Reprinted from the 
University Medical Magazine, 
December, 1889. 
THE USE OF CARBOLIC ACID IN DIARRHOEA. 
In the vast collection of literature on the uses of carbolic acid in medicine, 
it is curious to note that its application in diarrhoea has received but little notice. 
In a literature running up into hundreds of articles, there are probably not over 
a dozen scanty notices of such a use. Judging from this fact, it would seem 
that it had been tried but sparingly in diarrhoea, for on all sides this drug has 
been thoroughly investigated, and every fact in regard to it has been published. 
Its failure as a specific in the fevers discouraged its internal use ; this 
disuse has been strengthened by the knowledge of its lack of general action, 
and distrust in its antiseptic power in the ordinary dose. Its antiseptic proper- 
ties suggested its trial in diarrhoeas, due more or less to fermentative changes 
in the alimentary canal ; but the results in such cases have been somewhat 
uncertain and disappointing. Its power to check such processes in the intes- 
tines, given in the usual dose, may be doubted. 
Undoubtedly its dominant action on the intestines is that of its well-known 
power of quieting the peripheral nerve-filaments, producing local anaesthesia. 
Dr. Wood, in his lectures on carbolic acid, has suggested this belief repeatedly, 
but has not incorporated it as yet in his ' ' Therapeutics' ' ; in the range of lite- 
rature on the subject there seems to be no other suggestion of this idea. Pro- 
bably where the drug has been satisfactory in its action, it was in those cases 
where an anaesthetic condition was beneficial. Hence the importance of decid- 
ing this point in the application of the drug is apparent ; for if it is used as 
an antiseptic, it is indicated early in the course of the diarrhoea, while as an 
anaesthetic it would be indicated when the bowel has been completely emptied, 
but remains hyper-sensitive, easily irritated by any outside influence such as the 
entrance of food, and the diarrhoea exhibits a tendency to linger and become 
lienteric. Clinical experience shows that this latter theory is more successful in 
actual practice. 
The English surgeons in the Indian Service are the only observers 
who report the extensive use of this drug in diarrhoeas and dysenteries; 
and their accounts bear out the local anaesthesia theory. Cullen {Indian 
Med. Gazette, Calcutta, 1871) reports that in the service it was found 
especially useful in diarrhoeas and dysenteries which had lasted for some 
time ; the diarrhoeas accompanied with intense griping and small mucous 
discharges ; the dysenteries of long standing, characterized by tender abdo- 
men, slimy passages, great straining at stool, and evacuation of very little 
fecal matter. In an exhaustive report on the use of carbolic acid in the 
Dondon hospitals {British Med. Journal, 1869), Dr. Clark states that in 
mucous diarrhoeas and mucous disease of the large bowel, the drug is a most 
successful agent when properly employed. He uses it in the form of an enema ; THE USE OF CARBOLIC ACID IN DIARRHCEA. 
2 
recommending a prior injection of chlorate of potassium, five grains to the 
ounce, to remove adherent mucus ; then the solution of carbolic acid is made 
in the strength of one grain to six ounces, and the whole given as a forced 
enema, to be retained for some time. There is more or less danger of poisoning 
from the free absorption of the drug unless the total amount is kept small. 
Dr. Putnam (Boston Med. and Surg. Journal, 1878) reports a case of anaesthesia 
of the rectum, followed by symptoms of poisoning, due to the injection of two 
drachms of the liquefied crystals in two pints of water. 
In experimentation, in various forms of diarrhoea, with this drug, it was 
my personal experience, in common with the above observers, that the remedy 
was of more use when the trouble was of long standing, and especially where 
it had resisted all other treatment. I give the report of three cases :- 
Case I.-Woman, aged forty, healthy, plethoric, but with a tendency to diarrhoea on 
slight cause since childhood. The present diarrhoea had been due to a slight indiscretion 
in diet; no attempt was made to check the trouble, at first, either by diet, medicine or rest. 
As her disorder grew worse, she began to treat herself; paregoric, laudanum, bismuth in 
large doses, etc., which had served to check her diarrhoea previously, were tried. All served 
to stop the discharges somewhat, as long as she remained in bed or on a lounge ; but as 
soon as she attempted to stay on her feet for any length of time the diarrhoea returned w'ith 
redoubled vigor. She began to feel debilitated, lost her appetite, and suffered from intense 
griping. As her discharges were scanty, and undoubtedly her bowels were clear from any 
irritating substances, liquefied crystals of carbolic acid, in three-drop doses, given with bis- 
muth, were ordered ; enough of this latter drug was used to absorb the liquid carbolic acid. 
This required about twenty grains of bismuth. With rest in bed and a restricted diet, and one 
of these powders every four hours, a change was gradually brought about. In a short time 
she was greatly relieved from the tormina and the discharges became normal in two days' 
time. 
Case II.-Woman, aged twenty, at service in the country. She had constant diarrhoea 
for three mpnths before she was seen ; this she attributed to the drinking water. She had 
grown pale, w'eak, and discouraged. She tried various household remedies without avail ; 
she was able to recognize in the discharges different articles eaten. She was ordered the same 
prescription as for Case I. ; her diet was restricted to boiled milk, and she was told to avoid 
the suspected water, and to perform as little work as possible. She reported herself as 
well in five days. 
Case III.-Colored man, who had brought on slight choleraic symptoms by working 
in the sun. He had been vomiting, and going to stool excessively for four days before he 
was seen. He felt a desire to go to the closet on the slightest motion ; the movements were 
small, bloody, and consisted principally of mucus. A prescription was ordered containing 
carbolic acid ; improvement was noticed in a short time. Next day the stools were reduced 
to six in the twenty-four hours, and in two days more the man was ready for light work. 
A good way to administer the drug is to combine it in an emulsion with 
bismuth and peppermint wTater. Dr. Davis (Transactions III. Med. Society, 
Chicago, 1871) suggests its combination with glycerine and paregoric. The 
English surgeons always gave it in the infusion of gentian or chiretta. 
J. Howe Adams, M.D. 
252 South Seventeenth Street, Phieadeephia.