Salicylicum acidum

Volume I — Appendix

Description— It is prepared from flowers of Spiraa Ulmaria, Oil of Gaultheria (Wintergreen), Salicin, Indigo, and Phenol.

It has a sweetish-sour taste, and produces irritation of the throat. Slightly soluble in cold water, much more so in hot water. Alcohol dissolves it more readily than water, and either take up a considerable quantity.

Preparation. — Triturations.

Head.

Delirium; the patient's mind became very stupid; it was difficult for him to collect his ideas, then he laughed without cause, talked incessantly and disconnectedly, frequently looked about him, with apparent hallucinations.

Vertigo, — dulness of the head.

Rush of blood to the head. Headache.

Diminished acuteness of vision.

Roaring in the ears, with difficult hearing.

° Meniere's disease, — aural vertigo.

Throat.

Haemorrhagic pharyngitis, with difficulty of swallowing. Great dryness of the pharynx. Violent efforts to swallow, with difficulty in swallowing, woke him from sleep ; the pain and difficulty in swallowing became confined to the right side of the throat, with sticking pain, extending along the Eustachian tube to within the ear ; swelling of the right tonsil, so that it was noticed externally below the angle of the jaw, with sensitiveness when touched, and with increased temperature in the vicinity ; examination revealed redness and swelling of the mucous membrane of the throat and posterior fauces, with ulcers the size of a pin-head ; after a time a small lump of .cheesy matter of a strong odor was expectorated, with some bluish-red blood ; this was followed by a gradual return of the throat to its normal condition.

° Diphtheria (but inferior to Eucalyptol).

Stomach.

Erosions and ulcers in the stomach and bowels.

Generalities.

Immediately after the first powder he began to sweat profusely. The perspiration increased and his strength diminished so visibly, that his wife was unwilling to give him the fourth

powder. He insisted, however, and after taking it, vomiting and an agonizing headache set in, which continued all night. In the morning he seemed unconscious and simply groaned loudly. Only for a moment did his mind seem clear, when he cried out, " My head, my head ! " to the physicians who were present. All treatment was futile, and he died in forty hours after taking the first powder. No post-mortem examination was permitted. The course of the case was too rapid to be explained on the theory of a complicating cerebral inflammation ; all the symptoms seem to point to poisoning (10-grain doses).

Fever.

Increased warmth of skin. Profuse sweat. Sweat at times more or less profuse.

Volume II — Special Therapeutics

It is high time that the homoeopathic school had begun to investigate the pathogenetic action of this powerful remedy. I commenced the use of it about two years ago, first as a remedy in fermentative dyspepsia, when there occurred distension and formation of gases in the stomach and bowels after meals. Its action in such cases was followed by gratifying results.

My next experience with it was in cases of cholera infantum or other diarrhoea of children, when the eructations had a peculiarly putrid and offensive odor. It acted better than Arsenicum, removing the fetor, and benefiting the intestinal disorder.

Experimentally I tried it in several cases of phosphatic urine, when the secretion was very offensive. In one case pus and mucus were largely present. It not only benefited the local urinary trouble, but removed the fetor, the pus, and the mucus from the urine. I have reported one case of catarrh of the bladder, when this agent, locally applied by enema, removed the disease in the short time of five days.

In the month of May, 1876, I had three cases of septiccemia, occurring in lying-in women, due to absorption of morbid discharges through lesions of the vagina. In these cases the symptoms were very grave, the temperature was very high, with chills, abdominal tenderness, etc. Under the use of Salicylic acid, these cases recovered sooner than I had ever known such cases recover. In a paper read before the Wisconsin State Society, I narrated these cases. This paper was published in the “ Medical Investigator,” August, 1876.

In the winter of 1876 the allopathic journals teemed with reports of this wonderfully successful use of this medicine in acute inflammatory rheumatism. My pupil, Dr. E. A. Gatchell, while in attendance on the clinic of the Cook County Hospital, at my request carefully watched the results of its use in this disease. He reported the results as generally very successful, fully agreeing with the favorable experience reported in the various journals. The doses used in the hospital were about ten grains every hour.

I determined to test its value in my own practice. Selecting two cases of polyarthritis rheumatica, as severe as any I had ever seen, where the temperature was 105°, the pain intense, and the tenderness excessive, I prescribed the acid in doses of ten grains every three hours. The results surprised me. After five or six doses had been taken, the pain, soreness, and inflammation declined,, the temperature fell to 100°, and general improvement set in. In four or five days the patients were cured. Only weakness, such as might be expected from the disease, remained. Never before had I seen such results from any of our best remedies. With Aconite, Bryonia, Cimicifuga, and Verat. viride I had cured such attacks, but never in less than nine or fourteen days.

My stricter colleagues may inquire why I did not use the 3d trituration, or even the 30th dilution? I reply, that I adopted the rule Hahnemann laid down. He demanded of those who wished to test the value of the remedies he advised in disease, that they should use them as he did, namely, in the same strength and at the same interval.

If I had used fractions of a grain, or the 3d trituration, and failed to cure my patients, and then declared the medicine worthless in rheumatism, I should have been acting illogically and unjustly. As the sequel will show, I acted fairly and honestly, for not long after I had several similar cases, which I placed under the

use of Salicylic acid in smaller doses. To one I gave five grains every four hours, to another five grains of the lx (trit.) every two hours, and another, ten grains of the 3X, every three hours. These cases were not as severe and painful, nor did the temperature run as high as my first cases. The results were: In the first case (under five grains) he made rapid improvement, and was well on the seventh day. In the second case (under lx) the improvement was slow, and he was not free from the inflammation till the ninth day, and he was left with effusion of one knee-joint, which had to be removed by the galvanic current. The third case (under 31) progressed unsatisfactorily. The medicine did not seem to “ take hold,” and I resorted to Bry. and Puls., and the symptoms did not disappear for fourteen days.

Since this experience I have treated several cases successfully with Salicylic acid, but I have found that the dose which cures the most promptly, without causing any pathogenetic symptoms, ranges from five grains of the crude salt every two hours to five grains of the P trit. every two hours.

Notwithstanding the fulminations of a portion of our school I believe that certain medicines require to be given in definite material quantities to develop their curative action in certain diseases. I believe such is the case with Salicylic acid in acute rheumatism, Quinine in malarial intermittents, and Veratrum viride in acute inflammatory fever, and I shall adhere to this belief until cases of undoubted trustworthiness, proving to the contrary, are presented. I will here add, that in septicaemia (pysemic fever), it requires about the same quantity to remove the disease, while in dyspepsia, diarrhoea, and the morbid states of the urine above referred to, I got good results from the 3* trit. or dilution. (The dilutions run up in equal parts of Glycerin and Alcohol seem to act best.)

The allopathic experience with this agent up to this date is well summed up in the “Practitioner” of March, 1876, as follows:

In polyarthritis rheumatica its beneficial use is universally attested. Indeed, one may say with certainty that, in many cases, after three or four doses, or even after five or ten grams (75 or 150 grains), not only is the fever reduced, but the articular pains are also dispersed, so that in a few days acute cases may be looked upon as cured.

Dr. Strieker is quoted in an article in the Chicago “ Medical Journal and Examiner/’ as follows:

All the patients thus treated were not only relieved of their fever, but also of the local symptoms, i. e., the swelling, redness, and especially the painfulness of their joints, within forty-eight hours, most of them even within a much shorter period.

Professor Traube says that

Fourteen cases of acute rheumatism were treated with the acid, and in all cases, within two days, all fever had gone, as well as the redness, swelling, and pain in the joints.

It has also been used very successfully for offensive discharges from the ear, and offensive breath from any cause, even for offensive fetor of the expectoration in gangrene of the lungs.

Dr. (Ehrne, in the “ North American Journal of Homoeopathy,” quotes from three German physicians the results in fifty-six cases of diphtheritis, accompanied with the following symptoms:

Violent fever ; the entire fauces covered with a white exudate. In two cases hoarseness and barking cough (affection of the larynx) were present. In some a gargle was given, while in others it was not. The average dose was one-sixth of a grain, hourly, and the average duration of the disease was, in most of them, two to five days ; except in a few of the most severe it was eight days. Among the cases there were none of diphtheritic inflammation of the kidneys, nor any cases of paralysis of the palate.

I have used it in but few cases of diphtheria. In adults, a few drops of the l1 diluted in Glycerin, repeated every two hours, with a gargle of two grains to a teaspoonful of water, with 5 U of Glycerin, or Alcohol, has usually sufficed to remove the false membrane, and the fetor in two days. In children half the above strength is an ample dose. I think it far exceeds Carbolic acid as a topical application. In a few cases I alternated it with Phytolacca, but it might have been efficient alone.

Thus my own experience (although limited) shows that very large doses are not required. It is not necessary, therefore, to use massive doses, even in rheumatism (twenty grains every hour or two), to the risk of causing pathogenetic effects.

It may be well to record what such pathogenetic effects are. "We find reported that it has caused “vertigo, hallucinations, tinnitus aurium, burning pricking in the throat, copious, even colliquative sweating, partial collapse, great reduction of animal heat,” etc.

The drug effects have in some cases reached to such a degree of severity as to be worthy the name of poisoning, as witness the following :

After one hundred single doses of Salicylate of sodium, given at midday, in cases of typhoid fever of nearly equal severity, there was almost immediately a fall of temperature, the maximum result being reached in most cases in from four to five hours, and rarely in from eighteen to twenty-four hours. This fact was fully established by thermometric observations made every ten minutes in the axilla and rectum. This reduction of temperature was noticed in eighty per cent. — Dr. Ewald.

Within fifteen minutes, or even less, after the administration, a copious perspiration breaks out, first on the face, then on the thorax, abdomen, and the rest of the body, accompanied by a redness of the skin, more especially that of the face, and may be so copious that the patients may lose 500 to 750 grams of water (a pint to a pint and a half ).

The defervescence begins with the perspiration, though the two do not continue pari 'passu. Generally the pulse, respiration, and intestinal tract are unaffected. Contrary to the above, Dr. J. G. Richardson says, in the “Philadelphia Medical Times,” that, “in four cases, this agent, so lavishly lauded of late in rheumatism, was followed by some adverse symptoms. In the first case, 140 grains of Salicylic acid were administered in 120 hours, when it produced nausea, and was discontinued, without any effect upon the rheumatic complaint having resulted.” In the second cftse, 110 grains, given in 72 hours, produced a temperature of 96|° F., the pulse and heart-beat becoming intermittent. The pain and swelling were entirely abolished, and the patient received Quinine, beef-tea, and punch freely, and was soon discharged.

In the third case, a hyperdefervescence resulted from taking 45 grains in 3 days. In the fourth case, 55 grains were administered in 48 hours to a man fifty-one years old, an old rheumatic, on the tenth day of the attack. His pains were much relieved, but this favorable result was attended with profuse perspiration, rapid reduction of temperature, and marked diminution of the frequency and force of the pulse. He also complained of great prostration, and was slightly delirious upon

waking from sleep. In all these cases the tendency toward alarming prostration seems to be decided.

The acid excites some dryness in the mucous membrane of the mouth and pharynx, followed by increased secretion from their surfaces, slight deafness, and in some cases patients become unusually lively.

It is possible that some of the readers of this volume may be unacquainted with the pharmacology of Salicylic acid. As nearly as I can ascertain from chemists, and my own experiments, the following table will give the solubility of the acid (chemically pure) in the following vehicles, being those which we can use in homoeopathic practice, as they are non-medicinal.

Alcohol, 25 per cent., .

. 1 per cent.

Glycerin and Alcohol (equal parts), .

. 30 “

Glycerin, .

. 10 “

Glycerin, Alcohol, and water (equal parts),

• i “

Glycerin and water (equal parts), .

i “

Water, .

1 «

It will be seen that we can readily make the Pin pure Alcohol, and carry up the dilutions for internal administration, in cases when homoeopathically indicated. If we desire to give large quantities in acute rheumatism, we can prepare it of the strength of six or eight grains in each drachm of Glycerin, an excellent vehicle in which to administer it in that disease. In cases of pyaemia or septic fever, an excellent preparation is equal parts of Glycerin and brandy or whiskey, which will dissolve eight grains to 5j* From this strong solution the 2“ or 3X can be prepared in the same menstrua, and as it is necessary in nearly all cases of these pernicious fevers to give stimulants and food, the brandy or whiskey and Glycerin, a teaspoonful every two or three hours (gtts. 30 of each) answer a double purpose. It will be seen by reference to the table that water will not dissolve more than T ^th of the acid, making only the 1° dilution. But this small power may be made excellent use of in practice, for it has been discovered that even the strength of one part in one thousand will prevent putrefaction in water , thus enabling us to purify water in which there are organic substances.

Milk will dissolve as much if not more than water. One part

in five hundred of milk (1 gr. to 5ij) will postpone “curdling” thirty-six hours later than in milk not medicated with it. It has seemed to me that we can utilize this fact. When we consider that children who are fed on artificial food, milk, etc., with or without the bottle, are very apt to suffer greatly from the “ spoiling,” “ souring,” or “curdling” of such food, bringing on attacks of vomiting, diarrhoea, gastro-enteric fever, and even cholera infantum, the question arises, can we not, by adding this minute quantity of Salicylic acid to their food, prevent all this ?

I could answer favorably by citing a few cases where mothers, starting on a journey in hot weather, haveasked me to advise them as to the best plan of feeding on the cars. If condensed milk agrees with the child, I advise that. If not, I have advised the addition of two or three grains to a pint or quart of milk, with the effect, as I learned, of preventing the spoiling of the milk, without causing any medicinal symptom in the children. Of course it would not answer to advise this as a continuous practice, but only for a day or two.

There are some specimens of the acid which are much more soluble than others, and some that appear very insoluble. The pure German crystals are to be preferred. While I value Salicylic acid highly as a topical application in the treatment of offensive catarrh, otorrhoea, fetid breath, fetid sweat, etc., I have not been pleased with it as an enema in puerperal states. It does not seem to destroy the fetor of the vaginal and uterine discharges as well as Carbolic acid.

An aqueous solution cannot always be made strong enough unless the acid is very pure. Some specimens require one thousand parts of water to dissolve one of it. In such cases the addition of a few grains of Borax increases very greatly its solubility, and also increases its antiseptic and curative power. I usually use it in the above local affections in the strength of five grains to a pint of water. If a sediment is precipitated, add ten or fifteen grains of Borax, and apply this through a douche, spray atomizer, or as an enema.

Salicylic acid has been used most extensively in the Jacob’s Hospital, Leipsic, by Professor C. Thiersch. In the second series of R. Volkmann’s “German Clinical Lectures” may be found a report on the clinical results of the Lister method, and the substituting of Salicylic for Carbolic acid. The results of the Lister method with Carbolic acid as an agent, although good, were not so brilliant in the hands of Thiersch as he had hoped for, and it should be said that his trial of the method was made before its details had been perfected. Believing that the acid (Carbolic) itself was productive of a good deal of irritation, and that its volatility was a serious objection, necessitating frequent change of dressing, Thiersch finally selected Salicylic acid as a substitute. The part operated upon is prepared, as in Lister’s method, by washing with a five per cent, solution of Carbolic acid or Salicylic water.* The spray used during operation is Salicylic water, all vessels are secured by Lister’s catgut ligature, and the edges of the wound are put in apposition with antiseptic sutures. In all extensive wounds a drainage-tube is inserted, and thoroughly flushed with the Salicylic water until the fluid returns nearly clear. The line of the wound is covered with a strip, three fingers wide, of perforated oiled silk, gutta-percha tissue, or antiseptic gauze. Over this is placed, first, a layer of 10 per cent. Salicylic cottonf an inch thick, and, second, a two-inch layer of 3 per cent, cotton, £ the whole being secured by a gauze bandage. It hardly need be said that the cotton should overlap the boundaries of the wound to a considerable distance, say a hand’s breadth, in an amputation of the leg. In place of Salicylic cotton, Thiersch has of late used Salic}7lic jute, § containing 4 per cent, of the acid. In the absence of systemic disturbance, the dry dressing is left in position eight or ten days, when the second dressing is applied under antiseptic precautions, and left until the wound heals. Should a high temperature be present, or pain in the wound complained of, the

• Salicylic water. — Salicylic acid, 1 part ; water, 300 parts, f Salicylic wadding, 10 per cent. — Dissolve 1 kilogram of Salicylic acid in 10,000 grams of spirits, sp. gr. 0.830, dilute with 60 liters of water at 158° to 176° F., and soak 10 kilograms of clean cotton-wool in the mixture.

X Salicylic wadding, 3 per cent. — Dissolve 750 grams of Salicylic acid in 7500 grams of spirits, of sp. gr. 0.830, dilute with 150 liters of water at 158° to 176° F., and soak 25 kilograms of clean cotton-wool in the mixture.

\ Salicylic jute. — To soak 2500 grams of clean jute. Mix 75 grams Salicylic acid, 500 grams Glycerin, 4500 grams water, and raise the temperature to 158° to 176° F.

dressing must be opened, stitches removed, and the wound thoroughly washed out, the cotton being replaced. In case of failure to secure union primarily, irrigation by Salicylic water is to be practiced. Gangrenous flaps, after amputation, and greater compound fractures are treated by irrigation with Salicylic water, after Esmarch’s plan. Deepseated abscesses of size should be opened at one or more dependent points, and drainage-tubes inserted, washing out with Salicylic water being practiced as long as the walls are non-adherent. Large superficial abscesses are laid open, the granulations scraped away, a drainage-tube inserted, and compression made by Salicylic cotton or jute after thorough cleansing by flushing. A careful review of the elaborate tables of Thiersch shows that while in most instances the same brilliant results were obtained as under the Carbolic method, there are still many more cases of erysipelas than should be met with if that affection be dependent upon atmospheric germs.

Salicylic water should not be used to disinfect instruments on account of its action upon the metal ; for this purpose the Carbolic solution should be employed. The acid is somewhat irritating in odor, provoking coughing and sneezing when used in spray or in dry dressing, but can be depended upon as an efficient substitute for Carbolic or Thymic acid when deemed preferable.

In addition to the above uses, this acid has been used successfully in sciatica, in doses of one-tenth of a grain, or one grain every three or four hours. By reference to the provings (see Allen’s “ Encyclopaedia ”), as well as the toxic symptoms above mentioned, it will be seen that it causes in large doses a peculiar vertigo, with tinnitus aurium, vomiting, fainting, etc. These symptoms so closely simulated “ Monniere’s disease” of the internal ear, that several aurists of our school prescribed it successfully in that affection. Dr. Dyche Brown and others, of England, have published many cases illustrative of curative action in this disease.