Ointment

medical student slang for butter.
ointment. A soft, fatty, medicated mixture.

Ointments. In the list of ointments, the much vaunted virtues of advertised compounds are usually found.

Ointments and oils are used in the treatment of wounds and ulcers, either to stimulate granulations or to soften thick epidermis.

Ointments should never be used where there is a profuse discharge, as eczema is a complication which very often follows such treatment.

A great many different kinds of ointments are used and among these are:

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.

The ointment in a 10 per cent. strength is not recommended because it is too irritating.

In cases of chronic leg ulcers, especially those associated with enlarged veins, it is impossible to effect a cure until the chronic congestion of the limb is relieved and the blood supply of the part approaches the normal.

Often all that is necessary is a gauze, muslin or flannel bandage, properly applied over the dressing and extending from the ankle to the knee.

A rubber bandage when applied with moderate, even pressure, has for its purpose the relief of congestion, but in a great many cases the rubber has an irritating effect on the skin.

When the granulations are almost on a level with the surrounding skin, and also when there is considerable thickening of the edges of the ulcer, the best means of keeping up an even pressure and causing absorption of the thickened margins, as well as of hastening the epithelial growth, is to apply zinc oxide adhesive plaster in strips, one-half to one inch in width. These strips should overlap to the extent of about one-third of their width; should extend about three-fourths of the way around the limb, and should be evenly and smoothly applied. They should be started about one inch below the ulcer and should run from two to three inches above it.