On the of a Com- 
pound Salicylated Plaster 
in Dermatological and 
Surgical Practice. 
. by 
HERMANN G. KLOTZ, M. D. 
REPRINTED FROM 
NoU) York jRjUUical .Journal 
for September 17, 1887. Reprinted from the New York Medical Journal 
for September 17, 1887. 
ON THE ADVANTAGES OF 
A COMPOUND SALICYLATED PLASTER 
IN DERMATOLOGICAL AND SURGICAL PRACTICE. 
HERMANN G. KLOTZ, M. D. 
The value of salicylic acid in the treatment of skin 
diseases, particularly of eczema in its different forms, has 
been so generally recognized by dermatologists that it does 
not seem necessary to add any further testimony bearing on 
this question. Among the different means of applying the 
same, the plaster-mulls of Unna and similar preparations 
have been acknowledged to possess many advantages pe- 
culiar to themselves ; the high price, however, has pre- 
vented their general introduction, particularly into dispen- 
sary practice, where they probably would be the most wel- 
come. Comparatively little has been said or written about 
the application of salicylic acid in the form of the salicy- 
lated soap-plaster, which, I believe, was first recommended 
by Professor Joseph Pick, of Prague, in a paper, " Ueber 
den Arzneigelatinverband und die locale Behandlung des Ec- 
zems," published in 1883 in the "Prager med. Wochen- 
schrift," viii, pp. 53-55. After making extensive use of such 
a plaster during the last four years in private practice, as 
well as in my dispensary and hospital service, and having 2 
ON THE ADVANTAGES OF 
met with very satisfactory results, I take leave to call the 
attention of the profession to its advantages. 
Professor Pick (Z. c.) but briefly mentions that he em- 
ployed, instead of the plaster-mulls, a five-per-cent., ten-per- 
cent., or twenty-per-cent, salicylated soap-plaster, which 
could easily be prepared by any apothecary. I have not 
been able to ascertain whether the soap-plaster of the Aus- 
trian Pharmacopoeia differs in its composition from that of 
other pharmacopoeias. Usually it is composed of twelve 
parts of the simple lead or diachylon plaster, two parts of 
wax, and one part of Castile soap. Tf you prescribe this 
plaster, with even five per cent, of salicylic acid, the pa- 
tient will receive a mass of such hardness that he will not 
be able to spread it at all, or, if he really succeeds, it will 
be so dry and brittle that it will not stick, nor accommo- 
date itself to the surface of the part of the body to which 
it is to be applied. The addition of some substance was, 
therefore, required to render the mass softer and more 
pliable; vaseline, on account of its resistance to decom- 
position, seemed the most appropriate. A further change 
was considered advisable regarding the soap contained in 
the plaster. Although a pure soda soap, without any free 
alkali, acts but mildly on the healthy skin, and although 
the quantity contained in the soap-plaster is not very great, 
its macerating and softening influence on parts where the 
skin is more or less devoid of its epidermal covering might 
prove harmful during continuous application. I therefore 
preferred to reduce the quantity of soap by using equal 
parts of soap-plaster and of the simple diachylon plaster, 
to which Hcbra's diachylon ointment owes its efficacy. 
After these theoretical considerations, I sought the practical 
advice of the experienced apothecary of the German Dis- 
pensary, Mr. A. Rutenik, in regard to the proportion of 
vaseline needed to furnish a useful plaster. After several A COMPOUND SALICYLATED PLASTER. 
3 
experiments, Mr. Rutenik found the following formula to 
give the best mass : 
P Emplastri diachyli simplic., 
Emplastri saponati, 
.. aa 40 parts. 
Petrolati 15 " 
Acid, salicylic 5 " 
Several years' experience has proved the value of this 
formula, which, about two years ago, was added to the 
list of remedies regularly prescribed in the German Hos- 
pital and Dispensary of New York. For use in certain 
cases, a ten-per-cent, plaster of the same composition has 
been prepared. This plaster, to which I propose to give 
the name of the compound salicylic plaster-emplastrum 
salicylicum compositum-is of a yellowish-gray color, has 
no particular smell, and, while fully retaining the qualities 
of a plaster, is soft enough to be spread readily on linen or 
muslin by any one not entirely inexperienced in this work. 
In spreading plasters, patients often commit the error of 
trying to prepare a small piece of cloth, just large enough 
to cover the diseased part, instead of taking a large piece 
at once, which allows the application of greater force and of 
wider excursions of the hand, and cutting it up into smaller 
pieces afterward to suit the shape and size of the parts to 
be covered. It therefore often happens that they complain 
at first of the difficulties of spreading; as a rule, however, 
they soon gain in practice, and exhibit well-prepared plas- 
ters. The adhesive qualities of the compound salicylic 
plaster are not very great, and this is indeed its most seri- 
ous drawback. On some portions of the body, particularly 
on those covered by the stockings, or other closely fitting 
garments, it will not require any further means to hold it in 
its place, but'generally some cover, such as a glove or mitten, 
a roller bandage of muslin, a piece of doth, a pair of swim- 
ming tights, or a strip of adhesive plaster, will be required 4 
ON THE ADVANTAGES OF 
to secure it in its position. Hereby its applicability is re- 
stricted to certain regions of the body-a disadvantage 
which it has in common with Unna's plaster-mulls and simi- 
lar preparations, with the exception of collodium, traumati- 
cin, and, perhaps, the gelatins; but in my experience the 
latter do not furnish so absolutely dry a surface as has been 
stated, certainly in hot weather. One great advantage of 
the plaster is its low price-a point of particular impor- 
tance in public institutions. Mr. Rutenik has been kind 
enough to carefully compute the cost of the five-per-cent, 
salicylic plaster, as follows : If prepared from the ready- 
made plasters, one pound costs about 42 cents; if he origi- 
nally mixes the plasters himself, the cost amounts to only 20 
cents a pound. As one ounce will spread over about one 
square foot, it certainly furnishes a cheap remedy. In private 
practice my experience was at first not so satisfactory, as on 
the identical prescriptions different patients received widely 
different substances, sometimes too hard, sometimes too soft, 
at other times extremely irritating. I can not account for 
the difference, unless the preparation of smaller quantities 
is attended by particular difficulties. For several years 
Messrs. Eimer & Amend, of Eighteenth Street and Third 
Avenue, have prepared the plaster in large quantities, and 
have kept it ready for sale in excellent quality. 
The very same reflections that led Professor Pick to 
the adoption of medicated gelatins in general, and particu- 
larly of the salicylated gelatin, induced me to take up the 
salicylated soap-plaster rejected by him. As the paper in 
question was published in a periodical of not very wide 
circulation, and as it seems to me to be of great importance 
on account of the therapeutic principles proclaimed therein, 
I feel justified in citing part of it: 
" The point in question," Professor Pick says, " was to find 
a substitute for the very efficient but very disagreeable and un- A COMPOUND SALICYLATED PLASTER. 
5 
pleasant tar treatment. For this purpose efforts have been 
made to isolate the active principle of tar and to use it separated 
from the other components. As soon as the different products 
of the distillation of tar were obtained, they were applied to 
take the place of tar; but neither resineon, nor resinein, nor 
carbolic acid, nor others were able to produce identical effects 
with tar. Even naphthol, which Kaposi but recently be- 
lieved to possess all the advantages of tar without its disad- 
vantages, can not be considered a successful rival of tar. Upon 
inquiry to which peculiarities tar and its preparations owe their 
excellent effects on the diseased skin, particularly in eczema, it 
became apparent that, first, they were excellent antiseptics; 
and, secondly, that by the drying of their resinous components 
they formed a protecting cover, under which the regeneration 
of the epidermis could go on without molestation. 
" A careful study of the development and progress of ec- 
zema will show that the very indications for its treatment are 
the prevention of septic infection and the protection of the dis- 
eased surface from mechanical and chemical injuries until a 
sufficiently strong epidermis has been formed. Considering 
the single stages in the development of eczema, we find that 
really the progressive character of the eczematous process, de- 
fined by the smaller or greater exudation on the surface, is lim- 
ited to the conditions of eczema papulatum and vesiculosum, as 
well as to eczema madidans, which differs only in the removal 
of the covering of the vesicles; but that suppuration, the so- 
called stage of eczema impetiginosum, makes its appearance 
only when local septic influences complicate the moist stage. 
Wherever such an event does not take place, the vesicular or 
moist eczema passes immediately into the squamous stage." 
This means that suppuration can and ought to be pre- 
vented or stopped, when already developed, by antiseptic 
measures. The compound salicylic plaster represents, in- 
deed, a very simple form of antiseptic dressing, the place of 
which it can take under certain circumstances, as I shall 
show later on. The salicylic acid, being soluble but slowly 
and in limited quantities, and being not evaporable, retains 6 
ON THE ADVANTAGES OF 
the antiseptic qualities of the plaster for a considerable 
period. The mass of the plaster itself forms a non-irritat- 
ing cover for the surface of the diseased skin, not only 
protecting it from injuries, but offering several other ad- 
vantages. Unlike ointments, it prevents effectively the 
formation of crusts or scales on any moist surface by pre- 
venting the evaporation of the secretions, while on a dry or 
scaly skin it acts similarly to a rubber bandage or cover; it 
retains the evaporation of the product of the perspiratio 
insensibilis, and thus forms a kind of permanent bath. It 
is superior, however, to the rubber itself on account of the 
aseptic condition of this bath, while under the former, de- 
composition of the secretions and resorption of septic fluids 
can easily take place. I have twice observed the formation 
of a malignant phlegmon under the use of rubber gloves in 
cases of eczema where I firmly believe that the septic re- 
sorption had been favored, or rather forced, by the rubber 
cover. The salicylic plaster keeps the dry and infiltrated, 
skin softer and more pliable, thus preventing its cracking 
and tearing, so often the most painful and annoying feature 
of some skin diseases; and I know of no other remedy un- 
der which rhagades, once formed, lose their soreness and 
heal in so remarkably short a time, the formation or refor- 
mation of the hard inelastic edges being entirely prevented. 
The compound salicylic plaster owres a further beneficial 
quality to the effect of the salicylic acid itself on the re- 
moval of the thickened epidermal cover, and the replace- 
ment of the same by a new healthy epidermis. While it 
requires a stronger (at least a 10 per-cent.) salicylated plas- 
ter to effect such an elimination of thickened epidermis 
within a short time and in as conspicuous a manner, the 
milder 5-per-cent. plaster produces a slower and less dis- 
tinct transformation. 
All these advantages the compound salicylic plaster has A COMPOUND SALICYLATED PLASTER. 
7 
in common with Unna's plaster-mulls and similar prepara- 
tions. I have mentioned them here to show that the home- 
made article is inferior to the ready-made, more pretentious 
articles only in appearance. Some of my private patients 
who tried both were decidedly in favor of the plaster. As 
to dispensary patients, I have been gratified to observe that 
they apply hardly any other external application so faith- 
fully as the plaster, and quite often ask voluntarily for the 
renewal of the same in preference to other remedies. I do 
not know whether-the greater number of our patients 
being of German birth or extraction-this fondness for plas- 
ters of any kind is peculiar to our race; I believe, however, 
that this preference, wherever it exists, is founded on the 
experience that the plasters do not require frequent re- 
newals, and, being applied mornings and evenings at the 
utmost, allow the patients to attend to their day's work 
without interruption. 
From what has been stated heretofore, it has become 
evident already that the compound salicylic plaster finds 
its widest application in eczema. To avoid any misunder- 
standing, I want to state distinctly that, while quite a 
number of cases of eczema heal under external treatment 
alone, I do not believe -that the plaster renders general 
and internal treatment unnecessary in other instances. 
Except the most acute stages of eczema, which probably 
always require the application of lotions or dusting pow- 
ders, there is hardly a form of that disease in which the 
compound salicylic plaster is not borne well, and in the 
greater number of cases it proves beneficial. There are 
individual cases where for some reason or other the ob- 
jective and subjective symptoms of inflammation increase 
under the plaster; generally, however, the acuteness of the 
process is not an absolute counter-indication. Recent ve- 
sicular and pustular eruptions about the hands and feet 8 
ON THE ADVANTAGES OF 
heal readily under the plaster as well as moist eczema of 
some duration; it is advisable to cleanse the moist surface 
well with water or a solution of boric acid before making 
the application. The discharge of serous fluid is not di- 
minished at first; only with the gradually progressing forma- 
tion of new epidermis will the secretion decrease and finally 
cease. The beneficial effects of the compound salicylic plas- 
ter are not limited, however, to the moist stages ; under its 
protection better than under other treatment the newly 
formed epidermal layer gains in strength and smoothness, 
while the formation of scales and crusts is prevented. The 
infiltration and thickening of the more chronic forms of 
eczema yield very often to the softening influences of the 
plaster, while in some inveterate cases it will require the 
stronger application of tar, either pure or as an ointment or 
in the shape of the alcoholic tincture. As has been men- 
tioned already, rhagades are particularly amenable to the 
healing influences of the plaster ; often one night's applica- 
tion will be sufficient to cure cracks on the fingers, the pain 
and discomfort from which had for wreeks been harassing 
their unfortunate victims. Naturally the usefulness of the 
plaster greatly depends on the localization of the eczematous 
affection. While the face, neck and shoulders, and circum- 
scribed patches on the chest and trunk, allow of its applica- 
tion, while the scrotum and penis can be conveniently pro- 
tected, the extremities furnish by far the most favorable 
field for the propitious influences of the plaster. Applied 
to the hand, and particularly to the fingers, in small straps 
and covered by a glove or mitten, it allows a moderate use 
of the member, sometimes sufficient to enable the patients 
to work; the arms can remain covered all day without 
change; but more evident still is the advantage of its appli- 
cation to the lower extremities, the most frequent seat of 
eczema and its consequences among the laboring classes. A COMPOUND SALICYLATED PLASTER. 
9 
The plaster and a muslin bandage often enable the patients, 
who had before been forced into idleness for weeks or 
months under other applications, to be around and to at- 
tend to their business without much pain or inconvenience ; 
and it is particularly among those affected with eczema, and 
very often ulcers of the leg, that the plaster has been praised 
and asked for when a relapse of the old evil brought them 
back to the dispensary after months or years. 
Chronic ulcers of the leg, so closely allied to eczema, in- 
deed present a no less meritorious object for the services of 
the compound salicylic plaster. If small and shallow, they 
allow direct application of the same after a thorough cleans- 
ing and disinfecting; the deeper and more inveterate ones, 
however, often require previous reduction of the inflamma- 
tory conditions by rest and lotions or stimulation of the in- 
dolent surface by caustics, or astringents, or operative pro- 
cedures. But once reduced to a granulating surface and 
the edges lowered to the same, I know of no better dressing 
for these ulcers. 
Applied after cleansing and disinfecting by a solution 
of boric acid or the combined boric and salicylic acids, 
or by sublimate not over two per mille, and supple- 
mented by one or several layers of absorbent or medicated 
cotton and a muslin or gauze bandage, we have a complete 
antiseptic dressing that may remain unchanged for five or 
seven days or longer, according to the copiousness of secre- 
tion. It is often astonishing to notice the rapid spreading 
of the epidermal edges over the granulating surface, and the 
fast reduction of the latter. Not less conspicuous is this 
effect if such a dressing is applied to skin-graftings, made 
according to Reverdin's method, after they have once taken 
root on the granulations; under its protection they rapidly 
increase in circumference. The final result in all such cases 
will be a much smoother and firmer scar than after dressing 10 
ON THE ADVANTAGES OF 
with ointments, adhesive plaster, or the rubber bandage. 
Naturally the compound salicylic plaster may be applied 
with the same good results to any granulating wound; 
whether the same originally resulted from an operation or 
from a burn, from some severe form of dermatitis, the effects 
of caustics, etc., particularly when under iodoform, subli- 
mate, or other dressings, no more progress toward healing is 
made. Syphilitic ulcers, especially those of the more super- 
ficial type, resulting from pustular syphilides, often do 
much better under the salicylic than under the mercurial 
plaster. 
The same good results will be gained in such cases 
where the loss of substance is limited to the epidermis, or 
to the horny layers of the same, leaving exposed the rete 
Malpighii, the condition of the skin after the formation of 
blebs or pustules and the removal of their cuticle in erythem- 
atous and impetiginous eruptions in their different forms, 
herpes and pemphigus. In a very severe case of pemphi- 
gus, now under my observation, the plaster has proved to 
be a particularly useful and convenient dressing for very 
extensive raw surfaces on the back and the extremities; it 
greatly relieved the suffering of the patient and favored 
speedy reproduction of epidermis. 
I have not much experience in regard to the effects of the 
compound salicylic plaster in psoriasis and lichen, except as 
to the formation of cracks and rhagades in the former, but 
1 have no doubt it would do good service in both diseases 
against infiltration of the cutis. In cases of carbuncles and 
furuncles I have tried it quite frequently ; while I have 
found it useful and convenient as a dressing after the boils 
have been opened and the core or the diseased tissue has been 
removed, I have not observed in the earlier stages the same 
brilliant effects which L. Ileitzmann has quite recently at- 
tributed to a salicylic plaster of a nearly identical composi- A COMPOUND SALICYLATED PLASTER. 
11 
tion with the plaster of the pharmacopoeia of the German 
Dispensary. 
As I expect to report more fully in another paper on 
my experience in cases of lupus, lupus erythematosus, and 
others, which closely resemble the tuberculosis verrucosa 
cutis as described by Riehl and Paltauf, I want to mention 
but briefly that I have applied the 10-per-cent. compound 
salicylic plaster with excellent results for the last three 
years; slowly indeed, but without any pain or inconven- 
ience to the patients, even extensive affections have been 
gradually reduced to smooth and but little defacing scars. 
I hope I have avoided being so enthusiastic in my re- 
port on the advantages of the compound salicylated plaster 
as to impair its credibility with those who, from frequent 
deceptions and disappointments, have become used to ac- 
cept such reports with so much greater caution and sus- 
picion the more glowing they are. My own experience, 
extending over several years, and the confirmation of the 
same by several of my associates in the German Dispensary, 
make me feel confident that those who will give the plaster 
a fair trial, particularly those engaged in dispensary w'ork, 
will not entirely discard it. 
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