In country practice some years ago I often saw cases of suppuration between the toes in barefoot boys who were out in the dew-laden grass early and late; they called the affection "dewpoison." It is accompanied with great itching, some pain, and suppuration, and is evidently an infection of the superficial layers of the skin through an abrasion of the cuticle. It heals rapidly by the use of benzoate of bismuth. "Liver spots" will be removed by the use of the following: Tr. Benz. Comp. Hydrarg. Chlor. Corros. Apply twice a day. I have used it in many cases. 3jss 3 j For foul-smelling ulcers I know of no better dressing than benzoic acid or its bismuth salt. The sore should be well cleansed and dried, when it may be covered with the powder and bandaged under cotton. Usually the ulcers will be found improved at the next dressing. Bartholow says that benzoic acid destroys the bacillus of diphtheria. Of this I cannot speak personally, but I do know that I have seen very sore throats greatly improved by the acid in solution or the tincture applied locally. The tincture cannot be used in a spray because it clogs the tips, but the vapor may be inhaled by placing half an ounce in a pitcher of hot water and enveloping the head and face and pitcher with a sheet or large towel. Used thus it is very useful in acute or chronic laryngitis or bronchitis, and especially so in the bronchorrhea often seen in the aged, with offensive sputum. Internally. The great indication for the internal use of the benzoates is ammoniacal urine. They change the reaction from alkaline to acid, and destroy the odor in twenty-four to fortyeight hours. A large part being excreted by the kidneys as benzoic acid, they stimulate the vesical mucosa to a more healthy action, and relieve the cystitis which is always present if the case is of long standing. Some prefer the ammonium salt. Whichever of the salts (or the acid) is used is of little importance, provided the stomach receives it kindly. The good work is accomplished by converting the insoluble urates, phosphates, and uric acid into the more soluble hippurates. The urine is rendered less septic, or becomes really antiseptic. In cases of ammoniacal urine or chronic cystitis I give 15 or 20 grn. every two to four hours until the urine becomes acid; after that three times a day. It should be given largely diluted; and often a simple bitter, as gentian, given along with it will act beneficially by preserving the healthy action of the stomach. Because of its action on the urates, benzoic acid has been much used in rheumatism; but I have not had the results from it which have been claimed by others, and only employ it in such cases when the salicylates or salicin cannot be used because of their effects on the stomach. Lyman extols it as a remedy for gouty affections. My experience with gout has not been sufficient to allow me to speak concerning it. Nocturnal enuresis of children with neutral or alkaline urine will be much benefited by its use. They should have 3- to 5-grn. doses after each of the principal meals. Headache of lithemic origin will be cured by the use of these remedies. The acid has a gentle stimulant action on the gastric mucosa, creating a sensation of warmth and possibly increasing the action of the secretory apparatus of the stomach. It has a stimulant action on the liver, and seems to increase the amount of bile discharged; but this is possibly apparent rather than real, the seeming increase being due to the decrease in swelling of the mucosa of the ducts and consequent free vent for its discharge. It alone cannot be depended upon, but in combination with other and more active cholagogues it has a very happy effect upon cases of torpid liver. The benzoate of bismuth may be given in diarrheal troubles in children, with excellent results. It should be given in 2-grn. doses to a child one year old, every three or four hours. In chronic bronchitis benzoic acid or benzoate of ammonium will be found of signal service; and bronchorrhea of the aged with fetid expectoration will be much benefited by its use. It disinfects and liquefies the sputum, and destroys the fetid odor. Acting as a stimulant to the mucous membrane, it creates a healthier condition of its surface. In some cases of acute bronchitis, especially those of the lithemic diathesis, it gives good results; but experience has taught me that its greatest field of usefulness in these cases is after the subsidence of the acute symptoms. Acute tonsillitis and edema of the glottis are best treated by large doses every two hours, given in half an ounce of whiskey. [I don't like the whiskey.-ED.] The usual duration of such cases is from three to five days, but under the influence of the benzoates they may be checked in from 24 to 36 hours. All forms of influenza are benefited by its use, and if there is much arterial excitement I like to add 2 to 3 drops of tincture of gelsemium to each dose. As antiperiodic the benzoates are worthless; as antipyretics they are reliable only in so far as they exert their specific effects upon the disease for which they are given, and the slight diaphoresis and diuresis which are caused by them. [Therap. Gazette.] There is certainly not a drug-clerk who has not at some time or another dispensed this prescription. Tho strictly incompatible, it is nevertheless dispensed daily; and as it seems to give good results to both physician and patient, we must not object. The incompatibility is a double one: lead subacetate being an alkaloidal precipitant, precipitates the alkaloids of the opium; another portion of it combines with the meconic acid present in the opium tincture and precipitates as lead meconate. In the case where lead acetate is used instead of the subacetate (as it is in the National Formulary-see "Lotio Plumbi et Opii"), the precipitate is not quite so heavy. 147-Hydrarg. Chlor. Mitis......... Ammon. Carbon....... Sacch. Lactis......... M. et ft. pulv. No. 1. Tal. dos. No. xxiv. .gr. iij .gr. v .gr. v There is no positive proof on hand that a very poisonous compound is formed on mixing the above ingredients; nevertheless it is better to be on the safe side, and not dispense this prescription. When the ammonium carbonate and calomel are rubbed together the color of the powder is changed to black. This black color is due to the formation of mercurous oxide (Hg,O) and ammonium mercurous chloride (NH,Hg,CI); and, taking into consideration the instability of the mercurous compounds, there can hardly be any doubt that within a short time. a portion of them will lose the extra atom of metallic mercury and pass into the mercuric state. S.: Apply to throat and nose with cotton swab. The activity of Labarraque solution, or solution of chlorinated soda, depends upon the presence therein of sodium hypochlorite, which is easily decomposed, yielding chlorine. In the presence of the peroxide the hypochlorite becomes reduced, according to the following equation: NaClO + H2O2 = NaCl + H2O + O2 As is seen, the peroxide becomes reduced to water at the same time. This prescription forcibly illustrates a tendency which cannot be condemned in too severe terms: the habit which some physicians are acquiring of prescribing, in combination with official or other well-known remedies, proprietary compounds, the exact composition of which is not known to them. How can the prescriber be certain that the proprietary article does not react with the other remedies, possibly with a deleterious result to both? How can the druggist be in a position to prevent or correct an incompatibility? How can the physician know to which drug to ascribe beneficial results, following the administration of such a combination? Suppose the patient was relieved by the above mixture; how does the physician know whether the relief was due to the morphine and quinine, or to the antikamnia? I remember one physician used to praise to heaven a certain alterative compound; it was "the anti-syphilitic par excellence." Yet he used to prescribe it invariably in conjunction with the iodides and mercurials. I once asked him whether the therapeutic virtues, he thought the proprietary preparation possessed, might not be ascribed to those drugs; but he still owes me the answer. To return to the above prescription. If the quinine is dissolved by the aid of the acid, and the antikamnia is then added, effervescence takes place, due to the evolution of carbon dioxide. Whether precipitation will take place or not, will depend upon the amount of sulphuric acid. If enuf is present to neutralize all the bicarbonate of the antikamnia, none will take place; but if an insufficient quantity is taken, the bicarbonate precipitates the morphine and the quinine, and the prescription then is a dangerous prescription to dispense. The bulk of the antikamnia, i. e., the acetanilid, will in any case remain undissolved. 150--Hydrarg. Chlor. Mitis......... Hydrogenii Peroxidi......... S.: Apply externally three times a day. 3ij .zij The statement is generally made that hydrogen peroxide oxidizes or otherwise changes mercurous into mercuric salts. This may be true of soluble mercurous salts, such as mercurous ROBINSON'S PRESCRIPTION INCOMPATIBILITIES. 115 nitrate (I did not investigate that subject, as the only mercurous salt used in medicine is an insoluble one), but it must be accepted with great reservation as regards calomel. I shook calomel with hydrogen peroxide for many hours, and failed to detect any mercuric chloride. This assertion must therefore be based upon the following careless observation: When hydrogen peroxide is kept in contact with calomel and filtered, the filtrate will give quite an abundant precipitate with silver-nitrate solution; a precipitate soluble in ammonia water and re-precipitated by nitric acid. This shows the presence of a soluble chloride in the filtrate, beyond all doubt. On further investigation we discover that even before being shaken with calomel, the peroxide gives a white precipitate of silver chloride, because the commercial article always contains soluble chlorides. On testing the filtrate with KOH,H,S, or copper, or any other delicate test for mercury, none is discoverable. It is possible that on very prolonged contact, some bichloride may be formed; but then the decomposition may be due to other causes, such as light, etc. 151-Hydrogenii Peroxidi....... Sol. Hydrarg. Bichloridi 1: 1000. S.: Apply externally with cotton swab. .3ij This prescription is all right. I have tested this solution both therapeutically, on patients, and chemically. The antiseptic effect was not in any way diminished, and chemical tests failed to discover any change either in the peroxide or in the corrosive sublimate. 152-Iodoformi Aq. Hydrogenii Perox..... 3j .3j The combination is an odd one, but not incompatible. Careful tests failed to discover any decomposition in the iodoform. This is again due to the insolubility of the iodoform in the This prescription is incompatible. The iodoform dissolves in the ether, and on mixing the solution with the peroxide, iodine is liberated, as can be ascertained by adding gelatinized starch, when a deep-blue color is developed. Of course, the red-colored ethereal solution is not miscible with the H2O2 solution. (To be Continued). |