Inunction

INUNCTION, one of the methods of introducing medicinal substances into the body through the skin, whereby the effect of the medicine can be general (as, for example, in syphilis) or only local (for example, in neuralgia, etc.). For inunction, medicinal substances are used in the form of oily or alcoholic liquids, ointments, pastes, and soaps. If the patient's skin is not perfectly clean, the area where the inunction must be performed is washed with warm water, wiped thoroughly, and washed again with cotton wool moistened with alcohol or ether. The substance that needs to be rubbed in is heated by placing the bottle or jar in which it is stored into hot water. Inunction is performed with circular movements of the fingers, the palm, or the entire hand under moderate pressure. If it is necessary to introduce the medicine over a larger area of skin, the hand movements must be uniform, long, and broad. If the inunction is done with a bare hand, the latter must be perfectly clean, soft, and warm, but more often the inunction is performed with the help of a cloth, a piece of chamois, leather, etc. For mercury inunctions, many different instruments have been proposed as applicators (a glass disk by Fournier; a brush covered with kid leather by Besnier; a pestle shaped like a mushroom, the cap of which is made of flax tow, tightly covered with boiled calf pericardium, by Pospelov), but the soft hand, which adapts to the irregularities of the body, is irreplaceable in this regard. The inunction of fatty substances continues until they are completely absorbed into the skin. In the case of mercury inunctions (frictions), it is desirable to entrust this procedure to the patient himself, if only because the physical exertion, by raising the body temperature, facilitates the entry of mercury into the body. As a general rule, however, inunction should be entrusted to a special person, since this procedure is usually tiring and many patients are incapable of it due to a lack of strength. On average, inunction requires 15–20 minutes, and sometimes 30 minutes (mercury frictions), for the complete introduction of the medicinal substance. The area where this procedure is performed is covered with a layer of cotton wool or oilcloth in order to, on the one hand, warm the site of the medicine's introduction and thereby facilitate its entry into the body, and on the other, to avoid soiling the linen. In cases where the condition of the skin does not permit inunction, the latter can be replaced by gentle spreading (according to Welander), using a spatula for this purpose, with which the ointment is evenly distributed on the corresponding surface of the skin, and then covered with a piece of linen. The so-called "clapping" method (Einklatschen) proposed by Herxheimer for better penetration of the ointment into the skin follicles, in which the ointment applied to the skin is introduced inside by light tapping with the lower part of the palm, has not gained wide distribution even in mercury treatment. When repeated introductions of medicinal substances intended to affect the entire body are necessary, one should avoid inunction of the ointment into the same place and should adhere, approximately, to the following order: 1st day—left shoulder; 2nd day—right shoulder; third day—chest; 4th day—back, if the patient is not doing the inunction himself, otherwise—the left and right lateral parts of the torso; 5th day—left thigh; 6th day—right thigh.