Sulphur in 10 per cent. strength, or ammoniated mercury up to 5 per cent., where a paraciticide is indicated.
Balsam of Peru in 10 per cent. strength for the stimulation of granulations; or balsam of Peru and castor oil, equal parts; also boric acid, or ichthyol for their antiseptic properties.
Ten per cent. mercurial, for syphilitic cases.
Lassar’s paste (which consists of salicylic acid, one dram, starch and zinc oxide, each one ounce, and vaselin to make 4 ounces) is used when there is an eczema present.
One of the oldest as well as one of the best applications is balsam of Peru, which has a powerful effect in increasing the growth of granulations, but often after this has occurred the granulations are apt to become exuberant with little tendency to cicatrization.
The ointment which has given the best results is scarlet red, an aniline dye, which is known chemically as a sodium salt of a disulphonic acid derivative. Scarlet red (Biebrich) was originally prepared as a dye for wool and silk, and is so named because of the fact that it was first manufactured in the town of Biebrich. It was first used for medicinal purposes in 1907 in an 8 per cent. strength; because this strength was found to be too irritating, it was alternated with a bland ointment every 24 hours. It is now used only in strengths varying from one-half to five per cent., for the latter has proved to be as strong as necessary. When applied to granulating surfaces, scarlet red is sometimes absorbed in sufficient amount to color the urine a bright red, and a number of acute cases of nephritis have been reported from its use.
Its application to granulating surfaces causes healing, not by the formation of scar tissue, but in every case by producing a high grade of normal skin (this can be demonstrated by sections), which very soon becomes freely movable on the underlying tissue. The return of sensation in the healed area takes place from the periphery inward, instead of upward from the underlying tissue.
Scarlet red ointment should be applied in the following manner: after thorough cleansing of the part with tincture of green soap and water, then ether and finally 93 per cent. alcohol, the ointment should be spread in a thin layer over the entire surface on a piece of sterile gauze, and over this an ordinary dry sterile dressing. If the ointment is applied too thickly it may cause granulation tissue to break down, and for this reason it should be spread in a thin layer upon the granulating surface or its edges. Usually the dressing should be left undisturbed for from 24 to 48 hours, then reapplied, as indications warrant. The patient should invariably be informed that the dressing will be stained red, so as to forestall unnecessary alarm, due to the belief that a hemorrhage has occurred. He should also be apprised of the fact that stains on the linen are hard to eradicate. In removing the dressing, if it is adherent to the granulations, some peroxide of hydrogen should be used to loosen it. The skin about the granulating surface is best cleansed by benzine as this removes all traces of scarlet red better than any other solution. The three formulas that are recommended are the following:
| Strength | ||
| Grains. | Percent. | |
| Scarlet red (medicinal Biebrich) | 15 | 1 |
| ungt. acidi borici q.s., ad. 3 ounces. | ||
| Scarlet red (medicinal Biebrich) | 45 | 3 |
| ungt.zinci oxidi q.s., ad. 3 ounces. | ||
| Scarlet red (medicinal Biebrich) | 75 | 5 |
| balsam Peru, 75 minims. | ||
| Petrolati q.s., ad. 3 ounces. | ||
The first is indicated where its use is desired over a large area and for a long time; the second, where an astringent action is required because the granulations are profuse; the third, where the granulations are sluggish and require stimulation.