Am.  Jour.  Pharm.  \ 
November,  1917.  ' 
Pharmacologic  Superstitions. 
537 
the  local  application  of  lead  water  and  laudanum,  but  whether  as  a 
result  of  this  application  I  cannot  say. 
Of  course  a  counterirritant  would  likely  be  beneficial  in  various 
forms  of  arthritis  in  which  Goulard's  extract  is  commonly  employed, 
and  theoretically  the  counterirritant  effect  of  opium  might  be  bene- 
ficial. To  this  sophistical  defense,  however,  it  may  be  replied  in  the 
first  place  that  we  have  a  host  of  other  counterirritants  more  re- 
liable and  safer  than  opium,  and  secondly,  most  of  those  who  use  it 
seem  to  do  so  with  the  idea  that  the  opium  will  add  anodyne  or  anti- 
phlogistic effect  to  the  astringency  of  the  subacetate  of  lead.  Of 
the  local  anesthetic  action  of  opium  I  shall  speak  in  a  minute,  but 
first  let  me  digress  briefly  to  say  a  few  words  on  the  astringent  action 
of  the  leaden  half  of  this  medieval  embrocation. 
While  it  is  true  that  lead  acetate  is  an  astringent,  when  applied 
over  the  skin  its  astringent  action  must  be  expended  altogether  on 
the  superficial  layers  of  the  epiderm.  Moreover,  as  is  well  known, 
when  the  lead  is  combined  with  the  opium,  it  is  precipitated  as  an 
insoluble  meconate.  Although  some  of  the  older  writers  attributed 
mysterious  virtues  to  lead  meconate,  there  is  no  reason  to  believe 
that  it  possesses  any  properties  not  common  to  the  insoluble  salts  of 
the  heavy  metal,  such  as  bismuth  subnitrate.  The  improvement 
which  follows  local  applications  of  lead  water  and  laudanum  is  due 
in  part  to  the  lint  and  bandages  which  hold  it  in  place,  perhaps 
slightly  to  the  alcohol,  but  chiefly  to  the  action  of  time  which  passes 
by  while  the  application  is  left  in  place. 
When  for  any  reason  the  ingestion  of  food  must  be  interdicted 
for  a  considerable  period  of  time,  and  an  effort  is  made  partially  to 
maintain  nutrition  by  the  use  of  rectal  feeding,  the  physician  is  con- 
fronted with  the  difficulty  that  the  rectum  soon  becomes  irritated, 
and  ejects  the  enema  before  the  nutrient  it  contains  can  be  absorbed. 
To  prevent  this  nearly  every  textbook  on  medicine  recommends  the 
addition  of  tincture  of  opium  to  the  enema.  This  recommendation 
is  based  on  the  belief  that  opium,  by  virtue  of  its  local  anesthetic 
effect,  will  so  benumb  the  mucous  membrane  of  the  bowel  that  it  will 
not  feel  the  presence  of  the  nutrient  injection.  On  what  this  belief 
in  the  local  anodyne  effect  of  opium  is  based  I  do  not  know,  nor  do 
I  believe  that  its  adherents  themselves  have  any  definite  idea  of  the 
origin  of  the  fable.  It  is  true  that  Wiki20  found  that  the  injection 
of  the  alkaloids  of  opium  beneath  the  skin  lessens  the  activity  of 
20  Wiki :  Arch,  interat.  d.  pharmacod.,  1911,  xxi,  415. 
