Glycogelatins are used for protection and the exclusion of air. A simple formula is made by mixing on a hot water bath 1 part of zinc oxid, 2 of gelatin, 3 of glycerin and 4 of water. A greater proportion of gelatin makes it former and causes it to dry more quickly; while a larger percentage of glycerin makes a softer preparation, more acceptable to some skins but interferes with complete drying. Various antiseptic preparations may be added to the glycogelatins as needed.
Varnishes may be serviceable in protecting the skin. They usually contain glycerin and a single gum and are especially useful applications for the face because of their transparent and inconspicuous nature. All varnishes call for careful preparation and may serve as a base for desirable remedies. Pick’s formula is often used and is made of 5 parts of tragacanth, 2 parts of glycerin and 93 parts of distilled water. Elliott’s bassorin paste keeps better than the preparation just mentioned and is composed as follows:
Rx
Bassorin, zjss; 45
Dextrin., zvj; 24
Glycerin., zijss; 10
Aqua, q.s.ad. ziij; 90
Poultices are usually objectionable, applied to the skin, because they macerate the epidermis and encourage the growth of microorganisms. They may however be applied for the purpose of softening and removing crusts, may be used hot or cold, and may be composed of potatoes, starch, bread and milk, oatmeal, cornmeal or tobacco. They may be made antiseptic, if desired, by the addition of boric acid, mercuric chlorid or formalin.
Salve-pencils are composed of fatty substances insoluble in water while paste- pencils are destitute of fat and soluble when moist. These preparations are seldom used but may be employed when it is necessary to apply arsenious acid, cocaine, salicylic acid or one of the mercurials to small areas. They are pencil-sized crayons composed chiefly of wax, gum and starch.
Antipruritics will be referred to in detail elsewhere, especially under pruritus, urticaria and eczema. Alkaline lotions of borax or sodium bicarbonate (2 to 20 grains to the 1/2 pint) are the simplest preparations used, but phenol (carbolic acid), resorcin, boric acid, liquor carbonis detergens and other tarry preparations, hydrocyanic acid, camphor, menthol, chloral-camphor, phenol- camphor and numerous other substances in lotions or ointments are often useful. It is unnecessary to mention the various strengths employed because their specific use, especially that of phenol, will be fully outlined later.
Parasiticides are employed to destroy the grosser animal and vegetable parasites. Thus sulphur and its compounds and the tar derivatives are used for the destruction of vegetable parasites; the mercurials, petroleum, and staphisagria for the extermination of lice; and sulphur, balsam of Peru and styrax for the elimination of acari. Numerous other remedies such as iodine, betanaphthol, ichthyol, aristol and phenol are likewise destroyers of parasites as well as admirable antiseptics.
Caustics are employed for their destructive effects. Many of the substances so used may be employed in weaker strengths for the production of inflammation and counter irritation. Among these agents may be mentioned the thermocautery (Paquelin knife), galvanocautery, mineral acids and alkalies, argentic nitrate, cupric sulphate, zinc chlorid, sodium ethylate and several mercurials. Arsenic and pyrogallol have in a sense an elective affinity for certain diseased areas, as shown in the treatment of epithelioma. Lactic acid and salicylic acid have a caustic action if applied freely and continuously, but ordinarily they are more useful as keratolytics. The caustic action of solidified carbon dioxide will be mentioned in the next paragraph.
Liquid air and solidified carbon dioxide. Refrigeration by the means of liquid air was first introduced by Campbell White in 1899. In 1905 Juliusberg in Breaslau suggested carbonic acid as a substitute for liquid air. While his results were good he found it difficult to apply and control the spray. In the same year Pusey, upon seeing Dade’s application of liquid air in the treatment of certain skin affections, suggested the use of solidified carbon dioxide as a substitute. Pusey called this agent carbon dioxide snow because of its resemblance to snow in its solidified state. Liquid air and carbon dioxide snow produce very similar results. The former has a temperature of 418 degree F., is a bluish-white, clear liquid which rapidly evaporates when poured out. It is difficult to manipulate, measure and control, presents no advantages over the solid article and at the present time is not used in dermatological practice. Solid carbonic acid while not as cold as liquid air, being 110 degree F., is cold enough for all practical purposes. This substance is obtained by the combustion of coke and is a by-product in various industries. Carbonic acid gas is changed into liquid form by pumping it into steel cylinders under an average pressure of 950 pounds to the square inch. When this substance is allowed to escape in liquid form, it solidifies as a white snowlike mass and soon evaporates into gas unless compressed into a firm mass. If properly compressed it will keep intact for an hour or two wrapped in a poorly conducting substance such as lint or cotton wool and if preserved in a vacuum bottle, will last for a much longer period. I have employed this agent in the treatment of more than 1,500 lesions and while comparisons with other caustic methods avail little, it can be safely said that it is a most valuable agent for many dermal conditions. Frequent reference in the text will be made regarding its specific use. Among the diseases that are most favorably influenced by the use of solidified carbon dioxide are epitheliomata, angiomata, lymphangiomata, tuberculosis cutis, the various nevi, verrucae, the keratoses, xeroderma pigmentosum, lepra, lupus erythematosus, X-ray dermatitis, clavus, callositas, chloasma, lentigo, tattoo marks, powder stains, keloids, scars, hydrocystoma, adenoma sebaceum, xanthoma, colloid milium, acne, psoriasis, rosacea, sycosis, furunculus, carbunculus and many of the rarer new-growths. Its use as a local anaesthetic, preliminary to minor surgical procedure, is well known.
Liquid carbon dioxide is obtained in cylinders of two or forty pounds from any soda-water fountain supply company. When ready to draw off the carbon dioxide, the cylinder should either be placed vertically with the valve end pointing downwards, or at an angle with the valve end at a lower level than the other, in order that the gas may come out in a liquid state. A great many methods for collecting, molding or compressing and applying this agent have been suggested. Thus there are differences in the valve, its opening and the necessary key to manipulate it with. Various receptacles for collecting the snow have been suggested such as a piece of chamois which fits like a bag with the opening at the valve. The chamois should be held tightly while the key of the valve is manipulated so that the gas may escape in rushes and not continuously. The carbon dioxide solidifies on the inner side of the chamois and when a bulging of the latter can be appreciated, it should be squeezed so as to mold the snow together before opening the bag. It is often possible to collect the snow in a wooden or metal cylinder fitted to the valve. Among the outfits sold for the purpose of collecting and molding solidified carbon dioxide may be mentioned the Vienna apparatus used extensively in Europe, the Prana and Hall-Edwards outfits used in England and the Gooseman apparatus used in America. The detailed management of these simple instruments can be easily appreciated by their use. The necessary amount of snow having been collected, it must be handled by the operator with a small piece of chamois so as to protect himself. It is then applied directly to the diseased area with slight, moderate or firm pressure for ten to sixty seconds or even longer, depending upon the disease treated and the object to be obtained. When the snow is withdrawn, the area is frozen white and hard, decidedly depressed with a slight surrounding erythematosus zone. In a few minutes the frozen lesion thaws out, appears red and swollen and later a varying amount of vesiculation or bleb-formation is noticeable. This last development may rupture or be punctured and in the course of from five to ten days, thin crusting is usually noticeable. In from one to two weeks the lesion is clean, leaving a whitish mark or possibly a superficial scar, which usually is not difiguring. Pain is an inconstant feature, rarely objectionable, but of course it varies with the location and nature of the lesion and the peculiarities of the patient. No after treatment is necessary unless the clothing rubs the part frozen. Simple protective and mildly antiseptic preparations like boric acid may be applied in powder or ointment if there be a superficial abrasion or ulcer. Ulceration never ensues except from long and deep pressure; even then the sloughings is of a dry character. Observation will show whether the action of one treatment is sufficient. If not, it may be repeated as soon as the area treated has entirely reacted from the previous freezing. It is my practice to allow at least three weeks to intervene between freezings.
American homeopath, he directed several hospitals in New York.
Professor of dermatology.
Served as Lieut. Colonel during the 1st World War.
See his book online: American homeopathy in the world war