2174 



ULCERATIONS 



to the action of the drug, which may produce a severe fatty degenera- 

 tion of the heart, liver and kidneys. 



Tartar Emetic Carbolic Solution. — This contains i per cent, tartar 

 emetic and ^ per cent, carbolic acid, and does not need to be sterilized or 

 passed through a Berkefeld filter. 



Solutions for Intramuscular Injection. — Intramuscular injections are 

 in certain cases very convenient, especially in children, in whom the superficial 

 veins are often small. Unfortunately the usual solutions of tartar emetic 

 and other antimonial salts are painful, and may induce the formation of an 

 abscess. The following formulas will be found fairly satisfactory: — 



Formula No. i [Castellani) . — Tartar emetic, gr. viii.; ac. carbohci, TTj^x.; 

 glycerin., "^in.; aq. dest., ad §i.; ^ to i c.c. (8 to i6 minims) every other day 

 in the gluteal region. At the time of the injection there is as a rule no pain 

 whatever, but a few hours later in most cases there is a certain amount of pain 

 and an infiltrated patch often develops, as after an intramuscular injection 

 of quinine or of mercury perchloride. Care should be taken to give the injec- 

 tions in different spots, never giving a second one in the infiltrated part. If 

 the pain and infiltration should be severe, hot fomentations will be found 

 useful. 



The solution is prepared in bulk in a sterile bottle, and tested for sterility 

 forty-eight hours after preparation; it may then be put up in small i c.c. 

 ampoules, which it is advisable to keep in a cool dark place. The presence of 

 carbolic acid decreases the pain induced by tartar emetic and makes the 

 solution sterile. 



Formula No. i {Castellani). — Tartar emetic, gr. viii.; ac. carbolici, Tllx.; 

 glycerin., ^iii.; sodii bicarb., gr. |; aq. dest., ad gi. This solution differs 

 from No. i in being slightly alkaline. The results seem to be the same, and the 

 pain induced by it appears to be about the same as with formula No. i . 



Formula No. 3 {Martindale). — Antimonii oxidi, gr. -J^; glycerin., aq. dest., 

 aa ni^xv. (for one ampoule) . This preparation is good and is practically pain- 

 less, but our impression is that the curative action of antimonium oxide is 

 inferior to that of tartar emetic. 



Oral Administration of Tartar Emetic. — The oral administration 

 of the drug may be useful in conjunction with the intravenous or intramuscular 

 injections. The following mixture is often very convenient: — 



Tartar emetic, gr. v.; sodii bicarb., gr. xxx.; glycerin., ^i.; aq. chlorof., ^ii.; 

 aquae, ad §iii., 3i- ^ 3"- water, three times daily, m children; double 

 dose in adults. The presence of bicarbonate of soda and chloroform water 

 decreases the emetic action of the drug. 



Local Applications of Antimonial Preparations. — G. C. Low has 

 used with satisfactory results a i per cent, antimonial ointment. A i per cent, 

 antimonial lotion has been used by several authorities as a local appUcation 

 to the sores, and certain observers have used tartar emetic in powder, but 

 this is extremely painful, and we do not recommend it. 



Before the introduction of tartar emetic the treatment of Oriental sore was 

 very unsatisfactory. Nitrate of mercury ointment, alum ointment, boric acid, 

 and various antiseptics were recommended, with very poor results. Formalin 

 often irritates the ulcer, and may produce a dermatitis. Rontgen rays have 

 been tried, without any good results. An expectant treatment was generally 

 advised. The scabs should be removed by boracic acid fomentation, and 

 then the sores must be thoroughly disinfected once or twice daily with a 

 I in 1,000 solution of perchloride of mercury or 2 per cent, carbolic acid, after 

 which one of the ordinary antiseptic ointments (/3-naphthol, gr. v.; vaseline, 

 §i.; iodoform or europhen, gr. v. ; ung. ac. borici, §i.; balsam. Peru., gr. v.; to 

 vaseline, gi.) or an antiseptic powder (iodoform or xeroform or boric acid) is 

 applied. 



Salvarsan and atoxyl have been used without any good result. 

 Marzinowsky, after removing the crust and cleansing the ulcer with 

 antiseptic lotion, applies a 10 per cent, lotion of ferropyrin to stop the t^eeding. 



