– K. P. Muzumdar.
Hahnemann, while advocating the administration of medicines orally, did not lose slight of the fact that the same can also be administered by other than the oral route. In the 6th edition of Organon in aphorisms 284-85, he clearly mentions about external applications. He says that curative remedy may be continued internally, while the same remedy is used externally the ointment, liniment, cerate etc.
Homoeopathic medicines can be dispensed for external application in vehicles such as Olive Oil, Glycerin, Almond Oil, Soft paraffin, white wax, Spermaceti, Sesame Oil, Oil of Rosemary, Prepared lard, Curd soap, Hard soap, Soft soap, Starch, etc.
Almond Oil: (Oleum Amygdalae 011, Amygdale)
Almond oil is a volatile oil obtained from dried kernel (deprived of fixed oil) of Prunus amygdalus Batch. Var dulcis (DC) Koerhne, or of Prunus amygdalus Batsch, Var amara (DC) Focker, by macerations with water and subsequent distillation with steam. It contains not less than 80 Percent benzaldehyde.
Description: A pale yellow oil; odour, slight, and characteristic taste, bland and nutty.
Solubility: Almost insoluble in alcohol (95 per cent) miscible with solvent ether, with chloroform and with light petroleum (boiling range, 40* to 60*).
Acid Value : Not more than 4.00.
Freezing Point :Remains clear after exposure to a temperature of-10* (for three hours; does not congeal until the temperature has been reduced to about-18*.
Refractive Index: At 20*, 1.470 to 1.473.
Saponification Value: 188 to 196.
Weight per ml: At 20*, 0.910 to 0.915 g.
Apricot-Kernel Oil and Peach Kernel Oil:
Shake 5 ml. vigorously for one minute with 1 ml. of a freshly prepared mixture of equal parts of weight of sulphuric acid, nitric acid and water, kept cool while cautiously mixed; after fifteen minutes the whitish mixture produced shows no pink colour.
Complies with the best for the absence of arachis oil in other oils.
Cotton seed Oil: Complies with the test for the absence of cotton seed oil in other oils.
Sesame Oil: Complies with the test for the absence of Sesame oil in other oils.
Olive Oil (Oleum Olivae, Ol. Oliv.). It is obtained by crushing the recently collected ripe olives in milk without breaking the putamen, then moderately pressing the pulpy mass. This produces the highest grade oil known as virgin oil.
Description: A pale yellow or greenish-yellow oil; odour, slight, but not rancid; taste is characteristic. At lower temperatures it may be solid or partly solid.
Solubility : Almost insoluble in alcohol (95 per cent) miscible with solvent ether, with chloroform and with light petroleum (boiling range, 40* to 60*).
Acid Value: Not more than 2.0.
Refractive Index: At 20*, 1.468 to 1.471.
Saponification Value: 190 to 195.
Weight per ml.:At 20*, 0.910 to 0.913 g.
Arachis Oil: Complies with the test for the absence of cotton seed oil in other oils.
Sesame Oil: Shake with an equal volume of a mixture of 9 parts by volume of alcohol (90 per cent) and I part by volume of strong ammonia solution, and heat on a water bath until free from alcohol and test for the absence of sesame oil in other oils.
Storage: Olive oil should be kept in a well-closed container.
CH2OH. CH(H). CH3OH Mol. Wt. 92.1
Glycerin is a trihydric alcohol. It contains not less 98.0 per cent w/w of C2H8O3.
Description: A clear, colourless liquid of syrupy consistency; odourless; sweat, followed by a sensation of warmth. It is hygroscopic.
Solubility: Miscible with water and with alcohol; practically insoluble in chloroform in solvent ether and in fixed oils.
Identification: 1) Heat a few drops with 0.5 g. of potassium bisulphate; acrolein in evolved which is recognized by its characteristic pungent odour.2) Heat on a bunsen flame on a borax bead; it produces a given flame.
Colour: When viewed downward against a white surface in a 50 ml. Nessler tube, the colour of the sample is not darker than the colour of a standard solution make by diluting 0.40 ml. of ferric chloride with water to 50 ml. and similarly viewed in a Nessler tuber of approximately the same diameter and colour as the one containing the sample.
Reaction: At 10 per cent w/v solution is neutral to solution of litmus.
Weight per ml.: At 25*, 1.252 to 1,.257 g. corresponding to 98.0 to 100.- per cent of C2H803.
Storage: Preserve Glycerin in a well-closed container.
White Soft Paraffin: (White soft paraff.)
Synonym: White petroleum jelly.
Description: A white, translucent, soft mass, unctuous to touch; not more than slightly fluorescent by daylight, even when melted, odourless, when rubbed on the skin; tasteless. It is prepared by bleaching yellow soft paraffin.
Solubility: Practically insoluble in chloroform in solvent, ether, and in light petroleum (b.p. 40* to 60*), the solutions in some cases showing a slight opalescence.
Weight per ml.: At 20*, 0.815 to 0.880 g.
Melting range: 38* to 56*.
Reaction: Boil 5 g. with 10 ml. of alcohol previously neutralized to solution of litmus, the alcohol is natural to litmus.
Fixed Oils.: Digest 10 g. with 50 ml. of solution of
Fats and Resin: Sodium hydroxide at 100* for thirty minutes and allow the aqueous layer to separate. On acidifying acid no precipitate or oily matter is produced.
Foreign Organic: Volatilizes when heated, without emitting matter an acrid odour.
Sulphated Ash: Not more than 0.1 per cent.
Category: Pharmaceutical acid.
Preparations: While soft paraffin is an ingredient of emulsifying ointment, paraffins annluirt and simple ointment.
Yellow Soft Paraffin :
Synonym : Petroleum jelly. Yellow Soft Paraffin is a mixture of semi-solid hydrocarbons obtained from petroleum.
Description: A pale yellow to yellow, translucent soft mass, unctuous to the touch; not more than slightly fluorescent by day light, even when melted, Free or nearly free from odour and taste.
Solubility: Practically insoluble in water and in alcohol; soluble in chloroform in solvent there, and in light petroleum (b.p. 40* to 60*), the solution sometimes showing a slight opalescence.
Melting range: 38* C to 56* C.
Reaction: Complies with the test for reaction described under white soft paraffin.
Fixed Oil Resin & Foreign Organic Matter: Compiles with the tests for fixed oils, fats and resin and foreign organic matter described under White Soft Paraffin.
Yellow Colouring matter: Boil 5 g. with 10ml. of alcohol; the alcohol is not coloured yellow.
Sulphated Ash: Not more than 0.1 per cent.
Category: Pharmaceutical aid.
Preparation : Yellow Soft Paraffin is an ingredient of Paraffin Ointment Simple Ointment. Wool-Alcohols Ointment.
It is a soap made by the interaction of Sodium Hydroxide with a suitable vegetable oil or oils, or with fatty acids derived therefrom.
Description: A greyish white or yellowish-white substances; odour, faint and free from rancidity. Becomes horny and pulverisable when dried.
Solubility: Soluble in water, almost completely soluble in alcohol and more readily soluble when warmed.
Free Fatty Acid: Alkali Hydroxide: Total Free Alkali:
Boil 200 ml. of alcohol to remove carbon dioxide, add 0.5 ml. of solution of Phenolphthalein, allow to cool to 70 and, if the solution is not already pink, titrate at that temperature with 0.1 N Sodium hydroxide; not more than 0.2 ml. is required.
If the solution is already pink, add in a thick stream 5 ml. of hot solution of barium chloride previously neutralized to solution to Phenolphthalein, mix thoroughly and titrate with O.1 hydrochloric acid, until the pink colour disappears; not more than 1.I ml. is required.
Total Free Alkali:
To the remainder of the neutral alcohol add 10 g. of soap in thick shaving or in powder,m and dissolve it as quickly as possible by heating under a reflux condenser. Add immediately 3 ml. of 1 N sulphuric acid and boil on a water bath for at least ten minutes under a reflux condenser. If the solution is not pink, cool to 70* and titrate with 1 N sodium hydroxide, until a pink colour appears. If after boiling of 1 N Sulphuric acid must be added and the boiling repeated. The volume of 1 N sulphuric acid neutralized by the soap is not more than 1 ml.
Unsaponifiable Matter and Unsaponified Neutral Fat:
Dissolve 5 g. in thin shavings or in powder in 80 ml. of a mixture of 50 m. of alcohol and 100 ml. of water, avoiding excess heating as far as possible. Transfer to a separator after washing the vessel with the remaining 70 ml. of the mixture. Extract with 100 ml. of solvent ether while slightly warm; run off the alcoholic soap layer into a second separator, and extract with 50 ml. of solvent ether and pour the three ethereal extracts into a separator containing 20 ml. of water. Rotate the separator without violent shaking and, after allowing the liquid to separate, run off the water. Repeat the washing with water in the same way until the separated water is not more than faintly turbid, when acidified. Wash the ethereal solution twice by shaking vigorously with 20 ml. of 0.5 potassium hydroxide, each washing with alkali being immediately followed by washing with 20 ml. of water, shaking vigorously each time. Acidify the last alkali washing after separating it and, if the liquid becomes turbid, repeat the alkali washing remains clear on acidification. Finally, wash with successive quantities of 20 ml. of water until the water is no longer alkaline to solution of phenolphthalein. Transfer the ethereal solution to a weighed flask and remove the ether. When all the ether is nearly evaporated, add 3 ml. of acetone, and remove the solvent completely by the aid of a gentle current of air.
While passing the current of air the flask is preferably held obliquely, almost entirely immersed, and rotated in a boiling water both. Repeat the last operation until the weight of the residue is constant. The residue weighs not more than 40 mg.
Characteristics of the Fatty Acids. Resin
Prepare the fatty acids by the following process :-
Dissolve a sufficient quantity in hot water, add a slight excess of dilute sulphuric acid, and heat on a water bath until the liberated fatty acid form a transparent layer. Separate the fatty acids on a wet filter paper, and wash with hot water until the washings are neutral to solution of methyl orange. Filter the oily layer through a dry filter paper in a warm oven.
Acid Value: As determined on 2 or 3 g. of the fatty acids, using 0.5 N potassium hydroxide and substituting in the formula 0.02805 for 0.00561 not greater then 205.
Solidifying point: Not below 29 (unless the soap is made entirely from olive oil).
Resin : Mix 0.5 ml. of melted fatty acids in a test tube with 2 ml. of acetic anhydride, warm, shake until clear and cool to 15.5*; Transfer one drop of a cold mixture of equal volumes of sulphuric acid and water near to it, and gently bring the drops together with a glass rod; no transient violet colour is produced.
Chlorides and Other Alcoholic Soluble Substances:
Dissolve 5 g., in 100 ml. of hot alcohol, previously neutralized to solution of phenolphthalein; filter through a dried and tarred filter, wash the residue thoroughly with hot, neutralized alcohol and dry at 105*. The resides weighs not more than 50 mg.
Loss on Drying : Losses not less then 20 per cent, and not more than 20 per cent of its weight when dried to constant weight at 105*. The powdered soap loses not more than 5 per cent of its weight.
Storage: Preserve hard soap in well-container.
It is a soap made by the interaction of potassium hydroxide or sodium hydroxide, with a suitable vegetable oil or oils or with fatty acids derived therefrom. It yields not less then 44.00 per cent of the fatty acids.
Description : A yellowish white to green, or brown, unctuous substance.
Solubility : Soluble in water, and in alcohol.
Free fatty acid : Alkali hydroxide; Total free alkali.
Unsaponifiable matter and unsaponified neutral fat, complies with the test for free fatty acid; Alkali hydroxide; Total free alkali and unsaponifiable matter and unsaponified neutral fat described under hard soap.
Chlorides and Other Alcohol-insoluble Substances: Dissolve 5 g. in 100 ml. of hot alcohol previously neutralized to solution of phenolphthalein, filter through a dried and tarred filter, wash the residue thoroughly with hot, neutralized alcohol, and dry to constant weight at 105*. The residue weighs not more than 0.15 g.
The fatty acids obtained in the assay have the following characteristics:
Acid Value: As determined on 2 to 3 g. of the fatty acids 0.5 N potassium hydroxide and substituting 0.02805 in the formula not grater than 205.
Solidifying point: Not above 31* C.
Resin : Weigh accurately about 20 g. and dissolve in 100 ml. sulphuric acid, and extract with three successive quantities, each of 70 ml, of solvent ether. Mix the ethereal solutions in a separator, and wash with water until the washing are free from mineral acid. Transfer the ethereal solution to a weighed flask, remove the ether, dry the residue of the fatty acids to constant weight at 80*.
Storage : Pressive soft soap in a well-closed container.
Preparation : Soap Liniment.
Spermaceti U.S.P.: (Cetaceum; Sp. Esperma de Ballena) Spermaceti is a waxy substance obtained from the head of the sperm whale physeter macrocephalus Linn. (fam. Physeteridae).
Constituents : Spermaceti is a mixture of several constituents of which cetin, or cetyl palmitate C15 H3 COOC16 H33 predominates. When recrystallized from alcohol cetin is obtained, while the mother liquor on evaporation deposits is obtained, while the mother liquor on evaporation deposits on oil, cetin plain, which, when saponified, yields deposits, an oil, cetin plain, which when saponified yields celoleic acid, an acid resembling but distinct from oleic acid.
Preparation : Spermaceti is obtained by the forcible expression of the oleaginous material found in the head of the sperm whale. The liquid portion which is known as sperm oil, is a liquid wax. The solid fat is termed cetin (acetyl palmitate) and also belongs to the class of waxes.
Description : Whiter, somewhat translucent, slightly unctuous masses with a crystalling structures and pearly lustre. It as a faint odour, a bland milk taste, and is free from rancidity. Its specific gravity is about 0.94. It melts between 42* and 50*.
Solubility : It is insoluble in water, nearly insoluble in cold alcohol, and slightly soluble in cold petroleum, benzene, but it is soluble in boiling alcohol, in ether, chloroform, in fixed and volatile oils.
Storage and Uses : Preserve in well-closed containers. Spermaceti is one of the solid fatty substances employed to give consistency to cerates and ointments as in the well-known Rose Water Ointments.
Starch consists in the granules separated from the mature grain of Zea mays Linn. (Fam. Graminae.)
Preparation : In making starch from corn, the germ must be separated mechanically and the cells then softened, so at to permit the escape of the starch granules. This is generally done by permitting it to become sour and decomposed, stopping the fermentation before the starch is affected. for small scale, starch may be made from wheat flour by making a stiff ball of dough and kneading it white a small stream of water trickles upon it. The starch is carried off with the water, while the gluten remains as a soft, elastic mass; the latter may be purified and used for various purposes to which gluten is applicable. The quality of commercial starch largely depends upon the purity of the water used in its manufactures.
Starch may be made from potatoes by first grating them, and them washing the soft mass upon a sieve, which separates the cellular substances and permits the starch granules to be carried through. The starch must then be thoroughly washed by decantation, and the quality of the starch also depends largely upon the purity of the water that is used in washing it.
Description: Irregular, angular, white masses or a fine powder, consisting chiefly of polygonal, rounded or spheroidal grains up to 35 microns in diameter, and usually with a circular or several-layered central cleft. It is odourless and has a slight, characteristic taste.
Sesame Oil Sesame oil is the refined fixed oil obtained from the seed of one or more cultivated varieties of sesamum indicum Linn. (Fam. Pedalicaeae).
Description : A pale yellow, almost odourless oily liquid with a bland taste. Its specific gravity is between 0.916 and 0.921 It contains glycerides of oleic acid and linolenic acid and has properties similar to those of olive oil.
Rosemary Oil is the volatile oil distilled with steam from the fresh flowing tops of Rosmarinus officinalis Linn.
Description: A colourless or pale yellow liquid, having the characteristic odour of rosemary, and a a warm camphoraceous taste.
Specific gravity: 0.894 to 0.912
Optical rotation From -5* to plus 10* in a 100 mm tube.
Refractive Index: 1, 4640 to 1,4760 at 20*.
The oil is soluble in 1 volume of 90 per cent alcohol, by volume, but upon further may become turbid.
The purified internal fat or the abdomen of the hog. It is a white, soft, unctuous mass with a faint odour and a bland taste, free from rancidity.
It is insoluble in water but readily soluble in ether and chloroform. It consists of a mixture of stearin, palmitin, and olein, prepared by careful removal of membranes and adhering flesh and then rendered. It is used as an ingredient in ointments. Must be protected from conditions favouring rancidity.
Mother tincture is the remedial substance which is to be mixed in various proportions in the vehicles for external application.
Even to-day the manufacture of mother-tincture is done by mixed in various proportions in the vehicles for external application.
To make the external application the proportions of adding these mother tinctures differ. If the mother tincture is made according to old Hahnemann’s classification, the following proportions are advised :-
If mother tincture is prepared according to Class I and II: If no special proportion is advised under the respective monograph, add one part by wt. of M.T. to 1.5 part by wt. of Ethyl alcohol (45 Percent). This is the MT for external application. It should be labelled – “For external use only”.
If mother tincture is prepared according to Class IV, and: if no special proportion is advised under the respective monograph, add one part M.T. to one part of ethyl alcohol which was used in the preparation of the original M.T. This is the M.T. for external applications. It should be labelled – “For external use only.”
If the mother tincture is prepared according to New Method, the equal wt. of M.T. and ethyl alcohol will be taken and this M.T. will be used for external application. It should be labelled – “For external use only.”
Normally, except otherwise mentioned by the physician, 10 Percent mixture of M.T. for external application and liquid or solid base is used.
They are semi-solid preparation for external applications of such consistency that they may be readily applied to the skin by inunction. They must be soft but need not necessarily melt on application.
An ideal ointment is one which does not retard the healing process, is non-sensitive to the skin, less or least irritant, non-greasy and non-dehydrating, with minimum number of ingredients and having ease of compounding.
Preparation (a) Mechanical incorporation and (b) fusion.
Mechanical incorporation. It is made on a glass state wit a spatula. This method is used when the medicament is in powder form. Best results can be obtained by using a small portion of the base.
Slab is usually ground glass, the spatula is of stainless steel. In preparing an ointment by this technique, the spatula should be such that it acts as a roller, passing wrist is required to reverse the direction of movement of the spatula at the end of each operation.
(b) Fusion Method. When wax petroleum jelly and spermaceti are to be used as base, their method is utilized. They are just melted on a water bath so that they are slightly changed in their consistency. The drug substance mostly is in an alcoholic or aqueous solution, which is added according to the required proportion and the whole mass is stirred for a homogeneous mixture. Cool down the whole mass and the ointment is ready.
Sometimes slab man spatula are used in the dispensary. When a small quantity is to be dispensed, the base, while under the process of incorporation due to friction gets slightly thinner in consistency, the drops of drug are gradually added, when the spatula mixes it in the same way as it was done with the dry powder drugs. This is a convenient method in making very small quantity for the purpose of dispensing.
While removing the ointment from stock jar, always take care that one scrapes from the uppermost surface, and never dig into the ointment as there is a chance of rancidity and moulding.
Ointment should be preserved in a cool dark place, out f contact with air, if possible. Preferably all ointment can be refrigerated.
Nowadays we can get the ointment in collapsible tubes. These are mostly made of aluminium. They do not seem to affect the therapeutic value of the ointment. But in Homoeopathy it is advisable to use only glass jars to stock the ointments or paper cartons to dispense them. It is advisable to prepare the ointment by oneself.
Liniment : Ointment
These are spoken of as embrocations, solutions or mixtures of various substances in oil, alcohol solutions of soap or emulsions, intended for external application.
These are applied by rubbing the skin. Often they serve as protective coatings.
The base of the liniment is soft soap, the drug substance and the base are mixed in 1:10 proportion, and the liniment is painted over the painful part.
Glycerites are made from a solution or mixture of medicinal substances in glycerin. Most of these glycerites are extremely viscous and are of jelly-like consistency.
The most common glycerite in use is glycerite of Borax. It is anti-pruritic, anti-bacterial, and anti-fungal in nature. It is used mostly in cases of stomatitis and gingivitis. Mullein Oil is prepared in glycerin as ear drops.
These are unctuous substances called so because of wax (cera). The consistency is such that it gets easily spread over the surface, but maintains its solidified state and does not run as a liquid. These are mostly on inflamed parts and are made from base petroleum, jelly wax, lard, oil, to give the desired consistency. Paraffin and spermaceti are also used to raise its consistency.
These are made by fusion (as in ointment). In the other school this is not very much in use now. Cantharis, Urtica Urens cerates are the most common in homoeopathic practice.
These are liquid suspensions or dispersions intended as external applications to the body.
As the particles of these medicines remain in suspension, a label “Shake well before use” must be exhibited on the bottles.
Calendula is the commonest lotion used in homoeopathy as an antiseptic and a quick healer in wounds, cuts and bruises.
Plasters are intended for external application. They are made of such material and of such consistency as to adhere to the skin, mostly to give localized effect. They help in two ways; to give support and protection, and to bring the medication in direct contact with the affected bring the medication in direct contact with the affected part. Their use in homoeopathy is restricted.
These are soft-liquid external applications which either stimulate the body surface or relieve an inflamed part by supplying medicating substances in the presence of heat and moisture.
Poultice Oil is said to draw infectious material from a diseased tissue because of absorptive and hygroscopic character of the ingredients used, i.e. starch and glycerin.
Make a paste of starch by adding water and heat it constantly to steaming-boiling. Spread this part on the muslin cloth and add a few drops of mother tincture, say, Ranunculus Bulb (Ext), and spread it along the cloth with the remaining paste. Apply to the chest to the joint where there is localised pain. This helps the patient in addition to an internal remedy to get relief from pain through local action.
Fomentation is also a method of external application, but it does not contain any medicament. It acts on the thermal principle. There are hot and cold fomentations.
Hot fomentation is done by application of hot water to the affected part. This helps increase circulation and mobilizes the metabolites away from the inflamed site and brings relief.
Magnesium Sulphuricum, added to this, helps due to the astringent action of the salt, and draws out the metabolites from an opening of a boil or furuncle.
Cold fomentation is done to give relief temporarily by cold water or ice bag.
It works on the principle of evaporation. Sometimes the bleeding is stopped by application of ice, by producing contraction of the capillaries at the site of bleeding.
Medicated oils are solutions of medicinal ingredients in bland oil.
The most common oils used in homoeopathic practice are olive and oil of rosemary. Both are medicinally inert.
Arnica Hair Oil has Arnica in major proportion in the oil.
The term Surgical Dressings cover quite a number of materials used in the dressing of wounds. They are used to cover, absorb,m to protect or to support the injured or diseased part.
Classification of Dressings.
(1) Absorbent cotton (2) Bandages (3) Plasters (4) Protectives.
It is prepared from raw cotton fibers by a series of mechanical and chemical cleansing processes to remove the natural wax and other impurities so as to make the property of the cotton absorbent. Besides the regular roll form, it can be make into cotton balls. Normally, they are made of three sizes – large balls, medium balls, and small balls. They are used in application of antiseptics, local medications, cleansing the skin, and before parenteral introduction. Non-absorbent bleached cotton has water-repellant properties because while cleansing of the fibers the natural wax is retained. It is mostly used in packing, padding, to give cushioning effect to the bandages over the wound in draining the fluid. It is used also for sanitary napkins.
The function of surgical gauzes is to give tensile strength while still maintaining the absorbent quality of the material. The cotton is woven in long threads, and then the threads are woven in open mesh cloth. These meshes are measured on the basis of threads per square inch.
Gauze Pads – are made of surgical gauzes by folding on one another and cutting into various sizes, taking care that no loose threads are left out. When these gauze are unfolded, no cut ends are visible. The most popular sizes are 2 x 2, 12 ply, 3 x 2, 12 ply, 4 x 4.8 and 16 ply.
Cotton filmated gauzes are also available. Thin absorbent cotton is spread evenly in the folds of these gauzes and pads are then folded. These are more economical than simple gauzes.
Sanitary Napkins – have filter of absorbent cotton cellulose for better absorption and drainage. They are used in maternity and gynaecological cases.
Absorbent Lint – has a cotton fibre jetting our and woven cotton on one another. This is useful in applying ointment plasters and gives better support and protection to the wound.
Cotton Gauze Roller Bandages – these are absorbent cotton threads, woven in mesh and prepared in continuous roll of length. They can be sterilized and used in draining and bandage.
Elastic Bandages (Crape Bandages) – they are elastic but have no rubber. Elasticity is due to special weave which allows to stretch to practically twice its length. This helps, therefore, to bandage varicose veins, sprains, etc. It allows limited mobility and therefore does not impair circulation.
Elastic Adhesive Bandages – there is a special surgical adhesive spread over one side and still has elasticity due to its special weave and is used in places where more support is required, i.e. in rib fractures or where some muscles or ligaments are involved.
Plaster of Paris Bandages – these – are used in the treatment of broken bones where immobility is required and in certain conditions of joints where immobilization is wanted. These are always kept in water-proof packings as moisture tends to harden the plaster making it useless.