Salol in Acitte Tonsillitis and Pharyngitis 
BY 
JONATHAN WRIGHT, M. D., 
O/ Brooklyn, N. Y. 
prom 
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES, 
August, 1890. Extracted from 
The American Journal of the Medical Sciences for August, 1890. 
SALOL IN ACUTE TONSILLITIS AND PHARYNGITIS.1 
By Jonathan Wright, M.D., 
OF BROOKLYN, N. Y. 
The majority of our most efficient drugs are used empirically. We 
all know what mercury does for syphilis and what quinine does for 
malaria. Our great ignorance of chemical and biological changes 
compels us to reason directly from sequence to antecedent. The results 
which follow the administration of some drugs are so constant and so 
direct that we hardly appreciate the gap in our real knowledge of their 
modus operandi. The testimony in regard to them is too overwhelming 
for us to doubt for a moment their being the causes of the results which 
follow their use. 
When we reach a slightly lower grade in the pharmacopceial list— 
iron, arsenic, salicylic acid, the phosphates—it behooves us to draw our 
conclusions in regard to cause and effect with greater caution in any 
given case. 
Everyone recognizes that certain diseases, such as pneumonia, diph- 
theria, and typhoid fever, often result in recovery or death irrespective 
of any plan of treatment whatever. Certain more chronic and more 
usually fatal diseases, such as phthisis, chronic nephritis, and diabetes, 
often have their periods of temporary improvement and depression 
without, as well as with, treatment. The effects of therapeutic measures 
in all such affections are to be judged with great reserve, and they 
necessitate the collection and careful analysis of a large amount of 
clinical experience. 
This is still more eminently so of simple acute tonsillar or pharyngeal 
inflammations, which, almost without exception, end in recovery and 
are self-limiting diseases. The duration of the subjective symptoms, 
which are our principal and the patient’s sole concern, varies so much 
that conclusions drawn from the effects of any plan of treatment in a 
limited number of cases are apt to be extremely fallacious. General 
impressions made upon the observer are still more so, depending as they 
do upon individual power of observation and upon the strength of his 
imagination. Owing to these considerations, it was with a good deal of 
1 Presented and accepted as a candidate’s thesis for membership in the American 
Laryngological Association, May, 1890. 2 
WRIGHT, ACUTE TONSILLITIS AND PHARYNGITIS. 
scepticism that I read the article of Gouguenheim1 in which he spoke so 
enthusiastically of the treatment of acute inflammations of the pharynx 
by the internal administration of salol. He quotes Dr. Capart, of 
Brussels, as speaking of its “ almost miraculous action.” He reported 
twenty-two cases, and his claims were so strong of its power in relieving 
dysphagia in these annoying and very common affections that, recom- 
mended by such an authority, it seemed worthy of a trial. The results 
which I have obtained form the excuse for this paper. 
Max Thorner, of Cincinnati, has given the best and fullest account2 
of salol in this country, and was the first, as far as I know, to give it 
internally for throat affections. It may, nevertheless, not be superfluous 
to give a brief synopsis of its nature, and of its physiological and ther- 
apeutical action, as spoken of by him and others. 
It was discovered by Nencki, a Swiss chemist, in 1883, and first used 
by Sahli3 in 1886. It is a colorless substance, sold in the shops as a 
coarse white crystalline powder. It has a marked aromatic odor, and a 
faint taste, which is rather agreeable than otherwise. Chemically it 
consists of salicylic acid in which one atom of hydrogen has been re- 
placed by the phenol group, and contains synthetically forty per cent, 
of the latter and sixty per cent, of the former. It is a proprietary 
article, made abroad, and usually sells at four dollars a pound. 
It is insoluble in water, but, like the fats, is soluble in alcohol and 
ether, and is decomposed by sodium bicarbonate.4 Hence it should not 
be given in combination with the latter. It forms emulsions easily. 
Though crystalline in structure, it cannot be reduced to a fine powder, 
on account of the tendency of its particles to cohere. It has a low 
melting point (43° C.). 
It is insoluble in the gastric juice, but is readily dissolved in the 
pancreatic and intestinal secretions, where it is separated into its primary 
constituents, both of which are readily absorbed and appear in the 
urine, giving it the olive-green color caused by carbolic acid. In thirty- 
grain doses it is a powerful antipyretic, but in smaller and frequently 
repeated doses (five grains every hour) it is not so efficient in this 
regard.5 Its odor is very distinctly appreciated in the secretions and in 
the expired air. 
The unique characteristic of salol in being able to pass the gastric 
juice unchanged, while in the intestines it is decomposed into phenol 
and salicylic acid, both being antiseptics, has been taken advantage of 
in treating the summer diarrhoeas of children. The rapidity with which 
1 Annales des Mai. de l’oreille, etc., No. 9, 1889. 
2 Cincinnati Lancet Clinic, Dec. 10, 1887. 
3 Correspbl. f. Schw. Aertzle, Nos. 12 and 13, 1886. 
4 Nencki: Therap. Monatsheft, Nov. 1887. 
5 Georgi : Berl. klin. Woch., Feb. 28.T887. WRIGHT, ACUTE TONSILLITIS AND PHARYNGITIS. 
3 
these drugs are absorbed and the promptness with which they appear in 
the urine have made it valuable in treating cystitis, pyelitis, and 
gonorrhoea. 
Attempts have been made, with doubtful degrees of success, to diag- 
nose motor insufficiency of the stomach by noting the time required 
for its appearance in the urine as phenol after administration. This 
varies within such comparatively wide limits normally (thirty to ninety 
minutes) that it has not proved of much service for diagnostic purposes. 
It has been used locally as a dry dressing, and as a mouth and nose 
wash, dissolved in alcohol and mixed with water, but with very moderate 
results. It has been used as an antipyretic successfully. But its prin- 
cipal use has been as a substitute for the compounds of salicylic acid in 
the treatment of rheumatism. 
Its advantage over the former, it is claimed, consists in its agreeing 
better with the stomach and in its not producing the disagreeable head 
symptoms noticed in large doses of salicylic acid. The former asser- 
tion I think, from my own experience, true, but I have noticed 
occasionally tinnitus aurium and headache in doses of two drachms 
daily. This being equivalent in salicylic acid to about seventy grains, 
does not show any very great advantage over that drug. Like salicylic 
acid—perhaps more often—it utterly fails, in rare cases, to have any 
effect on rheumatism whatever. There seems to be evidence to show 
that its analgesic effect is more pronounced in rheumatism than the 
salicylates. Rosenberg1 says that pain disappears as a rule in twenty- 
four to forty-eight hours, and never later than five days. 
Bartholow2 says: “ The effects of salicylic acid are increased in all 
directions by members of the phenol group.” This probably explains 
why ninety grains of salol will do more work in rheumatism than the 
fifty grains of salicylic acid which it contains. Nencki3 has lately 
recommended the salicylate of creosol for internal use rather than salol 
(salicylate of phenol), on account of its being less liable to cause dis- 
agreeable symptoms. Ninety grains of salol daily are sufficient for throat 
inflammations, and this dose rarely, if ever, causes any head symptoms. 
Three drachms daily are mentioned as the maximum dose, but I have 
never given over two. It has proved of service in sciatica and lumbago. 
The observations on its effects in allaying the pain in rheumatism are 
interesting in a consideration of its action on the dysphagia of acute 
throat affections, the time in which it is said to relieve the pain—twenty- 
four to forty-eight hours—corresponding very closely to my experience. 
Its occasional entire failure is also noted in both cases. The carboluria, 
1 Therap. Monatsheft, 1887, p. 51. 
2 Materia Medica and Therapeutics, 1887, p. 335. 
3 Ref. Centrbl. f. Bact., No. 12, 1890, p. 386. 4 
WRIGHT, ACUTE TONSILLITIS AND PHARYNGITIS. 
which is always present, is the only sign of any phenol poisoning that is 
noticed, and need consequently give rise to no apprehensions. 
In its administration I have never given less than sixty grains daily, 
nor more than one hundred and twenty, the most frequent dose having 
been ninety grains for adults. It may be given in powder form or as 
an emulsion. The most efficient method is to give it in ten-grain doses 
every two hours during the day. Wyeth & Brother, of Philadelphia, 
made a lozenge for me containing five grains of salol with some licorice 
and sugar which may be found of value, but I have no faith in its local 
action whatever, both from theoretical reasons and from practical 
experience, its insolubility being sufficient to explain its lack of power 
in this regard. 
I have noticed the most marked effect in lacunar tonsillitis, less in 
catarrhal pharyngitis, and least in a well-developed quinsy. For the 
latter, hot fomentations and free incision are the best remedies, though 
salol may be given as an adjuvant. This, of course, only applies to 
cases after the fourth day, before that time the greatest relief being 
often obtainable by the use of the drug. 
We know that the pain in any form of simple acute tonsillitis or 
pharyngitis is apt to disappear after the third day under any plan of 
treatment. This is eminently true of the catarrhal and lacunar forms. 
When the inflammation, however, extends deeper and involves the 
parenchyma and peritonsillar tissue, the duration is sure to be longer. 
One form may, of course, merge into the other, they being usually only 
different degrees of the same disease. In considering their treatment, 
it is therefore manifestly misleading to class all cases together, whether 
treatment has begun upon the first, second, or third day. Like all 
diseases, the younger the patient, the quicker does he respond to treat- 
ment. 
In preparing the accompanying tables I have divided the cases into 
three classes: those in whom treatment was begun on or before the 
second day, those beginning during the third day, and, lastly, those 
beginning treatment on the fourth or later days. I have based my 
calculations on the patients’ statements in regard to the pain, that being 
the most striking and interesting phenomenon to them. My material is 
principally drawn from the case-books of my clinics at the Roosevelt 
and Demilt dispensaries in New York, from November, 1889, to May, 
1890. I am indebted to my friend, Dr. J. E. Newcomb, for the data of 
several cases coming under his observation elsewhere. WRIGHT, ACUTE TONSILLITIS AND PHARYNGITIS. 
5 
Table I.—Cases in which Treatment was begun on or before the 
Second Day of the Disease. 
Case. 
Sex. 
Age. 
Diagnosis. 
Day of 
disease. 
Relief 
from 
pain 
(hours). 
1 
F. 
40 
Lacunar tonsillitis. 
Second 
24 
2 
M. 
24 
Second 
18 
3 
M. 
18 
First 
12 
4 
M. 
7 
First 
24 
5 
F. 
26 
Second 
24 
6 
F. 
40 
Second 
12 
7 
F. 
9 
Second 
24 
8 
? 
? 
First 
12 
9 
F. 
13 
“ “ 
First 
24 
10 
9 
? 
? 
Second 
None 
No relief; records defective. 
11 
F. 
27 
Lacunar tonsillitis. 
Second 
18 
12 
F. 
17 
(i << 
Second 
6 
13 
M. 
20 
Parenchymatous ton- 
sillitis. 
Second 
None 
Pain grew steadily worse ; 1 drachm 
given. 
14 
F. 
28 
Catarrhal pharyngitis. 
Second 
30 
Also coryza. 
15 
F. 
23 
Lacunar tonsillitis. 
First 
4 
Atrophic rhinitis. 
16 
M. 
22 
Second 
4 
Swelling increased when next seen; 
two dayB later no pain. 
17 
F. 
18 
Catarrhal pharyngitis. 
Second 
24 
18 
F. 
24 
Second 
12 
Partial. 
19 
F. 
21 
Lacunar tonsillitis. 
First 
24 
20 
M. 
25 
Second 
6 
Supervened on uvulotomy: pain in 
uvula not relieved with the dys- 
phagia from the tonsillitis. 
21 
F. 
26 
Parenchymatous ton- 
sillitis. 
Second 
36 
Average 
17+ 
Table II.—Cases in which Treatment was begun on the Third 
Day of the Disease. 
Case. 
Sex. 
Age. 
Diagnosis. 
Day of 
disease. 
Relief 
from 
pain 
(hours 
1 
M. 
19 
Lacunar tonsillitis. 
Third 
28 
2 
M. 
22 
Quinsy. 
No relief from pain. 
3 
M. 
19 
Catarrhal pharyngitis. 
48 
4 
F. 
18 
Lacunar tonsillitis. 
24 
5 
F. 
23 
Quinsy ? 
24 
6 
F. 
30 
Lacunar tonsillitis. 
24 
7 
M. 
12 
(l 
24 
8 
F. 
13 
24 
9 
F. 
9 
“ “ 
it 
24 
10 
F. 
18 
Quinsy. 
(( 
None 
No relief from pain. 
11 
M. 
17 
Lacunar tonsillitis. 
24 
Cure in five days. 
12 
F. 
25 
it 
12 
xxx grain doses produced anorexia. 
13 
F. 
19 
“ “ 
t< 
24 
14 
M. 
24 
(( 
24 
Average 
27 6 
WRIGHT, ACUTE TONSILLITIS AND PHARYNGITIS. 
Table III.—Cases in which Treatment was begun after the 
Third Day of the Disease. 
Case. 
Sex. 
Age. 
Diagnosis. 
Day of 
disease. 
Belief i 
from 
pain 
(hours). 
1 
F. 
11 
Lacunar tonsillitis. 
Sixth 
24 Well in four days. 
2 
M. 
16 
“ “ 
Fifth 
28 
3 
M. 
21 
Quinsy. 
Seventh 
24 
4 
F. 
28 
Catarrhal pharyngitis. 
Fourth 
24 
5 
F. 
24 
Lacunar tonsillitis. 
Fourth 
24 Colored patient. 
6 
F. 
30 
Acute catarrhal pharyn- 
Seventh 
6 Patient’s hoarseness also relieved. 
gitis and laryngitis. 
7 
M. 
19 
Quinsy. 
Fourth 
24 
8 
M. 
13 
Lacunar tonsillitis. 
Tenth 
36 
9 
F. 
19 
<< <t 
Fifth 
3 
10 
F. 
. 38 
Catarrhal pharyngitis. 
Eighth 
12 
11 
M. 
28 
Quinsy? 
Fourth 
48 
12 
F. 
19 
Lacunar tonsillitis. 
Fifth 
3 
13 
F. 
20 
Catarrhal pharyngitis. 
Fifth 
24 Patient had pain in hones (spec. ?) at 
night, which was not relieved. 
14 
M. 
36 
:t u 
Fifth 
36 Phthisis case. 
15 
M. 
40 
Quinsy. 
Fourth 
24 
Average 
24 
Depending so entirely upon the statement of the patient as is neces- 
sary where reference is made to subjective symptoms, a great deal has 
to be allowed for his individual idiosyncrasies. Some patients, and 
they are not rare, among the dispensary class only admit relief from 
sutfering with great reluctance. Others, and everyone will admit they 
are fewer, take a more optimistic view of every remedial agent than the 
facts warrant. However, in as large a number as I have here reported 
such errors, to some extent, will correct themselves in the average. 
In recording the answers of the patients in regard to the pain, care 
has been taken to ascertain that the relief after the time noted was 
marked. In doubtful answers the time recorded was lengthened rather 
than shortened. Therefore it must be understood that all the figures 
are rather approximate than literal. The relief from the pain coincided 
in nearly all cases with the relief of the constitutional symptoms, but, 
strange to say, and the same remark has been made by Gouguenheim, 
the subsidence of the pain was often complete before the swelling or 
congestion had appreciably diminished. Indeed, in a few cases of paren- 
chymatous inflammation, and in one case of peritonsillar suppuration, I 
have seen the swelling increase after almost entire abolition of the pain. 
I ain unable to account for this, but the fact is incontestable. In lacunar 
tonsillitis, however, the disappearance of the little mucous plugs from 
the lacunae was more synchronous with the abolition of the pain. 
Thorner has laid great stress upon a rheumatic history in these cases. 
A complete previous and family history is taken, as a matter of routine, 
of every case in my dispensary classes, and the question of a rheumatic WRIGHT, ACUTE TONSILLITIS AND PHARYNGITIS. 
7 
history is always looked into. I have never been able to convince 
myself that a previous or a family history of rheumatism was any more 
frequent in the mild acute inflammations of the throat than coincidence 
would account for. In the severer forms of quinsy and parenchymatous 
tonsillitis there is an undoubted preponderance. I believe many of the 
cases of lacunar and catarrhal pharyngitis reported here would, without 
treatment, have gone on in their later stages to parenchymatous or peri- 
tonsillar inflammation. 
It will be noted that those cases, 21 in all, where treatment was begun 
in the first 48 hours, obtained relief, on the average, in 17 hours, the 
shortest being 4 hours and the longest 36 hours, while 2 received no 
benefit, the record as to the diagnosis in one of them being incomplete. 
The second class of cases, those in whom treatment was begun on the 
third day, received benefit, if any, in 27 hours on the average. Two 
also, in this division of 14, received no appreciable benefit, both having 
had quinsy. The shortest time was 12 hours, the longest 48 hours, in 
receiving benefit. 
The third division, 15 in all, obtained relief in 24 hours on the 
average. 
It will be seen that those beginning treatment after the third day 
recovered more quickly, on the average, than those in the second 
division. This was because, no doubt, many were already improving 
when treatment was begun. Indeed, the last two divisions are of value 
principally as a means of comparison with the first, to which, of course, 
the greater value is to be attached, leaving everyone, according to his 
own convictions, to judge of the results in the other cases. 
The cases recorded are all those which occurred under my own 
observation, or that of Dr. Newcomb, in whom the results could be 
learned. None were excluded who, I was at all sure, had taken the 
medicine, excepting a few who were too stupid to give intelligible 
answers. Besides the cases recorded, I have probably given it in as 
many more, from whom nothing could be learned, as they did not return 
a second time. It is fair to presume 'that these cases also received the 
average benefit, or they would have reappeared. 
I have previously used extensively salicylate and bicarbonate of sodium 
both internally and locally. I have used the combination of chlorate of 
potash with tr. ferri chlor. in many cases. In a few cases I have used 
the benzoate of sodium. Occasionally I have only given astringent and 
chloral hydrate gargles. In all methods of treatment, of course, the 
bowels were kept open with salines or calomel. My experience with 
guaiac is not sufficient to allow me to judge personally of its merits. As 
far as my observation goes, I should rank it after salicylate of sodium. 
Many claim it to be a specific, but its intensely disagreeable taste and 
its irritating effect on the stomach, and, in my hands, its uncertain 8 
WRIGHT, ACUTE TONSILLITIS AND PHARYNGITIS. 
action, make it in many respects an objectionable drug. Of course, my 
results from other methods have not been tabulated with care, but none 
of them have ever been so favorable as those indicated in these tables. 
Occasionally, as before said, salol fails utterly, but in a small proportion 
of cases. 
In conclusion, I cannot do better than translate Gouguenheim’s 
summary, with which I fully agree: 
1. Salol acts beneficially in acute anginas of whatever cause. 
2. It quiets the pain and dysphagia with the greatest rapidity. 
3. In quieting the pain it may shorten the duration of quinsy. 
4. It lowers the temperature. 
5. In nearly all cases it diminishes the duration of the angina. 
6. In order to attain those results, the dose should not be less than 
four grammes (sixty grains) daily. THE AMERICAN JOURNAL 
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