Original question.
Enumerate the counter irritants contained in the British Pharmacopœia, and state under what circumstances you would have recourse to the use of each.
The 1864 British Pharmacopoeia supplied mild rubefacients, blistering preparations and agents producing pustulation; these different degrees of injury were grouped under historical counterirritation. Redness of the skin demonstrates a local effect, not removal of inflammation from a distant organ. The following enumeration uses the preparations current for the 1865 examination.
- Mustard, as Sinapis and Cataplasma Sinapis, was a rapidly acting rubefacient, used historically for transient painful or spasmodic conditions and as a supposed revulsive application in internal disease. Its duration had to be limited because prolonged contact caused a burn. The later compound mustard liniment and mustard paper should not be silently inserted into this 1864 list.[ref]The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). Cruciferae, mustard and its official cataplasm
- Ammonia liniment, Linimentum Ammoniae, and the ammoniacal Linimentum Camphorae Compositum gave relatively prompt irritation. They were used for superficial muscular or rheumatic pains when a short rubefacient effect was desired. Simple camphor liniment and soap liniment were milder stimulating embrocations for stiff painful parts; the compound camphor liniment owed much of its greater irritation to Ammonia.[ref]The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). strong solution of ammonia; Lauraceae, camphor preparations
- Turpentine, in Linimentum Terebinthinae or Linimentum Terebinthinae Aceticum, and in the official turpentine ointment, was used as a stimulating application. Historical indications included muscular pain, neuralgic pain and chest or abdominal applications intended to act on deeper disease. The acetic preparation was the more irritating form. This does not establish that either could cure pneumonia or intestinal disease.[ref]The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). Coniferae, turpentine liniments and ointment
- Capsicum and its tincture supplied a pungent local stimulant, used in diluted embrocations for chronic painful conditions. Burgundy pitch, chiefly Emplastrum Picis, supplied milder sustained stimulation, historically chosen for chronic chest, back or rheumatic discomfort. An adhesive plaster could itself cause dermatitis.[ref]The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). Solanaceae, capsicum; Coniferae continued, pitch plaster
- Cantharides supplied Emplastrum Cantharidis, Linimentum Cantharidis, Emplastrum Calefaciens and Unguentum Cantharidis. The warming plaster aimed at a milder prolonged effect; the ordinary plaster and liniment were vesicants, while the ointment could maintain an already blistered surface. Period indications included pleurisy, pericarditis, chronic painful anatomical joints and neuralgia. These were intended remote effects, not demonstrated cures. The 1864 name is Linimentum Cantharidis; its later renaming as Liquor Epispasticus must not erase the edition difference. Cantharides vinegar and official blistering paper belong to the later additions, rather than this list.[ref]The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). Coleoptera, British preparations and distinction from the old London vinegar[ref]British Pharmacopoeia by the General Medical Council (1867). prefatory lists of additions and altered names, pp. xvii–xx
- Iodine, as Linimentum Iodi, Tinctura Iodi and Unguentum Iodi Compositum, was painted or rubbed over chronic swellings, indurations and diseased anatomical joints. The strong liniment could blister; the intended historical effect was alteration of local action or promotion of absorption. Such an indication was not equivalent to proof that a swelling was benign or that it would resolve.[ref]The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). iodine, official preparations and external therapeutic uses
- Croton oil, especially Linimentum Crotonis, and tartar emetic, in Unguentum Antimonii Tartarati, produced more persistent irritation and a pustular eruption. They were employed for prolonged counterirritation in chronic pulmonary or other deep-seated complaints when a temporary rubefacient was considered insufficient. Ulceration, scarring and systemic toxicity were substantial disadvantages, not evidence of effective elimination of disease.[ref]The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). Euphorbiaceae, croton liniment; tartarated antimony and its ointment
Other official substances could destroy tissue, but a caustic used to destroy a particular lesion is conceptually different from a counterirritant applied to influence another site. Likewise belladonna and aconite applications were principally intended to relieve pain, not simply to create a competing skin inflammation. Modern treatment should address the diagnosed condition; a historical claim of revulsion cannot justify blistering over a diseased heart or lung. The period literature itself recognised absorption, urinary irritation and sloughing from cantharides. No present-day use of a particular regulated skin preparation makes these broad historical indications valid.[ref]
The Essentials of Materia Medica and Therapeutics by Alfred Baring Garrod (1865). Coleoptera, precautions and toxic effects
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