internal administration as a bowel antiseptic, and as such has been much used in disturbances supposed to be caused by intestinal fermentation and putrefaction. For this reason it has been recommended and used in acne. It is doubtful if for this condition it is of any more benefit than other sulphur preparations, combined with a proper arrangement of the diet. Ichthyol has also been recommended for internal use in tuberculosis. Any advantage that it might have in this disease is probably due to the action of the sulphur on the bowels and, after its absorption, on the skin and possibly by such exhalations of sulphur as may occur through the lungs, i.e., the action is probably nothing but that of sulphur. When ichthyol is administered internally generally the sodium salt is preferred, and the dose is from 0.25 to 0.50 Gm (4 to 71⁄2 grains), in capsule, three times a day, after meals. When used for tuberculosis ichthyol has been diluted with water, and the dose has gradually been increased up to the point of causing indigestion. Externally ichthyol is used as an ointment, or in combination with an oil or glycerin, and the strength of the preparations vary from 10 to 50 per cent. When ichthyol is applied undiluted to the skin it is an irritant. When it is combined with an oil, or a fat, it can be rubbed into the skin, and some of the sulphur may be absorbed. It may have a mild antiseptic action. Though ichthyol is not as much used as it was some few years ago, it is still considered a valuable application in erysipelas, for sprains and swollen joints, for frost bites, chilblains, and for burns. It is well used in 25 per cent. ointment, or solution in either water or oil. In subacute swellings of the lymphatic glands applications of ichthyol ointment, 10 to 20 per cent., or in the same strength in glycerin or oil, have seemed to hasten the reduction of the swelling. This preparation has also been used in many skin diseases, especially in acute and chronic eczema. It has been used as suppositories for hemorrhoids and fissures of the anus, and has been much used as suppositories, or applications on tampons, in the vagina for chronic conditions of the pelvis and neck of the womb. Ichthalbin, N.N.R.1-Ichthyol albuminate is a compound of ichthyosulphonic acid and albumin. This solid preparation is used in place of ichthyol for internal purposes, and is less likely to disturb the stomach than the latter. The dose is 0.30 Gm. (5 grains). Inunctions. By inunction is understood rubbing into and through the skin some drug that is dissolved or contained in an oil or fat. Systemic effects may be produced by such a method of administration with a few drugs only, notably mercury and belladonna. The parts of the body best adapted for this method of administration are where the skin is soft and flexible, as the inner surfaces of the thighs and the inner surfaces of the This method is rarely utilized except for the administration of mercury in syphilis. arms. Antiseptic Ointments. For local stimulation of a chronically diseased portion of the skin, the following Pharmacopoeial preparations may be used: Balsamum Peruvianum Oleum Cadinum Pyrogallol Unguentum Chrysarobini Unguentum Picis Liquidæ One of the most important non-official preparations for stimulation of a chronic ulceration is Scarlet Red, (N.N.R.,) as it is termed. This preparation is a compound of betanaphthol and toluol, and occurs as a red ointment, which promotes the healing of ulcers, wounds, and burns. COUNTERIRRITATION Counterirritation means to so irritate a part of the surface of the body as to cause reflexly a modification of a condition in another part of the body, generally at some distance from the part irritated. The term is often used to indicate local irritation for local results. 1 New and Nonofficial Remedies, a book of drugs issued by the American Medical Association. Various ointments may be used for local stimulation or for their reflex or irritant action. Some are used only to increase the value of massage. The least irritant of the liniments is Linimentum Camphora (camphorated oil). Linimentum Saponis Mollis (soft soap) is used for cleansing purposes and for shampooing; it is strongly alkaline. The official stimulating liniments are: Linimentum Ammoniæ Linimentum Camphora Linimentum Chloroformi Linimentum Saponis Linimentum Terebinthinæ (a cerate) Menthol (in solutions) Methylis Salicylas (synthetic oil of wintergreen) Oleum Terebinthinæ Rectificatum (used as an addition to liniments). If the irritation from liniments goes a step farther, blistering may be caused, and if still farther, destruction of tissue occurs. Blistering for a reflex effect on some other part of the body is often practised. Destruction of tissue (causing a slough) to cause reflex action on some distant part is now rarely or never caused. For local effect, or at least for effect on the tissues closely associated with the part treated, the stimulating (rubefacient) liniments are frequently used. At the present time the benefits caused by counterirritation are probably not sufficiently utilized. Two effects are combined when a liniment is properly used: first, the massage, and second, the local irritation and hyperemia of the skin that is caused. The massage improves the circulation and nutrition of the part, and often is the factor of greatest advantage in the use of liniments; but the hyperemia of the skin may change for the better the circulation of the parts immediately beneath the skin or the parts closely associated with the part treated. Chloroform and menthol preparations may cause the part treated to feel cool, unless the skin is quickly covered and evaporation prevented after they are used. Blistering with liniments is inadvisable, as the blisters do not readily heal, and the process is more painful than when the Spanish fly blister is used. The value of dry heat applied to a part, whether by hot water, sand, salt, or bran bags, or by various hand stoves or electric pads, is very great, and many a surface nerve pain, or more deeply seated inflammation, is helped by such treatment. Moist applications of heat by hot water or hot water and alcohol are also valuable in certain conditions. The old-fashioned poultice is now rarely used, but may have its place. A substitute is hot water and alcohol:-a towel wet with one part of alcohol and three or four parts of hot water, then a hot water bag placed over it, and the combination applied closely to the body. Mustard is a very efficient counterirritant. It may be applied as a mustard paper, which is moistened and applied directly to the skin or with a thin piece of gauze between it and the skin. Or a mustard plaster may be made with equal parts of mustard and flour (or perhaps better with flaxseed meal instead of flour) which is efficient. This mixture of mustard and flour, or flaxseed meal, should be stirred to a paste with warm (not hot) water, then the paste is spread on a piece of cloth and applied to the skin; or it may be placed in a cheesecloth bag. This paste should be left on the skin from fifteen to thirty minutes, but not long enough to blister. For a thin-skinned individual and for a child the proportional strength of the mustard to the flour should be greatly diminished. Some stiff background for this improvised poultice, as a piece of stiff paper, facilitates the handling of the plaster. It should be emphasized that blistering from mustard is inadvisable and should be avoided if possible, as the blister is painful and hard to heal as compared with blisters causes by cantharides. A plaster that will not blister, but at the same time will have some of the stimulating effects of mustard, hence best for a child, is made of spice, and may be compounded with equal parts of ground cloves, cinnamon, allspice, and a small portion of black pepper. This mixture having been stirred up with warm water is spread on a cloth, then the side to be applied to the body should be wet with hot water. If the child is young and the skin is very tender, the pepper should be omitted from the plaster. A turpentine stupe is prepared by wringing out a piece of flannel from hot water, folding it several times, and sprinkling over it about half a teaspoonful of turpentine. This stupe should be applied closely to the part to be treated, generally the abdomen. All hot water fomentations and fomentations with alcohol and with turpentine should be applied as hot as can be borne, and be changed frequently, until the skin is well reddened. Then they should be removed and a dry, hot flannel should be applied. Blistering should not be allowed. If a blister inadvertently occurs from any of these treatments it should be treated like an ordinary burn. A milder treatment to cause reddening of the skin is furnished by capsicum ointments, which should be rubbed on the surface until slight irritation is caused. Various menthol preparations are also used. A menthol stick rubbed over the forehead, if there is headache, or over the region of some painful nerve is often beneficial. Iodine as an irritant to the skin is used too frequently. This is the iodine age. While all wounds with any possibility of infection may be treated with iodine, it should be remembered that it does not promote healing, and that frequent applications of it to a part that is trying to heal is a mistake. The skin over swollen glands, or the skin around a joint, may be painted, daily, with the tincture of iodine, if it is deemed advisable. Its use should be stopped before the skin becomes thick and leathery, and it should never be used to the point of causing a blister. Various iodine ointments may be used, and iodine may be rubbed through the skin and be absorbed. If a blister is desired, it is best produced by a plaster of cantharides, which can be obtained at any drug store in the size desired. The skin to which the plaster is to be applied should be cleansed, and, if the part is hairy, it should be shaved. The active plasters that can now be obtained should not be kept on more than three or four hours; they should then be removed and a portion of the cerate from which the plaster is made will remain on the skin and cause blistering after some length of time, anywhere from five to six hours. If the object of the |