^y ?fe% L ^~7 [ i\v-y y \ - feC Jyw i*;; AT mf 1 [fVfâf^ ; )i*y'/l ■; s ^w y >/ • i\ ^ ._ Z S il >v^ &, •' i. y X?.'.'i 7 ' i J 4\\\AW ! / L W y i HT .• yy s M 5m From the Caîifornia Médical Gazette, June, 1868. CARBOLIZATIÔN/IN SMALL POX. V By ARTHUR B. SÏOUT, M.D., San Francisco. As variola, with its suite of terrors, is now exciting the pub- lic mind, I propose to offer for publication the following sug- gestions for its more efficient treatment. Without losing time to wait for the confirmation of my views by m y oto expé- rience, I feel so firmly convinced of the efficacy of the proposed management of the disease, and that success will crown its application, that I do not hesitate to propose its adoption. Although variola is usually propagated by contagion, its origi- nal development most probably proceeded from a malarious source. Were its origin in an internai constitutional cause, from some degeneration in the solid tissues of the body, or the circulating fluids, the disease would probably be more confined than it is to individnals whose organic System had become contaminated by the décomposition of retained excré- tions, or otherwise. There are reasons to show that small pox may exist as an épidémie. Researchesas minute asthose of Salisbury into the sources of malarious maladies may yet demonstrate the spécifie nature of the variolous intoxication, and the prédiction may be ventured that it will be ultimately determined to be of an origin extraneous to the human body; hence of a malarious character, and originally begotten, like diseases of that type, by absorption through the lungs. Be this as it may, whether a modification of that form of sporule growth whïch gives rise to the vaiïeties of malarious disease, ôr another spécifie variety of vegetable germination générâtes variola, or whether the poison is first developed in the human body, the disease, when established, gives rise to éman- ations from the body which propagate indefinitely the malady ; the poisonous effluvia reproduce themselves, and the frightful contagion respects no class of society. Whether thèse émana- tions °from the skin, from the lungs, from any' or ail of the sécrétions or excrétions, are of vegetable or animal compo- sition, it is nevertheless they which diffuse the disease. It is against them, therefore, in the effort to suppress the disease, and at least divest it of its contagious character, that my views of treatment are directed. I am not of those who believe that the small pox must hâve its definite duration, but, on the contrary, that its course may be shortened. Also, that more may be accomplished in its treatment than simply to mitigate the severity of the attack by relieving the digestive organs, and the use of cooling bey- erages. The poison which intoxicates the circulating média appears to act like a ferment in the sécrétions. When its ac- tion is once established, it constantly reproduces itself, and thus continuously aliments the disease. It protracts and a»«ravates the syinptoms. When its contagious atoms are liberated from the body, the supply is thus constantly re- newed. If, then, we can find an agent which will destroy this poison, be it animal or vegetable in its nature, and which will prômptly arrést its development in its incipiency, surely we may hope to diminish the acuteness of the disease, to shorten its duration, and at any rate to control its propa- gation. This agent I believe to be carbolic acid. The prompt and immédiate action of this remarkable substance to destroy the vitality of ail confervoid growths—ail infusorial beings—is known. It not only immediately extinguishes the existing germs but arrests th'eir future development in the fluids in which it is infused. The minute qnantity which suffices for this purpose renders it cheap and accessible for ail uses. To sanify hospitals, ships, private dwellings, sewers, and the sick room of small pox patients, it is invaluable. It is by m- ference from thèse facts, that I propose to employ it m the active, as well as préventive, treatment of variola. In conjunction with the use of the Sarracenia purpurea, I feel confident in the hope to establish a new treatment for variola, and put an end in due time to the gênerai horror and fear and désertion from the holiest duties of life, which fol- low the announcement of small pox. In brief, then, let the patient be lightly moistened over several times daily with a weak solution of carbolic (phenic) acid. The best mode of application is in the form of solution in tepid water. It may be used with a soft sponge, or better still, with a broad camel's hair brush, such as is used for varnishing, say two inches broad. The brush will pass lightly over the pustules, without disturbing them or spread- ing the suppuration. As a gentle stimulant, it will accelerate the cure of the pustules. Wherever albumen is présent, it coagulâtes it iustantly. After its first use, and the slight in- fusion of its vapor in the air, giving to the atmosphère a faint odor like that of kreosote, and forthwith plunging ail the cast- off clothing into a (solution of the acid, I believe that the pa- tient and the apartment occupied will be disinfected. Rela- tives, nurses and attendants may hâve immunity from conta- gion, public confidence may be restored, the necessity foi- vaccination be less imperative, and, in severe cases, lives be saved, which otherwise, under the moral shock, would be sacrificed. The advantage I hâve derived from the use of carbolic acid in cutaneous diseases, although not fébrile, war- rants the anticipation of a good resuit in hastening the cica- trization of variolous pustules. As the addition of a few drops of carbolic acid, say ten drops to an eight-ounce mixture, in applications to the throat in diptheria, immediately suppresses the fœtor of the breath, and necessarily destroys ail the confervoid germs, as discov- ered by Salisbury in the saliva, and in diptheritic growths in the throat, so may it be useful when applied to the portai of the lungs, to neutralize their exhalations, and prevent the contamination of the atmosphère. The inhalation of carbolic acid vapor, as it cornes atomized from a weak solution in Cologne water, Fîorida water, or Bay rum, commences the internai carbolization of the System. A sufficient quantity may be thus introduced by the circulation to arrest the reproduction in the System of the variolous poison. A light pièce of gauze or mosquito net, satùrated with the préparation and laid over the face, will serve the combined objects of a local application, an inhalation, and a purifier of the atmosphère. Having great confidence in the efficacy of Sarracenia purpu- rea, I should be unwilling to dispense with its use. The addition of the carbolic acid would not neutralize its action; on the contrary, it would assist the opération of the sarracenia by leaving it less to do, and thereby enhance its merit. The dose being from one-half to one drop of the alcoholic solution, is readily added to any agreeable préparation, or may be given with the sarracenia. The introduction of the acid into the stomach, and its absorption thence into the circulation, would, I believe, sufficiently permeate ail the tissues to eradi- cate the poison, and thus materially shorten the duration, and moderate the virulence of the disease. The Sarracenia purpurea was introduced to use in the pro- fession in 1861, by Dr. F. W. Morris, of Halifax, Nova Scotia. (See Braithwaite's Retiospect, part 47, p. 21, N. Y. Ed., 1863.) He obtained it from an old Indian woman, who had success- fully used it. Seveial years ago I obtained it in Caîifornia, and at my instanée, Messrs. Keith & Co. prepared the fiuid extract, which I jised in doses of a teaspoonful every two hours. Steele & Ço. hâve the same préparation still. I ad- dressed Keith & Co., of New York, to prépare the proximate principle sarracenin, but received from that firm a négative answer. It was ilso provided by me to Mr. H. Webster, who was going as Indian Agent to Washington Territory, and among whose tribes of Indians the small-pox was very préva- lent. It was for tjiis object especially that it was désirable to possess the concefitrated sarracenin. As Dr. Morris was con- vinced of the "wînderful characteristics of this plant" in the two first instances in which he used it in 1861, so was I satis- fied of its merit in the few cases in which I could see its effects. Why, then, may we not anticipate the most happy results,'when with sarracenia and carbolization combined, this scourge of humanity can be assailed. Carbolic acid wa;s first prepared by Runge from coal tar, and has for its formula, according to Laurent, C,s H sO+HO. This hydro-carboij. is now obtained pure in crystals, which are readily rendered fluid by gently heating in hot water, and then adding a verjy small quantity of water. It requires but about sixty drops of this fluid to a gallon of water, when the water becomes antiseptic to an astonishing degree, destroys animal and vegetable life; applied to plants, kills their para- sites immediately; and for thèse reasons, when sprinkled in the sick room, disinfects it prômptly. In using it in variola, the entire body should be moistened several times daily. As it is colorless, and when diluted as above, is not corrosive, ail weaiïng apparel ahd bed clothing may be washed in it. For this purpose the solution of carbolic acid in alcohol should be added. Alcohol ôjissolves it in large quantity, and hence as a concentrated tinqture it may be kept and diluted to any degree. Allowing the carbolic acid to hâve been liberallyused in ail the various modes as hère stated, I am confident the apparel of the sick with variola may be worn immediately with safety; their * apartments may be visited with immunity from danger; thedreadof small-pox hospitals may be relieyed; boarding houses and hôtels need not be deserted, and variola may be left to the same régulations as rule in other diseases. ^ ^ x«-- c SI* )))*/ ;f ^ ■* y -, • asS C^; /> t/ l/ yfe /■■■■ H \ . IV v* A ! ■V; * M * yJ J fj ^-^ y*'/ ► *. ^^