This section is from the book "A Treatise On Therapeutics, And Pharmacology Or Materia Medica Vol2", by George B. Wood. Also available from Amazon: Part 1 and Part 2.
Antimonium if the application now cease, the vesicles dry up, and, in the large pustules, the central crust gradually extends till it covers the whole surface, and at length falls off, leaving the skin sound. Sometimes the pustules are only few, at other times numerous. Should the antimonial be continued, the eruption becomes gangrenous, and sloughs are produced, followed by ulcers. in some systems, disposed to ulceration, this condition takes place even from the ordinary pustules. Hence scars are not unfrequently left behind; and a surface, which has been repeatedly subjected to this remedial measure, sometimes looks as though it had been scarred with small-pox. Death is said to have occurred, in a child two years old, from the local effects of tartar emetic; but I have never seen what I should consider even as an approach to danger. if applied to a surface denuded of the cuticle, or to a fresh cut, the medicine acts very promptly, with very severe pains, and much inflammation, which is liable to end in a slough.
Syn. Tartar Emetic.
When tartar emetic, in the state of solution, ointment, or plaster, is kept for some time in contact with the skin, it produces inflammation, with a peculiar and quite characteristic eruption, which gives it, under certain circumstances, great therapeutic value. it operates with much greater facility in some persons than others, with, so far as appears, the same delicacy of cuticle; so that its influence is properly dynamic. in the course of a day or two, some effect is generally sensible. An increased heat is felt in the part, with a prickling sensation, and, on examination, the surface is found reddened, with numerous redder papulous spots. With a continuance of the application, there is an increase of uneasiness; and at length the pain becomes so severe as to render the suspension or removal of the antimonial necessary. in the mean time, the pimples have been converted into vesicles or pustules, some of which are small and hemispherical, others are large, from half an inch to an inch in diameter, flat, with a dark crust in the centre, and a surrounding inflamed areola. The contents of the pustules are false membrane, and a sero-purulent liquid. They are very painful.
Sometimes, though rarely, I have known tartar emetic, applied in this way, to produce so much nausea and vomiting as to forbid its continuance.
Therapeutically, pustulation by tartar emetic is indicated mainly on the principle of revulsion. it is rarely resorted to in cases requiring a prompt impression, or as a stimulant to the system. But in chronic affections of all kinds, and especially those of an unusually obstinate character, in which revulsion towards the surface is required, the remedy may be employed. it sometimes appears to produce curative effects, which cannot be obtained from blisters. This may result either from the depth of the impression on the skin, calling relations into play which may not exist, in the same degree, between the surface of the skin and interior parts; or from some peculiar influence which a pustular eruption may exercise, different from that of simple diffused inflammation, upon the nervous centres.
It is frequently resorted to in chronic bronchitis, pleuritis, and pericarditis, and sometimes as an application to the shaved scalp in chronic meningitis, threatening serious consequences. But the most frequent use of it has been in cases of spinal irritation, with great tenderness on pressure upon one or more of the spinous processes, and disorder in the functions supplied with nervous influence from the spinal marrow, as of the stomach, bowels, lungs, and heart. These affections occur most frequently in hysterical women; but they are by no means confined to this class of patients, and may be occasionally noticed in men. Violent dyspnoea, palpitation of the heart, gastric and enteric pain or spasm, and excessive sickness of stomach, are not unfrequent symptoms. These will generally yield promptly to a few cups or leeches, applied near the tender portion of the spinal marrow; but if these fail, or if the affection frequently recur, recourse can be had to tartar emetic; and it will not only often afford temporary relief, but will sometimes effect permanent cures, especially if its influence be long sustained, and the complaint do not depend on disease or malposition of the uterus.
Dr. S. P. Turner has found great advantage, in the treatment of varicose veins, by the application to minute blistered surfaces over the diseased veins obtained by means of cantharides, of a paste made by mixing tartar emetic and croton oil. (Am. Journ. of Med. Sci., April, 1863, p. 782.)
A saturated solution may be applied, either in the way of lotion, or by means of compresses of linen kept moistened with it. Such a solution may be made by dissolving two scruples of the salt in a fluidounce of boiling water, and allowing the liquid to cool. The ointment is more frequently used.
Antimonial Ointment (Unguentum Antimonii, U. S.; Unguentum Antimonii Tartarati, Br.) is prepared, according to the U. S. Pharmacopoeia, by thoroughly incorporating two drachms of tartar emetic with a troyounce of lard. The direction is important, first to rub the salt with a little of the lard, and afterwards with the whole. A more uniform mixture is thus prepared. The proportion may be lessened to one or increased to three drachms, according to the degree of effect desired, or the susceptibility of the patient. From half a drachm to a drachm of the ointment may be rubbed thoroughly upon the skin, twice or more frequently in the twenty-four hours; or the ointment may be applied spread on linen; or, what is still more effectual, the two methods may be combined. The British preparation is essentially the same as our own.
A Tartar Emetic Plaster may be prepared by sprinkling the salt, very finely powdered, upon the surface of a recently spread Burgundy pitch plaster, so as to cover the surface, yet not prevent its adhesion. it may be pressed gently into the substance of the plaster by a roller. An advantage of this mode of application is that it requires no attention, except merely to watch the effects of the plaster, and to see that it is removed in due time. The slight serous discharge which it excites at the commencement of its action may dissolve the salt, and thus hasten its characteristic effect.
The officinal Plaster (Emplastrum Antimonii, U. S.) is prepared somewhat differently; the powder being incorporated with the melted pitch, instead of being simply sprinkled on the surface of the pitch when spread. Though a much neater preparation, I doubt whether it is equally efficient, as the antimonial acts with its full force when upon the surface; while, in the officinal plaster, much of it is probably inert, being surrounded by the particles of the pitch.
Care should be taken that the part, upon which the plaster or any other preparation is applied, should be free from wounds or abrasion. For example, after cupping or leeching, time, as a general rule, should be allowed for the wounds to heal. in cases of great emergency, however, this caution may be overlooked for the sake of a prompt effect; but the patient should be watched carefully, in order to prevent sloughing.