b'\nClass ~RHiz \n\nBook_ Is \n\n(bpyiiglitN \xe2\x80\x94 \n\n\n\n<\\QSo^ \n\n\n\nC4)FXRIGHT DEPOSIT. \n\n\n\nPHARMACOLOGY \n\nAND \n\nTHERAPEUTICS \n\n\n\nWILCOX \n\n\n\nB\\ THE SAME AUTHOR \n\n\n\nMATERIA MEDICA AND PHARMACY \n\nIn the companion book on Materia Medica and \nPharmacy full attention is given to pharmaceutical \nprocesses, to the various kinds of preparations, with \ntheir dosage, and to the art of prescribing ; after which \nthe description of remedies is taken up in detail. The \nlist of therapeutic agents is divided into two main parts, \nunder the heads of Inorganic and Organic Materia \nMedica, and the general classification adopted is one \nbased on the groupings of the articles according to the \nclass and chemical division or natural order to which \neach belongs. In order to make the book more com- \nplete, condensed descriptions of the action and thera- \npeutic use of all the remedies have been appended. \n\nThe two works combined offer, it is believed, a very \ncomplete and up-to-date presentation of the whole sub- \nject of Materia Medica and Therapeutics. \n\n\n\n,\' \n\n\n\nPHARMACOLOGY \n\n\n\nAND \n\n\n\nTHERAPEUTICS \n\n\n\n\nBY \n\nREYNOLD WEBB WILCOX, M.A., M.D., LLD. \n\nPROFESSOR OF MEDICINE AT THE NEW YORK POST-GRADUATE MEDICAL SCHOOL AND \n\nATTENDING PHYSICIAN TO THE HOSPITAL; CONSULTING PHYSICIAN TO THE NASSAU \n\nHOSPITAL; VISITING PHYSICIAN TO ST. MARK\'S HOSPITAL; EX-PRESIDENT CF \n\nTHE AMERICAN THERAPEUTIC SOCIETY J FELLOW OF THE AMERICAN \n\nACADEMY OF MEDICINE; VICE-CHAIRMAN OF THE REVISION \n\nCOMMITTEE OF THE UNITED STATES PHARMACOPOEIA ; \n\nETC. \n\n\n\nSIXTH EDITION \n\nBased on the Fifth Edition of White and Wilcox\' s \n\' \' Materia Medica and Therapeutics \' \' \n\n\n\nPHILADELPHIA \nP. BLAKISTON\'S SON & CO. \n\nIOI2 WALNUT STREET \nI905 \n\n\n\n\n\n\n*%i \n\n\n\na* A \n\n\n\nLIBRARY of CONGRESS \nTwo Copies Received \n\nDEC 19 1905 \n\nCopyrizht Entry \n\nCLASS (X. XXc. No. \n\nCOPY B. \n\n\n\n\n\n\nCopyright, 1905, by P. Blakiston\'s Son & Co \n\n\n\n"Authority to use for comment the Pharmacopceia of the United \nStates of America, Eighth Decennial Revision, in this volume, has been \ngranted by the Board of Trustees of the United States Pharmacopoeia! \nConvention, which Board of Trustees is in no way responsible for the \naccuracy of any translations of the official weights or measures or for \nany statement as to strength of official preparations." \n\n\n\nPress of \n\nThe New Era Printing Company \n\nLancaster, Pa. \n\n\n\nPREFACE. \n\n\n\n( \n\n\n\nIn revising White\'s Materia Medica and Therapeutics to \nbring it into harmony with the United States Pharmacopoeia, \nso much additional matter has been introduced into the five \nAmerican editions that it seemed advisable to re-write the book. \nThe eighth decennial revision of the Pharmacopoeia has given \nthe opportunity. /The many advances in the subjects here \ntreated have necessitated the division of the work into two dis- \ntinct parts, the first being devoted to Materia Medica and \nPharmacy, and this, the second, to Pharmacology and Thera- \npeutics. Tt is hoped that this natural separation of the subjects \nwill be acceptable to the physician and the student. \\/ In the \npresent work the classification employed is based on the par- \nticular physiological systems upon which the various drugs or \nother agents principally act. There is a complete list of drugs \nand preparations, without special description, except as to \ndosage, and very elaborate accounts of their physiological action \nand therapeutics are given. In these descriptions the effort has \nbeen made to present the latest views of the highest authorities \nin these departments, and to render the book as practically use- \nful as possible by full details regarding treatment. The two \nworks combined offer, it is believed, a very complete and " up- \nto-date " presentation of the whole subject of Materia Medica \nand Therapeutics. \n\nFor valuable assistance, in revision and in proof-reading, the \nauthor would acknowledge the esteemed services of Doctor P. \nBrynberg Porter. \n\nThe Author. \n\n\n\nCONTENTS. \n\n\n\nPage. \n\nDefinitions i \n\nModes of Administration of Drugs 2 \n\nDoses (Posology) 5 \n\nPharmacological and Therapeutical Actions 8 \n\nRelation between Chemical Constitution and Physiological \n\nAction 9 \n\nTheory of Ions 10 \n\nDivision I. Drugs Acting upon Organisms which Infect the \n\nHuman Body, or upon Processes Going on Outside It... 14 \n\nAntiseptics 14, 19 \n\nAnthelmintics 17, 112 \n\nAntiparasitics 18, 122 \n\nAntiperiodics 18, 128 \n\nDivision II. Drugs Acting on the Blood 148 \n\nDrugs Acting on the Plasma 148, 152 \n\nDrugs Acting on the Red Corpuscles \'. 149, 220 \n\nDrugs Acting on the White Corpuscles 151 \n\nDivision III. Drugs Acting on the Cardiac Mechanism 249 \n\nDrugs Acting upon the Heart Directly 250, 253 \n\nDrugs Acting upon the Vagus Centre 252, 305 \n\nDrugs Acting upon the Accelerating Centre 253, 323 \n\nDivision IV. Drugs Acting on the Vessels 324 \n\nDrugs Acting Locally on Vessels 325, 329 \n\nVaso-dilators 325, 329 \n\nVaso-constrictors 327, 380 \n\nEmollients and Demulcents 328, 438 \n\nDrugs which act on the Vaso-motor Centres 329 \n\nDivision V. Drugs Acting on the Skin 493 \n\nDiaphoretics 494, 496 \n\nAnhidrotics 495 \n\nDrugs Producing a Rash on the Skin 496 \n\nDivision VI. Substances Acting on the Urinary System.... 509 \n\nDrugs Increasing the Quantity of Urine Secreted 509, 516 \n\nDrugs Diminishing the Quantity of Urine Secreted 512 \n\nDrugs Rendering the Urine Acid 512 \n\nvii \n\n\n\nVlll CONTENTS. \n\nPage. \n\nDrugs Rendering the Urine Alkaline 512 \n\nAntilithitics 512 \n\nLithontriptics 513 \n\nDrugs Preventing the Urine from Decomposing 514, 538 \n\nDrugs Altering the Composition of the Urine 514 \n\nDrugs Acting on the Bladder and Urethra 515 \n\nDiuretics 516 \n\nDivision VII. Drugs Acting on the Bodily Heat 553 \n\nAntipyretics 553, 556 \n\nDrugs which Cause a Rise of Temperature 555 \n\nDivision VIII. Drugs Acting on the Respiration 567 \n\nDrugs Altering the Composition of the Air Inhaled 568 \n\nDrugs Acting on the Respiratory Centre 569, 573 \n\nDrugs Affecting the Bronchial Secretion , 570, 581 \n\nDrugs Relaxing Spasm of the Muscular Coat of the Bronchial \n\nTubes, or Antispasmodics 571, 600 \n\nDrugs Acting on the Vessels of the Bronchi 571 \n\nExpectorants 572 \n\nDrugs which May Sometimes Produce Cheyne-Stokes Breath- \ning 573 \n\nDivision IX. Drugs Acting on the Digestive Apparatus 606 \n\nDrugs Acting on the Teeth 606 \n\nDrugs Acting on the Salivary Glands 607 \n\nDrugs Acting on the Stomach 609, 627 \n\nDrugs Acting on the Intestines 617, 680 \n\nDrugs Acting on the Liver 624 \n\nStomachics 627 \n\nGastric Sedatives 673 \n\nPurgatives 680 \n\nLaxatives 680 \n\nSimple Purgatives 686 \n\nDrastic Purgatives 697 \n\nIntestinal Antiseptics 7 J 8 \n\nDivision X. Drugs Acting on the Nervous and Muscular \n\nSystems 732 \n\nDrugs Acting on the Muscles 73 2 \n\nDrugs Acting on the Peripheral Endings of Motor Nerves. 732, 744 \nDrugs Acting on the Peripheral Endings of Sensory Nerves. 733, 756 \n\nDrugs Acting on the Trunks of Nerves 735 \n\nDrugs Acting on the Spinal Cord 735. 772 \n\nDrugs Acting on the Brain 737, 802 \n\n\n\ni \n\n\n\nCONTENTS. IX \n\nPage. \n\nDrugs Acting on the Eye 742 \n\nDrugs Acting on the Ear 744 \n\nDrugs Acting. on the Sympathetic System 744 \n\nDrugs Increasing the Irritability of the Anterior Cornua \n\nof the Spinal Cord 772 \n\nDrugs which Depress the Activity of the Anterior Cornua. 783 \n\nGeneral Cerebral Stimulants 802 \n\nGeneral Cerebral Depressants 843 \n\nGeneral Anaesthetics 888 \n\nDivision XL Drugs Acting on the Organs of Generation 908 \n\nAphrodisiacs 908, 911 \n\nAnaphrodisiacs 909 \n\nEcbolics or Oxytocics " 909, 919 \n\nEmmenagogues 910, 930 \n\nSubstances which Depress Uterine Action 910, 932 \n\nDrugs Acting on the Secretion of Milk 911 \n\nDivision XII. Antitoxins and Serums 933 \n\nDivision XIII. Organic Extracts 945 \n\nDivision XIV. Drugs Acting on Metabolism 960 \n\nAlteratives 960 \n\nTonics 960 \n\nDivision XV. Drugs which Have no Marked Therapeutic \n\nProperties 986 \n\nIndex 997 \n\n\n\nPHARMACOLOGY AND \nTHERAPEUTICS \n\n\n\nDEFINITIONS. \n\nTherapeutics. \xe2\x80\x94 The application of remedial agents in the \ntreatment of disease. It includes : \n\nGeneral Therapeutics. \xe2\x80\x94 The application of curative \nagents other than drugs and medicines. E. g., diet, \nclimate, baths, venesection. \nRational Therapeutics. \xe2\x80\x94 Therapeutics based upon Phar- \nmaco-dynamics. E. g., the use of digitalis for mitral \ndisease. \nEmpirical Therapeutics. \xe2\x80\x94 Therapeutics based upon clin- \nical experiences only. E. g., the use of colchicum for \ngout. \nWith the exception of such incidental allusion to other \nagents as occasion may require, in this work will be \nconsidered only that part of Therapeutics which is \nconcerned with drugs. \nPharmacology. \xe2\x80\x94 The study of Materia Medica and Thera- \npeutics, including the origin, history, properties and uses of \ndrugs and medicines. It includes : \n\nPharmacognosy. \xe2\x80\x94 The study of the physical and chem- \nical characters of drugs, and the art of identifying and \nselecting them in accordance with those characters. \nPharmaco-Dynamics. \xe2\x80\x94 The study of the action of \nremedial agents upon the organism of man. or the \nlower animals in a state of health. \nTherapeutics. \xe2\x80\x94 Although the correct definition of this \nterm is as given above, yet it is. for want of a better \none. often used as the name of the branch of study \nwhich deals with Therapeutics. Therapo-Dynamics \n2 i \n\n\n\n2 PHARMACOLOGY AND THERAPEUTICS. \n\nhas been used in the same sense, but is faulty. Expe- \nrimental Therapeutics has been suggested, but is not \ncomprehensive. \nToxicology. \xe2\x80\x94 The study of the nature, effects and detection \nof poisons, substances which, introduced into the body inoppor- \ntunely or in excessive amounts, are capable of destroying life. \nCourses of study and treatises upon Toxicology are, for conveni- \nence, commonly made to include the subject of antidotes and \ntreatment, although this is, strictly speaking, a part of Thera- \npeutics. \n\nAttention must be paid to the manner, quantity and form in \nwhich drugs are given before entering upon a description of \ntheir actions and uses. \n\nMODES OF ADMINISTRATION OF DRUGS. \n\n(a) Into the blood-vessels by injection. \xe2\x80\x94 This method, while fre- \nquently employed in experimental researches upon animals, is resorted \nto only under extraordinary circumstances in the human subject. It is \nmost commonly used for infusion of what is known as normal saline \nsolution {see Sodium Chloride) after profuse haemorrhage and in vari- \nous forms of toxaemia. Among the objections to intra-venous injection \nare the difficulty of finding the collapsed veins and the danger, in punc- \nturing a vein, of wounding the opposite wall of the vessel. Again, \nphlebitis is very liable to result, and thrombosis or embolism may pos- \nsibly be caused. As a rule, hypodermoclysis {see below) is therefore \npreferable ; but if the symptoms are very urgent, the tissues cedematous \nfrom dropsy, or the circulation too feeble to insure absorption, infusion \nshould be practiced without hesitation. It is the most prompt method \nin cases of shock, and it has even been proposed, with a view to the \nprevention of shock, that the free use of intravascular hot saline infu- \nsion, injected while the patient is still under the anaesthetic, should be \nadopted as a matter of routine, after all severe operations. This, how- \never, should not be practiced before the operation, unless under excep- \ntional circumstances, for the increased arterial tension would be likely \nto cause increased haemorrhage during operative procedures. Intraarte- \nrial, as well as intra-venous, infusion is sometimes practiced. \n\n{b) Into the subcutaneous tissues by hypodermatic injection. \xe2\x80\x94 A \nperfectly clean syringe, fitted with an aseptic hollow silver needle, \nshould be used for the injection. A part of the body is selected (com- \n\n\n\nMODES OF ADMINISTRATION OF DRUGS. 3 \n\nmonly the external surface of the fore-arm), where the skin is lax. \nThe skin is raised between the thumb and forefinger of one hand, and \nwith the other hand the needle is inserted under it for about an inch, \ncare being taken to avoid muscles and veins. The syringe is slowly \nemptied, then withdrawn, and slight pressure is made for a moment \nover the puncture. The bulk of an injection, as a rule, should be \nabout .30 c.c. (5 m.). In order that abscesses may not result, the fluid \nshould be aseptic, non-irritating, and free from solid particles. If not \nfreshly prepared, it is advisable that a little boric acid should be added \nto it. Much the most convenient and satisfactory plan is to keep the \ndrugs for hypodermatic use in the form of soluble tablets, and to dis- \nsolve one in the required quantity of water at the time the injection \nis called for. The advantage of this method is that it secures a much \nmore rapid absorption than when the drug is given by the mouth, and \nit is ordinarily employed when the promptest possible effects are \ndesired. \n\nHypodermoclysis. By the bedside is placed an aseptic jar containing \nsterilized warm normal salt saline solution, to which air gains access \nonly by means of a glass tube filled with sterilized cotton. From the \nlower part of this vessel extends a tube fitted to a trocar, which should \nbe made aseptic. The skin over the part chosen for the infusion (pref- \nerably the ilio-lumbar region \xe2\x80\x94 the space between the highest part of the \ncrest of the ilium and the lower border of the ribs) having also been \nrendered aseptic, the trocar is thrust into the subcutaneous tissue, and \nthe solution allowed to flow at a rate not exceeding 4 c.c. (1 fl. dr.) to \neach 500 gm. (1 pound) of body-weight in each fifteen minutes. The \nnecessary pressure is obtained by the elevation of the container, and \nabsorption of the fluid is aided by gentle massage. This procedure has \nbeen employed with advantage to replace the fluid lost from the body \nthrough haemorrhage or through excessive purging, as in cholera ; also \nto wash from the body various impurities circulating in the blood and \nlymph and to flush the kidneys. It has likewise proved of service in \ncases of surgical shock and of threatened death from anaesthetics. Hy- \npodermoclysis, however, is slower than other methods in shock, on ac- \ncount of the poor general circulation, and is also open to the objec- \ntions that the introduction of a proper amount of fluid (1^2 to 2 litres \xe2\x80\x94 \n3 to 4 pints) requires quite a number of punctures, which cause pain \nsubsequently, and that such a bulk of fluid causes such tension of the \ntissues that at the temperature best adapted to prevent shock (48.8\xc2\xb0 \nC. \xe2\x80\x94 i2o = F.) sloughing may possibly result. \n\nEnteroclysis is also employed in shock and allied conditions, and not \n\n\n\n4 PHARMACOLOGY AND THERAPEUTICS. \n\ninfrequently in association with intravascular infusion. This consists \nof the irrigation of the intestine, commonly with a saline solution, and \nit is most satisfactorily practiced by means of a double-current tube. \nWith a return-flow tube in use the fluid does not cool, since fresh hot \nfluid is continually entering to replace the cooler which passes out. \nThe method is of service in warding off shock, and has been resorted \nto for this purpose after surgical operations. \n\n(c) Into serous cavities by injection. \xe2\x80\x94 This method is employed only \nto secure certain local effects in such cavities themselves, as to wash \nout antiseptically the pleura after it has been opened or to cause adhe- \nsive inflammation in the tunica vaginalis by the injection of irritants. \nIt has been proposed to introduce hot saline infusion directly into the \nabdominal cavity by means of a hollow needle for the purpose of com- \nbating shock. Also when this cavity is opened, as in coeliotomy, it \nmay be flushed with hot saline infusion for the same purpose. \n\n(d) Into mucous cavities. \xe2\x80\x94 The most common way of administering \ndrugs is naturally by the mouth, so that they may be absorbed from the \nmucous membrane of the stomach or intestine. Circumstances condu- \ncive to rapidity of absorption are an empty stomach and a ready solu- \nbility of the drug in the gastro-intestinal secretions. When it is in- \ntended that the drug shall act only in the intestine, pills, made pur- \nposely insoluble in the ga*stric fluids, are administered. It is probable \nthat some drugs are excreted in the bile by the liver, and so never reach \nthe general circulation. Pains should be taken to prescribe drugs in as \npalatable a form as possible and so combined as not to cause irritation. \n\nIt is sometimes advisable to administer drugs by the rectum, supposi- \ntories being employed for solids, and enemata or clysters for liquids. \nThe fact must not be lost sight of that they are not then so readily \ndissolved or absorbed as when given by the mouth. \n\nDrugs are also used for local effects, as by the urethra or vagina \n(injections, bougies, pessaries), or by the respiratory passages (in- \nhalations, cigarettes, sprays or nebulae for inhalations; insufflations \nfor blowing into the nose, throat and larynx ; pigmenta, gargarismata, \ntrochisci, for a local effect on the mouth and pharynx ; nasal douches \nfor the nose). Sprays are given by means of an atomizer. Sometimes \nvolatile drugs, as ether, chloroform and amyl nitrite, are inhaled for \ntheir general effect. \n\n(e) By the skin. \xe2\x80\x94 Certain drugs may be absorbed from the skin if \nmixed with some fatty substance, especially hydrous wool-fat. In this \nway mercury may be absorbed by being rubbed in. Some may also be \nabsorbed from the skin when they are volatilized. In this way mercury \n\n\n\nDOSES. 5 \n\nis introduced into the system by fumigation. The chief purpose, how- \never, for which drugs are applied to the skin is to secure their local \neffects, and for this they are employed in ointments, cerates, plasters, \netc. \n\nTo the eye and ear they are applied in washes and injections. \n\nDOSES. \n\nThe study of doses is called Posology. In determining the dose the \nfollowing points deserve attention : \n\n1. Age. \xe2\x80\x94 The adult dose is that for a person between twenty and \nsixty years old, but for women the dose should be somewhat smaller \nthan for men. \n\nFor Children under twelve Cowling\'s rule \xe2\x80\x94 divide age at next birth- \nday by twenty-four \xe2\x80\x94 is the simplest and is generally of sufficient exact- \nness. It must be borne in mind, however, that in the case of certain \ndrugs the dose may be relatively larger than for adults, while in that \nof others they must be relatively smaller. Thus, children bear iron, \nalcohol, arsenic, belladonna, hydrated chloral, rhubarb, and cod liver oil \nremarkably well, but can take only very small doses of opium and its \npreparations. \n\nFor persons above sixty the dose should be slightly diminished as the \nage advances. \n\n2. Weight. \xe2\x80\x94 In pharmacological experiments upon animals, in which \nit is customary to express the dose as a proportion of the weight, it \nhas been found that if the same amount of poison be distributed through \nthe tissues of a large individual as of a small one, less is contained in \nany given organ of the former, and less effect is therefore observed. \nThis no doubt holds true as regards man also ; so that somewhat larger \ndoses of drugs should be prescribed for very large persons than for \nthose of ordinary stature, while in the case of persons of unusually \nsmall size the dose should be proportionately diminished. \n\n3. Habit. \xe2\x80\x94 A person who takes a drug continuously usually becomes \nless and less susceptible to its influence. Thus, an opium habitue after \na time finds it necessary to use enormous doses of the drug in order \nto secure the desired effect. With strychnine and some other similar \ndrugs, however, the susceptibility increases, instead of diminishing, and \namong purgatives cascara sagrada appears to be an exception as regards \nhabit. \n\n\xe2\x96\xa0A. Idiosyncrasy. \xe2\x80\x94 Many individual differences in the matter of sus- \nceptibility are met with. These idiosyncrasies, which have frequently \nbeen observed with almost all commonly used drugs, consist of extra- \nordinary sensitiveness, or tolerance, or of entirely atypical actions. \n\n\n\nO PHARMACOLOGY AND THERAPEUTICS. \n\n5. Time of Administration. \xe2\x80\x94 Drugs must be given with careful at- \ntention to the time which they require to produce their appropriate \neffects. Thus, some hypnotics have to be administered several hours \nbefore it is desired that the patient should go to sleep for the night, \nwhile for others to act but little time is needed. In order to cause \na morning evacuation of the bowels, slowly acting purgatives must be \ntaken the evening before, but promptly acting ones simply before break- \nfast. Drugs which are readily decomposed by the contents of the stom- \nach should be given when that viscus is empty, preferably a half hour \nbefore the meal time. Experience has shown that the body is gener- \nally more resistant in the morning than in the evening, especially in \nthe case of narcotic drugs. \n\n6. Mode of Administration. \xe2\x80\x94 Drugs being absorbed much more rap- \nidly from the subcutaneous tissue than from the stomach and upper \nportion of the intestinal canal, smaller doses are required when they \nare administered hypodermatically than by the mouth. On the other \nhand, their absorption is slower from the rectum ; therefore to produce \nthe desired effect, the rectal dose must be larger. \n\n7. Mental Influences. \xe2\x80\x94 The mental condition of the patient some- \ntimes has more or less influence on the effectiveness of drugs. Thus, \nif his mind is particularly fixed on the action of a hypnotic, so that he \nfeels convinced that he will sleep, quite a small dose may answer the \npurpose ; but if, on the contrary, he is laboring under considerable \nmental excitement and feels that it is quite impossible for him to sleep, \nan unusually large dose may be required. \n\n8. Other Temporary Conditions. \xe2\x80\x94 Various other temporary condi- \ntions may influence the activity of drugs. As the drug is diluted by \nthe stomach contents, absorption takes place more slowly after a meal \nthan when the stomach is empty, and any local irritant action is less \nmarked. Irritation of the stomach or intestine may also modify the \neffects of drugs, and vomiting and diarrhoea naturally tend to diminish \ntheir activity by quickly removing them from the alimentary canal. \nDuring pregnancy drugs must be used with great care. Purgatives may \ninduce pelvic congestion, and thus lead to abortion, while drugs causing \na marked fall of blood-pressure may have the result of asphyxiation of \nthe foetus. Drugs acting directly upon the uterus are naturally to be \navoided, and also those whose effects may be transmitted from the \nmother to the child and do injury to the latter. During lactation cer- \ntain drugs are excreted in the milk, and these may either act on the \nchild or render the milk distasteful to it. At the time of menstruation \nall very active drugs must either be given with great caution or tern- \n\n\n\nDOSES. / \n\nporarily intermitted, and as purgatives tend to increase the flow, they \nshould generally be avoided. \n\n9. Temperature. \xe2\x80\x94 The action of drugs often being in part chemical, \nthe temperature may be a factor of some importance in determining \ntheir effects in the case of cold-blooded animals and excised structures, \nbut as in man the temperature range is so limited, this element may be \npractically disregarded in Medicine. \n\n10. Preparation of a Drug. \xe2\x80\x94 As a rule, a smaller dose of a soluble \npreparation, as a tincture, will be required than of a solid preparation, \nas a pill, which may be only slowly dissolved before absorption can \noccur, although in the latter case much depends upon the process of \nmanufacture. Pills which have been manufactured for a long time may \nbe entirely insoluble. \n\n11. Rate of Excretion\'. \xe2\x80\x94 In order to produce a prompt effect, a \nsmaller dose (other things being equal) will naturally be required of a \ndrug that is excreted rapidly than of one the excretion of which is \nslow. It is also true that, in order to maintain a continuous effect from \ndrugs which are rapidly excreted, the doses must be repeated at shorter \nintervals. \n\n12. Cumulative Action. \xe2\x80\x94 It sometimes occurs that in a person who \nhas been taking a drug for some time without the manifestation of any \nuntoward effects, symptoms of poisoning suddenly make their appear- \nance, or, at all events, that small doses of certain drugs taken repeat- \nedly for a considerable period eventually give rise to symptoms which \nare more marked than those caused by a single dose. Such a result \nis attributed to the cumulative action of the drug, causing an acquired \nsusceptibility, in consequence of which a given dose will produce more \npronounced effects than it did originally. This is the opposite of habit- \nuation, and it may be due to any one of the following causes : (a) \nGreater capacity for absorption than excretion, as in the case of lead \nand mercury. (&) Inconstant absorption, successive doses of the drug \nlying unabsorbed in the alimentary canal until such time as the condi- \ntions, in consequence of some alteration in the intestinal contents, may \nbecome favorable to absorption, when the whole amount is taken into \nthe system at once. This is sometimes met with in the case of digi- \ntalis, (c) Summation of effects, the effect of the preceding dose not \nhaving disappeared when the succeeding dose is given, (d) Sudden \narrest in the excretion of the drug. For instance, it is thought prob- \nable that in the case of digitalis the renal vessels become contracted \nwhen the quantity of the drug in the tissues has reached a certain \namount, so that excretion can no longer take place. It has been sug- \n\n\n\n8 PHARMACOLOGY AND THERAPEUTICS. \n\ngested also that the organism is subject to what may be called an edu- \ncation to the effects of drugs, particularly in the case of certain ones \nacting upon the central nervous system. Under this hypothesis the fact \nthat the susceptibility to strychnine increases with its administration \nwould be explained by the central nervous system\'s becoming educated \nto the stimulating actions and responding more readily to them. Cumu- \nlative action, it should be noted, may occur along with tolerance. Thus \nit is found that the tolerance of certain tissues for nicotine does not \nprotect others from the effects of the abuse of tobacco. \n\n13. Disease. \xe2\x80\x94 The action of drugs is liable to be greatly modified by \ndisease. This is seen, for instance, in the case of antipyretics, which \nhave little or no influence upon normal temperature, but have a pro- \nnounced effect in reducing pyrexia. The dose also must sometimes be \nchanged very much on account of the conditions produced by disease. \nThus, in peritonitis it is a matter of common observation that enormous \ndoses of opium are borne perfectly well. The same is true also in many \ninstances of hepatic, renal and other very severe forms of colic. \n\nThe tendency of modern therapeutics is towards smaller and more \nfrequently repeated doses. \n\nPHARMACOLOGICAL AND THERAPEUTICAL ACTIONS. \n\nBy the action of a drug is ordinarily meant its physiological \naction. \n\nThe primary action is that due to the unaltered drug. The emetic \naction of such drugs as zinc sulphate is an illustration of this. \n\nThe secondary action is that due to compounds formed from the \ndrug in the body. Thus, genito-urinary disinfectants like cubeb and \ncopaiba owe their effects in this regard to a combination with glycuronic \nacid, in which form they are excreted by the kidneys. \n\nThe local action is that produced at the point of application before \nthe drug enters the circulation. \n\nThe direct action is that produced upon organs and tissues with \nwhich it comes into immediate contact. \n\nThe indirect or remote action is that produced as a secondary result \nof the direct effect. The paralysis of the heart caused by chloroform \nis a direct effect, while the fall of blood-pressure which results from \nthis is an indirect effect of the drug. \n\nThe general or systemic action is the effect produced by the drug \nafter absorption, and is due to its elective affinity for certain organs \nto which it is carried by the blood. Most active drugs have an elective \n\n\n\nPHARMACOLOGICAL AXD THERAPEUTICAL ACTIONS. 9 \n\naffinity for special organs, as the heart or the central nervous system. \nXot only this, but they attack certain definite tissues. Among those \nwhich select the central nervous system, for example, some act pri- \nmarily upon the cerebral cortex, some upon the medulla oblongata, and \nsome upon the spinal cord. It is sometimes the case that a drug has \nthe effect of altering different structures in directly opposite ways. \nAtropine depresses the peripheral terminations of the secretory nerves, \nbut stimulates the brain, while curara paralyzes the peripheral \nmotor nerve endings, but stimulates the spinal cord. Different drugs \nshow great differences in the extent of the field of their activity, and \nwith most poisons the scope of this depends largely on the quantity \nadministered. Hence, one which in small doses affects the medulla \noblongata only, in larger doses may extend its influence to the brain and \nspinal cord, and when given in still larger amount act also on the heart \nand other organs. It is to be noted that the local effects of a drug may \nbe entirely different in character from its general action ; so that while \nit acts as an irritant at the point of application, it may be a depressant \nto the brain when it is carried thence in the circulation. For the rea- \nson that they are not absorbed or are absorbed in inactive forms, some \ndrugs have only a local action. Others, again, have only a local action \nbecause they are excreted or deposited with such rapidity that there is \nnot a sufficient quantity in the blood at any one time to produce any \ngeneral effects. Many powerful poisons, on the other hand, show only \nan elective affinity for some internal organ to which they are conveyed \nin the circulation, and have little or no local action. \n\nRelation between Chemical Constitution and Physiological Ac- \ntion. \xe2\x80\x94 While it is true that in a general way drugs closely resembling \neach other as to their chemical composition and properties produce \nsimilar effects upon the organism, as seen, for instance, in the case of \nthe heavy metals, yet it is found that when their physiological action \nis carefully followed* out, considerable differences in their effects are \ndiscovered. This is due to the circumstance that certain factors are \nmet with which are apparently quite independent of their chemical con- \nstitution, or, at all events, which it is impossible to deduce from the \nlatter. It is worthy of attention that the position of the radicals in the \nmolecule is sometimes of great physiological importance. Thus, resor- \ncinol (metadihydroxy-benzene) has a very sweet taste, while pyrocatechin \n(orthodihydroxy-benzene) is bitter. Moreover, substitution of one radical \nfor another in organic compounds often greatly modifies the action. It \ncan be stated, then, that it may be inferred with some probability that \nany substance belonging to a chemical group of similar constitution will \n\n\n\n10 PHARMACOLOGY AND THERAPEUTICS. \n\ngive rise to symptoms resembling in general character those of the \nother members of the group, provided that it does not contain some \nradical which renders it inactive or gives it a more powerful action in \nsome other direction. At the same time, the details of its action \ncan be determined only by actual experiment. It is also equally true \nthat the details of the chemical behavior of such substance can be \nascertained only by performing the necessary reactions, and the point \nhas therefore been well taken that as there is no prospect at the present \ntime of explaining the latter from its constitution, there is still less \nhope that much advance will be made in the near future in formulating \nthe laws governing the details of its pharmacological effects. \n\nThe Theory of Ions. \xe2\x80\x94 It remains to speak in this connection of the \ntheory of electrolytic dissociation and the underlying doctrine of the \nions, which, there is every reason to believe, will, by opening up new \nmethods of investigation, prove of the utmost importance in elucidating \ncertain aspects of physiological action and affording a rational explana- \ntion of many obscure therapeutic facts. Furthermore, it gives promise \nof varied therapeutic possibilities in the future. According to this \ntheory, when acids, bases and salts which, since they conduct the elec- \ntric current, are termed electrolytes, are dissolved, either all or a part \nof the molecules are split up by the solvent into simpler substances, \nthe electrically charged atoms or groups of atoms known as ions. In \nother words, ions are those constituent parts of the molecules which, \nunder the directive influence of an electric current, travel in opposite \ndirections through the solution. Those which take on a positive charge \nare called kations, and those assuming a negative charge, anions. A \nsimple illustration is afforded in the case of hydrochloric acid, a solu- \ntion of which is made up not only of HC1 molecules, but also of H \nions and CI ions. When such a solution is completely dissociated, it \nwould be put down as H+ and CI \xe2\x80\x94 . It is a fact, however, that while \nin a solution of hydrochloric acid there are dissociated chlorine ions, it \ndoes not contain free chlorine in the condition met with in a solution \nof chlorine gas. In solutions of a chloride the existence of chlorine \ncannot be demonstrated by its physical properties, but its presence can \nalways be recognized by its reactions. The circumstance that all chlo- \nrides, by reason of their chlorine, yield a certain set of reactions which \nare precisely the same, whatever the associated element may be, is re- \ngarded as one of the strongest proofs of the correctness of the disso- \nciation theory. Since all chlorides thus give off free chlorine-ions on \nsolution, notwithstanding that each one in its solid condition is charac- \nterized by its own special properties, it becomes clear why they present \n\n\n\nPHARMACOLOGICAL AND THERAPEUTICAL ACTIONS. I I \n\na common set of reactions. The importance is insisted upon of the \nfact that only those portions of the substance which are ionized are \nchemically active, the ionized condition being necessary for the rapid \nreactions which electrolytes display. With the exception of hydrogen \ndioxide, water, the universal solvent of the body, seems to cause the best \ndissociation of molecules into ions. Formic acid comes next in this \nregard, then nitric acid ; methyl alcohol is superior to ethyl alcohol, ace- \ntone and various ethereal salts follow, and the hydrocarbons are of \nonly feeble power. It has been found by experiment that only those \nsubstances which afford abnormal osmotic pressure in solution are capa- \nble of conducting the electric current, and if they are dissolved in other \nsolvents in which they behave normally, they lose this power. With \nour present knowledge concerning the mode of action of electro- \nlytes, it is evident that the ions which conduct the current must al- \nways be present, i. e., they are not formed by the current. The ions \nnaturally act as molecules, and so increase the osmotic pressure. The \nions which are formed from a substance, it has been shown, must neces- \nsarily be charged very heavily with electricity ; otherwise they would \nnot conduct the current. For example, in a solution of acetic acid \nthere are undissociated molecules of C 2 2 H 4 and ions of H -f- and \nCH3COO \xe2\x80\x94 . Since the ions are charged with electricity, they do not \nbehave as they would in the molecular state, i. e., they are not given off \nas gases. Furthermore, it is a fact that some ions are always charged \nwith positive electricity, while others are charged with negative ; but no \nion is known which is \'at one time positive and at another negative. \n\nThe physiological as well as the chemical effects of most of the elec- \ntrolytes have been found to be entirely dependent upon their constitu- \nent ions, quite irrespective of the nature of their molecules. Thus, all \nacids are characterized by H ions, and it is in consequence of this that \nthey all have certain general properties, while the differences between \nthe solutions of different acids containing the same number of H ions \ndepend upon the difference between their anions. The kation of acids \nis hydrogen; the anion of bases is the hydroxyl group (OH). The \ngeneral conclusion to be arrived at is, then, that the physiological effects \nof an electrolyte are for the most part determined by the character of \nits ions. While the principal characteristics of most of the substances \nwhich are of importance in therapeutics are fairly well known, it is a \ndesideratum to understand why or how it is that they produce their \nspecial effects, and so far as the electrolytes are concerned the theory \nof ions would seem to largely supply such knowledge. For instance, \nthe long-recognized community of the reactions of the dissolved salts \n\n\n\n12 PHARMACOLOGY AND THERAPEUTICS. \n\nof a given metal (being the same with respect to that metal whether \nthe chloride, sulphate, nitrate, or other salt is employed), received no \nadequate explanation until the promulgation of this theory. In the solid \nstate, and when undissociated in solution, each salt has individual at- \ntributes ; while in dilute solution, when dissociation is usually more or \nless complete, the properties of the salt are merely the sum of the \nproperties of its ions. If, therefore, a series of salts contains a com- \nmon ion, the properties of this will be common to all its members. As \nan illustration of this the behavior of iron salts has been cited. While \nall the simple salts exhibit common chemical reactions and have a \nvery similar physiological action, compounds such as the ferrocyanides, \nfor instance, neither yield the reactions of iron o"r exhibit the influence \nof the metal in their physiological effects. The explanation .would seem \nto be that the simple salts yield metallic ions on dissociation, but the \nferrocyanides yield the group ferrocyanogen, neither the chemical be- \nhavior or the physiological action of which is identical with that of \niron itself. It is plain that when a dissociable body is administered, \nnot one, but two separate agents are put in action in the tissues, so that \nthe effect of each of the ions must be taken into consideration. In the \ngreat majority of such substances in the organic materia medica, how- \never, the action of one ion is so much more powerful than the other \nthat the less important one may be practically disregarded. This is \nespecially true of the more toxic bodies. In the case of morphine sul- \nphate, for instance, while this exists in the body as a morphine and \na sulphate-ion, the action of the former ion is so much more powerful \nthan the other that the sulphate-ion is of no consequence. Evidence \nof this is furnished by the fact that morphine hydrochloride, which in \nthe body is dissociated into morphine and chlorine-ions, has practically \nthe same action as morphine sulphate. With less poisonous substances, \nhowever, both the ions may exert a more or less powerful influence. \nThus, we find that quite different symptoms are produced by potassium \nsulphate and potassium bromide, and this is because here larger amounts \ncan be administered, and the S0 4 and Br ions are present in sufficient \nquantities to elicit their specific actions, which are quite as important \nas that of the K-ion. What are ordinarily called the strongest acids \nand the \'strongest bases are those which, in a given solution, are most \nionized. The effects of an ion can be determined only by administer- \ning it along with another in the form of a salt, but certain ions, it has \nbeen pointed out, are so inactive in the tissues that, if any effect is \nnoted after a compound of which they form part, the action can be \nascribed with certainty to the other ion, unless the change arises from \n\n\n\nPHARMACOLOGICAL AXD THERAPEUTICAL ACTIONS. I 3 \n\nalteration of the physical properties of the fluids. Thus, the sodium \nion and the chloride ion have been ascertained to be both practically \ninert, except in so far as they change the osmotic pressure ; hence if \na sodium salt or a chloride be found to cause some change which is \nnot due to the physical alteration, the action is to be attributed to the \nother ion of the molecule. By osmotic pressure is meant the resis- \ntance offered by a non-permeating salt to the passage through a partially \npermeable membrane of the fluid in which it is dissolved ; and this varies \nwith the number of molecules and ions. (For additional remarks on \nthe subject of osmosis see Sodium Chloride.) \n\nSome further points deserve attention. Many observations point to \nthe conclusion that the irritability of muscle and nerve depend upon \nthe presence in them of compounds of proteid with the various ions, \nsodium, potassium and calcium, in definite proportion. Furthermore, \nit has been demonstrated by experiment that the physiological effects \nof certain drugs can be modified in definite ways by the addition of \nchosen radicals to the molecule. Thus, the convulsive action of strych- \nnine, brucine and thebaine on the spinal cord is changed to a paralyzing \neffect by the introduction of methyl into the molecule. Again, the in- \ntroduction of chlorine-ions into certain fatty molecules increases their \nnarcotic and toxic properties. The results of these recent investiga- \ntions would seem to afford ground for the opinion that in the forces \nof ionic attraction and repulsion is to be found the explanation of the \nrouleau formation of red blood-corpuscles, the agglutination of bacteria \nin appropriate media, and the obscure facts of chemotaxis, illustrated \nby the attraction or repulsion which certain chemical media have for \nsome bacteria and for leucocytes. Protoplasmic movements doubtless \ntake place by means of ions, the electricity-bearing portions breaking \ndown when in solution, and it has been suggested that toxic and anti- \ntoxic effects may be due to various alterations in the composition of \nprotoplasm forming living tissue. If a toxin which depends for its \nactivity on a large number of monovalent anions can be controlled, by \na small number of bivalent anions, or even ions of much higher valence \n(thus requiring a smaller quantity), the question of remedy is apparent. \nSo, among "antiseptics, picric and salicylic acids may be destructive to \nlow forms of life because they are easily dissociated in the tissue elec- \ntrolytes and liberate large numbers of poisonous hydrogen kations. \nMercuric bichloride and copper kations are for the same reason effec- \ntive, but the solution of a mercury salt in strong alcohol (a substance \nin which no electrolytic dissociation occurs) has no germicidal proper- \nties. The neutralization of the effects of carbolic acid by concentrated \n\n\n\n14 PHARMACOLOGY AND THERAPEUTICS. \n\nalcohol is susceptible of a similar explanation. Under ordinary condi- \ntions, ions of high valence are markedly disinfectant ; those of lower \nvalence less so. As regards mercury salts, dissociation may be re- \ntarded by the introduction into an aqueous solution of either alcohol \nor of another salt dissociating the same anions. For example, calomel \ntreated with increasing proportions of sodium chloride shows a steady \ndecrease of toxicity, the cause of which is the progressive suppression \nof the formation of mercury ions. The dissociating power of a solvent \nis believed to be a function of all the physical or chemical properties \nof a substance, and not of any one of them. The results of a great \nnumber of experiments all tend to demonstrate the chemical inertness \nof molecules. As the reactions proceed, and the ions already present \nare used up, it is found that the molecules are gradually dissociated and \nfurnish new ions, which then enter into the reaction. The chemistry \nof atoms and molecules has thus given place to the chemistry of ions. \n\nThe classification of drugs which is adopted here is one in accordance \nwith the parts on which they act. \n\nDivision I. \xe2\x80\x94 Drugs acting upon Organisms which infect \nthe Human Body, or upon Processes going on outside it. \n\nA. Antiseptics are drugs which prevent the growth of micro- \norganisms, destroy or render innocuous the toxic products of \ntheir action upon the tissues of the body, or interfere with the \nabsorption of such products. By some the use of the word \nantiseptic is limited to those substances which restrain the de- \nvelopment of micro-organisms, while those which destroy the \nvitality of the latter are designated as germicides or disinfect- \nants. The term disinfectant, by extension, is applied to those \nagents which kill non-pathogenic bacteria, as well as to those \nwhich destroy disease germs. Much discrepancy of statement \nis to be found regarding the fact of certain drugs being really \nantiseptics and as to the relative power of various antiseptics, \nowing to the circumstance that antiseptics act differently upon \ndifferent organisms, while the difference between inhibiting the \ngrowth of micro-organisms and destroying their vitality has \nbeen lost sight of. There are also certain factors determining \nthe efficiency of an antiseptic which ought to be taken into \nconsideration. Among these are the following: The nature of \n\n\n\nDRUGS ACTING UPON INFECTIOUS ORGANISMS. . I 5 \n\nthe antiseptic agent, the strength in which it is used, the temper- \nature at which it acts, the nature and number of the micro- \norganisms, the nature and quantity of the associated material, \nand the time of exposure. In testing the value of any antiseptic \nit is requisite that all instruments and substances employed in \nthe procedure should first be exposed to a temperature sufficient \nto destroy any adventitious bacteria. A cultivating medium, \nsuch as agar-agar jelly, having been placed in two test-tubes, \nthe substance to be tested, in suitable solution, is added to one \nof them ; after which some fluid containing the micro-organisms \nselected is poured into both the tubes. Both are then plugged \nwith sterilized cotton to prevent the entrance of germs from the \nair, and observation from time to time will show how far the \ndevelopment of the micro-organisms has been interfered with \nby the supposed antiseptic. As the potency of an antiseptic is \ndependent upon so many circumstances, it is impossible to deter- \nmine with exactness the relative efficiency of various agents. \nIn the following list some of the most powerful and generally \nused antiseptics are placed first. \n\n1. Heat is the best antiseptic, but there must be a temperature of \nat least ioo\xc2\xb0 C. (212 F.). Infected clothing, bedding, etc., may be \nheated in a dry-air chamber to between 93. 5 and 149 C. (200 and \n300 F.), but, on account of its superior penetrating qualities, steam, \ndriven, under pressure, through the articles is decidedly preferable. In- \nstead of this, the infected material may be boiled in water. Surgical \ninstruments are generally disinfected in this way, but one per cent, of \nwashing soda (sodium carbonate) should be added to the water to pre- \nvent their rusting. \n\n2. Corrosive Mercuric Chloride. \xe2\x80\x94 A solution of 1 in 1000 is com- \nmonly used for disinfecting the hands and is sometimes employed in \nsurgery and obstetrics. For most uses, however, one part to 3000 or \n5000 of water, or even weaker, is the limit of safety. Gauze of the \nstrength of 1 to 2000 will blister, if the skin is damp. \n\n3. Formaldehyde, the official solution of which contains at least 37 \nper cent., by weight, has extraordinary power as a surface disinfectant, \ngreater indeed than that of any known substance. . It is especially use- \nful for the disinfection of rooms and their contents when volatilized \nfrom a specially constructed lamp. \n\n\n\n1 6 PHARMACOLOGY AND THERAPEUTICS. \n\n4. Chlorine for most purposes is too irritating, but the gas (which \nis generated by the action of hydrochloric acid on potassium chlorate \nor manganese dioxide) may be used to disinfect rooms. It is open to \nthe objection that it attacks and bleaches many substances. \n\n5. Phenol, or Carbolic Acid, is used but infrequently. If surgical \ninstruments have been previously sterilized, the use of phenol indicates \na distrust, on the part of the surgeon, of his assistants. \n\n6. Lysol, 7, Creolin, and various cresol compounds are powerful anti- \nseptics and employed to a large extent. \n\n8. Chorinated Lime is the best antiseptic for all excreta. \n\n9. Bromine, and, 10, Iodine, are rarely used, as they are too irri- \ntating. \n\n11. Quinine, and, 12, Salicylic acid, are too expensive for ordinary \nuse. \n\n13. Iodoform is used for dusting upon wounds, sores, etc., but is \nobjectionable on account of its extremely disagreeable odor. It should \nbe previously sterilized. \n\n14. Boric acid is used for many surgical purposes. Since in about \na two and one-half per cent, solution it inhibits the growth of most \nbacilli, it may be employed to preserve solutions intended for hypoder- \nmatic use. \n\n15. Zinc chloride, and, 16, Potassium permanganate, are much used \nfor domestic purposes. \n\n17. Solution of Hydrogen dioxide is the principal ingredient of \nvarious popular disinfectants. \n\n18. Sulphurous acid, generated by the burning of sulphur, is used to \ndisinfect rooms. It should always be associated with moisture. \n\n19. Creosote, 20, Benzoin, 21, Zinc sulphate, 22, Ferric oxide, 23, \nThymol, 24, Alcohol, 25, Balsam of Tolu, 26, Balsam of Peru, are not \nmuch used. \n\nAs to internal antisepsis, the objection has often been raised \nthat there are no known drugs which when swallowed or inhaled \nwill with certainty destroy micro-organisms, either in the gastro- \nintestinal tract or respiratory passages, unless they are suffici- \nently concentrated to injure or prove fatal to the patient. By \nsome authorities, however, it is claimed that calomel, naphthol \nand some other agents are capable of destroying certain varieties \nof micro-organisms in the stomach and intestines ; and, whether \nthis is the case or not, it is undoubtedly a fact (and one that is \n\n\n\nDRUGS ACTING UPON INFECTIOUS ORGANISMS. 1/ \n\noften lost sight of) that an infinitely small amount of a remedy \nwhich could not be administered in sufficient amounts to destroy, \nwill often completely inhibit the growth of micro-organisms. \nSuch drugs should therefore be classed as internal antiseptics. \n\nAntizymotics are agents which arrest fermentation, and are \nsometimes divided into two groups, antiseptics and disinfectants. \nThe fermentative processes may be caused by organized fer- \nments, such as bacteria and the yeast-plant, or by unorganized \nferments (enzymes), such as pepsin, diastase, ptyalin, etc. \n\nDeodorants, or deodorizers, are substances which destroy foul \nsmells. The volatile deodorants are mainly oxidizing and \ndeoxiding substances which act chemically on the noxious \neffluvia, while the non-volatile deodorants are mainly absorbents, \nwhich condense and decompose them. Many antiseptics and \ndisinfectants are also deodorants. Charcoal is often called a \ndisinfectant, but is merely a deodorizer. \n\nB. Anthelmintics are agents which kill (vermicides) or expel \n(vermifuges) parasitic worms infesting the alimentary canal. \nThree kinds only of such parasites are commonly met with in \nthe temperate zone : \n\n(i) Tape-worm (Tenia solium and Tenia mediocanellata). Anthel- \nmintics: Aspidium (mostly used), Oleum Terebinthinse, Kamala, \nCusso, Granatum, Pelletierine Tannate (easily administered and very \nefficient), and Pepo. \n\n(2) Round-worm (Ascaris lumbricoides). Anthelmintics: Santonin, \nChenopodium, and Spigelia and Senna. \n\n(3) Thread-worm (Oxyuris vermicularis). Anthelmintics: Rectal in- \njections of salt water, infusion of quassia, solutions of iron salts, or \ndiluted oil of turpentine are commonly recommended. It is probable, \nhowever, that ordinary rectal injections are useless. Large soap and \nwater enemata, the patient being in the knee-chest position, give the \nbest results. Lime water is often very efficient. In the case of chil- \ndren it is advised that the lower bowel should be first emptied by an \ninjection of warm soap and water. The child should then be placed \nupon a bed with its buttocks elevated, and the tube of the syringe be \npassed gently within the inner sphincter. The fluid (soap and water, \nlime water, or salt and water), previously warmed, must be injected with \nsome little force, so that it may be lodged in the upper part of the rec- \n\n\n\nI 8 PHARMACOLOGY AND THERAPEUTICS. \n\nturn ; otherwise expulsive efforts will be immediately excited. It is best \nthat the enema should be given at bedtime in order that it may be re- \ntained for a sufficient length of time. \n\nAnthelmintics for the tape or round-worm should be given \nwhen the alimentary tract is empty, to ensure their coming \nin contact with the parasite, and a purgative is therefore \nusually given a few hours before the anthelmintic. If the latter \nis itself not also a cathartic, another dose of purgative medicine \nshould be administered after it, to bring away the worm or \nworms. When aspidium is employed castor oil should always \nbe avoided, as its use is attended with considerable danger. In \nthe case of tape-worm, in order to see whether the head is dis- \ncharged, each stool should be received into a separate vessel, \nthen mixed with water, and filtered through coarse muslin. \n\nC. Antiparasitics or parasiticides are substances which destroy \nparasites. The term is usually applied to those which are \ndestructive to the animal and vegetable parasites found upon \nthe cutaneous surface. \n\n(i) For the various forms of tinea the following are used: Mercurial \npreparations, especially the oleate, tincture of iodine, glycerite of \nphenol, an ointment of pyrogallic acid, a boric acid lotion, a sali- \ncylic acid lotion, sulphurous acid, formaldehyde and thymol; and \nif the patches are small, severe irritants, as croton oil, cantharides, \nand chrysarobin ointment. Tinea versicolor never requires severe \nirritants. \n\n(2) As parasiticides for itch, sulphur ointment, Balsam of Peru, and \nStyrax are all effectual. \n\n(3) Pediculi vestimentorum will be killed by any mild parasiticide. \nUnguentum Staphisagriae, unofficial ; 1 part powdered seed, 2 parts each, \nolive oil and lard, is often used. \n\n(4) Pediculi capitis and pediculi pubis are also easily killed by mild \nparasiticides ; mercurials or Unguentum Staphisagriae are commonly \nemployed. \n\nD. Antiperiodics are drugs which in diseases which recur \nperiodically lessen the severity of the paroxysms or arrest their \nreturn. Some, and probably all, act as direct poisons to the \nmicro-organism causing the disease. \n\n\n\nMERCURY. 19 \n\nThey are cinchona bark, quinine and its salts (by far the most pow- \nerful), quinidine, cinchonine, cinchonidine, arsenic trioxide, eucalyp- \ntus, hydrastis, salicin, salicylic acid, and berberine. They are used \nfor all forms of malarial fever and neuralgia. \n\n(All doses of official drugs and preparations are to be under- \nstood as the " average approximate (but neither a minimum nor \na maximum) dose for adults.") \n\nA. Antiseptics. \nMERCURY. \n\n1. HYDRARGYRUM.\xe2\x80\x94 Mercury. (Quicksilver.) \n\nPreparations. \n\n1. Emplastrum Hydrargyri. \xe2\x80\x94 Mercurial Plaster. \n\n2. Unguentum Hydrargyri. \xe2\x80\x94 Mercurial Ointment. \n\n3. Unguentum Hydrargyri Dilutum. \xe2\x80\x94 Blue Ointment. \n\n4. Hydrargyrum Ammoniatum. \xe2\x80\x94 Ammoniated Mercury. \n(White Precipitate. Mercuric Ammonio-Chloride.) \n\n5. Unguentum Hydrargyri Ammoniati. \xe2\x80\x94 Ointment of Am- \nmoniated Mercury. (White Precipitate Ointment.) \n\n6. Hydrargyrum cum Creta. \xe2\x80\x94 Mercury with Chalk. (Gray \nPowder.) Dose, 0.250 gm. (250 milligm.) ; 4 gr. \n\n7. Massa Hydrargyri. \xe2\x80\x94 Mass of Mercury. (Blue Mass.) \nDose, 0.250 gm. (250 milligm.); 4 gr. \n\n2. HYDRARGYRI CHLORIDUM CORROSIVUM. \xe2\x80\x94 Corrosive \n\nMercuric Chloride. (Corrosive Sublimate. Mercuric Bichloride. Cor- \nrosive Chloride of Mercury.) Dose, 0.003 gm. (3 milligm.); Y V \xc2\xa7*\xe2\x80\xa2 \n\n3. HYDRARGYRI CHLORIDUM METE.\xe2\x80\x94 Mild Mercurous Chlo- \nride. (Calomel. Mild Chloride of Mercury. Subchloride of Mercury.) \nDose (laxative), 0.125 gm. (125 milligm.); 2 gr.; (alterative), 0.065 \ngm. (65 milligm.); 1 gr. \n\nPreparation. \n\nPilulae Catharticse Composite.\xe2\x80\x94 Compound Cathartic Pills. \nDose, 2 pills. \n\n\n\n20 PHARMACOLOGY AND THERAPEUTICS. \n\nPreparation. \n\n4. HYDRARGYRI IODIDUM FLAVUM.\xe2\x80\x94 Yellow Mercurous Io- \ndide. (Mercury Protiodide. Yellow or Green Mercury Iodide.) Dose, \n0.010 gm. (10 milligm.); y 3 gr. \n\n5. HYDRARGYRI IODIDUM RUBRUM.\xe2\x80\x94 Red Mercuric Iodide. \n(Mercury Biniodide. Red Iodide of Mercury.) Dose, 0.003 gm. (3 \nmilligm.); ^ gr. \n\nLiquor Arseni et Hydrargyri Iodidi. \xe2\x80\x94 Solution of Arsenic \nand Mercuric Iodides. (Donovan\'s Solution.) Dose, 0.1 C.C.; \n\n6. HYDRARGYRI OXIDUM FLAVUM.\xe2\x80\x94 Yellow Mercuric Oxide. \n\nPreparations. \n\n1. Unguentum Hydrargyri Oxidi Flavi. \xe2\x80\x94 Ointment of Yel- \nlow Mercuric Oxide. \n\n2. Oleatum Hydrargyri. \xe2\x80\x94 Oleate of Mercury. \n\n7. HYDRARGYRI OXIDUM RUBRUM.\xe2\x80\x94 Red Mercuric Oxide. \n(Red Precipitate.) \n\nPreparation. \nUnguentum Hydrargyri Oxidi Rubri. \xe2\x80\x94 Ointment of Red \nMercuric Oxide. (Red Precipitate Ointment.) \n\n8. LIQUOR HYDRARGYRI NITRATIS.\xe2\x80\x94 Solution of Mercuric \nNitrate. \n\n9. UNGUENTUM HYDRARGYRI NITRATIS. \xe2\x80\x94 Ointment of \nMercuric Nitrate. (Citrine Ointment.) \n\nUnofficial Preparations. \n\nAmmoniae et Hydrargyri Chloridum. \xe2\x80\x94 Ammonio-Mercuric \nChloride. (Sal Alembroth.) \n\nEmplastrum Ammoniaci cum Hydrargyro (U. S. P., 1890). \xe2\x80\x94 \n. Ammoniac Plaster with Mercury. \n\nHydrargyri Carbolas. \xe2\x80\x94 Mercuric Carbolate. Dose, 0.02 to \n0.03 gm.; y, to y 2 gr. \n\nHydrargyri Cyanidum (U. S. P., 1890). \xe2\x80\x94 Mercuric Cyanide. \nDose, 0.001 to 0.008 gm.; ^ to T \\ gr. \n\nHydrargyri et Zinci Cyanidum.\xe2\x80\x94 Mercuro-Zinc Cyanide. \n\nHydrargyri Formamidas. \xe2\x80\x94 Mercuric Formamidate. Dose, \nhypodermatically, 1 C.C.; 15 tl\\,. \n\n\n\nMERCURY. 2 1 \n\nHydrargyri Oxidum Nigrum. \xe2\x80\x94 Black Mercurous Oxide. \n\nHydrargyri Subsulphas Flavus (U. S. P., 1890). \xe2\x80\x94 Yellow \nMercuric Subsulphate. (Turpeth Mineral.) Dose, 0.12 to 0.21 \ngm.; 2 to 4 gr., as an emetic. \n\nHydrargyri Sulphidum Rubrum. \xe2\x80\x94 Mercuric Sulphide. (Cin- \nnabar. Red Sulphide of Mercury.) \n\nHydrargyri Tannas. \xe2\x80\x94 Mercurous Tannate. Dose, 0.06 to 0.12 \ngm.; 1 to 2 gr. \n\nHydrargyrol. \xe2\x80\x94 Hydrargyrol. (Mercury Paraphenylthionate.) \n\nHydrargyrum Colloidale. \xe2\x80\x94 Colloid Mercury. Dose, 0.09 to \n0.18 gm.; iy 2 to 3 gr. \n\nLotio Hydrargyri Flava (B. P.). \xe2\x80\x94 Yellow Mercurial Lotion. \n(Yellow Wash.) \n\nLotio Hydrargyri Nigra (B. P.). \xe2\x80\x94 Black Mercurial Lotion. \n(Black Wash.) \n\nMercurol. \xe2\x80\x94 Mercurol. \n\nPilulae Antimonii Compositae (U. S. P., 1890). \xe2\x80\x94 Compound \nPills of Antimony. Dose, 1 to 3 pills. \n\nAction of Mercury and its Salts. \nExternal. \xe2\x80\x94 Locally the metal itself and many of its salts are \ninert. The action of others varies from that of a mild stimu- \nlant to the effect of a powerful irritant and escharotic. Thus, \nthe acid solution of mercuric nitrate is strongly caustic. Mer- \ncury and its salts are readily absorbed by the skin, so that the \nphysiological effects of the drug can all be produced by inunc- \ntion. When metallic mercury, rubbed into fine globules, is \napplied to the integument in ointment, it passes into the gland \nducts and along the roots of the hairs, and, after being oxidized. \nis dissolved and taken up into the tissues. It is also possible \nfor the vapor to be absorbed by the mucous membrane of the \nlungs, and this pulmonary absorption of the drug is not at all \nuncommon when mercurial preparations (many of which are \nvery volatile) are applied to the skin. Some of these prepara- \ntions, when thus locally applied, have considerable efficiency in \nallaying itching, however produced, and a large number of \nthem (among which may be mentioned the oleate, oxide, am- \n\n\n\n22 PHARMACOLOGY AND THERAPEUTICS. \n\nmoniate and corrosive chloride) are anti-parasitic, destroying \nthe animal and vegetable parasites which infest the skin. \nMercury, it has been proved, is possessed of great germicidal \npower. \n\nLower Forms of Life. \xe2\x80\x94 Its germicidal potency is due to the \nfact that it is poisonous not only to the higher plants and ani- \nmals, but also to lower organisms. Whenever it comes into \nintimate contact with albumins, it forms the albuminate and \ndestroys life, and there can be no question that corrosive mercu- \nric chloride and the other soluble salts of mercury are among \nthe most important antiseptics at present known. It has been \ndemonstrated that the bichloride in the strength of i to 50,000 \ndestroys infusoria in about twenty minutes, and that even a \nsolution of one part in one million destroys algae in the course \nof a few days. While the bacteria are somewhat more resist- \nant than these, it is claimed that a solution of 1 to 1,000,000 will \ndelay the development of some of them, and the anthrax \nbacillus, it has been found, fails to grow in blood which con- \ntains 1 part in 8,000. At the same time, it is now regarded as \nindubitable that the germicidal power of the bichloride has been \nconsiderably over-estimated; for, while it has been commonly \naccepted that a strength of 1 to 1,000 is sufficient to completely \ndisinfect fluids within a few hours, it has been proved that \nanthrax spores, after having been exposed to the action of a 1 \nper cent, solution for many hours, are still capable of develop- \ning as soon as the antiseptic is removed. Calomel, it has been \ndemonstrated, has some effect as an intestinal antiseptic; but, \nowing to the difficulty of bringing them into intimate contact \nwith the microbes, the insoluble salts are naturally much less \nefficient as germicides than the soluble ones. \n\nInternal. \xe2\x80\x94 Mercury, unlike other metals, has, as is shown by \nits powerful germicidal influence, a strong specific action on \nprotoplasm, and this property is due to its marked affinity for \nnitrogenous molecules. While its different salts have different \nexternal actions, yet after absorption their effects on the sys- \ntem are as a rule much the same. Both the local and general \n\n\n\nMERCURY. 23 \n\neffects of a soluble salt, such as the bichloride, are more pro- \nnounced than those of one like calomel (which is entirely in- \nsoluble in water) since it comes into more intimate contact with \nthe tissues, and so acts more energetically locally, while it is \nalso absorbed more rapidly and in larger amount. When, how- \never, a sufficient quantity of mercury in the form of calomel \nhas been absorbed, the general effects are the same as if an \nequal amount had been taken up by the tissues as perchloride. \nWhen mercury is absorbed, it has been shown that it circulates \nin the blood in the form of the albuminate, which is insoluble \nin water, but is rendered soluble by excess of proteid, and, also \nby such quantities of sodium chloride as are met with in the \ntissues. It has- a marked corrosive action, which, as has been \npointed out, is the more powerful because the precipitate formed \nwith proteids is less insoluble in the surrounding fluids of the \nbody, and is therefore more flocculent and affords less protec- \ntion to the surface, than those formed by the other heavy \nmetals; so that this destructive influence is not limited to the \nsurface of a tissue, but extends into the deeper cells. \n\nAbsorption and Elimination. \xe2\x80\x94 When mercury is administered \nregularly for a considerable time, elimination, which appears to \ntake place irregularly and intermittently, fails to keep pace with \nabsorption. It disappears from the blood and is then deposited, \nin less soluble form, in the tissues and organs, and it has been \nfound that this accumulation is especially liable to occur in cer- \ntain parts of the body like the kidneys, the intestinal walls, the \nliver, the spinal cord, and the medullary cavities of long bones. \nAbsorption of the drug may take place from all surfaces, and \nis said to be especially rapid from serous ones. It is excreted \nprincipally by the bowels, but also to some extent in the urine, \nsaliva, perspiration and milk. The excretion by the kidneys, \nwhich begins in about two hours after ingestion, has been \nnoted as long as six months after the use of mercury has been \ndiscontinued. Mercury has been found in serum and in pus \nfrom ulcers. \n\nAlimentary Tract. \xe2\x80\x94 The first evidences of mercurialism are \n\n\n\n24 PHARMACOLOGY AND THERAPEUTICS. \n\nmet with in the mouth. The initiatory symptoms are usually \na slight fetor of the breath, which is sooner or later accom- \npanied by a disagreeable metallic taste, and tenderness of the \nteeth when they are forcibly brought together or knocked with \na metallic substance. These are followed by stomatitis, spongi- \nness of the gums, swelling of the tongue, and profuse salivation. \nThat this condition is not due to any local action of the mercury \nis shown by the fact that it results in exactly the same way \nwhen the drug is administered by inunction or by subcutaneous \ninjection. The salivation is apparently due to the direct effect \nof the agent on the secretory apparatus, and sometimes it is the \nvery first symptom to make its appearance. If the administra- \ntion be continued, the quantity of saliva poured out becomes \nenormous; it is altered in character, contains mercury, and \nirritates the skin over which it flows. The fetor is excessive \nand the gums are intensely inflamed, being marked by a dark \nred line at the junction of the teeth, and bleeding at the \nslightest touch. Both the parotid and submaxillary glands are \nenlarged and tender. The teeth become loosened in their \nsockets and may drop out, and excoriations caused by the irri- \ntation of the drug lead to the formation of ulcers, particularly \nwhere there are accumulations of microbes, as around carious \nteeth. Finally, the maxillary bones undergo necrosis, as a re- \nsult of the penetration of these ulcers, which sets up periostitis. \nChildren under the age of three years are seldom salivated, but \nthey are not exempt from the other effects of mercury on the \nsystem. In the stomach the action of the drug is less marked \nthan in the mouth, but it may produce more or less hyperemia, \nand in cases of poisoning this is accompanied by small haemor- \nrhages. In the small intestine also it has comparatively little \neffect, but in the caecum and colon it gives rise to well-marked \nlesions. These consist of congestion and tumefaction of the \nmucous membrane, which later result in necrotic patches of \nconsiderable extent and ulcers about the folds; the appearances \npresented being practically identical with those met with in \nchronic dysentery. Perforation of the gut may eventually \n\n\n\nMERCURY. 2 5 \n\noccur. The intestinal inflammation is naturally accompanied by- \nexcessive purging and intense abdominal pain, with tenesmus. \nThe stools, which are fluid in character and sometimes present \na rice-water appearance, contain blood, mucus and shreds of \nmucous membrane. Small doses of the insoluble salts, how- \never, usually cause loose passages without any griping or strain- \ning. They pass through the stomach undissolved, it is be- \nlieved, but in the intestine, where time is afforded for the ex- \nercise of their affinity for epithelium, they become partially dis- \nsolved and produce the characteristic irritant effect of the drug. \nWhile a small proportion of such preparations is absorbed from \nthe bowel, by far the greater part passes off unchanged in the \nfaeces. It is possible, therefore, for very large doses of calomel \nto be taken without giving rise to any serious disturbance of \nthe system. That salt, it has been found, exerts no action on \nthe digestive ferments, but it has the effect of limiting the \ndecomposition of food by retarding putrefaction in the intestine ; \nits antiseptic action being aided by the removal of the decom- \nposing mass in consequence of the increased peristalsis which \niv induces. After the use of calomel a diminution of the double \nsulphates in the urine is noted, and this is to be attributed as \nmuch to its cathartic as to its antiseptic qualities. When calo- \nmel is administered it is likely that a small portion will be \nchanged into the corrosive chloride, thus enhancing its anti- \nseptic effects. Further, it should be noted that the same \ntransformation may take place after prolonged trituration with \nmilk sugar. \n\nLiver. \xe2\x80\x94 At the present time it is held that there is no \nsufficient evidence, either experimental or clinical, to show \nthat, with the exception of the corrosive chloride, which in- \ncreases the biliary secretion, the liver is in any way directly \naffected by mercurials. It was formerly universally believed \nand taught that calomel and some of the other mercurial purges \nincrease the secretion of bile, but this has been demonstrated, \nboth in the case of man and of animals, to be a mistake. This \nopinion was apparently based on the spinach-green color of \n\n\n\n26 PHARMACOLOGY AND THERAPEUTICS. \n\nthe stools after the administration of calomel, but the latter \nis now known to be due to the circumstance that the bile is \npreserved by this drug from putrefaction in the intestine. \nMercury, it has been shown, acts in the bowel even when the \nbile is suppressed, and the stools are often of a greenish color, \nwhich has been thought to be due to a metallic compound formed \nin the bowel, but which really results from bile pigment. Com- \nmonly this is decomposed by the microbes in the intestine, with \nthe formation of the faecal pigment, but mercury prevents, by \nits antiseptic properties, the growth of the microbes, and the \nbile therefore appears in the stools undecomposed and having \nits ordinary color. It is true that so-called " biliousness " is \nvery frequently relieved by mercurials, but this is readily ex- \nplained by the fact that the condition thus designated is one not \ndependent upon the liver, but a disorder of the alimentary tract. \nIn this and other affections where the good effects of mercury \nwere supposed to be due to its power to increase the flow of bile, \nequally satisfactory results may be obtained by the use of \nother remedies not regarded as cholagogues. At the same time, \nit is true, as mentioned, that the corrosive chloride does actu- \nally have some effect in increasing the amount of bile, and it \nmay possibly be the case that occasionally when calomel is \nadministered, some of it, owing to the presence of special condi- \ntions, is converted into that salt. \n\nKidneys. \xe2\x80\x94 Although it has recently been shown that mercury \nin the form of calomel has a decided diuretic action in rabbits, \nin other animals and in the normal human subject it generally \nhas but a comparatively feeble influence on the kidneys. When \ndropsy due to cardiac disease is present, however, it has been \nfound that a moderate dose of calomel induces marked diuresis. \nIn the accumulations of fluid resulting from cirrhosis of the \nliver and from renal disease its action in this respect is much \nless constant, but in many instances is still quite pronounced. \nWhile the question has not as yet been definitely determined, it \nseems probable that, since calomel and other salts of mercury \nare known to have an irritant effect upon the kidneys, the \n\n\n\nMERCURY. 27 \n\ndiuresis produced by them is due to their direct action upon the \nrenal epithelium. When small amounts of mercury are taken, \nthe excretion of the drug by the kidneys has not been found to \ncause any pathological changes in the organs, but if the ad- \nministration is continued for a considerable length of time, it \ngives rise to interstitial and glomerular nephritis; while large \namounts induce parenchymatous nephritis with glycosuria. The \nrelative quantity of mercury excreted by the kidneys is said to \nbe increased by the inflammatory changes occasioned. In acute \nmercurial poisoning, when death does not result in a few hours, \nanuria is frequently observed. While the whole kidney is con- \ngested and the glomeruli are acutely inflamed, the most dis- \ntinctive feature met with is a necrosis of the epithelium of the \ntubules in portions of the cortex; and the anuria is the result \nof these pathological changes. As in the case of certain other \ndrugs, such as bismuth and aloin, there is sometimes a deposit \nof lime in the kidneys. In mercurial poisoning this is very \ngenerally noted in rabbits, but less frequently in dogs and in \nman. When it occurs, the tubules are found to be filled with \na deposit of calcium phosphate, which is occasionally mixed \nwith some chalk. It is thought most probable that this is \nthrown out in the necrosed cells and that, as these break up, \nit passes into the tubules. As a rule, the more marked the \nintestinal disturbance, the less pronounced are the destructive \nchanges in the kidney in cases of poisoning, and it has been \nfound that the latter changes are most frequently caused by \ncorrosive mercuric chloride. \n\nNervous System. \xe2\x80\x94 Mercury has comparatively little effect \non the central nervous system. In acute poisoning the only \nsymptoms observed are secondary to the fall of blood-pressure, \nwhile consciousness is preserved to the last. In chronic poison- \ning, however, there are not infrequently noticed tremor, \nerythism and hallucinations, which appear to be of central \norigin. Sometimes there is a dulling of the faculties. The \ngeneral muscular weakness observed is believed to be due, not \nto any affection of the peripheral muscles and nerves, but to \n\n\n\n28 PHARMACOLOGY AND THERAPEUTICS. \n\nalterations in the centres. The paralysis which is sometimes \nseen in the limbs of workers in mercury has, on the other hand, \nbeen attributed to the action of the drug on the peripheral \nnerves, destroying the myeline sheath, and the areas of partial \nanaesthesia and the pains in the joints are also probably due \nto peripheral changes. When peripheral neuritis occurs, it \ntakes place much later than in the case of lead poisoning. In \nman the muscles do not appear to be directly acted upon in \neither acute or chronic poisoning. Even when paralysis is \ndeveloped, they maintain their irritability and do not undergo \natrophy. In some instances, especially when the tremor is pro- \nnounced, the reflex excitability of the spinal cord is found to be \nexaggerated, but as a rule it remains unaffected. \n\nCirculation and Respiration. \xe2\x80\x94 In some cases of acute poison- \ning patches of fatty degeneration have been found in the heart. \nFor the most part, mercury has but little direct action on the \ncirculation, and such changes as occur in the pulse are attri- \nbutable to the shock and collapse in acute, and to the cachexia \nand malnutrition in chronic, poisoning. When general poisoning \nis caused by the intravenous injection of the drug, however, it \nis found that there occurs a very marked fall of blood-pressure, \nwhich is due to a direct paralyzing action on the heart (involv- \ning both ganglia and muscle) and on the blood-vessels. The \nrespiration is affected only indirectly. The marked breathless- \nness which is sometimes observed in cases of chronic poisoning \nhas been ascribed to the general muscular weakness. \n\nThe Blood and Nutrition.\xe2\x80\x94 In health the red corpuscles and \nthe haemoglobin appear to be at first augmented and afterwards \ndiminished, and while the number of newly formed leucocytes \nhas been found to be increased, this is more than counterbal- \nanced by the decline in the older cells. In syphilis it has been \nnoted that a pronounced decline in the amount of haemoglobin \nis followed by an increase to beyond that present before the \ntreatment was commenced, while there have been found fewer \nnewly formed leucocytes, and more mature ones, after mercury. \nIt would appear, therefore, that the blood reaction is different \n\n\n\nMERCURY. 29 \n\nin health from that in syphilis, and that it varies in the succes- \nsive stages of that disease. Large doses of the drug destroy the \ncrasis of the blood and impair the general nutrition. Whether \nmercury affects the nutrition in any way except through its \naction on the alimentary canal is not definitely known. It has \nbeen stated by some authors that the urea is increased by the \nuse of small doses, but the investigation of these metabolic \neffects is very inconclusive and difficult, on account of the ex- \ntensive action of mercury on the kidneys and intestine, and \nthe prolonged administration of the drug is necessarily restricted \nto experiments on animals and on syphilitics. Very small doses \nmay perhaps act in much the same manner, and have the same \nbeneficial effect upon metabolism, as small doses of arsenic, the \nsubject gaining in weight, etc. It seems to be fairly well \nestablished that in animals, at all events, the nutrition and \nweight are increased by minute doses of mercury given for \nsome time. Chronic mercurial poisoning affects metabolism \nprofoundly, producing marked cachexia. \n\nThe Skin. \xe2\x80\x94 The excretion of mercury through the skin may \nproduce various cutaneous affections. The most common erup- \ntion is a polymorphic erythema, more or less resembling that \nof scarlet fever. In other cases it is erysipelatous in charac- \nter, with subcutaneous cedematous swelling, and still other \nforms are urticaria, roseola, pemphigus and purpura. Some- \ntimes there is produced a very severe eczema, which eventually \nbecomes pustular, and this is said to occur most frequently as \nthe result of inunction. Usually the eruption is evanescent, \nbeing followed by desquamation in two or three days ; but cases \nhave been observed in which there has been a grave generalized \ndermatitis, with marked swelling of the face and extremities, \nexcessive desquamation, subcutaneous infiltration, excoriation, \nfever, disturbance of the respiration, and prostration, resulting \neven in death. \n\nTemperature. \xe2\x80\x94 Mercury in itself has no effect on the body \ntemperature, but in severe ptyalism and in the more serious \ncutaneous affections caused by it there is always more or less \n\n\n\n30 PHARMACOLOGY AND THERAPEUTICS. \n\nfebrile reaction. In collapse resulting from poisoning by the \ndrug the temperature may fall several degrees below the normal. \n\nTherapeutics of Mercury and its Salts. \nExternal. Antiseptic Action. \xe2\x80\x94 Mercurials, and especially the \nbichloride, are at the present time used very extensively for \nantiseptic purposes in surgery and midwifery. Of the numer- \nous methods which have been proposed for disinfecting the \nhands, two, those of Welch and Fiirbringer (which is much \nsimpler), are considered trustworthy. They are described as \nfollows: Welch\'s method: (i) The hands and nails are thor- \noughly cleansed with hot water and soap, the water to be as \nhot as can be borne, and the brush used to have been first \nsterilized with steam. This preliminary brushing should occupy \nfrom three to five minutes. (2) The hands are rinsed in \nclean, warm water. (3) They are next immersed for one or \ntwo minutes in a warm, saturated solution of potassium perman- \nganate, and while in this solution they are thoroughly rubbed \nwith a sterilized swab of absorbent cotton. (4) They are next \nplaced in a warm, saturated solution of oxalic acid, and kept \nthere until completely decolorized. (5) They are then \nthoroughly washed in clean, sterilized water or salt solution. \n(6) Finally, they are immersed for two minutes in 1 to 500 \ncorrosive sublimate solution, rinsed in water, and dried. Fiir- \nbringer\'s method: (1) Remove all dirt under and around the \nnails. (2) Brush nails and skin of hands thoroughly with soap \nand hot water. (3) Immerse in alcohol, 95 per cent., for not \nless than a minute, and before this evaporates (4) plunge the \nhands in 1 to 500 corrosive sublimate or 3 per cent, carbolic acid \nsolution, and thoroughly wash them for at least a minute; after \nwhich the hands may be rinsed in warm water and dried. On \naccount of the difficulty of thoroughly disinfecting the hands, \nhowever, many surgeons have now adopted the practice of wear- \ning rubber gloves when operating, and such gloves are also \noften used by obstetricians. For washing the walls or \nfloors of infected rooms and furniture, linen and other articles, \n\n\n\nMERCURY. 3 I \n\nand for soaking towels, lint, sponges, etc., used in operations, \na corrosive sublimate solution of the strength of I to 1,000 is \nusually employed. The corrosive chloride cannot be used for \ndisinfecting metallic instruments, as mercury becomes deposited \nupon them. The use of this salt for vaginal injections and \notherwise in obstetrics is believed to have been one of the \nprincipal factors in the remarkable reduction of the death-rate \nwhich has in recent years been noted in lying-in hospitals. \n\nIn preparing a surface of the body for operation the part is \ngenerally scrubbed with green soap and warm water, and, after \nbeing shaved, is cleansed with ether or alcohol. It is then \nirrigated with a I to 1,000 bichloride solution, but if the skin is \nat all broken a very much weaker one is employed. For a \nsingle washing of wounds or cavities the strength should not \nexceed i to 2,000, and weaker solutions are preferable. For \ncontinued irrigation it should not exceed 1 to 10,000, and even \nthis strength has been known, when used in the peritoneal \ncavity, to give rise to toxic symptoms. Gauze washed in a \nweak bichloride solution is frequently used as a dressing after \noperations. In using the bichloride and other preparations of \nmercury as antiseptics it is often advisable to add about 5 parts \nof tartaric, citric or hydrochloric acid to 1 of the mercurial in \nthe solution employed, in order to prevent its uniting with the \nalbumin of the tissues. Otherwise an insoluble and useless \nmercury albuminate may be formed, and the antiseptic value of \nthe fluid be destroyed. Bichloride solutions should as a rule \nbe freshly prepared, but if it is necessary for any reason to keep \nthem for some length of time, either sodium chloride or a weak \nacid should be added to prevent decomposition of the bichloride. \nBichloride tablets, tinted blue for safety, which are made of \nsuch a strength that one dissolved in a pint of water makes a \nsolution of 1 to 500, are extremely convenient for ready use. \nMercuric biniodide (1 to 4,000 to 1 to 20,000) has been used to \na small extent as an aniseptic, and in eye surgery is said to be \npreferred by some to the bichloride, on account of its being less \nirritating than the latter. The mixed mercury and zinc cyanide, \n\n\n\n$2 PHARMACOLOGY AND THERAPEUTICS. \n\nas suggested by Lister, is unirritating. It is said to have but \nslight germicidal value, but its inhibitory power is so great that \na solution of I to 1,200 will permanently prevent putrefaction in \nanimal fluids. Cyanide gauze may be made actively germicidal \nby impregnation with a solution of 1 to 4,000 of corrosive \nmercuric chloride. The following reaction may be used to \ndetermine whether the corrosive mercuric chloride with which \ngauze has been impregnated has partially changed into the \nmild chloride : If a black color appears upon application of \nlime water, calomel is present. \n\nIrritant Action. \xe2\x80\x94 The Unguentum Hydrargyri Iodidi Rubri, \nB. P. (mercuric iodide, 2; benzoated lard, 48), is employed as \na dressing to indolent scrofulous and syphilitic ulcers. The acid \nsolution of mercuric nitrate is of service in the treatment of \nwarts, chancroids, syphilitic condylomata, mucous patches, and \nulcers of the mouth, while citrine and red precipitate ointments, \nproperly diluted, may often be applied with advantage to ulcers \nand sores, whether syphilitic or not, when a stimulating effect \nis desired. The application of solution of the nitrate is painful \nand may cause haemorrhage, and it should be used with caution \non account of the danger of giving rise to sloughing. It is \nrecommended that it should never be employed for venereal \nulcers in full strength, and as a substitute for its application \nRicord\'s method of treatment may be adopted. This consists \nof washing the sores or condylomata with solution of chlorin- \nated soda, and, after drying with absorbent cotton, dusting calo-. \nmel, or equal parts of calomel and starch, over the surface. \nWhen a milder preparation is required, black wash (Lotio Hy- \ndrargyri Nigra, B. P. \xe2\x80\x94 Calomel, 1; glycerin, 8; mucilage of \ntragacanth, 20; lime water, to 160) ; is also very commonly \nused. \n\nAntiparasitic Action. \xe2\x80\x94 Mercurial preparations are among our \nmost valuable applications in external parasitic affections. For \ndestroying lice upon the head white precipitate ointment, dilute \ncitrine ointment, and corrosive sublimate, in the form of a wash, \nare all used, and the same agents, particularly the latter, are \n\n\n\nMERCURY. 33 \n\nalso efficient in such conditions as scabies, favus, ringworm, \ntinea sycosis, and pityriasis versicolor. The oleate of mercury \nis employed to some extent for the same purposes, but it should \nbe considerably reduced in strength for most cases. The oleate \ndiluted with oleic acid, with the addition of one-eighth part of \nether, has been recommended by some. Unguentum Hydrargyri \nOleatis B. P. (Oleate of mercury, i; benzoated lard, 3), may \nalso be used. Caution should be exercised in not applying \nmercurials over too large an area, on account of the risk of \nthe production of toxic effects through absorption. \n\nCutaneous Affections. \xe2\x80\x94 A weak calomel ointment is often of \nservice in itching affections, especially around the anus. The \nUnguentum Hydrargyri Subchloridi, B. P., contains 10 per cent, \nof calomel. In impetigo contagiosa and ecthyma such an oint- \nment may be applied after separation of the crusts. Calomel \nointments, as well as white precipitate ointment with the addi- \ntion of a little menthol and cocaine, are also beneficial in herpes, \nherpes zoster, seborrhcea, and eczema, especially of the genital \norgans. An ointment which is highly esteemed in many skin \ndiseases is composed of equal parts of diluted mercuric nitrate, \nzinc oxide and lead acetate ointments. The B. P. Unguentum \nHydrargyri Nitratis Dilutum consists of 20 per cent, mercuric \nnitrate ointment, with paraffin. For chronic psoriasis and \neczema, especially of the hands and feet, an ointment composed \nof equal parts of mercuric nitrate ointment and lanolin, with a \nvarying amount of oil of juniper, has been found efficient. \nBlack wash and yellow wash (Lotio Hydrargyri Flava, B. P.: \ncorrosive mercuric chloride, 1 ; lime water, 240) may also be \nused to allay the itching of such cutaneous affections as pruritus \nsenilis and urticaria, if the disease is not too extensive in area. \nFor the local treatment of variolous pustules and also of erysipe- \nlas it has been recommended that the surface should be sprayed \nwith a solution containing 1 gm. (15 gr.), each, of corrosive \nmercuric chloride and either citric or tartaric acid, 5 c.c. (80 ^l) \nof 90 per cent, alcohol, and a sufficient quantity of sulphuric \nether to make 90 c.c. (3 fl. dr.). The following application has \n\n4 \n\n\n\n34 PHARMACOLOGY AND THERAPEUTICS. \n\nalso been found highly successful in erysipelas : Resorcinol (or \nnaphthalene), 5; ichthyol, 5; mercurial ointment, 40; lanolin, \n50. When the skin is not too tender, it is advised that the \nproportion of ichthyol should be increased. After the affected \nparts have been anointed with this they are covered with \noiled silk or other impermeable material, and then enveloped \nin a light dressing and bandaged. \n\nDiseases of the Eye and Ear. \xe2\x80\x94 In ophthalmic practice the \nointment of yellow mercuric oxide, known as Pagenstecher\'s \nointment or ophthalmic salve, is largely employed. Calomel is \nalso used as a sedative application in conjunctivitis and other \naffections. Before applying calomel to the eye, however, it \nshould first be ascertained whether the patient has had a course \nof iodine treatment, since, if this is the case, a caustic com- \npound may be formed between the mercury and iodine which \nmay set up violent inflammation of the conjunctiva and the \nlids, possibly resulting in almost complete loss of vision. \nLargely diluted citrine ointment is sometimes used in the place \nof Pagenstecher\'s ointment in the treatment of chronic bleph- \naritis, tinea tarsi, and eczema. Favorable results have been \nreported from the subconjunctival injection of a small quan- \ntity (0.12 c.c. \xe2\x80\x94 2 HI) of 1 to 1000 solution of mercuric bichlo- \nride in iritis (both syphilitic and non-syphilitic), choroido- \niritis, exudative choroiditis, central choroido-retinitis, and de- \ntachment of the retina. Mercuric cyanide has sometimes been \nemployed instead of the bichloride. This method of treatment \nhas also proved successful in some cases of sympathetic ophthal- \nmia, but appears to have failed in keratitis. It is stated to be \nnot adapted to cases in which the stasis of the local circulation \nprevents, either wholly or in part, absorption of the injected \nfluid. In ear affections an ointment of yellow mercuric oxide, \n0.32-0.65 gm. (5 to 10 gr.) to 30 gm. (1 oz.) of lard or cold \ncream, is used to a considerable extent to subdue inflammatory \naction. \n\nAbsorbent Action. \xe2\x80\x94 Oleate of mercury and the various mer- \ncurial ointments are used to a considerable extent to reduce \n\n\n\nMERCURY. 35 \n\nswellings and promote the absorption of subcutaneous effusions \nand the general products of inflammatory action. They are not, \nhowever, superior in efficiency to other agents for such pur- \nposes, and have the disadvantage of introducing the poison \nmercury into the system. While in some instances the con- \nstitutional effects of the latter may not be contra-indicated, in \nmany others they may prove decidedly objectionable and even \ndangerous. The likelihood of the occurrence of such absorption \nand its possible consequences should always be borne in mind. \nMercurial ointment, blue ointment, Scott\'s ointment (Unguen- \ntum Hydrargyri Compositum, B. P., which consists of mercurial \nointment, 10; yellow wax, 6; olive oil, 6; and camphor 3), or \nthe oleate in an ointment, may be applied in affections of the \njoints, orchitis and chronically enlarged glands. Chronic peri- \ntonitis has sometimes been treated with success by the use of a \nbinder spread with one of these preparations or the Linimentum \nHydrargyri, B. P., which consists of equal parts of mercurial \nointment, solution of ammonia, and camphor liniment. The \nointment of red mercuric iodide, somewhat diluted and applied \nbefore a hot fire or in the direct sunlight, is said, in numerous \ninstances, to have speedily reduced goitre and enlarged spleen. \nInternal. Alimentary Canal. \xe2\x80\x94 One of the most important \ninternal uses of mercury is as a purge, and the two preparations \nemployed for this purpose are blue mass and calomel. In the \ncondition commonly known as biliousness, which is character- \nized by lassitude, headache, constipation, nausea, yellowish- \ncoated tongue, yellow conjunctivse, and more or less " muddi- \nness " of the skin, either of these drugs at night, followed by a \nhydragogue cathartic in the morning, will often completely \nrelieve the symptoms, which are due, not to hepatic derange- \nment, but to disorders resulting from the putrefactive changes \nin the gastro-intestinal tract which are responsible for the con- \nversion of the green bile pigments into those of the faeces. \nThe dark, greenish stools following the use of mercurials is \nexplained by the abolition or lessening of these putrefactive \nchanges. The principal action of the mercurials, it is believed, \n\n\n\n36 PHARMACOLOGY AND THERAPEUTICS. \n\nis exercised partly upon the glandular system of the gastro- \nintestinal tract, and partly upon the, bacteria of the region, \nwhich, after being destroyed by the antiseptic properties of \nthe mercurial, are swept away by the succeeding purge. Blue \nmass is less certain and less energetic in its action than calo- \nmel. In conditions where there are loss of appetite, tympanites, \njaundice and whitish or clay-colored stools, and which are \nbelieved to be due to a catarrhal state of the mucous membrane \nof the hepatic duct and of the intestine, mercurials have long \nbeen highly esteemed on account of their supposed cholagogue \naction. It is true that they are generally efficient in removing \nthe symptoms, but it is in the manner just referred to, and it \nhas been found that such salines as sodium phosphate, mag- \nnesium sulphate and Rochelle salt will often answer equally \nwell. In conditions like the above and in others where there is \nconstipation, instead of giving a single full dose of blue pill or \ncalomel, the practice has now become quite commonly adopted \nof prescribing the latter in small doses, such as .016 to .006 gm. \n(y A to-j^gr.), thoroughly triturated with sugar of milk and \nrepeated every hour until a movement is secured. Some physi- \ncians stop the calomel after four or five doses have been taken, \nand give a dose of bitter water or Rochelle salt the next morn- \ning. Others give the calomel every fifteen minutes until six \ndoses of .006 gm. (y 1 ^ gr.) have been taken, and four hours \nafterward, a saline. The efficiency of the calomel is believed \nby many to be increased by combining with each dose .13 gm. \n(2 gr.) of sodium bicarbonate. The action of repeated small \ndoses of calomel has been found to be entirely satisfactory, \nwhile this plan of administration is much more comfortable for \nthe patient than the use of large doses. Mercurials are usually \nwell borne by infants and children. Gray powder (Hydrargy- \nrum cum Creta), in minute doses, has been advised for the sud- \nden vomiting immediately after the ingestion of food sometimes \nobserved in children. In cholera infantum and in other diar- \nrhceal diseases, both acute and chronic, it may also often be \nused with good effect. In cases of diarrhoea due to the pres- \n\n\n\nMERCURY. 37 \n\nence of some irritant in the intestinal tract, one or two doses \nwill not infrequently prove curative by removing the offending \nmaterial. Gray powder is a very useful purgative for children, \nand also for adults when a very mild effect is desired. Its ac- \ntion does not, as a rule, cause any griping, which is sometimes \nquite marked in the case of calomel. On account of their anti- \nseptic effects in the intestine, mercurials are given to a con- \nsiderable extent, especially in Germany, in typhoid fever. Some \nphysicians make it a practice to commence their treatment of \nthis disease with calomel. Calomel has also been recommended \nin Asiatic cholera, but it cannot be said that the results from it \nhave proved very satisfactory. Formerly large doses at con- \nsiderable intervals were often employed, but at the present time, \nwhen its use is resorted to here, it is more commonly given in \nsmall doses, frequently repeated, and also combined with opium, \nchalk, piperine, etc. It is stated, however, that large doses \n(1.30 to 4 gm. ; 20 gr. to 1 dr.) sometimes appear to arrest \nvomiting when other means fail, though given in such amounts \nit is liable to produce excessive ptyalism when reaction sets in. \nCardiac and Inflammatory Diseases. \xe2\x80\x94 In valvular disease of \nthe heart with dropsy mercury sometimes proves of great ser- \nvice when combined with digitalis and squill, as in Guy\'s diuretic \npill, which is composed as follows: Blue pill, powdered squill, \nand powdered digitalis, each, .06 gm. (1 gr.) ; extract of hyo- \nscyamus, .10 gm. (gr. 1^2). The drug is considered by many a \nvery valuable antiphlogistic agent, provided that its use be \nrestricted to the treatment of inflammatory action of a sthenic \ntype. Some authorities believe it to be the best remedy in \nsthenic endocarditis, and useful also in myocarditis and peri- \ncarditis. While mercuric bichloride is sometimes used instead \nof calomel in these affections, for the reason that it does not \nproduce catharsis, it has not usually been found as efficacious \nas calomel. When the latter is given as an antiphlogistic, \nopium is commonly combined with it, not only to prevent its \nacting on the bowels, but also to relieve pain and irritation. In \nmeningitis resulting from head injuries it has been recom- \n\n\n\n3 8 PHARMACOLOGY AND THERAPEUTICS. \n\nmended that a powder containing .015 gm. (% gr.) each of \ncalomel and powdered opium should be given every hour for \nfive or six hours, while at the same time an ice-bag is kept \napplied to the head. In the early stages of diphtheria and \ncroup mercury is thought to exert distinct prophylactic power. \nIt is generally given in the form of the bichloride, but some \nadvocate, as preferable, the use of calomel, administered in \nsmall repeated doses in dry powders, believing that the good \neffect of the mercurial is at least in part due to its diffusion \nover the diseased surface, and the consequent antiseptic influ- \nence thus produced. In both pneumonia and pleurisy large \ndoses of calomel have been highly recommended by certain \nclinicians, but the weight of opinion is to the effect that mercury \nis of decidedly less value in parenchymatous inflammations, \nsuch as pneumonia and hepatitis, than in those of a serous, \ncharacter, like pleurisy, pericarditis and peritonitis. It should \nbe carefully borne in mind that it ought never to be given in \nasthenic inflammatory conditions, and that in employing it as \nan antiphlogistic it should be exhibited during the stage of \nexudation, and to facilitate the absorption of the newly organ- \nized lymph. In the treatment of iritis the use of mercury has \nproved especially successful, and it is the common practice in \nthis affection to push the remedy to the point of ptyalism when- \never the tendency towards the exudation of lymph is marked. \nAlthough the matter has never as yet been practically demon- \nstrated, there is considerable ground for the belief that the \ndrug has the effect of diminishing the fibrin in the blood, and \nas in inflammatory conditions the latter is known to be in- \ncreased, it has been supposed that there is a certain antagonism \nbetween the processes of mercurialization and of inflammation. \nBefore leaving this branch of the subject, however, the state- \nment should be made that many modern authorities believe \nthat mercury has little or no remedial influence in acute in- \nflammation, either in the serous membranes or elsewhere, and \nthat as it is commonly combined with opium, whatever benefit \nis noted from such treatment in inflammatory affections is to \n\n\n\nMERCURY. 39 \n\nbe attributed to that drug. In iritis, in which the efficacy of \nmercurials is admitted by all, it is contended that the good \nresult is due to the fact that this disease is almost universally of \nsyphilitic origin. With the growth of this opinion in the pro- \nfession the antiphlogistic use of mercury has undoubtedly be- \ncome much more restricted than formerly. The various forms \nof the drug are now very commonly administered in the form of \ntriturates, made with sugar of milk, which contain about 10 \nper cent, of the mercurial preparation. Thus minutely sub- \ndivided, the remedy is found to be more readily absorbed. \n\nSyphilis. \xe2\x80\x94 Undoubtedly the most important of all the uses of \nmercury is in the treatment of syphilis. Whatever question \nthere may be as to its special utility in other conditions, all are \nagreed as to its preeminent value in this disease. Like quinine \nin malarial fever, it is universally conceded to be a true specific, \nalthough its precise mode of action has not as yet been deter- \nmined. While some authorities have contended that its cura- \ntive influence is due simply to the general effects upon metab- \nolism, it seems altogether probable that this is attributable to a \nspecific toxicity for the syphilitic virus, which, when the drug is \nadequately exhibited, finally results in the complete destruction \nof the latter. Some eminent syphilographers hold that the \naction of mercury is to clear away from the tissues the products \nof a specific inflammation, or at least to relieve tissues encum- \nbered with superfluous and obstructive material; but whether \nit develops a specific destructive action on the virus or not, the \nfact remains that mercury is employed in syphilis because \nexperience has shown indisputably that it cures the disease. \nIn order to secure the most satisfactory results it is requisite \nthat its administration should be commenced at the earliest pos- \nsible moment and that it should be continued for a considerable \nperiod after all manifestations of the disorder have disappeared. \nIts value in syphilitic condylomata, ulcerations, etc., has already \nbeen referred to, but here its local application is not sufficient, \nand an internal mercurial course should be entered upon just as \nsoon as the diagnosis is established. This should never be dis- \n\n\n\n40 PHARMACOLOGY AND THERAPEUTICS. \n\ncontinued under one year, and it is not infrequently necessary \nto maintain it, with periods of intermission, for several years. \nWhile all are agreed as to the efficacy of the drug in the first \nand second stages of syphilis, authorities differ as to its value \nin the third stage. As a rule, however, in the tertiary period \nit will be found that the best results can be obtained by the \nmixed treatment, as it is called, mercurials in combination with \nthe iodides, particularly potassium iodide. In most cases in \nwhich the disease is recognized early and in which mercurial \ntreatment is promptly instituted and faithfully carried out, no \ntertiary symptoms occur and the use of the iodide is entirely \nuncalled for. The dose of the remedy should be carefully regu- \nlated in accordance with the circumstances of each individual \ncase. The effort should be made, it is recommended, to give \nthe largest amount that can be borne without the production \nof gastric, buccal, or other irritation; in other words, to over- \nwhelm the disease without detriment to the general condition \nof the patient. In the earlier stages the proto-salts of mercury \n(and particularly mercurous iodide, known as the yellow iodide) \nare considered the most serviceable; later in the disease, espe- \ncially when used in conjunction with potassium iodide, it is \ncustomary to employ the persalts, the bichloride and biniodide \nbeing the most esteemed. By some authorities the subcutaneous \ninjection of mercurials is recommended, and under special cir- \ncumstances these agents are introduced into the system in \nvarious other ways than by the mouth. Mercury is as efficient \nin congenital syphilis as in the acquired form. \n\nMercurol is a chemical combination of nucleinic acid and \nmercury, the former being obtained from yeast. It is sometimes \nemployed in a 2 per cent, solution as an injection in gonorrhoea. \nThis apparently destroys the gonococci, lessens the severity of \nthe inflammation, and tends to prevent the development of com- \nplications. It does not entirely stop the discharge in some cases. \nIt has also been used in the local treatment of other purulent \nconditions of a specific character, such as conjunctivitis, oph- \nthalmia neonatorum, and otitis media, and also as an antiseptic \ndressing. \n\n\n\nMERCURY. 41 \n\nSal Alembroth has useful antiseptic properties, and one of its \nadvantages is that it does not combine so readily with albumin \nas corrosive mercuric chloride. For antiseptic purposes it is \ngenerally employed in the form of gauze (containing 1 per cent, \nof the sal alembroth) or wool (with 2 per cent.). Both are \ntinted with aniline blue, and as the latter is bleached by the \ndischarge, it can readily be seen when it has soaked through. \nSal alembroth, in doses of .02 gm. (-i gr.) to .60 c.c. (10 HI) of \nwater, is considered a convenient and non-irritating prepara- \ntion for hypodermatic use in the treatment of syphilis. The \nprecautions mentioned below (p. 44) should be observed. \n\nMercuro-Zinc Cyanide. \xe2\x80\x94 As an antiseptic, this has been \nclaimed to possess the advantages of being non-volatile, unirri- \ntating, insoluble in water, and soluble only in three thousand \nparts of blood serum; so that it is not easily washed off from \ngauze by discharges from wounds. Its germicidal value, how- \never, is stated to be very slight, though its inhibitory power is \nsuch that a one-twelve-hundredth solution will permanently pre- \nvent putrefaction in animal fluids. In order that mercuro-zinc \ncyanide gauze may be made actively germicidal it is recom- \nmended that it should be impregnated with a solution of one to \nfour thousand of corrosive sublimate. The gauze and wool, as \nusually prepared, contain 3 per cent, of the salt each, and are \nboth tinted pink. Mercuro-zinc cyanide has also been used \nin the form of an ointment. \n\nHydrargyrol, which chemically considered is mercury para- \nphenyl thionate, has been proposed as a substitute for corrosive \nmercuric chloride in antiseptic surgery. It is claimed that, \nwhile precipitating alkaloids and basic toxins, it does not pre- \ncipitate albumin, and that a solution of 4 to 1000 is non-irritant \nto the mucous membrane or skin and is not injurious to surg- \nical instruments. Its toxic properties, as shown by experiments \nupon animals, are decidedly less marked than those of corrosive \nsublimate. \n\nColloid Mercury has been put forward as a reliable antisyphi- \nlitic, the advantages of which consist in the facility with which \n\n\n\n42 PHARMACOLOGY AND THERAPEUTICS. \n\nit is absorbed, the fact that it does not irritate the skin, its slow \nand enduring action, and its comparatively slight virulence. It \nis said to be effective also, when incorporated in ointments and \nplasters, for the treatment of epididymitis, arthritis, lymphade- \nnitis, etc. Internally, in pill form, it has been recommended \nas a substitute for blue pill and mercurous protiodide, as well \nas for corrosive mercuric chloride. \n\nModes of administration of mercurials. \xe2\x80\x94 (i) By the mouth. \xe2\x80\x94 A num- \nber of the preparations of mercury most commonly used for internal \nadministration have already been spoken of. Among those not as yet \nmentioned is mercurous tannate, the dose of which is .06 to .12 gm. (1 \nto 2 gr.) given in a tablet triturate or pill. It is used to a considerable \nextent in the treatment of syphilis, and is well thought of by many. It \nis asserted that it passes unchanged through the stomach, but is rapidly \nabsorbed in the small intestine, and that it does not irritate the alimen- \ntary canal. The Liquor Hydrargyri Perchloridi, B. P. (corrosive mer- \ncuric chloride, 1 ; ammonium chloride, 1 ; water, 1000), is a favorite \npreparation, and is frequently combined with potassium iodide in ter- \ntiary syphilis. The usual dose is 4 to 8 c.c. (1 to 2 fl. dr.). When \nused with potassium iodide, there is formed mercuric iodide, which is \nkept in solution by the excess of the potassium iodide. Mercurous \niodide should never be given at the same time as potassium iodide, as \nthe latter immediately converts it into red mercuric iodide and metallic \nmercury. Gray powder, as has been mentioned, is much used in the \nintestinal disorders of children. It is also the most generally satisfac- \ntory preparation for internal administration in syphilis of early life. \nThe ordinary dose is .03 to .06 gm. (H to 1 gr.), which should be given \nfrequently enough to bring the system under the influence of the drug \nwithout affecting the bowels. By some high authorities it is consid- \nered the best preparation for continued use in syphilitic adults, as well \nas children. Mercuric carbolate has been found quite efficient. It is \nreadily absorbed and it is said that it may be given for a long time \nwithout producing ptyalism. For syphilitic ulcerations of the mouth a \nvery good wash may be made of corrosive mercuric chloride, .24 gm. \n(4 gr.), in 30.0 c.c. (10 fl. oz.) of water, to which is added 4 c.c. (1 fl. \ndr.) of diluted hydrochloric acid and a little glycerin. In syphilitic \nulceration of the tongue troches of liquorice, each containing .003 gm. \n(to \xc2\xa3*".) of the bichloride, are sometimes employed. Allowed to dissolve \nin the mouth, they produce a constitutional as well as a local effect. \nMercurials are not well borne by patients suffering from Bright\'s dis- \n\n\n\nMERCURY. 43 \n\nease, in whom ptyalism is more readily induced than in others, nor in \ngouty or scrofulous subjects. In the latter, mercurialization may give \nrise to very serious results, and where there is a gouty tendency neural- \ngia is often caused by small doses. \n\n(2) By the rectum. \xe2\x80\x94 By the use of suppositories patients can be \nbrought very rapidly under the influence of the drug, and occasionally \nthis method will be found of service. Each suppository may contain .30 \ngm. (5 gr.) of mercurial ointment. \n\n(3) Endermatically. \xe2\x80\x94 Mercurials, externally applied, produce a gen- \neral, as well as a local, effect, on account of their ready absorption. \nReference has already been made to the use of various lotions in sores, \nulcers and syphilitic condylomata, and the preparations in powder, par- \nticularly calomel, are often dusted on the surface in these conditions. \nMercury is now never administered by the strict endermatic method, \nwhich consists of removing the cuticle by a blister or other means and \napplying the medicinal agent directly to the true skin, as it is a pain- \nful procedure and the systemic effects of the drug may be much more \nsatisfactorily obtained in other ways. \n\n(4) By inunction. \xe2\x80\x94 Mercury applied by inunction is quickly absorbed, \nand this method has a well-recognized position in the treatment of \nsyphilis. Among the other conditions in which it has been found of \nservice is gonorrheal rheumatism. It is used to a considerable extent \nin the treatment of infants and young children affected with congenital \nor acquired syphilis, and also in the case of adults when it is desired \nto bring the system rapidly under the influence of the drug, and at the \nsame time to avoid disturbance of the digestive apparatus. Either mer- \ncurial ointment or the oleate of mercury may be used for this purpose, \nand the latter possesses the advantage of not staining the clothing. It \nis customary to rub a piece about the size of a marble upon the inner \nside of the thigh or arm once or twice a day, and it is advised to change \nthe application from place to place on account of the local irritation \nsometimes caused by the mercury. A hot bath previous to each inunc- \ntion no doubt assists absorption. If the patient does not apply the mer- \ncurial himself, it is advisable that the person doing so, in order to avoid \naccidental salivation, should be protected by a bladder or a rubber glove, \nand should also wash his hands thoroughly with soap after each appli- \ncation. Another plan is to rub the ointment on the soles of the feet, \nso that the exercise of walking may promote absorption of the remedy. \nIn the case of children it is often smeared upon the abdomen, after \nwhich the latter is covered with a flannel binder. It should be noted \nthat in the eighth revision of the U. S. Pharmacopoeia there has been \n\n\n\n44 PHARMACOLOGY AND THERAPEUTICS. \n\nintroduced an Unguentum Hydrargyri Dilutum (mercurial ointment, \n670; petrolatum, 330), with the name Blue Ointment, a designation \nwhich formerly was commonly applied to the official Unguentum \nHydrargyri (mercurial ointment). At the present day it is not re- \ngarded as necessary that mercurials should be rubbed into the skin \nwith friction, as it has been found that the mere fact of spreading \nthem upon the surface of the body and leaving them in contact with \nthe skin is sufficient to secure the physiological effects of the drug. It \nis asserted that in Paris syphilis has been successfully treated by the \napplication over the spleen of a plaster composed of calomel, 20, castor \noil, 6, and diachylon plaster, 60 parts ; ptyalism being prevented by the \nalternate use and disuse of the plaster for periods of eight days at a \ntime. Another method of external application is to paint the patient\'s \nback, after bathing, with a solution of gutta percha in chloroform, to \nwhich has been added a quarter of its weight of calomel. After the \nchloroform has evaporated the skin remains coated with a mercurial \nvarnish. Calomel soap, made by triturating pure olive oil soap with \ncalomel in the proportion of one to two or three, has been used by \nsome as a substitute for mercurial ointment. It is cleanly and non-irri- \ntating to the skin, and its use is said to constitute an efficient method \nof mercurialization. A rare complication which has been attributed to \nthe effect of mercury on the system is polyneuritis, and it is said that \nthis has especially been noted after the very free use of mercurial in- \nunctions. \n\n(5) Hypodermatically. \xe2\x80\x94 This method is now practiced to a consid- \nerable extent in special cases, and is a cleanly, rapid and efficient way \nof producing the constitutional effects of mercury without gastrointes- \ntinal irritation. It is said to be more successful than any other in pre- \nventing relapses in syphilis. The corrosive chloride is usually selected \nfor this purpose, and if properly employed seldom produces local irrita- \ntion, although instances have been recorded in which it gave rise to \nabscesses and sloughing. Care should be taken that the syringe and \nneedle are aseptic, and it is recommended that the needle should be \ndeeply inserted, preferably into the muscles on the outer side of the \ngluteal region. If much pain is caused by the injections, a piece of ice \nmay be held over the spot both before and after the insertion of the \nneedle, or cocaine may be injected immediately before the mercurial. \nBut one injection a day should be given, and it is advised that this \nshould be at bedtime. A solution of .06 gm. (1 gr.) of corrosive chlo- \nride in 8 c.c. (2 fl. dr.) of distilled water may be employed, and of this \n.60 c.c. (10 m.) may be administered at first, and the dose gradually \n\n\n\nMERCURY. 45 \n\nincreased until 3 c.c. (50 m.) is reached, or until constitutional effects \nare observed. As soon as this is the case the dose should be reduced \nto the minimum. In some old cases of syphilis, in emaciated, broken- \ndown subjects, it is recommended, instead of using daily injections in \nsmall doses, to give as much as .015 to .02 gra. (% to )/$ gr.) two or \nthree times a week. A large number of mercurial preparations have \nbeen proposed for subcutaneous injection, but none of them appears to \nhave any distinct advantage over corrosive sublimate ; while most of \nthem have been found considerably more dangerous. Among them may \nbe mentioned mercuric formamidate, which is neutral in reaction, readily \ncombines with water, does not coagulate albumin, and is not precipitated \nby alkalies. While generally well tolerated, the formamidate injections \nhave proved very much less reliable than those of the bichloride, and \nrelapses are stated to have been extraordinarily common after their use. \nThe subcutaneous employment of sal alembroth has already been referred \nto. Gray oil, which consists of mercury, lanolin and olive oil, is more \nor less used for subcutaneous injection, and by some is preferred to \nany other preparation for this purpose. Some clinicians have reported \nvery favorable results from the use of hypodermatic injections in \ninfantile syphilis, particularly, of corrosive sublimate and of gray oil. \nA form in which the bichloride is said to be less liable to produce pain \nor irritation than in simple watery solution is the glutin-peptone sub- \nlimate, which contains 25 per cent, of the drug. In using mercurials \nhypodermatically points of importance are to see that the part is well \nrubbed immediately after the injection, so as to dispel the local accumu- \nlation of fluid, and that injections are not given on successive days at \nspots near to each other. One of the evil effects which are liable to \nbe produced by the continued and free administration of mercurials is \nnephritis, and it has been found that the safest method of mercurializa- \ntion, so far as the kidneys are concerned, is by the hypodermatic em- \nployment of the corrosive chloride, while the most dangerous is prob- \nably the use of inunctions. Very deep intra-muscular injections are \nadvocated by some authorities as not only painless, but productive of \nthe best practical results. A Pravaz syringe-full of a preparation con- \nsisting of purified mercury, 20 ; lanolin, 5 ; vaselin, 35, is injected deep \ninto the tissues of the back once in fifteen or twenty days. \n\n(6) Intravenous injection. \xe2\x80\x94 This method has been recommended by \nsome as having certain advantages, one of them being stated to be more \nrapid absorption and therapeutic effect than by any other. It possesses \ncertain disadvantages also, and the opinion has been expressed by good \nauthorities that it should not be preferably used in cases, of syphilig \n\n\n\n46 PHARMACOLOGY AND THERAPEUTICS. \n\neasily amenable to ordinary treatment or in the early stages of the dis- \nease, though it is of special value in obstinate cases resisting other \ntreatment ; also in advanced cases of organic syphilis, or when immedi- \nate relief is urgently called for by reason of pain, encroachments on a \nvital part, or rapid destruction of tissue. Cases of cerebral syphilis \nwhich had proved unamenable to ordinary treatment have been reported \nin which this method was attended with excellent results. The injec- \ntion, which was practiced daily, was usually made into the superficial \nveins in front of the elbow, and the dose of corrosive sublimate (the \npreparation employed) was gradually increased from .0004 gm. ( T y2 S r -) \nto .0027 gm. ( Jj gr.). Mercuric cyanide has also been used for intra- \nvenous injection, and is preferred by some to the bichloride. One c.c. \n(15 m.) of a 10 per cent, solution, made with distilled water, is injected \ninto a vein at the bend of the elbow, after a rubber tube has been tied \naround the arm above. Before the injection is made the needle is first \ninserted and then unscrewed, to note by the flow of blood that it has \nentered the vessel. It is claimed that neither thrombosis nor embolism \nhas been observed in consequence of the procedure. By some writers, \nhowever, intravenous injections are considered so dangerous as to ren- \nder this method unjustifiable. Certainly neither intravenous nor hypo- \ndermatic injection should be resorted to in the ordinary routine treat- \nment of syphilis. \n\n(7) Fumigation. \xe2\x80\x94 Mercurial fumigations often prove highly service- \nable in syphilis, and by some the most satisfactory method of treating \nthe secondary eruptions upon the skin is believed to be by fumigation \nwith calomel two or three times a week, accompanied by the administra- \ntion of the iodides internally, with tonics whenever necessary, and proper \nattention to the general health. The black oxide and the red sulphide, \nneither of which is now official, are also used for fumigations. The \nmethod is as follows : The patient, having taken a warm bath to prepare \nthe skin for absorption, sits upon a chair and is covered with a large \nblanket or rubber cloth (a mackintosh cloak serves very well for the \npurpose), which is gathered in closely about his neck and extends down \nto the floor all around. The mercurial preparation, say 1.20 gm. (20 \ngr.) of calomel, is placed in a porcelain or metallic dish, over a spirit \nlamp, underneath the chair. The most satisfactory apparatus is one in \nwhich the alcohol flame sublimes the calomel and boils water at the \nsame time, and is made of sheet iron or tin plate. The centre, on which \nthe mercurial is placed, is flattened, and around this is a circular depres- \nsion, which is about one-third filled with water. The heat produced gen- \nerally causes profuse sweating, and the mercury, after having become \n\n\n\nMERCURY. 47 \n\nvolatilized, is deposited upon the cutaneous surface. In about twenty \nminutes the lamp is extinguished, and the patient is then wrapped in \nblankets and put to bed with the mercury still adhering to his skin. \n\n(8) Inhalation. \xe2\x80\x94 Inhalation is occasionally used independently of \nfumigation, and not infrequently in connection with the latter, the mer- \ncurial preparation being volatilized in the same manner. When it is \ndesired to practice it in conjunction with fumigation the patient is di- \nrected to inhale for two or three separate minutes during the bath. In \ndoing this he should not put his head under the cloak or blanket, but \nsimply allow some of the vapor to escape from the, upper part, and \nbreathe it mixed with a large proportion of common air. When inhala- \ntions are employed separately the amount of calomel used should not \nexceed .260 to .325 gm. (4 to 5 gr.), and the face should be held six \nor eight inches from the receptacle. Unless a local action on the buc- \ncal mucous membrane is desired, it is advisable that the mouth should \nbe rinsed out with potassium chlorate solution in order to prevent the \noccurrence of mercurial stomatitis. \n\n(9) Baths of 12 gm. (3 dr.) of corrosive mercuric chloride, with 4 \nc.c. (1 fl. dr.) of hydrochloric acid, or of 4 to 8 gm. (1 to 2 dr.) of \nthe chloride, with twice as much common salt, to each bath, were for- \nmerly used to some extent for syphilitic subjects with skin-lesions, but \nare now very rarely resorted to. Remarkably successful results, how- \never, have recently been reported in the treatment of small-pox, even \nof the most serious type, by means of corrosive sublimate baths. Twice \na day a bath-tub was brought to the patient\'s bedside and filled with \na warm (40.5\xc2\xb0 C\xe2\x80\x94 105\xc2\xb0 F.) solution of the bichloride (1 to 10,000), \nwhen the patient was immersed, except the head and shoulders, for ten \nor twelve minutes, the nurse gently rubbing the entire body with a \nsoft cloth during the bath. \n\nTOXICOLOGY. \nAcute poisoning is not infrequently met with, and corrosive subli- \nmate and white precipitate are the preparations usually taken. Corro- \nsive mercuric chloride in toxic dose at once produces a metallic taste \nin the mouth and intense pain in the throat and stomach, quickly fol- \nlowed by severe retching and vomiting. Soon there is hsematemesis, \nand violent purging also sets in, the stools at first being serous and \nafterwards bloody in character. The urine becomes very scanty, and \ncontains albumin, blood and casts. The pulse becomes weak and rapid, \nthe temperature is lowered, and there is marked depression of all the \nvital powers, often ending fatally in a short time. After death the \n\n\n\n48 PHARMACOLOGY AND THERAPEUTICS. \n\nprincipal lesions customarily found are marked membranous colitis and \nparenchymatous and hemorrhagic nephritis, with widespread degenera- \ntion of the renal epithelium and, less commonly, a peculiar deposit of \ncalcium phosphate. Treatment. \xe2\x80\x94 In case of acute poisoning the stomach \nshould be evacuated by means of the stomach-tube, if possible. If this \nis not available, vomiting should be promoted by mustard and luke-warm \nwater or apomorphine, or by irritation of the fauces. Albumin, in the \nform of the white of an egg (one being sufficient for .24 gm. \xe2\x80\x94 4 gr. \xe2\x80\x94 \nof the corrosive chloride, the albuminate redissolving in an excess), \nmilk and flour are useful. Tannic acid may also be given to protect \nthe mucous membrarfe. \n\nChronic Poisoning. \xe2\x80\x94 Except in workers in mercury, this is now much \nmore rarely observed than formerly, when it was the common practice \nto give large doses of the drug. The characteristic salivation, stomati- \ntis, and other effects of mercurialization have already been described. \nOccasionally metabolism was so profoundly affected that the resulting \ncachexia ended in death. The tremor frequently seen in those who \nwork in the metal and inhale the vapor resembles paralysis agitans, \nand the muscular weakness has been designated " mercurial palsy." A \nlow grade but obstinate inflammation of the tongue or the lips, which \nproceeds to ulceration, sometimes extends, as gangrene, to the cheeks \nand produces frightful deformity of the face. Treatment. \xe2\x80\x94 As in other \nchronic metal poisoning, the object of the treatment should be to pro- \nmote elimination by all possible channels. Sulphur baths and ordinary \nhot baths are of service. Diuretics may be given to assist the kidneys \nin carrying off the mercury, and the drinking of as much water as can \nbe conveniently borne should be enjoined. The bowels should be kept \nfree, but if diarrhoea is present it may call for treatment by opiates or \nother remedies. Opium is also sometimes required for the relief of \npain, and the other symptoms should be treated on general principles. \nIt is commonly believed that potassium and sodium iodide have some \neffect in causing the elimination of the metal, and while this claim has \nbeen disputed by some, it has never been disproved. Care should be \ntaken, however, that the doses are not too large, since attention has \nbeen called to the fact that the combination of iodine with mercury in \nthe tissues produces a soluble salt which is very active and which may \nsecondarily cause mercurial intoxication of the system. Belladonna is \nsometimes required to diminish the excessive activity of the salivary \nglands, and in all cases a potassium chlorate solution is useful as a \nmouth-wash in the treatment of salivation and stomatitis. Incidentally \nit may be remarked that it is the prevalent opinion that the free use \n\n\n\nFORMALDEHYDE. 49 \n\nof such a mouth-wash, together with frequent and careful brushing of \nthe teeth, is of material service in warding off ptyalism during the con- \ntinued administration of mercurials. Tincture of myrrh is frequently \nadded to it, and tannic acid solution is also sometimes employed as a \nmouth-wash. Careful attention should always be paid to hygiene, and \nthe general cachexia be combated by the most nutritious food, and \nsuch tonic or other remedies as may be called for. In establishments \nwhere mercury is used in the arts the same prophylaxis as in the case \nof lead is recommended. \n\nFORMALDEHYDE. \n\nFORMALDEHYDUM.\xe2\x80\x94 Formaldehyde. (Not official.) \n\nPreparation. \nLiquor Formaldehydi. \xe2\x80\x94 Solution of Formaldehyde. (For- \nmalin. Formol.) \n\nUnofficial Preparations. \nAmyloformum. \xe2\x80\x94 Amyloform. \nDextroformum. \xe2\x80\x94 Dextroform. \nGlutoformum. \xe2\x80\x94 Glutoform. (Glutol.) \nGlycoformalinum. \xe2\x80\x94 Glycoformalin. \nFaraformum. \xe2\x80\x94 Paraform. (Paraformaldehyde.) \n\nAction of Formaldehyde. \nFormaldehyde is regarded as equal in germicidal power to \ncorrosive mercuric chloride, while, on account of its volatility, \nwhich enables it to diffuse much more rapidly, it can be used \nfor purposes to which the latter is not adapted. At the same \ntime, it is only slightly poisonous to the higher animals. When \nthe vapor is inhaled, its most characteristic effect is marked \nirritation of the respiratory mucous membrane, causing bron- \nchial catarrh and a prickling and burning sensation in the \nnose and throat. Even when present in the atmosphere in very \nminute amount it gives rise to violent irritation of the air-pas- \nsages. It also excites increased secretion from the salivary and \nlachrymal glands. The powerful action of formaldehyde on \n\n5 \n\n\n\n50 PHARMACOLOGY AND THERAPEUTICS. \n\nmicrobes and on mucous membranes has been attributed to its \ncombining with some amide group in the proteids. Egg albumin \nand serum to which formaldehyde solution has been added is \nnot, it is stated, precipitated by heat and is less easily digested by \nferments, while casein so treated is not coagulated by the rennet \nferment. The urine of animals to which it is given, even in \nmoderate quantities, is found to be incapable of putrefaction. \nExperimental research has shown that a i per cent, aqueous \nsolution will destroy all pathogenic spores within an hour. \nThe drug has also a very powerful influence on various forms \nof organic matter, one part in four thousand completely decolor- \nizing wine, precipitating the extractive and coloring matters. \nThe efficiency of urotropin, now so much used as a genito-urin- \nary antiseptic, is thought to be due to the liberation of formal- \ndehyde from it. The penetrating power of the gas has been \nfound to depend largely upon conditions of moisture, but under \nfavorable circumstances is very considerable. When the watery \nsolution is swallowed by animals its first effect is the production \nof nausea and vomiting. The blood-pressure is increased at \nfirst and the cardiac rhythm is retarded, as the result, it would \nappear, of stimulation, direct or indirect, of the medullary \ncentres. As the poisoning progresses, narcosis and coma are \nproduced, and in rabbits convulsions and opisthotonos. In \ndogs the respiration is very markedly quickened a considerable \ntime before death. It has been shown that a portion at least \nof the formaldehyde which is absorbed passes through the \ntissues unchanged and is excreted in the urine, and it is thought \nnot unlikely that the whole of it may do so. Some observers \ndeclare that it is a blood poison, causing alteration in the form \nof the cells and leading to the production of hsematin, and \naccordingly believe it probable that this effect is the chief \nfactor in the intoxication caused by it. The fact has been \nnoted that when administered hypodermatically formaldehyde \nproduces less severe symptoms than when taken by the mouth, \nand this would seem to indicate that the effects caused by it \nare largely the result of its local action. So far as known, no \n\n\n\nFORMALDEHYDE. 5 1 \n\ncase has occurred in which it has caused in the human subject \nsymptoms other than those of local irritation. One case has \nbeen reported in which a man took several ounces of formalin, \nby mistake, and recovered from its effects in three days, and \nanother in which 30 c.c. (1 fl. oz.) was swallowed, and the \npatient recovered in a week. Externally applied, formaldehyde \nhas the effect of hardening the skin. \n\nTherapeutics of Formaldehyde. \nThe great practical value of formaldehyde as an antiseptic, \ndisinfectant, deodorizer and germicide is now universally ac- \nknowledged, and the literature on the subject has become very \nvoluminous. In the report of a series of careful experiments \nmade under the supervision of the Health Department of New \nYork City the following were among the conclusions reached: \nFormaldehyde gas is the best disinfectant at present known for \nthe disinfection of infected dwellings. It is inferior in pene- \ntrative power to steam and dry heat at 230 F., but for the \ndisinfection of fine wearing apparel, furs, leather, upholstering, \nbooks and the like, which are injured by great heat, it is better \nadapted than any other disinfectant. It is superior to sulphur \ndioxide as a disinfectant for dwellings because (1) it is more \nefficient and rapid in its action; (2) it is less injurious in its \neffects on household goods; (3) it is less toxic to the higher \nforms of animal life; (4) when supplied from a generator \nplaced outside the room and watched by an attendant, there is \nless danger of fire. It is claimed that by the addition of 10 per \ncent, of glycerin to the solution of formaldehyde the polymeriza- \ntion of the latter by heat is prevented, and hence that the so- \ncalled gly co formalin (consisting of formaldehyde, 30 parts, \nglycerin, 10 parts, and water, 60 parts), is superior for disin- \nfecting purposes to the ordinary aqueous solution. This pre- \nparation has been used to a considerable extent and appears to \nbe very efficient, but has certain disadvantages, two of which \nare the sticky condition many articles are found in after its \nuse, from a coating of glycerin, and the persistency of the odor \n\n\n\n52 PHARMACOLOGY AND THERAPEUTICS. \n\nleft by it. Although its irritant action is objectionable, and \nthe pain caused by the application of even a weak solution to \nulcerated surfaces is very considerable, formaldehyde has been \nemployed to quite a large extent in surgery, particularly in in- \nfected wounds, tubercular ulcers and abscesses, and infectious \ninflammations of the mucous membranes. The pain, it is found, \ncan be obviated by the previous application of cocaine used in \nglycerin (i to 4 per cent.) ; also, it does not cause so much pain \nwhen applied to a mucous surface. A one per cent, solution of \nformaldehyde is often efficient, but by some it is thought some- \ntimes better to apply a rather strong solution once or twice than \na weaker one more frequently. Among the affections in which \nthis agent has been found useful may be mentioned parasitic \nstomatitis, ozsena, atrophic rhinitis, blepharitis, mucopurulent \nand follicular conjunctivitis, septic abrasions or ulcerations of \nthe cornea (solutions of 1 part of formalin in 200 to 3000), the \npacking and drainage of pus cavities and sinuses, etc., in the \nplace of iodoform gauze, tuberculous joints (by injection), \npuerperal sepsis (by packing the vagina), and lacerations of the \nperineum or cervix uteri. In the form of inhalations or sprays \nit has been employed in pertussis, bronchitis, influenza, diph- \ntheria, the angina of scarlet fever, and pulmonary tuberculosis. \nIn dermatology also it has been used to a considerable extent, \nbeing found beneficial in lupus, psoriasis, acne rosacea (by \nintradermal injection), in axillary and palmar hyperidrosis, and \nin sweating of the feet. It is reported to be of service in the \ntreatment of the night sweats of phthisis, the skin being tanned \nwith an application of a solution made according to the follow- \ning formula: Formalin, 50 gm. (i\xc2\xa34 oz J Absolute Alcohol, \n50 gm. (i^4 oz.). This solution is applied to different parts \nof the body alternately, a protecting covering being employed \nover the part painted. The sweating is stated to be arrested \nalmost immediately, and that part of the body keeps free from it \nfor from five days to a month ; after which the treatment is re- \npeated. At the present time formaldehyde is used to a con- \nsiderable extent in dentistry, as well as in veterinary practice. \n\n\n\nCHLORINE. 53 \n\nInjections of its solution have proved remarkably successful in \nbovine anthrax. One of the useful applications of formalde- \nhyde is in the preservation of human bodies and of anatomical \nand pathological specimens. It is also largely employed as a \nfixing agent in histological work. For Urotropin (hexamethyl- \nenamine), which is obtained by the action of ammonia on \nformaldehyde, see Division VI., page 509. \n\nParaform, the polymeric form of formaldehyde, which is a \ncolorless, crystalline powder, insoluble in water, and gives off \nformaldehyde gas when slowly heated, is sometimes employed \nfor disinfecting purposes. It is stated that instruments may be \nabsolutely disinfected in fifteen minutes by the evaporation \nby means of heat of .30 gm. (5 gr.) of paraform in a chamber \none cubic foot square. A 5 per cent, solution of paraform has \nbeen highly recommended as a caustic agent for the treatment \nof cutaneous growths of various kinds, such as warts and the \nlike. \n\nG-lutol is a combination of formaldehyde and gelatin which is \nemployed as an antiseptic powder. Drying on the surfaces of \nwounds or ulcers, it seals them and renders them sterile, and \nit is said to be especially efficacious in burns. Other antiseptic \ndressings are Amyloform and Dextroform, compounds of \nformaldehyde with starch and dextrin respectively. \n\nCHLORINE. \n\nCHLORUM.\xe2\x80\x94 Chlorine. (Not official.) \n\nPreparations. \n\n1. Calx Chlorinata (Calx Chlorata, U. S. P., 1890). \xe2\x80\x94 Chlorin- \nated Lime. Chlorinated Calcium Oxide. (Bleaching Powder.) \nDose, 0.250 gm. (250 milligm.) ; 4 gr. \n\n2. Liquor Chlori Compositus (Replacing Aqua Chlori, U. \nS. P., 1890). \xe2\x80\x94 Compound Solution of Chlorine. Chlorine Water. \nDose, 4 c.c.; 1 fl. dr. \n\n3. Liquor Sodae Chlorinatae (Liquor Sodae Chloratse, U. S. \nP., 1890). \xe2\x80\x94 Solution of Chlorinated Soda. (Labarraque\'s Solu- \ntion.) Dose, 1 c.c; 15 n\\. \n\n\n\n54 PHARMACOLOGY AND THERAPEUTICS. \n\nUnofficial Preparation. \nElectrozonum. \xe2\x80\x94 Electrozone. \n\nAction of Chlorine. \n\nExternal. \xe2\x80\x94 Chlorine gas, which is soluble in water in the \nproportion of two volumes to one, is greenish in color and has \na penetrating and peculiar odor. It is intensely irritating to \nmucous membranes, and air containing even a small proportion \nof it affects the eyes, nose, fauces, larynx, bronchi and lungs. \nIt is also a fact that it acts more energetically upon the deeper \nthan upon the upper respiratory passages, so that an amount of \nthe gas which gives rise to comparatively little irritation of the \nnose and pharynx may excite bronchitis and pulmonary conges- \ntion and haemorrhage. It has been found that while one volume \nof chlorine vapor in one million parts of air causes a certain \namount of irritation, ten volumes in the same quantity of air, \nif inhaled for some time, will induce such serious effects as \nsevere bronchitis and haemorrhage and inflammation of the \nlungs. Applied to the cutaneous surface, chlorine water pro- \nduces heat and redness, and, if the gas is prevented from escap- \ning, will give rise to vesication. The germicidal action of chlo- \nrine is very pronounced, and in the presence of moisture it is \none of the most powerful of disinfectants and deodorizers. \n\nInternal. \xe2\x80\x94 Chlorine has a marked affinity for hydrogen, and \nas a result of its combining with the hydrogen of water, nascent \noxygen is set free and acts on the tissues. When taken inter- \nnally, chlorine is largely converted into hydrochloric acid, \nwhich afterwards becomes changed to chlorides during the \nprocess of absorption. A portion of it, however, it is thought, \nmay form proteid compounds in the body. The claim that it \nis excreted in the free state in the urine is now held to be \nunfounded, as well as the statement that free chlorine has been \nrecognized in the brain after death from its inhalation. It is \npoisonous chiefly by its local action. Except in small doses, \nchlorine water causes corrosive and intense inflammation of \nthe mouth, throat and stomach, with the production of collapse. \n\n\n\nCHLORINE. 55 \n\nAfter fatal poisoning from the inhalation of the gas, however, \nthe gastric mucous membrane is found to remain unaffected. \nApart from its local action, chlorine is said to have a narcotic \neffect upon the brain, and this has been attributed to the action \nof the proteid compounds mentioned. \n\nTherapeutics of Chlorine. \n\nExternal. \xe2\x80\x94 As a disinfectant chlorine has the disadvantage \nof injuring colored fabrics and wearing apparel. It may also \ncause inconvenient or even dangerous symptoms in persons \nusing it, unless handled with great caution. It is regarded as \ninferior to sulphurous acid anhydride, and still more so to \nformaldehyde, not from its being weaker in action, but be- \ncause it is more difficult to apply in sufficient quantity. The \nroom to be disinfected by it should be hermetically sealed, after \nthe removal or protection of all metals and of fabrics likely to \nbe injured or bleached. The gas can be generated from com- \nmon salt, 18; manganese dioxide, 15; and sulphuric acid, 45; \nin iced water, 21 parts by weight. As it is heavier than atmo- \nspheric air, the vessel should be placed on a high shelf, in \norder that the chlorine may be diffused throughout the room. \nFor chlorine disinfection of rooms chlorinated lime, with the \naddition of acid in excess, is used by many. To disinfect hands, \nmoistened chlorinated lime is spread over the hands, next a \nlarge crystal of washing soda is held in the hands, and they \nare washed, with rubbing, under water until a cooling sensation \nis experienced. The best disinfectant for excreta is fresh chlo- \nrinated lime, i; dissolved in water, 16. 960 c.c. (one quart) \nis placed in the receptacle into which the dejecta are received, \nand left one hour. It may also be used with good effect in \ndrains, sinks, closets, urinals, etc. \n\nWhen exposed in the sick room, chlorinated lime acts \nrather as a deodorizer than as a disinfectant. The chlo- \nrinated preparations, in dilute solution, are very useful for \ndestroying fetor in scarlet fever, diphtheria, aphtha? and gan- \ngrene, and also in gangrenous wounds, sloughing ulcers, foul \n\n\n\n56 PHARMACOLOGY AND THERAPEUTICS. \n\ndischarges, etc. The preparation known as electrozone, which \nconsists of sea-water the alkaline chlorides of which have been \nconverted into hypochlorites by electrolysis, is said to have \nabout the same antiseptic strength as Liquor Sodae Chlorinatae. \nChlorinated oil (olive oil saturated with chlorine) has been \nfound a very efficient remedy in scabies. Chlorine water is \nsometimes used as an antiseptic in eye operations and diseases. \nA wash consisting of strong hydrochloric acid, .30 c.c. (5 Al) ; \npotassium chlorate, .60 gm. (10 gr.) ; water, 30 c.c. (1 fl. oz.), \nwhich gives off free chlorine, is serviceable for syringing the \nnose and fauces in scarlet fever, and a combination of the \ntincture of ferric chloride with potassium chlorate, in which \nsome free chlorine is also evolved, constitutes an excellent \nantiseptic gargle. A strong solution of chlorinated soda makes \na useful application for the bites of snakes and insects, and in \nAustralia chlorinated lime, freshly prepared, is used in solu- \ntions of varying strength by hypodermatic injection as an \nantidote to serpent venom; the remedy being inserted into \nseveral points about the wound. \n\nInternal. \xe2\x80\x94 Chlorine water, in weak solution, is somewhat \nstimulant and tonic to the stomach. It has been successfully \nused, well diluted, in the diarrhcea of typhoid fever, particularly \nin markedly se\'ptic patients. After the administration of doses \nof 4 c.c. (1 fl. dr.) every hour the temperature falls, the intellect \nbrightens, the tongue clears, and betterment goes on to recovery \nin many apparently hopeless cases. This remedy was formerly \nconsidered of service in chronic affections of the liver, but \nis seldom used now for the purpose of acting on this organ. \n\nTOXICOLOGY. \n\nIn poisoning with chlorine taken by the mouth alkalies should be \ngiven to neutralize the acid formed, and albumin, in the form of eggs, \netc., is also of service. Narcotics may be called for to allay pain. In \npoisoning by inhalation, steam may be inhaled to diminish the irritation. \nAmmoniacal gas may also be given for the purpose of forming am- \nmonium chloride, but it should be remembered that the ammonia is \nItself irritant. \n\n\n\nPHENOL. 57 \n\nPHENOL. \n\n1. PHENOL (Acidum Carbolicum, U. S. P., 1890).\xe2\x80\x94 Phenol. (Car- \nbolic Acid.) Dose, 0.065 gm. (65 milligm.) ; 1 gr. \n\nPreparations. \n\n1. Glyceritum Phenolis. \xe2\x80\x94 Glycerite of Phenol. Dose, 0.3 c.c; \n5 Til. \n\n2. TJnguentum Phenolis. \xe2\x80\x94 Ointment of Phenol. \n\n2. PHENOL LIQUEFACTUM.\xe2\x80\x94 Liquefied Phenol. Dose, 0.05 c.c.; \n\n1 Til. \n\n3. CRESOL.\xe2\x80\x94 Cresol. (Tricresol.) Dose, 0.05 C.C.; 1 TT\\.. \n\nPreparation. \nLiquor Cresolis Compositus. \xe2\x80\x94 Compound Solution of Cresol. \n\nUnofficial Preparations. \nChlorophenol. \xe2\x80\x94 Chlorophenol. \nPhenosalylum. \xe2\x80\x94 Phenosalyl. \n\nAction of Phenol. \nExternal. \xe2\x80\x94 Phenol is an antizymotic of considerable energy, \nand, while not so powerful as some other agents of this class, at \ntimes constitutes a useful antiseptic and disinfectant. In suf- \nficient strength it is poisonous to all varieties of protoplasm, \nbut, like other antiseptics, it is much less toxic to microbes than \nto the protozoa and other simple forms of life. Again, it af- \nfects some species of microbes much less powerfully than \nothers, and it has been found that it takes as long as two days \nfor the destruction of the spores of the anthrax bacilli by a \nfive per cent, solution. It has also been found, however, that \nthe development and reproduction of many micro-organisms is \ngreatly interfered with, or altogether prevented, as long as \nthey remain in a solution of one part of carbolic acid to 400-600 \nof water. It seems to be well established, moreover, that one \nper cent, in an aqueous solution will destroy with certainty the \nvirulence of ordinary septic and purulent matters, of the tubercle \n\n\n\n58 PHARMACOLOGY AND THERAPEUTICS. \n\nbacillus, and of the micrococcus of fowl-cholera. While some \nof the putrefaction germs are also destroyed by solutions of \nthis strength, it is requisite that the action should be maintained \nfor about two hours in order to insure this, and for the destruc- \ntion of the infection of vaccine and of glanders a two per cent, \nsolution is required. In oily solution the antiseptic influence \nof carbolic acid is extremely slight. \n\nPhenol has the property of precipitating albumins and other \nproteids in solution, and also whenever it comes in contact with \nthe tissues, and its action in this respect has been compared \nwith that of alcohol, in which the proteid is precipitated, it is \nalleged, not because an insoluble compound is formed, but be- \ncause of a change in the nature of the solvent. Hence it is \nargued that carbolic acid must penetrate more thoroughly than \nthe metallic antiseptics, which are rendered insoluble by the \nalbumin they meet, and whose action therefore tends to remain \nconfined to the surface. In sufficient concentration carbolic \nacid has a mild escharotic action. When applied momentarily \nto the cutaneous surface it produces at first a burning sensation \nand a white discoloration, followed by a reddish stain, which \ngradually fades away as the skin desquamates. If the applica- \ntion be prolonged, a white opaque scar is formed, which after- \nwards becomes red and shining. When in the course of a few \ndays it falls off, it leaves a light brown stain, which may persist \nfor several weeks. If prevented from evaporating, the acid, by \npenetrating to the deeper tissues, may produce extensive dry \ngangrene of the part. Carbolic acid is a decided local anaes- \nthetic. The application of a solution even as weak as five per \ncent, at first causes a sense of tingling and warmth, and this is \nfollowed by one of numbness, as an accompaniment of opacity \nand shrinking of the epidermis. If a strong solution is em- \nployed, the numbness amounts to almost complete anaesthesia. \nOn the mucous membrane the acid has an escharotic effect \nwhich varies in degree according to the strength of the solu- \ntion. Applied to wounds or abraded surfaces, a five per cent, \nsolution causes pain and irritation and the formation of a \npellicle from the precipitation of proteids. \n\n\n\nPHENOL. 59 \n\nInternal. G \'astro-intestinal Tract. \xe2\x80\x94 When taken in concen- \ntrated form phenol causes burning pain, of short duration, and \nwhite eschars of the mouth, oesophagus and stomach (the \nmucous membrane appearing as if brushed over with a strong \nsolution of silver nitrate and becoming hard and dry like \nleather), and, if death does not result at once, gives rise to \nviolent gastro-enteritis, with its attendant vomiting and purging. \nThe matters vomited have the characteristic odor of the drug. \nIf taken in therapeutic doses, it produces a cooling and rather \ngrateful sedative feeling in the stomach, and the bowels are \nunaffected by it. \n\nBlood. \xe2\x80\x94 According to the observations of some, the number of \nred blood-corpuscles is reduced. In toxic doses it sometimes \nappears to have a disintegrating effect on these cells. In one \ncase of poisoning in man the presence of haemoglobin in the \nurine indicated the destruction of some of the corpuscles, and \noccasionally such destruction has been noted as a result of the \ndirect injection of carbolic acid into the blood-vessels of ani- \nmals. While it gives rise to the slow formation of methsemo- \nglobin when added to defibrinated blood, it has been found that \nthis does not take place in the living animal. \n\nCirculation. \xe2\x80\x94 It has been demonstrated that one of the \ncharacteristic effects of carbolic acid, in large doses, is the \nreduction of the arterial pressure, and this appears to be princi- \npally due to depression of the vaso-motor centre in the medulla \noblongata. Weakness and slowness of the heart are observed, \nthough at an earlier period there is cardiac acceleration, which \nis thought to result from the direct action of the drug on the \nmuscle or on the regulating nerves. \n\nRespiration. \xe2\x80\x94 The respiration, like the heart, is accelerated, \nand as this quickening occurs previous to the increased muscular \nmovement caused by the drug, it has been attributed to action \non the medullary centre, which is first stimulated and subse- \nquently paralyzed; so that the breathing ultimately fails al- \ntogether. \n\nNervous System. \xe2\x80\x94 The most marked effects of phenol after \n\n\n\n60 PHARMACOLOGY AND THERAPEUTICS. \n\nits absorption into the blood are upon the central nervous sys- \ntem. In mammalian animals it causes, with or without a pre- \nliminary stage of depression, marked muscular tremor, which \nat intervals is interrupted by sudden twitches in different \nmuscles, and later by clonic convulsions. The respiration and \nthe heart, as mentioned, are at first accelerated, but afterwards \nbecome slow, irregular and weak. The movements grow pro- \ngressively more feeble and appear at longer intervals, and the \nanimal passes into a state of collapse, in which, however, the \nsensibility to pain is often preserved. Finally, death occurs \nfrom asphyxia. After very large doses the collapse may be \nimmediate. No convulsions are observed, and the heart and \nrespiration often cease simultaneously. In most cases there is \nan increased secretion of saliva, perspiration and tears, which \nis thought to be of central origin and possibly associated with \nthe nausea and vomiting present. Frequently also the temper- \nature falls far below the normal. In the frog a period of \ndepression always precedes the increased movement. In man \nconvulsions are comparatively rare, but delirium and excite- \nment are sometimes seen. When the quantity of carbolic acid \ntaken is large, immediate unconsciousness may occur, and death \nresult in a few minutes, but how far this is due to the extensive \nlocal corrosion and how far to direct action on the central \nnervous system is unknown. Increased irritability of the spinal \ncord appears to be the cause of the convulsions in the frog, \nwhich are similar to those seen after strychnine, and of the \nsudden contractions of the muscles in mammals, but the clonic \nconvulsions and the presistent muscular tremor observed in the \nlatter point to a cerebral origin. The infrequency of convul- \nsions in man has not as yet been accounted for. The pupils, it \nmay be noted, are almost invariably contracted in phenol \npoisoning; which is doubtless due to paralysis of the radiating \nfibres, the circular fibres being left unopposed. \n\nTemperature. \xe2\x80\x94 Phenol, in sufficiently large doses, causes a \nreduction of temperature which, as in the case of the antipyretic \ngroup, is probably due to some alteration effected in the heat- \n\n\n\nPHENOL. 6 1 \n\nregulating nervous mechanism, resulting also in an increase in \nthe dissipation of heat. In cases of poisoning, however, the fall \nwould seem to be very largely due to the collapse. While it \nundoubtedly possesses the power of reducing the temperature to \nsome extent in fever, ordinary medicinal doses of carbolic acid \nhave very little effect in this direction in the normal subject. \nUrine. \xe2\x80\x94 It is a fact of considerable interest that the produc- \ntion of phenol occurs normally in the body, and that it is a \nconstituent of the urine of man, as well as that of cattle, \nhorses, dogs and probably other animals. It has been found to \nbe constantly present also in normal human faeces, and it is \nconsidered probable that the acid is formed in the organism as a \nlate product of the pancreatic digestion. Its elimination by the \nurine appears to be markedly affected by different diseases and \nconditions, being vastly increased in ileus, and diminished in \nanaemia, scurvy, tuberculosis and scrofula. One of the charac- \nteristic effects of the absorption of carbolic acid is a peculiar \nsmokiness of the urine. The discoloration varies in intensity in \ndifferent cases. It is often a dusky green, which may change \nto dark brown or even black. It has been found that the \nacid passes through the tissues largely unoxidized, but a certain \nproportion of it is partially oxidized to pyrocatechin and hydro- \nquinone, which combine in the body with sulphuric and gly- \ncuronic acid and are excreted in the urine as double (ethereal) \nsulphates and phenol, pyrocatechin and hydroquinone glycuro- \nnates. Pyrocatechin and hydroquinone are unstable bodies, \nand their oxidation products are doubtless the cause of the dark \nurine; pyrocatechin can only exist in alkaline urine, so that it \ncannot be the sole cause of the dark color. The presence in \nthe urine of these results of carbolic acid is recognized by \nreactions after distillation. The distillate gives a blue color \nwith neutral ferric chloride, and a white crystalline precipitate \nof tribromophenol with bromine water, showing the presence of \nsulphocarbolic acid. The inorganic sulphates are usually ab- \nsent. This is determined by the use of the barium chloride test, \nwhich does not precipitate the combined sulphates (sulphocar- \n\n\n\n62 PHARMACOLOGY AND THERAPEUTICS. \n\nbolates) (Sonnenberg\'s test). The depth of the discoloration \nof the urine is said to depend on the quantity of dioxybenzols \npresent, and not on that of phenol sulphate. Hence a darker \nshade is apt to be observed when the absorption of carbolic acid \nhas occurred from an open wound (which presents conditions \nespecially favorable to oxidation) than from much larger \namounts absorbed from the alimentary canal. \n\nTherapeutics of Phenol. \nExternal. \xe2\x80\x94 Phenol was formerly employed in the form of a \nspray, with the idea of rendering the surrounding air antiseptic, \nduring surgical operations, but is no longer used in this way, \nand in the treatment of wounds in general it has been largely \nsuperseded by germicides recognized as more efficient. By some \nsurgeons, however, it is still held in esteem; carbolic lotion (i \nin 40) being used for the washing of wounds and carbolized \ngauze (bleached cotton gauze medicated with half its weight \nof a mixture of carbolic acid, 1 ; resin, 4 ; paraffin, 4) as an anti- \nseptic dressing. It is also employed to a considerable extent as \na disinfectant for surgical instruments, soiled linen, and hospital \napparatus, and as a disinfectant and deodorant for bed-pans, \nprivies, drains, etc. For the latter purposes and on the walls \nand floors the crude acid is preferable, as its principal impurity, \ncresol (cresylic acid) is a very powerful disinfectant, and also \nbecause it is cheaper in cost. As a local application carbolic \nacid is one of the most highly esteemed remedies, and is em- \nployed in a great variety of conditions. It has sometimes been \napplied undiluted to wounds and burns, turning the tissues \nwhite and also exerting a haemostatic influence. Afterwards \nthe surfaces are cleansed with sterilized water. The more \nusual form in which the acid is used in the treatment of burns \nis in that of carbolized oil. In carbuncle or malignant pustule, \nafter incision and scraping, the undiluted acid acts as an anti- \nseptic, and also relieves pain by its anaesthetic effect. Among \nthe other conditions in which its application, undiluted, has \nproved efficient may be mentioned ulcers of the cervix uteri, \n\n\n\nPHENOL. \xe2\x80\xa2 63 \n\nchronic endo-cervicitis and endometritis, lupus, mucous patches, \ncondylomata and cauliform excrescences. Even in scirrhus \nsuch applications, together with the daily injection of a five \nper cent, solution of the acid beneath the cancerous growth, has \nbeen thought to limit the extension and retard the progress of \nthe disease. In performing minor surgical operations local \nanaesthesia may be secured either by brushing over the surface \nwith the pure acid or by soaking the part, when this is prac- \nticable, for ten minutes in a 30 per cent, solution. A strong \nsolution (such as 1 in 20) will alleviate itching from almost any \ncause, and on account of this anaesthetic action carbolic acid \nhas been called the " opium of the skin." Its anti-pruritic and \nparasiticidal qualities render it a useful remedy in a large \nnumber of cutaneous affections. In vesicular eczema, ery- \nthema and in dermatitis, especially from poisonous substances, \nthe following formula is strongly recommended; liquefied phe- \nnol, .36 c.c. (6 TR.) ; powdered zinc carbonate, 30 gm. (1 oz.) ; \nlime water and glycerin, aa 90 c.c. (3 fl. oz.). An ointment \ncontaining sulphur and camphor with carbolic acid has been \nfound most effective in many pruritic skin diseases, especially \npapular eczema, psoriasis, lichen and urticaria. Scabies is said \nto have been cured by friction with carbolized oil of the strength \nof 1 to 15. The glycerite is a very serviceable form, and it \nmay be used (generally diluted) with good results in such \naffections as prurigo, tinea versicolor, tinea tonsurans, and the \nother forms of tinea. It is also applied as a stimulant to indo- \nlent ulcers and to the patches of aphthous stomatitis. A car- \nbolic lotion, to which glycerin or sweet oil may be added, is \nvery efficient in allaying the itching of jaundice. It has like- \nwise been used to prevent pitting from small-pox, and an oint- \nment containing carbolic acid and camphor has proved of ser- \nvice in alleviating the itching accompanying that disease. In \nthe vulvitis or leucorrhcea of young girls, injections of the acid, \nin the strength of 5 parts to 1000 of water (pads of lint \nsaturated with the same solution being used to separate the \ninflamed parts in the intervals) are said to be beneficial, and \n\n\n\n64 PHARMACOLOGY AND THERAPEUTICS. \n\nin the gonorrhoea of females a somewhat stronger solution, to \nwhich alcohol or cologne water is added. The strong acid is \ngenerally successful in relieving the pain of a carious tooth, \nbut the pledget of cotton on which it is inserted into the cavity \nshould be covered with dry cotton, in order to prevent its \ncoming in contact with the gum and possibly causing sloughing. \nIn ulcerated sore throat, tonsillitis, diphtheria and other throat \naffections a one per cent, solution in water and glycerin is \nuseful as a gargle or wash for cleansing purposes, and also for \nthe alleviation of pain, while a concentrated solution in glycerin \nis sometimes applied as a mild caustic. In " hay-fever," influ- \nenza and acute and chronic nasal catarrh, also, weak solutions \nare topically used to a large extent (frequently by means of \nthe atomizer), and a favorite one is that of Dobell, which con- \ntains, in addition to carbolic acid, sodium borate and sodium \nbicarbonate, with glycerin. In acute coryza the combination of \nthe fumes of carbolic acid and iodine is often very beneficial. \nFor this purpose a mixture of the acid and tincture of iodine, \ndropped upon a sponge placed in a wide-mouthed bottle, may \nbe volatilized by wrapping the latter in a cloth wrung out of \nhot water, or even by the heat of the hand. The spray from a \nsteam atomizer supplied with a 5 per cent, solution of the \nacid alone is also of service, and in acute conjunctivitis marked \nrelief is afforded by holding the eye open in a spray of this \nkind. The use of the following formula has been very highly \ncommended in the treatment of whooping-cough; Phenol, .36 \ngm. (6 gr.) ; menthol (4 per cent, solution), 15 c.c. (4 fl. dr.) ; \ncocaine hydrochlorate (3 per cent, solution), 11 c.c. (3 fl. dr.) ; \nglycerin, 4 c.c. (1 fl. dr.); cherry-laurel water, 30 c.c. (1 fl. \noz.). This mixture is to be inhaled every three hours, from an \natomizer, the nozzle of which is inserted as far as possible into \nthe mouth of the patient. \n\nThe deep-seated injection of phenol has been successfully \npractised in the treatment of lupus, ulcerations, poisoned \nwounds, erysipelas, secondary syphilitic abscesses, fistulae, en- \nlarged bursas, synovitis, etc. In synovitis the injections are \n\n\n\nPHEXOL. 65 \n\nmade into the affected joint. A solution of the strength of \nfrom 2 to 5 per cent, is commonly employed, but in the case of \nhydrocele the pure acid is sometimes injected into the sac, after \nthe removal of the fluid. Piles are also efficiently treated with \ninjections of carbolic acid, either pure or diluted with oil, but \nsome accidents have been reported from the procedure. In the \nearly stage of boils and carbuncles the formation of pus is \nsaid to be prevented by the use in this way of weak solutions, \nand gangrenous and necrotic anthrax has been reported to be \ncured by frequent injections of a 3 per cent, solution. It is \nrecommended that the hypodermatic needle should be inserted \nobliquely to the centre of the inflamed tissue (the skin having \nbeen first anaesthetized by the application of the acid or an \nether spray), and that it should not be connected with the \nsyringe until it has been observed whether any blood escapes \nfrom it. which would indicate that it had entered a vein. It \nmay also be mentioned that good results have been claimed \nfrom the parenchymatous injection of phenol in pleuro-pneu- \nmonia. septic puerperal fever, acute and subacute rheumatism, \nmalarial fever, tetanus and other diseases. \n\nInternal. \xe2\x80\x94 Phenol is a very useful remedy in gastro-intestinal \nirritation, especially in cases associated with or dependent upon \nfermentative changes from imperfect digestion, and also where \nthe disturbance is characterized by a nervous element. Vomit- \ning and flatulence, as well as gastrodynia. may often be re- \nlieved by it, and it is of great service in many cases of diar- \nrhoea. For the latter condition it is very generally combined \nwith bismuth subnitrate (.60 to 1.20 gm. ; 10 to 20 gr.), and \nadministered either in emulsion or in capsules. Carbolic acid \nhas been tried in a number of zymotic diseases, and while opin- \nions differ as to its efficacy, considerable evidence has accu- \nmulated in its favor. In a part of India where the mortality \nfrom typhoid fever had previously been very great, admirable \nresults in this disease were obtained from the use of a mixture \ncontaining carbolic acid and spirit of chloroform. The pure \nacid has also been employed successfully. .16 gm. (2 l / 2 gr.) \n6 \n\n\n\n66 PHARMACOLOGY AND THERAPEUTICS. \n\nbeing administered at a time, in the form of a pill coated with \nkeratin, in order to delay solution until after passing into the \nintestine. Another way of exhibiting phenol in typhoid which \nhas won considerable favor is in conjunction with tincture of \niodine, the two remedies sometimes being given in infusion of \ndigitalis. When iodine and phenol are thus employed together, \na colorless carbolate is said to be formed when they are dropped \ninto water. The most remarkable results from carbolic acid \nhave been reported in the treatment of scarlet fever. In this \nplan of treatment the acid is given in doses of from .06 to .36 \ngm. (1 to 6 gr.), according to the age of the child, freely diluted, \nevery two hours. The remedy is designedly pressed to the point \nof causing carboluria, and this condition is maintained until \nthe fever is fully abated. So far from this proving injurious \nto the kidneys, it has been found that renal complication, which \nordinarily occurs quite frequently in this disease, is exceedingly \nrare; while the cases thus treated prove in other respects very \nmild. It would seem, therefore, that the opinion which has \nprevailed in the profession, that when the urine begins to \nassume a smoky hue it should be regarded as a warning of \ndanger, is an erroneous one. It is stated, furthermore, that the \ninfection communicated by these carbolized patients is extra- \nordinarily light, but yet sufficient to confer permanent immunity; \nso that it has been urged that it is better to let children take \nthe disease in this modified form, rather than to leave them to \nthe chance of contracting it later in its normal virulence. \nWhere this was refused, however, it has been found that light \ncarbolization of those exposed gives immunity for the time \nbeing. Strong evidence has also been educed of the great \nvalue of large doses of phenol in the treatment of influenza, \nparticularly in the later stages of the disease, which often prove \nso intractable. In tetanus it is claimed that as good results \nhave been obtained from carbolic acid as from the use of anti- \ntoxin. It is usually given hypodermatically in a two per cent, \nsolution, from .30 to 1 gm. (5-15 gr.) being administered in the \ntwenty-four hours. It is thought by some authorities that it \n\n\n\nPHENOL. 67 \n\nneutralizes the tetanus poison in the same manner as the anti- \ntoxin. Its use is advocated on the ground that in addition to \nbeing an antidote to the toxin, it acts as an anaesthetic and \ngeneral antiseptic. In erysipelas it has been given by the \nmouth and subcutaneously, as well as by deep-seated injection \nat the affected part. Large doses by hypodermatic injection \nhave been recommended in bubonic plague, and cases of re- \ncovery under this treatment have been reported. Phenol ap- \npears to have a distinctly curative effect in malarial fevers, and \nthe combination of the acid with iodine in chronic malarial \ninfection, as well as in the more acute cases after quinine has \nstopped the paroxysms, has been found of great value. In \ngangrene of the lung the internal administration of carbolic \nacid combined with the use of a weak solution by atomization \nis said to be very advantageous. In this condition, however, \nas well as in pulmonary tuberculosis, creosote is generally con- \nsidered preferable at the present time. \n\nCresol has an action very similar to that of phenol, while its \ngermicidal power is said to be nearly three times as great as \nthat of the latter. It may be used internally and in surgery for \nthe same purposes as carbolic acid. It has been recommended, \nin a 1 to 1000 solution, as a solvent for atropine and other \ndrugs employed in ophthalmic practice; it being claimed that \nsuch solutions are non-irritant and that they remain free from \nbacteria. \n\nChlorophenols. \xe2\x80\x94 By the action of chlorine upon carbolic acid \na mixture of ortho- and parachlorphenol is produced, and if \nthe action is sufficiently continued, trichlorphenol results. It is \nalleged that these compounds are very powerful germicides, \nthe 2 per cent, solution being stronger than the 5 per cent, \ncarbolic acid solution, and but slightly weaker than the one- \nthousandth solution of mercuric chloride. \n\nPhenosalyl is an antiseptic mixture composed of 90 parts of \nphenol, 10 parts of salicylic acid, 20 parts of lactic acid, and 1 \npart of menthol. It is said to possess much greater antiseptic \npower and to be considerably less poisonous than carbolic acid. \n\n\n\n68 PHARMACOLOGY AND THERAPEUTICS. \n\n\n\nTOXICOLOGY. \n\nPhenol is employed for suicidal purposes far more frequently than any \nother poison, principally for the reason that it can be so readily ob- \ntained, and also, no doubt, because its lethal action, if the dose is suf- \nficiently large, is so extremely prompt. Death has been known to occur \nwithin three minutes! In surgical practice the free use of the drug is \nnot unattended with danger. Cases have been observed in which pa- \ntients have passed, immediately after the application of carbolic dress- \nings, into a condition of collapse similar to the shock following severe \ninjuries or surgical operations. Of five such cases related by one au- \nthor, recovery took place in only one instance. In other cases the \npoisoning occurs gradually and insidiously, and may be mistaken for \nsepticaemia. The correct diagnosis can be determined by an examina- \ntion of the urine. Cases have been reported in which, in addition to \nwounded surfaces, poisoning has occurred from absorption from the \nskin, the rectum, and the uterine and other cavities. The effects of \nthe drug when taken by the mouth have already been described. Be- \nsides the local action of the acid, the warnings of danger have been \npointed out to be sudden vertigo, contracted pupils, pallor of the face, \nenfeebled circulation, and embarrassed respiration. If the amount \ntaken is sufficiently large, the patient rapidly passes into insensibility. \nThe symptoms frequently resemble very closely those of apoplexy, but \nthe odor of carbolic acid may generally be detected in the breath and \nthe characteristic corrosion produced by the acid be found to be present \non an examination of the mouth. It is a fact, deserving of note that in \nsome instances where consciousness had been restored and the condition \notherwise become markedly improved, the patient after a number of \nhours sank rather suddenly into fatal collapse. \n\nPost-mortem. \xe2\x80\x94 If death has occurred quickly, the tissues and organs \nwill smell distinctly of the drug. The mucous membrane of the mouth, \npharynx, oesophagus and stomach, wherever acted upon by the poison, \nis found to be corrugated, tough and discolored. It is generally whitish, \nchanging to a brownish color, and the corrosions may be surrounded by \na zone of inflammatory redness. In some instances, where the pure \nliquid acid has been swallowed, the appearance is that of a broad choco- \nlate-colored slough, extending continuously from the lips down into the \nstomach, and involving more or less of the gastric mucous membrane. \nThe blood is dark-colored and generally coagulated in the heart and \ngreat venous trunks, although it has been maintained by some authori- \nties that in consequence of the alteration in its character caused by the \ndrug it coagulates with difficulty. While, however, the heart may be \n\n\n\nPHENOL. 69 \n\ndistended with loose clots, it is sometimes found empty and contracted. \nAcute fatty degeneration of the heart, as well as of the liver, kidneys \nand other organs, it is asserted, has been found in some cases. \n\nTreatment. \xe2\x80\x94 Many of the cases of poisoning met with present very \nlittle hope of amelioration from whatever measures may be adopted. \nIf the drug has been taken by the mouth, the stomach should be promptly \nevacuated by means of the stomach-pump or the hypodermatic adminis- \ntration of apomorphine hydrochloride, and demulcents, such as white \nof egg or thick soap-suds, given. Oils should not be used, as they are \nliable to increase the absorption of the poison. Saccharated lime should \nbe administered, in the hope that an insoluble combination may be \nformed in the stomach. Soap is also considered a chemical antidote. \nIn view of the fact that in the tissues carbolic acid forms a compara- \ntively harmless compound with sulphuric acid, the exhibition of sodium \nsulphate has been advocated by many authorities ; but it is stated that \npractically this is of little or no benefit, either because the tissues are \nentirely paralyzed by the excess of carbolic acid, or more probably be- \ncause the latter does not combine with sulphates as such in the body, \nbut with organic sulphur compounds which are only in process of being \noxidized to sulphuric acid. It is of the utmost importance to immedi- \nately give stimulants freely, such as ether or brandy subcutaneously. \nAlcohol should also be given by the mouth, as pure alcohol is the most \nimportant antidote to phenol known. Success in this treatment demands \nthat the acid and alcohol should be brought in contact ; therefore if the \nacid has been swallowed for some time alcohol may not be efficacious. \nAtropine has also been recommended as an antidote, experiments on \nanimals showing results which point strongly to the existence of the \nantagonism, and it is reported to have succeeded in some very unpromis- \ning cases. At all events, such stimulants to the central nervous system \nas atropine, camphor and caffeine are generally called for, and artificial \nrespiration should be resorted to in all serious cases. Hot applications \nand friction should also be employed to combat collapse. Cider vinegar \nis stated to be one of the antidotes of carbolic acid, having the effect \nwhen applied to a cutaneous or mucous surface which has been burnt \nby it of causing the prompt disappearance of the characteristic white \neschar produced by the acid, and also of preventing subsequent scarring \nto a large extent. As it is supposed to be equally efficacious when the \npoison has been taken into the stomach, vinegar diluted with an equal \nquantity of water may be given if the patient is able to swallow. This \narticle has the advantage of being always procurable without delay. \nWhen practicable, the patient\'s bowels should be moved with sodium, \n\n\n\nJO PHARMACOLOGY AND THERAPEUTICS. \n\nor magnesium, sulphate, and it is advised that the soluble sulphates \nshould be administered in small doses for several days, with the idea \nof facilitating the elimination of the phenol from the system. \n\nTHE PHENOSULPHONATES. \n\n1. SODII PHENOSULPHONAS (Sodii Sulphocarbolas, U. S. P., \n1890). \xe2\x80\x94 Sodium Phenosulphonate. (Sodium Sulphocarbolate.) Dose, \n0.250 gm. (250 milligm.) ; 4 gr. \n\n2. ZINCI PHENOSULPHONAS.\xe2\x80\x94 Zinc Phenosulphonate. (Zinc \nSulphocarbolate.) Dose, 0.125 gm. (125 milligm.); 2 gr. \n\nAction of Sodium Phenosulphonate. \nIt is less irritant and less poisonous than phenol, and while \nit is stated to possess less antiseptic power than the latter, has \nconsiderable efficiency as a gastro-intestinal antiseptic and dis- \ninfectant. It does not cause smoky discoloration of the urine, \nand appears to be excreted in that fluid unchanged. \n\nTherapeutics of Sodium Phenosulphonate. \nThe sulphocarbolates were introduced for the purpose of \nsecuring, if possible, the antiseptic and antipyretic action of \nphenol without the caustic and depressing action of the drug. \nWhile sodium phenosulphonate does not perhaps altogether \nmaintain the position anticipated for it, it may in some instances \nbe used with advantage as a substitute for carbolic acid. It \nis employed as a topical application to inflamed and diseased \nmucous membranes, and internally as a remedy for fermentative \ndyspepsia. It has also been given in typhoid fever and other \ninfectious diseases, such as septicaemia, puerperal fever, and \nthe exanthemata, and successful cases have been reported from \nits use even in malignant endocarditis. \n\nAction of Zinc Phenosulphonate. \nIt is antiseptic, but less actively so than phenol, and its \naction is the same as sodium phenosulphonate and other pheno- \nsulphonates, except that it is decidedly more astringent. \n\n\n\nLYSOL. J I \n\nTherapeutics of Zixc Phenosulphonate. \nIt is employed as an astringent for indolent or foul ulcers, \nand in subacute inflammations of mucous membrane, in solu- \ntions which are somewhat stronger than those of zinc sulphate \nin use. It is thought by some that it may replace the sulphate \nas an astringent. Internally it has been used to some extent as \nan intestinal antiseptic, and has been recommended in typhoid \nfever as having the advantage, over the phenol-and-iodine treat- \nment, of being less depressing to the heart and less injurious to \nthe kidneys. Some good results have been reported from doses \nof .12 to .20 gm. (2 to 3 gr.) four or rive times a day. \n\nLYSOL. \nLYSOL.\xe2\x80\x94 Lysol. (Xot official.) Dose, 0.06 to 0.50 gm.; 1 to 8 gr. \n\nAction of Lysol. \nLysol is an antiseptic, about one eighth as poisonous as car- \nbolic acid, and even less poisonous than creolin {see p. 72). In \nsufficient quantity, however, it may produce fall of temperature \nand general depression, with nephritis, and a few fatalities have \nbeen reported from its use. Experimental research is said to \nhave shown that both in pure cultures and in mixed masses of \npathogenetic bacteria it acts more energetically as a germicide \nthan either phenol or creolin; also that, except in strong \nsolution, it is non-irritating, so that wounds may be absolutely \ndisinfected by spraying with a 3 per cent, solution. Solutions \nof this strength, and even weaker ones, may produce a slight \nburning when applied to mucous membranes, but it is only \ntransient. A solution of 1 part in 200 has been found to de- \nstroy streptococci in fifteen minutes. \n\nTherapeutics of Lysol. \nThe official cresol has the same properties and uses as lysol. \nThe latter is used locally in from one half to two per cent, aque- \nous solution. The literature is extensive and generally favor- \nable. The value of this agent as an antiseptic has been con- \n\n\n\n72 PHARMACOLOGY AND THERAPEUTICS. \n\nfirmed by many surgeons, although some of them have found \nit a little more irritating than was at first supposed to be the \ncase. It is employed in much the same conditions as creolin, \nand has also been successfully tried in the treatment of lupus, \npityriasis versicolor, and other skin diseases. It is used to \nsome extent in obstetrical and gynaecological practice. Being \nreadily soluble, a good antiseptic and deodorant, and inexpen- \nsive in cost, it is very serviceable for the disinfection of stools, \nsputa, privies, walls, floors, etc. It does not injure either \nmetallic or rubber instruments, but, like creolin, it renders \nthem difficult to grasp firmly. On celluloid articles it has a \ndeleterious action. For cleansing the hands a one per cent, \nsolution may be used, but it is said to be necessary that \nthe water should be so hot as to be just short of boiling, \nwhich would make it somewhat painful when the hands \nare first introduced. Internally lysol has been given with good \nresults in dyspepsia, in doses of .06 to .50 gm. (1 to 8 gr.), the \ntaste being disguised with peppermint. It is stated that the \nuse of about 500 c.c. (1 pint) of a 1 per cent, solution as an \nenema three times daily has been found of service in dysentery. \n\nIzal, which is chiefly used in England, is a coal tar deriva- \ntive possessing similar properties and employed for the same \npurposes. \n\nCREOLIN. \n\nCREOLINUM.\xe2\x80\x94 Creolin. (Not official.) \n\nAction of Creolin. \nCreolin is a non-irritating antiseptic of considerable activity, \nthough its germicidal power has been overrated by some writers. \nIts internal administration is said to have produced restlessness, \nanxiety, nausea, amblyopia and a tendency to syncope, at the \nsame time giving rise to a peculiar strong taste of tea or of \nsmoke. In some of the cases observed the urine was dark- \ncolored and markedly albuminous. The case is recorded of an \ninfant three weeks old who was fatally poisoned by thirty drops \nof the undiluted drug. The chief symptoms were those of \n\n\n\nCREOLIX. 73 \n\nviolent irritation of the mouth and the upper respiratory and \ndigestive tracts, and death occurred chiefly through inflamma- \ntion of the glottis. Creolin. however, is one of the least toxic \nof all the powerful antiseptics. It has the additional advantage \nof exerting a local influence resembling that of oily or muci- \nlaginous preparations, instead of the irritating effect of carbolic \nacid. As compared with the latter agent, its germicidal power \nis somewhat smaller, since it is not efficient, in solutions con- \ntaining albumin, in the strength of less than I to ioo; but as \nits poisonous qualities are decidedly less marked, it can be used \nin stronger solutions than phenol. For practical purposes, \ntherefore, it is really a more powerful antiseptic. Toxic symp- \ntoms have been observed but rarely from the use of creolin. \n\nTherapeutics of Creolin. \nAs an antiseptic, creolin is frequently employed in place of \ncarbolic acid. It is used pure, in 2 per cent, solution, in an \nointment in gauze (5 to 10 per cent.), or as a soap (10 per \ncent.). It has been found of service in obstetrical and gynaeco- \nlogical practice, and in diseases of the eye. ear, nose and throat, \nas well as in general surgery. In gonorrhoea it is used both in \nthe form of bougies and of injections with olive oil (1 to 3). It \nis an excellent disinfectant for the hands, a 5 per cent, solution \nneither cracking the skin nor benumbing the sensory nerves. \nIt is not well adapted for cleansing instruments, however, as \nthe opacity of its solution prevents them from being seen at the \nbottom of the vessel. It also covers them with a soapy film.- \nwhich renders them somewhat slippery. While it does not \ncorrode metal, it acts rapidly upon caoutchouc and gutta-percha. \nIts use by enema has proved valuable in both acute and chronic \ndysentery and in the diarrhceal diseases of children. The \nstrength of the solution for injection should be about 5 to 1000 \nfor adults, and weaker than this for infants. It has been given \ninternally in gastric fermentation, dysentery and typhoid fever. \nIt has been recommended as a deodorant to iodoform. A \nmixture of from 1 to 2 per cent, produces a compound known \n\n\n\n74 PHARMACOLOGY AND THERAPEUTICS. \n\nas creolin-iodoform, with a faint aromatic odor, which is be- \nlieved to possess the therapeutic properties of iodoform. The \ncreolin may be removed from it by water, leaving the iodoform. \nJeyes\' disinfectant preparations contain creolin. The official \ncresol can well be employed in place of creolin. \n\nIODINE. \n\n1. IODOFORMUM.\xe2\x80\x94 Iodoform. Dose, 0.250 gm. (250 milligm.) ; \n4 gr. \n\nPreparation. \nUnguentum Iodoformi. \xe2\x80\x94 Iodoform Ointment. \n\n2. THYMOLIS IODIDUM.\xe2\x80\x94 Thymol Iodide. (Aristol.) \n\n3. IODOLUM.\xe2\x80\x94 Iodol. Dose, 0.250 gm. (250 milligm.) ; 4 gr. \n\nUnofficial Preparations. \nEurophenum. \xe2\x80\x94 Europhen. (Di-isobutyl-ortho-cresol Iodide.) \nLosophanum. \xe2\x80\x94 Losophan. (Tri-iodo-meta-cresol.) \nAcidum Di-iodosalicylicum. \xe2\x80\x94 Di-iodosalicylic Acid. \nSozoiodolum. \xe2\x80\x94 Sozoiodol. (Soziodolic Acid.) \nAcidum Iodosalicylicum. \xe2\x80\x94 Iodosalicylic Acid. \n\nAction of Iodoform. \nExternal. \xe2\x80\x94 Locally iodoform is capable of inducing analgesia \nof the rectum and the bladder, and when applied in considerable \nquantity to wounded surfaces also has considerable anaesthetic \neffect. In exceptional instances (for the most part confined \nto individuals with a predisposition to cutaneous affections) it \ngives rise to a certain amount of irritation, or efflorescence, \nand even to papular or eczematous eruptions, in the vicinity of \nsuch surfaces. On sound integument it ordinarily has no local \naction. Although it was formerly believed to be of very pro- \nnounced antiseptic value, it has since been demonstrated that \nthis opinion was founded on a misapprehension; pathogenic \nmicrobes frequently developing as rapidly after having been \nexposed to its action as in the control cultures. When it was \nshown that iodoform itself has no germicidal properties, the \n\n\n\nIODINE. 75 \n\ntheory was advanced that it only acts as an antiseptic after its \ndecomposition, this resulting in the liberation of free iodine, \nwhich exerts an antiseptic influence. According to the best \nauthorities, however, more recent investigations indicate \nthat microbes found in wounds under iodoform treatment \nare not retarded or weakened in their development; proving, \napparently, that the beneficial effects of such treatment are not \ndue to any poisonous action on the germs. At present it is \nheld that whatever benefits attend the use of iodoform dress- \nings must be explained on the ground of a supposed action on \nthe wounded surface, in consequence of which it secretes less \nfluid, and thus affords a less suitable medium for the growth of \nthe germs. It is thought also that such growth may to some \nextent be retarded by the formation by the iodoform of a crust, \nwhich mechanically prevents microbes from penetrating to the \nwounded surface. The favorable results which have been \nobserved from the application of iodoform to tuberculous ulcers \nof the larynx, tuberculous abscesses, and similar conditions are \nprobably due to its beneficial effect on the granulation tissue, \nrather than to a specific action upon tuberculous disease, which \nmany have regarded it as possessing. \n\nInternal. \xe2\x80\x94 From moderate amounts of iodoform the most \nconstant symptoms produced are headache, more or less nausea \nand vomiting, and an unpleasant taste and smell of the drug \nin the nose and mouth. When it is taken into the system in \nlarger quantities there is experienced the same taste and odor, \nthe headache is accompanied with giddiness, and the patient is \nrestless, uncomfortable, and unable to sleep. The action of the \nheart is feeble and accelerated, the pulse sometimes reaching \n180, and there is a rise of temperature to 104\xc2\xb0 F., or even \nhigher. From the first there is anxiety and a general depression \nwhich increases as the case progresses. This deepens into true \nmelancholia, with hallucinations, generally succeeded by violent \ndelirium and mania, which may last for days or terminate in \na shorter time in fatal collapse. In exceptional instances there \nis an entire absence of signs of cerebral excitement, and the \n\n\n\ny6 PHARMACOLOGY AND THERAPEUTICS. \n\npatient sinks into a profound sleep, ending in coma and col- \nlapse. Of all the symptoms of iodoform intoxication, the most \ncharacteristic are the delirium and mania. They are not de- \nveloped in the same intensity and of equal duration by any other \npoison, but it is not known what changes take place in the brain. \nIn striking contrast to the case of man, it is stated that no \nsimilar effects have been observed in animals. The cerebral \nsymptoms appear to be attributable to iodoform which circu- \nlates unchanged in the blood. Some of the other symptoms \nare no doubt due to iodine set free by the decomposition of a \nconsiderable portion of the iodoform and to the iodides which \nsome of the nascent iodine forms by combining with the alka- \nlies of the fluids. After iodoform absorption iodine is present \nin the saliva, perspiration and other secretions, but it is found \nto be chiefly excreted in the urine in the form of iodides. The \nelimination from the tissues seems to be very slow, since iodides \nare stated to have been detected in the urine more than a month \nafter the administration of iodoform. When renal disease is \npresent, the drug should always be used with caution, as under \nthese circumstances excretion takes place even more slowly \nthan usual, and the iodoform products are liable to accumulate \nin the tissues. The cardiac acceleration noted is thought to be \nprobably caused by abnormal activity of the cells of the thyroid \ngland, as the thyroid secretion has been found to be very con- \nsiderably increased by iodoform, like other substances from \nwhich iodine is liberated in the tissues. Children, it is stated, \nare less susceptible to the poisonous effects of iodoform than \nadults. While iodoform is absorbed slowly by the alimentary \ncanal, it is taken up quite freely in wounds, and many cases \nof poisoning have occurred in this way. \n\nTherapeutics of Iodoform. \n\nExternal. \xe2\x80\x94 Whatever may be the explanation of its local \n\naction, there can be no question of the great practical value of \n\niodoform as a surgical dressing. In the last twenty years it \n\nhas had an enormous vogue, and while, on account of its ex- \n\n\n\nIODINE. 77 \n\ntremely disagreeable odor and the numerous accidents which \nhave attended its use, various substitutes for it have been pro- \nposed and have proved more or less successful, it is still em- \nployed to a very considerable extent. To attempt to recount all \nthe various conditions in which it has proved of service would \nbe an interminable task, and is unnecessary here. One of its \nmost important applications, and that which first directed gen- \neral attention to its usefulness, is as a dressing for wounds. \nThe common practice is to sprinkle it freely upon the part and \nsecure it in place by a dry dressing. Since iodoform is not, as \nexplained above, itself antiseptic, it must, before being used, \nbe either sterilized or disinfected by washing in a I to 2000 solu- \ntion of corrosive mercuric chloride solution, and preserved, \nwhile damp, in closed sterilized jars. It is employed in the treat- \nment of all sorts of wounds, ulcers and sores, and is found \nespecially serviceable in tuberculous and syphilitic ulcerations. \nUsually the dry powder is simply dusted upon them, but iodo- \nform is also employed in a variety of different combinations. \nOne of these is a solution in collodion (1 part of iodoform to 12 \nof flexible collodion), which is painted over wounds, venereal \nsores, etc., with good effect. Another is a mixture of equal \nparts of iodoform, glycerin and alcohol, which is used for in- \njecting tuberculous abscesses. For the relief of chronic cystitis \ninjections have been given of iodoform dissolved in ether \n(1 in 8), of iodoform, starch and water, and of a solution of \niodoform in glycerin and water. The latter may be made as \nfollows : Iodoform, moistened with alcohol, 1 ; boiling water, 2 ; \nglycerin 7, and it is also useful for injection into abscess cavi- \nties, sinuses, etc. In fissure of the anus and diseased and pain- \nful conditions of the rectum the iodoform suppository (B. P., \neach .20 gm. ; 3 gr. in .80 gm. ; 12 gr. of oil of theobroma) \nserves an excellent purpose. Similar vaginal suppositories have \nbeen largely used in affections of the uterus and vagina, and \npowdered iodoform is sometimes introduced into the dilated \ncervix uteri by insufflation. In the uterus, the urethra and in \nthe nose, as well as in sinuses and other deep and narrow \n\n\n\nyS PHARMACOLOGY AND THERAPEUTICS. \n\ncavities, bougies made with cocoa-butter, mucilage and glycerin, \nor gelatin, may be employed. Mixed with bismuth subnitrate \nand starch it is used with benefit, by insufflation, for ozaena, \nulcers of the mouth and fauces, and tuberculous ulcerations of \nthe larynx. Syphilitic ulcers of the pharynx are sometimes \ntreated also with the ethereal solution and with gelatin lozenges \neach containing .06 or .12 gm. (1 to 2 gr.) of iodoform. In \nozaena, whether of the simple or syphilitic form, iodoform may \nbe used in an ointment prepared with vaselin, or by means of \nabsorbent cotton impregnated with it, instead of by insufflation. \nIodoform cotton is useful as an application to the rectum and \nvagina, as well as the nostrils. In various forms iodoform is \nemployed to a considerable extent in diseases of the eye and \near. In chronic suppuration of the middle ear, but more \nespecially of the internal auditory canal, it is regarded by many \nas excelling all other applications in diminishing the discharge, \ncorrecting its fetor, and restoring the part to its normal condi- \ntion. Iodoform gauze, which may be made by saturating the \nmaterial with a concentrated ethereal solution and afterwards \ndrying, is much used in operations involving the peritoneum, \nintestine, etc., and in contused, complicated and other wounds \nwhere good drainage is required. It is efficient also in the treat- \nment of open cancer, buboes, boils and carbuncles after incision, \nmany of the lesions of scrofula, lupus and syphilis, and a variety \nof other conditions. A 4 per cent, solution of iodoform in oil \nof turpentine, administered in the form of inhalation, may some- \ntimes be used with advantage in laryngeal tuberculosis, bron- \nchorrhcea, and other affections of the respiratory apparatus, and \ngood results have been reported from iodoform injections in \nthe treatment of goitre and of tuberculous joints and lymphatic \nglands. A number of cases of tuberculosis of the bladder are \nreported to have shown more or less improvement under the \nuse of a mixture of iodoform and vaselin. A novel use has \nrecently been made of the drug, in the form of " iodoform \nplugs," employed for filling up cavities produced by diseased \ntissues, and the treatment is stated to have been especially sue- \n\n\n\nIODINE. 79 \n\ncessful in bone cavities. They are composed as follows : Iodo- \nform, 3 to 6; spermaceti, 4; oil of sesame, 2. In exceptional \ninstances iodoform, instead of having a healing and beneficial \neffect upon wounds, sores, ulcers, etc., causes marked irritation, \nnecessitating its replacement by other applications. As the \ndisagreeable odor of iodoform constitutes a very serious objec- \ntion to its use, various means have been tried to obviate this, \nbut none of them with very marked success. Among the agents \nwhich have been employed to conceal the odor may be men- \ntioned musk, cumarin, creolin and balsam of Peru, and the oils \nof eucalyptus, turpentine, bergamot, geranium, peppermint, \nsassafras, cinnamon, lavender and thyme. Of these, oil of \ngeranium (1 to 25) is probably the best. Some believe that \nthe odor of iodoform is preferable to that of musk. By keep- \ning a Tonka bean or ground roasted coffee with it, the odor is \nlessened. It is claimed that the odor will rapidly disappear \nfrom the hands of the surgeon if they be washed with orange \nflower water or with flaxseed meal in water. It has been \npointed out also that as chloroform and ether are solvents of \niodoform, they may be successfully used for removing its odor \nfrom the hands, nails and clothing. An " odorless iodoform " \nhas been put upon the market, which is said to differ from ordi- \nnary iodoform only in that hydrogen is absent from its formula. \nIt is claimed that it is equally efficient with the latter, but \nwhether this claim is justified seems to be as yet undetermined. \nInternal. \xe2\x80\x94 On account of the great success of iodoform in \nsurgery as a supposed antiseptic, it was anticipated that it \nwould prove of decided benefit internally in many of the \ninfectious diseases, and on account of the large amount of \niodine in its composition (with the advantages of being non- \nirritant and having an organic nature), more especially in such \naffections as syphilis, scrofula and tuberculosis. It was there- \nfore given an extended trial, both by the mouth and by sub- \ncutaneous injection; but the expectations in regard to its \nefficacy were not at all realized, and although occasional reports \nof its use in various affections still continue to be published, it \n\n\n\n80 PHARMACOLOGY AND THERAPEUTICS. \n\nhas been practically abandoned as an internal remedy by the \nmass of the profession. \n\nTOXICOLOGY. \n\nMany deaths have been occasioned by the too free use of iodoform \nas an external application, and in the aged especially more or less severe \npoisoning is liable to occur from this cause. A surgeon who has em- \nployed iodoform in several thousand cases without a single instance of \npoisoning attributes this favorable result to the following circumstances : \nthat he did not use large quantities of the remedy, that the wound was \nnot subjected to pressure, and that carbolic acid was not employed at \nthe same time. It is a recognized fact, however, that in certain indi- \nviduals there is an idiosyncrasy which renders them peculiarly suscep- \ntible to the action of the iodides in general, and often particularly so \nto iodoform. It has been found that in some instances this idiosyncrasy \ndevelops suddenly and without warning ; grave toxic symptoms occurring \nat once and death quickly ensuing, notwithstanding the withdrawal of \nthe remedy. The following test for iodoform intoxication is of value \nif the patient is not at the same time using other preparations contain- \ning iodine : A few drops of the urine is mixed with a small quantity of \ncalomel on a white plate, by means of a glass rod ; when a well-marked \nyellow discoloration will be produced if the urine contains sufficient io- \ndine to indicate the absorption of a dangerous amount of iodoform. \n\nPost-mortem. \xe2\x80\x94 Fatty degeneration of the heart, liver, kidneys and \nmuscles is generally found. Among the other conditions observed are \necchymoses in the kidneys, beneath the endocardium, and in other parts \nof the body, congestion of the meninges, and reddening of the mucous \nmembrane of the gastro-intestinal tract, frequently associated with \ndegeneration of the epithelial cells. \n\nTreatment. \xe2\x80\x94 The first measure to be adopted is the complete removal \nof all iodoform that has been applied and the washing of the part with \na solution of sodium bicarbonate. In the milder cases of poisoning \nnothing further than this may be required. In more serious cases \nstimulants are called for, and small doses of tincture of opium fre- \nquently repeated, are recommended by some authorities as being espe- \ncially useful. At the same time elimination should be promoted by \nsponging the body with warm water and the free administration of \ndiaphoretics and diluents, such as potassium acetate, lemonade, etc. \nPotassium bicarbonate, .60 gm. (10 gr.) of which may be given every \nhour, is thought to have the effect of counteracting the toxic effects \nof iodoform, and potassium bromide, which is more active as a solvent \nfor this substance than any other salt, is also considered an antidote. \n\n\n\nIODINE. 8 1 \n\nAction of Thymol Iodide. \n\nAristol is non-irritant and in its general local action resembles \niodoform. It is, however, less desiccant than the latter, as the \nthymol appears to have some effect in increasing moisture. It \npossesses the great advantage of being practically odorless. It \nis claimed to be non-toxic, but it is possible for its prolonged \nuse to give rise to chronic iodine poisoning. It has been \ndemonstrated to have no influence upon the lower organisms, \nand is not, therefore, directly antiseptic. In regard to its \nelimination, very little is known, but it would seem to be \npartially decomposed in the system. Iodine has been found \npresent in the urine of animals to which it was given in con- \nsiderable quantities, but no traces of thymol have been de- \ntected. \n\nTherapeutics of Thymol Iodide. \n\nAristol has proved in many respects a very useful substitute \nfor iodoform. In surgery when dusted upon serous membranes, \nhowever, it tends to prevent their adhesion, and in the treat- \nment of wounds and sores it is contra-indicated when secretion \nis free. It is used for the same purpose as iodoform in cutane- \nous affections, such as lupus, psoriasis and eczema, in syphilitic \nlesions, and in a great variety of diseased conditions of the \nmucous membranes, and is very efficacious in the treatment of \nburns. It is employed as a powder and in flexible collodion, \nsolutions in oil or ether, and ointments made with lanolin or \nvaselin. Heat should not be used in dispensing it, as the iodine \nin its composition is readily set free; and it should not be mixed \nwith alkalies, metallic oxides, or starch. \n\nAction of Iodol. \nIodol is a cicatrizing agent with properties similar to those \nof iodoform, as a substitute for which it was first introduced. \nIt is without odor and does not produce stomatitis or nasal \ncatarrh. It is decomposed in the tissues, and iodides are \nexcreted in the urine. Its iodine is said to be less easily split \noff the molecule than that of iodoform, and it has been found \n7 \n\n\n\n82 PHARMACOLOGY AND THERAPEUTICS. \n\nless liable to cause poisoning than the latter; but in very large \ndoses it gives rise to symptoms in animals similar to those pro- \nduced by iodoform, while its prolonged administration may \nresult in fatal fatty degeneration of the internal organs. Its \nsurgical use is reported in one instance to have occasioned dizzi- \nness, marked rise of temperature, vomiting, small irregular \npulse of 136, albuminuria, and apathy, which continued for \nseveral days. Iodine was found in the urine for two weeks. \nExperiments have shown that iodol is absorbed quite slowly, \nand to this fact is attributed its greater safety than iodoform \nas a topical application. Locally it appears to have a very \nsuperficial caustic effect, forming a whitish film on ulcerated \nsurfaces, but not a scab. \n\nTherapeutics of Iodol. \nIt may be used for all the same purposes as iodoform, and \niodol gauze, cotton, ointment, bougies, pastils, etc., correspond- \ning to those made with iodoform, are now supplied. It is \nlargely employed in powder and also in solutions of various \nkinds. That known as Mazzoni\'s consists of iodol, 1 ; alcohol, \n16; glycerin, 34. An ethereal solution (4 gm. to 30 c.c. ; 1 dr. \nto 1 fl. oz.) has the advantage of leaving the remedy deposited, \nafter the evaporation of the ether, in a minutely divided state. \nIn ointment (10 per cent.) it has sometimes been substituted \nfor the iodine preparations. Painted over and around the \naffected part in a 10 per cent, solution in collodion, it is re- \nported to have proved successful in aborting erysipelas. Inter- \nnally it has been used in the place of potassium iodide, and it is \nsaid to be of value in tertiary syphilis, in quantities of from \n0.4 to 2 gm. (6 to 30 gr.) a day. Favorable results are also \nsaid to have been obtained with it in diabetes. \n\nAction of Europhen. \nEurophen has considerable value as a local germicide and \nbactericide, and its antiseptic properties, it is thought, depend \nmainly on the fact that it is a phenol derivative, rather than on \n\n\n\nBORON. 83 \n\nits containing iodine. In some respects it differs markedly from \niodoform and from iodol. Thus, iodine is not liberated by the \ntissues, and, so far as the iodine in it is concerned, europhen \npasses through the body unchanged. It has a specific aromatic \nodor, which is not unpleasant to most persons, and is said to \nbe entirely non-toxic. It is incompatible with starch, metallic \noxides, and the preparations of mercury. \n\nTherapeutics of Europhen. \nIt is used in the treatment of wounds for the other purposes \nfor which iodoform is employed, and in the same quantities as \nthe latter. It has been found efficacious in burns, chancres and \nsyphilitic ulcers and in psoriasis, eczema, lupus and other skin \naffections, as well as in diseases of the nose, throat and ear. \nMixed with collodion it is applied to buboes. It is largely \nused in ointments of a strength varying from 1 to 10 per cent. \nIt has considerable value as a haemostatic, and is regarded as \nespecially advantageous whenever a dry antiseptic application \nis required. \n\nVarious other iodoform substitutes (not official) are found in the \nmarket. The only advantage they have over iodoform is in the mat- \nter of odor. The principal ones are the following : \n\nLosophan contains 80.0 per cent, of iodine. \n\nDi-iodosalicylic acid " 66.0 " \n\nSozoiodol " 54.0 " \n\nIodosalicylic acid " 50.0 " \n\nBORON. \n\n1. ACIDUM BORICUM.\xe2\x80\x94 Boric Acid. (Boracic Acid.) Dose, \n0.500 gm. (500 milligm.) ; iy 2 gr. \n\nPreparations. \n\n1. Glyceritum Boroglycerini. \xe2\x80\x94 Glycerite of Boroglycerin. \n(Solution of Boroglyceride.) \n\n2. Cataplasma Kaolini. \xe2\x80\x94 Cataplasm of Kaolin. \n\n\n\n84 PHARMACOLOGY AND THERAPEUTICS. \n\n3. Liquor Antisepticus. \xe2\x80\x94 Antiseptic Solution. Dose, 4 c.c; \n1 fl. dr. \n\n4. Unguentum Acidi Borici. \xe2\x80\x94 Ointment of Boric Acid. \n\n2. SODII BORAS.\xe2\x80\x94 Sodium Borate. (Borax. Sodium Pyroborate.) \nDose, 0.500 gm. (500 milligm.) ; 7V 2 gr. \n\nUnofficial Preparations. \nMistura Magnesii Boro-citratis. \xe2\x80\x94 Mixture of Magnesium \nBoro-citrate. Dose, 16 c.c.; 4 fl. dr. \n\nPotassii Tartra-boras. \xe2\x80\x94 Potassium Tartra-borate. Dose, 1.20 \ngm.; 20 gr. \n\nUnguentum Boroglycerini. \xe2\x80\x94 Boroglycerin (or Boroglyceride). \nOintment. \n\nAction of Boric Acid and Borax. \n\nExternal. \xe2\x80\x94 Experiments have shown that while boric acid \nand borax are inefficient as germicides, they have some antiseptic \npower. The growth of almost all forms of bacilli is arrested by \na 2^2 per cent, solution, but the microbes are not destroyed, \nand it is stated that even the anthrax bacilli are capable of \nfurther growth after exposure to a 4 per cent, solution for \ntwenty-four hours. They would seem, therefore, to be of ser- \nvice as mild antiseptics, but to be valueless as disinfectants. \nA saturated solution of boric acid in broth will prevent putrefac- \ntion, and this agent is employed to a large extent in the preser- \nvation of milk, meats and other kinds of food. When applied \nin concentrated form to denuded surfaces, it is somewhat \nirritating and mildly astringent; in solution, while slightly \nastringent, it is sedative rather than irritating. Borax has no \nirritant effect. Its alkalinity renders it a cleansing agent of \nsome efficiency and also adds to its sedative action. Its pro- \nlonged use, as well as that of boric acid, is liable to give rise \nto scaly eruptions of the skin. \n\nInternal. \xe2\x80\x94 Taken in moderate amount borax does not affect \nthe digestion and assimilation of food, but larger quantities \nretard the absorption of proteids and fats and increase the bulk \n\n\n\nBORON. 85 \n\nof the faeces. Both borax and boric acid are found to be \nrapidly absorbed by the bowel, and not to affect the intestinal \nputrefaction. Their excretion, which occurs principally by the \nurine, is completed within twenty-four hours. The urine is \nrendered alkaline by borax, if taken in sufficient amounts, as by \nother alkalies; while boric acid, which is excreted in part un- \nchanged and in part as borates, increases its acidity. Borax \nseems to be excreted unchanged. Both these substances have \ngenerally been regarded as having something of a diuretic \neffect, but so far from this being the fact, the latest researches \ngo to show that the urine is really diminished in amount under \ntheir use. Borax is thought by some to have a somewhat stimu- \nlating influence upon the uterus, and is said to have produced \nabortion in certain instances. It is argued, therefore, that it \ncannot be employed with impunity in women. In some cases \neven moderate amounts of boric acid and borax have a mild \naperient action, while in large doses they are gastro-intestinal \nirritants, and cause vomiting and purging. Other symptoms \nproduced by toxic quantities are dryness of the throat and \ndysphagia, profound muscular weakness, lumbar pain and \nvesical tenesmus, with albuminuria and sometimes hematuria, \ndimness of vision, headache, sleeplessness, and nervous depres- \nsion; which may be followed by fatal collapse. A rise of tem- \nperature is frequently observed, and in the course of two or \nthree days, if death does not previously occur, eruptions which \nare described as scaly, papular or eczematous, appear upon the \nskin. When the drugs are given by the mouth it is stated that \nnausea, vomiting and diarrhoea appear earlier and are apt to be \nmore severe than if they are used in any other way, but the \nsame character of symptoms may result from their free applica- \ntion in the rectum, vagina and other parts. They are rapidly \nabsorbed from all mucous membranes and from lesions, and a \nnumber of serious cases of poisoning have been reported from \nthe use of boric acid as an antiseptic dressing. In chronic \npoisoning, the condition known as borism, the symptoms are \noften much the same as in cases of acute poisoning. The cu- \n\n\n\n86 PHARMACOLOGY AND THERAPEUTICS. \n\ntaneous manifestations, however, are more prominent, and \nmay constitute the only positive indication of toxic action, \nthough there are generally evidences of more or less renal and \ngastro-intestinal irritation. (Edema of the face and extremi- \nties may occur in consequence of the former, and it is advisable \nthat whenever these drugs are given in full doses, a careful \nwatch should be kept upon the state of the urine. The hair is \napt to become dry and fall out, and the eruption on the skin \nmay assume the form of seborrhceic eczema, reddish patches \nwhich desquamate like psoriasis, or papules attended with much \nitching. The commonest form of eruption is said to be a scaly \none, resembling seborrhceic dermatitis, but usually attended \nwith much more oedema. In some cases there are marked dry- \nness of the skin and mucous membranes, with Assuring of the \nlips and striation of the nails, and a blue line, resembling that \nof lead poisoning, has been observed upon the gums. The \nquestion of the effect of the continued and habitual introduction \ninto the body of boric acid or borax, as employed in the preser- \nvation of food, is one of interest. The results of recent careful \nexperiments conducted by the Bureau of Chemistry, United \nStates Department of Agriculture, show, on the whole, that one \nhalf gramme (y/ 2 grains) a day is too much for the normal man \nto receive regularly; while on the other hand the normal man \ncan receive one half gramme of boric acid, or of borax ex- \npressed in terms of boric acid, for a limited period of time \nwithout much danger of impairment of health. The main ob- \njection to the use, as food preservatives, of these and other \nantiseptics which are harmless in small doses seems to rest \nupon the fraud in permitting inferior goods to be disposed of \nas a first-class article. This applies particularly to meats and \nmilk, although the addition of small quantities may sometimes \nbe beneficial by delaying the souring of the latter. If larger \namounts are used for fraudulent purposes, the milk is apt to be \nkept too long and be of inferior quality, while the quantity of \npreservative may be sufficient to prove injurious to infants \ntaking it habitually. \n\n\n\nBOROX. 87 \n\nTherapeutics of Boric Acid and Borax. \nExternal. \xe2\x80\x94 These drugs are used to a much greater extent \nexternally than internally, and., especially on account of their \nnon-irritating qualities, are largely employed as local antiseptics. \nOccasionally they are used in powder. The saturated solution \nof boric acid (4 per cent.) may be applied to wounds, ulcers \nand sores to protect them against infection or decomposition. \nIt is efficacious in phlegmonous erysipelas and in a number \nof chronic scaly and parasitic skin eruptions. It is especially \nrecommended in the troublesome form of tinea known as \ntrichophytosis gcnito-cruralis, which affects the scrotum and \ninner side of the thigh, and it is considered the best remedy for \nfetid perspiration. It is also of service as an injection when \nthere are purulent discharges, as in otorrhcea and leucorrhoea, \nand to wash out cavities after operations. The irrigation should \nnot be continued too long, however, as toxic symptoms have \nbeen produced in this way. The same caution applies to wash- \ning out the large intestine with this solution, which has been \nfound of service in colitis ; tannic acid being sometimes added to \nit. Boric solutions, the strength of which may be varied ac- \ncording to circumstances, are very useful in conjunctivitis and \nother inflammations of the mucous membranes, and, applied \nupon lint or absorbent cotton, as a dressing for burns and \nscalds. The Glyceritum Boroglycerini, well diluted, also \nanswers well as an antiseptic wash in ophthalmia, ozsena, \npharyngitis, urethritis, vaginitis, etc.. and likewise for wounds \nand granulating surfaces. For washing out the bladder in cys- \ntitis Thompson\'s fluid (consisting of borax, 1; glycerin, 2; \nwater, 2), diluted with eight times as much water, is commonly \nemployed; and one of the most important antiseptic solutions \nis that of Thiersch, consisting of boric acid. 12 ; salicylic \nacid, 2; water, 1000. The glycerin of the B. P., which is \nborax, 1 ; water, 2 ; glycerin, 4, and the honey of borax of the \nB. P. (which is borax, 2; glycerin, 1; clarified honey, 16), are \nmuch used in aphthous sore mouth. This is also often treated by \nthe application of borax mixed with powdered sugar. The \n\n\n\n88 PHARMACOLOGY AND THERAPEUTICS. \n\nfollowing is an excellent mouth-wash: Glycerin of borax \n(B. P.), 6; tincture of myrrh, i; water, to 48. For sunburn, \npruritis and other skin affections, as well as for wounds, ulcers, \netc., boric acid ointments such as the official one will often be \nfound serviceable. The ointment of the B. P. consists of boric \nacid, 1; paraffin ointment (soft paraffin, 3; hard paraffin, 7; \nmelted together), 9. Lister\'s ointment consists of boric acid, 1; \nwhite wax, 1 ; paraffin, 2 ; almond oil, 2. An ointment of boro- \nglyceride (not official) is made of glycerin, 92; boric acid, 62; \nby heating. Greene\'s ointment is prepared by melting one part \neach of spermaceti and white wax with six parts of vaselin, and \nadding, while hot, two to four parts of a saturated glycerite of \nboric acid. For application to extensive burns it would be ad- \nvisable to dilute most of these ointments. Boric lint and boric \ncotton, made by steeping the materials in a saturated solution of \nboric acid at the boiling-point, are used to a considerable extent \nin surgery, gynaecology, etc. The external use, as well as the \ninternal administration, of boric acid and the borates should be \nemployed with caution when disease of the kidneys is present. \nBoric acid may be used to preserve solutions intended for hypo- \ndermatic use. \n\nInternal. \xe2\x80\x94 Internally boric acid is almost exclusively given \nfor correcting the fetor of fermentative dyspepsia and in cases \nof cystitis with decomposing urine, where it is also used in \nsolution for irrigation of the bladder. In ammoniacal cystitis \nit tends to render the urine acid (probably by checking the fer- \nmentation, and also because it is excreted in part as boric acid), \nand has a beneficial effect upon the vesical mucous membrane. \nIt should be given in full doses, in diluted watery solution, and \nits administration should occasionally be suspended. Borax is \nsometimes of service in relieving irritability of the bladder. \nAlthough at one time several observers reported beneficial ef- \nfects from the use of the latter drug in typhoid fever, the treat- \nment never won the confidence of the profession, and has been \npractically abandoned. It has been tried to a considerable ex- \ntent in epilepsy, but for the most part with disappointing re- \n\n\n\nPOTASSIUM PERMANGANATE. 89 \n\nsuits. While far less efficient than the bromides., it is, in the \nquantity in which it is required to produce any effect in this \ndisease, much more dangerous. It is said to be apparently of \nmost service in cases where these agents fail and in those in \nwhich the epilepsy is associated with gross organic disease. \nAmong the other conditions in which it has been employed are \ndysmenorrhea, amenorrhea and uterine haemorrhage, as well \nas inertia of the uterus during labor. It is sometimes taken \nin very large doses for the purpose of criminally causing abor- \ntion. That it really has any action on the uterus would seem \nto be problematical. It is thought by some to be of value as \na solvent for uric acid calculi; but here again grave doubts \nhave been expressed as to its efficacy. Another boric acid salt, \nmagnesium borocitrate, has also been strongly urged for this \npurpose, but in the opinion of other authorities potassium tartra- \nborate is preferable, on the ground that the potash compounds \nof uric acid are more soluble than the soda compounds. It is \nobtained by heating together until dissolved 4 parts of potas- \nsium bitartrate, 1 part of boric acid, and ten parts of water. \nThe solution is then evaporated to dryness and the residue \npowdered. 1.20 gm. (20 gr.) should be given three or four \ntimes a day in a large quantity of water. The unpleasant taste \nof borax may be covered with liquorice, or. preferably, with \nsyrup of orange-peel. \n\nPOTASSIUM PERMANGANATE. \n\nPOTASSI PEEMANGANAS.\xe2\x80\x94 Potassium Permanganate. Dose, \n0.065 gm. (65 milligm.) ; 1 gr. \n\nAction of Potassium Permanganate. \nExternal. \xe2\x80\x94 Kept dry. it is a permanent salt, but in the presence \nof moisture it rapidly gives up its oxygen and is converted into \nmanganese dioxide. In powder it has some effect on living \ntissues, and acts as a mild caustic. In concentrated solutions \nit causes irritation and even corrosion of the skin. When a \nsolution comes in contact with proteids. such as albumin, it \n\n\n\n90 PHARMACOLOGY AND THERAPEUTICS. \n\nat once parts with some of the oxygen which it contains, and \nthe latter unites with the albumin. It is therefore a powerful \noxidizing agent and, in consequence, is poisonous to proto- \nplasm. It has very considerable germicidal activity, but this \nis short-lived for the reason that it so quickly parts with its \noxygen; after which it becomes inert. Experiment has shown \nthat 0.12 per cent, (i part in 833) will destroy the micrococci \nof pus in two hours. Except in very superficial infection, \nhowever, its antiseptic value is smaller than that of many \nother agents, since, on account of the rapidity of its reduction, \nit fails to penetrate deeply, and its action is limited to the skin \nand the surface of the mucous membranes. Within a limited \nsphere it is a very efficient disinfectant and deodorant. \n\nInternal. \xe2\x80\x94 It is not absorbed in sufficient amount to have any \ngeneral action. When taken in poisonous quantities, the re- \nsulting phenomena are entirely local. This local action is \nmanifested in gastro-enteritis and irritation or inflammation \nof the kidneys. The lack of general action, according to some \nauthorities, holds true even when it is introduced into the \ncirculation by subcutaneous or intravenous injection. Accord- \ning to others, in acute poisoning the blood-pressure falls, from \ndepression and paralysis of the vaso-motor centre, while the \nheart is not affected until much later. Injected thus into the \ncirculation, it is excreted principally by the intestinal epithe- \nlium and to a smaller extent by the kidneys. When taken by \nthe mouth, very little appears to be absorbed from the stomach \nand intestines. In the mouth weak solutions of potassium per- \nmanganate have a sweetish but astringent and unpleasant taste, \nand there, as well as in the stomach, it is quickly reduced to \nthe dioxide and loses its oxidizing power. On account of its \ncaustic action this remedy, when taken in the form of pills or \ntablets, sometimes occasions considerable gastric irritation and \npains. In the blood of man and animals traces of manganese \nare very frequently found, but it has been shown that this \nmetal is not an essential constituent of the body; being appar- \nently absorbed accidentally with the food. The theory that \n\n\n\nPOTASSIUM PERMANGANATE. 9 I \n\nmanganese salts could replace iron in the body has been proved \nto be untenable. \n\nTherapeutics of Potassium Permanganate. \nExternal. \xe2\x80\x94 One objection to its use, when large quantities are \nrequired, is its expensiveness. Another objection is that it \nstains fabrics. The stain may be removed by the application \nof sulphurous acid, but as this results in the formation of sul- \nphuric acid, the fabric should be promptly rinsed in water. As \nan antiseptic it may be used to wash wounds, sores and ulcers \nin a solution of the strength of 4 gm. (1 dr.) to 500 c.c. \n(1 pint). For application to mucous membranes, as in a \ngargle or lotion for swabbing the throat in diphtheria, scarlet \nfever, and other diseases, the proportion should be about 1.20 \ngm. (20 gr.) to 500 c.c. (1 pint). Such solutions are em- \nployed in necrosis of the jaw, cancer of the tongue, and gener- \nally in affections causing foul breath. They are useful also \nfor correcting fetor in various other conditions, such as ozaena, \nbromidrosis of the feet, etc. Solutions of the strength of .06 to \n.26 gm. (1 to 4 gr.) to 500 c.c. (1 pint) may be employed as \ninjections for gonorrhoea and leucorrhcea, and for washing out \nthe stomach, bladder, uterus, abscess cavities, etc. One ad- \nvantage connected with the use of potassium permanganate in \nthis way is that it can be readily seen when it has lost its \nefficiency by the change in the color of its solutions. As soon \nas it has become reduced to the dioxide, by giving up its oxygen, \nthese turn dark brown, and so long therefore as such injections \nreturn with their pink color retained, the assurance may be \nfelt that the parts are being properly cleansed. It is asserted \nthat potassium permanganate, owing to its properties as an \noxidizing agent, is the most efficient antidote to snake-venom, \nif placed in the wound before the poison is absorbed. It is also \nrecommended that it should be injected subcutaneously about \nthe seat of the bite. As a local application in erysipelas its \nsolutions have been found beneficial. As a deodorizer for \nsputa, stools, drains, etc., and for washing utensils it is used \n\n\n\n92 PHARMACOLOGY AND THERAPEUTICS. \n\nin the proportion of about i to 150. The Liquor Potassi Per- \nmanganatis of the B. P. contains 1 part of the permanganate \nto 100 of distilled water, and Condy\'s fluid is a solution of 50 \ngm. (8 gr.) in 30 c.c. (1 fl. oz.) of distilled water. Potassium \npermanganate is one of the best known disinfectants for the \nhands. They should be washed in its saturated solution, which \nstains them a deep purple, and immediately decolorized with \na saturated solution of oxalic acid. \n\nInternal. \xe2\x80\x94 On account of its disagreeable taste, potassium \npermanganate should preferably be given in the form of pills \nor compressed tablets. As many substances tend to reduce it, \nit is considered best that the pills should be made with kaolin \nand soft paraffin, but cacao butter and rosin cerate are also \nused as excipients. For the dyspepsia and flatulence which so \nconstantly accompany excessive fat, and also for the reduction \nof the obesity itself, the permanganate is a remedy of consider- \nable value. It often affords relief to patients suffering from \nlithaemic conditions, with pain in the lumbar region and intesti- \nnal indigestion, associated with frequent micturition, acid urine, \nand much brick-dust sediment ; while it favors the conversion of \nuric acid into urea, and thus tends to prevent the formation of \nuric acid calculi. On account of its oxidizing properties it is \nalso sometimes of service in acute rheumatism. Potassium per- \nmanganate has been much extolled as an emmenagogue, but in \nthe large doses in which it is advised for this purpose (12 to 30 \ngm. ; 2 to 5 gr.), it is almost certain to create gastric disturb- \nance. Very few stomachs will tolerate more than one grain of \nthe salt, and the dose given for the B. P. solution, which is \nequivalent to from 1.2 to 2.4 grains, is therefore rather large \nfor most persons. As it is in fact reduced in the stomach to \nthe dioxide, tha\'t salt is preferable in amenorrhcea. If manga- \nnese is of any use in anaemia, which has not yet been proven, it \nprobably acts in the same way as iron. The iron-manganese \npreparations, so much lauded, owe their efficiency, if they pos- \nsess any, to the iron which they contain in varying amounts. \nPotassium permanganate oxidizes morphine, and is therefore \n\n\n\nHYDROGEN DIOXIDE. 93 \n\nan antidote to morphine poisoning. About two grains in solu- \ntion should be given for each grain (estimated) of morphine \nswallowed, and the stomach should be immediately and re- \npeatedly washed out with repetitions of the antidote. It has \nbeen shown that during the acute stage of morphine poisoning \nthere is a continuous excretion from the walls of the stomach \nof the morphine, which is subsequently reabsorbed either from \nthe stomach or the intestine. Potassium permanganate has \nalso been recommended, internally as well as locally, in snake- \nbite and erysipelas, and in septicaemia and puerperal fever. \n\nHYDROGEN DIOXIDE. \n\nAQUA HYDROGENII DIOXIDL\xe2\x80\x94 Solution of Hydrogen Dioxide. \n(Solution of Hydrogen Peroxide.) Dose, 4 C.C.; 1 fl. dr. \n\nAction of Hydrogen Dioxide. \nHydrogen dioxide readily yields oxygen to all oxidizable \nsubstances. When taken internally it gives oxygen to the blood, \nstimulates the nervous system, and increases urinary secretion. \nIn the blood the oxygen set free may cause the formation of \nemboli and lead to serious consequences. A death is recorded \nin which the fatal result is thought to have been due to this \ncause (the solution of hydrogen dioxide having been employed \nto wash out the pleural cavity) ; and in several instances \nhemiplegia is said to have been observed, apparently from em- \nbolism of the cerebral arteries. The different organs and tissues \nhave been found to vary considerably in their power of causing \nthe catalytic decomposition of the dioxide, the red corpuscles \nof the blood and the liver cells being the most active, and it is \nnow believed that this action of the tissue cells is closely asso- \nciated with the presence of nucleo-proteids, and not with fer- \nment action, as formerly held. It is a non-poisonous and \npowerful antiseptic. It decomposes pus and probably destroys \nthe microbes of suppuration. Its antiseptic activity is of com- \nparatively short duration, however, ending as soon as all the \noxygen is liberated. \n\n\n\n94 PHARMACOLOGY AND THERAPEUTICS. \n\nTherapeutics of Hydrogen Dioxide. \nHydrogen dioxide seems to have a favorable action in some \nforms of dyspepsia, and to improve digestion. In diphtheria it \nis useful as a cleansing agent and for absorbing false mem- \nbranes, but should be used in glass or hard rubber instruments. \nSome commercial preparations are very acid, and therefore too \nirritating for this purpose. This acidity may be neutralized by \nadding twice its quantity of lime water. It will check bleed- \ning, but from small vessels only. It is of great value in cleans- \ning wounds, ulcers and fistulous tracts, and for surgical dress- \nings ; the cessation of frothing indicates the destruction of pus. \nBut the converse of this is not true, for it will froth with \nperfectly normal blood. It should not be injected into a sup- \npurating cavity unless there is a free outlet for the escape of \nthe gas which is formed. Its most popular use is for bleach- \ning the hair, and in hirsuties it has been found to retard the \ngrowth of hair. It is employed to a considerable extent as an \ninjection in gonorrhoea on account of its activity in destroying \nthe gonococcus and arresting the formation of pus. It is also \nuseful in the treatment of leucorrhoea, otorrhoea, ozsena, \ntonsillitis, chancre, etc., and has proved of service as an irri- \ngating agent in ulcerative blepharitis, purulent conjunctivitis, \ngranular conjunctivitis, and other eye affections. A useful ap- \nplication of the dioxide is in the treatment of gunpowder burns, \nin which it is stated to absolutely remove the black stain which \nordinarily remains permanently. The solution (U. S. P.) \nshould be applied on the first or second day after the burn, and \nin such a way that it may get thoroughly into the centre of \neach pigment spot. It is necessary to prick each point well \nopen, when the bubbling resulting from the use of the dioxide \nwill remove the inorganic remains of the powder. Hydrogen \ndioxide has been highly recommended as a local anaesthetic. \nInjected under the epidermis it is claimed that it produces imme- \ndiate and complete analgesia of the whole skin, and it is stated \nto have been used successfully in this way in opening abscesses, \ncutting off redundant tissue in ingrowing toe-nails, in opening \n\n\n\nCHARCOAL. 95 \n\nthe pleural cavity, and even in performing laparotomy. It \nis a well-recognized fact that a small amount of the solution, \npoured over the closely adhering dressing of a wound, will \nnot only relieve the pain incident to the removal of the dress- \ning, but also alleviate any irritation that may be set up. Good \nresults have been reported from the use of the vapor of hydro- \ngen dioxide in the treatment of whooping-cough. A solution \nof the strength of 12 volumes is employed, and of this 80 gm. \n(3 oz.) is poured upon a linen cloth about three feet square, \nwhich is suspended in the room occupied by the patient. It is \nadvised that two small rooms should be*used, one for the day \nand one for the night, and that the solution should be replen- \nished every four hours. Internal treatment may be given at \nthe same time. In cases of persistent vomiting repeated sips \nof a weak solution sometimes prove efficient. The claims that \nhave been brought forward for the utility of hydrogen dioxide \nin low fevers, epilepsy, diabetes, uraemia and other grave con- \nstitutional states have never been substantiated, and it appears \nto possess no distinct value in internal medication. Its use by \nhypodermatic injection is attended with special risk, on account \nof the liability to the formation of emboli, which may either \nplug up the cerebral arteries or, lodging in the lungs, produce \nfatal asphyxia. \n\nCHARCOAL. \n\n1. CARBO ANIMALIS.\xe2\x80\x94 Animal Charcoal. \n\n2. CARBO ANIMALIS PURIFICATUS.\xe2\x80\x94 Purified Animal Char- \ncoal. \n\n3. CARBO LIGNL\xe2\x80\x94 Charcoal. (Wood Charcoal.) Dose, 1 gm.; \n15 gr. \n\nAction of Charcoal. \nExternal. \xe2\x80\x94 Charcoal is an oxidizing agent and a deodorant. \nOwing to its porous character, it is an active absorbent of gases, \nwhich become condensed in its interstices. It thus ordinarily \ncontains oxygen in large amount, being capable of absorbing \neighteen times its own volume of this substance. The latter, in \n\n\n\n96 PHARMACOLOGY AND THERAPEUTICS. \n\nconsequence apparently, of its condensed state, is possessed of \nspecial activity. When, therefore, charcoal is brought into con- \ntact with decomposing organic matter, it absorbs the gases, \nwhich of itself tends to remove the foul odor, while the oxygen \neffects the oxidation of the matter to its simplest combinations. \nCharcoal possesses the property of absorbing, in addition to \ngases, many colloid bodies, such as the coloring matter of plants \nand proteids, and has the power of oxidizing organic matters in \nsolution or in the solid form. It appears to act when moist \nalmost as efficiently as in the dry state, as is shown by its ac- \ntivity in oxidizing organic impurities in water when charcoal \nfilters are used. In time its power of oxidation becomes ex- \nhausted, the rapidity with which this takes place depending \nupon the amount of organic matter with which it comes in \ncontact; but this may be restored by heating the charcoal to \nredness. It is incorrect to speak of charcoal as a disinfectant \n(though it is popularly regarded in this light), as it is not ger- \nmicidal or antiseptic, having no influence upon living organisms. \n\nInternal. \xe2\x80\x94 Charcoal is altogether inert, as regards any effect \nupon the system, except in so far as by reason of its absorbent \nand oxidizing properties it may check meteorism and flatulence. \nBy its mechanical action on the intestinal walls it sometimes \nserves, when taken in large doses, as a mild laxative, and also \nhas some effect in clearing away mucus. It passes through \nthe alimentary canal unabsorbed, and is found unchanged in \nthe faeces. \n\nTherapeutics of Charcoal. \n\nExternal. \xe2\x80\x94 Charcoal makes a cheap and efficient deodorant \nand absorbent application to cancerous sores with offensive dis- \ncharges, foul ulcers, gangrenous wounds, etc. As, however, \nlarge quantities are required and as it is very dirty, ordinary \nantiseptic and disinfectant dressings will generally be found \nmore serviceable in such conditions. It may be used as a \npowder, made into a thin paste with water, or mixed with \npoultices. The most cleanly way of employing it is in thin bags \nof fine texture. Charcoal is sometimes used as a tooth-powder, \n\n\n\nCHARCOAL. 9/ \n\nbut it should not be recommended, because it abrades the enamel \nof the teeth and discolors the gums. In pharmacy it is useful as \na decolorizing agent and for filtering; but charcoal niters are \nobjectionable in the household because unless renewed very \nfrequently they not only lose their virtues but may become \nbreeding-places for infectious germs. \n\nInternal. \xe2\x80\x94 It is most conveniently administered in tablets or \ncapsules, but is sometimes given mixed with water. In some \ncases charcoal biscuits are preferred. Among the conditions \nin which it has been found of sen-ice are the following : Decom- \nposition of the contents of the stomach, flatulent dyspepsia at- \ntended with fetid breath, gastralgia, acidity, heartburn or foul \neructations, intestinal indigestion with meteorism, diarrhoea, \ndysentery, and ulceration of the intestines with foul stools. In \ncholeriform diarrhoea, both in adults and children, finely \npowdered charcoal, given in milk diluted with water and \nsweetened, has been found efficient, and in epidemic dysentery \ngood results have been obtained from the remedy, administered \nboth by the mouth and the rectum. In some instances it \nanswers well in the vomiting of pregnancy. Large doses, when \nnot accompanied with a sufficient amount of water, have been \nknown to cause intestinal obstruction. In view of the fact that \ncharcoal has the power of removing alkaloids from solutions, \nit has been recommended in diseased conditions resulting from \nthe formation in the alimentary canal of toxins and ptomaines \nof an alkaloidal nature. It is also said to be sometimes useful \nas an antidote in poisoning by phosphorus and by such alkaloids \nas morphine and strychnine, by removing the toxic agent from \nsolution. Purified animal charcoal is preferred for this pur- \npose, and it is advised that after its use the stomach should be \nevacuated by the stomach-pump or emetics. It is stated that \n15 gm. (y 2 oz.) of the charcoal, which should be rubbed up \nwith sufficient water to make a thin liquid, will render inert \nabout .06 gm. (1 gr.) of alkaloid. \n\n\n\n98 PHARMACOLOGY AND THERAPEUTICS. \n\nSULPHUR. \n\n1. SULPHUR SUBLIMATUM.\xe2\x80\x94 Sublimed Sulphur. (Flowers of \nSulphur.) Dose, 4 gm.; 60 gr. \n\n2. SULPHUR PR^CIPITATUM.\xe2\x80\x94 Precipitated Sulphur. (Lac \nSulphuris \xe2\x80\x94 Milk of Sulphur.) Dose, 4 gm.; 60 gr. \n\n3. SULPHUR LOTUM.\xe2\x80\x94 Washed Sulphur. Dose, 4 gm.; 60 gr. \n\nPreparation. \nUnguentum Sulphuris. \xe2\x80\x94 Sulphur Ointment. \n\nAction of Sulphur. \nExternal. \xe2\x80\x94 Sulphur is itself entirely inert, and whatever \neffects it has upon the system, whether internal or external, are \ndue to the agency of sulphides resulting from solution in the \nsecretions and of hydrosulphuric acid (H 2 S), or hydrogen sul- \nphide. The sulphides, being weak salts, readily yield them- \nselves to the formation of the free acid. Although they them- \nselves no doubt have some irritant action, in addition to that of \nthe latter, hydrogen sulphide differs from them in being an \nacid, with extremely marked irritant properties, and also in \nbeing a gas (sulphuretted hydrogen). It is a very powerful \npoison, which even in small amount is destructive to most forms \nof life. Thus it has been found that the microbes of putrefac- \ntion, which produce it themselves, are eventually killed by it, \nunless it escapes freely. Its toxic effects on the system are \ndue in part to its local irritation and in part to direct action on \nthe brain and medulla. When inhaled in concentrated form it \nproduces death almost instantly, and a very dilute vapor of it \ninduces irritation of the eyes, nose and throat and a reflex in- \ncrease in the secretion of tears, saliva and mucus. Upon the \nskin and mucous membranes sulphur has a stimulant, irritant \neffect and also a parasiticidal and antiseptic action. The con- \nversion of free sulphur into sulphides is ordinarily a somewhat \nslow process, and as it can exert any influence only in propor- \ntion to the extent to which such conversion takes place, the \nirritation produced by it is apt to be mild and prolonged. This, \n\n\n\nSULPHUR. 99 \n\nit has been pointed out, is the secret of its therapeutic success. \nApplied to skin already inflamed, however, it is apt to act as \na severe irritant, and to raw surfaces, such as wounds and \nulcers, as a powerful caustic. The sulphides, in contact with \nthe skin, have a solvent action upon the horny epidermis and \nthe hair. Absorption may take place from the cutaneous sur- \nface, as well as the alimentary canal. \n\nInternal. \xe2\x80\x94 When sulphur is taken by the mouth, much the \nlarger portion of it passes without change through the ali- \nmentary canal, and is so discharged in the faeces. The re- \nmainder is converted by the alkaline fluids of the intestine into \nsulphides, which form some hydrogen sulphide and, after being \nabsorbed into the blood, are oxidized rapidly and excreted \nprincipally by the urine, as sulphates and in obscure organic \ncombination. In some instances experiment has shown the \nurea in the urine to be considerably increased, but whether the \nnitrogenous waste is as a rule augmented by the sulphides has \nnot as yet been determined. A small amount of the converted \nsulphur is excreted by the lungs, in consequence of which the \ncharacteristic odor of hydrogen sulphide may be imparted to \nthe breath. The sulphur compounds, by reason of their irri- \ntant effect, act locally upon the intestine, causing increased \nperistalsis and mild purgation, with soft stools and but little \ngriping, They also have an antiseptic action in the intestines. \nUnder large doses of sulphur the symptoms of intestinal irrita- \ntion may be more severe than those mentioned, the evacuations \nassuming a bloody character. The drug has a slight diaphoretic \naction, the cutaneous secretions being stimulated to some extent \nduring its elimination. Hydrogen sulphide is excreted in \nminute amount by the skin (so that silver articles about the \npersons of those taking sulphur may be discolored), and also in \nthe milk of nursing women. When injected intravenously in \nmammals the sulphides induce violent convulsions, which are \napparently of cerebral origin, since it has been shown that they \ndo not occur in the hind limbs after section of the spinal cord. \nTheir action on the blood is to reduce the oxyhemoglobin and \n\n\n\nIOO PHARMACOLOGY AND THERAPEUTICS. \n\nso diminish the processes of oxidation, while at the same time \nthere is formed a compound known as sulpho-methaemoglobin or \nas sulpho-haemoglobin, which is considered more nearly related \nto methaemoglobin than to haemoglobin. The blood changes \nwere formerly supposed to be the cause of death in poisoning, \nbut it is now known that this is owing to direct action on the \ncentral nervous system. The respiration, which is at first ac- \ncelerated, later becomes dyspnceic and finally ceases; the fatal \nresult being due to this, together with the paralysis of the \nvasomotor centre. The heart is apparently affected only indi- \nrectly through the failure of respiration and the fall of blood- \npressure. While the effects of sulphur are due entirely to the \naction of the sulphides and hydrogen sulphide into which it is \nchanged in the intestine, therapeutically it is never given in \nsufficient amounts to elicit the toxic action of these agents upon \nthe system. Clinically, advantage is taken of its especial ten- \ndency to act upon the skin and mucous membranes. \n\nTherapeutics of Sulphur. \nExternal. \xe2\x80\x94 Inunction with sulphur has always been considered \nthe typical remedy for scabies, but at the present time balsam \nof Peru, which makes an efficient and much more agreeable \napplication, is used to a considerable extent in its stead. The \nsulphur treatment should be inaugurated with a warm bath \nlasting about twenty minutes, after which the patient should \nbe scrubbed all over, with the exception of the head and face, \nwith soft soap or potash, for the purpose of breaking open the \nfurrows and exposing the acari or itch-insects. Next the sur- \nface should be rinsed with clean water and dried, and then sul- \nphur ointment should be thoroughly rubbed in with friction. \nThe official ointment in full strength sometimes gives rise to \nan erythematous or papular, eczematous or pustular, eruption, \nand it is therefore generally well to dilute it. The following \napplication may be used: Oil of cade, 4 c.c. (1 fl. dr.) ; sulphur \nointment, 8 gm. (2 dr.) ; lanolin, 19.5 gm. (5 dr.). The patient \nshould then go to bed, sleeping in flannel, and the next morn- \n\n\n\nSULPHUR. 10 1 \n\ning should wash himself clean and put on clean underclothing. \nOne such application is generally sufficient to effect a cure, but \nit may be repeated once or twice. In order to prevent reinfec- \ntion by the parasite, the bed linen and the clothing previously \nworn should either be destroyed or disinfected by baking or \nthorough boiling. Sulphur is also employed for pediculosis and \nthe various forms of tinea, as well as chronic acne, rosacea, \neczema, psoriasis, and other skin diseases. In acne of the face it \nshould be used with caution, especially if the sebaceous follicles \nare in a patulous condition, as the sulphur, getting into their \nopenings, is liable to cause black points. Many of the parasitic \naffections are best treated by means of sulphur-vapor baths, \nand potassium sulphide baths are useful in syphilis. Insuffla- \ntions of powdered sulphur are sometimes made into the throat \nor nose in diphtheria, scarlet fever, and other infectious dis- \neases, and ointments containing sulphur have been applied to \nthe skin in scarlet fever, measles, small-pox and erysipelas. In \nalopecia circumscripta sulphur is sometimes of service in pro- \nmoting the growth of the hair. Associated with live steam, \nthe fumes of burning sulphur may be relied upon to disinfect \nrooms, ships, etc. Moisture is essential for the success of the \nprocess. {See Sulphurous Acid.) \n\nInternal. \xe2\x80\x94 The continued use of small doses of sulphur may \nprove useful in such affections as acne, sycosis, psoriasis and \nchronic eczema, and especially when the upper layer of the skin \nand the glands are affected, as well as in loss of hair and dis- \neased conditions of the nails. It is a very good laxative, espe- \ncially for children, and washed sulphur is one of the ingredients \nof the popular compound liquorice powder {see Senna). The \nsulphur lozenge of the B. P. contains .30 gm. (5 gr.) of pre- \ncipitated sulphur and .06 gm. (1 gr.) of acid potassium tartrate, \nand one or two of these at night generally answers very well \nin cases of mild constipation. On account of its lack of griping \nand the softness of the stools it causes, sulphur is very useful \nin piles, fistula and other rectal affections, and as a laxative \nafter operations upon the pelvic organs. It is also thought to \n\n\n\n102 PHARMACOLOGY AND THERAPEUTICS. \n\nbe of service in disordered conditions of the liver, for which \nthe various mineral waters containing sulphur and its salts \nmay likewise prove beneficial. Such waters, as for instance \nthose of Richfield Springs, are useful for chronic rheumatism, \nas well as for chronic sore throat, bronchitis, etc., especially \nassociated with digestive difficulties or a gouty or rheumatic \ndiathesis, and for lead poisoning and various skin diseases, in- \ncluding the late secondary eruptions of syphilis. They are used \nboth internally and in baths. \n\n4. SODII SULPHIS.\xe2\x80\x94 Sodium Sulphite. Dose, 1 gm.; 15 gr. \n\n5. SODII BISULPHIS.\xe2\x80\x94 Sodium Bisulphite. Dose, 0.500 gm. (500 \nmilligm.) ; 7 y 2 SX- \n\n6. SODII THIOSTJLPHAS (Sodii Hyposulphis, U. S. P., 1890).\xe2\x80\x94 \nSodium Thiosulphate. (Sodium Hyposulphite.) Dose, 1 gm.; 15 gr. \n\nUnofficial Preparation. \nPotassii Sulphis. \xe2\x80\x94 Potassium Sulphide. \n\nAction of Sodium Sulphite, Bisulphite and \nThiosulphate. \nThey tend to arrest putrefaction and other forms of fermen- \ntation, being moderately powerful antiseptics for the reason \nthat they withdraw oxygen from organic matter in order to \noxidize themselves to sulphates. Injected into animals they \nhave a decidedly toxic effect. In frogs they produce paralysis \nof the central nervous system (commencing in the brain and \ndescending to the spinal cord), and of the muscles and periph- \neral nerve endings, and the heart comes to a standstill in \ndiastole. In mammals the action is exerted chiefly upon the \nmedulla oblongata and the heart, and the respiration fails a \nlittle before the latter. As they are slowly absorbed from the \nalimentary canal, and a portion is changed to the harmless \nsulphate before reaching the blood, much larger quantities are \nrequired to poison animals by the mouth than by subcutaneous \ninjection. Large doses of sulphite have been taken by man \n\n\n\nSULPHUR. 103 \n\nwithout the production of toxic symptoms, but most of the prep- \narations are said to contain a very considerable amount of sul- \nphate. In some instances comparatively small quantities have \ngiven rise to more or less gastro-intestinal irritation. As it \nhas been found that even small doses, when given daily to \nanimals, cause haemorrhages in different parts of the body, the \nuse of these salts for the purpose of preserving wines, meats, \netc., should be condemned. \n\nTherapeutics of Sodium Sulphite, Bisulphite and \nThiosulphate. \nTheir therapeutic application is of somewhat limited range. \nSodium sulphite, in the form of a wash (4 gm. ; 1 dr. to 30 c.c. ; \n1 fl. oz.) is of service in aphthous sore mouth, and has also \nbeen locally used for various parasitic skin diseases. It may \nbe given with advantage in some forms of gastric fermentation, \nand is especially useful in yeasty vomitings where the sulphurous \nacid liberated from the salt in the stomach by the acid of the \nyeasty matter has the effect of destroying the microscopic fungi \npresent (sarcina ventriculi and torula cerevisicz) . It was be- \nlieved at one time that the sulphites would prove highly efficient \nin pyaemia and various zymotic diseases, from their supposed \naction as antiseptics in the blood; but the hopes thus entertained \nhave proved entirely fallacious. Atomized solution of sodium \nsulphite or thiosulphate may be inhaled in gangrene of the lung, \nfetid bronchitis, etc. Locally applied, in a solution of 2 gm. \n(30 gr.) to 30 c.c. (1 fl. oz), the thiosulphate is useful in poison- \ning from Rhus toxicodendron and in pruritus from other causes. \nThis salt, in doses of from .60 to 2 gm. (10 to 30 gr.) every four \nhours, is also said to be of value in malarial haematuria. \n\n7. CALX SULPHURATA.\xe2\x80\x94 Sulphurated Lime. (Crude Calcium \nSulphide.) Dose, 0.065 gm. (65 milligm.) ; 1 gr. \n\n8. SULPHURIS IODIDUM.\xe2\x80\x94 Sulphur Iodide. \n\nUnofficial Preparation. \nPotassa Sulphurata (U. S. P., 1890). \xe2\x80\x94 Sulphurated Potassa. \n(Liver of Sulphur.) \n\n\n\n104 PHARMACOLOGY AND THERAPEUTICS. \n\nAction of Sulphurated Potash, Sulphurated Lime, and \n\nSulphur Iodide. \nExternal. \xe2\x80\x94 These preparations are irritant, and are powerful \nparasiticides. The local action of sulphur iodide resembles that \nof iodine, and when diluted it is a stimulant to the glands of \nthe skin and aids the absorption of inflammatory exudation. \n\nInternal. \xe2\x80\x94 Sulphurated lime is less irritant than sulphurated \npotash, and small doses may cause a sensation of warmth at the \nepigastrium and also have a slight laxative effect. Both of \nthese substances in large doses excite gastro-enteritis. In the \ncase of the potash preparation, considerable hydrogen sulphide \nis formed from its decomposition in the alimentary canal, and \nthe absorption of this may produce poisoning so severe as to \ncause death in a short time. Small doses act in a similar man- \nner to sulphur, but occasion more local irritation. Sulphurated \nlime is believed to have a special influence in preventing or \nlimiting suppuration. The action of sulphur iodide is essentially \nthat of iodine, the proportion of sulphur not being sufficient to \nproduce any effect in the small doses in which alone it can be \ngiven. \n\nTherapeutics of Sulphurated Potash, Sulphurated Lime, \nand Sulphur Iodide. \nExternal. \xe2\x80\x94 Scabies may be cured by ointments made with \neither of these substances, and a weak sulphurated potash oint- \nment (.30 to 1.20 gm. ; 5 to 20 gr., to 30 gm. ; 1 oz.) is used \nto some extent for this purpose. The alkalinity of the drug- \nassists in penetrating the epidermis, but renders the applica- \ntion more or less irritating; so that if it is employed after the \nskin has been softened by a warm bath it may excite a trouble- \nsome eczema. In the treatment of scabies, Vleminckx\'s solu- \ntion, which is made by boiling 165 parts of freshly slaked lime \nwith 250 parts of sublimed sulphur in water, sufficient to make \n1000 parts, and the active agent of which is calcium penta- \nsulphide, is sometimes preferred to an ointment. It should be \napplied with a somewhat stiff brush or a piece of lint. Oint- \n\n\n\nSULPHUR. 105 \n\nments containing 2 gm. (30 gr.) of sulphurated potash to 30 gm. \n(1 oz.) are used with benefit in rosacea and acne indurata, but \ncare should be taken that they are applied to the affected parts \nonly. Chronic eczema and psoriasis are sometimes treated with \nwarm baths made with sulphurated potash, 1 ; water, 960, in \nimitation of the natural sulphide waters, such as those of Aix- \nla-Chapelle, as are also various forms of chronic rheumatic \ntrouble. Calcium sulphide may be used as a depilatory, in the \nform of a paste made by passing hydrogen sulphide into a \nthick milky mixture of lime and water, but is less satisfactory \nthan barium sulphide. An ointment of sulphur iodide, of the \nstrength of 2 gm. (30 gr.) to 30 gm. (1 oz.), is useful in ring- \nworm and other parasitic skin diseases, as well as in lupus vul- \ngaris and other forms of cutaneous tuberculosis and in rosacea \nand acne indurata. If there is much irritation present, it \nshould be used in greater dilution. An objection to the oint- \nment is its tendency to speedy decomposition. \n\nInternal. \xe2\x80\x94 Sulphurated potash and sulphur iodide are rarely \ngiven internally. In order to obtain the effects of sulphurated \nlime on the process of suppuration the dose should be repeated at \nvery frequent intervals. It is useful in the prevention and treat- \nment of styes, boils, carbuncles, abscesses, etc. It has also been \nused with advantage in acne, ezcema, ophthalmia and sores in \nscrofulous children, the suppuration of tuberculous glands, and \nacute tonsillitis, especially in strumous patients; and one case \nof elephantiasis is recorded in which it was successfully em- \nployed. The natural sulphide waters, such as those of the Blue \nLick Springs of Kentucky, which are said to be almost identical \nwith the well known Harrowgate water of England, are bene- \nficial in habitual constipation from deficient intestinal secretion, \nand in obesity, engorgement of the pelvic viscera in women, and \nhaemorrhoids in both sexes, when dependent upon torpid portal \ncirculation. Their prolonged use has also been attended with \ngood effects in glandular affections, hepatic, splenic, prostatic, \netc. They should be discontinued when anaemia is threatened, \nand if given at all in anaemic subjects should be associated with \n\n\n\n106 PHARMACOLOGY AND THERAPEUTICS. \n\nsuitable tonic treatment. In France sulphur iodide is asserted \nto have proved of great service in human glanders. \n\n9. ACIDUM SULPHUROSUM.\xe2\x80\x94 Sulphurous Acid. Dose, 2 c.c; \n30 m,. \n\nAction of Sulphurous Acid. \n\nExternal. \xe2\x80\x94 Sulphurous acid is characterized by its strong \naffinity for oxygen and is a disinfectant, deodorizer and para- \nsiticide. Through its powerful reducing action it becomes \noxidized to sulphuric acid, and is rendered highly poisonous, \n(independently of its acidity), to parasitic organisms, especially \nthose of a vegetable character. By it the activity of unformed \nferments is also abolished or diminished. Thus, it has been \nfound that i part in 1300 will arrest the action of pepsin, 1 in \n8600 that of ptyalin and diastase, and 1 in 20,000 that of myrosin \nand emulsin. The official solution has no effect upon the \nunbroken skin, but is more irritant to raw surfaces than many \nother equally powerful antiseptics. It is also strongly irritant \nto mucous membranes. \n\nInternal, \xe2\x80\x94 In concentrated form sulphur dioxide is entirely \nirrespirable, causing spasm of the glottis. Even when inhaled \nin the strength of 5 parts in 10,000 the gas is decidedly irritant \nto the respiratory mucous membrane, and when a little less \ndiluted excites catarrhal inflammation of the tract. It pene- \ntrates the tissues more rapidly than most other mineral acids. \nIn solution it has the same irritant action on the mucous mem- \nbranes as others of equivalent strength, while upon the contents \nof the stomach it has an antiseptic effect and also interferes \nwith the action of the digestive ferments. It is excreted by \nthe kidneys and alimentary canal in the form of sulphates, to \nwhich it is oxidized during absorption and in the tissues. The \nsulphites are said to be capable of causing death by paralyzing \nthe heart, as well as the respiratory and other motor nerve- \ncentres, but are so rapidly and completely changed into sul- \nphates that unless given in enormous amount they are found to \nexert very little influence upon the system. \n\n\n\nSULPHUR. I07 \n\nTherapeutics of Sulphurous Acid. \n\nExternal. \xe2\x80\x94 For disinfecting the holds of ships sulphur diox- \nide, generated from burning sulphur, is largely used associated \nwith steam; but in the case of apartments it has been to a \nconsiderable extent replaced by formaldehyde, which is more \nefficient and does not, like it, injure fabrics. When it is em- \nployed for this purpose at least three pounds of sulphur should \nbe burned for each thousand cubic feet of space (the sulphur \ncandles now to be found in pharmacies furnishing the most con- \nvenient method), after the room has been rendered as air-tight \nas possible. The action of the sulphurous acid is much more \nefficient when the air is saturated with moisture, and if steam \ncannot be used the walls and floors should be first sprayed with \nwater. The room must be kept closed for about twenty hours. \nScabies may be cured very rapidly by exposing the patient, his \nhead excepted, to the action of sulphur dioxide, generated by \nburning 46.7 gm. (12 dr.) of sulphur in a suitable closed appa- \nratus. Extreme care should be observed, however, to prevent \nthe inhalation of the smallest amount of the poisonous gas. \nSulphurous acid, generally considerably diluted, is sometimes \nemployed as a spray or gargle in diphtheria, scarlet fever and \nseptic sore-throat and as a spray in chronic bronchitis with \nprofuse and fetid expectoration. Its local application is of \nservice in thrush, pruritus, and parasitic skin affections, such as \nthe various forms of tinea, as well as for chilblains and for foul \nulcers and sloughing or gangrenous wounds. \n\nInternal. \xe2\x80\x94 It may be used in cases of dilated stomach, with \nfermentation and the presence of sarcinse and torulse, and of in- \ndigestion with pyrosis or the vomiting of acid matters due to \nacid fermentation of the starchy or saccharine elements of the \nfood; but it should be borne in mind that while it may prevent \nabnormal fermentation, it is also liable to interfere with the \naction of the normal ferments. It has been recommended in \ncertain cutaneous diseases, such as urticaria and purpura, after \nother methods have failed. In the treatment of purpura it may \nbe combined with the fluidextract of ergot. \n\n\n\n108 PHARMACOLOGY AND THERAPEUTICS. \n\nTHYMOL. \n\nTHYMOL.\xe2\x80\x94 Thymol. Dose, 0.125 gm. (125 milligm.); 2 gr. \n\nPreparations. \n\n1. Thymolis Iodidum. \xe2\x80\x94 Thymol Iodide. See p. 8i. \n\n2. Cataplasma Kaolini. \xe2\x80\x94 Cataplasm of Kaolin. \n\n3. Liquor Antisepticus. \xe2\x80\x94 Antiseptic Solution. Dose, 4 c.c; \n1 fl. dr. \n\nAction of Thymol. \nThymol was introduced as a substitute for phenol, which \nit resembles in its effects though it causes less stimula- \ntion of the central nervous system. It is also more slowly ab- \nsorbed, less irritant to wounded surfaces, and less poisonous to \nthe higher animals and man than that drug." As regards its \ninfluence on fermentation and putrefaction, it has been shown to \nhave a very decided antiseptic action, but although considerably \nmore powerfully antiseptic than carbolic acid, it is less soluble \nin the fluids of the body, and has not, consequently, been able to \nreplace it. A persistent acrid sensation in the fauces is \ncaused by thymol. Although it rarely produces vomiting, large \ndoses cause a feeling of warmth about the epigastrium, and \nquite frequently diarrhoea. In from half an hour to an hour, \nmore or less profuse sweating is apt to occur. It also causes \na reduction of temperature, but is regarded as less certain and \nmore dangerous as an antipyretic than salicylic acid, to which \nits composition indicates a close correspondence. Convulsions \nand tremors are rarely induced in either frogs or mammals, and \nunder toxic quantities the animal, after a stage of gradually \nincreasing weakness and apathy, generally sinks into fatal col- \nlapse. Thymol has been found to excite a greater amount of \nirritation in the kidneys than phenol, and under its use the \nurine may contain blood, as well as albumin. The urinary \nsecretion is sometimes increased, and is of a dark greenish hue, \ndue to the presence of a green coloring substance. This be- \ncomes blue on the addition of acid, and is thought to be nearly \n\n\n\nTHYMOL. IO9 \n\nrelated to but not identical with indigo. Experimental research \nhas shown that thymol is excreted in the urine in combination \nwith sulphuric and glycuronic acids, partly unchanged and \npartly oxidized to thymol-hydroquinone. \n\nTherapeutics of Thymol. \nThe addition of a little alcohol renders possible the prepara- \ntion of a 1 to 1000 aqueous solution, which for some purposes \nmay require weakening. As an antiseptic surgical dressing \nand in dermatology thymol has been used in solution and in the \nform of gauze and of ointment. One objection to its employ- \nment is that its odor is likely to attract house flies. A product \nobtained by the condensation of thymol and chlormethyl-salicylic \nacid has recently been claimed to possess remarkable antiseptic \nproperties. It is soluble in alcohol, ether and diluted alkaline \nsolutions, and with alkalies salts are formed which are soluble \nin water. Thymol is quite an efficient antiparasitic, and a solu- \ntion in alcohol or ether (1 in 15) may be employed in ring-worm \nand pityriasis versicolor. An ointment containing .65 gm. to \n30 gm. (10 gr. to 1 oz.) has proved of service in psoriasis, \neczema, acne, alopecia circumscripta, and other skin diseases. \nIn the treatment of burns, especially in children, its application \nhas been recommended in combination with Carron oil (Lini- \nmentum Calcis). Thymol is used to some extent in dentistry, \nand on account of its agreeable taste is quite frequently em- \nployed as a detergent antiseptic in ulcerated and diseased con- \nditions of the mouth and fauces. A glycerite (1 in 200) makes \na good mouth-wash. A solution has sometimes been used by \ninhalation with advantage in bronchitis, laryngitis and whoop- \ning-cough and as a disinfectant in diphtheria, phthisis and \ngangrene of the lung. For catarrh of the upper air-passages \ninhalations of the following mixture are highly spoken of: \nThymol, menthol and carbolic acid, each .32 gm. (5 gr.) ; oil of \neucalyptus, 60 c.c. (2 fl. oz.) ; oil of wild pine, 90 c.c. (3 fl. oz.) ; \n20 or 30 drops to be placed on a sponge or piece of cotton, or \na teaspoonful may be added to boiling water and the steam in- \n\n\n\nI IO PHARMACOLOGY AND, THERAPEUTICS. \n\nhaled. Thymol solutions are useful injections in gonorrhoea \nand vesical catarrh. Thymol is an internal antiseptic of some \nvalue. In gastric and intestinal catarrh it often acts favorably \nby arresting fermentation and stimulating digestion. In large \ndoses (up to 2 gm. ; 30 gr.) it is an efficient anthelmintic for \nthe Ankylostoma duodenale. On account of the danger of \ntoxic effects, the patient should be warned not to take any sol- \nvent of thymol, such as alcohol, oils, etc., after the administra- \ntion of the remedy. Thymol carbonate, under the name of \nthymotal, has been recently recommended as especially valuable \nin ankylostomiasis. Thymol, both alone and in combination \nwith gallic acid, is reported to have been used successfully in \nsome cases of chyluria of filarious origin. It is of no practical \nvalue as an antipyretic, as the doses required to affect the \ntemperature in fevers are so large as to be extremely apt to \ncause dangerous depression of the vital powers. As an internal \nremedy thymol has been recommended in acute rheumatism, \ntuberculosis, diabetes, typhoid fever, and other constitutional \ndiseases, but has proved entirely inefficient. \n\nBALSAM OF PERU. \n\nBALSAMUM PERUVIANUM.\xe2\x80\x94 Balsam of Peru. Dose, 1 gm.; \n15 gr. \n\nAction of Balsam of Peru. \nIt is a general stimulant, with a special tendency to the \nmucous membranes. On the skin it produces slight reddening, \nand its external application is occasionally followed by an ery- \nthematous, urticarial, or eczematous eruption. It has some \nantiseptic property, and is efficient in the destruction of animal \nand vegetable parasites. It also allays itching of the skin and \nmucous membranes. By its stimulating action on wounds and \nsores it facilitates the repair of tissue. Internally it is stomachic, \ncarminative and expectorant. In large doses it may act as a \ngastro-intestinal irritant, inducing vomiting and purging, but \nin smaller quantities causes some heat of skin and stimulates the \ncirculation. It is excreted by the skin, kidneys and respiratory \n\n\n\nBALSAM OF PERU. I I I \n\nmucous membrane, and during its elimination is believed to \nstimulate and have a tendency to disinfect the secretions from \nthese parts. The fact that in some cases, after large doses, \nthe addition of acid to the urine is followed by the formation of \nan abundant precipitate has led to the opinion that the drug \nhas an irritant action on the kidneys ; but in most instances the \nprecipitate is found to be dissolved by alcohol, which would go \nto show that it consists of resin, and not albumin. In one case, \nhowever, it is stated that an inunction of 18.5 c.c. (5 fl. dr.) \nof the balsam gave rise to nephritis and dropsy. \n\nTherapeutics of Balsam of Peru. \nExternal. \xe2\x80\x94 Balsam of Peru has long been used, either pure or \ndiluted, as an application to wounds, compound fractures, and \nindolent sores. As a stimulating dressing for sluggish granu- \nlations a 5 to 10 per cent, solution in castor oil is frequently \nemployed. This substance, saturating a number of layers of \ngauze, over which oiled silk or a starch bandage is applied, is \nvery efficient in maintaining drainage in wounds, abscesses, \nburns, etc. It is also an excellent deodorant, and is said to \ncover to a large extent the disagreeable odor of iodoform when \nit is used in connection with it. Balsam of Peru is a good \nlocal application for diphtheria, for chilblains, and for sore \nnipples and cracked lips, and is useful in moderating the dis- \ncharge of pus in chronic catarrhal conditions of the nose, the \nears or the vagina. When used for fissured nipples it should \nbe removed before the child is allowed to nurse. One case of \nfatal gastritis in an infant six days old is recorded which is \nstated to have been caused by balsam of Peru applied to the \nmother\'s nipples. It is one of the best known remedies for \npruritus vulva and other varieties of pruritus, especially the \nsenile, and is generally applied pure in these conditions. It is \nsuccessful in removing leucoplakia, or local epithelial thickening \nof the mucous membrane, and is of considerable* service in \nchronic inflammatory diseases of the skin, especially eczema. \nOne of its principal uses is as a parasiticide in ringworm, pedi- \n\n\n\nI I 2 PHARMACOLOGY AND THERAPEUTICS. \n\nculosis, and scabies, and for this purpose an ointment consist- \ning of balsam of Peru, 20; olive oil, 50; petrolatum, 100, may- \nbe employed. For scabies it should be employed in the same \nmanner as sulphur ointment (see p. 100). It is as efficient as \nthe latter, killing the eggs as well as the acarus, and is at the \nsame time much more agreeable to the patient. Sometimes the \nbalsam is used in combination with sulphur. \n\nInternal. \xe2\x80\x94 It is often a very useful remedy in chronic bron- \nchitis and bronchorrhcea, as well as at times in chronic intestinal \ncatarrh and dysentery. It has also been employed in the gastro- \nintestinal disorders of childhood. It may be given alone in \ncapsules or emulsion, or in mixtures with other drugs. Some \ntime ago it was claimed that by the use in phthisis of subcu- \ntaneous and intravenous injections of balsam of Peru and its \nchief constituent cinnamic acid, as well as of its sodium salt, \nhetol, a specific inflammation of the diseased areas might be set \nup, which would subsequently result in cicatrization of the tuber- \nculous nodules. Most of those who have employed this treat- \nment, however, pronounce against it, and it has not been re- \nceived with general favor, as no conclusive evidence has been \npresented that the alleged effects are produced. At the same \ntime, when given by the mouth or by inhalation, its expectorant \naction may no doubt sometimes be of more or less service in \nthis disease. Other uses of the balsam are in the treatment of \ngleet, leucorrhcea and chronic laryngitis (by inhalation). \n\nB. Anthelmintics. \nMALE FERN. \nASPIDIUM.\xe2\x80\x94 Male Fern. Dose, 4 gm.; 60 gr. \n\nPreparation. \nOleoresina Aspidii. \xe2\x80\x94 Oleoresin of Aspidium. Dose, 2 gm.; \n30 gr. \n\nAction of Male Fern. \nWhen given in ordinary doses this drug generally passes \nthrough the system, even when some absorption takes place, \n\n\n\nMALE FERN. I I 3 \n\nwithout giving rise to any symptoms, though there may be \nslight intestinal disturbance. When large quantities are taken, \nor if for any reason an unusual amount of its active constitu- \nents become absorbed, alarming and even fatal results may be \nobserved. Recently several cases of poisoning have been re- \nported, presumably not due to an excessive dose, but to the fact \nthat castor oil was administered at the same time, with the \neffect of notably increasing the absorption of filicic acid. The \ntoxic symptoms consist of nausea, vomiting, purging, intense \nabdominal pain, muscular weakness, cramps in the extremities, \ntremors, increased reflexes, confusion of ideas, and somnolence \ndeepening into coma, with collapse. The secretion of urine is \napt to be diminished. In many cases disturbances of vision, or \neven complete loss of sight, occur, without any distinct ophthal- \nmoscopic appearances, and sometimes there are convulsions, \nwhich may be tetanic in character and accompanied with opis- \nthotonos. In a considerable proportion of instances icterus is \npresent, and is thought to probably result from the duodenal \ncatarrh, though it may possibly be due to destruction of the \nred corpuscles of the blood. After death the gastro-intestinal \nmucous membrane is found to be congested, swollen, and some- \ntimes dotted with ecchymoses, and degeneration of the nerve- \nfibres is also observed. The treatment recommended for poison- \ning by aspidium is the administration of magnesium sulphate \nby the mouth and ammonia by subcutaneous injection. \n\nTherapeutics of Male Fern. \nAspidium acts as a direct poison to tape-worms, and is one \nof the most certain of all remedies for these entozoa. It is also \nused against the Ankylostoma duodenale, and the ethereal ex- \ntract of male fern has proved of service in the treatment of \ncysticercus disease. In cases of the latter the result is stated \nto have been especially favorable when the lesions were situated \nin the subcutaneous or muscular tissues. The drug is considered \nmore successful against the Taenia solium (the armed variety of \ntape-worm) and the Bothriocephalic latus (for which it is \n9 \n\n\n\n114 PHARMACOLOGY AND THERAPEUTICS. \n\nespecially efficient) than against the Tcunia medio-canellata. For \na day before taking the medicine the patient should use a liquid \ndiet, such as milk or beef-tea. On the following morning, the \nbowels having been previously evacuated, he should take, fast- \ning, a full dose of the oleoresin, which may be administered in \npills or capsules or in a draught made up with mucilage and \nflavored with ginger, cinnamon or peppermint. A good way \nalso to give it is with an equal quantity of aromatic syrup of \nrhubarb. It is sometimes advised that the dose should be re- \npeated in two or three hours. In the middle of the day the \npatient may eat a full meal, and in the evening should take a \nbrisk cathartic. Castor oil or other oils should not be used, on \naccount of the danger of increasing the absorption of filicic \nacid, and thus causing toxic symptoms. The head of the tape- \nworm should be carefully searched for in the stools. \n\nKAMALA. \n\nKAMALA (U. S. P., 1890; no longer official).\xe2\x80\x94 Kamala. (Rott- \nlera.) Dose, 4 to 8 gm.; 1 to 2 dr. \n\nAction of Kamala. \n\nKamala is an anthelmintic, and also a somewhat drastic \npurgative. As a rule, it does not cause nausea or vomiting, but \nsometimes this is the case. As it imparts its virtues to alcohol, \na tincture made from it is quite as efficient a vermicide as the \npowder. \n\nTherapeutics of Kamala. \n\nIt will kill the Tcunia solium, and probably also the Oxyuris \nvermicularis and the Ascaris lumbricoides. For tape-worm it \nis customary to give one full dose of the powder, mixed with \nsyrup, to which a little hyoscyamus is added to prevent griping, \nand the parasite is often expelled dead at the third or fourth \nstool after the use of the drug. If one dose proves insufficient, \nit may be repeated every three hours until five or six doses \nhave been taken. In the East kamala is employed, in the \nform of ointment, in the treatment of various skin diseases, \n\n\n\nPOMEGRANATE. 115 \n\nparticularly scabies. In Europe it has been successfully used \nin herpetic ring-worm. \n\nKOUSSO. \n\nCUSSO.\xe2\x80\x94 Kousso. (Brayera. Kooso.) Dose, 16 gm.; 240 gr. \n\nUnofficial Preparation. \nKoussinum.\xe2\x80\x94 Koussin. Dose, 1.20 to 2.40 gm.; 20 to 40 gr. \n\nAction of Kousso. \nKousso is an anthelmintic and gastro-intestinal irritant. \nKoussin is thought to be less liable to produce nausea than the \ndrug itself. According to recent authorities the active principle - \nof cusso is kosotoxin, a non-nitrogenous neutral principle, \nwhich is stated to be an energetic paralyzant to all muscles, in- \ncluding the heart, and also of the motor nerve-endings. It has \nbeen alleged that cusso is capable of bringing on abortion, but \nsuch action upon the uterus has never been conclusively shown. \n\nTherapeutics of Kousso. \n\nIt is used exclusively in the treatment of tape-worm, and its \nefficiency appears to depend considerably on the freshness of \nthe flowers employed. Objections to its use are that it is \noften retained with difficulty and is apt to create intestinal \ndistress. It may be administered in an infusion or in the form \nof the fluid extract, and should be taken in the morning on an \nempty stomach. \n\nKoussin has been given with good results. It is most con- \nveniently administered in capsules. \n\nPOMEGRANATE. \n\nGRANATUM. \xe2\x80\x94 Pomegranate. Dose, 2 gm.; 30 gr. \n\nPreparation. \nFluidextractum Granati. \xe2\x80\x94 Fluidextract of Granatum. Dose, \n2 c.c; 30 tc\\.. \n\n\n\ni 1 6 pharmacology and therapeutics. \n\nAction of Pomegranate. \n\nOn account of the large amount of tannin which it contains, \npomegranate is apt to disturb the stomach and cause nausea \nand vomiting. It also occasions flatulence and intestinal pain, \nand sometimes, but not always, acts freely on the bowels. Other \nsymptoms produced by large doses of the drug are general weak- \nness, muscular tremors and cramps, particularly in the leg- \nmuscles, hebetude, vertigo, and mental confusion, without loss \nof consciousness. The urine is increased in quantity. Like \nmale fern, pomegranate frequently causes disturbances of \nvision and diplopia, mydriasis and amaurosis have been ob- \nserved. \n\nTherapeutics of Pomegranate. \n\nPomegranate is exceedingly unpalatable and is so liable to \ncause emesis that the purpose of the drug may be thus defeated. \nWhen retained by the stomach it is usually an efficient remedy \nfor tape-worm. It is best administered in decoction (B. P., i to \n5; dose, 15 to 60 c.c; y 2 to 2 fl. oz.), and of this several doses \nmay be taken, fasting, at intervals of an hour. It should be \npreceded by a brisk cathartic, and, if the remedy does not have \na purgative effect, followed by another. In case the patient \nis unable to take the decoction in this way it is recommended \nthat the requisite quantity should be evaporated in a water-bath \nto a pilular consistency and administered in capsules, preceded \nand followed by a cathartic. On account of its powerful as- \ntringent properties pomegranate is sometimes employed for the \nsame purposes as tannic acid and other astringent remedies. \nThus, the decoction has been used as an injection in gonorrhoea, \nleucorrhcea, etc., and, flavored wth orange or aromatics, as a \ngargle for sore-throat and relaxed states of the fauces. Inter- \nnally pomegranate has been advantageously employed in the \ndiarrhoea and dysentery of hot climates, and also in Meniere\'s \ndisease. \n\nPELLETIEEIKffi TANNAi=>.\xe2\x80\x94 Pelletierine Tannate. Dose, 0.250 \ngm. (250 milligm.) ; 4 gr, \n\n\n\nPUMPKIN SEED. \\\\J \n\nAction of Pelletierine Tannate. \nPelletierine, the mixture of active principles of pomegranate, \nin sufficient quantity, acts like curare, causing paralysis of the \nmotor nerves, without affecting sensation or muscular contractil- \nity. In the frog it also acts upon the heart muscle, the pulsa- \ntions being slowed, although they may temporarily increase in \nforce. It has been proved experimentally to have a specific \ntoxic action on tape-worms, a solution of one part in 10,000 \ncausing their death in ten minutes, while other intestinal worms \nwere unaffected by stronger solutions. For practical purposes \npelletierine tannate is the most effective and least dangerous \nform of the drug, as its insolubility no doubt prevents its rapid \nabsorption and ensures its prolonged contact with the worm. \n\nTherapeutics of Pelletierine Tannate. \nIt is one of the most reliable of tseniafuges, and is decidedly \npreferable to pomegranate itself on account of the facility \nwith which it can be taken and its freedom from nauseating \nproperties. It is usually given in capsules, and, like pomegran- \nate, should be preceded and followed by a purgative. It should \nbe administered with great caution to children. Pelletierine \nhas been found successful in affording relief in paralysis of \nthe third and sixth nerves. \n\nPUMPKIN SEED. \n\nPEPO.\xe2\x80\x94 Pepo. (Pumpkin Seed.) Dose, 30 gin.; 1 oz. \n\nAction of Pumpkin Seed. \nPepo is one of the most efficient and at the same time harm- \nless taeniafuges. It has no purgative action or other known \nphysiological effects. \n\nTherapeutics of Pumpkin Seed. \nIt is employed exclusively as an anthelmintic for the tape- \nworm, and is preferably given in the form of emulsion. 60 gm. \n(2 oz.) of the fresh seed are powdered in a mortar, with 240 c.c. \n\n\n\nIl8 PHARMACOLOGY AND THERAPEUTICS. \n\n(8 fl. oz.) of water, until the husks are loosened and an emul- \nsion is made. The mixture is then strained, and the whole \namount taken fasting. By some it is maintained, however, that \nthe effect is better if the husks are retained in the emulsion. \nSometimes the seeds are beaten into a paste with milk and white \nsugar. The resin, in doses of I gm. (15 gr.), and the expressed \noil, which is bland and unirritating, in doses of 15 c.c. (4 fl. dr.), \nhave been used as substitutes for the seeds, and are said to be \nequally efficient. Some practitioners are in the habit of asso- \nciating the oleoresin of male fern with pumpkin seed in the \ntreatment of tape-worm, and others of adding pomegranate to \nthis combination. \n\nSANTONIN. \n\n1. SANTONICA.\xe2\x80\x94 Santonica. (Levant Wormseed.) \n\n2. SANTONINUM.\xe2\x80\x94 Santonin. Dose, 0.065 gm. (65 milligm.) ; \n1 gr. \n\nPreparation. \nTrochisci Santonini. \xe2\x80\x94 Troches of Santonin. \n\nAction of Santonin. \nSantonin is a very efficient vermifuge for the Ascaris lum- \nbricoides. Its modus operandi is not definitely understood. It \nhas generally been supposed that it has a specific destructive \naction upon ascarides; but experiment outside the body has \ndemonstrated that it is not directly fatal to these parasites, and \nthe most satisfactory explanation of the anthelmintic action of \nthe drug is that it renders the small intestine so disagreeable \na habitat for them that they are driven down into the lower \nbowel, from which they are dislodged by the purgative medicine \nemployed in connection with the santonin. On the human \nsystem santonin has distinct effects, resulting from its absorp- \ntion, the most characteristic of which is a derangement of color \nvision. There is also a discoloration of the urine (lemon-yel- \nlow or saffron when the latter is acid, and carmine or purplish \nred when it is alkaline), similar to that resulting from chryso- \nphanic acid, as in rhubarb and senna. The faeces, likewise, \n\n\n\nSANTONIN. II9 \n\nsometimes assume a deep yellow color. Ordinarily a portion of \nthe santonin is dissolved by the alkalies in the stomach, with \nwhich it forms soluble and absorbable santoninates, while the \nremainder passes into the intestine; but under special circum- \nstances the greater part of the drug may be absorbed in the \nstomach and cause general intoxication of the system. Santonin \nalways undergoes some oxidation in the tissues, and is said to \nbe excreted in the urine and faeces in several forms, two of \nwhich have been found to be oxysantonins. Even small doses \ngive rise to xanthopsia, or yellow vision. In this disorder \nwhite light has at first a violet hue, usually lasting but a short \ntime, and then a greenish-yellow color, which tints the entire \nfield of vision; and the same has occasionally been observed \nwith amyl nitrite. The power of seeing in dim light is also \nstated to be lessened. These effects have been demonstrated to \nbe peripheral, and consequently are not due to discoloration of \nthe media of the eye. The symptoms produced by large doses of \nsantonin are much the same in man as in other animals. Those \nobserved in experiments on dogs have been found to be as fol- \nlows : Twitching of the muscles of the head, often beginning on \none side; followed by rolling of the eyes, grinding of the teeth, \nflexion and extension of the neck and rotation of the head from \nside to side, later by regular epileptiform convulsions, in which \nthe animal is first thrown into opisthotonos and then into clonic \nspasms of the limbs and trunk. These are interrupted by inter- \nvals of repose, during which a momentary contraction of all the \nmuscles of the body may take place. During the convulsive \nseizures the respiration is irregular and insufficient, and in \nfatal cases it fails to return after the convulsion passes off, and \nthe animal dies of asphyxia. In man aphasia has occasionally \nbeen noted, and some mental confusion, as well as nausea and \nvomiting, may result from doses too small to cause convulsions. \nThe epileptiform convulsions are believed to be due principally \nto stimulation of the cortex and the brief contractions in the \nintervals of repose to increased activity of the parts between the \ncerebral peduncles and the medulla. That the medullary centres \n\n\n\n120 PHARMACOLOGY AND THERAPEUTICS. \n\nare comparatively little affected seems to be shown by the fact \nthat the respiration, interfered with during the spasms, returns \nto its ordinary rate and strength during the intervals. The \ncirculation is found to be deranged only by the asphyxia, while \nthe heart continues to beat long after the respiration has ceased. \nSantonin lowers the temperature, and this is attributed to its \naction on the central nervous system. \n\nTherapeutics of Santonin. \nSantonin is now almost universally used as a remedy for \nround-worms. Upon tape-worms and the Oxyuris vermicularis \nit has very little effect. In addition to its efficiency, it is espe- \ncially serviceable on account of the ease with which it can be \nadministered to children. Owing to its insolubility in water \nits taste is only very slightly bitter, and it may be readily given \nin powdered sugar or sprinkled upon bread and honey. It is \ngenerally most effective when exhibited two or three times a \nday until five or six doses have been taken, when a cathartic \nis to be administered. Lozenges containing it are not to be \ncommended, as they may fail to dissolve. Santonin has at \ntimes been tried in amaurosis, epilepsy, suppressio mensium, \nand other conditions, but is now probably exclusively employed \nas an anthelmintic. Sodium santoninate, on account of the \nuntoward effects to which it has- given rise, should not be \nadministered. \n\nTOXICOLOGY. \n\nSymptoms. \xe2\x80\x94 A number of deaths from santonin are on record, and \nin a few exceptional instances serious or even fatal effects have been \ncaused by quite small doses. The danger of poisoning is lessened if \nthe drug is given in castor oil. In cases of poisoning by santonin, in \naddition to the nervous phenomena described, there are generally \nmarked pallor and coldness of the surface, with a blue tint around the \neyes or involving the whole face, dilatation of the pupils, and sweat- \ning, which is sometimes very profuse. As has been mentioned, the \ntemperature is reduced, and there may be gastric or intestinal pain. \n\nTreatment. \xe2\x80\x94 Evacuation of the stomach and bowels. Ammonia, or \nstrychnine sulphate hypodermatically. The convulsions may be con- \ntrolled by ether or chloroform. \n\n\n\nSPIGELIA. 121 \n\n\n\nSPIGELIA. \n\n\n\nSPIGELIA.\xe2\x80\x94 Spigelia. (Pinkroot. Carolina Pink.) Dose, 4 gm.; \nCO gr\xc2\xab \n\nPreparation. \nFluidextractum Spigelian \xe2\x80\x94 Fluidextract of Spigelia. Dose, \n4 c.c; 1 fl. dr. \n\nUnofficial Preparation. \nFluidextractum Spigelian et Senna?. \xe2\x80\x94 Fluidextract of Spigelia \nand Senna. Dose, 8 to 15 C.C.; 2 to 4 fl. dr. for an adult; 2 \nto 4 C.C.; y 2 to 1 fl. dr., for a child two years old. \n\nAction of Spigelia. \nSpigelia is an efficient anthelmintic against the round-worm, \nand appears to act very much in the same way as santonin. \nGiven in sufficient amount, it has toxic effects upon the human \nsubject and upon animals. In the dog or cat its subcutaneous \ninjection gives rise to retching and vomiting, muscular weak- \nness and incoordination, hurried and dyspnceic respiration, \nmydriasis, exophthalmia, and restlessness, followed by somno- \nlence, coma and death from failure of the respiratory centre. \nSmall quantities, given by the mouth, produce no symptoms, but \nlarge doses, especially in the case of children, may cause flush- \ning and dryness of the skin, frequently associated with cedem- \natous swelling of the face, and such cerebral symptoms as \nvertigo, dimness of vision, spasm of the facial muscles, stupor \nand even convulsions. Experiment has shown that toxic doses \nslow and weaken the heart\'s action and depress the motor spinal \ncord and the respiratory centre. \n\nTherapeutics of Spigelia. \nSpigelia has long been a popular and reliable remedy for \nlumbricoid worms. It is much less liable to give rise to symp- \ntoms of narcotic poisoning when it is given in combination with \na cathartic, and senna is usually employed for this purpose. \nSantonin is sometimes prescribed in connection with the fluid- \nextracts of spigelia and senna. The fluidextract of spigelia and \n\n\n\n122 PHARMACOLOGY AND THERAPEUTICS. \n\nsenna, which contained a small proportion each of the oils of \nanise and caraway, was formerly official. It is a very good \npreparation, and pleasant to take. The dose of spigelia, com- \nbined with a cathartic, should be repeated every four hours \nuntil a purgative effect is produced. \n\nCHENOPOPODIUM. \n\nUnofficial Preparation. \nCHENOPODIUM (U. S. P., 1890).\xe2\x80\x94 Chenopodium. (Ameri- \ncan Wormseed.) Dose, 1 to 2 gm.; 15 to 30 gr. \n\nOLEUM CHENOPODIL\xe2\x80\x94 Oil of Chenopodium. Dose, 0.2 c.c; \n3 TTl. \n\nAction of Chenopodium. \nWormseed is one of the most efficient anthelmintics, particu- \nlarly against Ascarides. The oil acts as a stimulant to the \ncirculation and nervous system. It is said to increase the \ncardiac rate and to promote the secretions of the skin, bronchi \nand kidneys. Chenopodium album, known as white goose-foot \nand hog-weed, is possessed of some haemostatic properties. \n\nTherapeutics of Chenopodium. \nThe oil has sometimes been given in infantile colic, flatulent \ndyspepsia, chorea, hysteria, neurasthenia, chronic malaria, and \namenorrhcea, but at the present time is used almost exclusively \nas an anthelmintic. For this purpose it may be given dropped \non lump sugar, in capsules, or in emulsion. The dose is usually \nrepeated three times a day, before meals, for two days, when a \ncathartic should be ordered. It is, no doubt, the safest vermi- \nfuge in case the mucous membrane is inflamed, as it not only \ncauses the expulsion of the worms, but also appears to have \na beneficial action upon the intestinal irritation. \n\nC. Antiparasitics. \n\nCHRYSAROBIN. \n\nCHRYSAROBINUM.\xe2\x80\x94 Chrysarobin. Dose, 0.030 gm. (30 mil- \nligm.) ; y 2 gr. \n\n\n\nCHRYSAROBIN. 1 23 \n\nPreparation. \nUnguentum Chrysarobini. \xe2\x80\x94 Chrysarobin Ointment. \n\nAction of Chrysarobin. \n\nExternal. \xe2\x80\x94 Chrysarobin has a deep and strong local irritant \naction. Applied to the skin it induces itching, redness and \nswelling, and in some instances follicular or furuncular derma- \ntitis. It stains the skin and clothing a dark yellowish-brown or \npurple color, which may, however, be removed by a weak solu- \ntion of chlorinated lime or caustic soda, provided no soap or \nalkali has been used. Its application to the skin has been \nknown to cause slight albuminuria. A certain amount is ab- \nsorbed from the skin, and if it is applied over an extended area \nit may give rise to constitutional symptoms. It is also irritant \nto mucous membranes. Small quantities will excite conjuncti- \nvitis, and the inflammation set up by it is sometimes so severe \nas to result in corneal ulceration. It is said that those engaged \nin collecting the drug (goa powder) often suffer from irritation \nof the face and eyes, with palpebral oedema. In a dilute form \nchrysarobin acts as a reducing agent, having the property of \ntaking oxygen from the tissues and promoting the growth of \nnormal epithelium. The drug is a vegetable parasiticide, being- \npoisonous to organisms of a fungous type. \n\nInternal. \xe2\x80\x94 Chrysarobin is a decided gastro-intestinal irritant. \nIt produces copious, watery, brownish-colored stools, with re- \npeated vomiting, but not much nausea. The greater part of it \npasses through the tissues unchanged; the remainder is ab- \nsorbed and undergoes oxidation to chrysophanic acid. The \nportion absorbed is excreted in the urine, to which it imparts a \nyellow color, which turns to red upon the addition of alkalies. \nIn animals it has been observed to cause severe nephritis (in \nwhich the glomeruli were less affected than the epithelium of \nthe tubules), with albumin and sometimes blood in the urine. \n\nTherapeutics of Chrysarobin. \nIt is largely used locally for its stimulating action in certain \nchronic inflammatory diseases of the skin, and also for its cura- \n\n\n\n124 PHARMACOLOGY AND THERAPEUTICS. \n\ntive effect upon vegetable parasitic eruptions, such as the vari- \nous forms of tinea. In the former class it is of service in the \ntreatment of eczema, acne rosacea, lupus vulgaris, and especially \npsoriasis, in which it is considered by many the best known ex- \nternal remedy. It should always be used with caution, as it is \nliable to set up dermatitis of the surrounding integument. It is \nrecommended that the official ointment should be considerably \ndiluted before application, on account of the danger of exciting \ntoo much inflammatory reaction. In many instances the best \nway to use it is in the form of a pigment composed of chrysa- \nrobin, I ; solution of gutta percha (made by decantation of gutta \npercha, i; lead carbonate, i; chloroform, 9), 9. This can be \npainted with accuracy on the parts desired, and is less liable to \nstain. Another cleanly manner of employing chrysarobin is by \ndissolving 1 part in 7 parts of chloroform, and stirring an equal \nquantity of soft petroleum into the mass ; applying by means of \na brush. It may also be conveniently applied in the form of a \nstick made up with rosin, yellow wax and olive oil. Chrysa- \nrobin should rarely or never be used on the face, on account \nof the danger of inducing oedema of the eyelids or conjunctivi- \ntis. For the same reason it should also be used with great cau- \ntion on the scalp. Alopecia circumscripta and ringworm of the \nscalp, however, have both been very successfully treated by \nmeans of it. It is affirmed by some that the action of this drug \nupon certain cutaneous affections is not only local but also con- \nstitutional, the opinion being expressed that, absorbed from one \npart of the skin (as, for instance, one limb), it is capable of \nexerting a beneficial influence upon other parts of the skin (as \nanother limb) to which it has not been directly applied. How- \never this may be, there seems to be little question that in many \nof the conditions in which chrysarobin has been employed \nequally good results may be obtained by other remedies which \nare not so irritating and so liable to give rise to unpleasant \neffects. Excellent results have been claimed in external \nhaemorrhoids from the use of a salve containing chrysarobin, \niodoform and extract of belladonna, and in internal haemor- \n\n\n\nSTAPHISAGRIA. I 25 \n\nrhoids from suppositories made up with the same ingredients. \nThe extremely irritating effect of chrysarobin upon the intes- \ntinal tract, when given internally, renders it practically useless \nas a cathartic or systemic remedy. It has been tried in small, \nrepeated doses, especially in psoriasis, but the vomiting, grip- \ning, purging, and depression resulting have necessitated its \nabandonment. \n\nSTAPHISAGRIA. \n\nSTAPHISAGRIA.\xe2\x80\x94 Staphisagria. (Stavesacre.) Dose, 0.065 gm. \n(C5 milligm.); 1 gr. \n\nPreparation. \nFluidextractum Staphisagrise. \xe2\x80\x94 Fluidextract of Staphisagria. \nDose, 0.05 c.c; 1 TTL- \n\nUnofficial Preparation. \nDelphinina.\xe2\x80\x94 Delphinine. Dose, 0.001 to 0.008 gm.; -^ to \n\nAction of Staphisagria. \nIt is a parasiticide and is irritating to the skin, producing ery- \nthematous inflammation. Taken internally it is a gastrointesti- \nnal irritant and a depressant to the motor nerves, heart and \nrespiration, causing death by asphyxia. \n\nTherapeutics of Staphisagria. \nIt is principally used in pediculosis, and may be applied in \nthe form of ointment (B. P. Staphisagria, 4; yellow wax, 2; \nbenzoated lard, 17). Sometimes the dry powder is dusted over \nthe affected surface, and sometimes the fluidextract is used in \ncombination with diluted acetic acid. An oil has also \nbeen extracted from the seeds by ether, and it is applied \nin an ointment (4 c.c; 1 fl. dr. to 30 gm. ; 1 oz. of lard) or \ndiluted with from 6 to 12 parts of almond or olive oil. These \napplications are also efficient in scabies and in prurigo senilis. \nIn using staphisagria externally care should be taken not to \napply it to an abraded scalp, and only upon the unbroken skin. \nA case is recorded in which its too free use upon a child was \n\n\n\nI \n\n\n\n126 PHARMACOLOGY AND THERAPEUTICS. \n\nattended with fatal results. Delphinine has been employed both \nexternally and internally, principally for neuralgic affections, \nbut is not as efficient as various other remedies. It is very \nmuch less poisonous than aconitine. \n\nUnofficial Preparations. \nPICROTOXINUM (U. S. P., 1890).\xe2\x80\x94 Picrotoxin. Dose, \n0.0005 to 0.001 gm.; T ^ to ^ gr. \n\nDecoctum Cocculi. \xe2\x80\x94 Decoction of Cocculus. Dose, 4 to 8 \nc.c; 1 to 2 fl. dr. \n\nTinctura Cocculi. \xe2\x80\x94 Tincture of Cocculus. Dose, 0.12 to 1 \nc.c; 2 to 15 TT1 . \n\nAction of Picrotoxin. \n\nExternal. \xe2\x80\x94 Picrotoxin, being very destructive to lower forms \nof life, is an energetic parasiticide. \n\nInternal. \xe2\x80\x94 It is a powerful poison, causing vomiting, accelera- \ntion of respiration, slowing of the pulse and palpitation of the \nheart, stupor and unconsciousness, tonic spasms passing into \nclonic, collapse, repetition of convulsions, and asphyxia. The \nclonic spasms are entirely different from those produced by \nstrychnine, and the central nervous effects of the drug are due \nmainly to its action on the medulla oblongata; the spinal cord \nand the higher parts of the brain remaining comparatively little \naffected. As the result of the intense stimulation of the \nmedulla, there is clonic contraction of the muscles throughout \nthe body. In the frog, spasm of the laryngeal muscles, by pre- \nventing the escape of air from the lungs, leads to a characteristic \nbloating of the animal. It has been found that picrotoxin, like \nother convulsive poisons, tends to lower the temperature when \ngiven in quantities insufficient to cause the spasms. In very \nsmall doses it appears to act as a bitter tonic to the gastro- \nintestinal tract, increasing secretion and promoting peristalsis. \n\nTherapeutics of Picrotoxin. \nExternal. \xe2\x80\x94 In an ointment of the cocculus seeds in lard (1 to \n6) cocculus is efficient in destroying pediculi and the acarus sca~ \n\n\n\nPICROTOXIN. 127 \n\nbei and for the relief of trichophytosis, tinea versicolor, and \nother parasitic affections, but its use is attended with consider- \nable danger from poisoning. Care is therefore necessary, and \nabraded surfaces should be avoided. There is less risk if a \nsolution (15 c.c. ; 4 fl. dr. of the tincture to 120 c.c. ; 4 fl. oz. \nof water) or decoction (1 to 16) is applied to the scalp for a \nfew minutes for phthiriasis, or lousiness, and then washed \noff with warm water. Two or three daily applications may be \nsufficient. As the best way of employing this remedy, however, \nin the treatment of animal and vegetable parasitic affections, it \nis recommended that a small quantity of picrotoxin (not exceed- \ning 1 per cent.) be prescribed in combination with mercuric \noleate ointment (B. P. \xe2\x80\x94 Mercuric oleate, 20; benzoated lard, \n60). \n\nInternal. \xe2\x80\x94 Picrotoxin has been advised in atonic conditions \nof the stomach and cases of torpor of the intestines dependent \nupon deficient secretion and paresis of the muscular layer. In \nmigraine associated with the menstrual period and in nervous \ndysmenorrhea it is said sometimes to afford relief if given a \nday or two before the flow. Some observers have found it of \nbenefit in epilepsy, especially of the nocturnal and anaemic types \nand in cases attributable to onanism, while others assert that it \nreally tends to aggravate the paroxysms. It has been tried in \nother nervous diseases, such as chorea, infantile convulsions, \nand various forms of paralysis, but the results thus far have \nnot been such as to inspire confidence in its efficacy. There is \none application of the drug, however, in which all appear to \nagree as to its utility, at least in many instances, namely in the \ntreatment of the night-sweats of phthisis. It does not produce \nthe disagreeable dryness of the skin and throat caused by atro- \npine, and not infrequently succeeds in cases where the latter \nfails. It acts less promptly than that remedy, however, and it \nis generally necessary to repeat the dose for four nights in suc- \ncession before the sweating is completely controlled. The effect \nthus produced then lasts for from ten to fourteen days. This \naction of picrotoxin has been explained by its influence in in- \n\n\n\n128 PHARMACOLOGY AND THERAPEUTICS. \n\ncreasing the respiration, which, through the partial asphyxia \ncaused, prevents the stimulation of the mechanism of perspira- \ntion. In order to secure the desired result more quickly it may \nbe given three times a day. It is also useful in other forms of \nhyperidrosis. It is administered in tablets or pills or in solu- \ntion, and to keep better it is recommended that glacial acetic \nacid should be added to the latter. It is also sometimes injected \nhypodermatically, and tablets containing .0006 gm. (y^-g- gr.) \neach are prepared for this purpose. As it has been demon- \nstrated by experimental research that picrotoxin is the physio- \nlogical antagonist of chloral in rabbits and other animals, it \nwould seem likely to prove of service in the treatment of poison- \ning by that drug. Conversely, in cases of poisoning by picro- \ntoxin chloral should be used, together with anaesthetics, to con- \ntrol the spasms. The combined administration of chloral, mor- \nphine and minimal doses of atropine has recently been recom- \nmended as the result of animal experiments. \n\nD. Antiperiodics. \nCINCHONA. \n\n1. CINCHONA.\xe2\x80\x94 Cinchona. Dose, 1 gm.; 15 gr. \n\nPreparations. \n\n1. Fluidextractum Cinchonae. \xe2\x80\x94 Fluidextract of Cinchona. \nDose, 1 c.c; 15 m,. \n\n2. Tinctura Cinchonae. \xe2\x80\x94 Tincture of Cinchona. Dose, 4 c.c; \n1 fl. dr. \n\n2. CINCHONA RUBRA.\xe2\x80\x94 Red Cinchona. Dose, 1 gm.; 15 gr. \n\nPreparation. \nTinctura Cinchonae Composita. \xe2\x80\x94 Compound Tincture of Cin- \nchona. Dose, 4 c.c; 1 fl. dr. \n\n3. QTJININA\xe2\x80\x94 Quinine. Dose, 0.250 gm. (250 milligm.) ; 4 gr. \n\nPreparations. \n1. Elixir Ferri, Quininae et Strychninae Phosphatum.\xe2\x80\x94 \nElixir of Iron, Quinine and Strychnine Phosphates. Dose, 4 \nc.c; 1 fl. dr. \n\n\n\nCINCHONA. 129 \n\n2. Glyceritum Ferri, Quininse et Strychninae Phosphatum. \xe2\x80\x94 \nGlycerite of Iron, Quinine and Strychnine Phosphates. Dose, \n1 C.C.; 15 TTL- \n\n3. Syrupus Ferri, Quininae et Strychninae Phosphatum. \xe2\x80\x94 \nSyrup of Iron, Quinine and Strychnine Phosphates. Dose, 4 \nc.c; 1 fl. dr. \n\n4. Syrupus Hypophosphitum Compositus. \xe2\x80\x94 Compound Syrup \nof Hypophosphites. Dose, 8 c.c.; 2 fl. dr. \n\n4. QUININE SULPHAS.\xe2\x80\x94 Quinine Sulphate. Dose, 0.250 gm. \n(250 milligm.); 4 gr. \n\n5. QUININE BISULPHAS.\xe2\x80\x94 Quinine Bisulphate. Dose, 0.250 \ngm. (250 milligm.); 4 gr. \n\n6. QUININE HYDROBROMIDUM. \xe2\x80\x94 Quinine Hydrobromide. \nDose, 0.250 gm. (250 milligm.); 4 gr. \n\n7. QUININE HYDROCHLORIDUM. \xe2\x80\x94 Quinine Hydrochloride. \nDose, 0.250 gm. (250 milligm.) ; 4 gr. \n\n8. QUININE SALICYLAS.\xe2\x80\x94 Quinine Salicylate. Dose, 0.250 gm. \n(250 milligm.) ; 4 gr. \n\n9. OLEATUM QUININE.\xe2\x80\x94 Oleate of Quinine. \n\n10. CINCHONINiE SULPHAS. \xe2\x80\x94 Cinchonine Sulphate. Dose, \n0.250 gm. (250 milligm.) ; 4 gr. \n\n11. CINCHONIDINiE SULPHAS.\xe2\x80\x94 Cinchonidine Sulphate. Dose, \n0.250 gm. (250 milligm.) ; 4 gr. \n\nUnofficial Preparations. \n\n1. Extractum Cinchonas (U. S. P., 1890). \xe2\x80\x94 Extract of Cin- \nchona. Dose, 0.30 to 2 gm.; 4 to 30 gr. \n\n2. Infusum Cinchonae (U. S. P., 1890). \xe2\x80\x94 Infusion of Cinchona. \nDose, 30 to 60 c.c; 1 to 2 fl. oz. \n\n3. Cinchonina. \xe2\x80\x94 Cinchonine. Dose, 0.050 to 2 gm.; 1 to 30 \ngr. \n\n4. Cinchonidinae Salicylas. \xe2\x80\x94 Cinchonidine Salicylate. Dose, \n0.060 to 1.20 gm.; 1 to 20 gr. \n\n5. Quininae Carbamas.\xe2\x80\x94 Quinine Carbamide. (Quinine Urea.) \nDose, 0.30 to 1.20 gm.; 5 to 20 gr. \n\n10 \n\n\n\n130 PHARMACOLOGY AND THERAPEUTICS. \n\n6. Quininae Kinas.\xe2\x80\x94 Quinine Kinate. Dose, 0.30 to 1.20 gm.; \n5 to 20 gr. \n\n7. Quininae Sulphovinas.\xe2\x80\x94 Quinine Sulphovinate. Dose, 0.30 \nto 1.20 gm.; 5 to 20 gr. \n\n8. Quininae Tannas. \xe2\x80\x94 Quinine Tannate. Dose, 0.050 to 1.20 \ngm.; 1 to 20 gr. \n\n9. Quininae Valerianas (U. S. P., 1890).\xe2\x80\x94 Quinine Valerianate. \nDose, 0.050 to 2 gm.; 1 to 30 gr. \n\n10. Quinidinae Sulphas (U. S. P., 1890).\xe2\x80\x94 Quinidine Sulphate. \nDose, 0.050 to 1.20 gm.; 1 to 20 gr. \n\nAction of Cinchona and its Alkaloids. \n\nCinchona owes its effects on the organism almost entirely to \nthe quinine in it. The bark, however, is more of a gastric \nirritant than quinine and is also a decided astringent, while on \naccount of its bulk its active principles are more slowly ab- \nsorbed. Large doses of it have been known to cause an ap- \nparently well-marked febrile paroxysm, beginning with chill \nand terminating with slight perspiration, but quinine, while its \nuntimely use may reproduce the paroxysm with more or less \nseverity in a malarial subject, has been found incapable of ex- \nciting such symptoms in a healthy individual. Quinine sul- \nphate, bisulphate, hydrochloride and hydrobromide have the \nsame action as quinine itself. The action of the drug may be \nmost conveniently studied from the effects of quinine sulphate, \nwhich from its general use is commonly known simply as \nquinine. \n\nExternal. \xe2\x80\x94 Quinine has little or no influence upon sound \nskin, but is distinctly irritant to mucous membranes and raw \nsurfaces. It is recognized as a protoplasm poison, its action \nextending with but little variation throughout most forms of \nliving matter, and generally consisting in a transient augmen- \ntation of activity which is followed by depression and death. \nQuinine solutions, therefore, have considerable antiseptic \npower, while the lactic, butyric and alcoholic fermentations, \nthrough the effects of the alkaloid on the organisms, are either \n\n\n\nCINCHONA. 131 \n\nretarded or completely prevented. It appears to have an \nelective action, however, since it has been found devoid of in- \nfluence upon some of the lower forms, as, for instance, the com- \nmon mold penicillium, which grows freely in its solutions. \nThis same selective action is also observed in its effects on the \nferments of the higher animals. Thus, in artificial experiments \nit has been found that while the gastric and pancreatic ferments \nare rendered less active by the addition of quinine, the drug has \npractically no effect on the action of ptyalin and diastase. In \nbrief, from the results of careful experimental research it has \nbeen concluded that quinine hinders some, if not all, of the \nprocesses which normally occur in living matter and are ex- \npressed in movement and various chemical products, and also \nthat this action is not confined to the intact protoplasm, but \nextends to the ferments. In regard to the amount of its anti- \nseptic power, most observers have found this equal to or greater \nthan that of carbolic and salicylic acids, but considerably less \nthan the salts of mercury and silver. About 0.2 per cent, solu- \ntions are antiseptic; this strength, it is stated, preventing acetic \nand butyric fermentations and the decomposition of albuminous \nsubstances. Some bacilli are quite susceptible to its influence; \nothers, especially anthrax spores and the spirillum of relapsing \nfever, are found more refractory. \n\nInternal. Alimentary Canal. \xe2\x80\x94 Its chief action here is that \nof a vegetable bitter. The bitter taste is marked and pro- \nlonged. The gustatory and gastric nerves are stimulated re- \nflexly, inducing more or less increase in the salivary and gastric \nsecretions. It is, then, a stomachic tonic, promoting appetite \nand digestion. It is a question how far its antizymotic action, \nwhich if unrestrained would exert some slight retarding influ- \nence on the gastric juice, and so tend to interfere with digestion, \nis really operative ; but it seems probable that this is more than \ncounterbalanced by the reflex effects on the stomach and the \nmild stimulation of the gastric mucous membrane. In large doses \nit may cause nausea and vomiting. On the intestine quinine \nhas no well-marked effects except it be given in large amount, \n\n\n\n132 PHARMACOLOGY AND THERAPEUTICS. \n\nwhen it acts as an irritant and may cause diarrhoea, which in \nexceptional instances may be characterized by bloody stools. \nThe preparations of cinchona bark, owing to the presence of \ntannic acid, sometimes exercise an astringent effect upon the \nintestinal mucous membrane, and cause constipation. When \ntaken into the stomach quinine is dissolved by the acid gastric \njuice, and quinine chloride is formed. If not promptly ab- \nsorbed, however, it passes into the intestine and is liable to be \nprecipitated by the alkaline secretions, which form with it \ninsoluble salts ; so that under these circumstances a consider- \nable portion of the quinine escapes absorption and is discharged \nin the faeces. \n\nBlood. \xe2\x80\x94 Quinine has been shown to have a special action upon \nthe blood, which, however, is merely an illustration of its effects \non the tissues generally. \n\n(a) White corpuscles. \xe2\x80\x94 When a small quantity is added to a \ndrop of blood on the warm stage of the microscope it is ob- \nserved that the normal changes in form and position of the leu- \ncocytes are at once stopped, while these cells become spherical \nin shape, darker in color and granular, and shortly disintegrate \ninto debris. Similar results are observed in the mesentery of \nthe frog when quinine is applied locally, and if the part be \nslightly irritated, so as to set up inflammatory action, the leuco- \ncytes do not accumulate in the tissues, as would be the case \nwithout the application of the drug; while if the quinine is \napplied after such irritation has been resorted to, the outpour- \ning of the leucocytes through the capillary walls (diapedesis) \nis at once arrested. The same thing occurs when quinine is \ninjected into the circulation, and the leucocytes, which assume \na spherical form, are considerably diminished in number. \nWhile, however, these changes are due, no doubt, to the poison- \nous action of the drug on the white corpuscles, it has been \npointed out that it would be unjustifiable to infer from such \nexperiments that quinine, in therapeutic doses, inhibits the \nmovements of these cells in the human body. At the same time \nit is unquestionably true that in man ordinary quantities of qui- \n\n\n\nCINCHONA. I33 \n\nnine, even when absorbed from the gastro-intestinal tract, have \nthe effect of diminishing the number of leucocytes. \n\n(6) Red corpuscles. \xe2\x80\x94 On these it appears to have but little \neffect. It is true that certain observers have described an in- \ncrease in size and others a destructive influence on the red cor- \npuscles, but it has been found that this does not occur under \nordinary circumstances. It should be stated, however, that one \nauthority-, as the result of observations made upon himself, \narrived at the conclusion that quinine has a direct effect in \nincreasing the number of the red corpuscles. \n\n(c) Other effects on the blood. \xe2\x80\x94 Quinine has additional ef- \nfects on the blood by reason of its action on processes attributa- \nble to unorganized ferments. Thus, the addition of quinine to \ndrawn blood prevents the acid fermentation which normally \ntakes place in it as the result of the oxidation of certain un- \nknown substances at the expense of the oxyhemoglobin, which \nit partially reduces. That quinine exercises an inhibiting influ- \nence on the oxidizing action of the blood is shown by the fact \nthat blood to which the drug is added fails to decolorize indigo \nor to form the blue oxidation product of guaiac. It therefore \nlessens the ozonizing power of the blood; but although the oxi- \ndizing energy of the latter is diminished, and oxygen is given \noff less readily, it has been found that the haemoglobin is appa- \nrently uninfluenced. Another action which is stated to be re- \ntarded by the presence of quinine is the coagulation of the \nblood. \n\nHeart and Circulation. \xe2\x80\x94 On the isolated frog\'s heart it is \nfound that the action of quinine, which is entirely muscular, \nconsists in slowing of the organ and a marked diminution in \nthe strength of its contractions. In mammals it causes at \nfirst contraction of the arterioles and a quickening of the heart\'s \naction, which are followed by dilation of the vessels and a slow- \ning and weakening of the cardiac contractions. These effects \nare believed to be probably due to the direct influence of the \nalkaloid on the muscular structure of the circulatory system, \nalthough by some the acceleration has been attributed to de- \n\n\n\n134 PHARMACOLOGY AND THERAPEUTICS. \n\npression of the inhibitory mechanism in the heart or in the \nmedulla. Accompanying the acceleration of the pulse there is \na rise of blood-pressure, which seems to depend mainly on the \nvaso-constriction. It has been found that the pulse-rate in \ngeneral follows the blood-pressure, but that during the fall it \ndoes not sink so rapidly and markedly as the pressure. In fatal \npoisoning the heart is stated to be generally very much weakened \nwhen the respiration stops, but continues to beat for some time \nafterwards. Quinine very frequently causes derangement of \nthe sense of hearing and less commonly derangement of that of \nsight, which are believed to be due to vascular changes, rather \nthan to any effect upon the brain. In the one case there are \ndeafness and ringing in the ears and in the other defective \ncolor-vision, contraction of the visual field, and in some in- \nstances temporary blindness. The disorders of hearing are \nattributed to congestion of the auditory canal and those of \nsight to a very marked contraction of the retinal vessels, which \nmay even be obliterated; but why quinine should produce these \nopposite vascular effects in the eye and the ear still remains \nunexplained. The congestion of the membrana tympani has \nbeen known to result in inflammation which caused permanent \nimpairment of the hearing, and the constriction of the retinal \nvessels may be so severe as to cause degeneration of the gan- \nglion cells and ascending atrophy of the optic nerve. \n\nRespiration. \xe2\x80\x94 In moderate doses quinine slightly stimulates \nthe respiration, but in large ones acts as a depressant. In ani- \nmals lethal amounts cause death through failure of the respira- \ntion. In exceptional instances quinine induces an asthmatic \ncondition, characterized by a feeling of suffocation and rapid, \nnoisy and irregular breathing. \n\nCerebrum. \xe2\x80\x94 The activity of the brain is thought to be stimu- \nlated by small doses of quinine, which even seem to exhilarate \nin susceptible individuals. Large doses produce a sense of \nheaviness and fullness, with depression, confusion of ideas, hal- \nlucinations and difficulty of speech, and, in addition, there are \nsometimes observed giddiness or vertigo, uncertainty of gait, \n\n\n\nCINCHONA. 135 \n\nand slowness of the pulse. The mental depression may deepen \ninto melancholia or even dementia (which is generally cura- \nble) ; while in some instances, instead of depression there is \nexcitement, which may amount to mania. Collapse may follow. \nOne effect of quinine on the cerebrum is of special interest from \na therapeutic point of view, and that is the diminished appre- \nciation of pain which is caused by it. By some the blindness \nand deafness resulting from large doses are thought to be prob- \nably partly central in origin. From poisonous amounts of qui- \nnine administered to animals the only cerebral effects noted are \nsaid to be general depression and muscular weakness. \n\nSpinal Cord and Nerves: \xe2\x80\x94 In frogs quinine, in toxic doses, \ncauses a temporary increase of reflex excitability, which is fol- \nlowed by the loss of spontaneous movements and paralysis of \nthe spinal cord, as well as arrest of respiration. In mammals \nsmall quantities are said to have the effect of stimulating the \nspinal cord, which is afterwards depressed. It is stated that \nsolutions of quinine when applied locally, even in sufficient \nstrength to cause marked abnormalities in the muscular con- \ntraction, do not lessen the irritability of the nerve trunks, and \nthat no satisfactory proof has been offered that the alkaloid \naffects the peripheral ends of the motor or sensory nerves. \n\nMuscles. \xe2\x80\x94 Experiment shows that the strength of the contrac- \ntions may be increased as much as six times by moderate \namounts of quinine, but the muscle is much more quickly fa- \ntigued than the unpoisoned muscle, so that its total work is less. \nAs the same effect is observed in curarized muscle, it undoubt- \nedly depends upon a direct action on the muscle-fibre. Some- \nwhat stronger doses are found to lower the contraction from \nthe beginning, while large quantities produce a rigor analogous \nto that caused by caffeine. Quinine thus acts upon muscle in \nthe same way as upon the simpler organisms, at first augment- \ning its energy and then weakening it. \n\nUterus. \xe2\x80\x94 There is considerable evidence to show that quinine \nstimulates uterine contractions when labor has already com- \nmenced. In some cases it also appears to increase the men- \n\n\n\nI36 PHARMACOLOGY AND THERAPEUTICS. \n\nstrual flow, but it is improbable that it is capable of exciting \nabortion, as claimed by some. Its action in uterine inertia may \nperhaps be due in part to its action on unstriped muscle, such \nas it appears to have in the case of the arterioles, and in part \nto its effect in arousing the general nervous forces of the sys- \ntem. It tends to prevent post-mortem haemorrhage by causing \ncontraction of the uterus. \n\nUrine. \xe2\x80\x94 Quinine has sometimes, but not constantly, the effect \nof somewhat increasing the amount of urine, an action which \nis thought to be due to its influence upon the renal epithelium, \nby which it is excreted. Quinine is found in the urine within \nhalf an hour after its ingestion by the mouth, and about one-half \nthe quantity absorbed is stated to be excreted within six hours. \nAfter this its elimination takes place less rapidly, and traces \nmay be discovered in the urine seventy-two hours after its in- \ngestion. Even in very small doses quinine has a pronounced \neffect on metabolism, or tissue change. In the excretion of \nnitrogen there is at first a slight increase and then a marked \ndiminution, which, with large doses, may amount to 39 per cent. \nThis is the result of the powerfully depressant action of qui- \nnine on the elimination of all the nitrogenous excretory prin- \nciples, and especially urea and uric acid. In contrast to this, \nand somewhat contrary to what one would naturally be led to \nexpect, is the slight influence of quinine upon the oxidation of \nthe body; the quantity of oxygen absorbed and of carbon diox- \nide given off being practically unaffected by even large medici- \nnal doses. While quinine is excreted chiefly through the kid- \nneys, it appears to be diffused from the blood to a limited ex- \ntent through various other channels, and has been detected in \nthe tears, saliva, sweat and milk, as well as in the bile and in \ndropsical effusions. \n\nTemperature. \xe2\x80\x94 In the normal subject quinine sometimes has \nthe effect of reducing the body temperature to a small extent. \nIn other instances the temperature remains entirely unaffected, \nwhile in still others it undergoes a slight rise. As a rule, it \nmay be stated, small doses cause this slight rise, while doses \n\n\n\nCINCHONA. 137 \n\nconsiderably larger, but not sufficient to produce marked col- \nlapse, occasion an insignificant fall of temperature. In febrile \nconditions, however, it has a decided antipyretic effect, though \nnot so marked as that of drugs of the antipyrine and salicylic \nacid classes. The fact that this action may be produced after \ndivision of the spinal cord shows that it does not depend upon \nany influence exerted upon the central nervous system, and it is \nnow generally accepted that the temperature-reducing property \nof quinine is due to the direct action of the alkaloid upon the \ntissues. It is true that the excretion of carbon dioxide is gen- \nerally regarded as an index of chemical changes resulting in \nthe liberation of energy and consequently of heat; but, while, as \nhas been seen, quinine ordinarily does not seem to affect this \nto any appreciable extent, it is thought extremely probable that \nthe antipyretic action of the drug is due to its retarding the \nmetabolism. In support of this hypothesis it has been sug- \ngested that the presence of fever poisons throws the tissues into \na state of augmented activity, in which they are more suscepti- \nble to the sedative action of the drug, and that even in the nor- \nmal organism a reduction of the temperature might be induced \nif a sufficient quantity could be taken without exciting other \nsymptoms. In this connection attention is called to the fact \nthat in fever the nitrogenous decomposition is much increased, \nwhile quinine has a directly opposite effect; and it is pointed \nout that the diminution in the nitrogenous metabolism may \nalso lead to an increased resistance being offered to the cause \nof the fever, or may lessen the poisonous products circulating \nin the blood. Furthermore, it is argued, the bacteria causing \nfever may themselves be rendered less active by the alkaloid, \nalthough this antiseptic action is probably of subordinate im- \nportance, since many of the pathogenic forms have been found \nto offer great resistance to it. Other authorities hold, some- \nwhat in the same line, that as it is an indubitable fact that the \nproduction of heat is diminished by quinine in fever, we are \nforced to the conclusion that oxidation or combustion (as shown \nby the excretion of carbon dioxide) is not the only source of \n\n\n\nI38 PHARMACOLOGY AND THERAPEUTICS. \n\nheat; that heat may also be liberated by other changes \xe2\x80\x94 by the \nsplitting or hydration of nitrogenous molecules, in the course \nof which the nitrogen is converted into urea; and that these \nchanges are those which are hindered by quinine. If then it \nbe supposed that this form of heat production is, as seems prob- \nable, especially prominent in fever, the fact that quinine acts \non febrile, and not on normal temperature, would also be ex- \nplained. \n\nCinchonism is the name given to the train of symptoms to \nwhich doses of .60 gm. (10 gr.), or more, of quinine are liable \nto give rise. The most characteristic of these are a sense of \nfullness in the head, tinnitus aurium, and slight deafness. From \nlarger amounts these symptoms may be augmented, and in addi- \ntion the patient may suffer from disorders of vision, sometimes \namounting to blindness, and the severe cerebral disturbances \nwhich have already been mentioned. The susceptibility to the \nphysiological effects of the drug differs very greatly in different \nindividuals, and various idiosyncrasies as regards its influence \nhave frequently been noted. Occasionally it is the cause of \ncutaneous eruptions, such as erythema, urticaria, herpes, pur- \npura, etc., and instances have even been reported in which the \naffection was gangrenous. A peculiar rash has also been ob- \nserved among workers in cinchona bark. A case has been re- \ncorded in which .004 (-^ gr.) of quinine repeatedly produced \nan erythematous or bullous eruption, and .20 gm. (3 gr.) has \nbeen known to be followed by severe constitutional disturbance, \nhsematemesis and bloody stools. Gastro-intestinal irritation is \nnot infrequently occasioned by comparatively small doses, and \nin a very few instances albuminuria and hematuria have re- \nsulted from it. Death from quinine is of extremely rare occur- \nrence. Enormous doses have sometimes been taken without \nperil to life, and it seems probable that in these cases a large \nproportion of the drug passed through the system without being \nabsorbed. Hydrobromic acid has been found in many in- \nstances to prevent the ringing in the ears or headache caused \nby it, and from 2 to 7.5 c.c. (^ to 2 fl. dr.) of the diluted acid \n\n\n\nCINCHONA. I39 \n\nmay be given with ordinary doses of quinine. The bromides \nmay also be used for this purpose, and ergotin likewise is said \nto diminish the liability to cinchonism. In respect to their \neffects on the brain, morphine and quinine are regarded as \nantagonistic, and in respect to their action on the sympathetic \nsystem, on the heart, and on the temperature, quinine and atro- \npine. The latter drug is said to be successful in combating the \nannoying cutaneous effects sometimes caused by quinine. \n\nRelative Action of the Alkaloids. \xe2\x80\x94 The other alkaloids re- \nsemble quinine very closely in their effects on the system, but \nare weaker in their action. Quinidine is most likely quinine, \nwhile cinchonine and cinchonidine differ from the latter in \nhaving a convulsant influence; in consequence of which the \nstage of stimulation in their action on the central nervous sys- \ntem is more marked. This tendency to produce convulsions, \nwhich are of an epileptiform character, is said to be much the \nmore pronounced in the case of cinchonidine, which, but for its \nresemblance in other features to quinine, might, it is held, be \nclassed among the convulsive poisons. The relative antipyretic \neffect of the alkaloids has been set down as follows: Quinine, \n100; quinidine, 90; cinchonidine, 70; cinchonine, 40. \n\nTherapeutics of Cinchona and its Alkaloids. \nExternal. \xe2\x80\x94 The expensiveness of quinine renders it unavail- \nable, as a rule, for antiseptic purposes. A one per cent, solution \nof quinine sulphate is sometimes used, however, as an applica- \ntion to unhealthy sores and infected wounds, and a five per cent, \nsolution as a wash in diphtheria, an injection in otorrhcea, hay- \nfever, gonorrhoea and chronic cystitis, and an insufflation in \nwhooping-cough. An attack of hay-fever, if the catarrhal irri- \ntation is confined to the nares and fauces, may in some instances \nbe arrested by the topical application by means of a camel\'s-hair \nbrush, or in the form of a spray, of a solution of quinine hydro- \nchloride (.25 to .50 gm. ; 4 to 8 gr. ; to 30 c.c. ; 1 fl. oz. of \nwater). Powdered quinine sulphate, dusted upon chancroids, is \nsaid to promote rapid healing. \n\n\n\nI40 PHARMACOLOGY AND THERAPEUTICS. \n\nInternal. \xe2\x80\x94 G \'astro-intestinal Tract. \xe2\x80\x94 The preparations of cin- \nchona are used to a large extent in digestive troubles, especially \nwhen associated with a debilitated state of the system, and, if \ntheir administration is not maintained for too long a time, gen- \nerally serve an excellent purpose. In conditions such as atonic \ndyspepsia and gastric catarrh they may often be combined ad- \nvantageously with the mineral acids. They are contra-indi- \ncated in all inflammatory states of the gastro-intestinal mucous \nmembrane, but where the latter is relaxed and there is more \nor less diarrhoea without inflammation, preparations of the red \nbark are likely to be of great benefit. In many cases the com- \npound tincture, which contains other stomachics also, is to be \ncommended. (The name of " Huxham\'s tincture" is often \napplied, incorrectly, to this preparation.) In the gastric catarrh \nof drunkards the alkaloid quinine, generally combined with \nacids, is considered of special service. Quinine is one of the \nmost commonly used of all tonics, and in the small quantities \nrequired for this purpose may generally be continued for a very \nconsiderable time without causing any impairment of digestion \nor absorption. It is frequently given associated with iron, and \nis apt to be prescribed especially with the tincture of ferric \nchloride, the free acid in which readily dissolves it. Strychnine \nis also often added to combinations of quinine and iron, as in \nthe official elixir, glycerite and syrup. The tonic dose of qui- \nnine sulphate or hydrochloride is from .03 to .12 gm. (^ to \n2 gr.), and the latter salt is not infrequently preferred to the \nsulphate on account of its greater solubility. In many in- \nstances both as a tonic and an antiperiodic, cinchonidine salicyl- \nate (not official) is preferable to quinine sulphate, and may \nbe prescribed in doses of from .30 to .60 gm. (5 to 10 gr.). \n\nAntipyretic Effect. \xe2\x80\x94 While quinine was formerly much in \nvogue as an antipyretic, at the present time, except in the case \nof malarial fever, it is seldom employed in this capacity, since \nin the comparatively rare instances where it is deemed advisa- \nble to reduce the temperature by means of drugs this can be \nmuch more certainly and efficiently accomplished by the coal- \n\n\n\nCINCHONA. 141 \n\ntar derivatives, such as antipyrine, phenacetine and acetanilide. \nWhere for any reason it is desirable to use quinine in febrile \nconditions for this purpose it should be given preferably in a \nsingle dose of from 1.20 to 2.40 gm. (20 to 40 gr.) for an adult. \nIt may be administered in tablets or capsules, suspended in milk, \nor in solution. For dissolving the hydrochloride only water, in \nsufficient quantity, is required, but in the case of the sulphate \nit is necessary to add acid. With these large doses it is ad- \nvisable to give sodium or potassium bromide, in order to avoid \nthe disagreeable tinnitus which is likely to be set up by the \ndrug. The diluted hydrobromic acid is an excellent solvent, \nand, at the same time, will relieve the ringing in the ears. In \na considerable proportion of cases the antipyretic action of \nquinine may be relied upon, and, like the other antipyretics, it \nwill be found most efficient at a time when the temperature has \na natural tendency to fall. Usually about two hours elapse \nbefore the antipyretic effect manifests itself, and it should \ntherefore be given at that interval before an expected decline \nin temperature. Quinine, it is worth noting, possesses the \nadvantages over the coal-tar antipyretics of a more prolonged \naction and of exposing the patient to much less risk of collapse. \nIt is therefore still prescribed to some extent in surgical fever. \nSpecific Action. \xe2\x80\x94 One of the most positive effects in the whole \nrange of Medicine is that of quinine, and to a less pronounced \ndegree the other alkaloids of cinchona, in arresting the parox- \nysms of malarial fever. It is now known that this result is \ndue to the directly poisonous action of the drug upon the Plas- \nmodium malariae, which infests the blood and is the specific \ncause of the disease. Outside the body a 1 to 10,000 solution of \nquinine will immediately arrest the movements of the hsemato- \nzoon, and the same thing is found to occur when the alkaloid \nis circulating in the blood. Here it prevents the entrance of \nthe spores into the red-corpuscles, in which their cycle of \ndevelopment solely takes place. About three hours after the \nadministration of quinine by the mouth it is stated that the \nerdoglobular forms met with in tertian and quartan fever be- \n\n\n\n142 PHARMACOLOGY AND THERAPEUTICS. \n\ncome immobile and granular, and lose their affinity for certain \nstains; while several hours later they may be seen deformed \nand segmented. Experimental research has shown that quinine \ndoes not act equally on the parasite in all its stages; its most \npowerful effect being upon the forms which are just breaking \ninto spores and upon the free-swimming organisms, while its \naction is much weaker upon the older segmenting bodies, and \nleast upon the young endoglobular forms. Since it has been \nfound that these last exist in the blood just before the paroxysm, \ntheir sporulation giving rise to the characteristic chill with its \nensuing febrile reaction, quinine, on account of the inefficiency \nof its action upon them, will have little or no effect in counter- \nacting the paroxysm then impending. If, however, it is given \nat this time it will, it is argued, be present in the blood when \nthe spores are liberated, and as these, as has been seen, are most \nsusceptible to its action, it will be able (if the quantity adminis- \ntered has been sufficiently large) to destroy them, and thus \nprevent the development of the new cycle. It is advisable, \ntherefore, that the alkaloid should be given several hours be- \nfore the expected paroxysm, so as to allow time for absorp- \ntion. The powerful destructive action which quinine exerts \non the malarial parasite, both in and outside the body, is ex- \nactly the same as that which is observed in the case of amoebae \nand other similar forms. It is explained by the effects of \nthe alkaloid as a protoplasmic poison, by virtue of which it acts \nmore strongly (specifically) on the lower forms of life than on \nthe higher, and hence can be introduced into the human body \nwith perfect safety in quantities which are sufficient to destroy \nsuch simple organisms. In addition to this direct action, it is \nheld by some that quinine has an indirect action, manifesting \nitself in an alteration of the environment, in consequence of \nwhich the latter is rendered less favorable to the growth of \nthe parasite. As an example of this is cited the diminished \nreadiness with which the red blood-corpuscles part with their \noxygen after the addition of quinine. Both theory and experi- \nence, it has been observed, point to the decline of the fever as \n\n\n\n\n\n\nCINCHONA. I43 \n\nthe most advantageous time for the administration of the drug. \nSome prefer to give a single large dose (usually about 1 gm. ; \n15 gr.), and others divided doses, of about .30 gm. (5 gr.), at \nintervals between the attacks. Since the elimination of quinine \ntakes place with considerable rapidity, the maximum curative \neffect is believed to be obtained by the administration of the \nwhole amount required in one dose, rather than by a succession \nof small doses. As the result of a very extended observation \none of the best authorities on this subject states that according \nto his experience the most effective method of treating an inter- \nmittent is to give a full dose of quinine (.60 gm. ; 10 gr.) in the \nsweating stage, and the same quantity five hours before the time \nof the next paroxysm. He has also found that the anti-periodic \nproperty of quinine is increased, while the cerebral effects of \nlarge doses are diminished, by combination with morphine. If \nin any case a very prompt effect is desired, from 1 to 2 gm. (15 \nto 30 gr.) of quinine carbamide (not official), which is very \nsoluble, may be administered hypodermatically ; a smaller dose, \n.30 to .50 gm. (5 to 8 gr.) in an hour or two, is almost in- \nvariably successful in preventing the next immediate chill. \nAfter the paroxysms have been overcome the remedy should \nnot be entirely abandoned, but, for at least three weeks, on the \nseventh day from the date when the last one appeared full \ncinchonism should be produced, by the use of from .60 to 1 gm. \n(10 to 15 gr.) of quinine; as the attacks show a decided tend- \nency to recur in cycles of seven days. It has been found that \nthe action of quinine is materially assisted by the continuous \nadministration of arsenic during the intermissions, and until the \nthird septenary period has passed. Quinine is both curative \nand prophylactic, and it has in numberless instances been \nproved that its regular administration in very moderate quan- \ntities (from .20 to .30 gm. ; 3 to 5 gr. a day) will absolutely or \nto a large degree protect persons living in malarious regions \nfrom ague. If the malarial poison is concentrated and active, \nand the conditions are otherwise unfavorable, the amount \nshould be doubled; and it is to be noted that an enormous ex- \n\n\n\n144 PHARMACOLOGY AND THERAPEUTICS. \n\nperience has now shown that the drug when taken thus as a \nprophylactic is entirely free from injurious effects. In re- \nmittent fever the best plan of administration is to give from \n1.20 to 2 gm. (20 to 30 gr.) of quinine in a single dose once or \ntwice each day until the temperature is reduced to normal. \nIn the pernicious variety of malarial fever the patient\'s life \nis in imminent danger, and not only are large doses of quinine, \nfrom 1.20 to 3.60 gm. (20 to 60 gr.) demanded, but they must \nbe given promptly; so that administration by the stomach, \nrectum and hypodermatic injection may be in turn or simul- \ntaneously practiced. In any severe attack of ague Clark\'s pow- \nder, which consists of quinine, 10; powdered capsicum, 4; \npowdered opium, 1 part, may be resorted to. This is usually \ngiven in 1.00 gm. (15 gr.) doses, and is said to be more effica- \ncious in the treatment of the disorder than larger doses of \nquinine when given alone. In chronic malarial infection quinine \nis less curative than in the acute; the principal reason for this \nprobably being the presence of certain structural alterations re- \nsulting therefrom in the liver, spleen, kidneys, intestines or \ncentral nervous system. Here quinine salicylate and cinchoni- \ndine salicylate are said to be especially effective, and they may \noften be combined advantageously, according to circumstances, \nwith iron, arsenic or cholagogue cathartics such as the prepara- \ntions of podophyllum. When an individual has once suffered \nfrom malaria any subsequent affection which he has is apt to \nassume a malarial type. This is especially true of neuralgia, \nwhich is often located in the forehead and has received the \nname of "brow-ague." It generally yields promptly to quinine, \nwhich is also sometimes of service in neuralgias not of ma- \nlarial origin. Not only superficial neuralgias in various por- \ntions of the body, but also neuralgic pains in any of the deep- \nseated organs, may be an expression of the malarial cachexia \nas affecting the sensory nervous system ; while its influence \non the motor apparatus may be shown by such disorders as \nchorea, epilepsy, asthma, hiccough, laryngismus stridulus, and \nspasmodic stricture of the urethra. These neuroses, it has \n\n\n\nCINCHONA. 145 \n\nbeen found, may either be substituted for the ordinary malarial \nparoxysm (chill, fever and sweating) or may assume a period- \nical character in consequence of having occurred in a system \nalready affected with malaria. They are to be distinguished \nfrom other functional nervous- affections by the more uniform \nperiodicity in the recurrence of the paroxysms, and if the \npatient is known to have previously suffered from malarial in- \nfection the diagnosis is usually simple. In the case of ma- \nlarial neuralgias particularly, morphine is of material service as \nan adjunct to the action of quinine. Malarial diarrhoea, dysen- \ntery and jaundice may sometimes be promptly relieved by \nquinine, but if these depend on structural alterations in the liver \nor the intestinal glands they are naturally more intractable. \nHsematuria of malarial origin usually requires large doses of \nthe remedy. Warburg\'s tincture is a remedy which has long \nenjoyed a considerable reputation in the treatment of malarial \ninfection, especially in the tropics. It contains quinine sul- \nphate, 80; Socatrine aloes, 100; opium. 1; rhubarb, 32; cam- \nphor, 8; with a number of aromatics and menstruum to 4000. \nThe proportion of quinine is about .60 gm. (10 gr.) to 30 c.c. \n(1 fl. oz.) of menstruum, and the dose is 4 to 15 c.c. (1 to 4 \nfl. dr.). It may now be obtained in tablets, each of which rep- \nresents 4 c.c. (1 fl. dr.) of the preparation. In many instances \nWarburg\'s tincture is prescribed without the aloes. In enlarged \nspleen (ague-cake) and in conditions, such as malarial jaundice, \nwhere there is great irritability of the stomach or of the in- \ntestinal mucous membrane, as well as in all cases where it \nbecomes necessary to secure the promptest possible effect, it is \nadvisable that quinine should be administered subcutaneously. \nThe simple alkaloid and quinine sulphate are not adapted for \nthis purpose, as they produce too much irritation, and have even \nbeen known to give rise to tetanus; and hence it is requisite to \nuse some more soluble preparation of quinine, such as quinine \ncarbamide (quinine urea), hydrochloride, kinate, or sulpho- \nvinate. \nOther Uses.\xe2\x80\x94 Quinine has been employed in a great variety \n11 \n\n\n\nI46 PHARMACOLOGY AND THERAPEUTICS. \n\nof conditions besides those already mentioned, and in many of \nthem with good results. There is no question of its distinct \nvalue in the treatment of whooping-cough, which there is good \nreason to suppose is a microbic disease. In order to get the \nfull benefit of its remedial agency, however, it should be slowly \nswallowed in solution, so that it may act locally on the mucous \nmembrane of the fauces as well as produce an internal effect; \nand given in this way its intensely bitter taste proves an almost \ninsuperable objection, as it is extremely difficult to get children \nto take it. Still, in other forms it has been found of consider- \nable service by a number of observers. It may therefore be \ngiven in capsules or combined with chocolate or administered \nby the rectum in suppositories or enemata. It is advised that \nin the case of an infant under one year the treatment should \nbe commenced with as many centigrammes as its age in months, \nand that older children should take daily as many decigrammes \nas their age in years. In no case, however, should the amount \ntaken in a single day exceed 1.5 gm. (23 gr.). To children \nthe tannate is not infrequently given, as it is practically taste- \nless, and made into tablets with chocolate is readily taken. As \nit contains much less quinine, the dose should be twice as large \nas the sulphate. In influenza, quinine, either alone or combined \nwith other remedies, has been used with some success, and it \nis also claimed that it is of value as a prophylactic in this dis- \nease. When an attack has commenced it is said that its early \nadministration tends to prevent or diminish cardiac complica- \ntions, as well as other complications and sequelae. In certain \ncerebral affections it is of decided benefit. In the case of el- \nderly people it improves the intra-cranial circulation, and so \nrelieves a group of symptoms depending on sluggishness of the \nlatter which has been described as follows: Headache, vertigo, \nfailure of memory and despondency, associated with a slow \npulse, an atheromatous degeneration of the vessels, puffiness of \nthe eyelids, and dilatation of the superficial veins of the head. \nIn the adynamic form of delirium tremens small doses of qui- \nnine are of service in tranquilizing the patient, and in the pre- \n\n\n\nCINCHONA. 147 \n\nliminary stage of the affection known as " the horrors " has \nbeen found useful, especially when combined with a mineral \nacid, by correcting the digestion and invigorating the cerebral \nmotor centres. In some forms of insanity, and particularly the \npuerperal variety, where there is much weakness and the sur- \nface is cold and clammy, quinine is also likely to prove beneficial. \nIn headache and in neuralgias in various localities, as well as in \nchorea and epilepsy which are not dependent upon a malarial \ncachexia, it may prove useful, provided that anaemia is present \nand lies at the seat of the nervous derangement; but not other- \nwise. The laryngismus stridulus to which rachitic children are \nsubject is said to be ameliorated especially by quinine hydrobro- \nmide. As an adjuvant to other treatment, quinine is of value \nin adynamic diseases, such as diphtheria and in surgical affec- \ntions, where it aids in sustaining the vital powers and tends \nto check the formation of pus ; as well as in cutaneous diseases \nlike erysipelas, erythema nodosum, ecthyma and \'impetigo, \nwhere there is an enfeebled condition of the system. A com- \nmon cold may often be successfully aborted by the adminis- \ntration of .60 gm. (10 gr.) of quinine with .03 gm. ( T / 2 gr.), \nor less, of morphine at the onset of the attack. Quinine has \nalso been found of service in asthma and hay-fever after the \nsubsidence of the acute symptoms, in chronic bronchitis with \nbronchorrhcea, and in the night-sweats of pulmonary tubercu- \nlosis. For the latter, doses of from .90 to 1.20 gm. (15 to \n20 gr.) are required. A full dose is frequently given previous \nto the passage of the catheter or urethral sound, in order to \nprevent the occurrence of a chill. Quinine is found useful by \nobstetricians in promoting uterine contractions after labor \nhas once commenced, and is also thought to materially reduce \nthe danger from sepsis. As an emmenagogue in anaemic sub- \njects it is often combined with iron, and iron and quinine \ncitrate is a good preparation for this purpose. There are \ncertain classes of cases in which quinine should, if possible, \nbe avoided. Among these may be mentioned : Idiosyncrasy, \nin consequence of which quite small doses produce very severe \n\n\n\nI48 PHARMACOLOGY AND THERAPEUTICS. \n\ncinchonism, acute or subacute disease of the middle ear, gastro- \nintestinal irritation, meningitis, and inflammation of the genito- \nurinary tract. \n\nDivision II. \xe2\x80\x94 Drugs Acting on the Blood. \nA. Drugs Acting on the Plasma. \xe2\x80\x94 Substances of various kinds \nare capable, after absorption, of existing in solution in the \nplasma, and those which act as purgatives, diuretics and dia- \nphoretics must necessarily alter the composition of the plasma \nby abstracting substances from it. The object for which drugs \nare given to act on the plasma is to increase its alkalinity. \nWere it even desirable to render it acid, no agent is at present \nknown which is able to accomplish this, or even to reduce to \nany extent the natural alkalinity of the plasma. The mineral \nacids, as is well known, can exist in it only in the form of \nneutral salts. \n\nThe alkalizers of the plasma are salts of \xe2\x80\x94 \n\n(1) Potassium. (4) Lithium. \n\n(2) Sodium. (5) Magnesium. \n\n(3) Ammonium. (6) Calcium. \n\nThis is approximately the order of their alkalizing power, potassium \nbeing undoubtedly the most powerful, while calcium is very feeble. \n\nIt has been found that in the plasma the decomposition of the \ncitrates and tartrates of these metals into alkaline carbonates \ntakes place, and one of the purposes for which alkalies are \nadministered is to cause, if possible, the formation of soluble \nurates by their combination with uric acid. Furthermore, the \nexcretion of the urates is promoted by the diuretic action of \nthe alkalies. \n\nTherapeutics. \xe2\x80\x94 Alkalies are consequently ver.y largely em- \nployed in the treatment of gouty conditions, which are charac- \nterized by an excess of uric acid or an analogous substance \nin the plasma. Lithium preparations have been regarded by \nmany as especially beneficial in such cases, but there is no rea- \nson to suppose that this is a fact, particularly as the solubility \n\n\n\nDRUGS ACTING ON THE BLOOD. 1 49 \n\nof the urates is not increased by lithium. What is important \nis that the preparation selected should be one that is not apt \nto disturb the digestion, since the remedy must usually be \ncontinued for a considerable period; hence potassium citrate \nand lithium citrate are favorite salts, and the numerous natural \nalkaline waters are also very largely used. No doubt, one \nof the chief services which the latter render is the flushing \nof the system with a large amount of fluid. \n\nOn the hypothesis that acute articular rheumatism is due \nto a materies morbi of the plasma (by many believed to be lactic \nacid), which is generated within the body, large doses of the \nalkalies were long given in this and other affections involving \na so-called rheumatic diathesis, with the idea of neutralizing \nand eliminating such morbid principle from the blood. This \ntreatment, however, has now been practically supplanted by \nthe use of salicylic acid and its compounds. \n\nIn chronic lead poisoning potassium iodide has been and is \nstill almost universally employed. It has been supposed to \npromote the elimination by the kidneys of the lead, which \naccumulates in the tissues in a very sparingly soluble form, \nthough it has now been denied that this salt has any effect \non its excretion either by the urine or the intestine, by which \nmost of the lead is known to make its escape from the body. \n\nPurgatives, diaphoretics and diuretics necessarily have the \neffect of altering the composition of the plasma, and hence are \nfrequently employed in the treatment of local or general \ncedema and of effusion into serous cavities, for the purpose \nof draining off fluid from the plasma. They are also used to \nfacilitate the excretion of poisons from the blood in conditions \nsuch as uraemia and cholsemia. Venesection, transfusion and \nthe intravenous injection of watery solutions naturally alter \nthe composition of the plasma directly. \n\nB. Drugs Acting on the Red Corpuscles. \xe2\x80\x94 The most impor- \ntant are those which are capable of increasing the amount of \nhaemoglobin. It is a fact, however, that there are no known \ndrugs which will increase the amount of iron in perfectly \n\n\n\nI50 PHARMACOLOGY AND THERAPEUTICS. \n\nhealthy blood; hence, in a strict sense, the action of all such \nagents much be regarded rather as a pathological than a physi- \nological one. These drugs are called Haematinics. \n\n\n\nThey are \xe2\x80\x94 \n\n(1) Iron and its salts. \n\n(2) Arsenic trioxide. \n\n(3) Potassium permanga- \n\nnate (doubtful). \n\n\n\n(5) Hydrochloric acid \n(4) Copper salts \n\n(6) Potassium salts \n\n(7) Phosphorus \n\n\n\nM doubtful). \n\n\n\nThey increase the quantity of haemoglobin in each red cor- \npuscle, as well as the number of these corpuscles. Their effects \nare materially assisted by all measures which tend to improve \nthe digestion and the general health. The mode of action of \nthese haematinics is still obscure, and will be discussed under \neach drug. Iron is by far the most important and efficient. \n\nIndirect haematinics are drugs which are of service by re- \nmoving some obvious cause for a deficiency of haemoglobin \n(the condition known as anaemia), such as mercury, given \nfor syphilis, quinine, for ague, etc. \n\nAlcohol and quinine slightly diminish the oxygenating power of the \nblood by increasing the stability of the oxyhemoglobin. Citrates and \ntartrates of the alkaline metals are partially oxidized to carbonates at \nthe expense of the oxygen of the red blood-corpuscles. \n\nThe red blood-corpuscles are believed to be increased in size by oxy- \ngen and hydrocyanic acid, and to be rendered smaller by morphine and \ncarbon dioxide, as well as by quinine, when, with a high temperature, as \nis probably the case, they are a little larger than normal. By small doses \nof mercury they are said to be increased in number. \n\nIn consequence of the presence of a large amount of sodium chloride, \nthe red corpuscles pass rapidly through the walls of the capillaries. \n\nQuinine and hydrocyanic acid diminish the ozonizing power of the \nblood. \n\nCertain drugs destroy life by altering the composition of the \nhaemoglobin, and so preventing it from uniting with oxygen. \nWhatever their therapeutic effects, they are therefore of consid- \nerable importance from a physiological and toxicological point \nof view. Thus, carbon dioxide expels the oxygen from oxy- \n\n\n\nDRUGS ACTING ON THE BLOOD. I 5 I \n\nhaemoglobin; hydrocyanic acid forms cyano-haemoglobin ; potas- \nsium chlorate, the nitrites, especially amyl nitrite, and most of \nthe antipyretics (antipyrine and its compounds excepted) con- \nvert the haemoglobin into methaemoglobin ; acetanilide, amyl \nnitrite, potassium chlorate and pyrogallic acid destroy the red \ncorpuscles. \n\nPhosphorus, arsenic, hydrogen sulphide, turpentine, iodine, and sul- \nphur also reduce oxyhemoglobin. \n\nHydrocyanic acid, alcohol, chloroform, quinine, morphine, nicotine, \nstrychnine and brucine have the effect of diminishing the oxidation of \nfreshly drawn blood which is exposed to the air. \n\nC. Drugs Acting on the White Corpuscles. \xe2\x80\x94 Normally the \nwhite corpuscles undergo constant changes of form and position \nexactly similar to those of the amoeba, and it is found that gen- \nerally those drugs which are poisons to the amoebae are, when \napplied in sufficient concentration (which is rarely the case \nin the human body), toxic to the leucocytes. All irritants \nwhich set up inflammatory action have the effect of causing \nthe passage of white corpuscles through the capillary walls; \nwhile all the cinchona alkaloids, and especially quinine, have \nthe property of arresting this migration. Berberine sulphate \nand acetanilide act in a similar way. \n\nVeratrine destroys white co\'rpuscles when applied to them outside the \nbody. \n\nCamphor, myrrh and other aromatics are said to increase their pro- \nduction by increasing absorption from the intestine, while quinine, it \nis asserted, diminishes their number in the blood. \n\nA few other facts relative to the action of certain drugs \nupon the blood may be noted. Poisonous doses of mercury \nincrease the fluidity of the blood, impair its coagulability, and \ndiminish its solids. Phosphorus may also prevent the blood \nfrom clotting as readily as usual, and sometimes may cause it \nto remain fluid for forty-eight hours or more, but this is \nthought to be probably secondary to changes produced in the \nintestine and liver, rather than a direct effect of the poison. \n\n\n\n152 PHARMACOLOGY AND THERAPEUTICS. \n\nVarious astringents and calcium salts (especially the chloride), \non the other hand, promote coagulation. Cod liver oil in- \ncreases the solids of the blood. \n\nA. Drugs Acting on the Plasma. \nPOTASSIUM. \n\n1. POTASSII HYDROXIDUM (Potassa, U. S. P., 1890).\xe2\x80\x94 Potas- \nsium Hydroxide. (Potassa. Potassium Hydrate. Caustic Potash.) \n\nPreparations. \nLiquor Potassii Hydroxidi (Liquor Potassae, U. S. P., 1890). \n\xe2\x80\x94 Solution of Potassium Hydroxide. (Solution of Potassa.) \nDose, 1 c.c; 15 n\\. \n\nLiquor Cresolis Compositus. \xe2\x80\x94 Compound Solution of Cresol. \n\nUnofficial Preparations. \nPotassa Cum Calce (U. S. P., 1890). \xe2\x80\x94 Potassa with Lime. \n(Vienna Caustic. Vienna Paste.) \n\nPotassa Sulphurata (U. S. P., 1890). \xe2\x80\x94 Sulphurated Potassa. \n(Liver of Sulphur.) \n\nAction of Potassium Hydroxide. \n\nIn the hydrates and carbonates of the alkalies the action of \ntheir basic metallic constituents is now known to be of little \npractical importance, the alkalinity of the substance mainly de- \ntermining its pharmacological effects. The metallic ion serves \nfor the most part as merely the means of applying the non- \nmetallic constituent. It is incorrect, therefore, to regard potassa \nas typifying the action of potassium on the system. The in- \nfluence of the potassium ion is much more evident in other \nsalts, and notably the chloride, in which the Cl-ion is quite \ninactive, while the K-ion is the energetic constituent. \n\nAction of Potassium Salts in General. \xe2\x80\x94 In the salts of the \nlatter character it is seen that potassium has a distinctly \ntoxic action, the principal effects of which are depression of the \ncentral nervous system and of the heart. That the heart is \n\n\n\nPOTASSIUM. I53 \n\ninjuriously affected by the potassium salts in large amount is \nshown by the pulse becoming much slower and weaker and \nby a sudden fall of arterial pressure. In animals, when these \nsalts are injected into the circulation, the cause of death is \ncardiac failure. But while in cases of poisoning by quantities \nfar in excess of therapeutic doses the special toxic action of \npotassium upon the heart may, no doubt, have an important \nshare in bringing about the fatal result, the effects noted are \nin many instances believed to be due to the action of the poison \nupon the alimentary canal. Upon the brain and the motor and \nsensory nerves, and upon the spinal cord especially, as well \nas upon the heart and the muscles in general, potassium salts \nexert a pronounced depressant influence. In poisoning by \nthem in the frog the central action is shown by the spontaneous \nmovements becoming weak and slowly performed, while in \nmammals the chief nervous symptoms are great muscular weak- \nness and apathy. The respiration, it is stated, becomes rapid \nand labored, probably from the anaemia of the centres, and death \nin often preceded by weak and asphyxial convulsions. \n\nIt is a fact, however, that when administered in ordinary \nmedicinal doses these salts are not at any time present in the \nblood (owing to the rapidity of excretion) in sufficient quanti- \nties to produce marked toxic effects, such as are observed when \nthey are injected directly into the circulation of animals. Their \npoisonous action upon the heart has given rise to exaggerated \napprehensions of the danger of using them in therapeutics, and \nit should therefore be borne in mind that only very large quanti- \nties have any effect at all upon the heart, especially when given \nby the mouth. In this connection it has been pointed out that \nvery much larger quantities of potash are taken daily in the \nfood by thousands of persons than are ever prescribed in medi- \ncine, the amount of it in the food of some classes being esti- \nmated at from 50 to 100 gm. (i 1 /? to 3 oz.) per day. Still, the \npossibility of causing undesirable cardiac depression when \npotassium salts are given in large and long-continued doses \nshould lead to a certain amount of caution in their use, and \n\n\n\n154 PHARMACOLOGY AND THERAPEUTICS. \n\nespecially in the case of persons suffering from cardiac disease. \nIt is also well to remember that when administered in con- \nsiderable quantity for an extended period they are likely, as \nhas been found, to have the effect of dissolving out the haematin \nfrom the red corpuscles, and so produce a dyscrasia, with im- \npoverishment and excessive fluidity of the blood. \n\nExternal. \xe2\x80\x94 In concentrated form potassium hydroxide has a \npowerful irritant and caustic action, partly in consequence of its \ncombining with the water of the part to which it is applied. In \naddition, it combines with the tissue elements to form alkaline \nalbuminates, and with the fats to form soaps. In this way it \ndissolves the skin and produces necrosis of the deeper tissues. \nThe surface generally becomes coated with a semitransparent \ncrust, and this eschar is subsequently separated by inflammation \nfrom the uninjured parts, leaving an ulcer. As potash forms \nsoluble compounds with the proteids, it is only slowly neutralized \nby the tissues, so that it penetrates more readily than many other \ncorrosives. In weak solution it thoroughly cleanses the skin \nby dissolving the superficial layer of the stratum comeum and \nthe oily secretions of the glands, but if applied for some time \nit penetrates more deeply and may excite slight irritation and \nredness. On the mucous membranes it effects solution of \nmucus. Very dilute solutions apparently have a sedative effect; \nstrong solutions destroy all living tissues with which they come \nin contact. \n\nInternal. Alimentary Tract. Mouth. \xe2\x80\x94 It has the character- \nistic alkaline taste of the hydrates and carbonates. In very \nweak solution it simply causes a reflex flow of saliva. In more \nconcentrated form it dissolves the mucous secretions and the \nsuperficial layers of the lining membrane, the irritation chang- \ning to a bright red the lips, tongue and general surface of the \noral cavity, which feel soapy to the touch. Still stronger solu- \ntions have, as on the skin, a powerful escharotic effect, which \nextends to the throat and oesophagus, and may either prove \nimmediately fatal or give rise to subsequent cicatrization and \nstenosis. The accidental swallowing of caustic alkalies is prob- \n\n\n\n\n\n\nPOTASSIUM. I55 \n\nably the most frequent cause of cicatricial stricture of the \noesophagus. \n\nStomach. \xe2\x80\x94 As in the oesophagus, concentrated solutions pro- \nduce an amount of corrosion sufficient to destroy life in a short \ntime, or which may be followed subsequently by gastric ulcer or \nscar-formation. They may prove immediately fatal by causing \nperforation into the peritoneal cavity. Small quantities of the \ndrug appear to be soon neutralized by the hydrochloric acid of \nthe gastric juice, and act no longer from their alkalinity, but \nmerely from their effects as a salt, if at all. Larger quantities \nrender the contents of the stomach neutral or alkaline, diminish \nthe activity of the pepsin, and tend to prevent gastric diges- \ntion. It has been demonstrated that the alkalies have no effect \nwhatever on the activity of the secretory glands of the stomach, \nwhile, on the other hand, they may affect the juice already \nsecreted by making it neutral, or even alkaline, and thus com- \npletely interfere with its usefulness. In hyperacidity of the \nstomach, however, they may prove of benefit by lessening the \namount of free acid present. \n\nIntestines. \xe2\x80\x94 It is thought to be absorbed in combination with \nproteids or as a carbonate, and disappears rapidly from both \nthe stomach and small intestine. In the latter it is found to \nhave an indirect effect, in consequence of its diminishing the \nacidity of the gastric juice. Hence the secretion of the pan- \ncreas, which is normally stimulated by the acid fluid passing \nfrom the pylorus, is materially lessened. While, however, this \nagain may render digestion less complete, the greater alkalinity \nof the intestinal contents no doubt tends to increase the effi- \nciency of the pancreatic juice already secreted. Contrary to \nwhat was formerly believed, it has been conclusively shown that \nalkaline salts do not increase the secretion of bile, are not ex- \ncreted in it, and do not cause any change in its reaction. It \nis therefore inferred that any effect which these may exert in \naffections of the liver are due to their effects in the duodenum. \nIn therapeutic doses they apparently have no effect on intesti- \nnal putrefaction, but it is stated that very large quantities (15 \n\n\n\nI56 PHARMACOLOGY AND THERAPEUTICS. \n\ngm. ; y 2 oz.) increase the putrefaction, in consequence prob- \nably of their neutralizing the disinfectant gastric juice. \n\nBlood. \xe2\x80\x94 It is believed to exist in the blood chiefly as the car- \nbonate. The alkalinity of that fluid, like that of the body in \ngeneral, is increased; but the organism rapidly frees itself from \nthe excess of alkali by excreting alkaline salts. It is stated that \nthe blood of rabbits treated with alkalies is more strongly ger- \nmicidal than usual, and that under these circumstances the ani- \nmals show an increased resistance to infection with anthrax \nbacilli. \n\nRespiratory Passages. \xe2\x80\x94 The bronchial secretion appears to \nbe increased in quantity and also rendered less viscid. Mucin \nis more soluble in alkaline media, so that the alkalies dissolve \nany accumulations of mucus or make them more fluid. \n\nNervous System. \xe2\x80\x94 Among the effects, in addition to those \nof its corrosive action in the alimentary tract, which caustic \npotash causes from the destruction of the tissues with which \nit comes in contact, the reflex influence on the central nervous \nsystem is of great importance. In consequence of this, when \nthe dose is large, shock may appear so rapidly and be of such \nviolence as to completely overshadow the local symptoms, and \ndeath may occur from cardiac paralysis before these have had \ntime to develop. \n\nUrine. \xe2\x80\x94 The secretion of urine is increased, partly in con- \nsequence of the salt-action and partly, apparently, as the re- \nsult of an irritant effect upon the renal epithelium. The abso- \nlute amount of all salts excreted is increased, although their \npercentage is naturally lessened. The urine is temporarily ren- \ndered less acid or even alkaline. It generally soon regains its \nacidity, but under the use of repeated doses of sufficient amount \nits reaction may be kept alkaline indefinitely. Excretion takes \nplace chiefly by the urine. \n\nMetabolism. \xe2\x80\x94 In view of the fact that outside the body cer- \ntain substances undergo oxidation much sooner in alkaline solu- \ntion than when neutral, and also on account of the importance, \nas regards their functions, of the alkaline reaction of the tissues. \n\n\n\nPOTASSIUM. 157 \n\nit might be\' expected that an increase in the alkalinity of the \nfluids of the body would have the effect of increasing oxida- \ntion and promoting the general metabolism. There is, how- \never, no direct evidence that this is the case, and it is now \nrecognized that the alkalies have less influence upon tissue- \nchange than was formerly believed. The change in reaction, it \nis pointed out, can only be very brief, and is apparently not \nmarked enough, or not of such a nature, as to be capable of \ndemonstration by methods at present available. According to \nthe observation of the best authorities the excretion of urea \nis sometimes increased and sometimes diminished, the explana- \ntion of this probably being that the local action of the alkali \non the alimentary tract sometimes causes an increased forma- \ntion and destruction of the white corpuscles of the blood, and \nthus increases the uric acid. Some of the most reliable ob- \nservers have found that very large doses decrease the amount \nof the latter in the urine, while smaller ones have no effect on \nit. As regards the oxidation in the tissues, it is concluded that \nthe amount of tissue waste is but little affected by the increased \nalkalinity of the blood, and that the slight changes observed \nmay vary not only in different species, but in different persons, \nand even in the same person at different times. The cause of \nthis individual variation is attributed either to difference in the \namount of acid formed in the tissues or to differences in the \nlocal effect of the alkalies in the alimentary tract. \n\nTherapeutics of Potassium Hydroxide. \nExternal. \xe2\x80\x94 Caustic potash was formerly employed to make \nissues. It is sometimes used in the destruction of lupus car- \ncinomatous growths, etc., but its effects are somewhat difficult \nto limit, and great care should be taken in its application. On \naccount of the thorough and penetrating character of its eschar- \notic action it is to be preferred when a very deep and decided \ninfluence is desired, as after the bite of a venomous snake or \nrabid dog. For cauterizing morbid or cicatricial tissue it is \noften best to employ it in the form of Potassa cum Calce, which \n\n\n\nI58 PHARMACOLOGY AND THERAPEUTICS. \n\nis milder in its operation and more manageable than pure \npotassa. In using it it is generally first reduced to a paste \nwith a little alcohol, its action being limited laterally by means \nof adhesive plaster and in depth by the duration of the applica- \ntion. After the withdrawal of the caustic, diluted vinegar \nmay be applied in order to neutralize any alkali that may remain, \nand this is sometimes followed by a poultice. It is often of ser- \nvice in phagedena. Caustic potash is employed after operations \nfor the cure of fistula, for the purpose of preventing immediate \nunion. It also proves a very satisfactory agent in the treat- \nment of ingrowing toe-nail. The portion of nail to be removed \nis painted with a 40 per cent, solution of it, with the effect of \nrapidly softening its upper layer to such an extent that it can \nbe readily scraped off. This procedure is repeated until the \nnail which remains is only a thin scale, which can be excised \nwith fine scissors. Liquor Potassii Hydroxidi may be employed \nto dissolve oily secretions and thoroughly cleanse the skin before \noperations, and, diluted, is sometimes used to remove the epider- \nmis in some forms of chronic cutaneous disease. In like man- \nner it softens callosities, such as corns and bunions, resulting \nfrom the effects of local pressure. In sufficiently weak solution \nits sedative influence tends to allay itching, and the following \ncombination has been found efficient in pruritus: Solution of \npotassium hydroxide, 4; phenol, 4 to 8; flaxseed oil, 30. \n\nInternal. \xe2\x80\x94 Potash is not often used internally, except at \ntimes as an antacid for the relief of acid dyspepsia. It has \nbeen claimed that it is sometimes successful in reducing obesity, \na result attributed to its stimulation of the processes of meta- \nbolism, with consequent increased oxidation of proteids and \nfats ; but it seems more probable that in cases of this kind it \nacts by slowly poisoning the patient, producing disorganization \nof the blood and interfering with nutrition. It has been used \nwith good results in acne of the face, and is stated to be of \nservice in both promoting and relieving strangury from can- \ntharides. Potash, however, is liable to cause gastric irritation, \nand hence to obtain the effects of alkalies upon internal organs \n\n\n\nPOTASSIUM. 159 \n\npotassium, bicarbonate, citrate and acetate are usually employed \nin preference to it. \n\nTOXICOLOGY. \nSee Sodium Hydroxide. \n\n2. POTASSII CARBON AS.\xe2\x80\x94 Potassium Carbonate. (Salt of Tar- \ntar.) Dose, 1 gm.; 15 gr. \n\n3. POTASSII BICARBONAS.\xe2\x80\x94 Potassium Bicarbonate. Dose, 2 \ngm.; 30 gr. \n\nAction of Potassium Carbonate. \nThe action of potassium carbonate is essentially the same as \nthat of potassium hydroxide, except that it is much less corro- \nsive. In solution it rarely induces actual lesions of the skin \nunless after very prolonged application. \n\nTherapeutics of Potassium Carbonate. \nIn weak solution or as a paste it is sometimes used externally \nfor the relief of itching in cutaneous diseases. It is also em- \nployed in baths, where its irritant action on the skin is made \nuse of to soften the epidermis and cause stimulation of extensive \nareas, as is often desirable in such affections as ichthyosis. \nFor internal use potassium bicarbonate is almost invariably \npreferred, as the carbonates are too irritating to the stomach. \nIt enters into the composition of the Pilulae Ferri Carbonatis. \n\nAction of Potassium Bicarbonate. \nThe hydrates are much more powerful solvents than the car- \nbonates, and these than the bicarbonates. Hence potassium \nbicarbonate is but very feebly caustic. Otherwise its pharma- \ncological action is the same as that of the carbonate. \n\nTherapeutics of Potassium Bicarbonate. \n\nStomach. \xe2\x80\x94 While it is always advisable to remove the cause, \n\nif possible, the alkalies often serve a very useful purpose in the \n\ntreatment of dyspepsia. Sodium bicarbonate is much more \n\ngenerally relied upon to give relief, particularly in cases of \n\n\n\nl6o PHARMACOLOGY AND THERAPEUTICS. \n\nhyperacidity, than potassium bicarbonate. Where no excessive \nacidity exists, however, the latter is often preferred, and is \ncommonly efficacious in relieving the distention and discomfort. \nIt should be given in small doses and well diluted, so that it \nmay not irritate the stomach. Alkalies are of great service \nwhen there is impaired digestion of fats, not only preventing \nthe formation of butyric acid, but also assisting the emulsi- \nfication and absorption of the fats. In affections of the liver, \nand when from any cause the flow of bile into the intestine is \ninterfered with, they are likewise useful in promoting the di- \ngestion and absorption of fats. In these conditions potassium \nbicarbonate is considered preferable to other alkaline remedies. \nPotash water may be used as a substitute for soda water. It \nis made by passing carbon dioxide gas, under a pressure of \nfour atmospheres, into an aqueous solution of potassium bi- \ncarbonate of the strength of half of one per cent. Potassium \nbicarbonate should not be employed as an alkali in cases of \npoisoning by mineral acids, on account of the evolution of \ncarbon dioxide gas which is likely to result. \n\nBlood. \xe2\x80\x94 The absorption of both hydrates and carbonates leads \nto an increase in the alkalinity of the blood and tissues. Po- \ntassium bicarbonate and other alkalies have been used very \nextensively in the treatment of gout, rheumatism and the so- \ncalled uric acid diathesis generally. The explanation offered \nof their action in these conditions was that the increased oxi- \ndation caused by them results in the destruction of a larger \namount of the uric acid, while, in addition, the latter, being \nneutralized in the tissues, is excreted more easily and has less \ntendency to be deposited. In the light of our present knowledge \nneither of these theories appears to be tenable. At the same \ntime, there is abundant clinical evidence that the alkalies are \nof some value in gout and rheumatism, although in the treatment \nof the latter disease they have to a large extent fallen into dis- \nuse since the introduction of the salicylates. It must be con- \nfessed, therefore, that their mode of action is not clearly under- \nstood, though there is some ground for the belief that these \n\n\n\nPOTASSIUM. l6l \n\nagents may influence the formation, rather than the excretion, \nof uric acid. In acute rheumatism it has been shown that any \ninfluence exerted by the alkaline treatment in cutting short the \ndisease, lowering temperature, and relieving pain, is in no \nway comparable to that of the salicylates, which as has been \nmentioned, have now to a great degree superseded alkalies in \n\xe2\x80\xa2 the treatment of that affection. The opinion is still held by \nmany experienced observers, however, that alkalies have a \ndecided effect in preventing and relieving cardiac complications, \nand thus succeed, to some extent, it is claimed, where the sali- \ncylates fail. Hence it is the practice of some to associate the \nlatter with alkalies. In acute rheumatism potassium bicarbon- \nate may be given in doses of 1.20 to 2.40 gm. (20 to 40 gr.) \nevery two to four hours, or 15 gm. (y 2 oz.), or more, may be \ndissolved in barley water, and administered as a drink during \nthe twenty-four hours. As the remedy is very distasteful to \nmost persons, it may be given in effervescence with lemon- juice, \nor with citric acid solution. An equal quantity of potassium \ncitrate is sometimes prescribed with the carbonate when given \nin this way. It has been found that the alkaline treatment, \nhowever well adapted it may be to plethoric and muscular \nindividuals, is not usually suited to the delicate and anaemic. \n\nOther Uses. \xe2\x80\x94 Potassium bicarbonate is not infrequently used \nwith benefit in jaundice and gall-stone. It probably has no \ndirect effect on the bile, except perhaps in increasing its liquid- \nity, but affords relief principally by lessening duodenal irrita- \ntion. In bronchitis, added to other expectorants, it serves to \nincrease the secretion and render it less viscid and tenacious. \n\n4. POTASSII ACETAS.\xe2\x80\x94 Potassium Acetate. Dose, 2 gm.; 30 gr. \n\n5. POTASSII CITRAS.\xe2\x80\x94 Potassium Citrate. Dose, 1 gm.; 15 gr. \n\nPreparation. \nLiquor Potassii Citratis. \xe2\x80\x94 Solution of Potassium Citrate. \nDose, 16 c.c; 4 fl. dr. \n\n6. POTASSII CITRAS EFFERVESCENS.\xe2\x80\x94 Effervescent Potas- \nsium Citrate. Dose, 4 gm.; 60 gr. \n\n12 \n\n\n\n1 62 PHARMACOLOGY AND THERAPEUTICS. \n\nActon of Potassium Citrate and Acetate. \n\nExternal. \xe2\x80\x94 Potassium citrate is a salt of neutral or very \nslightly acid reaction. The acetate is perfectly neutral, and \nneither of them has any external action. \n\nInternal. \xe2\x80\x94 They are the least irritating to the stomach of \nall the potassium salts, and, with the exception of the tartrates, \nthe citrate is the least offensive to the palate. They have the \nadvantage of not neutralizing the gastric juice, or in any way \naffecting the digestion except from their salt-action, which\' \nmay be minimized by administration in dilute solution. Being \ndecomposed in the body, with the formation of carbonates, \nthey exert an alkaline action after absorption, and this has \nthe effect of increasing the alkalinity of the blood and of the \nurine, and of producing free diuresis. On account of its influ- \nence on the urinary secretion the acetate was formerly known \nas sal diureticus. The citrate is not so readily absorbed as the \nacetate, and therefore tends to act on the bowels. It is not \ncathartic, however, except when given in large quantities. \nThey both have some diaphoretic action, which is rather more \nmarked in the case of the citrate. Potassium acetate, like \nother acetates, is technically a food, as its oxidation supplies \nenergy to the body. Since the acetates, however do not lessen \nthe nitrogenous tissue-change, they are incapable of replacing \nthe fats and carbohydrates, and as they derange the stomach \nin the same way as common salt and also alter the character \nand amount of the urine, they are found to be practically \nuseless as foods. \n\nTherapeutics of Potassium Citrate and Acetate. \nBlood. \xe2\x80\x94 Both these salts are largely -employed in gouty con- \nditions, and were formerly much used also in the alkaline \ntreatment of acute rheumatism. The citrate dissolved in an \nexcess of lemon juice affords the most agreeable method of \nsecuring the influence of an alkaline potassium salt upon the \nsystem. They have some antiscorbutic effect, but are not so \nefficient in the prevention and treatment of scurvy as lemon- \njuice, lime-juice, and fresh vegetables. \n\n\n\nPOTASSIUM. 163 \n\nKidneys. \xe2\x80\x94 They are constantly used for their diuretic effect \nin feverishness, scarlatinal dropsy, chronic renal disease, gen- \neral dropsy from valvular disease of the heart, and other con- \nditions. Alkaline diuretics are of very little value, however, in \ndropsical accumulations in the various cavities, The best effects \nare usually obtained from a combination of diuretic remedies, \nand the following mixture will be found serviceable : Potassium \nacetate, 1.20 gm. (20 gr.) ; tincture of squill, .60 c.c. (10 HI) ; \n\'spirit of nitrous ether, 2.00 c.c. (30 HI) ; juice of broom, 4.00 \nc.c. (1 fl. dr.) ; water, to 30.00 c.c. (1 fl. oz.). Juice of broom, \nB. P., is obtained by bruising fresh broom tops, expressing the \njuice, adding one-third part of alcohol, and filtering after seven \ndays. In irritation of the urinary organs resulting from an \nexcess of acid and in inflammatory conditions of the passages, \nin which the acid urine acts as an irritant, they are of great \nservice by rendering the urine alkaline, and they possess the \nadvantage over other potassium salts of not affecting the \nstomach or interfering with digestion. In such conditions the \nLiquor Potassii Citratis is highly esteemed. It was long the \nopinion, and is still held by many, that the continued use of \nthese salts will effect the solution of renal calculi, which are \nusually composed principally of uric acid. It has been shown, \nhowever, that the alkaline treatment is incapable of removing \ncalculus either in the bladder or kidney. While outside the \nbody free alkalies and their carbonates dissolve uric acid quite \nreadily, it is found that the solution of the alkalies formed in \nthe urine is extremely dilute, the reaction, except under large \ndoses, being in fact not even constantly neutral. On the other \nhand, it is pointed out, even the alkaline urates are by no means \nvery soluble bodies, and are formed only with difficulty except \nin strong alkaline solutions. Some authorities contend that the \nalkalies, not being excreted as such, nor as carbonates, can- \nnot convert free uric acid into soluble alkaline urates, but at \nmost into acid urates, which are almost as insoluble as uric \nacid itself. Hence, it would be absolutely impossible to effect \nin this wav the solution of even verv small calculi. The fact \n\n\n\n164 PHARMACOLOGY AND THERAPEUTICS. \n\nthat in certain instances alkaline treatment has been observed \nto cause the breaking up of large stones into small fragments \nis explained on the hypothesis that the calculi were composed \noriginally of small fragments glued together by mucus, and \nthat the alkali caused the solution of the latter. Furthermore, \nit is claimed that the alkalies are to some extent objectionable \nin vesical calculus, inasmuch as alkaline urine is liable to de- \nposit phosphates in the bladder, and thus rather to increase the \nsize of the stone than to diminish it. Still, there can be no \nquestion that in any of the forms of irritation of the urinary \npassages (from gravel, stone, cystitis, stricture, enlarged pros- \ntate, etc.), such agents as potassium citrate and acetate afford \ngreat relief whenever the urine is acid in reaction. There is \nalso high authority for the opinion that they are of utility in \nthe prevention of uric acid gravel, it. being held that the most \npotent factor in determining the precipitation of free crystal- \nline uric acid in the urinary passages is a high degree of \nacidity in the urine; so that if the latter be rendered alkaline, \nor only faintly acid, no such precipitation can occur. In the \ndaytime the alkaline tide following the ingestion of meals will \nusually keep the urine from attaining an acidity sufficient for \nthe precipitation to occur, but during the fasting hours of the \nnight the opportunity for this is afforded. Hence, it is ad- \nvised that a moderately large dose of an alkali, such as 2.50 \nto 4.00 gm. (40 to 60 gr.) of potassium citrate should be taken at \nbedtime. In case this is not sufficient to prevent the hyper- \nacidity during all the hours of sleep, a second dose should be \ntaken in the course of the night, while in exceptional instances \nthe tendency to uric acid precipitation may be so great as to \nrequire the use of the remedy in the daytime also. This pre- \nventive treatment, it can readily be seen, may be materially \naided by a judicious arrangement of the meals, so as to avoid \nunnecessarily prolonged periods of fasting. \n\nSkin. \xe2\x80\x94 In feverish conditions, such as frequently result from \nan ordinary cold, they are of service on account of their diapho- \nretic as well as their diuretic action. \n\n\n\nPOTASSIUM. 165 \n\nRespiratory Passages. \xe2\x80\x94 Like potassium bicarbonate, they are \nof considerable utility in bronchitis, assisting the action of \nother expectorants by increasing the secretion and by render- \ning it more fluid and more easily expectorated. \n\n7. POTASSII SULPHAS.\xe2\x80\x94 Potassium Sulphate. Dose, 2 gm.; 30 \ngr. \n\n8. POTASSII BITARTItAS.\xe2\x80\x94 Potassium Bitartrate. (Acid Potas- \nsium Tartrate. Cream of Tartar.) Dose (diuretic), 2 gm.; 30 gr. \n\nAction of Potassium Bitartrate and Sulphate. \n\nExternal. \xe2\x80\x94 The aqueous solution of potassium bitartrate has \nan acid reaction on litmus paper, but it is only slightly acid, \nwhile the sulphate is neutral. Neither has any external action. \n\nInternal. Intestines. \xe2\x80\x94 They are hydragogue saline cathartics, \ndrawing fluid from the blood and tissues into the intestine, and \nconsequently rendering the blood more concentrated than usual. \nThis leads to a sensation of thirst and to a lessened excretion \nof fluid by the kidneys and other glands. They produce rather \nprofuse watery stools, with practically no irritation or griping. \nTo the sulphate, however, the last statement applies only when \nit is given in comparatively small doses (.60 to 2.40 gm. ; 10 to \n40 gr.) and freely diluted. In large doses and when insuffi- \nciently diluted it is a powerful irritant, and from 45 to 60 gm. \n(13^2 to 2 oz.) has been known to cause fatal gastro-enteritis, \nwhile 15 gm. (4 dr.), if not properly diluted, may give rise to \ngrave symptoms. In France it is stated to be used as a popu- \nlar abortifacient ; the ecbolic effect being secondary to the in- \nflammation produced in the alimentary canal. \n\nLiver. \xe2\x80\x94 Potassium sulphate has been supposed to have some \naction in increasing the biliary secretion, but, as in the case of \nother saline purgatives regarded as cholagogues, this has now \nbeen shown to be incorrect. \n\nKidneys. \xe2\x80\x94 The bitartrate, which is but slowly absorbed, is to \na large extent excreted unchanged in the urine and faeces. \nThat portion which is absorbed is converted into carbonate, \nwhich has a decided diuretic effect and also tends to render the \n\n\n\n1 66 PHARMACOLOGY AND THERAPEUTICS. \n\nurine alkaline. All the Sulphate is believed to be excreted un- \nchanged; consequently, it has no remote effects. \n\nTherapeutics of Potassium Sulphate and Bitartrate. \n\nG astro-Intestinal Tract. \xe2\x80\x94 Potassium sulphate, while used to \nsome extent in Europe, is rarely ever prescribed in this coun- \ntry; magnesium and sodium sulphates being much preferred \nto it. The bitartrate is frequently employed as a cooling \naperient, and for this purpose a dose of it (2 to 8 gm. ; y 2 to \n\'2 dr.) may be dissolved in a glass of hot water, and sipped \nduring dressing in the morning. Its use should not be con- \ntinued regularly too long, however, as it is liable to impair \nnutrition. In doses of 15 to 30 gm. (y 2 to 1 oz.) it is a valuable \nhydragogue cathartic, particularly in dropsy and uraemia. It \nis often combined with senna, magnesia or sulphur, or with \njalap, as in compound jalap powder. With sulphur or with \nconfection of senna it constitutes a convenient laxative when \nhaemorrhoids are present. With magnesia it is sometimes pre- \nscribed in habitual vomiting arising from gastric acidity and \nalso in the vomiting of pregnancy. \n\nKidneys. \xe2\x80\x94 The bitartrate is highly esteemed as a diuretic, \nand 30 gm. (1 oz.) in 500 c.c. (1 pint) of infusion of juniper- \nberries, taken in divided doses during the twenty-four hours, \nis often very serviceable in dropsy. This is too irritating to \nthe kidneys, however, to be used in acute desquamative nephritis. \nCream of tartar whey is made by dissolving about 8 gm. (2 dr.) \nof the bitartrate in 500 c.c. (1 pint) of milk. The beverage \nknown as "imperial" (potus imperialis) may be used with ad- \nvantage in some febrile affections. It consists of potassium \nbitartrate, 4 gm. (1 dr.); saccharin, .06 gm. (1 gr.) ; oil of \nlemon, .20 c.c. (3 Ttl) ; to 500 c.c. (1 pint) boiling water. The \nbitartrate is also conveniently given in ordinary lemonade, the \nsalt being dissolved in hot water and the solution allowed to \ncool before the lemons are added to it. Compound jalap powder \nis rendered more efficient, both as a diuretic and a purgative \nby the addition of .60 gm. (10 gr.) of potassium bitartrate to \neach dose. \n\n\n\nPOTASSIUM. 167 \n\nLiver. \xe2\x80\x94 In hepatic cirrhosis,, whether due to alcoholism or \nother causes, as well as in chronic peritonitis, good results are \nsaid to be sometimes obtained from potassium bitartrate. Both \nthe bitartrate and the sulphate have been used in gall-stone \ndisease. \n\n9. POTASSII NITRAS.\xe2\x80\x94 Potassium Nitrate. (Xitre. Saltpetre.) \nDose, 0.500 gm. (500 milligm.) ; 7 l / 2 gr. \n\nAction of Potassium Nitrate. \n\nExternal. \xe2\x80\x94 It has no action on the unabraded skin, but is \nirritant to mucous membranes and raw surfaces. \n\nInternal. \xe2\x80\x94 Gastro-Intestinal Tract. \xe2\x80\x94 In small doses it is un- \nirritating. In large quantities it is a decided gastro-intestinal \nirritant, producing nausea, vomiting, intense burning pain in \nthe stomach, and sometimes purging. In some instances blood \nis present in the matters vomited and in the stools. After death \nthere is found congestion of the stomach and intestines, and \nthere may be extravasations of blood. Even ulceration and cor- \nrosion of the mucous membrane have been observed. When \nit is very freely diluted, however, the local irritant action of \nthe drug is in great measure prevented, and very considerable \nquantities may be taken without serious results. \n\nBlood. \xe2\x80\x94 External to the body, nitrates have the effect of \npreventing the coagulation of the blood and of dissolving \nclots already formed. In the body they are said to have some \ninfluence on the red blood-corpuscles, which become crenated; \nbut it is thought that this is probably merely the salt-action, \nand not any specific nitrate effect. By reason of its high \ndiffusion power potassium nitrate rapidly passes into the blood \nunchanged. \n\nHeart. \xe2\x80\x94 It is so violently irritant that the local symptoms \nproduced by toxic quantities are apt to overshadow the effects \non the system of its potassium ion. The latter, however, is \ndepressant to the heart, weakening its movements and finally \narresting them. \n\nNervous System and Muscles. \xe2\x80\x94 Sometimes the nervous symp- \n\n\n\n1 68 PHARMACOLOGY AND THERAPEUTICS. \n\ntoms predominate, and the collapse caused by the drug may \nbe accompanied with paralysis of the lower extremities. It \ntends to exert a paralyzing- influence upon the spinal cord, \nand produces great muscular weakness and reduction of reflex \nsensibility. It also tends to paralyze unstriped muscular fibre. \n\nRespiration. \xe2\x80\x94 Large doses retard the respiration. \n\nSkin. \xe2\x80\x94 It has a slight diaphoretic effect. \n\nKidneys. \xe2\x80\x94 In moderate amounts it has considerable diuretic \ninfluence, which is believed to be due in part to the salt-action \nand partly to a true stimulation of the kidney, such as is ex- \nerted by many other intestinal irritants. Large quantities \ntend to produce renal inflammation and hematuria, and in some \ncases of poisoning the kidney is recorded to have presented \nthe lesions of acute nephritis, and also haemorrhages. \n\nElimination. \xe2\x80\x94 Some of the nitrate given by the mouth is \nusually found unchanged in the urine, but the greater portion \ndisappears in the tissues. Its fate in the body is not certainly \nknown, but it is supposed that it is reduced first to the nitrite, \nand then to ammonia, or that it is eventually excreted by the \nlungs as free nitrogen. Some of the nitrate is apparently \nexcreted in the saliva and perspiration; it may be unchanged, \nalthough it is said to be rapidly reduced to nitrite in these \nsecretions, and may in fact be changed to this form in the \nsecretory cells. \n\nTherapeutics of Potassium Nitrate. \nIt was formerly used to a large extent in febrile diseases, \nand especially acute rheumatism. At the present time, however, \nits internal administration for any purpose has been in great \nmeasure abandoned. It is stated, however, to be sometimes of \nvalue in the treatment of haemorrhage, more particularly haemop- \ntysis accompanied with febrile movement, and to have been \ngiven with advantage in purpura simplex (in 60 gm. ; 10 gr. \ndoses) and purpura haemorrhagica (in doses of from .60 to 4 \ngm. ; 10 to 60 gr.). As a diuretic it has been almost entirely \nsuperseded by the citrate and acetate, but is still used by some \n\n\n\nPOTASSIUM. 169 \n\nas an ingredient of diuretic mixtures, with digitalis and other \ndrugs. When given internally it is recommended that it should \nbe carbonated in order that its absorption may be accelerated \nand the gastric irritation proportionately lessened. A small \namount (.12 gm. ; 2 gr.) in a glass of sweetened water will, \nit is said, relieve the hoarseness to which speakers and singers \nare liable. By reason of its influence on the respiration and \non unstriped muscular fibre, potassium nitrate acts as an anti- \nspasmodic, and the one great purpose for which it is now em- \nployed is the relief of the symptom asthma. For the treat- \nment of this, linen or blotting paper, dipped in a saturated \nsolution of nitre and then dried, is burned, and the patient \ninhales the fumes. It is advised by some that the paper should \nbe also dipped in a solution of potassium chlorate. The fumes \nmay be diffused generally in the room, or if a more concentrated \neffect is desired the paper may be burned under a funnel, from \nthe mouth of which the patient inspires. The nitrate is a com- \nmon ingredient of so-called asthma powders, and is also some- \ntimes used in the form of cigarettes. Powdered nitre, moistened \nwith water and applied to the face night and morning, is useful \nfor removing freckles. \n\n10. POTASSII CHLORAS.\xe2\x80\x94 Potassium Chlorate. Dose, 0.250 gm. \n(250 milligm.) ; 4 gr. \n\nPreparation. \nTrochisci Potassii Chloratis. \xe2\x80\x94 Troches of Potassium Chlorate. \n\nAction of Potassium Chlorate. \n\nExternal. \xe2\x80\x94 Locally it is disinfectant and stimulant to mucous \nmembranes. It is easily decomposed by septic tissues, and the \nnascent oxygen given off acts as a stimulant and antiseptic to \nthem. \n\nInternal. Stomach and Intestines. \xe2\x80\x94 Small doses have no \neffect. Sometimes the only effect in the alimentary canal of \nlarge doses is to cause some nausea and vomiting. In other \ninstances the irritation caused by it is sufficient to excite gastro- \nenteritis. The first symptom is often prolonged and violent \n\n\n\n170 PHARMACOLOGY AND THERAPEUTICS. \n\nvomiting. There is severe gastric pain, and this may be fol- \nlowed by profuse diarrhoea. In subacute poisoning vomiting \nand diarrhoea are also observed, and the matter vomited usually \ncontains bile, and sometimes blood. The nausea and vomiting \nare believed to be principally due to the local salt-action of the \ndrug, but that this is not their only cause seems to be shown \nby the fact that vomiting has been observed in animals in \nwhich the chlorate was injected subcutaneously. After death \nswelling and ecchymosis of the mucous membrane of the \nstomach and intestines have been found. \n\nBlood. \xe2\x80\x94 When added to blood, either outside or in the body, \nit causes the formation of methaemoglobin from the conversion \nof haemoglobin ; so that its administration in toxic quantity may \nproduce an actual asphyxia. It also has the effect of subse- \nquently causing the destruction of the red blood-cells, with re- \nsulting liberation of proteids. In the most acute form of in- \ntoxication death is due chiefly to asphyxia caused by the \nreduction of a large amount of haemoglobin, but if the quantity \nof methaemoglobin thus formed is smaller, it is found that the \nlatter gradually disappears. Hence, in the subacute form of \npoisoning sufficient haemoglobin remains untransformed to con- \ntinue the respiration of the tissues. When cases of this kind \nterminate fatally some of the red corpuscles are found altered \nin shape, others are colorless, and in some the pigment, in- \nstead of being generally diffused, is aggregated in masses. No \nmethaemoglobin may be discovered, but the debris of the cor- \npuscles can be found in the liver, spleen, bone-marrow and \nrenal tubules. In acute poisoning the color of the blood is very \ndark and the methaemoglobin absorption band is found present \nin the spectrum. \n\nHeart and other Organs. \xe2\x80\x94 Toxic doses are likely to cause \ngreat failure of the heart\'s action, excessive dyspnoea, and \nmarked cyanosis of the surface. Increase in the amount of \nbile pigment results from the excessive destruction of red blood- \ncorpuscles, and the absorption of the pigment from the bile \ncapillaries may cause jaundice. After death both the liver and \n\n\n\nPOTASSIUM. I/I \n\nspleen have been found enlarged, from the deposition of the \ndebris in them. \n\nNervous System. \xe2\x80\x94 Among the nervous symptoms noted are \nheadache, delirium, tonic and clonic spasms, coma, and a \npeculiar stiffness of the extremities. These are believed to be \ndue, not to any specific effect upon the central nervous system, \napart from the salt-action of the chlorates, but to the blood \nchanges caused by the drug and to the uraemia resulting from \nits effects in the kidneys. The course of the poisoning may be \nvery rapid, death having been known to be caused in two and \na half hours; but usually it does not occur for several days. \nThe fatal result may be due either to asphyxia, to collapse from \ncardiac weakness, or to uraemia. Death from uraemic symptoms \nmay follow as late as a week after the appearance of the first \nsigns of poisoning, while in several instances complete re- \ncovery has occurred where the most severe effects had been \ncaused. A rare effect of potassium chlorate is the production \non the skin of an erythematous, vesicular or papular eruption. \n\nKidneys. \xe2\x80\x94 The effects of potassium chlorate in the kidneys \nare of great interest. In the subacute form of poisoning the \nproducts of the destruction of the red blood-corpuscles are ex- \ncreted in the urine, and in consequence the renal tubules be- \ncome stopped up with brown granular masses. These are found \nto be in part forced downwards and to appear in the urine as \ncasts, but may produce an almost complete suppression of urine \nand the consequent symptoms of uraemia. Probably as the re- \nsult of the plugging of the tubules, the epithelial cells may per- \nhaps become inflamed, but often, it is stated, no actual nephritis \nis present. The opinion formerly held that the chlorate be- \ncomes reduced and yields its oxygen in the system has been \nshown to be entirely incorrect. It passes unchanged through \nthe body, being principally excreted in the urine, from which \n90 to 96 per cent, of the amount given by the mouth has been \nrecovered. It is also excreted in small quantities in the per- \nspiration, saliva, tears, and probably all the other secretions, \nand is stated to pass from the mother to the foetus in utero. \n\n\n\n172 PHARMACOLOGY AND THERAPEUTICS. \n\nWhile the secondary effect of potassium chlorate may tend to \nproduce suppression of the urine, through the results in the \nkidneys of its destructive influence on the red blood cells, the \nabsorption of concentrated solutions is often shortly followed \nby considerable diuresis, from an action upon the kidney similar \nto the local salt-action in the stomach which induces nausea \nand vomiting. \n\nTherapeutics of Potassium Chlorate. \nIn the case of no drug has a greater change of opinion taken \nplace than as regards potassium chlorate. Under the supposi- \ntion that it yielded its oxygen to the blood it was for many \nyears extensively used in adynamic fevers and in diphtheria \nand other diseases attributed to blood-poisoning. Its internal \nuse, however, is now regarded as of little value, and may cause \ntoxic symptoms ; but locally it has distinctly curative effects \nupon mucous membrane in such conditions as catarrhal in- \nflammation of the mouth and fauces, aphthous, ulcerative and \nmercurial stomatitis, and thrush, or nursing sore-mouth, as \nwell as in acute tonsilitis. Its local action is not clearly under- \nstood. It has been suggested that it is an oxidizing disinfectant, \nbut there appears to be no ground for supposing that it is \nchanged here any more than in the tissues in general. It may \nbe applied in the form of a wash or gargle, and is sometimes \nassociated with other agents. In young children solutions of \nit are used with glycerin, honey or syrup to wash out the mouth. \nOf course, it is essential to the success of the treatment that \nthe general condition of the patient should also be carefully \nlooked after. It is sometimes given internally in solution, or \nin the form of lozenges, with the idea of obtaining its local \neffect while being swallowed and a subsequent similar effect \nfrom its excretion in the saliva. If it has no beneficial systemic \naction it would seem preferable to depend entirely on its local \napplication, which can be repeated as often as the circumstances \nrequire, and thus avoid the possibility of poisoning the patient. \nOn account of this danger the use of potassium chlorate lozenges \nis condemned by some authorities. If the salt is employed \n\n\n\nPOTASSIUM. 173 \n\ninternally it should always be administered with great caution, \nand pains should be taken to avoid giving it on an empty \nstomach. In diphtheria it has been thought especially effective \nin combination with tincture of ferric chloride and hydrochloric \nacid, in which, in addition to the local influence of the chlorate \nand the tonic effect of the iron, the action of free chlorine, gen- \nerated in the mixture, is obtained. It should not be exhibited \nin full doses, however, on account of the depressing effects \nupon the heart, as well as the danger of renal trouble. A tea- \nspoonful of the following may be given undiluted every two \nhours: To 4 gm. (1 dr.) of powdered potassium chlorate, mixed \nwith 6 c.c. (iy 2 fl. dr.) of hydrochloric acid, are added 8 c.c. \n(2 fl. dr.) of tincture of ferric chloride and enough water to \nmake 120 c.c. (4 fl. oz.). In order to render it less disagreeable \nto the taste a considerable proportion of the water may be sub- \nstituted by glycerin or a syrup such as that of blood orange. \nDiluted, this mixture makes an excellent gargle. Solutions \nof potassium chlorate which may be combined with a few drops \nof laudanum to secure retention, injected into the rectum at \nbed-time, are said to be of great service in haemorrhoids, and \nlarge enemata composed of them are sometimes employed in \nchronic dysentery and other diseases of the lower bowel. A \nsolution in glycerin (one part to ten) has been highly com- \nmended as a dressing for ill-conditioned wounds and ulcers. \n\nTOXICOLOGY. \nAs potassium chlorate is very largely used as a domestic remedy and \nis not regarded by the laity as a toxic agent, accidental poisoning from \nit is not unlikely to occur. The injurious effects of the drug have al- \nready been sufficiently described. In the treatment the stomach should \nbe promptly evacuated if there is reason to suppose that any of the salt \nstill remains in it. Demulcents such as white of egg, milk, flaxseed tea, \nor mucilage of acacia may be used, and ice given to control the vomit- \ning. Each case should be treated according to the special symptoms \nmet with. Cardiac stimulants or stimulants to the central nervous sys- \ntem may be called for. As the destructive action of the chlorate upon \nthe blood is believed to be less liable to occur when the latter is more \n\n\n\n174 PHARMACOLOGY AND THERAPEUTICS. \n\nalkaline than usual, the alkaline carbonates should generally be given in \nthe hope of preventing or checking these effects. After the acute symp- \ntoms have passed off the administration of diuretics and large quantities \nof fluid is recommended for the purpose of washing out the kidneys and \npreventing the accumulation of detritus in the tubules. \n\nSODIUM. \n\n1. SODII HYDROXIDUM (Soda, U. S. P., 1890).\xe2\x80\x94 Sodium Hy- \ndroxide. (Caustic Soda. Sodium Hydrate.) \n\nPreparation. \nLiquor Sodii Hydroxidi (Liquor Sodae, U. S. P., 1890). \xe2\x80\x94 \nSolution of Sodium Hydroxide. (Solution of Soda.) Dose, 1 \nC.C.; 15 TTt. \n\nAction of Sodium Hydroxide. \nIts action is practically the same as that of potash. The \nprincipal difference between the effects of the sodium and \npotassium salts, when given in large amount, is the depressant \ninfluence of the latter upon the cardiac, muscular and nervous \nsystems. It must be borne in mind, however, that soda and \nthe sodium carbonates, like the potassium hydrate and carbon- \nates, depend chiefly for their activity on their alkalinity, and not \non their metallic constituent. It is their hydroxyl ion which \ninduces the alkaline reaction of the solutions and determines \ntheir physiological effects. \n\nTherapeutics of Sodium Hydroxide. \nIt is very little used. Potash is almost always preferred. \n\nTOXICOLOGY. \n\nPoisoning by caustic alkalies is not very commonly met with. In \naddition to potash and soda, it may be caused by the impure potassium \ncarbonate (pearlash) or sodium carbonate (soap lees), which contain \nthese alkalies. The carbonates, however, are much less corrosive than \nthe hydrates. \n\nSymptoms. \xe2\x80\x94 The symptoms are those of a violent corrosive poison: \nburning heat in the throat and stomach, intense thirst, salivation, vom- \niting of blood-stained matter, agonizing abdominal pain accompanied \n\n\n\nSODIUM. 175 \n\nwith diarrhoea, feeble pulse, cold, clammy skin, and general collapse. \nThe lips, mouth, tongue and throat become swollen and assume a bright \nred color. The larynx is apt to be involved in the corrosive action, and \noedema of the larynx may cause death in a very brief time. If the \npatient should survive the immediate effects of the poison he is very \nlikely to suffer from more or less extensive ulceration or cicatrization \nof the mucous membrane of the throat, oesophagus or stomach, which \nmay subsequently prove fatal. In very exceptional instances the local \naction may be comparatively slight, and the principal effect of the poison \nexpend itself upon the nervous system, with the result of producing \nmuscular weakness, paralysis of the lower extremities, weak cardiac \naction, and coma : and, as has been stated, very large doses cause death \nsuddenly, through paralysis of the heart, before the local inflammation \nhas had time to develop. \n\nPost-mortem Appearances.* \xe2\x80\x94 The mucous membrane, wherever the \ncaustic has come in contact with it, is dark-colored, inflamed and cov- \nered with a grayish membrane. The sloughs may be very extensive and \ndeep, and there may even be complete destruction of a portion of the \nstomach wall. In the event of the patient\'s having survived long enough \nfor such sequel to occur, there will naturally be found evidences of peri- \ntonitis resulting from this lesion. In the oesophagus the points espe- \ncially affected will generally be found at its two ends and at the place \nwhere it crosses the left bronchus, and in the stomach, at the pylorus. \n\nTreatment. \xe2\x80\x94 The stomach should be evacuated as promptly as pos- \nsible, but it is not safe to use the stomach-pump for this purpose, as \nthe tube is liable to perforate the corroded wall of the oesophagus or \nstomach. Any one of the following emetics may be resorted to : Apo- \nmorphine hydrochloride, .006 gm. ( T L gr.), by subcutaneous injection; \nzinc sulphate, 1.20 gm. (20 gr.), or copper sulphate, .30 gm. (5 gr.), \nin 250 c.c. {y 2 pint) of tepid water; powdered ipecacuanha, 2.00 gm. \n(30 gr.) or wine or syrup of ipecacuanha, 30 c.c. (1 fl. oz.). The prep- \narations of ipecacuanha should not be employed if other emetics are \navailable, as this drug, which produces vomiting chiefly by its influence \non the medulla oblongata, is not sufficiently prompt in its action. If \nnone of these agents is quickly attainable, domestic remedies such as \nmustard, 16 gm. (1 tablespoonful) or common salt, 30 gm. (2 table- \nspoonfuls), may be administered in 250 c.c. (y 2 pint) of tepid water. \nAt all events, plenty of lukewarm water should be given, and vomiting \npromoted by tickling the fauces. As soon as the stomach has been \nemptied some form of dilute acid should be employed. The organic \nacids \xe2\x80\x94 acetic, citric or tartaric \xe2\x80\x94 are the best, and vinegar is almost \n\n\n\nI76 PHARMACOLOGY AND THERAPEUTICS. \n\nalways within easy reach. In place of it, lemon juice, acetic acid, or \nsolution of citric acid (all of which should be well diluted with water) \nmay be used. Demulcents such as white of egg, olive oil, or flaxseed \ntea are of service, and measures to counteract shock, heart-failure, and \ncollapse, such as the application of warmth, the exhibition of stimulants, \netc., are also generally called for. \n\n2. SODII CARBONAS MONOHYDRAS.\xe2\x80\x94 Monohydrated Sodium \nCarbonate. Dose, 0.250 gm. (250 milligm.) ; 1 gr. \n\nUnofficial Preparation. \nSodii Carbonas Exsiccatus (U. S. P., 1890).\xe2\x80\x94 Dried Sodium \nCarbonate. Dose, .30 to 1.00 gm.; 5 to 15 gr. \n\nAction of Sodium Carbonate and the Dried Carbonate. \nAs in the case of potassium, the carbonate is much less cor- \nrosive than the hydrate. With this exception, the action is \nthe same as that of soda. Sodium carbonate is, however, \ndecidedly more irritating than the bicarbonate. \n\nTherapeutics of Sodium Carbonate and the Dried Car- \nbonate. \nA one per cent, solution of sodium carbonate is used for \nboiling surgical instruments in the process of sterilization, in \norder to prevent their rusting. The carbonate is also employed \nexternally to some extent in the treatment of skin diseases in \nwhich the eruption is of a dry character, as lichen, prurigo, \nichthyosis, psoriasis and pityriasis, and especially in the form \nof baths. From 125 to 450 gm. (4 to 16 oz.) is dissolved in a \nsufficient quantity of tepid water, and it is advised that each \nbath should be at least an hour in duration. It has the effect \nof stimulating the affected portions of the skin, and at the \nsame time of removing sebaceous and acid secretions. If, how- \never, there is already an irritable condition present, but a \nsmall quantity of the alkali should be used, and mucilage or \nbran may be added to the water to render the bath more \nbland. This treatment is generally unsuitable for vesicular \nand pustular eruptions, but may occasionally prove of service \n\n\n\nSODIUM. 177 \n\niii them if the solution is made very weak. Lotions containing \nsodium carbonate have been used in certain local eruptions, \nespecially those of the scalp, and also in pruritus vulvae. The \nsalt is rarely employed internally except as it occurs in alka- \nline mineral waters. As an antidote to acids in corrosive poison- \ning, however, it is regarded as preferable to the bicarbonate, \nfor the reason that less carbon dioxide is formed. \n\n3. SODII BICARBONAS.\xe2\x80\x94 Sodium Bicarbonate. (Baking Soda. \nSoda.) Dose, 1 gm.; 15 gr. \n\nPreparation. \nTrochisci Sodii Bicarbonatis. \xe2\x80\x94 Troches of Sodium Bicar- \nbonate. \n\nAction of Sodium Bicarbonate. \nAs regards general alkaline properties the action of sodium bi- \ncarbonate is the same as that of potassium bicarbonate, but it \ndiffers from it in being less rapidly absorbed from the alimentary \ncanal. It is much more grateful to the stomach than either \nsodium or potassium carbonate. \n\nTherapeutics of Sodium Bicarbonate. \n\nExternal. \xe2\x80\x94 Either in saturated solution or as a fine powder \nsodium bicarbonate, locally applied, is the best remedy to relieve \nthe pain from burns. Of late it has been strongly recommended \nto be used for packing to prevent pain after operations upon \nthe vagina. To relieve itching a lotion of .50 gm. (7 gr.) to \n30 c.c. (1 fl. oz.) may be employed, and a saturated solution \nhas been found an efficient cure in poisoning by Rhus toxi- \ncodendron. Applied in powder to the tonsils in the initial \nstage of acute tonsilitis, it is claimed that it will often prevent \nthe further development of the disease. \n\nInternal. \xe2\x80\x94 In dyspeptic conditions, and especially hyperacidity \n\nof the stomach, it is much more commonly used than any other \n\nalkali. Among the symptoms for the relief of which it may be \n\nemployed are heartburn, sour eructations, aphthae, oesophageal \n\n13 \n\n\n\nI78 PHARMACOLOGY AND THERAPEUTICS. \n\nspasm, cramp in the stomach, colic, and irregular diarrhoea. In \ncases of hyperacidity it is given after meals, often affording \nimmediate relief, and, like other alkaline preparations, it should \nbe always well diluted in order to avoid undue irritation. \nWhen the secretion does not seem to contain an excessive \namount of acid it is sometimes prescribed before meals, and \nit may then be combined with other stomachics, such as bitters \nor volatile oils. Dilute solutions of the alkalies act as mild \nirritants to the stomach wall, and thus, it is thought, improve \nits circulation, and lessen pain, eructation and distention in \nthe same way as other slight gastric irritants, such as the \nvolatile oils, while in the case of the carbonates and bicarbonates \nthis carminative action is strengthened by the carbon dioxide \nliberated by the hydrochloric acid. Furthermore, by their mild \nirritant action they increase mucus-secretion, and as they also \nhave the effect of liquefying tenacious mucus, they serve to \nimprove the condition of the stomach. If there is hyperacidity \nin the intestine, rather than the stomach, sodium bicarbonate is \nnot suitable, because it is likely to be neutralized or absorbed \nbefore reaching the seat of trouble. In this case the insoluble \nalkaline earths or their carbonates should be advised. While \nthe immediate result of potassium bicarbonate in hyperacidity \nof the stomach is highly beneficial, the after-effect is to in- \ncrease the production of acid; so that those who habitually use \nthe remedy for acid indigestion are extremely apt to suffer \nseverely from acidity. It is very serviceable in the acid diar- \nrhoea of infants and young children, where it is often given \ncombined with demulcents or with the aromatic syrup of rhu- \nbarb. An important application of the salt is as an emetic in \nnarcotic stupor when other emetics fail to act. From 2 to 4 \ngm. (30 to 60 gr.) in solution in water is given to the patient \n(by means of the stomach tube if necessary), and this is fol- \nlowed by a similar quantity of tartaric acid. Brisk effervescence \nresults, and the contents of the stomach are evacuated. The \nsame expedient has been successfully tried in intussusception, in \nthis case the two drugs being successively injected mto the \n\n\n\nSODIUM. 179 \n\nrectum. Strong pressure being made on the anus to prevent \nits escape, the gas generated urges its way upward and forces \nthe invaginated gut back to its normal position. A stomach or \nbowel much softened by inflammation or weakened by ulceration \nwould constitute a contraindication to this practice. Brilliant \nresults have been reported from the use of sodium bicarbonate \nand carbonate in the treatment of diabetic coma, when given \nearly enough and in sufficient amount. If the alkali is used \nin the early stages before coma sets in, it is advised that it \nshould be given in quantities of about 40 gm. (10 dr.) a day, \nwhile if coma has already supervened the amount should be \n100 or 200 gm. (25 or 50 dr.). If catharsis occurs after these \nlarge doses, so much of the alkali may escape by the bowels \nthat it may be impossible to secure the absorption of a sufficient \nquantity. In this event it should be given by intravenous in- \njection of 0.3 per cent, solution of the crystallized salt, as \nhypodermatic injection is apt to cause sloughing. It is insisted \non that the administration of the remedy should not be left \nuntil coma actually occurs, as it may then be too late, and it \nis recommended that the treatment should be instituted as soon \nas the urine gives the characteristic reaction of acetone with \nferric chloride. In digestive troubles sodium bicarbonate is \noften combined with gentian, and a common gastric sedative \nmixture consists of .60 gm. (10 gr.) each of sodium bicarbonate \nand bismuth subcarbonate, suspended in mucilage. A useful \nstomach powder for children is composed of .06 or .12 gm. \n(1 or 2 gr.) of the bicarbonate and .06 gm. (1 gr.) of pulver- \nized rhubarb, with a little sugar. Effervescing soda water may \nbe made from sodium bicarbonate in the same way as potash \nwater from potassium carbonate (see p. 160). In commerce \nthese waters contain neither potash or soda, but the carbon \ndioxide has some effect as a carminative. \n\n4. SODII SULPHAS.\xe2\x80\x94 Sodium Sulphate. (Glauber\'s Salt.) Dose, \n16 gm.; 240 gr. \n\n5. SODII PHOSPHAS.\xe2\x80\x94 Sodium Phosphate. Dose, 2 gm.; 30 gr. \n\n\n\nl8o PHARMACOLOGY AND THERAPEUTICS. \n\nPreparations. \n\n1. Sodii Phosphas Effervescens.\xe2\x80\x94 Effervescent Sodium Phos- \nphate. Dose, 8 gm.; 120 gr. \n\n2. Sodii Phosphas Exsiccatus. \xe2\x80\x94 Exsiccated Sodium Phos- \nphate. Dose, 1 gm.; 15 gr. \n\n3. Liquor Sodii Phosphatis Compositus.\xe2\x80\x94 Compound Solution \nof Sodium Phosphate. Dose, 8 C.C.; 2 fl. dr. \n\n6. POTASSII ET SODII TARTRAS.\xe2\x80\x94 Potassium and Sodium Tar- \ntrate. (Rochelle Salt.) Dose, 8 gm.; 120 gr. \n\nPreparation. \nPulvis Effervescens Compositus. \xe2\x80\x94 Compound Effervescing \nPowder. (Seidlitz Powder.) Dose, one set of two powders. \n\nAction of Sodium Sulphate and Phosphate, and of \nPotassium and Sodium Tartrate. \n\nInternal. Intestines. \xe2\x80\x94 These are typical saline cathartics, \ndiffering from vegetable cathartics in not causing irritation of \nthe intestine, except when given in very large quantities. They \nowe their action, not to irritation, but to retarded absorption, \nand their characteristic effect is due to their acid constituent. \nSaline cathartics cause the abstraction of fluid from the blood \nand its accumulation in the intestine. The quantity of liquid \naccumulated depends upon the nature and amount of the salt \nand the strength of the solution employed, and it has been found \nthat the maximum amount corresponds closely to the quantity \nrequired to form a 5 or 6 per cent, solution of the salt em- \nployed. The liquid withdrawn from the blood is quickly re- \nplaced by liquid abstracted from the tissues, but there is a \nsecondary concentration of the blood later, resulting from the \nsubsequent diuresis occasioned by the portion of the salt ab- \nsorbed. After the maximum of accumulation in the intestine \nis reached, the fluid is gradually absorbed, and a soft painless \nmotion generally occurs within two or three hours after the \nadministration of the drug. The sulphate is the most active \nof these sodium salt cathartics, and it forms an important con- \n\n\n\nSODIUM. l8l \n\nstituent of many well-known mineral waters. It is the chief \ningredient of Carlsbad, Marienbad, Franzensbad, Tarasp, Villa- \ncabras and Rubinat Condal waters, and occurs in association \nwith magnesium sulphate in Friedrichshall, Hunyadi Janos, \nApenta, Seidlitz, Kissingen, Pullna, yEsculap and Franz Joseph \nwaters. Both the sulphate and phosphate are mild cholagogues, \nand Carlsbad waters have been shown to increase the amount, \nas well as the solid constituents, of bile. \n\nBlood and Kidneys. \xe2\x80\x94 On account of the slowness of their \nabsorption they have less influence than the corresponding \nsalts of potassium in rendering the blood and urine alkaline \nand in causing diuresis. It is said, however, that the basic \nportion of sodium sulphate is excreted much more quickly than \nthe acid, so that the urine may be rendered alkaline temporarily. \nIt is also stated that the intravenous injection of this salt pro- \nduces a copious diuresis. \n\nTherapeutics of Sodium Sulphate and Phosphate, and of \nPotassium and Sodium Tartrate. \nOn account of its extremely nauseous taste, the sulphate is \nrarely used in this country, except as it occurs in the various \naperient mineral waters. The taste may be in some degree dis- \nguised by the addition of a few drops of aromatic sulphuric \nacid, or by giving it in lemonade. In dysentery good results \nhave been obtained from it in daily quantities of 10 gm. (2^ \ndr.). Its use as an antidote in carbolic acid poisoning, which \nwas at one time recommended, on the supposition that it forms \nsulphocarbolates, which are not so poisonous, has been shown \nto be quite without effect on the progress of the intoxication. \nThis, it is believed, is due to the fact that phenol does not \ncombine with sulphates, as such, in the body, but with or- \nganic sulphur compounds which are only in process of being \noxidized to sulphuric acid. Rochelle salt is employed to a very \nconsiderable extent as a mild saline purgative. Although \nmuch less efficient, it is far less disagreeable to take than \neither magnesium or sodium sulphate, and is especially accept- \n\n\n\nl82 PHARMACOLOGY AND THERAPEUTICS. \n\nable in Seidlitz powders (Pulvis Effervescens Compositus), \nwhich form an effervescing draught. In small repeated doses \nit does not purge, and serves to render the urine alkaline. \nThe phosphate is not so powerful a cathartic as the sulphate, \nbut is also less offensive to the palate, and is used more or less \nin the case of children. Both these salts are often of service \nin gall-stones, probably chiefly by improving the condition of \nthe mucous membrane of the intestine. The phosphate is \nuseful in various affections of the liver, and is thought of \nespecial value in cirrhosis, if commenced early and persistently \nadministered. The belief has been expressed that it has the \npower to retard the development of the changes taking place \nin this disease, and, possibly, under favorable circumstances, \nto arrest them and to restore a comparatively normal functional \nstate. By correcting a catarrhal condition of the duodenum \nits persevering employment is often efficacious in the prevention \nof biliary calculus. This salt is also useful in catarrhal jaun- \ndice. It is stated to have seemed very beneficial in the hepatic \nform of diabetes, and that it is of great service, especially when \ncombined with sodium arsenate, in obese subjects when a suc- \ncession of boils portends the development of diabetes. When \ndissolved in a proper amount of water the following powder \nconstitutes a good imitation of Hunyadi Janos, iEsculap, Franz \nJoseph and other natural waters: 2 gm. (30 gr.) each of sodium \nsulphate and magnesium sulphate, and .06 gm. (1 gr.) each of \nsodium chloride and sodium bicarbonate; dose, 4 to 15 gm. \n(1 to 4 dr.). The combination of 60 gm. (2 oz.) of sodium \nphosphate, 15 gm. (4 dr.) of sodium sulphate, and 2 \ngm. (30 gr.) of potassium iodide, taken m sufficient \nlaxative doses and well diluted upon risin\'g, is said to be \nvery efficient in such cases as are benefited by Carlsbad \nwaters. All such remedies are more active when used hot. \nThere can be no question of the value of the Carlsbad treat- \nment in many cases of cholelithiasis, gouty dyspepsia, catarrh \nof the stomach and intestines, obesity, and other conditions, \nbut it is highly probable that the benefit derived from it is \n\n\n\nSODIUM. I83 \n\nlargely due to the change in habits and the restricted diet pre- \nscribed, as well as to the medicinal virtue of the waters. In \nadministering all saline cathartics it\' should be borne in mind \nthat they produce their proper effect only when given in solu- \ntions of a certain degree of dilution. Often it appears that \njust in proportion to the dilution of such a salt is its relative \nefficiency as a purgative, and this is well illustrated in the \ncase of the natural mineral waters that have been referred to, \nwhich are purgative in quantities which contain only an incon- \nsiderable proportion of the neutral salts. The phosphates \nhave been supposed to be of benefit in nervous diseases, on \nthe theory that these were due to the insufficiency of phosphorus \nin the brain, but there is high authority for the statement that \nthe animal organism is unable to form combinations between \nphosphates and proteids. At the same time some neurological \nclinicians claim to have obtained good results from the use \nof sodium phosphate in a number of these affections. In \ntri-facial neuralgia, neurasthenia and hysteria it is stated that \nthe results are often very satisf acton*. Subcutaneous injec- \ntions were employed of a mixture consisting of sodium phos- \nphate. 2 gm. (30 gr.), rectified spirit, 4 c.c. (1 fl. 5), and distilled \nwater, 120 c.c. (4 fl. oz.). Of this 1 c.c. (15 1*1) were injected \ndaily, and the amount gradually increased to 3 c.c. (45 ni). \nWhile believed to have only a palliative effect in organic dis- \norders of nerve centers, this method is reported to have been \nattended with marked improvement in certain cases of loco- \nmotor ataxia. \n\n7. SODII CHLORIDUM. \xe2\x80\x94 Sodium Chloride. (Common Salt.) \nDose (emetic), 16 gm.; 240 gr. \n\nActiox of Sodium Chloride. \nSodium chloride, which is an important constituent of the \nanimal economy, has practically no specific action. Its effects \nare limited to the alteration in the fluids produced by its excess \nor deficiency, and they present a typical example of what is \nknown as salt action. As its molecular weight is small and \n\n\n\nI84 PHARMACOLOGY AND THERAPEUTICS. \n\nas it dissociates readily into its two ions, it possesses great \nosmotic power. This is made use of in the preservation of \nmeats, which it effects by causing the withdrawal of their \nfluids and in this way rendering them hard and unfavorable \nfor the development of microbes. Strong salt solutions, placed \nin contact with skin or mucous membrane, withdraw fluid \nfrom the surface cells, and this, together with the passage of \nsalt into them, causes some irritation. They also withdraw fluid \nfrom the red blood-corpuscles, which shrink in size, and from \nmuscle, the vitality of which is impaired. On the other hand, \nwith very dilute solutions these all become swollen and soft- \nened from the absorption of fluid. Salt solutions which are \nmore concentrated than the blood-plasma are called hypertonic, \nthose which are weaker than it, hypotonic, and those which are \nof the same osmotic pressure as the plasma, isotonic. When \ntwo solutions are separated by a semi-permeable membrane, \nneither of the salts in solution being able to penetrate the \nmembrane, water accumulates on the side of the solution \nhaving the highest osmotic pressure. The osmotic pressure \nof a given substance is proportional to the number of molecules \nper volume of solution. A 0.7 per cent, solution of sodium \nchloride is called the normal or physiological saline solution \nbecause it is supposed to be isotonic or indifferent to the \nliving tissues. As a matter of fact, however, it is probable \nthat every cell and fluid in the body has its specific osmotic \npressure, with a consequent variation in the concentration of \nthe sodium chloride solution isotonic with it. The active tis- \nsues of the body contain a very large proportion of water, \nand physical continuity between these media is established by \nthe inter-cellular and intra-cellular lymph. It would naturally \nbe supposed, and experiment has shown this to be the case, \nthat the normal distribution of water between the blood, lymph \nand solid tissues is maintained through the nicest physiological \nadjustment, the direct working factor of which is probably \nthe force of osmosis. When the blood loses water, this is \nreplaced by fluid drawn from the lymph, which in turn makes \n\n\n\nSODIUM. 185 \n\ngood its loss from the solid tissues. When a dilute solution of \nsodium chloride which has a lower osmotic pressure than the \nblood is introduced in excess into a vein, the hydrsemic \nplethora thus produced begins at once to diminish, owing to \nthe rapid transudation of the fluid through the capillary walls, \nnot of the muscles, but of the intestine and peritoneum. In \nthe interchange of bodily fluids, however, the forces of filtra- \ntion and diffusion complicate those of osmosis in the trans- \nference of material. For the occurrence of osmotic interchange \nthe separating membrane must be permeable to water, but im- \npermeable to substances dissolved in it; and the capillary wall, \nwhich separates the blood from the lymph, is not of this char- \nacter, since through it there may take place both filtration \ndue to difference of hydrostatic pressure and diffusion of sub- \nstances in solution. The laws of osmosis have been thus \nsummarized: (1) Solutions separated by a membrane per- \nmeable to water tend to have an identical molecular composition. \n(2) If the membrane is perfectly permeable to both solvent and \ndissolved substance the exchange of molecules will take place \nwithout change in pressure or volume. (3) If the membrane \nis less permeable to the dissolved substance than to the solvent, \nan increase of liquid, or increase of tension, will occur in the \nstronger solution. (4) If a membrane is differently permeable \nto one dissolved substance than to another, equimolecular solu- \ntions of the less diffusible substance will be hyperisotonic \n(hypertonic) to the more diffusible. \n\nIn the mouth and fauces strong solutions of sodium chloride \nhave an astringent action, while in the stomach they may have \nan emetic effect from the irritation caused by the withdrawal \nof fluid and the impartation of salt to the mucous cells. They \nare also capable of exerting a purgative action. A small amount \nof sodium chloride in the food, by rendering the latter more \npalatable, no doubt often has the effect of increasing the flow \nof gastric juice through reflex influence; but it would seem \nthat stomachic digestion is not always improved by it, since it \nhas been found that even small quantities diminish the acidity \n\n\n\n1 86 PHARMACOLOGY AND THERAPEUTICS. \n\nof this secretion. Mineral waters in which common salt is \nthe chief constituent have no direct effect on the secretion, but \nappear to alter the nutrition of the gastric mucous membrane. \nThus it is found that in some individuals the hydrochloric acid \nis increased by these waters, while in others it is lessened. \nHypertonic and isotonic salt solutions are absorbed in the \nstomach and intestine, as well as hypotonic ones, and in order \nto explain this it is necessary to assume that there exists a \nconstant natural tendency for fluids and some salts to pass \ninwards from the lumen of the gastro-intestinal tract. Hypo- \ntonic solutions are naturally absorbed rapidly, while isotonic \nones are absorbed more slowly, because in their case the \nnatural flow alone is active. With hypertonic solutions the \nabsorption\' is still slower, for the reason that the natural flow \nis at first antagonized by the osmotic pressure-current, which \nis in the opposite direction. Hence, for a time the fluid in \nthe canal may actually be increased, by the abstraction of liquid \nfrom the blood; but as the absorption of salt is all the while \ntaking place, the concentration of the fluid is gradually reduced \nuntil it becomes isotonic, and it is then absorbed. In the \nserous cavities it is stated that when salt solution is injected, \nabsorption takes place in the same way as from the stomach \nand intestine, except that osmosis plays a more important part \nthan in them. The blood and lymph are in turn affected by the \nprocesses occurring in the alimentary canal, and while the \ndetails of the changes which take place between these are \nnot clearly understood, it is established that the absorption of \nsalt, as well as of water, leads to an augmentation of the nor- \nmal exchange of the two fluids. Again, the changes in the \nblood and lymph are followed by an increased activity of the \nexcretory organs. The flow of urine is increased to some \nextent by the absorption of salt solution from the alimentary \ncanal, and to a notable degree by the injection of such a solution \ninto the circulation, and this is believed to be the result of \nsalt-action, and not of any direct effect produced upon the \nrenal cells. The saliva is also increased, partly by a reflex \n\n\n\nSODIUM. 187 \n\nfrom the mouth and partly because a portion of the salt is \nexcreted by the salivary glands. While any salt solution caus- \ning an acceleration in the movement of the fluids of the \nbody necessarily tends to facilitate the excretion of waste \nproducts, the elimination thus caused is much smaller than \nhas generally been supposed to be the case, and recent investi- \ngations indicate that salt tends to lessen the proteid metabolism \nthrough acting directly on the cells. This action is stated to \nbe so slight, however, that the resulting fall in the nitrogen \neliminated is concealed by the increase caused by the more \ncomplete flushing. Both sodium chloride and the potassium \nsalts augment the salts of the urine. While carnivorous ani- \nmals and hunting peoples require no salt and often have a \ndistaste for it, in consequence of their food containing so large \na proportion of sodium salts, common salt forms an important \narticle of diet with all creatures living largely or exclusively \non vegetable food, in whom the potash in the food causes an \nintense craving for it. The cause of this desire for salt has \nbeen explained as follows : Blood plasma contains much sodium \nchloride, vegetable foods contain a large amount of potassium \nsalts ; when, therefore, these salts of potassium reach the blood, \npotassium chloride and the sodium salt of the acid which was \ncombined with the potassium are formed. This and the potas- \nsium chloride are excreted by the kidneys, and the blood loses \nits sodium chloride, which loss is therefore made up by taking \nsodium chloride with the food. Some doubt is said to have \nbeen recently thrown on this explanation by the discovery of \ncertain African tribes living on vegetable substances alone, and \nyet using the ashes of plants, which contain more potash than \nsoda, as civilized peoples use ordinary salt. As sodium chloride \nis the most important of the mineral constituents of the body, \nso far as regards its general distribution and the active part \nwhich it takes in the internal phenomena of nutrition, the \ningestion of an adequate amount of it is essential to the mainte- \nnance of health, and the deprivation of it leads to general \nweakness, oedema and anaemia. \n\n\n\n1 88 PHARMACOLOGY AND THERAPEUTICS. \n\nTherapeutics of Sodium Chloride. \n\nLocally it is used to limit the action of silver nitrate when \napplied to mucous membrane, as a gargle in ordinary sore \nthroat or in atomized solution in subacute and chronic affec- \ntions of the pharynx and larynx, in douches for the treatment \nof nasal catarrh and ozaena, as an injection for the vagina and \nrectum, and as a wash for indolent ulcers, hives and pruritus \nvulvae, as well as for the stings and bites of insects. As a rule, \nthe solution used for affections of the mucous membrane should \nnot exceed a strength of 1.20 gm. (20 gr.) to 500 c.c. (1 pint) \nof water, as stronger solutions are likely to be painful and to \naggravate the disease. Rectal injections of strong solutions of \nsalt, which by removing mucus serve to render the bowel unfit \nfor the habitation of the parasite, constitute one of the best \nmethods of treatment for the Oxyuris vermicularis. A solu- \ntion of it in whiskey is a popular remedy for muscular rheu- \nmatism and for bruises, sprains, glandular swellings, etc., and \nhot salt enclosed in bags is a good application in lumbago and \nother forms of myalgia and in colic, dysmenorrhcea, toothache \nand other painful conditions. In the strength of Yi per cent, \nit makes an invigorating as well as cleansing bath, and in a \n5 per cent, solution has been recommended as more agreeable \nand useful than soap baths in subacute eczema, psoriasis, etc. \nConcentrated hot salt baths, like those of Droitwich and Nant- \nwich, are beneficial in chronic rheumatism and sciatica. Sea- \nbathing, as is well known, has a pleasant general stimulating \neffect, and its beneficial results are largely due to the abundant \npresence of sodium chloride in the water. \n\nInternally it is used at times as an emetic, and from 15 to \n30 gm. (1 to 2 tablespoonfuls) in 250 c.c. (y 2 pint) of tepid \nwater are generally successful in causing a prompt evacuation \nof the stomach. In poisoning by silver nitrate it arrests the \ncorrosive action by the formation of insoluble silver chloride. \nIts efficiency as an emetic is increased by combining it with \nmustard water. Administered in the form of natural mineral \nwaters in which it is a principal ingredient, or in carbon dioxide \n\n\n\nSODIUM. 189 \n\nwater, it often proves of service in gastric disorders, and espe- \ncially dyspepsia attended with decomposition of food in the \nstomach, with resulting flatulence, acidity and pain. Salt meat, \nolives and other saline articles tend to prevent alcoholic in- \ntoxication, and enemata of salt and water are employed with \nsuccess to rouse drunkards from their lethargy or abate their \ndelirious outbreaks. In conditions where the body has lost \nmuch fluid, as from haemorrhage and in Asiatic cholera, life has \nrepeatedly been apparently saved by the intravenous injections \nof solutions of salt in distilled or boiled water, with the addi- \ntion sometimes of a small amount of sodium sulphate or car- \nbonate, calcium chloride, or other alkali ; and normal saline \nsolution is now commonly given in this way or by hypoder- \nmoclysis (see p. 3), as a substitute for transfusion of blood. \nThis may be prepared by dissolving 4 gm. (60 gr.) of common \nsalt in 500 c.c. (1 pint) of boiling water, and allowing the solu- \ntion to cool to 37. 7\xc2\xb0 C. (ioo\xc2\xb0 F.). It is often desirable, how- \never, to use it at a considerably higher temperature than this. \nRecently an effort has been made to secure a solution which \nmight be free from the disadvantages found in the actual use \nof saline infusions whether used by the intravenous method, \nby hypodermoclysis or by injection into the peritoneal cavity. \nAlthough its content of sodium chloride is higher than that \ngiven above the following has been lately recommended: So- \ndium chloride, 0.9; calcium chloride, 0.026; potassium chloride, \n0.01 ; distilled water, 99.064. Salt solution has also been em- \nployed in uraemia and similar intoxications, and in such condi- \ntions subcutaneous injection is preferred by some. In the case \nof insane patients who refused to take food the use of salt solu- \ntion by hypodermoclysis has sometimes been found of service, \nas it has the effect of exciting hunger and thirst. In poisoning \nby carbon dioxide and by coal gas good results have been re- \nported from this procedure or the intravenous injection of a \nsalt solution, after a preliminary bleeding. Intestinal lavage \nwith normal saline solution, by means of the rectal irrigator, \nis almost certain to have a marked diuretic effect, as it has \n\n\n\nI9O PHARMACOLOGY AND THERAPEUTICS. \n\nbeen pointed out that the association of action between the \nlower bowel and the kidneys is such that a movement of the \nbowels can scarcely take place without simultaneously in- \nducing a urinary flow. It is therefore of great service in various \nconditions, and especially acute nephritis. In colitis, particularly \nwhen chronic, medicinal remedies not infrequently fail to com- \nplete the cure until supplemented by the local effects of this \nlavage. The beneficial influence of the enteroclysis may be en- \nhanced by the addition to the fluid of antiseptic and anodyne \nagents. Auto-infection from retention of putrid contents in \nthe colon may give rise to grave cerebral symptoms, and the \nsame conditions are often met with in cholera infantum; here \nsuch intestinal irrigation is indicated, both to combat the toxic \ninfection and to secure the beneficial effects of the saline on \nthe blood, after it has been drained of its salts by the watery \nevacuations. This procedure may also prove valuable against \nthe toxaemia in fevers, particularly typhoid fever. \n\n8. SODII NITRAS.\xe2\x80\x94 Sodium Nitrate. Dose, 1 gm.; 15 gr. \n\nAction of Sodium Nitrate. \nIts action is practically the same as that of potassium nitrate, \nexcept that it is much less depressant to the heart. In dilute \nsolution it may be taken in large amount without producing any \neffect except diuresis. It is a less efficient diuretic than potas- \nsium nitrate, however, as it lacks the stimulating influence upon \nthe kidney which is due to the potassium constituent of the \nlatter salt. In concentrated form it acts as a gastro-intestinal \nirritant and may cause purgation, with the result of lessening \nthe force or frequency of the heart\'s action and of lowering \nthe temperature. \n\nTherapeutics of Sodium Nitrate. \nAt the present day it is very rarely employed in practical \nmedicine. Formerly it was chiefly used in diarrhoea and dysen- \ntery, in daily doses of from 30 to 60 gm. (1 to 2 oz.) dissolved \n\n\n\nSODIUM. I9I \n\nin a large quantity of water. It has been considered of service \nin relieving maniacal excitement, in daily quantities of from 3 \nto 5 gm. (45 to 75 gr.), and in two patients who suffered from \nepilepsy of psychical origin it is said that the attacks could be \nprevented by the exhibition of 6 gm. (1^2 dr.) immediately \nafter the appearance of the aura. \n\n9. SODII ACETAS.\xe2\x80\x94 Sodium Acetate. Dose, 1 gm.; 15 gr. \n\nAction of Sodium Acetate. \nThe same as potassium acetate, both resembling the chlorides \nand therefore owing any effect they possess to the salt-action. \nIn the. body, however, they are oxidized, with the formation of \ncarbonates, and hence their action before absorption is that of \nthe chloride, and afterwards that of the carbonate. The re- \nsult is that the alkalinity of the blood and of the urine, as \nwell as the amount of the latter, is increased. A mixture of \nequal parts of sodium acetate and potassium nitrate explode \nwith great violence. \n\nTherapeutics of Sodium Acetate. \nIt is employed principally to yield acetic acid by the action \nof sulphuric acid, and although it has decided diuretic prop- \nerties, is seldom prescribed medicinally. By some, however, it \nis considered more efficient as a diuretic, as well as milder and \nless apt to derange the digestion, than potassium acetate. It \nhas been given as an antacid in acute rheumatism and as a \ndiuretic in dropsies, and also used in irritation of the genito- \nurinary apparatus and gout. \n\n10. SODII CHLORAS.\xe2\x80\x94 Sodium Chlorate. Dose, 0.250 gm. (250 \nmilligm.) ; 4 gr. \n\nAction of Sodium Chlorate. \nPractically the same as that of potassium chlorate. The \neffects produced by both salts are principally due to their \nchlorate ion. \n\n\n\n192 PHARMACOLOGY AND THERAPEUTICS. \n\nTherapeutics of Sodium Chlorate. \nIt has never been used to anything like the extent of the \npotassium chlorate, but is occasionally employed as a substi- \ntute for the latter in affections of the mouth and throat. Its \ngreater solubility, it may be said, permits of stronger solutions. \nAs a gargle or wash a 2 to 5 per cent, solution may be pre- \nscribed. It has been used with asserted remarkable results in \ncancer of the stomach, but the large doses employed would seem \nto be attended with considerable danger from chlorate poison- \ning. \n\n11. SODII PYROPHOSPHAS.\xe2\x80\x94 Sodium Pyrophosphate. Dose, 2 \ngm.; 30 gr. \n\nAction of Sodium Pyrophosphate. \nSodium pyrophosphate has the same therapeutical action as \nsodium phosphate. \n\nTherapeutics of Sodium Pyrophosphate. \nIts principal use is in pharmacy, and it is rarely, if ever, \nemployed as a medicine. \n\n12. SODII CITRAS.\xe2\x80\x94 Sodium Citrate. Dose, 1 gm.; 15 gr. \n\nAction of Sodium Citrate. \nIt is a cooling and mild purgative, similar in its action to \nmagnesium citrate. \n\nTherapeutics of Sodium Citrate. \nIt may be given in cases where a pleasant saline laxative is \nrequired. \n\n13. SODII iETHYLAS (Not official).\xe2\x80\x94 Sodium Ethylate. \n\nPreparation. \nLiquor Sodii iEthylatis (Not official). \xe2\x80\x94 Solution of Sodium \nEthylate. \n\n\n\nSODIUM. I93 \n\nAction of Sodium Ethylate. \nWhen it is applied to living tissues the following effects \nhave been observed: 1, a removal of water from the tissue; 2, \nthe destructive action of the resulting caustic soda; 3, coagula- \ntion from the alcohol that is reproduced; 4, prevention of \ndecomposition in the resulting dead tissue. It is stated that \nthe liberated alcohol coagulates the albuminous compounds in \nits neighborhood, and thus limits the caustic action of the soda, \nand that the red blood-corpuscles become disintegrated, and \nthen crystalline, while the white are for a time unaffected. \nWhen used for local pathological conditions it affects the sur- \nrounding healthy skin to but a slight extent, its action being \nrestricted to the spot on which it is applied; and it produces \nscarcely any scarring. As compared with the action of nitric \nacid, there is but little destruction of the epidermis, while the \npain caused by it is less severe than that from the acid. \n\nTherapeutics of Sodium Ethylate. \nIt is used exclusively for its local effects, and is by some \nconsidered the best of all caustics. Its corrosive action is very \nspeedy and energetic, and it has been employed especially for \nthe destruction of naevi. It is customary to apply it, by \nmeans of a glass rod, for two or three days successively, and \nwhen the eschar thus formed has fallen off the treatment is \nrepeated, if necessary. The pain caused by it may be mitigated \nby mixing it with laudanum, and in pendulous vascular tumors \nthe risk of too great haemorrhage may be avoided by diluting \nthe ethylate with alcohol, so as to promote coagulation. This \ncaustic is also used with advantage in a variety of other condi- \ntions, such as tattoo, hypertrichosis, warts, moles, callous ulcers, \nnasal polypus, haemorrhoids, lupus, epithelioma, and melanotic \ngrowths. A 10 per cent, watery solution, applied after curet- \nting, has been found valuable in the treatment of lupus erythema- \ntosus, and it is stated that a 20 per cent, liniment, made with \nolive oil, if well rubbed in daily, will usually cure psoriasis in \na comparatively short time. Sodium ethylate has also been \n\n\n\n194 PHARMACOLOGY AND THERAPEUTICS. \n\nemployed in ringworm and other skin affections. Applied di- \nrectly to the unbroken skin, it is asserted that its destructive \naction is less painful than would be expected, and that when \npain is felt it may be quickly checked by dropping upon the \npart a little chloroform. The caustic alcohols may be used \nin combination with local anaethesia from cold. Potassium and \nsodium alcohol, added to amyl-hydride, dissolve the hydride \nand produce a caustic solution. A part rendered quite dead to \npain by freezing with ether spray may be directly destroyed, \nit is said, by the subcutaneous injection of caustic alcohol \xe2\x80\x94 a \npractice very important in the treatment of poisoned wounds; \nand it has been suggested that cystic tumors might be cured \nby such injections, after destruction of the sensibility of the \nparts by cold. \n\nAMMONIUM. \n\n1. AQUA AMMONITE FORTIOR.\xe2\x80\x94 Stronger Ammonia Water. \n\nPreparation. \nSpiritus Ammonias. \xe2\x80\x94 Spirit of Ammonia. Dose, 1 c.c; 15 n\\. \n\n2. AQUA AMMONIAS.\xe2\x80\x94 Ammonia Water. Dose, 1 C.C.; 15 H\\.. \n\nPreparations. \n\n1. Linimentum Ammonise. \xe2\x80\x94 Ammonia Liniment. (Volatile \nLiniment.) \n\n2. Spiritus Ammoniae Aromaticus. \xe2\x80\x94 Aromatic Spirit of Am- \nmonia. Dose, 2 c.c; 30 n\\. \n\nAction of Solutions of Ammonia. \nExternal. \xe2\x80\x94 Applied to the skin ammonia solutions of moderate \nstrength are rubefacient. Strong solutions cause a sensation \nof burning pain and, if the part is covered, will give rise to \nvesication. Ammonia differs from the other alkalies in being \nmore volatile, in consequence of which it penetrates more rap- \nidly and deeply. It passes through the stratum corneum of the epi- \ndermis without dissolving it, and produces the blisters by its ac- \n\n\n\nAMMONIUM. I95 \n\ntion on the lower layers of the skin. At the same time it is less \ncorrosive and less enduring in its effects than the fixed alkalies, \nalthough, if the application is continued sufficiently long, \nsloughing will result. \n\nInternal. Eyes, Nose and Air Passages. \xe2\x80\x94 Vapor of ammonia, \nin contact with the eye, causes severe pain and inflammation. \nWhen inhaled it is also irritating, occasioning smarting, sneez- \ning, lachrymation and coughing, with reflex acceleration of the \npulse and respiration. If sufficiently concentrated, it is likely \nto cause spasm of the glottis or such swelling of the mucous \nmembrane of the larynx and trachea as to induce asphyxia. \nAnimals immersed in such vapors become asphyxiated, and 5 \nparts of ammonia in 10,000 are considered dangerous. \n\nStomach. \xe2\x80\x94 In the mouth, fauces, oesophagus and stomach \nconcentrated solutions produce corrosions similar in character \nto those resulting from caustic potash and soda, but as the \ngas evaporates rapidly from ammonia solutions, some of the \nvapor generally escapes into the respiratory passages, and in \nthe manner described tends to produce asphyxia, which may \nresult in death very suddenly. In dilute solution ammonia acts \nas a mild gastric stimulant. Like other alkalies, it renders the \ngastric juice less acid and tends to liquefy the mucus in the \nstomach. \n\nSkin, Mucous Membrane, and Salivary Glands. \xe2\x80\x94 Ammonia \nand its salts have considerable effect in increasing the secre- \ntions, especially the saliva, mucus and perspiration. The \ndiaphoresis has been attributed to their action on the central \nnervous system, and the increase in the saliva and mucus to \na reflex stimualtion from mucous membranes due to a salt action, \nto direct stimulation of the secreting centres, and to local \nsalt-action upon the secretory cells themselves. It is considered \ndoubtful, however, whether these agents, although having a \ndirect action upon the central nervous system when injected \ninto the circulation, are capable of producing any such effect \nwhen they are absorbed from the stomach. The ammonium \nsalts are said to be excreted largely into the mouth by the saliva, \n\n\n\nI96 PHARMACOLOGY AND THERAPEUTICS. \n\nas also by the lungs, mainly in the form of carbonate. In \nthis way the local action is exerted twice (when the salt is \napplied and when it is excreted), and this excretion in the \nform of carbonate also tends to liquefy the mucus on account \nof the alkaline action. \n\nBlood. \xe2\x80\x94 Little is known of the behaviour of ammonia in the \nblood, although when injected in poisonous quantities it has \nbeen found to prevent the blood from taking up oxygen. \nIt was at one time supposed by some observers that the coagu- \nlation of the blood was caused by the escape of ammonia, but \nit is now known that this is not the case. Still, ammonia helps \nto maintain the fluidity of the blood, while its presence, in \nsufficient quantity, serves to hold the fibrin in solution. Thus, \nhaving the property of dissolving fibrin, it is believed to diminish \nthe local liability of the blood to coagulate, and also to be \ncapable of dissolving clots, in cases of thrombosis. \n\nHeart and Circulation. \xe2\x80\x94 Upon the circulation ammonia acts \nas a powerful, but fleeting stimulant. When it is inhaled, the \nirritation of the nasal mucous membrane causes a reflex stimula- \ntion of the vaso-motor centre, and consequent constriction of \nthe arterioles and increased blood-pressure. The cardiac action \nmay be temporarily slowed by inhibitory reflexes. Also when \nammonia is injected in moderate amounts into the circulation, \nthe blood-pressure rises from the contraction of the peripheral \nvessels caused by stimulation of the vaso-motor centre. The \nheart itself is sometimes slowed from increased activity of the \ninhibitory centre, and sometimes accelerated; whether in \nconsequence of action on the cardiac muscle or on the accelera- \ntion centre is not known. The pulse-rate and the pulse-force, \nas well as the blood-pressure, are usually increased, and the \nrise in the arterial pressure is followed, if the dose has been \nsufficiently large, by a decided fall, ending in permanent diastolic \narrest of the heart. If by means of intravenous injection the \nammonia reaches the heart in large amount in concentrated \nform, the organ at once ceases to beat, in consequence of \nparalysis of its muscular walls. Any effect that solutions of \n\n\n\nAMMONIUM. \n\n\n\nI 9 7 \n\n\n\nammonia, when taken by the mouth, may have in stimulating \ncardiac action, is probably not due to a direct influence upon \nthe heart, but to an action exerted reflexly from the gastric \nirritation. \n\nRespiration. \xe2\x80\x94 From the reflex stimulation of the respiratory \ncentre in the medulla, when ammonia is inhaled, the respiration \nis at first checked, and then rendered fuller and deeper. So, \nwhen the drug is injected subcutaneously or intravenously the \nrespiration often ceases for a moment, and then becomes very \nmuch accelerated, while in some instances it is deepened; this \nincrease in respiration being due to stimulation of the respira- \ntory centre. As to the preliminary pause, it has been attributed \nby some to action on the vagus terminations in the lungs, while \nthis is denied by others, and it is thought probable that it is \ndue simply to excessive stimulation of the respiratory centre. \nThe breathing finally stops in respiratory tetanus. \n\nNervous System and Muscles. \xe2\x80\x94 The action on the central \nnervous system consists of a stimulation, especially of the \nmedulla oblongata and spinal cord. According to some ob- \nservers the brain is found to be rather depressed, so that there \nis somnolence. Others believe that the brain is first stimulated, \nand that this action inhibits the reflexes. Then, as the stimula- \ntion passes downwards, the spinal cord is acted on in turn, and \nthe reflexes are exaggerated. The rise of arterial pressure and \nthe quickening of the respiration, from the action on the medul- \nlary centres, have already been mentioned. When the drug is \ninjected into the circulation tetanic convulsions may occur, \nthough appearing rather late, and they resemble strychnine \nspasms quite closely. As they persist after division of the \ncervical cord and destruction of the brain and medulla ob- \nlongata, they would appear to be due to changes in the spinal \ncord such as are observed in poisoning by strychnine. During \nthe convulsions the respiration is arrested and the blood-pres- \nsure becomes extremely high. If the amount injected into the \ncirculation be sufficiently large, the stimulation is followed by \nparalysis of the central nervous system, and death is caused by \n\n\n\nI90 PHARMACOLOGY AND THERAPEUTICS. \n\nasphyxia. The muscles are acted on by ammonia in much the \nsame way as by potassium, although it is stated that a prelimi- \nnary stage of augmented irritability not met with in the case \nof the latter has been observed by some investigators. Under \nthe effects of potassium the contraction of the muscle of the \nfrog appears to be somewhat greater in height, though shorter \nin length, while there is less tendency to contracture; and muscle \nexposed in a solution of potassium chloride dies very much \nsooner than in an isotonic solution of sodium chloride. \n\nKidneys. \xe2\x80\x94 Ammonia differs from the -fixed alkalies in not \nincreasing the alkalinity of the blood and in not reducing the \nacidity of the urine or rendering it alkaline. This is because \nit is changed to urea in the body, and is excreted in this form \nin the urine. The flow of urine is sometimes, but not always, \nincreased by the administration of the salts of ammonia; when \nthis is the case it is said to be due simply to the increase of \nurea. \n\nTherapeutics of Solutions of Ammonia. \n\nExternal. \xe2\x80\x94 The stronger water of ammonia is sometimes \nused as a rubefacient and vesicant. This solution, however, \nwill generally be found too strong for use in its unmixed state, \nand where a prompt and sufficiently powerful counter-irritant \neffect is indicated, as is sometimes the case in various neuralgic, \ngouty, rheumatic, spasmodic and inflammatory affections, it \nmay be combined, in the proportion of five parts to eight, with \na diluent liquid composed of spirit of camphor and rosemary. \nIf a very quick effect is called for, the proportion should be five \nto three. A convenient method of application is to fill the \ncover of an ointment-box, or other suitable receptacle, with \nlint, and, having saturated it with the lotion, press it upon \nthe part. The ammonia is thus prevented from escaping, and \na definite boundary given to the action desired. The less \ndiluted mixture will generally produce rubefaction in from one \nto eight minutes, and vesication in from three to ten minutes. \nIn severe neuralgias the skin may be blistered at points where \nthe affected nerve is found to be tender. Care should be always \n\n\n\nAMMONIUM. I99 \n\ntaken, however, that the application should not be continued too \nlong, as sloughing may then result. A salt of morphine may- \nbe added to the solution employed. In some cases " thimble- \nblistering " is advised ; in which small areas over the painful \nspots are vesicated by means of undiluted stronger water of \nammonia dropped upon absorbent cotton and confined with a \nthimble or watch-glass in contact with the skin. Ammonia is \nnot often used for epispastic purposes, as the blisters produced \nby it are more painful and slow to heal than those of other \nvesicants. It is especially applicable, however, when vesication \nis desired in cases of renal disease, in which cantharides is \ncontra-indicated. Aqua Ammonias is a very good application \nfor the stings and bites of insects. The stronger water is often \napplied in snake-bite, but so far as any antidotal action is con- \ncerned it would seem to be of no service, as ammonia has been \nshown to have no effect on the toxalbumins of snake-poison. \nThe inhalation of Aqua Ammonias is of great value in cases \nof syncope ; held to the nostrils of persons who have fainted, \nby its effect on the mucous membrane, it usually produces, \nthrough reflex influence, very prompt stimulation of the heart \nand respiration. In all cases of suspended animation, whether \nfrom syncope or asphyxia, it may be employed, but with caution, \non account of the possibility of its giving rise to inflammation \nof the fauces, glottis and larynx. Ammonia is the basis of most \nof the " smelling salts " in popular use, the ordinary form of \nwhich consists of the carbonate reinforced with some of the \nstrong solution of ammonia and flavored with oil of lavender. \nAmmonia water is much used in liniments, usually combined \nwith olive or other oil, and also in washes to prevent the hair \nfrom falling out or to stimulate its growth. Amenorrhoea, as \nwell as leucorrhcea, is said to have sometimes been successfully \ntreated by vaginal injections of a weak solution of ammonia. \nSuch solutions have also been used in the treatment of super- \nficial burns and frost-bite, and, in association with hot water, for \nsponging the surface for the relief of general exhaustion or \ndepression of the nervous system in low fevers. The early \n\n\n\n200 PHARMACOLOGY AND THERAPEUTICS. \n\ninhalation of dilute vapor of ammonia may perhaps sometimes \narrest the development of catarrhal affections of the throat \nand air passages, and also prove of service in chronic dry- \nness of the pharynx and chronic hoarseness. It has been known, \nit is said, to delay or prevent the paroxysms of whooping-cough \nand epilepsy. \n\nInternal. \xe2\x80\x94 In the stomach ammonia in solution acts as a \nstimulant antacid, and is useful in heart-burn, sick-headache, \netc., but in dyspeptic conditions it is not used alone so much \nas in combination with the carbonate in the Spiritus Ammoniae \nAromaticus. In sudden paralysis of the heart from chloroform \nnarcosis, poisonous gases, or toxic agents such as hydrocyanic \nacid, nicotine, etc., or in collapse from any cause, it may be \nintravenously injected \xe2\x80\x94 4 to 8 c.c. (1 to 2 11. dr.) of Aqua \nAmmoniae with an equal quantity of water. Injected subcu- \ntaneously, it almost invariably produces a slough. Intravenous \ninjections of ammonia are also called for when sudden throm- \nbosis of a large venous trunk occurs, as, for example, in the \npulmonary artery, after uterine haemorrhage. They may even \nbe employed when thrombosis is threatened, but has not actually \ntaken place, as in the puerperal state, after free haemorrhage, \nwhen the circulation is depressed from weak heart. In chloro- \nform narcosis this procedure not infrequently fails, and the \nreason for this is believed to be because the heart stops sud- \ndenly and completely, so that before the injection can be prac- \nticed the cardiac ganglia have entirely ceased to functionate. \nThe opinion has been expressed that \'failure has sometimes re- \nsulted in other classes of cases because a sufficient quantity of \nammonia was not employed, and a case is on record in which \na patient is stated to have been saved from inevitable death \nfrom the effects of the gases of a privy vault by no less than \ntwelve intravenous injections of the stronger water of ammo- \nnia, the whole amount thrown into the circulation being 8.624 \nc.c. (140 ui). The repetition of the injection should naturally \ndepend on the effects noted, and it is advised that the limit to \nthe amount of ammonia used should be determined by the state \n\n\n\nAMMONIUM. 20I \n\nof the heart. Notwithstanding the negative results obtained in \nexperimental researches, many instances have been reported in \nwhich ammonia injections seemed to be efficacious in poisoning \nby venomous serpents. In such cases the beneficial results were \nno doubt due to the prompt and energetic stimulation, rather \nthan to any antidotal value of the remedy. \n\n3. AMMONII CARBONAS.\xe2\x80\x94 Ammonium Carbonate. (Bakers\' Am- \nmonia. Hartshorn. Sal Volatile.) Dose, 0.250 gm. (250 milligm.) ; \n4 gr. \n\nPreparation. \nElixir Ferri, Quininse et Strychninae Phosphatum. \xe2\x80\x94 Elixir \nof Iron, Quinine and Strychnine Phosphates. Dose, 4 C.C.; 1 \nfl. dr. \n\nAction of Ammonium Carbonate. \nThe pharmacological effects of the carbonate are similar to \nthose of solutions of ammonia. Although not so corrosive as \nthe latter, when swallowed in sufficient quantity it acts as an \nirritant poison. Slight gastric irritation is produced by moder- \nate amounts, and nausea and vomiting by larger doses. It \nhas expectorant properties of great value, as it not only in- \ncreases the bronchial mucous secretion and renders it more fluid, \nbut reflexly stimulates the respiratory centre in the medulla \noblongata. In the urine it is excreted as urea. \n\nTherapeutics of Ammonium Carbonate. \nThe carbonate, either in solution, or in the form of aromatic \nspirit of ammonia, is given very frequently in cases of collapse \nand heart-failure, or where such conditions are threatened. \nHere the stimulating influence exerted by it is probably not, as \nhas been generally supposed, directly upon the heart and \nrespiratory centre in the medulla, but a reflex effect resulting \nfrom the gastric irritation. When thrown into the circulation, \nhowever, either by subcutaneous or intra-venous injection, there \ncan be no question that it has a direct action upon the medullary \ncentres, and thus causes a powerful, though evanescent, stim- \n\n\n\n202 PHARMACOLOGY AND THERAPEUTICS. \n\nillation. In less serious depression resulting from various \ncauses Spiritus Ammonise Aromaticus is a favorite remedy, \nand generally answers very well for temporary purposes; giv- \ning a feeling of increased strength, or even of exhilaration, and \nincreasing the warmth of the surface. It is useful as a gastric \nstimulant and carminative, and is employed especially in cases \nof headache attended with acidity of the stomach and flatulent \neructations. It is also of service in the sour stomach and \ntympanites met with particularly in hysterical women, and \nwill sometimes prevent or abort paroxysms of hysteria. In \nnervous headaches, whether attended with nausea or not, it \noften affords relief. Ammonium carbonate is likely to prove \nsuccessful in the treatment of delirium tremens when the latter \nis associated with cerebral anaemia and weak heart action. It \nsometimes counteracts even a high degree of alcoholic intoxi- \ncation, and is serviceable in the dyspepsia of drunkards from \nits stimulant and antacid properties, as well as its action in \ndissolving the tenacious mucus coating the stomach. In doses \nof from .30 to .60 gm. (5 to 10 gr.), administered with .60 c.c \n(10 ni) of tincture of capsicum in 30 c.c. (1 fl. oz.) of some \nbitter infusion, it is very efficient in relieving the sinking sen- \nsations and craving for stimulants experienced by subjects of \nalcoholism. It is a valuable cardiac and nervous stimulant in \nsyncope, heart-exhaustion, and all typhoid conditions, and may \ntherefore at times be employed with advantage in adynamic \nforms of pneumonia, scarlet fever, measles, small-pox and \nerysipelas, as well as in typhus and typhoid fevers. As it is \nquickly eliminated, it is best given in small doses repeated at \nshort intervals. By some, however, its administration in typhus \nand typhoid fevers has been regarded as improper, on the \nground that in these diseases the ammonia in the blood is \nincreased beyond the normal. In pneumonia it has been pointed \nout that to stimulate the heart merely, when an obstacle exists \nin the pulmonary circulation, is of doubtful utility; but am- \nmonium carbonate, by liquefying the exudation, also relieves \nobstruction of the air-sacs, and is thus a remedy of great value. \n\n\n\nAMMONIUM. 203 \n\nIt is sometimes prescribed with good effect in infusion of \nsenega, which is a stimulant expectorant. In bronchitis and \nbroncho-pneumonia it is often given in association with other \nexpectorants, and is perhaps most used in the case of children \nand old people. It is especially esteemed in the capillary bron- \nchitis of the young, and is employed by surgeons in the treat- \nment of children after operations to overcome the respiratory \nand circulatory depression produced by the anaesthetic. In \nrather large and frequently repeated doses it may prove effica- \ncious in aborting a cold. On account of its alkalinity, ammo- \nnium carbonate should not be prescribed in a mixture with \neither the vinegar or syrup of squill, the latter being made from \nthe vinegar. It is sometimes used as an emetic, in doses of 2 \ngm. (30 gr.) for an adult, and is less depressant than many \nother agents employed for this purpose. In diabetes it has been \nthought to sometimes prove of service, and its use has been \nstrongly recommended in the treatment of cystinuria. \n\n4. AMMONII CHLORIDUM.\xe2\x80\x94 Ammonium Chloride. (Sal Am- \nmoniac, Ammonium Muriate.) Dose, 0.500 gm. (500 milligm.) ; 7Y 2 \ngr. \n\nPreparation. \nTrochisci Ammonii Chloridi. \xe2\x80\x94 Troches of Ammonium Chlo- \nride. \n\nAction of Ammonium Chloride. \nApplied locally to mucous membranes, it stimulates their se- \ncretion. After absorption it also acts upon these membranes, \nrendering the secretions of the stomach and the bronchial \nmucous membrane less tenacious, as well as increasing their \namount. Injected into the circulation, it has, like ammonia \nand its carbonate, a stimulating action on the central nervous \nsystem, but when absorbed from the alimentary canal, it ap- \nparently has no such direct effect, though reflexly it may cause \nsome stimulation. When swallowed in considerable quantity \nit may induce irritation and vomiting, but only through its \naction as a salt. Solutions of the chloride are rapidly absorbed \nfrom the stomach and intestine, and permeate the red blood- \n\n\n\n204 PHARMACOLOGY AND THERAPEUTICS. \n\ncorpuscles with great facility. It apparently has some action \non the liver, and it is thought probable that this is explained \nby its increasing the excretion of urea by the kidneys. In the \nbody it is changed to urea, and this transformation seems to \ntake place principally in the liver. When urea is formed from \nit hydrochloric acid is liberated in the tissues, and this, it is \nstated, would act as a poison, were it not neutralized at once \nby ammonia being formed in the tissues themselves. It seems \nto have some effect in increasing the urine, as well as the \nsecretion of the salivary and sweat glands. It is said to \nbe excreted to some extent by the salivary glands, but its elimi- \nnation takes place principally by the kidneys. \n\nTherapeutics of Ammonium Chloride. \nIn consequence of its decided action on mucous membranes, \nammonium chloride (either in its nascent state, as generated \nby the action of hydrochloric acid on ammonia, or in the form \nof an atomized watery solution), is largely used by inhalation \nin pharyngitis, otitis media, laryngitis, bronchitis, etc., and \nespecially when these conditions are chronic. In both acute \nand chronic pharyngitis and bronchitis it is frequently admin- \nistered in the form of troches or compressed tablets. It is also \na favorite ingredient of expectorant mixtures. Combined with \npotassium iodide, tincture of ipecacuanha, and brown mixture, \nit is regarded as of special value in acute catarrhal pneumonia. \nIt is sometimes employed with good effect in so-called bilious- \nness, with coated tongue, decreased secretion of the intestinal \njuices, scanty, high-colored urine, etc., and in various hepatic \naffections, such as chronic torpor of the liver, chronic hepatitis, \nand catarrh of the bile-ducts with jaundice, it is often of great \nservice. In the first stage of cirrhosis it has also been found \nuseful by some authorities. The disagreeable taste of the drug \nmay be covered to a considerable extent by liquorice or by \nthe fluidextract of taraxacum. The former would naturally \nbe preferred as a vehicle for affections of the respiratory ap- \nparatus, and the latter in hepatic disorders. In these taraxacum \n\n\n\nAMMONIUM. 205 \n\nis used by many practitioners, although it would appear that \nthere is no sufficient ground for the belief that it has a specific \naction on the liver. Formerly ammonium chloride was some- \ntimes given in malarial fever, and large doses of it have been \nrecommended in neuralgia. By those who have found it useful \nit is believed to be chiefly serviceable in neuralgias depending \nupon cold, and tincture of aconite has sometimes been asso- \nciated with it. It has also been thought beneficial in myalgia \nand chronic muscular rheumatism. Like the other preparations \nof ammonia, it is employed in acute alcoholism, and 2 gm. (30 \ngr.) in 250 c.c. ( l / 2 pint) of water, swallowed at one draught, \nis said to be sometimes remarkably efficient in the case of \npatients on the verge of delirium tremens. By some it is con- \nsidered a very useful remedy in the subacute gastric and intes- \ntinal catarrh of children, in doses of from .12 to 1 gm. (2 to \n: 5 & r -)> preferably given with liquorice and water to mask the \ntaste. It is also beneficial in some cases of gastric catarrh in \nadults, and .60 gm. (10 gr.), given half an hour before meals, \nit is asserted, will afford extraordinary relief in painful dys- \npepsia due to hyperacidity of the stomach. In tropical dysen- \ntery good results have been reported from its use. When \nthis remedy is administered in the form of compressed pills \nit is advised that a large draught of water or milk be taken \nsimultaneously to protect the stomach. The local application \nof ammonium chloride is not resorted to at the present time \nto such an extent as was formerly the case. Its stimulating \naction has been made use of to arrest the progress of gangrene, \nespecially of the senile variety ; cataplasms or local baths con- \ntaining it being applied according to the situation of the dis- \nease. In weak solution it has been employed as a wash for \nulcers and a vaginal injection for leucorrhoea, and in stronger \nsolution as a stimulant and resolvent in contusions, contused \nand lacerated wounds, sprains, enlarged bursae and joints, in- \ndolent tumors, etc. A solution of from 8 to 15 gm. (2 to 4 dr.) \nto 500 c.c. (1 pint) of water removes ecchymosis from con- \ntusions, and is also applicable to subacute epididymitis. In \n\n\n\n206~ PHARMACOLOGY AND THERAPEUTICS. \n\nlocal inflammations the cold produced by it in dissolving may \nsometimes be taken advantage of. Five parts of ammonium \nchloride with 5 parts of potassium nitrate and 16 parts of \nwater will cause a very considerable lowering of the thermom- \neter, and such a mixture, applied in a bladder, has been em- \nployed for the reduction of hernial tumors. It forms a useful \ningredient in errhine powders, and a solution of 8 gm. (2 dr.) \nto 120 c.c. (4 fl. oz.) of water is an efficient topical application \nin rhus poisoning. \n\n5. LIQUOR AMMONII ACETATIS.\xe2\x80\x94 Solution of Ammonium Ace- \ntate. (Spirit of Mindererus.) Dose, 16 C.C.; 4 fl. dr. \n\nAction of Ammonium Acetate. \nLocally the acetate acts in the same way as the chloride, but \nin the tissues it undergoes oxidation and the whole of it is \nconverted into urea; so that while the urea of the urine is in- \ncreased, there is no increase in its ammonia. In the case of \nthe chloride, the net result of the effects produced upon the \nsystem is that the urea excretion is but little changed, while \nthe ammonia of the urine is much increased. Ammonium ace- \ntate causes an increase not only of the solid constituents of the \nurine, but also of its fluid, and it stimulates the secretion of the \nskin as well as that of the kidneys. \n\nTherapeutics of Ammonium Acetate. \nOn account of its diaphoretic and diuretic properties, it is \nsometimes prescribed in fever, either alone or together with \nmore powerful remedies. Except as a vehicle for the latter, \nhowever, it is much more rarely employed now than formerly. \nIn typhoid fever it has been found that the diarrhoea may be \nincreased by it. It used to be given very frequently combined \nwith spirit of nitrous ether, and in mild febrile conditions in \nchildren is still employed to some extent thus associated. \nSolution of ammonium acetate sometimes proves very grateful \nto fever patients when administered with an equal quantity of \ncarbon dioxide water. In sick headache from 4 to 8 c.c. (1 to \n\n\n\nLITHIUM. 207 \n\n2 fl. dr.) repeated every hour, is often very efficacious, and this \nremedy may also be given with good results in acute alcoholism. \nAs a diuretic it is employed as an adjuvant in the treatment of \nscarlatinous dropsy and of chronic Bright\'s disease. \n\n6. AMMONII NITRAS (U. S. P., 1890; no longer official).\xe2\x80\x94 Am- \nmonium Nitrate. \n\nAction of Ammonium Nitrate. \nIt has the general action of the nitrates, being a gastro- \nintestinal irritant and renal stimulant. \n\nTherapeutics of Ammonium Nitrate. \nIt is used to prepare nitrous oxide gas, freezing mixtures, \nand artificial cold applications. \n\nLITHIUM. \n\n1. LITHII CARBONAS.\xe2\x80\x94 Lithium Carbonate. Dose, 0.500 gm. \n(500 milligm.) ; 7V 2 gr. \n\n2. LITHII CITRAS.\xe2\x80\x94 Lithium Citrate. Dose, 0.500 gm. (500 mil- \nligm.) ; 71/2 gr. \n\nPreparation. \nLithii Citras Effervescens. \xe2\x80\x94 Effervescent Lithium Citrate. \nDose, 8 gm.; 120 gr. \n\n3. LITHII VANADAS (Unofficial).\xe2\x80\x94 Lithium Vanadate. Dose, \n.003 gm.; ^ gr. \n\nAction of Lithium Carbonate and Citrate. \nLithium is believed to possess an action midway between \nsodium and potassium, but comparatively little is known of the \nphysiological effects of its salts. When given to dogs by the \nmouth in sufficient quantity they have been found to produce \nsevere gastro-intestinal irritation, with diminished secretion of \nbile. Injected into mammals they have caused marked weak- \nness, gastric disturbance, diuresis, increasing dyspnoea, fall of \ntemperature, and death (often preceded by convulsions), from \n\n\n\n208 PHARMACOLOGY AND THERAPEUTICS. \n\narrest of the respiration. The heart of the frog is arrested in \ndiastole, but lithium acts much less powerfully on the mamma- \nlian heart than potassium. It appears to be depressant to the \nmotor nerves, as well as the spinal cord, and to weaken muscu- \nlar contraction. These salts in medicinal doses rarely give rise \nto any definite symptoms in man, unless it be an increased flow \nof urine, but large quantities may cause gastric derangement \nand possibly some muscular twitching. In the body lithium \nslightly increases the nitrogen excretion. The citrate is less \ndisagreeable to the taste and less liable to irritate the stomach \n(though in occasional instances it produces nausea and vomit- \ning) than the carbonate, and its effects are the same, as the \ncitric acid is consumed in the system and a lithium carbonate \nformed and excreted in the urine. Lithium salts are capable of \nrendering the urine very strongly alkaline. \n\nTherapeutics of Lithium Carbonate and Citrate. \nLithium salts are useful alkaline remedies, and are employed \nto a considerable extent in the treatment of rheumatism and \ngouty affections, especially of a subacute and chronic charac- \nter. They have been much lauded in the so-called uric diathesis, \nbut while outside the body lithia exhibits great solvent power \nover uric acid, with which it forms a biurate that is more \nsoluble than the corresponding salts of the other alkali metals, \nit has been pointed out that in the system it has a greater \naffinity for the acid sodium phosphate in the blood, and prac- \ntically leaves the uric acid to itself. There is unquestionably a \nlarge amount of clinical evidence going to show the beneficial ef- \nfects of lithium salts in gouty cases and where there is a ten- \ndency to uric acid, sand and gravel ; but there is reason to believe \nthat in the body fluids the amount of lithium introduced by \nordinary dosage can exercise no solvent influence upon gouty \ndeposits, and it is now the opinion of many of the best authori- \nties that the large amount of water generally taken with lithia \nhas more to do with relieving the conditions in question than \nthe drug itself. Most of the popular lithia waters contain \n\n\n\nMAGNESIUM. 209 \n\nlithium salts only in minute proportions, and whatever value \nis to be ascribed to them is no doubt principally due to their \neffect in dissolving effete materials resulting from imperfect \nelimination of tissue-waste. Lithium salts have no power to \ndissolve calculi, but are often of service in alkalizing the urine, \nas well as in increasing its amount and thus rendering it more \ndilute. On the whole, it would appear that their influence is \nsomewhat limited, but that as a minor remedy they possess a \ncertain amount of usefulness in gouty cases. In diabetes where \nthere is a gouty taint remarkably good results have been \nclaimed from the use of lithium carbonate or citrate with. \nsodium arsenate. Lithia solutions have been applied exter- \nnally to gouty joints and ulcers, with asserted good results. \nWhile it is maintained that such applications relieve the pain \nof gouty inflammation and aid the disappearance of deposits, \nthey would seem to have no effect in preventing the formation \nof the latter. Gouty conjunctivitis is also said to be relieved \nby washing the eye with a 1 to 500 solution of lithium car- \nbonate. \n\nLithium Vanadate closely resembles arsenic in its actions, \nand like arsenic it has been used as an alterative. It has also \nbeen recommended for the treatment of diabetes, in which it \nis claimed that it reduces the sugar in the urine one-half. \n\nMAGNESIUM. \n\n1. MAGNESII SULPHAS.\xe2\x80\x94 Magnesium Sulphate. (Epsom Salt.) \nDose, 16 gm.; 240 gr. \n\nPreparation. \n\nMagnesii Sulphas Effervescens.\xe2\x80\x94 Effervescent Magnesium \nSulphate. Dose, 16 gm.; 240 gr. \n\n2. MAGNESII CARBONAS.\xe2\x80\x94 Magnesium Carbonate. Dose, 3 \ngm.; 45 gr. \n\nPreparation. \n\nLiquor Magnesii Citratis.\xe2\x80\x94 Solution of Magnesium Citrate. \nDose, 360 c.c; 12 fl. oz. \n\n15 \n\n\n\n2IO PHARMACOLOGY AND THERAPEUTICS. \n\nUnofficial Preparations. \nMagnesii Citras Effervescens (U. S. P., 1890). \xe2\x80\x94 Effervescent \nMagnesium Citrate. Dose, 8 to 30 gm.; y 4 to 1 OZ. \n\nMistura Magnesiae et Asafoetidse. \xe2\x80\x94 Mixture of Magnesia and \nAsafetida. (Dewees\' Carminative.) Dose, 1.20 C.C.; 20 TT\\,. \n\n3. MAGNESII OXIDUM.\xe2\x80\x94 Magnesium Oxide. Magnesia. (Light \nMagnesia. Calcined Magnesia.) Dose, 2 gm.| 30 gr. \n\n4. MAGNESII OXIDUM PONDEROSUM. \xe2\x80\x94 Heavy Magnesium \n\nOxide. Heavy Magnesia. Dose, 2 gm.; 30 gr. \n\nAction of Magnesium Salts. \n\nExternal. \xe2\x80\x94 None. \n\nInternal. \xe2\x80\x94 When injected intravenously, magnesium pro- \nduces much the same effects as potassium, causing paralysis of \nthe heart and central nervous system ; but such results are \nnever observed when it. is taken by the mouth, as the salts ap- \npear to be rapidly excreted by the kidneys. Magnesium ox- \nide and carbonate differ from the other saline cathartics in \nbeing very insoluble and in having an alkaline reaction, and \nin many ways they act like the alkalies, sodium and potassium. \nIn the stomach they are partly converted into magnesium \nchloride, while in the intestine the carbon dioxide present may \ndissolve a part by forming the bicarbonate. They have a mild \npurgative action, and at the same time any excessive acidity in \nthe gastro-intestinal tract is overcome by their alkalinity. \nMagnesium sulphate is a much more powerful cathartic. When \nthis salt is converted into the bicarbonate in the small intes- \ntine, sodium sulphate is formed, and as the latter is, of course, \nalso cathartic, the effect produced is doubly great. Its action \nis as a rule very satisfactory, large watery stools being pro- \nduced, with but little nausea or griping, and on account of \nits non-irritating qualities it will often be retained by the \nstomach when other remedies of its class are rejected. Like \nother alkalies, magnesium oxide and carbonate are diuretic \nand have the effect of promoting the alkalinity of the blood \nand urine, but on account of the difficulty with which they are \n\n\n\nMAGNESIUM. 211 \n\nabsorbed, this effect is less pronounced than in the case of \nsodium and potassium salts. The magnesium of the urine is \nincreased by the administration of magnesium salts, especially \nif they fail to act on the bowels, but some of the magnesium \nmay perhaps be excreted by the intestine and some even ap- \npear in the milk. In the frog these salts are asserted to paralyze \nthe muscles in the same way as potassium, but in mammals \nthis is not the case even when they are intravenously injected, \nthe animal dying from the action on the heart and central ner- \nvous system before the muscular action is induced. It is a fact \nworthy of note that in some instances the formation of large \nconcretions in the bowel, resulting in obstruction, has been \ncaused by the prolonged use of considerable amounts of mag- \nnesium oxide. \n\nTherapeutics of Magnesium Salts. \nMagnesium oxide and carbonate are used as mild antacid \nlaxatives. They are favorite remedies in sick headache, espe- \ncially when accompanied by acidity and constipation, and in \nthe digestive derangements of children. For the correction of \nacidity the carbonate is preferable if gastric irritability is pres- \nent, as the carbon dioxide which is set free by the action of \nthe acid met with in the stomach serves as a local sedative and \nanodyne. If these preparations do not enter into combination \nwith the stomach acid, it is found that no laxative effect is \nproduced, and under these circumstances the latter can be \nsecured by following their administration with a solution of \ncitric acid. In the intestinal indigestion of infants attended \nwith flatulent colic magnesia is frequently given in association \nwith carminatives, as in the Mistura Magnesise et Asafcetidae \nwhich was formerly official (Dewees\' carminative). On ac- \ncount of its antacid property it is also often combined with \nother cathartics. It has been prescribed in lithiasis and gouty \naffections, but in these is much less efficient than other alkalies, \non account of the small amount of it which is absorbed. In \norder to produce alkaline effects upon the blood and urine it \nshould therefore never be given except in cases where the \n\n\n\n212 PHARMACOLOGY AND THERAPEUTICS. \n\npotassium or sodium salts cannot be borne. Magnesium ox- \nide and carbonate form insoluble compounds with mineral \nacids, oxalic acid, and the salts of arsenic, copper and mercury, \nwhile by their alkaline effect on the contents of the stomach \nthey retard the absorption of alkaloids. In emergency they \nmay therefore be used as antidotes to all these substances, but \nas to secure the desired effect they must be given very freely, \ntheir bulk makes them objectionable. Magnesia is to be pre- \nferred, as the carbonate gives off carbon dioxide gas. As an \nantidote to arsenic trioxide in solution it is inferior to ferric \nhydrate, but in the absence of the latter may be resorted to. \nFor this purpose it should be freshly precipitated. Magnesium \nsulphate is one of the best and most largely employed of saline \ncathartics. The commonly accepted view is that, like other \npurgatives of its class, it acts by abstracting water from the \nintestinal blood-vessels. It is frequently employed for the \nvarieties of constipation associated with hepatic disorder, gout, \nor excessive uric acid, and especially in the form of natural \nmineral waters. It is an important constituent of most of the \naperient waters. Whenever a thorough purgative action is de- \nsired, it should be given in concentrated form, so as to make \nits solution of as high a percentage as possible, and in cases \nof dropsy from 30 to 60 gm. (1 to 2 oz.) should be taken before \nbreakfast, or on an empty stomach, in as little water as will \ndissolve the salt. The efficiency of the drug is greater if the \namount prescribed is administered in divided doses every fifteen \nminutes until the whole is taken. For habitual constipation in \nthose of full habit and active circulation a daily morning dose \nof a teaspoonful is often a permanently effective remedy, and \nwhere constipation, congestion of the pelvic viscera, and anaemia \ncoexist it may be advantageously combined with ferric sul- \nphate, manganese sulphate, and dilute sulphuric acid. The \ndisagreeable taste of Epsom salt may be very satisfactorily \ncovered by coffee, and the following method of preparation has \nbeen recommended: Boil for two minutes in an earthen vessel \n30 gm. (1 oz.) of magnesium sulphate and 10 gm. (2 x / 2 dr.) of \n\n\n\nMAGNESIUM. 21 3 \n\nroasted copper in 500 c.c. (1 pint) of water; then remove from \nthe fire, allow it to " draw " for a few minutes, and strain. \nMagnesium sulphate may be given by the rectum for the double \npurpose of unloading the bowels and producing a depletant \neffect. It is useful with glycerin in concentrated enema for \nthorough cleansing of the bowels before surgical operations \n(glycerin, 30 c.c; 1 oz., in a saturated solution of magnesium \nsulphate, in hot water, 90 c.c; 3 oz., which is allowed to cool). \nAlthough theoretically it has been inferred that a saline cathar- \ntic injected intravenously or subcutaneously is incapable of \ncausing purgation, practically it is found that a purgative \naction is thus produced; so that magnesium sulphate can also \nbe used hypodermatically in dose of 20 gm. (3 gr.), which fre- \nquently will cause a watery evacuation. In operations during \nwhich the abdomen is opened, the subsequent intestinal paralysis \nmay be prevented from causing constipation by injecting into \nthe small intestine through a cannula 30 c.c. (one ounce) of a \nsaturated solution of magnesium sulphate. The wound in the \nbowel should be closed by a Lembert stitch. \n\nBeing non-irritant, magnesium sulphate may be given freely \nwhen inflammation is present, and in enteritis and peritonitis it \nis quite commonly used for its depletant action. It is also \nclaimed that it\' is better than ipecacuanha in the treatment of \ntropical and other dysenteries, and for this purpose is recom- \nmended to be administered in 4 c.c (1 fl. dr.) doses of a satu- \nrated solution with .60 to 1 c.c. (10 to 15 ^l) of aromatic sul- \nphuric acid every two hours. It is especially adapted to the \nacute stage, and morphine sulphate may be combined with it, or \nstarch enemata with laudanum employed in addition. In lead- \npoisoning it is also of great service, especially if associated with \nsulphuric acid. Thus combined with sulphuric acid it some- \ntimes is efficacious in arresting bleeding from piles, especially \nif the state of the haemorrhoidal vessels be due to constipation, \nand it may also serve to relieve uterine haemorrhage caused \nby the presence of a fibroid, or by subinvolution, and conges- \ntion of the pelvic viscera. In impaction of the caecum, with re- \n\n\n\n214 PHARMACOLOGY AND THERAPEUTICS. \n\nsuiting typhlitis, it will often liquefy the faecal masses and de- \nplete the vessels, and thus remove the obstruction without caus- \ning any irritation. Among other conditions calling for the \nuse of an active saline cathartic such as magnesium sulphate \nmay be mentioned cholaemia, uraemia, oedema of the brain, and \nincreased intra-cranial blood-pressure from whatever cause. \nThe citrate is a cooling purgative, which operates mildly. It is \nvery widely employed on account of its acceptability to the \nstomach and the facility with which it may be taken, and is \noften especially useful in the case of children. \n\nCALCIUM. \n\n1. CRETA PR^EPARATA. \xe2\x80\x94 Prepared Chalk. (Drop Chalk.) \nDose, 1 gm.; 15 gr. \n\nPreparations. \n\n1. Pulvis Cretae Compositus. \xe2\x80\x94 Compound Chalk Powder. \nDose, 2 gm.; 30 gr. \n\n2. Mistura Cretae. \xe2\x80\x94 Chalk Mixture. Dose, 16 c.c; 4 fl. dr. \n\n3. Hydrargyrum Cum Creta.\xe2\x80\x94 Mercury with Chalk. Dose, \n0.250 gm. (250 milligm.) ; 4 gr. \n\nUnofficial Preparation. \nTrochisci Cretae (U. S. P., 1890). \xe2\x80\x94 Troches of Chalk. Dose, \nad libitum. \n\n2. CALCII CARBONAS PR^ECIPITATUS.\xe2\x80\x94 Precipitated Calcium \nCarbonate. Dose, 1 gm.; 15 gr. \n\nAction of Prepared Chalk and Calcium Carbonate. \n\nExternal. \xe2\x80\x94 Mildly astringent and desiccant. \n\nInternal. \xe2\x80\x94 Calcium carbonate is an antacid, absorbent and \nastringent, though its action in the latter capacity has not yet \nbeen explained. The great proportion of it taken leaves the \nbody in the stools entirely unabsorbed. Such absorption as \noccurs has been found to take place in the upper part of the \nintestine, but the bulk of that which is absorbed appears to be \nre-excreted into the intestine. There is no evidence that it has \n\n\n\nCALCIUM. 215 \n\nany diuretic action. The animal carbonates are said to be less \nliable to derange the stomach than the mineral preparations \nof calcium. \n\nTherapeutics of Prepared Chalk and Calcium Carbonate. \n\nExternal. \xe2\x80\x94 Prepared chalk is a good dusting-powder in moist \neczema, intertrigo and hyperidrosis, and is sometimes used as \na protective dressing for ulcers and sores. It is largely em- \nployed, sometimes alone and sometimes with other substances, \nas a dentifrice, because of its mechanical action and also on \naccount of its antacid, astringent and sedative effect upon the \ngums and buccal mucous membrane. The following are good \nformulae for tooth-powders : Potassium chlorate, 4 ; powdered \nsoap, 8 ; carbolic acid, 2 ; oil of cinnamon, 1 ; precipitated cal- \ncium carbonate to 48 parts. Prepared chalk, 15; powdered \nblue flag flowers, 15; powdered cuttle-fish bone, 8 parts; oil \nof lemon, 1 part. \n\nInternal. \xe2\x80\x94 Chalk mixture is a useful remedy in diarrhoea, \nespecially when the intestinal discharges are acid, and opiates \nand astringents are frequently added to it. It should generally \nbe preceded by an evacuant to remove undigested food or other \nirritating substances. It is principally employed in the case \nof children. Compound chalk powder and mercury with chalk \nare also used in the treatment of diarrhoea. Calcium carbonate \nis given as a restorative and antacid in acid indigestion. Natural \nmineral waters which contain salts of calcium as prominent \nconstituents, such as those of Contrexeville, Wildungen, Vittel, \nClarendon and Waukesha, have gained considerable reputation \nfor the treatment of uric acid gravel and other affections of the \nurinary system ; but it seems probable that the benefit derived \nfrom them is principally due to the large amount of liquid \nswallowed. They are used in quantities of from 1500 to 3000 \nc.c. (3 to 6 pints) a day, and should be taken between meals \nin order to avoid indigestion from the excessive amount of fluid. \n\n3. CALX. \xe2\x80\x94 Lime. Calcium Oxide. (Burned Lime.) \n\n\n\n2l6 PHARMACOLOGY AND THERAPEUTICS. \n\nPreparations. \n\n1. Liquor Calcis. \xe2\x80\x94 Lime Water. Solution of Calcium Hy- \ndroxide. Dose, 16 c.c; 4 fl. dr. \n\n2. Linimentum Calcis. \xe2\x80\x94 Lime Liniment. (Liniment of Cal- \ncium Oxide.) (Carron Oil.) \n\n3. Syrupus Calcis. \xe2\x80\x94 Syrup of Lime. Syrup of Calcium Hy- \ndroxide. (Syrup of Lime.) Dose, 2 c.c; 30 n\\. \n\nAction of Lime. \nExternal. \xe2\x80\x94 Lime water, which is mildly astringent, is also \nslightly caustic, but less so than the syrup. Slaked lime is a \ncorrosive and disinfectant. The unslaked lime is changed \nat once to the hydrate in the presence of water, but the hydrate \ndiffers from those of the caustic alkalies in being much less \nsoluble. Hence it does not penetrate so deeply or spread so \nwidely. \n\nInternal. \xe2\x80\x94 Lime is antacid and astringent. The reason for \nits astringent action is unknown, but it has been suggested that \nit is probably due to its forming an insoluble compound with \nthe surface proteids, in the same way as tannic acid, or to its \nbeing deposited as the carbonate or phosphate, and thus protect- \ning the epithelium from irritation. It has the effect of allaying \nvomiting and it causes a subdivision of the coagula formed by \nmilk in the stomach. It acts as an antidote to zinc chloride, \noxalic acid, and mineral acids. The salts of lime are present in \nvery large amount in the normal tissues, and it has been demon- \nstrated that lime is required by the higher organisms, both \nanimals and plants, for some of their functions. \n\nTherapeutics of Lime. \nExternal. \xe2\x80\x94 As a caustic it is seldom employed alone, but is \ngenerally combined with caustic potash (forming Vienna paste) \nor with caustic soda to form what is known as London paste. \nLime water is used as a wash for foul and gangrenous ulcers \nand, either alone or combined with glycerin, in the treatment of \nacute vesicular eczema. It affords marked relief in the pruritus \n\n\n\nCALCIUM. 2 1/ \n\nwhich sometimes becomes intolerable in eczema and other in- \nflammatory affections of the skin and the itching experienced \nby the aged. It is also useful as an injection for thread-worms, \nleucorrhcea, gleet, and ulcerations of the bladder, and Lini- \nmentum Calcis is a standard remedy for burns. As the false \nmembranes of diphtheria, croup, plastic bronchitis, etc., are com- \nposed largely of mucus, they may be broken down by alkalies, \nand for this purpose lime water is quite commonly employed. \nA lime water spray, produced by the atomizer, may be inhaled \nby the patient, or the patient may inhale the vapors arising \nfrom lime undergoing the process of slaking with water. \n\nInternal. \xe2\x80\x94 Lime water is very largely used in the treatment \nof vomiting, and for this purpose is generally given with \nmilk, in varying proportion. It is constantly added to the \nmilk of infants and invalids, as it prevents the formation of \nbulky coagula, and milk thus treated is more easily digested \nand less liable to cause intestinal disturbance. In cases of acid \npoisoning the syrup should be employed, or lime shaken up \nwith water (milk of lime), as lime water contains too little \nof the base to be of service. Lime is especially valuable in \nthe treatment of oxalic poisoning. As an antacid in the stomach \nit is inferior to many other alkalies, since it tends to delay the \nevacuation of the contents. Lime water and the syrup are \nboth used as astringents in diarrhoea, more particularly in \nchildren, and when the stomach is irritable. In dyspepsia ac- \ncompanied with vomiting of food a diet exclusively composed \nof lime water and milk is often more effectual than any other \nplan of treatment. Lime water has sometimes been used in \nthe treatment of rickets arid bone-softening, but when the fact \nis considered that this contains really less lime than cow\'s \nmilk, it is difficult to see how it can be of any service in such \nconditions. Indeed, the utility of giving lime salts at all in \nrickets has been disputed, as it is contended that the disease \nis not due to a lack of lime in the food nor in the tissues gener- \nally, but to some abnormal condition which prevents the lime \nsalts from being deposited in the bones, although they may be \n\n\n\n2l8 PHARMACOLOGY AND THERAPEUTICS. \n\npresent in abundance in the blood. It has been claimed that \nsome improvement has occasionally been observed in cases \nin which the blood seemed less capable of coagulating them \nnormally \xe2\x80\x94 particularly haemophilia and aneurism \xe2\x80\x94 as a result \nof the use of lime, but it has again been contended that the \ndeficient coagulability is scarcely likely to be due to lack \nof the lime salts, since much more is taken in the food than is \nsufficient for the organism, and the medicinal lime preparations \nare not more easily absorbed than the combinations present \nin food. The urine of persons who take large quantities of \nlime water is stated to be often alkaline, and sometimes am- \nmoniacal. The latter circumstance has been explained as due \nto the presence of calcium carbamate, which readily undergoes \nammoniacal disintegration. \n\n4. CALCII PHOSPHAS PR^CIPITATUS.\xe2\x80\x94 Precipitated Calcium \nPhosphate. Dose, 1 gm.; 15 gr. \n\nPreparation. \nSyrupus Calcii Lactophosphatis. \xe2\x80\x94 Syrup of Calcium Lacto- \nphosphate. Dose, 8 c.c; 2 fl. dr. \n\nAction of Calcium Phosphate. \nSo far as regards its mass, calcium phosphate is, next to \nwater, the most important of the inorganic constituents of the \nbody, and in all the solid tissues it is of service by giving to \nthem their proper consistence and solidity. Thus, in the enamel \nof the teeth, the hardest tissue of the body, its quantity is no \nless than 885 parts in 1000, while in the bones there are 576 to \nthe 1000. The large amount of it required by the system is \nsupplied by the food (meats, vegetables, eggs, milk, bread and \ncereals all containing it), and a deficiency of the salt in the \nfood leads to softening of the bones. The great proportion \nof the lime taken either in the food or as a remedy is found \nto leave the body in the faeces entirely unabsorbed, while a \nsmall quantity of it, whether it is taken in a soluble or insoluble \nform, is absorbed from the alimentary canal. This portion \n\n\n\nCALCIUM. 219 \n\ncirculates in the blood (in combination with proteids, it is \nthought), and is slowly excreted, unless there is a deficiency in \nthe supply of lime, when it may be utilized by the tissues. \nWhen larger quantities are injected intravenously or subcu- \ntaneously, it is stated that the calcium of the blood remains \nabnormally high for some time, but that all the lime thus in- \njected is not in the circulation throughout its stay in the body; \nsome of it being temporarily deposited in some unknown organ, \nfrom whence it is gradually withdrawn and excreted after \nthe first excess is eliminated. The lime is excreted in part in \nthe urine, but for the most part through the epithelium of the \nlarge intestine. \n\nTherapeutics of Calcium Phosphate. \nNotwithstanding the theoretical objections which have been \nurged against the utility of lime salts in rickets, calcium phos- \nphate has been largely employed in the treatment of this dis- \nease, and with alleged good results. When used in rickets it \nis important that it should be made from bones. By some pe- \ndiatrists the syrup of calcium lactophosphate is given the pref- \nerence, and this preparation is also used to a large extent in \ntuberculosis and other debilitated conditions of the system. \nPregnant and nursing women are treated with calcium phos- \nphate for the purpose of supplying lime salts for the bones \nof the child. It is frequently combined with other phosphates, \nsuch as those of iron, sodium and potassium, in the treatment \nof rickets, mollities ossium, the different forms of scrofula, and \nanaemic conditions generally. It has also been thought useful \nin facilitating the union of fractured bones, and in experiments \nupon dogs and rabbits it is asserted that in fractures the callus \nforms more quickly under its use than without it. Being inert \nand almost insoluble, it is sometimes employed as a constituent \nof pills containing essential oils, and as it prevents agglutina- \ntion, is also used as a diluent for powders. \n\n5. CALCII CHLORIDUM.\xe2\x80\x94 Calciuni Chloride. Dose, 0.500 gm. \n(500 milligm.) ; 7V 2 gr. \n\n\n\n2 20 PHARMACOLOGY AND THERAPEUTICS. \n\nAction of Calcium Chloride. \nCalcium chloride is an irritant and resolvent. It is ex- \ntremely deliquescent, and its power of absorbing water is \nutilized for the dehydration of alcohol and ether and for other \npurposes. Outside the body it hastens the coagulation of the \nblood and produces a firmer clot. \n\nTherapeutics of Calcium Chloride. \nOn account of its solubility in water calcium chloride is \nreadily administered, and it has been employed in the treatment \nof chronic bronchitis, pneumonia, and phthisis and has been \nrecommended for gastric catarrh and fermentative dyspepsia. \nIts most important use is for the haemorrhages of scurvy and \nhaemophilia; one large daily dose of 2 gm. (30 gr.) is preferable \nto smaller ones frequently repeated. If maximum doses are \nadministered for several days previously, it is often possible \nto perform operations upon bleeders. It may be of use in \nhaematemesis and haemoptysis, and, possibly, also for aneurism. \nIt is said to sometimes cause the resolution of glandular swell- \nings and the calcification of the cicatrization of tuberculous de- \nposits, and also to be of service in lupus and other skin diseases. \n\nB. Drugs Acting on the Red Corpuscles. \n\nIRON. \n\n1. FERRUM.\xe2\x80\x94 Iron. \n\n2. FERRUM REDUCTUM.\xe2\x80\x94 Reduced Iron. (Quevenr.e\'s Iron. \nIron by Hydrogen.) Dose, 0.065 gm. (65 milligm.) ; 1 gr. \n\n3. FERRI SULPHAS.\xe2\x80\x94 Ferrous Sulphate. Dose, 0.200 gm. (200 \nmilligm.); 3 gr. \n\nPreparations. \n\n1. Ferri Sulphas Exsiccatus. \xe2\x80\x94 Exsiccated Ferrous Sulphate. \nDose, 0.125 gr. (125 milligm.) ; 2 gr. \n\n2. Ferri Sulphas G-ranulatus. \xe2\x80\x94 Granulated Ferrous Sulphate. \nDose, 0.250 gm. (250 milligm.) ; 4 gr. \n\n3. Mistura Ferri Composita. \xe2\x80\x94 Compound Iron Mixture. \nDose, 16 c.c: 4 fl. dr. \n\n\n\nIRON. 22 1 \n\n4. Pilulse Ferri Carbonatis. \xe2\x80\x94 Pills of Ferrous Carbonate. \n(Ferruginous Pills. Chalybeate Pills. Blaud\'s Pills.) Dose, 2 \npills. \n\n4. FERRI CARBONAS SACCHARATUS.\xe2\x80\x94 Saccharated Ferrous \nCarbonate. Dose, 0.250 gm. (250 milligm.) ; 4 gr. \n\n5. MASSA FERRI CARBONATIS.\xe2\x80\x94 Mass of Ferrous Carbonate. \n(Vallet\'s Mass.) Dose, 0.250 gm. (250 milligm.); 4 gr. \n\n6. SYRUPUS FERRI IODIDL\xe2\x80\x94 Syrup of Ferrous Iodide. Dose, \n1 c.c; 15 tt\\,. \n\n7. PILULE FERRI IODIDL\xe2\x80\x94 Pills of Ferrous Iodide. Dose, 2 \npills. \n\n8. FERRI CHLORIDUM.\xe2\x80\x94 Ferric Chloride. Dose, 0.065 gm. (65 \nmilligm.) ; 1 gr. \n\n9. LIQUOR FERRI CHLORIDL\xe2\x80\x94 Solution of Ferric Chloride. \nDose, 0.1 c.c; V/ 2 n\\,. \n\nPreparations. \n\n1. Tinctura Ferri Chloridi. \xe2\x80\x94 Tincture of Ferric Chloride. \nDose, 0.5 c.c; 8 1ii. \n\n2. Liquor Ferri et Ammonii Acetatis. \xe2\x80\x94 Solution of Iron and \nAmmonium Acetate. Dose, 16 C.C.; 4 fl. dr. \n\n10. LIQUOR FERRI TERSULPHATIS.\xe2\x80\x94 Solution of Ferric Sul- \nphate. \n\n11. LIQUOR FERRI SUBSULPHATIS.\xe2\x80\x94 Solution of Ferric Sub- \nsulphate. Dose, 0.2 c.c; 3 Til. \n\n12. FERRI HYDROXIDUM (Ferri Oxidum Hydratum, U. S. P., \n1890). \xe2\x80\x94 Ferric Hydroxide. (Hydrated Ferric Oxide.) \n\n13. FERRI HYDROXIDUM CUM MAGNESII OXIDO (Ferri \nOxidum Hydratum cum Magnesia, U. S. P., 1890). \xe2\x80\x94 Ferric Hydroxide \nwith Magnesium Oxide. Dose (arsenical antidote), 120 C.C.; 4 fl. OZ. \n\n14. FERRI ET AMMONII SULPHAS.\xe2\x80\x94 Ferric Ammonium Sul- \nphate. (Ammonio-Ferric Alum.) Dose, 0.500 gm. \' (500 milligm.) ; \nIV2 gr. \n\n15. FERRI PHOSPHAS SOLUBILIS.\xe2\x80\x94 Soluble Ferric Phosphate. \nDose, 0.250 gm. (250 milligm.) ; 4 gr. \n\n\n\n22 2 PHARMACOLOGY AND THERAPEUTICS. \n\nPreparations. \n\n1. Syrupus Ferri, Quininae et Strychninae Phosphatum.\xe2\x80\x94 \n\nSyrup of Iron, Quinine and Strychnine Phosphates. (Easton\'s \nSyrup. Syrupus Trium Phosphatum.) Dose, 4 gm.; 1 fl. dr. \n\n2. Elixir Ferri, Quininae et Strychninae Phosphatum. \xe2\x80\x94 \n\nElixir of Iron, Quinine and Strychnine Phosphates. Dose, 4 \nc.c.; 1 fl. dr. \n\n3. Glyceritum Ferri, Quininae et Strychninae Phosphatum. \n\n- \xe2\x80\x94 Glycerite of Iron, Quinine and Strychnine Phosphates. Dose, \n\n1 c.c; 15 ul. \n\n16. FERRI ET AMMONII TARTRAS.\xe2\x80\x94 Iron and Ammonium \nTartrate. Dose, 0.250 gm. (250 milligm.) ; 4 gr. \n\n17. FERRI ET POTASSII TARTRAS.\xe2\x80\x94 Iron and Potassium Tar- \ntrate. (Tartarated Iron.) Dose, 0.250 gm. (250 milligm.); 4 gr. \n\n18. FERRI CITRAS.\xe2\x80\x94 Ferric Citrate. Dose, 0.250 gm. (250 mil- \nligm.) ; 4 gr. \n\n19. FERRI ET AMMONII CITRAS.\xe2\x80\x94 Iron and Ammonium Citrate. \nDose, 0.250 gm. (250 milligm.); 4 gr. \n\nPreparation. \nVinum Ferri (Vinum Ferri Citratis, U. S. P., 1890). \xe2\x80\x94 Wine \nof Iron. (Wine of Ferric Citrate.) Dose, 8 C.C.; 2 fl. dr. \n\n20. FERRI ET QUININE CITRAS.\xe2\x80\x94 Iron and Quinine Citrate. \nDose, 0.250 gm. (250 milligm.); 4 gr. \n\nPreparation. \nVinum Ferri Amarum.\xe2\x80\x94 Bitter Wine of Iron. Dose, 8 c.c; \n\n2 fl. dr. \n\n21. FERRI ET QUININE CITRAS SOLUBILIS.\xe2\x80\x94 Soluble Iron \nand Quinine Citrate. Dose, 0.250 gm. (250 milligm.); 4 gr. \n\n22. FERRI ET STRYCHNINE CITRAS.\xe2\x80\x94 Iron and Strychnine \nCitrate. Dose, 0.125 gm. (125 milligm.); 2 gr. \n\n23. FERRI PYROPHOSPHAS SOLUBILIS.\xe2\x80\x94 Soluble Ferric Pyro- \nphosphate. Dose, 0.250 gm. (250 milligm.) ; 4 gr. \n\n24. FERRI HYPOPHOSPHIS. \xe2\x80\x94 Ferric Hypophosphite. Dose, \n0.200 gm. (200 milligm.); 3 gr. \n\n\n\nIRON. 22 3 \n\nPreparation. \nSyrupus Hypophosphitum Compositus. \xe2\x80\x94 Compound Syrup of \nHypophosphites. Dose, 8 C.C.; 2 fl. dr. \n\nUnofficial Preparations. \nSyrupus Hypophosphitum cum Ferro (U. S. P., 1890). \xe2\x80\x94 Syrup \nof Hypophosphites with Iron. Dose, i to 8 C.C.; 1 to 2 fl. dr. \n\nFerri Iodidum Saccharatum (U. S. P... 1890). \xe2\x80\x94 Saccharated \nFerrous Iodide. Dose, 0.30 to 1 gm.; 5 to 15 gr. \n\nFerri Lactas (U. S. P., 1890). \xe2\x80\x94 Ferrous Lactate. Dose, 0.06 \nto 0.30 gm.; 1 to 5 gr. \n\nLiquor Ferri Nitratis (U. S. P., 1890). \xe2\x80\x94 Solution of Ferric \nNitrate. Dose, 0.12 to 0.60 c.c; 2 to 10 TT[. \n\nLiquor Ferri Citratis (U. S. P., 1890). \xe2\x80\x94 Solution of Ferric \nCitrate. Dose, 0.30 to 1 c.c; 5 to 15 TT1 . \n\nLiquor Ferri Acetatis (U. S. P., 1890). \xe2\x80\x94 Solution of Ferric \nAcetate. Dose, 0.12 to 0.60 c.c; 2 to 10 TT\\. \n\nEmplastrum Ferri (U. S. P., 1890). \xe2\x80\x94 Iron Plaster. (Strength- \nening Plaster.) \n\nTrochisci Ferri (U. S. P., 1890). \xe2\x80\x94 Troches of Iron. Dose, \n1 to 2 troches. \n\nFerri Valerianas (U. S. P. ; 1890). \xe2\x80\x94 Ferric Valerianate. Dose, \n0.06 to 0.20 gm.; 1 to 3 gr. \n\nFerri Arsenas. \xe2\x80\x94 Iron Arsenate. Dose, 0.005 to 0.008 gm.; \nT V to Vs gr. \n\nFerrum Dialysatum. \xe2\x80\x94 Dialyzed Iron. Dose, 0.30 to 2 c.c; \n\n5 to 30 TTl. \n\nFerratinum. \xe2\x80\x94 Ferratin. Dose, 0.10 to 0.50 gm.; V/ 2 to 8 gr. \n\nAction of Iron and its Salts. \nExternal. \xe2\x80\x94 While the salts of iron and their solutions have \nno action on the unbroken skin, on the abraded cuticle and on \nmucous membrane they have a powerful astringent effect by \nreason of their property of precipitating proteids ; so that all \nalbuminous fluids are coagulated by them. In consequence \n\n\n\n224 PHARMACOLOGY AND THERAPEUTICS. \n\nof this action on the blood, as well as their effect on the vessels \nthemselves, by which the calibre of the latter is diminished \nby the contraction of the coagulated albumin, they tend to arrest \nhaemorrhage, and constitute in fact the most efficient local \nhaemostatics at our command. While, however, some of the \niron salts, such as the chloride, the nitrate, and the sulphate, \nhave very marked astringent value, others are practically inert \nin this respect. Solutions of both ferrous and ferric salts have \nmore or less antiseptic, germicidal and disinfectant activity, \nand since, in addition to arresting putrefaction, they neutralize \nthe sulphur and ammonium compounds given off from decay- \ning matter, they are also deodorizers. Ferric oxides, further- \nmore, have the power of converting oxygen into ozone. \n\nInternal. Mouth. \xe2\x80\x94 Most of the preparations of iron have \na peculiar metallic and astringent taste, known as chalybeate, \nwhich is most pronounced in the case of the persalts. The in- \nsoluble and albuminous ones should be practically tasteless. \nThe blackening of the teeth and tongue which is liable to result \nfrom the use of iron preparations has been supposed to be due \nto the formation of iron tannate from the tannic acid of the \nfood or from the sulphur present in carious teeth or in the tar- \ntar. To avoid this it is advisable to take them through a glass \ntube and immediately afterwards to brush the teeth. The free \nacid in the tincture of ferric chloride or the acidity of the \nchloride itself will destroy the dental enamel even if diluted \nwith eight parts of water. \n\nG astro -intestinal Tract. \xe2\x80\x94 In the stomach almost all the iron \nsalts, it is supposed, form chlorides to a greater or less ex- \ntent, and are then changed into albuminates. Ferric chloride \nis said to be the only one of them which does not abstract \nhydrochloric acid from the gastric juice, and it is believed that \nit is probably to this circumstance that its peculiar value as \na chalybeate remedy is due. Inorganic salts, if taken in suffi- \ncient quantity, act as gastro-intestinal irritants, causing pain \nand discomfort, with nausea and vomiting, and sometimes purg- \ning. The more strongly acid ones have a more or less marked \n\n\n\nIRON. 225 \n\ncaustic effect upon the stomach, in consequence of the acid \nliberated after the formation of chlorides, and this is the -case \neven with preparations of ferric chloride, which always con- \ntain free acid. Hence those preparations which are not at all \nor but slightly acid, such as reduced iron, ferrous carbonate, \nand the unofficial dialyzed iron, do not as a rule cause digestive \ntrouble, though it can also be said that they are generally not \nso efficient as the stronger preparations. However, this free \nacid may be neutralized by the addition of sodium bicarbonate, \nso that the tincture of ferric chloride will be acid only so far \nas the basic ferric chloride has an acid reaction; nor does \nthis neutralization impair its therapeutic properties, for hydro- \nchloric acid is added to it in the stomach. An effective prep- \naration is now made, in which these disadvantages of the tinc- \nture of ferric chloride are removed, which is known as Weld\'s \nsyrup of ferric chloride. As ferric chloride is strongly astrin- \ngent, most iron salts have an astringent action on the stomach, \nthe degree of astringency depending upon the amount of the \nchloride which is formed from the gastric juice or is otherwise \npresent. In the duodenum it is believed that the iron com- \npounds, having been changed from chlorides into albuminates \nin the stomach, may in part be absorbed in solution, or precipi- \ntated and taken up as solids by the epithelial cells and the leuco- \ncytes, while the great bulk is carried on into the lower parts of \nthe intestine. Under medicinal doses the secretions of the ali- \nmentary canal show a tendency to diminish, with the produc- \ntion of constipation, with hard, dry stools, while the faeces are \nblackened from the formation of ferrous sulphide and tannate. \nAbsorption and Excretion. \xe2\x80\x94 The absorption of iron has been \nthe subject of much discussion, but it seems to be now well \nestablished that inorganic iron salts, as well as the organic, \nare absorbed by the intestine. While authorities differ as to \nwhether organic iron given by the mouth increases the amount \nof iron in the urine or not, the preponderance of evidence is \nto the effect that the quantity which is normally excreted in \nthe urine (0.5 to 1.5 mg.) is not affected by the internal admin- \n16 \n\n\n\n226 PHARMACOLOGY AND THERAPEUTICS. \n\nistration of either the organic or inorganic preparations. Hence \nthe fact that an iron salt given by the mouth does not increase \nthe urinary iron affords no ground for the assumption that it \nhas not been absorbed. Neither does the iron absorbed increase \nthe amount of iron in the bile or other excretions. The latest \nresults of experimental researches would seem to indicate that \nthe small part of the iron which in the duodenum is absorbed \nby the epithelium and leucocytes passes through the lymph \nchannels to the mesenteric glands, and thence through the \nthoracic duct to the blood-vessels. It is then deposited in the \nspleen, where it may undergo some changes in form; later it \nis taken up by the blood and deposited in the liver and perhaps \nin the bone marrow. Where the supply of iron has been inade- \nquate for the formation of haemoglobin, it is thought that the \noriginally inorganic iron is probably worked into higher forms, \nand eventually into haemoglobin in the liver, and that ferratin \n(which is an iron-containing proteid) is one of the intermediate \nsteps in this synthesis. When there is no such deficiency, \nhowever, the liver slowly yields its store of iron to the blood, \nwhich carries it to the caecum and large intestine, by the epi- \nthelium of which it is finally excreted. Iron is normally present \nin all the tissues and secretions, but the greater portion of the \ntotal quantity in the body (estimated to be about 2.5 to 3.5 gm. ; \n40 to 55 gr., in a healthy adult), is to be found in the blood as \nhaemoglobin. While some .0054 to .0108 gm. ( T ^ to i- gr.) of \niron is taken in the food per diem, about the same amount is \nexcreted, chiefly in the faeces and to a much smaller extent in \nthe urine. Any excess of elimination following subcutaneous \ninjection or excessive absorption from the intestine, it may \nbe noted, takes place through the intestinal mucous membrane. \nBlood. \xe2\x80\x94 It is very much open to question whether an increase \nin the number of red blood-corpuscles or any other especial effect \non the blood, is caused by the administration of iron in health. \nIn many cases of anaemia, however, and particularly of chlorosis, \nthe remedy has the effect of rapidly increasing both the num- \nber of these corpuscles and the amount of haemoglobin in the \n\n\n\nIRON. 227 \n\nblood. Iron is therefore said to be a haematinic, and as an \nimprovement in the quality of the blood results in an improve- \nment in the functions of the various organs of the body, it is \nalso regarded as a tonic. Although the latest investigations \nshow that inorganic iron follows the same course in the tissues \nas food iron, in the treatment of anaemic conditions it may some- \ntimes have a much more satisfactory effect than the latter. \nThus, it has been pointed out that food-iron is always accom- \npanied by a large amount of colloid material, which may ma- \nterially delay its absorption, in particular as it seems absorb- \nable in only a very small part of the alimentary tract, the \nduodenum; inorganic iron on the other hand is much less \ncompletely enveloped and may be more easily absorbed. More- \nover, the iron preparations are used in much larger amounts \nthan the food-irons, since to obtain the same effect from the \nlatter it would be necessary to give more of them than could \nbe digested. Accordingly, certain cases of chlorosis are met \nwith in which little or no improvement seems to result from \nthe use of foods containing iron, but which recover rapidly \nunder inorganic iron. \n\nGeneral Symptoms. \xe2\x80\x94 The general effects of iron upon the \nsystem, it has been found, can be obtained only by the intra- \nvenous injection of double salts, like sodio-ferric tartrate, which \ndo not coagulate the blood and at the same time are capable of \nfreeing the iron ion in the tissues. From the results of ex- \nperimentation it would appear that iron, like the other heavy \nmetals, has a specific irritant effect on the gastro-intestinal \nmucous membrane, and to a less extent on the kidney. It also \ndepresses and eventually paralyzes the central nervous system, \nthough how far this is the result of direct action and how far \nit is secondary to its effects in the alimentary canal is as yet \nunknown. The heart is apparently but little affected, though \ntowards the end a rapid fall of blood-pressure is noticed. \nPost-mortem there is found swelling and congestion of the \nmucous membrane of the stomach and intestine, with numerous \nsmall blood extravasations in many instances. \n\n\n\n228 PHARMACOLOGY AND THERAPEUTICS. \n\nRemote Effects. \xe2\x80\x94 In addition to the improvement of the gen- \neral system in anaemic subjects derived from the continued ad- \nministration of iron, it has been thought that this agent has a \ndirect effect on the kidneys (as a mild diuretic), as well as \nupon the menstrual function. More oxygen is carried to all the \ntissues, however, and it is possible that these supposed specific \neffects, which are not of a marked character, are simply the \nresult of the benefit from the remedy in which the whole body \nshares. That the iron salts should have any remote astringent \nor haemostatic action, as has been contended by some, has never \nbeen demonstrated, and on theoretical grounds would seem to \nbe highly improbable. Indeed, it is held by high authorities \nthat to give iron in cases of metrorrhagia or menorrhagia is \nonly to increase the loss of blood. The continued use of \nferruginous preparations is liable to interfere with the diges- \ntion, and may produce gastric oppression, and even nausea and \nvomiting. In addition, they may give rise to acne, and in rare \ninstances to symptoms of plethora and vascular excitement, \nwith possibly haemorrhages from the mucous membranes. Ex- \nceptionally also they may induce irritation of the kidneys, \nwhile in gouty subjects iron is apt to be badly borne. In gen- \neral, the ferrous salts are likely to produce less disturbance in \nthe system than the ferric ones, and the preparations which are \nbest tolerated are reduced iron, the phosphate, and the pyro- \nphosphate. \n\nTherapeutics of Iron and its Salts. \nExternal. \xe2\x80\x94 Liquor Ferri Subsulphatis (Monsel\'s solution) and \nsolutions of the sulphate, chloride and nitrate have long been \nheld in the highest repute as local haemostatics, and are usually \nemployed on lint or cotton, the special method of application \ndepending on the part where the haemorrhage occurs. These \npreparations, however, form very disagreeable clots, which \nreadily decompose and give rise to septic infection. The \nastringent salts of iron are not to be recommended in either \nsuperficial or deep wounds, where the haemorrhage can usually \n\n\n\nIRON. 229 \n\nbe controlled with more satisfactory results by properly ap- \nplied pressure. As an astringent for painting on the parts in \npharyngitis or tonsillitis Liquor Ferri Chloridi, diluted with \nan equal quantity of water, is of service, or a solution of 1 \npart of ferric chloride in 4 of glycerin may be used. The \naqueous .solution of the chloride has also been employed as a \nspray for haemoptysis, but is objectionable for this purpose, as \nit is very liable to excite coughing. The tincture of ferric \nchloride has been highly recommended as a local application \nto the throat in diphtheria, and in erysipelas is sometimes painted \nover the inflamed surface. A wash containing .12 to .3 gm. (2 \nto 5 gr.) of the sulphate to 30 c.c. (1 fl. oz.) of water is often \nuseful in chronic and indolent ulcers, and a solution of the sul- \nphate (1 to 480) has also been used in gleet. \n\nInternal. Gastro-intestinal Tract. \xe2\x80\x94 In haemorrhage of the \nstomach, from whatever cause, the astringent preparations may \noften be employed with advantage. If the bleeding is profuse, \n4 c.c. (1 fl. dr.) of Liquor Ferri Chloridi, with 4 c.c. (1 fl. dr.) \nof glycerin to facilitate swallowing, should be given every hour \nor oftener; but such large quantities are not required in milder \ncases. Intestinal haemorrhage may also be treated in the same \nway, though the success of the remedy will depend largely on \nthe location of the trouble. \n\nIt is a common practice to counteract the tendency of the \nsalts of iron to cause constipation by combining purgatives \nwith them, but this method interferes with the time during \nwhich iron remains in the intestines, and it is better to admin- \nister the laxative separately, so that the dose can be regulated \naccording to circumstances. A pill of ferrous sulphate and ex- \ntract of nux vomica is often found very effectual in the treat- \nment of chronic constipation. Here the active agent would \nseem to be the nux vomica, although it has been claimed by \nsome that such constipation may be overcome by large doses \nof ferrous sulphate alone. At least, the constipating effect of \niron salts is no doubt often much exaggerated. They have \nsometimes been given for diarrhoea, but this can be more satis- \nfactorily treated by many other drugs. \n\n\n\n23O PHARMACOLOGY AND THERAPEUTICS. \n\nThread- worms may be killed by a rectal injection of 4 c.c. \n(1 fl. dr.) of the tincture of ferric chloride in 250 c.c. (half a \npint) of water, with the patient in the knee-chest position. \n\nOne of the most efficient means of treating arsenical poison- \ning is by ferric hydroxide with magnesium oxide. To prepare \nthis for use a mixture of magnesium oxide (10 gm.) with \nsufficient water to make a homogeneous, thin magma is added \ngradually to solution of ferric sulphate, 40 c.c, mixed with 125 \nc.c. of water, and the product is then shaken until a uniform, \nsmooth mixture results. For the rapid preparation of this \nantidote it is advised that the diluted solution of ferric sulphate \nand the mixture of magnesium oxide with water should always \nbe kept in readiness, in separate bottles. It should be given in \nlarge doses and frequently repeated. Another arsenical anti- \ndote is prepared by mixing together 90 c.c. (3 fl. oz.) of solu- \ntion of ferric sulphate and 30 gm. (1 oz.) of sodium car- \nbonate diluted with water, and of this, 15 c.c. ( z / 2 fl. oz.) should \nbe given at short intervals. The insoluble arsenite which is \nformed in the body may be gotten rid of by a large dose of \nsome simple purgative, such as magnesium sulphate. Poison- \ning by arsenic may be also successfully treated by a dose of \ncommon salt or of sodium bicarbonate, followed by 30 c.c. (1 \nfl. oz.) of dialyzed iron (which is useless as an iron prepara- \ntion), diluted with water. \n\nFerruginous preparations are often administered with ad- \nvantage for the purpose of improving the appetite and digestion, \nand it is held by some that the chief use of iron as a remedy, \neven in anaemia, is to promote the digestive function. To aid \nappetite and digestion ferrous sulphate will usually be found \nthe most serviceable preparation. \n\nBlood. \xe2\x80\x94 As has been stated, the administration of iron in \nanaemia, and especially chlorosis, often rapidly increases the \namount of haemoglobin and the number of red corpuscles; and \nit is to restore these to their normal quantity that the ferrugi- \nnous preparations are most commonly given. It is to be noted, \nhowever, that they are useless in pernicious anaemia and of little \n\n\n\nIRON. 23 1 \n\nvalue, if any, in the anaemia of leukaemia, exophthalmic goitre, \nand Hodgkin\'s disease. In common forms of anaemia which \nare secondary to some special cause, such as haemorrhage, lead \npoisoning, malaria, scurvy, etc., the removal of the cause is \nessential to recovery, but the use of iron salts is often of great \nservice in aiding the latter. It has frequently been observed \nthat iron has very little, if any, beneficial effect upon anaemic \npatients when it does not increase the desire for food and the \nability to digest it, and in the anaemic condition, therefore, \nferruginous preparations should be given not only for the \npurpose of restoring the quantity of the elements in which the \nblood is deficient, but also to increase the energy of the primary \nassimilation. To secure the latter object increasing quantities \nof the more active astringent salts, especially the sulphate and \nthe chloride, are best. Large doses of these are frequently \nwell borne, though it is worth noting that considerable amounts \nof the sulphate have been known to occasion obstruction of \nthe bowels. When they produce any untoward effects they \nshould be replaced by other preparations, preference being \ngiven to the most astringent ones which will be tolerated by \nthe stomach. The styptic taste of the astringent compounds \nmay be concealed by administering them with 4 c.c. (1 fl. dr.) \nof glycerin, which also has the effect of reducing some of the \nferric to a ferrous salt, and this substance is frequently added \nto the tincture of ferric chloride. To restore the amount of \nhaemoglobin and the number of red corpuscles, small doses \xe2\x80\x94 .06 \nto .12 gm. (1 to 2 gr.) \xe2\x80\x94 of reduced iron or of the carbonate, \nor some one of the combinations with vegetable acids, are \nusually the most serviceable. As the scale preparations rarely \ndisagree, they are much used for patients with weak digestion, \nand small doses can generally be continued for an indefinite \nperiod. The red wines and natural chalybeate waters, such \nas those of La Bourboule, Levico, Flitwick and the Columbian \nspring, Saratoga, may also prove useful. The numerous other \nsymptoms besides dyspepsia which are dependent upon anaemic \nconditions, such as constipation, neuralgia, amenorrhcea, etc., \n\n\n\n232 PHARMACOLOGY AND THERAPEUTICS. \n\nare naturally improved by the treatment of the anaemia with \niron. In chlorosis better results are often obtained from com- \nbinations of iron with strychnine or arsenic than from iron \nalone. Easton\'s syrup (Syrupus Ferri, Quininae et Strychninae \nPhosphatum) and Easton\'s pill (Pilula Trium Phosphatum), \nwhich consists of quinine, .06 gm. (1 gr.) ; strychnine, .002 gm. \n(ti & r > concentrated phosphoric acid, .10 c.c (i l / 2 HI) ; and \nliquorice powder to .30 gm. (5 gr.) are much employed in con- \nvalescence after serious illness and in anaemia and chlorosis gen- \nerally. Iron arsenate, although not official, is an excellent \nremedy in chlorosis. Good results have sometimes been claimed \nfrom ferrous iodide in cases of rheumatoid arthritis, and this \npreparation is very largely used for rachitic and scrofulous \nchildren, especially in association with codliver oil. The tinc- \nture of ferric chloride, in doses of .60 to 1.20 c.c. (10 to 20 HI), \nsometimes as often as every hour, has proved beneficial in \ndiphtheria and other severe diseases affecting the throat, and \nthis is a favorite remedy in erysipelas. As the administration \nof iron tends to elevate the temperature in the sick, however, \nferruginous preparations are generally inadvisable in other \nfebrile diseases. Some individuals cannot take iron at all, on \naccount of the severe headache or indigestion which it in- \nduces. Iron should always be administered when the stomach \nis full (after meals), except when given for follicular ton- \nsilitis, diphtheria, erysipelas, gastric haemorrhage, or arsenical \npoisoning. \n\nKidneys. \xe2\x80\x94 It would seem that iron probably has some specific \naction on the kidney, though its diuretic effect is comparatively \nslight. In Bright\'s disease the tincture of ferric chloride is \nconstantly resorted to, both for its tonic and diuretic properties. \nLiquor Ferri et Ammonii Acetatis (Basham\'s mixture), an \nelegant preparation which is useful as a diaphoretic as well \nas a diuretic, has long been a favorite prescription in the \nanaemia of both acute and chronic parenchymatous nephritis. \n\nThe Different Preparations of Iron. \xe2\x80\x94 While many of these \nare quite strongly astringent, others are practically non- \n\n\n\nIRON. 233 \n\nastringent. There are some, viz., the iodide, the arsenate, the \nphosphate, iron and quinine citrate, and iron and strychnine \ncitrate, in which the drugs with which the iron is com- \nbined increase their value and give them special applica- \ntions. While it has been thought that the arsenate must be \nexhibited in such small doses, in order to avoid arsenical poison- \ning, that the iron in it can have little or no effect, clinicians \nhave found that practically this preparation is by no means so \nactively toxic as is generally supposed, and that in compara- \ntively large doses it is an excellent remedy, particularly in \nchlorosis. In any case where arsenic is indicated in which \nsuch doses are not well borne, it is better to administer the \ntwo drugs separately. Ferric phosphate, which always con- \ntains some free phosphoric acid, is a reliable hsematinic, and \nit is a very palatable preparation. It has been largely used for \nchildren, and especially in rickets, under the idea that the \nphosphorus in it would promote the growth of bones. Parish\'s \nfood, known also as Squire\'s chemical food, and Dusart\'s syrup \nboth have for their chief ingredient ferric phosphate; the dose \nof each is 2 to 8 c.c. ; y 2 to 2 fl. dr. While in ferrous iodide \nthe proportion of iron to iodine is small (1 to 9), it is a very \nuseful preparation, although it is especially liable to injure the \nteeth. The iron and quinine citrate is a favorite mild prepara- \ntion for slight cases of anaemia, but must not be prescribed \nwith alkalies, as they precipitate the quinine. Ferratin (not \nofficial) is claimed to be the characteristic iron compound of \nthe liver. It is an acid albuminate, prepared artificially, and \nis used in doses from i l / 2 gr. ; .10 gm. to 8 gr. ; .50 gm. No \nevidence, experimental or clinical, has as yet been brought \nforward, which, outside of theoretical reasoning, makes the \nsuperiority of this over the older iron compounds probable. \nSince it is practically tasteless it is easily administered. Prac- \ntically all of the albuminates and peptonates to be found in the \nshops are worthless as hsematinics. \n\n\n\n234 PHARMACOLOGY AND THERAPEUTICS. \n\nARSENIC. \n\n1. ARSENI TRIOXIDUM (Acidum Arsenosum, U. S. P., 1890).\xe2\x80\x94 \nArsenic Trioxide. (Arsenous Acid. White Arsenic.) Dose, 0.002 \ngm. (2 milligm.) ; ^ gr. \n\nPreparations. \n\n1. Liquor Potassii Arsenitis. \xe2\x80\x94 Solution of Potassium Arsen- \nite. (Fowler\'s Solution.) Dose, 0.2 C.C.; 3 TT\\,. \n\n2. Liquor Acidi Arsenosi. \xe2\x80\x94 Solution of Arsenous Acid. Dose, \n0.2 c.c; 3 nl. \n\n2. SODII ARSENAS.\xe2\x80\x94 Sodium Arsenate. Dose, 0.005 gm. (5 mil- \nligm.) ; T \\ gr. \n\n3. SODII ARSENAS EXSICCATUS.\xe2\x80\x94 Exsiccated Sodium Arsen- \nate. Dose, 0.003 gm. (3 milligm.) ; ^\\ gr. \n\nPreparation. \nLiquor Sodii Arsenatis. \xe2\x80\x94 Solution of Sodium Arsenate. \n(Pearson\'s Solution.) Dose, 0.2 c.c; 3 Tit- \n\n4. ARSENI IODIDUM.\xe2\x80\x94 Arsenous Iodide. Dose, 0.005 gm. (5 mil- \nligm.) ; T \\ gr. \n\nPreparation. \nLiquor .Arseni et Hydrargyri Iodidi. \xe2\x80\x94 Solution of Arsenous \nand Mercuric Iodides. (Donovan\'s Solution.) Dose, 0.1 C.C.; \n\n1% ni. \n\nUnofficial Preparations. \nOleatum Arseni. \xe2\x80\x94 Oleate of Arsenic. \n\nUnguentum Arseni Oleati. \xe2\x80\x94 Ointment of Oleate of Arsenic. \nAcidum Cacodylicum. \xe2\x80\x94 Cacodylic Acid. Dose, .24 gm.; 4 gr. \n\nFerri Arsenas. \xe2\x80\x94 Iron Arsenate. Dose, 0.005 gm. to 0.008 \ngm.; T \\ to y 8 gr. \n\nSodii Cacodylas.\xe2\x80\x94 Sodium Cacodylate. Dose, .05 to .15 gm.; \n% to 2y 2 gl"., hypodermatically. \n\nAction of Arsenical Compounds. \nExternal. \xe2\x80\x94 Arsenic trioxide has no effect on the unbroken \nskin, unless it is repeatedly applied or allowed to remain in con- \n\n\n\n\n\n\nARSENIC. 235 \n\ntact with it for some time, when it may occasion redness or erup- \ntions of various kinds. Upon denuded surfaces and mucous \nmembrane it has a considerable though slow caustic action. It \nacts much more energetically upon the higher than upon the \nlower organisms, and is not therefore of value as a germicide. \nWhile arsenic is toxic to all animals having a central nervous \nsystem and to most of the higher plants, it is not so to all \nlower organisms, and hence cannot be regarded as a general \nprotoplasmic poison. It has the property of preserving animal \ntissues almost indefinitely. When metallic arsenic in a state \nof fine division is rubbed into the skin some toxic symptoms are \nobserved which are thought to be due to its absorption in the \nform of an oxide. \n\nInternal. Alimentary Canal. \xe2\x80\x94 Toxic doses of arsenical prep- \narations produce an acute gastro- enteritis. How far this is \ndue to local action is now considered somewhat uncertain. As \nhas been stated, the caustic action occurs but slowly, and the \npost-mortem findings show that the corrosion is seldom ex- \ntensive. Moreover, it has been found that the gastro-enteritis \nmay be obtained with equal facility by injecting arsenic into \nthe circulation. From the fact that under these circumstances \nsome arsenic is excreted into the alimentary canal there may no \ndoubt be some local action, but it is held that the quantity thus \nexcreted is quite insufficient to account for the symptoms. \nStill further, it is known that arsenical compounds do not, like \nthe corrosive poisons, change proteids in solution. The action \nof arsenic on the alimentary canal cannot therefore be re- \ngarded as due to any ordinary form of corrosion. No matter \nhow it is introduced into the system, the first and most marked \neffects are observed in the intestine. In consequence of the \ncapillary paralysis produced by the drug there results an exuda- \ntion, which, having caused the throwing off of the epithelium \nin shreds, is poured out into the gut, where it becomes in great \npart coagulated. The epithelial coat of the intestine is found \nto have undergone fatty degeneration, and the degenerated \nepithelium sometimes closely resembles false membrane. The \n\n\n\n236 PHARMACOLOGY AND THERAPEUTICS. \n\neffect of this action is to set up a diarrhoea with stools having a \n"rice water" appearance, due to the shreds of mucous membrane \nand coagulated exudation which characterize them. Attention \nhas been called to the fact that the pathology of this condition is \nexactly the same as that of Asiatic cholera, so that without \na history it is impossible to distinguish between the two ex- \ncept by chemical examination of the dejecta. In exceptional \ninstances the dilatation of the capillaries caused is so extreme \nthat they become ruptured, and there result ecchymoses upon \nthe mucous membrane, or even haemorrhage into the intestine \nor stomach, with bloody stools or vomiting. In therapeutic \ndoses arsenic acts as a gastric stimulant, the dilatation of the \nvessels causing an increased flow of gastric juice; and in the \nsame way the secretions of the duodenum are stimulated. It \nboth increases the appetite and promotes digestion, and its \nspecific action on the epithelium is no doubt concerned in the \nproduction of this effect. \n\nBlood-vessels and Circulation. \xe2\x80\x94 Mention has been made of \nthe paralysis of the capillary vessels produced by arsenic. It \nis now believed by many that this capillary paralysis explains \nthe whole course of the toxic action of the drug; the phenomena \nnoted resembling those produced by an irritant inflammation, \none of the essential features of which is increased permeability \nof the capillaries. In arsenical poisoning there is an early \nand pronounced fall of blood-pressure, and this has been demon- \nstrated to be almost entirely vascular in origin. The vascular \nparalysis occasioned is mainly peripheral, and as the arterioles \nare found to be still capable of contracting, it is assumed that \nthe structures beyond them, namely the capillaries, which more- \nover, are known to have become more permeable, are the seat \nof the paralysis. In addition, however, arsenic has some direct \naction upon the heart, paralyzing its rhythmic power and also \ndepressing its contractility. In the excised heart of the frog \nthe rapidity and force of the heart are diminished till the organ \nfinally stops. Some of the most recent investigators, in ac- \ncounting for the fall of blood-pressure, explain that the vaso- \n\n\n\nARSENIC. 237 \n\nmotor centre and later the splanchnic nerves lose their control \nover the vessels. The dilatation of the mesenteric vessels leads \nto very marked congestion of the stomach and intestine, and, \nalong with the lessened efficiency of the heart, reduces the \npressure to zero. It would seem, therefore, that arsenic is \npoisonous chiefly from its depressant action on the vessels of \nthe splanchnic area. \n\nBlood. \xe2\x80\x94 Opinions differ somewhat as to the action of arsenic \non the blood. Some observers have found that in the normal \nsubject it diminishes the number of the red corpuscles, but does \nnot alter the total haemoglobin of the blood. Others find the \nblood-cells and haemoglobin unaltered by arsenic in normal \nanimals, but describe the bone-marrow as evidently in a state \nof unusual activity, indicated by its increased vascularity, \ngreater number of red corpuscles, and lessened fat-cells. In a \ncase of pernicious anaemia recently examined it was noted that \narsenic increased the number of newly formed red corpuscles, \nbut that the number of more mature ones was diminished. \nWhile the action of arsenic is still obscure, it may be stated \nthat the amount of haemoglobin does not seem to be affected by \nit, and that in certain diseases in which deficiency of the red \ncorpuscles is a prominent symptom its administration is known \nto be capable of increasing their number, while in chlorosis and \nin health it apparently does not do so. In conditions of general \npoor health any improvement in the blood under its use has by \nmany been attributed to improved appetite and increased nutri- \ntional activity. \n\nRespiration. \xe2\x80\x94 The respiration is temporarily accelerated by \nthe intravenous injection of arsenic. In cases of poisoning in \nman it is only late that it is seriously affected, but it ceases \nbefore the heart. The failure of respiration is thought to be \ndue to exhaustion and low blood-pressure, rather than to any \nspecific action on the respiratory centre. \n\nNervous System. \xe2\x80\x94 In frogs arsenic produces a descending \nparalysis, and it is recognized that in them the brain, spinal \ncord, and nerve terminations are directly acted on by it. In \n\n\n\n238 PHARMACOLOGY AND THERAPEUTICS. \n\nmammals, however, there is no evidence of such direct action \nin acute poisoning, though in chronic poisoning, as well as after \na single large but not immediately fatal dose, lesions have \nsometimes been observed either in the spinal cord or the peri- \npheral nerves. \n\nAbsorption and Excretion. \xe2\x80\x94 Arsenic is taken into the blood \nwith great facility, and that absorption may take place even \nfrom the unbroken skin is shown by the fact that cases of \npoisoning occur from the use of cosmetic preparations contain- \ning the drug. It is excreted in the urine, faeces, sweat, and all \nthe other excretions, though chiefly by the kidney, and the \nprocess is a very slow one. It is stored in all the organs ; some \nauthorities stating that it is found, after absorption, in largest \nquantity in the liver, while others deny this. By means of the \nplacental circulation it may also pass from the mother to the \nfoetus. A minute amount of arsenic is normally present in the \nthyroid and thymus glands, the brain, and the skin in man, but \nnone is found in the liver. Owing to its more intense action \non the alimentary canal, the effect of arsenic on metabolism is \nnot so liable to be noted as in the case of phosphorus, but it \nis very much the same. While the nitrogen of the urine is \nconsiderably increased, it is somewhat uncertain whether this \nis to be attributed to an increase in the urea or of other nitrog- \nenous substances. The ammonia seems to be increased, while \nthe glycogen of the liver disappears entirely, and the liver is \napparently incapable of forming it from the sugar of the food. \nThe fatty degeneration which characterizes its action on the \ngastric and intestinal epithelium is also found in the liver and \nkidney, the muscle-cells of the heart, the blood-vessels and \nstriated muscles, and the lining membrane of the alveoli of the \nlungs. While arsenic, like phosphorus, lessens the oxidation \nof the tissues and causes fatty degeneration of the cells of \nvarious organs, it seems probable that it may also increase the \nwaste of the proteids of the body directly, though the increase \nin the nitrogen of the urine may possibly be secondary to the \nother features. The fatty degeneration which occurs may have \n\n\n\n\n\n\nARSENIC. 239 \n\nthe same results as in phosphorus poisoning. The liver is found \nto be somewhat enlarged, while the pressure on the bile ducts \nprevents the escape of bile into the intestine. Jaundice, how- \never, is but rarely a very marked feature of arsenical poison- \ning, and may be entirely absent. The improvement in nutrition \nunder arsenic in doses insufficient to induce chronic poisoning \nis not well understood, though it may be that more of the food \nis utilized by the digestive apparatus, while at the same time \nless proteid is decomposed by the tissues. While it cannot be \nregarded at present that the effects of arsenic on the nutrition \nare definitely established, it is a recognized fact that as long \nas the drug does not interfere with digestion and absorption, \nit increases the excretion of nitrogen. Under these circum- \nstances it also causes increased deposition of fat. In the moun- \ntainous districts of Styria many of the inhabitants regularly \neat white arsenic with the result of an increase in appetite, \nweight and strength and an improvement in the complexion. \nThey gradually accustom themselves to use quantities which \nwould prove fatal to ordinary individuals, and this tolerance \nseems the more remarkable as it has never been found possible \nto secure such an acquired immunity in the case of animals. It \nhas been suggested that an antitoxin may be developed in these \npeople. Usually, it is said, large doses are taken by them once \nor twice a week, and no fluid is swallowed for some time after- \nwards, so that some of the poison may pass through the bowel \nunabsorbed. These Styrian peasants generally live to old age, \nand no toxic symptoms are observed in them. On the other \nhand, the miners of Reichenstein, who are constantly exposed \nto arsenic, as it is contained in large quantities in the ore, are \nshortlived. They are described as very subject in childhood to \nsevere rickets and in adult life to dropsies and respiratory dis- \neases; while they offer little resistance to microbial infection \nand frequently present the cutaneous and nervous symptoms \nof arsenical poisoning. A characteristic feature of the con- \ntinued use of arsenic in many instances is the imparting to the \nbreath and sweat of the odor of garlic. The excretion of \n\n\n\n24O PHARMACOLOGY AND THERAPEUTICS. \n\narsenic takes place so slowly that the drug may be discovered \nin the urine five months after the last dose has been taken, and \nit is well known that arsenic may be found many years after \ndeath in the bodies of those who have taken it during life. \nEven in toxic doses, however, it is not always capable of pre- \nserving the body from corruption, since in the intestines of per- \nsons who have been poisoned with arsenic trioxide, examined \nsome months after death, the poison has been found in the \nstate of yellow arsenic sulphide, into which it has been con- \nverted by the hydrogen sulphide developed by the putrefactive \nprocess taking place in the bowel. \n\nUntoward Effects. \xe2\x80\x94 In very susceptible persons there have \noccasionally been noticed, from the use of medicinal doses, cer- \ntain effects which differ from the ordinary symptoms of chronic \nor arsenical poisoning. Among them may be mentioned rest- \nlessness, headache, alopecia circumscripta, bronchitis and \nhoarseness; more rarely, epistaxis, amblyopia, and anaphrodisia. \n\nTherapeutics of Arsenical Compounds. \nExternal. \xe2\x80\x94 Arsenic trioxide, either pure or as a paste, was \nformerly much more used than at present as a caustic for \ndestroying growths of various kinds. Marsden\'s paste con- \nsists of arsenic trioxide, 1 ; powdered acacia, 2 parts. Another \npaste which was once very popular consisted of arsenous acid, \n1 ; charcoal, 1 ; red mercuric sulphide, 4 parts ; and water \nsufficient to make a paste. Unless it is used in sufficient \nstrength to make the mass of dead tissue slough out quickly, \nthere is danger of the patient becoming poisoned, as the arsenic \nis rapidly absorbed. A caustic powder may be made of arsenic \ntrioxide, 1; calomel, 8; vermilion antimony sulphide, 8 parts. \nLiquor Potassii Arsenitis is sometimes used as an application \nfor corns. The ointment of oleate of arsenic (not official) \nmakes a useful application in the treatment of old ulcers, epithe- \nlioma and lupus. Its efficiency is increased by the addition of \na small amount of zinc chloride, and morphine sulphate may be \nincorporated with it to allay pain. Arsenous iodide in ointment \n\n\n\nARSENIC. 24I \n\n(.30 gm. ; 5 gr. to 4 gm. ; 1 dr.) has been found a valuable \nstimulating application in old dry eczema. For lupus it may \nbe made stronger, or may be combined with mercuric chloride. \nMercurial ointment containing from 5 to 10 per cent, of \narsenic has been advised for warts. Arsenic trioxide is now \nmuch employed for killing the nerves of teeth. As this requires \nseveral days, it illustrates the slowness of the corrosive action \nof arsenic. \n\nInternal. Alimentary Canal. \xe2\x80\x94 A course of arsenical treat- \nment should always be commenced with small doses ; for in- \nstance, .20 to .25 c.c. (3 or 4 R) of Liquor Potassii Arsenitis, \nor .001 to .0015 gm. (-g-^ to J ? gr.) of arsenic trioxide in pill or \ntablet. The dose should usually then be gradually increased. In \nthis way the gastric pain, nausea, diarrhoea and other symp- \ntoms of poisoning which the drug is liable to produce may be \navoided. Another precaution which should commonly be ob- \nserved is to administer arsenic immediately after eating, in order \nthat it may be diluted by the contents of a full stomach. When \nthe dose used is minute, however, it is often best to give it be- \nfore meals. As a rule, children bear arsenic well, while the aged \ndo not. As arsenic increases the appetite, it is useful as a \ntonic in many conditions, and it is also found of service in \nsome forms of dyspepsia. Small doses sometimes check vomit- \ning, and especially that variety in which there is simple regurgi- \ntation of the food. Liquor Potassii Arsenitis, in doses of .06 or \n.12 c.c. (1 or 2 TTL) before each meal proves efficient in some \ncases of the vomiting of pregnancy, as well as in the vomiting \nof chronic gastric catarrh, especially the alcoholic form. It is \nalso very beneficial, given in the same way, in what is known \nas irritative dyspepsia, which is characterized by a red and \npointed tongue, poor appetite, and distress after meals, the \npresence of the food causing intestinal pain, and the desire to \ngo to stool. Arsenic in these small doses is furthermore of \nservice in chronic gastric ulcer and also in cancer of the \nstomach, where it diminishes the pain and checks the vomiting; \nwhile gastrodynia and enteralgia, when idiopathic, are often \n17 \n\n\n\n242 PHARMACOLOGY AND THERAPEUTICS. \n\npromptly relieved by it. In some of the conditions mentioned \nthe effects of the arsenic are found to be increased by the con- \njoint administration of a little laudanum. In the treatment of \nstomach disorders it must be borne in mind that only small \ndoses are admissi-ble, as larger ones will serve to irritate the \nmucous membrane, and thus defeat the end in view. Occa- \nsionally it will be found that arsenic is capable of controlling- \ndiarrhoeas which prove unamenable to other remedies. It is \nespecially useful in that form of diarrhoea dependent upon an \nintolerance of the presence of food, where the undigested ali- \nment is evacuated soon after it is swallowed. Chronic diarrhoea \nand dysentery, particularly when due to malarial cachexia, may \nalso often be greatly benefited by it. In these cases it is best \nto give .12 c.c. (2 HI) of Liquor Potassii Arsenitis with .30 \nc.c. (5 TTL) of laudanum before meals. Arsenic has even been \nproposed as an appropriate remedy in Asiatic cholera. In cases \nof constipation where there is deficient intestinal secretion, with \ndry faeces, it sometimes acts well. It has proved of service in \ncatarrhal jaundice, and is especially recommended when the \ntrouble is of malarial origin. \n\nRemote Effects. \xe2\x80\x94 Arsenic is used to some extent in the \ntreatment of anaemia, and especially in cases of what is desig- \nnated primary anaemia, including leucocythaemia, exophthalmic \ngoitre, Hodgkin\'s disease, and pernicious anaemia. It may per- \nhaps prove of service, but in these conditions all remedies \nsometimes seem without effect. In chlorosis and in cases of \nanaemia where iron disagrees with the patient or proves un- \nsuccessful it is worthy of trial, and is considered by some \nclinicians one of the most valuable agents in the pharmacopoeia. \nIn these disorders the efficiency of iron is at times much in- \ncreased by the addition of arsenic. Although much inferior to \nthat drug, it is next to quinine the most efficient remedy in \nmalarial infection which we possess. It is in chronic cases that \nit is especially beneficial. Reference has already been made \nto its value in intestinal disorders due to such infection, and \nit is also of service (though distinctly less than quinine) in \n\n\n\nARSENIC. 243 \n\nvarious other affections when of malarial origin, such as hemi- \ncrania and other neuralgias. As a prophylactic against malaria \nsome of the observations made apparently indicate that arsenic \nis superior even to quinine. In a considerable number of ner- \nvous conditions, whether there is a malarial taint present or not, \nit is of value. Among these may be mentioned cerebral con- \ngestion, melancholy and hypochondria of the aged, and espe- \ncially chorea. In the latter it should be given in rapidly in- \ncreasing doses. In paralysis agitans, as well as in local chorea \nand histrionic spasm, the subcutaneous injection of Fowler\'s \nsolution or Pearson\'s solution of sodium arsenate (solution of \nsodium arsenate, U. S. P., 10 c.c. ; distilled water, 90 c.c.) has \nsometimes proved of great service. Arsenic employed by this \nmethod is also an efficient remedy in lymphadenoma and in \nmalarial hypertrophy of the liver and spleen, and has been \nknown to be successful in obstinate cases of general malaria \nwhich have resisted the action of quinine. Used either inter- \nnally or locally (often by fumigation in the form of arsenical \ncigarettes) arsenic is useful in chronic bronchitis, emphysema, \nspasmodic asthma, " hay asthma," chronic pneumonia (fibroid \nphthisis), and even pulmonary tuberculosis when the course of \nthe disease is very slow. Arsenous iodide, .30 c.c. (5 ni) after \neach meal of a 1 per cent, solution, increased to .90 c.c. (15 TTi) \nor 1.20 c.c. (20 HI), has been found of value in the bronchitis \nof strumous children. In both acute and chronic coryza the \nfumes of arsenical cigarettes, snuffed into the nares, are of \nservice. Such cigarettes may be made by saturating bibulous \npaper in a solution of 1 gm. (15 gr.) of potassium arsenate to \n30 c.c. (1 fl. oz.) of water. In short breathing from cardiac \nweakness, especially in elderly persons, arsenic is apt to afford \nrelief, and attacks of angina pectoris may sometimes be lessened \nor prevented by the persistent use of the drug in the interval. \nA course of . arsenic often has a valuable tonic influence in \norganic heart disease, and under its use dyspnoea, palpitation, \nintermittency of the pulse, and oedema improve. It has been \nfound very useful in a certain form of chronic arthritis, in \n\n\n\n244 PHARMACOLOGY AND THERAPEUTICS, \n\nwhich the joints become stiff and painful in consequence of \na peculiar state of the nervous system; the trophic nerves being \ninvolved and the condition one allied to neuralgia. As to its \nvalue in the kind of chronic rheumatism or rheumatic gout \nwhich is accompanied by nodosities of the joints authorities \ndiffer. By some it is claimed that it is of considerable service \nin those forms of chronic rheumatism in which potassium iodide \nis commonly employed, and that it is often advantageous to \nadminister these two alteratives alternately for periods of \nthree or four weeks. Arsenic has been employed with good \neffect in albuminuria following scarlatina, and also appears to \nbe useful in certain forms of chronic albuminuria. It is \nthought to be of considerable value in diabetes of hepatic origin, \nand at the present time Clemens\' bromide solution (consisting \nof a solution in water of arsenic trioxide, bromide and potassium \nbicarbonate) is much in favor as a remedy for diabetes. Good \nresults have also been claimed from the persevering use of \nsmall doses of arsenic in cirrhosis of the liver, in epithelioma, \nand in rodent ulcer, while some have believed that it is useful in \nscirrhus, especially as the disease manifests itself in the \nstomach, and in retarding the growth of uterine cancer. There \nappears to be good evidence that arsenic in large doses restrains \nthe growth of sarcomata, particularly of the fusiform-cell va- \nriety. \n\nOne of the most useful and general applications of the drug \nis in the treatment of diseases of the skin. As it exerts its in- \nfluence chiefly upon the epidermis, its action being upon nutri- \ntion through the nerves, diseases affecting the more superficial \nstrata of the integument are most amenable to it, while it pro- \nduces a less marked effect upon those having their seat in the \ndeeper structures. It should not be employed when there \nis great heat, burning, intense itching, or rapid cell-change, and \nshould therefore rarely be prescribed in the acute inflammatory \nstage of any cutaneous affection. It is of great value in many \ncases of psoriasis, in certain varieties of eczema, especially in \nchronic squamous and papular forms of the disease, in acne of \n\n\n\nARSENIC. 245 \n\nthe small papular variety, especially in neurotic cases, in certain \nglandular hypersecretory diseases of neurotic origin, such as \nseborrhcea and hyperidrosis, in lichen, and in pemphigus. It \nshould be avoided in acute eczema unless the case is distinctly \nneurotic. It is sometimes of service in chronic urticaria, and \nalso in morphcea, alopecia circumscripta, and other atropic dis- \neases. Dermatologists hold that in all diseases of the skin be- \nfore arsenic is prescribed the digestive tract should be carefully \ninvestigated, and if any abnormal condition is shown, that this \nshould be rectified. It is sometimes found that syphilitic affec- \ntions can be better treated by the combination of mercury with \narsenic than by mercury alone, and Donovan\'s solution (Liquor \nArseni et Hydrargyri Iodidi) is especially useful in old \nsyphilitic skin lesions. Furunculosis may be successfully treated \nby the persistent use of arsenic, and small doses of it are \nsaid to have a curative effect upon warts. Given in associa- \ntion with the bromides, it is useful in lessening or preventing \nthe disfiguring acne which so frequently results from the con- \ntinued administration of these drugs. \n\nThe springs of Levico and La Bourboule contain arsenic tri- \noxide. Strong Levico contains .005 gm. (-^ gr.) of arsenic \ntrioxide and 2 gm. (30 gr.) of iron to 500 c.c. (1 pint) ; weak \nLevico, .0005 gm. ( t ^-q gr.) and 0.5 gm. (8 gr.) respectively. \nLa Bourboule contains .005 gm. ( T ^.gr.) of arsenous acid and a \ntrace of iron to 500 c.c. (1 pint). These waters should always \nbe taken with the meals. \n\nCacodylic acid (AsO(OH)0(CH 3 ) 2 ), (not official), and so- \ndium cacodylate (AsONa(CH 3 ) 2 ), (not official) have recently \nbeen proposed as eligible methods for the administration of \narsenic. The former contains 58 per cent, of arsenic. Their \nsolubility, relatively small toxicity, and the diminished local \nirritation which they produce are advantages to be borne in \nmind. The best form of administration is as sodium cacodylate, \ngiven hypodermatically in daily amount of from .05 to 15 gm. \n(24 to 2 l / 2 gr.), in solution. By this method the arsenic is \nfully efficacious, no alliaceous odor is given to the breath or \n\n\n\n246 PHARMACOLOGY AND THERAPEUTICS. \n\nperspiration, and gastric and intestinal disturbances do not \nsupervene. Prolonged use, however, may set up albuminuria. \nBy the rectum it produces less irritation and the odor of garlic \nis not so pronounced as after the use of Fowler\'s solution. This \nmethod is preferable in the treatment of tuberculosis, diabetes, \nBasedow\'s disease, and leukaemia. It has been objected against \nthe use of the cacodylates that if they can be administered in \ncomparatively large doses without producing characteristic \nsymptoms of the action of arsenic, it must be because the arsenic \nion has been rendered inert; the reason for this probably being \nthat in these substances there is formed so firm and stable a \nunion of the arsenic with other ingredients that no dissociating \ninfluence to which it is subjected in the body is capable of \nsetting free the active arsenic ion from the combination. It \nis also claimed that in several diseases in which the older \narsenical compounds are given with advantage no therapeutic \nresults assignable to arsenic have been obtained from the caco- \ndylates; and, furthermore, that when these are administered, \nthey pass through the system and are eliminated in such stable \ncombinations with organic bodies that they fail to react to the \nusual tests for arsenates, and fail to yield arsenicum when sub- \njected to the dissociating influence of Marsh\'s process. To \nthese objections it may be answered that while the cacodylates \nare absorbed but slowly and the arsenic ion is dissociated with \ndifficulty, they do produce distinct arsenical effects in the body, \nas has been unquestionably shown by the fact that cases are on \nrecord in which poisoning with the characteristic symptoms of \narsenic has occurred. In addition, this has been demonstrated \nby the fact that in some diseases, at all events, in which the \nordinary compounds are known to be efficient, equally good re- \nsults have been obtained from the use of the cacodylates. In \nseeking for a cause for this discrepancy between observers at- \ntention should be called to the fact that the strongest objection \nto the use of the cacodylates has been made by those who have \nadministered them by the mouth. When given hypodermatic- \nally several disadvantages are obviated; the garlic-like odor of \n\n\n\nARSENIC. 247 \n\nthe breath, intestinal irritation, etc. Quite lately a new com- \npound, disodic-methyl-arsenate (AsCH 3 3 Na 2 H 2 2 ), to which \nthe name of arrhenal has been given, has been brought forward \n\nas an agent which, it is asserted, is free from certain alleged \ndisadvantages of other similar compounds, and for which some- \nwhat extravagant claims have been made for its efficacy in \nbronchitis, tuberculosis, chorea, syphilis, anaemia, adenitis, \nleukaemia, malaria, and other affections. These claims have \nalready been disputed, and it is as yet too soon to form any \npositive opinion regarding its merits. It is stated to be non- \ntoxic, and is given in quite large doses, ranging from .18 to 2.5 \ngm. (3 to 40 gr.) daily. \n\nTOXICOLOGY. \n\nAcute Poisoning. \xe2\x80\x94 Arsenic is used to a very considerable extent for \npoisonous purposes. The forms most employed are Scheele\'s and Paris \nGreen (cupric arsenite), and Schweinfurth\'s Green (a compound of \ncupric arsenite and arsenate). Symptoms. \xe2\x80\x94 As the pathology of the \neffects of arsenical salts in the alimentary canal is practically the same \nas that of Asiatic cholera, so the symptoms of poisoning by them gen- \nerally resemble very closely those met with in that disease. Large \ndoses frequently produce no distress for a considerable time, but in the \ncourse of half an hour, or perhaps longer, the patient experiences a \nsense of constriction in the fauces, with dysphagia. About the same \ntime he begins to suffer from slight epigastric pain, which soon becomes \nextreme, and spreads over the abdomen. It is accompanied with faint- \nness, nausea and excessive vomiting, and later by profuse watery diar- \nrhoea, with tenesmus and intense thirst. The matter vomited and the \nstools may contain blood, but this is not infrequently absent. The pa- \ntient also suffers from muscular cramps, headache and dizziness, and \ngradually sinks into collapse, with coldness of the extremities, pallor, \nsmall and feeble pulse, and sighing respiration. This condition passes \ninto one of coma, followed by death, which may or may not be pre- \nceded by convulsions. Exceptional cases have been noted in which the \nonly symptoms were those of collapse and coma. Death may perhaps \noccur within twenty-four hours, but more commonly the vital powers \nare not exhausted for considerably longer than this, and the patient \nmay linger for several days. Not infrequently it is found to be the \ncase that he recovers from the acute symptoms only to develop those \nof chronic arsenical poisoning. \n\n\n\n248 PHARMACOLOGY AND THERAPEUTICS. \n\nPost-mortem. \xe2\x80\x94 The mucous membrane of the gastro-intestinal tract is \ngenerally red and swollen, while its epithelial coat in many places can \nbe readily detached and is found to be in a state of fatty degeneration. \nAs a rule, no erosion is observed unless the arsenic has been swallowed \nin powder, when, if the latter has remained for some time in contact \nwith the wall of the stomach, there may perhaps be some erosion, as \nwell as more marked congestion, as the result of its local action. In \nthe intestine the swelling and congestion of the mucous membrane is \nmost pronounced around Peyer\'s patches, and the bowel generally con- \ntains a considerable quantity of thin fluid with flakes of membrane, like \nthe rice-water discharges of cholera. Haemorrhage is only occasionally \nmet with, but in both the stomach and intestine small particles of ar- \nsenic are not infrequently observed. \n\nTreatment. \xe2\x80\x94 It is important that the stomach should be completely \nemptied as soon as possible, either by washing out or the use of emetics \n(see p. 175), choice being made of those least depressing and least \nirritating. On account of the insolubility of arsenic it is advisable that \nthe stomach washing should be continued for some time. At the same \ntime large quantities of freshly prepared ferric hydroxide with mag- \nnesium oxide (see p. 230) or dialyzed iron should be given ; if these \ncannot be obtained, magnesia (preferably light magnesia) shaken up \nwith water. The antidote must be repeated at intervals as long as the \nacute symptoms continue. If neither magnesia nor the iron prepara- \ntions are procurable, dependence must be placed on large doses of \ncastor oil and water. For the collapse subcutaneous injections of \nbrandy or ether may be given, and warm applications made to the \nabdomen and extremities. \n\nChronic Poisoning. \xe2\x80\x94 When arsenic is given medicinally, too large \ndoses may induce slight symptoms of poisoning, such as abdominal pain, \nloss of appetite, nausea, indigestion, mild diarrhoea, pumness of the eye- \nlids, injection of the conjunctiva, and watering of the eyes and nose. \n\nCutaneous eruptions are also sometimes caused, and while these may \nbe due in part to circulatory derangements, they are believed to result \nchiefly from a direct action of the drug on the skin. They may be \nerythematous, papular, vesicular or pustular in character, and may be \nattended with erysipelatous swelling. Herpes zoster, it is said, has been \ncaused by its prolonged administration. As arsenic is very extensively \nused in the arts, particularly in the manufacture of wall papers and \nfabrics, accidental poisoning is not infrequent among workers in arsenic \nand may occur in persons using articles which contain it. The evidence \nin regard to chronic poisoning from occupancy of rooms decorated with \n\n\n\nDRUGS ACTING ON CARDIAC MECHANISM. 249 \n\narsenical wall paper is somewhat contradictory, but the facts point \ntowards its probability. Quite as often the poisoning is due to the \narsenic which is a contamination of aniline dyes as it is to the arsenical \npigments, so that the color should not be depended upon, but rather a \nchemical examination. \n\nAs the arsenical poisoning goes on, a catarrhal condition of the mu- \ncous membrane of the nose and throat is developed, with much sneezing \nand coughing, cutaneous eruptions of various kinds appear, and, in some \ninstances, a curious pigmentation of the skin occurs (arsenic melanosis) ; \nwhile eventually the hair and nails fall out. Swelling of the liver, with \njaundice, is sometimes met with, and the later phases of the disorder \nare characterized by sensory and motor disturbances in localized areas \n(generally in the hands and feet), the result of polyneuritis. There \nare acute pain and formication in the extremities, followed by sensory \nparalysis, with symptoms resembling those of locomotor ataxia. This \nagain is succeeded by motor paralysis, which as a rule is confined to the \nextremities, but may possibly invade the trunk. It is generally sym- \nmetrical and the affected muscles (more commonly the extensors than \nthe flexors) atrophy quite rapidly. Herpes of the face or trunk, of \nnervous origin, is a common symptom. In very prolonged cases the \npatient may sink into an apathetic, semi-idiotic condition, or may be- \ncome epileptic. After death from chronic poisoning, in addition to the \ngastro-intestinal and nervous lesions, there is found fatty degeneration \nof most of the organs of the body, and particularly the liver, kidneys, \nstomach and muscles, including the heart. \n\nThe tests for arsenic are so simple that every physician should be \nable to make use of them. They are: (1) Reinsch\'s. \xe2\x80\x94 Hydrochloric \nacid and a clean slip of copper are boiled in the suspected liquid. Bluish \nspots indicate the poison. (2) Marsh\'s. \xe2\x80\x94 Diluted sulphuric acid and \nzinc are introduced into a flask with the suspected liquid. The gas issu- \ning from the tube is ignited and the flame allowed to impinge upon a \nclean porcelain plate forming a steel-white mirror if arsenic be present ; \nor the delivery tube may be heated when the mirror will be deposited \nupon it. This mirror is distinguished from that produced by antimony \nby its solubility in potassium hypochlorite if arsenic is the cause. \n\nDivision III. \xe2\x80\x94 Drugs Acting on the Cardiac Mechanism. \nWhile it was formerly supposed that the spontaneous im- \npulses originating in the heart, which normally commence in \nthe sinus venosus and extend downwards over the auricle and \nventricle to the apex, had their birth in the cardiac ganglia, the \n\n\n\n2 50 PHARMACOLOGY AND THERAPEUTICS. \n\nreal function of these ganglia (which may possibly be a nutri- \ntive one), is still practically unknown, and there is now at \ncommand considerable evidence to the effect that it is in con- \nsequence of impulses originating in themselves that the muscu- \nlar fibres contract. The contractile function of the muscular \nfibres is, however, subject to two opposing influences, one that \nof the accelerator nerve-fibres connected with the sympathetic, \nwhich tends to augment it, and the other that of the pneumo- \ngastric, or vagus, which tends to inhibit it. In studying the \neffects of drugs on the heart, therefore, all that we are called \nupon to consider is their action on the muscular structure of \nthe heart, on the nerve-fibres distributed to it from the vagus \nand the sympathetic, and on the vagus and accelerator centres \nin the medulla oblongata. These centres, it may be stated, are \nextremely sensitive to afferent impulses conveyed from various \nparts of the body, as well as from the heart itself. Our knowl- \nedge of the action of drugs upon the human heart is necessarily \nsomewhat imperfect, since it is principally derived from experi- \nmentation on animals, in connection with which there are a \nnumber of difficulties and sources of error. Thus, many ex- \nperiments cannot be satisfactorily made upon the mammalian \nheart, and hence the cold-blooded animals have been made use \nof to a large extent. As some differences have been observed \namong them (as, for instance, between the frog and the tor- \ntoise) it is a question how far deductions from experiments \nupon the hearts of warm-blooded animals, among which, again, \ndecided differences are sometimes found, are applicable to the \nhuman heart. A uniformity of effect will naturally go far to \nestablish the character of any given action as regards man, but \nin general we have to depend largely on probabilities in this \nmatter. Attention may here be directed to one point of inter- \nest; the action of a large dose of a drug is as a rule the oppo- \nsite of that of a moderate dose. \n\nA. Drugs Acting Upon the Heart Directly. \xe2\x80\x94 Our knowledge \nof these has been derived from the application to the heart of \na solution of the drug externally, or by means of a transfusion \n\n\n\nDRUGS ACTING ON CARDIAC MECHANISM. 25 I \n\ncannula, and by the action of the drug upon the excised heart \nor section of a heart. Since the apex probably contains no \nnerves, it is customary to conclude that if a drug has an action \non the isolated apex it acts exclusively upon the muscles ; but \nas it is always a difficult matter to decide whether a drug acts \nupon the muscle fibre itself or upon the fine nerves between the \nfibres, it will be found advisable to make no attempt to distin- \nguish between these actions. In studying the nervous influ- \nences affecting the heart\'s action much more attention has been \npaid to the inhibitory or vagus than to the accelerating mechan- \nism. The effect of stimulating the muscle is the same as that \nof stimulating the accelerator fibres, and consists in an augmen- \ntation of either the rate or the force of the beat, or both. On \nthe other hand, stimulation of the vagus fibres or its cardiac \nterminations may cause a diminution in either the rate or the \nforce of the beat, or both; while the paralyzing of either the \naccelerator or vagus terminations naturally produces an effect \njust the opposite to their stimulation. As it is very difficult to \ndecide whether drugs act upon the muscle or on the nerve- \nendings, it will be most convenient to classify those which act \nlocally on the heart by the effect they produce, without refer- \nence to this point. \n\nDrugs increasing the force of the contraction : \n\n(1) Digitalis. (6) Caffeine. \n\n(2) Strophanthus. (7) Veratrine. \n\n(3) Adonidin. (8) Erythrophloeum. \n\n(4) Squill. (9) Barium Salts. \n\n(5) Convallaria Majalis. \n\nIn frogs these drugs, in large doses, always cause arrest of the heart \nin systole ; in mammals the final arrest may be in diastole with some, \ne. g., digitalis. They all slow the pulse. \n\n(10) Camphor. | (13) Dilute solutions of zinc \n\n(11) Musk. double salts. \n\n(12) Dilute solutions of cop- j (14) Dilute solutions of chloral. \n\nper double salts. I (15) Physostigmine. \n\nThese drugs have the same action without the final arrest in systole. \nThe rate of the pulse is not markedly altered. \n\n\n\n252 \n\n\n\nPHARMACOLOGY AND THERAPEUTICS. \n\n\n\nDrugs the chief action of which is to decrease the force of the con- \ntraction, usually with stoppage in diastole : \n\n\n\n(1) Diluted acids. \n\n(2) Strong solutions of salts \n\nof the alkaline metals. \n\n(3) Strong solutions of ba- \n\nrium salts. \n\n(4) Strong solutions of cop- \n\nper double salts. \n\n(5) Strong solutions of zinc \n\ndouble salts. \n\n\n\n(6) Strong solutions of chloral. \n\n(7) Muscarine. \n\n(8) Pilocarpine. \n\n(9) Saponin (large doses). \n\n(10) Apomorphine. \n\n(11) Emetine. \n\n(12) Salicylic acid (large doses). \n\n\n\nDrugs an important action of which is to increase the rate of the car- \ndiac beat: \n\n\n\n(1) Atropine. \n\n(2) Hyoscyamine. \n\n(3) Daturine. \n\n\n\n(4) Duboisine. \n\n(5) Cocaine. \n\n(6) Saponin. \n\n\n\nDrugs an important action of which is to slozv the rate of the cardiac \nbeat (see also first list given above) : \n\n(1) Muscarine. (2) Pilocarpine. \n\nDrugs which increase both the force and the number of the beats: \n\n\n\n(1) Ammonium salts. \n\n(2) Alcohol. \n\n(3) Ether. \n\n(4) Chloroform. \n\n(5) Cactus. \n\n\n\n(6) Anaesthetics. \n\n(7) Arsenical salts. \n\n(8) Quinine. \n\n(9) Strychnine. \n\n\n\nDrugs which decrease both the force and the number of the beats. \n\n\n\n(1) Antimony salts. \n\n(2) Aconite. \n\n(3) Hydrocyanic acid. \n\n\n\n(4) Ergot. \n\n(5) Veratrum. \n\n(6) Cevadilla. \n\n\n\nB. Drugs Acting on the Vagus Centre. \xe2\x80\x94 It may be concluded \nthat a drug acts on the vagus centre when it is found that while \nit has the effect of altering the beat of the heart, such altera- \ntion may be counteracted either by section of the vagi or by \nstimulation of the peripheral end of the nerve, if only one of \nthe vagi be cut. \n\n\n\nDIGITALIS. \n\n\n\n253 \n\n\n\nDrugs which stimulate the vagus centre: that is to say, the pulse is \nslowed, but this slowing disappears on section of the vagi : \n\n\n\n(1) Chloroform. \n\n(2) Hydrated Chloral. \n\n(3) Butyl-chloral hydrate. \n\n(4) Aconite. \n\n(5) Veratrum. \n\n(6) Nicotine. \n\n(7) Digitalis. \n\n(8) Sparteine. \n\n(9) Strophanthus. \n(10) Squill. \n\n\n\n(11) Convallaria Majalis. \n\n(12) Hydrocyanic acid. \n\n(13) Cocaine (large doses). \n\n(14) Staphisagr ia ( Delphinine ) . \n\n(15) Atropine \xe2\x96\xa0>. Only very \n\n(16) Hyoscyamine L e a r 1 y in \n\n(17) Daturine J their action. \n\n(18) Increased blood-pressure. \n\n(19) Venous blood. \n\n\n\nDrugs which depress the vagus centre: Large doses of the drugs men- \ntioned in the last list, and drugs which diminish the blood-pressure, such \nas amyl nitrite, nitroglycerin and the nitrites. \n\nC. Drugs Acting on the Accelerating Centre. \xe2\x80\x94 So far as \n\nknown, there are no drugs which have the effect of depressing \nthis. Probably some stimulate it, for their administration ren- \nders the pulse still more rapid after the vagi have been cut. \n\n\n\nThey are \xe2\x80\x94 \n\n(1) Ammonia. \n\n(2) Caffeine. \n\n(3) Picrotoxin. \n\n\n\n(4) Cactus. \n\n(5) Delphinine. \n\n(6) Any drugs which make \n\nthe blood venous. \n\n\n\nTherapeutics. \xe2\x80\x94 The drugs most used for their action on the \nheart are digitalis, strophanthus, ammonium salts, sparteine, \nsquill, convallaria majalis, caffeine, alcohol, ether, chloroform, \ncactus, strychnine, belladonna, aconite, antimony, and hydro- \ncyanic acid. The various indications for which they are \nseverally given will be mentioned under each drug. \n\n\n\nA. Drugs Acting Upon the Heart Directly. \nDIGITALIS. \n\nDIGITALIS.\xe2\x80\x94 Digitalis. (Foxglove.) Dose, 0.065 gm, (65 mil- \nligm.); 1 gr. \n\n\n\n2 54 PHARMACOLOGY AND THERAPEUTICS. \n\nPreparations. \n\n1. Extractum Digitalis.\xe2\x80\x94 Extract of Digitalis. Dose, 0.010 \ngm. (10 milligm.) ; y 5 gr. \n\n2. Fluidextractum Digitalis. \xe2\x80\x94 Fluidextract of Digitalis. \nDose, 0.05 c.c.; 1 TTt- \n\n3. Infusum Digitalis. \xe2\x80\x94 Infusion of Digitalis. Dose, 8 c.c; \n2 fl. dr. \n\n4. Tinctura Digitalis. \xe2\x80\x94 Tincture of Digitalis, Dose, 5 c.c; \n15 HI. \n\nUnofficial Preparations. \nDigitalinum. \xe2\x80\x94 Digitalin. Dose, 1 mg.; ^ \xc2\xa5 gr. \n\n\n\nDigitoxinum. \xe2\x80\x94 Digitoxin. Dose, .00025 to .00032 gm.; \n\n\n\ni \n\n2S0 \n\n\n\nAction of Digitalis. \n\nExternal. \xe2\x80\x94 It has but little effect on the skin; its principal \nlocal action being on the mucous membranes, where the primary \nirritation caused by it is not infrequently followed by paralysis \nof the nerve endings. \n\nInternal. G astro-intestinal Tract. \xe2\x80\x94 It causes gastrointesti- \nnal irritation, and in large doses gives rise to gastritis and \npurging, with green stools. There is some ground for suppos- \ning that these disturbances are in part at least of centric origin. \n\nBlood. \xe2\x80\x94 It has no appreciable effect upon the blood. \n\nHeart. \xe2\x80\x94 Digitalis has a pronounced effect upon the heart. \nThis is due principally to its direct action on the cardiac .mus- \ncle, but also, in part, to stimulation of the vagus apparatus, both \nin the medulla and peripherally. Applied locally to the heart \nof a frog, digitalis is capable of causing tonic contraction of the \norgan. It will also increase the force of the contraction when \napplied to the isolated apex, in which no nerves are believed to \nexist, and act on the embryonic heart of the chick before the \nnerves are developed. \n\nThe influence digitalis exerts may be divided into three \nstages. In the first, or therapeutic, stage the rhythm of the \nheart is markedly slowed, and the ventricles, emptying them- \n\n\n\nDIGITALIS. 255 \n\nselves more thoroughly than under normal conditions, become \ndiminished in size. As the contraction of the ventricle is more \ncomplete, the blood is expelled into the vessels under greater \npressure than normally. Relaxation of the ventricle during \ndiastole is also increased in the healthy heart, but if the organ \nis weak and dilated, digitalis tends to diminish the relaxation. \nThe auricles are slowed, as well as the ventricles, but in general \nthey are not so much affected as the ventricles. The diastole is \nprolonged, the force of the systole increased, and the size of the \nindividual pulse-wave also increased. If the heart is beating at \nits normal rate the diastole is increased by digitalis, but if the \nbeat is slow, and the slowness is due to weakness of the cardiac \nmuscle, the diastole is diminished instead. The slowing of the \npulse caused by the drug is apparently due to a simultaneous \nstimulation of both the central and peripheral vagus apparatus, \nsince it has been demonstrated that in the mammal the admin- \nistration of atropine entirely does away with this slowing. \nMoreover, if section of the vagi is made, the slowing is much \nless than when these nerves are left intact, and may be alto- \ngether absent. Under digitalis the work done by the heart is \nmuch greater than normal, and the slowness developed is not \nsufficient to counterbalance the increased output at each ventri- \ncular contraction. \n\nIn the second stage the pulse is very slow and irregular, for \nthe reason that the inhibitory mechanism is powerfully stimu- \nlated. During diastole the ventricle dilates more completely \nthan usual, while its systole varies in force. The contraction \nof the auricle becomes much weakened, and sometimes the \nrhythm of the latter is different from that of the ventricle. \nUnder certain circumstances this stage may be absent. \n\nThe third stage is always developed if a sufficient quantity \nof the drug be given. In this the heart\'s action becomes ex- \ntremely fast and irregular. This accelerated rate is believed to \nbe due, not to paralysis of the pneumogastric centres and car- \ndiac peripheral filaments, but to such an increased excitability \nof the heart muscle that the inhibitory apparatus can no longer \n\n\n\n256 PHARMACOLOGY AND THERAPEUTICS. \n\nhold it in check. The rhythm of the ventricle continues to in- \ncrease, but the strength of its contractions diminishes. The \noutput of the heart continues much augmented during the first \npart of the third stage, and then rapidly declines. The auricle \npasses into the condition known as delirium cordis, and finally \nthe ventricle also. Then the circulation is arrested; after \nwhich the heart dilates to an extreme degree. \n\nThe action of digitalis on the heart has been very carefully \nstudied in the frog, and it is found that in general its effects on \nthe mammalian heart resemble those on the batrachian. The \ncontraction, however, is not prolonged as it is in the latter, and \nthe inhibitory action is of greater importance. In the frog the \ndrug causes systolic arrest of the heart, while in man the arrest \nis in diastole. The reason for this difference is supposed to \nbe that the mammalian heart is not capable of continuous \nsystole. \n\nVessels. \xe2\x80\x94 Digitalis has the effect of markedly increasing the \nbiood-pressure in the vessels. Three factors are concerned in \nproducing this result namely: The expulsion from the heart of \nmore blood than usual and at a higher pressure, the stimulation \nof the vaso-motor centres, and the direct action of the drug on \nthe vessels themselves, exciting a condition of abnormal activity \nin their muscular coats, and thus diminishing their calibre. If \ndigitalis is injected into a frog and a small artery in its foot \nis measured, it will be found that during the action of the drug \nthe calibre of the vessel is diminished to about three fourths \nits natural size; and the mammalian kidney is also found to \ndecrease in size under digitalis. That the constriction of the \narteries from digitalis is to a great extent a muscular action is \nshown by the fact that it occurs in organs which have been \nexcised, even for several hours; but, as this constriction is not \nas marked as when the drug is administered under normal con- \nditions, the agency of the vaso-constrictor centres must also \nbe recognized. While the blood-pressure rises in the arteries \nthe velocity of the current diminishes, and as the pressure rises \nin the arteries it declines in the veins; both these effects indi- \ncating an increased resistance. \n\n\n\nDIGITALIS. 2 57 \n\nUnder toxic doses of digitalis the blood-pressure in the \nvessels diminishes with the extreme slowing of the heart, but \nas the latter becomes accelerated it again rises to a pronounced \ndegree; this result being due to the quickened heart and con- \ntraction of the arterioles. Then, as the heart becomes irregu- \nlar, the blood-pressure declines until it finally reaches zero \nwhen the heart stops. This fall results from the decreasing \nefficiency of the cardiac contractions and from vaso-motor \nparalysis. \n\nSome former experiments, made for the purpose of demon- \nstrating the action of digitalis and its allies upon the vessels, \nhave recently been repeated. The new experiments were con- \nducted on dogs. Two entirely different methods were em- \nployed: in one the amount of blood flowing out of the veins of \ndifferent regions was registered after a sufficient amount of \natropine had been given to overcome the slowing of the \npulse; in the other the plethysmograph was used. The ex- \nperiments showed that the increased blood-pressure is due to \nincreased heart action and contraction of the vessels, and that \nthe latter is due to peripheral action which, in the case of \ndigitoxin, is general. In the case of the other glycosides ex- \namined (digitalin, convallamarin, strophanthin) the action is \nrestricted to the splanchnic area. There is, however, some \nactive constriction going on here in the peripheral vessels, yet \nthis is overcome by a passive dilatation, owing to reflux of \nblood from the intestines and an active reflex dilatation set up \nby the splanchnic contraction. The general narrowing of the \npathway of the blood seen with digitoxin gives a high resistance \nwhich must be overcome by the heart; strophanthin, etc., open \nthe vessels of the periphery, and this materially relieves this \norgan. \n\nKidney. \xe2\x80\x94 In dropsy, especially when due to cardiac disease, \nthere is no question as to the value of digitalis as a diuretic, \nthough its action has been explained in a variety of ways. It \nhas been disputed, however, whether in health it has any effect \non the renal secretion. The weight of authority seems to favor \n18 \n\n\n\n258 PHARMACOLOGY AND THERAPEUTICS. \n\nthe view that it does exert some diuretic action, but this has \nproved so variable as to lead to the conclusion that it is prob- \nably, to a large extent at least, of an indirect, rather than a di- \nrect, nature. Nearly all are agreed that the kidneys are \naffected principally through changes in the circulation, and per- \nhaps the most satisfactory explanation of this is that the diure- \nsis is due to the cardiac action of the drug. Under this hypo- \nthesis it is supposed that arterial accumulation, with diminished \nvenous pressure, leads to an increased flow of lymph into the \nblood-vessels. The blood is thus diluted, and the kidneys incited \nto special activity, while at the same time the nutrition of the \norgans is improved. In addition to this indirect action, there is \nsome ground for believing that digitalis exerts a limited in- \nfluence directly upon the renal epithelium, on which it probably \nacts as a mild irritant. By the diuretic action of the drug the \nfluid of the urine is said to be much more largely increased than \nthe solids. As to its effect upon the urea and other urinary \nconstituents, the reports of various observers have been so con- \nflicting that no definite conclusions can be arrived at. \n\nTemperature. \xe2\x80\x94 In health digitalis, in medicinal doses, has \nlittle or no effect on the temperature. In febrile conditions it \nhas an antipyretic action, but this is somewhat uncertain. \nToxic doses cause a sustained reduction of temperature, \namounting to several degrees, but their first effect is to increase \nit. It is thought by some that this temporary elevation may be \ndue to the local irritation of the drug, and that if this can be \navoided the fall will occur without the antecedent rise. Others \nexplain the phenomena observed as follows: Owing to the in- \ncreased resistance from diminution of the calibre of the arter- \nioles, the actual energy expended by the heart is in part con- \nverted into heat. Subsequently the slowing of the circulation, \nespecially through the lungs, hinders the combustion process, \nand hence the fall of temperature. \n\nRespiration. \xe2\x80\x94 It has little or no effect on respiration unless \ntaken in toxic quantity, when, it is said, the respiratory move- \nments become deep and rapid from central nervous stimulation. \n\n\n\nDIGITALIS. 259 \n\nNervous System and Muscles. \xe2\x80\x94 In therapeutic doses the only \neffect of digitalis appears to be the stimulation of the inhibitory \ncardiac and the vaso-motor centres in the medulla oblongata. \nToxic doses, however, stimulate other centres, and general \nconvulsions may eventually result. They diminish reflex ac- \ntivity by directly exciting the reflex inhibitory centres of \nSetschenow in the medulla, and afterwards by depressing the \nspinal cord. Finally the motor nerve-trunks are depressed and \nthe muscles are paralyzed. While the cerebrum is not directly \naffected by digitalis, the disturbances in its circulation caused \nby the drug are liable to give rise to severe headache, excessive \nvomiting, dizziness, vertigo, confusion of sight, and possibly \nhallucinations and delirium. In some instances the whole field \nof vision is said to be blue and in others yellow. Exophthalmos \noccurs, and a peculiar blue color of the sclerotic has been quite \nconstantly noted in acute poisoning. \n\nUterus. \xe2\x80\x94 Digitalis appears to have some influence on the \nnon-striated muscular fibres throughout the body, and it thus \nacts like ergot in causing contraction of the uterus. \n\nTherapeutics of Digitalis. \n\nExternal. \xe2\x80\x94 Digitalis is sometimes used externally in the form \nof a poultice made from the leaves, and placed over the loins in \ncases of renal congestion. It has also been found serviceable \nin chilblains, in the form of a lotion in which tincture of digi- \ntalis is combined with thymol, alcohol and glycerin. \n\nInternal. \xe2\x80\x94 The most important use of digitalis is in affections \nof the heart, in which it is of very great value. It is indicated, \nin general, when the cardiac action is rapid and feeble, with \nlow arterial tension, and contra-indicated when the cardiac ac- \ntion is strong and arterial tension high. It not only slows \nand steadies the heart, but also improves the nutrition of its \nwalls by its stimulating influence on the pneumogastric nerve, \nas well as by increasing the blood supply of the heart muscle by \nrendering the systole more complete and prolonging the diastole. \nBy its action the pressure in the coronary arteries is increased, \n\n\n\n26o PHARMACOLOGY AND THERAPEUTICS. \n\nand more time allowed for their filling. The benefit derived \nfrom the drug in not too inveterate cardiac disease is often in a \nmeasure permanent, by reason of the assistance which it affords \nin the production of compensatory hypertrophy. The relief of \nthe circulation caused by it may in time bring about permanent \nnutritive changes in the heart-muscle, which is stimulated to \nsuch a marked degree by it, and dilatation is clearly less apt to \noccur when the muscular fibre is toned up and acting vigorously \nthan when it is lax and acting feebly. The constriction of the \nperipheral vessels caused by it has been thought by some to con- \nstitute a valid objection to the use of digitalis, but this may \nnot really be sufficient to seriously interfere with the increased \ncardiac power secured, while if such is the case, it may be \ncounteracted by means of drugs having an opposing action, as \nwill be more particularly dwelt upon later. \n\nCumulative Effect and Contra-indications. \xe2\x80\x94 Digitalis should \nalways be administered with caution, and it is advisable to \ncommence with small doses, which may afterwards be gradu- \nally increased, if necessary. A patient taking full doses of the \ndrug should preferably be kept in the recumbent posture. \nWhen, under its influence, the pulse has become much reduced, \non rising the heart is sometimes suddenly found unequal to \nmaintaining the circulation in face of the increased resistance \nin the arterioles, and against the force of gravity ; so that fatal \nsyncope may occur. Digitalis should always be stopped as \nsoon as symptoms of gastro-intestinal irritation supervene, or \nthe pulse becomes abnormally slow. In case the tincture is \nemployed, what is known as the fat-free tincture of digitalis \nwill be found less likely to disagree with the stomach than the \nofficial preparation. In this the fixed oil of the leaf and its free \nacids are eliminated. It must not be forgotten that digitalis \nhas a cumulative effect, and this is probably due to vaso-spasm \nand to the fact that if the drug is too closely pressed it is not \nexcreted by the kidneys as fast as it is absorbed, and conse- \nquently accumulates in the system. It sometimes happens, there- \n\n\n\nDIGITALIS. 26l \n\nfore, that, without any increase in the dose, individuals who \nhave been kept on digitalis for a long period suddenly develop \nsymptoms of poisoning by it. Such an untoward result may be \navoided if the doses are given at proper intervals; the effects \nof each being allowed to subside before the next is administered. \nThe plan has been adopted by some of stopping the remedy for \nseveral days at the end of each week. Others continue it for \nten days, then intermit for four days and begin again. It \nshould be kept up no longer than is necessary to re-establish \ncompensation. Digitalis is contra-indicated in cases where, \nwith dilatation there is extensive degeneration of the muscular \nwall, as the muscle is likely to be too weak to respond to its \nstimulus. Under these circumstances, the digitalis increasing \nthe pressure against which the heart has to contract, the most \nserious results may occur. Thus the systole becomes even \nweaker than before its administration, and cerebral anaemia, \nsyncope, and perhaps sudden death may ensue. Some individ- \nuals are unable to take digitalis at all, on account of the nausea \nwhich it produces. \n\nMitral Regurgitation. \xe2\x80\x94 It is especially valuable in those cases \nof mitral disease in which compensation (that is, the adapta- \ntion of the organs of circulation to the unusual conditions im- \nposed upon them by the valvular lesion), has begun to fail. In \nmitral insufficiency the good effect caused by it is principally \ndue to its tonic action in tending to produce a permanent sys- \ntolic condition, in consequence of which the rings of the valves \nare narrowed and brought together, and the orifice rendered \nsmaller. In this way it abolishes the effects of the distention \nand tends to lessen the insufficiency. As regards the adminis- \ntration of digitalis, cases of mitral regurgitaton have been \ndivided into three groups, as follows : ( 1 ) Those in which the \nventricle is but little enlarged, while the nutrition of its \nmuscular wall is still well-preserved, and which may be at- \ntended with perhaps no inconvenience except more or less \ndyspnoea (usually but slight) on exertion. (2) Those in which \ncardiac dropsy, of greater or less extent, is present. (3) Those \n\n\n\n262 PHARMACOLOGY AND THERAPEUTICS. \n\nin which, with extensive dilatation, there is little or no cardiac \ndropsy, but well-marked symptoms of pulmonary congestion. \nIn the last two varieties digitalis is of the greatest service. By \nincreasing the force of the left ventricle\'s contraction it causes \nthe approximation of the mitral flaps, thus reducing the amount \nof the regurgitation and diminishing venous congestion. Under \nthe action of the drug the increased force of the systole will \nthrow proportionately more blood through the aortic orifice than \nthrough the partially open and obstructed mitral valve, and, the \nlarger orifice eventually gaining on the smaller, more blood will \npass into the general circulation, and the pulmonic vessels be \nrelieved. The prolonged diastole will also be of service in \nallowing more time for the blood to flow into the left ventricle. \nThus, both the auricles and ventricles gain increased power to \nempty themselves, and the longer intervals between the pulsa- \ntions enable the former to more completely discharge their con- \ntents into the ventricles. The favorable action of the drug, \ntherefore, is seen (1) in increasing the length of the diastole \nand thus improving the nutrition of the cardiac walls; (2) in \nincreasing the tonic contraction of the heart, and thereby dimin- \nishing the size of the dilated cavity; (3) in increasing the \nforce of the pulsations; and (4) in causing more slowness and \nregularity in the cardiac rhythm. The general improvement \nin the circulation caused by it has an excellent effect in reliev- \ning the cardiac pain and distress and the dyspnoea and cyanosis \nincident to the disease, and the more a case of mitral regurgita- \ntion is characterized by the oedematous type the more efficient \nwill the drug prove. In addition, therefore, to its direct action \non the heart, the beneficial effects of digitalis are shown in a \nvariety of ways. One of the most prompt results of its ad- \nministration is a marked increase in the quantity of urine, and \nhence it is of essential service in relieving cardiac dropsy. \nHere it not only regulates the circulation, by its action on the \nheart, and causes the evacuation of the surplus fluid through \nthe kidneys, but also acts directly on the vessels by increasing \nvasomotor force. In some cases the diuretic effect of digitalis is \n\n\n\nDIGITALIS. 263 \n\nmaterially assisted by the administration in connection with it of \nan alkaline diuretic, such as potassium bitartrate or citrate, and \noccasionally it may be found that diuresis can be established \nonly after free purgation. Owing to the disordered circulation, \nsleeplessness is often a marked symptom of serious cardiac \ndisease. The normal relationship between the cerebral vessels \nand the general circulation is not maintained, and by restoring \nthis balance digitalis gives the patient ability to sleep. The \ndyspnoea is relieved by the action of the drug in establishing a \nmore efficient pulmonary circulation. By improving the venous \nflow towards the heart it will thus be of service in counteract- \ning the venous engorgement and oedema of the lungs, the right \nside of the heart, the liver, the kidneys, and the subcutaneous \ntissues so commonly met with. \n\nThere are some instances of mitral regurgitation in which \ndigitalis seems to be indicated and yet in which it proves in- \njurious rather than beneficial. This may b.e due, in a portion \nof the cases at least, to its causing too great a strain upon the \nauricle. The ventricle, as has been stated, is more affected by \nthe drug than the auricle, and as with a very patulous mitral \nvalve the blood is readily backed upon the auricle, the latter, \nalready too weak for the ventricle, cannot well withstand the \nstrain imposed upon it by the ventricle thus stimulated. Con- \nversely to the statement previously made, the less closely a case \nof mitral regurgitation approaches the oedematous type, the less \nthe benefit which is likely to be derived from digitalis in it. \n\nMitral Stenosis. \xe2\x80\x94 In most cases of mitral stenosis the same \nbenefit will attend the administration of digitalis as in cases of \nregurgitation. The increased resistance here leads to the \nsame general results as the leakage in mitral insufficiency, \nand, like the latter, it can be successfully combated by the \neffect of the drug in strengthening the heart-beat. The length- \nening of the diastole caused by it will allow more time for the \nauricle, the contracting power of which is at the same time \nincreased, to empty itself into the ventricle through the con- \nstricted orifice. The ventricle, thus more perfectly filled, sends \n\n\n\n264 PHARMACOLOGY AND THERAPEUTICS. \n\nout more blood into the systemic circulation. In addition, the \ncirculation is further improved by the stimulating effect of the \ndigitalis on the right ventricle, which enables it to overcome the \ntendency to congestion arising from the obstruction on the left \nside of the heart, and affords it greater power to force the \nblood through the lungs. It is possible, however, that the \nincreased work of the right ventricle, combined with the steno- \nsis of the mitral valve, may tend to produce congestion of the \npulmonary vessels, with the result of lessening the oxygenation \nof the blood and so interfering with the nutrition of the heart. \nOn the other hand, the slowing of the organ will afford the \nlungs more time in which to empty into the heart; so that in \nthe great majority of well-selected cases the beneficial effects \nof digitalis will greatly over-balance any possible evil ones. It \nis only necessary to add that the general amelioration of symp- \ntoms caused by it is much the same as in the case of mitral \n1 egurgitation. \n\nDiseases of the Tricuspid Valve. \xe2\x80\x94 In both tricuspid constric- \ntion and insufficiency digitalis is of service in the same manner \nas in mitral disease, and it has been found particularly useful \nin cases of regurgitation with dilated right ventricle. As a \nrule, however, it does not appear to be as beneficial in tricuspid \naffections as in those of the mitral valve. As in the case of the \nlatter, the rational signs furnish, for the most part, clearer \nindications for the use of digitalis than the physical. Thus, it \nis indicated when the cardiac action is rapid and feeble and the \ntension of the pulse low, and when there are cough, dyspnoea, \npulsating jugulars, duskiness of the countenance, scanty, high- \ncolored urine, and general dropsy. \n\nDiseases of the Aortic Valve. \xe2\x80\x94 There is a considerable diver- \nsity of opinion as to the advisability of giving digitalis in aortic \ndisease. While, however, a few authorities assert that its dis- \nadvantages are more than offset by its advantages, there can \nbe but little question that in uncomplicated aortic regurgitation \nthe drug is injurious, rather than beneficial. It increases the \nwork of the heart, and the prolonged diastole caused by it \n\n\n\nDIGITALIS. 265 \n\nfavors the return of blood through the imperfectly closed orifice \nand exposes the ventricular wall to excessive strain; so that \nthere is danger of syncope. In aortic stenosis, before com- \npensatory hypertrophy has occurred, it may sometimes be of \nservice. There is more or less obstruction to the normal \nflow of blood out of the heart, and digitalis will increase the \nventricular force, so that it may overcome the difficulty. \nAfter the impediment to the circulation caused by the valvular \ndefect has been compensated by a sufficient amount of cardiac \nhypertrophy it is not only useless, but may give rise to serious \nand even fatal results. But when aortic constriction leads to \nmitral incompetence and regurgitation, it may be given with \nadvantage. \n\nSo also in aortic regurgitation, when the marked cardiac \ndilatation apt to be caused by the condition has given rise to \nmitral insufficiency, digitalis is of great value. There are other \ncases of aortic regurgitation in which benefit is likely to result \nfrom its use; namely, those in which there is considerable dila- \ntation of the left ventricle, perhaps of sudden onset, and in \nwhich the prominent symptoms will be found to be shortness of \nbreath, precordial pain, and anxiety. While digitalis is gener- \nally contra-indicated in aortic regurgitation, especially when \nthe latter, as is often the case, accompanies aortic constriction, \nyet when the heart-muscle fails and the hypertrophy is not \ncompensatory, it is useful in both aortic insufficiency and con- \nstriction. In all cases of aortic valvular disease the effects of \nthe drug should be very carefully watched. \n\nIt has been well said that the indication for giving or with- \nholding digitalis in the treatment of valvular disease of the \nheart rests not so much upon the particular valvular lesion that \nis present as on the effects which have been produced by this \nupon the cardiac wall. A knowledge of the relation of the \nheart-muscle to the work required of it in any individual case \nis much more important, therefore, from a therapeutic point of \nview, than a recognition of the pathological condition of one \nor more of the valves. In general terms it may be stated that \n\n\n\n266 PHARMACOLOGY AND THERAPEUTICS. \n\ndigitalis is of special value in all conditions in which dilatation \nof the heart cavities has been brought about by failure of the \nmuscular wall as a result of valvular disease. \n\nConstriction of the peripheral vessels which, as has been seen, \nis one of the chief physiological effects of digitalis, is sometimes \nso marked as to interfere materially with the successful use of \nthe remedy in cardiac affections. When this is the case it may \nbe counteracted to a considerable extent by the simultaneous \nadministration of drugs causing vaso-dilatation, such as the \nnitrites. Nitroglycerin is a very useful agent for relaxing the \nspasm, and as its effect lasts but a short time while that of the \ndigitalis is prolonged, it should be given at much more frequent \nintervals than the latter. As digitalis acts very slowly and \nmaintains its effect for a long time, it may be sufficient, after \nits primary effects have been obtained, to administer it only \nonce a day, for the purpose of continuing its influence. \n\nCardiac Disease Other Than Valvular. \xe2\x80\x94 In palpitation due to \nover-exertion or heart-strain and in cardiac dilatation and \nasthenia digitalis is of decided value. In the " irritable heart \nof soldiers," a condition associated with muscular weakness and \nsupposed to be dependent upon exhaustion of the inhibitory \nnerves, it has been found better than any other remedy. When, \nhowever, cardiac hypertrophy has occurred it is of but little \nservice. The same remarks apply to the case of those indi- \nviduals who have engaged to excess in athletic exercise and \nwho are troubled with more or less shortness of breath, but \nwithout any appreciable valvular lesion of the heart. In \nthese cases the apex is often found to be a little outside its nor- \nmal position. Digitalis is frequently prescribed in tachycardia \n(rapid heart), but if acceleration of the rhythm is the only \nsymptom observed, other drugs, such as aconite, may generally \nbe substituted for it with advantage. In functional derange- \nments of the heart, usually the result of faulty digestion, char- \nacterized by irregularity and palpitation, digitalis is indicated \nand will prove of essential service if it can be given in such a \nway as not to disagree with the stomach. In many such sub- \n\n\n\nDIGITALIS. 267 \n\njects, however, on account of its liability to increase the indi- \ngestion, its administration is found impracticable, and the main \nreliance for relief of the condition must be placed on treatment \ndirected to the dyspepsia on which it depends. In certain cases \nof the functional trouble met with in highly neurotic subjects \nit is of marked benefit, but in a large number of these it fails \nto give relief. It is of great value in the weakness of the heart \nresulting from typhoid and scarlet fevers, pneumonia, rheu- \nmatism, pericarditis and other acute diseases, even if no \nvalvular lesion is present. The beneficial action of the drug is \nseen in the increased efficiency of the contractions and in the \nprolonged diastole, which allows more time for the cardiac \nmuscle to rest. In these cases its effect may often be increased \nby combining it with caffeine or ammonia. If the latter is \nused, 8 c.c. (2 fl. dr.) of the infusion of digitalis may be given, \nwith .20 c.c. (3 fll) of stronger ammonia water, in a little \nwater. It is often desirable to administer digitalis in combina- \ntion with iron; but when its fluid preparations are associated \nwith salts of the latter the mixture is rendered inky by the ac- \ntion of the iron, on the tannic acid in the digitalis. This diffi- \nculty may be obviated by adding a little diluted phosphoric \nacid, which acts as a clarifying agent, or a pill may be used \ncomposed of powdered digitalis leaves and dried ferrous sul- \nphate. Digitalis is also useful as a stimulant in cardiac weak- \nness resulting from such causes as haemorrhage, injury, poison- \ning and shock. In cases of this kind, on account of the slow- \nness of its action, it should be preceded by ammonia and alcohol \nif the symptoms are urgent; or its slowness of action may be \novercome by administering it hypodermatically. For this pur- \npose tincture of digitalis is preferable to digitalin on account of \nits being much less liable to produce local irritation. Digitalis \nis particularly indicated in poisoning by aconite, muscarine and \nthe nitrites, to which, as regards action on the heart, it is the \nphysiological antidote. In organic non-valvular diseases of \nthe heart dependent on degeneration of the cardiac muscle it \nshould be used with extreme caution, if at all; and in many \n\n\n\n268 PHARMACOLOGY AND THERAPEUTICS. \n\nsuch its effects are decidedly injurious. In fatty and other \ndegenerations, such as those resulting from alcohol and from \nchronic nephritis, the muscle is not in a condition to respond to \nthe stimulation of the drug, while the peripheral resistance is \nincreased from the vascular constriction caused by its action. \nUnder these circumstances it is possible that some of the degen- \nerated fibres may rupture. In dilatation of the right side of \nthe heart associated with chronic disease of the lungs digitalis \nmay sometimes prove of service, but this is the exception rather \nthan the rule. In the palpitation which is often such a dis- \ntressing feature of phthisis it has been found useful. \n\nBright\'s Disease. \xe2\x80\x94 In renal dropsy from acute desquamative \nnephritis (tubal nephritis) digitalis, given in the form of infu- \nsion, has been found of considerable value. While a number of \ndays may elapse before much effect is produced, the flow of \nurine is sometimes enormous, and this fact is regarded by some \nauthorities as going to show that digitalis has a direct action \non the glomeruli of the kidney. Although it is not infrequently \ngiven in acute Bright\'s disease, however, it has been questioned \nwhether, if it has the effect of causing dilatation of the renal \narteries, it is proper to increase the circulation in any acutely \ninflamed organ. Furthermore, even in the early stages the \narterial tension is somewhat raised, and it is undesirable to \nincrease this. In chronic Bright\'s disease the arterial tension \nis still further increased, and as, in addition, digitalis is an un- \ncertain diuretic where the heart is not affected, the drug is \ncontra-indicated, especially in cases of chronic tubal nephritis \nuncomplicated by cardiac disease. Still another reason why it \nshould not be employed is the fact that it retards the elimination \nof urea and the chlorides. In many cases of granular, con- \ntracted, or cirrhotic kidney, however, where the cardiac hyper- \ntrophy induced has not succeeded in overcoming the peripheral \nresistance (and in consequence there has occurred dilatation of \nthe left ventricle and of the mitral orifice, with resulting \nregurgitation), digitalis, acting in the same manner as in cases \nof mitral regurgitation without renal disease, renders efficient \n\n\n\nDIGITALIS. 269 \n\nservice. In this condition the well-known diuretic pill consist- \ning of calomel, digitalis, and squill, .06 gm. (1 gr.) each, made \nup with extract of hyoscyamus, may be used. \n\nExophthalmic Goitre. \xe2\x80\x94 It has been used to a considerable \nextent in this affection, but has proved an uncertain remedy. \nEven after a long course of it, the condition often remains un- \nimproved. Still, it would seem to be worth trying, as it is said \nsometimes to be remarkably successful in controlling the symp- \ntoms. It may be combined advantageously with iron, ergot \nand zinc bromide. Even in incurable cases the cardiac irregu- \nlarities and the dilatation of the cervical vessels are sometimes \nameliorated, while cases purely functional in character, in \nyoung subjects, have been reported to be cured by digitalis. \n\nBronchitis and Pneumonia. \xe2\x80\x94 In chronic bronchitis with pro- \nfuse secretion it has been found of more or less service in \ndiminishing the secretion and pulmonary congestion, and conse- \nquently the dyspnoea, sweating and progressive loss of strength \ncaused by them. It is also sometimes serviceable in chronic \nbronchitis with interstitial pneumonia (fibroid lung), when ac- \ncompanied with dyspnoea, secondary dilatation of the right \nheart, and general anasarca. Here, in cases in which its action \nis satisfactory, it lessens the cough and expectoration, tones up \nthe weakened and laboring heart, and reduces the oedema. In \nthe second stage of acute pneumonia, in cases where the heart, \nwith almost empty arteries, is laboring and unable to do its \nwork properly, it has proved of very great value. In any form \nof pneumonia (whether adynamic or not) when the right heart \nis becoming unable to force the blood through pulmonic capil- \nlaries which are compressed by the existing exudation, digitalis \nmay be found extremely useful. In the bronchitis and broncho- \npneumonia of children it may also prove beneficial. \n\nScarlet Fever. \xe2\x80\x94 Some authorities recommend digitalis highly \nin this disease, in which it is claimed that it reduces the tem- \nperature and maintains the action of the kidneys; thus dimin- \nishing the two principal sources of danger. From a teaspoon- \nful to a tablespoonful (according to age) of the infusion may \nbe given every two, three or four hours. \n\n\n\n27O PHARMACOLOGY AND THERAPEUTICS. \n\nIn various adynamic fevers digitalis is sometimes of the \ngreatest value in sustaining the heart\'s action during a crisis \nor period of special strain upon the organ. \n\nAlcoholism. \xe2\x80\x94 In chronic alcoholism digitalis, in moderate \ndoses, may prove of service, on account of the stimulating effect \nof the agent on the circulation. As to its value in delirium \ntremens authorities differ. While some maintain that it is \npractically useless, others assert that excellent results may be \nobtained from it, especially in cases where the pulse is very \nweak and compressible. The rest and sleep which, it is claimed, \nfollow its administration are believed to be due to the cardiac \nstimulation and increased flow of blood to the nerve-centres \ncaused by it. While enormous doses of the drug \xe2\x80\x94 15, c.c. \n( l / 2 fl. oz.) of the tincture being the usual dose \xe2\x80\x94 are generally \ntolerated in these cases, probably because by long habit the \nheart has become benumbed to the influence of stimulants, their \nuse is not altogether unattended with danger. Some who be- \nlieve in the efficacy of digitalis in this condition regard these \nlarge doses as unnecessary, and also hold that the infusion is \npreferable to the tincture. Of the infusion it is advised that \n15 c.c, or one tablespoonful, be given every four hours. Digi- \ntalis is sometimes given in the young and robust, with marked \ncerebral hyperemia, but it is probably more efficacious in pale \nsubjects with a tendency to cyanosis, in whom there is cerebral \nanaemia, with effusion and oedema. As has been mentioned, \nthere is a remarkable tolerance for digitalis in this affection, \nbut since the use of the drug is occasionally followed by fatal \nresults, it would seem to be the part of prudence to carefully \nselect the cases in which it is employed and to avoid excessive \ndoses. \n\nSpermatorrhoea. \xe2\x80\x94 Digitalis has decided value as an anaphro- \ndisiac. It has been found that it is capable of temporarily but \ncompletely annulling the activity of the sexual organs, and it is \ntherefore of service in preventing erections of the penis due to. \nlocal irritation, and also nocturnal seminal emissions and other \neffects of genital excitement. It is adapted to cases of sperma- \n\n\n\nDIGITALIS. 271 \n\ntorrhoea in which there is an atonic condition, shown by feeble \nerections, frequent emissions, and cold hands and feet (where \nit may advantageously be combined with ergot), and also to the \nspermatorrhoea of plethora. In the latter it is claimed that \nbetter results can be obtained from digitalis in combination \nwith potassium bromide than from any other treatment. In this \ncondition 15 c.c. { l / 2 fl. oz.) of infusion of digitalis, with 1.20 \ngm. (20 gr.) of potassium bromide may be given night and \nmorning for a week, and after that at night only. \n\nHemorrhage. \xe2\x80\x94 Digitalis is occasionally prescribed as a \nhaemostatic, but is unreliable because the increased blood-pres- \nsure to which it gives rise may excite still greater haemorrhage. \nWhile it causes constriction of the vessels, it also accelerates \nthe flow of blood through them. It may sometimes prove use- \nful, however, in haemorrhage from a large surface, as in the \nhaemorrhagic diathesis and in pulmonary haemorrhage. It has \nbeen found of advantage in cases of haemorrhage in the first \nstage of pneumonia and in haemoptysis due to disease of the \nmitral valve. \n\nUterus. \xe2\x80\x94 If, as seems to be the case, digitalis has the power \nof inducing uterine contractions, it would naturally be expected \nthat it would be of service in haemorrhages of that organ. In \npractice it has been found in cases of menorrhagia that shortly \nafter a large dose of the infusion has been taken severe pains \nresembling those of labor come on. There is a momentary \nprofuse discharge of blood and clots, if the latter be present, \nand this is followed by arrest of the flow for hours. The drug \nis stated to be particularly advantageous in menorrhagia or \nmetrorrhagia occurring in plethoric individuals and in cases \nwhere the haemorrhage is dependent upon mitral disease. Both \nmitral regurgitation and stenosis, by increasing the blood-pres- \nsure in the uterine veins, sometimes give rise to menorrhagia \nof a peculiarly obstinate kind. Digitalis has also been used \nsuccessfully to arrest post-partum haemorrhage, but is much in- \nferior to ergot in this regard. \n\nAntagonists. \xe2\x80\x94 Reference has already been incidentally made \n\n\n\n272 PHARMACOLOGY AND THERAPEUTICS. \n\nto the antagonism between digitalis and aconite and other \ndrugs. Aconite, while it also slows the heart, does so by \ndilating the peripheral vessels and lowering the blood-pressure, \nand is a cardiac poison; directly lowering the action of the \ncardiac motor ganglia and thus weakening instead of strength- \nening the pulsation. Aconite acts quickly and digitalis very \nslowly, and this interferes to some extent with the efficacy of \nthe latter in poisoning by the former. Opium, aconite, mus- \ncarine, lobelia, the nitrites and other agents antagonize some of \nthe actions of digitalis, but the antagonism does not extend \nthroughout the whole range of their effects. Saponin and \nsenegin, to which it is closely allied, are considered to be most \ncomplete physiological antagonists to digitalis. Tannin is the \nchemical antidote. \n\nSTROPHANTHUS. \n\n1. STROPHANTHUS.\xe2\x80\x94 Strophanthus. Dose, 0.065 gm. (65 mil- \nligm.); 1 gr. \n\nPreparation. \nTinctura Strophanthi. \xe2\x80\x94 Tincture of Strophantus. Dose, \n0.5 c.c.; 8 Til. \n\n2. STROPHANTHINUM.\xe2\x80\x94 Strophanthin. Dose, 0.0003 gm. (0.3 \nmilligm.); f fo gr. \n\nAction of Strophanthus. \n\nExternal. \xe2\x80\x94 It has no action on the skin, but causes marked \nirritation of mucous membranes. Locally strophanthin is an \nanaesthetic, rapid in action and durable in effect, but so irritating \nthat its application to the eye, for instance, is liable to set up \ninflammation or even ulceration. \n\nInternal. G astro -intestinal Tract. \xe2\x80\x94 In small doses it pro- \nmotes appetite and digestion, and in larger ones it does not \nordinarily cause gastro-intestinal derangement. It is true that, \nas in the case of digitalis, vomiting and diarrhoea are sometimes \noccasioned by strophanthus, but it will generally be found that \nthese disturbances result from preparations from which the fixed \n\n\n\nSTROPHANTHUS. 273 \n\noil contained in the seeds has not been extracted. The tinct- \nure, prepared from strophanthus kombe (pubescent variety), \ndoes not give rise to them; while fluidextracts made from this \nand other species cause digestive disturbances varying from \nsimple inappetence, nausea and vomiting to abdominal pain and \ndiarrhoea. Strophanthin, used hypodermatically, is not irritat- \ning to the digestive tract. \n\nMuscles. \xe2\x80\x94 Strophanthus is essentially a muscle poison, as \nshown in experiments upon the frog with the African kombe \narrow poison, which is made from the plant. Its first effect is \nto increase the tonicity of the muscular fibre, and when the \nmuscle dies it does not go into relaxation, but passes directly \nfrom life into post-mortem rigidity. It occasions stiffness of \nthe limbs and afterward complete loss of voluntary movement. \nIts influence is more generalized than that of digitalis, which, \nwhile acting on all the muscular tissue, has a more special ac- \ntion on the heart and the muscle of the arterial wall. The \nphysiological as well as the toxic action of strophanthus are \nmainly exerted on both the heart and the voluntary muscles, so \nthat when full effects are produced on the cardiac muscle the \ngeneral muscular system is decidedly affected. In toxic doses \nit paralyzes muscular tissue, not through the nervous system, \nbut by direct contact, and when contractility has once been \ndestroyed by its action, no stimulus will reexcite it. \n\nHeart. \xe2\x80\x94 Strophanthus being believed to exert its action upon \nmuscular tissue by direct contact through the blood, and the \nheart naturally receiving a much larger supply of blood in the \nsame length of time than any other muscle, that organ is \npromptly and decidedly influenced by the drug. By proper \nregulation of the amount administered the heart may be acted \nupon while the muscles in general remain practically unaffected. \nIn moderate doses strophanthus has the same effect on the heart \nas digitalis, stimulating the tonic contraction of the cardiac \nmuscle, increasing the force of the ventricular systole, prolong- \ning the diastole, lowering and regulating, the rhythm, and caus- \ning a pronounced though slow rise in the arterial pressure by \n19 \n\n\n\n274 PHARMACOLOGY AND THERAPEUTICS. \n\nthe increased force in the cardiac contractions. While some \nauthorities deny that it acts on the pneumogastric like digitalis, \nand others assert that it has a similar influence on the inhibitory \nmechanism, there can be no question that it does have the effect \nof slowing the rate of the beat. Apparently this is a result \nof its direct cardiac action. If it has any influence at all upon \nthe innervation of the heart, this would seem to be but tem- \nporary. In large amounts the drug paralyzes the heart, leaving \nits muscle completely rigid for the reason given above. \n\nVessels. \xe2\x80\x94 The latest researches show that strophanthus, \nthrough its characteristic action on all muscular tissue, includ- \ning that in the arterial walls, has a decided influence upon the \nvaso-motor system; but the constriction of the peripheral ves- \nsels due to it is considerably less marked than that caused by \ndigitalis. This is the most important point of difference be- \ntween the two agents. Under the effect of digitalis, which \npowerfully contracts the vessels, and thus occasions a greater \nrise of blood-pressure than strophanthus, the work of the heart \nis much increased by the resulting resistance, and for this rea- \nson the latter is the safer remedy of the two. \n\nKidneys. \xe2\x80\x94 Strophanthus is an efficient diuretic, increasing the \nquantity of urine not only in cases of cardiac disease, but also \nin healthy men and animals, and this diuretic influence is \napparently exerted not only through the increased force of the \nheart and the effect on the circulation caused by it, but also \nthrough direct action upon the secreting structure of the kid- \nneys. The correctness of this view seems to have been con- \nfirmed by the renal lesions observed in poisoning by strophan- \nthus and by oncometric experiments indicating that it produces \nno marked congestion of the kidneys. \n\nNervous System. \xe2\x80\x94 As has been stated, the pronounced effects \nwhich it has upon the heart and muscles are in all probability \ndue solely to its direct action by contact, through the blood, and \nnot through the agency of any influence it exerts upon the \nnervous system. On the latter, so far as known, it has no \naction. \n\n\n\nSTROPHANTHUS. 275 \n\nRespiration. \xe2\x80\x94 Strophanthus appears to have no action on \nthe respiratory centres. In experiments upon frogs it was \nfound that the respiration continued for some length of time \nafter the heart stopped, and the conclusion that the cessation of \nrespiration was due to muscular influence was reached. \n\nTemperature. \xe2\x80\x94 It is antipyretic within a limited range, be- \ncause under its administration the consumption of oxygen is \nsmaller and the processes of combustion are depressed. \n\nAbsorption and Elimination. \xe2\x80\x94 Since its active principle is \nsoluble in less than its own weight of water, strophanthus \npossesses the diffusibility of a soluble crystalloid; hence the \nprompt results from its administration. Again, its active prin- \nciple escapes with the urine, so that we also have ready elimi- \nnation. This, however, is somewhat slower than its absorption, \nand there is, therefore, an overlapping of effect from too fre- \nquently repeated doses. Habit does not seem to impair the \ntherapeutic usefulness of the drug. \n\nTherapeutics of Strophanthus. \nHaving the same general effects, strophanthus is employed \nto fulfil the same indications as digitalis. On the heart it acts \nmore promptly, though probably less permanently than the \nlatter. As the indication is generally as much to diminish the \nresistance to the heart as to increase the amount of work which \nthe organ is capable of doing, strophanthus has the great advan- \ntage over digitalis of not greatly constricting the arterioles. \nIf, therefore, the heart is feeble and the arterial tension high ; \nstrophanthus is decidedly to be preferred, unless some agent, \nlike nitroglycerin, which has the effect of causing dilatation of \nthe peripheral vessels should be given in connection with the \ndigitalis. In those cases where digitalis does harm by so over- \nstimulating the ventricle that the auricle cannot thoroughly \nempty itself, and hence becomes congested, strophanthus is \nsometimes of the greatest service. Where extensive degenera- \ntion of the arterial coats is present, so that the increased pres- \nsure in the interior of the vessels may lead to rupture of their \n\n\n\n276 PHARMACOLOGY AND THERAPEUTICS. \n\nwalls, strophanthus, as causing a less extensive rise in the \nblood-pressure than digitalis, should be employed if the admin- \nistration of a cardiac stimulant is called for. Its superiority \nas a diuretic renders it particularly valuable in oedema of the \nlungs or cases of general cardiac dropsy. It is often given \nadvantageously in combination with digitalis, especially where \nfree diuresis is desired, and is also much relied upon to take \nthe place of the latter where its administration has to be sus- \npended either on account of gastric irritation or for the pre- \nvention of cumulative effects. It is of great value in the car- \ndiac diseases of children, in which digitalis is very apt to fail, \nand excellent results may also be obtained with it in corpulent \nindividuals. Of especial importance should be considered its \nadministration for the weak hearts of anaemia and chlorosis, in \norder that nutrition may be improved; for so-called irritable \nhearts, where the pain and palpitation are relieved; for de- \nbilitated hearts, associated with dyspeptic symptoms, and par- \nticularly flatulence (which usually disappears) ; and in the aged \nwhen there is vertigo as the result of cerebral anaemia. It is also \nsaid to be particularly useful in the progressive heart-failure \nof elderly patients, with attacks of dyspnoea simulating angina. \nThe advantages which strophanthus possesses over digitalis \nmay be summoned up as (1) greater rapidity, modifying the \npulse-rate within an hour; (2) less marked vaso-constrictor \neffects; (3) greater diuretic powers; (4) no disturbance of \ndigestion from properly made preparations; (5) absence of so- \ncalled cumulation; (6) greater value in children; and (7) \ngreater safety in the aged. \n\nThe therapeutic indications for the use of strophanthus are, \nthen: (1) Rapidly recurring cardiac systoles of lessened force \nand irregular rhythm. We get, first, a more vigorous con- \ntraction of the ventricle, with a slowing of the pulse-rate and \nconsequently a lengthening of the diastole, which is the period \nof rest for the heart; next comes the disappearance of irregu- \nlarity of rhythm; and, lastly, from improved intracardiac \nnutrition, a permanent strengthening of the heart-muscle. (2) \n\n\n\nSTROPHANTHUS. 277 \n\nThe comparative insignificance of its vaso-motor effects enables \nus to use this remedy in those instances of permanent high \ntension which are met with in some forms of Bright\'s disease, \nin arterio-sclerosis, and in the rigid arteries of the aged. (3) \nWhenever diuresis can be promoted by increased blood-tension \nresulting from more vigorous cardiac contractions this may be \nexpected from the use of this remedy. (4) The rapidly ap- \npearing effects of its administration, together with its regular \nelimination, make it the drug of choice when the symptoms are \nurgent. (5) The absence of digestive disturbances from ther- \napeutic doses and slight likelihood of habituation to its admin- \nistration make it important when long-continued use is neces- \nsary. It should, therefore, be the remedy of choice in all cases, \n\n(1) in which we wish to establish compensation; (2) of arter- \nial degeneration in which a remedy which causes more ener- \ngetic cardiac contraction is required; (3) of cardiac disease \nwhen a diuretic is necessary; (4) of weak or irritable hearts; \n(5) of cardiac disease in childhood or old age. \n\nThe instances in which failure will follow its administration \nare those of (1) advanced degeneration of the myocardium; \n\n(2) extreme mechanical obstruction to the circulation from \nvalvular incompetency or obstruction; and (3) a combination \nof these. It will readily be understood that in fully com- \npensated hearts this \xe2\x80\x94 as well as other drugs of the same type \xe2\x80\x94 \nis unnecessary, and when over-compensation exists it will likely \naggravate the condition. It may be said, therefore, that success \nin the administration of strophanthus requires: I. An active, \nwell-made preparation from a reliable source. 2. Avoidance of \nits use in fully or over-compensated hearts and in those which \npresent advanced muscular degeneration or mechanical defects \nof high degree. 3. The use of not too large or too frequently \nrepeated doses. Careful observation has shown that the dose \nof 0.30 c.c. (5 HI) of a reliable tincture three or, possibly, four \ntimes a day is sufficient. \n\nStrophanthus has been found of service in exophthalmic \ngoitre, and, administered in combination with hoang-nan, it \n\n\n\n27 8 PHARMACOLOGY AND THERAPEUTICS. \n\nhas also given good results in psoriasis, especially in cases at- \ntended with marked congestion of the integument. \n\nADONIDIN. \n\nADONIDINUM.\xe2\x80\x94 Adonidin (not official). Dose, 0.01 to 0.02 gm.; \n% to y 3 gr. \n\nAction of Adonidin. \nAdonidin has the same physiological action as digitalis, and \nproduces its effects more promptly than the latter. In the frog- \nit causes tonic contraction of the heart and slows the pulse-rate. \nIt increases the force of the systole, and finally produces arrest. \nIn mammals it slows and strengthens the heart\'s action, and \nwhilst diminishing the pulse-rate, very markedly increases the \narterial pressure. It raises the general vascular tension by \ncausing constriction of the arterioles, but the contraction is not \nso persistent as under the use of digitalis. The slowing of the \nrate is no doubt due to stimulation of the inhibitory nerves, \nsince it is prevented by their previous section, while the rise \nin arterial pressure is chiefly attributable to the direct action of \nthe drug on the heart. Under the continuance of full doses the \nprimary rise is followed by a marked depression, and this late \nfall is believed to be the result, at least in great part, of vaso- \nmotor paralysis. In toxic doses it is found to paralyze the \nterminals of the pneumogastric, excite the accelerator apparatus \nof the heart, and finally cause paralysis of the cardiac motor \nnerves. Adonidin renders the respiratory movements more \nfull and less frequent. It also probably increases the flow of \nurine, its diuretic action being due to its effect on the circula- \ntion rather than to any direct influence on the secreting struct- \nure of the kidneys. In many subjects it seems to cause more or \nless nausea, vomiting and purging. It is rapidly eliminated \nfrom the system, and therefore does not appear to have any \ncumulative tendency. \n\n\n\nSQUILL. 279 \n\nTherapeutics of Adonidin. \nIt is used for the same kinds of cases as digitalis. It has been \nfound less certainly beneficial than the latter in valvular disease \nof the heart, but may prove a satisfactory substitute for it in \ncases in which that drug fails or is not well borne. As its action \nis more prompt, adonidin sometimes serves a useful purpose in \nbeginning the regulation of the cardiac movements before digi- \ntalis has had time to produce its effect. In addition to cases of \norganic disease, it has been found of service in functional \nirregularity, and especially in palpitation without any lesion of \nthe heart. In combination with the bromides it is also said to be \nused with success in the treatment of epilepsy. The irritating \nproperties of this drug prevent its subcutaneous use, and even \nprolonged administration by the mouth. \n\nSQUILL. \nSCILLA.\xe2\x80\x94 Squill. Dose, 0.125 gm. (125 milligm.) ; 2 gr. \n\nPreparations. \n\n1. Acetum Scillae. \xe2\x80\x94 Vinegar of Squill. Dose, 1 c.c; 15 TT\\.. \n\n2. Fluidextractum Scillae. \xe2\x80\x94 Fluidextract of Squill. Dose, 0.1 \nc.c; 1% Til. \n\n3. Syrupus Scillae. \xe2\x80\x94 Syrup of Squill. Dose, 2 c.c; 30 Til. \n\n4. Syrupus Scillae Compositus. \xe2\x80\x94 Compound Syrup of Squill. \n(Hive Syrup.) Dose, 2 c.c; 30 Til. \n\n5. Tinctura Scillae. \xe2\x80\x94 Tincture of Squill. Dose, 1 c.c; 15 tt\\.. \n\nAction of Squill. \nThe application of squill to the external integument is capable \nof producing the characteristic effects of the drug on the system. \nIt affects the heart and arterial system in the same manner as \ndigitalis, but its action on the heart, and especially on the periph- \neral vessels, is less marked and decidedly less persistent than \nthat of digitalis. The increased arterial pressure caused by it \nis due, it is believed, partly to the augmented cardiac force \nand partly to a peripherally produced vaso-motor contraction. \n\n\n\n280 PHARMACOLOGY AND THERAPEUTICS. \n\nIt is a much more violent gastro-intestinal irritant than digi- \ntalis ; causing, in sufficient doses, marked abdominal pain, vomit- \ning, purging, and even fatal gastro-enteritis. Even small doses \nare liable to cause nausea. Another pronounced action of \nsquill is that of an expectorant, and this, like its effect to a \ngreat extent on the gastro-intestinal tract, is probably produced \nduring excretion. In passing through the bronchial mucous \nmembrane it sets up an irritation which stimulates the blood- \nvessels of the part, and thus increases the functional activity oi \nthe membrane. In addition to these actions, it is an efficient \ndiuretic, promoting the activity of the renal circulation, and \nlargely increasing the watery portion of the urine. It is stimu- \nlating to the kidneys, and in excessive doses gives rise to such \nan amount of irritation as to cause strangury and diminished \nsecretion, the urine often being bloody and albuminous. The \nrenal inflammation may even be so violent as to result in com- \nplete suppression. \n\nTherapeutics of Squill. \nSquill has been called the " harsh digitalis." In cardiac dis- \nease, with or without dropsy, it is not prescribed alone, as \ndigitalis, strophanthus and other heart stimulants are more effi- \ncient, as well as less toxic, in their effects. It may, however, be \ncombined with digitalis with advantage, especially in dropsical \ncases, and a very favorite diuretic pill is composed of squill, \ndigitalis and calomel, .06 gm. (1 gr.) each, made up with ex- \ntract of hyoscyamus, .09 gm. (1^ gr.)- This is sometimes \nknown as Guy\'s triplex pill. Squill was formerly much in \nvogue in the treatment of renal dropsy, but is now rarely or \nnever employed in cases of this kind, on account of its irritating \neffect upon the kidneys. It is valuable in dropsy not dependent \non renal disease when the system is in an atonic condition, and \nit has been found of service, especially in combination with \ncalomel, in serous effusion into the pleura and the pericar- \ndium resulting from chronic inflammation of the parts. When \nthe stomach is intolerant of the drug, it may be sdmin- \n\n\n\nCONVALLARIA. 28 1 \n\nistered by rubbing its tincture, with that of digitalis, into the \nskin, or by applying compresses saturated with these to the \nabdomen, and covering them with an impermeable dressing. \nSquill is principally used, however, in subacute and chronic \nbronchitis and emphysema, and, given in suitable doses and in \nconnection with other appropriate drugs, is a most valuable \nremedy. It is more particularly indicated when the sputa are \ntenacious and coughed up with difficulty, and it is therefore \ndesirable to employ with it an agent which increases the expira- \ntory force. As a stimulating expectorant, it is especially useful \nin the second stage of bronchitis, when secretion is scanty or so \nexcessive as to need proper stimulation of the mucous mem- \nbrane to bring on a healthy action. It should not be given in \ncases of phthisis or other chronic disease where there is any \ngastric irritation. Neither the syrup nor the vinegar of \nsquill should be prescribed with ammonium carbonate, as the \nlatter is incompatible with acetic acid, which is contained in \nboth these preparations. \n\nCONVALLARIA. \n\nCONVALLARIA.\xe2\x80\x94 Convallaria. (Lily of the Valley.) Dose, 0.500 \ngm. (500 milligm.) ; 7V 2 gr. \n\nPreparation. \nFluidextractum Convallariae. \xe2\x80\x94 Fluidextract of Convallaria. \nDose, 0.5 c.c; 8 Ttl. \n\nAction of Convallaria. \nIn moderate doses convallaria has been found to at first slow \nthe heart and raise the arterial tension, while subsequently the \npulse is somewhat quickened. Section of the pneumogastric \ndoes not interfere with these actions. At the same time that the \nheart is thus affected, respiration is deepened and to some ex- \ntent slowed. It is a decided cathartic, increasing peristalsis and \nhaving an action on the bowels intermediate between those of \nscammony and aloes. It also acts to some extent on the kidneys. \n\n\n\n282 PHARMACOLOGY AND THERAPEUTICS. \n\nUnder toxic doses the respiratory movements become very full \nand slow, the reflex function of the cord is abolished, and the \nheart is paralyzed. Death is caused by the direct action of the \ndrug on the heart. It appears to have no cumulative action. \n\nTherapeutics of Convallaria. \nConvallaria has been used extensively in the same range of \ncases as digitalis. It is said to act more powerfully upon the \nright heart than the latter, but this is probably not true. The \nreports of the results of its employment in cardiac disease, how- \never, have been by no means uniformly favorable, and a more \nextended experience seems to indicate that this drug is very \nunreliable. It is, however, free from most of the undesirable \neffects of digitalis, to which reference has been made, and in \ndropsical cases especially it has sometimes proved of service. \nSome writers assert that it is particularly useful in cases of \narhythmia and " cardiac hurry." At the present time con- \nvallaria is employed very little. \n\nCAFFEINE. \nCAFFEINA.\xe2\x80\x94 Caffeine. (Theine. Guaranine.) Dose, 0.065 gm. \n(65 milligm.); 1 gr. \n\nPreparations. \n\n1. Caffeina Citrata. \xe2\x80\x94 Citrated Caffeine. Dose, 0.125 gm. \n(125 milligm.); 2 gr. \n\n2. Caffeina Citrata Effervescens. \xe2\x80\x94 Effervescent Citrated Caf- \nfeine. Dose, 4 gm.; 60 gr. \n\n3. Pulvis Acetanilidi Compositus. \xe2\x80\x94 Compound Acetanilide \nPowder. Dose, 0.500 gm. (500 milligm.) ; 7V 2 gr. \n\nUnofficial Preparations. \nCaffeinae Sodio-Benzoas. \xe2\x80\x94 Caffeine Sodium Benzoate. Dose, \n0.125 to 0.60 gm.; 2 to 10 gr. \n\nCaffeinae Sodio-Salicylas. \xe2\x80\x94 Caffeine Sodium Salicylate \nDose, 0.125 to 0.60 gm.; 2 to 10 gr. \n\n\n\nCAFFEINE. 283 \n\nAction of Caffeine. \n\nExternal. \xe2\x80\x94 Roasted coffee, especially in the form of powder, \nappears to have some disinfecting and deodorizing power. \n\nInternal. Alimentary Canal. \xe2\x80\x94 Coffee in small amounts is a \nstomachic tonic, and generally has a somewhat laxative effect; \nincreasing (probably by reason of its volatile oils) the peristaltic \nmovements of the intestine. The so-called biliousness sometimes \ncaused by its habitual use is probably occasioned by the em- \npyreumatic oil, caffeol or caffeone, which is one of its constitu- \nents and which, if taken alone, is likely to disorder the diges- \ntion. The excessive use of both tea and coffee is liable to give \nrise to indigestion, acidity and heart-burn. Such use of tea is \nmore prone than that of coffee to produce injurious effects in \nthe alimentary canal, as well as elsewhere, partly perhaps be- \ncause, as a rule, more of the former than of the latter is con- \\ \nsumed, and also because the effects of the continued action of \nthe tannin in the tea are no doubt even more deleterious than \nthose of caffeine. They not infrequently induce chronic con- \nstipation and cause very serious interference with digestion. \nThe teeth of tea-tasters are very liable to decay. \n\nHeart. \xe2\x80\x94 From recent careful experiments on the dog\'s heart \nthe effect of caffeine appears to consist in (1) an acceleration \nof the rhythm without further change; (2) a shortening of the \nmovements, commencing in the auricle and spreading to the \nventricle; and, in large doses, (3) auriculo-ventricular arhyth- \nmia, terminating in fibrillary contractions of the auricle, and \nfinally of the ventricle. The primary acceleration would seem \nto be due to stimulation of the most irritable part of the heart, \nthe so-called excito-motor apparatus, and as no further change \nin the movements is seen, the action of the drug at this stage \nappears to be confined to this area. The second change may \nbe due in part to the acceleration, and thus be considered a \nsecondary effect of the increased irritability of the excito-motor \narea; but it may also be ascribed, it is thought, to the action \nof the caffeine on the muscle of the auricle and ventricle, and \nmay thus indicate that the influence of the drug has extended \n\n\n\n284 PHARMACOLOGY AND THERAPEUTICS. \n\nto these less susceptible parts of the heart. The third stage, that \nof arhythmia, is believed to be due to the ventricular irritability \nhaving been so greatly increased as to give rise to an idioventri- \ncular rhythm. The interference of the two rhythms then ex- \nplains the major part of the variation in the strength of systole \nand the extent of diastole. The idioventricular rhythm indi- \ncates that the characteristic stimulant action on the cardiac \nmuscle has extended to the ventricle. When this has attained \na sufficient height it leads to fibrillary contractions in the ven- \ntricle ; the previous appearance of these in the auricle appearing \nto indicate that the stimulant influence spreads to this before \nit reaches the ventricle. The action of caffeine on the mamma- \nlian heart thus appears to consist in a descending stimulation, \nwhich begins in the excitomotor area at the junction of the \nauricle and great veins, and extends into the auricles and finally \nto the ventricles. The effects can be explained by direct action \non the muscle, without the necessity of appealing to any ner- \nvous apparatus, and these experiments do not support the idea \nthat the nervous apparatus of the heart is involved in the effects. \nComparing the action of caffeine on the dog\'s heart with that \nof digitalis, it is found that, as far as the direct action on the \nheart is concerned, they resemble each other in both affecting \nonly the heart muscle. But while in the case of digitalis the \nearliest changes seen are in the strength of systole and extent \nof diastole in the ventricle and auricle, the stimulation exer- \ncised by caffeine begins in the excitomotor area and descends \nto the auricle and then to the ventricle, and its effects on the \nrhythm (as far as these are caused by direct action on the \nheart) are of secondary importance. Furthermore, the pri- \nmary changes induced by digitalis are not so much evidenced \nby increased irritability of the parts affected as by increased \ncontractibility and lessened dilatation (increased tone), while \nthere is no evidence of such a change in the late stages of \ncaffeine poisoning, in which the ventricle is directly affected. \n\nVessels. \xe2\x80\x94 Caffeine stimulates the vaso-motor centre, and \nunder its influence the blood-vessels are therefore contracted, \n\n\n\nCAFFEINE. 285 \n\ncausing a marked rise in the arterial pressure. The muscle-fiore \n\nin the walls of the vessels, in common with the muscles in gen- \neral, is also acted upon by the drug. Under small doses the \nconstriction of the arteries, which is of comparatively short \nduration, is followed by an expansion of much longer duration, \nbut with larger doses the subsequent dilatation does not occur. \nAfter repeated intravenous injection caffeine is found to fail \nto produce vascular dilatation, and soon each injection is fol- \nlowed only by vascular constriction. It has been demonstrated \nthat the vaso-constriction caused by the drug is principally the \nresult of central stimulation by the fact that this effect is very \nlargely interfered with by chloral, which paralyzes the vaso- \nmotor centre. That the rise of pressure is not due to increased \ncardiac energy is shown by its absence in preparations of the \nisolated mammalian heart. \n\nMuscles. \xe2\x80\x94 Small doses increase the excitability of the muscles,\\ \naugmenting the quickness and force of their contraction. Under \nlarger doses the height of the contraction of the muscle is less, \nthe maximum load it is capable of lifting is smaller, and the \nmuscle is exhausted by tetanus more quickly than a normal \nmuscle. The contraction then becomes smaller and smaller, \nand the muscle gradually passes into rigor. In mammals much \nlarger quantities of the drug are required to induce rigor than \nto paralyze the respiration. \n\nRespiration. \xe2\x80\x94 Respiration is quickened and strengthened by \ncaffeine, which has a stimulating effect upon the respiratory \ncentre in the medulla. This effect is shown in the improvement \nin the respiration caused by it in cases of poisoning by alcohol, \nopium and other drugs, but it is much less marked in the normal \ncondition of the system. In toxic doses it produces first quicken- \ning and then paralysis of the medullary centre. \n\nNervous System. \xe2\x80\x94 Caffeine is a rapidly-acting stimulant to \nthe cerebrum, medulla oblongata, and spinal cord. In its effect \nupon the cerebral centres the blood-supply would seem to bear \nan important part; it being probable that the circulation in \nthe brain is affected indirectly by the changes produced in the \n\n\n\n286 PHARMACOLOGY AND THERAPEUTICS. \n\ngeneral circulation. Any agent which causes general arterial \nconstriction will tend to passively induce dilatation of the \ncerebral vessels, and hence it may be supposed that such dila- \ntation accompanies the general vaso-constriction due to the \nexhibition of caffeine. In the cerebrum the drug affects the \npsychic functions, and is without doubt the most certain and \neffective stimulant that we have to the nerve centres connected \nwith the intellectual faculties. Consciousness is enjoyed to the \nfullest extent, all drowsiness is banished, and the highest mental \npowers have full play. The cerebral stimulation caused by it \ndiffers from that due to opium in that the reasoning faculty is \nnot less affected than the imagination and in that the excitation \nis not incoordinate. Caffeine acts on the same parts as are \nfirst affected by alcohol and other agents of its class; but alters \nthem in the opposite direction. They are the centres which are \nalso first paralyzed, to some degree at least, by morphine and \ncannabis indica. Caffeine is therefore an efficient antidote for \nthese, and especially for alcohol, since the medullary and spinal \neffects are also antagonistic. The sleeplessness often caused \nby tea and coffee is probably due in part to stimulation of the \nnerve centres and partly to the indirect effect of the dilatation \nof the cerebral blood-vessels caused by the constriction of the \nvessels of the body generally. In addition to tea and coffee, \ncocoa, coca, kola, guarana and the various other substances \nwhich have long been in use as beverages in different parts of \nthe world all contain either caffeine or analogous alkaloids. \nThey impart a sense of grateful refreshment, relieve fatigue, \nmental and muscular, and increase the capacity for physical \nexertion and endurance. The effect of caffeine on the acuteness \nof the senses is shown by the greater accuracy of touch under \nits influence. While the results of the drug taken in moderate \nquantity are of distinct benefit in intellectual work, larger \namounts are apt to render connected thought more difficult, as \nimpressions follow each other so rapidly that the attention \nbecomes distracted. These larger doses often over-stimulate \nthe cerebral circulation, causing pain and a sense of fullness \n\n\n\nCAFFEINE. 287 \n\nin the head, restlessness and insomnia, with more or less con- \nfusion of mind, or even hallucinations and delirium. Sometimes \ntinnitus aurium and flashes of light before the eyes indicate \nderangement of the special senses. v\'The pulse becomes rapid \nand irregular, and cardiac uneasiness or palpitation may occur; \nwhile in some instances convulsive movements of the hand \nand tremor in different parts of the body are noted. It is stated \nthat such effects as these are induced only with difficulty in \nhabitual tea or coffee drinkers; so that the continued use of \nsmall quantities of caffeine would seem to give rise to tolerance. \nToxic doses, administered to animals, occasion rise of tem- \nperature, convulsions and general paralysis, but the temperature \ndeclines when paralysis supervenes. In the medulla, while \ncaffeine has a marked stimulant effect on the activity of the \nvaso-motor and respiratory centres, it exerts practically no \naction on the vagus centre. In the spinal cord it excites reflex \nactivity. It causes convulsions in the frog, and that these are \nnot of cerebral origin is shown by the fact that section of the \nupper cord does not prevent them. On the other hand, destruc- \ntion of the cord does have the effect of preventing them, so \nthat they are no doubt spinal. The effects of caffeine on the \ncord are reflex irritability, then tremors, and finally tetanus. \nThey closely resemble those of strychnine, but are very much \nsmaller, and occur only with relatively larger doses. This \ntetanus, which, like that of strychnine, is located in the cord, \nshows the same intermittent character and also involves the \nrespiratory muscles in the same manner. It occurs both in \nmammals and frogs, but the dose required for the former is \nconsiderably larger than that necessary to give a vaso-motor, \ncardiac or diuretic effect. The motor nerves appear not to be \naffected by caffeine, but the sensory nerves are apparently \nslightly influenced by it. \n\nKidneys. \xe2\x80\x94 Caffeine, in small doses, usually has a marked \neffect in increasing diuresis. It is a matter of common obser- \nvation that both tea and coffee augment the flow of urine to a \nmuch greater extent than the same amount of water, and this \n\n\n\n288 PHARMACOLOGY AND THERAPEUTICS. \n\nhas been shown to be due to the caffeine which they contain. \nIt was formerly supposed that the diuretic influence of this \nagent was principally owing, as in the case of digitalis, to an \nincrease of cardiac energy which improved the renal circula- \ntion, but this is now known not to be so, since it has been shown \nthat when changes in the circulation are prevented from taking \nplace the same increased flow of urine occurs under its influ- \nence. While the vascular expansion following the primary \nconstriction of the vessels \'caused by small doses of the drug no \ndoubt assists in the promotion of diuresis, the latter is mainly \ndue to the direct action which it has in stimulating the renal \nepithelium. The increased activity of the secretory cells oc- \ncasioned by it is also accompanied by a slight dilatation of the \nvessels of the part which is analogous to the vascular dilatation \nin a muscle undergoing contraction. But this tendency to pro- \nduce a dilatation of the renal vessels is always liable to be \ncounteracted by the pronounced action of the caffeine on the \nvasomotor centre, which, on the other hand, tends to constrict \nthe vessels. Such constriction has the effect of diminishing, \nand many even inhibit, the secretion of urine. Sometimes, \ntherefore, it is found that the administration of caffeine not \nonly produces no diuresis, but has the directly contrary effect; \nfor if the contraction of the arterioles caused by it is great \nenough, the epithelial cells, however active they may be, can, \nowing to the interference with their blood-supply, secrete but \nlittle. Consequently, it will be seen that caffeine is by no \nmeans a certain diuretic, and in cases where it thus fails meas- \nures must be taken which will prevent its action on the central \nnervous system. Under the diuretic effects of caffeine both the \nsolids and the fluids in the urine are increased, but the former \nto a less extent than the latter. It is said that the excretion \nof alkalies, and especially sodium, is augmented even out of \nproportion to the diuresis. \n\nMetabolism. \xe2\x80\x94 The effect of caffeine upon tissue waste has \nbeen much investigated, with very contradictory results. Ac- \ncording to some of the latest and best authorities it causes a \n\n\n\nCAFFEINE. 289 \n\nslight rise of temperature, partly by its action on the central \nnervous system, and more particularly by its direct muscular \neffects. In consequence of this, it is claimed, it also increases \nthe metabolism, that is, the production of urea and carbon- \ndioxide. If this view is correct, the older one that it lessens \nmetabolism is consequently erroneous. Caffeine is excreted in \nthe urine in small quantities, but a considerable proportion of it \nis probably decomposed, with the formation of xanthin, which \nis further broken up into urea. \n\nTherapeutics of Caffeine. \nHeart. \xe2\x80\x94 As caffeine cannot be administered subcutaneously \nalone, owing to its decomposition in the presence of water, it \nis necessary, for this purpose, to combine it with sodium salicy- \nlate or benzoate. The following solution will answer well for \nhypodermatic use: Caffeine, 40, sodium salicylate, 30, distilled \nwater, 60 parts. In cardiac disease caffeine has been employed \nto a considerable extent as a substitute for digitalis, but as has \nbeen seen, its action on the heart is different from that of the \nlatter and cannot, therefore, take its place. As a rapidly-acting \ncardiac stimulant it may prove of service in a variety of con- \nditions, and in certain cases with feeble action of the heart it \nalso does good by increasing the general blood-pressure, through \nits constricting influence on the arterioles, and thus producing \na more efficient circulation. Its chief utility in heart affections, \nhowever, is in cases attended with dropsy, where by its marked \ndiuretic action it proves highly efficacious in a considerable pro- \nportion of instances. It may often be combined with advantage \nwith digitalis, strophanthus, or other drugs having a similar \ncardiac action. The preparations of caffeine are useful also \nwhen combined with antipyrine or acetanilide derivatives to \ncounteract their depressing influence upon the heart, as in \nthe official compound acetanilide powder given above. Caffeine \nsometimes causes so much insomnia that its use has to be dis- \ncontinued, and it is alleged that occasionally it sets up con- \nsiderable smarting in the penis and even a mild form of ure- \n\n\n\n29O PHARMACOLOGY AND THERAPEUTICS. \n\nthritis. The nervous phenomena and the irregularity of the \nheart\'s action sometimes occasioned by tea and coffee are gen- \nerally recognized. \n\nKidney. \xe2\x80\x94 The physiological action of the drug shows it to \nbe within certain limitations a diuretic of great value. It is a \nfact worthy of note and to be borne carefully in mind in the \ntherapeutic use of caffeine, that the diuresis is produced by \nsmaller doses than those required for any other of its effects. \nThis constitutes a point of great practical importance, for the \nsmaller doses, while sufficient to bring about the desired effect \non the kidneys, do not as a rule affect the central nervous sys- \ntem to such an extent as to cause the antagonistic vaso-constric- \ntion which so seriously interferes with the renal function. Even \nwhen given in the smallest supposedly effective dose, however, \nits effect upon the urine is somewhat variable, and in order to \nsecure satisfactory diuresis it is therefore sometimes advisable \nto administer with it some such agent as chloral or paraldehyde \nwhich diminishes the excitability of the medullary centres. It \nshould seldom or never be employed in acute inflammatory \nconditions of the kidney, because stimulants are contra-indi- \ncated when the part they influence is inflamed; but it is some- \ntimes of service in chronic Bright\'s disease, especially when \nthere is marked cardiac failure. When, however, the secreting \ncells are in such a state as to be incapable of stimulation, it \nwill naturally prove inefficient; so that in renal dropsy it may \nbe said to be useful in inverse ratio to the amount of damage \nsuffered by the kidneys. In simple cardiac dropsy, where it \noften acts so effectively, the epithelial structures are not dis- \neased, but only passively congested. As a diuretic, caffeine is \nnow regarded as decidedly inferior to theobromine, and the \nreasons alleged for this are: (1) because the diuresis is less \ncertain and often accompanied by nervous symptoms such as \nrestlessness and insomnia, and (2) because the secretion is \nsmaller and lasts for a shorter time. Theobromine, while having \nan action similar to that of caffeine, has a much less pronounced \neffect upon the central nervous system. \n\n\n\nCAFFEINE. 29I \n\nNervous System. \xe2\x80\x94 As a stimulant to the central nervous sys- \ntem, and especially to the respiratory centres, caffeine is of \ngreat service in cases of poisoning by opium and by alcohol. \nIn the treatment of the former strong black coffee has long \nbeen in use, and caffeine might perhaps be substituted for it \nwith benefit. Hot coffee, however, has the advantage of adding \nto the heat of the body, which is apt to be quite cold. It has \nbeen ascertained by experiment that within narrow limits there \nis a direct physiological antagonism between caffeine and \nmorphine. In the insomnia of chronic alcoholism caffeine, in \nsmall doses given subcutaneously, has also been found useful. \nOn the other hand, it is sometimes taken, in larger quantity, to \nproduce wakefulness and increase the vigor of the mental \npowers during excessive use. So, in despondency and hypo- \nchondriasis and in neurasthenia it sometimes has a good effect. \nIn migraine and other forms of nervous headache, such as \nhemicrania, with or without gastric derangement, it is much \nused. In this class of affections it is not so efficient as anti- \npyrine; but it may often be advantageously combined with the \nlatter, and, in addition, sometimes with one of the bromides. \nSome observers have also found it especially efficient when given \nin connection with phenacetine. If the headache is due, as is \noften the case, to errors of refraction, much benefit can hardly \nbe expected from it. In trigeminal, cervico-brachial, and other \nneuralgias, particularly when given in combination with some \nof the coal-tar products, it often affords relief. Or, it may be \nadministered alone hypodermatically. In the adynamia of \ntyphoid and other acute fevers it may at times prove useful, \neither alone or as an adjuvant to alcoholic and other stimulants. \nIn some forms of malarial fever it is claimed that strong coffee \nhas a curative effect. One reason that caffeine, as sold in the \nmarkets, so frequently gives rise to the peculiar nervous and \nrenal by-effects that it does is because theine made from the \nsweepings of the tea-houses is substituted for caffeine. \n\nAlimentary Tract. \xe2\x80\x94 Caffeine is a stomachic tonic, improving \nthe appetite and digestion, and it has been found of service in \n\n\n\n292 PHARMACOLOGY AND THERAPEUTICS. \n\nconvalescence from various acute diseases. In nervous dys- \npepsias and in chronic catarrh of the stomach with occasional \nattacks of migraine it is often useful. So also in the diarrhoea \nof phthisis and of typhoid fever, and in ordinary atonic diar- \nrhoea, as well as in cholera infantum and in cholera morbus, \nespecially when dependent on agencies affecting the nervous \nsystem. In affections of this character the sodium benzoate or \nthe sodium salicylate, in combination with nux vomica or \nstrychnine, may sometimes be used with advantage. \n\nRespiration. \xe2\x80\x94 In certain cases of asthma it is of value; the \nparoxysm being promptly relieved by it. In many instances, \nhowever, it has little or no beneficial effect. In pneumonia or \nin congestion of the lungs, with weak heart, in elderly in- \ndividuals, it sometimes proves of material service. \n\nUterus. \xe2\x80\x94 The sodium benzoate has been recommended in \npuerperal haemorrhage, the statement being made that when \ngiven subcutaneously it acts more promptly than ergot. \n\nAs the solubility of caffeine citrate is variable, caffeine is \nbest given as such, but it is recommended that a dose of \nsodium salicylate half as large as that of the caffeine should \nbe administered with it to insure the solution of the caffeine. \n\nGUARANA. \nGUARANA.\xe2\x80\x94 Guarana. Dose, 2 gm.; 30 gr. \n\nPreparation. \nFluidextractum Guaranse. \xe2\x80\x94 Fluidextract of Guarana. Dose, \n2 c.c.; 30 TTt. \n\nAction of Guarana. \nGuarana is habitually used as a beverage by the South Amer- \nican Indians who make it. Its effects on the system are mainly \nthose of its alkaloid, although it contains sufficient tannic acid \nto have an appreciable influence. \n\nTherapeutics of Guarana. \nIn medicine guarana is employed almost exclusively for the \nrelief of headache. The forms of headache in which it is most \n\n\n\nCOLA. 293 \n\nserviceable are the nervous sick headache which recurs at short \nintervals, especially in women at the menstrual periods, and \nthat which follows a debauch, when the head throbs and the \neyes are bloodshot. In many instances, however, guarana, like \nmost other remedies, gradually loses its power over such attacks, \nand may eventually aggravate them. In the headache of \nchlorosis guarana is said to be efficient in combination with \ncannabis indica. Almost the only other purpose for which the \ndrug is now used is in the treatment of atonic chronic diarrhoea. \nBy the Indians it is considered valuable in the prevention and \ncure of bowel complaints. \n\nCOLA. \n\nCOLA.\xe2\x80\x94 Cola (not official). Dose, 1 gm.; 15 gr. \n\nAction of Cola. \nIt is somewhat stimulating to the digestion and is like coca \nin enabling the body to undergo unusual exercise without \nfatigue. Its effects on the nervous system appear to be much \nthe same as those of caffeine. Partly in consequence of its \nincreasing the force and frequency of the pulse, the blood \ntension rises and metabolism is carried on more rapidly. As \nit contains a larger proportion of theobromine, it is said to have \na more pronounced diuretic action than caffeine. \n\nTherapeutics of Cola. \nIt has been used in various phases of debility, including \ndiarrhoeas in the debilitated, in irregularity of the heart\'s action, \nas a vehicle for the administration of cardiac stimulants, in \nmigraine, and in neuralgia and other nervous disorders. It is no \ndoubt of most benefit in diseases characterized by great nervous \nweakness and in convalescence from acute diseases in which \nwasting is pronounced, of which typhoid fever is the type. It \nhas a marked effect in relieving the mental depression, while the \ndiminution of the natural tendency to faintness, the disappear- \nance of nervous irritability, and the acquisition of the ability to \n\n\n\n294 PHARMACOLOGY AND THERAPEUTICS. \n\nundergo muscular exertion, under its use, are well established \nfacts. When fatiguing literary work or monotonous mental ap- \nplication is called for, kola probably affords greater assistance \nthan any other drug. It may be of service in those occasional \ninstances of morbid somnolence which can be definitely stated to \nbe not dependent upon dyspepsia in its various forms, diabetes, \nlithsemia, gout, nervous exhaustion, or malarial disease. It is \nalso of value in the performance of muscular feats, from the \ncaffeine which it contains in a nascent condition. It is highly \nprized by the natives of equatorial Africa, who take it to enable \nthem to endure long exertion without fatigue, and use it as a \nmasticatory. It is also reputed to render bad water palatable \nand tainted meat palatable. The most effective manner of em- \nploying the drug is said to be by slow mastication and swallow- \ning the saliva. \n\nERYTHROPHLOEUM. \n\nERYTHROPHLCEUM. \xe2\x80\x94 Erythrophloeum (not official). (Sassy \nBark.) \n\nUnofficial Preparation. \nTinctura Erythrophloei. \xe2\x80\x94 Tincture of Erythrophloeum. Dose, \n0.30 to 0.60 c.c; 5 to 10 Til.. \n\nERYTHROPHLCEINA. \xe2\x80\x94 Erythrophlceine (not official). Dose, \n0.0015 to 0.0020 gin.; ^ to ^ gr. \n\nAction of Erythrophlceum. . \nUnder its influence the heart is at first slowed; later its action \nbecomes rapid. The ventricles contract regularly and stop in \nsystole, while the auricles may continue to beat. This slowing \nis remarkable (i) from the regularity and energy of the sys- \ntoles, and (2) from the fact that during the slowing the uni- \nform blood-pressure is not altered by respiratory movements. \nThe blood-pressure rises because (1) of the increased energy of \nthe heart and (2) of the contraction of the blood-vessels; this \ncondition persists until the heart becomes irregular, when it \nfalls. The respiratory movements are at first slower and fuller, \nbut when the heart grows feeble they become accelerated, and \n\n\n\nERYTHOPHLCEUM. 295 \n\nduring the period of weak and irregular cardiac action produce \nthe so-called respiratory oscillations in blood-pressure. Moder- \nate amounts increase diuresis; larger doses produce vomiting \nand increased peristalsis; poisonous doses induce convulsions, \nlater, marked weakness of all muscles, and, finally, death. The \nmode of action may be summed up as that of a muscle-poison \nacting primarily upon the heart for the reason that the latter \nreceives a larger quantity of poisoned blood. Still, its sphere \nof influence appears to be the inhibitory, rather than the muscu- \nlar system, and upon the vagus its action resembles that of \ndigitalis. It is a vaso-constrictor by acting on the vessels them- \nselves, on the vaso-motor nerves, or on some vaso-motor centre \nnot in the medulla, but probably in or around the vessels them- \nselves. The respiration is influenced through the pulmonary \nbranches of the vagus. Erythrophlceum is a sternutatory because \nthe powdered bark is irritant to the nasal mucous membrane, \nit causes vomiting by reason of its solutions possessing the same \nproperty, and it is diuretic for the same reason and under the \nsame conditions as digitalis. Its ability to slow the heart is \nrather greater than that of digitalis, but it is more decidedly a \ngastric irritant. Its vaso-constrictor properties are practically \nthose of digitalis and ergot combined. It is rather less cumu- \nlative than digitalis ; using this term in the same sense in which \nit is applied to the latter. \n\nThe alkaloid is locally anaesthetic, but although the anaesthetic \ncondition induced by it lasts several hours, practically it is in- \nferior to cocaine, since it dims the cornea and causes myosis, \nheadache, giddiness and even syncope. Its employment for this \npurpose has therefore been abandoned. \n\nTherapeutics of Erythrophlceum. \nThe field of use for erythrophlceum, of which a 10 per cent, \ntincture has been recommended in dose of from .30 to .60 c.c. \n(5 to 10 HI), by the British Pharmaceutical Conference, would \nseem to be limited to the heart and blood-vessels in cardiac dis- \nease whether accompanied by dropsy or not. The indications \n\n\n\n296 .PHARMACOLOGY AND THERAPEUTICS. \n\nfor its employment are identical with those for digitalis. As \nto constancy of effect in slowing the heart, strengthening the \npulse, and promoting diuresis, digitalis is rather more reliable. \nThe use of this remedy should, then, be confined to those cases \nof fairly competent heart with low vascular tension in which \nit will show its effects more rapidly and markedly, and to those \ncases in which digitalis has lost its usefulness or has utterly \nfailed. \n\nCAMPHOR. \n\n1. CAMPHORA.\xe2\x80\x94 Camphor. Dose, 0.125 gm. (125 milligm.) ; \n2 gr. \n\nPreparations. \n\n1. Linimentum Camphorae. \xe2\x80\x94 Camphor Liniment. (Camphor- \nated Oil.) \n\n2. Ceratum Camphorae. \xe2\x80\x94 Camphor Cerate. \n\n3. Aqua Camphorae. \xe2\x80\x94 Camphor Water. Dose, 8 c.c; 2 fl. \ndr. \n\n4. Spiritus Camphorae. \xe2\x80\x94 Spirit of Camphor. Dose, 1 c.c; \n15 TTL. \n\n2. CAMPHORA MONOBROMATA. \xe2\x80\x94 Monobromated Camphor. \nDose, 0.125 gm. (125 milligm.); 2 gr. \n\n3. ACIDUM CAMPHORICUM.\xe2\x80\x94 Camphoric Acid. Dose, 1 gm.; \n15 gr. \n\nAction of Camphor. \n\nExternal. \xe2\x80\x94 Like the volatile oils, camphor acts as an irritant \nto the skin and mucous membranes. It is a direct cutaneous \nstimulant, causing redness, itching and warmth, owing to a \nlocal dilatation of the vessels. Later this sense of warmth is \nfollowed by some degree of local anaesthesia from paralysis of \nthe sensory nerves. On mucous membrane it produces similar \nirritation, as indicated by congestion and smarting. It has \nsome antiseptic action, but this is considerably weaker than \nsome of the substances of the phenol group, and also than \nmany of the volatile oils. \n\nInternal. G astro-intestinal Tract. \xe2\x80\x94 In small doses it is \n\n\n\nCAMPHOR. 297 \n\nstomachic and carminative, inducing a feeling of warmth and \ncomfort in the stomach. Here, as on the cutaneous surface, it \ncauses dilatation of the vessels, and thus has a mildly stimulat- \ning effect on the secretion of gastric juice and on peristalsis. \nIn larger amounts it may produce sufficient irritation to cause \nnausea and vomiting. In medicinal doses it has little action on \nthe intestines themselves, but it exerts quite an efficient anti- \nseptic influence in the bowel, as it is found that the amount of \ncombined sulphates in the urine is diminished by it. \n\nAbsorption and Excretion. \xe2\x80\x94 Camphor is absorbed with con- \nsiderable rapidity from the stomach and intestine, as well as \nfrom the skin and the respiratory mucous membrane when in \ncontact with them. After absorption it is converted into cam- \nphorol, a body in which one atom of H in camphor is replaced \nby OH, and this combines with glycuronic acid and is excreted \nin part in the urine as camphor-glycuronic acid. An amido- \nderivative of this acid is formed at the same time, and is also \nfound in the urine. Camphorol acts like camphor, but its \nglycuronic combinations are inert, so that the effects of cam- \nphor are observed to pass off quickly in such animals as the \ndog, in which these combinations are rapidly formed. In ani- \nmals poisoned with camphor a considerable quantity of glucose \nis said to be frequently present in the urine. \n\nBlood. \xe2\x80\x94 It is said to increase the number of leucocytes in the \nblood. \n\nHeart and Circulation. \xe2\x80\x94 While the effects of camphor on the \nmammalian heart are as yet but very imperfectly known, it may \nbe stated that the heart is generally slowed by the drug, while \nthe contractions are at the same time greatly strengthened. \nThis appears to be due rather to a direct stimulation of the \ncardiac muscle than to the influence of the regulating nerves. \nThere may, however, be some slight reflex stimulation of the \norgan. On the normal heart camphor usually produces \nlengthening of the systole and shortening of the diastole, some- \nwhat after the manner of digitalis, and the pulse becomes fuller, \nstronger and slower. The blood-pressure may either rise or \n\n\n\n298 PHARMACOLOGY AND THERAPEUTICS. \n\nshow alternate rise and fall. Such variations are found to \npersist after convulsive movements have been prevented by \ncurara, and it is therefore believed that the rise is mainly caused \nby a stimulation of the vaso-motor centre, and that this stimula- \ntion is intermittent in character, since the variations mentioned \nare independent of the respiration. The stimulation of the \nheart and the reflexes, especially those arising from the stomach \nalso, no doubt, contribute to the rise in blood-pressure. \n\nRespiration. \xe2\x80\x94 The respiration is usually but slightly affected, \nbut as a rule becomes slower and deeper under large doses. \nSome observers find the rate as well as the volume increased \nby it. During the convulsions caused by camphor in animals \nthe respiration is arrested, and in the intervals may be accel- \nerated in consequence of the muscular exertion during the \nspasms. Whether any excretion of the drug takes place by the \nlungs is not positively known, but the breath of persons using \nit sometimes smells of it, and it is thought probable that some \ncamphor or some derivative from it is excreted by the bronchial \nmucous membrane, the vascularity and secretion of which is \nthus stimulated. It is generally regarded as an expectorant of \nsomewhat feeble power. \n\nNervous System. \xe2\x80\x94 The action of camphor on the central ner- \nvous system in mammals has been found to consist in stimula- \ntion, followed by paralysis of the cerebral areas and probably \nof other intracranial centres, with less marked effect on the \nspinal cord. As regards the brain the stimulant symptoms begin \nin man with excitement, impulsive movements, confusion and \ndelirium with hallucinations, and these are followed by epilepti- \nform convulsions. In the lower animals the symptoms are simi- \nlar: wild excitement and epileptiform convulsions, followed by \ndepression, stupor and collapse. The convulsions have generally \nbeen attributed to stimulation of the medulla oblongata, but the \nepileptiform character of the attacks points to an affection of \nthe cerebral cortex, and experimenters have found that re- \nmoval of the cortex prevented the convulsions in mammals, \nthough in the pigeon convulsions continued after the cerebrum \n\n\n\nCAMPHOR. 299 \n\nhad been removed. On the whole, there seems to be good reason \nfor supposing that these seizures have their origin, at least \npartly, in the higher areas of the nervous axis. The first evi- \ndence of stimulation of the medulla is vertigo. Later all the \nmedullary centres are stimulated : the respiration is increased \nin volume, the blood-pressure rises, and the face and skin be- \ncome flushed in consequence of the stimulation of the vaso- \ndilator centre. Under sufficiently large doses the medulla is \nparalyzed, and collapse ensues, with death from failure of the \nrespiration. Sometimes, however, the respiration ceases during \na convulsion, and fails to return when it passes off. In man the \nepileptiform convulsions alternate with intervals of quiet and un- \nconsciousness, until the patient sinks into complete stupor; and \nin exceptional instances of poisoning there is no stage of ex- \ncitement, the patient at once falling into a condition of drowsi- \nness, unconsciousness and stupor. As regards the spinal cord, \nin mammals there is observed some stimulation, followed by \nparalysis, but this is unimportant and does not occur until late. \nIn the frog, on the other hand, the spinal paralysis is found to \nbe so pronounced as to entirely obscure any effect the drug may \nhave upon the higher nervous centres. The reflexes, which do \nnot seem to be much affected at first, later disappear, and the \nanimal lies completely paralyzed. The susceptibility to the \neffects of camphor varies very greatly in different individuals. \n.30 to .60 gm. (5 to 10 gr.) will produce in some persons a con- \nsiderable amount of exhilaration, while in others the only effect \nobserved will be a sense of comfort and restfulness. \n\nTemperature. \xe2\x80\x94 In health the temperature is not affected, but \nin fever, camphor has, like many aromatic bodies, some anti- \npyretic action. \n\nMuscles. \xe2\x80\x94 On the striped muscles of the frog, when directly \nexposed to its solutions or vapor, camphor has a curara-like \naction, weakening and paralyzing them; but this is not observed \nin mammals. In certain experiments, made with a Mosso\'s \nergograph, the drug sometimes seemed greatly to increase the \nenergy and endurance of human muscles, but in other instances \nfailed to have any influence. \n\n\n\n300 PHARMACOLOGY AND THERAPEUTICS. \n\nSkin. \xe2\x80\x94 The fact that in those using camphor the sweat some- \ntimes smells strongly of the drug points to some excretion of it \nby the skin. It has a mild diaphoretic action, and this may be \ndue in part to its effects on the central nervous system. \n\nSexual Organs. \xe2\x80\x94 Occasionally camphor has the effect of in- \nducing dysuria. In small doses it\' sometimes appears to in- \ncrease the sexual appetite; but any such effect is probably to be \nattributed merely to its general stimulant action on the circula- \ntion. In large doses it has been held by many to be anaphro- \ndisiac. \n\nTherapeutics of Camphor. \n\nExternal. \xe2\x80\x94 On account of its stimulating properties, camphor \nis probably employed more extensively as an ingredient of lini- \nments of various kinds than any other drug. Thus, as a mild \nirritant or counter-irritant it is rubbed into the skin, in one \nform or another, for the relief of internal inflammations, chronic \ninflammatory induration, chronic rheumatism, etc. In such \nconditions as myalgia, sciatica, lumbago and neuralgia of \nsuperficial nerves it also answers the same purpose, and in addi- \ntion, by its effect in inducing local anaesthesia, serves to allay \nthe pain. Camphor and hydrated chloral triturated together \nform a clear liquid which will take up morphine, atropine and \nother alkaloids in considerable quantity, and such a solution can \nbe mixed with chloroform without precipitation. The resulting \nmixture constitutes a topical application of great power in the \ntreatment of pain and inflammation ; and it may be either painted \non the affected part with a camel\'s-hair brush or applied on \nabsorbent cotton or lint which is then covered with oiled silk. \nThe official chloroform liniment is made of chloroform, 300; \nsoap liniment (of which camphor is an ingredient), 700; and \na Chloroformum Camphorse may be prepared by dissolving cam- \nphor, 2, in chloroform, 1. The liquid preparations of camphor \nwith chloral, thymol and carbolic acid are excellent local \nanodynes for neuralgia, and may also be applied on cotton \nto the cavities of aching teeth. A warm flaxseed poultice to \nwhich camphor and morphine have been added is a good ex- \n\n\n\nCAMPHOR. 3OI \n\nternal application for the relief of toothache. The solution of \ncamphor in ether has been applied locally with benefit in ery- \nsipelas, and powdered camphor, freely sprinkled over the sur- \nface, is sometimes successful in preventing pitting of the face \nfrom small-pox. Powdered camphor has also been used with \nsuccess upon specific ulcers of the genitals, and is an efficient \napplication for indolent ulcers. For the latter the camphor oint- \nment of the National Formulary (camphor, 22; white wax, 11; \nlard, 67) may likewise be employed. Camphor, 14, combines \nwith salicylic acid, 1 1, with the aid of heat, and in the form \nof ointment has been used in chronic ulcers and in lupus. In \nchilblains ointments or liniments containing camphor are often \nuseful. For chapping or roughness of the skin camphor may \nbe employed in the form of Ceratum Camphorse or incorporated \nin suet or lanolin. Either alone or in combination with other \nagents it is of service in relieving the itching of eczema and \nother cutaneous affections. A combination of camphor, 3, and \nphenol, 1, is a valuable antiseptic and anodyne dressing \nfor wounds, and on account of its anaesthetic properties is \nuseful in the treatment of inverted toe-nail. It may also be \nlocally applied with benefit in pharyngitis or tonsillitis, herpes, \nerysipelas, vaginitis, vulvitis and paresthesia of the vulva and \nother parts. It may likewise be used to overcome the fetor of \nlochial discharges. Fluids having valuable antiseptic powers \nare also formed from camphor with salol and with betanaphthol. \nMixtures of camphor with menthol, of various strengths, are \nemployed in acute nasal catarrh, pharyngitis and laryngitis, in \nhypertrophic rhinitis, and in diseases of the ear. The vapor of \ncamphor is inhaled with some relief in coryza and also in \nsome forms of headache. In the household the spirit or " eau \nsedative," applied on a handkerchief or a flannel bandage, is \na popular remedy for headaches and various neuralgic pains. \nCamphor enters into the composition of many dentifrices. \n\nInternal. \xe2\x80\x94 Camphor is contra-indicated in inflammatory dis- \neases of the gastro-intestinal mucous membranes It is much \nused as a carminative, particularly in neurotic individuals. A \n\n\n\n302 PHARMACOLOGY AND THERAPEUTICS. \n\nfew drops of the spirit will often give relief in hysterical vomit- \ning, and camphor water with compound tincture of lavender is \nan excellent remedy for flatulence, especially hysterical flatu- \nlence. With the addition of laudanum this mixture is very \nuseful in ordinary diarrhoeas. Camphor in combination with \nopium is very largely used in the treatment of diarrhoea, and \neven in the preliminary diarrhoea of Asiatic cholera has fre- \nquently proved of the greatest service. Hope\'s camphor \nmixture, when freshly made with nitrous, rather than nitric, \nacid, is a useful preparation and is especially well adapted \nfor diarrhoea of relaxation in elderly subjects. Either rhu- \nbarb, capsicum, chloroform or some astringent is often added \nto the preparations of camphor and opium in diarrhoea \nmixtures. Camphor is very commonly used for aborting \ncolds and in the treatment of cold in the head. A very \ngood "cold powder" consists of camphor (dissolved in \nether), 5; ammonium carbonate, 4; powdered opium, 1. The \ndose of it ranges from .20 to .60 gm. (3 to 10 gr.). It has been \nfound of value in breaking up colds when taken in time, and in \nmodifying their force when taken later. For the treatment of \nacute coryza an excellent combination consists of camphor, \nquinine and fluidextract of belladonna, administered in pill or \ntablet. As camphor tends to allay cough and promote expec- \ntoration, it is a common ingredient of cough mixtures and is \nmuch employed in the form of paregoric. Camphor is used \nespecially in chronic bronchitis, emphysema, and capillary \nbronchitis. It has also been found of service as a stimulant \nin so-called typhoid pneumonia. It was formerly employed \nto a considerable extent in the treatment of asthma, but has \nnow been superseded by other remedies which have proved more \nefficient. Administered with spirit of chloroform and compound \ntincture of lavender, spirit of camphor has been given with ad- \nvantage in influenza. In typhus and typhoid fever and in the \nexanthemata generally it has long been used as a cardiac stimu- \nlant and also for the purpose of quieting delirium, subsultus or \nrestlessness. In Tokio, Japan, excellent results have been re- \n\n\n\nCAMPHOR. 3O3 \n\nported from the use of camphor, to the exclusion of other \nmedication, in the treatment of typhoid fever, the observations \nextending over a period of five years. The regular amount \nadministered daily was 1 gm. (15 gr.). In senile gangrene \nand hospital grangrene large doses of camphor have proved of \nvalue, while the powdered drug has been applied with advantage \nto the sloughing surfaces. According to some authorities, \n2 gm. (30 gr.) a day may be given hypodermatically (in the \nform of a 10 per cent, solution of olive oil) in the profound \nadynamia of acute endocarditis, typhoid fever, pneumonia, etc., \nwith the happiest result. It is stated that the addition of a \nfew drops of camphor to a small enema of ordinary water will \nproduce a prompt evacuation of .the bowels. A elyster of cam- \nphor is also an effective remedy against thread-worms. The \nuse of large doses of camphor in abnormal sexual excitement \nand in chordee, as well as in severe convulsive disorders such \nas whooping-cough, epilepsy and puerperal convulsions, has to \na large extent passed out of vogue, though monobromated cam- \nphor is still employed in some of these conditions. A full \ndose of camphor is sometimes given to arrest the strangury \nproduced by cantharides used for blistering. Combined with \nopium it has been quite generally employed, in the form of \nsuppositories, after operations upon the urethra, etc., though at \nthe present time surgeons are inclined to entirely dispense with \nthe use of narcotics and anodynes both before and after such \noperations. Suppositories of this kind are found of service, \nhowever, in cystitis, enlarged prostate, and other affections of \nthe genito-urinary organs. Camphor is a common remedy in \nattacks of nervousness and hysteria, and in hysterical convul- \nsions is a useful antispasmodic. In some cases of delirium \ntremens it works quite satisfactorily, but in maniacal excite- \nment, melancholia and erotomania it is a very uncertain agent. \nIt is extremely useful in nervous dysmenorrhcea and, combined \nwith morphine, is commonly relied upon for the relief of after- \npains. There are, indeed, many conditions met with in women \nto the alleviation of which no one remedv seems so well \n\n\n\n304 PHARMACOLOGY AND THERAPEUTICS. \n\nadapted as camphor. Monobromated camphor is used as \na nervous sedative. Its action is not identical with that of \nthe bromides, however, as the bromine is present in a differ- \nent form, and it is stated that no bromine ion is liberated; so \nthat the bromine effect would seem to be quite limited. Cam- \nphoric acid is successfully administered for colliquative sweat- \ning, e. g., that of pulmonary tuberculosis. The daily amount of \nfrom 1 to 5 gm. (15 to 75 gr.) should be given in the evening \nin divided doses at short intervals, either dry upon the tongue \nor in starch wafers. It has been used with success also in \nhyperidrosis occurring in a variety of cases which were non- \ntuberculous. \n\nMUSK. \n\nMOSCHUS.\xe2\x80\x94 Musk. Dose, 0.250 gm. (250 milligm.) ; 4 gr. \n\nPreparation. \nTinctura Moschi. \xe2\x80\x94 Tincture of Musk. Dose, 4 c.c; 1 fl. dr. \n\nAction of Musk. \nMusk is regarded as stimulant and antispasmodic. It is sup- \nposed to act in the same way as camphor, but almost nothing \nis definitely known in regard to this substance. The odoriferous \nmatter, which is believed to be the active principle, has scarcely \nbeen examined. According to some early observations musk \nwas found to cause headache, giddiness and confusion, with a \nfeeling of weight and uneasiness in the stomach; later, de- \npression and drowsiness, and eventually sleep. Tremors and \neven convulsive movements were also sometimes noticed, and \nthe pulse was said to be accelerated and quickened. A later \ninvestigator, however, reported (in 1888) that he could find no \neffects from the administration of musk to men or animals. \n\nTherapeutics of Musk. \nIn recent years the use of musk has been almost entirely dis- \ncarded. Its effects appear to be very uncertain at best, and \nas most of the musk on the market is adulterated, and moreover \n\n\n\nACONITE. 305 \n\nits price is extremely high, there would seem to be very little \nreason for retaining the drug in medicine. Its therapeutic use \nhas always been almost purely empirical, and it has been sug- \ngested that it was probably thought that a substance with such \na powerful odor could not but possess a marked physiological \naction, although no such action was ever demonstrated. Musk \nhas been mainly used in spasmodic diseases, such as chorea, \nwhooping-cough, hiccough, and laryngismus stridulus, and as \na stimulant in asthenic conditions, especially in pneumonia and \ndelirium tremens and in typhus, typhoid and other fevers. At \npresent it is said to be most often prescribed for the extreme \nweakness which follows typhoid fever. It is usually adminis- \ntered in pill. \n\nB. Drugs Acting on the Vagus Centre. \nACONITE. \n\n1. ACONITUM.\xe2\x80\x94 Aconite. Dose, 0.065 gm. (65 milligm.) ; 1 gr. \n\nPreparations. \n\n1. Fluidextractum Aconiti. \xe2\x80\x94 Fluidextract of Aconite. Dose, \n0.05 C.C.; 1 TTL. \n\n2. Tinctura Aconiti. \xe2\x80\x94 Tincture of Aconite. Dose, 0.6 c.c; \n10 TTL- The strength of this tincture has been reduced from 35 \ngm. of aconite in 100 c.c. (U. S. P., 1890) to 10 gm. in 100 c.c. \n\n2. ACONITINA.\xe2\x80\x94 Aconitine. Dose, 0.00015 gm. (0.15 milligm.); \n\nUnofficial Preparations. \nExtractum Accniti. \xe2\x80\x94 Extract of Aconite (U. S. P., 1890). \nDose, 0.010 gm.; y 5 gr. \n\nUnguentum Aconitinse. \xe2\x80\x94 Aconitine Ointment. \nColloidum Amyle.\xe2\x80\x94 Amyl Colloid. (Anodyne Colloid.) \n\nAction of Aconite. \nThe action of aconite is due chiefly to its constituent, acon- \nitine, which is recognized as the most toxic of all known \nalkaloids. \n\n\n\n306 PHARMACOLOGY AND THERAPEUTICS. \n\nExternal. \xe2\x80\x94 Locally it is an irritant, but, unlike other local \nirritants, it does not cause redness, blistering or other sign of \ninflammation. Applied to the skin or mucous membrane, it \nsoon affects the peripheral ends of the sensory nerves, causing \nitching, tingling and burning. This stimulation is followed by \nnumbness, and later by complete paralysis of sensation in the \npart. Inhaled through the nostrils, it gives rise to sneezing \nand symptoms of coryza, with an icy cold sensation. \n\nInternal. G astro -intestinal Tract. \xe2\x80\x94 When taken by the \nmouth it causes a disagreeable prickling and sense of constric- \ntion in the fauces. Other mucous membranes become affected, \nand various reflexes, such as sneezing, coughing, increased flow \nof saliva, nausea and vomiting, may be produced by the irri- \ntation of the sensory terminations. This stimulation is suc- \nceeded by a depression which gives rise to a sense of numbness \nin the different surfaces. Unless the dose is excessive, purg- \ning is not caused, and even then it occurs only in occasional \ninstances. \n\nHeart and Circulation. \xe2\x80\x94 The action of aconite on the heart is \nsomewhat complex, and, if given in sufficient amount, it has the \neffect of successively stimulating and paralyzing all the differ- \nent parts of the organ\'s mechanism. Under small doses the \nonly symptoms produced are those due to stimulation of the \nvagus centres in the medulla, the primary action of the drug. \nAs a result, the rate of the heart is slowed, the diastole is in- \ncreased, the systole is diminished, and there is a fall in blood- \npressure. That these effects are due to stimulation of the \ninhibitory centres is shown by the fact that if the vagus is \ndivided the heart-beat returns to the normal. With larger \ndoses the primary slowing action is the same, but this is soon \nfollowed by results due to the direct action of the drug upon \nthe heart itself, as well as its influence upon the vaso-motor \ncentres. The rhythm becomes markedly accelerated, instead of \nabnormally slow. This acceleration has been attributed to \nparalysis of the vagus terminals, but that it is not due entirely or \nprincipally to this is shown by the fact that it occurs after \n\n\n\nACONITE. \n\n\n\n30/ \n\n\n\nsection of the vagus. There is evidently a powerful stimulation \nof the cardiac muscle, and the action of the heart becomes not \nonly very rapid but also extremely irregular. The blood- \npressure likewise becomes exceedingly irregular, now falling \nto zero, and now rising again to a considerable extent. The \ncontractions of both the auricle and ventricle are imperfect \nand very unequal, the one part often beating at a different rate \nfrom the other. The ventricular action tends to become more \nrapid than the auricular, and the increasing irritability of the \nheart eventually results in delirium cordis. Finally the vaso- \nmotor centres become paralyzed and lose their function. \nThere is always in the end a complete fall in pressure from \nparalysis of the heart and blood-vessels. Clinically it appears \nthat the peripheral vessels are dilated, and this effect is some- \ntimes very marked. Aconite has been named the " vegetable \nlancet." \n\nXeri\'ous System. \xe2\x80\x94 There is still considerable uncertainty as \nto the mode and order in which the different parts of the \nnervous system are affected by aconite, and one reason for this \nis that the symptoms due to the action of the drug on the \ncentral nervous system are to a greater or less extent obscured \nby its effects on the peripheral nerve terminals. On the cere- \nbrum it has apparently but little influence. In cases of poison- \ning by it the intellectual faculties are not affected, and con- \nsciousness usually remains to the end. If the latter is lost or \nimpaired this may be due to changes in the circulation and \nrespiration, or possibly to collapse resulting from paralysis of \nthe medullary centres. Xear the end carbonic acid narcosis \nmay supervene. Aconite has decided effects on the medulla, \nand its action on the vagus centre has already been referred \nto. It is also believed that it affects the vaso-constrictor centre \nand that the vomiting so frequently present is due. at\' least in \npart, to increased irritability of the medullary centres. There \nis dilatation of the pupil, and this is regarded as due to stimu- \nlation of the central dilator apparatus, while the convulsions \nwhich are not infrequently observed are also attributed largely \n\n\n\n308 PHARMACOLOGY AND THERAPEUTICS. \n\nto central stimulation. The spasms have been thought to he \nchiefly respiratory, but the fact that they are not altogether \nabsent in frogs, and not always relieved by artificial respiration \nin mammals, indicates, it is held, an effect, in part, central. \nThe action of aconite on the spinal cord has not as yet been \ndefinitely determined, but the reflex function of the cord is \napparently impaired by it. Some authorities hold that it \nprimarily stimulates the motor portion of the cord, and at a very \nlate period in its toxic action causes centric motor depression. \nIts action on the motor spinal cord, however, is believed to be \nentirely subservient to its influence on the peripheral nerves. \nThe weight of evidence goes to show that it causes paralysis \nof the sensory nerves, commencing at their peripheral termi- \nnations and extending eventually to the centre of sensation in \nthe cord, and that the loss of reflex activity noted is due, at \nleast in great part, to the peripheral paralysis; furthermore, \nthat the motor nerves, upon which it exerts a feeble depressing \ninfluence, are not affected until after the sensory nerves. \nUnder toxic doses of aconite the special senses may be more or \nless interfered with, and the general sensibility is always greatly \ndiminished, so that marked anaesthesia of the surface is a \nprominent characteristic. \n\nRespiration. \xe2\x80\x94 In moderate doses aconite usually has the effect \nof quieting the respiratory movements. Under toxic doses the \nrespiration is at first quickened, but soon becomes very slow and \nlabored. When the full effect of the drug is produced both \ninspiration and expiration are prolonged, and the latter is fol- \nlowed by a long pause. Between the primary quickening and \nthe subsequent permanent slowing the respiration is some- \ntimes very irregular, and from the first there is always marked \ndyspnoea. The respiratory trouble has been shown not to be \ndue to action on the phrenic terminations, and it does not re- \nsult from stimulation of the vagus endings in the lungs, be- \ncause section of the vagi does not prevent the slowing. It \nseems certain, therefore, that it is caused by the depressing \naction of the drug upon the respiratory centre in the medulla; \n\n\n\nACONITE. 3O9 \n\nand it has been found that paralysis of this centre begins early. \nIt may sometimes occur that the heart ceases before the re- \nspiratory movements, but paralysis of the respiratory centre, \nrather than cardiac paralysis, constitutes the usual cause of \ndeath in aconite poisoning. The paralysis of this centre prog- \nresses more quickly than that of any other, and it is possible, \ntherefore, for death to take place from asphyxia while the \nrest of the central nervous system still continues irritable, as \nshown by the occurrence of convulsions. \n\nTemperature. \xe2\x80\x94 Attention has been called by certain observers \nto the peculiar effect (one that is unique) which aconite has of \ncausing a chilly sensation that occurs before either the tem- \nperature or the circulation through the skin is changed. This, \nit is thought, must result from a stimulation of certain tempera- \nture nerves. Both in febrile conditions and in the normal state \naconite has the effect of markedly reducing the temperature. \nIt is not positively known in what manner this fall is brought \nabout, but it seems probable that it is due in great part to the \ninfluence of the drug upon the nervous centres regulating heat \nproduction and to its action on the circulation. A considerable \namount of radiation, it might be expected, would take place \nfrom the surface of the body in consequence of the lowering of \nthe blood-pressure and dilatation of the peripheral vessels \ncaused by it, and the increase of perspiration which is also one \nof its effects no doubt assists in the reduction of the tempera- \nture. The lessening of the supply of oxygen to the tissues \noccasioned by the interference with the circulation and respira- \ntion is shown by the cyanotic appearance of the mucous mem- \nbranes, and this, it is believed, is largely instrumental in causing \nthe fall. \n\nSkin. \xe2\x80\x94 Profuse sweating is an almost constant symptom when \nlarge doses of aconite are taken. Whether it has any direct \naction on the perspiratory glands or not is not definitely known, \nbut the dilatation of the cutaneous vessels to which reference \nhas been made would seem, by increasing the blood-supply of \nthe parts, to facilitate an increased sudoriparous excretion. It \n\n\n\n3IO PHARMACOLOGY AND THERAPEUTICS. \n\nis probable, therefore, that aconite does have some positive \ndiaphoretic action, but, even if this is the case, the cold \nperspiration so commonly observed is undoubtedly largely \nattributable to the collapse induced by the drug. In occasional \ninstances an erythematous rash is caused by it. \n\nKidneys. \xe2\x80\x94 Aconite has some influence on the kidneys, but \nthis diuretic action is one of its minor effects. It thus in- \ncreases elimination to a certain extent, and not only the watery, \nbut the solid constituents, of the urine are said to be aug- \nmented by it. Aconitine is excreted mainly through the kid- \nneys. \n\nBenzaconine. \xe2\x80\x94 Benzaconine is very much less poisonous than \naconitine, the toxic effect of the latter being found by experi- \nment to be nearly two hundred and fifty times greater in warm- \nblooded animals. In many of its actions it is also distinctly \nopposed to aconitine. It slows the pulse-rate, and its special \neffect on the heart, when given in sufficient quantity, is to \nretard the systole of the ventricles, so that eventually there \nmay be only one beat of the latter to two or even three of the \nauricles. Section of the vagus, it is found, does not materially \naffect this action, which therefore appears to be chiefly on the \ncardiac muscle, and which naturally occasions a marked re- \nduction of blood-pressure. The alkaloid is thus the physiological \nantagonist of digitalin. It depresses the vaso-motor centre, but \nthis occurs quite late in its toxic action. It acts powerfully on \nthe motor nerves, but affects the sensory nerves only at a late \nstage, if at all. By some of the best authorities it is denied \nthat it has any influence on the sensory terminations, and prac- \ntically it is found that it does not produce tingling or numbness \nof the mucous membranes. Unlike aconitine, it gives rise to a \nlethargic or semi-comatose condition. In very large doses it \nhas a depressing effect upon respiration, but it causes a very \nslight reduction of temperature. \n\nAconine. \xe2\x80\x94 This is a very feeble agent, but, given in sufficient \nquantity, it has the effect of strengthening the heart-beat. Its \naction is distinctly opposed to that of aconitine, as it stimulates \n\n\n\nACONITE. 3 I I \n\nventricular contraction and so tends to prevent cardiac ase- \nquence and inco-ordination. It does not affect the vasomotor \ncentre, but has a stimulating effect on the roots of the vagi. \nLike curare, it paralyzes the terminations of the motor nerves, \nthe suspension of function lasting for a considerable time; but \nthe paralysis is not preceded by any excitement or spasmodic \naction. When death is caused by it this is in consequence of \nfailure of the respiration, which is probably of peripheral origin \nrather than dependent upon depression of the respiratory centre \nin the medulla. It is thought to be unlikely that the alkaloids \naconine and benzaconine have any influence on the action of \naconite preparations, but the question is still an undecided one. \n\nTherapeutics of Aconite. \nExternal. \xe2\x80\x94 The benumbing effects of aconite when locally \napplied have naturally suggested its external use in a variety \nof painful affections, and it is sometimes of considerable service, \nespecially in facial and other neuralgias. Among the other con- \nditions in which it has been employed are pruritus, prurigo, papu- \nlar eczema, chilblains and herpes zoster. In the last-named affec- \ntion care must be taken not to apply it to ruptured vesicles, and \nany preparation containing it should be used with great caution, \nif at all, upon an abraded cutaneous surface, on account of \nthe danger of absorption. It is also used locally for the relief \nof the pain of chronic rheumatism, gout, myalgia, and inflamma- \ntions of the structures of the eye and ear. In the different con- \nditions mentioned above it may be applied either in the form of \nthe tincture or in an ointment or liniment. The official aconitine \nointment of the B. P. (aconitine dissolved in alcohol, i; oleic \nacid, 8; benzoinated lard, 41) is a very expensive preparation, \nand as a substitute for this the liniment (B. P., a 40 per cent, \nsolution of powdered aconite root in alcohol, to which 2 per cent, \nof camphor is added), may be painted on with a camel\'s hair \nbrush. Other useful liniments are the Linimentum Aconiti Com- \npositum (not official), known as A. B. C. liniment because it \ncontains equal parts of aconite, belladonna and camphor lini- \n\n\n\n312 PHARMACOLOGY AND THERArEUTICS. \n\nments, and the " Baltimore liniment," consisting of tincture of \naconite and chloroform with soap liniment. Occasionally deep- \nseated pains, such as syphilitic pains in the bones and those due \nto sciatica are relieved by such liniments or by aconitine oint- \nment, and sometimes veratrine may be advantageously combined \nwith aconitine in local applications. \n\nInternal. \xe2\x80\x94 While aconite is contra-indicated in all cases where \nthe heart is weak and in adynamic conditions in general, it has \na considerable range of usefulness, and it would seem probable \nthat at the present time it is not employed to as great extent as \nit really deserves. In the early stages of acute inflammatory \ndiseases it often acts very happily, and the more promptly it is \nresorted to the greater will be the benefit derived from it. It \nreduces the temperature and the arterial tension, quiets the \nheart, allays pain by its influence on the sensory nervous sys- \ntem, and promotes elimination by its action on the skin and kid- \nneys. By its additional effect of slowing the respiratory move- \nments it is of special value in some of the acute affections of \nthe organs of respiration, the work of which is thus materially \nlessened. Among the conditions in which it can be used with \nadvantage, if administered sufficiently early, may be mentioned \ncoryza, pharyngitis, tonsillitis, bronchitis, pleurisy, pericarditis, \ngonorrhoea, urethral fever resulting from the passage of in- \nstruments, congestion and inflammation of the liver, peritonitis, \npuerperal metritis and peritonitis, inflammation of the cerebral \nand spinal meninges, cerebro-spinal meningitis, and the active \nfever of acute cerebral congestion. It will be understood, how- \never, that it should never be given when the disease present is \nof an adynamic type, nor should its use be continued after \neffusion has taken place in the serous inflammations or after \nthe febrile movement has abated in the others. The best prep- \naration for internal use is the tincture, and the exhibition of \nthis in minute quantities at frequent intervals during the day, \nfollowed by a full dose of Dover\'s powder at night, is con- \nsidered one of the best ways to " break up a cold." In catarrhal \nand fibrinous pneumonia it is more particularly useful before \n\n\n\nACONITE. 3 I 3 \n\nexudation has occurred, but may sometimes be continued after- \nward in order to combat the inflammatory processes. In acute \npleurisy before the stage of effusion and in some other inflamma- \ntions, notably peritonitis, great benefit may be derived by com- \nbining it with some preparation of opium, such as the deodorized \ntincture. In what are known as irritative fevers, especially \namong children, it is an extremely useful remedy. In small and \nrepeated doses it usually brings about a free diaphoresis, and \nthen the temperature promptly falls. It has been highly com- \nmended in the early stage of scarlatina, as not only reducing \nthe temperature and acting favorably on the skin and kidneys, \nbut also checking the nasal, faucial and aural inflammations \nwhich often constitute such serious complications and sequelae \nof the disease. In measles it sometimes serves the purpose of \narresting the catarrhal pneumonia which is one of the most \ndangerous complications of this affection. At times it is also \nof service in the hot stage of the paroxysms of malarial fever. \nIn typhoid and other continued fevers of asthenic character it \nshould be carefully avoided, and it is also contra-indicated in \ninflammatory conditions of the gastro-intestinal mucous mem- \nbrane. One of the diseases in which it has been employed with \nthe best effect is erysipelas of the non-traumatic variety, and \nespecially facial erysipelas. When, however, the affection is \nof an adynamic type and the eruption presents a dusky appear- \nance, belladonna should be resorted to instead of aconite. \nAconite may be of service in acute rheumatism when there is \nmuch heat and a dry skin, instead of the more common sweating, \nand if it is desirable to bring about a very free action of the \nskin it is recommended to combine it with pilocarpine and anti- \npyrine. It is also sometimes beneficial in muscular rheumatism \nwhen there is considerable temperature. \n\nIn conditions in which there is high arterial tension, chiefly \nof cardiac origin, aconite is a remedy of the greatest possible \nvalue. It is especially indicated in cases without valvular dis- \nease in which there is hypertrophy and over-action of the heart, \nand likewise when with valvular disease there is excessive com- \n\n\n\n314 PHARMACOLOGY AND THERAPEUTICS. \n\npensation. It is particularly useful in cardiac neuroses. In \nsimple nervous palpitation of the heart it is of great service, \nand it has sometimes also been found to relieve the pain \nof aneurism. While it has the power of allaying over-excite- \nment of the sensitive nerves, it has little effect in relieving such \naffections as migraine, where the pain is of central origin. It \nhas a certain amount of value in the treatment of neuralgias, \nbut is generally less efficient when given internally than when \nlocally applied, and is inferior in such affections to some other \nremedies at our command. It should be stated, however, that \nvery satisfactory results have been reported from the use of \nDuquesnel\'s aconitine in trigeminal neuralgia. While not \naffording relief in all cases, in a considerable proportion of in- \nstances it was found to be remarkably successful. It is of \nmore or less service in acute maniacal delirium and other mental \naffections, where vascular excitement and high arterial tension \nare present, but gelsemium has proved more efficient in this \nclass of cases. It sometimes has an excellent effect in con- \ntrolling the vomiting of pregnancy, and this has generally been \nattributed to its influence upon the peripheral sensory system, \nbut may perhaps be due to its action in benumbing the sensory \nreflex centres. In gonorrhoea it is thought to prevent chordee \nby its effect on the nervous centres. It may prove useful in \nspasmodic croup, and in certain cases of asthma, if adminis- \ntered early, it affords relief. It sometimes acts well in acute \nsuppression of the menses from cold, and it has been found a \nvaluable remedy in congestive dysmenorrhea in the full-blooded. \nIn epistaxis occurring in plethoric subjects it is also of service. \nFinally, aconite is said to be an antidote to the sting of the \nscorpion. \n\nTOXICOLOGY. \n\nSymptoms. \xe2\x80\x94 If the dose is sufficiently large, death (probably due to \ncardiac paralysis) may occur almost instantaneously. When the quan- \ntity taken is smaller, the effects of the drug are soon felt. The charac- \nteristic burning and prickling in the mouth, followed by a sense of \nnumbness, extends to the stomach, and eventually to the skin. There \n\n\n\nVERATRUM. 315 \n\nis a profuse flow of saliva and in some cases vomiting, while the cuta- \nneous surface becomes covered with a cold sweat. The pulse, at first \nslow as well as feeble, may afterwards become very rapid and scarcely \nperceptible. The respiration is labored, shallow, and accompanied by \nmarked dyspnoea. The patient\'s face is pale and anxious and there is \ngreat restlessness and general distress, with a sense of extreme fatigue \nand a loss of muscular power. With tingling and numbness in the \nextremities and more or less over the surface, there is a diminished \nsensibility to pain. The pupils remain dilated. Convulsions frequently \nprecede death, which is generally due to paralysis of the respiratory \ncentre, perhaps aided by anaemia of the medulla, but may be caused by \nparalysis of the heart. Under lethal doses the fatal result usually oc- \ncurs in from two to six hours. \n\nThe post-mortem appearances met with are not constant, but are \ngenerally such as are characteristic of death from asphyxia. \n\nTreatment. \xe2\x80\x94 Emetics may be tried, but will probably fail on account \nof the benumbed condition of the gastric mucous membrane. If the \nsymptoms are very severe, it is better not to attempt to excite vomit- \ning, on account of the risk of its causing fatal syncope. The stomach \nmust therefore be evacuated by means of a stomach-pump or tube. The \npatient should be kept flat on his back, with the feet somewhat higher \nthan the head, and artificial respiration should be resorted to as soon \nas difficulty of breathing occurs. His body should be wrapped in \nblankets and hot water bottles applied to the soles of the feet, or other \nmeans employed to maintain the temperature. Tannic acid is to some \nextent an antidote to aconite and may be tried ; but is not to be de- \npended upon. The main reliance must be upon stimulation. By the \nmouth ammonia and alcoholic stimulants may be administered, and for \nhypodermatic use it is recommended that ether, alcohol, and digitalis \nbe given in the order named ; the ether acting most promptly and sup- \nporting the heart until the alcohol can be absorbed, and the alcohol \ncontinuing the support until the digitalis, which is the physiological \nantagonist of aconite but acts slowly, has had time to produce its effects. \nIn addition, strychnine should also be given subcutaneously in full \ndoses, as a stimulant to the heart and respiration. If the case seems \nto require it, ammonia may be injected into the veins, and the inhala- \ntion of amyl nitrite may be cautiously employed. Other agents which \npartially antagonize the effects upon the heart and respiration are caf- \nfeine and atropine. \n\nVERATRUM. \n\n1. VERATRUM (Veratrum Viride, U. S. P., 1890).\xe2\x80\x94 Veratrum. \nDose, 0.125 gm. (125 milligm.) ; 2 gr. \n\n\n\n3 l6 PHARMACOLOGY AND THERAPEUTICS. \n\nPreparations. \n\n1. Fluidextractum Veratri. \xe2\x80\x94 Fluidextract of Veratrum. \nDose, 0.1 c.c; V/ 2 Tib \n\n2. Tinctura Veratri. \xe2\x80\x94 Tincture of Veratrum. Dose, 1 c.c; \n15 til. \n\n2. VERATRINA.\xe2\x80\x94 Veratrine. Dose, 0.002 gm. (2 milligm.) ; ^ \ngr. \n\n1. Oleatum Veratrinae. \xe2\x80\x94 Oleate of Veratrine. \n\n2. TJnguentum Veratrinae. \xe2\x80\x94 Veratrine Ointment. \n\nUnofficial Preparation. \nColloidum Amyle. \xe2\x80\x94 Amyl Colloid. (Anodyne Colloid.) \n\nAction of Veratrum. \n\nThe alkaloids of veratrum have been the subject of consider- \nable discussion, but according to the latest authorities, while \njervine is known to have some action on the system, the activity \nof the drug is really due to veratrine. The latter has a chemical \ncomposition similar to aconitine, and has practically the same \naction on the central nervous system and the sensory termina- \ntions, but shows, in addition, a peculiar action in prolonging \nthe relaxation of striped and cardiac muscle, which is entirely \nabsent in aconitine poisoning. The action of veratrum and \nveratrine may, therefore, be considered together. It is neces- \nsary to state, however, that veratrine as found in the shops \nis a mixture of alkaloids generally derived from plants other \nthan veratrum viride and veratrum album. The official vera- \ntrine is a mixture of alkaloids obtained from the seed of Asa- \ngrcea officinalis. \n\nExternal. \xe2\x80\x94 Applied to the skin the alkaloid veratrine, and \nto a less degree the drug itself, produces a feeling of warmth \nand prickling, followed by a sensation of coldness and by numb- \nness and anaesthesia. Applied to the mucous membrane of the \nnose and throat, it causes violent sneezing and coughing, and \na minute portion placed upon the tongue gives rise to burning \npain and free salivation. These phenomena, as in the case of \n\n\n\nVERATRUM. 3 I 7 \n\naconite, are due to stimulation of the peripheral endings of the \nsensory nerves. \n\nInternal. \xe2\x80\x94 Gastro-intcstinal Tract. \xe2\x80\x94 When full doses are \ntaken there are produced burning in the mouth, which spreads \nto the stomach, well-marked salivation, nausea and vomiting, \nand generally purgation accompanied by severe colic. The \nretching and vomiting, which are violent and persistent, have \nbeen attributed by some to central action and by others to irri- \ntation of the sensory nerve endings, and it seems probable that \nboth of these are concerned in their causation. It has been \nsupposed that the drug increases the biliary secretion, but the \namount of bile often noted in the vomit may be simply due to \nthe severity of the emesis, which causes the evacuation of the \ncontents not only of the stomach but of the gall bladder also. \n\nMuscles. \xe2\x80\x94 There is marked prolongation in the relaxation \nof muscles after contraction, which takes place normally, but \nis more complete than under ordinary circumstances. If a \ntracing be taken of the contraction of a muscle it will be seen \nthat the height of the contraction is slightly increased, and that \ninstead of the almost instantaneous return to the base-line seen \nin the normal tracing, the curve shows generally a slight undula- \ntion and then a very slow fall, the period of relaxation being \nfrom twenty to thirty times as long as in the unpoisoned muscle. \nThis prolonged relaxation would at first sight appear like \ntetanus, but is entirely free from any element of spasm or rigidity. \nIt has been found that it is accompanied by an increased for- \nmation of heat and use of material, and that it is lessened by \nfatigue, cold and other muscle-depressing agents, while in- \ncreased by moderate heat. It must therefore be looked upon \nas an expression of greater functional activity, a prolonged con- \ntracture rather than a loss of elasticity. The irritability and \nabsolute strength are also increased, so that the muscle re- \nacts to weaker stimuli and contracts against a greater weight \nthan usual. That the phenomena noted are not due \xe2\x96\xa0 to any \nnervous influence is shown by the fact that excised muscles \nshow exactly the same reaction. It has been found that in the \n\n\n\n3 l8 PHARMACOLOGY AND THERAPEUTICS. \n\nfrog the muscles are finally paralyzed, but that this does not \noccur in mammals because in them the respiratory centre fails \nlong before the quantity of veratrine necessary to produce this \neffect has been absorbed. \n\nHeart and Circulation. \xe2\x80\x94 In the frog\'s heart the ventricular \nmuscle is affected by veratrine in very much the same way as \nordinary striated muscle. The auricular muscle, consisting for \nthe most part of unstriated fibres, is much less powerfully in- \nfluenced by it, and in consequence the auricle is found to make \ntwo, or even three, beats to one of the ventricle. In the mamma- \nlian heart investigation shows that there is no such prolongation \nof the systole as is seen in the frog, but it has been proved that \na slight stimulating action is exercised by the drug. The prin- \ncipal cardiac effects observed, however, are due to the influence \nexerted upon the medullary centres. As in the case of aconite, \nthere is a primary stimulation of the vagus centre, resulting \nin a slowing of the heart\'s rate and a reduction of arterial pres- \nsure. At the same time constriction of the peripheral vessels \nis produced through stimulation of the vaso-motor centre. After \nlarger quantities the pulse is accelerated, the vaso-motor centre \nbeing depressed and the terminations of the, vagus paralyzed. \nIf, in the human subject, while it is depressed the posture is \nchanged from the recumbent to the upright, the pulse at once \nbecomes extremely rapid and thready. \n\nRespiration. \xe2\x80\x94 The effects on respiration, due to depression of \nthe respiratory centre in the medulla, are much the same as \nthose of aconite. The breathing is slow and labored and at- \ntended with dyspnoea, and after lethal doses death usually re- \nsults from paralysis of respiration. \n\nNervous System. \xe2\x80\x94 That the drug has decided actions on the \nmedullary centres has already been seen. It also has a stimu- \nlating effect on the spinal cord, but the influence exerted by it \non the highest cerebral centres is probably but slight, though \nthe convulsions produced by it are believed, as in the case of \naconite, to be due to central stimulation. It acts to some extent \non the motor nerves, and its effects on the sensory nerve end- \n\n\n\nVERATRUM. 3I9 \n\nings have been previously mentioned. After large doses the \nstimulation of the central and peripheral nervous system is suc- \nceeded by paralysis. \n\nSkin. \xe2\x80\x94 It produces free sweating, but this is probably the re- \nsult of arterial depression, rather than of any specific diaphoretic \naction. \n\nTemperature. \xe2\x80\x94 There is generally under its influence a con- \nsiderable reduction in temperature, which is thought to be due \nto the increased heat-dissipation resulting from vaso-motor \nparalysis and the slowing of the circulation. In cases, how- \never, where the convulsions are marked, increased heat-produc- \ntion is caused by the violent movements, and the temperature \nis even higher than normal. \n\nTherapeutics of Veratrum. \nVeratrum is a prompt and sure circulatory depressant, and \nits administration is safe because, the physiological action of \nthe drug giving warning of danger, its use can be stopped in \ntime to prevent accidents. In cardiac cases where there is ex- \ncessive hypertrophy, and drugs of the digitalis class are contra- \nindicated, it is less advantageous than aconite, which is more \npersistent in its effects and not so apt to cause gastric disturb- \nance, but in a number of other affections where the aim is to re- \nduce arterial action it is held in deservedly high repute. Thus, \nin the early stages of sthenic croupous pneumonia it has long \nbeen considered one of the most reliable of remedies, quieting \nthe increased action of the heart, lowering the temperature, and \nlessening the congestion of the lung. It may also be used with \nadvantage, if given sufficiently early, when only hyperemia is \npresent, in pleurisy, hepatitis, cerebritis, maniacal delirium, \nmania a potu, with strong, bounding pulse, and other sthenic \nconditions. If its employment is maintained after the primary \nstage of congestion, however, it can only do harm. In acute \ngastritis and peritonitis it is generally contra-indicated on ac- \ncount of its irritating effect upon the stomach, though in peri- \ntonitis it may sometimes be of service if carefully watched. In \n\n\n\n320 PHARMACOLOGY AND THERAPEUTICS. \n\naneurism where there is marked disturbance of the circulation \nand high pressure its cautious use is recommended, to decrease \nthe pressure and prevent rupture of the diseased vessel; and it \nmay prove a valuable adjunct to rest and other means of treat- \nment. The production of vomiting should be avoided, if possi- \nble, and the patient should therefore be kept in a strictly recum- \nbent position, while a small amount of opium may be given with \nthe remedy. With the various surgical expedients, such as \nforced flexion, compression and ligation, for the cure of aneurism \nit has also sometimes been employed, with excellent results, for \nlessening the force of the blood-current and the rapidity of the \npulse-rate. The action of veratrum is regarded as similar to \na depletion, but without the permanent loss of blood, and on \naccount of its influence in causing depression it has been desig- \nnated as " the younger brother of tartar emetic." \n\nThe very marked efficiency of the drug (especially in the \nform of Norwood\'s tincture) in puerperal eclampsia has been \nattested by a large accumulation of the most trustworthy evi- \ndence, and by many physicians it is considered by far the best \nremedy at command in this condition. Its good effects have \ngenerally been attributed mainly to the depressing influence of \nthe drug upon the motor tracts of the spinal cord; but, while \nthis influence no doubt contributes in some measure to the \nbeneficial results, its action in this respect is neither so energetic \nor sure as a number of other drugs, and its effect must there- \nfore be regarded as due to a very considerable extent to its \naction on the circulatory system. In puerperal convulsions the \nspasmodic condition is generally associated with abnormally \nhigh intravascular tension, and veratrum would consequently \nseem to be especially indicated. In this affection it has been \npointed out that it possesses the double recommendation \xe2\x80\x94 (i) \nthat it affords a certain and rapid means of lowering the blood- \npressure; (2) that although it is not cumulative to any marked \ndegree, its action is long maintained, and may be perpetuated by \na repetition of small doses. Sometimes, however, quite large \ndoses are well borne, and successful cases have been reported \n\n\n\nVERATRUM. 32 I \n\nwhere as much as 1.20 c.c. (20 1U) of Norwood\'s tincture has \nbeen given every hour for five consecutive days and nights. In \nthe early stage of peritonitis, phlebitis and other inflammatory \naffections of the puerperal state it may also prove of service, if \nthere is no cardiac weakness or general adynamia. Among the \nvarious other diseases in which its early use is said to have been \nattended with satisfactory results are acute rheumatism and \ntonsillitis, in the latter instance combined with morphine. It \nhas also been given in the case of certain wounds which tend \nto dangerous results, like those of the head, pericardium, heart \nand peritoneum, with the idea of securing, by means of the \ndiminished arterial movement caused by it, as little motion of \nthe affected part as possible. It should never be employed to \nproduce vomiting, as it is too harsh and depressing in its effects. \nNotwithstanding the criticisms of those who regard it as a type \nof those cardiac sedatives which tend, it is claimed, to retain in \nthe blood all that is injurious in it and at the same time to re- \nduce the patient to a state of utter wretchedness, veratrum \nundoubtedly has a legitimate, though limited, field in thera- \npeutics, and, within its proper range, is still esteemed by a large \nnumber of practitioners as a remedy of great value. \n\nTherapeutics of Veratrine. \nExternal. \xe2\x80\x94 Veratrine (as an oleate or ointment) is chiefly \nemployed, either alone or in combination with other remedies, \nin the external treatment of neuralgia, myalgia, herpes zoster, \nacute gout, and other painful affections. Used locally it has \nalso been found of service in alopecia circumscripta, chloasma, \nand chronic swelling and stiffness of the joints. For ordinary \nuse the official ointment is too strong, and should be reduced \none-half or more, or the oleate may be substituted for it. In \na weakened form it is sometimes employed in infantile paralysis, \nfor the alleged purpose of improving the nutrition of the affected \nmuscles. In the external application of veratrine preparations \ncare should always be taken to avoid abrasions of the cuticle, \non account of the danger of absorption. They should likewise \n\n\n\n322 PHARMACOLOGY AND THERAPEUTICS. \n\nbe used with caution near the eye, as violent inflammation of \nthe conjunctiva will be set up if any of the veratrine comes in \ncontact with it. {See also Amyl Colloid, below.) \n\nInternal. \xe2\x80\x94 Veratrine is very rarely given internally. It has, \nindeed, been suggested by one authority that as its activity is \ndue to this alkaloid, veratrum might well be dropped from \nthe Pharmacopoeia, but the fact remains that veratrum is \nstill held in high repute as a circulatory depressant, while \nveratrine is practically discarded. Probably the chief reason \nfor this is the dangerousness with which the alkaloid is re- \ngarded, and it is authentically recorded that alarming symptoms \nhave been produced by a dose of only 0.004 g m - (tV \xc2\xa7 r 0- \n\nAction of Amyl Colloid. \nThe object of this preparation is to obtain in an elegant and \nconvenient way the local anaesthetic action of both aconitine and \nveratrine, aided by the evaporation of amyl hydride. It is \nfound extremely difficult, however, to make a clear solution. \n\nTherapeutics of Amyl Colloid. \nIn neuralgia, sciatica, and other similar affections it is painted \non the skin over the painful areas, and its anaesthetic effect may \nbe still further promoted by the application of warm moist \nspongiopiline over the film formed by the collodion. \n\nTOXICOLOGY. \n\nNotwithstanding the severity of the symptoms caused by it, and \nalthough it has often been given with great freedom, fatal results \nhave very seldom been noted from the use of veratrum. This is \nprobably explained, at least to a considerable extent, by its prompt \nejection from the stomach in consequence of the emesis produced by \nlarge doses taken by the mouth. As most of the symptoms of poison- \ning by the drug have already been given, a further detailed description \nis unnecessary. There is often very severe abdominal pain, and head- \nache and giddiness are common. There may or may not be muscular \ntwitchings. After veratrine especially the convulsive movements are \nsometimes very marked. There is extreme debility, the features are \n\n\n\nCACTUS. 323 \n\npinched, and there is usually great pallor, with a cold and clammy skin. \nThe medullary and spinal centres become paralyzed, and death results \nfrom respiratory collapse, adjuvated by failure of the circulation. The \npost-mortem changes are not characteristic. \n\nTreatment. \xe2\x80\x94 The treatment is practically the same as in aconite \npoisoning, though the contents of the stomach are usually efficiently \nevacuated by the action of the drug itself. Atropine has proved of \nsome value in the poisoning of animals by veratrine, and its use is sug- \ngested on account of its action on the respiratory centre and on the \nvagus terminations in the heart. As the poison is rapidly excreted \nthrough the urine, it has also been recommended to administer hot tea \nas a diuretic. \n\nC. Drugs Acting on the Accelerating Centre. \nCACTUS. \nUnofficial Preparations. \nCereus G-randifLorus. \xe2\x80\x94 Cereus Grandiflorus. (Night-blooming \nCereus.) Dose, 0.30 to 0.60 gm.; 5 to 10 gr. \n\nFluidextractum Cacti. \xe2\x80\x94 Fluidextract of Cactus. Dose, 0.60 \nto 2 c.c; 10 to 30 TTL - \n\nAction of Cactus. \nCactus is non-irritating, but the crude drug is said to be \nused as a counter-irritant, and to produce pustulation. The \naction of cactus is upon the intra-cardiac ganglia and acceler- \nator nerves, through the cardiac plexus of the sympathetic, and \nthere is not any interference with the inhibitory nerves, nor, \nindeed, does its administration produce any very marked vaso- \nmotor changes. It shortens the ventricular diastole, thus quick- \nening the pulse, and increases the blood-pressure. Cactus is also \nsaid to have a stimulating effect upon the spinal nerve-centres \nand to increase the general nerve-tone. \n\nTherapeutics of Cactus. \nIt is useful in cardiac weakness, that is, relative incompetency ; \nin convalescence from typhoid fever; in simple eccentric cardiac \ndilatation; in functional cardiac diseases, from tea, coffee, tobacco \n\n\n\n324 PHARMACOLOGY AND THERAPEUTICS. \n\nand alcohol, dyspepsia, exophthalmic goitre, neurasthenia of \nthe climacteric, sexual exhaustion ; in the " slow heart," from \nover-stimulation of the pneumogastric or degeneration of the \nmuscular wall of the ventricles. It is of very great use in aortic \nregurgitation, but is absolutely contra-indicated in mitral \nstenosis, thus being of value in those cases where the use of \ndigitalis is inadmissible. It has also been found of service in \nsome cases of angina pectoris, more particularly pseudo-angina. \nCactus has a sphere of action entirely its own; not, however, \nreplacing other remedies used for cardiac disease, though it \nis useful in many cases where these drugs are not only dan- \ngerous, but absolutely contra-indicated. Failures to obtain re- \nsults depend upon the fact that many adulterated specimens are \nfound in the shops, or upon the use of inert, dried material. \nIf made from the green plant, as it should always be, the fluid- \nextract is of a peculiar green color. Cactus, in the form of \nthis preparation, is the only remedy known which will quicken \na slow heart. It deserves a better recognition in cases of this \nkind, few indeed, yet nevertheless presenting themselves, for in \nsuch it oftentimes yields brilliant results. \n\nDivision IV. \xe2\x80\x94 Drugs Acting on the Vessels. \nThe effects are usually determined (1) by direct observation \nof alterations caused by the drug in the size of the vessels of \nsome thin structure, such as the ear of the rabbit, the wing \nof the bat, or the web, lung, mesentery, tongue or mylo-hyoid \nmuscle of the frog; (2) by observing the rate at which the blood \nflows from the cut vessel of an animal, both under and without \nthe influence of the drug. In order to exclude influences acting \non the cardiac mechanism, the maintenance of an artificial cir- \nculation is quite commonly resorted to, and destruction of the \nspinal cord or section of the nerves supplying the part is re- \nquired to determine whether the changes observed are due to \nlocal or central effects. When alterations in the vessels result \nfrom the local application of a drug it is often uncertain, if \nthe nerves supplying the part are not divided, whether the effect \n\n\n\nDRUGS ACTING LOCALLY ON VESSELS. 325 \n\nis reflex or direct. It is probable that some of the drugs act \nby the vaso-constrictor and some by the vaso-dilator nerves, \nboth of which kinds of nerves connect the vessels with the \ncentral nervous system; but they can be classified only gen- \nerally into those drugs which dilate or constrict the vessels by \nlocal action and those which do so through their action on \nthe central nervous system. In the case of those acting locally \nit is impossible to determine whether they affect the muscular \ncoat of the vessel or the nerve terminations. It can readily \nbe seen that drugs which act on the heart or on a large area \nwill have a considerable effect upon the general blood-pressure. \nDrugs are applied to the interior of vessels by injecting them \ninto the circulation. \n\nA. Drugs acting locally on Vessels. \n1. Vaso-dilators. \n\nDrugs which, when locally applied to vessels, dilate them: \n\n\n\n(16) All volatile oils, as oils of \nturpentine, and many sub- \nstances containing them, \nas mustard, horse-radish, \netc. \n\n\n\n(1) Liquor Ammonise. \n\n(2) Silver nitrate -\\ \n\n(3) Zinc chloride r (strong) \n\n(4) Copper sulphate \n\n(5) Mercuric nitrate. \n\n(6) Arsenic trioxide. (17) Senega. \n\n(7) Antimony and potassium (18) Chrysarobin. \n\ntartrate. (19) Ipecacuanha. \n\n(8) Iodine. (20) Capsicum. \n\n(9) Chlorine. (21) Croton oil. \n\n(10) Mineral acids (strong). (22) Camphor. \n\n(11) Alcohol. ") If prevented (23) Cantharides. \n\n(12) Ether. I from evapo- (24) Phosphorus. \n\n(13) Chloroform. J rating. (25) Warmth, if transiently ap- \n\n(14) Phenol. plied. (When long applied \n\n(15) Creosote. it contracts blood-vessels.) \n\nIrritants. \xe2\x80\x94 All of the above, as they dilate the vessels, are often \nspoken of as vascular irritants. \n\nRubefacients are drugs which, in consequence of the vascular \ndilatation caused by them, redden the skin when they are applied \n\n\n\n326 PHARMACOLOGY AND THERAPEUTICS. \n\nto it. Desquamation frequently follows if the action has con- \ntinued for some time. All the above are rubefacients. \n\nVesicants. \xe2\x80\x94 With many of these drugs the irritant effect is \nsufficient to produce inflammation, and when they cause the \nexudation of serum between the epidermis and the true skin \nand the formation of vesicles or blisters they are known as \nvesicants; e. g., cantharides. \n\nPustulants are drugs which produce small discrete suppura- \ntions, the distinct and separate points of inflammation being \nsituated at the orifices of the skin glands. They do not affect \nthe intervening tissue, probably for the reason that they cannot \npass through the horny epidermis; e. g., croton oil. \n\nEscharotics. \xe2\x80\x94 With the most powerful of these drugs the irri- \ntation is sufficient to destroy the vitality of the tissues with \nwhich they came in contact, forming a slough, and to cause \nvascular dilatation in the surrounding parts. They are known \nas eschartics or caustics ; e. g., zinc chloride. \n\nCounter-irritants. \xe2\x80\x94 When any of these drugs are employed \nto produce a reflex influence on a part more or less remote from \nthe point of application, they are termed counter-irritants. The \nexact nature of the effects of counter-irritation on internal \norgans has not been determined, but it is considered most prob- \nable that an alteration in the calibre of the vessels and in the \nsensory nerves or their terminations is induced, and that such \nchanges may cause or be accompanied by a distinct alteration \nin the activity of the organs. \n\nThe following, when inhaled, dilate peripheral vessels by acting lo- \ncally on them: \n\n\n\n(1) Amyl nitrite. \n\n(2) Nitroglycerin. \n\n(3) Sodium nitrite. \n\n\n\n(4) Ethyl nitrite. \n\n(5) Spiritus aetheris nitrosi. \n\n(6) Erythrol tetranitrate. \n\n\n\nDrugs which, taken by the mouth, dilate arterioles by acting locally \non them: \n\n\n\n(1) Caffeine. \n\n(2) Amyl nitrite. \n\n(3) Nitroglycerin. \n\n(4) Sodium nitrite. \n\n\n\n(5) Ethyl nitrite. \n\n(6) Spiritus aetheris nitrosi. \n\n(7) Erythrol tetranitrate. \n\n(8) Nicotine. \n\n\n\nDRUGS ACTING LOCALLY ON VESSELS. \n\n\n\n327 \n\n\n\n2. Vaso-constrictors. \n\nDrugs which, taken by the mouth, contract arterioles by acting locally \non them: \n\n(1) Suprarenal extract. (4) Caffeine (early in its ac- \n\n(2) Barium salts. tion). \n\n(3) Ergot. (5) Digitalis. \n\n(6) Physostigmine. \n\n\n\nThe following have been shown by experiments to cause contraction \nof small arteries through which they circulate : copper, zinc, tin and \nplatinum salts, powerful contraction ; lithium, calcium, strontium, mag- \nnesium, cadmium, nickel, cobalt and iron salts, slight contraction. \n\nDrugs which, when locally applied to vessels, contract them: \n\nThese may act in two ways: (1) by contracting the muscular \ncoat of the vessels; (2) by coagulating the albuminous fluids \naround them, the coagulum by its contraction constricting the \nvessels. \n\n\n\nThose which act on the muscular coat of the vessels \n\n\n\n(1) Cold, temporarily applied. \n(If cold is long continued \nit dilates blood-vessels.) \n\n(2) Cocaine. \n\n(3) Lead salts. \n\n(4) Dilute solutions of silver \n\nsalts. \n\n\n\n(5) Diluted sulphuric acid. \n\n(6) Alum. \n\n(7) Hamamelis. \n\n(8) Ergot. \n\n(9) Hydrastis. \n\n(10) Acetanilide. \n\n(11) Antipyrine. \n\n\n\nThose which coagulate the albuminous -fluids around the vessels: \n\n\n\n(1) Tannic acid and all sub- \nstances containing it : e. g., \nnutgall, krameria, kino, I \nhaematoxylon, hamamelis, \ncinnamon, eucalyptus gum, \nand gambir. \n\n(2) Lead salts. \n\n\n\n(3) Silver salts. \n\n(4) Zinc salts. \n\n(5) Copper salts. \n\n(6) Alum. \n\n(7) Ferric salts. \n\n(8) Bismuth salts to a slight \nextent. \n\n\n\nAstringents are drugs which diminish the size of the vessels, \nand thus decrease the amount of exudation from them. They \nproduce contraction of muscular fibre by direct irritation and \n\n\n\n328 PHARMACOLOGY AND THERAPEUTICS. \n\ncondensation of other tissues by precipitating albumin and \ngelatin. \n\nStyptics, or Haemostatics, are drugs which stop bleeding. \nAmong them are included all astringents, the most important of \nthem being cold, lead and copper salts, hamamelis, ergot, hy- \ndrastis, tannic acid, and especially the salts of iron, which \ncoagulate escaping blood, while the clot thus formed tends to \nprevent further haemorrhage. Matico leaves, applied to a bleed- \ning surface, act as a mechanical haemostatic, the numerous hairs \non their underside favoring coagulation; and cobwebs have a \nsimilar effect. \n\n3. Emollients and Demulcents. \n\nEmollients are substances which soften and relax the parts \nto which they are applied. They serve to relieve tension, dimin- \nish pressure on the nerves, and also protect inflamed surfaces \nfrom the air and from friction. \n\nCommon emollients are substances soaked in warm water, as hot \nfomentations and poultices, fats of various sorts, as lard and lanolin \n(hydrous wool-fat) and non-irritating oils, as olive oil, spermaceti, \npetrolatum, vaseline, etc. \n\nDemulcents are substances which protect and soothe the \ntissues to which they are applied, and are often of a mucilagi- \nnous nature. This name is ordinarily employed for substances \nused for mucous membranes, and that of emollient for those \nused for the skin. Among demulcents may be mentioned gelatin, \nisinglass, glycerin, gum, honey, flaxseed, starch, and white of \n\negg- \n\nTherapeutics. \xe2\x80\x94 Drugs which locally dilate vessels are fre- \nquently used as stimulating applications for indolent ulcers and \nsores, as well as to promote the absorption of inflammatory \nproducts ; also as counter-irritants in various diseased conditions \nin internal organs. Drugs, such as the nitrites, which by their \ncentral action cause dilatation of all the vessels of the body, \nare employed in cardiac diseases, where the relief which they \nafford is no doubt largely due to their thus diminishing the work \n\n\n\nDRUGS ACTING ON VASO-MOTOR CENTERS. \n\n\n\n329 \n\n\n\nof the heart. Others having this general vaso-dilator action \nare used more particularly to cause diaphoresis. \n\nAstringents are used chiefly as styptics, but also to diminish \nsecretion from mucous membranes and check excessive dis- \ncharges generally, as well as to obviate relaxed vascular condi- \ntions. \n\nB. Drugs which act on the Vaso-motor Centres. \n\nDrugs which, by their action on the vaso-motor centres, dilate the \nvessels : \n\n(1) Belladonna. \n\n\n\n(2) Stramonium. \n\n(3) Hyoscyamus. \n\n(4) Alcohol. \n\n(5) Ether. \n\n(6) Chloroform. \n\n(7) Hydrated chloral. \n\n(8) Antimony and Potassium \n\nTartrate. \n\n\n\n(9) Aconite. \n\n(10) Ipecacuanha. \n\n(11) Lobelia. \n\n(12) Tobacco. \n\n(13) Veratrine. \n\n(14) Hydrocyanic acid. \n\n(15) Opium. \n\n\n\nSome of the substances, which in small doses contract the vessels by \ncentral action, in large doses dilate them ; viz., digitalis and squill. \n\nDrugs which, by their action on vaso-motor centres, cause contrac- \ntion of vessels: \n\n\n\n(1) Ergot. \n\n(2) Digitalis. \n\n(3) Strophanthus. \n\n(4) Sparteine. \n\n(5) Squill. \n\n(6) Physostigmine. \n\n\n\n(7) Cocaine. \n\n(8) Hydrastis. \n\n(9) Hamamelis. \n\n(10) Strychnine. \n\n(11) Lead salts \n\n(12) Ammonia \n\n\n\n(slightly). \n\n\n\nAlso, for a very short early period of their action, some substances \nwhose main action is to dilate the vessels by their central action ; viz., \nbelladonna, stramonium, hyoscyamus, alcohol, ether, chloroform, hydro- \ncyanic acid, and veratrine. \n\n\n\nA. Drugs Acting Locally on Vessels. \n\nI. Vaso-dilators. \nTHE ACIDS. \n1. ACIDUM SULPHURICUM.\xe2\x80\x94 Sulphuric Acid. (Oil of Vitriol.) \n\n\n\n330 PHARMACOLOGY AND THERAPEUTICS. \n\nPreparations. \n\n1. Acidum Sulphuricum Dilutum. \xe2\x80\x94 Diluted Sulphuric Acid. \nDose, 2 c.c; 30 ni. \n\n2. Acidum Sulphuricum Aromaticum. \xe2\x80\x94 Aromatic Sulphuric \nAcid. Dose, 1 c.c; 15 m.. \n\n2. ACIDUM NITRICUM.\xe2\x80\x94 Nitric Acid. \n\nPreparations. \n\n1. Acidum Nitricum Dilutum. \xe2\x80\x94 Diluted Nitric Acid. Dose, \n2 c.c; 30 Hi. \n\n2. Acidum Nitrohydrochloricum. \xe2\x80\x94 Nitrohydrochloric Acid. \n(Nitromuriatic Acid.) Dose, 0.2 C.C.; 3 T1J,. \n\n3. Acidum Nitrohydrochloricum Dilutum. \xe2\x80\x94 Diluted Nitro- \nhydrochloric Acid. Dose, 1 c.c; 15 TTt. \n\n3. ACIDUM HYDROCHLOEICUM.\xe2\x80\x94 Hydrochloric Acid. (Muri- \natic Acid.) \n\nPreparations. \n\n1. Acidum Hydrochloricum Dilutum. \xe2\x80\x94 Diluted Hydrochloric \nAcid. Dose, 1 c.c; 15 TT\\.. \n\n2. Acidum Nitrohydrochloricum. \xe2\x80\x94 Nitrohydrochloric Acid. \nDose, 0.2 c.c; 3 n\\. \n\n3. Acidum Nitrohydrochloricum Dilutum. \xe2\x80\x94 Diluted Nitro- \nhydrochloric Acid. Dose, 1 c.c; 15 TTL- \n\n4. ACIDUM PHOSPHORICUM.\xe2\x80\x94 Phosphoric Acid. \n\nPreparations. \n\n1. Acidum Phosphoricum Dilutum. \xe2\x80\x94 Diluted Phosphoric \nAcid. Dose, 2 c.c; 30 TH,. \n\n2. Elixir Ferri, Quininae et Strychninae Phosphatum. \xe2\x80\x94 \nElixir of Iron, Quinine et Strychnine Phosphates. Dose, 4 C.C. J \n1 fl. dr. \n\n3. Glyceritum Ferri, Quininae et Strychninae Phosphatum. \n\xe2\x80\x94 Glycerite of Iron, Quinine and Strychnine Phosphates. Dose, \n1 C.c; 15 TTL. \n\n4. Syrupus Ferri, Quininae et Strychninae Phosphatum.\xe2\x80\x94 \n\nSyrup of Iron, Quinine and Strychnine Phosphates. Dose, 4 \nc.c; 1 fl. dr. \n\n\n\nTHE ACIDS. 331 \n\n5. ACIDUM ACETICUM.\xe2\x80\x94 Acetic Acid. \n\nPreparation. \nAcidum Aceticum Dilutum. \xe2\x80\x94 Diluted Acetic Acid. Dose, \n2 c.c; 30 TTL. \n\n6. ACIDUM ACETICUM GLACIALE.\xe2\x80\x94 Glacial Acetic Acid. \n\n7. ACIDUM TRICHLOEACETICUM.\xe2\x80\x94 Trichloracetic Acid. \n\n8. ACIDUM CITRICUM.\xe2\x80\x94 Citric Acid. Dose, 0.500 gin. (500 mil- \nligm.); 7y 2 gr. \n\nPreparations. \n\n1. Syrupus Acidi Citrici. \xe2\x80\x94 Syrup of Citric Acid. \n\n2. Liquor Sodii Phosphatis Compositus. \xe2\x80\x94 Compound Solu- \ntion of Sodium Phosphate. Dose, 8 c.c; 2 fl. dr. \n\n9. ACIDUM TARTARICUM.\xe2\x80\x94 Tartaric Acid. Dose, 0.500 gin. \n(500 milligm.) ; 7% gr. \n\n10. ACIDUM LACTICUM.\xe2\x80\x94 Lactic Acid. Dose, 2 c.c; 30 ill. \n\nAction of Sulphuric, Nitric, Hydrochloric, Phosphoric, \nAcetic, Citric, Tartaric and Lactic Acids. \nExternal. \xe2\x80\x94 All these acids are powerful local irritants. The \nleast so is citric. While its concentrated solution does not affect \nthe sound skin, it is irritant to mucous membranes and abraded \nsurfaces. Next to this comes tartaric, the saturated solution \nof which acts upon the unabraded skin, and when applied to a \nraw surface produces more considerable irritation, with pain \nand heat. The remaining acids are very energetic caustics, and \neven when in very dilute solution cause an irritation which may \namount to vesication. The nature of the escharotic action \nvaries to some extent with the constituents of the tissues with \nwhich they come in contact, but, on the whole, is found to con- \nsist in withdrawal of water, the formation of acid albumins, \nsoftening of the connective tissue and epithelium, and, in special \nsituations, solution of calcareous material. The most typical \nacids in regard to the local action are sulphuric and hydro- \nchloric. Nitric causes the same effects, but differs in its \n\n\n\n332 PHARMACOLOGY AND THERAPEUTICS. \n\nchemical action, by which xanthoproteic acid is produced from \nthe proteids. Owing to the fact that it does not redissolve the \nalbumin it precipitates, its area of action is somewhat limited; \nbut nitrohydrochloric is very energetic. Nitric acid, because of \nits special chemical action, stains the skin a deep yellow and \ncauses a yellow eschar, while sulphuric, in consequence of its \nleaving the carbon untouched, blackens the surface and causes \na brown or black eschar. The latter causes necrosis of the skin \nand subcutaneous tissues, which is accompanied by intense pain \nand, if the surface involved is large, by symptoms of shock and \ncollapse such as are met with in severe burns. Ricord\'s paste is \ncomposed of sulphuric acid and willow charcoal; Michel\'s, of \nsulphuric acid and asbestos. Hydrochloric acid, though less \nliable to cause wholesale destruction of the skin than sulphuric, \npenetrates the epidermis and causes vesication. Phosphoric is \nconsiderably less irritant, but causes redness and even blister- \ning when applied in concentrated solution. Glacial acetic acid \nis especially applicable when a limited action is desired. The \ncorrosive action of the acids is much more intense upon mucous \nmembranes than upon the skin, and even small quantities of \nstrong sulphuric acid striking the eye are sufficient to destroy \nthe sight. \n\nAs all the more powerful acids unite with and coagulate \nalbumin, solutions of these which are not sufficiently strong to \nform a slough (which by its separation is likely to cause bleed- \ning), act as astringents and haemostatics, both by coagulating \nthe blood, and thus plugging the vessels, and by coagulating \nthe albumin in the tissues, with the effect of constricting the \nvessels. Weak solutions, moreover, are cooling to the skin in \nfebrile conditions, and hence they are classed also as refriger- \nants. Citric acid is added to tablets of corrosive mercuric chlor- \nide so that when these are dissolved in making solutions the \nantiseptic shall penetrate into the tissues. Tartaric acid is used \nfor the same purpose. As most living matter is neutral or \nslightly alkaline in reaction, and appears to be incapable of ex- \nisting in acid media, the acids are protoplasm poisons and anti- \nseptics of some power. \n\n\n\nTHE ACIDS. 333 \n\nAlimentary Canal \xe2\x80\x94 In the mouth, oesophagus and stomach \ncomplete destruction of the mucous membrane results from the \ncorrosive action of strong acids wherever they come in contact \nwith the membrane. As in the case of the caustic alkalies, per- \nforation of the oesophagus or stomach may be produced, causing \nimmediate death, with symptoms of shock and collapse, or if the \ncorrosion does not go to this extent, cicatrices may result which \neventually lead to a fatal termination. While hydrochloric and \nthe stronger organic acids are capable of causing corrosion of \nthe mucous membranes, this is not usually so extensive as that \nproduced by sulphuric and nitric acid. In the mouth the diluted \nacids have a characteristic sour and pungent taste, and, as it \nis popularly expressed, " set the teeth on edge." They also soften \nthe dental enamel. The saliva being alkaline, they augment its \nsecretion, and thus serve to allay thirst by keeping the mouth \nmoist. In both the mouth and throat they cause an astringent \nfeeling in consequence of their coagulating the superficial layers \nof proteids. When the gastric juice is deficient in acid, acids \ntaken after a meal, by remedying this, assist digestion, but it \nseems to be the case that if given before or during meals they \ntend to check the flow of the gastric juice. As the latter, when \nnormal, contains about 0.2 per cent, of hydrochloric acid, this \nacid, so far as both experimental and clinical results at present \nindicate, is undoubtedly the best for administration when the \namount of acid secreted by the gastric mucous membrane is \ndeficient. Recent researches have shown, however, that pepsin \nis excreted in actual combination with the hydrochloric acid, so \nthat it would seem to be impossible to completely replace the \ndeficiency of acid in the stomach by giving hydrochloric acid \nby the mouth. The prolonged treatment of animals with acids \nhas been found to be followed by anaemia and loss of flesh and \nstrength, a result which is thought to be attributable to the dis- \nturbance of the digestion induced, rather than to any specific \naction of the acids. If free acid penetrates into the intestinal \ncanal it acts as a very powerful irritant and produces increased \nperistalsis, but as acids given by the mouth are usually absorbed \n\n\n\n334 PHARMACOLOGY AND THERAPEUTICS. \n\nbefore passing the pylorus, this cathartic action is practically \nseen only when acids are generated in the intestine itself. As \na rule, acids quickly become converted into neutral salts, but \nsome, especially sulphuric, preserve, it is said, their astringent \naction in the intestine. According to some authorities, the in- \ncreased flow of pancreatic juice and of bile which has been \nascribed to acids is probably too small to be of any value, but \nothers are convinced that they do materially increase the amount \nof bile poured into the intestine (this being notably the case \nwith nitric acid), while nitrohydrochloric acid is not only a \ncholagogue, but also a hepatic stimulant of considerable power, \ncausing actual increase in the activity of the cells of the liver, \nand not merely evacuation of the gall bladder. \n\nAbsorption and Excretion. \xe2\x80\x94 Generally the acids are absorbed \nfrom the alimentary canal with considerable rapidity. \xe2\x80\xa2 The \nsalts formed in the blood and tissues after their absorption are \nquickly excreted by the kidneys. The latter, it is found, retain \nas much alkali as possible in the body, and the result is that they \nexcrete the salts in an acid form, and perhaps some free acid. \nConsequently, irritation of the kidneys is sometimes induced, \nwith albumin and even blood in the urine, which is rendered \nmore acid than usual and causes a sensation of heat and smart- \ning in the bladder and urethra. Nitric acid, however, is stated \nto be excreted to a small extent as ammonia, and hence to \nslightly increase the alkalinity of the urine. The alkalinity of \nthe latter is also increased by acetic, citric and tartaric acids, in \nconsequence of their being converted into alkaline carbonates in \nthe blood; while lactic acid is either so converted or passes out \nas carbon dioxide in solution in the urine. The acids in general \nincrease the ammonia of the urine (the total nitrogen being \npretty constantly increased to a moderate extent) at the ex- \npense of the urea, which is accordingly somewhat decreased. \nJust as the secretion of the acid gastric juice is stimulated by \nalkalies introduced into the stomach, acids appear to have the \npower of stimulating alkaline secretions. \n\nBlood. \xe2\x80\x94 Acids may have the effect of reducing the alkalinity \n\n\n\nTHE ACIDS. 335 \n\nof the blood, but the reaction of this fluid must necessarily re- \nmain slightly alkaline throughout life. It is found that if suffi- \ncient acid be given to an animal to neutralize the alkalies of \nthe body, it dies before the blood becomes neutral, although after \ndeath the latter may be found to be alkaline. Experimentation \nhas shown that the diminution of the alkalinity of the blood \nwhich results from the administration of acids is much more \npronounced in herbivorous animals than in man and the car- \nnivora; so that in these last no serious symptoms arise from \nthis cause. In rabbits the blood-pressure is much lowered by \nthe acids, from depression of the vaso-motor centre and the \nheart, and if the poisoning is pushed, the alkalinity of the blood \nbecomes so greatly reduced that the tissues are unable to rid \nthemselves of their carbon dioxide, and fatal collapse results; \nthe heart continuing to beat for some time after the respiration \nhas ceased. Even in the last stage of intoxication the injection \nof sodium carbonate, in consequence of the alkali thus supplied \nto the blood and tissues, will have the effect of bringing about \na rapid recovery. It has been found that the red blood-cor- \npuscles are increased in size by the addition of small quantities \nof acid outside the body, and the amount of phosphates in these \ncells is believed to be increased by the administration of phos- \nphoric acid. In chlorosis it is stated that the number of the \nred corpuscles will be increased by hydrochloric acid, though \nthe amount of haemoglobin remains unaltered. \n\nTherapeutics of Sulphuric, Nitric, Hydrochloric, Phos- \nphoric, Acetic, Citric, Tartaric and Lactic Acids. \nExternal. \xe2\x80\x94 Owing to their marked affinity for water, it is \ndifficult to limit the local action of sulphuric and phosphoric \nacids, and consequently nitric acid is much more commonly em- \nployed as a caustic. It is the preferred escharotic for venereal \nsores, warts, poisoned wounds, sloughing, phagedena and can- \ncrum oris, and may be advantageously applied in a variety of \nother conditions, such as uterine ulceration, haemorrhoids and \nprolapse of the bowel. In the form of a foot-bath or lotion \n\n\n\n336 PHARMACOLOGY AND THERAPEUTICS. \n\ndiluted nitric acid is useful in the treatment of chilblains, and \nits addition to the bath has been found of service in such skin \ndiseases as impetigo, lepra and acne. Nitric acid is used as \nHeller\'s test for determining the presence of albumin in the \nurine. At present his process is reversed, i. e., the urine is \nadded to the acid. Glacial acetic acid is successfully used for \nwarts, corns, ulcers, lupus, epithelioma and nasal hypertrophies, \nas well as for ringworm and other forms of tinea. If much \npain is occasioned it may be more or less diluted. A mixture \nof 30 parts of acetic acid with 2 parts of salicylic acid is a \ngood application for venereal warts. Hydrochloric acid is \nsometimes applied to septic wounds, dissecting wounds, and bites \nof rabid animals, and in combination with pepsin has been \nutilized for the removal of carious and necrotic bone. The un- \ndiluted acid is used to destroy warts on the hands of children, \nand has been successfully employed as a counter-irritant in \nsciatica. Three or four coats of it are painted with a small \nbrush along the course of the nerve, after which the part is \nwrapped up in cotton. The application may be repeated in \ntwenty-four or forty-eight hours, as required. Mixed with an \nequal proportion of honey it has been used as a topical applica- \ntion in diphtheria, care being taken that it should be confined \nstrictly to the diseased surface. It has also been recommended \nas an addition to baths in such skin affections as pityriasis and \ntinea. Lactic acid has been advocated as a solvent of false mem- \nbrane in diphtheria and croup, though its value in these diseases \nis somewhat problematical. Equal parts of lactic acid and water \nmay be applied with a mop, and glycerin is sometimes added \nto the solution. It may also be used as a spray, of the strength \nof 1 to 8. Lactic acid is employed perhaps more frequently than \nany other drug as a local application in tuberculosis of the \nlarynx. It is customary to begin with the following: lactic \nacid, 2 ; water, 1 ; glycerin, 1 ; which is applied with a brush. \nThe strength of the solution is then gradually increased until \nat length the pure acid is used. Lactic acid is also used as a \nlocal application for other laryngeal growths, as well as for \n\n\n\nTHE ACIDS. 337 \n\ntubercular ulcerations of the tongue and other accessible parts, \nand for caries, lupus and epithelioma. In the external lesions \nof tuberculosis gauze tampons soaked in lactic acid are some- \ntimes applied, while for tubercular fistulae gelatin bougies con- \ntaining the acid may be resorted to. They are composed of a \npaste made by gently heating 50 gm. (13 dr.) each of gelatin, \nlactic acid, and water, and then adding 30 gm. (1 oz.) of \nmenthol ; after which the bougies are covered with a coating of \ncollodion. In a 20 to 40 per cent, solution lactic acid has proved \nof service in the treatment of suppurative otitis and ulcers of \nthe nasal fossa. Any well-diluted acid may be applied to arrest \nslight bleeding, as from leech-bites, piles, etc. Dilute vinegar \nwill often answer, but sulphuric acid is particularly useful for \nthis purpose, and its astringent effect is also made use of \nlocally in the night-sweats of phthisis. Vinegar, properly di- \nluted, is often employed as a refrigerant for bathing the skin in \nfever. In chronic cystitis and phosphatic deposits a very weak \nsolution of nitric acid (.06 c.c. ; 1 1U to 30 c.c. ; 1 fl. oz.) has been \ninjected with advantage. On account of the intolerance of the \nbladder, such injections should be permitted to escape imme- \ndiately. \n\nInternal. Alimentary Canal. \xe2\x80\x94 In consequence of the in- \njurious effects of acids upon the teeth, it is better that they \nshould be taken through a glass tube. Diluted sulphuric \nacid is used to a considerable extent as a prophylactic and \nremedy for lead poisoning, and as a prophylactic measure a \nlemonade made with sulphuric acid is quite commonly taken \nby those employed in lead works and paint factories. This \ntreatment is recommended on the ground that the lead taken \ninto the system is by this means changed to the insoluble sul- \nphate and is thus less easily absorbed; but it is a fact that \npoisoning may be induced by lead sulphate, so that the utility \nof the measure would seem to be somewhat doubtful. It has \nbeen found in practice however, that dilute sulphuric acid is \neffective in the treatment of lead-colic and that the constipa- \ntion due to lead is relieved by a combination of sulphuric acid \n23 \n\n\n\n338 PHARMACOLOGY AND THERAPEUTICS. \n\nand magnesium sulphate, while the lead-cachexia is much bene- \nfited by sulphuric acid given in association with quinine and \nferrous sulphate. On the other hand, sulphuric acid is of no \nservice in removing the effects of lead upon the nervous sys- \ntem. Aromatic sulphuric acid, sufficiently diluted with water \nand syrup, makes a pleasant cooling drink for fever patients. \nIn gastric and intestinal hemorrhage it acts directly in part, and \nmay therefore prove useful, though its action is sometimes dis- \nappointing; and on account of its astringent effect it is often \nof great value in diarrhceic conditions. A combination of aro- \nmatic sulphuric acid with opium is considered one of the \nmost elficient remedies for summer diarrhcea and cholera, and \nin the treatment of dysentery dilute sulphuric acid may be pre- \nscribed with advantage in association with magnesium sulphate \nand morphine sulphate. Sulphuric acid, being more decidedly \nastringent, is as a rule, to be preferred to nitric and hydro- \nchloric acids in the treatment of diarrhcea, but the latter are \nuseful also, and the mineral acids as a class are very efficient \nremedies in summer and colliquative diarrhcea. Whenever the \nstools are painless, watery, of a light color, and alkaline in \nreaction, these agents are indicated. Hope\'s camphor mixture \nhas long been held in repute in such conditions, but it is said \nthat when made according to the formula now generally in use \n(Nitric acid 2 c.c. ; y 2 fl. dr.; tincture of opium, 1.20 c.c. ; \n20 Ul ; camphor water, 120 c.c; 4 fl. oz.) ; it is not nearly so \nserviceable as Hope\'s original formula, in which the acid em- \nployed was nitrous acid. Prepared in the original way and used \nwhile fresh, the mixture is regarded as a very efficient, though \nsomewhat disagreeable, remedy in serous diarrhceas, as well as \nchronic dysentery connected with disordered secretion of the \nliver and other glands of the alimentary canal. \n\nAs regards the action on the economy of the three prin- \ncipal mineral acids, the general statement has been made \nthat sulphuric more promotes astringency, nitric, secretion, \nand hydrochloric, digestion. As previously remarked, hy- \ndrochloric acid is the one most appropriate for rectify- \n\n\n\n\n\n\nTHE ACIDS. 559 \n\ning a deficiency in acidity in the gastric juice. In dys- \npepsia due to this cause it is the most valuable remedy \nwhich we at present possess, but in many instances the nitro- \nhydrochloric acid is also of great service. For the purpose men- \ntioned these acids have the best effect when taken a little while \nafter eating. A very useful combination consists of nitro- \nhydrochloric acid with tincture of nux vomica and some such \nother stomachic tonic as the compound tincture of gentian. Hy- \ndrochloric acid is sometimes useful, in association with other \nremedies, in cases of diarrhoea which are characterized by ex- \ncessive putrefaction of the intestinal contents. As a result of \nits administration the double sulphates of the urine are in \nmany instances lessened: so that it would seem probable that it \nhas the effect of disinfecting the stomach contents, as the hydro- \nchloric acid of the gastric secretion does normally. In the \nvariety of dyspepsia in which acid eructations, pyrosis, and \nheartburn occur acids are of decided service, particularly hydro- \nchloric and phosphoric, and they should then be administered \nbefore meals. It is said that hydrochloric acid prevents the \nlactic fermentation in I to 1,000 dilution, and that in addition \nto its action on the digestive ferment it increases the peristalsis \nof the stomach. Hydrochloric acid is given to a very consider- \nable extent in typhoid fever, where by increasing the secretion \nof mucus it relieves the dryness of the tongue and fauces, and \nwhere it also no doubt tends to disinfect the intestinal contents. \nIn this and other fevers it is believed to be indicated for the \nreason that the normal secretion of hydrochloric acid is much \ndiminished when the temperature is raised. It may often be \nadvantageously administered in beef-juice. If the diarrhoea is \ntroublesome, sulphuric acid may be given in its place. Hydro- \nchloric acid is sometimes of service also in phthisis ; serving to \nsupply to the digestive fluids a material in which they are \ndeficient (both acid and pepsin in the gastric juice being re- \nduced in this disease), and also to disinfect to some extent the \nalimentary canal. Xitrohydrochloric acid is not, as a rule, so \nefficient as hydrochloric in ordinary dyspepsia. Still, in many \n\n\n\n340 PHARMACOLOGY AND THERAPEUTICS. \n\ninstances it seems to act very satisfactorily, and it is particularly \nindicated when the biliary function needs stimulating. Its \nspecial value is believed to be in hepatic disorders and jaundice. \nIts mode of action in such conditions is not definitely known, but \nits peculiar composition may possibly afford some explanation. \nThis acid contains not only nitric and hydrochloric acid, but \na number of decomposition products, such as chlorine, nitroxy- \nchloride (NOC1), and nitrous acid. The acids, as is well \nknown, are incapable of acting as such except in the alimentary \ncanal, but it may be that some of the other constituents of this \ncompound, as the chlorine, for instance, have a specific effect on \nthe liver. Mucous duodenitis and catarrh of the gall-ducts ac- \ncompanied by jaundice and jaundice of malarial origin are \namong the affections which have been found to be benefited by it, \nand the experience of physicians practising in tropical countries \nhas been favorable to its use in chronic affections of the liver, \nas well as in dysentery and dropsy of hepatic origin. In hepa- \ntitis the acid is sometimes not only given internally, but applied \nexternally, in the form of a foot-bath or general bath or of a \ncompress placed over the liver. It is scarcely possible, however, \nto suppose that it can be absorbed in any quantity from the \nskin; so that any benefit which may be attributable to such ex- \nternal application would seem to be principally due to the \ncounter-irritation caused by it. In acute hepatic diseases and \nsuch chronic affections as cirrhosis and waxy degeneration \nnitrohydrochloric acid is not thought to be of sevice, as a rule, \nthough some authorities advise that it should be tried in the \nearly stages of cirrhosis, while the liver is still enlarged. In \nsome cases apparently of this character great benefit, it is said, \nhas been derived from its use. It is also stated that the wearing \naround the body of a flannel bandage soaked in a solution of \nthe acid and covered with oiled silk is serviceable in the first \nstage of cirrhosis, as well as in chronic hepatitis and jaundice. \nPhosphoric acid is sometimes used to make cooling draughts \nin fever, as well as to relieve the thirst in diabetes. Acetic acid \nin the form of vinegar is a popular remedy for obesity. Its \n\n\n\nTHE ACIDS. 341 \n\nfree use, however, is apt to be attended with more or less \nserious consequences, as it reduces flesh merely by interfering \nwith the digestion. The prolonged administration of large quan- \ntities of acids usually proves irritant, and thus, by setting up a \ncertain amount of gastritis, hinders the digestion and absorption \nof food. In order to allay the thirst of fever patients lemon \njuice or citric acid itself is used to stimulate the secretion of \nsaliva and keep the mouth moist, and lemonade is a common \nbeverage in febrile diseases. One or the other of these sub- \nstances thus frequently serves as the basis for cooling drinks, \nand the acid is largely employed, together with alkaline carbon- \nates, in the preparation of effervescing mixtures which are use- \nful as gastric sedatives. Citric and tartaric acids also form \ningredients of various granular effervescent preparations. \nLactic acid is only occasionally used in the treatment of dys- \npepsia, as hydrochloric acid is generally much more satisfac- \ntory. At one time, however, under the impression that lactic \nacid was the normal acid of the gastric digestion, it was quite \nextensively employed. \n\nRemote Effects. \xe2\x80\x94 With the exception of citric, tartaric and \nacetic acids, the remote effects of the acids are of comparatively \nlittle therapeutic importance. Aromatic sulphuric acid was at \none time quite largely relied upon for checking profuse sweat- \ning, especially the night-sweats of phthisis. It is occasionally \nso employed with advantage at the present day, but when it is \nused care should always be taken that it is not allowed to inter- \nfere with the digestion. Sulphuric acid was also highly \nesteemed formerly as a remote haemostatic, but is not very often \nused in this capacity now, though some still profess to find it \nserviceable in certain forms of metrorrhagia. In haemoptysis \nit is unquestionably inferior to other remedies. Nitric acid is \nstated to have been at times used with success in the treatment \nof intermittent fever, in which, in order to obtain a curative \neffect, it is insisted that it should be given in full doses every \nfour to six hours. This acid has also been found of service, \nafter an arrest of the paroxysms of intermittent fever by \n\n\n\n34 2 PHARMACOLOGY AND THERAPEUTICS. \n\nquinine, in removing the hepatic congestion and the changes in \nthe glandular apparatus of the intestines induced by the fever- \nmovement. Under these circumstances it is advised that it \nshould be combined with the bitters or used instead of aromatic \nsulphuric acid in the preparation of Infusum Cinchonse, for- \nmerly official. Chronic bronchitis and hoarseness and the apho- \nnia of singers and public speakers may sometimes be relieved by \ndilute nitric acid in doses of .60 c.c. (10 ni). Both nitric and \nnitro-hydrochloric acids have been used, internally as well as in \nthe form of baths, in such diseases of the skin as impetigo, acne \nand erythema nodosum, while sulphuric acid, also employed in- \nternally and locally, is said to be more or less effective in lichen, \nprurigo, and itching conditions in general. When uric acid is \nin excess in the urine from faulty digestion and assimilation, \nnitric acid is often of great service; the excess of uric acid \ndisappearing in consequence of the foods being more adequately \nprepared for admission into the blood. The mineral acids, and \nparticularly hydrochloric, have been proposed as remedies for \nacute rheumatism, and tincture of ferric chloride is undoubtedly \nsometimes of benefit in that disease. Lime juice was formerly \na popular remedy in acute rheumatism, but little can be said \nin its favor. Nitrohydrochloric acid is usually a very efficient \nremedy in oxaluria, a condition which seems to be dependent \nupon defective primary assimilation and is characterized by \ngeneral malaise, a feeling of weakness, great mental depression, \na sallow complexion, and often eructations of offensive gas, \ntogether with the presence in the urine of crystals of calcium \noxalate. It has at times been successfully employed in chronic \nsyphilis. Cases occasionally occur in which, in spite of the \nadministration of mercury and potassium iodide, specific lesions \npersistently reappear, particularly in the mouth, and it is in \nthis class of patients that benefit may sometimes be hoped for \nfrom the use of nitrohydrochloric acid, although it is in general \nvastly inferior to both of the remedies mentioned in the treat- \nment of syphilis. Citric, tartaric and acetic acids may be given \nto increase the alkalinity of the blood and to alkalize the urine \n\n\n\nTHE ACIDS. 343 \n\nor render it less acid. For an effervescent solution of citric \nacid about 8 parts of the acid may be prescribed along with 7 \nparts of sodium bicarbonate, with directions to dissolve the two \npowders separately, mix the solutions, and drink while effer- \nvescing. In large quantities this mixture acts as a saline \ncathartic; in smaller quantities it has the alkalizing effects just \nstated. There is probably no doubt as to the value of lemon and \nlime juice in the prophylaxis and treatment of scurvy. This, \nhowever, it is stated, is not due to the citric acid, but to some \nunknown property of the fruit juices. Orange juice has proved \ncompletely successful in the cure of infantile scurvy. It has \nbeen a common practice to give phosphoric acid to anaemic and \nfeeble children for the ostensible purpose of improving the con- \ndition .of the blood and assisting the growth of bones, and to \nemploy it in cachectic conditions somewhat generally, on the \ntheory that these were due to a deficiency of phosphates in the \nfoods and tissues. It has never been shown to be of any benefit, \nhowever, and experiments seem to have demonstrated that the \nanimal tissues are unable to build up phosphorus compounds \nfrom the inorganic phosphates. Lactic, as well as phosphoric \nacid, has proved useless in the treatment of diabetes, and there \nis reason to believe that the latter may even be injurious in \nthis disease. Mineral acids, if their administration is too pro- \nlonged, tend to impair the appetite and disturb digestion, causing \ntoothache and gastric oppression, and sometimes salivation and \ndiarrhoea. In addition, they are liable to produce loss of flesh, \npaleness of the skin, and anaemia. If taken for long periods in \ncomparatively large quantities they may induce degenerative \nchanges in such organs as the heart, liver and kidneys, as well \nas give rise to the production of methaemoglobin in the blood. \nThe prolonged use of nitric acid may occasion erosion of the \ngums and tongue, with loosening of the teeth. \n\nTOXICOLOGY. \n\nIn toxic doses all these acids are severe gastro-intestinal irritants. \nTartaric, citric, and lactic acids are very rarely taken as poisons. \n\n\n\n344 PHARMACOLOGY AND THERAPEUTICS. \n\nSymptoms. \xe2\x80\x94 There are intense, burning pains in the mouth, throat, \nstomach and abdomen, difficulty in swallowing, extreme thirst, and vio- \nlent vomiting; the ejected matter containing blood and sometimes shreds \nof mucous membrane. Not infrequently there is diarrhoea, the stools \nshowing a dark discoloration from the presence of blood. Some of the \nacid is likely to get into the larynx, causing swelling and consequent \ndyspnoea, from obstruction to respiration. Evidences of shock and \ncollapse quickly develop. The respiration is shallow, the pulse rapid \nand weak, and the skin, which shows marked pallor, covered with a \ncold sweat. The temperature falls below normal, and death usually \noccurs within a few hours. When fuming acids are swallowed and espe- \ncially in poisoning with hydrochloric acid, the irritant vapor, passing \ninto the respiratory passages, may cause spasm of the glottis or oedema \nof the larynx, with the result of an immediately fatal issue from \nasphyxia. It has been found that as small a proportion of hydrochloric \nacid vapor as i part in 20,000 of air causes sneezing and pain in the \nthroat and chest. \n\nPost-mortem. \xe2\x80\x94 There are the characteristic evidences of corrosive \npoisoning in the mouth, oesophagus and stomach, with or without per- \nforation, and sometimes extending into the intestine. The sloughs re- \nsulting from the destruction of the mucous membrane are of a whitish- \ngray color, and haemorrhages are frequently met with. When death \nhas been delayed for some time fatty degeneration of the heart, mus- \ncles, liver or kidney may be found, and in these cases a form of necro- \nsis of the renal cells has sometimes been observed. \n\nTreatment. \xe2\x80\x94 Alkalies should be given at once to neutralize the acid, \nthough there is a possibility that the stomach may be ruptured by the \ncarbon dioxide gas generated from the combination thus formed. The \nbest antidote is the insoluble magnesium oxide or carbonate, because \nthese are not themselves corrosive, but if neither is procurable, al- \nmost any accessible alkali may be resorted to, such as lime, chalk, soap \nor wood ashes. Then demulcents may be given, such as milk, white \nof egg, oil and flaxseed tea, which are useful in protecting the walls \nof the oesophagus and stomach ; and the acid may be rendered less cor- \nrosive by diluting it with large quantities. If strong sulphuric or nitric \nacid has been swallowed, the stomach-tube should not be employed, \non account of the danger of its extremity passing through the softened \nwalls of the gullet or stomach ; otherwise the stomach should be washed \nout. Morphine may be injected hypodermatically to relieve pain, and \nbrandy or other stimulants used in the same way to counteract collapse. \n\n\n\nTHE ACIDS. 345 \n\nCHROMIUM SALTS. \n\n1. CHEOMII TRIOXIDUM (Acidum Chromicum, U. S. P., 1890). \n\xe2\x80\xa2 -Chromium Trioxide. (Chromic Acid. Chromic Anhydride.) \n\n2. POTASSII DICHROMAS (Potassii Bichromas, U. S. P., 1890). \n-Potassium Dichromate. Dose, 0.010 gm. (10 milligm.) ; y 5 gr. \n\nAction of Chromium Trioxide. \n\nExternal. \xe2\x80\x94 Combining, as it does, the action of a metallic \noxide, an acid, and a strongly oxidizing agent, chromium triox- \nide is a powerful caustic. By reason of its oxidizing power it is \nalso an energetic deodorant and disinfectant. When applied in \nsubstance it corrodes the skin, as well as other tissues, but it \ncauses much less pain than the more penetrating caustic potash. \nEven in dilute solution it is an irritant to the skin, producing \nulcerations and other lesions, and workmen in factories where \nchromic acid is used are liable to suffer from perforation of the \nnasal septum from the local action of the acid applied acci- \ndentally upon the fingers. \n\nInternal. \xe2\x80\x94 The symptoms produced by large quantities are \nthose of gastro-intestinal corrosion, intense pain in the throat \nand stomach, vomiting and purging, with blood in the vomited \nmatter and the stools, collapse, and frequently death. Post- \nmortem the lesions met with are those of corrosive poisoning, \nand the mouth and throat show a characteristic yellow dis- \ncoloration. In mammalian animals the administration of the \ndrug elicits effects similar to those produced by the metals in \ngeneral. Weakness and slowness in the movements are caused, \nand these are followed by albuminuria, and later by diarrhoea \nand vomiting. Sometimes twitching of the muscles or even con- \nvulsions are observed, and then the weakness passes into gen- \neral paralysis. The heart appears to be little affected, but the \nblood-pressure falls. After death the stomach and intestine \nare found congested, while the mucous membrane is necrosed \nand ulcerated in some parts and covered with ecchymoses in \nothers. Haemorrhages are also found in other organs, and \nparticularly in the cardiac wall, and parenchymatous nephritis is \n\n\n\n346 . PHARMACOLOGY AND THERAPEUTICS. \n\nmet with. In chronic poisoning interstitial nephritis is said \nto occur. Chromium trioxide is readily absorbed from the \nstomach and intestine. It appears to be excreted principally \nthrough the kidney, and to a less extent through the intestinal \nepithelium. \n\nTherapeutics of Chromium Trioxide. \nExternal. \xe2\x80\x94 Chromium trioxide is never employed internally. \nIt is used, generally in the strength of 1 per cent., to harden \ncat-gut and kangaroo tendon for surgical purposes. A lotion \nof the same strength is used in Germany to toughen the feet of \nmarching soldiers. On account of its disinfectant properties it \nis employed in the form of a lotion, 1 to 40, or even stronger, \nfor cleansing foul ulcers and sores and as a local application, \nin various dilutions, in gonorrhoea, leucorrhcea, ozaena, severe \nulcerations of the mouth, etc. It is also sometimes used \nas a gargle, and for this purpose the solution should not \nbe stronger than 1 to 480. The Liquor of the B. P., \nwhich is one part of chromic acid in 3 o*f water, may \nbe employed as a caustic to destroy warts, condylomata \nand other small growths. As the escharotic action tends \nto spread, it should be used with caution. The adjacent sur- \nface should be protected with ointment, and the excess of acid \npromptly removed with an alkaline wash. A solution of chro- \nmium trioxide of the strength of .60 gm. (10 gr.) to 30 c.c. \n(1 fl. oz.), applied once or twice a day, is an excellent remedy \nfor enlarged tonsils and syphilitic mucous patches. It has also \nbeen used in endocervicitis, uterine haemorrhage, hypertrophies \nof the nasal passages, and some malignant growths, and has \nbeen injected into haemorrhoids. For parasitic skin diseases, \nsuch as sycosis, lupus and tinea circinata, a solution ten times \nthe strength of this may be employed. An ointment containing \n\n1 gm. (15 gr.) to 30 gm. (1 oz.) is serviceable in favus, after \nthe crusts have been removed, and a wash of the strength of \n\n2 gm. (30 gr.) to 500 c.c. (1 pint) of water, and also contain- \ning tannic acid, hydrated chloral, and morphine sulphate, has \n\n\n\nTHE ACIDS. 347 \n\nbeen recommended for chronic ulcers. A I per cent, solution \nin water, it is stated, has been found valuable in cases of viper \nbites. The following treatment has proved successful in ranula \nand cystic goitre: The tumors are opened and their contents \nwashed out, and, after haemorrhage has ceased, a saturated \nsolution of chromium trioxide is freely applied to several points \nof the cyst wall. \n\nAction of Potassium Dichromate. \n\nExternal. \xe2\x80\x94 Like chromium trioxide, it is an irritant caustic. \nIts escharotic, as well its antiseptic, action, however, is some- \nwhat less energetic than that of the trioxide; though the work- \nmen engaged in making it are liable to painful ulcerations of \nthe hands. Eczema of the hands, moreover, is said to occur in \nthose who prepare the dichromate solution used for dyeing pur- \nposes, and material dyed with the latter may produce ulceration \nof the integment. \n\nInternal. \xe2\x80\x94 The effects are essentially the same as those of \nchromium trioxide, and if the quantity swallowed is sufficiently \nlarge, death may result. Less than 30 gm. (1 oz.) has caused \nunconsciousness in five minutes, with death thirty-five minutes \nlater. In two recorded fatal cases of poisoning by it the \namounts taken were respectively 8 and 15 gm. (2 and 4 dr.). \nIn doses of 0.05 gm. (^ gr.) it acts as an emetic. \n\nTherapeutics of Potassium Dichromate. \n\nExternal. \xe2\x80\x94 It is used as a caustic for warts, venereal ulcers, \nand mucous patches. Its solution has also been employed as \na disinfectant wash for sloughing wounds. \n\nInternal. \xe2\x80\x94 It has been recommended for the treatment of \ngastric catarrh and gastric ulcer in dose of from .005 to .01 gm. \n(tV t0 i 8 T -)> gi yen thrice daily on an empty stomach, and is \nreputed to relieve nausea, vomiting and pain. In catarrhal con- . \nditions of the respiratory tract it has been advocated as an ex- \npectorant. It has been employed successfully in children, in \nsmall doses (0.003 g m - ; yV S r - f\xc2\xb0 r an infant of one year), \nevery hour, and it is advised that when the respiration is \n\n\n\n348 PHARMACOLOGY AND THERAPEUTICS. \n\nseriously embarrassed, the dose should be repeated every fifteen \nto thirty minutes. Favorable results have been reported from \nits use in cases of haematochyluria, some of which depended on \nthe presence of filariae, and it has been recommended for the \ntreatment of pernicious malarial anaemia. It has also been em- \nployed in syphilis and chronic rheumatism, but without any \nappreciable results. In cases of poisoning by chromium triox- \nide or potassium dichromate, soap, an alkaline carbonate, or \nmagnesia, together with milk, may be given at once, and the \nstomach washed out. \n\nTURPENTINE. \n\n1. TEREBINTHINA.\xe2\x80\x94 Turpentine. \n\nPreparation. \nCeratum Resinae Compositum. \xe2\x80\x94 Compound Rosin Cerate. \n\n2. OLEUM TEREBINTHINA.\xe2\x80\x94 Oil of Turpentine. \n\nPreparations. \n\n1. Oleum Terebinthinse Rectificatum. \xe2\x80\x94 Rectified Oil of Tur- \npentine. Dose, 1 c.c; 15 ni. \n\n2. Emulsum Olei Terebinthinse. \xe2\x80\x94 Emulsion of Oil of Tur- \npentine. Dose, 4 c.c; 1 fl. dr. \n\n3. Linimentum Terebinthinse. \xe2\x80\x94 Turpentine Liniment. \n\nUnofficial Preparations. \nSanitas. \xe2\x80\x94 Sanitas. \n\nTerebinthina Chia. \xe2\x80\x94 Chian Turpentine. Dose, .30 to 1.20 \ngm.; 5 to 20 gr. \n\nAction of Turpentine. \nExternal. \xe2\x80\x94 Oil of turpentine has the characteristic action of \nthe volatile oils in general. On the skin it acts as a rubefacient \nirritant, and counter-irritant, and its prolonged application may \ngive rise to vesication or even ulceration. The effects are more \nmarked if it is applied with \'friction. Under its external use, \n\n\n\nTURPENTINE. 349 \n\nthen, we find produced tingling, a feeling of warmth, and \nreddening of the surface, all of which result from the local \ndilation of blood-vessels caused by it. On mucous membranes \nthere is found the same irritation, with redness and congestion, \npain and smarting. Applied to fresh wounds, it is haemostatic, \ncontracting the blood-vessels and aiding coagulation. Oil of \nturpentine is a fairly energetic antiseptic, and it is less irritant \nthan many of the more powerful ones. It is absorbed from the \nunbroken skin. \n\nInternal. Alimentary Canal. \xe2\x80\x94 Kept in the mouth, it causes \nthe same redness and irritation of the mucous membrane, and \nis apt to excite a reflex secretion of saliva. In the stomach it \ngives rise to a feeling of warmth and comfort and causes some \nreflex stimulation of the heart. It also acts as a carminative, \naccelerating peristalsis and promoting the expulsion of gas. \nWhether the volatile oils have any direct action on the gastric \nsecretion is still a disputed point. It has been recently shown \nthat from the intestine, as well as the stomach, absorption occurs \nmore rapidly in the presence of slight irritants, such as these \noils. It is still unknown whether the peristaltic movements of \nthe bowel are increased by them, though turpentine certainly \nappears to have a marked stimulating effect upon the muscular \ncoat of the intestine. It diminishes flatulence and distention, \nand its antiseptic action may be concerned in the production of \nthis result. It is anthelmintic, and in sufficiently large doses \ncathartic, the faeces often containing blood. \n\nCirculation. \xe2\x80\x94 Our knowledge of its action on the circulation \nis very imperfect, and the statements of various observers re- \ngarding this differ greatly. It appears to produce a very \nslight rise of arterial pressure, increased pulse-rate, and in- \ncreased cardiac force. The drug is known to have haemostatic \nproperties, and this action is no doubt due to its power of con- \ntracting the vessels. After a large dose the stimulation is fol- \nlowed by depression, the action of the heart growing feeble, the \nblood-pressure falling, and the vessels dilating. \n\nNervous System. \xe2\x80\x94 In its action on the nerve cells oil of tur- \n\n\n\n350 PHARMACOLOGY AND THERAPEUTICS. \n\npentine differs from some of the other volatile oils in that \nthe preliminary stimulation caused by large amounts is only \ntransitory, being quickly followed by marked weakness and \ndepression; with heaviness, unsteady gait, and drowsiness. \nToxic doses are said to cause paralysis of sensory nerves, loss \nof reflex action, insensibility and coma. The depression of the \nrespiratory centre in the medulla is preceded by stimulation, \nthe breathing increasing in rapidity and volume. \n\nRespiration. \xe2\x80\x94 Oil of turpentine is in part excreted by the \nbronchial mucous membrane, and during the course of this \nexcretion it exerts an irritant action on the respiratory pas- \nsages which may be sufficient to lead to bronchitis. Such ex- \ncretion may be at once stimulating and antiseptic, and turpen- \ntine may also diminish the bronchial secretion in a specific man- \nner. According to some authors it acts as an expectorant, while \nothers consider that it diminishes excessive secretion and allays \ncough. It has consequently been suggested that both statements \nmay be true in different pathological conditions and with dif- \nferent doses of the drug. When inhaled, the vapor of turpen- \ntine has an irritating effect on the bronchial mucous membrane, \njust as the oil does when applied directly to mucous membranes \nand to the skin. The disinfecting agency of the drug is shown \nby the fact that turpentine prevents experimental tuberculosis \nin dogs. \n\nKidneys. \xe2\x80\x94 It is largely excreted by the kidneys. Its action \nupon these organs is more energetic than that of almost any \nother volatile oil, and especially results in diuresis. Large doses \nare very irritant, lessening the amount of urine, rendering it \nhighly colored, and in some cases producing albuminuria, \nhematuria, and even total suppression. This irritant action is \nnot confined to the kidneys, but extends to the whole genito- \nurinary tract. There is much aching in the loins, with spas- \nmodic pain in the ureters, a sensation of heat in the perineum, \na constant desire to pass water, without the ability to do so, \nin consequence of the urethral spasm, and a general condition \nof strangury. Priapism may be induced, and an intolerable irri- \n\n\n\n\n\n\nTURPENTINE. 351 \n\ntation may affect all the pelvic organs. In especially susceptible \nindividuals symptoms of this character may be caused by even \nmoderate amounts of the drug. A characteristic effect of tur- \npentine is the odor of violets which it imparts to the urine. \n\nSkin. \xe2\x80\x94 There is reason to believe that it is excreted to some \nextent by the skin glands. In persons with an idiosyncrasy to \nturpentine erythematous, papular or vesicular eruptions may \nbe caused by both its internal and external use. \n\nIt seems probable that oil of turpentine is excreted in part \nby the intestine and in the bile, milk, and other secretions. \n\nTemperature. \xe2\x80\x94 It appears to have a slight antipyretic action. \n\nOld oil of turpentine, containing oxygen, is an antidote to \nphosphorus {see phosphorus). The statement has been made \nthat this and the French oil are preferable in other respects; \nbut this seems questionable. \n\nTherapeutics of Turpentine. \n\nExternal. \xe2\x80\x94 Oil of turpentine is highly esteemed as a counter- \nirritant in bronchitis, pneumonia, pleurisy, peritonitis, osteo- \narthritis, and other inflammatory conditions, and in such pain- \nful disorders as pleurodynia, neuralgia, myalgia, lumbago and \nold rheumatic pains. It is often employed in the form of a \nstupe, which consists of a piece of flannel heated by steam or \nby being wrung out of hot water, on the surface of which a \nfew drops of turpentine are sprinkled just before application. \nTurpentine stupes should be removed as soon as they cause \npain. Spongiopiline may be used in place of the flannel. A mix- \nture of equal parts of turpentine and yolk of egg is sometimes \nemployed for external applications. In peritonitis a combina- \ntion of oil of turpentine with olive oil and mercurial ointment, \napplied warm upon flannel over the abdomen, has been used \nwith advantage. The external application of oil of turpentine \nis also sometimes of service in puerperal fever. When friction \nis desired, as in the case of rheumatic joints, it is advisable to \nuse turpentine in the form of a liniment, in which it is often \nassociated with other substances. The official liniment, for \n\n\n\n352 PHARMACOLOGY AND THERAPEUTICS. \n\nmost purposes, should be diluted. Preparations containing tur- \npentine are sometimes employed for topical application in in- \nflammatory affections of the pharynx, tonsils and larynx, and \nin diphtheria the oil has been brushed on the affected parts or \nused by inhalation. In this disease it is stated that advantage \nhas been derived from the continuous inhalation of a mixture \ncomposed of i part each of carbolic acid and oil of eucalyptus \nand 8 parts of oil of turpentine; cloths saturated in the fluid \nbeing hung or laid near the face of the patient, but not allowed \nto come in contact with the skin. Oil of turpentine has been \nused with success in the treatment of severe burns, accompanied \nby constitutional depression, and it is an excellent antiseptic for \nold suppurating wounds. Care must be taken that it does not \nblister the skin. It is sometimes used as a parasiticide for ring- \nworm, and an ointment of turpentine (B. P., soft soap, 37.5; \ndistilled water, 125; camphor, 25; oil of turpentine, 325), is said \nto be advantageous in chronic eczema, psoriasis and alopecia \ncircumscripta, as well as a good application for indolent ulcers. \nSanitas (not official), a very pleasant disinfectant, though not \nso strong as phenol, is an aqueous solution of common turpen- \ntine which has been allowed to oxidize in the air. Its active \nantiseptic principle is hydrogen dioxide, and it contains a lit- \ntle thymol. \n\nInternal. Stomach and Intestines. \xe2\x80\x94 For internal use the rec- \ntified oil only should be prescribed. It is not very frequently \nemployed as a stomachic, but is used to a considerable extent \nas an intestinal carminative; and flatulence may often be \npromptly relieved by a few drops on a lump of sugar. It is \nregarded as especially indicated in persistent flatulence result- \ning from a paretic condition of the muscular coat, and it has \nbeen shown to possess curative power in chronic intestinal \ncatarrh. Among the indications for its administration may be \nmentioned a dry and glazed tongue, tympanitic distention of \nthe abdomen, and stools which are either fluid or consist of \nscybala mixed with mucus and pale, watery blood. It is thus \na valuable remedy in subacute dysentery, where it is often given \n\n\n\nTURPENTINE. 353 \n\nin an emulsion with almond oil and opium. In these cases it \nis believed that it gives tonicity to the vessels and to the mus- \ncular fibres of the intestines, arrests the putrefactive and fer- \nmentative processes which take place in the vitiated mucus and \narticles of food, and by increasing the cutaneous capillary cir- \nculation relieves congestion of internal organs. From our \nknowledge of the physiological effects of oil of turpentine it \nwould naturally be supposed that it might prove of service in \ntyphoid fever, both as a haemostatic and an antiseptic, and in \nmany cases of this disease it is found to be of the greatest \npractical value. Here it not only acts as a local stimulant to \nthe ulcerated bowel, but also exerts a beneficial influence upon \nthe general state of the system. Two conditions or stages \nin the disease have been pointed out in which it is especially \nuseful. The first is when at about the end of the second week \nthe tongue becomes very dry, red, chapped, and perhaps coated \nin the centre with a brownish fur, and at the same time marked \nmeteorism develops. 0.6 c.c. (10 ni) of the oil of turpentine \ngiven every two hours during the day and every three hours \nin the night will be found in many instances to do away with \nthese unfavorable signs. The second is when the ulceration of \nPeyer\'s patches proves slow to heal, so that there is a constant \ntendency to the recurrence of diarrhoea, and convalescence is \nthus delayed. Here the remedy seems to act almost as a specific. \nIt is stated that the typhoid fever bacillus will not develop in \nair containing diluted vapor of turpentine, and dies when the \nair is saturated with the vapor, while thymol appears to be even \nmore efficient than turpentine. The intestinal haemorrhage of \ntyphoid may also often be successfully treated with oil of \nturpentine. Administered in the form of an enema, in some \nsuch vehicle as mucilage of starch, it is very effective in reliev- \ning flatulence of the bowels, and where there is impaction of \nthe caecum or rectum castor oil is frequently combined with it \nin the injection. Turpentine has also been used by enema \nas a derivative in insolation or sunstroke and in cerebro-spinal \nmeningitis, as well as a remedy for thread-worms. Given in- \n24 \n\n\n\n354 PHARMACOLOGY AND THERAPEUTICS. \n\nternally, oil of turpentine is efficacious in the treatment of \ntape-worm, but as the dose required for this purpose is large, \nit may produce strangury and other constitutional effects. For \nthis reason castor oil or other purgative should be promptly \nadministered after it, and many advise that the purgative should \nbe combined with it. A combination of equal parts of turpen- \ntine and ether (Durand\'s remedy) at one time acquired con- \nsiderable reputation in the treatment of biliary calculi. While \nduring the acute attack of biliary colic it is inferior to other \nremedies, as morphine and hydrated chloral, clinical experience \nseems to have shown that in the after-treatment its occasional \nadministration may sometimes be of service as an adjuvant \nto other measures. In yellow fever, puerperal septicaemia, and \nother febrile diseases, as well as in typhoid, oil of turpentine has \nbeen successfully employed as a stimulant and antiseptic. In \naffections of this class it is recommended that for the intestinal \ncomplications the dose, as a rule, should be small and frequently \nrepeated, while as a stimulant to the vaso-motor nervous sys- \ntem it should be somewhat larger and repeated at somewhat \nlonger intervals. \n\nCirculation. \xe2\x80\x94 It is contraindicated where there is active \nhaemorrhage and a condition of plethora, in hypertrophy of the \nheart, and when advanced atheroma of the cerebral arteries is \nbelieved to be present. In the passive haemorrhages in ataxic \ncases, where there is a condition of debility, relaxation of the \nvessels, and an impoverished condition of the blood, it is of \ngreat service. It may be given in haemorrhages from the \nstomach, bowels, lungs, etc., and is also efficacious in the \nhaemorrhagic transudations met with in purpura, scurvy, and \nallied states. \n\nRespiration. \xe2\x80\x94 For the purpose of inhalation turpentine may \ngenerally be replaced with advantage by the Vapor Olei Pini \n(see p. 356), especially as the latter is much more agreeable, \nbut it is occasionally used internally in chronic bronchitis with \nprofuse expectoration (especially when the latter has a fetid \nodor), and in gangrene of the lung. It may also be employed \n\n\n\nTURPENTINE. 355 \n\nin pneumonia and capillary bronchitis with marked depression \nof the vital powers and enfeeblement of the circulation, and \nparticularly when these affections occur in the course of typhus \nor typhoid fever and similar diseases. Here it is often applied \nexternally, as well as given by the mouth. \n\nGenito -urinary Tract. \xe2\x80\x94 Turpentine would no doubt be more \ngenerally employed than it is in a variety of affections (as it \nunquestionably has a considerable number of useful applica- \ntions), were it not that it is so disagreeable to take, and also \nbecause of the fact that it is so liable to cause inflammation of \nthe kidneys. On the latter account it must always be adminis- \ntered with caution, and it is, of course, entirely contra-indi- \ncated when renal disease is present. An exception as regards \nthe latter, however, is sometimes made in the case of chronic \npyelitis, where the oil of turpentine, as well as those of copaiba \nand cubeb, may have a good effect in changing the condition \nof the mucous membrane and limiting the formation of pus; \nalso in hydro- and pyo-nephrosis, where by actual contact it \nmay alter the relaxed state of the vessels and the patholog- \nical secretions of the mucous membrane. In these conditions it- \nshould always be given in small doses and its effects watched \nwith extreme care. In incontinence of urine, due to atony of \nthe muscular coat of the bladder and not to spasm, and in \nchronic cystitis, gleet, spermatorrhcea and prostatorrhcea, when \nthe discharges characterizing these affections are the result \nof relaxed conditions, turpentine, in moderate doses, may not \ninfrequently be administered with considerable benefit. In all \nthese cases it should be borne in mind that, with the exception \nof cantharides, oil of turpentine is the most actively stimulating \nof all the diuretics, so that it must be resorted to only when a \nstimulant effect is called for. It is never employed to increase \nthe flow of urine for the purpose of affecting serous effusions, \nbeing used as a diuretic simply for its local influence upon the \nkidneys. -Excessive diuresis sometimes is apparently dependent \nupon a relaxed condition of these organs, and under these cir- \ncumstances oil of turpentine may be of service. \n\n\n\n356 PHARMACOLOGY AND THERAPEUTICS. \n\nChian turpentine (not official) is an oleo-resin obtained from \nPistacia terebinthus. It has been recommended for the cure \nof scirrhus and other malignant disease, especially of the uterus, \nit being insisted that for this purpose the drug should be pure \nand that its administration should not only be begun early, but \nshould be continued for a year after the manifestations of the \ndisease have disappeared or the tumor has been removed by \noperation. Its value in cancer, however, has never been satis- \nfactorily demonstrated. In doses of from 0.30 to 1 gm. (5 to \n15 gr.) this agent has proved of service in pityriasis rubra. \nIt is stated that the solid form is not an eligible method of \nadministration when it is to be continued for a considerable \nlength of time, as it has been known to accumulate and form \na mass in the stomach. \n\nCANADA TURPENTINE. \n\nTEREBINTHINA CANADENSIS.\xe2\x80\x94 Canada Turpentine. (Canada \nBalsam. Balsam of Fir.) \n\nAction of Canada Turpentine. \nIts action is the same as that of oil of turpentine. \n\nTherapeutics of Canada Turpentine. \nUnder the names of Canada balsam and balsam of fir, as well \nas the deceptive title of " balm of Gilead," Canada turpentine \nhas been used to a considerable extent, especially in the treat- \nment of chronic bronchitis. It is principally employed (in con- \nsequence of its physical property of drying), for forming an \nadhesive varnish. \n\nFIR-WOOD OIL. \n\nUnofficial Preparations. \nOleum Pini. \xe2\x80\x94 Oil of Pine. (Fir-wood Oil. Pinol.) \nVapor Olei Pini. \xe2\x80\x94 Vapor of Oil of Pine. \n\n\n\n\n\n\nOIL OF ERIGERON. 357 \n\nAction of Fir-wood Oil. \nThe action of oil of pine is the same as that of oil of turpen- \ntine. \n\nTherapeutics of Fir-wood Oil. \n\nThis oil is used locally or by inhalation. It is much more \nagreeable than the oil of turpentine, and is employed in various \nsprays and inhalations in the treatment of acute coryza, nasal \ncatarrh and many diseases of the respiratory passages. It is \nespecially useful as a stimulating, disinfectant expectorant in- \nhalation in chronic bronchitis or laryngitis. \n\nOIL OF ERIGERON. \nOLEUM ERIGERONTIS.\xe2\x80\x94 Oil of Erigeron. (Oil of Fleabane.) \nDose, 1 c.c; 15 TT\\.. \n\nAction of the Oil of Erigeron. \nIt has the same general effects as oil of turpentine, but is \nless irritant. \n\nTherapeutics of the Oil of Erigeron. \n\nWhile it is less irritant, it is also less efficient than oil of tur- \npentine. Externally it is often applied to prevent insects from \ninjuring the skin. It has been used in diarrhoea, dysentery and \nhaemorrhages, in much the same way as oil of turpentine. It \nhas the advantage over the latter of being much less unpleasant \nto take, and has been found by some an effective remedy in \nhaemoptysis, as well as in menorrhagia and in metrorrhagia, \nwhen of passive character. In acute congestion of the kid- \nneys it is contra-indicated, but in the strictly chronic forms \nof renal disease it is thought to lessen the waste of albumin, \nand at the same time to improve the general condition of the \npatient. \n\nTAR. \n\nPIX LIQUIDA.\xe2\x80\x94 Tar. Dose, 0.500 gm. (500 milligm.) ; 7y 2 gr. \n\n\n\n358 PHARMACOLOGY AND THERAPEUTICS. \n\nPreparations. \n\n1. Syrupus Picis Liquidae. \xe2\x80\x94 Syrup of Tar. Dose, 4 c.c; 1 \nfl. dr. \n\n2. Unguentum Picis Liquidae. \n\nOLEUM PICIS LIQUID^.\xe2\x80\x94 Oil of Tar. Dose, 0.2 C.C.; 3 Til. \n\nUnofficial Preparation. \nPixol. \xe2\x80\x94 Pixol. \n\nAction of Tar. \n\nExternal. \xe2\x80\x94 Though its effects are somewhat less pronounced, \ntar is, like oil of turpentine, a local irritant, by reason of its \naction in dilating the blood-vessels. If its application is pro- \nlonged, it is likely to induce an eruption of red papules, some \nof which may suppurate, constituting what is known as " tar \nacne." This is sometimes met with in those who work in tar \nor are much exposed to its fumes. When applied over a large \narea, absorption from the skin may give rise to toxic symp- \ntoms resembling those of phenol poisoning. In less concen- \ntrated form it relieves itching, an effect which has been \nattributed to its reducing the sensibility of the sensory nerve \nterminations. The vapor, when inhaled, has a local antiseptic \nand stimulant action on the respiratory mucous membrane. \nTar has very valuable antiseptic and disinfectant properties, \nand on account of its cheapness it is especially serviceable for \nthe disinfection of excrementa, premises, etc. \n\nInternal. \xe2\x80\x94 In small doses it has the effect of stimulating the \ncirculation and increasing the secretions. It is excreted by the \nrespiratory mucous membrane and the kidneys, and acts as a \nstimulant and antiseptic during elimination. It is thus both \na diuretic and expectorant. In large doses it produces head- \nache, epigastric and abdominal pain, general malaise, indi- \ngestion, vomiting of dark-colored matter, loose black stools, and \nblackish-brown urine, which smells of tar and may contain \nblood or albumin. The urine may possibly be clear when \npassed, but on standing it throws down a dark deposit. The \nsymptoms, it will be seen, have considerable resemblance to \nthose of phenol poisoning. \n\n\n\ntar. 359 \n\nTherapeutics of Tar. \nExternal. \xe2\x80\x94 Wood tar is the only official form of tar, but coal \ntar is often used in medicine. The prepared form of it is \nmade by simply heating and stirring coal tar at 120 F. (48 C.) \nfor an hour. The chief use of tar is for the local treatment of \ncertain forms of skin disease, and for this purpose it is applied \nin lotions, paints, ointments, plasters, soaps and baths. The \nofficial ointment is liable to cause more or less irritation, and \nshould generally be diluted. In order to prepare an unirritating \ntar ointment, it has been advised that the tar be previously \nallowed to stand for several weeks in a warm place. It will \nbe found that it separates into two layers, the upper of which \nis thin and syrupy, and is destitute of irritant properties. \nLiquor Picis Carbonis (not official) is a favorite preparation \nfor many skin diseases. It may be made thus : Dissolve rosin \nsoap (see Rosin), I, in alcohol, 8; add prepared coal tar, 4; \ndigest at 125 F. (51 C.) for two days, allow it to cool, then \ndecant and filter. An ointment of 3 parts of lard with 1 of \nthis solution may be made. Liquor Picis Carbonis Detergens \n(not official) is an alcoholic solution of ordinary coal tar, which \nis used externally in skin diseases, diluted in 20 parts of water. \nTar is especially useful in scaly affections, such as psoriasis. \nAmong the other skin diseases in which it is serviceable may \nbe mentioned lichen, chronic eczema, comedo, sycosis, pemphi- \ngus, prurigo, and lupus erythematosus and vulgaris, as well as \nscabies and tinea. An alkaline tar-water, made by adding tar, \n8 c.c. (2 fl. dr.) and caustic potash, 4 gm. (1 dr.) to water, \n150 c.c. (5 fl. oz.), is a good application in eczema. A weakened \ntar ointment, by reason of its mildly anaesthetic action, is use- \nful in relieving pruritus ani and other itching affections. The \ntar-water which was formerly official (made by mixing 1 part \nof tar with 4 of water) is an efficient antiseptic application to \nunhealthy wounds or sores. This preparation used with an \natomizer or vaporized by heat is beneficial in acute pharyngitis \nand laryngitis, as well as in chronic catarrhal affections of \nthe air-passages. It has been found of service in winter cough, \n\n\n\n360 PHARMACOLOGY AND THERAPEUTICS. \n\nand is said to materially lessen the tendency to taking cold. \nSufferers from chronic bronchitis sometimes derive consider- \nable benefit from the fumes given off from tar which is allowed \nto simmer in a vessel placed on a stove in the room occupied by \nthem. In ozsena the inhalation of the fumes of a mixture con- \ntaining tar, camphor, potassium iodide, and tincture of iodine, \nplaced upon a water-bath, has been recommended. In the \ntreatment of haemorrhoids the application of a preparation con- \nsisting of tar, 3, extract of belladonna leaves, 3, and glycerite \nof starch, 30, has been found useful. In some individuals there \nis an intolerance of tar, so that even the smallest quantity will \nbe found to excite irritation and cause a papular, eczematous \neruption. \n\nInternal. \xe2\x80\x94 Except as a remedy for some chronic diseases of \nthe skin, tar is used internally almost exclusively as an ex- \npectorant. Wood tar only is given for bronchial affections, \nand it is in the chronic forms of these that it proves especially \nvaluable. It may be prescribed in pill, as the syrup, or as the \nFrench preparation, Eau de Goudron. Vinum Picis Liquidae \n(not official), which is a saturated solution of tar in sherry wine \nand the dose of which is 4 to 15 c.c. (1 to 4 fl. dr.), is used \nto a considerable extent. An excellent cough mixture consists \nof the syrups of tar and wild cherry, with .003 gm. (-g-^-gr.) of \napomorphine hydrochloride in each dose. The dose of tar- \nwater is 500 c.c. (1 pint) daily. The latter has been found of \nservice in some cases of chronic pulmonary tuberculosis; quiet- \ning cough, checking diarrhoea, and improving the appetite and \ndigestion. In chronic diseases of the skin the internal admin- \nistration of wood tar is sometimes a valuable adjunct to local \ntreatment, and the action of small doses has been found espe- \ncially favorable in psoriasis and eczema. Tar has also occa- \nsionally been given internally in haemorrhoids and in catarrh \nof the urinary tract. \n\nPixol, disinfectant and antiseptic, is a compound made by dis- \nsolving green soap in tar and slowly adding a solution of either \npotash or soda in water. It is a syrupy liquid which, in 5 per \n\n\n\nOIL OF CADE. 361 \n\ncent, dilution, has been used for disinfecting linen and washing \nthe hands. A 10 per cent, solution is said to be an efficient \ndisinfectant of excrementa, and it is extremely cheap. A solu- \ntion of this strength, it is asserted, is fatal to the micro-organ- \nisms of suppuration, anthrax, typhoid fever, and cholera. \n\nOIL OF CADE. \nOLEUM CADINUM.\xe2\x80\x94 Oil of Cade. (Juniper Tar Oil.) \n\nAction of Oil of Cade. \n\nIt has much the same action on the skin as tar, but its \npreparations have decidedly less odor and are less injurious to \nthe clothing. \n\nTherapeutics of Oil of Cade. \n\nOil of cade is too stimulating for most acute eruptions, but \nis used with benefit in chronic eczema, psoriasis, pityriasis \nrubra, lichen, prurigo, and various forms of pruritus. It is also \nan efficient parasiticide in favus and other varieties of tinea. \nIt is sometimes applied in full strength and sometimes diluted \nwith a bland oil, and is also made into ointments, and especially \ninto soaps. A common formula consists of oil of cade, 1 ; soft \nsoap, 4; alcohol, 4. An ointment made by melting with it an \nequal part of yellow wax is a stronger and also a more agreeable \npreparation. A mixture of oil of cade in acetone collodion has \nbeen recommended as having special advantages in psoriasis, \nlichenoid eczema, simple chronic lichen, lichen planus, and in \nnummular and seborrhceic eczemas. " Haarlem oil," which is \nsaid to be composed of equal parts of oil of cade and oil of \njuniper berries, has had a considerable vogue in chronic affec- \ntions of the kidneys and bladder. As an anthelmintic oil of \ncade has been given in doses of .15 to .30 gm. (3 to 6 ni), \nrepeated several times a day. \n\n\n\n362 PHARMACOLOGY AND THERAPEUTICS. \n\nBURGUNDY PITCH. \n\nUnofficial Preparations. \n\nPix Burgundica (U. S. P., 1890). \xe2\x80\x94 Burgundy Pitch. \n\nEmplastrum Picis Burgundicse (U. S. P., 1890). \xe2\x80\x94 Burgundy \nPitch Plaster. \n\nEmplastrum Picis Cantharidatum (U. S. P., 1890). \xe2\x80\x94 Can- \ntharidal Pitch Plaster. (Warming Plaster.) \n\nRetinol. \xe2\x80\x94 Retinol. (Resinol. Codol.) \n\nAction of Burgundy Pitch. \nBurgundy pitch is stimulating to the skin, and, applied as a \nplaster, produces itching, redness, and sometimes a papular \neruption. Upon a delicate integument it may occasion a vesicu- \nlar, or even a pustular, eruption, with superficial ulcers. \n\nUses of Burgundy Pitch. \n\nIt is employed as a basis for a number of plasters, and in \nthis form it is in general use to protect, sustain and stimulate \nthe parts to which it is applied. These plasters are often very \nuseful as mild counter-irritants in lumbago and other forms of \nmuscular rheumatism, chronic rheumatic swellings, and affec- \ntions of the chest and abdomen; and obstinate cases of sciatica \nare sometimes cured by enveloping the buttock and thigh in a \nBurgundy pitch plaster, and leaving it permanently in place. \nIn pulmonary diseases a plaster of proper dimensions gives to \nthe chest a greatly-needed mechanical support during the act \nof coughing. The cantharidal pitch plaster is especially service- \nable for its revulsive effect, as its counter-irritant action is \nsomewhat greater than that of the simple pitch plaster, though \nless than is caused by a blister. Burgundy pitch has been \nthought to have some special action upon the rectum, and for \nhaemorrhoids has sometimes been given in the form of pills. \n\nRetinol (resinol), a yellowish, oily liquid, is a product ob- \ntained by the distillation of Burgundy pitch. It has consider- \nable antiseptic power and is non-irritating, but is not soluble \n\n\n\nROSIN. 363 \n\nin water. When applied over a surface it forms a varnish-like \ncoating. Its principal use is as a solvent for various alkaloids \nand for such other medicinal agents as iodol, salol, thymol io- \ndide, chrysarobin, cocaine, phenol and phosphorus. The solu- \ntion of phosphorus is said to be very stable and serviceable for \nboth internal and external use. Retinol has been applied on \ntampons, with borax and other substances, and also used in \nsuppositories, in the treatment of vaginitis, and has been in- \njected into the bladder, in a 5 to 10 per cent, solution, in sub- \nacute cystitis. It is an excellent vehicle for medicaments in \ndiseases of the skin, and in a large number of these affections, \neither alone or as an antiseptic excipient for other substances, \nit is stated to have given good results. It mixes readily with \nfats, oils, lanolin, glycerin and petrolatum. The following has \nbeen employed as a topical application in diphtheria: Retinol, \n15; camphor, 2; naphthol, 1. In ophthalmological practice re- \ntinol, mixed with lanolin, has been used for conjunctivitis, \nsimple or gonorrhceal, and for affections of the lids and tear- \nducts, as well as for the preparation of dressings and the pro- \ntection of instruments. Internally, retinol has been given, in \ncapsules, in the treatment of gonorrhoea. \n\nROSIN. \n\nRESINA. \xe2\x80\x94 Rosin. (Resin. Colophony.) Dose, 0.250 gm. (250 \nmilligm.); 4 gr. \n\nPreparations. \n\n1. Ceratum Resinse.\xe2\x80\x94 Rosin Cerate. (Basilicon Ointment.) \n\n2. Ceratum Resinae Compositum. \xe2\x80\x94 Compound Rosin Cerate. \n\nUnofficial Preparation. \nEmplastrum Resinse (U. S. P., 1890). \xe2\x80\x94 Resin Plaster. (Ad- \nhesive Plaster.) \n\nAction of Resin. \nLocally rosin is antiseptic and slightly irritating; internally \nit is antiseptic and astringent in its effects upon the intestines. \nIt has the property of preventing the oxidization of fatty sub- \nstances, and thus contributes to the preservation of ointments. \n\n\n\n364 PHARMACOLOGY AND THERAPEUTICS. \n\nTherapeutics of Rosin. \n\nRosin cerate is a good dressing for indolent or unhealthy \nulcers and wounds, promoting cicatrization and granulation, as \nwell as acting as a disinfectant. It is also sometimes applied \nto burns and chilblains. Compound rosin cerate (Deshler\'s \nsalve) is more stimulating, as it contains crude turpentine. \nThe chief use of rosin is in plasters, which it renders adhesive \nand more or less stimulating. In some persons the skin is so \nsensitive that the simple Emplastrum Resinae will excite very- \nconsiderable irritation. Rosin soap is made from rosin, 6; \ncaustic soda, 1 ; water, 25 ; which are boiled together in an \nevaporating dish for two hours, after which the soap is \nseparated by a strainer and dried on a water-bath. In chronic \nbronchitis and winter cough the fumes from boiling rosin \nmay sometimes be inhaled with advantage. Rosin was at \none time employed in diarrhceal affections, in which it had \nsome vogue as a domestic remedy, but is now seldom given in- \nternally. \n\nFRANKINCENSE. \n\nTHUS AMERICANUM (B. P., not official).\xe2\x80\x94 Frankincense. \n\nAction of Frankincense. \nIt has the same effects as rosin. \n\nTherapeutics of Frankincense. \nIts toughness and adhesiveness make it a useful constituent \nof plasters. It is an ingredient of Emplastrum Picis (B. P.). \n\nAMYL NITRITE. \nAMYLIS NITRIS.\xe2\x80\x94 Amyl Nitrite. Dose, 0.2 c.c; 3 TTL- \n\nAction of Amyl Nitrite. \nExternal. \xe2\x80\x94 Amyl nitrite has no irritating or destructive quali- \nties, but it causes loss of functional power in tissues with which \nit is brought into contact. When externally applied, therefore, \n\n\n\nAMYL NITRITE. 365 \n\nit temporarily diminishes the activity of the sensory nerves. \n\nInternal. \xe2\x80\x94 When it is taken into the system by inhalation, the \nusual mode of administration, its characteristic effects are pro- \nduced with extraordinary rapidity, and if the dose is small \nthey are evanescent. \n\nCirculation. \xe2\x80\x94 Immediately on its inhalation there follow \nmarked flushing of the face, pain, heat, and a sense of fullness \nin the head, giddiness, throbbing of the temporal and carotid \narteries, and a rapid and tumultuous action of the heart. Some- \ntimes, it is stated, the cardiac disturbance is distinctly manifest \nbefore the other symptoms. While the area of redness usually \ncorresponds with that involved in blushing, it may extend over \nthe entire trunk, and the flushing is due to the dilatation of the \nperipheral blood-vessels, both arteries and veins. It is supposed \nthat these vessels in the face and neck occupy a somewhat ex- \nceptional position as regards their innervation and their sus- \nceptibility to the action of drugs, and as the meningeal vessels \nare also concerned in the dilatation, the various symptoms men- \ntioned are readily accounted for. The vascular dilatation \nspreads from the parts originally affected over the entire body, \nalthough the vessels of the extremities are involved to a less \nextent than those of the abdominal region. It seems prob- \nable that depression of the vaso-constrictor centre is concerned \nto some extent in the general vascular dilatation, but this has \nnever as yet been demonstrated, and is certainly not the main \ncause, since it has been shown positively that amyl nitrite pro- \nduces dilatation by acting on peripheral structures. The seat \nof action of the drug is held to be the unstriated muscle of the \narteries and veins, and the depression of this tissue and of the \nnerve terminations is now generally considered as the essential \ncause of the dilatation. That there is, however, an early cen- \ntral action, which later is overshadowed by this peripheral in- \nfluence, it is thought may perhaps be indicated by the rapidity \nwith which the flushing of the face comes on and disappears. \nIn experiments upon animals it has been found that the vascular \ndilatation is followed by a marked decline in blood-pressure, and \n\n\n\n366 PHARMACOLOGY AND THERAPEUTICS. \n\nin this it is believed that the heart is not concerned. The great \nacceleration of the heart has been mentioned, and in conse- \nquence of this there may at first perhaps be even a rise of blood- \npressure, the dilatation being more than overcome by the quick- \nened beat; but as the dilatation extends throughout the body \nthe relaxation, particularly in the splanchnic area, soon has the \neffect of producing a profound fall in the blood-pressure. It \nalso causes a dicrotic pulse. The tachycardia is generally \nattributed to a depression of the inhibitory (vagus) centre in \nthe medulla, though vasomotor paralysis would also produce a \nrapid pulse, and by some it is thought that there is present, in \naddition, a feeble direct action on the heart. Large doses of \namyl nitrite slow and weaken the cardiac contractions and \nfinally arrest them, owing to direct muscular depression; but \nthis direct action on the heart muscle, it is found, is produced \nmuch less readily than that on arterial muscle. While the drug \nhas such a marked influence in accelerating the beat, no per- \nceptible alteration in the force of the latter is caused by it. \n\nRespiration. \xe2\x80\x94 The quickness of the action of amyl nitrite is \ndue to the extraordinary rapidity with which it is absorbed, \nespecially through the lungs, and its first effects resemble very \nclosely an incipient asphyxia. Sometimes, as in the case of \nether, chloroform and other similar agents, the breath is held \nin the beginning, in consequence of a reflex from the nasal \nmucous membrane. Under the stimulating effect of the drug \nupon the respiratory centre in the medulla the respiration \xe2\x80\xa2 is \nquickened and deepened, but if the inhalation is maintained \nsufficiently long, this effect is replaced by a depressing one, \nand, in consequence, the respiratory movements are rendered \nmore slow and shallow, death eventually occurring from \nasphyxia due to a complete paralysis of the centre. \n\nBlood. \xe2\x80\x94 The immediate cause of the asphyxia is the produc- \ntion of methaemoglobin, a compound which parts with its oxygen \nmuch less readily than oxyhemoglobin, but which is eventually \nbroken up by the tissues. The nitrites, however, unlike most \nother agents which change haemoglobin into methaemoglobin, do \n\n\n\nAMYL NITRITE. 367 \n\nnot have the power of causing destruction of the red corpuscles ; \nso that the only action is interference with oxidation. This \neffect is seen in the change of the color of the blood to a dark \nchocolate in animals. In man very little of the methsemoglobin \nformation process usually occurs, and even after the inhalation \nof very large amounts of amyl nitrite such discoloration \nof the blood is said to be scarcely ever observed. \n\nKidneys. \xe2\x80\x94 The only effect of the drug on the urinary secre- \ntion appears to be one dependent upon its action on the cir- \nculatory system. If, therefore, the renal arterioles are relatively \nmore dilated than those of the general circulation, the flow of \nurine will be increased, while if the reverse of this condition \nis present, it will be diminished. Its diuretic influence is never \nvery marked, and if large amounts are taken, so that the \nblood-pressure is reduced to a low point, complete anuria may \nresult. Sometimes in animals there is persistent glycosuria, and \nit is thought that this may perhaps be due to the partial \nasphyxiation of the tissues resulting from the formation of \nmethaemoglobin. Amyl nitrite when given either by the mouth \nor by subcutaneous injection acts much less quickly and power- \nfully than when absorbed by the lungs, and it is stated that \nwhen administered hypodermatically it generally gives rise \nto glycosuria and slight diuresis. \n\nNervous System. \xe2\x80\x94 Amyl nitrite is not known to exert any \ninfluence on the higher cerebral centres. The spinal cord is \nnot acted upon in mammals, but is depressed in the frog. Its \neffects on the vagus and respiratory centres in the medulla \nhave been mentioned. While, as stated, action upon the vaso- \nmotor centre has not been demonstrated, it seems probable that \nthe drug does possess such action; which, however, must be \nquite insignificant when compared with its effects on the peri- \npheral vaso-constrictor mechanism. It acts not only upon the \nmuscular coats of the vessels, but also produces slow paralysis \nof muscle of all kinds with which it comes in contact. The \npain and sense of fullness in the head, as well as the giddiness \nand other symptoms following immediately upon inhalation, \n\n\n\n368 PHARMACOLOGY AND THERAPEUTICS. \n\nresult from the vascular dilatation, in which the cerebral circu- \nlation fully participates, and the headache may persist for a \nconsiderable time. If large quantities are inhaled, there may \nbe unsteadiness of gait and some confusion and restlessness. \nThe pupils are dilated and disturbances of vision are apt to \noccur. -Some individuals in looking at a dark object on a white \nbackground see it surrounded by a yellow circle, outside of \nwhich there is a blue circle. Convulsions are not infrequently \nobserved in animals. They are probably of cerebral origin, \nand, if so, due to direct action upon the nerve cells, and not \ndependent on the circulatory changes. Some authorities, how- \never, believe them to be due to anaemia of the brain, while \nothers regard them as probably secondary to the asphyxia. \n\nTherapeutics of Amyl Nitrite. \nHeart and Blood-vessels. \xe2\x80\x94 In attacks of angina pectoris amyl \nnitrite is of great service, provided the arterial tension is high. \nWhen the rise of blood-pressure is due to a nervous contracture \nof the vessels, it is certain to give relief. In many instances \nwhere valvular disease of the heart is present, as well as in \nthose in which there is merely functional disorder, it acts most \npromptly and efficiently. The nitrites are regarded as the most \npowerful pressure depressants known, and the action of amyl \nnitrite in the dyspnoea of cases of cardiac disease may, it is \nthought, be due to its lowering the pressure in the systemic \narteries and thus relieving the heart. Its beneficial effects would \nnot therefore result from any direct action on the heart, but \nfrom its decreasing the resistance against which the systole \nis performed. Its physiological action in accelerating the pulse- \nrate has led to its recommendation in all forms of sudden heart- \nfailure, even when such failure is dependent upon fatty degen- \neration or other disease of the heart itself. It may be stated, \nhowever, that in very advanced degeneration of the cardiac \nmuscle fibre it is distinctly contra-indicated, since, the blood- \npressure already being low, any further reduction may induce \nsyncope from cerebral anaemia, while the heart may be still fur- \n\n\n\nAMYL NITRITE. 369 \n\nther weakened by the lessening of its nutrition from lowered \npressure in the coronary arteries. The use of the drug would \nalso seem to be unsafe when advanced degeneration of the \ncerebral vessels exists. It may be employed in all cases in \nwhich, there being no contraindication to its use present, it is \ndesired to reduce the arterial tension. In practice it is found \nthat dyspnoeic attacks connected with heart failure from valvu- \nlar disease and other causes are not infrequently relieved by \nit. In spite of the fact that amyl nitrite, if used freely, is ca- \npable of producing syncope by its depressing influence on the \nheart, it is claimed that in many cases of syncope and collapse, \ndepending on a variety of conditions, recovery has attended \nits administration by inhalation. \n\nIt has even been recommended and used in chloroform syn- \ncope, and a considerable number of instances have been re- \ncorded in which the patients, it is asserted, were rescued by \nit from impending death. On the other hand, it is the opinion \nof some of the highest authorities on the action of drugs that \nthese patients recovered in spite of and not in consequence 01 \nits use. It would appear to be strongly contra-indicated, they \nstate, in those cases in which it is true that the heart is de- \npressed, but in which the arterial tension is practically zero; \nand its use is especially irrational if, as has been suggested, the \nfailure of the respiration is partly due to anaemia of the central \nnervous system. The reasoning of those who advocate the ex- \nhibition of amyl nitrite is as follows : It is certain that chloro- \nform contracts, and that amyl nitrite dilates, the capillaries of \nthe brain and of the skin of the face; under the former the \npatient grows pale, under the latter he is flushed. In experi- \nments upon animals if the nitrite be used in excessive dose, \ncyanosis arises in consequence of venous engorgement. Experi- \nments have also shown that if it is given in full doses to an \nanimal already narcotized by chloroform, it deepens instead of \nrelieving the narcotism, while if it be administered in moderate \nquantities, either by inhalation or hypodermatically, it revives \nthe heart\'s action and removes the pallor caused by the chloro- \n25 \n\n\n\n370 PHARMACOLOGY AND THERAPEUTICS. \n\nform. The salutary or pernicious effects of the nitrite therefore \nbeing due to the amount of it administered, they regard its \nbeneficial action as happily illustrated in the cases referred to. \nIn threatened death from chloroform the plan has been adopted \nby some of placing over the patient\'s face a little lint on which \namyl nitrite is sprinkled, and at the same time carrying on \nartificial respiration. A small amount of the vapor may no \ndoubt be of service in certain cases of syncope and cardiac \nfailure where deep inhalations might perhaps be a source of \ndanger. In heart-failure from fright, for instance, it has often \nproved of great value in single whiffs, but if it does not afford \nrelief at once it is worse than useless to continue it. \n\nAside from cardiac affections, it is especially indicated in \nvarious morbid conditions resulting from vaso-motor spasm, \nand may be employed in all cases in which dilatation of the \ncapillaries is likely to prove of service. For relaxing general \nspasm and spasm of either vaso-motor muscular fibres or \nthe voluntary or involuntary muscles it is a highly esteemed \nremedy. In tetanus and in strychnine poisoning it is worth \ntrying and may prove of distinct value. It should be used \nbetween the spasms or else administered by subcutaneous in- \njection, as the respiratory cramp interferes with its absorption \nby inhalation. Good results have been reported from its em- \nployment in trismus nascentium. In hydrophobia, although \nhaving no effect in checking the progress of the disease, it \nmay prove of service in alleviating suffering and in enabling \nthe patient to take food and drink. In persistent hiccough the \ninhalation of amyl nitrite has been known to arrest the spasm \nof the diaphragm after various other measures had failed. \n\nConsiderable attention has been paid to its use in the treat- \nment of epilepsy. There can be no question of its utility in \nmany cases in which the paroxysm is preceded by an aura \ngiving the patient warning of its onset. By relieving the vaso- \nmotor spasm of the cerebral vessels it often serves to prevent \nthe occurrence of the fit if inhaled in time, and consequently \nepileptics who have such a warning of impending seizures \n\n\n\n\n\n\nAMYL NITRITE. 371 \n\nshould always be provided with a supply of the nitrite, which \ncan be most conveniently used when put up in little glass cap- \nsules known as "pearls," each containing .30 gm. (5 1U), \nwhich can be readily crushed in the handkerchief. After the \nparoxym has commenced the remedy is hardly likely to be of \nmuch service, except in those cases which are apparently de- \npendent on a vaso-motor spasm of the vessels supplying the \nmotor areas, and if resorted to should be employed with cau- \ntion, because its early effects will be obscured by the patient\'s \ncondition. In what is known as the status epilepticus, however, \nwhere there is a series of recurring paroxysms, it has some- \ntimes been found of great service in putting a stop to the con- \nvulsions. One of the uses of amyl nitrite is as a means of \ndiagnosis between true petil mal and cases in which that affec- \ntion is simulated by attacks caused by temporary congestion \nof the nerve-centres. In the latter the nitrite, instead of \nalleviating the condition, intensifies the paroxysm. It should \nbe mentioned that certain authorities regard this agent of little \nor no value in spasmodic seizures, such as epilepsy, and state \nthat in some cases it even seems to increase the tendency to \nconvulsions. Good results have been claimed by some from \nits use in the treatment of puerperal eclampsia, but it should \nnever be employed in this disorder when the convulsions con- \ntinue after parturition or come on subsequently to the birth \nof the child, on account of the great danger of its inducing \nhaemorrhage by relaxing the uterus. It is also stated to be \nuseful for relieving after-pains, but its administration for this \npurpose is contra-indicated for the same reason. In any con- \nvulsive disorder in which the condition is regarded as attribu- \ntable to a vaso-motor spasm of the vessels supplying the motor \nareas it would naturally be likely to prove beneficial. In many \ncases of hysterical convulsions, whatever may be the primary \ncause of the nervous trouble, such a state of vaso-motor spasm \nundoubtedly exists, if only a link in the pathological chain, and \nin practice it has not infrequently been found to arrest the \nparoxysms, while not controlling other symptoms. In infantile \n\n\n\nU 2 PHARMACOLOGY AND THERAPEUTICS. \n\nconvulsions it has also sometimes proved of service. Amyl \nnitrite is antagonistic to ergot in its action. It may therefore \nbe given to counteract the evil effects of this drug, and its \ninhalation has been known to promptly reduce hour-glass con- \ntraction of the uterus caused by the latter. \n\nIt may often be used with advantage in various painful affec- \ntions in which there is a spasmodic element, and among these \nmay be mentioned spasmodic dysmenorrhcea, angiospastic hemi- \ncrania, and chordee. In those cases of migraine in which there \nis local vasomotor spasm, causing contraction of the capillaries, \nit is a most valuable remedy; but if, instead of a pallid there \nis a flushed countenance, with conjunctival injection, it will \nonly aggravate the patient\'s suffering. As to headache in gen- \neral, it will sometimes relieve and sometimes increase the pain, \nits beneficial effect or the reverse depending largely on whether \nthe arterioles are constricted or dilated. Neuralgia of the fifth \nnerve and other neuralgias are at times relieved and in some \ninstances cured by it. If the pain is mitigated or removed by \nit, but subsequently returns, the inhalations should be repeated \nfrom time to time as required. In that distressing affection \ntinnitus aiirium, which is also often very obstinate, decided \nbenefit has been derived from its use in a considerable propor- \ntion of cases. \n\nIn its action of relieving spasm of the muscular system gen- \nerally, as well as of the arterioles, are included the bronchial \ntubes, and hence it has been found a valuable remedy for the \nsymptom asthma. In the paroxysms of typical asthma it \nusually, though not always, affords immediate and complete \nrelief. What interferes to a considerable extent with its use- \nfulness, however, is the fact that the patient rapidly becomes \naccustomed to its employment, and hence increasing doses are \nnecessary when it has to be administered frequently in the \nsame case, in order to overcome the diminution in the effects \nresulting from repetition. This naturally applies to other affec- \ntions also. Amyl nitrite may often be used with advantage in \nthe treatment of catarrhal spasm or pseudo-croup of children \n\n\n\nAMYL NITRITE. 373 \n\nand of the various forms of laryngismus ; and in some instances \nis of service in Cheyne-Stokes respiration. In whooping-cough \nit is of no value. While it was at one time thought by some \nthat it allayed the violence of the cough and shortened the \nparoxysms, the remedy has now been practically abandoned in \nthat disease. It is said to have sometimes proved efficacious in \nthe vomiting of pregnancy, and there can be little question of \nits beneficial effect in many, though by no means all, cases of \nseasickness. In intermittent fever it will abort the cold stage \nof the paroxysm, but has no influence upon the ensuing hot \nstage. It would seem that the drug might be decidedly valu- \nable in the dangerous algid stage of pernicious malarial fever. \nIt has been recommended as an injection, much diluted, in \nchronic cystitis, where the secretion is catarrhal and has a bad \nodor. Fetor from the putrefaction of- other secretions and ex- \nudations, and from gangrene, the decomposition of morbid \ngrowths, etc., it is said, may also be corrected by solutions of \namyl nitrite. \n\nTOXICOLOGY. \n\nSo far as known, only one death has occurred from the use of amyl \nnitrite (in this case a patient suffering from pulmonary tuberculosis \ntook a large quantity by inhalation) ; but in a considerable number of \ninstances very alarming symptoms have been caused by it, and several \ncases are on record in which very small, and even minute, doses pro- \nduced unconsciousness. \n\nTreatment. \xe2\x80\x94 In case of serious symptoms arising from its use vomit- \ning may be caused, if necessary, by apomorphine or other emetics. Its \neffects should then be counteracted by the employment of artificial res- \npiration and by the subcutaneous injection of strychnine and digitalis, \nthe latter of which has an antagonistic action on the circulatory system. \nOther measures recommended are the exhibition of ammonia by inhala- \ntion, by the mouth, or by intra-venous injection, and the hypodermatic \nuse of atropine or ether. At the same time cold water or an ice bag \nmay be applied to the head, and a sinapism to the epigastrium. A hot \nmustard foot-bath may also be given, the patient being kept in a re- \ncumbent position. \n\n\n\n374 PHARMACOLOGY AND THERAPEUTICS. \n\nNITROGLYCERIN. \n\nSPIRITUS GLYCERYLIS NITRATIS (Spiritus Glonoini, U. S. P., \n1890). \xe2\x80\x94 Spirit of Glyceryl Trinitrate. Spirit of Nitroglycerin. (Spirit \nof Glonoin.) Dose, 0.05 C.C.; 1 TT[. \n\nAction of Nitroglycerin. \nIt is at first sweetish to the taste, but afterwards gives an \nimpression of aromatic pungency. Its action is practically the \nsame as that of amyl nitrite, but its effects on the system are \nproduced with less rapidity and last considerably longer. The \nheadache caused by it is frontal, and of great severity, and \noften persists for hours after the other effects have disap- \npeared. Nitroglycerin is a nitrate, and similarity of its action \nto that of amyl nitrite and other nitrites is due to the fact that \nit is readily converted into nitrites in the presence of alkalies, \na change which has been demonstrated to take place in the \nblood. It is thought probable that the action of all the nitrite \ngroup is due to the effects of nitrous acid. There, appears to \nbe a very great difference in the susceptibility of different in- \ndividuals to the influence of nitroglycerin. While in one person \n0.0013 gm. (-^L- grain) may give rise to its full physiological \neffects, it may take twenty-five times that amount to produce \nthe same result in another. Very small doses have been known \nto cause unconsciousness and complete disappearance of the \npulse at the wrist. After toxic quantities there is a marked fail- \nure of cardiac action. A number of deaths have been reported \nfrom over-doses of the drug, and in these cases there were \nvomiting and purging, while the immediate cause of the fatal \nresult seemed to be failure of the respiration. It may be men- \ntioned that, after gradually increasing the quantity, as much \nas 0.39 gm. (6 grains) of nitroglycerin for a dose has been \ngiven regularly, not only without any serious consequences, but \nwith apparent advantage. \n\nTherapeutics of Nitroglycerin. \nIts most important use is for the relief of symptoms asso- \nciated with the high tension pulse of chronic renal degeneration. \n\n\n\nNITROGLYCERIN. 375 \n\nHere the dose should be rapidly increased until relief is ob- \ntained. In general, it is much relied upon in cases of habitual \nhigh pressure, especially of arterial sclerosis in which the in- \ncreased peripheral resistance is developing, or has produced, in- \ncreased cardiac power. It is also of service in many of the \naffections in which amyl nitrite is used, and has the advantage \nof being more lasting in its effects. Among these may be \nmentioned asthma, angina pectoris, cardiac failure, seasickness, \nreflex vomiting, gastralgia, hepatic colic, hiccough, laryngismus, \nneuralgia of the fifth nerve, migraine (when the face is not \nflushed from dilated vessels), neuralgic dysmenorrhea, epilepsy, \nand tetanus. In some cases of chorea it is also said to have \nbeen efficient. In angina pectoris (in which amyl nitrite is \ngenerally to be preferred if the utmost promptitude is required), \nit will naturally prove of the most benefit in cases characterized \nby high tension of the peripheral vessels. A very happy appli- \ncation of nitroglycerin is in the warding off of anticipated \nattacks of angina. A patient subject to such may take a suffi- \ncient dose of the remedy a few minutes before making any \nexertion which experience has shown is likely to bring on a \nparoxysm, or he may be able to prevent the attacks by using \nminute doses at frequent intervals during the entire day. In \nheart troubles, whether valvular disease is present or not, it \noften affords the most efficient relief, and in all the various \nforms of cardiac dyspnoea it is of the greatest possible service. \nIt appears to do good by restoring or approximately restoring, \nat least for a time, the normal relationship between the force \nof the heart\'s action and the resistance of the vessels, and the \npulmonary circulation itself is no doubt favorably affected by \nits action. Its beneficial effects are not so much due to any \ndirect action on the heart as to its diminishing the resistance \nagainst which the systole is performed; so that the contraction \nof the ventricle is rendered more complete, and the output of \nthe heart increased. It has been noted that the continuous want \nof breath met with in some cases of cardiac failure is less \n\n\n\n376 PHARMACOLOGY AND THERAPEUTICS. \n\namenable to such relief than dyspncea which is more paroxysmal \nin character. Nitroglycerin may often be combined very ad- \nvantageously with digitalis in organic disease of the heart, in \norder to neutralize the marked vaso-constriction caused by that \ndrug. Digitalis has unquestionably been used far too indis- \ncriminately in cardiac affections; but it has been remarked by \nthose who have had good opportunities for observation that \nduring the past few years, in which the nitrites have been \ncommonly used in this way, digitalis has been productive of \nmuch less harmful results than formerly. Nitroglycerin is, \nthen, an efficient and generally safe remedy, and it can be given, \nin sufficient quantity to secure the desired action, for long \nperiods without ill effects. In cases of valvular disease in which \nthe cardiac muscle is incapable of being stimulated to increased \nforce by digitalis (as in fatty degeneration), and in which that \ndrug does harm instead of good, it may be used as a last resort, \neffecting relief if not contributing to a cure. \n\nIn the treatment of anaemia, in its ordinary form and in the \npernicious variety, it has proved a valuable agent. Here the \nassimilative processes are generally so imperfectly performed \nthat the food taken cannot be utilized in blood-making, while \nthe organs concerned in the latter may be in a pathological con- \ndition, or functionally torpid. To bring about a proper activity \nof the nutrition it is necessary to restore the organs of circula- \ntion and admit the fullest nutrient supply to all the tissues ; and \nthis, it is believed, nitroglycerin is of great assistance in accom- \nplishing. It has been recommended in the algid stage of cholera \nand, injected subcutaneously, has been found of service in \npoisoning by illuminating gas. The severe headache which it is \napt to produce is found in a considerable proportion of cases \nto disappear after repeated employment. \n\nSODIUM NITRITE. \nSODII NITRIS.\xe2\x80\x94 Sodium Nitrite. Dose, 0.065 gm. (65 milligm.) ; \n1 gr. \n\n\n\nNITROGLYCERIN. 377 \n\nAction of Sodium Nitrite. \n\nExternal. \xe2\x80\x94 Locally applied, sodium nitrite, like amyl nitrite- \ntends to destroy the functional activity of the tissues. \n\nInternal. \xe2\x80\x94 Under the effect of a moderate dose of sodium \nnitrite the heart\'s action is slightly quickened and the pulse \ntension falls. There may or may not be some feeling of full- \nness in the head, but not often any throbbing, and there is gen- \nerally no flushing of the face. With larger doses the fall of \ntension is very marked and the same characteristic symptoms \nin general are produced as in the case of amyl nitrite. Some- \ntimes profuse perspiration and more or less cyanosis are seen, \nand faintness and nausea may occur. In those specially sus- \nceptible to the influence of the drug partial unconsciousness and \ncollapse may result. It appears to have a depressing action \nupon muscular tissue, and in the frog, contrary to the effect \nof amyl nitrite, the muscles are paralyzed before the spinal \ncord. It is both absorbed and eliminated more slowly than \neither amyl nitrite or nitroglycerin, and its effects on the system \nare very much more permanent than those of the former and \nconsiderably more lasting than those of the latter. One dis- \nadvantage connected with its administration is the eructations \nto which it frequently gives rise, in consequence of the fact that \npart of its nitrous acid is liberated by the action of the gastric \njuice before absorption can take place. Some irritation of the \ngastro-intestinal mucous membrane also is liable to be caused \nby the nitric acid formed from it. The greater part of the \nnitrite which is absorbed is excreted as nitrate in the urine, but \nsome of it may remain unoxidized. In experiments on small \nanimals, such as cats and guinea-pigs, it has been found that \nlethal amounts of sodium nitrite produce general sedation, mus- \ncular paresis, slowing of the heart, fall of arterial tension, \ncyanosis, asphyxia and paralysis, while after death the heart \nand lungs are seen to be gorged with black or chocolate-colored \nblood. \n\n\n\n378 PHARMACOLOGY AND THERAPEUTICS. \n\nTherapeutics of Sodium Nitrite. \nThe action of this agent, though apparently milder and less \ncertain in effect, is analogous to that of amyl nitrite and \nnitroglycerin, and it may be employed in the various condi- \ntions in which these drugs are of service. As a mat- \nter of fact, however, it is much more rarely used in med- \nical practice than either of them. Wherever an immediate \nand powerful effect is desired they are both to be preferred to \nit, and while its effects may be more lasting, nitroglycerin is \nso extremely easy of administration that its repetition at suffi- \nciently frequent intervals will prolong its influence to any re- \nquired extent. In some cases, however, it may be found to \nact more satisfactorily than nitroglycerin, and as it is much \nless likely to produce severe headache than the latter, it may \nbe advantageously substituted for it in patients in whom the \nheadache proves an objection. As sodium nitrite is liable to be \ndecomposed by the gastric acids, it has been recommended that \nit should be given in an alkaline solution. \n\nSPIRIT OF NITROUS ETHER. \n\nSPIRITUS ^GTHERIS NITROSL\xe2\x80\x94 Spirit of Nitrous Ether. \n(Sweet Spirit of Nitre.) Dose, 2 c.c; 30 TTt- \n\nAction of Spirit of Nitrous Ether. \n\nExternal. \xe2\x80\x94 When applied to the cutaneous surface it quickly \nevaporates, giving rise to a slightly anaesthetic effect. \n\nInternal. \xe2\x80\x94 Spirit of nitrous ether, although it has long been \nextremely popular as a diaphoretic and a diuretic, has been \nfound to have in reality little action upon either the skin or \nthe kidneys, while it is inefficient in the reduction of tempera- \nture. Its principal value is as a carminative and diffusible \nstimulant. It also has some antispasmodic influence, and acts \nas a mild sedative to the nervous and circulatory systems. Its \nphysiological action as a nitrite is but feeble as compared with \nthat of amyl nitrite, sodium nitrite, or nitroglycerin, its effects \nin this respect being overcome or modified by the alcohol enter- \n\n\n\nERYTHROL TETRANITRATE. 379 \n\ning into its composition. In the case of a child of three years \nwho died from taking 120 c.c. (4 ounces) of the spirit, the \nsymptoms were those of alcoholic poisoning, with the addition \nof vomiting and purging. It should not be kept too long, as it \nis liable to turn acid after a time. \n\nTherapeutics of Spirit of Nitrous Ether. \nThis time-honored remedy, so long and universally given as \na diuretic, diaphoretic and antipyretic, no longer enjoys the \nvogue that it formerly held. It has, however, a limited sphere \nof usefulness. It may be given with good effect to children, \nparticularly, suffering from feverishness with nervous symp- \ntoms or mental excitement. Here it often has a pleasantly \ncalmative influence, quieting the restlessness and promoting \nsleep. On account of its stimulating qualities it is especially \nserviceable in adynamic conditions. It is a grateful stomachic \nand carminative, and is useful, especially when associated with \naromatic spirit of ammonia, in allaying nausea and causing the \nexpulsion of flatus. In asthma and bronchitis it may be of \nassistance in relieving spasm and increasing the secretions of \nthe mucous membrane, and it is frequently employed as a con- \nstituent in expectorant mixtures. It is also used to some ex- \ntent in combination with diuretics. Externally, it sometimes \nproves a soothing application to the forehead in neuralgic head- \nache. \n\nERYTHROL TETRANITRATE. \n\nERYTHROL NITRAS.\xe2\x80\x94 Erythrol Nitrate, not official. (Erythrol \nTetranitrate. Tetranitrole.) Dose, .03 to .06 gm.; y 2 to 1 gr. \n\nAction of Erythrol Tetranitrate. \nLike nitroglycerin, this is a dangerous explosive, and at \nleast one fatal accident has occurred from its trituration in a \nmortar (with glucose). It has the same general action as the \nnitrites, causing dilatation of the vessels and a marked fall in \nblood-pressure, together with the formation of methsemoglobin. \nIn the case of this drug and mannitol hexanitrate the charac- \n\n\n\n\n\n\n380 PHARMACOLOGY AND THERAPEUTICS. \n\nteristic effects on the system are produced more slowly and \ngradually, and last for a longer time, than under the influence \nof any others of the group. Its alcoholic solution is explosive, \nand it is therefore recommended that it should always be used \nin tablet form. \n\n. Therapeutics of Erythrol Tetranitrate. \nIt is highly recommended in the treatment of angina pectoris, \nalthough, like other members of the nitrite series, it sometimes \nfails to give relief. It is often of special value, however, in \nwarding off attacks of angina, for, while its influence is not \nexerted for half an hour or longer after ingestion, it is capa- \nble of preventing the attacks for four or five hours. Some \nauthorities, indeed, advise that the remedy should be used for \nthis purpose solely; but this is a great mistake, as it has proved \nof very marked service in other conditions also. It is considered \nby many to be the best of the series for the relief of some of \nthe symptoms of Bright\'s disease, and in cardiac affections, \nwhether associated with renal trouble or not, it can often be \nrelied upon with great confidence. This drug, it can scarcely \nbe doubted, has not as yet been as generally employed as its \nmerits deserve, and there can be little question that for con- \nstant use erythrol tetranitrate, properly administered; is superior \nto the more evanescent nitroglycerin and the somewhat uncer- \ntain sodium nitrite. It has been recently recommended in lead- \npoisoning with high arterial tension. \n\n2. Vaso-constrictors. \n\nSUPRARENAL GLAND. \n\nGLANDULE SUPRARENALES SICOE.\xe2\x80\x94 Desiccated Suprarenal \nGlands. (Suprarenal Extract.) Dose, 0.250 gm. (250 milligm.) ; \n4 gr. \n\nSuprarenal Gland is a vaso-constrictor of the first importance, \nbut will be considered in association with the other Organic \nExtracts, in Division XIII. \n\n\n\nBARIUM SALTS. 38 I \n\nBARIUM SALTS. \n\nUnofficial Preparations. \n\n1. Barii Dioxidum (U. S. P., 1890).\xe2\x80\x94 Barium Dioxide. \n(Barium Peroxide.) \n\n2. Barii Sulphidum. \xe2\x80\x94 Barium Sulphide. \n\n3. Barii Chloridum.\xe2\x80\x94 Barium Chloride. Dose, .006 to .03 \ngin.; tV to y 2 gr- \n\nAction of Barium Salts. \nBy its local action in the alimentary canal barium causes \ngastro-enteritis and some degree of corrosion. It is absorbed \nto a considerable extent, and the most conspicuous of its sys- \ntemic effects are on the circulation. Barium chloride causes \nthe cardiac contractions to become slower and more forcible, \nacting like digitalis. The blood-vessels are constricted, and \nthe blood pressure rises. The increased tension caused by it \nmay be due in part to the action on the heart, but is chiefly \nattributable to a very marked contraction of the muscular walls \nof the vessels. The plain muscular fibres of the intestine may \nbe excited, and the peristalsis is increased. In these respects \nit resembles ergot, as well as digitalis. It acts like veratrine \nwhen applied locally to voluntary muscles, prolonging the con- \ntraction; but this effect is done away with by the application \nof potassium salts. In warm-blooded animals barium salts, \ninjected intravenously, by stimulating the spinal cord and \nmedulla oblongata, induce violent tonic and clonic spasms. By \nsufficient quantities the central nervous system is finally para- \nlyzed. Barium is excreted in the urine and probably in the \nfaeces. When given in very dilute solutions the amount absorbed \nis small, and it is then deposited in the bones. \n\nTherapeutics of Barium Salts. \n\nThese are not often given, but the chloride has been used \n\nfor mitral insufficiency accompanied by irregularity of the heart, \n\nfor haemorrhage, and as a stimulant in atony of the bladder or \n\nintestine. Formerly it was given in nervous diseases. The \n\n\n\n382 PHARMACOLOGY AND THERAPEUTICS. \n\nwaters of Llangammarch wells contain .40 gm. (6.7 gr.) to \n4545 c.c. (Imperial gallon) of barium chloride, and have been \nused in cardiac cases. The sulphide has been used as a de- \npilatory. \n\nTOXICOLOGY. \n\nSymptoms. \xe2\x80\x94 Poisonous doses cause salivation, thirst, vomiting, purg- \ning, difficulty of breathing, a slow pulse, and, from the action on the \nspinal cord, paralysis of the limbs. The heart is arrested in systole. \n\nTreatment. \xe2\x80\x94 Poisoning should be treated by non-irritant emetics and \ndraughts of weak solution of sodium or magnesium sulphate, followed \nby albuminous drinks, and diffusible stimulants. \n\nTANNIC ACID. \n\nQUERCUS.\xe2\x80\x94 White Oak. Dose, 1 gm.; 15 gr. \n\nPreparation. \nFluidextractum Quercus. \xe2\x80\x94 Fluidextract of Quercus. Dose, 1 \nc.c; 15 TTL- \n\nGALLA. \xe2\x80\x94 Nutgall. Dose, 0.500 gm. (500 milligm.) ; iy 2 gr. \n\nPreparations. \n\n1. Tinctura Gallae. \xe2\x80\x94 Tincture of Nutgall. Dose, 4 c.c; 1 \nfl. dr. \n\n2. Unguentum Gallae. \xe2\x80\x94 Nutgall Ointment. \n\nACIDUM TANNICUM.\xe2\x80\x94 Tannic Acid. (Tannin.) Dose, 0.500 \ngm. (500 milligm.) ; 7y 2 gr. \n\nPreparations. \n\n1. Collodium Stypticum. \xe2\x80\x94 Styptic Collodion. \n\n2. Glyceritum Acidi Tannici. \xe2\x80\x94 Glycerite of Tannic Acid. \nDose, 2 c.c; 30 irt. \n\n3. Unguentum Acidi Tannici. \xe2\x80\x94 Ointment of Tannic Acid. \n\n4. Trochisci Acidi Tannici. \xe2\x80\x94 Troches of Tannic Acid. \n\nUnofficial Preparations. \n\nIodo-tanninum. \xe2\x80\x94 Iodo-tannin. \n\nTannalbinum. \xe2\x80\x94 Tannalbin. Dose, .30 gm.; 5 gr. \n\nTannigenum.\xe2\x80\x94 Tannigen. Dose, .30 to 2 gm.; 5 to 30 gr. \n\n\n\nTAXXIC ACID. 383 \n\nAction of Tannic Acid. \n\nExternal. \xe2\x80\x94 Locally, tannic acid is an astringent and haemo- \nstatic, and its characteristic effect is the precipitation of albu- \nmins and other proteids, as well as gelatin and many alkaloids \nand glucosides. The precipitate thus formed is dense and re- \nsists putrefaction. This action occurs when the acid is applied \nto animal tissue, as in the tanning of leather, and the result is \nthat the hide becomes harder, tougher, and somewhat shrunken, \nbut retains its flexibility. Tannic acid is very slightly irritant, \nbut this effect is more than counterbalanced by its astringent \naction. It apparently has no action on the unbroken skin, but \non mucous membrane it has the effect of causing more or less \ncoagulation in the cells, by direct action on the cells themselves; \nprecipitating the albumin of the secretions (which it dimin- \nishes), and forming a layer of albumin tannate which is pro- \ntective and antiseptic. Applied to a bleeding surface, it thus \nhas a haemostatic action, coagulating the effused blood and \nplugging the vessels with clots, and still further tending to \ncheck haemorrhage by the constriction of the vessels caused by \nthe contraction of the coagulum formed within the tissues. \n\nInternal. \xe2\x80\x94 Its taste is bitter, and in the mouth it produces a \nfeeling of dryness, stiffness, and puckering. Very soon the \nsense of taste is partially lost, and the movements of the tongue \nare somewhat interfered with in consequence of the coagulation \nof the superficial layers of proteids both within and without \nthe epithelium. This causes a roughness of the surface of the \nmucous membrane, so that the tongue cannot glide over it easily, \nas in the normal condition. In the throat the same feeling of \nastringency is experiencecd. Nausea and vomiting may some- \ntimes be caused by the drug, but this is not very often the case. \nIn the intestines it diminishes the mucous and other glandular \nsecretions, so that constipation results, and the faeces become \ndry, hard and scanty. The increased consistency of the stools \nis thought to be due to the layer of coagulated proteid acting \nas a protective to the bowel, lessening its irritability, and thus \nretarding its movements; so that there is longer time for the \n\n\n\n384 PHARMACOLOGY AND THERAPEUTICS. \n\nabsorption of the fluid part of its contents. In the stomach \ntannic acid is found to combine with and precipitate any pro- \nteid substance with which it comes in contact, but, as digestion \nproceeds, such combination is broken up, the peptones not com- \nbining with this agent in acid solution ; and the astringent action \nis therefore exercised on the walls of the stomach and intes- \ntines. When given in large amount, however, it sometimes \ncauses gastro-intestinal irritation and diarrhoea. Only about \none per cent, of the tannic acid swallowed reappears in the ex- \ncretions, either as tannic or gallic acid; the rest would seem to \nundergo complete oxidation in the tissues. A small proportion \nis occasionally eliminated by the bowel unchanged, but the \ngreater part is converted into gallic acid, some of which often \npasses out both in the stools and the urine. No evidence of \nany weight has been educed that tannic acid exerts any in- \nfluence after it has been absorbed. It does not exist in the \ntissues as such, but only in the form of traces of sodium \ngallate or tannate, too small to have any astringent effect; and \nit would appear, therefore, that its action is in fact limited to \nthe point of application. As to its effects on blood-vessels, the \nmost recent experiments show that solutions of less strength \nthan y 2 per cent, cause constriction of the mesenteric vessels \nof the frog or rabbit when applied directly, while more con- \ncentrated solutions occasion transient constriction, followed by \ndilatation. When it is injected intravenously, the precipitate \nproduced is found to lead to the formation of emboli. \n\nTannic acid is the chief principle of all the vegetable astring- \nents. The tannic acid present is not always the same chemical \nbody, but the various acids, such as catechutannic, kinotannic, \netc., all have in common the power of precipitating albumins \nand other properties characteristic of pure tannin. The dif- \nferences in the intensity of their effects is explained by the facts \nthat some are more energetic precipitators of albumin than \nothers, and that many of the drugs contain gum, resin and \nother matters which affect the solubility of the tannins. \n\n\n\nTANNIC ACID. 385 \n\nTherapeutics of Tannic Acid. \n\nExternal. \xe2\x80\x94 Tannic acid is a very useful remedy, and its appli- \ncations are quite extensive both in surgery and medicine. It is \nemployed to control bleeding in various parts of the body, and \nit may, if practicable, be dusted on the part, or be applied in \nthe form of the glycerite or of styptic collodion. The latter \nis of special service in uniting incised wounds and protecting \nlacerated wounds. When applied on wounded or abraded sur- \nfaces it checks the oozing and forms a firm coating in which \nthe coagulated blood and secretions participate, and which ex- \ncludes the air from the part. In order to produce special effects \non the diseased surface various agents, such as phenol, io- \ndine, or morphine, may be incorporated in the preparation, \nas desired, and carbolized styptic colloid, in which advantage is \ntaken of the antiseptic and styptic properties of carbolic acid, \nis a very efficient haemostatic. It is prepared by adding ten \nper cent, of phenol to the official styptic collodion. \n\nAside from its astringent and haemostatic effects, tannin is of \nvalue locally for removing fetor and for preventing or checking \nputrefactive changes in the tissues. Among the conditions in \nwhich its application in various forms is useful may be men- \ntioned aphthous ulceration of the mouth, spongy gums, mer- \ncurial salivation, relaxation of the uvula, pharyngitis, nasal \ncatarrh, otorrhoea, laryngitis, chronic inflammations of the \nconjunctiva, leucorrhcea, urethritis, cystitis, haemorrhoids, \nburns, chilblains, ulcers and other sores, and moist cutaneous \neruptions. For local use the glycerite is probably the most \ngenerally satisfactory preparation of tannic acid, and the \nofficial strength may be readily altered to suit special condi- \ntions. A very concentrated solution, two parts of glycerin to \none of tannin, may be made by the aid of moderate heat. \nThis will be found very useful to prevent sore nipples if applied \ndaily during the later months of pregnancy. The glycerite, in \nthe strength of one part to eight of water, makes an excellent \ngargle. For pharyngitis and tonsillitis the troches are con- \nvenient, and a spray (1 to 2 in 100 of water) or an insufflation \n26 \n\n\n\n386 PHARMACOLOGY AND THERAPEUTICS. \n\nof tannic acid and starch may be used for the larynx, as well \nas the fauces. A powder made with one part of tannin to 30 \nparts of orris \xe2\x80\x94 or marshmallow \xe2\x80\x94 root has been employed as a \nsnuff to arrest acute coryza in its forming stage, and an oint- \nment containing .06 gm. (1 gr.) of tannin and 8 gm. (2 dr.) of \nsimple ointment has been applied to the nostrils, on a roll of \nsoft linen or paper, for the same purpose in infants. In chronic \nnasal catarrh powdered tannin is sometimes used by insufflation, \nand in the treatment of nasal polypi a 10 per cent, solution in \nwater has been employed. In ozaena and other affections at- \ntended with fetor tannin-wool (made by soaking cotton-wool in \nwater, at 6o\xc2\xb0 C. ; 140 F., saturated with tannic acid, and \ndrying the wool), has been found of service. The ointment \nof nutgall and opium (1 to 14 of nutgall ointment) is a favorite \napplication for piles. In affections of the rectum tannic acid \nis recommended in the form of a suppository containing .20 gm. \n(3 &**\xe2\x80\xa2)> an d in those of the uterus in the form of a pencil \nabout an inch in length, made with 4 parts of the acid to 1 of \ntragacanth. The glycerite, as well as iodoform-tannin, is re- \ngarded as an excellent application for catarrhal inflammation \nof the cervix uteri, and even in cancer of the uterus is efficient \nin moderating the discharge and allaying odor. The benefit \nfrom it may be increased by combining with it the glycerite \nof phenol. Solutions (1 to 50) in water may be injected \ninto the bladder for cystitis and into the urethra in the treat- \nment of subacute gonorrhoea and gleet. Gonorrhoea has also \nbeen treated by filling the urethra once or twice daily with \na powder consisting of equal parts of tannic acid, iodoform \nand thalline sulphate, introduced through a metal tube. In \nwomen a watery solution may be used as a vaginal injection, \nor the vagina may be packed with gauze covered with tannin. \nThe decoction of oak bark, employed as a high rectal injection, \ndestroys the thread-worm. A preparation of nutgall dissolved \nin glycerin was formerly used as an injection into hernial sacs \n(Heaton\'s method). The temporary results were excellent, but \nsooner or later failures occurred in a large percentage of cases. \n\n\n\nTANNIC ACID. 387 \n\nA solution of tannic acid in tincture of benzoin (1 to 4) is said \nto tend to repress the development of the pustules of small-pox. \nA tannic acid lotion or ointment is sometimes of service in \nsuch skin affections as herpes, intertrigo, and weeping eczema, \nchecking the discharge and allaying itching and irritation. \nMade into a pomade, it has been found of benefit in dandruff, \nand it is also useful in alopecia circumscripta. Introduced into \na carious cavity, it not infrequently relieves toothache. A con- \ncentrated solution is an excellent palliative remedy in ingrown \ntoe-nail, especially when there are fungous growths, and is \nuseful also for hardening tender feet. Ulcers of the rectum and \nanus and fissures of the anus are sometimes effectively treated \nby the application of the powder of tannin, tannin and iodoform, \nor iodo-tannin (solution of iodine in tannic acid). \n\nIn acute dysentery good results have been obtained by the \nuse of hot enemata consisting of a 4 per cent, solution of boric \nacid in which 0.60 gm. (10 gr.) of tannin is dissolved, with the \naddition of a few drops of laudanum. In the early stage of \ncholera, also, tannic acid enemata, carried beyond the ileo-csecal \nvalve, have proved of service; the injections being composed \nof 6 to 20 gm. (i T / 2 to 5 dr.) of tannic acid dissolved in 2 litres \n(4 pints) of water, with the addition of 2 c.c. (30 Til) f \nlaudanum and 45 gm. (iy 2 oz.) of powdered gum arabic. \n\nInternal. \xe2\x80\x94 As an internal remedy pure tannic acid is of little \nvalue. It is often prescribed in internal haemorrhages such as \nhaemoptysis, metrorrhagia and haematuria, but it is doubtful \nwhether, except in those of the gastro-intestinal tract, where, \nif given in sufficient quantity, there may be some opportunity for \nit to exert its local action, it really does any good in these con- \nditions. Even for haemorrhage from the stomach or intestine \nother remedies are to be preferred. If employed in haemop- \ntysis, an atomized solution will afford the best chance of suc- \ncess. In excessive sweating, bronchorrhoea and leucorrhcea its \ninternal administration has no effect in diminishing the dis- \ncharge. In certain forms of diarrhoea its astringent action is \nof considerable value, and it may prove useful in checking the \n\n\n\n388 PHARMACOLOGY AND THERAPEUTICS. \n\nlooseness of the bowels sometimes caused by such remedies as \ncodliver oil. In these cases, however, the pure drug is seldom \nused, as it is liable to derange the stomach and to form com- \npounds with the albumins before it reaches the intestine, and \nsuch agents as kino, gambir, and krameria, which owe their \nastringent qualities to tannic acid, are generally selected in \nthe treatment. Remedies of this kind, whose activity depends \non their containing tannic acid, differ from the pure drug in \nthat the acid is only slowly dissolved out from the colloid mass, \nand therefore acts less on the stomach and affects a greater \nlength of intestine. In chronic albuminuria the acid, in various \nforms, has been recommended for the purpose of checking the \ndrain of albumin from the blood; but opinion is very divided \nas regards its efficacy, and it would seem altogether probable \nthat it has no effect either in lessening the albumin in the urine \nor preventing its increase. As a temporary expedient in cases of \npoisoning with metallic compounds, such as tartar emetic, and \nwith alkaloids, the exhibition of tannic acid may serve a useful \npurpose ; but it should always be followed by the prompt empty- \ning of the stomach, as otherwise the tannate formed becomes \ngradually dissolved in the fluids of the alimentary canal. Cer- \ntain individuals, it has been found, are peculiarly susceptible \nto the action of tannic acid, which in such cases produces local \nirritation, and even inflammation, wherever it is applied. This \nremedy should never be used hypodermatically. \n\nTannalbin (not official) is a tannin albuminate which has \nbeen subjected to a dry heat of 230\xc2\xb0-248\xc2\xb0 F. (uo\xc2\xb0-i20\xc2\xb0 C.) \nfor several hours. It is a faintly yellow, tasteless powder con- \ntaining about 50 per cent, of tannic acid. Laboratory experi- \nments have shown that it is not easily decomposed by an arti- \nficial gastric juice, but it is rapidly separated into its constituents \nin an alkaline medium or by an artificial solution of the pan- \ncreatic ferments. This preparation accordingly passes through \nthe stomach unchanged, and may not be broken up until it has \ngot well down into the intestine. Tannalbin is preferably \ngiven in wafers at frequent intervals. It has been used with \n\n\n\nGALLIC ACID. 389 \n\nconsiderable success in chronic diarrhoeas, even in cases in \nwhich intestinal ulceration was present. It has also been highly \ncommended in gastric catarrh, and is said to have been found \nuseful in diminishing the amount of albumin in chronic albumi- \nnuria. \n\nTannigen (not official), the acetic acid ester of tannic acid, \nis prepared by the action of glacial acetic acid on tannic acid. It \nis a tasteless, odorless powder, insoluble in water, and is be- \nlieved to pass unchanged through the stomach and to be slowly \ndecomposed in the intestines, thus exerting an astringent effect \nin them. This preparation also is usually prescribed in wafers. \nIt has been used to a considerable extent in the diar- \nrhoeas of children, in whom its tastelessness renders its ad- \nministration very advantageous, and it has proved especially \nserviceable in entero-colitis. In chronic intestinal troubles it \nis said to have been found less successful than in acute. Some \nobservers, however, recommend it in chronic cases, and espe- \ncially in the diarrhoea of phthisis. It does not disturb the diges- \ntion, and has proved efficient in the treatment of gastric catarrh \nwith excessive secretion of mucus. Locally applied, it appears \nto act well in catarrhal affections of the mucous membrane, and \nthe powder may be used by insufflation in chronic rhinitis and \nlaryngitis. \n\nGALLIC ACID. \n\n1. ACIDUM GALLICUM.\xe2\x80\x94 Gallic Acid. Dose, 1 gm.; 15 gr. \n\n2. PYROGALLOL.\xe2\x80\x94 Pyrogallol. \n\nUnofficial Preparations. \nGallacetophenonum. \xe2\x80\x94 Gallacetophenone. \nLenigallol.\xe2\x80\x94 Lenigallol. (Pyrogallol Triacetate.) \n\nAction of Gallic Acid. \n\nGallic acid, given by the mouth, is absorbed, and, as has been \n\nstated, is excreted to some extent by the kidneys; but much \n\nof it disappears in the tissues, apparently by oxidation. It does \n\nnot, like tannic acid, precipitate proteids, and has therefore no \n\n\n\n390 PHARMACOLOGY AND THERAPEUTICS. \n\nlocal styptic or astringent effect. It can be taken in very large \nquantity without producing any symptoms, its action being \nsimply that of a weak organic acid. \n\nTherapeutics of Gallic Acid. \nIt has been employed to a very considerable extent to pro- \nduce the supposed remote astringent effects of tannic acid, \nwhich, as has been seen, becomes largely converted into it in \nthe body. Thus, it has been commonly given in the treatment \nof haemorrhage of all kinds and to some extent also in albumi- \nnuria. With our present knowledge, however, it seems prob- \nable that it has little, if any, therapeutic value. At the same \ntime, it should be stated that it is still maintained by some clini- \ncians of repute that it should be prescribed when astringent \neffects on the tissues elsewhere than the intestinal canal are \ndesired, and that in the treatment of renal haemorrhage it is more \nuniformly successful than any other remedy. It is also claimed \nthat it is very serviceable in pyelitis, pyelo-nephritis, and catarrh \nof the bladder, as well as in chronic bronchial catarrh when \nthe latter is the sequel of acute bronchitis or the result of the \nirritation extending from disease of the parenchyma of the \nlung, or when it is produced by mitral or tricuspid regurgita- \ntion. Others hold that, combined with opium, it is one of the \nbest remedies in diabetes insipidus, and is even useful in dia- \nbetes mellitus; but it is probably the fact that whatever benefit \nmay be found in these cases is due entirely to the effect of the \nopium. It is also stated to have proved efficient in pyrosis, \nwhich is an annoying symptom of various dyspeptic conditions. \n\nAction of Pyrogallol. \nIn its effects on the system, as well as chemically, pyrogallol \nis more nearly related to phenol than to gallic acid. When \nadministered in large quantities to animals it gives rise to ner- \nvous symptoms analogous to those caused by carbolic acid, but \nin man, even in poisonous doses, it does not produce these ner- \nvous symptoms, or at all events to a very small extent; while \n\n\n\nGALLIC ACID. 39 1 \n\nthe other phenomena are similar to those observed in animals \nwhen smaller quantities are exhibited. The poison acts not so \nmuch directly on the central nervous system as upon the blood \nand, secondarily, upon the kidneys. The red corpuscles become \nshrunken and angular, and the greater part of their haemo- \nglobin, escaping into the plasma, is converted into methsemo- \nglobin, so that marked dyspnoea is likely to result. The color \nof the blood is changed to a brownish-red, in consequence of \nwhich the skin and mucous membranes become discolored, and \nif the toxic effect is not too acute, icterus follows, and both \nhaemoglobin and methaemoglobin are excreted in the urine. It \nis not known whether the methaemoglobin is a direct result of \nthe reduction of the haemoglobin by the pyrogallic acid, or \nwhether this action is accompanied by a secondary oxidation. \nIn the kidney the poison sets up an inflammatory process, which \nis indicated by the presence in the urine of albumin, epithelium, \ncasts and the products of blood-decomposition, and which may \nlead to the production of uraemic convulsions. Pyrogallol is \nexcreted in the urine partly as an ethereal combination with \nsulphuric acid and partly as unknown oxidized products, which \ngive the secretion a dark brown or black color. When the re- \nsult is fatal, death appears to be due to the changes in the blood \nand nephritis resulting therefrom, rather than to any direct ef- \nfects of the drug on the central nervous system. In dogs poi- \nsoned by it, it is said, hepatic lesions are produced identical with \nthose caused by phosphorus. Poisoning, it has been shown by \nexperiment, may readily take place by cutaneous absorption. \nThe mineral acids act as antidotes to its effects. Pyrogallol \nprecipitates albumin, and has a deep and strong local irritant \naction. In a 1 or 2 per cent, solution it is decidedly antiseptic. \nWhen it is applied in solution or ointment, it stains the skin, \nbut not permanently; linen and clothing are, however, perma- \nnently darkened. To avoid the staining it has been proposed \nto dissolve the remedy in flexible collodion, 1 or 2 to 24. Its \nincautious application may cause inflammation of the skin, \nwhich may result in extensive ulceration and sloughing. A \n\n\n\n392 PHARMACOLOGY AND THERAPEUTICS. \n\nGerman dermatologist has recently stated that pyrogallol is \na benzin with three hydroxyl groups, each of which may be \nreplaced by acid radicals. Lenigallol, or pyrogallol triacetate, \nhe describes as a mild preparation (ointments containing even \n50 per cent, causing no irritation when applied under a band- \nage), which is decomposed by the strongly alkaline perspira- \ntion, producing the characteristic darkening of pyrogallol, to- \ngether with its remedial action in cutaneous affections. \n\nTherapeutics of Pyrogallol. \nIt is rarely given internally, and is almost exclusively used \nin the local treatment of various diseases of the skin. It should \nnot be applied over too large a surface, on account of the \ndanger of absorption, and fatal cases have occurred from the \nfree use of an ointment on extensive cutaneous lesions. Con- \nsequently, chrysarobin, and also gallacetophenone, a derivative \nof pyrogallol, have been recommended and more or less ex- \ntensively employed as substitutes for it. If experience should \nconfirm the efficacy of lenigallol, it might likewise be used with \nadvantage in many instances in place of it. The curative effect \nof pyrogallol in skin affections is usually attributed to its irri- \ntant and antiseptic properties, but is referred by some to its \nreducing action. It undoubtedly has very considerable ger- \nmicidal power. It may be employed either in the form of \nan ointment, or dissolved in flexible collodion or alcohol with \nthe addition of a little glycerin. Jarisch\'s ointment (1 to 8) \nis entirely too strong for ordinary use; 1 or 2 parts (or even \nless) of pyrogallic acid to 48 of lard or lanolin will generally \nbe found more satisfactory. Psoriasis, pityriasis versicolor, \nringworm, ulcer, sloughing phagedena, and syphilitic lesions \nof the integument are among the affections in which it has \nproved of value. It has also sometimes been used with good \neffect in such serious diseases as lupus, leprosy and epithelioma. \nBefore pyrogallol is employed vaseline should generally be thor- \noughly applied, and wiped off, to remove scales and other \nmorbid products. In some conditions it is recommended that \n\n\n\nGAMBIR. 393 \n\nthe remedy should be mixed with a powder, such as kaolin or \nstarch, and dusted over the affected part. \n\nOccasionally it has been given internally, in frequently re- \npeated doses of .06 gm. (1 gr.), as a haemostatic in menor- \nrhagia, haemoptysis and haematemesis, but this practice has \nnever received general favor, and more evidence is needed of \nits efficacy. \n\nGAMBIR. \n\nGAMBIR.\xe2\x80\x94 Gambir. (Replacing Catechu, U. S. P., 1890.) Dose, 1 \ngm.; 15 gr. \n\nPreparations. \n\n1. Tinctura Gambir Composita. \xe2\x80\x94 Compound Tincture of \nGambir. Dose, 4 c.c; 1 fl. dr. \n\n2. Trochisci Gambir. \xe2\x80\x94 Troches of Gambir. \n\nAction of Gambir. \nGambir is a powerful astringent. It owes its astringent \nproperty to the tannic acid entering into its composition, and \naside from this has no special action. \n\nTherapeutics of Gambir. \nThe compound tincture is a favorite remedy in diarrhoea \narising from various causes. If there is any source of irrita- \ntion in the intestinal tract, or if a considerable quantity of \nmucus in the discharges indicates a catarrhal condition of the \nbowel, its administration should be preceded by a purge, such \nas castor oil or magnesium sulphate. In the case of children \nit is often given in combination with paregoric and chalk mix- \nture. It may be used to check internal haemorrhages, like \nhaemoptysis and haematuria, and also in albuminuria, but is not \nreliable for these purposes. Locally it has a number of useful \napplications. In relaxation of the soft palate and uvula and \nin simple pharyngitis it may be employed in troches or in the \nform of a gargle. It is also used as a mouth-wash for spongy \ngums and as an ingredient of dentifrices. An infusion of gam- \nbir, thrown up the nostrils, will frequently arrest epistaxis. It \n\n\n\n394 PHARMACOLOGY AND THERAPEUTICS. \n\nis serviceable likewise in gonorrhoea and leucorrhcea and in \nrelaxed conditions of the vagina. \n\nKRAMERIA. \nKRAMERIA. \xe2\x80\x94 Krameria. (Rhatany.) Dose, 1 gm.; 15 gr. \nPreparations. \n\n1. Extractum Krameriae. \xe2\x80\x94 Extract of Krameria. Dose, 0.500 \ngm. (500 milligm.) ; 7y 2 gr- \n\n2. Fluidextractum Krameriae. \xe2\x80\x94 Fluidextract of Krameria. \nDose, 1 c.c.; 15 rrt- \n\n3. Tinctura Krameriae. \xe2\x80\x94 Tincture of Krameria. Dose, 4 \nc.c; 1 fl. dr. \n\n4. Trochisci Krameriae. \xe2\x80\x94 Troches of Krameria. \n\n5. Syrupus Krameriae. \xe2\x80\x94 Syrup of Krameria. Dose, 4 c.c; \n1 fl. dr. \n\nAction of Krameria. \nKrameria, like gambir, is a powerful astringent, and its \naction also is due to the tannic acid it contains. In small doses \nit is slightly tonic. \n\nTherapeutics of Krameria. \nIt is used in the same class of cases as gambir, and, in addi- \ntion, sometimes as a stomachic and tonic. The fluidextract is \nespecially valuable in diarrhoea, and may also be used in gastric \nand intestinal haemorrhage. In incontinence of urine from de- \nbility of the urinary organs it has been thought to be of benefit. \nBleeding from the nose, the rectum, and other accessible parts \nmay be stopped by locally applying the drug in powder or in \ninfusion. The infusion (B. P., I to 20), as a gargle, and the \ntroches are very efficient in relaxed conditions of the throat. \nThe B. P. has a troche containing .06 gm. (1 gr.) of the \nextract and .003 gm. (^ gr.) of cocaine hydrochloride, with \na fruit basis. Locally krameria is used with good effect \nin dysentery (by injection), and has enjoyed considerable repu- \ntation as a remedy for fissure of the anus. In the latter con- \n\n\n\n\n\n\nkino. 395 \n\ndition it is believed, by constringing its walls, to prevent the \nformation in the rectum of large faecal masses, which would \ntend to stretch the fissure and render defecation more painful, \nand also to promote the healing of the lesion by diminishing the \nsupply of blood to the part. In order to keep the bowels from \nbecoming confined it is recommended that powdered belladonna \nroot, in doses of .06 gm. (1 gr.), or less, be given at night. In \nfissured nipples a mixture of the extract with white of egg \nmay be employed. In non-syphilitic ozsena an infusion of \nkrameria, especially in association with chlorinated soda or cal- \ncium chloride, is sometimes of service as a nasal douche. Other \nconditions in which the drug may be used locally with advan- \ntage are sponginess of the gums, leucorrhcea, gonorrhoea and \ngleet. \n\nKINO. \n\nKINO.\xe2\x80\x94 Kino. Dose, 0.500 gm. (500 milligm.) ; 7V 2 gr. \n\nPreparation. \nTinctura Kino. \xe2\x80\x94 Tincture of Kino. Dose, 4 c.c; 1 fl. dr. \n\nAction of Kino. \nKino is another powerful astringent. Kinotannic acid has the \nsame effects as tannic acid, and the action of the drug is almost \nidentical with that of gambir. \n\nTherapeutics of Kino. \nThe compound powder (B. P., kino, 75; opium, 5; cinnamon, \n20) is used especially for gastro-intestinal disorders attended \nwith diarrhoea. In diarrhoea kino, gambir, krameria and others \nof the vegetable astringents act more efficiently than pure tannic \nacid, for the reason, as has been stated, that the latter is apt \nto form compounds with the albumins and exerts its astringent \ninfluence on a smaller portion of the intestinal tract. The \ntincture of kino is considered one of the most efficient means \nof combating the atonic diarrhoea resulting from the disuse of \nopium or morphine. Owing to the tendency of its gummy \n\n\n\n396 PHARMACOLOGY AND THERAPEUTICS. \n\nmatter to coagulate, it is less eligible than gambir for use \nin connection with chalk mixture. It is often serviceable \nin relieving pyrosis. Locally kino has not, as a rule, been \nfound as efficient as a haemostatic as tannic acid, but the in- \nfusion often acts promptly in checking epistaxis. The tincture \nis sometimes applied as a stimulant dressing to indolent ulcers, \nand is also employed in astringent gargles and in mixtures for \ninjection in gonorrhoea. \n\nLOGWOOD. \nILffiMATOXYLON.\xe2\x80\x94 Haematoxylon. (Logwood.) \n\nPreparation. \nExtractum Haematoxyli. \xe2\x80\x94 Extract of Haematoxylon. Dose, \n1 gm.; 15 gr. \n\nAction of Logwood. \nHaematoxylon is astringent and tonic. When chewed it \ncolors the saliva a deep pink. It is unirritating, and does not \ncause constipation. It colors the urine and stools red, and also \nstains linen with which it comes in contact. It has been known, \nit is said, to give rise to phlebitis, and in very large doses is \ncapable of producing fatal gastro-enteritis in animals. It is \nvery feebly antiseptic. \n\nTherapeutics of Logwood. \nIn the treatment of diarrhoea it may be combined with other \nastringents, with chalk, and with opium to check peristalsis. \nOn account of its being pleasant to take and devoid of irritating \nqualities, it was formerly employed to a considerable extent in \nchildren\'s diarrhoeas; but its liability to stain the clothing ren- \ndered it objectionable, and of late it has been but little used, \nespecially since the general adoption of dietetic and antiseptic \nmethods in these affections. It is considered of decided value, \nhowever, in tuberculous diarrhoea and diarrhoeas of relaxation. \nThe following formula, the proportions of which may be varied \nto suit individual cases, will often be found efficient, as well \n\n\n\nWITCHHAZEL. 397 \n\nas agreeable to the patient: Extract of haematoxylon, 8 gm. \n(2 dr.) ; aromatic sulphuric acid, 12 c.c. (3 fl. dr.) ; paregoric, \n45 c.c. (i l / 2 fl. oz.) ; syrup of ginger, up to 120 c.c. (6 fl. oz.). \nDose, a teaspoonful, properly diluted. Externally, logwood is \nsaid to display some antiseptic and healing qualities in the treat- \nment of gangrenous and ill-conditioned sores, and a decoction \nmade from it may be used as an astringent in leucorrhcea and \nbleeding piles. \n\nWITCHHAZEL. \n\nHAMAMELIDIS CORTEX.\xe2\x80\x94 Hamamelis Bark. Dose, 2 gm.; 30 \ngr. \n\nHAMAMELIDIS FOLIA (Hamamelis, U. S. P., 1890).\xe2\x80\x94 Hamamelis \nLeaves. Dose, 2 gm.; 30 gr. \n\nPreparations. \n\n1. Fluidextractum Hamamelidis Foliorum. \xe2\x80\x94 Fluidextract of \nHamamelis Leaves. Dose, 2 C.C.; 30 TIT,. \n\n2. Aqua Hamamelidis. \xe2\x80\x94 Hamamelis Water. Dose, 8 c.c; 2 \nfl. dr. \n\nAction of Witchhazel. \nHamamelis, containing as it does, a considerable proportion \nof tannic acid, is astringent and haemostatic. Although extrava- \ngant claims as to the powers of this drug have been made from \ntime to time, no experimentation has shown that it has any \nphysiological action beyond that which might be expected from \nan agent rich in tannin. That it has a special influence over \nthe venous circulation, analogous to that of aconite on the \narterial system, as believed by some, has never been proved. \nIn full doses it is said to sometimes produce severe throbbing \npain in the head. \n\nTherapeutics of Witchhazel. \nWitchhazel is used internally to a very limited extent, not- \nwithstanding the fact that certain authorities claim that its \ncombined internal and external administration is of great effi- \nciency in a variety of conditions, such as haemorrhoids (par- \n\n\n\n398 PHARMACOLOGY AND THERAPEUTICS. \n\nticularly of the bleeding variety), varicose veins and ulcers, \nvaricocele, venous congestions, threatening local inflammations, \nleucorrhoea, and subacute gonorrhoea. Internally, they would \nhave us believe, it is of great service in haemorrhages from the \nnose, stomach, lungs, rectum, uterus and kidneys, in purpura \nhemorrhagica, in diarrhoea, enteritis and dysentery, in pyelitis \nand cystitis, in chronic bronchitis attended by copious dis- \ncharge and the night-sweats of phthisis, in phlegmasia dolens, \nand in dysmenorrhoea and threatened abortion. When so much \nis claimed for a remedy one cannot but feel somewhat skeptical \nas to its real efficacy, and the mass of the medical profession \nis by no means as yet convinced that it is such a panacea. Ex- \nternally, hamamelis is believed to have a sedative as well as \nastringent action upon congested or inflamed tissues, and an \nextract distilled from the fresh leaves (hazeline), especially, \nconstitutes a useful and agreeable application in a considerable \nvariety of conditions. Thus, it is used for sprains, bruises, and \nsuperficial inflammations, and, diluted, in inflammations of the \ngums, pharyngitis and nasal catarrh. Hamamelis is also em- \nployed locally in the form of the fluidextract of the leaves \nand as an ointment (B. P., 1 to 10, made from the fluid- \nextract). The former, diluted, may be injected into the bladder \nin cases of catarrhal inflammation or haemorrhage, and is com- \nmonly efficient in the treatment of capillary haemorrhage from \nwounds, epistaxis, spongy gums, bleeding sockets after the ex- \ntraction of teeth, and bleeding piles. It is also used as a lotion \nfor freckles, hyperidrosis, carbuncle and lupus erythematosus, \nand to relieve the pain and stiffness of chronic rheumatism. \nThe ointment is recommended in burns, erysipelas, eczema, \nherpes, seborrhoea, acne and rosacea, intertrigo and sunburn, \nas well as in ulcers of the anus or rectum and fissures of the \nanus. A preparation of witchhazel in popular use is known \nas Pond\'s extract. It is said to be made by distilling the bark \nwith very weak alcohol (6 per cent.), and no doubt owes its \ngreat pecuniary success more to the extensive manner in which \nit has been advertised and to the credulity of the public than \n\n\n\nGERANIUM. 399 \n\nto any pronounced virtue that the remedy possesses. The new \nofficial Aqua Hamamelidis, made from hamamelis bark, ioo; \nwater, 200; alcohol, 15, may be used for the same purposes as \nthe fluidextract of the leaves. Taken altogether, hamamelis \nhas not as yet been proved of such marked therapeutical value \nthat its loss from the Pharmacopoeia would be very seriously \nmissed. \n\nRHUS GLABRA. \n\nRHUS GLABRA.\xe2\x80\x94 Rhus Glabra. (Sumach.) Dose, 1 gin.; 15 gr. \n\nPreparation. \nFluidextractum Rhois Glabrae. \xe2\x80\x94 Fluidextract of Rhus Glabra. \nDose, 1 c.c; 15 in.. \n\nAction of Rhus Glabra. \nSumach fruit is astringent and refrigerant. \n\nTherapeutics of Rhus Glabra. \n\nThe fluidextract, when diluted, affords a simple and quite \neffective gargle for inflammation and ulceration of the throat. \nIt is also of service in the treatment of aphthae and other forms \nof stomatitis, including that produced by mercury. The glandu- \nlar excrescences on the leaves are powerfully astringent, and a \ndecoction made from the leaves or the inner bark of the root \nmay be used for the same purposes, as well as for a wash and \ndressing for wounds and ulcers. An infusion of the strength \nof 30 gm. (1 oz.) to 500 c.c. (1 pint) is also sometimes em- \nployed. Internally these preparations may occasionally be \nfound of service in mild catarrhal affections of the stomach \nand bowels. \n\nGERANIUM. \n\nGERANIUM.\xe2\x80\x94 Geranium. (Cranesbill.) Dose, 1 gm.; 15 gr. \n\nPreparation. \nFluidextractum Geranii.\xe2\x80\x94 Fluidextract of Geranium. Dose, \n1 c.c; 15 m.. \n\n\n\n400 PHARMACOLOGY AND THERAPEUTICS. \n\nUnofficial Preparation. \nDecoctum Geranii. \xe2\x80\x94 Decoction of Geranium. Dose, 30 to 60 \nc.c; 1 to 2 fl. oz. \n\nAction of Geranium. \nGeranium is one of the best indigenous astringents, and, on \naccount of the absence of unpleasant taste and irritating quali- \nties, it is well adapted for use in the case of children and per- \nsons with very delicate stomachs. It has some tonic action, \nimproving the appetite and digestion, and promoting nutrition. \n\nTherapeutics of Geranium. \nIt is very useful in diarrhoea and dysentery, and also in \nthe various haemorrhages. It is sometimes given to children \nboiled in milk. Among its other uses are the following: As \nan application to indolent ulcers, as an injection in gonorrhoea, \ngleet, leucorrhcea, fissure of the anus, etc., and as a gargle in \nrelaxed or ulcerated conditions of the throat. In catarrhal \ninflammations the decoction is not infrequently more serviceable \nthan a simple solution of tannic acid, which is thought to be \nprobably due to the fact that there is present mucilaginous \nmaterial, which acts as a demulcent. \n\nBLACKBERRY. \n\nRUBUS.\xe2\x80\x94 Rubus. (Blackberry.) Dose, 1 gm.; 15 gr. \n\nPreparations. \n\n1. Fluidextractum Rubi. \xe2\x80\x94 Fluidextract of Rubus. Dose, 1 \nc.c; 15 TTL. \n\n2. Syrupus Rubi. \xe2\x80\x94 Syrup of Rubus. Dose, 4 c.c; 1 fl. dr. \n\nAction of Blackberry. \nThe preparations made from blackberry root are tonic and \n.slightly astringent. \n\nTherapeutics of Blackberry. \nThese preparations are used for diarrhoea; blackberry brandy \nis a common domestic remedy. The most efficient one, how- \n\n\n\nRED GUM. 4OI \n\never, is the flmdextract. The fruit, either raw, cooked or pre- \nserved, has no astringent quality, and is only likely to prove \ninjurious, since the hard seeds serve to increase the intestinal \nirritation. \n\nRUMEX. \nRUMEX.\xe2\x80\x94 Rumex (U. S. P., 1890; no longer official). (Yellow \nDock.) Dose, 1 to 4 gm.; 15 to 60 gr. \n\nUnofficial Preparations. \n\n1. Extractum Rumicis Fluidum (U. S. P., 1890). \xe2\x80\x94 Fluidex- \ntract of Rumex. Dose, 1 to 4 c.c; y 4 to 1 fl. dr. \n\n2. Decoctum Rumicis. \xe2\x80\x94 Decoction of Rumex. Dose, 60 c.c; \n2 fl. oz. \n\nAction of Rumex. \n\nRumex is astringent, slightly tonic and alterative. The roots \nof some species unite a laxative with the tonic and astringent \nproperty, and their action has been compared to that of rhubarb. \nTaken very largely, the leaves are said to have produced poi- \nsonous effects. \n\nTherapeutics of Rumex. \n\nIt has been used in syphilis, scorbutic disorders, and cuta- \nneous eruptions. Some species of rumex, given in hot decoc- \ntion, have been thought efficient in intermittent fevers, and \nothers in chronic congestion of the liver with a gouty tendency. \nIt is said to possess a selective action on the mucous membrane \nof the larynx and to afford relief in many cases of laryngeal \nirritation with catarrhal symptoms. The fresh leaf when \nbruised is a popular antidote to the eruption caused by the \nstinging nettle, and the decoction is sometimes applied externally \nin glandular swellings and various skin diseases. \n\nRED GUM. \n\nEUCALYPTI GUMML\xe2\x80\x94 Eucalyptus Gum (B. P., not official). \n(Red Gum.) Dose, .12 to .60 gm.; 2 to 10 gr. \n\nAction of Red Gum. \nRed gum is a useful astringent and has the advantage over \n27 \n\n\n\n402 PHARMACOLOGY AND THERAPEUTICS. \n\nsome others of its class that its effects upon mucous mem- \nbranes are peculiarly permanent. It closely resembles kino, but \ndoes not equal that drug in astringency. \n\nTherapeutics of Red Gum. \nIt is employed in the same kinds of cases as kino and other \nvegetable astringents. One of its chief uses is, in the form of \nlozenges, in relaxed and other conditions of the throat requiring \nan astringent. These lozenges usually contain .06 gm. (1 gr.), \nand are made with fruit paste. Internally it is given in \ndecoction (1 to 40) and fluidextract (red gum, 7; water, 21; \nalcohol, 1) ; the dose of the one for diarrhoea being 8 to 15 c.c. \n(2 to 4 fl. dr.), and of the other, 2 to 4 c.c. { l / 2 to 1 fl. dr.). \nThe decoction is frequently employed as a gargle, and the \nfluidextract is much esteemed as a basis for gargles. Injected \ninto the nose the latter is often efficient in arresting epistaxis, \nand in the strength of 1 to 10 it may be injected into the rec- \ntum or vagina, or used as a mouth-wash. The fluidextract, \nunlike that of sumach, remains clear after being diluted with \nwater. A suppository containing 30 gm. (5 gr.) is sometimes \nof service in haemorrhoids. \n\nCOTO. \n\nUnofficial Preparations. \nCoto.\xe2\x80\x94 Coto Bark. Dose, .06 to .60 gm.; 1 to 10 gr. \nCotoinum. \xe2\x80\x94 Cotoin. Dose, .06 to .12 gm.; 1 to 2 gr. \nParacotoinum. \xe2\x80\x94 Paracotoin. Dose, .12 to .30 gm.; 2 to 5 gr. \n\nAction of Coto. \nCoto is not astringent, but, on account of the character of \nits therapeutic effects, may be given a place with this class of \nmedicinal agents. It is irritant to the skin and to mucous mem- \nbranes. The powder, rubbed on the integument, is said to pro- \nduce heat and redness, and in doses of 1 gm. (15 gr.) it has \ncaused persistent burning pain in the stomach, followed by re- \npeated vomiting. In doses of .06 gm. (1 gr.) it is found to in- \n\n\n\nLEAD SALTS. 403 \n\ncrease the appetite and also to have a somewhat constipating \neffect. Cotoin appears to pass through the stomach unchanged, \nand is absorbed in the small intestine. It has been classed \namong antiseptics, but while it may have the power of retarding \nputrefaction outside the body, it has been demonstrated that it \nhas no antiseptic action in the alimentary canal. When in- \njected intravenously or perfused through the mesenteric blood- \nvessels in animals, it has the effect of causing marked dilata- \ntion of the intestinal vessels. This appears to be its principal \nphysiological action, and to the improved nutrition and in- \ncreased absorptive power which by this means it produces it is \nbelieved that the beneficial effects of the drug in intestinal dis- \neases are to be attributed. After its internal administration it \nhas been noted that the urine assumes a dark-red color on the \naddition of nitric acid. \n\nTherapeutics of Coto. \nBecause coto produces absorption, coto bark and cotoin have \nestablished a reputation as remedies for diarrhcea, whether in- \nfantile, in phthisis or in typhoid fever. It also checks salivation \nand night-sweats. It is especially recommended for children \nsuffering from marasmus with intestinal troubles. Asiatic \ncholera has been successfully treated by the subcutaneous in- \njection of paracotoin in .20 gm. (3 gr.) doses, although this \nsubstance, which is a constituent of the paracoto bark, is much \nweaker than cotoin. It seems probable that whenever there is \na tendency to acute inflammation of the gastro-intestinal tract \nthis remedy should be used with considerable caution. A 10 \nper cent, tincture of coto has been recommended by the British \nPharmaceutical Conference; dose, .60 c.c. (10 "HI); every 2 \nhours, with mucilage or syrup to suspend the large amount of \nresin which it contains. It should not be combined with Mistura \nCretse. \n\nLEAD SALTS. \n\n1. PLUMBI OXIDUM.\xe2\x80\x94 Lead Oxide. (Litharge.) \n\n\n\n404 PHARMACOLOGY AND THERAPEUTICS. \n\nPreparations. \n\n1. Emplastrum Plumbi. \xe2\x80\x94 Lead Plaster. \n\n2. Emplastrum Adhaesivum. \xe2\x80\x94 Adhesive Plaster. \n\n3. Unguentum Diachylon. \xe2\x80\x94 Diachylon Ointment. \n\n2. PLUMBI ACETAS.\xe2\x80\x94 Lead Acetate. (Sugar of Lead.) Dose, \n0.065 gm. (65 milligm.) ; 1 gr. \n\nPreparations. \n\n1. Liquor Plumbi Subacetatis. \xe2\x80\x94 Solution of Lead Subacetate. \n(Goulard\'s Extract.) \n\n2. Liquor Plumbi Subacetatis Dilutus. \xe2\x80\x94 Diluted solution of \nLead Subacetate. (Lead Water.) \n\n3. Ceratum Plumbi Subacetatis. \xe2\x80\x94 Cerate of Lead Subace- \ntate. (Goulard\'s Cerate.) \n\n3. PLUMBI NITRAS.\xe2\x80\x94 Lead Nitrate. \n\n4. PLUMBI IODIDUM.\xe2\x80\x94 Lead Iodide. \n\nUnofficial Preparations of Lead. \nPlumbi Carbonas. \xe2\x80\x94 Lead Carbonate (U. S. P., 1890). \n\nUnguentum Plumbi Carbonatis. \xe2\x80\x94 Ointment of Lead Carbon- \nate (U. S. P., 1890). \n\nUnguentum Plumbi Iodidi. \xe2\x80\x94 Ointment of Lead Iodide (U. S. \nP., 1890). \n\nAction of Lead Salts. \nExternal. \xe2\x80\x94 Upon the unbroken skin the salts of lead have \nlittle or no action, though the integument is discolored by the \nuse of some of them. Upon denuded surfaces they have a \ndecided astringent effect, causing the contraction of the small \nblood-vessels, and in the case of sores and ulcers coagulating \nthe albumin of the discharge and the protoplasm of the neigh- \nboring superficial cells; in consequence of which a protective \ncoating is formed for the healthier structure beneath. In addi- \ntion, by reason of the local depletion resulting from vasocon- \nstriction and also, it is thought, because of a depressant effect \nupon the sensory nerve-endings, they have a marked sedative \n\n\n\nLEAD SALTS. 405 \n\naction. Any of these salts, if sufficiently concentrated and \napplied in sufficient amount, may be irritant and to a certain \nextent corrosive. \n\nInternal. Alimentary Canal. \xe2\x80\x94 From the mouth downward \nthe lead salts have the same powerfully astringent effect upon \nthe mucous membrane of the alimentary tract as upon the \nabraded skin. While they may occasion sufficient corrosion to \nbe absorbed, this absorption never appears to be of sufficient \nextent to produce acute fatal poisoning from systemic effects. \nAlmost the only result caused by ordinary doses is constipation. \nWhen given in large amounts they act as gastro-intestinal irri- \ntants, causing salivation, thirst, difficult of swallowing, abdomi- \nnal pain, vomiting and diarrhoea. There is a burning, sweet- \nish taste in the mouth, and the vomited matter consists of \nwhitish fluid containing curdy material, the color being due \nto the formation of lead chloride from a combination of \nthe excessive lead with the hydrochloric acid of the gas- \ntric juice. In consequence of the astringent action of lead \nsalts, the purging is not as marked as in the case of most \nirritant poisons, and sometimes there is constipation. If the \nbowels are moved, the passages are likely to be of a blackish \nhue from the presence of lead sulphide, and both the stools and \nthe matters vomited may contain blood. \n\nAbsorption and Excretion. \xe2\x80\x94 In whatever form or whatever \ndoses lead is given, a small quantity is promptly absorbed, and \nwhile this may be incapable of producing any immediate symp- \ntoms, its excretion is very slow, and consequently cumulative \naction is liable to result. Lead has been shown to be always \nabsorbed in the form of soluble proteid combinations, and these \nmay be formed from lead compounds which are perfectly in- \nsoluble in water or acids. Even lead sulphate, one of the most \ninsoluble of substances, will be absorbed in sufficient amount to \nproduce poisoning, and hence, as previously mentioned (see \nP- 337) \xc2\xbb sulphuric acid is of comparatively little value as a \nprophylactic in those exposed by their work to the action of \nlead. Lead is excreted in the secretion of the intestinal epi- \n\n\n\n406 PHARMACOLOGY AND THERAPEUTICS. \n\nthelium, the urine, bile, saliva and milk, and probably by the \nglands of the skin. Chronic lead-poisoning may sometimes be \ndetected, it is said, by painting the integument with ammonium \nsulphide, which under these circumstances stains it black from \nthe formation of lead sulphide. In the form of the sulphide \nthe lead is sometimes deposited on the edge of the gums, giving \nthe characteristic " lead line," which is also known as Burton\'s \nline. This is due to the presence of hydrogen sulphide produced \nby the action of bacteria, and is not often met with where the \nteeth are sound and kept clean. In the kidneys lead causes \ndecided irritation during the process of excretion ; so that \nnephritis is found to be a frequent result of acute poisoning and \nan invariable one of chronic poisoning. A remarkable circum- \nstance in connection with lead-poisoning is the frequency of \ngout in its subjects. It is asserted by those who have had the \nlargest experience with this disease that in one-fourth of the \ncases there is a history of saturnism; so that it would appear \nthat the latter predisposes to gout, if it does not actually cause \nit. In districts where ordinary gout is rare, however, it is \nsaid that lead-poisoning seldom leads to it. The nephritis of \nchronic poisoning is sometimes, no doubt, in part secondary to \nthis disease. It may also be in part secondary to the arterio- \nsclerosis resulting from fatty degeneration of the blood-vessels \ninduced by the lead. Fatty degenerations are likewise found \nin the kidneys, liver, and other organs. The lead which is re- \ntained in the body is stored in the liver, kidneys, brain, bones \nand muscles, but chiefly in the liver. Only traces of it are \nfound in the blood. \n\nBlood. \xe2\x80\x94 In chronic lead-poisoning there is always anaemia, \nwhich is due at first to the constriction of the peripheral vessels \nand subsequently to diminution of haemoglobin and the number \nof red corpuscles. The white corpuscles are generally, though \nnot invariably, increased. Not infrequently jaundice results \nfrom the breaking up of red corpuscles and the liberation of \nlarge amounts of haemoglobin. \n\nNervous System and Muscles. \xe2\x80\x94 In what is known as en- \n\n\n\nLEAD SALTS. 4O7 \n\ncephalopathia saturnalis the disorders met with are for the most \npart of cerebral origin, although the lower divisions of the \ncentral nervous system are sometimes also involved. Upon the \ncortex, which is chiefly affected, there is produced an irritation, \nfollowed by paralysis, and the effects are both sensory and \nmotor, the latter being the more pronounced. There are usually \nmuscular contractures and then choreic movements. In some \ninstances convulsions occur, and these are sometimes due to \nuraemia resulting from the nephritis, and sometimes to the lead \nitself. Later, paralysis succeeds the motor stimulation. In ad- \ndition, there is delirium, followed by depression and finally by \ncoma, and the latter may also be uremic. In autopsies of some \nof the patients dying from lead-poisoning atrophy of parts of \nthe cerebrum or haemorrhages, as well as disease of the blood- \nvessels, has been observed. In prolonged cases of lead-poison- \ning degenerative changes may occur in the anterior columns of \nthe spinal cord. On the motor system the effects produced are \nneuritis, paralysis and atrophy. Their usual seat is no doubt \nin the peripheral nerves and muscle cells, though the central \nnervous system would appear to be involved in some instances. \nIn chronic poisoning in animals there is early muscular fatigue, \nwhich is followed by paralysis, and later by total atrophy. The \nheart is liable to be similarly affected, and even quite early \nin the poisoning; especially if the lead-salt is injected directly \ninto the blood. The effect upon the motor peripheral nerves \nis believed to be very much like the direct muscular action. A \ncommon characteristic of lead-poisoning is the " drop wrist " \nor " painter\'s palsy," and this is probably attributable in part \nto paralysis of the extensor muscles and partly to the active \ncontracture of the opposing flexor muscles. The most promi- \nnent of the peripheral effects is lead colic, a phenomenon which \nis due to violent contraction of the intestinal muscles, probably \nfrom stimulation of the nerve endings. As it is largely relieved \nby nitrites and other agents which dilate the blood-vessels, it \nis inferred that a primary vaso-constriction is one of its causes. \nAs the spasm of the intestine forces the blood out of the \n\n\n\n408 PHARMACOLOGY AND THERAPEUTICS. \n\nsplanchnic area, the general blood-pressure is raised and the \npulse is slowed and rendered hard and tense. The pain, which \nis intense and grinding in character, . is located principally in \nthe umbilical region, and the abdomen is retracted and hard. \nParoxysms of the most acute agony are followed by intervals \nof comparative ease. The colic lasts for several days, or a \nweek, and then disappears, but is apt to recur at intervals. \nOther affections, apparently, of the peripheral nerves are \nanaesthesia of various parts, lasting perhaps one or two weeks, \nand lead arthralgia, which consists of sharp lancinating or \nboring pains in the joints, bones, or the flexor muscles around \nthe joints, and which generally appears and disappears quite \nsuddenly. Neuralgias are occasionally observed, and these are \nprobably sometimes due to peripheral neuritis and sometimes \nof central origin. One of the rarer phenomena of lead-poison- \ning is amblyopia, in which the sight may be lost entirely or only \nrendered somewhat dim. This may be due to optic neuritis \n(which, unless arrested early, leads to atrophy of the nerve), \nto uraemia with an effusion into the optic sheath, or to albumi- \nnuric retinitis. \n\nUterus. \xe2\x80\x94 Lead is very fatal to the life of the foetus, and under \nits influence abortion is liable to occur, or the child be still- \nborn. It has been suggested that this result is probably due, \nin part at least, to the poor quality and diminished quantity of \nthe blood supply. \n\nTherapeutics of Lead Salts. \nExternal. \xe2\x80\x94 Lead salts, in the form of lotions and ointments, \nare used, for both their sedative and astringent action, in a \ngreat variety of acute local inflammations. A very serviceable \npreparation is the glycerin of the subacetate of the B. P. (lead \nacetate, 10; lead oxide, 7; glycerin, 40; water, 24; boiled \ntogether), which should ordinarily be diluted fourfold with \nglycerin or milk. The Liquor Plumbi Subacetatis is sometimes \nsuccessful in aborting a felon. For most other purposes it is \napt to be too irritating, but the diluted solution, as well as the \n\n\n\nLEAD SALTS. 4O9 \n\ncerate of lead subacetate (which should also usually be diluted), \nmay be applied with advantage to contusions, acute eczema, \nerysipelas, and inflammations of various kinds. The solution \nmay also be employed to allay itching in such affections as \nurticaria, paresthesia, etc. A lotion of lead and opium has \nlong been a favorite application for relieving pain and inflam- \nmation. It may be prepared by mixing 30 gm. (5 gr.) of ex- \ntract of opium with 30 c.c. (1 fl. oz.) each of lead water and \nwater, or may be made as follows: Solution of lead acetate, 15; \ntincture of opium, 30; distilled water, 120. Lead lotions, to \nwhich zinc sulphate is often added, are used for injections in \ngonorrhoea, gleet, vulvitis, leucorrhcea and otorrhcea. They \nwere formerly also employed in conjunctivitis, but have been \nabandoned as applications for the eye; for if ulceration of the \ncornea be present, the white precipitate formed is liable to \nlead to permanent opacity. Y\\ "hite-lead paint is a good applica- \ntion for burns and scalds where the skin is unbroken, and lead \ncarbonate, mixed wtih olive oil and with the addition of a \nfew drops of creosote, is recommended for erysipelas, burns, \nand for bruises, especially when the surface has a blue or dark \ndiscoloration. The following is an efficacious dusting-powder in \nacute eczema, herpes and seborrhcea: Lead carbonate, 8 gm. \n(2 dr.) ; zinc carbonate, 15 gm. (y 2 oz.) ; oil of eucalyptus, \n.30 c.c. (5 Tr L). Diachylon ointment mixed with an equal quan- \ntity of zinc oleate ointment and mercuric oleate ointment forms \na transparent ointment, which will be found of service in a \nconsiderable number of conditions. Diachylon ointment is use- \nful in seborrhcea, hyperidrosis, eczema, dermatitis, herpes zoster, \nand sycosis. Hebra*s diachylon ointment is made by melting \nequal, parts, by weight, of lead plaster and flaxseed oil, to \nwhich a proportion of balsam of Peru and a little oil of laven- \nder are sometimes added. Even in chronic diseases of the skin \nlead salts are often of service on account of their soothing and \nastringent effects. Lead plaster is excellent for preventing bed- \nsores and as a basis for other plasters, and is used by surgeons \nto protect parts of the body exposed to chafing by splints or \n\n\n\n410 PHARMACOLOGY AND THERAPEUTICS. \n\nother apparatus. Lead iodide ointment is a useful resolvent for \nglandular swellings, scrofulous tumors, goitre, chronic synovitis, \netc., and, applied with steady friction, is said to be especially \nserviceable in acute mastitis with threatened suppuration. It \nmay also be applied in acne and other cutaneous affections. A \ntwo per cent, solution of lead nitrate in glycerin is a very effi- \ncient application for fissured nipple, care being always taken \nto thoroughly remove all traces of it before the child is allowed \nto nurse. The nitrate, in very dilute solution, may be used \nalso as a wash in leucorrhcea and to correct the fetid odor \nof discharges from ulcers, etc. Lead acetate, on account of its \nastringent action, is occasionally employed for mouth-washes \nand gargles, but other agents are ordinarily preferred for those \npurposes. In haemorrhoids, when there is much pain and a \nsense of burning heat at the anus, the addition of lead water \nto the ointments frequently used in these cases often affords \nmarked relief. \n\nInternal. \xe2\x80\x94 Lead iodide, it is said, has been given in order to \nreduce enlargement of the spleen due to malaria. Practically, \nhowever, the only lead salt which is used for internal adminis- \ntration is the acetate, which is highly prized for its astringent \nand haemostatic effects. It has been largely employed for the \npurpose of arresting haemorrhage from the lungs, but is more \nespecially adapted to the haematemesis accompanying gastric \nulcer. In this affection it is also a very useful remedy in other \nways; not only relieving pain, but modifying the ulcerated sur- \nface and checking inflammatory action as well. It is likewise of \nservice in chronic catarrh of the stomach, with gastralgia and \npyrosis. Theoretically it is incompatible with preparations of \nopium, but notwithstanding this, it is very often advantageously \ncombined with them in painful affections of the stomach, as well \nas in various forms of diarrhoea. It is in the latter that lead ace- \ntate is most frequently used, and it is also relied upon for con- \ntrolling intestinal haemorrhage, such as is liable to be met with \nin typhoid fever and tuberculosis. For these purposes a very \nsatisfactory preparation is found in the Pilula Plumbi cum Opio \n\n\n\nLEAD SALTS. 4 I I \n\nof the B. P. (lead acetate, .20 gm. (3 gr.) ; opium, .06 gm. \n(1 gr.)). In choleraic diarrhoea, powders consisting of lead \nacetate, opium and camphor may be employed, or a mixture in \nwhich the acetate is associated with acetic acid and the tincture \nof deodorized opium. For the diarrhoea of typhoid, bismuth \nis usually preferable to lead acetate and opium. In rectal \nhaemorrhage from various causes and in both acute and chronic \ndysentery the last-named remedies are of great service when \nemployed locally, either by suppositories or enemata, and the \nfollowing enema will be found useful in relieving the tenesmus \nof acute dysentery: lead acetate, .24 gm. (4 gr.) ; morphine \nacetate, .03 gm. ( J / 2 gr.) ; hot water, .30 c.c. (1 fl. oz.). Al- \nthough now prescribed comparatively rarely in haemoptysis, \nlead acetate seems in some cases to act quite efficiently, and in \nthis condition, as well as in caseous pneumonia, it has some- \ntimes been combined with digitalis and opium. Formerly the \nacetate was given in hypertrophy of the heart under the sup- \nposition that it retarded the action of that organ, and also in \ninternal aneurism. It is of some value in checking the night- \nsweats of pulmonary tuberculosis, and diminishes the copious \nsecretion sometimes accompanying chronic bronchitis. It is \nopen to the objection, however, of causing constipation. \n\nIf lead acetate is administered for any length of time there \nis more or less risk of plumbism being induced, and some per- \nsons are peculiarly susceptible to the poisonous action of the \ndrug. Its effects should therefore always be watched with \ncare. Even the external application of lead solutions or oint- \nments have occasionally been attended by colic and other un- \ntoward symptoms. \n\nTOXICOLOGY. \n\nAcute Lead Poisoning. \xe2\x80\x94 The acetate is most frequently taken, and \na very large quantity of it is required to produce a fatal effect. Owing \nto the fact that so much of the drug is generally vomited, cases \nof acute poisoning rarely terminate fatally. The gastro-intestinal symp- \ntoms have already been described. They are followed by great weak- \nness, coldness of the surface, and collapse. In some cases in which \n\n\n\n412 PHARMACOLOGY AND THERAPEUTICS. \n\nrecovery took place the patients have been known to suffer from \nchronic lead poisoning, but it has been pointed out that apart from \nthese nothing in the course of the acute poisoning suggests the absorp- \ntion of lead ; all the symptoms being obviously due to the local effects \non the alimentary tract, and to the subsequent collapse. Post-mortem. \n\xe2\x80\x94 In the stomach and intestine such signs of irritant poisoning as red- \nness, excoriation and softening are found. \n\nTreatment. \xe2\x80\x94 The stomach should be washed out or emetics {see p. \nJ75) given. The precipitation of the lead should then be attempted \nby the administration of sodium or magnesium sulphate, or, if such \nsulphates are not procurable, by white of egg or milk, forming an insol- \nuble albuminate. If collapse is present, it should be combated by the \nadministration of stimulants, by hypodermatic injection or by the mouth, \nand the external application of warmth. \n\nChronic Lead Poisoning. \xe2\x80\x94 This is so common that the sources of \naccidental poisoning should be borne in mind. The most important \nare : soft water, carbonated waters and alcoholic drinks (beer) which \nhave passed through lead pipes or been stored in receptacles lined with \nlead. The occupations of painters (colica pictonum), plumbers, type- \nsetters, gold miners, white lead workers, potters, glaziers (Devonshire \ncolic), because the men will not wash their hands before meals nor use \nordinary care ; lead hair dyes and face powders, biting leaded white \nthread, eating certain canned fruits (lead solder), sheet-lead (tin-foil) \nabout tobacco, filling holes in mill stones with lead, playing with tin (lead) \nsoldiers by children, use of lead carbonate ointment on burns, lead bullets \nin flesh, white or red lead used for preparing rubber for vulcanizing, lead \nplates in dentistry, the use of lead chromate to color buns yellowish, \nhave all been followed by chronic plumbism. Most of the symptoms \nand effects have been mentioned. Not only the extensors of the hand, \nbut any muscle may be paralyzed (sometimes almost all the muscles \nof the body seem to be affected), and it is a clinical observation that \nsuch muscles are very refractory to electricity. The supinator longus, \nhowever, usually escapes, the reason for this apparently being that the \nsupinator is not an extensor muscle. Lead is regarded as perhaps the \nbest example of a poison which is comparatively free from danger in \na single dose, however large, but which becomes fatal in the most min- \nute doses, if these are taken for a sufficiently long time. \n\nTreatment. \xe2\x80\x94 The first thing to be done is the removal of the patient \nfrom the danger of further poisoning. In the general treatment reli- \nance is placed upon potassium iodide, saline purgatives, diuretics, and \nthe use of hot baths and massage to promote elimination, and the im- \n\n\n\nLEAD SALTS. 413 \n\nprovement, by appropriate measures, of the patient\'s nutrition and \nstrength. Potassium iodide is universally employed, and appears to \nhave a remedial effect, though the manner of its action is not clearly \nunderstood. It has generally been supposed to accelerate the elimina- \ntion of the poison by the kidneys, but recently it has been denied that \nit has any influence on the excretion either by the urine or by the intes- \ntine, by which most of the lead escapes from the body. Baths of sul- \nphurated potassa are quite efficient, especially if the patient is after- \nwards well soaped, then thoroughly rinsed off, and finally rubbed down \nwith a rough towel. For the various effects of lead in the system spe- \ncial treatment is required. For the colic, opium or morphine is often \nnecessary, alum, in .12 gm. (2 gr.) doses, is of great service, and sul- \nphuric acid is also useful {see p. 337). In a considerable number of cases \nof chronic lead poisoning it is found that cathartics fail to act unless \nmorphine is given to overcome the intestinal inhibition produced by the \nirritation resulting from the lead. Opiates may also be required for \nthe relief of the arthralgia. For the paralysis strychnine may be used, \nbut the main reliance is to be placed on electrical stimulation and \nmassage. If the muscles contract in response to the faradic current, \nthis should be employed, but if they do not, the galvanic current. Ne- \nphritis and gout due to plumbism should be treated in the same way as \nif resulting from other causes, while the cerebral symptoms must be \ndealt with according to the special manifestations present. \n\nThe following method may be employed to determine the presence \nof lead in the urine : Administer potassium iodide for four days, in the \nmeanwhile collecting the urine. Evaporate the latter to 500 c.c. (1 pint), \nand filter. Pass hydrogen sulphide gas through the urine thus concen- \ntrated, when a black precipitate will form if lead is present. Other \nsubstances give a black precipitate with hydrogen sulphide, but none \nsuch is likely to be present in the urine. A simple test for lead in the \nsystem is to paint a small area of skin with a six per cent, solution of \nsodium sulphite. If lead is present the painted area will darken after \na few days. Patients using face enamels containing lead will find the \nskin blackened on taking baths in water containing hydrogen sulphide \n(Richfield Springs). \n\nProphylaxis is of the greatest importance, and the public should be \nmore generally instructed in regard to the insidious dangers of lead. \nSpecial precautions are required in lead works and paint factories, and \nin exposed trades. Dust should be avoided as much as possible, and \nwhere this is necessarily present, thorough ventilation of the rooms \nshould be insisted upon. The necesssity of frequent bathing and of \n\n\n\n4I4 PHARMACOLOGY AND THERAPEUTICS. \n\nthorough washing before meals ought to be impressed upon the work- \nmen. Food should not be permitted upon the premises, and the cloth- \ning should be changed before leaving the works. The habitual employ- \nment of milk in large quantity as a food has been recommended as of \nservice. Sulphuric acid lemonade is quite generally made use of as a \nprophylactic, but little reliance can be placed upon it. Weak and anae- \nmic men ought not to be admitted as operatives in lead factories, and \nit is advisable that women should not be employed at all in them. \n\nSILVER SALTS. \n\n1. ARGENTI NITRAS.\xe2\x80\x94 Silver Nitrate. Dose, 0.010 gm. (10 mil- \nligm.); y- gr. \n\nPreparations. \n\n1. Argenti Nitras Mitigatus (Argenti Nitras Dilutus, U. S. \nP., 1890). \xe2\x80\x94 Mitigated Silver Nitrate. (Mitigated Caustic.) \n\n2. Argenti Nitras Fusus. \xe2\x80\x94 Moulded Silver Nitrate. (Lunar \nCaustic.) \n\n2. ARGENTI OXIDUM.\xe2\x80\x94 Silver Oxide. Dose, 0.065 gm. (65 mil- \nligm.) ; 1 gr. \n\n3. ARGENTI CYANIDUM.\xe2\x80\x94 Silver Cyanide. \n\nUnofficial Preparations of Silver. \n\nArgenti Iodidum (U. S. P., 1890).\xe2\x80\x94 Silver Iodide. Dose, \n0.015 to 0.06 gm.; y 4 to 1 gr. \n\nArgenti Citras.\xe2\x80\x94 Silver Citrate. (Itrol.) \n\nArgenti Fluoridum. \xe2\x80\x94 Silver Fluoride. \n\nArgenti et Sodii Hyposulphis. \xe2\x80\x94 Silver and Sodium Hyposul- \nphite. \n\nArgenti Lactas. \xe2\x80\x94 Silver Lactate. (Actol.) \n\nArgentum Colloidale.\xe2\x80\x94 Colloid Silver. Dose, .01 gm.; y 6 gr. \n\nArgentaminum. \xe2\x80\x94 Argentamine. \n\nArgoninum. \xe2\x80\x94 Argonin. (Silver Caseinate.) \n\nArgyrol.\xe2\x80\x94 Argyrol. (Silver Vitellin.) Dose, .30 to .60 gm.; \n5 to 10 gr. \n\nLarginum. \xe2\x80\x94 Largin. \n\nProtargol. \xe2\x80\x94 Protargol. \n\n\n\nSILVER SALTS. 4I 5 \n\nAction of Silver Salts. \n\nExternal. \xe2\x80\x94 The local action of silver salts is in general simi- \nlar to that of lead salts \xe2\x80\x94 astringent and haemostatic \xe2\x80\x94 but they are \nmore irritant and corrosive, especially the nitrate. The astring- \nent effect produced by them is due to the formation of a protec- \ntive layer of albumin. While dilute solutions of the nitrate \nmay possibly have some vaso-constrictor effect, if the salt is \napplied in sufficient strength to induce irritation, the blood-ves- \nsels will become dilated in consequence of this. Even in dilute \nsolution silver is apt to be slightly irritating to the skin, pro- \nducing redness and itching, while stronger solutions vesicate, \nand the solid nitrate causes an eschar. This is at first of a \nwhitish color, but later turns black from the reduction of silver \nin light. The corrosive action of silver is less deep than that \nof some other metals, as its penetration is interfered with by \nthe precipitation of silver albuminate. On abraded surfaces and \nmucous membranes dilute solutions act as astringents, but con- \ncentrated ones are irritant and caustic. The silver salts possess \nvery considerable antiseptic power, and, like other astringents, \nthey tend to diminish suppuration by rendering the walls of \nthe blood-vessels less permeable to inflammatory products. At \nthe same time, they tend to prevent the further penetration of \nbacteria, and hinder their development by rendering the culture- \nground unsuitable. Silver nitrate not only coagulates the pro- \nteids of the micro-organisms, but is also antiseptic from the \nspecific effects of the metal, as is shown by the fact that silver \nalbuminate is likewise an active disinfectant. The nitrate is \nemployed by histologists for staining epithelium for micro- \nscopical purposes. \n\nInternal. \xe2\x80\x94 Unlike the lead salts, those of silver appear to \nhave no astringent action when administered internally. In \nthe stomach the soluble salts are probably converted into the \nchloride and albuminate, though the form in which the metal is \nabsorbed is uncertain. As it is reduced to the inactive metallic \nstate soon after entering the body, the use of silver does not \nlead to general poisoning. When it is given for prolonged \n\n\n\n41 6 PHARMACOLOGY AND THERAPEUTICS. \n\nperiods, however, a slight proportion of the metal ingested is \nabsorbed, this absorption being shown by a pigmentation of \nthe skin and mucous membranes (argyria). Such discoloration \nis due to the deposit of minute granules which were formerly \nsupposed to consist of metallic silver, but which are now \nthought to be an organic compound. They are found also in \nmany internal organs, but are chiefly present in the connective \ntissues of the body. Argyria is sometimes observed in the \nworkers in artificial pearls, who use silver as a pigment, and \nit may also result from the prolonged use of silver nitrate solu- \ntion as a local application to the eye, nose and throat. In man \nthis pigmentation appears to be the only evidence of absorption. \nIt is believed that most of the silver passes through the ali- \nmentary canal unabsorbed, and that none of the very small \nproportion which is taken up is eliminated; the entire amount \nremaining imbedded indefinitely in the tissues. In animals, how- \never, some is excreted by the epithelium of the alimentary canal. \nWhen silver is introduced into the circulation by subcutaneous \nor intravenous injection, its effects are found to differ from \nthose of other metals in the predominance of nervous symp- \ntoms. In mammals the action is chiefly upon the central ner- \nvous system, and especially the medulla oblongata, as shown by \na rise of blood-pressure and slowing of the pulse, in consequence \nof increased activity of the vaso-motor and vagus centres. \nThis stimulation is followed by paralysis ; the blood-pressure \nfalling, and the respiration becoming slow and labored and then \nfailing altogether. The heart is comparatively unaffected, and \nmay continue to beat for some time after the respiration has \nceased. There is also motor paralysis, beginning in the lower \nextremities. The secretion of bronchial mucus may be so \nmarkedly increased that it may lead to asphyxia, and this is \nthought to be due to injury to the epithelium. In cold-blooded \nanimals violent convulsions, resembling those from strychnine \nand followed by paralysis, have been observed. Silver nitrate, \nin solid form or concentrated solution, is a gastro-intestinal irri- \ntant and corrosive. \n\n\n\nSILVER SALTS. 417 \n\nTherapeutics of Silver. \n\nExternal. \xe2\x80\x94 Silver foil, or metallic silver in very thin sheets, \nis used as a surgical dressing for wounds and burns. It consti- \ntutes a protective covering which may be painlessly removed and \nrenewed and which prevents or curtails suppuration. It is also \nsaid to reduce shock. Silver nitrate is in universal use as a caus- \ntic whenever a limited and clearly defined action is required, \nbut is of no value for producing a deep or extensive escharotic \neffect. It is often applied to the bites of dogs and other ani- \nmals, but it is a dangerous caustic to employ in deep bites, for \nthe pellicle of silver albuminate retains the poison in the wound. \nThe solid nitrate is used also to destroy warts and other \ngrowths, to restrain the bleeding from leech-bites, and as an \napplication for ulcers of the mouth, rectum and other parts, \nfor venereal sores, and in catarrh of the cervix uteri. It is \nsaid to be of service when applied to the scrotum in acute \nepididymitis or orchitis, and in lymphangitis of the forearm from \na poisoned wound of the finger, if applied along the course \nof the affected vessels. In erysipelas the disease may sometimes \nbe arrested, it is claimed, by delimiting the affected area with \nsilver nitrate. Boils or a stye on the eye have been aborted \nby its early use, and it has also been employed with good re- \nsults in eczema, lichen, herpes and other cutaneous affections \nwhen occurring in circumscribed patches. For tinea tricophy- \ntosis a solution in nitrous ether (2.60 gm. to 30 c.c. ; 40 gr. to \n1 fl. oz.) may be used. The mitigated caustic is a good appli- \ncation to granular lids, chancroids, small-pox vesicles (to pre- \nvent pitting), and in general to excite a healthy action of granu- \nlar surfaces. The injection of a strong solution of silver \nnitrate in the early stage of the disease has been advocated by \nsome as a method of aborting gonorrhoea. Buboes have been \nsuccessfully treated by the injection, after puncture, of a 2 per \ncent, solution of the nitrate, and in punctured wounds the in- \njection of a solution of the strength of .60 gm. (10 gr.) to 30 \nc.c. (1 fl. oz.), after the wound has been disinfected, has been \nrecommended for preventing the development of tetanus. \n28 \n\n\n\n41 8 PHARMACOLOGY AND THERAPEUTICS. \n\nUniting, as it does, an irritant stimulating, with an astringent, \neffect, lotions of the salt, the strength of which is usually about \n.30 gm. (5 gr.) to 30 c.c. (1 fl. oz.) of water, are often of \ngreat service as an application for chronic pharyngitis or laryn- \ngitis and indolent ulcers, or as an injection in gleet or inflam- \nmation of the cervix uteri, while weaker solutions are used for \nvarious forms of ophthalmia. Ophthalmia neonatorum is suc- \ncessfully treated by early applications of a 1 per cent, aqueous \nsolution of silver nitrate. This is commonly known as Crede\'s \nmethod, but the original formula as prescribed by him was double \nthis strength. In spasmodic stricture of the oesophagus the oc- \ncasional use of a very weak solution by means of a sponge pro- \nbang may prove of service. A solution containing 1.20 gm. (20 \ngr.) to 30 c.c. (1 fl. oz.) is efficient in pruritus vulvae and in \nthe prevention of bed sores, and the injection in small quan- \ntities of a solution varying from this strength up to one which \nis three or four times as concentrated into the sac of a hydrocele \nor cystic tumor has been attended with good results. Irrigation \nof the bowel with a solution of from .30 to .60 gm. (5 to 10 gr.) \nto 30 c.c. (1 fl. oz.) is often useful in pseudomembranous en- \nteritis, while prolapsed rectum, especially in children, is bene- \nfited by cauterization with mitigated silver nitrate. \n\nA useful injection in gonorrhoea is silver caseinate (Argonin, \nnot official) in 1.5 per cent, solution which causes the speedy \ndisappearance of gonococci, but since this is not astringent, \nother remedies must be employed to relieve the inflammation. \nSilver lactate (Actol, not official) is used as an antiseptic in \nsore throat, gonorrhoea, etc., in a 2 per cent, solution. Silver \ncitrate (Itrol, not official) in 1 to 4000 solution is employed for \nthe same purpose. Protargol (not official), a proteid compound \ncontaining 8 per cent, of silver easily soluble in water, is used \nas an injection for gonorrhoea. The usual strength is 1 per \ncent. Argentamine (not official), a 10 per cent, solution of \nsilver nitrate in a 10 per cent, solution of ethylendiamine, has \nbeen used in gonorrhoea and conjunctivitis in a 1 to 4000 solu- \ntion; also as a disinfectant. This sterilizes a pure culture of \n\n\n\nSILVER SALTS. 419 \n\ngonococci in from five to seven minutes. It can be used in as \nstrong a solution as 1 to 1000 in the urethra, it penetrates deeply \ninto the tissues without altering them, and by the seventh day \nthe discharge is usually quite thin and gonococci can hardly be \nfound. It then disappears rapidly. The iodide possesses the \ngeneral properties of the nitrate. \n\nSilver, soluble in water, an allotropic form discovered about \n1890, now termed colloidal silver (not official), has recently \nbeen well received and has obtained a permanent place in thera- \npeutics. It is employed as a 15 per cent, ointment (Crede) by \ninunction. It has been used successfully for chronic furun- \nculosis, phlebitis and other septic processes. Largin (not offi- \ncial) is an albumin-silver compound, containing in the air- \ndried condition 11 per cent, of silver, which is said to be a \npowerful astringent and germicide, non-irritant, and not pre- \ncipitated by chlorides or albumin. It is used in gonorrhoea in \nsolutions of from % to i J / 2 per cent. Silver fluoride (not \nofficial) has been recommended as an efficient application in \nanthrax. It is a dark-colored hygroscopic mass, readily soluble \nin water, equal in caustic effect to the nitrate, and powerfully \nantiseptic, being destructive to the anthrax bacillus, while non- \ntoxic to man. Silver and sodium hyposulphite (not official), \nwhich is also very soluble in water and does not coagulate \nalbumin, or stain the skin or the clothing, is preferred by some \nto silver nitrate for local application to the throat, on account \nof its being less disagreeable to the taste. \n\nArgyrol or silver vitellin (not official) is a very recent prep- \naration, which, it is claimed, is distinguished from other silver \nsalts by the high amount of silver it contains (30 per cent.), its \nintense penetrating action on the tissues, its freedom from irri- \ntating properties, and its power to allay the signs and symptoms \nof inflammation. In spite of its large percentage of silver, a \n20 per cent, solution of argyrol may be dropped in the normal \nconjunctival sac without producing irritation or discomfort, \nwhile the penetrating action of the salt is demonstrated by its \naction on catgut, a strand of which, after immersion in the \n\n\n\n420 PHARMACOLOGY AND THERAPEUTICS. \n\nsolution, is found to be penetrated through and through with \nthe argyrol. Hence it is argued that argyrol will exert the \nantiseptic effects of silver in the deep submucous structures \nwhere, in most pathological conditions, pathogenic organisms \nfind and maintain lodgment in spite of energetic measures to \neradicate them. Practically the remedy, topically applied, has \nproved of service in various diseases of the eye, ear, nose, \nthroat and genito-urinary organs, as well as in a number of \nsurgical conditions. It appears to be especially efficient in the \ntreatment of gonorrhoea (which may sometimes be aborted by \nit) and of purulent conjunctivitis (of the new born, gonorrhceal, \netc.). In trachoma the lids may be painted with a 25 per cent, \nsolution, and a 2 per cent, solution, used by instillation, is said \nto be a certain prophylactic against ophthalmia neonatorum. It \nis stated to be the only silver salt which does not permanently \nstain the conjunctiva. Laryngologists who have employed \nargyrol in different conditions of the larynx and pharynx re- \nport that it seems to be quite as effective as silver nitrate, while \nit is far more agreeable to the patient. Argyrol has also been \nused internally, in place of silver nitrate, in the treatment of \ngastric ulcer, gastritis, gastro-enteritis, etc. It is claimed for it \nthat, taken internally, it is absolutely non-toxic, is not absorbed, \nand is unchanged in the stomach or intestine; hence, with it, it \nis possible to secure the local effects of silver directly upon the \naffected portions of the mucous membrane. It is advised that \nit should be taken, in doses of .30 to .60 gm. (5 to 10 grs.), in \ncapsules, followed by a glass of water, three times a day. \n\nInternal. \xe2\x80\x94 Silver salts were formerly employed to a con- \nsiderable extent in nervous diseases, in which they were sup- \nposed to be in some way efficacious, and the nitrate especially \nwas largely used in the treatment of epilepsy. At the present \nday its long continued administration is wholly unjustifiable on \naccount of the objectionable discoloration of the skin to which \nit gives rise, while we have at our disposal other remedies which \nare far more efficient. Indeed, it seems very unlikely that sil- \nver reaches the central nervous system in any other form than \n\n\n\nSILVER SALTS. . 42 1 \n\ninert granules. There are, however, some conditions met with \nin the alimentary canal in which it is considered of value, and \nif it is not used too freely, or for too long consecutive periods, \nthere would appear to be little risk of inducing argyria. There \nis no case on record, it is stated, of the latter having been \ncaused by less than 30 gm. (1 oz.) of silver nitrate. The gums \nshould be examined from time to time, as it has been found that \nthe cutaneous pigmentation is preceded by the development on \nthe edge of the gum of a dark line, which is removable by a \ncourse of acid potassium tartrate. On account of the conversion \nwhich takes place in silver salts upon reaching the stomach it is \nsomewhat perplexing to explain the remedial action of silver \nnitrate as an internal remedy, but clinical experience seems to \nshow that it is of service in gastric ulcer and in chronic gastric \ncatarrh and gastritis accompanied with sour eructations or \nwith vomiting after meals. In the treatment of ulcer it is \nrecommended that it should be given in pill form with extract \nof hyoscyamus or opium. Combined with opium it has been \nfound effective in the diarrhoea of phthisis, and with opium and \nipecacuanha, in the diarrhoea of typhoid fever. It has also been \nemployed in other forms of diarrhoea and in dysentery. In in- \ntestinal ulceration it has been highly recommended, it being \nadvised that under these circumstances the drug should be \nadministered in hard or keratin-coated pills, in order that it \nmay pass through the stomach without being chemically \nchanged. In ulceration of the caecum and rectum, as well as \nin dysentery, rectal or colonic injections of silver nitrate are \nno doubt preferable. From .60 to 1.20 gm. (10 to 20 gr.) to 500 \nc.c. (1 pint) of water may be employed for this purpose. For \nhigh injections a flexible tube should be used, and the bowel \nshould be washed out with tepid water previous to the intro- \nduction of the silver solution. As silver nitrate when given by \nthe mouth is usually associated with opium or other remedies, \nit would seem open to question whether much of the benefit \napparently attending its use in affections of the gastro-intestinal \ntract may not in reality be due to these other drugs. For use \n\n\n\n422 .PHARMACOLOGY AND THERAPEUTICS. \n\nin stomach troubles some prefer silver oxide to the nitrate, \non account of its less caustic qualities. \n\nColloidal silver, which is entirely soluble in water and in \nalbuminous fluids, is unirritating, so that it can be administered \nhypodermatically and intravenously as well as by inunction, as \nis mentioned above. For internal use, to prevent its conversion \ninto a chloride in the stomach, it is first dissolved in equal parts \nof albumin and glycerin. The dose of o.i gm. ( gr.) may be \ngiven two or three times daily. It is claimed that it has a very \nbeneficial influence and often affords a rapid cure in recent and \nalso in chronic sepsis when secondary changes in the vital \norgans have not occurred. It seems to inhibit the action of \nstaphylococci and streptococci, or destroy them altogether. It \nhas been used in various conditions: osteomyelitis, so-called \ngonorrhceal rheumatism, puerperal fever, cerebro-spinal menin- \ngitis, and septic processes in general. Thus far no instance of \nargyria from its use has been reported. \n\nTOXICOLOGY. \n\nThe nitrate sometimes causes acute poisoning. \n\nSymptoms. \xe2\x80\x94 These are intense pain in the abdomen and muscular \nspasm, followed by vomiting, and generally purging. The face is livid \nand covered with perspiration. The vomited matter is black and con- \ntains coagulated mucus. If the salt is in solution, the mucous mem- \nbrane of the mouth will be covered with a grayish-white membrane, \nwhich afterwards becomes dark-colored. Should the case terminate \nfatally, the post-mortem appearances are those commonly met with in \nacute corrosive poisoning. Chronic poisoning or argyria shows itself \nby a permanent slaty discoloration of the skin, conjunctivae and labial \nmucous membrane and ulcerations in the digestive tract. \n\nTreatment. \xe2\x80\x94 This consists of administering a solution of sodium chlo- \nride (common salt), soothing the mucous membranes by injection of \nmilk, and relieving pain with opium. The chronic form is avoided by \ninterrupting the treatment, using eliminating remedies, and preventing \nstaining of the skin by baths of sodium hyposulphite. \n\nZINC SALTS. \n\n1. ZINCUM.\xe2\x80\x94 Zinc. \n\n2. ZINCI CHLORIDUM.\xe2\x80\x94 Zinc Chloride. (Butter of Zinc.) \n\n\n\n\n\n\nZINC SALTS. 423 \n\nPreparation. \nLiquor Zinci Chloridi. \xe2\x80\x94 Solution of Zinc Chloride. \n\n3. ZINCI SULPHAS.\xe2\x80\x94 Zinc Sulphate. (White Vitriol.) Dose \n(emetic), 1 gm.; 15 gr. \n\n4. ZINCI CARBONAS PR^CIPITATUS.\xe2\x80\x94 Precipitated Zinc Car- \nbonate. \n\n5. ZINCI OXIDUM.\xe2\x80\x94 Zinc Oxide. Dose, 0.250 gm. (250 mil- \nligm.); 4 gr. \n\nPreparation. \nUnguentum Zinci Oxidi. \xe2\x80\x94 Ointment of Zinc Oxide. \n\n6. ZINCI ACETAS.\xe2\x80\x94 Zinc Acetate. Dose, 0.125 gm. (125 mil- \nligm.) ; 2 gr. \n\n7. ZINCI STEARAS.\xe2\x80\x94 Zinc Stearate. \n\nPreparation. \nUnguentum Zinci Stearatis. \xe2\x80\x94 Ointment of Zinc Stearate. \n\nUnofficial Preparation of Zinc. \nOleatum Zinci (U. S. P., 1890).\xe2\x80\x94 Oleate of Zinc. \n\nAction of Zinc Salts. \n\nExternal. \xe2\x80\x94 Zinc chloride is an energetic corrosive. It causes \nmuch pain and penetrates deeply, but is valuable as a caustic \nfor the reason that its action is limited to the seat of application. \nIt is strongly antiseptic, and constitutes the chief ingredient of \nBurnett\'s fluid, a well-known domestic disinfectant. Solutions \nof the chloride of moderate strength are excitant, astringent and \nslightly haemostatic. The other zinc salts are also astringent \nand mildly haemostatic, thus acting like those of silver and lead, \nthough their action is less powerful. The most active of them \nare the sulphate and acetate, the oxide, stearate and precipi- \ntated carbonate being quite feeble astringents. \n\nInternal. \xe2\x80\x94 Zinc chloride is a violent corrosive poison to the \nalimentary canal, causing a burning pain in the mouth, throat \nand abdomen, with vomiting and purging, followed by collapse. \nThe matter vomited is likely to contain blood and shreds of \n\n\n\n424 PHARMACOLOGY AND THERAPEUTICS. \n\nmucous membrane, and the stools may also contain blood. \nZinc salts, as a rule, act as astringents upon the gastro-intestinal \nmucous membrane, as well as upon the abraded skin and ulcer- \nated surfaces. They are believed to have a somewhat specific \nirritant action, affecting at first exclusively the nerve structures \nin the stomach which form the starting point of the vomiting \nreflex; consequently emesis occurs before there is time for \ncorrosion, and even very large amounts may be free from dan- \nger. The most typical in its action is the sulphate, which in \ndoses of I to 1.20 gm. (15 to 20 gr.) is a very prompt emetic. \nIts action is so rapid that there is no time for nausea, and its \ndepressing effects are also very slight. \n\nRemote Effects. \xe2\x80\x94 The general action of zinc salts can be \nobserved only when they are thrown directly into the circula- \ntion. Injected intravenously, they appear to depress the cen- \ntral nervous system, and to a less extent the heart and volun- \ntary muscles, and to cause irritation and congestion of the \ngastro-intestinal mucous membrane, as well as inflammation of \nthe kidney. Emesis is one of the effects produced, and this is \nthought to be probably due to the inflammation of the stomach \ninduced by the metal, rather than to any direct action upon \nthe medullary centre for vomiting. Zinc has been found to \npossess a special affinity for the haemoglobin of the blood, \nwith which it forms a compound (zinc-haemol), but its ad- \nministration has no effect on the formation of haemoglobin. \nZinc is excreted by the stomach and intestinal walls, and \nin much smaller amounts in the bile and urine. Of the \nzinc absorbed from the stomach and intestine, most is found \nto be contained in the liver and bile. Less of it is met \nwith in the spleen, kidney, thyroid and pancreas, and very \nlittle in the other tissues. It is said that the exhibition of 155 \ngm. of zinc carbonate, in the course of 335 days, induced no \nappreciable effects in the dog, and that the continued adminis- \ntration of zinc salts has no effect in man, except those of dis- \nordered digestion and constipation. Workers in zinc are occa- \nsionally the subjects of what is known as " brassfounders\' ague," \n\n\n\nZINC SALTS. 425 \n\nan affection which is apparently due to the fumes of zinc which \nescape in the process of casting. After a period of general \nmalaise, followed by prolonged rigors and shivering, soreness \nof the chest occurs, accompanied by coughing and headache. \nThen profuse perspiration supervenes and the patient falls into \na deep sleep, from which he awakes in ordinary health. A \nnumber of obscure nervous conditions have been described as \nbeing caused by zinc in those who work with the metal, but \nthey appear to be extremely rare, and when present may pos- \nsibly be due to arsenic, lead, or other impurities occurring in \nzinc compounds. \n\nTherapeutics of Zinc Salts. \nExternal. \xe2\x80\x94 Zinc chloride is an effective caustic for morbid \ngrowths, such as epitheliomata, nsevi, warts and condylomata, \nand for gangrenous sores. It may be applied in the form of a \npencil made with plaster-of-Paris or of a paste made with \nstarch, flour or dried gypsum. Canquoin\'s paste is a mixture \nof zinc chloride in varying strength with wheat flour and water. \nIn malignant disease of the uterus the chloride has been used \nboth in paste and in saturated solution applied by means of a \ntampon. Injections of zinc chloride (about 1 c.c. ; 15 Til of \na 1 per cent, solution) have sometimes been made into the \ntissues in the vicinity of the fracture, for the purpose of pro- \nmoting the union of fractured bones, and in a case of recurrent \nluxation of the shoulder the tendency to dislocation is stated \nto have been overcome by a number of injections of .12 c.c. \n(2 TT1) of a 10 per cent, solution into the anterior superior por- \ntion of the capsule below the acromion process. The same \nplan of treatment has also been applied in tuberculosis of joints \nand in lupus, and even in the early stages of pulmonary tuber- \nculosis minute quantities of such solutions have been injected \ninto the lung, with the object of favoring the formation of \nfibrous tissue and thus arresting the disease. Liquor Zinci \nChloridi, much diluted, may be employed as a detergent and \nstimulating application to old sores and as a disinfectant for \n\n\n\n\n\n\n426 PHARMACOLOGY AND THERAPEUTICS. \n\nwounds. Either the Liquor, or Burnett\'s fluid (which is a \nsomewhat stronger solution), is sometimes used to disinfect \nfaeces, urinals, closets, etc. Piatt\'s chlorides is said to consist \nof various salts of zinc, chiefly the chloride, in saturated \nsolution. Lotio Rubra, a solution of the sulphate (generally \nabout 1 to 240), colored red with compound tincture of lavender, \nis used as an astringent application to abraded surfaces, ulcers, \netc., and as an injection in gonorrhoea, leucorrhcea, or otitis. \nEither alone or combined with other agents, zinc sulphate is \nvery commonly employed as an injection in gonorrhoea and \ngleet and as a collyrium in conjunctivitis. The acetate (.03 to \n.06 c.c. ; y 2 to 1 gr.) in rose-water (30 c.c. ; 1 fl. oz.) is also \nuseful for the latter purpose. The oxide, stearate and precipi- \ntated carbonate, either dusted on the part or in the form of oint- \nment, may be employed in a great variety of conditions where \nonly a mild astringent effect is required. The ointment of zinc \noxide is perhaps more widely used than any other as a protective \nand slightly astringent application to acute skin affections, and \nto it are frequently added phenol, oil of cade, tar, and various \nother agents, according to the case, for the treatment of eczema, \nherpes, erysipelas, burns, etc. What is known as Unguentum \nMetallorum, which consists of equal parts of the ointments of \nzinc oxide, lead acetate, and diluted mercuric nitrate, is a ser- \nviceable application for some forms of eczema and other skin \ndiseases, as well as for sores and ulcers. Another useful oint- \nment, which has the advantage of being transparent, is the one \nalready referred to (see p. 409) composed of equal parts of zinc \noleate, mercuric oleate, and diachylon ointment. For pruritus \nthe following combination is recommended : Zinc oxide, 25 ; \ngelatin, 20 ; glycerin, 60 ; water, to 480. This compound is to be \nmelted and applied with a brush, after which the part should be \ncovered with cotton. Unna\'s zinc-glue, which, when rubbed \ninto the gauze or muslin of a bandage, forms a stiff surgical \ndressing, consists of 10 parts of zinc oxide, and 30 parts each \nof gelatin, glycerin and water. Good preparations of calamine \n(purified zinc carbonate), which is efficacious as a mild astring- \n\n\n\nZINC SALTS. 427 \n\nent for cutaneous affections, are the following: An ointment \nwith benzoated lard (1 to 5) and a lotion consisting of calamine, \n3; zinc oxide, 3; glycerin, 4; lime-water, 16; water, 60. \n\nInternal. Alimentary Canal. \xe2\x80\x94 Zinc chloride is not given in- \nternally. The sulphate was formerly much employed to pro- \nduce vomiting in cases of croup, but has now for the most part \nbeen superseded by other remedies. It is, however, a very ser- \nviceable emetic in narcotic and other poisoning, where prompt \nand efficient action is required. It is quite safe so long as the \nmucous membrane is intact, for under these circumstances it is \nnot absorbed. Practically, however, it always produces some \nirritation of the gastric walls, and its use should therefore be \nlimited to cases in which the poison is not injurious to the stom- \nach itself. Its only advantage over apomorphine appears to con- \nsist in a less degree of nausea and depression. In doses of .03 \nto .12 gm. (y 2 to 2 gr.) it has been found to afford great relief \nin that form of dyspepsia which gives rise to oxaluria. Both \nthe sulphate and oxide are occasionally given in chronic diar- \nrhoea and dysentery. The oxide is useful in gastralgia, and has \nbeen recommended, usually in association with other drugs, \nwhen the following conditions are present: pain after eating, \nnausea, and intestinal pain, succeeded by prompt evacuation \nof the bowels, the faeces being made up largely of undigested \nfood. In the summer diarrhoea of children it is sometimes ad- \nministered with bismuth and pepsin, and to diminish the crav- \ning for alcohol and relieve the gastric catarrh of drunkards it \nhas been employed in combination with piperin. \n\nRemote Effects. \xe2\x80\x94 The preparations of zinc have been thought \nto exert an antispasmodic influence upon the nervous system, \nand the sulphate and oxide were formerly employed to a con- \nsiderable extent in the treatment of such affections as epilepsy, \nchorea, hysteria and whooping-cough. Their efficacy is doubt- \nful, however, and they have now largely fallen into disuse as \nnervous depressants. The oxide is of some service in checking \nthe night-sweats of phthisis, particularly when combined with \nextract of belladonna, but it is quite likely to interfere with \n\n\n\n428 PHARMACOLOGY AND THERAPEUTICS. \n\nthe digestion. Trousseau\'s pill for this purpose consists of zinc \noxide, .30 gm. (5 gr.), with extract of hyoscyamus, .06 gm. \n(1 gr.). Zinc bromide, iodide, phenosulphonate and valerate \nare considered elsewhere. \n\nTOXICOLOGY. \n\nThe appearances met with after death from zinc chloride are those \nwhich commonly characterize the action of a gastro-intestinal irritant. \nThe sulphate, in large doses, also acts as an irritant poison, producing \ncolicky pains, diarrhoea and prostration. \n\nTreatment. \xe2\x80\x94 The salt itself usually produces such prompt and copious \nvomiting that other emetics are scarcely required, but these may be \ngiven (see p. 175), or the stomach may be washed out. Demulcents \nshould then be administered : lime-water, mucilaginous drinks, and al- \nbumin freely in the form of eggs or milk. \n\nCOPPER SULPHATE. \nCUPRI SULPHAS.\xe2\x80\x94 Copper Sulphate. (Cupric Sulphate. Blue \nVitriol. Bluestone.) Dose (astringent), 0.010 gm. (10 milligm.) ; \ni/ 5 gr.; (emetic) 0.250 gm. (250 milligm.); 4 gr. \n\nUnofficial Preparation of Copper. \nOleatum Cupri. \xe2\x80\x94 Oleate of Copper. \n\nAction of Copper Sulphate. \n\nExternal. \xe2\x80\x94 Used in substance, it is somewhat corrosive. In \nsolution it acts like zinc sulphate, but is more strongly astringent \nand antiseptic. \n\nInternal. Alimentary Canal. \xe2\x80\x94 In moderate doses it is a \nprompt and efficient emetic, acting in precisely the same man- \nner as zinc sulphate, though it is more irritant. In large quan- \ntities it causes corrosion of the gastro-intestinal mucous mem- \nbrane, with violent vomiting and purging. In small doses it \nis markedly astringent. \n\nRemote Effects. \xe2\x80\x94 Small amounts may be taken for an indefi- \nnite period without giving rise to any appreciable effect, so \nthat the general action of copper salts in man is unknown. In \nanimals their intravenous injection in sufficient quantity in- \nduces paralysis of the spontaneous movements and of the heart \n\n\n\n\n\n\nCOPPER SULPHATE. 429 \n\nand respiration, the respiration failing somewhat earlier than \nthe heart. The blood-pressure at first rises, and afterwards falls, \nin consequence of the failure of the vaso-motor nerves to main- \ntain the contraction of the vessels, as well as from the weakness \nof the heart itself. According to most observers, no emesis is \ninduced, so that it seems certain that the vomiting resulting \nfrom the administration of copper salts by the mouth is due \nto the gastric irritation, and not to any direct action on the \ncentral nervous system. If the animal survives long enough, \nviolent and perhaps bloody diarrhoea is generally observed. \nCopper is absorbed from the stomach and intestine, and also \nfrom other mucous membranes and from wounds, and the metal \nis stored chiefly in the liver, though it is found in smaller \namount in the spleen, kidney and thyroid. It is excreted in the \nintestinal secretions, bile, urine, saliva and milk, and is said to \npass from the mother to the foetus in utero. It is stated to \nhave a strong affinity for haemoglobin, forming with it a com- \npound called cuprohsemol, but, like zinc, does not increase the \nhaemoglobin of the blood. Animals have been fed with food \ncontaining considerable amounts of copper for many months at \na time without showing any special evidence of poisoning, and \nthis metal, it is said, is found so regularly in the tissues of man \nand animals that it may be regarded as a normal constituent, \nalthough its function is quite unknown and it may be merely \nstored up on its way to excretion. \n\nTherapeutics of Copper Sulphate. \nExternal. \xe2\x80\x94 As a caustic it is milder in action and also less \npainful than silver nitrate. In solid form or powder it is applied \nto indolent ulcers and granulations, syphilitic and other sores in \nthe mouth and throat, granular lids, corneal ulcers, etc. In \nweak aqueous solution it is sometimes employed in subacute \nconjunctivitis, but the acetate is preferable for this purpose. \nIn place of the pure sulphate, what is known as Lapis Divinus \nmay be used as a caustic. It consists of copper sulphate, potas- \nsium nitrate, and alum, each 24 parts, and camphor, 1 part. \n\n\n\n430 PHARMACOLOGY AND THERAPEUTICS. \n\nThe camphor is added after the other ingredients have been \nfused together, and the whole mass is then cast into cylindrical \nmoulds. Lotions of copper sulphate are more strongly astringent \nthan those made with zinc sulphate, but are often employed for \nthe same purposes in the strength of about i to 240. In this \nstrength it may be instilled into the eye. Somewhat more con- \ncentrated solutions have a mild haemostatic effect, and the solid \nsalt is also serviceable for checking haemorrhage from slight \nwounds, leech bites, and irritable ulcers. Associated with zinc \nsulphate and lead acetate, or with fluid extract of geranium or \nother remedies, copper sulphate is used to a considerable ex- \ntent in gonorrhoea, and weak solutions of it also make good \ninjections for vaginitis, leucorrhcea and gleet, as well as good \nstimulant dressings for chancres and chancroids. In the \nstrength of from .60 to 1.20 gm. (10 to 20 gr.) to 30 c.c. (1 fl. \noz.) of menstruum it is sometimes thrown into the bowel for \nthe relief of chronic diarrhoea and dysentery and of acute \ndiarrhoea of severe form, and a solution of .30 to .60 gm. (5 \nto 10 gr.) in 30 c.c. in glycerin has been recommended as an \ninjection in pseudomembranous enteritis. An aqueous solution \nof .30 gm. (5 gr.) or more to 30 c.c. (1 fl. oz.) may be used \nwith good effect as a gargle in relaxed sore throat and as an \napplication for hyperidrosis or bromidrosis. A solution of 30 \ngm. (1 oz.) in 500 c.c. (1 pint) of water is said to be very \nefficacious in the treatment of scabies, and in weaker solutions \nand ointments copper sulphate is of service in psoriasis, sycosis \nand other forms of tinea, acne, chronic eczema, and other skin \ndiseases. Thus, oleate of copper (not official), made with lano- \nlin into a 10 to 20 per cent, ointment, is an excellent parasiticide \nfor ringworm. \n\nInternal. \xe2\x80\x94 As an emetic it is used in the same class of cases \nas zinc sulphate. As it is more irritant than the latter, the \nstomach should be promptly evacuated by some other means \nin any case in which it fails to produce vomiting. On account \nof its irritant effect some would restrict its use as an emetic to \ncases of phosphorus poisoning, in which it has been supposed \n\n\n\nCOPPER SULPHATE. 43 I \n\nto be particularly serviceable on account of the possible deposi- \ntion of copper on the particles of phosphorus preventing the \nabsorption of the latter. It is extremely doubtful, however, \nwhether copper sulphate is especially valuable in this way. In \nacute dysentery it may be given with advantage combined with \nmagnesium sulphate and dilute sulphuric acid, and, after the \nacute symptoms have subsided, with morphine or opium. Asso- \nciated with opium, it is a useful palliative astringent in the \ndiarrhoea of phthisis, and of all the metallic astringents in \nuse, it has been pronounced the most effective in chronic diar- \nrhoea and chronic dysentery. It is regarded as indicated when \ncolicky pains and tenesmus are present, and the stools, partly \nfeculent, contain mucus streaked with blood, and it may be \ngiven in pill form in doses of .005 gm. (yL- gr.) combined with \nthe same amount of morphine sulphate and .12 gm. (2 gr.) of \nquinine sulphate. When tolerance of the copper sulphate is \nestablished, it is advised that the dose should gradually be in- \ncreased to .015 gm. (34 g r -)- I n gastro-intestinal catarrh \nalso minute doses of it are of service. In some states of the \nbody, particularly in cutaneous affections of the dry type and \nin persons with tubercular tendencies, it is thought to act like \narsenic, and may be given in cases in which that drug is not \nwell borne. It has been used in anaemia and chlorosis, and \nhas also been recommended in the treatment of syphilis. \n\nTOXICOLOGY. \n\nAcute poisoning. \xe2\x80\x94 The copper is apt to give a blue or green tinge \nto the vomit and faeces, and later blood appears in them from the cor- \nrosion of the mucous membrane. There is intense abdominal pain, and \nthe usual symptoms of acute corrosive poisoning may follow \xe2\x80\x94 collapse, \nwith weak pulse and respiration, cold, clammy skin, dizziness, uncon- \nsciousness, delirium, coma, convulsions and paralysis. \n\nChronic poisoning. \xe2\x80\x94 This is a matter of great practical interest. \nPreserved peas and other vegetables, the green color of which is due \nto preparation with copper, are in common use by the public. Copper \nis also added to flour to improve the bread made from it, and it may \nenter the food from the use of cooking utensils made of this metal \n\n\n\n432 PHARMACOLOGY AND THERAPEUTICS. \n\nand in a variety of other ways. No deleterious effects appear, as a \nrule, to result from such introduction of copper into the system, and it \nhas been disputed whether chronic copper poisoning occurs in man at \nall ; especially as it is claimed that copper may be taken directly, either \nin the form of the metal or of its soluble salts, for prolonged periods \nwithout the production of any symptoms except perhaps more or less \nnausea and the evidences of a mild intestinal catarrh. Still, the facts \nshow unquestionably that instances of chronic poisoning are occasion- \nally met with. Among workers in copper and brass the skin and hair \nnot infrequently have a greenish tint, while the upper borders of the \nteeth may show a green discoloration which is known as the " copper \nline." In addition, colic and diarrhoea, or acute febrile attacks of gas- \ntrointestinal catarrh, which may be followed by local paralysis, are \nsometimes observed, and the following symptoms have also been noted : \nanaemia, wasting, dyspepsia, tremors, headache, vague pains, pharyngeal \nand laryngeal catarrh with occasional haemoptysis and aphonia, and \nprofuse secretion of sweat, which may be of a greenish hue. The oc- \ncurrence of these various manifestations has been attributed in part \nto the deposit of copper dust upon the skin, hair and teeth, and in part \nto the lead, arsenic and other poisons often associated with copper. It \nwould seem altogether probable that in a considerable proportion of \ninstances such an explanation will suffice for the symptoms present, but, \non the other hand, certain cases come under observation from time to \ntime in which the evidences of chronic poisoning are indisputably due \nto copper alone. \n\nTreatment. \xe2\x80\x94 For acute poisoning give albumin, milk or magnesia. \nPotassium ferrocyanide is the chemical antidote. Then promptly empty \nthe stomach and saturate the system with potassium iodide. Chronic \npoisoning is best treated by the administration of fifteen drops of diluted \nphosphoric acid before each meal, the ingestion of large quantities of \nmilk, and thorough daily evacuation of the bowels with magnesium or \nsodium sulphate. \n\nALUMINUM SALTS. \n\n1. ALUMEN. \xe2\x80\x94 Alum. (Aluminum and Potassium Sulphate. Potas- \nsium Alum.) Dose, 0.500 gm. (500 milligm.) ; iy 2 \xc2\xa3*\xe2\x80\xa2 \n\nPreparation. \nAlumen Exsiccatum. \xe2\x80\x94 Dried Alum. (Burnt Alum.) \xe2\x80\xa2 \n\n2. ALUMINI HYDROXIDUM.\xe2\x80\x94 Aluminum Hydroxide. (Alumi- \nnum Hydrate.) \n\n3. ALUMINI SULPHAS.\xe2\x80\x94 Aluminum Sulphate. \n\n\n\nALUMINUM SALTS. 433 \n\nUnofficial Preparations of Aluminum. \nAlumini Acetas. \xe2\x80\x94 Aluminum Acetate. \nGlyceritum Aluminis. \xe2\x80\x94 Glycerite of Alum. \nAlumnol. \xe2\x80\x94 Alumnol. (Aluminum Naphthol-Sulphonate.) \n\nAction of Aluminum Salts. \n\nExternal. \xe2\x80\x94 Aluminum salts in solution are astringent and \nhaemostatic, throwing down a layer of precipitated albumin on \nthe surface of mucous membranes and on raw surfaces; also \ncoagulating the albumin in the underlying tissues, and thus con- \nstricting the blood-vessels. In concentrated form they act as \nirritants, and dried alum, by reason of its marked avidity for \nwater, is somewhat escharotic. On account of their property \nof precipitating proteids aluminum salts are antiseptic, as well \nas astringent, and in particular the acetate (not official) in \nsaturated solution is a very penetrating antiseptic. In haemor- \nrhage, when the leaking vessels can be directly reached, alum \nis a valuable haemostatic, as it acts in three ways to arrest the \nbleeding: coagulating the albumin, constringing the parts, \nand, by crystallizing when applied in large amounts on lint, \naffording a surface which is rough and aids coagulation. \n\nInternal. Alimentary Tract. \xe2\x80\x94 They have a purely local \naction, not being absorbed to any extent from the alimentary \ncanal, and even very large amounts cause only a local exudative \ninflammation (in consequence of the precipitation of proteids) \nwhich is characterized by nausea and vomiting and in extreme \ncases by purging. In small doses they act as astringents upon \nthe mucous membrane of the mouth, stomach and intestine, and \nusually cause constipation. In larger doses they are mechanical \nemetics. On account of the lack of absorption, no symptoms of \ngeneral poisoning are induced by their internal administration, \nand their long-continued use is never attended with evidences \nof chronic poisoning. Locally, however, they have, as has been \nmentioned, a decided action, and it is probably true that their \ncontinued administration in even small doses will produce dele- \nterious effects. \n29 \n\n\n\n434 PHARMACOLOGY AND THERAPEUTICS. \n\nRemote Effects. \xe2\x80\x94 The general action of aluminum salts is \nseen only when they are thrown directly into the circulation. \nAluminum, like various other metals, acts on the intestine and \nkidney, and also appears to have a direct action on the brain. \nThe intoxication is a very slow one, the symptoms appearing \nonly several days after the intravenous injection, at a time when \nthe metal has entirely disappeared from the blood, and has be- \ncome fixed in the cells. In mammals the first symptoms are ob- \nserved in from three to five days, and are found to consist in \nconstipation, rapid loss of weight, weakness, torpor and vomit- \ning. Later, marked abnormalities in movement and sensation \nare noticed, such as tremor, jerking movements, clonic con- \nvulsions, paresis of the hind legs, anaesthesia of the mouth and \nthroat, and lessened sensation over all parts of the body. \nEventually diarrhoea and albuminuria are generally noted. \nAfter death there are found swelling and congestion of the \ngastro-intestinal mucous membrane, fatty degeneration of the \nliver and kidney, and haemorrhages in the cortex of the latter \norgan; while aluminum is found in the urine. It has recently \nbeen shown also that the nerve cells of the spinal cord and \nmedulla oblongata, and particularly those of the lower cranial \nnerves, undergo degeneration. What little aluminum is ab- \nsorbed from the alum salts of the food is thought to be rapidly \nexcreted by the intestine and perhaps by the kidney. \n\nTherapeutics of Aluminum Salts. \nExternal. \xe2\x80\x94 Alum is in general use as a local astringent. \nThus, solutions of it are applied on lint or injected in the vul- \nvitis of children, and are used as injections in leucorrhoea, \ngonorrhoea, gleet, chronic cystitis, dysentery, and haemorrhage \nfrom the rectum. Alum, dissolved in infusion of logwood, is \noften an efficient application for prolapsus of the rectum in \nchildren. In powder or strong solution it is serviceable as a \nstyptic for capillary haemorrhage from wounds, haemorrhage \nafter tooth-extraction, leech bites, epistaxis, bleeding from the \ngums, bleeding piles, etc. An excellent styptic combination \n\n\n\nALUMINUM SALTS. 435 \n\nconsists of equal parts of glycerite of alum (not official), alcohol \nand soap liniment. The topical application of powdered alum \nis sometimes very useful in chronic pharyngitis, tonsillitis and \nnasal catarrh, and in ozsena the nasal chambers may be irrigated \nwith a solution containing 4 gm. (1 dr.) to 500 c.c. (1 pint) \nof water. A solution of about the strength of .30 gm. (5 gr.) \nto 30 c.c. (1 fl. oz.) of water is employed as a gargle, and \ngargling the throat with alum dissolved in a decoction of barley, \nto which a small quantity of honey of roses is added, is said \nto be of service to speakers or singers if practised shortly be- \nfore using the voice. Alum has been used in solution as a \nmouth wash for ulcerative stomatitis and mercurial ptyalism, but \nis objectionable for this purpose, as well as for making gargles, \nas it attacks the enamel of the teeth. For conjunctivitis a watery \nsolution of the glycerite may be employed as a collyrium, and \nalum curd (2 gm. ; 30 gr., of alum beaten up with the white of \na fresh egg) is also sometimes applied externally. A solution \ncontaining .30 gm. (5 gr.) each of alum, copper sulphate, zinc \nsulphate, and ferrous sulphate, to 30 c.c. (1 fl. oz.) of distilled \nwater, to be brushed upon the inside of the lids, once daily, \nhas been recommended in chronic granular conjunctivitis. The \nlocal astringent action of alum may be utilized for weeping \neczema and purpura, and, dissolved in water to which whiskey \nor alcohol is added, it may be sponged over the surface for \nnight-sweats or excessive sweating of the feet or hands, or \nemployed to harden the nipples of pregnant women. Alum \nsolutions are also more or less effective in the treatment of bed \nsores, chilblains, and ingrowing toe-nail. In the latter condi- \ntion a piece of twisted absorbent cotton saturated with a strong \nsolution is inserted under the nail. A hot solution will some- \ntimes relieve pruritus vulvae, and ointments containing alum \nare often useful in herpes and bromidrosis. The dried powder \nis occasionally applied as an escharotic for destroying granu- \nlations and warty growths, and is also used to stimulate in- \ndolent ulcers and mucous membranes with morbid secretions. \nAluminum naphthol-sulphonate (alumnol, not official), in i \n\n\n\n43^ PHARMACOLOGY AND THERAPEUTICS. \n\nto 3 per cent, solutions, is an unirritating astringent which, \nalthough precipitating albumin, dissolves it when in excess, \nand therefore penetrates below the surface. It is used for the \ntreatment of acute and chronic inflammations of various mucous \nmembranes. \n\nInternal. \xe2\x80\x94 It is said that .60 gm. (10 gr.) of alum, placed \nupon the tongue, will sometimes arrest a paroxysm of asthma. \nNot being depressing, alum is a good emetic, especially for \nchildren suffering from croup, bronchitis, etc. 4 gm. (1 tea- \nspoonful) of powdered alum, dissolved in syrup, may be given \nevery fifteen minutes until vomiting is produced. As an internal \nastringent or haemostatic it is not as a rule as efficient as some \nother remedies, but in the form of alum whey (milk curdled \nby alum), it may often be given with advantage in cases of \ntyphoid fever in which the diarrhoea calls for special treatment. \nIn intestinal haemorrhage when dependent upon mechanical \ncauses, such as cirrhosis, if the mucous membrane is free from \nacute inflammation, and in haematemesis when the haemorrhage \nis passive and the gastric mucous membrane relaxed, alum is \nlikely to be of service. It may also be used in catarrh of the \nstomach, especially where there is vomiting of glairy mucus; a \npill containing .24 gm. (4 gr.) of alum and .06 gm. (1 gr.) of \nextract of gentian being administered three times a day. Alum \nis one of the most effective of all remedies in the treatment of \nlead colic, and by many it is considered to relieve the pain and \nnausea and overcome the constipation of plumbism more \ncertainly than any other agent. Its beneficial action is at- \ntributed by some to the fact that, being a sulphate, it \nprecipitates any lead salts present in the intestine as in- \nsoluble lead sulphates. Others, however, hold that the chem- \nical theory of its action is entirely inadequate to account \nfor its remarkable effects, believing that the conversion of \nany portion of the lead present into the insoluble sul- \nphate would not suffice to quiet pain, relieve flatulence, and \nrelax the obstinately constipated bowels. The explanation they \nbring forward is that its action is doubtless dynamical, being \n\n\n\nKAOLIN. 437 \n\nexerted upon the muscular layer of the bowel, on the abnormal \ncondition of which the phenomena of lead colic depend. Still \nothers, finding that alum is of service when there is no lead in \nthe alimentary canal, state that it must act in some way as \nyet unknown. Being a soluble sulphate, as well as an emetic, \nalum may also be used as an antidote in acute lead poisoning. \nIn the form of a very fine spray a strong solution of alum, 1.20 \ngm. (20 gr.) to 30 c.c. (1 fl. oz.), is sometimes efficacious in \nhaemoptysis, and such a spray may also be employed in bron- \nchorrhoea and in chronic catarrh of the pharynx and larynx. \n\nKAOLIN. \nKAOLINUM.\xe2\x80\x94 Kaolin. \n\nPreparation. \nCataplasma Kaolini. \xe2\x80\x94 Cataplasm of Kaolin. (Kaolin Poul- \ntice.) \n\nAction of Kaolin. \n\nKaolin is emollient and a drying agent; it has the power in \na pronounced degree of clarifying and decolorizing oils, \nwhether animal, vegetable or mineral. \n\nTherapeutics of Kaolin. \nKaolin is an efficient dusting powder for inflamed surfaces \nand irritated conditions of the skin. As it is resistant to most \nchemical agents, it is used as a basis for making pills of such \nsubstances as phosphorus, silver nitrate, and potassium per- \nmanganate, in which chemical reaction would ordinarily take \nplace. An excellent substitute for poultices is made as follows : \nKaolin, 1000 parts, is sifted and sterilized by heat; glycerin, \n1000 parts, is added (the heat being continued) and mixed by \nstirring for half an hour. When nearly cool, add boric acid, \n100 parts, and oil of peppermint, 1, oil of wintergreen, 1, and \noil of eucalyptus, 2 parts. The Cataplasma Kaolini which is \nnow official is made as follows: Kaolin, in very fine powder, \n577, is heated at ioo\xc2\xb0 C. (212 F.), with occasional stirring, \nfor one hour, after which boric acid, 45, is mixed intimately \n\n\n\n438 PHARMACOLOGY AND THERAPEUTICS. \n\nwith it and the mixture thoroughly incorporated with glycerin, \n375. Finally, thymol, 0.5, dissolved in methyl salicylate, 2, and \noil of peppermint, 0.5, are added, and a homogeneous mass \nproduced. Kaolin is employed to quite a large extent in \nclarifying oils, such as lard and cotton-seed oils and mineral \nlubricating oils, as well as wine, beer, honey, syrups, etc. \n\n3. Emollients and Demulcents. \n\nSTEARIC ACID. \n\nACIDUM STEARICUM.\xe2\x80\x94 Stearic Acid. \n\nPreparations. \nZinci Stearas. \xe2\x80\x94 Zinc Stearate. \nUnguentum Zinci Stearatis. \xe2\x80\x94 Ointment of Zinc Stearate. \n\nAction of Stearic Acid. \nStearic acid has no known general action upon man. \n\nTherapeutics of Stearic Acid. \nStearic acid is used in the manufacture of glycerin supposi- \ntories. Stearates of zinc and copper (the latter unofficial) \nhave been introduced and used with success in the treatment \nof various diseases of the skin and mucous membranes. \n\nWOOL-FAT. \nADEPS LAKflB.\xe2\x80\x94 Wool-Fat. \n\nPreparation. \nAdeps Lanae Hydrosus. \xe2\x80\x94 Hydrous Wool-Fat. (Lanolin. \nCEsypum.) \n\nAction of Hydrous Wool-Fat. \nHydrous wool-fat is very soothing to the skin, and when \ngently rubbed in is more quickly absorbed than most fats. \n\nTherapeutics of Hydrous Wool-Fat. \nAs it assists the glandular functions of the skin, it is useful \nin comedo and anidrosis. In ichthyosis and scleroderma and \n\n\n\nISINGLASS. 439 \n\nin senile atrophy of the integument it softens the surface, and \ninunction with it is considered one of the best methods of \nobliterating wrinkles. It is serviceable as an application for \nchapped hands and lips, burns, scalds, frost-bite, erythema, \nimpetigo contagiosa, dermatitis, erysipelas and acute eczema, \nand, when it contains a sufficient amount of water, is efficient \nin allaying the itching of scarlet fever and other exanthematous \ndiseases. In chronic eczema with infiltration and in psoriasis it \nsoftens the skin and favors the action of remedies which may \nbe combined with it. It is often an excellent basis for oint- \nments expected to act especially upon the skin, but as it passes \nreadily through the integument, it is not well adapted for a \nprotective. It is a useful vehicle for remedies to be used by \ninunction, and on account of its penetrative power, as well as \nits ready miscibility with mercury, it is of peculiar value in \nthe inunction treatment of syphilis. It is employed to a con- \nsiderable extent also as a vehicle for cocaine in affections of \nthe nose and genito-urinary tract, and for cocaine, morphine, \natropine and other anodynes in neuralgias and painful joints. \nIt is not used internally. \n\nISINGLASS. \nICHTHYOCOLLA (U. S. P., 1890; no longer official).\xe2\x80\x94 Isinglass. \nUnofficial Preparation. \nEmplastrum Ichtliyocollse (U. S. P., 1890). \xe2\x80\x94 Isinglass Plas- \nter. (Court Plaster.) \n\nAction of Isinglass. \nIsinglass is an emollient and nutritive substance. \n\nTherapeutics of Isinglass. \nIt is chiefly used externally as a protective. A better court \nplaster has goldbeaters\' skin as a base. Salicylated isinglass \nplaster has the advantage of the antiseptic properties of salicylic \nacid. A codliver-oil jelly may be made by means of isinglass \nwhich, flavored with the oils of almond, cinnamon and allspice, \nis readily taken by children. \n\n\n\n440 PHARMACOLOGY AND THERAPEUTICS. \n\nLARD. \n\n1. ADEPS.\xe2\x80\x94 Lard. \n\nPreparations. \n\n1. Adeps Benzoinatus. \xe2\x80\x94 Benzoinated Lard. \n\n2. Ceratum. \xe2\x80\x94 Cerate. \n\n3. Ceratum Resinae. \xe2\x80\x94 Rosin Cerate. \n\n4. Ceratum Resinae Compositum. \xe2\x80\x94 Compound Rosin Cerate. \n\n5. Unguentum. \xe2\x80\x94 Ointment. \n\n2. OLEUM ADIPIS.\xe2\x80\x94 Lard Oil. \n\n\xe2\x80\xa2 Action of Lard. \nLard is one of the best emollients, its application to the skin \nbeing followed by a pleasant feeling of softness and flexibility. \nMelting at the temperature of the body, it is readily absorbed \nby the integument. The benzoated lard has the advantage of \nnot quickly becoming rancid, but it is irritating to tender skins. \n\nTherapeutics of Lard. \nLard has been used with some success as a soothing enema in \ndysentery. When the secretory formation of the skin is im- \npaired or suppressed, inunction with lard serves as a partial \nsubstitute for the natural secretion, and such inunction is some- \ntimes employed by professional rubbers as an aid to friction. \nIt is also of service in chest affections. Washed lard, beaten \nup with an equal quantity of lime water, and a few drops of \noil of bitter almond, thymol, or carbolic acid added, is said to \nmake an elegant substitute for Carron oil as a dressing for \nburns, as well as for some acute inflammations of the skin. On \naccount of its penetrating power, active agents, such as mer- \ncury and the alkaloids, can be combined with lard for adminis- \ntration by inunction, and its chief use in medicine is as a basis \nfor ointments. \n\nSPERMACETI. \n\nCETACEUM.\xe2\x80\x94 Spermaceti. \n\nPreparation. \nUnguentum Aquae Rosas. \xe2\x80\x94 Ointment of Rose Water. \n\n\n\nCHAULMOOGRA OIL. 44 I \n\nUnofficial Preparation. \nCeratum Cetacei (U. S. P., 1890). \xe2\x80\x94 Spermaceti Cerate. \n\nAction of Spermaceti. \nSpermaceti is emollient and demulcent. \n\nTherapeutics of Spermaceti. \nIt is used almost entirely as a basis for ointments and cerates. \nIn the form of powder, which may be obtained by triturating \nit with a little alcohol, spermaceti is sometimes employed, \nmixed with an equal weight of talc, as a dusting powder for \nthe feet, for the purpose of preventing friction. \n\nEGG. \n\nUnofficial Preparations. \n\n1. Vitellus (U. S. P., 1890).\xe2\x80\x94 Yolk of Egg. \n\n2. Glyceritum Vitelli (U. S. P., 1890).\xe2\x80\x94 Glycerite of Yolk of \nEgg. (Glyconin.) Dose, freely. \n\n3. Ovi Albumin. \xe2\x80\x94 Egg Albumin. \n\nAction of Yolk of Egg. \nYolk of egg is nutritive and emollient. \n\nTherapeutics of Yolk of Egg. \nIt is used to make emulsions. \n\nAction of Egg Albumin. \nLike the yolk of egg, it is nutritive and emollient. \n\nTherapeutics of Egg Albumin. \nEgg albumin is an antidote to poisoning by corrosives and \nirritants, especially corrosive -mercuric chloride, copper sul- \nphate, lead salts, and silver nitrate. \n\nCHAULMOOGRA OIL. \n\nUnofficial Preparation. \nOleum Gynocardiae.\xe2\x80\x94 Chaulmoogra Oil. Dose, 0.30 to 1.20 \nc.c.; 5 to 20 m,. \n\n\n\n442 PHARMACOLOGY AND THERAPEUTICS. \n\nAction of Chaulmoogra Oil. \n\nIt is a local irritant, apparently similar in character to can- \ntharidin and other agents of its class, though less energetic in \nits action. \n\nTherapeutics of Chaulmoogra Oil. \n\nIt has been largely employed as a local application for bruises, \nsprains and stiffness by athletes, and also in veterinary practice. \nIt is recommended as a stimulant in scaly eczema, psoriasis, \nichthyosis, syphilitic cutaneous lesions, chronic rheumatism, etc., \nand for such purposes an ointment composed of 3 parts of \nchaulmoogra oil to 8 of lanolin may be employed. It is best \nknown as a remedy for leprosy, in which it has been extensively \ntried both externally and internally. It is not apparently cura- \ntive, but the bacilli of the disease present in the blood have \nbeen shown to decrease in number under its use, and it is un- \ndoubtedly one of the best agents at our command in this intract- \nable affection. Internally it is usually administered in capsules. \n\nPETROLATUM. \nPETROLATUM (Petrolatum Molle, Petrolatum Spissum, U. S. P., \n1890) . \xe2\x80\x94 Petrolatum. \nPETROLATUM ALBUM.\xe2\x80\x94 White Petrolatum. \nPETROLATUM LIQUIDUM.\xe2\x80\x94 Liquid Petrolatum. \n\nAction of Petrolatum. \n\nPetrolatum is purely emollient. None of the petroleums are \nnutritive. \n\nTherapeutics of Petrolatum. \n\nPetrolatum is used principally as a bland, neutral protective, \nand, because it does not become rancid nor act as an irritant, \nand as it is not affected by acids, alkalies or powerful reducing \nagents, it is employed as a substitute for fatty materials in oint- \nments. But as it is absorbed with difficulty it is not a suitable \nvehicle for drugs which are intended for absorption through the \nskin. Liquid petrolatum has been used as a local soothing ap- \n\n\n\ncotton. 443 \n\nplication in inflammation of the mucous membrane of the nose, \nthroat, larynx, and even of the bronchial tubes, by means of \nan atomizer. It may also be employed as a vehicle for various \nmedicinal substances. \n\nCOTTON. \n\n1. GOSSYPIUM PURIFICATUM.\xe2\x80\x94 Purified Cotton. (Absorbent \nCotton.) \n\n2. PYROXYLINUM.\xe2\x80\x94 Pyroxylin. (Gun Cotton.) \n\nPreparations. \n\n1. Collodium. \xe2\x80\x94 Collodion. \n\n2. Collodium Flexile. \xe2\x80\x94 Flexible Collodion. \n\n3. Collodium Cantharidatum. \xe2\x80\x94 Cantharidal Collodion. (Blis- \ntering Collodion.) \n\n4. Collodium Stypticum. \xe2\x80\x94 Styptic Collodion. \n\n3. OLEUM GOSSYPII SEMINIS.\xe2\x80\x94 Cotton Seed Oil. Dose, 16 \nc.c; 4 fl. dr. \n\nAction of Cotton. \n\nNone. \n\nTherapeutics of Cotton. \n\nCotton is used in various forms as a covering, protection, or \nsupport, and also for the topical application of remedies. Ab- \nsorbent cotton, lint and gauze are frequently medicated, e. g., Sal \nAlembroth, 2 per cent.; Boric Acid, 5 or 10 per cent.; Salicylic \nAcid, 5 per cent; Chrysarobin, 10 per cent.; Phenol, 5 per \ncent.; Iodoform, 5, 10 and 50 per cent. The only use of py- \nroxylin is for making collodion, which, when painted on the \nskin, quickly forms a thin and dry protective film over it, in \nconsequence of the evaporation of the ether. Flexible collodion \nhas the advantage over ordinary collodion of not cracking when \nthus dried on the integument. These preparations are pro- \ntective to small wounds and excoriated surfaces, and are used \nafter slight operations. The edges of larger wounds may be \ndrawn together and kept in position by strips of gauze, which \nare made to adhere to the skin by the application of several \n\n\n\n444 PHARMACOLOGY AND THERAPEUTICS. \n\ncoats of flexible collodion. Collodion is especially serviceable \nfor scalp-wounds, in which it often renders a bandage unneces- \nsary. The contraction and compression resulting from the dry- \ning of the substance are sometimes utilized in the abortive treat- \nment of boils and styes, and of the papules of small-pox (to \nprevent pitting), as well as in the treatment of epididymitis (in \nwhich the testicle and cord are freely painted over with it), \nof umbilical hernia, of varicocele, and of spina bifida. Collo- \ndion may also be applied in superficial burns, in erysipelas, and \nin herpes zoster, and, after the parts have been antiseptically \ncleansed with a phenol solution, it often affords relief in \npruritus ani. The closing of the orifice of the urethra or the \nprepuce with it at bedtime is sometimes successful in putting \na stop to nocturnal incontinence of urine in male children. Sev- \neral cases of tuberculous peritonitis have been reported by \nFrench physicians in which the repeated application of collo- \ndion to the entire surface of the abdomen was followed by \nrecovery. \n\nAction of Cotton Seed Oil. \nCotton seed oil is nutrient and emollient. \n\nTherapeutics of Cotton Seed Oil. \nThis is used simply as a bland, nutritious oil, and in lini- \nments. \n\nOIL OF THEOBROMA. \nOLEUM THEOBROMATIS.\xe2\x80\x94 Oil of Theobroma. (Cacao Butter.) \n\nAction of Oil of Theobroma. \nOil of theobroma is nutrient and emollient. \n\nTherapeutics of Oil of Theobroma. \nOil of theobroma is used to make suppositories, and as a \nsource of stearic acid. It is also used by inunction to improve \nthe nutrition of the body. Its slight tendency to become oxi- \ndized renders it serviceable for preserving steel instruments \nfrom corrosion by exposure to the air. \n\n\n\nFLAXSEED. 445 \n\nFLAXSEED. \n\nLINUM.\xe2\x80\x94 Linseed. Flaxseed. \n\nOLEUM LINL\xe2\x80\x94 Linseed Oil. (Flaxseed Oil.) Dose, 30 C.C.; 1 fl. \noz. \n\nPreparation. \n\nLinimentum Calcis. \xe2\x80\x94 Lime Liniment. \n\nAction of Flaxseed. \nFlaxseed is demulcent and emollient. It has been thought \nby some to have expectorant qualities, but it probably has no \ndirect action on the bronchial mucous membrane. It is mildly \ndiuretic, and its preparations, if given in sufficient amount, have \na laxative effect. Its diuretic action, it is believed, may be \ndue to the excretion by the kidneys of the resinoid oxidation \nproducts formed from the oil. \n\nTherapeutics of Flaxseed. \nExternally the meal (lini farina), in the form of poultices \n(4 to io of boiling water with constant stirring and the basin \nbeing kept hot), is very extensively used for the purpose of \napplying warmth and moisture, especially in inflammatory con- \nditions, both superficial and deep-seated. It relaxes the tissues \nand relieves pain. It tends to check inflammation if applied \nearly, and accelerates the evacuation of pus after suppuration \nhas commenced. The poultice, as ordinarily used, however, is \nuncleanly, and has come to be regarded as a hot-bed for bac- \nteria and not infrequently a means of favoring the extension \nof the infectious process present. It has been suggested as a \ngood method of preparing poultices to make several bags of \nsuitable size, of either of the fabrics known as Swiss and \ncheese cloth, fill them half-full with flaxseed meal, and then \nsew up the open ends. When wanted for use, one of these \nbags is submerged in boiling water for a few minutes (which \ncauses the meal to swell so as to fill the bag), and, after the \nsuperfluous water has been squeezed out, it is laid on the \naffected part and covered with oiled silk and a bandage. Care \n\n\n\n446 PHARMACOLOGY AND THERAPEUTICS. \n\nshould, of course be taken not to apply the poultice so hot as \nto scald the skin. Flaxseed and other poultices not only pro- \nmote local vascular dilatation, but also have a counter-irritant \neffect. Their action may be increased, if desired, by the addi- \ntion of 1 part of mustard to 16 of the material composing the \npoultice, or by smearing the surface to be covered with equal \nparts of belladonna and glycerin, or sprinkling on it a little \ndry mustard or a few drops of turpentine. Laudanum, or lead- \nwater and laudanum, may be incorporated in the poultice or \napplied under it if there is much pain or if the skin is broken. \nPoultices are also sometimes medicated with astringents and \nother agents. Linseed oil, made into an emulsion with an equal \npart of lime-water which is popularly known as Carron oil \n(the official Linimentum Calcis), was long a favorite remedy \nfor burns, but as it is uncleanly and has a disagreeable odor, it \nhas largely been supplanted by other agents. The oil is also \nsometimes used for laxative purposes as an enema, especially \nin children. An infusion of flaxseed, 15 gm. ( x / 2 oz.) to 500 \nc.c. (1 pint), is considered an excellent enema in inflammation \nof the rectum, fissure, piles, etc., and is also used as an injection \nin irritations of the bladder and vagina. Flaxseed mucilage, \nprepared by boiling the seed, has been employed to a con- \nsiderable extent as an external application in erysipelatous and \nother cutaneous inflammations, burns, etc., but if allowed to \nget dry it renders the skin stiff. Lead acetate is sometimes dis- \nsolved in it, precipitating the solution of lead subacetate. Flax- \nseed tea (flaxseed, 3; liquorice, 1; boiling water, 100; infuse \nfor two hours) is a common domestic demulcent, which is used \nespecially in acute bronchitis and sore throat. If given hot it \nhas a diaphoretic effect, and the large amount of mucilage which \nit contains renders it very soothing to the inflamed mucous \nmembrane. In the mouth and pharynx it forms a coating \nwhich is of service in relieving " tickling of the throat " and \nirritative cough. The hot infusion is also used to a considerable \nextent in enteritis and dysentery and in irritation of the stomach \nand the kidneys, cystitis, strangury, etc. It should never be \n\n\n\nolive oil. 447 \n\nboiled during the process of preparing it, as the application \nof too much heat causes the extraction of more or less of the \noil, and so renders it less palatable. Lemon and sugar may be \nadded, according to the taste of the patient, and it may be taken \nad libitum. Whole flaxseed, in doses of 15 gm. { J / 2 oz.), is \noccasionally used as a laxative in habitual constipation, and the \noil in doses of 60 c.c. (2 fl. oz.) has been recommended as a \nlaxative in the treatment of haemorrhoids. \n\nOLIVE OIL. \nOLEUM OLIV^E.\xe2\x80\x94 Olive Oil. (Sweet Oil.) Dose, 30 C.C.; 1 fl. oz. \n\nUnofficial Preparation. \nEunatrol.\xe2\x80\x94 Eunatrol. (Sodium Oleate.) Dose, 2 to 5 gm.; \n30 to 80 grs. daily. \n\nAction of Olive Oil. \nOlive oil is lubricant, emollient, demulcent, nutritive and \nmildly laxative. Externally applied it acts as a protective to the \nskin, which it renders soft and pliant. When rubbed in with suffi- \ncient friction it is absorbed, and afterwards assimilated by the \nsystem. Taken by the mouth, it is, like other oils, partly emulsi- \nfied and partly saponified in the intestine, and the olein it con- \ntains is finally deposited in the body as fat. If the quantity \ningested is larger than can be absorbed, the excess will appear \nunchanged in the urine. \n\nTherapeutics of Olive Oil. \nExternal. \xe2\x80\x94 It is much used to facilitate the rubbing of joints \nand other parts of the body. It is sometimes employed in mas- \nsage, but lanolin and neat\'s-foot oil are considered the best \nforms of grease for this purpose. Unless the skin is very \nharsh, dry or scaly, however, the manipulation can usually be \nmore efficiently performed without any lubricant. Warm olive \noil is useful for removing crusts in such conditions as sebor- \nrhcea, eczema and psoriasis. It should not be allowed to get \n\n\n\n448 PHARMACOLOGY AND THERAPEUTICS. \n\ninto the eyes, as it is liable to produce considerable irritation \nif it comes in contact with the conjunctiva. It is a common \nsoothing protective in burns and acute inflammatory affections \nof the skin, coating the surface and excluding the air. In the \nformer it is sometimes used in place of linseed oil in Linimentum \nCalcis (see p. 446). Carbolized oil (1 to 24) often constitutes \na good dressing for wounds. Olive oil is employed as an emol- \nlient addition to poultices, and with poultices applied in the \nordinary way it is of service in preventing them from adhering; \nfor this purpose it may either be incorporated in the poultice \nor smeared on the surface to which the latter is to be applied. \nAs it is absorbed by the lymphatics when rubbed vigorously into \nthe skin, it may be used in this way for the purposes of a food \nin cases where sufficient nourishment cannot be taken by the \nmouth. As a nutritive, however, it is less valuable than codliver \noil, which is administered to a considerable extent by inunction \nin wasting diseases. Oil inunctions are of great service in \nscarlet fever and other exanthematous diseases. They reduce \ntemperature and are very grateful to the patient; allaying the \nburning heat and itching of the skin, and in this way diminish- \ning excitement and restlessness. Their antipyretic effect is also \nprobably due to a considerable extent to their influence in \nmitigating one of the chief sources of distress in this class of \naffections. They are especially valuable in the desquamative \nstage of scarlet fever, where they serve a prophylactic purpose \nby preventing the dispersion of the scales in the atmosphere. \nFor inunction in fevers carbolized olive oil (1 to 40) is a very \ngood preparation, possessing as it does disinfecting properties; \nthough cocoa-butter is a more elegant one, and some consider \nbenzoated lard the most satisfactory. By dropping a little \nolive oil into the auditory canal insects can readily be removed \nfrom the ear. The oil was formerly much used as a lubricant \nfor catheters, sounds and other instruments, but vaseline has \nhere replaced it to a considerable extent. It is employed as an \ningredient in many liniments, plasters, ointments and cerates, \nbut the foreign article is so frequently adulterated with inferior \n\n\n\nolive oil. 449 \n\noils that cotton-seed oil is now directed in its place in many \nofficial preparations. A very large proportion of the olive oil \nof commerce at the present day is known to be in reality cotton- \nseed oil, and there appears, indeed, to be no appreciable differ- \nence between the physiological and therapeutic properties of the \ntwo, although cotton-seed oil is not so agreeable in flavor. \nOlive oil is a common application in the bites and stings of in- \nsects, and in some parts of Europe and the east it is used both \nlocally and internally in the treatment of snake bites. \n\nInternal. \xe2\x80\x94 From ancient times to the present it has been a \nregular article of diet in olive-growing lands, but, except as an \ningredient of salad-dressings, it is not much used as a food in \nthis country. Taken promptly into the stomach in sufficient \nquantity, it is useful in mitigating the effects of irritating \npoisons, but it should not be employed after phosphorus has \nbeen swallowed, as the latter dissolves in it. As a laxative it \nis much used (in teaspoonful doses) for infants, and it also \nanswers very well sometimes in adults. Where the patient does \nnot object to its taste it may be advantageously given with \nfood. It is especially recommended in the constipation caused \nby opium and as a demulcent laxative in haemorrhoids and fissure \nof the anus. Occasionally it has been successful, when given \nin large doses, in causing the expulsion of tape-worms. On \naccount of its blandness it is frequently prescribed in the form \nof an enema, which may be composed entirely of olive oil or of \noil and warm mucilage of starch in the proportion of 15 to 18. \nThe soap enema (soap, 1 ; warm water, 32), however, is the one \nmost generally employed for ordinary purposes. Olive oil is \nsometimes injected into the rectum to get rid of thread- worms, \nbut is not as reliable as some other agents. It has been found \nvery useful in the case of workmen employed in white-lead \nfactories in keeping the bowels free and preventing the absorption \nof the metal, and it is also efficient in the treatment of lead colic \nitself. There is now at command abundant clinical evidence of \nthe marked value of olive oil in biliary calculi. While out- \nside the body the oil is a solvent for cholesterin, the chief con- \n\n\n\n45 O PHARMACOLOGY AND THERAPEUTICS. \n\nstituent of gall-stones, it has been doubted by some if when \ntaken internally, even in very large amount, it is possible for \nthe oil to exert this solvent action. High authorities claim that \nit does assist materially in the solution of calculi ; but whether \nthis is the case or not, there can be no question that it is of \nvery great service in cholelithiasis by increasing the watery \nsecretion of bile. It is recommended that not less than from \n60 to 250 c.c. (2 to 8 fl. oz.) should be taken daily. It may be \nrendered more palatable by the addition of a small quantity of \nmenthol and 4 c.c. (1 fl. dr.) of brandy to each 250 c.c. (half- \npint), or it may be given in aromatized emulsion with a little \nbrandy or whiskey. Certain patients can take it better mixed \nwith fish, mashed potatoes, or other kinds of food. Some assert \nthat the best results may be obtained by giving from 30 to 60 \nc.c. (1 to 2 fl. oz.) of olive oil in hot milk for ten nights in \nsuccession. The remedy is then omitted for a week, and this \ncourse is kept up for a number of months. In addition to the \ntreatment of the gall-stones themselves, sodium benzoate and \nsalicylate are recommended as intestinal antiseptics. Eunatrol, \nor pure sodium oleate, is also stimulating to the biliary secre- \ntion and has been found useful in gall-stone disease. From \n2 to 2.40 gm. (30 to 40 gr.) may be taken daily, in .30 gm. \n(5 g r piU s or capsules. Olive oil, in doses increasing from \n15 to 90 c.c. (y 2 to 3 fl. oz.), is said to have caused the dis- \nappearance of obstructive jaundice. In obstinate and painful \ncases of dry pleurisy a small quantity of the oil, sterilized, has \nbeen injected into the pleural sac with the idea of imitating \nNature in providing a lubricating fluid. \n\nOLEIC ACID. \n\nACIDUM OLEICUM.\xe2\x80\x94 Oleic Acid. \n\nAction of Oleic Acid. \nOleic acid is bland and unirritating, and penetrates the skin \nmore readily than fats and oils. \n\n\n\nSOAP. 451 \n\nTherapeutics of Oleic Acid. \nIt is not employed by itself in medicine, but used pharma- \nceutically in the preparation of oleates and also in plasters and \nsoaps. Oleates, which are readily soluble in fats, and thereby \nrendered more efficient for local application, are made from \nthe alkaloids, not from their salts. If metals are employed, \nthe oxides only are chosen. The oleates are used for the pur- \npose of securing the absorption of drugs through the skin. \nMany substances which are either not absorbed at all or only \nto a very limited extent from aqueous, are freely absorbed from \noily, solutions, while many which are not soluble in oils dissolve \nin oleic acid. Hence the special utility of the oleates. Besides \nthe official oleates, a considerable number of others are also \nnow in use. Some of them, such as the oleates of copper and \nmercury, are excellent parasiticides, and this class of prepara- \ntions is steadily growing in favor in the treatment of cutaneous \naffections generally, as well as of a variety of other conditions. \n\nSOAP. \n\n1. SAPO.\xe2\x80\x94 Soap. (White Castile Soap. Hard Soap.) \n\nPreparations. \n\n1. Emplastrum Saponis. \xe2\x80\x94 Soap Plaster. \n\n2. Linimentum Saponis. \xe2\x80\x94 Soap Liniment. (Opodeldoc.) \n\n2. SAPO MOLLIS.\xe2\x80\x94 Soft Soap. (Green Soap.) \n\nPreparation. \nLinimentum Saponis Mollis. \xe2\x80\x94 Liniment of Soft Soap. (Tinc- \ntura Saponis Viridis.) \n\nUnofficial Preparation. \nSapo \' Animalis (B. P.). \xe2\x80\x94 Curd Soap. \n\nAction of Soap. \nExternally soap is detergent and discutient, combining with \nthe fat of the excretions and removing, along with this, epi- \n\n\n\n452 PHARMACOLOGY AND THERAPEUTICS. \n\nthelial scales, bacteria and dirt, or other foreign matter. In- \nternally it is laxative and antacid. While it softens the epi- \ndermis, it may set up considerable irritation if applied too long \nor with too much friction, or if the soap used is too strongly \nalkaline or not sufficiently diluted with water. \n\nTherapeutics of Soap. \nIn modern surgery it is customary to scrub the part to be \noperated upon with hard soap and water before washing it \nwith an antiseptic solution. Good Castile soap is considered the \nbest representative of a pure soap to be had. Hard soap, in \npowder, is used to some extent as an ingredient of dentifrices, \nand it no doubt aids in the preservation of the teeth. In recent \nyears it has been considerably employed for medicated soaps, \nwhich, if judiciously applied, are decidedly beneficial in a \nvariety of cutaneous affections. Among the agents commonly \nincorporated in them are sulphur, tar, phenol, mercuric bi- \nchloride, ichthyol, eucalyptol, naphthol and salicylic acid. In \nordering a medicated soap the desired percentage of the drug \nto be used should be given in the prescription. Soaps are \nordinarily used for cleansing. Most toilet soaps, it has been \npointed out, are too strongly alkaline and often contain irritating \nessential oils; while many cheap kinds are made with animal \nfat which has not been properly purified, and therefore liable \nto contain the bacteria of putrefaction and possibly of disease. \nIn the case of persons with delicate skins, and especially in- \nfants, it is very important that only a bland and pure article \nshould be selected. A carefully prepared glycerin soap is be- \nlieved to be, on the whole, the best for the skin. Soap mixed \nwith brown sugar has long been a favorite domestic remedy \nin the local treatment of boils. It makes a useful stimulating \ndressing, and, if applied sufficiently early, appears to mitigate \nthe pain as well as quicken suppuration. Soap suppositories \ninserted in the rectum generally cause a prompt evacuation of \nthe bowels, and are frequently resorted to in the constipation \nof infants. For use in adults, particularly, their efficiency may \n\n\n\nsoap. 453 \n\nbe increased by the addition of glycerin. Hard soap is a good \nexcipient for pills, and it forms the basis of several of those in \nthe Pharmacopoeia. Soap is of considerable value as an anti- \ndote in poisoning by acids and other irritants. It also acts as \nan aid to emetics, and has the great advantage of being always \naccessible. In such cases its use should be resorted to at the \nearliest possible moment and continued until more powerful \nalkalies, such as chalk, magnesia, or sodium bicarbonate, can be \nobtained. A teacupful of solution of soap, in the proportion of \nabout one to four, by weight, of water, may be repeated at short \nintervals until the patient has taken all that he can swallow. \nIf promptly applied, soapsuds are also an excellent remedy for \nexternal burns by acids and by phosphorus. Soap was formerly \nused to some extent in dyspepsia attended with inactivity of \nthe liver and constipation, and is still occasionally employed in \nacidity of the stomach, as it is readily decomposed by very \nweak acids, which combine with the alkali. Even as an antacid, \nhowever, it has been largely supplanted by other agents, and \nit is very rarely given internally at all except in combina- \ntion with other agents in pills. By its alkaline properties \nit may afford more or less relief in cystitis, but the claim \nonce made for it that it is a solvent for vesical calculi \nhas long since been disproved. Soap plaster is protective \nagainst bed-sores, and is also sometimes used as a support \nabout sprained joints. Linimentum Saponis is a cutaneous \nstimulant. It is employed with friction in sprains, stiffness of \nthe joints or muscles, etc., and it constitutes the basis of the \nofficial chloroform liniment. It is also a favorite basis for ex- \ntemporaneous liniment prescriptions, and such agents as aconite, \nopium and belladonna are frequently combined with it. \n\nSoft soap, which is also known as green soap, although it is \nnot generally green, but of a brownish color, is much more \nstrongly alkaline than hard, and, containing free potassium \nhydroxide, as it does, is decidedly irritant. It has a soft- \nening effect on tissues with which it comes in contact, \nand is therefore of considerable service in chronic indur- \n\n\n\n454 PHARMACOLOGY AND THERAPEUTICS. \n\nations of the skin. One of its uses is to remove crusts \nand epithelial scales in cutaneous affections. It is also of \nvalue in the general treatment of a number of diseases of \nthe skin, and among the more prominent of those in which \nit has proved of service are chronic psoriasis, acne, tinea, and \neven lupus. If there is much itching, it may be combined with \noil of cade. For chronic eczema it has been found that the \nbest form in which to use it is the Linimentum Saponis Mollis, \nwhich should be well rubbed into the affected part and fol- \nlowed by a soothing application, such as simple cerate. The \nliniment is an excellent cleansing agent for the scalp, especially \nin seborrhoea, and for shampooing purposes it should be diluted \nwith three parts of alcohol or Cologne water. When pediculi are \npresent it is useful in preparing the way for a parasiticide appli- \ncation by dissolving the adhesion of the nits to the hair shafts. \nThis, like the Linimentum Saponis, is also employed as an appli- \ncation, usually enforced by more energetic medicinal agents, \nfor sprains, stiff joints, etc. Soft soap is furthermore used \nlocally in the treatment of enlarged glands, whether the con- \ndition is a simple inflammatory one or of strumous or syphilitic \norigin. Its external application may be of some service, as well, \nin other strumous or tuberculous conditions, such as disease \nof the mesenteric glands or periostitis, and in exudations into \nserous cavities. One of the most common uses of both hard \nand soft soap is for purgative enemata; but the latter is de- \ncidedly preferable. For this purpose either may be made into \na lather with 500 c.c. (1 pint) or more of water at a tempera- \nture of 37.8 C. (ioo\xc2\xb0 F.). Soap enemata are somewhat liable \nto give rise to an erythematous or urticarial eruption, and this \nappears to be especially the case with those made with hard \nsoap. In some individuals such a rash makes its appearance \nregularly after each injection, however often the enema may \nbe repeated. This may be due to some irritant in the soap em- \nployed, or possibly, as some are inclined to believe, may result \nfrom the solution and consequent absorption of some fsecal \ntoxin. Doubt has been expressed whether the rectal injection \n\n\n\nraisins. 455 \n\nof soap and water has any more effect in causing an evacuation \nof the bowels than would an enema of warm water alone or the \nsame quantity of thin oatmeal gruel; but it seems altogether \nprobable that the soap itself has some purgative action, though \nthis may sometimes be but slight. In order to increase the effi- \nciency of a soap enema it may be advisable to add to it a cer- \ntain amount of castor oil. The quantity of soft soap used is \nusually about 30 c.c. (1 fl. oz.). In some hospitals there is \nemployed an enema, known as the " House Mixture," which \nconsists of soft soap, molasses and water in varying proportions, \nand to which turpentine and olive oil are added if flatulence be \npresent. This, it is claimed, is " as efficient as it is cheap and \ndirty." \n\nSapo Animalis, or curd soap, consists chiefly of sodium \nstearate, and, like other soaps, it is detergent. Its solution \nin boiling alcohol, after cooling, forms a jelly-like mass which \nconstitutes the basis of hard opodeldoc. Curd soap is also used \nas a basis for plasters, liniments, pills and suppositories. Em- \nplastrum Saponis Fuscum (brown soap plaster, not official) is \ncurd soap, 20 ; yellow wax, 25 : olive oil, 40 : lead oxide, 30 ; \nvinegar, 320. \n\nRAISINS. \n\nJJYJE. \xe2\x80\x94 Raisins (not official). \n\nAction of Raisixs. \n\nRaisins are demulcent and nutritive. Taken in bulk, they \nare slightly laxative, but are difficult of digestion and liable to \nproduce flatulence. The fresh pulp has some diuretic action, \nwhich is attributed in great part to the grape-sugar which it \ncontains. \n\nTherapeutics of Raisixs. \n\nRaisins are used as sweetening and flavoring agents, especially \nin demulcent and amylaceous beverages, such as the infusions \nof flaxseed, rice, oatmeal and barlev. \n\n\n\n45^ PHARMACOLOGY AND THERAPEUTICS. \n\nSOJA BEAN. \nSOJA HISPIDA.\xe2\x80\x94 Soja Bean (not official). \n\nAction of Soja Bean. \nSoja bean is demulcent and nutritive. In southern Asia it is \nused as a food, and the plant is also cultivated for the purpose \nof preparing from it a sauce called soy. \n\nTherapeutics of Soja Bean. \nIn the dietetic treatment of diabetes it is used, in the form of \nbread and biscuits made from the flour, as a substitute for \ngluten bread. Many patients prefer the taste of these to that \nof the latter, and they have been found quite as efficacious in \nreducing the amount of sugar passed in the urine. \n\nMALT. \nMALTUM.\xe2\x80\x94 Malt. (Byne.) \n\nPreparation. \nExtractum Malti. \xe2\x80\x94 Extract of Malt. Dose, 16 c.c; 4 fl. dr. \n\nUnofficial Preparation. \nTaka-diastasum. \xe2\x80\x94 Taka-diastase. Dose, 0.30 to 0.60 gm.; \n5 to 10 gr. \n\nAction of Malt. \nMalt is demulcent and nutritive. Many of the malt extracts \nmanufactured are quite inert as regards the digestion of starch, \ninasmuch as the diastase of the malt has been destroyed by the \nheat employed in their preparation; but, while thus devoid of \ndigestive power, they form a pleasant, easily digested food. \nAlcohol, as well as heat, destroys the ferment, and the liquid \nmalts containing alcohol are also worthless for assisting starch \ndigestion. Many are only beers of an inferior quality, and the \nbest of them are indistinguishable from stout. True extract of \nmalt contains no alcohol at all. Taka-diastase, which is named \n\n\n\nMALT. 457 \n\nafter its discoverer, Takamine, and is an enzyme derived from \nEnrotium oryza, a fungus of the aspergillus family, has been \nfound to be very much more energetic than any of the malt \nextracts, as it digests over one hundred times its own weight \nof starch. As soon as the acidity of the gastric juice exceeds \no.i per cent, it ceases to act in it, but it is able, no doubt, to \ndigest a considerable amount of starch in the mouth and \nstomach before it is destroyed. It is a question of great prac- \ntical interest, however, whether the ordinary digestive juices \nare ever unable to digest the starch of the food, and it may be \nstated, on high authority, that no satisfactory evidence of the \nexistence of a supposed class of cases to which the name of \namylaceous dyspepsia has been given has as yet ever been \nbrought forward. Until it is shown that in some instances the \ndigestion of starch by the intestinal ferments is insufficiently \nperformed, the diastase preparations would seem, therefore, to \nbe superfluous. As the opinion is very widely held, however, \nthat in many cases the natural ferments do fail to adequately \nperform this function, and that in them diastase to some extent \nsupplies their place, it appears to be the part of wisdom, for \nthe present at least, to give the latter the benefit of the doubt. \nAll malts, consequently, should be rejected which do not con- \ntain at least 4 per cent, of diastase. Maltose, which is a prod- \nuct of the action of the ferment diastase upon starch, leads to \nthe formation of fat and constitutes, in many conditions, a very \nexcellent food. Its value in this respect rests on the fact that \nit is readily absorbed both in the stomach and small intestine. \nIn the system it undergoes a transformation into dextrose, and \nit is not found present as maltose in the tissues. As the malt \nliquors contain malt extract, as well as hops, an aromatic \nbitter, their nutritive, tonic and stomachic qualities are greater \nthan those of spirits and wine. At the same time, it must not \nbe forgotten that the beneficial effects of these constituents are \nto a very considerable extent diminished by the process of fer- \nmentation; so that the value of such beverages as foods is apt \nto be greatly exaggerated by their habitual consumers. They in- \n\n\n\n45 8 PHARMACOLOGY AND THERAPEUTICS. \n\ncrease the appetite and lead to the deposition of fat, and when \ntaken in excess are not infrequently the cause of fatty degenera- \ntion in various organs, more particularly the liver and the \nheart. \n\nTherapeutics of Malt. \nMalt extracts, the value of which depends principally on the \namount of maltose they contain, are used in all conditions where \nit is desirable to give a readily assimilable carbohydrate food. \nThey are particularly indicated in convalescence from acute \ndisorders, in the derangements of the system caused by chronic \ndisease, and in cases of wasting and of poor digestion and \nassimilation. They are usually well borne by the stomach, \nand in many instances can be taken by those who reject other \nnutritive agents, such as codliver oil. While not possessing \nall the virtues of the latter in pulmonary tuberculosis, they \nsometimes prove a satisfactory substitute for it. Not infre- \nquently extract of malt is advantageously combined, in emul- \nsion, with codliver oil; the comparatively small dose of the \nlatter then required being less apt to disagree with the patient \nthan a larger quantity taken by itself. Such emulsions should \ncontain about I part of oil to 4 of malt. Malt extracts are very \nlargely given for the purpose of assisting the digestion of \nstarchy foods. Diastase, it should be remembered, like the fer- \nments of the saliva and pancreatic fluid, can act only in a \nneutral or alkaline medium. As experiments have demonstrated \nthat this agent, when taken into the stomach, must sooner or \nlater be completely destroyed by the gastric juice, it has been \nadvised that when the diastatic action of malt extract is de- \nsired, it should always be given at the beginning of a meal. \nUsually, however, it is directed to be taken at least two hours \nafter a meal, by which time the stomach is presumed to be \nfree from the acid gastric juice. By some authorities it is be- \nlieved that in most cases the administration of diastatic ferments \nis of little benefit, and that the great value attached to them \nrests on the fact that they are useful agents in producing pre- \ndigested foods. Malt extract may be used to form a syrupy \n\n\n\nsugar. 459 \n\nmixture with preparations of iron or cinchona. The follow- \ning will often be found serviceable : Ferric pyrophosphate, 2 ; \nwater, 3; dissolve and add extract of malt, 95. Dose, 4 to 15 \nc.c. (1 to 4 fl. dr.). Malt extract, to which a suitable amount \nof fluidextract of cascara sagrada has been added, is an ex- \ncellent laxative. \n\nPEARL BARLEY. \n\nHORDEUM DECORTICATUM.\xe2\x80\x94 Pearl Barley (not official). \n\nAction of Pearl Barley. \nBarley, the best form of which for medicinal use is pearl \nbarley, is demulcent and highly nutritious. It contains rather \nmore proteid than wheat, and is rich in phosphates and iron. It \nconstituted the principal diet on which the Grecian athletes were \ntrained. It is one of the blandest and least irritating of fari- \nnaceous substances, and is an excellent antiscorbutic. \n\nTherapeutics of Pearl Barley. \nBarley water (1 to 15 of boiling water) forms a pleasant \ndemulcent drink, especially if the throat be dry and inflamed. It \nis the most ancient of fever beverages, and its efficiency in sore \nthroat and bronchial affections may be increased by the addi- \ntion of honey. It is used to a considerable extent in various \ninflammatory conditions, especially when the mucous membrane \nof the stomach or the urinary tract is involved. It is also \ngiven for the diarrhoeas of infants, and its addition to the milk \nof all bottle-fed children has been recommended. For ordi- \nnary use it may be sweetened and flavored with lemon. \n\nSUGAR. \n\nSACCHARUM.\xe2\x80\x94 Sugar. (Cane Sugar. Sucrose.) \n\nPreparation. \nSyilipus. \xe2\x80\x94 Syrup. \n\nUnofficial Preparation. \nLevulosum.\xe2\x80\x94 Levulose. (Fruit Sugar. Diabetin.) \n\n\n\n460 PHARMACOLOGY AND THERAPEUTICS. \n\nAction of Sugar. \n\nSugar is nutrient, demulcent and antiseptic. It is an anti- \nputrefactive, but not an antifermentative. While essentially a \nfood, it contains no nitrogen, and is therefore incapable of sus- \ntaining life by itself. It is a hydrocarbon, and in the system \ndevelops adipose tissue and acts as a respiratory fuel. In the \nhealthy individual sugar and sugar-forming food, it is estimated, \nconstitute more than one-half of the nourishment required by \nthe body. It also has some diuretic action. Eaten freely, it is \nsaid to interfere with the development of alcoholic intoxication, \nan effect which has been attributed to its retarding gastric \nabsorption. \n\nTherapeutics of Sugar. \n\nSugar is used as a sweetening and preservative agent. Syrup \nis used as a vehicle. Syrupus Glucosi (B. P., not official). \nSyrup, 2; liquid glucose of commerce, 1, is used in pharmacy, \nespecially in the making of pills, as it forms a neutral basis. \nSugar is the principal basis of troches, gum pastilles, and \nvarious other preparations. Mixed with iron preparations, it is \na protective against oxidation. On account of its attraction \nfor water, powdered or granulated sugar, locally applied, makes \na good styptic (which is also antiseptic), in cases of emergency. \nWhite sugar does not seem to have any aperient effect, but \nmolasses and imperfectly refined sugar intensify intestinal \naction and are considerably used in domestic medicine as mild \nlaxatives. When taken in moderation sugar tends to promote \ndigestion and allay nervous excitement, and sweetened water \n(cau sucree) is very extensively used for such purposes in \nFrance and other parts of Europe. In catarrhal affections of \nthe air-passages sugar has a soothing effect upon the mucous \nmembrane, and the vapor of boiling cane-juice is stated to have \nproved of great value in bronchitis and even pulmonary tuber- \nculosis. Finely powdered lump sugar may relieve the hiccough \nof nursing infants which arises from over-feeding, and lump \nsugar is a common domestic remedy for hiccough in general. \nThe chemical compound which sugar forms with lime, calcium \n\n\n\nLIQUORICE. 461 \n\nsaccharate (Syrupus Calcis, U. S. P.), is said to be an anti- \ndote to phenol. Sugar is contraindicated in diabetes mellitus, \nobesity, and conditions involving fermentative changes in the \nstomach or intestines. Levulose, a fruit-sugar sold under the \ntrade-name of Diabctin, is now extensively used as a food and \nsubstitute for cane-sugar in cases of diabetes. It is well assimi- \nlated in the disease, a small proportion only being excreted in \nthe urine, and is regarded as having the same nutrient value as \ncane-sugar. \n\nLIQUORICE. \n\nGLYCYRRHIZA.\xe2\x80\x94 Glycyrrhiza. Liquorice Root. Dose, 2 gm.; \n30 gr. \n\nPreparations. \n\n1. Extractum Glycyrrhizse. \xe2\x80\x94 Extract of Glycyrrhiza. (Ex- \ntract of Liquorice.) Dose, 1 gm.; 15 gr. \n\n2. Extractum Glycyrrhizse Purum. \xe2\x80\x94 Pure Extract of Gly- \ncyrrhiza. Dose, 1 gm.; 15 gr. \n\n3. Fluidextractum Glycyrrhizse. \xe2\x80\x94 Fluidextract of Glycyr- \nrhiza. Dose, 2 c.c; 30 trt- \n\n4. Elixir Adjuvans. \xe2\x80\x94 Adjuvant Elixir. \n\n5. Glycyrrhizinum Ammoniatum. \xe2\x80\x94 Ammoniated Glycyrrhizin. \nDose, 0.250 gm. (250 milligm.) ; 4 gr. \n\n6. Mistura Glycyrrhizse Composita. \xe2\x80\x94 Compound Mixture of \nGlycyrrhiza. (Brown Mixture.) Dose, 8 C.C.; 2 fl. dr. \n\n7. Pulvis Glycyrrhizse Compositus. \xe2\x80\x94 Compound Powder of \nGlycyrrhiza. Dose, 4 gm.; 60 gr. \n\n8. Pilulse Laxativse Compositse. \xe2\x80\x94 Compound Laxative Pills. \nDose, 2 pills. \n\nAction of Liquorice. \nLiquorice is demulcent, expectorant and laxative. Locally it \nhas a slightly stimulating action, and it increases the flow of \nsaliva and mucus when slowly chewed or sucked. \n\nTherapeutics of Liquorice. \nIn sore throat and bronchitis liquorice is an excellent de- \nmulcent. The hardened extract is a popular remedy for tickling \n\n\n\n462 PHARMACOLOGY AND THERAPEUTICS. \n\ncough and hoarseness, and Brown Mixture is much used in \ndispensary practice as an expectorant. Liquorice is largely \nemployed to conceal the taste of disagreeable medicines and as \na basis for pills. The root is commonly used as a dusting- \npowder and coating for the latter. The compound liquorice \npowder is a pleasant and efficient laxative, and is especially well \nadapted for pregnant women and children. When necessary, \nit may be advantageously combined with an equal quantity of \ncompound jalap powder. The demulcent properties of liquorice \nrender it serviceable in irritable conditions of the mucous mem- \nbrane of the bladder and intestines, as well as of the air-pas- \nsages. It may also be given with flaxseed tea or barley water \nin various febrile affections. Ammoniated glycyrrhizin pos- \nsesses no advantage over the extract, and is devoid of the \ndemulcent properties of the drug. \n\nSLIPPERY ELM BARK. \nULMUS.\xe2\x80\x94 Elm. (Slippery Elm Bark.) \n\nPreparation. \nMucilago Ulmi. \xe2\x80\x94 Mucilage of Elm. Dose, 16 c.c; 4 fl. dr. \n\nAction of Slippery Elm Bark. \nSlippery elm bark is highly demulcent and in some degree \ntonic and nutritive, as well as slightly astringent. \n\nTherapeutics of Slippery Elm Bark. \nSlippery elm bark is an excellent demulcent, and is especially \nrecommended in dysentery, diarrhoea and diseases of the urinary \npassages. It is often employed to make poultices, especially for \nuse upon children, because it is lighter than flaxseed. The \npoultices, with lead water, are serviceable in erysipelas and \nvarious forms of local inflammation ; they may be applied either \nhot or cold. The bark is also used in the dilatation of fistulae, \nstrictures and the os uteri, and, in conjunction with various \nmedicinal extracts, in the formation of rectal and vaginal sup- \n\n\n\nACACIA. 463 \n\npositories. When chewed it moistens the mouth and throat, and \nemployed in this way it is soothing in irritable conditions of \nthe faucial and bronchial mucous membrane. It is stated to \nhave sometimes proved successful in the treatment of tape- \nworm. \n\nACACIA. \n\nACACIA. \xe2\x80\x94 Acacia. (Gum Arabic) \n\nPreparations. \n\n1. Mucilago Acacise. \xe2\x80\x94 Mucilage of Acacia. Dose, 16 c.c; 4 \nfl. dr. \n\n2. Syrupus Acacise. \xe2\x80\x94 Syrup of Acacia. \n\nAction of Acacia. \nAcacia is a valuable demulcent. It has been experimented \nwith as a food, but appears to have little or no nutrient quality, \nthough it may possibly retard tissue-waste and in this way \nprove capable of prolonging life. \n\nTherapeutics of Acacia. \nOn account of its demulcent properties it is employed at times \nin inflammatory conditions of the bronchial, gastric, vesical \nand intestinal mucous membrane, in which it acts as a local \npalliative. One part dissolved in 30 of water and flavored with \nsyrup of lemon, or otherwise, makes a pleasant and serviceable \nbeverage. Acacia is also useful as a vehicle for more powerful \nremedies. As a protective to the inflamed surfaces in pharyn- \ngitis, laryngitis, etc., it is commonly used in the form of lozenges, \nin which astringents or other agents may be incorporated in ac- \ncordance with the indications present. To loosen hacking coughs \nit is largely employed with flaxseed in the form of a mucilage, \nflavored with lemon-juice and sweetened, to which liquorice \nis generally added. Mucilage of acacia may sometimes be of \nservice in cases of irritant poisoning. One of the chief uses \nof acacia is to emulsify oils and resins. 30 c.c. (1 fl. oz.) of \nmost oils or resinous tinctures require 12 c.c. (3 fl. dr.) of \n\n\n\n464 PHARMACOLOGY AND THERAPEUTICS. \n\nmucilage of acacia for suspension, but copaiba requires 40 c.c. \n(10 fl. dr.). The tendency of the mucilage to undergo acetous \nfermentation, which greatly interferes with its emulsifying \ncapacity, may be overcome to some extent by making it with \ntolu or clove water. For the suspension of insoluble powders \nit is not so satisfactory as tragacanth, as it is liable to form \ncements which are difficult to disperse. Externally, acacia has \na certain amount of utility. Its thick mucilage, to which some \nantiseptic should be added, may be employed as a protective for \nsuperficial burns, excoriations and ulcers. Powdered acacia \nis sometimes used to arrest bleeding from leech bites and other \nsources of slight haemorrhage. Mixed with one-half its quan- \ntity of powdered arrow-root and one-quarter of borax, together \nwith a small amount of camphor, it is serviceable, dusted over \nthe surface, for sore nipples. An ointment made with 24 gm. \n(6 dr.) of powdered acacia and 4 gm. (1 dr.) of oleate of zinc \nto 30 gm. (1 oz.) of lanolin, is also a good application in this \naffection, as well as in some diseases of the skin. A snuff com- \nposed of acacia and bismuth subnitrate, to which a little mor- \nphine may be added, is often useful in checking coryza. \n\nTRAGACANTH. \n\nTRAGACANTHA.\xe2\x80\x94 Tragacanth. \n\nPreparation. \nMucilago Tragacanthse. \xe2\x80\x94 Mucilage of Tragacanth. Dose, 16 \nc.c; 4 fl. dr. \n\nUnofficial Preparation. \nBassorinum. \xe2\x80\x94 Bassorin. \n\nAction of Tragacanth. \nTragacanth is demulcent and slightly nutritive. If given in \nlarge quantity it is apt to cause indigestion, unless accompanied \nby some antiseptic agent, like creosote or naphtol, in order to \nprevent fermentation. \n\nTherapeutics of Tragacanth. \nIts chief use is to suspend insoluble powders. The mucilage \n\n\n\nALMOND. 465 \n\nis better for this purpose than the compound powder (B. P., \nnot official), tragacanth, 1; acacia, 1; starch, 1; sugar, 3; \nwhich, because of its starch, is liable to ferment. More- \nover, acacia is contra-indicated when tragacanth is employed \nas a suspending agent. Tragacanth is less useful than acacia \nas an emulsifying agent for resins and oils, for the reason that \nit is almost insoluble in water. Glycerin of tragacanth (B. P.) \nis sometimes employed as a pill excipient, but is apt to render \nthe pills hygroscopic, and glucanth is more generally useful for \nthis purpose. It is composed of tragacanth, 1 ; glycerin, 1 ; \nwater, 1 ; commercial syrupy glucose, 7. Tragacanth is some- \ntimes used as a vehicle for medicinal agents in gargles, and \nis a constituent of most of the official troches. It may be em- \nployed as a demulcent in pharyngitis, gastritis and intestinal \ninflammation. On account of its greater tenacity, its mucilage \nmay sometimes be preferable to that of acacia as an external \nprotective. Bassorin (found in India gum and in salep) has \nbeen used as a base for the application of cutaneous medica- \nments. \n\nALMOND. \n\n1. AMYGDALA AMARA.- Bitter Almond. \n\n2. OLEUM AMYGDALA AMAE5I.- Oil of Bitter Almond. \nDose, 0.03 c.c; y 2 n\\. \n\nPreparations. \n\n1. Aqua Amygdalae Amarae. \xe2\x80\x94 Bitter Almond Water. Dose, \n4 c.c; 1 fl. dr. \n\n2. Spiritus Amygdalae Amarae.\xe2\x80\x94 Spirit of Bitter Almond. \n(Essence of Bitter Almond.) Dose, 0.5 C.C.; 8 Tl\\. \n\n\n\nin.. \n\n\n\n4. AMYGDALA DULCTS.\xe2\x80\x94 Sweet Almond. (Jordan Almond.) \n\n\n\nPreparations. \n\n1. Emulsum Amygdalae. \xe2\x80\x94 Emulsion of Almond. (Milk of \nAlmond.) Dose, 120 c.c.; 4 fl. oz. \n\n2. Syrupus Amygdalae.\xe2\x80\x94 Syrup of Almond. Dose, 4 c.c; 1 \nfl. dr. \n\n\n\n31 \n\n\n\n466 PHARMACOLOGY AND THERAPEUTICS. \n\n5. OLEUM AMYGDALA EXPRESSUM.\xe2\x80\x94 Expressed Oil of Al- \nmond. Dose, 30 c.c; 1 fl. oz. \n\nUnofficial Preparation of Almond. \nKesorbinum. \xe2\x80\x94 Resorbin. \n\nAction of Almond. \nThe sweet almond is demulcent and nutritive. Bitter almond, \nwhich differs from it in containing amygdalin, is poisonous in \nlarge quantities. \n\nTherapeutics of Almond. \nThe official emulsion, formed by triturating sweet almonds \nwith water, is a soothing and emollient drink which may prove \nof service in irritations of the pharynx and air-passages, as \nwell as of the stomach and intestines. It is also a pleasant \nvehicle for other remedies in various conditions, and is espe- \ncially useful for insoluble drugs. The emulsion of bitter \nalmond (not official), in teaspoonful doses, is used for the same \npurposes, and particularly as a vehicle for expectorant medi- \ncines. Both emulsions are employed to some extent as a vehicle \nin gonorrhoea, as they serve to relieve ardor urinse. The com- \npound powder of almonds, B. P. (sweet almond, 8; sugar, 4; \nacacia, 1) is a palatable basis for powders. The expressed oil \nof almond might be used for the same purposes as olive oil, \nbut is more expensive. To most persons it is much more \npalatable than the latter. This oil is used to a considerable \nextent in ointments, producing a whiter preparation than olive \noil, and is especially useful as an application to the hair. It \nis serviceable for excoriations, chapped hands, and inflamma- \ntory affections of the skin, and also as a local application in \nearache. Internally it may be used as a laxative. One of \nthe most important medicinal uses of the sweet almond \nis in the form of bread and biscuits made from almond \nflour. They contain practically no starch, and, being pal- \natable and nutritious, have proved a very satisfactory sub- \nstitute for the various preparations of wheat flour in the diet \n\n\n\nGLYCERIN. 467 \n\nof diabetics. They are expensive, but with a little care may- \nbe made at home; thus reducing the cost to the minimum. \nAlmond meal is sometimes used instead of soap for the toilet, \nrendering the skin soft and smooth. Resorbin, made by emulsi- \nfying expressed oil of almond with distilled water and yellow \nwax, gelatin and soap, with the addition of a small quantity of \nlanolin, is a good vehicle for active drugs in the medication \nof the skin, and will, it is said, promote the cutaneous absorp- \ntion of mercury. It has been employed in the treatment of \nichthyosis, pityriasis, scleroderma, prurigo, seborrhceic eczema, \nand other affections. Sweet almond emulsion, combined with \nbismuth subnitrate and thymol iodide, or with ammonium chlo- \nride and mercuric bichloride, may be used locally for the re- \nmoval of sunburn, freckles and skin pigmentations. With mer- \ncuric bichloride alone it is recommended in acne rosacea. As a \nsubstitute for cherry-laurel water, which is considerably used in \nEurope as a sedative narcotic and which owes its effects to the \nprussic acid which it contains, but which is objectionable from \nits unequal strength, it has been proposed to employ an extem- \nporaneous mixture of amygdalin with emulsion of sweet almond. \n\nGLYCEKIN. \n\nGLYCERINUM.\xe2\x80\x94 Glycerin. Glycerol. Dose, 4 C.C.; 1 fl. dr. \n\nPreparations. \n\n1. Glyceritum Amyli. \xe2\x80\x94 Glycerite of Starch. \n\n2. Glyceritum Phenolis. \xe2\x80\x94 Glycerite of Phenol. (Glycerite of \nCarbolic Acid.) Dose, 0.3 c.c; 5 n\\,. \n\n3. Glyceritum Acidi Tannici. \xe2\x80\x94 Glycerite of Tannic Acid. \nDose, 2 c.c; 30 lit. \n\n4. Glyceritum Boroglycerini. \xe2\x80\x94 Glycerite of Boroglycerin. \n\n5. Glyceritum Hydrastis.\xe2\x80\x94 Glycerite of Hydrastis. Dose, 2 \nc.c; 30 TTt- \n\n6. Glyceritum Ferri, Quininae et Strychnine Phosphatum. \n\n\xe2\x80\x94 Glycerite of Iron, Quinine and Strychnine Phosphates. Dose, \n1 c.c; 15 TTt. \n\n\n\n468 PHARMACOLOGY AND THERAPEUTICS. \n\n7. Suppositoria Glycerini. \xe2\x80\x94 Suppositories of Glycerin. \n\n8. Gelatinum Glycerinatum.\xe2\x80\x94 Glycerinated Gelatin. \n\nUnofficial Preparations. \nGlyceritum Vitelli (U. S. P., 1890).\xe2\x80\x94 Glycerite of Yolk of \nEgg. Dose, freely. \n\nGlycerinum Boracis (B. P.). \xe2\x80\x94 Glycerin (or Glycerite) of \nBorax. \n\nMel Boracis (B. P.). \xe2\x80\x94 Borax Honey. \n\nAction of Glycerin. \n\nExternal. \xe2\x80\x94 Glycerin is powerfully hygroscopic. Applied to \nthe cutaneous surface, it is somewhat irritant, and even when \ndiluted causes a temporary smarting in cuts and abrasions. \nThis local irritation is attributable to its great avidity for \nwater, in consequence of which it tends to abstract the fluids \nfrom the tissues. The pain quickly subsides, however, and it \nthen acts as a protective to the parts. In its completed action, \nespecially when diluted, it is emollient and demulcent to the \nskin and to mucous membranes. When injected into the rec- \ntum, however, it causes, by its irritant action, peristalsis and \nevacuation of the bowels. \n\nInternal. \xe2\x80\x94 In animals large doses of glycerin, injected sub- \ncutaneously, cause death in periods varying from one hour to \nseveral days according to the amount administered. The symp- \ntoms noted are restlessness, acceleration of the heart and re- \nspiration, dryness of the mucous membrane, with marked thirst, \nloss of muscular power, vomiting, bloody urine, fall of tem- \nperature, convulsions, somnolence, coma, and death from failure \nof the respiration. The larger the dose, the more pronounced \nthe convulsions, which are tetanic in character. In such cases \nthe fall of temperature is preceded by a considerable rise, while \nin the more prolonged cases (in which the dose is not ex- \ncessive), the fall may or may not be preceded by a rise, and \ndoes not usually occur until quite late in the poisoning. The \nprincipal change found post mortem is intense pulmonary, renal \n\n\n\nGLYCERIN. 469 \n\nand intestinal congestion, with more or less softening of the \ntissue. Glomerulo-nephritis has sometimes been observed. The \nhaemoglobin which appears in the urine when glycerin is sub- \ncutaneously injected in large quantities is due to the destruction \nof the red blood-corpuscles ; although when glycerin is added \nto the drawn blood it does not act as powerfully on it as many \nother agents which produce no haemoglobinuria. The latter \neffect after its subcutaneous injection has been explained on \nthe hypothesis that the glycerin remains outside the vessels \nfor some time, and withdraws the fluid from the red corpuscles \nas they pass through the poisoned zone. When, however, glyc- \nerin is injected into the blood, it diffuses rapidly throughout the \nbody, and the blood-cells are less acted on by the diluted poison. \nAccordingly, it is found that haemoglobin scarcely ever appears \nin the urine after intravenous injection, although this is occa- \nsionally noted when glycerin is given in large doses by the \nmouth. The violent convulsions caused by it would seem to \nindicate that glycerin acts directly on the central nervous sys- \ntem. Notwithstanding the fact that in animals it destroys life \nin a few hours, in man very large doses of glycerin, taken by \nthe mouth, ordinarily produce only a mild gastro-intestinal \nirritation. In the case of a man who was accustomed to take \n90 c.c. (3 fl. oz.) daily it is said, however, to have caused ex- \ntreme cerebral excitement. Glycerin is rapidly absorbed from \nthe intestine and undergoes oxidation in the tissues; only a \nvery small fraction of it appearing in the urine. Like alcohol, \nwhich is also readily absorbed, it therefore acts in some sense \nas a food, and serves to increase the total energy of the body. \nGlycerin, it has been pointed out, tends to increase the non- \nnitrogenous, and not the nitrogenous reserve of the body, its \ncombustion saving a certain amount of the fat from being de- \nstroyed. It is, therefore, of only secondary importance as a \nfood, although, like alcohol, it may be of value in certain con- \nditions. As in the case of the latter, it is still regarded as un- \ndecided how far it leads to an economy of the nitrogenous \ntissues, as the fats and carbohydrates do. Internally, as \n\n\n\n470 PHARMACOLOGY AND THERAPEUTICS. \n\nwell as externally, glycerin is a good demulcent, but, since \nit is so quickly absorbed, its action does not extend be- \nyond the stomach. It has been claimed by some authors \nthat its administration at times occasions the appearance \nin the urine of a substance which reduces cupric oxide \nand gives the fermentation test for sugar, but this is \nstated not to have been confirmed on more careful in- \nvestigation. In some forms of experimental glycosuria glyc- \nerin appears to reduce the amount of sugar present, and it is \nbelieved that it probably has some effect on the sugar formation \nin the tissues, although no satisfactory explanation of its action \nin this particular has as yet been given. It has been demon- \nstrated to have decided value as an antiseptic, and this is \nthought to be due to its well-known hygroscopic properties, in \nconsequence of which water is withdrawn from the microbes. \nIt is destructive to parasites, both intestinal and external. \n\nTherapeutics of Glycerin. \nExternal. \xe2\x80\x94 Glycerin is employed to a considerably greater \nextent externally than as an internal remedy. It is an ex- \ntremely useful emollient, and as it does not evaporate or turn \nrancid, and is readily absorbed when rubbed into the skin, it \nhas many advantages as a vehicle for the application of active \nmedicinal agents. Applied to the mucous membrane by means \nof a camel\'s hair brush, pure glycerin affords much relief in \nacute coryza. Glycerin, diluted one-half with distilled water, \nor the glycerin of borax (B. P.) is of great service in reliev- \ning the dryness of the lips, mouth and tongue in fevers, and \nthe latter preparation, as well as the honey of borax (B. P.), \nin which glycerin is an ingredient, is also used as a demulcent \nand sedative to the mucous membrane of the mouth and \npharynx. A solution of morphine in glycerin is sometimes ap- \nplied with a brush to the fauces to allay the irritating cough \nof phthisis. A mixture of glycerin, crystallized sugar, and \nwhiskey, which is allowed to trickle down the throat, may also \nbe given for the same purpose. Among the many other useful \n\n\n\nGLYCERIN. 47 1 \n\napplications of glycerin are the following: For chapped face \nand hands, sore nipples, and piles it may be combined with \nwitchhazel water and rose water; for excoriations, erythema, \nand superficial burns, with lime water and rose water; for \nerythematous or vesicular eczema, burns, and seborrhcea, espe- \ncially about the axilla and the genital organs, with carbolic acid, \nwitchhazel water, and either bismuth subnitrate or sodium \nbicarbonate; for freckles and other skin pigmentations with \nlactic acid and rose water, and for pruritus, eczema and urti- \ncaria with creosote and oil of peppermint. The latter combina- \ntion may also be used, in the form of a spray, in nasal catarrh, \npharyngitis and laryngitis. The glycerite of tannin makes an \nexcellent astringent application for sore throat (particularly \nchronic follicular pharyngitis), relaxed mucous membranes, and \nother conditions, and it is said that the daily topical use of \nglycerin is capable of causing a steady reduction in the size \nof hypertrophied tonsils. The glycerite of starch is frequently \nemployed as a vehicle for the application of astringents to the \neye, and glycerin and its preparations are also much used in \near affections. Glycerized collodion (glycerin, 2; collodion, \n100), which is extremely supple and does not crack and scale \noff from the skin, is less painful than pure collodion, and forms \na serviceable protective for fissures and abrasions. For fissured \nnipples a liniment composed of one part of tincture of benzoin \nto six or eight of glycerin is also highly recommended. Glyc- \nerin is a convenient vehicle for the absorption of drugs by the \nskin, and one of the most common applications of this use is \nin the case of belladonna, the local anodyne action of which \nmay be obtained by rubbing it in mixed with glycerin. Glyc- \nerin, either alone or combined with an astringent or sedative, \nmay be employed for the prevention of bed-sores. Glycerin, as \nwell as boroglycerin (see p. 88), is used extensively in various \nlocal applications in the treatment of diseases of women, and \nin congested states of the genital organs it is of special service \nby causing, on account of its affinity with water, an abundant \nserous transudation. For the use of glycerin with kaolin see \nKaolin (p. 437). \n\n\n\n472 PHARMACOLOGY AND THERAPEUTICS. \n\nInternal. \xe2\x80\x94 On account of its sweetness glycerin is employed \nto a considerable extent as a flavoring agent. Large doses of \nglycerin sometimes cause purgation, but it is not a reliable \nremedy for this purpose, and alone is seldom given by the \nmouth as a laxative, except perhaps in the case of haemorrhoids, \nupon which it is asserted to have a peculiarly soothing effect. \nTo produce efficient cathartic action it is advised that it should \nbe combined with magnesium sulphate or carbonate, rhubarb, \nand tincture of belladonna. As a laxative, however, it is much \nmore frequently administered by the rectum, where 4 to 8 c.c. \n(1 to 2 fl. dr.) produces a prompt evacuation, without pain \nor other disturbance; and the most convenient way to use it \nis in the form of the glycerin suppository. The glycerin is \nsaid to pass upwards as far as the sigmoid flexure, and even be- \nyond. While, from its contact with the epithelial walls, it may \nthus perhaps increase the peristalsis of the greater part of the \nlarge intestine, the local irritation of the lower portion of the \nrectum is itself no doubt sufficient to set up reflex movement \nof the bowel. Enemata of glycerin diluted with water, or, \nbetter, of glycerin combined with flaxseed tea, in the proportion \nof one to four, are of considerable service in dysentery; reliev- \ning the tenesmus. Glycerin has been advised by some as a food \nin conditions of malnutrition, but, although it forms part of \nthe composition of ordinary fats, it proves, as a rule, a very \ninferior substitute for codliver oil and other fatty substances. \nIn the form of glyconin (Glyceritum Vitelli), however, it con- \nstitutes an admirable vehicle for the administration of cod- \nliver oil, and, given in this way, it is thought to increase the \nefficiency of the latter. On theoretical grounds it has been \nemployed in the treatment of diabetes, but it appears to have \nlittle or no practical value in that disease. It was formerly \nused to a considerable extent by diabetics as a substitute for \nsugar, but its sweetness is of a kind rather disagreeable to many, \nand its place has now largely been taken by saccharin and \nlevulose. Glycerin, it has been found, is capable of destroying \ntrichinae in the intestinal tract, and it is therefore a remedy of \n\n\n\nICELAND MOSS. 473 \n\ndistinct value in cases of trichiniasis. Among other conditions \nin which it has been used internally may be mentioned acne, \nvomiting of pregnancy, gallstone disease, and nephrolithiasis. \n\nICELAND MOSS. \n\nUnofficial Preparations. \nCetraria (U. S. P., 1890). \xe2\x80\x94 Cetraria. (Iceland Moss.) \nDecoctum Cetrarise. \xe2\x80\x94 Decoction of Cetraria. Dose, 0.30 to \n\n1.20 c.c; 1 to 4 fl. oz. \nAcidum Cetraricum. \xe2\x80\x94 Cetraric Acid. Dose, 0.03 to 0.12 \n\ngm.; V2 to 2 gr. \n\nAction of Iceland Moss. \n\nIceland moss is demulcent, nutritive and mildly tonic. It \nis also stated to have antihaemorrhagic properties. The cetraric \nacid gives its decoction a bitter taste, but this and the other \nacids which the moss contains can be removed, if desired, by \nsoaking for some time in dilute alkaline solutions. It has been \nasserted that cetraric acid augments the number of the red and \nto a still greater degree, of the white blood-corpuscles, that it \nincreases intestinal paralysis, and that it is a mild stimulant \nto the central nervous system. Intravenously injected, it is said \nto cause an increased secretion of saliva, bile and pancreatic \njuice. \n\nTherapeutics of Iceland Moss. \n\nThe decoction is demulcent, and may be given in sore throat. \nCetraria, as well as Irish moss, was formerly supposed to pos- \nsess some peculiar virtue in pulmonary affections, but this \nopinion is no longer held, and it is now almost entirely employed \nas an article of diet for the sick. As a food it is not of very \nhigh nutritive value, but it may at times serve a useful purpose. \nThe jelly formed by boiling may be taken by diabetics and other \ninvalids. It should be suitably flavored. The decoction, with \nits acids allowed to remain, may be used as a stomachic tonic \nin cases where the more active agents of this class are not well \nborne. Cetraria has been recommended in haemoptysis, in \n\n\n\n474 PHARMACOLOGY AND THERAPEUTICS. \n\nwhich condition it had long been employed by Danish physi- \ncians before it became generally known, and the powder, blown \ninto the nostrils, has been found to arrest epistaxis. A tinc- \nture of cetraria, locally applied, is of service in spongy gums. \nIn Iceland the moss is regarded as prophylactic against a form \nof elephantiasis which prevails there. \n\nCetraric Acid, given in accordance with the indications de- \nrived from the experiments on animals showing that it augments \nthe digestive secretions, is said to have proved beneficial in \ndyspepsia. The acid has also been suggested as a remedy in \nanaemia and chlorosis, especially when associated with consti- \npation, but no clinical evidence has as yet been educed of its \nutility in such conditions. \n\nIRISH MOSS. \n\nCHONDRUS.\xe2\x80\x94 Chondrus. (Irish Moss. Carragheen.) Dose, 15 \ngm.; 4 dr. (in decoction). \n\nAction of Irish Moss. \n\nIrish moss is demulcent and somewhat nutrient, though the \ngum which enters largely into its composition does not digest \nvery readily. \n\nTherapeutics of Irish Moss. \n\nThe decoction (made by boiling 750 c.c. (1^2 pints) of water \nwith 15 gm. (y 2 oz.) of the moss down to 500 c.c. (1 pint)) \nwas formerly much more generally used than at present, in \nbronchial affections, diarrhoea, dysentery and irritation or in- \nflammation of the genito-urinary tract. Whatever beneficial \neffect it may have had was probably due to its protective quali- \nties, and also possibly to some extent to the influence on nutri- \ntion of the minute quantity of iodine in it. When made into \na jelly it is a pleasant article of diet. At one time this was \nsupposed to constitute an important food in illness, but it is \nreally of little practical value, as only -^ to -^ of the jelly is \nsolid matter; the rest being water. Irish moss is also used as \na vehicle in preparations of bone marrow. \n\n\n\nGELATIN. 475 \n\nMARSHMALLOW. \nALTERA. \xe2\x80\x94 Althaea. (Marshmallow.) \n\nUnofficial Preparations. \nSyrupus Althaeas (U. S. P., 1890). \xe2\x80\x94 Syrup of Althaea. Dose, \nfreely. \n\nAsparaginum. \xe2\x80\x94 Asparagin. Dose, 0.06 to 0.12 gin.; 1 to 2 \ngr. \n\nAction of Mash mallow. \nMarshmallow is demulcent, emollient and slightly nutritious. \n\nTherapeutics of Marshmallow. \nIt is a useful demulcent for irritation and inflammation of \nmucous membranes. It is held in popular esteem, especially as \na remedy for sore throat, and the confections of it are service- \nable in scarlet fever and diphtheria, as well as in ordinary \npharyngitis. The decoction is sometimes given for gastric irri- \ntation and used locally in irritations of the vagina and of the \nrectum. An excellent emollient poultice is made from the \npowdered root, and, combined with benzoinated lard, marsh- \nmallow is employed as a bland dressing in cutaneous affections. \nIt is a constituent in blue mass and in phosphorus pills, to which \nit serves to give the proper consistence, and the syrup is an \nagreeable vehicle. It is thought to be slightly diuretic on ac- \ncount of the asparagin contained in it, and in the form of a \nfresh infusion it has been given to children, especially in \nBright\'s disease. Asparagin itself has been recommended as a \ndiuretic, though its value has not as yet been established. \n\nGELATIN. \n\nGELATINUM.\xe2\x80\x94 Gelatin. \n\nPreparation. \nGelatinum Glycerinatum. \xe2\x80\x94 Glycerinated Gelatin. \n\nAction of Gelatin. \nGelatin is a demulcent and styptic, and is also believed to be \nto some extent nutrient, as it increases vital action in the same \ndirection, though not in the same degree, as albumin. \n\n\n\n476 PHARMACOLOGY AND THERAPEUTICS. \n\nTherapeutics of Gelatin. \nIt is used as a basis for capsules, lozenges, bougies, supposi- \ntories and pessaries, as a coating for pills, and as a protective \ncovering in certain diseases of the skin. An admirable basis \nfor throat pastilles is the following, known as glycogelatin : \ngelatin, 2; glycerin, 5; orange flower water, 5; colored with \ncarmine. Each should weigh 2 gm. (30 gr.), and any desired \nmedicinal agent may be incorporated in such pastilles. As a \ncovering for the skin Unna\'s zinc-gelatins, which are dis- \npensed in small cubes, are extremely serviceable. After being \nmelted they are painted over the affected surface, and the part \nis then covered with a layer of cotton wool. Perhaps those in \nmost frequent use are zinc gelatin with ichthyol, 1 to 5 per \ncent., with phenol, 1 to 3 per cent, with sulphur, 5 per cent., \nand with resorcinol, 2 per cent. As an antidote, gelatin is of \nespecial value against iodine, bromine and the alums, but re- \nquires too much time for its preparation, as for this purpose it \nshould be broken up and reduced to the consistency of honey by \nbeing soaked for half an hour in water. Sterilized gelatin in \nsolution has been administered subcutaneously to increase the \ncoagulability of the blood in aneurism. \n\nSTARCH. \n\nAMYLUM.\xe2\x80\x94 Starch, Corn Starch. \n\nPreparation. \nGlyceritum Amyli. \xe2\x80\x94 Glycerite of Starch. \n\nAction of Starch. \nStarch is demulcent and nutritive. It and its derivative, \ngrape-sugar, are the chief members of the non-nitrogenous \ngroup of alimentary principles known as carbohydrates. In \nthe animal economy starch undergoes digestion by ptyalin, pan- \ncreatin and the secretion of the intestinal glands, which convert \nit first into soluble dextrin and then into grape-sugar, in which \nform it passes into the blood. The non-nitrogenous principles \n\n\n\nSUGAR OF MILK. 477 \n\n(starches, sugars and fats) are mainly concerned in heat-pro- \nduction. The excessive consumption of starchy food delays \ntissue-metamorphosis, causes a redundancy of fat, and often \ngives rise to acidity and flatulence. Undigested starch passes \ninto the faeces, and the urine may become saccharine. \n\nTherapeutics of Starch. \nMedicinally starch is inert, and it is used principally on ac- \ncount of its mechanical properties, which make it a good basis \nfor dusting powders and insufflations. The mucilage (i to 40), \nwhich is made by gradually adding the starch and then boiling \nand stirring for a few minutes, is a convenient basis for \nenemata. It may also be used as a basis for ointments and to \nsuspend insoluble powders or oils, though it is open to the \nobjection that it keeps badly. The glycerite is a very soothing \nlocal emollient, and is also employed as a basis for suppositories. \nA starch poultice (made by enclosing clear starch, prepared as \nin the laundry, between folds of soft muslin) is also a very \nsoothing application in inflammatory conditions of the eye or \nlids. Mixed with glue, starch makes an excellent stiff bandage \nfor surgical purposes. Starch is employed as an antidote in \npoisoning by iodine or bromine. \n\nSUGAR OF MILK. \n\nSACCHARUM LACTIS.\xe2\x80\x94 Sugar of Milk. (Lactose.) \n\nAction of Sugar of Milk. \n\nSugar of milk is a non-nitrogenous, bland article of diet, \n\nwhich is less apt to ferment in the gastro-intestinal tract than \n\ncane- or grape-sugar. It is stated by some authorities to be \n\na very active diuretic, especially when cardiac dropsy is present. \n\nTherapeutics of Sugar of Milk. \nBeing very hard, and also but slightly deliquescent, it is a \nvaluable excipient for powders requiring the minute subdivis- \nion of their medicinal constituent and as a diluent to bring \n\n\n\n478 PHARMACOLOGY AND THERAPEUTICS. \n\nextracts to the required strength. It has been used as a carbo- \nhydrate food in consumption and other wasting diseases, and, \non account of its smaller liability to ferment, is preferred to \ncane-sugar for the sweetening of infant\'s food. It is also a \nserviceable food in acute febrile diseases, and, being tasteless \nand easily soluble in most fluids, it may often be taken with \nadvantage to the extent of 30 to 60 gm. (1 or 2 oz.) a day. \nAccording to the observers mentioned above, it is a diuretic \nwhich may be employed with good results in cardiac dropsy. \nBy them it is claimed that it causes a greater excretion of \nurine than any other drug, acting even more powerfully than \ncaffeine, and without any of the disadvantages of the latter. \nIt is said, however, that its diuretic action is but very slight in \ncases where extensive renal disease exists. \n\nMUSTARD. \n\n1. SINAPIS ALBA. \xe2\x80\x94 White Mustard. Dose (emetic), 8 gm.; \n120 gr. \n\n2. SINAPIS NIGRA.\xe2\x80\x94 Black Mustard. Dose (emetic), 8 gm.; \n120 gr. \n\nPreparation. \nCharta Sinapis. \xe2\x80\x94 Mustard Paper. \n\n3. OLEUM SINAPIS VOLATILE.\xe2\x80\x94 Volatile Oil of Mustard. \nDose, 0.008 c.c; y 8 rty. \n\nUnofficial Preparation. \nLinamentum Sinapis Compositum (U. S. P., 1890). \xe2\x80\x94 Com- \npound Liniment of Mustard. \n\nAction of Mustard. \nExternal. \xe2\x80\x94 Oil of mustard differs from the other volatile oils \nin that it produces a markedly greater irritation. Being ex- \ntremely diffusible, it has a very deep action, without producing \nvery profound destruction of the surface. Locally applied, mus- \ntard is a rubefacient, counter-irritant, and nervous stimulant, \ncausing heat, redness, and severe burning pain. These effects \n\n\n\nMUSTARD. 479 \n\nare produced by its action in dilating the blood-vessels and \nirritating the sensory nerves. The stimulation of the latter is \nfollowed by their paralysis, in consequence of which there re- \nsults a local loss of sensibility. If the application is sufficiently \nprolonged, it induces vesication, the irritation of the vessels \nleading to the transudation of plasma, which raises the epider- \nmis and thus forms vesicles or blisters. The blistering caused \nby it is more painful and heals less rapidly than that of can- \ntharides, which is no doubt due to the fact that the oil of mus- \ntard penetrates more deeply into the tissues and thus sets up \nmore extensive inflammation. When the crude drug, mois- \ntened, is applied to the skin, the oil is found to form only \nslowly, so that the action of the irritant becomes continuously \nmore intense. The excitation of the sensory nerves caused by \nthe external application of mustard is sufficiently powerful to \ninduce more or less reflex stimulation of the heart and respira- \ntion, and sometimes to restore consciousness to those suffering \nfrom syncope. \n\nInternal. G astro -intestinal Tract. \xe2\x80\x94 Mustard is also a power- \nful irritant to the alimentary canal. In small amounts it is \ntaken as a condiment and stimulates the appetite. It has gen- \nerally been supposed to increase the secretion of gastric juice, \nbut this is said not to be the case. Large doses irritate the \nstomach and produce prompt vomiting, which, in consequence \nof the reflex stimulation of the heart and respiration caused by \nthe drug, is not attended with the depression usually resulting \nfrom emetics. The emetic effect is increased by giving the \nmustard in a considerable quantity of lukewarm water. The \noil of mustard is an energetic irritant, a single drop upon the \ntongue producing an intense burning pain in the nose, throat \nand stomach. Mustard seeds, swallowed whole, have a laxative \neffect upon the bowels, and as they are discharged in the faeces \nwithout perceptible change, would appear to act merely by \nmechanically stimulating the intestine. \n\nGeneral Action. \xe2\x80\x94 Upon the organs and tissues mustard, in \nordinary doses, has very little appreciable effect, but very large \n\n\n\n48O PHARMACOLOGY AND THERAPEUTICS. \n\ndoses of the oil prove fatal to rabbits. The action of the \nheart is at first increased and then diminished, the respiration \nbecomes impeded, insensibility follows, and a fall of surface \ntemperature precedes death. Post mortem there is found red- \nness, but only slight inflammation, of the gastro-intestinal tract, \nwith destruction of the epithelium. The kidneys are also hyper- \nsemic, and the blood is said to smell of mustard. \n\nTherapeutics of Mustard. \nExternal. \xe2\x80\x94 A mustard plaster or sinapism is a very useful \nmeans of relieving pain in gastralgia, colic, neuralgia, chest \naffections, lumbago, and a great variety of other conditions. \nWhile the application itself may be temporarily painful, the \nsecondary effect, both as to the pain due to the mustard and \nthat from the condition present, is soothing, in consequence of \nthe loss of sensibility resulting from the paralysis of the sensory \nnerves produced by the drug. Sinapisms are prepared by mix- \ning mustard (to which an equal quantity of flour is usually \nadded to render the effect less severe), with warm water to a \nsmooth paste, which is spread upon linen. A layer of muslin \nor thin unglazed paper is usually placed between the mustard \nand the skin. As a rule, they are best applied a little distance \nfrom the seat of pain. Thus, to relieve headache they are most \nserviceable when placed at the nape of the neck. Sinapisms are \nalso applied to the epigastrium in persistent vomiting, to the \nloins in suppression of urine, to the precordial region in \nthreatened syncope, and to the calves of the legs and other \nparts of the body in narcotic poisoning, asphyxia or syncope. \nIn the latter conditions the object is, of course, to arouse the \nnervous system, but in all cases of insensibility care should \nbe taken that the application is not continued too long, on ac- \ncount of the danger of causing vesication or even more serious \nlocal trouble. In the case of children the proportion of mus- \ntard employed should not exceed one-fourth. The mustard \nleaves and papers sold in the shops are very convenient for \nready use. They are generally very strong, however, and one \n\n\n\nMUSTARD. 48I \n\nor two layers of moistened linen should be placed between the \nsinapism and the skin to prevent too great an action. In the \nofficial Charta Sinapis a surface of 60 square c.c. contains \nabout 4 gm. of black mustard deprived of oil. One advan- \ntage which mustard possesses for the purpose of revulsion is \nthe readiness with which its action may be controlled by the \nregulation of the strength of the application and the time which \nit is allowed to remain. In many cases it is desirable to main- \ntain for hours a mild, equable, counter-irritant impression, and \nthis may be done by adding about one-sixteenth part of mus- \ntard to a flaxseed poultice. In bronchitis, pleurisy or pneu- \nmonia a "jacket poultice" is often applied to the chest, and \nthe larger the poultice the more pronounced is the effect upon \nthe internal organs. Large mustard poultices are also used with \nadvantage in acute inflammations of the abdominal viscera. \nWhen it is desired to dilate the peripheral vessels over a large \narea, in order to withdraw blood from internal parts and thus \nproduce a " derivative effect," a hot bath to which mustard is \nadded (1 to 128) is often serviceable. A general mustard bath \nis chiefly employed for children in the early stages of febrile \ndiseases or bronchitis. In older persons a hot mustard foot- \nbath (which ought to reach nearly to the knees) is useful for \nthe relief of incipient common colds and various febrile con- \nditions. A hot mustard sitz-bath is commonly employed, just \nbefore the expected period, to induce menstruation. In place \nof the sitz-bath the foot-bath is sometimes used for this pur- \npose, as well as to relieve the congestive headaches, hot flush- \nings, and nervous symptoms often met with at the time of the \nmenopause. \n\nInternal. \xe2\x80\x94 A tumblerful of lukewarm water, with the addi- \ntion of 4 to 15 gm. (1 to 4 teaspoonfuls) of mustard is in \ngeneral use as an emetic, and is especially advantageous in \ncases of narcotic poisoning by reason of the reflex stimulation \ncaused by the mustard. Otherwise the drug is not very often \nemployed internally, except as a condiment, though it may \noccasionally prove of service. White mustard seeds have some \n32 \n\n\n\n\n\n\n482 PHARMACOLOGY AND THERAPEUTICS. \n\nreputation as an emmenagogue, and obstinate hiccough is said \nto have been relieved by an infusion of mustard, 4 gm. (1 tea- \nspoonful) to 120 c.c. (4 fl. oz.) of water. In the treatment of \ndropsy a mustard- whey, made by boiling 15 gm. (y 2 oz.) of \nmustard-flour in 500 c.c. (1 pint) of milk, and an alcoholic solu- \ntion of the oil of mustard have both been sometimes used with \ngood effect, and the latter preparation has been found of more \nor less service in chronic bronchial and gastric catarrh. \n\nOIL OF CAJTTPUT. \nOLEUM CAJUPUTL\xe2\x80\x94 Oil of Cajuput. Dose, 0.5 c.c; 8 TTl . \n\nUnofficial Preparation. \nOleum Miaouli. \xe2\x80\x94 Oil of Miaouli. Dose, .12 to .60 gm.; 2 to \n10 grs. daily. \n\nAction of Oil of Cajuput. \nThe action of oil of cajuput, externally and internally, is \nidentical with that of the oil of cloves. \n\nTherapeutics of Oil of Cajuput. \n\nExternal. \xe2\x80\x94 Being a strong, stimulating rubefacient and irri- \ntant, it is rubbed into the skin \xe2\x80\x94 usually diluted with olive oil \xe2\x80\x94 \nin a variety of conditions such as muscular rheumatism, chil- \nblains, nervous headaches, and chronic inflammatory affections \nof the joints and periosteum, as well as in such cutaneous \ndiseases as chronic eczema, psoriasis and rosacea. In alopecia \nit is used as an ingredient of various stimulating ointments. \nOn account of its parasiticidal properties it is also of service \nin the treatment of tinea, scabies, etc. Like many other oils \nof its class, it will relieve toothache if introduced into the \nhollow of the carious tooth. To some individuals its strong \nodor makes it rather objectionable as an application. \n\nInternal. \xe2\x80\x94 Being a stimulant carminative, it is useful in flatu- \nlent colic and other varieties of dyspepsia, and it is also of ser- \nvice in spasmodic affections of the stomach and bowels. In \n\n\n\nEUCALYPTUS. 483 \n\nthese conditions it is usually associated with other remedies. \nIt sometimes proves successful in relieving nervous dysphagia, \nvomiting, hiccough, dyspncea and dysmenorrhea. It has been \ngiven as a diffusible stimulant in typhoid and other low fevers, \nand in doses of 1 to 4 c.c. (15 to 60 ni) has even yielded good \nresults in the collapse stage of cholera. It is furthermore said \nto have been used with benefit in chronic rheumatism, laryn- \ngitis, bronchitis and catarrh of the bladder, as well as in ele- \nphantiasis and certain other skin diseases. It has also been ad- \nministered as a vermifuge, and prescribed, in the form of an \nemulsion, as an injection for thread-worms. As an internal \nremedy it may be taken on sugar or swallowed in capsules. \n\nOil of Miaouli. \xe2\x80\x94 It seems probable that more or less of the \ncajuput oil of commerce is derived from two trees of New \nCaledonia, the Melaleuca flaviftora and the Melaleuca viridi- \nUora. The oil of miaouli, or niaouli, which is distilled from \ntheir leaves, is described as of a pale-yellow color and anal- \nogous in chemical composition to terpinol, and is said to pos- \nsess properties very similar to those of oil of cajuput. It is \nreported to have been used with benefit in bronchitis and to \nhave a marked effect in diminishing the expectoration in pul- \nmonary tuberculosis, and it has also been employed for the pur- \nposes for which oil of cajuput is usually given. It is best ad- \nministered in capsules. \n\nEUCALYPTUS. \n\n1. EUCALYPTUS.\xe2\x80\x94 Eucalyptus. Dose, 2 gm.; 30 gr. \n\nPreparation. \nFluidextractum Eucalypti. \xe2\x80\x94 Fluidextract of Eucalyptus. \nDose, 2 c.c; 30 TTL- \n\n2. OLEUM EUCALYPTI.\xe2\x80\x94 Oil of Eucalyptus. Dose, 0.5 c.c; \n\n8 Tt\\. > \n\n3. EUCALYPTOL.\xe2\x80\x94 Eucalyptol. Cineol. Dose, 0.3 c.c; 5 TT],. \n\n\n\n484 PHARMACOLOGY AND THERAPEUTICS. \n\nAction of Eucalyptus. \n\nExternal. \xe2\x80\x94 Oil of eucalyptus is a very active disinfectant. \nOld oil is said to have greater antiseptic power than new, and \nthis is thought to be due to the larger amount of ozone which \nit contains. As regards the antiseptic properties of eucalyptus \noil, ozone is regarded as its most valuable constituent, and next \nto this come the pinenes and other terpenes, which are not only \nantiseptic in themselves, but are the agents in the production \nof the ozone. Recent experiments indicate that eucalyptol is \nthe weakest antiseptic of all, and that it is chiefly valuable as \na carrier of ozone. Oil of eucalyptus is a rubefacient, but less \nirritant to the skin than oil of turpentine and some other volatile \noils. If evaporation is prevented, however, it will produce vesi- \ncation, and even pustulation. \n\nInternal. Gastro-intcstinal Tract. \xe2\x80\x94 Ordinarily it produces \nvery much the same effects as oil of turpentine in small doses, \nbut large amounts of it are capable of exciting indigestion with \neructations, and nausea, vomiting and diarrhoea, with severe \nabdominal pain. \n\nCirculation. \xe2\x80\x94 In doses such as promote appetite and diges- \ntion it increases the heart\'s action and causes a rise of blood- \npressure ; effects which are no doubt due to the reflex stimula- \ntion from the stomach. Large doses depress the heart and \ncause a fall of blood-pressure, at the same time producing great \nmuscular weakness and lowered temperature. As the arterial \npressure falls in animals after section of the spinal cord or of \nthe vagi, as well as after atropine, eucalyptus has been thought \nto act directly upon the heart. The leucocytes of the blood are \nrestricted in their movements, diapedesis is prevented, and pus \nformation diminished. The surface of the red corpuscles has \nbeen observed to appear wrinkled, and the nucleus, when pres- \nent, more distinct. \n\nRespiration. \xe2\x80\x94 While small doses slightly accelerate the re- \nspiration, large doses depress it, and in toxic amount it causes \nparalysis of this function by direct action on the respiratory \ncentre in the medulla. \n\n\n\nEUCALYPTUS. 485 \n\nNervous System. \xe2\x80\x94 As in the case of turpentine, the stimula- \ntion of the central nervous system is only very transient, and \nis followed by marked depression. It is stated to be even a \nmore pronounced depressant than turpentine, though conscious- \nness is retained for a longer time. Under large or toxic doses \nthe brain, medulla, and spinal cord are all affected, the reflexes \nare abolished, and loss of sensation in the lower limbs may \noccur. Small doses have the effect of stimulating mental \nactivity. \n\nSpleen. \xe2\x80\x94 Like quinine, eucalyptus, it is believed by some, \nhas the power of causing contraction of the spleen, though \nto a much smaller degree. It has also been thought to be more \nor less antiperiodic, but that it has any specific action of this \nkind is denied by competent authorities, on the ground that it \nhas the same constituents as several other oils, and seems to \nhave no peculiar qualities. \n\nAbsorption and Excretion. \xe2\x80\x94 It is absorbed from the skin, \nrespiratory mucous membrane, and alimentary canal, and is\' \nexcreted by the skin, the respiratory and other mucous mem- \nbranes, and the kidneys. It imparts its odor to the breath \nand the urine, and is somewhat irritant at the points of elimi- \nnation. It therefore has more or less action as a diaphoretic, \nexpectorant, diuretic, and stimulant to the genito-urinary tract. \n\nIn a case of fatal poisoning by oil of eucalyptus death was \npreceded by great embarrassment of respiration. Post mortem \nthere was found a large quantity of blood in the pleural cavi- \nties, the lungs were collapsed and bloodless, and the right heart \ncontained frothy blood. \n\nTherapeutics of Eucalyptus. \nExternal. \xe2\x80\x94 It is used as an antiseptic in surgery, and is pre- \nferred by some to phenol, as it is said to be three times as \nenergetic as the latter. As a wash or dressing for wounds, \nsores, etc., and especially for chronic, indolent, or unhealthy \nulcers, the tincture or the water of eucalyptus (neither official), \nor a weak solution of the oil in alcohol, may be employed. An \n\n\n\n486 PHARMACOLOGY AND THERAPEUTICS. \n\nointment of eucalyptus, containing 10 per cent, of the oil, is \nofficial in the British Pharmacopoeia, and a eucalyptus gauze is \nalso available. A soap (sapo eucalyptoli), containing 5 per \ncent, of the oil, is of service in the treatment of foul wounds \nor ulcers and of bromidrosis. An ointment composed of \neucalyptus, 8 ; iodoform, 1 ; hard paraffin, 40 ; vaseline, 40, is \na good application for chancres and chancroids, and the oil \nin the form of an emulsion (1 to 50), may be advantageously \nused as an injection in gonorrhoea. The oil has been employed \nas a mild counter-irritant in affections of the chest and of the \njoints, and its local stimulant effects sometimes prove valuable \nin the treatment of anidrosis and of alopecia when a thickened \nand vitiated sebum occludes the glands and covers the scalp. \nIt is a serviceable addition to other medicaments in ointments \nfor chronic eczema and other cutaneous affections. A 10 per \ncent, solution of eucalyptol in pure alcohol has been used as a \nlocal antiseptic application in diphtheria, and the oil in a \nvaporized state has been employed for inhalations in this dis- \nease. Similar inhalations may likewise be given in pulmonary \ntuberculosis, dilated bronchi, bronchitis with fetid expectora- \ntion, gangrene of the lungs, ozsena, etc. In phthisis not much \nis to be hoped for in the way of permanent benefit, as the tuber- \ncle bacillus has been found to be peculiarly resistant to the \naction of the volatile oils. In asthma, eucalyptus-leaves are \nsometimes smoked in cigarettes made with stramonium-leaves \nand belladonna or cocoa, but how much of the benefit derived \nfrom their use is attributable to the eucalyptus seems rather \nuncertain. A decoction of the leaves is an efficient local appli- \ncation in stomatitis, pharyngitis, tonsillitis, etc., after the sub- \nsidence of the acute stage. It may also be used as an injec- \ntion for thread-worms. In cancer of the rectum or uterus the \ntopical application of eucalyptus frequently diminishes the \namount and fetor of the discharges. \n\nIt is worth noting that eucalyptus is of service in preserving \nsolutions of alkaloids designed for hypodermatic use. An \naqueous preparation will prevent the development of the peni- \n\n\n\nEUCALYPTUS. 487 \n\ncillium which rapidly destroys the alkaloid when the solution \nis made with simple distilled water. \n\nInternal. \xe2\x80\x94 Eucalyptus is useful as a stomachic and carmina- \ntive, provided no inflammatory action is present, in atonic dys- \npepsia, and in chronic gastric and intestinal catarrh. In con- \nsequence of its action the alimentary tract becomes more \nhealthy, and no longer affords a place of development for para- \nsites, and it is especially efficient in the form of vomiting and \nindigestion caused by sarcinse. In convalescence from acute \ndisease, in debility arising from defective assimilation, and in \ncachectic conditions generally, it strengthens the action of the \nheart and often constitutes a satisfactory tonic and stimulant. \nHysteria, neurasthenia, chorea, and similar conditions, as well \nas cerebral anaemia, may be benefited by eucalyptus, and, like \noil of cajuput, it is likely to be of service in the nervous phe- \nnomena which characterize the climacteric period. It has been \nknown to afford decided relief in the headache which accom- \npanies epidemic influenza, and may sometimes likewise prove \nefficacious in migraine and other forms of headache. The \nremedy is especially valuable in subacute and chronic catarrhal \naffections of the bronchial mucous membrane and that of the \ngenito-urinary organs, by both of which it is excreted. There \nseems to be no question of its value in the declining stage of \npneumonia, in pulmonary gangrene, in chronic bronchitis, and \nparticularly in bronchorrhcea and fetid bronchitis. It has been \ngiven in tuberculosis, in the hope that in its excretion through \nthe lungs it would exercise an antiseptic action. The objection \nhas been raised, however, that the traces excreted in this way \nare quite incapable of any noticeable effect on microbial growth, \nwhile, as has been mentioned, the tubercle bacillus appears to \nbe peculiarly resistant to this class of remedies. Among the \ngenito-urinary affections in which it has been found of ser- \nvice may be mentioned chronic desquamative nephritis, granular \ndegeneration of the kidneys, pyelonephritis, hydronephrosis, \ngleet, vaginitis, and particularly chronic catarrh of the bladder. \nIn these conditions it is necessary, however, to administer it \n\n\n\n488 PHARMACOLOGY AND THERAPEUTICS. \n\nwith caution and not to use it too long continuously, on account \nof the danger of exciting renal congestion and irritation. In \nthe hope that it might prove beneficial as an antipyretic and in- \nternal antiseptic, oil of eucalyptus has been given both by the \nmouth and by hypodermatic injection in pyaemia, septicaemia \nand puerperal fever, as well as in typhoid and scarlet fevers. \nWhile the results from its use have sometimes appeared to be \nfavorable, the remedy would seem to possess no special advan- \ntages over the other volatile oils. For subcutaneous use it is \ndiluted with olive oil (i to 4). \n\nThere is considerable difference of opinion as to the value \nof eucalyptus in malarial fever. By some it was at one time \nthought, like quinine, to have a specific action in this disease, \nbut this opinion has now been abandoned by most observers. \nIf it has any such effect at all, it is positive that it is vastly \ninferior to that of the cinchona preparations. At the same \ntime, it appears to have a certain amount of usefulness as a \nremedy for malarial conditions, and some of the most experi- \nenced clinicians have found it very serviceable in the con- \nvalescence from intermittent and remittent fevers and in chronic \nmalarial poisoning. While it cannot by any means take the \nplace of quinine in arresting the paroxysms or preventing re- \nlapses at the septenary periods, it is asserted that it is even \nmore useful than that remedy for reconstructing the damages \nin the organs of assimilation occasioned by the malarial in- \nfection. It has sometimes proved curative in cases where \nquinine had failed. Eucalyptus trees have been largely culti- \nvated in malarial regions, with the effect of often improving \nmarkedly the healthfulness of such districts. This result has \nbeen attributed in part to the action of the eucalyptus in puri- \nfying the atmosphere in its vicinity by its aseptic emanations, \nbut it would seem to be due rather to the drying of the soil, \nin consequence of the large amount of water withdrawn from \nit by the rapidly growing tree. \n\nIn most instances eucalyptol can be substituted for the oil \nwith advantage. \n\n\n\nARNICA. 489 \n\nOIL OF ROSEMARY. \nOLEUM ROSMARINI.\xe2\x80\x94 Oil of Rosemary. Dose, 0.2 C.C.; 3 TF\\. \n\nAction of Oil of Rosemary. \nThe action of oil of rosemary is like that of other similar \nvolatile oils. It is said, especially when inhaled, to reduce the \nbody-heat and impart to the urine a violaceous odor. \n\nTherapeutics of Oil of Rosemary. \n\nRosemary was formerly employed to some extent as an era- \nmenagogue, galactagogue and diuretic., but is not now used with \nthese actions in view. The chief use of the oil is as an external \nstimulant in lotions, liniments and ointments. In facial acne \nit is thought to have a special beneficial action. It is frequently \nprescribed with tincture of cantharides and Cologne water in \nalopecia resulting from defective nutrition of the hair-bulbs, \nand, on account of its parasiticidal property, it is efficacious in \napplications for scabies and the different varieties of pediculosis. \nAs an ingredient of rubefacient liniments it is serviceable for \nsprains and painful joints, and the compound rosemary oint- \nment of the German Pharmacopoeia (consisting of one part \neach of the oils of rosemary and juniper-berries in thirty parts \nof ointment), may be employed in neuralgia, lumbago, chronic \nrheumatism, etc. Oil of rosemary is also largely used simply \nto give a pleasant scent to lotions and other preparations for \nexternal use. \n\nInternally, it is occasionally given as a carminative in flat- \nulence and colic and as a stimulant in hysteria accompanied \nby depressed spirits. \n\nIt enters into the composition of soap liniment and the com- \npound tincture of lavender. \n\nARNICA. \n\nARNICA. \xe2\x80\x94 Arnica (Arnicae Flores, U. S. P., 1890). Dose, 1 gm.J \n15 gr. \n\nPreparation. \nTinctura Arnicae. \xe2\x80\x94 Tincture of Arnica. Dose, 1 c.c; 15 n\\. \n\n\n\n490 PHARMACOLOGY AND THERAPEUTICS. \n\nUnofficial Preparation. \nTrimethylamini Hydrochloras. \xe2\x80\x94 Trimethylamine Hydrochlo- \nrate. Dose, 0.12 to 0.30 gm.; 2 to 5 gr. \n\nARNICA RADIX (U. S. P., 1890; no longer official).\xe2\x80\x94 Arnica \nRoot. Dose, 0.30 to 1.20 gm.; 5 to 20 gr. \n\nUnofficial Preparations. \n\n1. Extractum Arnicae Radicis (U. S. P., 1890). \xe2\x80\x94 Extract of \nArnica Root. Dose, .30 to 1.20 gm.; 5 to 20 gr. \n\n2. Extractum Arnicae Fluidum (U. S. P., 1890). \xe2\x80\x94 Fluidextract \nof Arnica Root. Dose, .30 to 1.20 C.C.; 5 to 20 nT.. \n\n3. Tinctura Arnicae Radicis (U. S. P., 1890). \xe2\x80\x94 Tincture of \nArnica Root. Dose, .30 to .60 c.c; 5 to 10 n\\. \n\n4. Emplastrum Arnicae (U. S. P., 1890). \xe2\x80\x94 Arnica Plaster. \n\nAction of Arnica. \nOn account of its volatile oil, arnica has the same action as \nthe volatile oils in general. In large doses it is a gastroin- \ntestinal irritant, causing vomiting and purging, and also pro- \nduces headache, unconsciousness, fall of temperature, paralysis \nof the nervous system (motor and sensory), and sometimes \ncollapse and death. In some cases convulsions occur. In \nmoderate doses it slows the pulse, raises the blood-pressure \nslightly, and stimulates the vagus nerves, while toxic amounts \nproduce a rapid pulse from paralysis of these nerves. Arnica \nis excreted mainly by the kidneys and mucous membranes. \n\nTherapeutics of Arnica. \nExternal. \xe2\x80\x94 The diluted tincture is used for myalgia, sprains, \nbruises and external inflammations generally, and is a very \npopular domestic remedy for such affections. It should not \nbe applied if the skin is broken, and should always be used \nwith caution if the integument is sensitive. Some individuals \nappear to have a special indiosyncrasy in respect to arnica, and \nin such there may be caused by it violent cutaneous inflamma- \ntion, with the production of pustules, or even distinct bullae, \n\n\n\nARNICA. 491 \n\nattended with severe constitutional symptoms. The idiosyn- \ncrasy is found to be often marked in the gouty. It is said, \nhowever, that this untoward action has not been observed from \npreparations made from the root. Some authorities assert that \nany good effects which tincture of arnica may have, such as \ncausing absorption of ecchymoses, are in reality due to the \nalcohol; on the other hand, it is claimed that the infusion (not \nofficial), which is made with water only, is even more efficacious \nas a local application than the tincture. The aqueous prepara- \ntion, it is also said, promotes the rapid union of cut surfaces. \nClinical experience shows that arnica often has a very effec- \ntive local action, particularly in rheumatism, boils, abscesses, \nand in all thickened conditions of the integument, and that it \nalso has some influence over haemorrhages. For boils, ab- \nscesses and thickening of the skin an application consisting \nof equal parts of fluidextract of arnica root (not official), \nsoap liniment, and tincture of opium is recommended, and for \nhaemorrhages, one of equal parts of fluidextract of arnica root \nand distilled witchhazel water, to be used on lint or muslin. \nA rheumatic joint may be covered with cloths saturated with \nthe latter combination, which is often more efficient when ap- \nplied hot. Arnica plaster sometimes affords a very useful \nmeans of employing the drug locally. \n\nInternal. \xe2\x80\x94 Except as a stomachic, carminative and reflex \nstimulant, when given in small doses, many writers consider \narnica, internally, as too unreliable in its effects to be of much \ntherapeutic value. Others, however, confidently assert that it \nis a remedy of distinct usefulness in a very considerable variety \nof conditions. Thus, it is claimed that ecchymoses are rapidly \ndispersed by its internal, as well as its external administration, \nand that for internal contusions from shock or concussion its \nuse by the mouth has proved very efficacious. Furthermore, \nthat it has rendered good service in typhus and typhoid fevers \n(as a stimulant and antipyretic), delirium tremens, rheumatism \nand rheumatic gout, epistaxis, haemoptysis and other haemor- \nrhages, amaurosis, concussion of the brain, paralysis of the \n\n\n\n492 PHARMACOLOGY AND THERAPEUTICS. \n\nbladder, and chronic dysentery. The assertion is made that it \nhas often checked an exhausting diarrhoea after many other \nremedies have failed, and that in aqueous preparation it has \ngiven great satisfaction in idiopathic mania, after the first ex- \ncitement has diminished. It has also been found beneficial in \nacute eczema, in erysipelas, and in other cutaneous affections \nof gouty or rheumatic origin. Many of these claims would \nseem to be exaggerated. \n\nTrimethylamine (C 3 H N), a compound which is frequently \nincorrectly called propylamine, with which it is isomeric, has \nbeen obtained from arnica flowers and those of several other \nplants, as well as from decomposing albuminous substances, \nsuch as herring-pickle and human urine. In its pure state it \nis a colorless, thin, and strongly alkaline liquid, having a marked \nammoniacal odor modified by the peculiar odor of herring- \npickle, and boiling at 9.8 C. (49. 6\xc2\xb0 F.), while at ordinary \ntemperatures it is a colorless inflammable gas. It is readily \nsoluble in water and alcohol. The hydrochlorate, its most stable \nsalt, which crystallizes in white or colorless prisms and is very \ndeliquescent, is also freely soluble in water and alcohol. In \ndoses of .12 gm. (2 gr.) every three hours it is said to be a \npowerful antipyretic, and it has been used with considerable suc- \ncess in acute rheumatism and gout. In chronic rheumatism a \nliniment (1 to 3 of glycerin) has also afforded great relief; and \nit has been suggested that the fact that arnica contains tri- \nmethylamine is probably the true explanation of the utility of \nthat drug in rheumatic and gouty affections. Trimethylamine, \nwhen given to the extent of 1 to 1.30 gm. (15 to 20 gr.) a day, \nhas been reported as efficient in the treatment of chorea, greatly \nmoderating the spasmodic movements when not altogether pre- \nventing them. \n\nMEZEREUM. \n\nMEZEREUM.\xe2\x80\x94 Mezereum. (Mezereon.) Dose, 0.500 gm. (500 \nmilligm.); 7V 2 gr. \n\nPreparation. \nFluidextractum Mezerei. \xe2\x80\x94 Fluidextract of Mezereum. \n\n\n\nELEMI. 493 \n\nAction of Mezereum. \n\nExternal. \xe2\x80\x94 Mezereum has the same action as volatile oils \ngenerally. It is a powerful rubefacient and vesicant externally. \n\nInternal. \xe2\x80\x94 It is a gastric stimulant, producing in large doses, \nvomiting and diarrhoea. \n\nTherapeutics of Mezereum. \n\nExternal. \xe2\x80\x94 It has been used chiefly in the compound mustard \nliniment (no longer official), where it excites the same effects \nand is employed for the same purposes as the oil of mustard. \nAlmost its only other external use at present is to keep open \nan issue, a procedure which is now very rarely employed. Un- \nguentum Mezerei was official in U. S. P., 1880. In the mouth, \nhowever, mezereum-bark has been successfully employed to \nrelieve toothache, and also as a sialogogue. \n\nInternal.\xe2\x80\x94 Internally its use is now practically restricted to \nits administration, in combination with sarsaparilla, as an alter- \native in syphilis, chronic rheumatism, and chronic skin diseases, \nin all of which its value is very doubtful. It is an ingredient \nof both the compound decoction (no longer official) and the \ncompound fluidextract of sarsaparilla. \n\nELEMI. \n\nELEMI.\xe2\x80\x94 Manila Elemi (not official). \n\nAction of Elemi. \nElemi acts like volatile oils generally. \n\nTherapeutics of Elemi. \nIt is only used as a stimulating disinfectant ointment which \nwas formerly official in B. P. as elemi, 1 ; ointment, 4. In this \ncountry it is very rarely prescribed. \n\nDivision V. \xe2\x80\x94 Drugs Acting on the Skin. \nWhile the drugs described in Division IV act on the cutaneous \nvessels, in addition we have \xe2\x80\x94 \n\n\n\n494 PHARMACOLOGY AND THERAPEUTICS. \n\nA. Diaphoretics, or drugs which increase the amount of per- \nspiration. These may do this: (i) By affecting the circula- \ntion in the skin. This may be locally (by local irritation) or \nsystemically. In the latter case the action may be an indi- \nrect one, and due to a rise of general blood-pressure if the \ncutaneous vessels are not at the same time constricted; or a \ndirect one, due either to stimulation, direct or reflex, of the \ncentral dilator mechanism of the cutaneous vessels, or to \nparalysis of the vaso-constrictor mechanism of these vessels. \n(2) By directly augmenting the secretory activity of the cells of \nthe sweat glands, either through stimulation, direct or reflex, \nof the sweat centres in the spinal cord, or through peripheral \nstimulation of the terminations of the nerves in the glandular \ncells themselves. As it is difficult to decide whether drugs \nacting on the vessels do not affect the other parts of the \nmechanism, and also whether a drug acts on the gland-cells or \non the nerve endings, diaphoretics will be considered under \ntwo headings only: (a) those acting peripherally, and (b) \nthose acting centrally. These are differentiated by observing \nwhether the drug acts on a part of the skin after- division of the \nnerves going to it or whether it acts after destruction of the \nspinal cord. \n\n(a) Diaphoretics acting peripherally : Pilocarpine greatly increases \nthe amount of sweat, acting on the nerve terminations in the gland- \ncells, but not on the vessels. Nicotine also acts peripherally. Local \napplications of warmth, and Alcohol taken internally perhaps act in \nthe same way in addition to their vascular action. \n\n(b) Diaphoretics acting centrally: \n\n\n\n(1) Antimony salts. \n\n(2) Ammonium acetate. \n\n(3) Ammonium citrate. \n\n\n\n(4) Ipecacuanha. \n\n(5) Opium. \n\n(6) Camphor. \n\n\n\n(c) Diaphoretics zvhose mode of action is doubtful: Potassium Ci- \ntrate and acetate, senega, cubeb, colchicum, salicin, lobelia, arnica and \naconite. All these, except the first two, are very feeble. \n\nWhen a diaphoretic acts very powerfully it is called a Sudorific, \n\n\n\nDRUGS ACTING ON THE SKIN. 495 \n\nB. Anhidrotics, or Antihidrotics, drugs which diminish the \namount of perspiration. The part on which these act is de- \ntermined in the same way as in the case of diaphoretics. \n\n(a) Anhidrotics acting peripherally : Atropine is very powerful; it \nacts on the terminations of the nerves in the glands, and hyoscyamus \nand stramonium apparently act in the same way. The local applica- \ntion of cold has a similar action. \n\n(b) Anhidrotics the mode of action of which is doubtful: \n\n\n\n(1) Acids. \n\n(2) Nux vomica. \n\n(3) Quinine. \n\n(4) Picrotoxin. \n\n\n\n(5) Zinc salts. \n\n(6) Salicylic acid. \n\n(7) Camphoric acid. \n\n\n\nTherapeutics. \xe2\x80\x94 Diaphoretics are used for the following pur- \nposes: (1) To remove fluid from the body, as hy causing the \nabsorption of exudates. (2) To relieve diseased and overtaxed \nkidneys; for this purpose pilocarpine is much used. (3) To \nremove poisons introduced from without. or formed in the body. \nPilocarpine is also used to promote excretion by the sweat in \nuraemia and similar conditions. (4) To re-establish disturbed \ncirculation in the skin, in order to relieve internal congestions, \nbreak up an incipient " cold," bring out the rash in exanthemata, \npromote defective nutrition of the skin in certain cutaneous \ndiseases, etc. The increased vascularity of the skin is also made \nuse of to facilitate the absorption of local medicaments, such \nas ointments. Diaphoretics act as mild antipyretics. (5) To \nincrease the alkalinity of the tissues, as in gout, oxybutyric acid \ncoma (diabetes), etc. For this purpose drugs which directly \nstimulate the glandular activity are required, as the sweat is \nacid only when produced in this manner. It has been shown \nthat an injection of pilocarpine is so effective in removing acid \nthat it will render the urine of a healthy person markedly alka- \nline. In general, the sweat which results from increased circu- \nlation contains less solid matters and is more alkaline, while \nthat resulting from direct action on the glands is more con- \ncentrated and less alkaline. This is the character of the cold \nsweat which carbon dioxide produces by stimulating the sweat \n\n\n\n496 \n\n\n\nPHARMACOLOGY AND THERAPEUTICS. \n\n\n\ncentres, and which is often of serious import in the course of \na disease, as indicating asphyxia. Certain drugs when taken \ninternally are excreted in the sweat. Among them may be men- \ntioned iodine, iodides, and tartaric, succinic and benzoic acid, \nthe latter in the form of hippuric acid. \n\nAnhidrotics are employed to a limited extent either for gen- \neral conditions, as phthisis, or for local conditions, as hyperi- \ndrosis of the hands or feet. Little or nothing is known of the \neffect of drugs on the sebaceous secretion, though iodides and \nsome other substances are excreted in the sebum. \n\nCertain drugs, when taken internally in large doses, produce \na rash on the skin, possibly because in the course of their ex- \ncretion through the skin they irritate it. Such are \xe2\x80\x94 \n\n\n\n(0 Copaiba. \n\n(2) Cubeb. \n\n(3) Bromides. \n\n(4) Iodides. \n\n(5) Turpentine. \n\n(6) Belladonna. \n\n(7) Hydrated chloral. \n\n(8) Opium. \n\n(9) Quinine. \n\n(10) Salicylic acid. \n\n\n\n(11) Arsenical salts. \n\n(12) Acetanilide. \n\n(13) Antipyrine. \n\n(14) Phenacetine. \n\n(15) Chloralamide. \n\n(16) Antitoxins. \n\n(17) Serums. \n\n(18) Silver salts may discolor \n\nthe skin. \n\n(19) Sulphonal. \n\n\n\nThe following quite rarely produce an eruption : \n\n\n\n(1) Iron. \n\n(2) Strychnine. \n\n(3) Creosote. \n\n(4) Mercury. \n\n(5) Veratrum. \n\n\n\n(6) Digitalis. \n\n(7) Sulphur. \n\n(8) Antimony. \n\n(9) Santonin. \n(10) Cod liver oil. \n\n\n\nDiaphoretics. \nPILOCARPUS. \n\n1. PILOCARPUS.\xe2\x80\x94 Pilocarpus. (Jaborandi.) Dose, 2 gm.; 30 gr. \n\nPreparation. \nFluidextractum Pilocarpi. \xe2\x80\x94 Fluidextract of Pilocarpus. \nDose, 2 c.c; 30 tt\\,. \n\n2. PILOCARPINE HYDROCHLORIDUM.\xe2\x80\x94 Pilocarpine Hydro- \nchloride. Dose, 0.010 gm. (10 milligm.); y 5 gr. \n\n\n\npilocarpus. 497 \n\n3. PILOCARPINE NITRAS.\xe2\x80\x94 Pilocarpine Nitrate. Dose, 0.010 \ngm. (10 milligm.) ; y 5 gr. \n\nAction of Pilocarpus. \n\nExternal. \xe2\x80\x94 None. \n\nInternal. G \'astro-intestinal Tract. \xe2\x80\x94 Pilocarpine, which is \npromptly absorbed, is a glandular stimulant of extraordinary \npower. Its first effect is seen in a marked increase of the \nsaliva, which contains an abundance of salts and ptyalin, and \nwill readily convert starch into sugar. There is a feeling of \nwarmth in the mouth, and often a sensation of tenseness about \nthe salivary glands. The seat of the stimulation is the termina- \ntions of the secretory nerves. That it does not reside in the \ncells is shown by the fact that the action of the drug is instantly \nantagonized by atropine, which acts upon the nervous struc- \ntures alone, and not upon the secretory cells ; and that it is not \ncentral in character is evident from the fact that section of \nthe secretory nerves does not materially alter the action. \nNausea, retching and vomiting are occasionally observed, and \nthere is always some increase in the gastric and pancreatic \nsecretions. Whether there is any increase in the intestinal \nsecretion is still unsettled, though this seems highly probable. \nPeristalsis is increased by the contraction of the intestinal \nmuscle from the stimulation of its peripheral nervous apparatus. \nUnstriped muscle generally, with the exception of that of the \nblood-vessels, appears to be thrown into contraction, but this \naction is more marked in the bowel than elsewhere; so that \nrepeated diarrhceic evacuations occur, accompanied with more \nor less colic. This muscular action also takes place inde- \npendently of the central nervous system, and is antagonized by \natropine in the same way as the effect on the glandular secre- \ntions. The secretion of bile is not directly affected. \n\nEye. \xe2\x80\x94 Myosis (contraction of the pupil) and spasm of accom- \nmodation are produced through stimulation of the motor oculi \nterminations. The intra-ocular tension is reduced, after a tem- \nporary increase; myosis being generally attended with lowered \ntension. \n33 \n\n\n\n498 PHARMACOLOGY AND THERAPEUTICS. \n\nSkin. \xe2\x80\x94 Shortly after the augmentation of the salivary secre- \ntion begins, there follow a flow of tears and excessive perspira- \ntion. The effect on the sweat glands is so pronounced as to \nleave no question that pilocarpus is the most efficient diaphoretic \nof all known drugs. The general increase in the secretions is \nfound to be mainly due to water. Although the solids are in- \ncreased also, yet, owing to the excess of fluid poured out, their \npercentage is diminished. After a single subcutaneous dose of \npilocarpine the water lost in the sweat, saliva, mucus, and other \nsecretions may amount to 3785 c.c. (1 gallon). The loss of \nweight is naturally very great also, and this has been set down \nat from 2 to 4 kilogrammes (4J/2 to 9 pounds). The mucous \nglands of the mouth, throat, nose and deeper respiratory pas- \nsages, as well as the ceruminous glands of the ears, all partici- \npate in the activity induced by the pilocarpine stimulation. The \neffect upon the secretion of milk is doubtful. Under a course \nof pilocarpus the hair grows more luxuriantly, but it becomes \nquite coarse. \n\nCirculation. \xe2\x80\x94 In man pilocarpine is found to give a marked \nacceleration to the pulse, with increased blood-pressure and later \nwith arhythmia. This is attributed to vagus paralysis, though \nthe rise of blood-pressure is believed to be partly due to a \nstimulation of the vaso-motor centres. Under large doses there \nfollow muscular slowing and weakening of the heart, with fall \nof blood-pressure; and this action is judged to be on the cardiac \nmuscle directly. In rabbits, it is stated, there is a primary \nvagus stimulation, which is shown by slowing of the heart and \nfall of blood-pressure, and this action sometimes occurs in \nman also. The increased activity of the glands is accom- \npanied by an acceleration of the blood current through them, \nwith dilatation of the vessels, and this is believed to be probably \nnot due to the direct action of the drug on the latter, but simply \na result of the stimulus imparted to the glands. After pilo- \ncarpine there is frequently noticed a redness of the skin, espe- \ncially of the face, and this is no doubt due to the vascular dila- \ntation accompanying the increased activity of the sweat glands. \n\n\n\npilocarpus. 499 \n\nThe sugar of the blood has been found increased, a result \nattributed to the action of pilocarpine on the terminations of \nthe nerves in the liver which regulate the glycogenic function \nof that organ. \n\nRespiration. \xe2\x80\x94 The respiration is often quick and dyspnoeic, \nand rales may be heard over the bronchi, denoting an accumu- \nlation of mucus in them ; the bronchial secretion being markedly \naugmented. The effect on the respiration of ordinary doses is \nmerely an indirect one, resulting from changes in the circula- \ntion which diminish the amount of blood passing through the \nlungs and tend to produce asphyxial dyspnoea. \n\nCentral Nervous System. \xe2\x80\x94 In experiments on animals it is \nfound that the action here is weak and appears late; being en- \ntirely overshadowed by the peripheral actions. It is described as \nfollows : The effects are mainly depressing. Vasomotor paraly- \nsis is a rather early and prominent symptom; it leads to dyspnoea. \nLater, the respiratory centre is also depressed. (Edema of the \nlungs (consisting rather in the aspiration of bronchial effusion \nthan in a true serous effusion), consequent on the weakened \nheart and obstruction of the bronchi by mucus, is a frequent \noccurrence. The motor centres, especially those of the cord, \nshow some stimulation (increased reflexes, tremors, convul- \nsions), and later paralysis. \n\nUrinary Organs. \xe2\x80\x94 The urine, like the bile, does not seem to \nbe affected directly, although it may be reduced in quantity \nor otherwise modified by the withdrawal of a large amount of \nfluid from the body by the sweat and other secretions. The \nbladder muscle participates in the general contraction of un- \nstriped muscular fibre induced by the drug, and repeated evacua- \ntion and straining may occur. Pilocarpine is excreted un- \nchanged in the urine. \n\nUterus. \xe2\x80\x94 The spleen and bronchi contract under the influence \nof pilocarpine upon unstriped muscle, and the uterus is sup- \nposed to be affected in the same manner. In occasional in- \nstances abortion has been attributed to the action of the drug. \n\nTemperature. \xe2\x80\x94 In consequence of the hyperaemia of the skin \n\n\n\n500 PHARMACOLOGY AND THERAPEUTICS. \n\nthe temperature is apt to be temporarily elevated, but there \nsoon follows a decided fall, which is apparently due in great \nmeasure to the evaporation of the perspiration. The decline in \nbody-heat is maintained on an average for about four and a \nhalf hours. \n\nThe most important effects of pilocarpine on the system are \nthe diaphoresis, the salivation, and the myosis. The antagonism \nto atropine is complete with both glands and muscles. The \nalkaloid pilocarpine is more generally employed than pilocarpus \nitself, as it is more prompt and efficient in its action, as well as \nless liable to disagree with the stomach. Children usually bear \nlarge doses of it well. \n\nJaborine, having an action like that of atropine, opposes the \neffects of pilocarpine, but although the amount of it varies in \ndifferent specimens of pilocarpus leaves, there is never a suffi- \ncient quantity to entirely overcome the action of the principal \nalkaloid of the drug. \n\nTherapeutics of Pilocarpine. \n\nExternal. \xe2\x80\x94 For promoting the growth of the hair an oint- \nment composed of pilocarpine hydrochloride, I ; petrolatum, \n60 ; lanolin, 60 ; may be used, or a lotion : Pilocarpine hydro- \nchloride, 1; quinine hydrochloride, 4; glycerin, 60; rose water, \n180. The following, applied with friction, is more stimulating \nto the scalp: Fluidextract of pilocarpus, 15; soap liniment, 15; \nperfumed spirit (not now official), 60. Pilocarpus and its \npreparations also have the effect of rendering the hair darker \nin color. The fluidextract has been employed as a local appli- \ncation in eczema and erysipelas. Pilocarpine is used topically \nas a myotic in many eye affections. Lozenges containing .001 \ngm. ( \xc2\xa5 ^-gr.) are said to relieve dryness of the throat. \n\nInternal. \xe2\x80\x94 Pilocarpine may be used whenever a prompt dia- \nphoretic effect is desired. It is most commonly employed to \nproduce sweating in cases of Bright\'s disease. The usual prac- \ntice is to administer .01 gm. (*. gr.), or more, of pilocarpine \nhydrochloride, in the evening, aiding the sweating by wrapping \nthe patient, who should be naked, in warm blankets, applying \n\n\n\nPILOCARPUS. 501 \n\nheat to the feet, and administering hot drinks. As soon as the \nsweating has ceased he should be rubbed dry and left in a dry \nblanket. In this affection the drug is often of great service by \nrelieving the strain on the kidneys, by eliminating toxins from \nthe blood and diminishing the inflammatory condition in the \nkidneys by lowering the blood-pressure. On account of its \ndepressing action on the heart, it should always be used with \ngreat caution when there is any cardiac disease present, and \nalcohol or strychnine may often be administered with advan- \ntage to guard against depression of that organ. By some, pilo- \ncarpine is never employed in chronic parenchymatous nephritis, \nand the opinion is held generally that it is contra-indicated in \nthe nephritis of middle or advanced age associated with cardiac \nchanges. Theoretically it is the most prompt and efficient \nremedy at our disposal in uraemia, and in many instances it is \npractically of great service. In dropsy due to organic disease \nof the heart it is generally too depressing, and fatal results may \nattend its use. It may be used in pleurisy with effusion, but is \nnot so efficient as some other remedies. Injected subcutaneously \nevery second day, it has proved successful in the treatment of \nsome cases of catarrhal jaundice of a persistent type. Its ad- \nministration by the same method has been highly recommended \nas a preventive and curative measure in the early stages of \nerysipelas, and has been found effective in cases of obstinate \naural vertigo. Deafness resulting from disease of the auditory \nnerve or its terminations is sometimes relieved by pilocarpine, \nand the drug is often given internally for deafness due to otitis \nmedia sicca. Locally applied, pilocarpine is of service as an \nocular tonic to relieve pain after excessive use of the eyes, and \nin small doses internally has been shown to be a good remedy in \ntobacco and alcoholic amblyopia. Among other diseases of \nthe eye in which it has been employed are detachment of the \nretina, chronic iritis, keratitis, haemorrhages into the vitreous, \nhaemorrhages and exudations of the retina, glaucoma, atrophic \nchoroiditis, and commencing atrophy of the optic nerve. When \ngiven hypodermatically it is sometimes successful in stopping \n\n\n\n502 PHARMACOLOGY AND THERAPEUTICS. \n\nhiccough, and also in arresting paroxysms of spasmodic asthma. \nEfficient aid to the action of iodides and mercurials in the re- \nmoval of exudations has been found to be rendered by the \nuse of pilocarpine or pilocarpus, which is here given chiefly \nfor the purpose of increasing the rate at which the exudates \nliquefied by the agents mentioned are taken up and excreted. \nIn the case of gummata it is advised that the adjuvant remedy \nshould be exhibited once or twice a day. For the attempted re- \nmoval of inflammatory deposits such as those met with in \nchronic pneumonia and chronic pleurisy, it is thought prefer- \nable to give pilocarpine for three or four days at a time, and \nthen to discontinue its use until the following week. The \ndosage and frequency of administration must be regulated by \nthe degree of action, and an amount which will cause but little \nsweating and salivation is said to suffice. In subacute and mus- \ncular rheumatism, as well as in dry and scaly skin eruptions, \nit may often be used with great advantage. Injected subcu- \ntaneously, pilocarpine is sometimes successfully employed as an \nantidote in belladonna or atropine poisoning. \n\nTOXICOLOGY. \n\nDeath very rarely results from the use of pilocarpus or its alkaloid. \nWhen it does occur, it is by paralysis of the heart or oedema of the \nlungs. Treatment. \xe2\x80\x94 Atropine is a physiological antidote. In addition \nto its use, the general treatment of alkaloidal poisoning is called for. \n\nANTIMONY. \n\nANTIMONII ET POTASSII TARTRAS.\xe2\x80\x94 Antimony and Potas- \nsium Tartrate. (Tartar Emetic. Tartarated Antimony.) Dose (ex- \npectorant), 0.005 gm. (5 milligm.); 1 gr.; (emetic) 0.030 gr. (30 \n\nPreparations. \n\n1. Vinum Antimonii. \xe2\x80\x94 Wine of Antimony. Dose, 1 c.c; \n\n15 m.. \n\n2. Syrupus Scillae Compositus. \xe2\x80\x94 Compound Syrup of Squill. \n(Hive Syrup.) Dose, 2 C.C.; 30 111. \n\n\n\nANTIMONY. 503 \n\nUnofficial Preparations. \n\n1. Antimonii Sulphidum (U. S. P., 1890). \xe2\x80\x94 Antimony Sul- \nphide. \n\n2. Antimonii Sulphidum Purification (U. S. P., 1890).\xe2\x80\x94 \nPurified Antimony Sulphide. (Purified Black Antimony.) \n\n3. Antimonium Sulphuratum (U. S. P., 1890). \xe2\x80\x94 Sulphurated \nAntimony. (Kermes mineral.) Dose, 0.01 to 0.05 gm.; % to \n1 gr. \n\n4. Pilulae Antimonii Composite (U. S. P., 1890). \xe2\x80\x94 Com- \npound Pills of Antimony. (Plummer\'s Pills.) Dose, 1 to 3 \npills. \n\n5. Antimonii Oxidum (U. S. P., 1890). \xe2\x80\x94 Antimony Oxide. \nDose, 0.05 to 0.25 gm.; 1 to 4 gr. \n\n6. Pulvis Antimonialis (U. S. P., 1890). \xe2\x80\x94 Antimonial Pow- \nder. (James\' Powder.) Dose, 0.15 to 1 gm.; 3 to 15 gr. \n\nAction of Salts of Antimony. \n\nExternal. \xe2\x80\x94 They are powerful local irritants. Tartar emetic \nproduces a pustular eruption on the skin, and the Liquor Anti- \nmonii Chloridi of the B. P., which is a solution of antimony \nchloride in hydrochloric acid, is a severe caustic. \n\nInternal. Alimentary Canal. \xe2\x80\x94 Antimony acts very much like \narsenic, though differing from the latter in the severity of its \nlocal action and in being absorbed more slowly. In large doses \nby the mouth, or if injected into the circulation, its effects are \nfound to be practically identical with those of arsenic, but \nvomiting is always a prominent symptom, the poison being \nrapidly excreted into the alimentary canal. The only result of \nvery small doses of tartar emetic is the production of some \nperspiration. In somewhat larger amounts, by its direct action \non the walls of the stomach, it causes nausea and vomiting with \nmarked prostration and the usual accompaniments of emesis, \nsuch as salivation, sweating and quickened pulse. Like other \nantimonial preparations, it is irritant to the intestine if given \nin sufficient quantity. (A round mass of metallic antimony \nwas formerly known as the " family pill," because it could be \n\n\n\n504 PHARMACOLOGY AND THERAPEUTICS. \n\nrepeatedly used as a laxative.) In poisonous doses tartar \nemetic gives rise to violent and continuous vomiting, the vomit, \nafter the ordinary contents of the stomach have been evacuated, \nconsisting of slimy mucus, which eventually may have blood \nmixed with it. With the vomiting are associated profuse \nwatery diarrhoea, great muscular weakness, and collapse, with \ncold perspiration, clammy skin, and cyanosis of the face and \nextremities. This drug when thrown directly into the blood \nalso produces vomiting, but it is found that much larger quan- \ntities are required for this than when it is given by the mouth. \nMoreover, a portion of the antimony which is injected intra- \nvenously is carried to the stomach and intestine, where it causes \nlocal irritation. Some have believed that the emesis is due \nto action on the medulla, but from the facts just mentioned it \nwould appear that this is attributable entirely to its effects as \na gastric irritant. It is true that, when injected into the circu- \nlation, it may have an emetic effect even if the stomach is \nreplaced by a bladder, as has been shown by experiment; but in \nexplanation of this it has been suggested that although the \nantimony cannot act on the stomach under these circumstances, \nit may induce vomiting by causing irritation of some other \npart of the alimentary tract. While large quantities affect the \ngastro-intestinal tract much in the same way as arsenic, caus- \ning hyperemia and swelling of the mucous membrane, medicinal \ndoses do not cause any such effects. Even with large doses, \nhowever, the intestine may remain unaffected, both because \nantimony is, as has been mentioned, absorbed more slowly than \narsenic, and because the larger portion of the poison is usually \ngotten rid of by the violent vomiting excited. \n\nHeart and Circulation. \xe2\x80\x94 Antimony is a direct depressant to \nthe cardiac muscle. The temporary acceleration of the pulse \nis simply one of the effects of the vomiting, and is succeeded \nby a diminution in both the frequency and force of the beat \nof the heart. The final stoppage of the organ is found by ex- \nperiment to take place in diastole. There is no evidence that \nthe cardiac nerves are affected. There is a continuous fall in \n\n\n\nANTIMCNY. 505 \n\nblood-pressure, due in some measure to the weakness of the \nheart, but principally to the effect of the drug on some part of \nthe vaso-motor system. The peripheral nerves and muscle of \nthe vessels are known to be implicated, though it is uncertain \nwhether or not the vaso-motor centre shares in the action. \n\nRespiration. \xe2\x80\x94 Like the pulse, the respiration is often quick- \nened at first, and may be shallow and irregular from the nausea, \nbut in cases of poisoning it becomes slow and labored, and \neventually ceases along with the heart. The weakening of this \nfunction is believed to be chiefly due to the disturbance of the \ncirculation and the irritation of the alimentary canal, though \nthe respiratory centre may possibly be in some degree directly \nacted upon. \n\nNervous and Muscular Systems. \xe2\x80\x94 In the frog the central ner- \nvous system has been shown to be directly depressed by anti- \nmony. This is thought to be probably the case in mammals also, \nthough the effects of the poison on the circulation and alimen- \ntary canal render the true nature of the nervous action obscure. \nThere is good authority for stating that the depression and \ncollapse resulting from the drug are due to the gastric irritation \nand slowed circulation, and not to any involvement of the per- \nipheral nerves and muscles, as has been believed by some. In \nthe frog the voluntary muscular tissue is found to be weakened \nto some extent, but only after large doses and at a late stage \nof the poisoning. \n\nTemperature. \xe2\x80\x94 Antimony, in considerable doses, produces a \nmarked reduction of temperature, the fall being stated to some- \ntimes amount to 6\xc2\xb0 C. (42. 8\xc2\xb0 F.) in animals in the course of \na few hours. This is attributed to the slowness of the circula- \ntion, the general depression and collapse, and the profuse \nsweating. \n\nSecretion and Excretion. \xe2\x80\x94 Such secretions as the sweat, the \nsaliva, and the mucus of the respiratory tract are increased by \nantimony, not in consequence of any direct action upon the \nglands, but simply as a result of the emesis caused by the drug. \nIts action on the urinary secretion is not very marked. The \n\n\n\n506 PHARMACOLOGY AND THERAPEUTICS. \n\nurine is sometimes more or less increased, and sometimes dimin- \nished or even entirely suppressed. This has been explained by \nthe suggestion that there is a temporary stimulation of the renal \nepithelium, but that later, when a larger amount of the anti- \nmony has been absorbed, an acute irritation of the kidneys is \nexcited. The prolonged use of the drug, as in the case of \narsenic, is liable to induce fatty degeneration of many organs \nand abrogation of the glycogenic function of the liver, while the \nnitrogen of the urine is increased. Very small quantities of anti- \nmony, given repeatedly, are stated, however, to augment the \nhepatic glycogen and fat, without apparently altering the nitro- \ngen of the urine. Antimony is absorbed from the gastro- \nintestinal tract and very slowly from the skin, and it passes into \nthe tissues much more gradually than arsenic; consequently \ndoses can be chosen whose only action is to produce nausea, \nor, if somewhat larger, vomiting. After absorption it is stored \nin considerable amount in the liver. It is excreted into the \nstomach and intestine, in the urine, and also probably in the bile \nand milk. \n\nTherapeutics of Salts of Antimony. \n\nExternal. \xe2\x80\x94 A solution of antimony chloride, known as Butter \nof Antimony, was once used as a caustic, but its employment has \nbeen abandoned, as the sore produced is difficult to heal. An \nointment of tartar emetic which was formerly employed as a \ncounter-irritant has also fallen into disuse, as its application \ncauses considerable pain. If tartar emetic is persistently rubbed \non the skin, the pustules caused by it may become confluent and \nform small abscesses, and, later, extensive necrosis and ulcera- \ntion of the integument may be induced. \n\nInternal. \xe2\x80\x94 Tartar emetic was at one time given in a large \nnumber of conditions which it is unnecessary to enumerate, as, \non account of its depressing effects, it has been superseded by \nother remedies. Almost the only class of affections in which \nit is now employed to any extent is diseases of the respiratory \npassages, in which it has a limited field of usefulness. In com- \nmencing bronchitis it is occasionally given until vomiting \n\n\n\nANTIMONY. 507 \n\noccurs, and then continued in smaller doses and at longer in- \ntervals. More commonly, in the early stage of acute bronchitis, \nit is used in doses insufficient to produce emesis. Here it serves \nto promote secretion, diminish fever, induce diaphoresis, and \nhasten the elimination of inflammatory products. When a free \nsecretion of bronchial mucus has once been established, it \nshould as a rule be discontinued, as after that it is too de- \npressing to constitute a satisfactory expectorant. It is also a \nuseful remedy in the first stage of acute nasal and pharyngeal \ncatarrh. It is not a suitable preparation for infants or very \nyoung children, and compound syrup of squill (Coxe\'s hive \nsyrup), which is a domestic remedy for croup, has been known \nto prove fatal. When an emetic is required in laryngitis, bron- \nchitis, or other acute inflammation of the respiratory tract, \nipecacuanha is usually preferable. In acute inflammatory and \nfebrile diseases, other than those of the air-passages (provided \nthere is not much irritability of the stomach), minute doses of \ntartar emetic (.004 gm. ; J^ gr.) are still highly spoken of by \nsome writers, and impending attacks of malarial fever are said \nto be sometimes successfully aborted by emetic doses of anti- \nmony and ipecacuanha. As a diaphoretic tartar emetic has \nbeen very largely supplanted by pilocarpine. \n\nTOXICOLOGY. \n\nAcute Poisoning. \xe2\x80\x94 The symptoms resemble those of arsenical poison- \ning (see p. 247). Post-mortem. \xe2\x80\x94 There is hyperemia, tumefaction and \nerosion, with ecchymoses, of the gastric and intestinal mucous mem- \nbranes. Pustules may be found in the mouth, oesophagus, stomach and \nsmall intestine, and there may be congestion or inflammation of the \nlungs. \n\nTreatment. \xe2\x80\x94 Emetics are seldom required, but if the poison does not \ncause free vomiting, the stomach should be washed out or emetics ad- \nministered subcutaneously (apomorphine hydrochloride) or by the mouth \n(zinc sulphate). A purge may also be given to remove the poison in \nthe bowel. Tannic acid, in repeated doses of 2 gm. (]/ 2 dr.), is used \nto precipitate the antimony in the stomach, and the tannate thus formed \nshould be washed out. A form of tannic acid which is usually readily \n\n\n\n5<d8 pharmacology and therapeutics. \n\nobtainable is strong tea, which is also serviceable as a stimulant for \nthe collapse. Mucilaginous drinks may likewise be given freely, and \nstimulants by hypodermatic injection, as well as the external applica- \ntion of heat, are generally called for. \n\nChronic Poisoning is very rare, and it is difficult to recognize, as \nthe symptoms do not present any very definite characteristics. Among \nthem are described headache, dizziness, depression, indistinct sight, \nnausea and vomiting, dyspepsia with more or less gastric pain, diar- \nrhoea, loss of flesh, albuminuria, general weakness and exhaustion, and \nfinally collapse. As the symptoms resemble those of acute gastrointesti- \nnal catarrh, poisoning with small, repeated doses of antimony is some- \ntimes resorted to criminally, and an instance of the use of the drug for \nhomicidal purposes has recently been the subject of judicial inquiry. \nPustular eruptions, it is said, have been observed from the prolonged \ninternal use of tartar emetic. \n\nPost-mortem. \xe2\x80\x94 Antimony is said to be found in the liver, kidneys, \nspleen, bones and muscles, and there is also fatty degeneration of the \nviscera, especially the liver. \n\nTHOROUGHWORT. \n\nEUPATORIUM.\xe2\x80\x94 Eupatorium. (Thoroughwort. Boneset.) Dose, \n2 gm.; 30 gr. \n\nPreparation. \nFluidextractum Eupatorii. \xe2\x80\x94 Fluidextract of Eupatorium. \nDose, 2 c.c; 30 n\\. \n\nAction of Thoroughwort. \nThoroughwort is tonic and mildly laxative. It is also dia- \nphoretic in infusion, but the diaphoretic properties of the prep- \naration are chiefly due to its hot water. \n\nTherapeutics of Thoroughwort. \nIt is, like many other substances of vegetable origin, a do- \nmestic remedy for the commencement of catarrh, influenza, or \nmuscular rheumatism. \n\nMARRUBIUM. \nMARRUBIUM. \xe2\x80\x94 Marrubium. (Horehound.) Dose, 2 gm.; 30 gr. \n\n\n\nSUBSTANCES ACTING ON URINARY SYSTEM. 509 \n\nAction of Horehound. \nHorehound, used as a decoction or an infusion, is in moder- \nate doses diuretic and diaphoretic, and in large doses laxative. \nIt is probably also a bitter stomachic. \n\nTherapeutics of Horehound. \nIt may be given to increase the action of the skin and kid- \nneys, but its effects are not marked. Horehound candy, slowly \ndissolved in the mouth, relieves the relaxed throat of public \nspeakers. \n\nDivision VI. \xe2\x80\x94 Substances Acting on the Urinary System. \n1. Drugs Increasing the Quantity of Urine Secreted. \xe2\x80\x94 These \nare called diuretics. The kidneys are susceptible to a variety \nof influences. Thus, anatomically they present two distinct \nvarieties of epithelium and have an extremely abundant supply \nof vessels and vaso-motor nerves, while the activity of the \norgans is profoundly affected by variations in the quantity of \nblood flowing through them. In the present state of our \nknowledge it is impossible to say in just what manner many \ndiuretics act. A considerable number of them, no doubt, are \neffective in more ways than one, and the following table, taken \nfrom Brunton but somewhat modified, presents the various \nways in which these agents probably act: \n\n\n\n5io \n\n\n\nPHARMACOLOGY AND THERAPEUTICS. \n\n\n\n\n\n\n\n\n\nIncreased car- \ndiac action. \n\n\nr Digitalis, \nCaffeine, \nAlcohol, \nStrophanthus, \n\n\n\n\nGenerally. \n\n\n4 \n\n\nGeneral vas- \ncular contrac- \n\n\n. Sparteine, \n\nErythrophlo3um, \n\nDigitalis, \n\nSquill, \n\n\nRaise \narterial < \n\n\n\n\n\n\ntion. \n\n\nConvallaria, \n\n\n\n\n\n\nStrychnine, \n\n\n\n\n\n\n\n\nCold to skin. \n\n\npressure. \n\n\n\n\n\n\n\n\n\n\n\n\n\n\n. Act on vaso- \n\n\n? same as above. \n\n\n\n\n\n\n\n\nmotor centres. \n\n\n\n\n\n\n\n\n\n\nBroom, \n\n\n\n\n\n\n,\xe2\x96\xa0 Contract \n\n\n\n\nCaffeine (large \n\n\n\n\n\n\nefferent - \n\n\n\n\ndoses), \n\n\n\n\n\n\nvessels. \n\n\nx n \xe2\x80\xa2< \n\n\nBuchu, \n\nUva ursi, \n\n\n\n\nLocally \n\n\n\n\nLocally on \n^ kidney. \n\n\nJuniper, \nTurpentine, \n\n\n\n\n^in kidney. \n\n\n\n\nCopaiba, \n\n\n\n\n\n\nCantharides. \n\n\n\n\nDilate, chiefly \n\n\nCaffeine, \n\n\n\n\nlocally, renal - \n\n\nUrea. \n\n\n\n\n^ vessels. \n\n\n. \n\n\n\n\n\n\nr Urea, \n\n\n\n\nr \n\n\nCaffeine, \n\n\n\n\nIncrease water excreted. \n\n\nTheobromine So- \ndio-salicylate, \nCalomel, \n\n\nAct on secreting \n\n\n\n\n. Colchicum, \n\n\nnerves or renal cells. \xc2\xab \n\n\n\n\nSolution of Potas- \nsium Hydroxide, \n\n\n\n\nIncrease water and solids \n\n\nPotassium Acetate, \n\n\n\n\nexcreted. \n\n\nPotassium Citrate, \nPotassium Nitrate, \nSodium Citrate and \n\n\n\n\n\n\nt. \n\n\n\n\nother salines. \n\n\n\nTherapeutics. \xe2\x80\x94 Diuretics are used chiefly for the following \npurposes: (i) To maintain the action of the kidneys. Dimin- \n\n\n\nSUBSTANCES ACTING ON URINARY SYSTEM. 5 I I \n\nished urinary excretion may be purely functional in its origin, \nas in fevers. In these it is essential that the action of the kid- \nneys should be maintained, and the free use of water is often \nvery serviceable for this purpose. The ingestion of large quan- \ntities of water greatly increases the urinary flow, and may in- \ncrease not only the amount, but also the solids, of the urine. \nInvestigation has shown that when the tissues are full of the \nproducts of disintegration the effect of water is very marked, \nbut that upon the wasting processes of the body it exerts no \ninfluence ; hence, while it may not be possible to produce tissue- \ndisintegration by water, there would seem to be no question \nthat water is capable of washing out the retained products of \ntissue change. This naturally renders it of value in various \ndiseases. Intestinal lavage (enteroclysis) with normal saline \nsolution, by means of the rectal irrigator, has been found one \nof the best and most certain of diuretics. Diuretics are used \nin cardiac and pulmonary affections when, owing to the general \nvascular disturbance, the quantity of urine becomes diminished. \nIn diseased conditions of the kidney itself the maintenance of \nthe urinary excretion is urgently demanded, but on account \nof organic changes in the renal secretory structures, it is often \nthe case that diuretics fail to produce their appropriate effect. \nIn many such conditions it is a question how far it is desirable \nto stimulate the diseased organ, and in the great majority of \ninstances only the mildest diuretics should be prescribed. When \nrenal inflammation is present, even if it be chronic, irritating \ndiuretics should be avoided. In acute Bright\'s disease large \ndraughts of water at regular intervals not infrequently have \na very favorable effect; not only greatly increasing the amount \nof urine, but also lessening the irritation of the kidneys. In \ngrave cases, with violent irritation of the kidneys and per- \nhaps suppression of urine, hypodermoclysis has proved of \ngreat benefit. (2) To get rid of fluid in various parts of the \nbody. For this purpose hydragogue diuretics are employed in \nall forms of dropsy. (3) To diminish irritation of the genito- \nurinary organs, as from the deposit of solids from the urine. \n\n\n\n5 I 2 PHARMACOLOGY AND THERAPEUTICS. \n\nHere diuretics are of great service by diluting the secretion, \nand the value of water as an adjuvant to medicinal diuretics \nshould always be taken advantage of. The alkalies are also of \nspecial utility. \n\nIn the use of diuretics it is important to have in mind that \nthey may act in a variety of ways, and as it is not always pos- \nsible to determine the precise cause of the deficiency in the \nurinary excretion, it is quite customary to prescribe two or \nmore of these drugs in combination, in the hope that one of \nthem at least may prove effective. \n\n2. Drugs Diminishing the Quantity of Urine Secreted. \xe2\x80\x94 These \nare usually of such a character as to induce acute nephritis \nwhen given in large doses; e. g., turpentine, cantharides, phos- \nphorus. Exalgin also is reputed to diminish the quantity of \nurine. They are never given for this purpose in medicine. \n\n3. Drugs Rendering the Urine Acid. \xe2\x80\x94 Urotropin is the most \nreliable remedy to render an alkaline urine acid. The benzoates \nare also used for this purpose, as benzoic acid during its pas- \nsage through the kidney is converted into hippuric acid, and \nthey may be given for alkaline decomposition in the urinary \npassages. The free use of carbonated water increases the \nacidity of the urine. Salicylic acid is capable of slightly in- \ncreasing it, and also very large doses of citric and tartaric acids, \nborax, and possibly saccharin. \n\n4. Drugs which Render the Urine Alkaline. \xe2\x80\x94 Some salts of \nthe metals potassium, sodium, lithium and calcium will do this, \ne. g., the carbonates, borates and hydroxides; even the tar- \ntrates, citrates, malates, lactates, and acetates, since they are \nexcreted by the kidney as carbonates. Nitric acid is said to \nincrease the amount of ammonia in the urine, and thus to render \nit slightly alkaline. Ammonium salts given internally do not \nrender the urine alkaline, because they are decomposed in the \nbody, with the formation of urea; they may even increase the \nacidity from the larger amount of nitric acid excreted. \n\nAntilithics are drugs which tend to prevent the decomposition, \nin the urinary passages, of the solids of the urine. When the \n\n\n\nSUBSTANCES ACTING ON URINARY SYSTEM. 513 \n\nsecretion is acid, gravel or uric acid calculus is liable to occur \nfrom the crystallization of uric acid, or, more rarely, lime oxa- \nlate calculus, from the crystallization of lime oxalate. When- \never a tendency is shown to the formation of either of these \ncalculi, alkalies or other remedies reputed to prevent this should \nbe administered. For uric acid the following are chiefly used: \ndistilled water, potassium salts, lithium salts, magnesium citro- \nborate, piperazine, lysidine and lycetol. For lime oxalate, dilute \nnitro-hydrochloric acid, carbonated water, and lactic acid (for \ndigestion). When, on the other hand, the urine undergoes alka- \nline decomposition, phosphatic calculi are liable to form from \nthe crystallization of phosphates. Here the aim must be to \nrender the secretion acid and aseptic, and benzoic acid, the \nbenzoates, salicylic acid, the salicylates, as well as urotropin or \nother urinary antiseptics, are given for this purpose. Lithon- \ntriptics are agents which are supposed to promote the solution \nof calculi, but as a matter of fact, no means has as yet been \ndiscovered which is capable of dissolving a calculus when once \nformed. It is true that alkalies have been credited, owing to \ntheir action in the test-tube, with the power to dissolve uric acid \ncalculi; but in the body alkalies cannot convert free uric acid \ninto soluble alkaline urates, but at most into acid urates, which \nare found to be almost as insoluble as uric acid itself. Hence, \nit is believed, it would be quite impossible to effect in this way \nthe solution of even very small calculi. \n\nTherapeutics. \xe2\x80\x94 The chief use of alkalies in this connection is \nto diminish or entirely neutralize acidity of the urine, and thus \nprevent as far as possible the precipitation of uric acid. In this \nway they tend to prevent increase in the size of a stone already \nformed. They are also of service in lessening the irritability \nof the urinary passages. In the case of gouty subjects they are \nprescribed not only to alkalize the blood, but also to alkalize \nthe urine, since in such persons the deposition of uric acid in \nthe urine is a common occurrence. The citrates and acetates \nare the best forms in which to give the alkalies, as they are not \napt to interfere with the digestion, and potassium and lithium \n34 \n\n\n\n514 PHARMACOLOGY AND THERAPEUTICS. \n\ncitrate and acetate are to be preferred, since these metals form \nmore soluble urates than sodium. Copious draughts of water, \nby diluting the urine, aid in the prevention of calculi, and \nnatural mineral waters, especially those containing lithium, are \nin very general use. \n\n5. Drugs Preventing the Urine from Decomposing. \xe2\x80\x94 Urine \nretained from any cause in the bladder will undergo alkaline \ndecomposition, and the same result is likely to occur from the \nadmixture of pus, as from cystitis or pyelitis, with the urine. \nThis decomposition of the urine may be prevented by the ad- \nministration of drugs which in their excretion by the urine \nrender it aseptic. Such are \xe2\x80\x94 \n\n\n\n(1) Urotropin. \n\n\n(6) Cubeb. \n\n\n(2) Benzoic acid. \n\n\n(7) Oil of Sandal Wood \n\n\n(3) Salicylic acid. \n\n\n(8) Saccharin. \n\n\n(4) Uva Ursi. \n\n\n(9) Many volatile oils. \n\n\n(5) Copaiba. \n\n\n(10) Boric acid. \n\n\n\n6. Drugs Altering the Composition of the Urine. \xe2\x80\x94 Almost any \ndrug will do this, either because it is excreted in the urine, or \nbecause it sets up certain changes in the body the products of \nwhich are excreted in the urine; but it will be sufficient to refer \nto a few striking examples. \n\nTurpentine, cantharides and salicylic acid in large doses will cause \nhematuria, for the reason that they set up inflammation of the kidney. \n\nPotassium chlorate, all nitrites, acetanilide, pyrogallic acid, poisoning \nby the mushroom {Helvetia esculenta), and transfusion of blood break \nup red blood-corpuscles, and the products when excreted by the urine \nrender it dark. Large doses of mineral acids, arsenic, naphthol and \nnaphthalene may occasionally produce the same result. \n\nPhosphorus in large doses causes leucin and tyrosin to appear in the \nurine, while the urea is greatly increased. \n\nThe saline diuretics increase the solids of the urine. \n\nThe chrysophanic acid in rhubarb and senna makes the urine, if it \nis acid, a brownish color ; if it is alkaline, a purplish red. Logwood \nrenders alkaline urine reddish or violet. Santonin colors acid urine \nyellow or greenish-yellow, and alkaline urine, reddish. Phenol, naph- \n\n\n\nSUBSTANCES ACTING ON URINARY SYSTEM. 5 I 5 \n\nthalene, creosote and other preparations of tar, as well as the arbutin \nin uva ursi, chimaphila and gaultheria make it dark greenish-brown. \nPicric acid makes it a bright yellow, and methyl violet a dark blue. \nThe urine of persons poisoned with carbonic oxide remains sweet for \nmonths. \n\nPoisoning by carbonic oxide, curare, amyl nitrite, and turpentine, and \nsometimes chloroform, camphor, mercury, morphine, hydrocyanic acid, \nsulphuric acid, alcohol, lead compounds, and salicylic acid, lead to the \nappearance in the urine of a body which like sugar reduces Fehling\'s \ncopper solution. In the case of some of these drugs, at least, the urine \ndoes not contain glucose, but glycuronic acid ; for although it re- \nduces blue copper solutions, it does not undergo alcoholic fermentation \non the addition of yeast or give the phenyl-hydrazin test. Chloral was \nformerly supposed to induce glycosuria, but this has been shown not to \nbe the case, the reducing agent in the urine being urochloralic acid, and \nnot sugar. The administration of phloridzin, a glucoside from the \nbark of stems and roots of the apple, pear, plum and cherry, which, when \ncontinuously heated with dilute mineral acids, is resolved into glucose \nand phloretin, leads to the production of genuine glucose in the urine. \n\nSome drugs impart a peculiar odor to the urine ; for instance, the \nsmell of violets is produced by turpentine and oil of juniper. The \naromatic odor of cubeb and copaiba can be detected in the urine after \nthe administration of these substances. \n\nProlonged poisoning by lead often induces chronic nephritis. This is \nusually of the granular type, but in some instances the kidney presents a \nmixture of interstitial and parenchymatous disease. In acute mercurial \npoisoning, when death does not follow in the course of a few hours, \nanuria is not infrequently observed, and this has been found to be due \nto renal changes, the most prominent feature of which is necrosis of \nthe epithelium of the tubules. Fatty degeneration of the renal epi- \nthelium may be caused by phosphorus and arsenic. \n\n7. Drugs Acting on the Bladder and Urethra. \xe2\x80\x94 Practically, \nthe only ones of value are sedatives to the urinary tract. \n\nIf the urine shows a tendency to decompose, the drugs which prevent \ndecomposition, and if the urine is excessively acid, alkalies, act as \nurinary sedatives. Other sedatives are opium, belladonna, hyoscyamus, \npareira, buchu and uva ursi, which are direct sedatives to the vesical \nand urethral mucous membrane. \n\nUrinary sedatives are used very largely in cases of cystitis and \nurethritis, whatever the cause may be. Local astringent and antiseptic \ninjections are also employed. \n\n\n\n5 l6 PHARMACOLOGY AND THERAPEUTICS. \n\nA. Diuretics. \n\nWATER. \n\n1. AQUA.\xe2\x80\x94 Water. \n\n2. AQUA DESTILLATA.\xe2\x80\x94 Distilled Water. \n\nAction of Water. \n\nExternal.\xe2\x80\x94 An indifferent bath (31. i\xc2\xb0 to 36.6 C\xe2\x80\x94 88\xc2\xb0 to 98 \nF.), or one in which there is experienced a sensation of neither \nheat or cold, produces no particular effect. \n\nIn a healthy individual a cold bath causes at first a feeling \nof extreme chilliness, the teeth chatter, and the extremities are \nblue and covered with cutis anscrina. This is because the blood \nis driven away from the surface, which is consequently left \ncold. The abstraction of heat lowers the bodily temperature, \nas the calorific centres are not able to produce all the heat re- \nquired for the preservation of the normal temperature. Very \nshortly, however, reaction sets in; the extremities grow warm, \nthe pulse grows stronger and more rapid, and the respiration, \nwhich was at first gasping, becomes full and regular. Every \nportion of the body now receives a more perfect supply of \nblood, and a general feeling of exhilaration is experienced, \nwhich, if the bath is left at this stage, often remains for many \nhours. This action is explained by the fact that cold always \ncontracts the blood-vessels and reflexly stimulates the vital \ncentres to increased activity. If the bath is unduly prolonged, \nthe system suffers from the effects of over-stimulation, with \nmore or less profound depression of the nervous system and \ncirculation, and consequent interference with functional activity. \nThe proper duration and temperature of the cold bath differs \nvery greatly for different individuals. The daily use of a suit- \nably regulated cold bath no doubt diminishes the liability to \ncatch cold. \n\nWarm baths cause flushing of the skin and have the effect \nof accelerating the pulse and respiration. They have a tend- \nency to raise the temperature of the body by imparting heat to \n\n\n\nWATER. 5 I 7 \n\nit and preventing loss of warmth from it. After the bath pro- \nfuse perspiration results, while the excretion of urine is dimin- \nished. Owing to the dilatation of the cutaneous vessels caused \nby warm baths, the blood is withdrawn to a considerable extent \nfrom the internal organs, and in consequence of this their func- \ntional activity is lessened. \n\nWater is not absorbed into the circulation through the skin \nin mammals. It has been ascertained that when it is absorbed \ninto the red blood-corpuscles outside the body, some obscure \nchange takes place in the latter, and the haemoglobin diffuses \ninto the surrounding fluid. \n\nInternal. \xe2\x80\x94 Water if swallowed in sufficient quantities washes \nout the tissues and increases the flow of urine. Taken habitu- \nally thus, it somewhat augments the excretion of urea, while \nthe amount of uric acid is said to be diminished. It has been \nsupposed to have considerable effect in promoting tissue meta- \nmorphosis, through the increased movement of the lymph flush- \ning out the cells and leading to a more complete removal of \nthe waste products. It does indeed have some such action, but \nthis is not as pronounced as is thought by many, as the increase \nin the nitrogen and sulphur eliminated in the urine has been \nfound to amount to only 5 per cent., or less. Lukewarm water, \nas is well known, will cause nausea and vomiting, while hot \nwater, in small amounts frequently repeated, is often, very \nuseful in controlling irritability of the stomach. \n\nTherapeutics of Water. \nExternal. \xe2\x80\x94 Cold baths are used for the subsequent exhila- \nrating effects, which may be increased by brisk rubbing with \na rough towel, but persons whose systems do not promptly react \nafterward should not resort to them. Cold salt baths, particu- \nlarly if they are sea baths, are more stimulating than fresh- \nwater bathing. The use of a cold bath is popularly supposed \nto be dangerous to the over-heated, but persons with healthy \ncirculations find nothing so refreshing and so preventive of \nmuscular stiffness after severe exercise and sweating: as a brief \n\n\n\n5 l8 PHARMACOLOGY AND THERAPEUTICS. \n\ncold plunge- or shower-bath. Cold baths at the present time \nare very largely employed in the treatment of febrile diseases, \nmore particularly typhoid fever. Vogel\'s statistics of typhoid \nat the Military Hospital in Munich, covering a period of fifty \nyears, show a\' reduction of mortality from 20 per cent., under \nother methods, to 2.07 per cent, under what is known as the \nBrand treatment. The latter consists in the use of water at \nabout 21.1 C. (70 F.), for fifteen minutes every three or four \nhours, when the rectal temperature is at or above 39.4 C. \n(103 F.). In applying the method, the temperature of the \nbath is made at first about 29. 4 C. (85 F.), and in each suc- \ncessive bath the temperature is lowered 2.8 C. (5 F.), until \n18. 3 C. (65 F.) is reached. Sometimes a bath is employed at \na temperature 5.5 C. (io\xc2\xb0 F.) below that of the patient, and \nthe water is then cooled by adding cold water or ice until it \nfalls to a temperature of about 20 C. (68\xc2\xb0 F.). In these baths \nthe patient is lowered into the tub by means of a sheet, and on \nbeing lifted back into bed is carefully dried without rubbing \nand left covered with a sheet or blanket. Brisk rubbing of the \nwhole body should be carried out during the bath, and the feet \nkept warm. Cold baths are no longer used in the treatment of \ntyphoid fever with the notion that they simply reduce tempera- \nture. They are useful for the stimulation of the nervous system \nwhich they effect to a greater or less degree, and for the \nmarked diuresis which they produce, thus, supposedly, favoring \nthe elimination of toxins by the urine. If for any reason the \nuse of the cold bath is impracticable or unadvisable, various \nsubstitutes for this may be resorted to, such as sponging, \naffusion, or the cold pack. The latter consists of a sheet, four \nfolds thick, wrung out in cold water and wrapped around the \nnaked body for five or ten minutes at a time. Affusions were \nemployed as long ago as 1795 by Currie, and in the form known \nas "slush baths" were used with excellent effect among our \ntroops in the Spanish-American war. Rubbing the surface with \npieces of ice is also sometimes practiced. In pneumonia the \ncold bath is occasionally used, when the fever fs high, but cold \n\n\n\nWATER. 5 I 9 \n\nis more commonly applied by means of powdered ice, which, \nconfined in rubber tissue, is placed in a flannel bag and bound \nto the chest over a layer of lint. Cold baths are also sometimes \nof service in entero-colitis and in acute rheumatism with high \nfever, and they undoubtedly constitute the best treatment for \nany sudden hyperpyrexia. Thus, ice-water baths are of the \ngreatest possible service in sunstroke, or thermic fever, care \nbeing taken that friction of the skin is at the same time em- \nployed, in order to bring the hot blood to the surface and pre- \nvent congestions. Cold water may also be injected into the \nbowel in cases where the skin is cold but the central tempera- \nture very high. The application of ice-bags or of the cold \nwater coil to various parts of the body is used for the purpose \nof controlling inflammatory action and sometimes also for the \nhaemostatic effect of the cold, as in pulmonary haemorrhage, by \nits vaso-constricting action. \n\nIn nocturnal seminal emissions the submerging of the scro- \ntum in a tumbler of cold water, or the dashing or sopping of \ncold water against the perineum, scrotum and lumbar region, \nis not infrequently found beneficial. A very useful practice in \ndysentery is the gentle injection into the bowel of considerable \nquantities of cold water, and the use of a moderately forcible \nstream of water of varying temperature is highly esteemed by \nsome physicians in the treatment of a number of affections of \nthe rectum, anus, and genito-urinary apparatus. Among these \nmay be mentioned haemorrhoids, internal and external, prolapsus \nani, slight cases of prolapsus recti, pruritus ani and vulvae, \neczema of the margin of the anus, vaginitis, varicocele, chronic \nprostatitis, and atonic impotence in the male. In these various \ntroubles the application is made by means of a bidet, which, it \nis advised, should be attached to the water-closet seat habitually \nused by the patient. The bidet pipe should be movable by means \nof a handle, so that the stream can be directed wherever de- \nsired, and it should also have connection with the hot and cold \nwater-supply of the house. \n\nA cold bath is one the temperature of which is below 21 \xc2\xb0 C. \n\n\n\n520 PHARMACOLOGY AND THERAPEUTICS. \n\n(yo\xc2\xb0 F.), and a hot bath one with a temperature above 36.6 C. \n(98 F.). Anything between 31. i\xc2\xb0 and 36.6 C. (88\xc2\xb0 and \n98 F.) is often spoken of as a warm bath, though it is really \nindifferent, and should more properly be called tepid. Hot \nbaths, as they have the effect of liquefying the fatty secretions, \nare naturally more cleansing than cold. Like the application \nof heat in other forms, they soothe pain, and they are useful \nin alleviating muscular and mental fatigue and various in- \nflammatory conditions. \' They also serve to relieve muscular \nspasm, as well as internal congestion, by withdrawing blood \nfrom the internal organs to the surface, and often prove of \ngreat value in colic, spasmodic stricture of the urethra, laryn- \ngeal spasm, infantile convulsions, etc. Hot baths and the hot \npack are useful in renal disease and uraemia and in commencing \ncolds, on account of the free diaphoresis which they induce ; and \nafter a hot bath the patient should be immediately wrapped in \nwarm blankets and put to bed. in order to prevent contraction \nof the cutaneous blood-vessels and arrest of perspiration. A \nhot bath at bedtime is not infrequently of service in insomnia, \nand in many asylums for the insane it is customary to give a \nbath of the temperature of 40 C. (104 F.) as a remedy for this \ncondition. The hot vapor, or Russian, bath is employed for \nmany of the same purposes as the hot air, or Turkish, bath, and \nparticularly when the skin or kidneys are inactive, but is not so \ngenerally useful, as no evaporation of perspiration can take \nplace during the bath. A valuable method for using the hot \nvapor bath in a mild form is the "bronchitis tent," which con- \nsists of a bed canopy made by sheets, into which the steam \narising from a steam sterilizer is introduced by means of a \ntube. While equally efficacious in the first stage of bronchitis \nin adults, it is more conveniently employed in the case of chil- \ndren on account of the size of the bed. \n\nLocalized hot baths act in the same way as general ones, but \nare less pronounced in their effects. A hot sitz bath causes dila- \ntation of the vessels of the pelvic viscera and a hot foot bath \nof proper depth, dilatation of the branches of the femoral and \n\n\n\nWATER. 5 2 I \n\nprobably of the iliac arteries. Mustard is often added to in- \ncrease their effect, and both these forms are much used in \namenorrhcea. The sitz bath is more particularly suited to spas- \nmodic dysmenorrhea, and the foot bath is commonly employed \nin the first stage of a cold. In gonorrhoea a hot sitz bath is a \ngood prophylactic against c-hordee, and steeping the penis in hot \nwater is a widely used remedy for this painful affection when \nit does occur. In spasmodic croup benefit may.be derived from \nthe application to the neck of a hot compress made from \nspongiopiline wet with hot water, or from several layers of \nflannel wrung out of water and covered with cotton and oiled \nsilk. In various painful inflammatory and other affections of \nthe eyes much relief may be derived from the use of hot water \napplied by cotton pledgets, frequently renewed, or allowed to \ndrop continuously upon the eye from a fountain syringe. Irri- \ngation with plain hot water, or with normal saline solution \n(see Sodium Chloride) has proved of great service in markedly \nlessening tenesmus in acute dysentery. Enteroclysis is now \nalso employed with advantage in a variety of other conditions, \namong which may be mentioned shock, nephritis, especially \nacute uraemia, auto-infection from retention of putrid contents \nin the intestine, cholera infantum, toxaemia in fevers, particu- \nlary typhoid, septic endocarditis and septic conditions generally, \npelvic and genito-urinary inflammations, and haemorrhage in \nthe rectum or adjacent organs. Such antiseptics or other medi- \ncaments as seem to be indicated are often added to the irriga- \ntion fluid. \n\nInternal. \xe2\x80\x94 Water is principally used to wash out the tissues \nand for its supposed effect upon tissue metamorphosis and the \nexcretions. It is of great service in keeping the urine diluted. \nBy its free use the liability to the formation of gall-stones may \nbe diminished, in consequence of its effect in increasing the \nwatery secretion of bile, so that the bile becomes less concen- \ntrated and flows more freely. The liability to the formation \nof gravel or urinary calculi is also lessened, as the crystals com- \nposing such calculi are washed out of the urinary tract before \n\n\n\n522 PHARMACOLOGY AND THERAPEUTICS. \n\nan opportunity is afforded them of forming in aggregations of \nany size, while if they consist of uric acid, the habitual use \nof a sufficient quantity of water, as has been mentioned, tends \nto diminish the excretion of that substance. When large \namounts of water are taken, pure distilled water should be \nused, and it should be drunk for the most part between meals. \nOne or more glasses of cold water swallowed upon rising has \nthe effect in some individuals of causing an evacuation of the \nbowels. Tepid water, to which mustard is often added, is \nvery commonly used as an emetic. In a work of this kind the \nnatural mineral waters employed for baths and internal medic- \ninal use can be only incidentally alluded to as their principal \nsolid ingredients from time to time come under consideration. \nFor more extended information in regard to them reference \nmust be had to the special treatises on physical therapeutics. \n\nBROOM. \n\n1. SCOPARIUS. \xe2\x80\x94 Scoparius. (Broom.) Dose, 1 gm.; 15 gr. \n\n2. SPARTEINE SULPHAS.\xe2\x80\x94 Sparteine Sulphate. Dose, 0.010 \ngm.; y 5 gr. \n\nJJnfRcxal Preparation. \nExtractum Scoparii Fluidum (U. S. P., 1890). \xe2\x80\x94 Fluidextract \nof Scoparius. Dose, 1 to 4 c.c; y 4 to 1 fl. dr. \n\nAction of Broom. \n\nExternal. \xe2\x80\x94 None. \n\nInternal. \xe2\x80\x94 Nervous System. \xe2\x80\x94 Its alkaloid sparteine if given \nin poisonous doses causes, in the lower animals, tremblings, \nincoordination, increase of reflexes, clonic and tonic convul- \nsions, followed by enfeeblement of all the functions, paralysis, \nand death from asphyxia. \n\nRespiration. \xe2\x80\x94 It paralyzes the respiratory centres, causes \nembarrassment of the respiration, and paralyzes the motor \ncentres of the spinal cord, but has a very feeble influence upon \nthe muscles; lessening, though not destroying, their excitability. \n\nCirculation. \xe2\x80\x94 Under the influence of this alkaloid, it is stated, \nthere is a very great increase in the size and height of the \n\n\n\nBUCHU. 523 \n\ncardiac wave. If the dose has been a small one, the pulse is \nat first accelerated; after large doses there is a slowing, fol- \nlowed by enfeeblement of the heart. The arterial pressure is \nnot materially changed unless the dose is toxic, when it falls. \nSmall doses weaken, and large ones paralyze the pneumogas- \ntric; upon the vaso-motor system it appears to have no influ- \nence, unless in very large toxic doses, when it may perhaps act \nas a paralyzant. \n\nKidneys. \xe2\x80\x94 Broom is of value as a diuretic. Scoparin prob- \nably represents the diuretic principles of the plant. \n\nTherapeutics of Broom. \n\nBroom is a very useful diuretic, which is generally prescribed \nin association with other diuretics in cases of dropsy from heart \ndisease or chronic nephritis. In acute nephritis, or where pul- \nmonary congestion or inflammation is present, it is contra- \nindicated. According to some authorities, sparteine sulphate is \nof very great value in producing regularity in cases of irregular \ncardiac action. It accelerates the beats when a weak, atonic \nstate is present, and has the great advantage of acting quickly. \nOn the whole, it is probably inferior to digitalis in power, but \nit is not cumulative, and is a useful remedy in uncompensated \ncardiac, especially mitral, disease. In the treatment of the \nopium habit it has been employed to stimulate the heart\'s action \nat periods of depression. \n\nBUCHU. \n\nBUCHU.\xe2\x80\x94 Buchu (Bucco). Dose, 2 gm.; 30 gr. \n\nPreparation. \nFluidextractum Buchu. \xe2\x80\x94 Fluidextract of Buchu. Dose, 2 \nc.c.; 30 ni. \n\nAction of Buchu. \n\nIn moderate doses buchu causes in the stomach a feeling of \n\nwarmth, which is often diffused gradually over the body. In \n\nlarge doses it gives rise to nausea, vomiting, purging and \n\nstrangury, with a burning sensation in the epigastric region. \n\n\n\n524 PHARMACOLOGY AND THERAPEUTICS. \n\nBuchu stimulates the appetite and digestion, and slightly in- \ncreases the pulse-rate. Its volatile oil, which is diffused into \nthe blood, is excreted by the kidneys, the bronchial mucous \nmembrane, which it stimulates, and probably also by the skin, \nas it induces mild diaphoresis. The excretion is chiefly by the \nurine, which it renders slightly antiseptic, but, although it is \ngenerally regarded as a diuretic, it does not appear to appre- \nciably increase the renal activity. Under its influence the urine \nbecomes darker in\' color, assumes an aromatic odor, and depos- \nits a brownish sediment. After its elimination by the kidneys \nit acts as a disinfectant to the urinary tract. The free use of \nbuchu, if continued for a considerable period, is said to be in- \njurious to the kidney. \n\nTherapeutics of Buchu. \nIt has been used in atonic dyspepsia, certain cutaneous affec- \ntions, dropsy, and chronic rheumatism. It is difficult to see how \nit could have any effect in the last of these conditions, and in \ndropsy also it probably does no good when given by itself. The \ninfusion (B. P., 1 to 20, dose 30 to 60 c.c. ; 1 to 2 fl. oz.) con- \ntains very little of the volatile oil, but is an excellent vehicle \nfor saline diuretics. The chief therapeutic use of buchu is in \nchronic affections of the mucous membrane of the genito- \nurinary tract, and it is a valuable remedy in pyelitis, lithiasis, \ncystitis, urethritis, and prostatitis. It is also occasionally pre- \nscribed as an expectorant in bronchitis. It is well to note that \nthe fluidextract, on account of the oil in its composition, is not \nreadily miscible with water. \n\nUVA URSI. \nUVA URSI.\xe2\x80\x94 Uva Ursi (Bearberry). Dose, 2 gm.; 30 gr. \n\nPreparation. \nFluidextractum Uvae Ursi. \xe2\x80\x94 Fluidextract of Uva Ursi. Dose, \n2 c.c; 30 Tn_. \n\nUnofficial Preparations. \nExtractum Uvae Ursi (U. S. P., 1890). \xe2\x80\x94 Extract of Uva Ursi. \nDose, 0.25 to 1.00 gm.; 5 to 15 gr. \nArbutinum. \xe2\x80\x94 Arbutin. Dose, .20 to .30 gm.; 3 to 5 gr. \n\n\n\nUVA URSI. 525 \n\nAction of Uva Ursi. \nUva ursi is a tonic, astringent and diuretic, and is also re- \nputed to have some oxytocic action. In medicinal doses it \npromotes the appetite and has a somewhat constipating effect \nupon the bowels. Large doses ordinarily occasion vomiting \nand purging, but it is stated that these effects may be prevented \nby filtering the watery preparations through animal charcoal, \nor by administering the glucosides instead of the cruder prep- \narations. Arbutin is decomposed by the action of acids or of \nemulsin into glucose and hydroquinone or methylhydroquinone, \nand in the body a part of the arbutin appears to undergo this \ndecomposition. The larger portion of it, however, is found to \nbe eliminated by the kidneys unchanged, and it has been sug- \ngested that the small amount of hydroquinone and methylhydro- \nquinone which appears in the urine may perhaps be formed \nfrom arbutin by the bacteria of the intestine, and not by the \nactivity of the tissues. The diuretic effect of uva ursi seems \nto be unquestionably due to the direct action of the drug upon \nthe renal epithelium. It also has a decidedly anti-putrefactive \neffect upon the urine, which was formerly attributed to the \nformation of hydroquinone, but which is now believed to be \ndue to the arbutin itself; which, in addition to exerting a mod- \nerate stimulant action on the kidney cells, appears to be some- \nwhat antiseptic. Uva ursi is therefore a mild disinfectant to \nthe urinary tract. Under its influence the urine often becomes \ndark in color, the discoloration becoming more marked when \nit is allowed to stand and undergo putrefaction, and this is due \nto the hydroquinone, which becomes further oxidized and forms \nbrownish-green pigments similar to those observed after phenol \nand other agents of its class. \n\nTherapeutics of Uva Ursi. \nLike buchu, it is used in pyelitis, cystitis, urethritis, etc. It \noften serves to relieve incontinence of urine, dysuria and stran- \ngury, and the fluidextract is an excellent remedy for the ardor \nurinae of acute gonorrhoea. Arbutin has been successfully em- \n\n\n\n526 PHARMACOLOGY AND THERAPEUTICS. \n\nployed in gonorrhoea and also as a diuretic in cardiac dropsy. \nUva ursi is said to have sometimes proved serviceable in uter- \nine haemorrhages. \n\nSABAL. \nSABAL.\xe2\x80\x94 Sabal. Dose, 1 gm.; 15 gr. \n\nUnofficial Preparation. \nFluidextractum Sabal. \xe2\x80\x94 Fluidextract of Sabal. Dose, 2 c.c; \n30 Hi. \n\nAction of Sabal. \nIt is a nutrient, tonic and diuretic, and also has expectorant \nand sedative properties. Under its use the digestion is im- \nproved and the strength and weight increased, and it likewise \ntends to induce sleep. Its volatile oil is excreted mainly by the \nmucous membranes, and on these its principal effects are \nexerted. \n\nTherapeutics of Sabal. \nIn general, all catarrhal conditions are improved by sabal, \nespecially when it is combined with oil of santal. It has been \nemployed for irritated states of the mucous membrane of the \nnose, pharynx, larynx and bronchial tubes. It relieves cough \nof various kinds, and is of some service in chronic bronchitis, \nlaryngeal phthisis, and cardiac asthma. It is also given in cys- \ntitis and to relieve the vesical distress of prostatic hypertrophy, \nand is thought to be more or less effective in functional im- \npotence. \n\nJUNIPER. \nOLEUM JUNIPER!.\xe2\x80\x94 Oil of Juniper. Dose, 0.2 c.c; 3 111 \xe2\x80\xa2 \n\nPreparations. \n\n1. Spiritus Juniperi. \xe2\x80\x94 Spirit of Juniper. Dose, 2 c.c; 30 ni . \n\n2. Spiritus Juniperi Compositus. \xe2\x80\x94 Compound Spirit of \nJuniper. Dose, 8 c.c; 2 fl. dr. \n\nAction of Oil of Juniper. \nOil of juniper is a stomachic tonic, antiseptic, diaphoretic, \ndiuretic and aphrodisiac. Its action is practically the same as \n\n\n\nPAREIRA. 5 27 \n\nthat of oil of turpentine, but it is less apt to interfere with the \ndigestion or to cause hematuria and albuminuria. It is, how- \never, a powerful renal stimulant and in large doses irritant; so \nthat from sufficient amounts there may result strangury, pria- \npism, hematuria, suppression of urine, and ursemic convul- \nsions. It imparts a violaceous odor to the urine, and will \nproduce diuresis when inhaled in an atomized solution. Be- \ncause of its antiseptic properties it is employed for the preser- \nvation of cat-gut. \n\nTherapeutics of Oil of Juniper. \nIt is a very efficient diuretic, and is largely used, combined \nwith other less irritant diuretics, in the treatment of dropsies \nresulting from cirrhosis of the liver, organic heart disease, and \nchronic Bright\'s disease. As it is a constituent of gin, this, or \nthe compound spirit of juniper, may be given to patients suffer- \ning from such affections who require alcoholic stimulus. Oil \nof juniper may also be used in chronic pyelitis, cystitis, pros- \ntatorrhcea, gleet, etc., but it should never be prescribed when \nacute nephritis is present. Occasionally it is employed as a \ncarminative and stomachic. \n\nPAREIRA. \nPAREIRA. \xe2\x80\x94 Pareira (Pareira Brava). Dose, 2 gm.; 30 gr. \n\nPreparation. \nFluidextractum Pareirae. \xe2\x80\x94 Fluidextract of Pareira. Dose, 2 \nc.c; 30 TH,. \n\nAction of Pareira. \nWith the exception of its diuretic action, in which it closely \nresembles buchu, pareira is not known to have any physiological \neffects. \n\nTherapeutics of Pareira. \nLike buchu, it is employed in chronic pyelitis, vesical catarrh, \ngleet, and other chronic inflammatory affections of the genito- \nurinary tract. It was formerly renowned as a lithontriptic. \n\n\n\n528 PHARMACOLOGY AND THERAPEUTICS. \n\nPICHI. \n\nFABIANA.\xe2\x80\x94 Pichi (not official). Dose, 2 gm.; 30 gr. \n\nUnofficial Preparation. \nFluidextractum Fabianae. \xe2\x80\x94 Fluidextract of Fabiana. Dose, \n.30 to 2.50 c.c; 5 to 40 n\\. \n\nAction of Pichi. \nPichi is a diuretic with properties similar to those of buchu \nand uva ursi. \n\nTherapeutics of Pichi. \nIt is of great value in inflammation of the bladder and \ncatarrh of the urinary tract. It should not be used in organic \ndisease. It is best prescribed in combination with an alkali, \nas sodium carbonate. \n\nTHEOBROMINE. \n\nTHEOBROMINE SODIO-SALICYLAS. \xe2\x80\x94 Theobromine Sodio- \n\nsalicylate (not official). Dose, 1.0 to 20 gm.; 15 to 30 gr. \n\nAction of Theobromine Sodio-Salicylate. \nThis is a pure diuretic, acting upon the renal epithelium, \nwithout action upon the heart, and it is believed that it does not \nirritate the kidneys. \n\nTherapeutics of Theobromine Sodio-Salicylate. \nThe daily dose is from 4 to 8 gm. (1 to 2 dr.), best admin- \nistered in solution with aromatic water. It has been given \nwith benefit in cases of severe cardiac or hepatic dropsy. It \ndoes not ordinarily cause depression, but in occasional instances \nis said to have had an untoward action. This may, however, \nhave been due to impurities. \n\nAPOCYNUM. \n\nAPOCYNUM.\xe2\x80\x94 Apocynum. (Canadian Hemp.) Dose, 1 gm.; 15 gr. \n\nPreparation. \nFluidextractum Apocyni, \xe2\x80\x94 Fluidextract of Apocynum. Dose, \n1 c,c.; 15 TT\\, \n\n\n\nSTRONTIUM. 529 \n\nUnofficial Preparation. \nInfusum Apocyni. \xe2\x80\x94 Infusion of Apocynum. Dose, 30 to \n60 c.c; 1 to 2 fl. oz. \n\nAction of Apocynum. \n\nWhen used as an infusion (1 to 16), Canadian hemp is not \nonly diuretic, but has an action resembling that of strophanthus \nand similar drugs. In large doses it is also a hydragogue \ncathartic. \n\nTherapeutics of Apocynum. \n\nThis is a more valuable medicinal agent than its limited use \nwould indicate. It frequently produces copious diuresis after \nother, and better known, drugs have failed, and the infusion, \nespecially, has been found beneficial in dropsy. \n\nCORN-SILK. \n\nZEA.\xe2\x80\x94 Zea. (Corn-silk.) \n\nUnofficial Preparations. \nFluidextractum Zeae. \xe2\x80\x94 Fluidextract of Zea. Dose, 2 to 8 \nc.c; y 2 to 2 fl. dr. \nInfusum Zeae. \xe2\x80\x94 Infusion of Zea. Dose, freely. \n\nAction of Corn-Silk. \n\nCorn-silk is a mild but fairly certain diuretic when given in \nfull doses. It increases the secretion of urine in consequence \nof the effect of its resinous acid in stimulating the renal epi- \nthelium. \n\nTherapeutics of Corn-Silk. \n\nIt is useful in acute and chronic cystitis, in the bladder irri- \ntation of uric acid, and for phosphatic gravel. It is possibly, \nas well, a cardiac stimulant in the dropsy of heart disease. \nIt is best administered in the form of an infusion, in boiling \nwater (1 to 8), taken almost ad libitum. \n\nSTRONTIUM. \n1. STRONTII LACTAS (U. S. P., 1890; no longer official).\xe2\x80\x94 \nStrontium Lactate. Dose, 1 to 8 gm.; y 4 to 2 dr. \n\n35 \n\n\n\n530 PHARMACOLOGY AND THERAPEUTICS. \n\n2. STRONTII BROMIDUM. See Bromine. \n\n3. STRONTII IODIDUM. See Iodine. \n\n4. STRONTII SALICYLAS. See Salicylic Acid. \n\nAction of Strontium Lactate. \nThe strontium salts have been demonstrated to be harmless \nto animals and men, and to have a diuretic action. If given \nfor some time and in large quantities they impair gastric diges- \ntion and subsequently the general nutrition. The lactate re- \nduces the amount of albumin in albuminuria, and it is claimed \nto have a sedative effect on the heart in diseases of the valves \nand of the muscular tissue. It also checks fermentation and \nputrefaction in the small intestine. \n\nTherapeutics of Strontium Lactate. \nThe strontium salts improve the appetite and facilitate diges- \ntion in gastric affections, and are also used in chronic intestinal \ncatarrh. The lactate is useful in albuminuria, due to renal \natony, on account of its diuretic properties, but not in uraemia, \nnor in interstitial nephritis, nor in the high fever of acute \nparenchymatous nephritis. In chronic renal disease due to \nscrofula, rheumatism or gout it is of service. It is also thought \nto have a decidedly beneficial action in diabetes of hepatic \norigin, and in cirrhosis of the liver. \n\nPIPERAZINE. \n\nUnofficial Preparations. \n1. Piperazinum. \xe2\x80\x94 Piperazine. (Piperazidine. Diethlenedia- \nmine. Dispermine.) Dose, .50 to 1 gm.; 8 to 15 gr. \n\n2. Lysidinum. \xe2\x80\x94 Lysidine. Dose, 2 to 10 c.c; y 2 to 2 x / 2 \nfl. dr., daily. \n\n3. Lycetol.\xe2\x80\x94 Lycetol. Dose, .90 to 1.80 gm.; 15 to 30 gr. \n\nAction of Piperazine. \nPiperazine is believed to increase slightly the amount of urea \nin the urine, while the uric acid coefficient is diminished. The \ntestimony as to its diuretic action is conflicting, but the weight \n\n\n\nCANTHARIDES. 53 1 \n\nof clinical evidence is in favor of its being a reliable diuretic. \nIn ordinary doses it does not appear to have arty influence upon \nthe nervous, circulatory or respiratory systems; nor does it \nirritate the gastro-intestinal or the genito-urinary tract. \n\nTherapeutics of Piperazine. \n\nThere is much clinical testimony as to the value of this drug \nin gout, goutiness (uricacidaemia) and rheumatism. It is here \ngiven in water containing carbon dioxide. It is so highly \nhygroscopic that it cannot be administered as pill or powder. \n\nLysidine, which is a base obtained by the action of sodium \nacetate upon ethylene-diamine hydrochlorate, is reputed to \nhave an even more pronounced effect in uricacidaemia than \npiperazine. It is said to have been given in cases of chronic \ngout with good results, especially as regards lessening of the \njoint-stiffness and reduction in the tophi around the joints. \nThe dose is 2 to 10 c.c. (J-4-2^ fl. dr.) of the 50 per cent, \nalkaline solution, administered in a glassful of carbonated \nwater. \n\nLycetol, or dimethyl-piperazine tartrate, has been introduced \nfor the purpose of combining the action of piperazine with the \nalkalizing and diuretic effects of a tartrate. It may be given \nin carbonated water or in the form of a lemonade. \n\nCANTHARIDES. \nCANTHARIS. \xe2\x80\x94 Cantharides. (Spanish Flies. Blister Beetles.) \n\n\n\nPreparations. \n\n1. Ceratum Cantharidis. \xe2\x80\x94 Cantharides Cerate. \n\n2. Collodium Cantharidatum. \xe2\x80\x94 Cantharidal Collodion. \n\n3. Tinctura Cantharidis. \xe2\x80\x94 Tincture of Cantharides. Dose, \n0.3 c.c; 5 TTL- \n\nUnofficial Preparation. \nPotassii Cantharidinatum. \xe2\x80\x94 Potassium Cantharidinate. Dose, \n.0006 gm.; t \xc2\xb1q gr., hypodermatically. \n\n\n\n532 pharmacology and therapeutics. \n\nAction of Cantharides. \n\nExternal. \xe2\x80\x94 Cantharides is a powerful irritant, but the irri- \ntant action of this and other agents of its class still remains \nunexplained. It acts more slowly than most irritants, so that \nif a preparation of cantharides is applied to the skin, it will \nusually be two or three hours before any appreciable effect is \nproduced. The first symptom from it is a tingling, burning \npain in the part, which very shortly becomes reddened in con- \nsequence of the local vascular dilatation caused. In the course \nof three or four hours after the application numerous vesicles \nmake their appearance, and these soon coalesce, forming one \nlarge blebs (varying in area according to the extent of the \napplication), which is filled with clear serum. Although the \nlocal action is thus a violent one, it is also very superficial. \nHence, as less of the irritant penetrates into the deeper tissues \nthan in the case of the volatile oil of mustard, and the process \nis so much slower, the vesication is much less painful than \nthat caused by mustard. If the blister be broken, however, and \nthe irritant be allowed to come in contact with the unprotected \ndermis, severe inflammation with much pain, suppuration and \neven sloughing is liable to result. Cantharides is an energetic \ncounter-irritant, as well as a rubefacient and vesicant, and this \naction is probably due to an alteration in the calibre of the \nblood-vessels and in the sensory nerves, or their terminations, \nreflexly induced by it in the deep-seated organs in the vicinity \nof the part to which it is applied. \n\nCantharidin may be absorbed through the skin and in this \nway produce the constitutional effects of the drug. \n\nInternal. \xe2\x80\x94 G astro-intestinal Tract. \xe2\x80\x94 When taken in sufficient \nquantity by the mouth, cantharides produces the same irritant \neffect along the alimentary canal, and gastro-enteritis results. \nIf cantharidin is swallowed in solution, blisters are formed in \nthe mouth and throat, and deglutition is rendered difficult or \nimpossible by the excruciating pain and the swelling in the \noesophagus caused by it. There is also intense pain in the \nabdomen, and vomiting ensues, followed by purging, with all \n\n\n\nCANTHARIDES. 533 \n\nthe symptoms of shock and collapse. Both the matters vom- \nited and the stools may contain blood. Ulceration of the \nstomach and other portions of the alimentary canal have been \nobserved after death, not only when cantharides has been ad- \nministered by the mouth, but also when the drug has been given \nby subcutaneous injection, and it is thought possible that under \nthese circumstances it is excreted in part by the stomach, and \nthat these lesions are produced in the act of excretion. \n\nGenito-urinary Tract. \xe2\x80\x94 Cantharidin is absorbed from the ali- \nmentary canal and also to a less extent from the skin, and will \nexert its irritant action elsewhere, especially upon the organs \nof excretion. The effect upon the kidneys is seen in diuresis, \nand when a larger amount is absorbed, in nephritis, albuminu- \nria, hematuria, glycosuria, and sometimes in total suppression \nof urine. The other parts of the urinary tract, the bladder and \nurethra, also show the action of the irritant, and strangury, \nwith a constant desire for micturition, priapism, etc., is reflexly \ninduced. The vesical tenesmus is extreme, and the patient suf- \nfers from severe pain in the loins. The local irritation is apt \nto occasion erotic excitement, with seminal emissions in the \nmale, and there may also be swelling and inflammation of the \nexternal genitals. Sufficient of the active principle may be \nabsorbed from a cantharides blister to cause marked renal irri- \ntation and strangury. The drug is chiefly excreted by the kid- \nney, and the nephritis is the main factor in death from can- \ntharidal poisoning. \n\nNervous System. \xe2\x80\x94 While cantharidin, thus absorbed, has no \nimportant action upon the internal organs other than those by \nwhich it is eliminated, when injected into the circulation of \nanimals this agent is stated to affect the central nervous system \nmuch in the same way as phenol, producing short stimulation, \nexcitement and increased reflexes, followed by paralytic symp- \ntoms, coma, etc. It is found, however, that this central action \nis not often observed, as it is mostly obscured by the gastro- \nenteritis or nephritis. \n\n\n\n534 PHARMACOLOGY AND THERAPEUTICS. \n\nTherapeutics of Cantharides. \nExternal. \xe2\x80\x94 Cantharides is of all drugs the most commonly \nused as a vesicant and counter-irritant. Blisters may be spread \nwith cerate of cantharides, or preferably with the cerate of the \nextract of cantharides (U. S. P., 1880). The raised cuticle \nshould not be removed, but simply punctured to allow the \nescape of the serum, and the surface should then be dressed \nwith some bland fat. A very convenient method of blistering \nis to paint the desired area with one or two coats of can- \ntharidal collodion, and then lay over it a piece of waxed paper. \nIn using a blistering plaster sodium bicarbonate or a little mor- \nphine with powdered camphor may be sprinkled over its sur- \nface before it is applied, for the purpose of lessening the danger \nof strangury, and with the same end in view the preliminary use \nof an alkaline diuretic has been suggested. The tendency to \nstrangury is also diminished by the free use of diluent drinks. \nBlisters are employed to relieve pain, reduce inflammation, and \npromote the removal of inflammatory products by absorption. \nThey are thus of service in a great variety of conditions, al- \nthough not in such general use as formerly, when heroic meth- \nods of treatment were more in vogue. Only a few of the spe- \ncial uses of blisters need be referred to here. They are ap- \nplied over the chest in pleuritic effusions (a succession of small \nblisters being most efficacious), behind the ear in aural inflam- \nmations, on the perineum in obstinate gleet, around the affected \njoints in acute rheumatism, at the nape of the neck in severe \nheadaches, and over the epigastrium for persistent pain in the \nstomach, vomiting, etc. They are of great value in neuralgia, \nespecially if applied close to the emergence of the nerve from \nthe spinal column, and also in sciatica and neuritis and in sub- \nacute joint affections. It has been shown by careful researches \nthat a distinct relation exists between irritation of an internal \norgan and that part of the skin which is supplied by the same \nsegment of the spinal cord or brain. While these superficial \npoints are connected with the diseased organ only by means of \nnerve-fibres, it appears that a nervous impulse from these \n\n\n\nCANTHARIDES. 535 \n\norgans does not pass in an indeterminate manner through the \ncentral nervous system, but has a distinct tendency to affect \nthe superficial areas which are supplied with sensory nerves \nfrom the same segment of the cord. It is therefore argued \nthat an affection of these superficial areas may affect the cor- \nresponding internal organ more than the rest of the body, and \nthat this satisfactorily explains the benefits derived from \ncounter-irritants. In confirmation of this, attention is called to \nthe fact that several of the points which were observed to be \naffected by internal disease are precisely those points at which \nexperience has shown irritation to be of most service. Thus, \nthe application of a blister to the epigastrium has long been \nrecognized as a means of relieving stomach disorders, while the \nold treatment of iritis by means of a blister on the temple may \nbe justified by the fact that in the researches mentioned an \narea of tenderness in this region was found to accompany the \neye-disease. An aura proceeding from an extremity may some- \ntimes be intercepted, and epileptic seizures averted, by encirc- \nling the limb with a strip of blistering-plaster. The moral \nimpression produced by the use of vesication is not infrequently \nvery beneficial. Hysterical paralysis is most successfully \ntreated by encircling the affected extremity with narrow blis- \nters, and hysterical aphonia may sometimes be quickly cured \nby a blister over the larynx. If in any case an especially pro- \nnounced counter-irritant effect is desired, the blister, after hav- \ning been punctured, may be irritated by the application of an \nirritating ointment. Unguentum Sabinae (savin, 8; yellow \nwax, 3; benzoated lard, 16) was formerly much used for this \npurpose. In blistering with cantharidal preparations the plas- \nter should be removed as soon as the blebs has formed, on \naccount of the danger of the absorption of cantharidin. When \nstrangury is produced, relief may be afforded by an enema of \nlaudanum or by a small hypodermatic injection of morphine. \nAmong the conditions contra-indicating the use of blisters in \ngeneral may be mentioned the acute stage of an inflammation, \nscurvy and purpura, pregnancy, infancy and debility. They \n\n\n\n536 PHARMACOLOGY AND THERAPEUTICS. \n\nshould never be applied to a part on which a patient lies, on \naccount of the risk of the formation of bed-sores, or to para- \nlyzed limbs. Cantharidal blistering is contra-indicated in renal \ndisease or inflammation of the urinary passages, and here vesica- \ntion by ammonia water or chloroform (evaporation being pre- \nvented) may be substituted for it. These are rather more rapid \nin action, but much more painful than cantharides. By some \nit is advised that blisters should not be opened at all, but should \nbe covered with antiseptic wool, by which means ulceration \nand inflammatory complications may be avoided. It is held \nalso that the removal of the serum is practically equivalent to \na blood-letting of the same amount, and that this is very rarely \ndesirable. The cuticle raised by a blister may be used for skin- \ngrafting. \n\nCantharides is one of the most common and useful remedies \nemployed in the treatment of loss of hair. Good results may \noften be obtained from its use if the alopecia has not progressed \ntoo far, but it is hardly likely to prove of service if the treat- \nment is begun late. It is usually applied in the form of tinc- \nture, largely diluted with alcohol, or as the active constituent \nof a pomade. Some such preparation as the following may \nalso be employed to stimulate the growth of hair: Vinegar of \ncantharides (B. P., cantharides, 1; glacial acetic acid, 5; \nwater), 1; glycerin, 1; spirit of rosemary, 1; water, 10. In \nalopecia circumscripta cantharidal collodion, painted over the \nbald patches every week or ten days, is occasionally successful. \n\nInternal. \xe2\x80\x94 On account of its irritating properties cantharides \nis used internally to only a limited extent. It is given in the \nform of the tincture, in small doses, principally as a stimulant \nto the urinary organs, and among the conditions in which it \nhas been commended are hematuria, incontinence of urine, \nchronic pyelitis, chronic cystitis, irritability of the bladder, \ngleet, prostatorrhcea, and spermatorrhoea due to deficient tone \nof the seminal vesicles. It is naturally contra-indicated when \nany active inflammation is present. Cantharides has some \npopular reputation as an emmenagogue, but if it has any influ- \n\n\n\nCANTHARIDES. 537 \n\nence at all upon the menstrual function, this is quite insignifi- \ncant, and due, no doubt, only to its irritant effect upon the \nurinary organs and passages. It is one of the drugs most \nrelied upon in the treatment of impotence, in which condition \nit may prove of service through reflex irritation from the \nurethral mucous membrane. Its administration is attended \nwith considerable danger, however, since efficient doses are apt \nto induce nephritis. Several cases of poisoning have been re- \nported from its use as an aphrodisiac, though it is stated that its \naphrodisiac effect is usually more manifest under ordinary or \neven small medicinal doses than from immoderate amounts. \nSometimes, but not often, it relieves chordee. Small doses are \nsometimes useful in the late stage of acute desquamative nephri- \ntis. It has been recommended for diabetes insipidus. Can- \ntharidin, in the form of potassium cantharidinate, administered, \nhas been used as a remedy for pulmonary tuberculosis, and for \nlupus. Notwithstanding that cures of both of these diseases \nhave been claimed, the value of the drug in such conditions is \nby no means established. \n\nTOXICOLOGY. \n\nSymptoms. \xe2\x80\x94 The effects of toxic doses of cantharides have already- \nbeen described. In cases where lethal amounts have been taken, there \nusually result dyspnoea, great frequency of the pulse, and finally col- \nlapse and coma, death being sometimes preceded by convulsions. These \nfatal effects would appear to be dependent upon suppression of the \nurinary functions in consequence of the violent nephritis caused by \nthe drug. It is one of the substances employed for the purpose of \nproducing abortion with criminal intent, and it is in cases of this \nkind that symptoms of poisoning are most likely to be observed. \n\nPost-Mortem. \xe2\x80\x94 There are found swelling and intense hyperemia of \nthe gastro-intestinal mucous membrane, with ecchymoses and often \nulceration, and the appearances of acute inflammatory action also in \nthe kidneys, bladder and whole genito-urinary tract. \n\nTreatment. \xe2\x80\x94 There is no chemical or physiological antidote to \nCantharides. The stomach should be emptied by emetics (see p. 175), \nor washed out by the stomach-pump. Mucilaginous and demulcent \nliquids should be freely given. Opium is indicated to relieve the pain \nand gastro-enteritis. \n\n\n\n538 PHARMACOLOGY AND THERAPEUTICS. \n\nTRITIOUM. \nTRITICUM.\xe2\x80\x94 Triticum. (Couch-grass.) Dose, 8 gin.; 120 gr. \n\nPreparation. \nFluidextractum Tritici. \xe2\x80\x94 Fluidextract of Triticum. Dose, 8 \nc.c; 2 fl. dr. \n\nUnofficial Preparation. \nInfusum Tritici. \xe2\x80\x94 Infusion of Triticum. Dose, freely. \n\nAction of Triticum. \nTriticum is emollient and demulcent, and has some nutrient \nqualities. It has been regarded as a diuretic also, but the in- \ncrease in the amount of urine noted under its use appears to \nbe due simply to the water given with it. \n\nTherapeutics of Triticum. \nFor its soothing and supposed diuretic properties it has been \nused in dysuria, irritability of the bladder, chronic cystitis, irri- \ntable prostate, gleet, and other affections of the genito-urinary \ntract. The infusion is a popular fever-drink in Europe. \n\n\n\nB. Drugs Preventing the Urine from Decomposing. \n\nUROTROPIN. \n\nHEXAMETHYLENAMINA. \xe2\x80\x94 Hexamethylenamine. Hexamethyl- \nene Tetramine. (Urotropin.) Dose, 0.250 gm. (250 milligm.) ; 4 gr. \n\nAction of Urotropin. \nLarge doses in man, e. g. (io gm. ; 150 gr.), are well borne; \nintravenous injections in rabbits and dogs do not increase, but, \nrather, slightly lower blood-pressure. Very large doses cause \nalbuminuria in rabbits and hematuria in dogs. Of most im- \nportance is the inhibitory action of this remedy upon micro- \norganisms when it is split up into formaldehyde and ammonia, \nthe former being the active agent. This takes place for the \n\n\n\nBENZOIN. 539 \n\nmost part, after ingestion, in the urine, which is not only of the \nproper temperature for the purpose, but also contains uric acid \nand acid salts which are efficient. Further, as has been shown, \nit will dissolve uric acid at the temperature of the body. Lastly, \nit may or may not produce diuresis. \n\nTherapeutics of Urotropin. \n\nThis remedy is of especial value in diseases of the urinary \npassages. In ammoniacal fermentation of the urine, which is \nextremely frequent in the cystitis of prostatic hypertrophy, the \nmaximum dose given for two or three successive days is effi- \ncient in clearing that excretion. Inasmuch as the growth of \nthe micro-organisms is inhibited, the remedy should be con- \ntinued in sufficient amount to maintain this result. In gonor- \nrhceal posterior urethritis, cystitis and pyelitis the results are \nequally favorable. It may be employed as a prophylactic meas- \nure before operations upon the genito-urinary tract. For the \nuric acid diathesis it has been used with good results by most, \nwith failure by a very few, physicians. Since it is not always \ndiuretic, other measures should be employed to increase kidney \naction. As a so-called lithontriptic some success has been \nclaimed. For phosphaturia excellent results are reported. In- \nasmuch as the specific bacillus of the disease is found in a very \nconsiderable percentage of urines from patients suffering from \ntyphoid fever, and failure to disinfect this excretion is a source \nof danger, urotropin should be administered not only for this \npurpose but also in order to avoid the cystitis which sometimes \nsupervenes in the course of this disease. \n\nBENZOIN. \n\nBENZOINUM.\xe2\x80\x94 Benzoin. (Gum Benjamin.) Dose, 1 gm.; 15 gr. \n\nPreparations. \n\n1. Adeps Benzoinatus. \xe2\x80\x94 Benzoinated Lard. \n\n2. Tinctura Benzoini. \xe2\x80\x94 Tincture of Benzoin. Dose, 1 c.c; \n15 TT\\. \n\n\n\n540 PHARMACOLOGY AND THERAPEUTICS. \n\n3. Tinctura Benzoini Composita. \xe2\x80\x94 Compound Tincture of \nBenzoin. (Friar\'s Balsam.) Dose, 2 C.C.; 30 TIT.. \nACIDUM BENZOICUM.\xe2\x80\x94 Benzoic Acid. Dose, 0.500 gm. (500 \nmilligm.) ; 7y 2 gr. \n\nPreparations. \nLiquor Antisepticus. \xe2\x80\x94 Antiseptic Solution. Dose, 4 c.c; 1 \nfl. dr. \n\nAmmonii Benzoas. \xe2\x80\x94 Ammonium Benzoate. Dose, 1 gm.; \n15 gr. \nLithii Benzoas. \xe2\x80\x94 Lithium Benzoate. Dose, 1 gm.; 15 gr. \nSodii Benzoas. \xe2\x80\x94 Sodium Benzoate. Dose, 1 gm.; 15 gr. \n\nUnofficial Preparations. \nBismuthi Benzoas. \xe2\x80\x94 Bismuth Benzoate. Dose, 1 gm-; 15 gr. \nAcidum Cinnamicum. \xe2\x80\x94 Cinnamic Acid. Dose, .30 to .60 \ngm.; 5 to 10 gr. \n\nAction of Benzoic Acid. \n\nAs benzoic acid, its salts, and benzoin all have practically the \nsame action, that of benzoic acid only will be here described. \n\nExternal. \xe2\x80\x94 Like salicylic acid, it is irritant to mucous mem- \nbranes, and its vapors when inhaled are capable of exciting a \ncatarrhal condition of the bronchial membrane. When ap- \nplied in a concentrated form it is also irritant to the skin. In \nantiseptic power it appears to be equalj if not superior, to sali- \ncylic acid, preventing the growth of many forms of bacteria in \na solution of I in iooo. \n\nInternal. \xe2\x80\x94 In the body its action is in many respects very \nsimilar to that of salicylic acid, and, like the latter, it may be \ntaken in comparatively large quantities without the production \nof toxic symptoms. In very large doses it sometimes causes \nnausea and vomiting, and in occasional instances the matters \nvomited may be tinged with blood. It produces a moderate \nacceleration of the pulse, and has some effect in increasing and \ndisinfecting the bronchial secretion. It is therefore regarded \nas an expectorant, and it is thought probable that either the \nacid or one of its derivatives is excreted by the bronchial mu- \ncous membrane. It is said also to be excreted by the skin, \n\n\n\nBENZOIN. 541 \n\nand thus stimulate its functional activity, though this has been \ndenied by some. It differs from salicylic acid in being less \nstimulant to the central nervous system, and in man a certain \nsedative effect has been observed under it. In dogs it may \ngive rise to tremors and convulsions, and the following phe- \nnomena have also been observed: Ataxia and paresis, followed \nsuccessively by complete paralysis of the anterior and posterior \nextremities and trunk; fall of temperature; death from as- \nphyxia. The pulse and respiration are first accelerated and \nthen slowed, from a direct action on the heart and on the res- \npiratory centre. As the gastric mucous membrane has been \nfound after death to be eroded and ecchymosed, even when the \nacid has been injected subcutaneously or intravenously, it is \nbelieved that benzoic acid has a specific action on this mem- \nbrane quite apart from its irritant effects when applied locally. \nIn the dog, as well as in man, vomiting is produced when the \nacid is given by the mouth in sufficient quantity. While traces \nof benzoic acid have been found in the saliva of dogs after the \nadministration of the drug, it is thought that it is not excreted \nby the salivary glands in man. It no doubt lessens the putre- \nfaction in the intestinal canal, as some diminution in the double \nsulphates and the indican of the urine has been observed after \nits administration by the mouth. Benzoic acid and the ben- \nzoates, particularly sodium benzoate, appear to have the effect \nof somewhat stimulating the functional activity of the liver. \n\nAn important feature of the action of benzoic acid is that it \nis in great part excreted in the urine as hippuric acid, which is \nformed in the body from a combination with glycocoll. Hip- \npuric acid is benzoyl-glycocoll (or glycosine), so that a syn- \nthetic process takes place, benzoic acid combining with glyco- \ncoll, and hippuric acid and water being the result \xe2\x80\x94 \n\nC 6 H 5 \xe2\x80\xa2 COOH + H 2 N \xe2\x80\xa2 CH 2 \xe2\x96\xa0 COOH = \n\nC 6 H 5 \xe2\x80\xa2 CO \xe2\x96\xa0 HN \xe2\x80\xa2 CH 2 \xe2\x96\xa0 COOH + H 2 0. \n\nIt has not as yet been determined from what source the nitro- \ngen required for this is derived. Some of the benzoic acid \n\n\n\n542 PHARMACOLOGY AND THERAPEUTICS. \n\nescapes in the urine, and the proportion of hippuric acid formed \nappears to depend more or less upon the condition of the kid- \nneys (in which the synthesis takes place) and of the general \nhealth, as well as upon the amount of benzoic acid ingested. \n\nIf hippuric acid is given by the mouth, it is stated that ben- \nzoic acid is found in the blood, but that hippuric acid reappears \nin the urine. When benzoic acid has been administered to the \nmother shortly before delivery, hippuric acid has been observed \nin the urine of the new-born infant. It is generally believed \nthat the hippuric acid formed from benzoic acid in the system \nincreases the acidity of the urine and renders alkaline uric \nacid, while it also tends to disinfect and stimulate the genito- \nurinary tract. Most clinicians agree that the acidity of the \nurine is increased after benzoic acid, and it is thought probable \nthat the disappearance of uric acid crystals from the urine \nunder its influence is due to the conversion of insoluble uric \nacid into soluble hippuric acid. It has been asserted by some, \nhowever, as the result of experiment, that sodium benzoate \ndoes not increase the acidity of the urine, and that the mistake \nof clinicians has arisen from the fact that in cystitis the urine \nhas its acidity increased by the drug for the reason that the \nammoniacal fermentation is checked by the benzoic acid. Dur- \ning its excretion by the kidney benzoic acid slightly stimulates \nthe renal cells, and thus has a mild diuretic effect. After large \ndoses there has sometimes been found in the urine a reducing \nbody, which is presumed to be glycuronic acid. By some it is \nbelieved that the reducing property of the urine is always the \nresult of intoxication, so that unless symptoms of poisoning \nare present, no such reducing action will be observed. Phthalic \nacid, and possibly succinic acid, may also occasionally appear \nin the urine after the administration of benzoic acid. Benzoic \nacid is found to increase to a considerable extent the nitrogen \neliminated in the urine, and it would therefore seem, like sali- \ncylic acid, to augment the decomposition of the proteids in the \nbody. \n\n\n\nBENZOIN. 543 \n\nThe action of benzoic acid on the body-temperature is prob- \nably similar to that of salicylic acid. \n\nOne of the rarer results of the administration of the drug \nis urticaria or an erythematous condition of the skin. \n\nTherapeutics of Benzoic Acid. \nExternal. \xe2\x80\x94 On account of its marked antiseptic qualities, as \nwell as its stimulating effect, the compound tincture of benzoin \nis quite largely used as a surgical dressing. It is applied on \nlint to wounds and ulcers or other sores, and when injected \ninto old sinuses it disinfects the tract and promotes healing. \nIt makes a good application for spongy gums, and is also used \nto paint over abrasions and excoriations, as in the case of \ntender nipples. Its use in the same way is recommended in \nthe treatment of chilblains, after the part has been washed with \na 5 per cent, solution of carbolic acid. It sometimes relieves \nthe itching of urticaria or eczema, and, mixed with an equal \nquantity of glycerin, is serviceable for chapped lips and hands, \nchapped and fissured nipples, and frost-bite. A solution of \ntincture of benzoin in cologne-water is also often successful in \nurticaria, and a lotion made with the tincture, and containing \nmercuric chloride, may be applied for the removal of freckles \nor moth-spots and in pityriasis versicolor and chronic urticaria. \nIn catarrhal affections of the pharynx and larynx the compound \ntincture, more or less diluted, makes an efficient application, \nand the hoarseness of singers and public speakers, the result \nof undue strain upon the vocal cords, is frequently relieved by \nthis remedy. Bismuth benzoate (not official), which contains \nabout 65 per cent, of bismuth, is an efficient dressing for chronic \nor sloughing ulcers and for venereal lesions of various kinds, \nand is usually dusted on the parts after they have been thor- \noughly bathed with a weak solution of mercuric chloride. Ben- \nzoated lard is a favorite basis for ointments the active ingre- \ndient of which it is desired to have absorbed, as the benzoin \nprevents the decomposition of the lard when melted on the \nskin. Where the benzoin causes irritation, as it may near the \n\n\n\n544 PHARMACOLOGY AND THERAPEUTICS. \n\neye, a non-irritant basis which keeps indefinitely may be made \nby adding 3 parts of oil of cloves or 2 of oil of gaultheria to \n480 parts of lard. \n\nInternal. \xe2\x80\x94 Urinary Organs. \xe2\x80\x94 The chief value of the benzoic \ncompounds is no doubt in diseases accompanied by disordered \nconditions of the urine. Ammonium and sodium benzoate are \npreferable to benzoic acid itself on account of their much \ngreater solubility, and they may with advantage be combined \nwith some such sedative as hyoscyamus. Spirit of chloroform \nis sometimes employed to cover the taste. In pyelitis or cys- \ntitis the alkalinity of an ammoniacal urine is promptly dimin- \nished, the hippuric acid which is formed combines with ammo- \nnia to form ammonium hippurate, less triple phosphate results \nin consequence, and the condition is therefore ameliorated. As \nthe acidity of the urine is increased by the salts, they may also \nbe of more or less service in phosphaturia and in vesical cal- \nculus. During the presence of fever the transformation of ben- \nzoic acid into hippuric acid is much diminished, and in ad- \nvanced parenchymatous nephritis and amyloid disease of the \nkidney is entirely abolished, the benzoates being excreted as \nsuch. The latter fact goes to confirm the results obtained from \nexperiments on dogs, showing that this change takes place only \nin the kidneys, and probably in the renal cells. In some ani- \nmals, however, notably the rabbit and the frog, the kidney is \nnot the only place of synthesis. In certain cases of chronic \nBright\'s disease the benzoates may be used with advantage. \nThey are also sometimes of value in chronic gonorrhoea, in \nobstinate irritation of the urethra due to the condition of the \nurine, and in incontinence caused by an alkaline urinary reac- \ntion. \n\nPulmonary Organs. \xe2\x80\x94 Benzoin and its derivatives, especially \nsodium benzoate, were at one time employed to a considerable \nextent in phthisis, but have now for the most part been aban- \ndoned, as it has been found that they have no such effect on \nthe tubercle bacillus as had been hoped, though they may some- \ntimes be of service when the sputum is fetid. In bronchitis \n\n\n\ncopaiba. 545 \n\nthey are of more value, and in this affection, as well as in \nlaryngitis, much benefit may often be derived from the inhala- \ntion of a mixture of compound tincture of benzoin (4 c.c. ; 1 \nfl. dr.) and water (500 c.c; 1 pint), heated to a temperature \nof 6o\xc2\xb0 C. (140 F.). The simple or compound tincture is used \nalso as an ingredient of expectorant mixtures, and is regarded \nas more especially beneficial when the mucus is tenacious and \ncoughed up with difficulty. \n\nOther Uses. \xe2\x80\x94 Sodium benzoate has been lauded by some in \nthe treatment of gout, but its value here is very questionable. \nThe same is true as regards diphtheria, and it has quite fallen \ninto disuse in this disease. It has been given as an antipyretic \nin pneumonia and in intermittent, typhoid, and other fevers, and \non account of its antiseptic properties in erysipelas and puer- \nperal fever and other septic conditions, but without satisfactory \nresults. In diseases of the alimentary canal the benzoates have \nproved of considerable value, though inferior to some other \nremedies. They are sometimes efficient in chronic diarrhoea \nand dysentery and the intestinal catarrh of children. As he- \npatic stimulants they are but little used, and even if the claims \nonce made for them in this capacity were true, it is now ac- \ncepted that the functions of the liver can generally be much \nbetter modified indirectly than by direct action upon the organ. \nIn acute rheumatism the benzoates appear to have somewhat \nthe same effects as the salicylates, but are much less reliable. \n\nCinnamic Acid is thought to resemble benzoic acid in its \npharmacological characters. It is said to increase the leuco- \ncytes of the blood and the uric acid of the urine to a marked \ndegree. \n\nCOPAIBA. \n\nCOPAIBA. \xe2\x80\x94 Copaiba. (Copaiva. Balsam of Copaiba.) Dose, 1 \nc.c; 15 Til,. \n\nOLEUM COPAIBA.\xe2\x80\x94 Oil of Copaiba. Dose, 0.5 c.c; 8 TTL- \n\nUnofficial Preparations. \nMassa Copaibae. \xe2\x80\x94 Mass of Copaiba. Solidified Copaiba. (U. \nS. P., 1890.) Dose, 1.0 to 4.0 gin.; y 4 to 1 dr. \n36 \n\n\n\n546 PHARMACOLOGY AND THERAPEUTICS. \n\nResina Copaibae. \xe2\x80\x94 Resin of Copaiba. (U. S. P., 1890.) Dose, \n.30 to 1.00 gm.; 5 to 15 gr. \n\nAction of Copaiba. \n\nExternal. \xe2\x80\x94 Copaiba is slightly stimulating to the skin and \nmucous membranes, and is also antiseptic. \n\nInternal. \xe2\x80\x94 G astro-intestinal Tract. \xe2\x80\x94 Its taste is very unpleas- \nant, and it often occasions disagreeable eructations, which taste \nof the drug. Its action is like that of other volatile oils, in \nordinary doses causing a pleasant sense of warmth in the stom- \nach, and in large amounts acting as a gastro-intestinal irritant, \nwith the production of vomiting and purging. Like cubeb \nand sandalwood oil, however, it is less irritant to the stomach \nthan many of the volatile oils, though its prolonged adminis- \ntration is apt to give rise to more or less gastric disturbance. \n\nMucous Membrane. \xe2\x80\x94 After entering the circulation it is ex- \ncreted to a considerable extent by the various mucous mem- \nbranes, in the process stimulating their action and also having \na disinfectant effect. It is thus a stimulating disinfectant to \nthe bronchial mucous membrane and that of the genito-urinary \ntract, acting especially on the latter. It imparts to the mucous \nsecretions and breath, as well as to the urine, a peculiar aro- \nmatic odor. \n\nSkin. \xe2\x80\x94 It appears to be eliminated by the skin also, and in \nsome instances it occasions cutaneous eruptions and annoying \nitching. The more common form of effervescence is a coarse \nrash, resembling measles, but sometimes there is urticaria, \nerythema or a bullous eruption. The cause of these eruptions \nis unknown. By some they have been attributed to the irritant \neffect of its excretion by the skin; by others to the gastric \ndisturbance caused by the drug. \n\nKidneys. \xe2\x80\x94 Copaiba is diuretic not only by virtue of its vola- \ntile oil, but also because of its resinous acid, which has an \naction both upon the bronchial mucous membrane and the kid- \nneys. This resin is excreted in the urine, where it may be \nprecipitated by acids. The precipitate can be readily distin- \n\n\n\ncopaiba. 547 \n\nguished from albumin, as it is evenly distributed through the \nfluid and is dissolved by both heat and alcohol. While it might \nthus at first be mistaken for albumin, it also leads to confusion \nwhen Trommer\'s test is employed to detect glucose. As co- \npaiba exerts an antiseptic action in the urine, the bladder and \nurethra are bathed in an antiseptic, slightly irritant fluid, which \nnot only tends to retard the growth of microbes, but also to \npromote the healing of lesions of the mucous membrane. In \nlarge doses it causes irritation in these parts, with a con- \nstant desire to micturate. The act of micturition is attended \nwith difficulty and pain, and sometimes the pain is so severe \nas to lead to complete retention. Large quantities are also irri- \ntating to the kidneys, and from this cause may result a dimin- \nished secretion, with blood and albumin in the urine. While \ncopaiba is excreted partly by the lungs and mucous membranes \nand in the milk and other secretions, its main excretion takes \nplace by the kidneys and in combination with glycuronic acid. \n\nTherapeutics of Copaiba. \n\nExternal. \xe2\x80\x94 Like other terebinthinates, copaiba serves to stim- \nulate, as well as protect, parts to which it is applied. It is \nsometimes used as a dressing for chilblains, frost-bite, sore \nnipples, anal and other fissures, etc. A mixture of equal parts \nof copaiba and rosin cerate has been recommended as an effi- \ncient application for indolent ulcers. It has also been used, on \naccount of its stimulating and antiseptic effects, in chronic \nskin diseases, such as psoriasis, lupus and leprosy, and as a \ntopical application to the urethra or vagina in chronic gonor- \nrhoea. \n\nInternal. \xe2\x80\x94 Occasionally copaiba is employed as an expector- \nant in bronchitis, especially where the secretion has become \nprofuse and fetid. In chronic conditions it has the effect of \ndiminishing, instead of increasing, secretion, and on this ac- \ncount as well as its disinfectant properties, it may serve a use- \nful purpose. The resin is an efficient diuretic for hepatic \nascites and cardiac dropsy, but should not be used in Bright\'s \n\n\n\n548 PHARMACOLOGY AND THERAPEUTICS. \n\ndisease on account of its irritant action upon the kidneys. It \nis, however, a very disagreeable remedy to take. The follow- \ning mixture, for one dose, is probably as palatable as any that \ncan be made: To I gm. (15 gr.) of resin of copaiba, rubbed up \nwith 1 gm. (15 gr.) of tragacanth and 1.20 c.c. (20 Til) of \nalcohol, are added 4 c.c. (1 fl. dr.) of syrup of ginger in 30 \nc.c. (1 fl. oz.) of water. It is found that after copaiba has \nbeen administered for some time it loses its effect to a consid- \nerable degree, so that the diuresis produced by it is less copious \nthan at first. It was formerly given to a considerable extent \nin pyelitis, cystitis, vaginitis, and a variety of other affections, \nbut at the present time its use is almost entirely restricted to \nthe treatment of gonorrhoea and gleet. The reasons for this \nare its unpleasant taste, the offensive odor which the drug gives \nto the breath of those taking it, and its liability to cause dis- \nagreeable eructations, to derange the digestion, or to produce \neruptions on the skin. In gonorrhoea it has proved so unde- \nniably efficacious, however, that in spite of the objectionable \nfeatures attendant .upon its administration, it still holds its place \nas a standard remedy in this disease. It is regarded as safe \nto begin the use of copaiba in gonorrhoea as soon as the initial \nseverity of the attack has subsided and the bowels have been \nfreely opened. It is best administered in capsules, and may \nbe combined with other agents if desired. \n\nCUBEB. \n\nCUBEBA.\xe2\x80\x94 Cubeb. Dose, 1 gm.; 15 gr. \n\nPreparations. \n\n1. Fluidextractum Cubebae. \xe2\x80\x94 Fluidextract of Cubeb. Dose, 1 \nc.c; 15 TTt- \n\n2. Oleoresina Cubebae. \xe2\x80\x94 Oleoresin of Cubeb. Dose, 0.500 \ngm. (500 milligm.); 7V 2 gr. \n\n3. Trochisci Cubebae.\xe2\x80\x94 Troches of Cubeb. \nOLEUM CUBEBA.\xe2\x80\x94 Oil of Cubeb. Dose, 0.5 c.c; 8 m.. \n\nUnofficial Preparation. \nTinctura Cubebae (U. S. P., 1890).\xe2\x80\x94 Tincture of Cubeb. \nDose, 2 to 12 c.c ; y 2 to 3 fl. dr. \n\n\n\nCUBEB. 549 \n\nAction of Cubeb. \n\nExternal. \xe2\x80\x94 By reason of its volatile oil cubeb is irritant and \nrubefacient when applied by inunction. \n\nInternal. \xe2\x80\x94 Its action is much the same as that of copaiba, \nthough it is somewhat less irritant. In small doses it is an \naromatic stomachic and carminative, and assists digestion. \nLarge doses cause marked gastric and sometimes intestinal \nirritation, with nausea, vomiting, abdominal pain, and perhaps \npurging, while the urine may contain albumin or blood, or \nboth. It is absorbed, and, like other volatile oils, produces \nsome cardiac stimulation and also stimulates the functions of \nthe organs by which it is eliminated. It is excreted by the \nkidneys and lungs, and perhaps by the skin, and its chief action \nis on the mucous membrane of the genito-urinary tract. This \nis not only powerfully stimulated but also disinfected by it, as \nthe urine containing the drug acts as a stimulant and antiseptic \nlotion. It sometimes gives rise to a cutaneous papular or \nerythematous eruption, but whether this is due to its excretion \nby the skin, as believed by some, or to the gastric disturbance \nis as yet undetermined. As cubeb induces considerable irrita- \ntion of the kidney, it is a diuretic. Containing, as it does, like \ncopaiba, a resinous acid, this is considered to aid the effects \nof the oil in its action upon the renal epithelium, as well as \nupon the bronchial mucous membrane. This resin also is ex- \ncreted in the urine and is precipitated by the addition of acids. \n\nTherapeutics of Cubeb. \nCubeb is one of the drugs most commonly employed in the \ntreatment of genito-urinary affections, especially gonorrhoea, \ngleet and chronic cystitis. It is considered most valuable in \nthe acute stage of gonorrhoea. It often relieves functional irri- \ntability of the bladder, and sometimes checks nocturnal inconti- \nnence of urine. Some patients are peculiarly susceptible to its \neffects, and in them even small doses may produce gastric dis- \nturbance or vesical irritation, with bloody urine. In the treat- \nment of affections of the respiratory passages it has a well- \n\n\n\n550 PHARMACOLOGY AND THERAPEUTICS. \n\nestablished position. Powdered cubeb, blown into the nostrils \nby an insufflator, is employed in chronic nasal catarrh, and is \nalso sometimes an efficient local application in hay-asthma un- \naccompanied with fever and in follicular pharyngitis. The \nsymptom asthma is often relieved by cubeb cigarettes, and these \nare useful also in sensitive hypertrophies of the nose and in \nmild bronchitis. The official troches are employed by vocalists \nand public speakers, and many popular bronchial troches con- \ntain cubeb. It is of considerable service in subacute or chronic \nbronchitis, especially when there is a profuse muco-purulent \nsecretion. It is not much used as a stomachic or cardiac stim- \nulant, on account of its liability to cause digestive disturbance, \nbut in atonic dyspepsia its carminative effect on the stom- \nach may sometimes be availed of by its cautious employment \nin small doses. Cubeb is of decided service in cases of \nchronic catarrh of the colon and rectum, with a relaxed condi- \ntion of the mucous membrane and of the inferior hemorrhoidal \nvessels, whether the affection assumes the form of mucous \ndysentery or not. In haemorrhoids it is less efficient than black \npepper. \n\nOIL OF SANTAL. \n\nOLEUM SANTALL\xe2\x80\x94 Oil of Santal. (Oil of Sandal Wood.) Dose, \n0.5 c.c; 8 ni. \n\nAction of Oil of Santal. \n\nThe action of the oil of santal closely resembles that of \ncopaiba and cubeb, but it is less irritant, as well as more agree- \nable to take, than either of the others. Like them, it is a \nbronchial and genito-urinary stimulant and disinfectant. Its \nabsorption and excretion are very rapid, and it appears in the \nurine in about half an hour after ingestion by the mouth. \nAfter daily doses of 4 c.c. (60 Ttl) irritation of the alimentary \ncanal and urethra, with an eruption of small red papules upon \nthe skin and conjunctiva, have been observed. \n\n\n\nOIL OF THYME. 55 I \n\nTherapeutics of Oil of Santal. \n\nIt is best administered in capsules, or in an emulsion, and is \nmuch used in gonorrhoea and gleet. One objection to it is its \nexpensiveness, and on account of its high cost it is frequently \nadulterated. The advantage of pure oil of santal over copaiba \nand cubeb is that it does not nauseate or disturb digestion, and it \ncan be given with good results during the inflammatory stages \nof gonorrhoea or cystitis. In addition to these affections, it is \nof service in pyelitis, urethral haemorrhage, and bronchitis. \nTwo or three drops on sugar will often be found to relieve the \nhacking cough with which there is little expectoration. \n\nMATICO. \nMATICO. \xe2\x80\x94 Matico. Dose, 4 gin.; 60 gr. \n\nPreparation. \nFluidextractum Matico. \xe2\x80\x94 Fluidextract of Matico. Dose, 4 \nc.c; 1 fl. dr. \n\nUnofficial Preparation. \nOleum Matico. \xe2\x80\x94 Oil of Matico. Dose, 0.30 to 1.20 c.c.; 5 to \n20 TT1.. \n\nAction of Matico. \n\nThe volatile oil of matico probably has much the same action \nas that of cubeb, influencing chiefly the genito-urinary passages. \n\nTherapeutics of Matico. \nIt has been given for the same cases as cubeb, but is now \nrarely used. The leaves are sometimes placed upon a bleeding \nsurface. Their numerous hairs promote the clotting of the \nblood, and thus they are haemostatic. \n\nOIL OF THYME. \nOLEUM THYML\xe2\x80\x94 Oil of Thyme. Dose, 0.2 c.c; 3 TT|.. \n\nAction of the Oil of Thyme. \nIts action is similar to that of copaiba. \n\n\n\n552 PHARMACOLOGY AND THERAPEUTICS. \n\nTherapeutics of the Oil of Thyme. \nThe chief use of oil of thyme is as a source of thymol. It \nhas been employed in the treatment of bronchitis, gonorrhoea, \ngleet, leucorrhoea, and vesical catarrh. \n\nSACCHARIN. \n\nBENZOSULPHINIDUM.\xe2\x80\x94 Benzosulphinide. Saccharin. (Gluside.) \nDose, 0.200 gm. (200 milligm.) ; 3 gr. \n\nUnofficial Preparation. \nDulcinum. \xe2\x80\x94 Dulcin. (Sucrol. Para-phenetol-carbamide.) \nDose, .03 to .12 gm.; y 2 to 2 gr., up to a daily maximum of \n2 gm.; 30 gr. \n\nAction of Saccharin. \n\nSaccharin is an antiseptic, but almost the only practical use \n\nwhich is made of it in this capacity is in the surgery of the \n\nbladder. Its principal use is as a sweetening agent. It is not \n\na food, and is eliminated in the urine and saliva without change. \n\nTherapeutics of Saccharin. \n\nIt is quite generally employed as a substitute for sugar when \nfrom any cause, as in diabetes mellitus, this cannot be taken. \nIt may be used in tablets (for sweetening a cup of tea or coffee \none-quarter to one-half grain is sufficient) or in the form of \nsoluble saccharin, which is prepared by neutralizing a solu- \ntion of sodium bicarbonate with saccharin. It contains about \n90 per cent, of saccharin, and is soluble in 15 of water. An \nexcellent elixir for covering the taste of nauseous medicines \nmay be prepared as follows: Saccharin, 2; sodium bicarbon- \nate (90 per cent.), 1; alcohol, 5; water, 35 parts. Saccharin \nis used as an internal antiseptic in cystitis with ammoniacal \nurine, and has been highly commended as a mouth-wash, in \naphthae and a topical agent in ozsena. \n\nDulcin (para-phenetol-carbamide) is a urea derivative of \nphenetidin, the sweetening power of which is about 200 times \nthat of sugar. It is said not to give rise to the disgust en- \n\n\n\nDRUGS ACTING ON THE BODILY HEAT. 553 \n\ngendered by saccharin on prolonged use, but it has the disad- \nvantage of great insolubility. It is soluble in 800 of water, 55 \nof boiling water, and 25 of alcohol. It is said that 1 gm. (15 \ngr.) will usually reduce the temperature in fever one degree \ncentigrade in about three hours. \n\n\n\nDivision VII. \xe2\x80\x94 Drugs Acting on the Bodily Heat. \n\nA. Antipyretics, or Drugs which decrease the Body Tem- \nperature. \xe2\x80\x94 With the exception of those which, when given in \nsufficient quantity to induce severe collapse may in this way \ncause the temperature to fall below normal, there are few drugs \ncapable of reducing the temperature in health. The term anti- \npyretic is therefore limited to such drugs as have the power of \ndepressing the body temperature in fever. In health the tem- \nperature is maintained at a uniform point through a balance \nestablished between the production of heat (thermogenesis) \nand its dissipation (thermolysis) through the skin, lungs and \nother organs. The main source of production is the voluntary \nand involuntary contraction of the muscles, and the loss of \nheat occurs to some extent through the lungs, but chiefly by \nmeans of radiation from the cutaneous blood-vessels and the \nevaporation of perspiration. Now if an excessive formation \nof heat takes place, as during active muscular exertion, this is \ncompensated for by an increased output from the skin, through \nthe dilation of the vessels and by the perspiration. On the \nother hand, if there is an increased heat dissipation from ex- \nposure to cold, this is offset by an augmented combustion of \nthe tissues, with the formation of more heat. In order to pre- \nserve a balance between the heat producing and heat dissi- \npating agencies there must be present a coordinating mechan- \nism, and there is considerable ground for locating this about \nthe corpus striatum, in the basilar ganglia of the cerebrum. \nLesions in this part of the brain are usually found to cause a \nvery marked rise of temperature, and it is stated that in ani- \n\n\n\n554 PHARMACOLOGY AND THERAPEUTICS. \n\nmals no shivering is produced by cold after section of the cere- \nbral peduncles. The heat regulating function (thermotaxis) \nis more or less deranged by various poisons, and especially by \nsuch as are generated in fever. The existence of a heat-regu- \nlating centre in the brain, it may be stated, has never as yet \nbeen definitely proved, and some investigators believe that the \nvasomotor centre in the medulla oblongata is sufficient to ex- \nplain the normal coordination of formation and output. It has \nlately been suggested that the thyroid and suprarenal glands, \none of which is thought to be perhaps the main organ of the \nbody to provide vaso-dilating material, while the other fur- \nnishes the chief supply of vaso-constricting material, may play \nan important part, by their opposed action, in this alternate \nopening and shutting of the blood-vessels. As affording some \nsupport to this view, attention has been called to the fact that \nin the babe, which apparently has no heat governor or regula- \ntor, since its temperature varies with that of its surroundings, \nthe thyroid is but imperfectly developed, while the suprarenal \nglands have been observed to contain no vaso-constricting \nmaterial. \n\nAntipyretics which increase the loss of heat. \xe2\x80\x94 Among these \nare included all sudorifics and dilators of the cutaneous blood- \nvessels. Cold, as in the form of a cold bath, acts by direct \nabstraction of caloric. The action of salicylic acid and salicin \nin reducing temperature is probably explained by the vascular \ndilation caused and the increase in the output of heat. This \nis also now believed to be the case with drugs of the class to \nwhich acetanilide, antipyrine and phenacetine belong, so that the \ncells of the body grow and change less when removed from the \nhigh temperature to which they were previously exposed. \nSome investigators, however, regard the fall in heat formation \nas too great to be explained in this way, and infer that these \nantipyretics diminish the combustion through some other action, \nthough not by affecting the tissues directly. \n\nDrugs wJtich probably diminish the production of heat. \xe2\x80\x94 \nQuinine apparently does this by lessening the metabolism. The \n\n\n\nDRUGS ACTING ON THE BODILY HEAT. 555 \n\nantipyretic action of digitalis may perhaps be due to its causing \nan increased activity of the heat-regulating centre, as has been \nshown to be the case with picrotoxin and several other central \nnervous stimulants. The fall of temperature produced by anti- \nmony has been explained by the slowness of the circulation and \nby the general depression and profuse perspiration. The pre- \ncise manner in which aconite reduces the temperature is un- \nknown. A cold bath not only abstracts heat, but if continued \nfor a time diminishes its formation. Sometimes the removal \nof some reflex source of irritation may lower the temperature, \nand in this way purgatives occasionally act as antipyretics. \n\nTherapeutics. \xe2\x80\x94 Alcohol, spirit of nitrous ether, antimony, \nipecacuanha and opium were formerly in constant use as anti- \npyretics, but at present are not very often given to reduce fever. \nCold is more often employed, either by cold sponging, ice, or a \ncold bath. Sponging with hot water will, by the vascular dila- \ntation and subsequent sweating it induces, reduce a febrile \ntemperature. \n\nOf the drugs which are now used for this purpose, acetanilide \nand antipyrine are dangerous because of the collapse they may \nbring about, while quinine and salicylic acid are rather uncer- \ntain, except in ague and rheumatic fever respectively. Anti- \npyrine is a very prompt and certain antipyretic, and, notwith- \nstanding its dangerousness, it and phenacetine are most in de- \nmand. Phenacetine is less powerful, but quite safe, as a rule. \nAntipyretics, however, should be rarely given, as in sufficient \ndoses to reduce the temperature they may cause dangerous \ndepression. Fever is only a surface indication of the essential \npathological condition, systemic infection, and if the pyrexia is \nnot excessive, no special action is called for. When this is the \ncase the external use of cold is generally preferable, since in \naddition to its antipyretic effect, it is likely to furnish a needed \nstimulus to the nervous system and prove beneficial in other \nways. \n\nB. Drugs which cause a rise of Temperature. \xe2\x80\x94 Belladonna \nmay have this effect. The cause is not definitely known, but it \n\n\n\n55^ PHARMACOLOGY AND THERAPEUTICS. \n\nhas been attributed to direct action on the heat centres in the \nbrain. The temperature is generally increased by poisonous \ndoses of cocaine, also it is thought probable, from some disorder \nof the cerebral heat-regulating centres. Picrotoxin, like other \nconvulsive poisons, may cause a rise of temperature when given \nin poisonous amounts. \n\nTuberculin, various albumoses, and certain animal poisons, such as \nthat of shell-fish, will cause a rise of temperature. Their mode of action \nis unknown. \n\nANTIPYRETICS. \n\nACETANILIDUM.\xe2\x80\x94 Acetanilide. (Phenylacetamide. Antifebrin.) \nDose, 0.250 gm. (250 milligm.) ; 4 gr. \n\nPreparation. \nPulvis Acetanilidi Compositus. \xe2\x80\x94 Compound Acetanilide Pow- \nder. Dose, 0.500 gm. (500 milligm.) ; 7V 2 gr. \n\nAction of Acetanilide. \n\nExternal. \xe2\x80\x94 It is antiseptic, haemostatic, and slightly sedative. \n\nInternal. \xe2\x80\x94 Blood. \xe2\x80\x94 Upon the red corpuscles it has the effect \nof causing the formation of methsemoglobin, and, in larger \namounts, a disintegration of the corpuscles. The movements \nof the leucocytes are also arrested by it. The formation of \nmethsemoglobin has been found to be much more pronounced \ninside than outside the body. The actions on the blood are \ndecidedly weaker than in the case of phenol and other sim- \nilar agents, but they occasion a peculiar cyanosis, which is \nmuch more intense than that caused by the formation of the \nsame amount of methaemoglobin by other poisons. It is often \naccompanied by dyspncea and acceleration of the pulse, and \nlasts for periods ranging from a few hours to several days. \n\nHeart and Vessels. \xe2\x80\x94 The heart is at first accelerated and \nafterwards slowed, and this is attributed to the direct action \nof the drug upon the cardiac muscle. When a considerable \nreduction in temperature is caused, this also contributes largely \nto the slowing of the organ. The increased rhythm of the heart \nleads to a slight rise in the blood-pressure, but this falls as the \npulse becomes slower. \n\n\n\nANTIPYRETICS. 557 \n\nRespiration. \xe2\x80\x94 This is not usually affected by ordinary doses, \nbut under poisonous amounts it progressively fails. \n\nKidneys. \xe2\x80\x94 Acetanilide has some diuretic property. Some \nobservers consider it probable that in large doses it increases \nthe excretion of uric acid, but others state that in health it has \nno effect on the excretion of this substance. After ordinary \ndoses the urea and total nitrogen of the urine may be slightly \naugmented, and in large amounts it causes an increase in these \nof from 30 to 35 per cent., so that there is a large increase in \nthe tissue waste. Acetanilide is rapidly absorbed and rapidly \nexcreted by the kidneys. It undergoes a partial oxidation, but, \nexcept after very large doses, none of the original body appears \nin the urine. Some of it enters into combinations with sul- \nphuric and glycuronic acids, and the oxidation products often \ngive a smoky color to the urine, especially after it has been \nexposed to the air for some time. After large doses the color \nof the urine may also be darkened in consequence of the pres- \nence of methsemoglobin. After acetanilide, ferric chloride gives \na reddish-brown tinge to the urine. \n\nSkin. \xe2\x80\x94 Diaphoresis may be produced in consequence of the \nincreased cutaneous circulation, and in fever profuse sweating \nnot infrequently follows its use. Sometimes an erythematous \nrash is caused which usually resembles that of measles. Occa- \nsionally urticaria occurs, and more rarely eczema and bullae, \nwhile in some instances an oedematous swelling is observed. \nSuch skin affections, which are less frequently elicited by ace- \ntanilide than by antipyrine, may possibly be accompanied by \nsome febrile reaction. \n\nTemperature. \xe2\x80\x94 Acetanilide has little effect upon the normal \ntemperature, though it may cause a slight elevation unless the \namount administered is sufficient to produce pronounced symp- \ntoms of collapse. If the temperature is above normal, how- \never, it has a marked antipyretic effect, often reducing .it to \nbelow normal. It was at one time supposed that acetanilide and \nother drugs of- its class diminished the heat production in con- \nsequence of lessening the metabolism, in the same way as qui- \n\n\n\n55$ PHARMACOLOGY AND THERAPEUTICS. \n\nnine. It is now known, however, that such is not the case, and \nit is held that the seat of their action is the base of the cere- \nbrum. As to the modus operandi of these antipyretics, it is \nbelieved that they effect the reduction of pyrexia through alter- \nations produced in the heat-regulating mechanism which result \nin lowering the point at which the temperature is maintained. \nConsequently, a great increase in the dissipation of heat must \ntake place in order to get rid of the warmth that has accumu- \nlated in the body, and this augmented output is attained by \ndilatation of the cutaneous blood-vessels. Their principal ac- \ntion practically, therefore, is by causing an increased heat loss \nthrough this vascular effect, by reason of which a large amount \nof blood is exposed to the cold air. It has been shown experi- \nmentally that the dilatation of the cutaneous vessels is suffi- \nciently marked to be recorded by the plethysmograph in many \ninstances, while in others flushing of the skin is observed. \nThere is also a lessened heat production, but this is found to \nbe much less important, and is now generally regarded as due \nto the fact that, at the lower temperature caused, metabolism \ngoes on less actively. The decrease in metabolism is really, \nthen, an effect, and not a cause, of the fall of temperature. The \ndegree of antipyretic action produced by these drugs is thought \nto depend to a great extent on the functional activity present \nin the centres, as it is found that there is a difference in the \nsusceptibility of different fevers to the action of such agents; \nhigh continuous fevers reacting least, and those of an intermit- \ntent type being most amenable. Acetanilide, and its group, \ntherefore, possesses anti-periodic properties, and in malarial \nfever the greatest effect is always produced when the action \nfalls in the period of the natural decline of temperature. \n\nNervous System. \xe2\x80\x94 The action on the central nervous system, \naside from that on the heat-regulating centre, consists m stimu- \nlation followed by paralysis, and a narcotic, a convulsant, and \na collapse effect, which pass insensibly into each other, have \nbeen described. Its narcotic action renders acetanilide a power- \nful analgesic, although the narcosis is only slight and not at \n\n\n\nANTIPYRETICS. 559 \n\nall comparable to that of the true narcotics, since cerebral ac- \ntion may be induced by small doses which do not apparently \ninfluence the mental activity. As the influence of ordinary \ndoses upon the nerve cells appears to be very slight, it has been \nsuggested that the action may perhaps be confined to some spe- \ncial areas of the brain. The convulsions produced by large \ndoses are stated to be intermittent in character and preceded \nby increased reflex irritability. In the frog the excitability of \nthe spinal cord may lead to convulsions, but in mammals the \norigin of the convulsions is not clearly understood. In general, \nthey appear to be referable to the cerebrum, but it is thought \npossible that in some cases they may not be due to the direct \naction of the poison on the brain, but are rather asphyxial in \ncharacter and dependent upon the changes in the blood, circu- \nlation and respiration. In ordinary poisoning the peripheral \nnerves and nerve ends do not seem to be seriously involved, \nand in both frogs and mammals the final paralysis is consid- \nered to be undoubtedly central. The convulsive stage is fol- \nlowed by unconsciousness, collapse, and total paralysis. The \npulse, at first accelerated, becomes slowed, and the respiration \nis dyspnceic and then diminished. The skin is cyanotic and \ncovered with cold sweat, and sometimes there are vomiting \nand dilatation of the pupils. Symptoms of collapse are occa- \nsionally produced in susceptible persons by medicinal doses, and \nespecially if these are large, though death has been known to \noccur after only .30 gm. (5 gr.) in one instance. In this, how- \never, it is possible that the drug may have been impure. In the \nmilder cases the skin is cool and the pulse rather small and rapid, \nbut the condition soon passes off. In severe cases the skin is \ncold and covered with a clammy sweat, the heart is weak, irreg- \nular, and sometimes fluttering, and the body temperature may \nbe subnormal. The weakness of the heart is the principal source \nof anxiety, and the total failure of the circulation seems to be \nthe cause of death. These cases of collapse occur more fre- \nquently when a rapid fall of temperature has been produced \nthan under other circumstances, but may be observed in per- \n\n\n\n560 PHARMACOLOGY AND THERAPEUTICS. \n\nsons who have had no fever. The collapse sometimes appear- \ning after small doses in fever, it has been suggested, may be \ndue, not to the drug, but to the reduction of the temperature. \nIn such cases, it is claimed, there was a pre-existing collapse, \nwhich was masked by the hyperpyrexia, the effects of which \nare in certain ways antagonistic to those of collapse. When, \ntherefore, the stimulus of the high temperature is removed, the \nhidden collapse becomes apparent. Notwithstanding its insolu- \nbility, acetanilide is said to have been absorbed from wounds in \nsufficient amount to produce toxic symptoms. \n\nUntoward Action. \xe2\x80\x94 In addition to the collapse and to the \ncutaneous eruptions or the cyanosis which occasionally follow \nmedicinal doses of acetanilide, may be mentioned certain other \nuntoward effects: digestive disturbances, symptoms resembling \ncinchonism, and paroxysms of sneezing. Under prolonged use \nof the drug congestion of the liver, spleen and kidneys is said \nto occur. \n\nTherapeutics of Acetanilide. \n\nExternal. \xe2\x80\x94 Acetanilide has been used with advantage as a \ndusting powder for soft and hard venereal ulcerations, in place \nof iodoform, and in the form of an ointment (1 to 24) for \nchronic ulcers, eczema, urticaria, erysipelas, and other affec- \ntions associated with, considerable irritation. It has also been \nemployed as an antiseptic for wounds. Too large a surface, \nhowever, should not be dusted over. \n\nInternal. \xe2\x80\x94 Pyrexia. \xe2\x80\x94 Acetanilide was originally introduced as \na rival to antipyrine on account of its powerful antipyretic \naction in fever, and it is still used to some extent for the reduc- \ntion of temperature. The opinion is gaming ground, however, \nthat if the temperature is not very high no attempt should be \nmade to reduce it, as there is then no danger from this source, \nand, moreover, the theory is still held by some that fever is a \ndefensive measure taken by the organism against the causes of \ndisease. The principal objection to the use of acetanilide and \nother similar drugs is the cardiac depression which they are \nliable to induce, and hence in exhausting diseases like the con- \n\n\n\nANTIPYRETICS. 56 1 \n\ntinued fevers they may prove distinctly dangerous. By most \nphysicians of the present day, therefore, it is deemed safer, as \nwell as preferable in some other respects, to use cold baths or \nsome of the modifications of the Brand treatment whenever \nthe temperature reaches such a point that the hyperpyrexia is \ndangerous to life. If it is decided to use antipyretics acetani- \nlide will often produce a rapid reduction of temperature. The \nminimum is reached in about two hours, and the effect may \ncontinue for a considerable time. This action does not persist \nafter the drug is excreted, however, and hence the administra- \ntion must be a continuous one, although if it is given when the \nfever is just beginning to rise again, smaller doses are required \nthan at first. Of the more usual antipyretics, acetanilide pro- \nduces probably the strongest collapse effects, and it is found \nnot to keep the temperature down quite so long as some other \nremedies of its class. As it has no direct action upon the intes- \ntinal tract, it may be administered by the rectum when this \nseems desirable. \n\nAnalgesic Action. \xe2\x80\x94 Acetanilide is frequently useful in reliev- \ning the pain of neuralgia, sciatica, dysmenorrhoea, locomotor \nataxia, migraine, and various headaches. \n\nUnder the name of Antikamnia a substance has been intro- \nduced that is probably a mixture of 20 parts of sodium bicar- \nbonate, 70 of acetanilide and 10 of caffeine; which is the com- \nposition of the new official compound acetanilide powder. Since \nacetanilide is a cardiac depressant, the addition of caffeine is \nadvantageous in most instances, though a case of death has \nbeen reported which was attributed to the ingestion of 1.50 \ngm. ; 24 gr. of this mixture. Antinervine contains acetanilide, \nsodium salicylate and potassium bromide. \n\nAmmonol is a proprietary antipyretic and analgesic, claimed \nto possess unusual stimulating and expectorant properties in \nconsequence of the ammonia in its composition. It is believed \nto be merely an admixture of acetanilide, 2 parts ; sodium bicar- \nbonate, 1 ; and ammonium carbonate, 1 part ; with a minute \nquantity of the dye, metanyl-yellow. A similar mixture is in \n\n37 \n\n\n\n562 PHARMACOLOGY AND THERAPEUTICS. \n\nuse at the Philadelphia Hospital, consisting of acetanilide, 5; \nsodium bicarbonate, 3; ammonium carbonate, 2. \n\nTOXICOLOGY. \nWhen collapse symptoms are caused by acetanilide the treatment con- \nsists in stimulation, as in collapse from other causes. General stimula- \ntion is called for by alcohol and ether, given subcutaneously or by the \nmouth, or in both ways, and stimulation of the heart by the subcu- \ntaneous injection of strychnine. Oxygen inhalations may also be of \nservice, and hot applications should be made to the extremities and body. \n\nANTIPYRINE. \n\nANTIPYRINA.\xe2\x80\x94 Antipyrine. (Phenazonum, B. P. Phenyldimethyl- \npyrazolon.) Dose, 0.250 gm. (250 milligm.) ; 4 gr. \n\nUnofficial Preparations. \n\nIodopyrinum. \xe2\x80\x94 Iodopyrine. \xe2\x80\x94 (Iodantipyrine.) Dose, 0.40 to \n2 gm.; 6 to 30 gr. \n\nMigraninum. \xe2\x80\x94 Migranine. Dose, 1 gm.; 15 gr. \n\nPyramidonum. \xe2\x80\x94 Pyramidon. (Dimethyl - ami do - antipyrine.) \nDose, 0.25 to 0.50 gm.; 4 to 8 gr. \n\nSalipyrinum. \xe2\x80\x94 Salipyrine. (Antipyrin Salicylate.) Dose, 0.40 \nto 2 gm.; 6 to 30 gr. \n\nAction of Antipyrine. \nAntipyrine in small doses may moderately increase arterial \npressure by direct stimulation of the heart; in large doses it is \na cardiac depressant, the final fall of blood-pressure being cer- \ntainly due, at least in part, to a direct action upon the heart. \nIt is mildly antiseptic, and will preserve blood for some days \nwhen added to it so as to form a 2 to 5 per cent, solution. It \nis also haemostatic, having the property of coagulating proteids. \nLike acetanilide, it is somewhat diuretic, and it is excreted in \ngreat part unchanged in combination with sulphuric acid and \nperhaps with glycuronic acid. After antipyrine has been taken \nthe addition of ferric chloride to the urine gives a red color. \nIt is a local anaesthetic, but irritation has followed its hypoder- \nmatic use. It may produce an erythematous or other rash. It \n\n\n\nANTIPYRINE. 563 \n\nrapidly reduces an elevated temperature in the same way as \nacetanilide. In large doses it is said to produce convulsions; \nlater, coma and paralysis of motor nerves and muscles. \n\nTherapeutics of Antipyrine. \n\nAntipyrine is given internally as a powerful antipyretic, in \nfevers of various kinds. It is also used as a haemostatic in \nhaemorrhoids and epistaxis. It has been given with some suc- \ncess in diabetes. It is largely employed as an anti-neuralgic, \nrelieving the pains of locomotor ataxia and other nervous affec- \ntions, and as an anti-rheumatic. It has been highly recom- \nmended in chorea and epilepsy. \n\nSalipyrine is prepared by the action of antipyrine upon sali- \ncylic acid in substance. It is a white, coarsely-crystalline pow- \nder with a rather sweetish taste, readily soluble in alcohol and \nbut slightly in water. In chronic articular rheumatism and sci- \natica it may prove of service, but it does not prevent relapses. \nIt has been successfully used for spasmodic dysmenorrhcea. \n\nIodopyrine, or iodantipyrine, is supposed to have a hydrogen \natom in the phenyl group of antipyrine replaced by iodine. It \noccurs in colorless, prismatic needles, which are tasteless. It \nis with difficulty soluble in cold water or alcohol, but readily \nin hot. It causes a fall of temperature and considerable dia- \nphoresis, but it is doubtful if it has any advantage over anti- \npyrine. \n\nMigranine is a double citrate of antipyrine and caffeine which \nis stated to be efficacious in sick headache and neuralgia. \n\nPyramidon, dimethyl-amido-antipyrine, is a derivative of \nantipyrine by a substitution process, which occurs as a yellow- \nish-white crystalline powder, soluble in 10 parts of water. As \ncompared with antipyrine, with which it has the same general \naction, it is less soluble and acts with less promptness, but its \neffects are more lasting, and the same results are said to be \nproduced with about one-third the dose. As an antipyretic it \nhas been highly praised in the fever of tuberculosis, in acute \narticular rheumatism, and in typhoid fever. It is claimed that \n\n\n\n564 PHARMACOLOGY AND THERAPEUTICS. \n\nwhen properly administered it has no deleterious effect upon the \nblood or the digestion, and that it exerts a beneficial rather than \nan unfavorable action upon the heart. As an analgesic and \nanti-neuralgic it has been given with considerable success in \nthe pains of locomotor ataxia, in migraine, and in intercostal, \ntrigeminal, and other neuralgias. \n\nTOXICOLOGY. \nWhile antipyrine is somewhat less liable to such action, it occasionally \nproduces collapse effects in the same way as acetanilide. The treat- \nment of the depression caused by it is the same as in the case of the \nlatter. Antipyrine has been credited with a considerable number of \ndeaths, but it is quite likely that most of them have been due to im- \nproper dosage. \n\nACETPHENETIDIN. \n\nACETPHENETIDINTJM.\xe2\x80\x94 -Acetphenetidin. (Phenacetine.) Dose, \n0.500 gin. (500 milligm.) ; 7V2 \xc2\xa3*- \n\nAction of Acetphenetidin. \nAcetphenetidin, or phenacetine, as it has hitherto been \nknown, has no action externally nor on the gastro-intestinal \ntract, and with ordinary doses the blood is unaffected. It \nslightly depresses the heart, but does not in ordinary doses \naffect the respiration. It is a mild diuretic, and large doses \ncause the passage of altered blood. It is a powerful antipyretic, \nby increasing heat dissipation and also diminishing heat pro- \nduction to some extent. It is likewise a powerful analgesic. \n\nTherapeutics of Acetphenetidin. \n\nIt is a valuable remedy for reducing fever, and, because it \ndepresses the heart but little, it is safer than either antipyrine \nor acetanilide. It is, however, very insoluble, and slower and \nless powerful than these remedies, though its effects last longer. \nSince it possesses a very marked analgesic action, acetpheneti- \ndin is to be preferred as a remedy for the relief of pain, as in \nneuralgia, sciatica, locomotor ataxia, migraine and various \nheadaches. For this purpose, the dose of .30 gm. (5 gr.) should \n\n\n\nLACTOPHENINE. 565 \n\nbe administered every hour for three or four hours ; when relief \ngenerally results. This drug has been of service in the treat- \nment of epilepsy. \n\nTOXICOLOGY. \nSymptoms. \xe2\x80\x94 Acetphenetidin sometimes produces severe vomiting, \nsweating, feeble and rapid pulse, and collapse. Treatment. \xe2\x80\x94 Alcoholic \nstimulation. Strychnine hypodermatically. External warmth. \n\nEXALGIN. \n\nUnofficial Preparation. \nExalginum. \xe2\x80\x94 Exalgin. (Methyl Acetanilide.) Dose, 0.03 to \n0.20 gm.; y 2 to 3 gr. \n\nAction of Exalgix. \nIt has the general action of the antipyretics. In medicinal \ndoses it rarely causes depression, but large amounts, since they \nare capable of causing disintegration of the red blood-corpus- \ncles, may prove dangerous. \n\nTherapeutics of Exalgix. \nExalgin is an excellent analgesic, and not infrequently gives \nrelief when various other drugs have failed. It may be advan- \ntageously dissolved in Tinctura Aurantii Dulcis, but is often \ngiven in pill or tablet form. It is used for migraine., sciatica, \nthe pains of rheumatism, and, of late, for chorea. \n\nTOXICOLOGY. \n\nSeveral severe cases of poisoning having been reported, the usual dose \nshould not be exceeded. The symptoms are similar to those of ace- \ntanilide. \n\nTreatment. \xe2\x80\x94 As for acetanilide. {See p. 562.) \n\nLACTOPHENINE. \n\nUnofficial Preparation. \nLactopheninum. \xe2\x80\x94 Lactophenine. (Lactylparaphenetidin.) \n\nDose, 0.60 to 1 gm.; 10 to 15 gr. \n\n\n\n566 PHARMACOLOGY AND THERAPEUTICS. \n\nAction of Lactophenine. \n\nLactophenine is an analgesic and antithermic. It is usually \nbetter borne than antipyrine. Although it may, in some in- \nstances, give rise to sweating, it does not cause collapse nor \ncyanosis. It produces a considerable and persistent lowering \nof a febrile temperature, but without abundant perspiration, and \nits use is not followed by chilly sensations. \n\nTherapeutics of Lactophenine. \n\nIt has been administered in articular rheumatism, influenza, \nscarlet fever, septicaemia and other infectious diseases. Excel- \nlent results have been reported from it in typhoid fever, with \ndaily doses from 0.50 to 1 gm. (7 to 15 gr.), not only in reduc- \ning the fever, but as a sedative when delirium becomes a promi- \nnent symptom. \n\nPHENOCOLL HYDROCHLORIDE. \n\nUnofficial Preparation. \nPhenocolli Hydrochloridum. \xe2\x80\x94 Phenocoll Hydrochloride. Dose, \n0.30 to 2 gm.; 5 to 30 gr. \n\nAction of Phenocoll Hydrochloride. \n\nIt is not poisonous to animals, nor does it injuriously affect \nthe blood. It is a fairly powerful antipyretic, not followed by \ncollapse or cyanosis; the perspiration is not more marked than \nafter large doses of antipyrine. It is rapidly excreted by the \nurine, to which it gives a brownish color, and it probably in- \ncreases the excretion of uric acid. \n\nTherapeutics of Phenocoll Hydrochloride. \nIn addition to its use as an antipyretic it has been employed \nas an antineuralgic, while in severe acute articular rheumatism \nit has exercised a beneficial action upon the joints when other \nremedies have failed. The reports, of which there are now a \nconsiderable number, are favorable to this remedy. \n\n\n\nDRUGS ACTING ON THE RESPIRATION. 567 \n\nUnofficial Preparation. \nThallinae Sulphas.\xe2\x80\x94 Thalline Sulphate. Dose, 0.12 to 0.60 \ngin.; 2 to 10 gr. \n\nAction of Thalline Sulphate. \nThis drug was introduced into medicine as an antipyretic, \nbut it was soon abandoned because of the dangerous collapse, \nwith marked cyanosis, which it produced. It is rarely given \ninternally, because it is poisonous to the red blood-corpuscles \nand to the nervous system. \n\nTherapeutics of Thalline Sulphate. \nIts chief use is as an injection for gonorrhoea, in aqueous \nsolution ( 1 or 2 to 120), or it can be used in a 2 per cent, \nsolution in gelatin bougies. In gleet beneficial results have \nfollowed the injection of 1 to 8 aqueous solutions. \n\n\n\nDivision VIII. \xe2\x80\x94 Drugs Acting on the Respiration. \n\nThe influences affecting the respiration are so numerous and \nvaried that it is not always easy to determine the precise mode \nof action of any drug which produces an impression upon it. \nThus, the respiratory centre in the medulla (which is subject \nto direct or reflex influences from almost all the organs of the \nbody), the movements of the respiratory muscles, or the circu- \nlatory mechanism influencing the respiration may be acted \nupon; or, again, alterations produced in the blood or in the air \nrespired may affect the function. In therapeutics, however, the \nobject is generally to remove the cause of or alleviate respira- \ntory difficulty, rather than act upon the respiration itself. \nDrugs which produce changes in the blood and circulation have \nalready been considered, while for the consideration of such \nmodifications of the temperature, moisture and atmospheric \npressure as are of service reference must be made to works on \ngeneral therapeutics. Therefore, the respiratory drugs will \nnow be treated of under the following heads : \n\n\n\n568 PHARMACOLOGY AND THERAPEUTICS. \n\nA. Drugs altering the Composition of the Air inhaled. \xe2\x80\x94 In \n\nthis come drugs which, when inhaled, have some direct effect \non the respiratory mucous membrane, or the bronchial and \npulmonary contents, and may also have remote effects. Certain \ndrugs, although they are not employed for their effects on the \nrespiration, are most conveniently administered by inhalation; \ne. g., anaesthetics and amyl nitrite. \n\nSome drugs when inhaled produce very marked irritation of \nthe bronchial mucous membrane, thus giving rise to vascular \ndilatation and augmented secretion, and reflexly causing cough \nfrom stimulation of the sensory nerves of the part. \n\nSuch are iodine, bromine, chlorine, senega, ipecacuanha, sulphurous \nanhydride, nitric acid fumes, ammonia, and tobacco, as well as cold \ndry air. These are rarely used therapeutically as inhalations, and their \ninhalation is to be particularly avoided in irritable conditions of the \nbronchi. \n\nThe drugs which, when inhaled, are soothing to the bron- \nchial mucous membrane, but are rarely employed, are \xe2\x80\x94 \n\nHydrocyanic acid. Conium. \n\nInhalations which are used to stimulate the bronchi, that is \nto say, to increase their vascularity, secretion, and muscular \npower, are \xe2\x80\x94 \n\n\n\n(i) Phenol 1 1.20C.C. (4) Tincturaben- \n\n(2) Oil of cajuput I (20 TTt ) . zoini composita, \n\n(3) Oleum pini sylvestris, 2 c.c. (5) Creosote, \n\n(30 TTL). (6) Oil of cubeb. \n\n\n\n15 c.c. (fl 3 SS )- \n\n\n\nThe amounts given after each are the quantities that should be added \nto 500 c.c. (1 pint) of water at 6o\xc2\xb0 C. (140 F.). \n\nInhalations which are used to disinfect foul secretions from \nthe bronchial mucous membrane are those of \xe2\x80\x94 \n\n\n\n(1) Creosote. \n\n(2) Iodoform. \n\n(3) Mild solutions of benzoin. \n\n(4) Phenol. \n\n\n\n(5) Sulphurous anhydride. \n\n(6) Oil of juniper. \n\n(7) Oil of cubeb. \n\n(8) Oil of eucalyptus. \n\n\n\nDRUGS ACTING ON THE RESPIRATION. \n\n\n\n569 \n\n\n\nInhalations for relieving spasm of the bronchial tubes are \nthose of \xe2\x80\x94 \n\n\n\n(1) Conium. \n\n(2) Stramonium. \n\n(3) Chloroform. \n\n\n\n(4) Ether. \n\n(5) Amyl nitrite. \n\n\n\nB. Drugs acting on the Respiratory Centre. \xe2\x80\x94 If, when in- \njected into the carotid artery, a drug produces a very prompt \neffect on respiration, it is concluded that it acts on the respira- \ntory centre. In order to determine whether the drug acts on \nthe centre, or on the vagal terminations in the lung, it is cus- \ntomary to divide the vagi and then observe whether it acts in \nthe same way after, as before, the section. \n\nDrugs which directly stimulate the respiratory centre are \xe2\x80\x94 \n\n\n\n(1) Strychnine. \n\n(2) Ammonia (very power- \n\nful). \n\n(3) Apomorphine. \n\n\n\n(4) Belladonna. \n\n(5) Stramonium. \n\n(6) Hyoscyamus. \n\n\n\nDrugs which depress the respiratory centre are \xe2\x80\x94 \n\n\n\n(1) Physostigmine (very \n\n\n(9) Aconite. \n\n\npowerful). \n\n\n(10) Veratrine. \n\n\n(2) Hydrated chloral. \n\n\n(11) Conium. \n\n\n(3) Chloroform. \n\n\n(12) Caffeine. \n\n\n(4) Ether. \n\n\n(13) Quinine. \n\n\n(5) Alcohol. \n\n\n(14) Ipecacuanha. \n\n\n(6) Opium. \n\n\n(15) Antimony salts (very \n\n\n(7) Hydrocyanic acid. \n\n\nweak). \n\n\n(8) Codeine. \n\n\n\n\n\nAlcohol, ether, chloroform, caffeine, and quinine slightly excite, be- \nfore they depress, the respiratory centre. \n\nTherapeutics. \xe2\x80\x94 Drugs exciting the respiratory centre may be \ngiven when there is any difficulty in respiration for the purpose \nof increasing the force of the respiratory act; at the same time \nmeasures should be employed to remove the cause of the diffi- \n\n\n\n5/0 PHARMACOLOGY AND THERAPEUTICS. \n\nculty. They are, naturally, most frequently required in respir- \natory diseases, and especially bronchitis. Ammonia and apo- \nmorphine are very frequently prescribed for the reason that \nthey are also powerful expectorants, and belladonna is applica- \nble in cases with excessive bronchial secretion. \n\nDrugs which depress the respiratory centre are very seldom \nrequired for this action; but the centre for the reflex act of \ncoughing is in the immediate vicinity of the respiratory centre, \nand opium, morphine, codeine, heroine, hydrocyanic acid, co- \nnium, and ipecacuanha are often very valuable in allaying the \ncontinual hacking cough frequently accompanying disease of \nthe heart and lungs. \n\nThe drugs which relieve cough are very numerous, since this \nmay be reflexly set up by irritation of so many peripheral parts, \nviz., nose, throat, pharynx, ear, teeth, larynx, trachea, bronchi, \nlungs, pleura, stomach, and liver; and consequently its success- \nful treatment may depend upon the removal of peripheral irri- \ntation in any of them. \n\nC. Drugs affecting the Bronchial Secretion. \n\n(a) Those increasing it: \n\n\n\n(i) Apomorphine. \n\n\n\n\n\n\n(9) Camphor. \n\n\n(2) All alkalies, \n\n\nespecially \n\n\nam- \n\n\n(10) Benzoin. \n\n\nmonium carbonate \n\n\nand \n\n\n(11) Balsam of Peru. \n\n\nother ammonium salts. \n\n\n\n\n(12) Balsam of Tolu. \n\n\n(3) Cocillana. \n\n\n\n\n\n\n(13) Antimony salts. \n\n\n(4) Ipecacuanha. \n\n\n\n\n\n\n(14) Sulphur. \n\n\n(5) Senega. \n\n\n\n\n\n\n(15) Iodine. \n\n\n(6) Squill. \n\n\n\n\n\n\n(16) Tobacco. \n\n\n(7) Turpentine. \n\n\n\n\n\n\n(17) Pilocarpus. \n\n\n(8) Terebene. \n\n\n\n\n\n\n(18) Many volatile oils \n\n\n\nIt is probable that volatile oils and substances containing them de- \ncrease the amount of bronchial secretion as a later effect. \n\n(b) Those decreasing it: \n\n(1) Acids. (3) Stramonium. \n\n(2) Belladonna. (4) Hyoscyamus. \n\n\n\nDRUGS ACTING ON THE RESPIRATION. 57 1 \n\nMany authorities believe that under some circumstances alkalies de- \ncrease the secretion. \n\n(c) Those disinfecting it: \xe2\x80\x94 Drugs which, when inhaled, act in this \nway have already been mentioned. Copaiba, cubeb, eucalyptus, and \nmany volatile oils are excreted partly by the bronchial mucous mem- \nbrane, and thus will disinfect the secretion. \n\nTherapeutics. \xe2\x80\x94 In bronchitis, remedies which increase the \nsecretion are used when the latter is so viscid that it adheres \nto the tubes and cannot be coughed up; and those which de- \ncrease it are employed when it is too watery to be easily expec- \ntorated. The use of the disinfectants is obvious. \n\nD. Drugs relaxing Spasm of the Muscular Coat of the Bron- \nchial Tubes, or Antispasmodics. \xe2\x80\x94 It is believed that the symp- \ntom asthma is due to a spasmodic contraction of the bronchial \ntubes, and as \xe2\x80\x94 \n\n\n\n(1) Stramonium \n\n(2) Belladonna \n\n(3) Hyoscyamus \n\n\n\n(4) G-rindelia \n\n(5) Aspidosperma \n\n\n\nrelieve this symptom, it is concluded that these drugs relax \nspasm of the muscular coat of the bronchial tubes. Stramo- \nnium is the most powerful. From their analogous action in \nother parts of the body, it is probable that the following drugs \nact in the same way: \n\nChloroform, ether, opium, hydrated chloral, cannabis indica, amyl \nnitrite, and conium. \n\nTherapeutics. \xe2\x80\x94 Stramonium is of great use for relief of the \nsymptom asthma, and this and the other drugs may be employed \nfor cases of bronchitis in which spasm of the tubes seems to \nresult from the inflammation present. Many of these muscu- \nlar depressants in all probability depress the nerves at the same \ntime. \n\nE. Drugs acting on the Vessels of the Bronchi. \xe2\x80\x94 These are \nthe same as have been already described (p. 324) as acting on \nthe vascular system generally. \n\n\n\n57 2 PHARMACOLOGY AND THERAPEUTICS. \n\nF. Expectorants. \xe2\x80\x94 On account of the complexity of the \nmodes of action of drugs affecting the respiratory system, it is \ncustomary to regard most of them clinically: simply as drugs \nwhich hinder or aid the expectoration of the contents of the \nbronchial tubes. Those which aid it are divided into two \ngroups, named after their action, not on the lungs, but on the \ncirculation. \n\ni. Stimulating expectorants. \xe2\x80\x94 These are stimulants to the circulation \ngenerally. They are \xe2\x80\x94 \n\n\n\n(i) Acids. \n\n\n(9) Balsam of Peru. \n\n\n(2) Ammonium salts. \n\n\n(10) Turpentine preparations \n\n\n(3) Cocillana. \n\n\n(n) Terebene. \n\n\n(4) Senega. \n\n\n(12) Oleum Pini Sylvestris. \n\n\n(5) Squill. \n\n\n(13) Nux Vomica. \n\n\n(6) Benzoin. \n\n\n(14) Sulphur. \n\n\n(7) Benzoic acid. \n\n\n(15) Quillaja. \n\n\n(8) Balsam of Tolu. \n\n\n\n\n\n2. Depressing expectorants. \xe2\x80\x94 These depress the general circulation. \nThey are \xe2\x80\x94 \n\n\n\n(1) Alkalies. \n\n(2) Antimony salts. \n\n(3) Ipecacuanha. \n\n(4) Lobelia. \n\n\n\n(5) Pilocarpus. \n\n(6) Apomorphine. \n\n(7) Potassium iodide. \n\n\n\nTherapeutics. \xe2\x80\x94 It is almost impossible to lay down any gen- \neral directions. In any case before us we must consider the \nacuteness or the reverse of the disease and whether we wish \nto stimulate or to depress the circulation, to increase, to \ndiminish or to disinfect the expectoration, to stimulate the \nrespiratory centre, to overcome spasm of the bronchial tubes, \nor to allay a hacking cough; and then employ such remedy or \ncombination of remedies as seems best to meet the indications \npresent. Warmth to the chest and warm drinks are sedative, \nand increase the amount of secretion, while cold and cold drinks \nhave an opposite effect. \n\n\n\nHYDROCYANIC ACID. 573 \n\nG. Drugs which in Man sometimes produce Cheyne- Stokes \nBreathing. \xe2\x80\x94 These are morphine, potassium bromide, and \nhydrated chloral. In animals the following, in addition, may do \nit: picrotoxin, muscarine, digitalin, strychnine and ammonium \ncarbonate. \n\nB. Drugs Acting on the Respiratory Centre. \nHYDROCYANIC ACID. \n\nPOTASSII FERROCYANIDUM.\xe2\x80\x94 Potassium Ferrocyanide. (Yel- \nlow Prussiate of Potash.) Dose, 0.500 gm. (500 milligm.) ; 7V 2 gr. \n\nPOTASSII CYANIDUM.\xe2\x80\x94 Potassium Cyanide. Dose, 0.010 gm. \n(10 milligm.) ; y 5 gr. \n\nPreparation. \nAcidum Hydrocyanicum Dilutum. \xe2\x80\x94 Diluted Hydrocyanic \nAcid. (Prussic Acid.) Dose, 0.1 c.c; iy 2 "HI- \n\nAction of Potassium Cyanide and Diluted Hydrocyanic \n\nAcid. \n\nExternal. \xe2\x80\x94 Hydrocyanic acid is a violent protoplasmic poi- \nson, and is toxic to all forms of life. It inhibits fermentation \nand putrefaction, and retards the growth of plants and the \nmovement of animal cells. The diluted acid, when applied to \nthe unbroken skin, is at first slightly irritating, but, as it \npenetrates the epidermis, it soon causes paralysis of the sensory \nnerve-endings, and thus has a sedative and anaesthetic effect. \nFrom raw surfaces it is very rapidly absorbed, and toxic effects \nmay result from this absorption. Potassium cyanide may pos- \nsibly give the same results. It also produces a dermatitis on \nlocal application to the epidermis. \n\nInternal. Alimentary Tract. \xe2\x80\x94 Hydrocyanic acid is quickly, \nand potassium cyanide less rapidly, absorbed by mucous mem- \nbranes, and on the fauces, oesophagus and stomach the same \nsedative and anaesthetic effects are produced as upon the skin. \n\nBlood. \xe2\x80\x94 Under the influence of hydrocyanic acid the tissues \nare unable to absorb the oxygen brought to them by the blood \ncells; in consequence, the oxyhaemoglobin of the blood is not \n\n\n\n574 PHARMACOLOGY AND THERAPEUTICS. \n\nreduced in the capillaries, and the venous blood, therefore, has \nthe same bright red color as the arterial. Lactic acid and sugar, \nwhich are always present when the oxidation of the tissues is \nimperfect, are found in the blood in unusually large quantities \nduring the action of hydrocyanic acid. In the body the acid \ndoes not enter into any combination with the haemoglobin of \nthe red corpuscles. Blood to which it has been added retains \nits red color much longer than ordinary blood, and it is \nthought by some observers that the reason for this is that the \nacid destroys some oxidizing substance or ferment in the blood. \nWhenever hydrocyanic acid and methaemoglobin come in con- \ntact, a combination is formed (cyanomethsemoglobin) which is \ndistingushed from ordinary methsemoglobin by having a bright \nred color; and in cases of cyanide poisoning the dependent \nparts of the body are often found to present such a tinge in \nconsequence of this action on the methsemoglobin which they \ncontain after death. The blackness of the blood which is \nobserved in the internal organs is believed to be simply the \nresult of the rapid death, such as is met with after any sudden \ndeath in well-nourished persons; the tissues being still alive \nafter the stoppage of the circulation, and using up all the \noxygen contained in the blood. \n\nHeart and Circulation. \xe2\x80\x94 The circulation is altered mainly \nthrough the action on the central nervous system, but the drug \nalso acts directly on the heart. The pulse is apt to be slowed \nfrom the primary stimulation of the inhibitory centres, while \nthe increased activity of the vaso-constrictor centres occasions \na very considerable rise in blood-pressure. This central stimu- \nlation is succeeded by paralysis, in consequence of which the \nblood-pressure falls very low, but the movements of the heart \ngenerally remain slow, notwithstanding the cessation of the \ninhibitory stimulation, since the cardiac muscle is now directly \naffected by the depressing action of the drug. It is found that \nif very large quantities are injected intravenously or inhaled, \nthe heart may cease contracting for a few seconds, and then \nrecommence a slow and feeble beat, which is quickly arrested \n\n\n\nHYDROCYANIC ACID. 575 \n\nagain. This is thought to be due to primary action on the \ninhibitory centre, followed by direct paralysis of the heart. \n\nRespiration. \xe2\x80\x94 The respiratory changes are caused by primary \nstimulation and subsequent paralysis of the medullary centre. \nAfter very large quantities the respiration may cease within \na few seconds. Under the use of smaller doses it is rendered \nquicker and deeper at first. It then becomes irregular, subse- \nquently grows very slow and deep, and finally ceases. \n\nNervous System and Muscles. \xe2\x80\x94 The central nervous system \nis primarily stimulated and then depressed and paralyzed, and \nthe medulla oblongata and lower portions of the brain are \nat first much more profoundly affected than the cerebral cortex, \nalthough the final paralysis apparently includes all parts of \nthe central axis. When the drug is given in doses small enough \nto permit of watching its action, it is found that this com- \nmences in the medulla, where the vaso-motor, respiratory, \nvagus, vomiting and pupil-dilator centres are all stimulated. \nThen unconsciousness results, and after this convulsions, which \nin man are believed to be chiefly medullary in origin. Finally, \nparalysis of the whole central nervous system ensues, and in- \nvoluntary evacuations of faeces, urine and semen are frequently \nobserved. During the convulsions, which are rare in man but \ncommon in animals, there is generally a temporary rise in \nblood-pressure, and the respiration is naturally very irregular. \nDeath is due to arrest of the respiratory function, the heart \ncontinuing to beat for a short time. The phenomena of the \naction of hydrocyanic acid on the central nervous system, it will \nbe seen, are very much like those of asphyxia, and it is regarded \nas probable that the latter plays an important part in their \nproduction, though the rapidity of their development indicates \nthat they cannot be attributed entirely to asphyxia. The peri- \npheral nerves and muscles, when suspended in an atmosphere \nof hydrocyanic acid, are weakened and eventually paralyzed; \nbut in the living animal, unless large amounts of the drug are \ninjected, are found to be not much affected. \n\nExcretion. \xe2\x80\x94 Hydrocyanic acid is rapidly decomposed in the \n\n\n\n57^ PHARMACOLOGY AND THERAPEUTICS. \n\nbody. Part of it combines with sulphur-containing molecules \nto form sulphocyanides, and is excreted as such in the urine, \nwhile part undergoes further changes which are as yet un- \nknown. \n\nTherapeutics of Potassium Cyanide and Diluted Hydro- \ncyanic Acid. \n\nExternal. \xe2\x80\x94 Hydrocyanic acid is a valuable antipruritic. The \nofficial preparation should always be well diluted, and lotions \nof a strength of about 1 to 48 may be applied, to allay itching \nfrom almost any cause. They should not be employed in any \ncase where the skin is broken. \n\nInternal. \xe2\x80\x94 Hydrocyanic acid may be administered as the \nofficial diluted acid, oil of bitter almond (3 to 14 per cent, of \nacid), bitter almond water, cherry laurel water (B. P.), the \nfluidextract, infusion and syrup of wild cherry, and as potas- \nsium cyanide. Reference should be made to each of these. In \nsmall doses the diluted acid, on account of its sedative and an- \naesthetic effect, is often useful in relieving vomiting or gastric \npain, and in many instances it may be administered most ac- \nceptably in an effervescing draught. Since the effect of the \nremedy is transient, it should be given at frequent intervals. \nEnteralgia also not infrequently yields promptly to hydrocyanic \nacid. It is sometimes employed with advantage to allay cere- \nbral irritation and excitement. The giddiness of Meniere\'s \ndisease (auditory nerve vertigo) is sometimes benefited by \nit, and it may prove useful in relieving the nervous palpita- \ntion met with in some cases of organic disease of the heart \nand also attacks of palpitation occurring as a symptom of \na nervous condition in patients not affected with cardiac \ndisease. It has been given in whooping-cough, and is very \nserviceable for the nervous cough of mothers which is not \nuncommonly observed in those whose children are suffering \nfrom this disease. It is used to a considerable extent as an \ningredient of cough mixtures, on account of its effect in dimin- \nishing reflex excitability by reason of its depressing action on \n\n\n\nHYDROCYANIC ACID. 577 \n\nthe central nervous system, and is especially valuable where \nthere is a dry, hacking cough, without expectoration. Inhala- \ntions of a solution containing about .20 c.c. (3 Til) of diluted \nhydrocyanic acid to 250 c.c. (8 fl. oz.) of water, at a tempera- \nture of 48. 8\xc2\xb0 C. (120 F.), are sometimes given with benefit in \nasthma and the irritative cough of phthisis. The uses of potas- \nsium cyanide are similar to those of hydrocyanic acid. \n\nTOXICOLOGY. \n\nThe great danger from hydrocyanic acid is the rapidity of its action, \nfor the lethal dose of the pure acid in man (probably about .06 to .09 \ngm. (1 to i l / 2 gr.)) is much larger than that of some of the poi- \nsonous alkaloids. After large doses in mammals there may be prac- \ntically no symptoms. The animal falls to the ground with a slight \nconvulsive movement or a scream, and death results in a few seconds \nfrom arrest of the respiration and heart. One drop of the pure acid, \nhowever, when placed inside the eye of even moderately large animals, \nhas been known to destroy life instantly. In man the symptoms usually \ncommence in a few seconds after taking a large dose of hydrocyanic \nacid. The patient falls insensible, and the eyes will be found fixed, \nglassy, and with dilated pupils, the limbs relaxed, the skin cold and \nclammy, the pulse so small as to be scarcely perceptible, and the res- \npiration slow, deep, and convulsive. Death takes place, as has been \nmentioned, from respiratory failure. When the poisonous quantity \ntaken is smaller, there is at first an acrid, burning taste, which is ac- \ncompanied by increased salivary secretion and followed by numbness \nof the mouth and throat. In the stomach there is a feeling of warmth, \nfollowed by nausea and vomiting. Other symptoms are headache, con- \nfusion, dyspnoea, slowness of the pulse, and great prostration, while \nthe pupils are widely dilated and the eyeballs protrude. Soon uncon- \nsciousness supervenes, with or without convulsions, and then general \nparalysis, with involuntary defecation and micturition. \n\nPost-mortem. \xe2\x80\x94 The characteristic odor of hydrocyanic acid is gen- \nerally perceptible. The body is livid and the blood very dark. The \nheart is soft and flaccid and there is generally considerable congestion \nof the gastric mucous membrane. Post-mortem rigidity sets in very \nearly, and the teeth are clinched, the fingers tightly closed, the toes \nstrongly flexed, and the eyes prominent and staring. \n\nTreatment. \xe2\x80\x94 In cases of poisoning by hydrocyanic acid the fatal re- \nsult is usually produced so rapidly that the physician rarely has the \n\n38 \n\n\n\n57$ PHARMACOLOGY AND THERAPEUTICS. \n\nopportunity of interfering. If life is not already extinct, the utmost \npromptitude is called for. The stomach should be washed out imme- \ndiately, or vomiting should be induced by inserting the finger into \nthe throat. Should this prove ineffectual, large doses of emetics must \nbe given, as every moment is precious, and it is found that recovery \nis rapid when it has once set in. Atropine has been proposed as an \nantidote, but there is no reason to suppose that it will prove of ser- \nvice, since it has been shown that it is of no benefit in experiments on \nanimals. The real element of danger is the stoppage of the heart, for \nalthough the respiration fails before this, respiratory paralysis can \nalways be more or less successfully counteracted by artificial respiration, \nwhich is usually called for in poisoning by this drug. General stimu- \nlants, such as brandy or ether, given subcutaneously, are indicated, \nand ammonia, by inhalation, and caffeine may also be of service. Cold \naffusions, or alternately hot and cold, may be of assistance. Cobalt chlo- \nride, which has proved valuable in a considerable number of instances, is \nbelieved by some to be the best chemical antagonist. A thirty per cent, \nsolution of hydrogen dioxide may be employed to wash out the \nstomach. Intravenous injections of sodium thiosulphate (producing \ntheoretically the relatively harmless sulphocyanide) enable animals to \nsurvive an otherwise lethal dose. The following results of experiments \nrecently made in Australia are of great interest and value: i to 100,000 \nof potassium cyanide produced in rabbits, within seven minutes, stag- \ngering gait and very rapid respirations, followed shortly by labored \nbreathing. Convulsions of varying intensity always occurred, and at \ntimes appeared within three minutes after introduction of the drug. \nExhaustion followed the spasms, respiration became shallower and \nshallower, and the animals died. Hydrogen dioxide, when used sub- \ncutaneously, as recommended, in 3 per cent, solution was immediately \nbroken up, and its effects were nil. A similar result followed its ad- \nministration by the stomach, even when the poison and the supposed \nantidote were introduced mixed. While hydrogen dioxide does oxidize \ncyanides, its action was found to be too slow to be of therapeutic value. \nTwenty-six experiments with cobalt chloride pointed to the fact that \nthis salt is capable of forming an insoluble cyanide, but that for this \npurpose it must be given in excess. The acid of the gastric juice does \nnot interfere with the reaction. Cobalt chloride itself, however, is not \nfree from poisonous action, producing severe gastro-enteric symptoms. \nThese should be carefully guarded against. Ferrous hydrate, when added \nto a cyanide salt forms a ferrocyanide almost instantaneously. This is \nbut slightly poisonous, and its administration would seem to be even \nbetter than the cobalt, in view of the toxic action of the latter. Un- \n\n\n\nWILD CHERRY. 579 \n\nfortunately, however, the strongly acid contents of the stomach con- \ntents greatly hinder the action of the ferrous hydrate, and hence alkalies \nmust be added to neutralize the free hydrochloric acid. Magnesium \noxide is the best for this purpose. Another drawback is that the ferro- \ncyanides are kept in solution with difficulty. As the result of their \ninvestigations the experimenters recommend the following treatment : \nHave in readiness in places where cases of cyanide poisoning are likely \nto occur the following: 30 c.c. (1 fl. oz.) of a 23 per cent, solution of \nferrous sulphate; 30 c.c. ( 1 fl. oz.) of a 5 per cent, solution of caustic \npotash; 1.80 gm. (30 gr.) of powdered magnesium oxide; a metal re- \nceptacle of 500 c.c. (1 pint) capacity; a stomach-tube. The first two \nsolutions should be kept in air-tight tubes, which can be broken into \nthe receptacle. When a case of poisoning occurs this is to be done, \nthe powdered magnesia and 250 c.c. (^ pint) of water added, and the \nmixture shaken up and administered. This amount of antidote, it is \nstated, will take care of 6.50 gm. (75 gr.) of potassium cyanide. As \ncyanide poisoning has become not infrequent among the Australian \nminers since the introduction of the cyanides in the extraction of gold, \nit is advised that the antidote be kept in all mines where such processes \nare employed, in readiness for instant use, since time is the most im- \nportant factor in securing a successful result. \n\nWILD CHERRY. \nPRUNUS VIRGINIANA.\xe2\x80\x94 Wild Cherry. Dose, 2 gm.; 30 gr. \n\nPreparations. \n\n1. Fluidextractum Pruni Virginianse. \xe2\x80\x94 Fluidextract of Wild \nCherry. Dose, 2 C.C.; 30 Tl\\.- \n\n2. Infusum Pruni Virginianse. \xe2\x80\x94 Infusion of Wild Cherry. \nDose, 60 c.c.; 2 fl. oz. \n\n3. Syrupus Pruni Virginianse. \xe2\x80\x94 Syrup of Wild Cherry. Dose, \n4 c.c.; 1 fl. dr. \n\nAction of Wild Cherry. \nWild cherry is an aromatic bitter tonic. As hydrocyanic \nacid is yielded when it is treated with water, its preparations \npossess more or less of the sedative action of that agent, and \nvery large doses have a depressing influence upon the heart. \nIn common with the apple and some other fruit trees, the root- \nbark contains a glucoside, phloridzin, which has the effect of \n\n\n\n58O PHARMACOLOGY AND THERAPEUTICS. \n\nproducing glycosuria. This differs from the glycosuria met \nwith in the disease diabetes mellitus in that the sugar of the \nblood is not augmented. Hence, it has been pointed out, it is \nnot attributable to any change in the general metabolism, but \nno doubt to some alteration of the renal epithelium, in conse- \nquence of which the blood sugar escapes into the urine, instead \nof being retained in the system and used as a source of energy. \n\nTherapeutics of Wild Cherry. \nIt is highly esteemed as a stomachic tonic, and the infusion \nis used in atonic dyspepsia and chronic gastric catarrh, as well \nas in convalescence from acute diseases and\' other debilitated \nstates of the system. The preparations of wild cherry have \nthe same effect as hydrocyanic acid in relieving cough, by \ndiminishing reflex excitability. The drug is sometimes a use- \nful palliative in phthisis, where it may serve not only to alle- \nviate the irritative cough, but also as a remedy for cardiac \npalpitation and gastric debility. The syrup is very largely \nemployed as an ingredient of cough mixtures in\' general. Used \nas a vehicle for tincture of digitalis, it renders the latter less \nlikely to produce gastric disturbance. \n\nCHERRY LAUREL. \n\nLAUROCERASI FOLIA.\xe2\x80\x94 Cherry Laurel Leaves (B. P., not offi- \ncial). \n\nUnofficial Preparation. \nAqua Laurocerasi.\xe2\x80\x94 Cherry Laurel Water. Dose, 2.0 to 8.00 \nc.c; y 2 to 2 fl. dr. \n\nAction of Cherry Laurel. \nIts action is the same as that of diluted hydrocyanic acid. \n\nTherapeutics of Cherry Laurel. \nAqua Laurocerasi, B. P., is made by distillation and stand- \nardized so that its strength is 0.1 per cent, of absolute hydro- \ncyanic acid ; dose, 2 to 8 c.c.. ; ^ to 2 fl, dr. Owing to evapora- \n\n\n\nAPOMORPHINE. 58 1 \n\ntion, it is of very varying strength, and as it cannot therefore \nbe depended upon, and the inequality of its effects may possibly \nlead to disastrous results, it is but rarely employed, except it \nmay be merely as a flavoring agent. As any virtues which it \nmay possess are due entirely to the hydrocyanic acid contained \nin it, it is preferable to use in its stead a definite solution of \nthis acid or of oil of bitter almonds. \n\nC. Drugs Affecting the Bronchial Secretion. \nAPOMORPHINE. \n\nAPOMORPHINE HYDROCHLORIDUM.\xe2\x80\x94 Apomorphine Hydro- \nchloride. Dose (expectorant), 0.002 gm. (2 milligm.) ; -\xc2\xa3 gr.; \n(emetic), 0.005 gm. (5 milligm.); T ^ gr. \n\nUnofficial Preparation. \nApocodeina. \xe2\x80\x94 Apocodeine. Dose, 15 to 20 gm.; y 4 to y 3 gr., \n\nhypodermatically. \n\nAction of Apomorphine Hydrochloride. \n\nExternal. \xe2\x80\x94 Apomorphine is said to have some anaesthetic \neffects on the cornea when a solution is dropped upon it. \n\nInternal. G astro -intestinal Tract. \xe2\x80\x94 Apomorphine is the \nmost powerful emetic known. It is an indirect emetic, because \nits action is on the vomiting centre in the medulla, and not a \nlocal one on the stomach. This is apparent from the fact that \nvomiting is produced more promptly, and with a smaller dose, \nif the drug is administered hypodermatically than when it is \ngiven by the mouth. It is shown even more positively by the \nfact that when injected subcutaneously it acts if the blood- \nvessels are ligatured in such a way that none of it can reach \nthe stomach, while it does not act if they are so tied that none \ncan reach the medulla. Moreover, no emesis is produced if \napomorphine is placed in the stomach after the vessels supply- \ning that organ have been ligatured. Still again, if the medulla \nbe brushed with apomorphine solution, vomiting follows imme- \ndiately. The act of vomiting is preceded by nausea, and it is \n\n\n\n582 PHARMACOLOGY AND THERAPEUTICS. \n\nfound that symptoms of nausea may be elicited by doses of the \ndrug too small to give rise to vomiting. Under the ordinary \nhypodermatic dose the latter usually occurs in man inside of \nfifteen minutes. The nausea generally disappears rapidly, but \noccasionally persists for some time and may be accompanied \nby a repetition of the vomiting. Collapse has been known to \noccur, but this is simply a result of the vomiting and not a \ndirect effect, and it is not usually dangerous. In frogs no \nemesis is induced by apomorphine. \n\nMuscles. \xe2\x80\x94 Under large amounts the irritability of striped \nmuscle is much diminished and finally abolished in frogs, but \nno such action has been observed in mammals. This weaken- \ning in the contraction of the muscles is quite distinct from the \nfeeling of weakness accompanying nausea in man. In frogs \na similar action has been demonstrated on the cardiac muscle; \nthe heart being stopped even after atropine. \n\nHeart and Circulation. \xe2\x80\x94 During the act of vomiting there is \nan increase of pulse and of blood-pressure. The acceleration \nof the pulse, however, as well as the feeling of depression and \nmuscular weakness present, is simply a result of the emetic \naction. Although in a few instances alarming collapse has been \nobserved, no actual fatality is stated to have occurred from \nthe use of the drug. \n\nRespiration. \xe2\x80\x94 There is an increase of respiration in conse- \nquence of the vomiting. If the amount of the drug is suffi- \nciently large, its irritant effects are produced upon the rest of \nthe central nervous system, as well as the vomiting centre, and \nin consequence of this action also the respiration is quickened. \nPhysiological experiments show that apomorphine produces a \nwatery discharge from the blood-vessels of the respiratory \nmucous membrane, which is found to be paler after the admin- \nistration of this remedy, as well as less cedematous. This \neffect is produced within a half hour after ingestion, and it is \nnot in any respect the first stages of emesis. Large doses \neventually depress the respiration. \n\nNervous System. \xe2\x80\x94 Its action on the central nervous system \n\n\n\nAPOMORPHINE. 583 \n\nis shown first and mainly upon the vomiting centre, so that the \nonly direct effect of small doses is the production of the symp- \ntoms of emesis. If the drug is administered in large quantities, \nand especially to animals incapable of vomiting, like the herbi- \nvora, its irritant effects upon the rest of the central nervous \nsystem are seen in the production of marked restlessness, with \ncircus movements, excitement and terror. The movements \nthen become less coordinated, and eventually tetanic convul- \nsions set in. During the convulsions the respiration, which \nwas at first greatly accelerated, ceases, while the heart con- \ntinues to beat for some time later. In man minute doses are \nsaid to be slightly hypnotic. \n\nFate in the Body. \xe2\x80\x94 Apomorphine is not excreted into the \nstomach, like morphine, and it is stated that it has not been \nfound in the mucous membranes of the air passages. It is \npossible that it may be decomposed in the tissues. \n\nTherapeutics of Apomorphine Hydrochloride. \n\nVomiting Action. \xe2\x80\x94 The advantages of apomorphine over \nother emetics are that it is certain, prompt and energetic, that \nit can be given when emetics exhibited by the stomach would \nnot act, and that it produces no gastric irritation. It is hence \nparticularly valuable in cases of poisoning. It is usually ad- \nministered subcutaneously, dissolved in camphor water; 1 in \n50. Dose, .25 to .50 c.c. (4 to 8 ^l). This must be prepared \nextemporaneously, as it will not keep. \n\nExpectorant Action. \xe2\x80\x94 It is, when given by the mouth, a valu- \nable expectorant. In an adult .002 gm. (/* gr.), or 4 c.c. (1 \ndr.) of the syrup (see below) will produce a watery expectora- \ntion within the time above stated, and this effect will last from \ntwo to three hours. It is particularly useful in the early stages \nof acute bronchitis, in chronic dry bronchitis, in chronic ca- \ntarrhal pneumonia, and in old tuberculous patients who are \nharassed by an unproductive cough. \n\nSoporific Action. \xe2\x80\x94 Recently it has been claimed that when \ngiven hypodermatically at bedtime, in dose just short of pro- \n\n\n\n584 PHARMACOLOGY AND THERAPEUTICS. \n\nduring emesis, sleep, closely approaching the normal, ensues. \nThis is not always the case, and its hypnotic action may be \ndue to contamination with other alkaloids. \n\nThe British Pharmaceutical Conference recommends the fol- \nlowing Syrup of Apomorphine: Mix Rectified Spirit, 84; with \nthe same amount of water; dissolve in this Apomorphine Hy- \ndrochloride, 1 ; add Diluted Hydrochloric Acid, 24 ; and finally \nSyrup, 1728 parts. Dose, 2 to 4 c.c. (/ 2 to 1 fl. dr.). The \ndrug may also be given as a lozenge. \n\nApocodeine is formed from codeine in the same way as apo- \nmorphine from morphine. According to some observers, it \nhas, when injected subcutaneously, the same action as apomor- \nphine, while others state that pure apocodeine is not an emetic, \nbut a cerebral depressant. It induces free secretion of saliva, \nand is used chiefly as an expectorant, particularly in chronic \nbronchial affections. \n\nCOCILLANA. \nUnofficial Preparation. \nCocillana.\xe2\x80\x94 Cocillana. Dose, .30 to 1.20 m.; 5 to 20 gr. \n\nAction of Cocillana. \nCocillana acts upon muciparous glands, increasing their ac- \ntivity; on the bronchial mucous membrane, causing expectora- \ntion; on the intestinal mucous membrane, producing a laxative \neffect; it also slightly increases the appetite; it slightly \nstrengthens the heart beat and the pulse, but does not stimulate \nthe respiratory centre. The syrup does not act as a laxative, \nwhile the resins are distinctly purgative. \n\nTherapeutics of Cocillana. \nCocillana is of very great value as an expectorant, preferable \nto ipecacuanha, in that it does not so readily cause nausea and \na metallic taste in the mouth, while it assists the regular move- \nment of the bowels. If, however, nausea should be produced, \nthis is very persistent. Its action is fully established in from \nthree to six hours after administration, and persists at least for \n\n\n\nIPECACUANHA. 585 \n\nsix hours. It can, in many cases, be substituted for apomor- \nphine, ammonium carbonate, and many other drugs, classed, \nwith more or less reason, as expectorants. \n\nIPECACUANHA. \n\nIPECACUANHA. \xe2\x80\x94 Ipecac. Dose (expectorant), 0.065 gm. (65 \nmilligm.) ; 1 gr.; (emetic), 1 gm.; 15 gr. \n\nPreparations. \n\n1. Fluidextractum Ipecacuanha. \xe2\x80\x94 Fluidextract of Ipecac. \nDose (emetic), 1 C.C.; 15 TTL ; (expectorant), 0.05 C.C.; 1 TTL- \n\n2. Syrupus Ipecacuanha. \xe2\x80\x94 Syrup of Ipecac. Dose (expec- \ntorant), 1 c.c; 15 ul; (emetic), 15 c.c; 4 fl. dr. \n\n3. Vinum Ipecacuanhae. \xe2\x80\x94 Wine of Ipecac. Dose, 1 c.c; 15 TTL. \n\n4. Pulvis Ipecacuanha et Opii. \xe2\x80\x94 Powder of Ipecac and \nOpium. (Dover\'s Powder.) Dose, 0.500 gm. (500 milligm.) ; \n7V 2 gr. \n\n5. Tinctura Ipecacuanha et Opii. \xe2\x80\x94 Tincture of Ipecac and \nOpium. Dose, 0.5 c.c.; 8 n\\. \n\n6. Pilula Laxativa Composita. \xe2\x80\x94 Compound Laxative Pills. \nDose, 2 pills. \n\nUnofficial Preparations. \nTrochisci Ipecacuanha (U. S. P., 1890). \xe2\x80\x94 Troches of Ipecac. \nTrochisci Morphina et Ipecacuanha (U. S. P., 1890). \xe2\x80\x94 \nTroches of Morphine and Ipecac. \n\nAction of Ipecacuanha. \n\nExternal. \xe2\x80\x94 Ipecacuanha powder is a powerful irritant to the \nskin, producing redness, vesication, and even pustulation and \nulceration, when its application is prolonged. It is also irritant, \nnaturally, to mucous membranes, and some individuals are so \nsusceptible to its local action that the opening of a jar of the \ndrug at a distance of several feet will produce violent sneezing, \nirritation of the eyes, coughing, and other unpleasant symptoms. \nIt possesses some antiseptic properties, being capable of de- \nstroying the bacilli of anthrax, though having no offect on the \nspores. \n\nInternal. Alimentary Canal. \xe2\x80\x94 When taken by the mouth its \n\n\n\n586 PHARMACOLOGY AND THERAPEUTICS. \n\nirritant effect is exerted on the mucous membrane of the ali- \nmentary canal, and in small doses it is a stomachic; producing \nmoderate gastric hyperemia and an increased flow of saliva \nand gastric juice, and thus aiding digestion. In large doses it \nis a powerful emetic. It is still an unsettled question whether \nthis action is due entirely to the local effect of the emetine on \nthe stomach, or in part to this and partly to its influence on the \nvomiting centre in the medulla. Most of the reliable evidence \nat command, however, points to a peripheral gastric, and not \nto a central, action. Unlike apomorphine, which is known to \nact directly on the centre, ipecacuanha causes vomiting as \nquickly and with as small doses when it is given by the mouth \nas when administered hypodermatically ; and the fact that \nemetine, like many other irritants, has a specific action on the \nalimentary canal when injected subcutaneously would seem \nto satisfactorily explain the emetic action of the drug when \ngiven by this method. A certain amount of depression is pro- \nduced by ipecac, but this is simply a result of the vomiting. If \nthe dose is sufficiently large, and the most of it is not ejected \nin the emesis caused, the irritant effect of the drug is continued \nin the intestine, with the production of increased secretion and \npurging. It also has a cholagogue action, directly augmenting \nthe biliary secretion. When injected subcutaneously in animals, \nemetine induces nausea, vomiting and catharsis, frequently with \nbloody stools, followed by collapse and generally by death \nfrom exhaustion in the course of a few hours. When vomiting \nis not produced by large doses given in this manner collapse \nstill results, and after some weak convulsive movements, the \nanimal dies of cardiac failure. When the fatal result does not \noccur for from eighteen to twenty-four hours, evidences of \ngastro-enteritis are often found after death. \n\nCirculation and Nervous System. \xe2\x80\x94 When emetine is injected \nintravenously the cardiac effects are more pronounced than \nwhen it is given by the mouth or hypodermatically. After \nlarge amounts the central nervous system is acted upon. Para- \nlytic symptoms are developed, and among the earliest in mam- \n\n\n\nIPECACUANHA. 587 \n\nmals is vaso-motor paralysis with fall of blood-pressure. Con- \ntributory to the production of the fall is weakening of the \nheart\'s action from the direct effect of the drug upon the \ncardiac muscle, and this results in death. In the frog, in \nwhich no vomiting is caused, a slowly advancing central \nparalysis is observed, and the heart\'s movements grow weak \nand irregular, and finally cease from paralysis of the cardiac \nmuscle. \n\nRespiration. \xe2\x80\x94 The respiratory movements are but little \naffected by moderate doses of ipecac, though as the result of \nthe vomiting they may be somewhat quickened. The inhala- \ntion of the powder causes congestion of the bronchial mucous \nmembrane, with increased secretion, and excites cough by re- \nflex stimulation; and the same effect is produced by the ex- \ncretion by this membrane of the drug when it is taken inter- \nnally. Animals poisoned by large doses of emetine present \nafter death more or less hyperemia of the bronchial mucous \nmembrane and of the lungs, and in some instances, especially \namong rabbits, pulmonary oedema is found. \n\nSkin. \xe2\x80\x94 Ipecac is in part excreted by the skin, and it acts as \na mild diaphoretic. The cutaneous action resembles that pro- \nduced by the application of warmth. \n\nTherapeutics of Ipecacuanha. \n\nExternal. \xe2\x80\x94 Ipecacuanha has been used with success, as an \nantiseptic, in cases of anthrax. In the dermatitis caused by \nrhus toxicodendron a lotion containing powdered ipecac, 12 gm. \n(3 dr.) to 500 c.c. (1 pint) of water, has been recommended, \nand for the bites of insects, especially mosquitoes, one com- \nposed of 2 gm. (y 2 dr.) and 15 c.c. { l / 2 fl. oz.) each of alcohol \nand ether. \n\nInternal. Alimentary Tract. \xe2\x80\x94 Ipecac is quite generally em- \nployed as an emetic. It is contra-indicated in the very feeble, \nas it has no property that will serve to mitigate the depressing \neffects of the vomiting; nor on account of the slowness of \nits action, should it be used in cases where, as in poisoning, \n\n\n\n588 PHARMACOLOGY AND THERAPEUTICS. \n\na prompt evacuation of the stomach is called for. Its chief \nuse as an emetic is for clearing the passages in diseases of the \nrespiratory organs, and in infants and young children, par- \nticularly, who cannot cough well, it often acts very happily. \nIn the domestic treatment of laryngismus stridulus an emetic \ndose of the syrup is the most usual remedy. Ipecacuanha is \nalso of service as an emetic when the stomach is to be relieved \nof undigested food, and attacks of acute indigestion, migraine, \nand the so-called bilious headache may sometimes be cut short \nby the vomiting caused by it. An ipecac emetic was formerly \nadministered to a considerable extent at the beginning of con- \ntinued fevers, the eruptive fevers, erysipelas, and malarial \nfever, and some clinicians still advocate this method of treat- \nment in suitable cases, claiming that experience has shown the \ngood effects of the practice on the subsequent course of the \ndisease. The indications for its use in cases of this kind are \nconsidered by them to be : a heavily coated tongue, much nausea \nwith ineffectual efforts to vomit, marked epigastric oppression, \nicterus or an icterode hue of the surface, a hot and dry skin, \nacid and turbid urine. For emetic purposes a small dose (.03 \ngm. to y 2 gr.) of tartar emetic is sometimes combined with it. \nIn small doses, such as .25 to .30 c.c. (4 or 5 1U) of the wine \nor .015 gm. (J4 gr.) of the powder, ipecac is sometimes used \nas a stomachic, and, employed in this way, it may even serve \nto check vomiting. It has been known to arrest obstinate \nattacks of vomiting which had resisted all other treatment, and \none of the recognized methods of controlling the vomiting of \npregnancy is the administration of .06 to .12 c.c. (1 or 2 ""l) \nof the wine in water every half hour. .03 gm. {]/ 2 gr.), or \nmore, of ipecacuanha, combined with other cholagogues, has \nbeen found useful in cases of dyspepsia in which there is \nfunctional derangement of the liver, and in gastric ulcer \nDover\'s powder {see p. 590) is sometimes beneficial. One of \nthe most important applications of the drug is in the treatment \nof dysentery. Epidemic dysentery, especially of malarious \nand tropical countries, is the form of the disease to which it \n\n\n\nIPECACUANHA. 589 \n\nseems best adapted, but it may often be used with advantage \nin other varieties also. In the severe attacks of tropical regions \nfrom 1.20 to 4.00 gm. (20 to 60 gr.) are usually given for the \ninitial dose and about 1.20 gm. (20 gr.) every four., six or eight \nhours afterward. It is considered important to establish toler- \nance of the remedy as soon as possible, and subsequent doses \nmay be retained if the first one is rejected. In order to secure \nthe retention of these large doses it may be combined with \nopium and aromatic powder, or other expedients may be re- \nsorted to. Milk is a good vehicle for the administration of \nipecacuanha, and in acute dysentery doses of 1 gm. (15 gr.), \ngiven in milk, are generally fairly well borne. Some authori- \nties advise doses of 2 gm. (30 gr.), without any liquid, at the \nonset, the ipecac to be preceded by a sedative dose of opium. \nThe good effects of the remedy have been attributed by some \nto the large amount of tannic acid contained in the root, and \nas emetine and cephaeline are much more irritant to the in- \ntestine than the unaltered drug, a preparation from which \nthe alkaloids have been removed (Ipecacuanha Deemeti- \nnisata, dose .60 to 2.00 gm. ; 10 to 30 gr.) has been used \nwith advantage, it is claimed, in this disease. On the other \nhand, it has been stated that the efficient agent in the treat- \nment of dysentery is the emetine, and those holding this view \ndeny that the same results are obtained by the use of this \npreparation. The deemetinized ipecac is said to have the ad- \nvantage of not causing any nausea or vomiting, and if the \nclaims of its advocates should prove to be well founded, it \nwould undoubtedly be much preferable on this account. In \nchronic dysentery ipecac is by no means so distinctly efficient \nas in acute, but in association with other remedies is often \nvery useful. In catarrhal jaundice and in diarrhoea, especially \nwhen associated with hepatic derangement, it is sometimes of \nservice. In bowel affections it is often combined with opium \nand mercury. It is useful also in the summer complaint of \ninfants and young children when the stools are of a greenish \ncolor and contain mucus or blood. With it may be associated \nbismuth, pepsin, zinc oxide or other remedies, as indicated. \n\n\n\n590 PHARMACOLOGY AND THERAPEUTICS. \n\nRespiratory Tract. \xe2\x80\x94 It is in very general use as an expec- \ntorant in the form of the syrup, the wine, and ipecac troches. \nIt not only increases the secretion of the bronchial mucous \nmembrane, but also has the effect of rendering it more fluid \nand therefore less tenacious; while its property of exciting the \nact of coughing often adds to its usefulness. The fluidextract \nis considered the most efficient preparation by some practition- \ners. The wine, more or less diluted, in the form of a spray \nfrom a hand atomizer, has sometimes been found of service in \nwinter cough, chronic bronchitis, emphysema and fibroid phthi- \nsis, in allaying the spasmodic vomiting and liquefying the secre- \ntions. In children, too, the wine, in doses of from .30 to .60 \nc.c. (5 to 10 TTL), is apt to be especially beneficial in the chronic \nbronchitis which remains after whooping-cough, measles or \ninfluenza, or is associated with chronic tonsillo-pharyngitis or \nadenoids. A general tonic treatment should also be maintained \nat the same time. In the treatment of acute bronchitis ipe- \ncac is usually much more valuable in children than in the case \nof adults. Cephaelin seems to possess the expectorant proper- \nties of ipecacuanha. \n\nAs a Diaphoretic. \xe2\x80\x94 Dover\'s powder is an excellent anodyne \ndiaphoretic, and is frequently given, in doses of .60 gm. (10 \ngr.) in chills and in the early stage of catarrh of the respira- \ntory passages and of mild feverish attacks in general. In the \nintense suffering which sometimes results from the sudden sup- \npression of menstruation it is often of great service in reliev- \ning pain and promoting diaphoresis. In acute rheumatism and \nother diseases where also it is desired to allay pain and at the \nsame time increase the action of the skin, this powder may be \nadministered in doses of from .18 to .30 gm. (3 to 5 gr.) every \ntwo, three or four hours, according to circumstances. \n\nAs a Hemostatic. \xe2\x80\x94 Ipecacuanha has long been regarded as \nan internal haemostatic, and it has been employed especially in \nhaemoptysis, haematemesis and uterine haemorrhage. At the \npresent time, however, it is much less frequently used as an \nanti-haemorrhagic remedy than formerly. In haemoptysis small \n\n\n\nSENEGA. 59I \n\ndoses, short of producing vomiting, it is stated, serve to reduce \nthe bleeding by decreasing the pulmonary congestion. Some \nwriters, on the other hand, advise that in haemorrhages the \ndrug should be given in frequently repeated doses until vomit- \ning ensues, maintaining that when this effect is produced the \nhaemorrhage usually ceases. \n\nOn account of their irritant properties, neither the prepara- \ntions of ipecac nor its alkaloids are suitable for subcutaneous \ninjection. \n\nSENEGA. \n\nSENEGA. \xe2\x80\x94 Senega. Dose, 1 gm.; 15 gr. \n\nPreparations. \n\n1. Fluidextractum Senegae. \xe2\x80\x94 Fluidextract of Senega. Dose, \n1 c.c; 15 ttl. \n\n2. Syrupus Senegae.\xe2\x80\x94 Syrup of Senega. Dose, 4 c.c; 1 fl. dr. \n\n3. Syrupus Scillae Compositus. \xe2\x80\x94 Compound Syrup of Squill. \nDose, 2 c.c; 30 Ttl. \n\nAction of Senega. \n\nExternal. \xe2\x80\x94 Senega is irritant to the skin when applied re- \npeatedly or rubbed on in the form of ointment, and has a very \nmarked irritant action on mucous membranes. When the pow- \ndered root is inhaled it causes hyperaemia and increased secre- \ntion in the respiratory passages, and excites violent sneezing \nand coughing. \n\nInternal. Alimentary Canal. \xe2\x80\x94 When swallowed, its irritant \neffect on the mucous membrane induces increased secretion of \nsaliva and gastric juice. In large doses it causes not only \nsalivation, but more or less marked inflammation of the gastro- \nintestinal tract, with nausea, vomiting and purging. \n\nRespiration. \xe2\x80\x94 Senega is a stimulating expectorant. When \nthe drug is taken internally, senegin is excreted through the \nbronchial mucous membrane, with the result of producing vas- \ncular dilatation and augmented secretion and of reflexly excit- \ning cough. It is on the respiratory passages that it appears \nto exert its-most important influence. \n\n\n\n592 PHARMACOLOGY AND THERAPEUTICS. \n\nBlood and Circulation. \xe2\x80\x94 When added to defibrinated blood, \nsenegin is found to dissolve the red corpuscles and liberate the \nhaemoglobin and the salts. Even when it is injected into the \nblood of living animals this action is observed to some extent, \nthe plasma containing haemoglobin, while the corpuscles are \nconsiderably diminished in number. In mammals the circula- \ntion appears to be comparatively little affected until shortly \nbefore death, when there is a rapid fall of blood-pressure and \nthe pulse becomes feeble and slow. For a short time after the \nrespiration fails the heart continues to beat, but its movements \nare extremely weak, and it finally stops in diastole, even if arti- \nficial respiration is maintained. \n\nNervous System and Muscles. \xe2\x80\x94 When senegin is injected \ninto the blood in moderate toxic quantities, the symptoms usu- \nally produced are principally intestinal, and fatal collapse from \nthe changes in the alimentary canal occurs after the elapse of \nseveral days ; but when large doses are used the central nervous \nsystem is most affected. At first there are violent convulsions, \nthen paralysis, especially of the respiratory centre, and the \nfatal result is very rapid. If the poison is applied directly to \nskeletal or cardiac muscle or to nerve trunks, they lose their \nirritability at once, and even in dilute solutions muscle con- \ntracts more weakly, and eventually is not only paralyzed but \nstructurally altered. \n\nKidneys. \xe2\x80\x94 Senegin is absorbed with difficulty, and is ex- \ncreted by the kidney, as well as the bronchial mucous mem- \nbrane, and also to some extent, it is said, by the skin. In the \nprocess of excretion it irritates the renal epithelium, and the \ndrug therefore has diuretic properties. \n\nTherapeutics of Senega. \nSenega is used now only- as a stimulating expectorant. In \nsubacute and chronic bronchitis it may prove useful in excit- \ning an increased secretion of mucus and facilitating its expul- \nsion from the respiratory passages. It should not be given in \nacute conditions on account of its irritant effect on mucous \n\n\n\nQUILLAJA. 593 \n\nmembranes, and for the same reason it is contra-indicated \nwhenever gastric irritability or intestinal disorder is present. \nIt is commonly prescribed in combination with other drugs in \nexpectorant mixtures. \n\nQUILLAJA. \nQUILLAJA. \xe2\x80\x94 Quillaja. (Panama Bark. Soap Bark.) \n\nPreparations. \nFluidextractum Quillajse. \xe2\x80\x94 Fluidextract of Quillaja. Dose, \n0.2 c.c; 3 m,. \n\nTinctura Quillajae. \xe2\x80\x94 Tincture of Quillaja. \n\nUnofficial Preparation. \nInfusum Quillajae. \xe2\x80\x94 Infusion of Quillaja. Dose, 8 to 30 c.c; \n2 to 8 fl. dr. \n\nAction of Quillaja. \n\nQuillaja is allied to senega in its properties, but is a much \nmore powerful irritant, as the principle quillaja-sapotoxin is \nstated to be about ten times more poisonous than senegin. \n\nTherapeutics of Quillaja. \nOn account of its soapy nature, it may be used to aid the \ndiffusion of oils and other soluble bodies, but the fact that it \ncontains such a toxic substance as saponin renders it objec- \ntionable for emulsifying medicines for internal use. It is em- \nployed chiefly as an ingredient of hair lotions, and hairdressers, \nfor shampooing, use an aqueous decoction (i to 20), which \nmakes an excellent lather. An infusion, employed by means \nof a roller-bandage saturated with it, makes a good stimulant \napplication for old ulcers and chronic eczema, and this prepara- \ntion is also useful for hyperidrosis and bromidrosis. In chronic \neczema and alopecia circumscripta the tincture, used locally, \nmay prove of service, and for certain forms of acne the fluid- \nextract, mixed with glycerin, has been recommended. The tinc- \nture has been given occasionally as an expectorant, and it is \nstated to have proved efficient, especially in cases requiring the \nfree expectoration of mucus which was accumulating in the \n39 \n\n\n\n594 PHARMACOLOGY AND THERAPEUTICS. \n\nchest. On account of its irritant qualities, however, it should \nalways be employed with caution. \n\nTEREBENE. \nTEREBENUM.\xe2\x80\x94 Terebene. Dose, 0.5 c.c; 8 TTL. \n\nAction of Terebene. \n\nIts odor is more pleasant, but in other respects it for the \nmost part closely resembles oil of turpentine. Like turpentine \nand many other volatile oils, it causes irritation of the lungs \nin the course of excretion, and therefore increases the bron- \nchial secretion. It is likewise diuretic from the irritation of \nthe kidneys excited in the process of excretion, and by its anti- \nseptic properties it disinfects both the renal and bronchial \nsecretions. \n\nTherapeutics of Terebene. \n\nExternally it has been used successfully as a general anti- \nseptic dressing for wounds, ulcers, burns, etc. It has also been \nemployed with advantage as a substitute for copaiba and other \nsimilar drugs in the treatment of genito-urinary diseases. In \nfermentative dyspepsia it is useful as an antiseptic. Its most \nimportant use is as a stimulating disinfectant expectorant, and \nit is highly esteemed in chronic bronchitis, emphysema, winter \ncough, and even phthisis. Although it is said to form an in- \nsoluble compound with sugar, it seems to be efficient when \ngiven on a lump of sugar, which is quite a common method \nof administering it. A few drops taken in this way several \ntimes a day will not infrequently cure a slight winter cough. \nIt may also be given in capsules, in an emulsion, or in a mix- \nture with other expectorants. It is sometimes employed as an \ninhalation, in some such way as the following: Pure terebene, \n2; magnesium carbonate, i; distilled water, 24; to be used in \nwater (1 to 128) at a temperature of 6o\xc2\xb0 C. (140 F.) in an \napparatus so arranged that air can be drawn through it and \ninhaled. \n\n\n\nstorax. 595 \n\nTERPIN HYDRATE. \nTERPINI HYDRAS.\xe2\x80\x94 Terpin Hydrate. Dose, 0.125 gm. (125 \nmilligm.); 2 gr. \n\nAction of Terpin Hydrate. \nTerpin hydrate is an antiseptic, and it is stated that it will \narrest the development of tubercle bacilli. It increases the \nsecretion of the mucous membrane, and the functional activity \nof the kidneys. \n\nTherapeutics of Terpin Hydrate. \nIt has been given as an antiseptic in acute and chronic bron- \nchitis, when the secretion is unusually free, in whooping-cough, \nand rarely in the treatment of chronic nephritis, chronic cys- \ntitis and gonorrhoea. \n\nBALSAM OF TOLU. \nBALSAMUM TOLUTANUM.\xe2\x80\x94 Balsam of Tolu. Dose, 1 gm.; \n15 gr. \n\nPreparations. \n\n1. Syrupus Tolutanus. \xe2\x80\x94 Syrup of Tolu. Dose, 16 c.c; 4 \nfl. dr. \n\n2. Tinctura Tolutana. \xe2\x80\x94 Tincture of Tolu. Dose, 2 c.c; 30 Til . \n\nAction of Balsam of Tolu. \nIn action, as well as in composition, though it contains more \nbenzoic acid, it resembles the balsam of Peru. \n\nTherapeutics of Balsam of Tolu. \nIt is used only as an expectorant and, on account of its \ngrateful taste, to flavor medicines, particularly cough mixtures. \nThe syrup is almost always prescribed. \n\nSTORAX. \nSTYRAX. \xe2\x80\x94 Storax. Dose, 1 gm.; 15 gr. \n\nUnofficial Preparation. \nStyronum. \xe2\x80\x94 Styrone. \n\nAction of Storax. \nIts action is the same as that of the balsams of Tolu and \nPeru and of benzoin, and also resembles that of copaiba. \n\n\n\n596 PHARMACOLOGY AND THERAPEUTICS. \n\nTherapeutics of Storax. \n\nStorax is a serviceable application to stimulate and disinfect \nulcers. Mixed with an equal part of olive oil, it is used in \nsome diseases of the skin requiring slight stimulation, and also \nas a parasiticide in scabies and pediculosis. In the form of an \nointment it is recommended for the ulcerations of frost-bite. \nInternally it has been employed to some extent in the treat- \nment of gonorrhoea, gleet and catarrhal affections of the genito- \nurinary organs. At present its principal internal use is as an \nexpectorant in the compound tincture of benzoin. \n\nStyrone, a derivative of styracin (chemically, cinnamic or \ncinnamylic alcohol), in a solution of 1 to 12 is said to make \nan excellent antiseptic dressing. It is a prompt deodorizer of \nfoul wounds or ulcers, and, being non-poisonous, it may be \ninjected into cavities, as after the operation of empyema. It \nmay also be used in a spray for affections of the respiratory \npassages. \n\nSANGUINARIA. \n\nSANGUINARIA. \xe2\x80\x94 Sanguinaria. (Bloodroot.) Dose, 0.125 gm. \n(125 milligm.) ; 2 gr. \n\nPreparations. \n\n1. Fluidextractum Sanguinariae. \xe2\x80\x94 Fluidextract of Sangui- \nnaria. Dose, 0.1 c.c.; iy 2 1T\\,. \n\n2. Tinctura Sanguinariae. \xe2\x80\x94 Tincture of Sanguinaria. Dose, 1 \nc.c; 15 HI. \n\nAction of Sanguinaria. \n\nSanguinaria is an acrid emetic with stimulant, and in large \ndoses, narcotic powers; it is also expectorant and said to be \nan emmenagogue. \n\nTherapeutics of Sanguinaria. \nIt is chiefly used as a stimulating expectorant in chronic \nbronchitis or in advanced stages of the acute disease. \n\nPLEURISY ROOT. \n\nUnofficial Preparation. \nAsclepias. \xe2\x80\x94 Asclepias (U. S. P., 1890). (Pleurisy Root.) \nDose, 2.0 to 8.0 gm.; y 2 to 2 dr. \n\n\n\ncreosote. 597 \n\nUnofficial Preparation. \nExtractum Asclepiadis Fluidum (U. S. P., 1890). Fluid- \nextract of Asclepias. Dose, 2.0 to 8.0 c.c; y 2 to 2 fl. dr. \n\nAction of Pleurisy Root. \nPleurisy root possesses diaphoretic, carminative, and expec- \ntorant properties, without being stimulant. \n\nTherapeutics of Pleurisy Root. \nIt is used in the disease which gives its name, and in various \npectoral affections. \n\nCREOSOTE. \n\nCREOSOTUM.\xe2\x80\x94 Creosote. Dose, 0.2 c.c; 3 TTt- \n\nPreparation. \nAqua Creosoti. \xe2\x80\x94 Creosote Water. Dose, 8 c.c; 2 fl. dr. \n\nUnofficial Preparation. \nCreosoti Carbonas. \xe2\x80\x94 Creosote Carbonate. (Creosotal.) Dose, \n1 to 4 c.c; 15 to 60 Til. \n\nAction of Creosote. \nThe action of creosote, externally and internally, is prac- \ntically the same as that of phenol. \n\nTherapeutics of Creosote. \nBefore the introduction of carbolic acid it was employed ex- \nternally as a mild anaesthetic and a parasiticide, as well as a \nstimulating antiseptic, and internally to relieve vomiting and \nflatulence. It is really superior to phenol as an antipruritic, \nbut is not much used on account of its acrid and penetrat- \ning odor. When applied on cotton to the cavity, it is effi- \ncient in relieving the aching of a carious tooth, and in the \nform of creosote water is valuable as a haemostatic. The most \nimportant use of creosote is as a pulmonary antiseptic, ad- \nministered by the mouth, hypodermatically, or by inhalation. \n\n\n\n598 PHARMACOLOGY AND THERAPEUTICS. \n\nIn cases of tuberculosis it can be administered in the form of \nan emulsion with cod-liver oil and acacia ; or with the hypophos- \nphites and cod-liver oil; or with the syrup of wild cherry and \nacacia (.12 c.c. of creosote to 4 c.c. (1 fl. dr.) of emulsion in \neach case), or in a mixture of glycerin and whiskey. The dose \nof creosote should be .03 to .12 c.c. (y 2 to 2 HI), given thrice \ndaily, and increased to 1.20 to 1.50 c.c. (20 to 25 ti\\) in the \ntwenty-four hours, by easy stages. Administered in the form of \nenteric pills (which will dissolve only in the intestinal fluids), \na daily dosage of 3 to 3.30 c.c. (45 to 50 ^l) can be reached \nwithout inconvenience. This method is preferable to that \nof Sommerbrodt, which consists in the administration of .06 c.c. \n(1 ^l) of creosote in 12 c.c. (2ITI) of cod-liver oil, in capsules. \nThe method of hypodermatic injection in sterilized olive oil \nrequires a special apparatus, is very tedious, somewhat painful, \nand altogether irksome to patient and physician. By inhala- \ntion creosote is employed with equal parts of alcohol and spirit \nof chloroform, or in alcohol, one part to eight, in a perforated \nzinc inhaler, of which 1 c.c. (15 ^l) is placed upon a bit of \ncotton and used for fifteen minutes in every hour. If the best \nbeechwood creosote is employed, no untoward results are likely \nto be obtained. If the dose is increased too rapidly there may \noccur some nausea, epigastric uneasiness, and even vomiting. \nDisturbance of the kidneys has been produced, and the urine \nthen presents practically the same appearances as after the \ningestion of phenol {see p. 61). The stomach symptoms have \nbeen relieved by the patient\'s placing himself upon his back, \nfor half an hour after administration of the remedy. It is \nquite likely that the patient acquires a tolerance, for the daily \ndose of 20 c.c. (300 Til) has been given for a considerable time, \nwith benefit, although 3.30 c.c. (50 1U) should be considered as \nthe maximum daily dose. Creosote is more efficient than either \nof its principal constituents, guaiacol or creosol, even if given \nin proportionate dose. Creosote should never be given to the \naged. \n\nCreosote carbonate (not official), which contains 92 per cent. \n\n\n\nQUAIACOL. 599 \n\nof creosote, does not possess the caustic and irritative proper- \nties of the pure creosote, and can be administered in dose of \nfrom i to 4 c.c. (15 to 60 ^l) in a wineglass of sherry after \nmeals. As it is slowly absorbed, it is probable that it is elimi- \nnated for the most part by the bronchial mucous membrane. \nSince it does not irritate the gastro-intestinal tract nor the kid- \nneys, it is the method of choice in the treatment of pulmonary \ntuberculosis. Creosote carbonate is also highly esteemed in the \ntreatment of pneumonia, and under its use, as in the case of \nsodium salicylate, defervescence is much more frequently by \nlysis than by crisis, which is ordinarily the rule in this disease. \n\nGUAIACOL. \n\nGUAIACOL. \xe2\x80\x94 Guaiacol. (Methyl Pyrocatechin.) Dose, 0.5 C.C.; \n8 Til . \n\nPreparation. \nGuaiacolis Carbonas. \xe2\x80\x94 Guaiacol Carbonate. Dose, 1 gm.; \n15 gr. \n\nUnofficial Preparations. \nGuaicolis Benzoas. \xe2\x80\x94 Guaiacol Benzoate. (Benzosol. Benzoyl \nGuaiacol.) Dose, 0.10 to 0.60 gm.; 2 to 10 gr. \n\nGuaiacolis Salicylas. \xe2\x80\x94 Guaiacol Salicylate. Dose, 0.30 to \n2.00 gm.; 5 to 30 gr. \n\nAction of Guaiacol. \nGuaiacol is locally an antiseptic and its general action is \nsimilar to that of creosote, but it is less likely to irritate the \nintestinal canal and kidneys. \n\nTherapeutics of Guaiacol. \n\nExternal. \xe2\x80\x94 If painted on the skin over an area of from 10 \nto 50 sq. cm. (4 to 20 square inches), it is capable of reducing \npyrexia, but it is not used for this purpose on account of the \nsweating and collapse which it occasions. \n\nInternal. \xe2\x80\x94 Benzosol was introduced as a nearly tasteless com- \nbination for the administration of guaiacol. In the digestive \ntract it splits up into guaiacol and benzoic acid. As an in- \n\n\n\n600 PHARMACOLOGY AND THERAPEUTICS. \n\ntestinal disinfectant it has proved to be of service in the treat- \nment of diabetes mellitus. The carbonate and salicylate have \nbeen used as substitutes for guaiacol, and are in many cases \npreferable to it. Guaiacol, especially the carbonate, has been \nused to a large extent in pulmonary tuberculosis, under the \nidea that it has a destructive effect upon the bacilli of the \ndisease; but there is no absolutely certain evidence that such \nis the case. The carbonate has given excellent results in the \ntreatment of typhoid fever in limiting the decomposition in \nthe intestines. \n\nINULA. \n\nUnofficial Preparation. \nInula. \xe2\x80\x94 Inula (U. S. P., 1890). (Elecampane.) Dose, 1 to \n4 gm.; y 4 to 1 fl. dr. \n\nUnofficial Preparation. \nHeleninum.\xe2\x80\x94 Helenin. Dose, .02 to .12 gm.; y 3 to 2 gr. \n\nAction of Inula. \nInula is demulcent, tonic and gently stimulant. \n\nTherapeutics of Inula. \nIt is chiefly used in diseases of the lungs, especially when \nthe affection is associated with general debility. Recently, some \nlaboratory experiments have suggested that helenin (its active \nprinciple) may be of value in the treatment of tuberculosis, \nsince it is believed to be a bactericide. \n\nD. Antispasmodics. \n\nGRINDELIA. \nGRINDELIA.\xe2\x80\x94 Grindelia. Dose, 2 gm.; 30 gr. \n\nPreparation. \nFluidextractum Grindelise. \xe2\x80\x94 Fluidextract of Grindelia. Dose, \n2 c.c; 30 TTL- \n\n\n\nGRINDELIA. 6oi \n\nAction of Grindelia. \nBy reason of its volatile oil, grindelia is gently stimulating \nto the stomach. In therapeutic doses it appears to have little \nor no action on the heart or arteries, but in large quantities it \nslows the heart by stimulating the vagi and raises blood- \npressure by stimulating the vaso-motor centre. In these large \ndoses it may also induce paralysis of the peripheral sensory \nnerves, the sensory centres in the spinal cord, and, finally, the \nmotor centres and nerve-trunks. It is excreted by the bron- \nchial mucous membrane, as well as by the kidneys, and at first \nslightly increases the secretion of mucus, but afterward dimin- \nishes it. It appears to have a special action in relaxing the \nmuscular coats of the bronchi, and this is said to be through \ndepression of the ends of the- motor fibres of the vagus dis- \ntributed to the parts and of the reflex centre in the medulla \noblongata. The terminations of the sensory nerves supplying \nthe bronchial mucous membrane are also said to be depressed. \nIn the course of its elimination by the kidneys it excites more \nor less renal irritation, with increased urinary secretion. \n\nTherapeutics of Grindelia. \nIn ivy poisoning rapid relief is often afforded by the appli- \ncation of cloths dipped in a mixture of the fluidextract with \nfrom 30 to 50 parts of water. Such a mixture may also be \nused to allay the pain of herpes zoster and as a lotion for burns \nand blisters, as well as an injection in gonorrhoea, gleet, and \nvaginitis. One part of the fluidextract to four parts of water \nhas been employed as a topical dressing in iritis, and diluted \nwith glycerin or water this preparation makes a good appli- \ncation for chronic or irritable ulcers. On account of its prop- \nerty of relaxing the bronchial muscles, grindelia is one of the \nremedies most commonly resorted to for the relief of the symp- \ntom asthma, and two or three doses of 1.20 c.c. (20 ni) of the \nfluidextract given every twenty minutes in milk (which pre- \nvents the precipitation of the resin) will often prove effica- \ncious in arresting the paroxysms. Between the attacks this \n\n\n\n602 PHARMACOLOGY AND THERAPEUTICS. \n\ndose should be taken three times a day. Grindelia may also \nbe combined advantageously with other asthmatic remedies, \nsuch as lobelia and belladonna. Sometimes during the parox- \nysms it is administered by inhalation. Grindelia leaves steeped \nin a saturated solution of nitre and dried are smoked in \na pipe or burned on a plate, so that the patient may inhale the \nfumes as they rise. The leaves prepared in this way, and with \nor without the addition of tobacco, lobelia, stramonium, etc., \nmay also be rolled into cigarettes and smoked. Cough by imi- \ntation and habit, whooping-cough, and the spasmodic difficulty \nof breathing which accompanies various pulmonary and cardiac \ndiseases, hay-asthma, etc., are not infrequently helped by grin- \ndelia. It is often of service in subacute bronchitis, chronic \nbronchitis (especially of the aged), emphysema and bronchor- \nrhoea, and is usually prescribed in association with other expec- \ntorants. Grindelia is also a remedy of some value in the treat- \nment of chronic pyelitis, chronic cystitis and other diseases of \nthe urinary tract, all along which, in consequence of the excre- \ntion by the kidneys, the local application of the oleo-resin takes \nplace. The bitter taste of the drug is perhaps best covered by \nspirit of chloroform. \n\nASPIDOSPERMA. \n\nUnofficial Preparations. \n\nAspidosperma. \xe2\x80\x94 Aspidosperma (U. S. P., 1890). (Quebracho. \nIron Wood.) Dose, 0.30 to 2.00 gm.; 5 to 30 gr. \n\nFluidextractum Aspidospermatis. \xe2\x80\x94 Fluidextract of Aspido- \nsperma. Dose, 0.30 to 2.00 c.c; 5 to 30 HI. \n\nAspidosperminum. \xe2\x80\x94 Aspidospermine. Dose, 0.015 to 0.03 \ngm.; y 4 to y 2 gr. \n\nAction of Aspidosperma. \n\nNone of the alkaloids fully represent the drug. In the lower \nanimals large doses of the bark produce motor paralysis, with \ndyspnoea and finally death from asphyxia. The breathing early \nbecomes slower, but deeper; the blood-pressure is not affected \n\n\n\nERIODICTYON. 603 \n\nuntil late. There is reason to believe that the relief of dysp- \nnoea, which is obtained clinically, is caused by its increasing the \npower of the blood to take up oxygen. \n\nTherapeutics of Aspidosperma. \n\nIt is a bitter which may aid the appetite, and is a valuable \nremedy when the respiration is embarrassed by emphysema, \nchronic bronchitis, or chronic pneumonia; even uraemic asthma \nis benefited by it. It is not of benefit in dyspnoea of cardiac \norigin. The commercial aspidospermine, which is an impure \nmixture of all the alkaloids, and therefore represents their com- \nbined action, may be given in place of the drug itself. \n\nPULSATILLA. \n\nUnofficial Preparations. \n\nPulsatilla.\xe2\x80\x94 Pulsatilla (U. S. P., 1890). Dose, 0.05 to 0.30 \ngm.; 1 to 5 gr. \n\nFluidextractum Pulsatilla. \xe2\x80\x94 Fluidextract of Pulsatilla. Dose, \n.06 to .30 c.c; 1 to 5 HI. \n\nAction of Pulsatilla. \nIt is said to be very nearly the equivalent of senega, and also \nto paralyze the heart and respiratory centres. \n\nTherapeutics of Pulsatilla. \nIt has been used for the treatment of the symptom asthma, \nconvulsive coughs, and ordinary bronchitis. Pulsatilla is a \nfavorite remedy for dysmenorrhoea in its various forms, ob- \nstructive excepted. The fluidextract has been highly recom- \nmended for orchitis and epididymitis. \n\nERIODICTYON. \n\nERIODICTYON. \xe2\x80\x94 Eriodictyon. (Yerba Santa. Mountain Balm.) \nDose, 1 gm.; 15 gr. \n\nPreparation. \nFluidextractum Eriodictyi. \xe2\x80\x94 Fluidextract of Eriodictyon. \nDose, 1 c.c; 15 irt. \n\n\n\n604 PHARMACOLOGY AND THERAPEUTICS. \n\nAction of Eriodictyon. \n\nEriodictyon has long been used in California as a bitter tonic, \nand as a stimulating expectorant. \n\nTherapeutics of Eriodictyon. \n\nIt has been found useful in chronic bronchitis, and as it \nappears to have something of the anti-spasmodic action of \ngrindelia, it is sometimes combined with that drug. In asth- \nmatic attacks it has also been employed by smoking. It is an \nexcellent vehicle for quinine, concealing its bitter taste. \n\nCHESTNUT. \n\nUnofficial Preparations. \n\nCastanea.\xe2\x80\x94 Castanea (U. S. P., 1890). (Chestnut.) Dose, 2 \nto 8 gm.; V2 to 2 dr. \n\nFluidextractum Castaneae. \xe2\x80\x94 Fluidextract of Castanea. Dose, \n2 to 8 c.c; V2 to 2 fl. dr. \n\nAction of Chestnut Leaves. \nChestnut leaves are mildly sedative. \n\nTherapeutics of Chestnut Leaves. \n\nThey are used in whooping-cough, because they are supposed \nto possess anti-spasmodic and expectorant properties. \n\nOXYGEN. \n\nUnofficial Preparation. \nOxygenium. \xe2\x80\x94 Oxygen. \n\nAction of Oxygen. \n\nThe first effect of the inhalation of oxygen in the pure state \n(not as air) is a sensation of warmth in the respiratory pass- \nages. The appetite is increased, and a feeling of mental ex- \nhilaration and a disposition to greater bodily activity are pro- \n\n\n\nOXYGEN. 605 \n\nduced. The pulse is generally quickened, but may be reduced \nin frequency. It has been shown that the administration of \noxygen in from 40 to 90 litres (ioj4 to 2^/2 gallons) per day, \ngiven in two doses and mixed with a determinate quantity of \nair, energizes to some extent the nutritive functions, increases \nthe appetite, slightly elevates the temperature, stimulates the \ncardiac movements, and augments the body-weight. These \neffects are chiefly attributable to the action on the blood; the \nred corpuscles being increased in number and stimulated to \ngreater organic activity. The capacity of the blood for the \nabsorption of oxygen, however, is limited, as the oxygen forms \na definite chemical compound with haemoglobin, and as soon as \nthe latter is saturated, the blood will not take up any further \namount. With the normal amount of oxygen in the air, the \nnormal rapidity of the circulation, and the normal extent of \nlung surface, the blood is almost, but not completely, saturated, \nand it is this small difference between the possible and actual \nsaturation which seems to be sufficient to cause some stimula- \ntion to the formation of red corpuscles. In disease the case \nis often very different, and when the absorption of oxygen is \nin any way impeded the blood passes through the pulmonary \ncirculation before it has time to absorb all the oxygen it is \ncapable of absorbing. There is, therefore, a very evident indi- \ncation for an artificial supply of the gas for the more complete \noxygenation of the blood. \n\nTherapeutics of Oxygen. \nOxygen inhalations are used in cardiac disease, pneumonia, \npulmonary oedema, emphysema, convulsions, chloroform nar- \ncosis, asphyxia from toxic gases, and in various other condi- \ntions characterized by great lividity or by dyspnoea due to \ncauses interfering with the oxygenation of the blood. Even \nthough they should fail to avert a fatal issue, they often greatly \nrelieve the distress of the patient, and in many instances they \nare of material assistance in tiding over a temporary risk of \ndeath. In various chronic conditions, as anaemia, albuminuria, \n\n\n\n606 PHARMACOLOGY AND THERAPEUTICS. \n\nglycosuria and different forms of sub-oxidation, the persistent \nuse of oxygen has given excellent results. There seems to be \nsatisfactory evidence that it is beneficial in some cases of phthi- \nsis, especially those in which emaciation, dyspeptic symptoms, \netc., have occurred without marked change in the condition \nof the lungs. When cavities have formed and hectic fever has \nset in, oxygen can be of service simply as a palliative of dysp- \nnoea. In the administration of this remedy the gas should be \nallowed to issue in a gentle stream, and it is advisable that the \ninhaler should not be held too near the patient. The ordinary \ninhaling mouth-piece may often be replaced with advantage by \na glass funnel three or four inches in diameter, and the latter \nshould be held, an inch or so away, over the nose and mouth \nof the patient. Small doses of oxygen at frequent intervals \nare usually best. \n\n\n\nDivision IX. \xe2\x80\x94 Drugs acting on the Digestive Apparatus. \n\nA. Drugs acting on the Teeth. \xe2\x80\x94 For cleaning the teeth pow- \nders are commonly used, but soaps and liquid dentifrices are \noccasionally employed. Chalk, which acts mechanically, con- \nstitutes the basis of most tooth powders, and charcoal, which, \nhowever, may abrade the enamel, is also sometimes used for its \nmechanical effect. In order to prevent the decomposition of \nfood lodged between the teeth, antiseptics, such as quinine, \nborax and phenol, are often used as ingredients of tooth-pow- \nders. Astringents such as krameria are employed when the \ngums are inclined to bleed. As iron is apt to blacken the teeth \nand mineral acids and alum are injurious to them, it is advisa- \nble that these drugs should not be used as gargles for long \nperiods and that when prescribed internally they should be \ntaken through a glass tube. \n\nFor the relief of toothache local anodynes such as creosote \nor pure carbolic acid may be employed on absorbent cotton, \nwhich is inserted into the cavity of the carious tooth. There \nis some danger of damage to the dental pulp, and to prevent \n\n\n\nDRUGS ACTING ON DIGESTIVE APPARATUS. 607 \n\ninjury to the gums and mouth a pledget of unmedicated cotton \nshould be placed over the carbolized cotton. \n\nB. Drugs acting on the Salivary Glands. \xe2\x80\x94 Drugs which in- \ncrease the amount of saliva are called Sialogogues; those which \ndiminish it, Anti-sialogogues. The saliva is derived from the \nsecretion of the parotid, submaxillary and sublingual glands \nand the muciparous glandules of the buccal cavity, and the \nsecretions produced by these different glands vary somewhat \nin their physical properties, especially in the degree of their \nviscidity. The function of the submaxillary gland and the \ninfluences affecting it have been especially studied in the \ndog, and from these researches it is known that the gland \nis largely under the control of the chorda tympani nerve, \nsome of whose fibres are of a vaso-dilator character, and \nthus secondarily influence the glandular secretion, while others \naffect the latter directly. This nerve, which has its centre in \nthe medulla, may be reflexly excited by stimulation of various \nnerves, and particularly the gastric branches of the vagus and \nthe lingual and buccal terminations of the glosso-pharyngeal \nand gustatory nerves. The gland has also a nerve-supply from \nbranches of the cervical sympathetic trunk, and these are vaso- \nconstrictor in character. The secretion of saliva in the normal \nanimal appears to occur only when impulses reach the gland \ncells through the chorda tympani or through the cervical sym- \npathetic fibres. The positively known modes of action of sia- \nlogogues and anti-sialogogues will alone be mentioned here. \n\n1. Sialogogues acting either on the secretory cells or upon \nthe terminations of the nerves in them. \xe2\x80\x94 Of these, pilocarpus \nhas been the most carefully investigated, and it has been shown \nthat it acts on the terminations of the secretory nerves \xe2\x80\x94 the \nminute fibrils which ramify between the epithelial cells and \nperhaps even enter them. It is found that its action is not at \nall interfered with by section of all the nerves supplying the \nmaxillary gland; also that it acts when injected directly into \nthe gland but is prevented from entering the general circula- \ntion. When pilocarpus has been administered, the effect which \n\n\n\n608 PHARMACOLOGY AND THERAPEUTICS. \n\nstimulation of the chorda tympani or of the sympathetic pro- \nduces is only such as can be readily explained by the vascular \neffects. \n\nSialogogues falling under this heading are \xe2\x80\x94 \n\n(0 Pilocarpus. (4) Mercury. \n\n(2) Muscarine. (5) Nicotine. \n\n(3) Iodine compounds. (6) Physostigmine. \n\nThe last two probably act also by stimulating the centre in the medulla, \nfor section of the chorda tympani decidedly lessens the secretion \ncaused by them. Physostigmine soon ceases to cause an increase of the \nsecretion, for it tightly contracts the vessels of the gland. \n\n2. Sialogogues acting reiiexly by stimulating the peripheral \nends of afferent nerves. \xe2\x80\x94 Of these there are two important \nvarieties : \n\n(a) Those stimulating the gustatory and glosso-pharyngeal nerves in \nthe mouth : \n\n\n\n(1) All Acids and \n\n(2) Acid salts. \n\n(3) Chloroform. \n\n(4) Alcohol. \n\n\n\n(5) Ether. \n\n(6) All pungent substances, as \n\nmustard, ginger, etc. \n\n\n\n(b) Those stimulating the vagus in the stomach: \nMost emetics, especially Antimony and Ipecacuanha. \n\n3. Anti-sialogogues acting either on the secreting cells or the \nterminations of the nerves in them. \xe2\x80\x94 Of these atropine has \nbeen most studied, and that it acts directly on the gland is \nshown by the fact that it prevents any increase of salivary \nsecretion on stimulation of the chorda, although the vessels \ndilate as usual. It appears to act on the terminations of nerve \nfibres in the gland cells, but this action is limited to certain \ndefinite terminations, since the sympathetic secretory nerve \nfibres are not paralyzed, and it has been ascertained that not all \nthe fibres of the chorda tympani are acted upon. Atropine \n\n\n\nDRUGS ACTING ON DIGESTIVE APPARATUS. 609 \n\nwould seem, then, to select the terminations of the secretory \nfibres for paralysis, and to leave all others unaffected. \n\nAnti-sialogogues falling under this heading are \xe2\x80\x94 \n\n(1) Belladonna, 1 (3) Stramonium, and \n\n(2) Hyoscyamus, (4) Nicotine in excess. \n\n4. Anti-sialogogues acting reflexly by depressing the peri- \npheral ends of afferent nerves. \xe2\x80\x94 Such are alkalies, opium, and \nany substances allaying irritation of the mouth. Part of the \neffect of opium is due to its depressing action on the medullary \ncentre. \n\nTherapeutics. \xe2\x80\x94 A deficiency in the amount of saliva secreted \nis a prominent feature of belladonna poisoning, and it is also \nsometimes a disease in itself, being then probably of nervous \norigin. It is most commonly met -with in fevers, the mouth \nbecoming extremely dry and the patient suffering from thirst. \nRemedies which relieve this febrile thirst and impart a sensa- \ntion of coolness are known as Refrigerants. In fever, acid \ndrinks, such as lemonade, and beverages containing carbon \ndioxide gas are of service as sialogogues. For the condition \nknown as " dry mouth " pilocarpus has been employed, and this \nis also useful in relieving the dryness caused by belladonna or \natropine. Excessive salivary secretion is seldom met with ex- \ncept as a symptom of poisoning by such drugs as mercury, \niodine and pilocarpus. In some forms of indigestion the saliva \nacquires a very disagreeable taste, or perhaps the secretion may \nbecome diminished, but here the correction of the difficulty is \nto be sought in the improvement of the digestion. \n\nC. Drugs acting on the Stomach. \xe2\x80\x94 In the present state of our \nknowledge it is not possible to speak with accuracy of the \nspecial action of many of the drugs affecting the stomach, and \nit will therefore serve the most useful purpose to divide this \nclass of drugs into those affecting the secretion of gastric juice \nas a whole, the secreted contents, the vessels, nerves, and move- \nments of the stomach, and, lastly, those which are emetics. \n\n1. Drugs increasing the amount of gastric juice secreted.\xe2\x80\x94 \nThese are usually called Stomachics, and they include a large \n40 \n\n\n\n6io \n\n\n\nPHARMACOLOGY AND THERAPEUTICS. \n\n\n\nvariety of agents. The secretion of gastric juice is reflexly \naugmented by all bitter and aromatic substances (which like- \nwise increase the appetite), as well as by stimulants to the \nmouth. Indeed, the smell and taste of food constitute the most \npowerful stimulant to gastric secretion, and substances of \nagreeable flavor cause a marked increase in it by reflexes from \nthe mouth and nose. The simple presence of food in the \nstomach also tends to promote the flow. The aromatics appear, \nlike other volatile oils, to cause an irritation, hyperemia and in- \ncreased secretion and peristalsis, with consequent improvement \nin digestion and absorption. It is thought probable, though this \nhas not been proved, that bitters also cause an irritation, lead- \ning reflexly to the same results. Their effects are, however, \nno doubt largely due to their acrid taste, which is very lasting. \n\n\n\n(a) The drugs which increase the flow of gastric juice are \xe2\x80\x94 \xe2\x96\xa0 \n\n\n\n(i) Aromatics. \n\n(2) Bitters. \n\n(3) All alkalies (especially potas- \n\nsium and sodium bicarbon- \nates, and Spiritus Ammonise \nAromaticus). \n\n(4) Alcohol. \n\n\n\n(5) Ether. \n\n(6) Chloroform. \n\n(7) Magnesium oxide. \n\n(8) Magnesium carbonate. \n\n(9) Pungent substances (pep- \n\nper, mustard, horse-radish). \n\n\n\nTherapeutics. \xe2\x80\x94 Stomachics are extensively employed to fa- \nvorably modify the digestive process in various functional \ndisorders. \n\n2. Drugs decreasing the amount of gastric juice secreted. \n\n\n\n(1) Mineral acids. \n\n(2) Acetic acid. \n\n\n\n(3) Many of those in the last list \nif given in large doses, e. g., \nalcohol, ether and chloro- \nform. \n\n\n\nTherapeutics. \xe2\x80\x94 These drugs, it may be stated, are never \ngiven for this purpose. It should be noted here that acids and \nalkalies have opposite effects as regards the gastric juice and \n\n\n\nDRUGS ACTING ON DIGESTIVE APPARATUS. 6 1 I \n\nthe saliva. While acids diminish the secretion of the gastric \njuice, which is acid, they increase that of the saliva, which is \nalkaline; alkalies, on the other hand, diminish the secretion of \nthe alkaline saliva, but increase that of the acid gastric juice. \n\n3. Drugs altering the composition of the gastric contents. \xe2\x80\x94 \nThe reaction of the gastric contents may, of course, be modi- \nfied by acids and alkalies. In cases of dyspepsia believed to \nbe due to a deficient secretion of hydrochloric acid, diluted \nmineral acids are often prescribed, and they should be taken \nabout two hours after eating, so as not to interfere with the \nsecretion of the natural acid. If, on the other hand, there \nappears to be an excess of acid in the stomach, alkalies are \nordered at meal-times, and sodium bicarbonate is the one gen- \nerally selected. When it is thought that the secretion of pepsin \nis at fault, pepsin is administered, and it is customary to pre- \nscribe it with diluted hydrochloric acid. In order to prevent \nfermentation and putrefaction in the stomach, antiseptics are \nsometimes employed, but their field of usefulness is compara- \ntively limited, since doses large enough to accomplish the de- \nsired purpose are liable to prove injurious to the patient. \xe2\x80\xa2 In \nall varieties of indigestion it should be borne in mind that it \nis of much greater importance to remove the primary cause \nof the trouble than to endeavor to modify the composition of \nthe gastric contents. \n\nDrugs which have been used for this purpose are \xe2\x80\x94 \n(1) Phenol. (9) Bismuth salicylate. \n\n\n\n(2) Iodoform. \n\n(3) Boric acid. \n\n(4) Creosote. \n\n(5) Eucalyptus. \n\n(6) Thymol. \n\n(7) Resorcinol. \n\n(8) Salicin. \n\n\n\n(10) Phenyl salicylate (salol). \n\n(11) Sodium thiosulphate. \n\n(12) Sodium phenosulphonate. \n\n(13) Sulphurous anhydride. \n\n(14) Naphthol. \n\n(15) Charcoal. \n\n\n\nCharcoal has been considered by many to be useless when it \nis moist, but it has been shown that when moist it is capable \n\n\n\n6l2 PHARMACOLOGY AND THERAPEUTICS. \n\nof absorbing the gases from decomposing matter almost as \nreadily as when in the dry state. \n\n4. Drugs which dilate the vessels of the stomach. \xe2\x80\x94 The vas- \ncularity of the stomach is very readily affected. Thus, me- \nchanical irritation, such as results from the presence of food, \nand particularly peptones, causes a considerable dilatation of \nthe vessels. Such increased vascularity, if not excessive, is \nadvantageous, since it tends to promote absorption, as well as \ngastric secretion. \n\nThe substances which increase the vascularity of the stomach \nare, all stomachics (except alkalies), diluted mineral acids, the \ndrugs. which have been already enumerated as irritants gener- \nally, and squill, digitalis, colchicum, senega, copaiba, gamboge, \nguaiacum, and veratrine. Most of these, however, produce, \neven in small doses, too powerful an irritant effect to be of \nservice in this regard, and practically the only class of drugs \nmuch employed to increase gastric vascularity is the stomach- \nics. Even these may induce gastritis, if used to excess, as is \nconstantly seen in the case of alcoholics. \n\nGastro-intestinal irritants. \xe2\x80\x94 It will be found that in the de- \nscription of the action of drugs a large number are designated \nas gastro-intestinal irritants. Caustic potash and mineral acids \nsuch as nitric and sulphuric acids are very powerful agents of \nthis class, and the reader is referred to the sections on these \ndrugs for a narration of the local and general symptoms pro- \nduced. There is naturally a great variation in the severity of \nthe effects of different gastro-intestinal irritants, and it is \nworthy of note that many of them have no action on the mouth. \n\n5. Drugs which contract the gastric vessels. \xe2\x80\x94 These have \nalready been mentioned as being generally astringent. As they \nare much more frequently employed for intestinal disorders \nthan for those of the stomach, their detailed consideration is \ndeferred to the section on drugs acting on the intestines. \n\n6. Drugs acting on the nerves of the stomach. \xe2\x80\x94 The terminal \nbranches of the right and left pneumogastric nerves, which \nsupply the stomach, are markedly affected by all powerful gas- \n\n\n\nDRUGS ACTING ON DIGESTIVE APPARATUS. 613 \n\ntrie irritants, with the causation of severe pain; while drugs \nwhich are only mildly irritant to the stomach give rise merely to \na sensation of warmth, which is often agreeable, rather than \notherwise. It is, of course, never desirable to produce gastric \npain. \n\n(6) Gastric Sedatives. \xe2\x80\x94 These drugs are the same as those \nwhich are local sedatives to other parts of the body. Those \nmost used for the stomach are \xe2\x80\x94 \n\n\n\n(1) Bismuth subcarbonate. \n\n(2) Bismuth subnitrate. \n\n(3) Bismuth salicylate. \n\n(4) Opium. \n\n(5) Hydrocyanic acid. \n\n\n\n(6) Carbon dioxide. \n\n(7) Ice. \n\n(8) Belladonna. \n\n(9) Hyoscyamus. \n(10) Stramonium. \n\n\n\nThey are most commonly employed in the various painful \nforms of dyspepsia, and all of them, with the possible exception \nof stramonium, are in constant use. \n\n7. Drugs acting on the movements of the stomach. \xe2\x80\x94 As it \nhas been observed that the movements of the stomach increase \nproportionately with an increased acidity of the gastric contents, \nit would appear that anything which causes an increase of \nacidity will tend to produce more pronounced movements. In \naddition, stomachics seem to promote the movements, while \nstrychnine has been thought to directly stimulate the unstriped \nmuscle of the gastric wall. Many authorities, however, believe \nthat the latter has no such specific action, but affects the diges- \ntion merely in the same way as the simple bitters. Under this \nclass of drugs we have, then, mineral acids, stomachics, and nux \nvomica, and as an adequate amount of gastric movement is \nessential to the digestive process, they are of great value in \nthe treatment of dyspepsia. \n\nCarminatives. \xe2\x80\x94 This term is usually applied to substances \nwhich promote the expulsion of gas from the stomach and in- \ntestine by increasing peristalsis, stimulating the circulation, \nand perhaps relaxing the two orifices of the stomach. Many \n\n\n\n6 14 PHARMACOLOGY AND THERAPEUTICS. \n\nof them are also antiseptics. The most efficient carminatives \nare \xe2\x80\x94 \n\n(i) Stomachics generally, espe- \ncially \xe2\x80\x94 \n\n(2) Aromatics, \n\n(3) Bitters, \n\n(4) Pungent substances, \n\n\n\n(5) Asafetida, \n\n(6) Ammoniac, \n\n(7) Valerian, \n\n(8) Camphor and \n\n(9) Volatile oils. \n\n\n\n8. Emetics. \xe2\x80\x94 The act of vomiting is a reflex one, and is con- \ntrolled by a nerve centre in the medulla which is situated near \nand closely related to the respiratory centre. This may re- \nspond to afferent impulses reaching it from many organs, as \nthe cerebrum (through the special senses), the various parts \nof the alimentary canal, the gall bladder, the genito-urinary \ntract, etc. Disturbance of the mechanism of equilibrium, as \nin vertigo and seasickness, is also a common cause of vomiting. \nNumerous drugs which, by their action on special organs, are \ncapable of reflexly stimulating the centre might be included \namong emetics, but it is customary to limit this designation to \nthose which produce vomiting either by acting on the stomach \nor on the medullary centre. The first class are sometimes \ncalley direct emetics, and the second, indirect emetics, but as \ncertain authors use these terms in just the opposite way, making \nthe direct emetics those which act on the centre, it will be \nmore satisfactory to divide emetics into gastric, or local, and \ncentral, or general. The following experiments have been \nemployed to determine the mode of action of the different \nemetics : \n\n1. If when the drug has been injected directly into the cir- \nculation (preferably into the carotid artery, on account of its \nnearness to the medulla), it is found that vomiting results very \npromptly, it is concluded that the action is on the centre. If, \nhowever, a considerable time elapses between the injection and \nthe production of vomiting, the conclusion is reached that the \naction is on the stomach and that the drug must have been \nexcreted into this organ before vomiting could be caused. \n\n2. If the smallest amount of the drug which is capable of \n\n\n\nDRUGS ACTING ON DIGESTIVE APPARATUS. 6 1 5 \n\ncausing vomiting when injected into the circulation is larger \nthan is required when it is introduced directly into the stomach, \nit is concluded that the primary action is on the stomach and \nthat such vomiting as follows its injection into the circulation \nis due to the fact that a portion of the drug has been excreted \ninto the stomach. \n\n3. If when the stomach has been replaced by a bladder no \nvomiting results from its injection into the circulation, it is \nconcluded that the drug acts on the stomach; but if vomiting \ntakes place under these circumstances, the inference is that the \naction is on the centre, the vomiting being caused by the con- \ntraction of the abdominal muscles. \n\n4. If, when the drug has been introduced into the stomach, \na long time elapses before vomiting is produced, it is concluded \nthat the action is on the centre, the delay being due to the time \nrequired for the absorption of the drug. \n\nIt has been found, however, that such experiments are not \naltogether reliable, since some emetics act both locally and cen- \ntrally, and, moreover, some of them, in the course of their cir- \nculation through the blood, probably act on some of the numer- \nous organs from which impulses are transmitted to the vomit- \ning centre. \n\n\n\nThe following are the emetics most commonly used \nEmetics acting on the stomach: \n\n(1) Yellow mercuric subsul- \n\nphate. \n\n(2) Alum. \n\n(3) Ammonium carbonate. \n\n(4) Copper sulphate. \n\n\n\n(5) Zinc sulphate. \n\n(6) Sodium chloride. \n\n(7) Ipecacuanha. \n\n(8) Mustard. \n\n(9) Warm water. \n\n\n\nIpecacuanha has\' often been classed among emetics which act on the \ncentre, but it has been demonstrated that emetine, like many other irri- \ntants when injected subcutaneously, has a specific action on the alimen- \ntary canal, and, according to the best authorities, almost all the facts \nbrought forward as evidence of the supposed central action of the drug \nhave now been disproved. \n\n\n\n6l6 PHARMACOLOGY AND THERAPEUTICS. \n\n\n\nEmetics acting on the medullary centre, \n\n\n\n(i) Apomorphine. \n(2) Tartar emetic. \n\n\n\n(3) Senega. \n\n(4) Squill. \n\n\n\nApomorphine and tartar emetic are very powerful, and much \nmore depressant than the ordinary local emetics. Tartar \nemetic, however, acts partly on the stomach, and by many it \nis believed that the vomiting caused by it is mainly due to \ngastric irritation. \n\nTherapeutics. \xe2\x80\x94 Emetics are employed for three purposes : \n(1) To evacuate the stomach. This is a very important indi- \ncation in most cases of poisoning. In many instances, however, \nwashing out the stomach is preferable to the use of an emetic. \nEmetics sometimes aid the expulsion of foreign bodies which \nhave become impacted in the fauces or oesophagus. When with \na distended stomach there is a feeling of nausea, and also in \ncertain cases of sick headache, the emptying of the stomach \nmay afford relief. Emetics were formerly employed in a great \nvariety of conditions in which their use is now obsolete. (2) \nTo expel the contents of the air-passages. Thus, an emetic \noften aids the expulsion of a foreign body lodged in the larynx. \nThis class of drugs is especially useful in infants and young \nchildren, who cannot expectorate well, to clear the air-pas- \nsages in bronchitis, laryngitis, diphtheria, etc. (3) To pro- \nduce nausea. The dose for this purpose is usually about one- \ntenth of the emetic dose. The nauseant stage is employed \nprincipally in the treatment of catarrhal conditions and coughs, \nand it is indicated when the mucous secretion is deficient or \nthick and tenacious. The milder emetics should be chosen, as \nthe nauseant stage is to be prolonged without the production \nof actual vomiting. \n\nOn account of the straining induced by the vomiting, emetics \nare as a rule contra-indicated in cases of aneurism, hernia, peri- \ntonitis, prolapse of the uterus or rectum, and where there is a \ntendency to haemorrhage. \n\n9. Anti-emetics. \xe2\x80\x94 The causes of vomiting being so numerous, \nthe number of agents which may serve as anti-emetics is also \n\n\n\nDRUGS ACTING OX DIGESTIVE APPARATUS. 6l/ \n\nvery large ; but. as in the case of emetics., only those substances \nwill be considered which act either on the stomach or on the \nvomiting centre. \n\nAnti-emetics acting on the stomach. \xe2\x80\x94 These are all those sub- \nstances which have been already enumerated as having a seda- \ntive influence on the gastric nerves (see p. 613). \n\nAlso some drugs which occasionally appear to have a specific local \naction in arresting vomiting ; such are : \n\n(1) Cocaine. 8 Phenol. -> \n\n(2) Cerium oxalate. (9) Chloroform. \n\n(3) Menthol. (10) Creosote. In \n\n(4) Wine of ipecac. 1 In (n) Ether. -small \nS Tincture of iodine. Lminute (12) Silver nitrate. doses. \n\n(6) Arsenic trioxide. j doses. (13) The phenosul- \n\n- Alcohol. phonates. \n\n\n\n. \n\n\n\nAnti-emetics acting centrally \xe2\x80\x94 \n\n: Opium. (6) Amyl nitrite. \n\nI 2 Ammonium, (7) Nitroglycerin. \n\n3 Potassium, and (8) Diluted hydrocyanic acid. \n\n(4) Sodium bromides. (9) Alcohol. \n\n(5) Hydrated chloral. \n\nIt will be noticed that some drugs fall under both headings. \n\nTherapeutics. \xe2\x80\x94 The really efficient way to treat vomiting is \nto remove the cause, but. of course., this is not always possible. \nThese drugs are. indeed, only palliative, and all are quite uncer- \ntain. Sometimes, however, one will be successful in controll- \ning vomiting where a number of others have failed. Perhaps \nthe most trustworthy anti-emetics are ice. diluted hydrocyanic \nacid, carbon dioxide, bismuth salts, morphine and menthol. \n\nD. Drugs Acting on the Intestines. \xe2\x80\x94 Owing to various circum- \nstances, among which may be mentioned the lack of accurate \nknowledge regarding both intestinal physiology and pathology \nand the fact that many drugs are altered in composition by the \ntime they reach this portion of the alimentary tract, it is as yet \n\n\n\n6l8 PHARMACOLOGY AND THERAPEUTICS. \n\nimpossible to classify the drugs acting on the intestines upon a \nphysiological basis. We have, in fact, only three important \ndivisions : purgatives, antiseptics and astringents. \n\nOne of the methods of experimentation which has been used \nto determine the mode of action of purgatives is as follows: \nThe intestine is cut across in two places a short distance apart; \nthe isolated part, still attached to the mesentery, is sewed up at \none end; the other, the open end, is attached to the abdominal \nwall, thus giving a test-tube-like piece of intestine in which \ndrugs can be placed. The parts of the bowel on either side of \nthe excised piece are then sewed together, so that the whole in- \ntestine is the same as before, with the exception of being a little \nshorter. The results of this method not having proved very \nsatisfactory, another was devised, which seems more trust- \nworthy. Four ligatures are put around the intestine at equal \ndistances apart, so that three pieces are shut off from the rest \nof the intestine and from each other, each of the same length. \nWith a fine syringe the drug to be experimented upon is in- \njected into the middle piece, and the whole returned into the \nabdominal cavity. In a few hours the animal is killed, and the \nstate of the interior of the middle piece is contrasted with that \nof the pieces on either side of it. Before these experiments there \nhad been much discussion as to whether some purgatives did \nnot act only by increasing the action of the muscular coat, and \nothers only by stimulating the secretions ; but from such experi- \nments it appears that probably the majority act in both ways, \nsome very slightly on the secretion and powerfully on the mus- \ncle, and others slightly on the muscle and powerfully on the \nsecretion. We will first consider intestinal purgatives, then \nintestinal antiseptics, and finally intestinal astringents. \n(C) Purgatives are divided into the following classes: \nLaxatives. \xe2\x80\x94 These are substances which slightly increase the \naction of the bowels, chiefly by stimulating their muscular coat. \n\n\n\nThey are \xe2\x80\x94 \n\n(i) Whole meal bread. \n(2) Honey. \n\n\n\n(3) Treacle. \n\n(4) Most fruits, especially^ \n\n\n\nDRUGS ACTING ON DIGESTIVE APPARATUS. 6 1 \n\n\n\n(5) Tamarind, \n\n\n(10) Cassia fistula. \n\n\n(6) Fig, \n\n\n(11) Sulphur. \n\n\n(7) Prune, and \n\n\n(12) Magnesium oxide \n\n\n(8) Stewed apples. \n\n\n(magnesia). \n\n\n(9) Manna. \n\n\n(13) Olive oil. \n\n\n\n(14) Castor oil (small doses). \n\nMost of these are well known domestic remedies, and many \nof them are habitually used as articles of diet by persons in- \nclined to constipation. Ergot, physostigma, nux vomica, bella- \ndonna, hyoscyamus, and stramonium are also laxatives, but are \nnot used except under medical orders. Nux vomica is thought \nto increase the tone of the intestine, and is frequently prescribed \nin association with purgatives. In small doses belladonna in- \ncreases peristaltic movements, for the reason that it paralyzes \nthe inhibitory fibres of the splanchnics. In moderate doses, \nhowever, it completely arrests peristalsis, and it is largely given \nfor this purpose, especially in combination with opium. Hyos- \ncyamus has a similar action, and in small doses is frequently \ncombined with the stronger purgatives in order to counteract \nthe irregular contractions they induce, and thus prevent griping. \n\nErgot and physostigma are almost never employed for their \nlaxative effect. Ergot, however, so often produces diarrhoea \nthat its purgative action should be kept in mind. \n\nSimple Purgatives. \xe2\x80\x94 These are somewhat more powerful in \ntheir action than laxatives; promoting peristalsis and also in- \ncreasing intestinal secretion. Some of the laxatives, as castor \noil and magnesia, when given in large doses act as simple \npurgatives. \n\n\n\nThe simple purgatives are \xe2\x80\x94 \n\n(1) Aloes. \n\n(2) Rhubarb. \n\n(3) Frangula. \n\n\n\n(4) Cascara sagrada. \n(s) Senna. \n(6) Oxgall. \n\n\n\nAll of these are constantly prescribed, and each has its spe- \ncial indications, which will be pointed out when their several \nactions are described. \n\n\n\n620 PHARMACOLOGY AND THERAPEUTICS. \n\nDrastic Purgatives, often called Cathartics. \xe2\x80\x94 These cause \nmarkedly increased secretion and peristaltic movements, and in \nlarge doses severe irritation of the intestine, characterized by \nexcessive secretion of mucus, pronounced vascular dilatation \xe2\x80\x94 \npossibly haemorrhage \xe2\x80\x94 and profuse loose stools. This condi- \ntion is attended with intense abdominal pain and tends to pro- \nduce collapse. It is customary to prescribe hyoscyamus or bel- \nladonna with these drugs on account of the irregular peristalsis \nand severe griping pain which would otherwise be induced. \nThe drastic purgatives are as follows : \n\n\n\n(i) Calomel. \n\n(2) Podophyllum. \n\n(3) Leptandra. \n\n(4) Aloes. \n\n(5) Jalap. \n\n(6) Scammony. \n\n\n\n(7) Gamboge. \n\n(8) Oil of turpentine. \n\n(9) Colocynth. \n\n(10) Elaterium. \n\n(11) Croton oil. \n\n\n\nThe most powerful are placed last. Some, as jalap, elaterium and \nscammony, are often called hydragogue, because of the large amount of \nsecretion they excite. \n\nTherapeutics. \xe2\x80\x94 These drugs are very useful in severe consti- \npation, and are also frequently given for the purpose of with- \ndrawing fluid from the body in consequence of the watery \nevacuations they occasion. Thus, for instance, jalap is in con- \nstant use to fulfill this indication in Bright\'s disease. \n\nSaline Purgatives. \xe2\x80\x94 The action of these is obscure. They \ndiffer from the vegetable purgatives in not inducing intestinal \nirritation, unless when given in very large quantities. They \nare absorbed from the intestine very slowly, probably because \nthey fail to penetrate into the cells, just as the salts of the heavy \nmetals fail to penetrate the red blood-corpuscles. There being \na distinct affinity between the intestinal epithelium and sodium \nchloride, but only a much weaker one between it and the saline \ncathartics, the latter do not permeate it. It seems certain that \nthese cathartics very greatly increase the secretion of intestinal \nfluid, and hinder its reabsorption, so that a large amount of it \n\n\n\nDRUGS ACTING OX DIGESTIVE APPARATUS. 621 \n\naccumulates in the intestine. Secretion goes on till the fluid in \nthe intestine has become a 5 or 6 per cent, solution of the drug, \nso that if a very concentrated solution is given, much intestinal \nfluid is secreted. This tends to excite peristalsis mechanically, \nand, in addition, a salt stimulation results from the withdrawal \nof liquid and salts from the cells, as well as from the slight \nabsorption of the salt itself; consequently there are produced \nan increased quantity and number of stools of fluid consistency. \nIt has been denied that catharsis results if the salts are in- \njected into the blood, but in medical practice it has been re- \npeatedly demonstrated that magnesium sulphate, administered \nhypodermatically, purges. It is possible that other salines may \nact similarly. The saline purgatives are \xe2\x80\x94 \n\n(1) Potassium and sodium tar- (5) Sodium tartrate. \n\ntrate. (6) Sodium citro-tartrate. \n\n(2) Potassium bitartrate. (7) Sodium citrate. \n\n\n\n(3) Potassium sulphate. \n\n(4) Sodium sulphate. \n\n\n\n(8) Sodium phosphate. \n\n(9) Magnesium sulphate and \n\nother salts. \n\n\n\nTherapeutics. \xe2\x80\x94 These are very largely used as habitual pur- \ngatives and such salts constitute the essential ingredient of the \nvarious cathartic mineral waters, such as Hunyadi Janos, \nApenta, Pullna, Friedrichshall, /Esculap, Rubinat, Villacabras, \netc. The most efficient way of using them is to add some hot \nwater to the required dose of the salt or mineral water in a \ntumbler and slowly sip it in the morning. \n\nCholagogue purgatives will be considered under the heading \nof Drugs Acting on the Liver. \n\nEnemata. \xe2\x80\x94 Any fluid preparation, injected into the rectum \nis called an enema. It is customary to give purgatives in this \nway when there is danger of their exciting nausea or when, in \nconsequence of peritonitis or of obstruction, ulceration or other \naffection of the intestines, it is unadvisable to administer them \nby the mouth. Castor oil, olive oil. soap, aloes and magnesium \nsulphate are among the substances most commonly employed \n\n\n\n62 2 PHARMACOLOGY AND THERAPEUTICS. \n\nfor purgative enemata, enough of the vehicle selected for the \ninjection being used to make an enema of at least 350 c.c. \n(}i pint). Such large enemata act mainly by distending the \nbowel and thus exciting peristalsis, though the soap or other \nagent employed no doubt has an irritating effect in addition. \nAttention has recently been drawn, however, to the use of pur- \ngatives by enema with only 4 to 12 c.c. (1 to 3 teaspoonfuls) \nof fluid. With the small enema, of course, there is no distention, \nand the movement is produced solely by the irritant action of \nthe drug that is given in it. It is found that colocynthine \n(.01 to .03 gm.; { to/ 2 gr.), aloin (.4 to .5 gm. ; 7 to 8 gr.), \nand cathartinic acid (.6 gm. ; 10 gr.), dissolved in glycerin, will \ncause purgation in periods varying from half an hour to twelve \nhours. Colocynthine acts the most promptly and efficiently, \nthe other two being certain in their effects only when the con- \nstipation present is of moderate degree. The action of the \npurgatives is attributed to absorption from the rectum. A \nteaspoonful (4 c.c.) of glycerin injected into the rectum, or the \nsame amount given as a suppository, often promptly opens the \nbowels. \n\n(d) Intestinal Antiseptics. \xe2\x80\x94 These are believed to check fer- \nmentation and putrefaction in the intestines and are \xe2\x80\x94 \n\n\n\nchlo- \n\n\n\n(1) Naphthol. \n\n\n(7) Creosote. \n\n\n(2) Bismuth naphtholate. \n\n\n(8) Corrosive mercuric \n\n\n(3) Naphthalene. \n\n\nride. \n\n\n(4) Bismuth salicylate. \n\n\n(9) Oil of turpentine. \n\n\n(5) Phenyl salicylate. \n\n\n(10) Silver nitrate. \n\n\n(6) Chlorine. \n\n\n\n\n\nNaphthol has been shown to destroy micro-organisms in situ. \nBismuth naphtholate has not the irritating properties of naph- \nthol, but appears to be equally effective. When pure, naphtha- \nlene is not absorbed, it does not cause toxic symptoms, nor is \nthere any change in the urine. Phenyl salicylate, a combina- \ntion of salicylic and carbolic acids, decomposes only in an alka- \nline solution, and this is useful for action in the small intestine, \n\n\n\nDRUGS ACTING ON DIGESTIVE APPARATUS. 623 \n\nChlorine water has been used for the disinfection of the intes- \ntine in typhoid fever. Creosote is valuable if administered in \nthe form of enteric pills, which are soluble only in the intestinal \nfluids. Corrosive mercuric chloride is too poisonous for use, \nsave in exceptional cases. Brilliant success has been achieved \nwith oil of turpentine in the treatment of typhoid fever. Silver \nnitrate has a limited use as an antiseptic, in its local application \nto dysenteric ulcerations within reach in the rectum and sig- \nmoid flexure. The intelligent use of the foregoing drugs has \ngreatly improved the success of the treatment of the various \nforms of enteritis, diarrhoea, colitis, dysentery and typhoid \nfever. \n\nIntestinal Astringents. \xe2\x80\x94 These may be described under the \nfollowing heads : \n\nAstringents acting on the vessels of the intestine. \xe2\x80\x94 These are \nthe same as those acting on vessels generally. Those employed \nfor their action on the intestine are \xe2\x80\x94 \n\n(1) Lead salts. (3) Alum. \n\n(2) Dilute solutions of silver! (4) Diluted sulphuric acid. \n\nsalts. \n\nAstringents coagulating albuminous fluids and thus constrict- \ning the vessels: \xe2\x80\x94 \n\n\n\n(1) Tannic acid, and all sub- \n\nstances containing it, as \xe2\x80\x94 \n\n(2) Krameria, \n\n(3) Kino, \n\n(4) Haematoxylon, \n\n(5) Cinnamon, \n\n(6) Gambir, and \n\n\n\n(7) Eucalyptus gum. \n\n(8) Lead salts, \n\n(9) Silver salts, \n\n(10) Zinc salts, \n\n(11) Bismuth salts, \n\n(12) Copper salts, and especially \n\n(13) Ferric salts. \n\n\n\nAstringents diminishing the amount of intestinal fluid se- \ncreted : \n\n\n\n(1) Opium. (3) Lead salts. \n\n(2) Coto. (4) Calcium salts. \n\nThe precise action of these is obscure, but it is probable that \noperate in the way indicated. \n\n\n\nthey \n\n\n\n624 PHARMACOLOGY AND THERAPEUTICS. \n\n\n\nAstringents diminishing the contractions of the muscular coat \nof the intestines: \n\n\n\n(1) Opium. \n\n(2) Belladonna. \n\n(3) Hyoscyamus. \n\n(4) Stramonium. \n\n\n\n(5) Lead salts. \n\n(6) Lime. \n\n(7) Bismuth salts. \n\n\n\nTherapeutics. \xe2\x80\x94 The most important point in the treatment of \ndiarrhoea is to remove the cause, if possible. Not uncommonly \nthe cause is the presence of irritating matters in the intestine, \nand a mild purgative, such as castor oil or rhubarb, is indicated \nto remove them. In many instances a certain amount of en- \nteritis appears to be present in diarrhoea, and remedies serving \nto constrict the dilated vessels and to diminish intestinal move- \nments and secretion are called for. Hence, it is often advan- \ntageous to combine two or more astringents. Opium has long \nbeen recognized as an agent of very great value in diarrhceal \ndiseases, and is a very frequent ingredient in prescriptions em- \nployed for them. In such troubles, however, it must be remem- \nbered that drugs constitute only a small part of the treatment. \nIt is. essential that the diet should be very carefully regulated, \nand if the case is at all severe, absolute rest and attention to \nkeeping the patient warm are called for. If there is a per- \nsistent cause, as tubercular ulceration, palliation of the symp- \ntoms is generally all that can be looked for. \n\nE. Drugs Acting on the Liver. \xe2\x80\x94 The liver has several distinct \nfunctions; viz.: (a) to secrete bile; (b) to form and store up \nglycogen; (c) to form urea; (d) to excrete substances absorbed \nfrom the intestine; and (e) to destroy poisonous substances \nabsorbed from the intestine. \n\n1. Drugs Influencing the Secretion of Bile. \xe2\x80\x94 Because an in- \ncreased amount appears in the faeces it does not necessarily \nfollow that more bile is secreted. Thus, it may be that the \ngall bladder and ducts have been thoroughly emptied, or that \nthe bile which has been poured into the duodenum has been \n\n\n\nDRUGS ACTING ON DIGESTIVE APPARATUS. \n\n\n\n625 \n\n\n\nswept along quickly before reabsorption, which is ordinarily \nrapid, has had time to take place. Drugs which increase the \namount of bile actually secreted are called direct cholagogues. \nThey are also sometimes spoken of as hepatic stimulants, but \nthis is an unsatisfactory designation on account of the liver\'s \nhaving so many different functions. Drugs which simply lead \nto a larger amount of bile being found in the faeces, without \nany additional secretion, are called indirect cholagogues. \n\nDirect Cholagogues. \xe2\x80\x94 These have been studied in fasting, \ncurarized dogs. A cannula having been inserted into the bile- \nduct, in order to conduct the fluid outside the body, the amount \nof bile secreted before and after the administration of the drug \nunder experiment is noted. A fasting state is essential because \nfood itself causes a considerable increase in the biliary flow. \n\n\n\nDirect cholagogues (the most powerful being placed first) are- \n\n\n\n(1) Euonymus. \n\n\n(11) Ipecacuanha. \xe2\x80\xa2 \n\n\n(2) Sodium benzoate. \n\n\n(12) Diluted nitric acid. \n\n\n(3) Sodium salicylate. \n\n\n(13) Diluted nitrohydrochloric \n\n\n(4) Podophyllin. \n\n\nacid. \n\n\n(5) Iridin. \n\n\n(14) Colocynth. \n\n\n(6) Leptandra, \n\n\n(15) Colchicum. \n\n\n(7) Corrosive mercuric chlo- \n\n\n(16) Potassium sulphate. \n\n\nride. \n\n\n(17) Rhubarb. \n\n\n(8) Sodium sulphate. \n\n\n(18) Jalap. \n\n\n(9) Sodium phosphate. \n\n\n(19) Scammony. \n\n\n(10) Aloes. \n\n\n(20) Diluted arsenic trioxide. \n\n\n\nThere are individual differences among direct cholagogues. Some \nincrease the fluidity of the bile, while others have the opposite effect. \nEuonymin, sodium benzoate, sodium salicylate, Harrogate old sulphur \nspring, and Carlsbad water, all markedly increase both the total quan- \ntity and the solids. Podophyllin and iridin, on the other hand, increase \nthe solids without affecting the quantity. \n\n\n\nIndirect Cholagogues. \xe2\x80\x94 These appear to stimulate the upper \npart of the jejunum and the lower part of the duodenum, thus \nsweeping the bile on before there is time for it to be re- \nabsorbed. \n\n\n\n626 PHARMACOLOGY AND THERAPEUTICS. \n\nThey are \xe2\x80\x94 (1) Mercury; (2) most Cathartic purgatives, especially \nCalomel. \n\nTherapeutics. \xe2\x80\x94 Cholagogues are used for cases of digestive \nderangement in which hepatic disorder seems to be the cause \nof the trouble, and in order to secure the excretion of the bile, \nas well as the secretion of a proper amount, it is often advanta- \ngeous to combine direct and indirect cholagogues. Bile being \na stimulant to peristalsis, all cholagogues naturally have a pur- \ngative action. In cases of dyspepsia in which the liver is at \nfault careful attention to the diet is a matter of importance, and \nactive exercise, such as horseback riding, rowing, etc., is of \nservice in promoting the expulsion of bile from the gall-bladder \nand ducts. \n\nAnti-Cholagogues. \xe2\x80\x94 These decrease the quantity of the bile \nsecreted, and are sometimes called hepatic depressants. Calo- \nmel, castor oil, gamboge, magnesium sulphate, opium and lead \nacetate have something of this effect, but it is not sufficiently \npronounced to interfere with the therapeutic actions for which \nthey are employed. \n\n2. Drugs modifying the glycogenic function of the liver. \xe2\x80\x94 We \nwill here refer to those drugs which cause sugar to appear in \nthe urine, and to those drugs which diminish the glycogenic \nfunction of the liver. \n\nDrugs causing Sugar to appear in the Urine. \xe2\x80\x94 Until re- \ncently it was assumed that all these drugs acted on the liver, \nprobably by increasing the amount of sugar made from the \nhepatic store of glycogen; but now we have reasons for think- \ning that sometimes the pancreas may be the organ at fault in \ndiabetes, for its excision causes sugar to appear in the urine, \nand other symptoms of diabetes; also it has been suggested \nthat perhaps some perversion of processes going on in muscles \nmay cause diabetes. Therefore it is rash to assume that all \ndrugs causing sugar to appear in the urine (glycosuria) must \nact on the liver. What little can be stated as to the mode of \naction of these drugs will be given when each individual drug \nis considered. \n\n\n\nCALUMBA. 62J \n\nThe drugs stated to cause glycosuria have already been mentioned \n(see p. 515). \n\n\' Depressants of the Glycogenic Function. \xe2\x80\x94 Phosphorus, arsenic, \nand antimony diminish and may even arrest the formation of gly- \ncogen by the liver ; they also cause fatty degeneration of the organ. In \nmany instances of diabetes opium, morphine and codeine have a \nmarked effect in diminishing the quantity, of sugar in the urine. \n\n3. Drugs modifying the formation of urea by the liver. \xe2\x80\x94 The \nquantity of urea excreted by the urine is increased by phos- \nphorus, arsenic, antimony, ammonium chloride, and iron. Phos- \nphorus may also lead to the appearance in the urine of leucin \nand tyrosin. There is some evidence that this drug causes an \nincrease of the urea through its action on the liver, for in phos- \nphorus poisoning that organ undergoes extreme fatty degenera- \ntion, and jaundice supervenes. Whether the other drugs act \nthrough the liver is uncertain, but antimony and arsenic, like \nphosphorus, are capable of producing general fatty degenera- \ntion. Very large doses of all these substances are required to \nincrease the amount of urea in the urine, and they are not \nemployed therapeutically for this purpose. \n\nOpium, colchicum, alcohol and quinine are among the drugs \nstated to increase the quantity of urea excreted. \n\nC. Drugs Acting on the Stomach. \n\n(a) Stomachics. \n\nCALUMBA. \n\nCALUMBA.\xe2\x80\x94 Calumba. (Columbo.) Dose, 2 gm.; 30 gr. \n\nPreparations. \n\n1. Fluidextractum Calumbae. \xe2\x80\x94 Fluidextract of Calumba. \nDose, 2 c.c; 30 ni . \n\n2. Tinctura Calumbae. \xe2\x80\x94 Tincture of Calumba. Dose, 4 c.c; \n1 fl. dr. \n\nAction of Calumba. \nExternal. \xe2\x80\x94 Calumba is slightly antiseptic and disinfectant. \nInternal. Mouth. \xe2\x80\x94 Calumba is a typical simple bitter. It \n\n\n\n628 PHARMACOLOGY AND THERAPEUTICS. \n\nirritates the terminations of the gustatory nerves in the papillae \nand mucous membrane of the tongue, increasing the appetite \nand reflexly stimulating the salivary and gastric secretions. \nThe reflex action of bitters has recently been particularly stud- \nied. In these experimental researches there was employed Pav- \nlow\'s method of sham feeding in a dog in which oesophagotomy \nhad been performed and a gastric fistula also established. The \nbitter substances, therefore, did not pass into the stomach, and \nthe reflex effects of their presence in the mouth could be accu- \nrately judged. It was found that if a little wad of wool soaked \nin tincture of gentian was put into the mouth immediately \nbefore food was administered, a marked stimulant effect upon \ngastric secretion resulted; but if the bitter was used fifteen to \nthirty minutes before the meal it was quite inefficacious. It is \nconcluded, therefore, that these substances have the power of \nrendering gustatory sensations more acute and of exercising a \ntemporary stimulant effect upon gastric secretion; for this pur- \npose they should be given in small doses and in the form of \ntinctures (.60 to 1.20 c.c. ; 10 to 20 drops). \n\nG astro -intestinal Tract. \xe2\x80\x94 The gastric nerves are probably \nstimulated, and a sort of artificial hunger produced. The diges- \ntion is improved, as there is vascular dilatation, and the secre- \ntion of gastric juice is increased by this, as well as by the \narrival in the stomach of an increased amount of alkaline \nsaliva; while the gastric movements also appear to be some- \nwhat augmented. The stronger bitters have some tendency to \nincrease intestinal peristalsis and act on the bowels. The secre- \ntions of the pancreas and the bile are unaffected by any of them. \nThey are more or less antiputrefactive, and, by removing mor- \nbid states of the intestinal mucous membrane, they favor assim- \nilation. Too large doses are apt to interfere with digestion, \nand their long-continued use induces gastric catarrh and con- \nsequent indigestion. Calumba is rapidly absorbed. Like some \nother bitters, it is feebly anthelmintic. \n\nBlood and Circulation. \xe2\x80\x94 The leucocytes of the blood are \nmarkedly augmented, which may possibly assist in the absorp- \ntion of food, and the red corpuscles are also stated to be in- \n\n\n\nCALUMBA. 629 \n\ncreased. Calumbin, when injected intravenously, has the effect \nof increasing the blood-pressure by stimulation of the vasomotor \ncentre. \n\nBerberine, an alkaloid found in calumba and many other vege- \ntable drugs, is, in large doses, an irritant which gives rise to \na yellow discoloration of the intestines and urine. It is never \nfatal when given by the mouth, but when injected subcutane- \nously or intravenously it causes convulsions and paralysis, and \ndeath is likely to result by asphyxia from failure of the respi- \nratory centre. \n\nTherapeutics of Calumba. \n\nCalumba and other simple bitters are used with good effect \nin atonic dyspepsia, and are often of material service in cases \nof anaemia and weakness, and in convalescence from acute dis- \neases. In general, they may be said to be most advantageous \nin debilitated conditions in which the stomach participates in a \nfeebleness of all the various organs. Calumba is the mildest \nagent of its class, and may be used with safety in many in- \nstances when other bitters would be too irritating. The tinc- \nture in doses of a few drops and the infusion in 4 c.c. (1 fl. dr.) \ndoses are occasionally used for the relief of the vomiting of \npregnancy and of seasickness. In diarrhoea due to relaxation \nof the mucous membrane (without the presence of any inflam- \nmation), and in the relaxation of the bowels following acute \naffections of the intestines, the tincture may often be employed \nwith benefit. In such cases it is sometimes combined with the \ntincture of deodorized opium. To permanently cure a disposi- \ntion to the accumulation of flatus in the intestines an infusion* \nis highly recommended which is made with calumba, ginger, \nsenna and boiling water. Thread worms may be treated by the \nrectal injection (the patient being in the knee-chest position) \nof 240 c.c. ( J / 2 pint) of the infusion (B. P.), which is made \nwith calumba, 1 ; cold water (to avoid extracting the starch), 20. \n\nThe use of bitters ought to be combined, whenever possible, \nwith measures designed to relieve the cause of the dyspepsia. \nThey should not be given in too concentrated form, nor em- \n\n\n\n63O PHARMACOLOGY AND THERAPEUTICS. \n\nployed for too long a time continuously. They are contra- \nindicated in acute and subacute inflammation of the stomach, or \nwhen the secretion of gastric juice is diminished as the result \nof organic disease. Neither should they be prescribed as stom- \nachics during the continuance of acute febrile diseases. Should \nthe appetite remain good, although the digestion is impaired, it \nwill usually indicate that the indigestion is intestinal, and rem- \nedies other than the bitters are called for. \n\nGENTIAN. \nGENTIANA. \xe2\x80\x94 Gentian. Dose, 1 gm.; 15 gr. \n\nPreparations. \n\n1. Extractum Gentianae. \xe2\x80\x94 Extract of Gentian. Dose, 0.250 \ngm. (250 milligm.) ; 4 gr. \n\n2. Fluidextractum Gentianae. \xe2\x80\x94 Fluidextract of Gentian. Dose, \n1 c.c.; 15 TTl. \n\n3. Tinctura Gentianae Composita. \xe2\x80\x94 Compound Tincture of \nGentian. Dose, 4 C.C.; 1 fl. dr. \n\nAction of Gentian. \n\nGentian has the same action as calumba and other simple \nbitters. \n\nTherapeutics of Gentian. \n\nIt is given in the same kinds of cases as the other drugs of \nits class, and, on account of its more agreeable flavor, it is \nperhaps more widely used than any of the rest. The compound \ntincture is esteemed an excellent vehicle for the administration \nof codliver oil, the digestion and assimilation of which it serves \nto promote. For potassium iodide the compound infusion (B. \nP. : Gentian, 8 ; dried bitter orange peel, 3 ; cardamom, 1 ; alco- \nhol \xe2\x80\x94 45 per cent. \xe2\x80\x94 80) is a good vehicle in cases where its tonic \neffects would be useful. \n\nQUASSIA. \n\nQUASSIA.\xe2\x80\x94 Quassia. Dose, 0.5 gm.; 7y 2 gr. \n\n\n\nCALAMUS. 63 I \n\nPreparations. \n\n1. Extractum Quassiae. \xe2\x80\x94 Extract of Quassia. Dose, 0.065 gm. \n(65 milligm.) ; 1 gr. \n\n2. Fluidextr actum Quassiae. \xe2\x80\x94 Fluidextract of Quassia. Dose, \n0.5 c.c; 8 m.. \n\n3. Tinctura Quassiae. \xe2\x80\x94 Tincture of Quassia. Dose, 2 c.c; \n30 TTl . \n\nAction of Quassia. \n\nQuassia is an aromatic bitter stomachic, which has the same \naction as calumba and gentian. In doses of .12 gm. (2 gr.) \nquassin is said in many individuals to produce burning in the \nthroat and stomach, discomfort, headache, nausea and vom- \niting. \n\nTherapeutics of Quassia. \n\nAs it contains no tannic acid, quassia is often prescribed with \niron. On account of its intense bitterness it is objectionable \nto some patients, but it is a very useful remedy in the class of \ncases in which these bitters are given. It is regarded as espe- \ncially serviceable in the dyspepsia of inebriates, and whenever \nthere are much relaxation and digestive torpor it is apt to be \nefficient as a stomachic tonic. A goblet turned out of quassia- \nwood may be used, by allowing water to stand in it for a num- \nber of hours, for making an extemporaneous infusion of the \ndrug. The infusions of quassia, gentian and calumba are fre- \nquently employed as vehicles for the administration of acids or \nalkalies, according to the requirements of the case, in gastric \nindigestion. 250 c.c. (y 2 pint) of the infusion (1 to 100 of cold \nwater to avoid extraction of too much of the bitter principle), \ninjected into the rectum, with the patient in the knee-chest posi- \ntion, may be used with advantage against thread-worms. \n\nCALAMUS. \nCALAMUS. \xe2\x80\x94 Calamus. (Sweet Flag.) Dose, 1 gm.; 15 gr. \n\nPreparation. \nFluidextractum Calami. \xe2\x80\x94 Fluidextract of Calamus. Dose, 1 \nc.c; 15 TTL. \n\n\n\n632 PHARMACOLOGY AND THERAPEUTICS. \n\nAction of Calamus. \nSweet flag is a simple bitter and feeble aromatic. \n\nTherapeutics of Calamus. \nIt is used with advantage in pain or uneasiness in the stom- \nach or bowels arising from flatulence, or as an adjuvant to \npurgative medicines. \n\nBARBERRY. \n. BERBERIS.\xe2\x80\x94 Berberis. (Barberry.) Dose, 2 gm.; 30 gr. \n\nPreparation. \nFluidextractum Berberidis. \xe2\x80\x94 Fluidextract of Berberis. Dose, \n2 c.c; 30 Hi. \n\nAction of Barberry. \nIt is in moderate doses a stomachic tonic, and somewhat \nastringent. It is also credited with alterative qualities. In \nlarge amounts it is a gastro-intestinal irritant. \n\nTherapeutics of Barberry. \nLocally it has been used in conjunctivitis, and internally in \na variety of chronic conditions for its alterative effect. \n\nCASCARILLA. \n\nUnofficial Preparations. \n\nCascarilla.\xe2\x80\x94 Cascarilla (U. S. P., 1890). Dose, 0.60 to 2 \ngm.; 10 to 30 gr. \n\nInfusum Cascarillse. \xe2\x80\x94 Infusion of Cascarilla. Dose, 30 c.c; \n1 11. oz. \n\nTinctura Cascarillae. \xe2\x80\x94 Tincture of Cascarilla. Dose, 2 to 8 \nc.c; y 2 to 2 fl. dr. \n\nAction of Cascarilla. \nCascarilla has astringent properties, on account of its tannic \nacid, and, because of its bitter principle cascarillin, it improves \nthe appetite and digestion like calumba, while the volatile oil \n\n\n\nCUSPARIA. 633 \n\nin its composition gives it an increased stomachic and carmina- \ntive effect. It is an agreeable aromatic tonic, without unpleas- \nant bitterness. Large doses are somewhat irritant. \n\nTherapeutics of Cascarilla. \nIts medicinal uses are similar to those of calumba. It is some- \nwhat difficult to dispense, as the infusion (1 to 20) quickly de- \ncomposes unless the tincture (1 to 15) is added to it, and acids \nprecipitate the resin from the tincture. \n\nCHIRATA. \nCHIRATA.\xe2\x80\x94 Chirata. (Chiretta.) Dose, 1 gin.; 15 gr. \n\nPreparation. \nFluidextractum Cbiratse. \xe2\x80\x94 Fluidextract of Chirata. Dose, 1 \nc.c; 15 1TL- \n\nUnofficial Preparation. \nTinctura Chiratae (U. S. P., 1890). \xe2\x80\x94 Tincture of Chirata. \nDose, 2 to 8 c.c; y 2 to 2 fl. dr. \n\nAction of Chirata. \nChirata is a simple bitter, like calumba. \n\nTherapeutics of Chirata. \nIt has the same uses as calumba and gentian, and in India, \nwhere it is more frequently employed than elsewhere, it is \ngiven considerably as a substitute for cinchona. It diminishes \nflatulency and acidity, and is thought to be especially service- \nable in the dyspepsia of gouty subjects. As it contains no tan- \nnic acid, it can be prescribed in combination with the iron salts. \n\nCUSPARIA. \n\nUnofficial Preparation. \nCusparise Cortex.\xe2\x80\x94 Cusparia Bark. (Angustura Bark.) Dose, \n.60 to 2.40 gm.; 10 to 40 gr. \n\n\n\n634 PHARMACOLOGY AND THERAPEUTICS. \n\nAction of Cusparia. \nCusparia bark is an aromatic bitter. It has been supposed \nto possess valuable antiperiodic properties, but there seems no \nmore reason to ascribe such action to it than to the simple \nbitters. In large quantities it is a gastro-intestinal irritant. \n\nTherapeutics of Cusparia. \nIt is a stimulant to digestion, and in order to prevent its \ncausing nausea it is often combined with aromatics. It is given \nin large doses as an antiperiodic in South America, and it is \nsaid to be peculiarly efficacious in bilious diarrhoeas and trop- \nical dysentery. It is used for the manufacture of Angustura \nBitters. \n\nSERPENTARIA. \n\nSERPENTARIA.\xe2\x80\x94 Serpentaria. (Virginia Snakeroot.) Dose, 1 \ngm.; 15 gr. \n\nPreparations. \n\n1. Fluidextractum Serpentariae. \xe2\x80\x94 Fluidextract of Serpentaria. \nDose, 1 c.c.; 15 n\\. \n\n2. Tinctura Serpentariae. \xe2\x80\x94 Tincture of Serpentaria. Dose, 4 \nc.c; 1 fl. dr. \n\nAction of Serpentaria. \nSerpentaria is an astringent bitter and stimulating expector- \nant. In large doses it causes nausea, vomiting, colic, flatulence \nand rectal tenesmus, with frequent, but not watery stools. The \nirritant action appears to produce gas rather than fluid. It is \nslightly diuretic and diaphoretic. \n\nTherapeutics of Serpentaria. \nIt was formerly regarded as an antidote to snake poison, but \nis without value in this capacity, and a number of other virtues \nhave been attributed to it which it quite likely does not possess. \nIt may be employed as a bitter stomachic, and is of consider- \nable utility as a stimulant expectorant in capillary bronchitis \nand in pneumonia of low grade, when ammonium carbonate is \ncombined with it. It is seldom administered alone. \n\n\n\nCANELLA. 63 5 \n\nDANDELION. \n\nTARAXACUM.\xe2\x80\x94 Taraxacum. (Dandelion.) Dose, 8 gm.; 120 gr. \n\nPreparations. \n\n1. Extractum Taraxaci. \xe2\x80\x94 Extract of Taraxacum. Dose, 1 \ngm.; 15 gr. \n\n2. Fluidextractum Taraxaci. \xe2\x80\x94 Fluidextract of Taraxacum. \nDose, 8 c.c; 2 fl. dr. \n\nAction of Dandelion. \nDandelion is a simple bitter, promoting appetite and diges- \ntion. For a long time it was supposed to have some action in \nincreasing the secretion of bile, but it has been shown that this \nidea has no foundation in fact. It is a mild laxative, however, \nand as such may, by reflex stimulation, have some effect in tend- \ning to evacuate the gall bladder. The vulgar name by which \ndandelion is known both in England and France suggests that \nit may be diuretic. \n\nTherapeutics of Dandelion. \nIt is not nearly as frequently employed now as formerly, but \nis still occasionally prescribed as a laxative in catarrhal jaun- \ndice, in ascites from hepatic disease, and in some forms of dys- \npepsia. By German physicians particularly it has been given \nin combination with ammonium chloride. Its practical utility \nas a diuretic seems to be very limited. \n\nCANELLA. \n\nUnofficial Preparation. \n\nCanellae Cortex. \xe2\x80\x94 Canella Bark. Dose, 1 to 4 gm.; 15 to \n60 gr. \n\nAction of Canella. \nCanella is an aromatic bitter stomachic. \n\nTherapeutics of Canella. \nIt is not much used. When it is prescribed, it is almost in- \nvariably in association with other bitters or, for its tonic action, \nwith purgatives which tend to debilitate. \n\n\n\n636 PHARMACOLOGY AND THERAPEUTICS. \n\nBAEL FRUIT. \n\nUnofficial Preparation. \nBelae Fructus. \xe2\x80\x94 Bael Fruit. Dose, 1 to 2 gm.; 15 to 30 gr. \n\nAction of Bael Fruit. \nVery little is known in regard to the principles or action of \nbael fruit, but it is thought that it may perhaps have some effect \nas a bitter; it appears to be slightly astringent. \n\nTherapeutics of Bael Fruit. \nIn India bael fruit, although it contains very little tannic acid, \nis a very popular remedy for diarrhoea and dysentery, especially \nwhen unattended by fever. Various preparations of it are \nemployed, particularly a decoction boiled down until the water \ncontaining the fresh fruit is reduced to one-quarter its original \nquantity, and sometimes the fruit is eaten in its natural state. \nThe imported bael fruit is probably of no therapeutic value. \n\nCLOVES. \n\nCARYOPHYLLUS.\xe2\x80\x94 Cloves. Dose, 0.250 gm. (250 milligm.) ; \n4 gr. \n\nOLEUM CARYOPHYLLL\xe2\x80\x94 Oil of Cloves. Dose, 0.2 c.c; 3 m.. \nEUGENOL.\xe2\x80\x94 Eugenol. Dose, 0.2 c.c; 3 Til. \n\nUnofficial Preparations. \nInfusum Caryophylli. \xe2\x80\x94 Infusion of Cloves. Dose, 15 to 30 \nc.c; y 2 to 1 fl. oz. \nEugenol Acetamidum. \xe2\x80\x94 Eugenol Acetamide. \n\nAction of Cloves and Oil of Cloves. \nExternal. \xe2\x80\x94 Oil of cloves has antiseptic and parasiticidal \nproperties. Rubbed into the skin, or applied to mucous mem- \nbranes, it is rubefacient and irritant, producing hyperemia, and \nthe burning sensation to which it at first gives rise is followed \nby anaesthesia of the part. The action on the skin is mainly \none of sensory irritation. \n\n\n\n\n\n\nCLOVES. 637 \n\nInternal. Mouth. \xe2\x80\x94 In the mouth the effects just mentioned \nare naturally produced, and, in addition, the nerves of taste and \nsmell are stimulated and the salivary glands excited to increased \nsecretion. \n\nStomach. \xe2\x80\x94 Oil of cloves is preeminently stomachic and car- \nminative, and its gastric effects constitute the most important \npart of its action. It has the characteristic action of the vola- \ntile oils, appearing to induce dilatation of the blood-vessels, to \nstimulate the secretion of the gastric glands, and to accelerate \nthe movements of the stomach, in consequence of which there \nis more or less eructation of gas. The oil also acts as an anti- \nseptic here, as elsewhere, and it thus no doubt hinders the de- \nvelopment of yeasts and other organisms. As soon as it reaches \nthe stomach a grateful sensation of warmth is experienced, and \nits whole action in the organ tends to increase appetite and \ndigestion. By the stimulation of the gastric nerves the heart \nis reflexly stimulated to a certain extent, and the rate and force \nof the heart are consequently moderately increased. \n\nIntestine. \xe2\x80\x94 Similar effects are believed to be produced in the \nintestine, though it is not positively known whether the peri- \nstaltic movements of the latter are increased by the volatile \noils. At all events, flatulence and distention are relieved, an \neffect which may be due in part at least to the antiseptic action. \nIt is well known that the colic caused by some of the more pow- \nerful purgatives is much diminished by the administration with \nthem of oil of cloves and other volatile oils. It has been shown \nthat the intestine, like the stomach, absorbs more rapidly in the \npresence of small quantities of these oils. Oil of cloves, like \nothers of its class, is capable when given in sufficient quantity \nof exciting gastro-enteritis. \n\nExcretion. \xe2\x80\x94 Oil of cloves is absorbed from the intestine, and \nin the course of its excretion exerts more or less irritant action \non the kidneys and respiratory passages, the secretions of which \nit tends to disinfect. \n\nEugenol has the same general action as the oil of cloves, of % \nwhich it is one of the chief constituents. \n\n\n\n638 PHARMACOLOGY AND THERAPEUTICS. \n\nTherapeutics of Cloves and Oil of Cloves. \n\nExternal. \xe2\x80\x94 The expensiveness of oil of cloves is an objection \nto its free or frequent use. On account of its local anaesthetic \naction it is sometimes employed as an external application for \nneuralgias. It is more or less used in combination with other \nrubefacients, counter-irritants and antiseptics. It is of service, \nin an ointment made with lanolin, in some cases of eczema, \nand in lupus vulgaris its repeated application is said to cause \nseparation of the epithelium and retrocession of the nodules. \nAs a parasiticide it has been used for pediculosis. It is one \nof the remedies most commonly resorted to for the relief of the \npain of carious teeth, and is an important constituent of many \n" toothache drops." It is sometimes employed to give a pleas- \nant odor to liniments. \n\nInternal. \xe2\x80\x94 In cooking, cloves are largely used for seasoning. \nThe oil or infusion (B. P., 1 to 40) may be given as a stom- \nachic or as a carminative for the relief of gastric or intestinal \npain, and the oil is sometimes combined with preparations of \nscammony, of castor oil, and of colocynth, to prevent griping. \nIts aromatic qualities render it an agreeable adjuvant to other \nremedies besides purgatives, and in minute doses it has been \nsuccessfully given for severe vomiting. In gastric fermenta- \ntion the following combination has proved quite efficient: .06 \nc.c. (1 1T L) each of the oils of cloves, cinnamon and peppermint, \nwith .06 c.c. (1 ni) of creosote, administered three times a day \nin a soft capsule containing about ^6 c.c. (6 ^l) of olive oil. \n\nEugenol acetamide, a crystalline substance obtained from \neugenol-acetic-ethyl-ester by treating with a strong solution of \nammonia, has been used in dentistry and minor surgery. It is \nsaid to be not only an active antiseptic, but a powerful local \nanaesthetic, analogous to cocaine in its action. \n\nALLSPICE. \n\nPIMENTA. \xe2\x80\x94 Pimenta. (Allspice.) Dose, 1 gm.; 15 gr. \nOLEUM PIMENTO.\xe2\x80\x94 Oil of Pimenta. Dose, 0.2 c.c; 3 m,. \n\n\n\nNUTMEG AND MACE. 639 \n\nAction of Allspice. \nThe same as that of cloves and oil of cloves. \n\nTherapeutics of Allspice. \nThe uses, as well as the action, are the same as those of cloves \nand oil of cloves. \n\nNUTMEG AND MACE. \nMYRISTICA. \xe2\x80\x94 Nutmeg. Dose, 0.500 gm. (500 milligm.) ; 7Y 2 gr. \n\nPreparations. \nPulvis Aromaticus. \xe2\x80\x94 Aromatic Powder. Dose, 1 gm.; 15 gr. \nFluidextractum Aromaticum. \xe2\x80\x94 Aromatic Fluidextract. Dose, \n1 c.c.; 15 m,. \n\nOLEUM MYRISTIOdE.\xe2\x80\x94 Oil of Nutmeg. Dose, 0.2 c.c; 3 HI. \n\nUnofficial Preparations. \n\nSpiritus Myristicae. \xe2\x80\x94 Spirit of Nutmeg, U. S. P., 1890. \n(Essence of Nutmeg.) Dose, 0.06 to 0.18 C.C.; 1 to 3 TTj,. \n\nOleum Myristicae Expressum. \xe2\x80\x94 Expressed Oil of Nutmeg. \nDose, 0.10 to 0.30 gm.; 2 to 5 gr. \n\nMacis. \xe2\x80\x94 Mace (U. S. P., 1890). Dose, 0.30 to 1.20 gm.; 5 \nto 20 gr. \n\nAction of Nutmeg and Mace. \nOil of nutmeg has the same action as that of other aromatic \noils. Its effects after absorption appear to render it more toxic \nthan most volatile oils. In addition to its aromatic and carmina- \ntive qualities, it is possessed of considerable narcotic power, and, \ninjected into the circulation of the dog, it has been found to \nproduce profound sleep, with slowing of the circulation, and, \nif the dose is sufficiently large, loss of reflex activity. \n\nTherapeutics of Nutmeg and Mace. \nThe expressed oil of nutmeg may be rubbed on the skin as \na rubefacient in rheumatism, neuralgia and paralysis, and in \nplasters it is used as a sweet-smelling stimulant. For mild \n\n\n\n64O PHARMACOLOGY AND THERAPEUTICS. \n\ncases of ringworm a liniment composed of one part of the oil \nto three of olive oil may be employed as an elegant antipara- \nsiticide. In itching and painful haemorrhoids the following oint- \nment affords relief: Powdered nutmeg, 8; tannic acid, 4; pe- \ntrolatum, 31. Nutmeg and mace are much used in cooking, as \ntheir volatile oil renders them agreeable stomachics. In medi- \ncine powdered or grated nutmeg, or the volatile oil, is given as \na carminative and anodyne for the relief of nausea or colic \nand, combined with other remedies, of diarrhoea. The narcotic \nproperties of the drug make it of service at times in the treat- \nment of delirium tremens. \n\nCINNAMON. \nCINNAMOMUM SAIGONICUM.\xe2\x80\x94 Saigon Cinnamon. Dose, 0.250 \ngm. (250 milligm.) ; 4 gr. \n\nPreparations. \n\n1. Pulvis Aromaticus. \xe2\x80\x94 Aromatic Powder. Dose, 1 gm.; \n15 gr. \n\n2. Tinctura Cinnamomi. \xe2\x80\x94 Tincture of Cinnamon. Dose, 2 \nc.c; 30 tt\\.. \n\n3. Fluidextractum Aromaticum. \xe2\x80\x94 Aromatic Fluidextract. \nDose, 1 c.c; 15 Trt. \n\nCINNAMOMUM ZEYLANICUM.\xe2\x80\x94 Ceylon Cinnamon. Dose, 0.250 \ngm. (250 milligm.) ; 4 gr. \n\nOLEUM CINNAMOMI.\xe2\x80\x94 Oil of Cinnamon. Oil of Cassia. Dose, \n0.05 c.c; 1 TTt- \n\nPreparations. \n\n1. Aqua Cinnamomi. \xe2\x80\x94 Cinnamon Water. Dose, 16 cc; 4 \nfl. dr. \n\n2. Spiritus Cinnamomi. \xe2\x80\x94 Spirit of Cinnamon. Dose, 2 c.c; \n30 1TL. \n\nCINNALDEHYDUM.\xe2\x80\x94 Cinnamic Aldehyde. Dose, 0.05 C.C. J 1 1TL- \n\nUnofUcial Preparation. \nCinnamomum Cassia (U. S. P., 1890). \xe2\x80\x94 Cassia Cinnamon. \n(Cassia Bark.) Dose, 0.250 gm.; 4 gr. \n\n\n\nHORSE RADISH. 64 1 \n\nAction of Cinnamon. \nOil of cinnamon has the same action as other aromatic oils. \nThe bark, on account of its tannic acid, has considerable astrin- \ngent property. \n\nTherapeutics of Cinnamon. \nFinely powdered cinnamon is sometimes of service in arrest- \ning nausea and vomiting, and in doses of 4 to 6 gm. (60 to 90 \ngr.), night and morning, is said to be efficient in acute dysen- \ntery. Cinnamon is much used as an ingredient of carminative \nand astringent powders and mixtures, and is also combined with \npurgatives to prevent griping. On account of its tannic acid \nit is incompatible with iron preparations. It has been claimed \nthat in large doses it is of value in the palliative treatment of \ncarcinoma of various internal organs. Spirit of Cinnamon, \nalthough in full strength very irritant, has been utilized, when \ndissolved in retinol, as a surgical dressing, and it has consid- \nerable antiseptic value. For counter-irritation, especially in \nchildren, a spice plaster made by placing Aromatic Powder \nbetween two layers of flannel and moistening it with hot whis- \nkey or other form of alcohol, is sometimes employed. Spice \nplasters may also be obtained already prepared for use. Oil of \ncinnamon dissolved in one of the liquid petroleum preparations \nhas been recommended as an injection in gonorrhoea. \n\nHORSE-RADISH. \n\nUnofficial Preparation. \nArmoracia. \xe2\x80\x94 Horse-Radish. Dose, 1.20 to 2 gm.; 20 to 30 gr. \n\nAction of Horse-Radish. \nThe action of horse-radish is similar to that of mustard. It \nespecially stimulates the secretion of urine. \n\nTherapeutics of Horse-Radish. \nIt may be employed as a rubefacient and counter-irritant. \nAs a condiment it is used particularly with meats and raw \n42 \n\n\n\n642 PHARMACOLOGY AND THERAPEUTICS. \n\noysters. It is occasionally given in dropsy attended with en- \nfeebled digestion and general debility, and the addition of grated \nhorse-radish to cider renders it actively diuretic. The com- \npound spirit (B. P., scraped horse-radish root, 10; bitter orange \npeel, 10; nutmeg, 1; alcohol, 192; water, 196; dose, 4 to 8 c.c; \n1 to 2 fl. dr.) is used for flavoring and as a carminative. \n\nSUMBUL. \nSUMBUL.\xe2\x80\x94 Sumbul. (Musk Root.) Dose, 2 gm.; 30 gr. \n\nPreparations. \n\n1. Extractum Sumbul. \xe2\x80\x94 Extract of Sumbul. Dose, 0.250 gm. \n(250 milligm.) ; 4 gr. \n\n2. Fluidextractum Sumbul. \xe2\x80\x94 Fluidextract of Sumbul. Dose, \n2 c.c; 30 HI. \n\nUnofficial Preparation. \nTinctura Sumbul (U. S. P., 1890). \xe2\x80\x94 Tincture of Sumbul. \nDose, 4 to 16 c.c; 1 to 4 fl. dr. \n\nAction of Sumbul. \nLittle is known positively of the effects of sumbul on the \nsystem, but its action appears to resemble that of the volatile \noils in general, and it is usually classed with the substances \nhaving malodorous oils, such as asafetida and valerian. It is \nstomachic and carminative, and is regarded more particularly \nas an antispasmodic and nerve tonic. It stimulates appetite, \nimproves digestion, and allays irregular nerve action. It is \nsaid to directly influence the cerebro-spinal nerve centres, and \nthus control spasm, restlessness and incoordination of movement \ndependent upon disturbances of their circulation. Its resinous \nand volatile constituents, it is believed, are excreted by the \nmucous surfaces of the kidney and air-passages; stimulating \ntheir vessels and controlling excessive secretions. \n\nTherapeutics of Sumbul. \nSumbul may be given for its carminative effects in colic and \nflatulence. It is thought to be especially beneficial in depressed \n\n\n\nLAVENDER. 643 \n\nor excitable conditions of the nervous system, and among the \naffections in which it has been recommended are neuralgia, \nfacial, ovarian or sciatic, occurring in hysterical subjects, hys- \nteria in general, chlorosis, neurotic migraine, functional de- \nrangement of the heart, alcoholic and other insomnia, chorea, \ncatarrhal and spasmodic conditions of the respiratory and \ngenito-urinary tracts, nervous dyspepsia, neurasthenia, and the \nunrest of nervous females. It is usually associated with such \nother remedies as may be indicated by the condition present. \nIn Russia it is highly esteemed as a stimulant in atonic dyspep- \nsia, asthenic diarrhoea, dysentery and typhoid fever. \n\nLAVENDER. \n\nOLEUM LAVANDULA FLORUM.\xe2\x80\x94 Oil of Lavender Flowers. \nDose, 0.2 c.c; 3 n\\,. \n\nPreparations. \n\n1. Spiritus Lavandulae. \xe2\x80\x94 Spirit of Lavender. Dose, 2 c.c; \n30 TIL \n\n2. Tinctura Lavandulae Composita. \xe2\x80\x94 Compound Tincture of \nLavender. Dose, 2 C.C.; 30 1T1 . \n\nUnofficial Preparations. \nAqua Lavandulae. \xe2\x80\x94 Lavender Water. \n\nOleum Lavandulae.\xe2\x80\x94 Oil of Lavender. Dose, .06 to .30 c.c; \n1 to 5 n\\. \n\nAction of Oil of Lavender Flowers. \n\nThis has the same action as oil of cloves and other aromatic \nvolatile oils. \n\nTherapeutics of Oil of Lavender Flowers. \nIn nervous headache a few drops of the oil are sometimes \nrubbed upon the temples. Its principal external use is as an \nagreeable stimulating ingredient of liniments and ointments, \nand the compound tincture is largely employed to color the \nLotion Rubra {see p. 426) and other red lotions. The com- \n\n\n\n644 PHARMACOLOGY AND THERAPEUTICS. \n\npound tincture, which is a very palatable carminative and gas- \ntric stimulant, is in constant use in the treatment of nausea, \nflatulence, gastralgia, etc., and as an adjuvant or corrigent of \nother medicines. In hysterical and other nervous conditions it \nis a pleasant antispasmodic, and it is used as a stimulant in \nfainting. As a tranquilizing remedy in various disturbed states \nof the system it is not infrequently combined with Hoffman\'s \nanodyne (Spiritus ^Etheris Compositus), which it renders less \ndisagreeable to take. To calm nervous headache the oil may \nbe used internally as well as externally. Lavender water, which \nis an alcoholic solution of the oil with other volatile substances, \nis a well-known perfume and deodorant. \n\nOil of Lavender (B. P.) is usually distilled from the flowers \nand flower-stems conjointly, and consequently is inferior in \nquality to that obtained from the flowers exclusively. \n\nBERGAMOT. \n\nUnofficial Preparation. \nOleum Bergamottae (U. S. P., 1890). \xe2\x80\x94 Oil of Bergamot. \n\nAction of Oil of Bergamot. \nOil of bergamot has the same action as other aromatic vola- \ntile oils. \n\nTherapeutics of Oil of Bergamot. \nAlthough possessing the carminative and stimulant properties \nof other similar oils, it is employed chiefly, if not exclusively, \nas a perfume. \n\n\' PEPPERMINT. \n\nMENTHA PIPERITA.\xe2\x80\x94 Peppermint. Dose, 4 gm.; 60 gr. \nOLEUM MENTHA PIPERITA.\xe2\x80\x94 Oil of Peppermint. Dose, 0.2 \nc.c; 3 n\\. \n\nPreparations. \n\n1. Aqua Menthae Piperitae. \xe2\x80\x94 Peppermint Water. Dose, 16 \nc.c; 4 fl. dr. \n\n2. Spiritus Menthse Piperitae. \xe2\x80\x94 Spirit of Peppermint. (Es- \nsence of Peppermint.) Dose, 2 CCS. J 30 n\\. \n\n\n\nLAVENDER. 645 \n\nUnofficial Preparations. \n\nInfusum Menthae Piperitae. \xe2\x80\x94 Infusion of Peppermint. Dose, \nfreely. \n\nTrochisci Menthae Piperitae (U. S. P., 1890). \xe2\x80\x94 Troches of \nPeppermint. Dose, freely. \n\nAction of Peppermint. \nOil of peppermint has the action of volatile oils in general. \nThe feeling of coolness and numbness which sometimes attends \nthe external application of these agents is particularly marked \nin the case of oil of peppermint, on account of the menthol in \nits composition. Like many other volatile oils, especially those \ncontaining a considerable amount of terpene, it is actively \nantiseptic. \n\nTherapeutics of Peppermint. \n\nExternal. \xe2\x80\x94 Oil of peppermint is in common use as the " pep- \npermint test " for defective plumbing. The menthol in it ren- \nders its external application of value in many cases of neural- \ngia. The surface painted over with it should be covered with \noiled silk to prevent evaporation. Similar applications may be \nmade for the relief of myalgia and various rheumatic and \ngouty pains. Peppermint water, with the addition of 4\'to 8 gm. \n(1 to 2 dr.) of borax to each 500 c.c. (1 pint), is useful in \npruritus of the genitals. \n\nInternal. \xe2\x80\x94 Peppermint is very largely employed as an efficient \nstomachic and carminative (often in association with sodium \nbicarbonate), and also as a flavoring agent. An infusion \n("peppermint tea"), generally made with about a tablespoon- \nful of the herb to one or two cupfuls of water, is a popular \nhousehold remedy to induce perspiration or promote diuresis in \nfevers or chills, as well as to relieve attacks of colic. For the \nlatter purpose the spirit, in hot water, is more effective, and it \nis especially well suited to children. Peppermint water is in \nvery general use as a component of carminative mixtures for \ninfants. The inhalation of the oil, vaporized by means of hot \nwater, is reported to have been of material service in a number \n\n\n\nI \n\n\n\n646 PHARMACOLOGY AND THERAPEUTICS. \n\nof cases of pulmonary tuberculosis. The troches are sometimes \nuseful in relieving nausea, as well as flatulence and pain. \n\nSPEARMINT. \nMENTHA VIRIDIS.\xe2\x80\x94 Spearmint. Dose, 4 gm.; 60 gr. \n\nOLEUM MENTHA VIRIDIS.\xe2\x80\x94 Oil of Spearmint. Dose, 0.2 C.C.; \n\n3 m,. \n\nPreparation. \n\n1. Aqua Menthae Viridis.\xe2\x80\x94 Spearmint Water. Dose, 16 c.c; \n4 fl. dr. \n\n2. Spiritus Mentha Viridis. \xe2\x80\x94 Spirit of Spearmint. (Es- \nsence of Spearmint.) Dose, 2 C.C.; 30 nT.. \n\nAction of Spearmint. \nIt has the same action as peppermint, but its effects are less \npronounced. \n\nTherapeutics of Spearmint. \nThe therapeutic applications of spearmint are the same as \nthose of peppermint, but its oil is not so agreeable as oil of \npeppermint. The preparations of spearmint are in less gen- \neral use than those of peppermint. \n\nANISE AND STAR-ANISE. \n\nANISTJM.\xe2\x80\x94 Anise. Dose, 0.500 gm. (500 milligm.) ; 7V 2 gr. \nOLEUM ANISL\xe2\x80\x94 Oil of Anise. Dose, 0.2 c.c; 3 Ifl,. \n\nPreparations. \n\n1. Aqua Anisi. \xe2\x80\x94 Anise Water. Dose, 16 c.c; 4 fl. dr. \n\n2. Spiritus Anisi. \xe2\x80\x94 Spirit of Anise. Dose, 4 c.c; 1 fl. dr. \n\nUnofficial Preparations. \nIllicium (U. S. P., 1890).\xe2\x80\x94 Illicium. (Star-Anise.) Dose, 0.30 \nto 2.00 gm.; 5 to 30 gr. \n\n\n\nCORIANDER. 647 \n\nOleum Illicii. \xe2\x80\x94 Oil of Star- Anise. Dose, .06 to .30 c.c; 1 \n\nto 5 TT\\. \n\nAction of Anise. \nThe action of oil of anise is the same as that of aromatic oils \ngenerally. Although anise imparts a peculiar taste to the milk \nof nursing women, it apparently does not augment the secre- \ntion, as is supposed by some. Anisic acid (which is formed \nfrom anethol, the main constituent of the oil, by the action of \nchromic and nitric acids) and sodium anisate are antiseptic \nand are also said to be antipyretic. \n\nTherapeutics of Anise. \n\nAnise is the pleasantest carminative for infants and young \nchildren, and the seeds are used in many culinary products as a \ncondiment which tends to increase their digestibility. It prob- \nably has some slight efficacy as an expectorant, and it is em- \nployed to a considerable extent as an agreeable component of \ncough mixtures. It is also much used as a general flavoring \nagent. \n\nAction of Star-Anise. \n\nStar-anise owes its properties entirely or chiefly to its vola- \ntile oil, the action of which is the same as that of oil of anise. \n\nTherapeutics of Star-Anise. \nIts seeds and oil have been used externally to relieve local \npains, such as colic, rheumatism, earache, etc., and internally in \nthe treatment of flatulent colic and bronchitis. \n\nCORIANDER. \n\nCORIANDRUM.\xe2\x80\x94 Coriander. Dose, 0.500 gm. (500 milligm.) ; \n7y 2 gr. \n\nOLEUM CORIANDRL\xe2\x80\x94 Oil of Coriander. Dose, 0.2 c.c; 3 Vf\\,. \n\nAction of Coriander. \n\nOil of coriander has the same action as other aromatic vola- \ntile oils. \n\n\n\n648 PHARMACOLOGY AND THERAPEUTICS. \n\nTherapeutics of Coriander. \nCoriander is employed in confectionery and to promote the \ndigestion of certain kinds of pastry. In medicine it is used \nalmost entirely for flavoring purposes, for disguising the taste \nof senna and rhubarb, and for preventing the griping of these \nand other purgatives. \n\nFENNEL. \n\nFCENICULUM.\xe2\x80\x94 Fennel. Dose, 1 m.; 15 gr. \n\nOLEUM FCENICULL\xe2\x80\x94 Oil of Fennel. Dose, 0.2 c.c.; 3 HI. \n\nPreparation. \nAqua Foeniculi. \xe2\x80\x94 Fennel Water. Dose, 16.0 c.c; 4 fl. dr. \n\nUnofficial Preparation. \nInfusum Foeniculi. \xe2\x80\x94 Infusion of Fennel. Dose, freely. \n\nAction of Fennel. \nOil of fennel has the same action as that of anise and other \nsimilar oils. It has been supposed to have the effect of increas- \ning the secretion of milk, urine, perspiration and bronchial \nmucus, and also to act as an emmenagogue. \n\nTherapeutics of Fennel. \n, As. one of the most grateful of the various aromatics, fennel \nis employed to quite a large extent as a stomachic and carmina- \ntive, and as a corrective against the griping effects of purga- \ntives. It is still sometimes used in hot infusion, as an adju- \nvant, in the treatment of amenorrhcea dependent on uterine con- \ngestion and for re-establishing the mammary secretion when \nsuppressed. The infusion (not official, 4 gm. ; 1 dr. to 250 c.c; \ny 2 pint of water) is given as an enema to infants for the \nexpulsion of flatus. \n\nCARAWAY. \n\nCARUM. \xe2\x80\x94 Caraway. Dose, 1 gm.; 15 gr. \n\nOLEUM CARL\xe2\x80\x94 Oil of Caraway. Dose, 0.2 c.c; 3 TTt. \n\n\n\nELDER. 649 \n\nAction of Caraway. \nThe action of oil of caraway is the same as that of other \naromatic volatile oils. \n\nTherapeutics of Caraway. \nCaraway is used chiefly as a flavoring agent and a carmina- \ntive for flatulent colic, especially in infants. The seeds are often \nbaked in cakes, which thus receive a pleasant aromatic taste \nand have the effect of stimulating the digestive organs. \n\nDILL. \n\nUnofficial Preparation. \nAnethum.\xe2\x80\x94 Dill. Dose, 0.60 to 2.00 gm.; 10 to 30 gr. \n\nAction of Dill. \nThe same as that of anise and caraway. \n\nTherapeutics of Dill. \nIt is not much used in this country, but may be employed for \nthe relief of flatulent colic and hiccough due to gastric indiges- \ntion. In England, dill water (B. P.; dill fruit, 1; water, 10; \ndose, 30 to 60 c.c. ; 1 to 2 fl. oz.) is a common carminative for \nchildren, and it is also sometimes given to cover the taste of \nsodium salts. \n\nELDER. \nUnofficial Preparations. \nSambucus (U. S. P., 1890). \xe2\x80\x94 Sambucus. (Elder.) Dose, 2 to \n4 gm.; 1/2 to 1 dr. \n\nDecoctum Sambuci. \xe2\x80\x94 Decoction of Sambucus. Dose, freely. \n\nAction of Sambucus. \nElder flowers are gently stimulant and diaphoretic. The in- \nner bark of the elder is a hydragogue cathartic and in large \ndoses emetic. \n\nTherapeutics of Sambucus. \nThe flowers are considerably used for flavoring purposes. \nElder-flower water (B. P. \xe2\x80\x94 1 in 1) makes a good vehicle for \n\n\n\n65O PHARMACOLOGY AND THERAPEUTICS. \n\ncollyria and lotions. The berries are edible, and jam or con- \nserve made from them is somewhat laxative. A decoction of \nthe fresh inner bark is said to be strongly diuretic and to have \nbeen used with good effect in acute nephritis. \n\nPENNYROYAL. \n\nHEDEOMA. \xe2\x80\x94 Hedeoma. (Pennyroyal.) Dose, 8 gm.; 120 gr. \nOLEUM HEDEOM^E.\xe2\x80\x94 Oil of Hedeoma. Dose, 0.2 c.c.; 3 m_. \n\nAction of Pennyroyal. \nPennyroyal is a gentle aromatic stimulant. \n\nTherapeutics of Pennyroyal. \nIt may be given in flatulent colic and sick stomach. The oil \nis in common use locally applied as a remedy for mosquito \nbites. \n\nWORMWOOD. \n\nUnofficial Preparations. \n\nAbsinthium (U. S. P., 1890). \xe2\x80\x94 Absinthium. (Wormwood.) \nDose, 0.50 to 2.40 gm.; 8 to 40 gr. \n\nInfusum Absinthii. \xe2\x80\x94 Infusion of Wormwood. Dose, 30 to 60 \nc.c; 1 to 2 fl. oz. \n\nAction of Wormwood. \nIn medicinal doses wormwood is a digestive stimulant. Ab- \nsinthol differs from many of the volatile oils in the profound \neffect which, when given in sufficient amount, it has upon the \ncentral nervous system, the result of which is seen in a marked \nincrease in the reflexes. It gives rise to epileptiform convul- \nsions, and in these, other parts of the central axis are involved \nas well as the cerebrum, which is mainly responsible for them. \nIt is found that the continued use of absinthe produces various \nnervous symptoms, morning nausea and vomiting, and a ten- \ndency to such epileptiform convulsions. \n\n\n\nCHAMOMILE. 65 I \n\nTherapeutics of Wormwood. \nWormwood is used in an infusion as an aromatic tonic in \natony of the stomach or intestines. The volatile oil has been \nemployed as a local anaesthetic for rheumatic and other pains \nand internally in the form of a liqueur, as a narcotic stimulant \nin cerebral exhaustion. \n\nCHAMOMILE. \nANTHBMIS. \xe2\x80\x94 Anthemis. (Chamomile.) Dose, 2 gm.; 30 gr. \n\nUnofficial Preparations. \n\nInfusum Anthemidis. \xe2\x80\x94 Infusion of Anthemis. Dose, 30 to \n60 c.c; 1 to 2 fl. oz.; as an emetic, 150 to 300 c.c; 5 to 10 fl. oz. \n\nOleum Anthemidis. \xe2\x80\x94 Oil of Anthemis. Dose, .06 to .25 c.c; \n1 to 4 TTt. \n\nAction of Chamomile. \n\nChamomile has the general action of the aromatic volatile \noils. Its oil is said to have the power of reducing reflex excita- \nbility in frogs, even after its excitation by strychnine or \nbrucine. \n\nTherapeutics of Chamomile. \n\nExternal. \xe2\x80\x94 A poultice made with chamomile flowers is a \npopular domestic remedy, but it has no special advantages over \nother kinds of cataplasms. The oil, on account of its sedative \naction, has been recommended as a serviceable addition to fatty \npreparations for various inflammations of the skin. Combined \nwith other remedies in ointments, it may be used in erysipelas, \nerythema, acute eczema, seborrhcea, etc. \n\nInternal. \xe2\x80\x94 Chamomile is more or less used as a stomachic \nand carminative. The infusion acts as an emetic when given \nin doses of considerable size. In smaller doses it is aro- \nmatic and carminative, and favors diuresis and the action of the \nskin. It is a popular household remedy for colds, dyspepsia \nand intestinal disorders. The oil has some effect in checking \nreflex cough, and may prove useful in spasmodic asthma. It \nis believed that it should be of service in poisoning by strych- \n\n\n\n652 PHARMACOLOGY AND THERAPEUTICS. \n\nnine, on account of its depressant action upon the reflex excita- \nbility of the spinal cord. \n\nGERMAN CHAMOMILE. \n\nMATRICARIA.\xe2\x80\x94 Matricaria. (German Chamomile.) Dose, 16 \ngm.; 240 gr. \n\nAction and Therapeutics of Matricaria. \nThese are identical with those of chamomile. \n\nGARLIC. \n\nUnofficial Preparations. \n\nAllium (U. S. P., 1890). \xe2\x80\x94 Garlic. Dose, 1.0 to 2.0 gm.; 15 to \n30 gr. \n\nSyrupus Allii. \xe2\x80\x94 Syrup of Garlic. Dose, 4.0 to 16.0 c.c; 1 to \n4 fl. dr. \n\nAction of Garlic. \nThe effects of garlic are those of a general stimulant, quick- \nening the circulation, exciting the nervous system, and promot- \ning expectoration. \n\nTherapeutics of Garlic. \nIt is beneficial in impaired digestion and in chronic affections \nof the respiratory organs in which symptoms of inflammation \nhave subsided and a relaxed state of the vessels remains. \n\nSAGE. \n\nSALVIA.\xe2\x80\x94 Salvia. (Sage.) Dose, 2 gm.; 30 gr. \n\nUnofficial Preparation. \nInfusum Salviae. \xe2\x80\x94 Infusion of Salvia. Dose, 30 to 60 C.C.; \n1 to 2 fl. oz. \n\nAction of Sage. \nSage has the action of volatile oils generally and is also \nastringent in consequence of its tannic acid. The oil has been \nshown to occasion epileptiform convulsions in dogs. \n\n\n\nROSE. "653 \n\nTherapeutics of Sage. \nWhile used chiefly as a condiment, it is said to be beneficial \nin checking the perspiration of hectic fever. Infusion of sage \n(1-4) is employed as a gargle and an astringent wash for the \nmouth or nasal passages. The compound sage-gargle is made \nas follows: Sage, 30; alum, 15; clarified honey, 60; boiling \nwater, 500. Sage is sometimes combined with other remedies \nas an injection for urethritis or cystitis. \n\nROSE. \nROSA GALLICA.\xe2\x80\x94 Red Rose. \n\nPreparations. \n\n1. Confectio Rosae. \xe2\x80\x94 Confection of Rose. \n\n2. Fluidextractum Rosse. \xe2\x80\x94 Fluidextract of Rose. Dose, 2 \nc.c; 30 TTj.. \n\n3. Mel Rosae. \xe2\x80\x94 Honey of Rose. Dose, 4 C.C.; 1 fl. dr. \n\n4. Syrupus Rosas.\xe2\x80\x94 Syrup of Rose. \n\nOLEUM ROS^:.\xe2\x80\x94 Oil of Rose. (Attar of Rose.) \n\nPreparations. \n\n1. Aqua Rosae Fortior. \xe2\x80\x94 Stronger Rose Water. Dose, 8 c.c; \n2 fl. dr. \n\n2. Aqua Rosae. \xe2\x80\x94 Rose Water. Dose, 16 c.c; 4 fl. dr. \n\n3. Unguentum Aquae Rosae. \xe2\x80\x94 Ointment of Rose Water. \n\nUnofficial Preparation. \nRosa Centifolia (U. S. P., 1890).\xe2\x80\x94 Pale Rose. \n\nAction of Rose. \nPreparations of rose are somewhat astringent, but have not \nmuch other action. \n\nTherapeutics of Rose. \n\nThe confection is a good base for pills, and the water an \n\nagreeable excipient for collyria, lotions and urethral injections. \n\nThe ointment of rose water is a favorite soothing application \n\nfor the skin, The infusion (B. P., not official : Dried petals, 2; \n\n\n\n654\' PHARMACOLOGY AND THERAPEUTICS. \n\ndiluted sulphuric acid, i; water, 80), which is slightly astrin- \ngent, constitutes an acceptable gargle and wash for inflamed or \nulcerated conditions of the throat and mouth. Given inter- \nnally it offers a pleasant method of administering sulphuric \nacid. \n\nORANGE. \n\nAURANTII AMARI CORTEX.\xe2\x80\x94 Bitter Orange Peel. Dose, 1 \ngm.; 15 gr. \n\nPreparations. \n\n1. Fluidextractum Aurantii Amari. \xe2\x80\x94 Fluidextract of Bitter \nOrange Peel. Dose, 1 c.c; 15 TT\\. \n\n2. Tinctura Aurantii Amari. \xe2\x80\x94 Tincture of Bitter Orange \nPeel. Dose, 4 c.c; 1 fl. dr. \n\nUnofficial Preparations. \nTinctura Aurantii Recentis Corticis. \xe2\x80\x94 Tincture of Fresh \nOrange Peel. Dose, 4 c.c.; 1 fl. dr. \n\nAURANTII DULCIS CORTEX.\xe2\x80\x94 Sweet Orange Peel. Dose, 1 \ngm.; 15 gr. \n\nPreparation. \nTinctura Aurantii Dulcis. \xe2\x80\x94 Tincture of Sweet Orange Peel. \nDose, 4 c.c; 1 fl. dr. \n\nSyrupus Aurantii. \xe2\x80\x94 Syrup of Orange. \n\nOLEUM AURANTII CORTICIS.\xe2\x80\x94 Oil of Orange Peel. Dose, 0.2 \nc.c; 3 TTt. \n\nPreparations. \n\n1. Spiritus Aurantii Compositus. \xe2\x80\x94 Compound Spirit of \nOrange. \n\n2. Elixir Aromaticum. \xe2\x80\x94 Aromatic Elixir. \n\n3. Elixir Adjuvans. \xe2\x80\x94 Adjuvant Elixir. \n\nUnofficial Preparation. \nSpiritus Aurantii (U. S. P., 1890). \xe2\x80\x94 Spirit of Orange. Dose, \n2 c.c; 30 TTL- \n\nPreparations of the Volatile Oil of Fresh Orange Flowers. \nUnofficial Preparation. \n1. Aqua Aurantii Florum Fortior. \xe2\x80\x94 Stronger Orange Flower \nWater. (Triple Orange Flower Water.) Dose, 8 C.C.; 2 fl. dr. \n\n\n\nLEMON. 655 \n\n2. Aqua Aurantii Florum.\xe2\x80\x94 Orange Flower Water. Dose, 16 \nc.c; 4 fl. dr. \n\n3. Syrupus Aurantii Florum. \xe2\x80\x94 Syrup of Orange Flowers. \n\nUnofficial Preparation. \nOleum Aurantii Florum (U. S. P., 1890). \xe2\x80\x94 Oil of Orange \nFlowers. (Oil of Neroli.) \n\nAction of Orange. \nOrange is slightly bitter and aromatic, stomachic and tonic. \nIts oil has the action of other volatile oils. In large amounts \nit is a gastro-intestinal irritant and may give rise to convul- \nsions. Persons much exposed to its fumes are liable to skin \neruptions and various nervous disorders. \n\nTherapeutics of Orange. \nThe preparations of the orange are used extensively for fla- \nvoring purposes. The aromatic and adjuvant elixirs are excel- \nlent flavoring agents and vehicles for liquid medicines. \n\nLEMON. \nLIMONIS CORTEX.\xe2\x80\x94 Lemon Peel. \n\nPreparation. \nTinctura Limonis Corticis. \xe2\x80\x94 Tincture of Lemon Peel. \nOLEUM LIMONIS.\xe2\x80\x94 Oil of Lemon. Dose, 0.2 c.c.; 3 m.. \n\nUnofficial Preparation. \nSpiritus Limonis (U. S. P., 1890). \xe2\x80\x94 Spirit of Lemon. (Es- \nsence of Lemon.) Dose, 2 c.c; 30 TT\\. \n\nLIMONIS SUCCTJS.\xe2\x80\x94 Lemon Juice. Dose, 30 c.c; 1 fl. oz. \n\nAction of Lemon. \nThe same as that of orange. \n\nTherapeutics of Lemon. \nThe preparations of the lemon, like those of the orange, are \nemployed as flavoring agents. The oil may be applied exter- \nnally as a rubefacient, but is seldom used for this purpose. \n\n\n\n656 PHARMACOLOGY AND THERAPEUTICS. \n\nAction of Lemon Juice. \n\nLemon juice, which contains a considerable amount of free \ncitric acid, has the same action as this acid (see pp. 331 and \n342). \n\nTherapeutics of Lemon Juice. \n\nLemon juice, in the form of lemonade and various effer- \nvescing mixtures, relieves thirst and makes an otherwise re- \nfreshing beverage. Hot lemonade, to which whiskey or gin \nis often added, is useful as a diaphoretic in commencing colds. \nLemon juice is also largely employed for flavoring flaxseed tea \nand the mildly nutritive drinks given in fevers. Its most im- \nportant medicinal use is in the prophylaxis and treatment of \nscurvy, in which lemon and lime juice may almost be consid- \nered specifics. Orange juice is also efficient. The beneficial \neffect appears to be due, not to the citric acid, but to some \nunknown property of the fruit juices. 90 to 120 c.c. (3 to 4 \nfl. oz.) should be taken daily. A somewhat larger amount is \nsaid to have afforded marked relief in certain cases of rheu- \nmatism, both chronic and acute. Lemon juice is one of the \npopular remedies in this disease, though not very much reliance \nis probably to be placed upon it. Its local application is effi- \ncient in arresting post-partum haemorrhage. For this purpose \na gashed lemon should be carried up into .the uterine cavity and \nsqueezed, when vigorous contractions will be excited in the \nsame manner as by squeezing in the uterus a rag saturated with \nvinegar. Lemon juice is applied to the integument to relieve \npruritus and to remove sunburn, freckles, moth-spots, and ink- \nstains. For sunburn an excellent lotion is made of equal parts \nof lemon juice and glycerin, with the addition of some bismuth \nsubnitrate. \n\nPEPPER. \n\nPIPER.\xe2\x80\x94 Pepper. (Black Pepper.) Dose, 0.500 gm. (500 \nmilligm.); 7V 2 gr. \n\nPreparation. \nOleoresina Piperis. \xe2\x80\x94 Oleoresin of Pepper. Dose, 0.030 gm. \n(30 milligm.) ; y 2 gr. \n\nPIPERINA.\xe2\x80\x94Piperine. Dose, 0.200 gm. (200 milligm.) ; 3 gr, \n\n\n\nPYRETHRUM. 657 \n\nAction of Pepper. \nBy reason of its volatile oil, pepper has much the same action \nas cloves. In the course of its excretion it acts as a disinfect- \nant and stimulant to the genito-urinary tract, and it is reputed \nto be feebly antiperiodic and antipyretic. \n\nTherapeutics of Pepper. \nIn the form of ointment pepper is efficient in tinea capitis. \nIt is occasionally employed for counter-irritation, as a substi- \ntute for mustard, and, in washes and gargles, for relaxed con- \nditions of the gums and throat. It is universally used as a \ncondiment, and its chief medical application is to stimulate the \nstomach and correct flatulence. Pepper lozenges, or the con- \nfection (B. P., Pepper, 2; carroway, 3; honey, 15. Synonym, \nWard\'s paste), are sometimes given for the relief of ulcers of \nthe rectum, anal fistulae and fissures, haemorrhoids, gleet and \nleucorrhcea. In malarial fevers the oleoresins of both black \npepper and capsicum have sometimes proved of service as adju- \nvants to other remedies. Piperine has been used in cholera as \na stimulant, local and general, and in low conditions of the \nsystem from various causes other than gastro-intestinal inflam- \nmation. \n\nPYRETHRUM. \n\nPYRETHRUM.\xe2\x80\x94 Pyrethrum. (Pellitory.) Dose, 2 gm.; 30 gr. \n\nPreparation. \nTinctura Pyrethri. \xe2\x80\x94 Tincture of Pyrethrum. \n\nAction of Pyrethrum. \nPyrethrum is an irritant sialogogue. When chewed it has a \nprickly, pungent effect upon the mouth, tongue and fauces, and \nexcites a free secretion of saliva and buccal mucus. It is a \nrubefacient and when inhaled into the nostrils causes sneezing. \nInternally it has the characteristic action of the volatile oils, \nand when taken in considerable quantities may cause gastro- \nenteritis, with bloody stools, and more or less stupor. In a \n43 \n\n\n\n658 PHARMACOLOGY AND THERAPEUTICS. \n\nchild 2^/2 years old tetanoid convulsions were also produced \nby it. \n\nTherapeutics of\' Pyrethrum. \nIt is chewed as a masticatory in paralysis of the tongue, and \nwhen in other conditions an increased flow of saliva is desired. \nIn neuralgic, rheumatic, or other painful affections of the \ntongue or teeth it may also be chewed or held in the mouth, as \nthe burning sensation to which it at first gives use is followed \nby one of numbness; the stimulation of the nerves of the parts \nwhich it causes being succeeded by depression and a blunted \nsensibility. For the aching of a carious tooth a few drops of \nthe tincture may be introduced into the cavity on cotton wool. \nProperly diluted, it makes an efficient lotion for scorbutic and \nother forms of sore mouth and gargle for relaxed uvula. Pyre- \nthrum is sometimes used as an ingredient of tooth-powders. Its \nsialogogue action has been found of service in the removal of \niodine from the system in cases of chronic poisoning by that \ndrug. The powder has been recommended as a sternutatory in \nchronic catarrh of the frontal sinuses. Persian insect powder \nconsists of the flowers of the chrysanthemum (or pyrethrum) \nroseum, a variety of pellitory growing in Asia. \n\nCAPSICUM. \n\nCAPSICUM. \xe2\x80\x94 Capsicum. (Cayenne Pepper. Guinea Pepper.) \nDose, 0.065 gm. (65 milligm.) ; 1 gr. \n\nPreparations. \n\n1. Fluidextractum Capsici. \xe2\x80\x94 Fluidextract of Capsicum. Dose, \n0.05 c.c; 1 TTL. \n\n2. Oleoresina Capsici. \xe2\x80\x94 Oleoresin of Capsicum. Dose, 0.030 \ngm. (30 milligm.) ; y 2 gr. \n\n3. Tinctura Capsici. \xe2\x80\x94 Tincture of Capsicum. Dose, 0.5 c.c; \n8 rc\\,. \n\n4. Emplastrum Capsici. \xe2\x80\x94 Capsicum Plaster. \n\n5. Pilulae Podophylli, Belladonnae et Capsici. \xe2\x80\x94 Pills of \nPodophyllum, Belladonna and Capsicum. Dose, 1 pill. \n\n\n\nCAPSICUM. 659 \n\nAction of Capsicum. \nAlthough it contains no volatile oil, the action of capsicum \nis like that of the volatile oils generally. It is a powerful local \nirritant, its oleoresin when applied to the skin producing in a \nshort time intense pain and redness, and eventually destroying \nthe cuticle. In the alimentary canal it acts in a similar way. \nIn the stomach, in small doses, it occasions a feeling of warmth, \nexcites hyperemia, and stimulates the muscular coat and the \nsecretions, while large doses give rise to gastro-enteritis, which \nafter a time is accompanied by strangury and other evidences \nof irritation of the genito-urinary tract. Aphrodisiac effects \nhave sometimes been noted. It is chiefly eliminated by the \nkidneys, and moderate amounts increase the flow of urine. It \nis a powerful stimulant to the heart, and thus increases the \nstrength and frequency of the pulse. \n\nTherapeutics of Capsicum; \nExternal. \xe2\x80\x94 The tincture of capsicum, like that of cantharides, \nhas been used to stimulate the scalp in the various forms of \nalopecia, and it is frequently employed as a domestic remedy \nfor toothache and chilblains. The diluted tincture, or an infu- \nsion, makes a serviceable gargle in scarlet fever and for relaxed \nuvula, pharyngitis, and other throat affections. In tonsillitis \nthe tincture, with an equal quantity of glycerin, may be topically \napplied by means of a swab. The tincture is used in making \nup rubefacient liniments, and capsicum ointment (B. P.) is also \nemployed as a counter-irritant (Capsicum, 6; spermaceti, 3; \nolive oil, 22). This resembles Smedley\'s paste. A strong tinc- \nture of capsicum-pods, mixed with an equal quantity of muci- \nlage of gum arabic, has been recommended in chilblains (when \nthe surface is unbroken), discolored bruises, chronic rheumatic \npains, etc. The preparation is brushed two or three times upon \ntissue paper, which is then applied to the affected surface. \nCapsicum plaster is quite extensively used as a rubefacient and \ncounter-irritant. \n\n\n\n660 PHARMACOLOGY AND THERAPEUTICS. \n\nInternal. \xe2\x80\x94 Capsicum is much used as a condiment. In medi- \ncine it is an excellent remedy for flatulent colic and for cases \nof atony of the stomach due to general debility, errors in diet, \nand subacute and chronic alcoholism. In acute alcoholism it \nshould be given with caution, if at all, as there is likely to be \npresent more or less gastric irritation, which may be aggra- \nvated by the drug. After a few days it may usually be given \nwith advantage, as it serves to increase the appetite and diges- \ntive power, and by its stimulating effect and the hot sensation \nto which it gives rise it often satisfies, at least to some degree, \nthe craving for liquor. In these cases the tincture may be \nadministered every four or five hours in doses of .30 to .60 c.c. \n(5 to 10 ni), or the oleoresin in a pill containing .03 to .06 gm. \n(^ to 1 gr.). In delirium tremens capsicum is often valuable \nin quieting restlessness and inducing sleep. It should here be \ngiven in a dose of about 2 gm. (30 gr.), which may be admin- \nistered in an animal broth or made into a bolus with syrup or \nhoney. Tincture of capsicum has been resorted to in the treat- \nment of the opium, as well as the alcohol, habit. Capsicum \ntends to check albuminuria, and is therefore sometimes of ser- \nvice in chronic parenchymatous nephritis. It may also prove \nbeneficial in functional torpidity of the kidney, but it is never \nadmissible in acute renal inflammation. In chronic pyelitis, \nchronic cystitis, and prostatorrhcea it is of some value, though \nnot as efficient as cubeb. Good results may often be obtained \nfrom it in functional impotence and in spermatorrhoea from \ndeficient tone. The oleoresin is the best preparation for use in \nthese genito-urinary affections. Capsicum has been given as \na diffusible stimulant in low fevers, but is more useful in the \nanorexia and impaired digestion of convalescence. \n\nGINGER. \nZINGIBER.\xe2\x80\x94 Ginger. Dose, 1 gm.; 15 gr. \n\nPreparations. \n1. Fluidextractum Zingifoeris. \xe2\x80\x94 Fluidextract of Ginger. \nDose, 1 c.c; 15 IT],. \n\n\n\nCARDAMOM. - 66 I \n\n2. Oleoresina Zingiberis. \xe2\x80\x94 Oleoresin of Ginger. Dose, 0.030 \ngm. (30 milligm.) ; y 2 gr. \n\n3. Tinctura Zingiberis. \xe2\x80\x94 Tincture of Ginger. Dose, 2 c.c; \n30 tti. \n\n4. Syrupus Zingiberis. \xe2\x80\x94 Syrup of Ginger. Dose, 16 c.c; \n4 fl. dr. \n\n5. Pulvis Aromaticus. \xe2\x80\x94 Aromatic Powder. Dose, 1 gm.; 15 \ngr. \n\n6. Fluidextractum Aromaticum. \xe2\x80\x94 Aromatic Fluidextract. \nDose, 1 c.c; 15 1TI. \n\nUnofficial Preparation. \nTrochisci Zingiberis (U. S. P., 1890). \xe2\x80\x94 Troches of Ginger. \nDose, freely. \n\nAction of Ginger. \nGinger has the same action as that of other substances con- \ntaining aromatic volatile oils. \n\nTherapeutics of Ginger. \nIt is much used as a stomachic, carminative, and flavoring \nagent. It is a favorite domestic remedy for colic, and, given \nin hot water, is also frequently employed as a sudorific and \nstimulant in the pain due to acute suppression of the menses. \nIt is administered in association with various other remedies \nin the treatment of atonic dyspepsia, especially in elderly per- \nsons, and is useful in flatulence and some forms of diarrhoea. \nIt may be given with salines to disguise their taste, and the \noleoresin is a useful addition to purgative pills to prevent \ngriping. \n\nCARDAMOM. \n\nCARDAMOMTJM. \xe2\x80\x94 Cardamom. Dose, 1 gm.; 15 gr. \n\nPreparations. \n\n1. Tinctura Cardamomi. \xe2\x80\x94 Tincture of Cardamom. Dose, 4 \nc.c; 1 fl. dr. \n\n2. Tinctura Cardamomi Composita.\xe2\x80\x94 Compound Tincture of \nCardamom. Dose, 4 c.c.; 1 fl. dr. \n\n\n\n662 PHARMACOLOGY AND THERAPEUTICS. \n\n3. Pulvis Aromaticus. \xe2\x80\x94 Aromatic Powder. Dose, 1 gm.; 15 \ngr. \n\n4. Fluidextractum Aromaticum. \xe2\x80\x94 Aromatic Fluidextract. \nDose, 1 c.c; 15 n\\,. \n\nAction of Cardamom. \nCardamom is carminative and stomachic, acting, by reason \nof its volatile oil, like cloves or pepper. \n\nTherapeutics of Cardamom. \nAs the compound tincture has a bright red color, due to its \ncochineal, and an agreeable aromatic taste, it is frequently \nemployed as a coloring and flavoring agent. It is a customary \naddition to mixtures given for the relief of flatulent colic, and, \nmixed simply with sweetened hot water, is also a favorite rem- \nedy for such affections. The Tinctura Carminativa of the \nBritish Pharmaceutical Conference is likewise an excellent \nflavoring carminative. (Cardamom, 6; tincture of ginger, 6; \noil of cinnamon, oil of cloves, oil of caraway, of each, i ; recti- \nfied spirit to 96. Dose, .12 to .60 c.c; 2 to 10 HI.) Cardamom \nmakes one of the best flavoring additions to saline solutions or \nmixtures, and when combined with purgatives is very efficient \nin correcting flatulence and griping. \n\nPEPSIN. \n\nPEPSINXJM.\xe2\x80\x94 Pepsin. Dose, 0.250 gm. (250 milligm.) ; 4 gr. \n\nUnofficial Preparation. \nPepsinum Saccharatum (U. S. P., 1890). \xe2\x80\x94 Saccharated Pep- \nsin. Dose, 1 gm.; 15 gr. \n\nAction of Pepsin. \nThe only action of pepsin, which is a normal constituent of \nthe gastric juice, appears to be on the digestive system. In the \npresence of hydrochloric acid it digests the proteid elements of \nthe food, converting them into albumoses, and finally into pep- \ntones. In alkaline solution it is not only inert, but is rapidly \ndecomposed. \n\n\n\nPEPSIN. 663 \n\nTherapeutics of Pepsin. \nPepsin is usually prescribed on the hypothesis that in cer- \ntain conditions the stomach does not secrete a sufficient quan- \ntity of it. It has been questioned, however, whether this is true \nin even a small proportion of the cases in which this ferment \nis given, since the gastric juice is found to be almost always \ncapable of digesting proteids if it is acid in reaction. In a \nnumber of forms of dyspepsia, while the acid secretion is defi- \ncient, pepsin is generally present in quantity, since it will digest \nproteids outside the body as soon as it becomes acid in reaction. \nConsequently, pepsin would seem to be indicated only in those \ninstances in which the gastric contents acidulated with hydro- \nchloric acid fail to perform their digestive work. Pepsin may \nbe used as an aid to stomach digestion in those in whom from \nold age, continued illness, or other cause, the secretion of gas- \ntric juice is inadequate. It has been found to be more certain \nin its effects in the impaired digestion of infants than of adults, \nand this has been attributed by some, who hold that the ordi- \nnary quantities given to adults are entirely too small, to the \nfact that to young children it is administered in proportionately \nmuch larger doses. When it is prescribed together with alka- \nline carbonates, any effects produced are due entirely to the lat- \nter, the pepsin being decomposed in the presence of alkalies. \nIt is naturally of no service in promoting the digestion of fatty \nor carbohydrate foods. Unless obtained from an absolutely \nreliable source, pepsin should be tested before giving it to a \npatient, as many of the specimens sold are quite inert. It \nshould be administered, in a powder, pill or tablet, immediately \nafter meals, and followed in about half an hour with a suitable \ndose of hydrochloric acid. One of the applications now made \nof pepsin is the predigestion by it of albuminous food, which \nmay then be given either by the mouth or the rectum, and as \nmorbid processes which interfere with digestion may be going \non in the stomach, this method is not infrequently preferable to \nusing the ferment in the ordinary way. As a rule, however, \npancreatin is found to be of more service for purposes of pre- \n\n\n\n\n\n\n664 PHARMACOLOGY AND THERAPEUTICS. \n\ndigestion than pepsin. The rectum, as is well known, has only- \nvery feeble digestive powers, and consequently nutrient ene- \nmata or suppositories should always be predigested. In the use \nof predigested foods, either by the mouth or rectum, much dis- \ncretion should be employed, and except in case of absolute \nnecessity the method should not be maintained for a very long \nperiod continuously, as there is some danger that the digestive \nfunctions of the stomach, from lack of use, may become inca- \npable of action. \n\nMeat may be peptonized in the following manner: Reduce \nto a fine pulp 450 gm. (1 pound) of lean meat, add six times \nits weight of water containing 0.2 per cent, of hydrochloric \nacid and 8 gm. (120 gr.) of pepsin, and digest at 48 C. (120 \nF.) in a porcelain digester for five or six hours, with frequent \nstirring; neutralize with sodium carbonate, boil and filter; \nevaporate the filtrate on a water-bath until it is of the con- \nsistency of a soft extract. Peptonized meat suppositories are \noften very serviceable. To make one suppository 2 gm. (30 \ngr.) of the above extract is mixed with 2.40 gm. (40 gr.) of \noil of theobroma, and shaped in a conical mould. \n\nPANCREATIN. \n\nPANCREATINUM.\xe2\x80\x94 Pancreatin. (Zymine.) Dose, 0.500 gm. (500 \nmilligm.); 7y 2 gr. \n\nUnofficial Preparation. \nTrypsinum. \xe2\x80\x94 Trypsin. \n\nAction of Pancreatin. \nPancreatin, in the presence of alkalies, has the power of \ndigesting albuminoids and all proteid substances, which are \nchanged to peptones, of converting starch into sugar, and, when \nnot over twenty-four hours old, of emulsionizing fats. It co- \nagulates and then peptonizes milk, and will also peptonize gruel, \noysters and many other articles of diet. It is incapable of act- \ning in an acid medium, or in a temperature above 6o\xc2\xb0 C. \n(140 R). \n\n\n\nVALERIAN. 665 \n\nTherapeutics of Pancreatin. \n\nIt is used as an artificial agent to assist the digestion of in- \nvalids and of old persons, or those prostrated by fever or ex- \nhaustion. Also by means of it food may be partially or \nwholly digested previous to administration. It should be used \nin combination with an alkali, as sodium bicarbonate, in the \nproportion of 1 to 4. Nutritive enemata should be thoroughly \npancreatized. If pancreatin be administered two hours after \nmeals it will assist intestinal digestion, and it is especially indi- \ncated in those conditions in which starch and fat are imper- \nfectly digested. It should be preceded by full doses of sodium \nbicarbonate, or other alkali, to insure an alkaline reaction in \nthe contents of the stomach. It is sometimes of service in the \nvomiting of pregnancy or of hysteria. In diphtheria a spray \nof trypsin (the proteolytic ferment of pancreatin) or of pan- \ncreatin solution has been used with considerable success for \nthe purpose of dissolving the false membrane and promoting \nits expulsion. Pancreatin has also been employed in the blad- \nder, like pepsin, to dissolve blood-clots resulting from haemor- \nrhage. \n\nVALERIAN. \n\nVALERIANA.\xe2\x80\x94 Valerian. Dose, 2 gm.; 30 gr. \n\nPreparations. \n\n1. Fluidextractum Valerianae. \xe2\x80\x94 Fluidextract of Valerian. \nDose, 2 c.c; 30 n\\.. \n\n2. Tinctura Valerianae. \xe2\x80\x94 Tincture of Valerian. Dose, 4 c.c; \n1 fl. dr. \n\n3. Tinctura Valerianae Ammoniata. \xe2\x80\x94 Ammoniated Tincture \nof Valerian. Dose, 2 c.c; 30 m,. \n\nAMMONII VALERAS.\xe2\x80\x94 Ammonium Valerate. Dose, 0.500 gm. \n(500 milligm.) ; 7V 2 gr. \n\nZINCI VALERAS.\xe2\x80\x94 Zinc Valerate. Dose, 0.125 gm. (125 mil- \nligm.) ; 2 gr. \n\nUnofficial Preparations of Valerian. \nFerri Valerianas (U. S. P., 1890). \xe2\x80\x94 Ferric Valerianate. \n(Ferric Valerate.) Dose, 0.05 to 0.15 gm.; 1 to 3 gr. \n\n\n\n666 PHARMACOLOGY AND THERAPEUTICS. \n\nQuininse Valerianas (U. S. P., 1890). \xe2\x80\x94 Quinine Valerianate. \n(Quinine Valerate.) Dose, 0.05 to 2.00 gm.; 1 to 30 gr. \n\nSodii Valerias. \xe2\x80\x94 Sodium Valerate. Dose, 0.05 to .30 gm.; 1 \nto 5 gr. \n\nOleum Valerianae. \xe2\x80\x94 Oil of Valerian. Dose, .12 to .30 c.c; \n2 to 5 HI. \n\nAction of Valerian and the Valerates. \nNeither valerianic acid nor ammonium, ferric, sodium, qui- \nnine or zinc valerates are known to have any physiological \naction, although their extensive use warrants the belief that \nthey are valuable remedies. Valerian itself acts in virtue of \nits volatile oil, which has the same properties as other volatile \noils. Valerian is therefore an irritant when applied externally, \ncausing redness, itching and warmth by reason of the local \ndilatation of vessels which it induces. Internally it stimulates \nthe mouth (leading to a reflex secretion of saliva) and the \ngastro-intestinal tract. It causes increased appetite and in the \nstomach a sense of warmth and comfort, with reflex stimula- \ntion of the heart and nervous system. The slight irritation \nproduces hyperemia of the mucous membrane, with some in- \ncrease of secretion, and the movements of the stomach are \naccelerated. Similar effects are observed in the intestine. \nWhile nervous effects are produced reflexly by the local action, \nsufficient doses affect the central nervous system independently \nof such local action. There is a preliminary stimulation fol- \nlowed by a depression of the nerve-cells, and the higher divi- \nsions of the central axis are more markedly acted upon than \nthe lower. Excretion takes place principally by the lungs and \nkidneys, and in the course of this action some irritation and \nincreased secretion may be induced in these organs. The heart \nis stimulated indirectly, but does not seem to be affected except \nin this indirect manner. It has been found that in cases of \npoisoning by the volatile oil the collapse and shock may alter \nthe cardiac contractions, but direct effects on the cardiac mus- \ncle, it is stated, have not been shown to be produced, unless \nwhen enormous quantities are injected intravenously. Under \n\n\n\nCYPRIPEDIUM. 66? \n\nlarge doses by the mouth nausea, hiccough, eructations of the \ndrug, vomiting and diarrhoea may be caused. \n\nTherapeutics of Valerian and the Valerates. \nValerian in various forms is much used as a carminative for \nthe relief of flatulence, especially in hysterical conditions. Any \nfeeling of fullness after meals is removed, and this is often \naccompanied by the eructation of quantities of gas. Though \nthe oil is not official, it is more efficient as a carminative than \nthe valerates. It is most conveniently administered suspended \nin mucilage with cinnamon water. The tincture and fluid- \nextract also usually promptly relieve the flatulence of the \nhysterical and hypochondriacal. Preparations of valerian are \nlikewise serviceable as reflex stimulants in syncope, palpi- \ntation, etc., and their chief therapeutic use is in the treat- \nment of nervousness, hysteria and hysterical disorders gen- \nerally. In these ammonium valerate is preferred by many. \nIn neuralgic conditions they sometimes prove of value, ai d \nagain fail to give relief. As a rule, the best preparation here \nis zinc valerate, which has also been employed with some suc- \ncess in nervous affections such as chorea and epilepsy. In \nboth forms of diabetes the fluidextract has been used tempor- \narily with advantage. It serves to diminish the amount of \nurinary water, and in the saccharine variety to lessen the ex- \ncretion of sugar. It has no curative effect, however, for as \nsoon as the remedy is discontinued all benefit from it ceases. \n\nCYPRIPEDIUM. \n\nCYPRIPEDIUM.\xe2\x80\x94 Cypripedium. (Ladies\' Slipper.) Dose, 1 gm.; \n15 gr. \n\nPreparation. \nFluidextractum Cypripedii. \xe2\x80\x94 Fluidextract of Cypripedium. \nDose, 1 c.c; 15 TTt. \n\nAction of Cypripedium. \nCypripedium is a gentle, nervous stimulant, resembling vale- \nrian in its action. \n\n\n\n668 PHARMACOLOGY AND THERAPEUTICS. \n\nTherapeutics of Cypripedium. \nIt has been used for nervous diseases, epilepsy, hypochon- \ndriasis and neuralgia, but is not a very reliable remedy. \n\nASAFETIDA. \nASAFCETIDA.\xe2\x80\x94 Asafetida. Dose, 0.250 gm. (250 milligm.) ; 4 gr. \n\nPreparations. \n\n1. Emulsum Asafoetidas. \xe2\x80\x94 Emulsion of Asafetida. (Mistura \nAsafoetidae. Milk of Asafetida.) Dose, 16 C.C.; 4 fl. dr. \n\n2. Pilulae Asafoetidae. \xe2\x80\x94 Pills of Asafetida. Dose, 2 pills. \n\n3. Tinctura Asafoetidae. \xe2\x80\x94 Tincture of Asafetida. Dose, 1 \nc.c; 15 nr. \n\nUnofficial Preparation. \nPilulae Aloes et Asafoetidae. \xe2\x80\x94 Pills of Aloes and Asafetida. \nDose, 1 to 5 pills. \n\nAction of Asafetida. \nOwing to its containing allyl sulphide, asafetida is extremely \nunpleasant to the taste. Its action is due entirely to its vola- \ntile oil, the external and internal effects of which are those of \nthe volatile oils in general. On the intestine it has a specially \nmarked stimulant action, expelling flatus and producing an \nefficient carminative effect. Large doses may cause nausea and \nvomiting, though the action of the drug varies greatly in dif- \nferent individuals. A series of experiments showed that in a \nnumber of persons headache and giddiness, with some aphro- \ndisiac effect, were produced by 1.20 gm. (20 gr.), while others \ntook as much as 15 gm. ( l / 2 oz.) with no other result than \noffensive eructations and foul-smelling faeces. It often has a \npowerful stimulant and antispasmodic effect upon the nervous \nsystem, and there is reason to believe that in hysterical sub- \njects this is in part at least due to the mental influence result- \ning from the odor and taste of the drug. In some women an \nemmenagogue effect has been noticed from it. It is excreted \nby the lungs, skin and kidneys, and is found to act like other \nvolatile oils in increasing and disinfecting the secretions. \n\n\n\nasafetida. 669 \n\nTherapeutics of Asafetida. \nExtraordinary as this may seem, asafetida is used in India \nas a condiment, but it is a fact also that valerian was formerly \nemployed in England as a perfume. Were it not for its un- \npleasant characteristics, and especially the extremely disagree- \nable eructations to which it gives rise, asafetida might prove \nvery useful as a stomachic tonic in atonic dyspepsia accom- \npanied by torpor of the bowel. It is contained in small amount \nin some of the popular sauces. The emulsion was long held \nin high repute in the flatulent colic of infants, and is still used \nto some extent, though most practitioners prefer to give reme- \ndies less obnoxious to the attendants, if not to the little patients \nthemselves. Asafetida is especially serviceable in the flatu- \nlence of neurotic subjects, expelling the flatus, promoting intes- \ntinal secretion and digestion, and relaxing the bowels; and it \nis commonly very well borne by this class of individuals. The \npill of aloes and asafetida is a favorite form of administering \nthe drug, particularly when there is constipation associated with \namenorrhcea, and an asafetida enema (1 to 64 of water) is also \nused to relieve flatus. Partly on account of its reflex stimulat- \ning effect, and partly on account of the moral effect of its \noffensive odor and taste, this remedy is not infrequently em- \nployed to control hysterical, emotional and other mental dis- \nturbances, and for this purpose it is sometimes combined with \nvalerian. Although asafetida, in the course of its excretion, \nwould serve a useful purpose in disinfecting the urine and the \nexpectoration, its disagreeableness ordinarily prevents its use \nfor these purposes. Still, it is occasionally employed in sub- \nacute bronchitis and bronchorrhcea (especially in old people), \nthe cough succeeding the paroxysmal stage of pertussis (which \nis often maintained by habit), and the sympathetic cough of \nmothers whose children are suffering from whooping-cough ; \nall of which conditions are found to be greatly benefited by it. \nThis remedy is of service in the convulsions of children from \nreflex irritation, though it is useless in those depending upon \ncerebral or renal disease ; and may also be given with advantage \n\n\n\n67O PHARMACOLOGY AND THERAPEUTICS. \n\nin chorea, particularly in young girls about the period of \npuberty and when the affection is associated with menstrual \ndifficulty. The chronic scaly eruptions (eczema, etc.), espe- \ncially when the skin is dry and harsh, are said to be much im- \nproved by the persistent use of the drug, but few patients, it \nmay well be imagined, would be willing to submit to such a \ncourse of treatment. One of the ways of treating cases of \nmalingering is to make the patient take, three times a day, an \neffervescing draught containing a few drops of the tinctures \nof asafetida and valerian; the effervescence causing the un- \npleasant taste of the medicines to recur in the mouth for some \ntime after they have been swallowed. \n\nAMMONIAC. \n\nUnofficial Preparations. \n\nAmmoniacum (U. S. P., 1890). \xe2\x80\x94 Ammoniac. Dose, 0.30 to \n2 gm.; 5 to 30 gr. \n\nEmplastrum Ammoniaci cum Hydrargyro (U. S. P., 1890). \n\xe2\x80\x94 Ammoniac Plaster with Mercury. \n\nEmulsum Ammoniaci. \xe2\x80\x94 Emulsion of Ammoniac (U. S. P., \n1890). \xe2\x80\x94 Dose, 15 to 30 c.c; y 2 t0 1 fl \xc2\xab oz - \n\nAction of Ammoniac. \n\nExternally and internally the action of ammoniac is that of \nvolatile oils. On the skin its irritant effect, which is usually \nmild, sometimes gives rise to a papular eruption. It is a stimu- \nlating expectorant and a laxative. Its action is very similar \nto that of asafetida, but while the drug is free from the objec- \ntionable features of the latter, its effects are considerably less \npowerful. \n\nTherapeutics of Ammoniac. \n\nThe plaster is employed as a stimulant alterative and resol- \nvent in glandular enlargements and indolent swellings, espe- \ncially of the joints and periosteum, and is sometimes useful for \nsmall patches of very chronic skin diseases. The principal use \nof ammoniac internally is as an expectorant. Being excreted \n\n\n\nMYRRH. 67I \n\nby the bronchial mucous membrane, it increases and disinfects \nthe secretion of the latter, and this makes it a useful remedy in \nchronic bronchitis with offensive expectoration. It is largely \nemployed for old people, in whom the bronchitis is often accom- \npanied by emphysema, and its beneficial effect is increased by \ncombining ammonium carbonate or chloride with it. \n\nGALBANUM. \n\nUnofficial Preparation. \nGalbanum. \xe2\x80\x94 Galbanum. Dose, 0.30 to 1.20 gm.; 5 to 20 gr. \n\nAction of Galbanum. \nIt is stimulant, expectorant and antispasmodic, like other sub- \nstances containing a volatile oil. Its effects, in general, are \nsimilar to those of asafetida and ammoniacum, with one or the \nother of which it has usually been prescribed. Applied to the \ncutaneous surface, it occasions a papular eruption, and, if the \ntrue skin is exposed, causes it to ulcerate. \n\nTherapeutics of Galbanum. \n\nIt has been used as a carminative, expectorant and emmena- \ngogue and as an alterant in chronic rheumatism. At the pres- \nent time it is very rarely employed internally, its principal \nuse being as an ingredient of stimulating or resolvent plasters \nfor indolent swellings. The following is a good formula for \nsuch a plaster : Galbanum, 1 ; ammoniacum, 1 ; yellow wax, 1 ; \nlead plaster, 8. \n\nMYRRH. \n\nMYRRHA.\xe2\x80\x94 Myrrh. Dose, 0.500 gm. (500 milligm.) ; 7y 2 gr. \n\nPreparations. \n\n1. Tinctura Myrrhae. \xe2\x80\x94 Tincture of Myrrh. Dose, 1 c.c; \n\n15 TTL- \n\n2. Tinctura Aloes et Myrrhae. \xe2\x80\x94 Tincture of Aloes and \nMyrrh. Dose, 2 C.C.; 30 TTt. \n\n\n\n672 PHARMACOLOGY AND THERAPEUTICS. \n\n3. Pilulae Aloes et Myrrhae. \xe2\x80\x94 Pills of Aloes and Myrrh. \nDose, 2 pills. \n\n4. Mistura Ferri Composita. \xe2\x80\x94 Compound Iron Mixture. \nDose, 16 c.c; 4 fl. dr. \n\n\n\nAction of Myrrh. \n\nExternal. \xe2\x80\x94 Locally applied it is mildly irritant to the skin \nand stimulant and disinfectant to mucous membranes and ulcer- \nated surfaces. \n\nInternal. \xe2\x80\x94 Its internal, as well as its external, effects are due \nto its volatile oil. In moderate doses it is carminative, stimu- \nlant and tonic, and in large doses a gastro-intestinal irritant, \nexciting vomiting and purging. It is excreted by mucous mem- \nbranes, especially the bronchial and the genito-urinary, and it \nis believed to increase the number of leucocytes in the blood. \nIt has expectorant qualities and is also reputed to be a stimu- \nlant to the ovarian and uterine functions. \n\nTherapeutics of Myrrh. \n\nExternal. \xe2\x80\x94 The tincture is sometimes used for the removal \nof freckles, and a lotion or ointment containing myrrh may be \napplied as a stimulant and antiseptic dressing to indolent or \nunhealthy ulcers. In cases of eczema requiring moderate \nstimulation an ointment made by heating together myrrh with \nwax and oils has been found useful. The undiluted tincture \nmay be applied to ulcerated gums, aphthous patches, and re- \nlaxed uvula. Diffused in water (1 to 16), with the addition \nof a little carbolic acid or thymol, the tincture is a good mouth- \nwash for spongy gums, for mercurial ptyalism, or for wounds \nafter operations upon the mouth, and may also be used as a \ngargle in pharyngitis, etc. As a mouth-wash it is very com- \nmonly associated with borax, as in the following formula: \nMyrrh, 1; Cologne water, 16; borax, 1; water, 3; syrup, 3. \nMyrrh has long been employed as an ingredient of dentifrices. \n\nInternal. \xe2\x80\x94 Its internal administration is considered of ser- \nvice in checking excessive discharges: bronchorrhcea, leucor- \n\n\n\nBISMUTH. 673 \n\nrhoea, cystitis, etc. It has some vogue as a disinfectant expec- \ntorant for chronic bronchitis, and under the name of myrrholin \na concentrated solution of one part of myrrh in one part of \noil, conjoined with creosote, has been given in capsules in pul- \nmonary tuberculosis. It has also been brought forward as a \nremedy for diphtheria, in which it is administered internally \nand likewise applied locally to the pharynx. In laryngeal diph- \ntheria frequent inhalations are advised of from 8 to 15 c.c. (2 \nto 4 fl. dr.) of a 2 per cent, mixture of myrrh. Myrrh is fre- \nquently prescribed with purgatives on account of its carmina- \ntive and stomachic properties, and, in combination with other \nremedies, is more or less employed in atonic dyspepsia and gas- \ntralgia. It is considered more especially useful in such condi- \ntions when they are associated with flatulence, mucous evacua- \ntions, constipation, and the presence of nervous disorders of a \nhysterical or hypochondriacal character. Here it may profit- \nably be combined with vegetable bitters and iron. The com- \npound iron mixture, in which myrrh is one of the chief con- \nstituents, is quite extensively used in amenorrhcea connected \nwith anaemia and general torpor of the system. It has been \ndoubted by some whether myrrh really has any effect on the \nmenstrual function, its apparent value in amenorrhcea being due, \nit is alleged, to the iron, aloes, or other drugs usually combined \nwith it. It has remained in use as an emmenagogue, however, \nfor a very long time, and in this capacity still seems to retain \nthe confidence of the profession. \n\n(b) Gastric Sedatives. \n\nBISMUTH. \n\n1. BISMTJTHT CITRAS.\xe2\x80\x94 Bismuth Citrate. Dose, 0.125 gm. (125 \nmilligm.) ; 2 gr. \n\n2. BISMUTHI ET AMMONII CITRAS.\xe2\x80\x94 Bismuth and Ammo- \nnium Citrate. Dose, 0.125 gm. (125 milligm.) ; 2 gr. \n\n3. BISMUTHI SUBCARBONAS.\xe2\x80\x94 Bismuth Subcarbonate. Dose, \n0.500 gm. (500 milligm.) ; 7% gr. \n\n4. BISMUTHI SUBGALLAS.\xe2\x80\x94 Bismuth Subgallate. (Dermatol.) \nDose, 0.250 gm. (250 milligm.); 4 gr. \n\n44 \n\n\n\n674 PHARMACOLOGY AND THERAPEUTICS. \n\n5. BISMUTHI SUBNITRAS.\xe2\x80\x94 Bismuth Subnitrate. Dose, 0.500 \ngm. (500 milligm.); 7y 2 gr. \n\n6. BISMUTHI SUBSALICYLAS.\xe2\x80\x94 Bismuth Subsalicylate. Dose, \n0.250 gm. (250 milligm.); 4 gr. \n\nUnofficial Preparations. \n\nBismuthi Naphtholas. \xe2\x80\x94 Bismuth Naphtholate. (Beta-Naph- \nthol Bismuth.) Dose, .30 to 2.00 gm.; 5 to 30 gr. \n\nBismuthi Oxidum. \xe2\x80\x94 Bismuth Oxide. Dose, .30 to 1.20 gm.; \n5 to 20 gr. \n\nBismuthi Oxyiodidum. \xe2\x80\x94 Bismuth Oxyiodide. (Red Bismuth \nOxyiodide. Bismuth Subiodide.) Dose, .30 to .60 m.; 5 to \n10 gr. \n\nBismuthi Phenolas. \xe2\x80\x94 Bismuth Phenolate. (Phenol-Bismuth.) \nDose, .30 to 2.00 gm.; 5 to 30 gr. \n\nBismuthi Tetra-iodophenol-phthaleinas. \xe2\x80\x94 Bismuth Tetra- \niodophenol-phthaleinate. (Eudoxin.) Dose, .30 to .50 gm.; 5 \nto 8 gr. \n\nBismuthi Tribromophenolas. \xe2\x80\x94 Bismuth Tribromophenolate. \n(Tribromophenol-Bismuth. Xeroform.) Dose, .30 to 2.00 gm.; \n5 to 30 gr. \n\nAction of Bismuth Salts. \n\nExternal. \xe2\x80\x94 Bismuth salts have no action on the unbroken \nskin. On raw surfaces they are antiseptic and mildly astrin- \ngent. When dusted on such a surface they form a protecting \ncoat over it. Used in this way their value, as in the case of \niodoform, probably depends not so much on their germicidal \naction as on their absorption of the fluids of the part, which \nrenders the surface less favorable for the growth of bacteria. \n\nInternal. \xe2\x80\x94 When injected in large quantities directly into the \ncirculation, bismuth salts produce, like arsenic, a relaxation of \nthe walls of the capillaries, and it is believed that they have a \ndirect action on the central nervous system and depress the \nvasomotor centre in the medulla. There is also a depressant \naction on the cardiac muscle, and from both these influences \nthe blood-pressure falls rapidly. Late in the poisoning the \nheart is often found to stop entirely for some time, and then \nsuddenly resume its action. The respiration is at first quick- \n\n\n\nBISMUTH. 675 \n\nened, and violent convulsions, both clonic and tonic, follow at \nshort intervals, during which the movements are feeble and \nincoordinated. In some animals the respiration ceases before \nthe heart, and in others the reverse of this is noted. The in- \njection of smaller quantities is followed by more chronic effects, \nwhich resemble those met with in cases of poisoning in the \nhuman subject. In man medicinal doses of the insoluble salts, \nalthough maintained for a long period, produce very few appre- \nciable symptoms. Any action which they may have in increas- \ning peristalsis and the secretion of mucus in the stomach is \nprobably simply that which would be caused by the presence \nof any heavy powder. In the intestine they are said to have \nsome effect in augmenting the leucocytes of the blood, and \nthey are apt to induce more or less constipation. The stools \nare blackened, a result which is generally supposed to be due \nto the formation in the large intestine of bismuth sulphide, but \nwhich is attributed by some to the reduction of bismuth in the \nbowel. Occasionally a purplish line makes its appearance on \nthe gums. As long as bismuth was employed only internally, \nno serious effects were produced by its insoluble salts, as it is \nnow known that certain cases of poisoning formerly ascribed \nto them were in reality due to the arsenic, lead or antimony \nwith which they were contaminated. Since their use was ex- \ntended to the treatment of wounds and abraded surfaces, how- \never, several instances of dangerous intoxication have been \nobserved, though the patients have generally recovered when \nthe bismuth dressing was removed. Among the symptoms \nwhich have been noted may be mentioned black spots, or even \ngangrene, in the mouth and fauces, swelling of the gums, tongue \nand throat, increased flow of saliva, dysphagia, nausea, vomit- \ning, diarrhoea and albuminuria. As much less bismuth is used \nfor external applications than is often given by the mouth, it \nwould appear either that the drug is more readily absorbed \nfrom raw surfaces than from mucous membranes or else that \nwhat is absorbed from the alimentary canal is prevented by \nthe liver from reaching the general circulation. In animals in \n\n\n\n676 PHARMACOLOGY AND THERAPEUTICS. \n\nwhich chronic poisoning is induced by the intravenous or sub- \ncutaneous injection of moderate amounts of bismuth salts there \nare caused salivation, ulcerative stomatitis, gastro-intestinal \nirritation, muscular weakness and incoordination, and usually \ntetanic convulsions at intervals, while the urine contains albu- \nmin and casts. The blood-pressure is low, as a result of the \nintestinal disturbance and general collapse, and complete paraly- \nsis eventually results. Post-mortem there are found ulcera- \ntions of the mouth and gums and of the large intestine, and \ninflammation and necrosis of the kidneys. There is also an \nintense black pigmentation of the upper part of the large intes- \ntine, which is limited very exactly by the ileo-csecal valve and \nwhich extends throughout the thickness of the bowel-wall. \nThis is caused by the depositing of bismuth sulphide on the \nmucous membrane and in the capillary vessels and lymph \nspaces, and the ulceration found is no doubt due to the em- \nbolism which results from this precipitation in the vessels. \nBismuth is excreted all along the alimentary canal, but par- \nticularly in the large intestine, and also by the urine and pos- \nsibly by the milk; and is stored in considerable amount in the \nliver. In therapeutic doses bismuth salts, especially the naph- \ntholate act as antiseptics, and it is believed that the benefit \nderived from them is also due to some extent to their ridding \nthe intestinal canal of hydrogen sulphide, in consequence of \nthe avidity of bismuth for this irritant compound. \n\nTherapeutics of Bismuth Salts. \nExternal. \xe2\x80\x94 Bismuth salts are useful as dusting powders for \nulcers and excoriated surfaces and as a dressing for wounds, \nwhen not too large. For such purposes the tribromophenolate \nand subgallate, the latter also known as dermatol, are preferable. \nThe subnitrate and subcarbonate are also employed to some \nextent. In acne, vesicular eczema, intertrigo and the erythema \nof infants one of these salts may be lightly dusted over the \nsurface. Bismuth compounds are also used in ointments, and \nthe following will be found serviceable; Bismuth oxide (official \n\n\n\nBISMUTH. 677 \n\nin B. P.), i part, and oleic acid, 8 parts, stirred in with 3 parts \nof white wax liquefied by heat, and with 9 parts of soft paraffin. \nBy some the red oxyiodide is preferred to iodoform as an anti- \nseptic for wounds and sores, and also for ointments for skin dis- \neases, and it is recommended as an excellent application to \nchancre, chancroids, open buboes, ulcers, unhealthy wounds, \nand phlegmonous erysipelas. The subnitrate, snuffed into the \nnostrils, is sometimes employed in coryza and simple ozaena and \nas a tropical application in aphthous or nursing sore mouth, \nmercurial ptyalism, chronic conjunctivitis and granular lids. \nAn ointment composed of bismuth subnitrate, boric acid, lanolin \nand olive oil has been found especially suited to the treatment \nof burns in children. The subnitrate, suspended in mucilage, \nmay be used as an injection for gonorrhoea or leucorrhGea. It \nmay also be applied in the form of soluble bougies and supposi- \ntories, and preparations of this kind are of service for ulcers \nof the rectum. \n\nInternal. \xe2\x80\x94 Bismuth salts are used internally chiefly for their \nlocal action upon the alimentary tract, as they form a protec- \ntive coating over the irritated or inflamed surfaces and keep \nthem from coming in contact, and also exert an astringent, \nsedative and antiseptic influence. The ones perhaps most fre- \nquently prescribed are the subnitrate and subcarbonate, which \nare safer and also appear to be more efficient than the soluble \nsalts. The latter when absorbed are likely to act as irritant \npoisons, and for this reason should not be used. The insoluble \ncompounds are best given suspended in mucilage, which should \nbe made with tragacanth, for when acacia is used a compact \nmass is formed at the bottom of the bottle. However they may \neffect these results, bismuth preparations are very efficacious in \nrelieving gastric pain, whether due to organic disease, such as \nscirrhus, or to less serious causes, and also not infrequently in \nchecking vomiting of whatever origin. They are said not to \nbe beneficial in the gastralgia of chlorosis and hypochondriasis, \nnor in that produced by habitual constipation. In the latter \ncondition they are naturally contra-indicated on account of \n\n\n\n678 PHARMACOLOGY AND THERAPEUTICS. \n\ntheir astringent effects. They are of great service in both \nacute and chronic gastritis, and also in gastric ulcer, where \nthey not only alleviate the pain but contribute to the cure of \nthe condition. In these painful affections their good effects \nare increased by having morphine combined with them. \n\nSodium bicarbonate also often enhances their effects as gas- \ntric sedatives, but it should not be prescribed in a mixture with \nbismuth subcarbonate, as the formation of carbon dioxide is \nlikely to result. Bismuth salts are also useful in the treatment \nof diarrhoea of various kinds. They are generally most effi- \ncient when given in large doses, and this is especially true in \nthat of tuberculosis and in chronic diarrhoea. For internal use \nthe phenolate and naphtholate are preferable to the inorganic \nsalts. The subsalicylate is also a very useful preparation. It \nprobably passes through the stomach unchanged to be broken \nup in the small intestine where it acts as an unirritating anti- \nseptic. It has been proved to be a valuable remedy in the \ntreatment of diarrhoeas, typhoid fever, and catarrhs of the ali- \nmentary tract. Reliable observations in Asiatic cholera prove \nthat the tribromophenolate (xeroform) is a valuable intestinal \nantiseptic. Bismuth subgallate was formerly much employed in \nthe treatment of gastro-intestinal indigestion, but has been \nlargely supplanted by the more efficient naphtholate and tribro- \nmophenolate. \n\nEudoxin (not official) is bismuth tetra-iodophenol-phthalein- \nate, and occurs as a tasteless, odorless, reddish-yellow, insoluble \npowder. This is decomposed in the intestines, and is claimed \nto be a germicide. It is certainly known that iodine is liber- \nated. It is employed as an intestinal antiseptic. \n\nTOXICOLOGY. \n\nWhen applied in large quantity to an exterior wounded surface suffi- \ncient bismuth may be absorbed to produce poisoning. This may also \noccur if glycerin is used to form an emulsion for injection into closed \ncavities (abscesses, joint-disease). \n\nSymptoms. \xe2\x80\x94 These are acute stomatitis with a peculiar blackish dis- \ncoloration of the mucous membrane, generally upon the borders of \n\n\n\nCERIUM. 679 \n\nthe teeth and extending over the whole mouth, ulceration of the mucous \nmembrane, intestinal catarrh, pain and diarrhoea. Even desquamative \nnephritis may be set up. \n\nTreatment. \xe2\x80\x94 Use demulcents. \n\nCERIUM. \n\nCERII OXALAS. \xe2\x80\x94 Cerium Oxalate. (Cerous Oxalate.) Dose, \n0.065 gm. (65 milligm.) ; 1 gr. \n\nAction of Cerium Oxalate. \nVery little is known of the effects of cerium oxalate, but \nwhen injected into the circulation it is said to produce gastro- \nintestinal irritation, .with vomiting and diarrhoea and hyper- \nemia and ecchymoses of the mucous membranes, and also con- \ngestion or inflammation of the kidneys. It seems to be ab- \nsorbed with difficulty from the stomach and bowel. \n\nTherapeutics of Cerium Oxalate. \nIt is used empirically as an anti-emetic, and especially for \nthe vomiting from pregnancy, seasickness and other conditions \nin which gastric irritation is not the primary cause. It is not \nknown how it acts in controlling emesis, but it is thought prob- \nable that its effects are local and similar to those of bismuth \nsubnitrate. The dose above given is often exceeded; 2 gm. \n(30 gr.) have been frequently given with good results. Cerium \noxalate appears to have some action as a sedative to the gastric \nmucous membrane, and so may allay the pain of gastralgia or \nprove beneficial in dyspepsia occasioned by deranged innerva- \ntion. In cases of cough (no doubt of reflex origin) associated \nwith vomiting, it is sometimes of great service, and it has even \nbeen recommended for controlling excessive cough in phthisis \nor chronic bronchitis. In chronic diarrhoea it may be used in \nthe place of bismuth. It has been thought to be of service in \nnervous dysmenorrhoea and such other nervous disorders as \nchorea and epilepsy, but it is difficult to see how this can be \nthe case, and probably little reliance can be placed on it in this \nclass of affections. \n\n\n\n68o PHARMACOLOGY AND THERAPEUTICS. \n\nD. Drugs Acting on the Intestines. \n\n(c) Purgatives. \n\nHONEY. \n\nMEL. \xe2\x80\x94 Honey. Dose, 4 c.c; 1 fl. dr. \n\nPreparations. \nMel Depuratum (Mel Despumatum, U. S. P., 1890). \xe2\x80\x94 Clari- \nfied Honey. Dose, 4 c.c; 1 fl. dr. \n\nMel Rosae. \xe2\x80\x94 Honey of Rose. Dose, 4 c.c; 1 fl. dr. \n\nAction of Honey. \nHoney is demulcent, nutritive and slightly laxative. Gener- \nally it constitutes an agreeable article of diet. In some indi- \nviduals, however, it causes pyrosis, flatulence and colic, and in \nothers an eruption of urticaria. \n\nTherapeutics of Honey. \nHoney is useful in relieving dryness of the mouth and facili- \ntating swallowing, and oxymel (clarified honey, 8; acetic acid, \n1; water, 1) is a pleasant addition to gargles or vehicle for \nastringents or expectorants. Honey is sometimes a sufficient \nlaxative for the constipation of children. \n\nTAMARIND. \n\nTAMARINDTJS.\xe2\x80\x94 Tamarind. Dose, 16 gm.; 240 gr. \n\nUnofficial Preparation. \nInfusum Tamarindi. \xe2\x80\x94 Infusion of Tamarind. Dose, freely. \n\nAction of Tamarind. \nTamarind is nutritive, laxative and refrigerant. \n\nTherapeutics of Tamarind. \nIt may be given to fever patients or convalescents in infu- \nsion or in the form of tamarind whey (1 part of tamarind to \n30 of milk) as an acid, cooling, slightly purgative \'drink. As a \n\n\n\nMANNA. 68 1 \n\nlaxative it is often prescribed in association with other reme- \ndies, but in the case of children it may be given alone, spread \nupon bread and butter. \n\nFIG. \nFICUS.\xe2\x80\x94 Fig. \n\nAction of Fig. \nFig is a pleasant and mildly purgative article of diet. The \nmucilaginous and saccharine constituents of the fresh fruit give \nit a laxative action. This effect in dried fig is largely due to \nthe indigestible skins and seeds, which act mechanically in \nstimulating intestinal paralysis, but also have some tendency to \ncreate flatulence. \n\nTherapeutics of Fig. \n\nIt may be used as a dessert to correct slight constipation, and \nconfection of senna, in which fig is contained, is a very ser- \nviceable laxative for children. Split open and heated, fig may \nbe employed, particularly in the mouth for gum-boils, etc., to \nfulfill the indications of a poultice. Poultices made with the \ndried fruit and milk have sometimes been found by surgeons \nto neutralize the most persistent fetor of cancerous and other \nulcers. \n\nPRUNE. \n\nPRUNUM.\xe2\x80\x94 Prune. \n\nAction of Prune. \nPrune is demulcent, nutritive and slightly laxative. \n\nTherapeutics of Prune. \nIt may be eaten, either raw or stewed, as an article of diet \nin cases of slight constipation. It is used as a corrective for \nsenna in the confection. In " medicated prune " senna or podo- \nphyllin is added to give a more pronounced purgative effect. \n\nMANNA. \nMANNA.\xe2\x80\x94 Manna. Dose, 16 gm.; 240 gr. \n\n\n\n682 PHARMACOLOGY AND THERAPEUTICS. \n\nAction of Manna. \nManna is aperient when taken in considerable quantities. \n\nTherapeutics of Manna. \nManna is given as a mild laxative to children. It dissolves \neasily in milk, and is pleasant to the taste. \n\nCASSIA FISTULA. \nCASSIA FISTULA.\xe2\x80\x94 Cassia Fistula. (Purging Cassia.) Dose, 4 \ngm.; 60 gr. \n\nPreparation. \nConfectio Sennae. \xe2\x80\x94 Confection of Senna. Dose, 4 gm.; 60 gr. \n\nAction of Cassia Fistula. \nCassia-pulp is laxative in doses of 4 to 8 gm. (1 to 2 dr.), and \nin quantities sufficient to purge causes nausea, flatulence and \ngriping. \n\nTherapeutics of Cassia Fistula. \nThe pulp is administered as one of the ingredients of con- \nfection of senna, and in this country is rarely ever prescribed \nin any other form. \n\nCASTOR OIL. \nOLEUM RICINL\xe2\x80\x94 Castor Oil. Dose, 16 c.c; 4 ft. dr. \n\nUnofficial Preparation. \nFluidextractum Ricini Foliorum. \xe2\x80\x94 Fluidextract of Ricinus \nLeaves. Dose, 2 to 8 c.c.; y 2 to 2 fl - dr - \n\nAction of Castor Oil. \n\nExternal. \xe2\x80\x94 Castor oil, like other bland fixed oils, is protec- \ntive and sedative when applied to the skin and mucous mem- \nbranes. \n\nInternal. G astro -intestinal Tract. \xe2\x80\x94 The so-called unpleasant \ntaste of castor oil is mostly due to the smell, and if the nose is \nheld when the oil is swallowed loses most of its objectionable- \n\n\n\nCASTOR OIL. 683 \n\nness. It is non-irritant to the stomach, upoji which it produces \nno effects. When it reaches the intestine, however, it is de- \ncomposed by the digestive juices, and the ricinoleates thus \nformed are irritant and cause purgation. Castor oil may be \ntaken in very large quantities without producing any other \neffect than that of a simple laxative. The seeds of the Ricinus \ncommunis contain an intensely poisonous toxalbumin, Ricin, \nwhich was at one time supposed to be the active principle of \nthe oil, but it is now known that the latter is entirely free from \nthis substance, and that its action is solely due to the ricinoleic \nacid of which it is the glyceride. A similar but less poisonous \ntoxalbumin is found in the seeds of the Croton Tiglium, but \ndoes not enter into the composition of croton oil itself. It \ntakes about five hours for castor oil to operate, the stools from \nit being soft, but not liquid, and it does not usually cause grip- \ning. Even when rubbed into the skin, it is capable of acting \non the bowels, and also when thrown into the rectum. It is \nabsorbed from the intestine and disappears in the tissues like \nordinary oils. A single dose is not followed by constipation, \nbut this is very apt to result from the habitual use of the drug. \nThe symptoms of poisoning by castor beans are violent abdom- \ninal pain, vomiting and purging, with collapse, and in fatal \ncases evidences of some severe gastro-enteritis have been found \npost mortem. \n\nMammary Glands. \xe2\x80\x94 The leaves of Ricinus communis when \napplied to the breasts have some reputation as a galactagogue. \n\nTherapeutics of Castor Oil. \nOn account of the mildness of its action, castor oil is one of \nthe most useful drugs we have in cases where it is desired sim- \nply to evacuate the alimentary canal. For instance, it is well \nadapted for getting rid of undigested food that is causing diar- \nrhoea. When irritating substances or hardened faeces are to be \nremoved from the intestines it is the most efficient purgative \ncompatible with safety. Formerly it was advised, as a routine \npractice, to give a dose of castor oil early on the morning of \n\n\n\n684 PHARMACOLOGY AND THERAPEUTICS. \n\nthe third day after parturition, for the purpose of modifying \nthe severity of the so-called milk-fever. Since the general in- \ntroduction of the thermometer into practice, however, and the \nbetter understanding of the causes of febrile temperatures in \nthe puerperal state, the existence of a distinct milk-fever refer- \nable to functional disturbance in the breasts during the period \nin question has been found to be an entirely exceptional occur- \nrence. Still, although the administration of this particular \nlaxative at this time has largely fallen into disuse, the canonical \npractice of opening the patient\'s bowels on the third day is of \nunquestionable utility, for the reason that very few women \nescape from an accumulation of faecal matter during the last \nweeks of pregnancy, which is often very great and which cre- \nates a predisposition to puerperal affections. In some an ordi- \nnary injection of soap and olive oil in water suffices to procure \nan adequate evacuation ; in others, compound liquorice powder, \ncompound rhubarb pill, or a dose of some cathartic mineral \nwater. In obstinate cases a calomel purge may be called for. \nA very favorite post-partum combination is a pill composed of \ncompound extract of colocynth, extract of hyoscyamus, pow- \ndered socotrine aloes, and extract of nux vomica, with a small \nquantity of podophyllin and ipecacuanha. By some of the best \nobstetricians castor oil is now given only in cases of severe \ncolic, in which it is sometimes found advisable to combine with \nit a small dose of laudanum. When inflamed haemorrhoids, \nfissures of the anus or surgical operations on the pelvic viscera \nrequire the use of a certain, but mild and unirritating, laxative, \ncastor oil should be selected. It is often very useful in the \ntemporary constipation of children, as well as in diarrhoea in \nyoung subjects induced and maintained by undigested food or \nirritating secretions. In the latter condition the oil may be \nfollowed with advantage by an opiate or an enema containing \nlaudanum, and in some forms of diarrhoea, both in adults and \nchildren, a small quantity of laudanum is frequently adminis- \ntered with it. In the dysentery of children and the sporadic \ndysentery of adults, especially after the more acute febrile \n\n\n\nCASTOR OIL. 685 \n\nsymptoms have subsided, an emulsion of castor oil made with \nmucilage of acacia (to which laudanum or paregoric may be \nadded if the symptoms are severe), is generally of great \nservice. It may also prove valuable in the entero-colitis of \ninfants and young children. In these cases the amount of oil \nin each dose should be quite small. Except in the case of \naspidium (see Aspidium), castor oil is a good purgative to give \nbefore and after the use of anthelmintics. It is not suited for \ncases of chronic constipation. As an enema it does not appear \nto possess any advantages over olive oil. One part of castor \nthoroughly mixed with five parts of warm olive oil may be used \nfor a mild injection. \n\nAs most persons object to taking castor oil by itself, it is \ngenerally necessary to disguise its taste in some way. It may \nbe given in soft capsules, which can be obtained of any desired \nsize. If for any reason these are objectionable, it is best ad- \nministered in the beverage known as sarsaparilla. Lemon \njuice or coffee conceals the taste to some extent, and the fol- \nlowing is recommended as a good way in which to take it: \nThe oil is added to 4 c.c. (1 fl. dr.) of peppermint water, and \nthen a little brandy added till the oil neither sinks nor floats. \nIf the inside and rim of the glass are moistened with the vehicle, \nthe oil, which should, if possible, be between two layers of the \nvehicle, is scarcely tasted. In the same way it may be taken in \nthe froth of ale or beer. In the B. P. a mixture is official \nwhich is composed of castor oil, 6; mucilage of acacia, 3; \norange-flower water, 2, and cinnamon water, 5, and various \nother more or less palatable mixtures have been recommended. \nThe extemporaneous dose prepared at the soda-water fountain \nis preferred by many persons. Castor oil with balsam of Peru \n(see Balsam of Peru) makes an excellent surgical dressing \nwhich is applicable for burns, wounds, abscesses, and many \nother conditions, and the oil is occasionally used as a basis for \nointments for the treatment of alopecia. A drop of the oil in \nthe eye will often relieve the irritation caused by a foreign \nbody or by granular lids. A poultice made of the leaves of \n\n\n\n686 PHARMACOLOGY AND THERAPEUTICS. \n\nthe castor-oil plant may be applied to the breasts to promote \nthe secretion of milk, and a fluidextract of the leaves (not offi- \ncial), taken three or four times a day and also locally applied, \nis likewise supposed to have some effect in increasing this. \n\n\n\n(b) Simple Purgatives. \n\n\n\nALOES. \n\n\n\nALOE (Aloe Barbadensis, Aloe Socotrina, U: S. P., 1890). \xe2\x80\x94 Aloes. \nDose, 0.250 gm. (250 milligm.) ; 4 gr. \n\nPreparations. \n\n1. Aloe Purificata. \xe2\x80\x94 Purified Aloes. Dose, 0.250 gm. (250 \nmilligm.); 4 gr. \n\n2. Extractum Aloes. \xe2\x80\x94 Extract of Aloes. Dose, 0.125 gm. \n(125 milligm.); 2 gr. \n\n3. Pilulae Aloes. \xe2\x80\x94 Pills of Aloes. Dose, 2 pills. \n\n4. Pilulae Aloes et Ferri. \xe2\x80\x94 Pills of Aloes and Iron. Dose, 2 \npills. \n\n5. Pilulse Aloes et Mastiches. \xe2\x80\x94 Pills of Aloes and Mastic. \n(Lady Webster\'s pill.) Dose, 2 pills. \n\n6. Pilulae Aloes et Myrrhae. \xe2\x80\x94 Pills of Aloes and Myrrh. \nDose, 2 pills. \n\n7. Tinctura Aloes. \xe2\x80\x94 Tincture of Aloes. Dose, 2 c.c; 30 TTt- \n\n8. Tinctura Aloes et Myrrhae. \xe2\x80\x94 Tincture of Aloes and \nMyrrh. Dose, 2 C.C.; 30 TTt. \n\nUnofficial Preparation. \nPilulae Aloes et Asafcetidae. \xe2\x80\x94 Pills of Aloes and Asafetida. \nDose, 1 to 5 pills. \n\nALOINUM.\xe2\x80\x94 Aloin. Dose, 0.065 gm. (65 milligm.); 1 gr. \n\nPreparation. \nPilulae Laxativae Compositae. \xe2\x80\x94 Compound Laxative Pills. \nDose, 2 pills. \n\nAction of Aloes. \nExternal. \xe2\x80\x94 Aloes has no action on the unbroken skin, but is \nthought to be slightly stimulating to denuded surfaces. Pow- \ndered aloes, dusted upon an abrasion, blister or ulcer, is capable \n\n\n\nALOES. 68? \n\nof being absorbed and producing the characteristic internal \neffects of the drug. \n\nInternal. Gastro-intestinal Tract. \xe2\x80\x94 Like other substances \nhaving a strong bitter taste, aloes, in small doses, acts as a \nstomachic. It is a slowly acting but efficient cathartic. Its \nmain action is shown in the stimulation of the large intestine, \nparticularly the rectum, and the result of this is chiefly muscular \ncontraction, though some increase of secretion is also produced \nby it. The presence of bile in the intestine is necessary to elicit \nits full effects, and it is believed itself to cause some increased \nsecretion of bile, as indicated by the dark character of the \npassages from it. If given alone it usually causes a consider- \nable amount of griping pain. Aloin is regarded as less certain \nin its purgative action than aloes, and there can be little ques- \ntion, it is thought, that the crystalline aloin itself is inactive \nin the bowel, but is there changed under certain conditions to \nan amorphous compound which has irritant effects. It is \nstated, however, that a warm solution of aloin will produce \npurgation if injected subcutaneously. \n\nPelvic Organs. \xe2\x80\x94 Aloes produce a comparatively marked con- \ngestion of the pelvic organs, and is therefore regarded as an \nemmenagogue. \n\nExcretion. \xe2\x80\x94 It is readily absorbed, and is eliminated through \nthe bowels and kidneys, and also in the milk. It is quite likely \nthat the habitual use of the drug will result in irritation of the \nkidney. \n\nTherapeutics of Aloes. \n\nAs it usually requires from twelve to fifteen hours, or more, \nto act on the bowels, it is customary to administer it compara- \ntively early in the evening in order to secure a movement from \nit in convenient season on the following morning. On account \nof the griping which it is apt to cause if employed alone, it is \nusually associated with carminatives or other agents calculated \nto promote greater regularity of peristaltic contraction. A \nsmall amount of extract of hyoscyamus or extract of bella- \ndonna generally answers very well. The bitter principles of \n\n\n\n688 PHARMACOLOGY AND THERAPEUTICS. \n\naloes are of service in aiding digestion, and a very good dinner \npill is composed of .06 gm. (1 gr.) of extract of aloes and .015 \ngm. (14 gr.) of extract of mix vomica. If the faeces are hard, \n.03 gm. (y 2 gr.) of powdered ipecacuanha should be added. \nSuch a pill, with the addition of .06 or .12 gm. (1 to 2 gr.) of \nferrous sulphate is often very useful in anaemia. For cases of \nchronic constipation, especially in children and also in persons \nof middle age, many of which are due to an imperfect contrac- \ntion of the muscular coat of the large intestine, aloes is an \nexcellent purgative. If given in moderate doses, it has the \nadvantage of not producing subsequent constipation, and, in \naddition, of seldom requiring an increase in the dose. Simple \njaundice, of an atonic kind, and jaundice, or at least a bilious \nstate, in which the tongue is coated, the breath foul, the abdo- \nmen tumid, and the colon impacted, may usually be successfully \ntreated with this remedy. The constipation of hypochondriasis \nand melancholia also is best overcome by the use of aloes, and, \nwith the removal of the impacted faeces, there is not infre- \nquently an improvement in the mental state. In cerebral dis- \norders when purgatives are indicated for their derivative effect, \nthis is the one commonly selected. In cases of hysteria, with \nanaemia and constipation, the pills of aloes and asafetida, which \nhave also a carminative effect, may be given. Combined with \niron and asafetida or myrrh, aloes is used to a considerable \nextent in the treatment of amenorrhoea, whether associated \nwith chlorosis or not. It is generally prescribed on account of \nits tendency to induce hyperaemia of the pelvic organs, but it \nseems quite possible that the relief by it of the constipation \nwhich is so commonly present in these cases is largely, if not \nchiefly, responsible for the improvement which frequently takes \nplace under its use. It is often stated that aloes is contra- \nindicated in cases of menorrhagia. This is no doubt true as \nregards full-blooded subjects, but when this condition occurs in \nthe debilitated and relaxed, it is sometimes relieved by the drug. \nAs to the risk of employing it in pregnancy, lest the fullness \nof the uterine vessels induced by it may lead to abortion, which \n\n\n\nRHUBARB. \n\n\n\n689 \n\n\n\nhas also been suggested by writers, it would appear doubtful \nwhether the danger from aloes in this respect is greater than \nthat from any other active cathartic. The presence of haemor- \nrhoids has been regarded as another contra-indication, but if \na patient suffers from haemorrhoids which are not inflamed, \naloes can be safely administered, and even with marked benefit \nif they are due to a relaxed rectal mucous membrane. In gon- \norrhoea aloes has been used both internally and by injection, \nafter the acute inflammation has subsided. The following \nenema may be given for ascarides : Aloes, 8; potassium carbon- \nate, 3; mucilage of starch, 960. As the purgative principle of \naloes is excreted to some extent in the milk, the drug should be \navoided or given with great caution in the case of nursing \nwomen, on account of the danger of its causing diarrhoea in the \ninfant. \n\nRHUBARB. \n\nRHEUM.\xe2\x80\x94 Rhubarb. Dose, 1 gm.; 15 gr. \n\n\n\nPreparations. \n\n1. Extractum Rhei. \xe2\x80\x94 Extract of Rhubarb. Dose, 0.250 gm. \n(250 milligm.); 4 gr. \n\n2. Fluidextractum Rhei. \xe2\x80\x94 Fluidextract of Rhubarb. Dose, \n1 c.c; 15 n\\. \n\n3. Pilulae Rhei Composite. \xe2\x80\x94 Compound Pills of Rhubarb. \nDose, 2 pills. \n\n4. Pulvis Rhei Compositus. \xe2\x80\x94 Compound Powder of Rhu- \nbarb. Dose, 2 gm.; 30 gr. \n\n5. Syrupus Rhei. \xe2\x80\x94 Syrup of Rhubarb. Dose, 8 c.c; 2 fl. dr. \n\n6. Syrupus Rhei Aromaticus.\xe2\x80\x94 Aromatic Syrup of Rhubarb. \n(Spiced Syrup of Rhubarb.) Dose, 8 C.C.; 2 fl. dr. \n\n7. Tinctura Rhei. \xe2\x80\x94 Tincture of Rhubarb. Dose, 4 C.C.; 1 \nfl. dr. \n\n8. Tinctura Rhei Aromatica. \xe2\x80\x94 Aromatic Tincture of Rhu- \nbarb. Dose, 2 c.c; 30 TT\\. \n\n9. Mistura Rhei et Sodse. \xe2\x80\x94 Mixture of Rhubarb and Soda. \nDose, 4 c.c: 1 fl. dr. \n\n\n\n45 \n\n\n\n69O PHARMACOLOGY AND THERAPEUTICS. \n\nUnofficial Preparations. \n\nPilulae Rhei (U. S. P., 1890).\xe2\x80\x94 Pills of Rhubarb. Dose, 3 to \n5 pills. \n\nTinctura Rhei Dulcis (U. S. P., 1890).\xe2\x80\x94 Sweet Tincture of \nRhubarb. Dose, 15 to 30 c.c; y 2 to 1 fl. oz. \n\nAction of Rhubarb. \n\nExternal. \xe2\x80\x94 Rhubarb is never used for external application. \nIf it were so applied, it would probably give rise to a mild irri- \ntation in consequence of its chrysarobin, which by itself excites \ninflammation of the skin. \n\nInternal. Alimentary Canal. \xe2\x80\x94 In the mouth, rhubarb slightly \nincreases the salivary secretion. In moderate doses it is sto- \nmachic, by reason of its bitter resins, increasing gastric secre- \ntion, peristalsis, vascularity and absorption, and thus promoting \ndigestion. In larger doses it has a purgative action, producing \nin from four to eight hours, generally with some griping, *a \nsoft, though not watery, evacuation which is of a yellowish- \nbrown color, due to the chrysarobin. The purgative properties \nof the drug have been attributed to the chrysarobin, although, \nchrysophanic acid, which it yields, is stated not to cause purga- \ntion, on account of its rapid absorption. Rhubarb has some \neffect in increasing the biliary secretion, but its cholagogue \naction is not sufficiently marked to entirely explain its pur- \ngative properties. It probably also increases the excretion \nof bile by accelerating its passage through the intestine and \npreventing its reabsorption. Rhubarb, as well as podophyllin \nand resin of jalap, is said to require the presence of bile \nin the intestine as a necessary condition for its operation, \nso that in its absence these drugs may be either altogether \ninactive or much less energetic than usual. It is often stated \nthat rhubarb affects chiefly the muscular coat of the intestine, \nand thus purges by increasing peristalsis, but no satisfactory \nproof of this has apparently been educed. The purgative action \nis succeeded by constipation, due, no doubt, to the astringent \neffect of the rheotannic acid. This is presumably absorbed \nquickly and subsequently excreted back into the bowel, for were \n\n\n\nRHUBARB. \n\n\n\n69I \n\n\n\nit not thus soon absorbed it would be swept away in the evacua- \ntions and would have no opportunity of producing its astrin- \ngent action. \n\nKidneys. \xe2\x80\x94 Rhubarb has the effect of slightly increasing the \namount of urine. The excretion of chrysophanic acid gives a \nyellowish color to this fluid, and also to the milk of nursing \nwomen. Rhubarb urine may be distinguished from that of \njaundice by its becoming purplish-red on the addition of an \nalkali. \n\nSkin. \xe2\x80\x94 The skin may also assume a yellowish tinge from the \npresence of chrysophanic acid, and in rare instances cutaneous \neruptions of different kinds are produced. \n\n\n\nTherapeutics of Rhubarb. \nRhubarb is an excellent purgative for the indigestion of chil- \ndren, whether attended by diarrhoea or not, as it efficiently \nclears the intestinal canal of undigested food and irritating \nsecretions, and its stomachic and after-astringent effects often \nserve a very useful purpose. A very satisfactory stomachic \nfor young children consists of equal parts of powdered rhubarb \nand sodium bicarbonate (which conceals the taste of the rhu- \nbarb), with the addition of some powdered gentian; or, if pre- \nferred, the same remedies may be associated in a liquid mixture. \nThe aromatic syrup combined with an alkali is especially ser- \nviceable in the summer complaints of children when the stools \nare greenish and mucous. Rhubarb is much used in diarrhoea, \nwith intestinal weakness or relaxation, to unload the bowels of \nacrid secretions. In small doses, the tincture is a good sto- \nmachic tonic in dyspepsia with deficient biliary and intestinal \nsecretions. On account of the griping which it is apt to occa- \nsion, rhubarb should rarely be prescribed alone, though in habit- \nual constipation some individuals find benefit from chewing the \nroot. Notwithstanding its astringent property, rhubarb is \nlargely used as an habitual laxative, as it not only does not \nimpair, but improves the appetite and digestion. It is adapted \nto those of relaxed habit, and should not be given in a high \n\n\n\n692 PHARMACOLOGY AND THERAPEUTICS. \n\nsthentic state of the system, with hyperemia of the mucous \nmembrane, or when depletion is necessary. For the treatment \nof constipation, however, it has the disadvantage of requiring \nto be frequently repeated, its astringent after-effect being in \nmany cases a decided objection. The compound rhubarb pill \nis a mild and efficient preparation for moving the bowels. It \nis often combined with calomel to act upon the so-called torpid \nliver, as in Quain\'s pill, which is calomel, .06 gm. (1 gr.) with \ncompound rhubarb pill; .20 gm. (3 gr.). \n\nBUTTERNUT. \n\nUnofficial Preparations. \n\nJuglans (U. S. P., 1890). \xe2\x80\x94 Juglans. (Butternut.) Dose, 4 \nto 8 gm.; 1 to 2 dr. \n\nExtractum Juglandis (U. S. P., 1890). \xe2\x80\x94 Extract of Juglans. \nDose, 0.30 to 2.00 gm.; 5 to 30 gr. \n\nAction of Butternut. \nButternut is a mild cathartic, and resembling rhubarb in the \nproperty of evacuating, without debilitating, the alimentary \ncanal. \n\nTherapeutics of Butternut. \nButternut has some reputation in dysentery and in chronic \nconstipation. It was much employed during the war of the \nRevolution. \n\nCASCARA SAGRADA. \n\nRHAMNUS PURSHTANA.\xe2\x80\x94 Cascara Sagrada. (Sacred Bark.) \nDose, 1 gm.; 15 gr. \n\nPreparations. \n\n1. Extractum Rhamni Purshianae. \xe2\x80\x94 Extract of Cascara Sa \ngrada. Dose, 0.250 gm. (250 milligm.) ; 4 gr. \n\n2. Fluidextractum Rhamni Purshianse. \xe2\x80\x94 Fluidextract of \nCascara Sagrada. Dose, 1 C.C.; 15 hi,. \n\n3. Fluidextractum Rhamni Purshianse Aromaticum. \xe2\x80\x94 Aro- \nmatic Fluidextract of Cascara Sagrada. Dose, 1 C.C.; 15 m\\. \n\n\n\nCASCARA SAGRADA. 693 \n\nAction of Cascara Sagrada. \nThe fresh bark is emetic, but after it has been kept for about \ntwo years this action is lost. Cascara sagrada is a simple, but \nefficient, purgative, which does not occasion much griping. Its \naction resembles that of buckthorn, but it is more powerful \nand certain in its operation. One of the advantages of this \ndrug is that it overcomes constipation without purging, and \nconsequently without weakening, and the stomachic properties \nwhich it derives from its bitter principle add to its value by \nimproving the appetite and digestion. \n\nTherapeutics of Cascara Sagrada. \nAlthough introduced only a few years ago, cascara sagrada \nhas established itself as a favorite and reliable remedy in habit- \nual constipation. It should not be employed as a purgative \nwhen a powerful impression is required. It does not operate \nhurriedly or urgently, like many purgatives which produce \nwatery stools, and is best suited to cases of simple constipation, \nor of torpor of the colon without associated disease. It may \nbe given for the relief of catarrhal jaundice, as well as of \nhaemorrhoids and affections of the pelvic organs, and is often \nvery useful in cases of dyspepsia accompanied by constipation. \nA special virtue of cascara sagrada is that in its continued use \ngradually increasing doses are unnecessary. As the condition \nimproves the daily quantity may be reduced, and a considerable \nnumber of cases of chronic constipation are eventually cured \nby the drug. As the fluidextract is very bitter, it is advisable \nthat its taste should be covered by aromatics, liquorice or sal \nvolatile, or it may be administered in chloroform water. The \naromatic syrup (B. P., liquid extract of cascara, 8; tincture \nof orange, 2 ; alcohol \xe2\x80\x94 90 per cent. \xe2\x80\x94 1 ; cinnamon water, 3 ; \nsyrup, 6) also conceals the taste satisfactorily. The liquid \nextract is made with alcohol (90 per cent.) and water. A \npreparation known as Tinctura Laxativa, consisting of equal \nparts of fluidextract of cascara sagrada, aromatic spirit of \nammonia, spirit of chloroform, tincture of belladonna leaves, \n\n\n\n694 PHARMACOLOGY AND THERAPEUTICS. \n\nand tincture of nux vomica, is miscible in water and constitutes \na pleasant simple purge which is highly recommended in habit- \nual constipation. The dose is 1.20 to 4 c.c. (20 to 60 ill). \nThe official aromatic fluidextract is an excellent preparation, \nand some of the unofficial preparations now made, such as \n" Cascara Cordial," are very palatable, and seem to be quite \nefficient as laxatives. The drug is also sold in various pills and \ntablets. The preparations of cascara sagrada have to some \nextent supplanted the compound liquorice powder, which was \nformerly in very general use. \n\nSENNA. \nSENNA.\xe2\x80\x94 Senna. Dose, 4 gm.; 60 gr. \n\nPreparations. \n\n1. Confectio Sennse. \xe2\x80\x94 Confection of Senna. Dose, 4 gm.; \n60 gr. \n\n2. Fluidextractum Sennas. \xe2\x80\x94 Fluidextract of Senna. Dose, 2 \nc.c; 30 hi.. \n\n3. Infusum Sennae Compositum. \xe2\x80\x94 Compound Infusion of \nSenna. (Black Draught.) Dose, 120 C.C.; 4 fl. OZ. \n\n4. Pulvis Glycyrrhizae Compositus. \xe2\x80\x94 Compound Powder of \nGlycyrrhiza. (Compound Liquorice Powder.) Dose, 4 gm.; \n60 gr. \n\n5. Syrupus Sennae. \xe2\x80\x94 Syrup of Senna. Dose, 4 c.c; 1 fl. dr. \n\nAction of Senna. \n\nExternal. \xe2\x80\x94 None. \n\nInternal. \xe2\x80\x94 Senna is one of the class of drugs, including rhu- \nbarb, aloes, frangula and cascara sagrada, which are known as \nthe anthracene purgatives, because they owe their activity to \nthe presence of certain irritant anthracene (C 14 H 10 ) compounds. \nOnly a few of the latter have as yet been isolated. Senna dif- \nfers from rhubarb in the absence of any astringent property, \nand its use is not followed by constipation. It is somewhat \nmore liable to induce griping and nausea than rhubarb, but its \ntendency to gripe may be almost abolished, without greatly \n\n\n\nSENNA. 695 \n\nreducing its activity, by first exhausting it with strong alcohol. \nGenerally five or six hours elapse between its administration \nand the first action of the bowels, and the stools resulting from \nit are watery and of a pale yellow color. Senna has little or \nno action on the secretion of bile. The cathartic acid in it is \nsupposed to stimulate the muscular coat of the intestine, espe- \ncially the colon, occasioning some hyperemia, and, in conse- \nquence, the contents of the small intestine are hurried through \nthe lower bowel, so that some undigested food may appear in \nthe motions. Some observers state that senna acts directly as \na stimulant upon the mucous membranes, and so produces a \nlocal peristalsis as it is moved along. It will cause purgation, \nhowever, if it is injected into the circulation, and this is prob- \nably because cathartic acid is excreted into the bowel. While \nthis acid is by far the most important purgative principle of \nsenna, there is reason to suppose that there are other substances \nin it which also have such action. Some constituents of the \ndrug are absorbed and the chrysophan (chrysarobin) may \ncause discoloration of the urine, staining it carmine if that fluid \nis alkaline, or yellow if it is acid. The purgative properties of \nthe drug may be imparted to the milk of nursing women, and \ntherefore senna should be used with caution in this class of \npatients. \n\nTherapeutics of Senna. \nThe most active preparation is an extemporaneous infusion, \nwhich should not, however, be boiled very long. It soon under- \ngoes decomposition if left to itself, but this may be prevented \nby adding nitre to it (1 to 480). Senna is a safe and reliable \npurgative for cases of simple constipation, but is usually com- \nbined with other remedies. As it acts largely upon the colon, \nit is serviceable in slight cases of faecal accumulation. It is \nuseful to complement the action of duodenal purgatives, and \nan illustration of this is seen in the old prescription of a blue \npill at night and black draught in the morning. As the com- \npound infusion of senna is a very disagreeable mixture, how- \never, the compound liquorice powder is preferable to it. The \n\n\n\n696 PHARMACOLOGY AND THERAPEUTICS. \n\nlatter preparation is still used to a considerable extent in habit- \nual constipation, especially among children, and in the consti- \npation of pregnancy. In pregnant women and other patients \nwhen cascara sagrada alone will not move the bowels, senna is \nsometimes combined with it with good effect. Confection of \nsenna is also a very satisfactory preparation for children, and \nespecially in the form of Tamar Indien, in which it is coated \nwith sugar or chocolate and which is readily taken by them. \nIn the case of children manna is often combined with senna, \nand an excellent laxative mixture consists of fluidextract of \nsenna, manna and magnesium carbonate, with syrup of ginger \nand water. Coffee has been recommended for masking the \ndisagreeable taste of senna. 8 gm. (2 dr.) of senna and 4 gm. \n(1 dr.) of coffee may be infused in 90 c.c. (3 fl. oz.) each of \nhot milk and boiling water, and the whole drunk after twelve \nhours. \n\nFRANGULA. \nFRANGULA.\xe2\x80\x94 Frangula. (Buckthorn.) Dose, 1 gm.; 15 gr. \n\nPreparation. \nFluidextractum Frangulae. \xe2\x80\x94 Fluidextract of Frangula. Dose, \n1 c.c; 15 ttl. \n\nAction of Frangula. \nThe fresh bark is a violent gastro-intestinal irritant, but that \nwhich has been kept a year is a mild purgative, acting like senna. \n\nTherapeutics of Frangula. \nIt is suitable for children, and for use in chronic constipation. \n\nOXGALL. \nFel Bovis. \xe2\x80\x94 Oxgall. (Fel Tauri.) \n\nPreparation. \nFel Bovis Purificatum.\xe2\x80\x94 Purified Oxgall. Dose, 0.500 gm. \n(500 milligm.); 7V 2 gr. \n\n\n\nEUONYMUS. 697 \n\nAction of Oxgall. \nOxgall when added to albuminous solutions delays their de- \ncomposition. It aids in the absorption of fats. If given by the \nmouth it is mostly absorbed from the intestine and acts as a \ncholagogue. \n\nTherapeutics of Oxgall. \nOxgall has been used as a cholagogue purgative, not infre- \nquently associated with aloes. Although theoretically of value \nin replacing deficient biliary secretion, it has the great disad- \nvantage of disturbing the gastric digestion, and on this account \nis not now very much employed. It may be found useful, how- \never, when given as an enema in cases of impacted faeces in \nwhich there is not sufficient room in the rectum for a bulky \ninjection. For this purpose 30 to 60 gm. (1 to 2 fl. oz.) of \noxgall in 500 c.c. (1 pint) of water should be used. It is claimed \nthat bile has some antitoxic power with reference to the poi- \nsons produced by pathogenic micro-organisms, and oxgall has \nsometimes been used as an antiseptic in typhoid fever and in \nintestinal fermentation. \n\n(c) Drastic purgatives. \n\nEUONYMUS. \n\nEUONYMUS.\xe2\x80\x94 Euonymus. (Wahoo. Spindle Tree.) Dose, 0.500 \ngm. (500 milligm.); 7 l / 2 gr. \n\nPreparations. \n\nExtractum Euonymi. \xe2\x80\x94 Extract of Euonymus. (Euonymin.) \nDose, 0.125 gm. (125 milligm.); 2 gr. \n\nFluidextractum Euonymi. \xe2\x80\x94 Fluidextract of Euonymus. \nDose, 0.5 c.c.; 8 HI. \n\nAction of Euonymus. \n\nIn small doses euonymus is a gastric stimulant, promoting \n\nappetite and digestion. In both moderate and large doses it is \n\nalso regarded as an hepatic stimulant, increasing the biliary \n\nsecretion, while in the latter amounts it is distinctly irritant \n\n\n\n698 PHARMACOLOGY AND THERAPEUTICS. \n\nto the intestine and is an energetic purgative. It owes its \nactivity to its euonymin, a substance which has the same \naction on the heart as digitalis. The drug is also said to have \nslight diuretic and expectorant effects. Beyond its tonic and \npurgative properties it probably has no special virtue. \n\nTherapeutics of Euonymus. \nIt has been chiefly employed in cases of constipation asso- \nciated with impaired functional derangement of the liver, and \nis often combined with calomel. In dyspepsia its administra- \ntion two or three times a week is sometimes attended with good \nresults. \n\nIRIS. \n\nUnofficial Preparations. \n\nIris (U. S. P., 1890).\xe2\x80\x94 Iris. (Blue Flag.) Dose, 0.60 to \n2.00 gm.; 10 to 30 gr. \n\nExtractum Iridis (U. S. P., 1890). \xe2\x80\x94 Extract of Iris. Dose, \n0.05 to 0.015 gm.; 1 to 3 gr. \n\nExtractum Iridis Fluidum (U. S. P., 1890). \xe2\x80\x94 Fluidextract of \nIris. Dose, 0.60 to 2 c.c; 10 to 30 TT\\. \n\nIridinum. \xe2\x80\x94 Iridin. (Irisin.) Dose, 0.05 to 0.30 gm.; 1 to \n5 gr. \n\nAction of Iris. \nIris is a cholagogue and hydragogue cathartic. Like euony- \nmus, it is stimulant to the intestinal glands, but it is more \npowerfully purgative than that drug, and is also more apt to \ncreate gastric disturbance. As in the case of other cathartics \nof its class, moderate quantities do not appear to induce griping \nso frequently as some of the anthracene purges. It is credited \nwith some diuretic action. \n\nTherapeutics of Iris. \nIt may be used in dropsy, for the purpose of causing diuresis \nas well as purgation, and it has been found an efficient cathar- \ntic in malarial and catarrhal jaundice and bilious remittent \nfever. It is also said to exert a specific influence in enlarge- \n\n\n\nPODOPHYLLUM. 699 \n\nment of the thyroid gland. It is a common practice to com- \nbine iridin, which has a cholagogue action, with euonymin, \ncalomel, podophyllin or similar purgatives. \n\nCELANDINE. \n\nUnofficial Preparation. \n\nChelidonium (U. S. P., 1890). \xe2\x80\x94 Chelidonium. (Celandine.) \nDose, 1.0 to 4.0 gm.; 15 to 60 gr. \n\nAction of Celandine. \nCelandine apparently possesses a stimulating effect upon the \nhepatic secretions. It is a somewhat irregularly acting purga- \ntive, giving rise to watery motions, but at the same time to \ngriping pains. \n\nTherapeutics of Celandine. \nIt has been found useful in jaundice, and it constituted the \nchief ingredient in the old Decoctum ad Ictericos of the Edin- \nburgh Pharmacopoeia. \n\nPODOPHYLLUM. \n\nPODOPHYLLUM.\xe2\x80\x94 Podophyllum. (May Apple. Mandrake.) Dose, \n0.500 gm. (500 milligm.) ; 7y 2 gr. \n\nPreparations. \n\n1. Fluidextractum Podophylli. \xe2\x80\x94 Fluidextract of Podophylli. \nDose, 0.5 c.c; 8 TH.. \n\n2. Resina Podophylli. \xe2\x80\x94 Resin of Podophyllum. (Podo- \nphyllin.) Dose, (purgative) 0.015 gm. (15 milligm.); y 4 gr.; \n(laxative) 0.005 gm. (5 milligm.); T \\ gr. \n\n3. Pilulae Podophylli, Belladonnse et Capsici. \xe2\x80\x94 Pills of Podo- \nphyllum, Belladonna and Capsicum. Dose, 1 pill. \n\n4. Pilulae Catharticae Vegetables. \xe2\x80\x94 Vegetable Cathartic \nPills. Dose, 2 pills. \n\nUnofficial Preparation. \nExtractum Podophylli (U. S. P., 1890). \xe2\x80\x94 Extract of Podo- \nphyllum. Dose, .10 to .60 gm.; 2 to 10 gr. \n\n\n\n/OO PHARMACOLOGY AND THERAPEUTICS. \n\nAction of Podophyllum. \n\nExternal. \xe2\x80\x94 Podophyllum is irritant to the skin and mucous \nmembranes and from denuded surfaces it may be absorbed and \nproduce a purgative effect. \n\nInternal. G \'astro-intestinal Tract. \xe2\x80\x94 Podophyllin is a drastic \npurgative. Large doses cause marked gastro-intestinal irrita- \ntion, and have been known to prove fatal from acute inflamma- \ntion of the bowel. Medicinal doses occasion considerable colic \nand in some instances nausea. Podophyllin is like aloes in the \nslowness of its action, catharsis rarely occurring earlier than \nten or twelve hours after its administration, and sometimes not \nfor twenty to twenty-four hours. The watery passages which \nit produces are stained dark by the presence of bile. In small \ndoses podophyllin probably increases the secretion of that fluid \n\xe2\x80\x94 at all events, under its action there is an augmentation of the \nsolids in it. When it is given in purgative doses the quantity \nof bile is said not to be increased, though more of it is emptied \nfrom the gall bladder into the intestine. Podophyllin would \nthus seem to act both as a direct and indirect cholagogue. An \nold name for this drug is Vegetable Mercury. Both podophyl- \nlin and podophyllotoxin cause purgation when injected subcu- \ntaneously, and this is probably because after absorption they \nare excreted into the bowel, since they have been detected in \nthe faeces when administered in this way. Podophyllotoxin \noccasions the formation of methaemoglobin in the red corpuscles \nwhen added to blood outside the body, and when thrown into \nthe circulation in large amount gives rise to glomerular nephri- \ntis and haemorrhages into various organs. While it has a de- \npressant effect upon the central nervous system, this is thought \nto be indirect, and due to the shock and haemorrhage resulting \nfrom its severe intestinal action. \n\nTherapeutics of Podophyllum. \nAs podophyllum is believed to act especially on the liver, it \nis quite largely employed in constipation with hepatic derange- \nment, and particularly in so-called bilious attacks. In conges- \n\n\n\nLEPTANDRA. JO I \n\ntion of the portal circulation, in catarrhal and malarial jaun- \ndice, and in ascites it generally acts with great efficiency, and \nhaemorrhoids of recent formation which bleed in consequence \nof stasis in the portal circulation may sometimes be cured by \na brisk podophyllum cathartic. Habitual constipation due to \ninactivity of the muscular coat of the intestine may also be \ncured by the nightly use of a small dose of podophyllin com- \nbined with belladonna. The resin has been recommended for \ninfants one or two months old who have hard, stony stools, .12 \nc.c. (2 HI), or more, of a solution of .06 gm. (1 gr.) of podo- \nphyllin in 4 c.c. (1 fl. dr.) of alcohol being used on sugar once \nor twice a day. It should not be given in association with \npromptly acting purgatives, as in that case it will be carried \nthrough the bowel before it has had time to produce its effects. \nIt may often be advantageously combined with belladonna, nux \nvomica, or with hyoscyamus to prevent griping. The only \npreparation that should be employed is the resin (podophyllin), \nand this is almost universally administered in pill form. \n\nLEPTANDRA. \nLEPTANDRA. \xe2\x80\x94 Leptandra. (Culver\'s Root.) Dose, 1 gm.; 15 gr. \n\nPreparations. \n\n1. Extractum Leptandrse. \xe2\x80\x94 Extract of Leptandra. Dose, \n0.250 gm. (250 milligm.) ; 4 gr. \n\n2. Fluidextractum Leptandrae. \xe2\x80\x94 Fluidextract of Leptandra. \nDose, 1 c.c; 15 TIL \n\n3. Pilulae Catharticse Vegetabiles. \xe2\x80\x94 Vegetable Cathartic \nPills. Dose, 2 pills. \n\nAction of Leptandra. \nRecent leptandra root acts as a violent cathartic, and some- \ntimes as an emetic. It is an excellent cholagogue, owing its \nactivity to leptandrin, and appears to have a special influ- \nence upon the muciparous follicles of the intestine. \n\n\n\n702 PHARMACOLOGY AND THERAPEUTICS. \n\nTherapeutics of Leptandra. \nIt acts very advantageously in cases of duodenal indigestion \nand chronic constipation. \n\nSCAMMONY. \n\nSCAMMONIUM.\xe2\x80\x94 Scammony. Dose, 0.250 gm. (250 milligm.) ; \n4 gr. \n\nPreparation. \nResina Scammonii. \xe2\x80\x94 Resin of Scammony. Dose, 0.200 gm. \n(200 milligm.); 3 gr. \n\nAction of Scammony. \nScammony, which consists very largely of jalapin, is a hydra- \ngogue cathartic of rapid and energetic action. It has no effect \nuntil it enters the duodenum, and the presence of bile appears \nto be essential for its activity. With the aid of the bile it pow- \nerfully stimulates the intestinal glands to increased secretion, \nand incidentally causes more or less hyperemia of the bowel \nand stimulation of its muscular coat. In about four hours after \nits administration a profuse watery evacuation occurs, and its \naction is attended with considerable griping. In over-doses it \nis likely to cause violent gastro-enteritis. No purgative effect \nis produced when it is injected subcutaneously or intravenously. \n\nTherapeutics of Scammony. \nAs it is a prompt and efficient cathartic, scammony may be \nused in cases of obstinate constipation and impaction of faeces. \nOn account of its violent properties, however, it is usually best \nto combine with it some carminative or less active purgative. \nIt is often serviceable in the treatment of dropsical effusions \nand of cerebral affections, and is well adapted for severe cases \nof mania and hypochondriasis. For dropsy the compound \njalap powder is more commonly employed, but when this fails \nto act recourse may be had to scammony or the compound \nscammony powder of the B. P. (scammony resin, ioo; jalap, \n75; ginger, 25). The latter preparation is also used as a vermi- \n\n\n\nJALAP. 703 \n\nfuge. Scammony is efficient in clearing mucus from the intes- \ntines, and is anthelmintic against both round-worms and tape- \nworms. For children, however, this remedy is unnecessarily \nsevere in the treatment of worms. Where active purgation is \nrequired in children, calomel and scammony may be given \ntriturated with sugar of milk, or scammony may be adminis- \ntered rubbed up with milk or with syrup of rhubarb. \n\nJALAP. \n\nJALAPA. \xe2\x80\x94 Jalap. Dose, 1 gm.; 15 gr. \n\nPreparations. \n\n1. Pulvis Jalapse Compositus. \xe2\x80\x94 Compound powder of Jalap. \nDose, 2 gm.; 30 gr. \n\n2. Resina Jalapae. \xe2\x80\x94 Resin of Jalap. Dose, 0.125 gm. (125 \nmilligm.); 2 gr. \n\n3. Pilulse Catharticae Composite. \xe2\x80\x94 Compound Cathartic \nPills. Dose, 2 pills. \n\n4. Pilulse Catharticae Vegetables. \xe2\x80\x94 Vegetable Cathartic \nPills. Dose, 2 pills. \n\nUnofficial Preparation. \nExtractum Jalapae (U. S. P., 1890). \xe2\x80\x94 Extract of Jalap. \nDose, .12 to .50 gm.; 2 to 8 gr. \n\nAction of Jalap. \n\nExternal. \xe2\x80\x94 It causes pain and irritation when applied to the \nnostrils in fine powder. \n\nInternal. \xe2\x80\x94 The action of jalap is very much the same as that \nof scammony, but it is somewhat less powerful and produces \nrather less colic, while it promotes even greater intestinal \nsecretion. It has also been credited by some observers with \ndiuretic properties. Jalapin administered by the mouth cannot \nbe detected in the faeces or urine, and is therefore supposed to \nundergo complete or partial oxidation in the body. \n\n\n\n704 \xe2\x80\xa2 PHARMACOLOGY AND THERAPEUTICS. \n\nTherapeutics of Jalap. \nJalap is occasionally employed for severe constipation, and \nan old prescription consists of equal parts of powdered jalap \nand calomel, well triturated. The dose is from .30 to .60 gm. ; \n5 to 10 gr. This is known as Rush\'s thunderbolt. Curiously \nenough, it does not gripe. The principal use of jalap is in the \ntreatment of all forms of dropsy, and particularly that from \nBright\'s disease. For this purpose the compound powder, \nwhich produces abundant watery evacuations, is commonly \nemployed, and while the diuresis which also is frequently ob- \nserved after its administration may possibly be due in a small \nmeasure to the effect upon the kidney of the jalap itself, the \naction of the potassium bitartrate and the relief of the engorge- \nment of renal vessels resulting from the drain of fluid from the \nintestinal vessels would seem to be important factors in the \naugmentation of the urine. In order to enhance the diuretic \neffect, some clinicians are in the habit of prescribing an addi- \ntional amount of the potassium salt with each dose of compound \njalap powder. For renal dropsy, and to avert the dangers of \nuraemia, it is customary to aid and supplement the action of the \npowder by the more or less frequent use of vapor baths. Jalap \nshould not be employed for too long a time continuously, since \nit may occasion a form of gastro-enteritis and, in addition, may \nfavor cardiac weakness. It is sometimes given in the begin- \nning of inflammations and fevers or other acute diseases where \nan efficient cathartic is required, and is also found of service \nin various forms of cerebral congestion. The clrug is natur- \nally contra-indicated in all inflammatory states of the alimen- \ntary canal, and large doses of it should not be given if the \nintestinal mucous membrane is liable to inflame easily. \n\nGAMBOGE. \nCAMBOGIA. \xe2\x80\x94 Gamboge. Dose, 0.125 gm. (125 milligm.) ; 2 gr. \n\nPreparation. \nPilulae Catharticae Composite. \xe2\x80\x94 Compound Cathartic Pills. \nDose, 2 pills. \n\n\n\nCOLOCYNTH. fO$ \n\nAction of Gamboge. \n\nGamboge belongs to the class of drastic or hydragogue ca- \nthartics, and is violent in its action, causing marked irritation \nof the alimentary canal, energetic peristalsis, with considerable \ngriping, and greatly augmented intestinal secretion. It owes its \nactivity to gambogic acid, which, however, is insoluble, and \nseldom acts unless it is accompanied with the inert bodies of \nthe crude drug. Most of it escapes unaltered in the stools, but \nsome is absorbed, and small and repeated doses are slightly \ndiuretic. It colors the urine yellow. \n\nTherapeutics of Gamboge. \n\nAs its action is somewhat uncertain, and is so violent and \napt to cause severe colic when it does take place, gamboge is \nnot often prescribed, except as the official pill into which it \nenters (Pilulse Catharticae Compositse). Even the gum-resin, \non account of its solubility, is irritant to the stomach, so that \nthe drug should always be used in pill form. It should also \nalways be administered in combination with other remedies. \nIt is quite an efficient anthelmintic, and is occasionally given \nwith other agents of this class. \n\nCOLOCYNTH. \n\nCOLOCYNTHIS.\xe2\x80\x94 Colocynth. (Bitter Apple. Bitter Gourd. Bitter \nCucumber.) Dose, 0.065 gm. (65 milligm.) ; 1 gr. \n\nPreparations. \n\n1. Extractum Colocynthidis. \xe2\x80\x94 Extract of Colocynth. Dose, \n0.030 gm. (30 milligm.) ; y 2 S 1 - \n\n2. Extractum Colocynthidis Compositum.\xe2\x80\x94 Compound Ex- \ntract of Colocynth. Dose, 0.500 gm. (500 milligm.) ; iy 2 \xc2\xa3?\xe2\x80\xa2 \n\n3. Pilulae Catharticae Composite. \xe2\x80\x94 Compound Cathartic \nPills. Dose, 2 pills. \n\n4. Pilulae Catharticae Vegetabiles. \xe2\x80\x94 Vegetable Cathartic \nPills. Dose, 2 pills, \n\n46 \n\n\n\n706 PHARMACOLOGY AND THERAPEUTICS. \n\nUnofficial Preparations. \n\nTinctura Colocynthidis. \xe2\x80\x94 Tincture of Colocynth. Dose, .12 \nto 4.00 c.c; 2 TTL to 1 fl. dr. \n\nCitrullinum.\xe2\x80\x94 Citrullin. Dose, .01 to .30 gin.; y 6 to 5 gr. \n\nColocynthinum.\xe2\x80\x94 Colcynthin. Dose, .01 to .30 gm.; y 6 to \n5 gr. \n\nAction of Colocynth. \n\nExternal. \xe2\x80\x94 Colocynthin is irritant to mucous membranes, \nespecially those of the eye, nose and throat. \n\nInternal. \xe2\x80\x94 The action of colocynth varies in accordance with \nthe amount given and the mode of administration. In small \ndoses it acts as a simple bitter, increasing appetite and gastric \nsecretion. In larger doses it is a powerful intestinal stimulant, \naugmenting the biliary and intestinal secretions, and accelerat- \ning the movements of both the large and small intestine. It \noccasions considerable griping pain, but the amount of colic \ndoes not seem to be entirely dependent upon the quantity taken, \nas even small doses may be followed by much discomfort if \nthe drug is given alone. It produces abundant watery passages, \nand if the dose is excessive may set up enteritis, with bloody \nstools. Toxic symptoms are not infrequently met with from \nthe use of colocynth, as it is one of the drugs commonly em- \nployed for the purpose of producing abortion. It appears to \nhave a distinct diuretic action, for colocynthin is stated to excite \nrenal irritation or inflammation when it is given either hypo- \ndermatically or by the mouth, and even when the powder is \ninhaled during its manufacture. This glucoside not only \npurges when swallowed, but also when administered subcu- \ntaneously or by intravenous injection, a result probably due to \nits excretion into the intestine, though it has been suggested \nthat this and some of the other purgative principles may have \na specific action quite apart from their irritant effects. Ap- \nplied to the skin of the abdomen, colocynth causes intestinal \npain and some purgation, \n\n\n\nCOLOCYNTH. JOJ \n\nTherapeutics of Colocynth. \nColocynth is perhaps the most generally useful of the drastic \ncathartics, but it is of great importance that it should be admin- \nistered in carefully regulated doses and properly combined with \nother remedies. On account of the griping to which it gives \nrise it should never be given by itself, but a proper mode of em- \nployment renders its effects almost comparable to those of sim- \nple purgatives. The violence of its action may be moderated to \na considerable degree by its administration with aromatic sub- \nstances or with intestinal sedatives such as belladonna or hyos- \ncyamus, as in the colocynth and hyoscyamus pill (B. P.: Com- \npound colocynth pill, 2 ; extract of hyoscyamus, 1 ) . Compound \ncolocynth pill consists of colocynth pulp, 1 ; Barbadoes aloes, \n2 ; resin of scammony, 2 ; potassium sulphate, l /\xc2\xb1 \\ oil of cloves, \nY^ ; water, q. s. The compound extract is a safe, effective, and \nnot unpleasant preparation for the relief of constipation, and \nthe compound cathartic pill is also a very serviceable combina- \ntion. This pill is sometimes made extemporaneously with podo- \nphyllin in the place of calomel. Some prefer the official veg- \netable cathartic pill. For some cases of habitual constipation \nthe compound extract of colocynth, combined with the ex- \ntracts of belladonna and physostigma, seems to answer very \nwell. In cerebral congestion the preparations of colocynth \nare employed for their revulsive effect. Hypochondriasis and \nmelancholia, when associated with sluggishness of the large \nintestine and faecal accumulations, are benefited by colocynth, \nas by other hydragogue cathartics. Notwithstanding its diur- \netic action, even in the condition of health, colocynth is not so \ngenerally serviceable in the treatment of dropsy as jalap, al- \nthough it is more or less used. Minute doses of a tincture of \ncolocynth (not official) have proved efficient, it is said, in colic, \nsciatica, ovarian and other neuralgias, and for relieving the \npain of glaucoma. Like other remedies of its class, colocynth \nis contra-indicated in inflammatory states of the intestinal canal. \nIt is often stated that colocynth is unsafe during the existence \nof pregnancy, but there seems to be no good reason for this \n\n\n\n708 PHARMACOLOGY AND THERAPEUTICS. \n\nassertion, provided the remedy be administered with due cau- \ntion. Some of the most eminent obstetricians are in the habit \nof prescribing it when required, often with hyoscyamus and \nnux vomica. Colocynth in combination with colchicum is found \nin some popular remedies for gout. \n\nBoth citrullin and colocynthin are occasionally used in medi- \ncine, particularly in the form of suppositories or enemata. The \nformer is stated to be of value in hernia when strangulation is \nthreatened. Colocynthin, in doses of .01 to .03 gm. (-J to T /z \ngr.), dissolved in glycerin and administered in a small enema \nconsisting of not more than from one to three teaspoonfuls of \nthe fluid, has been found to be a very reliable purgative, acting \nin from half an hour to two hours. Its action is attributed to \nabsorption from the rectum. \n\nELATERIN. \n\nUnofficial Preparation. \n\nElaterium (B. P.). \xe2\x80\x94 Elaterium. Dose, .005 to .03 gm.; T \\ \nto 14 gr. \n\nELATERINUM.\xe2\x80\x94 Elaterin. Dose, 0.005 gm. (5 milligm.) ; T \\ gr. \n\nPreparation. \nTrituratio Elaterini. \xe2\x80\x94 Trituration of Elaterin. Dose, 0=030 \ngm. (30 milligm.); y 2 gr. \n\nAction of Elaterin. \n\nExternal. \xe2\x80\x94 Elaterium is a marked local irritant. It is stated \nto cause ulcerations upon the fingers of those who handle the \nfruit and prepare the drug for the market. \n\nInternal. \xe2\x80\x94 The action of elaterin closely resembles that of \ncolocynth, but is much more energetic, and it is regarded as \nthe most powerful hydragogue cathartic known. The drain of \nfluid which it induces even in medicinal doses is so profuse \nthat its use is commonly attended with considerable exhaustion \nand prostration. When externally applied, it is said, as well \n\n\n\nELATERIN. 7O9 \n\nas when it is injected into the circulation, it also produces a \npurgative effect. If given in properly regulated amount, it \noccasions comparatively little pain or irritation, notwithstand- \ning the very free catharsis caused. In small doses by the \nmouth it increases the secretion of saliva and promotes appe- \ntite. \n\nTherapeutics of Elaterin. \n\nOn account of the violence of its action, elaterin is not \nadapted to cases of ordinary constipation. It is the most effi- \ncient of the hydragogue cathartics in general dropsy or in \nascites, and while there appears to be no authority for the \nclaim that it is capable of increasing the intestinal elimination \nof urea, its practical value in uraemia has been demonstrated \nby clinical experience. The great drawback to its use is the \ndepression resulting from it, and hence great care should be \nexercised not to administer it in too large doses, and also to \nsupport the strength of the patient by appropriate measures \nwhen it is employed. Almost always it may be advantageously \nfollowed by alcoholic stimulants. It ought never to be given \nin cases of marked exhaustion, and its injudicious use in the \nlater stages of dropsical affections may induce fatal collapse. \nIt should always be given with the greatest caution, if at all, in \ndisease of the heart, but under proper restrictions it may be \nemployed for the effusion in pericarditis, as well as in pleurisy. \nIn cerebral congestions or effusions and in other affections of \nthe brain it is valuable as a derivative. Elaterin has been em- \nployed in various diseases for the purpose of depletion, but to \naccomplish this the salines are usually preferable. Especially \nis this the case if there is present any gastro-intestinal irrita- \ntion or inflammation, in all instances of which, it need scarcely \nbe said, elaterin is contra-indicated. Clutterbuck\'s elaterium, \nthe dose of which is .008 gm. ( l /g gr.) has been used, because \nof the confidence reposed in its reliability, to a considerable \nextent in uraemia and puerperal eclampsia. \n\n\n\n7 TO PHARMACOLOGY AND THERAPEUTICS. \n\nBRYONIA. \n\nUnofficial Preparations. \n\nBryonia (U. S. P., 1890).\xe2\x80\x94 Bryonia. (Bryony.) Dose, 0.60 \nto 4.00 gm.; 10 to 60 gr. \n\nTinctura Bryoniae (U. S. P., 1890). \xe2\x80\x94 Tincture of Bryonia. \nDose, 8.0 to 15.0 c.c; 2 to 4 fl. dr. \n\nAction of Bryonia. \nBryonia is an active hydragogue cathartic. \n\nTherapeutics of Bryonia. \nIt was formerly much employed, but has been superseded by \njalap. \n\nCROTON OIL. \nOLEUM TIGLIL\xe2\x80\x94 Croton Oil. Dose, 0.05 c.c; 1 ni. \n\nAction of Croton Oil. \n\nExternal. \xe2\x80\x94 Croton oil is an irritant of extraordinary power. \nA single drop applied to the skin causes pain, hyperemia and \nprompt vesication. The vesicles thus formed rapidly undergo \npustulation, while the surrounding tissue becomes inflamed and \ncedematous. The pustules may be umbilicated, but differ from \nvariolous pustules in that they vary greatly in their size. It \nhas now been determined that the subcutaneous injection of \ncroton oil, provided that it contains free acid, is capable of \ncausing the formation of pus without the presence of microbes, \nwhich was formerly thought by many to be necessary for such \naction. \n\nInternal. \xe2\x80\x94 On the mucous membrane of the mouth, fauces, \noesophagus and stomach croton oil exerts its irritant action, as \nupon the skin, but it is found that if the free acid in it is \nremoved, this irritant effect will be prevented, while the oil \nwill simply cause purgation in consequence of its saponifica- \ntion by the intestinal juices. Under these circumstances it is \nquite bland, and can only be distinguished from castor oil by \nits more energetic purgative action. Ordinarily croton oil is \n\n\n\nCROTON OIL. 711 \n\nsuch a powerful irritant poison that except in the smallest doses \nit produces marked gastro-enteritis, with nausea and vomiting, \nsevere abdominal pain, violent purging, with bloody stools, col- \nlapse and death. A drop of it will cause considerable colic and \nin the course of one or two hours an evacuation of the bowels. \nThis is likely to be followed by others, the passages becoming \nmore and more fluid. At the same time there are produced \nhyperemia of the gastro-intestinal tract, increase of secretion, \nand probably increased peristalsis. Whether the latter is due \nsimply to the irritation or to some action of the drug exerted \nafter absorption is undetermined, but the other effects are at- \ntributable to the local action of the oil. As to what becomes of \ncroton oil in the body nothing is known with positiveness, but \nit is thought probable that part of it is excreted into the large \nintestine. Applied to the skin, the oil may cause free purga- \ntion. The toxalbumin, Crotin, which is found in the Croton \nTiglium, but which does not pass into the oil, resembles that \nof the castor oil bean (Ricin), but is considerably less poi- \nsonous. \n\nTherapeutics of Croton Oil. \n\nExternal. \xe2\x80\x94 Croton oil was formerly employed to produce \ncounter-irritation, especially in diseases of the chest and of the \njoints, but is not often used for this purpose now, at least in \nan undiluted state, as in many instances permanent cicatrices \nare left as the result of the suppuration caused. Corson\'s paint \nis a 5 to 10 per cent, solution of croton oil in ether, to which \na small quantity of tincture of iodine is added to color it ; while \nthe liniment of the B. P. consists of 15 per cent, of the oil in \nequal parts of alcohol and oil of cajuput. .30 c.c. (15 ^l) of \nthis liniment in 30 c.c. (1 fl. oz.) of olive oil may be used as a \nstimulant application in alopecia. In very obstinate cases of \nringworm, which have resisted other remedies, croton oil is \nsometimes applied to a spot about the size of a dime. It should \nnever be used for such purposes in delicate children. \n\nInternal. \xe2\x80\x94 The chief advantages of croton oil are its rapid \naction as a drastic cathartic and the smallness of the dose \n\n\n\n712 PHARMACOLOGY AND THERAPEUTICS. \n\nrequired. It is therefore of great value for patients who are \nunconscious or maniacal, and it is used to a considerable ex- \ntent in cerebral apoplexy, uraemia and puerperal eclampsia. As \na revulsive in cerebral congestion it may be of service by in- \ncreasing vascular dilatation in the bowel, and thus lowering the \nintra-cranial blood-pressure. By some authorities it is consid- \nered the one cathartic to employ when it is desired to revulse \nby the intestines. It is unsuitable for the treatment of dropsy \nor of other conditions requiring frequency of administration, \nas the action may be followed by considerable irritation. In \nobstinate constipation when there is no organic intestinal ob- \nstruction a dose of croton oil often acts very happily. Thus, \nit is appropriate in cases of faecal impaction, without inflamma- \ntory symptoms, and the constipation due to lead poisoning may \nnot infrequently be overcome by it after less energetic cathar- \ntics have failed. It is contra-indicated in all very feeble per- \nsons, in pregnant women, and in patients suffering from haemor- \nrhoids, peritonitis, or affections of the stomach or bowels. As \na rule, it should be avoided in children, but occasionally it may \nbe called for in them. As washing with alcohol removes the \nacidity without impairing the purgative effect of the oil, a prep- \naration so treated is the best for this class of subjects, and it \nmay be administered rubbed up with sugar of milk. The un- \npleasant effects of croton oil may be modified by combining it \nwith other remedies, as the compound extract of colocynth and \nextract of belladonna, and if in any exceptional case there should \nseem to be sufficient reasons for giving it continuously for a \nshort period, it would certainly be advisable to employ it in this \nway. The treatment of poisoning by croton oil is the same as \nthat for gastro-enteritis from other causes. Fortunately, when \nan over-dose is swallowed, vomiting is usually very promptly ex- \ncited, and hence very large quantities have been taken without \nproducing a fatal result. In case free emesis has not been \ncaused by the drug the first step in the treatment would of \ncourse be to evacuate the stomach. \n\n\n\nCOLCHICUM. 713 \n\nCOLCHICUM. \n\nCOLCHICI CORMUS (Colchici Radix, U. S. P., 1890).\xe2\x80\x94 Colchicum \nCorm. Dose, 0.250 gm. (250 milligm.) ; 4 gr. \n\nPreparation. \nExtractum Colchici Cormi. \xe2\x80\x94 Extract of Colchicum Corm. \nDose, 0.065 gm. (65 milligm.); 1 gr. \n\nCOLCHICI SEMEN.\xe2\x80\x94 Colchicum Seed. Dose, 0.200 gm. (200 mil- \nligm.) ; 3 gr. \n\nPreparations. \n\n1. Fluidextractum Colchici Seminis. \xe2\x80\x94 Fluidextract of Col- \nchicum Seed. Dose, 0.2 C.C.; 3 TT\\,. \n\n2. Tinctura Colchici Seminis. \xe2\x80\x94 Tincture of Colchicum \nSeed. Dose, 2 c.c; 30 TT\\.- \n\n3. Vinum Colchici Seminis. \xe2\x80\x94 Wine of Colchicum Seed. \nDose, 2 c.c; 30 TO,. \n\nCOLCHICINA.\xe2\x80\x94 Colchicine. Dose, 0.0005 gm. (0.5 milligm.); \n\nT28 S 1, \n\nUnofficial Preparations of Colchicum. \n\nExtractum Colchicis Radicis Fluidum (U. S. P., 1890). \xe2\x80\x94 \nFluidextract of Colchicum Root. Dose, .12 to .50 C.C.; 2 to 8 Vl\\,. \n\nVinum Colchici Radicis (U. S. P., 1890). \xe2\x80\x94 Wine of Colchicum \nRoot. Dose, 0.30 to 1 c.c; 5 to 15 TT\\. \n\nColchicine Salicylas. \xe2\x80\x94 Colchicine Salicylate. (Colchisal.) \nDose, 0.0006 gm.; T ^ gr. \n\nAction of Colchicum. \n\nExternal. \xe2\x80\x94 Colchicum is a decided local irritant, causing red- \nness and smarting when applied to the skin, while the dust, \nwhen inhaled, excites sneezing and conjunctival hyperemia, \nwith a burning sensation in the mouth and throat. \n\nInternal. Gastro-intestinal Tract. \xe2\x80\x94 In the great majority of \ninstances moderate doses of colchicum give rise to no appre- \nciable effect. In some individuals, however, there is produced \nafter a time a feeling of malaise, with discomfort in the stom- \nach and bowels, followed by some nausea and diarrhcea. It \nmay also have the effect of slightly increasing the biliary secre- \n\n\n\n714 PHARMACOLOGY AND THERAPEUTICS. \n\ntion. In large amounts it causes salivation and nausea, with \nviolent vomiting and purging, and afterwards a condition of \ndepression, apathy and collapse; and the same effects are pro- \nduced by the intravenous injection of colchicine. Several \nhours elapse after the administration of the drug before these \nsymptoms are elicited, and the reason for this is stated to be \nthat it is not the colchicine itself which produces them, but an \noxidation product, oxydicolchicine, which is formed from it in \nthe mammalian organism. In man, at least, it would appear \nthat the gastro-intestinal irritation is not altogether an inflam- \nmatory action, since the intestine may appear quite normal \nafter death, and there is seldom more than a simple catarrh of \nthe duodenum. When ecchymoses, etc., have been found, they \nhave been ascribed to the mechanical effects of the extremely \nenergetic peristalsis occasioned. The explanation of the symp- \ntoms which has been offered is that there appears to be an \nincreased irritability of the intestinal tract, so that normal im- \npulses, which ordinarily keep up a moderate peristalsis, now \nproduce a very violent one. In mammalian animals poisoned \nwith colchicine, however, it is stated that the alimentary canal \npresents all the appearances of acute gastro-enteritis ; so that \nthis explanation would seem somewhat inadequate. The \namount of the drug ingested appears to have little influence on \nthe duration of the preliminary stage of quiescence. \n\nCirculation and Respiration. \xe2\x80\x94 In animals the heart\'s action \nand blood-pressure remain unaffected, and while in man the \npulse may become small, rapid and thready, this is no doubt \nsimply the result of the collapse. The respiration is found to \nbe slow, though deep and full at first. Later it becomes shal- \nlow, and death is due to failure of the respiratory centre, the \nheart continuing to beat for some time afterward. \n\nNervous System and Muscles. \xe2\x80\x94 The action on the central \nnervous system is almost purely depressant, but it is believed \nthat the nervous symptoms caused are probably secondary to \nthe effect upon the abdominal organs, rather than due to any \ndirect central action. In the case of mammalian animals poi- \n\n\n\nCOLCHICUM. 715 \n\n\xc2\xab \n\nsoned with colchicine when the collapse sets in the movements \nare found to become slow and difficult, more especially in the \nposterior extremities, which are eventually rendered completely \nmotionless. The paralysis then extends upwards until the \nmovements of the fore limbs and respiratory muscles are in- \nvolved, when death occurs from asphyxia. In man the con- \nsciousness and intelligence as a rule remain unimpaired, though \nthere is generally some giddiness. In exceptional instances \nthere is more or less confusion, and even delirium may precede \nthe collapse. In the frog colchicine is said to have little or no \neffect, but if the solution be exposed for some time to the air, \nso that oxydicolchicine is formed, it is found to cause a pro- \nlongation of the muscular contraction similar to that seen after \nveratrine, and eventually a tetanus resembling that due to \nstrychnine. This oxidation product does not seem to be capa- \nble of formation within the frog\'s system, as in that of a warm- \nblooded animal. \n\nKidneys. \xe2\x80\x94 In some instances the urine is slightly increased, \nwhile in others complete anuria, lasting for many hours, is pro- \nduced. According to the latest and most reliable researches, \nit has been found that small quantities of colchicine increase \nthe amount, and both the urea and uric acid, as well as the \nfluid, while under larger doses the fluid is diminished, the urea \nand uric acid being less affected than with the smaller ones. \nIn animals, it is stated, bloody urine sometimes results from \nthe colchicine. \n\nTherapeutics of Colchicum. \nColchicum has long been used empirically in the treatment \nof gout, but it is not now as universally employed in this dis- \nease as formerly. Authorities differ as to its value, and some \nphysicians have denied that it has any beneficial effect. It has \nbeen shown, as has been mentioned, that it increases the elim- \nination of uric acid, but unfortunately for the explanation of \nits remedial action on rational grounds, it seems now to be \nestablished that gout is not due to a deficient excretion of this \nagent. As the pathology of the disease, therefore, remains \n\n\n\nyi6 PHARMACOLOGY AND THERAPEUTICS. \n\nentirely uncertain, it can only, like other medicines, be used in \nits treatment in a purely empirical manner; but it appears to \nbe a fact that in a considerable proportion of cases, at least, \nits administration is attended with more or less decided benefit. \nIn these, if given in suitable quantities during the attack, it \nmarkedly relieves the pain, while in smaller doses between the \nattacks it seems to lessen their severity. In certain instances \nalso where headache, neuralgia, dyspepsia, neuritis, eczema, \nconjunctivitis, bronchitis and various other ailments recur in \ngouty subjects, it is found useful. According to some who \nconsider the drug almost a specific in acute gout, provided that \nit be pushed until it causes a slight griping or laxity of the \nbowels, it is the opinion that it not only does not have any \nmarked effect in preventing attacks, but that it often seems to \nhasten their onset. The active principle, colchicine, is believed \nby some to be more successful in gout than any form of the \ncrude drug. The preparation known as colchicine salicylate \nis a solution of colchicine in oil of wintergreen. Colchicum is \nused to some extent in the treatment of chronic rheumatism \nand so-called rheumatic gout, or rheumatoid arthritis, and here, \nas well as in subacute or chronic gout, it is advised that it \nshould be given in conjunction with potassium iodide. In gout \nthe commencement of the treatment with a purgative is usually \nadvisable, and it is also a common practice to administer col- \nchicum with magnesium sulphate or carbonate. A well-known \nformula is: Extract of colchicum corm, calomel, powdered aloes, \npowdered ipecacuanha, of each .06 gm. (1 gr.), with .015 to \n.03 gm. (34 to y 2 gr.) of extract of nux vomica. The seed is \nsaid to be less active than the corm. To elderly persons and \nto those whose circulatory apparatus is feeble it is advised \nthat colchicum should be administered with caution, or not at \nall. Moreover, some individuals exhibit an intolerance of even \nvery small doses, which quickly produce intestinal irritation or \ncardiac depression. It is found that the paroxysms of gout may \noften be suppressed by large purgative doses, but experience \nhas shown that this use of the drug is dangerous, as such sup- \n\n\n\nPHYTOLACCA. 7 I J \n\npression is liable to be followed by serious internal disease, ap- \nparently due to a transfer of the gouty affection. \n\nTOXICOLOGY. \nIn the treatment of colchicum-poisoning an emetic and a cathartic \nshould be administered at once, if the stomach and bowels have not \nbeen freely evacuated. Large quantities of warm water may also be \ngiven to aid in these operations and to act on the kidneys. Tannic \nacid is a chemical antidote, forming an insoluble tannate with the alka- \nloid, and though experiments upon animals have shown that it is \nnot to be relied upon, it should be thoroughly tried in large amount. \nOtherwise the treatment must be symptomatic. Opium is usually re- \nquired to relieve the pain and check vomiting and diarrhoea, and \nstimulants to counteract depression. \n\nPHYTOLACCA. \n\nPHYTOLACCA (Phytolacca Radix, U. S. P., 1890).\xe2\x80\x94 Phytolacca. \n(Poke Root.) Dose, (emetic) 1 gm.; 15 gr.; (alterative) 0.125 gin. \n(125 milligm.) ; 2 gr. \n\nPreparation. \nFluidextr actum Phytolaccae. \xe2\x80\x94 Fluidextract of Phytolacca. \nDose, (emetic) 1 C.C.; 15 Til; (alterative) 0.1 C.C.; V/ 2 TTV. \n\nUnofficial Preparation. \nPhytolaccae Fructus (U. S. P., 1890). \xe2\x80\x94 Phytolacca Fruit. \n(Poke Berry.) Dose, 0.05 to 0.30 gm.; 1 to 5 gr. \n\nAction of Phytolacca. \nPhytolacca is an emeto-cathartic, acting slowly and causing \nconsiderable depression. In large doses it possesses also some \nnarcotic properties. \n\nTherapeutics of Phytolacca. \nPhytolacca is used as a laxative and alterative. Recently a \npreparation made from the berries has been used to reduce adi- \npose tissue. \n\n\n\n7l8 PHARMACOLOGY AND THERAPEUTICS. \n\n(d) Intestinal Antiseptics. \n\nBETANAPHTHOL. \n\nBETANAPHTHOL (Naphtol, U. S. P., 1890).\xe2\x80\x94 Betanaphthol. \nDose, 0.250 gm. (250 milligm.) ; 4 gr. \n\nUnofficial Preparations. \nHydronaphthol. \xe2\x80\x94 Hydronaphthol. Dose, .12 to .18 gm.; 2 \nto 3 gr. \n\nNaphthol Camphoratum. Camphorated Naphthol. \n\nAction of Betanaphthol. \nThis substance is antiseptic and irritant. In animals, in \nlarge doses, it causes symptoms similar to those of phenol \npoisoning, except that the convulsions are less pronounced, \nand in the dog are not observed at all. In solution or in vapor \nit is irritant to mucous membranes, and in the course of excre- \ntion it induces pain in the bladder and urethra, with strangury, \nand hyperemia and swelling of the mucous membrane. Either \nwhen injected subcutaneously or absorbed from the alimentary \ncanal in sufficient quantity it excites acute nephritis, with albu- \nminuria and hemoglobinuria. In man some nephritis is said \nto have been caused from its external application. \n\nTherapeutics of Betanaphthol. \nBetanaphthol was first introduced as an antiseptic in der- \nmatological practice and used, in a 10 per cent, ointment, in \nscabies, ringworm and psoriasis; it is, however, irritating in \neczema. It is a remedy of great value in obtaining intestinal \nantisepsis, bacteriological investigations showing that it de- \nstroys certain micro-organisms in situ when administered to the \nextent of 2.70 gm. (40 gr.) a day. As it is more or less irri- \ntating to the stomach it should be administered in keratin- \ncoated pills when its action is desired in the intestine only. It is \nuseful in flatulent dyspepsia, chronic gastric or intestinal ca- \ntarrh, and dilatation of the stomach. Good results have also \nbeen reported from its employment in typhoid fever, tubercu- \nlous ulceration of the bowels, scarlatina, diphtheria and erysipe- \n\n\n\n\n\n\nASAPROL. 719 \n\nlas. Fatal inflammation of the kidneys has resulted in some \ninstances where it has been used in large quantities. \n\nHydronaphthol (not official) occurs in glistening, micaceous \nscales and is sparingly soluble in water, but freely soluble in \nalcohol, ether, chloroform, glycerin and oils. It has been rec- \nommended for antiseptic purposes generally, and it is beneficial \nas an external application in many skin diseases. It has been \nshown, however, to exist only as an impure form of beta- \nnaphthol. \n\nCamphorated Naphthol (not official), which is prepared by \ncarefully heating one part of naphthol with two of camphor, is \na homogeneous, oily fluid which is insoluble in water and read- \nily decomposes on exposure to light and air. It is used as a \nparenchymatous injection, either undiluted or in olive oil, in \ndoses of .12 to .30 c.c. (2 to 5 1*1). It is reported to have been \nextensively employed in the irrigation of joints, bony cavities, \ntendinous sheaths, cold abscesses in the pleural and uterine \ncavities, and in tuberculosis of the bladder; all of which parts \nseemed to bear the undiluted fluid well. It has also been sub- \ncutaneously injected, with alleged good results, in tuberculous \nadenitis and tuberculosis of the testis. It is considered by some \npractitioners to be superior to all other remedies for prevent- \ning suppuration in acute tonsillitis. \n\nASAPROL. \n\nUnofficial Preparation. \n\nAsaprol. \xe2\x80\x94 Asaprol. (Calcium betanaphthol alpha-monosui- \nphonate.) Dose, 1 to 4 gm.; 15 to 60 gr. \n\nAction of Asaprol. \nAsaprol is a useful, soluble and safe antiseptic. \n\nTherapeutics of Asaprol. \nIt is valuable in epidemic influenza, relieving the pain and \nreducing the fever, not giving rise to prostration or inter- \n\n\n\n720 PHARMACOLOGY AND THERAPEUTICS. \n\nference with the heart or respiration. In atonic dyspepsia, \nwhen fermentation alternates with acid eructations, it has \nachieved brilliant results. Since it is not irritating to the ali- \nmentary mucous membranes, it can advantageously replace \nbetanaphthol. In chronic rheumatism it will relieve the pain of \nan acute exacerbation. In acute rheumatism, although it does \nnot present the disadvantages of the salicylates, it is not so use- \nful, nor so uniformly successful. It has also been employed \nin typhoid fever. \n\nNAPHTHALENE. \n\nNAPHTHALENTJM (Naphtalinum, U. S. P., 1890).\xe2\x80\x94 Naphthalene. \n(Naphthalin.) Dose, 0.125 gm. (125 milligm. ) ; 2 gr. \n\nAction of Naphthalene. \nNaphthalene is antiseptic, antifermentative, disinfectant and \ndeodorant. Since it is not absorbed by the system, it acts only \nupon the mucous membrane of the bowels. \n\nTherapeutics of Naphthalene. \n\nIt is a true intestinal antiseptic, and is of great value in \ndysentery and in catarrhal, typhoid and tuberculous diarrhoea, \nwhere it markedly lessens or entirely abolishes the foetor of the \nmovements. It has also been used as a vermifuge (dose, .20 \nto .40 gm. ; 3 to 6 gr.). Success in the treatment of dysentery \nusually requires a daily dose of from 4 to 8 gm: (1 to 2 dr.), \nbest administered in starch wafers with oil of bergamot. \n\nExternally, naphthalene is a useful antiseptic for ulcers, can- \ncers and pus cavities, and can be employed in watery emulsion, \nin alcoholic solution, or in a dry form. In ointments, in which \nit is sometimes combined with calomel, it has been used with \nadvantage for chancres, chancroids, syphilitic ulcers, sloughing \nwounds, psoriasis and chronic eczema. Naphthalene is well \nsuited for the disinfection of urinals, since it is so sparingly \nsoluble and very cheap. It is also in common use for preserv- \ning furs and woollen goods from moths. \n\n\n\n\n\n\nSALICYLIC ACID. J2\\ \n\nRESORCINOL. \n\nResorcinol (Resorcinum, U. S. P., 1890). \xe2\x80\x94 Resorcinol. (Resorcin.) \nDose, 0.125 gm. (125 milligm.) ; 2 gr. \n\nAction of Resorcinol. \n\nResorcinol was originally introduced as an antipyretic, but \nis now seldom employed for this purpose, as the necessarily \nlarge doses are too depressant to the heart. It is powerfully \nantiseptic. Dark-colored urine, often described as smoky, is \nsometimes seen after large doses. \n\nTherapeutics of Resorcinol. \n\nA solution of resorcinol in glycerin, 1 to 4, is a good appli- \ncation for removing epidermic scales in chronic skin diseases \nand also the scales in seborrhcea sicca of the scalp; here it \ndoubtless inhibits the action of the bacteria which may be the \ncause of dandruff. A lotion of resorcinol, 1 ; ether, 1 ; castor \noil, 1; eau de Cologne, 10; alcohol (90 per cent.), 35, may be \nused both for dandruff and alopecia. A 5 per cent, solution \nof resorcinol is an excellent antiseptic injection for the bladder \nin cystitis. This remedy is of great value in fermentative dys- \npepsia when administered, well diluted, one hour after the in- \ngestion of food. \n\nSALICYLIC ACID. \n\nSALICINTJM.\xe2\x80\x94 Salicin. Dose, 1 gm.; 15 gr. \n\nACIDUM SALICYLICUM.\xe2\x80\x94 Salicylic Acid. Dose, 0.500 gm.; \n7V 2 gr. \n\nSODII SALICYLAS.\xe2\x80\x94 Sodium Salicylate. Dose, 1 gm.; 15 gr. \n\nLITHII SALICYLAS.\xe2\x80\x94 Lithium Salicylate. Dose, 1 gm.; 15 gr. \n\nAMMONTE SALICYLAS.\xe2\x80\x94 Ammonium Salicylate. Dose, 0.250 gm. \n(250 milligm.); 4 gr. \n\nSTRONTII SALICYLAS.\xe2\x80\x94 Strontium Salicylate. Dose, 1 gm.; \n15 gr. \n\nUnofficial Preparation. \n\nAspirinum. \xe2\x80\x94 Aspirin. (Acetyl Salicylic Acid.) Dose, 0.30 to \n4 gm.; 5 to 60 gr. \n\n7 \n\n\n\n722 PHARMACOLOGY AND THERAPEUTICS. \n\nAction of Salicin, Salicylic Acid, and of Sodium, Lithium, \nAmmonium and Strontium Salicylates. \n\nExternal. \xe2\x80\x94 Salicylic acid is somewhat more powerfully anti- \nseptic than phenol, but its salts are less strongly antisep- \ntic. Salicin, it is stated, has no antiseptic properties unless \ndecomposed into its constituents. Applied to the skin, salicylic \nacid has the effect of softening the epidermis and also of dimin- \nishing perspiration. It is irritant to mucous membranes and \nabraded surfaces, and its continued application in concentrated \nform may have some destructive action on the tissues. When \ninhaled or applied to the fauces, it excites sneezing and cough- \ning. \n\nInternal. Alimentary Tract. \xe2\x80\x94 When swallowed in powder \nsalicylic acid causes irritation, and sometimes soreness, of the \nmouth and throat. In the stomach it is also irritant, and is \napt to cause pain, nausea and vomiting, with more or less con- \ngestion. In some instances even erosion of the mucous mem- \nbrane is produced. In dilute solution, however, it has no such \neffect. Salicin is a bitter tonic, instead of an irritant to the \nstomach, though after absorption its action is similar to that \nof the acid. The sodium and lithium salts are also much less \nirritating than salicylic acid. In the body salicin, when given \nby the mouth, is decomposed into glucose and saligenin \n(C 7 H 8 2 ), and this process no doubt takes place in the intes- \ntine, for when it is injected into the circulation it is chiefly \nexcreted unchanged. Saligenin is further decomposed into \nsalicylic acid, salicylous acid or salicylic aldehyde (C 7 H 6 0,), \nand salicyluric acid (HC 9 H 8 N0 4 ). \n\nLiver. \xe2\x80\x94 Salicylic acid and the salicylates increase the biliary \nsecretion, through some specific action, it is thought, on the \nliver cells, and they are probably the strongest cholagogues \nknown. Both the amount of bile and the solids are augmented, \nand in one case of biliary fistula it was found that the concen- \ntration of the secretion was increased, the solids being aug- \nmented in greater proportion than the fluid. In dogs, however, \n\n\n\nSALICYLIC ACID. 723 \n\nthe bile is stated to become more liquid, and to contain less than \nthe usual amount of solid constituents. \n\nHeart and Circulation. \xe2\x80\x94 In animals small doses intrave-, \nnously injected have the effect of accelerating the heart, prob- \nably from a direct action on the cardiac muscle, while the \nblood-pressure is increased from stimulation of the vasocon- \nstrictor centre in the medulla. Very large doses produce weak- \nness and slowness of the heart, which becomes dilated, and a \nfall in the blood-pressure. The lowered pressure is due prin- \ncipally to the cardiac action of the drug, and to a less extent, \nit may be, to depression of the vaso-constrictor centre. It has \nbeen shown by sphygmographic tracings that in man full doses \nof sodium salicylate (5 gm. \xe2\x80\x94 yy gr. \xe2\x80\x94 in two doses of 2.5 gm. \xe2\x80\x94 \n38^ gr. each, given in water with an interval of one hour \nbetween the doses) possess rather a raising than a lowering \naction upon the intra-arterial blood-pressure and the frequency \nof the pulse. In febrile cases, some of which were rheumatic, \nthe continued use of the drug in doses of 2 to 4.5 gm. (30 to \n7\xc2\xb0 & r -) P er diem did not produce any appreciable depression. \nThe depressing effect of salicylates upon the heart which has \nsometimes been observed clinically may, it is thought likely. \nhave been due to impurities in the drug, since it has been shown \nthat orthocreosotic acid is a powerful cardiac poison, and that \nartificial salicylic acid and its sodium salt, containing creosotic \nacids, were fatal to rabbits, while much larger doses of the \npure acid had no injurious effects. \n\nBlood. \xe2\x80\x94 It is now known that salicylic acid, which is readily \nabsorbed, exists in the blood as the salicylates of the alkalies. \nBy some observers it has been found to be taken up from the \nblood by the synovial membranes and rapidly excreted into the \ncavities of the joints. If this is the case, it would thus be \ncapable of exercising a specific action in acute rheumatism. \nThe number of leucocytes in the blood is increased. \n\nRespiration. \xe2\x80\x94 In man, acceleration of the respiration and \ndyspnoea are occasionally observed, and such results have been \nattributed to a central action. In animals the respiration is \n\n\n\n724 PHARMACOLOGY AND THERAPEUTICS. \n\nfirst quickened to some extent, and then slowed; showing prob- \nably that the respiratory centre is at first stimulated and then \ndepressed. Very large doses eventually paralyze the respira- \ntion, and death is apparently due to this cause, the heart con- \ntinuing to beat for some time afterwards. \n\nTemperature. \xe2\x80\x94 Medicinal doses have no influence on the nor- \nmal temperature. Very large quantities, by producing a col- \nlapse-like condition, may bring about some reduction in it. In \nfever patients, however, a distinctly antipyretic action is often \nobserved, though the fall in temperature is usually smaller and \nof shorter duration than that caused by drugs of the acetanilide \nseries. This action has been attributed to dilatation of the \ncutaneous vessels and an increase in the output of heat. Sali- \ncylic acid and salicin are antiperiodic. \n\nSkin. \xe2\x80\x94 It has been shown by plethysmographic measurements \nthat the vessels of the skin are dilated by salicylic acid in the \nsame way as by the antipyretics, and this action is supposed \nto be due to excitation of the vaso-dilator centres in the medulla \nwhich control the cutaneous areas. Probably the reason that \nsuch dilatation does not cause any reduction of the normal tem- \nperature is that it is counter-balanced by an increased heat \nformation. In some individuals skin eruptions of various \ncharacter (possibly due in great measure to the dilation of the \ncutaneous vessels) are observed, but they occur less frequently \nthan under the use of the antipyretics. The perspiration which \nso often follows the administration of salicylic acid and its salts \nis due, it is thought, rather to increased activity of the sweat \ncentres than to the vascular dilation. \n\nNervous System. \xe2\x80\x94 Except in cases where a special idiosyn- \ncrasy is present, the effects of salicylic acid on the central ner- \nvous system are unimportant. In animals no marked depres- \nsion appears to be produced except in the medulla oblongata. \nIt is true that convulsions sometimes make their appearance \nbefore death, but they are believed to be due to the asphyxia \ncaused rather than to any direct effect of the drug. In the \nmedulla there is apparently at first a stimulation and subse- \n\n\n\nSALICYLIC ACID. 725 \n\nquently a depression of the respiratory, the vaso-constrictor, \nand, probably, the vaso-dilator centres. \n\nKidneys. \xe2\x80\x94 Salicylic acid has a moderate diuretic action, prob- \nably increasing the urinary secretion by its irritating effect on \nthe renal epithelium. The increased formation of urea may \nalso be a factor in the diuresis. Nephritis, with albuminuria and \nhematuria, has occasionally been observed. An increase of 10 to \n12 per cent, in the nitrogen and sulphur of the urine is caused by \nsalicylic acid, indicating a considerably augmented decomposition \nof the proteids of the body. There is also a very marked in- \ncrease in the excretion of uric acid, different observers esti- \nmating this at from 30 to 100 per cent. Salicylic acid first \nappears in the urine in from ten to thirty minutes after inges- \ntion. It is excreted by the kidneys to some extent unchanged, \nbut for the most part in combination with glycocoll. The com- \npound thus formed, salicyluric acid, is analogous to hippuric \nacid. It reduces Fehling\'s solution, and has been mistaken for \nsugar. The color of the urine is often dark or\' greenish in \nconsequence of the presence of pyrocatechin or indican, or \nboth. The urine of persons taking salicylic acid gives a purple \ntint with ferric chloride. Under the use of salicylic prepara- \ntions the normal acidity of the urine is increased, and alkaline \nurine may become acid. It acts as an antiseptic to the mucous \nmembrane of the urinary tract, and will remain undecomposed \nfor a considerable time after it has been passed. \n\nSalicylic acid does not appear to be excreted by the stomach, \nbut it has been found in the milk, bile and perspiration. \n\nSalicylism. \xe2\x80\x94 In some individuals a train of symptoms ana- \nlogous to those of cinchonism, and designated as salicylism, is \nproduced by the use of salicylic preparations. The skin rashes \nhave already been referred to. Perhaps the most frequent of \nthe manifestations is deafness, generally with tinnitus aurium, \nand these disorders of hearing, as in the case of quinine, have \nbeen shown to depend upon congestion of the tympanum, in \nwhich ecchymoses and even inflammation may be found. Such \nsymptoms, it is well to note, may be relieved by the administra- \n\n\n\n726 PHARMACOLOGY AND THERAPEUTICS. \n\ntion of a small amount of alcoholic stimulant fifteen minutes \nbefore each dose. The eye may also be affected; so that there \nmay be dimness of vision, sometimes amounting to total blind- \nness, in consequence, it is supposed, of constriction of the ocular \nvessels. Headache, with a sense of fullness, is also a common \nsymptom, and this is very often associated with epistaxis. In \nsome instances haemorrhages from the retina, mouth, intestine, \nkidney, or uterus likewise occur. Abortion has been repeat- \nedly observed under salicylate treatment, but, as in the case \nof quinine, it is considered an open question whether this was \ndue to the remedy or the disease. If the administration of \nthe drug is continued, the disturbances of the circulation of the \nbrain may produce violent delirium. Nausea and vomiting \noccur, and the pulse and respiration gradually become de- \npressed. That some at least of these untoward symptoms, as \nwell as others which are occasionally met with, may be due to \nimpurities present in artificial salicylic acid seems probable. \n\nTherapeutics of Salicin, Salicylic Acid, and of Sodium, \nLithium and Strontium Salicylates. \nExternal. \xe2\x80\x94 For external applications salicylic acid has the \nadvantages of being odorless and comparatively free from the \ndanger of toxic symptoms following absorption. The ointment \n(official in B. P., 1 part of the acid to 9 of hard, and 18 of soft \nparaffin) may be used when an antiseptic and stimulating un- \nguent is called for. Other useful preparations are a collodion \ncomposed of salicylic acid, 1, flexible collodion, 8; a glycerin \ncontaining 10 per cent, of salicylic acid; and a plaster, also 10 \nper cent. Strong applications of salicylic acid are very ser- \nviceable for removing excess of epidermis, as in warts or corns, \nbecause it softens epithelium. The acid has a peculiar action \nupon the epidermis, and especially upon the corneous layer; \nthe horny cells are softened, gradually loosened, and separated \nfrom the corium without any inflammatory reaction. What is \nknown as "green solution," consisting of salicylic acid, 11; \nextract of cannabis indica, 2; flexible collodion, 87 parts, is \n\n\n\nSALICYLIC ACID. 727 \n\noften used for corns, but the tincture of hemp is of no special \nadvantage and makes an unsightly stain. Strong applications \nof the acid are also employed for the destruction of such \ngrowths as lupus nodules. Salicylic acid may be combined with \nchalk as a dentifrice, and with chalk, talc, starch, cornmeal or \nrice flour for checking profuse or fetid perspiration of the feet \nand axillae and also the night-sweats of phthisis. This acid is \nthe principal ingredient in Thiersch\'s solution (see p. 87), \nand a small amount of it is often added to Thompson\'s fluid \n(see p. 87). In gangrene or sloughing ulcer it may be ap- \nplied either in full strength or diluted, as seems advisable. \nDressings may be saturated with an alcoholic solution and \ndried. Aqueous solutions, made by means of alcohol, act as a \nlocal anodyne, when applied in thrush and catarrhal stomatitis, \nallaying the burning pain of the erosions left after the vesicles \nhave ruptured. Salicylic acid is used to a considerable extent \nin cutaneous diseases. On account of its germicidal activity \nit is efficacious in tinea circinata, and a solution of it in collo- \ndion is said to be a serviceable application for scabies, after the \nskin has been cleansed by a hot alkaline bath. An ointment con- \ntaining it may be used to remove freckles, and for the treatment \nof chronic eczema, lupus erythematosus of the face and eyelids, \nand ulcerated lupus vulgaris. To relieve the smarting and itch- \ning of urticaria the following powder has been recommended: \nSalicylic acid, 5; zinc oxide, 15; powdered starch, 30 parts. \n\nInternal. \xe2\x80\x94 In many cases of rheumatic fever salicylic acid \nseems to act as a specific. Under its influence the temperature \nis rapidly reduced and the swelling and pain in the joints dimin- \nished, and it apparently has some effect in preventing the car- \ndiac complications so frequently met with in this disease. In \norder to avoid gastric disturbance it should be administered \nwell diluted. Sodium salicylate is frequently given on account \nof its greater solubility, in preference to the acid itself. When \nthis preparation is used, care should be taken that it is made \neither from natural salicylic acid or from artificial acid known \nto be free from impurities. In a well-marked attack of the \n\n\n\n728 PHARMACOLOGY AND THERAPEUTICS. \n\ndisease it is customary to give 1.20 gm. (20 gr.) every two to \nthree hours for the first day, or longer if there is not a satis- \nfactory abatement in the symptoms. When this has been ac- \ncomplished, the remedy, in the same dose, should be given \nthree times a day, and continued for about ten days after the \nfever and pain have gone. Salicin, which is usually very well \nborne and is thought to be less depressant, is less certain in its \neffects, as its therapeutic activity probably depends upon its \nconversion into salicylic acid, and this process has been found \nto be a slow and imperfect one. The salicylic preparations \nare sometimes of service in chronic as well as acute rheuma- \ntism. They are of no benefit in rheumatoid arthritis. In gout \ntheir value is questionable, some authorities advocating their \nemployment and others believing them to be entirely inefficient. \nIf given at all in this disease, very large doses seem to be \nrequired, and even then no effect may be produced. For the \nglycosuria of patients affected with gout or goutiness they are \ndistinctly useful. In many cases of migraine and sciatica the \nsalicylates are of incontestible service, and their efficacy in such \naffections is explained by the action of these remedies in elim- \ninating uric acid. So far as they limit intestinal fermentation \nthey are also beneficial in diabetes. Except in the case of rheu- \nmatic fever they are not employed as antipyretics, as in other \nfebrile conditions the temperature can be more efficiently re- \nduced, when this is desirable, by other means. In cases of \nalkaline urine and cystitis salicylic acid has sometimes been \nresorted to to alkalize the urine, but there are better remedies \nfor this purpose. In the treatment of cholelithiasis, sodium \nsalicylate, in association with sodium benzoate, has been found \nvery useful for the conditions which tend to cause intestinal \ncatarrh and thus lead to catarrh of the biliary passages. Sali- \ncin, which, like other bitters, promotes appetite and digestion, \nmay be employed as a stomachic in atonic dyspepsia. It has \nalso been found useful in preventing the fermentations which \ntake place in the food in cases of gastro-intestinal catarrh, and \nas a remedy for the chronic diarrhoea of children. \n\n\n\nSALICYLIC ACID. 729 \n\nAspirin (not official) is acetyl salicylic acid, which occurs as \na white, insoluble, crystalline powder, or in needles, of an agree- \nable taste. In an alkaline fluid it breaks up and sets free sali- \ncylic acid. It has been employed for acute polyarticular rheu- \nmatism in the same doses as sodium salicylate, over which it is \nbelieved to possess the advantage of not deranging digestion. \n\nOLEUM BETULA. (Oleum Betulae Volatile, U. S. P., 1890.) \xe2\x80\x94 \nOil of Betula. (Oil of Sweet Birch.) Dose, 1 C.C.; 15 TTL . \n\nOLEUM GAULTHERIA.\xe2\x80\x94 Oil of Gaultheria. (Oil of Winter- \ngreen.) Dose, 1 c.c; 15 TT\\. \n\nPreparation. \nSpiritus Gaultheriae.\xe2\x80\x94 Spirit of Gaultheria. Dose, 2 c.c; \n30 TT\\. \n\nMETHYLIS SALICYLAS.\xe2\x80\x94 Methyl Salicylate. Dose, 1 C.C.; \n15 T\\. . \n\nPreparation. \nCataplasma Kaolini. \xe2\x80\x94 Cataplasm of Kaolin. \n\nAction of Oil of Betula, Oil of Wixtergreex and Methyl \nSalicylate. \nThe action of these substances is the same as that of salicylic \nacid. When taken in moderate quantities, they are, like that \nacid, broken up and eliminated as salicyluric acid. It is as- \nserted that methyl salicylate, which is an ester, formed syn- \nthetically, can be produced of more uniform quality and is more \ncertain and definite in its action than either of the natural oils. \n\nTherapeutics of Oil of Betula, Oil of Wixtergreex axd \nMethyl Salicylate. \nThe uses of these drugs are the same as of salicylic acid, and \nthey possess the additional advantage that they are not liable \nto contamination with impurities such as ortho- and para- \ncreosotic acids ; the former of which is a powerful cardiac de- \npressant, and both of which are found in the artificial salicylic \nacid. \n\n\n\n730 PHARMACOLOGY AND THERAPEUTICS. \n\nPHENYLIS SALICYLAS (Salol, U. S. P., 1890). Phenyl Salicy- \nlate. Dose, 0.500 gm. (500 milligm.) ; 7y 2 gr. \n\nUnofficial Preparation. \nSalol Camphoratum. \xe2\x80\x94 Camphorated Salol. (Salol Camphor.) \n\nAction of Phenyl Salicylate. \nPhenyl Salicylate, or Salol, is an antiseptic, germicide and \nantipyretic. It has little or no local action in the mouth or \nstomach, but in the intestine is decomposed by the fat-splitting \nferment of the pancreatic juice into phenol, about 36, and sali- \ncylic acid 64, per cent. It is thought that under certain con- \nditions some decomposition also takes place in the stomach. \nThe two constituents, thus set free, are absorbed and produce \ntheir characteristic effects on the system. It is not generally \ntoxic in therapeutic doses, but its too free use may give rise to \nthe symptoms of carbolic acid poisoning. In moderate quanti- \nties it sometimes produces the disturbances of hearing observed \nunder salicylic acid, without any evidences of carbolic intoxi- \ncation. \n\nTherapeutics of Phenyl Salicylate. \n\nExternal. \xe2\x80\x94 As an antiseptic for external use it has probably \nbeen overrated, as it is stated to be active only when decom- \nposed by the microbes which it is designed to destroy. It has \nbeen used, mixed with talc (1 to 5), as a dusting powder, and \nas a dressing for wounds, burns and ulcers, as well as for ery- \nsipelas, impetigo, pustular eczema, and other cutaneous affec- \ntions. A camphorated salol is recommended in the treatment \nof suppurative otitis. \n\nInternal. \xe2\x80\x94 In rheumatic fever it is used to some extent as a \nsubstitute for salicylic acid. Although somewhat slower in \naction, it has the advantage of being tasteless and of producing \nno gastric irritation. Occasionally, however, the considerable \namount of phenol freed by its decomposition has induced \ntroublesome symptoms. Since the decomposition of salol takes \nplace in alkaline fluids, it has been used as an intestinal anti- \n\n\n\nSALOPHEN. 731 \n\nseptic in acute diarrhoea, catarrh of the bile-ducts, dysen- \ntery, cholera and other diseases; also in affections of the urin- \nary tract. For the last the following may be used : Salol, 1 ; \nalmond oil, 2 ; powdered acacia, 1 ; syrup, 2 ; water, 24. The \nemulsion should be made in a warm mortar with water at 65.5 \xc2\xb0 \nC. (150 F.). It is a remedy of very great value in the treat- \nment of typhoid fever, for by the active disinfection of the con- \ntents of the intestine and of the ulcerations, it favors their \nhealing and prevents reinfection, thus lowering temperature and \ndiminishing the liability to relapse and to permanent damage to \ntissues. This is the logical treatment, because it destroys the \ncause of the symptoms at their point of origin. On account of \nthe large proportion of phenol which it contains salol is more \ndangerous than the corresponding amount of salicylic acid, and \nit is especially to be used with great caution if the kidneys are \ndiseased. Sometimes, in fever, on account of the lessened alka- \nlinity of the intestinal contents, it is not decomposed into its \nconstituents, and for that reason becomes very much less effec- \ntive. In this case an alkali should be administered at the same \ntime. Salol has proved efficient in the so-called bilious form \nof sick headache and in some varieties of neuralgia, and is \nhighly praised in the treatment of epidemic influenza. \n\nUnofficial Preparation. \nSalophenum. \xe2\x80\x94 Salophen (Acetylparamidophenol Salicylate). \nDose, .30 to 1 m.; 5 to 15 gr. \n\nAction of Salophen. \nSalophen is regarded as possessing the medicinal virtues of \nsalol, while at the same time free from its toxic qualities. In \na warm alkaline solution it is broken up into salicylic acid and \nacetylparamidophenol, the latter being harmless. It is decom- \nposed in the intestines, even when given hypodermatically. \n\nTherapeutics of Salophen. \nIt is used as a substitute for salicylic acid in acute rheuma- \ntism, and as an intestinal antiseptic. It is probably quite as \n\n\n\n732 PHARMACOLOGY AND THERAPEUTICS. \n\nefficient, and much safer than salol. The fact that it is taste- \nless renders it easy of administration. \n\nDivision X. \xe2\x80\x94 Drugs acting on the Nervous and Muscular \n\nSystems. \n\nA. Drugs acting on the Muscles. \xe2\x80\x94 While many facts of inter- \nest have been ascertained in regard to this class of drugs, they \nhave no practical bearing on therapeutics. Brunton\'s classifi- \ncation, founded on that of Kobert, is as follows: \n\nClass I. Irritability of muscle unaffected ; total amount of work it \ncan do diminished. \xe2\x80\x94 The following produce this effect : Apomorphine, \ndelphine, saponin, copper, zinc, and cadmium, and in large doses, anti- \nmony, arsenic, platinum, and iron. \n\nClass II. Both the irritability and the capacity for work diminished. \n\xe2\x80\x94 The following produce this effect : Potassium, lithium, ammonium, \nquinine, alcohol, hydrated chloral, and chloroform. \n\nClass III. Diminish the capacity for work, and make the excitability \nvery irregular. \xe2\x80\x94 Lead, emetine, and cocaine. \n\nClass IV. Alter the form of the muscle curve. \xe2\x80\x94 Veratrine, digitalis, \nsquill, and barium, strontium and calcium salts. \n\nClass V. Increases the excitability. \xe2\x80\x94 Physostigmine. \n\nClass VI. Increase the capacity for work. \xe2\x80\x94 Caffeine and theobromine. \n\nSmall doses of strychnine and veratrine shorten the latent period ; \nlarge doses lengthen it. \n\nDilute alkalies diminish the extensibility ; dilute acids increase it. \n\nB. Drugs acting on the Peripheral Endings of Motor Nerves. \n\n\xe2\x80\x94 Curare is the typical drug of this class. While many of the \nothers have a special action on the motor nerve terminations in \ncommon with curare, in the greater number of them this action \nis more or less over-shadowed by other effects. With curare, \nhowever, the action is so widely distributed that it may be \nlooked upon as a peculiar expression of fatigue and as a sign \nof injury to these endings. In experiments upon animals it \ncan be shown by a process of exclusion that curare paralyzes \nthe peripheral endings of motor nerves alone, the sensory \nnerves and the muscle-fibres being unaffected. \n\n\n\nDRUGS ACTING ON NERVES AND MUSCLES. 733 \n\nDrugs paralyzing the termination of the motor nerves in muscle: \n\n\n\n(1) Curare. \n\n(2) Conium. \n\n(3) Belladonna (atropine). \n\n(4) Stramonium. \n\n(5) Hyoscyamus. \n\n(6) Scopola. \n\n(7) Saponin. \n\n(8) Sparteine. \n\n(9) Amyl nitrite. \n\n\n\n(12) Camphor. \n\n(13) Lobeline. \n\n(14) Nicotine. \n\n(15) Methyl-brucine. \n\n(16) Methyl-cinchonine. \n\n(17) Methyl-codeine. \n\n(18) Methyl-morphine. \n\n(19) Methyl-quinine. \n\n(20) Methyl-nicotine. \n\n\n\n(10) Diluted hydrocyanic acid. (21) Methyl-strychnine, and \n\n(11) Cocaine. many others. \n\nCurare and conium are by far the most important, but this action is \nnot made use of in medicine. \n\nDrugs stimulating the termination of motor nerves in muscle: \n\n\n\n(1) Aconite. \n\n(2) Nicotine. \n\n(3) Pilocarpine. \n\n\n\n(4) Pyridine. \n\n(5) Strychnine (slightly). \n\n\n\nIt is possible that some of the beneficial action of strychnine in cer- \ntain cases may be due to its slight action on motor nerves, but other- \nwise these drugs are not employed for this action. \n\nC. Drugs acting on the Peripheral Endings of Sensory- \nNerves (other than those of special sense). \xe2\x80\x94 As it is very diffi- \ncult to secure any satisfactory data regarding sensation from \nanimals, our knowledge of the action of this group is neces- \nsarily derived almost entirely from observations on man. \n\nDrugs which Stimulate the Termination of Sensory Nerves. \n\xe2\x80\x94 These are the same as those already enumerated (p. 325) \nas acting locally on vessels. When topically applied they give \nrise to pain, and in the case of most of them the cause of the \npain is the local inflammation they set up. \n\nTherapeutics. \xe2\x80\x94 It is for their action on the blood-vessels that \nlocal irritants are principally used, but they are not infrequently \nemployed also for their counter-irritant effects. By their ap- \nplication to the skin it is probable that changes are induced in \n\n\n\n734 PHARMACOLOGY AND THERAPEUTICS. \n\nthe calibre of the vessels and in the sensory nerves of internal \norgans, so that deep-seated pain is thereby relieved. The heart \nand respiration are also reflexly stimulated by peripheral exci- \ntation of nerves, and hence counter-irritation is made use of to \nrouse persons who have fainted or became unconscious from \nopium poisoning, etc. It is essential that the action should be \na prompt one, and the application of the faradic current is quite \ncommonly employed as an external stimulus in such cases. \n\nDrugs which Depress the Terminations of Sensory Nerves. \xe2\x80\x94 \nOf these there are two kinds: those which simply relieve pain, \nor local anodynes; and those which diminish sensibility, or \nlocal anaesthetics. \n\nLocal Anodynes. \xe2\x80\x94 These have no action unless pain be present. They \n\n\n\n(i) Aconite. \n\n(2) Phenol. \n\n(3) Menthol. \n\n(4) Diluted hydrocyanic acid. \n\n(5) Veratrine. \n\n(6) Ether. ^v These must \n\n(7) Alcohol. I be allowed to \n\n(8) Chloroform. ] evaporate. \n\n\n\n(9) Hydrated chloral. \n\n(10) Belladonna. \n\n(11) Stramonium. \n\n(12) Hyoscyamus. \n\n(13) Scopola. \n\n(14) Opium. \n\n(15) Sodium bicarbonate. \n\n(16) Zinc oxide. \n\n\n\nIn the above list the most powerful are placed first. The local \nanodyne action of opium has been disputed, and it is probable that \nmany substances not included in this list which have been regarded as \nlocal anodynes have little if any claim to this designation. Cold is an \neffective local anodyne because of its depressant effect on sensibility, \nand so likewise is warmth, which relieves pain by diminishing tension, \nin consequence of the vaso-dilation which it primarily induces. \n\nTherapeutics. \xe2\x80\x94 Local anodynes, it may readily be supposed, \nare called for in a great variety of conditions, and while often \nof service as adjuvants to internal treatment, they are espe- \ncially useful in those affections in which it is not possible to \nremove the cause of the pain or irritation present. \n\nLocal Anaesthetics. \xe2\x80\x94 These are cocaine, eucaine, holocaine, ortho- \nform, phenol, and extreme cold, whether produced by ice or by \n\n\n\nDRUGS ACTING ON NERVES AND MUSCLES. 735 \n\nthe evaporation of ethyl chloride, methyl chloride, or ether. As re- \ngards the performance of operations, the ether spray has the disad- \nvantage of stiffening the parts so that it is only useful for a single incision \nas for opening furuncles. Upon a damp day it is ineffectual. Ethyl chlo- \nride sprayed from tubes by the heat of the hand is the best method and \nthe one most frequently employed at present. Eucaine and cocaine, \nwhich produce a high degree of local insensibility, are largely employed. \n\nD. Drugs Acting on the Trunks of Nerves. \xe2\x80\x94 These, if taken \nfor a considerable period, give rise to chronic neuritis, with \nmuch augmentation of the areolar tissue and also fatty degen- \neration of the nerve-fibres. During the earlier stages of the \ninflammation much pain and tingling are experienced, but later \nthese are replaced by numbness and diminished sensation as \nthe function of the nerves becomes more and more depressed, \nand finally paralysis, often accompanied by trophic lesions, re- \nsults. These actions are of pathological, rather than pharma- \ncological, interest, and will be found fully described in works \non medicine. \n\nThe drugs producing peripheral neuritis are \xe2\x80\x94 \n\n\n\n(1) Lead. \n\n(2) Mercury. \n\n\n\n(3) Arsenic. \n\n(4) Alcohol. \n\n\n\nE. Drugs Acting on the Spinal Cord. \xe2\x80\x94 After the administra- \ntion of certain drugs it is found that a slight peripheral stimu- \nlus will produce such marked reflex action that convulsions will \nresult. When this is due to stimulation of the spinal cord, it \nis determined in the following way: If the cord is cut across \nand convulsions are still caused by such slight stimulus, it is \nevident that these cannot be of cerebral origin, since in that \ncase they would not take place below the point of section. On \nthe other hand, if the drug does not cause convulsions when \npreviously to its injection into the circulation the vessels of the \ncord have been ligatured, it is inferred that its action is not \non the muscles or nerves. Other experiments going to show \nthat the action is on the cord are the following: If when the \ndrug is injected into vessels by which it reaches the cord \n\n\n\n73^ \n\n\n\nPHARMACOLOGY AND THERAPEUTICS. \n\n\n\nquickly, convulsions appear sooner than when it is injected into \nother vessels; if convulsions do not occur when the cord is \ndestroyed ; if when the destruction of the cord is gradually pro- \nduced by pushing a wire down the vertebral canal, the convul- \nsions cease from above downward as the destruction proceeds. \n\n(i) The drugs increasing the irritability of the anterior cornua are \xe2\x80\x94 \n\n\n\n(i) Strychnine. \n\n(2) Brucine. \n\n(3) Ammonia. \n\n(4) Thebaine. \n\n\n\n(5) Chloroform. \n\n(6) Ether. \n\n(7) Ergot. \n\n(8) Opium. \n\n\n\n(The last four only slightly, and early in their action.) \n\nTherapeutics. \xe2\x80\x94 Strychnine is at times useful for paralysis \nresulting from diseases of the spinal cord, but with this excep- \ntion it is rare that affections of the cord are benefited by stimu- \nlation of the anterior cornua. \n\n(2) Drugs which depress the activity of the anterior cornua: \n\n\n\n(1) Physostigmine. \n\n\n(15) Lithium salts. \n\n\n(2) Gelsemium. \n\n\n(16) Antimony salts. \n\n\n(3) Muscarine. \n\n\n(17) Arsenical salts. \n\n\n(4) Bromides. \n\n\n(18) Camphor. \n\n\n(5) Alcohol. \n\n\n(19) Amyl nitrite. \n\n\n(6) Chloroform. \n\n\n(20) Sodium nitrite. \n\n\n(7) Ether. \n\n\n(21) Hydrated chloral \n\n\n(8) Ergot. \n\n\n(22) Phenol. \n\n\n(9) Opium. \n\n\n(23) Apomorphine. \n\n\n(10) Mercury. \n\n\n(24) Veratrine. \n\n\n(11) Zinc salts. \n\n\n(25) Turpentine. \n\n\n(12) Silver salts. \n\n\n(26) Saponin. \n\n\n(13) Sodium salts. \n\n\n(27) Emetine. \n\n\n(14) Potassium salts. \n\n\n(28) Colchicum. \n\n\n\nOf these, apomorphine, alcohol, chloroform, ether, arsenic, camphor, \nmorphine, phenol, hydrated chloral, nicotine, and veratrine first excite \nslightly before depressing. \n\n\n\nDRUGS ACTING OX NERVES AND MUSCLES. 737 \n\nTherapeutics. \xe2\x80\x94 So far as their action on the spinal cord is \nconcerned, these drugs are of very little practical utility. Phys- \nostigmine, which is by far the most powerful, has been tried to \na considerable extent in tetanus and other diseases accompanied \nby convulsions, but with little benefit. \n\nF. Drugs Acting on the Brain. \xe2\x80\x94 The action of these can by \nno means be so distinctly localized as that of drugs acting on \nthe spinal cord and nerves. Drugs acting on the brain illus- \ntrate two very important general laws : \n\n(1) The law of dissolution, which, when stated as it applies \nin pharmacology, is as follows : When a drug affects functions \nprogressively, those first affected are the highest in develop- \nment ; that is to say, they are the last acquired by the individual \nand the last to appear in the species. The next affected are \nthose next to highest, and so on; till finally the lowest of all \nfrom an evolutionary point of view, that is to say, the functions \nof respiration and circulation, are affected. This law is well \nexemplified in the case of alcohol, under the influence of which \nthe first functions to be disordered are those of the intellect, \nespecially the highest, such as judgment and reason; then follow \ndisorders of movement, and finally death from failure of respi- \nration and circulation. \n\n(2) When a drug in moderate doses excites a function, in \nlarge doses it often paralyzes it. Cerebral stimulants may thus \nalso be hypnotics. \n\nDrugs Acting on the Motor Centres of the Brain. \xe2\x80\x94 To inves- \ntigate these, the motor area of the cortex is exposed by trephin- \ning. One method is to note, before and after the administration \nof the drug, the strength of the electric current which it is neces- \nsary to apply to this area to produce corresponding movements. \nAnother is to observe the strength of current necessary to elicit \na movement and then to allow the wound made by the trephine \nto close; after which the drug is regularly administered to the \nanimal for several weeks. The opposite motor area is then ex- \nposed, and the strength of the current required for the same \npurpose is noted. \n48 \n\n\n\n738 \n\n\n\nPHARMACOLOGY AND THERAPEUTICS. \n\n\n\nIt has been found that the following diminish the activity of the \nmotor area. \n\n\n\n(i) Alcohol. \n\n(2) Anaesthetics. \n\n(3) Hydrated chloral. \n\n\n\n(4) Potassium bromide. \n\n(5) Sodium bromide. \n\n(6) Ammonium bromide. \n\n\n\nIt is on account of this action that bromides are largely em- \nployed in epilepsy and other convulsive affections. \n\nDrugs exciting the motor cells of the cortex are \xe2\x80\x94 \n\n\n\n(1) Atropine. \n\n(2) Absinthium. \n\n\n\n(3) Strychnine. \n\n(4) Physostigmine. \n\n\n\nThey are not used in medicine for this purpose. \n\n(1) General Cerebral Stimulants. \xe2\x80\x94 Experiments on animals \nare of no value in determining the effects of these. In the \nhuman subject they produce general excitation of the mental \nfaculties, and this is not infrequently followed by confusion, \nincoherence and delirium, the character of the latter varying to \nsome extent with the particular drug employed. In many in- \nstances the stimulation is soon replaced by a paralyzing in- \nfluence. \n\n\n\nSuch drugs are \xe2\x80\x94 \n\n\n\n\n(1) Belladonna. \n\n\n(11) Guarana. \n\n\n(2) Stramonium. \n\n\n(12) Coca. \n\n\n(3) Hyoscyamus. \n\n\n(13) Cannabis Indica \n\n\n(4) Scopola. \n\n\n(14) Lupulin. \n\n\n(5) Alcohol. \n\n\n(15) Opium. \n\n\n(6) Chloroform. \n\n\n(16) Camphor. \n\n\n(7) Ether. \n\n\n(17) Santonin. \n\n\n(8) Nitrous oxide. \n\n\n(18) Quinine. \n\n\n(9) Coffee. \n\n\n(19) Salicylic acid. \n\n\n(10) Tea. \n\n\n(20) Tobacco. \n\n\n\nTherapeutics. \xe2\x80\x94 These are of the greatest importance in their \ntherapeutic applications, and many of the drugs are taken habit- \nually as cerebral stimulants in various parts of the world. \n\n\n\nDRUGS ACTING OX NERVES AXD MUSCLES. 739 \n\n(2) General Cerebral Depressants. \xe2\x80\x94 These are commonly \ndivided into three classes : Hypnotics or Soporifics. Narcotics \nand Anaesthetics. \n\nHypnotics or Soporifics are drugs which produce sleep, \nclosely resembling, if not identical with, natural sleep. It is \nknown that during sleep the brain is anaemic, and it is probable \nthat the anaemia is the cause of sleep. It may be that the action \nof some hypnotics is due to their inducing cerebral anaemia. \n\nThe hypnotics are \xe2\x80\x94 \n\n(1) Opium. (10) Paraldehyde. \n\n(2) Morphine. (n) Alcohol. \n\n(3) Hydrated chloral. (12) Hyoscine. \n\n(4) Chloralamide. (13) Scopolamine. \n\n(5) Butyl-chloral hydrate. (14) Cannabis Indica. \n\n(6) Bromides. (15) Urethane. \n\n(7) Trional. (16) Lupulin. \n\n(8) Peilotine. (17) Lactucarium. \n\n(9) Sulphonal. \n\n\n\nTherapeutics. \xe2\x80\x94 In all cases of insomnia the underlying condi- \ntion should be carefully looked into and removed if possible. \nThese drugs should be resorted to with the greatest reluctance \non account of the danger of habituation. Chloral, if used with \ngreat caution, peilotine, paraldehyde, trional. and choralamine \nare perhaps the most satisfactory, but the use of hypnotics \nis apt to be greatly abused. It is well to remember that sleep \nmay often be induced by causing dilatation of the vessels of \nother parts of the body than the brain. Thus,, a warm bath or \na full meal tends to promote sleep. \n\nNarcotics are substances which not only produce sleep, but \nalso in large doses depress the functions of respiration and cir- \nculation. Many of them fall also under the head of general \nanaesthetics; others are. in smaller doses, hypnotics. All must \nbe given in considerable doses. \n\n\n\n740 PHARMACOLOGY AND THERAPEUTICS. \n\nThe following is a list of them. \n\n(i) General Anaesthetics. i (6) Hyoscyamus. \n\n(2) Opium. (7) Scopola. \n\n(3) Hydrated chloral. (8) Alcohol. \n\n(4) Belladonna. (9) Cannabis Indica. \n\n(5) Stramonium. (10) Lupulin. \n\nTherapeutics. \xe2\x80\x94 They are of great value in .diminishing mor- \nbidly acute perception, relieving pain, allaying irritation, ner- \nvous excitability, and spasm, inducing sfeep, and regulating the \nvital functions by rest. For instance, opium and belladonna are \nsometimes of much service in cardiac disease. \n\nGeneral Anesthetics. \xe2\x80\x94 These are drugs which lead to a \ntotal loss of consciousness, so that pain is no longer felt, while \nat the same time reflex action is abolished. They illustrate \nadmirably the law of dissolution, and also the fact that, after \nexcitement, paralysis often succeeds. The various stages of \ntheir action will be described under Chloroform and Ether. \n\nThere are individual differences in the different anaesthetics, \nand different individuals are sometimes differently affected by \nthe same anaesthetic. \n\n\n\n(3) The general anaesthetics are- \n\n(1) Chloroform. \n\n(2) Ether. \n\n(3) Nitrous oxide.\' \n\n(4) Pental. \n\n\n\n(5) Ethyl bromide. \n\n(6) Many other substitution \n\nproducts derived from \nalcohols and ethers. \n\n\n\nTherapeutics. \xe2\x80\x94 Anaesthetics are given to cause unconscious- \nness, so that pain may not be experienced during operations, to \nrelax muscles in cases of dislocations, abdominal examinations, \nphantom tumors, etc., to relieve severe pain, such as that of \nparturition, biliary and renal colic, and to control convulsions, \nas in tetanus and hydrophobia. \n\nThe chief dangers of anesthetics are \xe2\x80\x94 1. Death from shock. \nThis usually takes place before the patient is fully under the \ninfluence of the anaesthetic; reflex action being not yet quite \n\n\n\nDRUGS ACTING ON NERVES AND MUSCLES. 74 1 \n\nabolished, the heart is stopped reflexly in consequence of the \nperipheral stimulus of the operation. Such a deplorable result \nmay generally be avoided by taking care that the patient is fully \nunder the influence of the anaesthetic before the operation is \nbegun. \n\n2. Death from paralysis of respiration. This may be due to \nvarious circumstances. Thus, too much of the anaesthetic may \nhave been given, the patient may be suffering from some disease \nof the lungs which renders respiration difficult, or the operation \nmay demand a posture which interferes with the breathing. It \nis not usually a very grave danger, as warning is afforded by the \nlividity of the surface. Changing the posture and the with- \ndrawal of the anaesthetic are often all that is required to restore \nthe patient, but artificial respiration, with the head thrown back \nand the tongue pulled forward, may be called for, and in some \ninstances it is necessary to maintain this for hours. \n\n3. Cardiac failure may occur if the vapor is too concentrated. \nGradual heart-failure is always preceded by respiratory changes, \nbut cardiac arrest may occur suddenly and without warning. \nThe patient all at once grows pale, and the pulse stops. In such \na case the anaesthetic should be discontinued, the patient should \nbe placed in the inverted posture, and artificial respiration main- \ntained as before. The heart may be stimulated by large rectal \ninjections of hot normal saline solution or of coffee, if at hand, \nby the inhalation of amyl nitrite, by the plunging of electric \nneedles into the heart or, better, by making a series of forcible \ncompressions of the chest over the heart; also, if the reflexes \nare not abolished, by flicking the chest over the heart with hot \ntowels and placing hot compresses over it. Giving brandy sub- \ncutaneously is to but add the effect of one poison to that of an- \nother. The application of the faradic current over the cardiac \nregion is also objectionable. \n\n4. Vomited matter or, if the operation is about the mouth, \nblood, may suffocate the patient. No food should be taken for \nsome time before the operation, and if the patient is sick at the \n\n\n\n74 2 PHARMACOLOGY AND THERAPEUTICS. \n\nstomach, he should be turned on his side. In operations about \nthe mouth special precautions are required. \n\nG. Drugs Acting on the Eye. \n\ni. Drugs Acting on the Pupil. \xe2\x80\x94 If when a drug having the \nproperty of dilating or contracting the pupil is applied locally \nto one eye, it acts promptly and powerfully, and only upon the \neye into which it is dropped, it is evident that its action must \nbe local. So also when it acts on an excised eye. Again, if \nthe drug will act when thrown into the eye after all the vessels \ngoing to the eye are ligatured, but will not act when thrown into \nthe general circulation, its action is shown to be local. On the \nother hand, if after being dropped into one eye it acts but feebly \nand after some time upon both eyes, it is to be inferred that its \naction is a central one. So, if all the vessels of the eye are \nligatured, and the drug will not act if dropped in the eye, al- \nthough it would do so if thrown into the general circulation, it \nis proved to act centrally. If such a drug acts when locally \napplied, the inference is that its action is due to the fact that \nsome of it has been absorbed. \n\nAs to the manner in which a centrally-acting drug exerts its \ninfluence, it has been shown that it may act either upon the \nmuscular fibres of the iris, upon the terminations of the third, \nor motor oculi, nerve in these fibres, or upon the terminations \nof the cervical sympathetic in them. Stimulation of the third \nnerve causes the pupil to contract and stimulation of the cer- \nvical sympathetic causes it to dilate; while section of these \nnerves produces just the opposite effects. If, when the pupil is \ndilated by the local action of a drug, stimulation of the third \nnerve will not cause contraction, notwithstanding the muscular \nfibres are responsive to mechanical stimulation, it shows that the \nterminations of the third nerve are paralyzed. If, on the other \nhand, the pupil is contracted by the drug, and although respon- \nsive to mechanical stimulation, will not dilate after section of \nthe third nerve, it shows that the terminations of this nerve \nare stimulated. If a drug, locally applied, causes dilatation of \nthe pupil, but not to the same extent as is caused by stimulation \n\n\n\nDRUGS ACTING ON NERVES AND MUSCLES. 743 \n\nof the sympathetic, it is shown that its whole effect is not due \nto stimulation of the sympathetic; and if the muscle remains \nlocally irritable, there must be paralysis of the terminations of \nthe third nerve. In a similar way the actions on the sympa- \nthetic may be determined. It has been found, however, that \nmany drugs act both on the third nerve and on the sympathetic, \nand in the following list they are classified under their main \nactions : \nMydriatics (dilate the pupil) \xe2\x80\x94 \n\nA. Paralyze the termination of the third nerve. \n\n(6) Gelsemine. \n\n\n\n(1) Atropine. \n\n(2) Homatropine. \n\n(3) Daturine. \n\n(4) Hyoscyamine. \n\n(5) Coniine. \n\n\n\n(7) Muscarine. \n\n(8) Hydrocyanic Acid. \n\n(9) Aconite. \n\n(10) Amyl nitrate. \n\n\n\nprob- \nably. \n\n\n\nB. Stimulate the terminations of the sympathetic. \xe2\x80\x94 Cocaine. \n\nC. Act centrally. \xe2\x80\x94 Anaesthetics (late in their action). \n\nMyotics (contract the pupil). \n\nA. Stimulate the terminations of the third nerve. \xe2\x80\x94 Pilocarpine, and \nnicotine (probably). \n\nB. Stimulate the muscle. \xe2\x80\x94 Physostigmine. \n\nC. Act centrally. \xe2\x80\x94 Anaesthetics (early in their action) and Opium. \n\nTherapeutics. \xe2\x80\x94 Dilators of the pupils, especially atropine and \nhomatropine, are used to dilate the pupil for ophthalmoscopic \nexamination, and to prevent or break down adhesions of the \niris. Contractors of the pupil, especially physostigmine, are \nused to overcome the effects of atropine, to prevent or break \ndown adhesions of the iris, and to prevent too much light enter- \ning the eye in painful diseases of the organ. \n\n2. Drugs Acting on the Ciliary Muscle. \xe2\x80\x94 The following \ndrugs impair or paralyze accommodation: \n\n\n\n(1) Atropine. \n\n(2) Daturine. \n\n(3) Hyoscyamine. \n\n(4) Homatropine. \n\n(5) Cocaine. \n\n\n\n(6) Physostigmine. \n\n(7) Pilocarpine. \n\n(8) Gelsemine. \n\n(9) Coniine. \n\n\n\n744 PHARMACOLOGY AND THERAPEUTICS. \n\nIntra-ocular tension is increased by atropine (large doses), \nhyoscyamine, and daturine. It is decreased by cocaine, hyos- \ncine, and physostigmine. \n\nGelsemine paralyzes the external ocular muscles, especially \nthe levator palpebral and the external rectus, by its action on \nthe terminal nerve filaments. \n\nCocaine, by stimulating the unstriped fibres in the orbital \nmembrane and the eyelids, causes the eye to protrude. Coniine, \nwhen given in large doses, produces ptosis. \n\nThe capacity for seeing blue is increased by strychnine. San- \ntonin causes first violet, then yellow vision. \n\nH. Drugs Acting on the Ear. \xe2\x80\x94 Very little is known of the \naction of drugs upon the organ of hearing. Some substances, \nsuch as quinine and salicylic acid, cause ringing and buzzing in \nthe ears, and sometimes deafness. \n\nI. Drugs Acting on the Sympathetic System. \xe2\x80\x94 The principal \npoints in regard to the actions of drugs on the sympathetic sys- \ntem have already been touched upon in discussing their actions \nupon blood-vessels. In regard to nicotine, it is a curious cir- \ncumstance that if a large dose of it is administered, or if the \nsubstance be locally applied to the superior cervical ganglion, \nstimulation of the nerve below the ganglion fails to produce its \ncharacteristic effects, although these still result from stimulation \nof the nerve above the ganglion. \n\nB. Drugs Acting on the Peripheral Endings of Motor \nNerves. \n\nCURARE. \n\nUnofficial Preparation. \n\nCurara. \xe2\x80\x94 Curare, (Wourara. Ourari. Urari. Wourali.) \n\ngr. \n\nAction of Curare. \nThe characteristic effects of curare are paralysis of the nerve \nendings in striped muscles and, later, paralysis of the nerve end- \n\n\n\nconium. 745 \n\nings around sympathetic ganglia. Under very large doses there \nis induced a direct depression of the irritability of the muscle \nsubstance. In some instances tetanic convulsions, from an \naction on the central nervous system, are caused before the \ncharacteristic curare action makes its appearance, but under \nordinary conditions, and especially if the amount given is only \nmoderately large, these are masked by the paralysis of the \nnerve endings. When curare is applied directly to the spinal \ncord, it gives rise to typical strychnine convulsions. It is elim- \ninated chiefly in the urine, but some of it appears also in the \nfaeces. The urine of a curarized animal will poison another \none, and this may be repeated to several animals. \n\nTherapeutics of Curare. \nIt has been used, by hypodermatic injection, with a limited \nmeasure of success in tetanus. It has also been tried in hydro- \nphobia, and recoveries have been reported from its employment \nin two alleged cases of this disease. In epilepsy some observers \nhave found it beneficial, and it has been experimented with in \nthe treatment of various other nervous affections. In practice \nit has proved unsuccessful as an antidote in strychnine poi- \nsoning. \n\nCONIUM. \n\nCONIUM.\xe2\x80\x94 Conium. (Spotted Hemlock.) Dose, 0.200 gm. (200 \nmilligm.) ; 3 gr. \n\nPreparation. \nFluidextractum Conii. \xe2\x80\x94 Fluidextract of Conium. Dose, 0.2 \nc.c; 3 n\\. \n\nUnofficial Preparations. \nExtractum Conii (U. S. P., 1890). \xe2\x80\x94 Extract of Conium. \nDose, 0.02 to 0.05 gm.; y 3 to 1 gr. \n\nSuccus Conii. \xe2\x80\x94 Juice of Conium (B. P.). Dose, 4 to 8 c.c; \n1 to 2 fl. dr. \n\nConiina.\xe2\x80\x94 Coniine. Dose, 0.003 to 0.01 c.c; fa to 1 n\\,. \n\n\n\n746 PHARMACOLOGY AND THERAPEUTICS. \n\nAction of Conium. \n\nExternal. \xe2\x80\x94 It has no action on the unbroken skin. When \napplied to bruised surfaces it has been alleged to exert some- \nthing of an anaesthetic influence, but, in view of the manner of \naction of the drug, very large doses being required to produce \na depressant effect upon the sensory nerves, this seems im- \nprobable. \n\nInternal. G astro-intestinal Tract. \xe2\x80\x94 Coniine, even when in- \njected directly into the circulation, causes nausea and frequently \nvomiting at an early stage of its action, and this effect is no \ndoubt due to a medullary influence. The nausea is accom- \npanied by profuse salivation and sometimes by perspiration. \nLarge doses by the mouth may produce some diarrhoea, as well \nas vomiting. \n\nCirculation. \xe2\x80\x94 The cardiac action is not marked. As the in- \nhibitory mechanism is stimulated, the pulse is usually rather \nslow and weak. Sometimes, however, paralysis of the ganglia \non the inhibitory nerve may cause its acceleration. A consid- \nerable, though transient, increase in the arterial tension which \nis observed has been attributed to a stimulation of the gangli- \nonic apparatus situated in the course of the vaso-constrictor \nnerves. \n\nRespiration. \xe2\x80\x94 The respiration is at first quickened and deep- \nened, but later becomes slow and labored, and then weak and \nirregular. It finally ceases while the heart is still strong, and \nthe asphyxia is believed by the majority of recent investigators \nto be due to paralysis of the nerve endings in the diaphragm. \nMany, however, consider that the respiratory centre in the \nmedulla is paralyzed before these terminations. \n\nNervous System. \xe2\x80\x94 In the frog the chief effect is a paralysis \nof the motor nerve terminations, such as is caused by curare, \nbut it is thought probable that while in frogs the symptoms are \nall due to the action on the nerve endings, in mammals, in \nwhom this paralysis is much less marked, some of the phenom- \nena observed are due to central stimulation and to subsequent \nparalysis of the respiratory centre. On the nerve terminations \n\n\n\nconium. 747 \n\nin ganglia coniine acts in the same way as curare. It is found \nthat after large doses of the drug, the inhibitory impulses, owing \nto paralysis of the ganglionic apparatus, no longer reach the \nheart, and that stimulation of the vagus nerve has no effect on \nthe pulse-rate. Weak convulsive movements are often observed \nbefore death, but they are due simply to the asphyxia. \n\nIn the earlier stages of the intoxication, twitchings and tre- \nmors may occur. While coniine has been supposed to have a \nnarcotic depressing action on the central nervous system, this \nis by no means a characteristic feature of its effects. Languor \nand drowsiness are observed, but the latter does not pass into \nactual sleep. In both man and animals consciousness is gen- \nerally retained until immediately before the cessation of respira- \ntion, and in most cases the intelligence remains clear to the end, \nas in the case of Socrates. \n\nIn man the main symptoms relate to the motor, system, and \nthese are very characteristic. Under poisonous doses there is \nan ascending paralysis, beginning with the lower extremities \nand finally reaching the tongue, so that the patient may be un- \nable to speak, though his intellect remains unimpaired. This \nascending paralysis has been ascribed to a lowered conductivity \nof the spinal cord to impulses coming from the brain, the path \nbeing blocked at first only to those impulses which have a long \ndistance to traverse. The sensory, as well as the motor, nerves \nare depressed. \n\nEye. \xe2\x80\x94 In coniine poisoning the pupils are generally somewhat \ndilated, and ptosis also occurs, indicating that the dilatation is \ndue to oculo-motor paralysis. In many instances imperfect \nvision, from paralysis of accommodation, is noted. \n\nExcretion. \xe2\x80\x94 Coniine is excreted in the urine, and very rap- \nidly, so that its action passes off quite soon even when a con- \nsiderable quantity has been taken. \n\nTherapeutics of Conium. \nExternal. \xe2\x80\x94 Hemlock leaves, in the form of poultices and oint- \nments, have been applied to painful swellings and ulcers, but \n\n\n\n74-8 PHARMACOLOGY AND THERAPEUTICS. \n\nare of doubtful benefit. Conium applications for the relief of \nmyalgia or rheumatic pains are quite useless. \n\nInternal. \xe2\x80\x94 Conium has fallen into almost complete disuse, and \none reason for this is the unreliability of its preparations, which \nmay contain no coniine whatever. This substance is very vola- \ntile and unstable, and light and air render it inert. Succus \nConii (B. P., the expressed juice of the leaves and young \nbranches, to which 25 per cent, of alcohol is added) is generally \nconsidered the most reliable preparation of the drug, but it is \nstated that ounces of it have been taken without producing any \neffects. Conium has been employed in spasmodic affections, as \nchorea, paralysis agitans, tetanus, epilepsy, whooping-cough, \nasthmatic attacks and laryngismus stridulus, and also in mani- \nacal and hysterical excitement. It has little value except in \nspasms due to irritation of a nerve-trunk, when it may perhaps \nbe of service. In those of cortical or spinal origin other reme- \ndies should certainly be employed, as the physiological action of \nthe drug shows that it has really very little quieting effect upon \nthe central nervous system, but only prevents the impulses which \nare sent out from manifesting themselves in movements of the \nmuscles. \n\nTOXICOLOGY. \n\nAttention has already been called to the languor and drowsiness and \nto the eye-symptoms in cases of poisoning. The other phenomena have \nbeen so accurately described by Plato in his account of the death of \nSocrates, who was probably given the expressed juice of the root, that \nhis words may be taken as a fair representation of the ordinary symp- \ntoms : " He went about, and as he noticed that his thighs became heavy, \nhe lay down on his back, as the man directed. The latter \xe2\x80\x94 the one who \nhad given him the poison \xe2\x80\x94 touched him from time to time, and examined \nhis feet and thighs. Then he pressed his foot strongly, and asked \nwhether he could feel it ; he answered, No. Then he tried the knees, \nand so went higher and higher, and showed us how he gradually became \ncold and stiff. Then he touched him once more, and said that when it \ncame to the heart he would be dead. Now almost everything from \nthe abdomen down was cold." The mental powers of the sage re- \nmained unimpaired until near the end. Post-mortem. \xe2\x80\x94 No distinctive \nlesions are found, but only the usual indications of death from asphyxia, \nsuch as engorgement of the organs with venous blood. \n\n\n\ntobacco. 749 \n\nTreatment. \xe2\x80\x94 Emetics (see p. 175) should be administered and the \nstomach washed out. Then tannic acid should be given freely, and \nthe stomach again washed out. Strychnine, as a respiratory stimulant, \nand other stimulants, by hypodermatic injection, are called for. Warmth \nshould be applied to the surface and artificial respiration resorted to. \n\nTOBACCO. \n\nUnofficial Preparations. \nTabacum (U. S. P., 1890).\xe2\x80\x94 Tobacco. \nNicotinae Salicylas. \xe2\x80\x94 Nicotine Salicylate. (Eudermol.) \nPyridina. \xe2\x80\x94 Pyridine. Dose, .40 to 1.50 c.c; 6 to 25 TTL daily. \n\nAction of Tobacco. \n\nExternal. \xe2\x80\x94 Nicotine is powerfully antiseptic. It is absorbed \nfrom the unbroken skin, as well as from abraded surfaces and \nmucous membranes. \n\nInternal. \xe2\x80\x94 The action of tobacco is due to nicotine, which is. \none of the most fatal and rapid poisons known. Very large \ndoses may cause death within a few seconds. \n\nGastro-intestinal Tract. \xe2\x80\x94 Even in very small doses (.009 gm. ; \n-i gr.) nicotine, by its stimulation of the ganglia, causes in- \ncreased salivary secretion. It produces irritation of the fauces \nand a burning sensation in the mouth, oesophagus and stomach, \nwith extreme nausea. The sensation of heat spreads from the \nepigastric region all over the body. Nicotine is a violent \ngastro-intestinal irritant, and vomiting and purging quickly set \nin. The drug causes contraction of the muscular coats of the \nhollow viscera, and this is chiefly a peripheral effect, but is also \ndue in part to stimulation of ganglia within the walls. Thus, \nthe stomach is thrown into contraction, and powerful and spas- \nmodic movement of the intestine occurs, with repeated evacua- \ntion of its contents. A special feature of the action is the \nprofound collapse which attends these effects. \n\nCirculation. \xe2\x80\x94 The heart appears to be at first slowed in con- \nsequence of stimulation both of the vagus centre and the vagus \nganglia. Very soon, however, its action becomes markedly ac- \n\n\n\n750 PHARMACOLOGY AND THERAPEUTICS. \n\ncelerated and irregular, from paralysis of the ganglia, which \nobstructs the passage of the inhibitory impulses from above. If \nthe dose of the alkaloid is sufficiently large, however, no slow- \ning is caused, as immediate paralysis of the ganglia then results, \nwithout any primary stimulation. In addition, nicotine has \nsome direct action on the cardiac muscle, which apparently is \nfirst stimulated and then depressed. A rise in blood-pressure is \nproduced partly by the quickened action of the heart and partly \nby vaso-constriction from stimulation of the constrictor ganglia. \nThis stimulation also is succeeded by depression, and in con- \nsequence of this, as well as the enfeebling action on the heart, \nthe blood-pressure falls. Owing to the increased irritability of \nthe cardiac muscle caused by the drug, the heart may continue \nto beat for a considerable time after death. Nicotine produces \ndisintegration of the red corpuscles in freshly-drawn blood, but \nis not found to have this effect upon living blood, although the \nspectrum of haemoglobin is said to be altered by it. \n\nRespiration. \xe2\x80\x94 The respiratory centre in the medulla is first \nstimulated, then depressed, and finally paralyzed. As a result \nof the stimulation, the respiratory movements are accelerated \nand deepened; later they become slow, shallow and irregular, \nand death occurs from asphyxia. During the convulsions \ncaused by the alkaloid they are completely arrested. Before \nthe effects of central stimulation of the respiration become evi- \ndent, however, it has been observed that the breathing is tem- \nporarily shallow and at the same time rapid, with some defi- \nciency of the expiratory movements, and this is believed to be \ndue to an irritation of the pulmonary branches of the pneumo- \ngastric. \n\nNervous System. \xe2\x80\x94 When very large doses prove almost in- \nstantaneously fatal, the symptoms are those of sudden paralysis \nof the central nervous system, including the respiratory centre. \nIn these exceptional instances no convulsions are observed. \nThe regular action of the drug is a stimulation, followed by \ndepression, of the whole cerebro-spinal axis, from above down- \nward. The effect of considerable amounts on the cerebrum is \n\n\n\nTOBACCO. 751 \n\nto cause evanescent excitement, with violent headache, which \nis quickly succeeded by a comatose condition. In the medulla \noblongata nicotine affects particularly the respiratory, vagus, \nvaso-constrictor and convulsive centres, while the salivation and \nvomiting caused by it are probably also partly of medullary \norigin. Its action on the spinal cord is shown by increased \nexcitability, tremors and heightening of the reflexes. Convul- \nsions also are observed, but as these are clonic instead of tonic \nin type, and are found to be much weaker after division of the \ncord immediately below the medulla than in the intact animal, \nit is concluded that they have their seat in the medulla and hind \nbrain rather than in the cord. The peripheral actions are essen- \ntially the same as those of pilocarpine, with the exception that \nthe stimulation is shorter and under large doses entirely absent, \nwhile the depression is much more marked. Nicotine causes a \nstimulation, and subsequently more lasting paralysis, of sympa- \nthetic ganglia in all situations. In the skeletal muscles there \nare produced fibrillary twitchings, which are succeeded by \ncomplete paralysis of the nerve endings, as in the case of curare. \nUltimately, therefore, the function of the motor nerves is abol- \nished, and as a result of this there is intense muscular weakness. \n\nUnstriped Muscle. \xe2\x80\x94 As has been mentioned, the stomach is \npowerfully contracted. This contraction extends throughout \nthe intestine, and eventually results in a tetanic condition \nwhich for a time arrests peristalsis, though afterwards the wave \ncontractions recur with increased vigor. Similar contraction \noccurs in the uterus and bladder. In consequence of the latter \nbeing thrown into this tetanic contraction, the urine is expelled \nvery soon after the injection of nicotine, and on this account, \nno doubt, the impression has obtained that the drug augments \nthe renal secretion. Apparently, however, it has no diuretic \naction. \n\nEye. \xe2\x80\x94 The influence of nicotine on the pupil differs in differ- \nent animals, and it is supposed that the varying effects are prob- \nably due to the amount of stimulation relatively exerted upon \nthe ciliary and the superior cervical ganglia in different in- \n\n\n\n752 PHARMACOLOGY AND THERAPEUTICS. \n\nstances. In acute poisoning in man the pupil is generally first \ncontracted and then dilated. \n\nSecretion. \xe2\x80\x94 Reference has already been made to the increased \nsecretion of saliva. The seat of action is the ganglionic appa- \nratus of the secretory nerves, and there is at first stimulation \nand later, depression; so that the secretion is eventually much \nlessened or suppressed from paralysis of the apparatus. If the \ndose is sufficiently large, the saliva is diminished at once. The \nother secretory glands appear to be affected in the same way ; \nthe secretions of the sweat, lachrymal and bronchial mucous \nglands being increased and afterwards diminished. The secre- \ntion of bile and urine does not seem to be so dependent upon \nnervous influences, and it has not been shown that these secre- \ntions are affected by nicotine. \n\nExcretion. \xe2\x80\x94 Nicotine is eliminated by the kidneys, and, to a \nless extent, probably by the lungs. It has also been detected \nin the sweat and saliva. It is believed that that which is ab- \nsorbed from the stomach and intestine usually loses much of its \ntoxic activity during its passage through the liver. \n\nTherapeutics of Tobacco. \n\nAn excellent poultice for epididymitis is made of fine-cut \ntobacco and flax-seed. In non-smokers tobacco is useful to \nrelieve the symptom asthma, and for this purpose it is often \nmixed with stramonium, belladonna, etc., and the smoke inhaled. \nPulverized tobacco, or snuff, has been employed for arresting \nstubborn paroxysms of hiccough, a pinch being drawn into the \nnostrils by a strong inspiration. Enemata made from the leaves \nwere formerly used sometimes for purgative purposes and also \nto relax muscular spasm and so facilitate the reduction of dis- \nlocations, herniae, etc. The objects for which tobacco was at \none time employed, however, can now be accomplished more \nefficiently and safely by anaesthetics and other agents. \n\nNicotine salicylate (eudermol), in the form of an ointment \n(i per cent), is said to be efficacious in the treatment of scabies \nand to possess the adavntage of not staining the linen, as well \n\n\n\ntobacco. 753 \n\nas being odorless. Pyridine which is found in tobacco, but com- \nmercially is obtained from other sources, when administered by \ninhalation will frequently relieve the paroxysms of asthma. \nFor this purpose 4 c.c. (1 fl. dr.) is generally placed in a \ndish, so that it may slowly evaporate. Its persistent and abom- \ninable odor is a great obstacle to its use. \n\nTobacco smoking is often indulged in on the supposed ground \nthat it aids digestion and that after breakfast it promotes the \ndaily movement of the bowels. It appears in many instances, \nparticularly in persons who lead sedentary lives, to stimulate \nthe mental powers and induce a feeling of serenity. Many indi- \nviduals use tobacco to a moderate extent for many years with \nimpunity, but its excessive use not infrequently leads to more \nor less serious disorders. One of the most common effects is \na catarrhal condition of the throat and upper parts of the respi- \nratory passages. The tongue is also irritated, especially when \nthe smoke is concentrated on one point, as in pipe-smoking, and \nit has been thought that this constant local irritation may favor \nthe development of cancerous disease in the tongue or lip. \nOther effects liable to be produced are dyspepsia and want of \nappetite, with consequent loss of flesh, palpitation and irregu- \nlarity of the heart, vertigo, depression, neuralgia, insomnia, \nmuscular weakness, and various ocular disturbances. Atrophy \nof the optic nerve may eventually result, and chronic nicotine \nintoxication is said to favor arterio-sclerosis. The use of to- \nbacco in those who are unaccustomed to it almost invariably \ncauses nausea and vomiting attended by depression, which may \neven amount to collapse. The records of the senior classes of \nYale University for eight years showed that those who used no \ntobacco were 20 per cent, taller, 25 per cent, heavier, and had \n66 per cent, more lung capacity than the smokers. \n\nTOXICOLOGY. \nThe symptoms are those which we would expect from the physiological \naction of nicotine. Thus, there are marked nausea, vomiting and purg- \ning, accompanied or followed by profound collapse, with coldness and \nclamminess of the surface, icy extremities, a weak and rapid pulse, great \n49 \n\n\n\n754 PHARMACOLOGY AND THERAPEUTICS. \n\ndyspnoea, and extreme muscular weakness. There is usually partial loss \nof consciousness, and convulsions are often observed. Notwithstanding \nthe extreme toxicity of nicotine, in animals as well as man a certain \ntolerance may be acquired. Post-mortem. \xe2\x80\x94 When the poison is taken \nby the mouth there may be more or less hyperemia of the gastric and \nintestinal mucous membrane, since nicotine is sufficiently alkaline to be \nsomewhat caustic ; but the appearances are not characteristic. The odor \nmay furnish a valuable indication. \n\nTreatment. \xe2\x80\x94 Tannic acid followed by emetics (see p. 175). Strych- \nnine is the true physiological antidote. Alcohol and ammonia stimu- \nlate the heart. The recumbent position must be maintained. Artificial \nrespiration may be necessary. \n\nLOBELIA. \nLOBELIA.\xe2\x80\x94 Lobelia. (Indian Tobacco.) Dose, 0.5 gin.; 7V 2 gr. \n\nPreparations. \n1. Fluidextractum Lobeliae. \xe2\x80\x94 Fluidextract of Lobelia. Dose, \n0.5 c.c; 8 TH,. \n\n2. Tinctura Lobelia. \xe2\x80\x94 Tincture of Lobelia. Dose, (expecto- \nrant) 1 C.C.; 15 TTt; (emetic) 4 C.C.; 1 fl. dr. \n\nUnofficial Preparation. \nInfusum Lobelia. \xe2\x80\x94 Infusion of Lobelia. Dose, 15 to 30 c.c; \ny 2 to 1 fl. oz. \n\nAction of Lobelia. \n\nExternal. \xe2\x80\x94 Lobelia is absorbed through the skin, but has no \nlocal action on it. The local application of lobeline to the eye \nis followed by contraction of the pupil, though in general poi- \nsoning by it dilatation has been observed. \n\nInternal. G astro -intestinal Tract. \xe2\x80\x94 Lobelia is a powerful \ngastro-intestinal irritant. Ordinarily, however, it produces \nviolent vomiting without any action on the bowels, as most of \nit is expelled by the emesis, which is attended by extreme pros- \ntration. When the vomiting is insufficient to get rid of the \n\n\n\nLOBELIA. 755 \n\npoison it causes active purging, and the collapse condition is \nmarked. When injected into animals lobeline induces vomit- \ning and salivation, these effects being ascribed to stimulation \nof the medullary centres. \n\nCirculation. \xe2\x80\x94 In consequence of its action on the inhibitory- \napparatus of the heart, the pulse-rate is slowed at first, but after- \nwards is more or less accelerated. The blood-pressure, at first \ndiminished, is afterwards increased beyond the normal. As a \nresult of vomiting, however, marked variations in the rate of \nthe heart and in the arterial tension are apt to be observed. In \nthe collapse resulting from the gastro-intestinal irritation caused \nby lobelia the pulse is naturally small and weak. \n\nRespiration. \xe2\x80\x94 Small doses stimulate and large doses paralyze \nthe respiratory centre, while the vagus terminations in the mus- \ncular coat of the bronchi or in ganglia in the lungs are also \nparalyzed by lobeline. The respiratory movements may at first \nbe much increased in rate and force. Later they become dysp- \nnceic and asphyxia supervenes, death occurring from respira- \ntory failure. \n\nNervous System. \xe2\x80\x94 When injected into mammals lobeline in- \nduces increased reflex irritability, as well as accelerated respira- \ntion. The same is true as regards frogs, so that it is inferred \nthat in both it causes primary stimulation of the spinal cord \nand of the medulla oblongata. Only in the frog, however, does \nthere appear to be any action on the higher divisions of the \nnervous system. They are depressed in frogs and in them the \nterminations of the motor nerves are paralyzed in the same \nmanner as by curare. In man and warm-blooded animals gen- \nerally coma and convulsions may be observed after poisonous \namounts, but they would seem to be simply a result of the as- \nphyxia. By some, however, these effects are regarded as due \nto a direct action on the higher cerebral centres. \n\nExcretion. \xe2\x80\x94 Lobelia is apparently excreted by the kidneys \nand to some extent by the skin, and it is credited with a diuretic \nand diaphoretic action. \n\n\n\n7 $6 PHARMACOLOGY AND THERAPEUTICS. \n\nTherapeutics of Lobelia. \n\nExternal. \xe2\x80\x94 As an external application tincture of lobelia, with \nan equal quantity of glycerin, is a most useful remedy for the \nrelief of pain in acute epididymitis. An infusion (i to 16) may \nbe used for the dermatitis of poison ivy. \n\nInternal. \xe2\x80\x94 As it has the effect of relaxing bronchial muscle, \nthe chief use of lobelia is for the relief of the symptom asthma. \n4 c.c. (i fl. dr.) of the tincture may be given until nausea is \ninduced, and as soon as this appears it should be discontinued. \nThe administration of .6 c.c. (io HI) every ten minutes, if begun \nearly, often shortens the paroxysm. Lobelia is also employed \nto some extent as an expectorant in bronchitis, and especially \nwhen the latter is characterized by a spasmodic element. It is \noften combined with other antispasmodics and expectorants. \nIn both bronchitis and asthmatic attacks its good effects are no \ndoubt largely due to the free secretion of mucus which is pro- \nduced by its nauseant action. It is, relatively, better borne by \nchildren than by adults. It was formerly prescribed as an \nemetic and also as a purgative, but it is now regarded by most \nas too depressing to be used for these purposes, while its action \nas a purgative is very uncertain. In very small doses, how- \never (.06 to .12 c.c; 1 to 2 Til every hour, or .6 c.c; 10 in. at \nbed-time), the tincture is still recommended by some writers \nas useful in promoting peristalsis and intestinal secretion in \ncases of habitual constipation, dependent upon atony of the \nmuscular layer and deficient secretion of the bowel, where \nthere is an impacted caecum, but no inflammatory action has \nsupervened. An infusion of lobelia has sometimes succeeded \nin relieving strangulated hernia, intussusception and faecal im- \npaction, and is regarded as safer than tobacco. \n\nC. Drugs Acting on the Peripheral Endings of Sensory \n\nNerves. \n\nMENTHOL. \n\nMENTHOL.\xe2\x80\x94 Menthol. Dose, 0.065 gm. (65 milligm.) ; 1 gr. \n\n\n\nMENTHOL. 757 \n\nAction of Menthol. \nMenthol is antiseptic and locally anaesthetic, producing a \nsensation of coldness wherever it is applied. The blood-vessels \nof the part are, however, dilated, and instead of there being a \nfall of temperature, the skin temperature is higher there than \nelsewhere. The drug is generally regarded as exerting a pecu- \nliar stimulating effect upon the nerves conveying the sense of \ncold, but this has been denied by some authorities, who assert \nthat it acts only on the terminations of the nerves of common \nsensation or pain. The feeling of coldness is associated with \nmore or less prickling, and later there follows some heat and \nburning. Like camphor, menthol stimulates the central ner- \nvous system, and its general effects are practically identical, \nexcept that the convulsions to which it gives rise are much less \nsevere. It is excreted in combination with glycuronic acid. \n\nTherapeutics of Menthol. \nMenthol, externally applied, will often relieve neuralgic pains, \nprovided they are of superficial and peripheral origin. The \nsolid menthol, in the form of a pencil or cone, is sometimes \nemployed for this purpose, and sometimes it is used in alcoholic \nsolution, or in a solution of oleic acid (i to 2.4) made by heat. \nA menthol plaster is composed of menthol, 3 ; yellow wax, 1 ; \nrosin, 15; and an excellent liniment, of menthol, 3; chloroform, \n4; olive oil, 9. Rubbed up with an equal part of camphor, \nchloral or pure phenol, and placed in the cavity, it promptly \ncures the aching of a carious tooth. It has considerable \npower in controlling superficial inflammations, and in an \nethereal solution of from 10 to 50 per cent, may be applied two \nor three times a day for the purpose of aborting boils, car- \nbuncles, cutaneous abscesses, etc. An excellent combination \nfor inflamed joints, whether the inflammation is rheumatic or \ngonorrhceal, is a mixture of menthol, thymol and hydrated \nchloral (each 8 gm. ; 2 dr.), rubbed up together until liquefied, \nand to which are added morphine sulphate, .13 gm. (2 gr.) and \natropine sulphate, .008 gm. (^ gr.), or cocaine hydrochloride, \n\n\n\n758 PHARMACOLOGY AND THERAPEUTICS. \n\n.06 gm. (1 gr.). Or, a solution of menthol, thymol and chloral \nin ether or chloroform may be painted over the inflamed part. \nThese combinations are also applicable in local neuralgias. \nMenthol is very useful for allaying itching, and is employed in \nsolutions (to which other drugs may be added, if called for), in \nsuch affections as pruritus ani, urticaria, eczema and herpes \nzoster. In laryngeal and tracheal tuberculosis great relief is \nafforded by a 20 per cent, solution in olive oil, introduced into \nthe larynx with a syringe or spray, and followed by inhalations \nof the same from boiling water or by means of a respirator. \nA pigment of 1 to 4 of the oil may also be employed for paint- \ning the larynx. In bronchiectasis the injection twice daily of \n4 c.c. (1 fl. dr.) of a mixture composed of menthol, 10; guaiacol, \n2; olive oil, 88, has been followed by marked improvement. \nInhalations of menthol (volatilized in a tea-pot by the addition \nof hot water) have sometimes proved successful in relieving \nthe symptom asthma. It has also been used by inhalation in \nhay fever and diphtheria. In solution, or rubbed up with sugar \n(5 to 10 per cent.), it may be applied by means of a large cam- \nel\'s hair brush as a disinfectant and anodyne for the throat in \ndiphtheria, scarlet fever, tonsillitis, pharyngitis, etc. A 10 per \ncent, alcoholic solution, applied on cotton wool, is preferred by \nsome. Menthol is now used to a considerable extent topically \nin diseases of the ear and nose. In the nasal form of hay fever \na mixture of menthol and ammonium carbonate has been found \nto make a very efficient smelling-salt. Internally menthol has \nbeen used in small doses (.006 gm. ; -J^ gr.) to relieve nausea \nand vomiting. In doses of .10 gm. (i*/2 gr.), in capsules with \nolive oil (six or eight being taken daily), it has been given as \nan intestinal antiseptic. It is also said to have been used with \nadvantage, by means of the stomach-tube, in cases of atonic \ndyspepsia. The stomach is first washed out and then a 1-5 per \ncent, solution of menthol in liquid petroleum is blown through \nthe tube. In spasmodic cough, asthma and hiccough its inter- \nnal administration is sometimes of service. \n\n\n\ncoca. 759 \n\nCOCA. \nCOCA. \xe2\x80\x94 Coca. (Erythroxylon. Cuca.) Dose, 2 gm.; 30 gr. \n\nPreparations. \nFluidextractum Cocae. \xe2\x80\x94 Fluidextract of Coca. Dose, 2 c.c; \n30 Til. \n\nVinum Cocae. \xe2\x80\x94 Wine of Coca. Dose, 16 c.c; 4 fl. dr. \n\nCocaina. \xe2\x80\x94 Cocaine. Dose, 0.030 gm. (30 milligm.) ; y 2 gr. \n\nOleatum Cocainae. \xe2\x80\x94 Oleate of Cocaine. \n\nCocainae Hydrochloridum. \xe2\x80\x94 Cocaine Hydrochloride. Dose, \n0.030 gm. (30 milligm.) ; y 2 S r - \n\nUnofficial Preparation. \nTrochiscus Krameriae et Cocainae (B. P.). \xe2\x80\x94 Krameria and \nCocaine Lozenge. Dose, 1 lozenge. \n\nAction of Coca. \n\nExternal. \xe2\x80\x94 Cocaine has little or no action on the unbroken \nskin, but upon mucous membranes or the subcutaneous tissue \nit produces complete local anaesthesia. At first, owing to the \ncontraction of the vessels caused, the surface to which it is \napplied becomes somewhat blanched, but later there is hyper- \nemia with increased redness of the part, in consequence of \nsecondary vascular dilation. A 5 to 10 per cent, solution of \nthe hydrochloride will paralyze the sensory nerves, but to pro- \nduce this effect on motor nerves requires a much stronger dose. \nThe local application of cocaine to the tongue abolishes the \nsense of taste, and to the nose, that of smell. This alkaloid is a \ntypical protoplasmic poison, and its effects as a local anaesthetic \nare no doubt attributable to its destructive action on the proto- \nplasm of the end organs. \n\nInternal. G astro -intestinal Tract. \xe2\x80\x94 In South America from \ntime immemorial the natives have chewed coca leaves to relieve \nhunger and fatigue. On account of its anaesthetic effect on the \ngastric mucous membrane cocaine deadens the sensation of \nhunger, and tends to allay irritability of the stomach, but the \n\n\n\n760 PHARMACOLOGY AND THERAPEUTICS. \n\ndrug is not an aliment, and if no food is taken, rapid emaciation \noccurs under its use. In exceptional instances vomiting is \ncaused when poisonous quantities are swallowed. According \nto some observers intestinal peristalsis is markedly increased by \nmoderate doses, while after large doses this increase is followed \nby great sluggishness, deepening into paralysis. \n\nCirculation. \xe2\x80\x94 The pulse-rate is lessened by very small doses, \nin consequence of stimulation of the vagus centre, but increased \nby large doses, which depress the vagus. Usually, but not, it \nis said, invariably, the heart is eventually slowed, apparently \nfrom a direct depressant action on the cardiac muscle. Cocaine \nconstricts the arterioles, mainly from stimulation of the vaso- \nconstrictor centre, and in the earlier stages of the poisoning \nthe vessels are much contracted. This, together with the in- \ncreased rate of the heart, leads to a marked rise in the blood- \npressure. Later the pressure falls, probably from peripheral \naction. \n\nRespiration. \xe2\x80\x94 The respiratory centre in the medulla is at first \nstimulated and then depressed. Consequently, the respiration \nis primarily accelerated, but as the depression comes on, the \namount of air inspired gradually becomes diminished, and the \nbreathing grows slow, weak and irregular. Cheyne-Stokes \nrespiration is frequently present, and death occurs from as- \nphyxia. \n\nNervous System. Cerebrum. \xe2\x80\x94 The first effect is a stimula- \ntion of the higher parts of the brain, such as is caused by caf- \nfeine. In animals there is increased movement, which is per- \nfectly coordinated, and in man wakefulness and mental exhilara- \ntion. All observers agree that cocaine has remarkable potency \nin increasing muscular power and removing fatigue. If the \nquantity taken is sufficiently large, the stimulation is followed \nby depression, which is often first shown in choreic movements, \nfrom derangement of the coordinating functions. The animal \nmoves in a circle, the symptoms resembling the forced move- \nments often seen in affections of the cerebellum. Narcosis \nensues, and this is succeeded by convulsions, the seat of which \n\n\n\n\n\n\nCOCA. 761 \n\nhas not been determined, but is supposed to be in some portion \nof the hind brain. If the paralysis is rapid, it is found that \nthe convulsive stage may be absent. \n\nMedulla Oblongata. \xe2\x80\x94 The medulla is early affected, and the \nvarious centres are first stimulated and then depressed. \n\nSpinal Cord. \xe2\x80\x94 The cord, too, is at first stimulated, as is shown \nby exaggeration of the reflexes, and very large doses may cause \nconvulsions, of spinal origin, resembling those due to strych- \nnine. It will thus be seen that the action of cocaine on the \ncentral nervous system consists in a descending stimulation, \nfollowed by depression, which successively progresses from the \ncerebrum to the spinal cord. In some cases, however, it is to \nbe noted, the stage of stimulation is very short or altogether \nabsent, and it has also been observed that the two stages are \nnot definitely divided, so that one part of the cerebrum may \nshow depression while another is still excited. With small \ndoses the cerebrum chiefly is affected. \n\nEye. \xe2\x80\x94 Cocaine, applied to the eye, causes local anaesthesia and \npallor of the conjunctiva and iris, from vascular constriction. \nWhen it is applied to the conjunctiva, in considerable quantity \nand for some time, and also when it is administered system- \nically, ocular phenomena are produced which are the same as \nthose caused by stimulation of the cervical sympathetic. It is \ntherefore considered that cocaine has a special action on the \ncentres or terminations of this nerve, and there is reason to be- \nlieve that the stimulation to which it gives rise really affects \nboth. Mydriasis is caused, though the iris still reacts to light, \nand the accommodation is impaired. The intra-ocular ten- \nsion is somewhat reduced, and the palpebral aperture is \nwidened. The dilatation of the pupil differs from that due to \natropine as regards the persistence of the reaction to light and in \nbeing less complete. The mydriasis is also more readily over- \ncome by pilocarpine and muscarine than that caused by atro- \npine. Either strong or weak cocaine solutions when fre- \nquently applied desiccate the corneal epithelium. \n\nTemperature. \xe2\x80\x94 Under large doses of cocaine the temperature \n\n\n\n762 PHARMACOLOGY AND THERAPEUTICS. \n\nrises, and this has been ascribed to a stimulation of the thermo- \ngenetic centre in the brain. In poisoning in animals it has \nbeen observed that the higher the temperature, the more readily \nare convulsions produced and the more severe their character. \n\nExcretion. \xe2\x80\x94 Cocaine is eliminated in the urine and probably \nalso excreted into the intestine. The quantity of urine appears \nto be sometimes increased and sometimes diminished. In some \ninstances the injection of the drug has been followed by com- \nplete anuria lasting for several hours. In view of the variations \nnoted, it has been suggested that the action is not a direct one \non the kidney, but is caused merely through the changes in the \ncalibre of the vessels. The effects on the vasomotor centre, \nan early stimulation and later paralysis, would account for such \nvariations. The other secretions beside the urinary seem to be \nrather diminished than increased. Cocaine has some anaphro- \ndisiac effect. \n\nTherapeutics of Coca. \n\nExternal. \xe2\x80\x94 A 5 to 10 per cent, solution of cocaine hydrochlo- \nride may be injected subcutaneously as a local anaesthetic for the \nperformance of small operations. In the infiltration method \nof Schleich three solutions are employed: cocaine hydrochlo- \nride, 0.2 (strong) ; 0.1 (normal) ; or 0.01 (weak) ; morphine \nhydrochloride, 0.025; sodium chloride, 0.2; sterilized distilled \nwater or saturated boric acid solution to 100. These are in- \njected into the substance of the skin, forming wheals. This \nmethod requires less of the drug than when it is used subcu- \ntaneously. Yet it should be borne in mind that the anaesthetic \nproperties of the two weaker solutions depend largely upon the \nmechanical anaesthesia produced by injection of water, the anal- \ngesic effect of which had been previously pointed out. Solu- \ntions of cocaine hydrochloride, topically applied, are used for \noperations on the mouth, throat, teeth (4 per cent.), eye (1 to \n4 per cent.), ear, vagina, urethra and rectum (4 to 10 per cent.). \nCongestive urethral stricture may be temporarily relieved by it \nso that instruments may be passed, but it should be employed \nwith great care in urethral operations. It is used on mucous \n\n\n\nCOCA. 763 \n\nmembranes for the relief of pain in various conditions, and also \nfor the abatement of inflammation. It is of service in painful \nulcers, fissures, etc., and in pruritus of the vulva and anus, and \nis also used as an application to the nasal passages in coryza and \nhay fever. In the latter affections a powder consisting of co- \ncaine, 1 ; morphine, 1 ; bismuth subnitrate, 5, may be snuffed \ninto the nostrils. Ointments, bougies, and suppositories, usually \ncontaining 2 to 5 per cent, of cocaine, which mixes better than \nthe hydrochloride, are very useful. A 15 per cent, solution has \nbeen injected into the gums for tooth extraction, but is hardly \nto be commended. Ophthalmic surgeons employ it very largely \nto produce local anaesthesia of the eye. If inflammation is pres- \nent, however, anaesthesia is produced with great difficulty. \n\nA solution is useful for painting or spraying on the throat \nprevious to laryngeal examinations. Lozenges of the hydro- \nchloride, containing .003 gm. ( J^gr.) in each, are valuable for \npainful sore throat. Often in addition each lozenge contains \n.06 gm. (1 gr.) of extract of krameria. \n\nInternal. \xe2\x80\x94 Cocaine, because of its effect in depressing the gas- \ntric sensory nerves, is sometimes employed to relieve vomiting \nin pregnancy, seasickness and other conditions. It or the fluid- \nextract of coca may be given, as a supportive and stimulant in \nlow fevers, and in cases where great physical and mental \nstrain is to be borne. The preparations of coca, especially the \nwine, are much used as stomachic tonics, and in the debility \nof convalescence from acute diseases. Some clinicians have \nfound cocaine a remedy of the highest value in chorea, and \nstate that paralysis agitans, alcoholic tremors, and senile tremb- \nling are more favorably affected by it than by any other drug. \n\nMedullary Anasthesia. \xe2\x80\x94 Within the last few years it has been \nproposed to obtain surgical anaesthesia by injection of from \n-jlj- to^- gr. ; .006 to .012 gm. into the arachnoid space. Puncture \nis made between the third and fourth lumbar interspace of the \nspine with a specially prepared needle, as for diagnostic pur- \nposes. A few drops of the spinal fluid is allowed to escape \nand the solution is injected. Anaesthesia supervenes, gradually \n\n\n\n764 PHARMACOLOGY AND THERAPEUTICS. \n\nextending from the feet upwards, and may reach to the chest or \neven higher ; this persists for a variable time, but generally suffi- \ncient for the performance of surgical operations. This method \nof anaesthesia does not interfere with labor further than abol- \nishing its pain. Strict asepsis must be observed. Beyond some \nnausea, vomiting and headache, after-effects are not usually \nnoticed. Several deaths have now been reported as due to the \nprocedure, however, so that it seems hardly likely that it will \nsupplant ether or chloroform narcosis, or that it can be per- \nformed without too great risk when contra-indications exist to \neither. \n\nTOXICOLOGY. \n\nSymptoms. \xe2\x80\x94 Acute poisoning in quite a large number of instances has \nfollowed the injection of cocaine into the urethra previous to some \noperation, and sometimes occurs from the injection of the drug under \nthe gums or skin. Otherwise it is not often met with. The symptoms \nvary in different individuals, but usually the patient at first becomes more \nor less excited, restless and garrulous. The pulse and respiration are \nquickened, the pupils dilated, and there are present dryness of the throat, \nheadache, vertigo and confusion. There may be exaggeration of the \nreflexes, and tremors and slight convulsive movements are apt to occur. \nLater, powerful tonic or clonic convulsions may come on. The heart \nbecomes turbulent in its action, and the respiration, which soon grows \ndyspnoeic in character, may be arrested during a convulsion. In other \ncases no actual convulsions may be met with, while fainting and collapse \nrapidly supervene. The patient suffers from profound cardiac and res- \npiratory depression, with tremors, and the skin is cold, cyanotic and \nclammy. Death may take place from gradual failure of the respira- \ntion, and if the patient survives he may suffer for months from tremors \nand other nervous symptoms. Out of 250 cases of accidental poisoning \nfrom the medicinal use of cocaine, 13 proved fatal. \n\nChronic poisoning, or cocamania, is not infrequently seen. The victim \nof the cocaine habit rapidly loses flesh and sometimes suffers from faint- \ning fits. Among the phenomena characterizing the condition are dis- \norders of the circulatory system, insomnia, mental failure, and delusions \nnot unlike those of chronic alcoholism. Visual and other hallucinations, \ngenerally of a disagreeable type, are often present, and one symptom \nwhich is regarded as pathognomonic of subacute or chronic intoxication \nwith this drug is a sensation of crawling worms or insects, "cocaine \n\n\n\nALPHA-EUCAINE HYDROCHLORIDE. 765 \n\nbugs," under or on the skin. Sometimes there is delirium or acute \nmania. The central nervous system seems to undergo degeneration like \nthat observed in chronic morphine poisoning. Cocaine habitues are by \nno means infrequently met with. The moral degradation is fully equal \nto that of opium-eaters. Cocaine, which is usually taken by hypoder- \nmatic injection in these cases, is often employed in association with \nmorphine, and the habit is sometimes acquired by those making use of \nthis drug to break themselves of the morphine habit. \n\nTreatment. \xe2\x80\x94 Acute poisoning. If the drug has been taken by the \nmouth the stomach should first be evacuated by washing out or by the \nuse of apomorphine. The treatment is mainly one of stimulation, and \nstrychnine is especially indicated as a respiratory stimulant. Artificial \nrespiration may also be called for. Amyl nitrite may be of service if \nthe blood-pressure is high, and small quantities of chloroform or ether, \nby inhalation, may be required for the convulsive attacks. \n\nChronic poisoning. \xe2\x80\x94 The habit is difficult to cure, as relapses are \nfrequent. The most important point in the treatment is the withdrawal \nof the drug, though the sudden stopping of it may bring on profound \ncollapse. There is little chance of a successful result unless the patient \nis confined for a considerable time in an asylum or sanitarium. \n\nUnofficial Preparations. \n\nAlpha-Eucainae Hydrochloridum. \xe2\x80\x94 Alpha-eucaine hydrochlo- \nride. (Eucaine Hydrochloride. Eucaine. Alpha-eucaine hydro- \nchlorate.) \n\nBeta-Eucainae Hydrochloridum. \xe2\x80\x94 Beta-eucaine hydrochlo- \nride. (Beta-eucaine hydrochlorate.) \xe2\x80\xa2 \n\nAction of Eucaine Hydrochloride. \nThe general action of eucaine, both in cold and warm-blooded \nanimals, consists in a marked excitation of the entire central \nnervous system, followed by paralysis; in toxic doses going on \nto death. Small doses administered to mice and rabbits cause \nincreased reflex excitability, and increased but weakened respi- \nratory movements. Medium doses in rabbits cause repeated \ntonic and clonic convulsions. The animals lie senseless on their \nsides, with dyspnoea, opisthotonos, and finally paresis of the \nposterior limbs. These phenomena are still more marked when \nlarge toxic doses are administered; the convulsions return con- \n\n\n\n766 PHARMACOLOGY AND THERAPEUTICS. \n\ntinuously, and affect all the muscles of the body. The animals \nfinally die when the paralysis reaches the respiratory muscles. \nWhen the dose is not a fatal one, the convulsions gradually \ncease, the increased reflex excitability disappears, and the pare- \nsis of the hind limbs slowly improves. The effect on the cen- \ntral nervous system is therefore at first excitant, and later, in \ntoxic doses, paralyzing. The paralysis is a central one, for if \nthe sciatic nerve of a frog poisoned with eucaine is exposed, \nand its peripheral end irritated with the induced current, the \nlimb reacts in a normal manner. As regards its action on the \nheart and the blood-vessels, the subcutaneous and intravenous \ninjection of small and medium doses slows the heart on the \naverage from twenty to thirty beats per minute, but without \notherwise modifying the beats, or increasing the blood-pressure. \nThis effect on the pulse is caused by the excitation of the cen- \ntral vagus ; for section of the vagi causes an immediate increase \nof the pulse to the normal and above it, together with an in- \ncrease of the blood pressure. Death occurs from paralysis of \nthe respiratory centres, for the heart continues to beat for some \ntime thereafter. It is claimed that eucaine solutions possess \nmoderate antibacterial powers. \n\nTherapeutics of Eucaine Hydrochloride. \nEucaine is used in from 1 to 5 or even 10 per cent, solutions \nfor the same purposes as is cocaine. The anaesthesia comes on \nsomewhat more slowly, with solutions of the same strength is \nabout equal to, and its effects last about the same time as with \nthe latter drug. It possesses the disadvantage of causing hyper- \nemia of mucous membranes, and in 2 per cent, solution may \nirritate the conjunctiva. A 1 per cent, solution, however, does \nnot cause any disturbance. It is preferable to cocaine in that \nits aqueous solutions are permanent and can be sterilized by \nheat without decomposition. It does not cause mydriasis nor \ndisturbance of accommodation, nor does it dry the corneal epi- \nthelium, and further it is relatively safer, so far as circulation \nand respiration are concerned, than cocaine. \n\n\n\nHOLOCAINE. j6j \n\nBeta-Eucaine. \xe2\x80\x94 In order to avoid the burning sensations, pain \nand hyperemia to which eucaine may give rise, a substance \nknown as Benzoylvinyldiacetonalkamin hydrochloride, named \nBeta-eucaine (hydrochloride), a compound closely related chem- \nically to eucaine, has been recommended. Its chemical and \nphysiological properties, with the above exceptions, are the \nsame. It is safe, being three and three-quarters less toxic than \ncocaine, does not affect the heart, and is unirritating. It does \nnot produce, when employed in the eye, mydriasis, corneal le- \nsions, nor disturbances of accommodation. It can be sterilized \nby boiling without deterioration ; its solutions are permanent \nand do not decompose when kept. Its field is the same as that \nof cocaine, and it can be employed for the various operations \nupon the eye, nose, ears, genito-urinary tract, in minor surgery \nand dentistry, and for infiltration anaesthesia. For medullary \nanaesthesia, while the after-effects seem no greater than with \ncocaine, the analgesia is not so uniform nor lasting. Its ease \nand certainty of sterilization by boiling are in its favor, and \nsome operators are strong advocates of it. It is employed in \nfrom y 2 to 4 per cent, (saturated) aqueous solution, but of the \nlatter not more than 2 c.c. (30 HI) should be employed at one \ntime, although for a prolonged operation five times this quan- \ntity may be employed. \n\nUnofficial Preparation. \nHolocaina. \xe2\x80\x94 Holocaine. (Holocaine hydrochloride. Para- \ndiethoxyethenyl-diphenyl-amidine-hydrochloride.) \n\nAction of Holocaine. \nIt is a local anaesthetic, and paralyzes the sensory nerves of \nthe cornea and mucous surfaces even more powerfully than \ncocaine. It does not produce any necrosis, and has no effect \nupon the blood-vessels. It should not be used hypodermatically, \nas it is said to be about five times as toxic as cocaine. Even \nsmall doses cause in both frogs and warm-blooded animals con- \nvulsions which appear to be of cerebral origin. It is a muscle \n\n\n\n?68 PHARMACOLOGY AND THERAPEUTICS. \n\npoison, a I per cent, solution rapidly killing voluntary and \ncardiac muscles in the frog, and it also exerts a curare-like \ninfluence on the motor nerves. It is powerfully antiseptic: a \ni per cent, solution has not only an inhibitory effect upon pus \norganisms, but destroys them when they are exposed to its \naction for a certain length of time. \n\nTherapeutics of Holocaine. \n\nIt is used as a local anaesthetic for the same purposes as \ncocaine; while it has some advantages over the latter, it is \nnecessary that its application should be renewed in from ten to \nfifteen minutes. It is largely employed in ophthalmic practice, \nwhere its peculiar value lies in the rapidity of its action and \nthe fact that it leaves the pupil, accommodation and intra-ocular \ntension quite unaffected. Its germicidal power is a further \nadvantage, and it has a very beneficial effect on septic ulcers \nof the cornea. Holocaine is widely used also in affections of \nthe nose, throat and ear and in operative procedures upon these \nparts, and no toxic effects appear to have been observed from \nits use as a local anaesthetic. A I per cent, solution is gener- \nally employed, and it should be prepared in porcelain (not in \nglass), as this salt is very sensitive to alkalies, and even the \nsmall amount of alkali dissolved out of the glass on boiling a \nsolution of it in a test-tube is sufficient to decompose it. \n\nUnofficial Preparation. \nOrthoformum. \xe2\x80\x94 Orthoform. (Methyl-para-amido-meta-oxyben- \nzoate.) Dose, 0.30 to 0.60 gm.; 5 to 10 gr. \n\nAction of Orthoform. \nIt has a similar action on the sensory nerve terminations to \ncocaine, but as its chemical composition is entirely different \nfrom the latter, this is the only point in which it resembles it \nin its effects. The anaesthetic quality of orthoform is appa- \nrently due to its being an aromatic derivative. The special \nfeature of its anaesthetic influence is its long continuance. An- \n\n\n\nORTHOFORM. 769 \n\nsesthesia is caused for many hours, or perhaps even for days, \nby a single application of the powder to abraded surfaces, and \nthe reason for this is that the drug becomes dissolved only very \nslowly, and hence remains in contact with the part for a long \ntime. Occasionally it has been known to produce a necrosis. \nIt is found, however, that it is unable to penetrate mucous mem- \nbrane like cocaine, and on this account it produces its anaes- \nthetic effect only when it comes into actual contact with ex- \nposed nerve-ends. Therefore on sound skin or mucous mem- \nbrane it has no influence, and is consequently unfit for ordi- \nnary use as a surgical anaesthetic. On account of its very \nslight solubility, and because it is also excreted very rapidly, \nit is practically non-toxic. Its insolubility renders its subcu- \ntaneous use difficult, but it is stated that if it is artificially \nbrought into solution and then injected, it is no less dangerous \nthan cocaine. Apparently on account of its insolubility, it has \nvery little influence on the system, whether applied to abraded \nsurfaces or taken by the mouth, even in very large amounts. \n\nTherapeutics of Orthoform. \nIt is commonly applied as a dusting powder or in ointments. \nIn burns, ulcers, abscesses, etc., where it can reach nerve ter- \nminations, it is very efficient in relieving pain, and also exerts \na healing influence similar to that of iodoform ; but in affections \nof the nose or throat it has very little effect unless ulceration \nbe present. In ulcerative disease of the larynx if a spray con- \nsisting of a solution of 0.30 gm. (5 gr.) of orthoform in 3 \nc.c. (50 ^1) each of alcohol and water is made use of, a pro- \ntective coating is deposited on the parts. Or, an emulsion of \n1 part orthoform to 4 parts olive oil may be applied to the \nlarynx. Insufflation of the powder is also frequently employed \nin diseased conditions of the throat and nose. For many pur- \nposes the saturated solution of orthoform in collodion is most \neffective. Orthoform has been used with much success in gyn- \naecological and genito-urinary practice, as well as dentistry, and, \nadministered by the mouth, it is very efficient in controlling the \n50 \n\n\n\n770 PHARMACOLOGY AND THERAPEUTICS. \n\npain of ulcer or cancer of the stomach. It is of no service, \nhowever, in relieving headache or neuralgic conditions. It is \nsometimes employed hypodermatically to produce local anaes- \nthesia for surgical operations, it being found that after violent \nshaking in water it is divided into such small particles that they \ncan be injected with a somewhat large needle. The pain caused \nby the passage into the tissues may be obviated by a prelim- \ninary injection of a small quantity of cocaine. Orthoform \nwhen applied to ulcers has been known to produce sloughing \nsimilar to that caused by pure carbolic acid, and on the skin to \ncause redness and irritation and even a decided pruritic erup- \ntion. In rare instances it is stated to have given rise to an \nerythema complicated with vesicles and to gangrenous erup- \ntions. \n\n^ETHYLIS CHLOKIDUM.\xe2\x80\x94 Ethyl chloride. (Mono-chlor-ethane. \nHydrochloric ether.) \n\nUnofficial Preparation. \nMethylis chloridum. \xe2\x80\x94 Methyl chloride (Mono-chlor-methane.) \n\nTwo substances used to produce local anaesthesia may be \nhere considered: Ethyl chloride and methyl chloride. \n\nEthyl chloride is an inflammable liquid which is even more \nvolatile than ether, entering into ebullition at 12.5 C. (55 F.), \nand producing intense cold by its evaporation. It is used for \nthe production of local anaesthesia and to relieve the pain of \nneuralgia, etc. It is supplied in hermetically sealed glass tubes \nhaving a pointed extremity, and when the end is broken off \nand the tube held in the hand, it escapes in a fine stream which \nis directed upon the part it is desired to affect. The skin should \nfirst be cleansed of all fat by the use of soap, followed by wash- \ning with ether. More recently ethyl chloride has been used \nwith considerable success as a general anaesthetic for short \noperations and as an anaesthetic preliminary to ether or chloro- \nform in longer operations. It acts very promptly, and is pref- \nerably employed with a special inhaler. It is claimed to be as \nsafe as nitrous oxide gas. \n\n\n\nTONGA. 771 \n\nMethyl chloride is also extremely volatile, producing local \nanaesthesia through the cold resulting from its evaporation. It \nis used for the same purposes as ethyl chloride. One objection \nto the use of both these substances, as well as of ether, for the \nproduction of local anaesthesia, is that the intense cold caused \nis sometimes as painful as the operation itself would be without \nany anaesthetic. \n\nUnofficial Preparation. \nOuabainum. \xe2\x80\x94 Ouabain. Dose, .00013 gm.; jfa gr. \n\nAction of Ouabain. \n\nOuabain paralyzes cardiac muscle by direct action, and when \ngiven hypodermatically is an emetic. It is a local anaesthetic, \nand is stated to have ten times the power of cocaine in this \nregard. \n\nUses of Ouabain. \n\nIt has been recommended as a local anaesthetic and also for \nthe treatment of all stages of whooping-cough in doses of .00006 \ngm. (y-oVoS 1 "-) ^ or children. As it is a very powerful drug, \n.001 gm. (^ig-gr.), when taken into the blood, being sufficient to \nkill a man, it should be used with extreme caution. \n\nTONGA. \n\nUnofficial Preparations. \nTonga.\xe2\x80\x94 Tonga. Dose, 1 to 4 gm.; y 4 to 1 dr. \nFluidextractum Tongas.\xe2\x80\x94 Fluidextract of Tonga. Dose, 1 to \n4 c.c; 14 to 1 fl. dr. \n\nAction of Tonga. \nVery little is known of the action of this drug. In large \ndoses it is purgative. \n\nTherapeutics of Tonga. \nTonga as a fluidextract, dose, 1 to 4 c.c. {]/ A to 1 fl. dr.), \nundoubtedly relieves some cases of intractable neuralgia. Com- \n\n\n\n772 PHARMACOLOGY AND THERAPEUTICS. \n\nbined with salicylates it is of great value for the treatment of \nso-called muscular rheumatism. \n\n\n\nE. Drugs Acting on the Spinal Cord. \ni. Drugs increasing the irritability of the anteria cornua. \n\nNUX VOMICA. \n\nNUX VOMICA.\xe2\x80\x94 Nux Vomica. (Poison Nut. Dog Button.) Dose, \n0.125 gni. (125 milligm.); 2 gr. \n\nPreparations. \ni. Extractum Nucis Vomicae. \xe2\x80\x94 Extract of Nux Vomica. \nDose, 0.015 gm. (15 milligm.) ; y 4 gr. \n\n2. Fluidextractum Nucis Vomicae. \xe2\x80\x94 Fluidextract of Nux \nVomica. Dose, 0.05 c.c; 1 TT\\. \n\n3. Tinctura Nucis Vomicae. \xe2\x80\x94 Tincture of Nux Vomica. Dose, \n0.6 c.c; 10 Til. \n\nSTRYCHNINA.\xe2\x80\x94 Strychnine. Dose, 0.001 gm. (1 milligm.) ; ^ gr. \n\nPreparations. \n\n1. Elixir Ferri, Quininae et Strychninae Phosphatum. \xe2\x80\x94 Elixir \nof Iron, Quinine and Strychnine Phosphates. Dose, 4 C.C.; \n1 fl. dr. \n\n2. Glyceritum Ferri, Quininae et Strychninae Phosphatum. \xe2\x80\x94 \n\nGlycerite of Iron, Quinine and Strychnine Phosphates. Dose, 1 \nC.C.; 15 fll. \n\n3. Syrupus Ferri, Quininae et Strychninae Phosphatum. \xe2\x80\x94 \n\nSyrup of Iron, Quinine and Strychnine Phosphates. Dose, 4 C.C.; \n1 fl. dr. \n\n4. Pilulae Laxativae Compositae. \xe2\x80\x94 Compound Laxative Pills. \nDose, 2 pills. \n\n5. Syrupus Hypophosphitum Compositus. \xe2\x80\x94 Compound Syrup \nof Hypophosphites. Dose, 8 C.c; 2 fl. dr. \n\nSTRYCHNINE NITRAS.\xe2\x80\x94 Strychnine Nitrate. Dose, 0.001 gm. \n(1 milligm.) ; ^ gr. \n\n\n\nnux vomica. 773 \n\nSTRYCHNINE SULPHAS.\xe2\x80\x94 Strychnine Sulphate. Dose, 0.001 \ngm. (1 milligm.) ; ^ T gr. \n\nUnofficial Preparation. \nBrucina. \xe2\x80\x94 Brucine. \n\nAction of Nux Vomica and Strychnine. \n\nExternal. \xe2\x80\x94 Strychnine is a very powerful antiseptic, and \nwhen injected subcutaneously in concentrated solution it is irri- \ntating to the tissues. Brucine is a weak local anaesthetic. \n\nInternal. Gastro-intestinal Tract. \xe2\x80\x94 Xux vomica is a sto- \nmachic bitter, increasing the appetite, aiding the digestion, and \nacting generally like other agents of this class. In the intes- \ntine it is directly stimulating to the muscular coat of the bowel. \nHence it promotes peristalsis and has a purgative action. \nStrychnine is believed to be absorbed mainly from the intestine. \n\nCirculation. \xe2\x80\x94 Strychnine, by stimulating the vaso-motor cen- \ntre, produces constriction of the arterioles, thereby causing a \nrise of blood-pressure, which is augmented by the increased \nperipheral resistance arising from the general activity of the \nmuscles. The result is that the force of the heart is increased \nand the diastole lengthened. The pulse is also slowed by the \nstimulation of the vagus centre in the medulla. The direct ac- \ntion on the heart is probably less marked than has been gener- \nally supposed. In experiments upon the excised mammalian \nheart it has been found that a small dose slows the heart and \nincreases its force, while somewhat larger doses cause a slight \nacceleration, also with increased force. It is thought likely, \nhowever, that these effects are not sufficiently marked to be of \ntherapeutic importance. Very large doses cause cardiac mus- \ncular paralysis. During the convulsions caused by the alkaloid \nthe blood-pressure is raised to an extreme height, partly by the \naction on the vaso-motor centre and partly, it may be. in con- \nsequence of the blood being pressed out of the abdominal or- \ngans and the muscles by their violent contraction. Immediately \nafter a convulsion the blood-pressure falls. The vascular con- \n\n\n\n774 PHARMACOLOGY AND THERAPEUTICS. \n\nstriction, it would seem, affects chiefly the internal vessels, \nwhile, as a result probably of stimulation of vaso-dilator areas \nin the medulla, those of the skin and possibly of the muscles \nare dilated; consequently there is an afflux of blood to the ex- \ntremities and cutaneous surface. The heart is found to beat \nlong after the respiration has failed, and if artificial respiration \nbe maintained, may continue to do so for an indefinite period. \nBlood that is mixed with strychnine and shaken with air con- \ntains more oxygen and less carbon dioxide than ordinary blood, \nbut there is no reason to suppose that strychnine, at least in \nordinary doses, increases the oxidizing power of living blood. \n\nRespiration. \xe2\x80\x94 The respiratory centre in the medulla is stimu- \nlated directly and also reflexly by reason of the increased mus- \ncular activity. The respiratory movements are consequently \naccelerated and strengthened. As the muscles of respiration \nparticipate in the general convulsive seizures, however, they \nultimately become completely exhausted, and death by asphyxia \nmay occur suddenly after a spasm. In other instances the fatal \nresult is due to gradual paralysis of the respiratory centre. \nBetween the convulsions the breathing is usually fairly regular, \nbut during their presence it is arrested by the violent contrac- \ntion of the diaphragm and the other respiratory muscles. \n\nNervous System and Muscles. \xe2\x80\x94 The cerebrum is believed to \nbe somewhat affected by strychnine, though to a less extent \nthan the lower divisions of the central axis. In man the intel- \nlect and consciousness remain unaffected, but the special senses \nare rendered more acute, and the majority of investigators \nmaintain that the irritability of the motor parts of the cortex \nis distinctly increased, except during a convulsion. In the \nmedulla oblongata there is produced an active stimulation, fol- \nlowed by paralysis, of the respiratory, vaso-motor and vagus \ncentres. While the stimulation of the vagus causes slowing of \nthe pulse, this effect is more or less offset by the influence of \nthe convulsions, since great muscular activity always tends to \naccelerate the heart. The clinical evidence is in favor of the \ncardiac centre\'s being strongly influenced. Strychnine in small \n\n\n\nnux vomica. 775 \n\namounts increases the tone of the medulla, augmenting the im- \npulses which the medullary centres are constantly receiving. \nConsequently, the increased activity of the higher reflex areas \nmay diminish or inhibit the irritability of the cord, so that the \nreflex response from the latter may be rendered more marked \nby the removal of the cerebrum and medulla oblongata. The \nmost marked effect of toxic amounts of strychnine is an in- \ncreased reflex irritability of the spinal cord, which is shown \nmost conspicuously by the production of tetanus. After a short \nperiod of augmented reflex excitability, severe spasms occur, in \nwhich there are sudden and violent contractions of all the mus- \ncles of the body, the stronger extensor muscles generally pre- \nvailing against the flexors. In the intervals (lasting only a \nfew minutes) between the convulsions there is complete relaxa- \ntion. Mammals usually die after the first few spasms, but in \nfrogs, in which respiration can be dispensed with for long \nperiods, the alternations of convulsions and the quiescent state \nmay continue for hours or days. That these spasms are of \nspinal origin is shown by the fact that they are at least as well \nmarked (if not more violent), both in mammals and frogs, \nwhen the brain has been destroyed or severed below the medulla \noblongata, while destruction of the spinal cord stops them en- \ntirely. Muscle and motor nerve endings may be excluded by \nsection of the nerve-trunk, which stops the convulsions : while \nsensory nerve endings may be excluded by ligating a leg, with \nthe exception of the nerve, and then injecting strychnine. The \nleg will be seen to take part in the convulsions, although its \nsensory terminations are excluded from the poison. The con- \nvulsions take place if the posterior nerve-roots are cut. provided \nthe proximal end is stimulated and if a probe be slowly passed \ndown the spinal canal of an animal convulsed by strychnine, \nthe spasms of the muscles will successively cease from above \ndownward. Furthermore, the convulsions are not only spinal, \nbut reflex; so that they will not occur unless some stimulus \nfrom without reaches the cord. After the convulsive action \nhas been established the spasms may seem to occur without any \n\n\n\nJj6 PHARMACOLOGY AND THERAPEUTICS. \n\nsuch stimulus, but this is not the case, for they may be induced \nby a very insignificant stimulation, as for instance, a slight \ncontraction of a muscle. The conduction power of the cord \nmust be enormously exaggerated by strychnine, since general \nconvulsions follow upon a peripheral stimulation so slight as \nto be even imperceptible. Strychnine convulsions are abolished \nby curare, for the latter has the effect of blocking impulses \nfrom the cord to the muscles. The exact location of the action \nof strychnine in the spinal cord has not as yet been determined. \nIn the present state of our knowledge it may be said that the \ndrug removes resistances which normally oppose the passage \nof impulses somewhere between the point at which the centri- \npetal fibres enter the cord and the motor cells, but does not \napparently act upon the motor cells of the anterior horn, nor \nupon those of the posterior root ganglion. It is consequently \nregarded as most probable that it affects chiefly some cells in- \ntercalated between these structures. Strychnine does not seem \nto have any direct action on the voluntary muscles. While \nvery small quantities have the effect of increasing their tone, \nthis is attributable to action on the spinal cord and not on the \nmuscle fibres. Neither muscles nor afferent nerves are af- \nfected by the largest doses of the poison. Under large quanti- \nties the motor nerve endings are paralyzed by the direct action \nof the drug, but this effect is probably only to be observed in \ncertain species of frogs, in which these terminations are para- \nlyzed before the central nervous system. In mammals central \nparalysis destroys life before paralysis of the nerve endings is \ninduced, though towards the end of a case of poisoning their \nfunctional activity is said to be depressed. \n\nSpecial Senses. \xe2\x80\x94 Mention has been made of the influence of \nstrychnine in increasing the acuteness of the special senses. \nThis effect is produced by small doses, and is believed to be \nprobably a cerebral action, although it is contended by some \nthat it is due to alterations in the peripheral organs. While the \nacuteness of the hearing and the sense of smell is apparently \nincreased, the effect of the drug is most decidedly shown in the \n\n\n\nNUX VOMICA. "/J? \n\nsense of touch, the delicacy of which is markedly augmented, \nand in the vision. The field of the latter is widened, especially \nfor blue, and differences can be recognized between shades of \ncolor which ordinarily seem identical ; while in certain condi- \ntions of amblyopia light is said to be rendered much more \ndistinct. \n\nMetabolism. \xe2\x80\x94 In consequence of the violent contractions of \nthe muscles throughout the body, there is naturally an increased \noxidation, and the amount of oxygen absorbed and of carbon \ndioxide excreted by the lungs shows a corresponding augmen- \ntation. This increased excretion of carbon dioxide is found, \nhowever, to occur, though to a less extent, even when the skele- \ntal muscles have been curarized, and it is concluded, therefore, \nthat it is due in part to the contraction of the muscular coats \nof the blood-vessels and possibly to the increased metabolism \nof the central nervous system. There is an increased produc- \ntion of heat in consequence of the increased oxidation of the \ntissues, but this is offset, to a varying degree in different ani- \nmals, by an augmented skin dissipation. While, however, the \ninternal temperature may be even slightly lower than normal, \nthe cutaneous temperature generally shows a considerable rise \non account of the afflux of blood to the surface. \n\nElimination. \xe2\x80\x94 Strychnine, which is rapidly absorbed, is ex- \ncreted in part unchanged, principally in the urine, but also in \nthe saliva, sweat and bile. The excretion, although it com- \nmences promptly, is very prolonged, usually continuing for a \nweek or more. Part of the strychnine is destroyed, probably \nthrough oxidation, in the tissues. The characteristic symptoms \nof the poison are found to be very much less marked when the \nanimal is placed in an atmosphere of oxygen, and it is also \nstated that if the dose (though large enough to prove fatal \nunder ordinary circumstances) is injected into the leg of the \nanimal, but prevented from reaching the circulation for an \nhour, it has absolutely no effect. Strychnine is said to be re- \ntained for a long time in the liver and central nervous system. \n\nThe action of Brucine, while in general similar to that of \n\n\n\nyy8 PHARMACOLOGY AND THERAPEUTICS. \n\nthe more powerful alkaloid, is distinguished from the action \nof strychnine in showing a greater tendency to produce paraly- \nsis of the central nervous system and a more marked curare- \nlike action. A 5 to 10 per cent, solution of chemically pure \nbrucine is stated to produce rapid loss of sensibility when ap- \nplied to the buccal mucous membrane in man, while a 20 per \ncent, solution is capable of exciting a decided local anaesthetic \neffect when applied to the skin. \n\nTherapeutics of Nux Vomica and Strychnine. \n\nExternal. \xe2\x80\x94 On account of its very pronounced toxic charac- \nter, strychnine is never employed for antiseptic purposes. \n\nInternal. G astro -intestinal Tract. \xe2\x80\x94 Tincture of nux vomica \nis an admirable stomachic bitter, and is especially useful in \ncases where impairment of digestion is due to enfeeblement of \nthe general system. 1.20 c.c. (20 ^l) of it in a wineglass of \nhot water will frequently at once check gastro-intestinal fer- \nmentation. Nux vomica may often be combined with good \neffect with diluted hydrochloric acid and some such bitter as \ngentian or cinchona. In the gastric catarrh and morning vom- \niting of drunkards it is considered as next in value to arsenic. \nIt may be given advantageously with mineral acids. In cases \nof constipation in which the contractile power of the muscular \ncoat of the intestine is feeble, in consequence, like the impaired \ndigestion referred to, of general weakness of the system, it is \nof great service in promoting peristalsis by its action on the \nintestinal muscle. In instances of this kind it is commonly \nassociated, in pill or otherwise, with remedies especially appro- \npriate to the special condition of the patient, as, for instance, \nwith preparations of iron in cases of anaemia. It has sometimes \nproved useful in epidemic dysentery, and in some epidemics \nof cholera strychnine, combined with opium and mineral acids, \nhas appeared to ward off the stage of collapse. Nux vomica \nhas been advised in a variety of indefinite conditions of depres- \nsion and general want of tone, in which it is difficult to say \nwhether the results are to be ascribed to its effect in improving \n\n\n\nnux vomica. 779 \n\nthe appetite and digestion or in increasing the activity of the \nspinal cord and medulla. \n\nCirculation. \xe2\x80\x94 Nux vomica and strychnine are useful as car- \ndiac stimulants, especially in cases of disease of the heart in \nwhich digitalis is contra-indicated. They are sometimes com- \nbined with other cardiac stimulants, such as caffeine. In in- \nstances of urgent danger from failure of the heart\'s action in \nthe course of chronic cardiac disease and other affections the \nprompt use of strychnine by hypodermatic injection not infre- \nquently proves of the greatest service. \n\nRespiration. \xe2\x80\x94 Strychnine is an excellent respiratory as well \nas cardiac stimulant. It may be given with expectorants when \nthere is an abundant mucous secretion and little effort is made \nfor its expulsion, but is contra-indicated in dry constant cough \nwith small expectoration. It is especially valuable when in \nbronchitis and other thoracic diseases the respiration has be- \ncome weak and shallow. In pneumonia it is extremely useful \nwhen death is imminent from dilatation of the right heart. In \nthis condition it should be administered hypodermatically and \nat frequent intervals. In many cases of poisoning also, espe- \ncially by agents tending to cause failure of the respiration, its \nemployment in judicious doses by this method serves a useful \npurpose on account of its pronounced stimulating action upon \nthe respiratory centre in the medulla. Strychnine has been \nrecommended in the night-sweats of phthisis, on the supposi- \ntion that these are due to imperfect respiration during sleep. \n\nNervous System. \xe2\x80\x94 In nervous diseases strychnine has been \nused to quite a large extent, and often without proper discrim- \nination. Consequently, the results obtained have not always \nbeen of a satisfactory character. On account of its action on \nthe central nervous system, it is prescribed in different forms \nof paralysis, and some restitution of function, or, it may be, \nsome retardation of the disease, may attend its use in many of \nthem. It is found that the cases in which it is of the most \nbenefit are those in which there is present no appreciable or no \nwell-marked central anatomical lesion, as in hysterical, neuras- \n\n\n\n78O PHARMACOLOGY AND THERAPEUTICS. \n\nthenic, diphtheritic and syphilitic paralyses, and in paralysis \ndue to such poisons as lead and arsenic. Little is to be ex- \npected from it when sclerosis exists, and in paralysis resulting \nfrom cerebral apoplexy it may possibly prove injurious in con- \nsequence of the congestion of the brain and tendency to recur- \nrence of the haemorrhage caused by its action in increasing the \nblood-pressure. It may, however, be sometimes given with ad- \nvantage in hemiplegia when sufficient time has elapsed to per- \nmit repair of the damage done by the extravasation, and is of \nmost service when the paralyzed members are completely re- \nlaxed. When the paralysis has existed so long that the muscles \nhave undergone fatty degeneration it is quite useless. Strych- \nnine is always contra-indicated in paralytic cases when head- \nache, vertigo and tinnitus aurium are present. It sometimes \nproves useful in the nocturnal enuresis of children, as well as \nof incontinence of urine in adults, and this has been attributed \nto the increased tone of the sphincters resulting from aug- \nmented excitability of the spinal cord. Apparently on account \nof the action of the cord, it has also been used as an emmena- \ngogue and as an aphrodisiac in impotence. Combined with the \nfluidextract of ergot, tincture of nux vomica has been recom- \nmended as a remedy for post-partum haemorrhage, and the neu- \nralgic form of dysmenorrhcea may sometimes be cured by nux \nvomica given between the menstrual periods. \n\nBrucine, in 5 per cent, solution, has been found to give great \nrelief as a local application in inflammations about the external \near, and in stronger solution in the itching of chronic pruritus. \n\nTOXICOLOGY. \n\nSymptoms. \xe2\x80\x94 The time of the appearance of the symptoms will depend \nlargely upon individual differences and upon the manner of introduction. \nIf the poison is taken by the mouth, the promptness of its action will be \naffected by the condition of the stomach, whether empty or full, and by \nthe nature of the food, if any is present. If subcutaneous injection has \nbeen employed, the time will be affected somewhat by the place of \nintroduction. Strychnine will act more rapidly than tincture of nux \nvomica, and both of these more quickly than pills. The symptoms do \n\n\n\nNUX VOMICA. /S I \n\nnot often develop in less than fifteen minutes, and are not generally \ndelayed beyond half an hour, but have been known not to appear for \nnearly two hours. If the dose is within therapeutic limits and yet \nsufficient to produce an ontoward effect, the first symptom is likely to be \na feeling of uneasiness with a heightened reflex irritability, and this \nmay be followed by muscular twitching in some part of the body. \nWhen a large dose has been taken, with or without a preliminary sense \nof impending suffocation convulsive movements begin, which have \nthe effect mechanically, of causing the patient to cry out or shriek, and \nthey are very quickly followed by the characteristic spasms, which now \nset in with great violence. These are at first clonic and then tonic. \nOpisthotonos results from the extensor muscles overcoming the flexors, \nand the feet are curved inward. The spasms then again become clonic, \nand soon an intermission ensues. Suddenly the convulsions start up \nagain, and there is thus an alternation of the convulsive attacks and \nremissions. During the latter there is complete muscular relaxation \nand general depression in the place of stimulation. With each succes- \nsive attack the symptoms increase in violence. The patient often rests \non his head and feet, the remainder of his body being arched above the \nbed or floor. The face becomes livid and the eyeballs staring, while \nthe chest and abdomen are stiff as boards. The contractions of the \nfacial muscles occasion risus sardonicus, the patient grinning in a \nghastly manner, but those of the jaw are not affected till towards the \nlast. This aids in distinguishing strychnine poisoning from tetanus, \nin which the muscles of the jaw are implicated very early. Other \ndiagnostic marks of tetanus, as contrasted with it, are the slower \ndevelopment of the symptoms and the continuous muscular rigidity ; \nfor while between the paroxysmal exacerbations there is some diminu- \ntion of this, there is never complete relaxation, as in strychnine poison- \ning. During the attack (in strychnine poisoning) the pulse is very \nrapid, and the sight, hearing and sense of touch become abnormally \nacute. The patient is entirely conscious, and usually suffers excruciating \npain, though in exceptional instances the asphyxia produces more or less \nanaesthetic effect. The interference with circulation and the pressure \non the abdominal viscera, aided by the stimulation of the medullary \ncentres, may give rise to vomiting and purging. The respiration during \nthe attack is at first labored and dyspnceic, and then is temporarily ar- \nrested by the spasmodic contraction of the diaphragm. Foaming at the \nmouth may occur in consequence of the interference with respiration, \nand the asphyxia resulting from the latter induces cyanosis, dilatation of \nthe pupils, and eventually coma. In the intermission the patient lies \n\n\n\n782 PHARMACOLOGY AND THERAPEUTICS. \n\nexhausted, and covered with a cold sweat. The slightest noise or touch, \nor even a bright light, is likely to bring on a convulsive seizure, which \nmay jerk the patient out of bed. The number of seizures varies in \ndifferent instances, but three or four are usually fatal ; the patient suc- \ncumbing to asphyxia and exhaustion. The smallest dose of strychnine \nknown to have proved lethal is .03 gm. (Y 2 gr.). Post-mortem. As in \nother conditions characterized by violent convulsions, there is early and \noften persistent rigor mortis. The appearances are those due to \nasphyxia and the convulsions : venous engorgement of the internal \norgans and, generally, hyperemia of the central nervous system, with \nsmall haemorrhages. Quite rarely there is also hyperemia of the \nmucous membrane of the gastro-intestinal tract. \n\nTreatment. \xe2\x80\x94 Give emetics (p. 175), particularly apomorphine hydro- \nchloride hypodermatically, or wash out the stomach if the patient is \nseen early enough for the passing of the tube not to cause spasm. \nLavage may be practised with solution of potassium permanganate, as \nin cases of opium poisoning, but it is not so effective here. If very \nviolent convulsions are already present, evacuation of the stomach, as \na rule, should be avoided, as either emetics or the stomach-pump will \nhave the effect of starting the spasms. Both potassium permanganate \nand iodine are chemical antidotes, and when one of these is employed, \nit is not so necessary to empty the stomach. When a fatal dose has been \ntaken, however, the chances are that neither evacuation or any chemical \nantidote will be of service, for by the time the physician can arrive \nsufficient of the poison will probably have been absorbed to render \nboth useless. Chloroform is the best physiological and most practical \nantidote, and it has the special advantage that its action can be very \nlargely controlled. Chloral may be useful, and is often advised, but \nis open to the objection that with it there is always the risk that its para- \nlytic effects may coincide with those of the strychnine, and thus increase \nthe patient\'s danger. Both chloral and morphine are antidotal to strych- \nnine as regards the effect on the cerebrum, but this is of little importance, \nwhile morphine may only add to the gravity of the symptoms by in- \ncreasing the reflex excitability of the spinal cord and by its depressing \neffect on the respiration. Although calabar bean and gelsemium are \ntheoretically more perfect physiological antagonists, since both depress \nthe anterior cornua, they are practically of very little value in strychnine \npoisoning. Other measures which have been recommended are the \nadministration of large doses of potassium bromide per rectum and the \nuse of amyl nitrite inhalations. If the case is seen early, the employ- \nment of tannin in large quantities may be of service, as the insoluble \n\n\n\nCALABAR BEAN. 783 \n\ntannate is formed in the stomach. This should be gotten rid of, how- \never, as soon as possible, as it becomes broken up by the action of the \ngastric juice, and the strychnine is then rapidly absorbed. It is claimed \nas a result of animal experiments that the application of external heat \ndecreases the mortality. Artificial respiration, as well as the inhalation \nof oxygen, should usually be begun early. \n\n2. Drugs which depress the activity of the anterior cornua. \n\nCALABAR BEAN. \n\nPHYSOSTIGMA.\xe2\x80\x94 Physostigma. (Calabar Bean.) Dose, 0.100. \ngm. (100 milligm.) ; iy 2 gr. \n\nPreparations. \n\n1. Extractum Physostigmatis. \xe2\x80\x94 Extract of Physostigma. \nDose, 0.008 gm. (8 milligm.); y 8 gr. \n\n2. Tinctura Physostigmatis. \xe2\x80\x94 Tincture of Physostigma. \nDose, 1 c.c; 15 n\\. \n\nPHYSOSTIGMINE SALICYLAS. \xe2\x80\x94 Physostigmine Salicylate. \n(Eserine Salicylate.) Dose, 0.001 gm. (1 milligm.) ; i gr. \n\nPHYSOSTIGMINE SULPHAS.\xe2\x80\x94 Physostigmine Sulphate. (Eser- \nine Sulphate.) Dose, 0.001 gm. (1 milligm.); ^ gr. \n\nAction of Calabar Bean. \n\nExternal. \xe2\x80\x94 A strong solution of physostigmine is said to have \nthe effect of slightly diminishing the functional activity of mo- \ntor and sensory nerves, while, applied to the conjunctiva, it \ncauses contraction of the pupil, myopia, dimness of vision, and \nother symptoms. \n\nInternal. Alimentary Tract. \xe2\x80\x94 Physostigmine has the effect \nof increasing the secretions of the glands, especially the sali- \nvary, mucous, lachrymal, sweat, and pancreatic, and this is due \nto its stimulating action on the terminations of the secretory \nnerves in the gland-cells. It thus acts on the same point as \natropine, but in an exactly opposite manner. After the drug \nhas been absorbed, therefore, there is usually an augmented \nflow of saliva, but the secretion may be inhibited or soon \nchecked by the contraction of the arterioles caused, and the \n\n\n\n784 PHARMACOLOGY AND THERAPEUTICS. \n\nconsequent insufficient nutrition of the gland cells. In the \nstomach and intestine it induces a marked increase in peristal- \nsis, in consequence, it is believed, of its action on the nerve end- \nings in the muscular coats of these viscera, and consequently, \nif the dose is not too small, vomiting and purging are caused. \nThe powerful contractions to which it gives rise are of the same \ngeneral character as those produced by pilocarpine and mus- \ncarine, but it is found to differ from them in causing these \nmovements after small quantities of atropine, while larger doses \nof atropine again stop the contractions set up by physostigmine. \nThe peristaltic movements culminate in a tetanic contraction \nof the muscular walls, which prevents the passage onward of \nthe contents of the viscera. \n\nUnstriped Muscle. \xe2\x80\x94 On unstriped muscle in many parts of \nthe body physostigmine has the same action as in the gastro- \nintestinal tract. It thus probably induces contraction not only \nof the iris, but of the bronchial tubes, spleen, uterus, ureters, \nand the gall and urinary bladders. It is also said by some to \naffect the arterioles in the same way, but proof is lacking that \nit causes contraction of their muscular coats by stimulating the \nvasomotor terminations in them. \n\nCirculation. \xe2\x80\x94 In consequence of the violent contractions of \nthe stomach and intestine, which expel the blood from a very \nlarge area, and also in part, it is supposed, of a stimulation of \nthe vasomotor centre in the medulla, there is a considerable \nrise in the blood-pressure. The contraction of the cardiac mus- \ncle is strengthened in frogs. This is denied as regards mam- \nmals, but some reliable investigators claim to have demonstrated \nit in experiments on dogs. However this may be, the pulse is \nslowed by physostigmine, and this is believed to be due to its \ndirect action on the heart muscle rather than to any inhibitory \ninterference, since slowing occurs even after large amounts of \natropine. The amplitude of the cardiac movements, whether \ndue to a strengthening of the contractions or to the slow \nrhythm, is afterwards diminished, and in the frog large doses \ncause arrest of the heart in systole. The rise in blood-pressure \n\n\n\nCALABAR BEAN. 785 \n\nis also succeeded by a fall, and this is ascribed to paralysis of \nthe vaso-motor centre. If large quantities of the alkaloid are \ninjected, there is an immediate fall in the blood-pressure, and \nthis is accompanied by a further slowing of the pulse. In the \nfrog physostigmine, by reason of its effect in increasing the \nirritability of the cardiac muscle, is capable of starting a heart \nwhich has been stopped by muscarine. \n\nRespiration. \xe2\x80\x94 The respiration, which is at first quickened and \nstrengthened, soon becomes retarded and dyspnceic, and death, \nwhich is due to paralysis of the respiratory centre, takes place \nfrom asphyxia. The primary acceleration may be due in part \nto stimulation of the sensory terminations in the lungs and \npartly to central stimulation. The subsequent dyspncea is no \ndoubt owing in some measure to spasm of the bronchial mus- \ncles, as well as to depression of the respiratory centre in the \nmedulla. \n\nNervous System. \xe2\x80\x94 It is not known positively whether or not \nany general stimulation of the central nervous system is caused \nby physostigmine, but the primary quickening of the respira- \ntion, as well as the changes in the blood-pressure, points \nstrongly towards this. As regards the cortex, it is still unde- \ntermined whether the collapse met with in severe poisoning is \npreceded by a stage of slight stimulation. There is no question \nas to the drug\'s causing central depression. Whether this be- \ngins in the spinal cord and medulla, and only spreads to the \ncerebrum after large doses, is unknown, and some observers \nhold that the higher centres are depressed earlier than the lower \nones. In man, however, at least, the consciousness remains \nunimpaired after the respiration and muscular power have be- \ncome seriously affected ; indicating that some of the higher \ncerebral areas preserve their functions after others have been \nweakened. In the medulla, as has been mentioned, the respira- \ntory and vaso-motor centres eventually become paralyzed. Re- \nflex activity is inhibited in consequence of depression of the \nanterior cornua of the spinal cord, as may be seen when phy- \nsostigmine is applied directly to the cord. At first such activ- \n5i \n\n\n\n786 PHARMACOLOGY AND THERAPEUTICS. \n\nity is slightly increased, but this is the result of irritation, such \nas may be caused by almost any substance, and there soon suc- \nceeds a total abolition of reflex excitability. Subsequently \nthere is paralysis of the posterior portion of the cord also, with \ndiminution of cutaneous sensibility. \n\nMuscles and Nerves. \xe2\x80\x94 In mammals muscular twitchings are \ncaused by large amounts of physostigmine, and constitute one \nof the most characteristic features of the poisoning. They are \nalso observed in frogs, but much more rarely. In some in- \nstances they are so pronounced in warm-blooded animals as to \nsimulate convulsions, but are distinguished from the latter in \nnot involving the whole of a muscle at one time. This phenom- \nenon is probably attributable to the action on the motor nerve \nterminations, though some hold that it is due to direct action \non the muscle. \n\nEye. \xe2\x80\x94 Although the application of a solution of physostig- \nmine to the conjunctiva always causes the pupil to contract to \nits smallest diameter, this effect is not invariably observed in \nsystemic poisoning. In man, however, some contraction is gen- \nerally produced. Such a variation points to its being due to \nchanges in the local mechanism, and there is every reason to \nsuppose that it is caused by a stimulation of the ends of the \nmotor fibres in the sphincter, such as is seen in unstriped mus- \ncle elsewhere. The action of physostigmine on the eye resem- \nbles that of muscarine, except that it antagonizes atropine much \nmore completely. By its effect on the motor nerve termina- \ntions in the ciliary muscle it causes spasm of accommodation, in \naddition to the contraction of the pupil from its influence on \nthe iris, and in consequence of the myosis there results a \ndiminution of intra-ocular pressure. Associated with these \nphenomena, especially when they are decidedly pronounced, \nthere are apt to occur some twitching of the lids, dimness of \nvision, and supra-orbital pain. \n\nExcretion. \xe2\x80\x94 Physostigmine is readily absorbed and is elim- \ninated chiefly in the urine, though traces of it have been found \nin the bile and saliva. The action of the alkaloid is much more \n\n\n\nCALABAR BEAN. 787 \n\nconstant than that of calabar bean itself, and this may be be- \ncause the effects of the other active principles in the crude drug \ninterfere to some extent with those of the physostigmine. \n\nTherapeutics of Calabar Bean. \n\nUnstriped Muscle. \xe2\x80\x94 Calabar bean has been used to a limited \nextent in affections in which its property of stimulating invol- \nuntary muscle may be availed of. It has a certain value in \natony of the bladder and intestines and in catarrh of the bow- \nels, and is sometimes given in purgative pills to stimulate the \nmuscular layer of the intestine. Combined with nux vomica, \nit has been employed with advantage in gastric and intestinal \ndilatation. It has been especially recommended for the trouble- \nsome flatulence of women at the time of the menopause, which \nis ordinarily associated with a paretic state of the muscular coat \nof the bowel, and it is stated that with the relief afforded to \nthe flatulence there usually comes relief to the headache, ver- \ntigo and morbid fancies so often attending it. In chronic bron- \nchitis with deficient power of expectoration, bronchial asthma. \nand emphysema it may be of service in promoting the expul- \nsion of mucus by its influence over the muscular fibres in the \nbronchial tubes. \n\nCentral Nervous System. \xe2\x80\x94 Calabar bean has been quite \nlargely employed in the treatment of tetanus, but as a consider- \nable number of cases of this disease show a tendency to spon- \ntaneous recovery, it is difficult to determine its real value. \nAbout one-half the cases in which it has been used are said to \nhave been reported cured, and it is possible that this proportion \nmight have been larger if sufficient attention had been paid to \nthe quality of the drug employed and to the mode of administra- \ntion. It has been advised by competent authority always to \ncommence the treatment by a subcutaneous injection and to \nrepeat such injection until the system is decidedly affected: \nthen to administer the remedy by the mouth in doses three \ntimes as large as those employed hypodermatically. Instead \nof the bean, it is better to employ physostigmine sulphate. \n\n\n\n788 PHARMACOLOGY AND THERAPEUTICS. \n\nDoses of .002 gm. (^i_gr.) may be given hypodermatically and \nfrequently repeated, the condition of the patient in the mean- \nwhile being watched with great care. This remedy has been \nresorted to in trismus neonatorum and other spasms, but with \nonly moderately good results. It has also been extensively \ntried in epilepsy and chorea, but in most cases has proved of \nlittle service and in others has seemed positively deleterious. \nPhysostigmine has been given as an antidote for strychnine \npoisoning. \n\nEye. \xe2\x80\x94 A solution of physostigmine salicylate (i or 2, to \nwater, 480) is dropped in the eye to break up adhesions of the \niris, to diminish intra-ocular tension, and to prevent prolapse of \nthe iris after wounds, or ulcers of the cornea. It is also em- \nployed in glaucoma, in paralysis of the iris and ciliary muscles, \nand to prevent the entrance of light into the eye in photophobia. \nIt is useful when for any reason it is desired to rapidly over- \ncome atropine mydriasis, but as it is less powerful than atro- \npine, a larger amount will be required for this purpose than it \ntook of atropine to produce the contraction of the pupil. \n\nANTAGONISM. \nIt will be observed that in its action on the pupil and on involuntary \nmuscle generally, on secretion, on the heart, and on respiration, physos- \ntigmine is antagonistic to atropine. In its action on the spinal cord and \nrespiratory centre it is antagonistic to strychnine. \n\nGELSEMIUM. \n\nGELSEMIUM.\xe2\x80\x94 Gelsemium. (Yellow Jasmine.) Dose, 0.065 (65 \nmilligm.) ; 1 gr. \n\nPreparations. \n\nFluidextractum Gelsemii. \xe2\x80\x94 Fluidextract of Gelsemium. Dose, \n0.05 c.c; 1 TT1. \n\nTinctura Gelsemii. \xe2\x80\x94 Tincture of Gelsemium. Dose, 0.5 c.c; \n\n8 m- \n\nUnofficial Preparation. \nGelseminae Hydrochloridum. \xe2\x80\x94 Gelsemine Hydrochloride. \n(Gelsemine Hydrochlorate.) Dose, 0.0003 gm.; ^0 S 1 - \n\n\n\nGELSEMIUM. 789 \n\nAction of Gelsemium. \n\nExternal. \xe2\x80\x94 If a solution of gelsemium or either of its alka- \nloids is dropped into the eye, it causes momentary smarting and \nhyperemia of the conjunctiva together with rapid dilatation of \nthe pupil and paralysis of accommodation. \n\nInternal. \xe2\x80\x94 The action of gelsemium is essentially the same \nas that of gelseminine, which is much the more powerful of its \ntwo alkaloids. It usually has no effect on the alimentary tract, \nthough in poisoning by it attempts at vomiting are observed in \nsome animals. \n\nCirculation. \xe2\x80\x94 Almost the only appreciable effect it has upon \nthe circulation is to induce paralysis of the inhibitory mechan- \nism of the heart. Very little change is observed in the blood- \npressure in animals, even after large amounts, if artificial res- \npiration is maintained after the failure of the natural respira- \ntion. \n\nRespiration. \xe2\x80\x94 Gelsemium powerfully depresses the respira- \ntion, and when taken in toxic doses causes death by asphyxia. \nThe failure of the respiration is probably due to paralysis of \nthe respiratory centre, though it seems likely that partial pa- \nralysis of the nerve endings in the respiratory muscles may be \na contributory cause. Before death the temperature falls, and \nthe skin is covered with a cold sweat. \n\nNervous System and Muscles. \xe2\x80\x94 The action of gelseminine in \ngeneral resembles in some respects that of coniine, but it differs \nfrom the latter in not causing any increase in arterial tension \nand in having a more depressant action on the central nervous \nsystem. The respiratory centre in the medulla oblongata, as \nhas been mentioned, is apparently paralyzed. The higher cere- \nbral functions and the sense of pain remain unimpaired until \njust before death. Gelseminine in poisonous amounts causes \nloss of coordinating power and extreme muscular weakness, \nwith marked tremor when any movement is attempted. The \nanimal falls to the ground and is presently unable to raise even \nits head, while the tremors, which are ascribed to the action on \n\n\n\n790 PHARMACOLOGY AND THERAPEUTICS. \n\nthe nerve terminations, as in the respiratory muscles, become \nstill more pronounced. The muscles, while not being com- \npletely paralyzed, are incapable of a continued contraction, in \nconsequence of the failure of the nerve endings to transmit \nenough impulses for the purpose, and the interruptions of the \ncontractions no doubt furnish the explanation of the tremor. \nReflex excitability for the most part remains unaltered. In the \nfrog the injection of gelseminine produces feebleness and slow- \nness of movement, followed by a partial paralysis of the motor \nnerve endings in striated muscle. If the dose is sufficiently \nlarge, the animal is found to lie perfectly motionless and unre- \nsponsive to any form of stimulation, just as if poisoned by \ncurare. It is stated that the contractions of the heart are unaf- \nfected by stimulation of the vagus, apparently because the gan- \nglionic connections along the course of the inhibitory fibres are \nparalyzed by gelseminine in the same way as by nicotine, while, \non the other hand, the terminations of the inhibitory fibres in \nthe cardiac muscle seem to retain their function, since musca- \nrine continues to weaken and slow the heart, as under ordinary \nconditions. \n\nGelsemine is entirely devoid of action on mammals, but in \nthe frog has an action similar to that of strychnine, increasing \nthe reflex excitability of the spinal cord and inducing tonic \nspasms, and in large quantities paralyzing the motor nerve end- \nings in muscle. \n\nEye. \xe2\x80\x94 The effects of the local application of gelsemium have \nalready been referred to. The mydriasis is less complete and \nless persistent than that occasioned by atropine, but is thought \nto be due to the same cause, paralysis of the terminations of \nthe motor oculi nerve. In general poisoning by it marked \ndilatation of the pupil does not occur until quite late. Distur- \nbance of vision, followed by diplopia and ptosis is not infre- \nquently observed after gelsemium, and these effects have been \nattributed to paralysis of the ocular muscles. \n\n\n\nMUSCARINE. 791 \n\nTherapeutics of Gelsemium. \nAt one time gelsemium was employed as a circulatory de- \npressant, but is not now used in this way, since its other effects \nare so harmful. Nor is it any longer prescribed for convulsive \ndiseases, as tetanus, whooping-cough, chorea, etc., as it was \nfound not to do any good. It is often successfully used for \nneuralgia and migraine, though how it acts is quite uncertain. \nFor these the tincture may be given, or the following combina- \ntion : Gelsemine hydrochloride, .0003 gm. (-^J^gr.) and butyl \nchloral hydrate, 20 gm. (3 gr.), made into a pill with mucilage. \nOne pill should be given every two hours until the pain is re- \nlieved. Gelsemium seems to be especially efficacious in neural- \ngia of the facial branches of the trigeminus. It is occasionally \nused locally to dilate the pupil and paralyze accommodation, \nand it has the advantage that its influence passes off rapidly. \nA convenient method of applying it is in gelatin discs, each con- \ntaining .00013 gm. (-5-J-0 gr.) of gelsemine hydrochloride. Gel- \nsemium has been employed with success in the treatment of \nsome cases of eczema and pruritus. It is advised that .18 to \n.60 c.c. (3 to 10 HI) of the tincture should be taken every two \nor three hours until some of the characteristic effects of the \ndrug appear. The tincture has also been used in Meniere\'s \ndisease, in doses of 0.60 c.c. (10 Tit) three times a day, and to \narrest attacks of bilious colic, in doses of 0.30 c.c. (5 TU) every \nquarter of an hour. Gelsemium has sometimes proved of ser- \nvice in torticollis, rigid os in labor, after-pains, spasmodic dys- \nmenorrhea, haemoptysis, laryngismus stridulus, asthma and \nwhooping-cough, and as an antispasmodic in coughs in general. \n\nMUSCARINE. \n\nUnofficial Preparation. \nMuscarina.\xe2\x80\x94 Muscarine. Dose, 0.008 to 0.12 c.c; y 8 to 2 TH.. \n\nAction of Muscarine. \nMuscarine in its action somewhat resembles calabar bean \nand pilocarpine, and it is antagonistic to atropine. It produces \n\n\n\n792 PHARMACOLOGY AND THERAPEUTICS. \n\nfree salivation, abundant perspiration, diminution of the force \nand frequency of the pulse, dyspnoea, paralysis and finally death. \nThe pupil is contracted; dilating, however, before death. The \ncardiac diastole is prolonged, owing to action upon the inhibitory \nnerves. The muscles of the intestines and bladder are mark- \nedly contracted. The abdominal secretions are increased. \n\nTherapeutics of Muscarine. \nAlthough it has been but little employed in medicine, musca- \nrine is likely to be useful in intestinal torpor, duodenal catarrh, \nand in inflammatory effusions and exudations. As it produces \ncontraction of pulmonary capillaries, it is indicated in pulmo- \nnary haemorrhage and incipient pulmonary congestion. \n\nBROMINE. \nBROMUM.\xe2\x80\x94 Bromine. \n\nPreparations. \ni. Potassii Bromidum. \xe2\x80\x94 Potassium Bromide. Dose, 1 gm.; \n15 gr. \n\n2. Sodii Bromidum. \xe2\x80\x94 Sodium Bromide. Dose, 1 gm.; 15 gr. \n\n3. Ammonii Bromidum. \xe2\x80\x94 Ammonium Bromide. Dose, 1 gm.; \n15 gr. \n\n4. Lithii Bromidum. \xe2\x80\x94 Lithium Bromide. Dose, 1 gm.; \n15 gr. \n\n5. Calcii Bromidum. \xe2\x80\x94 Calcium Bromide. Dose, 1 gm.; 15 gr. \n\n6. Zinci Bromidum. \xe2\x80\x94 Zinc Bromide. Pose, 0.125 gm. (125 \nmilligm.) ; 2 gr. \n\n7. Strontii Bromidum. \xe2\x80\x94 Strontium Bromide. Dose, 1 gm. \n15 gr. \n\nUnofficial Preparations. \nRubidii Bromidum. \xe2\x80\x94 Rubidium Bromide. Dose, 0.30 to 4 \ngm.; 5 to 60 gr. \n\nRubidii et Ammonii Bromidum. \xe2\x80\x94 Rubidium and Ammonium \nBromide." Dose, 0.30 to 4 gm.; 5 to 60 gr. \n\n\n\nBROMINE. 793 \n\nAction of Bromine. \n\nBromine closely resembles chlorine in its effects on the \nsystem. \n\nTherapeutics of Bromine. \n\nIt is at present very little used in medicine. Locally it has \nbeen employed with success as a caustic in hospital gangrene, \nchancre and carcinoma uteri, but its escharotic action is at- \ntended with great pain. The vapor of bromine with alcohol \n(i to 64) is sometimes used for inhalation in coryza and hay- \nasthma. \n\nAction of the Bromides. \n\nExternal. \xe2\x80\x94 Potassium, sodium and other bromides, locally \napplied in solution, are slightly sedative to mucous membranes, \nlessening the reflex excitability, especially of the pharynx. \n\nInternal. Alimentary Canal. \xe2\x80\x94 Administered in bulk or con- \ncentrated solution, they induce salivation and thirst, and if the \namount is large, gastric irritation with nausea and vomiting. \nOccasionally diarrhoea is caused by concentrated solutions \nreaching the intestine. These irritating effects are probably \ndue for the most part to the withdrawal of fluid from the \nmucous membranes, as in the case of sodium chloride, and are \nnot observed when the bromides are given in dilute solution. \nIt has also been pointed out that bromides may disorder the \nstomach by so decreasing reflex action that the proper secre- \ntion of gastric juice and the digestive process do not take place \nwith sufficient rapidity, and that for similar reasons they may \ncause constipation. \n\nNervous System. \xe2\x80\x94 They have a direct effect upon the central \nnervous system, that of the potassium salt being most marked \nbecause with it the bromide action is supplemented by the de- \npressant action of the base. The action consists in a depres- \nsion rather than an abolition of function. In man the bromides \ninduce a diminution of mental activity in general, but this is \naffected in some respects more than others. Thus, the percep- \ntion is but little impaired, while the appreciation apparently \n\n\n\n794 PHARMACOLOGY AND THERAPEUTICS. \n\nbecomes decidedly defective, so that while stimuli reach the \nbrain much as usual, they do not seem to be adequately appre- \nhended. External objects are perceived, but arouse no interest \nin the patient, and frequently this state of apathy passes into \ndrowsiness and sleep. The sleep, however, is never very deep \nand is not refreshing, while for several hours after waking the \npatient is apt to be more or less affected with mental confusion. \nBefore slumber comes on there are observed fatigue, lassi- \ntude, disinclination for exertion, and often muscular weakness. \nThere is also a marked diminution in reflex activity. Thus, \nthe irritation of the mucous membranes of the genito-urinary \ntract is less liable to set up reflex movements, tickling of the \nfauces does not induce nausea, and after very large doses the \nconjunctiva may sometimes be touched without causing wink- \ning. In some instances the general cutaneous sensibility is also \ndiminished, and after large doses there may be more or less \ncomplete anaesthesia, which extends to the skin. In addition \nto the ordinary reflexes, some special functions, as the respira- \ntion and the sexual instinct, are depressed. The depression of \nthe spinal reflexes caused by the bromides renders them antag- \nonistic to strychnine, so that in bromidized animals this alka- \nloid induces convulsions only when given in much larger \namount than is ordinarily required for this purpose. As re- \ngards the motor areas of the cerebral cortex, it is found that a \nstimulation of the areas which, under the conditions of the \nexperiment ordinarily give rise to general epileptiform convul- \nsions, will, after the administration of bromide, be confined to \nthe area directly stimulated. It would appear, therefore, that \nthe whole cerebrum, as well as the spinal cord, is powerfully \ndepressed by the bromides. In man, at least, the depression, \nbeginning with the higher functions of the brain, takes place \nin regular order from above downwards, in the reverse order \nof the physiological development of the functions; the action, \nas in the case of many other drugs, following out the Law of \nDissolution (see p. 737). \n\n\n\nBROMINE. 795 \n\nCirculation. \xe2\x80\x94 Large doses of potassium bromide have a de- \npressant action on the heart, an effect which is due to the potas- \nsium ion. If the amount is sufficiently great, diastolic arrest \nmay be caused in animals. Sodium bromide has little or no \ndepressing influence, while the ammonium salt is slightly stimu- \nlating to the heart. After the bromides there is often found a \ncontraction of the blood-vessels of the pia mater, and this con- \ndition has been supposed to produce cardiac depression, but it \nseems probable that this anaemia of the brain is analogous to \nthat observed in sleep, and is a result, rather than the cause, \nof the depression. \n\nRespiration. \xe2\x80\x94 The respiration is more or less depressed by \nlarge doses. Under toxic amounts the breathing grows pro- \ngressively slower and shallower, probably from depression of \nthe respiratory centre. Asphyxia is the usual cause of death \nin animals, although if the potassium salt is employed in any \nlarge amount, fatal cardiac paralysis may be induced by the \npoisonous action of the potassium on the heart muscle. After \na small toxic dose the frog\'s heart has been observed to con- \ntinue beating long after the failure of the respiration. \n\nTemperature. \xe2\x80\x94 In animals toxic doses not infrequently pro- \nduce some fall of temperature, and this is regarded as being \ndue to the lessened movement. \n\nSexual Organs. \xe2\x80\x94 Bromides have a distinct anaphrodisiac \ninfluence. Whether the depression of the sexual instinct \nwhich has been mentioned is due to the action on the cerebral \ncortex or on the spinal cord has not been determined. A fail- \nure of sexual vigor almost invariably results from the long- \ncontinued administration of the bromides. \n\nMetabolism. \xe2\x80\x94 Under large doses there is a marked diminu- \ntion in the amount of carbon dioxide exhaled. The quantity \nof urine is increased, particularly after the use of the lithium \nsalt. The nitrogenous metabolism is not apparently affected, \nbut the sulphur in the urine is increased, while quite commonly \nthe phosphates are materially reduced. \n\nExcretion. \xe2\x80\x94 The bromides, which are rapidly absorbed by \n\n\n\nyg6 PHARMACOLOGY AND THERAPEUTICS. \n\nthe mucous membranes, are eliminated mainly by the kidneys, \nbut to a small extent also in the perspiration and milk. There \nis probably some excretion likewise by the bronchial and intes- \ntinal mucous membrane. The disagreeable odor sometimes \nnoticed in the breath in chronic poisoning has been supposed \nto be due to the elimination by the lungs of bromine or some \nof its volatile organic compounds. The hydrobromic acid \nsecreted into the stomach in bromism is thought to be all reab- \nsorbed in the intestines. Some of the bromide is rapidly elim- \ninated, as it can be detected in the urine a few minutes after \ninjection, but the great mass of the drug is found to be excreted \nonly very slowly. Therefore, under its continued administra- \ntion there is an accumulation in the system, though it has been \nshown that the proportion excreted increases with the increase \nof the salt in the blood until an equilibrium is established, \nexactly as much bromine appearing in the urine as is absorbed \nfrom the stomach. After the discontinuation of the drug the \nexcretion still goes on, and it has been detected in the urine for \nas long as sixty-five days later. The slow excretion of bro- \nmides is regarded as affording support to the theory that the \nbromine enters into combinations in the body, and it is thought \nprobable that it may to some extent take the place of chlorine \nin the combinations of the latter, especially as the excretion of \nchloride is increased. The administration of sodium chloride, \nit is said, accelerates the excretion of the bromine, and ameli- \norates the symptoms of bromism. \n\nComparative Action of the Bromides. \xe2\x80\x94 Certain of the differ- \nences between the various salts have already been incidentally \nreferred to, but a little further attention may be given to the \nsubject. None of the bromides has any action on nerve and \nmuscle unless applied directly to the excised structures. The \neffects of potassium and sodium salts differ chiefly in the ab- \nsence of any changes in the heart or in the muscles when ex- \nposed to the solution of sodium bromide. Potassium bromide \nis also more depressant to the central nervous system on ac- \ncount of the influence of the potassium ion. Under large doses \n\n\n\nBROMINE. 797 \n\nof ammonium bromide the convulsive action characteristic of \nammonium has been observed in animals. The depressant \naction of lithium bromide is probably next to that of the potas- \nsium salt, and it is said by some even to exceed the latter in \nthis respect. It is the richest in bromine, containing 92 per \ncent., and though it has not been so largely used as the others, \nis thought to have the most pronounced hypnotic influence of \nany. It is asserted that the strontium and calcium salts cause \nless disturbance of the .digestion than the others, but they are \napt to be absorbed more slowly by the intestine than those of \nthe alkalies. Zinc bromide, if the dose is sufficiently large, may \nact as an irritant poison. \n\nBromism. \xe2\x80\x94 The name bromism has been given to chronic \npoisoning by the bromides. It is to be noted that hydrobromic \nacid (see p. 801), although containing a larger proportion of \nbromine, rarely gives rise to this condition. Usually the first \nsymptom is an eruption of papular acne, which appears chiefly \nupon the face and back. In severe cases the papules pustulate \nand then the pustules may coalesce, forming small abscesses \nand eventually ulcers. In other instances the rash produced \nresembles eczema, and in still others there is erythema or a \nbrown discoloration of the skin. A coated tongue and disor- \ndered digestion are constant symptoms. There is not infre- \nquently some coryza, with or without an increased secretion \nfrom the bronchial mucous membrane, and sometimes a \nmild conjunctivitis. These various effects are regarded as due \nto a local irritant action, due in part to the salt action of the \nbromide salt and in part to the decomposition of the bromide, \nwith liberation of bromic acid and bromine, by the free acids \nin different situations: as hydrochloric acid in the stomach, \ncarbon dioxide in the air passages, and the acid secretions of \nthe sebaceous glands in the skin. This action is said to be \nfavored by insufficiency of the kidney and to be more readily \ninduced in old age. From the influence of the drug on the \nnervous system the general cutaneous sensibility and the sen- \nsitiveness of the faucial mucous membrane are distinctly re- \n\n\n\n798 PHARMACOLOGY AND THERAPEUTICS. \n\nduced, while the sexual appetite also becomes markedly dimin- \nished. The patient is indisposed to make any exertion and is \neasily fatigued, while his gait is uncertain and every movement \nmay be attended by tremor. The mental phenomena observed \nare of the nature of continuations and exaggerations of the \neffects of a single dose. The intellect is dulled and the memory \nespecially is affected. The patient takes little or no notice of \nwhat is going on around him, he speaks slowly and stammers, \nand is apt to mispronounce ordinary words or miss several \nwords out of a sentence. The mental condition induces a stu- \npid and apathetic expression of countenance, while the eyes \nbecome heavy and lustreless. Occasionally maniacal excite- \nment, mental confusion, and even delirium are observed after \ncontinued use of moderate doses, particularly of the potassium \nsalt. Those who take bromides habitually generally find them- \nselves unable to sleep without them, and as a gradual increase \nof the dose is required to produce sleep, the effects on the sys- \ntem are usually disastrous. In addition to suffering from the \nspecial evils of bromism, the patient, on account of his lowered \nresistance, is rendered more liable to contract disease of any \nkind, and not infrequently the immediate cause of death is an \nattack of pneumonia or bronchitis. Notwithstanding the grav- \nity of the symptoms in bromism, after the withdrawal of the \ndrug they generally disappear soon after there no longer re- \nmains any bromine in the system. \n\nTherapeutics of the Bromides. \nExternal. \xe2\x80\x94 Before the days of local anaesthetics it was cus- \ntomary to paint the pharynx with a bromide solution in order \nto diminish the sensibility of the throat before making a laryn- \ngeal examination. Finely powdered potassium bromide is \nstimulant to chronic ulcers, and is said to be advantageous in \nepithelioma. With 5 parts of glycerin, it has been used as a \nsoothing application for painful haemorrhoids and fissures of the \nanus, and in solution (.60 to 1.20 gm. ; 10 to 20 gr. to 30 c.c. ; \n1 fl. oz. of water) for the relief of paraesthesia. \n\n\n\nBROMINE. 799 \n\nInternal. \xe2\x80\x94 As would be inferred from their physiological \naction, the bromides are of great service in various nervous dis- \neases for the relief of which a depressant effect is required. \nThey are the most valuable remedies at our command in the \ntreatment of epilepsy, their good effects being probably due to \ntheir influence in reducing the excitability of the cortical motor \nareas. When pushed in a suitable manner, they sometimes \nprove curative, and though this happy result is by no means \nalways to be looked for, they are in most instances of great \nservice in diminishing both the frequency and severity of the \nattacks. Consequently, they may be said to be indicated in \nevery case of the disease, and their use should be abandoned \nonly after a thorough trial has demonstrated their inefficiency. \nAs a rule, they are more successful in cases of grand mal than \nof petit mal, and in cases in which the seizures occur in the \ndaytime rather than in those where they are exclusively noc- \nturnal. Experience seems to show that rubidium and ammo- \nnium bromide (in doses of 2 gm. ; 30 gr.) is the most serviceable \nin some instances, but the potassium salt is the one in most \ngeneral use and considered the most efficient by many. There \nare special circumstances, however, in which some one of . the \nvarious other bromides possesses certain advantages and may \nsucceed when the potassium salt has failed. Sometimes the \ncombination of the three bromides, potassium, sodium and am- \nmonium, acts better than any one of the salts alone. Bella- \ndonna often increases the efficiency of bromides in petit mal. \nAs the bromides when applicable in epilepsy must be admin- \nistered for an indefinite period, every effort should be made to \nminimize their objectionable effects upon the system. Thus, it \nis often advisable to intermit the remedy from time to time, or \nto change from one bromide to another. To counteract the \ndepression, the bromide is sometimes given in infusion of ca- \nlumba or digitalis, or strychnine is given hypodermatically at \nthe same time. It has been claimed by some that most of the \nill effects of the bromides may be avoided by giving them in \ncombination with intestinal antiseptics, such as sodium sali- \n\n\n\n800 PHARMACOLOGY AND THERAPEUTICS. \n\ncylate and naphthol; while others have observed that taking \nstrong coffee with the meals hinders the development of bro- \nmism. For the prevention or amelioration of acne, arsenic is \nthe best remedy. When the convulsive attacks have ceased to \nmake their appearance, it is advised that a single dose of 4 gm. \n(1 dr.) of bromide should be taken daily at bedtime for a year, \nand after that on alternate nights for at least a year longer. \nIt is better that the remedy should not be discontinued alto- \ngether for fully three years. As hypnotics and for quieting \nnervousness and hysteria the bromides are often extremely use- \nful, but their too long continued employment should be avoided \non account of the risk of the patient\'s becoming an habitue of \nthe drug. They are especially useful in the wakefulness of \nfatigue, worry and cerebral over-work. In various forms of \nconvulsions both in adults and children they are efficient, par- \nticularly when combined with hydrated chloral. This combina- \ntion may be useful also in delirium tremens. Here the dose of \nbromide should be very large, often as much as 4 gm. (1 dr.), \nand it is of more service in the preliminary stage of wakeful- \nness and excitement than after the delirium is fully developed. \nOther affections in which bromides may be employed are laryn- \ngismus stridulus, the night-screaming of children, migraine, \nneuralgia, dysmenorrhea and menorrhagia, particularly in \nyoung subjects, seminal emissions, satyriasis and nymphomania. \nIn migraine and neuralgia the combination with caffeine is \noften very efficient. The bromides have been considerably used \nin the treatment of whooping-cough, but cannot be said to have \nproved of much value. They are of service in the laryngeal \ncrises of locomotor ataxia and, in full doses, in acute laryn- \ngitis. In cases where irritability of the pharynx and larynx \ninterfere with a satisfactory examination of these parts, the \ntrouble may be obviated by the administration of one or two \nfull doses. They are the best prophylactics which have as yet \nbeen discovered for seasickness, and should usually be em- \nployed in doses of about .60 gm. (10 gr.) three times a day for \na number of days before sailing, though a larger amount will \n\n\n\nBROMINE. 8oi \n\nsometimes be required. After seasickness has commenced, \nthey should be given in small doses, frequently repeated, in an \neffervescing draught made by mixing a solution of citric acid \nwith one containing the bromide and potassium bicarbonate. \nThey may also be used in the same way in the vomiting of \npregnancy, the vomiting following etherization, and other per- \nsistent forms of vomiting which are not due to primary gastric \ndisturbance. In cases where this method proves inefficient, the \nbromide may be given with the tincture of deodorized opium in \na small enema of starch water. The bromides have also been \nemployed to prevent the nausea and depression resulting from \nopium, as well as for the symptoms of cinchonism and salicyl- \nism. They are of service in the abdominal neuroses, such as \ncholera infantum when it is due, not to defective alimentation \nor other local trouble in the gastro-intestinal tract, but to an \nirritable state of the nervous system. In some varieties of \nfunctional disease of the heart they are of decided benefit. \nLithium bromide has been prescribed in various gouty and rheu- \nmatic conditions, and potassium bromide is recommended as an \neliminating agent, combined with potassium iodide, in mercurial, \ncopper and lead poisoning. In a considerable number of cases \npotassium bromide has proved successful in the treatment of \ntetanus. Not less than 15 gm. ( J / 2 oz.) should be given in the \nday, and hydrated chloral should be used as an hypnotic at \nnight. This bromide, in full doses, is also of value as an anti- \ndote for strychnine poisoning. \n\nACIDUM HYDROBROMICUM DILUTUM.\xe2\x80\x94 Diluted Hydrobromic \nAcid. Dose, 4 c.c; 1 fl. dr. \n\nAction of Hydrobromic Acid. \nHydrobromic acid appears to have the characteristic bromide \naction after absorption, but it also has the local action of an \nacid; which makes it more irritant than the bromides. While \npleasanter to take than the latter, it is, therefore, more apt to \ncreate gastric disturbance. \n52 \n\n\n\n802 PHARMACOLOGY AND THERAPEUTICS. \n\nTherapeutics of Hydrobromic Acid. \nIt was introduced as a substitute for the bromides, but it \nfailed to fulfill the expectations of its usefulness, and is now \nvery rarely employed for the same purposes. It has some re- \npute in preventing the untoward symptoms of quinine, of which \ndrug it is an excellent solvent. Thus, it is said to give prompt \nrelief in the annoying tinnitus aurium occasioned by it, though \nit often fails in relieving tinnitus from other causes. It has \nbeen highly recommended for headaches due to eye-strain, espe- \ncially in nervous women. \n\nF. Drugs Acting on the Brain, \ni. General cerebral stimulants. \n\nBELLADONNA. \nBELLADONNA FOLIA.\xe2\x80\x94 Belladonna Leaves. (Deadly Night- \nshade.) Dose, 0.065 gm. (65 milligm.) ; 1 gr. \n\nPreparations. \ni. Extractum Belladonnae Foliorum (Extractum Belladonna \nFoliorum Alcoholicum, U. S. P., 1890). \xe2\x80\x94 Extract of Belladonna \nLeaves. Dose, 0.010 gm. (10 milligm.); y 6 gr. \n\n2. Pilulae Podophylli, Belladonnae et Capsici. \xe2\x80\x94 Pills of Podo- \nphyllum, Belladonna and Capsicum. Dose, 1 pill. \n\n3. Pilulae Laxativae Compositae. \xe2\x80\x94 Compound Laxative Pills. \nDose, 2 pills. \n\n4. Tinctura Belladonnae Foliorum. \xe2\x80\x94 Tincture of Belladonna \nLeaves. Dose, 0.5 C.C.; 8 TT\\,. \n\n5. Unguentum Belladonnae. \xe2\x80\x94 Belladonna Ointment. \n\n6. Emplastrum Belladonnae. \xe2\x80\x94 Belladonna Plaster. \n\nBELLADONNA RADIX.\xe2\x80\x94 Belladonna Root. Dose, 0.045 gm. (45 \nmilligm.); % gr. \n\nPreparations. \n1. Fluidextractum Belladonnae Radicis. \xe2\x80\x94 Fluidextract of \nBelladonna Root. Dose, 0.05 C.C.; 1 Til. \n2. Linimentum Belladonnae. \xe2\x80\x94 Belladonna Liniment. \n\n\n\nBELLADONNA. 803 \n\nATROPINA.\xe2\x80\x94 Atropine. Dose, 0.0004 gm. (0.4 milligm.) ; y i \xc2\xa5 gr. \n\nPreparation. \n\nOleatum Atropinae. \xe2\x80\x94 Oleate of Atropine. \n\nATROPINE SULPHAS.\xe2\x80\x94 Atropine Sulphate. Dose, 0.0004 gm. \n(0.4 milligm.) ; T ^ gr. \n\nUnofficial Preparation. \n\nAtropinae Santonas. \xe2\x80\x94 Atropine Santonate. Dose, 0.06 (1 ni ) \nof a solution of 0.01 gm. (y 6 gr.) in 20 gm. (300 gr.) of water is \nsufficient to dilate the pupil. \n\nAction of Belladonna. \n\nThe action of belladonna is due to the atropine in it. \n\nExternal. \xe2\x80\x94 Atropine by itself is not absorbed by the unbroken \nskin, but when rubbed in with absorbable substances, such as \nalcohol, glycerin, camphor, animal fats, etc., or when applied to \nabraded surfaces or mucous membranes, it has a well-marked \nlocal action and is also capable of producing systemic effects. \nIts chief local effect is a paralyzation of the sensory nerve ter- \nminations, so that it acts as an anaesthetic and anodyne, and \nit also depresses the motor nerve terminations, though less \nmarkedly, and tends to inhibit secretion. On the peripheral \nvessels it has first a constricting and then a dilating influence. \nApplied to the conjunctiva, it is a typical mydriatic. \n\nInternal. Blood. \xe2\x80\x94 Atropine is rapidly absorbed into the \nblood, and it is stated to diminish the number of leucocytes. \n\nNervous System. \xe2\x80\x94 The main action of atropine is on the \nnervous system, and most of its effects in the organism are due \nto its influence upon the various portions of this. The action \nextends from the hemispheres downward, and in the medulla \noblongata the drug first stimulates and then depresses the three \nprincipal centres. Its dominant and characteristic action is a \ndepression of the terminations of most varieties of nerves. \n\nSecretory Nerves. \xe2\x80\x94 On the activity of the peripheral termina- \ntions of all the secretory nerves in the body, it has, so far as \n\n\n\n804 PHARMACOLOGY AND THERAPEUTICS. \n\nknown, a distinctly depressant effect. The secretions are not, \nhowever, all affected to the same extent, since with some of \nthem the nervous influence is not so important as in the case \nof others. The secretion of saliva is entirely dependent upon \nthe integrity of the nervous connection, and hence may be \nentirely arrested by atropine. Thus, in an animal under the \ninfluence of the drug, stimulation of the chorda tympani, which \nis the secretory nerve of the submaxillary gland, no longer \ncauses an increased flow of saliva, as is the case under ordi- \nnary circumstances, and it has been shown by experiments ex- \ncluding the participation of the ganglia and gland cells that the \naction is on the nerve endings. Furthermore, it has been shown \nthat no paralysis results of the vaso-dilator fibres which move \nalong with the secretory fibres of the chorda tympani, the secre- \ntory fibres alone being selected by the atropine for its attack. \nIn the same way the secretory nerve terminations in the other \nsalivary glands and the buccal mucous glands are paralyzed, \nand as the normal impulses are thus prevented from reaching \nthe gland cells, the mouth becomes dry. Even small doses of \natropine will cause a considerable amount of dryness. From \nthe same cause the secretion of the glands of the throat, nose \nand respiratory passages is stopped, and as a result there are \nproduced hoarseness of the voice, thirst and difficulty of swal- \nlowing. The skin likewise becomes dry from the paralysis of \nthe terminations of the nerves in the sudoriparous glands. \nWhile atropine diminishes the secretion of milk by the same \nprocess, it does not check its flow entirely, as the mammary \ngland has been found to continue to secrete after all its nerves \nhave been severed. The solids of the milk are thought to be \naugmented rather than diminished. Recent investigations have \nshown that by its action in paralyzing the terminations of the \nsecretory fibres of the pneumogastric nerve in the stomach,, \natropine diminishes or may even entirely arrest the secretion \nof gastric juice. The pancreatic secretion, although it is not \nentirely dependent on nervous impulses, is similarly affected; \nso that after atropine the increased secretion which ordinarily \n\n\n\nBELLADONNA. 805 \n\noccurs upon the entrance of food or of acid into the intestine \ndoes not take place, while stimulation of the pneumogastric, \nwhich ordinarily increases it, has no effect. The bile is also \nsaid to be diminished, and it would seem probable that the in- \ntestinal secretions are affected likewise. Some diminution in \nthe urine, as well as an alteration in the proportion between \nits nitrogenous constituents, has been observed after atropine, \nbut it is unknown how far such results may be due to its action \non the kidney and how far to its effect on other organs. The \namount of the urinary flow, as is well known, is largely de- \npendent on the secretion of sweat. The flow of lymph is not \naffected by atropine, and from this fact it is inferred that this \nis not controlled by nerves in the same way as the true secre- \ntions. \n\nSensory Nerves. \xe2\x80\x94 The effect of atropine when locally applied \nin paralyzing the terminations of the sensory nerves has already \nbeen mentioned. The same local anodyne action is not ob- \nserved from its internal administration, although some recent \ninvestigators have claimed that the sensory terminations are \nfirst stimulated and then paralyzed by the drug. It is said, \nhowever, that the frog may be rendered less sensitive to cuta- \nneous irritation if poisoned with atropine. \n\nInvoluntary Muscles and their Nerves. \xe2\x80\x94 The innervation of \nall unstriped muscle seems to be depressed or paralyzed by \natropine. Hence the movements of the stomach, intestine, \nbladder, uterus, spleen, bronchial muscle, thoracic duct, and of \nthe pupil and oesophagus (except in animals in which these \nconsist of striped muscle) are more or less diminished by it. \nIn the intestine not only is normal peristalsis lessened, but that \nwhich is caused by direct nerve stimulation, as by electricity \nor drugs such as muscarine and pilocarpine\'s promptly arrested \nby atropine. Immediately after the injection of the atropine \nthere usually occurs an increase in the intestinal movements. \nThis might be cited as proof that it causes a preliminary stimu- \nlation of the nerve terminations, but may also be explained by \nthe inhibitory endings being paralyzed earlier than the motor. \n\n\n\n806 PHARMACOLOGY AND THERAPEUTICS. \n\nOrdinarily the movements, although they become diminished, \nare not finally arrested, since the intestinal muscle, like the other \ninvoluntary muscles, is capable of maintaining a regular move- \nment independently of nervous impulses from without. It is \nthus found that any irritating substance will cause peristalsis \nafter atropine, and that the action of purgative drugs is not in- \nterfered with by it. It is a common practice to give belladonna \nin association with purgatives for the purpose of preventing \ngriping, and the generally accepted explanation of this result is \nthat the local contractions of the intestinal wall which are sup- \nposed to give rise to the griping are due to nervous influence, \nand hence disappear under the action of the drug. Very large \nquantities of atropine are said to paralyze the muscle of the in- \ntestinal wall, but this, it has been pointed out, could scarcely \noccur except under special conditions, as paralysis of the res- \npiratory centre would undoubtedly -precede it. \n\nVoluntary Muscles and their Nerves. \xe2\x80\x94 Atropine has no direct \naction on the voluntary muscles. In the frog the terminations \nof the motor nerves are paralyzed by very large amounts, but it \nis said that this result has not been elicited in mammals by \nordinary methods of experimental investigation. \n\nThe Eye and its Nerves. \xe2\x80\x94 Whether atropine be dropped into \nthe eye or given by the mouth, it has the effect of widely dilat- \ning the pupil. This is due to paralysis of the terminations of \nthe motor oculi nerve in the sphincter muscle. It is found that \nthe paralysis is limited to the periphery, and that the muscle \nis not acted on is shown by the fact that it reacts to electrical \nstimulation. The pupil dilates because the elastic fibres of the \niris have an opportunity to act. That the action is local is \nshown by its remaining confined to the eye, and even to that \nside of the eye to which atropine is directly applied, and also \nby the fact that it can be produced on the excised eye of a frog \nand even on the isolated iris. There is also a loss in the power \nof accommodation, and this is caused by paralysis of the motor \noculi terminations in the ciliary muscle. In consequence of it, \nnear objects are no longer seen clearly. In addition, there is \n\n\n\nBELLADONNA. 807 \n\nincrease of intra-ocular tension, such as usually accompanies \ndilatation of the pupil, and this is supposed to be probably due \nto the dilatation. The dilatation is found to be not quite maxi- \nmal, since it is generally increased, though but slightly, by \nstimulation of the cervical sympathetic trunk. In birds and \nreptiles atropine has no action on the iris, which in them con- \ntains striped instead of unstriped muscle. \n\nThe Heart and its Nerves. \xe2\x80\x94 The inhibitory terminations of \nthe vagus in the heart are paralyzed by atropine. Consequently \nthe heart-beat is accelerated, and stimulation of the vagus does \nnot produce any change in it. In man the amount of accelera- \ntion produced varies considerably with the age of the subject, \nthe vagus being most active in middle life. In the new-born \ninfant there is no quickening of the heart, but up to about 30 \nthe acceleration increases with the age, and from this point on \nlessens again. In its main action on the heart atropine is there- \nfore directly antagonistic to muscarine, which has the effect of \nstimulating the cardiac terminal filaments of the vagus. A \nsecond effect on the heart is often said to be a slight stimula- \ntion of the cardiac muscle by small doses, but there is reason \nto believe that the drug really has no such action. Large \namounts undoubtedly weaken and depress the muscle, and may \ncause arrest in diastole. Furthermore, atropine has some stimu- \nlating influence on the cardiac centres in the medulla oblongata. \nThis action, however, is for the most part overshadowed by \nthe peripheral effects, though it may induce a preliminary slow- \ning of the pulse. The circulation always persists after the \ncessation of respiration, and its failure is therefore not the \ncause of death in atropine poisoning. \n\nVaso-motor System and its Nerves. \xe2\x80\x94 Atropine causes a con- \nsiderable rise in blood-pressure, an effect which is due in part \nto the acceleration of the heart-beat, and largely also to stimu- \nlation of the vaso-constrictor centre in the medulla oblongata, \nsince it is much less marked after division of the spinal cord. \nThis central stimulation has the effect of causing a contraction \nof the abdominal arterioles, which is accompanied by a dila- \n\n\n\n808 PHARMACOLOGY AND THERAPEUTICS. \n\ntion of the arterioles of the skin and probably also, it is thought, \nof the brain, from excitation of the vaso-dilator centre. Hence \nthere results a movement of blood from the abdomen towards \nthe periphery; but as the dilation of the cutaneous vessels can- \nnot altogether counteract the constriction of the abdominal \nones, a rise in blood-pressure is induced. The dilatation of the \nsurface vessels is most marked in the region of the head and \nneck, where it causes a pronounced flushing of the skin. In \nmany instances there is observed a rash like that of scarlet \nfever, and the hyperemia may be so intense as to lead to des- \nquamation. That it is due to central action is shown by the \nfact that it is prevented by section of the cervical sympathetic \ntrunk. The increased arterial tension is maintained for some \ntime after small doses, but large amounts soon bring about a \nfall in the blood-pressure by this action on the muscle fibre of \nthe heart. Under toxic doses the pressure falls very low from \nparalysis of the vaso-motor centre and arterial muscles, as \nwell as of the cardiac muscle. The spinal vaso-motor centres \nare acted on in the same way as the medullary. \n\nRespiration and its Nerves. \xe2\x80\x94 The respiration is often slow \nat first, not, as was formerly supposed, from paralysis of the \nsensory peripheral filaments of the vagus in the lungs, but from \nsome central action the precise nature of which has not as yet \nbeen explained. Soon, however, in consequence of stimulation \nof the respiratory centre in the medulla, the breathing becomes \nquicker and also probably deeper, and the amount of air in- \nspired per minute is found to be considerably increased. Under \nlarge amounts of atropine the centre is rapidly depressed. The \nrespiration grows shallower and slower, and in fatal cases \ndeath results from failure of this function. Not infrequently \nthe breathing is interrupted by convulsive movements, and in \nmany instances is then never resumed. Both the afferent and \nefferent terminations of the vagus in the lungs are paralyzed \nby atropine, and not only is the bronchial muscle relaxed, but \nthe secretions, which are diminished in quantity, are now less \n\n\n\nBELLADONNA. 809 \n\nirritating in consequence of the depression of the afferent fila- \nments. In this way the drug has the effect of lessening cough. \n\nCentral Nervous System. \xe2\x80\x94 The action on the central nervous \nsystem consists of a true stimulation, followed by depression, \nand if the amount is sufficient, paralysis. While caffeine affects \nchiefly the higher divisions of the central axis, and strychnine \nthe lower, the seat of the influence of atropine may be said in \na general way to be intermediate as regards these. In the case \nof caffeine the highest functions of the cerebrum, the psychical, \nare involved first of all, but atropine acts principally on the \nmotor divisions of the brain. It is likely to cause restlessness, \nvertigo, garrulity, incoherence of speech, staggering gait, chore- \noid movements, uncontrollable laughter or weeping, a busy \ndelirium, and mania. In the subsequent paralytic stage, drow- \nsiness, coma, and finally convulsions may occur, the latter \nlargely from asphyxia. In the poisoning the medulla and spinal \ncord are involved, but in the cord the action is very much \nweaker than that of strychnine and appears much later. In the \nfrog much the same effects are found to be produced by atro- \npine as by the latter drug, because, the higher parts of the \ncentral nervous system being less developed than in mammals, \nthe first symptoms observed are those arising from the cord. \nYoung animals can bear much larger quantities of atropine or \nbelladonna than older ones, and it has been suggested that the \nexplanation of this is because the brain is less highly developed \nand the cerebral symptoms are therefore elicited less easily. It \nis also a fact that in the human subject children are much less \nsusceptible to the influence of the drug than adults. \n\nTemperature. \xe2\x80\x94 Atropine often causes a rise of temperature, \nwhich may amount to 2\xc2\xb0 C. (4 F.) or more. This has been \nattributed to a direct action on the cerebral heat centres, though \nit cannot be said that proof of such action is positively estab- \nlished, and seems to be independent of the blood-pressure and \nthe diminished respiration, as well as of the convulsions. While \nthe dissipation of heat is increased, probably because the flush- \n\n\n\n8lO PHARMACOLOGY AND THERAPEUTICS. \n\ning of the skin leads to a greater loss by radiation, the heat \nproduction is apparently increased to a still greater extent. \n\nElimination. \xe2\x80\x94 Atropine is excreted principally by the kidneys, \nbut also passes into the milk and into the fcetal circulation. In \nherbivorous animals particularly it is excreted very rapidly in \nthe urine. They exhibit a much greater tolerance of the drug \nthan the carnivora or man, and this probably accounts largely \nfor the difference. Rabbits, it is found, may be fed for weeks \nexclusively on belladonna leaves without presenting any symp- \ntoms of poisoning. Pigeons are also very insusceptible to the \naction of the drug. The uric acid of the urine is said to be \ndiminished by it. \n\nTherapeutics of Belladonna. \nExternally. \xe2\x80\x94 Belladonna, and sometimes atropine, is used \nlocally to relieve pain of all kinds, to check sweating and the \nsecretion of milk, and to relax spasm, while atropine is em- \nployed to a considerable extent in ophthalmological practice. \nFor neuralgia, myalgia, lumbago, acute inflammations, and \nchronic rheumatism and other painful affections of the joints \nbelladonna is often applied in the form of liniment, ointment \nor plaster. It is also used in a great variety of combinations. \nA very good one is Chloroformum Belladonnas (Brit. Pharm. \nConference), in which the root is extracted with ammonia and \nchloroform, and it should be diluted with a little olive oil. An- \nother is a preparation made by rubbing the extract of bella- \ndonna leaves, 4, with boiling water, 1, and then gradually \nadding glycerin, 12. For severe local pain atropine is some- \ntimes combined with aconitine or other alkaloids. To re- \nlieve the pain of herpes zoster, and of irritable or malignant \nulcers, cocaine hydrochloride, .30 gm. (5 gr.) with belladonna \nointment, 30 gm. (1 oz.), may be of service. Belladonna is also \nuseful in painful haemorrhoids and fissure of the anus, to check \nthe suppurative process in furuncle, abscess and carbuncle, and \nto promote the resolution of enlarged glands. The plaster is \nan excellent application to relieve the chest-pains of phthisis \n\n\n\nBELLADONNA. 511 \n\nor to allay irritability of an over-excited heart. For inter- \ncostal neuralgia or pleurodynia, strapping the chest with bella- \ndonna plaster is usually the most efficient way of applying the \ndrug. In the form of the plaster or ointment it is much used \nas an antigalactagogue. A more elegant method is to envelop \nthe breast in lint wet with a solution of atropine in rose-water, \n.24 gm. (4 gr.) to 30 c.c. (1 fl. oz.). The liniment, applied \nseveral times a day, is of great service in restraining excessive \nlocal sweating, and a lotion or ointment containing belladonna \nmay be successfully employed in pruritus, urticaria and chronic \neczema attended with much itching. In rigidity of the cervix \nuteri in the first stage of labor an old practice is to smear the \nos with extract of belladonna, but it is of very doubtful utility. \nA suppository containing the extract, alone or in association \nwith opium, has been recommended in dysmenorrhea dependent \nupon spasm of the cervix. It has been asserted that oleate of \natropine makes a suppository of much more uniform composi- \ntion than when -extract of belladonna is employed. A solution \nof atropine in chloroform or in equal parts of chloroform and \nalcohol (.30 gm. ; 5 gr. of the alkaloid to 30 gm. ; 1 oz. of men- \nstruum), applied to the epigastrium on a piece of lint, will some- \ntimes relieve obstinate vomiting, cerebral or reflex, such as that \nof pregnancy, seasickness, etc. In ophthalmological practice \natropine is used to dilate the pupil and relax the accommoda- \ntion in order to facilitate examination of the eye and determine \nits refraction, and also to destroy adhesions and to prevent con- \ntraction of the iris or its protrusion through an ulcer of the cor- \nnea. The solutions of atropine for such purposes, as well as for \nhypodermatic injection, should be freshly prepared and steril- \nized each time, in order to avoid the development of penicillium \nin the liquid. Atropine sulphate is the salt commonly selected \nfor dilating the pupil, and some such solution as the following \nmay be employed : Atropine sulphate, 4 ; boric acid, 5 ; in water to \n480. Some oculists prefer atropine santonate, and some advo- \ncate the use of atropine sulphate and duboisine sulphate, with \ncocaine hydrobromide ; claiming that by this combination of al- \n\n\n\n8l2 PHARMACOLOGY AND THERAPEUTICS. \n\nkaloids the same effects may be obtained with smaller doses. \nAtropine must not be used if the patient is suffering from glau- \ncoma. In certain individuals even perfectly neutral solutions \nare very irritant, giving rise to what is known as atropine \nconjunctivitis, and the alkaloid also acts as an irritant in some \ncases of iritis, particularly those occurring in rheumatic pa- \ntients with posterior adhesions. When belladonna is applied \nin the ointment or other form to open surfaces, the pupils and \nthroat of the patient should always be carefully watched. \nAtropine sulphate is employed locally to a limited extent in \ndiseases of the ear. \n\nInternal. \xe2\x80\x94 Belladonna or atropine is given to check saliva- \ntion from the use of mercury or other drugs and the excessive \nptyalism sometimes met with in children and pregnant women. \nIt is one of the best remedies known for the night-sweats of \nphthisis, and for checking this and other objectionable forms \nof sweating atropine sulphate (.006 gm. ; T fa gr.) may be in- \njected hypodermatically, or .06 to .12 c.c. (1 or 2 "ni) of a solu- \ntion of atropine sulphate in camphor water (1 to 100) given \nby the mouth. For bromidrosis of the feet and other localized \nsweatings also the drug may be used internally, as well as exter- \nnally. It has been employed in serous diarrhoea on the ground \nthat it tends to check this by stimulating the splanchnic vaso- \nmotor filaments of the intestinal blood-vessels, the inactivity of \nwhich permits a transudation of liquid into the bowel. It is \nalso given to overcome constipation and colic, and the ex- \ntract of belladonna leaves is a frequent constituent of purga- \ntive pills. In appendicitis or peritonitis this extract is some- \ntimes administered in frequently repeated doses in a pill with \nopium, for the purpose of paralyzing intestinal movements and \nthus assisting the action of the latter drug. In intestinal ob- \nstruction the propriety of administering atropine has given rise \nto much discussion. It is only in the paralytic or spastic forms \nthat internal treatment would seem to be useful, and in the for- \nmer small doses of atropine and in the latter large ones may \nbe of service. In gastralgia, as well as the pain accompanying \n\n\n\nBELLADONNA. 8 I 3 \n\ngastric ulcer, and in pyrosis, chronic gastric catarrh, and irri- \ntative dyspepsia, atropine often affords marked relief, and in \ncases of this kind it may usually be combined advantageously \nwith small doses of zinc sulphate. Administered with dilute \nhydrochloric acid, it is useful in heart-burn, water-brash, etc. \nIt may also be of service in the vomiting of pregnancy and \nother reflex varieties of vomiting when given by the mouth, as \nwell as when applied to the epigastrium. Sometimes it seems \nto be more efficient if used in suppository. Sick-headache due \nto or accompanied by spasm of the arterioles (as indicated by \npallor of the face, vertigo and tinnitus anrium), is frequently \nrelieved by belladonna. It is also of service in the headache \nof young persons, often due to over-work, in which there is \npain in the eyeballs and forehead, with a sensation commonly \ndescribed as a feeling that the orbits are too small for the eye- \nballs. This drug is a valuable remedy in many cardiac affec- \ntions. Thus, as it accelerates the heart\'s pulsations without \ndiminishing their force, it may be employed whenever it is \ndesired to completely empty the ventricles. Its greatest service, \nhowever, is in relieving cardiac pain and distress. Here it may \nbe applied over the precordial region, as mentioned, or given \ninternally, usually as the tincture of the leaves. It is also use- \nful in the treatment- of shock and collapse from injury or in \nthe course of disease, and in pneumonia particularly it should be \nresorted to when after the crisis there is great relaxation of the \nvascular system and heart stimulants are found to be ineffective. \nHere the administration of atropine or belladonna will dry a \nmoist skin and by increasing the vaso-motor tone often pro- \nduce marked improvement. In caseous pneumonia the drug, it \nis claimed, has a distinctly curative effect. Given in full dose, \nit will not infrequently abort colds in which the pharynx is hot \nand dry and has a feeling of rawness, while the local capillaries \nappear injected and red. It is also of much benefit in acute \ncoryza. In whooping-cough (where it should be given freely) \nand other spasmodic affections of the respiratory passages it \nhas long been esteemed one of the most reliable remedies. For \n\n\n\n8 14 PHARMACOLOGY AND THERAPEUTICS. \n\nthe symptom asthma it is of most service when combined with \nopium, and it may be given both during the attacks and as a \nprophylactic in the interval. Belladonna leaves rolled into \ncigarettes or put into a pipe are often smoked by asthmatics, \nbut the most effective way of administering the drug here is \nthe hypodermatic injection of atropine. In bronchitis with a \ntendency to paroxysmal spasm the tincture of the leaves is \nfrequently associated with other remedies. The following is \na very satisfactory mixture : Tincture of belladonna leaves, 3 ; \nvinegar of squill, 5 ; syrup of tolu, 10; glycerin, to 60 parts. For \nthe nervous cough of both children and adults belladonna is an \nexcellent remedy. It is also useful in laryngismus stridulus \nand in hiccough. Atropine has been used with good effect in \nthe aphonia caused by fatigue of the vocal cords and likewise \nin hysterical aphonia. The utility of belladonna, when applied \nto the breasts, for " drying up " the milk has already been men- \ntioned. It is also of great service, employed both locally and \ninternally, in cases of mastitis, and even when the formation \nof pus has already commenced it will often check the inflam- \nmatory process if used in sufficient amount. Belladonna is \nprobably the most efficient remedy we have for the nocturnal \nenuresis of children, and is also valuable in urinary inconti- \nnence in adults when this depends upon vesical spasm. It re- \nlieves enuresis because it has an anodyne effect upon the cen- \ntres in the cord, and, when excreted in the urine, anaesthetizes \nthe neck of the bladder. It is also sometimes useful in the \ntreatment of nocturnal seminal emissions. Its property of re- \nlaxing the spasm of involuntary muscle is well shown in the \nrelief which it affords in the acutely painful vesical spasm which \naccompanies urinary calculus, cystitis and prostatitis. Here it \nmay be employed in the form of a suppository or applied to the \nperineum in ointment or plaster, or it may be used both inter- \nnally and externally. In urethral spasm and in chordee it may \nbe given internally, and the ointment may be smeared along the \nunder surface of the penis. By its action in relaxing spasm \nbelladonna will also often give relief in the colic resulting from \n\n\n\nBELLADONNA. 8 I 5 \n\nthe passage of hepatic and renal calculi. On account of the \nsimilarity of the symptoms of atropinism with those of scarlet \nfever, belladonna has been vaunted as a prophylactic against \nthis disease, but abundant experience has shown that the drug \nis absolutely valueless in this regard. It may, however, prove \nuseful in relieving some of the symptoms of scarlatina, and is \nthought to be indicated when during the stage of eruption the \npulse is feeble, the system much depressed, and the rash im- \nperfectly developed. As ammonium carbonate is often pre- \nscribed in this condition of affairs, it must not be forgotten that \nthese two remedies are chemically incompatible, and should not \ntherefore be used together. Belladonna appears to have a posi- \ntive curative effect in erysipelas. It is of most service in the \nidiopathic form of the disease, especially the facial variety, and \nnot so well suited to traumatic erysipelas. Clinical observa- \ntions go to show that in typhoid and typhus fever it is some- \ntimes indicated, and may prove very beneficial when there is \nmuch low, muttering delirium, subsultus and stupor. \n\nAlthough in the healthy individual this drug tends to induce \nwakefulness and busy delirium, yet in certain morbid states of \nthe brain it appears to have a hypnotic action, and it is consid- \nered to be indicated in cases of mental disorder in which there \nare found a low state of the blood-pressure, deficient intra- \ncranial circulation, and a contracted pupil, with prostration and \ninsomnia. Thus, a hypodermatic injection of atropine may \novercome the insomnia of delirium tremens in cases where there \nare coma \xe2\x80\x94 vigil, great restlessness, and feeble heart-action, with \ncoldness of the surface, blue skin, and a clammy sweat. Bella- \ndonna was formerly employed to a considerable extent in epi- \nlepsy, but its use in that disease has now been almost entirely \nabandoned, though it is still claimed by some that while in gen- \neral it is vastly inferior in efficacy to the bromides, yet good \nresults may sometimes be obtained from it in nocturnal epilepsy \nand petit mal, and in the case of pale, delicate and anaemic sub- \njects, with cold extremities, cyanosis, and weak heart. The sub- \ncutaneous use of atropine in neuralgia is of recognized value. It \n\n\n\n8l6 PHARMACOLOGY AND THERAPEUTICS. \n\nhas been found particularly efficient in tic douloureux and sciat- \nica, and to secure the best results it is advised that deep injec- \ntions of the largest doses compatible with the safety of the \npatient should be made in the vicinity of the affected nerve- \ntrunk. Atropine is also very highly recommended in peri- \nuterine and dysmenorrhoeal neuralgia. In traumatic neuralgias \nit is practically worthless. In the treatment of neuralgia in \ngeneral it is inferior to morphine, while its systemic effects are \nusually much more disagreeable than those of the latter. It \nshould be resorted to more particularly in the case of patients \nwho show an idiosyncrasy against morphine. \n\n\n\nTOXICOLOGY. \n\nSymptoms. \xe2\x80\x94 The most characteristic early symptoms of belladonna \npoisoning are dryness of the mouth and throat, dysphagia, and dilatation \nof the pupil, with dimness of vision. The skin is dry and the scarlati- \nnous rash may or may not be present. The conjunctivae are injected \nand the face is flushed, while the pulse is very markedly quickened and \nthe temperature more or less elevated. There is often nausea, and \nsometimes vomiting. There may be purging, but this is not ordinarily \nobserved. Frequently the urine is voided at an early period, and after \nthat there is a constant desire to micturate without the ability to do \nso. It has been suggested that the preliminary contraction of the \nbladder is analogous to that of the intestine, and the subsequent inability \nto empty it to the diminution of the peristalsis. The patient staggers \nlike a drunken man when he attempts to walk, and excitement passing \ninto delirium is a prominent feature. The cerebral symptoms have al- \nready been sufficiently detailed. Convulsions are rare. The respiratory \nmovements, which at first are slow and full, become quicker and \nshallower, from the depression of the medullary centre. The breathing \ngrows dyspnoeic in character, and death at length takes place from \nrespiratory failure. A fatal ending, however, is comparatively infre- \nquent. If the patient should survive, it sometimes happens that he has \nno recollection of his illness. Post-mortem. There is nothing character- \nistic about the appearances, which are simply those met with in \nasphyxia from any cause, the result of venous engorgement of the \nvarious internal organs. \n\nTreatment. \xe2\x80\x94 Quite commonly the prognosis is favorable, as there is \nusually ample time for a successful treatment. The stomach should \n\n\n\nHOMATROPINE HYDROBROMIDE. 817 \n\nbe washed out or evacuated with emetics (see p. 175). The general \nsymptoms are best treated by the hypodermatic injection of pilocarpine \nand the delirium by the application of an ice-cap to the head. Chloro- \nform or ether may be used to control spasms. In the stage of depression \nstimulants should be given subcutaneously and strong coffee by the \nrectum. Warmth must be applied to the surface and extremities, and \nartificial respiration may be called for. The effects on the eye may be \ncounteracted by the local application of physostigmine, as well as by \npilocarpine. \n\nANTAGONISM. \n\nThe antagonism between atropine and morphine is discussed on page \n864. Morphine might, on theoretical grounds, be administered in the \nearly stages of atropine poisoning, but its action on the respiratory \ncentre renders its use dangerous in severe cases, for the stimulation \ncaused by atropine soon passes into depression, and the effects of the \ntwo drugs would therefore supplement each other. As a sialogogue, \ndiaphoretic and myotic, pilocarpine completely antagonizes the action of \natropine on the secretory nerve endings in the salivary and sudoriparous \nglands and the terminal filaments of the motor oculi nerve in the iris \nand ciliary muscle. Contraction of the pupil and spasm of the ciliary \nmuscle are also induced by physostigmine, which in like manner stimu- \nlates the motor oculi terminations, and it is furthermore antagonistic to \natropine in that it at once has a depressant action on the respiratory \ncentre. \n\nHOMATROPINE HYDROBROMIDUM.\xe2\x80\x94 Homatropine Hydro- \nbromide. Dose, 0.0005 gm. (0.5 milligm.) ; T lj gr. \n\nAction of Homatropine Hydrobromide. \nIts action appears to be much the same as that of atropine, \nbut it is less poisonous and its mydriatic effects, while more \nrapidly produced, are somewhat less complete. It also has the \neffect of slowing, instead of accelerating, the action of the \nheart. \n\nTherapeutics of Homatropine Hydrobromide. \n\nIt is largely employed for the purpose of dilating the pupil \n\nin ophthalmic practice, and it has the advantage over atropine \n\nthat the mydriasis passes off in about one-quarter of the time. \n\nIt is therefore better adapted for diagnostic purposes, while \n\n53 \n\n\n\n8l8 PHARMACOLOGY AND THERAPEUTICS. \n\natropine is preferable when it is desired to keep the pupil dilated \nfor some time, as in the treatment of iritis. It may be used in \nsolution, i to 120 of distilled water. Sometimes a solution in \ncastor oil is employed, as being less liable to be washed out by \nthe tears, but this may produce some irritation. \n\nUnofficial Preparation. \nDuboisinae Sulphas. \xe2\x80\x94 Duboisine Sulphate. \n\nAction of Duboisine. \n\nThe action of duboisine is practically the same as that of \natropine. \n\nTherapeutics of Duboisine. \n\nIt is principally employed in ophthalmic practice, and its \nadvantages over atropine are its more rapid action, the shorter \nduration of its mydriatic effects, and the slight degree of con- \njunctival irritation produced by it. Discs containing .000013 \ngm. (-g-oVoS 1 *-) are used to dilate the pupil. It has been given \nwith alleged good results in puerperal mania, the mental excita- \nbility of the insane, paralysis agitans, and the morphine habit. \nIt has also been used in place of atropine in the night-sweats \nof phthisis, respiratory neuroses, cardiac failure, and other \nconditions. \n\nSTRAMONIUM. \n\nSTRAMONIUM (Stramonii Folia, U. S. P., 1890).\xe2\x80\x94 Stramonium. \n(Thorn Apple. Jamestown Weed.) Dose, 0.065 gm. (65 milligm.) ; \n1 gr. \n\nPreparations. \n\n1. Fluidextractum Stramonii (Extractum Stramonii Seminis, \nU. S. P., 1890). \xe2\x80\x94 Fluidextract of Stramonium. Dose, 0.05 C.C.; \n\nim. \n\n2. Extractum Stramonii. \xe2\x80\x94 Extract of Stramonium. Dose, \n0.010 gm. (10 milligm.) ; i gr. \n\n3. Tinctura Stramonii. \xe2\x80\x94 Tincture of Stramonium. Dose, 0.5 \nc.c; 8 TTL. \n\n4. Unguentum Stramonii. \xe2\x80\x94 Stramonium Ointment. \n\n\n\nSTRAMONIUM. 819 \n\nUnofficial Preparation. \nStramonii Semen (U. S. P., 1890). \xe2\x80\x94 Stramonium Seed. Dose, \n0.05 to 0.15 gm.; 1 to 3 gr. \n\nAction of Stramonium. \nThe physiological action of stramonium is practically the \nsame as that of belladonna, though it is asserted that in poison- \ning by it irregularity of the heart\'s action is more marked. It \nalso appears to relax the bronchial muscle more completely than \nbelladonna. It is generally regarded as more toxic than the \nlatter, and accidental poisoning by it, especially among children, \nis quite common. \n\nTherapeutics of Stramonium. \nStramonium might, apparently, be employed for all the vari- \nous purposes of belladonna, but it is not very often used except \nto relieve the spasm of the bronchial tubes in cases where this \nproduces the symptom asthma. Here it is of very great value. \nIt may be given internally, but most commonly the fumes from \nthe burning leaves are inhaled from cigarettes or otherwise, \nand the drug is more beneficial when used in this way. The \nfollowing powder, when burned, is often very efficient in giving \nrelief: Powdered leaves of Datura Stramonium, Datura Tatula \n(not official), Cannabis Indica, and Lobelia Inflata, of each, 12; \nnitre in powder, 16; oil of eucalyptus, I. Mix thoroughly. \nHimrod\'s, Bliss\'s and other " cures " for asthma are of similar \ncomposition. Stramonium leaves are sometimes applied locally \nin poultices or fomentations for their anodyne effect, and the \nointment is more or less used for irritable or malignant ulcers, \nhaemorrhoids, fissures and other painful affections, especially \naround the anus. \n\nHYOSCYAMTJS. \n\nHYOSCYAMUS.\xe2\x80\x94 Hyoscyamus. (Henbane.) Dose, 0.500 gm. (500 \nmilligm.) ; 7y 2 gr. \n\nPreparations. \n1. Extractum Hyoscyami. \xe2\x80\x94 Extract of Hyoscyamus. Dose, \n0.065 gm. (65 milligm.); 1 gr. \n\n\n\n820 PHARMACOLOGY AND THERAPEUTICS. \n\n2. Fluidextr actum Hyoscyami. \xe2\x80\x94 Fluidextract of Hyoscyamus. \nDose 0.2 c.c.; 3 IT].. \n\n3. Tinctura Hyoscyami. \xe2\x80\x94 Tincture of Hyoscyamus. Dose, \n1 c.c; 15 m_. \n\nHYOSCINE HYDROBROMIDUM. \xe2\x80\x94 Hyoscine Hydrobromide. \nDose, 0.0005 gm. (0.5 milligm.) ; ^gr. \n\nHYOSCYAMINE SULPHAS. \xe2\x80\x94 Hyoscyamine Sulphate. Dose, \n0.0005 gm. (0.5 milligm.) ; T ^ gr. \n\nHYOSCYAMINE HYDROBROMIDUM.\xe2\x80\x94 Hyoscyaminse Hydro- \nbromidum. Hyoscyamine Hydrobromide. Dose, 0.0005 gm. (0.5 \nmilligm.) ; T | \xc2\xa5 gr. \n\nSCOPOLAMINE HYDROBROMIDUM. \xe2\x80\x94 Scopolamine Hydro- \nbromide. Dose, 0.0005 gm. (0.5 milligm.) ; T | \xc2\xa5 gr. \n\nAction of Hyoscyamus. \nAs may be inferred from the alkaloidal composition of the \ndrug, the action of hyoscyamus is very similar to that of bella- \ndonna and stramonium. There are some particulars, however, \nin which it differs, though the difference is really one of degree \nrather than of kind. Thus, under atropine the primary stimu- \nlation of the central nervous system is usually very marked, \nwhile with hyoscyamus (an effect due to the influence of both \nits alkaloids) the stage of stimulation is much shorter, or may \napparently be entirely absent. By its depressant action it may \ntherefore produce drowsiness and sleep without any preliminary \nexaltation. Both hyoscyamine and hyoscine, as a rule, are \npowerful hypnotics, and the sleep caused by them very closely \nresembles natural sleep. It is to be noted, however, that in \nsome instances this is preceded by a stage of excitement, with \nconfusion and garrulous delirium, as in the case of atropine, \nwhile occasionally the hypnotic effect is almost or altogether \nabsent. In fact, they may have the opposite effect and cause \ninsomnia. Hyoscine is even more depressant to the brain than \nhyoscyamine, and very small amounts are usually sufficient to \ninduce sleep. As a rule, no confusion is complained of on \nawaking, but dryness of the throat and thirst are said to be \n\n\n\nHYOSCYAMUS. 821 \n\noften present. As regards the peripheral action, while induc- \ning the same effects, it is believed that hyoscyamine acts some- \nwhat more powerfully on the heart, intestine, pupil and sweat- \nglands than atropine, while hyoscine appears to have a still \nstronger action on the peripheral nerve terminations than hyos- \ncyamine, and in man produces no distinct quickening of the \npulse. Hyoscine is generally said to produce mydriasis and \nloss of accommodation more quickly than atropine, but for a \nshorter period, and according to some observers it acts five \ntimes more strongly on the pupil than that alkaloid. Scopola- \nmine is chemically identical with hyoscine. \n\nTherapeutics of Hyoscyamus. \n\nThe preparations of hyoscyamus are weaker than the corre- \nsponding ones of belladonna, and accordingly must be used in \nlarger doses. In general, the drug might be employed to ful- \nfill any of the indications for which belladonna is used, but in \npractice it is almost exclusively given for two special purposes. \nAs the peripheral action of its alkaloids is more powerful than \nthat of atropine, it has more effect in preventing local con- \ntractions of the intestine depending upon nervous stimulation, \nand thus obviating griping, and hence it is very largely given \nwith purgatives on this account. In the same way, it has a \nmore marked sedative action on the urinary unstriped muscle \nthan belladonna, and accordingly it is also much used to relieve \nvesical spasm in the same class of affections in which, as we \nhave seen, belladonna is of service. It is very commonly pre- \nscribed with other urinary sedatives, such as buchu, uva ursi, \nor benzoic acid if the urine be alkaline. \n\nHyoscyamine and hyoscine (scopolamine) are very power- \nful alkaloids and should always be administered with great \ncaution, especially as the activity of different specimens varies. \nHyoscine is the less dangerous of the two. Both are used as \nhypnotics to a considerable extent, and especially in hospitals \nfor the insane. They often act very satisfactorily in cases of \nmania, delirium tremens, hysteria, etc., and may also be given \n\n\n\n822 PHARMACOLOGY AND THERAPEUTICS. \n\nfor the delirium of fevers and for severe insomnia. Hyoscine \nis the one more commonly used; it is generally given by hypo- \ndermatic injection and is often combined with morphine. Some \npatients, it is found, are not quieted by the drug, but pace up \nand down in a semi-insane condition till its action has worn \noff. It is considered of great value in spermatorrhoea and sem- \ninal emissions. A certain degree of tolerance is produced by \nit, - so that it is necessary to increase the dose from time to \ntime in any case where its use is continued for some time. \nThese alkaloids have been employed in chorea, paralysis agi- \ntans, locomotor ataxia, and a variety of other nervous affec- \ntions, but apparently without permanent benefit. Hyoscyamine \noften temporarily controls very efficiently the tremor of paraly- \nsis agitans, and it is at times very useful in the treatment of \nthe morphine habit, though it should not be given habitually in \nthese cases. It is used to some extent in ophthalmic practice. \n\nSCOPOLA. \n\nSCOPOLA.\xe2\x80\x94 Scopola. Dose, 0.045 gm. (45 milligm.) ; % gr. \n\nPreparations. \ni. Extractum Scopolae. \xe2\x80\x94 Extract of Scopola. Dose, 0.010 gm. \n(10 milligm.) ; * gr. \n\n2. Fluidextractum Scopolae. \xe2\x80\x94 Fluidextract of Scopola. Dose, \n0.05 c.c; 1 n\\. \n\nSCOPOLAMINE HYDROBROMIDUM. \xe2\x80\x94 Scopolamine Hydro- \nbromide. Dose, 0.0005 gm. (0.5 milligm.) ; T ^ f gr. \n\nAction of Scopola. \nScopola is a mydriatic, analgesic and hypnotic. Its action \nappears to be identical with that of belladonna in kind, though \ndiffering somewhat in degree. Thus, scopola is to some extent \nmore depressant to the spinal cord and is decidedly more toxic. \nLike belladonna, it has been found to raise the blood-pressure, \nparalyze the vagus terminations, and primarily stimulate the \nrespiratory centre, while in lethal amounts it causes death by \n\n\n\nSCOPOLA. 823 \n\nasphyxia. In the frog it is stated to be a paralyzant to the \nspinal cord and to Setschenow\'s centre, and, when brought in \ndirect contact with a motor nerve, to lessen its function. From \nthe fact that, as mentioned, scopola is slightly more depressant \nto the cord and is also considerably more toxic than belladonna, \nit is believed that the dominant alkaloids of the two drugs are \nprobably not identical. As regards effects upon the eye, sco- \npola acts much more promptly, but for a shorter time, in dilat- \ning the pupil and slightly increasing the tension of the globe, \nwhile the systemic effects are more pronounced than from bella- \ndonna. The general conclusions which have been derived from \na series of recent researches by a number of different investi- \ngators are as follows: While scopola is more depressing and \ntoxic than belladonna, yet when administered externally it \nshows almost no tendency toward absorption to the extent of \nproducing systemic effects. When it is absorbed, however, it \nacts locally with promptness and energy. As regards the eye, it \neffects are more rapid and less prolonged. In all the other ways \nexperimented with it acts more efficiently, with the exception of \nthe matter of plasters, where it is slightly less efficient than \nbelladonna. Scopola exhibits a distinct superiority over bella- \ndonna root in its greater uniformity of alkaloidal percentages. \nThe predominating alkaloid of scopola is hyoscyamine in an \nalmost pure condition. \n\nTherapeutics of Scopola. \nScopola has been employed for a number of the same pur- \nposes as belladonna. It is to be noted, however, that while \nbelladonna is active, scopola is nearly inert, when used by in- \nunction either in the form of the pure fluidextract or in lini- \nment. It is apparently more efficient than belladonna when \nused as a solid extract to dry the milk in breasts after wean- \ning. It is advised that the drug should not be given when renal \ndisease is present, nor in advanced age. Scopolamine hydro- \nchloride is employed, in solutions of from T L to J per cent, in \n\n\n\n824 PHARMACOLOGY AND THERAPEUTICS. \n\neye practice and by hypodermatic injection in hospitals for the \ninsane. \n\nALCOHOL. \n\ni. ALCOHOL.\xe2\x80\x94 Alcohol. (Ethylic Alcohol. Spirit of Wine.) \n\nPreparation. \nAlcohol Dilutum. \xe2\x80\x94 Diluted Alcohol. (Proof Spirit.) \n\n2. ALCOHOL ABSOLUTUM.\xe2\x80\x94 Absolute Alcohol. \n\n3. SPIRITUS VINI GALLICL\xe2\x80\x94 Brandy. \n\n4. SPIRITUS FRUMENTL\xe2\x80\x94 Whiskey. \n\n5. VINUM ALBUM.\xe2\x80\x94 White Wine. \n\n6. VINUM RUBRUM.\xe2\x80\x94 Red Wine. \n\nUnofficial Preparation. \nAlcohol Deodoratum (U. S. P., 1890). \xe2\x80\x94 Deodorized Alcohol. \n\nAction of Alcohol. \nExternal. \xe2\x80\x94 Alcohol is antiseptic and disinfectant, but it has \ncomparatively little bactericidal action at the temperature of \nthe body. 50 to 70 per cent, alcohol is said to be more destruc- \ntive to germs than either stronger or weaker solutions. Curi- \nously enough, it has been pointed out that many substances \nwhich are antiseptic when dissolved in water lose much of this \nproperty when dissolved in alcohol, and it seems to be an estab- \nlished fact that the presence of alcoholism, whether acute or \nchronic, actually predisposes to bacterial infection. This is a \nmatter of common observation in the human subject, and has \nbeen demonstrated repeatedly in experiments on animals, whose \npower of resistance is diminished by alcoholization. Alcohol \nis both refrigerant and rubefacient, and is also astringent, an- \nhydrotic and slightly anaesthetic. Applied to the skin, it quickly \nevaporates ; thereby cooling the surface, with the effect of tem- \nporarily constricting the superficial vessels and checking the \nsecretion of the sweat-glands. If, however, evaporation is pre- \nvented, as by covering the spot with a watch-glass or piece of \n\n\n\nALCOHOL. 825 \n\nrubber, or by rubbing the application in, the alcohol (which has \nthe property of extracting water from all tissues) promptly \nabsorbs moisture from the skin, and thus has the effect of hard- \nening it. Having passed through the epidermis, it exerts an \nirritant action, similar to that of the volatile oils, which pro- \nduces a dilatation of the vessels and redness, itching and a sen- \nsation of heat in the part. It also causes a temporary pre- \ncipitation of albumins. Upon ulcers and abraded surfaces the \nirritant action is much more marked. The albumin is coagu- \nlated and there is first an astringent and afterwards a corrosive \neffect, until the alcohol becomes diluted by the fluids of the \nwound. \n\nInternal. Mouth. \xe2\x80\x94 Upon the mucous membrane of the mouth \nand pharynx concentrated solutions cause effects similar to \nthose on the skin when evaporation is prevented, but there is \nmore of a burning sensation produced, and at once also there \nresults, from reflex action, an increased flow of saliva and pos- \nsibly a quickening of the pulse. Then follows a slight local \nanaesthesia, and if the alcohol is held in the mouth for some \ntime, the mucous membrane becomes whitish and opaque, from \ncoagulation of albumin and abstraction of water from the tis- \nsues. This soon disappears, as resolution of the albumin \noccurs. \n\nG astro -intestinal Tract. \xe2\x80\x94 In the stomach also a burning sen- \nsation is produced by concentrated solutions, and large quanti- \nties give rise to so much local irritation that nausea and vomit- \ning are caused. In animals it has been demonstrated that alco- \nhol, when given in moderate amount, induces, by its irritant \naction on the walls of the stomach, an increased cell activity, \na more active circulation, and a more rapid secretion of both \nacid and solids of the gastric juice; also that gastric peristalsis \nis augmented and the absorption of fluids from the stomach and \nintestine much accelerated. In man the same effects have been \nobserved in cases of gastric fistula, and it has generally been \nfound by experimenters that the digestion is promoted. In \nsome instances, however, in which observations on the dura- \n\n\n\n826 PHARMACOLOGY AND THERAPEUTICS. \n\ntion of gastric digestion with and without alcohol were made, \nit was found that the process was retarded, instead of being \naccelerated, by this agent. To explain this discrepancy it has \nbeen suggested that the effect must vary in different individ- \nuals, and that it is not unlikely that the taste has some influence \non the result; so that in those who enjoy the taste of alcohol \nit induces a more rapid secretion and an improved digestion, \nwhile in those to whom it is disagreeable, the secretion is in- \nhibited. In general, it may be said that alcohol in moderate \namounts tends to favor the process of digestion through an \nincreased secretion of gastric juice, increased gastric move- \nment, and increased absorption. With a percentage above 15, \nthese are found to be counteracted by the lessened ferment \naction; so that the actual result will depend upon which of \nthese two \xe2\x80\x94 the beneficial irritant or the deleterious anti-ferment \naction \xe2\x80\x94 predominates. Small amounts of weak alcohol taken \nat meals, it would seem, therefore, can scarcely have a bad \neffect upon digestion, and may be of service in promoting it. \nThe primary effect of the irritation of the gastric mucous mem- \nbrane is to sharpen the appetite, and this explains the quite \ncommon custom of taking a little alcohol just before meals. \nFurthermore, the local anaesthetic effect of alcohol may at \ntimes prove useful in relieving gastric pain. Alcohol is unique \nin one respect, no other known substance, it is said, having this \neffect: it causes the gastric glands to secrete when it is intro- \nduced into the small intestine or even into the rectum. It would \nseem, therefore, that it may act generally throughout the whole \nintestinal canal, to stimulate the flow of the gastric juice. In \naddition, alcohol by promoting the latter, indirectly promotes \nthe pancreatic secretion also, since it has been shown that the \nchief stimulus to the flow of pancreatic juice is the action of \nthe hydrochloric acid of the gastric juice upon the wall of the \nduodenum. The injection of a single dose of alcohol in concen- \ntrated form, as pure brandy, is immediately followed by pro- \nnounced reflex effects. Thus, the action of the heart is accel- \nerated and increased in force, the blood-vessels generally, and \n\n\n\nALCOHOL. 827 \n\nparticularly those of the skin, become dilated, giving rise to a \nfeeling of warmth throughout the body, and the blood-pressure \nrises. The respiration is also quickened. These reflex effects, \nwhich are not produced by dilute forms of alcohol, such as \nbeer, are well shown in the immediate restoration of a faint- \ning person by a dose of brandy. They are quickly followed by \nthe action on the circulation of the alcohol after its absorption \ninto the blood. The repeated use of large amounts of alcohol \nleads to persistent congestion of the mucous membrane, and, if \nlong continued, to chronic gastritis. The activity of the gas- \ntric juice is soon impaired and afterwards lost, the gastric \nglands atrophy, an excessive amount of mucus is secreted, and \nthe permanent dyspepsia of drunkards results. In the intes- \ntines alcohol ordinarily has a slightly astringent effect. In \ndrunkards, however, there usually results a catarrhal enteritis, \nas well as gastritis. \n\nMetabolism. \xe2\x80\x94 About 90 per cent, of the alcohol absorbed from \nthe alimentary tract is found to undergo combustion. In doing \nso it gives up energy to the body, and is therefore to be con- \nsidered as a food, though the mere fact of its transmission of \nenergy does not constitute it an advisable food in all conditions. \nAlcohol ceases to be a food when it is ingested in such large \namounts that it cannot be completely oxidized. In this in- \nstance the excess is likely to be harmful. Taken in addition \nto the ordinary food, alcohol is either itself transformed into \ntissue, or undergoes oxidation in the place of some substance \nwhich in turn is utilized to build up the body. It has been \nshown that alcoholized animals lay on more fat than others \nreceiving the same food without alcohol, and it is a familiar \nfact that in the human subject habitual drinkers evince a \nmarked tendency to obesity. It is evident, therefore, that to \nsome extent, at least, alcohol acts as a substitute for fats and \ncarbohydrates in the food. While, however, it is well known \nthat these principles can without any injurious effect be sub- \nstituted for a certain amount of the nitrogenous food required \nby the system, it is as yet an undetermined question how far al- \n\n\n\n828 PHARMACOLOGY AND THERAPEUTICS. \n\ncohol, although undergoing combustion in the tissues and leading \nto the deposition of fat, is able to replace the fats and .carbo- \nhydrates in their relation to nitrogenous metabolism. As far \nas can be judged, it would seem that while alcohol really tends \nto prevent the waste of fats and carbohydrates, it is probably \nof less value than the latter in economizing nitrogenous waste; \nso that if alcohol is used as a food it should be associated with \na diet rich in albuminous matter. Under these circumstances it \nis believed to be capable of replacing to some extent the ordinary \nfood-stuffs. The only way in which alcohol, in moderate \namounts, is supposed to have any action on the tissues is as a \nfood, since the oxidation of the tissues, as measured by the \nabsorption of oxygen and exhalation of carbon dioxide, is af- \nfected only in the same way as by any other food. When \nexcessive quantities of alcohol are taken, the combustion of the \ntissues is first greatly augmented by the violent movements \ncharacterizing the stage of excitement, but later it becomes \nreduced from the lessening of the rri\'uscular movements in con- \nsequence of the stupor and depression induced. Naturally, fats \nare saved from combustion by the oxidation of alcohol by the \ntissues, and it is thought possible that in the case of some other \nbodies also, as benzene, the energy which would ordinarily be \nexpended in their oxidation, is diverted to that of the alcohol. \nThe observations on the effect of alcohol in moderate doses on \nnutrition have led to the following conclusions : ( I ) With a \ndiet on which the individual gains in weight, the addition of \nalcohol lowers the rate of increase; (2) when added to a diet \non which the weight remained constant, it tends to cause a loss \nof weight; (3) with insufficient diet, it lessens the loss of \nweight, or may even cause a gain. \n\nBlood and Circulation. \xe2\x80\x94 On the leucocytes of the blood it \nhas the effect of first augmenting and then reducing the amoe- \nboid movements; while as regards the red corpuscles it inter- \nferes with the ready yielding up of its oxygen by the oxyhemo- \nglobin, and thus tends to retard oxidation in the tissues. The \nreflex effects of alcohol on the circulation have been referred \n\n\n\nALCOHOL. 829 \n\nto in connection with its influence on the alimentary tract. Its \naction on the circulation after absorption has been the subject \nof much controversy. There is always a quickening of the \nheart during the excitement of alcoholic intoxication, but there \nis reason to believe that this is due to the increased muscular \nmovement, rather than to any direct action on the heart. It \nhas been shown that in normal cases the pulse-rate is unaf- \nfected by alcohol, provided that no excitement be produced by \nthe environment, and this also remains unaltered in animals, \nunless a very large amount of alcohol is administered. In that \ncase there are induced weakening of the auricular systole and \nafterwards of the ventricular, with distention of both cavities \nand slowing. It has been pointed out that these effects are \nsimilar to those caused by ether and chloroform, though the \ninfluence on the heart is very much less marked than in the \ncase of these drugs. Whatever action alcohol has as regards \nthe heart appears to be on the cardiac muscle. While it has \nbeen claimed that it increases the force of the contraction, \nproof, of this is lacking, and, on the contrary, experiments on \nanimals have indicated that the first effect of alcohol on the \nheart is diminished efficiency and weakness of the contractions. \nIn alcoholic intoxication one of the most noticeable features \nrelating to the circulation is the flushing of the cutaneous sur- \nface. This can be attributed only to dilatation of the vessels \nof the skin, but it is undetermined whether such dilatation is \nthe result of stimulation of the dilator centres or paresis of the \nvaso-constrictors. This action apparently has very little effect \non the general blood-pressure. A marked fall in this is caused \nby very large amounts of alcohol, which weaken the muscular \ntissue of the heart and depress the vaso-constrictor centres ; but \nno such effect is to be expected from medicinal doses. In fever \nthe heart is frequently slowed by the administration of alcohol, \nand the results of study of its influence on the circulation would \nseem to indicate that this is due to its effect in diminishing \ncerebral excitement, rather than to any direct action on the \nheart. In shock, whatever improvement in the circulation may \n\n\n\n83O PHARMACOLOGY AND THERAPEUTICS. \n\nfollow the use of alcohol is to be attributed to the reflex influ- \nence from its local irritant action which has already been men- \ntioned. It would appear that the reputation which alcohol has \nlong enjoyed as a cardiac stimulant is not altogether supported \nby fact; but, at the same time, there can be no question that it \nis often of value in circulatory disorders for this reason, if for \nno other, that by its cerebral action it tends to lessen anxiety \nand other mental symptoms. \n\nRespiration. \xe2\x80\x94 While experimenters now agree as to the main \nfacts in the action of alcohol on the respiratory function, the \ninterpretation of these is still a matter of dispute. During the \nexcitement of alcoholic intoxication the respiration is usually \nquickened, and this may be due simply to the increased mus- \ncular activity rather than to a stimulation of the respiratory \ncentre in the medulla. Such excitement is not induced by \ntherapeutic doses, but the evidence at command goes to show \nthat without this the amount of air inhaled is generally in- \ncreased by alcohol, and such increase has even been noted in \nsome cases where a well-marked narcotic effect was present. \nAt present it is impossible to say whether the augmentation of \nthe air inhaled is due to direct action on the respiratory centre \nor to reflexes arising from the stomach, to both of which agen- \ncies it has been attributed by different observers. This is a \nquestion of practical importance in cases in which the respira- \ntion is insufficient, and not one of merely theoretical interest; \nfor, it has been pointed out, if the augmented respiration is \ncaused only by the local action in the stomach, this indicates \nthat much of the surplus oxygen is used in doing the work of \nabsorbing the alcohol, and that the rest of the body profits to \na correspondingly small extent from the increased aeration. \nOn the other hand, if the air inspired is augmented in a greater \nratio than the products of the increased activity of the alimen- \ntary tract, as is the case when the respiratory centre is directly \nstimulated, the advantage to the organism is correspondingly \ngreat. On the whole, it would seem that while the use of \nalcohol as a respiratory stimulant is not actually supported by \n\n\n\nALCOHOL. 83I \n\nexperimental investigation, it is nevertheless not to be entirely \ncondemned. \n\nNervous System. \xe2\x80\x94 Alcohol is very generally regarded as a \ncentral nervous stimulant, which first excites and then depresses \nthe cerebral and other cells. It should be stated, however, that \nthe majority of experimental observers lean to the view that \nthe stimulation is apparent rather than real. Their explana- \ntion of the cerebral excitement caused by alcohol is that it is \ndue, not to the augmented vitality of the nerve cells, but to a \nloss of the associations which ordinarily retard the expression \nof mental activity. Their argument against the stimulant ac- \ntion of alcohol is based on the narrow limits to which this is \nconfined. While it is true that all the central nervous stimu- \nlants act on some particular part, in small doses, it is found \nthat when larger amounts are employed, the stimulant action \nspreads over a wider area of the central nervous system and \ngives rise to the symptoms characteristic of stimulation of that \narea. Alcohol, they claim, appears to have only a depressant \naction on the nervous tissues, except in the human cerebrum; \nthough it is true that the exceptional development of the human \nbrain might permit of a departure which is without analogy \nwith other forms of poisoning. The conclusion arrived at by \nthem is that the investigations thus far made point strongly to \nthe correctness of the theory that alcohol really acts as a nar- \ncotic. The acceptation of this theory, they hold, is by no means \nequivalent to condemning the therapeutic use of alcohol for its \neffects on the brain, but, on the contrary, it is maintained that \nthe narcotic or depressant action of alcohol, far from being in \nconflict with its clinical use, supplies a definite and logical ex- \nplanation of the improvement noted in a large number of in- \nstances where the effect of alcohol in allaying the subjective \nsymptoms, relieving the nervous strain, and promoting the rest \nand comfort of the patient is not surpassed by that of any other \ndrug. Accordingly, it would seem a question whether the re- \nsults aimed at by the clinician when he prescribes alcohol have \nnot been misnamed stimulation, and are not in reality narcotic \n\n\n\n832 PHARMACOLOGY AND THERAPEUTICS. \n\nin their nature, and hence in entire agreement with the experi- \nmental results. The clinician, it is suggested, in applying the \nterm stimulant to alcohol, uses the word in quite a different \nsense from that in which it is understood by the experimental \nobserver \xe2\x80\x94 his meaning is less definite, and he wishes to indi- \ncate only the improvement often noted in the general condi- \ntion, without considering whether this is due to an augmenta- \ntion or a retardation of the mental processes. The view gen- \nerally accepted in the medical profession is that alcohol is a \npowerful nervous as well as cardiac stimulant, and that the \nincreased functional activity which it induces, especially in the \nnervous system, is followed by a period of diminished activity \nor depression ; furthermore, that alcohol, like many other drugs, \nacts on the higher functions first, so that the stimulation and \nthe subsequent depression proceed in a descending scale from \nthe highest or least firmly fixed function to the lowest or most \nfirmly fixed, in accordance with the Law of Dissolution (see \np. 737). In the highest centres the special effect produced by \nalcohol appears to depend on the nature of their activity in the \nindividual. In many individuals moderate amounts increase \nthe facility of speech and in exceptional instances the brilliancy \nof thought. It must be acknowledged, however, that some of \nthe highest functions of the brain are thrown out of action by \ndoses of the drug which induce the. phase of exhilaration. \nThus, while a person may show greater brilliancy in conversa- \ntion and generosity of sentiment, he is apt to lack that con- \nsideration for his own position or that of others which he ordi- \nnarily manifests, and to lose his self-control and self-restraint, \nhis sense of responsibility and his power of discrimination. \nSuch results would be explained, according to the stimulant \ntheory, by the brief period during which the activity of the \nhighest centres is augmented; so that the power of judgment \nbecomes abolished very early, while the imagination, the emo- \ntions, and the power of speech are still in increased activity. \nThese various functions then successively fail in the order \nnamed, and after them the muscular movements, commencing \n\n\n\n\n\n\nALCOHOL. 833 \n\nwith the more delicate, become first incoordinated and then \nparalyzed. If the quantity of alcohol taken is sufficiently large, \nthe reflex activity of the spinal cord next becomes abolished, \nand the bladder and bowels are evacuated involuntarily. The \ncomparative immunity from injuries in falling, etc., which is \noften noted in drunken people, is believed to be due to the \ndepression of the reflex centres of the cord, since the heart \nand respiration, on account of the general central depression, \nare not affected reflexly by them. After the spinal centres, the \nrespiratory centre in the medulla fails, and finally the heart \nmay be paralyzed and death result. A fatal issue of the poison- \ning, however, is exceptional, and generally recovery takes place \nafter a prolonged sleep. This is deep and torpid, passing into \ntotal unconsciousness, with slow and stertorous breathing, while \nthe face, which has hitherto been flushed, grows pale or cyan- \notic. If unconsciousness continues for more than ten or twelve \nhours, it is said that a fatal result is almost certain to occur. \nIt has been conclusively shown that regiments supplied with \nalcoholic liquors are less capable of long marches and suffer \nmore from fatigue than others without them, and, in addition, \nthat the capacity for forms of work in which more mental \nactivity is required than by marching soldiers is lessened by \nalcohol. Thus, when even a small quantity of alcohol is al- \nlowed, typesetters do a less amount of work and make a larger \nnumber of errors than when they are not supplied with it, \nwhile students exhibit a diminished capacity for mental work \nand less ability to keep the attention concentrated. The ten- \ndency toward sexual excess frequently observed after alcohol \nis not due to any influence upon the generative organs them- \nselves, but to the loss of control from the cerebral action of \nthe drug. \n\nTemperature. \xe2\x80\x94 Small doses of alcohol have no effect on the \nbody-temperature, although, in consequence of the dilatation of \nthe gastric and cutaneous blood-vessels induced, they cause a \nsense of warmth both internally and on the surface. Moderate \namounts (30 to 90 c,c r ; 1 to 3 fl. oz.) cause a fall of .5\xc2\xb0 C, \n54 \n\n\n\n834 PHARMACOLOGY AND THERAPEUTICS. \n\nand this without causing intoxication. The reduction of tem- \nperature is believed to be due chiefly to a loss of heat from \nthe dilatation of the cutaneous vessels. This is usually accom- \npanied by a feeling of warmth, and a thermometer applied to the \nskin may actually show a rise of several degrees, in consequence \nof more warm blood flowing through the vessels. If much \nexcitement and movement are caused by the drug, the increased \nheat resulting may counterbalance the augmented output; so \nthat there may be no fall in the temperature, and in some cases \neven an elevation may be observed. Narcotic doses generally \ncause a fall amounting to from 3 to 5 C, which is due to the \nlessened movements during unconsciousness and may last for \na considerable time. During exposure to cold a more marked \nreduction of temperature than under ordinary conditions ap- \npears to be caused by alcohol, in consequence, perhaps, of its \nrendering the heat-regulating mechanism less sensitive. Alco- \nhol is, therefore, very unsuitable for a person who has to be \nexposed to severe cold. Besides, it causes drowsiness, and in \nthis way dangerous results and even death may occur from a \nfree indulgence in liquor under these circumstances. \n\nSkin. \xe2\x80\x94 Alcohol is a mild diaphoretic, the action of the sweat- \nglands being augmented by the dilatation of the cutaneous ves- \nsels and also possibly by some direct influence on the glands. \n\nKidneys. \xe2\x80\x94 Alcohol has some diuretic influence, but it is un- \nknown whether this is due at all to a direct action on the \nkidney. Some of the spirituous liquors, such as gin, induce \nfree diuresis, but this is owing to the other constituents rather \nthan the alcohol. \n\nExcretion. \xe2\x80\x94 The small percentage of alcohol which is not \noxidized in the tissues is excreted unchanged, principally by \nthe lungs and kidneys and to a very much less extent in the. \nsweat and milk. The exact amount thus eliminated varies with \nthe quantity taken. If the amount ingested is very large, about: \n0.3 per cent, escapes in the milk, but if moderate, none. The \npopular notion that an infant may become intoxicated or acquire \na taste for spirituous liquors from the alcohol absorbed in the \n\n\n\nALCOHOL. 835 \n\nmilk of a drunken mother or wet-nurse is without any founda- \ntion in fact. Both the amount and quality of the milk are said \nto be unaffected by the administration .of alcohol. When me- \ndicinal doses are taken, it is found that the quantity excreted \nthrough the lungs amounts to 5 l / 2 to 6 1 /- per cent., and through \nthe kidneys at most to 1 to 2~/ 2 per cent., while none is elim- \ninated by the skin. Alcohol has been demonstrated in the blood \nfor twenty-four hours after intra-venous injection of large \nquantities. \n\nTolerance is produced by the continued use of alcohol, and \nhence it is necessary to prescribe much larger doses in the case \nof habitual drinkers than for other persons. \n\nTherapeutics of Alcohol. \nExternal. \xe2\x80\x94 Alcohol is used as an evaporating lotion for \nsprains, bruises and local inflammations generally. A common \nform is the Lotio Spiritus, which is found in many hospital \npharmacopoeias, and which consists of 4 parts of rectified spirit \nto 1 of water. This is applied to the affected part upon a single \nlayer of lint or cotton, and allowed to evaporate. Diluted alco- \nhol, 3, with lead-water, 1, to which some morphine acetate may \nbe added if the pain is severe, is also employed in the same \nway. Headaches are often relieved by the refrigerant and an- \naesthetic effect of alcohol when used in the form of bay rum \nor eau de Cologne to bathe the forehead, and spirit lotions, in \nconsequence of their effect in constricting the cutaneous blood- \nvessels, may be of service in checking undue sweating. Brandy \nor ordinary alcohol is a good application for hardening the \nskin to prevent cracking of the nipples in nursing women and \nalso for the prevention of bed-sores. Its efficiency for this \npurpose may be increased by the addition of a little alum. The \nrubefacient property of alcohol may be availed of for promoting \nthe absorption of inflammatory products, or for the relief of \npain in such affections as myalgia and chronic rheumatism, by \nrubbing it in the skin in the form of Linimentum Saponis and \nother liniments into which it enters. Hot applications of alco- \n\n\n\n836 PHARMACOLOGY AND THERAPEUTICS. \n\nhol also alleviate pain, and a favorite method for securing re- \nlief in facial neuralgia, toothache, and various other painful \nconditions is the use of a flannel hop-bag which has been \ndipped in hot whiskey. A little brandy held in the mouth will \nalso frequently relieve toothache. Properly diluted, alcohol \nmay be employed as an astringent and antiseptic gargle or \nmouth-wash in pharyngitis, stomatitis, scurvy, salivation, etc. \nPort wine is very commonly used for this purpose. Concen- \ntrated alcoholic preparations are of service in the treatment \nof frost-bite, ulcers, loss of hair, freckles, and certain vegetable \nparasitic diseases. Alcohol dressings have been found valuable \nin tuberculous lesions and to relieve the pain of herpes zoster, \nand the local application of alcohol is said to be an effective \nabortive measure in- herpes. \n\nInternal. \xe2\x80\x94 Used with careful discrimination, alcohol is one \nof the most valuable remedies we possess. It is not to be \nrecommended in acute dyspepsia, as it is then apt to be irri- \ntant to the gastric mucous membrane, but given before or with \nthe meals it is in many instances of service in sharpening the \nappetite and improving the digestion, especially in the seden- \ntary, aged and feeble, and in cases of exhaustion from acute \ndisease or over-work, where the stomach is naturally affected by \nthe general condition. Sometimes it is best administered after \neating. On account of its anaesthetic effect, alcohol, as has \nbeen mentioned, may relieve gastric pain, and it is also some- \ntimes useful in allaying nausea and vomiting, particularly when \ngiven in the form of champagne or of brandy in small doses \nwith pounded ice or effervescent mineral waters. When in \ndelirium tremens nothing is retained on the stomach, so that \nthe patient\'s life may be endangered on account of the lack of \nnutriment, a little brandy and ice will sometimes settle the \nstomach, and thus enable it to receive and digest the food so \nurgently needed. In cholera infantum and in other diarrhceal \naffections, in adults as well as children, brandy is at times very \nuseful, and port wine is also employed in diarrhoeas. Alcohol \nmay relieve intestinal as well as gastric colic, but gin and hot \n\n\n\nALCOHOL. 837 \n\nwater has too often been relied upon by old nurses in the flatu- \nlence of infants and young children when proper attention to \nthe feeding would have prevented the indigestion. Alcohol is \nof immense advantage in many cases of febrile disease, where \nduring critical periods it sustains the vital powers by supple- \nmenting the insufficient quantity of nutriment which the sys- \ntem is capable of appropriating; at the same time stimulat- \ning the digestion, and thus enabling the patient to dispose of \nan increased amount of food. It is advisable under these cir- \ncumstances, therefore, that it should be given with milk, broth, \neggs or other suitable aliment. It is by no means adapted for \nall cases of fever, and hence its effects should always be very \ncarefully watched. If under its use the pulse becomes stronger \nand fuller, the tongue and skin less dry, the respiration less \nembarrassed, the delirium and subsultus less marked, and the \npatient grows more tranquil and disposed to sleep naturally, \nwe may know that the drug is doing good. Although it is not \ngiven as an antipyretic, in cases in which it thus acts bene- \nficially it will usually be found that the temperature is more or \nless reduced by it. On the other hand, if the fever rises and \nthe other effects produced are the opposite of those just men- \ntioned, the alcohol is doing harm and should be discontinued. \nWhile it is often given when it is quite unnecessary, there are \nmany instances in which it is of inestimable value in such affec- \ntions as typhoid and typhus fevers, pneumonia, small-pox, \ncholera and diphtheria, and also in gangrene, pyaemia, septi- \ncaemia, etc. It is also of the highest usefulness to arouse and \nsupport the flagging powers in sudden depression of the sys- \ntem, and may be given by the mouth, by the rectum, hypoder- \nmatically, or applied to the external surface with friction. It \nis thus resorted to in shock, syncope, severe haemorrhage, and \npoisoning by tobacco, digitalis, antimony, conium, chloroform, \nether, etc. In snake-bite and poisoning by carbolic acid it may \nnot only serve to tide the system over until the poison is elim- \ninated, but also to directly antagonize the latter in the blood, \nand it therefore constitutes the best antidote in these cases. \n\n\n\n838 PHARMACOLOGY AND THERAPEUTICS. \n\nThe beneficial effect of the reflex stimulating action of alcohol \non the circulation is well shown in cases of fainting or collapse \nfrom cold or other cause, where a single dose of strong spirits \noften promptly revives the patient. Alcohol may be said to be \nindicated in general whenever adynamia is a pressing symptom, \nand should then always be employed, tentatively at least, unless \nthere are special circumstances present which render its admin- \nistration unadvisable. In acute disease frequently, and more \nrarely in chronic conditions, it is given with excellent effect in \nquantities which in health would cause intoxication and alto- \ngether disastrous results. The case is recorded by an eminent \nclinician of a young woman suffering from pulmonary tuber- \nculosis who took one pint of whiskey daily for nearly two years \nand who finally recovered from the disease. In many instances \nof tuberculosis and other wasting diseases it is a remedy of the \ngreatest service, lessening tissue-waste, promoting constructive \nmetamorphosis, favoring the deposition of fat, and in general \ntending to retard the progress of the disease. The narcotic \neffect of alcohol on the nervous system may be employed to \nrelieve pain, to promote sleep, and to quiet delirium, but except \nin the case of acute disease it should be resorted to for these \npurposes with the greatest possible discriminating judgment, on \naccount of the patient\'s moral welfare. When given as a di- \nuretic, it is usually in the form of gin, in which its effect is \ngreatly augmented by the juniper contained in this liquor. Al- \nthough but little alcohol is excreted by the kidneys, its abuse, \nparticularly in the form of ardent spirits, is one of the recog- \nnized causes of chronic Bright\'s disease. In all inflammations \nof the urethra it seems to be irritating, and in the treatment of \ngonorrhoea is always interdicted to the patient. Beer is re- \ngarded as particularly harmful. Among the other contraindi- \ncations for the use of alcohol may be mentioned acute nephri- \ntis, all states of cerebral excitement, unless due to exhaustion, \napoplexy, meningitis, aneurism, advanced atheroma, and the \nalcoholic habit. For its diaphoretic effect, a glass of hot spirits \nand water, taken at bedtime, is frequently employed to break \n\n\n\nALCOHOL. 839 \n\nup an incipient cold. In malarious regions it is a common \npractice to take whiskey with quinine as a prophylactic against \nintermittent fever. \n\nTOXICOLOGY. \n\nVery large quantities of alcohol are capable of causing instantaneous \ndeath by reflex arrest of the heart, but such a result is rare. Commonly \nthey induce a torpid sleep which gradually deepens into a condition like \nthat seen in chloroform anaesthesia, and which may end in death, usually \nfrom respiratory failure. In some fatal cases convulsions have pre- \nceded death. When the patient is first seen in the advanced stage of \ndeep coma, the absolute diagnosis of acute alcoholic poisoning cannot be \nmade out. \n\nChronic Poisoning. \xe2\x80\x94 Among the more common results of chronic \npoisoning by the drug are chronic gastritis, cirrhosis of the liver, \ndelirium tremens and mania. A great variety of other serious diseases \nhave been attributed to its effects, among which may be mentioned \ngout, peripheral neuritis, pachymeningitis, organic heart disease, and \nchronic nephritis. There are, in fact, but few organs and tissues not in \nsome way changed in chronic alcoholism, and its results, from their \nfrequency and importance, have come to claim the attention of syste- \nmatic writers on the practice of medicine. Changes met with. It need \nonly be said here that the changes met with have been classified under \ntwo groups, sclerosis and steatosis. While these anatomical alterations \nare developing, the exterior of the body assumes characteristic appear- \nances. The subject may either be pale and flabby, but fat, with a \nheavy and imbecile expression, or have a dusky red or purplish, pimply \nand bloated skin, with bulging under the eyes, yellow and injected con- \njunctivas, and blue and swollen lips. Alcoholics are especially liable to \ncontract pneumonia, tuberculosis and other infectious diseases, and when \nattacked by them show less powers of resistance than most other per- \nsons. They are also bad subjects for surgical operations. It is possible, \nhowever, that some of the bad effects resulting from the use of alcoholic \ndrinks may be due to other substances than alcohol contained in them. \n\nUnofficial Preparation. \nAlcohol Amylicum.\xe2\x80\x94 Amylic Alcohol. (Fusel Oil.) \n\nAction of Amylic Alcohol. \nThis substance is present in small quantity in most forms of \nspirits, especially when these are freshly distilled. It has a \n\n\n\n84O PHARMACOLOGY AND THERAPEUTICS. \n\nmore violent acute action and more pronounced after-effects \nthan ethylic alcohol. \n\nTherapeutics of Amylic Alcohol. \nFusel oil is a poison, and is not used in medicine. The manu- \nfacturers of cinchona alkaloids employ it as a solvent; formerly \nit was required for the preparation of valeric acid. \n\nCANNABIS INDICA. \n\nCANNABIS INDICA. \xe2\x80\x94 Indian Cannabis. (Indian Hemp.) Dose, \n0.065 gm. (65 milligm.) ; 1 gr. \n\nPreparations. \n\n1. Extractum Cannabis Indicae. \xe2\x80\x94 Extract of Indian Cannabis. \nDose, 0.010 gm. (10 milligm.) ; \xc2\xa3 gr. \n\n2. Fluidextractum Cannabis Indicae. \xe2\x80\x94 Fluidextract of Indian \nCannabis. Dose, 0.05 c.c; 1 Hi. \n\n3. Tinctura Cannabis Indicae. \xe2\x80\x94 Tincture of Indian Cannabis. \nDose, 0.6 c.c; 10 ni. \n\nAction of Cannabis Indica. \n\nExternal. \xe2\x80\x94 None. \n\nInternal. \xe2\x80\x94 The action of cannabis indica seems to have many \nfeatures in common with that of opium, and even more closely \nresembles the action of anhalonium (see Pellotine, p. 877). Its \nprincipal influence is on the cerebrum, and it is regarded as per- \nhaps the most powerful stimulant of the psychic functions \nknown. It is largely employed for this purpose in the Orient \n(often in the form of haschisch) , and its moderate use does not \nappear to be attended by any injurious effects. When taken to \nexcess, it leads to tremor and loss of appetite and strength, and \nsometimes to mania and dementia. In some cases convulsive at- \ntacks have been observed, and among the natives of India cata- \nlepsy is said to occasionally occur. If the drug were generally \nused by Caucasians, it is thought that the effects would probably \n\n\n\nCANNABIS INDICA. 84 1 \n\nbe more serious than is usual among Orientals. Death from \nacute poisoning is stated to be extremely rare, and recovery has \ntaken place after enormous doses. At the same time, experi- \nments on dogs have shown that it undoubtedly presents some \ndanger. In the influence of cannabis indica upon the nervous \nsystem depression is mixed with the stimulation in a manner \nsimilar to that which is occasionally seen in the case of morphine. \nWithin a short time after taking it the patient experiences the \nmost pleasurable emotions. Everything seems to amuse him, \nand he becomes hilarious and indulges in actions which he may \nknow to be ridiculous but which he cannot restrain. Double \nconsciousness is now well marked; in fact the ego may become \na severe critic of the alter ego. In the exuberance of his spir- \nits he feels on the best possible, and even affectionate, terms \nwith everyone about him. He passes in^o a dreamy, semi- \nconscious state, in which, while the judgment is practically lost, \nthe imagination runs riot. All his ideas are on a grand and \nmagnificent scale; time and space seem to be indefinitely ex- \ntended. He may say brilliant or witty things, but there is little \ncontinuity in his thought, which changes rapidly from one sub- \nject to another. Delightful visions pass before him in an end- \nless phantasmagoria. True hallucinations are sometimes present \nand sometimes not. The general sensibility is much dimin- \nished, and this effect may deepen into complete anaesthesia. \nThe pupil is usually somewhat dilated. As the system becomes \nmore profoundly influenced by the drug the dreams alternate \nwith periods of consciousness, and eventually there results a \ntranquil sleep. From this the patient usually awakens without \nany feeling of depression, but refreshed and with an acute sense \nof hunger. Occasionally, in the midst of the pleasurable \nthoughts there is experienced a feeling of impending danger or \nother disagreeable sensation, and in some instances melancholia \nprecedes the stage of sleep. In the Caucasian race the primary \nstage of exaltation may be quite short, and is sometimes alto- \ngether absent, deep sleep coming on after a preliminary feeling \nof heaviness and drowsiness, with noises in the ears and numb- \n\n\n\n842 PHARMACOLOGY AND THERAPEUTICS. \n\nness of the extremities. It is a well recognized fact, however, \nthat the effects of cannabis indica may vary greatly in different \npersons. This difference of action is due largely to individual \npeculiarities and also in part, no doubt, to the varying strength \nof the preparations of the drug. In man the heart is generally \naccelerated when cannabis indica is inhaled. In animals it is \nsaid that its intravenous injection slows the heart, partly through \ninhibitory stimulation and partly through direct action on the \ncardiac muscle, and that this action on the heart is the cause \nof death after poisonous quantities. In them the general effects \nappear to resemble those met with in man and also to present \nthe same marked variations. There is sometimes observed a \nstage of exaltation with increased movement, and this is fol- \nlowed by depression and sleep. In dogs and cats vomiting is \na not infrequent symptom. In frogs the reflex excitability is \nfound to be first augmented and then depressed. While the \nhabitual use of the drug in large amount may lead to grave \npsychic disturbances, it does not appear to cause constipation \nand the same disturbance of digestion and nutrition as opium. \nSome writers, however, assert that while a single dose does not \nusually produce constipation, and may even have a slightly \nlaxative effect, after long continued administration there is a \ntendency to constipation both in man and in dogs. Dryness of \nthe mouth, thirst, nausea, vomiting and strangury are untoward \neffects occasionally seen. \n\nTherapeutics of Cannabis Indica. \nWhile the physiological effects of this agent constitute a \nvery interesting study, it is not of any great therapeutic im- \nportance, since almost any indication that it might be supposed \nto fulfill can be more satisfactorily and certainly met by other \nremedies. As a cerebral depressant it has been employed in \na considerable number of affections, and in many of them it has \nbeen entirely abandoned. As a hypnotic it is unreliable, and, \naccording to some authors, it produces sleep in only about 50 \nper cent, of the cases. In many instances there is excitement \n\n\n\nOPIUM. 843 \n\nwithout sleep. It might be used, however, in certain instances \nin which opium is contra-indicated, and also as a substitute for \nopium in some mental diseases. As an analgesic it is some- \ntimes of service. It has been given with advantage in cases \nof migraine and neuralgia, although it not infrequently fails to \nafford relief. In biliary colic it also sometimes proves success- \nful. Cannabis indica enters into the composition of the pro- \nprietary medicine known as chlorodyne {see p. 888) and vari- \nous other similar preparations which are more or less used as \nanodynes and hypnotics and are sometimes of great service in \nbowel troubles. When prescribing the tincture, the resin from \nwhich is precipitated by the addition of water, it is necessary \nto employ mucilage to suspend it, while the taste is usually \ncovered with spirit of chloroform. \n\n2. General cerebral depressants. \n\nOPIUM. \nOPIUM.\xe2\x80\x94 Opium. Dose, 0.100 gm. (100 milligm.) ; V/ 2 gr. \n\nOPII PUL VIS.\xe2\x80\x94 Powdered Opium. Dose, 0.065 gm. (65 milligm.) ; \n1 gr. \n\nPreparations. \n\n1. Extractum Opii. \xe2\x80\x94 Extract of Opium. Dose, 0.030 gm. \n(30 milligm.) ; i/ 2 gr. \n\n2. Emplastrum Opii. \xe2\x80\x94 Opium Plaster. \n\n3. Trochisci Glycyrrhizae et Opii. \xe2\x80\x94 Troches of Glycyrrhiza \nand Opium. \n\n4. Vinum Opii. \xe2\x80\x94 Wine of Opium. Dose, 0.5 c.c; 8 TTL. \n\n5. Pilulae Opii. \xe2\x80\x94 Pills of Opium. Dose, 1 pill. \n\n6. Purvis Ipecacuanha et Opii. \xe2\x80\x94 Powder of Ipecac and \nOpium. (Dover\'s Powder.) Dose, 0.500 gm. (500 milligm.); \n71/2 gr. \n\n7. Acetum Opii. \xe2\x80\x94 Vinegar of Opium. (Black Drop.) Dose, \n0.5 c.c; 8 TTL. \n\n8. Tinctura Opii. \xe2\x80\x94 Tincture of Opium. (Laudanum.) Dose, \n\n0.5 c.c; 8 ni. \n\n\n\n844 PHARMACOLOGY AND THERAPEUTICS. \n\n9. Tinctura Opii Camphorata. \xe2\x80\x94 Camphorated Tincture of \nOpium. (Paragoric.) Dose, 8 C.C.; 2 fl. dr. \n\n10. Tinctura Ipecacuanhae et Opii. \xe2\x80\x94 Tincture of Ipecac and \nOpium. Dose, 0.5 c.c; 8 T\\{. \n\nOPIUM GRANULATUM.\xe2\x80\x94 Granulated Opium. Dose, 0.065 gm. \n(65 milligm.); 1 gr. \n\nPreparations. \n\n1. Opium Deodoratum. \xe2\x80\x94 Deodorized Opium. Dose, 0.065 gm. \n(65 milligm.); 1 gr. \n\n2. Tinctura Opii Deodorati. \xe2\x80\x94 Tincture of Deodorized Opium. \nDose, 0.5 c.c; 8 7H,. \n\nMORPHINA.\xe2\x80\x94 Morphine. Dose, 0.012 gm. (12 milligm.); $ gr. \n\nMORPHINE HYDROCHLORIDUM.\xe2\x80\x94 Morphine Hydrochloride. \nDose, 0.015 gm. (15 milligm.) ; y 4 gr. \n\nMORPHINE ACETAS.\xe2\x80\x94 Morphine Acetate. Dose, 0.015 gm. (15 \nmilligm.); y 4 gr. \n\nMORPHINE SULPHAS.\xe2\x80\x94 Morphine Sulphate. Dose, 0.015 gm. \n(15 milligm.) ; y 4 gr. \n\nPreparation. \nPulvis Morphinae Compositus. \xe2\x80\x94 Compound Powder of Mor- \nphine. Dose, 0.500 gm.; 7y 2 gr. \n\nUnofficial Preparations. \nTrochisci Morphinae et Ipecacuanhae (U. S. P., 1890). \xe2\x80\x94 \nTroches of Morphine and Ipecac. Dose, 1 to 5 troches. \n\nLiquor Morphinae Bimeconatis. \xe2\x80\x94 Solution of Morphine \nBimeconate. Dose, .30 to 2.50 c.c; 5 to 40 nl. \n\nAcidum Meconicum. \xe2\x80\x94 Meconic Acid. \n\nPilula Ipecacuanhae cum Scilla. \xe2\x80\x94 Pill of Ipecacuanha with \nSquill. Dose, .30 to .60 gm.; 5 to 10 gr. \n\nTinctura Chloroformi et Morphinae Composita. \xe2\x80\x94 Compound \nTincture of Chloroform and Morphine. Dose, .30 to .60 C.C. J \n5 to 10 TTL- \n\nTinctura Opii Ammoniata. \xe2\x80\x94 Ammoniated Tincture of Opium. \nDose, 2 to 4 c.c; y 2 to 1 fl. dr. \n\n\n\nOPIUM. 845 \n\nHeroina. \xe2\x80\x94 Heroine. (Morphine Diacetic Ester.) Dose, .003 \nto .012 gm.; ^ to i gr. \n\nHeroinae Hydrochloridum. \xe2\x80\x94 Heroine Hydrochloride. Dose, \n.003 to .012 gm.; & to I gr. \n\nDionina. \xe2\x80\x94 Dionine. (Morphine Mono-ethyl Ester Hydrochlo- \nrate.) Dose, .01 to .015 gm.; 1 to i gr. \n\nPeronina. \xe2\x80\x94 Peronine. (Morphine Benzylic Ester Hydrochlo- \nrate.) Dose, .0004 gm.; yi^ gr. \n\nAction of Opium. \n\nThe effects of opium being due almost entirely to its mor- \nphine, the action and therapeutics of the two may be studied \ntogether. Codeine and some other alkaloids are considered a \nlittle later on (see pp. 865 and 866). Meconic acid appears to \nbe nearly free from physiological properties. \n\nExternal. \xe2\x80\x94 Though locally it has been said to possess feeble \nanalgesic properties, opium probably has no action when applied \nto the unbroken skin ; but from mucous membranes and raw sur- \nfaces it is absorbed, and it then exerts a marked anodyne in- \nfluence. The latter, however, is due to the central action of \nthe drug, as the sensory nerve endings appear to be in no way \naffected by it. \n\nInternal. Secretions. \xe2\x80\x94 Most of the secretions are diminished \nby opium. The sweat, however, appears to be increased in \nconsequence of dilatation of the cutaneous blood-vessels. \nOpium tends to check the secretion of saliva, but when nausea \nis caused, both the saliva and sweat are often markedly in- \ncreased in consequence of this condition, rather than from any \ndirect effect of the drug itself. It is noted also that in the \nlast stages of opium poisoning the perspiration is sometimes \nprofuse, but this is simply a result of the asphyxia. It is not \nknown precisely what effect the drug has upon the bile or the \npancreatic secretion. The urine is scarcely affected by it, \nthough, in consequence of the absence of sphincter reflex, re- \ntention in the bladder not infrequently occurs. So far as \nknown, all the other secretions are diminished. \n\n\n\n846 PHARMACOLOGY AND THERAPEUTICS. \n\nAlimentary Canal. \xe2\x80\x94 Unless the dose is very small, dryness \nof the mouth and a feeling of thirst are promptly caused. \nWhether administered by the mouth or not, opium tends to \nproduce nausea and vomiting and to impair the digestion. The \nnausea and vomiting would seem to be probably due in part to \nperipheral and in part to central action. When morphine is \ngiven by subcutaneous injection, it is quickly excreted into the \nstomach, and yet the great rapidity with which vomiting fol- \nlows its administration in this way in dogs (in which this \nsymptom is more constantly produced than in the human sub- \nject) points to an action on the medullary centre. Small quan- \ntities of opium lessen the sensation of hunger, and this is be- \nlieved to be probably due rather to central action than to a \nlocal influence on the stomach. Because of the lessened per- \nception of hunger and the gastric derangement, the appetite is \ndiminished. In man and certain animals opium causes diminu- \ntion of intestinal peristalsis and constipation, in consequence, \nprobably, of some peripheral action. Not only does it tend to \ncheck the movement of the bowels, but it abolishes or mitigates \nabdominal pain when present. Very large doses cause violent \nperistalsis and diarrhoea in the dog, cat and, according to some \nobservers, the rabbit. \n\nCirculation. \xe2\x80\x94 Small doses have little or no effect upon the \nheart and circulation. With either large or small doses, how- \never, there may be some quickening of the pulse at first, in con- \nsequence of nausea. Large amounts cause slowing of the heart \nthrough primary stimulation of the vagus centre in the medulla, \nas well as by an action on the cardiac motor ganglia. At the \nsame time, from some obscure central action, the cutaneous \nvessels dilate. This gives rise to a full pulse and to a sensa- \ntion of warmth in the skin, which may be followed by itching \nor discomfort, but has little influence on the general blood- \npressure. The latter generally remains high, and the circula- \ntion is only greatly depressed quite late in the poisoning. While \nsuch depression is dependent to a considerable extent on vaso- \nmotor paralysis, it is no doubt largely secondary to respiratory \n\n\n\nOPIUM. 847 \n\nfailure. The heart finally stops in diastole, but death is rarely \ndue to the effects of the poison on this organ or its nervous \napparatus. \n\nRespiration. \xe2\x80\x94 The respiration is slowed and at first deepened, \nbut the increased depth is not sufficient to counterbalance the \nslowness of the breathing, so that the air inspired per minute \nis reduced. Later the respirations become not only shallow \nbut irregular, and may assume the Cheyne-Stokes type. Pa- \nralysis of the respiratory centre, to which opium acts as a \ndirect poison, is the ordinary cause of death. The bronchial \nmucus, like the secretions in general, is diminished by opium. \n\nNervous System. Brain. \xe2\x80\x94 The action on the cerebrum con- \nsists for the most part of a depression of the higher functions. \nIn man, owing to the greater development of the brain, the \nnarcotic effect of the drug is much more pronounced than in \nother animals. The depression is usually preceded by a stage \nof excitement, characterized by restlessness and increased men- \ntal activity, the length of which varies greatly in different indi- \nviduals; but in some instances this appears to be entirely lack- \ning. As a rule, it is found that the period of excitation can be \nmaintained for a considerably longer time by the administration \nof small doses at frequent intervals, while under the effect of \na single large dose it is short or absent, and deep sleep very \nsoon comes on. During this first stage the imagination is often \nstimulated, the fancy has free play, and the creative powers are \naugmented, while the attention, judgment, coordination of the \nbrain, and reasoning faculties are less keen than ordinarily. \nIn exceptional instances, however, the intellectual power and \nmental vigor are increased. The general effect seems to be \nthat of a series of stimulations and depressions going on at the \nsame time, but whether these successively involve the same or \ndifferent centres is unknown. Different parts of the brain \nappear to be affected in different degrees and at different inter- \nvals of time, so that, as held by some, these act in a dissociated \nmanner and more or less independently of each other. It is \nwell recognized that the symptoms are greatly influenced by \n\n\n\n848 PHARMACOLOGY AND THERAPEUTICS. \n\nindividual susceptibility and by race, and among Oriental peo- \nples the stage of excitement is generally much more prolonged \nthan in Europeans. The motor areas of the brain are affected \nmuch more markedly in some animals than in man, and dogs, \nin which there is often noted a paralysis of the hind legs, are \nsaid to always exhibit a clumsiness in their voluntary move- \nments which closely resembles that observed after ablation of \nthese areas. In man it is often difficult to detect any evidence \nof stimulation of the cerebral motor centres, but the depres- \nsion of these is never so pronounced as that of the intellectual \nfaculties. It is true that the patient, in consequence of the \ndebility and muscular weakness present, seeks a recumbent \nposture, but he can be walked about if he is supported. He feels \nin a most contented frame of mind, and sooner or later sinks \ninto a sleep which is generally filled with dreams, often of the \nmost fantastical character, though in some individuals it is en- \ntirely free from dreams. If the dose is large, the slumber is \nmore apt to be dreamless. If it is not a poisonous one, the \npatient can be easily aroused, but under toxic amounts he soon \nsinks into complete coma. Opium is not only a powerful hyp- \nnotic, but the most perfect analgesic known. The dose required \nin any given case to annul pain naturally depends largely upon \nthe severity of it. After small doses of the drug patients gener- \nally awake refreshed, though not infrequently there is a little \nlanguor, dryness of the throat, headache, and possibly nausea. \nIn some instances the headache is quite severe and accompanied \nby nausea, vomiting and depression. \n\nMedulla Oblongata and Spinal Cord. \xe2\x80\x94 The principal effect \nin the medulla is the profound depression of the respiratory \ncentre. The other centres are much less affected, and in cases \nof fatal poisoning this is paralyzed before the centres of car- \ndiac inhibition* and vaso-constriction are depressed to any \nmarked extent. There is, however, a distinct depression of the \nvomiting centre, so that, although vomiting may perhaps be at \nfirst induced by its transient irritation, emetics do not act well \nin opium poisoning. In man the spinal cord is but little af-^ \n\n\n\nOPIUM. 849 \n\nfected except by large amounts. Mostly there is depression of \nits conducting and reflex functions, but in a few instances, after \nlarge doses, there have been observed increase of reflex excita- \nbility and twitchings or convulsions of spinal origin. In some \nof the higher animals there may be evidences of a similar action \non the cord, but for the most part in mammals, after poisonous \ndoses, the failure of the respiration closes the course of the \nintoxication. In the cold-blooded animals, however, there is \nfound to follow a further development of excessive reflex irri- \ntability, which may pass into tetanic spasm. In the frog this \nreflex action is first diminished to a slight extent, and then \nincreased to the same degree as by strychnine. In man opium \nsometimes has an aphrodisiac influence, and this has been at- \ntributed in part to stimulation of the cord and in part to the \neffect on the imagination. \n\nNerves and Muscles. \xe2\x80\x94 Except when given in enormous doses, \nthe drug has no effect upon the peripheral muscles and nerves. \nEven when directly applied to the nerve, it has been found to \nhave little influence on its irritability. Practically, therefore, \nopium has no action upon nerve fibres or endings. While in \nthe frog the subcutaneous injection of large amounts of mor- \nphine may diminish the power of the end-organs to transmit \nimpulses, this is not the case in mammals. In them the sensi- \nbility of the skin is lessened by an injection, but this appears \nto be a result of central action, since no more effect is produced \nat the point of application than elsewhere. In its general effect \nupon the nervous system opium affords a good example of the \nlaw of dissolution (see p. 737). \n\nPupil. \xe2\x80\x94 One of the characteristic effects of the drug is con- \ntraction of the pupil, and this is undoubtedly a central and not \na peripheral action, since it does not occur after local applica- \ntion, nor after division of the nerve-trunks going to the iris. \nIt is at once overcome by the application of atropine to the \nconjunctiva. After large doses of opium the pupil is reduced \nto the size of a pin-head, but in fatal poisoning it often becomes \nwidely dilated shortly before death, as a result of the asphyxia. \n55 \n\n\n\n85O PHARMACOLOGY AND THERAPEUTICS. \n\nIn birds, which are not much more tolerant of morphine, when \ngiven subcutaneously, than most mammalian animals, the pupil \nremains unaffected. In animals in which the drug causes move- \nment and excitement, such as the cat tribe, it is widely dilated, \nwhile in some other animals, such as dogs and rabbits, it is \naffected in much the same way as in man. \n\nTemperature. \xe2\x80\x94 Sometimes opium causes a slight preliminary \nrise of temperature. In most instances it occasions an incon- \nsiderable fall, which is probably attributable to the lessened \nmovement, as well as the dilatation of the cutaneous blood- \nvessels. Experiments on animals indicate that the heat centre \nin the brain is rendered less sensitive by the drug. \n\nSkin. \xe2\x80\x94 As has been seen, opium causes some increased secre- \ntion of sweat, though its diaphoretic property is not usually very \nmarked. As the effects of the drug are passing off, redness and \nitching of the skin are sometimes observed, and in susceptible \nindividuals the erythema may lead to exanthemata, such as an \neruption of small red spots resembling roseola. \n\nMetabolism. \xe2\x80\x94 The metabolism is ordinarily lessened as a \nresult of the quiet condition of the subject caused by the drug, \nso that the excretion of carbon dioxide is diminished in conse- \nquence of the depression; but in animals like the cat, in which \ngreat excitement is caused, its output is increased from the \naugmented muscular movement. There is also a lessened ex- \ncretion of nitrogen. In consequence of the impairment of res- \npiration, there may be an increase in the lactic acid of the \nblood and urine, and glycosuria may be present, while glycogen \nmay disappear from the liver. In patients suffering from dia- \nbetes the amount of sugar in the urine is diminished. Tran- \nsient albuminuria may occur after opium, and it has been sug- \ngested that this may possibly be due to vaso-motor changes \naffecting the circulation of the kidney. In chronic morphinism \nalso there is diminished metabolism, but this is probably attrib- \nutable for the most part to the derangement of digestion. \n\nExcretion. \xe2\x80\x94 Opium is excreted chiefly by the digestive tract, \nin the salivary, gastric and intestinal secretions, and is found \n\n\n\nOPIUM. 85I \n\nin large amount in the faeces. As morphine has been detected \nin the stomach in 2 T / 2 minutes after the subcutaneous injection \nof .03 gm. ( J / 2 gr.), there appears no question that the drug \nis capable of reabsorption from the gastro-intestinal tract. \nTraces of the drug have been found in the urine, but only after \nlarge doses. It is thought that a certain amount of it may \nperhaps undergo partial oxidation in the tissues, since oxida- \ntion products, such as oxydimorphine, have been observed in \nthe urine. It is also excreted to some extent in the milk of \nnursing women, so that it may cause morphinism in the child. \nThe substances which produce the characteristic odor of opium \nare excreted largely by the urine and less freely by the breath, \nsweat and milk. \n\nPeculiarities. \xe2\x80\x94 Reference has already been made to the \nmarked differences in the effects of opium in different indi- \nviduals. In some instances, instead of having a soothing in- \nfluence and putting the patient to sleep, it produces sleepless- \nness and excitement, which may amount to delirium. In others \nit causes marked nausea and vomiting, gastric pain, and indi- \ngestion, often with very severe headache. Some of these bad \neffects may very likely be due to the varying composition of \nthe drug, but certain individuals present such a pronounced \nidiosyncrasy against opium that it cannot be administered to \nthem in any form without very unpleasant results. Children \nare much more susceptible to its influence than adults, so that \nit must always be given to them with great caution, and women \nare, as a rule, more easily affected by it than men. Among the \nother untoward effects of opium may be mentioned diarrhoea, \ndyspnoea, aphrodisia, fever and hyperidrosis. Its effect in some- \ntimes causing skin eruptions has been previously mentioned. \nThe tolerance of the drug by the system is remarkable, so that \npersons who use it habitually are soon able to take enormous \nquantities with impunity, so far as any immediate danger to \nlife is concerned. The explanation of the tolerance is believed \nto be the increased power of the organism to destroy the poison. \n\nDifferences in Action between Opium and Morphine. \xe2\x80\x94 A \n\n\n\n852 PHARMACOLOGY AND THERAPEUTICS. \n\nnumber of differences have been noted in the effects of mor- \nphine and opium. These are as follows: (1) Morphine is \nabsorbed more rapidly, and hence acts more quickly. It is \ntherefore especially adapted for subcutaneous injection, and, \nadministered in this way, it produces its effects with great \npromptness. (2) Opium is more apt to interfere with the \ndigestion, although it is claimed by some that it causes less \nnausea than morphine. (3) Opium is more liable to cause con- \nstipation. This is both on account of the greater local action \nof crude drugs as compared with alkaloids, and because it re- \nmains in the intestine for a longer time than morphine. Con- \nsequently, it produces a more pronounced effect there than else- \nwhere in the economy, and this fact is availed of in the treat- \nment of many abdominal diseases. (4) Opium has greater \ndiaphoretic properties. (5) Morphine is more certain, as well \nas more rapid, in its anodyne and hypnotic effects. (6) Mor- \nphine is less convulsant. (7) Opium is thought to have a \nstronger effect in reducing the sugar in the urine when glyco- \nsuria is present. (8) Opium affects the bladder sphincter less. \n(9) Morphine causes more pruritus. (10) Morphine is ex- \ncreted more readily. \n\nTherapeutics of Opium. \nExternal. \xe2\x80\x94 Local applications of opium to relieve pain have \nlong been in common use and are still often employed, but as \nit has been clearly shown that the drug has no effect on sen- \nsory nerve terminations, the practice must be regarded as sim- \nply a concession to a deeply-rooted popular sentiment, which \nhas been handed down from the past. The apparent good \nresults obtained are no doubt due for the most part to the \nabsorption of the drug from wounds or mucous surfaces. \nWhen it is applied to the unbroken skin, there is either no \nbenefit, or else such relief as is afforded is attributable to adven- \ntitious circumstances. Thus, it must be due to the heat, and \nnot to the opium, when hot fomentations or poultices sprinkled \nwith laudanum (a very common application) are employed. \n\n\n\nOPIUM. 853 \n\nSo, while Linimentum Opii (B. P., tincture of opium and soap \nliniment, equal parts), rubbed into the skin, may be of service \nin chronic rheumatism, neuralgia, etc., it is probably the fric- \ntion that is the principal factor in relieving the pain. The most \npopular form of this external use is the lead and opium wash, \nand the probable explanation of its undoubted efficacy in \nsprains, contusions and other painful conditions is to be found \nin the non-irritating covering furnished by the lead precipitate \nand the astringent action of the lead itself. The ointment of \nnutgall and opium (B. P., powdered opium, 2; gall ointment, \n27) is much used to relieve the pain of haemorrhoids and anal \nfissures. The warm decoction of the white poppy is used in \nEngland as an anodyne fomentation. Poppy capsules (Papav- \neris Capsular, B. P.) are obtained from the Papaver somnif- \nerum, which is cultivated in England. A ten per cent, decoc- \ntion made from these contains but a small and uncertain amount \nof opium, and its beneficial effects, if any, are doubtless due \nto its warmth. \n\nInternal. G astro -intestinal Tract. \xe2\x80\x94 Morphine, which is here \npreferable to opium, is of much value in relieving the pain of \norganic disease of the stomach (ulcer and cancer), as well as \nof irritative dyspepsia. It may be given in solution (morphine, \n1; water, 480; dose, 4 c.c. ; 1 fl. dr.), and it is also much used \nin combination with bismuth, zinc and silver salts in painful \nstomach diseases. Opium is often of great service in acute \ngastritis, and it is advised that it should always be given in \nliquid form, preferably as the Tinctura Opii Deodorati. Many \nforms of vomiting, whether of peripheral or reflex origin, are \nchecked by morphine, and it is likely to prove useful after the \nstomach has been emptied in cases of vomiting caused by irri- \ntant matters. In colic, and especially lead colic, it often re- \nlieves the pain without increasing the constipation; while \nallaying the spasm of the intestine, it does not appear to entirely \nstop its peristalsis. In diarrhceal diseases opium is of the \ngreatest possible value, but it must be used with discrimination \nand judgment. In acute diarrhoea due to irritating kinds of \n\n\n\n854 PHARMACOLOGY AND THERAPEUTICS. \n\nfood and in mucous diarrhoea it is advisable that before using \nit the bowel should be cleared by a purgative. When the evacu- \nations are watery, it may be combined with advantage with lead \nacetate or a mineral acid. In acute dysentery it is generally \nmost efficacious after the preliminary administration of mag- \nnesium sulphate or other saline. It is frequently given by the \nrectum either in an enema with starch or milk or in supposi- \ntory. In chronic dysentery it is the most reliable remedy, and \nmay be employed in association with the salts of zinc, silver, \ncopper or arsenic. In malarial dysentery, particularly, Patna \nopium, which contains over 6 per cent, of anarcotine, an anti- \nperiodic, is especially indicated in combination with arsenic. \nIn cholera morbus the hypodermatic injection of morphine is \nof great service, but in cholera infantum any form of opium \nmust be used with great caution on account of the danger of \nproducing narcosis. In cholera it is useless in the stage of \ncollapse, but may prove of benefit in the preliminary diarrhoea, \nand it is an important ingredient of the various so-called cholera \nmixtures. In intestinal colic and abdominal pain of whatever \norigin opium generally affords relief, and it is largely used in \nthe treatment of peritonitis and other inflammations and after \noperations or wounds of the abdomen. In severe abdominal \ncases it has been customary to push the drug to decided narco- \nsis, without paying any attention to the constipation caused, \nbut the more recent and better practice is to keep the bowels \nslightly open by the use of salines. When the full-dose opium \ntreatment is employed in peritonitis, so that the paralyzing of \nthe intestinal movements prevents the peritoneal surfaces from \nrubbing against each other, extensive adhesions are quite likely \nto result. As mercury is regarded by many as of special value \nin modifying inflammations of the serous membranes, particu- \nlarly if combined with opium, it is a common practice to give \ncalomel along with the opium, at least for a time. The follow- \ning general caution has been suggested as one of great prac- \ntical importance: As a rule, opium does harm in all gastro- \nintestinal affections in which there is a deficiency in the proper \n\n\n\nOPIUM. 855 \n\nsecretion, or a suspension of the functions, of the liver and \nkidneys. At the same time, the hypodermatic injection of mor- \nphine, by the action of the drug in relaxing spasm, is invaluable \nfor the relief of the agonizing pain accompanying the passage \nof biliary and renal calculi, and is also of service in control- \nling the vomiting which is often present. \n\nHeart. \xe2\x80\x94 It is quite probable that in small doses administered \nhypodermatically morphine is a cardiac stimulant. At all \nevents, it often acts very happily in the pain and distress caused \nby disease of the heart, and its cautious subcutaneous injection \nmay be tried in all forms of cardiac dyspnoea. It is especially \nindicated in those cases in which the patient, while perhaps \nable to breathe quite easily when awake, suffers from marked \ndistress as soon as he falls asleep. Opium or morphine given \nby the mouth are usually much less efficient in affording relief \nin heart-trouble than morphine administered in this manner. \nThe pain of aortic aneurism and intra-thoracic growths, like \npain in general, is relieved by morphine. It is quite customary \nto give the drug in association with small doses of atropine, as \nit is found that its analgesic effect is rather increased than \ndiminished thereby, while the sleep resulting is less disturbed \nand more nearly approaches normal sleep. In addition, the \natropine serves to counteract some of the depressing effects \nupon the heart and respiration and also to largely prevent sub- \nsequent headache, vertigo and nausea, as well as constipation. \nIt has been shown that in the use of chloroform for anaesthetic \npurposes a hypodermatic injection of morphine just before the \ninhalation begins prolongs the stage of narcosis with a less \nquantity of chloroform, diminishes the danger of cardiac paraly- \nsis, and tends to prevent the after-nausea and depression. The \nsame is true as regards other anaesthetics, and especially in the \ncase of persons addicted to alcoholic stimulants and of excep- \ntionally neurotic patients does the preliminary morphine injec- \ntion render the anaesthetization safer and favorably affect the \nstage of recovery. \n\n\n\n856 PHARMACOLOGY AND THERAPEUTICS. \n\nVessels. \xe2\x80\x94 Although not acting directly upon the vessels or \nblood, opium is most valuable as an internal haemostatic. This \neffect is largely in consequence of the quietude secured by it, \nwhich allows the blood to coagulate in ruptured vessels. When, \nas is frequently the case, the haemorrhage is attended by marked \nrestlessness, the drug is absolutely indicated because of its \nsedative effect both on mind and body. It is especially effica- \ncious in gastric and intestinal haemorrhage, where its influence \nin diminishing peristalsis is of material service, and also in \npulmonary haemorrhage. In haematemesis and haemoptysis the \nbenefit derived from it is in no small measure due to its con- \ntrolling of vomiting and coughing, both of which are apt to \nbring on fresh bleeding. A very good preparation to use is \nthe Pilula Plumbi Cum Opio (B. P., powdered opium, 1; lead \nacetate, 6; dose, .12 to .25 gm. ; 2 to 4 gr.). Hypodermatic \ninjections of morphine are preferred by some, and when these \nare used they should be repeated at regular intervals as long \nas further haemorrhage or the risk of it continues. \n\nRespiration. \xe2\x80\x94 Opium, on account of its depressant effect upon \nthe medullary centre, must be given with caution in respiratory \ndiseases, but in well selected cases it is of marked benefit. An \nincipient catarrh may often be aborted by a full dose of Dover\'s \npowder. In bronchitis with excessive secretion very small \namounts of opium may be sufficient to diminish its amount, as \nwell as allay cough. If, however, the secretion is scanty and \ntenacious and expectoration difficult, opium may aggravate \nrather than relieve the condition. In pleurisy and pneumonia \nit is often of great service in controlling cough and relieving \npain, but the tendency to asphyxia in serious diseases attended \nwith cough must always be borne in mind. Opium should \ntherefore never be used in the last stages of pneumonia and \nbronchitis. By its antispasmodic properties it is frequently \nefficient in arresting the symptom asthma, but its use here is \nobjectionable on account of the danger of inducing the opium \nhabit. It is a very frequent and useful ingredient of expec- \ntorant mixtures, and among the preparations commonly em- \n\n\n\nOPIUM. 857 \n\nployed in the treatment of cough are paregoric, Dover\'s powder, \ncompound liquorice mixture, the ammoniated tincture (B. P.), \nthe pills of ipecacuanha and squill (B. P.) the compound mor- \nphine powder, and the compound tincture of chloroform and \nmorphine (B. P.). Codeine is preferable to all other prepara- \ntions and alkaloids of opium for relief of cough in pulmonary \ndiseases. Heroine is also very much used for this purpose at \nthe present day. To relieve the pain of tubercular or other \norganic disease of the larynx an insufflation may be used con- \nsisting of morphine acetate, .06 gm. (1 gr.) and .30 gm. (5 gr.) \nof starch, with or without .06 gm. (1 gr.) of iodoform or \nboric acid. As the morphine produces its action only after \nabsorption, however, other agents have a more prompt and \nefficient local anaesthetic effect. The intra-laryngeal applica- \ntion of menthol and orthoform constitutes one of the best means \nof affording relief in these cases. \n\nNervous System. \xe2\x80\x94 Opium is unrivalled in its influence in \nrelieving pain from whatever source and in inducing sleep when \ninsomnia is due to pain. For these purposes the hypodermatic \ninjection of morphine is usually preferred, as acting more \npromptly and certainly and less liable to cause nausea - or diges- \ntive disturbances than opium or morphine given by the mouth, \nand atropine sulphate is often added to the solution in- \njected for the purpose of minimizing as far as possible any \nill-effects of the morphine salt. Morphine is of great value \nin relieving the after-pains of labor, and may be of ser- \nvice in spasm of the bladder sphincter and spasmodic stricture \nof the urethra by its action in relaxing the muscular contrac- \ntion. It is manifestly impossible to more than hint at the al- \nmost unnumbered applications of opium or morphine as an \nanalgesic and hypnotic, but it is obvious that its use should as \na rule be restricted to acute or rarely recurring conditions, on \naccount of the very great danger of the patient\'s contracting \nthe opium habit. For the relief of pain and insomnia in in- \ncurable diseases, however, the judicious employment of the \ndrug for an indefinite period is entirely justifiable. Enormous \n\n\n\n858 PHARMACOLOGY AND THERAPEUTICS. \n\ndoses are often borne by patients suffering from very severe \npain without the development of any indications of poisoning. \nMorphine is sometimes an efficient sedative in delirium tremens \nand other forms of mania, but not infrequently such large quan- \ntities are required as to render it an unsafe remedy. In acute \nmania small doses are said to be the most efficient if the arterial \ntension is low, but if the pulse is quick and the blood-pressure \nhigh, the full effect of the drug is necessary. Large hypoder- \nmatic doses require the utmost circumspection, especially in \nobese and aged subjects. In delirium tremens chloral is usually \na more satisfactory hypnotic than morphine. In melancholia \nexcellent results have been claimed from the use of opium in \nsmall or stimulant doses, and here the best form for its admin- \nistration is the tincture. There is reason to believe that the \nhypodermatic injection of morphine is of great value in many \ncases of puerperal eclampsia, and its use appears to be growing \nin favor. It has also been advocated for the relief of ursemic \nconvulsions when due to acute nephritis, whether puerperal or \nnot, on the ground that it tends to arrest muscular spasms by \ncounteracting the effect of the poison on the nerve-centres, to \nestablish profuse diaphoresis, and to facilitate the action of \ncathartics and diuretics. In hysteria it is not as efficient as \nvarious other remedies, and is especially objectionable from \nthe risk of its inducing the opium habit. In arachnitis, pachy- \nmeningitis and basilar meningitis opiates in small doses seem \nto accomplish more than other remedies, and the hypodermatic \ninjection of morphine in quantities sufficient to relieve the \npain and rigidity is considered of value in the earlier \nstages of cerebro-spinal meningitis. When effusion has taken \nplace and stupor and coma supervene, opiates are no \nlonger of use. In conditions of increased excitability, such as \ntetanus, strychnine poisoning, and epilepsy, opium has been \nfound on the whole to be harmful rather than beneficial. Still, \nin a large number of affections it is one of the most efficient \nof all remedies for relieving spasm, and its admirable action \nin this capacity has been incidentally referred to in several \n\n\n\nOPIUM. 859 \n\nclasses of cases. It may be mentioned here that severe hic- \ncough is very commonly arrested by a hypodermatic injection \nof morphine. As opiates are as completely absorbed from the \nrectum (if the latter be thoroughly cleared) as from the stom- \nach, it is often advantageous to administer them in enemata or \nsuppositories. Since the absorption is slower, however, the dose \nshould be twice or possibly three times as large as when they \nare given by the mouth. In surgical practice opium has always \nbeen widely used to prevent or mitigate shock, as well as to \nrelieve pain and check or alleviate inflammation. Its uses in \nsurgery can only be briefly referred to in passing, but there \nseems to be no question that it not only relieves existing \nshock, but is a potent factor in the prevention of secondary \nshock. It is the first remedy called for when pain or haemorrhage \nis present, and the hypodermatic injection of morphine is strongly \nindicated in shock following injury, especially if an operation \nis required. It is an inestimable boon in severe burns, and it \nis particularly indicated in fractures, where it not only allays \nthe immediate pain, but brings about muscular relaxation and \nrelieves many distressing symptoms. It is not uncommon now \nto hear surgeons decrying the use of opium under almost any \ncircumstances, but while its careless and unscientific employ- \nment has brought this powerful therapeutic agent into more \nor less disrepute, there can be no doubt that it will still con- \ntinue to occupy the highest position in the estimation of those \nwho use it judiciously, \n\nKidneys. \xe2\x80\x94 It is probable that the feeling which has existed \nagainst the use of opium when Bright\'s disease is present has \nbeen due to the idea that the impaired state of the kidneys pre- \nvents the proper elimination of the drug; but since it has been \nconclusively shown that only the faintest traces, if any, are nor- \nmally excreted by these organs, it would seem, from a theoret- \nical point of view at all events, that there is less risk in its \nemployment in this class of cases than has generally been sup- \nposed. As a matter of fact, however, several instances of \nchronic nephritis are on record in which death was apparently \n\n\n\n860 PHARMACOLOGY AND THERAPEUTICS. \n\ncaused by quite small doses of opium. It is the part of pru- \ndence, therefore, to use it with great caution in cases of chronic \nBright\'s disease. Still, ample justification is afforded for its \njudicious employment, notwithstanding the apparent risk, by \nthe marked relief which often attends the hypodermatic injec- \ntion of small amounts of morphine in the uraemic dyspnoea, \nuraemic insomnia, and cardiac dyspnoea so likely to be met with \nin the course of this affection. Its employment in uraemic con- \nvulsions has already been referred to as limited to cases due \nto acute nephritis. \n\nSkin. \xe2\x80\x94 Dover\'s powder is of considerable utility as a dia- \nphoretic. It is commonly given in acute muscular rheumatism, \nand at the onset of " colds " and febrile attacks of various \nkinds, and will often effect a cure, particularly if its action is \naided by hot drinks and a hot foot-bath. \n\nMetabolism. \xe2\x80\x94 Opium and its derivatives are acknowledged to - \nhave a favorable effect in many cases of diabetes, not only \nmaterially diminishing the amount of sugar in the urine, but \nalso often causing an amelioration in the general condition of \nthe patient. Codeine is undoubtedly the most serviceable form \nin which to employ the drug in this disease. Opium has ap- \nparently a beneficial influence, the precise nature of which is \nnot very clear, in all sorts of inflammations, and it is thought \nto be particularly efficacious in those of the serous membranes. \n\nHeroine (not official) is morphine diacetic ester, which as a \nhydrochloride is freely soluble in water and alcohol. It gen- \nerally produces no disagreeable symptoms, beyond headache, \nand is stated not to give rise to habituation. A more extended \nknowledge of the drug, however, would seem to indicate that \nthe latter assertion is not entirely correct. It occasionally pro- \nduces violent and uncontrollable vomiting. Since it diminishes \nthe sensitiveness of the respiratory centres to an excess of car- \nbon dioxide in the blood, it is useful in some forms of dysp- \nnoea. It is of great value in quieting cough. \n\nDionine (not official) is morphine mono-ethyl ester hydro- \nchlorate, which is readily soluble in water. It is somewhat \n\n\n\nopium. 861 \n\nhypnotic, and like heroine is useful to allay cough. It is said \nto check night sweats. \n\nPeronine (not official) is morphine benzylic ester hydro- \nchlorate, soluble in water. This is .hypnotic, producing sound \nsleep without previous excitement, and is useful in allaying the \ncough of pulmonary tuberculosis, chronic bronchitis and pertus- \nsis. \n\nTOXICOLOGY. \n\nAcute . Poisoning. \xe2\x80\x94 The symptoms usually appear in from ten \nminutes to one hour after opium has been taken by the mouth. As \nmight be expected from the effects of the drug upon the central nervous \nsystem, they are those of profound narcotism. Drowsiness may or may \nnot be preceded by some slight excitation, and as a rule it supervenes \nvery quickly. The drowsiness passes into sleep, from which the patient \nmay be roused, but soon this deepens into stupor and eventually into \ncomplete coma, in which reflex excitability is abolished and no stimula- \ntion of any kind has the slightest effect. A characteristic phenomenon is \nthe extreme contraction of the pupils. The countenance, at first flushed, \nbecomes pale and then cyanotic, while the lips are livid. The general \nsurface is cold, and as the poisoning advances becomes bathed with \nprespiration. In the earlier stages the pulse is apt to be full, slow and \nlaboring : later it becomes so weak as to be almost imperceptible. The \nbreathing gradually grows slower and more stertorous, as well as irregu- \nlar. The limbs are relaxed, but death, which, as mentioned, is due to \nrespiratory failure, may possibly be preceded by asphyxial convulsions. \nThe fatal result may occur in from two to ten hours. Even when coma \nand convulsions have developed, recovery is possible, and in that case \nthe coma passes into a condition of slumber which not infrequently lasts \nfor from twenty-four to thirty-six hours. The patient is then apt to \nsuffer from much nausea, headache and nervousness. \n\nDiagnosis of Poisoning by Opium. \xe2\x80\x94 (i) From Alcoholic Poisoning. \xe2\x80\x94 \nThis is often very difficult, especially when the patient has taken alcoholic \nstimulus, and it is important that a correct history of the case should be \nobtained, if possible. Points of difference are that in opium poisoning \nthe pupils are more minutely contracted and the patient can be roused \nwith less difficulty. The breath usually has a characteristic odor after \nopium (though not after morphine), but this may be obscured by the \nsmell of alcohol if this has been taken. An examination of the urine \nmay perhaps be of service in determining the true condition present. \n(2) From Cerebral Hemorrhage. \xe2\x80\x94 If the pupils are unequally dilated, \n\n\n\n862 PHARMACOLOGY AND THERAPEUTICS. \n\ncerebral haemorrhage is present. If such haemorrhage has its site in the \npons Varolii, the resultant contraction of the pupils may render the \ndifferential diagnosis very difficult, and local paralysis should be care- \nfully looked for. When hemiplegia is present, the recognition of cere- \nbral haemorrhage is easy. With a small haemorrhage, and especially in \nthe pons, the temperature may be elevated, while with a large one, this \nis lowered for the first few hours, though it may rise afterwards. (3) \nFrom Phenol Poisoning. \xe2\x80\x94 While here there may be coma and con- \ntraction of the pupils, the characteristic odor of the acid is present \nand its caustic effects may be observed upon the mucous membrane of \nthe mouth. The urine is dark and smoky, and gives little of no pre- \ncipitate with barium chloride. (4) From Chloroform and Ether Poison- \ning. \xe2\x80\x94 The smell of the breath and of the matters vomited will be a \nsufficient indication that the coma is due to one of these drugs." (5) \nFrom Uremia. \xe2\x80\x94 In uraemia the presence of albuminuria, even if no \nother sign of Bright\'s disease can be detected, will show the nature of \nthe case. The odor of the breath is also characteristic in uraemia. (6) \nFrom Diabetic Coma. \xe2\x80\x94 Here the odor of the breath is likewise character- \nistic, and sugar will be found in the urine. (7) From the Comatose \nStage of an Epileptic or other Fit. \xe2\x80\x94 In this condition the lividity of the \nface does not become progressively more marked, and the pupils are as \na rule dilated. The history of the case, if obtainable, is also of service. \n\nPost-mortem. \xe2\x80\x94 The appearances are simply those characteristic of \nasphyxia. If death is due to opium, and not its alkaloids, the odor of \nthe drug may be detected. The condition of the pupils varies in \ndifferent instances. The gastric mucous membrane is sometimes found \nto be reddened. \n\nTreatment. \xe2\x80\x94 The stomach should be washed out, not merely once, but \nrepeatedly and at short intervals, because the morphine which has been \nabsorbed is excreted into the stomach. On this account the evacuation \nof the latter is called for whether the drug has been taken subcutaneously \nor not. Prompt emetics {see p. 175) should also be given, and especially \napomorphine hydrochloride hypodermatically. If narcosis has already \nset in, however, the action of emetics may be materially interfered with. \nPotassium permanganate, well diluted, has been successfully used in an \namount equal to that of the alkaloid ingested ; it almost immediately \ndestroys the latter, through its chemical action. It is claimed that it \ncan act upon the poison when in the blood, so that a hypodermatic injec- \ntion of it even for some hours after its ingestion * may afford relief. \nThis has been denied, however, and it would seem probable that it is \nefficient only on that part of the poison present in the stomach. The \n\n\n\nOPIUM. 863 \n\nreports have been so generally favorable that potassium permanganate \nshould be used immediately. It has been recommended that atropine \nsulphate (.003 gm. ; ^ gr.) should be given hypodermatically, or tincture \nof belladonna (2 c.c. ; 30 TTL) by the mouth, and repeated every fifteen \nminutes ; but great caution must be exercised with the use of this anti- \ndote \xe2\x80\x94 if, indeed, it should be employed at all. Instances of recovery \nfrom opium poisoning followed by death from the belladonna or atropine \ngiven as an antidote have been observed. Some advise that .006 gm. \n(yL gr.) of atropine sulphate should be given as soon as possible, and \nnot repeated. Caffeine, especially in the form of strong, black, hot \ncoffee, is one of the best antidotes, and given in this way the tannin is \nalso useful. Coffee may be administered by the mouth, and an enema \nof it (500 c.c. ; 1 pint) should also be given. Every effort should be \nmade to rouse the patient and keep him awake, especially by walking \nhim about, as the constant movement contributes to the better tone of \nthe medullary centre. Flapping with a towel, pinching, etc., may also be \nrestored to, as well as such general reflex stimulants as the application \nof the faradic current, cold affusions, the inhalation of ammonia, and \nthe hypodermatic injection of ether. The patient should be kept warm, \nand artificial respiration may be called for. Oxygen or amyl nitrite \ninhalations are sometimes of service. The treatment must be kept up \nfor several hours, of necessary. \n\nChronic Opium Poisoning. \xe2\x80\x94 Chronic poisoning is, unfortunately, \nquite common, opium (usually in the form of laudanum or pills) being \ntaken habitually by the mouth, or morphine by hypodermatic injection. \nThe effects of the prolonged use of the drug, mental, moral and physical, \nare most deplorable. The symptoms, however, are more or less indefi- \nnite, and some individuals appear to continue the habit for many years \nwith comparative immunity. Usually the patient loses weight, becomes \nanaemic, and suffers from loss of appetite and indigestion. The bowels \nmay be continuously constipated, or constipation may alternate with \ndiarrhoea. The pupils are contracted, the skin and tongue dry, and the \nnails brittle, while the hair turns prematurely gray and falls out. The \nheart is apt to be irregular, and muscular tremors and unsteadiness of \ngait are often observed. The patient is nervous, lacking in energy and \nwill-power, and entirely unfit for work of any kind. He is utterly un- \ntrustworthy in his statements, and becomes lost to all sense of honor \nand uprightness ; lying in the most bare-faced manner and even com- \nmitting theft, if necessary, in his endeavors to obtain the drug. Sexual \nimpotence is a common result, and melancholia and dementia may \neventually supervene, especially when morphine is used. In morphine \n\n\n\n864 PHARMACOLOGY AND THERAPEUTICS. \n\nhabitues the arm, leg, or front of the body will usually be found to be \nscarred with marks of the needle. The craving for the drug is so \nintense that the patient suffers agonies when temporarily deprived of it, \nand it becomes necessary for him to increase the dose from time to time \nin order to secure the desired effect. The daily quantity of morphine \nused is thus often exceedingly large. The practice of opium smoking, \nthe method of employment in vogue among Oriental peoples, appears \nto be less harmful in its results than the prolonged use of opium by the \nmouth or morphine by subcutaneous injection. \n\nTreatment. \xe2\x80\x94 The treatment of chronic poisoning is attended with \nimmense difficulties, especially on account of the degraded moral con- \ndition of the habitue, and is very often unsuccessful in effecting a cure. \nAs a rule, the patient should be isolated, and watched with the greatest \nvigilance to prevent his securing the drug surreptitiously. The morphine \nmust not be withdrawn suddenly, as this is likely to be attended by \ncollapse and aggravated mental disturbance, but the dose should be \ngradually diminished until it is deemed judicious to stop it altogether. \nThere is no known drug which seems to have any curative effect, and \nthe results of substituting agents such as cocaine for morphine have \nalways proved disastrous. No reliance can be placed upon any of the \nadvertised cures for the morphine habit ; most contain morphine and \nthe remainder are useless. The patient on entering an institution for \nhis cure must be most thoroughly and carefully searched so that he \nshall not be possessed of a supply sufficient to keep him comfortable \nduring his treatment. \n\nAtropine. \xe2\x80\x94 Atropine {see p. 803) is a valuable antidote to morphine, \nespecially from the fact that it powerfully stimulates the respiratory \ncentre, and also because it tends to antagonize the depressing effects \nof this drug upon the cerebrum and upon intestinal peristalsis. At \nthe same time, as mentioned above, the danger of substituting bella- \ndonna for opium poisoning must always be borne in mind. While \nappearing to be antagonistic in some other respects, this is really not \nthe case. Thus, although it arrests perspiration and dilates the pupil, \nit produces these effects by its action on the peripheral nerve termina- \ntions, while the opposite effects caused by morphine are due to action \non the central nervous system. Still, it is found that in giving \nmorphine by hypodermatic injection, certain of its disadvantages, \nsuch as indigestion, constipation and cardiac depression may be pre- \nvented or rendered less marked by combining atropine sulphate (.0004 to \n.0006 gm. ; T i^ to T ^gr.) with each dose. \n\n\n\nCODEINE. 865 \n\nCODEINA.\xe2\x80\x94 Codeine. (Methyl Morphine.) Dose, 0.030 gm. (30 \nmilligm.); y 2 gr. \n\nCODEINJE PHOSPHAS.\xe2\x80\x94 Codeine Phosphate. Dose, 0.030 gm. \n(30 milligm.) ; y 2 gr. \n\nCODEINE SULPHAS.\xe2\x80\x94 Codeine Sulphate. Dose, 0.030 gm. (30 \nmilligm.); y 2 gr. \n\nAction of Codeine. \nCodeine is much less toxic than morphine, which it some- \nwhat resembles in the general character of its action. While it \nis powerfully analgesic, however, its hypnotic influence is quite \nlimited. Small doses induce light sleep, but somewhat larger \nones are apt to cause restlessness and more or less exaggera- \ntion in the reflex excitability. It is much less depressant to \nthe higher cerebral centres than morphine, and has a decidedly \nstimulating effect upon the spinal cord, as well as the medulla \nand lower parts of the brain. Owing, it is believed, to its \naction on the cord, tetanic spasm is sometimes caused by \nlarge doses. In man it is much less constipating than mor- \nphine or opium, and in animals not infrequently has a purga- \ntive action. It has comparatively little effect in slowing the \nrespiration, and, though the pupil is slightly contracted while \nthe sleep it causes lasts, dilation is observed when the excite- \nment stage follows. \n\nTherapeutics of Codeine. \nIn diabetes it is frequently used for reducing the amount of \nsugar in the urine, which it does more effectually than opium \nitself. For this purpose it is usually given as a pill or in a \nsyrup. It is, as mentioned, very efficient in relieving cough \nof all kinds, and is an excellent substitute for morphine as an \ningredient of expectorant mixtures. It is also very useful for \nallaying ovarian pain and as an analgesic generally, and is \nespecially esteemed in cases where, as often happens in malig- \nnant disease, an anodyne effect is required to be maintained \nmore or less continuously. \n56 \n\n\n\n866 PHARMACOLOGY AND THERAPEUTICS. \n\nThe other more important alkaloids of opium are the fol- \nlowing: \n\nPapaverine. \xe2\x80\x94 This is regarded as occupying a position mid- \nway between morphine and codeine as regards its action on \nthe central nervous system, but it is very much less powerful \nthan either. After large quantities some tetanic spasm may \nbe produced by its action on the spinal cord, and, by a direct \naction on the cardiac muscle, the rhythm of the heart is \nslowed by it. \n\nAnarcotine (known also as narcotine) is even less depres- \nsant than codeine, and reflex stimulation characterizes its action. \nIt is an antiperiodic and valuable in the prevention as well as \nthe treatment of malarial fever. \n\nThebaine (paramorphine), rather than a depressant, has a \nstimulating character, which appears to be identical with, \nthough much feebler than that of strychnine. It has been found \nto increase peristalsis in the intestine. \n\nHYDRATED CHLORAL. \n\nCHLORALUM HYDRATUM.\xe2\x80\x94 Hydrated Chloral. (Chloral U. S. \nP., 1890.) Dose, 1 gm.; 15 gr. \n\nUnofficial Preparations. \nHypnalum. \xe2\x80\x94 Hypnal. (Antipyrine Monochloral.) Dose, 1 \ngm.; 15 gr. \n\nHypnonum. \xe2\x80\x94 Hypnone. (Phenyl-methyl-acetone.) Dose, 0.30 \nto 0.60 c.c; 5 to 10 TTt. \n\nSomnalum. \xe2\x80\x94 Somnal. (Ethylirtes Chloral-urethane.) Dose, 1 \nto 4 c.c; y 4 to 1 fl. dr. \n\nAction of Hydrated Chloral. \nExternal. \xe2\x80\x94 Like chloroform, chloral has marked antiseptic \nproperties. Locally, it is irritant, and at the same time anaes- \nthetic. Applied to the unbroken skin in concentrated solution \nit causes redness and sometimes vesication. On raw surfaces \n\n\n\nHYDRATED CHLORAL. 867 \n\nit has a decided corrosive action, and when injected subcuta- \nneously is liable to excite considerable irritation. \n\nInternal. Alimentary Canal. \xe2\x80\x94 Unless well diluted, it is irri- \ntant to the gastro-intestinal mucous membrane, and is there- \nfore apt to occasion nausea, vomiting and purging. \n\nBlood. \xe2\x80\x94 Chloral was first introduced as a hypnotic under the \nsupposition that it was decomposed in the blood and chloroform \nliberated, but it is now known that it circulates unchanged, \nsince no chloroform is found in the blood or expired air, and \nthe drug itself is present in the urine both in a free state and \nin combination with glycuronic acid. \n\nCirculation. \xe2\x80\x94 Large amounts, by depressing the vaso-motor \ncentre in the medulla and by direct action on the cardiac muscle, \nhave the effect of slowing and weakening the heart and of \nproducing a fall of blood-pressure. It is thought probable also \nthat the action of the drug on the muscular walls of the vessels \nhas some influence in reducing the arterial tension. The same \nalterations in the heart are produced as by chloroform, the \nauricular contractions becoming weak before the ventricular, \nand some dilatation occurring in both cavities. In fatal poison- \ning the heart is arrested in diastole. In consequence of the \nvaso-motor paralysis, there results a marked dilatation of the \ncutaneous blood-vessels, and this may give rise to eruptions on \nthe skin. Moderate doses usually have little effect on the pulse \nor blood-pressure, though these may possibly be transiently \nraised. Sometimes, however, even small amounts have a dis- \ntinctly depressing effect upon the heart. \n\nRespiration. \xe2\x80\x94 Under large doses the respiratory movements \nbecome more and more slow and shallow from the depressing \naction of the drug on the medullary centre, which may be aided \nby the extreme weakness of the heart. In fatal cases death \nusually occurs from paralysis of the respiratory centre, though \nsometimes, as in the case of chloroform, it is due to paralysis \nof the weakened heart. With moderate doses the respiration \nbecomes slower and weaker, but scarcely more so than in nat- \nural sleep, in which the excitability of the respiratory centre and \n\n\n\n\n\n\n868 PHARMACOLOGY AND THERAPEUTICS. \n\nthe volume of the inspired air appear to be very much the same \nas after small amounts of chloral. \' \n\nCentral Nervous System. \xe2\x80\x94 Chloral is the purest hypnotic we \npossess. It has the effect of depressing and eventually com- \npletely paralyzing the central nervous system. Under its influ- \nence there is a successive depression, first of the brain, then of \nthe spinal cord, and finally of the medulla oblongata. With \nsmall doses, therefore, it is often possible to confine the action \nof the drug entirely to the cerebrum, with the result of pro- \nducing a sleep closely resembling ordinary sleep. Under some- \nwhat larger quantities the sleep is more profound, and there is \na depression of the spinal reflexes, while under still larger \namounts the depression extends to the medullary centres, which \nare finally paralyzed. Chloral differs from morphine in ap- \nparently having no specific action on the analgesic areas of the \nbrain ; so that acute pain is apt to prevent sleep after it. While \na powerful hypnotic, it is not, therefore, an analgesic. It has \nalso less influence on the sensibility of the skin than morphine, \nthough very large doses cause anaesthesia. The pupil is al- \nways contracted under chloral. The irritability of the motor \nareas of the cerebral cortex is reduced by it, and they finally \nfail to respond to the strongest electrical stimulation. The \nspinal reflexes become paralyzed before the failure of the res- \npiration. In the frog it has been observed that the depression \nof the reflex irritability may be preceded by a temporary in- \ncrease, but this is believed to be probably due rather to the \nremote effects of the local irritation than to the direct action \nof the drug on the cord. Chloral appears to have no action \non muscle or nerve when taken internally or injected into the \ncirculation, but when applied to an exposed nerve it is found first \nto irritate and then paralyze it, and, when injected directly into \nthe artery of a muscle, to produce immediate rigor. After the \nsleep caused by it the patient usually awakes refreshed, and free \nfrom headache or other disagreeable symptoms, though occa- \nsionally nausea and discomfort are felt. \n\nTemperature. \xe2\x80\x94 Chloral causes a considerable reduction in the \n\n\n\nHYDRATED CHLORAL. 869 \n\ntemperature, and this is largely due to the diminished heat pro- \nduction from the lessened muscular activity. Another factor, \nno doubt, is the increased output from the dilatation of the \ncutaneous vessels, and it is possible also that the irritability of \nthe heat-regulating centres in the brain may be diminished. \n\nSkin. \xe2\x80\x94 Chloral habitues often present peculiar purplish \nblotches upon the face. \n\nMetabolism. \xe2\x80\x94 There appears to be an increased destruction \nof proteids, with a more or less incomplete oxidation of waste \nproducts. The acidity of the urine is found to be much in- \ncreased by the presence of urochloralic acid (a combination of \nchloral and glycuronic acid), and the alterations in the metab- \nolism are attributed to the excessive production of this acid \nin the tissues. It is to be noted also that less oxygen is ab- \nsorbed and less carbon dioxide given off in consequence of the \nlessened muscular movement. \n\nExcretion. \xe2\x80\x94 It is excreted mainly by the kidneys as chloral \nand more largely as urochloralic acid. Part of it, however, \nis thrown into the stomach, and to this circumstance may pos- \nsibly be due, it is thought, the gastric irritation which, as men- \ntioned, is in some instances experienced on awaking from the \nsleep caused by chloral. \n\nTherapeutics of Hydrated Chloral. \n\nExternal. \xe2\x80\x94 Chloral is used to some extent as a rubefacient \nand counter-irritant, as well as an antiseptic, but it is more \nexpensive than many other equally effective remedies. As a \nwash or dressing for suppurating wounds, cancer of the uterus, \nfoul ulcers, etc., it may be applied in a solution of the strength \nof .30 to .60 gm. (5 to 10 gr.) to 30 c.c. (1 fl. oz.), and for \nbromidrosis or hyperidrosis in solutions of from 2 to 5 per \ncent. A 1 per cent, solution has been found efficient as an \ninjection in gonorrhoea, and a 10 per cent, solution as an injec- \ntion (into the sac) for hydrocele. The same may be injected \ninto the neighborhood of varicose veins, with the effect of caus- \ning gradual coagulation of the blood and contraction of the \n\n\n\n87O PHARMACOLOGY AND THERAPEUTICS. \n\nvessels. The injection per rectum of from 1 to 1.60 gm. (15 \nto 25 gr.) of chloral, properly diluted, has been used as a \nremedy for haemoptysis. The continued application of a solu- \ntion of 4 gm. (1 fl. dr.) in 16 c.c. (4 fl. dr.) each, of glycerin \nand water, has been recommended as a successful treatment for \nfuruncle. Chloral solutions (about 5 per cent.) may be applied \nto parasitic skin diseases, such as tinea versicolor, and used to \nallay itching in eczema, prurigo, etc. The powdered drug in- \ncorporated in ointments is also of service in relieving the itch- \ning of cutaneous affections. In urticaria the following lotion \nhas been employed : Chloral, 5 ; boric acid, 30 ; distilled water, \n180 parts. In combination with other remedies it is used as \na local anodyne and counter-irritant in neuralgia, pleurodynia, \nlumbago and other painful affections. An excellent prepara- \ntion of this kind is composed of equal parts of chloral, camphor \nand menthol, rubbed up together to form a liquid. It may be \napplied to aching teeth and also to the larynx to relieve pain. \nIt is also an effective preparation for rubbing into the legs to \nrelieve painful cramps in the calves. \n\nInternal. \xe2\x80\x94 Chloral has the advantages of being a promptly- \nacting and certain hypnotic. It is far from being a safe one, \nhowever; it depresses the heart and respiration so markedly \nthat the prescriber should be always upon his guard. It does \nnot relieve the distress and cough of disease of the heart and \nlungs, and must naturally be given, if at all, with special cau- \ntion when these organs are affected. It had better be avoided \nfor the most part, also, when stomach or bowel troubles are \npresent, as it is very liable to increase the irritation of these \nparts. In the insomnia of fevers it is often of great service \nin the early stages, but as the disease progresses, the weakness \nof the heart may contra-indicate its use. As has been stated, \nit is of no value in producing sleep in cases in which insomnia \nis due to pain from any cause. It has been used as a cerebral \ndepressant in puerperal convulsions, delirium tremens, and \nmania, but very large doses are usually required, and the effects \nof the drug must be watched with great care. Cases are re- \n\n\n\nHYDRATED CHLORAL. 8/ I \n\ncorded in which it has caused sudden death in alcoholics with \nfatty heart. In threatened delirium tremens, however, sleep \nmay sometimes be induced by quite moderate doses in associa- \ntion with potassium or sodium bromide. It is of special value \nin sleeplessness from mental over-work, worry, etc.. and in other \nforms of nervous insomnia. A very important use of chloral \nis in midwifery; here it has been designated the medicinal for- \nceps. Frequently after rest has been obtained by this drug \nlabor proceeds vigorously and is rapidly terminated. It has \nbeen employed with more or less success in incontinence of \nurine, tetanus, and poisoning by strychnine, physostigma and \npicrotoxin. If on account of spasm the patient is unable to \nswallow, it may be administered by the rectum. It is especially \nindicated in tetanus and strychnine poisoning because it de- \npresses the motor tract of the spinal cord. It is a safer remedy \nfor children than for adults, and is often prescribed for infan- \ntile convulsions, chorea, laryngismus stridulus, whooping- \ncough, and other spasmodic affections. It sometimes acts very \nhappily in controlling or alleviating the paroxysms of whoop- \ning-cough. Chloral is of considerable value in seasickness, \nand may sometimes be efficacious in the morning sickness of \npregnancy, especially in cases in which there is much dizziness, \nfaintness, and repugnance to food, with but little vomiting. \nShould the odor of the drug tend to excite nausea, it may be \ngiven by the rectum. Administered in this way it has been \nadvised for other forms of nausea and vomiting of reflex origin, \nsuch as occur in uterine fibroids and various other conditions. \nNotwithstanding the theoretical objections to the use of the \ndrug in gastro-intestinal disorders, in severe cholera morbus, \nwith symptoms of collapse, and in true cholera the hypoder- \nmatic injection of chloral is considered by some the most effec- \ntive treatment that we have, and especially when morphine is \nemployed with it. A favorite vehicle for the administration of \nchloral is syrup of tolu, and its unpleasant taste can be con- \ncealed by giving it in bottled " lemon soda." \n\nHypnal is a compound of chloral with antipyrine made by \n\n\n\n872 PHARMACOLOGY AND THERAPEUTICS. \n\nmixing their solutions, and is obtained in crystalline form. It \nwas proposed as a hypnotic, more certain than chloral, nearly \nfree from taste, entirely free from irritating effect upon the \nmucous membranes, and having distinct analgesic effects. It \nhas been but little used. \n\nHypnone, while not a very powerful hypnotic, is said to be \nespecially useful in the insomnia of alcoholism. In moderate \ndoses it is ordinarily devoid of danger, its only unpleasant \nresult being a disagreeable odor left on the breath. In very \nlarge doses it has induced coma, followed by cardiac and res- \npiratory paralysis. \n\nSomnal is regarded as a fairly satisfactory hypnotic, but, \nlike other agents of its class, it will not always produce the \ndesired effect. \n\nTOXICOLOGY. \n\nAcute Poisoning. \xe2\x80\x94 The symptoms of poisoning, as might naturally \nbe supposed from the physiological action of the drug, closely resemble \nthose of opium. Thus, there is profound coma, with weak and slow \nrespiration and pulse and lividity of the surface. There is complete \nmuscular relaxation, the reflexes are abolished, and the pupils contracted. \nThe temperature is depressed, and the skin cold and clammy. The \naction of the heart is irregular as well as weak, and before death may \nbecome rapid. The pulse should always be carefully watched whenever \nchloral has been administered. It frequently happens that symptoms \nof failing heart come on unexpectedly even after small doses. \n\nTreatment. \xe2\x80\x94 The stomach should be evacuated by the stomach tube. \nEmetics (see p. 175) may be employed, but are of less value on account \nof the depressing action of the drug on the medullary centres. Artificial \nwarmth must be supplied by means of hot bottles and blankets, and the \ntemperature maintained also by friction and massage. Somnolence is to \nbe resisted by injecting strong coffee into the rectum and by such \nmeasures as flagellation, douches, flapping with wet towels, and shout- \ning at the patient. On account of the cardiac depression, the patient \nshould not be forced to take active exercise, such as brisk walking. The \ninhalation of amyl nitrite may be employed to stimulate the heart, and \nstrychnine or caffeine subcutaneously injected to stimulate the respira- \ntion. Artificial respiration may also be called for. \n\nChronic Poisoning. \xe2\x80\x94 The chloral habit is very easily acquired by \npersons who have used the drug in ordinary doses for even a short \n\n\n\nBUTYL-CHLORAL HYDRATE. 873 \n\ntime continuously for the relief of insomnia or other purpose, and, once \nestablished, it produces serious results and is very difficult to break up. \nThe patient suffers from digestive disturbances, marked physical and \nmental weakness, with sudden flushings due to vaso-motor derangement, \nfrom palpitation of the heart, and from erythematous eruptions, gener- \nally of a purplish color, especially found on the face. In some instances \nthere are bed-sores, ulcerations and sloughs. Dyspnoea, dependent upon \nthe cardiac and respiratory depression and the general cachexia, is a \nprominent symptom. Sleep can be secured only by the accustomed \nhypnotic, and an over-dose may at any time result in collapse and \ndeath, since by reason of the cumulative effects of the poison in the \nsystem the vital functions are greatly impaired and elimination may be \nrendered impossible. It is to be noted also that the sudden withdrawal \nof the drug may lead to symptoms resembling those of delirium tremens, \nand as fatty degeneration of the heart is likely to be present, such a \ndevelopment is sometimes attended with the gravest danger. \n\nUnofficial Preparation. \nButyl-CMoral Hydras (B. P.).\xe2\x80\x94 Butyl-Chloral Hydrate. \n(Croton Chloral Hydrate.) Dose, 0.30 to 1.20 gm.; 5 to 20 gr. \n\nAction of Butyl-Chloral Hydrate. \nThe action of butyl-chloral hydrate is apparently identical \nwith that of chloral. It has been claimed that it is much less \ndepressant to the heart and circulation; also that it possesses \nmore analgesic power than chloral and that it has a specific \nanaesthetic action on the nerves of the face and head. These \nstatements, however, have been denied by writers of high \nauthority, who assert that such claims have been disproved by \nthe results of experimental research. \n\nTherapeutics of Butyl-Chloral Hydrate. \nWhether the drug has the specific analgesic action alleged \nor not, there is some clinical evidence going to indicate that \nit may be preferable to chloral in insomnia due to pain. On \nthe whole, however, it has failed to sustain itself, and is less \nused now than formerly. Some have found it very efficacious \nin facial neuralgia and migraine, particularly when the fifth \n\n\n\n874 PHARMACOLOGY AND THERAPEUTICS. \n\nnerve is involved, but in the experience of others, if it has \nafforded any relief in tic douloureux and similar painful states, \nthe effect has been only temporary. It has been recommended \nin the headache and neuralgia associated with carious teeth, in \nheadache of pregnancy, in neurasthenic headaches and those \ndue to eye-s.train, and also in dysmenorrhea and sciatica. \n\nCHLORALFORMAMIDUM.\xe2\x80\x94 Chloralformamide. (Chloralamide.) \nDose, 1 gm.; 15 gr. \n\nAction of Chloralformamide. \n\nThis compound appears to have the cerebral action of chloral, \nwithout its depressing effects upon the circulation; the latter \nbeing counteracted by the stimulating influence of the forma- \nmide. In poisonous doses only does it produce any noteworthy \ndepression. It is also less liable to produce gastric irritation \nthan chloral, but would seem to be somewhat slower and less \ncertain in its hypnotic effect. Chloral is formed by its decom- \nposition in the body, and fatty degeneration is said to have been \nobserved after its prolonged administration. Cutaneous erup- \ntions are sometimes produced by it. \n\nTherapeutics of Chloralformamide. \nChloralformamide may be employed in all cases in which \nchloral is indicated. It usually induces calm, refreshing sleep \nwithout any unpleasant after-effects, but in some instances \ncauses confusion, dizziness and headache. It is generally re- \ngarded as of no more service than chloral in insomnia due to \npain, but some claim that it has a distinct anodyne effect, and \nthat it is useful in neuralgia and in the pains of tabes dorsalis. \nIt has been given with good results in some cases of nocturnal \nepilepsy and also in chorea. There seems to be no question \nthat it is better borne than chloral when cardiac weakness is \npresent, and it has sometimes been found to give relief in asth- \nmatic symptoms due to heart trouble. If given for sleepless- \nness at night in the form of capsule or powder, it is advisable, \non account of the slowness with which it is absorbed, that the \n\n\n\nCHLORATONE. 875 \n\ndose should be administered rather early. Perhaps the best \nway to give it is dissolved in a little alcohol. 1.20 gm. (20 \ngr.), or more, may be dissolved in a sufficient quantity of \nbrandy, and then water added at a temperature not above 54.4 \nC. (130 F.). It may also be administered very satisfactorily \nin a watery solution with syrup and a little dilute hydrochloric \nacid. 60 c.c. (10 TTL) of aromatic sulphuric acid added to 30 c.c. \n(1 fl. oz.) of water will generally dissolve 2 gm. (30 gr.) of \nchloralformamide, but not always, as some specimens of the \ndrug are very insoluble. It may be given by the rectum as well \nas the mouth. Remarkable results have been obtained in seasick- \nness from the use of chloralformamide in association with potas- \nsium bromide. In order to secure the best effect it is advised \nthat the patient should take a cholagogue for two days before \nsailing. As soon as he gets on board the ship he should take 2 \ngm. (30 gr.) of each drug on an empty stomach, and at once \ngo to bed and sleep. This combination may be of service in \nacute mania and other forms of insanity, and has been used in \na proprietary medicine known as " chlorobrom." In using \nchloralformamide continuously it is not necessary to increase \nthe dose, and with it there appears to be less danger of the \npatient\'s becoming an habitue of the drug than in the case of \nchloral. \n\nUnofficial Preparation. \nChloretonum. \xe2\x80\x94 Chloretone. (Trichlor-tertiary. Butyl Alcohol. \nAcetone-Chloroform.) Dose, 0.30 to 1.20 gm.; 5 to 20 gr. \n\nAction of Chloretone. \nWithout markedly influencing respiration or blood-pressure \nit produces anaesthesia and sleep. The hypnotic effect is ob- \ntained by the use of smaller amounts than are required in the \ncase of chloral. It directly affects sensory nerves, and so may \nbe used as a local anaesthetic. After excessive doses of it \ndogs may sleep for several days, finally succumbing from \nasphyxia. Since neither acetone nor chloroform are found \nin the expired air or the urine, and the chlorides are increased \nin the latter, it is probably broken up in the body. \n\n\n\n8y6 PHARMACOLOGY AND THERAPEUTICS. \n\nTherapeutics of Chloretone. \nIn one per cent, solution it may be applied as a local anaes- \nthetic to ulcers and infected wounds. Internally, its chief use \nis as a hypnotic which is both safe and generally efficient. In \nmoderate -doses it promptly relieves irritability of the stomach. \n\nUnofficial Preparation. \nAnhydrogluco-Chloralum. \xe2\x80\x94 Anhydrogluco-Chloral. (Chlo- \nralose.) Dose, 0.10 to 0.25 gm.; 2 to 4 gr. \n\nAction of Chloralose. \nChloralose will produce sound sleep in which sensibility is \nnot lost, although the reflex activities are greater than usual. \nBy its excitation of the spinal cord the reflexes may be increased \nuntil convulsions resembling those of strychnine result. The \nsleep is caused by its depressant action on the functions of the \nbrain, and the awakening is without unpleasant effects. Unless \nvery large doses are given the heart and respiration are not \nacted upon. \n\nTherapeutics of Chloralose. \nChloralose on account of its bitter taste is best given in cap- \nsules. .60 gm. (10 gr.) have produced profound unconscious- \nness, so that caution should be exercised in prescribing it. This \ndrug has been known to produce diplopia, muscular tremors, \nand other unpleasant results, and if a habit is induced by its \nconstant use, it is said that its hypnotic influence is diminished, \nwhile the untoward effects are more likely to be marked. In \nnervous and tuberculous patients it may possibly give rise to \ntetanic or cataleptic symptoms, with disturbance of the mental \nfaculties. \n\nUnofficial Preparation. \nBromalum, CBr 3 COH.\xe2\x80\x94 Bromal. Dose, 0.12 to 0.24 gm.; 2 to \n4 gr. \n\nAction of Bromal. \nIt resembles chloral in its chemical properties, like it exist- \ning as an oily colorless liquid, or, when united with water or \n\n\n\nPELLOTINE. 877 \n\nalcohol, as a crystalline hydrate or alcoholate. It is prepared \nby slowly adding from 3 to 4 parts of bromine to refrigerated \nalcohol; the mixture being distilled after fifteen or twenty \nhours of contact. It depresses the heart like chloral, but is \nmuch more poisonous. In several respects, however, it differs \nfrom chloral in its action. In animals it causes at first rest- \nlessness and excitement and afterwards stupor, which is often \naccompanied by dyspnoea, and terminates in respiratory failure \nor in convulsions. There are marked contraction of the pupil \nand profuse salivation. \n\nTherapeutics of Bromal. \n.18 gm. (3 gr.) administered at bedtime are said to have \nproduced sleep or relieved pain, but the drug appears to be \ndistinctly dangerous, and scarcely deserves a place in medicine. \n\nUnofficial Preparation. \nAmyleni Hydras.\xe2\x80\x94 Amylene Hydrate. (Dimethylethyl-carbi- \nnol. Tertiary Amylic Alcohol.) Dose, 2 to 4 C.C.; y 2 to 1 fl. dr. \n\nAction of Amylene Hydrate. \nAmylene hydrate is a hypnotic, about midway in power be- \ntween chloral and paraldehyde, and having a pleasanter taste \nthan the latter. The sleep is generally natural, and the awaken- \ning prompt and complete. It is a safe hypnotic, having but little \naction upon the heart or respiration, and it appears also to have \nanodyne properties. \n\nTherapeutics of Amylene Hydrate. \nIt can be administered in wine, raspberry syrup, or simply \nin water. It has been given hypodermatically, with one-half \nits volume of alcohol. After continued use it is apt to dis- \nagree with the stomach. \n\nUnofficial Preparation. \nPellotinum. \xe2\x80\x94 Pellotine (an alkaloid of Anhalonium). Dose, \n0.03 to 0.06 gm.; y 2 to 1 gr. (hypodermatically). \n\n\n\n8y8 PHARMACOLOGY AND THERAPEUTICS. \n\nAction of Pellotine. \nIn frogs slight narcosis follows its injection in from ten to \nfifteen minutes. The reflexes are somewhat diminished. After \ntwenty to thirty minutes there appears a distinct increase \nof reflex irritability, followed by spasms, resembling strychnine \npoisoning. If large doses are administered this condition may \npass into one of complete paralysis. In man the pulse rate is \nslightly diminished, and drowsiness and sleep supervene. It \napparently has no effect on the secretions. The drug is prob- \nably excreted by the kidneys. \n\nTherapeutics of Pellotine. \nPellotine has been recently introduced as a hypnotic which, \nbecause it is unirritating, can be used hypodermatically. With \nthe slight slowing of the pulse, it induces a feeling of weariness, \nweight of eyelids and limbs, and disinclination to mental and \nbodily exertion, and a quiet sleep follows. The awakening is \neasy and usually without untoward symptoms. In full doses, \nwith the patient in an upright position it may give rise to \nvertigo. It is somewhat analgesic, as well as hypnotic, and \nhas afforded relief to the pains of locomotor ataxia and \nperipheral neuritis. \n\nSULPHONMETHANE. \n\nSULPHONMETHANUM. \xe2\x80\x94 Sulphonmethane. (Diethyl sulphonedi- \nmethylmethane. Sulphonal.) Dose, 1 gm.; 15 gr. \n\nAction of Sulphonmethane. \nSulphonmethane, or Sulphonal, while a less efficient hypnotic \nthan chloral, is also less dangerous, as it has no depressing \ncardiac action. It does not affect the heart directly, though it \nmay cause a slight quickening of the pulse through its depres- \nsant effect upon the inhibitory centre. Through its action on \nthe central nervous system it also has some influence in dimin- \nishing metabolism. Its excretion appears to be slower than its \nabsorption, so that there is a tendency to a cumulative action, \n\n\n\nSULPHONMETHANE. 879 \n\nThis may lead to gastritis, renal disease, and certain changes \nin the blood which are not very clearly understood. In conse- \nquence of the latter there is a characteristic discoloration of \nthe urine, due to the presence in it of a reddish-brown pigment, \nhaematoporphyrin, which is an iron-free product of the decom- \nposition of hsematoglobin. This is found to occur chiefly in \nanaemic women, and is accompanied by constipation, vomiting \nand gastric pain, weakness and ataxia, confusion and partial \nparalysis, while eventually there may result suppression of the \nurine or collapse and death. Several fatal cases of poisoning \nby this drug have been reported from small doses continued for \nlong periods. Sulphonal does not often lead to a habit, but \ncases of this are sometimes met with. Though its continued \nuse may not induce the very grave results mentioned, it may \nbe attended by severe functional disturbances. Persons taking \nit regularly for a considerable time are liable to suffer from \nmental, moral and muscular weakness, indigestion, impaired \nnutrition, and persistent cutaneous eruptions. The untoward \neffects of the drug can usually be avoided by intermitting its \nadministration from time to time. It is thought to have some \ndeleterious action on the heart when used for long periods, \nand is found to be a much less certain hypnotic in cases of \ncardiac disease than in other conditions. Very large quanti- \nties of sulphonal have been taken without fatal results, and in \nfact without any more serious consequences than prolonged \nunconsciousness. An enormous single dose, however, has been \nknown to cause paralysis of the sphincters, anuria, a fall of \ntemperature, and, late in the case, depression of respiration. \nVery large amounts are said to produce convulsive movements \nin animals. The drug is largely decomposed in the body, and \nexcreted in the urine as ethylsulphonic acid, but a small portion \nescapes unchanged. Sulphonal has little or no effect in reliev- \ning pain. As its absorption is very slow on account of its \ninsolubility, sleep is somewhat late in following its administra- \ntion, and not infrequently more or less drowsiness and depres- \nsion are experienced the next day. \n\n\n\n880 PHARMACOLOGY AND THERAPEUTICS. \n\nTherapeutics of Sulphonmethane. \nSulphonal is used exclusively to produce sleep. It is prefer- \nably administered in hot water, but on account of their con- \nvenient form, it is often given in wafers or tablets. These \nshould be taken at least an hour and a half before the time \nwhen sleep is desired. \n\nSULPHONETHYLMETHANE. \n\nSULPHONETHYLMETHANUM.\xe2\x80\x94 Sulphonethylmethane. ( Diethyl \nsulphonmethylethylmethane. Trional.) Dose, 1 gm.; 15 gr. \n\nUnofficial Preparation. \nTetronalum. \xe2\x80\x94 Tetronal. (Diethyl sulphondiethylmethane.) \nDose, 1 to 2.40 gm.; 15 to 40 gr. \n\nAction of Trional. \nSulphonethylmethane, or Trional, is a prompt hypnotic, with- \nout cumulative action, and it has no injurious or unpleasant \nafter-effects. Apparently the patients do not become habitu- \nated to its use. \n\nTherapeutics of Sulphonethylmethane. \n\nAs it is more soluble, quickly absorbed and active, trional is \ngenerally preferred to sulphonal. It has been used as a hyp- \nnotic and sedative for the insane; for narcotic habitues, so far \nas is known, it is a safe remedy. It is important that the daily \naction of the bowels be secured, an alkaline water be given \ndaily, and weekly intermissions be insisted upon; otherwise it \nmay give rise to disagreeable after-effects. It but rarely pro- \nduces hsematoporphyrinuria. As in the case of sulphonal, \nmultiple neuritis may very rarely follow the prolonged admin- \nistration of small doses of trional. \n\nTetronal is of similar chemical composition, containing four \ninstead of three ethyl groups, and is used for the same pur- \nposes, but in somewhat larger dose. \n\n\n\nVERONAL. 50 1 \n\nVERONAL. \n\nUnofficial Preparation. \n\nVeronalum. \xe2\x80\x94 Veronal. Dose, 0.5 to 1.5 gm.; iy 2 to 22y 2 gr. \nin hot liquids. \n\nAction of Veronal. \n\nExternal. \xe2\x80\x94 None. \n\nInternal. Alimentary Canal. \xe2\x80\x94 It does not usually cause nau- \nsea, vomiting or any gastric disturbance. \n\nBlood. \xe2\x80\x94 It probably has no effect upon the blood, for no blood \npigments appear in the urine. \n\nCirculation. \xe2\x80\x94 It does not influence arterial tension, nor does \nit have any effect upon the pulse rate. \n\nSkin. \xe2\x80\x94 A slight antipyrine-like rash, has been observed in a \nfew instances, accompanied by itching. \n\nRespiration. \xe2\x80\x94 There is no effect. \n\nTemperature. \xe2\x80\x94 This is slightly lowered two or three hours \nafter a moderate dose has been taken. \n\nBrain. \xe2\x80\x94 Sleep generally ensues within an hour after the in- \njection of the drug and is likely to last from four to ten hours. \nThe awakening may be accompanied by some torpor. \n\nSpinal Cord. \xe2\x80\x94 There is a possible analgesic action. \n\nExcretion. \xe2\x80\x94 The urine usually remains normal, free from \nalbumin, sugar, and blood pigment. In very rare instances \nthe drug causes hsemato-porphyrinuria. The nitrogen excre- \ntion is diminished. \n\nTherapeutics of Veronal. \nThe remedy is useful in the treatment of insomnia of \nvaried causation. It is especially useful in the simple in- \nsomnia and sleeplessness of neurasthenic or hysterical origin. \nIn conditions of excitement the maximum dose should be em- \nployed. Since it is without action upon the circulation or \nrespiration it may be administered to patients suffering from \ncardiac or pulmonary diseases. As it does not increase the \nnitrogenous output of the kidneys it can be safely given to \n\n\n\ni \n\n\n\n882 PHARMACOLOGY AND THERAPEUTICS. \n\ndebilitated individuals, and for considerable periods of time, \nas well as in febrile conditions and wasting disorders. As it is \nsafe for continued use, reasonably sure in its results, possesses \ncomparative freedom from habituation, and produces a sleep \napproaching the normal, it is a valuable addition to the avail- \nable hypnotics. The perspiration of pulmonary tuberculosis, it \nmay be noted, is sometimes diminished by evening doses of \nthe drug. \n\nUntoward Symptoms. \xe2\x80\x94 These occur but infrequently and are \nthe exanthem already mentioned, loss of appetite, nausea, vom- \niting, diarrhoea, headache, vertigo, and rarely torpor lasting \nthrough the following day. Cumulation is not to be anticipated. \n\nTOXICOLOGY. \n\nSymptoms. \xe2\x80\x94 In a single instance febrile reaction for six or eight days, \ndryness of the mouth, burning sensation in the throat, a morbilliform \nexanthem on the face, extending to the chest and arms, becoming con- \nfluent, followed by a vesicular and bullous eruption upon the buccal \nand pharyngeal mucous membranes, conjunctivitis, and pain in the ears, \nhas been observed. \n\nTreatment. \xe2\x80\x94 Interruption of the treatment, or alternation with hyp- \nnotics of other series, administration of the alkaline mineral waters, with \nthe securing of a daily movement of the bowels, will obviate these symp- \ntoms. \n\nPARALDEHYDE. \n\nPARALDEHYDUM.\xe2\x80\x94 Paraldehyde. Dose, 2 C.C.; 30 Til. \n\nAction of Paraldehyde. \n\nExternal. \xe2\x80\x94 It is antiseptic and antifermentative. \n\nInternal. \xe2\x80\x94 Paraldehyde is a prompt, powerful and safe hyp- \nnotic. The system is usually very tolerant of it, and it may \nbe continued and found useful for long periods. In animals, \nin which it acts in the same manner as upon man, it depresses \nthe higher nervous centres first; later it diminishes the re- \nflexes, and finally there is a marked effect on the spinal cord. \nThe anterior cornua are paralyzed, and there are abolition of \nreflex action, paralysis and anaesthesia. Fatal results from it \n\n\n\nPARALDEHYDE. 883 \n\nare rare, but enormous quantities may cause death by para- \nlyzing the respiratory centre in the medulla. Its action on the \nheart is similar to that of sulphonal, causing a slight accelera- \ntion of the pulse by its depressant effect upon the inhibitory \ncentre. It often produces gastric irritation and an increased \nflow of urine. It is chiefly excreted by the kidneys, but in part \nalso by the lungs, and the odor of the drug may be detected in \nthe breath for some time after its hypnotic effect has passed \noff. An erythematous rash is sometimes caused, and its pro- \nlonged use is said to have induced gastric catarrh and ulcers \nabout the nose. Diarrhcea has also been observed. Instances \nof the paraldehyde habit have been occasionally reported. \nThere is great emaciation, cardiac weakness, unsteady gait, \nmental confusion and agitation, with hallucinations of sight \nand hearing and unpleasant delusions. Restraint for several \nmonths is necessary for cure. \n\nTherapeutics of Paraldehyde. \nUnlike chloral, paraldehyde may be given with safety in cases \nof cardiac disease. The principal objection to the drug is its \ndisagreeable and burning taste, and hence it is usually admin- \nistered in capsules. If not given in this way, syrup and tinc- \nture of orange peel (with at least 60 c.c. ; 2 fl. oz. of water, \nso as to insure the dissolving of the paraldehyde) may be em- \nployed to conceal the taste, or the drug may be administered \nin glycerin, in a 25 per cent, solution, which renders it more \npalatable. The large dose required is also a disadvantage. If \nparaldehyde is to be of service, it usually produces sleep in from \nfifteen to thirty minutes, and this is placid, dreamless and re- \nfreshing. No lassitude or depression is experienced the follow- \ning day, and the appetite often improves under its use. It is \nuseful in most cases of simple sleeplessness, but is found to \nbe of little service if there is any active pain, or if there is \ncause for worry and anxiety. To patients with gastric irrita- \nbility and in cases where there are convulsions it may be given \nby the rectum. Paraldehyde is principally used in institutions \n\n\n\n884 PHARMACOLOGY AND THERAPEUTICS. \n\nfor the insane. It has been found valuable in all forms of \nmania, including the delirious mania due to alcohol or epilepsy. \nIn cases of melancholia it may induce sleep, but is often dis- \nappointing. It is useful in mental excitement associated with \nchorea, and in many cases of senile excitement, with marked \nrestlessness, it has been pronounced the best remedy. It has \na certain value in convulsive diseases, and has proved of ser- \nvice in some cases of epilepsy, chorea and strychnine poisoning. \nIt sometimes relieves the symptom asthma and the paroxysms \nof whooping-cough, but on account of its disagreeable taste and \npungent odor it is not well suited for children. As an expec- \ntorant, as well as an antispasmodic, it seems to be useful in the \ntreatment of cough in general. It is said to have been effica- \ncious in some cases of polyuria. \n\nETHYL CARBAMATE. \n\n-ffiTHYLIS CARBAMAS. \xe2\x80\x94 Ethyl Carbamate. (Urethane. Ethyl \nUre thane.) Dose, 1 gm.; 15 gr. \n\nAction of Ethyl Carbamate. \nUrethane is a hypnotic, and is believed to induce a calm, \nnatural sleep without any disagreeable after-effects. \n\nTherapeutics of Ethyl Carbamate. \nIt was employed more frequently formerly than at present, \nas it so often proves disappointing. In some instances it ap- \npears to act as an almost ideal hypnotic, but, unfortunately, \nthere are many cases in which it has no effect. It is most \nsuccessful in those in which there is no pain and where the sleep \nis wanting rather from habit than from any uneasy feeling or \nfrom worry. It has been found beneficial in children and in \nsome cases of sleeplessness following fevers or the result of \nalcoholic excess; also in some instances where other more \npowerful drugs, such as chloral, have been taken for some time \nand where the patient feels that he must have sedatives to help \n\n\n\nHOPS. 885 \n\nhim to sleep. It does not appear to be of much service among \nthe insane. \n\nHOPS. \n\nHUMULUS.\xe2\x80\x94 Hops. Dose, 2 gm.; 30 gr. \n\nLUPULINUM.\xe2\x80\x94 Lupulin. Dose, 0.500 gm. (500 milligm.) ; iy 2 gr. \n\nPreparations. \n\n1. Fluidextractum Lupulini. \xe2\x80\x94 Fluidextract of Lupulin. Dose, \n0.5 c.c.; 8 Til. \n\n2. Oleoresina Lupulini. \xe2\x80\x94 Oleoresin of Lupulin. Dose, 0.200 \ngm. (200 milligm.) ; 3 gr. \n\nUnofficial Preparation. \nTinctura Humuli (U. S. P., 1890). \xe2\x80\x94 Tincture of Hops. Dose, \n4.0 to 8.0 c.c; 1 to\' 2 fl. dr. \n\nAction of Hops. \nLike other volatile oils, its constituent, valerol, which to a \nslight extent also reflexly excites the circulation, is stomachic \nand carminative. \' The bitter principle likewise adds to the \nstomachic properties of the drug. Hops have an undoubted \nsedative and hypnotic influence, which is supposed to be prob- \nably due to the volatile oil, but it is not very marked, and ap- \npears to be subject to considerable variations. Lupulinic acid, \nwhen injected as a neutral salt into the blood, has been found \nto cause first stimulation and then paralysis of the medullary \ncentres, but to have very little effect when given by the mouth, \neven in large doses. \n\nTherapeutics of Hops. \nHops are used medicinally chiefly in the form of bitter ale, \nwhich derives from them its peculiar flavor and taste, as well \nas a certain degree of its heavy, soporific effect. Ale, stout, \nor good beer may sometimes serve to improve the appetite and \ndigestion and to secure sleep, and such effects are naturally \nincreased by the alcohol contained in them. Hops may some- \n\n\n\n886 PHARMACOLOGY AND THERAPEUTICS. \n\ntimes be employed with advantage in atonic dyspepsia, flatulent \ncolic and mild diarrhoeas. Lupulin has been used in nervous \ntremors, wakefulness and the delirium of drunkards. Equal \nparts of fluidextract of lupulin and tincture of capsicum con- \nstitute an excellent substitute for alcoholic stimulants when it \nis desired to break off the use of the latter, and this combina- \ntion is also very useful for the wakefulness and excitement \npreceding a threatened attack of delirium tremens. Lupulin is \nsupposed to have some value as an anaphrodisiac, and it is \nsometimes of service in spermatorrhoea. The oleoresin is here \nregarded as the best preparation. It has been recommended \nfor chordee, but appears to have very little effect in this con- \ndition. A hop pillow often seems to have a soothing and \nsoporific influence, but this result is doubtless to a great extent \nthe effect of imagination and the association of ideas. So, hop \npoultices are used for their alleged anodyne action, but any \nbenefit derived from them is to be attributed simply to the heat \nand moisture. \n\nLACTUCARIUM. \n\nLACTUCARIUM. \xe2\x80\x94 Lactucarium. (Lettuce.) Dose, 1 gm.; 15 gr. \n\nPreparations. \n\n1. Tinctura Lactucarii. \xe2\x80\x94 Tincture of Lactucarium. Dose, 2 \nc.c; 30 TH.. \n\n2. Syrupus Lactucarii. \xe2\x80\x94 Syrup of Lactucarium. Dose, 8 c.c; \n2 fl. dr. \n\nAction of Lactucarium. \nLactucarium has been credited with mild hypnotic powers. \nFresh lettuce is said to contain traces of hyoscyamine, in addi- \ntion to lactucin, and since classic times has been known as tend- \ning to induce slumber. Large doses of the green extract may \ncause mental derangement, and will dilate the pupil. \n\nTherapeutics of Lactucarium. \nIt is quite unreliable as a hypnotic, but in some instances \nappears to have a quieting and soporific effect. It may be \n\n\n\nMETHYLENE BLUE. 887 \n\ntried as a substitute for opium and its alkaloids when these dis- \nagree. The syrup is sometimes added to cough mixtures as a \nsedative, especially for children, and has also been employed to \nallay nervous irritability and as a substitute for the soothing \nsyrups containing opium. Aubergier\'s syrup of lactucarium \n(not official) has the reputation of being active and uniform \nin strength. \n\nMETHYLENE BLUE. \n\nMETHYLTHIONIN-ffi HYDROCHLORIDUM. \xe2\x80\x94 Methylthionine \nHydrochloride. Methylene Blue. Dose, 0.250 gin. (250 milligm.) ; \n4 gr. \n\nAction of Methylene Blue. \nMethylene blue (not to be confounded with methyl blue) has \nbeen introduced into medicine as an antiseptic. It also possesses \nanodyne and diuretic properties. It imparts a blue color to \nnerve substance and a like color to the urine. \n\nTherapeutics of Methylene Blue. \nIt has been used for rheumatism of the joints and muscles, \nmigraine, sciatica and other neuralgias; also for alcoholic neu- \nritis and the pains of locomotor ataxia. It would seem to be \na remedy of some value for quieting patients suffering from \nincurable mental disease in which excitement is a prominent \nsymptom. In a number of cases of mania and paretic demen- \ntia it produced a calmative effect which did not resemble the \naction of hypnotic drugs, but seemed rather a natural quietude. \nLately it has been given for intermittent fevers, but the reports \nshow that it possesses no advantage over quinine except its \ntastelessness. It may be substituted for quinine if the latter \ncannot be taken or has been unsuccessfully used. Recent reports \nindicate that even when given internally, it causes gonococci to \nrapidly disappear from the urine in specific urethritis. As to \nits effects upon inoperable neoplasms when injected into them \nclinical reports differ widely. It may produce irritation at the \n\n\n\n888 PHARMACOLOGY AND THERAPEUTICS. \n\nneck of the bladder, which about 2 gm. (30 gr.) of powdered \nnutmeg is said to relieve. \n\n(3) General Anaesthetics. \n\nCHLOROFORM. \n\nCHLOROFORMUM.\xe2\x80\x94 Chloroform. (Trichloromethane.) Dose, 0.3 \nc.c; 5 m,. \n\nPreparations. \n\n1. Aqua Chloroformi. \xe2\x80\x94 Chloroform Water. Dose, 16 c.c; \n4fl. dr. \n\n2. Emulsum Chloroformi. \xe2\x80\x94 Emulsion of Chloroform. Dose, \n8 c.c; 2 fl. dr. \n\n3. Linimentum Chloroformi. \xe2\x80\x94 Chloroform Liniment. \n\n4. Spiritus Chloroformi. \xe2\x80\x94 Spirit of Chloroform. (Chloric \nEther.) Dose, 2 c.c; 30 ul. \n\nUnofficial Preparation. \nTinctura Chloroformi et Morphinae Composita (B. P.). \xe2\x80\x94 \nCompound Tincture of Chloroform and Morphine. Dose, .30 to \n1 C.C.; 5 to 15 Til. (This preparation is an imitation of the \nproprietary remedy known as Chlorodyne. Among its principal \ningredients are chloroform, tincture of cannabis indica, tincture \nof capsicum, and morphine hydrochloride.) \n\nAction of Chloroform. \nExternal. \xe2\x80\x94 The local action of chloroform quite resembles \nthat of alcohol, but is more energetic. It is also more power- \nfully antiseptic. Chloroform is a protoplasmic poison of great \nintensity, and no living substance is capable of withstanding its \nlethal effect if exposed to its concentrated vapor for a sufficient \ntime. Its evaporation on the skin has a refrigerant effect, and \nhence causes contraction of the blood-vessels and anaesthesia at \nthe point of application. If, however, the vapor is confined, or \nif chloroform is rubbed into the skin, it has the effect of causing \nheat and redness, with dilatation of the local vessels; and the \nirritation may be sufficient to produce vesication. While when \n\n\n\nCHLOROFORM. 889 \n\nlocally applied it is more irritant to mucous membranes than \nether, yet when inhaled it is less irritant than the latter to the \nrespiratory tract. \n\nInternal. Alimentary Tract. \xe2\x80\x94 In the mouth it causes, in con- \ncentrated form, a burning sensation and pain, followed by anaes- \nthesia, and increased secretion of saliva and mucus by reflex \nexcitation of the glands. In the stomach and intestine it is \nalso markedly irritant, often causing violent gastro-enteritis. \nIn small doses its action is very much like that of the volatile \noils, producing in the stomach a sense of warmth and comfort \nand inducing increased peristalsis. Absorption, it is believed, \ntakes place more rapidly than in the case of the volatile oils. In \nthe intestine it may perhaps have a slightly astringent effect. \n\nBlood. \xe2\x80\x94 Chloroform is absorbed into the blood from the \ngastro-intestinal tract, and, if administered by inhalation, from \nthe lungs, and after absorption is thought to form a loose com- \nbination with the cholesterin and lecithin in the blood, perhaps \nin the red corpuscles. \n\nNervous System. \xe2\x80\x94 The effects of the drug, when inhaled, are \ncommonly divided into three stages. It must be borne in mind, \nhowever, that there are no sharply denned dividing lines be- \ntween them, and that they are simply different degrees of the \nsame action. For convenience of study they may be named \nthe stimulant, the anaesthetic, and the paralytic. \n\nFirst Stage. \xe2\x80\x94 There is a more or less marked preliminary \nfeeling of asphyxia, but with this exception, the sensations are \nrather pleasant than otherwise. There is a sense of warmth \nexperienced first about the face and head, but afterwards ex- \ntending throughout the body, while the imagination is tem- \nporarily excited. The patient\'s comfort, however, may be dis- \nturbed by the local effects, such as pricking and smarting of \nthe nose, throat and conjunctiva, accompanied by increased \nsecretion of saliva, mucus and tears. Vomiting may possibly \noccur, but is rare at this period. The mind becomes confused \nfrom the irregular stimulation of the higher cerebral functions, \nbut this stimulation is only evanescent, and the patient soon be- \n\n\n\n89O PHARMACOLOGY AND THERAPEUTICS. \n\ngins to lose consciousness. Hallucinations are apt to be present, \nand the special senses are disturbed, so that he experiences un- \nusual sensations of light and ringing, hissing and roaring in the \nears. There is formication and a feeling of stiffness in the \nmuscles and of inability to move the limbs. He loses his \nself-control, and gives way to manifestations which vary with \nhis character \xe2\x80\x94 loud talking, laughing, singing, weeping, swear- \ning, etc. The general sensibility becomes blunted, but is not \nabolished. With the depression of the higher functions comes \non excitation of the lower motor functions, and the patient \nnow often begins to struggle violently. He will kick, fight and \nthrow his arms and legs about to such an extent that it is diffi- \ncult to restrain him. These motor phenomena vary greatly in \ndifferent individuals, and in some instances, especially in chil- \ndren, are entirely absent. Occasionally, and particularly in \nhysterical subjects, convulsions are observed. In this stage \nusually the pupils are somewhat dilated, the skin warm and \nmoist, the face flushed or cyanotic, the pulse accelerated, and \nthe apex-beat augmented. The respiration is generally slightly \nquickened, but may be more or less irregular, at first in conse- \nquence of the sensation of asphyxia and later from the \nstruggling. \n\nSecond Stage. \xe2\x80\x94 The inhalation being maintained, the move- \nments cease and the muscles become relaxed. In consequence \nof this relaxation, the face, which is now pale, assumes a calm \nand death-like appearance. The smooth muscles are not usu- \nally affected, but there is sometimes a relaxation of the sphinc- \nters. There is paralysis of the motor reflex centres of the \ncord, as well as paralysis of the brain and depression of the \nmedullary centres. Consciousness, sensation and most reflexes \nare abolished, and one of the last reflexes to disappear is the \ncorneal. The pupils are contracted and do not respond to light, \nand the patient lies in a deep sleep. Snoring is apt to be pro- \nduced from the falling back of the tongue. The respiration \nbecomes regular, but slower and shallower than before the \ninhalation was commenced. The pulse is generally somewhat \n\n\n\nCHLOROFORM. 89 1 \n\nslow and weak, but regular, and the blood-pressure falls on \naccount of the depression of the vaso-motor centre. Vomiting \nis a frequent occurrence, and dilatation of the pupil and in- \ncreased pallor are generally indications of its approach. The \nbody temperature invariably sinks in consequence of the less- \nened muscular activity and to a less extent of the increased \nheat loss, and in prolonged anaesthesia the fall may be as much \nas 3 to 5 C. When the inhalation is discontinued, the patient \nagain passes through a stage of excitement, which is generally \nmuch less violent but may be more prolonged than before. \nUsually in recovering from the anaesthesia he falls into a sleep \nwhich lasts several hours, but not infrequently there are dizzi- \nness, nausea and vomiting for a considerable time. \n\nThird Stage. \xe2\x80\x94 The characteristic feature of this stage, which \nmust be carefully guarded against, is progressive paralysis of \nthe medulla. The surface is cold and covered with a clammy \nsweat, and the pupils become widely dilated, though at the last \nthey may be either dilated or contracted. The faeces and urine \nare often passed involuntarily. The respiration grows irregu- \nlar, stertorous and labored. The pulse, now also irregular, \nbecomes more and more slow and feeble, the blood-pressure \nfalls to zero, and the heart, weakened and dilated, is finally \narrested in diastole. \n\nThere has been much discussion as to the cause of death in \nchloroform anaesthesia, and in 1889 the Nizam of Hyderabad \nappointed a special commission to investigate the question. \nAfter experimenting on over six hundred animals the commis- \nsion arrived at the conclusion that death is always due to arrest \nof the respiration. The criticism has been made that the altera- \ntions in the circulation produced by chloroform were not prop- \nerly appreciated by these investigators, or, at all events, were \nnot sufficiently emphasized in their report, and in the United \nStates it has generally been believed that death is from depres- \nsion of the heart. It may be stated that it is now generally \naccepted that the fatal effect of chloroform, as seen in its use \nas an anaesthetic in surgery, is due chiefly and in most instances \n\n\n\n892 PHARMACOLOGY AND THERAPEUTICS. \n\nto its action upon the circulatory system, and especially upon \nthe heart itself. There seems to be no doubt of the fact that \nin general the mode of administration really determines the \nmanner of its lethal action. Thus, a percentage of chloroform \nvapor so low as to be practically incapable of causing sudden \ndeath will, if the administration is maintained, finally bring \nabout a fatal result from over-narcosis, and under these cir- \ncumstances it is almost invariably the case that death is due \nto failure of the respiration from paralysis of the respiratory \ncentre in the medulla. Experiment has demonstrated that un- \nder the inhalation of very dilute chloroform the respiration \nalways ceases several minutes before the heart, which continues \nto beat quite strongly for a short time and then grows rapidly \nweaker, and that as the concentration of the vapor is increased, \nthe interval between the failure of the respiration and of the \nheart becomes shorter. When air saturated with chloroform \nvapor is inhaled, the interval between the two is so brief as to \nbe inappreciable. The pulse, indeed, may be so weak as to be \nno longer perceptible before the respiration ceases, but if the \nmovements of the heart be registered directly, it is usually \nfound beating as long as the respiratory movements are car- \nried on. From a practical point of view, it has been pointed \nout, it is of comparatively little importance whether there are \na few fluttering beats of the heart after the last inspiration or \nnot; the all-important question is whether the heart has been \nso injured as to be unable to carry on the circulation. Clinical \nexperience has shown that it is the sudden administration of \na high percentage of chloroform vapor which is responsible \nfor most of the fatalities from this drug, and it is through its \ndirect action on the heart that death is then caused. The car- \ndiac muscle becomes paralyzed and more or less suddenly fails \nto be effective in maintaining the circulation, so that the blood- \npressure falls rapidly. The heart is now incapable of empty- \ning itself, and, the organ becoming distended with blood, its \nmuscle, after a few slight fibrillar contractions, confined to \nthe ventricular bases, finally stops acting. In some instances \n\n\n\nCHLOROFORM. 893 \n\nin dogs, however, the heart has been found flabby and empty. \nThe action of the respiratory system during this time must be \nregarded as for the most part secondary to the state of the \ncirculation. When the blood-pressure has fallen considerably, \nthe medullary centres become anaemic and the respiration fails. \nWhen the respiratory movements cease, the lesser, or pulmonic, \ncirculation fails in consequence, and this embarrasses the heart \nstill further, precipitating its distention and complete paralysis. \nNot only is the heart in a condition of paralytic distention, but \nthe great vessels of the chest and abdomen are also distended \nwith blood. In fact the vaso-motor paralysis of the vessels in \nthe splanchnic system must always be taken into consideration \nin determining the factors which bring about a fatal issue. \n\nIn its action on the central nervous system, as has been \nseen, chloroform affords an excellent illustration of the law of \ndissolution (see p. 737). Thus, the paralysis caused by it \ncommences with the highest cerebral functions, those of self- \ncontrol, and passes progressively downwards through the lower \nintra-cranial divisions. The spinal cord is affected before the \nmedullary centres, which are the last portions of the cerebro- \nspinal axis to become paralyzed. In the recovery from chloro- \nform also the law of dissolution is illustrated, the lowest func- \ntions, such as muscular tone, being the first to reappear. The \nmuscles and nerves are not affected by chloroform when in- \nhaled. \n\nMetabolism. \xe2\x80\x94 A marked resemblance has been noted between \nthe effects of chloroform on the metabolism and those of phos- \nphorus, and in both cases the formation of acid in excess in \nthe tissues has been assigned as the cause of these effects. \nAfter the administration of chloroform either by inhalation or \nby the mouth both nitrogen and sulphur elimination is consid- \nerably augmented, indicating, it is believed, an increased de- \nstruction of nitrogenous bodies in the tissues. The sugar of \nthe blood has been found to be increased, and the glycogen of \nthe liver diminished, or entirely absent. This is stated to be \ndue to a specific action on the liver cells, which form glycogen \n\n\n\n894 PHARMACOLOGY AND THERAPEUTICS. \n\ninto sugar much more rapidly than usual. Fatty degeneration \nof various organs, especially the liver, heart and kidneys, have \nbeen observed after the repeated administration of chloroform, \nand even after a single inhalation in some instances. If this \nprocess attains a certain degree of development it is found that \nit may lead to failure of the heart, but otherwise the tissues \nrecover in a few days. Atrophic cirrhosis of the liver has been \nproduced by the drug when given in small quantities for several \nmonths. Similar but less marked effects have been observed in \nthe kidneys, spleen and lungs, and they are regarded as the \nresult of a preliminary fatty degeneration of the parenchyma- \ntous cells. In addition to its action on the central nervous \nsystem, it must therefore be recognized that chloroform pro- \nduces marked changes in the processes of life and the nutrition \nof the different organs. \n\nExcretion. \xe2\x80\x94 Chloroform is excreted mainly by the lungs, but \nin small quantities may also escape in the urine, perspiration \nand milk. Some of the chloroform inhaled seems to undergo \ncombustion in the body, and an increased acidity of the urine \nis attributed to hydrochloric acid formed by the combustion. \n\nTherapeutics of Chloroform. \nExternal. \xe2\x80\x94 The local application of chloroform has been \nfound useful in a variety of conditions. In severe neuralgias \nits deep injection in the vicinity of the affected nerve is a valu- \nable resource. The official liniment is employed to relieve the \npain of neuralgia, myalgia and chronic rheumatism and to re- \nduce chronic inflammations. Chloroform is also often used in \nliniments in association with camphor, tincture of aconite, or \nopium preparations. The following is highly recommended as \na local anaesthetic: Chloroform, 12 c.c. (3 fl. dr.); camphor, \n2 gm. (30 gr.) ; tincture of aconite, 12 c.c. (3 fl. dr.) ; tincture \nof capsicum, 4 c.c. (1 fl. dr.) ; tincture of pyrethrum, oil of \ncloves, each 2 c.c. (J4 A- dr.). The camphor is first dissolved \nin the chloroform, and the oil of cloves and the tinctures are \nthen added. For overcoming rigidity of the perineum in labor \n\n\n\nCHLOROFORM. 895 \n\nthe following application has been found useful: Chloroform, \n1 ; ether, 1 ; Cologne water, 8. The following combination has \nbeen recommended as an efficient anaesthetic spray for the per- \nformance of minor surgical operations: Chloroform, 37; men- \nthol, 4; ether, 56. An aching tooth may often be relieved by \nplugging it with cotton saturated with chloroform. Chloro- \nform is a good haemostatic, and applied upon lint or absorbent \ncotton, may be used to arrest superficial bleeding. The solution \nof gutta percha in chloroform has been employed as a protec- \ntive in small-pox and erysipelas, and has also been found use- \nful in the treatment of fissured nipple, superficial burns, furun- \ncles, psoriasis and herpes zoster. A lotion containing chloro- \nform may be of service in urticaria. In irritable ulcer of the \nrectum and itching about the anus an ointment, such as that \nof zinc oxide, to which chloroform has been added in the pro- \nportion of 4 c.c. (1 fl. dr.) to 30 gm. (1 oz.), often affords great \nrelief. Chloroform is an excellent antiseptic to preserve urine \nin transportation. .20 c.c. (3 Til) to 120 c.c. (4 fl. oz.) of urine \nis sufficient. The chloroform should be allowed to evaporate \nbefore testing the urine. \n\nInternal. \xe2\x80\x94 As chloroform disguises the taste of many nau- \nseous drugs, it is in common use for this purpose. Aqua \nChloroformi is frequently employed as a vehicle and Spiritus \nChloroformi as a flavoring agent. Like alcohol, the gastric \neffects of which are similar, chloroform is useful in some forms \nof dyspepsia, and in small doses it is sometimes given as a car- \ndiac stimulant. Chloroform water, or a few drops of chloro- \nform taken upon sugar or in water, will often relieve vomiting \nwhen not due to inflammations of the stomach. Small doses \nof it, however, may prove of service for the vomiting and pain \nof gastric ulcer, especially when given in association with bis- \nmuth preparations. The spirit of chloroform is used to arrest \nhiccough and also to relieve restlessness and irritating cough \nin pneumonia, pleurisy and bronchitis. A small quantity of it \nis a serviceable addition to expectorant mixtures when a neu- \nrotic element is present. 2 c.c. {]/ 2 fl. dr.), with an equal quan- \n\n\n\n896 PHARMACOLOGY AND THERAPEUTICS. \n\ntity of tincture of capsicum, in water, every half hour, hour, \nor two hours, has proved a very valuable hypnotic in delirium \ntremens with symptoms of depression and adynamia. The \nspirit of chloroform is sometimes given with advantage in com- \nbination with astringents and opium in diarrhcea, and is con- \nsidered especially useful in cholera morbus. In the treatment \nof true cholera no single remedy has been found more effica- \ncious than the empirical preparation known as chlorodyne (see \np. 888). The following, taken as a draught, is said to be suc- \ncessful in the treatment of tape-worm: Chloroform, 4 c.c. (1 \nfl. dr.) ; croton oil, .06 c.c. (1 "HI) ; glycerin, 30 c.c. (1 fl. oz.). \nSomnolence, so prolonged as to become serious, may, however, \nfollow the administration of this prescription. \n\nInhalation. \xe2\x80\x94 The inhalation of chloroform for anaesthetic \npurposes is principally employed for surgical operations, in \nbiliary and renal colic, and in parturition. For painful de- \nlivery but a small quantity is required, as it is given, not to \nproduce unconsciousness, but merely to blunt the sensibility, \nand it is a matter of common observation that chloroform inhal- \nation is borne better by women in labor than by any other class \nof subjects. Other purposes for which its inhalation is used \nare the relaxation of muscular spasm, as for the reduction of \ndislocations and hernias, and to relax the muscles for diagnostic \nreasons, as for making a thorough examination of fractures or \nof the abdomen, for the detection of malingering, etc. Finally, \nit is used for the relaxation of spasm in the convulsions of \ntetanus, hydrophobia and other affections. In certain anaes- \nthetic mixtures, which contain both ether and chloroform, the \nobject is to obtain the anaesthetic effects of both these agents \nwithout the cardiac and respiratory depression of either. The \nbest known of these is the A. C. E., which consists of 1 part \nalcohol (sp. gr. .838), 2 parts of chloroform (sp. gr. 1.497), an d \n3 parts of ether (sp. gr. .735). It is claimed that all of its \nthree constituents volatilize from it at an equal rate, but as \nthis has been found not to be the case (the ether evaporating \nfirst, the chloroform next, and the alcohol last), the advantages \n\n\n\nI \n\n\n\nCHLOROFORM. 897 \n\nof the mixture would seem to be doubtful. While the A. C. E. \nenjoys considerable popularity in England, it has never been \nmuch liked in the United States. \n\nIn the administration of chloroform careful attention must \nbe paid to a number of points: \n\n1. The ansesthetizer must be skilled and give his attention \nexclusively to the production and maintenance of narcosis. \n\n2. False teeth should be removed from the patient\'s mouth, \nto prevent the possibility of their falling into the throat and \nchoking him. \n\n3. No undigested food should be in the stomach; the patient \nshould be fasting for at least four hours, if possible. If vomit- \ning occurs, his head should be placed in such a position that no \nfood can get into the larynx. \n\n4. The clothing must be loose enough to allow perfect free- \ndom of respiration. \n\n5. The head should be a little raised and the lower jaw held \nup, in order to prevent the tongue from falling back over the \nlarynx. \n\n6. The chloroform must be pure. \n\n7. It should be given in such a way that the vapor may be \nthoroughly mixed with air in the proportion of about 5 to 95. \n\n8. The administration must be gradual, as " pushing " the \nanaesthetic is dangerous. \n\n9. The respiration should be watched with extreme care, as \nit appears to be a fact that gradual cardiac failure never takes \nplace without producing respiratory changes from the first. A \nsudden cardiac arrest, as sometimes occurs in fatty heart, will \nnot give warning either by the pulse or respiration. Unless, \ntherefore, it is possible to have an extra assistant to watch the \npulse, it seems advisable to neglect this, since a slighting of \nboth objects in view is too often the result of dividing the \nattention. \n\n10. The operation should never be commenced until the stage \nof muscular relaxation has set in, when reflex action is to a \nlarge extent abolished. From neglect of this precaution many \n\n58 \n\n\n\n898 PHARMACOLOGY AND THERAPEUTICS. \n\nlives have been lost, the heart being reflexly stopped by the \nstimulus of the knife; and it is a fact that most of the deaths \nfrom chloroform have occurred during slight operations, in \nconsequence of the mistaken notion that because an operation \nis trivial it may be begun early. \n\n11. In operations about the mouth care must be taken to pre- \nvent the entrance of blood into the air-passages. \n\n12. The anaesthetic must be administered with special care in \nthe old and in all cases where pulmonary disease is present or \nwhere the heart is feeble from any cause. It is contra-indi- \ncated in fatty heart. \n\n13. Special care is also called for when the operation neces- \nsitates awkward positions, and particularly those (such as the \nlateral position) in which the respiration is more or less inter- \nfered with. \n\n14. In consequence of the reduction of temperature caused by \nchloroform, the warmth of the patient must be seen to. \n\n15. Chloroform should never be administered without a hypo- \ndermatic syringe, in good order, being at hand. Amyl nitrite, \nether and ammonia should be in readiness. \n\n16. Inasmuch as substances irritating to the lungs may be \nproduced when the vapor of chloroform comes in contact with \na naked flame (in the presence of which chloroform is decom- \nposed), good ventilation should be insisted upon when gas \nlight must be employed. \n\nShould any signs of respiratory failure occur, artificial respi- \nration must at once be commenced, the tongue being pulled \nforward by forceps to facilitate the ingress of air. The most \nefficient means of performing artificial respiration is the use \nof the Hoyt pump, each full stroke of the piston of which \nforces into the lungs, through an intubation tube inserted in \nthe larynx, an amount of air corresponding with the normal \ninspiration. Other measures which may be employed are the \nflicking of the face and abdomen with wet towels, the adminis- \ntration of amyl nitrite by inhalation, and the hypodermatic in- \njection of strychnine or ether. Brandy, or alcohol in other \n\n\n\nCHLOROFORM. 899 \n\nform, should not be given. Galvanization over the cardiac \narea has been recommended, but it is probable that this is harm- \nful rather than beneficial. The heart may be stimulated by \nlarge rectal injections of hot normal saline solution, or of hot \ndecoctions of coffee, if at hand. One of the most efficient \nmeans of maintaining or restoring the action of the heart and \nthe respiration is the Maas process. This consists of the ap- \nplication of a series of compressions of the chest over the heart \nsufficiently forcible to create an artificial carotid pulse, the com- \npressions being made at the rate of 120 per minute. The object \nin view is to create an artificial circulation which may free the \nheart from distention and chloroformed blood, and raise the \narterial tension so that the respiratory centre may be supplied \nwith blood. If symptoms of improvement do not appear at \nonce, the patient should be inverted, and this procedure is \nfacilitated by hooking the knees over the table. It is claimed \nby some that inversion only adds to the danger, but there is a \nvast amount of clinical evidence going to show that it is of \npractical benefit, numerous instances being on record in which \nit was undoubtedly the means of saving the patient\'s life. The \nmeasures just mentioned should be maintained for hours, if \nnecessary; but if in spite of them the heart utterly ceases to \npulsate and the respiration completely fails, as a last resort \nthe chest should be opened and cardiac massage practiced by \nthe Kemp-Gardner method, artificial respiration at the same \ntime being maintained and the prolonged infusion of hot normal \nsaline solution employed. \n\nIn spite of all care in administration and the observance of \nall precautions, one death takes place in about three thousand \nadministrations. A painstaking series of experiments, how- \never, has afforded ground for the belief that chloroform is safe \nfor the majority of cases, provided it be given by one skilled \nin its use, and who not only knows how to give it, but to detect \nsigns of danger. The respiration should be especially watched, \nbecause, as has been mentioned, so soon as enough chloroform \nis used to endanger the circulation, the respiration will show \n\n\n\n900 PHARMACOLOGY AND THERAPEUTICS. \n\nsome abnormality. In the healthy animal death is due to res- \npiratory failure, accompanied by circulatory depression. The \nlatter itself may be severe enough to cause death, even if arti- \nficial respiration be skillfully used. In most of the cases in a \nseries of careful experiments on dogs respiratory failure oc- \ncurred first, followed by heart failure. In several instances, \nhowever, heart and respiration failed -synchronously, and in one \nthe heart stopped as if it had been stabbed. Chloroform may be \nchosen in hot climates ; when a large number of persons are to \nbe anaesthetized; in Bright\'s disease; in aneurism; in marked \natheroma of blood-vessels; in children or adults who already \nhave bronchitis; and in persons who struggle violently. \n\nIn 1901 a special committee was appointed by the British \nMedical Association to investigate chloroform in its therapeutic \nuses, the ultimate aim of the research being to determine the \nminimum dose of chloroform capable of producing adequate \nanaesthesia without endangering life. The first report of the \ncommittee was made in the summer of 1902 and the final report \nin that of 1903. In regard to the point whether the ordinary \nmethods of administering chloroform are trustworthy and safe, \nthe conclusion was reached that it is absolutely necessary to \nregulate the dosage of the drug, and that an apparatus is emi- \nnently desirable which will on the one hand permit the admin- \nistration of a definite dose capable of securing anaesthesia and \non the other not endanger life. Furthermore, that safety de- \npends upon dosage, that is, the proper percentage to be mixed \nwith air. Concentration has been shown to be fatal, whereas it \nis maintained that a vapor below 2 per cent, is wholly safe, and \nthat in most patients as low as 1 per cent, will maintain anaes- \nthesia. A further step was to determine with scientific accu- \nracy what the physical effects of various percentages were. \nWorking with the isolated mammalian heart, the investigators \nfound, among other points, that heart muscle takes up chloro- \nform from fluid circulating in the coronary vessels and that its \nlethal effects vary according to the fluid used. In diluted blood, \nfor example, the chloroform gives less effect than in saline solu- \n\n\n\nCHLOROFORM. 9OI \n\ntion. With the increase of chloroform in the circulating fluid, \nmore is taken up by the heart muscle, until finally toxic effects \nresult. With weaker doses an equilibrium appears to be estab- \nlished between the chloroform-containing fluid and the heart \nmuscle, so that at last no further effect upon the muscle mani- \nfests itself, in spite of the continued flow of the chloroform \nfluid. It was found that under toxic doses the ventricle is \nparalyzed in its action before the auricle. The experiments go \nto show the extreme importance of restricting the dosage of \nchloroform to relatively weak percentages, and that the size \nof the dose circulating in fluid through the heart is the im- \nportant element, rather than the length of time during which \nit circulates. Higher concentrations than 2 per cent, should be \nlooked upon as potentially dangerous, since their tendency is, \nother things being equal, to paralyze the heart muscle. The \nprolongation of the anaesthesia with a dilution under this per- \ncentage is not to be regarded as dangerous, although naturally \nindividual susceptibility must be taken into account, and, as \nusual, arguments drawn from animals cannot be forthwith and \nwithout modification applied to man. It will be observed that \nthese experiments in a measure controvert the idea that chloro- \nform has a cumulative effect upon the heart. As they were \nmade upon the isolated heart, they would appear to leave unas- \nsailed the position that the use of low percentages, if continued \nsufficiently long, may bring about a fatal result by inducing \nparalysis of the respiratory centre. \n\nETHER. \n\n-SJTHER.\xe2\x80\x94 Ether. (Sulphuric Ether. Ethylic Ether. Ethyl Oxide.) \nDose, 1 c.c; 15 TO,. \n\nPreparations. \n\n1. Oleum uEthereum. \xe2\x80\x94 Ethereal Oil. \n\n2. Spiritus Athens. \xe2\x80\x94 Spirit of Ether. Dose, 4 c.c; 1 fl. dr. \n\n3. Spiritus ^Etheris Compositus. \xe2\x80\x94 Compound Spirit of Ether. \n(Hoffmann\'s Anodyne.) Dose, 4 C.C.; 1 fl. dr. \n\n\n\ng02 PHARMACOLOGY AND THERAPEUTICS. \n\nAction of Ether. \n\nExternal. \xe2\x80\x94 By its rapid evaporation when applied to the skin, \nether produces a sensation of cold, and the part becomes \nblanched from the resulting contraction of the blood-vessels. \nWhen it is used in the form of a spray, this action is intensified, \nand marked local anaesthesia is caused. If, however, evapora- \ntion is prevented, or the ether is rubbed in, an irritant effect is \nproduced, though less pronounced than in the case of alcohol \nor chloroform. \n\nInternal. \xe2\x80\x94 In the mouth and stomach its effects are similar \nto those of alcohol and chloroform. It is a very prompt car- \nminative, causing increased secretion of the glands and dilata- \ntion of the gastric vessels. By reflex action it also at once \nstimulates the heart, increasing the force and frequency of the \npulse and raising the blood-pressure, and at the same time \nexcites respiration. It is absorbed rapidly and is not only a \nquickly acting diffusible stimulant, but also an anti-spasmodic. \n\nNervous System. \xe2\x80\x94 The action on the central nervous system \nin general resembles that of chloroform, but in some important \nparticulars there is a difference. The respects in which the \ntwo differ, when given for anaesthetic purposes, are somewhat \nas follows: \n\ni. Chloroform acts 36 to 48 times as powerfully as ether in \nparalyzing the heart. The pulse is not nearly so much affected \nby ether as by chloroform; while it may be somewhat slower \nthan usual, it is full and strong. \n\n2. Chloroform is 3 to 3^2 times as depressant as ether to the \nmedullary centres and the rest of the central nervous system. \n\n3. Anaesthesia is produced with greater difficulty, more \nslowly, and often less powerfully with ether than with chloro- \nform; consequently, the stage of excitement is usually more \nmarked and prolonged, and naturally attended with more \nstruggling. \n\n4. It is necessary to give the ether in much more concen- \ntrated form in order to produce narcosis \xe2\x80\x94 about 70 per cent, \nof ethereal vapor to 30 per cent, of air. \n\n\n\nETHER. 9O3 \n\n5. Consequently, it is much more difficult to administer than \nchloroform. \n\n6. Also it produces more irritation of the respiratory pass- \nages. \n\n7. Ether is much more likely to irritate the kidneys. \n\n8. Chloroform is much more agreeable to inhale. Its odor \nand taste are sweet and pleasant, and it causes less irritation \nand less feeling of suffocation. \n\n9. Ether is eliminated more slowly, and the odor therefore \nlingers about the person for some time. \n\n10. On account of its inflammability, ether is dangerous in \nthe vicinity of a naked flame or where the actual cautery is \nto be used. When artificial light, other than the incandescent \nelectric, must be employed, the lamp should always be adjusted \nabove the patient, since the ether vapor is heavier than air. \n\nKidneys. \xe2\x80\x94 From experimental researches it appears that in \nthe dog, at least, ether anaesthesia has for some as yet unex- \nplained reason a specific action upon the kidney, consisting of \na constriction of the arterioles of the organ. This is entirely \nindependent of any change in the general arterial circulation, \nsince it is found from the carotid tracings that the blood- \npressure is raised from the beginning. The vascular contrac- \ntion in the kidney has a damaging effect upon the renal secre- \ntory cells, similar to that which follows clamping the renal \nartery; the kidney shrinks in bulk, and as the etherization \nprogresses to deep narcosis there is a diminished secretion of \nurine, marked albuminuria, hematuria, and, finally, suppression. \nIt would seem probable that in man a corresponding action is \nelicited. \n\nExcretion. \xe2\x80\x94 So far as known, ether appears to be excreted \nonly by the lungs. \n\nTherapeutics of Ether. \nExternal. \xe2\x80\x94 The pouring of ether on the scalp sometimes \npromptly arrests headache. An ether spray may be used in \nsuperficial neuralgia, where the benumbing of the nerve some- \n\n\n\n9O4 PHARMACOLOGY AND THERAPEUTICS. \n\ntimes effects a permanent cure. It is also employed at times \nto produce local anaesthesia (by the cold resulting from the \nevaporation of the ether), for small operations, and it is par- \nticularly useful where thoracentesis or paracentesis abdominis \nis to be performed, or a simple incision made. As a rule, how- \never, the hardness of the tissues caused by it is a serious ob- \njection as regards operations, while the subsequent reaction is \nliable to produce considerable tingling and pain, as well as \noozing of blood from the wound. In any case where such local \nanaesthesia is used, the cold produced should not be intense \nenough to actually freeze the tissues, as this is apt to render \nthe healing slow. Since it dissolves fat from the skin, ether may \nalso be employed as a detergent before operations, the part to \nbe operated on being washed with it after soap has been used. \nEther being a good solvent of the active principles of many \ndrugs and also of sebaceous matter, it has been strongly recom- \nmended as a menstruum for various remedies to be applied to \nthe skin. The ether-spray has sometimes been successfully \nused in strangulated hernia, and its application to the spine has \nbeen followed by good results in some cases of chorea. \n\nInternal. Stomach. \xe2\x80\x94 Ether is very useful in colic and some \nforms of dyspepsia. Small doses of Hoffmann\'s anodyne, which \nmay be administered in camphor water, are efficient in expel- \nling flatus from the stomach and are often of service in gastral- \ngia and sick headache. A few drops of ether, added to cod- \nliver oil, render it more tolerable to the stomach and facilitate \nits digestion and absorption, probably by increasing the secre- \ntion of pancreatic juice. \n\nHeart. \xe2\x80\x94 On account of the rapidity of its action, ether is a \ncardiac stimulant of great value, and it is frequently employed \nin fainting, palpitation and heart-failure. According to cir- \ncumstances, it may be given either by the mouth or by hypo- \ndermatic injection. The dose for the latter purpose is 0.60 to \n1 c.c. (10 to 15 HI). It is also a useful anti-spasmodic in \nasthmatic attacks. \n\n\n\nETHER. 905 \n\nInhalation. \xe2\x80\x94 Ether is administered as a general anaesthetic \nfor the same purposes as chloroform. On account of its greater \nsafety, it is more commonly used in the United States. Some \naccidents with chloroform are no doubt due to carelessness, on \naccount of the great facility with which it can be administered, \nbut granting this, there can be no question that chloroform, as \nmight be supposed from the points in which its action differs \nfrom that of ether, is the more dangerous agent of the two. \nFrom the published statistics it would appear that the imme- \ndiate mortality with chloroform is from three to five times as \ngreat as with ether. The difference in the concentration re- \nquired to produce anaesthesia and that which will cause serious \nimpairment of the heart\'s action, or which will stop the respira- \ntion, is very much smaller in the case of the one than of -the \nother. Hence the preference should be given to ether except \nwhen this is specifically contra-indicated, as in bronchitis, \nnephritis, etc. From clinical observation, as well as experi- \nmental research, it is clear that ether has a special tendency \nto produce kidney trouble, and as a rule, therefore, it had bet- \nter be avoided when renal disease is present, and particularly \nwhen with this there is a tendency to pulmonary oedema. If \nemployed at all, it should be administered with the greatest \ncaution to those suffering from the various forms of acute or \nchronic kidney disease, or renal insufficiency from any cause. \nBoth ether and chloroform have been shown to be highly dan- \ngerous in cases of diabetes. Much attention has of late been \ndirected to fatalities occurring as sequelae of surgical anaesthe- \nsia : in the case of chloroform more particularly in consequence \nof fatty degeneration of the heart and kidneys or of diabetic \ncoma, and in that of ether from uraemia and from bronchitis, \npneumonia and pulmonary oedema, especially in the subjects of \nnephritis. In a considerable number of instances death from pul- \nmonary oedema with bronchial effusion and aspiration pneumonia \nhas occurred in the course of a few days after etherization. It \nis claimed by many that these post-anaesthesia deaths are decid- \nedly more frequent after ether than after chloroform, and, in \n\n\n\ng06 PHARMACOLOGY AND THERAPEUTICS. \n\nfact, that their number is large enough to bring the total mor- \ntality from ether, immediate and secondary, quite up to or even \nbeyond that of chloroform. Some surgeons, it may be stated, \nwho formerly used ether almost exclusively, believing that if \na fair estimate were made the fatal uraemias and pneumonias \ndepending on ether, if properly credited to it, would reverse \nthe record as it stands at present, are now chiefly employing \nchloroform. As it is very difficult, however, to distinguish \nbetween the results of the anaesthetic and the ordinary forms \nof disease, no very reliable statistics are as yet available in \nregard to the point at issue. The practice is now quite common \nof commencing ether anaesthesia with the preliminary inhala- \ntion of nitrous oxide gas, and in this way the disagreeableness \nof ether to the patient may be largely obviated and a more \nrapid and satisfactory narcosis secured. For the nausea and \nvomiting sometimes caused by ether the administration of I \ngm. (15 gr.) of sodium bromide has been recommended. \n\nAETHER ACETICUS.\xe2\x80\x94 Acetic Ether. (Ethyl Acetate.) Dose, 1 \nc.c; 15 TTt. \n\nAction of Acetic Ether. \nIt resembles ether in its carminative, stimulant and anti- \nspasmodic properties, but as it is less volatile, its action is \nless prompt and more prolonged, and it is more irritating to \nthe skin. While its inhalation will produce general anaesthesia, \nits effect in this respect is too slow for practical purposes. \n\n\n\nTherapeutics of Acetic Ether. \nOn account of its agreeable odor and taste it is combined \nwith other carminatives as a stimulant and antispasmodic. It \nis employed as an ingredient of Cologne water, and is some- \ntimes applied externally with friction, as a resolvent and for \nthe relief of rheumatic and other pains. The inhalation of its \nvapor allays laryngeal and bronchial irritation, and may also \nbe found useful in nervous cough. \n\n\n\nETHYL BROMIDE. 9O7 \n\nUnofficial Preparation. \njEthylis Bromidum. \xe2\x80\x94 Ethyl Bromide. (yEther Bromatus. \nHydrobromic Ether.) \n\nAction of Ethyl Bromide. \nEthyl Bromide was introduced to the profession in 1880 as \nthe most agreeable and rapid anaesthetic. \n\nTherapeutics of Ethyl Bromide. \n\nSeveral fatal cases having been reported, its use was aban- \ndoned. Recently, however, the inhalation of ethyl bromide, \nwhen pure, has been recommended in doses of from 12 c.c. ; 3 \nfl. dr. (child of two years), to 24 c.c; 6 fl. dr. (adult), for \nsurgical anaesthesia. The following precautions should be ob- \nserved: Food, even a glass of milk, is absolutely forbidden on \nthe day of operation. A mask is to be employed, and this \nshould perfectly cover the mouth and nose, so that no air is \nallowed to enter. The entire dose should be given at once. \nWhen narcosis is complete, the mask should be removed, and \nunder no consideration be re-applied. The administration must \nnot be prolonged over one minute. Sleep is obtained in from \ntwenty to thirty seconds, and lasts from two to three minutes, \nsometimes longer. The contra-indications to its use are dan- \ngerous lesions of heart, lungs, or kidneys. \n\nSomnoform, which is a mixture of ethyl bromide, 5 parts; \nethyl chloride, 60 parts ; and methyl chloride, 35 parts, has been \nhighly recommended as an anaesthetic for small operations, \nthough a number of surgeons have failed to find that it pos- \nsesses advantages over the ordinary anaesthetics in use. It has \nnow been tried to a considerable extent, especially in dentistry, \nas a substitute for nitrous oxide. It acts promptly, and if it \nis inhaled for from fifty seconds to two minutes does not give \nrise to nausea and vomiting or other unpleasant results. It is \nsaid to induce complete relaxation of the muscles, without \ncyanosis. A mask should be employed for the inhalation. A \nsingle dose of somnoform is 5 gm. (75 gr.), and this is supplied \n\n\n\nPHARMACOLOGY AND THERAPEUTICS. \n\n\n\nin a graduated glass. In prolonged operations it is necessary \nto repeat the dose several times. Mixed anaesthetics are much \nmore commonly resorted to in England and on the Continent \nthan in America. \n\nPENTAL. \n\nUnofficial Preparation. \nPentalum. \xe2\x80\x94 Pental. (Trimethylethyhene.) \n\nAction of Pental. \nPental is an anaesthetic, the equal of nitrous oxide in rapidity \nof action and perhaps safety, but superior to it in its more pro- \nlonged action and in having no unpleasant after-effects. Even \nwhen insensibility to pain is reached, consciousness is retained \nsufficiently to respond to commands. The stage of exhilaration \nis seldom present. The drug does not lose its effect by repeated \ninhalations. It differs from chloroform in that it acts more \npromptly, and has no evil after-effects ; from ethyl bromide, in \nthat it is somewhat slower in its action, but is more lasting in \nits effects, and can be prolonged as may be necessary; from \nnitrous oxide, in its freedom from unpleasant effects. \n\nTherapeutics of Pental. \nIt may be used for short operations, but it is not absolutely \nsafe, as was at one time claimed. \n\nDivision XL \xe2\x80\x94 Drugs Acting on the Organs of Generation. \n\nA. Aphrodisiacs. \xe2\x80\x94 These are substances which increase sex- \nual desire and power. They are supposed to act by stimulating, \ndirectly or reflexly, either the cerebral or spinal genital centre. \nThe latter has been located in the lumbar portion of the cord, \nand irritation of it induces erection. It is conceivable that it \nmay be excited by afferent impulses conveyed to it from various \nparts of the parts, but especially from the cerebrum and the \ngenital organs. Its activity appears to be largely dependent \n\n\n\n\n\n\nDRUGS ACTING OX ORGANS OF GENERATION. 909 \n\nupon the condition of the general health, and hence tonics and \nall measures promoting the bodily nutrition may act as indirect \naphrodisiacs. \n\nThe following drugs are known as aphrodisiacs ; their mode of action \nin this regard is not very clearly understood. \n\n\n\n(1) Strychnine. \n\n(2) Cantharides. \n\n(3) Alcohol. \n\n(4) Cannabis Indica. \n\n\n\n(5) Camphor. \n\n(6) Phosphorus. \n\n(7) Damiana. \n\n\n\nStrychnine probably acts by raising the tone of the spinal \ncentres, cantharides. camphor and damiana through reflex irri- \ntation from the urethral mucous membrane, alcohol and can- \nnabis indica by their effect on the imagination, and phosphorus \nby improving the general condition, especially in chronic ner- \nvous exhaustion. \n\nB. Anaphrodisiacs. \xe2\x80\x94 These are remedies employed to dimin- \nish sexual desire. They are supposed to act by decreasing the \nlocal circulation, by lessening the excitability of the nerves of \nthe genital organs, or by depressing the genital centres. Most \nof them, it may be said, are probably effective by diminishing \nor removing some source of irritation which is reflexly pro- \nducing an aphrodisiac effect. \n\nDrugs used as anaphrodisiacs are \xe2\x80\x94 \n\n(1) Bromides. (5) Hyoscyamus. \n\n(2) Potassium iodide. (6) Stramonium. \n\n(3) Opium. (7) Digitalis. \n(1) Belladonna. (8) Purgatives. \n\nLocal applications of ice, or cold baths, are sometimes of \nservice as anaphrodisiacs. \n\nC. Ecbolics or Oxytocics are remedies which during or im- \nmediately after parturition increase uterine action. \n\n\n\n9io \n\n\n\nPHARMACOLOGY AND THERAPEUTICS. \n\n\n\nThey are \xe2\x80\x94 \n\n(1) Ergot. \n\n(2) Cotton root bark. \n\n(3) Hydrastis. \n\n(4) Caulophyllum. \n\n(5) Savin. \n\n\n\n(6) Rue. \n\n(7) Cimicifuga. \n\n(8) Quinine. \n\n(9) Powerful purgatives. \n\n\n\nOf these ergot is by far the most important. Occasionally some of \nthese drugs will act upon the gravid uterus to produce abortion before \nparturition has begun. Most of them have been used for this purpose \nwith criminal intent. \n\nD. Emmenagogues are substances used to increase the men- \nstrual flow. Diminution of the menstrual flow is a symptom \nof quite a large number of conditions ; so that the various drugs \nwhich are beneficial in any of these are indirect emmenagogues. \nCertain substances, however, appear to have a special action in \nincreasing the menstrual flow. They are \xe2\x80\x94 \n\n\n\n(1) All Ecbolics. \n\n(2) Manganese salts. \n\n(3) Asafetida. \n\n(4) Apiol. \n\n(5) Myrrh. \n\n\n\n(6) Guaiac. \n\n(7) Cantharides. \n\n(8) Borax. \n\n(9) Tansy. \n\n\n\nAmong the many indirect emmenagogues the commoner are purga- \ntives, iron, cod-liver oil, and strychnine, which act by improving the \ngeneral health. Hot foot- or hip-baths, especially if mustard be added, \noften aid the onset of menstruation. \n\nE. Substances which depress Uterine Action. \xe2\x80\x94 These are em- \nployed to diminish or abolish the contractions of the gravid \n\nuterus. \n\n\n\nThey are \xe2\x80\x94 \n\n(1) Bromides. \n\n(2) Opium. \n\n(3) Hydrated chloral. \n\n(4) Viburnum. \n\n\n\n(5) Cannabis Indica. \n\n(6) Chloroform. \n\n(7) Antimony and potassium \n\ntartrate. \n\n\n\nPHOSPHORUS. 9I I \n\nF. Drugs acting on the Secretion of Milk. \nGalactagogues are drugs which increase the secretion of \nmilk. The most prominent are: \n\nPilocarpus, Leaves of Ricinus communis, and Alcohol. \xe2\x80\x94 Of these \npilocarpus is the most powerful, but its effects soon pass off. The \nleaves of the castor-oil plant are used, applied as a poultice, while a \ndecoction or the fiuidextract of them is given internally at the same \ntime. Alcohol has but a feeble effect, although the malt liquors have \nconsiderable reputation as galactagogues. The secretion is very depend- \nent on the condition of the system at large ; so that the best means of \nsecuring an abundant flow of milk is to maintain the general health. \n\nAntigalactagogues are drugs which decrease the secretion of \nmilk. \n\nBelladonna, either given internally or applied locally, is usually \nefficient for this purpose, by paralyzing the nerves of the mammary \ngland. \n\nThe following drugs are excreted by the milk, and are therefore \ntaken in by the nursing child : \xe2\x80\x94 Oil of anise, oil of dill, garlic, oil of \nturpentine, oil of copaiba, and probably all volatile oils, sulphur, rhu- \nbarb, senna, jalap, scammony, castor oil, opium, iodine, indigo, anti- \nmony, arsenic, bismuth, iron, lead, mercury, zinc and potassium iodide. \nIt is evident, therefore, that these remedies must be administered with \ncare to the mother ; for example, copaiba or turpentine will make the \nmilk so unpleasant that the child will not take it. Such of the above \nlist as are purgatives, when given to the mother, may cause diarrhoea \nin the child. Opium should not be given in large doses to the mother. \nOn the other hand, mercury, arsenic, and potassium iodide may be \nadministered to the child by being given to her. \n\nA. Aphrodisiacs. \nPHOSPHORUS. \nPHOSPHORUS.\xe2\x80\x94 Phosphorus. Dose, 0.Q005 gm. (0.5 milligm.); \n\nPreparation. \nPilulae Phosphori. \xe2\x80\x94 Pills of Phosphorus. Dose, 1 pill. \n\nUnofficial Preparations. \nSpiritus Phosphori (U. S. P., 1890). \xe2\x80\x94 Spirit of Phosphorus. \n(Tincture of Phosphorus.) Dose, .50 to 2.50 c.c; 8 to 40 TT\\,. \n\n\n\n912 PHARMACOLOGY AND THERAPEUTICS. \n\nOleum Phosphoratum (U. S. P., 1890). \xe2\x80\x94 Phosphorated Oil. \nDose, 0.05 to 0.30 c.c; 1 to 5 Hi. \n\nElixir Phosphori (U. S. P., 1890). \xe2\x80\x94 Elixir of Phosphorus. \nDose, 2.0 to 10 c.c.; y 2 to 2 l / 2 fl. dr. \n\nAction of Phosphorus. \nPhosphorus has a specific action on bones, and especially \nthose of young animals which are still growing. Under the \ninfluence of . minute quantities the cancellous tissue tends to \nbecome compact, and there is a deposition of true bone of nor- \nmal composition. This effect is attributed to the phosphorus \nacting as an irritant or stimulant to the bone-forming cells, and \narsenic also appears to produce it to some extent. Small doses \nof phosphorus generally increase the number of red blood- \ncorpuscles in man. Unless taken in a state of fine division or \ndissolved in oil, it is absorbed with difficulty, because of its \ninsolubility in the fluids of the body and of its slow volatiliza- \ntion. The great mass of it, if finely divided, is absorbed un- \nchanged and exists in the blood as phosphorus, and its action \nis due to this element rather than to its compounds. But little \nis known of its fate in the body. It is thought that a portion \nmay perhaps be oxidized to phosphoric acid, and some of it is \nstated to be eliminated by the lungs, while some is excreted in \nthe urine in obscure organic combinations. Phosphorus dimin- \nishes tissue waste, decreasing the elimination of urea and of \ncarbon dioxide. As it is found as a necessary element in the \nnervous system, its action is that of a stimulant to its growth. \nFurther details of its action are given under Toxicology. \n\nTherapeutics of Phosphorus. \nThe best known liquid preparation is Thompson\'s solution : \nPhosphorus, 1; absolute alcohol, 300; glycerin, 720; and spirit \nof peppermint, 40; dose, 1.20 to 4 c.c. (.J to 1 fl. dr.). Phos- \nphorus is especially indicated in osteomalacia, in rickets, and \nin cases of ununited fracture. Without doubt it promotes \ncalcareous deposit in the healing of fractures. It is of value \n\n\n\nPHOSPHORUS. 913 \n\nin convalescence from exhausting diseases, in nervous exhaus- \ntion, in neuralgia when dependent upon debility, in alcoholism, \nin sexual exhaustion, and in various suppurative affections. \n\nTOXICOLOGY. \n\nAcute Poisoning. \xe2\x80\x94 As phosphorus is quite accessible in the form \nof matches or vermin paste, poisoning by it, either accidental or suici- \ndal, is not uncommon. \n\nSymptoms. \xe2\x80\x94 For some hours no effect is observed. Then there is a \nburning pain in the abdomen, with nausea. The vomit has the char- \nacteristic garlicky odor of phosphorus and is luminous if heated with \nsulphuric acid. There is more or less general depression, and this \nmay amount to fatal collapse. Usually, however, the patient recovers \nfrom these effects and appears to be quite well for two, three or four \ndays, when he again begins to suffer from vomiting, and the vomited \nmatter is often bloody. There are also abdominal pain, distention and \ntenderness, and sometimes diarrhoea, and the stools may contain blood. \nWith these symptoms there occurs jaundice, which soon becomes very \nmarked, and the area of liver dullness is increased in consequence of \nfatty changes occasioned in that organ. The emesis, abdominal pain, \nand diarrhoea are explained by the same cause, the epithelial cells of \nthe stomach and intestine undergoing fatty degeneration. There is \nconsiderable muscular weakness and pain, together with a small and \nquick pulse and general prostration. Slight fever is sometimes ob- \nserved, but the temperature is often lowered in the later stages, \nthough the patient usually complains of intense thirst. There is likely \nto be a garlicky odor to the breath. Haemorrhages may occur in many \ndifferent situations, and the immediate cause of these is fatty degener- \nation of the muscular coat of the smaller arteries throughout the body. \nThe urine also may contain blood, as well as bile, leucin and tyrosin \ncrystals, albumin, and an abnormal amount of ammonia. Peptone is \nsometimes excreted, and the phosphates and sulphates are apt to \nbe increased from the augmented tissue-waste. The chlorides are much \ndiminished, in consequence of the patient\'s taking little or no food. \nSarcolactic acid appears in considerable quantity in the urine, and is \nsometimes accompanied by some sugar. The acid is regarded as diag- \nnostic of phosphorus poisoning. This condition lasts from five to eight \ndays, when the patient usually dies of heart failure, as a result of fatty \ndegeneration of the cardiac muscle from the direct action of the poison \nupon it. Towards the last convulsions and coma may occur, and these \n\n59 \n\n\n\n9I4 PHARMACOLOGY AND THERAPEUTICS. \n\nare regarded as a result of disordered metabolism, rather than due to \nany direct influence on the central nervous system. Even when the \nsymptoms are very severe, however, recovery is possible. With phos- \nphorus burns none of the symptoms of phosphorus poisoning are pre- \nsented. \n\nPost-mortem. \xe2\x80\x94 As might be supposed from the above description, \nwide-extended fatty degeneration is a prominent feature of the post- \nmortem findings, and in this respect phosphorus resembles arsenic, anti- \nmony and chloroform. This pathological change is most marked in the \nliver, but numerous fat globules are observed in the cells of many other \norgans, notably the kidneys and the gastric and intestinal glands, and also \nin the muscle fibres of the heart, stomach, intestines, smaller arteries, \nand often of the skeletal muscles. As to whether this fat is formed by \nthe degeneration of the protoplasm of the cells in which it is found, \nor whether it is carried from other parts of the body and simply de- \nposited in these cells, is as yet undetermined, but the weight of evidence \nappears to be decidedly in favor of the latter view. Another char- \nacteristic feature is the appearance of numerous haemorrhages and \necchymoses. In addition to the fatty degeneration of the muscular \ncoats of the arteries referred to, it is probable that the absence of \nclotting in the blood, due to the changes in the intestine and liver, \nwhich interfere with the formation of fibrin, is a factor in the causation \nof these. It has been noted that if the patient lives long enough, \nthere may be a diminution in the size of the liver, and altogether the \neffects of phosphorus poisoning present a considerable resemblance to \nthose of acute yellow atrophy of this organ. \n\nTreatment. \xe2\x80\x94 As phosphorus is absorbed from the alimentary canal \ncomparatively slowly, an attempt should be made in the early stages to \nremove it by emetics or the washing out of the stomach and by purges. \nAfterwards the object is to oxidize the phosphorus. Formerly copper \nsulphate was much lauded as an antidote, but recent researches appear \nto prove that it is itself a dangerous poison. Experiments on dogs \nhave shown that old oil of turpentine, which contains oxygen, if ad- \nministered before the poison is absorbed, is an antidote. Ordinary oil \nof turpentine, however, is worse than useless, for as phosphorus is \nsoluble in oils, we simply aid in its absorption by giving any oily or \nfatty substances. It is stated that only old, ozonized French oil of \nturpentine is really antidotal in its influence. Repeated and free in- \nhalations of oxygen have been used, and this suggests that hydrogen \ndioxide may be efficacious when given by the mouth. Potassium per- \nmanganate has also been advised for the purpose of oxidizing the \n\n\n\nPHOSPHORUS. 915 \n\nphosphorus. In the secondary stage alkalies are recommended in order \nto neutralize the excess of sarcolactic acid formed in the tissues. \n\nChronic Poisoning. \xe2\x80\x94 From the fact that the red or non-poisonous \nphosphorus is now generally employed in match factories, chronic \npoisoning, which was formerly frequently met with in those who worked \namong phosphorus fumes, has become a very rare occurrence. Such \npoisoning manifests itself in gastro-intestinal irritation and a peculiar \nnecrosis of the jaws. The latter, which usually has its starting-point \nin carious teeth, begins with salivation and suppurative ulceration of \nthe gums ; after which there results a profound periostitis, involving \nthe whole jaw. The lower jaw is more often affected. Phosphorus \nnecrosis must be treated surgically on the same principles as other \nnecroses. The diseased bone readily becomes the seat of tuberculous \ndeposit, and sufferers from phosphorus necrosis not infrequently die \nfrom general tuberculosis. \n\n1. CALCII HYPOPHOSPHIS.\xe2\x80\x94 Calcium Hypophosphite. Dose, \n0.500 gm. (500 milligm.) ; 7V 2 gr. \n\n2. SODII HYPOPHOSPHIS.\xe2\x80\x94 Sodium Hypophosphite. Dose, 1 \ngm.; 15 gr. \n\n3. POTASSII HYPOPHOSPHIS. \xe2\x80\x94Potassium Hypophosphite. \nDose, 0.500 gm. (500 milligm.); iy 2 gr. \n\n4. FERRI HYPOPHOSPHIS.\xe2\x80\x94 Ferric Hypophosphite. Dose, 0.200 \ngm. (200 milligm.); 3 gr. \n\n5. MANGANI HYPOPHOSPHIS. \xe2\x80\x94 Manganese Hypophosphite. \nDose, 0.200 gm. (200 milligm.) ; 3 gr. \n\n6. ACIDUM HYPOPHOSPHOROSUM.\xe2\x80\x94 Hypophosphorous Acid. \n\n7. ACIDUM HYPOPHOSPHOROSUM DILUTUM.\xe2\x80\x94 Diluted Hy- \npophosphorous Acid. Dose, 0.5 c.c; 8 Tr\\,. \n\nPreparations. \n\n1. Syrupus Hypophosphitum. \xe2\x80\x94 Syrup of Hypophosphites. \nDose, 8 c.c; 2 fl. dr. \n\n2. Syrupus Hypophosphitum Compositus. \xe2\x80\x94 Compound Syrup \nof Hypophosphites. Dose, 8 C.C.; 2 fl. dr. \n\n3. Emulsum Olei Morrhuae cum Hypophosphitibus. \xe2\x80\x94 Emul- \nsion of Cod Liver Oil with Hypophosphites. Dose, 8 C.C.; \n2 fl. dr. \n\n\n\ngi6 PHARMACOLOGY AND THERAPEUTICS. \n\nUnofficial Preparation. \nSympus Hypophosphitum cum Ferro (U. S. P., 1890). \xe2\x80\x94 \nSyrup of Hypophosphites with Iron. Dose, 4 to 8 C.C.; 1 to 2 \nfl. dr. \n\nZinci Phosphidum (U. S. P., 1890).\xe2\x80\x94 Zinc Phosphide. Dose, \n0.006 to 0.02 gm.; ^ to 1 gr. \n\nAction of Ferric, Calcium, Sodium, Potassium and Man- \nganese Hypophosphites. \nThe hypophosphites were introduced under the supposition \nthat they exert some special influence on nutrition. Practically \nthe whole of the hypophosphite administered can be recovered \nfrom the urine, showing that they are not oxidized to phos- \nphates in the tissues, as was formerly believed to be the case. \nSo far as investigations regarding their effects on nutrition has \ngone, no evidence has been furnished, according to the best \nauthorities, that they have any further action than the other \nindifferent salts, such as the chlorides. The chief effect of \nferric hypophosphite is regarded as undoubtedly due to its me- \ntallic iron. \n\nTherapeutics of Ferric, Calcium, Sodium, Potassium and \nManganese Hypophosphites. \n\nNotwithstanding the unsatisfactory experimental evidence of \ntheir value, these drugs are extensively used in cachectic con- \nditions, especially tuberculosis, and are the basis of a large \nnumber of proprietary preparations. \n\nFollowing Churchill, they should be of chemical purity, neu- \ntral in reaction; the presence of free alkali or alkaline carbon- \nates quickly giving rise to an atonic dyspepsia. The official \nsyrups of the hypophosphites are faulty in that each salt \nhas a peculiar property, for the final result is due to the \nhypophosphite and its beneficial effect upon nutrition. In the \nearly stages of phthisis (infiltration) the sodium salt should be \nadministered and the sodium salt alone ; if excavation is present \nthe calcium salt is indicated, and that alone, provided that it \n\n\n\nCALCIUM HYPOPHOSPHITE. 917 \n\ndoes not too suddenly check expectoration; when the sodium \nsalt should be resumed. \n\nThe potassium salt is a valuable expectorant in chronic bron- \nchitis; but it has a very limited usefulness in phthisis. The \nhypophosphites, when administered intelligently, will improve \nnutrition and relieve some of the symptoms of phthisis. If \nadministered in too large doses, or simultaneously with other \nremedies, as arsenic, stimulants, strychnine, or cod-liver oil, \nthey are likely to produce headaches and dyspepsia, and fail \nto cause improvement. The objection to the official syrups, \nnamely, the use of the salts in combination, applies to nearly \nall of the proprietary preparations, most of which contain im- \npure salts, contain a low percentage of hypophosphites, and \nare not scientific combinations. The syrup of hypophosphites \nwith iron is valuable as a reconstructive. Zinc phosphide is \nbelieved to have the same physiological and therapeutical effects \nas phosphorus. \n\nUnofficial Preparations. \nCalcii Glycerophosphas. \xe2\x80\x94 Calcium Glycerophosphate. Dose, \n0.30 to 1 gm.; 5 to 15 gr. \n\nSodii Glycerophosphas. \xe2\x80\x94 Sodium Glycerophosphate. Dose, \n0.6 to 2 C.C.; 10 to 30 TTt, usually hypodermatically. \n\nAction of the Glycerophosphates. \nThe administration of these substances has been found to \nincrease the solids of the urine, the urea, the carbon dioxide \nand sulphur oxidation coefficient, the chlorides, sulphates, lime, \nmagnesia and potash, with but little effect on uric acid. They \nimprove the nutrition of all organs, but more particularly that \nof the nervous system. Potassium, Lithium, Iron and Mag- \nnesium Glycerophosphates (none of them official) are also \nprepared. \n\nTherapeutics of the Glycerophosphates. \nInasmuch as the urine of neurasthenics contains relatively \nlarge amounts of incompletely oxidized phosphorus, especially \n\n\n\n91 8 PHARMACOLOGY AND THERAPEUTICS. \n\nin the form of glycerophosphoric acid, the effort was made to \nreplace this loss by the introduction of phosphorus into the \norganism in a form approaching, as nearly as is possible, that \nin which it exists in the nervous system. The indications for \nthe glycerophosphates are conditions of nerve depression. If \ngiven subcutaneously they are at least as efficacious as testicular \nfluid (q. v.), which owes its activity to its contained organic \nphosphates, and possess the advantage of more accurate dosage. \nThey are useful in various neuralgias, as sciatica, tic doulou- \nreux, Addison\'s disease, and in the symptom-complex, known as \nneurasthenia. Chlorosis, albuminuria, phosphaturia and anaemia \n(the latter by the iron salt) have been benefited. In diabetes the \ngeneral condition improves and the amount of sugar may dimin- \nish. In various diseases of the bones, such as rachitis, osteo- \nmalacia and tuberculous affections, the lime and magnesium salts \nare indicated, though, as has been stated, the value of lime salts \nin these has been seriously disputed {see p. 217). The reme- \ndies should not be expected to rejuvenate senility, but are use- \nful, even if slowly acting, adjuncts to the systemic treatment \nof an impaired nervous system. \n\nDAMIANA. \n\nUnofficial Preparations. \n\nDamiana. \xe2\x80\x94 Damiana. Dose, 15 to 30 gm.; y 2 to 1 oz. \n\nFluidextractum Damianae. \xe2\x80\x94 Fluidextract of Damiana. Dose, \n2 c.c; y 2 fl. dr. \n\nAction of Damiana. \nDamiana has enjoyed considerable reputation as a remedy \nfor sexual atony. Some observers believe it to be only tonic. \n\nTherapeutics of Damiana. \nIt is best administered as a fluidextract, in the dose of 2 \nc.c. {J/2 A. dr.), and in conjunction with remedies of this class \nof established worth. \n\n\n\nERGOT. 9 1 9 \n\nC. Ecbolics. \nERGOT. \nERGOTA.\xe2\x80\x94 Ergot. (Ergot of Rye.) Dose, 2 gin.; 30 gr. \n\nPreparations. \n\n1. Extractum Ergotae. \xe2\x80\x94 Extract of Ergot. (Ergotin.) \nDose, 0.250 gm. (250 milligm.) ; 4 gr. \n\n2. Fluidextractum Ergotae. \xe2\x80\x94 Fluidextract of Ergot. Dose, \n2 c.c; 30 m.. \n\n3. Vinum Ergotae. \xe2\x80\x94 Wine of Ergot. Dose, 8 c.c; 2 fl. dr \n\nAction of Ergot. \nThe effects of cornutine are quite distinct, in some respects \nat least, from those of the other constituents of ergot. Like \npicrotoxin, it produces a stimulation of the medulla oblongata, \nfollowed by paralysis. A rise in blood-pressure results from \nthe stimulation of the vaso-constrictor centre. While the other \nmedullary centres, the salivary, vagus, vomiting, respiratory, \netc., are acted upon to some extent, the stimulating influence \nis most conspicuously shown in the production of convulsions, \nwhich are chiefly clonic in character. In the frog it acts, like \nveratrine, directly on the fibres of skeletal muscle, thus produc- \ning an alteration in the contraction of the muscles; but, unlike \nveratrine, it has no action on the heart. Under its influence \ncontractions of a peristaltic nature have been observed in the \nstomach and intestine and also in the uterus, whether pregnant \nor not. The action of sphacelic acid consists in a constriction \nof unstriped muscle, especially of the blood-vessels, and a pri- \nmary depression, resulting in paralysis of the central nervous \nsystem. The latter is usually the cause of death when it is \ngiven in fatal amount. The muscular constriction is apparently \ndependent on both a central and peripheral influence, and is \nshown most conspicuously in a tonic spasm of the arterioles, \nleading to a rise of blood-pressure. In man, the pig, and the \nchicken, but not in other animals, the contraction produced in \n\n\n\n920 PHARMACOLOGY AND THERAPEUTICS. \n\nsome of the arterioles is so extreme and prolonged that a hya- \nline formation in the lumen and walls of the vessels takes place \nwhich effectually obstructs the circulation after the muscular \ncoats have relaxed, and gangrene results. This is a typical \naction of sphacelic acid, and it is not met with to nearly the \nsame extent in the case of any other known agent. It is ob- \nserved in the greatest perfection in the comb of the cock, in \nconsequence of the special arrangement of the blood-vessels in \nthis structure. In all animals the acid causes contraction of \nthe pregnant uterus, peristaltic under moderate doses and often \ntetanic when the quantity is large. From this sketch of the \nchief effects of these two substances the action of ergot itself \nmay, it is hoped, be more clearly understood. \n\nExternal. \xe2\x80\x94 Upon the skin ergot has no appreciable action, \nbut upon mucous membranes it has somewhat of an astringent \nand haemostatic effect. \n\nInternal. G astro -intestinal Tract. \xe2\x80\x94 Digestion is much im- \npaired in consequence of the disturbance caused in the circula- \ntion, and vomiting is common, partly in consequence of the \ndisturbed circulation and partly from the action of the cornu- \ntine on the medullary centre. Increased peristalsis of the in- \ntestine is induced by the stimulation of its muscular walls, and \ndiarrhcea frequently results in chronic poisoning. The intes- \ntinal vessels are constricted, partly in consequence of the con- \ntraction of their own muscular coats and in part from that of \nthe muscular fibres of the bowel. \n\nCirculation- \xe2\x80\x94 A high blood-pressure is indicated by a hard \nand small pulse, which is usually slow also. The rise in blood- \npressure may for a time be concealed by the slowness of the \nheart, but it is always very marked, and is one of the charac- \nteristic effects of ergot. It is dependent upon a general con- \ntraction of the arteries, which appears to be due in part to \naction on the vaso-motor centres and in part to direct action \non the muscular coats of the vessels. Because it constricts the \narterioles ergot is haemostatic. Very large doses may paralyze \nthe vaso-motor centres, with the effect of causing a fall of \n\n\n\nERGOT. 92 1 \n\nblood-pressure from vascular dilatation and cardiac depression. \nIf ergot is taken continuously for a considerable time gangrene \nin various situations is apt to result from the vascular contrac- \ntion and stasis of the blood stream, with coagulation and hya- \nline thrombosis. This is a prominent feature of chronic poison- \ning, which is known as ergotism, and it was frequently met \nwith in former times among the lower classes of Europe, who \nafter poor harvests especially were obliged to use bread con- \ntaining ergot. \n\nNervous System. \xe2\x80\x94 Besides the gangrenous form of chronic \nergot poisoning, the other principal form is the convulsive. \nThe differences in the several varieties of ergotism are ex- \nplained by the different actions of the constituents of the drug \nand by the fact that they may act partly on the blood-vessels \nand in part directly on the central nervous system. In some \nepidemics both the gangrenous and convulsive forms have been \npresent, but, as a rule, one has been much more prevalent than \nthe other. In convulsive or spasmodic ergotism there are at \nfirst formication, itching and tingling of the surface, followed \nby numbness and local anaesthesia. Not infrequently anaesthe- \nsia and hyperesthesia are found at the same time in different \nparts, or even in the same part. These manifestations com- \nmence in the hands and feet, and then spread over the whole \nbody. This disturbance of sensation even affects the alimen- \ntary canal, so that there may be present at once both voracious \nhunger and loss of appetite. At the same time there are much \nweakness and depression, often with severe headache and gid- \ndiness, as well as central disturbances of the special senses, \nsuch as dimness of vision and impairment of the hearing. \nThere may follow convulsions, usually clonic in character and \noften epileptiform, and these have as sequelae contractures in \nthe limbs and sometimes in the trunk muscles. The disease \nwas immediately fatal in a large proportion of cases in earlier \ntimes, and when recovery took place it was apt to be followed \nby more or less loss of intellectual power, and in some instances \nby complete dementia. \n\n\n\n922 PHARMACOLOGY AND THERAPEUTICS. \n\nUterus. \xe2\x80\x94 One of the most prominent features of the action \nof ergot is its property of exciting contractions in the pregnant \nuterus. Whether the ecbolic effects of ergot are due to its \naction on the uterus itself or on the nervous centres is still \nan unsettled question. Its action upon the unimpregnated \nuterus appears to be the same in kind, but less marked in de- \ngree, and of much less constant occurrence. \n\nThe saliva, perspiration, urine and milk are diminished by- \nergot, and this is supposed to be due to the general vascular \ncontraction caused by it. \n\nTherapeutics of Ergot. \nErgot is chiefly used for the purpose of insuring tonic con- \ntraction of the uterus after parturition, and thus guard against \nthe occurrence of post-partum haemorrhage. In case severe \nhaemorrhage is threatened, it is advisable, in order to obtain a \nmore prompt effect, to administer it hypodermatically. The \nmodern practice is to forbid the use of ergot until after the \nexpulsion of the placenta. The only possible exception to this \nrestriction is during the second stage of labor in cases where \nit may seem to be indicated as a prophylactic against post- \npartum haemorrhage. Even under these circumstances it should \nnever be given if there be the slightest mechanical obstacle to \ndelivery, or if the fcetal head be high up in the pelvic canal. \nThat ergot is justifiable in only very exceptional instances is \nillustrated by the fact that out of twenty-seven cases recorded \nby one obstetrical authority in which it was employed during \nthe second stage on account of inertia uteri, spontaneous de- \nlivery occurred in only seven. If the remedy is made use of \nat this period of labor, it is essential that the foetal heart should \nbe carefully watched, so that in case of threatened asphyxia \ninstrumental delivery may be promptly resorted to. One great \nobjection to the use of ergot before delivery is that the uterine \ncontractions induced by it are likely to become more and more \nsevere and prolonged, so that ultimately the continued pressure \nmay endanger the life of the child, while if serious mechanical \n\n\n\nERGOT. 923 \n\nobstruction is present, even rupture of the uterus may be \ncaused. If employed before the membranes have ruptured, it \nmay prevent the further dilatation of the os uteri and deprive \nthe foetus of its blood supply through the constriction of the \nuterine vessels. When given, as has been a very common prac- \ntice, at the time of the passage of the child\'s head, it is likely \nto produce its effect prematurely, and thus to give rise to hour- \nglass contraction and interfere with the expulsion of the \nplacenta. \n\nErgot enjoys some reputation as an internal haemostatic, and \nin addition to uterine haemorrhage, it has been employed in \nepistaxis, haemoptysis, haematemesis and renal and intestinal \nhaemorrhage. While some authorities regard it with much \nfavor, it is certainly by no means uniformly successful, and the \nmarked increase of blood-pressure which it causes may prove \na serious objection to its use. In all cases where it is given \nit is of great importance that the preparation should be a reli- \nable one, and that a sufficient quantity should be exhibited. \nThus, if the fluidextract is selected, it is advised that in urgent \ncases 4 to 8 c.c. (1 to 2 fl. dr.) should be given every half-hour \nor hour. Ergot is often combined with ipecacuanha or astrin- \ngents in these cases. The special indication for its use in \nhaemorrhage is regarded as a want of tonicity of the vessels. \nW T here an especially prompt effect is required it should be \nadministered subcutaneously, and this method is often prefer- \nable in haematemesis on account of the irritability of the stom- \nach. With suitable means for improving the quality of the \nblood, it is regarded by some as very serviceable in the haemor- \nrhagic diathesis, but it is not to be relied upon alone. In aneur- \nisms, and especially those beyond the reach of surgical treat- \nment, ergot may prove distinctly valuable. By its action in \nslowing the heart and causing such contraction of the arterioles \nas to induce a marked increase of blood-pressure, the coagula- \ntion of the blood in the aneurismal sac is promoted. In small \naneurisms of the peripheral main arterial trunks it is thought \npossible that it may effect a cure by means of the contraction \n\n\n\n924 PHARMACOLOGY AND THERAPEUTICS. \n\nresulting from its direct action on the unstriped muscular fibres \nin the affected portion of the vessel. It is also recommended \nin miliary aneurisms of the intra-cranial arterioles, giving rise \nto such symptoms as vertigo, epistaxis, headache and tinnitus \naurium; likewise when there is a sluggish and partially ob- \nstructed state of the intra-cranial veins, usually due to chronic \narteritis and accompanied by hebetude, dizziness, epistaxis, etc. \nIn certain forms of mental disease, such as recurrent mania, \nchronic mania with lucid intervals, and epileptic mania, when \nassociated with cerebral hyperemia, ergot has been found use- \nful, and in epidemic cerebro-spinal meningitis it is claimed as \none of the remedies from which the best results are to be ex- \npected. Much success is also claimed for it, when given in \nlarge doses, in congestion of the spinal cord and meninges \nand in acute myelitis, as well as in the congestive form of \nmigraine. Other conditions in which it has proved of service \nare acute conjunctivitis and blepharitis, congestive dysmenor- \nrhea, amenorrhea dependent on plethora, incontinence of urine \ncaused by a paretic or paralytic state of the bladder sphincter, \nand some forms of spermatorrhoea. It has also been used to \ncheck the night-sweats of phthisis and as an antigalactagogue. \nIt is sometimes beneficial in uterine fibroids and polypi, and \ngood results have been obtained from the long-continued use \nof ergotin in chronic metritis. Ergotin, especially when com- \nbined with opium and nux vomica, has been found highly use- \nful in persistent chronic diarrhoea. \n\nErgot is employed to some extent in topical applications. \nOil of ergot (not official) is serviceable in seborrhcea, loss of \nhair, and sycosis. Ergotin, in combination with various other \nremedies, has been used in ointments for fissures of the nose, \nmouth and anus, haemorrhoids, acne rosacea, boils, etc. \n\nNot infrequently it is desirable to use the fluidextract of \nergot in combination with ferric chloride. The inky mixture \nwhich results, by reason of the tannic acid contained in the \nergot, may be clarified by the addition of a little citric acid, \nand chloroform water is a good flavoring agent for it. \n\n\n\nHYDRASTIS. 925 \n\nCOTTON ROOT BARK. \n\nGOSSYPII CORTEX (Gossypii Radicis Cortex, U. S. P., 1890).\xe2\x80\x94 \nCotton Root Bark. Dose, 2 m.; 30 gr. \n\nUnofficial Preparation. \nExtractum Gossypii Radicis Fluidum (U. S. P., 1890). \xe2\x80\x94 \nFluidextract of Cotton Root Bark. \xe2\x80\x94 Dose, 1 to 4 C.C.; 14 to 1 \nfl. dr. \n\nAction of Cotton Root Bark. \nCotton Root Bark has the same action as ergot, and is an \nemmenagogue and an abortifacient. \n\nTherapeutics of Cotton Root Bark. \n\nIt is used as a uterine haemostatic in the treatment of menor- \nrhagia and metrorrhagia from various causes, and particularly \nfrom uterine fibroids. \n\nHYDRASTIS. \nHYDRASTIS.\xe2\x80\x94 Hydrastis. (Gold Seal.) Dose, 2 gm.; 30 gr. \n\nPreparations. \n\n1. Fluidextractum Hydrastis.\xe2\x80\x94 *Fluidextract of Hydrastis. \nDose, 2 c.c; 30 VS\\.. \n\n2. Tinctura Hydrastis. \xe2\x80\x94 Tincture of Hydrastis. Dose, 4 \nc.c; 1 fi. dr. \n\n3. Glyceritum Hydrastis. \xe2\x80\x94 Glycerite of Hydrastis. Dose, \n2 c.c; 30 TTL- \n\nHYDRASTINA.\xe2\x80\x94 Hydrastine. Dose, 0.010 gm. (10 milligm.) ; \n\n1ST\' \n\nHYDRASTININ^E HYDROCHLORIDUM.\xe2\x80\x94 Hydrastinine Hydro- \nchloride. Dose, 0.030 gm. (30 milligm.); y 2 S r - \n\nAction of Hydrastis. \nHydrastis is a stomachic tonic, and the large amount of \nberberine in its composition would seem to give it a place among \n\n\n\n926 PHARMACOLOGY AND THERAPEUTICS. \n\nthe simple bitters. In moderate doses it promotes appetite and \ndigestion, increasing the gastro-intestinal secretions and the flow \nof bile. Its general action is due principally to the alkaloid hy- \ndrastine. This primarily stimulates the centres of the medulla \noblongata, causing slowing of the heart, increased arterial ten- \nsion, and a quickening of the respiration. The rise in blood- \npressure is due to constriction of the arterioles. Under larger \namounts there is a stimulation of the spinal cord similar to that \ncaused by strychnine and causing clonic convulsions, followed \nby tonic convulsions and tetanus. Furthermore, it weakens and \nparalyzes muscle, an action which is confined to the heart in \nwarm-blooded animals, but affects the muscles generally in the \nfrog. In consequence of the cardiac depression the blood- \npressure falls, and eventually both the medulla and cord are \nparalyzed, death occurring from failure of the respiration. \nThe constriction of the arterioles is not due, apparently, to any \ndirect action on the walls of the vessels, but rather to the \nstimulation of the vaso-motor centre. There seems to be no \nvery satisfactory ground for the assertion, made by some writ- \ners, that hydrastis produces contraction of the uterus, from \naction on the muscle. The drug has decided antiperiodic prop- \nerties. The behaviour of hydrastine towards oxidizing sub- \nstances has led to the supposition that this alkaloid is changed \ninto hydrastinine in the body, but this is disproved by the fact \nthat it is excreted unchanged in the urine. Hydrastinine has \nbeen found to cause a much greater constriction of the periph- \neral vessels, as well as less depression of the heart, than hydras- \ntine. It is also stated to differ from the latter in producing no \nmarked disturbance of the centres of motion except when given \nin enormous doses, which paralyze the nervous system. \n\nTherapeutics of Hydrastis. \nExternal. \xe2\x80\x94 Hydrastis is much used empirically for subacute \nand chronic inflammations of the mucous membranes. It may \nbe that the benefit derived from it is due in great measure to \n\n\n\nHYDRASTIS. 927 \n\nits action in causing the contraction of dilated blood-vessels. \nThe various preparations, diluted with water, may be employed \nas injections in gonorrhoea, vaginitis, leucorrhoea, otorrhcea, \nand nasal catarrh, and as lotions for syphilitic mouth-lesions, \nmercurial or aphthous stomatitis, follicular pharyngitis, fissured \nnipples, hyperidrosis, acne, seborrhcea, and various other con- \nditions. A mixture of equal parts of the fluidextracts of hy- \ndrastis and ergot has been used as a local application in fissure \nor prolapse of the anus, ulcerations of the rectum,, haemorrhoids, \nand ulcerations or erosions of the os uteri. In the form of \nointments hydrastine and hydrastinine hydrochloride may be \nused for unhealthy ulcers, sloughing sores, chancroids, etc. \n\nInternal. \xe2\x80\x94 Hydrastis is very useful in gastric catarrh, espe- \ncially when induced by chronic alcoholism, and, combined with \nother appropriate remedies, often proves of service in intes- \ntinal indigestion and various forms of dyspepsia. In chronic \ncatarrh of the intestine, even when ulceration has occurred, it \nmay prove of great service, and it is especially esteemed in \nduodenal catarrh accompanied by catarrh of the gall-ducts and \njaundice. It is employed to a considerable extent in uterine \ndisorders such as menorrhagia and dysmenorrhcea, and also to \ncheck the growth of uterine tumors. For the arrest of haemor- \nrhage hydrastinine hydrochloride is to be preferred, but while \nthis is valuable in other uterine haemorrhages, it has little or \nno effect in post-partum haemorrhage, so that it would seem \nhighly probable that hydrastis has no action on the uterine \nmuscle. On account of its marked action in constricting the \narterioles in general, hydrastinine should prove of service in \nhaemorrhages other than uterine. As an antiperiodic, hydras- \ntis, while much inferior, ranks next in value to quinine. In \nchronic malarial cachexia it may be given with iron prepara- \ntions. Hydrastinine has been suggested in epilepsy on the \nground that it has some effect in diminishing the irritability of \nthe motor areas of the brain. \n\n\n\n928 PHARMACOLOGY AND THERAPEUTICS. \n\nCAULOPHYLLUM. \n\nUnofficial Preparation. \n\nCaulophyllum (U. S. P., 1890).\xe2\x80\x94 Caulophyllum. (Blue \nCohosh. Squaw Root.) Dose, 0.30 to 2 gm.; 5 to 30 gr. \n\nAction of Caulophyllum. \nBut little is known positively of the effects of this drug, but \nit is regarded as sedative, antispasmodic and oxytocic. \n\nTherapeutics of Caulophyllum. \nCaulophyllum is used to increase the force of uterine con- \ntractions ; it has been employed as a remedy for deficient labor- \npains, and is believed to be useful in dysmenorrhea. \n\nSAVIN. \nSABINA.\xe2\x80\x94 Savin. Dose, 0.5 gm.; 7V 2 gr. \n\nPreparation. \nFluidextractum Sabinse. \xe2\x80\x94 Fluidextract of Savin. Dose, 0.3 \n\n\n\nc.c; 5 tt\\. \n\n\n\nOLEUM SABIN^E.\xe2\x80\x94 Oil of Savin. Dose, 0.05 c.c; 1 m,. \n\nAction of Savin. \nOil of savin has the same action as oil of turpentine, but it \nis more marked. Thus externally it causes great redness, pain, \nvesication, and even pustulation. Internally it may produce \nsevere gastro-intestinal irritation, with vomiting, abdominal \npain and purging. In its excretion through the kidney and the \nmucous membranes of the genito-urinary tract it severely irri- \ntates them; thus hematuria, scanty urine, and pain on micturi- \ntion may follow its use. The point in which the action of oil \nof savin differs from that of the oil of turpentine is that it \npowerfully irritates the ovaries and uterus, causing hyperemia \nof these organs and accelerating menstruation. It also induces \ncontractions of the pregnant uterus, and therefore it is an \necbolic. \n\n\n\nCIMICIFUGA. 929 \n\nTherapeutics of Savin. \nA cerate made from the fluidextract, I, in rosin cerate, 4, \nhas been used as a powerful irritant and counter-irritant, and \ninternally savin may be given as an emmenagogue; but, on the \nwhole, its use is to be discouraged, as it is so liable to cause \nserious gastro-enteritis. It has often been administered as an \necbolic with criminal intent, but it is rarely used in medicine. \n\nRUE. \n\nUnofficial Preparation. \nOleum Eutae.\xe2\x80\x94 Oil of Rue. Dose, .06 to .25 c.c; 1 to 4 HI. \n\nAction of Oil of Rue. \n\nExternal. \xe2\x80\x94 Oil of rue is irritant and vesicant. \n\nInternal. \xe2\x80\x94 In large doses it is a powerful gastro-intestinal \nirritant. It is eliminated in, and may be recognized by its odor \nin the urine, breath and perspiration. It is irritant to the kid- \nneys, ovaries and uterus, and excites the menstrual flow. In all \npoints its action resembles that of savin. \n\nTherapeutics of Oil of Rue. \nFrom its stimulating action on the uterus rue has been used \nfor amenorrhcea and also as an abortifacient, and fatal cases \nof poisoning by it, from gastro-intestinal irritation, have been \nrecorded. It is very rarely given as a medicine. \n\nCIMICIFUGA. \n\nCIMICIFUGA.\xe2\x80\x94 Cimicifuga. (Black Snakeroot. Black Cohosh.) \nDose, 1 gm.; 15 gr. \n\nPreparations. \n\n1. Fluidextractum Cimicifuga. \xe2\x80\x94 Fluidextract of Cimicifuga. \nDose, 1 c.c; 15 Hi. \n\n2. Extractum Cimicifuga. \xe2\x80\x94 Extract of Cimicifuga. Dose, \n0.250 gm. (250 milligm.) ; 4 gr. \n\n3. Tinctura Cimicifuga. \xe2\x80\x94 Tincture of Cimicifuga. Dose, 4 \nc.c; 1 fl. dr. \n\n60 \n\n\n\n930 PHARMACOLOGY AND THERAPEUTICS. \n\nAction of Cimicifuga. \nCimicifuga is an astringent bitter and to some extent a car- \ndiac stimulant, slowing the action of the heart, but increasing \nits force. Its action in this respect is not important. In large \ndoses it depresses the heart and vaso-motor system. In frogs \nit paralyzes the sensory side of the spinal cord, producing com- \nplete anaesthesia, with loss of reflex activity, at a time when \nvoluntary movement is still preserved. The respiration is de- \npressed and finally arrested. Cimicifuga is said to cause uter- \nine contractions. \n\nTherapeutics of Cimicifuga. \nIt has been employed in a great variety of conditions. \nAmong them may be mentioned dyspepsia, fatty and irritable \nheart, dysmenorrhcea, amenorrhcea, subinvolution, rheumatism, \nneuralgia, chronic bronchitis, and especially chorea. That it \nis of very much benefit beyond that accomplished by a simple \nbitter is open to question. It has been asserted that it some- \ntimes promptly cures urticaria of nervous origin after the \nfailure of other treatment. \n\nD. Emmenagogues. \nMANGANESE. \n\nMANGANI DIOXIDUM PR^CIPITATUM.\xe2\x80\x94 Precipitated Man- \nganese Dioxide. (Black Manganese Oxide.) Dose, 0.250 gm. (250 \nmilligm.) ; 4 gr. \n\nMANGANI SULPHAS.\xe2\x80\x94 Manganese Sulphate. Dose, 0.250 gm. \n(250 milligm.) ; 4 gr. \n\nAction of Manganese Dioxide. \nWhen given by the mouth the salts of manganese exercise \nan effect only in so far as they are dissolved in the secretions. \nIn large amounts they cause gastro-intestinal irritation, and in \nsmaller doses have some astringent action. When given by \nsubcutaneous or subvenous injection they cause descending \n\n\n\nAPIGL. 93 I \n\nparalysis of the brain and spinal cord in frogs, and may give \nrise to epileptiform convulsions in mammals. These salts, and \nespecially the dioxide, are thought by many to have a specific \ninfluence upon the uterus. \n\nTherapeutics of Manganese Dioxide. \n\nIt has been used empirically as an emmenagogue and is prob- \nably the most certain of all when administered in maximum \ndose. \n\nAction of Manganese Sulphate. \n\nLike the dioxide, manganese sulphate in small doses has a \nsomewhat astringent effect, but larger amounts (2 to 4 gm. ; \n30 to 60 gr.) cause vomiting and purging, in consequence of \nthe local irritation of the stomach and intestine. As in the case \nof iron, only a very minute quantity is absorbed from the ali- \nmentary canal, and no constitutional symptoms \'have been ob- \nserved from its prolonged administration by the mouth to \nanimals. \n\nTherapeutics of Manganese Sulphate. \nIt has been used as a cholagogue purgative, but on account \nof its irritating properties it is a very unsafe remedy. Its \naction upon the uterus is much less pronounced than that of \nthe dioxide. \n\nAPIOL. \n\nUnofficial Preparation. \n\nApiolum. \xe2\x80\x94 Apiol. (Parsley.) Dose, 0.60 to 1 C.C.; 10 to \n15 TTl. \n\nAction of Apiol. \nApiol in large doses acts as a cerebral and circulatory stim- \nulant. It is also believed to have a special action on the uterine \ncirculation. \n\nTherapeutics of Apiol. \nIt is useful in amenorrhcea, scanty menstruation, and dys- \nmenorrhcea when administered immediately before the expected \n\n\n\n932 PHARMACOLOGY AND THERAPEUTICS. \n\nperiod in cases in which these conditions are due to a want of \novarian activity; that is, where direct emmenagogues are \nrequired. \n\nTANSY. \n\nUnofficial Preparation. \nTanacetum (U. S. P., 1890). \xe2\x80\x94 Dose, 1 to 4 gm.; 14 to 1 dr. \n\nAction of Tansy. \nTansy possesses the properties of an aromatic bitter, and is \nan irritant narcotic. \n\nTherapeutics of Tansy. \nIt has been used as an abortifacient, but is dangerous in \nlarge doses, several fatal cases having been recorded. \n\nE. Substances which Depress Uterine Action. \nVIBURNUM. \n\nVIBURNUM PRUNIFOLIUM.\xe2\x80\x94 Viburnum Prunifolium. (Black \nHaw.) Dose, 2 gm.; 30 gr. \n\nPreparation. \nFluidextractum Viburni Prunifolii. \xe2\x80\x94 Fluidextract of Vibur- \nnum Prunifolium. Dose, 2 C.C.; 30 til. \n\nVIBURNUM OPULUS. \xe2\x80\x94 Viburnum Opulus. (Cramp Bark.) \nDose, 2 gm.; 30 gr. \n\nPreparation. \nFluidextractum Viburni Opuli. \xe2\x80\x94 Fluidextract of Viburnum \nOpulus. Dose, 2 c.c.; 30 n\\. \n\nAction of Viburnum. \nViburnum is believed to be an antispasmodic, diuretic and \ntonic. \n\nTherapeutics of Viburnum. \nIt is especially used in the nervous diseases of pregnancy and \nto prevent miscarriage. It has considerable reputation as a \n\n\n\nANTITOXINS AND SERUMS. 933 \n\nremedy for spasmodic dysmenorrhcea, in the treatment of after- \npains, and in menorrhagia. This remedy has been in extensive \nuse for more than twenty-five years and is undoubtedly of \nvalue. \n\nDivision XII. \xe2\x80\x94 Antitoxins and Serums. \nAntitoxins and serums have been classed by some among \nalterative remedies, and there is a certain amount of reasonable- \nness in this designation; but their manner of action and the \nmethods by which they are administered are so different from \nthose of ordinary alteratives that it seems preferable to give \nthem in a division by themselves. To the class of substances \n(believed to be of albuminous nature) produced in the animal \norganism by pathogenic germs which is deleterious to the ani- \nmals themselves the name toxin has been given, while to a \ndifferent class of substances, also albuminous and also produced \nby the same germs, but which is inimical to the bacteria, the \nname antitoxin has been assigned. The toxin acts both as a \nlocal and systemic poison, and by its hostile influence upon the \nbacteria the antitoxin tends to counteract both of these effects. \nThe precise modus operandi is as yet unknown, but it is thought \nprobable that the antitoxin affects the protoplasm in such a way \nas to render it capable of resisting the action of the toxin. It \nis to be noted, however, that the antitoxin has been demon- \nstrated not to be a germicide, and thus capable of killing the \npathogenic organism; so that there is still considerable mystery \nas to just how it produces the beneficial effects observed from \nit. The antitoxins are: \n\n(1) Diphtheria Antitoxin. (2) Tetanus Antitoxin. \n\nThe most important one is diphtheria antitoxin. \n\nSerums, other than antitoxins or nutrient serums, are attenuated \ncultures made from pathogenic germs, and often called vaccines, the \nadministration of which is designed to confer immunity from the spe- \ncial disease represented by the germs from which the cultures are \nmade. Among the serums which have been employed are the follow- \ning : \n\n\n\n934 \n\n\n\nPHARMACOLOGY AND THERAPEUTICS. \n\n\n\n(1) Antistreptococcic Serum. \n\n(2) Antipneumococcic Serum. \n\n(3) Antivenomous Serum. \n\n\n\n(4) Antiplague Serum. \n\n(5) Anticholera Serum. \n\n(6) Antityphoid Serum. \n\n\n\nFor the sake of convenience Nutrient Serum, which is supposed to \nreplace the blood serum, and also Hydrophobia Antidote, although it \nis neither an antitoxin nor a serum, are considered in this Division. \n\nSERUM ANTIDIPHTHERICUM.\xe2\x80\x94 Antidiphtheritic Serum. Diph- \ntheria Antitoxin. Dose, 3000 units. Immunizing dose for well per- \nsons, 500 units. \n\n\n\nAction of Diphtheria Antitoxin. \n\nAntitoxin serum has a favorable effect upon all the symp- \ntoms of diphtheria and also a marked influence in preventing \nthe occurrence of sudden heart-failure which constitutes one of \nthe great dangers of the disease. The temperature, however, \nis less affected than the other symptoms. Statistics collected \nfrom reliable sources afford overwhelming evidence as to the \nvalue of antitoxin in reducing the mortality from diphtheria. \nThey also show that the frequency of laryngeal diphtheria is \ndiminished by its use, and that the mortality of patients upon \nwhom intubation or tracheotomy has been practiced is likewise \ndiminished. Furthermore, the time during which the tube must \nbe worn is decreased. After the serum has been employed, it \nis found that although the bacilli continue to be present, the \nformation of membranous exudation ceases, and that which is \nalready present rapidly disappears. Consequently, if antitoxin \nbe used early, the membrane rarely extends from the fauces \ninto the larynx. It is not until twenty-four hours after injec- \ntion, however, that the maximum effect of the antitoxin is ob- \nserved. It is stated that the frequency of the occurrence of \npost-diphtheritic paralysis is not diminished, although the per- \ncentage of recoveries in cases with paralysis is slightly in- \ncreased. \n\nThe use of the antitoxin is sometimes attended with untoward \neffects, but as a rule these are of very little importance. That \nthey are not due to the antitoxin itself, but to something else \n\n\n\nANTIDIPHTHERITIC SERUM. 935 \n\nin the serum, seems to be shown by the fact that they may \nresult from the injection of the simple serum of animals. The \nmost common of these is a rash, usually erythematous in charac- \nter, but sometimes resembling measles or urticaria, and another \nis pain and swelling in the joints. Somewhat rarely there have \nbeen observed an irregular temperature range and consecutively \nemaciation and death; evidently pointing toward an acquired \nsepticaemia. Further, in a few cases an early fatal result has \nbeen reported. It has been shown that in a fatal issue nephritis \nis the cause of death in a majority of instances, and clinically \nhemorrhagic nephritis is by no means rare. \n\nTherapeutics of Diphtheria Antitoxin. \nAs the mortality of the disease when antitoxin is used in- \ncreases in proportion to the lateness of its employment, it is \nevident that the administration should be commenced at the \nearliest possible moment. It is the safest plan to give antitoxin \non a clinical diagnosis, without waiting for a bacteriological \nculture. Inasmuch as this remedy militates solely against the \ninfection of the Klebs-Loeffler bacillus and clinically most cases \nof diphtheria are cases of mixed infection, the usual local anti- \nseptic and general supporting measures must not be omitted. \nThe danger of antitoxin lies in the horse-serum, for, many years \nbefore antitoxin was made, the results of injection of an alien \nserum had been pointed out. Concentrated serums then should \nbe preferred in that they give the largest amount of antitoxin \nwith the smallest amount of serum. In cases of moderate \nseverity it is recommended that a dose of 5000 units (10 c.c. \nof serum containing 500 units per c.c.) should be given at once. \nA second injection may not be required, but if the symptoms \ndemand it, the dose should be repeated two or three times at \nintervals of twelve hours. In severe cases, or in those treated \nlate, the dose should be 8,000 to 10,000 units. If no ameliora- \ntion of the condition is observed within two or three days, the \nfurther continuance of the treatment appears to be useless. \nThe injections are usually made, with a specially devised \n\n\n\n\n\n\n936 PHARMACOLOGY AND THERAPEUTICS. \n\nsyringe, between the shoulders or on the side of the abdomen, \nand should be given under strict aseptic precautions. \n\nSo far as prophylaxis is concerned, the question is still sub \njudice. Many failures are reported, and, indeed, instances of \nreinfection have occurred even after suitable doses of antitoxin \nhave been used during a previous attack. \n\nUnofficial Preparation. \nSerum Antitetanicum. \xe2\x80\x94 Antitetanus Serum. Tetanus Anti- \ntoxin. Dose, 10 to 20 c.c; 2y 2 to 5 fl. dr. \n\nAction of Tetanus Antitoxin. \nWhile diphtheria is recognized by the local inflammation long \nbefore the nerves and heart have become affected, tetanus is \nfirst recognized only when the poison has gained access to the \ncentral nervous system. The hypothesis has been advanced \nthat the toxin of the bacillus tetanus has a chemical affinity for \nnerve-tissue, and enters into chemical combination with and \ndestroys such tissue, and that the convulsions result from the \nchanges thus brought about in the nerve centres. Furthermore, \nthat the antitoxin, having no such chemical affinity, is capable \nof neutralizing only the toxin that may still remain in the cir- \nculation, and naturally cannot have any effect on the destruc- \ntive lesions already present in the centres. While tetanus \nserum possesses antitoxic, it has no antibacterial properties. \n\nTherapeutics of Tetanus Antitoxin. \nIn view of the extreme gravity of the disease, in acute and \nrapidly developing cases it would seem advisable to employ the \nserum freely at the earliest possible moment in every case of \ntetanus. The injections may be repeated every six or twelve \nhours at first, and afterwards at longer intervals if there is \nevidence of improvement. In some instances the antitoxin has \nbeen injected directly into the brain, after trephining the skull, \nand in others into the spinal cord, and this is preferable in \nsevere cases. In any case of injury in which there appears to \n\n\n\nANTIDIPHTHERITIC SERUM. 937 \n\nbe a likelihood of the development of tetanus the use of the \nserum as a prophylactic is advisable. \n\nIt is a well-known fact that tetanus toxin has proved far less \nsuccessful than diphtheria antitoxin, and quite recent investiga- \ntions have presented an explanation of the difficulties met with \nin the use of this serum. In these it was found that not only \nis the tetanus toxin carried to the central nervous system along \nthe motor nerves, but also that the toxin gains entrance to the \nnerves through the motor end-plates, that it does not reach the \ncentral nervous system by any other route than the nerves, that \ntetanic rigidity is altogether a result of central irritation, and \nthat the latent period between the injection of toxin (in ex- \nperiments on animals) and the onset of tetanic symptoms is \nalmost altogether due to the time required for the toxin to \npass along the motor nerves to the cord or brain. Further- \nmore, it was found that tetanus antitoxin is not carried along \nthe nerves, and has practically no action except upon that toxin \nwhich has not yet entered into the motor axis cylinders. Other \nrecent experiments also go to show that the toxin is absorbed \nonly by the motor nerves; the antitoxin only by the circulation \nand lymph. This peculiar mechanism, now demonstrated for \nthe first time, brings the tetanus toxin in concentrated form \nupon the susceptible cells along the motor axis cylinders, and it \nfurthermore places the toxin at an early period (and some time \nbefore the onset of symptoms) beyond the reach of the anti- \ntoxin. From these researches the following practical lessons \nhave been drawn : ( I ) Subcutaneous, intravenous and subdural \ninjections of antitoxin are of no value as measures to relieve \ntetanus when the symptoms have once appeared. (2) Injec- \ntions of antitoxin, especially near the injected wound, will effec- \ntually bind any toxin present in the system: i. e., toxin before \nit has been picked up by the motor end-plates. (3) It is prob- \nable that injections of antitoxin directly into the motor nerve \nleading from the infected wound, or even into the segment of \nthe cord reached by this nerve, will have some influence upon \nthe toxin. \n\n\n\n93 8 PHARMACOLOGY AND THERAPEUTICS. \n\nUnofficial Preparation. \nSerum Antistreptococcicum. \xe2\x80\x94 Antistreptococcic Serum. \nDose, 10 to 20 c.c; 2y 2 to 5 fl. dr. \n\nAction of Antistreptococcic Serum. \n\nAntistreptococcic serum has been used to a limited extent \nfor some time, but it labors under the great disadvantage that \ndifferent cultivations of apparently the same streptococcus show \nsuch variance that serum which is bactericidal to one cultiva- \ntion may not be so to another. \n\nTherapeutics of Antistreptococcic Serum. \n\nIt has been employed in various diseases in which infection \nis largely attributed to the streptococcus, such as erysipelas, \nmalignant endocarditis, otitis media, thrombosis of the lateral \nsinus, and puerperal and surgical septicaemia; and trial may be \nmade of it in any affection attended with the presence of strep- \ntococci. While the results are not infrequently disappointing, \nsuccessful cases have been recorded in the disorders mentioned, \nand also cases of scarlet fever in which it has apparently proved \nuseful in shortening the course of the disease and in prevent- \ning serious complications and sequelae, such as otitis media and \nother suppurative processes, due to this microbe. It has per- \nhaps been found of most service in erysipelas and puerperal \nsepticaemia, and it is recently reported to have been used suc- \ncessfully in grave cases of scarlet fever and in inflammatory \nrheumatism. With an increased knowledge of its appropriate \napplication there seems every reason to believe that the serum \nwill prove a valuable addition to our therapeutic resources. \nThe chief beneficial effects observed from its use are a fall in \ntemperature and a general improvement in the patient\'s con- \ndition. In many acute cases such effects have been noted after \neach injection. In acute cases the serum may be administered \ntwo or three times a day, and in chronic cases once daily. \n\n\n\nANTIDIPHTHERITIC SERUM. 939 \n\nUnofficial Preparation. \nSerum Antipneumococcicum. \xe2\x80\x94 Antipneumococcic Serum. \nDose, 10 to 20 c.c; 2y 2 to 5 fl - dr\xc2\xab \n\nAction of Anti-Pneumococcic Serum. \nThis serum is antibacterial, but does not appear to possess \nantitoxic properties. As in the case of antistreptococcic serum, \nthere are serious difficulties in its practical application. Pneu- \nmococci, when derived from various sources, differ from one \nanother in virulence and in cultural characteristics; hence a \nserum which proves protective in some instances may be of no \nvalue in others. Consequently, the results thus far obtained \nhave not been very satisfactory. \n\nTherapeutics of Anti-Pneumococcic Serum. \nThe serum is injected subcutaneously, and it is advised that \nthe doses should be given twice a day until the temperature has \nsubsided and the patient is convalescent. It is thought possible \nthat it may be of more advantage in some other pneumococcal \naffections (such, for example, as infective endocarditis) than \nin pneumonia itself. \n\nUnofficial Preparation. \nSerum Antivenenosum. \xe2\x80\x94 Antivenomous Serum. (Anti- \nvenene.) Dose, 10 to 30 c.c; 2y 2 to 8 fl. dr. \n\nAction of Antivenomous Serum. \nThis serum is protective in animals when employed before, \nat the same time, or shortly after inoculation with snake poison. \nThe immunity conferred by it, however, is found not to last \nlonger than six days. Up to a certain period after inoculation \nthe serum is protective, even though symptoms of poisoning \nmay have manifested themselves; but after that no amount of \nit, however large, can prevent a fatal result. \n\n\n\n940 PHARMACOLOGY AND THERAPEUTICS. \n\nTherapeutics of Antivenomous Serum. \nThe serum should be administered as soon as possible after \nthe snake bite. It may be given subcutaneously, but, on account \nof the greater rapidity of absorption, it is preferable to inject \nit into a vein, due aseptic precautions being taken. The results \nof this treatment thus far recorded leave no doubt of its ex- \ntreme value. In a number of instances recovery from the bites \nof venomous snakes has taken place even after well-marked \nsymptoms of poisoning had made their appearance. \n\nUnofficial Preparation. \nSerum Antipestilens. \xe2\x80\x94 Anti-plague Serum. Dose, 10 to 20 \nc.c; 2y 2 to 5 fl. dr. \n\nAction of Anti-Plague Serum. \nAnti-plague serum is antibacterial. If, as is said to be the \ncase, it also possesses antitoxic properties, these seem to vary \nwith the method of preparation, and are certainly less pro- \nnounced than the antibacterial. The prophylactic vaccine (in- \noculation) contains the toxins derived from the bodies of the \nbacteria and also those produced in or diffused into the sur- \nrounding medium, which are stated to be so modified as to be \nalmost entirely nonpathogenic to susceptible animals. From \nthree to five hours after inoculation there is a marked rise of \ntemperature, with pain and swelling at the site of inoculation. \nWhile the temperature subsides in from twenty-four to thirty- \nsix hours, the latter symptoms continue for several days. \n\nTherapeutics of Anti-Plague Serum. \nThe anti-plague serum, which is injected subcutaneously, \nshould be administered as early as possible. Two or three doses \nshould be given the first day, and one dose daily afterwards. \nThe results thus far obtained with this serum have not been \nvery encouraging. While in some cases it appears to do good, \nin others it has no effect. Such protection as is afforded by it \n\n\n\nANTICHOLERA SERUM. 94 1 \n\nhas been found to last for only a few days, so that it is avail- \nable as a prophylactic only under special circumstances. \n\nThe prophylactic vaccine should be injected, with strict asep- \ntic precautions, into the subcutaneous tissue, preferably by the \narm. It is stated that if the temperature does not rise as high as \n38.8 C. (102 F.) in several individuals, the prophylactic is \nnot up to the standard potency, and increased doses must be \ngiven. From an extensive use of this vaccine, particularly in \nIndia, its efficacy against plague appears to be clearly estab- \nlished, and it is believed that still more favorable results will \nbe obtained when better methods of standardizing the prophy- \nlactic have been obtained and further improvements made in \nthe method of preparation. \n\nUnofficial Preparation. \nSerum Anticholeraicum. \xe2\x80\x94 Anticholera Serum. Dose, 10 to \n20 c.c; 2y 2 to 5 fl. dr. \n\nAction of Anti-Cholera Serum. \nThis serum is antibacterial, but not antitoxic; it is said to \nprotect against the living vibrios but not against their toxins. \nTwo prophylactic vaccines have been used, one consisting of \nan emulsion in sterile broth of a fresh agar cultivation of viru- \nlent vibrios, and the other of an emulsion in sterile broth made \nfrom attenuated vibrios. They must be administered immedi- \nately after being made. One vaccine (inoculation) is used five \ndays, or more, after the other, and they are injected into the \nsubcutaneous tissue of the abdomen under strict aseptic pre- \ncautions. There is a moderate, but brief, febrile reaction after \nthe first vaccination, and a less marked one after the second. \n\nTherapeutics of Anti-Cholera Serum. \nAs the serum has no antitoxic properties and as the disease \nruns such a rapid course, this serum does not appear to have \nany value in the treatment of cholera. On the other hand, \n\n\n\n942 PHARMACOLOGY AND THERAPEUTICS. \n\nprophylactic vaccination (inoculation) affords considerable \nprotection against the disease. The statistics of its employ- \nment in India, however, go to show that while it undoubtedly \ndiminishes the actual number of deaths from cholera, this is \ndue to the smaller number of individuals attacked, in conse- \nquence of its prophylactic agency, and not to a decrease in the \ncase mortality. It appears, therefore, that if a vaccinated per- \nson contracts the disease, he has no better chance of recovery \nthan an unvaccinated one. The dose is stated to be an eighth \npart of an emulsion made in sterile broth from the whole of \nan agar cultivation which has been incubated for twenty-four \nhours at a temperature of 35 C. (95 F.). \n\nRecent investigations have shown that in many instances, at \nleast, of the severe summer diarrhoea of infants and young \nchildren the infection is due to the bacillus of dysentery (Shi- \nga\'s bacillus), and a serum against this has been prepared. \nAlthough but a very limited trial of this has as yet been made, \nthe results obtained with it are stated to have been such as to \nlead to the hope that much may be expected from this method \nof treatment in the future. It has also been proposed to use \nan attenuated serum for prophylaxis against dysentery in per- \nsons exposed to the disease, as in the case of troops in tropical \nclimates. It has been found feasible to protect small animals, \nlike guinea pigs, against the bacillus. Such inoculation is at- \ntended with no danger whatever, but whether it is really effec- \ntive as an immunizing agent can only be determined after \nextended trial and observation. \n\nUnofficial Preparation. \nSerum Antityphoideum. \xe2\x80\x94 Antityphoid Serum. \n\nAction of Anti-Typhoid Serum. \nThe inoculation of dead typhoid bacilli, for prophylactic pur- \nposes, is made, with strict aseptic precautions, into the subcu- \ntaneous tissue of the abdomen. It is followed in three or four \nhours by local inflammatory reaction and by pyrexia which \n\n\n\nNUTRIENT SERUM. 943 \n\nusually subsides within twelve hours. The average tempera- \nture observed is about 38.8 C. (102 F.). \n\nTherapeutics of Anti-Typhoid Serum. \n\nIt is advisable that the injection should be made in the even- \ning, so that the patient may go to bed as soon as the symptoms \nmake their appearance. In order to secure the best chance of \nsuccess the inoculation may be repeated in a week. At present \nno definite conclusions can be reached as to the immunizing \npower of this method, but the inoculation appears to exercise \na pronounced influence on the system, since it renders the blood \nserum capable of agglutinating typhoid bacilli. The dose of the \nstrongest vaccine prepared is about 5 c.c. (8 ni) and of the \nweakest, 1.5 c.c. (25 til). \n\nAs to the treatment of typhoid with anti-typhoid serum, there \nis as yet no reliable evidence that the procedure is of value. \nCases thus treated have from time to time been reported, but \nthe fact that the serum employed, so far as known, was not \nstandardized renders it impossible to judge of results. \n\nUnofficial Preparation. \nSerum Nutriens. \xe2\x80\x94 Nutrient Serum. Dose, 30 to 120 c.c; \n1 to 4 fl. oz. \n\nAction of Nutrient Serum. \nAt the time of the first introduction of diphtheria antitoxin \na very large amount of the serum had to be injected, on account \nof its diluteness; as much as 320 c.c. (10 fl. oz.) being used in \ntwo days for a child of five years. As the employment of such \nquantities was found to be attended by no bad results, the idea \nwas suggested that serum might be injected subcutaneously as \na food, and a series of experimental researches in animals was \naccordingly instituted for the purpose of determining, as far as \npossible, the practical utility of this procedure. The results of \nthese were as follows: The injection of small quantities of \nserum, by increasing the katabolism of the body, induces an \n\n\n\n944 PHARMACOLOGY AND THERAPEUTICS. \n\nincrease of urinary nitrogen, and a loss of weight, but when \nlarge quantities are employed, the loss from the increased kata- \nbolism caused is more than offset by the utilization of the serum \nas a food. It was thus found that in animals which were de- \nprived of all other means of sustenance life was prolonged for \na very considerable period by the subcutaneous injection of \nserum in sufficient quantity. Furthermore, it was ascertained \nthat if the serum be heated to 65 C. (149 F.), this has the \neffect of destroying the bodies which produce increased nitrog- \nenous katabolism and also those which give rise to certain un- \ntoward effects when the serum of one animal is injected into \nanother of a different species. At the same time, the nutritive \nvalue of the serum remains unimpaired. These results have \ntherefore been made use of in the human subject. \n\nTherapeutics of Nutrient Serum. \n\nA horse-serum or sheep-serum, heated to the proper tempera- \nture, may be injected in a variety of conditions: as after grave \nabdominal operations when it is impossible or inadvisable to \nfeed the patient by the mouth or rectum, in the vomiting some- \ntimes met with in post-diphtheritic paralysis, or in certain cases \nof gastric ulcer, typhoid fever, infantile diarrhoea, etc. The \ndose for an infant is 30 to 40 c.c. (8 to 10 fl. dr.), for a child, \n60 to 80 c.c. (16 to 20 fl. dr.), and for an adult 100 to 120 c.c. \n(3 to 4 fl. oz.), and these doses may be repeated as required. \nWhere the daily administration of the serum is called for, the \ninjection should be made each time in a different part of the \nbody in order to avoid undue local irritation. Goat serum or \nlymph has been employed to improve the general nutrition in \nmany chronic diseases with some benefit. The exaggerated \nclaims formerly made for it, however, have not been substan- \ntiated. \n\nUnofficial Preparation. \nAntidotum Rabiis. \xe2\x80\x94 Hydrophobia Antidote. \n\n\n\nORGANIC EXTRACTS. 945 \n\nAction of Hydrophobia Antidote. \nIt has of late years been the practice when a person has been \nbitten by a dog supposed to be rabid to inoculate him on suc- \ncessive days with rabbits\' spinal cords of progressively increas- \ning virulence, and it has been claimed that if this treatment is \nbegun soon after the bite, hydrophobia does not usually de- \nvelop. The spinal cords employed are taken from rabbits \nwhich have been inoculated with rabies. For inoculating the \nhuman subject emulsions of dried cords are employed, and the \nvirulence of the injection depends on the shorter or longer time \nfor which the cord used has been allowed to dry. \n\nTherapeutics of Hydrophobia Antidote. \nThe reports of the use of this suggest that some of the \ndeaths after treatment may be due to it rather than to the bite. \nInasmuch as the incubation period of hydrophobia is so ex- \ntremely variable, the pathological findings so inconstant and \nthe symptoms so diverse, there is much reason for doubting the \nexistence of the disease in man. At least, the majority of al- \nleged cases have been shown to have been those of various \ndiseases (tetanus, septicaemia, hysteria). For this reason the \nantidote possesses but little interest save to those who are inter- \nested in spreading hydrophobia-phobia. \n\nDivision XIII. \xe2\x80\x94 Organic Extracts. \nThe glands of the body, it is thought, are more or less inter- \nchangeable in their functions; so that if one is unable to do its \nwork, another seems to assume extra activity. It is now a \nrecognized fact that the blood is continuously supplied by cer- \ntain glands with substances which are essential to the welfare \nof the system; so that a lack of these induces very serious re- \nsults. It has been demonstrated also that the bad effects fol- \nlowing the excision of the glands can be successfully obviated \nby the administration of the gland substance. The use of ex- \ntracts of the glands of the body, known as animal extracts or \n61 \n\n\n\n946 PHARMACOLOGY AND THERAPEUTICS. \n\norganic extracts, now has a legitimate place in medicine. They \nare usually active when given by the mouth, as well as by sub- \ncutaneous or intravenous injection, and thus present a marked \ncontrast to the antitoxins, which, being proteid substances, are \ndestroyed in the stomach. The chief object of the therapeutic \nemployment of the organic extracts has hitherto been to supply \na deficiency of the normal secretion, but at present their field \nof usefulness is becoming more and more extended, as their \npharmacological action becomes more definitely understood and \ntheir practical therapeutic value is demonstrated in various \npathological conditions. It seems altogether probable that the \nfurther developments in the subject of organo-therapy will be \nof great interest and utility. The organic extracts most in use \nare: \n\n\n\n(1) Thyroid Extract. \n\n(2) Suprarenal Extract. \n\n(3) Thymus Extract. \n\n(4) Pituitary Extract. \n\n(5) Mammary Extract. \n\n\n\n(6) Ovarian Extract. \n\n(7) Testicular Extract. \n\n(8) Brain Extract. \n\n(9) Splenic Extract. \n\n\n\nThese substances might, with better reason than the anti-toxins and \nserums, be classified with the alteratives, but inasmuch as each one \nhas a definite, aside from a general, action they are properly considered \nseparately. The extract which is of the greatest practical importance \nis the thyroid, and next to that comes the suprarenal. \n\nGLANDULE THYROIDEiE SICCJE.\xe2\x80\x94 Desiccated Thyroid Glands. \n(Thyroid Extract.) Dose, 0.250 gm. (250 milligm.) ; 4 gr. \n\nUnofficial Preparations. \nLiquor Glandularum Thyroidearum. \xe2\x80\x94 Solution of Thyroid \nGlands. (Solution of Thyroid.) Dose, .30 to 1.00 c.c; 5 to \n15 HI. \n\nIodothyrinum. \xe2\x80\x94 Iodothyrin. (Thyroiodin.) Dose, .06 to .30 \ngm.; 1 to 5 gr. \n\nAction of Thyroid Gland. \nCirculation. \xe2\x80\x94 The thyroid gland is thought to be probably \nthe main organ of the body to furnish vaso-dilating material. \n\n\n\nDESICCATED THYROID GLANDS. 947 \n\nand the administration of its substance has the effect of dilat- \ning the peripheral blood-vessels and reducing arterial tension. \nConsequently, the cutaneous surface becomes flushed and moist, \nand the cardiac action is more or less depressed. Unless its \nuse is continued for a considerable time it has only a slight \naction on the heart muscle, but small doses increase and large \ndoses diminish its force. The pulse-rate is quite constantly \naccelerated. Injections of thyroid extract into the circulation \nhave been found to cause a fall in blood-pressure of relatively \nshort duration. The only effect of ordinary doses observed on \nthe blood is an augmentation of lymphocytes. \n\nAlimentary Canal. \xe2\x80\x94 Loss of appetite and diarrhoea are quite \nfrequently caused by large amounts and occasionally by small \ndoses. \n\nNervous System. \xe2\x80\x94 Thyroid is a cerebral stimulant, capable \nof causing wakefulness, acuteness and rapidity of thought, and \ngeneral brain activity. Given to excess, it produces headache, \nnervousness, restlessness, insomnia, palpitation, hot flushes, \nsweating, increased irritability of the reflexes, tremors of the \nextremities, and even convulsions. \n\nKidneys. \xe2\x80\x94 The quantity of urine is uniformly increased. \nThis effect has been thought by some to be due to some specific \naction on the kidney, or to the changes in the circulation, but \nit may possibly result simply from the augmented excretion of \nurea and other urinary elements. In some instances sugar is \nfound in the urine. \n\nMetabolism. \xe2\x80\x94 A greatly increased oxidation is induced, both \nnitrogenous and non-nitrogenous bodies being rapidly used up. \nOn this account there is an increased excretion of urea, uric \nacid, and xanthin bases in the urine and of carbon dioxide by \nthe lungs. It is found that the first effects are upon fat, the \nproteids not being acted upon until this has been reduced to a \ncertain minimum. These tissue changes result in a rise of \ntemperature and a loss of body weight. \n\nExcretion. \xe2\x80\x94 The elimination of the active constituents of \nthyroid gland takes place, so far as known, entirely through \nthe kidneys. \n\n\n\n948 PHARMACOLOGY AND THERAPEUTICS. \n\nTherapeutics of Thyroid Gland. \nIn man and the monkey one of the constant and characteris- \ntic effects of removal of the thyroid gland is a myxcedematous \ncondition. At an early period there is an abundance of mucus \nand later there occurs a marked hyperplasia of connective tis- \nsue, embryonic in character. The skin is hard, rough and dry, \nbecause there is no secretion, and the hair loses its vitality and \nfalls out. Among the other changes observed are, abdominal \nvaso-dilation, fatty and colloidal degeneration of the liver and \nkidneys, and hyaline degeneration of the arterial walls. All \nof these phenomena may be made to disappear by feeding thy- \nroid. It is also a well known fact that atrophy of the thyroid \ngland always accompanies myxcedema, and it has been found \nthat if patients suffering from this affection are treated with \nsheep\'s thyroid, all the symptoms disappear, usually in about \nsix weeks. For the treatment of myxcedema the solution is \npreferable to the powder, as the latter is liable to decomposi- \ntion. .30 c.c. (5 TTi) may be given three times a day in water, \nand the dose gradually increased to .60 c.c. (10 1*1). After the \nsymptoms have all disappeared it will be necessary, in order \nto prevent a recurrence, that the patient should take the latter \ndose about twice a week for the rest of his life. Compressed \ntablets of the powder are very convenient to take, and are used \nto a considerable extent. Goitre may sometimes be favorably \naffected by thyroid, and the variety in which it is most bene- \nficial is that known as the hyperplastic follicular. Complete \ndisappearance is exceptional, but as a rule considerable de- \ncrease takes place, especially in the young. As recurrence is \notherwise almost certain, the remedy must be continued indefi- \nnitely. In exophthalmic goitre it generally seems to be injuri- \nous, rather than beneficial. In sporadic cretinism excellent \nresults are often obtained with it, and the brain symptoms share \nin the general relief afforded. Poorly developed young chil- \ndren are often benefited by it. In a few instances of imbecility \nin children, of tetany, and of climacteric insanity much im- \nprovement is reported to have been caused by it. In cases of \n\n\n\nSUPRARENAL GLAND. 949 \n\narterio-sclerosis where nitroglycerin in small doses is of value \nto reduce such disturbances from high tension as dizziness, \nsleeplessness and headache, thyroid has been found of marked \nbenefit. It must be used with some caution in persons suffer- \ning from organic disease of the heart. It has been observed \nin feeding thyroid for other purposes that not infrequently \nmenorrhagia is produced, and it is asserted that in delayed \nmenstruation, with or without anaemia, no drug is as efficient \nin causing normal menstruation as thyroid extract, given in \n.20 gm. (3 gr.) doses thrice daily. It has been given with \nsuccess in chronic eczema and some other skin diseases, but the \neffects are by no means always permanent. This remedy has \nbeen advised and considerably employed in the treatment of \nobesity, but as it is not as efficient as some other means, and as \nits continued use in these cases is not unattended with danger, \nit is not to be commended. \n\nIodothyrin, a substance isolated from thyroid which possesses \nall the physiological properties of the gland extract, is now \nused to a considerable extent. A milk-sugar triturate of this \nis given in daily dose of 1 to 2 gm. (15 to 30 gr.). \n\nPoisoning. \xe2\x80\x94 A condition somewhat resembling exophthalmic \ngoitre in its symptoms, though without exophthalmos or in- \ncrease in the size of the thyroid, and known as Thyroidism, \nmay be induced by over-doses. Very large doses taken for a \nlong time make patients thin; and also produce degeneration \nof the cardiac muscle, so that permanent disability may result. \nSurgeons are especially liable to make this error. \n\nSUPRARENAL GLAND. \n\nGLANDULE SUPRARENALES SICC^.\xe2\x80\x94 Desiccated Suprarenal \nGlands. (Suprarenal Extract.) Dose, 0.250 gm. (250 milligm.) ; 4 gr. \n\nUnofficial Preparation. \nAdrenalinum. \xe2\x80\x94 Adrenalin. \n\n\n\n950 PHARMACOLOGY AND THERAPEUTICS. \n\nAction of Suprarenal Gland. \n\nThe principal effects of suprarenal gland, as demonstrated \nby experiment, are to increase the tone of all muscular tissue, \nmainly if not entirely by direct action, to constrict the small \narteries through its action on the vaso-motor centre, and to \nraise blood-pressure more than any other known substance. \nIts action on the circulation is thus exactly the opposite of \nthyroid. The rise in blood-pressure is immediate, but it is to \nbe noted that this effect is very brief, lasting less than a min- \nute, and that it is not elicited at all when the administration \nis by the stomach. Suprarenal is a strong cardiac stimulant. \nThe pulse-rate is slowed from stimulation of the pneumogastric \ncentre in the medulla oblongata, and the heart muscle is affected \nin the same way as by digitalis, its systole being much strength- \nened and its diastole being often rendered less complete. The \nheart becomes more and more slowed, and is finally arrested in \nsystole. The cardiac stimulation is not produced for some \ntime after the constriction of the vessels. Additional actions \nof this substance are a depression of the respiratory centre, \nwhich may result in respiratory failure and death, and a dimin- \nution of peristalsis through peripheral action on the nervous \nmechanism. Its action on the muscles strongly resembles that \nof veratrine. \n\nCertain unfavorable clinical results have been noticed to be \ncoincident with the use of suprarenal solutions, and have been \nattributed to their effect. These doubtful results are stated to \nbe: haemorrhage, reactionary symptoms, swelling and localized \nareas of oedema, retarded healing, sloughing, and unhealthy \ncondition of wounds. Hence, with a view to determine the \neffect of suprarenal preparations on living protoplasm, a series \nof experiments was recently undertaken, and the main results \nof these, with the deductions, drawn from them, have been \ngiven as follows : \n\nIt seems fair to conclude that solutions in the strength of \no.ooi interfere with the phenomena of clotting of blood in \nsome of the cold-blooded animals (asteria and limulus), but \n\n\n\nSUPRARENAL GLAND. 95 I \n\nthat in other animals there is no change. If these results can \nbe applied to warm-blooded animals we may assume that the \nactive principle of suprarenal gland has no effect upon the \ncoagulation phenomenon, and that the danger of secondary \nhaemorrhage from softening of the clot is not increased by \nits use. \n\nIn the egg of the arbacia (sea-urchin) strong adrenalin solu- \ntions may kill the protoplasm, while weaker solutions have a \nmarked and regular effect in preventing the cell-division and \ndevelopment of the egg. At a certain stage in the cell-division \nthe protoplasm is changed, so that it never develops further. \nFrom these effects on the sea-urchin\'s egg it seems fair to \nassume that the same effects may be active in the human indi- \nvidual, since the properties of protoplasm are much the same \nwherever it is found. If this be true, then we may assert that \nsuprarenal preparations have a marked effect on cell-division \nof healing tissue and upon the proliferation of cells constitut- \ning granulation tissue. It may also be assumed that these solu- \ntions will have an effect depending on the strength of the solu- \ntion, as well as the duration of the exposure, and that it is \npossible to kill cells or to prevent their activity, or retard cell- \ndivision. In this connection it should be remarked that other \nsubstances, especially alkaloids (atropine and aconitine), seem \nto act similarly. As it was also shown that the rate of pro- \ngression of the moving ciliated ovum was much slower in cases \nthat were developed in weak solutions, it would appear that the \nvitality of the protoplasm is weakened by suprarenal solutions. \n\nThe cilia of the aronicula larvae are affected only by stronger \nsolutions than are necessary to paralyze muscle movement. By \nthese the ciliated movement is markedly retarded. In inter- \npreting these results we again see a clear line of demarcation \ndrawn between the strength of solutions; these slight differ- \nences show a potentiality which we would not suspect. \n\nIt would seem that the cilia on the gill of the salt-water clam \nare more resistant to the effect than those of the arbacia or \naronicula, and this we might expect in an adult animal. When \n\n\n\n952 PHARMACOLOGY AND THERAPEUTICS. \n\nthe oesophageal membranes of a frog are placed in a solution \nof o.oooi the immediate effect is to produce a slowing in the \nciliated movement. These cilia are also more resistant to the \neffect of this solution than the arbacia or aronicula, and it has \nnot been found possible to entirely check the action of the cilia \nwith solutions of o.ooi. \n\nExperiments on the hearts of turtles and frogs show that \nsuprarenal solutions are powerful muscle stimulants. \n\nIn the medusa the suprarenal alkaloid is a powerful stimu- \nlant to contraction, and it affects the contractile tissue in a \nmost characteristic and marked way. It was found that this \nanimal reacted best in a solution of the strength of 0.0005. \n\nThere is therefore warrant for asserting that, at least in the \nlower animals studied in these experiments, suprarenal prepa- \nrations have a most marked influence in interfering with the \npower of cell-division, the development of protoplasm, and the \nmovement of cilia, and also in stimulating contractile tissue. \n\nTherapeutics of Suprarenal Gland. \nIt may be used as a local vaso-constrictor in minor surgery. \nOn account of this property it may be applied to inflamed tis- \nsues so that these may be rendered anaesthetic by cocaine. For \ntopical application, a filtered, freshly-made aqueous solution \nshould be employed. It may be sterilized by heat without de- \nstroying its active principle. All antiseptics, used as preserva- \ntives, are disappointing. The active principle has been iso- \nlated by Abel, who proposed the name epinephrin for it. Its \nsalts produce an exceedingly powerful effect on blood-pressure. \nThe gastric contents, it is found, have no effect upon the ex- \ntract. For internal treatment it is well to commence with .06 \ngm. (1 gr.) of the powder, three times a day, and progressively \nincrease the dose. It should be given dry on the tongue and \nswallowed without water. It should never be given hypoder- \nmatically on account of the collapse which it causes when ad- \nministered in this way. It is of great value in the treatment of \n" hay-fever," given internally and also applied locally. It is \n\n\n\nTHYMUS EXTRACT. 953 \n\nuseful in the treatment of acute and chronic bronchitis, bron- \nchial asthma, congestion and oedema of the lungs, haemoptysis, \nand oedema of the glottis. It may be cautiously used in dis- \neases of the heart, which, as has been stated, it stimulates from \ndirect action on the heart muscle. Suprarenal has been used to \na considerable extent in the treatment of Addison\'s disease, but \nwithout much benefit. It might perhaps be of service if it \ncould be brought into the blood directly, but its intravenous \ninjection would be quite unjustifiable in this affection. In \nshock it has been proposed to inject a solution of one of the \nsuprarenal preparations drop by drop into a vein, timing the \nrapidity of the injections by the behaviour of the pulse. \n\nAdrenalin is the name proposed by Takamine for a sub- \nstance which he has isolated from the suprarenal gland. This \nis employed in a i per mille solution as a local astringent. \n\nUnofficial Preparation. \nExtractum Thymiamum. \xe2\x80\x94 Thymus Extract. Dose, .20 to \n.30 gm.; 3 to 5 gr. \n\nAction of Thymus Extract. \nAs the thymus gland atrophies in childhood and disappears \nafter puberty, it is probable that it performs some important \nfunction in the development and growth of the young child. \nFrom the fact that it is so active during the period of greatest \nbone growth of the body, it has been inferred that it is con- \ncerned in the formation of bone salts; and a comparison of \nthe salts found in the gland with those distributed in the \nbones lends color to this view. The thymus contains a larger \namount of nuclein, and hence of phosphorus, than any other \nof the glands, and thymus extract is believed to be a recon- \nstructive. It has some coagulant action on blood, and in \nthis connection the statement which has been made that the \nthymus gland has been found absent in cases of haemophilia is \nof interest. In dogs, after injections of the watery extract \ninto the circulation, there have been observed lowering of the \n\n\n\n954 PHARMACOLOGY AND THERAPEUTICS. \n\nblood-pressure with acceleration of the heart\'s action, and this \nfall was not prevented by section of the vagi or by paralyzing \nthem with atropine. It is thought probable that, as in case \nof thyroid extract, this effect is due to the organic extractive \nand mineral salts present, and not to any active principle. \nWith large injections toxic effects have been produced, espe- \ncially in young animals; the phenomena observed being agita- \ntion, intense dyspnoea, collapse, and finally death. In the study \nof the effects of extirpation of this gland, it has been shown \nthat in many animals the thymus is not essential to life. Some \nexperimenters have found no bad effects whatever resulting, \nwhile others have observed extreme voracity with emaciation \nfor some time after the removal; the animals after one or two \nmonths recovering their normal condition. It is stated that as \na result of the operation there have been noted an increase of \nthe leucocytes and a diminution of the red corpuscles of the \nblood, and that nutritional changes have been the more marked \nthe younger the animal. Among the morbid conditions in \nwhich a persistent and sometimes a large thymus has been \nobserved are exophthalmic goitre, acromegaly, acute leucocy- \nthaemia and, more rarely, simple goitre. \n\nTherapeutics of Thymus Extract. \nIt would seem to be indicated in rickets, haemophilia and the \nscurvy of children. In the latter affection, as the blood is \nevidently inadequately supplied with its requirements, it is \nthought likely that it is the thymus gland that cannot get the \nsalts which it needs; this being the cause of the bleeding and \nother symptoms of that condition. Fairly good results have \nbeen reported from its use in goitre, and it is possible that \nthese may have been due to the fact that in the thymus there \nare traces of an iodine-containing compound similar to the iodo- \nthyrin of the thyroid. In exophthalmic goitre (Graves\' disease) \nthe results have not been so satisfactory, though many cases \nare stated to have improved under its use. One observer, after \nan extensive trial of it, concludes that the thymus gland admin- \n\n\n\nPITUITARY EXTRACT. 955 \n\nistered internally has no specific action in this affection, hav- \ning no direct effect on the goitre, the heart, or the exophthalmos, \nthough it possibly has some value in improving the general \ncondition of the patients, and in this way may contribute \ntowards their recovery. He publishes the results of the \ntreatment of twenty cases, comparing them with twenty cases \ntreated in other ways. In pulmonary tuberculosis it has been \nfound by some to aid the hygienic and medical treatment, its \nemployment being based on the ground that the earthy salts \nof the bones are necessary to permanently encapsulate or heal \ntuberculous lung lesions. One clinician reports, however, that \nwhile in five out of six carefully selected cases of apyretic \nphthisis an increase in weight occurred during the first weeks \nof treatment, the gain was followed by a loss; otherwise there \nwas no change in the general condition. Thymus has also \nbeen given for haemoptysis. A few cases have been reported \nin which it has appeared to do good in chlorosis, and it has \nbeen given with benefit in malnutrition and in defective devel- \nopment in children. Thus, it is said to be useful in pseudo- \nhypertrophic paralysis, and other conditions in which it has \nbeen recommended are leucocythaemia and idiopathic and per- \nnicious anaemia. \n\nUnofficial Preparation. \nExtractum Pituitarium. \xe2\x80\x94 Pituitary Extract. Dose, .20 to \n.30 gm.; 3 to 5 gr. \n\nAction of Pituitary Extract. \nThe function of the pituitary secretion in the body is some- \nwhat uncertain. Pituitary substance slightly stimulates the \nheart and constricts the blood-vessels, but is greatly inferior \nto suprarenal in this respect. Other effects which have been \nobserved after subcutaneous injection in small animals are \nquickened respiration and paralysis of the hind limbs. The \npituitary body is thought to be always hypersecreting in the \ncondition of giantism and is stated to be always diseased in \nacromegaly. In cases of the latter when this secretion be- \n\n\n\n956 PHARMACOLOGY AND THERAPEUTICS. \n\ncomes disturbed there results almost continuous headache, \nsometimes excruciating in character. \n\nTherapeutics of Pituitary Extract. \nIt has been used chiefly in acromegaly, and sometimes with \ngood results. Of thirteen cases collected in which it was em- \nployed, in seven varying degrees of improvement were re- \ncorded, in five there was no benefit, and in one the treatment \nappeared to make the patient worse. In one case where there \nwas marked improvement this extract was given in combina- \ntion with thyroid. In a number of instances the severe head- \naches accompanying acromegaly have been relieved by the \nadministration of pituitary extract. It has been proposed to \nfeed it to young dwarfs. \n\nUnofficial Preparation. \nExtractum Mammarium. \xe2\x80\x94 Mammary Extract. Dose, .20 to \n.30 gm.; 3 to 5 gr. \n\nAction of Mammary Extract. \nIt is believed to have some influence on the uterus, though its \naction is not well understood. \n\nTherapeutics of Mammary Extract. \nIt has been given with alleged good results in uterine fibroma \nand carcinoma, also in menorrhagia, dysmenorrhea and en- \nlarged, sensitive uterus. In too frequent menstruation, and par- \nticularly in chlorotic girls, there is no remedy which acts so \nsatisfactorily (delaying the period to the regular time) as mam- \nmary extract. It should be given for five or six days before the \nexpected period. \n\nUnofficial Preparation. \nExtractum Ovarianum. \xe2\x80\x94 Ovarian Extract. Dose, .20 to .30 \ngm.; 3 to 5 gr. \n\n\n\nTESTICULAR EXTRACT. 957 \n\nAction of Ovarian Extract. \nBut little is known of its pharmacological action. Fresh \novarian extract is said, when injected into the circulation in \nrabbits, to raise the blood-pressure, diminish the heart\'s action, \nand slow the respiration, and when administered to the human \nfemale also to increase the arterial tension. In the castrated \nanimal it is found to increase oxidation to somewhat above \nthe normal degree, but on the normal animal it has no such \neffect. Its administration does not prevent atrophy of the \nuterus after removal of the ovaries. \n\nTherapeutics of Ovarian Extract. \nSome time since it was suggested in cases of removal of the \novaries, and it has been given with more or less success in the \nvarious conditions following the functional loss of these organs, \neither through operation or disease. It has been employed \nto relieve congestion and ovarian neuralgia, and may be used \nwhen the functions of the ovaries are either partially or wholly \narrested. It is reported to have a decidedly beneficial action \nnot only upon typical climacteric disturbances, but also upon the \npsychical depression and constitutional affections, such as gout \nand psoriasis, which may make their appearance at this period. \nIn five cases of epilepsy which appeared to be connected with \nthe climacteric or with amenorrhcea much benefit is said to \nhave been derived from its use. It has been employed in \ndelayed or scanty menstruation, ordinary amenorrhcea, uterine \nfibroids, and exophthalmic goitre. \n\nUnofficial Preparation. \nExtractum Testicularium. \xe2\x80\x94 Testicular Extract. (Testicular \njuice.) Dose, .20 to .30 gm.; 3 to 5 gr. \n\nAction of Testicular Juice. \nThe theory has been advanced that certain organs supply to \nthe body a natural ferment which is essential to health. When \nthis ferment is absent the vital forces degenerate. Under the \n\n\n\n95 8 PHARMACOLOGY AND THERAPEUTICS. \n\nuse of testicular juice the functions of organic life are per- \nformed with new vigor. \n\nTherapeutics of Testicular Juice. \nFavorable reports of its use in many hundreds of patients \nsuffering from organic nervous diseases are on record, but \nthe claims are so broad that further observations are necessary. \n\nUnofficial Preparation. \nExtractum Cerebralum. \xe2\x80\x94 Brain Extract. Dose, .20 to .30 \ngm.; 3 to 5 gr. \n\nAction of Brain Extract. \nFebrile reaction, prostration, and in some cases cardiac \nweakness, have followed its administration. \n\nTherapeutics of Brain Extract. \nIt has been made use of for the treatment of various nervous \ndisorders, and excellent, although not always constant, results \nhave been claimed. \n\nUnofficial Preparation. \nExtractum Splenicum. \xe2\x80\x94 Splenic Extract. Dose, .20 to .30 \ngm.; 3 to 5 gr. \n\nAction of Splenic Extract. \nExcision of the spleen, or the serious impairment of its func- \ntions by disease, it is stated, is usually followed by marked tis- \nsue changes and great susceptibility to alterations of tempera- \nture, especially in malarial subjects. Scarcely anything is \nknown of the action of splenic extract. According to some ex- \nperimenters its subcutaneous injection produces no physiolog- \nical effects, while others have found that in the dog intravenous \ninjections cause first a prompt fall of blood-pressure, followed \nlater by a pronounced and continuing rise, which again is suc- \nceeded by a slow return to the normal. It has been found \n\n\n\nSPLENIC EXTRACT. 959 \n\nthat if it is given by the mouth in sufficient amount to produce \neffect it is apt to violently disturb the digestion and cause \nmuch pain, nausea and vomiting, and that administered hypo- \ndermatically it frequently causes marked local irritation and \nsometimes abscesses. \n\nTherapeutics of Splexic Extract. \n\nIn various disorders of the blood it has been employed with \nthe idea of supplying to that fluid some material which may \nbe required for its healthy condition. It has been pointed out \nthat the possession of bacteriological power by some secretion \nof the spleen is indicated by such facts as the evident incom- \npatibility of tuberculosis and malaria and by the enlargement \nof the spleen in acute infectious diseases, as though working \nagainst the germs of such affections. Accordingly, it was pro- \nposed that the splenic substance of animals immune against \ncertain of these diseases, such as tuberculosis, malaria and ty- \nphoid fever, should be employed as a remedy in them. Splenic \nextract has been given with more or less benefit in exophthalmic \ngoitre, and is stated to have improved the mental, as well as \nthe general condition, of the patients in some cases of insanity. \nLike red bone marrow, it has been tried in leucocythsemia, but \nwith no great success, and it has been suggested that the reason \nfor the failure of these remedies is that in this affection both \nthe bone marrow and the spleen are hypertrophied, not \natrophied. \n\nRed bone marrow, in addition to its use in leucocythsemia, has \nbeen given particularly in pernicious anaemia, and also em- \nployed in the ordinary forms of anaemia and in osteomalacia, \ntuberculous joint diseases, etc. The reports as to the results, \nhowever, are conflicting, and as a rule these appear to have \nbeen negative. \n\nParotid extract has been used to diminish uterine fibroids \nand in ovarian disease, and is said by some to be practically spe- \ncific in certain forms of dysmenorrhea. \n\n\n\n960 PHARMACOLOGY AND THERAPEUTICS. \n\nDivision XIV \xe2\x80\x94Drugs Acting on Metabolism. \n\nThe action on metabolism of many of the drugs previously \ndescribed has already been referred to. As our knowledge of \nthe normal metabolism of the body is as yet very limited, no \nfurther remarks on this subject need be made except as regards \nthe individual drugs now to be considered. In this place it \nmay be well to call attention to two names in common use, viz. : \nalterative and tonic. \n\nAlterative is a vague term which cannot be accurately de- \nfined. It is often employed to cloak our ignorance of the exact \naction of a drug, but in general it is applied to agents which \nappear to modify the nutritive processes and thereby cure or \nalleviate many diseases of chronic type. They thus favorably \nalter morbid processes, as in the case of mercury in syphilis, \nbut the modus operandi, of which almost nothing is definitely \nknown, probably varies very greatly in the case of different \ndrugs. \n\nTonic. \xe2\x80\x94 A tonic has been stated to be a drug which so influ- \nences nutrition as to increase the reconstruction or upbuilding \nof the tissue or tissues concerned. While this definition is not \nentirely adequate, it is perhaps as satisfactory as any that can \nbe given. \n\nThis division also includes substances used as foods. \n\nIODINE. \nIODUM.\xe2\x80\x94 Iodine. Dose, 0.005 gm. (5 milligm.) ; T ^ gr. \n\nPreparations. \n\n1. Liquor Iodi Compositus. \xe2\x80\x94 Compound Solution of Iodine. \n(Lugol\'s Solution.) Dose, 0.2 C.C.; 3 Tl\\,. \n\n2. Tinctura Iodi. \xe2\x80\x94 Tincture of Iodine. Dose, 0.1 c.c; \n\niy 2 TTL- \n\n3. Unguentum Iodi. \xe2\x80\x94 Iodine Ointment. \n\n\n\nIODINE. 961 \n\nAction of Iodine. \n\nExternal. \xe2\x80\x94 Iodine is an irritant, disinfectant, and parasiti- \ncide. The first effect of its application to the skin is a yellow- \nish-brown or dark brown discoloration, which is removable \nby alkalies or sodium hyposulphite. It acts more slowly than \nmost other irritants, but on account of its volatility and because \nit precipitates proteids and enters into easily dissociated com- \npounds with them, its action is both penetrating and prolonged. \nIt produces a sensation of heat and itching, accompanied by \nlocal hyperemia and sometimes by more or less cedematous \nswelling. Some exudation of leucocytes takes place, and the \nstrong absorbent action of iodine has been attributed to this. \nUnless used in very concentrated solution or in the solid form, \nwhich may cause vesication or even corrosion, its irritant action \nis comparatively mild. By repeated applications, however, it \nis possible to secure very pronounced counter-irritation with- \nout the production of a deep destruction of tissue. The super- \nficial cuticle is usually destroyed, and the skin afterwards ex- \nfoliates. As a result of its local application, small quantities \nare absorbed. The subcutaneous injection of solutions of it \ncauses intense pain and irritation. The inhalation of the vapor \nof iodine also gives rise to very considerable irritation; excit- \ning sneezing, coughing and some dyspnoea, with smarting, \nswelling and increased secretion in the nasal mucous membrane, \nconjunctiva, throat and lower respiratory passages. \n\nInternal. \xe2\x80\x94 Iodine naturally exerts its local irritant action on \nthe gastro-intestinal tract, causing pain and vomiting, and \nsometimes purging. The drug may be recognized in the vom- \nited matter and in the stools. In minute doses the slight \nirritation produced on the mucous membrane of the stomach \nmay have a somewhat tonic effect, improving the appetite and \ndigestion, and be followed by a sedative action. In excessive \ndoses it produces marked irritation of the oesophagus and severe \ngastro-enteritis, but death is rarely caused by it. In fatal \ncases of poisoning the mucous membrane of the stomach and \nintestine has been found tumefied and loosened. The irritation \n62 \n\n\n\n962 PHARMACOLOGY AND THERAPEUTICS. \n\nof the alimentary canal may also prove fatal by inducing col- \nlapse and failure of the heart and respiration. In animals \nfatty degeneration of the heart, liver and kidneys has some- \ntimes been found. Iodine, in the form of iodides and, it may \nbe, in a combination with proteids, is rapidly absorbed by the \nmucous membranes generally. Its chief effects after absorption \nare due to its action on the thyroid gland. The symptoms pro- \nduced by its continued administration, such as acceleration of \nthe pulse and certain nervous phenomena, are much the same \nas those caused by large amounts of thyroid extract, and are \nthought to be probably due to the excessive production of the \norganic compound, iodothyrin. In the thyroid gland iodine \nexists normally in the form of this substance, and the adminis- \ntration of the drug may lead to an increase in its formation. \nIodine is excreted, in the form of iodides, chiefly by the kid- \nneys, but also to some extent in the saliva, perspiration, milk \nand bronchial secretion. Free iodine has been detected in the \nstomach, and this is believed to probably result from the de- \ncomposition of hydriodic acid excreted into that organ. \n\nTherapeutics of Iodine. \nExternal. \xe2\x80\x94 Iodine preparations are much relied upon as irri- \ntants, counter-irritants and resolvents. The tincture is one of \nthe most popular of all external applications. While mild in \nits action, a sufficient effect may usually be secured by the repe- \ntition of its use. The ointment and compound solution are \nalso comparatively mild preparations. If a more powerful \neffect is desired, the liniment (B. P., 1885, which contains \niodine, 5 ; potassium iodide, 2 ; glycerin, 1 ; alcohol, 40) may \nbe employed. As it is otherwise liable to cause severe inflam- \nmation, it should be painted on the skin quite lightly, and in \ncase it causes much pain it may be washed off with a solution \nof potassium iodide. " Iodine paint " is a tincture twice as \nstrong as the official tincture. The conditions for which these \nand other iodine preparations are used are almost innumerable, \nand need not be given in detail. Among them may be men- \n\n\n\nIODINE. 963 \n\ntioned chronic inflammation of joints, periostitis, ringworms, \nenlarged glands, buboes, abscesses, chilblains, pleurisy, and \ninflammation or retraction of the gums. For the last-named, \nwhat is known as dental tincture of iodine, consisting of \ntincture of iodine, 11, alcohol, 30, is sometimes applied over \na very circumscribed area. This, or the official tincture, \nmay be painted over a spot of tinea or ringworm, and \nthe tincture is usually efficacious in tinea versicolor. Other \npreparations used for these parasitic affections are iodized \ncollodion (.75 gm. ; 12 gr. ; iodine, dissolved in ether and \nalcohol, to 30 c.c. ; 1 fl. oz. ; of collodion); the liquor (B. P., \niodine, 10; potassium iodide, 15; water, 200), and Coster\'s \npaste, which consists of iodine dissolved in light oil of wood \ntar (1 to 4). Tincture of iodine is sometimes of service in \nlupus, and is curative in lentigo and chloasma. Added to salt \nwater, it forms a useful wash in chronic ozsena. Two prep- \narations of iodine are frequently employed in the treatment of \ndiseases of women, namely: Churchill\'s tincture: iodine, 5; \npotassium iodide, 1; water, 8; alcohol, 24; and Battey\'s fluid: \niodine, 2; free carbolic acid, 1. A colorless tincture of iodine \nhas the advantage of not staining the skin, but is much milder \nthan the ordinary tincture. In it iodine is dissolved in alcohol \nand deodorized by a strong solution of ammonia; but it really \ncontains no iodine, ammonium iodide and iodate being formed, \nand any irritant affect which it may have is due to excess of \nammonia. A colorless iodine ointment is also prepared, in \nwhich the decolorization is effected by means of sodium sul- \nphate. Formerly the practice was much in vogue of injecting \ntincture of iodine into the sac of hydrocele and into cysts, ab- \nscesses, dropsical joints, and the pleural cavity after empyema, \nas well as into other cavities, for the relief of various affections, \nbut other methods of treatment have largely superseded this. \nWhen it is employed, great caution must be observed, as intense \npain and irritation may be caused, which may possibly be fol- \nlowed by collapse or by suppuration and gangrene. Fatal sys- \ntemic poisoning has also been known to result from the injec- \n\n\n\n964 PHARMACOLOGY AND THERAPEUTICS. \n\ntion of large quantities of iodine into cysts. The same objec- \ntions hold true as regards the parenchymatous injection of the \ntincture in hypertrophied tonsil, goitre, glandular tumors, etc. \nIn some cases of spina bifida a successful result may be ob- \ntained by the injection of Morton\'s fluid, which consists of \niodine, 1 ; potassium iodide, 3 ; glycerin, 48. \n\nInternal. \xe2\x80\x94 Among the ignorant classes the idea has long pre- \nvailed that seaweed has the effect of reducing obesity, and the \nFucus vesiculosis, or bladderwrack, has been especially esteemed \nfor this purpose. Consequently, it has been made the basis of \nvarious quack preparations, but any action it may have in this \nregard would seem to be due simply to the interference with \nnutrition caused by the digestive disturbances arising from the \niodine, chlorine and bromine in its composition. .06 to .12 c.c. \n(1 or 2 m.) of tincture of iodine, largely diluted and repeated \nfrom time to time, may sometimes have the effect of arresting \nvomiting. Minute doses of the tincture or compound solu- \ntion may also be of service in passive intestinal hemorrhage or \ndiarrhoea from atony of the mucous membrane. Goitre, when \nthere is present simply a hypertrophy of the gland elements, \nmay not infrequently be successfully treated by the internal \nand external use of iodine. For the internal treatment the \nbest mode of administration is to give the tincture in small \ndoses with potassium iodide, freely diluted. Thyroid extract, \nhowever, is much more efficient. Iodine has been thought to \nhave some curative influence in malarial fevers, but probably \nnot much reliance is to be placed upon it. To increase its \nefficiency it has been advised that phenol should be combined \nwith it. Thus, .60 to .90 c.c. (10 to 15 R), well diluted, of a \nmixture of the tincture with phenol, in the proportion of 8 to \n1, may be prescribed three times a day; though, as this dosage \nis large, its effects should be carefully watched. A similar com- \nbination has sometimes proved of service in typhoid fever: \nTincture of iodine, 2; carbolic acid, 1; dose, .06 to .18 c.c. (1 \nto 3 m.) three times a day. The compound solution has also \nbeen employed in typhoid. This preparation has obtained re- \n\n\n\nPOTASSIUM IODIDE. 965 \n\npute as a remedy in scrofulous affections of the skin and of \nthe lymphatic glands, especially in syphilitic children, and is \nstated to be useful in some old syphilitic skin diseases attended \nby thickening and scaling. Judiciously employed, iodine prep- \narations are of some value as inhalations. The vapor of the \nB. P. (tincture of iodine, 1; water, 8; to be gently heated) is \nsometimes prescribed for diseases of the lungs and air-passages, \nbut it is too irritating. The following method of inhalation \nhas been found beneficial in acute nasal catarrh, " hay-asthma," \nand chronic bronchitis: Tincture of iodine (.30 to .60 c.c. \xe2\x80\x94 5 to \n10 m.) is dropped upon a moistened sponge in a small, wide- \nmouthed bottle, which is placed in a vessel of hot water, and \nthe vapor of the iodine is inhaled with that of the water. \nThe carbolate (tincture of iodine, 2; carbolic acid, 1) may be \nused instead of the simple tincture of iodine. Camphor is also \nsometimes inhaled with tincture of iodine. In some cases of \n" hay asthma " the local application of the following with a \npost-nasal syringe is of advantage: tincture of iodine, 6; car- \nbolic acid, 1 ; water, 190. The inhalation of iodine and tur- \npentine has been recommended, as an adjuvant to other meth- \nods of treatment, in laryngeal and pulmonary tuberculosis. \n\n1. POTASSII IODIDUM.\xe2\x80\x94 Potassium Iodide. Dose, 0.500 gm. \n(500 milligm.) ; iy 2 gr. \n\nPreparations. \n\n1. Liquor Iodi Compositus. \xe2\x80\x94 Compound Solution of Iodine. \nDose, 0.2 c.c; 3 HI. \n\n2. Acidum Hydriodicum Dilutum. \xe2\x80\x94 Diluted Hydriodic Acid. \nDose, 0.5 c.c; 8 n\\. \n\n3. Syrupus Acidi Hydriodici. \xe2\x80\x94 Syrup of Hydriodic Acid. \nDose, 4 c.c; 1 fl. dr. \n\n4. Unguentum Potassii Iodidi. \xe2\x80\x94 Ointment of Potassium \nIodide. \n\n2. SODII IODIDUM.\xe2\x80\x94 Sodium Iodide. Dose, 0.500 gm. (500 \nmilligm.); iy 2 gr. \n\n\n\n966 PHARMACOLOGY AND THERAPEUTICS. \n\n3. AMMONII IODIDUM.\xe2\x80\x94 Ammonium Iodide. Dose, 0.250 gm. \n(250 milligm.) ; 4 gr. \n\n4. STRONTII IODIDUM.\xe2\x80\x94 Strontium Iodide. Dose, 0.500 gm. \n(500 milligm.) ; 7V 2 gr. \n\n5. ZINCI IODIDUM. \xe2\x80\x94 Zinc Iodide. Dose, 0.065 gm. (65 \nmilligm.); 1 gr. \n\nUnofficial Preparation. \nRubidii Iodidum. \xe2\x80\x94 Rubidium Iodide. Dose, 0.30 to 1.20 \ngm.; 5 to 20 gr. \n\nAction of the Iodides. \n\nExternal. \xe2\x80\x94 None. Iodides in watery solution are not ab- \nsorbed from the unbroken skin, but are rapidly absorbed from \nmucous membranes. \n\nInternal. \xe2\x80\x94 The effects produced by the iodides appear to vary \nvery considerably, not only in different individuals, but also in \nthe same individual at different times, and their mode of action \nis still a matter of great uncertainty. It is recognized, how- \never, that they are capable of causing two distinct kinds of \neffects, one an irritation, in consequence of their salt-action, of \nthe alimentary canal, manifested by nausea and vomiting and \nsometimes by diarrhoea, and the other a series of symptoms to \nwhich the name of iodism has been given. The latter symp- \ntoms may be elicited by considerably smaller doses than the \ngastric irritation, but, as a rule, appear only when the adminis- \ntration has been continued for some time, the length of this \nperiod varying greatly in different instances. The size of the \ndose naturally has some relation to their onset. When admin- \nistered internally the iodides are absorbed unchanged by the \nstomach and intestine, and it is found that they make their ap- \npearance in the secretions within a very short time. They are \nexcreted mainly in the urine, in which they are found as salts; \nalso to some extent in the saliva and in various other secretions, \nas those of the nasal mucous membrane and sebaceous glands, \nand in the tears, sweat and milk. By the stomach small amounts \nare eliminated as hydriodic acid and sometimes as free iodine. \n\n\n\n\n\n\nPOTASSIUM IODIDE. 967 \n\nNo free iodine, however, has been found in the saliva, sweat \nor nasal secretion, and it is stated that no iodine can be de- \ntected in the breath of animals poisoned with iodides. There \nseems to be no question that some of the iodide undergoes de- \ncomposition in the body, and there is strong ground for be- \nlieving that the symptoms of iodism are produced by the iodine \nthus set free. Support to this view is afforded by the fact that \nrepeated doses of iodine sometimes cause symptoms resembling \nthose of iodism, and also by the fact that formerly much the \nsame therapeutic effects were produced by the internal admin- \nistration of iodine which are now obtained with the iodides. \nAs has been stated, free iodine is excreted into the stomach, \nand, furthermore, an organic compound of iodine has been \nfound in the hair, muscles, heart, etc., after iodide treatment. \nVarious explanations have been offered regarding the forma- \ntion of free iodine from iodides, but as none of the theories \nadvanced has as yet been positively demonstrated, they need \nnot be given here. Some of the symptoms are thought to be \nprobably due to action on the thyroid gland. The urine is gen- \nerally increased by the iodides, although so far as known they \nhave no specific action on the kidneys. On the other hand, the \nsecretion of milk is diminished. Infants have been known to \nsuffer with iodism from being nursed by persons under iodide \ntreatment. \n\nIodism. \xe2\x80\x94 This is induced by all the iodides, and the basic ion \ndoes not appear to be concerned in the effect. Owing to the \nfact that iodine is more readily freed from it, ammonium \niodide is said to be more liable than the others to cause iodism. \nThe symptoms may be divided into two groups. (1) Very \ncommonly there is catarrh of the respiratory passages, which \ncommences in the nasal mucous membrane, exciting a profuse \nwatery discharge, and extends both upward and downward. \nAccordingly there is conjunctivitis, and severe headache may \nresult from the invasion of the frontal sinuses. At the same \ntime there is much swelling and irritation about the fauces, the \ntonsils are liable to become inflamed, and laryngitis or bron- \n\n\n\n968 PHARMACOLOGY AND THERAPEUTICS. \n\nchitis may result. (Edema of the larynx, which unless promptly \nrelieved may prove fatal, occasionally occurs. In animals it \nhas been shown that the bronchial secretion is increased by \nquite small quantities intravenously injected. Usually some- \nwhat later, an eruption may appear upon the skin. This most \ncommonly consists of erythematous patches, but instead there \nmay be papules, which sometimes become pustular, and, more \nrarely, other forms of cutaneous disease. (Edema of the face \nis met with in some instances, and very rarely there is albumin- \nuria. Nervous troubles, neuralgia, singing in the ears, con- \nvulsive movements, disturbed intellection, and rarely atrophy \nof the mammae and testes may be noticed. (2) Iodic cachexia \n(which is characterized by rapid emaciation), severe cardiac \npalpitation, and ravenous appetite occasionally occur as late \nphenomena. The local manifestations of iodism can sometimes- \nbe prevented by the administration of alkalies, and hence it is \nthought that the variation of their extent in different persons, \nor in the same person at different times, may perhaps be ex- \nplained by a different degree of acidity. Children appear to be \nless subject to iodism than adults. A tolerance may be estab- \nlished, and not infrequently the symptoms disappear while the \nadministration is still being maintained. Although the mani- \nfestations may be very severe, a cessation begins soon after the \ntreatment is discontinued, and the chewing of pellitory will \nhasten the elimination of iodine in the chronic forms. When \niodic cachexia has supervened, however, the symptoms may not \ndisappear for a considerable time. \n\nTherapeutics of the Iodides. \nThe iodides were largely substituted for iodine in therapeu- \ntics for the reason that they are less irritating to the gastro- \nintestinal tract. Potassium iodide is the one in most general \nuse. The iodides are perhaps more extensively employed than \nany other of the salts of the alkalies. The most conspicuous \nof their applications is in the treatment of syphilis, in which \ntheir very great value has long been established. It is in the \n\n\n\nPOTASSIUM IODIDE. 969 \n\nthird stage of the disease that they produce results which can- \nnot be accomplished by any other means; often causing the \nrapid absorption of nodes, gummata and other deposits. In \norder to secure the best effect it is necessary to give very large \ndoses in many instances, so that 8, 12 or even 16 gm. (2 to 4 \ndr.) may be taken in a day. In syphilis of the nervous system \nlarge doses are especially called for, and daily amounts of 30 \ngm. (1 oz.) are not infrequently required in these cases. No \nsymptoms of iodism are likely to appear until the disease sub- \nsides. What is known as the " mixed treatment " is often re- \nsorted to in syphilis, and it is believed by the majority of prac- \ntitioners to be especially effective in the intermediate period, \nwhen the secondary stage is passing into the tertiary. This \nconsists of the combination of potassium iodide with corrosive \nmercuric chloride; as a result red mercuric iodide is formed and \ndissolved in the excess of potassium iodide. It has been sug- \ngested that in syphilis the iodides may act as a specific poison \n(antiseptic) to the unknown cause of the disease, but if this \nwere so it seems reasonable to suppose that they would be \nmuch more efficacious in the early stages than is the case. \nTheir remedial action remains in fact as yet unexplained. In \nvarious troubles not directly attributable to syphilis, but occur- \nring in those who have at one time had the disease, iodides are \noften beneficial. \n\nWhile these drugs are of little value in acute rheumatism, \nthey are relied upon to some extent in chronic rheumatic mani- \nfestations. Rheumatoid arthritis would seem to be more \namenable to the long-continued use of ferrous iodide than of \nthe potassium salt, which is more commonly employed for its \nrelief. In any affection in which the administration of the \niodides must be maintained for a great length of time it will \nusually be found advantageous to allow occasional intermis- \nsions. In so-called gonorrhceal rheumatism the syrup of hy- \ndriodic acid is preferable to potassium or other iodide. In sub- \nacute catarrh of the duodenum and of the biliary ducts com- \nparatively small doses of sodium or ammonium iodide may be \n\n\n\n970 PHARMACOLOGY AND THERAPEUTICS. \n\nof service, and it is asserted that the latter, especially when \ncombined with arsenic, is one of the best remedies for the first \nstage of cirrhosis of the liver. Some good results with potas- \nsium iodide have been obtained in aneurism, but whether it has \nany effect in cases where there is no syphilitic taint seems \ndoubtful. The iodides are not infrequently useful in promot- \ning the absorption of inflammatory products, as, for instance, \nin joint disease, pleurisy and catarrhal and fibrinous pneumo- \nnia; and there is reason to believe that their prolonged use in \nsufficient dose may be of benefit in arterio-sclerosis, interstitial \nnephritis, and amyloid disease of the kidney and other organs. \nSimple hypertrophy of the spleen may be cured by the internal \nuse of the iodides and the external application of iodine paint \nor ointment of red mercuric oxide, and ammonium iodide is \noften efficacious in removing the enlargements of the spleen \nand liver caused by malarial disease. Iodides have long been \nemployed in the treatment of goitre, but now seem likely to be \nentirely supplanted by thyroid extract. Ammonium iodide is \nhighly esteemed in capillary and in chronic bronchitis, and \npotassium iodide is sometimes quite efficacious in relieving the \nsymptom asthma. For the internal treatment of " hay asthma " \nit should be given in full doses, and it may be advantageously \ncombined with arsenic. The iodides have been recommended \nin various cerebral affections, but unless these are of syphi- \nlitic origin, not much is probably to be expected from their use. \nPotassium iodide is occasionally prescribed to diminish the \nsecretion of milk. This salt is commonly given to promote the \nelimination of lead and mercury in cases of chronic poisoning \nfrom these metals, though experiments appear to indicate that \nit is not more efficient in this regard than the chloride or bro- \nmide. The iodide treatment is sometimes of service in non- \nsyphilitic skin diseases. It is regarded as especially useful in \nactinomycosis and psoriasis. In many of the conditions in \nwhich potassium iodide is employed, particularly when the ad- \nministration is long-continued, it would seem that sodium iodide \nshould be preferred, as it does not occasion so much depression. \n\n\n\n\n\n\nGOLD AND SODIUM. CHLORIDE. 97 1 \n\nRubidium iodide (not official), which, it is asserted, is better \nborne than the potassium salt, has been proposed as a substi- \ntute for potassium iodide. \n\nStrontium iodide has been recently introduced, and is used \nfor the same purposes as the other iodides. It is believed that \nit is less likely to disturb the stomach, cause acne, and depress \nthe heart than the remaining iodides. In many instances the \nsyrup of hydriodic acid can be substituted with advantage for \nthe iodides. It is not so likely to produce iodism, nor does it \nso readily give rise to the " iodide punishment." Its pleasant \ntaste is grateful to most patients, and it should be admin- \nistered, well diluted, one-half hour before meals, or at least \nupon an empty stomach. Some of the commercial preparations \nare likely to decompose readily, especially when made from \ntartaric acid and potassium iodide, and are objectionable from \nthe amount of syrup which is administered when large doses \nare employed. \n\nGOLD. \n\nAURI ET SODII CHLORIDUM.\xe2\x80\x94 Gold and Sodium Chloride. \n\ngr. \n\nAction of Gold and Sodium Chloride. \nIn small doses gold and sodium chloride is supposed to pro- \nmote appetite and digestion, to stimulate the functions of the \nbrain and to be an aphrodisiac. Full doses cause nausea and \nvomiting, and finally impair nutrition. The toxic symptoms \nresemble those of poisoning by corrosive mercuric chloride. \n\nTherapeutics of Gold and Sodium Chloride. \nIt is useful in irritative dyspepsia, gastro-duodenal catarrh, \nhypochondriasis, and also chronic ovarian irritation and ovari- \ntis, as well as in chronic albuminuria, hepatic sclerosis, and \ngranular kidney, since it prevents hyperplasia of connective \ntissue. It is a valuable remedy in the tertiary manifestations \nof syphilis, especially of the bones, and presents fewer disad- \nvantages than corrosive mercuric chloride. \n\n\n\n972 PHARMACOLOGY AND THERAPEUTICS. \n\nGUAIAC. \n\nGUAIACUM (Guaiaci Resina, U. S. P., 1890).\xe2\x80\x94 Guaiac. (Gum \nGuaiac.) Dose, 1 gm.; 15 gr. \n\nPreparations. \nTinctura Guaiaci.\xe2\x80\x94 Tincture of Guaiac. Dose, 4 c.c; 1 fl. dr. \n\nTinctura Guaiaci Ammoniata. \xe2\x80\x94 Ammoniated Tincture of \nGuaiac. Dose, 2 c.c; 30 TT1. \n\nUnofficial Preparation. \nGuaiaci Lignum (U. S. P., 1890). \xe2\x80\x94 Guaiacum Wood. \n(Lignum Vitae.) Dose, 1 to 4 gm.; 14 to 1 dr. \n\nAction of Guaiac. \n\nExternal. \xe2\x80\x94 The tincture of guaiac is used for the detection \nof blood stains. \n\nInternal. \xe2\x80\x94 Guaiacum is diaphoretic, expectorant and laxa- \ntive, and in large doses a gastro-intestinal irritant, pro- \nducing vomiting and purging. When it fails to act on the \nskin it is apt to cause free diuresis. In moderate amount it \nincreases the flow of saliva and occasions a feeling of warmth \nin the epigastrium, and in its local effects on the stomach and \nreflex stimulation of the heart it resembles the volatile oils. It \nis thought to probably have a slight antiseptic action as regards \nthe alimentary canal and the secretions, and when taken in \nsmall doses for some time is said to favorably affect metabolism. \nIt is also considered to have emmenagogue properties. In some \nindividuals a skin rash is produced by it. \n\nTherapeutics of Guaiac. \nInternal. \xe2\x80\x94 Guaiacum is so disagreeable and its therapeutic \nvalue rests on such a slender basis that it is not very often \nprescribed. Its effectiveness in many chronic and obscure \ncomplaints, it has been observed, no doubt correctly, is due \npartly to its purgative property and partly to its nastiness, a \nquality which is highly appreciated by many patients. Prob- \n\n\n\nPRICKLY ASH. 973 \n\nably its most useful application is in the treatment of tonsillitis, \nwhere in doses of 2 c.c. [}/& fl. dr.) given in emulsion or yolk of \negg every four hours, it often serves to abort the disease, or at \nall events to reduce the inflammation. In chronic sore-throat \nit is also sometimes of service, and, it is said, more particularly \nin patients who have had syphilis. It is preferably used here \nin the form of lozenges (.20 gm. ; 12 gr. of the resin with a fruit \nbasis). The ammoniated tincture may be employed as a gar- \ngle. On account of its purgative properties, guaiac has been \ngiven in habitual constipation. Malt extract is a good vehicle \nfor it, or it may be prescribed in a pill in combination with \nother remedies. It is practically useless in syphilis and chronic \nrheumatism, for which it was at one time largely prescribed. \nIt is thought by some to be of benefit in warding off attacks of \ngout. Doses of .75 gm. (12 gr.), taken in wafers and followed \nby effervescent lithium citiate, are recommended, and it is ad- \nvised that the treatment should be maintained indefinitely. The \nmixture of the B. P. (Guaiacum resin, 6; sugar, 6; tragacanth, \n1; cinnamon water, 240; dose, 15 to 30 c.c; ^ to 1 fl. oz.) is \nsaid to be a more efficient preparation than the tincture. \n\nPRICKLY ASH. \n\nXANTHOXYLUM.\xe2\x80\x94 Xanthoxylum. (Prickly Ash Bark.) Dose, \n2 gm.; 30 gr. \n\nPreparation. \nFluidextractum Xanthoxyli.\xe2\x80\x94 Fluidextract of Xanthoxylum. \nDose, 2 c.c; 30 nt. \n\nAction of Prickly Ash Bark. \nXanthoxylum has about the same action as guaiac. It pro- \nduces, when swallowed, a sensation of heat. \n\nTherapeutics of Prickly Ash Bark. \nIt enjoys some reputation as a remedy for chronic rheuma- \ntism, and has been used in syphilis and chronic hepatic dis- \norders. For patients suffering from chronic syphilis who do \n\n\n\n974 PHARMACOLOGY AND THERAPEUTICS. \n\nnot tolerate either mercury or the iodides, McDade\'s formula \nmay be employed. This is equal parts of the fluidextracts of \nsarsaparilla, stillingia, lappa, and phytolacca and of tincture of \nxanthoxylum. The dose is from 4 to 15 c.c. ; 1 to 4 fl. dr., \nthrice daily. The bark, used as a masticatory, is a popular \nremedy for tooth-ache. \n\nICHTHYOL. \n\nUnofficial Preparation. \n\nIchthyol. \xe2\x80\x94 Ichthyol. (Ammonium Ichthyol-Sulphonate.) \n\nDose, 0.60 to 1.20 gm.; 10 to 20 gr. \n\nAction of Ichthyol. \nIchthyol is an active reducing agent. It has some antiseptic \nproperty and it is mildly irritant to the skin, from which a \ncertain amount of absorption takes place when it is rubbed in. \nIn large doses it produces gastro-intestinal irritation. It is \nexcreted by the kidneys and also, it is believed, by the intestine. \n\nTherapeutics of Ichthyol. \nIt is used chiefly as a local application in skin diseases, espe- \ncially chronic eczema and psoriasis. For acne rosacea ichthyol \npaste is recommended (starch, 40; moisten with water, 20; \nrub in ichthyol, 40, and then a strong solution of albumin, 1 or \nmore). In erysipelas in which it is thought to be of con- \nsiderable service, an ointment composed of lanolin and ichthyol \n(20 to 50 per cent.) may be applied. Ichthyol has also been \nused for ulcers of the leg and for burns, and in the form of a \nsuppository for chronic prostatitis. Combined with glycerin \n(1 to 10) it is employed in gynaecological practice. It has been \nadvised as an application over inflamed and rheumatic joints, \nindurated glands and swellings, as well as for chronic inflam- \nmations of the pelvic viscera, and is said to cause the absorp- \ntion of inflammatory products. Internally it has been given in \ncapsules or pills (in dose from .60 to 2 gm. ; 10 to 30 gr.) for \n\n\n\nSARSAPARILLA. 975 \n\na variety of chronic affections, including rheumatism, syphilis \nand pulmonary disease, but it seems doubtful whether it is of \nany practical value. Under the name of Thiol, a mixture of \nsulphuretted hydrocarbons has been used as a substitute for \nichthyol, because it is less offensive. It has been applied as an \nointment in vaseline (i to \'8). \n\nSARSAPARILLA. \nSARSAPARILLA. \xe2\x80\x94 Sarsaparilla. Dose, 2 gm.; 30 gr. \n\nPreparations. \n\n1. Fluidextractum Sarsaparillae. \xe2\x80\x94 Fluiciextract of Sarsapa- \nrilla. Dose, 2 c.c; 30 m,. \n\n2. Fluidextractum Sarsaparillae Compositum. \xe2\x80\x94 Compound \nFluidextract of Sarsaparilla. Dose, 2 C.C.; 30 TTL- \n\n3. Syrupus Sarsaparillae Compositus. \xe2\x80\x94 Compound Syrup of \nSarsaparilla. Dose, 16 C.C.; 4 fl. dr. \n\nUnofficial Preparation. \n\nDecoctum Sarsaparilla Compositum (U. S. P., 1890). \xe2\x80\x94 \n\nCompound Decoction of Sarsaparilla. Dose, 30 to 1.20 C.C.; \n1 to 4 fl. oz. \n\nAction of Sarsaparilla. \nSarsaparilla is not known to have any physiological action. \n\nTherapeutics of Sarsaparilla. \nIt is apparently useful only as a vehicle. On account of its \ncontaining an acrid glucoside similar to saponin it should be \nadministered with some care, as intestinal ulceration has been \nattributed to its prolonged use. \n\nINDIAN SARSAPARILLA. \n\nUnofficial Preparations. \nHemidesmus. \xe2\x80\x94 Hemidesmus. (Indian Sarsaparilla.) \nSyrupus Hemidesmi. \xe2\x80\x94 Syrup of Hemidesmus. Dose, 2 to 4 \n\n\n\ngy6 PHARMACOLOGY AND THERAPEUTICS. \n\nAction of Indian Sarsaparilla. \nHemidesmus has been described as diaphoretic, diuretic and \nalterative, but, like sarsaparilla, it does not appear to have \nany distinct physiological action. \n\nTherapeutics of Indian Sarsaparilla. \nIt has been employed for the same purposes as sarsaparilla, \nand in India, where it is chiefly used, the native physicians are \nsaid to give it for the relief of renal troubles. The syrup con- \nstitutes a pleasant vehicle for other remedies, and this is prob- \nably the only service that this drug renders. \n\nSASSAFRAS. \nSASSAFRAS.\xe2\x80\x94 Sassafras. Dose, 8 gm.; 120 gr. \nSASSAFRAS MEDULLA.\xe2\x80\x94 Sassafras Pith. \n\nPreparation. \nMucilago Sassafras Medullae. \xe2\x80\x94 Mucilage of Sassafras Pith. \nDose, 16 c.c.; 4 fl. dr. \n\nOLEUM SASSAFRAS.\xe2\x80\x94 Oil of Sassafras. Dose, 0.2 c.c; 3 HI. \nSAFROLUM.\xe2\x80\x94 Safrol. Dose, 0.3 c.c; 5 IT^ \n\nAction of Sassafras. \n\nSassafras has the action of the volatile oils in general. The \npith is demulcent. \n\nSafrol, which also occurs in the oils of camphor, star-anise, \nand cinnamon leaves and in various barks, constitutes about \n8o per cent, of the oil of sassafras, and its action is therefore \npractically the same as that of the latter. \n\nTherapeutics of Sassafras. \nThe mucilage is somewhat stimulant in its action, and is \nan excellent vehicle. The infusion, made from the bark (not \nofficial), is considered highly efficacious in poison oak eruption, \nfor which it may be used both internally and locally. \n\n\n\nj \n\n\n\nDULCAMARA. 977 \n\nSTILLINGIA. \nSTILLINGIA.\xe2\x80\x94 Stillingia. (Queen\'s Root.) Dose, 2 C.C.; 30 gr. \n\nPreparation. \nFluidextractum Stillingiae. \xe2\x80\x94 Fluidextract of Stillingia. \nDose, 2 c.c; 30 TTL. \n\nAction of Stillingia. \nStillingia is in large doses emetic and cathartic, but in smaller \nones, alterative. \n\nTherapeutics of Stillingia. \nIt is a valuable remedy in syphilis and in the cutaneous and \nhepatic diseases which are benefited by so-called alterative \nmedicines. \n\nBURDOCK. \n\nLAPPA.\xe2\x80\x94 Lappa. (Burdock.) Dose, 2 gin.; 30 gr. \n\nPreparation. \nFluidextractum Lappae. \xe2\x80\x94 Fluidextract of Lappa. Dose, 2 \nc.c; 30 ttl. \n\nAction of Burdock. \nBurdock is considered to be a diuretic and a diaphoretic alter- \native. \n\nTherapeutics of Burdock. \nIt has been recommended in the treatment of various chronic \nskin diseases, especially in psoriasis and acne. \n\nDULCAMARA. \n\nDULCAMARA (U. S. P., 1890).\xe2\x80\x94 Dulcamara. (Bittersweet.) \n\nDose, 4 to 8 gm.; 1 to 2 dr. \n\nUnofficial Preparation. \nExtractum Dulcamarse Fluidum (U. S. P., 1890).\xe2\x80\x94 Fluid- \nextract of Dulcamara. Dose, 4 to 8 c.c; 1 to 2 fl. dr. \n\n63 \n\n\n\n97 8 PHARMACOLOGY AND THERAPEUTICS. \n\nAction of Dulcamara. \nDulcamara increases the secretions, particularly those of the \nkidneys and skin, with some diminution of sensibility. In large \ncloses it is an acro-narcotic poison. \n\nTherapeutics of Dulcamara. \nIt has been employed chiefly for cutaneous eruptions, par- \nticularly of a scaly character, but is seldom prescribed. \n\nCHIMAPHILA. \nCHIMAPHILA.\xe2\x80\x94 Chimaphila. (Pipsissewa.) Dose, 2 C.C.; 30 gr. \n\nPreparation. \nFluidextractum Chimaphilae. \xe2\x80\x94 Fluidextract of Chimaphila. \nDose, 2 c.c; 30 Til. \n\nAction of Chimaphila. \nThis plant is diuretic and diaphoretic. \n\nTherapeutics of Chimaphila. \nIt is used for rheumatism and nephritic affections. \n\nMARIGOLD. \n\nCALENDULA.\xe2\x80\x94 Calendula. (Marigold.) Dose, 1 gm.; 15 gm. \n\nPreparation. \nTinctura Calendulae. \xe2\x80\x94 Tincture of Calendula. \n\nAction of Marigold. \nMarigold was formerly supposed to be antispasmodic, sudo- \nrific and emmenagogue, but now it is believed to have no thera- \npeutic value. \n\nTherapeutics of Marigold. \nThe tincture has been employed topically to promote the heal- \ning process in wounds, burns, ulcers, etc. \n\n\n\nRHUS TOXICODENDRON. 979 \n\nSCUTELLARIA. \nSCUTELLARIA.\xe2\x80\x94 Scutellaria. (Skullcap.) Dose, 1 gm.; 15 gr. \n\nPreparation. \nFluidextractum Scutellariae. \xe2\x80\x94 Fluidextract of Scutellaria. \nDose, 1 c.c; 15 TT\\,. \n\nUnofficial Preparation. \nDecoctum Scutellariae. \xe2\x80\x94 Decoction of Scutellaria. Dose, 30 \nto 60 c.c; 1 to 2 fl. oz. \n\nAction of Scutellaria. \nScutellaria has little medicinal effect. \n\nTherapeutics of Scutellaria. \nIt is used as a nervous sedative; formerly it was given, in \ndecoction, for epilepsy. \n\nCANADIAN MOONSEED. \n\nUnofficial Preparations. \nMenispermum (U. S. P., 1890). \xe2\x80\x94 Menispermum. (Canadian \nMoonseed.) Dose, 0.30 to 2 gm.; 5 to 30 TTt. \n\nExtractum Menispermi Fluidum (U. S. P., 1890). \xe2\x80\x94 Fluid- \nextract of Menispermum. Dose, 0.30 to 2 C.C.; 5 to 30 TT\\.- \n\nAction of Canadian Moonseed. \nThe action of menispermum is similar to that of sarsaparilla. \nLike sarsaparilla, it is probably inert. \n\nTherapeutics of Canadian Moonseed. \nIt has some repute in domestic practice as a " blood purifier," \nbut is rarely prescribed in medicine. \n\nRHUS TOXICODENDRON. \n\nUnofficial Preparations. \nRhus Toxicodendron (U. S. P., 1890). \xe2\x80\x94 Rhus Toxicodendron. \n(Poison Ivy.) Dose, 0.05 to 0.30 gm.; 1 to 5 gr. \n\n\n\n98O PHARMACOLOGY AND THERAPEUTICS. \n\nTinctura Rhois Toxicodendri. \xe2\x80\x94 Tincture of Rhus Toxicoden- \ndron. Dose, .006 to .12 c.c; T \\ to 2 Ti\\.. \n\nAction of Rhus Toxicodendron. \nApplied to the skin it produces redness and swelling, with \na vesicular eruption and intense itching, which may spread \nrapidly over the surface of the body. The irritation may ex- \ntend to the mucous membranes, causing conjunctivitis, pharyn- \ngitis, etc. In addition, there may be fever, general rheumatoid \npains, colic, and diarrhcea with bloody stools. Sometimes there \nis also hematuria. Similar phenomena are said to result from \nits internal administration, but no cases of fatal poisoning have \nbeen observed from it. Some individuals are so susceptible to \nits influence that the exhalations from the plant will produce \non them its characteristic effects, while others are not at all \naffected by contact with it or even by chewing the leaves. The \neffects of the drug are partly due to its volatile active principle, \nbut also to a fixed oil which it contains, as the dried plant may \nalso cause poisoning. The eruption produced by it is followed \nby desquamation. \n\nTherapeutics of Rhus Toxicodendron. \nThe tincture of the fresh leaves has been used in paralysis, \nnocturnal incontinence of urine, and cutaneous diseases; but \nthe remedy is dangerous and, probably, a useless one for these \npurposes. Largely diluted it has been used as a lotion for \nbruises and burns. \n\nCOD LIVER OIL. \n\nOLEUM MORRHU^E.\xe2\x80\x94 Cod Liver Oil. (Oleum Jecoris Aselli.) \nDose, 16 c.c; 4 fl. dr. \n\nPreparations. \n\n1. Emulsum Olei Morrhuae. \xe2\x80\x94 Emulsion of Cod Liver Oil. \nDose, 8 c.c; 2 fl. dr. \n\n2. Emulsum Olei Morrhuae cum Hypophosphitibus.\xe2\x80\x94 Emul- \nsion of Cod Liver Oil with Hypophosphites. Dose, 8 C.C.; 2 fl. dr. \n\n\n\nCOD LIVER OIL. 98 I \n\nAction of Cod Liver Oil. \n\nExternal. \xe2\x80\x94 Cod liver oil is emollient to the skin, and when \nrubbed in is absorbed from it. \n\nInternal. G astro -intestinal Tract. \xe2\x80\x94 Cod liver oil, while often \nwell borne by the stomach, has, especially in large doses, a \ntendency to cause eructation, nausea and sometimes diarrhoea. \nIt is generally believed that it is more rapidly absorbed from \nthe intestine than other oils, though the evidence on this point \nis not altogether conclusive. Some authorities attribute this \nsupposed superior absorbability to the free acid in the oil, the \npresence of this facilitating saponification and emulsion. While \nthis explanation might hold good as regards the old dark- \ncolored oils, the pale oil now generally in use is found to \noften contain less free acid than ordinary olive oil. In the \ntest-tube, at all events, cod liver oil forms an emulsion more \nrapidly than other oils. \n\nTissues. \xe2\x80\x94 Cod liver oil reduces the color of a solution of \npotassium permanganate more promptly than other oils, show- \ning that it is more readily oxidized. As it is a fat which is readily \nabsorbed and readily assimilated, its continued ingestion leads \nto a marked increase in weight and strength. It is thus a food \nof the highest value, and it is especially esteemed for the reason \nthat many delicate persons who cannot digest ordinary animal \nfats are able to take this. In addition, there is some ground for \nsupposing that cod liver oil, aside from its admirable qualities \nas a food, possesses certain peculiar virtues in consequence of \nspecial elements in its composition. Thus, if it is true, as has \nbeen stated, that iodine may occur in the proportion of 1 to \n2,000 of the oil, the influence of this remedy is not to be ignored. \nErythema or acne is sometimes caused by cod liver oil. \n\nTherapeutics of Cod Liver Oil. \nExternal. \xe2\x80\x94 The external application of cod liver oil by rub- \nbing it into the skin is undoubtedly of considerable value in \ncases of defective nutrition or wasting disease, both in adults \nand children, but the very disagreeable odor of the oil is a \n\n\n\n982 PHARMACOLOGY AND THERAPEUTICS. \n\nserious objection to its use. In infants the common practice \nhas been to apply it simply under the binder, but in order to \nprevent the child from smelling so much of the oil the following \nmethod is recommended: The patient is stripped and the oil \napplied over the surface of the body, with the manipulations of \nmassage, before a warm fire; a blanket is wrapped around him \nand should be kept on for an hour or two; the excess of oil \nis then removed by a warm bath containing a little whiskey or \nbay rum. Inunction with cod liver oil has sometimes been \npractised in the case of adults suffering from chronic dysen- \ntery or scaly skin diseases, and, when other treatment proves \ninadequate, it may be resorted to in children affected with \nchronic skin diseases, marasmus, scrofula, tuberculosis and \nwasting diseases generally. It is regarded as especially ser- \nviceable in the coeliac affection of children characterized by \nsuspension of the function of the pancreas. \n\nInternal. \xe2\x80\x94 Cod liver oil is of more value than any other one \nremedy in nearly all varieties of tuberculosis. The following \nconditions are regarded as contra-indicating its use : Diarrhoea, \nwhether due to the disease or caused by the oil, severe haemo- \nptysis, vomiting, aggravated dyspepsia, and high temperature. \nWhen none of these is present, it is indicated in convales- \ncence from acute disease, especially in children, and in all \nchronic diseases attended with malnutrition and loss of flesh. \nIt was first introduced in medicine for the treatment of chronic \nrheumatic affections, and while not now so generally employed \nin these as formerly, it may not infrequently prove of service \nwhen they occur under bad hygienic influences in cachectic sub- \njects. It is beneficial in strumous synovitis and in caries and \nnecrosis of bone, and both its local and internal use has been \ncommended in rheumatic gout with deposits about the joints. \nIn diseases of the skin of strumous origin it has been designated \n" our sheet-anchor," and there is no question of its utility in \ntertiary syphilis, chronic bronchitis, emphysema, and various \nchronic affections of the brain and nervous system. It may con- \nstitute a very efficient element in the treatment of neuralgia, \n\n\n\nCOD LIVER OIL. 983 \n\nchorea, epilepsy, mercurial tremor, and paralysis agitans, and in \natheroma of the arteries it has been found useful in combating \ndegenerative changes and preventing failure in the nutrition of \nthe brain. Here its prolonged administration with phosphates \nor hypophosphites is commended. Cod liver oil is invaluable in \nthe treatment of rickets and the wasting diseases of children, \nespecially in cases of strumous diathesis, and in these condi- \ntions it may often be given with advantage in association with \nsyrup of ferrous iodide. Many infants and young children \ntake the undisguised oil with avidity. Older persons, however, \nare apt to object to its unpleasant odor and taste. When such \nobjection is made, the oil may be administered in soft capsules \nor in one of the numerous carefully compounded preparations \nto be found in the market. Some patients are able to take the \noil by rinsing out the mouth with whiskey or brandy before- \nhand, and 6thers by putting a little salt in the mouth after \nswallowing it. To render it less unpalatable .60 c.c. (10 Tl) \nof pure ether or .06 to .12 c.c. (1 to 2 ni) of oil of peppermint \nor cloves may be added to each dose. One part of essential \noil of eucalyptus to 100 parts of pale oil is said to entirely do \naway with the odor and taste. A very nutritious combination \nin which the taste of the oil is quite well disguised is made by \nrubbing together equal parts of cod liver oil and extract of \nmalt. In this, however, the oil is likely to repeat.\' Paresi\'s \nwell-known disguise is prepared as follows: To 400 parts of \ncod liver oil are added 10 parts of animal charcoal and 20 parts \nof ground roasted coffee. The mixture is digested in a water- \nbath at a temperature of 50 to 6o\xc2\xb0 C. (122 to 140 F.), and \nafter standing for three days is filtered and put into well- \nstoppered bottles. The oil is also sometimes given in ordinary \nblack coffee. The most popular way of taking it is in the form \nof emulsions, and a great variety of these have been suggested. \nThe following is advised by the British Pharmaceutical Con- \nference: Cod liver oil 240 c.c. (8 fl. oz.) ; the yolk of two \neggs; tragacanth in powder, 1 gm. (15 gr.) ; elixir of saccharin, \n4 c.c. (1 fl. dr.) ; tincture of benzoin, 4 c.c. (1 fl. dr.) ; spirit of \n\n\n\n984 PHARMACOLOGY AND THERAPEUTICS. \n\nchloroform, 15 c.c. (4 fl. dr.) ; oil of bitter almonds, .50 c.c. \n(8 ni); distilled water to 500 c.c. (16 fl. oz.). The elixir of \nsaccharin consists of saccharin, 1.50 gm. (24 gr.) ; sodium \nbicarbonate, .75 gm. (12 gr.) ; alcohol, 4 c.c. (1 fl. dr.); dis- \ntilled water, 28 c.c. (7 fl. dr.). When, as is often the case, \nit is desirable to give iron with cod liver oil the following may- \nbe used: Cod liver oil, 15 c.c. (4 fl. dr.) ; iron and ammonium \ncitrate, .30 gm. (5 gr.) ; potassium carbonate, .20 gm. (3 gr.) ; \nsaccharin, .015 gm. (% gr.) ; oil of caraway, .015 c.c. (*4 1T L) ; \nwater to 30 c.c. (1 fl. oz.). The hypophosphites are also some- \ntimes incorporated in emulsions of the oil. It will be seen that \nemulsions of the oil, with and without hypophosphites, are now \nofficial preparations. \n\nEXTRACT OF MEAT. \n\nUnofficial Preparation. \nExtraction Carnis. \xe2\x80\x94 Extract of Meat. \n\nAction of Extract of Meat. \nExtract of meat is a nutrient and a stimulant. \n\nTherapeutics of Extract of Meat. \nIt is useful in relieving prostration and fatigue. The solu- \ntion seasoned with capsicum is valuable in alcoholic excess and \ndelirium tremens. In infantile bowel disturbances, when milk \nmust be forbidden, it is often indicated. In phthisis it will fre- \nquently sustain the patient ; in the aged it will support life with- \nout taxing the digestive powers. The amount to be used should \nbe regulated by the age and condition of the patient. \n\nMILK. \n\nUnofficial Preparations. \nLac. \xe2\x80\x94 Milk. \n\nLac Humanum Artificiosum. \xe2\x80\x94 Artificial Human Milk. \nLac Peptonizatum. \xe2\x80\x94 Peptonized Milk. \nKumyss. \xe2\x80\x94 Kumyss. \n\n\n\nMILK. 985 \n\nAction of Artificial Human Milk. \nIt is designed to produce the effects of human milk, and is \ninvaluable as a food for infants whose mothers cannot suckle \nthem. \n\nTherapeutics of Artificial Human Milk. \n\nMany cases of diarrhoea, indigestion and other ailments \ncan be cured by substituting this milk for the usual milk and \nwater given to infants. Some manufacturers supply it on \nprescriptions designating the amount of milk sugar, fat, pro- \nteids and salts, which it should contain, but it is cheaper to \nmake it at home, and the method of preparing it is easily car- \nried out. When bought it is often sterilized, or pasteurized, \nand sold in air-tight bottles. It should be remembered that a \nlong-continued diet of sterilized milk may, in children, cause \nrickets. \n\nAction of Peptonized Milk. \n\nThe nutritive value of the peptones has been shown by the \ngain in weight observed in animals in whose diet they were \nmade to replace the ordinary proteids, and the same result is \nseen in kittens fed with peptonized milk. The alkaline reac- \ntion of peptonized food has the effect of stimulating secretion. \n\nTherapeutics of Peptonized Milk. \nIt is ordinarily given in any condition in which the stomach \nis incapable of digesting unchanged milk. It is also used where \nit is desirable, as may be the case in typhoid fever, to avoid the \nrapid precipitation of casein in the stomach. Small quantities \nof peptonized milk are sometimes of great service in cases of \nacute febrile diseases in which vomiting is a troublesome symp- \ntom, as also in repeated vomiting from whatever cause. Pep- \ntonized milk and other peptonized foods are especially useful in \ncases in which there is a marked deficiency of the secretion of \nthe stomach, as in gastric catarrh, atrophy of the gastric mu- \ncous membrane, and advanced cancer of the stomach. Among \nthe numerous other conditions in which they are of service \n\n\n\n986 PHARMACOLOGY AND THERAPEUTICS. \n\nmay be mentioned chronic Bright\'s disease, pulmonary tuber- \nculosis, and pernicious anaemia, when the digestive function is \ngreatly impaired. As a rule, the use of peptonized food should \nbe resorted to only as a temporary expedient. Milk is often \ngiven by the rectum, and when administered in this way it \nshould always be peptonized. A nutrient enema which is much \nused consists of the yolk of an egg with sufficient milk to make \n120 c.c. (4 fl. oz.). The mixture may be peptonized in the same \nway as plain milk, and 2 gm. (30 gr.) of common salt should \nbe added before the injection is made. \n\nAction of Kumyss. \nThis preparation has the nutritious properties of ordinary \nmilk, and, as it contains a small quantity of alcohol, is also a \nmild stimulant. A large amount of carbon dioxide gas is gen- \nerated in kumyss, and great care must therefore be exercised \nin opening the bottles containing it. \n\nTherapeutics of Kumyss. \nOn account of its slightly stimulating quality it is of much \nservice in convalescence, in phthisis, and in various other de- \npressed conditions. It is also used in gastric ulcer and cancer, \nand other diseases of the stomach, and for the same general \npurposes as milk. It is usually more agreeable to the patient \nthan the latter, and is often borne by the stomach when all other \nfood is vomited. The preparations found in the market are \nvery good substitutes for the kumyss drunk by the Tartars, who \nprepare it by fermenting mares\' milk. \n\nDivision XV. \xe2\x80\x94 Drugs which Have no Marked Therapeutic \nProperties. \nMany of the drugs here presented are official, although some \nhave been dismissed from the Pharmacopoeia, and a number of \nthem are in daily use in the pharmacies. Their interest to the \nphysician lies chiefly in their employment to make prescriptions \nmore palatable or sightly. \n\n\n\nBALM. 987 \n\nVANILLA. \n\nVANILLA.\xe2\x80\x94 Vanilla. Dose, 1 gm.; 15 gr. \n\nPreparation. \nTinctura Vanillae. \xe2\x80\x94 Tincture of Vanilla. \nVANILLINUM.\xe2\x80\x94 Vanillin. Dose, 0.030 gm. (30 milligm.) ; 1/2 gr. \n\nAction of Vanilla. \n\nVanillin has been asserted to be locally irritant and to have \nproduced in frogs spinal convulsions, followed by paralysis \naffecting both the spinal cord and the motor nerves. Vanilla \nis probably inert as regards any action on the human system. \nThere can be little question that the cases of poisoning which \nfrom time to time have been reported from the eating of ice- \ncream and other articles flavored with vanilla were due to \nptomaines. \n\nTherapeutics of Vanilla. \n\nVanilla has been suggested as a remedy in hysteria, but it \nis used for the most part simply as a flavoring agent. \n\nRASPBERRY. \n\nUnofficial Preparations. \n\nRubus Idseus (U. S. P., 1890). \xe2\x80\x94 Raspberry. \nSyrupus Rubi Idsei (U. S. P., 1890). \xe2\x80\x94 Syrup of Raspberry. \nDose, indefinite. \n\nAction of Raspberry. \nRaspberry has no medicinal properties. \n\nTherapeutics of Raspberry. \nRaspberry syrup is used chiefly as a flavoring agent. \n\nBALM. \n\nUnofficial Preparation. \n\nMelissa (U. S. P., 1890).\xe2\x80\x94 Melissa. (Balm.) Dose, 4 to 8 \ngm.; 1-to 2 dr. \n\n\n\n988 PHARMACOLOGY AND THERAPEUTICS. \n\nAction of Balm. \nBalm has no appreciable effects upon the system. \n\nTherapeutics of Balm. \nIt is used as a flavoring agent. \n\nCOCHINEAL. \n\nCOCCUS.\xe2\x80\x94 Cochineal. \n\nUnofficial Preparation. \nTinctura Cocci (B. P.). \xe2\x80\x94 Tincture of Cochineal. Dose, 0.30 \nto 1 c.c; 5 to 15 Tn,. \n\nAction of Cochineal. \nIt has been supposed by some to possess anodyne properties, \nbut it probably has no action. \n\nTherapeutics of Cochineal. \nCochineal is used only as a coloring agent. It was formerly \nemployed in the treatment of whooping-cough (in which it had \na considerable vogue), and of neuralgia. \n\nSAFFRON. \n\nUnofficial Preparations. \n\nCrocus (U. S. P., 1890).\xe2\x80\x94 Saffron. Dose, 0.30 to 2 gm.; \n5 to 30 gr. \n\nTinctura Croci (U. S. P., 1890). \xe2\x80\x94 Tincture of Saffron. Dose, \n4 to 8 c.c; 1 to 2 fl. dr. \n\nInfusum Croci. \xe2\x80\x94 Infusion of Saffron. Dose, freely. \n\nAction of Saffron. \nSaffron is somewhat aromatic, and is credited with mild anti- \nspasmodic and anodyne properties. \n\n\n\nSESAME. 989 \n\nTherapeutics of Saffron. \nSaffron is used to color pharmaceutical preparations. It has \nsometimes been given as an emmenagogue. A hot infusion, \nknown as saffron tea, is a popular remedy in domestic practice \nto promote the eruption in measles and other exanthemata. \nAny diaphoretic influence that it may have is no doubt due \nsimply to the hot water. \n\nRED SAUNDERS. \nSANTALUM RUBRTJM.\xe2\x80\x94 Red Saunders. \n\nAction of Red Saunders. \nRed Saunders is of no value medicinally. \n\nTherapeutics of Red Saunders. \nIt is used only as a coloring agent. \n\nMYRCIA. \n\nUnofficial Preparations. \n\nOleum Myrcise (U. S. P., 1890).\xe2\x80\x94 Oil of Myrcia. (Oil of \nBay.) \n\nSpiritUS Myrcise (U. S. P., 1890). \xe2\x80\x94 Spirit of Myrcia. (Bay \nRum.) \n\nAction of Myrcia. \n\nOil of myrcia has the general action of the volatile oils. \n\nTherapeutics of Myrcia. \nOil of myrcia is used solely as a perfume. Bay rum is used \nas a refrigerant lotion. \n\nSESAME. \n\nUnofficial Preparation. \n\nOleum Sesami (U. S. P., 1890). \xe2\x80\x94 Oil of Sesamum. (Sesame \nOil.) \n\n\n\n990 PHARMACOLOGY AND THERAPEUTICS. \n\nAction of Oil of Sesamum. \nIt is emollient and in large doses laxative. \n\nTherapeutics of Oil of Sesamum. \nBenne oil is used in preparing hair oil. \n\nWAX. \nCERA FLA VA.\xe2\x80\x94 Yellow Wax. \nCERA ALBA.\xe2\x80\x94 White Wax. \n\nAction of Wax. \nWax has no medicinal qualities. \n\nTherapeutics of Wax. \nYellow and white wax are used only as bases for various \nplasters, cerates and ointments. \n\nPARAFFIN. \n\nPARAFFINUM.\xe2\x80\x94 Paraffin. \n\nAction of Paraffin. \nNone. \n\nTherapeutics of Paraffin. \nIt makes a good basis for ointments used for protecting \nwounds or sores, but as it is absorbed with difficulty, it is not \nsuitable for ointments to be applied in cases in which the ab- \nsorption of drugs is desired. In recent years subcutaneous in- \njections of paraffin have been largely and successfully employed \nfor the correction of deformities, especially of the nose. \n\nSUET. \n\nSEVUM PR^PARATUM (Sevum, U. S. P., 1890).\xe2\x80\x94 Prepared \nSuet. \n\n\n\nBENZIN. 991 \n\nAction of Suet. \nSuet has the action of fats in general. \n\nTherapeutics of Suet. \nSuet is used chiefly in cerates. \n\nLYCOPODIUM. \nLYCOPODIUM.\xe2\x80\x94 Lycopodium. (Vegetable Sulphur.) \n\nAction of Lycopodium. \n\nThe plant was formerly regarded as diuretic and antispas- \nmodic, but it probably has no physiological action. Lycopodium \npowder has a pronounced property of absorbing oils and oleo- \nresins. \n\nTherapeutics of Lycopodium. \n\nIt makes an excellent absorbent and protective powder when \ndusted over an excoriated surface, as in the intertrigo of in- \nfants. For this purpose it is often mixed with an equal quantity \nof powdered starch. It is also used as a basis for insufflations. \nAs it is powerfully repellent to water, and thus protects hygro- \nscopic substances, it is a good basis for pills, and it is exten- \nsively employed for facilitating the rolling of the pilular mass \nand preventing the adhesion of pills to each other. \n\nBENZIN. \n\nBENZINUM.\xe2\x80\x94 Petroleum Benzin. \n\nPreparation. \nBenzinum Purification. \xe2\x80\x94 Purified Petroleum Benzin. \n\nAction of Benzin. \nLarge doses give rise to gastro-enteritis, and benzin-poison- \ning may be induced by its inhalation. \n\nTherapeutics of Benzin. \nBenzin is used to obtain volatile oils and for depriving pow- \ndered drugs of their fixed oil by percolation, as a substitute \n\n\n\n992 PHARMACOLOGY AND THERAPEUTICS. \n\nfor ether in making oleoresins, and for dissolving fats, resins, \ncaoutchouc and some of the alkaloids. It has occasionally been \nemployed externally in the treatment of neuralgia, rheumatic \npains, scabies and prurigo, and internally as a remedy for tape- \nworm. \n\nCARBON DISULPHIDE. \n\nCARBONEI DISULPHIDUM.\xe2\x80\x94 Carbon Disulphide. (Carbon Bisul- \nphide.) \n\nAction of Carbon Disulphide. \nPersons exposed to its fumes in the arts are liable to be- \ncome emaciated and to be affected with headache, vertigo, \nnervous excitement, incoordination of movement, and de- \npression of the special senses, with impairment of sensation and \nmotility. Even insanity is said to sometimes result. Directly \ninhaled, it excites violent coughing and produces general an- \naesthesia with marked muscular rigidity. It is a powerful car- \ndiac depressant, and even in small doses by the mouth it causes \nsevere nausea and vomiting, with a burning sensation in the \nepigastrium, and a weak and rapid action of the heart. \n\nTherapeutics of Carbon Disulphide. \nCarbon disulphide is used as a solvent. It is the best solvent \nfor rubber and similar bodies. It can be freed from its usual \ndisgusting odor by repeated rectification. In minute doses it \nis said to relieve gastralgia and the pain of cancer of the \nstomach, as well as nausea and vomiting. \n\nACETONE. \n\nACETONUM.\xe2\x80\x94 Acetone. \n\nAction of Acetone. \nIn small amount it is a normal constituent of the blood \nand urine, and in certain pathological conditions is found in \nlarger quantities. It is stated to possess anaesthetic, hypnotic \nand anthelmintic properties. \n\n\n\ntalc. 993 \n\nTherapeutics of Acetone. \nIt has been given in rheumatism and gout, but its principal \nuse is in pharmacy. It is employed in the preparation of chloro- \nform and sulphonal and as a solvent for resins, fats, camphors, \ngun-cotton, etc. \n\nMASTIC. \nMASTICHE.\xe2\x80\x94 Mastic. Dose, 2 gm.; 30 gr. \n\nPreparation. \nPilulae Aloes et Mastiches. \xe2\x80\x94 Pills of Aloes and Mastic. Dose, \n2 pills. \n\nAction of Mastic. \nMastic is a mild stimulant. \n\nTherapeutics of Mastic. \nIt is mostly used as a masticatory, for filling decayed teeth, \nand for cements and varnishes. \n\nRUBBER. \n\nELASTICA.\xe2\x80\x94 Rubber. (India-rubber. Caoutchouc.) \n\nAction of Rubber. \nIt is so insoluble that it cannot be absorbed in any form into \nthe blood. It therefore has no action on the system. \n\nTherapeutics of Rubber. \nRubber is used for making plasters, bougies, pessaries, and \nsyringes. \n\nTALC. \nTALCUM.\xe2\x80\x94 Talc. \n\nPreparation. \nTalcum Purificatum. \xe2\x80\x94 Purified Talc. \n\nAction of Talc. \n\nNone. \n64 \n\n\n\n994 PHARMACOLOGY AND THERAPEUTICS. \n\nTherapeutics of Talc. \n\nPurified talc makes an excellent filtering basis, and it is em- \nployed in the manufacture of a large number of official pharma- \nceutical preparations. \n\nDRIED CALCIUM SULPHATE. \n\nCALCII SULPHAS EXSICCATUS.\xe2\x80\x94 Dried Calcium Sulphate. \n(Dried Gypsum. Plaster of Paris.) \n\nAction of Dried Calcium Sulphate. \nDried calcium sulphate is inert. \n\nTherapeutics of Dried Calcium Sulphate. \nDried calcium sulphate is used for making casts of deformi- \nties and injuries, and for making immovable bandages and ap- \nparatus for injuries and diseases when immobilization is neces- \nsary. \n\nSODIUM SILICATE. \n\nUnofficial Preparation. \n\nLiquor Sodii Silicatis (U. S. P., 1890). \xe2\x80\x94 Solution of Sodium \nSilicate. \n\nAction of Sodium Silicate. \nNone. \n\nTherapeutics of Sodium Silicate. \n\nIt is employed on bandages for making immovable dressings ; \nit is stronger than starch and lighter than plaster of Paris. \n\nThe following drug properly belongs in the Class of General \nAnaesthetics, Division X. \n\nBROMOFORM. \n\nRROMOFORMUM.\xe2\x80\x94 Bromoform. (Tribromomethane.) Dose, 0.2 \nc.c; 3 IT].. \n\n\n\nBROMOFORM. 995 \n\nAction of Bromoform. \nBromoform, an analogue of chloroform, is anaesthetic and \nantispasmodic, and also has antiseptic properties. When in- \nhaled, the narcosis produced by it is shorter than that of ether \nor chloroform. \n\nTherapeutics of Bromoform. \nIt has been employed internally in influenza and spasmodic \ncough, and especially in whooping-cough. In the latter it is \na remedy of considerable value, but must be employed with \ngreat caution, as a number of cases of poisoning from its use \nhave been reported. As a rule, it is better in this affection \nto depend upon agents attended with less danger than bromo- \nform. On account of its high specific gravity it is likely to \nseparate from mixtures unless very carefully compounded. It \ncan be administered as follows: Bromoform, i; alcohol. 8; \nglycerin, 48; compound tincture of cardamom, 8. Each fluid \ndrachm contains the official dose. \n\n\n\nNDEX. \n\n\n\nIn all Latin titles of more than one syllable, the accented syllable is distin- \nguished by the sign \' placed after the corresponding vowel. \n\n\n\nABSI NTHIUM, 650 \nAbsorbent cotton, 443 \nAca\'cia, 463 \nAccelerating centre, drugs \n\nacting on, 253, 323 \nA. C. E. mixture, 896 \nAcetanilide, 556 \nAcetyl paramidophenol \n\nsalicylate, 731 \nAcetone, 992 \nAcetone-chloroform, 875 \nAcetphenetidin, 564 \nAcetyl paramidophenol \nsalicylate, 731 \n\nsalicylic acid, 721 \nAcid, acetic, 331 \n\nacetyl salicylic, 721 \n\narsenous, 234 \n\nbenzoic, 540 \n\nboracic, 83 \n\nboric, 83 \n\ncacodylic, 234, 245 \n\ncamphoric, 296 \n\ncarbolic, 57 \n\ncetraric, 473 \n\nchromic, 345 \n\ncinnamic, 540 \n\ncitric, 331 \n\nchrysophanic, 690, \n691 \n\ndi-iodosalicylic, 78, 83 \n\ngallic, 389 \n\nhippuric, 541 \n\nhydriodic, 965 \n\nhydrobromic, 801 \n\nhydrochloric, 330 \n\nhydrocyanic, 573 \n\nhypophosphorous, 915 \n\niodosalicylic, 74, 83 \n\nlactic, 331 \n\nmeconic, 845 \n\n\n\nAcid, muriatic, 330 \n\nnitric, 330 \n\nnitrohydrochloric, 330 \n\nnitromuriatic, 330 \n\noleic, 450 \n\northocreosotic, 729 \n\nphenic, 57 \n\nphosphoric, 330 \n\nprussic, 573 \n\nsalicylic, 721 \n\nsphacelic, 919 \n\nstearic, 438 \n\nsulphuric, 329 \n\nsulphurous, 106 \n\ntannic, 382 \n\ntartaric, 331 \n\ntrichloracetic, 331 \nAcids, 329 \nAconine, 310 \nAconite, 305 \n\npreparations of, 305 \nAconitine, 305 \nActions, pharmacological \n\nand therapeutical, 8 \nActol, 418 \nA\'deps, 440 \n\nbenzoina\'tus, 440 \n\nla\'nse, 438 \n\nhydro\'sus, 438 \nAdhesive plaster, 404 \nAdjuvant elixir, 461 \nAdministration of drugs, \n\n2, 6 \nAdonidin, 278 \nAdrenalin, 949, 953 \n^Esculap, 621 \nvE\'ther, 901 \n\nace\'ticus, 906 \n\nbroma\'tus, 907 \nJEthy\'lis bro\'midum, 907 \n\nca\'rbamas, 884 \n\n\n\niEthy\'lis chlo\'ridum, 770 \nAir inhaled, drugs alter- \ning composition of, 568 \nAix-la-Chapelle, 105 \nA\'lcohol, 824 \n\namylic, 839 \n\nethylic, 824 \n\ntertiary amylic, 877 \n\ntrichlor-tertiary butyl, \n875 \nAldehyde, cinnamic, 640 \n\nformic, 49 \nA\'llium, 652 \nAllspice, 638 \nAlmond, 465 \nAloes, 686 \nAloin, 687 \n\nAlpha-eucaine hydrochlo- \nride, 765 \nAlteratives, 960 \nAlthse\'a, 475 \nAlum, 432 \n\nammonia-ferric, 221 \nAlu\'mini hydroxidum, 433 \n\nsu\'lphas, 432 \nAluminum salts, 432 \nAlumnol, 435 \nAmmonia, solutions of, \n194 \n\nspirit of, 194 \nAmmoniac, 670 \nAmmonium, 194 \n\nacetate, 206 \n\nbenzoate, 540 \n\nbromide, 792 \n\ncarbonate, 201 \n\nchloride, 203 \n\nichthyol sulphonate, \n974 \n\niodide, 966 \n\nmuriate, 203 \n\n\n\n997 \n\n\n\nINDEX. \n\n\n\nAmmonium nitrate, 207 \n\nsalicylate, 721 \n\nvalerate, 665 \nAmy\'gdala ama\'ra, 465 \n\ndu\'lcis, 465 \nAmyl colloid, 322 \n\nnitrite, 364 \nAmylene hydrate, 877 \nA\'mylis ni\'tris, 364 \nAmyloform, 49 \nA\'mylum, 476 \nAnaesthesia, medullary, \n\n763 \nAnaesthetics, general, 740, \n888 \n\nlocal, 734 \n\ndangers of, 740 \nAnalgesics, 556, 739 \nAnaphrodisiacs, 909 \nAnarcotine, 866 \nAne\'thum, 649 \nAngustura bark, 633 \nAnhalonium, 840, 877 \nAnhydrotics, 495 \nAnhydrogluco-chloral, 876 \nAnise, 646 \nAnodyne, Hoffmann\'s, 901 \n\ncolloid, 316 \nAnodynes, local, 734 \nAnthelmintics, 17, 18, 112 \nA\'nthemis, 651 \nAnthracene purgatives, \n\n694 \nAnticholagogues, 626 \nAnticholera serum, 941 \nAntidiphtheritic serum, \n\n934 \nAntidote, arsenical, 221, \n230 \n\nhydrophobia, 944 \nAnti-emetics, 616 \nAntifebrin, 556 \nAntigalactagogues, 911 \nAntihydrotics, 495 \nAntikamnia, 561 \nAntilithics, 512 \nAntimony, preparations \n\nof, 502 \nAntinervine, 561 \nAntiparasitics, 18, 122 \nAntiperiodics, 18, 128 \nAntiplague serum, 940 \n\n\n\nAntipneumococcic serum, \n\n939 \nAntipyretics, 553, 556 \nAntipyrene, 562 \n\nmonochloral, 866 \nAntiseptic solution, 84 \nAntiseptics, 14, 19 \n\ngastric, 611 \n\ninternal, 16, 611, 622 \n\nintestinal, 622, 718 \nAntisialogogues, 607, 608 \nAntispasmodics, 571, 600 \nAntistreptococcic serum, \n\n938 \nAntitetanus serum, 936 \nAntitoxin, diphtheria, 934 \n\ntetanus, 936 \nAntitoxins and serums, \n\n933 \nAntityphoid serum, 942 \nnntivenomous serum, 939 \nAntizymotics, 17 \nApenta, 181, 621 \nAphrodisiacs, 908, 911 \nApiol, 931 \n\nApocodeine, 581, 584 \nApo\'cynum, 528 \nApomorphi\'nae hydrochlo\'- \n\nridum, 581 \nApomorphine, 581 \nA\'qua, 516 \n\ndestilla\'ta, 516 \n\nhydroge\'nii dio\'xidi, \n93 \nArbutin, 524 \nArgentamine, 418 \nArge\'nti cya\'nidum, 414 \n\nni\'tras, 414 \n\no\'xidum, 414 \nArgonin, 418 \nArgyrol, 419 \nAristol, 74, 81 \nArmora\'cia, 641 \nA\'rnica, 489 \nAromatic elixir, 654 \n\nfluidextract, 640 \n\npowder, 640 \nArrhenal, 247 \nArsenic, 234 \n\nantidote, 221, 230 \n\npreparations of, 234 \n\npoisoning, 247 \n\n\n\nArtificial human milk, 985 \n\noil of wintergreen, \n729 \nAsafetida, 668 \nAsafrol, 719 \nAscle\'pias, 596 \nAsh, prickly, 973 \nAsparagin, 475 \nAspi\'dium, 112 \nAspidospe\'rma, 602 \nAspirin, 721, 729 \nAstringents, 327 \n\nintestinal, 623 \nAtropine, 803 \n\nand morphine, 864 \nAubergier\'s syrup, 887 \nAura\'ntii a\'mari co\'rtex, \n654 \n\ndu\'lcis, co\'rtex, 654 \nAu\'ri et so\'dii chlo\'ridum, \n971 \n\nBAEL fruit, 636 \nBaker\'s ammonia, 201 \nBaking soda, 177 \nBalm, 987 \nBalsam of fir, 356 \n\nFriar\'s, 540 \nBa\'lsamum Peruvia\'num, \nno \n\nToluta\'num, 566 \nBarberry, 632 \nBarium salts, 381 \nBark, Angustura, 633 \n\ncassia, 640 \n\ncotton root, 925 \n\ncramp, 932 \n\nPanama, 593 \n\nPeruvian, 128 \n\nprickly ash, 973 \n\nsacred, 692 \n\nsassy, 294 \n\nsoap, 593 \nBarley, pearl, 459 \nBasham\'s mixture, 221, \n\n232 \nBasilicon ointment, 363 \nBassorin, 465 \nBaths, 516 \n\ncold, 516, 517, 519 \n\nhot, 516, 520 \n\nice-water, 519 \n\n\n\nINDEX. \n\n\n\n999 \n\n\n\nBaths, indifferent, 516, 520 \n\ntepid, 520 \n\nwarm, 516, 520 \nBattey\'s fluid, 963 \nBay rum, 989 \nBearberry, 524 \nBe\'lse fruc\'tus, 636 \nBellado\'nna, 802 \nBenzaconine, 310 \nBenzaldehyde, 465 \nBenzin, 991 \nBenzoin, 539 \nBenzosol, 599 \nBenzoyl-guaiacol, 599 \nBenzosulphinide, 552 \nBerberine, 629 \nBe\'rberis, 632 \nBergamot, 644 \nBeta-eucaine, 765 \nBetanaphthol, 718 \nBe\'tula, oil of, 729 \nBile, drugs acting on, 624 \nBismuth, 673 \nBitter apple, 705 \nBitters, 610, 627 \nBittersweet, 977 \nBladder, drugs acting on, \n\n515 \nBladderwrack, 964 \nBlackberry, 400 \n\ncohosh, 929 \n\ndraught, 694 \n\ndrop, 843 \n\nhaw, 932 \n\nmanganese oxide, 930 \n\nmustard, 478 \n\npepper, 656 \n\nsnake root, 929 \n\nwash, 21 \nBlaud\'s pills, 221 \nBleaching powder, 53 \nBliss\' cvire, 819 \nBlisters, 534 \nBlood, drugs acting on, \n\n148 \nBloodroot, 596 \nBlue cohosh, 928 \n\nflag, 512 \n\nLick Springs, 105 \n\nmass, 19 \n\nmethylene, 887 \n\nointment, 19 \n\n\n\nBlue pill, 19 \n\nstone, 428 \n\nvitriol, 428 \nBoneset, 508 \nBorax, 84 \nBoro-glycerin, glycerite \n\nof, 83 \nBougies, 4 \n\nBourboule water, 231, 245 \nBrain, drugs acting on, \n737, 802 \n\nextract, 958 \nBrandy, 824 \nBromal, 876 \nBromides, 792, 793 \n\ncomparative action of \nthe, 796 \nBromine, 793 \nBromism, 797 \nBromoform, 994 \nBro\'mum, 792 \nBronchial secretion, drugs \naffecting, 570, 581 \n\nvessels, drugs acting \non, 571 \n\nspasm, drugs relax- \ning, 57i \nBroom, 522 \nBrown mixture, 461 \nBrucine, 777, 780 \nBryo\'nia, 710 \nBucco, 523 \nBuchu, 523 \nBuckthorn, 696 \nBurdock, 997 \nBurgundy pitch, 362 \nBurnett\'s fluid, 426 \nBurton\'s line, 406 \nButternut, 692 \nButter of cacao, 444 \n\nof zinc, 422 \nButyl-chloral hydrate, 873 \nByne, 456 \n\nCACAO butter, 444 \nCacodylic acid, 234, \n245 \nCa\'ctus, 323 \nCade, oil of, 361 \nCaffeine, 282 \nCajuput, oil of, 482 \nCalabar bean, 783 \n\n\n\nCa\'lamus, 631 \nCalcium, 214 \n\nbeta-naphthol alpha- \nmonosulphonate,7i9 \n\nbromide, 792 \n\ncarbonate, precipitat- \ned, 214 \n\nchloride, 219 \n\nglycerophosphate, 917 \n\nhydroxide, 216 \n\nhypophosphite, 915 \n\nlacto-phosphate, syrup \nof, 218 \n\noxide, 215 \n\nphosphate, 218 \n\nsulphate, dried, 994 \n\nsulphide, crude, 103 \nCale\'ndula, 978 \nCalomel, 19 \nCalu\'mba, 627 \nCalx, 215 \n\nchlorina\'ta, 53 \n\nsulphura\'ta, 103 \nCambo\'gia, 704 \nCamphor, 296 \n\npreparations of, 296 \n\nsalol, 730 \nCanada turpentine, 356 \nCanadian hemp, 528 \n\nmoonseed, 979 \nCane\'lla, 635 \nCa\'nnabis i\'ndica, 840 \nCanquoin\'s paste, 425 \nCantha\'rides, 531 \nCaoutchouc, 993 \nCa\'psicum, 658 \nCaraway, 648 \nCarbamate, ethyl, 884 \nCa\'rbo, anima\'lis, 95 \n\nli\'gni, 95 \nCarbolic acid, 57 \nCarbon disulphide, 992 \nCardamom, 661 \nCardiac mechanism, drugs \n\nacting on, 249 \nCarlsbad water, 181 \nCarminative tincture, 662 \nCarminatives, 613 \nCarolina pink, 121 \nCarron oil, 216, 446 \nCa\'rum, 648 \nCaryo\'phyllus, 636 \n\n\n\nooo \n\n\n\nINDEX. \n\n\n\nCasca\'ra sagra\'da, 692 \nCascari\'lla, 632 \nCa\'ssia bark, 640 \n\nfi\'stula, 682 \n\npurging, 682 \nCasta\'nea, 604 \nCastile soap, white, 451 \nCastor oil, 682 \nCatapla\'sma kaoli\'ni, 437 \nCa\'techu, 393 \nCathartic pills, compound, \n19 \n\nvegetable, 705 \nCathartics, 620 \nCaulophy\'llum, 928 \nCaustic, lunar, 414 \n\nmitigated, 414 \n\npotash, 152 \n\nsoda, 174 \n\nVienna, 152 \nCaustics, 326 \nCelandine, 699 \nCe\'ra a\'lba, 990 \n\nfla\'va, 990 \nCerate, 440 \nCerates, 5 \n\nCerebral depressants, 739, \n843 \n\nexcitants, 738 \n\nstimulants, 738 \nCe\'reus grandiflo\'rus, 323 \nCe\'rium oxalate, 679 \nCeta\'ceum, 440 \nCetra\'ria, 473 \nChalk, preparations of, 214 \nChamomile, 651 \n\nGerman, 652 \nChampagne, 836 \nCharcoal, 95 \nChaulmoogra oil, 441 \nChelido\'nium, 699 \nChemical constitution and \n\nphysiological action, 9 \nChenopo\'dium, 122 \nCherry laurel, 580 \n\nwild, 579 \nChestnut, 604 \nCheyne-Stokes breathing, \ndrugs which produce, \n\n573 \nChima\'phila, 978 \nChira\'ta, 633 \n\n\n\nChire\'tta, 633 \nChloral, 866 \nChloralamide, 874 \nChloralformamide, 874 \nChlora\'lum hydra\'tum, \n\n866 \nChloralose, 876 \nChloretone, 875 \nChlorinated lime, 53 \n\nsoda, solution of, 53 \nChlorine, 53 \n\ncompound solution \nof, 53 \n\nwater, 53 \nChlorobrom, 975 \nChlorodyne, 888 \nChloroform, 888 \n\nCommission, British \nMedical Associa- \ntion, 900 \n\nHyderabad, 891 \nChlorofo\'rmum bellado\'n- \n\nnae, 810 \nChlorophenol, 57, 67 \nChlo\'rum, 53 \nCholagogues, 625 \nCholera serum and inocu- \nlation, 941 \nCho\'ndrus, 474 \nChromium trioxide, 345 \nChrysophan, 695 \nChrysophanic acid, 691 \nChrysarobin, 122, 690, 695 \nChurchill\'s tincture, 963 \nCigarettes, 4 \nCiliary muscle, drugs \n\nacting on, 743 \nCimici\'fuga, 929 \nCincho\'na, 128 \n\nrelative action of al- \nkaloids of, 139 \n\npreparations of, 128 \n\nru\'bra, 128 \nCinchonism, 138 \nCineol, 483 \nCinnabar, 21 \nCinnaldehy\'dum, 640 \nCinnamic aldehyde, 640 \nCinnamon, 640 \nCitrine ointment, 20 \nCitric acid, 331 \nCitrullin, 707, 708 \n\n\n\nClarendon, 215 \n\nClaret, 824 \n\nClark\'s powder, 144 \n\nClassification of drugs, 14 \n\nClemens\' bromide solu- \ntion, 224 \n\nCloves, 636 \n\nClutterbuck\'s elaterium, \n709 \n\nClysters, 4 \n\nCo\'ca, 759 \n\nCocaine, 759 \n\nCocainization, spinal, 763 \n\nCocamania, 764 \n\nCo\'ccus, 988 \n\nCochineal, 988 \n\nCocilla\'fia, 584 \n\nCodeine, 865 \n\nCod liver oil, 950 \n\nCoffee, 283, 291 \n\nCohosh, blue, 928 \nblack, 929 \n\nCo\'la, 293 \n\nColchicine, 716 \n\nCo\'lchicum, 713 \n\nColchisal, 713, 716 \n\nCollodion, 443 \n\nColloid, amyl, 305 \nmercury, 21 \n\nColloidal silver, 419, 422 \n\nColocynth, 705 \n\nColocynthin, 706, 708 \n\nColophony, 363 \n\nColumbian spring, Sara- \ntoga, 231 \n\nColumbo, 627 \n\nCondal, 181 \n\nCondy\'s fluid, 92 \n\nConiine, 746 \n\nConi\'um, 74s \n\nContrexe\'ville, 215 \n\nConvalla\'ria, 281 \n\nCopa\'iba, 545 \n\nCopaiva, 545 \n\nCopper sulphate, 428 \n\nCoriander, 647 \n\nCorn-silk, 529 \n\nCornutine, 919 \n\nCorrosive sublimate, T9 \n\nCorson\'s paint, 711 \n\nCoster\'s paste, 963 \n\nCoto, 402 \n\n\n\nINDEX. \n\n\n\nIOOI \n\n\n\nCotton, 443 \n\nroot bark, 925 \nCouch grass, 538 \nCounter-irritants, 326 \nCourt plaster, 439 \nCramp bark, 932 \nCream of tartar, 165 \nCrede\'s ointment, 419 \nCreolin, 72 \nCreosotal, 597, 598 \nCreosote, 597 \nCre\'sol, 57, 67 \nCre\'ta praepara\'ta, 214 \nCro\'cus, 988 \nCrotin, 711 \n\nCroton chloral hydrate, \n873 \n\noil, 710 \nCubeb, 548 \nCu\'ca, 759 \n\nCucumber, bitter, 705 \nCulver\'s root, 701 \nCumulative action, 7 \nCu\'pri su\'lphas, 428 \nCurare, 744 \nCurd soap, 451, 455 \nCuspa\'ria, 533 \nCusso, 1 1 5 \nCypripe\'dium, 667 \n\n\n\nDAMIA\'NA, 918 \nDandelion, 635 \nDeco\'ctum ad icte\'ricos, \n\n699 \nDefinitions, 2 \nDeliriants, 738 \nDelphinine, 125, 126 \nDemulcents, 328 \nDeodorants, 17 \nDepressants, cerebral, 739, \n\n843 \nDermatol, 673 \nDextroform, 49 \nDiabetin, 461 \nDiachylon ointment, 404 \n\nplaster, 404 \nDialyzed iron, 223 \nDiaphoretics, 494, 496 \nDiastase, 456 \nDiethylsulphonedimethyl- \n\nmethane, 878 \n\n\n\nDiethylsulphonmethyl- \nethyl-methane, 880 \n\nDigestants, animal, 662 \n\nDigestive apparatus, drugs \nacting on, 606 \n\nDigitalin, 254 \n\nDigita\'lis, 253 \n\nDigitoxin, 254 \n\nDi-iodosalicylic acid, 74, \n83 \n\nDi-isobutylorthocresol \niodide, 74 \n\nDill, 649 \n\nDimethylethylcarbinol, \n877 \n\nDinner pill, 686 \n\nDionine, 844, 860 \n\nDiphtheria antitoxin, 934 \n\nDirect action, 8 \n\nDisinfectants, 14 \n\nDispermine, 530 \n\nDissolution, law of, 737 \n\nDiuretics, 509, 516 \n\nDiuretin, 528 \n\nDock, yellow, 401. \n\nDog button, 772 \n\nDonovan\'s solution, 234 \n\nDoses, 5 \n\nfor children, 5 \n\nDover\'s powder, 843 \n\nDroitwich water, 188 \n\nDrop chalk, 214 \n\nDrugs, modes of adminis- \ntration of, 2 \n\nDuboisine, 818 \n\nDulcama\'ra, 977 \n\nDulcin, 552 \n\nDurand\'s remedy, 354 \n\nDusart\'s syrup, 233 \n\n\n\nEAR, drugs acting on, \n744 \nEaston\'s pill, 232 \n\nsyrup, 232 \nEau de goudron, 360 \nEcbolics, 909, 919 \nEffervescing powder, com- \npound, 143 \nEgg, 441 \nEla\'stica, 993 \nElaterin, 708 \n\n\n\nElaterium, 708 \nElder, 649 \nElecampane, 600 \nElectrozone, 54, 56 \nElemi, 493 \nEli\'xir, adjuvant, 461 \n\naromatic, 654 \n\nfe\'rri, quini\'nae et \nstrychni\'nse phos- \npha\'tum, 222 \n\npho\'sphori, 912 \nElm, slippery, 462 \nEmetics, 614 \nEmetine, 586 \nEmmenagogues, 910, 930 \nEmollients, 328 \nEmpirical therapeutics, 1 \nEne\'mata, 4, 621 \nEnteroclysis, 3 \nEpinephrin, 952 \nEpson salt, 209 \nErgot, 919 \n\noil of, 924 \nErgotin, 919 \nErgotism, 921 \nErigeron, oil of, 357 \nEriodi\'ctyon, 603 \nErythrophlceine, 2q.\\ \nErythro\'phloeum, 294 \nErythrol tetranitrate, 379 \nErythro\'xylon, 759 \nEscharotics, 326 \nEserine, 783 \nEssence of nutmeg, 639 \n\nof peppermint, 644 \n\nof spearmint, 646 \nEther, 901 \n\nacetic, 906 \n\nchloric, 883 \n\nhydrobromic, 907 \n\nnitrous, spirit of, 378 \n\nsulphuric, 901 \nEthyl acetate, 906 \n\nalcohol, 824 \n\nbromide, 907 \n\ncarbamate, 884 \n\nchloride, 770 \n\noxide, 901 \n\nurethane, 884 \nEthylirtes chloral-ure- \n\nthane, 866 \nEucaine, 765 \n\n\n\n1002 \n\n\n\nINDEX. \n\n\n\nEucalyptol, 483 \nEucal\'yptus, 483 \n\ngum, 401 \nEudermol, 749, 752 \nEudoxin, 678 \nEugenol, 636, 638 \nEunatrol, 447 \nEuonymin, 698 \nEuo\'nymus, 697 \nEupato\'rium, 508 \nEurophen, 74, 82 \nExalgin, 565 \nExcretion, rate of, 7 \nExpectorants, 572, 581 \nExtracts, organic, 945 \nEye, drugs acting on, 742 \n\nFABIA\'NA, 528 \nFamily pill, 503 \nEel bo\'vis, 696 \nFennel, 648 \nFerratin, 223, 233 \nFerric hypophosphite, 915 \nFe\'rrum, 220 \nFi\'cus, 581 \nFig, 681 \nFir wood oil, 356 \n\nbalsam of, 356 \nFlag, sweet, 631 \nFlaxseed, 445 \nFleabane, oil of, 357 \nFlitwick water, 231 \nFlowers of sulphur, 98 \nFceni\'culum, 648 \nFormaldehyde, 15, 49 \nFormalin, 49 \nFormol, 49 \nFowler\'s solution, 234 \nFoxglove, 253 \nFra\'ngula, 696 \nFrankincense, 364 \nFranz Joseph, 181 \nFriedrichshall, 181, 621 \nFriar\'s balsam, 540 \nFusel oil, 839 \n\nGALACTAGOGUES, \n9.. \nGalba\'num, 671 \nGa\'lla, 382 \n\nGallacetophenone, 389 \nGambir, 393 \n\n\n\nGamboge, 704 \nGargari\'smata, 4 \nGargles, 4 \nGarlic, 652 \n\nGastric antiseptics, 611 \njuice, action of drugs \n\non, 609 \nsedatives, 613, 673 \nGastro-intestinal irritants, \n\n612 \nGaulthe\'ria, 729 \nGelatin, 475 \xc2\xbb \n\nGelsemine, 790 \nGelse\'mium, 788 \nGeneration, drugs acting \n\non organs of, 908 \nGentian, 630 \nGera\'nium, 399 \nGin, 527 \nGinger, 660 \n\nGla\'ndulae suprarena\'les \nsi\'ccae, 380, 949 \nthyroide\'ae si\'ccae, 946 \nGlauber\'s salt, 179 \nGlonoin, spirit of, 374 \nGluside, 552 \nGlutoform, 49 \nGlutol, 49, 53 \nGlycerin, 467 \nGlycerites, 467 \nGlycerol, 608 \nGlycerophosphates, 917 \nGlyceryl trinitrate, 374 \nGlycoformalin, 49 \nGlycogelatin, 476 \nGlycogenic function, 626 \nGlyconin, 441 \nGlycosuria, 626 \nGlycyrrhi\'za, 461 \nGlycyrrhizin, ammoniated, \n\n461 \nGold and sodium chloride, \n\n971 \nGold seal, 925 \nGossy\'pii co\'rtex, 925 \nGoulard\'s cerate, 404 \n\nextract, 404 \nGourd, bitter, 705 \nGrana\'tum, 115 \nGray powder, 19 \nGreen mercurous iodide, \n\n20 \n\n\n\nGreen, Paris, 247 \n\nScheele\'s, 247 \n\nSchweinfurth\'s, 247 \n\nsoap, 451 \n\nsolution, 726 \nGrinde\'lia, 600 \nGuaiac, 972 \nGuaiacol, 599 \nGuara\'na, 292 \nGum arabic, 463 \n\nBenjamin, 539 \n\ncamphor, 296 \n\nguaiac, 972 \n\nred, 401 \nGun cotton, 443 \nGuy\'s pill, 280 \n(jypsum, dried, 994 \n\nH.EMATINICS, 150 \nindirect, 150 \nHacmato\'xylon, 396 \nHaemostatics, 328 \nHamame\'lis, 397 \nHabit, 5 \n\nHarrogate water, 105 \nHartshorn, 201 \nHaschisch, 840 \nHeart, drugs acting on, \n\n250, 253 \nHeat as an antiseptic, 15 \n\nbodily, drugs acting \non, 553 \nincreasing, 555 \nHedeo\'ma, 650 \nHelenin, 600 \nHemide\'smus, 975 \nHemlock, spotted, 745 \nHemp, Indian, 840 \n\nCanadian, 528 \nHenbane, 819 \nHepatic stimulants, 625 \nHeroine, 845, 860 \nHexamethylenamine, 538 \nHimrod\'s cure, 819 \nHive syrup, 279, 502 \nHoffman\'s anodyne, 901 \nHolocaine, 767 \nHomatropine hydrobrom- \n\nide, 817 \nHoney, 680 \nHops, 885 \nHorehound, 508 \n\n\n\nINDEX. \n\n\n\nIOOl \n\n\n\nHorseradish, 641 \n\nHu\'mulus, 885 \n\nHunyadi Janos, 181, 621 \n\nHyderabad commission, \n891 \n\nHydragogues, 620 \n\nHydra\'rgyri cklo\'ridum \ncorrosi\'vum, 19 \nchlo\'ridum mi\'te, 19 \ncya\'nidum, 20 \nempla\'strum, 19 \nio\'didum fla\'vum, 20 \nio\'didum ru\'brum, 20 \no\'xidum fla\'vum, 20 \no\'xidum ru\'brum, 20 \nsubsu\'lphas fla\'vus, 21 \n\nHydrargyrol, 21 \n\nHydra\'rgyrum, 19 \n\nammonia\'tum, 19 \ncum cre\'ta, 19 \n\nHydrastine, 925 \n\nHydra\'stis, 925 \n\nHydrated chloral, 866 \n\nHydriodic acid, 965 \n\nHydrobromic acid, 801 \nether, 907 \n\nHydrochloric acid, 330 \nether, 770 \n\nHydrocyanic acid, 573 \n\nHydrogen dioxide, solu- \ntion of, 93 \n\nHydronaphthol, 718, 719 \n\nHydrophobia antidote, 944 \n\nHydroxide, ferric, 221 \npotassium, 152 \nsodium, 174 \n\nHyoscine, 820 \n\nHyoscyamine, 820 \n\nHyoscy\'amus, 819 \n\nHypnal, 866, 871 \n\nHypnone, 866, 872 \n\nHypnotics, 739 \n\nHypodermic injections, 2 \n\nHypodermoclysis, 3 \n\nHypophosphites, 916 \n\nHypophosphorus acid, 915 \n\nTCE BAGS, 519 \nA Ice-water baths, 519 \nIchthyoco\'lla, 439 \nIchthyol, 974 \nIdiosyncrasy, 5 \n\n\n\nUli\'cium, 646 \nImperial drink, 166 \nIndex, 997 \nIndia rubber, 993 \nIndian hemp, 840 \n\ntobacco, 754 \n\nsarsaparilla, 975 \nIndirect action, 8 \nInfusions, intravenous, 2 \nInhalations, 4 \nInjections, 2, 4 \nInsufflations, 4 \nIntestinal antiseptics, 622 \n718 \n\nastringents, 623 \nIntestines, drugs acting \n\non, 617, 680 \nIntra-ocular tension, 744 \n\nvenous injection, 2 \nI\'nula, 600 \nInunction, 4 \nIodantipyrine, 562 \nIodides, 966 \nIodine, 74, 960 \nIodism, 967 \nIodoform, 74 \nIodol, 74, 81 \nIodopyrine, 562 \nIodosalicylic acid, 74, 83 \nIodo-tannin, 382 \nIodothyrin, 946, 949 \nIons, theory of, 10 \nIpecac, 585 \nIpecacua\'nha, 585 \nIridin, 699 \nIris, 698 \nIron, 220 \n\npreparations of, 220, \n232 \n\nQuevenne\'s, 220 \n\nwood, 602 \nIrritants, 325 \n\ngastro-intestinal, 612 \nIsinglass, 439 \nItrol, 418 \nIvy, poison, 979 \nIzal, 72 \n\nTABORANDI, 496 \nJ Jaborine, 500 \nJalap, 703 \nJalapin, 702, 703 \n\n\n\nJames\' powder, 503 \nJamestown weed, 818 \nJarisch\'s ointment, 392 \nJasmine, yellow, 788 \nJervine, 316 \nJeyes\' disinfectant, 74 \nJu\'glans, 692 \nJuniper, 526 \n\nKAMA\'LA, 114 \nKaolin, 437 \nKemp-Gardner method, \n\n899 \nKermes mineral, 503 \nKi\'no, 395 \nKissingen, 181 \nKombe poison, 273 \nKousso, 1 1 5 \nKrame\'ria, 394 \nKumyss, 986 \n\nLABARRAQUE\'S solu- \ntion, 53 \nLa Bourboule, 231, 245 \nLac, 984 \n\nsu\'lphuris, 98 \nLactic acid, 331 \nLactophenine, 565 \nLactose, 477 \nLactuca\'rium, 886 \nLactylparaphenetidine, 56 5 \nLady Webster\'s pill, 686 \nLadies\' slipper, 667 \nLanolin, 438 \nLa\'pis divi\'nus, 429 \nLa\'ppa, 977 \nLard, 440 \nLargin, 419 \nLaudanum, 843 \nLauroce\'rasus, 580 \nLavender, 643 \nLaxative tincture, 693 \n\npills, compound, 686 \nLaxatives, 618, 680 \nLead poisoning, 411 \n\nsalts, 403 \nLemon, 655 \nLenigallol, 389, 392 \nLepta\'ndra, 701 \nLettuce, 886 \nLevant wormseed, 118 \nLevico water, 231, 245 \n\n\n\nioo4 \n\n\n\nINDEX. \n\n\n\nLevulose, 461 \nLi\'gnum vi\'tae, 972 \nLily of the valley, 281 \nLime, 216 \n\nchlorinated, 53 \n\npreparations of, 216 \n\nsulphurated, 103 \nLimo\'nis co\'rtex, 655 \n\nsu\'ccus, 655 \nLinseed, 445 \nLi\'num, 445 \nLi\'quor antise\'pticus, 84 \n\nchlo\'ri compo\'situs, 53 \n\npi\'cis carbo\'nis, 359 \n\nso\'dae chlorina\'tae, 53 \nLiquorice, 461 \nLister\'s ointment, 88 \nLitharge, 403 \nLithium, 207 \n\nbenzoate, 657 \n\nbromide, 792 \n\ncarbonate, 207 \n\ncitrate, 207 \n\nglycerophosphate, 917 \n\nsalicylate, 721 \n\nvanadate, 207 \nLithontriptics, 513 \nLiver, drugs acting on, \n\n624, 626 \nLlangammarch wells, 382 \nLob\'elia, 754 \nLobeline, 755 \nLocal action, 8 \n\nanodynes, 734 \n\nanaesthetics, 734 \nLogwood, 396 \nLondon paste, 216 \nLosophan, 74, 83 \nLo\'tio fla\'va, 21 \n\nni\'gra, 21 \n\nru\'bra, 426 \nspi\'ritus, 835 \nLugol\'s solution, 960 \nLunar caustic, 414 \nLupulin, 885 \nLycetol, 530 \nLycopo\'dium, 991 \nLysidine, 530 \nLysol, 71 \n\n\n\nM \n\n\n\nAAS\' PROCESS, 899 \nMace, 639 \n\n\n\nMagnesia, 210 \nMagnesium, 209 \n\nglycerophosphate, 917 \nsalts, 210 \nMale fern, 112 \nMalt, 456 \nMaltose, 457 \nMammary extract, 956 \nMandrake, 699 \nManganese dioxide, 930 \n\nhypophosphite, 915 \n\nsulphate, 930 \nMa\'nna, 681 \nMarienbad, 181 \nMarigold, 978 \nMarrow, red bone, 959 \nMarru\'bium, 508 \nMarsden\'s paste, 240 \nMarsh\'s test, 249 \nluarshmallow, 475 \nMass, blue, 19 \n\nof copaiba, 545 \n\nof ferrous carbonate, \n221 \n\nVallet\'s, 221 \nMastic, 993 \nMa\'tico, 551 \nMatrica\'ria, 652 \nMay apple, 699 \nMcDade\'s formula, 974 \nMeat extract, 984 \nMedullary anaesthe\'sia, 763 \nMel, 680 \nMeli\'ssa, 987 \nMenispe\'rmum, 979 \nMental influences, 6 \nMe\'ntha piperi\'ta, 644 \n\nvi\'ridis, 646 \nMenthol, 756 \nMercuric ammonium chlo- \nride, 20 \n\nchloride, corrosive, \n15, 1 \n\ncyanide, 20 \n\niodide, red, 20 \n\nnitrate, 20 \n\noxide, red, 20 \nyellow, 20 \n\nsubsulphate, yellow, \n21 \n\nsulphide, 21 \nMercurol, 21 \n\n\n\nMercuro-zinc cyanide, 41 \nMercurous chloride, mild, \n19 \niodide, yellow, 20 \ntannate, 21 \nMercury, 1 9 \n\nammoniated, 19 \nantiparasitic action \n\nof, 32 \ncolloid, 21 \nmass of, 19 \nmodes of administra- \n\' tion of, 42 \noleate of, 20 \npreparations of, 19 \nin syphilis, 39 \nvegetable, 700 \nwith chalk, 19 \nMetabolism, drugs acting \n\non, 960 \nMethyl acetanilide, 565 \nchloride, 770 \nmorphine, 865 \nsalicylate, 729 \nMethylene blue, 887 \nMethylthionine hydrochlo- \nride, 887 \nMezere\'um, 492 \nMiaouli, oil of, 482 \nMichel\'s paste, 332 \nMilk, 984 \n\nartificial human, 985 \ndrugs acting on, 911 \ndrugs excreted by, \n\n911 \npeptonized, 985 \nsugar of, 477 \nMindererus, spirit of, 206 \nModes of administration \n\nof drugs, 2 \nMonochlor-ethane, 770 \n\nmethane, 770 \nMonsel\'s solution, 220, \n\n228 \nMoonseed, Canadian, 979 \nMorphine, 844 \n\nbenzylic ester hydro- \nchlorate, 845 \ndiacetic ester, 845 \nmethyl, 865 \nmonoethyl ester hy- \ndrochlorate, 845 \n\n\n\nINDEX. \n\n\n\nIOO5 \n\n\n\nMorton\'s fluid, 964 \n\nMo\'schus, 304 \n\nMoss, Iceland, 473 \nIrish, 474 \n\nMotor nerves, drugs act- \ning on, 732 \n\nMountain balm, 603 \n\nMuriatic acid, 330 \n\nMuscarine, 791 \n\nMuscles, drugs acting on, \n732 \n\nMuscular and nervous \nsystems, drugs acting \non, 732 \n\nMusk, 304 \n\nMusk root, 642 \n\nMustard, 478 \n\nMutton suet, 990 \n\nMydriatics, 743 \n\nMyotics, 743 \n\nMy\'rcia, 989 \n\nMyri\'stica, 639 \n\nMyrrh, 671 \n\nN\\NTWICH water, 188 \nNaphthalene, 720 \nNaphthol, camphorated, \n\n719 \nNaphtol, 718 \nNarcotics, 739 \nNarcotine, 866 \nNasal douches, 4 \nNe\'bulae, 4 \nNeroli, oil of, 654 \nNerves, drugs acting on, \n\n732, 733 \nNervous system, drugs \n\nacting on, 732 \nNeuritis, drugs causing, \n\n735 \nNicotine, 749 \n\nsalicylate, 752 \nNight blooming cereus, \n\n323 \nNightshade, deadly, 802 \nNitre, sweet spirit of, 378 \nNitric acid, 330 \nNitrites, 364 \nNitroglycerin, 374 \nNitrohydrochloric acid, \n\n330 \nNitromuriatic acid, 330 \n\n\n\nNitrous ether, spirit of, \n\n378 \nNorwood\'s tincture, 320 \nNutgall, 382 \nNutmeg, 639 \nNutrient serum, 943 \nNux vo\'mica, 772 \n\nOAK, poison, 660 \nwhite, 382 \nOil of allspice, 638 \n\nalmond expressed,466 \nAmerican wormseed, \n\n122 \nanise, 646 \nbay, 989 \nbergamot, 644 \nbetula, 729 \nbitter almond, 465 \ncade, 361 \ncajuput, 482 \ncaraway, 648 \nCarron, 216, 446 \ncassia, 640 \ncastor, 682 \nchamomile, 651 \nchaulmoogra, 441 \ncinnamon, 640 \ncloves, 636 \ncod liver, 980 \ncopaiba, 545 \ncoriander, 647 \ncotton seed, 443 \ncroton, 710 \ncubeb, 548 \ndill, 649 \nerigeron, 357 \nergot, 924 \nethereal, 901 \neucalyptus, 483 \nfennel, 648 \nfirwood, 356 \nflaxseed, 445 \nfleabane, 357 \nfusel, 839 \ngaultheria, 729 \nhedeoma, 650 \njuniper, 526 \nlard, 440 \nlavender, 643 \n\nflowers, 644 \nlemon, 655 \n\n\n\nOil, linseed, 445 \n\nmiaouli, 482 \n\nmustard, volatile, 478 \n\nmyrcia, 989 \n\nneroli, 654 \n\nnutmeg, 639 \n\nolive, 447 \n\norange flowers, 654 \npeel, 654 \n\npennyroyal, 650 \n\npeppermint, 644 \n\nphosphorated, 912 \n\npimenta, 638 \n\npine, 356 \n\nrose, 653 \n\nrosemary, 489 \n\nrue, 929 \n\nsantal, 550 \n\nsassafras, 976 \n\nsavin, 928 \n\nsesame, 989 \n\nspearmint, 646 \n\nstar-anise, 647 \n\nsweet, 605 \n\nsweet birch, 729 \n\ntar, 358 \n\ntheobroma, 444 \n\nthyme, 551 \n\nturpentine, 348 \n\nvalerian, 666 \n\nvitriol, 329 \n\nwintergreen, 729 \nOleic acid, 450 \nOlive oil, 447 \nOpium and its prepara- \ntions, 843 \n\nand morphine, differ- \nences in action, 851 \n\npoisoning, diagnosis \nof, 861 \nOpodeldoc, 451 \nOrange, 654 \nOrganic extracts, 945 \nOrganisms infecting the \nbody, diugs acting on \n14 \nOrthoform, 768 \nOsmosis, 13 \nOuabain, 771 \nOvarian extract, 956 \nOxgall, 696 \nOxygen, 604 \n\n\n\nioo6 \n\n\n\nINDEX. \n\n\n\nOxymel, 680 \nOxytocics, 909 \n\nPACK, cold, 518 \nhot, 526 \nPainter\'s palsy, 407 \nPancreatin, 664 \nPapaverine, 866 \nParacotoin, 402 \nParaffin, 990 \nParaform, 49, 53 \nParaldehyde, 882 \nParamorphine, 866 \nParasiticides, 18, 122 \nParegoric, 844 \nPare\'ira, 527 \nParis green, 247 \nParish\'s food, 233 \nParsley, 931 \nParotid extract, 959 \nPaste, Coster\'s, 963 \nLondon, 216 \nMarsden\'s, 240 \nRicord\'s, 332 \nVienna, 216 \nPearson\'s solution, 243 \nPelletieri\'nse ta\'nnas, 116 \nPellitory, 657 \nPellotine, 877 \nPennyroyal, 650 \nPental, 908 \nPe\'po, 117 \nPepper, 656 \n\ncayenne, 658 \nGuinea, 658 \nPeppermint, 644 \nPepsin, 662 \nPeronine, 845, 861 \nPeru, balsam of, no \nPeruvian bark, 128 \nPessaries, 4 \nPetrola\'tum, 442 \nPetroleum benzin, 991 \nPharmaco-dynamics, 1 \nPharmacognosy, defini- \ntion, 1 \nPharmacological actions, \n\n8 \nPharmacology, definition, \n\n1 \nPhenacetine, 564 \nPhenazo\'num, 562 \n\n\n\nPhenocoll hydrochloride, \n\n566 \nPhenol, 57 \nPheno-salyl, 57, 67 \nPhenosulphonate, sodium, \n70 \nzinc, 70 \nPhenylacetamide, 556 \ndimethylpyrazolone, \n\n562 \nmethyl-acetone, 866 \nsalicylate, 730 \nPhosphorated oil, 912 \nPhosphoric acid, 330 \nPho\'sphorus, 91 1 \n\npoisoning, 913 \nPhysiological action, 8 \nPhysosti\'gma, 783 \nPhysotigmine, 783 \nPhytolacca, 717 \nPichi, 528 \nPicrotoxin, 126 \nPigme\'nta, 4 \nPills, Blaud\'s, 221 \nblue, 19 \n\ncathartic, compound, \n19 \nvegetable, 705 \nchalybeate, 221 \nferruginous, 221 \nLady Webster, 686 \nlaxative, compound, \n\n686 \nof podophyllum, bel- \nladonna and capsi- \ncum, 699 \nTrousseau\'s, 428 \nPiloca\'rpus, 496 \nPi\'lula plumbi cum opio, \n856 \ntri\'um phospha\'tum, \n232 \nPime\'nta, 638 \nPink root, 121 \nPinol, 356 \nPi\'per, 656 \nPiperazine, 530 \nPiperine, 656 \nPipsi\'ssewa, 978 \nPitch, Burgundy, 362 \nPituitary extract, 955 \nPix H\'quida, 357 \n\n\n\nPixol, 360 \n\nPlague serum and inocu- \nlation, 940 \nPlasma, drugs acting on, \n\n148, 152 \nPlaster of Paris, 159 \nPlasters, 5 \n\nPiatt\'s chlorides, 426 \nPleurisy root, 496 \nPlu\'mbi ace\'tas, 404 \nca\'rbonas, 404 \nio\'didum, 404 \nni\'tras, 404 \no\'xidum, 403 \nPlummer\'s pills, 503 \nPneumogastric, drugs act- \ning on, 252 \nPodophyllum, 699 \nPoison hemlock, 745 \nivy, 979 \nnut, 772 \noak, 979 \nPoisons, 2 \nPoke berry, 717 \n\nroot, 717 \nPomegranate, 115 \nPond\'s extract, 398 \nPoppy capsules, 853 \nPosology, 5 \nPotash, caustic, 152 \n\nyellow prussiate of, \n573 \nPota\'ssa, 152 \n\nsulphura\'ta, 103 \nPota\'ssium, 152 \nacetate, 161 \nalum, 432 \nand sodium tartrate, \n\n180 \narsenite, solution of, \n\n234 \nbicarbonate, 159 \nbichromate, 345 \nbitartrate, 165 \nbromide, 792 \ncantharidinate, 531 \ncarbonate, 1 59 \nchlorate, 169 \ncitrate, 161 \ncyanide, 573 \ndichromate, 345, 347 \nferrocyanide, 573 \n\n\n\nINDEX. \n\n\n\n007 \n\n\n\nPota\'ssium glycerophos- \nphate, 917 \nhydroxide, 152 \nhypophosphite, 915 \niodide, 965 \nnitrate, 167 \noleate, 453 \npermanganate, 89 \nsalts, action of, 152 \nsulphate, 165 \ntartrate, acid, 165 \nPowder, aromatic, 640 \n\ncompound effervesc- \ning, 180 \nDover\'s, 843 \ngray, 19 \nJames\', 503 \nSeidlitz, 180 \nPrecipitate, red, 20 \n\nwhite, 19 \nPreparations, 7 \nPrimary action, 8 \nProof spirit, 824 \nProtargol, 418 \nPrune, 681 \n\nPru\'nus Virginia\'na, 579 \nPrussiate of potash, yel- \nlow, 573 \nPrussic acid, 573 \nPullna, 181, 621 \nPulsatilla, 603 \nPu\'lvis acetanili\'di com- \npo\'situs, 556 \naroma\'ticus, 640 \ncre\'tse compo\'situs, \n\n214 \neffeve\'scens compo\'si- \ntus, 180 \nglycyrrhi\'zse, com- \n\npo\'situs, 461 \nipecacua\'nhae et o\'pii, \n\n843 \njala\'pae compo\'situs, \n\n703 \nmorphi\'nae compo\'si- \ntus, 844 \nrhe\'i compo\'situs, 639 \nsalicy\'licus cum \n\nta\'lco, T2"j \nPumpkin seed, 117 \nPupil, drugs acting on, \n742 \n\n\n\nPurgatives, 618, 680 \nanthracene, 694 \ndrastic, 620 \nsaline, 620 \nsimple, 619, 686 \n\nPustulants, 326 \n\nPyre\'thrum, 657 \n\nPyridine, 749, 753 \n\nPyrogallol, 389 \n\nPyroxylin, 443 \n\nQUAIN\'S pill, 692 \nQua\'ssia, 630 \n\nQuebracho, 602 \n\nQueen s root, 977 \n\nQue\'rcus, 382 \n\nQuevenne\'s iron, 220 \n\nQuicksilver, 19 \n\nQuilla\'ja, 593 \n\nQuinine, 128 \n\npreparations of, 128 \nspecific action of, 141 \n\nRAISINS, 455 \nRaspberry, 987 \nRed bone marrow, 959 \n\ncorpuscles, drugs act- \ning on, 149, 220 \n\ncinchona, 128 \n\ngum, 401 \n\nprecipitate, 20 \n\nsaunders, 989 \n\nwine, 824 \nRefrigerants, 609 \nReinsch\'s test, 249 \nRemote action, 8 \nResi\'na, 363 \nResorbin, 467 \nResorcinol, 721 \nRespiration, drugs acting \n\non, 567 \nRespiratory centre, drugs \nacting on, 569, 573 \n\ndepressants, 569 \n\ndisinfectants, 568 \n\nstimulants, 569 \nRetinol, 362 \n\nRha\'mnus purshia\'na, 692 \nRhatany, 394 \nRhe\'um, 689 \nRhubarb, 689 \nRhus gla\'bra, 399 \n\n\n\nRhus toxicode\'ndron, 979 \nRichfield Springs, 102, 413 \nRicin, 683 \nRicord\'s paste, 332 \nRise of temperature, drugs \n\ncausing, 555 \nRisus sardonicus, 781 \nRochelle salt, 180 \nRose, 653 \n\nRosemary, oil of, 439 \nRosin, 363 \nRubber, 993 \nRubefacients, 325 \nRubidium and ammonium \nbromide, 792 \niodide, 966 \nRubinat, 621 \n\nCondal, 181, 621 \nRu\'bus, 400 \n\nidae\'us, 987 \nRue, 929 \n\nRush\'s thunderbolt, 704 \nRu\'mex, 401 \nRye, ergot of, 919 \n\nSA\'BAL, 526 \nSabi\'na, 928 \nSaccharin, 552 \nSa\'ccharum, 459 \n\nla\'ctis, 477 \nSaffron, 988 \nSafrol, 976 \nSage, 652 \nSal alembroth, 41 \n\nammoniac, 203 \n\nvolatile, 201 \nSalicin, 721 \nSalicylism, 725 \nSaligen, "J22 \nSaline purgatives, 620 \nSalipyrine, 562 \nSalivary glands, drugs \n\nacting on, 607 \nSalol, 730 \n\ncamphor, 730 \nSalophen, 731 \nSalt action, 183 \n\nEpsom, 209 \n\nGlauber\'s, 179 \n\nRochelle, 180 \n\nof tartar, 159 \nSa\'liva, 652 \n\n\n\n:oo8 \n\n\n\nINDEX. \n\n\n\nSambu\'cus, 649 \n\nSandalwood, oil of, 550 \n\nSanguina\'ria, 596 \n\nSanitas, 352 \n\nSantal, oil of, 550 \n\nSa\'ntalum ru\'brum, 989 \n\nSanto\'nica, 118 \n\nSantonin, 118 \n\nSa\'po, 451 \n\nanima\'lis, 455 \nmo\'llis, 453 \n\nSarsapari\'lla, 975 \nIndian, 975 \n\nSa\'ssafras, 976 \n\nSassy bark, 294 \n\nSaunders, red, 989 \n\nSavin, 928 \n\nSaw palmetto, 526 \n\nScammony, 702 \n\nScheele\'s green, 247 \n\nSchleich\'s infiltration \nmethod, 762 \n\nSchweinfurth\'s green, 247 \n\nSci\'lla, 279 \n\nScopa\'rius, 522 \n\nScopo\'la, 822 \n\nScopolamine, 820, 822 \n\nScott\'s ointment, 35 \n\nScutellaria, 979 \n\nSecondary action, 8 \n\nSedatives, gastric, 613, 673 \n\nSeidlitz powder, 180 \n\nSe\'nega, 591 \n\nSenegin, 591 \n\nSe\'nna, 694 \n\nSensory nerves, drugs act- \ning on, 733, 734, 756 \n\nSerous cavities, injections \ninto, 4 \n\nSerpenta\'ria, 634 \n\nSerum, anticholera, 941 \nantidiphtheric, 934 \nantiplague, 940 \nantipneumococcic, 939 \nantistreptococcic, 938 \nantitetanus, 936 \nantityphoid, 942 \nantivenomous, 939 \nnutrient, 943 \n\nSerums, 933 \n\nSesame, 989 \n\nSe\'vum prsepara\'tum, 990 \n\n\n\nSialogogues, 607 \nSilver salts, 414 \nSi\'napis a\'lba, 478 \n\nni\'gra, 478 \nSkin, drugs acting on, 493 \nSkullcap, 979 \nSmedley\'s paste, 659 \nSnakeroot, black, 929 \n\nVirginia, 634 \nSoap, 451 \nSoda, 174 \n\nbaking, 177 \n\ncaustic, 174 \n\ntartarated, 180 \nSodium, 174 \n\nacetate, 191 \n\narsenate, 234 \n\nbenzoate, 540 \n\nbicarbonate, 177 \n\nborate", 84 \n\nbromide, 792 \n\ncacodylate, 234, 245 \n\ncarbonate, 176 \ndried, 176 \nmonohydrated, \n176 \n\nchlorate, 191 \n\nchloride, 144 \n\ncitrate, 192 \n\nethylate, 192 \n\nglycerophosphate, 917 \n\nhydroxide, 174 \n\nhypophosphite, 915 \n\nhyposulphite, 102 \n>^iodide, 965 \n\nnitrate, 190 \n\nnitrite, 376 \n\noleate, 447 \n\nphenosulphonate, 70 \n\nphosphate, 179 \n\npyroborate, 84 \n\npyrophosphate, 192 \n\nsalicylate, 721 \n\nsilicate, 994 \n\nsulphate, 179 \n\nsulphite, 102 \n\nsulphocarbolate, 70 \n\nthiosulphate, 102 \n\nvalerate, 666 \nSoja bean, 456 \nSoporifics, 739 \nSomnal, 866, 872 \n\n\n\nSomnoform, 907 \nSozo-iodol, 74, 83 \nSpanish flies, 531 \nSparteine sulphate, 522 \nSpearmint, 646 \nSpermace\'ti, 440 \nSpige\'lia, 121 \nSpinal cocainization, 763 \n\ncord, drugs acting on, \n735, 112 \nSpindle tree, 697 \nSphacelic acid, 919 \nSpirit of Mindererus, 206 \n\nnitrous ether, 378 \n\nproof, 824 \n\nof wine, 824 \nSpi\'ritus se\'theris nitro\'si, \n378 \n\nfrume\'nti, 824 \n\nvi\'ni ga\'llici, 824 \nSplenic extract, 958 \nSponging, cold, 518 \nSprays, 4 \nSquaw root, 928 \nSquill, 279 \nSquire\'s chemical food, \n\n233 \nStaphisa\'gria, 125 \nStar-anise, 646 \nStarch, 476 \nStavesacre, 125 \nStearates, 438 \nStearic acid, 438 \nStilli\'ngia, 977 \nStimulants, cerebral, 738 \n\nhepatic, 625 \nStomach, drugs acting on, \n\n609, 627 \nStomachics, 609, 627 \nSto\'rax, 595 \nStramo\'nium, 818 \nStrangury, 350, 533 \nStrengthening plaster, 223 \nStreptococcus antitoxin, \n\n938 \nStro\'ntium, 529 \n\nbromide, 792 \n\niodide, 966 \n\nlactate, 529 \n\nsalicylate, 721 \nStrophanthin, 272 \nStropha\'nthus, 272 \n\n\n\nINDEX. \n\n\n\n1009 \n\n\n\nStrychnine, 772 \nStyptics, 328 \nStyrax, 595 \nStyrone, 596 \nSublimate, corrosive, 19 \nSucrol, 552 \nSucrose, 459 \nSudorifics, 494 \nSuet, prepared, 990 \nSugar, 459 \n\ndrugs causing it in \nurine, 626 \nSulphonal, 878 \nSulphonethylmethane, 880 \nSulphonmethane, 878 \nSu\'lphur, 98 \n\niodide, 103 \n\nlo\'tum, 98 \n\nprecipitated, 98 \n\nsublimed, 98 \n\nvegetable, 991 \n\nwashed, 98 \nSumach, 399 \nSumbul, 642 \nSuppositories, 4 \nSuprarenal extract, 949 \nSweet almond, 613 \n\nbirch, 729 \n\nflag, 631 \n\noil, 447 \n\norange peel, 654 \n\nspirit of nitre, 378 \nSympathetic system, drugs \n\nacting on, 744 \nSy\'rupus, 459 \n\ntri\'um phospha\'tum, \n232 \nSystemic action, 3 \n\nTABA\'CUM, 749 \nTaka-diastase, 456 \nTalc, 993 \nTamar indien, 696 \nTamarind, 680 \nTanacetum, 932 \nTannalbin, 382, 388 \nTannigen, 382, 389 \nTannin, 382 \nTansy, 932 \nTar, 357 \nTarasp, 181 \nTa\'raxacum, 635 \n\n\n\nTartar, emetic, 502 \n\ncream of, 165 \nTartaric acid, 266 \nTea, 283 \nTeeth, drugs acting on, \n\n606 \nTemperature, drugs caus- \ning rise of, 555 \n\ndrugs decreasing, \n\n553, 556 \nTerebene, 594 \nTerebi\'nthina, 348 \n\ncanade\'nsis, 356 \nTerpin hydrate, 595 \nTesticular extract, 957 \nTetanus antitoxin, 936 \nTetronal, 880 \nThalline sulphate, 567 \nThebaine, 866 \nTheine, 282 \nTheobro\'ma, oil of, 444 \nTheobromine sodio-salicy- \n\nlate, 528 \nTherapeutic actions, 8 \nTherapeutics, 1 \n\ndefinition of, 1 \n\ngeneral, 1 \n\nrational, 1 \n\nempirical, 1 \n\nexperimental, 2 \nTherapo-dynamics, 1 \nThermogenesis, 553 \nThermolysis, 553 \nThermotaxis, 554 \nThiol, 975 \n\nThiersch\'s solution, 87 \nThompson\'s fluid, 87 \n\nsolution, 912 \nThorn-apple, 818 \nThoroughwort, 508 \nThus America\'num, 364 \nThyme, oil of, 551 \nThy\'mol, 108 \n\niodide, 74, 81 \nThymus extract, 953 \nThyroid extract, 946 \nThyroiodin, 946 \nTinctu\'ra antiperio\'dica, \n145 \n\nlaxati\'va, 693 \nTobacco, 749 \n\nIndian, 754 \n\n\n\nTobacco, smoking, 754 \nTolu, balsam of, 595 \nTonga, 771 \n\nTonic, definition of, 960 \nToxicology, definition of, \n\n2 \nTragacanth, 464 \nTribromomethane, 994 \nTrichloromethane, 888 \nTrichlor-tertiary butyl-al- \ncohol, 875 \nTrimethyl amine hydro- \nchlorate, 490, 492 \nTrimethylethylene, 908 \nTrional, 880 \nTri\'ticum, 538 \nTroches, 4 \nTrousseau\'s pill, 428 \nTrunks of nerves, drugs \n\nacting on, 735 \nTrypsin, 664 \nTurpentine, 348 \nCanada, 356 \nChian, 348, 356 \nTurpeth mineral, 21 \nTyphoid serum and inoc- \nulations, 942 \n\n\n\nU\'LMUS, 462 \nUngue\'ntum metal- \nlo\'rum, 426 \nUrea, drugs acting on, \n\n627 \nUrethane, 884 \n\nethylated chloral, 866 \nUrethra, drugs acting on, \n\n5i5 \nUrinary system, drugs \nacting on, 509 \nsedatives, 575 \nantiseptics, 574 \nUrine, composition al- \ntered, 514 \nincreased, 509 \ndiminished, 512 \nrendered acid, 512 \nalkaline, 512 \naseptic, 514 \nUrotropin, 538 \nUterus, drugs acting on, \n909, 919 \n\n\n\nIOIO \n\n\n\nINDEX. \n\n\n\nUterine action, substances Vitriol, oil of, 329 \n\nwhich depress, 910, 932 white, 423 \n\nU\'va u\'rsi, 524 Volatile liniment, 194 \n\n\n\nWormseed, Levant, 11! \nWormwood, 650 \nWourara, 744 \n\n\n\nVAGUS centre, drugs \nacting on, 252, 305 \nValerian, 665 \nVallet\'s mass, 221 \nVani\'lla, 987 \nVanillin, 987 \nVascular irritants, 325 \nVasomotor centre, drugs \n\nacting on, 329 \nVaso-constrictors, 327 \nVaso-dilators, 325, 329 \nVegetable cathartic pills, \n\n705 \n\nmercury, 700 \n\nsulphur, 991 \nVeratrine, 316 \nVera\'trum, 315 \nVermicides, 17 \nVermifuges, 17 \nVeronal, 881 \nVesicants, 326 \nVessels, drugs acting on, \n\n324 \nVibu\'rnum, 932 \nVienna paste, 215 \nVillacabras, 181, 621 \nVi\'num a\'lbum, 824 \n\nru\'brum, 824 \nVittell, 215 \nVitellus, 441 \nVitriol, blue, 428 \n\n\n\nWAHOO, 697 \nWarburg\'s tinc- \nture, 145 \nWard\'s paste, 657 \nWarming plaster, 362 \nWash, black, 21 \n\nyellow, 21 \nWater, 516 \n\ndistilled, 516 \nWaukesha, 215 \nWax, 990 \nWeight, 5 \nWeld\'s syrup of ferric \n\nchloride, 225 \nWhiskey, 824 \nWhite corpuscles, drugs \nacting on, 151 \n\nmustard, 478 \n\noak, 382 \n\npetrolatum, 442 \n\nprecipitate, 19 \n\nvitriol, 423 \n\nwax, 990 \n\nwine, 824 \nWildungen, 215 \nWine, red, 824 \n\nwhite, 824 \nWir.tergreen, oil of, 729 \nWitchhazel, 397 \nWool-fat, 438 \nWormseed, American, 122 \n\n\n\nVANTHOXYLUM, \n\n\n\n973 \n\n\n\nYELLOW DOCK, 401 \njasmine, 788 \nmercuric oxide, 20 \n\nsubsulphate, \n21 \nmercurous iodide, 20 \nprussiate of potash, \n\n573 \nwash, 2 1 \nwax, 990 \nYe\'rba Sa\'nta, 603 \n\nZE\'A, 529 \nZinc salts, 422 \nZi\'nci ace\'tas, 423 \n\nbro\'midum, 792 \n\nca\'rbonas prsecipita\'- \ntus, 423 \n\nchlo\'ridum, 422 \n\nio\'didum, 966 \n\no\'xidum, 423 \n\nphenosu\'lphonas, 70 \n\npho\'sphidum, 916 \n\nste\'aras, 423 \n\nsu\'lphas, 423 \n\nva\'leras, 665 \nZi\'ncum, 422 \nZingiber, 660 \n\n\n\n\n\n\n6 \n\n\n\n<<& \n\n\n\no, \n\n\n\n\n\n\nLIBRARY OF CONGRESS \n\n\n\n0002^0^377 \n\n\n\n\n\n\n'