinc has been beneficially used combined with honey, in the 
 strength of twenty grains to the ounce. 
 
 In the larynx, solutions of the salt are not employed in uniform 
 strengths. Weak solutions, /'. e., those from one to five grains to the
 
 ZINCI SULPHOCARBOLAS. 
 
 449 
 
 ounce, are often efficient in giving tone to the membranes in vocal 
 fatigue, while stronger preparations have been used when a decided im- 
 pression is to be made upon the vocal cords. Ten to sixty grains to 
 the ounce in this way can be applied to the parts, either in the form of 
 a spray or a pigment. A strength of forty grains to the ounce is com- 
 mended by C. E. Bean (N. Y. Med. Journal, September 24, 1887) in 
 arresting LARYNGEAL HEMORRHAGE. 
 
 Mandl makes the commendation that insufflations, in any strength, of 
 sulphate of zinc received in the oesophagus may excite emesis. Nasal 
 bougies are available which contain each one grain of the drug. They 
 are either plain or combined with carbolic acid, one-quarter of a grain ; 
 or the fluid extract of hydrastis, five minims; extract of belladonna, one- 
 quarter of a grain ; or morphine, one-quarter of a grain. 
 
 Diseases of the Eye. Sulphate of zinc has been extensively used 
 as a collyrium in CONJUNCTIVITIS, and has held its own for many years. 
 Being rather irritating, it is better adapted to chronic than to acute cases. 
 Solutions of from half a grain to two grains to the ounce of water may be 
 used two or three times a day. 
 
 ZINCI SULPHOCARBOLAS. Sulphocarbolate of Zinc. Sulpho- 
 phenate of Zinc. 
 
 Sulphocarbolate of zinc is official in the British Pharmacopoeia. It is stated that it 
 " may be obtained by heating a mixture of carbolic acid and sulphuric acid, saturating 
 the product with oxide of zinc, evaporating, and crystallizing ; " and it is described as in 
 " colorless, transparent, tabular, efflorescent crystals, soluble in about twice their weight 
 of rectified spirit or of water." (See Sodii Sulphocarbolas.} The U. S. D. questions- the 
 efficacy of the sulphocarbolates. 
 
 Sulphocarbolate of zinc is antiseptic and astringent. The property 
 last named is represented in strengths of two to thirty grains to the ounce 
 of water. On the whole, the salt represents the properties of chloride of 
 zinc, but is less irritating. 
 
 General Surgery. Harrison advises the douching or irrigating of 
 the urethra with a solution of the sulpho-carbolate of zinc. It is well JLo 
 begin with a weak solution, one to three grains to the ounce, and gradu- 
 ally increase its strength. 
 
 Diseases of the Ear, Throat, etc. This salt has been praised as 
 an instillation in the external meatus in OTORRHEA accompanied with 
 perforation of the tympanic membrane, and in ECZEMA OF THE EXTERNAL 
 ' AUDITORY PASSAGE, as well as in the nose in PURULENT CATARRH of 
 children (in solution of five grains to the ounce) and of the naso-pharynx. 
 It also forms an agreeable and useful spray in CATARRHAL LARYNGITIS. 
 29
 
 450 LOCAL THERAPEUTICS. 
 
 Sulphocarbolate of zinc is used by some French physicians as an astrin- 
 gent for the nasal mucous membrane. {Journ. de Med. de Paris, 1890.) 
 
 ZINCI SULPHIDUM. Sulphide of Zinc. Sulphuret of Zinc. 
 This compound is found in nature as zinc blende, or it may be prepared as a whitish 
 powder by precipitating acetate of zinc by sulphuretted hydrogen. This method furnishes 
 an impalpable powder adapted to medical use. 
 
 Diseases of the Skin. The sulphide of zinc was recommended 
 some years ago by Duhring (Philadelphia Med. News, November 10, 
 1883) as a remedy in some forms of LUPUS ERYTHEMATOSUS. It is one 
 of the best local applications we possess for the sub-acute forms of this 
 affection. The formula employed is the following: R. Zinci sulphat., 
 potassii sulphidi, aa^ss; aquse rosae, f^iij; alcoholis, f^iij-vj. M. 
 
 A double decomposition takes place, and the sulphide of zinc is the 
 result. 
 
 This preparation should not be used in the acute exacerbations which 
 occur in lupus erythematosus, when purely sedative remedies alone should 
 be employed. When, however, the disease is in a quiescent and not 
 highly inflammatory condition in the sub-acute stage of its progress, in 
 fact this preparation is useful. 
 
 ZINCI TANNAS. Tannate of Zinc. 
 
 When a solution of acetate of zinc is treated with a solution of tannic acid a white 
 precipitate of tannate of zinc is formed. When this is collected, washed, and carefully 
 dried, it furnishes a fine, nearly white powder, insoluble in water, in alcohol, and in ether. 
 
 Diseases of the Nose, etc. Tannate of zinc is used by some French 
 physicians as an astringent for the nasal mucous membrane. {Journ. de 
 Med. de Paris, 1890.)
 
 APPENDIX.* 
 
 ACONITUM. Aconite. 
 
 " The tuberous root of Aconitum napellus." (U. S. P.) 
 
 In the Ph. Br. both the leaves and the root of Aconitum napellus are official, but in 
 the U. S. P. the root only is official. Aconitina is official in the Ph. Br. The products 
 used under the names of aconitine, aconitina, and aconitia are so varied in activity that 
 there is great danger in prescribing them. 
 
 The doses of the galenical preparations of aconite are so small, and their activity 
 applied externally so great, that there is rarely an excuse for risking the danger incurred 
 in prescribing the alkaloid. The preparations suitable for external use are Extractum 
 Aconiti (of variable strength), Extractum Aconiti Fluidum (one cubic centimetre equals 
 one gramme of the root), and Tinctura Aconiti Radici (five parts representing two parts 
 of the root). 
 
 General Surgery. Aconite, owing to its benumbing influence upon 
 the skin, is often added with advantage to liniments for the relief of neu- 
 ralgic and'rheumatic pains. The tincture is frequently employed in the 
 local treatment of SCIATICA and Tic DOULOUREUX, by being painted 
 frequently over the course of the painful nerve. Toothache is sometimes 
 speedily cured by rubbing the gums with a few drops of the tincture, or 
 introducing it on cotton into the carious tooth. As stated by Ringer, 
 if aconite succeeds at all its action is usually prompt. 
 
 Diseases of the Skin. The local action of aconite is possibly to 
 paralyze the vaso-motor nerves. It produces also tingling, prickling, 
 heat, and numbness. 
 
 This effect is taken advantage of in the treatment of skin diseases 
 accompanied by pain or pruritus. In PERNIO (chilblain) tincture of 
 aconite often allays the burning and tingling pain. In HERPES ZOSTER 
 also the external application of the tincture has proved of service. 
 
 In ALOPECIA a mixture of aconite tincture with other ingredients has 
 proved valuable as a local application. R. Tinct. aconit. rad., f^iv ; 
 chloroform., fgij ; liq. ammoniae, f^j ; pulv. camphone, ) ; ol. olivse, 
 fjvij. M. This mixture has undoubtedly proved efficacious, although how 
 much of the effect has been due to the aconite it is impossible to say. 
 
 * The insertion of the accounts of Aconitum, Ammonii Carbonas, Ammonii Chloridum, 
 Aqua Ammonias Fortior were inadvertently omitted at their proper places in the text. 
 
 451
 
 452 APPENDIX. 
 
 Diseases of the Throat, etc. One-half drachm of the tincture ot 
 the root diluted in eight ounces of water has been used with advantage 
 as a gargle in ACUTE PHARYNGITIS where great pain and muscular irrita- 
 bility were prominent symptoms, according to T. F. Rumboldt. (Sf. Louis 
 Med. Arch., 1873.) From the potent nature of this drug it is evident 
 that such a solution must be used with great caution. 
 
 E. D. Shurly (N. Y. Med. Journal, September n, 1886) believes that 
 aconite is not of sufficient value to compensate for its unpleasant effects. 
 R. C. Brandeis (Archives of Otology, vol. xm, 1884, p. 18) recommends 
 the use of the tincture of aconite in relieving painful affections of the 
 ear. 
 
 Aconite lozenges are prepared each lozenge containing one-half minim 
 of the tincture. (B. P.) 
 
 The oleate of aconitine in a two per cent, solution is recommended by 
 S. Solis-Cohen (N. Y. Med. Journal, March 6, 1886) in painful affections 
 of the throat. 
 
 Diseases of the Eye. Aconite is useful as an application to the 
 skin in ORBITAL NEURALGIA. The tincture is used alone or in combina- 
 tion with chloroform and camphor. It produces a tingling sensation 
 followed by numbness. 
 
 The alkaloid aconitin is official in the Br. Ph., but not in the 
 U. S. P. The former directs unguentum aconitinae to be made by dis- 
 solving eight grains of aconitin in one-half drachm of rectified spirit and 
 mixing with an ounce of benzoated lard. It may be used on the brow in 
 twice this strength, but should not be allowed to come in contact with 
 the delicate skin of the lid. 
 
 I 
 
 AMMONII CARBONAS. Carbonate of Ammonium. 
 Carbonate of ammonium is decomposed by acids, the acid salts, the fixed alkalies, and 
 their carbonates, lime-water and magnesia, solution of chloride of calcium, alum, most 
 solutions of iron salts, corrosive sublimate, the acetate and subacetate of lead, and sulphate 
 of zinc. (U. S. D.) It is soluble in four parts of cold water. 
 
 Carbonate of ammonium is refrigerant and stimulant. 
 
 Diseases of the Skin. The carbonate of ammonium possesses 
 the peculiar property of dissolving the epidermic scales met with so abund- 
 antly in psoriasis, and thus prepares the way for subsequent local treat- 
 ment. It probably owes its value in this respect to its alkaline character. 
 The following formula is employed: R. Pulv. ammonii carb., gr. c.; 
 lanolin, ^iv ; ung. aquae rosae, 3j. M. 
 
 The Spiritus Ammoniae Aromaticus, which is essentially a solution of 
 carbonate of ammonium, containing in addition an excess of aqua
 
 AMMONII CHLORIDUM. 
 
 453 
 
 ammonise, is used in pityriasis and other diseases of the scalp, where it is 
 employed to dissolve the fats and hasten the cleansing of the diseased 
 parts of scales. 
 
 It is sometimes combined with more active stimulants, as in the follow- 
 ing : R. Sp. ammonise aromat., tinct. cantharidis, aq. rosae, aa 3*55. 
 
 Diseases of the Throat. A teaspoonful of the aromatic spirit in 
 a pint of water at 80 F. to 100 F. is recommended by Lefferts as a 
 stimulant in the first stage of acute inflammation of the throat. F. H. 
 Hooper (Trans. Amer. Laryngol. Ass'n., 1887, p. 159) directs that a 
 gargle composed of thirty to forty drops in a half tumbler of soda water 
 be used for the relief of the distress arising from straining the throat 
 muscles in singing. The vapor from common smelling salts is of popular 
 esteem in ACUTE CORYZA. 
 
 AMMONII CHLORIDUM. Chloride of Ammonium. Muriate of 
 Ammonia. Sal Ammoniac. 
 
 This occurs in both a crude and purified condition. The purified salt only is 
 intended. "Soluble in three parts of water at 15 C. (59 F.), and in one and thirty- 
 seven hundredths parts of boiling water ; very sparingly soluble in alcohol." (U. S. P.) 
 
 Nascent chloride of ammonium (in a gaseous or vaporous condition) for inhalation may 
 be made by mingling, by means of a proper apparatus, the vapors of hydrochloric acid 
 and of ammonia. This nascent, gaseous salt should be washed by being passed through 
 water before inhalation, in order to free it from any excess of either constituent. There 
 are many cheap and efficient inhalers for its generation and inhalation in the shops. 
 
 General Surgery. The chloride of ammonium has a much more 
 extensive range of application than have other salts of ammonium. A 
 solution is useful in the treatment of INFLAMMATORY SWELLINGS. It is 
 also indicated in the removal of the ECCHYMOSIS of BRUISES. In resolv- 
 ing the induration following SUPPURATIVE MASTITIS, the following lotion, 
 originally prescribed by Justamond, has been found of service: R. 
 Ammonii chlor., 3] ; spr. rosmarini, Oj. Lint is saturated with this and 
 kept constantly over the part. Solutions of chloride of ammonium may 
 also be used in other glandular enlargements,- such as INDOLENT BUBOES, 
 which are said to subside rapidly under the application of a hot solution, 
 two drachms to an ounce. In EPIDIDYMITIS and ORCHITIS absolution of 
 chloride of ammonia, half an ounce to one pint, will often be found a 
 valuable application. We have employed it with advantage in the 
 treatment of CONGENITAL HYDROCELE in the strength of ten grains to 
 the ounce of water. A lotion of three drachms to the pint is available 
 in the treatment of VAGINITIS, used either as an injection or tampon. 
 In the form last named strips of lint are saturated with the solution and
 
 454 APPENDIX. 
 
 left in position for twenty-four hours. In the absence of ice, the cold 
 produced by dissolving muriate of ammonia with nitrate of potash may 
 sometimes be taken advantage of. When two solutions containing 
 respectively five parts of muriate of ammonia and five parts of nitrate 
 of potash, in sixteen parts of water, are mixed, the temperature of the 
 combined solutions will fall from 50 to 10 F. This is placed in a 
 bladder and may be applied to HERNIAL TUMORS and used to promote 
 their reduction. According to Gru {Brit. Med. Jour., January 18, 1868) 
 placing the affected foot in a foot bath containing eight ounces of the 
 drug affords relief to the pain of SENILE GANGRENE when opium fails. 
 
 Diseases of the Ear, Throat, etc. Chloride of ammonium is a 
 mild solvent and increases the normal secretion. It closely resembles 
 the action of sodium carbonate in most affections of the respiratory 
 passages, but the indications for its use are more precise. Since the 
 recommendation of Von Troeltsch, the nascent fumes of the salt have 
 a reputation in the treatment of CHRONIC AURAL CATARRH. The vapor 
 is carried into the Eustachian tube by the catheter. Various forms of 
 apparatus exist by means of which the vapors of carbonate of ammo- 
 nium and hydrochloric acid are brought into contact. The resultant 
 white fumes are thrown into the catheter by means of a Richardson bulb. 
 Mr. F. E. Morgan, of Philadelphia, has recently offered a compact 
 and portable apparatus of the kind. The value of this treatment for the 
 reduction of submucous thickenings has undergone some fluctuations. 
 In the treatment of the ear a solution of two to five grains to the 
 ounce may be used instead of the nascent vapors. For acute perfora- 
 tion of the tympanic membrane English writers speak of the efficiency of 
 a solution of the same strength instilled into the meatus. Its chief advo- 
 cate in pharyngeal conditions in this country has been J. Solis-Cohen. 
 Many agree with C. Seiler that the good effects of the agent are transient. 
 T. F. Rumbold (St. Louis Archives, 1873) uses a solution of five or ten 
 grains to the ounce as a gargle in CHRONIC PHARYNGITIS characterized 
 by dilatation of the superficial veins, as occasionally observed in the 
 aged. He observes that it cannot be used for a long time, since the 
 continued impression aggravates the complaint. 
 
 B. Robinson (Trans. Amer. Laryn. Ass'n, 1887, p. 156) commends the 
 use of ammonium chloride tablet triturates (one every fifteen minutes) in the 
 CHRONIC LARYNGITIS of professional singers. Some of the good effects of 
 the treatment are probably topical. A spray of a solution of one to twenty 
 grains to the ounce is an old preparation for the treatment of FETID 
 CORYZA, but it is greatly inferior to many other agents now in use. Four 
 grains to the ounce have been employed in inhalation though dependent 
 on diminished secretion of trachea and bronchi. The unpleasant saltish 
 taste of the ammonium chloride renders it an unsuitable drug for con-
 
 AQUA AMMONLE FORTIOR. 455 
 
 centrated use. Prolonged impressions by inhalation may be followed by 
 depression of the general strength. 
 
 Ammonium chloride is frequently employed as an ingredient of a 
 lozenge for CHRONIC PHARYNGITIS of a mild grade. Each lozenge and 
 pastille should contain about two grains of the drug. 
 
 AQUA AMMONLE FORTIOR. Stronger Water of Ammonia. 
 
 " An aqueous solution of Ammonia (NH 3 ), containing 28 per cent., by weight, of the 
 gas. (U.S. P.) 
 
 Ammonia is stimulant and even vesicant. In weak solution it is 
 refrigerant. Stronger water of ammonia, applied to the skin, has a slight 
 rubefacient effect when allowed to evaporate. It is in repute as an anti- 
 dote to the venom of serpents. 
 
 General Surgery. Avendano (Lancet, January 9, 1886) speaks in 
 the highest terms of ammonia in the treatment of anthrax and carbuncle. 
 He says that it is a specific, and should always be used. In malignant 
 pustules, after an incision has been made, some drops of the official solu- 
 tion should be introduced into the wound with the hope of destroying 
 the bacilli. 
 
 When evaporation is prevented ammonia soon passes through the epi- 
 dermis and acts as a powerful vesicant, and can be thus employed for 
 that purpose. It can be employed for vesicating purposes when cantha- 
 rides is objectionable and when a prompt action is desired. Vesication 
 is best produced by saturating a pledget of cotton with 'the ammonia 
 water and applying the cotton to the skin and covering it with a watch 
 glass, which is to be kept in place until a red ring is formed around the 
 glass. The glass may then be removed and a poultice applied. In this 
 way a blister can be produced in from ten minutes to half an hour. 
 This method is, however, somewhat uncertain, and occasionally fails 
 altogether. 
 
 The pain and swelling resulting from poisoning by nettles and inse,ct- 
 bites can be greatly lessened by rubbing the water of ammonia over the 
 part affected. The poison of spiders and wasps, and of similar creatures, is 
 said to contain formic acid, and it is probable that the ammonia acts by 
 neutralizing the acid. Aqua ammonise has long been used in the treatment 
 of .bites of serpents. It should be rubbed and injected into the bitten 
 part. Halford (Lancet, January 30, 1869) strongly recommends the intra- 
 venous injection of aqua ammonise and distilled water (one part to two) 
 in the treatment of snake bite. The mixture should be slowly injected 
 into a superficial vein by means of a hypodermic syringe, and the injec- 
 tions should be repeated as soon as any beneficial effect from it ceases.
 
 456 APPENDIX. 
 
 Of twenty apparently hopeless cases in which this method of treatment 
 was employed, seventeen recovered. (Brit. Med. Journ., August 27, 
 1870.) In similar cases, where Sir Joseph Fayrer adopted this method of 
 treatment for bites of venomous snakes in India, it proved a failure. Sir 
 Joseph Fayrer also found by experiment that mixing ammonia with snake 
 venom, before injecting it into an animal, in no way delayed the fatal 
 result. Therefore, ammonia cannot be regarded as a specific for the 
 bites of venomous snakes, but its intravenous injection may be employed 
 in conjunction with other measures. 
 
 Aqua ammonias forms the active ingredient of many liniments. As 
 equal parts of aqua ammonias, tinct. opium, and sweet oil. The following 
 is used largely at the University Hospital: R. Tr. aconit. rad., f^ss; 
 chloroformi, f^ij ; aq. ammoniae, f^ss ; ol. olivae, %v. 
 
 Diseases of the Throat, etc. Water of ammonia (sp.gr. 960) added 
 to an equal quantity of water is recommended by M. Mackenzie as a 
 stimulating inhalant. Ammonia enters largely in the " Hagerbrand 
 Anti-catarrhal Remedy ;" or the following maybe substituted : Equal parts 
 of water of ammonia, magnesia, and water are mixed to make an ounce. 
 A teaspoon ful is added to a pint of water at 80 F. To be used as an 
 inhalant in CHRONIC LARYNGITIS. 
 
 "MEDICATED BATHS."* 
 
 Diseases of the Skin. The following diseases are those in which 
 baths may be employed at times with advantage : ERYTHEMA, URTI- 
 CARIA, ECZEMA, PEMPHIGUS, LICHEN RUBER, PRURIGO, PSORIASIS, PITYRI- 
 ASIS RUBRA, DERMATITIS, ICHTHYOSIS, SCLERODERMA, and the neuroses of 
 the skin, particularly PRURITUS. 
 
 Parasiticides act favorably in the form of baths in TINEA TRICOPHYTINA 
 and in TINEA VERSICOLOR, also in SCABIES. When used in PEDICULOSIS 
 VESTIMENTORUM baths are chiefly useful as antipruritic. 
 
 The following formulae for the more commonly employed baths may 
 be given here. The temperature of these baths should not, it is under- 
 stood, vary much above or below 90 F., and since to obtain their full 
 effect baths must often be prolonged to half an hour, or even an hour, 
 the temperature should be kept up by successive additions of hot water, 
 and the room in which the patient takes his bath should be kept at an 
 even warmth. Evening is the best time in general for taking medicated 
 baths, and the patient should be warned against going into the bath soon 
 after a hearty meal. 
 
 * For Baths, see p. 98.
 
 "MEDICATED BATHS.' 
 
 457 
 
 The medicated baths commonly employed in diseases of the skin are 
 the following : * 
 
 The Acid Bath : 
 
 R. Acidi nitrici fort., f^fiss 
 
 Acidi hydrochlorici fort., f^j 
 
 Aquae, C. xxx. M. 
 
 Employed in PRURITUS, URTICARIA, and PAPULAR ECZEMA. 
 
 The Alkaline Bath : 
 
 R . Sodii carbonat., , . . . ^ iv 
 
 Aquas, C. xxx. M. 
 
 Another is as follows : 
 
 R . Potassii carbonat. , "Z iv 
 
 Sodii carbonat., ^iij 
 
 Sodii biborat., ^ij. M. 
 
 One such powder is to be used in a thirty-gallon bath, with half a 
 pound of starch, the latter previously boiled with water to make a " clear 
 starch." 
 
 Employed in ACUTE ECZEMA, URTICARIA, ERYTHEMA, PSORIASIS, and 
 ICHTHYOSIS. 
 
 A formula employed for children is as follows : 
 
 R. Sodii biborat., ?j 
 
 Sodii carbonat., /fij 
 
 Potassii carbonat., ^iij. M. 
 
 Two to four teaspoonfuls of this powder for every gallon of water, with 
 double the amount of dry starch. 
 
 The Creasote or Carbolic Acid Bath : 
 
 R. Creasoti (seu acid carbolic), f^ij 
 
 Glycerini, f^'J 
 
 Aquas, C. xxx. M. 
 
 This is employed in PRURITUS and in certain forms of SQUAMOUS 
 ECZEMA. 
 
 The Sulphur Bath : 
 
 R. Potassii sulphuret., ' % iv 
 
 Aquas, C. xxx. M. 
 
 This is employed in PSORIASIS, PITYRIASIS, ACNE, and IMPETIGO, 
 and as a specific in SCABIES. Another formula is the following : 
 
 R . Sulphur, precipitat., 3 iv 
 
 Sodii hyposulphit., 3J 
 
 Acid, sulphuric, fort., fjj 
 
 Aquas, C. xxx. M. 
 
 * Not to be used in a metal-lined tub.
 
 458 APPENDIX. 
 
 This last is employed exclusively for SCABIES. 
 
 The Sublimate Bath : 
 
 R . Hydrarg. bichlor. corrosiv. , 9 ij 
 
 Ammonii chloridi g iiss. 
 
 Aquae, f 3 iiss. M. 
 
 Put in a bath of thirty gallons. 
 
 This is sometimes employed in PRURITUS, but we should doubt the 
 advantage of its employment. It is better adapted to SYPHILIS. 
 
 The sublimate baths which are so useful in INFANTILE SYPHILIS are 
 composed of ten grains of bichloride of mercury to each bath, in 
 a child's bath-tub. A cloth or blanket should be tied around the child's 
 neck and spread over the tub, so that none of the solution shall be 
 splashed into mouth or eyes. 
 
 Tan baths, containing a handful of tan bark to each bath, have been 
 recommended in PURPURA. 
 
 Tar baths are employed by rubbing tar into the diseased parts of the 
 patient's skin, and then employing an ordinary warm bath. They are 
 used in PSORIASIS. 
 
 The baths connected with mineral springs possess little or no virtues in 
 the cure of skin diseases, other than those possessed by the water which 
 they contain. 
 
 OLEUM PINI SYLVESTRIS. Pine-needle Oil. 
 
 This oil is distilled from the small branches of Pinus sylvestris, and other species of 
 pine growing in Europe. In some of its properties it resembles ordinary turpentine oil, 
 but possesses a more refined and agreeable odor, owing to its containing oxygen com- 
 pounds of high boiling-points. According to Atterberg, oil of Pinus sylvestris may be 
 separated into three fractions: (i) Ordinary turpentine oil, (2) sylvestrin, and (3) a 
 strongly aromatic, high-boiling compound of a very characteristic odor. In the light of 
 more recent investigation, this last fraction consists of one or more compound ethers of 
 borneol. 
 
 Owing to the scarcity of the true product from Pinus sylvestris, chiefly on account of 
 its increased use in influenza, the oils from Pimts Pices and Pinus Pumilio have been 
 more or less substituted. It is probable, however, that the composition of the substitutes 
 closely resembles that of the true oil. The latter is known in Germany as Fichtennadelol. 
 
 OLEATUM ZINCI. Oleate of Zinc. 
 
 Oleate of zinc is best prepared by dissolving, with the heat of a water-bath, oxide of 
 zinc in oleic acid. When made of five per cent, strength, the product is a soft solid. 
 When made with twenty per cent, of oxide, it is hard and friable, but transparent when 
 melted. The Br. Ph., directs that one part of the oxide be dissolved in nine parts of 
 oleic acid. 
 
 The National Formulary directs it to be prepared by precipitating a solution of Castile
 
 SODIUM ETHYLATE " STENOCARPINE. " 459 
 
 soap with a solution of acetate of zinc. The product contains about thirteen per cent, 
 of zinc oxide, and is in the form of a white powder, insoluble in water and in alcohol. 
 
 Diseases of the Skin. Oleate of zinc was suggested as a remedy in 
 ECZEMA AND OTHER INFLAMMATORY SKIN DISEASES by Marshall, of Lon- 
 don. The formula is herewith given : R. Zinci oxidi, 5] ; acidi oleici, 
 3J ; vaselini, gix. M. The oxide of zinc is to be rubbed up with the oleic 
 acid and allowed to stand for about two hours. The mixture is then 
 placed in a water bath until the oxide of zinc is dissolved, when the vase- 
 line is added and the mixture is stirred until cold. 
 
 If we have the oleate already prepared, the following formula is a good 
 one: R. Zinci oleat, gj ; vaselini, ung. aq. rosse, aa ss. M. 
 
 Diseases of the Ear, etc. Oleate of zinc is recommended by H. 
 McNaughton Jones as the basis of an ointment in the treatment of 
 ECZEMA OF THE AURICLE. 
 
 SODIUM ETHYLATE. 
 
 The liquid sodium ethylate becomes solid on cooling, and contains alcohol, which it 
 loses at 200 C. It is rubbed to a fine powder, and preserved in a well-stopped bottle. 
 In contact with water it is decomposed into alcohol and sodium hydrate. Richardson's 
 sodium ethylate is a solution of one part of the above compound in three parts of absolute 
 alcohol. (See p. 408.) 
 
 "STENOCARPINE." 
 
 A preparation under the name of Stenocarpine, or Gleditschine, was, a 
 few years ago, one of the most ambitious of the rivals of cocaine, and 
 was tested and written about by a number of well-known authorities. 
 John Marshall, Demonstrator of Chemistry in the University of Penn- 
 sylvania (Phila. Med, News, October 29, 1887), showed that it was a 
 fraudulent mixture of atropine and cocaine.
 
 INDEX OF REMEDIES. 
 
 TJie page numbers in Roman type will be found in the Introduction. 
 
 NAME A. PAGE 
 
 Abrus 310 
 
 Abstractum Conii 209 
 
 Acacia 17 
 
 Acetanilid 89 
 
 Acetate of Lead . 364 
 
 Acetate of Zinc 437 
 
 Acetic Acid 19 
 
 Acetic Aldehyde 78 
 
 Acetic Ether 74 
 
 Acetized Cotton 20 
 
 Acetum Opii 343 
 
 Acid Bath 457 
 
 Acid Nitrate of Mercury 278 
 
 Acidum Aceticum 19 
 
 ' Arseniosum 23 
 
 ' Benzoicum 136 
 
 ' Boricum 24 
 
 ' Camphoricum 161 
 
 ' Carbolicum 29 
 
 ' Chloraceticum 17 
 
 " Chromicum 39 
 
 " Citricum 42 
 
 " Gallicum 43 
 
 " Hydrochloricum 44 
 
 " Hydrocyanicum dil 45 
 
 Lacticum 45 
 
 Nitricum 48 
 
 Oxy-naphthoicum 51 
 
 Phosphoricum 52 
 
 Pyrogalicum 53 
 
 Salicylicum 54 
 
 Sulphuricum 58 
 
 Sulphurosum 60 
 
 " Tannicum 62 
 
 " ' Tartaricum 68 
 
 Aconite 451 
 
 Aconitum 451 
 
 Actsea 194 
 
 Action of Alkalies xiv 
 
 " Astringents xiii 
 
 " Caustics xiii 
 
 " Solvents xiv 
 
 Adeps 68 
 
 " Benzoinatus 68 
 
 " Lanse Hydrosus 316 
 
 Adhesive Plaster 426 
 
 yEther 69 
 
 /Ether, Aceticus 74 
 
 " Fortior 69 
 
 Agaric 74 
 
 Albolene . 355 
 
 Alcohol 75 
 
 Aldehyde 78 
 
 Alkaline Bath 457 
 
 Almond . . 83 
 
 Almond Meal 84 
 
 Alpha 51 
 
 Alterants 
 
 Anthrarobin 87 
 
 Europhen 231 
 
 Hyposulphite of Silver 103 
 
 Iodide of Potassium 378 
 
 " Sodium 424 
 
 Iodine 300 
 
 lodoform 290 
 
 Sodii Sozoiodolate 416 
 
 Yellow Oxide of Mercury .... 270 
 
 Althaea 78 
 
 Alum 79 
 
 " Curd 83 
 
 Alumen 79 
 
 Alumen Exsiccatum 79 
 
 Ammonia Liniment 102 
 
 Ammoniaca'l Ointment of Gondret . . 102 
 
 Ammoniated Mercury 277 
 
 Ammonii Carbonas 452 
 
 " Chloridum 453 
 
 Amygdala 83 
 
 Amyl Nitris ...../ 84 
 
 Amylum . . 86 
 
 Anaesthetics 
 
 yEther 69-73 
 
 Campho-Phenique 164 
 
 Camphor 161 
 
 Carbolic Acid 32-34 
 
 Chloral 184 
 
 Chloroform 188 
 
 Ethylate of Sodium . 408 
 
 Ethyl Bromide , . . 227 
 
 Menthol 322 
 
 Rhigolene 351 
 
 461
 
 462 
 
 INDEX. 
 
 Analgesics 
 
 Antipyrin 89 
 
 Bromide of Ethyl 228 
 
 Brucine 150 
 
 Cocaine 195 
 
 Coffee 151 
 
 Creasote 211 
 
 Hyposulphite of Soda 410 
 
 Ice 100 
 
 lodoform 290 
 
 Menthol 321 
 
 Methyl Violet 381 
 
 Resorcin 387 
 
 Salicylate of Soda 41 
 
 Strophanthus 421 
 
 Storone 421 
 
 Anodynes 
 
 Lactucarium 314 
 
 Oil of Peppermint 336 
 
 " Spearmint . 336 
 
 Opium 343 
 
 Stramonium 420 
 
 Anthemis 88 
 
 Anthrarobin 87 
 
 Antifebrine 89 
 
 Antimonii Oxidum 88 
 
 Antimonii et Potassii Tartras .... 88 
 Antipyrin 89 
 
 Antiphlogistics 
 
 Ice 100 
 
 Copaiba 210 
 
 Antipruritics 
 
 Carbonate of Potassium 375 
 
 Creasote 211 
 
 Cyanide of Potassium 377 
 
 Guaco 253 
 
 Tar 360 
 
 Thymol 432 
 
 Tumenol 435 
 
 Antiseptics 
 
 Aristol 119 
 
 Balsam of Tolu 1 23 
 
 Benzoic Acid 137 
 
 Benzoin 134 
 
 Bicarbonate of Soda 402 
 
 Bichloride of Mercury 259 
 
 Biniodide " " 268 
 
 Bismuth Subnitras 139 
 
 Borax 404 
 
 Boric Acid 25-28 
 
 Bromol 148 
 
 Campho-Phenique 164 
 
 Carbolic Acid 30 
 
 Chinoline 184 
 
 Chloral 184 
 
 Chloride of Gold and Sodium . . 121 
 
 Antiseptics 
 
 Copaiba 210 
 
 Creoline 214 
 
 Creasote 211 
 
 Dermatol 223 
 
 Eucalyptus 229 
 
 Glycerin 242 
 
 Hyposulphite of Soda 410 
 
 Iodine 300 
 
 Kerosene 352 
 
 Lime Water 157 
 
 Methyl Violet 381 
 
 Menthol 321 
 
 Naphthaline 327 
 
 Naphthol 328 
 
 Oil of Cassia 334 
 
 Oil of Fir 339 
 
 " Gaultheria 335 
 
 " Turpentine 427 
 
 Permang. of Potash 379 
 
 Peroxide of Hydrogen 282 
 
 Resorcin 387 
 
 Retinol 389 
 
 Salicylate of Soda 411 
 
 Salol 393 
 
 Salt 406 
 
 Soap 395 
 
 Sodii Benzoas 401 
 
 Storone 421 
 
 Sulphur . 421 
 
 Tar 360 
 
 Terebene . 429 
 
 Thiol 431 
 
 Thymol 432 
 
 Tumenol 435 
 
 Yellow Oxide of Mercury .... 270 
 
 Zinc Iodide 443 
 
 Zinc Sulphocarbolate 450 
 
 Antispasmodics 
 
 Amyl Nitris 84 
 
 Belladonna 124 
 
 Bromide of Potassium 374 
 
 Chloroform 188 
 
 Ethyl Iodide 228 
 
 Oil of Sandal Wood 341 
 
 Oil of Valerian 342 
 
 Stramonium 420 
 
 Sumbul . 424 
 
 Tobacco 425 
 
 Aqua 90 
 
 Ammonite 102, 455 
 
 Fortior 102 
 
 Chlori 102 
 
 Lauro-Cerasi 102 
 
 Picis Liquida 363 
 
 Rosae 391 
 
 Arbor Vitae 432 
 
 Argenti Hyposulphas 103 
 
 " Nitras 103 
 
 " lodidum 119
 
 INDEX. 
 
 463 
 
 NAME PAGE 
 
 Aristol 119 
 
 Arnica 120 
 
 Arsenic 23 
 
 Artificial Gum 223 
 
 Ash 238 
 
 Astringents 
 
 Acetate of Zinc 437 
 
 " Lead 364 
 
 Alum 79 
 
 Bismuth Subnitrate 139 
 
 Calendula 156 
 
 Carbonate of Lead 3^7 
 
 Catechu .... 174 
 
 Creasote 216 
 
 Creta Preparata 152 
 
 Ferric Alum 235 
 
 Ferri Chloridum 232 
 
 Gallic Acid 43 
 
 Geranium 241 
 
 Grindelia , . 252 
 
 Hamamelis 256 
 
 Hematoxylon 256 
 
 Hemlock 359 
 
 Kino 313 
 
 Krameria 314 
 
 Lime 157 
 
 Lime Water 157 
 
 Monsel's Salt 236 
 
 Myrrh 326 
 
 Nitrate of Lead 368 
 
 " " Silver 103 
 
 Pale Rose 391 
 
 Precip. Carbonate of Zinc 438 
 
 Rhus Glabra 390 
 
 Sage 394 
 
 Soda Sulphocarbolate 412 
 
 Sodii Sozrel, Sozoiodolas 416 
 
 Sozoiodol 414 
 
 Sulphate of Iron 237 
 
 Sulphuric Acid 59 
 
 Tannic Acid 63 
 
 Tar 360 
 
 Zinc Chloride 439 
 
 Iodide . 443 
 
 Oxide 444 
 
 Salicylate 447 
 
 Sozoiodolate 416 
 
 Sulphate 447 
 
 Sulphocarbolate 449 
 
 Tannate 450 
 
 Atropia 123 
 
 Auri et Sodii Chloridum 121 
 
 Ava 313 
 
 B. 
 
 Baby Powder 86 
 
 Baking Soda 402 
 
 Balsam of Peru 121 
 
 " Tolu 123 
 
 Balsamum Tolutanum ....... 123 
 
 Basic Ferric Sulphate 235 
 
 " Gallate of Bismuth 223 
 
 " Mercuric Sulphate 273 
 
 Basis Seifa 396 
 
 Baths 98 
 
 Baume Tranquille 419 
 
 Belladonna 123 
 
 Benzen 137 
 
 Benzene 137 
 
 Benzine 133 
 
 Benzoate of Soda 136 
 
 Benzoic Acid 136 
 
 Benzoin 133 
 
 Benzoinol 355 
 
 Benzoinated Lard 68-133 
 
 Benzol 137 
 
 Berberine 281 
 
 Beta Napbthol 327 
 
 Bicarbonate of Soda 402 
 
 Bichloride of Mercury 259 
 
 Bichromate of Potash 375 
 
 Biniodide of Mercury 268 
 
 Bismuthi Boras .... .... 137 
 
 Bismuth Nitrate 141 
 
 Bismuth Oleas 138 
 
 Oxychloridum 138 
 
 Sub-Benzoas ...:... 138 
 
 Sub-Carbonas 138 
 
 Sub-Iodidum 139 
 
 Subnitras 139 
 
 Tannas 141 
 
 Trinitras 141 
 
 Bisulphite of Soda 404 
 
 Black Pepper 359 
 
 " Snakeroot 194 
 
 " Wash, 158-266 
 
 Bloodroot 394 
 
 Blue Ointment 227 
 
 Blue Stone 220 
 
 Blue Vitriol 220 
 
 Boletus 74 
 
 Boracic Acid 24 
 
 Borate of Bismuth 137 
 
 Borate of Soda 404 
 
 Borax 404 
 
 Boric Acid 24 
 
 Boroglycerin 29 
 
 Bougies 145 
 
 Bouginaria 145 
 
 Boulton's Solution 307 
 
 Bran H7 
 
 Bromide of Ethyl . . 227 
 
 " Potash 374 
 
 Bromine 149 
 
 Bromoform 148 
 
 Bromol 148 
 
 Bromum 149 
 
 Brown Sulphurated Lanolin .... 430 
 
 Brucine 15 
 
 Bryonia IS 1
 
 464 
 
 INDEX. 
 
 Burgundy Pitch 360 
 
 Burows' Liquid 365 
 
 C. 
 
 Cacao-butter 341 
 
 Cadmium Iodide 15* 
 
 Caffea 151 
 
 Caffeine 151 
 
 Calabar Bean 356 
 
 Calcii Carbonas 
 
 " Precipitatus 152 
 
 " Chloridum 153 
 
 " Hydras 154 
 
 " Hyposulphis 154 
 
 Calcii Phosphas. Prase ip 155 
 
 " Sulphas 155 
 
 Calendula 156 
 
 Calomel 266 
 
 Calx 157 
 
 " Chlorata 159 
 
 " Saccharata 160 
 
 " Sulphurata 160 
 
 Campho-Phenique 161 
 
 Camphor 161 
 
 Camphor Liniment idl 
 
 Camphorated Chloral 161 
 
 " Iodine 309 
 
 " Menthol 164 
 
 " Naphthol .... 161,330 
 
 " Salol 166 
 
 Camphoric Acid 164 
 
 Camphor Wool 163 
 
 Cane Sugar 391 
 
 Cannabis Indica 166 
 
 Canquoin's Paste 441 
 
 Cantharides 166 
 
 Cantharis 166 
 
 Capsicum 171 
 
 Carbolic Acid 29 
 
 Carbo-Ligni 173 
 
 Carbolized Camphor 164 
 
 " Cotton 30 
 
 " Gauze 250 
 
 Carbonate of Ammonia 452 
 
 ' Lead 366 
 
 ' Lithium 319 
 
 ' Magnesium 320 
 
 ' Potassium 375 
 
 ' Sodium 406 
 
 Carron Oil 158 
 
 Cashew Nut Oil 332 
 
 Castor Oil 340 
 
 Catechu 174 
 
 Caustics 
 
 Acid Nitrate of Mercury 278 
 
 Alum 79 
 
 Bromine . 149 
 
 Caustic Soda 409 
 
 Carbolic Acid 30 
 
 NAME PAGE 
 
 Caustics 
 
 Creasote 211 
 
 Chromic Acid 39 
 
 Croton Oil 342 
 
 Glacial Acetic Acid 21 
 
 Iodine 300 
 
 Lactic Acid 45 
 
 Lime 157 
 
 Mercuric Bichloride 259 
 
 " Sozoiodol 415 
 
 Monsel'sSalt 236 
 
 Nitrate of Silver 103 
 
 Nitric Acid 48 
 
 Pyrogallic Acid 53 
 
 Soda cum Calce . , 408 
 
 Sulphuric Acid 59 
 
 Trichloracetic Acid 18 
 
 Zinc Chloride 439 
 
 Zinc Sulphate 447 
 
 Caustic Alcohol 408 
 
 " Lead 370 
 
 " Potash 370 
 
 " Soda 401 
 
 Cera Flava 182 
 
 Ceratum Ext. Cantharidis 166 
 
 " Plumbi Subacetatis .... 364 
 
 " Resinse 426 
 
 Cerii Oxalas 183 
 
 Cetraria 183 
 
 Chamomile 88 
 
 Charcoal 173 
 
 Charpie 319 
 
 Charta Cantharidis 166 
 
 " Potassii Nitratis 379 
 
 Cherry Laurel Water 102 
 
 China Root 239 
 
 Chinoline 183 
 
 Chloracetic Acid 17 
 
 Chloral 184 
 
 Chloral Hydrate 184 
 
 Chloralum 186 
 
 Chlorate of Potash . 375 
 
 Chloride of Ammonium 153 
 
 Calcium 153 
 
 Gold and Sodium . . . .121 
 
 Iron 232 
 
 Sodium 406 
 
 Zinc 439 
 
 Chlorinated Lime 159 
 
 Chlorine 187 
 
 " Water 102 
 
 Chloroform 187 
 
 Chromic Acid 39 
 
 Chrysarobin 192 
 
 Churchill's Tincture 304 
 
 Cimicifuga 194 
 
 Citrate of Potash 377 
 
 Citric Acid 42 
 
 Citrine Ointment 279 
 
 Clove Bark 327 
 
 Coal Oil 352
 
 INDEX. 
 
 465 
 
 Coca 227 
 
 Cocaine 194, 202 
 
 Cocainre Phenas 205 
 
 Cocoa-nut Oil 334 
 
 Codeine 343 
 
 Cod-liver Oil 337 
 
 Coffee 157 
 
 Cold Bath 98 
 
 Cold Cream 84 
 
 Collodion 205 
 
 Collodium cum Cantharide 166 
 
 Cologne Water 417 
 
 Condy's Fluid 379 
 
 Confectio Rosse 390 
 
 Conium 309 
 
 Copaiba 210 
 
 Copperas 237 
 
 Corrosive Chloride of Mercury . . . 258 
 
 " Sublimate 258 
 
 " " Gauze 250 
 
 Cosmoline 352 
 
 Coster's Paste 306 
 
 Cotoin 211 
 
 Cotton 247 
 
 Coumarin 211 
 
 Counter-irritants 
 
 Tartar Emetic 88 
 
 Cantharides 1 66 
 
 Capsicum 171 
 
 Cranesbill 241 
 
 Creasote 211 
 
 " or Carbolic Acid Bath . . . 457 
 
 Creolin 214 
 
 Creta Prseparata 152 
 
 Croton Oil 342 
 
 Cubebs 218 
 
 Cupping 142 
 
 Cupri Nitras 220 
 
 ' Sulphas 220 
 
 Cyanide of Potash 377 
 
 Cydonium 222 
 
 D. 
 
 Datura Tatula 420 
 
 Daturine 419 
 
 Dehydrogenated Alcohol 78 
 
 Dermatol 223 
 
 Deshler's Salve 426 
 
 Desoxyalizarin 87 
 
 Dextrin 223 
 
 Diachylon Plaster 369 
 
 Di-iodol-di-tymol 119 
 
 Dil. Hydrocyanic Acid 45 
 
 Dimethylphenylpyrazolon 89 
 
 Dobell's Snuff 66 
 
 " Solution 30 
 
 Double Cyanide of Mercury and Zinc 
 
 Gauze 250 
 
 Douches xviii 
 
 3 
 
 Dry Cupping 143 
 
 Duboisia 224 
 
 E. 
 
 Earth 425 
 
 Elder 394 
 
 Elm 435 
 
 Emollients 
 
 Almond Oil 84 
 
 Cacao Butter 341 
 
 Castor Oil 340 
 
 Goose Grease 69 
 
 Lard 68 
 
 Mutton Suet 69 
 
 Olive Oil 338 
 
 Emplastrum Ammoniac! 
 
 Cum Hydrargyro .... 277 
 
 Belladonnse 123 
 
 Capsici 171 
 
 Ferri 360 
 
 Galbani 360 
 
 Hydrargyri ..... 274 
 
 Opii 343 
 
 Picis Burgundicae . . . 360 
 " cum Cantharide . . 360 
 
 Plumbi 369 
 
 Resinse 426 
 
 Saponis 398 
 
 Ergota ' 224 
 
 Ergotine 224 
 
 Ergot of Rye 224 
 
 Erythrophleine 226* 
 
 Erythroxylon 227 
 
 Escharotics 
 
 Bloodroot 394 
 
 Bromine 149 
 
 Caustic Potash 370 
 
 Chromic Acid 39 
 
 Hydrochloric Acid 44 
 
 Nitrate of Silver 108 
 
 Zinc Chloride 439 
 
 Zinc Iodide 443 
 
 Eserine 356 
 
 Ether 69 
 
 Ethyl Bromide 227 
 
 " Iodide '228 
 
 Ethylate of Sodium 408 
 
 Eucalyptus 229 
 
 Europhen 231 
 
 Excitants 
 
 Acetic Acid 19 
 
 Arbor Vitae 43 2 
 
 Bichloride of Mercury 259 
 
 Capsicum I7 1 
 
 Creasote 211 
 
 Hydroxylamine Hydrochloride . . 285 
 
 Nitrate of Silver 103 
 
 Zinc Chloride 439
 
 4 66 
 
 INDEX. 
 
 Extra 
 
 NAME PAGE 
 
 ctum Arnicae . 121 
 
 Belladonnse 
 Conii . . . 
 
 . 123 
 
 . 2OQ 
 
 Opii . - 34.3 
 
 Aconiti Fl 
 Arnicse 
 Belladonnas 
 Conii 
 Ergotae 
 Eucalypti 
 Gelsemii 
 Geranii 
 Grindelise 
 Hamamelidis 
 Ipecacuanhse 
 Lactucarii 
 Matico 
 Rosse 
 ' Sabinse 
 
 1 . 451 
 
 .... 121 
 
 "3 
 209 
 
 . 22<; 
 
 229 
 
 241 
 
 241 
 
 252 
 2 5 6 
 30 
 
 . 314 
 
 321 
 
 . TOO 
 
 .301 
 
 F. 
 
 Farina Amygdalae 84 
 
 Febure's Remedy 24 
 
 Ferric Alum 235 
 
 Ferric Chloride 232 
 
 Ferrier's Snuff 17, 141 
 
 Ferri et Ammonii Sulphas 235 
 
 Ferri Subsulphas 235 
 
 Ferri Sulphas 237 
 
 Flaxseed 317 
 
 " Oil 318 
 
 .Fluid Extracts (see Extractum, Fid.) 
 
 Fluorescein . . 238 
 
 Foot Bath 98 
 
 Fowl's Egg 349 
 
 Fraxinus 238 
 
 Friar's Balsam 134 
 
 Fuller's Earth 312 
 
 Fuchsine 239 
 
 G. 
 
 Galanga 239 
 
 Galangal 239 
 
 Gauze 250 
 
 Gauze and Collodion Dressing . . . 206 
 
 Gallic Acid 43 
 
 Gelatin 239 
 
 Gelatin Capsules 239 
 
 Gelsemium 241 
 
 Geranium 241 
 
 Germicides 
 
 Biniodide of Mercury 269 
 
 Carbolic Acid 30 
 
 Chlorinated Lime 159 
 
 Chlorine Water 102 
 
 Hydronaphthol . . . . 330 
 
 Naphthol 328 
 
 Sozoiodol 414 
 
 NAME PAGE 
 
 Germicides Continued 
 
 Sulphite of Sodium 412 
 
 Sulphocarbolate of Sodium . . . .412 
 
 Terebene 429 
 
 Glacial Acetic Acid 20 
 
 " Phosphoric Acid 52 
 
 Glycerin 242 
 
 Glycerite of Carbolic Acid 38 
 
 " Starch 245 
 
 Glycyrrhiza 246 
 
 Goa Powder 192 
 
 Goddard's Astringent Gargle . . . 67 
 
 Golden Seal 281 
 
 Gossypium 247 
 
 Goulard's Cerate 364 
 
 " Extract 364 
 
 Green Iodide of Mercury 270 
 
 " Soap 395 
 
 " Vitriol 237 
 
 Grindelia 252 
 
 Guaiac 253 
 
 Guaiaci Resina 253 
 
 Guaco 253 
 
 Gum Arabic 17 
 
 Gum Mastiche . . . . 321 
 
 Gurjun 254 
 
 Gurjun Balsam 254 
 
 Gutta Percha 254 
 
 Gypsum 155 
 
 H. 
 
 Hsematoxylon 256 
 
 Hagar's Anticatarrhal Mixture ... 36 
 Hagerbrand's Anticatarrhal Remedy . 456 
 
 Haemostatics 
 
 Acetic Acid 19 
 
 Acetized Cotton 20 
 
 Agaric 74 
 
 Alcohol 75 
 
 Alum 79 
 
 Antipyrin 89 
 
 Cautery 176 
 
 Charcoal 173 
 
 Creoline 214 
 
 Creasote 211 
 
 Ferric Chloride 234 
 
 Ice 100 
 
 Monsel's Salt . 236 
 
 Nitrate of Silver 103 
 
 Oil of Turpentine 427 
 
 Tannic Acid 67 
 
 Yellow Wax 182 
 
 Zinc Chloride 439 
 
 Zinc Sulphate . . 447 
 
 Hamamelis 256 
 
 Hebra's Diachylon Ointment .... 369 
 
 Helmerich's Ointment 422 
 
 Hemlock 359 
 
 " Spruce 359
 
 INDEX. 
 
 467 
 
 Hip Bath 98 
 
 Homberg's Sedative Salt 24 
 
 Homatropine ..131 
 
 Hops 258 
 
 Hot Bath . . ' 99 
 
 Hot Drops 172 
 
 Humulus 258 
 
 Hydrargyri Chloridum Corrosivum . 258 
 
 " Chloridum Mite 266 
 
 " lodidum Rubrum .... 268 
 
 " " Viride 270 
 
 " Nitras 278 
 
 " Oxidum Flavum 270 
 
 " " Rubrum 272 
 
 " Oxychloridum 273 
 
 " Salicylas 280 
 
 " Sozoiodol 415 
 
 " Subsulphas Flavus .... 273 
 
 Hydrargyrum 273 
 
 " Ammoniatum 277 
 
 Hydrastis 281 
 
 Hydrate of Calcium 154 
 
 " Chloral 184 
 
 " Lime 154 
 
 " Sodium 409 
 
 Hydriodate of Hyoscine . 286 
 
 Hydriodic Ether 228 
 
 Hydrobromic Ether 227 
 
 Hydrochloric Acid 44 
 
 Hydrogen Dioxide 282 
 
 Hydrogen Peroxide 282 
 
 Hydronaphthol 330 
 
 Hydroxylamine Hydrochlo: ide . . . 285 
 
 Hyoscyamine 286 
 
 Hyoscyamus 285 
 
 Hypochloride of Sulphur 424 
 
 Hyposulphite of Calcium 154 
 
 " Silver 103 
 
 " Sodium 410 
 
 I. 
 
 Ice loo 
 
 Ice Bag 92 
 
 Iceland Moss 183 
 
 Ichthyocolla 286 
 
 Ichthyol 287 
 
 Ichthyol-Sulphonate of Ammonium . 287 
 
 Indian Hemp 166 
 
 Iodide of Silver 119 
 
 Iodide of Bismuth 139 
 
 " Cadmium 151 
 
 " Ethyl 228 
 
 " Lead 367 
 
 " Potash 378 
 
 " Soda 424 
 
 " Zinc 443 
 
 lodo-di-iso-butyl-ortho-cresol . . . .231 
 
 lodoform 290 
 
 " Gauze . . 250 
 
 lodol 297 
 
 NAME PAGE 
 
 Iodine . . 299 
 
 " Sodium Chloride 310 
 
 lodotannin 309 
 
 Ipecacuanha 310 
 
 Irrigation 91 
 
 Isinglass 286 
 
 Isinglass Plaster 287 
 
 Iso-naphthol 327 
 
 J- 
 
 Jaborandi 358 
 
 Jackson's Cough Mixture 17 
 
 " Pectoral Syrup 348 
 
 Jamestown Weed 419 
 
 Jequirity 310 
 
 Jesuits' Drops 134 
 
 Jeye's Sanitary Compound 218 
 
 " Surgical Soap 218 
 
 Jujube 312 
 
 " Paste 312 
 
 Jumble Beads 310 
 
 Jusetmond's Arsenical Powder ... 24 
 
 K. 
 
 Kaolin 312 
 
 Kava 313 
 
 Kawa 312 
 
 Kerosene 352 
 
 Kino 313 
 
 Kummerfeld's Lotion 423 
 
 Krameria 313 
 
 L, 
 
 Labarraque's Solution 413 
 
 Lactic Acid 45 
 
 Lactucarium 314 
 
 Lambs' Wool 314 
 
 Laminaria 315 
 
 Lanolin 316 
 
 Laudanum 344 
 
 Lead Plaster 369 
 
 Lead Water and Laudanum .... 364 
 
 Leeches 142 
 
 Leiter's Tubes '. 90 
 
 Lemon Juice 316 
 
 Leucoline 183 
 
 Licorice Root 246 
 
 Lidoyen's Disinfecting Fluid . . . 368 
 
 Lime 157 
 
 Limonis Succus 316 
 
 Linimentum Cantharidis 166 
 
 Linseed 317 
 
 " Oil 318 
 
 Lint 318 
 
 Linum 317 
 
 Liquid Glass 411 
 
 " Pepsin 351
 
 468 
 
 INDEX. 
 
 Liquid Petrolatum 355 
 
 Vaseline 355 
 
 Liquor Carbonis Detergens 362 
 
 " Calcis 157 
 
 <: Gutta Perchse 254 
 
 " Hydrargyri Nitratis 278 
 
 " lodi Comp 299 
 
 " Pepsini 351 
 
 " Plumbi Acetas 364 
 
 " " Subaceiatis 364 
 
 " " " Dil. ... 364 
 
 " Picis Alkalinus 373 
 
 " Potassae 370 
 
 " Sod?e Chloratse 413 
 
 Liquorice Root 246 
 
 Lister's Boric Acid Ointment .... 26 
 
 " Carbolized Gauze 183 
 
 " Protective 223 
 
 Litharge 369 
 
 Lithii Carbonas 319 
 
 Liver of Sulphur 374 
 
 Local Actions of Drugs xi 
 
 Local Treatment of Diseases 
 
 of Eye xxv 
 
 of Respiratory Tract xxi 
 
 of Skin xix 
 
 Logan's Plaster 399 
 
 Logwood 256 
 
 London Paste 408 
 
 Lotio Flava 158 
 
 " Nigra 158 
 
 Lugol's Solution 299 
 
 Lunar Caustic 103 
 
 Lund's Oil 32 
 
 Lycopodium 320 
 
 Lysol 320 
 
 M. 
 
 Maas' Mixture 264 
 
 McCall Anderson's Camphor Powder . 99 
 
 " " Ointment . , . .138 
 
 Magnesii Carbonas 320 
 
 Manec's Paste 24 
 
 Marigold 156 
 
 Marshmallow 78 
 
 Mastic 321 
 
 Mastiche 321 
 
 Matico 321 
 
 Medicated Baths 456 
 
 Mel Rosse 390 
 
 Menthol 321 
 
 Mercurammonium Chloride 277 
 
 Mercurial Bath 280 
 
 " Ointment 275 
 
 " Plaster 274 
 
 Mercuric Chloride 258 
 
 " Iodide 268 
 
 Mercurous Chloride 266 
 
 Metallic Mercury 273 
 
 Methods of using Medicines . . xiv 
 
 Methyl Violet 381 
 
 Michel's Paste 59 
 
 Mild Chloride of Mercury . . . . 266 
 
 Mist. Oleo-Balsamica 122 
 
 Mixture of Almond . 83 
 
 Molasses 392 
 
 Mollin 325 
 
 Monsel's Salt 235 
 
 " Solution 237 
 
 Morphia 345 
 
 Morphinse Acetas 348 
 
 Moxa 74 
 
 Muriate of Ammonia 453 
 
 Muriatic Acid 44 
 
 Muscarine 325 
 
 " Sulphate 326 
 
 Musk Root 424 
 
 Mustard 400 
 
 Mustard Plaster . 400 
 
 Mydriatics 
 
 Belladonna 127 
 
 Cocaine 202 
 
 Daturine 420 
 
 Duboisine . 224 
 
 Gelsemium 241 
 
 Hydriodate of Hyoscine 286 
 
 Hyoscyamine 286 
 
 Scopolenine 399 
 
 Myotics 
 
 Eserine . . 356 
 
 Muscarine 326 
 
 Pilocarpine 358 
 
 Myrrh 326 
 
 Myrtle Oil 337 
 
 Myrtus 327 
 
 N. 
 
 Naphthalene 327 
 
 Naphthalin 327 
 
 Naphthol 327 
 
 Nitrate of Copper 220 
 
 Lead 368 
 
 Mercury 278 
 
 Potassium 379 
 
 Silver 103 
 
 Zinc 443 
 
 Nitre Paper 252 
 
 Nitric Acid 48 
 
 Nitrite of Amyl 84 
 
 Nux Vomica 331 
 
 Nyssa 332 
 
 O. 
 
 Oil of (see Oleum}. 
 
 Oleoresin of Capsicum 171 
 
 Oleum Amygdalae Expressum ... 83
 
 INDEX. 
 
 469 
 
 Oleum Anacardii 332 
 
 " Cadini 335 
 
 Cajuputi 332 
 
 " Calami 333 
 
 Camphoric 161 
 
 " Caryophylli 333 
 
 Cassiae 333 
 
 " Cinnamomi 333 
 
 " Cubebse 219 
 
 Cocois Nuciferae 334 
 
 Gaultheriae 334 
 
 Juniperi 335 
 
 Limonis 336 
 
 Lini 318 
 
 " Sulphuratum 424 
 
 Menthae Piperitae 336 
 
 " Viridis 336 
 
 Morrhuae 337 
 
 Myristicae 337 
 
 Myrti 337 
 
 Olivae 338 
 
 Petras 351 
 
 Petrolatum 355 
 
 " Picis Liquidae 361 
 
 " Pini Sylvestris 339 
 
 ' Ricini 340 
 
 " Rusci 361 
 
 " Rutae 340 
 
 " Sabinae 391 
 
 " Santali 34! 
 
 " Sassafras 399 
 
 " Terebinthinae 427 
 
 " Theobromas 341 
 
 " Thymi 341 
 
 " Tiglii 342 
 
 " Valerianae 342 
 
 Oleate of Bismuth 139 
 
 " Mercury 279 
 
 " Veratrine 436 
 
 " Zinc 458 
 
 Ouabain 343 
 
 Opii Pulvis 344 
 
 Opium 343 
 
 Ordeal Bean 356 
 
 Origanum 348 
 
 Ovi Albumen 349 
 
 " Vitellus 349 
 
 Oxalate of Cerium 183 
 
 Oxide of Antimony 88 
 
 " Lead 369 
 
 " Zinc 444 
 
 Oxychloride of Bismuth 138 
 
 " Mercury 273 
 
 Oxy iodide of Bismuth 139 
 
 P. 
 
 Pale Rose 341 
 
 Panas' Solution 270 
 
 Papain 350 
 
 Papaver 344 
 
 NAME PAGE 
 
 Papayotin 350 
 
 pa P r 35 1 
 
 Papoid 350 
 
 Paraffin . 355 
 
 Paraffinum Liquidum 355 
 
 Parasiticides 
 
 Ammoniated Mercury 277 
 
 Anthrarobin . : 87 
 
 Aristol 119 
 
 Balsam of Peru 1 22 
 
 Benzoic Acid 136 
 
 Carbolic Acid 30 
 
 Chloroform 188 
 
 Glacial Acetic Acid 22 
 
 Hydroxylamine Hydrochloride . . 285 
 
 Hyposulphite of Soda 410 
 
 Ichthyol 288 
 
 Iodine 300 
 
 Labarraque's Solution 413 
 
 Naphthalene 327 
 
 Potassa Sulphurata 374 
 
 Pyrogallic Acid 53 
 
 Resorcin 387 
 
 Salicylic Acid 55 
 
 Stavesacre 419 
 
 Sulphur 421 
 
 Sweet Spirits of Nitre . % 417 
 
 Tar "...... 360 
 
 Thymol 432 
 
 Tumenol 435 
 
 Veratrine 436 
 
 Water .... 100 
 
 Zinc Iodide 443 
 
 Parchment Paper 251 
 
 Pellitory 384 
 
 Pepper 359 
 
 Peppermint Camphor 321 
 
 Perchloride of Iron 232 
 
 Perfumed Spirits .417 
 
 Permanganate of Potash 379 
 
 Peroxide of Hydrogen 282 
 
 Petitgand's Coil 92 
 
 Petrolatum 352 
 
 " Liquidum 355 
 
 Petroleum 351 
 
 Petroleum Ether 133 
 
 Phenacetine '. 356 
 
 Phenazonum 89 
 
 Phenate of Cocaine 205 
 
 Phenic Acid 23 
 
 Phenylhydride 137 
 
 Phenyl Alcohol 29 
 
 Phenylic Acid 29 
 
 Phenylic Salicylate 393 
 
 Phenol 23 
 
 " Camphor 164 
 
 " -Sodique 38 
 
 Phosphate of Calcium 155 
 
 Phosphoric Acid 52 
 
 Physostigma 356
 
 47 
 
 INDEX. 
 
 Pilocarpus 358 
 
 Pine Needle Oil 458 
 
 Pinol 359 
 
 Pinus Canadensis 359 
 
 Piper 359 
 
 Pix Burgundica 360 
 
 Pix Liquida 360 
 
 Plasters xvii 
 
 Plaster of Paris 155 
 
 Plumbi Acetas 364 
 
 " Carbonas 366 
 
 " lodidum 367 
 
 " Nitras 368 
 
 " Oxidum 369 
 
 Po-ho-yo 322 
 
 Poppy Heads 344 
 
 Potash with Lime 373 
 
 Potassa 370 
 
 Potassa cum Cake 370 
 
 Potassa Sulphurata 374 
 
 Potassii Bichromas 375 
 
 Bromidum 374 
 
 Carbonas ... 375 
 
 Chloras 375 
 
 Citras 377 
 
 Cyanidum 377 
 
 lodidum 378 
 
 Nitras ^ 379 
 
 Permanganas 379 
 
 Sulphurata 374 
 
 Tartras 380 
 
 Powdered Opium 344 
 
 Prayer Beads 310 
 
 Precipitated Carbonate of Calcium . .152 
 " " " Zinc ... 438 
 
 " Chalk 152 
 
 Prickly Ash 437 
 
 Protectants 
 
 Agaric 74 
 
 Aristol 119 
 
 Balsam of Peru 122 
 
 " Tolu 123 
 
 Benzoin 34 
 
 Bicarb, of Soda 402 
 
 Bismuth Subnitrate 139 
 
 Cacao Butter 341 
 
 Carbonate of Lead 367 
 
 Conium 210 
 
 Cosmoline 353 
 
 Dermatol 223 
 
 Earth 425 
 
 Elder 394 
 
 Europhen 231 
 
 Flaxseed 317 
 
 Fowl's Egg 349 
 
 Gum Mastiche 321 
 
 lodoform 290 
 
 lodol 297 
 
 Isinglass 287 
 
 Kaolin 312 
 
 NAME PAGE 
 
 Protectants Continued 
 
 Kerosene 352 
 
 Lycopodium 320 
 
 Molasses . 392 
 
 Ol. Olivse 338 
 
 " Ricini 340 
 
 Salt 406 
 
 Silicate of Soda 411 
 
 Sol. of Gutta Percha 254 
 
 Starch 86 
 
 Talc 425 
 
 Thiol 431 
 
 Yellow Wax 182 
 
 Prussic Acid 45 
 
 Pulsatilla 381 
 
 Pulvis Ipecac, et Opii 310 
 
 Pumex 381 
 
 Pumice 381 
 
 " Stone 381 
 
 Pyoctanin 381 
 
 Pyoktanin 381 
 
 Pyrethrum 384 
 
 Pyridine 384 
 
 Pyrogallic Acid 53 
 
 Pyrogallol 53 
 
 Pyroligneous Acid 23 
 
 Q- 
 
 Quercus Alba 285 
 
 Quicksilver 273 
 
 Quillaia 385 
 
 Quince Seed 222 
 
 Quinine 385 
 
 Quinoline 183 
 
 R. 
 
 Raw Cotton 241 
 
 Red Iodide of Mercury 268 
 
 Red Oxide " 272 
 
 Red Precipitate 272 
 
 Red Rose 390 
 
 Refrigerants 
 
 Ammonia Fortior 455 
 
 Ammonium Carbonate 452 
 
 Benzine 133 
 
 Ice 100 
 
 Rhigolene 351 
 
 Sweet Spirits of Nitre 417 
 
 Resin 426 
 
 Resina 426 
 
 Resinol 389 
 
 Resin Plaster 426 
 
 Resorcin 386 
 
 " -phtalein 238 
 
 Retinol 389 
 
 Rhatany 313 
 
 Rhigolene 351
 
 INDEX. 
 
 471 
 
 Rhus Glabra 390 
 
 Rochard's Ointment 269 
 
 Rock Oil 351 
 
 Rosa Centifolia 391 
 
 " Gallica 390 
 
 Rosin 426 
 
 Rosinol 389 
 
 Rubber Plaster 255 
 
 Rubefacients 
 
 Benzine 133 
 
 Cantharides 166 
 
 Capsicum 171 
 
 Chloroform 188 
 
 Iodine 300 
 
 Kerosene 352 
 
 Mustard 400 
 
 Oil of Turpentine 427 
 
 Salt 406 
 
 Tartar Emetic . . 88 
 
 S. 
 
 Sabina 391 
 
 Saccharate of Lime 160 
 
 Saccharum 391 
 
 " Lactis 392 
 
 Sage 394 
 
 Sal Ammoniac 453 
 
 Salicylated Cotton 54 
 
 Salicylate of Mercury 280 
 
 " Soda 410 
 
 " Zinc 446 
 
 Salicylic Acid 54 
 
 Salol 393 
 
 Saltpetre 379 
 
 Salvia 394 
 
 Sambucus 394 
 
 Sanguinaria 394 
 
 Sapo . 395 
 
 Sapo Viridis 395 
 
 Sassafras 399 
 
 Savine 391 
 
 Sayre's Dressing . 427 
 
 Scheele's Hydrocyanic Acid .... 45 
 
 Scopolenine 399 
 
 Scott's Dressing 276 
 
 Sea Tangle 315 
 
 Sedatives 
 
 Acetate of Lead 364 
 
 Ammonium Carbonate 452 
 
 Antipyrin 89 
 
 Balsam of Peru 122 
 
 Belladonna 124 
 
 Bismuthi Subnitras 139 
 
 Borax , . 404 
 
 Bromide of Potash 374 
 
 Carbonate of Lead 367 
 
 Chloroform . 188 
 
 NAME PAGE 
 
 Sedatives Continued 
 
 Conium 209 
 
 Cyanide of Potash 377 
 
 Eucalyptus 229 
 
 Grindelia 252 
 
 Hydroxylamine Hydrochloride . . 286 
 
 Ichthyol 288 
 
 Oil of Peppermint 336 
 
 " Spearmint 336 
 
 " Sandal 341 
 
 Precip. Carbonate of Zinc .... 438 
 
 Tobacco 425 
 
 Zinc Oxide 444 
 
 Seiler's Antiseptic Tablets 403 
 
 Sesquichloride of Iron 232 
 
 Shower Bath . . 98 
 
 Sialogogues 
 
 Citrate of Potash 377 
 
 Pellitory 384 
 
 Tartrate of Potash 380 
 
 Silicate of Soda 411 
 
 Sinapis Alba 400 
 
 " Nigra 400 
 
 Sitz Bath 98 
 
 Slaked Lime 145 
 
 Slippery Elm 435 
 
 Soap 395 
 
 Soap Bark 385 
 
 Soap Plaster 398 
 
 Soda 401 
 
 Soda cum Cake 408 
 
 Soda with Lime 408 
 
 Sodii Benzoas 401 
 
 ' Bicarbonas 402 
 
 ' Bisulphas 404 
 
 ' Boras ..404 
 
 ' Carbonas 406 
 
 ' Chloridum 406 
 
 ' Ethylas 408 
 
 ' Hydras 49 
 
 ' Hypochloritis 413 
 
 ' Hyposulphis 410 
 
 ' Salicylas 4 IQ 
 
 ' Silicas 41 1 
 
 ' Sozoiodolas 4'6 
 
 ' Sulphis 412 
 
 ' Sulphocarbolas i 412 
 
 ' Sulphoricinatis 413 
 
 Sodium Bicarbonate 4 2 
 
 " Sulphite 412 
 
 Solution of Caustic Potash 372 
 
 Chlorinated Lime . . . .413 
 
 Gutta Percha 254 
 
 Hydroxyl 282 
 
 Nitrate of Mercury . . .278 
 
 Pepsin 35 I 
 
 Peroxide of Hydrogen . . 282 
 Pernitrate of Mercury . . 278 
 Potassa 372
 
 472 
 
 INDEX. 
 
 NAME PAGE 
 
 Solvents 
 
 Acetic Acid 19 
 
 Papain 350 
 
 Salt 406 
 
 Soap 395 
 
 Trypsin 434 
 
 Sozoiodol 414 
 
 Sozoiodolate of Mercury 415 
 
 " Potash 415 
 
 " Sodium 416 
 
 " Zinc 416 
 
 Spanish Fly 166 
 
 Spender's Lime Ointment 154 
 
 Spiritus Ammon. Aromat 452 
 
 " Camphorse 161 
 
 " Myristicse 337 
 
 " Odoratus 417 
 
 Spirits of Nitrous Ether 417 
 
 Spitta's Lozenge 219 
 
 Sponge Bath 98 
 
 Sponges 417 
 
 Spongio-piline 419 
 
 Spunk 74 
 
 Staphisagria 419 
 
 Starch 86 
 
 " Bandage . . 86 
 
 " Poultice 86 
 
 Stavesacre 419 
 
 Stenocarpine 459 
 
 Sterilized Water .94 
 
 Stimulants 
 
 Acetic Acid 19 
 
 Alcohol 75 
 
 Ammonia 102 
 
 Ammonia Fortior 455 
 
 Ammoniated Mercury 277 
 
 Benzoic Acid 136 
 
 Black Pepper 359 
 
 Blood Root 394 
 
 Burgundy Pitch 360 
 
 Calomel 266 
 
 Carbolic Acid 30 
 
 Chromic Acid 39 
 
 Cubehs ... 218 
 
 Galanga 239 
 
 Hamamelis 256 
 
 Hemlock 359 
 
 Hydrochloric Acid 44 
 
 Labarraque's Solution 413 
 
 Naphthalene 327 
 
 Nitric Acid . 48 
 
 .Oil of Cade 335 
 
 " Fir 339 
 
 ' Gaultheria 335 
 
 " Juniper 335 
 
 " Lemon 336 
 
 " Rue 340 
 
 Peroxide of Hydrogen 282 
 
 Salt 406 
 
 NAME PAGE 
 
 Stimulants Continued 
 
 Sassafras Oil 399 
 
 Tar 360 
 
 Thymol 432 
 
 Trichloracetic Acid 18 
 
 Wild Marjoram 348 
 
 Zinc Iodide 443 
 
 " Sozoiodolate 416 
 
 " Sulphate 447 
 
 St. John Long's Liniment ... 19, 349 
 
 Storone 421 
 
 Stramonium 419 
 
 Strophanthus 421 
 
 Stronger Water of Ammonia .... 455 
 
 Strychnia 331 
 
 " Sulphate 331 
 
 Styrone 421 
 
 Styptic Collodion 62 
 
 " Cotton 247 
 
 Subcarbonate of Bismuth 138 
 
 Subgallate " 223 
 
 Subiodide " 139 
 
 Subnitrate " 139 
 
 Sublimate Bath 458 
 
 Sugar 391 
 
 Sugar of Lead 364 
 
 " Milk 392 
 
 Sulphate of Calcium 155 
 
 " Copper 220 
 
 Sulphate of Iron 237 
 
 Iron and Ammonia . . . 235 
 
 Strychnine 331 
 
 Zinc 446 
 
 Sulphide of Calcium 160 
 
 Potash 374 
 
 Zinc 449 
 
 Sulphite of Soda 412 
 
 Sulphocarbolate of Soda 412 
 
 Sulphocarbolate of Zinc 449 
 
 Sulphophenate of Zinc 450 
 
 Sulphoricinate of Soda 413 
 
 Sulphur 421 
 
 Balsam 424 
 
 Bath 457 
 
 Hypochloride 424 
 
 Iodide 424 
 
 Lotum 421 
 
 Precipitatum 421 
 
 Sublimatum 421 
 
 Sulphurated Lime 160 
 
 " Potassa 374 
 
 Sulphuric Acid 58 
 
 " Ether 69 
 
 Sulphurous Acid 60 
 
 Sumach 390 
 
 Sumbul 424 
 
 Sweet Oil 338 
 
 Sweet Spirits of Nitre 417 
 
 Syrupus Calcis 157 
 
 Syrupy Phosphoric Acid 5 2
 
 INDEX. 
 
 473 
 
 Tabacum 425 
 
 Table Salt 40 
 
 Tailor's Chalk 425 
 
 Talc 425 
 
 Tannate of Zinc 450 
 
 Tannic Acid 62 
 
 Tar 360 
 
 Tarlatan 251 
 
 Tartar Emetic 88 
 
 Tartaric Acid 68 
 
 Tartrate of Potash 380 
 
 " Antimony and Potash . . 88 
 
 Tar Water 363 
 
 Terebene 429 
 
 Terebinthinse 426 
 
 Terpin-Hydrate 430 
 
 Terpinol 430 
 
 Terra 425 
 
 Terraline 355 
 
 Tetraiodopyrrol 297 
 
 Theine 151 
 
 Theriaca 392 
 
 Thilanin 430 
 
 Thiol 430 
 
 Thioresorcin 431 
 
 Thiosulphite of Soda 410 
 
 Thuja 432 
 
 Thymic Acid 432 
 
 Thymol 432 
 
 Tinctura Aconiti 451 
 
 " Arnicje 120 
 
 " " Rad 120 
 
 " Belladonnse 121 
 
 ' Benzoini 133 
 
 " Comp 133 
 
 " Bryonise 151 
 
 " Cantharidis 1 66 
 
 " Capsici 171 
 
 " Catechu 174 
 
 " Cimicifugse 194 
 
 " Conii 209 
 
 " Ferri Chloridi 232 
 
 " Gelsemii 241 
 
 Guaiaci 253 
 
 lodi 293 
 
 Kino 313 
 
 Matico 321 
 
 Moschi 325 
 
 Opii 343 
 
 < Camph 313 
 
 " Deodor 343 
 
 Saponis Viridis 395 
 
 " Tolutanum 123 
 
 Tinder 174 
 
 Tobacco 425 
 
 Touch Wood 74 
 
 Treacle 392 
 
 Tribromphenol 148 
 
 Trichloracetic Acid 18 
 
 Trochisci Ipecacuanhse 310 
 
 " " et Morphia . . . .310 
 
 Trypsin 434 
 
 Tumenol 435 
 
 Tupelo 332 
 
 Turlington's Balsam 134 
 
 Turner's Cerate 438 
 
 Turpeth Mineral 273 
 
 U. 
 
 Ulmus 435 
 
 Unguentum Acidi Gallici 43 
 
 " Tannici 63 
 
 Aquse Rosse . . . 84,391 
 
 Belladonnas 123 
 
 Diachylon 338 
 
 Hydrargyri 275 
 
 " Nitratis . . . 279 
 
 lodi 299 
 
 Picis Liquids 360 
 
 Plumbi Carbon atis . . . 366 
 
 " lodidi 378 
 
 Potassii lodidi 367 
 
 Sulphuris 422 
 
 Veratrinse 436 
 
 Zinci Oxidi 444 
 
 V. 
 Veratrine 436 
 
 W. 
 
 Wade's Balsam 134 
 
 Washing Soda 406 
 
 Water 90 
 
 " of Ammonia 102 
 
 Waxed Paper 251 
 
 White Lead 366 
 
 Oak .385 
 
 " Precipitate 277 
 
 Wild Marjoram 348 
 
 Wilkinson's Ointment 361 
 
 Wine of Opium , . . . 345 
 
 Wintergreen, Oil of . . .... 334 
 
 Wistar's Cough Lozenge 348 
 
 Witch Hazel 256 
 
 Wood Oil P54 
 
 Wood Tar . ....... 3 6 
 
 X. 
 
 Xanthoxylum 
 
 437 
 
 Y. 
 
 Yellow Jasmine 241 
 
 " Mercuric Oxide 270 
 
 " Pyoktanin 3^1 
 
 " Subsulphate of Mercury . . . 273 
 " Wash 158, 259
 
 474 ' 
 
 INDEX. 
 
 Yellow Wax 182 
 
 Yerba Reuma 437 
 
 Z. 
 
 Zinci Acetas -437 
 
 " Carbonas Precip 438 
 
 " Chloridum 439 
 
 Zinci lodidum 443 
 
 Nitras 443 
 
 Oleas 458 
 
 Oxidum 444 
 
 Salicylas 446 
 
 Sulphas 446 
 
 Sulphocarbolas 449 
 
 Sulphidum 449 
 
 Tannas 450
 
 INDEX OF DISEASES. 
 
 The page numbers in Roman numerals -will be found in the Introduction. 
 
 NAME A. PAGE 
 
 Abscess 
 
 Boroglycerin 29 
 
 Brucine 151 
 
 Glycerin 242 
 
 Iodine 301 
 
 Menthol 322 
 
 Phosphate of Lime 155 
 
 Resorcin 387 
 
 Sugar 392 
 
 Abscess Cold 
 
 lodoform 292 
 
 Naphthalene 327 
 
 Abscess of Eyelid - 
 
 Hot Stupe 249 
 
 Abscess of Joint 
 
 Iodine 302 
 
 Acidity of Mouth and Pharynx 
 
 Prepared Chalk 153 
 
 Acne 
 
 Acid Nitrate of Mercury 279 
 
 Bismuth Subnitrate 140 
 
 Green Iodide of Mercury 270 
 
 Hypochloride of Sulphur 424 
 
 Ichthyol 290 
 
 Iodide of Soda 424 
 
 Kaolin 312 
 
 Kummerfeld's Lotion 423 
 
 Mercuric Chloride 263 
 
 Naphthol 329 
 
 Prepared Chalk 153 
 
 Pumice 381 
 
 Salicylic Acid 57 
 
 Sulphur 423 
 
 " Bath 457 
 
 Thiol 431 
 
 Zinc Iodide 443 
 
 " Oxide 445 
 
 NAME PAGE 
 
 Acne Rosacea 
 
 Ichthyol .... 289 
 
 Thilanin 430 
 
 Thiol 431 
 
 Adenitis 
 
 Iodide of Cadmium 151 
 
 " Lead 367 
 
 " Potash 378 
 
 Iodine 306 
 
 lodol 297 
 
 Lanolin 316 
 
 Naphthalin 327 
 
 Ungt. Belladon 124 
 
 " Hydrarg 276 
 
 Adenoid Growth of Naso-Pharynx 
 
 Alum, 8l 
 
 Nitrate of Silver 113 
 
 Alopecia 
 
 Aconite 45 1 
 
 Cantharides 170 
 
 Capsicum I7 2 
 
 Ether 73 
 
 Oil of Savine 391 
 
 Pilocarpine 358 
 
 Quinia ^86 
 
 Turpeth Mineral 273 
 
 Alopecia Areata 
 
 Ammonia 102 
 
 Cantharides 17 
 
 Chrysarobin 194 
 
 Collodion 208 
 
 Oil of Turpentine 428 
 
 Alopecia Prematura 
 
 Acetic Acid 20 
 
 Ammonia 102 
 
 Cantharides I? 1 
 
 475
 
 476 ' 
 
 INDEX. 
 
 NAME 
 
 Alveolar Abscess 
 Carbolic Acid 
 
 37 
 
 Anaemia, Syphilitic 
 
 Mercury 274 
 
 Anal Fistula 
 
 Iodine 303 
 
 Caustic Potassa 371 
 
 Aneurism 
 
 Ergot 225 
 
 Ferri Chloridi 232 
 
 Angina 
 
 Alum 81 
 
 Benzoic Acid 137 
 
 Capsicum 172 
 
 Chlorate of Potash 377 
 
 Ice .... 101 
 
 Labarraque's Solution 414 
 
 Myrrh 326 
 
 Oil of Cassia 334 
 
 Prickly Ash 437 
 
 Sulphate of Copper 222 
 
 Sulphocarbolate of Soda . .412 
 Vinegar 21 
 
 Angina Pectoris 
 
 Amyl Nitris 85 
 
 Angioleucitis 
 
 Ungt. Hydrarg 276 
 
 Anosmia 
 
 Strychnine 332 
 
 Anthrax 
 
 (See Carbuncle.} 
 Aphonia 
 
 Sulphurous Acid 62 
 
 Aphthous Ulcers of Mouth - 
 
 Bismuth Subnitrate 141 
 
 Boric Acid, 28 
 
 Chlorate of Potash 376 
 
 Labarraque's Solution 413 
 
 Pyoktanin 383 
 
 Sulphate of Copper .....'.. 222 
 Tannic Acid 67 
 
 Arthritic Effusion, Serous 
 
 Iodine 301 
 
 Arthritis 
 
 Oakum 319 
 
 Ungt. Belladon 125 
 
 Articular Disease 
 
 Cautery 175 
 
 Ascarides 
 
 Salicylic Acid 56 
 
 Aspergillus 
 
 Boric Acid 27 
 
 Chlorinated Lime 159 
 
 Salicylic Acid 58 
 
 Veratrine 436 
 
 Asthenopia 
 
 Eserine 357 
 
 Pilocarpine 359 
 
 Veratrine 436 
 
 Asthma 
 
 Amyl Nitris 85 
 
 Chloroform 192 
 
 Coca 227 
 
 Ethyl Iodide 228 
 
 Grindelia 252 
 
 Hydrocyanic Acid 45 
 
 Nitrate of Potash 379 
 
 Pyridine .... 384 
 
 Resorcin 389 
 
 Stramonium 420 
 
 Tobacco 425 
 
 Aural Catarrh 
 
 Ammon. Chlorid 454 
 
 Camphorated Iodine 310 
 
 lodoform 296 
 
 Menthol 323 
 
 Nitrate of Silver 112 
 
 Zinc Sulphate 448 
 
 Aural Furuncle 
 
 Nitrate of Silver ill 
 
 Aural Polypus 
 
 Acid Nitrate of Mercury ..... 279 
 
 Alcohol .77 
 
 Alum 80 
 
 Caustic Potash 372 
 
 Chloracetic Acid 1 8 
 
 Ferric Chlor 234 
 
 Nitrate of Silver 112 
 
 Nitric Acid 51 
 
 Tannic Acid 66 
 
 Vienna Paste 374 
 
 B. 
 
 Balano-Posthitis 
 
 Nitrate of Silver 1 06 
 
 Bed Sores 
 
 Alcohol 75 
 
 Alum 79 
 
 Boric Acid 25 
 
 Bran 148 
 
 Glycerin 242 
 
 Lead Plaster 369 
 
 Nitrate of Silver 105 
 
 Oakum 319 
 
 Soap Plaster 398
 
 INDEX. 
 
 477 
 
 NAME PAGE 
 
 Bites, Wounds Caused by 
 
 Ammonia Fortior 455 
 
 Copper Sulphate 222 
 
 Mercuric Chloride 261 
 
 Nitrate of Silver 104 
 
 Sulphuric Acid 60 
 
 Blennorrhagia 
 (See Gonorrhoea.'] 
 
 Blepharitis, Marginal 
 
 Aristol 120 
 
 Creolin . 218 
 
 Resorcin 389 
 
 Yellow Oxide of Mercury . . . .271 
 
 Boils- 
 Belladonna . . 125 
 
 Campho-phenique 164 
 
 Chloral 186 
 
 Collodion 206 
 
 Deshler's Salve 426 
 
 Ichthyol 289 
 
 Iodine 305 
 
 Menthol 322 
 
 Opium 344 
 
 Pyoktanin 382 
 
 Breast, Painful and Swollen 
 
 Camphor-Chloral 165 
 
 Bromidrosis 
 
 Acetate of Lead 365 
 
 Boric Acid 27 
 
 Chloral 186 
 
 Oleate of Mercury 280 
 
 Permanganate of Potash .... 380 
 
 Bronchial Asthma 
 
 Ipecac 
 
 310 
 
 Bronchitis, Chronic 
 
 Albumin 349 
 
 Benzoic Acid 136 
 
 Carbolic Acid 35 
 
 Chlorine . 187 
 
 Creasote 213 
 
 Croton Oil 342 
 
 Eihyl Iodide 229 
 
 Iodine 300 
 
 lodoform 296 
 
 Kerosene 352 
 
 Mustard 400 
 
 Nitrate of Silver 116 
 
 Resorcin 389 
 
 Sulphurous Acid 62 
 
 Terpinol 430 
 
 Turpentine Stupe 428 
 
 Bronchocele 
 
 (See Goitre.} 
 Bronchorrhcea 
 
 Carbolic Acid 35 
 
 444 
 
 NAME 
 
 Brush Burns 
 
 Zinc Oxide 
 
 Buboes 
 
 Ammonium Chloride 453 
 
 Iodine 305 
 
 Nitrate of Silver 108 
 
 Peroxide of Hydrogen 283 
 
 Poultice 318 
 
 Bubo, Chancroidal 
 
 Caustic Potash 371 
 
 Bubo, Suppurating 
 
 lodoform 294 
 
 Bunion 
 
 Yellow Oxide of Mercury 
 Burns 
 
 371 
 
 Albumin 349 
 
 Bicarbonate of Soda . 402 
 
 Boric Acid 25 
 
 Carbolic Acid 32 
 
 Carbonate of Lead 367 
 
 Carron Oil . ' 158 
 
 Chloral 185 
 
 Cocaine 196 
 
 Copaiba 2IO 
 
 Cosmoline 354 
 
 Creoline . 216 
 
 Dermatol 223 
 
 Eucalyptus 230 
 
 Europhen 231 
 
 Glycerite of Starch 246 
 
 Hot Baths 100 
 
 lodoform 294 
 
 Lime Water 158 
 
 Menthol 322 
 
 Molasses 392 
 
 Nitrate of Silver 104 
 
 Phenol- Sodique 39 
 
 Prepared Chalk 152 
 
 Raw Cotton 247 
 
 Resin 426 
 
 Salol 393 
 
 Sozoiodol 414 
 
 Subnitrate of Bismuth 139 
 
 Thiol 431 
 
 Thymol 432 
 
 Zinc Oxide ^44 
 
 C. 
 
 Callosities- 
 
 57 
 
 Salicylic Acid 
 
 Cancer of Breast 
 
 Alcohol . 76 
 
 Arsenious Acid .24 
 
 Antipyrin 89 
 
 Calendula 156 
 
 Conium 209 
 
 Eucalyptus 230
 
 478 
 
 INDEX. 
 
 NAME PAGE 
 
 Cancer of Breast Continued 
 
 Febure's Remedy 2 
 
 Jusetmond's Arsenical Powder . . 24 
 
 Manec's Paste 24 
 
 Permanganate of Potash 380 
 
 Prepared Chalk 152 
 
 Pyoktanin 382 
 
 Stramonium 420 
 
 Storone 421 
 
 Sulphuric Acid 60 
 
 Tannic Acid 64 
 
 Vienna Paste 373 
 
 Zinc Chloride 440 
 
 Zinc Oxide 444 
 
 Cancer of Cervix Uteri 
 
 Antipyrin 89 
 
 Nitric Acid 50 
 
 Permanganate of Potash 380 
 
 Salicylic Acid 56 
 
 Vienna Paste 373 
 
 Zinc Chloride 44 
 
 Cancer of Larynx 
 
 Carbolic Acid 37 
 
 Cancer of Lips 
 
 Antipyrin 90 
 
 Cancer of CEsophagus 
 
 Monsel's Salt 236 
 
 Cancer of Tongue 
 
 Antipyrin 90 
 
 Carbolic Acid 37 
 
 Cautery 176 
 
 Permanganate of Potash 380 
 
 Cancer of Uterus 
 
 Bromine 149 
 
 Cautery 175 
 
 Chloral 185 
 
 Cocaine 196 
 
 Conium 210 
 
 Creasote 212 
 
 Eucalyptus 230 
 
 Ferric Chloride 233 
 
 lodoform 294 
 
 Mustard 401 
 
 Terebene 429 
 
 Zinc Chloride 440 
 
 " Sulphate 448 
 
 Cancrum Oris 
 
 Eucalyptus 230 
 
 Carbuncles 
 
 Belladonna 125 
 
 Dermatol 233 
 
 Ergot ... 226 
 
 Menthol 322 
 
 Opium 344 
 
 Poultice 318 
 
 NAME PAGE 
 
 Caries 
 
 Hydrochloric Acid 44 
 
 Myrrh 326 
 
 Oil of Turpentine 428 
 
 Sulphuric Acid 59 
 
 Zinc Sulphate 447 
 
 Caruncles of Urethra 
 
 Cocaine 196 
 
 Catarrh of Cervix 
 
 Bougies 146 
 
 Catarrh, Chronic Nasal 
 
 Alcohol 77 
 
 Antipyrin 90 
 
 Aristol 1 20 
 
 Benzoic Acid 136 
 
 Bismuth Subnitrat . . 141 
 
 Bleeding 143 
 
 Borax 405 
 
 Boric Acid 27 
 
 Bougies 147 
 
 Bromine 150 
 
 Calendula 157 
 
 Carbolic Acid 36 
 
 Chlorinated Lime 160 
 
 Cocaine 200 
 
 Creoline . 217 
 
 Cubebs 219 
 
 Europhen 231 
 
 Ferric Alum 235 
 
 Gallic Acid 43 
 
 Glycerin 245 
 
 Hydrastis 281 
 
 lodol 298 
 
 Lactic Acid 47 
 
 Lycopodium 320 
 
 Marigold 157 
 
 Menthol 233 
 
 Mercuric Chloride 264 
 
 Monsel's Salt 236 
 
 Nitrate of Silver 113 
 
 Nitric Acid 51 
 
 Oxalate of Cerium 183 
 
 Sage 394 
 
 Salicylic Acid 58 
 
 Salt 407 
 
 Soap Bark 385 
 
 Sozoiodol 415 
 
 Sozoiodolate of Potash .... 416 
 
 " Soda 416 
 
 " Zinc 416 
 
 Sulphurous Acid . . 62 
 
 Tannic Acid 66 
 
 Tobacco 425 
 
 Water 97 
 
 Witch-hazel 257 
 
 Yerba-Reuma 437 
 
 Zinc Iodide ... 433 
 
 " Salicylate 446 
 
 See also fihinitis, Atrophic and Hyper- 
 trophic.
 
 INDEX. 
 
 479 
 
 NAME PAG 
 
 Catarrh of Ear 
 (See Aural Catarrh.} 
 
 Catarrh of Larynx 
 
 Alum 8l j 
 
 Bismuth Subcarbonate 139 
 
 Oil of Turpentine 429 
 
 Catarrh, Purulent Nasal 
 
 Alum 8l | 
 
 Calomel 268 
 
 Nitrate of Silver !I 3 
 
 Cellulitis 
 
 Copper Sulphate 222 
 
 Cerumen 
 
 (See Wax.} 
 Chafing 
 
 Bismuth Subnitrate 140 
 
 Starch 86 
 
 Chancre 
 
 Antifebrin 89 
 
 Bismuth Sub-benzoas 138 
 
 Cocaine 196 
 
 lodoform 294 
 
 Iron Sulphate 237 
 
 Resorcin 387 
 
 Sulphuric Acid 59 
 
 Chancre, Hard 
 
 Charcoal 173 
 
 Chancre, Phagedaenic 
 
 Boric Acid 25 
 
 Nitric Acid 49 
 
 Water, Hot 95 
 
 Chancroid 
 
 Antifebrin 89 
 
 Bismuth Subiodide 139 
 
 Cocaine 196 
 
 Copper Sulphate 221 
 
 Gallic Acid 43 
 
 Hydrogen Peroxide 284 
 
 lodoform 294 
 
 Pyrogallic Acid 53 
 
 Salicylic Acid 55 
 
 Yellow Oxide of Mercury .... 272 
 " Wash 158 
 
 Chapped Hands 
 
 Bismuth Subnitrate . . . . . . .140 
 
 Glycerin 244 
 
 Lanolin 316 
 
 Nitrate of Lead 368 
 
 Sol. of Gutta Percha 255 
 
 Chilblain 
 
 Acetate of Lead 365 
 
 Aconite 45 1 
 
 Chilblain Continued 
 
 Alcohol 76 
 
 Ammonia 102 
 
 Capsicum 172 
 
 Carbolic Acid 34 
 
 Collodion 208 
 
 Creasote 213 
 
 Tannic Acid 65 
 
 Chloasma 
 
 Bismuth Oxychloride 138 
 
 Chrysarobin 193 
 
 Hydrogen Peroxide 284 
 
 Lactic Acid 46 
 
 Nitric Acid 51 
 
 Chordee 
 
 Belladonna 126 
 
 Hop Poultice 258 
 
 Morphia 346 
 
 Choroiditis, Acute 
 
 Bleeding 145 
 
 Pyoktanin 383 
 
 Ciliary Paresis 
 
 Pilocarpin 359 
 
 Circumcision 
 
 Cocaine 197 
 
 Colic 
 
 Hot Bath 99 
 
 Comedo 
 
 Citric Acid 42 
 
 Ichthyol 289 
 
 Kaolin 312 
 
 Pumice 381 
 
 Salicylic Acid 57 
 
 Sulphur 423 
 
 Compound Ganglion, 
 (See Ganglion, Camp.} 
 
 Condylomata 
 
 Acetic Acid 20 
 
 Acid Nitrate of Mercury 279 
 
 Caustic Lead 370 
 
 Chloracetic Acid '18 
 
 Chromic Acid 40 
 
 Europhen 231 
 
 Ferric Chloride 233 
 
 Resorcin 388 
 
 Tannic Acid 65 
 
 Congestion of Larynx 
 
 Creasote 214 
 
 Congestion of Tubes, Ovaries, etc. 
 
 Croton Oil 342 
 
 Glycerin 243 
 
 Zinc Sulphate 449
 
 48o 
 
 INDEX. 
 
 NAME PAGE 
 
 Congestion of Vocal Cords 
 
 Iodine 309 
 
 Congestive Headache 
 
 Mustard Bath 401 
 
 Conical Cornea 
 
 Cautery 
 
 182 
 
 Conjunctivitis, Acute 
 
 Acetate of Lead 366 
 
 Acetic Acid 21 
 
 Alum 81 
 
 Borax 405 
 
 Boric Acid .28 
 
 Boroglycerin 29 
 
 Camphor 163 
 
 Cocaine 204 
 
 Cydonium 222 
 
 Hot Stupe 249 
 
 Ice 101 
 
 Morphia Acetate 348 
 
 Nitrate of Silver 116 
 
 Oxychloride of Mercury 273 
 
 Salt 407 
 
 Sassafras 399 
 
 Yellow Oxide of Mercury . . . .271 
 
 Conjunctivitis, Chronic 
 
 Alum 8l 
 
 Camphor 163 
 
 Copper Sulphate 222 
 
 Glycerin 245 
 
 Hydrastin 282 
 
 Mercuric Chloride 266 
 
 Nitrate of Silver 116 
 
 Tannic Acid 67 
 
 Wine of Opium 345 
 
 Zinc Chloride 443 
 
 " Sulphate . 449 
 
 Conjunctivitis, Palpebral 
 
 Alum 83 
 
 Nitrate of Silver 117 
 
 Conjunctivitis, Diphtheritic 
 
 Hydrogen Peroxide 284 
 
 Conjunctivitis, Muco-purulent 
 
 Alum 8l 
 
 Creoline 2l8 
 
 Nitrate of Silver 118 
 
 Pyoktanin 383 
 
 Conjunctivitis, Phlyctenular 
 
 Aristol .120 
 
 Constipation 
 
 Glycerin 243 
 
 Soap 396 
 
 Water, Cold 94 
 
 NAME PAGE 
 
 Contusions 
 
 Alcohol 75 
 
 Calendula 156 
 
 Camphor Liniment 162 
 
 Chloroform Liniment 191 
 
 Cologne Water 417 
 
 Ichthyol 289 
 
 Laudanum 344 
 
 Lead Water and Laudanum . . . 364 
 
 Oil of Turpentine 428 
 
 Tr. of Arnica 121 
 
 Water, Cold 91 
 
 Contusions, of Eyelids 
 
 Alum Curd 83 
 
 Corneal Abscess 
 
 Cautery 182 
 
 Corneal Fistula 
 
 Cautery 182 
 
 Corneal Opacities 
 
 Antipyrin 90 
 
 Corneal Ulcers 
 
 (See Ulcers of Cornea.'] 
 
 Corns 
 
 Ferric Chloride -234 
 
 Glacial Acetic Acid 22 
 
 Salicylic Acid 57 
 
 Coryza 
 
 Ammonium Carbonate 453 
 
 Bismuth Subnitrate 141 
 
 "Camphor 162 
 
 Chlorate of Potash 376 
 
 Chloroform 191 
 
 Cocaine 201 
 
 Ferric Sulphate 238 
 
 Glacial Acetic Acid 22 
 
 Hops 258 
 
 Iodine 308 
 
 Menthol 323 
 
 Nitrate of Silver 113 
 
 Red Oxide of Mercury 272 
 
 Salicylic Acid 58 
 
 Salt 407 
 
 Tar / 363 
 
 Tr. Benzoin 135 
 
 Tr. Musk 325 
 
 Vinegar, 21 
 
 Zinc Sulphate 448 
 
 Coryza, Fetid 
 
 Ammonium Chloride 454 
 
 Camphor 162 
 
 Chlorine 187 
 
 Copper Sulphate 222 
 
 Labarraque's Solution 414 
 
 Nitrate of Mercury 278 
 
 Zinc Sulphate 448 
 
 Coryza, Syphilitic 
 
 Biniodide of Mercury 269 
 
 Ethyl Iodide 228
 
 INDEX. 
 
 481 
 
 Cough 
 
 Acacia 17 
 
 Bromide of Ethyl 228 
 
 " Potash 375 
 
 Camphor Chloral 165 
 
 Chloroform 192 
 
 Cubebs 219 
 
 Iodine 300 
 
 Morphia 348 
 
 Oil of Sandal Wood 341 
 
 Oil of Thyme, 341 
 
 Terebene 429 
 
 Cracked Nipples 
 (See Fissure of Nipples.) 
 
 Croup 
 
 Acetic Acid 21 
 
 Alum 8 1 
 
 Calcium Hydrate .154 
 
 Calomel 268 
 
 Carbolic Acid 35 
 
 Nitrate of Silver 116 
 
 Tannic Acid 67 
 
 Croupous Disease of Nose 
 
 Mercuric Chloride 264 
 
 Cyclitis 
 
 Belladonna . 133 
 
 Cystitis, Chronic 
 
 Acetate of Lead 365 
 
 Acetic Acid 20 
 
 Borax 405 
 
 Boric Acid 25 
 
 Cocaine 197 
 
 Creolin 216 
 
 Hydrochloric Acid 44 
 
 Hydrogen Peroxide 283 
 
 Hyoscyamus 286 
 
 Hyposulphite of Soda 410 
 
 lodoform 294 
 
 Morphia 346 
 
 Nitrate of Silver 107 
 
 Nitric Acid 49 
 
 Tannic Acid 65 
 
 Water 95 
 
 Cystitis of Gonorrhoea 
 
 Resorcin 387 
 
 Cysts, Ovarian 
 
 Iodine 303 
 
 Cysts, Sebaceous 
 
 Ether 73 
 
 Paraffin 355 
 
 D. 
 
 Dacryocystitis 
 
 Cotton, Use of, in Poulticing . . . 249 
 
 Deafness Catarrhal 
 
 Borax 405 
 
 Camphorated Menthol 165 
 
 Ethyl Iodide 228 
 
 Iodine 308 
 
 3 1 
 
 Dental Caries 
 
 Eucalyptus 231 
 
 Gum Mastiche 321 
 
 Hydronaphthol 331 
 
 Mercuric Chloride 264 
 
 Oil of Cloves 333 
 
 " Gaultheria 335 
 
 Spearmint 336 
 
 434 
 
 Dermatitis 
 
 Acetate of Lead 365 
 
 Acetic Acid 20 
 
 Carbolic Acid 34 
 
 Carbonate of Potash 375 
 
 Hot Baths 100 
 
 Medicated Baths 456 
 
 Sulphur 422 
 
 Thilanin 430 
 
 Zinc Oxide 445 
 
 Dermatitis Calorica 
 
 (See Chilblain.') 
 Dermatitis of Ear 
 
 Magnesii Carbonas 320 
 
 Dermatitis Herpetiformis 
 
 Thiol . 
 
 431 
 
 Dermatitis Venenata 
 
 Acetate of Lead 366 
 
 Aristol 119 
 
 Grindelia 252 
 
 Leadwater and Laudanum .... 366 
 
 Quinine 386 
 
 Sodium Bisulphite 404 
 
 Sweet Spirits of Nitre 417 
 
 White Oak 385 
 
 Zinc Sulphate 448 
 
 Diphtheria 
 
 Acetic Acid 21 
 
 Alcohol 77 
 
 Balsam of Peru 122 
 
 Balsam of Tolu 123 
 
 Boric Acid 28 
 
 Bromide of Potash 375 
 
 Bromine 150 
 
 Calcii Hydras 154 
 
 Calomel 268 
 
 Campho-phenique 164 
 
 Carbolic Acid 35 
 
 Cautery 181 
 
 Chinoline 184 
 
 Chloral 186 
 
 Chlorate of Potash 376 
 
 Chlorinated Lime 160 
 
 Chlorine 187 
 
 Creoline 217 
 
 Eucalyptus 230 
 
 Gum Mastiche . . .321
 
 482 
 
 INDEX. 
 
 Diphtheria Continued 
 
 Hydrochloric Acid 44 
 
 Hydrogen Peroxide 284 
 
 Hydronaphthol 331 
 
 Hyposulphite of Soda 410 
 
 Ice 101 
 
 Iodine 309 
 
 lodoform 296 
 
 Labarraque's Solution 414 
 
 Lemon Juice 317 
 
 Liquor Potassae 373 
 
 Menthol 323 
 
 Mercuric Chloride 264 
 
 Naphthol 329 
 
 Nitrate of Silver 1 1 1 
 
 Oil of Fir 339 
 
 Papain 350 
 
 Permanganate of Potash 380 
 
 Pilocarpin 358 
 
 Pyoktanin 383 
 
 Quinine 385 
 
 Resin 426 
 
 Resorcin 389 
 
 Salicylic Acid 58 
 
 Sodium Benzoate 402 
 
 Sugar 392 
 
 Sulphite of Soda 412 
 
 Sulphocarbolate of Soda 412 
 
 Sulphoricinate of Soda 413 
 
 Sulphur 424 
 
 Sulphurous Acid .62 
 
 Syrup of Lime 160 
 
 Tannic Acid 67 
 
 Tar Water 363 
 
 Tartaric Acid 68 
 
 Thiol . 433 
 
 Tr. Benzoin Comp 135 
 
 Tr. Ferri Chlor 235 
 
 Trypsin 434 
 
 Turpentine 428 
 
 Water 47 
 
 Zinc Chloride ......... 442 
 
 Diphtheria, Laryngeal 
 
 Alum 8 1 
 
 Hydrogen Peroxide 284 
 
 Diphtheria, Nasal 
 
 Lactic Acid 47 
 
 Sodium Salicylate 411 
 
 " Sulphite 412 
 
 Discharges from Middle Ear 
 
 Boric Acid ' . . . 27 
 
 Dislocations, Muscular relaxation in 
 Hot Bath 99 
 
 Dysenteric Diarrhoea 
 
 Salicylic Acid 56 
 
 Starch Water . . 86 
 
 NAMB PAGH 
 
 Dysentery 
 
 Bismuth Subniirate 140 
 
 Nitrate of Silver 108 
 
 Dysmenorrhcea 
 
 Bougies 146 
 
 Croton Oil 342 
 
 Dysphagia 
 
 Cocaine 201 
 
 Cod-Liver Oil 337 
 
 Lactic Acid 47 
 
 Menthol 324 
 
 Olive Oil 339 
 
 Dyspnoea, Cardiac 
 
 Amyl Nitris -85 
 
 Dyspnoea, Phthisical 
 Ethyl Iodide 
 
 229 
 
 E. 
 
 Ecchymosis 
 
 Ammonium Chlor 453 
 
 Table Salt 406 
 
 Ecthyma 
 
 Soap 397 
 
 Sulphur ... 423 
 
 Eczema 
 
 Alkaline Bath 457 
 
 Acetate of Lead 365 
 
 " Zinc 438 
 
 Belladonna 127 
 
 Bismuth Subnitrate 140 
 
 Black Wash 159 
 
 Boric Acid 26 
 
 Calcium Chloride . . 154 
 
 Cantharides 170 
 
 Carbolic Acid 34 
 
 Carbonate of Potash 375 
 
 Castor Oil 340 
 
 Chromic Acid 40 
 
 Cod-Liver Oil 337 
 
 Collodion 208 
 
 Copper Sulphate 221 
 
 Creasote 212 
 
 Elder 394 
 
 Ext. Jaborandi Fid 358 
 
 Grindelia . 252 
 
 Glycerite of Starch 246 
 
 Guaco 253 
 
 Gurjun 254 
 
 Hot Bath 99 
 
 Hydrocyanic Acid 45 
 
 Kaolin 312 
 
 Medicated Baths 456 
 
 Menthol 322 
 
 Naphthol 329 
 
 OleateofZinc 459 
 
 Precipitated Carbonate of Zinc . . 438
 
 INDEX. 
 
 483 
 
 NAMK PAGE 
 
 Eczema Continued 
 
 Prepared Chalk 153 
 
 Rock Salt 407 
 
 Salicylic Acid 57 
 
 Salol .393 
 
 Sodium Carbonate 406 
 
 Starch 87 
 
 Sulphur 422 
 
 Thilanin 430 
 
 Thioresorcin 431 
 
 Thymol 433 
 
 Tumenol 435 
 
 Zinc Oxide 445 
 
 Zinc Sulphate 448 
 
 Eczema of Anus 
 Belladonna , 
 
 127 
 
 Eczema of Auditory Meatus 
 
 Alum 8l 
 
 Bicarbonate of Soda 403 
 
 Black-wash 268 
 
 Cod- Liver Oil 337 
 
 Chromic Acid 41 
 
 Ferric Sulphate 238 
 
 Iodine 308 
 
 Lanoline 316 
 
 Liquor Potassse 373 
 
 OleateofZinc 457 
 
 Zinc Ointment 446 
 
 " Sulphocarbolate 449 
 
 Eczema of Ears 
 
 Ammoniated Mercury 277 
 
 Acetate of Lead 366 
 
 Coffee 152 
 
 Creasote 213 
 
 Glycerite of Starch 246 
 
 Mercuric Chloride 263 
 
 Oil of Cade 335 
 
 Eczema Erythematosa 
 
 Camphor 162 
 
 Ichthyol 290 
 
 Prepared Chalk 152 
 
 Zinc Oxide 444 
 
 Eczema of Eyelids 
 
 Aristol 120 
 
 Liquor Plumbi Subacetat 366 
 
 Yellow Oxide of Mercury . . . .271 
 Zinc Ointment 446 
 
 Eczema Fissum 
 
 Nitrate of Silver 109 
 
 Sol. of Gutta Percha 255 
 
 Eczema, Indurated 
 
 Anthrarobin 87 
 
 Nitrate of Silver 109 
 
 Salicylic Acid 57 
 
 NAME PAGE 
 
 Eczema of Lips 
 
 Nitrate of Silver 109 
 
 Phosphoric Acid 53 
 
 Eczema, Moist 
 
 Alum 80 
 
 Chlorate of Potash 376 
 
 Dermatol 223 
 
 Nitrate of Silver 112 
 
 Resorcin 388 
 
 Salicylic Acid 56 
 
 Thiol 431 
 
 Eczema of Nostril 
 
 Ammoniated Mercury 277 
 
 Bismuth Subnitrate 140 
 
 Elder 394 
 
 Red Oxide of Mercury 272 
 
 Eczema Palmarum 
 
 Papain . 350 
 
 Eczema, Papular 
 
 Acid Bath - . . 457 
 
 Tar 362 
 
 Thiol 431 
 
 Eczema Plantarum 
 
 Paraffin 355 
 
 Eczema Pustulosum 
 
 Soap 397 
 
 Warm Bath loo 
 
 Eczema Rubrum 
 
 Collodion 208 
 
 Diachylon Ointment 370 
 
 Kaolin 312 
 
 Salicylic Acid 56 
 
 Sol. of Gutta Percha 255 
 
 Thiol 431 
 
 Zinc Oxide 445 
 
 Eczema of Scalp 
 
 Carbonate of Soda 406 
 
 Copper Sulphate 221 
 
 Glycerite of Starch 246 
 
 Starch 87 
 
 Eczema of Scrotum 
 
 Nitrate of Silver 109 
 
 Eczema Squamosa 
 
 Carbolic Bath 457 
 
 Ichthyol 289 
 
 Naphthol 3 2 9 
 
 Salicylic Acid 56 
 
 Eczema Vesicular 
 
 Ichthyol 289 
 
 Soap 379 
 
 Zinc Oxide 444 
 
 Emphysema 
 Nitrate of Silver 116
 
 4 8 4 
 
 INDEX. 
 
 Empyema 
 
 Hydrogen Peroxide 283 
 
 Iodine 301 
 
 Pyoktanin 382 
 
 Storone 421 
 
 Empyema, Ethmoidal and Frontal 
 
 Sinuses 
 Pyoktanin 382 
 
 Empyema of Maxillary Sinus 
 
 lodol 298 
 
 Lugol's Solution 307 
 
 Tannic Acid 66 
 
 Zinc Chloride 442 
 
 " Sulphate ' 448 
 
 Encephalocele 
 
 Iodine 302 
 
 Endometritis 
 
 Boric Acid 26 
 
 Creoline 217 
 
 Glycerine 243 
 
 Hydrogen Peroxide 284 
 
 Iodine 304 
 
 Tannic Acid 65 
 
 Thiol 431 
 
 Zinc Chloride 441 
 
 Entorrhcea 
 
 (See Hemorrhage from Intestine.'] 
 Entropion 
 
 Collodion 209 
 
 Enteritis 
 
 Cantharides 167 
 
 Enucleation of Eye 
 
 Aristol 120 
 
 Cocaine 205 
 
 Ephilis 
 
 Collodion 209 
 
 Epididymitis 
 
 Ammonium Chloride 453 
 
 Collodion 207 
 
 Nitrate of Silver 1 06 
 
 Ungt. Hydrarg 276 
 
 Epilepsy 
 
 Amyl Nitris 85 
 
 Epistaxis 
 
 Agaric 75 
 
 Alum 82 
 
 Antipyrin 90 
 
 Boletus 75 
 
 Bryonia 151 
 
 Copper Sulphate 222 
 
 Ether 74 
 
 Epistaxis Continued 
 
 Europhen 231 
 
 Kino 313 
 
 Lemon Juice 316 
 
 Matico 321 
 
 Nitrate of Silver in 
 
 Paper ; .... 251 
 
 Sulphuric Acid 60 
 
 Tannic Acid 66 
 
 Tr. Benzoin Comp 135 
 
 Tr. Ferri Chlor 233 
 
 Vinegar 21 
 
 Water, Hot 97 
 
 Zinc Sulphate 448 
 
 Epithelioma 
 
 Arsenious Acid 24 
 
 Caustic Potassa 372 
 
 Cautery 176 
 
 Chloracetic Acid 18 
 
 Chlorate of Potash 376 
 
 Citric Acid 42 
 
 Ergot 226 
 
 Ethylate of Soda 409 
 
 Lactic Acid 46 
 
 Nitric Acid 50 
 
 Pyoktanin ....'. 382 
 
 Pyrogallic Acid 54 
 
 Resorcin 387 
 
 Vienna Paste 374 
 
 Epitheliomatous Ulcers 
 
 Aristol 119 
 
 Chloracetic Acid 18 
 
 Chromic Acid 42 
 
 Cocaine 199 
 
 Erosion of Cervix Uteri 
 
 Glycerin 243 
 
 Tannic Acid 65 
 
 Erysipelas 
 
 Albumen 349 
 
 Campho-phenique 164 
 
 Carbolic Acid 33 
 
 Carbonate of Lead 367 
 
 Collodion 208 
 
 Copper Sulphate 222 
 
 Cosmoline 354 
 
 Creolin 216 
 
 Creasote 212 
 
 Ferric Sulphate 237 
 
 Glycerite of Starch 245 
 
 Grindelia 252 
 
 Hyposulphite of Soda 410 
 
 Ichthyol 288 
 
 lodoform 293 
 
 Lead Water 364 
 
 Mercuric Chloride 263 
 
 " Ointment 276 
 
 Nitrate of Lead 368 
 
 " Silver 105
 
 INDEX. 
 
 485 
 
 Erysipelas Continued 
 
 Prepared Chalk ......... 153 
 
 Raw Cotton .......... 247 
 
 Salicylate of Soda ........ 411 
 
 Salicylic Acid ......... 55 
 
 Sulphurous Acid ........ 61 
 
 Syrup of Lime ......... 160 
 
 Tannic Acid .......... 65 
 
 Thiol ............. 431 
 
 Erysipelas of Larynx 
 
 Nitrate of Silver ........ I r5 
 
 Erysipelas of Pharynx 
 
 Acetate of Lead ........ 365 
 
 Ext. Jaborandi, Fid ........ 358 
 
 Morphia ........... 347 
 
 Erythema 
 
 Acetate of Zinc ........ 437 
 
 Alcohol ............ 76 
 
 Alkaline Baths ......... 457 
 
 Bismuth Subnitrate ....... 140 
 
 Camphor ........... 162 
 
 Collodion ........... 208 
 
 Hydrocyanic Acid ....... 45 
 
 Kaolin ............ 312 
 
 Medicated Baths ........ 456 
 
 Erythema Calorica 
 (See Chilblain?) 
 
 Erythema Intertrigo 
 
 Alum ............. 80 
 
 Zinc Sulphate ......... 448 
 
 Erythema Multiforme 
 
 Hydrocyanic Acid ....... 45 
 
 Thiol ............. 431 
 
 Erythemasma 
 
 Anthrarobin 
 
 87 
 
 Evulsion of Scalp 
 Copaiba 
 
 F. 
 Fatigue of Larynx 
 
 Cubebs 219 
 
 Favus 
 
 Salicylic Acid 56 
 
 Soap 398 
 
 Felon 
 
 Alcohol 75 
 
 Cocaine 198 
 
 Nitrate of Silver 105 
 
 Fetid Catarrh of Atrophy 
 (See Atrophic Rhinitis.} 
 
 NAME PAGB 
 
 Fetor of Breath- 
 Charcoal 174 
 
 Chlorinated Lime 160 
 
 Naphthol 329 
 
 Permanganate of Potash 380 
 
 Salicylic Acid 58 
 
 Sponge 419 
 
 Talc 425 
 
 Fever 
 
 Hot Bath 99 
 
 Fissures 
 
 Copper Sulphate 221 
 
 Soap 398 
 
 Tannic Acid 63 
 
 Fissures of Anus 
 
 Belladonna 126 
 
 Bismuth Subnitrate ... ... 140 
 
 Ext. Hydrastis Fluid 281 
 
 Tannic Acid 64 
 
 Witch Hazel 257 
 
 Zinc Oxide 444 
 
 Fissure of Lip 
 
 Castor Oil 340 
 
 Collodion 207 
 
 Nitrate of Lead 368 
 
 " Silver ill 
 
 Sol. of Gutta Percha 255 
 
 Fissure of Nipple 
 
 Catechu 174 
 
 Chloral 185 
 
 Collodion 208 
 
 Glycerite of Starch 245 
 
 Nitrate of Lead 368 
 
 " " Silver 105 
 
 Sol. of Gutta Percha 255 
 
 Tr. of Benzoin Comp 134 
 
 Fissure of Nostril 
 
 Ichthyol 290 
 
 Fissure of Rectum 
 
 Witch Hazel 257 
 
 Fissure of Tongue 
 
 Borax 45 
 
 Carbolic Acid 3 
 
 Glycerin 2 44 
 
 Papain 35 
 
 Fistulae 
 
 Bougies 14 
 
 Carbolic Acid 3 2 
 
 Cocaine *9% 
 
 Hydrogen Peroxide 283 
 
 Phosphate of Calcium 155 
 
 Fistula in Ano 
 (See Anal Fistula.')
 
 486 
 
 INDEX. 
 
 NAME PAGE 
 
 Fistula, Vesico-Vaginal 
 Cocaine 196 
 
 Fracture 
 
 Alcohol . . 76 
 
 Bran 147 
 
 Camphorated Soap Liniment . . .162 
 
 Iodine '*'.,.. 305 
 
 Leadwater and Laudanum .... 345 
 
 Plaster of Paris 155 
 
 Silicate of Soda 411 
 
 Soap . 395 
 
 Freckles 
 (See Ephilis.} 
 
 Frostbite 
 
 Alcohol 76 
 
 Carbolic Acid 35 
 
 Thiol 43 1 
 
 Tr. Benzoin Comp 134 
 
 Fungoid Granulations of Uterus 
 Nitric Acid 50 
 
 Fungus on Tongue 
 
 Pepper 360 
 
 Furuncles 
 (See Soils.} 
 
 Furuncles of Ear 
 
 Brucine . 150 
 
 Menthol 323 
 
 Mercuric Chloride 263 
 
 Nitrate of Silver ill 
 
 Zinc Sulphate 448 
 
 Furunculosis 
 
 Rock Salt 407 
 
 Soap 397 
 
 G. 
 
 Ganglion, Compound 
 
 Iodine 302 
 
 Gangrene of Dental Pulp 
 
 Chinoline 184 
 
 Gangrene, Hospital 
 
 Bromine 149 
 
 Camphor 161 
 
 Ferric Chloride 232 
 
 Nitric Acid ... 49 
 
 Permanganate of Potash 380 
 
 Resorcin 387 
 
 Gangrene of Larynx 
 
 Carbolic Acid 35 
 
 Eucalyptus 230 
 
 NAME PAGE 
 
 Gangrene, Senile 
 
 Ammonium Chloride 454 
 
 Camphor 161 
 
 Gangrenous Patches 
 
 Labarraque's Sol 413 
 
 Gangrenous Wounds or Sores 
 
 Charcoal Poultice i?3 
 
 Chlorine Water 102 
 
 Permanganate of Potash 380 
 
 Glandular Enlargements 
 
 Emp. Hydrarg 245 
 
 Hyoscyamus 286 
 
 Iodine 305 
 
 Glaucoma 
 
 Eserine . ... 
 
 357 
 
 Gleet- 
 Arbor Vitae 432 
 
 Bismuth Subnitrate 140 
 
 Bougies 145 
 
 Cantharides 17 
 
 Glycerin 243 
 
 Grindelia 252 
 
 Lime Water 158 
 
 Nitrate of Silver 107 
 
 Tannic Acid 64 
 
 Glossitis 
 
 Chromic Acid 4 2 
 
 Subnitrate of Bismuth 141 
 
 Goitre, Cystic 
 
 Iodine 3 2 
 
 Tr. Ferri Chlor 233 
 
 Goitre, Parenchymatous 
 
 Biniodide of Mercury 269 
 
 Iodine 3 2 
 
 lodoform 293 
 
 Yellow Oxide of Mercury . . . .271 
 
 Gonorrhoea 
 
 Acetate of Lead 364 
 
 Alum 79 
 
 Antipyrin 89 
 
 Bicarbonate of Soda 402 
 
 Bismuth Subnitrate 139 
 
 Borax 45 
 
 Boric Acid 25 
 
 Bougies J45 
 
 Bromide of Potash 374 
 
 Chinoline 184 
 
 Chloral 185 
 
 Cocaine *97 
 
 Copper Sulphate 221 
 
 Creoline 216 
 
 Creasote 212
 
 INDEX. 
 
 487 
 
 NAME PAGE 
 
 Gonorrhoea Continued 
 
 Ergot 225 
 
 Glycerin 243 
 
 Grindelia 252 
 
 Hydrogen Peroxide 283 
 
 lodoform 294 
 
 Laudanum 345 
 
 Mercuric Chloride . 262 
 
 Nitrate of Silver 106 
 
 Pyoktanin 382 
 
 Sulphite of Soda 412 
 
 Tannic Acid 64 
 
 Water, Warm 95 
 
 Zinc Chloride 441 
 
 " Sozoiodolate 416 
 
 " Sulphate 447 
 
 Gonorrhoea of Rectum 
 
 Zinc Sulphate 447 
 
 Gonorrhceal Ophthalmia 
 
 Alum 83 
 
 Cosmoline 354 
 
 Ice ioi 
 
 Water, Hot 98 
 
 Gout, Acute 
 Collodion . 
 
 207 
 
 Gout, Chronic 
 
 Carbonate of Lithium 319 
 
 Iodine 301 
 
 Menthol 322 
 
 Granular Lids 
 
 Chloride of Gold and Sodium . . 121 
 Glycerite of Carbolic Acid .... 38 
 
 Granular Ophthalmia 
 
 (See Ophthalmia Granular.'] 
 
 Granulations of Middle Ear 
 
 Carbolic Acid 35 
 
 Gunshot Wounds 
 
 Water, Cold 92 
 
 Gynecological Troubles 
 
 Hydrogen Peroxide 283 
 
 Laminaria 315 
 
 Mercuric Chloride . 262 
 
 Water, Hot 95 
 
 H. 
 
 Hsematuria 
 
 Nitrate of Silver 107 
 
 Haemoptysis 
 Tr. Ferri. Chlor 234 
 
 Hay Fever 
 
 Amyl Nitris 85 
 
 Belladonna 127 
 
 Boric Acid 28 
 
 Cannabis Indica 166 
 
 Capsicum 172 
 
 Chromic Acid 42 
 
 Cocaine 201 
 
 Ethyl Iodide 228 
 
 Hydrocyanic Acid 45 
 
 Quinine 386 
 
 Headache 
 
 Bleeding 144 
 
 Cologne Water 417 
 
 Ferrier's Snuff 347 
 
 Hyoscyamus 286 
 
 Menthol 322 
 
 Hemorrhoids 
 
 Belladonna 126 
 
 Bougies 146 
 
 Bromide of Potash 374 
 
 Cautery 176 
 
 Chlorate of Potash 376 
 
 Chromic Acid 40 
 
 Chrysarobin 192 
 
 Cocaine 198 
 
 Ergot 225 
 
 Gallic Acid 43 
 
 Hemorrhoids 
 
 Goulard's Cerate 365 
 
 Hyoscyamus . 286 
 
 Menthol 322 
 
 Morphia 346 
 
 Nitric Acid 49 
 
 Opium 344 
 
 Stramonium 420 
 
 Tr. Ferri Chlor 233 
 
 Tobacco 425 
 
 Water 94 
 
 Witch Hazel 257 
 
 Yellow Wax 183 
 
 Hemicrania 
 
 Chloral . 
 
 186 
 
 Hemorrhage 
 
 Acetic Acid 19 
 
 Acetized Cotton 20 
 
 Agaric 74 
 
 Alcohol 75 
 
 Alum 79 
 
 Antipyrin 89 
 
 Cocaine 205 
 
 Copper Sulphate 220 
 
 Creolin . 218 
 
 Hydrogen Peroxide 284 
 
 Ice ioi 
 
 Oil of Turpentine 429
 
 488 
 
 INDEX. 
 
 NAME PAGE 
 
 Hemorrhage Continued 
 
 Styptic Collodion 248 
 
 Tannic Acid 67 
 
 Water, Cold 91 
 
 Witch-Hazel 256 
 
 Hemorrhage from Bone 
 Yellow Wax . 
 
 .'83 
 
 Hemorrhage from Vocal Cords 
 
 Monsel's Salt 237 
 
 Nitrate of Silver 115 
 
 Zinc Sulphate 449 
 
 Hemorrhage from Intestines 
 
 Ergot 225 
 
 Hemorrhage from Tonsil 
 
 Monsel's Salt 236 
 
 Hemorrhage from Uterus 
 (See Uterine Hemorrhage?) 
 
 Hernia 
 
 Ammonium Chloride 454 
 
 Hot Bath 99 
 
 Tobacco 425 
 
 Water, Cold 92 
 
 Herpes of Ear 
 
 Olive Oil ... 339 
 
 Herpes Labiaiis 
 
 Chlorate of Potash 376 
 
 Herpes Zoster 
 
 Aconite 451 
 
 Thiol 431 
 
 Hordeolum 
 
 Hot Stupe 249 
 
 Horus 
 
 Glacial Acetic Acid 22 
 
 Resorcin 387 
 
 Hospital Gangrene 
 
 (See Gangrene, Hospital.') 
 
 Housemaid's Knee 
 
 Iodine 302 
 
 Hydrocele 
 
 Ammonium Chloride 453 
 
 Carbolic Acid 33 
 
 Chloral 185 
 
 Cocaine 197 
 
 Iodine 302 
 
 Zinc Chloride 441 
 
 Hydrophobia 
 
 Cocaine 200 
 
 Nitrate of Silver 109 
 
 Hydrothorax 
 Cantharides . 
 
 1 68 
 
 Hyperaemia 
 
 Oil of Juniper 335 
 
 Hyperaemia of Larynx 
 Oil of Fir 339 
 
 Hyperaesthesia 
 
 lodoform 295 
 
 Hyperidrosis 
 
 Acetate of Lead 365 
 
 Alum 80 
 
 Alcohol 76 
 
 Belladonna 126 
 
 Boric Acid 27 
 
 Chloral 186 
 
 Chromic Acid 40 
 
 Ferric Chloride 234 
 
 Naphthol 329 
 
 Salicylic Acid 56 
 
 Tannic Acid 65 
 
 Hyperplasia of Turbinals 
 
 Chromic Acid . .4' 
 
 Hypertrophy, Fibrous, of Mucous 
 Membrane 
 
 Chromic Acid 41 
 
 Iodine 308 
 
 Hypertrophy of Glands 
 
 Iodide of Lead 367 
 
 Hypertrophy of Nasal Mucous Mem- 
 brane 
 
 Carbolic Acid 36 
 
 Cautery 178 
 
 Ergot 226 
 
 Ferric Chloride 234 
 
 Glacial Acetic Acid 22 
 
 Iodine 308 
 
 Lactic Acid 47 
 
 Soda Cum Cake 408 
 
 Tri-Chloracetic Acid 19 
 
 Hypertrophy of Prostate 
 Ergot 
 
 226 
 
 Hypertrophy of Tongue 
 
 Iodine 309 
 
 Hypertrophy of Tonsil 
 
 Acetic Acid, Dil 21 
 
 Chromic Acid 42 
 
 Iodine 308 
 
 Sulphuric Acid 60 
 
 Tannic Acid 67 
 
 Zinc Iodide 443
 
 INDEX. 
 
 4 S 9 
 
 NAME I. PAGE 
 
 Ichthyosis 
 
 Alkaline Bath 457 
 
 Chromic Acid 41 
 
 Naphthol 329 
 
 Tepid Bath 100 
 
 Impetigo 
 
 Ichthyol 290 
 
 Soap 397 
 
 Sulphur 422 
 
 Sulphur Bath 457 
 
 Tumenol 435 
 
 Impetigo Contagiosa 
 
 Bismuth Subnitrate 140 
 
 Salicylic Acid 56 
 
 Incontinence of Urine 
 
 Collodion 207 
 
 Nitrate of Silver 107 
 
 Tr. Nucis Vomicse 331 
 
 Incurvation of Nail 
 
 Potassa 371 
 
 Indurated Cervical Glands- 
 Yellow Oxide of Mercury . . . .271 
 
 Infected Wounds of Eye 
 
 Cautery 182 
 
 Inflammation 
 
 Camphor Chloral 165 
 
 Hop Poultice 258 
 
 Laudanum 344 
 
 Menthol 322 
 
 Inflammation of Attic 
 
 Resorcin . . 388 
 
 Inflammation of Bowels 
 (See Enteritis.') 
 
 Inflammation of Breast 
 
 Ammonium Chloride 453 
 
 Belladonna 124 
 
 Kaolin 312 
 
 Inflammation of External Ear 
 
 Alum 80 
 
 Bicarbonate of Soda 403 
 
 Carbonate of Lead 39 
 
 Cherry Laurel Water 103 
 
 Creoline 217 
 
 Ichthyol 290 
 
 Nitrate of Silver 112 
 
 Talc 425 
 
 Zinc Ointment 446 
 
 Inflammation of Fauces 
 
 Borax 405 
 
 Hyposulphite of Silver ..... 103 
 
 Salicylic Acid 5^ 
 
 Sassafras 399 
 
 NAME PAGE 
 
 Inflammation of Female Genitals 
 
 Ichthyol 288 
 
 Opium 344 
 
 Thymol 433 
 
 Inflammation of Joints 
 
 (See Arthritis.} 
 
 Inflammation of Matrix of Nail 
 
 (See Onychia.) 
 
 Inflammation of Middle Ear 
 (See Otitis Media.) 
 
 Inflammation of Naso-Pharynx 
 
 Nitrate of Silver in 
 
 Oil of Gaultherise 355 
 
 Pinol 359 
 
 Sage 394 
 
 Sodii Benzoate 402 
 
 Inflammation of (Esophagus 
 
 (See (Esophagitis . ) 
 
 Inflammation of Uterus 
 (See Endo- and Perimetritis.) 
 
 Inflammation, Phlegmonous 
 
 Flaxseed 
 
 Influenza 
 Stramonium 
 
 317 
 
 420 
 
 Ingrowing Toe Nail 
 
 Agaric 74 
 
 Boletus 74 
 
 Collodion 207 
 
 Liquor Potassa 372 
 
 Nitrate of Silver 105 
 
 Subnitrate of Bismuth 139 
 
 Tannic Acid . 64 
 
 Insomnia 
 Hot Bath 
 
 99 
 
 Inspissated Mucus in Ear 
 
 Bicarbonate of Soda 43 
 
 Intertrigo 
 
 Bismuth Subnitrate 14 
 
 Boric Acid 27 
 
 Camphor 162 
 
 Iridectomy 
 
 Cocaine . 
 
 209 
 
 Iritis 
 
 Alum 83 
 
 Atropia 129
 
 49 
 
 INDEX. 
 
 NAME PAGE 
 
 Iritis Continued 
 
 Belladonna 133 
 
 Bleeding 145 
 
 Cocaine 204 
 
 Hot Stupes 249 
 
 Pyoktanin 383 
 
 J- 
 
 Jaundice of Newborn 
 Mercuric Ointment . 
 
 276 
 
 K. 
 
 Keratitis 
 
 Alum 83 
 
 Atropine 130 
 
 Creoline 218 
 
 Keratitis, Chronic 
 
 Calomel 268 
 
 Yellow Oxide of Mercury . . . .271 
 
 Keratitis, Parenchymatous 
 
 Pyoktanin 383 
 
 Keratitis, Phlyctenular 
 
 Atropia 129 
 
 Keratitis, Pustular 
 
 Cautery 182 
 
 Keratitis, Sloughing 
 
 Cautery 182 
 
 Eserine 357 
 
 Fluorescein 238 
 
 Hot Stupes 249 
 
 Hydrogen Peroxide 285 
 
 lodoform 297 
 
 Pyoktanin 383 
 
 L. 
 Laryngeal Papilloma 
 
 Arbor Vitse 432 
 
 Chromic Acid 42 
 
 Laryngeal Phthisis 
 
 Balsam of Peru 122 
 
 Belladonna 127 
 
 Bismuth Subcarbonate 139 
 
 Coffee 152 
 
 Creasote 214 
 
 Ethyl Iodide \ 228 
 
 Iodine 309 
 
 lodoform 296 
 
 lodol 299 
 
 Lactic Acid 47 
 
 Menthol 324 
 
 Mercuric Chloride 265 
 
 Morphia 347 
 
 Naphthol 329 
 
 Laryngeal Phthisis Continued 
 
 Nitrate of Silver 115 
 
 Pyoktanin 383 
 
 Resorcin 389 
 
 Sulphurous Acid 62 
 
 Tar Water 363 
 
 Terebene 429 
 
 Laryngitis, Acute 
 
 Bleeding 145 
 
 Camphorated Menthol 165 
 
 Cantharides 171 
 
 Cocaine 201 
 
 Conium 210 
 
 Hops 258 
 
 !ce 97 
 
 Menthol 323 
 
 Oil of Turpentine ', . 429 
 
 Permanganate of Potash 380 
 
 Tartar Emetic 89 
 
 Thymol 433 
 
 Wild Marjoram 349 
 
 Laryngitis, Catarrhal 
 
 Camphoric Acid 164 
 
 Creasote 213 
 
 OilofCubebs 219 
 
 Laryngitis, Chronic 
 
 Acetate of Zinc 438 
 
 Acetic Acid 21 
 
 Aldehyde 78 
 
 Alum 8l 
 
 Ammonium Chloride 454 
 
 Ammonia Fortior 456 
 
 Belladonna 127 
 
 Benzoic Acid . 137 
 
 Bismuth Subnitrate 141 
 
 Borate of Bismuth 137 
 
 Camphor 163 
 
 Carbolic Acid 37 
 
 Chlorate of Potash 377 
 
 Chromic Acid 42 
 
 Ferric Alum 235 
 
 " Sulphate 238 
 
 Gallic Acid 43 
 
 Glycerin 245 
 
 Hydriodate of Hyoscine 286 
 
 Iodide of Potash 378 
 
 Iodine ' . . . . 309 
 
 Morphia . . 347 
 
 Nitrate of Lead 368 
 
 " Mercury 278 
 
 " Silver 114 
 
 Oil of Fir 339 
 
 " Juniper 335 
 
 " Rue 340 
 
 Oxide of Antimony 88 
 
 Pellitory 384 
 
 Sozoiodol 415 
 
 Table Salt 407 
 
 Tannic Acid . . 66
 
 INDEX. 
 
 491 
 
 NAME PAGE 
 
 Laryngitis, Chronic, Contimied 
 
 ' Tar Water 363 
 
 Tr. Benzoin Comp 135 
 
 Tr. Ferri Chlor 234 
 
 Zinc Chloride 
 
 " Sulphocarbolate 449 
 
 Lead Poison 
 
 Potassa Sulphurata 374 
 
 Leech Bites 
 
 Agaric 74 
 
 Alum 79 
 
 Boletus 74 
 
 Lentigo 
 
 Chrysarobin 194 
 
 Lactic Acid 46 
 
 Mecuric Chloride 263 
 
 Leprosy 
 
 Cashew-nut Oil 332 
 
 Gurjun 254 
 
 Leptothrix Buccalis 
 
 Mercuric Chloride 264 
 
 Leucoplasia 
 
 Balsam of Peru 122 
 
 Leucorrhcea 
 
 Alum 79 
 
 Belladonna 125 
 
 Bismuth Subnitrate 140 
 
 Borax 405 
 
 Boric Acid 26 
 
 Bougies 146 
 
 Catechu . , 174 
 
 Creoline 216 
 
 Ferric Alum . 235 
 
 Geranium 242 
 
 Grindelia . . 252 
 
 Hydrastis 281 
 
 Kino 313 
 
 Zinc Sulphate 448 
 
 Lichen Planus 
 
 Mercuric Chloride 263 
 
 Salicylic Acid 57 
 
 Lichen Ruber 
 
 Medicated Bath 456 
 
 Mercuric Chloride 263 
 
 Lime in Conjunctiva 
 
 Acetic Acid 21 
 
 Olive Oil 339 
 
 Lithotrity 
 
 Cocaine 197 
 
 Lochia, Offensive 
 
 Thymol 433 
 
 NAME PAGE 
 
 Lumbago 
 
 Amyl Nitris .......... 85 
 
 Antipyrin ........... 89 
 
 Capsicum ........... 172 
 
 Emp. Picis. Burgund ....... 360 
 
 Morphia ........... 346 
 
 Lupus 
 
 Aristol ............ 119 
 
 Cautery ....... ..... 176 
 
 Ethylate of Soda ........ 409 
 
 Europhen ........... 231 
 
 Gurjun ............ 254 
 
 Hydroxylamine Hydrochloride . . 285 
 lodoform ........... 295 
 
 Lactic Acid .......... 46 
 
 Salicylic Acid ......... 56 
 
 Lupus Erythematosum 
 
 Cautery ............ 117 
 
 Chrysarobin .......... 194 
 
 Glacial Acetic Acid ....... 22 
 
 Ichthyol ........... 290 
 
 Mercuric Chloride ....... 269 
 
 Zinc Nitrate .......... 443 
 
 " Sulphide ......... 450 
 
 Lupus Ulcers 
 
 Chromic Acid ......... 40 
 
 Lactic Acid .......... 46 
 
 Lupus Vulgaris 
 
 Cautery ........ .... 177 
 
 Lactic Acid .......... 46 
 
 Mercuric Chloride ...... 263 
 
 Nitrate of Silver ........ 108 
 
 Pyrogallic Acid ........ 54 
 
 Lymphangeitis 
 (See Angioleucitis.} 
 
 Lymphatic Enlargements 
 Ichthyol 
 
 288 
 
 M. 
 Maggots in Nose 
 
 Chloroform , 19* 
 
 Mercuric Chloride 264 
 
 Malignant Pustule 
 
 Caustic Potash 37 * 
 
 lodoform 293 
 
 Marasmus 
 
 Lard . . 69 
 
 Mastitis 
 
 (See Inflammation of Breast.} 
 
 M asturbation 
 
 Cantharides '7
 
 49 2 
 
 INDEX. 
 
 NAME PAGE 
 
 Measles 
 
 Mustard Bath 401 
 
 Meningitis 
 
 Cantharides 168 
 
 Meningocele 
 
 (See Encephalocele.) 
 
 M enorrhagia 
 
 Conium , .210 
 
 Mercurial Stomatitis 
 
 (See Stomatitis, Mercurial?) 
 Metritis 
 
 Iodine 304 
 
 Milia 
 
 Nitrate of Silver 109 
 
 Miliaria 
 
 Citric Acid 43 
 
 Cold Bath 
 
 99 
 
 Hot Bath 99 
 
 Moles 
 
 Acid Nitrate of Mercury 279 
 
 Cautery 177 
 
 Cocaine 199 
 
 Nitric Acid 57 
 
 Molluscum 
 
 Cautery 177 
 
 Nitrate of Silver 109 
 
 Mucous Patches 
 
 Acid Nitrate of Mercury 279 
 
 Chlorate of Potash 377 
 
 Copper Sulphate 221 
 
 Sulphite of Soda 412 
 
 Sulphurous Acid 62 
 
 Tr. Iodine 309 
 
 Mucous Patches of Pharynx 
 Nitrate of Silver . 
 
 "3 
 
 Mumps 
 
 lodoform 296 
 
 Myalgia 
 
 Iodine 301 
 
 Mycosis of Tonsil 
 Fuchsin . 
 
 239 
 
 Mydriasis 
 
 Eserine 357 
 
 Pilocarpine 358 
 
 Myopia 
 
 Bleeding 145 
 
 Myxomatous Hypertrophy of Nasal 
 
 Mucous Membrane 
 Cautery 179 
 
 N. 
 Naevi 
 
 Acid Nitrate of Mercury 279 
 
 Alcohol 76 
 
 Cantharides 170 
 
 Cautery 176 
 
 Collodion 208 
 
 Creasote 212 
 
 Croton Oil 342 
 
 Ferric Chloride 232 
 
 Glacial Acetic Acid 22 
 
 Mercuric Chloride 262 
 
 Nitric Acid 50 
 
 Sodium Ethylate 409 
 
 Trichloracetic Acid 18 
 
 Yellow Wax 183 
 
 Naevi, Pigmented 
 
 Chrysarobin 194 
 
 Nasal Polypus 
 
 Absorbent Cotton 248 
 
 Cautery 180 
 
 Chromic Acid 41 
 
 Ethylate of Soda 409 
 
 Nitrate of Silver 113 
 
 Tannic Acid 66 
 
 Zinc Chloride 442 
 
 Naso-Pharyngeal Catarrh . 
 
 Chloralum 186 
 
 Creolin 218 
 
 Geranium 242 
 
 Muscarine Sulphate 326 
 
 Permanganate of Potash 380 
 
 Nebulae 
 
 Calomel 268 
 
 Necrosis 
 
 Copaiba 210 
 
 Liquid Pepsin 351 
 
 Myrrh 326 
 
 Zinc Sulphate 447 
 
 Neoplasms 
 
 Cocaine 199 
 
 Nephritis 
 
 Dry Cupping 143 
 
 Neuralgia 
 
 Aconite 451 
 
 Benzine 133 
 
 Camphor-Chloral 165 
 
 Cantharides 168 
 
 Capsicum 172
 
 INDEX. 
 
 493 
 
 NAME PAGE 
 
 Neuralgia Continued 
 
 Carbolic Acid 33 
 
 Chloroform 190 
 
 Ether 73 
 
 Glycerin 245 
 
 Menthol 322 
 
 Morphia 346 
 
 Veratrine 436 
 
 Neuralgia, Facial 
 
 Cantharides . 168 
 
 Oil of Spearmint 336 
 
 Neuralgia, Intercostal 
 
 Antipyrin 89 
 
 Belladonna 125 
 
 Croton Oil 342 
 
 Neuritis 
 
 Iodine 304 
 
 Nipples, Chapped 
 
 (See Fissure of Nipple.'] 
 Nipples, Tender 
 
 Gallic Acid 43 
 
 Tr. Benzoin Comp 134 
 
 Nodes, Painful 
 
 Stramonium 420 
 
 Nodes, Syphilitic 
 
 Emp. Hydrarg 275 
 
 Noma 
 
 Acid Nitrate of Mercury 278 
 
 Alcohol 77 
 
 Hydrochloric Acid 44 
 
 Labarraque's Solution 414 
 
 Nitric Acid 51 
 
 Nose Bleed 
 (See Epistaxis.} 
 
 O. 
 
 CEdema of Cords 
 
 Resorcin 389 
 
 CEdema of Glottis- 
 Bleeding 145 
 
 Ice ' . . 101 
 
 Nitrate of Silver 115 
 
 Pilocarpin 358 
 
 Water, Warm 97 
 
 CEdema of Uvula 
 
 Ice . 101 
 
 CEsophagitis 
 
 Bismuth Subnitrate 141 
 
 Lemon Juice 317 
 
 Nitrate of Silver 113 
 
 Vinegar 21 
 
 NAME PAGE 
 
 Onychia 
 
 Alum 80 
 
 Iodine 304 
 
 Monsel's Salt 236 
 
 Nitrate of Lead 368 
 
 " Silver 105 
 
 Tr. Ferri Chlorid 233 
 
 Opacities of Cornea 
 
 Yellow Oxide of Mercury . . . .271 
 
 Ophthalmia, Granular 
 (See Trachoma.) 
 
 Ophthalmia Neonatorum 
 
 Alum 83 
 
 Nitrate of Silver 118 
 
 Water, Hot 98 
 
 Zinc Ointment 446 
 
 Ophthalmia, Phlyctenular 
 
 Calomel 268 
 
 Creoline 218 
 
 Yellow Oxide of Mercury . . . .271 
 
 Ophthalmia, Purulent 
 
 Cotton 249 
 
 Hydrogen Peroxide 284 
 
 lodoform 297 
 
 Oxychloride of Mercury 273 
 
 Pyoktanin 383 
 
 (See Chronic Conjunctivitis.) 
 
 Ophthalmia Tarsi 
 (See Blepharitis.) 
 
 Orchitis 
 
 Ammonium Chloride 453 
 
 Belladonna 126 
 
 Hop Poultice 258 
 
 Orchitis, Syphilitic 
 
 Mercuric Ointment 276 
 
 Osseous Diseases 
 
 Cautery 175 
 
 Osteitis 
 
 Hydrochloric Acid 44 
 
 Iodine 304 
 
 Sulphuric Acid 60 
 
 Otalgia 
 
 Belladonna 127 
 
 Bromide of Ethyl 228 
 
 Chamomile 88 
 
 Cherry Laurel Water 103 
 
 Chloroform J9 1 
 
 Poppy Heads . 344 
 
 Tobacco . 425
 
 494 
 
 INDEX. 
 
 NAMB PAGE 
 
 Otitis Media 
 
 Aristol 120 
 
 Bicarbonate of Soda 403 
 
 Bismuth Subiodide 139 
 
 Bleeding 143 
 
 Cantharides 171 
 
 Carbolic Acid 35 
 
 Pyoktanin 382 
 
 Resorcin 388 
 
 Turpeth Mineral 273 
 
 Zinc Sulphate ... 448 
 
 Otorrhcea 
 
 Alcohol . 76 
 
 Alum 80 
 
 Boric Acid 27 
 
 Cadmium Iodide 151 
 
 Calomel 268 
 
 Camphorated Salol 166 
 
 Carbolic Acid 35 
 
 Chinoline 184 
 
 Creoline . . . : 217 
 
 Dermatol 223 
 
 lodoform 296 
 
 Mercuric Chloride 263 
 
 Nitrate of Silver 112 
 
 Salicylic Acid 58 
 
 Storone 421 
 
 Zinc Chloride 442 
 
 " Sulphate 448 
 
 " Sulphocarbolate 449 
 
 Otorrhcea, Purulent 
 
 Copper Sulphate 221 
 
 Table Salt 407 
 
 Ovarian Neuralgia 
 Chloroform 
 
 191 
 
 Ovaritis 
 
 Cantharides 170 
 
 Iodine 303 
 
 Tartar Emetic 89 
 
 Ozena 
 
 Aristol 120 
 
 Biniodide of Mercury 269 
 
 Bromoform 148 
 
 Camphor 163 
 
 Camphorated Naphthol 330 
 
 Caustic Potassa 372 
 
 Chloral 186 
 
 Chlorate of Potash 376 
 
 Chlorinated Lime 1 60 
 
 Creoline 217 
 
 Creasote 214 
 
 Ferric Sulphate 238 
 
 lodoform . 296 
 
 Labarraque's Solution 414 
 
 Mercuric Chloride 264 
 
 NAMB PAGE 
 
 Ozena Continued 
 
 Myrrh 326 
 
 Nitrate of Silver 114 
 
 Pyoktanin 383 
 
 Quinine 386 
 
 Salol 393 
 
 Table Salt 407 
 
 Tar Water 363 
 
 P. 
 Paget's Disease of Nipple 
 
 Fuchsine 239 
 
 Pannus 
 
 Yellow Oxide of Mercury 
 
 . 271 
 
 Papilloma, Hard 
 
 Arbor Vitoe 432 
 
 Lactic Acid 46 
 
 Papilloma of Larynx 
 (See Laryngeal Papilloma) 
 
 Paronychia 
 
 Ichthyol 289 
 
 Monsel's Salt 236 
 
 Pediculosis Capitis 
 
 Labarraque's Solution 414 
 
 Mercuric Chloride 263 
 
 Naphthol 329 
 
 Stavesacre 419 
 
 Pediculosis Corporis 
 
 Stavesacre 419 
 
 Pediculosis Pubis 
 
 Chloroform 191 
 
 Medicated Bath 456 
 
 Mercuric Chloride 263 
 
 Sweet Spirits of Nitre 417 
 
 Pediculosis Vestimentorum 
 
 Naphthol 329 
 
 Pelvic Cellulitis 
 
 Mercuric Ointment 276 
 
 Pelvic Congestion 
 
 Hot Bath 99 
 
 Pemphigus 
 
 Hot Bath ioo 
 
 Medicated Bath 45 6 
 
 Tumenol 435 
 
 Perforation of Tympanum 
 
 Ammonium Chloride 454 
 
 Carbolic Acid 35 
 
 Copper Sulphate 221 
 
 Nitrate of Silver 1 1 2
 
 INDEX. 
 
 495 
 
 NAME PAGE 
 
 Perichondritis of Auricle 
 
 Tannic Acid 65 
 
 Pericarditis 
 
 Cantharides 1 68 
 
 Perimetritis 
 
 Thiol . 
 
 43' 
 
 Periostitis 
 
 Cantharides 169 
 
 Iodine 304 
 
 Laudanum 345 
 
 Peritonitis 
 
 Belladonna , 125 
 
 Cantharides 169 
 
 Leeches 142 
 
 Mercury Ointment 276 
 
 Mustard 400 
 
 Oil of Turpentine 428 
 
 Poultice 318 
 
 Pernio 
 
 (See Chilblain.') 
 
 Phagedenic Ulceration 
 
 Acid Nitrate of Mercury 278 
 
 Copper Sulphate 236 
 
 Labarraque's Solution 413 
 
 Nitric Acid 49 
 
 Pyrogallic Acid 54 
 
 Resorcin 388 
 
 Pharyngitis 
 
 Aconite 452 
 
 Alum 81 
 
 Arbor Vitse 432 
 
 Benzoic Acid 137 
 
 Bichromate of Potash 375 
 
 Bismuthi Boras 137 
 
 " Oxychloridum 138 
 
 " Subcarbonas 139 
 
 " Subnitras 141 
 
 Boric Acid 28 
 
 Bromide of Potash 375 
 
 Camphor 163 
 
 Carbolic Acid 36 
 
 Chamomile 88 
 
 Chloride of Gold and Silver . . *. 121 
 
 Cimicifuga 194 
 
 Elm 435 
 
 Ergot 226 
 
 Ether 73 
 
 Ferric Alum 235 
 
 Fuchsine 239 
 
 Gallic Acid 43 
 
 Lactucarium 314 
 
 Menthol 323 
 
 . Mercuric Chloride 264 
 
 Nitrate of Potash 379 
 
 Prickly Ash 437 
 
 Pharyngitis Conlimted. 
 
 Resorcin 389 
 
 Rhus Glabra 390 
 
 Salicylate of Soda 411 
 
 Tannic Acid 66 
 
 Thiol 433 
 
 Th y mo1 433 
 
 Pharyngitis, Catarrhal 
 
 Camphoric Acid 164 
 
 Creoline 218 
 
 Ice ioi 
 
 Marigold 157 
 
 Sulphurous Acid 162 
 
 Tr. Benzoin Comp 135 
 
 Pharyngitis, Chronic 
 
 Alum 81 
 
 Ammonium Chloride 454 
 
 Balsam of Tolu 123 
 
 Bleeding 145 
 
 Chlorate of Potash 377 
 
 Iodine 308 
 
 Monsel's Salt 236 
 
 Tar Water 363 
 
 Zinc Chloride 442 
 
 " Sulphate 448 
 
 Pharyngitis, Follicular 
 
 Nitrate of Silver 112 
 
 Zinc Chloride 442 
 
 Pharyngitis, Granular 
 
 Bicarbonate of Soda 404 
 
 Lactic Acid 47 
 
 Nitrate of Silver 112 
 
 Pharyngitis, Malignant 
 
 Chlorine 187 
 
 Cimicifuga 194 
 
 Pharyngitis, Putrid 
 
 Hydrocyanic Acid 44 
 
 Nitric Acid 51 
 
 Oil of Fir 339 
 
 Permanganate of Potash 380 
 
 Quinine 386 
 
 Zinc Sozoiodolate 416 
 
 Pharyngitis Sicca 
 
 Capsicum 172 
 
 Chloral 186 
 
 Creoline 217 
 
 Eucalyptus 230 
 
 Galanga 239 
 
 Labarraque's Sol 4'4 
 
 Sozoiodol 4'5 
 
 Sulphur 423 
 
 Pharyngitis, Syphilitic- 
 Mercuric Chloride 264 
 
 Nitrate of Silver 113 
 
 Zinc Chloride 44 2
 
 49<5 
 
 INDEX. 
 
 NAME PAGE 
 
 Pharyngitis, Ulcerative 
 
 Chloroform 191 
 
 Phlebitis 
 
 Cantharides 170 
 
 Phlegmasia Alba Dolens 
 Witch Hazel 257 
 
 Phlegmonous Inflam. of Throat 
 
 Acetic Acid 21 
 
 Oil of Sandal Wood 341 
 
 Phthisis 
 
 Benzoic Acid 136 
 
 Cantharides 168 
 
 Carbolic Acid 38 
 
 Chlorine 187 
 
 Chloroform 192 
 
 Creoline 218 
 
 Creasote 213 
 
 Croton Oil 342 
 
 Emp. Picis Burgund 360 
 
 Hydrocyanic Acid 45 
 
 Iodine 301 
 
 lodoform 296 
 
 Lard 69 
 
 Mercurial Ointment 297 
 
 Salicylic Acid 58 
 
 Piles, External 
 
 Alum 79 
 
 Gallic Acid 43 
 
 Starch 86 
 
 Piles, Sessile 
 
 (See Sessile Piles.) 
 
 Pimples 
 
 Collodion 206 
 
 Pityriasis 
 
 Cantharides 170 
 
 Castor Oil 340 
 
 Medicated Bath 456 
 
 Oil of Cade . . . . . . ' . . . .335 
 
 Ointment of Zinc Oxide 445 
 
 Salicylic Acid 56 
 
 Soap Bark 385 
 
 Sulphur 457 
 
 Pityriasis Capitis 
 
 Cantharides 171 
 
 Creasote 212 
 
 Ichthyol . 289 
 
 Naphthol 329 
 
 Soap and Resorcin 398 
 
 Thymol 433 
 
 Turpeth Mineral . . . 273 
 
 Pleurisy 
 
 Belladonna 125 
 
 Blisters 167 
 
 NAME PAGE 
 
 Pleurisy Continued 
 
 Iodine 300 
 
 Kerosene 352 
 
 Mustard 400 
 
 Poultice 318 
 
 Pleurodynia 
 
 Belladonna 125 
 
 Croton Oil 342 
 
 Iodine 301 
 
 Pneumonia 
 
 Cantharides 167 
 
 Dry Cupping 143 
 
 Mustard 400 
 
 Poultice . 318 
 
 Raw Cotton 247 
 
 Pneumonia, Chronic 
 
 Iodine 301 
 
 Pneumothorax 
 
 Carbolic Acid 35 
 
 Polyps of Ear 
 (See Aural Polyps.} 
 
 Polyps of Nose 
 (See Nasal Polyps^ 
 
 Polypus 
 
 Tannic Acid 66 
 
 Post-partum Hemorrhage 
 
 Ergot 225 
 
 Ether . . , 72 
 
 Ferric Chloride 232 
 
 lodoform 294 
 
 Prickly Heat 
 (See Miliaria.} 
 
 Procidentia Recti 
 
 Alum 80 
 
 Proctitis 
 
 Althea 78 
 
 Prolapse of Rectum 
 
 Cautery 176 
 
 Ergot 225 
 
 Iron Sulphate 237 
 
 Nitric Acid 50 
 
 Tannic Acid 64 
 
 Prostatitis 
 
 Cantharides 170 
 
 Leeches I4 2 
 
 Tannic Acid 64 
 
 Prostatorrhcea 
 
 Cantharides 17 
 
 Nitrate of Silver 107 
 
 Tannic Acid . 64
 
 INDEX. 
 
 497 
 
 Prurigo 
 
 Alpha 52 
 
 Medicated Baths 456 
 
 Naphthol 329 
 
 Tumenol 435 
 
 Pruritus 
 
 Acetate of Lead 365 
 
 Acid Bath 457 
 
 Alum 80 
 
 Almond 84 
 
 Almond Oil 84 
 
 Balsam of Peru 122 
 
 Belladonna 127 
 
 Campho-phenique 164 
 
 Camphorated Chloral 165 
 
 Carbolic Acid 34 
 
 " " Bath 457 
 
 Chloroform 191 
 
 Citric Acid 43 
 
 Cocaine 199 
 
 Cyanide of Potash 378 
 
 Ether 73 
 
 Glycerin 244 
 
 Guaco 253 
 
 Hot Bath 99 
 
 Hydrocyanic Acid 45 
 
 Hyposulphite of Soda 410 
 
 Ichthyol 289 
 
 lodoform 295 
 
 Medicated Baths 456 
 
 Menthol 322 
 
 Naphthol 329 
 
 Nitric Acid 51 
 
 Oil of Spearmint 336 
 
 Olive Oil 339 
 
 Pyroligneus Acid 23 
 
 Resorcin 388 
 
 Retinol 390 
 
 Salicylic Acid 57 
 
 Sodium Carbonate 406 
 
 Starch 87 
 
 " Sublimate " Bath 458 
 
 Tobacco 425 
 
 Tumenol 435 
 
 Witch Hazel . 257 
 
 Yellow Oxide of Mercury . . . .271 
 
 Psoriasis 
 
 Acetic Acid 20 
 
 Alkaline Bath 457 
 
 Ammoniated Mercury 277 
 
 Anthrarobin . . 87 
 
 Aristol 119 
 
 Carbonate of Potash 375 
 
 Chrysarobin 193 
 
 Gurjun 254 
 
 Hydroxylamine Hydrochloride . . 285 
 
 Ichthyol 289 
 
 Medicated Bath 456 
 
 Naphthol 328 
 
 3 2 
 
 NAME PAGE 
 
 Psoriasis Continued 
 
 Oil of Tar 361 
 
 Oil of Turpentine 428 
 
 Pyrogallic Acid 53 
 
 Rock Salt 407 
 
 Salicylic Acid 56 
 
 " Sublimate " Bath 458 
 
 Sulphur Bath 457 
 
 Tar 360 
 
 Thiol 433 
 
 Thioresorcin 431 
 
 Vlemingckx's Solution 423 
 
 Wilkinson's Ointment 423 
 
 Ptyalism 
 
 Myrrh 
 
 326 
 
 Puerperal Convulsions 
 
 Amyl Nitris 85 
 
 Chloroform 190 
 
 Purpura 
 
 " Sublimate " Bath 458 
 
 White Oak 385 
 
 Putrid Exhalations 
 
 Oil of Camphor 164 
 
 Pyaemia 
 
 Creoline 216 
 
 Pyorrhosa Alveolaris 
 
 Carbolic Acid 36 
 
 Hydronaphthol 331 
 
 Iodine 306 
 
 Q- 
 
 Quinsy 
 
 Guaiac 253 
 
 Iodine 309 
 
 Rhus Glabra 390 
 
 R. 
 
 Rabies 
 
 (See Hydrophobia.') 
 
 Ranula 
 
 Chromic Acid 4 2 
 
 Nitrate of Silver . .... 106 
 
 Rectal Diseases 
 Cocaine . 
 
 Rectal Hemorrhage 
 Iron Sulphate . . . 
 
 198 
 
 237 
 
 Rectal Ulcer 
 
 Chloroform 191 
 
 Copper Sulphate 221
 
 498 
 
 INDEX. 
 
 Relaxed Uvula 
 
 Capsicum 172 
 
 Renal Congestion 
 
 Dry Cupping 143 
 
 Rhagades 
 
 Isinglass Plaster 287 
 
 Zinc Sulphate 444 
 
 Rheumatism 
 
 Aconite 451 
 
 Belladonna 125 
 
 Benzine 133 
 
 Bicarbonate of Soda 411 
 
 Cantharides 169 
 
 Capsicum 172 
 
 Emp. Picis Burgund 360 
 
 Iodine 301 
 
 Kerosene ^52 
 
 Oil of Fir 339 
 
 Oil of Nutmeg 337 
 
 Salicylate of Soda 441 
 
 Thiol 430 
 
 Rheumatic Pains 
 
 Capsicum 172 
 
 Raw Cotton 247 
 
 Rhinitis, Acute 
 
 Belladonna 127 
 
 Bismuth Oxychloride 138 
 
 Borax 405 
 
 Carbolic Acid 36 
 
 Menthol 323 
 
 Morphia 347 
 
 Phenacetine 356 
 
 Fulsatilla 381 
 
 Resorcin 388 
 
 Rhinitis, Atrophic 
 
 Ammoniated Mercury 277 
 
 Balsam of Peru 122 
 
 Bicarbonate of Soda 403 
 
 Bleeding 144 
 
 Bloodroot 395 
 
 Cautery 177 
 
 Cotoin 211 
 
 Creoline 217 
 
 Creasote '. .213 
 
 Galanga 239 
 
 Lactic Acid 47 
 
 Mercuric Chloride 264 
 
 Thiol 434 
 
 Zinc Sozoiodolate 416 
 
 Rhinitis, Croupous 
 
 lodoform 296 
 
 Rhinitis, Hypertrophic 
 
 Borate of Bismulh 137 
 
 Boric Acid 27 
 
 Rhinitis, Hypertrophic, Continued 
 
 Bleeding 144 
 
 Carbolic Acid 36 
 
 Gallic Acid 43 
 
 Glycerin 244 
 
 Lactic Acid . - 47 
 
 Nitric Acid 51 
 
 Resorcin 388 
 
 Yellow Oxide of Mercury . . . .271 
 Zinc Sozoiodolate 416 
 
 Rhinitis, Purulent 
 
 Acetate of Lead 366 
 
 Ichtbyol 290 
 
 Sulphocarbolate of Zinc 449 
 
 Rhus Poisoning 
 
 (See Dermatitis Venenata.} 
 
 Ringworm 
 
 Carbolic Acid 34 
 
 Chrysarobin 193 
 
 Iodine 306 
 
 Mercuric Chloride 263 
 
 Sulphate of Copper 221 
 
 Sulphurous Acid 61 
 
 Tr. Benzoin. Comp 134 
 
 Rosacea 
 
 Acid Nitrate of Mercury . . . . 279 
 Ichthyol 290 
 
 S. 
 
 Salivary Fistula 
 Chromic Acid . 
 
 40 
 
 Salpingitis, Chronic- 
 Copper Sulphate 221 
 
 Scabies 
 
 Balsam of Peru 122 
 
 Creoline 217 
 
 Medicated Bath 456 
 
 Naphthalene 321 
 
 Naphthol 317 
 
 Oxy-naphthoic Acid 52 
 
 Potassa Sulphurata 374 
 
 Sulphide of Calcium 161 
 
 Sulphur 422 
 
 " Bath . , 457 
 
 Tar 361 
 
 Thioresorcin 431 
 
 Water, Warm 100 
 
 Wilkinson's Ointment 423 
 
 Vlemingckx's Sol 422 
 
 Scalds- 
 Carbonate of Lead 367 
 
 Carron Oil 158 
 
 Copaiba 2IO
 
 INDEX. 
 
 499 
 
 Scalds Continued 
 
 Resin 426 
 
 Subnitvate of Bismuth 139 
 
 Thiol 431 
 
 Scarlet Fever 
 
 Mustard Bath 4o 
 
 Sciatica 
 
 Aconite 45 * 
 
 Antipyrin 89 
 
 Cantharides 1 68 
 
 Carbolic Acid 33 
 
 Ether 73 
 
 Morphine 346 
 
 Sulphur 422 
 
 Scleroderma 
 
 Medicated Bath 45 6 
 
 Scrofuloderma 
 
 Cod-Liver Oil 337 
 
 Europhen 231 
 
 Rock Salt 47 
 
 Seat Worms 
 
 Camphor 161 
 
 Ferric Chloride 233 
 
 Lime Water 1 5$ 
 
 Olive Oil 338 
 
 Table Salt 407 
 
 Tobacco 4 2 5 
 
 Sebaceous Cysts 
 
 Ether 73 
 
 Nitrate of Silver 109 
 
 Seborrhcea 
 
 Castor Oil 34O 
 
 Ichthyol 290 
 
 Zinc Ointment 445 
 
 Seborrhcea Capitis 
 
 Tannic Acid 65 
 
 Senile Gangrene 
 (See Gangrene, Senile. .) 
 
 Serpent Ulcers of Eye 
 
 Cautery 182 
 
 Sessile Piles 
 
 Chromic Acid 4 
 
 Shock- 
 Ether 72 
 
 Morphia 346 
 
 Sinuses 
 
 Benzoic Acid 136 
 
 Sponge 
 
 NAME PAGE 
 
 Sloughing Sores 
 
 Charcoal 173 
 
 Creasote 212 
 
 Sore Throat 
 
 (See Angina.} 
 
 Sore Throat of Scarlatina- 
 Chlorine 187 
 
 Eucalyptus 230 
 
 Spasm 
 
 Hot Bath 99 
 
 Spasm of Glottis 
 
 Amyl Nitris 85 
 
 Camphor 163 
 
 Chloroform 192 
 
 Datura Tatula 420 
 
 Oil of Cassia 334 
 
 Stramonium 4 2 
 
 Spasm of Larynx and Bronchi 
 
 Camphor 163 
 
 Oil of Valerian . 34 2 
 
 Sumbul 424 
 
 Spasm of Neck of Bladder- 
 Belladonna 125 
 
 Spasm of (Esophagus 
 
 Nitrate of Silver 113 
 
 Spasmodic Stricture- 
 Belladonna 125 
 
 Spermatorrhoea 
 Nitrate of Silver 
 
 107 
 
 Sprains 
 
 Calendula *5 6 
 
 Camphor Liniment 162 
 
 Chloroform " 19* 
 
 Laudanum . . 344 
 
 " . and Lead Water . . . 364 
 
 Oil of Nutmeg 337 
 
 Soap 395 
 
 Tr. of Arnica '. . . 121 
 
 Water, Cold 9 2 
 
 Witch Hazel 256 
 
 Sterility 
 Boric Acid 
 
 Stings of Insects 
 Table Salt .... 
 
 26 
 
 407 
 
 Stomatitis, Aphthous 
 
 Chlorine Water 102 
 
 Sulphite of Soda 4>2
 
 500 
 
 INDEX. 
 
 NAME PAGE 
 
 Stomatitis, Catarrhal 
 
 Chlorate of Potash 377 
 
 Copper Sulphate 222 
 
 Salicylic Acid 58 
 
 Stomatitis, Gangrenous 
 
 Creasote . .212 
 
 Stomatitis, Mercurial 
 
 Alum 81 
 
 Chlorate of Potash ... . . 377 
 
 Labarraque's Sol 413 
 
 Lugol's Sol 307 
 
 Rhus Glabra 390 
 
 Sulphurous Acid 62 
 
 Strangury 
 
 Belladonna 126 
 
 Camphor 161 
 
 Strictures 
 Olive Oil 338 
 
 Stye 
 
 (See Hordeolnm.) 
 
 Sudamina 
 
 Citric Acid 43 
 
 Sunstroke 
 Cold Bath 98 
 
 Suppuration of Ear 
 
 Brucine 150 
 
 Iodine 307 
 
 Sycosis 
 
 Hydroxylamine Hydrochloride . . 285 
 
 Pyoktanin 382 
 
 Pyrogallic Acid 54 
 
 Salicylic Acid 57 
 
 Salol 393 
 
 Sulphur , 423 
 
 Thilanin ........... 430 
 
 Synovitis, Acute 
 
 Leeches . , . 14.2 
 
 Synovitis, Chronic 
 
 Belladonna 125 
 
 Camharides 1 68 
 
 Emp. Ammoniac Cum Hydrarg. . . 277 
 
 " Hydrarg 274 
 
 Ichthyol 288 
 
 Iodine 301 
 
 Oleate of Mercury ........ 279 
 
 Soap Liniment 162 
 
 Ungt. Hydrarg 276 
 
 Synovitis, Parenchymatous 
 
 lodoform 293 
 
 Syphilis 
 
 Blue Ointment 275 
 
 Calomel 267 
 
 Mercury 274 
 
 Oleate of Mercury 280 
 
 Sozoiodolate of Mercury 415 
 
 " Sublimate " Bath 458 
 
 Syphilis of Larynx 
 
 Acid Nitrate of Mercury .... 279 
 
 Calomel 268 
 
 Carbolic Acid 35. 37 
 
 Chromic Acid . . 42 
 
 Nitrate of Silver 115 
 
 Syphilitic Anaemia 
 (See An&mia, Syphilitic.) 
 
 Syphilitic Angina 
 
 Copper Sulphate 222 
 
 Syphilitic Caries 
 
 Creasote 214 
 
 Nitrate of Silver ,.114 
 
 Sulphuric Acid ........ 60 
 
 Syphilitic Eruptions 
 
 Ammoniated Mercury 277 
 
 Syphilitic Otitis 
 
 Lactic Acid 47 
 
 Syphilitic Rhinitis 
 
 Aristol 1 20 
 
 Syphilitic Ulcers 
 
 Bismuth Subiodide 139 
 
 lodol 298 
 
 lodoform 294 
 
 Red Oxide of Mercury 272 
 
 Salicylic Acid _ 280 
 
 Sozoiodolate of Mercury 415 
 
 Yellow Wash 159 
 
 Syphilitic Ulcers of Nose and 
 Throat 
 
 Acid Nitrate of Mercury 279 
 
 Chromic Acid 42 
 
 Europhen 232 
 
 Mercuric Biniodide 269 
 
 Sulphurous Acid 42 
 
 Syphilodermata 
 
 lodoform 295 
 
 Labarraque's Sol 414 
 
 Laudanum 345 
 
 Mercurial Bath 280 
 
 Rock Salt 407 
 
 Vapor Bath 100
 
 INDEX. 
 
 NAME T. PAGE 
 
 Telangiectasis 
 
 Ethylate of Soda 409 
 
 Mercuric Chloride 262 
 
 Tendo-Synovitis 
 
 Iodine 302 
 
 Tetanus 
 
 Chloral 185 
 
 Conium 210 
 
 Thrush- 
 Bicarbonate of Soda 403 
 
 Borax 405 
 
 Glycerin 244 
 
 Salicylic Acid 58 
 
 Sulphite of Soda 412 
 
 Turpentine 428 
 
 Tic Douloureux 
 
 Aconite 451 
 
 Veratrine 436 
 
 Tinea Circinata 
 
 Ammoniated Mercury 277 
 
 Anthrarobin 87 
 
 Cantharides 170 
 
 Chromic Acid 140 
 
 Chrysarobin 193 
 
 Gutta Percha 255 
 
 Hydroxylamine Hydrochloride . . 285 
 
 Mercuric Chloride 263 
 
 Naphthol 329 
 
 Salicylic Acid 56 
 
 So 3 ? 395 
 
 Sulphurous Acid 61 
 
 Tinea Favosa 
 
 Hydroxylamine Hydrochloride 
 
 Tinea Kerion 
 Citric Acid 
 
 .285 
 . 42 
 
 Tinea Sycosis 
 
 Chrysarobin 193 
 
 Creasote 213 
 
 Tinea Tonsurans 
 
 Ammoniated Mercury 277 
 
 Cantharides 170 
 
 Carbolic Acid 34 
 
 Coster's Paste 306 
 
 Croton Oil 342 
 
 Glycerite of Starch 246 
 
 Gutt'a Percha 255 
 
 Hydronaphthol 330 
 
 Hydroxylamine Hydrochloride . . 285 
 
 Oil of Turpentine 428 
 
 Oleate of Mercury 280 
 
 Salicylic Acid 56 
 
 Wilkinson's Ointment 423 
 
 Tinea Tricophytina, Capitis 
 
 Medicated Baths 456 
 
 Thio1 ' 433 
 
 Tinea Tricophytina, Cruris 
 
 Hyposulphite of Soda 410 
 
 Medicated Baths 456 
 
 Tinea Ungium 
 
 Glacial Acetic Acid 22 
 
 Tinea Versicolor 
 
 Anthrarobin 87 
 
 Calx Sulphurata 161 
 
 Hydroxylamine Hydrochloride . . 285 
 
 Hyposulphite of Soda 410 
 
 Medicated Bath 456 
 
 Mercuric Chloride . .... 263 
 
 Salicylic Acid 56 
 
 Sozoiodolate of Mercury 415 
 
 Sulphur 422 
 
 Sulphurous Acid 6 1 
 
 Vlemingckx's Sol 422 
 
 Tinnitus 
 
 Belladonna 127 
 
 Bleeding 144 
 
 Camphor 162 
 
 Chloroform 191 
 
 Cocaine 200 
 
 Tonsillitis, Acute 
 
 Bicarbonate of Soda 403 
 
 Boric Acid 27 
 
 Camphorated Naphthol 330 
 
 Carbolic Acid 37 
 
 Creasote 213 
 
 Creoline 218 
 
 Eucalyptus 230 
 
 Myrtle Oil 338 
 
 Oil of Cassia 334 
 
 Quinine 
 
 Subcarbonate of Bismuth .... 139 
 
 Tr. Ferri Chlor 234 
 
 Water, Hot 97 
 
 Tonsillitis, Follicular 
 
 Alum '. 8l 
 
 Bromoform 148 
 
 Guaiac 253 
 
 Rose Water 391 
 
 Tonsillitis, Granular 
 
 Bicarbonate of Soda 404 
 
 Tonsillitis, Phlegmonous 
 
 Bleeding 145 
 
 Mercuric Chloride 264 
 
 Toothache 
 
 Acetate of Lead 366 
 
 Aconite 451
 
 5 02 
 
 INDEX. 
 
 Toothache Continued 
 
 Camphor 161 
 
 Capsicum I7 2 
 
 Carbolic Acid 37 
 
 Chloral .' . . 186 
 
 Collodion 209 
 
 Creasote 214 
 
 Menthol 3 2 S 
 
 Oil of Cajuput 333 
 
 " Cloves . . . 333 
 
 " Nutmeg 337 
 
 Pellitory 384 
 
 Po-ho-yo 322 
 
 Tannic Acid 67 ' 
 
 Torticollis 
 
 Capsicum 172 
 
 Ether 73 
 
 Tracheitis 
 
 Menthol 325 
 
 Terpinol 430 
 
 Trachoma 
 
 Acetate of Lead 366 
 
 Boric Acid 28 
 
 Copper Sulphate 222 
 
 Glycerin 245 
 
 Glycerite of Carbolic Acid .... 38 
 
 " Tannin -68 
 
 Iodide of Silver 119 
 
 Jequirity . 311 
 
 Mercuric Chloride 266 
 
 Pyoktanin 383 
 
 Zinc Chloride 443 
 
 Tubercular Joints 
 
 lodoform 293 
 
 Tuberculosis 
 
 lodoform 292 
 
 Tuberculosis Cutis 
 
 Resorcin 388 
 
 Tuberculosis, Nasal 
 
 Lactic Acid 47 
 
 Tuberculosis of Tongue 
 
 Chromic Acid 41 
 
 Eucalyptus 230 
 
 Lactic Acid 46 
 
 Nitrate of Copper 220 
 
 Tuberculous Glands 
 
 Phosphoric Acid 53 
 
 Tuberculous Laryngitis 
 
 Cocaine 201 
 
 Lactic Acid 47 
 
 Salol 393 
 
 Sozoiodolate of Mercury 415 
 
 Tannic Acid 67 
 
 NAME PAGE 
 
 Tuberculous Ulcers 
 
 (See Ulcers, Tubercular?) 
 
 Tumors, Cystic 
 
 Chromic Acid 41 
 
 Turgescence of Nasal Mucous Mem- 
 brane 
 
 Coca 227 
 
 Cubebs 219 
 
 Tylosis 
 
 Lactic Acid 46 
 
 Salicylic Acid 57 
 
 Soap 398 
 
 Typhoid Fever- 
 Cold Bath . . 98 
 
 U. 
 
 Ulcers 
 
 Adhesive Plaster 427 
 
 Alcohol . 76 
 
 Anthrarobin 87 
 
 Arsenious Acid 24 
 
 Aristol 119 
 
 Bismuth Subiodide 139 
 
 Bromine 149 
 
 Camphor 162 
 
 Carbolic Acid 34 
 
 Castor Oil 340 
 
 Creasote 212 
 
 Dermatol .. 223 
 
 Eucalyptus 229 
 
 Europhen 231 
 
 Ichthyol 289 
 
 lodoform 294 
 
 Nitrate of Lead 368 
 
 " " Silver 104 
 
 Nitric Acid 51 
 
 Phosphoric Acid 53 
 
 Prepared Chalk 152 
 
 Pyoktanin 383 
 
 Pyrogallic Acid 53 
 
 Resorcin 388 
 
 Salol 393 
 
 Sponge 418 
 
 Sulphurous Acid 6l 
 
 Thiol . ... 431 
 
 White Oak 385 
 
 Witch Hazel 257 
 
 Yellow Wash 159 
 
 Zinc Sozoiodolate 416 
 
 Ulcers, Atonic 
 
 (See Atonic Ulcers.} 
 
 Ulcers of Cervix 
 
 Acid Nitrate of Mercury 278 
 
 Thymol 433
 
 INDEX. 
 
 53 
 
 NAME PAGE 
 
 Ulcers of Cornea 
 
 Atropia 130 
 
 Carbolic Acid 38 
 
 Castor Oil 340 
 
 Cautery 181 
 
 Eserine 357 
 
 Hydrogen Peroxide 284 
 
 Labarraque's Solution 414 
 
 Pyoktanin 383 
 
 Ulcers, Foul- 
 Chloral 185 
 
 Chlorate of Potash 396 
 
 Hydrogen Peroxide ....... 284 
 
 Hyposulphite of Soda 410 
 
 Naphthol 329 
 
 Permanganate of Putash 380 
 
 Storone 421 
 
 Ulcers, Gangrenous 
 
 Creasote 212 
 
 Hyposulphite of Soda 410 
 
 Zinc Sulphate 448 
 
 Ulcers, Gummatous 
 
 lodol 297 
 
 Ulcers, Indolent 
 
 Arbor Vitse 432 
 
 Bromide of Potash 374 
 
 Chlorate of Potash 375 
 
 Citrine Ointment 279 
 
 Copaiba 210 
 
 Creoline 215 
 
 Creasote 212 
 
 Grindelia 252 
 
 lodol 297 
 
 Kino 313 
 
 Monsel's Salt 236 
 
 Nitrate of Lead 368 
 
 Peroxide of Hydrogen . . . 283 
 
 Soap 397 
 
 Sozoiodol . . 415 
 
 Sulphate of Copper 220 
 
 Ulcers, Irritable 
 
 Cocaine 199 
 
 Ulcers of Larynx 
 
 Acetate of Lead 366 
 
 Menthol 324 
 
 Nitrate of Silver ..... . . in 
 
 Resorcin 389 
 
 Ulcers of Lupus 
 
 Chromic Acid 40 
 
 Ulcers of Mouth and Throat 
 
 Hydrastis 281 
 
 Ulcers of Nasal Chambers 
 
 Aristol .... 120 
 
 Boroglycerin 29 
 
 lodol 298 
 
 NAME PAGE 
 
 Ulcers of Pharynx 
 
 Fraxinus 238 
 
 Ulcers of Pharynx, Syphilitic 
 
 Caustic Potassa 372 
 
 Permang. of Potash 380 
 
 Zinc Sozoiodolate 416 
 
 Ulcers of Rectum 
 
 Bougies 146 
 
 Extract Hydrastis Fid 281 
 
 Glycerin . . .' 244 
 
 Ulcers of Tongue 
 
 Sulphite of Soda 412 
 
 Ulcers of Tongue, Syphilitic 
 
 Papain 350 
 
 Ulcers of Uterus 
 
 Hydrastis 281 
 
 lodoform 294 
 
 Ulcers of Vagina 
 
 lodoform 294 
 
 Ulcers of Vocal Chords 
 
 Creasote 213 
 
 Ulcers, Scrofulous 
 
 Acid Nitrate of Mercury 279 
 
 Phosphoric Acid 53 
 
 Ulcers, Syphilitic 
 
 Rosorcin 389 
 
 Retinol 390 
 
 Salol 393 
 
 Ulcers, Tuberculous 
 
 Bromol 149 
 
 lodoform 295 
 
 Lactic Acid .46 
 
 Menthol 322 
 
 Naphthol . 330 
 
 Phosphate of Calcium 155 
 
 Sozoiodol 415 
 
 Sugar 392 
 
 Ulcers, Varicose 
 
 Creoline / 2I 5 
 
 Ichthyol 289 
 
 Retinol ... 390 
 
 Salol 393 
 
 Urethritis of Female 
 
 Resorcin 3^7 
 
 Tannic Acid 65 
 
 Zinc Oxide 444 
 
 " Sulphate 447 
 
 Urticaria 
 
 Acid Bath 457 
 
 Alcohol 76 
 
 Alkaline Bath 457
 
 54 
 
 INDEX. 
 
 NAME PACK 
 
 Urticaria Continued 
 
 Benzole Acid 136 
 
 Carbonate of Potash 375 
 
 Camphor 162 
 
 Chloral 186 
 
 Chloroform 19' 
 
 Citric Acid 43 
 
 Cyanide of Potash 37 8 
 
 Ether 73 
 
 Hydrocyanic Acid 45 
 
 Medicated Bath 45 
 
 Menthol 3 22 
 
 Rock Salt 407 
 
 Witch Hazel . 257 
 
 Uterine Catarrh 
 
 Bougies 14 
 
 Myrrh . . 326 
 
 Zinc Sozoiodolate 416 
 
 Uterine Fibroids 
 
 Ergot 225 
 
 Uterine Hemorrhage 
 
 Alcohol 76 
 
 Alum 79 
 
 Antipyrin 89 
 
 Monsel's Salt 236 
 
 Nitric Acid 50 
 
 Uterine Polyps 
 
 Ferric Chloride 233 
 
 Uvula, Tuberculosis of 
 
 Pyoktanin 383 
 
 Uvulitis 
 
 Cocaine . . 201 
 
 V. 
 
 Vaginal Catarrh 
 
 Myrrh 326 
 
 Vaginal Ulceration 
 
 Lactic Acid 46 
 
 Vaginismus 
 
 Cocaine 196 
 
 Vaginitis 
 
 Althea 78 
 
 Ammonium Chloride 453 
 
 Boric Acid 26 
 
 Bougies 146 
 
 Ferric Alum 235 
 
 Grindelia 252 
 
 Lime Water 158 
 
 Retinol 390 
 
 Tannic Acid 65 
 
 Thiol 431 
 
 Zinc Sozoiodolate 416 
 
 NAME 
 
 Vaginitis, Specific 
 Mercuric Chloride 
 
 262 
 
 Varicose Ulcers 
 (See Ulcers, Varicose.} 
 
 Varicose Veins 
 
 Ferric Chloride 232 
 
 Variolous Eruption 
 
 ArUtol 120 
 
 Glycerite of Starch 246 
 
 Ichthyol 289 
 
 Varus 
 
 Chloral 186 
 
 Varix 
 
 Vienna Paste 3/3 
 
 Venereal Sores and Ulcers 
 
 Acid Nitrate of Mercury 278 
 
 Black Wash 158,276 
 
 Chloral 186 
 
 Europhen 231 
 
 Ferric Sulphate 237 
 
 lodol 297 
 
 Venereal Warts 
 
 Arbor Vitse 432 
 
 Nitric Acid 49 
 
 Tannic Acid 64 
 
 Verrucae 
 (See Warts.} 
 
 Vulvitis 
 
 Alum 80 
 
 Borax 405 
 
 Vulvitis, Aphthous 
 
 lodoform 295 
 
 Vulvitis, Gangrenous 
 
 Bromine 15 
 
 W. 
 
 Warts- 
 
 Carbolic Acid 35 
 
 Cautery l?7 
 
 Chloracetic Acid 1 8 
 
 Chromic Acid 39 
 
 Creasote 212 
 
 Glacial Acetic Acid 22 
 
 Lactic Acid 4 
 
 Nitrate of Silver 109 
 
 NitricAcid 50 
 
 Salicylic Acid 57 
 
 Trichloracetic Acid 18 
 
 Tr. Ferri Chlor 233 
 
 Warts on Eyelids- 
 Chromic Acid . . 
 
 42
 
 INDEX. 
 
 55 
 
 Warts, Syphilitic 
 
 Acetate of Lead 365 
 
 Chromic Acid 39 
 
 Lead Plaster 369 
 
 " Wax in Ear" (Cerumen) 
 
 Bicarbonate of Soda 403 
 
 Glycerin 244 
 
 Hydrogen Peroxide 284 
 
 Liquor Potassa 373 
 
 Olive Oil 339 
 
 Papain 350 
 
 Whitlow- 
 Carbolic Acid 33 
 
 Citrine Ointment 279 
 
 Honey 392 
 
 Whooping Cough 
 
 Carbolic Acid 37 
 
 Cocaine 202 
 
 Coffee 152 
 
 Eucalyptus 230 
 
 Quinine 386 
 
 Resorcin 389 
 
 Terebene 430 
 
 Tr. Benzoin. Comp 135 
 
 Wounds 
 
 Absorbent Cotton 247 
 
 Alum 79 
 
 Aristol 119 
 
 Bromol 149 
 
 Camphor Naphthol 1 66 
 
 Chlorine Water 102 
 
 Dermatol 223 
 
 NAME 
 
 Wounds Continued 
 
 Eucalyptus 229 
 
 Glycerin 243 
 
 Isinglass Plaster 287 
 
 Kerosene 353 
 
 Laudanum 
 
 344 
 
 Mercuric Chloride 261 
 
 Naphthalene 327 
 
 Naphthol 328 
 
 Nitrate of Silver 104 
 
 Oil of Turpentine 428 
 
 Phenol Sodique 39 
 
 Pykotanin 382 
 
 Salicylic Acid 55 
 
 Salol 393 
 
 Storone 421 
 
 Sugar 392 
 
 Sulphurous Acid . 61 
 
 Tannic Acid .64 
 
 Water 91 
 
 Witch Hazel 256 
 
 Wounds, Poisoned or Dissecting 
 
 Cantharides 170 
 
 Zinc Chloride 441 
 
 Wounds, Septic 
 
 Creoline 216 
 
 Wounds, Suppurating 
 
 Oakum 319 
 
 X. 
 
 Xanthoma 
 
 Mercuric Chloride 
 
 262
 
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