Salicylicum Acidum

Among the more recent additions to the materia medica this agent holds a prominent place, particularly so in the surgical world. Pre- pared from carbolic acid or from salicin, the neutral principle of the willow, it resembles the former in many respects, especially in its remarkable power as an antiseptic. The Cliemist and Druggist tell us that brewer's yeast does not affect a solution of glucose to which one-thousandth part of salicylic acid has been added. Mustard flour, which, when mixed with a little tepid water, almost immediately de- velops a sharp odor of the essence of mustard, remains quite inodorous, if a small quantity of salicylic acid be added.

Fresh milk mixed with 0.04 per cent of salicylic acid and allowed to stand at a temperature of 80° F. in an open vessel took thirty-six hours longer to curdle than the same quantity similarly exposed in a pure state. Fresh meat, on which the acid had been sprinkled, remained sweet for several weeks.

It is claimed to be superior to carbolic acid in its freedom from offensive odor and taste, and in its comparative harmlessness when taken into the stomach. The phenic acid is, however, much the cheapest and hence is and probably will be in more common use as a deodorizer. Professor Kolbe has taken from one to 1.25 grammes of salicylic acid per diem in water or spirits without disturbance to his digestion or general health, and when prescribed as a remedy it has been given in very formidable doses without any apparent ill- results.

If taken recklessly, it produces effects not unlike those caused by excessive doses of quinine. Dr. Napier mentions the case of an old gentleman, to whom he had given twenty grains of salicylate of soda every two or three hours for a rheumatic affection of the wrist and ankle joints. During a subsequent attack, the patient took the remedy on his own responsibility, continuing its use for more than a week, in the manner above stated, in order to effect a comj)lete cure.

He became very deaf, had ringing noises in the ears, severe head- ache, thirst, loss of appetite, and felt dull and heavy. Upon discontinuance of the remedy, these symptoms speedily vanished.

It has already been stated that salicylic acid is obtained from car- bolic acid ; it is also produced from carbonic acid and other sources. To obtain an absolutely pure article, M. Thresh states in the Jour, de Pharm. et de Chern., that the common acid should be dissolved by

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moans of heat, in four times its weight of glycerine, then adding an excess of cold water. The coloring matter remains in the solution, and the salicylic acid is precipitated. By washing this with cold water, expressing in bibulous paper, and drying in an oven, the pure acid is obtained in the form of colorless prismatic needles, having an acid, astringent, somewhat saccharine taste, inodorous, and soluble in water or alcohol. The common acid is soluble only in three hundred parts of water, but easily in alcohol.

This watery solution, although seemingly very weak, is nevertheless a powerful disinfectant and antiseptic, preventing decomposition of urine, blood or pus for a long time and answering, in the dressing of wounds, the same purpose as the carbolic acid.

Urine containing traces of salicylic acid gives a deep-red, violate precipitate upon the addition of a mixture of one part of the officinal solution of perchloride of iron and four parts of distilled water. The following directions are given for its detection in mixtures : Concentrate the mixture in the water bath, to remove any accom- panying alcohol, add to the residue dilute sulphuric acid in excess, so as to render it strongly acid, and to restore it to a fluid condition, and shake the whole with ether, which dissolves the salicylic acid.

On evaporating the ethereal solution, the acid is left behind and may be weighed. (Pharm. Centralh, 1877, p. 321).

The use of salicylic acid in surgical practice depends upon its antiseptic properties. Professor Thiersch was one of the first surgeons to experiment with salicylic acid with a view of substituting it for phenic acid. He was induced to make these experiments by observing that the former rivaled cabolic acid as an antiseptic and caused less local irritation.

In an article on the subject (see Am. Jour. Horn. Mat.

Med., July, 1875,) we find the following description of Professor Thiersch's method : " For the use of the spray, for disinfection of the operat- ing field and of the operating hands, he employed the watery solution. Instead of the carbolic gauze, he used cotton-wool, impregnated with a strong alcoholic solution of the acid, and afterward dried in two different sorts, one containing ten per cent, the other three per cent of the crystallized acid. But, of course, the use of this agent has also its drawbacks.

One is, that the solution decomposes metal, and is, therefore, not to be used for disinfection of the instruments, and that it irritates the skin of the operating hand ; another, that the

132 ACIDUM SALICYLICUM.

impregnated cotton-wool proved less porous than the antiseptic gauze. In cases, therefore, where an abundant secretion takes place, only the deepest layers of the wool become impregnated with it, and their disinfecting power is soon exhausted, whilst the secretion con- tinues ; so that the rest is liable to decomposition and stagnation. For these cases Thiersch used continual irrigation of the bandage with a watery solution of the salicylic acid, or he took oft' the bandage and irrigated the open wound from time to time with the solution. * * * As regards the antiseptic healing process, Thiersch believes Lister's method and his own equally efficacious, but he prefers salicylic acid because the irritation is less, and it does not evaporate; the dressing can also remain longer without being changed, and can contain a larger quantity of the disinfectant."

Salicylic acid is frequently used in the treatment of contused wounds, ulcerated or gangrenous surfaces. In such cases it may be strewn on dry.

According to Professor Thiersch, a solution of one part of the acid to three parts of phosphate of soda and fifty parts of water, favors the coating over of granulating surfaces. It is recommended in

CATARRH OF THE MUCOUS MEMBRANE, characterized by free, bland secretion and fulness of tissue. In a case of nasal catarrh, where the tissues were full, rather pallid, and the patient had sensation of fulness and stuffing up of the head, with the usual frontal headache, all of which had lasted for three years, the acid, locally applied by means of a spray, effected a cure in two months. In

LEUCORRHCEA it has been used successfully, when characterized by evident atony, sensations of dragging and weight, without any sensitiveness of the parts. In

SPECIFIC INFLAMMATIONS (syphilitic) of the mucous membrane the use of the acid has been followed by excellent results.

In the Am. your, of Med. Science (1875,) we ^n^ a number of cases on record, among them the following :

F. L., an officer suffering with acute gonorrhoea, painful erections, insomnia, etc. ; glans swollen ; lips of meatus purplish red, and protruding. Treated him with injections of salicylic acid of I-200, increasing gradually in strength as the inflam- mation subsided until a solution of 1-100 of water was attained. At the same time a mixture of salicylic acid was given by the mouth as follows : Prescribed acid, salicylici, grains xviii; tincture anodyne, simple gtt. 25; aquoe destillatse, oz. iii.

M. S. A teaspoonful hourly. Patient did not complain of any scalding sensation after an injection, such as is often experienced after using zincum sulphuricum, argentum nitricum or plumbum aceticum.

At the end of five weeks he was discharged cured.

Gleet of eighteen months standing. N. A. C, a carpenter, aged forty years. The endoscope was used and the interior of the urethra illuminated. Discovered a large purplish red patch at the point of junction between the pars cavernosa with the pars

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prostatica. A concentrated solution of salicylic acid 1-5 was injected through Guyon's graduated stem syringe. The instrument was passed down beyond the patch as recommended by Mr. Berkely Hill; in withdrawing slowly, when the bulb of the stem reached the inflamed patch, three grains were injected.

A weaker solution of the acid (1-100) was then ordered to be injected thrice daily for four days, when the concentrated solution was again used, followed as before by the weaker. This man, after twenty-five days treatment, was discharged cured.

Vaginal gonnorrhcea. Sarah P. H., aged Nineteen, unmarried. Disease con- tracted in the latter part of February. First saw her on April 2d. Used vaginal injections and douches of salicylic acid solution 1-100, containing two parts of phosphate of soda; the acid was also administered internally, as stated in a previous case. On April 30th the patient was discharged cured.

The effect of salicylic acid upon the temperature of the body is not quite clear. It is, however, generally acknowledged that it has the power to decrease the temperature of the body in acute and inflammatory diseases. The physiological schools utilize it in the treatment of

INTERMITTENT FEVER and of

ACUTE RHEUMATISM. Professor Traube, in the Klinisclie Wochenschrift, reports fourteen cases treated with the acid, and in all of them, within two days, the fever had gone, as well as the redness, swelling and pain in the joints. Dr. Milam reports in the Louisville Med.

JVeivs (Feb. 16, 1878,) six cases of rheumatism in which the salicylate of soda was employed. The first case terminated fatally. The second patient, aged seven years, had rheumatic inflammation of the left elbow and wrist. Salicylate of sodium, in doses of fifteen grains every four hours, produced an amelioration of symptoms within six hours, and recovery took place within two days.

The third case was equally successful. The fourth patient had been sick for two weeks, when thirty grains of salicylate of sodium were ordered to be taken every four hours ; the pain was as effectually relieved as if opium had been used, and at the next visit, her physician found her convalescent. The fifth case was relieved of most of her symptoms within two days, by doses similar to those employed in the fourth case. One wrist remained swollen and was treated with stimulating liniments in addition to the sodium salicylate.

Bv the sixth day she too had entirely recovered. In the last case also the result was favorable, although the disease ran a somewhat more tedious course.

Dr. J. S. Rooker (American Practitioner, February, 1878), reports a case of a woman, aged sixty-seven years, in which the use of the acid in doses of two scruples every three hours, in combination with the borate of sodium and glycerine, reduced the temperature from 102. 50 to ioo° within twenty-four hours, secured mobility of the diseased joints and improvement of all the symptoms.

Stoppage of the remedy and exhibition of iodide of potassium and colchicum were accompanied with a re- lapse, and a return to the salicylic acid again improved the condition of the patient, and led to the removal of the disease in about ten days.

134 ACIDUM SALICYLICim.

Professor Da Costa (Med. Times, March 2, 1878,) says that salicylic acid should be discontinued at once if its administration causes no change for the better in two or three days. He thinks that large doses of the drug may prove dangerous by causing fatal depression and insists upon immediate change of treatment, if under its exhibi- tion, the pulse becomes feeble and the patient delirious. Moreover, salicylic acid should never be given in cases of cerebral rheumatism.

We have no systematic proving of salicylic acid. Homoeopathic physicians, it is true, have used it in various diseases, such as rheum- atismus, dyspepsia, and diphtheria, but clinical experience can be of real value only to the homoeopath as a verification of the patho- genetic record of a drug, for outside of such a record, there is little to hinder us from straying into lawless empiricism.

SCIATICA. — The following case of sciatica, reported by Dr. H. Goullon, is taken from the Halm. Monthly, March, 1877 :

A robust old man, aged eighty, formerly had foot-sweats, and since their suppres- sion is more liable to rheumatic pains. His present affection attacks him especially at night. After an hour's sleep the pains force him to leave the bed; he changes to the sofa, but soon he has to leave that again, and thus he passes a sleepless night. The seat of the pain corresponds exactly to the exitus of the left ischiatic nerves, goes from behind forward and downward to the knees and toes.

The pain is drawing, shooting, at the toes burning, or, as the patient expresses himself, " as if the foot were on an ant hill," and as if the foot would like to perspire. No fever. He can hardly ascend stairs, so that he has to look for some support, or else he might fall. Rhus, (aggravation of pains during rest), and causticum (burning pains, paretic sensations) failed to give relief, nor did silicea (foot-sweats) do any better.

Finally I gave him the first decimal trituration of salicylic acid, morning and evening, as much as he could put on the point of a pen-knife, and after a few doses these nightly exacerba- tions stopped, and he could walk up and down stairs.

Dr. A. C. Rickey, (Cincinnati Med. Advance, February, 1878,) speaks as follows of the use of salicylic acid in

DYSPEPSIA. "I have given this new remedy a trial in several cases of gastric derangement characterized by sour stomach, burning in the stomach, flatulence, belching up of hot, sour substance. I have used it, after first trying other remedies, with marked success in six cases, failed in none. Used it in one case, where, in addition to the above symptoms, there was chronic vomiting of almost every- thing eaten.

The trouble was of several years standing, and had been treated by an experienced homoeopath for several months with- out benefit. Salicylic acid 2x, cured the case in one month."

DIPHTHERIA. — The following symptoms are said to indicate its use in diphtheria : High fever ; great prostration ; redness of the fauces ; soft, white exudate covering the entire fauces ; difficult deg- lutition. *

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TAENIA. — Salicylic acid has been given for the removal of taeiiiu. Marynowski gave four doses of the acid, followed by oil, which were followed by the prompt and painless discharge of the worm.