To those who are doubtful of the absorption of medicinal agents when applied to the cutaneous surface, I would recommend a little work by Dr. W.H.M. Madeen, entitled An Experimental Inquiry into the Physiology of Cutaneous Absorption. I may here give a brief resume of his observations in reference to the cutaneous absorption of medicines in the solid, the fluid, and the gaseous states. 1. Solids Dr. Kellie mentions a case of salivation produced by wearing a mercurial plaster; Segin found that the power of tartar emetic applied to the skin was absorbed, causing nausea and vomiting, but without producing its usual local effects. Arsenic has caused violent inflammation, when used to destroy vermin on the skin. Haller states that pills placed on the epigastrium have caused purgation, and that the same effect has resulted from the mere handling of colocynth. A rhubarb poultice will often, purge children, and a cantharides blister- plaster has been known to produce violent effects on the urinary organs. Frictions with squill and digitalis will often cause diuresis. Opium, belladonna, tobacco, veratria, strychnia, asafoetida, are all capable of producing their specific effects when applied in a dry from to the skin. 2. Fluids. Salivation has occurred from the absorption of a solution of corrosive sublimate. After immersing his arm in a solution of hydriodate of potash, Dr. Madeen detected iodine in his urine. On rubbing a solution of tartar emetic on his hands he experienced nausea, languor, and emetic on his hands he experienced nausea, languor, and debility, that lasted some hours. Solutions of salts of lead have been known to act through the skin. Dr. Madden produced on his won person purgative effects by applying solutions of rhubarb, jalap, and gamboge to the skin. Turpentine poured on the arm, which was enclosed in a glass jar, soon caused the peculiar violet colour in the urine. Solutions of opium, belladonna, tobacco, and oil of biter almonds produced their specific effects on the system when applied to the skin. 3. Gases. The action of mercury on the system when it is applied to the skin in a gaseous form is well known. Dr. Madden killed a rabbit by exposing its body to the action of sulphuretted hydrogen; and he mentions an experiments of Collard de Martigny to show that carbonic acid also produces it toxical effects when the surface to the body is exposed to bit.
Dr. Hering seems to be almost the only one among the homoeopathists who has recommended the endermic method, and his application of it is rather peculiar, as he selects for it the sole of the foot, precisely the spot of all others in the body where the epidermis is thickets, and, one would suppose, least likely to favour absorption. In his Domestic Physician he recommends, for the cure of gonorrhoea, the application of copaiba, parsley, or cubebs to this most unlikely part of the body. I cannot speak from experience of the effects of this treatment, but should be very happy to find it successful, for gonorrhoea is a disease that often gives us much trouble.
In most cases, I take it, is desirable that the medicine should be applied to a healthy organ in order to act beneficially on the system. Now, in many cases the skin is the only healthy organ to which we can apply the medicine. The whole mucous membrane of the primae viae my be diseased, disorganized, and utterly incapable of performing its proper functions of absorption and assimilation; the stomach may be filled constantly with the most acrid secretions, or the mouth may be beset with ulcers, and the power of deglutition for the time lost. In such cases it would seem a thankless and a useless labour to give the medicine in the ordinary way, and the healthy skin offers the best medium through which we can introduce our remedies into the system. In such cases I have more than once seen good effects from employing the medicine by the skin. The mode I have employing the medicine by the skin. The mode I have usually adopted is this, and I would recommend it to your adoption in cases of the description I have cited. With a sponge dipped in warm water wash a portion of the epigastrium six or eight inches square, dry it well with a piece of warm flannel, and continue a gentle friction on the spot for a few minutes, in order to excite the cutaneous capillaries and absorbents; to the surface thus prepares supply the medicinal solution, by means of a piece of clean linen soaked in it, and over all a piece of gutta-percha tissue may be laid. The place where the medicine is thus applied may be varied according to circumstances, but I greatly prefer the surface of the abdomen to cases, however, it may be advisable to practise this endermic method as never the seat of the disease as possible; thus in cynanche tonsillaris, where the medicine cannot be swallowed; it may be advantageous to apply it to the neck, in a water-compress, and in case of neuralgic pain. In some cases it may be advantageous to combine the medicine with some oleaginous substance, whereby it will be rendered more suitable for rubbing- in. Pure olive oil, fresh lard, unsalted butter, or unscented spermaceti ointment may be employed for this purpose.
The next subject that falls under consideration is the local employment of medicine, in other words, the application of the remedy to the diseased part.
One of Hahnemann’s earliest reforms upon the usual method of treatment was his denunciation, in his treatise on Venereal Diseases, published in 1789, of the practice of treating the primary sore locally. His argument against this practice was that the chancre was the sole external sign of the internal syphilis, and acted as a silencer of the constitutional disease; that if it were destroyed or healed up by means of external applications, the internal disease would in consequence spread all the more rapidly and destructively, which it could not do as long as the chancre remained as its vicarious external representative, and, besides, the state of the untouched sore was the only guide we had as to the condition of increase or decrease of the disease.
For some time even after his enunciation of the homoeopathic principal this diseases seems to have been the only one where the expressly forbade the employment of local means, for we find him in 1796 (Lesser Writings, p. 317.) giving two examples of the successful local employment of conium; the one was a painful hard swelling of the under lip in a child, the other an induration of the mamma in a girl, both the result of external injury, and in 1797 (Ibid., p,. 364.) he recounts the case of an old gentleman with ulcers on the legs, whom he cured with corrosive sublimate externally; and again in 1801 (Ibid., p. 408,) and 1805 (Ibid., p. 526.) he details a case of paralysis cured by the local application of cold. The illustrations he gives of the homoeopathic law in the last edition of the Organon, (Page 101, note.) in the application of cold to frostbites and warmth to burns, are equally instances of the local employment of the remedial, agent, and many of the instances of homoeopathic practice he adduces in the same work from allopathic practice (See especially Organon, p. 98.) note. are nothing more than examples of the local application of the remedial agent.
In the first edition of the Organon, as well as in the Medicine of Experience, (Lesser Writings, p. 512.) he admits the curability of itch by means of the external employment of sulphur, hepar sulphuris, and sulphureous baths, and in the first-named work he allows the itch to be treated externally with hepar “when it is almost cured by the internal homoeopathic treatment,” and he also speaks favourably of the local application of arsenic in cancer of the face.
Subsequently (Org., fifth edition, Aphorism 205.) he prohibits altogether the employment of any local remedies, and expressly retracts (Ibid., note.) the opinion he had formerly given utterance to respecting the local employment of arsenic in cancer, on the ground that though we might succeed in removing this malignant ulceration, the fundamental disease could not be thoroughly destroyed; on the contrary, it would be more at liberty to attack some more vital organ, and thus hasten death. It is curious to remark, that to the last he allowed two exceptions to this universal prohibition of local remedies. The one is in the case of contusions, (R.A.M.L., 470.) where he permits the local employment, for the first twenty-four hours, of a lotion formed of a pound of wine, or of equal parts of water and brandy, mixed with from five to ten drops of the first dilution of arnica, along with the internal administration of the same drug. The other exception is in the case of tedious old cases of condylomata, where he advises the daily moistening of the largest with the strong tincture of thuja.
In the former of these exceptional cases, the malady, the result of local injury, may be held to be a purely local one, and consequently its local treatment would be no violation of Hahnemann’s rules; but in the latter case, the external disease is stated to be and is truly the outward manifestation of the internal derangement, and consequently its local treatment with thuja-tincture is a direct infringement of Hahnemann’s own rules, and its cure by such means ought to be inevitably followed by disastrous results to the constitution.
Robert Ellis Dudgeon practiced at the London Homeopathic Hospital and specialised in Optics.
Robert Ellis Dudgeon wrote Pathogenetic Cyclopaedia 1839, Cure of Pannus by Innoculation, London and Edinburgh Journal of Medical Science 1844, Hahnemann’s Organon, 1849, Lectures on the Theory & Practice of Homeopathy, 1853, Homeopathic Treatment and Prevention of Asiatic Cholera 1847, Hahnemann’s Therapeutic Hints 1847, On Subaqueous Vision, Philosophical Magazine, 1871, The Influence of Homeopathy on General Medical Practice Since the Death of Hahnemann 1874, Repertory of the Homeopathic Materia Medica, 2 vols 1878-81, The Human Eye Its Optical Construction, 1878, Hahnemann’s Materia Medica Pura, 1880, The Sphygmograph, 1882, Materia Medica: Physiological and Applied 1884, Hahnemann the Founder of Scientific Therapeutics 1882, Hahnemann’s Organon 1893 5th Edition, Prolongation of Life 1900, Hahnemann’s Lesser Writing.