THE USES OF TAR-WATER IN 
OBSTETRICAL AND GYNAE- 
COLOGICAL PRACTICE. 
BY 
JOSEPH EVE ALLEN, M.D., 
Augusta, Ga. 
Bead before the Doctors’ Society of Augusta, Ga. 
Reprint from Atlanta Medical and Surgical Journal, October, 1880. THE USES OF TAR-WATER IN OBSTETRICAL AND 
GYNAECOLOGICAL PRACTICE. 
JOSEPH EYE ALLEN, M.D., Augusta, Ga. 
Read before the Doctors’ Society of Augusta, Ga. 
Tar-water has long been known in medicine, for more 
than a hundred years ago Dr. Berkeley, Bishop of Cloyne, 
published a treatise* upon its therapeutic uses. This is 
the first written record which exists on the subject, but it 
is certain that tar-water had been employed before this 
time, because the author states that he first learned of its 
medicinal virtues during his travels in America, where it 
was used as a popular remedy for man and beast. 
Lewis, Cullens, Erasmus/ Darwin, Lisfranc and other 
distinguished men since Dr. Berkeley’s time, have advised 
the use of tar-water in the treatment of various diseases. 
To Dr. L. A. Dugas, of Georgia, is due its general intro- 
duction into Southern surgical practice; his extensive 
experience with tar-water, especially during the late war, 
having conclusively demonstrated its great value as an 
anti pyogenic. 
Tar-water is made, according to the United States Dis- 
pensatory, by adding one pint of wood tar to four pints of 
cold water, mixing thoroughly and shaking frequently 
*Siris, A Chain of Philosophical Reflections and Inquiries Concern- 
ing the Virtues of Tar-Water, etc.; second edition, 1744. 
Vol. XVIII.—No. 7—25, 2 
during twenty-four hours, and then filtering the infusion. 
The German Pharmaeopseia directs that it be prepared by 
mixing one part of tar with ten parts of boiling distilled 
water, and macerating with constant stirring for two days. 
The French Codex leaves the tar in contact with thirty 
parts of water for one day, then rejects this strongly acid 
solution, and macerates the again with thirty parts of 
water for eight or ten (Jays. 
Lefort has determined the amount of tar taken up by 
hot water to be two grammes to the liter*. 
The solvent action of cold water is greatly interfered 
with by the large quantity of oily principle present in 
tar. Magnes-Lohens has shown, however, that a saturated 
solution (six grammes of extract to the liter of water) may 
be obtained by first dividing the tar by admixture with 
twice its weight of some inert material, such as saw-dust; 
the use of magnesia for this purpose is inadmissible on 
account of the formation of soluble salts. 
AVhen prepared according to these different methods— 
that of the United States Dispensatory being, perhaps, the 
best—tar-water is a light brown liquid of a slmrp, pum-. 
gent taste, smoky odor and acid re-action ; it is principally 
in solution a small proportion of pyroligne- 
ous acid, empyreumatic oil, creasote and resinous matters. 
If coal tar be substituted for wood tar in the preparation 
of tar-water the product is much the same, except that it 
contains carbolic acid instead of creasote. 
Internally administered, tar-water is stimulant and 
diuretic in its action, and locally applied it is slightly 
astringent, unirritating and alterative ; it is antiseptic 
and disinfectant, and hence antipyogenic, for by destroying 
the putrefactive germs it prevents or restrains the process 
of suppuration. 
In calling attention to the uses of tar-water in obstet- 
rical and gynaecological practice it is not expected to 
present anything especially new or original, but simply 
to report the good results which have attended its employ- 
ment, in the hope that its value may become more gen- 
erally recognized by the profession. 
Dispensatory, page 754. 3 
Tar-water as an antiseptic during the puerperal state.— 
Puerperal women, says Prof. Lusk*, tremble in the balance 
between a physiological and a pathological condition. 
The greatest danger to which they are exposed is septicae- 
mia, to the development of which the state after delivery 
is peculiarly favorable, for the separation of the placenta 
leaves an extensive surface of the uterus unprotected by 
its lining membrane, and the bruised and lacerated tissues 
of the parturient passages are for days bathed in the lochial 
discharge—a fetid fluid consisting of the dissolved remains 
of blood-clots, pieces of placenta, shreds of membrane and 
other putrescent material. The absorption of this or any 
other decomposing matter is followed by some one of the 
manifestations of septicaemia. Autoinfection does not often 
occur because the lochial discharge does not begin to pu- 
trefy until after the placental site has become obliterated 
by the uterine contractions and the lacerations about the 
cervix and vulva have either healed by first intention or 
begun to granulate, for Billroth has shown that after 
healthy granulation is fairly established absorption of 
putrid matter goes on so slowly, if at all, that the poison- 
ing of the blood does not occur, and that hence, for infec- 
tion to take place, a fresh wound is required through which 
the septic material can enter the system. In exceptional 
cases, however, autoinfection may happen at the time of 
delivery, or immediately afterwards, before the wounds 
granulate, as when a putrid foetus is expelled, or when the 
maternal soft parts have been so long subjected to pressure 
that sloughing is induced, or when from some diseased 
state of the genital organs, such as carcinoma, decomposing 
matter is already present at the time labor begins. 
The clinical observations of Dr. Fordyce Barkerf cer- 
tainly prove that blood-poisoning may also result without 
traumatism being necessarily antecedent from septic ma- 
terial being formed within the system by certain morbid 
processes such as go on during the course of typhoid,, 
scarlet and other fevers, and which give rise to disorgani- 
tion and death of tissue, necrobiosis as it is called by 
Virchow. 
of the International Medical Congress, 1876, page 833, 
tPuerperal Diseases, page 402. 4 
Septicsemia is often due to decomposing matter being 
brought in contact with the recent wounds of the genitals 
by means of cloths, sponges, instruments and the hands 
of the accouchuer or attendants, and it is possible that septic 
material may even be conveyed to the puerperal woman 
by the air, but this method of infection is hardly probable. 
The experiments of Pasteur and Tyndall have demon- 
strated that neither animal or vegetable substances can 
undergo putrifaction without the presence and rapid mul- 
tiplication of living germs. When suppuration takes 
place these germs are met with in great numbers in the 
purulent discharges; they are variously termed micros- 
pores, micrococci or bacteria, and are always found in the 
air and water, and present different physical peculiarities 
which, in the higher forms, enable the microscopist to 
distinguish and classify them. 
Burdon-Sanderson have proved that if 
a septic fluid be deprived of these bacteria by filtration it 
is no longer capable of producing toxaemia, though it 
may excite local inflammation; whereas the matter re- 
tained on the filter containing these organic germs pos- 
sesses all the virulent properties of the original fluid; it 
does not follow from this, however, that bacteria are the 
sole sources of septicaemia, for it is possible that the septic 
poison and these germs may both be left upon the filter. 
Pathologists regard bacteria as the cause of the morbid 
changes in septicaemia for the reason that, although all 
efforts to produce blood poisoning by isolated germs have 
as yet been attended with negative results, still the de- 
struction of these germs in putrid material renders it 
innocuous, and they are constantly found in the infected 
wounds and throughout the diseased tissues. It is not 
known how bacteria induce disease in the human organism. 
Whether they produce a specific poison in the course of 
their growth and multiplication, or whether they simply 
act as carriers of the septic virus, or as mechanical irri- 
tants are questions to be settled by future pathological 
research. 
Bacteria are always found on post-mortem examina- 
tion in the tissues and fluids of the subjects of surgical 5 
pysemia, erysipelas, diphtheria and puerperal septicsemia, 
and never found in those who have died of other diseases. 
This proves the existence of a common morbific element 
which binds these diseases due to septic infection together 
and establishes the connection which clinical observation 
has long shown to exist between them.* 
The statement of Schroeder f cannot be accepted that 
puerperal fever is nothing else but the poisoning of the 
system with septic matter from the genital organs, because 
fever during the puerperal state may be dependent on a 
number of causes other than blood-poisoning, such as sim- 
ple traumatic inflammation, zymotic and malarial influ- 
ences and emotional disturbance, yet it is certain that 
that variety of puerperal fever, due to septicaemia, is the 
one most usually met with. Tyler Smith states that 
three thousand mothers die annually in England and 
Wales of puerperal fever and. according to Prof, Lusk, the 
mortality in New York city from this disease is one in ev- 
ery one hundred and forty-six confinements. When we 
consider therefore the great danger of septic infection to 
which the puerperal woman is exposed and the suffering 
and fatality which attends septicaemia in all of its differ- 
ent lorms, we cannot too highly estimate the importance 
of using every means and agency to prevent its occur- 
rence. The brilliant success of Listerism in surgery has, 
in England and Germany, led to its modified application 
in obstetrics with most satisfactory results. Thus for exam- 
ple, the method which Prof. Bischoff enforces in the Ma- 
ternity of Basel,t and which has reduced the number of 
cases of septicaemia in that institution to an average of 16 
per cent, for six years, requires the utmost cleanliness in 
the parturient woman and her surroundings. The use of 
antiseptic vaginal washes at the commencement and at 
intervals during the progress of labor, and the thorough 
disinfection of the hands before, and inunctions with car- 
*Lusk on Puerperal Fever, Transactions International Medical Con- 
gress, 1876, page 841. 
fAddress on Obstetrics by E. S. Lews, M.D., Transactions Ameri- 
can Medical Association, 1879, page 229. 
tManual of Midwifery, page 331. 6 
bolized oil during examinations. Directly after delivery 
the vagina is injected with a two or three per cent, solu- 
tion of carbolic acid, and also the uterus, should its cavity 
have been entered by the hand as in cases of the removal 
of the placenta, turning or post partum hemorrhage. Du- 
ring the puerparel state vaginal injections of two per cent, 
solution of carbolic acid are used twice daily, or repeated 
every two hours in cases of difficult labor, putrid foetus or 
retention of the ovum or placenta. Lacerations of the 
perineum are closed immediately with carbolized silk or 
cat gut sutures, and the vulva protected by a pad of 
picked lint soaked in a ten per cent, carbolized oil, which 
pad is frequently renewed. 
The antiseptic management of labor puerperal 
state, as a matter of prophylaxis, is very important but 
unfortunately it is imposssible in private practice to carry 
out all its minute details, yet as far as possible they should 
be complied with. 
The advantages which tar-water has over carbolic acid, 
chloride soda, thymol and other antiseptics, and which fit 
it especially for use during confinement, are : Ist. It is a. 
perfect antiseptic and disinfectant, while its odor is pleasant 
and agreeable, and such as not to offend the most fastidious. 
2d. The oily and resinous principles which it contains 
exerts a healing action upon the genital lesions, and 
suppuration is prevented. 3d. The ease with which tar- 
water can be obtained and its great cheapness places 
it within the reach of the poorest people. Tar-water is to 
be used as a vaginal wash three times daily during the 
lying-in period, and the cloths used to protect the 
and receive the discharges should be moistened with it. It 
may also be employed, should occasion demand, as a wash 
for the uterine cavity. 
The value of tar-water as a locaVjapplication in the treatment 
of certain diseases of the vulva,['vagina and bladder, and as an 
antiseptic and disinfectant after operations in gynaecological sur- 
gery.—Pruritus vulva? is one of the most distressing affec- 
tions peculiar to women, being usually not in itself a dis- 
ease, but symptomatic of a number of diseases of the female 
genito-urinary apparatus; it is frequently met with in 7 
practice, and is often very obstinate and rebellious to 
treatment. Dependent upon so many and different causes 
no single remedy can be expected to prove efficacious in 
■every case. The first effort of the physician should always 
-be, therefore, to find out in each instance the pathological 
•condition which produces the itching, and try to remove 
it by proper therapeutic measures. Often, however, the 
-etiology of the affection is so obscure and the distress of 
dhe patient so great that palliative treatment is immedi- 
ately demanded. 
When, as is sometimes the case, itching of the vulva is 
a pure neurosis, a hyperaesthesia or neuralgia of the puden- 
dal nerves, it is, of course, to be treated by remedies directed 
especially to the nervous system. This form of the affection 
is most usually met with during the early months of 
pregnancy, when, owing to the hypersemia of these parts, 
all the pelvic organs are in a state of nervous etherism. 
Sub acute inflammation of the vulva induced either by 
irritating discharges or eruptive disorders is most fre- 
quently the cause of prurituS-thus it is according to Dr. 
JSarnes, one of the earliest symptoms of uterine cancer, 
and it often occurs in the latter months of pregnancy 
caused by the acrid and profuse leucorrha which is present 
at the time. Itching is also met with in cases of chronic 
cervical and corporeal endometritis and vaginitis, the 
most obstinate form being that occurring after the meno- 
pause, caused by the scanty discharge of senile endome- 
tritis. During the course of diabetes, pruritus vulvse is a 
common symptom due, as Dr. Thomas has shown, to the 
local action of the altered urinary secretion. Certain skin 
diseases such as eczema, prurigo, lichen and scabies—when 
occurring on the vulva, give rise to itching just as when 
seated elsqjvhere. 
As excessive and acrid secretion is in the great majority 
of cases of pruritus vulvse the exciting cause of the ner- 
vous irritation, we have in tar-war a remedial agent 
which, used in connection with the other treatment 
appropriate to the case in hand, subserves a most valuable 
purpose. Its use in such cases as a vaginal injection and 
lotion to the vulva, neutralizes and renders innocuous the 8 
irritating discharges, and by its sedative and alterative 
action it restrains or stops the morbid process. When the 
pruritus is due to skin diseases, the benefit derived from 
the use of tar-water is readily understood in view of the 
long recognized curative value of tar preparations in the 
treatment of these affections in other parts of the body. 
In acute and chronic catarrhal vaginitis, tar-water 
used either alone or as a vehicle for other medicinal sub- 
stances is of the greatest benefit; its disinfectant and as- 
tringent properties render it especially valuable in gonorr- 
hoeal vaginitifs. In the latter months of pregnancy women 
frequently suffer from a profuse and very irritating leu- 
ccrrhoea, which comes from the upper part of the vagina, 
and is due to the congestion of the mucous membrane,, 
which presents granulations similar to that observed in 
cases of vaginitis from contagion. Doubtless in very severe 
cases of this affection the cauterization of the cervix, as 
advised by Dr, Henry Bennett, is necessary to effect a 
cure, but generally washing out the vagina with warm 
tar-water twice daily, is attended with such amelioration 
in the condition of the patient that the end of gestation 
may be awaited without resort to more active treatment. 
Leucorrhoea, great in quantity and purulent in charac- 
ter, is often met with in young girls, due to inflammation 
of the vulva, caused most frequently by uncleanliness,, 
though sometimes by the presence of ascarides, and by 
reflex irritation from the teeth and digestive organs. Con- 
stitutional influences such as the strumous diathesis are 
of great etiological importance, the discharge in such cases 
being of the nature of the otorrhoea, which is also common 
to these subjects. That uncleanliness is, however, the 
most usual cause of this affection is certain. M#. Bou- 
s 
chut has shown* that the pudendal glandAin the female,, 
like the preputial glands in the male, furnish a secretion 
which, when allowed to accummulate, invariably causes 
irritation, followed by catarrhal inflammation. In cases 
of this affection, frequent ablutions with tar-water, together 
with the internal administration of tonics and alteratives 
Gazette Obstetricalf-June 20, 1880, 9 
are rapidly curative. After each washing a pledget of lint 
soaked in tar should be placed between the labia. 
In the treatment of various uterine diseases hot tar- 
water vaginal irrigations, after the method of Dr. Emmet, 
is of great benefit. 
Prof. Skene mentions* tar-water internally adminis- 
tered as a remedy for chronic cystitis. In this disease the 
daily injection of the bladder with hot tar water in con- 
nection with appropriate internal treatment, is often 
attended with the most marked and rapidly beneficial 
results. By its use the decomposition of the urine in the 
bladder is perfectly prevented, and the cure of the inflam- 
mation of the mucous membrane, as evinced by the subsi- 
dence of vesical irritability, tenesmus and the stopping of 
the secretion of purulent mucous, is soon effected. 
After operations in gynecological surgery, tar-water 
has been found to be equal to carbolic acid solution in 
value as an antiseptic and disinfectant, while its greater 
virtue as an antipyogenic makes it more efficacious in 
preventing suppuration. 
of the bladder and urethra in women, page 195.