In the aphthae of children, nursing sore mouth, the milder cases of mercurial salivation, and in those painful ulcers of the mucous membrane of the mouth due to disorders of digestion, bismuth applied freely to the affected parts is often very serviceable, by diminishing the pain and promoting the healing process. Bismuth allays the irritability of the mucous membrane in cases of acute indigestion, if given after the contents of the stomach are fully evacuated. It is especially indicated when there is not only painful digestion, but a tendency to diarrhoea, the inclination for stool coming on soon after the food has been taken. It is given with great advantage in subacute and chronic gastritis, and in gastralgia arising from a state of irritation of the gastric mucous membrane. It is contraindicated, and is not beneficial, in the gastralgia produced by habitual constipation and in the gastralgia of chlorosis and hypochondria. The pain and vomiting attendant on gastric ulcer and scirrhus of the stomach are relieved by bismuth, and in the case of the former disease this remedy contributes to the cure. In these painful affections, the good effects of the bismuth are enhanced by combination with morphine. Rx Bismuthi subnitrat., 3 ij ; morphinae sulphat., gr. j. M. Ft. pulv. no. vj. Sig. : One three times a day in milk. When morphine is, from any cause, inadmissible, hydrocyanic acid may be given in a mixture with bismuth. Rx Bismuthi subnitrat., 3 ij; acid, hydrocyan. dil., 3 ss ; mucilag. acaciae, aquae menthae pip., ậậ oz ij. M. Sig. : A tablespoonful three times a day. Although arsenic as an impurity is so objectionable that special pains are taken in the pharmaceutical process to separate it in the preparation of subnitrate, yet the author has witnessed excellent results from a combination of arsenic and bismuth in the more chronic stomach-disorders for which the latter is prescribed.

When bismuth is not well borne by the stomach, it may be combined with aromatic powder, or, when alkalies are indicated, it may be given with chalk or magnesia. When constipation is produced by it, bismuth can be administered with rhubarb or magnesia.

Bismuth is one of the remedies most frequently employed in the treatment of the vomiting of teething children, cholera infantum, and summer diarrhoea. Numerous combinations are employed : with pepsin, when these disorders appear to depend on the condition known as apepsia, the discharges containing masses of undigested casein; with rhubarb, when the symptoms are produced by undigested aliment, or when the stools are white and pasty; with soda and chalk, when the stools are acid and excoriate the buttocks. In cases of vomiting of pregnancy, the vomiting of teething children, acidity, and pyrosis, excellent results are sometimes obtained from bismuth and carbolic acid. Rx Bismuthi subnitrat., 3 ii; acid, carbol., gr. ij—gr. iv; mucil. acaciae, oz j; aquae menthae pip., oz iij. M. Sig.: A tablespoonful for adults and a proportionate quantity for children three or four times a day.

The diarrhoea of typhoid fever is restrained by bismuth in scruple to half-drachm doses. In chronic diarrhoea large doses of bismuth are beneficial and often curative, but thirty to sixty grains must be given every three or four hours. Equally large doses check the diarrhoea of phthisis. The salicylate of bismuth has been much used of late in these maladies, and its action, especially in typhoid, has been much commended.

Bismuth is employed for a variety of purposes in the treatment of external maladies. It is a good application to the reddened surface of the skin in cases of acne rosacea, and may be used as a cosmetic in this mortifying disease. The author has seen excellent results from the free application of bismuth in cases of eczema when there was much serous exudation. Under the crusts thus formed healing proceeded satisfactorily. In intertrigo and in the erythema which occurs about the genitals of infants, dusting the affected surface with bismuth soothes the pain and promotes healing. Bismuth is one of the numerous applications to the eye in cases of chronic conjunctivitis and granular lids. It is also used as an injection, mixed with mucilage, or with cocoa-butter in the form of a suppository, in chronic gonorrhoea and in gleet, and in leucorrhoea. Rx: Bismuthi subnitrat., gr. vj; hydrarg. chlor. cor., gr. ss; tinct. camphorae, τη jss; aquae ad § j. M. Lotion for skin diseases.

The best vehicle for the administration of bismuth is milk. It should be given before meals as a rule when employed in stomach-disorders.

Bismuth (subnitrate and salicylate) has become a very popular antiseptic dressing for wounds, ulcers, and epithelioma. Eltzina succeeded in curing an unpromising case of noma by the application of bismuth and resorcin. Gosselin and Herét have employed it as an antiseptic dressing for wounds in general, and they advocate it for its influence over the process of suppuration, and its power to prevent septic decomposition. On the other hand, Dr. Delbastaille finds various objections to the use of bismuth for surgical dressing, although admitting its antiseptic power. The weight of evidence is in its favor, on the whole.

Dermatol is the proprietary designation of the subgallate of bismuth. It contains somewhat more than 50 per cent of the oxide of bismuth. It is a yellowish, odorless, and permanent powder, insoluble in the ordinary menstrua. For internal administration it may be prescribed in powder, wafer, or capsule, in tablets or pills, or suspended in mucilage. The dose ranges from 5 gr. to Эj. In surgical practice it may be applied in powder or in the form of gauze.

Bismuth Actions and Uses

Topically, it is astringent, deodorant, and antiseptic. Opinions differ somewhat as to its germicide power. Wiemer, for example, highly extols it for its antiseptic qualities ; Stone, of Boston, holds that it is not destructive of pathogenic organisms, basing his opinion on culture experiments. There is, however, a general consensus of opinion as to its power to prevent septic decomposition, to change the character of poisoned wounds, to prevent or arrest suppuration. According to Hecht, of Breslau, it is an efficient haemostatic, quickly arresting haemorrhage from accessible-parts.

As a local application, it is much esteemed by ophthalmic and aural surgeons in suppurating wounds and ulcerations. In surgical practice in general it has been found a valuable antiseptic dressing in the treatment of unhealthy wounds, abscesses, sinuses, and to promote healing without suppuration in the case of ordinary wounds. It is said to be an excellent application in the intertrigo of children, in eczema, and in general in cases with abundant secretion. It affords great relief in excessive and foetid perspiration of the feet. Suspended in mucilage, dermatol is a capital injection in gonorrhoea, and as a dry powder is an excellent application to soft chancre and to herpes of the prepuce.

By Colasanti and Dutto, dermatol is held to be the great antidiar-rhoea medicine. They have found it highly effective in the enterocolitis of children, in the diarrhoea of phthisis and of typhoid fever. It has proved useful in the author's knowledge in chronic diarrhoea. In gastric catarrh, pyrosis, acid fermentation, and in general when there is excessive secretion in stomachal disorders, it has proved highly useful. When pain is present in these maladies, opium can be combined with it.

Authorities referred to:

Colasanti, C, und W. Dutto. Untersuchungen über die therapeut. Wirkung. Vir-chow u. Hirsch Jahresbericht, 1893.

Dornberger, Eugen. Weber die Behandlung mit Dermatol, Therapeutische Monats-hefte, February, 1892.

Hecht, Dr. Ueber Dermatol als Haemostaticum. Ibid., June, 1895.

Weimer, Dr. 0. Zur Characteristik des Dermatol. Ibid., January, 1895.

Stone, Dr. Arthur K. Boston Journal, September, 1892.