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On the therapeutic value of oil and water

The skin, as is well known, is furnished with two kinds of glands for the purpose of keeping it soft and pliable – viz. sebaceous and sudoriparous glands.

While the excretions they pour forth serve other important purposes among the general uses of the economy, there can be little doubt that they have a special action on the skin itself. Further, their diminution or suppression is a circumstance that materially influences the progress of various diseases which attack this important organ. Observation has induced me to believe that there are some of these which more especially affect the oily, whilst others injure the watery secretion. For example, prurigo, lichen, and the scaly diseases are accompanied by dryness of the skin, whilst eczema and impetigo are accompanied by excessive moisture of the surface. Be this as it may, experience has convinced me that there is a class of skin disorders which are readily cured by applying oil or grease constantly to the surface, whilst there is another class which require a similar application of water.

Moreover, I believe, although innumerable ointments and lotions have long been employed in cutaneous diseases, that the active agents in all of them, with few exceptions, are not the drugs which they hold in suspension or solution, but simply the oily or watery matters which constitute the bases of these preparations. The establishment of this doctrine, and the careful discrimination of the diseases or textural alterations which require the one remedy or the other, must not only simplify but give greater precision to our therapeutical efforts for their proper management.

Indications for the employment of oil.— In all cases where there is excessive dryness of the skin, inunction with oil or grease is necessary. For eruptions which are essentially dry in their nature, such as prurigo, lichen, psoriasis, lepra, pityriasis, favus, &c. oil or grease are essential remedies, and have long been used in the form of various ointments. Pure oil, though beneficial when friction is desirable, and used as a liniment, is too thin and too easily removed from the skin to produce a permanently emollient effect on indurated epidermis. Hence grease or fat, that is, inspissated oil, has long been employed as ointment. Even this, however, rapidly melts on the surface of the warm skin, and is soon rubbed off, or absorbed by the clothes or substances on which it is spread. This is corrected by mixing with it various dry powders, such as sulphur, oxide of zinc, calamine, &c. These give to the fat a consistence which renders its action permanent, and prevent its rapidly melting or being too readily lost or absorbed.

I have long satisfied myself that the various powders mixed with fat act mechanically by thickening it, and exert no other therapeutical action. Sulphur ointment, for example, is an excellent application in scabies, because lard thickened with sulphur is more tenacious, more readily blocks up the follicles and grooves inhabited by the itch insect, and thus induces their more perfect asphyxiation. But that sulphur exerts any specific action, either on the insects or the human economy, is disproved by numerous facts. The oxide of zinc, or white precipitate ointments, are excellent applications in prurigo or lichen; but that zinc or mercury are the active agents which cure is disproved by the circumstance that simple lard will in those diseases, as in scabies, produce, though more slowly, the same effect.

Indications for the employment of water.— In all cases where there is excessive moisture on the surface, originating in vesicular, pustular, or ulcerative diseases, the constant application of water is necessary. I say constant because occasional applications by means of lotions or baths are of little service. For this purpose lint well saturated in water is first applied to the affected parts. This must be covered with oil silk or gutta-percha sheeting, that should well overlap the lint below so as to prevent evaporation. The whole must be kept in its place by a bandage, or strings, which is often a matter of great difficulty.

Patients are very slow in accepting the idea that constant moisture of the part is absolutely necessary, and they seldom so apply the upper covering in such a manner as to prevent evaporation from the lint below. The result is, it becomes dry, sticks to the inflamed surface, and is a source of irritation rather than comfort. Hence vigilant superintendence and frequent visits are requisite in order to watch the progress of the case. Even in the hospital, constant care is necessary to see that nurses properly cover the eruption; and when, as sometimes happens, this task is made over to the patients themselves, it almost always fails.

Long experience in the treatment of skin diseases, both in hospital and private practice, has now convinced me that the really active agents in the treatment of those referred to are simply oil and water, if properly applied in appropriate cases. I have also observed that while watery applications have no effect on the dry eruptions, so greasy substances seldom fail to exasperate such as have fluid discharges. A correct diagnosis, therefore, is of the utmost importance. I have frequently had occasion to see in the hands of others much time and trouble lost in applying water to a scaly eruption, and an acute eczema rendered most painful and intense by having pitch or other irritating ointments applied, under the mistaken idea that it was psoriasis. There are certain chronic conditions, however, of originally moist eruptions, where dry induration of the skin is caused, and then unguents are serviceable. To give a description of the forms and stages in which sometimes one or both may be useful is impossible. Nothing but a lengthened experience of the treatment and familiarity with the appearances of cutaneous diseases under varied conditions will suffice for this.

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