Charles D. F. (Charles Douglas Fergusson) Phillips.

Materia medica and therapeutics, inorganic substances; (Volume 2) online

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and antacids. The phosphate is a mechanical astringent to some extent,
but the sulphate may alternately confine and relax the bowels, according
to the irritation produced.

Circulatory System. Xo effect upon this system is commonly traced
to lime compounds, but full doses of the chloride are said to produce some-
times the symptoms of a " muscular poison " like potash, with lowering
of temperature, slowing of pulse, and arrest of heart-action (Rabuteau and
others: Comptes Rendus, February 10, 1873).

Nutrition. The most interesting point in the physiological action of
lime salts is their influence on nutrition, the necessity of phosphate for
healthy growth, whether vegetable or animal, being especially evident.
Experiments with plants have shown that the phosphates are in close
relation with the nitrogenous elements. If, for instance, the nitrogenous
husk or coating of a seed be removed, the phosphates are removed with
it, and in the starchy part of the grain none are found. In the leaves
they occur in the parenchyma, not in the nervules, and generally are
most abundant in the cellular parts of vegetables wherein nutrition and
reproduction are most active (Liebig). Wheat, planted in earth contain-
ing phosphates, germinates and thrives, but if all phosphate of lime be
removed, it germinates, indeed, but soon dies. Peas (which contain a
larger proportion of azotized matter), when similarly treated, germinate
and even bear a crop, but if this crop be sown in a soil without phosphates,
it does not flower (Georges Ville: Conferences, Paris, 1865, Rabuteau).
That the improvement in nutrition is not due to the presence or absence
of phosphorus as such, but to phosphate of lime, is shown by experiments
on birds. Wheat contains a large quantity of phosphate of potash, and
when pigeons are fed upon this alone, and are prevented from getting
any carbonate or other salts of lime, they waste away, and their bones
become weak and brittle. If, on the other hand, they can obtain lime in
any form, it becomes changed into a chloride during digestion, and com-
bining with the alkaline phosphates of wheat, provides them with lime
phosphates, and secures or favors their due nutrition (Chossat).

There is also evidence that lime phosphates serve especially to nourish
cartilage, bone, tendon, and muscle, so that they have been fairly called
" restorative or analeptic tonics " to the locomotor organs, as iron is to
the blood, or phosphorus to the nerve-tissue. Thus, as the result of ob-
servations on the reproduction of the shell in crabs, Schmidt found that
a combination of phosphate of lime and albuminous material was most
favorable for the formation of osteoid cells; phosphate was required for
the first growth, though carbonate was formed later. Mr. Bridgman noted
the formation of " artificial cartilage " by the passage of an electrical
current through a viscous solution of carbonate of lime (Hughes Bennett:
Lancet, i., 1863, p. 5). Beneke found that phosphate of lime was



100 MATERIA MEDIC A AND THERAPEUTICS.

specially abundant in plastic exudations and wherever new growth was
going on, and he adopted the microscope as a ready means of its detec-
tion for if a drop of sulphuric acid be added to the liquid, crystals of
lime sulphate are very quickly formed (Lancet, i., 1851, p. 432). The
organism can assimilate phosphate of lime either in the soluble acid form
(for the liquids and soft tissues), or to some extent in the basic insoluble
form (for the skeleton); but its effects are produced slowly, and without
the evident stimulation which we associate with the action of wine, iron,
or quinine, so that we describe such lime compounds rather as restoratives
than as general tonics, and as modifying rather than stimulating nutri-
tion. (As a readily noticed, though slight evidence, of the effect of lime
phosphates on nutrition, Rabuteau notes that white spots on the nails
often disappear under their use.)

Besides their effects on ossification, etc., M. Mouries, a distinguished
chemist, has described a special effect of lime salts upon " irritability," or
vital organic changes, so that if these salts are absent, assimilation and
nutrition do not go on, and emaciation and death ensue, while if they are
simply deficient, various degrees of lymphatic and osseous disease are
produced. He has calculated especially that the food of those who live
in towns is deficient in these principles, and that while every one ought
to have at least 90 gr. daily, many, women especially, receive only about
half that quantity; hence a secretion of poor milk and consequent weakly
children, and he claims that by the use of a certain food containing lime
phosphate with albumen, the proportion of still-born and of rachitic chil-
dren in many families has been markedly reduced (quoted by Trousseau).

Any difference in the amount of urea and carbonic acid excreted under
the influence of phosphate of lime is not exactly ascertained. The chlo-
ride of calcium is said to increase the amount of urine (Giacomini); and
it is probable that like other chlorides it increases the excretion of urea
(Rabuteau).

Lime in Potable Waters. Waters that do not contain lime are flat
and insipid, while a proportion of from 7 to even 20 gr. of carbonate in
the gallon is compatible with their being good, wholesome, and pleasant
(Parkes); such waters may be rendered sufficiently " soft " by boiling.
Hardness dependent upon a soluble bicarbonate of lime is best treated
by Clark's process, of adding slaked lime, which precipitates an insoluble
carbonate.

Lime sulphate is contained in water from selenitic rocks, and a pro-
portion of from 6 to 21 gr. per gallon must be considered unwholesome;
it is liable to irritate the bowels, causing alternately diarrhoea and consti-
pation, as was verified, especially in some prisons and hospitals of Paris,
by Parent Duchatelet; such water is not much softened by boiling.

Nitrate of lime is sometimes found in drinking water, being derived
probably from organic sources; it is likely to cause diarrhoea.



LIME. 101

Water from magnesian limestone, containing magnesia with some
carbonate, and 4 to 12 gr, per gallon of sulphate of lime, has been con-
sidered specially likely to cause goitre / but professional opinion, though
still divided on this question, is now more inclined to the negative view.

Dr. McClelland (in an able report on the medical topography of Ben-
gal) certainly gave remarkable instances from many villages scattered
over a large district where the inhabitants, though living close together,
were affected with goitre or not, according as to whether they drank or
not of certain wells, to which they were restricted according to caste;
and he found that the wells used by goitrous persons contained up to 25
per cent, carbonate of lime (Abstract in British and Foreign Review,
1861. i., p. 42 ; and Watson's " Practice of Physic," vol. i., 3d ed.); the
presence of magnesia is not mentioned. Dr. Inglis, in his treatise on the
subject, Dr. Coindet, of Geneva, and other authorities, have agreed in
blaming lime-waters mainly for the production of goitre, and its greater
prevalence along ranges of lime-rock, as in Nottinghamshire, Derbyshire,
and in parts of South America, are quoted in favor of the same view.
Some connection has been further traced between this cause and cretinism,
as well as goitre; and Kolliker and others maintain, not without the sup-
port of post-mortem evidence, that by the habitual use of such lime com-
pounds ossification is increased at the base of the skull, so that the cranial
foramina become narrowed, and the supply of blood to the brain lessened
(British and Foreign Review, January, 1SG1, p. 46). On the other hand,
Dr. Mitchell has published a careful report upon the " Nithsdale neck,"
prevalent in that part of the south of Scotland, and has shown that some
other element than water must be concerned. It is true that many of the
wells used contained from 4 to 14 gr. of carbonate in the gallon (with
magnesia), but that limit is compatible with health, and several wells in
the same district contained the same quantity, and even to 24 gr., with-
out the production of any goitre (British and Foreign Review, April,
1862).

SYNERGISTS. Alkaline and earthy bases have a similar absorbent ac-
tion to that of the carbonate of lime, and reconstituents generally, such
as iron and cod-liver oil, are adjuvants to the lime phosphates; aromatics
also are often well combined.

ANTAGONISTS AND INCOMPATIBLES. Mineral acids, laxatives, and irri-
tants either decompose or neutralize the action of lime compounds, with
the exception of phosphoric acid, which is sometimes used with the acid
phosphate, to render it more soluble.

Saccharated lime is said to be a specially good antidote to carbolic
acid, and the following is Ferraud's formula: IJ. Sugar 15 parts, water
40 parts; dissolve, and mix thoroughly with quick-lime 5 parts (Lancet,
i., 1876).

Hypochlorite of lime is an antidote for sulphuretted hydrogen.



102 MATERIA MEDICA AND THERAPEUTICS.

THERAPEUTICAL ACTION (EXTERNAL). Epithelioma. A mixture of
quick-lime (2 parts) and caustic potash (1 part) is sometimes a useful es-
charotic for superficial forms of epithelial cancer; it should be mixed,
just before using, with sufficient alcohol to form a paste (" Vienna
paste"), and spread over a suitable aperture in diachylon plaster pre-
viously placed on the part; its action begins immediately, and lasts for
about half an hour; the eschar is dark-colored, and separates in from ten
to twelve days. A proportion of 6 parts of lime to 5 of potash is recom-
mended by some authors, and for application to deeper-seated parts, such
as the neck of the uterus, a combination of 1 part of lime with 2 of pot-
ash is used, especially by French surgeons (" caustique Filhos "); it is
fused by heat, and poured into a small mould of lead, which can be cut
away as the caustic is required.

Chronic Tonsillitis. A mixture of equal parts of lime and caustic
soda has been recommended under the name of " London paste " for oc-
casional application to chronic conditions of enlarged tonsil (Mackenzie),
but has not come into general use.

Onychia. Prof. Vanzetti has recommended the application of caustic
lime in preference to nitrate of lead for onychia maligna, and has reported
two successful cases, in one of which the application was renewed several
times, and in the other it was left in continuous contact (Practitioner,
vol. xiii.).

As a Depilatory to remove superfluous hair, lime is sometimes used
with arsenic (as in the Turkish " Rusma "), or in the form of a hydrated
sulphide, prepared by passing hydrogen through a mixture containing 2
parts of lime with 3 parts of water: when saturated with the gas, this
forms a greenish jelly, which is spread upon the part for a few minutes,
and then removed with an ivory knife (Trousseau).

As a Moxa, or to produce an issue, a fragment of lime may be slaked
on the skin by adding to it a few drops of water; much heat is produced,
and the neighboring skin requires to be protected.

As a Vapor JSath, a piece of unslaked lime half the size of a man's
closed hand is wrapped in a moist cloth, and this again in a dry one
doubled several times, and fastened securely : and if one of these packets
be placed on either side of a patient while in bed, the moist heat soon
induces a copious perspiration lasting for one or two hours (Serre d'Alais:
^Bulletin de Therapeutique, 1846). Dr. Hassall has recommended this as
a ready means of establishing reaction in cholera, and others .have used
it in tetanus.

Hay-Fever. In this malady the vapor evolved from lime chloride has
been found serviceable, when the air of the patient's house is impregnated
with it as far as possible; the solution should be used as a wash to the face
and hands. It is reasonably presumed to act by destroying a fermentative
or " germ " source of irritation to the mucous membranes (Elliotson).



LIME. 103

Croup and Diphtheria. In the form of a warm, finely atomized spray,
solutions of lime (1 in 30) have been much commended as chemical sol-
vents of croupous membrane. Forster, Biermer, and others have shown
that such membranes, and especially their fibrinous constituents, are sol-
uble in lime-water (Archiv der Jleilkunde, v., p. 522), but doubts have
been expressed whether such an effect can be usefully and practically
obtained in the living body. Biermer treated a true case of membra-
nous croup (verified by rejection of membrane) by means of a warm lime-
spray, and although the patient was in great peril, he obtained relief and
finally recovered ; this physician, however, generally gave calomel at the
same time (British and Foreign Jteview, July, 18G5). Kuchenmeister
has recorded several good cases treated successfully by the spray (Bulle-
tin Gen., April, 1865), and the experience of Steiner proved that diph-
theritic layers on the fauces were dissolved by it in a marked manner:
subsequently, however, the growths formed again, and could not be con-
trolled by the remedy (Jahrb. fur Kinderheilk., 1870). Beigel has report-
ed good results with it in croup, and Geiger, of Philadelphia, in diph-
theria (Practitioner, i., p. 101); but Senator has more recently written
against its employment, even from a theoretical point of view, and doubts
its power of dissolving membranes "in situ." Gottstein and others con-
sider the direct application of lime-water to the larynx by means of a
brush to be more advantageous than the spray, and Albers, of Berlin, in
desperate cases has injected the solution into the larynx from below, pass-
ing his syringe between the tracheal rings: cough was caused, and shreds
of membrane were ejected (Berlin. Klin. Woch., February 1, 1869 ;
Ranking, i., 1870). The experience of the profession is not yet such as
to enable us to decide the real value of lime-water applied locally in the
treatment of these affections, but my own results have not been largely
in its favor. Mackenzie finds it useful " when the false membrane is not
very thick " (" On Diphtheria," p. 69).

Lactic acid and carbonate of lithia act similarly, and even better, in
dissolving croupous membranes; Kuchenmeister, however, still maintains
the superiority of lime-water. Sanne recommends the saccharate.

Cancrum Oris Ulcerations. Applied in substance or in solution,
the chloride of lime is a valuable antiseptic and stimulant to fetid dis-
charging surfaces. In cancrum oris, a little of the dry powder may be
applied by the finger, and washed away immediately afterward, and in
unhealthy ulcerations about the gums in general, and in salivation, a
wash may be used containing 2 dr. to the pint of water, with glycerin, or
ordinary lime-water may be used with nearly equal benefit.

A proportion of 1 to 10 or 15 of water has been found extremely use-
ful, applied as a compress in cases of ruptured perineum, when the torn
surface is apt to discharge offensively, and in unhealthy and indolent ul-
cerations of any part, the same remedy, or even ordinary lirne-water, will



10J: MATERIA MEDICA AND TIIEEAPEUTICS.

diminish discharge, cleanse the surface, and promote a healthy action.
Chloride of lime lotions are also good in erysipelas.

Skin Diseases. In pustular and erythematous skin diseases, prepara-
tions of lime are often very useful. In chronic acne, I have often ordered
lime-water, mixed with an equal part of rose-water, and applied three or
four times daily with the best results. In ecthyma, it is commended by
Mr. Wilson, and in the discharging stages of eczema and impetigo, it
makes a useful lotion. In impetigo capitis, and in fissured nipples, lime-
water mixed with oil is good. In chronic eczematous and scrofulous
disease, lime salts are often useful when given internally (Tilbury Fox
speaks well of " saccharated wheat phosphate " in such conditions). Caz-
enave thought the chloride good in lupus. In carbuncles and boils, a
compress soaked in lime-water and covered with oiled silk, often acts
beneficially; it checks inflammation, soothes pain, and promotes suppura-
tion more quickly than ordinary poultices. In erythema and the pruritus
of reddened and irritable skin, lime-water has a sedative, moderately con-
stringing effect, and may be used either alone, or as a vehicle for other
similar remedies. In pruritus pudendi it is often useful when applied
freely and tepid, and in osmidrosis it will relieve the unpleasant secretion
from the sweat-glands. Dusting powders containing precipitated car-
bonate of lime are used for erysipelas and erythema, and in cases of much
sebaceous secretion, especially about the face. Combined with lard as
" chalk-ointment " it is often a good application for indolent and irritable
sores. In tinea capitis, after thorough cleansing, lime-water may be
brushed in, but as a rule stronger remedies are necessary: a lotion of
chloride is more satisfactory. In scabies, a strength of 1 oz. of chloride
to 1 pint of water has been found sufficient to cure, but a more depend-
able preparation is made by boiling together 1 part of quick-lime and 2
of sulphur with 10 of water; this should be constantly stirred till well
mixed, and then the liquid poured off for use; it is too strong to be
rubbed in like sulphur ointment, but should be applied lightly with a
brush, and afterward removed with a warm sponge, if necessary (Lancet,
i., 1865). Pharmaceutists now commonly make such a preparation under
the name of liquor calcis c. sulphure (vol. i., p. 33).

Burns and Scalds. Lime-water, mixed with an equal part of linseed-
oil (Carron-oil), or better, of olive-oil, was long since commended by Boyle
and by Velpeau as a suitable dressing for the early stages of burns in
every degree, and, though rather unpleasant, it has come into general
use. It may be applied on carded cotton, and if the skin be unbroken,
resolution of inflammation is promoted by it, and if suppuration occur, the
liniment controls it, and hastens cicatrization. It relieves pain and in-
flammation in cases of wasp and other stings (Dauverne).

In severe cases of Small-pox, Dr. Joseph Bell recommended the same
liniment to be applied to the face on cotton wool, carefully arranged to



LIME. 105

cover the affected part, but leaving apertures for the eyes, nose, and
mouth. The wool should be fastened with another covering or with tape,
so as to prevent admission of air, and by this means pitting may be pre-
vented or decidedly lessened. An improved formula is a saturated su-
crate of lime, made with lime, sugar, water, and glycerin; it forms a cool,
drying varnish, and for burns may be diluted with oil, or ether may be
added (PharmaceuticalJournal, October, 1873).

Chronic Discharges. In chronic mucous arid purulent discharges,
lotions and injections of lime-water exert a most beneficial influence, as
maybe observed in chronic urethritis and in leucorrhcea, syphilitic or
otherwise; in the former, a combination with mercurial oxides, such as
the " black or yellow wash," is still more potent, and is in daily use for
all forms of syphilitic ulceration.

The profuse nasal discharge, so usual in scarlatina and also muco-
purulent otorrho3a, may be well and safely treated by washing out the
affected parts with a tepid injection of milk and lime-water three or four
times daily: over the affected ear a compress of lime-water, worn at
night, is often advantageous. In chronic purulent ophthalmia a lotion
containing chloride of lime is effective.

Ascarides. Rectal injection of a few ounces of lime-water several
times repeated is effectual in curing ascarides, and Dr. Price, of Margate,
and Kuchenmeister have reported some successful instances of this treat-
ment (Lancet, i., 1864); it has long been a favorite prescription of mine.

THERAPEUTICAL ACTION (INTERNAL). Lime-water was formerly much
esteemed as an internal medicine, and was given not only as an antacid
and astringent, but also as an antiseptic, and especially as a lithontriptic
or solvent of calculi. It was not unfrequently given in excess, and pro-
duced irritant effects, but its use now is more restricted, and the doses
given are smaller and more diluted.

Dyspepsia Vomiting. When digestion is accompanied with dis-
comfort and oppression, or with acidity, pyrosis, and flatulence, espe-
cially if there be a tendency to diarrhoea, and to acidity of urine, lime-
water and the carbonate of lime are often more serviceable than alkalies,
because they are not only antacid but astringent. I have found them
specially useful in the dyspepsia of chlorotic women, marked by the
above symptoms, and generally by craving for acids and dislike to ani-
mal food. When flatulent distension affects the lower bowel, lime-water
has been used in enema as absorbent of carbonic and other gases. Dr.
Habershon has recommended the carbolate of lime in such conditions
(Lancet, i., 1868). For cases of acid dyspepsia, when flatulent distension
is not so prominent a symptom, but when there are heartburn and pain
with evidence of gastric congestion, the bicarbonate of lime, dissolved
with an excess of carbonic acid in the slightly effervescent form known
as carrara water, is very useful, for it is less nauseous to some patients,



106 MATERIA MEDICA AND THERAPEUTICS.

and more easily tolerated than lime-water, so that more of it may be given
at a time; it may be mixed with an equal part of milk, while of lime-water
not more than one-eighth part should be used.

For the special symptom of nausea and vomiting 1 from irritative gas-
tric conditions, milk and lime-water is a simple and often effective treat-
ment; given frequently in small quantities, iced, it provides digestible
nourishment which is sometimes better retained than any other. It is
valuable in the vomiting of pregnancy, and even in that of gastric ulcer,
in which latter malady only a dessertspoonful in a wineglassful of milk
should be tried at a time. The lime acts partly as a sedative to the mu-
cous membranes, partly as an antacid, and partly mechanically by break-
ing up the curd of milk; hence it is particularly useful as an addition to
cow's milk for children brought up by hand, only in any case where con-
stipation is marked, soda-water may be substituted for a time.

Mr. Metcalfe Johnson has written highly of the value of hydrated
phosphate of lime in the sickness of pregnancy; and Dr. Leared of the
chloride (|- dr. to 1 dr. liq. calcis chloridi) in sarcinous vomiting. Dr.
Cleland specially recommends the saccharate as a better antacid than
magnesia, and useful in dyspepsia dependent on either too little or too
great secretion of gastric juice; it does not constipate like other lime
compounds; it may, however, cause nausea if taken on an empty stomach
(Edinburgh Medical Journal, 1859).

Carrara water is suitable for taking with wine at the later meals, and
several other natural mineral waters containing lime are of acknowledged
value in gouty and acid forms of dyspepsia generally (vol. i., p. 173):
Seltzer contains 3 gr. of carbonate in the pint, Pyrmont 4, Kreuzbrunnen
4.13 with much carbonic acid, Wildungen 5.4 to 9.7, and Pouges (a Spa
between Paris and Lyons) contains as much as 12 gr., and is of great
repute. Dr. Basham found such waters especially suitable for hypochon-
driacal, but not for anaemic cases.

Intestinal Catarrh Diarrhoea. Lime-water and lime carbonate are
useful in these conditions, especially if gastro-intestinal acidity be present,
as it usually is in young children; the breath is then offensive, the motions
frequent, loose, greenish, sour-smelling, and deficient in bile; the abdomen
is distended, cramping pain occurs at intervals with drawing-up of legs,
and there is often sickness. Restriction to milk and broth diet, with the
addition of 1 or 2-gr. doses of carbonate of lime, will often cure this dis-
order; in the diarrhoea of dentition as well as in the more chronic forms
connected with strumous or mesenteric disease, such treatment is spe-
cially indicated. (Castor-oil may be required at first to remove any
cause of direct irritation such as undigested food, mucus, etc., and the
use of insoluble lime salts should not be prolonged more than neces-
sary, otherwise irritation or some degree of obstruction may be caused.)

In chronic diarrhoea dependent upon relaxed condition of the ali-



LIME. 107

mentary canal, and also when kept up by ulceration of the bowel, I have
used lime preparations with the best possible effect. Bretonneau recom-
mended them in enema for these cases.

In the diarrhoea of enteric fever, and of tuberculosis, milk and lime-



Online LibraryCharles D. F. (Charles Douglas Fergusson) PhillipsMateria medica and therapeutics, inorganic substances; (Volume 2) → online text (page 13 of 40)