Carbolicum Acidum

Carbolic acid, also called phenic acid, or phenylic alcohol, was discovered in 1834 by Eunge, a German chemist. It is one of the products obtained in the distillation of coal tar. The commercial article is dark-brown in color and possesses a remarkable, pungent odor. The pure substance, prepared for medicinal purposes, comes to us in white, detached crystals, and fuses at 93° F. It is soluble in twenty parts of water, very soluble in alcohol, and boils at 367° F.

Mr. Crooks has suggested the following tests for the purity of the acid:

1. Put a teaspoonful of the carbolic acid in a bottle; pour upon it half a pint of water; shake the bottle at intervals for half an hour, when the amount of oily residue will show the impurity.

2. Dissolve one part of caustic soda in ten parts of wTarm water and shake it up with five parts of the carbolic acid. As before, the residue will indicate the amount of impurity.

Few medicinal agents have produced, in a limited way, so pro-

52 ACIDUM CAKBOLICUM.

found an interest, especially in the surgical world. This is due to its remarkable antiseptic power, holding inactive the noxious body by arresting chemical changes, thus making the acid an antiseptic proper or a colytic. If brought in contact with an organized mass,, its peculiar effect is exerted only upon the germs of putrefaction and of fermentation, without ordinarily producing an injurious effect upon the mass of other matter present. Its effect is directly destructive to the source of noxious gases and of organic decomposi- tion.

It requires a surprisingly small amount of the acid to produce very remarkable results. Sir William Crooks states, that one per cent of carbolic acid in water will preserve fresh meat indefinitely, and will do so without materially affecting its taste or flavor; also- that one per cent will destroy the power of yeast to induce fermenta- tion, without any alteration of the yeast-cells, appreciable by the highest power of the microscope, The 5000th part of carbolic acid will prevent the decomposition of urine, blood, glue, flour paste, etc.,. for months, and even a little vapor of the acid will preserve meat for several days, in ordinary atmosphere, and prevent its being fly-blown*

Professor Ohandelon, of Liege, states that during a cholera epidemic when one hundred and thirty-five nurses attended upon cholera patients of whom two thousand died, only one nurse fell a victim to the disease; he attributes this remarkable fact to the free use of carbolic acid, with which the nurses were washed and had their clothing sprinkled.

It is believed that the large rate of mortality, which attends major surgical operations, and the very serious results which are apt to fol- low even minor injuries depend, in part, upon the action of micro- scopic organisms or germs, which float in the air, upon the wounded surface, and upon the irritation and poisonous action of decomposing blood and tissues. This fact has led to the so-called antiseptic treat- ment, initiated and held up before the surgical world by the eminent Professor Lister, of the University of Glasgow. " Lister's method " consists simply in the free use of carbolic acid, of which a fine spray is caused to fall continuously upon the exposed surface during the operation; all the bandages, lint, etc., in fact, the entire dressing is saturated with a solution of the acid. Oiled silk, cerates and glyceroles, all containing the acid, are freely used; and the result of this treatment has been so eminently successful, that with disin- fection of the wards, the loss of patients, after capital operations even,. is surprisingly small.

The effect of the acid, if promptly applied to a flesh-wound, seems to enable union by the first intention to take place, by a removal of everything "productive of local irritation or poisoning by the absorption of decomposing tissue or blood."

Dr. C. W. Boyce relates the following (Transactions of N. Y. State Horn. Med. Socieiy, 1868, page 215):

Mr. M. M. Fry, seventy years old, while unloading a log from a wagon, was struck by the binder on the left side of the face, about half way between the nose and the cheek-bone.

The blow of the stick completely turned the flesh from the point where it struck, to the ear, making a wound four or five inches long to two or three inches wide, laying the bone bare. The flap was placed as nearly as possible to its place and retained by a few adhesive strips. There was more or less bleeding, but owing to the bluntness of the instrument, the amount of blood lost was not very great. From such a wound, produced in such a manner and in so old a man, I expected there would be profuse suppuration, and that it would heal very slowly.

In order to correct any bad smell that might arise from the wound during the stages of suppura- tion I prepared a solution of ten drops of carbolic acid in a coffee-cupful of water, keeping the parts wet with this lotion. To my surprise there was not a drop of pus discharged, and at the end of the week the wound was entirely healed.

C. S., eighteen years old, had his right middle finger mashed by machinery. The first phalanx was mashed fine and felt like pieces of bone in a small bag. The first joint was implicated.

The wound was compound and pieces of bone protruded. The condition was so bad that it seemed wrong to try to save the end of the finger, but with the knowledge of the above case before me, I concluded to try the lotion. The finger was put in as good a shape as possible, held by adhesive strips and the lotion was applied. In an incredibly short time young S. used his hand to write with, and has continued to do so ever since.

He removed one or two fragments of bone, but there was no suppuration, nor much soreness; even the joint is intact.

ABSCESSES often task to the utmost the patience of both patient and surgeon, by refusing to heal promptly. This is apt to occur particularly in persons laboring under some specific taint. Free injection of highly-diluted carbolic acid into the abscess, and other local applications of the same agent are highly useful.

Dr. James Martin {Eclectic Med. Journal, 1868, page 562) relates the case of a scrofulous young man, who had an abscess situated to the left of the junction of the first and second bones of the sternum, about the size of half a large orange, lying under the aponeurosis of the pectoralis muscle. After unsuccessfully trying various expedients, Dr. Martin resorted to injections of carbolic acid, and experienced from this treatment the most satisfactory results.

In protracted cases of illness, such as tedious fevers, bed-sores frequently become a source of much suffering. The system is at such times usually in the right condition to develop a breaking down of tissues, which may become truly formidable. The following case occurred in our own private practice:

A young Swede was very sick with typhoid fever ; and, before long, bed-sores showed themselves. The destructive process spread with more than usual rapidity, destroying the glutei muscles so fully as to expose here and there the underlying peri- osteum. The suffering caused was an item of much importance in so grave a state ; but the posibility of a physical deformity was unbearable to the friends and to the patient. A solution of one ounce of carbolic acid to a quart of water was employed, saturating with it balls of lint, which were introduced into the cavity formed and

54 ACIDUM CARBOLIBUM.

changed as often as required. Under this application healthy granulation took place, and when the patient had sufficiently recovered to leave the sick-bed, there was no trace left of the once so threatening local difficulty.

UTERINE CATARRH in an aggravated form has been treated successfully by introducing into the uterus, by means of a flexible probe, a thin film of cotton wool, saturated with a solution of the acid. The eminent Dr. Playfair, of London, England, recommends the use of a solution, which seems, however, dangerously strong, namely, eighty parts of the concentrated acid to twenty parts of water. Where there is much uterine tenderness the intra-uterine treatment should be postponed until it has been relieved.

Allow me to select one of a number of cases given by Dr. Playfair, in the Lancet

Mrs. P., aged thirty-three years, was the mother of four children, the youngest of whom was six years of age. Ever since the birth of her last child she had suffered from uterine diseases, the prominent symptoms being constant bearing down pain, which entirely incapacitated her for work, and a very profuse leucorrhoeal discharge of a transparent, gelatinous character. The latter was steadily increasing, and she became thin and cachectic.

The menstrual flow was irregular, scanty and very pain- ful. The uterus was large and tender on pressure ; the cervix was greatly hyper- trophied, and covered with a villous erosion, which bled on being touched. The leucorrhoeal discharge was seen to issue freely from the os uteri. During six months the patient had attended the out-patient department of a metropolitan hospital, and during two months she had been treated generally, with occasional applications of tincture of iodine to the cervix.

Her general health improved somewhat, but the uterine symptoms did not become much better, while the discharge continued una- bated. She was then treated by the intra-uterine application of carbolic acid, once a week, along with the application of iodized cotton and glycerine to the cervix. After the third application, the discharge was much diminished, and the erosion of the cer- vix almost healed. In four months the patient was perfectly well ; the uterus being of normal size, and the uterine leucorrhcea having entirely disappeared.

She has since remained perfectly well in every respect.

CANCER In the treatment of the various forms of cancer the valuable antiseptic properties of carbolic acid make it an agent of much usefulness. Dr. Pease, (Med.

Investigator, Oct., 1872,) says: " The acid is given in two-drop doses, largely diluted with water, two or three times a day, not when the stomach is empty, but some little time after a meal. This prescription is carried out for three to six months. I have seen cases where diagnosis was nearly certain as to the existence of cancerous disease, and which, upon the exhibition of the acid, began to show signs of recovery, and gradually the tumor would grow smaller and finally disappear altogether."

It is well known to the profession that in a large majority of cases of cancer, the disease is so thoroughly constitutional that an extirpa- tion of the diseased mass is of no great value, not even in prolonging life ; even when an operation gives temporary relief, the disease is more than apt to re-localize itself in an aggravated form. This latter tendency, Dr. Pease believes, is prevented by the carbolic acid, and

A.CIDUM CARBOLICUM. 55

he cites the following cases, each representing one type of the disease, in support of his claim. It will be necessary to remember that the cases were published in 1872.

1866. Mrs. L., aged fifty-five years, had a cancer of the mamma, involving the whole gland. The tumor was extirpated with the knife, and the carbolic acid pre- scribed. The result was a union by first intention and complete restoration to health. She is still living; and there is no indication of a return of the disease.

1867. Miss C, aged twenty-two years. Cancer of the ovary; ovariotomy was performed and carbolic acid administered. Complete recovery and no return.

1869. Miss B., h?ematoid cancer, located on the right cheek, to the ala of the nose. Carbolic acid internally and externally, without operation, fully removed all traces after two months' persistent use of the acid.

Carbolic acid has been used as a ,wash in the sore throat of scarlatina and in diphtheritis; injections into the rectum of a solution of the acid in water are claimed to destroy " pin- worms " most effectually; it has been used as an injection in gonorrhoea; in the form of a spray, consumptive patients are said to have been greatly benefited by it ; in the form of an ointment it has cured tinea capitis; and hypodermically it has been used in

FEBRILE ARTICULAR RHEUMATISM. Prof. Autrecht and Dr. Runge claim that " half an hour to two hours after the injection (one or two per cent) the joint is free from pain and can be moved in every direction. The more swollen the joint, the more beneficial is its action, especially on joints surrounded by soft parts, as the large joints." The injection has to be made directly into the joint.

Professor Heuter, of Greifswald, has experimented largely with carbolic acid and writes as follows in the Centralblatt, of January, 1874:

1. In synovitis hyperplastica granulosa (white swelling) of the knee, the injection was thrown into the most central part of the joint, so that the needle came in contact with its walls. The effect was, cessation of pain, diminution of long enduring elevation of the temperature at night, and a remarkable diminution of the swelling. On account of the chronic nature of the case, the injection had to be repeated at intervals of two or three days.

2. In subacute glandular swellings with tendency to suppuration, or buboes, whether in the inguinal or femoral region. Effects: cessation of pain, the redness of the skin and the oedema disappear- ing; the gland becomes rounded in form, and gradually returns to its normal condition. Several injections have been necessary to secure complete recovery*

3. In acute phlegmon of the subcutaneous and subfacial con- nective tissues. The most peripheric part of the phlegmon is to be chosen, so that the lymphatic vessels may convey the acid in a central direction. In extensive inflammations, two syringes full

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may be injected at different points. Effects : shriveling of the tissues in a few hours; immediate cessation of pain; and recovery without suppuration (if this had not already been developed,) although it seemed imminent.

In this disease I have injected the acid at different points along its border, in order to prevent erysipelas of the forehead, for example, spreading to the hairy scalp. This end has been attained; but as yet I have not ventured to inject the acid along the whole border of the erysipelatous inflammation in numer- ous places in order to cut short its course.

If taken internally the carbolic acid produces a very interesting

train of symptoms. The following case of poisoning, copied from

the American Observer, March, 1875, will be of interest.

PROVINGS, SYNOPSIS OF THE.—

Very acute smell. Nasal catarrh.

Flushed. Sallow, soapy and bloodless complexion.

Diminished.

Stitches in the heart. (Carbolic acid has been found curative in organic valvular disease, as a sequela of inflammatory rheumatism; in fearful palpitation, accompanied with great dyspnoea; and in heart diseases worse at night and aggravated upon the least indiscretion in diet).

ACIDUM CAR 150 LIC UM.

Permit me now to call your attention to those pathological states, in the treatment of which the carbolic acid has been found a valu- able internal remedy. In the

VOMITING OF PREGNANCY it has been prescribed when there existed frantic headache and great irritability; so also in the

Mrs. B., aged thirty-nine years, nervous, sharp-featured, thin, small and frail in appearance ; has been afflicted for many years with dyspepsia, but managed to be

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about and to attend to her household duties. Her condition is at times greatly aggra- vated ; she has had periodical spells of diarrhoea, followed by constipation ; frequently •complained of colicky pains, soreness of the stomach and bowels ; haemorrhoids, with great tenderness in the rectum at all times; external piles; sometimes bleeding and internal ; has had four miscarriages that were very tedious and accompanied by great loss of blood, followed by cedema of the feet, hands and face, with soapy, colorless complexion.

Gave her carb. ac. ix. It acted like a charm. From frequent disappoint- ments she had become indifferent to the taking of all medicines, but after taking this remedy a week she sent me a message that she v/as greatly improved and wanted more of the same medicine. I gave her the first centesimal dilution, and two weeks subsequently she called in high glee, all ready for a three weeks' visit among her friends in a distant part of the country and wanted to take a plentiful supply of medi- cine along.

Said she was sure it was just the thing for her, and had hopes of becom- ing again as sound and healthy as ever.

DIARRHCEA AND DYSENTERY The pathogenesis of the

drug justifies its use in diarrhoea and dysentery, accompanied by severe gastric disturbances, with pain and tenderness in the bowels, discharges of thin, watery stools or of bloody stools ; tenesmus.

Twin sisters, nine months old, have been more or less affected during the summer months with vomiting and diarrhoea, which at times assumed a very grave form ; as they were being raised on the bottle, my apprehensions regarding them were con- stantly on the qui vive. The irritability of the stomach at such times was very great, throwing up everything they took, with constant desire to drink water, which, how- ever, was not retained any more than any other substance. The passages from the bowels were frequent, like rice-water in appearance, and very offensive to the smell, resembling the odor of foul eggs, so peculiar to this complaint.

I found, after trying many other remedies, such as arsenicum, veratrum, euphorbium, etc., that none of them answered as well as the carbolic acid, which I gave them in the first centesimal dilution. (Dr. Haeseler.)

A gentleman had dysentery ; the discharges were frequent and composed of blood and mucus, the latter appearing like shavings of mucous membrane ; there was much tenesmus, and great tenderness over the transverse colon ; tongue dry, and coated with thick, yellow fur; excessive thirst and high fever, the pulse beating at no per minute. The patient had taken a dose of castor oil with 15 drops of laudanum the day before my seeing him ; and the evening previously had taken an injection of starch and laudanum. In the morning after the day of my visit, he was much worse, and continued so in spite of my remedies, until the day after, when I gave him car- bolic acid in half-teaspoonful doses of the first decimal dilution every hour, whereupon he soon gave evidence of improvement, and on the fourth day was entirely restored. {Ibid.)

ACIDUM CAEBOLICUM. 61

A little girl, about ten years of age, and in the eleventh day of the disease. When I saw her, she was apparently in the last stage; pulse 140; restless; partially de- lirious; white circle around the mouth; the rest of the face dusky red; eyes bloodshot, gummy ; lips, mouth and tongue black ; sordes and ulcerated patches on the inside of the lips and cheeks ; breath exceedingly fetid and repulsive. Liquids on being swallowed would squirt out of her nose and ears; skin dry and scurfing off; urine high-colored and scanty; abdomen slightly tympanitic; altogether a most formidable and unpromising case; in fact such a case as, in my experience, very rarely recovered, or, I ought more properly to say, never recovered, under ordinary remedies. ***** Carbolic acid, first decimal dilution,,

about twenty drops in a half tumblerful of water was given, one teaspoonful every hour for six hours, then every two hours. In about twelve hours we met again. The effect was gratifying, and relieved me of much anxiety about the result;, there was such a favorable change in our patient, that we were both much aston- ished; the pulse was reduced; the dry heat of the skin was much less; the foul,, fetid breath was corrected ; the dusky hue of the face was not so evident ; in fine, all the symptoms improved most unexpectedly, so that on the third day of its administra- tion we considered her out of danger, so great was the progressive improvement from day to day.

At this stage we left off the acid and gave some nitric acid, which we thought was indicated by the condition of her mouth and bowels. In two days,, under this treatment, she became worse ; increase of pulse ; breath again became fetid; more restlessness; very irritable; sleepless. Again the carbolic acid was resumed and in a few days more she was convalescent; certainly a very remarkable escape from a malignant phase of a very destructive disease. ■

62 ACIDUM CAKBOLICUM.

Dr. Middleton used the first decimal dilution, about ten drops in half a glass of water.

ACIDUM CARBOLICUM. 63

PYAEMIA. — Carbolic acid has been found of excellent service in pyaemia as illustrated in the following case :

ANTIDOTAL TREATMENT.— Sugar of lime, prepared by dissolving sixteen parts of white sugar in forty parts of water, digest- ing with lime for three days, filtering and evaporating.

64 ACIDUM CITRICUM.

In cases of poisoning by the internal use of the acid, and in the absence of other means, an active emetic should be given at once, to be followed, after a few minutes, by a free dose of castor oil or sweet oil.